Background: Hepatitis B vaccine is the single most effective and safest strategy for the prevention of the disease among health care workers (HCW), trainees and medical students. There is scanty information on knowledge, attitude and practice (KAP) regarding Hepatitis B vaccination among medical students who are likely to get exposed in the future as they start practicing. This study was undertaken to understand the knowledge, attitude and practice of hepatitis B vaccination among clinical medical students of Manipal College of Medical sciences at Pokhara, Nepal.Methods: Two hundred and four medical students were enrolled for an observational, cross-sectional study at Manipal College of Medical sciences at Pokhara, Nepal after obtaining ethical clearance from Institutional Review Committee. Answers to pre-tested questionnaire were collected. Knowledge, attitude and practice regarding Hepatitis B vaccination were studied. Results: All participants demonstrated good knowledge and positive attitude towards Hepatitis B infection and vaccination. However majority had poor practice towards it. Only 47.1% were completely vaccinated. The most common reason for non vaccination was that many thought they will vaccinate in internship or when they start practicing.Conclusion: Despite good knowledge and positive attitude towards Hepatitis B infection and vaccination, low rates of vaccination and poor practice was observed among HCW indicating the necessity of encouragement for vaccination and proper practices among them. All medical students should be immunized against Hepatitis B during their medical school. Regular Hepatitis B vaccination, educational and awareness programs must be conducted in coordination and with active participation of the medical students.Keywords: Attitude; Hepatitis B; knowledge; Medical students; Practice; Vaccination

Background and Aims: Microalbuminuria (MA) (urinary albumin excretion of 30-299 mg/d in a 24 hours collection or 30-299 μg/mg creatinine in a spot collection) is well accepted marker of micro and macrovascular damage in patients with diabetes mellitus and is considered as a surrogate marker for endothelial dysfunction in diabetic and non-diabetic patients. This study has been undertaken to investigate the prevalence of microalbuminuria among non-diabetic Acute Coronary Syndrome (ACS) patients. Methods: A hospital based cross-sectional study of 100 consecutive non-diabetic ACS patients was done. Traditional risk factors (like smoking, hypertension, dyslipidemia, obesity) of coronary artery disease were studied for the association with microalbuminuria in study subjects. Investigations were carried out in all the cases as per proforma and entered in the SPSS software for analysis. Results: The prevalence of microalbuminuria in non-diabetic ACS patients in the study was 73% which was statistically significant (p=0.04). A statistically significant higher prevalence of microalbuminuria was seen with different presentations of ACS; being highest (81.96%) in NSTEMI followed by STEMI (63.15%) and Unstable Angina (55%). It was found to be significant with the history of smoking (81.25%, p=0.013) and hypertension (82.25%, p=0.013). No significant association was found with age, body mass index (BMI) and dyslipidemia. A statistically significant higher prevalence of microalbuminuria was seen with increasing number of risk factors. Conclusion: There is increased prevalence of microalbuminuria in ACS patents. MA was associated with statistically higher number of cases with history of smoking and hypertension and presence of increasing number of risk factors.

Background: Diabetic peripheral neuropathy (DPN) is a most common micro vascular complication of diabetes posing significant morbidity and mortality with early and insidious onset. Studies has variably pointed that older age, gender, duration of diabetes, dyslipidemia, are linked with development of DPN. Aims and Objectives: To determine the prevalence of neuropathy in diabetic patients and see its link with age, gender, duration of diabetes, therapy and ethnicity. Materials and Methods: This is a cross-sectional study involving 110 clinically diagnosed diabetic patients, meeting the inclusion criteria. Basic demographic data were taken during clinical examination. Presence of degree of neuropathy was screened by measuring vibration perception threshold using Biothesiometer. Data was entered on SPSS and were categorized, necessary non parametric statistical tests were applied to these categorical variables as needed. The level of significance was set at p value less than 0.05. Results: Presence of neuropathy was measured in 110 diabetic patients. The overall prevalence of DPN was 45.45%. Frequency of neuropathy was higher with increase in age with 72.7% in more than 60 years of age and 23.5% in less than or equal to 40 years of age group (p=0.007). Similarly, the increasing trend of DPN with increase in duration of DM was evident in this study with DPN present in more than 55% of patients with more than 5 years of diabetes(p=0.004). Conclusion: The prevalence rate of DPN in diabetes was observed to be higher (45.45%). Our result suggested that DPN is associated with old age and the duration of diabetes mellitus. Asian Journal of Medical Sciences Vol.10(1) 2019 72-76

Background: Most of the bleeding in the lower gastrointestinal tract are usually located in the rectum, colon and terminal ileum. Colonoscopy is an invasive procedure used for both diagnostic and therapeutic purposes for detection of lower gastrointestinal (GI) tract pathologies and haemorrhage. Aims and Objective: The purpose of the study was to understand the clinical profile and colonoscopic findings in patients with lower gastrointestinal haemorrhage. Materials and Methods: Seventy-two patients presenting with lower GI haemorrhage were included in the study. All patients underwent colonoscopy after achieving hemodynamic stability and bowel preparation. Clinical profile and colonoscopic findings were studied. Results: The common aetiologies of lower GI haemorrhage were haemorrhoids followed by nonspecific colitis, colorectal polyp and carcinoma of colon. Rectum followed by sigmoid harbored majority of pathologies that presented with lower GI haemorrhage. Conclusions: The diagnosis of the pathological lesion and management of underlying cause not only prevents another episode of lower GI haemorrhage but also help in reducing morbidity and mortality. Colonoscopy or at least sigmoidoscopy is strongly recommended for evaluation, diagnosis and management of lower GI haemorrhage.

Introduction: Snakebite is an environmental hazard associated with significant morbidity and mortality. It is an important medical emergency and cause of significant numbers of hospital admissions in many parts of the Asian region. In this study, we assess the epidemiology and clinical outcome of snake bite. Methods: This was a retrospective study of all patients with snake bites admitted to the Department of Internal Medicine, Manipal Teaching Hospital, Pokhara, kaski, Nepal. A total numbers of 265 snake bite cases in the period of 2013 to 2016 were enrolled in this study. Snake bite cases by person, place and time along with month of snake bite and time of bite, were analyzed. We also identified the types of snake and site of the bite. Sign and symptoms were clinically observed and the management of the snake bite cases was clinically done. Prothrombin time (PT) test along with INR value was performed by Medical Technologist at the Department of Laboratory, Manipal Teaching Hospital. Data was entered in to the Microsoft excel and analyzed by SPPS version 21.0. Percentages were applied to find the results. Results: Total numbers of snake bite cases were 265. More than half, 60.4% of the snake bite cases were females. Regarding the age group, nearly half, 47.9% were in the age group of 20 - 40 years and 9.8% cases were in the age group of 60 years and above. In this study, 50.6% bite cases were held at the day time and most of the bites were reported/ observed in the limb, 53.6% in lower limb, and 43.4% in the upper limb. Very few bites were in the head, neck and trunk. Our result shows 49.1% were green snake and 30.9% snake were unidentified. When we observed the sign and symptoms, 153 (57.7%) cases showed local swelling, 83 (31.3%) showed fang mark. Hematological manifestation were 144 (54.3%) cases and complication observed in 145 (54.7%) cases. Snake bite cases were managed after PT/INR test, INR. Antibiotic were prescribed in 154 cases and in 135 (50.9%) cases blood was transfused. There were no fetal cases noticed among hospital admitted snake bite cases. Conclusion: There is gross disparity in the management and outcomes of snake bite in different hospitals. Snake bite cases should manage in tertiary care hospital as early as possible.