BackgroundThoracoabdominal trauma presents a diagnostic challenge for the emergency physician. The introduction of bedside ultrasonography (USG) provides a screening tool to detect hemoperitoneum, hemothorax, pneumothorax and pericardial effusion in torso injuries.AimTo evaluate the accuracy of extended focused assessment with sonography for trauma (EFAST) for chest and abdominal injuries performed by first responders in a tertiary care hospital of Nepal.MethodsThis was a prospective study including all trauma patients who obtained either an Injury Severity Score ≥15 or direct trauma to the trunk in 1 year period in the emergency department (ED) of Dhulikhel Hospital-Kathmandu University Hospital. The results of the EFAST were then compared with contrast-enhanced CT (CECT), radiology ultrasound (USG)/chest X-ray, or intraoperative findings when the EFAST was positive. The negative EFAST cases were observed for a minimum of 4 hours in the ED. Descriptive statistics and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated.ResultsOut of 267 cases, 261 patients underwent an EFAST examination. The sensitivity and specificity were 94.8% and 99.5%, respectively. The negative predictive value was 98.53% whereas the positive predictive value was 98.21%. The overall accuracy was 99.4%.ConclusionThe results of this study suggest that EFAST examination performed by first-line healthcare providers is a useful method for assessment of thoracic and abdominal injuries. EFAST was found to have a high specificity (99.5%) and positive predictive value (98.21%) which indicates that it is an effective technique for detecting intra-abdominal or thoracic injuries. However, the effectiveness of EFAST is limited by its being operator dependent, and thereby human error. For negative EFAST cases, we recommend a monitoring period of at least 4 hours, serial fast scan, or further investigation through other methods such as a CECT.Level of evidenceLevel I

Leprosy affects multiple systems causing morbidity.1 However with attainment of global elimination and prevalence being 0.89/10000 at national level; it is seldom considered a diagnosis when it doesn’t manifest telltale signs. 2,3 Leprosy can masquerade various dermatological, orthopedic or neurological problems thus delaying the diagnosis.

Background: Laparoscopic surgery, a minimally invasive procedure, has gained popularity due to early recovery rate and minimal incision. Port site infection following laparoscopic surgery is an infrequent complication, increasing patient's morbidity, and also damaging surgeon's reputation. It depends on sterilization and surgical techniques, which have improved with time. The aim of this study is to evaluate the role of prophylactic antibiotics in preventing port site infection after laparoscopic cholecystectomy. Materials and Methods: A comparative cross-sectional study on 200 patients undergoing elective laparoscopic cholecystectomy was conducted from November 2021 to February 2022 in tertiary care Hospital by using systematic random sampling.Among the 200 patients, 100 odd numbered patients were given antibiotics, and 100 even numbered patients were not. The outcome of the two groups was measured with regard to port site infection. Results: The mean age in prophylactic antibiotic receiving group and not receiving group was 42.13 (SD = 14.41) and 42.71(SD = 14.29) years, respectively. The female: male ratio for total patients was 2.77.There were three cases of port site infection in total, in group receiving antibiotics (Cefotaxime), there was one case, whereas in placebo group, there were two. Simple logistic regression was utilized to compare the results of two groups (p>0.05). Similarly, Chi-square test was applied to histopathology diagnosis, which showed no statistically significant difference (χ2 = 0.99, P = 0.80). Conclusion: Antibiotic prophylaxis does not lower the rate of infectious in patients undergoing elective laparoscopic cholecystectomy.