Background: Acute confusion is a common reason for presentation of elderly patients to the emergency which may be of neurological or non-neurological origin. Computerized tomography (CT) scans are often routinely ordered to investigate the cause. Objective:To determine the usefulness of CT scan brain in confused elderly patients. Methods:A cross-sectional observational study was conducted in emergency room (ER) of B. P. Koirala Institute of Health Sciences over a period of 6 months in 84 patients above the age of 65 years who had CT scan brain done in view of acute confusion. They were reviewed for symptoms, indications of CT scan and presence of focal neurological deficits (FND).Results: Among patients presenting in confusion and with loss of consciousness or limb weakness, CT scan was abnormal in 90% and 92% cases respectively (p <0.05) whereas those presenting with fever, cough, headache, dizziness, seizure in confusion also had abnormal CT but was statistically not significant (p> 0.05). Out of 84 elderly cases of acute confusion, 52 had FND and the remaining 32 cases were without FND. Among those with FND, 40% and 46% cases had features of ischemic and hemorrhagic stroke respectively. Among the 32 without FND, 66% patients had normal scan and 38% had cerebral atrophy. In patients with Glasgow Coma Scale (GCS) < 9 with FND, 75% had CT scan suggestive of hemorrhagic stroke whereas those with GCS> 13 with FND, 57% and 29% cases had ischemic and hemorrhagic stroke respectively. Conclusion:CT scan brain for confused elderly should be advised for those with focal neurological symptoms and may be suggested in cases of head trauma or alleged history of fall irrespective of GCS and symptomatology.

Background: Perinatal mortality includes both deaths in the first week of life and fetal

with partners outside of one's household. We tried to elucidate motives and barriers for complying with sexual distancing among men who have sex with men (MSM) and the relation with social distancing. Methods In this exploratory qualitative study we interviewed STI clinic visiting MSM during the first COVID-19 lock down using a semi-qualitative questionnaire from March-May 2020. We interviewed both men who complied and did not comply with the sexual distancing measures. The interviews were transcribed using verbatim transcription and analyzed using MAXQDA. Results We included 18 non-compliers and 4 compliers. Motivations mentioned to comply with sexual distancing measures were: perceiving COVID-19 as a serious health threat, experiencing critically ill COVID-19 patients first hand, protecting someone dear from COVID-19, and being satisfied with social and/or sexual distancing measures. Barriers mentioned to comply with sexual distancing measures were: not being aware of the need for sexual distancing, being single, previously having had an active sex life, importance of the social aspect of sex, a strong urge for sex, having sex to reduce stress, being under the influence of alcohol or drugs, and not perceiving COVID-19 is a serious health threat. Conclusion Our findings suggest that the information on sexual distancing needs to be made more explicit, accessible, understandable, customized and relatable to the key populations. This will improve effective measures and health advises for the current COVID-19 pandemic and future droplet borne outbreaks.

Background: It is a great challenge for a doctor to give proper care and discharge because of overcrowding in emergency units like ours. The clinical records in emergency are an essential document that reflects the quality of care which is given to the patient. Objectives: To find out the time taken for discharge from emergency and to find out the current trend of problems presenting to emergency and their prescription pattern. Methods: A retrospective descriptive hospital based study was carried out using all emergency discharged patients' case sheet records from 14th April to 14th May 2013. A number of 1022 files were analyzed. Results: Out of 1022 discharge files, majority (72%) of the patients included Australian Triage Score (ATS) 3. Patients with ATS 5 had a mean duration of stay of 24 hours whereas ATS 2, 3, 4 patients had mean duration of stay of 10.10 hours, 8.75 hours and 5.48 hours respectively. Most common clinical presentation was trauma (31.3%).Out of 1022 patients, 504 (49%) were treated with antibiotics. Cefixime was the most frequently administered antibiotics (24.7%). Of all 506 patients received analgesic, mostly diclofenac (30.8%), 79 received antispasmodic drugs, mostly hyoscine butyl bromide (6.2%), and antipyretics mostly paracetamol. Proton pump inhibitors (PPI) were used in 594 (58.1%) patients mostly pantoprazole (47.2%) Conclusion: Sicker patients had longer duration of stay in the emergency unit. Trauma is the most common presentation, analysis, antibiotics and PPL are the most commonly prescribed which show in the emergency unit.

Background: Alcohol use remains a major cause of preventable death worldwide occurring prematurely. Despite its global burden, alcohol still is a legal drug. Various studies have also shown that factors like education, occupation, influence from films and family, for stress relief, pleasure during alcohol use, better self-esteem, and occupational boredom are associated with alcohol use. The consumption of alcohol, even in relatively small amounts, increases the risk of being involved in a crash for motorists and pedestrians. It is also associated with impaired judgments and so is often linked to road traffic accident. Objectives: To assess the prevalence, type of alcohol use, and the associated factors for the initiation of alcohol use among bus drivers and staffs of long route bus of Dharan. To assess the knowledge, attitude, and practice regarding alcohol use for their willingness to quit it with medical help. Materials and Methods: The cross-sectional survey was conducted in 250 long route drivers and staffs in Dharan Bus Park in 2016 with the help of a self-designed questionnaire in Nepali language. The sample size was preliminarily estimated on the basis of the prevalence of alcohol use. The “Alcohol consumer” refers to drivers who used alcohol at least once in the previous year. Results: Alcohol dependency among Hindu was found to be significantly more than other religious group. The prevalence of alcohol consumption was found to be 78%. About 51% drivers are likely to have alcohol problems, 39% are alcohol abuser, and 45% are alcohol dependent. Conclusion: Drinking and driving increase the vulnerability to injury and death on the road. The study creates awareness among drivers about the harmful use of alcohol and psychosocial consequences.