Advances in internal medicine最新文献

{"title":"A Case Report of Splenic Tuberculous Abscess","authors":"M. Sah, B. Thapa, Samrat Shrestha","doi":"10.3126/JAIM.V7I1.19579","DOIUrl":"https://doi.org/10.3126/JAIM.V7I1.19579","url":null,"abstract":"Tuberculosis is a common infectious disease in South-Asian region which can involve different organs. Splenic tuberculosis is a rare clinical entity. Here we report a case of tuberculous abscess of spleen in a 72 year old diabetic male. It was disseminated type, it was confirmed by ultrasonography guided aspiration of abscess for gene x-pert test, which was positive. Patient was given antitubercular treatment after the confirmation of the diagnosis and is improving with given treatment.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"7 1","pages":"23-25"},"PeriodicalIF":0.0,"publicationDate":"2018-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V7I1.19579","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49485413","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":"Study of Leukocytes level as a prognostic marker in patients with organophosphate poisoning","authors":"S. Sapkota, A. Khanal, A. Maskey, N. Paudel, R. Paudel","doi":"10.3126/JAIM.V7I1.19576","DOIUrl":"https://doi.org/10.3126/JAIM.V7I1.19576","url":null,"abstract":"Background : Elevated leukocytes level at admission is a common finding in patients with organophosphates poisoning. It has been suggested as a prognostic marker. Since early leukocytosis is frequent and mulifactorial in origin, we hypothesized that leukocytes level after 24 hours may be a better predictor of mortality.Objectives : To evaluate the prognostic value of leukocytes level at admission; and at 24-48 hours in organophosphate poisoning.Methods : A hospital based, retrospective, cohort study of patients with organophosphate poisoning was conducted in Manipal Teaching Hospital, Pokhara, Nepal. After obtaining ethical clearance from Institutional research committee, records of patients presenting with poisoning were reviewed. 103 records were considered eligible for study. Relevant data were collected in a preformed pro forma and statistical analyses were carried out.Results : Mean age of 103 participant was 29.4 (SD=11.68). Out of them 57% were females and 43% were males. T-test was applied to test for difference in age, blood pressure, leukocytes at admission, at 24-48 hrs and blood sugar of those patients with different outcomes. Except for leukocytes levels at admission (p=0.104), statistically significant difference was seen in all other parameters (p<0.001). Logistic regression analysis indicated that leukocytes levels at 24-48 hrs (B=0.002, p=0.013) is a better predictor of mortality than leukocytes levels at admission (B=0.000, p=0.034).Conclusion : Our analysis supports the hypothesis that leukocytes level at 24-48 hrs is a better predictor of mortality than leukocytes level at admission. However further study with a prospective design is recommended to confirm or refute the hypothesis.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"7 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2018-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V7I1.19576","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43694517","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":"Takayasu arteritis presenting as renovascular hypertension with hypertensive encephalopathy","authors":"V. Tanwar, Anjali Saini, Anurag Singh, R. Tank","doi":"10.3126/JAIM.V6I2.18540","DOIUrl":"https://doi.org/10.3126/JAIM.V6I2.18540","url":null,"abstract":"Takayasu arteritis is a large vessel vasculitis that has variable presentation. It is suspected when there are pulse and BP discrepancies between upper limbs or absent pulses. We here presenting a case of takayasu arteritis that remained undiagnosed till 40 years and at first time manifested with hypertensive encephalopathy and managed well with medical therapy.Journal of Advances in Internal Medicine 2017;06(02):35-37.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"35-37"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49630790","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":"Non-Endoscopic Parameters for Predicton of Esophageal Varices","authors":"R. Pathak, R. Jha, P. Khadga, Shashi S. Sharma","doi":"10.3126/JAIM.V6I2.18537","DOIUrl":"https://doi.org/10.3126/JAIM.V6I2.18537","url":null,"abstract":"Introduction: Non invasive assessment of esophageal varices may improve the management and lower the medical and financial burden related to the screening. In this study, Our aim was to validate the prediction of varices using platelet count/spleen diameter ratio and Alanine transaminase/platelet ratio index (APRI).Methods: Fifty patients with newly diagnosed and treatment naive cirrhosis underwent screening endoscopy along with hematological and ultrsonographic studies. Platelet count/spleen diameter ratio and APRI index were assessed and their diagnostic accuracy calculated. Based on previous studies, a cutoff of 909 was applied for platelet count/spleen diameter ratio and cutoff of > 1.3 for APRI. The diagnostic accuracy of both the indices were further evaluated for severity and size of varices.Results: Prevalence of varices was 36% out of which 24% were large varices. Platelet count/spleen size diameter, portal vein diameter and APRI index had significant association for prediction of presence of varices and strongly correlated with size of varices. Platelet count/spleen size diameter of 909 had diagnostic accuracy of 80.5% for prediction of varices with diagnostic accuracy being 95.8 for predicting large varices. APRI index of more than 1.3 had accuracy of 75% for predicting varices and 87.5% for accurately predicting them as large varices.Conclusions: In a resource limited country like ours, where access to specialized and tertiary care hospitals and availability of endoscopy facilities in rural areas is an issue, these non invasive parameters platelet count/spleen diameter and APRI can be taken as a safe and reliable predictor for esophageal varices.Journal of Advances in Internal Medicine 2017;06(02):21-26.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"21-26"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V6I2.18537","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43537898","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":"Palliative Care and Hospice: A Paradigm for End-of-Life Care in Developing Nations","authors":"P. Clark","doi":"10.3126/JAIM.V6I2.18541","DOIUrl":"https://doi.org/10.3126/JAIM.V6I2.18541","url":null,"abstract":"Traditionally, medical care has had two mutually exclusive goals: either to cure disease and to prolong life or to provide comfort care. Given this dichotomy, the decision to focus on reducing suffering is made usually only after life-prolonging treatment has been ineffectual and death is imminent, usually by days or hours. As a result, one of the best kept secrets in a hospital today in the United States is palliative care and hospice care. We estimate that of the 2.4 million Americans that die each year, about 80% end their lives in hospitals attached to the latest advances in technology; 300,000 die at home under hospice care. The reasons why more people do not receive palliative or hospice care range from the patient’s fear of abandonment and the unknown, the family’s denial of the inevitability of death of their loved one, and physician’s denial of medicine’s limitations. Unless the options of palliative or hospice care are given to patients the fears that people have of dying--fear of dying alone and fear of dying in pain--will continue to make the dying process one that lacks dignity and respect. In this review article we have reviewed the state of palliative and hospice care in the United States through a historical, ethical and legal perspective. We have discussed its scope in the developing world and the potential challenges.Journal of Advances in Internal Medicine 2017;06(02):38-44.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"38-44"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V6I2.18541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45877644","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":"Apical Variant of Hypertrophic Cardiomyopathy Presenting as Recurrent Syncope and Wide Complex Tachycardia","authors":"N. Paudel, V. M. Alurkar, G. Jha, R. Kafle, S. Sapkota, N. Dhakal","doi":"10.3126/JAIM.V6I2.18539","DOIUrl":"https://doi.org/10.3126/JAIM.V6I2.18539","url":null,"abstract":"Apical hypertrophic cardiomyopathy (AHC) is an uncommon variant of hypertrophic cardiomyopathy usually found as an incidental finding during routine echocardiography. It was first described by Sakamoto in 1976 in Japanese patients. Echocardiography is still considered as the best screening tool to assess AHC although MRI is considered as the gold standard for confirmation. In this case, we present a 21-year-old man with AHC who presented with recurrent brief syncopal episodes which were ignored by the patient until he was brought to us with prolonged syncope and wide complex tachycardia/ posterior fascicular ventricular tachycardia. We observed the classical findings in the plain twelve lead electrocardiograms done after cardioversion. It is always wise to keep special attention to evaluate hypertrophic cardiomyopathy (HCM) in young patients presenting with syncope.Journal of Advances in Internal Medicine 2017;06(02):32-34.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"32-34"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46680036","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 ST-Elevation Myocardial Infarction in Young in Shahid Gangalal National Heart Centre, Kathmandu, Nepal","authors":"C. Adhikari, R. Manandhar, D. Prajapati, Murari Dhungana, A. Hirachan, M. Shrestha, Manjila Basnet, Binita Tamrakar, S. Rajbhandari","doi":"10.3126/JAIM.V6I2.18538","DOIUrl":"https://doi.org/10.3126/JAIM.V6I2.18538","url":null,"abstract":"Background and Aims: Acute ST elevation myocardial infarction (STEMI) is often present in old populations. STEMI in young has significantly increased in recent years. We aim to study the conventional risk factors, clinical presentation, management and outcome of Acute STEMI in young patients.Methods: Medical records of all the young patients (aged less than 45 years), who were admitted in our hospital with the diagnosis of Acute STEMI and treated in between 1st July 2015 to 30th June 2016, were retrospectively reviewed. Demographics, conventional risk factors, clinical presentation, management and outcome were recorded.Results: There were total 1211 patients admitted for Acute STEMI, among them, 132(10.9%) were young patients, age ranged from 24 to 45 years with mean age 39.1±4.8 years, with 110 males. Anterior wall MI 50(37.8%) was the most common MI. Symptom onset to arrival to hospital ranged from 1 hour to 144 hours with mean of 19.4±2.4hours. Primary PCI was the mode of reperfusion in 59(44.6%) patients; thrombolysis was done in 19(14.3%) patients. The most common conventional risk factor was tobacco consumption; present in 91(68.9%) patients. Tobacco consumption was the only conventional risk factors in 27(20.4%) patients. There were four (4%) in-hospital mortality. Among the discharged patients all patients received Aspirin, Clopidogrel and Statin. Betablocker and Angiotensin converting enzyme inhibitor/Angiotensin receptor blocker were prescribed in 99(75%) and 96 (72.7%) patients respectively. Mean left ventricular ejection fraction was 45.5±8.6%, with 99(77.3%) having Ejection Fraction ≥40%.Conclusions: Acute STEMI in young was common in male. Tobacco consumption was significant riskfactor. Acute STEMI in young has good prognosis.Journal of Advances in Internal Medicine 2017;06(02):27-31.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"27-31"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V6I2.18538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42018642","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":"Coexistence of Pulmonary tuberculosis and lung cancer","authors":"S. Mahajan, Vijay Gotwal, Neeraj Lata, P. Nisanth","doi":"10.3126/JAIM.V6I1.18313","DOIUrl":"https://doi.org/10.3126/JAIM.V6I1.18313","url":null,"abstract":"Pulmonary Tuberculosis can co-exist with lung malignancy masking the underlying disorder leading to delay in diagnosis and management. Here we present an interesting case of a 72 year old female who on initial presentation was diagnosed with tuberculosis but later developed plural effusion during treatment and on investigation was found to have an underlying lung malignancy.Introduction: Pulmonary Tuberculosis and lung carcinoma are the two co morbidities that have been shown in many studies to coexist. Many of Signs and symptoms of Pulmonary Tuberculosis mimics lung carcinoma and coexistence increases mortality and morbidity. So we are presenting a case which had pulmonary Tuberculosis and later developed carcinoma lung.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"11-13"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V6I1.18313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46323987","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":"Endoscopic Mucosal Resection of gastric dysplastic lesion by band ligation technique","authors":"U. Shrestha","doi":"10.3126/JAIM.V6I1.18312","DOIUrl":"https://doi.org/10.3126/JAIM.V6I1.18312","url":null,"abstract":"MEDICAL IMAGE A 55 years old female presented with the pain in the epigastric region for 6 months. The upper gastrointestinal endoscopy revealed slightly raised mucosal lesion in the antrum; the biopsy from the lesion showed the high-grade dysplasia. The CT scan of abdomen was done, which was normal. The decision was made to perform Endoscopic Mucosal Resection (EMR) of the gastric dysplastic lesion by band ligation technique (Figure).","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"9-10"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46571051","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":"Coronary dominance and predictors of adverse events during coronary interventional procedures: an observational study","authors":"N. Paudel, G. Jha, V. M. Alurkar, R. Kafle, S. Sapkota","doi":"10.3126/JAIM.V6I1.18311","DOIUrl":"https://doi.org/10.3126/JAIM.V6I1.18311","url":null,"abstract":"Background: Coronary dominance is associated with adverse peri-procedural events during coronary interventions. There are limited data regarding events during coronary angiography in Nepal.Aims and methods: The aim of this article is to get information regarding events during invasive procedures of this region which has a large feeder population. All the cases undergone cardiac interventional procedures were included and analyzed.Results: Out of 200 cardiac interventional procedures, 160 cases underwent coronary angiography (CAG) and 20 percutaneous coronary intervention (PCI). 54% of the study populations were male. The mean age of study population was 61.2 years (range: 29-85 years). Most common indication for performing CAG was for post ACS (69%) followed by chronic stable angina (CSA) (16%). Most common finding in CAG was SVD (35%) LAD was the commonest (55% of SVD), DVD (19%), non-critical CAD (13%), TVD (14%) and left main (2%). Myocardial bridging was seen in 2% and 15% had normal coronaries. Commonest risk factor for CAD was Hypertension (45%) followed by smoking (35%) and diabetes (16%). CAG was most commonly performed from right radial (70%) followed by right femoral (24%), left radial (5%) and left femoral (1%). 78% of patients had right dominance, 16% had left dominance while 6% had co-dominance. Out of 40 non-right dominant (left or co-dominant) patient twenty three (57.5%) were female. There was no significant association of left dominance with the gender although the odds ratio was high (1.8) in female gender (P=0.12). Considering Left dominant patients only, the odds ratio of Tiger catheter versus Judkins Right (JR) is 8.33 but not statistically significant (P=0.17). Major complications encountered were ventricular tachycardia (VT) in 4 cases. The odds for VT with left dominance and right dominance was high with statistical significance [OR: 53.48, C.I :( 2.79-1023.4); P=0.002].Conclusion: Ventricular tachycardia which is among the major complication is found to be significantly associated with left dominance. Further studies are necessary to evaluate the evidence provided by this study.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"4-8"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V6I1.18311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43958292","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}