Presentation, treatment profiles, and outcome of snake bite patients presented in emergency department at a tertiary hospital in Eastern Nepal.

Background: Snake bite is one of the most common animal bites in Nepal. Different species of snake cause different clinical presentations. The incidence of snakebite is very high in rural Nepal. The objectives were to assess the presenting pattern, demographic profile, outcome, and treatment profiles of snakebite victims admitted to the emergency ward. Materials and Methods: A retrospective cross-sectional study was conducted among the patients who presented in emergency department with alleged history of snake bites from 2015 to 2016. The patient's record files were reviewed and the relevant data were recorded on a self-designed proforma. Descriptive statistics were calculated using SPSS version 11.5. Results: Out of 137 snakebite victims, 73 (53.3%) were female. The mean age was 35.17 ± 18.27 years. The upper limb (59%) was the most common site for snake bites followed by the lower limb (35.1%). Fifty patients (36.2%) were bitten by snakes during night (20.00-2.59 AM). Twenty-eight (20.4%) patients presented with ptosis as the most common sign and symptom followed by diplopia (15.3%). Out of 137 patients, 39 (28.5%) were admitted, 65 (47.4%) discharged, and 12 (8.8%) patients expired. Antisnake venom was given to 30 patients among which 23 patients (76.7%) were improved. Conclusions: Snake bite is one of the major problems in rural Nepal. It can be easily managed if treatment is given properly and in a timely manner. The importance of effective first aid management and effective treatment have to be disseminated among the peoples in rural areas via social media and radio.

Anaphylactic reactions due to pantoprazole: case report of two cases.

BACKGROUND: Drug-induced hypersensitivity reaction is of great clinical significance in therapeutics. The objective of this reporting of two cases is to show that anaphylaxis reaction can occur with pantoprazole. CASE SUMMARIES: A 38-year-old female reported to the emergency ward in a critical condition, with a history of periorbital edema, edema of the skin, pruritus, nausea, vomiting, and difficulty breathing 20 minutes after ingestion of a pantoprazole 40 mg tablet. A 32-year-old female reported to the emergency ward in a critical condition, with complaints of rashes all over the body, itching on the whole body, and swollen lips and eyes after ingestion of a pantoprazole 40 mg tablet. CONCLUSION: It is necessary for all health care providers to know that pantoprazole can cause anaphylaxis, which is a life-threatening reaction, and to be cautious while prescribing it.

Rheumatic heart disease revisited: patterns of valvular involvement from a consecutive cohort in eastern Nepal.

BACKGROUND: The burden of rheumatic heart disease (RHD) continues to be a major contributor to morbidity and premature death in poor and developing countries. We investigated patterns of valvular involvement in patients with RHD as observed in a large tertiary care hospital in eastern Nepal. METHODS: We retrospectively reviewed transthoracic echocardiography reports from patients diagnosed with RHD between June 1999 and February 2011. RESULTS: Among 10 860 transthoracic echocardiography studies, 1055 female and 658 male patients were diagnosed with RHD, 25.7% of the patients being below 20 years of age. Mitral regurgitation was the most common valvular lesion across all age groups irrespective of sex (n = 1321, 77.1%). Female patients were significantly older as compared to male patients at the time of presentation (32.8 ±â€Š15.2 versus 28.5 ±â€Š15.4 years; P < 0.001) and more commonly presented with mitral stenosis as compared to male patients (62.8 versus 51.5%; P < 0.001), with a peak between the age of 30 and 49 years. Conversely, aortic regurgitation was more common in men as compared to women (55.6 versus 48.9%; P = 0.007). Involvement of both the mitral and the aortic valve was observed in 49.8% of the patients and was more common in men as compared to women (52.7 versus 47.8%; P = 0.047). CONCLUSION: In this consecutive cohort of patients with RHD in Nepal differential patterns of valvular involvement are observed across sex and age categories.

Presentation and outcome of patients with acute coronary syndromes in eastern Nepal.

BACKGROUND: The burden of ischemic heart disease (IHD) in developing countries is on the rise, due to urbanisation, industrialisation and the low availability of evidence based therapies and interventions. AIMS AND OBJECTIVES: Data was collected on consecutive patients admitted with acute coronary syndrome (ACS), from 1st January to 31st December 2008, to a tertiary care centre in eastern Nepal. Final diagnosis, risk factors, educational status, time delays, treatment and in-hospital outcomes were evaluated. RESULTS: A total of 153 patients with ACS were admitted in 2008: 58 with ST elevation myocardial infarction (STEMI) (38%), 28 with non-ST elevation myocardial infarction (NSTEMI) (18%) and 67 with unstable angina (UA) (44%). 40% of patients with STEMI presented within 12 hours of symptom onset. Most patients presented late and 33% of them presented after 2 days or more. Over half the patients were not literate. Due to the unavailability of percutaneous coronary intervention (PCI) at the centre, thrombolysis with Streptokinase was considered for patients presenting with STEMI up to 24 hours after symptom onset. However, due to financial constraints, only 53% of patients in this broadened time window actually received thrombolytic treatment. The in-hospital mortality was 14% for all patients with ACS, and 17% for the patients with STEMI. CONCLUSIONS: Only a small proportion of patients with ACS in Eastern Nepal are admitted to hospital, and those who are often arrive late, or cannot afford optimal medical management. Awareness, better referral and transport facilities, financial support for the needy, and the availability of on-site coronary angiography and angioplasty for selected patients should contribute to treat more ACS patients and improve their prognosis.