Journal of Advances in Internal Medicine <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=""></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="" rel="license">Creative Commons Attribution 4.0 International License</a> <a href="" rel="license"><img src="" 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> Society of Internal Medicine of Nepal (SIMON) en-US Journal of Advances in Internal Medicine 2091-1432 CT head findings in methanol poisoning <p>Not available.</p> Gentle Sunder Shrestha Akshay Prasad Pradhan Subash Phuyal Copyright (c) 2022 2022-09-09 2022-09-09 11 1 17 18 10.3126/jaim.v11i1.48193 Knowledge, Attitude and Practice Regarding Kidney Diseases among Primary Care Physicians working in Nepal <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> Richa Nepal Bharosha Bhattarai Abhishek Bhandari Bishow Nath Adhikari Rhishikesh Nepal Nimesh Khanal Copyright (c) 2022 2022-09-09 2022-09-09 11 1 1 9 10.3126/jaim.v11i1.48039 Internal jugular vein distensibility: Rapid and reliable bedside assessment tool to predict fluid responsiveness in mechanically ventilated septic patients <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> Shubha K. Shrestha Gentle S. Shrestha Hem R. Paneru Pramesh S. Shrestha Bishwas Pradhan Subhash P. Acharya Copyright (c) 2022 2022-09-09 2022-09-09 11 1 10 16 10.3126/jaim.v11i1.48192 A Rare Case of Synchronous Gastric Signet Ring Cell Adenocarcinoma Metastasis at the right colon angle <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> Seifeddine Baccouche Sarraj Achref Mohamed Hajri Osman Rania Wael Ferjaoui Ahlem Lahmer Sana ben Slama Dhouha Bacha Copyright (c) 2022 2022-09-09 2022-09-09 11 1 19 21 10.3126/jaim.v11i1.48194 Case Report: Splenic Mucormycosis; A Post-Covid Sequelae <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> Ankita Guragain Sanjeet Krishna Shrestha Subodh Ghimire Sunil Kumar Sharma Dhakal Copyright (c) 2022 2022-09-09 2022-09-09 11 1 22 24 10.3126/jaim.v11i1.48195 Severe anaphylaxis following administration of radiocontrast in patient undergoing coronary intervention <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> Bishal KC Samir Gautam Sachin Dhungel Mazhar Khan Binesh Shakya Copyright (c) 2022 2022-09-09 2022-09-09 11 1 25 28 10.3126/jaim.v11i1.48197 Omicron: Subvariants, Flurona, Deltacron media misinformation and plot twists <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> Jared Robinson Indrajit Banerjee Copyright (c) 2022 2022-09-09 2022-09-09 11 1 29 31 10.3126/jaim.v11i1.48198