Rickettsial Infection amongst Febrile Illness Patient in a Tertiary Care Hospital: A Retrospective Cross-sectional Study.

Background Rickettsial infection is an emerging neglected tropical disease in the Southeast Asia. In past few years Nepal is also reporting escalating prevalence of rickettsia. The under evaluation is resulting it as undiagnosed or are simply labeled as pyrexia of unknown origin. Objective To find out the prevalence of rickettsia in a hospital setting, assess the sociodemographic and other relevant clinical features of the rickettsia patients. Method This is a hospital based retrospective cross-sectional study from October 2020 to October 2021. This study reviewed the medical records of the department. Result The study included 105 eligible patients and the prevalence rate was 4.38 per 100 patients. The mean age of the participants was 42 years, and the mean hospital stay was 3 (SD ±2.06) days. More than 55% of the participants had fever for less than or equal to 5 days and 9% had Eschar present. Vomiting, headache, and myalgia were the most common symptoms and hypertension, and diabetes were the common comorbidities. Pneumonia and the acute kidney injury were the two complications of the patients as stated in the study. The severity of the thrombocytopenia deducted from admission time to discharge, and the case fatality was 4%. Conclusion The future studies shall consider on collaborative clinical and entomological research. This would help in better understanding of the etiology of supposedly unknown febrile illness and the under-investigated field of emerging rickettsia in Nepal.

Clinical Dilemma of Diabetic Ketoacidosis and COVID-19 Infection.

The COVID-19 Pneumonia with diabetic ketoacidosis is a dreadful health condition. Diabetic ketoacidosis is one of the severe metabolic complications and it can be precipitated by infection. We presented a case of 48 years female with no known comorbidities who presented with COVID-19 symptoms and with Diabetic Ketoacidosis. The case presented with elevated inflammatory markers, high anion gap metabolic acidosis with type I respiratory failure. During admission, the oxygen saturation had marked drop, later her improvement was steady followed by gradual tapering of the oxygenation. Marked improvement was noticed in the subsequent follow-up. COVID-19 infection can be precipitated by preexisting diabetes or newly diagnosed diabetes and the severity of COVID-19 infection is more pronounced in patients with diabetes mellitus, thus should be managed timely and accordingly. The scarce studies among the COVID-19 cases with diabetic ketoacidosis reflect the need for further studies for the availability of a wider range of information.

Association of Subjective Sleep Quality and Glycemic Level in Patients with Type 2 Diabetes Mellitus: A cross sectional study.

Background Sleep disorders are considered as one of the important risk factor which have a great impact on patients with type 2 diabetes mellitus. Objective The objectives of this study was to determine the effect of sleep quality on the glycemic level among type 2 diabetic patients. Method This was a cross sectional study done in 208 type 2 diabetic patients visiting Kathmandu Medical College Public Limited from July 2019 to December 2019. Data regarding sleep quality was collected by using Pittsburgh Sleep Quality Index taking global cut off score ≥ 8 as poor sleeper. Glycated hemoglobin level ≥ 7 was considered as poor glycemic control. Chi square test was used to compare parameters between good sleeper and poor sleeper. Independent sample t test compared the means of Pittsburgh Sleep Quality Index factors and glycemic contol. A logistic regression analysis of Pittsburgh Sleep Quality Index factors and glycated hemoglobin was done. Values of p ≤ 0.05 were considered statistically significant. Result The study findings revealed that 62 % had poor glycemic control and 58.7 % were poor quality sleeper. There was a significant association of sleep quality with glycemic control and duration of diabetes. Logistic regression analyses showed that subjective sleep quality was risk factor for poor glycemic control. The odds ratio for subjective sleep quality was found to be 4.59 (2.13-9.91). Conclusion Poor sleep quality was common in type 2 diabetic patients. This study showed that the risk factors for poor subjective sleep quality include poor glycemic control and longer duration of diabetes mellitus.

Leprosy disease in Nepal : knowledge and non-compliance of patients.

Non-compliance among leprosy patients has always been a problem in Nepal. Many researches on drug compliance has indicated that if a patient understands well about his /her disease and its treatment, he /she is more likely to be motivated to take the whole prescribed course of treatment properly. It is widely believed that the understanding and behavior of patients in relation to drug compliance are largely influenced by their socio-economic condition and level of knowledge. In order to determine the socio-economic characteristics of non-compliant leprosy patients and their level of knowledge of leprosy disease and treatment, a non-intervention study was carried-out in Dhanusha - a high prevalent district in Nepal bordering India. A total of 57 non-compliant leprosy cases were selected using systematic sampling method on the basis of available clinical records and an interview-schedule was used for data collection. The result shows that the majority of non-compliant cases were illiterate, laborers by occupation and from poor economic class family background (73.7%). Data revealed that majority did not understand the cause of the disease and were not aware of the duration of treatment. It was interesting to note that an overwhelming majority (94.7%) were having strong belief that the disappearance of sign/symptoms was the only meaning of the "cure of leprosy disease". In view of this, it is strongly recommended that the patient education and counseling, public/community awareness program should be improved and further strengthened. A socio-economic rehabilitation program with vocational/trade training to leprosy patients or their family members should be arranged to up-lift their socio-economic status.