Advances in internal medicine最新文献

{"title":"Cadaveric Donation and Post-mortem Reuse of Pacemakers and Defibrillators in Nepal: Medical, Legal and Ethical Challenges","authors":"Y. Sedhai, Aloysius Ochasi, S. Basnyat, D. Acharya, P. Clark","doi":"10.3126/JAIM.V6I1.18314","DOIUrl":"https://doi.org/10.3126/JAIM.V6I1.18314","url":null,"abstract":"Cardiovascular diseases (CVDs) are the number one cause of death globally. An estimated 17.5 million people died from CVDs in 2012, representing 31% of all global deaths. Over three quarters of all deaths related CVDs take place in low- and middle-income countries (LMICs). Studies have estimated that 1 to 2 million people worldwide die each year due to lack of access to cardiac rhythm management devices (CRMDs) i.e. implantable cardiac defibrillator (ICD) or a pacemaker. The principal challenge is the high cost of these devices and the resource constraint in LMICs. A growing body of literature, mostly single center, uncontrolled and retrospective studies has suggested reuse of CRMDs from deceased donors as a safe and effective alternative. This paper seeks to propose the concept of post-mortem CRMD donation and reutilization program within Nepal as a life-saving initiative. Though the spirit of the program is in line with the ethical principles of respect for persons, beneficence, justice, and the common good, it is challenged with several logistical barriers and legal concerns. In this paper we have discussed the clinical, legal and ethical perspectives with a literature review on similar programs.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"14-20"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V6I1.18314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44744102","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":"Transcatheter closure of Patent ductus arteriosus at Shahid Gangalal National Heart Centre, Kathmandu, Nepal","authors":"C. Adhikari, R. Malla, U. Shakya, M. Shrestha, B. Rauniyar, Deepak Limbu, Poonam Sharma, M. Gautam, Shilpa Aryal, Achhita Kc","doi":"10.3126/JAIM.V6I1.18310","DOIUrl":"https://doi.org/10.3126/JAIM.V6I1.18310","url":null,"abstract":"Background and Aims: In the current era, transcatheter closure of patent ductus arteriosus (PDA) using either coils or device is a well-established procedure. The aim of this study was to assess safety of transcatheter closure of PDA at Shahid Gangalal national heart Centre, Kathmandu, Nepal.Methods: It was a single centre, retrospective study conducted between March 2007 to March 2017. Cardiac catheterization laboratory records of all consecutive patients who underwent PDA device closure were included. A lateral view Aortic angiogram was performed to determine the morphology and size of the duct. Device type and size was selected as per the aortogram. A second aortic angiogram was performed 5 min after device deployment to determine the success of the closure. Echocardiography was done next day of the procedure to assess success of the closure.Result: During the study period 126 patients were attempted for transcatheter closure of PDA. Six patient were thought to have unfavorable size or shape, and transcatheter occlusion was not attempted. In one patients attempt was made to close the duct with cook coil which embolized to pulmonary artery. One hundred and nineteen patient PDA was successfully closed. Among the 119 patients 89 were female and 30 were male. The PDA was closed by Amplatzer duct occluder in 99 patients, Life tech PDA occluder in 14 patients, Hyperion PDA occluder in two patients, Post-infarct Muscular VSD Occluder in four patients.Conclusions: Transcatheter closure of PDA can be done safely with high success rate.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"6 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V6I1.18310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43349547","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":"Percutaneous approach to a tight post-isthmic aortic coarctation: a case report and literature review","authors":"F. Cortese, M. Gesualdo, T. Acquaviva, A. Cortese, E. D. Cillis, M. Ciccone, A. Bortone","doi":"10.3126/JAIM.V5I2.17353","DOIUrl":"https://doi.org/10.3126/JAIM.V5I2.17353","url":null,"abstract":"Correction: Figure 1 and Figure 2 were omitted from the PDF. On 5th June 2017, the new PDF including the figures was uploaded and the page numbers of the article changed from 41-44 TO 41-45. A 17 years-old boy with hypertension underwent cardiology assessment for episodes of dyspnoea and palpitations. Cardiac angiography showed post-istmic severe aortic coarctation. The malformation was successful treated by implanting a covered stent in aorta. The manuscript describes in detail this case and analyzes the available literature on the topic. Journal of Advances in Internal Medicine Vol.5(2) 2016: 41-45","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"41-45"},"PeriodicalIF":0.0,"publicationDate":"2017-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44979235","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":"Hydatid Disease of liver communicating with common bile duct managed by ERCP - A case report","authors":"A. Jha, R. Pathak, Sashi Sharma, P. Khadga","doi":"10.3126/JAIM.V5I2.17352","DOIUrl":"https://doi.org/10.3126/JAIM.V5I2.17352","url":null,"abstract":"Cystic hepatic disease is common in Asia, South America and Africa. Rupture of the hydatid cyst into the biliary tree can lead to serious cholangitis. In this report, a 53-year-old lady presented with the signs and symptoms of obstructive jaundice and cholangitis. Ultrasonography reported dilated common bile duct(CBD) with sludge and hydatid cysts in the liver. CECT revealed large cysts with enhancing thin wall in left and right lobe of liver with communicating into CBD and right IHBD respectively and features of obstructive biliopathy. Due to signs and symptoms of obstructive jaundice in addition to lab data and imaging modalities, ruptured hydatid cyst into the biliary tree was considered, and ERCP intervention was performed, after  endoscopic sphincterotomy , membranes of the cysts were extracted. Post intervention, signs and symptoms and cholestasis enzymes subsided. Journal of Advances in Internal Medicine Vol.5(2) 2016: 38-40","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"38-40"},"PeriodicalIF":0.0,"publicationDate":"2017-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48134359","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":"Spectrum of glomerular diseases in native kidneys in patients attending Nepal Medical College Teaching Hospital","authors":"D. Manandhar, Chhetri Pk, P. Poudel, N. Singh, S. K. Baidya, A. Maskey","doi":"10.3126/JAIM.V5I2.17349","DOIUrl":"https://doi.org/10.3126/JAIM.V5I2.17349","url":null,"abstract":"Background and Aims: Glomerular disease is the one of the major cause of end stage kidney disease in Nepal. We have undertaken this study to know the spectrum of glomerular disease in native kidneys in patients attending department of nephrology of Nepal Medical College Teaching Hospital. Methods: This is a retrospective analysis of patients who have undergone native kidney biopsy from July 2013 to June 2014. Seventy five cases were included. We reviewed the biopsy requisition and where available admission forms for symptoms, indications and complications of the biopsy, urine analysis report and final biopsy report. Kidney biopsy was done under USG guidance or assistance. Automated biopsy gun of 16 or 18G was used. Kidney tissues were sent for light microscopy and immune fluorescence examinations. After 24 hrs of biopsy, USG-KUB and urine RME were repeated for complications Results: Majority of our study population (62%) was from age group of 13 to 30 years. Sixty five percent of the patients (n= 49) were admitted with a diagnosis of nephrotic syndrome. Most frequent histopathological finding was Minimal Change Disease (26.7%) followed by LN (21.3%), Membranous Nephropathy (18.6%), Focal Segmental Glomerulosclerosis (13.4%) and IgA nephropathy (9.3%). Patients with the histopathological diagnosis of LN and IgAN presented with hematuria in 81.2% and 71.4% respectively. MCD patients presented with proteinuria only. Total no. of glomeruli in the sample was 23.41±11.55. Conclusion: Nephrotic syndrome was the most common indication for the renal biopsy. MCD was the most common histological finding in our series and Lupus nephritis is not uncommon in our series. Journal of Advances in Internal Medicine Vol.5(2) 2016: 24-28","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2017-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41465509","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":"Etiological profile of benign esophageal stricture and its management with through-the-scope endoscopic balloon dilation in the western region of Nepal","authors":"U. Shrestha","doi":"10.3126/JAIM.V5I2.17350","DOIUrl":"https://doi.org/10.3126/JAIM.V5I2.17350","url":null,"abstract":"Background: Benign esophageal stricture is a common cause of dysphagia with a considerable morbidity and endoscopic balloon dilatation (EBD) is a minimally invasive modality for its treatment. The aim of present study was to determine the etiology of benign esophageal stricture and to evaluate the role of EBD in its management in the western region of Nepal. Methods: This is a prospective descriptive study from December 2012 to September 2016, in which a total of 44 patients with esophageal stricture having benign lesion, confirmed in histopathological examination, were included. Wire-guided through-the-scope EBD of esophageal stricture was performed with Controlled Radial Expansion Balloon to relieve the stricture and the procedure was repeated every two weeks until the symptoms of dysphagia was relieved. The patients were followed up on three months and six months for the assessment of recurrence of dysphagia. Results: Among 44 patients of benign esophageal stricture [mean age 51.5 years (± 15.6; range 18 to 75 years), male 54.5%, female 45.5%], the frequency of different etiology was 54.5% peptic injury, 18.2% post-radiotherapy, 15.9% idiopathic, 6.8% corrosive ingestion and 4.5% eosinophilic esophagitis. A total of 75 sessions of dilations were performed for 44 patients who had various degrees of dysphagia prior to each session. Among them, increased number of sessions of EBD was needed for stricture caused by corrosive ingestion, post radiotherapy and eosinophilic esophagitis (p<0.001). The technical success rate for EBD was 100% and there was no any perforation or other complication during the procedure except for minor bleeding at the site of stricture dilation. After a session of one or more dilations, all patients could maintain a solid diet at 6 months of follow up. Conclusions: Peptic stricture was the commonest cause of benign esophageal stricture followed by post-radiotherapy, idiopathic, corrosive ingestion and eosinophilic esophagitis in the western region of Nepal. The stricture caused by radiotherapy, corrosive ingestion and eosinophilic esophagitis required more sessions of EBD. When performed carefully by an experienced endoscopist, through-the-scope EBD is safe and effective in treating benign esophageal strictures. Journal of Advances in Internal Medicine Vol.5(2) 2016: 29-33","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2017-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47924449","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":"Complications of continuous ambulatory peritoneal dialysis: An early experience in tertiary hospital of Western region of Nepal","authors":"A. Maskey, N. Dhakal, Chirayu Regmi","doi":"10.3126/JAIM.V5I2.17351","DOIUrl":"https://doi.org/10.3126/JAIM.V5I2.17351","url":null,"abstract":"Background and Aims: Chronic ambulatory peritoneal dialysis (CAPD) has been established form of therapy in adults patients with end stage kidney diseases and has emerged as a feasible modality of renal replacement therapy. The aim of the study was to evaluate the complications of CAPD and its contributing factor in order to improve the patient survival and reduce morbidity and mortality. Methods: A hospital based retrospective study of 35 patients who opted for CAPD at Manipal teaching hospital, Pokhara from 1st June 2015 to 31st May 2016 was carried out. Results: Total 35 CAPD patients were included in study. The mean age of the patients was 45.78±16.34 years. Nineteen (54%) patients were male. The total follow up was 533 patients months with mean follow up of 15.22 ±5.02 months. There were 41 episodes of different complications that occurred during the study period with rate of 0.9 episodes/patient years. There were 18 (43%) episodes of peritonitis including 5 recurrence of peritonitis in 5 patients, 6 (15%) exit site infections, 6 (15%) failure of drainage, 2 (5%) pericatheter leakage, 2 (5%) catheter displacement , 2 (5%) omental wrapping, 2 (5%) catheter removal, 2 (5%) mortality. The commonest pathogen for peritonitis was staphylococcus aureus in 5 (22%) episodes. Conclusion: Overall complications rate was comparable to other studies . Peritonitis rate has been declined in our study. The majority of non-infectious complications are treatable and do not interfere with the catheter survival. CAPD is a safe and viable mode of renal replacement therapy alternative to hemodialysis. Journal of Advances in Internal Medicine Vol.5(2) 2016: 34-37","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"34-37"},"PeriodicalIF":0.0,"publicationDate":"2017-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V5I2.17351","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44318482","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":"-119C/G in MYG1 Gene and 49A/G in CTLA4 Gene Polymorphisms in Turkish Patients with Vitiligo","authors":"S. Yıldız, A. Yıldırım, Pınar Ozuğuz, M. Erdogan, S. Kaçar, E. S. A. Terzi, Elvin Kuşku, Z. Söylemez, M. Solak","doi":"10.3126/JAIM.V5I1.17063","DOIUrl":"https://doi.org/10.3126/JAIM.V5I1.17063","url":null,"abstract":"Vitiligo is a disease characterized by sharply limited white macular depigmentation as a result of melanocyte loss. Disease is divided into three types according to prevalence and localization as localized, general and universal. Etiology of vitiligo is unknown, but clearly shows a complex structure. Genetic predisposition, stress, many influencing factors such as systemic diseases and physical trauma causes vitiligo. In our study, MYG1 gene rs1465073 (-119C/ G) and CTLA4 gene rs231775 (49A/G) polymorphisms were evaluated in 106 patients diagnosed with vitiligo and 97 controls. Genotyping was performed using real time PCR method. There is no statistically significant differences between patients and controls in terms of allele frequencies of MYG1 gene rs1465073 and ve CTLA4 gene rs231775 polymorphisms. Beside, there is no statistically significant differences between patients and controls in terms of genotype frequencies of CTLA4 gene rs231775 polymorphism. On contrary to this there is statistically significant differences between patients and controls in terms of genotype frequencies of MYG1 gene rs1465073 polymorphism. In conclusion, consistent with the literature data, there is a significant association between MYG1 gene rs1465073 polymorphism and vitiligo. But there is no directly association between CTLA4 gene rs231775 polymorphism and vitiligo. Journal of Advances in Internal Medicine 2016;05(01):1-5","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V5I1.17063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45548110","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":"Comparision of Various Vasodilators Regimen During Radial Corornary Angiogram: A Prospective Randomised Trial","authors":"R. Malla, B. Kc, C. Adhikari, B. Rauniyar, Deepak Limbu, B. Baniya, S. Dhungel, Khagendra Jung Shah, S. Khadka, Sabita Aryal, Pratikshya Joshi, A. Bhattarai","doi":"10.3126/JAIM.V5I1.17065","DOIUrl":"https://doi.org/10.3126/JAIM.V5I1.17065","url":null,"abstract":"Background and Aims: Coronary intervention through radial artery is a preferred over femoral route. Different vasodilators are used to prevent radial artery spasm. Till date there is no study to compare the effects of various vasodilator regimes during radial coronary angiogram in Nepal. We aim to compare the efficacy of different vasodilator in our patients. Methods and Result: This is a single centre, prospective randomized trial between Verapamil, Nitroglycerine (GTN) and cocktail (Verapamil with GTN). All the patient undergoing coronary angiogram via radial approach, without the contraindication were randomized by a computer generated randomization protocol. Patient undergoing coronary procedures via the radial artery were divided into three groups. Patients in group A received intra-arterial cocktail (2.5 mg of Verapamil plus 100 mcg Nitroglycerine in 10 ml of normal saline), patients in group B received Verapamil (5mg) and patient in group C received Nitroglycerine (200mcg). Heparin of 3000U was given intravenously in all three groips. Altogether 207 patients underwent transradial coronary angiogram, 203 were randomized after exclusion. Over all Radial artery spasm was reported in 28 patients (13.79%). There was no statistically significant difference in spasm between the three regimens however when grading, there was significant higher grade of spasm in Verapamil group (13.23%, P value < 0.05). When comparing Verapamil and GTN separately there was significant higher spasm (21% vs 7%, P value < 0.05) with higher grades of spasm in verapamil group. Journal of Advances in Internal Medicine 2016;05(01):11-14","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"11-14"},"PeriodicalIF":0.0,"publicationDate":"2017-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V5I1.17065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41334353","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":"Seroprevalence of hepatitis B virus, hepatitis C virus and human immunodeficiency virus in the western region of Nepal","authors":"U. Shrestha, B. Bhatta","doi":"10.3126/JAIM.V5I1.17064","DOIUrl":"https://doi.org/10.3126/JAIM.V5I1.17064","url":null,"abstract":"Background and aims: The hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are associated with major public health concerns. The aim of the study was to determine the seroprevalence of HBV, HCV and HIV in the western region of Nepal. Methods: This was a cross-sectional observational study, in which 15,791 patients, attending to Manipal Teaching Hospital, Pokhara, Nepal, were investigated for HBV, HCV and HIV from June 2013 to March 2016; demographic and biochemical profile were studied among the patients with positive test results. Results: Among 15,791 patients [male 6614 (41.9%) and female 9177 (58.1%)], HBV was found in 180 (1.1%), HCV in 52 (0.3%) and HIV in 77 (0.5%). The HBV was found in 63.9% of males and 36.1% of females, HCV in 67.3% of males and 32.7% of females, and HIV in 61% of males and 39% of females which showed that males had more positivity of HBV (P<0.001), HCV (P<0.001) and HIV (P 0.001) than that of female. The HBV was found more in 20-29 years age group (27.2%), HCV in 30-39 years (32.7%), and HIV in 40-49 years (28.6%), with all having p<0.001. Among the patients of HBV, HCV and HIV, the mean values of total bilirubin were 1.4 mg/dl, 0.8 mg/dl and 2.6 mg/dl, Aspartate Transaminase 75.9 U/L, 54.3 U/L and 92.7 U/L, Alanine Transaminase 54.6 U/L, 55.5 U/L and 56.1 U/L, and Alkaline Phosphatase 124.2 U/L, 109.2 U/L and 107.2 U/L, respectively. The majority of patients with HCV had a history of intravenous drug abuse and HIV had concomitant alcoholic liver disease. Conclusion: The HBV was more prevalent followed by HIV and HCV in the western region of Nepal with more prevalence seen in males than in females. Regular screening of HBV, HCV and HIV among the selected patients can help detecting many new cases in Nepal. Journal of Advances in Internal Medicine 2016;05(01):6-10","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2017-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48253696","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}