Introduction: Substance use including tobacco and alcohol is the most important cause of preventable morbidity, disability, and premature mortality. The study aims to specify the prevalence and the pattern of use of different substance. Methods: A cross sectional study was performed amongst first year and final year students in four medical colleges in Kathmandu using self administered anonymous questionnaire.Data collectedfrom 446 students were analyzed. Results: Prevalence of substance use was found to be 60.3% among the medical students. Alcohol (57.6%) was the substance most prevalently used followed by tobacco (27.58%) and cannabis (12.8%). Mean age of first exposure was 17.94 (Confidence interval: 17.91-17.97). There was significant difference in the useof tobacco and cannabis amongst final year students than first year students. Male and female differed significantly in use of every substance except for benzodiazepine. Medical college, college and school were place of first exposure in 17.26%, 15.92% and 13.23% of the cases respectively. Family history was associated with substance use in medical students and was statistically significant (P<0.0001).Experimentation was the major reason for the use of most of the substances. Conclusions: Substance use is prevalent in male medical students of both first and final year. Hence steps should be initiated early in school, college and medical college to prevent substance use. Keywords: alcohol, medical students, substance use, tobacco.

Introduction: In the background of resource limited setting like Nepal, we set out to identify if specific clinical characteristics and basic lab parameters would guide differentiation of Tuberculous from other causes of exudative pleural effusion.Methodology: Retrospective study of 109 consecutive patients with exudative pleural effusion.Results: Compared to Tubercular pleural effusions (41.3%), increased age, increased duration of symptom and increased pack years statistically favoured a diagnosis of Malignant pleural effusion(21.1%), whereas presence of fever, cough and increased pleural ADA levels favoured Tubercular pleural effusions. With regards to Parapneumonic effusions (26.6%), a shorter duration of symptom, smaller effusions, higher pleural Neutrophils, lower pleural lymphocyte neutrophil ratio and lower ADA favoured the diagnosis as compared to Tubercular pleural effusions.Conclusions: The appreciation of important clinical and pleural biochemical differences between Tubercular and other major causes of exudative pleural effusions aids in improved clinical decision making with minimal resources in resource limited settings like ours.SAARC J TUBER LUNG DIS HIV/AIDS, 2017; XIV(1), page: 33-39

Introduction: The management of Empyema Thoracis is challenging. It requires specialist medical and surgical care at the same time. There are of lack of data regarding the clinical profile and the steps of day to day management, hence this study aims to identify these parameters and focus on the gaps in management that is commonplace in our setting and that are representative of other resource limited settings as well. Methods: Clinical profile, etiological agents, hospital course and outcome of 30 patients with empyema thoracis treated from 2012 to 2014 in B.P. Koirala Institute of Health Sciences was analyzed. All patients were diagnosed on the basis of aspiration of frank pus from pleural cavity. Results: 28 cases (93.3%) were Male and the mean age was 42.07±18.28 years. 73.3% of the empyema was Right sided and 60% were classified as medium sized and 40% as small sized. 60% of the patients were smokers. 80% of the case were diagnosed as bacterial infection whereas 20% were presumed tubercular on clinical basis and responded to treatment. Fever was the commonest presentation in 80% of the cases followed by shortness of breath (66.7%), cough (60%), chest pain (53.3%) and sputum production (20%). On investigation, pH was not measured in the fear of clogging the ABG machine. Pleural fluid glucose was below 40 mg/dl in all the cases. The median ADA value was 54.30 (15-350) and ADA was higher than 40 U/l in 10 cases with non-tubercular empyema. All cases were managed with Chest tube insertion and antibiotics. Four patients had to be referred for BPF closure whereas five for decortications. In all cases requiring decortications, a “pleural peel” could be identified in Chest Xrays. Since the patients were being managed in different units the outcome of referred patients could not be ascertained. Conclusion: The gaps in the management of empyema in resource limited setting starts from inappropriate early treatment, inadequate diagnostic facilities, delayed referral and lack of early and appropriate surgical intervention. All these factors combine to the increased morbidity and mortality associated with the management of Empyema thoracis.