A study of risk factors of stroke in patients admitted in Manipal Teaching Hospital, Pokhara.

BACKGROUND: Stroke is usually end result of predisposing conditions that originated years before the ictus. Identification of its modifiable risk factors can help in planning preventive strategies. OBJECTIVE: To study the risk factors of stroke in adult patients. METHODS: A hospital based prospective cross sectional study was carried out in 160 stroke patients admitted in Manipal Teaching Hospital, Pokhara from November 2007- October 2010. Diagnosis of stroke was confirmed by CT scan of brain. Patients were then investigated for presence of conventional risk factors. The data was statistically analysed using Epi-Info. RESULTS: The mean age of stroke patients was 65.98 years +/- 10.69 with 126 (78.8%) of patients belonging to age group = 60 years. It afflicted higher percentage of males 104 (65%) than females 56 (35%). Analysis of stroke subtypes showed preponderance of haemorrhagic stroke in 85 (53.1%) as against infarction in 75 (46.9%) of cases. Other conventional modifiable risk factors were seen as follows: hypertension 98 (61.2 %), cigarette smoking 95 (59.4%), alcohol use 43 (26.9%), left ventricular hypertrophy 44 (27.5%), atrial fibrillation 37(23%), elevated triglyceride 37(23%), diabetes mellitus 15 (9.3%) and elevated total cholesterol 12 (7.5%). Multiple risk factors (=2) were seen in 122 (76.5 %) cases. CONCLUSIONS: The maximum occurrence of stroke was seen in patients > 60 years. Overall male preponderance and higher occurrence of haemorrhagic stroke was seen in our study. Significant risk factors in order of descending order were hypertension, cigarette smoking, left ventricular hypertrophy, alcohol use, atrial fibrillation and elevated triglycerides.

An unusual presentation of acute coronary syndrome.

Acute coronary syndrome in elderly can manifest with a variety of atypical presentation and may be associated with other comorbid conditions. We present an atypical presentation of ACS in an elderly left handed female presenting with sudden onset of slurred speech preceded by dizziness and vomiting. After through clinical examination and investigation she was managed as a case of non ST elevation myocardial infarction and ischaemic stroke.

Tuberculosis diagnosed / managed at NGMC, Teaching Hospital, Kohalpur: a joint private-public effort.

INTRODUCTION: Medical colleges both in public and private sector in Nepal have been supporting national TB control program (NTP) in its effort to control TB and its eventual elimination. Official collaboration between Nepalganj Medical College (NGMC), a private sector medical college and NTP was developed in 2000; a joint private-public initiative to contain TB. OBJECTIVES: This study has been done with the objectives a) to review the TB cases diagnosed/managed at NGMC Teaching Hospital (TH), Kohalpur, in Financial Year 2063/2064 (Shrawan 63 Asad 64) and b) to assess the contribution of NGMC, TH, Kohalpur towards TB control. METHODOLOGY: This is record based review of TB cases diagnosed, categorized, treated at NGMC TH, Kohalpur and referred to respective health facilities in Financial Year 2063/2064 (Shrawan 63 Asad 64). And case detection with respect to detected TB cases in Midwestern Region and entire country. RESULTS: Around 13% of detected TB cases for Mid Western Region and 1.5 % of detected TB cases at national level were diagnosed at NGMC, TH, Kohalpur. 35% of cases were of pediatric TB; lymph node TB, pleural effusion & abdominal TB were common form of extra pulmonary (EP) TB seen in children. 20.8%, 44.8% and 34.4% of cases in adults were of sputum smear (SS) + pulmonary TB (PTB), SS- PTB & EPTB respectively; pleural effusion, lymph node TB, Miliary & abdominal TB were common form of EPTB seen in adults. CONCLUSION: Contribution of NGMC, TH, Kohalpur towards case detection seems to be significant. The role of medical colleges in TB control can not be underestimated.

Situs inversus with dextrocardia with multiple cardiac lesions in adult.

Situs inversus with dextrocardia is the malposition most likely to occur with structurally normal heart; generally discovered on routine chest x-ray or physical examination performed for other reasons. These persons experience normal longevity of life and have similar risk of getting acquired disease as that of other person of same age and sex group. Symptoms related to acquired disorder may also lead to discovery of such cardiac malposition. Incidence of congenital cardiac anomalies in dextrocardia with situs inversus is very low globally but its figure in Nepal is not known. We report an adult of 43 years age having situs inversus with dextrocardia associated with multiple cardiac lesions i.e. ventricular septal defect, aortic regurgitation, mitral regurgitation and tricuspid regurgitation.

Human neurocysticercosis managed at Nepalganj Medical College, Teaching Hospital, Kohalpur, Nepal.

INTRODUCTION: Neurocysticercosis is the most common parasitic infection of the central nervous system. It is endemic in Central Europe, South Africa, South America and parts of Asia including Nepal. OBJECTIVE: This study has been conducted with the objectives to know the diagnostic criteria for neurocysticercosis and the outcome of treated cases. METHODOLOGY: This retrospective study was done at Nepalganj Medical College, Teaching Hospital, Kohalpur, by reviewing the record of the patients managed as case of neurocysticercosis in one financial year. RESULTS: All patients presented with seizure as a main symptom started in adult life. The mean age was 21 years; 80% were male and 20% female. The diagnosis seemed to be based on clinical presentation, CT scan findings and high index of suspicion. All were put on albendazole, steroids and anticonvulsant drugs; 93% was discharged when fits got controlled, one patient left against medical advice. Follow up record was not available to comment on resolution. CONCLUSION: Neurocysticercosis is difficult to diagnose and has a significant socioeconomic impact because of chronic morbidity, variable mortality, decreased productivity of affected persons, and high cost of medical diagnosis and treatment. It is therefore suggested to develop criteria for diagnosis of neurocysticercosis to be followed at national level.

Tuberculosis: an unusual presentation.

Patient with tuberculosis may present with atypical, unusual or complex features. The reported case is of 31 years lady admitted with fever, breathlessness and features of cardiac failure. She was detected to have right lower lung consolidation, minimal bilateral pleural effusion, features suggestive of sub-acute pericarditis and subsequent chest x-ray revealed miliary mottling as well. Later on Acid Fast Bacilli were detected in sputum and pleural fluid. Clinicians need to keep complex presentation of TB in mind to manage the case at its earlier stage to avoid residual complication.