Journal of Medical Research and Innovation <p style="text-align: justify;">&nbsp;</p> <p style="text-align: justify;">The <em><strong>Journal of Medical Research and Innovation</strong></em>&nbsp;is a peer-reviewed, clinically oriented journal covering all aspects of Medicine including cellular biology, zoology and futuristic medicine (Robotics and Artificial Intelligence in medicine). The journal will feature original research, reviews, editorials, case studies, Brief Communications, Opinions/Views, Poster Presentations and Audios and Videos. This will be of interest to medical practitioners, clinical educators, nurse practitioners and other health care professionals involved in the care of patients.</p> <p style="text-align: justify;">The journal will publish at least three issues (Bi-Annually) each year (January and July). Articles are published online when ready for publication (Continuously) as Article in Press. Additional issues may be published for special events (e.g. conferences) and when special themes are addressed.</p> Varavime Health Care en-US Journal of Medical Research and Innovation 2456-8139 Valproic Acid-Induced Hyperammonemia with Encephalopathy (VIHE): A Case Report <div>Valproic acid (VPA) is a wide spectrum antiepileptic medication indicated for seizure prophylaxis across the spectrum of epilepsy. Since coming into clinical use, VPA has also been recommended for the management of a variety of other pathologies, including, most notably, mood stabilization in the manic patient. <br> VPA’s common adverse effects include gastrointestinal, influenza-like symptoms, headache, and difficulties with sleep; nonetheless, in rare instances, VPA has been noted to cause the severe and potentially lethal condition of hyperammonemia with encephalopathy (VIHE). <br> VIHE is the result of a dose-independent increase in ammonia levels. Often the patient is asymptomatic; if symptoms reach clinical threshold, lethargy is most common, though seizures, focal neurologic deficits and even coma are possible. VIHE can occur in patients despite normal hepatic function, normal loading doses, chronic stable doses and normal free serum drug levels. Once the diagnosis is confirmed, the first approach for symptomatic patients is to discontinue VPA, start alternative mood stabilizer as indicated, and supplement hyperammonemia treatment with lactulose, carnitine or carglumic acid. Below is a case report of VIHE that developed in an adolescent girl with a history of Bipolar I Disorder who was hospitalized in our facility for stabilization of mania.&nbsp; As demonstrated below, early diagnosis of VIHE is pivotal in reducing morbidity and ultimately can be life-saving.</div> <div><strong>Keywords:</strong> Valproic acid, Hyperammonemia, Encephalopathy</div> Yasar Sattar Benjamin Merotto Anthony Dedousis Muhammad Aadil Ahsan Zil-E-Ali ##submission.copyrightStatement## 2018-01-28 2018-01-28 2 1 e000108 e000108 10.15419/jmri.108 Editors and Reviewers Acknowledgement, 2(1), January-June, 2018 <div> <p>The Journal of Medical Research and Innovation would like to thank each and every one who has helped us to review and edit the articles. As a small token of appreciation, we would like to mention the names of all the editors and reviewers in random order here who have edited or reviewed the articles for the January-June, 2018 issue. The list will be updated as when more reviewers review the articles.</p> <h3><strong>Editors</strong></h3> <p>1) Varshil Mehta<br><br>2) Shakti Goel<br><br>3) Surya Parajuli<br><br>4) Nikhil Nalluri<br><br>5) <span id="cell-276-name">Vitaliy Bezsheiko </span></p> <h3><strong>Reviewers</strong></h3> <p>1) Shakti Goel</p> <p>2) <span id="cell-176-name" class="gridCellContainer"><span class="label">Assad Mughal </span></span></p> <p>3) <span id="cell-174-name" class="gridCellContainer"> <span class="label"> Harsha Makwana </span> </span></p> <p>4) <span id="cell-180-name" class="gridCellContainer"><span class="label">Megha Patel </span></span></p> <p>5) <span id="cell-197-name" class="gridCellContainer"> <span class="label"> Ishpreet Biji </span> </span></p> <p>6) <span id="cell-199-name" class="gridCellContainer"><span class="label">Surya Parajuli </span></span></p> <p>7) Varshil Mehta</p> <p>8) <span id="cell-201-name" class="gridCellContainer"> <span class="label"> Heera KC </span> </span></p> <p>9) <span id="cell-207-name" class="gridCellContainer"><span class="label">Prem Bhattarai </span></span></p> <p><span class="gridCellContainer"><span class="label">10) <span id="cell-206-name" class="gridCellContainer">Tushar Kunder </span></span></span></p> <p><span class="gridCellContainer"><span class="label">11) <span id="cell-211-name" class="gridCellContainer"> Akshay Avula </span></span></span></p> <p><span class="gridCellContainer"><span class="label">12) <span id="cell-240-name" class="gridCellContainer"> Mykola Khaitovych </span></span></span></p> <p><span class="gridCellContainer"><span class="label">13) <span id="cell-238-name" class="gridCellContainer"> K Bedmutha </span></span></span></p> <p><span class="gridCellContainer"><span class="label">14) <span id="cell-267-name" class="gridCellContainer">Mayank Jain </span></span></span></p> <p><span class="gridCellContainer"><span class="label">15) <span id="cell-268-name" class="gridCellContainer"> Joseph Bell </span></span></span></p> <p><span class="gridCellContainer"><span class="label">16) <span id="cell-276-name" class="gridCellContainer"> Vitaliy Bezsheiko </span></span></span></p> <p><span class="gridCellContainer"><span class="label">17) <span id="cell-281-name" class="gridCellContainer">Ahmad Farrokhi</span></span></span></p> <p><span class="gridCellContainer"><span class="label"><span class="gridCellContainer">18) N. Kumar</span></span></span></p> </div> Editorial Team ##submission.copyrightStatement## 2018-01-16 2018-01-16 2 1 e000110 e000110 10.15419/jmri.110 Prognostic importance of acute heart failure persistence in patients with ST-elevation myocardial infarction <p><strong>Introduction</strong><strong>:</strong> Acute heart failure (AHF) is one of the most frequent complication of acute myocardial infarction (AMI). It is not only associated with a several-fold increase of in-hospital mortality but also, worsens the long-term survival in comparison to those without AHF. The AHF is observed to be more in AMI patients whose in-hospital stay is more than 3 days. The clinical implications and prognostic accuracy of the AHF term in the setting of AMI are yet unknown.</p> <p><strong>Methods: </strong>We observed 1,104 consecutive cardiac care patients, who were admitted with ST-elevation AMI (STEMI). They were divided into groups according to the AHF presence {AHF(+) n=334 and AHF(-) n=764}. Among 334 AHF(+) patients: 252 patients were found to have a transient AHFt(+), whereas 82 of AHF(+) patients had persistent AHFp(+) during in-hospital period. &nbsp;Patients' baseline characteristics, blood analysis, left ventricle (LV) and renal function data were assessed and analyzed on the admission day and 10<sup>th</sup> day post-admission. The follow-up was conducted on the 30<sup>th</sup> day and after 2 years.</p> <p><strong>Results. </strong>STEMI patients accompanied by AHF(+) were older, presented mostly with anterior AMI (p&lt;0.01), had lower LV ejection fraction (EF) (p&lt;0.01) and a higher heart rate (p&lt;0.05). Their rates of comorbidities and of in-hospital complications such as recurrent angina, reinfarction, LV aneurism were higher in comparision to AHF(-) patients. AHFp(+) patients had the shortest time from symptoms onset before thrombolysis in comparision to AHFt(+) and AHF(-) groups. Partial recovery of cardiac function according to Left ventricular ejection fraction (LVEF) and end-systolic volume index, occurred mainly in AHF(-) and AHFt(+) patients on the 10<sup>th</sup> day post-admission, but not in AHFp(+).</p> <p>STEMI patients with AHFp(+) demonstrated a larger infarct size, higher C-reactive protein and VGEF level, fasting glucose and heart rate on admission, higher erythrocyte sedimentation rate, absence of heart rate normalization on the 10<sup>th </sup>day post-admission. All of these markers were the signs of severe myocardial damage and inflammation, which can reflect worse recovery in AHF patients despite optimal management. Patients with AHF(+) had renal dysfunction on admission while its creatinine clearance (CrCl) decreased during the in-hospital period which is the reflection of a poor prognosis.</p> <p>Сardiovascular mortality and non-fatal MI were significantly higher in the AHFp(+) group as compared to the AHFt(+) and the AHF(–) groups during the 30 days and 2 years of follow-up.</p> <p><strong>Conclusion</strong>: The AHF is a frequent STEMI complication. AHF lasting &gt;3 days had worse short- and long-term prognosis. Therefore, an aggressive strategy should be recommended particularly in patients who have clinical signs and symptoms of persistent AHF.</p> <p><strong>Keywords:</strong> myocardial infarction, acute heart failure, infarct size, survival.</p> Sergey Kozhukhov Alexander Parkhomenko Nataliia Dovganych ##submission.copyrightStatement## 2018-01-02 2018-01-02 2 1 e000100 e000100 10.15419/jmri.100 Clinical Profile of Ascites Based on Presentation and Laboratory Findings: An institutional experience from Kathmandu, Nepal <p><strong>Introduction: </strong>Ascites is the fluid collection in the potential space of the peritoneal cavity. Alcoholic liver disease and intra-abdominal malignancy are two major etiologies behind it. Also, diagnosis of tuberculous ascites should be thought of due to endemicity. Cirrhotic patients at any time during the course of disease, invariably present with ascites which is one of the marker of decompensation. In our context, etiology behind ascites and its correlation with symptoms and clinical findings not yet studied, so present study is conceptualized.</p> <p><strong>Methods:</strong>This is a cross-sectional retrospective descriptive hospital based record review of patients presented with ascites in a tertiary center of Kathmandu. One hundred fourteen patients with ascites under regular follow up of Shree Birendra Hospital (SBH) were reviewed. Data regarding presenting complaints, examination findings, relevant investigations during first visit and final diagnosis were retrieved from our own record keeping and recorded information were then evaluated.</p> <p><strong>Results: </strong>Patients having ascites have myriad of symptoms and signs, commonest clinical feature being icterus (74, 64.9%). Most of them were anemic at presentation. Forty-two (36.8%) had high blood urea and 36 (31.5%) with high creatinine suggesting approximately 30-40% cases presented with deranged renal function test. Ninety-three (81.5%) had raised total serum bilirubin. Similarly, PT/INR derangements were in 74 (64.9%) and 57 (50%) suggesting deranged liver function. Serum albumin was less than 3.5 gram/deciliter in 83(72.8%) cases. Among the patients studied, 80 (70.1%) had high Serum-Ascites Abumin Gradient (SAAG) suggesting transudative type of ascites and rest 34 had low SAAG suggesting exudative type of ascites. Overall assessment revealed, majority of patients (71.05%) had Chronic liver disease (CLD) as the cause of ascites.</p> <p><strong>Conclusions: </strong>Ascites due to chronic liver disease was the main finding with etiology supported by laboratory findings. Significant numbers of the patients had deranged renal function on top of liver function derangement, so these parameters need to be properly taken care of.</p> <p><strong>Key Words: </strong>Ascites, liver cirrhosis, serum ascetic albumin gradient.</p> Rinku Joshi Dhan Bahadur Shrestha Rajib Pande Sukriti Maharjan ##submission.copyrightStatement## 2018-01-02 2018-01-02 2 1 e000101 e000101 10.15419/jmri.101 Welcome to volume 2 of Journal of Medical Research and Innovation <div>It is my pleasure to introduce the first issue of volume 2 from&nbsp;<em>Journal of Medical Research and Innovation (JMRI)</em>. The entire JMRI team is excited to begin our second year journey of publishing good quality-research from across all the medical-related disciplines, all the way from the bench to the bedside. Although we have some quite interesting things planned for 2018, in this Foreword, we will have a look back over some important highlights from volume 1 and some achievements of JMRI from the year 2017.</div> <div><strong>Keywords:</strong> New year, look back, publishing.</div> Varshil Mehta ##submission.copyrightStatement## 2017-12-09 2017-12-09 2 1 e000106 e000106 10.15419/jmri.106