Background Spontaneous pneumothorax is not an uncommon medical emergency in pulmonary practice. Related data are not available in our setting. In emergency departments, clinical presentation is often confused with other cardiopulmonary problems. Follow up outcome is important for better patient care. Objective To study clinical profile and outcome after non surgical intervention in a tertiary care center. Method This was a prospective observational study carried out in Nobel Medical College, Biratnagar over last 3 years. We enrolled consecutive spontaneous pneumothorax patients over 15 years of age. Each data related to individual patients were collected in predefined proforma. To study follow up outcome of management, we used OPD attendance or if not possible took, at least two telephone numbers from the patients. All patients were followed for recurrences. Data was statistically analyzed using SPSS software. Result Over the last 3 years, we enrolled 65 spontaneous pneumothorax patients. Secondary spontaneous pneumothorax was more common (92.3%). Commonest presentations were acute pleuritic chest pain (92.3%), dyspnea (84.62%) and cough (92.3%). COPD (46.14%), PTB sequelae (15.38%), bronchiectasis (23.07%) and bullous lung disease (23.07%) were common risk factors. Tube thoracostomy (95.38%) with pleurodesis with iodopovidone (84.61%) led to lung expansion in 92.3% cases. During follow up, only 4.61% had recurrences of pneumothorax. There was one mortality. Conclusion Spontaneous pneumothorax is a common pulmonary emergency. Meticulous and careful assessment of the patients may help reach the diagnosis even in primary care setting. Tube thoracostomy followed by pleurodesis with iodo-povidone suffices in most circumstances leading lower future recurrences.

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Introduction: Dyslipidemia is one of the major risk factors for acute coronary syndrome. Dyslipidemiawith an increase in total cholesterol, low-density lipoprotein cholesterol, triglycerides and decrease inhigh-density lipoprotein cholesterol is one of the major risk factors for the acute coronary syndromeand alone account for more than 50% of population attributable risk. This study was conducted tofind out the prevalence of dyslipidemia. Methods: This descriptive cross-sectional study was conducted in 105 patients admitted at thetertiary care center with a diagnosis of acute coronary syndrome from July 2018 to March 2019 afterapproval from the institutional review committee (Ref no. 205/2018). Fasting serum lipid profilewas obtained within 24 hours of hospitalization with the convenient sampling method. Data wereanalyzed with the help of the Statistical Package for Social Sciences version 20. Point estimation at95% Confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 105 people, dyslipidemia was present in 51 (48.6%). The mean age of the participantswas 59.19±12.69 years. The majority 81 (77.1%) were male. The mean total cholesterol, triglycerides,low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were 183.43±35.9 mg/dl, 140.59±46.83 mg/dl, 109.9±26.38 mg/dl and 41.17±4.78 mg/dl respectively. High total cholesteroland triglyceride were found in 34 (32.4%) each, low high-density lipoprotein in 31 (29.5%) and highlow-density lipoprotein in 22 (21%).  Conclusions: Dyslipidemia is a significant risk factor in patients with acute coronary syndromeand commonly associated with other risk factors. Careful attention to its management may help toreduce further events.

Introduction: Semen analysis is an initial basic step in evaluating and diagnosing male infertility. Multiple risks factors in combination or alone are responsible for abnormal semen parameters. The present study aimed to study certain risk factors and semen parameters of infertile male. Methods: It was a descriptive cross-sectional study. We consecutively enrolled 186 male partners of infertile couple who underwent certain risk factors evaluation and semen analysis according to WHO guideline. Results: Multiple risk factors were present like Gulf country migration, smoking, chemical exposure and heat exposure in infertile male partners. Forty six percent of our patients were gulf workers. Eleven percent patients had azoospermia, 27% had abnormal sperm morphology and 23% had <25% motile spermatozoa. Conclusions: Surprisingly 46% of our patients were Gulf country workers and abnormal semen analysis is very important factor for infertility. Large prospective studies need to be carried out involving Gulf migrant workers only.

Introduction: Acid base disorder is a condition characterized by alteration in blood pH by theimbalance between the components of blood leading to a life threatening situation. The main aimof this study was to find the prevalence of acid-base disorders and biochemical findings of suchdisorders in patients in a tertairy care hospital. Methods: This descriptive cross-sectional study was conducted in Nobel Medical College TeachingHospital from 1st September, 2018 to 31st August, 2019. Ethical apporoval was taken from InstitutionalReview Committee. All the patients presented to emergency department, intensive care units andwards were included during the study period. Data were entered and calculations were done inMicrosoft Excel, point estimate at 95% Confidence Interval was calculated along with frequency andproportion for binary data. Results: Out of arterial blood gas analysis of 1144 patients, the prevalence of acid base disorderswas 718 (62.76%) at 95% Confidence Interval (59.96-65.56%). Simple and mixed acid base disorderswere observed in 332 (46.24%) and 386 (53.76%) patients respectively. Respiratory alkalosis was mostcommon among 134 (40.36%) cases in simple acid base disorder whereas metabolic acidosis andrespiratory alkalosis was most common among 204 (52.85%) in mixed acid base disorder. All typesof disorders were observed more in elderly people (41-60 and >60 age group) than other age groups. Conclusions: Acid base disorder was found to be more common in very ill patients in emergency andintensive care units compared to similar studies. Mixed acid base disorder was the most commonwith male and elderly patients in predominance.

Background: Sepsis has been defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Sepsis is an important cause of mortality in intensive care unit worldwide. The study aims to identify the outcome of sepsis patient admitted at tertiary care hospital.Methods: This is a descriptive cross-sectional hospital based study on 76 adult patients admitted at intensive care unit of Nobel Medical College with diagnosis of sepsis with an objective of estimating mortality of sepsis and identifying associated symptoms with it. Baseline demographics, clinical and laboratory data were collected and analyzed. Results: Out of 76 patients with sepsis, mean age of the patients was 50.07±18.15 years. Majority of patients 31.6% with sepsis were above age groups >60 years. The most common symptoms among the patients were fever, which was seen in 69 (90.8%) patients. The most common source of infection in those patients was found to be unknown, which was seen in 36.8% of patients. While analyzing the outcome, it was noted that 25 patients with sepsis (32.9%) died during treatment.Conclusions: Sepsis is related with high mortality. Elderly patients are at more risk. Fever is the commonest presentation and source is not identified in majority of cases. Keywords: Intensive care unit; mortality; sepsis.

Background Diabetes Mellitus (DM) is one of the most common health problem characterizd by hyperglycemia. Type II Diabetes Mellitus is the most common one. Diabetic nephropathy is the most common clinical condition arises with in these patients which progressively leads to impairment in kidney’s function. Measurement of microalbumin in urine is the earliest dectactable stage of diabetic kidney disease.Material and Methods The total of 200 diabetic patients (112 males and 88 females) were enrolled and biochemical estimations including blood glucose level, serum creatinine, blood urea, urine albumin was conducted.Results Prevalance of microalbuminuria was 26 % in type II diabetic patients.Renal functions parameters like blood urea and serum ceratinine were higher in patients with positive microalbuminuria.60 % of diabetic patients are normoalbuminrics and rests 14% are proteinurics.Conclusion Various factors like increasing age, duration of diabetics, blood sugar level,blood urea, serum creatinine are the causes for microalbuminuria and proteinuria. Therefore, to rule out the early screening of diabetic kidney disease, DM patients should get routinely checked up with blood sugar level as well as renal profile test like serum creatinine, blood urea and albumin level in urine.Journal of Nobel Medical College Vol.5(2) 2016; 1-4

Introduction: Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. Methods: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. Results: A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. Conclusions: Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.