Mortality pattern in Emergency Department of a Tertiary Care Center in Western Nepal

Background : There is abundance of evidence regarding various aspects of mortality in emergency department from different parts of world but there is limited number of studies on mortality in context of western Nepal. The objectives of this analysis were to review the demographical pattern of mortalities and define the cause and frequency of death in the Emergency Department (ED) of our institute within 24 hours of treatment process.Material and Methods : A retrospective study was carried out evaluating all patients who died during the treatment process in the Emergency Department of Lumbini Medical College in a three and half year of period from January 2014 to June 2017.Results : A total of 33,472 patients attended to ED with mortality rate of 36.4%, 33.6% and 28.2% on consecutive three years in which 110 deaths occurred. There were 66 (60%) male and 44 (40%) female. The highest mortality was seen after age of 60 years (range 2 month to 90 year). Non-communicable causes &amp; stroke deaths were found to be higher in number. Most of our patient n=52 (47.3%) death occurred within 6-12 hours of admission in ED.Conclusion : Mortality within 24 hours of presentation at ED remains high. Well organized emergency setup, transport, development of protocol as well as new guideline will definitely help in reducing hospital mortalities.Journal of Nobel Medical CollegeVolume 6, Number 2, Issue 11 (July-December, 2017) Page:48-52</jats:p

A Rare Case of Leptomeningeal Carcinomatosis Secondary to Metastatic Non-Small Cell Lung Carcinoma.

Leptomeningeal carcinomatosis is a rare complication of metastatic systemic malignancy, with lung cancer being the most common cause. We present a case of a 75-year-old man with a past medical history of right non-small cell lung carcinoma and ischemic stroke who presented with a persistent headache and swallowing difficulties. On evaluation, the patient was initially diagnosed with a subacute infarct of the right posterior frontal lobe following magnetic resonance imaging (MRI). The patient\u27s headache and dysphagia worsened, increasing the possibility of brain metastasis. The patient underwent cerebrospinal fluid analysis including cytology and multiple MRI studies with no obvious explanation for the symptoms. The patient eventually developed multiple cranial nerve palsies, and a diagnosis of leptomeningeal carcinomatosis was made with neuroradiology consultation for the MRI

Immune Checkpoint Inhibitor-Induced Lymphocytic Esophagitis.

Immune checkpoint inhibitors (ICIs) have emerged as effective treatments for a wide variety of advanced malignancies. However, their use is associated with numerous immune-related toxicities, including within the gastrointestinal tract. We present a rare case of checkpoint inhibitor-induced lymphocytic esophagitis. A 79-year-old male with a past medical history significant for metastatic renal clear cell carcinoma on nivolumab presented to the hospital with dysphagia and symptomatic choledocholithiasis. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) for the extraction of stones and esophagogastroduodenoscopy (EGD) for dysphagia, which showed esophagitis. Biopsies revealed lymphocytic infiltration of the epithelium, dyskeratotic keratinocytes, and acanthosis, raising suspicion for nivolumab-associated lymphocytic esophagitis. Treatment includes proton pump inhibitors and steroids; however, efficacy is not well described due to the rarity of the condition

Symptomatic Meckel\u27s Diverticulum Presenting As Recurrent Gastrointestinal Bleeding in an Adult.

A 51-year-old male presented to the hospital with recurrent gastrointestinal bleeding. Prior work up with an esophagogastroduodenoscopy (EGD), colonoscopy, and video capsule endoscopy failed to reveal a bleeding source. Given a history of a terminal ileum diverticulum noted on previous colonoscopy and persistence of hematochezia, a Meckel\u27s scan was performed, which revealed abnormal uptake suspicious for a Meckel\u27s diverticulum containing ectopic gastric mucosa. After surgical resection, pathology confirmed a Meckel\u27s diverticulum with gastric heterotopia. This case highlights the importance of considering Meckel\u27s diverticulum for instances of recurrent gastrointestinal bleeding, especially in patients who are still symptomatic despite an extensive workup. Moreover, it is important to note that a Meckel\u27s diverticulum can be missed on video capsule endoscopy

Immune Checkpoint Inhibitor-Induced Lymphocytic Esophagitis.

Immune checkpoint inhibitors (ICIs) have emerged as effective treatments for a wide variety of advanced malignancies. However, their use is associated with numerous immune-related toxicities, including within the gastrointestinal tract. We present a rare case of checkpoint inhibitor-induced lymphocytic esophagitis. A 79-year-old male with a past medical history significant for metastatic renal clear cell carcinoma on nivolumab presented to the hospital with dysphagia and symptomatic choledocholithiasis. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) for the extraction of stones and esophagogastroduodenoscopy (EGD) for dysphagia, which showed esophagitis. Biopsies revealed lymphocytic infiltration of the epithelium, dyskeratotic keratinocytes, and acanthosis, raising suspicion for nivolumab-associated lymphocytic esophagitis. Treatment includes proton pump inhibitors and steroids; however, efficacy is not well described due to the rarity of the condition