Prevalence, Associated Factors, and Impact of Workplace Violence among Physicians.

BACKGROUND: There is a dearth of objective data and studies pertaining to the prevalence and consequences of workplace violence against physicians in Nepal. This study aims to assess the prevalence, associated factors, and implications of workplace violence on Nepalese physicians. METHODS: We conducted a cross-sectional study from March 2021 to August 2021. Nepal Medical Council-certified physicians currently working in Nepal were included in the study. Baseline characteristics, types of violence experienced, patterns, psychosocial impacts, and changes in patient management were collected. RESULTS: Out of 318 responses received, 302 responses met the inclusion criteria and were included in the final analysis. One-hundred and ninety (62.9%) respondents had ever faced workplace violence. Madhesh Province had the highest prevalence (81.5%). Verbal abuse (93.2%) was the most common type of violence encountered. We found a significant association between workplace violence and hours worked each week. We also found an association between workplace violence and years of experience. Our study found a significant increase in stress/depression/anxiety/idea of persecution, sense of defeat, job turnover, and loss of productivity/income with the increase in severity of workplace violence. CONCLUSIONS: Workplace violence is largely prevalent among Nepalese physicians. In the aftermath of workplace violence, a physician can undergo a multitude of adverse psychosocial consequences leading to a further decrease in productivity. More insights through research, formal training, and policy implementation are necessary to overcome this largely ignored problem of the medical fraternity in Nepal.

Indomethacin-Induced Hypertensive Crisis.

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed drugs to treat pain, and are easily available over the counter in lower dosages. NSAID use is associated with various side effects and elevated blood pressure is one of them. NSAIDs vary considerably in their effect on blood pressure with indomethacin being one of the NSAIDs associated with a significant increase in blood pressure. We present a case of a 58-year-old woman who developed a hypertensive crisis after a single dose of prescription indomethacin.

Soluble Guanylate Cyclase Stimulators in Heart Failure.

Heart failure has a high global burden of morbidity and mortality. Despite significant advances in medical management of heart failure, the prognosis remains poor. This justifies the search for newer therapeutic agents. Recently, soluble guanylate stimulators have demonstrated favorable results in clinical trials. This article aims to summarize the guanylate cyclase signaling pathway, the role of soluble guanylate cyclase stimulators in heart failure, and data from recent clinical trials of these drugs. We concluded that soluble guanylate cyclase stimulators have significant benefits in reducing hospitalizations in patients with heart failure with reduced ejection fraction that are at high risk of cardiovascular events. There appears to be no benefit of these drugs in patients with heart failure with preserved ejection fraction.

Use of Tocilizumab May Avoid the Need of Invasive Ventilation.

Coronavirus disease 2019 (COVID-19) is an illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Increased pro-inflammatory cytokines including interleukin 6 (IL-6) are associated with severe forms of illnesses. The severe cases of COVID-19 require a high amount of oxygen supplementation and might even require endotracheal intubation with ventilator support. A blockade of inflammatory cascade with the use of tocilizumab has been shown to decrease the need for intubation and ventilator requirement.

Emerging Treatments of Cardiorenal Syndrome: An Update on Pathophysiology and Management.

Cardiorenal syndrome refers to combined cardiac and renal dysfunction that adversely impacts both organs and is also associated with severe clinical outcomes. The pathophysiology is believed to be multifactorial and complex. Increased central venous pressure and intra-abdominal pressure, overactivation of the Renin-Angiotensin-Aldosterone System (RAAS), systemic illnesses like sepsis, amyloidosis, diabetes are important factors in developing the cardiorenal syndrome. Our review article attempts to review the pathophysiology and treatment aspect of cardiorenal syndrome and explores potential therapeutic strategies that can be adopted for the management. We searched PubMed, EMBASE, Google Scholar for relevant articles using different keywords and Medical Subject Headings, and finalized 38 articles to be included in our study. Cardiorenal syndrome management aims to eliminate venous congestion and fluid retention, which leads to improved cardiorenal status. This is usually achieved using pharmacologic agents like diuretics, vasodilators, inotropes, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), neprilysin inhibitors, and extracorporeal methods like ultrafiltration. The use of therapeutic agents such as sodium-glucose co-transporter 2 inhibitors and tolvaptan (a vasopressin V2 receptor antagonist), and cardiac resynchronization therapy has also been shown to have potential benefits in managing the disease. These agents can be instrumental in the management and require large-scale clinical trials specifically aimed at improving cardiorenal outcomes based on severity and type of cardiorenal syndrome.

Acute Mycophenolate Mofetil Overdose Managed Conservatively.

Mycophenolate mofetil (MMF) is an immunosuppressant drug widely used in post-transplant patients and the treatment of various inflammatory conditions. It is considered a relatively safe drug with minimal adverse effects. We managed an acute overdose of 19 grams (g) of MMF with a suicidal intention in a 17-year-old female with no significant past medical history. Apart from episodes of mild headaches, she did not develop other symptoms, laboratory abnormalities, or complications.

Leiomyosarcoma of the Uterus: A Rare Diagnosis.

Uterine leiomyosarcoma is a rare malignant tumor that accounts for almost 2-5% of all uterine malignancies. It has the highest prevalence during pre and perimenopause. Further, it clinically resembles benign conditions like leiomyoma, and the diagnosis is confirmed with the histologic findings of the mass. Here, we present the case of a 70-year-old female who presented with lower abdominal pain for two years. Exploratory laparotomy with hysterectomy was performed, and the diagnosis of leiomyosarcoma was confirmed after histological examination of the resected tumor.