Publications by authors named "Sijan Basnet"

Atrial fibrillation (AF), a cardiac arrhythmia, exhibits a heightened prevalence among individuals diagnosed with cancer, notably prominent in cases of lung and gastrointestinal malignancies. Robust evidence from extensive studies underscores this association, emphasizing its clinical significance. However, the precise mechanistic underpinnings and specific risk factors linking cancer and AF remain a subject of incomplete understanding.

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Idiopathic systemic capillary leak syndrome (SCLS) is characterized by an increased capillary hyperpermeability with subsequent hemoconcentration, hypoproteinemia, and hypovolemia. Patients present with diffuse swelling, weight gain, low blood pressure, and shock. We present our case of idiopathic SCLS in a 50-year-old man presenting with prodromal flu-like illness associated with shock that was complicated by compartment syndrome requiring four limb fasciotomies, disseminated intravascular coagulation, acute kidney injury requiring dialysis, and cardiac arrest.

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  • A 55-year-old man developed confusion, initially believed to be a side effect of pembrolizumab treatment for renal cell carcinoma.
  • After an extensive evaluation ruling out other causes of his confusion, he was treated with high-dose intravenous methylprednisolone, followed by a prednisone taper and intravenous immunoglobulin.
  • Gradually, his cognitive function improved following the treatment.
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Macrophage activation syndrome (MAS) is a potentially fatal complication of an autoimmune rheumatologic disease characterized by overwhelming inflammation, multiorgan failure, and high mortality if untreated. We report a rare case of a 56-year-old man who presented with fever for three weeks and had a constellation of clinical features and laboratory findings, meeting the diagnostic criteria for systemic lupus erythematosus (SLE) and SLE-associated MAS. He was treated with high dose intravenous corticosteroid and hydroxychloroquine, resulting in resolution of fever and dramatic clinical improvement.

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Paget-Schroetter syndrome (PSS) is a rare form of spontaneous upper extremity deep vein thrombosis associated with vigorous activity of the upper extremities. We present a rare case of a young swimmer who presented with a painful right upper extremity swelling, with compression ultrasound (CUS) revealing extensive venous clots in the basilic, axillary, and subclavian veins. Venous duplex revealed extrinsic compression of the subclavian vein, and catheter-based contrast venography confirmed our diagnosis of PSS.

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Leptomeningeal carcinomatosis is a rare complication of metastatic systemic malignancy, with lung cancer being the most common cause. We present a case of a 75-year-old man with a past medical history of right non-small cell lung carcinoma and ischemic stroke who presented with a persistent headache and swallowing difficulties. On evaluation, the patient was initially diagnosed with a subacute infarct of the right posterior frontal lobe following magnetic resonance imaging (MRI).

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Elevated potassium levels can be a life-threatening emergency. We describe a case of falsely elevated serum potassium level in a patient with leukemia, which was suspected to be falsely elevated because the patient was asymptomatic with a normal electrocardiogram (EKG). Common reasons behind such a discrepancy in leukemia patients are the use of a tourniquet before collection, use of vacuum/pneumatic tubes for transportation, prolonged periods of incubation, use of heparin for sample collection, and processing of samples via centrifugation.

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BACKGROUND Lambl's excrescences (LE) are threadlike fronds that occur along valve closure lines where minor endothelial damage occurs, resulting in thrombus formation. It is often asymptomatic but can result in cerebral embolism and coronary artery obstruction. The criterion standard for diagnosis is transesophageal echocardiography.

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Article Synopsis
  • Serotonin syndrome is a serious condition that can be fatal if not recognized quickly, typically occurring within 4 to 13 hours after starting certain medications.
  • A case was presented where symptoms appeared after 48 hours, highlighting that delayed onset can occur, especially in patients on multiple medications (polypharmacy).
  • Healthcare providers should be vigilant for serotonin syndrome in elderly patients taking several drugs, as they may present with confusion, and delayed symptoms can lead to severe consequences.
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Diffuse exanthematous drug eruption due to intravenous immunoglobulin (IVIg) is a rare adverse event reported only in case reports. We present a case of a 71-year-old woman with a diffuse maculopapular rash 5 days after receiving an IVIg infusion for treatment of chronic inflammatory demyelinating polyneuropathy. She was managed conservatively with antihistamines; she was already receiving prednisone 25 mg daily as part of treatment for the neuropathy.

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We present a rare case of recurrent nonbacterial thrombotic endocarditis (NBTE) and stroke despite anticoagulation. A 48-year-old man with history of antiphospholipid syndrome, prior nonbacterial aortic valve endocarditis status post valve replacement and prior stroke was found to have acute ischemic stroke while on apixaban and nonbacterial thrombotic endocarditis of mitral valve. This was initially managed conservatively with therapeutic dose of enoxaparin, but the patient later underwent mitral valve replacement.

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  • * The patient, a 19-year-old man, initially presented with shortness of breath and pain but was sent home after normal test results, only to return two days later with additional symptoms like difficulty swallowing and chest tightness.
  • * He had a recent finger cut and a complete immunization history, prompting treatment with tetanus vaccine and penicillin, with his tetanus antitoxoid levels confirmed as protective.
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  • Obstructive sleep apnea (OSA) is linked to an increased risk of various cardiac arrhythmias and has a notable association with sudden cardiac arrest, especially in obese patients.
  • A study analyzing data from the National Inpatient Sample revealed that patients with OSA have a significantly higher mortality rate compared to those without OSA.
  • Early screening for OSA and potential treatment with continuous positive airway pressure (CPAP) could help reduce cardiovascular risks and improve outcomes for affected individuals.
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  • Gilteritinib is a medication used to treat acute myeloid leukemia (AML) with specific FLT3 mutations, but it can lead to complications like febrile neutropenia and Sweet's syndrome (SS).
  • A case study highlights a 55-year-old woman who developed fever and skin lesions after starting Gilteritinib, which were linked to her low neutrophil count and improved temporarily with prednisone.
  • Despite stopping Gilteritinib due to the rash, the patient ultimately faced severe disease progression and sepsis, emphasizing the need for clinicians to recognize potential skin issues related to FLT3 inhibitors, even in neutropenic patients.
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  • - An elderly Caucasian male with a complex medical history including dextrocardia, polymyalgia rheumatica, and heart issues was admitted with acute heart failure and serious breathing difficulties.
  • - After a recent transient ischemic attack, tests revealed severe mitral regurgitation due to myxomatous degeneration, necessitating mitral valve replacement.
  • - Genome sequencing linked his valve pathology to culture-negative endocarditis, leading to a treatment plan of antibiotics that improved his condition.
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  • Abnormalities in thyroid function, specifically hyperthyroidism and hypothyroidism, can increase the risk of developing hypertension.
  • A study using data from the National Inpatient Sample (2012-2014) examined the correlation between thyroid disorders and hypertension among individuals without thyroid diagnoses.
  • The results indicated that hyperthyroidism was linked to a higher likelihood of hypertension (odds ratio: 1.18) compared to hypothyroidism (odds ratio: 1.06).
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  • Heart failure patients in hospitals are increasingly at risk for venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), from 2000 to 2013.
  • The study used the Nationwide Inpatient Sample database, focusing on non-pregnant patients over 18, and analyzed data based on specific medical coding (ICD-9-CM) using STATA software.
  • Findings showed a rise in DVT (0.55% to 0.96%), PE (0.17% to 0.4%), and overall VTE (0.76% to 1.46%), but a decline in mortality rates associated with these conditions among heart
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Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion.

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Acute generalized exanthematous pustulosis (AGEP) is a rare adverse effect of clindamycin characterized by widespread papules and pustulosis 1 - 3 weeks of its use. We present a case of a 71-year-old woman diagnosed with AGEP after clindamycin use for a tooth infection. She had been started on empiric prednisone without benefit.

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Negative-pressure pulmonary edema (NPPE)-related diffuse alveolar hemorrhage (DAH) is an underdiagnosed clinical entity seen with alveolar capillary damage. The pathophysiology of type I NPPE is generation of a negative pleural pressure against an upper airway obstruction. We suspect this process was facilitated by preexisting alveolar damage with smoking and administration of the irritating and coagulopathic inhaled anesthetic sevoflurane.

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Pembrolizumab is a novel immune checkpoint inhibitor approved for use in non-small cell lung carcinoma. There have been a few cases that have associated adverse renal outcomes with pembrolizumab. We present a case of acute kidney injury in a patient on pembrolizumab who was noted to have acute tubulointerstitial nephritis on renal biopsy.

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  • Low carbohydrate diets have gained popularity for weight loss but can lead to serious health risks.
  • A rare case of life-threatening metabolic acidosis was reported in a 31-year-old man who experienced chest pain and shortness of breath after only one week on such a diet.
  • The case highlights the importance of monitoring health while following restrictive diets, as they can cause unexpected medical issues.
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: Abnormalities in serum potassium levels have been associated with variable mortality risk among hospitalized patients with heart failure (HF). We aim to use a large database study to further characterize risk of mortality, demographic factors, and associated comorbidities among heart failure inpatients. : Our sample population was from the US National Inpatient Sample database from the year 2009-2011.

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  • Apixaban is a type of blood thinner that blocks factor Xa, which helps prevent blood clots.
  • An 86-year-old man experienced sudden left upper abdominal pain and signs of severe bleeding.
  • Medical imaging revealed he had a splenic rupture (splenic tear) and blood accumulation in the abdominal cavity, likely linked to his use of apixaban.
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: Acute proximal muscle weakness has a broad differential. Infectious myositis is difficult to differentiate clinically from inflammatory myopathy, often causing a delayed diagnosis. Infectious myositis should be thought of as a differential for proximal muscle pain and weakness in the right context.

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