Practicing Medicine Wisely: Routine Use of Urine Legionella in Suspicious Pneumonia - Are we Overdoing?

ABSTRACT: Legionella spp. is an underreported cause of Community Acquired pneumonia that affects significant population specially in urban areas and its prevalence is on an increasing trend. The routine practice of testing for urinary antigen of Legionella in all suspected cases of pneumonia is prevalent is resource rich western countries. Although several studies have shown no distinct advantage of performing routine urinary antigen testing, this practice continues to be preferred by clinicians. In this viewpoint, we have discussed the advantages and disadvantages of urinary antigen testing, its relevance in current practice and its impact on clinical outcomes.

Histopathological Spectrum of the Upper Gastrointestinal Tract Endoscopic Biopsies at a Tertiary Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Upper gastrointestinal tract disorders are prevalent worldwide, encompassing neoplastic and non-neoplastic lesions like infections and inflammation. Endoscopic biopsies play a crucial role in diagnosis, treatment monitoring, and complication detection. Despite their routine use, comprehensive data on their histopathological spectrum is sparse. This study aimed to delineate this spectrum and assess the prevalence of non-neoplastic and neoplastic lesions in upper gastrointestinal tract endoscopic biopsies. METHODS: This descriptive cross-sectional study at a tertiary care center analyzed upper gastrointestinal endoscopic biopsies from August 1, 2019, to July 31, 2021. After obtaining ethical clearance (reference number: 039-078/079), we collected all upper gastrointestinal endoscopic biopsies received during the two-year study period, excluding inadequate biopsies, resection specimens, therapeutic cases, and specific lesions.Histopathological examination was conducted using H&E, Giemsa, and Periodic acid-Schiff stains. Diagnoses were categorized into non-neoplastic and neoplastic lesions following WHO guidelines. Data were analyzed using SPSS 16.0 to determine the frequency of neoplastic and non-neoplastic cases. RESULTS: Among 155 upper gastrointestinal biopsies, 124 (80%) were non-neoplastic (95% CI: 73.71-86.29%) and 31 (20%) were neoplastic (95% CI: 13.71-26.29%). Non-neoplastic lesions were predominantly chronic gastritis, with chronic active gastritis being the most frequent 34 (27.41%). Neoplastic lesions were mainly adenocarcinomas in the stomach 20 (64.51%) and squamous cell carcinomas in the esophagus 7 (22.58%). CONCLUSIONS: The prevalence of neoplastic lesions were found to lower compared to the published literature and showed predominance of adenocarcinoma in upper gastrointestinal neoplastic lesions.

Pancreaticopleural fistula causing pleural effusion: a case report and review of the literature.

BACKGROUND: Pancreaticopleural fistula is a rare complication of pancreatitis and poses diagnostic and therapeutic challenges. This case report sheds light on the unique challenges posed by pancreaticopleural fistula as a rare complication of pancreatitis. The aim is to contribute valuable insights to the scientific literature by presenting a case involving a middle-aged man with acute necrotizing pancreatitis and associated pleural effusion. CASE PRESENTATION: A 41-year-old Asian male with a history of pancreatitis and chronic alcohol use presented with severe dyspnea, chest pain, and left-sided pleural effusion. Elevated serum amylase lipase levels and imaging confirmed acute necrotizing pancreatitis with a computed tomography severity index of 8/10. Magnetic resonance cholangiopancreatography revealed pancreatic necrosis and pseudocyst formation and findings suggestive of pancreaticopleural fistula. The patient was then treated with octreotide therapy. CONCLUSION: The management of pancreaticopleural fistula demands a comprehensive and individualized approach. Recognition guided by high clinical suspicion coupled with appropriate investigations and a careful balance between medical, endoscopic, and surgical interventions is crucial for achieving favorable outcomes. This case report adds to the scientific literature by providing insights into the complexities of pancreaticopleural fistula and emphasizing the importance of personalized strategies in its management.

Post-operative Unilateral Visual Loss and Ophthalmoplegia following Cervical Spine Surgery in Prone Position: A Case Report.

ABSTRACT: Visual loss following a spine surgery in a prone position is a disastrous and irreversible complication. Moreover, the recommended treatment for such visual loss is lacking and the outcome is not so satisfactory. A 38-year-old gentleman developed profound right sided visual loss after an uneventful cervical spine surgery in a prone position that lasted approximately two and half hours. Immediate ophthalmic consultation was done and the case was diagnosed as right-sided central retinal artery occlusion. Despite the initiation of vasodilatation, anticoagulation, and adequate fluid infusion, satisfactory improvement was not achieved. Extensive review of pertinent literature highlighted limited efficacy of treatments for postoperative visual loss after prone spinal surgery, further emphasizing the importance of preventive measures as the cornerstone in such procedures.

Ghost complications in biliary surgery: A case series on pneumobilia.

INTRODUCTION: Laparoscopic cholecystectomy is a commonly performed surgical procedure and there are instances where complications may occur intraoperatively which can go undiagnosed or unreported and the patient can present at a later time with the manifestations of those complications. This study presents a case series comprising three instances of "ghost complications" following laparoscopic cholecystectomy, emphasizing the utmost significance of careful follow-up care and efficient communication to promptly recognize and manage any complications arising after the surgery. CASE PRESENTATION: Three cases of ghost complications post-biliary surgery are presented. These complications were initially overlooked or dismissed due to factors such as atypical symptom presentation and inadequate follow-up. The cases involve retained stones leading to secondary complications, bile leak masked by postoperative symptoms, and post-cholecystectomy syndrome mistaken for unrelated conditions. CLINICAL DISCUSSION: Diagnosing ghost complications is challenging when symptoms diverge from the expected postoperative course. Meticulous clinical suspicion and interdisciplinary collaboration are crucial for accurate diagnoses and timely intervention. Effective communication between patients and surgeons is pivotal in ensuring appropriate management. CONCLUSION: This study illuminates the concept of "ghost complications" after biliary surgery, highlighting challenges in their recognition and management. Through three distinct cases, the study underscores the significance of vigilant follow-up care, early symptom recognition, and open communication to prevent and address such complications. Transparent communication and meticulous monitoring are vital for enhancing patient outcomes and mitigating the occurrence of "ghost complications."

Lipoma of the middle finger in an elderly male: A case report.

INTRODUCTION AND IMPORTANCE: Lipomas are common benign tumors originating from adipocytes, often found in adipose-rich regions of the body. Lipomas in the fingers are rare, and their occurrence in acral areas is even more exceptional. We present a case of an elderly male with a lipoma on the middle finger of his left hand, highlighting the rarity of this presentation and the importance of surgical management. CASE PRESENTATION: A 70-year-old male presented with a painless swelling on the palmar aspect of his left middle finger. The mass had gradually enlarged over two years, without associated symptoms. Physical examination revealed a soft, painless mass between the proximal and distal interphalangeal joints, with intact finger function. Surgical excision was performed successfully, and histopathological examination confirmed the diagnosis of a benign lipoma. CLINICAL DISCUSSION: Lipomas are most commonly found in adipose-rich areas but rarely manifest in the fingers. Surgical intervention is considered when symptoms arise or for cosmetic reasons. In this case, the patient's desire for symptom relief and the potential for compression-related issues justified surgical excision. Surgical management of finger lipomas has shown positive outcomes with minimal complications and low recurrence rates. CONCLUSION: This case emphasizes the importance of considering lipomas in the differential diagnosis of painless finger swellings, even in atypical locations. Surgical intervention can provide effective symptom relief and prevent potential complications. While this case contributes to our understanding of finger lipomas, further research and long-term follow-up are needed to enhance our knowledge of these rare occurrences and their management.

Management and Leadership Development in Healthcare Professionals.

In the healthcare system, leadership has never been more crucial. Initiatives to improve health care in underdeveloped nations frequently fail, not for lack of clinical and public health understanding, but rather for lack of management ability. However, there are currently few possibilities for thorough leadership development at any level of career. This short communication highlights the success of the International Public Health Management Development Program by the Nepal Medical Association in conjunction with the Indian Embassy in Nepal, financed by the Ministry of External Affairs under the Indian Technical Education Corporation. Keywords: leadership; Nepal; public health; training activities.

Alcoholic Liver Disease among Patients Admitted to the Department of Internal Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Alcoholic liver diseases comprise a spectrum of liver diseases including fatty liver, alcoholic hepatitis, and cirrhosis. Diagnosis at advanced stages is frequent for this condition and data regarding the prevalence of such patients at early stages are limited. The aim of this study is to find out the prevalence of alcoholic liver disease among patients admitted to the Department of Internal Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among 538 patients admitted to the Department of Internal Medicine of a tertiary care centre in Nepal between 3rd November, 2021 and 22nd February, 2022 after receiving ethical approval from the Institutional Review Committee of the hospital (Reference number: 006-078/079). Convenience sampling was done. Data were collected and entered in Microsoft Excel and analysed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data along with mean and standard deviation for continuous data. Results: Among 538 patients, alcoholic liver disease was seen in 42 (7.80%) (5.53-10.07 at 95% Confidence Interval). The mean age of the patients was 53.85±10.88 years. Among these patients 25 (59.52%) were males and 17 (40.47%) of them were females. Conclusions: Our study showed that the prevalence of alcoholic liver disease was lower as compared to similarly reported literature. Keywords: alcoholic liver diseases; jaundice; liver function test; Nepal.

Organophosphorus Poisoning among Patients Admitted to the Intensive Care Unit of the Department of Internal Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Organophosphates are potent cholinesterase inhibitors that when ingested in excessive amounts can be fatal. Organophosphorus poisoning has become an important clinical problem with increased mortality in the country from accidental or intentional ingestion of, or exposure to the pesticide. This study aimed to find out the prevalence of organophosphorus poisoning among patients admitted to the Intensive Care Unit of the Department of Internal Medicine in a tertiary care centre. METHODS: A descriptive cross-sectional study was conducted among patients admitted to the Intensive Care Unit of the Department of Internal Medicine of a tertiary care centre after receiving ethical approval from the Institutional Review Committee (Reference number: 2003202205). The study was conducted between 1 February 2021 and 1 February 2022 using hospital records. Convenience sampling was done among the patients who met the eligibility criteria. The diagnosis of organophosphorus poisoning was made based on the patient's history, clinical examination and the measurement of serum acetylcholinesterase levels. Point estimate and 95% Confidence Interval were calculated. RESULTS: Among 1108 patients admitted, organophosphorus poisoning was seen in 50 (4.15%) (3.29-5.73, 95% Confidence Interval). CONCLUSIONS: Our study found that the prevalence of organophosphorus poisoning was lower when compared to similar studies done in similar settings.

Intestinal Obstruction of Congenital Origin: A Case Report.

Congenital bands are rare causes of intestinal obstruction and often leads to diagnostic challenges. Diagnostic delays in cases of mechanical obstruction might lead to irreversible bowel ischemia and perforation. Presently described is a case of an 18 month young child with severe vomiting developed for one day. The child was initially thought to have acute viral enteritis and treated accordingly. Due to the severity, an X-Ray and computed tomography scan were sent which pointed towards the possibility of having congenital bands. He was treated operatively. The child was kept under observation for eleven days and was discharged. Although rare, intestinal obstruction due to congenital bands must be considered when treating a child with severe vomiting. Keywords: case reports, congenital abnormalities, intestinal obstruction, vomiting.

Quarantine: A Period of Self-discovery and Motivation as Medical Student.

The ongoing nationwide lockdown due to the global pandemic COVID-19 started from March 24, 2020, in Nepal. Lots of medical students are in dilemma about how to utilize this time to make it more productive. To live a good life, we must be able to balance our life in general so, we can use this time to discover ourselves. It is equally important to adjust to the global pandemic and help locally to combat the current situation. This difficult time demands resilience. This article focuses on some ideas to discover ourselves and develop resilience within us.

Sleep Quality among Medical Students of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Medical students are under constant stress due to demanding academic load, fear of exam failure and hectic schedules. These factors can lead to poor sleep quality among medical students. Sleep quality of medical students not only determine their academic performance but is also important in determining long term effect on cognitive, psychosocial, behavioural as well as physical health of individuals. Although there are not enough recent studies to assess sleep quality of students, it is necessary to evaluate the condition of sleep among students. This study aims to find out the prevalence of poor sleep quality among medical students. METHODS: This descriptive cross-sectional was conducted among undergraduate medical students of Kathmandu Medical College from October to November 2019 after taking ethical clearance from Institutional Review Committee of a tertiary care hospital before collecting data from participants. Subjects were recruited by simple random sampling from students of first, second, third and final years and were asked to fill the self-reported questionnaires, using Pittsburgh Sleep Quality Index. Descriptive statistical analysis was done using Statistical Software for Social Sciences version 24. RESULTS: Out of 217 selected medical students, 96 (44.23%) of students have poor sleep quality with prevalence among male and female students as 41 (39.8%) and 55 (48.2%) respectively. The mean duration of sleep among students was 6.7±1.6 hours. CONCLUSIONS: Significant numbers of medical students have poor sleep quality which may affect their academic performance and may have long term impact on their health. Efforts must be directed towards educating about the sleep hygiene as well as proper time management skills.

Diagnosis of Achondroplasia at Birth: A Case Report.

Autosomal dominant mutations in fibroblast growth factor receptor 3 cause achondroplasia, the most common form of dwarfism in humans. Achondroplasia is a genetic disorder causing rhizomelic shortening of limbs. Head is often large with prominent forehead causing vaginal delivery difficult. A twenty-one years old multipara mother gave birth to a baby with achondroplasia via spontaneous vaginal delivery with episiotomy without any complication. Achondroplasia, in this case, was diagnosed on the basis of antenatal ultrasonography finding, clinical features and radiological finding of the baby. He was admitted in the special baby care unit for observation and discharged on the next day as no complications were noted. Keywords: achondroplasia; dwarfism; ultrasonography.

Prevalence of Smoking among Medical Students in a Tertiary Care Teaching Hospital.

INTRODUCTION: Tobacco smoking is one of the most important preventable risk factors for noncommunicable diseases. It has been seen that medical students have a higher frequency of smoking compared to the general population. This study aims to determine the prevalence of smoking among third-year medical students in a tertiary care teaching hospital in Nepal. METHODS: This descriptive cross-sectional study was conducted among the hospital's third-year undergraduate medical students over a four-month period (October 2019 to January 2020). Ethical clearance was received from the Institutional Review Committee of Kathmandu Medical College and Teaching Hospital. The whole sampling technique was used to collect data. The Global Health Professional Students Survey questionnaire was used to collect data. Data analysis was done in the statistical package for social sciences. RESULTS: The prevalence of current smoking among selected medical students of Kathmandu Medical College and Teaching Hospital is 34 (30.1%), majority male 26 (23%). Fifty-six (49.4%) of them had ever smoked cigarettes in their life, and 27 (23.9%) had their first cigarette in late adolescence. The number of students who used other forms of tobacco was comparatively lower i.e. 6 (5.3%). Many of the students 53 (46.9%) were exposed to second-hand smoke both at home and in public, while 18(15.9) exposed only at public places, and 6 (5.3%) only at home. CONCLUSIONS: Our study has concluded that there is a notable prevalence of smoking among the participants. This points to the need for specific training sessions in their clinical years about smoking cessation for themselves and regarding counseling for patients.

Acute Stroke in Tubercular Meningitis: A Case Report.

Most of the strokes in tubercular meningitis are multiple, bilateral, and located in the basal ganglia, especially the 'tubercular zone', which comprises of the caudate, anterior thalamus, anterior limb, and genu of the internal capsule. These are attributed to the involvement of medial striate, thalamotuberal, and thalamostriate arteries, which are embedded in exudates and likely to be stretched by coexistent hydrocephalus. Corticosteroids with antitubercular therapy were thought to reduce mortality and morbidity but their role in lowering strokes has not been proven. The mechanism of stroke in our case was vasculitis. Here, we are reporting a case of 22-years female patient with tubercular meningitis. She had complications of ischemic infarct and severe communicating hydrocephalus with a seizure disorder. Keywords: meningeal tuberculosis; stroke; tuberculoma; vasculitis.