Assessment of patients presenting in shock at emergency department in a tertiary care teaching hospital Hospital

IIntroductions: Clinical profile of patient presenting with shock is important in early recognition and intervention to improve outcome especially in resource limited setup. This study is designed with an objective to evaluate history, clinical findings, laboratory findings and provisional diagnosis of patient presenting with shock. Methods: This was cross sectional observational study conducted at Patan Hospital emergency department from September to November 2014. All consecutive patients presenting with shock were included in this study during that period of time. Patient’s demography, clinical profile, provisional diagnosis and treatment were analyzed. Results: In two month period, 40 patients presented with shock to the emergency. Out of them 21(53.3 %) were female and 17(47.7%) were male. Commonest presenting complain was fever and shortness of breath 12(31.6%) each, shortness of breath followed by diarrhea 6(13.4%) and shortness of breath 5(13.2%). The diagnosis was as follows; septic shock 17(44.7%), hypovolaemic shock 10(26.3%), cardiogenic shock 7(18.4%) and unclassified 4(10.5%). Out of 17 patients with septic shock, 12 patient had pneumonia. Mean duration of stay in emergency was 100.6 minutes, minimum 30 minutes and maximum 225 minutes. Mean fluid given in emergency was 2328.9 milliliters, minimum 1000 millilitres and maximum 5000 millilitres. Conclusions: Sepsis was an important cause of shock in the emergency department. Pneumonia was common cause of sepsis and chronic obstructive pulmonary disease was common underlying condition. Keywords: emergency, lactate, shockÂ

Keraunoparalysis, a neurological manifestation after lightning strike: a case Report

Lightening strike can have wide range of physical and neuropsychiatric symptoms. Burn, extensive tissue damages, cardiac rhythm disturbances and secondary injuries are well described and observed. The patient may also go through transient neurological symptoms, which may go unseen in some cases while in some cases it may get extra attention and series of investigations. Keraunoparalysis is one of the immediate neurological complications encountered after lightning strike. This manifests as transient self-limiting symptoms. Keywords: keraunaparalysis, lightning, neurological symptom

Digital learning Initiatives, Challenges and Achievement in Higher Education in Nepal Amidst COVID-19

The COVID-19 pandemic has affected higher education institutions (HEIs) worldwide and reshaped the existing educational system. Due to travel constraints and physical separation, there has been a global shift toward distance learning, and Nepal is no exception. This research intends to assess the practicality of online education by evaluating learners' experiences amidst COVID-19. A cross-sectional study was directed among HEIs students in Nepal using self-structured questionnaires. Our study revealed that 64.6% of the respondents were unsatisfied with online classes. More than half of the respondents (53.4%) use cell phones for online studies. Online education was reported to be unappealing to 28.8% of respondents. Variables such as age group (p = 0.05), enjoying class (p < 0.001), hours spent for an online class in a day (p = 0.05), and period for educational work using an electronic device (p = 0.1) were found significant with satisfaction level using both bivariate test and inferential test of univariate binary logistics regression. The challenges and opportunities encountered among students and faculties are highlighted along with the recommendations for fortifying communication in online-based teaching/learning

Bacteriological Etiology and Antibiotics Susceptibility Pattern in Blood Samples from the Patients Attending Emergency Department of a Tertiary Care Hospital, Nepal

Background: Bacteriological aetiology and its culture sensitivity pattern is an important parameter for evaluating antibiotic use in Emergency Department. Blood-stream infections cause significant morbidity and mortality, increase in length of hospital stay and increased cost of care. Frequent inappropriate antibiotic use contributes to emergence of drug-resistant bacteria pathogens. Objectives: The objective of this study was to identify likely etiologic agents’ and antibiotic sensitivity profile of bacteria from blood stream infection in Emergency Department of Patan Hospital. Methodology: The study was conducted at tertiary care hospital from July to August 2014  blood culture was done and  antibiotic susceptibility test was performed following Kirby Bauer disc diffusion technique and growth and sensitivity pattern of organisms isolated were analyzed.   Results: There were 282 blood culture sent from the Emergency Department. The most common bacterial isolates were Enterobacter species. Second most common bacteria were Streptococcus pneumoniae.  Enterobacter species was more sensitive to Chloramphenicol, Amikacin and Gentamycin. While Streptococcus pneumoniae was sensitive to most of the antibiotics, we also found that 65.3% bacterial isolates were resistant to Cephalosporin. Conclusion:  Contaminated blood samples were found higher therefore, emphasis should be given in reducing the contamination. Proper cleaning of skin with antiseptic and guidelines to draw blood for culture should be familiarized and strictly followed while drawing the blood and others from Emergency Department of Patan Hospital.  

Perspective of medical graduates from Patan Academy of Health Sciences on the management of COVID-19, during the initial phase of pandemic in Nepal: Perspective of medical graduate on management of COVID-19

Introduction: Nepal with a poor health infrastructure and resources when hit by the COVID-19 pandemic in 2020, the health system  and the health workers were not well prepared to handle the crisis.   Method: We conducted a survey during the initial phase of the pandemic (July-October, 2020) to understand the perspective of PAHS medical graduates on the management of COVID-19. A survey questionnaire was prepared in Google form and circulated through official group emails.   Result: Total 80 graduates participated in the survey of which 55(68.8%) were working in the country (36/55 working within the government health system) during the pandemic and 7(8.8%) were enrolled into residency program in the country. Of the participats 66% reported that their health facility was only partially prepared to take care of COVID-19 patients. The local government and the community of their workplace were reported as supportive for the efforts of the pandemic management by 30(37.7%) and 33(41.5%) respondents respectively. The graduates working during the pandemic were involved in various activities like swab collection (8), screening (30), critical care (37), patient education/counseling (41), managing non-COVID-19 patients (47) and administrative work (17).   Conclusion: Inadequate planning of service delivery, finance, risk communication and resources were identified as major lacking nationally while shortage of human resources, logistic and PPE were reported as the major lacking locally by the participating graduates. The fresh PAHS graduates were found to be contributing at their respective workplaces fitting into both the clinical and non-clinical roles during the initial phase of pandemic in Nepal. &nbsp

A synergy of linear model and wavelet analysis towards space-time characterization of aerosol optical depth (AOD) during pre-monsoon season (2007–2016) over Indian sub-continent

The pre-monsoon aerosol concentration plays a significant role in modifying precipitation amount over the Indian sub-continent. A large variety of aerosol from different sources produces a complex radiative and climate response through the interaction with the hydrometeorological parameters. In this study, we analyzed the space-time dynamics of aerosol optical depth (AOD) in relation to the meteorological and surface parameters over Indian sub-continent during pre-monsoon season from 2007 to 2016. The level-3 daily aerosol products from Moderate Resolution Imaging Spectroradiometer (MODIS) and Multi-angle Imaging Spectroradiometer (MISR) were used. The IMD gridded rainfall and temperature, ECMWF derived RH and wind velocity, and GLADS derived soil moisture data were also used at daily time scale. For the space-time model, the Mann-Kendall trend test and a pixel-based multiple linear regression were used, while, wavelet transformation was used on these daily observations for analyzing periodicities of AOD. The time-series average shows moderate to high AOD (0.4–0.8), including a consistent positive anomaly in the Indo-Gangetic basin (IGP) in north India. A significant inter-annual variation is also observed both in MODIS and MISR datasets. The trend statistics shows an increasing trend of aerosol concentration in the eastern and southern India. The linear regression shows a variable response of AOD with changing magnitude of meteorological factors. However, a substantial spatial coverage of significantly decreased AOD is observed with increasing soil moisture content (β &lt; −0.04). The wavelet analysis manifests the abundances of 32–128 days of cycle with a periodic interjection of 8–32 days of cycle suggesting occurrence of fine and coarse mode aerosols events, respectively. The coherency of time series AOD and other covariates shows varying leading and lagging dynamics in these two principal periodicities. The findings, however, evidenced a notable difference in the space-time patterns of AOD in MODIS and MISR datasets. The analyzed AOD cycles are coincided with the Madden-Julian-Oscillation (MJO) that recurs every 30–60 days interval. The findings also support the theoretical proposition of elevated heat pump theory (EHP) driven by fine mode aerosols for occurring pre-monsoon and monsoon precipitation over the Indian sub-continent. The analyzed periodicity of AOD can provide useful insights in studying the short/long term variability of precipitation over polluted environments during the pre-monsoon season.</p

An Experience of Video Based Training on Basic Life Support

Introduction: Basic life support is foundation to save lives. In contrast to the developed countries, there is still no national standard BLS training module in Nepal. Basic life support training is being provided by various institutions but lack in consistency and coordination. The Nepal basic life support Course is the video based training in Nepali language with reference to recent advances which was intended for all health care personnel of Nepal in urban as well as rural setting. We aimed to describe the features of this video based training module in local language, to analyse the differences of knowledge and find out the participants perception and satisfaction with this course. Methods: This is a descriptive cross-sectional study based on data of trainings conducted over the study period. Ethical approval was taken. The post-test score was recorded and compared with the occupational using ANOVA. On the spot and delayed feedbacks from the participants were collected voluntarily and summarized. Results: Total of 576 participants (435 clinical doctors, 92 nurses/paramedics, 18 non-clinical doctors and 41 intern doctors) successfully completed the training. The difference in post test scores (mean = 12.9±1.8) among the different occupational background was not significant (P=0.159). The feedbacks from the participants were mostly positive and encouraging. Conclusions: The knowledge of basic life support improved significantly irrespective of the occupation of the participants. A universal, nationwide video based training module in Nepali language should be developed focusing all health care personnel of urban as well rural Nepal

A glimpse into the clinical proteome of human malaria parasites Plasmodium falciparum and Plasmodium vivax

Malaria causes a worldwide annual mortality of about a million people.Rapidly evolving drug-resistant species of the parasite have created a pressing need for the identification of new drug targets and vaccine candidates. By developing fractionation protocols to enrich parasites from low-parasitemia patient samples, we have carried out the first ever proteomics analysis of clinical isolates of early stages of Plasmodium falciparum (Pf) and P. vivax. Patient-derived malarial parasites were directly processed and analyzed using shotgun proteomics approach using high-sensitivity MS for protein identification. Our study revealed about 100 parasite-coded gene products that included many known drug targets such as Pf hypoxanthine guanine phosphoribosyl transferase, Pf L-lactate dehydrogenase, and Plasmepsins. In addition,our study reports the expression of several parasite proteins in clinical ring stages that have never been reported in the ring stages of the laboratory-cultivated parasite strain. This proof-of-principle study represents a noteworthy step forward in our understanding of pathways elaborated by the parasite within the malaria patient and will pave the way towards identification of new drug and vaccine targets that can aid malaria therapy

A cross strain Plasmodium falciparum microarray optimized for the transcriptome analysis of Plasmodium falciparum patient derived isolates

Malarial parasite P. falciparum, an apicomplexan protozoan has a 23.3 MB nuclear genome and encodes ~5600 transcripts. The genetic diversity of the parasite within and across geographical zones is a challenge to gene expression studies which are essential for understanding of disease process, outcome and developing markers for diagnostics and prognostics. Here, we describe the strategy involved in designing a custom P. falciparum 15K array using the Agilent platform and Genotypic's Right Design methodology to study the transcriptome of Indian field isolates for which genome sequence information is limited. The array contains probes representing genome sequences of two distinct geographical isolates (i.e. 3D7 and HB3) and sub-telomeric var gene sequences of a third isolate (IT4) known to adhere in culture condition. Probes in the array have been selected based on their efficiency to detect transcripts through a 244K array experimentation. Array performance for the 15K array, was evaluated and validated using RNA materials from P. falciparum clinical isolates. A large percentage (91%) of the represented transcripts was detected from Indian P. falciparum patient isolates. Replicated probes and multiple probes representing the same gene showed perfect correlation between them suggesting good probe performance. Additional transcripts could be detected due to inclusion of unique probes representing HB3 strain transcripts. Variant surface antigen (VSA) transcripts were detected by optimized probes representing the VSA genes of three geographically distinct strains. The 15K cross strain P. falciparum array has shown good efficiency in detecting transcripts from P. falciparum parasite samples isolated from patients. The low parasite loads and presence of host RNA makes arrays a preferred platform for gene expression studies over RNA-Seq