Basista Rijal

Medical students' characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal's first medical college.

Objective To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas. Design Observational cohort study. Setting Medical college registry, with internet, phone, and personal follow-up of graduates. Participants 710 graduate doctors from the first 22 classes (1983-2004) of Nepal’s first medical college, the Institute of Medicine. Main outcome measures Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student. Results 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal. Conclusions A cluster of medical students’ characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school.

Enterohaemorrhagic Escherichia coli (E.coli O157): A Case Report from Nepal

E.coli O157 is one of the important causes of bloody diarrhea which can be self-limiting or may complicate into Haemolytic Ureaemic Syndrome (HUS). We are reporting a case of Enterohaemorrhagic Escherichia coli (E.coli O157) in a thirty year old male who presented to the surgical OPD of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal with the complaint of bloody diarrhea and abdominal pain along with the history of consumption of food in local restaurant. Stool sample of the patient was processed to find out the cause of bloody diarrhea. Microscopic examination of the stool sample revealed plenty of red blood cells but no pus cells. Stool culture on MacConkey agar revealed lactose fermenting (pink) colonies whereas on sorbitol MacConkey agar, sorbitol fermenting (pink) and non-sorbitol fermenting (pale) colonies were isolated. Both the sorbitol fermenting and non-fermenting isolates were identified as Escherichia coli on the basis of biochemical tests. The non-sorbitol fermenting colonies which were identified as Escherichia coli were serotyped which were positive on polyvalent antisera 3 and monovalent antisera O157. Therefore, on the basis of biochemical reaction and serotyping, Escherichia coli O157 (Enterohaemorrhagic E. coli) was identified as the cause of the bloody diarrhea. The patient was managed symptomatically without any antibiotics and got improved in few days without any complication.

Clinicomycological Characterization of Superficial Mycoses from a Tertiary Care Hospital in Nepal.

Background. Superficial mycosis is a common fungal infection worldwide, mainly caused by dermatophytes. However, the prevalence of species varies geographically. In addition, fungal treatment is best guided according to species isolated. This study was carried out to determine the clinical as well as mycological profile of superficial mycoses in a tertiary care hospital, Nepal. Methods. This was a prospective case-control laboratory based study conducted over a period of six months from January to June 2014 at Tribhuvan University Teaching Hospital, Nepal. A total of 200 specimens were collected from the patients suspected of superficial mycoses. The specimens were macroscopically as well as microscopically examined. The growth was observed up to 4 weeks. Results. Out of total 200 specimens from the patients suspected of superficial mycoses, tinea corporis 50 (25%) was most common clinical types. KOH mount was positive in 89 (44.5%) and culture was positive in 111 (55.5%). Trichophyton mentagrophytes 44 (39.6%) was the most common isolate. Conclusions. The diagnostic yields of KOH mount and culture were found to be complementary to each other. Thus both the methods added with clinical findings are equally important to establish superficial mycosis.