Background: Evaluation of cardiac diseases in chronic kidney disease has been rarely investigated in Nepal. Objectives: Objective of this study is to evaluate cardiac lesions in admitted chronic kidney disease patients. Methodology: It is a prospective observational study of echocardiography of chronic kidney disease patients from April, 2007 to April, 2013 in Nepal Medical College Teaching Hospital. Results: One hundred chronic kidney disease patients were evaluated. Male to Female ratio was 1.8:1 and age ± SD was 46.3 ± 17.2 years. Forty eight percent of the chronic kidney disease patients had left ventricular hypertrophy. Patients with chronic kidney disease with left ventricular hypertrophy group had interventricular septum of 1.5 ± 0.3 cm vs. 1.1 ± 0.1 cm (p<0.0001) and posterior wall of 1.1 ± 0.2cm vs. 1.0 ± 0.1cm (p< 0.01) in comparison to chronic kidney disease without left ventricular hypertrophy. Forty one percent had left ventricular systolic dysfunction with left ventricular ejection fraction of 39 ± 9.9 %. Pulmonary arterial hypertension was noticed in 39% patients. Valvular regurgitant lesions were quite common (24.1%) usually as multivalvular lesions (4.4 lesions per patient). Mitral regurgitation was the commonest regurgitant lesion (81%). Conclusion: Echocardiographic cardiac evaluation is useful to diagnose concomitant cardiac lesions for standard care of chronic kidney disease patients.
Introduction: Neonatal morbidity and mortality rates reflect efficiency of health services of a country. This study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to neonatology unit. Methods: The study was conducted in Neonatal Unit of Karnali Academy of Health Sciences, Jumla for a period of one year from 1st May 2017 to 30th April 2018. Data of all admitted patients were reviewed and analyzed in terms of gender, gestational age, age at presentation, weight, cause of admission and their outcome. Diagnosis was made on clinical examination, radiological findings and laboratory investigations. Data were analyzed using SPSS version 20. Results: Out of 153 neonates admitted during the study period, 2 were excluded because of deficient record. Full-term neonates were 122(80.7%) while preterm were 29 (19.3%). Low birth weight (LBW) babies were 32 (21.18%). Neonatal sepsis 91 (60.26%) was the most common cause of hospital admissions followed by meconium aspiration syndrome 21(13.9%) and prematurity 10(6.62%). Out of 151 newborns, 112 babies (74.1%) were discharged after improvement, 15(9.93%) left against medical advice, 13(8.6%) babies were referred to higher centers for intensive care and there were 9 (5.9%) mortalities and 2(1.3%) got absconded. Conclusions: The majority of neonatal morbidity is due to sepsis, prematurity and respiratory causes. All these causes are preventable to some extent and, can be effectively treated in order to reduce morbidity and mortality.
Background Vitiligo is common worldwide. The highest incidence is reported from Indian subcontinent. However, there are only few studies available on epidemiology of vitiligo from Nepal Objective To determine the clinical patterns of vitiligo, the associated sociodemographic factors and its associated disorders among patients attending dermatology outpatient department of Manipal Teaching Hospital, Gandaki Medical College Teaching Hospital and Fishtail Hospital and Research Center Pokhara. Methods All patients presenting with signs and symptoms suggestive of vitiligo over a period of one-year (from march 2009 to march 2010 ) at the out-patient clinics in the Dermatology Department of Manipal Teaching Hospital, Gandaki Medical College Teaching Hospital and Fishtail Hospital and Research Center, Pokhara were included in the study. Socio-demographic details regarding age, sex, marital status, education and occupation were recorded .A detailed clinical history related to the presenting complain and clinical examination findings were recorded. Relevant available investigations were ordered based on signs and symptoms to determine if any associated disorders. Results Two hundred and twenty four patients with clinical diagnosis of vitiligo were studied. Males constituted 102 (45%) patients and females 122 (55%) of the total number of patients. Duration of disease at the time of presentation ranged from two weeks to 40 years. The lower limb was the initial site of onset of vitiligo in majority 77 (34.37%) of the patients, followed by the upper limbs, head and neck, trunk and mucosae in decreasing order of frequency. The commonest clinical pattern found was vitiligo vulgaris followed by acrofacial, segmental and mucosal types. Lesions showing leukotrichia were observed in 40 (18.87%) patients and koebnerization was observed in 42 (18.75%) patients. Eleven children had halo nevi. Associated abnormalities included alopecia areata (13 patients), diabetes mellitus (12 patients) and one patient had atopic dermatitis. A positive family history was obtained in 14(6.25%) of the patients. Conclusion Vitiligo vulgaris is on of the common clinical-type skin disorder observed in Nepal. There w e re associated disorders/abnormalities in some patients such as alopecia areata , diabetes mellitus and atopic dermatitis. Keywords Clinical Profile; Vitiligo; Western Nepal. DOI: http://dx.doi.org/10.3126/njdvl.v9i1.5771 NJDVL 2010; 9(1): 40-43
Introduction Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare and severe forms of drug-induced skin reaction. Most frequently involved drugs are noted to be non-steroidal anti-inflammatory agents, antibiotics, and anticonvulsants. These have high morbidity and mortality and counts among dermatological emergencies. Case presentation We report an eventful case of a 22-year-old lady who suffered and recovered from carbamazepine-induced SJS/TEN overlapping during her pregnancy. Our patient had a history of epilepsy for which she was under sodium valproate. Switching to carbamazepine due to its low teratogenicity led our patient to this condition. History of prodromal symptoms and exposure to carbamazepine helped in the diagnosis. Carbamazepine abstinence and a multidisciplinary approach in symptomatic management worked very well for the patient. Clinical discussion Carbamazepine-induced TES/SJS manifests multisystem effects and requires a multidisciplinary approach for management. The condition itself is life-threatening and in its addition, their sequelae further threaten the life of the patients. Early intervention is the key. Genetically susceptible are thought to be the ones carrying human leukocyte antigen B*15:02 (HLA-B*15:02) allele and it is most prevalent in South-East Asian populations. Screening of this allele before using carbamazepine prevents the incidence of carbamazepine-induced SJS/TEN. Conclusion Prodromal symptoms of carbamazepine-induced SJS/TEN constitute flu-like symptoms that should not be missed. Early intervention and multidisciplinary approach prevent secondary infections and complications. Screening for HLA-B*15:02 variant allele and close monitoring of these adverse reactions along with proper counseling to patients goes a long way in preventing the development of this life-threatening condition.
Introduction: Dyspepsia is a common problem faced in our country and elsewhere. Benign causes predominate with occasional incidences of carcinoma of the stomach, esophagus. The presence of warning signs helps indicate the presence of such carcinomas though various studies differ as to its usefulness. Methods: Patients presenting with dyspepsia were investigated with a gastroscope to see the etiological pattern seen in the Karnali region and the usefulness of the warning signs. This study included the initial 100 patients undergoing upper gastrointestinal endoscopy for dyspepsia evaluation in our institution. Results: The majority of the patients (53%) showed normal findings on visual examination despite being symptomatic suggestive of functional dyspepsia. The most common warning sign was weight loss which had a positive predictive value of only 4%. Malena was present in 10% of the patients with a positive predictive value of 30%. Conclusions: Significant weight loss as a warning sign to screen patients for gastrointestinal pathology seems unsuitable in the rural setting.
Introduction: Acute appendicitis is the most common abdominal surgical emergency. Both abdominal ultrasonography and computed tomography are common diagnostic tools in its diagnosis with each having its own advantages and disadvantages. Methods: Patients of suspected acute appendicitis were evaluated with an ultrasound to see the sensitivity, specificity, positive and negative predictive value of ultrasound for intraoperative appendicitis diagnosis. The study included 113 patients of suspected acute appendicitis presenting in the emergency during a one year duration. Sensitivity, specificity, positive predictive value and negative predictive value was calculated from their respective formulae. Results: The majority of the patients were male patients between the age group of 18 to 30. The sensitivity of ultrasound for diagnosis of acute appendicitis was 96% and specificity was 33%. The positive predictive value was 98% and the negative predictive value was 20% Conclusion: Ultrasound has good sensitivity and the low cost along with no radiation exposure makes this an acceptable screening investigative modality though due to low specificity, it would be recommended to go for a computed tomography scan if ultrasound shows negative result for appendicitis.
Introduction: COVID-19 highly contagious viruses that have reached every corner of the world. Despite the heroic efforts to control the pandemic, health care professional risk for COVID-19 exposure was an important measure to identify due to lack of personal protective equipment. The objective of the study was to find out the prevalence of healthcare professionals providing direct care to the COVID-19 patient. Methods: A descriptive cross-sectional was conducted through online questionnaire from June 2020 to August 2020. Ethical approval was obtained from the Ethical Review Board of Nepal Health Research Council (Reference number: 363/2020 P). World Health Organization risk assessment protocol questionnaire was used for COVID-19 and distributed among 300 health care workers of Nepal involved in the management of COVID-19 hospitals. Convenience sampling was used. The KoBo toolbox was used for online data collection. Data analysis was done using Statistical Package for the Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 300 study participants, 109 (36.33%), (30.85-41.74 at 95% Confidence Interval) of participants provide direct care to infected patients. With total respondents, 41 (37.61%) were registered nurses, medical doctors 28 (25.68%) and paramedics 36 (33.02%). Conclusions: Health care workers who provide direct care to the COVID-19 patient were similar to other studies done in similar settings. About half of the participants were exposed to COVID-19 virus from the hospital setting rather than from community setting which is similar to the study done in similar setting which might be due to lack of follow of protocols during COVID-19 patient care.
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