Perceptions of Medical Students About Bedside Teaching in a Medical School.

INTRODUCTION: Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching. METHODS: This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis. RESULTS: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient's uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study. CONCLUSIONS: The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.

Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Nepal.

BACKGROUND: The national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated P. falciparum infected patients at health centers/hospitals treated over the period of 2 years (2013-2014). METHODS: Giemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000-10,000 /µL of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance). RESULTS: A total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of P. falciparum (28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level. CONCLUSION: Only one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal.

Human papillomavirus infection in women with and without cervical cancer in Nepal.

OBJECTIVES: Cervical cancer is the most common malignancy among Nepalese women. Rational prevention measures are informed by epidemiological data on human papillomavirus (HPV) prevalence. METHODS: Cervical specimens were obtained from 932 married women aged 15-59 years from the general population of Bharatpur, Nepal, as well as from 61 locally diagnosed invasive cervical cancers (ICC). HPV was detected using a GP5+/6+ PCR-based assay. RESULTS: Among the general population, the overall prevalence of HPV was 8.6% (6.1% for high-risk types). Prevalence of abnormal Pap smears was 3.6%, including five high-grade squamous intraepithelial lesions. Residence in slum housing, lower education level, > or =3 sexual partners in a woman's lifetime, and husband's extramarital affairs were significantly associated with HPV positivity. HPV prevalence was relatively constant across all age groups. HPV16 was the most common type, both among the general population (1.9%) and among 54 women with HPV-positive ICC (68.5%). HPV18 (22.2%) and 45 (5.6%) were also common in ICC. CONCLUSIONS: Nepal has an intermediate burden of HPV infection, lower than many areas in India and China. Approximately 80% of cervical cancer in Nepal is theoretically preventable by HPV16/18 vaccines. In the meantime, screen-and-treat approaches should be encouraged to overcome difficulties that were encountered to recall women with screening-positive findings.