Vitamin D Deficiency among Patients Visiting a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction:

Vitamin D deficiency is a common condition prevalent among both developed and developing countries where it is seen mostly in females. It has been linked to various skeletal and non-skeletal diseases. This study was done to find out the prevalence of Vitamin D deficiency and clinical features of deficient patients attending the outpatient department of a tertiary care hospital.

Methods:

This descriptive cross-sectional study was done among the patients attending the outpatient department of a tertiary care hospital in Kathmandu, Nepal. The study was conducted from May 2019 to July 2019. The ethical approval was taken from the Institutional Review Committee (ref no. 310520113). Convenient sampling was done. The collected data was entered in Microsoft Excel and was analyzed in the Statistical Package for the Social Sciences (SPSS) version 26.

Results:

Out of 481 participants, the prevalence of vitamin D deficiency was 335 (69.6%) (65.49-73.71 at 95% Confidence Interval). Severe vitamin D deficiency was seen in 78 (16.2%) and insufficient vitamin D in 77 (16%) of the patients. The mean serum vitamin D concentration by gender was 22.38±17.07ng/ml in males and 18.89±15.25ng/ml in females. A total of 263 (54.6%) females and 72 (14.97%) males had vitamin D deficiency. The most common symptoms found in vitamin D deficiency patients were fatigue 187 (55.8%), muscle cramps 131 (39.1%), generalized myalgia 125(37.31%), bone and joint pain 111 (33.13%).

Conclusions:

Vitamin D deficiency was prevalent especially in females and elderly people. Fatigability was present in more than half of the vitamin D deficient patients.

Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report

Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported. Here we report a case of peripheral extravasation of vasopressors, successfully managed with topical nitroglycerin in intensive care unit in Kathmandu. To our knowledge, this is the first report of such kind from Nepal.

Acupuncture induced pneumothorax: A case report

Various forms of alternative medicinal practices are gaining popularity. With this, there will be rise in the complications arising from these practices. Acupuncture is also such practice which though safe can rarely cause life-threatening complications.

Prevalence of Atrial Fibrillation in Obstructive Sleep Apnea Patients in a Tertiary Care Center

Introduction:

Atrial fibrillation is the most common sustained arrhythmias.Recently there has been evidence of higher prevalence of atrial fibrillation in obstructive sleep apnea patients compared to the general population. The aim of this study was to find the prevalence of atrial fibrillation in patients of obstructive sleep apnea in a tertiary care center.

Methods:

This descriptive cross-sectional study was done in Om Hospital and Research Centre from January 2016 to 2018 March after ethical clearance.All the patients who were diagnosed to have OSA underwent detailed history taking, cardiovascular examination and underwent electrocardiogram evaluation.All the patients who were referred for sleep study underwent technician attendant in hospital Level A polysomnography were included. Convenience sampling was done. Data was collected and entry was done in microsoft excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

Results:

The prevalence of atrial fibrillation in patients with obstructive sleep apnea is 7 (10.44%) at 95% Confidence Interval (6.70-14.17%). Apnoea-Hypopnoea Index of more than 30was present in 3 (42.8%) patients of atrial fibrillation. Atrial fibrillation was seen highest, 3 (42.8%) in patients with BMI more than 30 and lowest, 1 (14.28%) patients with BMI less than 23.5. Prevalence of atrial fibrillation was seen 5 (71.4%) in male patients and 2 (28.57%) in female patients. Sixty seven (75.28%) patients had obstructive sleep apnea in which male patients was predominant 48 (71.64%).

Conclusions:

Prevalence of atrial fibrillation in patients of obstructive sleep apnea was found to higher than the similar studies done. It is important to obtain detail cardiac history in any patients with obstructive sleep apnea and look for arrhythmias speciallyatrial fibrillation.

Diffuse Systemic Sclerosis with Left Ventricular Diastolic Dysfunction: A Case Report

Systemic sclerosis is a connective tissue disease characterized by wide-spread vascular lesions and fibrosis of the skin and internal organs. It is an immune mediated rheumatic disease with the presence of an immunological dysfunction of T lymphocytes, especially Th1 and Th17 subtypes. It affects gastrointestinal, pulmonary, vascular, musculoskeletal, cardiac and various other systems. This disease is rare but has high morbidity and mortality with less known effective management. We report a case of 70-year-old female with systemic sclerosis presented with pain along with swelling over multiple joints since 18 months which exacerbated since last 6 months and wound over finger tips since last 2 weeks. We present here other various signs, investigations and management of this uncommon disease systemic sclerosis, also known as scleroderma. Various systems are evident to be involved including cardiac (left ventricular diastolic dysfunction) and peripheral vascular system (Raynaud's phenomenon).

Oxidative stress and nutritional status in chronic obstructive pulmonary disease

BACKGROUND

Oxidative stress and malnutrition are shown to have pathogenic effect in Chronic Obstructive Pulmonary Disease (COPD).

AIM

This study was done to assess the burden of oxidative stress in COPD and to determine its relation to their nutritional status.

MATERIALS AND METHODS

In this cross-sectional study, 100 COPD cases from emergency and medical ward and meeting inclusion criteria, along with age, sex and occupation (mainly farmers, housewives and drivers) matched 100 controls without COPD and meeting inclusion criteria were enrolled. Oxidative stress was assessed by measuring lipid peroxidation product, Malondialdehyde (MDA) and antioxidants, like Vitamin C, E and Red Blood Cell Catalase (RBCC). Mini Nutritional Assessment (MNA) tool and Body Mass Index (BMI) were used to assess nutritional status.

STATISTICAL ANALYSIS

Chi-square test was applied for categorical variable. Student t-test was applied for comparison of means. Analysis of Variance (ANOVA) was applied for comparison between groups followed by Bonferroni post hoc analysis. Pearson correlation method was used for quantitative variables. Statistical significance was defined as p< 0.05 (two tailed).

RESULTS

COPD cases had significantly high MDA level with low level of Vitamin E and catalase as compared to controls (p < 0.001). Most of the COPD cases were underweight (BMI ≤ 18.5 Kg/m(2)) and malnourished (MNA score less than 7). Bonferroni post-hoc analysis, showed significantly high burden of oxidative stress in underweight and malnourished cases as compared to normal weight (p < 0.05) among COPD cases. Highly significant correlation was seen between BMI and plasma MDA level (r = -0.27, p = 0.008) in COPD cases.

CONCLUSION

This study shows impaired oxidant/antioxidant balance along with malnutrition and underweight in COPD, which signals for considering antioxidant therapy along with nutritional management.

The Study of Prevalence of Helicobacter Pylori in Patients with Acne Rosacea

Background Acne rosacea is an inflammatory disease affecting the central part of the face characterized by erythema, papules, papulo pustules and telangiectasias of unknown etiology. More recently numerous studies have described an association with Helicobacter pylori (Hp) and the extra gastric symptoms of cutaneous origin. Objectives To establish the prevalence of Helicobacter pylori (Hp) infection in the stomach in patients with rosacea based on standard Hp serological test. Methods All patients with the clinical staging of 2, 3 and 4 rosacea attending the Dermatology Out Patient Department from May 2009 – April 2010 were included in the study. Quantitative serological test using the SERION ELISA classic Helicobacter pylori IgG was done. Result A total of 26 patients were enrolled in the study with the age ranging from 26- 82 years. There were 14 males and 12 females and the male: female ratio was 1.6:1. Three (11.53%) patients presented with Grade IV rosacea, a severe clinical presentation and symptoms suggestive of acid peptic diseases were found in 14/26 (53.8%) patients. A positive serology to H. pylori was found in 17/26 (65.4%) of patients. A statistically significant correlation was found when association of H.pylori positivity in patients of rosacea compared with the seropositivity in controls. However correlation in the seropositivity was not found amongst the patients having gastritis and rosacea. Conclusion There still proves to find a correlation of Hp infection with patients with rosacea but it can still be hypothesised as a cutaneous manifestation of an internal peptic ulcer disease . DOI: http://dx.doi.org/10.3126/kumj.v10i4.10995 Kathmandu Univ Med J 2012;10(4):49-52

Tuberculosis in patients undergoing maintenance hemodialysis: one year follow up study from Nepal

In Nepal where tuberculosis is endemic and data regarding the prevalence of tuberculosis in patients undergoing maintenance haemodialysis is not known we tried to see the cumulative incidence of tuberculosis in these higher risk groups' patients. Forty patients were followed up for one year after initial screening for tuberculosis. Among forty patients 34 (85%) were male and 6 (15%) were female. During initial screening four patients had sputum positive tuberculosis and three more patients had sputum positive tuberculosis during follow up. Among nine patients with pleural effusion two patients had pulmonary tuberculosis. One patient had tubercular cervical lymphadenitis. Two patients died during follow up and the rest improved with anti tubercular treatment. So in the part of the world where tuberculosis is endemic patients undergoing maintenance haemodialysis should be screened for tuberculosis regularly.

Nocardia brasiliensis primary pulmonary nocardiosis with subcutaneous involvement in an immunocompetent patient

This is a report of an unusual case of Nocardia brasiliensis causing primary pulmonary nocardiosis with disseminated subcutaneous lesions in an immunocompetent patient. This case highlights the importance of considering nocardiosis as a differential diagnosis in patients with pulmonary and cutaneous lesions and the need for vigorous management for complete cure.

Clinical features and histological patterns of lupus nephritis in Eastern Nepal

To determine the clinical profile and patterns of lupus nephritis patients in Eastern Nepal, we studied 38 patients fulfilling the 1982 revised criteria of American College of Rheumatology for systemic lupus erythematous (SLE), followed up from January 2004 to January 2008. Arthritis was a common initial feature in addition to variable cutaneous, cardiac, pulmonary and neuropsychiatric manifestations. Renal biopsy showed grade 1 changes in 5 (13.5%) patients, grade 2 changes in 13 (35.1%) patients, grade 3 changes in 9 (24.3%) patients, grade 4 changes in 7 (18.9%) patients, grade 5 changes in 2 (5.4%) patients, and grade 6 changes in 2.7% patients. Antinuclear antibody (ANA) assay and anti-ds DNA were positive in 78.4 and 81.1%, respectively. We conclude that mesangial proliferative glomerulonephritis (grade 2) was the most common pattern of lupus nephritis encountered in our study. Timely diagnosis and treatment may improve the overall patients' survival.

Chronic Cough in Thymoma

Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis. KEYWORDS: Chronic cough, Thymoma, Anterior Mediastinum.

Chronic cough in thymoma

Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis.

Clinical spectrum of patients presenting with bronchiectasis in Nepal: evidence of linkage between tuberculosis, tobacco smoking and toxic exposure to biomass smoke

AIMS AND OBJECTIVES

The aim of the study was to describe the clinical spectrum of the patients presenting with bronchiectasis at the referral clinic for the respiratory diseases in eastern Nepal. An attempt would also be made to provide an overview of factors responsible for poor lung health in the community.

MATERIALS AND METHODS

This is a retrospective observational study conducted at the Adult chest clinic of the department of internal medicine at the B.P Koirala Institute of Health Sciences (BPKIHS), Dharan Nepal. The medical records of all the consecutive patients presenting with the diagnosis of bronchiectasis in the adult chest clinic of department of medicine from January 2003 to December 2004 (two years) were reviewed for patient characteristics (age, gender, place of residence, occupation, smoking history, exposure to indoor air pollution due to use of biomass smoke, past and family history related to tuberculosis, and clinical characteristics such as clinical features and duration of symptoms.

RESULTS

During the study period of two years, 100 patients presented with the diagnosis of bronchiectasis, 80 (80%) patients were smokers and 50 (50%) patients had history of significant exposure to indoor air pollution. Abnormal Chest X-ray was seen in 85(85%) patients. Post tubercular bronchiectasis was the most common etiological diagnosis Smoking status and exposure to indoor air pollution were important determinant for hospitalisation in patients with post tubercular bronchiectasis.

CONCLUSIONS

In Nepal bronchiectasis remains one of the important chronic respiratory diseases, post tubercular variety being the commonest type. Tuberculosis, tobacco smoking and exposure to indoor air pollution contributes towards higher morbidity of this diseases.

Spectrum of cutaneous manifestations in lupus erythematous -a dermatologist perspective

Background: The cutaneous manifestations of lupus erythematosus (LE) specific skin disease consists of acute cutaneous LE (ACLE), Subacute cutaneous (SCLE) and Chronic cutaneous (CCLE). Objective: To evaluate the spectrum of cutaneous manifestation in patients of LE. Methods: A case series of 41 clinically diagnosed cases of LE attending the outpatient department of Dermatology, BPKIHS were evaluated for the specific and non-specific skin changes. Results: All the patients enrolled in the study were female,with the age ranging from 14-64 years. ACLE was detected in 22/41(78.04%). Malar rash was the frequent skin lesion. CCLE was seen in 6/41 (14.63%) patients with classical discoid lesions (localized and generalized) in 4/6(66.66%) and 2/6(33.33%) respectively. Non specific skin lesions were found in 30/ 41(73.17%) of patients. Mucosal ulcers were seen in 23/41(56.09%), Facial telangiectasias 20/41(48.78%), Raynaunds phenomena 22/41(53.65%), Chronic urticaria 9/41(21.95%), Nail changes 12/41(29.26%) and non scarring alopecia was seen in 6/41(14.63%) patients. Eye involvement was seen in 3/41(7.3%), cutaneous vasculitis in 5/41(12.19%) and scaring alopecia in 3/41(7.3%) patients. Conclusion: The cutaneous manifestations of patients with lupus erythematosus (LE) are very frequent, show a great variety and can occur at any stage of the disease. DOI: http://dx.doi.org/10.3126/hren.v10i1.5999 HREN 2012; 10(1): 8-11