Persistent chronic calcific pancreatitis with intraductal calculi associated with secondary diabetes mellitus type 3 and diabetic ketoacidosis - A case report.

Diabetes mellitus type 3 refers to diabetes secondary to an existing disease or condition of the exocrine pancreas and is an uncommon cause of diabetes occurring due to pancreatogenic pathology. It accounts for 15-20% of diabetic patients in Indian and Southeast Asian continents. This is case report of a rare case of type 3 diabetes mellitus (T3DM) presenting with diabetic ketoacidosis (DKA). The patient was admitted for DKA along with complaint of hyperglycemia, blood glucose of 405 mg/dl with HbA1c level of 13.7%. Computed tomography evidence revealed chronic calcific pancreatitis with intraductal calculi and dilated pancreatic duct.

Impact assessment of pharmacist-supervised intervention on health-related quality of life of newly diagnosed diabetics: A pre-post design.

INTRODUCTION: Diabetics face a series of challenges that affect all aspects of their daily life. Diabetes related complications adversely affect patient's health-related quality of life (HRQoL). Knowledge and self-care skills of diabetics are corner stones to improve their HRQoL. OBJECTIVE: To assess the impact of pharmacist-supervised intervention on HRQoL of newly diagnosed diabetics using an Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire. MATERIALS AND METHODS: A pre-post comparison study was conducted among the control group (CG), test 1 group (T1G) and test 2 group (T2G) patients with three treatment arms to explore the impact of pharmacist-supervised intervention on HRQoL of newly diagnosed diabetics for 18 months. Patients' HRQoL scores were determined using ADDQoL questionnaire at baseline, 3, 6, 9 and 12-months. T1G patients received pharmacist's intervention whereas T2G patients received diabetic kit demonstration in addition to pharmacist's intervention. CG patients were deprived of pharmacist intervention and diabetic kit demonstration, and only received care from attending physician/nurses. Non-parametric tests were used to find the differences in an average weighted impact scores (AWIS) among the groups before and after the intervention at P ≤ 0.05. RESULTS: Friedman test identified significant (P < 0.001) improvement in AWIS among the test groups' patients. Differences in scores were significant between T1G and T2G at 6-months (P = 0.033), 9-months (P < 0.001) and 12-months (P < 0.001); between CG and T1G at 12-months (P < 0.001) and between CG and T2G at 9-months (P < 0.001) and 12-months (P < 0.0010) on Mann.Whitney U test. CONCLUSION: Pharmacist's intervention improved AWIS of test groups' diabetics. Diabetic kit demonstration strengthened the disease understanding and selfcare skills of T2G patients. Disease and self-care awareness among diabetics should be increased in Nepali healthcare system by involving pharmacists for better patient's related outcomes.

Reading habits and attitude toward medical humanities of basic science students in a medical college in Western Nepal.

BACKGROUND: The Manipal College of Medical Sciences, Pokhara, Nepal, admits students from Nepal, India, Sri Lanka, and other countries to the undergraduate medical course. PURPOSES: The present study sought to describe and explore reading habits of medical students during the first three semesters and obtain their views regarding inclusion of medical humanities in the course. METHODS: The authors introduced a voluntary module in medical humanities to the fifth- and sixth-semester students. Gender, semester, and nationality of respondents were noted. Commonly read noncourse books (fiction and nonfiction) were noted. Student attitudes toward medical humanities were studied using a set of nine statements. A total of 165 of the 220 students (75%) participated. Indians followed by Nepalese were the most common nationalities. RESULTS: Romantic fiction and biography were most commonly read. The Alchemist and The Da Vinci Code were commonly read books. Students were in favor of inclusion of medical humanities in the curriculum. The median total score was 30 (maximum possible score = 45). CONCLUSIONS: Students read widely beyond their course. The possibility of introducing medical humanities in the curriculum should be explored.

Science attitudes and knowledge among preclinical medical students in Pokhara, Nepal.

Knowledge of science and the scientific method are important in learning about and using evidence-based medicine in practice. Courses in research methodology have been introduced for both medical students and practicing doctors. In Pokhara, the basic science subjects are taught in an integrated manner during the first four semesters of the undergraduate medical course. Studies on students' attitudes towards and knowledge of science are lacking in medical colleges in Nepal. Hence the study was carried out to obtain information on students' attitude towards and knowledge of science and scientific methodology among preclinical medical students and note the association, if any, of students' attitudes and their demographic characteristics. The study was carried out in March 2005 among the students of the first four semesters at the Manipal College of Medical Sciences, Pokhara, Nepal using a questionnaire developed by Hren and coworkers. Two hundred and twenty students (overall response rate 73.3%) successfully completed the questionnaire. Seventy-five respondents were Nepalese, 115 were Indians, 27 were Sri Lankans and 3 belonged to other nationalities. The X +/- SD total attitude score was 147.4 +/- 10.8 (neutral score 135). The X +/- SD scores on the subscales, value of science to humanity, value of scientific methodology and value of science to medicine were 51.3 +/- 5.4, 39.6 +/- 3.7 and 58.5 +/- 5.9 (neutral scores were 36, 51 and 48 respectively). The knowledge score measured using a set of 8 multiple choice questions was 3.3 +/- 1.4. The attitude scores were lower and the knowledge score was comparable to that reported previously in a study in Croatia but higher than that reported from Southeast Europe.

Fluoroquinolone utilization among inpatients in a teaching hospital in western Nepal.

OBJECTIVE: To obtain information on the prescribing patterns of fluoroquinolones among hospitalized patients, other antibiotics and drugs co-prescribed, calculate fluoroquinolone utilization using defined daily dose (DDD), calculate mean cost of drugs and detail the sensitivity patterns of isolated microorganisms. METHODS: The study was carried out over a five-month period (1st November 2003 to 31st March 2004) at the Manipal Teaching Hospital, Pokhara, Nepal. Demographic details and duration of hospitalization was noted. The percentage of patients prescribed parenteral antibiotics and fluoroquinolones were recorded. The cost of drugs was determined using the price list supplied by the pharmacy. Fluoroquinolone utilization was measured in DDD/100 bed-days. RESULTS: Fluoroquinolones were prescribed to 263 patients during the study period; 160 females and 103 males. Mean +/- SD number of drugs prescribed and duration of hospitalization were 6.5 +/- 3.3 and 6.2 +/- 5.4 days respectively. Fluoroquinolone utilization was 7.76 DDD/100 bed-days. Ciprofloxacin was the most commonly prescribed drug (6.83 DDD/100 bed-days). Fluoroquinolones were used for prophylaxis in 110 patients (41.8%). Other indications were urinary tract infections and acute gastroenteritis. E.coli, S.aureus and P. aeruginosa were common organisms isolated. The mean cost of drugs was 13.1 U.S. $ and fluoroquinolones contributed to 36.7% of the total drug costs. CONCLUSION: The use of fluoroquinolones was high compared to that reported previously.