Responding to changing case definition of COVID-19: experience from Patan Academy of Health Sciences, Nepal

It is important to track the changing case definition to plan for the clinical response. Transmission pattern of disease have been changing in COVID-19. Countries with no reported cases have moved on to sporadic, cluster of cases and then to community transmission. The response depends on how rapidly the transmission is changing in the country. Keyword: case definition, COVID-19, transmissio

Spirometry Findings in Patients with Chronic Obstructive Pulmonary Disease

Introductions: Clinical diagnosis of chronic obstructive pulmonary disease is often not accurate and treated for prolong duration. This study explores the use of pulmonary function test to confirm the diagnosis and further management of such patients.Methods: This was a cross sectional study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal. All patients coming for spirometry between June 2012 and May 2013 with the clinical diagnosis of chronic obstructive pulmonary disease were enrolled in the study.Results: Out of 338 patients with clinical diagnosis of chronic obstructivepulmonary disease that underwent spirometry, 80 (23.7%) patients had ratio of forced expiratory volume in one second and forced vital capacity less than 70%. Out of these 80 patients, 50 (14.8%) had irreversible airway obstruction and 30 (8.9%) had reversible airway obstruction. Patient with normal spirometry findings was 258(76.3%).Conclusions: Clinically diagnosed chronic obstructive pulmonary disease is best confirmed by spirometry for optimum management.Keywords: chronic obstructive pulmonary disease, pulmonary function, spirometr

Follow-up Study of Mortality after Clinical Protocol Based Intervention at Emergency of Patan hospital

Introductions: Decreasing the mortality of patients is one of the majorconcerns of emergency department. Mortality decreases after implementation of protocol based intervention. This follow up study has been done to see the benefit of protocol based approach.Methods: This was a cross sectional study conducted at emergency department of Patan hospital from January 2013 to June 2013. All records of patient with mortality were reviewed excluding those who were brought dead.Results: Total mortality in six months was 31. Mortality rate was 1.7 perthousand emergency visits. Mean duration of stay at emergency was fivehours, range 30 minutes to 25 hours. The common diagnoses at presentation were Pneumonia 12 (45.1%), Upper gastrointestinal tract bleeding 4 (13%), Hypoglycaemia 3 (9.7%) followed by blunt abdominal trauma, penetrating neck injury, pneumothorax, spinal shock, head injury and zinc phosphide poisoning 2 (6.5%) each. The most common causes of death were septic shock 9 (29%), hypovolaemic shock 7 (25.8%), respiratory failure 6 (19.4%), hypoglycaemia 3 (9.7%), cardiogenic shock, raised intracranial pressure and spinal shock 2 (6.5%) each.Conclusions: Protocol based management are important tools to decrease mortality but it is not the only factor that decreases the mortality.Keywords: clinical protocol, emergency, mortalit

Clinical characteristics of suspected COVID-19 admitted to the isolation ward of Patan Hospital, Nepal

Introduction: Understanding clinical characteristics of patient is important to plan human resource and logistics. Moreover, this gives understanding of pattern of disease. This study aim to find the clinical characteristics observed in patients with suspected COVID-19 admitted at Patan Hospital. Method: This is cross sectional descriptive study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal, on April 2020. Suspected COVID-19 patient admitted from January 25 to April 20, 2020 is taken for the study. Record files were retrieved from record section and patient’s age, gender, place of residence, travel history, duration of symptom onset, symptoms on admission like fever, cough, rhinorrnoea, sore throat, myalgia and shortness of breath was recorded. Signs on admission like temperature, pulse, blood pressure, respiratory rate and oxygen saturation were also recorded. Data were descriptive analyzed. Ethical approval was obtained. Result: Total 40 suspected COVID-19 patients got admitted from 25 January to 20 April 2020. Of these admissions 25 (62.5%) were male, median age was 30 years, median days of return from abroad was 9 days, average duration of stay at hospital was 3.8 days. There were two COVID-19 positive patients who were asymptomatic. Conclusion: Travel history and history of travel to the community inside the country where COVID-19 has been detected is important to suspect COVID-19. Keyword: COVID-19, clinical characteristics, Nepa

Quality improvement in virtual classroom

Introductions: Online teaching method has shown to be equally effective as the traditional teaching method. An online teaching method, the virtual classroom (VCR) was developed for undergraduate medical students of Patan Academy of Health Sciences (PAHS). This study aims to present the outcome of complete audit cycle of VCR for quality improvement of the program. Methods: Feedbacks were collected from final year medical students who are posted in four different rural sites of PAHS. A validated google feedback form was used to collect the feedbacks from individual students after every VCR sessions. Students from 2017 were group one and students from 2018 were group two. Feedbacks were recorded in Likert scale of five. Ratings were done for quality of video, sound and power supply. Plan, do, study, and act (PDSA) cycle was used for quality improvement process. The necessary changes were done after analysis of data from group A. Same process was repeated for group B. Results: Fifty-six feedbacks were collected in first cycle. The complete PDSA audit cycle showed improvement in quality of VCR, with mean score on video of 3.0 and 4.1, audio 3.1 and 4.03, internet 3.6 and 4.03, power supply 4.0 and 3.98 in first cycle group A vs second cycle group B. Conclusions: Improvement was achieved by running quality feedback cycle and quality improvement cycle should be continued to maintain the quality achieved with this process. Keywords: audit cycle, PDSA cycle, virtual class roo

Demographic profile of patient with acute watery diarrhea during monsoon 2022: Patan Hospital, Nepal

Introduction: Diarrhea is the passage of three or more loose or liquid stools per day or more. Acute watery diarrhea is a major public health problem worldwide.  In Nepal, diarrhea is among the top 10 inpatient morbidity. This study’s objective is to monitor demographic characteristics and laboratory findings of stool specimens of diarrhea. Method: This is a cross-sectional descriptive study done at Patan Hospital. Ethical approval was taken from the Ethical committee. Data for Monsoon 2022 (June to September 2022) were collected from the Patan Hospital record system. Cases from within the Lalitpur district were included. Result: Out of 119 cases, 50(42%) were male and 69(58%) were female. The mean age±SD was 33.28±25.38 (p=0.083) with maximum cases observed during June and a peak observed during the fourth week of June. Out of 119, 4(3.3%) were stool culture positive. Two cases of Vibrio cholera, one case of Shigella sonnei, and one case of Salmonella parathypi B were isolated. In the etiological profile, 14 Entamoeba histolytica were isolated. Conclusion: During the outbreak of diarrhea in Monsoon 2022, adults were affected most. The culture of acute watery diarrhea showed two cases of Vibrio cholera

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

Adverse events following Pfizer-BioNTec vaccine against COVID-19 in population more than 12 years of age, Nepal: Adverse events following Pfizer-BioNTec vaccine

Introduction: Pfizer-BioNTec vaccine was started in Nepal for the age group of more than 12 years. This study was conducted to find out the adverse event following immunization with Pfizer-BioNTech vaccine against COVID-19 at Patan Academy of Health Sciences (PAHS). Method: This is a descriptive study conducted at PAHS from November to December 2021. The vaccine recipients were called over the phone after 72 hours of receiving the vaccine to find out adverse events following immunization (AEFI). They were inquired about the list of pre-defined AEFI. Result: A total of 1377(27.4%) individuals among 5014receivingthe first dose and 983(71.4%) of 1377 receiving the second dose were enrolled in the study. Vaccine recipients who had minor AEFI in the first dose were 462(33.6%) and in the second dose were 205(20.9%). The most commonly reported AEFI in both first and second dose was pain which was reported by 377(27.4%) and 97(9.9%) respectively, while fever was the second most common AEFI in both first and second dose reported by 65(4.8%) and 91(9.3%) respectively. There were no severe AEFI reported in both doses of vaccination. Most of the AEFI started within 24 h and subsided within 72 h. Conclusion: Minor AEFI was reported with the first and second dose of the Pfizer-BioNTech vaccine. There were no severe and serious AEFI reported in this study population