Journal Issue: Volume: 38, No. 2&3 (2016) August & December
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Volume
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Issue Date
2016
Journal Title
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Building a health research culture in Nepal: An initiative from the Institute of Medicine
(Institute of Medicine, 2016) Singh, YP
NA.
Clinical and Epidemiological Profile of Herpetic Eye Disease in a Tertiary eye Care Center
(Institute of Medicine, 2016) Chaudhary, M
Abstract
Introduction: Herpes simplex virus (HSV) is the most common infective cause of blindness in developed countries, with a reported incidence of between 5.9 and 20.7 episodes per 100,000 persons each year. It remains the most common cause of unilateral corneal blindness worldwide. HSV ocular infections include conjunctivitis, blepharitis, epithelial infections like dendritic ulcer, geographic ulcer and punctate epithelial keratitis, stromal infections like disciform and necrotizing stromal keratitis, and iritis. Visual loss usually occurs from the cumulative effect of multiple recurrences.
Methodology: Hospital based prospective study was conducted for a period of one year (1st Jan 2015- 31st Dec 2015) at B.P.koirala Lions Center for Ophthalmic Studies, IOM, Kathmandu, Nepal. All patients. with symptoms and signs suggestive of herpes eye disease having decreased comeal sensation were included. Performa included demographic profile of patients, clinical pattern, presenting symptoms, visual acuity on presentation and treatment received.
Results: Incidence of Herpetic Eye Disease was 10.3%. Patients presented with mean age of 36.63 ± 16.94years.59.23% patients presented in productive young adult age group of 16-45 years.Patients presented with chief complain of redness 38%, Diminution of vision 33%, Pain 12%, foreign body sensation 13% and photophobia in (4%) of cases. Clinical pattern was Blepheroconjunctivitis in 26%. Filamentary keratitis in 1%, dendritic ulcer in 22%, Geographical ulcer in 4%, disciform keratitis in 28%, Stromal keratitis in 11% and recurrent keratitis in 3% cases. Treatment received included topical Acyclovir in 54% cases, oral Acyclovir and topical steroids in 43% cases and topical, oral acyclovir with topical steroids in 3%cases. Visual acuity on presentation was 6/6-6/18 in 59.23% of patients and only 8.47%cases had visual acuity >3/60.
Conclusion: Herpetic eye disease is a corneal blinding disease with varying clinical presentation. The recurrence rate was low in our study. But, recurrent nature of this disease and the treatment required to decrease this recurrence needs to be further studied
Keywords: Herpes simplex virus, dendritic ulcer, cornea, disciform keratitis, acyclovir
Clinical Profile and Outcome of Infective Endocarditis patients admitted in tertiary care center in eastern part of Nepal
(Institute of Medicine, 2016) Sherpa, K; Shah, P; Khati, Y; Jha, SK; Sharma, SK; Karki, P
Abstract
Introduction: Data regarding the pattern and outcome of infective endocarditis from developing countries are sparse and there have been few studies in our part of the world understanding the clinical profile and outcome of patients with infective endocarditis.
Methods: It was a hospital based descriptive retrospective cross-sectional with the objective on clinical profile and outcome of infective endocarditis patients admitted in tertiary care center in eastem part of Nepal. The study included cases admitted in department of internal medicine ward, BPKIHS with diagnosis of infective endocarditis from year 2008 to 2015.
Results: A total of 20 patients were diagnosed as case of infective endocarditis during the period from 2008 to 2015 in department of internal medicine. The median age of study group was 31 years (range 14-56). Male to female ratio was 9:1. Among various risk factors, history of Intravenous drug use was the main risk factor present in 50% of patients, followed by definite rheumatic heart disease in 40% of study population. Fever, Chills and sweats were main symptom present in all patients anemia in 90 %, heart murmur in 80%, anorexia in 45%, myalgia in 35%, splenomegaly in 15%, neurological manifestation, clubbing, Roth's s and embolic phenomenon in 5% of patients. The most common valve involved was tricuspid valve, present in 50% patient, followed by mitral valve in 35% patient and aortic valve in 15% of patients. Anemia was most common laboratory abnormalities present in 90% of the patients followed by leukocytosis in 80% of patients, microscopic hematuria and disarranged renal function test was present in 40% of the patients. Blood culture positivity was seen in 30% of cases and the pathogen isolated was Staphylococcus aureus. Prior antibiotic treatment was received by 40% of patients. Acute Renal failure was the main complication appeared which was present in 25% of patients followed by Neurological manifestations in 5% and peripheral embolic phenomenon was present 5% of patients.
Conclusion: The spectrum of our infective endocarditis patients differ from those seen in the west in terms of epidemiology, predisposing factors, microbiology, complications, and outcome. Fever, pallor and heart murmur were most common symptoms and acute renal failure was the most common complication. Majority of our patients improve despite having lack of surgical backup. Culture-negative endocarditis continues to have a high prevalence in developing countries like Nepal, largely due to prior antibiotic use before clinical presentation.
Determination of complications in computed tomography guided fine needle aspiration cytology of lung mass
(Institute of Medicine, 2016) Joshi, BR; Khadgi, K; Ghimire, RK
Abstract
Introduction: The purpose of this study was to determine the complications of computed tomography (CT) guided fine needle aspiration cytology (FNAC) of lung mass.
Methods: This prospective study was done in 56 patients in Department of Radiology and Imaging, Tribhuvan University Teaching Hospital (TUTH). The CT guided FNAC was performed in patients having lung mass. The complications during CT guided FNAC were recorded and statistical analysis was done.
Results: Among 56 individuals 29 were males and 27 were females, age ranging from 42 to 80 years. Most of the lesions were located in upper lobe of lungs. There were no complications in 34 cases whereas 16 cases had local hemorrhage, 5 cases had pneumothorax of less than 30% and 1 case had pneumothorax of more than 30%.
Conclusion: CT guided FNAC is a safe procedure for diagnostic accuracy without significant complications.
Keywords: Complication, CT guided FNAC, Fine Needle Aspiration Cytology, Lung mass
Reproductive Parameters in Upper Mustang: A Camp Based Pilot Study
(Institute of Medicine, 2016) Bista, KDB
Abstract
Introduction: Published medical information on Upper Mustang is very scarce as no specific studies have been done due to its remoteness. This was the first multidisciplinary medical health camp, done to benefit the people of Upper Mustang who have limited access to health services and also to get some basic information on reproductive parameters of woman living there.
Methods: This was a camp based prospective study done between 3-8th October 2015, in Upper Mustang among women who attended the camps for various obstetrical and gynecological problems. A fixed questionnaire was utilized after taking proper verbal consent from patients. Results were analyzed and expressed in mean and averages.
Results: Out of total 614 patients, 180 woman who attended the Obs & Gyne clinic were studied. All 7 villages of Upper Mustang were represented. Most woman ie 36% were with parity 2-4 and 72% of the woman were illiterate. Mean age of the woman was 36.8yrs with maximum between 31-40 yrs age group. Contraceptive related problems was the most common presenting problem followed by pervaginal discharge. Depo contraceptive was the most common contraceptive, used by 50% of the population. About 83 (46.1%) woman experienced death of an infant or child under 5.
Conclusion: Illiteracy was high among the woman who attended the Gyne & Obs clinic. Infant mortality was found in almost 50% of the mothers with most not knowing specific cause. Depo injection was the most common contraceptive used by the woman.
Keywords: Reproductive, Parameters, Upper Mustang