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Kadel A, Kharal N, Sapkota S, Pokhrel P, Sharma AK, Bhattarai A, Raut M, Dubey RK, Tuladhar ET, Sharma VK, Niraula A. Antidiuretic hormone deficiency secondary to inactive hydrocephalus: a case report. J Med Case Rep 2024; 18:133. [PMID: 38555457 PMCID: PMC10981802 DOI: 10.1186/s13256-024-04467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Diabetes insipidus is a syndrome characterized by polyuria, which is almost always associated with polydipsia. The most frequent cause is central diabetes insipidus, which is the result of an inadequate secretion of the antidiuretic hormone, and diagnosis involves differentiating it from other causes of polyuria and polydipsia. CASE PRESENTATION Here, we present a clinical case of a previously healthy 13-year-old Nepali boy, who, in December 2022, was found to have intense polydipsia accompanied by polyuria. He had bilateral lower limb weakness at the time of presentation. Biochemical evaluation demonstrated raised serum sodium (181 mEq/L), serum creatinine (78 μmol/L), and serum uric acid (560 μmol/L) with suppressed serum potassium (2.7 mEq/L), which was the major concern to the clinicians. Further laboratory workup revealed an increased serum osmolarity (393.6 mOsm/kg) with reduced urine osmolarity (222.7 mOsm/kg). On contrast magnetic resonance imaging of the brain, a thick-walled third ventricular cyst with bilateral foramen obstruction, thin membrane-like structure at top of aqueduct of Sylvius with gross obstructive hydrocephalus (inactive), and compressed and thinned pituitary gland with no bright spot was observed. The laboratory findings, radiological findings, and case presentation provided the provisional diagnosis of diabetes insipidus due to hydrocephalus and third ventricular cyst. CONCLUSIONS Central diabetes insipidus due to hydrocephalus, though rare, can have serious complications including the predilection to develop a deficit of other pituitary hormones. Thus, even if hydrocephalus is dormant with normal intracranial pressure, it must be addressed during investigations of central diabetes insipidus.
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Affiliation(s)
- Anuradha Kadel
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Nikita Kharal
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Srijana Sapkota
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Prakash Pokhrel
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Arun Kumar Sharma
- Department of Paediatrics, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Aseem Bhattarai
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Mithileshwer Raut
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Raju Kumar Dubey
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Eans Tara Tuladhar
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Vijay Kumar Sharma
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Apeksha Niraula
- Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal.
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Lamichhane A, Pokhrel S, Thapa TB, Shrestha O, Kadel A, Joshi G, Khanal S. Associated Biochemical and Hematological Markers in COVID-19 Severity Prediction. Adv Med 2023; 2023:6216528. [PMID: 37900669 PMCID: PMC10602699 DOI: 10.1155/2023/6216528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/03/2023] [Accepted: 10/06/2023] [Indexed: 10/31/2023] Open
Abstract
Background The global threat of COVID-19 has created the need for researchers to investigate the disease's progression, especially through the use of biomarkers to inform interventions. This study aims to assess the correlations of laboratory parameters to determine the severity of COVID-19 infection. Methods This study was conducted among 191 COVID-19 patients in Sumeru Hospital, Lalitpur, Nepal. According to their clinical outcomes, these patients were divided into severe and nonsevere groups. Inflammatory markers such as LDH, D-dimer, CRP, ferritin, complete blood cell count, liver function tests, and renal function tests were performed. Binary logistic regression analysis determined relative risk factors associated with severe COVID-19. The area under the curve (AUC) was calculated with ROC curves to assess the potential predictive value of risk factors. Results Out of 191 patients, 38 (19.8%) subjects died due to COVID-19 complications, while 156 (81.7%) survived and were discharged from hospital. The COVID-19 severity was found in patients with older age and comorbidities such as CKD, HTN, DM, COPD, and pneumonia. Parameters such as d-dimer, CRP, LDH, SGPT, neutrophil, lymphocyte count, and LMR were significant independent risk factors for the severity of the disease. The AUC was highest for d-dimer (AUC = 0.874) with a sensitivity of 82.2% and specificity of 81.2%. Similarly, the cut-off values for other factors were age >54.5 years, D-dimer >0.91 ng/ml, CRP >82.4 mg/dl, neutrophil >78.5%, LDH >600 U/L, and SGPT >35.5 U/L, respectively. Conclusion Endorsement of biochemical and hematological parameters with their cut-off values also aids in predicting COVID-19 severity. The biomarkers such as D-dimer, CRP levels, LDH, ALT, and neutrophil count could be used to predict disease severity. So, timely analysis of these markers might allow early prediction of disease progression.
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Affiliation(s)
- Anit Lamichhane
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
- Department of Pathology, Sumeru Hospital Pvt Ltd., Lalitpur, Nepal
| | - Sushant Pokhrel
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | | | - Ojaswee Shrestha
- Department of Pathology, Sumeru Hospital Pvt Ltd., Lalitpur, Nepal
| | - Anuradha Kadel
- Department of Pathology, Sumeru Hospital Pvt Ltd., Lalitpur, Nepal
| | - Govardhan Joshi
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Sudip Khanal
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
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Kharal N, Kadel A, Sapkota S, Pokhrel P, Baidya S, Lamichhane M, Sharma AK, Tuladhar ET, Sharma VK, Niraula A. An interesting case of unintentional vitamin D toxicity in an infant due to erroneous supplement concentration: a case report. Ann Med Surg (Lond) 2023; 85:1971-1974. [PMID: 37228984 PMCID: PMC10205217 DOI: 10.1097/ms9.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/18/2023] [Indexed: 05/27/2023] Open
Abstract
Despite the rare occurrence of vitamin D toxicity in infants, increased use of vitamin D formulations as well as incorrect supplement concentration by manufacturing pharmaceutical companies, has contributed to an increased incidence of vitamin D toxicity. Over-the-counter vitamin D preparation constitutes variable concentrations that can render life-threatening consequences in children. Case presentation Here, we present a case of a 2.5-month-old infant presenting with failure to thrive. The clinical presentations were nasal blockage, noisy breathing, poor feeding, lethargy, dehydration, and fever for 3 days with decreased appetite. Her urine culture report showed a urinary tract infection. The biochemical evaluation demonstrated raised total serum calcium (6.0 mmol/l) and serum 25-hydroxy vitamin D (>160 ng/ml) with suppressed parathyroid hormone concentration (3.7 pg/ml), which was the major concern to the clinicians. On ultrasonographical examination, nephrocalcinosis was observed. Further evaluation unveiled that the vitamin D supplement administered to the infant constituted a deucedly high dose of 42 000 IU instead of the recommended dose of 0.5 ml of 800 IU. Clinical discussion The patient developed vitamin D toxicity after consuming a mega dose of vitamin D supplements due to a manufacturer error. Conclusions Hypervitaminosis D has severe life-threatening consequences like failure to thrive in otherwise healthy-born infants. Regular monitoring of vitamin D supplements administered in infants by medicinal practitioners and strict supervision of all stages of the production process by pharmaceutical companies is crucial to prevent complications from supplement overdose.
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Affiliation(s)
| | | | | | | | | | - Machhindra Lamichhane
- Department of Pediatrics, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Arun K. Sharma
- Department of Pediatrics, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
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Baidya S, Kandel P, Rajkarnikar S, Kadel A, Niraula A, Dubey RK, Lamichhane M, Raut M, Bhattarai A, Tuladhar ET, Sharma VK. Porphyria: a case report. J Med Case Rep 2022; 16:490. [PMID: 36575494 PMCID: PMC9795741 DOI: 10.1186/s13256-022-03708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/04/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prompt diagnosis of metabolic disorders in a resource-limited country like Nepal is daunting. Acute intermittent porphyria is a rare but common hepatic porphyria mostly seen in females of the reproductive age group. As its incidence is quite uncommon, conjectures about porphyria diagnosis are often duped into a diagnostic conundrum. CASE PRESENTATION Here we unravel a case of a 15-year-old Hindu Nepalese girl distraught by the myriad of symptoms in the setting of severe abdominal pain accompanied by constipation and limb pain as the chief complaints. She presented with acute severe hypertension with marked persistent hyponatremia (up to 109 mEq/L). Despite conservative management of hypertension and electrolytes, unresolved electrolyte imbalance led us to the speculation of disturbance in the renin-angiotensin-aldosterone system. Due to her exacerbating neurovisceral status, she also required intensive care during the disease course. After thorough investigations and exemption of presumed provisional diagnoses, based on sustained symptomatic presentation, the clinical suspicion was driven towards a diagnosis of porphyria-related disorders. Positive Watson-Schwartz test substantiated the diagnosis of acute intermittent porphyria. Her symptoms gradually abated after the consumption of high carbohydrate diets. CONCLUSION This case highlights the baffling amalgamation of symptoms that simulate common diseases of concern yet are buried in the realm of porphyric disorders. Porphyria can be diagnosed using simple screening tools and timely treatment can diminish serious consequences.
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Affiliation(s)
- Sujata Baidya
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Pratibha Kandel
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Smrity Rajkarnikar
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Anuradha Kadel
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Apeksha Niraula
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Raju Kumar Dubey
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Machhindra Lamichhane
- grid.80817.360000 0001 2114 6728Department of Paediatrics, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Mithileshwer Raut
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Aseem Bhattarai
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Eans Tara Tuladhar
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Vijay Kumar Sharma
- grid.80817.360000 0001 2114 6728Department of Clinical Biochemistry, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
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Rauniyar BK, Kadel A, Thakur K, Adhikari RB, Limbu D, Acharya K, Rajbhandari S, Kansakar S, Malla R, Adhikari CM, Maskey A, Rajbhandari R. Spectrum of coronary angiographic findings in patients with ST Elevation Myocardial Infarction (STEMI) undergoing primary PCI in a tertiary care center of Nepal. Ann Cardiol Angeiol (Paris) 2021; 71:32-35. [PMID: 33637314 DOI: 10.1016/j.ancard.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Even in developing countries like Nepal, prevalence of ST-elevation myocardial infarction has been shown to be increased with rise in prevalence of conventional risk factors like diabetes, Hypertension, smoking, dyslipidemia and obesity. Our aim is to retrospectively analyze for various risk factors and angiographic patterns of coronary artery disease in patients with ST-elevation myocardial infarction undergoing Primary Percutaneous Intervention. RESULTS During the period of 1 year (January 2019 to December 2019), 816 patients presented to our ER with acute STEMI, among them 437 (53.6%) patients underwent primary PCI strategy and among them 22 (5.3%) patients were died. Thirty-six (4.4%) patients received thrombolysis, among them 5 (13.9%) patients were died while remaining 343 (42.0%) patients were managed conservatively and among them 20 (5.8%) were died. The mean age of patient who underwent primary PCI was 58.5±12.7 years range from 25 years to 99 years. Among them 55-75 years old 217 (49.6%) were highest in number followed by<55 years old 180 (41.2%). Males 318 (72.8%) were predominant. Among those who underwent primary PCI, hypertension 214 (49%) was the most common risk factor, followed by smoking 198 (45.3%), diabetes mellitus 123 (28.1%), dyslipidemia 53 (12.1%) and family history of premature coronary artery disease 18 (4.1%). Among those patients, 292 patients (66.8%) had single vessel disease, 99 patients (22.7%) had double vessel disease, 41 patients (9.3%) had triple vessel disease and 5 patients (1.1%) had non-significant coronary artery stenosis. Left anterior descending (53.3%) was the most frequently found culprit artery, followed by right coronary artery, left circumflex, ramus intermedius and left main artery. CONCLUSION Fifty percent of patients presented with acute ST-elevation myocardial infarction and underwent primary PCI were between 55-75 years of age. Hypertension and smoking were the most common risk factors present in those patients. Single vessel disease was most prevalent with left anterior descending found to be the most commonly involved coronary artery followed by right coronary artery and left circumflex.
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Affiliation(s)
- B K Rauniyar
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - A Kadel
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - K Thakur
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R B Adhikari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - D Limbu
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - K Acharya
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - S Rajbhandari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - S Kansakar
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R Malla
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - C M Adhikari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - A Maskey
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R Rajbhandari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
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