Point prevalence and clinical profile of patients with delirium admitted in internal medicine department at tertiary care centre in eastern Nepal: a descriptive cross-sectional study.

Introduction: Delirium, marked by acute disturbances in consciousness and cognition, remains underdiagnosed despite its significant impact on morbidity and mortality. This study investigates the point prevalence and clinical profile of delirium in patients at an eastern Nepal tertiary care centre. Methods: A 1-month descriptive cross-sectional study involved 152 Internal Medicine Department patients at BPKIHS, Dharan. Data, collected through face-to-face interviews and the Confusion Assessment Method (CAM), analyzed demographic details, clinical history, and laboratory findings. Ethical clearance and informed consent were obtained. Results: Among 152 participants, 13.2% exhibited delirium, with notable risk factors identified. Elderly patients (≥65 years) and those with nasogastric tubes faced higher risks. Significant associations were found with cardiovascular diseases (P=0.002), central nervous system diseases (P=0.015), and alcoholism (P=0.003). Laboratory findings revealed correlations with elevated creatinine, hyperuremia, and abnormal aspartate aminotransferase levels. The study emphasizes key contributors to delirium, providing valuable insights for clinicians in identifying, preventing, and managing delirium in a hospital setting. Conclusions: This study provides critical insights into delirium prevalence and profiles in Eastern Nepal. Identified risk factors underscore the importance of routine screenings and targeted interventions for at-risk populations. Study limitations, including sample size and single-centre focus, call for further research to validate findings and enhance our understanding of delirium's management across diverse healthcare settings. Overall, the study informs clinical practices and prompts broader exploration of delirium in healthcare contexts.

Transformation of HHV-8-negative idiopathic multicentric Castleman disease into diffuse large B-cell lymphoma: A case report from Nepal.

Key Clinical Message: Idiopathic Castleman disease transforming into Diffuse Large B-cell Lymphoma has an aggressive course and can lead to mortality. Hence, early diagnosis and intervention are required. Abstract: Idiopathic Castleman disease transforming into non-Hodgkin lymphoma has an aggressive course, poor prognosis, and high mortality rate. Hence, early diagnosis and intervention are necessary. In a developing country like Nepal, where infectious diseases, particularly TB, are high, concomitant infection worsens the disease course. It also poses a diagnostic challenge as the clinical presentation may be similar.

Outcome of Epidermal Growth Factor Receptor Mutated and Non Mutated Adenocarcinoma Lung to Standard Therapy.

BACKGROUND: Asian patients with adenocarcinoma of lung have higher incidence of epidermal growth factor receptor mutations which predict increased response and survival in patients to oral tyrosine kinase inhibitors. This study was conducted to study the frequency of epidermal growth factor receptor mutation in patients in Nepal and compare the outcome in epidermal growth factor receptor mutated versus non-mutated patients receiving standard therapy. METHODS: This is an observational study conducted among newly diagnosed patients with stage IV adenocarcinoma of lung in Bir Hospital from April 2017 to June 2018. Demographic and clinical data collection along with epidermal growth factor receptor mutation testing was done. Patients with epidermal growth factor receptor mutations received Gefitinib while non-mutated patients received systemic chemotherapy. Response evaluation, progression free survival at 1 year, objective response rate and quality of life were compared. Follow up period was for 1 year. RESULTS: Eighty three (33%, n=253) patients were diagnosed with adenocarcinoma of the lung with mean age at diagnosis being 59.4 years. epidermal growth factor receptor mutations were found in 29% patients. Complete response was achieved in 9.1% vs 3.0 % (p=0.46), objective response rate was 27.3% versus 15.2% (p=0.23), progression free survival at 1 year was 39% vs 27%, (p = 0.29) and mean score of global health status was 68.1 versus 61.6 in epidermal growth factor receptor mutated versus non-mutated (p = 0.036). CONCLUSIONS: The frequency of epidermal growth factor receptor mutation in patients with adenocarcinoma of the lung was lower than in Eastern Asian studies, but higher than in western populations. epidermal growth factor receptor mutated patients had improved survival, better treatment response and quality of life in comparison with non-mutated.

Plasmablastic lymphoma of the colon in HIV negative patient; a case report with literature review.

Introduction: Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B cell lymphoma characterized by weak or absent expression of conventional B cell markers and strong expression of plasma cell markers. Very few cases of PBL of the colon have been reported in HIV negative patients. Case presentation: A 57 years female with HIV negative serology, a known case of hypertension under medication presented with right lower abdominal pain associated with vomiting and significant weight loss. On abdominal examination, soft, tender, and globular lump was palpable. Contrast enhanced computed tomography of abdomen and pelvis revealed asymmetrical enhancing mass like wall thickening involving ileocaecal region, caecum, and ascending colon, which on colonoscopy was found to be ulceroproliferative in nature. Open right hemicolectomy was performed and postoperative histopathology and immunohistochemistry results confirmed plasmablastic lymphoma as the final diagnosis. She was treated with nine cycles of chemotherapy. Clinical discussion: Although PBL is commonly found in the oral cavity, and HIV positive patients, it can rarely occur in extra-oral sites, and HIV negative patients. Due to its rarity, no optimal therapeutic approach has yet been defined for the treatment of PBL. It has a poor prognosis, and the overall survival rate has been correlated with international prognostic index score and achievement of complete remission. Conclusion: As plasmablastic lymphoma is rare and highly aggressive, its delayed diagnosis will lead to poor outcome. Thus, awareness about its clinical presentation, histopathological features, and immunophenotype is essential.

Dengue and malaria coinfection: the first case report in Nepal.

A 21-year-old male from Nepal, with a history of travel to Mumbai 2 months ago, presented with fever with chills and rigors, vomiting and multiple joint pain for 1 week. Clinical examination was noteworthy for tachycardia, hypotension and positive tourniquet test. Lab reports showed NS1-Ag positive, thrombocytopenia, lymphocytosis, transaminesemia, hyperbilirubinemia, increased urea and creatinine. He was treated for severe dengue. His laboratory parameters started improving; however, he had fever with chills and rigors daily and persistent vomiting. Repeat peripheral smear for Malaria showed schizonts and trophozoites of Plasmodium vivax. He recovered following treatment with IV fluids and injection artesunate. The presence of fever even in a critical phase of dengue, the typical rise of temperature daily, and jaundice gave a clue of coinfection with Malaria. On follow-up, after 2 weeks, he had no symptoms, and all the laboratory parameters were normal.

Overt Hyperthyroidism in Third Trimester of Pregnancy: A Case Report.

Hyperthyroidism is a state of excessive thyroid function. The most common cause of hyperthyroidism is Graves' disease. Overt hyperthyroidism if not treated can have serious outcome on the mother and the fetus. We present a pregnant women at 31 weeks of gestation presented with shortness of breath and palpitation with previous history of caesarean section and was treated with propyl thiouracil, beta blockers, antihypertensive drug, and during her course of treatment had Preterm Prelabor Rupture of Membrane with subsequent onset of labor and had normal vaginal delivery of 1.7 kg healthy baby. This report emphasize on the timely management of overt symptoms before the onset of labor.

Old is gold: Krukenberg operation performed in a tertiary setup in India for the rehabilitation of the amputated hand of a poor patient.

It is a known fact that a disabled person is a greater burden to society than a dead person. Krukenberg operation, first described by German army surgeon in 1917, Hermann Krukenberg, converts a forearm stump into a pincer, so as to retain some dexterity of the hand rather than it being reduced to a mere stump. We report this case of Krukenberg operation performed in a tertiary care setup, wherein an amputated forearm stump was converted into a functional pincer that can result in huge advantage for poor amputee patients in developing countries who rely heavily on the functionality of their hands to earn their everyday meal and are unable to bear the expense of costly prosthesis. One such patient, a 25-year-old male hailing from a very poor background who came to us with traumatic amputation of his dominant hand.