Journal of Advances in Internal Medicine <p>Official journal of the Society of Internal Medicine of Nepal (SIMON). Full text articles available. The journal is no longer accepting online submissions. Please submit manuscripts as email attachments to <a href=""></a></p> en-US <p>Authors who publish with this journal agree to the following terms:</p><ol><li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a<br /> <a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence" /></a><br /><a href="" rel="license">Creative Commons Attribution 4.0 International License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li><li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li><li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>).</li></ol> (Dr Umid Kumar Shrestha, MD, PhD) (Sioux Cumming) Thu, 05 Apr 2018 00:00:00 +0000 OJS 60 Iron Deficiency Anemia: A profile of a tertiary care hospital <p><strong>Background and aim: </strong>Iron deficiency refers to the reduction of iron stores that precedes overt iron deficiency anemia. Iron deficiency anemia (IDA) is the commonest nutritional deficiency around the globe. Though etiology of IDA is multifaceted, and results from the iron demands which is not met by iron absorption in the body, regardless of the reason. This study was aimed to observe the several hematologic parameters among IDA cases presented to a tertiary level referral hospital of Nepal army.</p><p><strong>Methods: </strong>This prospective hospital based study was conducted among cases of iron deficiency anemia presented to a hematology clinic for six-month duration. With the help of semi-structured questionnaire demographic variables, presenting complaints, baseline laboratory parameters, iron profile and etiology of iron deficiency anemia were recorded. The collected data were entered in SPSS version 22 and analyzed.</p><p><strong>Results: </strong>In the six-month study period, there were 175 IDA cases who presented to hematology clinic. IDA was more common in females accounting 78% of 175 cases while rest were male. Mean value of parameters of iron profile were all significantly lower than normal range except TIBC which was significantly raised clinching the diagnosis of IDA. Weakness was the commonest mode of presentation (83, 47.4%). Poor intake was the main culprit of IDA (88, 50.3%). Most of the cases (82, 46.9%) belonged to moderate anemia group. Severity of anemia was associated with platelet count and total leucocyte count (p&lt;0.05) while it was not associated with iron profile values (p&gt;0.05).</p><p><strong>Conclusion: </strong>In adult group, IDA is more common in women and non-specific symptoms like weakness is the commonest mode of presentation. Poor dietary intake is the main cause of IDA in our context. Among IDA cases, most of them belonged to moderate anemia.</p> Rinku Joshi, Dhan Bahadur Shrestha, Drishti RL Shah, Sitaram Khadka ##submission.copyrightStatement## Thu, 05 Apr 2018 12:33:47 +0000 Study of Leukocytes level as a prognostic marker in patients with organophosphate poisoning <p><strong>Background : </strong>Elevated leukocytes level at admission is a common finding in patients with organophosphates poisoning. It has been suggested as a prognostic marker. Since early leukocytosis is frequent and mulifactorial in origin, we hypothesized that leukocytes level after 24 hours may be a better predictor of mortality.</p><p><strong>Objectives : </strong>To evaluate the prognostic value of leukocytes level at admission; and at 24-48 hours in organophosphate poisoning.</p><p><strong>Methods : </strong>A hospital based, retrospective, cohort study of patients with organophosphate poisoning was conducted in Manipal Teaching Hospital, Pokhara, Nepal. After obtaining ethical clearance from Institutional research committee, records of patients presenting with poisoning were reviewed. 103 records were considered eligible for study. Relevant data were collected in a preformed pro forma and statistical analyses were carried out.</p><p><strong>Results : </strong>Mean age of 103 participant was 29.4 (SD=11.68). Out of them 57% were females and 43% were males. T-test was applied to test for difference in age, blood pressure, leukocytes at admission, at 24-48 hrs and blood sugar of those patients with different outcomes. Except for leukocytes levels at admission (p=0.104), statistically significant difference was seen in all other parameters (p&lt;0.001). Logistic regression analysis indicated that leukocytes levels at 24-48 hrs (B=0.002, p=0.013) is a better predictor of mortality than leukocytes levels at admission (B=0.000, p=0.034).</p><p><strong>Conclusion : </strong>Our analysis supports the hypothesis that leukocytes level at 24-48 hrs is a better predictor of mortality than leukocytes level at admission. However further study with a prospective design is recommended to confirm or refute the hypothesis.</p> S Sapkota, A Khanal, A Maskey, N Paudel, R Paudel ##submission.copyrightStatement## Thu, 05 Apr 2018 12:33:56 +0000 Prevalence and Associated Risk Factors of Hypertension in a Rural Community of Western Nepal: A Cross Sectional Study <p><strong>Background and aim: </strong>Hypertension is a major risk factor for cardiovascular disease. Hypertension evolved as a major public problem in urban populations of many countries including Nepal, but little is known about its prevalence and risk factors in rural areas. The objective of our study was to assess the prevalence of and risk factors associated with hypertension.</p><p><strong>Methods: </strong>A community-based cross-sectional survey was carried out in November 2017 in a four days health camp where peoples from ward number eight of Suklagandaki municipality of Tanahu district were called for screening of diabetes mellitus. No prior notice was given to the population about screening of hypertension. We screened total of 568 participants. Demographics, anthropometry and two independent blood pressure (BP) readings were taken. The data was analyzed using descriptive and inferential statistics using SPSS version 18.0.</p><p><strong>Results</strong>: A total of 568 individuals were interviewed and taken complete BP, weight and height measurements. More than 1/3rd (36.26%) of the respondents were in age group 18- 39 years with mean age 47.49 ± 16.61. Nearly, 60% of the respondents were female. Whilst 17.3% were smokers and 20% reported drinking alcohol. Overall prevalence of hypertension was 41.55% and this was significantly associated with age, gender, education, size of family, smoking habits, intake of alcohol, presence of diabetes mellitus.</p><p><strong>Conclusion: </strong>The prevalence of hypertension was found to be high and it has become a important public health issue even in rural part of Nepal. Community screening program, timely detection, lifestyle modification, treatment and prevention are all important to deal  </p> RC Kafle, D Sharma, N Paudel, S Sapkota, VM Alurkar ##submission.copyrightStatement## Thu, 05 Apr 2018 12:34:04 +0000 Role of fasting and postprandial hypertriglyceridemia and its association with carotid intima media thickness in Type II diabetes patients <p><strong>Background and aim</strong>: Type 2 diabetes mellitus is associated with the development of premature arteriosclerosis and a higher cardiovascular morbidity and mortality. Diabetic dyslipidaemia is believed to play an important role in the pathogenesis of accelerated atherosclerosis in this condition. B-mode ultrasound enables non-invasive, direct visualization of the arterial wall. The aim of this study was to correlate intima media thickness of the carotid artery (CIMT) quantification as a reliable marker of atherosclerotic burden in diabetes patients.</p><p><strong>Method: </strong>It was a Cross Sectional Study done on 50 patients in the age group of 30-70 years with type II Diabetes Mellitus of more than 5 years duration without hypertension. Carotid Intima Media Thickness (CIMT) was measured using an echotomographic system with a 7.5-MHz linear transducer probe. With the carotid bulb and the longitudinal projection of the common carotid artery 2cmx from carotid bulb, the site of the greatest thickness including a plaque lesion was sought along both near and far walls bilaterally.</p><p><strong>Results: </strong>The mean CIMT of subjects with fasting triglyceride level less than 150 mg/ dL was 13.2±0.48 mm with a range of 0.6-2.4 mm. Similarly the level between 150- 200 mg/dL was 1.89±0.54 mm with a range of 1.3-2.6 mm and level more than 200 mg/dL was 2.00±0.63 mm with a range of 0.8-2.6 mm. From the present study, it is clearly evident that age, duration of disease, fasting triglycerides and postprandial triglycerides have a significant impact on the CIMT, whereas other variables are having any significant impact on CIMT.</p><p><strong>Conclusion: </strong>The present study concludes both fasting and postprandial triglyceride levels correlate significantly with carotid intima media thickness. But, the correlation of postprandial triglyceride levels with carotid intima media thickness is better than that of fasting triglyceride levels with carotid intima media thickness, the postprandial hypertriglyceridemia despite normal fasting triglyceride level can be considered as an independent risk factor for atherosclerosis in type 2 diabetes mellitus.  </p> R Pathak, Prabin Adhikari, UN Pathak ##submission.copyrightStatement## Thu, 05 Apr 2018 12:34:12 +0000 A Case Report of Splenic Tuberculous Abscess <p>Tuberculosis is a common infectious disease in South-Asian region which can involve different organs. Splenic tuberculosis is a rare clinical entity. Here we report a case of tuberculous abscess of spleen in a 72 year old diabetic male. It was disseminated type, it was confirmed by ultrasonography guided aspiration of abscess for gene x-pert test, which was positive. Patient was given antitubercular treatment after the confirmation of the diagnosis and is improving with given treatment.  </p> Manoj Kumar Sah, Bhawesh Thapa, Samrat Shrestha ##submission.copyrightStatement## Thu, 05 Apr 2018 12:34:20 +0000 Late presentation of Ellis van Creveld Syndrome with Common atrium anomaly: A case report in a Nepalese Adult <p>Ellis Van Creveld syndrome (EVC) is a rare genetic disorder having autosomal recessive inheritance characterized by chondrodystrophy, polydactyly, ectodermal dysplasia, and various cardiac anomalies. Acromelic shortening of upper and lower limbs, genu valgum, deformed teeth, short ribs and narrow thorax and other systemic anomalies complete the picture of this syndrome. The patients with the syndrome rarely survive into adulthood. Here, we report a 30 year old male with EVC presenting for the first time in middle age with Common atrium anomaly.</p> Anish Hirachan, KC Bishal, Arun Maskey, Madhu Roka, Gopi Prasad Hirachan ##submission.copyrightStatement## Thu, 05 Apr 2018 12:34:24 +0000