![]() ![]() The other was a 38-year-old male, known case of PNH for 2 years, presented with left lower leg numbness, coldness along with loss of movement and was found to have popliteal artery occlusion, likely a complication of PNH, ultimately needing knee amputation. He was found to have multiple unexplained thrombosis and a diagnosis of PNH was confirmed with a flow cytometry. One of them was a 26-year-old male from rural Nepal presenting with complaints of abdominal pain, fatigue and icterus who was inappropriately treated for four years prior to that presentation. The other two cases were reported in 2021. The second case reported in 2016 was of a 45-year-old woman with a known case of PNH for 5 years, who presented with severe headache, multiple episodes of vomiting, and confusion for 5 days along with weakness of the right side of the body and was found to have left transverse sinus thrombosis. Treatment was not described as the patient was referred to India where immunophenotyping was performed and diagnosed with PNH. A 29-year-old Nepalese male, a manual laborer in Saudi Arabia presented to Patan Hospital with easy fatigability, pallor, and a few episodes of gum and nose bleeding for a year, initially misdiagnosed as megaloblastic anemia. The first case of PNH was reported in 2005 in Nepal. On a PubMed search, only four cases of PNH have been reported and published in Nepal. Unfortunately, there is no available data on its incidence and/or prevalence in Nepal. PNH is rare, with an incidence of 15.9 individuals per million worldwide. Eculizumab is a lifesaving therapy that is associated with a greater than 50% reduction in transfusion requirements and a close to 70% reduction in the risk of thrombotic events and significant adverse vascular complications. Eculizumab is a humanized monoclonal antibody that blocks terminal complement activation by binding to the C5 complement and preventing it from being cleaved, thus preventing terminal complement activation. The development of the terminal complement inhibitor eculizumab has revolutionized the treatment of PNH and, in turn, has revealed insights into the pathophysiology of the disease. This causes uncontrolled activation of the complement system leading to excessive or persistent intravascular hemolysis causing anemia, hemoglobinuria, and complications related to the presence of plasma-free hemoglobin, including thrombosis, abdominal pain, dysphagia, erectile dysfunction, and pulmonary hypertension. PNH results from a clonal proliferation of hematopoietic stem cells with a mutation in the phosphatidylinositol glycan class A (PIG-A) gene that results in the absence of two glycosylphosphatidylinositol (GPI) anchored proteins, CD55 and CD59. Nocturnal asthma is common and should be treated to improve the quality of life for asthma sufferers.Paroxysmal nocturnal hemoglobinuria (PNH), since its first definitive description in 1882 by the German physician Paul Strübing, has fascinated hematologists. Treatment for nocturnal asthma can include a variety of drugs, or CPAP for those with asthma and sleep apnea. Obstructive sleep apnea is common in the whole population and could also contribute to asthma problems at night. This sleep disorder causes repeated pauses in breathing throughout the night – a serious problem in itself, but also one that can set off or worsen asthma symptoms. People with asthma who work on the night shift may have breathing attacks during the day when they are sleeping.īreathing colder air at night or sleeping in an air-conditioned bedroom may also cause loss of heat from the airways.Īnother sleep-related condition that can worsen nighttime asthma is sleep apnea. This may trigger nighttime coughing, which can cause more tightening of the airways.Īsthma problems may occur during sleep, despite when the sleep period is taking place. Sleep itself may even cause changes in bronchial function.ĭuring sleep, the airways tend to narrow, which may cause increased airflow resistance. Many doctors often underestimate nocturnal asthma or nighttime asthma. Nocturnal wheezing, cough, and trouble breathing are common yet potentially dangerous. The chances of experiencing asthma symptoms are higher during sleep. Nocturnal asthma, with symptoms like chest tightness, shortness of breath, cough, and wheezing at night, can make sleep impossible and leave you feeling tired and irritable during the day. ![]()
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