Prevalence, Associated Factors, and Impact of Workplace Violence among Physicians.

BACKGROUND: There is a dearth of objective data and studies pertaining to the prevalence and consequences of workplace violence against physicians in Nepal. This study aims to assess the prevalence, associated factors, and implications of workplace violence on Nepalese physicians. METHODS: We conducted a cross-sectional study from March 2021 to August 2021. Nepal Medical Council-certified physicians currently working in Nepal were included in the study. Baseline characteristics, types of violence experienced, patterns, psychosocial impacts, and changes in patient management were collected. RESULTS: Out of 318 responses received, 302 responses met the inclusion criteria and were included in the final analysis. One-hundred and ninety (62.9%) respondents had ever faced workplace violence. Madhesh Province had the highest prevalence (81.5%). Verbal abuse (93.2%) was the most common type of violence encountered. We found a significant association between workplace violence and hours worked each week. We also found an association between workplace violence and years of experience. Our study found a significant increase in stress/depression/anxiety/idea of persecution, sense of defeat, job turnover, and loss of productivity/income with the increase in severity of workplace violence. CONCLUSIONS: Workplace violence is largely prevalent among Nepalese physicians. In the aftermath of workplace violence, a physician can undergo a multitude of adverse psychosocial consequences leading to a further decrease in productivity. More insights through research, formal training, and policy implementation are necessary to overcome this largely ignored problem of the medical fraternity in Nepal.

Air under the diaphragm-perforation or Chilaiditi sign?

Chilaiditi sign is a rare radiological finding in which the colon is interposed between the liver and the abdominal wall. Once patients become symptomatic, the condition is called Chilaiditi syndrome. We discuss a unique patient who presented with intermittent abdominal pain for 2 years that worsened 6 months before presentation. Her radiological evaluation revealed Chilaiditi sign. She was treated conservatively and the sign resolved. We emphasize the importance of conservative management in Chilaiditi syndrome.

Neurosarcoidosis Presenting as Young-Onset Chronic Headache: A Case Report.

Sarcoidosis causes granulomatous inflammation in multiple organ systems. Lungs are the most commonly affected organs. In 50% of the cases with lung involvement, other organs are also involved. The central nervous system is one of the rarer organ systems involved - comprising 5-15% of all the cases. Neurological involvement, when present, can affect virtually every part of the central and peripheral nervous system. We present an interesting case of a 30-year-old nonalcoholic, nonsmoker man who presented with a chronic headache of 6 years. He had a recent swaying of the body for 6 months and mild forgetfulness for 4 months. The patient had 2 episodes of facial nerve palsy in the past - which had responded to the treatment of Bell's palsy; however, the patient had some residual findings on presentation. While CSF findings suggested meningeal tuberculosis, the radiological evidence and biopsy confirmed the diagnosis of neurosarcoidosis. On follow-up after 6 weeks of steroid therapy, the patient displayed a marked improvement in headache, cognitive function, and a good response on imaging studies. Our case emphasizes that neurosarcoidosis should be considered in the differential diagnosis of chronic headaches and recurrent facial nerve palsy despite being very rare.

Efficacy and safety of solriamfetol for excessive daytime sleepiness in narcolepsy and obstructive sleep apnea: a systematic review and meta-analysis of clinical trials.

INTRODUCTION: Excessive daytime sleepiness (EDS) is the inability to maintain wakefulness and alertness during the major waking episodes of the day, with sleep occurring unintentionally or at inappropriate times. Solriamfetol is a selective norepinephrine-dopamine reuptake inhibitor approved for EDS. This review was done to assess the efficacy and safety of solriamfetol in patients with EDS in narcolepsy or OSA. METHODS: A systematic search of the electronic database was conducted for relevant studies. Any randomized controlled trial with outcome measures on the efficacy or safety of solriamfetol in EDS were eligible for inclusion. The primary outcomes were mean difference in the maintenance of wakefulness test (MWT), Epworth sleepiness scale (ESS) score, and risk ratio of adverse events. The random-effects model was used to calculate pooled effect estimates. RESULTS: We identified 336 records from the database search. We analyzed eight articles reported from six clinical trials. We pooled outcome measures from five trials. The overall mean difference for MWT was 9.93 min (95% CI: 8.25-11.61), and the mean difference of ESS score was -4.44 (95% CI: -5.50 to -3.38), both in favor of solriamfetol over placebo. The overall risk ratio of adverse events with solriamfetol was 1.47 (95% CI: 1.28-1.69). The most common adverse events reported were headache, nausea, decreased appetite, anxiety, nasopharyngitis, and insomnia. CONCLUSIONS: Solriamfetol is efficacious and has a favorable safety profile in the treatment of EDS in patients with narcolepsy and OSA. Solriamfetol is well tolerated and may be recommended for the treatment of EDS in these patients.