Clinical profile of patients with acute coronary syndrome in Lumbini Medical College and Teaching Hospital: A prospective study

Background: The clinical profile among patients with acute coronary syndromes (ACS) is not well studied in this western part of Nepal where Lumbini Medical College and Teaching Hospital (LMCTH) is situated. Cardiovascular disease is now the most common non communicable disease killing thousands of people worldwide. The trend of incidence is increasing in the developing countries including Nepal. Objective: To obtain the clinical profile of patient presenting with ACS in LMCTH. Material and Method: This is a prospective study carried out in LMCTH in the department of Internal Medicine April 14, 2013 to October 14, 2013. Patients were diagnosed to have ACS based on their clinical findings, Electrocardiogram (ECG) and Troponin test. Those with non-cardiac chest pain were excluded. A detail history and all the data pertaining to the patient were noted analyzed in a systematic way. Results: A total of 40 patients with ACS presented during the study period in LMCTH. The mean age of presentation was 67±18 years. Thirty out of those constitute male (75%). Six patients (15%) died during the study period. Seventeen (42.5%) presented with central chest pain, 13(32.5%) presented with left sided chest pain, 4(10%) presented with acute shortness of breath. Four (10%) patient presented in the state of cardiogenic shock and 2 (5%) presented with the Ventricular tachycardia (VT) as their complication. 6 (15%) had unstable angina (UA), 14 (35%) had Non ST elevation Myocardial Infarction (NSTEMI) and 20 (50%) had ST elevation Myocardial Infarction (STEMI). Of the total 20 (50%) patient who had STEMI, only four of them underwent thrombolysis. Anterior wall MI was the most common wall involved. Circadian variation study showed peak incidence of acute coronary syndrome during the early morning hours.  Mean duration of symptoms before presentation to the hospital facility was 4 days. Mean hospital stay was 5±2 days. Conclusion: Cardiovascular disease is common in this Western part of Nepal. STEMI was the commonest presentation and the incidence was more among the male and the elderly patients

A Comprehensive and Detailed Within-Host Modeling Study involving crucial Bio markers and Optimal Drug regimen for Lepra Type-I Reaction : A Deterministic Approach

Leprosy (Hansen's disease) is an infectious, neglected tropical disease caused by the Mycobacterium Leprae (M. Leprae). Each year there are approximately 2,02,189 new cases are detected globally. In the year 2017 more than half million people were disabled due to leprosy and almost 50000 new cases are added every year world wide. In leprosy, lepra reactions are the major cause for nerve damage leading to disability. Early detection of lepra reactions through study of biomarkers have important role in prevention of subsequent disabilities. To our knowledge there seems to be very limited literature available on within-host modeling at cellular level involving the crucial biomarkers and the possible optimal drug regimen for leprosy disease and lepra reactions. Motivated by these observations, in this study, we have proposed and analyzed a three dimensional mathematical model to capture the dynamics of susceptible schwann cells, infected schwann cells and the bacterial load based on the pathogenesis of leprosy. We estimated the parameters from various clinical papers to make the model more practical. The sensitivity of couple of parameters was evaluated through PRCC method to find out the single most influential parameter and also combination of two most influential parameters was studied using SRCC method. The sensitivity of other remaining parameters was evaluated using Sobol's index. We then have framed and studied an optimal control problem considering the different medication involved in the Multi Drug Therapy (MDT) as control variables. We further studied this optimal control problem along with both MDT and steroid interventions. The finding from this novel and comprehensive study will help the clinicians and public health researchers involved in the process of elimination and eradication of leprosy

Upper Gastrointestinal Endoscopy in Lumbini Medical College and Teaching Hospital

  Introduction: Upper gastrointestinal (UGI) endoscopy includes visualization of the oropharynx, esophagus, stomach, and proximal duodenum, with real time assessment and interpretation of the findings encountered. An upper endoscopy is indicated in the diagnostic evaluation of signs and symptoms of a wide variety of gastrointestinal disorders. Besides there are some therapeutic implication of the endoscopy. This study was conducted to study the spectrum of diseases found during the upper gastrointestinal endoscopy in patient presenting in Lumbini Medical College and Teaching Hospital (LMCTH).   Methods: This was a retrospective observational study carried out in LMCTH. The endoscopic record book of the patients who underwent UGI endoscopy for various reasons from February 2011 to 2013 was analysed. The risk factor of smoking and alcohol was also included and analysed in the study.   Results: All together 550 upper GI endoscopy was performed in the two years. There were 290 males (52.72%) and females were 260 (47.38%). The mean age was 45.7 years (SD=17.9). Most of the patient belonged to the age group 41 to 80 years (71%). Among total patients, 209 (38%) of them were found to be macroscopically normal. Of those who had positive endoscopic findings; 165 (48.4%) had gastritis and 36 (10.6%) had duodenal ulcer, esophageal varices was in 30 (8.8%), gastric carcinoma in nine (2.6%) of cases. Cigarette smoking was significantly associated with the presence of peptic ulcer disease (p=0.01) and malignancy of gastrointestinal tract (p=0.03). Alcohol intake was non-significantly related to peptic ulceration (p=0.07) and malignancy of gastrointestinal tract (p=0.09).   Conclusion: Upper gastrointestinal endoscopy is a safe and useful procedure for investigating patients with gastrointestinal complains. Gastritis was the most common finding among the patients who had abnormal endoscopy followed by duodenal ulcer and esophageal varices

Characteristics of Patients with Tuberculous Pleural Effusion in Rural Nepal

  Introduction: Tuberculosis (TB) is a major cause of mortality and morbidity in developing countries. TubercularPleural effusion is the second most common form of extra pulmonary tuberculosis (EPTB), superseded in Prevalence only by lymph node tuberculosis. Pleural effusion occurs in approximately 5% of patients with TB. The purpose of this study was to assess the demographic characteristics of patients presenting with pleural effusion in rural Nepal.   Methods: A retrospective study was conducted with all the cases diagnosed and admitted with pleural effusion at Lumbini Medical College And Teaching Hospital from April 2011 to March 2013 of all the cases diagnosed andadmitted with pleural effusion were included in the study. Hundred cases diagnosed with pleural effusion by clinical Examination or chest X-ray or ultrasonography’s (USG) of the chest were included in the studied. The following parameters patients demographic profile, causes of pleural effusion, location (unilateral/bilateral), hemoglobin and complete blood count, sputum stain and culture sensitivity, Monteux test, chest X-ray and USG findings and Pleural fluid analysis (biochemical, hematological, microbiological and cytological) were analyzed by using SPSS 21.   Results: Out of 100 cases, the cause of pleural effusion in 59 patients was tuberculosis, 14 by malignancy, next 14 by Para pneumonic Effusion, 12 by congestive cardiac failure and three cases by alcoholic liver disease. Patients with tuberculous pleural effusion were younger, predominantly males, had unilateral effusion, lower blood hemoglobin, lower Pleural fluid neutrophils, higher pleural fluid Adenosine Deaminase (ADA) levels and higher level of pleural fluid to serum protein ratio as compared to the patients with non-tuberculous effusion.   Conclusion: Tuberculosis is the most common cause of pleural effusion in patients of rural Nepal

Optimal Drug Regimen and Combined Drug Therapy and its Efficacy in the Treatment of COVID-19 : An Within-Host Modeling Study

The COVID-19 pandemic has resulted in more than 30.35 million infections and 9, 50, 625 deaths in 212 countries over the last few months. Different drug intervention acting at multiple stages of pathogenesis of COVID-19 can substantially reduce the infection induced mortality. The current within-host mathematical modeling studies deals with the optimal drug regimen and the efficacy of combined therapy in treatment of COVID-19. The drugs/interventions considered include Arbidol, Remdesivir, Inteferon (INF) and Lopinavir/Ritonavir. It is concluded that these drug interventions when administered individually or in combination reduce the infected cells and viral load. Four scenarios involving administration of single drug intervention, two drug interventions, three drug interventions and all the four have been discussed. In all these scenarios the optimal drug regimen is proposed based on two methods. In the first method these medical interventions are modeled as control interventions and a corresponding objective function and optimal control problem is formulated. In this setting the optimal drug regimen is proposed. Later using the the comparative effectiveness method the optimal drug regimen is proposed based on basic reproduction number and viral load. The average infected cell count and viral load decreased the most when all the four interventions were applied together. On the other hand the average susceptible cell count decreased the best when Arbidol alone was administered. The basic reproduction number and viral count decreased the best when all the four interventions were applied together reinstating the fact obtained earlier in the optimal control setting. These findings may help physicians with decision making in treatment of life-threatening COVID-19 pneumonia.Comment: 16 pages, 13 figure

Knowledge, Attitude and Practice of Health Care Professionals towards Antimicrobial Resistance and its stewardship at tertiary care teaching Hospital

Background: Irrational antibiotic use leads to resistance, a serious problem which is increasing tremendously and requires urgent response. The goal of this study is to evaluate knowledge, attitude, and practice of health care professionals (HCPs) regarding antimicrobial resistance (AMR) and its stewardship. Methods: This questionnaire based prospective cross-sectional study was conducted in 216 HCPs of Universal College of Medical Sciences (UCMS). Chi-square analysis was used to see the association of knowledge, attitude, and practice (KAP) with other demographic variables. Pearson correlation was done to analyze the correlation between knowledge and attitude, knowledge and practice, and attitude and practice. Results: Among all participants, 33% had good knowledge, majority of them (78.2%) had positive attitude and 43.5% had good practice related to antimicrobial resistance and its stewardship. There was no significant correlation between knowledge and practice, as well as between practice and attitude. However, a weak positive correlation was found between knowledge and attitude (r=0.186; p=0.006). Conclusion: The majority of health care professionals showed a positive attitude towards antibiotic resistance and its stewardship. However, in spite of positive attitude of HCPs, the level of knowledge and practice were found to be poor

Atypical hemolytic uremic syndrome in a child: A rare case report

Key Clinical Message Atypical hemolytic uremic syndrome, a rare thrombotic microangiopathy, necessitates early diagnosis and comprehensive care due to its potential severity, emphasizing the importance of a multidisciplinary approach to improve outcomes

Clinical profile of patients with acute coronary syndrome in Lumbini Medical College and Teaching Hospital: A prospective study

Background: The clinical profile among patients with acute coronary syndromes (ACS) is not well studied in this western part of Nepal where Lumbini Medical College and Teaching Hospital (LMCTH) is situated. Cardiovascular disease is now the most common non communicable disease killing thousands of people worldwide. The trend of incidence is increasing in the developing countries including Nepal. Objective: To obtain the clinical profile of patient presenting with ACS in LMCTH. Material and Method: This is a prospective study carried out in LMCTH in the department of Internal Medicine April 14, 2013 to October 14, 2013. Patients were diagnosed to have ACS based on their clinical findings, Electrocardiogram (ECG) and Troponin test. Those with non-cardiac chest pain were excluded. A detail history and all the data pertaining to the patient were noted analyzed in a systematic way. Results: A total of 40 patients with ACS presented during the study period in LMCTH. The mean age of presentation was 67±18 years. Thirty out of those constitute male (75%). Six patients (15%) died during the study period. Seventeen (42.5%) presented with central chest pain, 13(32.5%) presented with left sided chest pain, 4(10%) presented with acute shortness of breath. Four (10%) patient presented in the state of cardiogenic shock and 2 (5%) presented with the Ventricular tachycardia (VT) as their complication. 6 (15%) had unstable angina (UA), 14 (35%) had Non ST elevation Myocardial Infarction (NSTEMI) and 20 (50%) had ST elevation Myocardial Infarction (STEMI). Of the total 20 (50%) patient who had STEMI, only four of them underwent thrombolysis. Anterior wall MI was the most common wall involved. Circadian variation study showed peak incidence of acute coronary syndrome during the early morning hours.  Mean duration of symptoms before presentation to the hospital facility was 4 days. Mean hospital stay was 5±2 days. Conclusion: Cardiovascular disease is common in this Western part of Nepal. STEMI was the commonest presentation and the incidence was more among the male and the elderly patients