Sumi Singh

We describe the case of a 26-year-old man who presented with acute chest pain and was found to have single-vessel coronary occlusion most consistent with probable paradoxical embolism. Coronary angiography demonstrated complete occlusion of the ramus intermedius artery. Aspiration thrombectomy restored flow without stent implantation. Intravascular ultrasound showed no plaque rupture, atherosclerosis, or coronary dissection, supporting but not definitively confirming an embolic etiology. Transthoracic and transesophageal echocardiography subsequently identified a large patent foramen ovale with bidirectional shunting. Lower-extremity Doppler studies and an extensive hypercoagulable evaluation were negative. The patient later underwent successful percutaneous closure of the patent foramen ovale. This case highlights probable paradoxical coronary embolism as a rare cause of acute myocardial infarction in a young patient without significant atherosclerotic disease and underscores the value of multimodality imaging in supporting the diagnosis and guiding management.

Introduction: Gestational diabetes mellitus is increasing globally leading to significant maternal and foetal morbidity. This study aimed to find out the prevalence of gestational diabetes mellitus among pregnant women delivering in a tertiary care hospital. Methods: A descriptive cross-sectional study on a total of 3034 pregnant women was conducted in a tertiary care hospital from 14^th April 2017 to 13^th April 2018 with ethical approval from Research and Institutional Review Committee (Reference number: 061-077/078) of the hospital. Pregnant women who met the eligibility criteria were included in the study. Convenience sampling was done. Data were analysed using the Statistical Package for the Social Sciences version 24.0 and Microsoft Excel. Point estimate at 99% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 3034 patients who delivered in the tertiary centre, the prevalence of gestational diabetes mellitus was found to be 104 (3.42%) (2.57-4.26 at 99% Confidence Interval). The majority of women were of maternal age >30 years in 69 (66.34%). Out of which 48 (46.15%) women had family history of diabetes mellitus. Thirty-eight (36.53%) patients required a caesarean section. The most common obstetric complication was polyhydramnios in 35 (35.57%). Conclusions: The prevalence of gestational diabetes was lower when compared to other studies done in similar settings. The majority of women were of higher maternal age, had family history of diabetes mellitus and were also obese.

Reaction time is an indirect index of the processing speed of the central nervous system. It is affected by several factors including dominant and non-dominant hands and obesity. Obesity can be measured by body mass index. Thus, the aim of this study was to find out the relationship between body mass index, dominant and non-dominant hand with visual reaction time in healthy young females. A cross-sectional study was conducted in the Department of Physiology, among 89 females. The height and weight were recorded, and the body mass index was calculated. The subjects were divided into four groups, underweight, normal weight, overweight, and obese according to WHO criteria. Visual reaction time was measured using the ruler drop method in milliseconds. The data were analyzed by using the paired t-test and one-way ANOVA using the IBM Statistical Package for the Social Sciences version 22. Out of 89 participants, 26 (29.21%) were underweight, 47 (52.80%) had normal weight, 12 (13.48%) and four (4.49%) were overweight and obese with mean reaction time in the dominant hand and non-dominant hand were (176.75±16.68 vs. 186.58±16.21), (175.12±15.03 vs. 185.43±15.64), (188.74±16.07 vs. 190.70±17.88), and (200.7±9.77 vs. 210.50±9.50) respectively. All participants were right-handers. In right-handers, the right hand reacted faster than the left hand. Reaction time was prolonged in underweight, overweight,and obese; when compared with normal weight individuals. Our study showed that the reaction time of people appears to be influenced by body mass index, dominant, and non-dominant hand, which was an indirect measure of the sensory motor association.

Brucellosis is also known as Undulant fever, Malta fever, rock fever, intermittent fever, Gibraltar fever, contagious abortion, Maltese fever, Crimean fever, or even Mediterranean fever. Clinical manifestations commonly encountered are fever and arthralgia. It has veterinary importance making it the leading cause of abortion and infertility in animals. Countries in which mixed agriculture is still the leading occupation have reported this disease in high number. The disease is common in areas where the mixed type of farming is still practiced, it is a type of farming where owners cohabit with their animals in the shed during the nighttime. The incidence of the disease is reported more in humans who have direct contact with the animal’s abortus fetus and reproductive secretions. A favorable environment is created for transmission when the healthy and infected animals are kept together free and are difficult to segregate. Diagnosis of the disease is done by isolation of the bacteria from the sample using the polymerase chain reaction (PCR) technique. The disease was claimed to be eradicated but now as the global trend of infectious diseases is constantly changing it now appears to be a re-emergent disease. The best way to prevent the spread of the infection is through the One Health approach. Although brucellosis has been widely reported in animals and humans only a few studies have addressed the true prevalence of the disease in the context of Asia which is quite a challenge. It is unable to provide the true context of the disease. The case burden is more prevalent in the developing countries where it is found to be endemic in animals as well as in humans. Thus, this paper highlights the risk factors commonly found in Asian countries that are associated with increased prevalence of infection in humans which has now been believed to be involved many generations across the globe. Countries in which mixed agriculture is still the leading occupation have reported this disease in high number. The disease is common in areas where the mixed type of farming is still practiced, it is a type of farming where owners cohabit with their animals in the shed during the nighttime. The incidence of the disease is reported more in humans who have direct contact with the animal’s abortus fetus and reproductive secretions. A favorable environment is created for transmission when the healthy and infected animals are kept together free and are difficult to segregate. Diagnosis of the disease is done by isolation of the bacteria from the sample using the polymerase chain reaction (PCR) technique. The disease was claimed to be eradicated but now as the global trend of infectious diseases is constantly changing it appears to be a re-emergent disease. The best way to prevent the spread of the infection is through the One Health approach. Although brucellosis has been widely reported in animals and humans only a few studies have addressed the true prevalence of the disease in the context of Asia which is quite a challenge. It is unable to provide the true context of the disease. The case burden is more prevalent in the developing countries where it is found to be endemic in animals as well as in humans. Thus, this paper highlights the risk factors commonly found in Asian countries that are associated with increased prevalence of infection in humans which has now been believed to be involved many generations across the globe.

Body packing is the process of smuggling illicit drugs in the form of packages concealed within the gastrointestinal tract via ingestion or inserting into body orifices. These individuals are described as “body packers”, “stuffers”, “mules” or “swallowers” and resort to carrying drugs like heroin, cocaine and cannabis. They present to the hospital following the development of complications or brought dead due to the rupture of packets or directly from detention for further investigations. This case illustrates a suspected case detained from the airport who was found to be carrying 93 pellets of an illicit drug, heroin, weighing 900 grams, one of the highest quantity carried by any body packer in the country till date. This case further sheds light on the fact that a meticulous history, detailed clinical examination and radiographic investigations like abdominal radiograph and imaging are the keys to diagnose body packers in a resource limited setting.

The main objective of this study is to analyze the prescribing pattern of medicine in outpatient departments of tertiary care centre in Kathmandu using World Health Organization (WHO) drug use prescribing indicators. As per WHO consideration, 100 prescriptions were taken from each outpatient departments (OPD) of Nepal medical college including Orthopedics, Obstetrics and Gynecology, Surgery, Medicine, Ophthalmology, Otorhinolaryngology, Pediatrics, Dermatology and Psychiatry. Analysis of variance (ANOVA) was used to assess the statistical significance between means between all departments. Among a total of 900, 47.7% were male and 52.3% were female. Average medicine per prescription was 2.43±0.039. Number of Medicines by generic name 76 (3.4%), antibiotics 416 (19.0%), Injection 34 (1.5%), from Essential Medicine List (EML) 1,312 (60.1%), Fixed Dose Combination (FDC) 468 (21.4%) and the polypharmacy (≥4) was 129 (14.3%). The average cost was NPR 404.72±19.3 (3.69$; 1$=109.41NPR) and duration of treatment was 16.43±0.73 days. Patient’s age had positive correlation with number of medicines (p=0.002) and negative correlation with antibiotics (p=0.988). Cost of treatment had positive correlation with number of medicines (p=0.00), EML (p=0.00), duration of treatment (p=0.00) and antibiotics (p=0.33). Average medicines, from EML, and antibiotic use were high in Otorhinolaryngology with statistical significance of difference between mean. Prescription with FDC and intravenous were significantly high in Obstetrics and Gynecology. Cost and treatment duration were significantly high in Psychiatry. Tertiary healthcares need to develop and implement specific guidelines for prescriptions writing and also should develop a system to record them.