Advances in internal medicine最新文献

{"title":"Awareness regarding organ transplantation among visitors of the ICU patients in three tertiary care centres in Kathmandu, a cross-sectional study","authors":"G. Shrestha, A. Bhattarai, Tseten Yonjen, R. Bhandari, P. Lakhey, S. Acharya, Shreejana Singh, M. Marhatta","doi":"10.3126/JAIM.V10I1.37087","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37087","url":null,"abstract":"Background and aims: Organ transplant is often the only viable treatment option for various end stage organ failures. Inadequacy of organ procurement from living as well as cadaveric donors is common, more so in developing countries. The aim of this study was to find out the knowledge and attitude regarding organ transplantation. Methods: A questionnaire-based survey was carried out among 150 respondents, who were the visitors of patients admitted to ICU of three tertiary care centres in Kathmandu. Results: Majority of the respondents were male 105 (70%) and 132 (88%) were aware about organ transplant. Likewise, 111 respondents (84.1%) hold the belief that organ transplant save lives. Ninety-four of the responses (34.8%) believe that media was the source of knowledge and 121 (91.7 %) of the respondents stated that organ transplant should be promoted. Majority of them, 80 of the total respondents (60.6%) believed that organ can be donated by both living and deceased donors and 111 (84.1%) of them believed that organ transplant save lives. While 88 of the respondents (66.7%) have heard about brain death, 60 of them (45.4%) believe that there is an organ transplant act in Nepal. Out of all respondents who are aware about transplantation, 91 of them (68.9%) have opinion that they are willing to donate the organ of their beloved ones should there be a situation of brain death. Conclusions: The study concludes that respondents have adequate knowledge regarding organ transplantation. Respondents have overall positive attitude towards organ donation and transplantation.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"26-28"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46700196","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":"Post COVID-19 pulmonary fibrosis","authors":"G. Shrestha, P. Agrawal","doi":"10.3126/JAIM.V10I1.37091","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37091","url":null,"abstract":"","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"43-44"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42943695","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":"Clinical and laboratory differences and role of gene xpert in tuberculous pleural effusion","authors":"M. Shah, S. Baral, T. Bhattarai","doi":"10.3126/JAIM.V10I1.37082","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37082","url":null,"abstract":"Background: The diagnosis of pleural effusion and its cause are essential for pleural fluid analysis. We have evaluated clinical and laboratory differences among the tubercular pleural effusion. Methods: The cross-sectional, observational hospital based study was conducted in Bir hospital, Nepal. All patients were evaluated by clinically and laboratory investigations. Patients enrolled for study have pleural effusion and pleural fluid analysis indicative of an exudative pleural effusion using lights criteria. The criteria of enrollment of the patients were pleural fluid for Adenosine deaminizes value more than 40 IU/L, positive for gene xpert test and pleural effusion of any cases with sputum positive pulmonary tuberculosis. Patients were divided into two groups lymphocytic and neutrophilic predominant pleural effusion. Results: Among 100 patients with diagnosis of exudative tubercular pleural effusion, the most common symptom was pleuritic chest pain in 85%, followed by fever in 84% and cough in 82%. Among the tubercular pleural effusion, 21% had neutrophils predominant and 79% had Lymphocytes predominant. The patients with neutrophil predominant Tubercular pleural effusion had higher fever rates (90.5vs.82.5%) than those with lymphocyte-predominant Tubercular pleural effusion. The mean value of Neutrophil predominant pleural fluid for lactate dehydrogenase (LDH) level was 1657.5 IU/L and protein was 5.3gm/dl and in lymphocyte predominant pleural fluid for LDH value was 610.2 IU/L and protein was 4.6 gm/dl; the difference wasstatistically significant with P value of <0.001. Only 15% of patients had sputum positive for Acid fast bacilli. Among the sputum positive patients, 47% had positive for pleural fluid for gene xpert test with all patients had rifampicin sensitive. The sensitivity of pleural fluid for gene xpert test was 46.6%, and specificity was 90%. Conclusion: In pleural effusion, the positivity of gene xpert for pleural fluid was higher among the sputum positive patients. The prevalence of Neutrophil-predominant pleural effusion was common in tubercular pleural effusion.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"4-7"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41986720","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":"46, XY Disorder of Sexual Development with Ambiguous Female External Genitalia: A Case Report","authors":"A. K. Sah, Bipin Maharjan, M. B. Adhikari, S. Baral, M. Giri","doi":"10.3126/JAIM.V10I1.37096","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37096","url":null,"abstract":"Disorder of Sexual Development (DSD) is a group of congenital conditions with atypical development of sex at chromosomal, gonadal or anatomic level. Genetic males with DSD (46 XY DSD) can present with female external genital phenotype, ambiguous, or a micropenis. It is caused by incomplete intrauterine masculinization with or without the presence of Müllerian structures. It results either from decreased synthesis of testosterone or DHT or from impairment of androgen action. Herein, we report a case of a 13-year child raised as female with hoarseness of voice and gradual enlargement of clitoris with hormonal assessment not suggestive of either 5 Alfa Reductase deficiency, Congenital Adrenal Insufficiency Syndrome or 17β-Hydroxysteroid Dehydrogenase deficiency","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"45-47"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49499211","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":"Diagnostic accuracy of monofilament test to detect diabetic neuropathy","authors":"S. Shrestha, Mamen Prasad Gorhaly, M. Bajracharya","doi":"10.3126/JAIM.V10I1.37086","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37086","url":null,"abstract":"Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available. Sujan Shrestha1, Manen Prasad Gorkhaly1, Manil Ratna Bajracharya2","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"20-25"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43593798","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":"Outcome of Pneumatic Balloon Dilatation in Achalasia Cardia","authors":"Shankar Baral, B. Paudel, Ajit Khanal, J. Thapa, B. Yadhav, Ramila Shrestha, B. Basnet, M. S. Paudel, S. Thapa, Dibas Khadka, Manoj Shah, U. Shrestha","doi":"10.3126/JAIM.V10I1.37083","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37083","url":null,"abstract":"Background: Achalasia Cardia is a rare esophageal motility disorder. Among various treatment options, Pneumatic Dilatation (PD) is the most widely used and cost effective modality till date. This is the first observational study aiming to evaluate the short term response and complications of PD for Achalasia Cardia in Nepal. Methods: This prospective observational study was conducted between 28th Jan 2020 to 27th Jan 2021. It included 39 patients with Achalasia Cardia diagnosed by clinical presentation, esophagoscopy, barium esophagogram and high resolution manometry. Two patients of Type III achalasia were excluded from study. Thirty seven patients underwent pneumatic dilatation with 30 mm Rigiflex balloon (Boston Scientific, USA) for a duration of 1 minute. Response was assessed by Eckardts score at 3 and 6 months. Result: Among 39 cases (mean age= 39.03±15.017 years, 59% men), commonest was Type II Achalasia (71.8%) followed by Type I (23.1%) and Type III (5.1%). Dysphagia was present in all patients (100%), followed by weight loss (84.6%), regurgitation (79.5%) and chest pain (35.9%). Mean basal Eckardts score and Lower Esophageal Sphincter pressure of the study population was 7.81±1.24 and 24.40±6.83 respectively. Response to pneumatic dilatation was 89.2%. Eckardts score changed significantly from7.81±1.24 to 1.03±1.82 at 6 months (p<0.001). None of the patients had major complications. Younger age (23±6.377 years) had poor response to treatment, while predilatation Lower Esophageal Sphincter pressure, gender and type of achalasia did not affect the treatment outcome. Conclusion: PD is safe and effective treatment modality for Achalasia. Younger patients have poor response to treatment with Pneumatic Dilatation. Shankar Baral1*, Bidhan Nidhi Paudel1, Ajit Khanal1, Jiwan Thapa1, Bhuwneshwer Yadhav1, Ramila Shrestha1, Bhupendra Kumar Basnet1, Mukesh Sharma Paudel1, Suresh Thapa2, Dibas Khadka1, Manoj Kumar Shah1, Umid Kumar Shrestha3","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"8-13"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48977584","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":"Acute flaccid Paralysis as first presentation of Primary Sjogren’s Syndrome: A case report from Nepal","authors":"Abhishek Thapaliya, B. Shah, R. Chhetri, Auraj Uprety, Deepak Dhakal, Sanjib Sharma","doi":"10.3126/JAIM.V10I1.37097","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37097","url":null,"abstract":"Sjögren’s syndrome is an autoimmune disease with glandular and extra-glandular involvement. The common neurological manifestation of Sjögren’s syndrome are peripheral neuropathy, anterior horn cell disease, transverse myelitis and aseptic meningitis. However, Sjögren’s syndrome presenting with acute flaccid paralysis is rare phenomenon. We report a case of a 35-year-old woman who presented with acute flaccid paralysis with respiratory failure who was later diagnosed as Primary Sjogren’s syndrome.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"48-50"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41900065","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":"Ethics in Medical Practice and Research","authors":"P. Kattel","doi":"10.3126/JAIM.V10I1.37100","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37100","url":null,"abstract":"","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"54-56"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46869802","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":"Microalbuminuria and its associations with clinical profile and complications of type 2 Diabetes Mellitus","authors":"S. Shrestha, R. Mandal, Kijan Maharjan","doi":"10.3126/JAIM.V10I1.37088","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37088","url":null,"abstract":"Background and Aims: Microalbuminuria is an early marker of diabetic nephropathy, which accounts for a significant reduction in life expectancy of diabetic patients. Timely detection of microalbuminuria facilitates appropriate preventive and therapeutic approaches to minimize risks. The aim of this study is to determine the prevalence and association of microalbuminuria with clinical profile and complications of type 2 diabetes mellitus. Methods: This study was a descriptive, cross sectional study involving 100 diabetic subjects between July 2018 to January 2019 at Bir Hospital. Microalbuminuria (mg/dl) was defined as spot urine albumin to creatinine ratio of 30-300 mg/g ( Kidney Disease Improving Global Outcomes guidelines) in a single spot urine sample. Statistical analysis was done using Statistical package for the social sciences version 20. Results: Microalbuminuria was found in 35% of the sample and the rate was significantly higher among males (P =0.027). Microalbuminuria was significantly related to Body mass index (P = 0.018), duration of diabetes (P =0.000), retinopathy (P = 0.000) and stroke (P = 0.043). No statistically significant relation was found between microalbuminuria and age (P = 0.366), hypertension (P = 0.208), HbA1c (P = 0.098), dyslipidemia (P = 0.171) and ischemic heart disease (P = 0.651). Conclusions: This study shows high prevalence of microalbuminuria in Nepalese Type 2 diabetes mellitus. Screening for microalbuminuria should be done for all the type 2 diabetes mellitus patients for early detection and management of complications of diabetes mellitus. Sanjay Shrestha1*, Rajesh Kumar Mandal2, Kijan Maharjan1 1Department Of Internal Medicine, Sukraraj Tropical and Infectious Disease Hospital, Teku,Kathmandu, Nepal 2Department of Internal Medicine, Bheri Hospital, Nepalgunj, Nepal","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"29-32"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44045871","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":"Comparing four standard Sleep Questionnaires to Polysomnography to predict possibility of Obstructive Sleep Apnea and its severity","authors":"S. Shrestha, Sanjeev Shrestha, Ruja Rajkarnikar, J. Malla, Sulav Rayamajhi, S. Bhattarai, L. Sharma, Yuvaraj Bhusal","doi":"10.3126/JAIM.V10I1.37089","DOIUrl":"https://doi.org/10.3126/JAIM.V10I1.37089","url":null,"abstract":"The commonly used screening tools; Epworth Sleepiness Scale Abstract Background and Aims: Obstructed Sleep Apnea (OSA) is emerging as a significant problem in South East Asia with the rise of Obesity. Polysomnography (PSG) being expensive in Nepal, is usually deferred. The commonly used screening tools are cornerstone to evaluate clinical possibility and effects of OSA without having to rely on the PSG at the onset in Nepal. In this study, we proposed the use of four sleep related questionnaires separate as well as in combination to clinically predict OSA and its severity. And to do that we have compared these scores with Apnea Hypo-apnea Index (AHI) derived from the gold standard level one PSG. MethodThis was a prospective randomized trial comparing level one polysomnography with individual scores from Epworth Sleepiness Score, STOP BANG score, Pittsburg Sleep Quality and Functional Outcome of Sleep Quality-10 and the composite sleep score from all the four.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"10 1","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43444196","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}