Intravenous paracetamol vs tramadol for pain management in patients with acute pancreatitis

Introduction: Acute Pancreatitis causes severe and persistent pain, and thus, necessitates effective treatment. Opioids are widely used to relieve pain in acute pancreatitis due to their efficacy and effectiveness. Intravenous paracetamol has been documented to have comparable effectiveness as that of opioids, with lesser side effects. In this study, the analgesic efficacy of tramadol, an opioid was compared with paracetamol in acute pancreatitis.  Method: This was an open label comparative study conducted in a tertiary referral hospital of Nepal. Patients with Acute Pancreatitis were randomly assigned to receive 1 g of paracetamol or 50 mg of tramadol with 100 mL normal saline within 4-5 minute. Pain measurements of the patients were conducted at baseline and 24 hours after the treatment intervention. Changes in pain scores were calculated by subtracting the mean scores at baseline and 24 hours as pairs.  Result: In this study, 80 patients were enrolled and included in the final analysis. The study subjects had a mean age of 39.33 +/- 13.3 years and 62(77.5%) of them were male. Alcohol was the etiology for pancreatitis in 67.5% (n=54) of patients. Mean pain scores at baseline and 24 hours were similar in the two groups. Similarly, change of scores from baseline to 24 hours did not differ between the groups. Comparison of pain improvements failed to reveal any differences between groups.  Conclusion: Intravenous paracetamol is an effective alternative to tramadol in pain management of acute pancreatitis

Performance of Garden Pea Genotypes in Eastern Hills of Nepal

Garden pea (Pisum sativum L) is an important winter legume used as fresh vegetables and other drier food products. Despite of its importance as cash crop in many parts of Nepal, much study on various aspects for enhancing production and productivity has yet to be done. Therefore, to evaluate the production performance different genotypes of garden pea in eastern hills agro-ecological conditions present experiments were carried out consecutively for two years (2015 and 2016) at Agricultural Research Station, Pakhribas. The experiment comprised of 11 different genotypes of garden pea including a check variety Arkel. The production performance was evaluated in a completely randomized block design with three replications. The seeds were sown at 50 × 10 cm spacing during first week of October for two years. The result showed that DGP-05 genotype had earliest 104 days after sowing. The DGP-08 genotype showed 13 which were the maximum numbers of pods per plant (13), while DGP-01 showed 8 numbers of seeds as the maximum per pod. The DGP-03 genotype had the longest pod of 9.78 cm among others. The highest fresh pod yield of 18.14 t/ha was achieved from genotype DGP-09 followed by Arkel with (16.32 t/ha).Journal of Nepal Agricultural Research Council Vol.3 2017: 15-1

Effect of Revascularization on Headache Associated with Moyamoya Disease in Pediatric Patients

Episodic headache is common in childhood moyamoya disease (MMD). The onset, mechanism, cause of headache and the effect of revascularization surgery on headache are not yet clear. We studied 10 cases of children (7 boys and 3 girls) younger than 18 years who underwent revascularization for MMD between 2009 and 2013. We evaluated frequency of headache and cerebral blood flow changes by single photon emission computed tomography brain imaging with [I123]-labeled iofetamine (IMP­SPECT) before and after surgery. Patients’ ages ranged from 0 to 15 years at onset and 2 to 17 years at the time of surgery, mean age being 6.7 and 8.0 years respectively. 9 of 10 patients presented with ischemic symptoms and 8 had headache. 5 patients underwent indirect bypass and 5 underwent combined direct and indirect bypass. Cerebral blood flow improvement was obtained in 14 of the 15 cerebral hemispheres revascularized mean follow-up duration was 32.9 months. All the patients had good outcomes with improvement of ischemic neurological deficits. Headache improved in 7 (87.5%) of 8 patients. Headache in pediatric moyamoya disease is associated with change in cerebral hemodynamics. Revascularization including combined direct bypass and indirect techniques may be required to reduce headache in patients with MMD

Solitary Cranial Langerhans Cell Histiocytosis : Two case reports

Langerhans cell histiocytosis (LCH) is a proliferation of Langerhans cells intermixed with inflammatory cells, in particular eosinophils, that may manifest as a unisystem (unifocal or multifocal) or multisystem disease. We describe the clinical and histologic spectrum of LCH of the orbit and skull in our two cases. Both cases had unifocal erosive skull lesions with a history of trauma. Typical histologic features included numerous histiocytes with varying degrees of giant cell formation and scattered eosinophilic granulocytes. The presence of Langerhans cells was confirmed by CD1a and S100 immunohistochemistry. LCH has an excellent prognosis when treated with surgical resection, steroids and radiotherapy or chemotherapy. One of our patients is disease free at 7 year follow-up and one patient had regression of lesion on follow-up

Linkages among forest, water, and wildlife: a case study from Kalapani community forest in Lamahi bottleneck area in Terai Arc Landscape.

Forest and water are important entities for sustaining life on earth. In a terrestrial ecosystem, linkages between the entities creates a mosaic benefiting the wildlife by creating the suitable habitat. In turn, communities get benefits stemming up from ecosystem services such as fodder, fuelwood, and water. We present a case study from a forest restoration project to assess the linkages between forest, water and wildlife across Lamahi bottleneck area in Terai Arc Landscape. We used combination of surveys such as forest area and canopy cover change (2001-2016) analysis followed by household questionnaire, water hole, camera trapping including process documentation. Forest area has increased by ~20 km2 in last 16 yrs. followed by number of water spouts along the identified tributaries. Water spouts are conserved in the form of conservation pond by the communities living downstream and utilized in the vegetable farming. Communities have benefited financially (~ US$ 1,252) contributing to their income level from the sale of fresh season vegetables in nearby market. Camera trap survey including the assessment of historical records showed presence of wildlife including elephant, hyena and other small carnivores in and around bottleneck forest. Both, motivation and enthusiastic support from local communities followed by the conducive government policies led to improve condition of natural resources over the period. This has also created a mosaic habitat for wildlife forming functional connectivity along the linear Terai Arc Landscape

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Hyponatremia in Patients with Community Acquired Pneumonia

Introduction: Community acquired pneumonia is one the frequent cause of hospital admissions. Whereas, hyponatremia is a common electrolyte abnormality in hospitalized patients and has been shown to be associated with considerable morbidity and mortality. We aim to studyt the association of hyponatremia with community acquired pneumonia in terms of morbidity and mortality. Methods: A prospective observational hospital based study was conducted in a hospital for a year. All patients with a diagnosis of community acquired pneumonia and admitted in medicine ward, were included. Patients with diarrhea, known Chronic Kidney Disease, Heart Failure, Cirrhosis of Liver, Malignancy, taking diuretics, chemical pneumonitis, interstitial pneumonias and other debilitating disease were excluded. Results: Among the 72 cases of CAP, 61% were females and 39% were males. The mean age of patients was 51.3 years, 22 (30.55%) patients had severe CAP. A total of 7 cases expired with an overall mortality of 13.7%. The mortality risk increased with increasing CURB-65 score; CURB-65 score 0, 0%; CURB-65 score 1, 0%; CURB-65 score 2, 0%; CURB-65 score 3, 10%; CURB-65 score 4, 33%; CURB-65 score 5, 100%. i.e higher the CURB-65 score, higher the death rate of CAP patients (p<0.05). Hyponatremia was a common occurrence at hospital admission with an incidence of 36.11%. Hyponatremia at hospital admission was also associated with a longer length of hospital stay in cured CAP patients. The mean length of hospital stay was 4.3 days. Conclusions: High CURB-65 scores and lower values of serum sodium at admission in patients of CAP are associated with adverse outcomes both in terms of mortality and longer length of hospital stay. CURB-65 score should be incorporated into assessment of CAP and sodium of the patients during admission.  Keywords: CURB-65 score; hyponatremia; mortality. | PubMe

Hyponatremia in Patients with Community Acquired Pneumonia

Introduction: Community acquired pneumonia is one the frequent cause of hospital admissions. Whereas, hyponatremia is a common electrolyte abnormality in hospitalized patients and has been shown to be associated with considerable morbidity and mortality. We aim to studyt the association of hyponatremia with community acquired pneumonia in terms of morbidity and mortality. Methods: A prospective observational hospital based study was conducted in a hospital for a year. All patients with a diagnosis of community acquired pneumonia and admitted in medicine ward, were included. Patients with diarrhea, known Chronic Kidney Disease, Heart Failure, Cirrhosis of Liver, Malignancy, taking diuretics, chemical pneumonitis, interstitial pneumonias and other debilitating disease were excluded. Results: Among the 72 cases of CAP, 61% were females and 39% were males. The mean age of patients was 51.3 years, 22 (30.55%) patients had severe CAP. A total of 7 cases expired with an overall mortality of 13.7%. The mortality risk increased with increasing CURB-65 score; CURB-65 score 0, 0%; CURB-65 score 1, 0%; CURB-65 score 2, 0%; CURB-65 score 3, 10%; CURB-65 score 4, 33%; CURB-65 score 5, 100%. i.e higher the CURB-65 score, higher the death rate of CAP patients (p&lt;0.05). Hyponatremia was a common occurrence at hospital admission with an incidence of 36.11%. Hyponatremia at hospital admission was also associated with a longer length of hospital stay in cured CAP patients. The mean length of hospital stay was 4.3 days. Conclusions: High CURB-65 scores and lower values of serum sodium at admission in patients of CAP are associated with adverse outcomes both in terms of mortality and longer length of hospital stay. CURB-65 score should be incorporated into assessment of CAP and sodium of the patients during admission. Keywords: CURB-65 score; hyponatremia; mortality. | PubMe

Predictors of treatment response in cirrhotic patients with overt hepatic encephalopathy: Treatment response in hepatic encephalopathy

Introduction: Hepatic encephalopathy (HE) is a frequent complication and one of the most debilitating manifestations of liver cirrhosis, which negatively impacts patient survival. This study aims to identify the factors influencing the treatment response in patients with liver cirrhosis and HE. Method: This was a prospective observational study conducted from July 2019 to June 2020 in a tertiary referral center in Nepal. The ethical clearance was obtained from the Institutional Review Board of the center (Reference No. 46/076/77). Patients with Liver cirrhosis with HE grade II or more were included. Standard medical therapy for HE was given to all the patients, and treatment response for the first five days post admission was recorded. The response was categorized as a good response, no response, and deterioration, based on improvement or deterioration of the patient`s symptoms or changes in West Haven criteria. Result: In this study total of 78 patients were enrolled and included in the final analysis. The mean age was 50.17± 10.36 years and 63(80.76%) were male. Alcohol was the etiology of cirrhosis in 62(79.5%). Seventy-two (92.3%)  patients had a good response to the treatment, 3(3.8 %) of patients had no response, and the rest 3(3.8%) deteriorated. On logistic regression, high creatinine, high bilirubin, and low serum protein were the predictors of non-response to standard therapy (p&lt;0.05). Conclusion: High serum creatinine, high bilirubin, and low serum protein were the predictors of non-response to standard therapy in patients with Liver Cirrhosis with Hepatic Encephalopathy. Keywords: Hepatic encephalopathy, liver cirrhosis, predictors, respons