Introduction: Diabetes mellitus is a global health problem with increasing incidence worldwide in an epidemic form including Nepal. This chronic disease leads to many complications, hospital admissions and premature morbidity and mortality. This study aimed to study the cause and number of emergency visits and to evaluate the rate and duration of hospitalisation among diabetic patients who visit the emergency department Method: This was an observational cross-sectional study including 98 diabetic patients of >18 years presenting to emergency department of KIST medical college and teaching hospital between January 2020 to June 2020. The number and reason of emergency visits as well as number and duration of hospitalization was recorded in a semi structured proforma. The data entry was done in Microsoft Excel and analysis was done using the SPSS 24. Result: While 61 cases (62.2%) of this sample utilized the emergency department (ED) services in last 12 months’ period, 32.7% reported using ED once and 23.5% used 2-3 times and only 6% of the subjects had visited emergency more than 4 times within 12 months. Heart disease (18.1%) and infections (18.1%) were the most common reason for ED visit. There were 62 (63.3%) admissions from ED, 32.2% patients were hospitalized for 1-3 days, 50% were hospitalized for 3-7 days and 17.8% stayed for 1-2 weeks’ duration in the hospital. Conclusion: Majority of the diabetic patients had utilized ED more than once in past 12 months and the most common cause was found to be related to cardiac illness and infections. More than half of the diabetic patients visiting ED were admitted for mostly 3-7 days’ duration.

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

Introduction: Global pandemic of Novel corona virus (Covid 19) has become a public health emergency with multidimensional effect including education system. World has implemented physical distancing by “lockdown” strategy leading to disruption of normal routines of academic institutions. Medical students are bound to adapt web based online education system however; virtual teaching has both opportunities as well as challenges that needs to be explored for better medical education ahead. Methods: This is an observational cross sectional survey conducted on 9th batch MBBS 4th year students of KIST medical college and teaching hospital. The online survey was done by google form via emails and responses were complied on Microsoft database Excel program. Result: Out of 93 students 88 (95.44%) responded comprising 63.6% female and 36.4% male. Among them 54.5% were from within the valley whereas 45.5% were from outside the valley. 26.1% found virtual teaching was very effective with several opportunities however 58% thought online classes were slightly effective. 65.9% found 45min duration is appropriate per session. Conclusion: During the Covid pandemic, virtual online teaching has been alternative mode for continuity of medical education which can be attended from safe environment of home with proper utilization of time.

Introduction: Pediatric injury is one of the common emergencies encountered in the emergency department. It is emerging as leading cause of death and disabilities in children. This study aims to analyze the patterns of pediatric injury based on age group, gender, mode, type, place of injury and its outcome. Methods: This is a descriptive cross sectional study conducted in Emergency Department of KIST Medical College and Teaching Hospital from 1st May 2019 to 30th July 2019. A total of 110 patients aged 15 years and below and with history of trauma were included in this study. Results: A hundred and ten pediatric patients presented to emergency with injuries. Majority of pediatric trauma cases belonged to age group 1-5 years (38.2%, n=42) and more frequent in male children (66.4%, n=73) .In both gender, male (45.5%, n=50) and female (17.3%, n=19); fall was most common mode of injury followed by accidental cut injury (7.3%,n=8) in male and road traffic accident (6.4%,n=7) in female. Most of the cases sustained soft tissue injury (32.7%, n=36) followed by cut injury (26.4%, n=29) and fracture (16.4%, n=18). Common place of injury was found to be at home (64.5%, n=71). Majority were discharged (n=100; 90.9%), Nine (8.2 %) were admitted and one expired (0.9 %) expired. Conclusion: Fall injuries are the major mode of injury encountered in both male and female children. Injuries tend to occur more at home than school. Children should be adequately supervised at home and school.

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.

Introductions: Competency in basic knowledge and skill of emergency care is the fundamental goal of all the medical graduates irrespective of their specialty. The aim of this study is to understand the view of young doctors regarding the importance of emergency medicine (EM) both during internship and undergraduate MBBS curriculum. Methods: This was a descriptive cross sectional study conducted at emergency department, KIST Medical College, Lalitpur, Nepal, during 2016 to 2017. Interns were asked to fill up preformed questionnaires to explore the effectiveness of the posting and its necessity to integrate in undergraduate medical education. Results: All the respondent medical interns accepted emergency medicine posting was fruitful. Ninety-six (62.3%) thought one month Emergency Department (ED) posting as appropriate. All the participants thought EM should be included in the undergraduate curriculum (UG). Majority believed it would be appropriate in third year (42%) and final year (42%). One hundred and thirteen (73.4%) wanted to pursue emergency medicine career however 41 (26.6%) were reluctant. Conclusions: All the interns surveyed accepted emergency medicine to be fruitful and should be included in the undergraduate curriculum with one month emergency department posting, and two thirds wanted to pursue it as future career.