Pub Date : 2023-07-15DOI: 10.3126/jaim.v12i1.56679
Susmin Karki, G. S. Shrestha, S. Yadav, Ravi Shah, Saurav Agrawal, Asmita Parajuli
A 26-year male came to the emergency department complaining of left flank pain. On examination, the patient was afebrile with stable vitals. With clinical features, lab investigations, and ultrasonographic findings, a diagnosis of left hydroureteronephrosis was made. He was managed with intravenous ketorolac 30mg, after which he developed an anaphylactic reaction, and the patient was contained in the red area of the emergency. Anaphylactic reaction to intravenous ketorolac is rarely reported. Ketorolac is one of the common drugs used in pain management in acute care settings; health professionals should be aware of the possible complication in the form of an anaphylactic reaction, which is rare yet potentially fatal.
{"title":"Anaphylactic reaction after intravenous injection of ketorolac for colicky pain: a case report and literature review","authors":"Susmin Karki, G. S. Shrestha, S. Yadav, Ravi Shah, Saurav Agrawal, Asmita Parajuli","doi":"10.3126/jaim.v12i1.56679","DOIUrl":"https://doi.org/10.3126/jaim.v12i1.56679","url":null,"abstract":"A 26-year male came to the emergency department complaining of left flank pain. On examination, the patient was afebrile with stable vitals. With clinical features, lab investigations, and ultrasonographic findings, a diagnosis of left hydroureteronephrosis was made. He was managed with intravenous ketorolac 30mg, after which he developed an anaphylactic reaction, and the patient was contained in the red area of the emergency. Anaphylactic reaction to intravenous ketorolac is rarely reported. Ketorolac is one of the common drugs used in pain management in acute care settings; health professionals should be aware of the possible complication in the form of an anaphylactic reaction, which is rare yet potentially fatal.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116949708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.3126/jaim.v12i1.56682
J. Robinson, Indrajit Banerjee, Alexandra Leclézio
The Marburg virus (MBV) phylogenetically belongs to the filovirus family and its clinical picture, spread and virulence resemble the Ebola virus very closely. The marked virulence of MBV is of great concern for not only the African region, but the globe in its entirety as a recent outbreak of the virus from a lab handling African green monkeys has rapidly spread to Uganda, South Africa, Kenya and Angola. On contamination of the virus the individual develops a plethora of symptoms with haemorrhage, seizures and shock being the most profound and deadly. No drug nor vaccine or cure is available against the deadly progression and course of the virus, and thus it often disseminates through households, between close loved ones and ultimately leaving a trail of death in its wake. It is now of upmost importance that international funding, knowledge and expertise become unified for the greater good; to develop treatments and vaccines to such viruses a likened to Ebola and Marburg virus to not only protect oneself, but humanity across all boarders around the world.
{"title":"Marburgvirus: A Global Virus, not just an African problem","authors":"J. Robinson, Indrajit Banerjee, Alexandra Leclézio","doi":"10.3126/jaim.v12i1.56682","DOIUrl":"https://doi.org/10.3126/jaim.v12i1.56682","url":null,"abstract":"The Marburg virus (MBV) phylogenetically belongs to the filovirus family and its clinical picture, spread and virulence resemble the Ebola virus very closely. The marked virulence of MBV is of great concern for not only the African region, but the globe in its entirety as a recent outbreak of the virus from a lab handling African green monkeys has rapidly spread to Uganda, South Africa, Kenya and Angola. On contamination of the virus the individual develops a plethora of symptoms with haemorrhage, seizures and shock being the most profound and deadly. No drug nor vaccine or cure is available against the deadly progression and course of the virus, and thus it often disseminates through households, between close loved ones and ultimately leaving a trail of death in its wake. It is now of upmost importance that international funding, knowledge and expertise become unified for the greater good; to develop treatments and vaccines to such viruses a likened to Ebola and Marburg virus to not only protect oneself, but humanity across all boarders around the world.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130022658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.3126/jaim.v12i1.56678
R. Mandal, Rajan Pande, K. Yadav, Kuldip Goit
BACKGROUND Maintenance hemodialysis is a popular treatment modality of renal replacement therapy for end stage renal disease patients. The clinical profile of end-stage renal disease (ESRD) and dialysis in Mid Western Nepal are scarce. This study aimed to study the clinical profile of ESRD patients undergoing hemodialysis at the tertiary care Hospital. METHODS This study was a single center based cross sectional observational study carried out over a period from 15th December 2022 to 15th February 2023 in Department of Medicine. A total of 40 patients undergoing maintenance hemodialysis were enrolled in the study. Data about Socio demographic profiles , clinical data, duration of chronic kidney disease (CKD), major comorbidity, the presumed etiology of ESRD, duration of haemodialysis, laboratory parameters including Renal function tests etc were entered in MS Excel and analyzed through SPSS 21. RESULTS A total of 40 patients were enrolled in the study. Males were 25(62.5%) and females were 15(37.5%). The mean age of the patient was 45.75±15.2 years. The most common cause of end stage renal disease and reasons for admission were hypertension nephropathy 36(90%) and Type 2 diabetes mellitus 9(22.5%) respectively. Anemia was the most common hematological findings in ESRD patients (>90%) followed by hypocalcemia in 65%. CONCLUSIONS Hypertensive nephropathy was the commonest cause for CKD followed by diabetic nephropathy and glomerulonephritis. Early detection and effective management of these illnesses can delay the onset, progression of CKD to end stage and subsequent morbidity and the requirement of renal replacement therapy.
{"title":"Clinical Profile of End Stage Renal Disease Patients Undergoing Hemodialysis in a Tertiary Care Hospital of Nepal","authors":"R. Mandal, Rajan Pande, K. Yadav, Kuldip Goit","doi":"10.3126/jaim.v12i1.56678","DOIUrl":"https://doi.org/10.3126/jaim.v12i1.56678","url":null,"abstract":"BACKGROUND Maintenance hemodialysis is a popular treatment modality of renal replacement therapy for end stage renal disease patients. The clinical profile of end-stage renal disease (ESRD) and dialysis in Mid Western Nepal are scarce. This study aimed to study the clinical profile of ESRD patients undergoing hemodialysis at the tertiary care Hospital. \u0000METHODS This study was a single center based cross sectional observational study carried out over a period from 15th December 2022 to 15th February 2023 in Department of Medicine. A total of 40 patients undergoing maintenance hemodialysis were enrolled in the study. Data about Socio demographic profiles , clinical data, duration of chronic kidney disease (CKD), major comorbidity, the presumed etiology of ESRD, duration of haemodialysis, laboratory parameters including Renal function tests etc were entered in MS Excel and analyzed through SPSS 21. \u0000RESULTS A total of 40 patients were enrolled in the study. Males were 25(62.5%) and females were 15(37.5%). The mean age of the patient was 45.75±15.2 years. The most common cause of end stage renal disease and reasons for admission were hypertension nephropathy 36(90%) and Type 2 diabetes mellitus 9(22.5%) respectively. Anemia was the most common hematological findings in ESRD patients (>90%) followed by hypocalcemia in 65%. \u0000CONCLUSIONS Hypertensive nephropathy was the commonest cause for CKD followed by diabetic nephropathy and glomerulonephritis. Early detection and effective management of these illnesses can delay the onset, progression of CKD to end stage and subsequent morbidity and the requirement of renal replacement therapy.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"85 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122206741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.3126/jaim.v12i1.56680
R. Rajbhandari, J. Shah, Arya Pradhan, Rebika Dangol, Utsav Dangol
A single coronary artery (SCA) is a relatively rare coronary artery anomaly. Absent right coronary artery (RCA) is the rarest of coronary artery anomalies occurring when the right coronary artery doesn’t develop. In the past 14 years till 2020, only 26 cases of congenital absence of RCA have been reported in 24 articles. We report a rare case of single left coronary artery with congenital absence of right coronary artery detected by coronary angiography and confirmed by coronary CT angiography. The RCA territory was being supplied by a branch from left circumflex (LCX) artery. The patient presented with nonspecific central chest pain. We aim to shed light on this rare anomaly and raise awareness among medical practitioners.
{"title":"A rare case of single coronary artery with congenital absence of right coronary artery","authors":"R. Rajbhandari, J. Shah, Arya Pradhan, Rebika Dangol, Utsav Dangol","doi":"10.3126/jaim.v12i1.56680","DOIUrl":"https://doi.org/10.3126/jaim.v12i1.56680","url":null,"abstract":"A single coronary artery (SCA) is a relatively rare coronary artery anomaly. Absent right coronary artery (RCA) is the rarest of coronary artery anomalies occurring when the right coronary artery doesn’t develop. In the past 14 years till 2020, only 26 cases of congenital absence of RCA have been reported in 24 articles. We report a rare case of single left coronary artery with congenital absence of right coronary artery detected by coronary angiography and confirmed by coronary CT angiography. The RCA territory was being supplied by a branch from left circumflex (LCX) artery. The patient presented with nonspecific central chest pain. We aim to shed light on this rare anomaly and raise awareness among medical practitioners.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114781552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.3126/jaim.v12i1.56681
Sai Yogesh, T. Singh, A. Kashyap, Indrajit Banerjee
The ongoing COVID-19 pandemic has led to an unprecedented global health crisis with a significant impact on people's daily lives. Despite dealing with the pandemic for over three years, the situation still remains uncertain, with the emergence of new variants posing a threat to the population's health. China's dynamic zero-COVID policy was initiated in August 2021, to control the rapid spread of the novel virus, which proved successful. However, the policy's draconian approach and severe economic ramifications led to widespread protests and civil unrest, ultimately compelling the Chinese government to lift imposed restrictions. The emergence of the new Omicron variant, which has shown high transmissibility and a decrease in vaccine efficacy, has posed a new challenge in the fight against COVID-19. The abandonment of the zero-COVID policy has resulted in an increase in COVID-19 cases in China, with lack of natural hybrid immunity being one of the primary contributing factors. The situation requires close monitoring, and effective measures should be implemented to control the spread of the virus and mitigate its impact on people's lives.
{"title":"Sudden upsurge of COVID-19 cases in China: A global threat","authors":"Sai Yogesh, T. Singh, A. Kashyap, Indrajit Banerjee","doi":"10.3126/jaim.v12i1.56681","DOIUrl":"https://doi.org/10.3126/jaim.v12i1.56681","url":null,"abstract":"The ongoing COVID-19 pandemic has led to an unprecedented global health crisis with a significant impact on people's daily lives. Despite dealing with the pandemic for over three years, the situation still remains uncertain, with the emergence of new variants posing a threat to the population's health. China's dynamic zero-COVID policy was initiated in August 2021, to control the rapid spread of the novel virus, which proved successful. However, the policy's draconian approach and severe economic ramifications led to widespread protests and civil unrest, ultimately compelling the Chinese government to lift imposed restrictions. The emergence of the new Omicron variant, which has shown high transmissibility and a decrease in vaccine efficacy, has posed a new challenge in the fight against COVID-19. The abandonment of the zero-COVID policy has resulted in an increase in COVID-19 cases in China, with lack of natural hybrid immunity being one of the primary contributing factors. The situation requires close monitoring, and effective measures should be implemented to control the spread of the virus and mitigate its impact on people's lives.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128930142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.3126/jaim.v12i1.56675
K. Khanal, S. Poudel, A. Ghimire, Ashim Regmi, Bikash Khadka, Manoj Bist, S. Shrestha, R. Sharma, U. Shrestha
BACKGROUND AND AIMS Severe acute pancreatitis can have serious consequences and a high mortality rate and may necessarily require intensive care unit admission. This study is to describe the demographic and clinicopathological characteristics of severe acute pancreatitis (SAP) in a tertiary-level intensive care unit (ICU). METHODS The study was designed retrospectively with a diagnosis of severe acute pancreatitis (SAP) admitted to the tertiary-level adult ICU “between” January 2019 to December 2022. RESULTS A total of 52 patients were enrolled in this study. The maximum numbers of patients were between 41 to 52 years of age, with a median age of 47.6 years. Gallstone (biliary) was identified as the most important etiological factor associated with severe acute pancreatitis. Among the known etiological factors, 52% of the cases were related to gallstone disease, 28.8% were due to alcohol, 7 (13.4%) to other causes (such as idiopathic, post-viral, post-ERCP, and drug-induced), and 5.7% were due to triglycerides. In our study, the most common symptoms were abdominal pain and vomiting. And the majority of patients recovered with conservative treatment. The majority 48 (92.3%) of patients improved, while 4 (7.6%) died. Eighteen (34.6%) patients required Mechanical ventilation (MV), while 10 (19%) with vasopressor supports. Eleven patients (21%) had evidence of an acute kidney injury on admission. Three patients (5.7%) underwent surgery, including necrosectomy and open cholecystectomy. The median length of ICU stay was 6.3 days. CONCLUSIONS The most common cause of severe acute pancreatitis was gallstone, followed by alcohol-related. SAP was seen more commonly in the male gender in the age group of 41-52 years. The most common presenting symptoms were abdominal pain and vomiting. Most SAP cases could be managed conservatively.
{"title":"A study on demographic and clinicopathological characteristics of severe acute pancreatitis in a tertiary-level intensive care unit in Nepal","authors":"K. Khanal, S. Poudel, A. Ghimire, Ashim Regmi, Bikash Khadka, Manoj Bist, S. Shrestha, R. Sharma, U. Shrestha","doi":"10.3126/jaim.v12i1.56675","DOIUrl":"https://doi.org/10.3126/jaim.v12i1.56675","url":null,"abstract":"BACKGROUND AND AIMS Severe acute pancreatitis can have serious consequences and a high mortality rate and may necessarily require intensive care unit admission. This study is to describe the demographic and clinicopathological characteristics of severe acute pancreatitis (SAP) in a tertiary-level intensive care unit (ICU).\u0000METHODS The study was designed retrospectively with a diagnosis of severe acute pancreatitis (SAP) admitted to the tertiary-level adult ICU “between” January 2019 to December 2022.\u0000RESULTS A total of 52 patients were enrolled in this study. The maximum numbers of patients were between 41 to 52 years of age, with a median age of 47.6 years. Gallstone (biliary) was identified as the most important etiological factor associated with severe acute pancreatitis. Among the known etiological factors, 52% of the cases were related to gallstone disease, 28.8% were due to alcohol, 7 (13.4%) to other causes (such as idiopathic, post-viral, post-ERCP, and drug-induced), and 5.7% were due to triglycerides. In our study, the most common symptoms were abdominal pain and vomiting. And the majority of patients recovered with conservative treatment. The majority 48 (92.3%) of patients improved, while 4 (7.6%) died. Eighteen (34.6%) patients required Mechanical ventilation (MV), while 10 (19%) with vasopressor supports. Eleven patients (21%) had evidence of an acute kidney injury on admission. Three patients (5.7%) underwent surgery, including necrosectomy and open cholecystectomy. The median length of ICU stay was 6.3 days.\u0000CONCLUSIONS The most common cause of severe acute pancreatitis was gallstone, followed by alcohol-related. SAP was seen more commonly in the male gender in the age group of 41-52 years. The most common presenting symptoms were abdominal pain and vomiting. Most SAP cases could be managed conservatively.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127481538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.3126/jaim.v12i1.56676
R. Rajbhandari, J. Shah, Arya Pradhan, Rebika Dangol, Utsav Dangol, Ashreyata Manandhar, B. Banskota, Niraj Baidhya, T. Bajracharya
BACKGROUND Although new-onset arrhythmia are a common problem in cardiothoracic surgery, their incidence in major non- cardiac surgery has not been studied properly. The aim of the study is to assess the incidence of arrhythmia after non cardiac surgery. While we have some data on postop arrhythmia after general surgery, we don’t have much data on orthopedic surgery, and good proportion of our patient in the study belong to this category. Thus it is also aimed to compare the incidence of arrhythmia in different types of surgery. METHODOLOGY The present study is a retrospective cohort of 100 patients who recently underwent surgery between 2023 January 1st till 2023 June 1st. All included patients were monitored in ICU and post-operative ward after surgery. 100 patients (28 female and 72 male) without any history of prior arrhythmia were analyzed and included in the study. Incidence of postoperative arrhythmia (PA) was observed and compared in patients undergoing different types of surgery. Impact of age factor on the incidence of PA was also studied. RESULTS Incidence of overall PA among all patients were 31%. Incidence of significant PA were 14.3%. Incidence of significant PA was highest in gastro-surgery patients (22%) whereas orthopedics patients had 11% incidence of PA. CONCLUSION Gastro surgery seems to give high impact on incidence of PA. In our analysis, age of the patient appear to be associated with the causation of PA.
{"title":"Incidence of new onset arrhythmia after non cardiac surgery","authors":"R. Rajbhandari, J. Shah, Arya Pradhan, Rebika Dangol, Utsav Dangol, Ashreyata Manandhar, B. Banskota, Niraj Baidhya, T. Bajracharya","doi":"10.3126/jaim.v12i1.56676","DOIUrl":"https://doi.org/10.3126/jaim.v12i1.56676","url":null,"abstract":"BACKGROUND Although new-onset arrhythmia are a common problem in cardiothoracic surgery, their incidence in major non- cardiac surgery has not been studied properly. The aim of the study is to assess the incidence of arrhythmia after non cardiac surgery. While we have some data on postop arrhythmia after general surgery, we don’t have much data on orthopedic surgery, and good proportion of our patient in the study belong to this category. Thus it is also aimed to compare the incidence of arrhythmia in different types of surgery. \u0000METHODOLOGY The present study is a retrospective cohort of 100 patients who recently underwent surgery between 2023 January 1st till 2023 June 1st. All included patients were monitored in ICU and post-operative ward after surgery. 100 patients (28 female and 72 male) without any history of prior arrhythmia were analyzed and included in the study. Incidence of postoperative arrhythmia (PA) was observed and compared in patients undergoing different types of surgery. Impact of age factor on the incidence of PA was also studied. \u0000RESULTS Incidence of overall PA among all patients were 31%. Incidence of significant PA were 14.3%. Incidence of significant PA was highest in gastro-surgery patients (22%) whereas orthopedics patients had 11% incidence of PA. \u0000CONCLUSION Gastro surgery seems to give high impact on incidence of PA. In our analysis, age of the patient appear to be associated with the causation of PA.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121964211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-12DOI: 10.3126/jaim.v11i2.52394
G. S. Shrestha, A. Pradhan, Satyam Kharga, Manjit Shrestha, Tenzing Lobsel, Birendra Kumar Raut, Bal Chandra Karki, N. Poudel, R. Gautam, N. Maharjan
BACKGROUND AND AIMS Dengue is a viral disease transmitted by mosquitoes. The burden of disease related to Dengue is considerable in tropical and sub-tropical countries. Recently, many countries observed the outbreak of Dengue. Our study aims to explore the clinical profile and outcome of the dengue positive cases admitted in the intensive care unit (ICU) of a tertiary level hospital in Lalitpur. METHODS We conducted a retrospective single center study in patients with proven Dengue, admitted to ICU. Data were collected between 20th August and 15th October 2022. Data collected were the baseline characteristics of patients, signs and symptoms and need for organ support. Patients were graded according to WHO severity scale. RESULTS A total of 31 cases were admitted during the study period. Fever, vomiting and malaise were the common presenting symptoms. Comorbidities like hypertension and diabetes were common. Hypotension, requiring inotropic support was present in nine (29.0%) of cases. Ten patients (32.3%) required respiratory support. Derange hepatic and renal function were common. Five patients (16.1%) presented with clinically significant bleeding. Six (19.4%) of the cases expired in ICU. Among the non-survivors, five (83.3%) had severe Dengue and one (16.7%) case had Dengue with warning signs. CONCLUSION Critically ill patients with Dengue have multisystem involvement. Severe Dengue and Dengue with warning signs is associated with significant morbidity and mortality.
{"title":"Clinical profile of critically ill patients admitted with Dengue in a tertiary level hospital in Nepal: A retrospective study","authors":"G. S. Shrestha, A. Pradhan, Satyam Kharga, Manjit Shrestha, Tenzing Lobsel, Birendra Kumar Raut, Bal Chandra Karki, N. Poudel, R. Gautam, N. Maharjan","doi":"10.3126/jaim.v11i2.52394","DOIUrl":"https://doi.org/10.3126/jaim.v11i2.52394","url":null,"abstract":"BACKGROUND AND AIMS Dengue is a viral disease transmitted by mosquitoes. The burden of disease related to Dengue is considerable in tropical and sub-tropical countries. Recently, many countries observed the outbreak of Dengue. Our study aims to explore the clinical profile and outcome of the dengue positive cases admitted in the intensive care unit (ICU) of a tertiary level hospital in Lalitpur. \u0000METHODS We conducted a retrospective single center study in patients with proven Dengue, admitted to ICU. Data were collected between 20th August and 15th October 2022. Data collected were the baseline characteristics of patients, signs and symptoms and need for organ support. Patients were graded according to WHO severity scale. \u0000RESULTS A total of 31 cases were admitted during the study period. Fever, vomiting and malaise were the common presenting symptoms. Comorbidities like hypertension and diabetes were common. Hypotension, requiring inotropic support was present in nine (29.0%) of cases. Ten patients (32.3%) required respiratory support. Derange hepatic and renal function were common. Five patients (16.1%) presented with clinically significant bleeding. Six (19.4%) of the cases expired in ICU. Among the non-survivors, five (83.3%) had severe Dengue and one (16.7%) case had Dengue with warning signs. \u0000CONCLUSION Critically ill patients with Dengue have multisystem involvement. Severe Dengue and Dengue with warning signs is associated with significant morbidity and mortality.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115316427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-12DOI: 10.3126/jaim.v11i2.52395
Hari Prasad Panthi, D. Koirala, R. Pathak, Brindeswari Kafle Bhandari, A. Jha, R. Hamal, Mohan Bhusal, Manoj Lamsal, Susmita Gyawali
BACKGROUND Cirrhosis is the end result of varieties of chronic liver disease. A large proportion of patients with cirrhosis develop cardiopulmonary complication. The aim of this study was to evaluate the cardiopulmonary functions of patient with cirrhosis of liver and to correlate these abnormalities with CTP and MELD score. METHODS The study involved 81 cirrhotic patients admitted in Department of Gastroenterology of TUTH over a period of one year. The diagnosis of cirrhosis was established and clinical evaluation and investigation done. RESULTS The mean age of cirrhotic patients included in the study was 52 years. Alcohol was most common cause of cirrhosis (75.31%). The mean CTP score and MELD score was 10.02±1.77 and 23.59±7.53 respectively. Thirty patients (37.03%) had prolonged QTc interval, which had statistically significant association with alcohol as etiology of cirrhosis (p = 0.04). More than half (50.62%) of patients had diastolic dysfunction but it was not statistically significantly associated with CTP and MELD-Na score. Seven patients had evidence of intrapulmonary shunting, which had statistically significant association with MELD-Na score (p =0.01). Similarly, total 5 patients (6.17%) had PPHTN but there was no statistically significant association with CTP and MELD-Na score. Seventeen patients had dilated left atrium with no statistically significant association with CTP score and MELD-Na score. CONCLUSION There was significant incidence of cardiopulmonary abnormalities in cirrhotic patients. Every patient with decompensated cirrhosis irrespective of severity of disease should be evaluated for cardiopulmonary complication with a noninvasive, real-time, rapid imaging transthoracic contrast echocardiography.
{"title":"An Echocardiographic Evaluation of Cardiopulmonary Evaluation of Cardiopulmonary Functions in Patients with Cirrhosis of Liver and Correlation with Severity of Disease","authors":"Hari Prasad Panthi, D. Koirala, R. Pathak, Brindeswari Kafle Bhandari, A. Jha, R. Hamal, Mohan Bhusal, Manoj Lamsal, Susmita Gyawali","doi":"10.3126/jaim.v11i2.52395","DOIUrl":"https://doi.org/10.3126/jaim.v11i2.52395","url":null,"abstract":"BACKGROUND Cirrhosis is the end result of varieties of chronic liver disease. A large proportion of patients with cirrhosis develop cardiopulmonary complication. The aim of this study was to evaluate the cardiopulmonary functions of patient with cirrhosis of liver and to correlate these abnormalities with CTP and MELD score. \u0000METHODS The study involved 81 cirrhotic patients admitted in Department of Gastroenterology of TUTH over a period of one year. The diagnosis of cirrhosis was established and clinical evaluation and investigation done. \u0000RESULTS The mean age of cirrhotic patients included in the study was 52 years. Alcohol was most common cause of cirrhosis (75.31%). The mean CTP score and MELD score was 10.02±1.77 and 23.59±7.53 respectively. Thirty patients (37.03%) had prolonged QTc interval, which had statistically significant association with alcohol as etiology of cirrhosis (p = 0.04). More than half (50.62%) of patients had diastolic dysfunction but it was not statistically significantly associated with CTP and MELD-Na score. Seven patients had evidence of intrapulmonary shunting, which had statistically significant association with MELD-Na score (p =0.01). Similarly, total 5 patients (6.17%) had PPHTN but there was no statistically significant association with CTP and MELD-Na score. Seventeen patients had dilated left atrium with no statistically significant association with CTP score and MELD-Na score. \u0000CONCLUSION There was significant incidence of cardiopulmonary abnormalities in cirrhotic patients. Every patient with decompensated cirrhosis irrespective of severity of disease should be evaluated for cardiopulmonary complication with a noninvasive, real-time, rapid imaging transthoracic contrast echocardiography.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126617344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-12DOI: 10.3126/jaim.v11i2.52414
K. Khanal, S. Poudel, A. Ghimire, Ashim Regmi, Rashmita Bhattarai, Aakash Pandey
Acute pancreatitis (AP) is a rare complication of Dengue fever with unpredictable progression and outcome. There have been increasing reports of acute pancreatitis due to dengue. Fever, abdominal pain or tenderness are the presenting clinical manifestations on hospital admission. We reported two similar cases of Dengue who presented with the complaints of fever, abdominal pain, and generalized body ache. Acute pancreatitis was diagnosed in both cases following blood investigations, ultrasound and contrast enhanced computed tomography (CECT) of the whole abdomen.
{"title":"Dengue Fever Presenting as Acute Pancreatitis: A Case Series","authors":"K. Khanal, S. Poudel, A. Ghimire, Ashim Regmi, Rashmita Bhattarai, Aakash Pandey","doi":"10.3126/jaim.v11i2.52414","DOIUrl":"https://doi.org/10.3126/jaim.v11i2.52414","url":null,"abstract":"Acute pancreatitis (AP) is a rare complication of Dengue fever with unpredictable progression and outcome. There have been increasing reports of acute pancreatitis due to dengue. Fever, abdominal pain or tenderness are the presenting clinical manifestations on hospital admission. We reported two similar cases of Dengue who presented with the complaints of fever, abdominal pain, and generalized body ache. Acute pancreatitis was diagnosed in both cases following blood investigations, ultrasound and contrast enhanced computed tomography (CECT) of the whole abdomen.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122157929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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