Multiple myeloma treated with single agent dexamethasone

Abstract

Multiple myeloma is less frequently diagnosed in our part of the world. As per the hospital based cancer registry of Nepal, it accounts for 0.4% of all cancer cases diagnosed annually1. Usually they present with symptoms of chronic renal failure which is part of CRAB: elevated calcium (C), renal failure (R), anemia (A) and bone lesions (B). The symptoms and signs vary greatly as many organs can be affected by myeloma. Furthermore, the incidence is high in older age group with co morbidities demanding the patient tailored treatment. Here, we present a case of multiple myeloma which was treated with single agent dexamethasone. On initial evaluation patient had stage III disease with features of cord compression, so was started with immediate radiation therapy to the cervical and lumbar vertebrae followed by single agent dexamethasone as he denied further cytotoxic treatment. The patient is on regular follow up and in remission after six years of treatment. We are in the era where there is armor of chemotherapeutic agents along with bone marrow transplantation for the treatment of multiple myeloma. This case may represent an example and single agent dexamethasone can be an option for the treatment of the patient who is in poor general condition to receive the cytotoxic chemotherapy or denies to such therapy but it should be a choice only to a selected subgroup of patient population.Journal of Kathmandu Medical College, Vol. 4(1) 2015, 26-28

NGOs, Foreign Aid, and Development in Nepal

“…This may create a difficult situation as seen in the international response to Nepal’s earthquake in April, 2015. Many NGOs wanted to work on their own, getting relief materials from the international community and choosing to go independently ( 42 ). Although distributing and working through government may not be effective and rapid in an emergency situation, there must be a co-ordination mechanism with government so that there is accountability for NGOs and there is good communication among all stakeholders to avoid duplication and to ensure the neediest are being served.…”

An Outline of FDI Inflows and Nepal’s Economic Evolvement

“…It also helps the host economy's goods to be exported on a wider scale in foreign markets. Foreign direct investment is a significant source of resources for both the host and host economies (Acharya & Khatiwada, 2003).…”

Ganga Bahadur’s books: landmark proletarian novels and the Nepali communist movement

“…They were also inspired by the Chinese revolution and the struggles of the "common people" in India and elsewhere (Rimal 2005, 146) took over the publication of translations of literary classics from Progress. 22 In South Asia, it was not only avowed communists who read books published by Progress This is the version of the article accepted for publication in Inter-Asia Cultural Studies17 (3), 357-374 published by Taylor & Francis available at: http://dx.doi.org/10.1080/14649373.2016.1217630 Accepted version made available via SOAS Research Online: http://eprints.soas.ac.uk/23080/ Publishers and Raduga: their readership included many thousands of others, both adults and children.…”

“…The Nepali government might also have been wary of offending the Chinese government by restricting access to the literature it distributed in Nepal, though it was less concerned about the Soviets, who were a more remote influence. 25 This relative freedom was restricted to the Kathmandu urban area, however.…”