Sanjeet Krishna Shresth, Sanjeev Shrestha, L. Sharma, Trilok Shrivastava, Rinki Mahaseth, A. Neopane
Background and Aims: Shift work has been growing more prevalence and involves irregular working hours when compared to daytime work schedule. This study aims to assess sleep quality, its functional outcome, excessive daytime sleepiness and incidence of obstructive sleep apnea between shift and non-shift workers. Methods: The study candidates were randomly drawn Nepalese, from age 18 years and older, and were enrolled between January 2018 to January 2019. The subjects were divided into either: Shift work or Non-Shift work. The assessment measures were done with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), STOP-BANG and FOSQ-10 (Functional Outcome of Sleep Quality – 10), using a standard form. Results: A total of 358 participants were included in the main study (176 Non-shift workers, and 182 Shift-workers). The mean BMI among the two group were not significantly different (p =0.43). There was significant difference with 25% Non-Shift workers and 41.21% of Shift workers were found to have Abnormal Sleepiness in the Epworth Sleepiness Scale score (p=0.004). Shift workers showed comparatively higher values for Epworth Sleepiness scale compared to Non-Shift workers in Mann-Whitney analysis, with mean rank 194.11 versus 164.39, respectively, p=0.006. Similarly, 26.29% Non-Shift workers and 36.72% Shift workers were found to have abnormal FOSQ-10 scores, χ2 (1) =4.44, p=0.035. 7.95% of Non-Shift workers and 6.59% of Shift-workers were found to have high risk of OSA in STOP BANG questionnaire, with no significant association, p=0.725. Conclusions: Shift work caused excessive daytime sleepiness and had worse functional outcome but did not increase probability of obstructive sleep apnea.
{"title":"Assessing quality of sleep, its functional outcome and excessive day time sleepiness in shift workers and non-shift workers","authors":"Sanjeet Krishna Shresth, Sanjeev Shrestha, L. Sharma, Trilok Shrivastava, Rinki Mahaseth, A. Neopane","doi":"10.3126/jaim.v8i1.27999","DOIUrl":"https://doi.org/10.3126/jaim.v8i1.27999","url":null,"abstract":"Background and Aims: Shift work has been growing more prevalence and involves irregular working hours when compared to daytime work schedule. This study aims to assess sleep quality, its functional outcome, excessive daytime sleepiness and incidence of obstructive sleep apnea between shift and non-shift workers. \u0000Methods: The study candidates were randomly drawn Nepalese, from age 18 years and older, and were enrolled between January 2018 to January 2019. The subjects were divided into either: Shift work or Non-Shift work. The assessment measures were done with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), STOP-BANG and FOSQ-10 (Functional Outcome of Sleep Quality – 10), using a standard form. \u0000Results: A total of 358 participants were included in the main study (176 Non-shift workers, and 182 Shift-workers). The mean BMI among the two group were not significantly different (p =0.43). There was significant difference with 25% Non-Shift workers and 41.21% of Shift workers were found to have Abnormal Sleepiness in the Epworth Sleepiness Scale score (p=0.004). Shift workers showed comparatively higher values for Epworth Sleepiness scale compared to Non-Shift workers in Mann-Whitney analysis, with mean rank 194.11 versus 164.39, respectively, p=0.006. Similarly, 26.29% Non-Shift workers and 36.72% Shift workers were found to have abnormal FOSQ-10 scores, χ2 (1) =4.44, p=0.035. 7.95% of Non-Shift workers and 6.59% of Shift-workers were found to have high risk of OSA in STOP BANG questionnaire, with no significant association, p=0.725. \u0000Conclusions: Shift work caused excessive daytime sleepiness and had worse functional outcome but did not increase probability of obstructive sleep apnea.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116983401","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}
Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy. Eendoscopic Mucosal Resection (EMR) has been the commonly used endoscopic procedure for duodenal carcinoid tumors, but the conventional EMR done to resect duodenal NET s is likely to have positive vertical margins. However, the ligation assisted EMR has recently been shown to be a promising technique for the treatment of duodenal NET that can have a negative free margin. In our study, we present a patient of 51-year-old male, who presented with pain over epigastrium and upper gastrointestinal endoscopy revealed a small submucosal lesion of 10 mm in the duodenal bulb. The endoscopic ultrasound showed the lesion arising from the echo layer three. The biopsy was taken which showed the duodenal NET. The computed tomography of abdomen did not show any evidence of distant metastasis. The EMR of duodenal NET was done by band ligation technique. The biopsy from the resected duodenal lesion confirmed the duodenal NET with the margin free of the tumor. The patient was followed at 6, 12, 18 and 24 months. During the follow up visits, the repeat upper gastrointestinal endoscopy did not show recurrence of the lesion and there was no any evidence of distant metastasis either. Ligation assisted EMR is an acceptable treatment in the hands of expert for small duodenal NET without the evidence of metastasis and can ensure the complete removal of the lesion with vertical free margin.
{"title":"Ligation assisted endoscopic mucosal resection of neuroendocrine tumor of duodenal bulb: a case report with a follow up of 24 months","authors":"Umid Kumar Shestha, G. Aryal","doi":"10.3126/jaim.v8i1.28001","DOIUrl":"https://doi.org/10.3126/jaim.v8i1.28001","url":null,"abstract":"Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy. Eendoscopic Mucosal Resection (EMR) has been the commonly used endoscopic procedure for duodenal carcinoid tumors, but the conventional EMR done to resect duodenal NET s is likely to have positive vertical margins. However, the ligation assisted EMR has recently been shown to be a promising technique for the treatment of duodenal NET that can have a negative free margin. In our study, we present a patient of 51-year-old male, who presented with pain over epigastrium and upper gastrointestinal endoscopy revealed a small submucosal lesion of 10 mm in the duodenal bulb. The endoscopic ultrasound showed the lesion arising from the echo layer three. The biopsy was taken which showed the duodenal NET. The computed tomography of abdomen did not show any evidence of distant metastasis. The EMR of duodenal NET was done by band ligation technique. The biopsy from the resected duodenal lesion confirmed the duodenal NET with the margin free of the tumor. The patient was followed at 6, 12, 18 and 24 months. During the follow up visits, the repeat upper gastrointestinal endoscopy did not show recurrence of the lesion and there was no any evidence of distant metastasis either. Ligation assisted EMR is an acceptable treatment in the hands of expert for small duodenal NET without the evidence of metastasis and can ensure the complete removal of the lesion with vertical free margin.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116036173","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}
I. P. Adhikary, A. Pokhrel, T. Bhattarai, Y. Bhusal, S. Acharya, Aarjan Khanal
Thrombotic thrombocytopenic purpura (TT P) is a life threatening thrombotic microangiopathy which may not present with the classic pentad of microangiopathic hemolytic anemia, fever, neurologic changes, thrombocytopenia and renal dysfunction. High level of clinical vigilance has to be rendered in suspected cases of TT P and therapeutic plasma exchange (TPE) must be started as soon as possible as this can be a lifesaving intervention. TT P is a category 1 recommendation for plasmapheresis as per the guidelines from American Society for Apheresis (ASFA). We present a case of 55 years old male who presented with abdominal pain, vomiting and fever and was clinically suspected as a case of thrombotic thrombocytopenic purpura. He received an intensive care treatment (endotracheal intubation with mechanical ventilation and renal replacement therapy) and after no improvement following fifth day of treatment, he was started on therapeutic plasma exchange (TPE). After two cycles of plasmapheresis, he had marked clinical improvement. Due to the cost unaffordability by the patient›s family, further sessions of plasma exchange therapy could not be done. The patient was later discharged and followed up in outpatient basis.
{"title":"A clinically suspected case of thrombotic thrombocytopenic purpura managed with therapeutic plasma exchange in Kathmandu Medical College Teaching Hospital","authors":"I. P. Adhikary, A. Pokhrel, T. Bhattarai, Y. Bhusal, S. Acharya, Aarjan Khanal","doi":"10.3126/jaim.v8i1.28000","DOIUrl":"https://doi.org/10.3126/jaim.v8i1.28000","url":null,"abstract":"Thrombotic thrombocytopenic purpura (TT P) is a life threatening thrombotic microangiopathy which may not present with the classic pentad of microangiopathic hemolytic anemia, fever, neurologic changes, thrombocytopenia and renal dysfunction. High level of clinical vigilance has to be rendered in suspected cases of TT P and therapeutic plasma exchange (TPE) must be started as soon as possible as this can be a lifesaving intervention. TT P is a category 1 recommendation for plasmapheresis as per the guidelines from American Society for Apheresis (ASFA). We present a case of 55 years old male who presented with abdominal pain, vomiting and fever and was clinically suspected as a case of thrombotic thrombocytopenic purpura. He received an intensive care treatment (endotracheal intubation with mechanical ventilation and renal replacement therapy) and after no improvement following fifth day of treatment, he was started on therapeutic plasma exchange (TPE). After two cycles of plasmapheresis, he had marked clinical improvement. Due to the cost unaffordability by the patient›s family, further sessions of plasma exchange therapy could not be done. The patient was later discharged and followed up in outpatient basis. ","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132089359","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}
Background and Aims: Kidney biopsy is decisive while evaluating for the diagnosis of glomerular, vascular, tubulointerstitial and genetic diseases. There is paucity of data on prevalence and pattern of various types of kidney diseases in Nepalese population. We describe various types of kidney diseases in patient population undergoing kidney biopsy at our centre. Methods: This is a prospective analysis of all patients, who underwent percutaneous renal biopsy at Manipal teaching hospital, over a duration of 30 months, i.e. August 2017 to January 2019. All kinds of kidney disease patients were included for kidney biopsy, irrespective of their clinical syndromes and underlying diagnosis. Results: A total of 175 consecutive biopsies were analyzed. The mean age of the patient was 35 } 15 years. Majority of the biopsy performed were in females. The majority of biopsy cases were age between 21-30 years of age. The youngest case to undergo renal biopsy was a child with asymptomatic isolated hematuria. The most frequent histological pattern observed in our study was IgA nephropathy (34.6%), followed by Focal segmental glomerulosclerosis (15.45%) and Membranous nephropathy (14.85%). Regarding complication macroscopic hematuria was seen in 15 (8.5%) cases and 8 (4.5%) cases had perinephric hematoma. There was no death related to renal biopsy. Conclusion: IgA nephropathy was the commonest histological pattern. Subnephrotic proteinuria was the commonest indication for biopsy. Complication of kidney biopsy is rare and considered safe procedure in clinical practice to determine diagnosis, prognosis and treatment.
{"title":"Pattern of glomerular diseases in biopsy proven native kidney in Western Nepal","authors":"A. Maskey, L. Lamsal","doi":"10.3126/jaim.v8i1.27998","DOIUrl":"https://doi.org/10.3126/jaim.v8i1.27998","url":null,"abstract":"Background and Aims: Kidney biopsy is decisive while evaluating for the diagnosis of glomerular, vascular, tubulointerstitial and genetic diseases. There is paucity of data on prevalence and pattern of various types of kidney diseases in Nepalese population. We describe various types of kidney diseases in patient population undergoing kidney biopsy at our centre. \u0000Methods: This is a prospective analysis of all patients, who underwent percutaneous renal biopsy at Manipal teaching hospital, over a duration of 30 months, i.e. August 2017 to January 2019. All kinds of kidney disease patients were included for kidney biopsy, irrespective of their clinical syndromes and underlying diagnosis. \u0000Results: A total of 175 consecutive biopsies were analyzed. The mean age of the patient was 35 } 15 years. Majority of the biopsy performed were in females. The majority of biopsy cases were age between 21-30 years of age. The youngest case to undergo renal biopsy was a child with asymptomatic isolated hematuria. The most frequent histological pattern observed in our study was IgA nephropathy (34.6%), followed by Focal segmental glomerulosclerosis (15.45%) and Membranous nephropathy (14.85%). Regarding complication macroscopic hematuria was seen in 15 (8.5%) cases and 8 (4.5%) cases had perinephric hematoma. There was no death related to renal biopsy. \u0000Conclusion: IgA nephropathy was the commonest histological pattern. Subnephrotic proteinuria was the commonest indication for biopsy. Complication of kidney biopsy is rare and considered safe procedure in clinical practice to determine diagnosis, prognosis and treatment. ","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117020611","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}
Snake bite, is a significant public health problem and medical emergency in tropical countries including Nepal. Acute renal failure is one of the devastating complications of Russell’s viper envenoming which may cause death of patient in the absence of prompt and adequate management. Treatment with anti-venom and hemodialysis can salvage the patient. Although Russell’s viper is widely distributed in Nepal, AKI due to Russell’s viper envenoming was not reported previously from Nepal.
{"title":"Acute Kidney Injury due to Russell’s Viper Envenomation: First Documented Case in Nepal","authors":"B. Bartaula, B. Shah, N. Bhurtel, Sanjib K Sharma","doi":"10.3126/JAIM.V7I2.23492","DOIUrl":"https://doi.org/10.3126/JAIM.V7I2.23492","url":null,"abstract":"Snake bite, is a significant public health problem and medical emergency in tropical countries including Nepal. Acute renal failure is one of the devastating complications of Russell’s viper envenoming which may cause death of patient in the absence of prompt and adequate management. Treatment with anti-venom and hemodialysis can salvage the patient. Although Russell’s viper is widely distributed in Nepal, AKI due to Russell’s viper envenoming was not reported previously from Nepal.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129367665","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}
Rakshya Shrestha, Sashi Sharma, P. Khadga, M. Sayami, U. Chitrakar, G. Dhungana
Introduction: Post exposure prophylaxis (PEP) to HIV is the short term use of prescribed dose of antiretroviral therapy among persons exposed to high risk behaviors in order to prevent them from HIV infection. While occupationally exposed cases among health care workers are the major target of PEP, it is equally applicable to non occupational exposure to HIV including sexually exposed cases. This study was carried out to know the current scenario of PEP for HIV in terms of various determinants/ risk factors and outcomes of HIV positivity after prophylaxis. Methods: A prospective study was carried out by Antiretroviral therapy center of Tribhuvan University Teaching Hospital. The study period was between August 2006 and September 2016. Altogether 50 cases exposed to known HIV seropositive persons were included in this study. Results: The majority of the occupationally exposures were interns (48.6%), followed by staff nurse (18.9%), CMLT student (13.5%), hospital staff (10.8%) and resident doctor (8.1%). Majority (70.3%) were exposed to needle prick injury. Six-month follow-up showed zero seroconversion for HIV ELISA among the exposed cases. Conclusion: Intern constituted the greater proportion of health care workers exposed to accidental needle stick injury. Timely administration of prophylaxis might have resulted zero seroconversion for HIV ELISA among the exposed cases.
{"title":"Post exposure prophylaxis for occupational and non occupational exposure to HIV in a tertiary care hospital in central Nepal","authors":"Rakshya Shrestha, Sashi Sharma, P. Khadga, M. Sayami, U. Chitrakar, G. Dhungana","doi":"10.3126/JAIM.V7I2.23488","DOIUrl":"https://doi.org/10.3126/JAIM.V7I2.23488","url":null,"abstract":"Introduction: Post exposure prophylaxis (PEP) to HIV is the short term use of prescribed dose of antiretroviral therapy among persons exposed to high risk behaviors in order to prevent them from HIV infection. While occupationally exposed cases among health care workers are the major target of PEP, it is equally applicable to non occupational exposure to HIV including sexually exposed cases. This study was carried out to know the current scenario of PEP for HIV in terms of various determinants/ risk factors and outcomes of HIV positivity after prophylaxis. \u0000Methods: A prospective study was carried out by Antiretroviral therapy center of Tribhuvan University Teaching Hospital. The study period was between August 2006 and September 2016. Altogether 50 cases exposed to known HIV seropositive persons were included in this study. \u0000Results: The majority of the occupationally exposures were interns (48.6%), followed by staff nurse (18.9%), CMLT student (13.5%), hospital staff (10.8%) and resident doctor (8.1%). Majority (70.3%) were exposed to needle prick injury. Six-month follow-up showed zero seroconversion for HIV ELISA among the exposed cases. \u0000Conclusion: Intern constituted the greater proportion of health care workers exposed to accidental needle stick injury. Timely administration of prophylaxis might have resulted zero seroconversion for HIV ELISA among the exposed cases.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131032334","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}
{"title":"Double pyloric ostium, an extremely rare endoscopic finding, in a 62-year-old male patient presenting with melena","authors":"U. Shrestha","doi":"10.3126/jaim.v7i2.23494","DOIUrl":"https://doi.org/10.3126/jaim.v7i2.23494","url":null,"abstract":"No abstract available.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"488 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115881096","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}
Apical Hypertrophic cardiomyopathy is a rare variant of HCM and has a prevalence of around ~ 15 % among HCM patients. As compared to other variants, it has a relatively benign prognosis. Predominantly prevalent in the Japanese population; it is characterized by localized hypertrophy of the LV apex as compared to other segments. It is usually silent in early stages and is manifested at an adult stage with typical ECG changes of giant T wave inversions in the precordial leads. Transthoracic echocardiography remains the mainstay of non – invasive diagnosis. We report a case of an asymptomatic elderly male who presented with the classical deep T wave inversion in ECG for which echocardiography revealed the apical variant of hypertrophic cardiomyopathy.
{"title":"Apical Hypertrophic Cardiomyopathy in an asymptomatic male","authors":"A. Hirachan, B. Kc","doi":"10.3126/jaim.v7i2.23489","DOIUrl":"https://doi.org/10.3126/jaim.v7i2.23489","url":null,"abstract":"Apical Hypertrophic cardiomyopathy is a rare variant of HCM and has a prevalence of around ~ 15 % among HCM patients. As compared to other variants, it has a relatively benign prognosis. Predominantly prevalent in the Japanese population; it is characterized by localized hypertrophy of the LV apex as compared to other segments. It is usually silent in early stages and is manifested at an adult stage with typical ECG changes of giant T wave inversions in the precordial leads. Transthoracic echocardiography remains the mainstay of non – invasive diagnosis. We report a case of an asymptomatic elderly male who presented with the classical deep T wave inversion in ECG for which echocardiography revealed the apical variant of hypertrophic cardiomyopathy.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"523 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116705290","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}
Correction: Unfortunately, several authors on this paper were omitted. Therefore, on 15th April 2019 the following authors were added to the paper: Mathew Ibrahim Amprayil, Rahul Taparia and Shailesh Mani Pokhrel. The editorial board apologises for this error. The common risk factors for Idiopathic intracranial hypertension are obesity, female gender, hypervitaminosis A, and steroid withdrawal. Even though Idiopathic intracranial hypertension is considered as a neuropsychiatric manifestation of Systemic lupus erythematosus, it is often missed by the physician as a cause of a headache in a patient with Systemic lupus erythematosus. We report a case of 21-year-old female who presented in our outpatient department with a history of a severe intractable progressive headache for a duration of four weeks and blurring of vision for five days who was later diagnosed as a case of idiopathic intracranial hypertension with Systemic lupus erythematosus. She recovered dramatically with the institution of steroid and acetazolamide therapy.
更正:不幸的是，本文中遗漏了几位作者。因此，在2019年4月15日，以下作者被添加到论文中:Mathew Ibrahim Amprayil, Rahul Taparia和Shailesh Mani Pokhrel。编委会为这个错误道歉。特发性颅内高压的常见危险因素是肥胖、女性、维生素A过多症和类固醇戒断。尽管特发性颅内高压被认为是系统性红斑狼疮的一种神经精神表现，但在系统性红斑狼疮患者中，它经常被医生遗漏为引起头痛的原因。我们报告一个21岁的女性病例，她在我们的门诊出现了严重的顽固性进行性头痛，持续了四周，视力模糊了五天，后来被诊断为特发性颅内高压合并系统性红斑狼疮的病例。通过类固醇和乙酰唑胺治疗，她迅速康复。
{"title":"Idiopathic intracranial hypertension as a cause of severe intractable headache in a patient with Systemic Lupus Erythematosus: A case report from Eastern Nepal","authors":"B. Shah, M. Amprayil, R. Taparia, S. M. Pokhrel","doi":"10.3126/JAIM.V7I2.23490","DOIUrl":"https://doi.org/10.3126/JAIM.V7I2.23490","url":null,"abstract":"Correction: Unfortunately, several authors on this paper were omitted. Therefore, on 15th April 2019 the following authors were added to the paper: Mathew Ibrahim Amprayil, Rahul Taparia and Shailesh Mani Pokhrel. The editorial board apologises for this error. \u0000The common risk factors for Idiopathic intracranial hypertension are obesity, female gender, hypervitaminosis A, and steroid withdrawal. Even though Idiopathic intracranial hypertension is considered as a neuropsychiatric manifestation of Systemic lupus erythematosus, it is often missed by the physician as a cause of a headache in a patient with Systemic lupus erythematosus. We report a case of 21-year-old female who presented in our outpatient department with a history of a severe intractable progressive headache for a duration of four weeks and blurring of vision for five days who was later diagnosed as a case of idiopathic intracranial hypertension with Systemic lupus erythematosus. She recovered dramatically with the institution of steroid and acetazolamide therapy.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128993777","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}
Background and Aims: Chronic pancreatitis is a condition characterized by chronic inflammatory and fibrotic changes in the pancreas leading to irreversible parenchymal damage and loss of glandular function. This retrospective study was conducted to study the clinic-epidemiologic profile of chronic pancreatitis in eastern Nepal. Methods: All adult patients admitted with chronic pancreatitis from June 2014 to June 2016 were included in this study. Data pertaining to demographics and clinical profile was obtained by retrospective chart review. Results: A total of (n=55) patients were enrolled in the study with a median age of 28 years. Idiopathic pancreatitis was the most common form of chronic pancreatitis (n= 37, 67.3%) and alcoholic chronic pancreatitis accounted for about a third of cases (n=18, 32.7%). Abdominal pain was a presenting symptom in all the cases (n=55,100%). Thirty-seven patients (67.3%) had diabetes mellitus. Ductal dilatation (n=55,100%) and calculi (n=43, 83.6%) were the most common findings on imaging using ultrasonography and Computed tomographic scan of abdomen). All the patients were receiving medical therapy. Most patients receiving medical therapy were on opioids (n=37, 67.3%) or pancreatic supplements (n=18, 32.7%). Complications were seen in only nine patients (16.4%). All of them had pseudocyst. Conclusions: In this study, idiopathic chronic pancreatitis (CP) was observed as the most common etiologic form of CP unlike CP related to alcohol use in other similar studies. CP related to alcohol use was seen as the second most common etiologic form. Diabetes was the most commonly associated comorbidity in our CP cohort. This study was performed in a small study population and is limited by several factors including statistical power. Larger studies are warranted to study the etiologic forms and outcomes of CP in Nepalese population.
{"title":"Clinical and Epidemiologic Profile of Chronic Pancreatitis, A Retrospective Study in Eastern Nepal","authors":"R. Sharma, B. Pradhan, P. Karki, M. Subedi","doi":"10.3126/JAIM.V7I2.23487","DOIUrl":"https://doi.org/10.3126/JAIM.V7I2.23487","url":null,"abstract":"Background and Aims: Chronic pancreatitis is a condition characterized by chronic inflammatory and fibrotic changes in the pancreas leading to irreversible parenchymal damage and loss of glandular function. This retrospective study was conducted to study the clinic-epidemiologic profile of chronic pancreatitis in eastern Nepal. \u0000Methods: All adult patients admitted with chronic pancreatitis from June 2014 to June 2016 were included in this study. Data pertaining to demographics and clinical profile was obtained by retrospective chart review. \u0000Results: A total of (n=55) patients were enrolled in the study with a median age of 28 years. Idiopathic pancreatitis was the most common form of chronic pancreatitis (n= 37, 67.3%) and alcoholic chronic pancreatitis accounted for about a third of cases (n=18, 32.7%). Abdominal pain was a presenting symptom in all the cases (n=55,100%). Thirty-seven patients (67.3%) had diabetes mellitus. Ductal dilatation (n=55,100%) and calculi (n=43, 83.6%) were the most common findings on imaging using ultrasonography and Computed tomographic scan of abdomen). All the patients were receiving medical therapy. Most patients receiving medical therapy were on opioids (n=37, 67.3%) or pancreatic supplements (n=18, 32.7%). Complications were seen in only nine patients (16.4%). All of them had pseudocyst. \u0000Conclusions: In this study, idiopathic chronic pancreatitis (CP) was observed as the most common etiologic form of CP unlike CP related to alcohol use in other similar studies. CP related to alcohol use was seen as the second most common etiologic form. Diabetes was the most commonly associated comorbidity in our CP cohort. This study was performed in a small study population and is limited by several factors including statistical power. Larger studies are warranted to study the etiologic forms and outcomes of CP in Nepalese population.","PeriodicalId":374721,"journal":{"name":"Journal of Advances in Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130502327","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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