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Background: Rational use of analgesic drugs is needed for immediate relief of pain. This study was conducted to find out the prescribing pattern of analgesics in the emergency department. Materials and Methods: A descriptive cross-sectional study among patients attending the emergency department of a tertiary care hospital from March 2022 to February 2023 after approval from the Institutional Review Committee. Demographic profile, indications for analgesics use, route, and frequency of administration were recorded based on the pre-structured questionnaires. Convenient sampling was done. Data were analyzed by using SPSS, version 20. Results: Prescription patterns of analgesics were analyzed in 325 patients. The mean age was 46.93 ± 17.79 years with a male predominance of 196 (60.6%). Orthopedic problems 99(30.5%) due to trauma were the most common indications followed by medical and surgical indications for analgesic use. Non-steroidal anti-inflammatory drugs were used in 46.6%, opioids in 26.8%, combinations in 23%, and antispasmodics in 3.6%. Commonly prescribed analgesic was ketorolac (27.4%), tramadol (19.7%), and diclofenac (11.4%). The most common combination was ketorolac and tramadol (14.5%). Paracetamol alone was used in 16 (4.9%). A prescription with a generic name was 149 (45.8%). Parenteral use accounted for 86.8%. Co-administration of gastroprotective drugs was used in 93.2%. A fixed-dose combination was used in 1.2%. Conclusion: Non-steroidal anti-inflammatory drugs are the commonly used analgesics for various indications, including acute pain and fever. The choice of analgesics and their prescription pattern varied depending on indications, medical history, and the presence of co-morbidities. Ketorolac and tramadol were the most commonly prescribed analgesics.

Introduction: Sodium-glucose co-transporter 2 inhibitors were initially used in the treatment of type 2 diabetes mellitus and subsequently, it was shown to be useful in heart failure among patients with or without diabetes mellitus. This study aimed to find out the prevalence of empagliflozin use among patients with heart failure in an outpatient department of medicine in a Tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with heart failure attending the outpatient Department of Internal Medicine from 1 December 2022 to 30 May 2023 after obtaining ethical approval from the Institutional Review Committee. All patients with heart failure in the given study period were included. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 550 patients, 188 (34.18%) (30.22-38.15, 95% Confidence Interval) received empagliflozin. The mean age was 55.11±9.99 years. A total of 124 (65.95%) were male. The mean duration of use was 104.97±63.16 days. Among the adverse effects, electrolyte imbalance was present in 14 (7.44%), hypotension in 14 (7.44%), and acute kidney injury in 12 (6.38%). Conclusions: The prevalence of empagliflozin use among patients with heart failure was found to be lower than mentioned in the guidelines.

Background: One of the main complications of chronic kidney disease is anemia. Disorders of iron homeostasis seen in such patients make the management of anemia more challenging and risky. To obtain the desired result, erythropoietin and iron dose must be carefully regulated. The aim of the study is to find out the prevalence of anemia and level iron indices in patients of chronic kidney disease at a tertiary care hospital. Methods: A cross-sectional descriptive study was conducted on chronic kidney disease patients at a tertiary care center. Demographic data like age, sex, height and weight were collected with the help of using Performa. The hematological and biochemical study variables were assayed by blood sample of the patients in the clinical laboratory services. Data were analyzed by statistical package for the social sciences Version 20.0 Results: Out of 171 patients with chronic kidney disease, 162 (94.7%) were anemic, with the highest percentage 54 (31.5%) having hypertension. The median value with inter-quartile range of hemoglobin, serum iron, serum ferritin, TIBC and transferring saturation were 8.9 gm/dl (6.7-10.0), 115.0 (µg/dl) (60.0-140.0), 599.0 ng/ml (142.6-973.0), 279.0 µg/dl (250.0-342.0) and 41.0 % (22.0-53.0) respectively. Serum creatinine and eGFR were significantly correlated with hemoglobin and iron indices. Conclusions: The current study showed that anemia was more prevalent in patients of chronic kidney disease in our setting as compared to similar studies. Hypertension was the most common disease among them. The median value of parameters of iron profile except ferritin among them was within the reference limit. Keywords: Anemia; chronic kidney disease; iron

Introduction: Chronic kidney disease is a condition, which worsens the quality of life in many ways including thyroid disorder in many cases. The aim of the study was to find out the prevalence of subclinical hypothyroidism among chronic kidney disease patients admitted to the Nephrology Department of a tertiary care centre. Methods: A descriptive cross-sectional study was carried out on the patients diagnosed with chronic kidney disease at a tertiary care hospital from 15 May 2022 to 10 October 2022 after getting ethical approval from the Institutional Review Committee (Reference number: 621/2022). Pre-designed proforma was used to collect demographic data like age, sex, height and weight. Blood samples of the patients were analysed for thyroid function tests (triiodothyronine, thyroxine and thyroid stimulating hormone levels) by chemiluminescence immunoassay. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 156 study participants with chronic kidney disease, subclinical hypothyroidism was present in 34 (21.79%) (15.31-28.27, 95% Confidence Interval) patients. Conclusions: The prevalence of subclinical hypothyroidism amongst chronic kidney disease patients was found to be lower than in other similar studies conducted in similar settings.

Background: Prescription of rational drugs is needed to save critically ill patients. This study was conducted to assess the prescription patterns of drugs in the intensive care unit. Materials and Methods: A descriptive cross-sectional study among patients admitted in intensive care unit from March 2020 to February 2021 after approval from the Institutional Review Committee (ref no. 344 /2019). Demographic profile, prescription patterns, the average number of drugs used, route of administration, and duration of hospitalization were recorded based on the pre-structured questionnaires. Convenient sampling was chosen. Data were analyzed by SPSS, version 20. Results: Prescription patterns of 225 were analyzed. The mean age was 55.60 ± 20.16 years with a male predominance of 131(58.2%). Cardiac disorders 57(25.3%) were the most common admitting diagnosis followed by pulmonary, neurological, and kidney disorders. The average length of hospital stay was 4.14 days (range 1-38 days). A total of 887 drugs were prescribed. The mean number of drugs prescribed per patient was 7.71 ± 1.92. Parenteral drugs accounted for 81.39%. Antibiotics were prescribed to all patients. Intravenous fluids were given to 62.2% of patients, blood and blood products to 21.33%. Thromboprophylaxis was used in 15 (6.7%) patients. Seven hundred twenty-two (81.39%) drugs were injectables, 129(14.54%) were used by the oral or nasogastric route and 36 (4.05%) were inhaled drugs. Conclusion: Newer generations antibiotics were the most commonly prescribed drugs. Pantoprazole, Metoclopramide, and Hydrocortisone were the top three most commonly prescribed individual drugs. There was marked underuse of thromboprophylaxis, analgesics, and sedatives.

Introduction: Diarrhoea is an important cause of morbidity and mortality among young children. It is reported that a large number of under five-year children still die of diarrhoea in Nepal. Nepal is striving for reducing childhood mortality by two thirds. The aim of this study is to find out the prevalence of diarrhoea among children under five years of age in a village development committee. Methods: This was a descriptive cross-sectional study performed among 356 children below 5 years of age residing in the Village Development Committee between January, 2018 and December, 2018 after getting ethical approval from the Institutional Review Committee (Reference number: 209/2017). A semi-structured questionnaire was used to collect the demographic data and other pertinent information. Convenience sampling was done. The data were entered into Microsoft Excel version 16.0 and analyzed using the Statistical Package for the Social Sciences version 23.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean with standard deviation for continuous data. Results: Out of 356 children less than five years of age, diarrhoea was prevalent in 156 (43.82%) (38.67-48.97 at 95% Confidence Interval). Eighty-six (55.12%) were males and 70 (44.87%) were females. Conclusions: The prevalence of diarrhoea in our study was higher when compared to similar studies conducted in similar settings.

Introduction: The cases of dengue fever have been reported more frequently in Nepal these days. The aim of this study was to find the prevalence of seropositivity among blood samples drawn from suspected dengue cases at a tertiary care centre of Nepal. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital from 1st June 2017 to 31st October 2018 after getting approval from the Institutional Review Committee (Reference number: 23/2016). A total of 537 suspected dengue patients were selected for the study using convenience sampling. These dengue positive sera were assayed for their reactivity with Immunoglobulin M and Immunoglobulin G present in sera and synthetic peptides of dengue virus by enzyme linked immunosorbent assay. Data was entered and analysed in Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation. Results: Among 537 suspected dengue cases, the seropositivity for dengue was found in 124 (23.09%) (19.52-26.65 at 95% Confidence Interval) of the serum. Conclusions: The present study revealed that dengue was more prevalent in our setting compared to similar studies. All the synthetic peptides showed reactivity with dengue-positive sera with maximum reactivity shown by RR2 peptide. In dengue-positive sera, RR2 peptide of dengue virus identified more Immunoglobulin M than Immunoglobulin G.

Background: Pancreatitis is well known for its painful state of illness causing a severe impact on the quality of life which can be followed by life-threatening long-term sequelae of diabetes mellitus and pancreatic cancer as its complications.The present study was conducted to evaluate biochemical findings and outcomes following treatment of ICU admitted patients suffering from pancreatitis in Nobel Medical College Teaching Hospital (NMCTH). Materials and Methods: All the patients admitted in the ICU of NMCTH from 15th January 2017 to 14th January 2018 having been diagnosed as suffering from pancreatitis were enrolled in this study. Age, sex, differential diagnosis, blood amylase and lipase level and outcomes of the treatment of the patients were measured as major variables. Blood amylase and lipase level of these patients were estimated in the department of Biochemistry, NMCTH by the standard protocols using Randoxkits, provided by the manufacturer. The study was carried out after getting the approval from Institutional review committee (IRC). Statistical significance was compared using Student's two-tailed t-test. Results were considered significant if p ≤ 0.05. Results: The number of patients admitted in ICU and suffering from pancreatitis was 136 out of 2204 total admission in ICU within a period of 1 year. Out of 136 pancreatitis patients, 44 were of biliary pancreatitis, 40 of alcoholic and 52 were patients of pancreatitis suffered from some other unknown factors. The mean age of the patients was 41.5±14.2 year. While analyzing the pancreatitis cases gender wise, it was found that male (N=80) were more sufferers than females (N=56). The mean ±SD value of blood amylase and lipase of these patients with pancreatitis were 1040±1062 IU/L & 442±425 IU/L respectively, which was significantly higher than the normal range. The maximum numbers of pancreatitis cases were seen in age group (30-39), (44 patients). It was found in our study that male patients were more sufferers of alcoholic pancreatitis than females; where as female patients were more in number among patients with biliary pancreatitis than males. The patients after getting the proper line of treatment, 88 of them recovered completely without any complication, 38 patients developed some complication, in which 26got recovered fully and 12 were referred. Mortality was seen in 10 patients. Conclusion: The results shows a very high prevalence rate of pancreatitis, the highest number being shared by those suffering from unknown factors followed by biliary pancreatitis and alcoholic pancreatitis in the descending order. In biliary pancreatitis, female patients are more whereas, the males are taking the major share among alcoholic pancreatitis. The level of the marker enzymes (amylase & lipase) are significantly higher than the normal confirming the cases to be of pancreatitis. Out of 136 patients, except for 12 cases referred and 10 patients died, all are fully recovered and discharged.

Introduction: Semen analysis is an initial basic step in evaluating and diagnosing male infertility. Multiple risks factors in combination or alone are responsible for abnormal semen parameters. The present study aimed to study certain risk factors and semen parameters of infertile male. Methods: It was a descriptive cross-sectional study. We consecutively enrolled 186 male partners of infertile couple who underwent certain risk factors evaluation and semen analysis according to WHO guideline. Results: Multiple risk factors were present like Gulf country migration, smoking, chemical exposure and heat exposure in infertile male partners. Forty six percent of our patients were gulf workers. Eleven percent patients had azoospermia, 27% had abnormal sperm morphology and 23% had

Background: Sepsis has been defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Sepsis is an important cause of mortality in intensive care unit worldwide. The study aims to identify the outcome of sepsis patient admitted at tertiary care hospital. Methods: This is a descriptive cross-sectional hospital based study on 76 adult patients admitted at intensive care unit of Nobel Medical College with diagnosis of sepsis with an objective of estimating mortality of sepsis and identifying associated symptoms with it. Baseline demographics, clinical and laboratory data were collected and analyzed. Results: Out of 76 patients with sepsis, mean age of the patients was 50.07±18.15 years. Majority of patients 31.6% with sepsis were above age groups >60 years. The most common symptoms among the patients were fever, which was seen in 69 (90.8%) patients. The most common source of infection in those patients was found to be unknown, which was seen in 36.8% of patients. While analyzing the outcome, it was noted that 25 patients with sepsis (32.9%) died during treatment. Conclusions: Sepsis is related with high mortality. Elderly patients are at more risk. Fever is the commonest presentation and source is not identified in majority of cases. Keywords: Intensive care unit; mortality; sepsis.

Introduction: Dyslipidemia is one of the major risk factors for acute coronary syndrome. Dyslipidemia with an increase in total cholesterol, low-density lipoprotein cholesterol, triglycerides and decrease in high-density lipoprotein cholesterol is one of the major risk factors for the acute coronary syndrome and alone account for more than 50% of population attributable risk. This study was conducted to find out the prevalence of dyslipidemia. Methods: This descriptive cross-sectional study was conducted in 105 patients admitted at the tertiary care center with a diagnosis of acute coronary syndrome from July 2018 to March 2019 after approval from the institutional review committee (Ref no. 205/2018). Fasting serum lipid profile was obtained within 24 hours of hospitalization with the convenient sampling method. Data were analyzed with the help of the Statistical Package for Social Sciences version 20. Point estimation at 95% Confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 105 people, dyslipidemia was present in 51 (48.6%). The mean age of the participants was 59.19±12.69 years. The majority 81 (77.1%) were male. The mean total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were 183.43±35.9 mg/ dl, 140.59±46.83 mg/dl, 109.9±26.38 mg/dl and 41.17±4.78 mg/dl respectively. High total cholesterol and triglyceride were found in 34 (32.4%) each, low high-density lipoprotein in 31 (29.5%) and high low-density lipoprotein in 22 (21%). Conclusions: Dyslipidemia is a significant risk factor in patients with acute coronary syndrome and commonly associated with other risk factors. Careful attention to its management may help to reduce further events.

Introduction: Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. Methods: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. Results: A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. Conclusions: Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.

Introduction: Acid base disorder is a condition characterized by alteration in blood pH by the imbalance between the components of blood leading to a life threatening situation. The aim of this study was to analyze the biochemical findings and the pattern of acid base disorder in critically ill patients. Methods: This is a descriptive cross-sectional study conducted on patients presented to emergency and other intensive care units of Nobel Medical College Teaching Hospital. Arterial blood gas analysis of such patients was carried out by il5 blood gas and chemistry automated analyzer in the department of Biochemistry, clinical laboratory services. The data were analyzed in MS excel. Results: Arterial blood gas analysis of 1144 patients was done, 426 patients were normal without acid base disorder. Simple and mixed acid base disorder was observed in 332 and 386 patients respectively. The number of male and female suffering with the disorder was 403 and 315 respectively. Respiratory alkalosis was most common (134 cases) in simple acid base disorder whereas metabolic acidosis and respiratory alkalosis (204 cases) was most common in mixed acid base disorder. All types of disorders were observed more in elderly people (41-60 and > 60 age group). Chronic obstructive disease was the most common (147 cases) diagnosis among the patients. Death was reported in 43 cases whereas 397 patients were discharged with cure and 278 were referred to higher centers. Conclusions: Acid base disorder was found to be more common in very ill patients in emergency and intensive care units. Mixed acid base disorder was the most common with male and elderly patients in predominance. Chromic pulmonary obstructive disease was the most frequent diagnosis in such patients. Death was observed more in mixed metabolic acidosis and respiratory alkalosis.

Introduction: The major emotions such as fear, anger, joy and sadness are created through a complex mechanism in the temporal lobe combining data from all the sensory inputs to the brain. However, these emotions may turn into extreme manifestations when the hypothalamus and the autonomic nervous system transform these emotions to panic, rage, orgasm/laughter and grief. The Papez circuit which is at play for this “different turn” may be inactivated or could be over ridden by forebrain activity, that is, sequencing. This probably was the reason to the old adage of counting to ten when one is emotional. In this article, we hope to look at the basis and the neurology behind this and formulate a method to overcome panic. Materials & Methods:A pilot study of 10 children aged 10 -16 was done on 16th October 2017. These children were shown pictures inducing fear and anger. A Visual Analogue Score (VAS) was used to determine the induced emotion. Next, the children were made to do sequencing tasks like mathematical calculations while viewing the similar graphics again. The new score was recorded and the data analyzed. Results: The most frequently recorded VAS (n=4) before sequencing was around 6.0, and between 3.0-3.5 post sequencing. The mean VAS without sequencing was 6.19 ± 0.91, which reduced to 3.65 ± 0.665. On comparing the individual VAS scores before and after sequencing, there was a general trend of a decreased VAS post-sequencing. The results were statistically significant with a p-value

Background Diabetes Mellitus (DM) is one of the most common health problem characterizd by hyperglycemia. Type II Diabetes Mellitus is the most common one. Diabetic nephropathy is the most common clinical condition arises with in these patients which progressively leads to impairment in kidney’s function. Measurement of microalbumin in urine is the earliest dectactable stage of diabetic kidney disease. Material and Methods The total of 200 diabetic patients (112 males and 88 females) were enrolled and biochemical estimations including blood glucose level, serum creatinine, blood urea, urine albumin was conducted. Results Prevalance of microalbuminuria was 26 % in type II diabetic patients.Renal functions parameters like blood urea and serum ceratinine were higher in patients with positive microalbuminuria.60 % of diabetic patients are normoalbuminrics and rests 14% are proteinurics. Conclusion Various factors like increasing age, duration of diabetics, blood sugar level,blood urea, serum creatinine are the causes for microalbuminuria and proteinuria. Therefore, to rule out the early screening of diabetic kidney disease, DM patients should get routinely checked up with blood sugar level as well as renal profile test like serum creatinine, blood urea and albumin level in urine. Journal of Nobel Medical College Vol.5(2) 2016; 1-4

Background A study was conducted to evaluate Prostate specific antigen (PSA) level in different age group of patients in Nobel Medical College Teaching Hospital (NMCTH), Biratnagar, Eastern Nepal. Material and Methods A total of 1870 male patients (age 51-88), attending OPD in different departments of NMCTH, were sent to Clinical Laboratory Services for estimation of Prostate specific antigen from 1st January 2013 to 30thJune 2014 and recruited for this study after Institutional ethical approval. Blood serum of these patients was tested for Prostate specific antigen level by Chemiluminescence Immunoassay (CLIA). Mean value and standard deviation were calculated using Student’s two–tailed t–test. Analysis of data was performed using one– way ANOVA. Results are considered statistically significant if p ≤0.05. Results Out of 1870 patients, 178 patients showed significantly higher level of PSA in their serum when compared to normal individuals. Out of this 178, 37 were from age group of 51-60, 51 were from age group of 61-70, 42 were from age group of 71-80 and 48 were from age group of 81-88. The remaining 1692 patients were having PSA within normal limit. PSA was found to be elevated up to a maximum of 34.5 ng/ml in patient. PSA level of