BackgroundMedical education can play important role in cultivating the willingness among the medical students to work in underprivileged areas after their graduation. Experiential learning through early exposure to primary health care centers could help students better understand the opportunities and challenges of such settings. However, the information on the real experiences and reflections of medical students on the rural primary health care settings from low-income countries like Nepal are still limited. The aim of this study is to demonstrate the learning process of the medical students through their reflective writings based on Kolb’s theory of experiential learning.MethodsThe students wrote their experiences, observations and reflections on the experiential learning from the primary health care centers on individual logbook as part of their community posting assignments. We analyzed the data of 50 logbooks through content analysis using Kolb’s experiential learning cycle as a theoretical framework.ResultsThe students’ reflections are structured around the four main learning stages of Kolb’s experiential learning theory. Each learning stage consisted of different categories. The first stage consisted of concrete experiences on rural health and learning by doing. The second stage included their reflective observations on primary versus tertiary care, application of theoretical knowledge and role of supervisors. In the third stage, the students developed and refined their concepts on self-development, understanding reality, compassion and sense of responsibility. The final stage, active experimentation, included their immediate future plans, suggestions to improve curriculum, plans after becoming a doctor and suggestions to improve policies.ConclusionThis study provided important insights on different stages of experiential learning of medical students on primary health care in low resource rural settings. Reflective writing of experiential learning could be an important step to address the gaps in medical education for resource constraint settings like that of Nepal and other low-income countries.

The PAWPER XL tape was the only method found to be accurate in estimating the weight of Nepalese children.

Introduction: The corona virus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 belonging to corona viruses which are enveloped positive stranded RNA viruses. Non-critical coronavirus disease 2019 patients often lack follow up visits which has led to incomplete understanding of disease process. The aim of this study was to find out the prevalence of persistent symptoms in such patients during two months follow-up to a district hospital. Methods: This descriptive cross-sectional study was conducted in a district hospital from September 2020 to February 2021 among non-critical corona virus disease 2019 patients admitted to the isolation center of Nepal. Ethical approval was taken from the ethical review board of Nepal Health Research Council (reference number: 1707). Convenience sampling was done. Data was collected using a structured questionnaire. Data analysis was done using Statistical Package for the Social Sciences version 26. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 132 patients, 66 (50%) (41.5-58.5 at 95% Confidence Interval) patients had persistent symptoms at two-month follow-up. Forty-eight (36.4%) patients showed one symptom, 15 (11%) had two symptoms, and 3 (2%) had two or more symptoms. The most frequent symptom reported was fatigue in 17 (13%), cough in 15 (11%), myalgia in 9 (7%), and headache in 9 (7%). Conclusions: The prevalence of persistent symptoms at two months follow up in our study was lower than findings from other international studies.

A 33-year-old female presented with a history of high-grade fever, cough, dyspnea, joint pain and myalgia. On examination, the patient was febrile with tachycardia, hypotension and decreased oxygen saturation. Chest auscultation revealed bilateral decreased air entry with crepitation supported by bilateral pulmonary infiltrates on chest X-ray. The laboratory investigations showed leukocytosis, thrombocytopenia, transaminitis and renal impairment. The patient was treated with intravenous fluids, ceftriaxone and levofloxacin; however, there was no clinical improvement till 48 h. She was then diagnosed with scrub typhus and dengue co-infection via serologies. Doxycycline was started following which the patient improved in 24 h. Scrub typhus can present with septic shock but does not respond to the usual antibiotics and the addition of doxycycline will result in rapid clinical improvement. Co-infection with other tropical diseases such as dengue is also common, hence it is important to test based on local endemicity.

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