Journal of Advances in Internal Medicine

Marburgvirus: A Global Virus, not just an African problem

Jared Robinson — 2023-07-15

The Marburg virus (MBV) phylogenetically belongs to the filovirus family and its clinical picture, spread and virulence resemble the Ebola virus very closely. The marked virulence of MBV is of great concern for not only the African region, but the globe in its entirety as a recent outbreak of the virus from a lab handling African green monkeys has rapidly spread to Uganda, South Africa, Kenya and Angola. On contamination of the virus the individual develops a plethora of symptoms with haemorrhage, seizures and shock being the most profound and deadly. No drug nor vaccine or cure is available against the deadly progression and course of the virus, and thus it often disseminates through households, between close loved ones and ultimately leaving a trail of death in its wake. It is now of upmost importance that international funding, knowledge and expertise become unified for the greater good; to develop treatments and vaccines to such viruses a likened to Ebola and Marburg virus to not only protect oneself, but humanity across all boarders around the world.

A study on demographic and clinicopathological characteristics of severe acute pancreatitis in a tertiary-level intensive care unit in Nepal

Kishor Khanal — 2023-07-15

BACKGROUND AND AIMS Severe acute pancreatitis can have serious consequences and a high mortality rate and may necessarily require intensive care unit admission. This study is to describe the demographic and clinicopathological characteristics of severe acute pancreatitis (SAP) in a tertiary-level intensive care unit (ICU).

METHODS The study was designed retrospectively with a diagnosis of severe acute pancreatitis (SAP) admitted to the tertiary-level adult ICU “between” January 2019 to December 2022.

RESULTS A total of 52 patients were enrolled in this study. The maximum numbers of patients were between 41 to 52 years of age, with a median age of 47.6 years. Gallstone (biliary) was identified as the most important etiological factor associated with severe acute pancreatitis. Among the known etiological factors, 52% of the cases were related to gallstone disease, 28.8% were due to alcohol, 7 (13.4%) to other causes (such as idiopathic, post-viral, post-ERCP, and drug-induced), and 5.7% were due to triglycerides. In our study, the most common symptoms were abdominal pain and vomiting. And the majority of patients recovered with conservative treatment. The majority 48 (92.3%) of patients improved, while 4 (7.6%) died. Eighteen (34.6%) patients required Mechanical ventilation (MV), while 10 (19%) with vasopressor supports. Eleven patients (21%) had evidence of an acute kidney injury on admission. Three patients (5.7%) underwent surgery, including necrosectomy and open cholecystectomy. The median length of ICU stay was 6.3 days.

CONCLUSIONS The most common cause of severe acute pancreatitis was gallstone, followed by alcohol-related. SAP was seen more commonly in the male gender in the age group of 41-52 years. The most common presenting symptoms were abdominal pain and vomiting. Most SAP cases could be managed conservatively.

Incidence of new onset arrhythmia after non cardiac surgery

Rajib Rajbhandari — 2023-07-15

BACKGROUND Although new-onset arrhythmia are a common problem in cardiothoracic surgery, their incidence in major non- cardiac surgery has not been studied properly. The aim of the study is to assess the incidence of arrhythmia after non cardiac surgery. While we have some data on postop arrhythmia after general surgery, we don’t have much data on orthopedic surgery, and good proportion of our patient in the study belong to this category. Thus it is also aimed to compare the incidence of arrhythmia in different types of surgery.

METHODOLOGY The present study is a retrospective cohort of 100 patients who recently underwent surgery between 2023 January 1st till 2023 June 1st. All included patients were monitored in ICU and post-operative ward after surgery. 100 patients (28 female and 72 male) without any history of prior arrhythmia were analyzed and included in the study. Incidence of postoperative arrhythmia (PA) was observed and compared in patients undergoing different types of surgery. Impact of age factor on the incidence of PA was also studied.

RESULTS Incidence of overall PA among all patients were 31%. Incidence of significant PA were 14.3%. Incidence of significant PA was highest in gastro-surgery patients (22%) whereas orthopedics patients had 11% incidence of PA.

CONCLUSION Gastro surgery seems to give high impact on incidence of PA. In our analysis, age of the patient appear to be associated with the causation of PA.

Clinical Profile of End Stage Renal Disease Patients Undergoing Hemodialysis in a Tertiary Care Hospital of Nepal

Rajesh Kumar Mandal — 2023-07-15

BACKGROUND Maintenance hemodialysis is a popular treatment modality of renal replacement therapy for end stage renal disease patients. The clinical profile of end-stage renal disease (ESRD) and dialysis in Mid Western Nepal are scarce. This study aimed to study the clinical profile of ESRD patients undergoing hemodialysis at the tertiary care Hospital.

METHODS This study was a single center based cross sectional observational study carried out over a period from 15th December 2022 to 15th February 2023 in Department of Medicine. A total of 40 patients undergoing maintenance hemodialysis were enrolled in the study. Data about Socio demographic profiles , clinical data, duration of chronic kidney disease (CKD), major comorbidity, the presumed etiology of ESRD, duration of haemodialysis, laboratory parameters including Renal function tests etc were entered in MS Excel and analyzed through SPSS 21.

RESULTS A total of 40 patients were enrolled in the study. Males were 25(62.5%) and females were 15(37.5%). The mean age of the patient was 45.75±15.2 years. The most common cause of end stage renal disease and reasons for admission were hypertension nephropathy 36(90%) and Type 2 diabetes mellitus 9(22.5%) respectively. Anemia was the most common hematological findings in ESRD patients (>90%) followed by hypocalcemia in 65%.

CONCLUSIONS Hypertensive nephropathy was the commonest cause for CKD followed by diabetic nephropathy and glomerulonephritis. Early detection and effective management of these illnesses can delay the onset, progression of CKD to end stage and subsequent morbidity and the requirement of renal replacement therapy.

Sudden upsurge of COVID-19 cases in China: A global threat

Sai Yogesh — 2023-07-15

The ongoing COVID-19 pandemic has led to an unprecedented global health crisis with a significant impact on people's daily lives. Despite dealing with the pandemic for over three years, the situation still remains uncertain, with the emergence of new variants posing a threat to the population's health. China's dynamic zero-COVID policy was initiated in August 2021, to control the rapid spread of the novel virus, which proved successful. However, the policy's draconian approach and severe economic ramifications led to widespread protests and civil unrest, ultimately compelling the Chinese government to lift imposed restrictions. The emergence of the new Omicron variant, which has shown high transmissibility and a decrease in vaccine efficacy, has posed a new challenge in the fight against COVID-19. The abandonment of the zero-COVID policy has resulted in an increase in COVID-19 cases in China, with lack of natural hybrid immunity being one of the primary contributing factors. The situation requires close monitoring, and effective measures should be implemented to control the spread of the virus and mitigate its impact on people's lives.

Anaphylactic reaction after intravenous injection of ketorolac for colicky pain: a case report and literature review

Susmin Karki — 2023-07-15

A 26-year male came to the emergency department complaining of left flank pain. On examination, the patient was afebrile with stable vitals. With clinical features, lab investigations, and ultrasonographic findings, a diagnosis of left hydroureteronephrosis was made. He was managed with intravenous ketorolac 30mg, after which he developed an anaphylactic reaction, and the patient was contained in the red area of the emergency. Anaphylactic reaction to intravenous ketorolac is rarely reported. Ketorolac is one of the common drugs used in pain management in acute care settings; health professionals should be aware of the possible complication in the form of an anaphylactic reaction, which is rare yet potentially fatal.

A rare case of single coronary artery with congenital absence of right coronary artery

Rajib Rajbhandari — 2023-07-15

A single coronary artery (SCA) is a relatively rare coronary artery anomaly. Absent right coronary artery (RCA) is the rarest of coronary artery anomalies occurring when the right coronary artery doesn’t develop. In the past 14 years till 2020, only 26 cases of congenital absence of RCA have been reported in 24 articles. We report a rare case of single left coronary artery with congenital absence of right coronary artery detected by coronary angiography and confirmed by coronary CT angiography. The RCA territory was being supplied by a branch from left circumflex (LCX) artery. The patient presented with nonspecific central chest pain. We aim to shed light on this rare anomaly and raise awareness among medical practitioners.