Background: COVID-19 infection usually presents with respiratory symptoms. Many hospitalised patients of COVID-19 present with gastrointestinal symptoms which can alter the clinical outcomes of patients. Objectives: To characterise the gastrointestinal manifestations of COVID-19 patients requiring hospitalisation and their correlation with disease severity and clinical outcomes. Methods: This was a single centre prospective, observational, cohort study done at Kathmandu Medical College, a tertiary health care centre after ethical clearance. All consecutive hospitalised patients with COVID-19 disease admitted during May and June 2021 were included in the study after ethical clearance. Diagnosis of COVID-19 infection was done by RT-PCR. Gastrointestinal symptoms of abdominal pain, aguesia, nausea/vomiting, and diarrhoea were recorded on hospital admission and outcomes accessed at discharge. Data were analysed using SPSS v.24. Results: A total of 196 consecutive adult patients with COVID-19 infection were included in study. Gastrointestinal symptoms were recorded in 48 (24.5%) patients. The most frequent symptom was nausea/vomiting (23, 11.7%) followed by aguesia (19, 9.7%), diarrhoea (14, 7.1%), and abdominal pain (8, 4.1%). There was no significant association between duration of hospital stay and presence of gastrointestinal symptoms (10.15 vs 10.95 days; p = 0.481). No significance was seen on association of gastrointestinal symptoms with ICU admission and mortality but requirement of mechanical ventilation was significantly higher in patients without symptoms (10.4 vs 23.6%; p = 0.048). Conclusion: Significant proportion of patients with COVID-19 infection can have gastrointestinal manifestations. Presences of these symptoms do not have any association with the final clinical outcome of the patient.
Background: Scrub typhus can present with atypical signs and symptoms such as those of acute kidney injury, gastroenteritis, pneumonitis, and acute respiratory distress syndrome. Meningitis, encephalitis, and hepatic dysfunction have also been reported, particularly in severe cases with multisystem involvement. Scrub typhus has never been reported in the literature to cause urinary tract infections (UTIs) which includes cystitis and pyelonephritis.Case presentation: A 45-year old male presenting to the outpatient unit with fever, right flank pain, and burning micturition for three days was initially treated for UTI. However, he returned to the hospital on the fourth day of illness with persistent symptoms. He was hospitalized, with intravenous (IV) ceftriaxone. Computerized tomography scan of his abdomen-pelvis showed features of acute pyelonephritis, so his antibiotics were upgraded to meropenem and teicoplanin. Despite this, the patient's condition deteriorated. Laboratory investigations showed multisystem involvement: decreasing platelets, raised creatinine, and deranged liver panel. As Kathmandu was hit by dengue epidemic during the patient's hospitalization, on the seventh day of his illness, blood samples were sent for tropical fever investigation. All tests came out negative except for scrub typhus-IgM antibodies positive on rapid diagnostic test. The patient's symptoms subsided after 48 h of starting doxycycline and he became fully asymptomatic four days later. Fever did not recur even after discontinuing other IV antibiotics, favoring scrub typhus disease rather than systemic bacterial sepsis. Conclusions: Scrub typhus is an emerging infectious disease of Nepal. Therefore, every unexplained fever cases (irrespective of clinical presentation) should be evaluated for potential Rickettsiosis. Moreover, for cases with acute pyelonephritis, atypical causative agents should be investigated, for example scrub typhus in this case.
Background: Coronavirus disease 2019 (COVID-19) causes mild to severe respiratory illness and is associated with ICU admission and mortality. Since data regarding clinical profile of COVID-19 patients in Nepal is still lacking, it is important to study clinical behaviour of COVID-19 in Nepal. In this study the demographic profile, clinical features, lab parameters, and outcomes in hospitalised COVID-19 patients in a tertiary care hospital are reported. Objective: To assess the clinical profile in terms of clinical symptoms, laboratory parameters, and outcome of COVID-19 admitted patients in a tertiary care hospital. Methods: This is a descriptive cross-sectional study conducted at KMCTH, from June 1, 2021 to July 31, 2021 after taking ethical clearance from institutional review committee. All patients infected with COVID-19 admitted in this hospital, from June 1, 2021 to July 31, 2021 were included by convenience sampling. Data were collected, and entry and analysis were done in Microsoft Excel Sheet 2007. Results: During the study period, 245 COVID-19 patients were admitted and were included in the study. The median age of the patients was 55 years, the mean age was 55 ± 17 years, and 139 (56.74%) were male. The common presenting complaints were cough in 180 (73.47%) followed by fever in 176 (71.84%) patients. Most common comorbidity found was hypertension in 89 (36.33%), followed by diabetes in 50 (20.44%). Conclusion: In this single-centred study, the characteristic features included presence of comorbidities, higher level of inflammatory markers, and high mortality rate in severe to critical hospitalised COVID-19 patients.
Introduction: Chronic liver disease with cirrhosis is a significant cause of morbidity and mortality not only in developed but also in developing countries. Many patients already develop complications before hospital admission and require intensive medical care during hospital treatment. The main objective of the study was to find out the prevalence of the chronic liver disease among patients admitted in the Department of Internal Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Department of Internal Medicine of a tertiary care centre from 1 January 2022 to 31 March 2022. Ethical approval was obtained from the Ethical Review Board (Reference number: 2211202105). The patient admitted in the Department during the study period was included and those who do not gave consent were excluded. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 447 patients, the prevalence of chronic liver disease was 93 (20.8%) (17.04-24.56, 95% Confidence Interval). The mean age of the patients was 49.69±10.94 years and among them, males were 64 (68.82%). Conclusions: The prevalence of the chronic liver disease among patients admitted to the Department of Internal Medicine of a tertiary care centre was lower than in other studies conducted in similar settings.
Background: Acute upper gastrointestinal bleeding is one of the common and life threatening condition presenting in emergency. The aim of the present study was to determine the clinical profile and in-hospital outcomes in these patients admitted at a tertiary care center in Kathmandu, Nepal. Materials and Methods: This is a descriptive, observational study conducted over 9 months (October 2021– July 2022). All consecutive patients aged 16 years and above admitted in the hospital ward with the history of acute bleeding were included in the study after informed consent. Demographic data, clinical, laboratory and endoscopic data were noted during the hospital stay. Statistical analysis was done used SPSS v.24. Results: The mean age of our study population (N = 132) was 46.92 years. Among 132 patients who underwent endoscopy, 43.9% had portal hypertension related bleeding, 41.7% had ulcer related bleeding, 5.3% had malignancies, 3% had corrosive intake. No etiology was found in 3 patients. Hematemesis with melena was the most common mode (53.8%) of presentation to the hospital.Shock was preset in 25% of patients at presentation to the hospital. In-hospital re-bleeding rate and mortality were 12.7% and 9.8% respectively. Conclusion: Portal hypertension related bleeding followed by ulcers related bleeding is the common cause of acute upper gastrointestinal bleeding. In-hospital mortality was 9.8%.
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