Journal of Advances in Internal Medicine

Clinical and Epidemiologic Profile of Chronic Pancreatitis, A Retrospective Study in Eastern Nepal

2019-05-27T06:26:39+00:00

DOI: https://doi.org/10.3126/jaim.v7i2.23487

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.

Keywords: Calculi, Chronic Pancreatitis, Ductal dilatation, Nepal, Pseudocyst

Post exposure prophylaxis for occupational and non occupational exposure to HIV in a tertiary care hospital in central Nepal

2019-05-27T06:26:39+00:00

DOI: https://doi.org/10.3126/jaim.v7i2.23488

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.

Keywords: HIV, Needle-prick, prophylaxis

Apical Hypertrophic Cardiomyopathy in an asymptomatic male

2019-05-27T06:26:39+00:00

DOI: https://doi.org/10.3126/jaim.v7i2.23489

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.

Keywords: Apical hypertrophic cardiomyopathy

Idiopathic intracranial hypertension as a cause of severe intractable headache in a patient with Systemic Lupus Erythematosus: A case report from Eastern Nepal

2019-05-27T06:26:39+00:00

DOI: https://doi.org/10.3126/jaim.v7i2.23490

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.

Keywords: Idiopathic intracranial hypertension, systemic lupus erythematosus, headache, Nepal, papilledema, steroid

Epstein-Barr Virus (EBV) infection related thrombocytosis : A Case Report

2019-05-27T06:26:39+00:00

DOI: https://doi.org/10.3126/jaim.v7i2.23491

EBV infection can occur worldwide. We managed a 17 year old male who developed transient pancytopenia followed by thrombocytosis concurrent with EBV infection. To the best of our knowledge we have not encountered any cases of thrombocytosis concurrent with EBV infection before. Our case was diagnosed as a case of EBV infection with the help of serology and managed conservatively. In our case, though it is uncommon to find thrombocytosis due to EBV infection, it is possible that following pancytopenia concurrent with the EBV infection, the patient might have developed secondary or reactive thrombocytosis due to elevated endogenous levels of thrombopoietin, interleukin-6, catecholamines.

Keywords: Epstein-Barr Virus (EBV), infection, thrombocytosis

Acute Kidney Injury due to Russell’s Viper Envenomation: First Documented Case in Nepal

2019-05-27T06:26:40+00:00

DOI: https://doi.org/10.3126/jaim.v7i2.23492

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.

Keywords: Kidney injury, Russell's viper, envenomation

Double pyloric ostium, an extremely rare endoscopic finding, in a 62-year-old male patient presenting with melena

2019-05-27T06:26:39+00:00

DOI: https://doi.org/10.3126/jaim.v7i2.23494

No abstract available

Keywords: Peptic ulcer disease, complication, double pyloric ostium