Introduction: Medical students are under constant stress due to demanding academic load, fearof exam failure and hectic schedules. These factors can lead to poor sleep quality among medicalstudents. Sleep quality of medical students not only determine their academic performance but isalso important in determining long term effect on cognitive, psychosocial, behavioural as well asphysical health of individuals. Although there are not enough recent studies to assess sleep qualityof students, it is necessary to evaluate the condition of sleep among students. This study aims to findout the prevalence of poor sleep quality among medical students. Methods: This descriptive cross-sectional was conducted among undergraduate medical studentsof Kathmandu Medical College from October to November 2019 after taking ethical clearance fromInstitutional Review Committee of a tertiary care hospital before collecting data from participants.Subjects were recruited by simple random sampling from students of first, second, third and finalyears and were asked to fill the self-reported questionnaires, using Pittsburgh Sleep Quality Index.Descriptive statistical analysis was done using Statistical Software for Social Sciences version 24. Results: Out of 217 selected medical students, 96 (44.23%) of students have poor sleep quality withprevalence among male and female students as 41 (39.8%) and 55 (48.2%) respectively. The meanduration of sleep among students was 6.7±1.6 hours. Conclusions: Significant numbers of medical students have poor sleep quality which may affecttheir academic performance and may have long term impact on their health. Efforts must be directedtowards educating about the sleep hygiene as well as proper time management skills.
Multiple large joint swellings in an elderly alcoholic manA 65-year-old male (BMI: 23 kg/m 2 ) with chronic hypertension under amlodipine presented with chief complaints of multiple joint swelling on bilateral hands and feet. The swelling appeared 15 years back, and gradually increased over the years. The patient had frequent pain from the swelling in the past, but instead of seeking medical attention, he took over-the-counter painkillers. He has no family history of such swellings but has a 35-year history of chronic alcohol use, smokeless tobacco use, and cigarette smoking. On examination, multiple large, firm, and immobile swellings were located over the proximal and middle phalanges along with the metacarpophalangeal joints of both hands (Figure 1). Similar swellings were present over the metatarsophalangeal joints and ankle joints of both feet (Figure 2). There was no ulceration over the swelling. On lab evaluation, his uric acid level was 9.6 mg/dl (N: 2.5-7.8 mg/dl) with a normal renal function test. Plain radiography of both hands and feet revealed significant osteolysis of the involved joint. Needle aspiration yielded white viscous fluid which showed numerous needle-shaped birefringent crystals of monosodium urate on polarized light. The patient was prescribed Allopurinol 100mg/day along with counseling on lifestyle modifications.An accumulation of monosodium urate crystals causes gout that most frequently affects the first metatarsophalangeal joint. Risk factors include increased age, alcohol use, osteoarthritis, purine-rich foods, family or personal history of gout attacks, and medications such as thiazide diuretics for hypertension. 1 Hyperuricemic patients ([?] 6.8 mg/dl) can develop polyarticular tophaceous gout from intermittent arthritis if untreated. Acute flares and tophi development can be avoided by lowering blood urate levels with xanthine oxidase inhibitors or uricosuric medications. A target serum uric acid level of <6.0 mg/dl is desirable. 2 Surgery is only indicated for gout in situations of repeated attacks with deformities, excruciating pain, infection, and joint damage. 3
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