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Objective: The objective of the present study is to evaluate the characteristics of acute poisoning cases admitted to emergency department over a one year period. The demographic, clinical and psycho-social aspects of the patients were analysed. Materials and methods: A hospital based study was carried out in the emergency department, Kathmandu University Teaching Hospital/ Dhulikhel Hospital, Dhulikhel analysing the data of the poisoning cases attended for one year. The study was carried out amongst inpatients attending emergency with acute poisoning. Results: A total of 54 patients were admitted to the emergency department with acute poisoning. The female-to-male ratio was 1.34:1. Most poisoning occurred in the age group of above 40 years. The mean ages of female and male were 29.87 ±14.85 years and 35.54±15.02 years respectively. By occupation 40.38% of the cases were farmers. Only 35.29% of the patients were illiterate. 79.24% of the cases intentionally consume the poison. Organ phosphorus poisoning (OP) was the most common poisoning. Oral route was the commonest route of poisoning accounting 98.1%. Sixty-six percentage (66.66%) of the cases had the poison stored in their home with 27.7% bought from the market once needed. Among the cases of acute poisoning 5.55% were fatal. Conclusion: The following conclusions were reached: (1) females were at greater risk for poisoning than males, (2) self-poisoning cases constituted the majority of all poisonings, and (3) the main agents of self-poisoning were OP poisoning. Key words: poisoning; insecticides; organophosphorus DOI: 10.3126/kumj.v7i2.2711 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26,152-156

The COVID-19 pandemic is a global challenge that is not just limited to the physical consequences but also a significant degree of a mental health crisis. Self-harm and suicide are its extreme effects. We aim to explore the impact of this pandemic on suicide and self-harm in our Emergency Department. A cross-sectional study was conducted including all fatal and nonfatal self-harm patients presenting to the emergency department during the lockdown period (March 24-June 23, 2020; Period1), matching periods in the previous year (March 24-June 23,2019; Period 2) and 3 months period prior (December 24 2019-March 23, 2020; Period 3) were included through the electronic medical record system. The prevalence and the clinical profile were compared between these three periods. A total of 125 (periods 1 = 55, 2 = 38, and 3 = 32) suicide and self-harm cases were analyzed. Suicide and self-harm had increased by 44% and 71.9% during the lockdown in comparison to periods 2 and 3. Organophosphate poisoning was the most common mode. Females were predominant in all three periods with a mean age of 32 (95%CI: 29.3–34.7). There was a significant delay in arrival of the patients in period 1 (p = 0.045) with increased hospital admission (p = 0.003) and in-hospital mortality (18.2% vs 2.6% and 3.1%) (p<0.001). Our study showed an increase in suicide and self-harm cases in the emergency department during the initial phase of the COVID-19 pandemic which may reflect the increased mental health crisis in the community in low resource settings like Nepal. This study highlights the importance of priming all mental health care stakeholders to initiate mental health screening and intervention for the vulnerable population during this period of crisis.

Background Simulation is well established as an effective strategy to train health care professionals in both technical and nontechnical skills and to prevent errors. Despite its known efficacy, adequate implementation is restricted due to the financial burden in resource-limited settings like ours. We therefore pursued to introduce cost-effective in situ simulation (ISS) in the emergency department (ED) to explore its impact on perception and learning experience among multidisciplinary health care professionals and to identify and remediate the latent safety threats (LST). Methods This is a prospective cross-sectional study with a mixed method research design, which was conducted in the ED of Dhulikhel Hospital-Kathmandu University Hospital. The pretest questionnaire was used to determine baseline knowledge, attitude, and confidence of the staff. The ISS with minimal added cost was conducted involving multidisciplinary healthcare workers. The LSTs were recorded and appropriate remediation was performed. Voluntary post simulation feedback was collected after the sessions. Results Overall 56 staff participated in at least one of the 35 simulation sessions, among which 45 (80%) responded to the questionnaires`. Twenty participants (45.5%) were reluctant to use the defibrillator. The self-reported confidence level of using defibrillator was low 29 (64.6%). The knowledge score ranged from 0 to 8 with the median score of 3 and a mean of 3.29 ± 1.8. There was no statistically significant difference in knowledge scores among participants of different occupational backgrounds, previous training, duration of work experience, and previous use of a defibrillator. A total of 366 LSTs {individual (43%), medication (17%), equipment (4%), and system/team (36%)} were identified (10.45 LST per ISS). The overall feedback from the participants was positive. Eighty percent of participants reported increased skills to use a defibrillator, and 82% reported increased confidence for managing such cases. They also agreed upon the need and continuity of such type of simulation in their workplace. Conclusions The baseline knowledge score and the confidence level of the staff were low. Self-reported feedback suggested increased confidence level and teamwork skills after ISS. It promoted identification and remediation of latent safety threats. ISS serves as a cost-effective powerful educational model that can be implemented even in settings where finances and space are limited.

This paper intends to analyse responses of the working people to heat stress in Nepal's Tarai region. Here, the heat stress responses refer to the working environments-indoor and outdoor settings, prevailing diseases, and adaptive measures by the workers. Data were gathered from the sample households by using household survey, observation, and informal discussions. Environmental conditions in terms of heat exposure in the working areas have been measured with heat index, humidity index, and WBGT, based on the HOTHAPS approach. The findings are that: the average temperature during the peak hot months reached to over 39 °C and the environmental conditions in the selected factories during the hot summer months were too hot to the workers to work continuously during the day, where there was inadequacy of facilities to combat against the hot. Males were more exposed than females to the heat due to heavy type of works in outdoor settings. Few workers found to have adapted coping measures such as shift in working time, wearing thin cotton clothes, etc but they were inadequate against the heat stress. More quantitative measurements of workers' health effects and productivity loss will be of interest for future works.