https://nepjol.info/index.php/JAIM/issue/feed Journal of Advances in Internal Medicine 2022-09-09T00:00:00+00:00 Dr Umid Kumar Shrestha, MD, PhD umidshrestha@gmail.com Open Journal Systems <p>Official journal of the Society of Internal Medicine of Nepal (SIMON). Full text articles available. Please submit manuscripts as email attachments to <a href="mailto:umidshrestha@gmail.com">umidshrestha@gmail.com</a>. The Ethics committee approval statement (IRC approval) is compulsory at the time of manuscript submission.</p> <p>The inaugural issue was published on February 10, 2012 with an initiative from Prof. Umid Kumar Shrestha, MD, PhD, Editor-in-Chief of Journal of Advances in Internal Medicine (J Adv Intern Med). The journal has since been publishing Original Articles, Review Articles, Case Reports, Medical Images, Editorials and others. The articles in the journal are licensed under a <a href="http://creativecommons.org/licenses/by/4.0/" rel="license">Creative Commons Attribution 4.0 International License</a> <a href="http://creativecommons.org/licenses/by/4.0/" rel="license"><img src="https://i.creativecommons.org/l/by/4.0/88x31.png" alt="Creative Commons License" /></a></p> <p>Authors do not have to pay for the submission, processing or publication of articles in this journal.</p> https://nepjol.info/index.php/JAIM/article/view/48193 CT head findings in methanol poisoning 2022-09-08T01:25:36+00:00 Gentle Sunder Shrestha gentlesunder@hotmail.com Akshay Prasad Pradhan gentlesunder@hotmail.com Subash Phuyal gentlesunder@hotmail.com <p>Not available.</p> 2022-09-09T00:00:00+00:00 Copyright (c) 2022 https://nepjol.info/index.php/JAIM/article/view/48039 Knowledge, Attitude and Practice Regarding Kidney Diseases among Primary Care Physicians working in Nepal 2022-09-04T01:55:28+00:00 Richa Nepal nepaldeepika123@gmail.com Bharosha Bhattarai nepaldeepika123@gmail.com Abhishek Bhandari nepaldeepika123@gmail.com Bishow Nath Adhikari nepaldeepika123@gmail.com Rhishikesh Nepal nepaldeepika123@gmail.com Nimesh Khanal nepaldeepika123@gmail.com <p><strong>Background:</strong> Medical officers and resident doctors as primary care physicians (PCPs) are the first contact health care providers to most of the kidney disease patients in Nepal. This study intends to assess knowledge, attitude and practice regarding kidney diseases among these nonnephrology doctors, working in different health institutes all over Nepal.</p> <p><strong>Methods:</strong> This was a descriptive, cross sectional, questionnaire based study, conducted over the span of 12 weeks among the primary care physicians. The Ethical Review Board of Nepal Health Research Council had approved our protocol prior to starting the study. An arbitrary scoring system was used to classify knowledge, attitude and practice scores as: 0 to &lt;50% - Poor score, 50% to &lt;75% - Moderate score, ≥ 75% - Good score. Data was entered in Microsoft Excel and analyzed using IBM Statistical Package for the Social Sciences version 25.</p> <p><strong>Results:</strong> Out of 239 PCPs enrolled in our study, 41 (17%) obtained good knowledge scores, 124 (51.8%) obtained good attitude scores and 198 (82.8%) obtained good practice scores. None of the study participants had negative attitude towards kidney diseases. The mean scores obtained in our study were 23.03±4.49 for knowledge, 17.64±2.30 for attitude and 6.27±1.24 for practice domains out of total score of 37, 24, and 8 respectively.</p> <p><strong>Conclusions:</strong> Our study demonstrated that the majority of PCPs had obtained moderate to poor knowledge scores regarding kidney diseases. However, the majority had a positive attitude and good practice regarding kidney diseases in our study.</p> 2022-09-09T00:00:00+00:00 Copyright (c) 2022 https://nepjol.info/index.php/JAIM/article/view/48192 Internal jugular vein distensibility: Rapid and reliable bedside assessment tool to predict fluid responsiveness in mechanically ventilated septic patients 2022-09-08T00:12:50+00:00 Shubha K. Shrestha gentlesunder@hotmail.com Gentle S. Shrestha gentlesunder@hotmail.com Hem R. Paneru gentlesunder@hotmail.com Pramesh S. Shrestha gentlesunder@hotmail.com Bishwas Pradhan gentlesunder@hotmail.com Subhash P. Acharya gentlesunder@hotmail.com <p><strong>Background and Aims:</strong> This study aims to evaluate whether respiratory changes in internal jugular vein (IJV) diameter predicts fluid responsiveness in mechanically ventilated patients with sepsis.</p> <p><strong>Methods:</strong> In this prospective observational analytic study, mechanically ventilated patients in septic shock received 7ml/kg of Normal Saline (NS) over 15 minutes. Patients were then categorized into two groups retrospectively; fluid responders (R), if there was an increment in Cardiac Index (CI) by more than or equal to 15% following fluid administration, and non-responders (NR) if the increase in CI was less than 15%. The primary outcome was respiratory changes in IJV diameter before and after fluid administration. Ultrasonographic assessment of IJV distensibility was carried out in all mechanically ventilated septic patients before and after fluid administration.</p> <p><strong>Results:</strong> In our study, 74 mechanically ventilated septic patients were enrolled. Among them, 29 (39.2%) patients were fluid responders whereas 45 (60.8%) patients were non-responders. Responders demonstrated higher IJV distensibility before volume expansion than non-responders (33.33% vs 16.9%; P &lt;0.001). Significant reduction in this difference was observed following volume challenge in responders (33.33% to 20.18%). An IJV distensibility of &gt;28.2% before fluid administration predicted the change in CI ≥15% with 90% sensitivity and 100% specificity with area under curve of 0.985 (CI 0.963 to 1.006).</p> <p><strong>Conclusion:</strong> Ultrasound evaluation of respiratory changes in IJV distensibility effectively predicts fluid responsiveness in mechanically ventilated septic patients.</p> 2022-09-09T00:00:00+00:00 Copyright (c) 2022 https://nepjol.info/index.php/JAIM/article/view/48194 A Rare Case of Synchronous Gastric Signet Ring Cell Adenocarcinoma Metastasis at the right colon angle 2022-09-08T01:34:48+00:00 Seifeddine Baccouche farjaouiwael4@gmail.com Sarraj Achref farjaouiwael4@gmail.com Mohamed Hajri farjaouiwael4@gmail.com Osman Rania farjaouiwael4@gmail.com Wael Ferjaoui farjaouiwael4@gmail.com Ahlem Lahmer farjaouiwael4@gmail.com Sana ben Slama farjaouiwael4@gmail.com Dhouha Bacha farjaouiwael4@gmail.com <p>Although it can affect any part of the gastrointestinal system, signet ring cell carcinoma (SRC) is a common malignant entity of stomach cancers. We discuss the case of a patient who had a prior history of gastric adenocarcinoma with signet ring cells, for which he underwent a partial gastrectomy with a gastro-jejunal anastomosis. Four months after surgery, he presented an acute postoperative blockage. Operative findings and pathology exams concluded the presence of SRC at the right angle of the colon.</p> <p>In patients with obstructive symptoms after surgery for SRC neoplasms of the stomach, the possibility of a second lesion should be considered among the differential diagnoses.</p> 2022-09-09T00:00:00+00:00 Copyright (c) 2022 https://nepjol.info/index.php/JAIM/article/view/48195 Case Report: Splenic Mucormycosis; A Post-Covid Sequelae 2022-09-08T01:50:29+00:00 Ankita Guragain drankitagb@gmail.com Sanjeet Krishna Shrestha shrestha.sanjeet@gmail.com Subodh Ghimire soobot7@gmail.com Sunil Kumar Sharma Dhakal samknp63@gmail.com <p><strong>Introduction:</strong> Mucormycosis is an invasive disease associated with high mortality ranging from 25-62%. There is an increase in the incidence of mucormycosis in post COVID-19 infection patients.</p> <p><strong>Case presentation:</strong> A 55 year old male presented to the emergency department with complain of pain abdomen and with a past medical history of renal transplantation and recent COVID-19 infection. On CT abdomen evaluation he was found to have hypodense spleen suggestive of splenic abscess. Investigations and Treatment: Splenectomy was done, which on microbiological examination revealed mucormycosis. The patient was treated with amphotericin B for 3 weeks followed by posaconazole for another 2 weeks.</p> <p><strong>Discussion:</strong> Mucormycosis, although a rare infection, has been classically linked to organ transplantation which can also be considered as a possible reason for immunosuppression in this case. Transplant physicians must be aware that patients with COVID-19 are at risk of developing unusual opportunistic infections.</p> 2022-09-09T00:00:00+00:00 Copyright (c) 2022 https://nepjol.info/index.php/JAIM/article/view/48197 Severe anaphylaxis following administration of radiocontrast in patient undergoing coronary intervention 2022-09-08T02:54:32+00:00 Bishal KC bishalk@gmail.com Samir Gautam bishalk@gmail.com Sachin Dhungel bishalk@gmail.com Mazhar Khan bishalk@gmail.com Binesh Shakya bishalk@gmail.com <p>Radiocontrast material is among the common drugs causing allergic reaction. Mostly it is well tolerated. The symptoms range from mild with urticaria to fatal anaphylaxis, developing rapidly. Anaphylaxis is the most severe form of radiocontrast media (RCM) induced hypersensitivity reaction. With more use of diagnostic and therapeutic procedure, the use of the radiocontrast media is increasing. We report here two cases of severe anaphylactic reaction that occurred during the coronary intervention for myocardial infarction.</p> 2022-09-09T00:00:00+00:00 Copyright (c) 2022 https://nepjol.info/index.php/JAIM/article/view/48198 Omicron: Subvariants, Flurona, Deltacron media misinformation and plot twists 2022-09-08T03:06:54+00:00 Jared Robinson indrajit18@gmail.com Indrajit Banerjee indrajit18@gmail.com <p>The worldwide SARS-CoV-2 pandemic has taken the global community through a series of unprecedented events. The frustrating and crippling element in the global COVID saga is that of the catastrophic mutations and or discoveries which set the barely recovering fragile global markets and medical systems alight. One such mutation which ravaged the global recovery and crippled international trade and travel was the Omicron variant. Omicron and its subvariants are rising and becoming the predominant variants globally. The BA.2 subvariant however is seeing an increase in cases due to its enhanced transmissibility an secondary attack rate, it is however not of great concern as no vaccine efficacy discrepancy is evident between the predominant BA.1 variant subtype and that of BA.2. The global community is hypersensitive to COVID-19 and any new findings, it is therefore of the upmost importance that media outlets do not sensationalize and or misconstrue any new information, as such instances can have massive international repercussions. Flurona is not a hybrid virus and is simply a co-infection of the simple seasonal influenza and the Omicron variant, although this co-infection is highly serious, no risk of genetic recombination and hybrid formation is present. Finally, a recombinant variant of the Delta and Omicron variant has been discovered in the UK and is under investigation, initial reports however do not flag the variant as one of concern, more research and data will need to be assessed as for experts to ascertain whether it is a cause for additional health measures or not.</p> 2022-09-09T00:00:00+00:00 Copyright (c) 2022