Perception of rotating interns on emergency medicine posting of undergraduate curriculum and future career

Introductions: Competency in basic knowledge and skill of emergency care is the fundamental goal of all the medical graduates irrespective of their specialty. The aim of this study is to understand the view of young doctors regarding the importance of emergency medicine (EM) both during internship and undergraduate MBBS curriculum. Methods: This was a descriptive cross sectional study conducted at emergency department, KIST Medical College, Lalitpur, Nepal, during 2016 to 2017. Interns were asked to fill up preformed questionnaires to explore the effectiveness of the posting and its necessity to integrate in undergraduate medical education. Results: All the respondent medical interns accepted emergency medicine posting was fruitful. Ninety-six (62.3%) thought one month Emergency Department (ED) posting as appropriate. All the participants thought EM should be included in the undergraduate curriculum (UG). Majority believed it would be appropriate in third year (42%) and final year (42%). One hundred and thirteen (73.4%) wanted to pursue emergency medicine career however 41 (26.6%) were reluctant. Conclusions:  All the interns surveyed accepted emergency medicine to be fruitful and should be included in the undergraduate curriculum with one month emergency department posting, and two thirds wanted to pursue it as future career. Keywords: emergency department posting, emergency medicine, perception of interns, undergraduate medical curriculu

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

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.  

Helicobacter pylori infection among patients with upper gastrointestinal symptoms: prevalence and relation to endoscopy diagnosis and histopathology

Aim: To determine the prevalence of H. pylori based on endoscopic biopsy and to investigate the association between H. pylori and endoscopy diagnosis and histopathological diagnosis. Materials and Methods: Over a period of two years, 228 endoscopic biopsies were included. Endoscopy diagnosis, histopathological diagnosis, and colonization with H. pylori were recorded and compared using appropriate statistical tests. Results: The overall prevalence of H. pylori was 68%; 69.6% in males and 66.7% in females. Duodenal and gastric ulcers were seen more in males (63.2% and 60%) compared with females (32.1% and 40%) (P < 0.001). The total rate of colonization of H. pylori in duodenal ulcer and gastric ulcer (85.7% and 84%, respectively) was significantly higher than those in gastritis, duodenitis, and gastric cancer (61.8%, 69.2%, and 60%, respectively) (P = 0.046). Histologically, chronic active gastritis and chronic follicular gastritis was significantly higher in duodenal ulcer and gastric ulcer (57.1%, 44% and 21%, 40%) in comparison to chronic persistent gastritis (21.4%, 16%) with P value < 0.001. Similarly, chronic active gastritis and chronic follicular gastritis had higher prevalence of H. pylori infection in comparison to chronic persistent gastritis (85.3%, 83.3% vs. 41.4%) with P value < 0.001. Conclusion: This study reveals that the overall prevalence of H. pylori infection is high in our setting with no significant difference in gender. Peptic ulcers were common in males. Those with peptic ulcers had higher rates of H. pylori colonization. Chronic active gastritis and chronic follicular gastritis were common histological findings in ulcerative diseases with significantly higher H. pylori positivity

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