Assessment of performance and confidence level of simulation based clinical examination of respiratory system in undergraduate medical students of a medical college: a comparative cross-sectional study.

Introduction: Students in the preclinical phase have adequate clinical exposure to normal physiological findings of clinical examinations performed in healthy peers but do not have exposure to pathological findings other than theoretical knowledge, which is challenging for students during the clinical phase of curricula in examining actual patients. Simulation based medical education (SBME) has recently emerged to address this gap. This study aimed to assess performance and confidence level of simulation based clinical examination of respiratory system in preclinical undergraduate medical students of a medical college. Methods: A comparative cross-sectional study was conducted in the Department of Human Physiology of Medical College. All second year medical students using purposive sampling were taken. Students were divided into three groups and subdivided into six subgroups and each subgroup carried out examination in either healthy subjects or both healthy subjects and manikin. Predesigned proforma was used for assessment of students and the clinical examination process was invigilated by certified physiologists. Results: Students who received both simulation and conventional tutoring methods were able to accurately identify all lung sounds better as compared to those with conventional tutoring with the percentage difference being maximum in identifying vesicular (29 vs 6), stridor (28 vs 6), and bronchial (25 vs 6) breath sounds and least in identifying coarse crackles (3 vs 2). Majority (39 out of 41) of the students receiving SBME of respiratory system were satisfied with the simulation based practice and 34 of those students were even confident on clinical examination. Conclusion: SBME increases performance status and confidence level in medical students. A practical curriculum can be planned to incorporate simulation based clinical examination in preclinical medical students in practical sessions.

Carotid sinus hypersensitivity, as a cause of syncope, in a patient with coronary artery disease: A case report.

Introduction: Carotid sinus hypersensitivity is one of the unexplained causes of syncope in old age. There are variations in presentations of carotid sinus hypersensitivity. Case presentation: A 56-year-old male, known case of coronary artery disease, presenting with syncope, was diagnosed as carotid sinus hypersensitivity finally. He was treated with the placement of dual chamber pacemaker. Clinical discussion: The etiology of unexplained syncope is itself a challenging for clinicians. In the presence of a known risk factor, it is uncommon for carotid sinus hypersensitivity to be present as a cause of syncope. Conclusions: Hence, the rare disorder like carotid sinus hypersensitivity should also be considered as a cause of syncope despite the presence of co-morbidity like coronary artery disease.

An Outbreak Investigation of Varicella Zoster among Male Military Personnel in a Military Training Centre.

Introduction: Chickenpox is an acute, highly infectious disease. Outbreaks can occur in adults in closed institutional settings like hostels and barracks. This study aims to report varicella zoster outbreak among male military personnel in a military training centre. Methods: An outbreak investigation of chickenpox in a military training school and tertiary hospital was conducted. Ethical approval was taken from the Institutional Review Committee (Reference number: 267). Data was collected from February 5, 2020 to April 10, 2020 by questionnaire and clinical examination. Case definitions were prepared as per the Centre for Disease Control and Prevention criteria. Data was entered and analysed in Microsoft Excel 2010. Results: Out of the 167 male personnel in the training centre, 90 (53.89%) were susceptible to varicella and 84 (50.29%) were close contacts. The secondary attack rate of varicella zoster was 21.43% (18 cases). The mean age of the patients was 22.33±1.72 years. The mean days of admission were 5±2.28 days. The most common clinical features were generalised rash in 18 (100%), fever in 15 (83.33%), and body ache in 12 (66.67%) cases. Conclusions: Natural history, clinical, and epidemiological features of varicella zoster in a closed institutional setting was studied with the secondary attack rate being less as compared to other studies. Keywords: chickenpox; military; outbreak.

Willingness of Nepalese medical and nursing students to volunteer during COVID-19 pandemic: A single-centered cross-sectional study.

BACKGROUND: Medical students, being more familiar with medical situations, can play a vital role as volunteers during medical crises like mass casualty emergencies and epidemics. This study was conducted to know the willingness of medical and nursing students to volunteer during the coronavirus disease-19 (COVID-19) pandemic. MATERIALS AND METHODS: This cross-sectional study was conducted among undergraduate medical and nursing students of a medical college in Kathmandu. A proportionate stratified random sampling technique was used. A pretested, self-administered questionnaire was emailed to participants and the data were collected from 8th July to July 29, 2021 via the Google forms, extracted to the Google sheets, and then analyzed using Statistical Package for Social Sciences (SPSS) version 16. RESULTS: Out of 288 randomly selected participants, a total of 261 valid responses were obtained, giving a response rate of 90.6%. The majority (n = 203, 77.8%) of the participants were willing to volunteer. The most preferred area of work during volunteering was clinical care of the COVID-19 patients (n = 74, 36.5%), followed by involvement in health education and awareness-raising activities (n = 63, 31%). Among those not willing to volunteer (n = 58, 22.2%), the most commonly reported reason was the lack of adequate training and skills (n = 23, 40%). CONCLUSION: Since the majority of medical and nursing students were willing to volunteer during the times of COVID-19, they can be of great help as a human resource in case of shortage of healthcare professionals. As lack of training and adequate skills was the main reason for those not willing to volunteer, we recommend the provision of adequate training and skills before deploying students as volunteers during health crises like COVID-19.

Successfully managed aluminum phosphide poisoning: A case report.

INTRODUCTION: and Importance: Aluminum phosphide (ALP) is a commonly available pesticide in agricultural countries like Nepal. Upon ingestion, this releases highly toxic phosphine gas in the gastrointestinal tract when it comes in contact with humidity. This leads to refractory shock, metabolic acidosis, cardiac arrhythmia, renal failure, and hepato-biliary impairment. CASE PRESENTATION: We present a successfully managed case of a 17-year-old girl who ingested 6 g (2 tablets) of ALP tablets with suicidal intent. Although the mortality has been reported as 70-100% with mere ingestion of 150-500 mg of ALP, this case survived even after developing severe metabolic acidosis, acute renal failure, refractory shock, and ventricular tachycardia. CLINICAL DISCUSSION: ALP poisoning is most often lethal. However, there is an emerging evidence of successful use of various drugs such as magnesium sulfate, trimetazidine, and other interventions such as intra-aortic balloon pump and extra corporeal membrane oxygenation in case of ALP poisoning. CONCLUSION: Owing to the unavailability of an effective antidote of ALP to date, we emphasize early initiation of supportive management, intensive monitoring, and potential role of membrane stabilizers like magnesium sulfate, and cardio-protective agents like trimetazidine, N-Acetyl cysteine, thiamine, vitamin C, and hydrocortisone in decreasing the likelihood of fatal outcome.

Sodium-glucose cotransporter-2 Inhibitors in Heart Failure: An Updated Systematic Review and Meta-analysis of 13 Randomized Clinical Trials Including 14,618 Patients With Heart Failure.

ABSTRACT: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors showed benefit in patients with heart failure. In this updated meta-analysis, we evaluate the therapeutic efficacy and safety of SGLT-2 inhibitors in patients with heart failure. Different electronic databases were searched to find relevant articles. RevMan 5.4 was used for pooling data using a random/fixed-effects model, complemented by several sensitivity and subgroup analyses. A total of 13 randomized clinical trials including 14,618 patients with heart failure were included in analysis among 6797 studies screened. The overall mortality rate was 12.45% in the SGLT-2 group and 14.67% in the placebo group with 18% lower odds of overall mortality [odds ratio (OR), 0.82; confidence interval (CI), 0.75-0.91] in the SGLT-2 group. Odds of cardiovascular mortality was 18% lower (OR, 0.82; CI, 0.74-0.92) in the SGLT-2 group. The odds of hospitalization for heart failure (HHF) was 38% lower during the study period (OR, 0.62; CI, 0.56-0.68) in the SGLT-2 group. In addition, a benefit was seen for composite outcome HHF or mortality and considering subgrouping based on diabetes status, gender, and age groups. Although genital infection was significantly higher in the SGLT-2 group, the occurrence of severe adverse events, hypoglycemia, urinary tract infection, bone fracture, volume depletion, and other renal events did not differ between the 2 groups. Thus, SGLT-2 inhibitors improved cardiovascular outcomes among patients with heart failure with no significant difference in adverse events. Clinical benefit was comparable in diabetic and nondiabetic individuals, males and females, people in younger and older age groups with underlying heart failure, and HF with reduced ejection fraction.