Scrub typhus is an endemic disease caused by the bites of infected chiggers (larval mites) harboring causative bacteria Orientia tsutsugamushi. Acute pancreatitis is a rare but occasionally fatal complication of scrub typhus infection caused by vascular and perivascular inflammation of the pancreas. A 34-year-old female presented with severe epigastric pain and multiple episodes of vomiting. Extensive evaluation of the patient revealed acute pancreatitis secondary to scrub typhus. The patient also had septic shock and multiple organ dysfunction syndrome. The patient was mechanically ventilated and treated with doxycycline, and pancreatitis was managed conservatively.
Background: Acute upper gastrointestinal bleeding is one of the common and life threatening condition presenting in emergency. The aim of the present study was to determine the clinical profile and in-hospital outcomes in these patients admitted at a tertiary care center in Kathmandu, Nepal. Materials and Methods: This is a descriptive, observational study conducted over 9 months (October 2021– July 2022). All consecutive patients aged 16 years and above admitted in the hospital ward with the history of acute bleeding were included in the study after informed consent. Demographic data, clinical, laboratory and endoscopic data were noted during the hospital stay. Statistical analysis was done used SPSS v.24. Results: The mean age of our study population (N = 132) was 46.92 years. Among 132 patients who underwent endoscopy, 43.9% had portal hypertension related bleeding, 41.7% had ulcer related bleeding, 5.3% had malignancies, 3% had corrosive intake. No etiology was found in 3 patients. Hematemesis with melena was the most common mode (53.8%) of presentation to the hospital.Shock was preset in 25% of patients at presentation to the hospital. In-hospital re-bleeding rate and mortality were 12.7% and 9.8% respectively. Conclusion: Portal hypertension related bleeding followed by ulcers related bleeding is the common cause of acute upper gastrointestinal bleeding. In-hospital mortality was 9.8%.
Introduction: Microalbuminuria is an abnormal increase in albumin excretion rate with a specific range of 30-299 mg of albumin/g of creatinine or excretion of 20-200 mg/l of albumin in spot urine samples. Diabetic patients with microalbuminuria are at increased risk for cardiovascular death as compared with normoalbuminuria. The aim of this study was to find out the prevalence of microalbuminuria among patients visiting the Department of Nephrology in a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted among diabetic patients visiting the Department of Nephrology in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee (Reference number: 04072022/04). The study was conducted between 1 October 2022 to 30 November 2022 where patients providing written consent and had documented diabetes were included in the study whereas patients without documented diabetes, having comorbidities such as congestive heart failure, nephritic/nephrotic syndrome and those who refused to give consent were excluded from the study. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 103 patients, microalbuminuria was found to be in 19 (18.45%) (10.96-25.94, 95% Confidence Interval). Out of 19 patients, 8 (42.11%) were male and 11 (57.89%) were female. The mean HbA1c among participants with microalbuminuria was 7.67±0.67%. Conclusions: The prevalence of microalbuminuria among diabetic patients was similar to other studies done in similar settings.
Rhabdomyolysis refers to skeletal muscle breakdown causing a release of different intracellular proteins including myoglobin and several electrolytes in the bloodstream. Elevations diagnose rhabdomyolysis in serum creatine kinase. Mass envenomation by multiple wasp stings can cause rhabdomyolysis followed by acute kidney injury, although it is scarce. A 24-year-old male presented to our tertiary centre in an anaphylaxis-like state after multiple wasps sting, rapidly developing rhabdomyolysis followed by acute kidney injury. Despite having an ectopic kidney with a pre-existing renal parenchymal disease, he recovered and was discharged, which in itself is a rare entity of low clinical incidence. Wasp stings can potentially result in serious clinical manifestations, which need to be watched over, assessed and promptly treated.
Toxic epidermal necrolysis is a potentially life-threatening dermatological condition whose pathogenesis and exact treatment are not yet known. Drugs like anticonvulsants, allopurinol and non-steroidal anti-inflammatory drugs like etoricoxib, a selective cyclo-oxygenase-2 inhibitor prescribed for pain management are associated with a high risk of toxic epidermal necrolysis. It is also associated with immunodeficiency and dysregulated immune reactions like systemic lupus erythematosus, an autoimmune disease in which organs and cells undergo damage initially mediated by tissue binding auto-antibodies and immune complexes. Here, a 34 year old lady was presented in emergency with multiple maculopapular rashes over the neck and trunk region after treatment with etoricoxib for osteoarthritis of the left foot.
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