In-hospital mortality of heparin-induced thrombocytopenia in end-stage kidney disease. A retrospective national population-based cohort study.

AIM: Heparin induced thrombocytopenia (HIT) and end stage kidney disease (ESKD) are independent conditions associated with increased mortality and morbidity, however, whether ESKD is an independent risk factor for increased mortality in HIT admissions is not well studied. Therefore, we aimed to compare in-hospital mortality in HIT admissions based on their ESKD status. METHODS: This is a retrospective cohort study of HIT hospitalizations aged 18 and older using the 2016-2019 national inpatient sample (NIS) database. RESULTS: From 2016 to 2019 we had 12 161 admissions for HIT among 28 484 087 total hospitalizations. The annual incidence rate for HIT admissions per 100 000 admissions were: 47, 46, 41.1, and 36.6, respectively (p < .001) in 2016, 2017, 2018, and 2019 respectively. Among HIT admissions, the mean age was 64.3 years, 46.8% were females, 68% were Whites and 16% were Blacks. Black patients have a significantly higher likelihood of in-hospital mortality than White patients (aOR 1.25; 95% CI: 1.06, 1.48; p = .007). Patients who did not have any insurance or self-pay had higher mortality compared to Medicare (aOR 1.64; 95% CI: 1.13, 2.38; p = .009). ESKD status was not associated with higher or lower in-hospital mortality among HIT admissions (aOR 1.002; 95% CI: 0.84, 1.19; p = .981) after adjusting for age, sex, race, and insurance status. CONCLUSION: There are no higher or lower odds of in-hospital mortality in the ESKD subgroup in HIT admissions in adults. Decreasing incidence of HIT hospitalizations was seen over the years from 2016 to 2019.

Primary Immune Thrombocytopenic Purpura (ITP) and ITP Associated with Systemic Lupus Erythematosus: A Review of Clinical Characteristics and Treatment Modalities.

Immune thrombocytopenic purpura (ITP) is an immune-mediated disorder characterized by the destruction of platelets and megakaryocytes due to autoantibodies against the platelet surface proteins. ITP without any apparent cause of thrombocytopenia is defined as primary ITP, and ITP in the setting of SLE is secondary ITP, which can be diagnosed after excluding other causes of thrombocytopenia by history, physical examination, and laboratory testing. Patients with ITP associated with SLE have higher median platelet count and less bleeding manifestations compared to the patients with primary ITP. It can be very challenging to diagnose primary ITP in SLE patients as other causes of thrombocytopenia including drug-induced thrombocytopenia, antiphospholipid syndrome, and thrombotic microangiopathic process should be ruled out. Corticosteroids are the main modality of treatment. IVIG can be used in severe cases. Splenectomy was found to be less effective in ITP associated with SLE compared to primary ITP. Control of disease activity with immunosuppressive therapy can be helpful in some cases associated with active disease flares in SLE patients.

Osteitis Condensans Illi - An overlooked cause of low back pain mimicking sacroiliitis.

Osteitis Condensans Illi (OCI) is an underrecognized cause of low back pain involving iliac bones with relative sparing of sacroiliac joint. We present a case of 48-year-old female who was diagnosed as a case of OCI after having back symptoms for 4 years.

Interpersonal Violence during the COVID-19 Lockdown Period in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: The government issued a country-wide lockdown in Nepal as a measure to curb the spread of COVID-19 pandemic. This has resulted in various difficult experiences which includes financial loss, separation from loved ones, grief, uncertainty over disease status and loss of freedom. During these stressful situations, interpersonal violence is likely to be aggravated. To avoid the occurrence of adverse events such as impulsive acts, homicide, or suicide, it is important to identify high-risk individuals. METHODS: This is a descriptive cross-sectional, questionnaire-based, online survey by convenience sampling. The prevalence of different types of interpersonal violence with socio-demographic factors, substance use, and overall mental wellbeing was assessed by using descriptive statistical tests. RESULTS: Out of total 556 participants included in the analysis, 50.9% (283) were male and 48.7% (271) were female. There were 100 (18.0%) participants who reported being a victim of interpersonal violence and 101 (18.2%) participants who reported being a perpetrator during the lockdown. The victims of violence were more likely to be living with their spouse alone. The victims and perpetrators were also more likely to have increased alcohol and tobacco use. More number of victims and perpetrators had lower mental wellbeing scores on the WHO wellbeing index. CONCLUSIONS: There was prevalence of interpersonal violence during the COVID-19 lockdown. In addition to the fear regarding pandemic, victims have to face domestic violence placing them at a double injustice. Identification of vulnerable groups and proper management of survivors must be prioritized given the unanimous consensus on the rise of interpersonal violence during periods of heightened stress.

Mental Wellbeing during the Lockdown Period following the COVID-19 Pandemic in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: COVID-19 pandemic has profoundly affected all aspects of society, including mental and physical health. Often missed is the fact that the pandemic is occurring against the backdrop of a very high prevalence of mental health issues. Protecting the mental health of people and healthcare workers is important for long-term positive health outcomes and proper control of the outbreak. METHODS: This is a descriptive cross-sectional, questionnaire-based, online survey by convenience sampling. Ethical approval was obtained from the institutional review committee of Nepal Health Research Council (reference no. 2467). Open access, pre-validated questionnaires were used. Participants with significantly poor Mental wellbeing were identified using the WHO well-being index threshold score. Descriptive statistical analysis was carried out. RESULTS: Five hundred and fifty-six participants were included in the analysis. Forty percent of the participants reported a WHO well-being index score of below 13, indicative of poor mental wellbeing and a need for further assessment for depression. Poor Mental wellbeing was more prevalent among participants less than 30 years of age, female gender, never married, diagnosed mental disorder, living alone and those using informal sources for COVID-19 related information. More participants with lower sleep quality score and higher perceived stress score reported poor Mental wellbeing. CONCLUSIONS: Combating this challenge requires integration across disciplines. One potential part of the solution is psychological intervention teams. An emerging positive connotation to the pandemic is that it needs to be harnessed as a tool for improving health facilities, community participation, and fighting misinformation.

Changes and Compromises in Health Choices during COVID-19 Lockdown in Kathmandu Valley: A Descriptive Cross-sectional Study.

INTRODUCTION: Nepal government enforced a lockdown as a social distancing measure to curb the COVID-19 pandemic. The lockdown has led to compromises in day to day choices like food, exercise, sleep, self-care routines and utilization of healthcare facilities - directly and indirectly influencing aspects of health. Identification of compromised health choices can assist in better planning of inevitable future crises. METHODS: This is a cross-sectional descriptive study based on an online self -administered questionnaire, done using CHERRIES criteria, conducted from March 30, 2020, to July 31, 2020. Ethical approval for the study was obtained from the Institutional Review Committee of Nepal Health Research Council (Registration number: 2119; 300/2020 P). Descriptive statistics was used for analysis. RESULTS: Our study had 340 (51%) female and 325 (48.7%) male participants. A total of 112 (67.9%) reported decreased consumption of tobacco and 178 (53.6%) reported decreased consumption of alcohol during the lockdown period. Participants who reported that they would have visited a hospital if they had a flu-like illness increased from 151 (22.6%) pre-pandemic to 391 (58.6%) post-pandemic. Increase in news consumption was reported by 528 (79.2%). Out of 43 (6.4%) participants with a chronic condition, 30 (69.8%) reported having missed follow up due to the lockdown. CONCLUSIONS: The health of an individual is determined by various choices s/he makes on a day to day basis. Many of those choices are in turn influenced by the availability and accessibility of commodities. Lessons learned from the affected lives due to COVID-19 can be used in proper planning of inevitable future crises.

Patient Satisfaction with Nursing Care in Five Major Departments in a Tertiary Care Centre.

INTRODUCTION: Patient satisfaction is an important component of quality nursing care and is often determined by the nursing care in any health institution. The aim of the study is to find the presence of satisfaction among in-ward patients of five major wards at a tertiary care hospital regarding the quality of care provided by nursing staff. METHODS: A descriptive cross-sectional study was conducted among 105 patients of Patan Hospital from 3rd July to 3rd August, 2015 after obtaining ethical clearance from Institutional Review Committee. Sample size was calculated and stratified random sampling was done. Data was collected in Microsoft Excel and analyzed in Sta 13.0. Point estimate at 95% Confidence Interval was calculated and frequency and percentage was calculated for binary data. Subgroup analysis was done on the basis of demographic variables. RESULTS: Among 105 patients, 99 (94.3%) [94.93-95.07 at 95%CI] were satisfied with the nursing care provided at a tertiary care center in Nepal. Among them, 60 (60.6%) were females and 39 (39.4%) were males. Age of the patients ranged from 1 year to 85 years. The length of the stay in the hospital ranged from 2 to 17 days (mean = 5.6 days). CONCLUSIONS: Most of the patients were satisfied with the nursing care provided in a tertiary care centre. Routine nursing care surveys and immediate feedbacks would keep the authorities updated and deliver good health care.

Prevalence of Kawasaki Disease in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Kawasaki disease is an acute vasculitis of unknown etiology. The epidemiological data available for Nepal remains insufficient. In Nepal, Kawasaki disease has only been reported in cases of brief reports, leaving the true disease burden unknown. Many cases go undiagnosed and untreated due to a lack of knowledge regarding this entity. The objective of this study was to find the prevalence of Kawasaki disease in a tertiary care hospital. METHODS: This descriptive cross-sectional study was carried out in a tertiary care hospital of Nepal from 2013 to 2018 after taking ethical approval from the Institutional Review Committee. The sample size was calculated and the consecutive sampling method was done. Data collection and entry was done in Microsoft Excel, point estimate at 99% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The overall prevalence of Kawasaki disease was found to be 0.10% at 95% Confidence Interval (0.07-0.13%) among 11,416 patients under the age of 5 years admitted in pediatrics ward. There were 4 (33.33%) cases of complete Kawasaki and 8 (66.67%) cases of incomplete Kawasaki. There were 9 (75%) males and 3 (25%) females and the male to female ratio was 3:1. There was a male preponderance. The age at diagnosis ranged between 4 and 60 months. The median age at diagnosis was 10.5 months. The most common presentation was fever, conjunctivitis, rash, and oral changes. CONCLUSIONS: Prevalence of Kawasaki disease was found to be lesser compared to other studies done in other countries. Knowledge of Kawasaki disease among Nepalese pediatricians should be enhanced to guarantee the appropriate diagnosis and treatment of this disease.

Patients' Preference to Bedside Teaching Encounters in Four Major Wards in a Tertiary Care Centre.

INTRODUCTION: Patient interaction is a vital aspect of medical education. Bedside teaching encounters involve clinicians, medical students, and patients, and comprise a formative and focused activity. Patients' willingness to cooperate and contribute to the education and training of medical students provide better teaching opportunities. The study aims to find the patients' preference to bedside teaching encounters in four major wards in a tertiary care center in Nepal. METHODS: This descriptive cross-sectional study was performed in four major wards in a tertary care centre from June 3, 2015 to July 3, 2015 after receiving ethical approval. Convenient sampling was done. Data was collected in Microsoft Excel and analyzed in Statistical Package for Social Sciences 13.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Subgroup analysis was done on the basis of demographic variables. RESULTS: Seventy-eight (77.2%) patients preferred bedside teaching encounters among 101 participants (77.12-77.28%) at 95% Confidence Interval. Among which, females, age ranging from 16 to 32 years, education below secondary school and with hospital stay<4 days were most common. CONCLUSIONS: The results showed that most of the patients preferred bedside teaching encounters which was congruent with the other national and international studies.