Suicidal Attempt among Psychiatry Patients Presented to the Department of Emergency of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: More than 700, 000 people die due to suicide every year. Suicide is the fourth leading cause of death among 15-29 year-olds. A total of 77% of global suicides occur in low- and middle-income countries. There is an increasing number of suicide all over the world. There is limited data regarding this issue. The available data are based on police reports or on specific populations. The aim of this study was to find out the prevalence of suicidal attempts among psychiatry patients presented to the Department of Emergency of a tertiary care centre. Methods: A Descriptive cross-sectional study was done in a tertiary care centre from January 2019 to July 2020 after taking Ethical approval from the same institute. Beck Suicide Intent Scale, MINI-7, IPDE and PLESS were used to assess suicidal intent, psychiatric comorbidities, personality disorder and life stress event scores respectively. Bronfenbrenner's Social Ecological Model was used to access various stressors. Point estimate and 95% Confidence Interval were calculated. Results: The Prevalence of suicidal attempts among psychiatry patients in the emergency department was 265 (24.50%), (21.66-26.74, 95% Confidence Interval). The majority were females 135 (51%). The majority attempted at home 238 (89.81%). Poisoning was the most common mode of attempting suicide. Conclusions: The Prevalence of suicidal attempts among psychiatry patients was higher than in the other studies done in similar settings. Keywords: comorbidity; cross-sectional studies; prevalence; psychosocial factors; suicide attempt.

Median Nerve Passing below the Ulnar Head of Pronator Teres in Cadavers of a Medical College in Western Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Median nerve passes between two heads of pronator teres muscle while passing through the elbow. Detailed knowledge of these variations in the course of Median Nerve in relation to pronator teres and its neighboring structure is required for diagnosis of pronator syndrome. The aim of the study is to find out the proportion of Median Nerve passing below the ulnar head of pronator teres in cadavers of a medical college in Western Nepal. METHODS: A descriptive cross-sectional study was carried out at the Department of Anatomy in a medical college of Nepal from 20th July 2021 to 2nd September 2021 after ethical clearance from the same institution (Reference number: UCMS/IRC/079/21). Variations in the course of the median nerve while passing through pronator teres were observed, recorded and photographed. Convenience sampling method was used. Data were analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. RESULTS: Out of 54 prosected specimens of upper limbs, 4 (7.40%) (0.418-14.38 at 95% Confidence Interval) Median Nerve passed below the ulnar head of pronator teres muscle and in 50 (92.60%) specimens Median Nerve passed between two heads of pronator teres. CONCLUSIONS: Our study shows that the median nerve passed below the ulnar head of pronator teres muscle is higher as compared to other studies done in similar settings. Thus, knowledge of variations in the course of Median Nerve in elbow has immense importance in the academic and clinical arena.

Perception towards Online Classes during COVID-19 among MBBS and BDS Students in a Medical College of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Sudden outbreak of COVID-19 pandemic has affected the educational system worldwide, forced the medical colleges to close due to lock down, and disrupted the classroom face-to-face teaching process. As a result, medical colleges shifted to an online mode of teaching. The aim of this study is to find out the perception towards online classes during COVID-19 lockdown period among MBBS and BDS students at a medical college of Nepal. METHODS: This was a descriptive cross-sectional study carried out at Universal College of Medical Sciences and Teaching Hospital among first and second year Bachelor in Medicine, Bachelor of Surgery and Bachelor in dental surgery students from 1st June 2020 to 30th August 2020. Ethical approval was taken from Institutional Review Committee of Universal College of Medical Sciences and Teaching Hospital (IRC UCMS, Ref: UCMS/IRC/025/20). Convenient sampling method was used. Semi-structured questionnaire was used. Statistical Package for Social Sciences 22 was used for analysis and frequency and percentage was calculated. RESULTS: One hundred fifty six (73.93%) students were enjoying online learning only to some extent, 135 (63.98%) felt online class not equally effective as face-to-face teaching. The students had disturbance during online classes as internet disturbance 168 (79.60%), and electricity problem 47 (22.3%). Similarly, many students 155 (73.50%) felt external disturbance, headache 26 (12.3%), and eye strain 26 (12.3%). CONCLUSIONS: Most of the students suffered from disturbances during online classes probably because of internet and electricity problem. When compulsory to conduct online classes, students felt that not more than three online classes per day should be conducted to avoid eye strain and headache.

Fahr's Disease Presenting with Manic Symptoms.

Bilateral striopallidodentate calcinosis, commonly known as Fahr's disease, is a rare syndrome characterised by symmetrical calcification over the basal ganglion and dentate nucleus. No case of Fahr's disease with associated manic symptoms has been described in the literature to date. We report an unusual case of Fahr's Disease in a 18 year old unmarried male who presented to the emergency department of Universal College of Medical Sciences - Teaching Hospital, Nepal with symptoms of mania. Computed tomographic scan of the patient demonstrated extensive symmetrical calcification over the basal ganglia and dentate nuclei. No underlying cause for the bilateral calcification was found. This rare case of Fahr's disease, which has never been reported in Indian literature has been reported to highlight this unusual condition and its differentiation from the commoner Fahr's syndrome.

Mix headache: A valid clinical entity?

BACKGROUND: Chronic daily headache (CDH) patients respond better with a combination of anti-migraine and anti-stress medications, irrespective of clinical diagnosis of chronic migraine (CM) or chronic tension-type headache (CTTH). HYPOTHESIS: "CDH: Mix headache" type is a valid clinical entity. MATERIALS AND METHODS: A total of 70 participants fulfilling the diagnosis of "primary CDH", aged between 15 and 55 years were taken up for the present study. All these patients were subdivided into either CM or CTTH, based on the predominance of symptom profiles in these patients, in confirmation with the International Headache Society guidelines (International Classification of Headache Disorders-2, 2004). Schedules for clinical assessment in neuropsychiatry (SCAN) were applied to these patients to collect information about any mental or behavioral symptoms present at the time of the study. Psychiatric comorbidity was confirmed according to the International Classification of Diseases (ICD)-10. RESULTS: Forty-eight (68.6%) patients could be differentiated into CM and rest 22 (31.4%) patients were given a diagnosis of CTTH. SCAN and ICD-10 diagnosis revealed the presence of comorbid anxiety and depressive illness in 47 (67.2%) patients. Thirty-four of them belonged to CM (MH) group and the rest 13 had CTTH. DISCUSSION: We propose that these 47 (67.2%) patients of CDH form our special category of "CDH - mix headache" subtype. Thus, 14 (20%) patients constitute "CDH - migraine" subtype and rest 9 (12.8%) patients have a diagnosis of "CDH - tension headache" subtype. CONCLUSION: Findings of the present study validate the concept of "mix headache" and explains the clinical observation that chronic daily headache (CDH) patients responds better with a combination of anti-migraine and anti-stress medications.

A factor analytical study report on mania from Nepal.

BACKGROUND AND OBJECTIVES: Phenomenological studies on mood disorder are rare in Nepal which prompted us to undertake the current factor analytical study of mania. MATERIALS AND METHODS: It was a cross-sectional descriptive study for which we did purposive sampling technique according to certain inclusion and exclusion criteria. The study sample consists of fifty patients, who fulfilled the International Classification of Diseases, Tenth Edition (ICD-10) diagnostic criteria for Manic Episode and/or Bipolar Affective Disorder-current episode mania. Tools used were ICD-10 Diagnostic Criteria for Research, Young's Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). Principal component factor analysis was applied to the 35 symptoms taken from YMRS and BPRS. RESULTS: Factor analysis revealed the presence of four main factors, which explained 51.082% of the total variance. These are "pure mania" which isolated 11 manic symptoms, "dysphoric mania" which isolated five depressive symptoms, "hostile mania" which isolated six symptoms, and the fourth factor, we called it "delirious mania," isolated four symptoms. CONCLUSION: The identified factors and subtypes are a useful conceptualization of atypical features among patients with acute mania. Further validation studies are required to determine whether the identified subtypes are of clinical and theoretical importance.

Use of ECT in Nepal: A One Year Study From the Country's Largest Psychiatric Facility.

INTRODUCTION: Electro-Convulsive Therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. Since the development of ECT, it's use has been consistent. Inspite of the common use, data pertaining to the use of ECT in Nepal is lacking. AIM: This study was undertaken with the aim of exploring the clinico-demographic profile of patients treated with ECT in the largest psychiatry facility in the country. MATERIALS AND METHODS: It is a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Universal College of Medical Sciences Teaching Hospital, Bhairahawa, Nepal during a period of one year (August 2012 to July 2013). RESULTS: Out of 1095 patients admitted during the specified period, 81 (7.39%) patients received ECT. About 44.44% of the patients belonged to 20-29 years age group. Female patients constituted more than half of the subjects (55.56%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (44.4%), followed by Bipolar Affective Disorder/Mania (29.6%), Depressive disorder (11.1%), Acute and Transient Psychotic Disorder (6.2%), Post-partum Psychosis (3.7%) and substance induced mood/psychotic disorders (3.7%). A significant majority of subjects (75.3%) received about 5-7 ECT treatments. The mean seizure duration after ECT treatment was 31.13±5.79 seconds. No any major complications were noted during ECT treatment. CONCLUSION: This study suggests that ECT, use, as a treatment modality is common in young adults and females with Schizophrenia being the most common indication. Direct ECT is safe when used judiciously.