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

Determinants and Impact of Giardia Infection in the First 2 Years of Life in the MAL-ED Birth Cohort

Background. Giardia are among the most common enteropathogens detected in children in low-resource settings. We describe here the epidemiology of infection with Giardia in the first 2 years of life in the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED), a multisite birth-cohort stu dy. Methods. From 2089 children, 34 916 stool samples collected during monthly surveillance and episodes of diarrhea were tested for Giardia using an enzyme immunoassay. We quantified the risk of Giardia detection, identified risk factors, and assessed the associations with micronutrients, markers of gut inflammation and permeability, diarrhea, and growth using multivariable linear regression. Results. The incidence of at least 1 Giardia detection varied according to site (range, 37.7%–96.4%) and was higher in the sec - ond year of life. Exclusive breastfeeding (HR for first Giardia detection in a monthly surveillance stool sample, 0.46 [95% confidence interval (CI), 0.28–0.75]), higher socioeconomic status (HR, 0.74 [95% CI, 0.56–0.97]), and recent metronidazole treatment (risk ratio for any surveillance stool detection, 0.69 [95% CI, 0.56–0.84]) were protective. Persistence of Giardia (consecutive detections) in the first 6 months of life was associated with reduced subsequent diarrheal rates in Naushahro Feroze, Pakistan but not at any other site. Giardia detection was also associated with an increased lactulose/mannitol ratio. Persistence of Giardia before 6 months of age was associated with a −0.29 (95% CI, −0.53 to −0.05) deficit in weight-for-age z score and −0.29 (95% CI, −0.64 to 0.07) deficit in length-for-age z score at 2 years. Conclusions. Infection with Giardia occurred across epidemiological contexts, and repeated detections in 40% of the children suggest that persistent infections were common. Early persistent infection with Giardia , independent of diarrhea, might contribute to intestinal permeability and stunted growth

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