Pub Date : 2022-09-09DOI: 10.3126/jaim.v11i1.48039
R. Nepal, Bharosha Bhattarai, A. Bhandari, B. Adhikari, Rhishikesh Nepal, Nimesh Khanal
Background: Medical officers and resident doctors as primary care physicians (PCPs) are the first contact health care providers to most of the kidney disease patients in Nepal. This study intends to assess knowledge, attitude and practice regarding kidney diseases among these nonnephrology doctors, working in different health institutes all over Nepal. Methods: This was a descriptive, cross sectional, questionnaire based study, conducted over the span of 12 weeks among the primary care physicians. The Ethical Review Board of Nepal Health Research Council had approved our protocol prior to starting the study. An arbitrary scoring system was used to classify knowledge, attitude and practice scores as: 0 to <50% - Poor score, 50% to <75% - Moderate score, ≥ 75% - Good score. Data was entered in Microsoft Excel and analyzed using IBM Statistical Package for the Social Sciences version 25. Results: Out of 239 PCPs enrolled in our study, 41 (17%) obtained good knowledge scores, 124 (51.8%) obtained good attitude scores and 198 (82.8%) obtained good practice scores. None of the study participants had negative attitude towards kidney diseases. The mean scores obtained in our study were 23.03±4.49 for knowledge, 17.64±2.30 for attitude and 6.27±1.24 for practice domains out of total score of 37, 24, and 8 respectively. Conclusions: Our study demonstrated that the majority of PCPs had obtained moderate to poor knowledge scores regarding kidney diseases. However, the majority had a positive attitude and good practice regarding kidney diseases in our study.
背景:医疗官员和住院医生作为初级保健医生(pcp)是尼泊尔大多数肾病患者的第一个接触卫生保健提供者。本研究旨在评估在尼泊尔各地不同卫生机构工作的非肾病科医生对肾脏疾病的知识、态度和做法。方法:这是一项描述性、横断面、基于问卷的研究，在初级保健医生中进行了为期12周的研究。尼泊尔卫生研究理事会伦理审查委员会在研究开始前批准了我们的方案。采用任意评分系统将知识、态度和实践得分分为:0 ~ <50% -差分，50% ~ <75% -中分，≥75% -好分。数据在Microsoft Excel中输入，并使用IBM Statistical Package for the Social Sciences version 25进行分析。结果:239名执业医师中，有41名(17%)知识分良好，124名(51.8%)态度分良好，198名(82.8%)实践分良好。研究对象对肾脏疾病均无消极态度。在总分37分、24分和8分中，知识、态度和实践领域的平均得分分别为23.03±4.49分、17.64±2.30分和6.27±1.24分。结论:我们的研究表明，大多数pcp对肾脏疾病的知识得分中等到较差。然而，在我们的研究中，大多数人对肾脏疾病持积极的态度和良好的做法。
{"title":"Knowledge, Attitude and Practice Regarding Kidney Diseases among Primary Care Physicians working in Nepal","authors":"R. Nepal, Bharosha Bhattarai, A. Bhandari, B. Adhikari, Rhishikesh Nepal, Nimesh Khanal","doi":"10.3126/jaim.v11i1.48039","DOIUrl":"https://doi.org/10.3126/jaim.v11i1.48039","url":null,"abstract":"Background: Medical officers and resident doctors as primary care physicians (PCPs) are the first contact health care providers to most of the kidney disease patients in Nepal. This study intends to assess knowledge, attitude and practice regarding kidney diseases among these nonnephrology doctors, working in different health institutes all over Nepal.\u0000Methods: This was a descriptive, cross sectional, questionnaire based study, conducted over the span of 12 weeks among the primary care physicians. The Ethical Review Board of Nepal Health Research Council had approved our protocol prior to starting the study. An arbitrary scoring system was used to classify knowledge, attitude and practice scores as: 0 to <50% - Poor score, 50% to <75% - Moderate score, ≥ 75% - Good score. Data was entered in Microsoft Excel and analyzed using IBM Statistical Package for the Social Sciences version 25.\u0000Results: Out of 239 PCPs enrolled in our study, 41 (17%) obtained good knowledge scores, 124 (51.8%) obtained good attitude scores and 198 (82.8%) obtained good practice scores. None of the study participants had negative attitude towards kidney diseases. The mean scores obtained in our study were 23.03±4.49 for knowledge, 17.64±2.30 for attitude and 6.27±1.24 for practice domains out of total score of 37, 24, and 8 respectively.\u0000Conclusions: Our study demonstrated that the majority of PCPs had obtained moderate to poor knowledge scores regarding kidney diseases. However, the majority had a positive attitude and good practice regarding kidney diseases in our study.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115493065","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 : 2022-06-30DOI: 10.3126/jaim.v11i1.48194
S. Baccouche, Sarraj Achref, M. Hajri, Osman Rania, W. Ferjaoui, A. Lahmer, S. Slama, D. Bacha
Although it can affect any part of the gastrointestinal system, signet ring cell carcinoma (SRC) is a common malignant entity of stomach cancers. We discuss the case of a patient who had a prior history of gastric adenocarcinoma with signet ring cells, for which he underwent a partial gastrectomy with a gastro-jejunal anastomosis. Four months after surgery, he presented an acute postoperative blockage. Operative findings and pathology exams concluded the presence of SRC at the right angle of the colon. In patients with obstructive symptoms after surgery for SRC neoplasms of the stomach, the possibility of a second lesion should be considered among the differential diagnoses.
{"title":"A Rare Case of Synchronous Gastric Signet Ring Cell Adenocarcinoma Metastasis at the right colon angle","authors":"S. Baccouche, Sarraj Achref, M. Hajri, Osman Rania, W. Ferjaoui, A. Lahmer, S. Slama, D. Bacha","doi":"10.3126/jaim.v11i1.48194","DOIUrl":"https://doi.org/10.3126/jaim.v11i1.48194","url":null,"abstract":"Although it can affect any part of the gastrointestinal system, signet ring cell carcinoma (SRC) is a common malignant entity of stomach cancers. We discuss the case of a patient who had a prior history of gastric adenocarcinoma with signet ring cells, for which he underwent a partial gastrectomy with a gastro-jejunal anastomosis. Four months after surgery, he presented an acute postoperative blockage. Operative findings and pathology exams concluded the presence of SRC at the right angle of the colon.\u0000In patients with obstructive symptoms after surgery for SRC neoplasms of the stomach, the possibility of a second lesion should be considered among the differential diagnoses.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121686090","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 : 2021-12-31DOI: 10.3126/jaim.v10i2.42197
S. Adhikari, P. Bhandari, B. Karmacharya, N. Yogi
A ventriculoperitoneal shunt is a major surgical modality to relieve intracranial pressure in patients with hydrocephalus. Shunt obstruction and infection are the most common complications following shunt surgery whereas VP shunt-associated pseudocyst formation is a rare complication. These are the cystic space without the epithelial lining, filled with fluid around the distal tip of the catheter. In this case report, we present you a 47-year-old male who underwent VP shunt placed a year back presented with huge abdominal swelling, headache, and weight loss. CT scan of the abdomen showed abdominal pseudocyst with the peritoneal end of the shunt within the cyst. Though the exact mechanism is not known, abdominal adhesion, multiple revisions, obstruction, or dislodgement are thought to predispose to the formation of a pseudocyst.
{"title":"Pseudocyst of Abdomen Presenting as a Huge Abdominal Mass after Ventriculoperitoneal Shunt: A Case Report","authors":"S. Adhikari, P. Bhandari, B. Karmacharya, N. Yogi","doi":"10.3126/jaim.v10i2.42197","DOIUrl":"https://doi.org/10.3126/jaim.v10i2.42197","url":null,"abstract":"A ventriculoperitoneal shunt is a major surgical modality to relieve intracranial pressure in patients with hydrocephalus. Shunt obstruction and infection are the most common complications following shunt surgery whereas VP shunt-associated pseudocyst formation is a rare complication. These are the cystic space without the epithelial lining, filled with fluid around the distal tip of the catheter. \u0000In this case report, we present you a 47-year-old male who underwent VP shunt placed a year back presented with huge abdominal swelling, headache, and weight loss. CT scan of the abdomen showed abdominal pseudocyst with the peritoneal end of the shunt within the cyst. \u0000Though the exact mechanism is not known, abdominal adhesion, multiple revisions, obstruction, or dislodgement are thought to predispose to the formation of a pseudocyst.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126095257","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 : 2021-12-31DOI: 10.3126/jaim.v10i2.40289
Shyam Dhodary, S. Uranw, N. Pandey, P. Karki
Background and Aims: Hypertension is a common health problem. Left ventricular hypertrophy, a condition in hypertension is a risk factor for myocardial infarction, stroke and heart failure. This study aims to detect left ventricular hypertrophy in hypertensive patients using Electrocardiography and echocardiography. Methods: In this descriptive cross-sectional study; 143 patients of Hypertension from February 2019 to August 2019 were enrolled. They were evaluated for left ventricular hypertrophy using electrocardiography and echocardiography. Sokolow-Lyon and Cornell Voltage electrocardiographic criteria were used and their sensitivities and specificities to detect left ventricular hypertrophy were calculated taking echocardiography as a gold standard method. Results: The mean age of the study population was 58.69 ± 11.33 years. Mean duration of hypertension was 4.72 ±3.2 years. The mean systolic and diastolic blood pressure were 137 ± 15.42 mmHg and 84 ± 10.5 mmHg respectively. Out of 143 study population, 30(21%) of them had left ventricular hypertrophy on electrocardiography as defined by Sokolow-Lyon criteria, and 29(20.3%) had left ventricular hypertrophy on electrocardiography as per Cornell Voltage criteria. On combining both Sokolow-Lyon and Cornell Voltage criteria, 37(25.9%) of the study population had left ventricular hypertrophy on electrocardiography (either as per Sokolow-Lyon or Cornell Voltage criteria). On echocardiography, 62(43.4%) of them were found to have left ventricular hypertrophy. Conclusions: Electrocardiography is a less sensitive tool to diagnose Left Ventricular Hypertrophy in hypertension but its specificity is high (>95%). Investigation of choice to detect Left Ventricular Hypertrophy in hypertensive people is still the echocardiography.
{"title":"Comparative Study of Electrocardiographic and Echocardiographic Evidence of Left Ventricular Hypertrophy in Systemic Hypertension","authors":"Shyam Dhodary, S. Uranw, N. Pandey, P. Karki","doi":"10.3126/jaim.v10i2.40289","DOIUrl":"https://doi.org/10.3126/jaim.v10i2.40289","url":null,"abstract":"Background and Aims: Hypertension is a common health problem. Left ventricular hypertrophy, a condition in hypertension is a risk factor for myocardial infarction, stroke and heart failure. This study aims to detect left ventricular hypertrophy in hypertensive patients using Electrocardiography and echocardiography.\u0000Methods: In this descriptive cross-sectional study; 143 patients of Hypertension from February 2019 to August 2019 were enrolled. They were evaluated for left ventricular hypertrophy using electrocardiography and echocardiography. Sokolow-Lyon and Cornell Voltage electrocardiographic criteria were used and their sensitivities and specificities to detect left ventricular hypertrophy were calculated taking echocardiography as a gold standard method.\u0000Results: The mean age of the study population was 58.69 ± 11.33 years. Mean duration of hypertension was 4.72 ±3.2 years. The mean systolic and diastolic blood pressure were 137 ± 15.42 mmHg and 84 ± 10.5 mmHg respectively. Out of 143 study population, 30(21%) of them had left ventricular hypertrophy on electrocardiography as defined by Sokolow-Lyon criteria, and 29(20.3%) had left ventricular hypertrophy on electrocardiography as per Cornell Voltage criteria. On combining both Sokolow-Lyon and Cornell Voltage criteria, 37(25.9%) of the study population had left ventricular hypertrophy on electrocardiography (either as per Sokolow-Lyon or Cornell Voltage criteria). On echocardiography, 62(43.4%) of them were found to have left ventricular hypertrophy.\u0000Conclusions: Electrocardiography is a less sensitive tool to diagnose Left Ventricular Hypertrophy in hypertension but its specificity is high (>95%). Investigation of choice to detect Left Ventricular Hypertrophy in hypertensive people is still the echocardiography.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"159 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127000725","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 : 2021-12-31DOI: 10.3126/jaim.v10i2.42154
Bikash Khadka, Hemant Adhikari, S. Poudel, K. Khanal
Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinastatin is a serine proteases inhibitor that reduces inflammation by suppressing the infiltration of neutrophils and elastase release and inflammatory mediators that help improve clinical symptoms and reduce mortality. This study aims to evaluate the clinical utility of Ulinastatin. Methods: Fifty-two patients admitted to ICU with acute pancreatitis were divided into; Ulinastatin group who received a 3 to 5 days course of 200,000IU, and Control Group who didn’t receive ulinastatin. Pearson's Chi-square and Fisher's exact test were used and a p-value < 0.05 was considered statistically significant. Results: Mean age was lower among the Ulinastatin group at 43 years (p-Value 0.014) and Hepatic dysfunction was more among this group (p-value 0.04). Among new onset of organ dysfunction, only CVS dysfunction was significant among the Control group ( p-value 0.044) while respiratory function recovery (p-value 0.04) and coagulation profile improvement (p-value 0.017) was statistically significant among the Ulinastatin group. The mean duration of hospital stay was shorter among control group, 9.65 days vs 14 days, a p-value of 0.05and also the average duration of stay in MDICU was lower, 4 days vs 8.5 days, p-value 0.0044 in comparison to Ulinastatin group. Overall mortality incidence was 15.38%, 19% in Ulinastatin group vs 11.5% in Control group. Conclusion: This retrospective study is our experience in the use of Ulinastatin which has shown little efficacy in declining mortality and/or hospital stay duration though it helps prevent new organ dysfunctions.
{"title":"Retrospective analysis of the role of Ulinastatin in reducing mortality in severe pancreatitis in critical care unit in Nepal","authors":"Bikash Khadka, Hemant Adhikari, S. Poudel, K. Khanal","doi":"10.3126/jaim.v10i2.42154","DOIUrl":"https://doi.org/10.3126/jaim.v10i2.42154","url":null,"abstract":"Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinastatin is a serine proteases inhibitor that reduces inflammation by suppressing the infiltration of neutrophils and elastase release and inflammatory mediators that help improve clinical symptoms and reduce mortality. This study aims to evaluate the clinical utility of Ulinastatin.\u0000Methods: Fifty-two patients admitted to ICU with acute pancreatitis were divided into; Ulinastatin group who received a 3 to 5 days course of 200,000IU, and Control Group who didn’t receive ulinastatin. Pearson's Chi-square and Fisher's exact test were used and a p-value < 0.05 was considered statistically significant.\u0000Results: Mean age was lower among the Ulinastatin group at 43 years (p-Value 0.014) and Hepatic dysfunction was more among this group (p-value 0.04). Among new onset of organ dysfunction, only CVS dysfunction was significant among the Control group ( p-value 0.044) while respiratory function recovery (p-value 0.04) and coagulation profile improvement (p-value 0.017) was statistically significant among the Ulinastatin group. The mean duration of hospital stay was shorter among control group, 9.65 days vs 14 days, a p-value of 0.05and also the average duration of stay in MDICU was lower, 4 days vs 8.5 days, p-value 0.0044 in comparison to Ulinastatin group. Overall mortality incidence was 15.38%, 19% in Ulinastatin group vs 11.5% in Control group.\u0000Conclusion: This retrospective study is our experience in the use of Ulinastatin which has shown little efficacy in declining mortality and/or hospital stay duration though it helps prevent new organ dysfunctions.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128114301","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 : 2021-12-31DOI: 10.3126/jaim.v10i2.42199
S. Adhikari, P. Bhandari, N. Poudel, N. Yogi, B. Karmacharya, Asmita Dhakal
A novel coronavirus that started from the Wuhan province of China is affecting the whole world. As of this date, more than 222 million cases are reported with more than 4.60 million fatalities. Nepal has more than 771,000 cases reported with almost 11,000 death recorded to date. Though most of the patients present with flu-like symptoms, people with comorbidities like Diabetes mellitus, hypertension, lung, and heart disease most likely suffer from severe disease and even death. As reported, neurological manifestations are common in critically ill patients. The most common manifestation of CNS is headache, dizziness, and encephalopathy whereas loss of smell and taste is the common PNS manifestation. Other neurological complications seen are fatigue, myalgias, hemorrhage, altered consciousness, Guillain-Barre Syndrome, syncope, seizure, and stroke. Non-specific neurological symptoms may be present in the early stages which can mislead the treatment. In some cases, neurological manifestations precede the typical presentation of fever, cough, and shortness of breath and later develop into typical features. The virus enters the brain through 2 systems: hematogenous route or olfactory route. Angiotensin-converting enzyme-2 (ACE-2) is the port of entry to the brain for COVID- 19(SARS-CoV-2) which was also the entry point for SARS-CoV. Covid-19 cases are increasing in the world and prevention and control of spread are a must. Understanding the neurological invasion pathogenesis, and manifestation will help the neurologists and physicians on frontlines to recognize early cases with nervous system involvement, neurological complications, and sequelae during and after the pandemic.
{"title":"Neurological manifestations of COVID-19: A literature review","authors":"S. Adhikari, P. Bhandari, N. Poudel, N. Yogi, B. Karmacharya, Asmita Dhakal","doi":"10.3126/jaim.v10i2.42199","DOIUrl":"https://doi.org/10.3126/jaim.v10i2.42199","url":null,"abstract":"A novel coronavirus that started from the Wuhan province of China is affecting the whole world. As of this date, more than 222 million cases are reported with more than 4.60 million fatalities. Nepal has more than 771,000 cases reported with almost 11,000 death recorded to date. Though most of the patients present with flu-like symptoms, people with comorbidities like Diabetes mellitus, hypertension, lung, and heart disease most likely suffer from severe disease and even death. As reported, neurological manifestations are common in critically ill patients. The most common manifestation of CNS is headache, dizziness, and encephalopathy whereas loss of smell and taste is the common PNS manifestation. Other neurological complications seen are fatigue, myalgias, hemorrhage, altered consciousness, Guillain-Barre Syndrome, syncope, seizure, and stroke. Non-specific neurological symptoms may be present in the early stages which can mislead the treatment. In some cases, neurological manifestations precede the typical presentation of fever, cough, and shortness of breath and later develop into typical features. The virus enters the brain through 2 systems: hematogenous route or olfactory route. Angiotensin-converting enzyme-2 (ACE-2) is the port of entry to the brain for COVID- 19(SARS-CoV-2) which was also the entry point for SARS-CoV. Covid-19 cases are increasing in the world and prevention and control of spread are a must. Understanding the neurological invasion pathogenesis, and manifestation will help the neurologists and physicians on frontlines to recognize early cases with nervous system involvement, neurological complications, and sequelae during and after the pandemic.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114169187","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 : 2021-12-31DOI: 10.3126/jaim.v10i2.42200
J. Robinson, Indrajit Banerjee
The novel SARS-CoV-2 infection has ripped through international health systems and protocols causing unprecedented mortality, morbidity and global trade deficits amounting to billions. Various monoclonal antibodies have been proposed for use in the treatment of COVID-19 infections. One such drug is LY-CoV555 which in an ongoing phase two trial study conducted by Chen P et al, showed to have an elimination of 99.97% of the viral RNA. The monoclonal antibody 47D11 discovered by Wang et al, binds to SARS-CoV-2. The 47D11 has been reconfigured into a human IgG1 isotope. It has shown that the 47D11 mAb effectively neutralizes the SARS-COV-2 virus. The stance and development however for the treatment of COVID-19 with monoclonal antibodies has shifted from a monotherapy to a so-called monoclonal antibody “cocktail” therapy. REGN-COV2 is such a cocktail developed with the use of two monoclonal antibodies REGN10987 and REGN10933 which have subsequently been named Imdevimab and Casirivimab. REGN-COV2 is currently under study in four phase 2 and 3 trial studies. These studies are multicentric in nature and are being conducted to evaluate the drug’s efficacy, dosing and clinical use as compared to the placebo. The mechanism of action of such monoclonal antibodies is related chiefly to the inhibition of the virus’s ability to perform its invasion and multiplication within the human body. The severity coupled with the sheer novelty of the SARSCoV-2 virus demands the use of newer therapies to both decrease the mortality and morbidity in patients suffering from the infection. The use of a combination of monoclonal antibodies is thereby well established and evident to both decrease the viral infection load, but is also useful in disrupting the virus’s life cycle and thus decreases the replication and viral shedding. It is therefore poignant that a combination of monoclonal antibodies, a “cocktail” therapy is employed so as to attack the virus at its various stages and thus this multifaceted approach may enhance the patient’s prognosis.
{"title":"Monoclonal Antibody Cocktail therapy for COVID-19: A Pharmacological innovation","authors":"J. Robinson, Indrajit Banerjee","doi":"10.3126/jaim.v10i2.42200","DOIUrl":"https://doi.org/10.3126/jaim.v10i2.42200","url":null,"abstract":"The novel SARS-CoV-2 infection has ripped through international health systems and protocols causing unprecedented mortality, morbidity and global trade deficits amounting to billions. Various monoclonal antibodies have been proposed for use in the treatment of COVID-19 infections. One such drug is LY-CoV555 which in an ongoing phase two trial study conducted by Chen P et al, showed to have an elimination of 99.97% of the viral RNA. The monoclonal antibody 47D11 discovered by Wang et al, binds to SARS-CoV-2. The 47D11 has been reconfigured into a human IgG1 isotope. It has shown that the 47D11 mAb effectively neutralizes the SARS-COV-2 virus. The stance and development however for the treatment of COVID-19 with monoclonal antibodies has shifted from a monotherapy to a so-called monoclonal antibody “cocktail” therapy. \u0000REGN-COV2 is such a cocktail developed with the use of two monoclonal antibodies REGN10987 and REGN10933 which have subsequently been named Imdevimab and Casirivimab. REGN-COV2 is currently under study in four phase 2 and 3 trial studies. These studies are multicentric in nature and are being conducted to evaluate the drug’s efficacy, dosing and clinical use as compared to the placebo. The mechanism of action of such monoclonal antibodies is related chiefly to the inhibition of the virus’s ability to perform its invasion and multiplication within the human body. \u0000The severity coupled with the sheer novelty of the SARSCoV-2 virus demands the use of newer therapies to both decrease the mortality and morbidity in patients suffering from the infection. The use of a combination of monoclonal antibodies is thereby well established and evident to both decrease the viral infection load, but is also useful in disrupting the virus’s life cycle and thus decreases the replication and viral shedding. It is therefore poignant that a combination of monoclonal antibodies, a “cocktail” therapy is employed so as to attack the virus at its various stages and thus this multifaceted approach may enhance the patient’s prognosis.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133759454","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 : 2021-12-31DOI: 10.3126/jaim.v10i2.38477
G. Nepal, J. Rehrig, Rajan Sharma Kandel, Shaik Tanveer Ahamad, Bipin Kandel, R. Ojha, J. Yadav, Sujan Jamarkattel, R. Shah, Jeevan Gautam, G. Shrestha
Preliminary studies suggest combined albendazole and praziquantel (ABZ+PZQ) therapy has superior anti-parasitic effect compared to albendazole (ABZ) or praziquantel (PZQ) monotherapy, due to potential pharmacokinetic synergism. We thus present an evidence-based review evaluating the risks and benefits associated with combination ABZ+PZQ therapy compared to standard ABZ monotherapy in the treatment of viable parenchymal Neurocysticercosis (NCC). Our systematic review is based on PRISMA (Preferred Reporting Items for Systematic review and Meta- Analysis) statement. Our primary outcome measure was to compare the efficacy of ABZ+PZQ with ABZ alone for treatment of NCC. Efficacy was determined based on clinical and radiographic evaluation. The secondary outcome measured the incidence of adverse effects in each treatment group. Literature search yielded a total of 120 articles. After excluding duplicates and those not meeting inclusion criteria, five papers were reviewed for data collection. Medication regimens, number of cyst, patient age, and location varied amongst included papers. The combination therapy resulted in significant symptom and cyst resolution in patients with more than two viable parenchymal cysts as compared to monotherapy. The two treatment arms were comparable in treating NCC with low cyst burden. There was no significant difference in the adverse effects between two treatment groups. In individuals with multi-cystic NCC, the patients who received dual therapy had better outcomes than those who received ABZ monotherapy as evidenced by radiographic improvement and reduced seizure episodes. The adverse effect profile in patients receiving dual therapy was similar and comparable to those with monotherapy.
{"title":"The efficacy of combined Albendazole and Praziquantel therapy versus Albendazole monotherapy in treatment of parenchymal neurocysticercosis: A systematic review","authors":"G. Nepal, J. Rehrig, Rajan Sharma Kandel, Shaik Tanveer Ahamad, Bipin Kandel, R. Ojha, J. Yadav, Sujan Jamarkattel, R. Shah, Jeevan Gautam, G. Shrestha","doi":"10.3126/jaim.v10i2.38477","DOIUrl":"https://doi.org/10.3126/jaim.v10i2.38477","url":null,"abstract":"Preliminary studies suggest combined albendazole and praziquantel (ABZ+PZQ) therapy has superior anti-parasitic effect compared to albendazole (ABZ) or praziquantel (PZQ) monotherapy, due to potential pharmacokinetic synergism. We thus present an evidence-based review evaluating the risks and benefits associated with combination ABZ+PZQ therapy compared to standard ABZ monotherapy in the treatment of viable parenchymal Neurocysticercosis (NCC). Our systematic review is based on PRISMA (Preferred Reporting Items for Systematic review and Meta- Analysis) statement. Our primary outcome measure was to compare the efficacy of ABZ+PZQ with ABZ alone for treatment of NCC. Efficacy was determined based on clinical and radiographic evaluation. The secondary outcome measured the incidence of adverse effects in each treatment group. Literature search yielded a total of 120 articles. After excluding duplicates and those not meeting inclusion criteria, five papers were reviewed for data collection. Medication regimens, number of cyst, patient age, and location varied amongst included papers. The combination therapy resulted in significant symptom and cyst resolution in patients with more than two viable parenchymal cysts as compared to monotherapy. The two treatment arms were comparable in treating NCC with low cyst burden. There was no significant difference in the adverse effects between two treatment groups. In individuals with multi-cystic NCC, the patients who received dual therapy had better outcomes than those who received ABZ monotherapy as evidenced by radiographic improvement and reduced seizure episodes. The adverse effect profile in patients receiving dual therapy was similar and comparable to those with monotherapy.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129609431","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}
COVID19 (Corona virus disease 2019) is an illness caused by novel corona virus, first reported from Wuhan in China in December 2019. This pandemic has spread to most of the countries of the world and has already taken a huge human toll. Transmission is mostly by the respiratory droplets and also by fomites. While most infected individuals have mild symptoms, a small but significant proportion of individuals develop severe bronchopneumonia, sometimes leading to multiorgan dysfunction. Common symptoms are fever, cough, myalgia, fatigue, nausea, vomiting, diarrhoea, breathlessness etc. Diagnosis is made by clinical features in the right epidemiological setting, blood tests and usually confirmed by a PCR test with a nasopharyngeal and oropharyngeal swab. Management is mainly supportive as currently there is no proven antiviral treatment. Reconfiguration of services was necessary to manage a large number of patients admitted to a UK hospital with COVID 19 disease as elective admissions were cancelled and hospital admissions due to due to other diseases significantly declined. Staff were reallocated to cope with the surge in hospital admissions. A system of training was put in place to upskill the staff. All but absolutely necessary outpatient consultations were done by telephone or videoconferencing. COVID 19 patients were cared for in dedicated areas of the hospital and strict infection control procedures were followed. Intensive care unit facilities with ventilators were rapidly expanded with involvement of operation theatre areas. Non-invasive respiratory support was provided in respiratory wards.
{"title":"COVID-19: Literature review and learning from UK Experience","authors":"S. Shrestha, S. Lohani","doi":"10.3126/jaim.v9i1.29160","DOIUrl":"https://doi.org/10.3126/jaim.v9i1.29160","url":null,"abstract":"COVID19 (Corona virus disease 2019) is an illness caused by novel corona virus, first reported from Wuhan in China in December 2019. This pandemic has spread to most of the countries of the world and has already taken a huge human toll. Transmission is mostly by the respiratory droplets and also by fomites. While most infected individuals have mild symptoms, a small but significant proportion of individuals develop severe bronchopneumonia, sometimes leading to multiorgan dysfunction. Common symptoms are fever, cough, myalgia, fatigue, nausea, vomiting, diarrhoea, breathlessness etc. Diagnosis is made by clinical features in the right epidemiological setting, blood tests and usually confirmed by a PCR test with a nasopharyngeal and oropharyngeal swab. Management is mainly supportive as currently there is no proven antiviral treatment. \u0000Reconfiguration of services was necessary to manage a large number of patients admitted to a UK hospital with COVID 19 disease as elective admissions were cancelled and hospital admissions due to due to other diseases significantly declined. Staff were reallocated to cope with the surge in hospital admissions. A system of training was put in place to upskill the staff. All but absolutely necessary outpatient consultations were done by telephone or videoconferencing. \u0000COVID 19 patients were cared for in dedicated areas of the hospital and strict infection control procedures were followed. Intensive care unit facilities with ventilators were rapidly expanded with involvement of operation theatre areas. Non-invasive respiratory support was provided in respiratory wards.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"08 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125423886","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}
G. Shrestha, S. Acharya, P. Shrestha, Ninadini Shrestha, H. Paneru, S. Paudel, B. Lohani, S. Pradhan, D. Aryal, N. Bista, B. L. Shah, A. Bhattarai, B. Parajuli, M. Koirala, P. Acharya, Sabin Koirala, A. Amatya, Sandip Bhandari, Arjun Gurung, Bibhush Shrestha, S. Sigdel, B. M. Shakya, N. Keyal, Anand C. Thakur, Achyut Sharma, T. Bajracharya
Background and Aims: Use of point-of-care ultrasound (POCUS) in acute care setting has rapidly increased and has potentials to guide patient management. This survey study aims to explore the usefulness of a one-day workshop and to elicit the perceived barriers for effective use of POCUS. Methods: A total of 169 doctors who had attended one day Acute Care Ultrasound workshop were approached through email. Online link to access the survey created using Google forms was sent. The survey contained questions related to the details about the participants, feedback about the workshop, whether the workshop has helped to change the practice of the participants, availability of ultrasound machine during the daily practice and the perceived barriers for use of POCUS. Results: A total of 41 responses were obtained. Majority of the participants had anaesthesiology as the base specialty followed by general practice. Most of them had ICU as their predominant working place, followed by emergency room and operating room. The workshop was found to be helpful by most of the participants. Majority of the participants (20 participants; 49%) had ultrasound machine sometimes available during their daily practice. Only 20% (8 participants) had ultrasound machine always available during their clinical practice. Similarly, 46% (19 participants) considered lack of access to ultrasound machine as a barrier for application of POCUS. Significant number of participants considered lack of supervision and guidance (18 participants; 44%) and lack of knowledge and skills (13 participants; 32%) as the barriers. Conclusions: Majority of the participants found the one-day workshop helpful. Doctors from various specialty, working in acute care setting had participated in the survey. Limited access to ultrasound machine, together with lack of adequate knowledge and skills were perceived as major barriers for effective use of point-of-care ultrasound.
{"title":"Point-of-care ultrasonography: training, applications and barriers. A survey study","authors":"G. Shrestha, S. Acharya, P. Shrestha, Ninadini Shrestha, H. Paneru, S. Paudel, B. Lohani, S. Pradhan, D. Aryal, N. Bista, B. L. Shah, A. Bhattarai, B. Parajuli, M. Koirala, P. Acharya, Sabin Koirala, A. Amatya, Sandip Bhandari, Arjun Gurung, Bibhush Shrestha, S. Sigdel, B. M. Shakya, N. Keyal, Anand C. Thakur, Achyut Sharma, T. Bajracharya","doi":"10.3126/jaim.v8i1.27995","DOIUrl":"https://doi.org/10.3126/jaim.v8i1.27995","url":null,"abstract":"Background and Aims: Use of point-of-care ultrasound (POCUS) in acute care setting has rapidly increased and has potentials to guide patient management. This survey study aims to explore the usefulness of a one-day workshop and to elicit the perceived barriers for effective use of POCUS. \u0000Methods: A total of 169 doctors who had attended one day Acute Care Ultrasound workshop were approached through email. Online link to access the survey created using Google forms was sent. The survey contained questions related to the details about the participants, feedback about the workshop, whether the workshop has helped to change the practice of the participants, availability of ultrasound machine during the daily practice and the perceived barriers for use of POCUS. \u0000Results: A total of 41 responses were obtained. Majority of the participants had anaesthesiology as the base specialty followed by general practice. Most of them had ICU as their predominant working place, followed by emergency room and operating room. The workshop was found to be helpful by most of the participants. Majority of the participants (20 participants; 49%) had ultrasound machine sometimes available during their daily practice. Only 20% (8 participants) had ultrasound machine always available during their clinical practice. Similarly, 46% (19 participants) considered lack of access to ultrasound machine as a barrier for application of POCUS. Significant number of participants considered lack of supervision and guidance (18 participants; 44%) and lack of knowledge and skills (13 participants; 32%) as the barriers. \u0000Conclusions: Majority of the participants found the one-day workshop helpful. Doctors from various specialty, working in acute care setting had participated in the survey. Limited access to ultrasound machine, together with lack of adequate knowledge and skills were perceived as major barriers for effective use of point-of-care ultrasound.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125526801","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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