Aim:To determine the prevalence of H. pylori based on endoscopic biopsy and to investigate the association between H. pylori and endoscopy diagnosis and histopathological diagnosis.Materials and Methods:Over a period of two years, 228 endoscopic biopsies were included. Endoscopy diagnosis, histopathological diagnosis, and colonization with H. pylori were recorded and compared using appropriate statistical tests.Results:The overall prevalence of H. pylori was 68%; 69.6% in males and 66.7% in females. Duodenal and gastric ulcers were seen more in males (63.2% and 60%) compared with females (32.1% and 40%) (P < 0.001). The total rate of colonization of H. pylori in duodenal ulcer and gastric ulcer (85.7% and 84%, respectively) was significantly higher than those in gastritis, duodenitis, and gastric cancer (61.8%, 69.2%, and 60%, respectively) (P = 0.046). Histologically, chronic active gastritis and chronic follicular gastritis was significantly higher in duodenal ulcer and gastric ulcer (57.1%, 44% and 21%, 40%) in comparison to chronic persistent gastritis (21.4%, 16%) with P value < 0.001. Similarly, chronic active gastritis and chronic follicular gastritis had higher prevalence of H. pylori infection in comparison to chronic persistent gastritis (85.3%, 83.3% vs. 41.4%) with P value < 0.001.Conclusion:This study reveals that the overall prevalence of H. pylori infection is high in our setting with no significant difference in gender. Peptic ulcers were common in males. Those with peptic ulcers had higher rates of H. pylori colonization. Chronic active gastritis and chronic follicular gastritis were common histological findings in ulcerative diseases with significantly higher H. pylori positivity.

BACKGROUND: Pain in the emergency department (ED) is common but undertreated. The objective of this study was to examine the effi cacy and safety of intranasal (IN) ketamine used as an analgesic for patients with acute injury with moderate to severe pain. METHODS:This study was a cross sectional, observational study of patients more than 8 years old experiencing moderate to severe pain [visual analog score (VAS) >50 mm]. The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15 minutes. Pain scores and vital signs were recorded at 0, 15, 30 and 60 minutes. Side-effects, sedation level and patient's satisfaction were also recorded. The primary outcome was the number of patients achieving ≥ 20 mm reductions in VAS at 15 minutes. Other secondary outcome measures were median reduction in VAS at 15, 30 and 60 minutes, changes of vital signs, adverse events, satisfaction of patients, and need for additional ketamine. RESULTS:Thirty-four patients with a median age of 29.5 years (IQR 17.5-38) were enrolled, and they had an initial median VAS of 80 mm (IQR 67-90). The VAS decreased more than 20 mm at 15 minutes in 27 (80%) patients. The reduction of VAS from baseline to 40 mm and 20 mm respectively at 15, 30 and 60 minutes (P<0.001). No critical changes of vital signs were noted and adverse effects were mild and transient. CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.

Introduction: Basic life support is foundation to save lives. In contrast to the developed countries, there is still no national standard BLS training module in Nepal. Basic life support training is being provided by various institutions but lack in consistency and coordination. The Nepal basic life support Course is the video based training in Nepali language with reference to recent advances which was intended for all health care personnel of Nepal in urban as well as rural setting. We aimed to describe the features of this video based training module in local language, to analyse the differences of knowledge and find out the participants perception and satisfaction with this course. Methods: This is a descriptive cross-sectional study based on data of trainings conducted over the study period. Ethical approval was taken. The post-test score was recorded and compared with the occupational using ANOVA. On the spot and delayed feedbacks from the participants were collected voluntarily and summarized. Results: Total of 576 participants (435 clinical doctors, 92 nurses/paramedics, 18 non-clinical doctors and 41 intern doctors) successfully completed the training. The difference in post test scores (mean = 12.9±1.8) among the different occupational background was not significant (P=0.159). The feedbacks from the participants were mostly positive and encouraging. Conclusions: The knowledge of basic life support improved significantly irrespective of the occupation of the participants. A universal, nationwide video based training module in Nepali language should be developed focusing all health care personnel of urban as well rural Nepal.

Background: Sepsis is a leading cause of death in emergency department. Serum lactate level assessment can play an important role for risk assessment and prognostication in critically ill septic patient. Objective: The objective of this study is to determine the relevance of initial serum lactate measurement after the implementation of sepsis protocol in emergency department, based on guidelines of Surviving Sepsis Campaign. Methods: This was a cross sectional descriptive study conducted at Patan Hospital from January 2014 to January 2015 among 94 sample of serum lactate who had clinical suspicion of sepsis as per established sepsis emergency department protocol. Data of serum lactate sent from emergency department was noted from the registry book of department of biochemistry, Patan Academy of Health Sciences. Based on clinical practice the obtained lactate results were stratifi ed intothreerisk groups: high (> 4 mmol/L), intermediate (2.5 to 3.99 mmol/L) and low (< 2.5 mmol/L). Result: Out of the total 94 samples, 56 (59.6%) were male and 38 (40.4%) were female. Mean lactate level in males was 5.73 mmol/L and that in females was 5.47 mmol/L. Abnormal lactate level was predominantly high 85 (80%) out of which 31 (29%) had intermediate whereas more than half 54 (50.76%) had high lactate level. Conclusion: This study tells that clinically diagnosed sepsis do have higher serum lactate level. So, in our context, this needs to be explored to be used for early diagnosis of sepsis.

Introduction: Vaccination is one of the best ways to flatten the curve of COVID 19 infection and success of vaccination is achieved when vaccine hesitancy is minimal. The aim of this study is to analyze reasons for vaccine hesitancy among health care workers of a tertiary care hospital in Kathmandu Valley scheduled for COVID-19 vaccination. Method: This is a descriptive cross sectional study conducted at KIST Medical College and Teaching Hospital from 25th February 2021 to 15th March 2021.This study included 156 health care workers of KIST Medical College who did not opt for the first dose of vaccination for COVID-19. Result: The majority of health care workers hesitant for vaccination belonged to age group 18-29 years 67(42.9%)and females 117(75%) were more hesitant to vaccine than males. Helper and cleaning staffs 45(28.8%) were found to be more hesitant for vaccination followed by nursing staffs 29(18.6%). The reasons for vaccine rejection were due to safety issues 65(41.7%), followed by willingness to get vaccination at a later date 17(10.9%), misunderstanding the need of vaccination if already infected 14(8.9%), planning for pregnancy 14(8.9%), lactating mothers 14(8.9%) and pregnancy 11(7.1%). Conclusion: This study emphasizes on the need of more advocacies in the safety of Covid19 vaccination. Its safety during pregnancy and lactation is to be addressed to increase the vaccination rate. Keywords: COVID-19, health care workers, vaccine hesitancy