Journal of Advances in Internal Medicine

Epidemiological profile of Kala-azar in a tertiary care center of Mid Western Nepal

Rajesh Kumar Mandal — 2023-12-31

BACKGROUND Kala-azar has been endemic in the central and eastern Terai region of Nepal neighbouring North Bihar, India. Data of Kala-azar in Mid and Far Western Nepal is scarce. We conducted this study to highlight the burden of Kala-azar in this region.

METHODS This study was a cross sectional study conducted from July 2019 to May 2023 in the Department of Internal Medicine of Bheri Hospital. A total of 112 patients diagnosed with Kala-azar were enrolled in study. Data about socio-demographic profile and outcome were entered in MS EXCEL and analyzed by SPSS 20.

RESULTS A total of 112 patients were enrolled in study with female predominance 86 (76.79%). Majority of the patients 37(33.03%) were of less than 15 years of age. Kala-azar cases were distributed not only to Terai districts but also in hilly and mountainous districts of Karnali and Sudur paschim provinces. 95(84.82%) cases were new and 17 cases were relapsed cases. 98(87.50%) cases improved with treatment, 5(4.46%) cases expired while one case was referred.

CONCLUSIONS Kala-azar is a neglected tropical disease in Nepal. Once confined to the tropical Terai region, it has now been moving towards hills and mountains of Mid and Far Western Nepal. Public awareness campaign and strengthening the Kala-azar treatment centers would help to attain the goal of Kala-azar elimination program of Nepal.

Pattern of Rheumatic Heart Disease in Western Nepal - an Echocardiographic study: a single centre experience

Bishal KC — 2023-12-31

BACKGROUND AND AIMS Rheumatic heart disease (RHD) is a preventable but chronic debilitating sequela to the acute rheumatic fever. It takes several years for manifestations, however can present early in places with high prevalence. Most common valve involved are mitral and aortic. Echocardiography is simple tool to diagnose the presence as well as quantify the valvular lesion. This study aims at identifying the pattern of valvular involvement in RHD in community heart center in western Nepal.

METHODS This was a retrospective analysis of the patients presenting with Rheumatic heart disease over the period of two years from July 2020 to July 2022.

RESULTS Altogether 563 echocardiograms with diagnosis of RHD were recorded over the period of two years. The mean age was 33.59±12 years. The commonest age group involved was 21-40years (56.66%). Overall, there was female preponderance over male, 77.4% vs 22.6%. Isolated MR was the commonest among the isolated lesion (64.44%). Multivalvular lesion was more common than isolated lesions 76.03% vs 23.97%. Isolated mitral stenosis (MS) and isolated mitral regurgitation (MR) was more common in female 82.1% and 758% respectively whereas isolated aortic regurgitation (AR) was more common in male (55%). Involvement was in the order of MS+MR>AR+MR>MS+AR>AS+AR>MS+AS>AS+MR in the cases of multivalvular lesion. Mean mitral valve area was .2±0.39 cm2. Among the MS, 65(19.69%) had mild, 145(43.93%) had moderate and 120(36.36%) had severe lesion and all were common in female and the age group 21-40years. Mild, moderate and severe MR was more common in female while severe AR was found only in male. Overall, 271(48.13%) had pulmonary hypertension and was more common in severe MS.

CONCLUSION Valvular heart disease is common and the most common lesion is RHD in developing country like ours. This study shows that RHD is more common in female and middle age group. Multivalvular lesion is more common than the isolated lesions.

Holter ECG Monitoring in Assessing Arrhythmias in Patients with Palpitation

Brijesh Pandey — 2023-12-31

BACKGROUND Palpitation is one of the most common indications for Holter study. 24- hour Holter monitoring helps to detect abnormal cardiac rhythm which can be managed earlier if picked up sooner. Spot ECG has less sensitivity to pick episodic abnormal rhythm so longer monitoring time is essential. Various treatment modalities can thus be planned for non-benign and relatively benign arrhythmias like VT and PSVT respectively.

METHODS This was a single center prospective observational cross-sectional study conducted at BPKIHS, Dharan for three months between July 2023 to September 2023. The primary objective was to study abnormal cardiac electrical events in patients having palpation. There were 38 patients of palpitations that underwent 24-hour Holter study after fulfilling inclusion criteria. The data was recorded on an excel sheet and was analyzed using software SPSS 20.

RESULTS There were 47.4% (18) males and 52.6% (20) females. The mean age was 49.61± 17.63 years. There were 36.8% (14) patients in age group <45 years while 42.1% (16) were in age group 45 to 65 years and 21.1% (8) were in the age group >65 years. The maximum and minimum Heart rate were 180 and 35 beats per minute respectively. There was abnormal Holter ECG in 57.9% (22) and 42.1% (16) had normal ECG. Most common arrhythmia was VPC 17(77.2%) in our study. The association between the age group and Normal vs Abnormal Holter ECG was statistically significant (P Value=0.023) (Table 8). DM was the most common co-morbid illness in 5(13.2%), one participant had DM and HTN along with Dyslipidemia and other findings were smoking (5.3%), dyslipidemia (5.3%). There was no association between comorbid conditions and normal vs abnormal ECG Holter rhythm (P Value = 0.448).

CONCLUSION Out of 38 participants VPC was the most common (77.2%) arrhythmia. The association between Age group and Normal vs Abnormal Holter was statistically significant (P Value=0.023). Most of the arrhythmias were benign. Diabetes was the most common risk factor present while 50% of subjects had no co-morbid illness.

Nipah outbreak in Kerala India: The next COVID?

Indrajit Banerjee — 2023-12-31

Not available

CNS Histiocytosis- Rare Disease with An Unusual Manifestation

Saurabh Sadekar — 2023-12-31

CNS histiocytosis is a rare and debilitating disease with multiple presentations. We here present a rare case of histiocytosis in a 4 year old child manifesting with diplopia as the sole neurological symptom. The patient had only saccadic abnormalities on examination and lesions in tectal pons and cerebellum. Initially considering the possibility of demyelinating disorder, steroids were given with partial resolution of signs but no improvement in signs or MRI imaging. Biopsy gave the diagnosis. The diagnosis of CNS histiocytosis should be considered even in patients with few symptoms and actively evaluated for.

Fahr's Disease a Rare calcific Neurodegenerative Disorder: A case report

Mahendra Kumar Agrahari — 2023-12-31

Fahr's disease, also known as Fahr's syndrome is a rare neurodegenerative disorder mentioned by abnormal deposition of calcium in the bilateral basal ganglia and other regions of the brain. We report a case presented to us with detailed description diagnosed as Fahr's disease, the clinical presentation, diagnostic challenges, and treatment options.