Background. Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that current... more Background. Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that currently lacks reliable diagnostic biomarkers. The meta-analysis is performed with an aim to evaluate the diagnostic potential of cerebrospinal fluid (CSF) total tau (t-tau), phosphorylated-tau (p-tau), and their ratio in ALS patients. Methods. A comprehensive search for literature published between the 1st of January 2000 and the 15th of May 2022 was performed in databases PubMed, medRxiv, and Google Scholar. The retrieved articles were first screened by title and abstract, and later, full-text screening was performed based on the eligibility criteria. Data on p-tau and t-tau levels and p-tau/t-tau ratio in ALS patients and controls were extracted, and a meta-analysis was performed using random-effects models in Review Manager version 5.4. Results. Data were analyzed from seven studies reporting p-tau and t-tau levels and their ratio among ALS patients and controls. The number of total study ...
Neurodegenerative disorders (NDD) are chronic neurological diseases characterized by loss and/or ... more Neurodegenerative disorders (NDD) are chronic neurological diseases characterized by loss and/or damage to neurons along with the myelin sheath, and patients are at higher risk of severe infection with the SARS‑CoV‑2. A comprehensive literature search was performed using relevant terms and inclusion‑exclusion criteria. Recent articles, subjects older than 50 years, and articles written in the English language were included, whereas letters to the editor and articles related to pregnant women were excluded from the review study. COVID‑19 appears to damage angiotensin‑II receptors which cause natural killer cells to lose the ability to clear virus‑infected cells, owing to worse outcomes in patients with NDD. COVID‑19 can worsen the symptoms of Alzheimer’s disease. In addition, COVID‑19 worsens drug‑responsive motor symptoms in Parkinson’s disease (PD) and other symptoms like fatigue and urinary complaints. Vitamin D is essential in decreasing pro‑inflammatory and increasing anti‑infla...
Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomp... more Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomplete blockage of the culprit artery, whereas ST elevation myocardial infarction is frequently thought to be caused by total occlusion of the culprit artery. The objective of the study was to find out the prevalence of occluded coronary arteries among non-ST elevation myocardial infarction patients department of cardiology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among non-ST elevation myocardial infarction patients in a tertiary care centre from 22 June 2020 to 21 June 2021 after taking ethical approval from the Institutional Review Committee [Reference number: 4271 (6-11) E2 076/077]. A total of 196 patients were included in the study by simple randomized sampling. Data on the patient’s clinical profile, angiographic findings, and in-hospital complications were recorded. Point estimate and 95% Confidence Interval were calculated. Results: Amo...
Autoimmune hepatitis is a rare form of chronic liver inflammation that begins as acute hepatitis ... more Autoimmune hepatitis is a rare form of chronic liver inflammation that begins as acute hepatitis and progresses to chronic liver disease. It presents with varied clinical features from acute hepatitis to chronic liver diseases like chronic viral hepatitis and alcoholic liver disease, making it difficult to diagnose in the absence of a high index of suspicion and adequate laboratory support. Autoimmune hepatitis is divided into two categories autoimmune hepatitis-1 and autoimmune hepatitis-2 based on the antibodies involved. We discuss the case of a 37-year-old woman who developed autoimmune hepatitis-1, with swelling and epigastric pain. These symptoms later progressed to liver cirrhosis leading to the death of the patient. Autoimmune hepatitis is extremely sensitive to immunosuppressive medication, it is necessary to maintain a high suspicion index for the disease because a prompt diagnosis can be an integral step toward a better prognosis of the disease.
Background and aim Sensorineural hearing loss (SNHL) is the commonest hearing disorder prevalent.... more Background and aim Sensorineural hearing loss (SNHL) is the commonest hearing disorder prevalent. Borrelia burgdorferi is a spirochete whose infection has been shown to result in SNHL. This systematic review aims to investigate the prevalence and association of B. burgdorferi infection in SNHL. Methods A systematic literature search on the databases PubMed, Google Scholar, and UpToDate® was performed. Study selection process was done in accordance with the PRISMA guideline. In brief, studies were selected first by title and abstract screening followed by a full-text inspection. The quality assessment of the included studies was performed using the Joanna Briggs Institute Critical Appraisal tool. Data on study characteristics, patient demographics, audiological, microbiological, symptomatological, and therapeutical findings were extracted. Results The study search retrieved a total of 8,772 studies and 9 of them met out eligibility requirement. There were altogether 964 SNHL patients...
Background: Rasmussen’s encephalitis (RE) is a rare chronic neurological disorder that presents w... more Background: Rasmussen’s encephalitis (RE) is a rare chronic neurological disorder that presents with progressive neurological and cognitive deterioration, and intractable seizures that lacks definitive management. We aimed to identify case reports of RE in the literature to assess the treatment based on the symptoms and outcomes after the treatment. Methods: We searched the databases PubMed, Google Scholar, and the Cochrane Library from 1990 to 22nd February 2022 in order to review the case reports that included the treatment options and clinical outcomes of RE. A pre-established protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (ID: CRD42021261999). Results: The mean age of onset of seizure was 31.44 and 6.87 years in adult onset RE and children (below 15 years of age) with RE respectively. A total of four (44.44%) out of nine adult patients and 81 (66.39%) out of 122 children underwent surgery. Tacrolimus was used in 17 (13...
AIM To report an another case of duodenal GIST in patient that was treated with Whipple procedure... more AIM To report an another case of duodenal GIST in patient that was treated with Whipple procedure. MATERIAL OF STUDY We report a case of 69 years old men that was admitted with melena. The preoperative investigations suggested a suspected duodenal GIST.A Whipple pancreatico-duodenectomy was performed. Only 3-5% of GISTs occur in the duodenum. DISCUSSION GIST were described as a separate entity by Mazur and Clark in 1983. These tumors are the most common among mesenchymal tumors of the gastrointeninal tract. The clinical presentations of duodenal GIST are highly variable. There is no consensus on the optimal surgical treatment of duodenal GIST.The aim was to achieve a R0-type surgery with complete en bloc surgical resection of the tumor and the surrounding tissue CONCLUSION: In conclusion the duodenal GIST are fairly rare. The clinical symptomatology is very variable even if frequently occur with digestive bleeding. the purpose of the surgery is the complete removal of the tumor (R0) however looking to perform minimum resections. KEY WORDS GI bleeding, GIST, Pancreaticoduodenectomy.
Bleeding disorders are a major group of hematological disorders, which are highly prevalent in th... more Bleeding disorders are a major group of hematological disorders, which are highly prevalent in the world. Excessive bleeding can result in serious consequences including hypoperfusion and cardiac arrest. The body has its selfmechanism to control excessive bleeding which is termed hemostasis. Hemostasis is achieved in two major steps, the formation of the primary and secondary hemostatic plugs. Endothelium, platelets, and coagulation factors are three components involved in hemostasis. Endothelium and platelets have a major role in forming the primary hemostatic plug. Consequently, the first step in investigating a bleeding disorder is platelet count. Despite normal platelet count, abnormality in the primary hemostatic plug may arise due to functional defects of the platelets including adhesion, activation, and aggregation. Von Willebrand disease (VWD) is an endothelial defect and the most prevalent inherited defect in coagulation. Abnormalities in the secondary hemostatic plug are l...
Background and objective. Numerous novel biomarkers have been proposed for the early diagnosis of... more Background and objective. Numerous novel biomarkers have been proposed for the early diagnosis of cardiovascular diseases. Measurement of the carboxyl-terminal (CT) fragment of IGFBP-4, the CT-IGFBP-4, has shown promising efficacy in cardiac risk assessment in various studies. We performed a systematic review of studies that accessed the utility and predictability of CT-IGFBP-4 in different ischemic cardiovascular events. Methods. The electronic databases PubMed, medRxiv, ScienceDirect, and Google Scholar were searched for relevant literature from inception to the 10th of December, 2021. Thus, retrieved literature was screened by title and abstract, followed by full-text screening based on the eligibility criteria. The risk of bias was accessed using the quality in prognostic studies (QUIPSs) tool. The data on cardiovascular outcomes about CT-IGFBP-4 levels were studied and the results were synthesized. Results. Five studies with a total of 1,417 participants were included in our st...
Introduction: Cerebral venous thrombosis (CVT) is a rare cause of stroke. The increased awareness... more Introduction: Cerebral venous thrombosis (CVT) is a rare cause of stroke. The increased awareness among the physicians and the suspiciousness of the myriad of its clinical presentation with increased availability of investigation modules and therapeutic options has led to a decrement of mortality and morbidity. The study intends to assess the clinical etiological profile of patients of CVT and also to assess short-term outcomes and if any factors are associated with it. Methods: It was a hospital-based retrospective, observational cross-sectional study at a tertiary care center in Kathmandu among adult CVT patients from August 2019 to August 2021. Clinical, etiological, and radiological data, the outcome at discharge, and any factors influencing this were assessed where possible. Data were analyzed using SPSS 25 software. Analysis of the descriptive data was performed and independent factors influencing short-term outcome (admission date < 7 days) were analyzed. Results: There we...
Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis that inflicts ... more Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis that inflicts high rates of morbidity and mortality. Differentiating a progressing encephalitis syndrome from a lobar hemorrhage as a complication presents a challenge and requires great vigilance and insight on part of the treating physician.
Interdisciplinary Perspectives on Infectious Diseases
Background. Patients infected with coronavirus disease 2019 (COVID-19) present with various clini... more Background. Patients infected with coronavirus disease 2019 (COVID-19) present with various clinical presentations with majority of them developing pulmonary complications. This study focuses on cardiac implications of COVID-19 which are less discussed and thus will help to address cardiac implications of COVID-19. Methods. PubMed, PubMed Central, and Google Scholar were screened for articles which mentioned cardiac implications of COVID-19. NHLBI Study Quality Assessment Tools for the observational cohort and cross-sectional studies was used for assessing the risk of bias of our studies. Results. All 14 studies selected were good and had score of ≥9 by NHLBI Study Quality Assessment Tools. Cardiac complications of COVID-19 are common. They are associated with significant mortality. Also, people infected with COVID-19 with premorbid conditions such as cardiovascular diseases and diabetes mellitus have poor prognosis as compared to those without premorbid conditions. Cardiac biomarke...
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Interdisciplinary Perspectives on Infectious Diseases
Background. The Centers for Disease Control and Prevention (CDC) identifies asthma as a comorbidi... more Background. The Centers for Disease Control and Prevention (CDC) identifies asthma as a comorbidity in COVID-19 that increases the risk of severity and death. However, research has shown that asthma is not associated with increased severity and death, thus making the consequences of asthma in COVID-19 unclear. Methods. We searched the electronic databases PubMed, WHO COVID-19 database, and Taylor and Francis Online for studies that compared the medical outcomes of COVID-19 between patients with and without asthma, from the emergence of SARS-CoV-2 in December 2019 to the 3rd of September 2021, excluded duplicates, reviews, editorials, and case reports, and screened the titles, abstracts, and full texts. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS) for nonrandomized studies. Rates of intensive care unit (ICU) admission, intubation, and death among patients with and without asthma were compiled and meta-analysis was conducted using a random-ef...
Background. Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that current... more Background. Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that currently lacks reliable diagnostic biomarkers. The meta-analysis is performed with an aim to evaluate the diagnostic potential of cerebrospinal fluid (CSF) total tau (t-tau), phosphorylated-tau (p-tau), and their ratio in ALS patients. Methods. A comprehensive search for literature published between the 1st of January 2000 and the 15th of May 2022 was performed in databases PubMed, medRxiv, and Google Scholar. The retrieved articles were first screened by title and abstract, and later, full-text screening was performed based on the eligibility criteria. Data on p-tau and t-tau levels and p-tau/t-tau ratio in ALS patients and controls were extracted, and a meta-analysis was performed using random-effects models in Review Manager version 5.4. Results. Data were analyzed from seven studies reporting p-tau and t-tau levels and their ratio among ALS patients and controls. The number of total study ...
Neurodegenerative disorders (NDD) are chronic neurological diseases characterized by loss and/or ... more Neurodegenerative disorders (NDD) are chronic neurological diseases characterized by loss and/or damage to neurons along with the myelin sheath, and patients are at higher risk of severe infection with the SARS‑CoV‑2. A comprehensive literature search was performed using relevant terms and inclusion‑exclusion criteria. Recent articles, subjects older than 50 years, and articles written in the English language were included, whereas letters to the editor and articles related to pregnant women were excluded from the review study. COVID‑19 appears to damage angiotensin‑II receptors which cause natural killer cells to lose the ability to clear virus‑infected cells, owing to worse outcomes in patients with NDD. COVID‑19 can worsen the symptoms of Alzheimer’s disease. In addition, COVID‑19 worsens drug‑responsive motor symptoms in Parkinson’s disease (PD) and other symptoms like fatigue and urinary complaints. Vitamin D is essential in decreasing pro‑inflammatory and increasing anti‑infla...
Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomp... more Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomplete blockage of the culprit artery, whereas ST elevation myocardial infarction is frequently thought to be caused by total occlusion of the culprit artery. The objective of the study was to find out the prevalence of occluded coronary arteries among non-ST elevation myocardial infarction patients department of cardiology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among non-ST elevation myocardial infarction patients in a tertiary care centre from 22 June 2020 to 21 June 2021 after taking ethical approval from the Institutional Review Committee [Reference number: 4271 (6-11) E2 076/077]. A total of 196 patients were included in the study by simple randomized sampling. Data on the patient’s clinical profile, angiographic findings, and in-hospital complications were recorded. Point estimate and 95% Confidence Interval were calculated. Results: Amo...
Autoimmune hepatitis is a rare form of chronic liver inflammation that begins as acute hepatitis ... more Autoimmune hepatitis is a rare form of chronic liver inflammation that begins as acute hepatitis and progresses to chronic liver disease. It presents with varied clinical features from acute hepatitis to chronic liver diseases like chronic viral hepatitis and alcoholic liver disease, making it difficult to diagnose in the absence of a high index of suspicion and adequate laboratory support. Autoimmune hepatitis is divided into two categories autoimmune hepatitis-1 and autoimmune hepatitis-2 based on the antibodies involved. We discuss the case of a 37-year-old woman who developed autoimmune hepatitis-1, with swelling and epigastric pain. These symptoms later progressed to liver cirrhosis leading to the death of the patient. Autoimmune hepatitis is extremely sensitive to immunosuppressive medication, it is necessary to maintain a high suspicion index for the disease because a prompt diagnosis can be an integral step toward a better prognosis of the disease.
Background and aim Sensorineural hearing loss (SNHL) is the commonest hearing disorder prevalent.... more Background and aim Sensorineural hearing loss (SNHL) is the commonest hearing disorder prevalent. Borrelia burgdorferi is a spirochete whose infection has been shown to result in SNHL. This systematic review aims to investigate the prevalence and association of B. burgdorferi infection in SNHL. Methods A systematic literature search on the databases PubMed, Google Scholar, and UpToDate® was performed. Study selection process was done in accordance with the PRISMA guideline. In brief, studies were selected first by title and abstract screening followed by a full-text inspection. The quality assessment of the included studies was performed using the Joanna Briggs Institute Critical Appraisal tool. Data on study characteristics, patient demographics, audiological, microbiological, symptomatological, and therapeutical findings were extracted. Results The study search retrieved a total of 8,772 studies and 9 of them met out eligibility requirement. There were altogether 964 SNHL patients...
Background: Rasmussen’s encephalitis (RE) is a rare chronic neurological disorder that presents w... more Background: Rasmussen’s encephalitis (RE) is a rare chronic neurological disorder that presents with progressive neurological and cognitive deterioration, and intractable seizures that lacks definitive management. We aimed to identify case reports of RE in the literature to assess the treatment based on the symptoms and outcomes after the treatment. Methods: We searched the databases PubMed, Google Scholar, and the Cochrane Library from 1990 to 22nd February 2022 in order to review the case reports that included the treatment options and clinical outcomes of RE. A pre-established protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (ID: CRD42021261999). Results: The mean age of onset of seizure was 31.44 and 6.87 years in adult onset RE and children (below 15 years of age) with RE respectively. A total of four (44.44%) out of nine adult patients and 81 (66.39%) out of 122 children underwent surgery. Tacrolimus was used in 17 (13...
AIM To report an another case of duodenal GIST in patient that was treated with Whipple procedure... more AIM To report an another case of duodenal GIST in patient that was treated with Whipple procedure. MATERIAL OF STUDY We report a case of 69 years old men that was admitted with melena. The preoperative investigations suggested a suspected duodenal GIST.A Whipple pancreatico-duodenectomy was performed. Only 3-5% of GISTs occur in the duodenum. DISCUSSION GIST were described as a separate entity by Mazur and Clark in 1983. These tumors are the most common among mesenchymal tumors of the gastrointeninal tract. The clinical presentations of duodenal GIST are highly variable. There is no consensus on the optimal surgical treatment of duodenal GIST.The aim was to achieve a R0-type surgery with complete en bloc surgical resection of the tumor and the surrounding tissue CONCLUSION: In conclusion the duodenal GIST are fairly rare. The clinical symptomatology is very variable even if frequently occur with digestive bleeding. the purpose of the surgery is the complete removal of the tumor (R0) however looking to perform minimum resections. KEY WORDS GI bleeding, GIST, Pancreaticoduodenectomy.
Bleeding disorders are a major group of hematological disorders, which are highly prevalent in th... more Bleeding disorders are a major group of hematological disorders, which are highly prevalent in the world. Excessive bleeding can result in serious consequences including hypoperfusion and cardiac arrest. The body has its selfmechanism to control excessive bleeding which is termed hemostasis. Hemostasis is achieved in two major steps, the formation of the primary and secondary hemostatic plugs. Endothelium, platelets, and coagulation factors are three components involved in hemostasis. Endothelium and platelets have a major role in forming the primary hemostatic plug. Consequently, the first step in investigating a bleeding disorder is platelet count. Despite normal platelet count, abnormality in the primary hemostatic plug may arise due to functional defects of the platelets including adhesion, activation, and aggregation. Von Willebrand disease (VWD) is an endothelial defect and the most prevalent inherited defect in coagulation. Abnormalities in the secondary hemostatic plug are l...
Background and objective. Numerous novel biomarkers have been proposed for the early diagnosis of... more Background and objective. Numerous novel biomarkers have been proposed for the early diagnosis of cardiovascular diseases. Measurement of the carboxyl-terminal (CT) fragment of IGFBP-4, the CT-IGFBP-4, has shown promising efficacy in cardiac risk assessment in various studies. We performed a systematic review of studies that accessed the utility and predictability of CT-IGFBP-4 in different ischemic cardiovascular events. Methods. The electronic databases PubMed, medRxiv, ScienceDirect, and Google Scholar were searched for relevant literature from inception to the 10th of December, 2021. Thus, retrieved literature was screened by title and abstract, followed by full-text screening based on the eligibility criteria. The risk of bias was accessed using the quality in prognostic studies (QUIPSs) tool. The data on cardiovascular outcomes about CT-IGFBP-4 levels were studied and the results were synthesized. Results. Five studies with a total of 1,417 participants were included in our st...
Introduction: Cerebral venous thrombosis (CVT) is a rare cause of stroke. The increased awareness... more Introduction: Cerebral venous thrombosis (CVT) is a rare cause of stroke. The increased awareness among the physicians and the suspiciousness of the myriad of its clinical presentation with increased availability of investigation modules and therapeutic options has led to a decrement of mortality and morbidity. The study intends to assess the clinical etiological profile of patients of CVT and also to assess short-term outcomes and if any factors are associated with it. Methods: It was a hospital-based retrospective, observational cross-sectional study at a tertiary care center in Kathmandu among adult CVT patients from August 2019 to August 2021. Clinical, etiological, and radiological data, the outcome at discharge, and any factors influencing this were assessed where possible. Data were analyzed using SPSS 25 software. Analysis of the descriptive data was performed and independent factors influencing short-term outcome (admission date < 7 days) were analyzed. Results: There we...
Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis that inflicts ... more Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis that inflicts high rates of morbidity and mortality. Differentiating a progressing encephalitis syndrome from a lobar hemorrhage as a complication presents a challenge and requires great vigilance and insight on part of the treating physician.
Interdisciplinary Perspectives on Infectious Diseases
Background. Patients infected with coronavirus disease 2019 (COVID-19) present with various clini... more Background. Patients infected with coronavirus disease 2019 (COVID-19) present with various clinical presentations with majority of them developing pulmonary complications. This study focuses on cardiac implications of COVID-19 which are less discussed and thus will help to address cardiac implications of COVID-19. Methods. PubMed, PubMed Central, and Google Scholar were screened for articles which mentioned cardiac implications of COVID-19. NHLBI Study Quality Assessment Tools for the observational cohort and cross-sectional studies was used for assessing the risk of bias of our studies. Results. All 14 studies selected were good and had score of ≥9 by NHLBI Study Quality Assessment Tools. Cardiac complications of COVID-19 are common. They are associated with significant mortality. Also, people infected with COVID-19 with premorbid conditions such as cardiovascular diseases and diabetes mellitus have poor prognosis as compared to those without premorbid conditions. Cardiac biomarke...
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Interdisciplinary Perspectives on Infectious Diseases
Background. The Centers for Disease Control and Prevention (CDC) identifies asthma as a comorbidi... more Background. The Centers for Disease Control and Prevention (CDC) identifies asthma as a comorbidity in COVID-19 that increases the risk of severity and death. However, research has shown that asthma is not associated with increased severity and death, thus making the consequences of asthma in COVID-19 unclear. Methods. We searched the electronic databases PubMed, WHO COVID-19 database, and Taylor and Francis Online for studies that compared the medical outcomes of COVID-19 between patients with and without asthma, from the emergence of SARS-CoV-2 in December 2019 to the 3rd of September 2021, excluded duplicates, reviews, editorials, and case reports, and screened the titles, abstracts, and full texts. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS) for nonrandomized studies. Rates of intensive care unit (ICU) admission, intubation, and death among patients with and without asthma were compiled and meta-analysis was conducted using a random-ef...
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