Journal Issue: Volume: 40, No. 1 (2018) April
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2018
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
A Study on Clinical Profile, Risk Factors, Angiographic findings and in hospital outcomes in patient with Acute Myocardial Infraction presented in Tertiary Care Cardiac Centre of Nepal
(Institute of Medicine, 2018) Gajurel, R M
Abstract
Introduction: Cardiovascular diseases are the commonest cause of death globally account for approximately 12 million deaths annually and are the major contributor to the burden of premature mortality and morbidity1. Coronary Artery Disease (CAD) is becoming a major cause in the developing world as well. Asians have been associated with a more severe form of CAD that has its onset at a younger age group with a male predominance2.
Methods: The study was carried out for the identification of clinical profiles, risk factors and to know the severity of coronary lesions in angiography in acute myocardial infarction. We enrolled 200 consecutive patients with clinical history and typical ischemic ECG changes admitted in Man Mohan cardiothoracic vascular and transplant center through emergency department from January 2016 to December 2017. A predefined Performa was completed to every patient with a detailed clinical history, physical examinations, and investigation studies. The clinical history revealed information about age, gender, risk factors, and modes of presentation and duration of symptoms. The details of physical examination including anthropometric data, vital signs and complete systemic evaluation were recorded. The regions of infarction and rhythm disturbances were also documented by 12 lead ECG
Results: The study showed a significant male predominance with mean age being 54.5 years. The commonest presenting symptom was chest pain (90%), followed by sweating (86%) and. breathlessness (62%) Tobacco was identified as major risk factors (62%) followed by Hypertension (42%), Diabetes (38%) and strong family history of CAD (28%), Dyslipidemia (26%) & obesity (BMI >25) is least common risk factor (19%) in this study. Patients had typical chest pain (90%) and ECG showed anterior wall changes in 51%. Angiography revealed Left anterior descending (LAD) was the most common culprit artery (41%) followed by Right Coronary Artery (RCA) in STEMI and Left Circumflex Artery (LCX )and multi vessel involvement in NSTEMI. Complications developed in 42.5% of patients, majority being different type of arrhythmias (56%) and least common is mechanical complications (3.5%). All the patients with mechanical complications died in the hospital.
Conclusion: Thus we conclude that AMI is more common in adult male, typical chest pain was the most common presenting symptoms with tobacco use being the major risk factors, anterior wall was the most common STEMI and LAD was the most common culprit artery, Multi vessel with LCX was the predominantly involved in NSTEMI in our study population.
Keywords: Chest pain, CAD, AMI, STEMI, NSTEMI, LAD, LCX, RCA, ECG
Evaluation of clinical profile, management and outcomes of molar pregnancy
(Institute of Medicine, 2018) Rijal, H
Abstract
Introduction: Hydatidiform mole is benign form of gestational trophoblastic disease characterized by hydropic swelling of the chorionic villi and proliferation of the trophoblasts. The majority of Hydatidiform mole is cured by simple surgical intervention. The disease can re-occur. The patients are followed up with serial serum BhCG till the normal level is acheived.With raised, plaetue level of serum β-hCG values, persistant GTD is diagnosed. So the proper monitoring and follow up of gestational trophoblastic disease is a must. It reduces both the morbidity and mortality of the women. This study details the clinical profiles and outcome of molar pregnancy.
Methods: This is an observational study conducted in Department of Obstretics and Gynaecology at Tribhuvan University Teaching Hospital from 1st May 2015 to 30th April 2017(2 years). Patients with the provisional diagnosis of molar pregnancy during the study period were included. After all required investigations, cases were managed according to the diagnosis. And were followed up with serial serum B- hCG. Further required treatment was given according the histopathological diagnosis.
Results: Total 46 cases of gestational trophoblastic disease (GTD) were diagnosed and it accounted for 4.9 per 1000 deliveries. Majority of patients belonged to age group of 20-40 years, presented during second trimester with amenorrhoea and per vaginal bleeding. Among these patients 93% (n=43) had suction evacuation, 5 % (n=2) had total abdominal hystrectomy with bilateral salphingo ophorectomy (TAH BSO), 2 % (n=1) had suction evacuation and laparotomy with untwisting of twisted theca luteal cyst. Thirteen patients developed persistent gestational trohphoblastic tumour (PGTT) and six patients were diagnosed as gestational trophoblastic neoplasia (GTN) and managed with multiagent chemotherapy.
Conclusions Any deviation from normal norms in pregnancy or post delivery, gestational trophoblastic disease has to be thought of. Along with proper diagnosis and management, counseling regarding follow up should also be emphasized, which not only reduces morbidity but also reduces the mortality.
Keywords: Beta hCG, GTD, Choriocarcinoma, PGTT
Clinical outcome of patients with psychiatric illness following Electroconvulsive therapy in a teaching hospital in Kathmandu
(Institute of Medicine, 2018) Pant, SB; Upadhyaya, S; Ojha, SP; Chapagai, M; Tulachan, P; Dhungana, S
Abstract
Introduction: Electroconvulsive therapy (ECT) is a safe and effective procedure used for treatment of variety of psychiatric illness. In spite of its proven efficacy ECT is underutilized due to stigma and prejudice attached to it among patients, their families and even among mental health service providers. The purpose of the study was to evaluate the clinical outcome of patients diagnosed with psychiatric illness following electroconvulsive therapy.
Methods: This is a retrospective hospital based study of patients who underwent electroconvulsive therapy at department of Psychiatry and Mental health, Tribhuvan University Teaching hospital during 1 year duration. Pre-ECT and Post-ECT BPRS and GAF were obtained and the data were analyzed subsequently.
Results: A total of 39 patients underwent Electroconvulsive therapy during the study period. There were 16 males and 23 females. Among all cases receiving ECT, mean BPRS scores at the time of admission and discharge were 74.41±9.61 and 47.31±7.27 respectively whereas mean GAF scores at the time of admission and discharge were 20.21±6.03 and 57.95±11.05 respectively. The most common diagnosis for which ECT was used was Schizophrenia 14(35.89%). All patients showed statistically significant functional and symptomatic improvement except those with organic psychosis (GAF p<0.05 and BPRS p<0.05).
Conclusions: ECT is found to be effective in the treatment of patient diagnosed with various psychiatric illnesses.
Keywords: Brief Psychiatric Rating Scale, Electroconvulsive therapy, Global Assessment of Functioning
Differentiation of Crohn’s disease from intestinal Tuberculosis and Ulcerative Colitis: a single tertiary centre experience in Nepal
(Institute of Medicine, 2018) Hamal, R; Pathak, R; Kafle, B; Khadga, PK; Sharma, S
Abstract
Introduction: Differentiating intestinal luminal tuberculosis from Crohn’s disease (CD) is an important clinical challenge of considerable therapeutic significance. Likewise differentiating ulcerative colitis from Crohn’s disease with colonic or ileocolonic involvement is difficult. The aim of this study was to investigate the clinical, endoscopic, radiologic and histological features that will help to differentiate Crohn’s disease from intestinal luminal tuberculosis as well as from ulcerative colitis.
Methods: A total of 40 patients diagnosed with Crohn’s disease, Intestinal luminal TB and Ulcerative colitis who were admitted under the Gastroenterology Department TUTH from July 2017 to February 2018 were included in this retrospective study. Clinical, endoscopic, radiologic, histopathologic and microbiologic features as well as response to treatment of these patients were studied in detail.
Results: Among 40 patients, Intestinal TB was diagnosed in 52.5% patients, ulcerative colitis in 32.5% patients and Crohn’s disease in 15% patients. There was a higher incidence of fever, night sweats, lung involvement and ascites in Intestinal TB whereas diarrhea, perianal disease, hematochezia and extraintestinal were predictive for Crohn’s disease. Similarly on colonoscopy involvement of IC valve, patulous IC valve and transverse ulcers favored a diagnosis of intestinal TB in contrast to Crohn’s disease where longitudinal ulcers, aphthous ulcers, cobblestone appearance and rectal involvement were seen.Similarly the diagnosis of Ulcerative colitis was favored by rectal involvement and contiguous involvement whereas patients with Crohn’s disease had significantly more deep ulcers, cobblestoning, skip areas and ileal involvement.
Conclusions: Crohn’s disease must be differentiated from Intestinal luminal TB and Ulcerative colitis before treatment. According to our study, a combination of clinical, endoscopic, serologic, radiologic, histopathologic and microbiologic features can be utilized in order to reliably predict and distinguish Crohn’s disease from Intestinal luminal TB and from Ulcerative colitis. In complicated cases deep enteroscopy and surgery may be needed before a confident diagnosis is reached.