Emergency unit assessment of seven tertiary hospitals in Nepal using the WHO tool: a cross-sectional study.

BACKGROUND: In 2021, the Nepal national emergency care system's assessment (ECSA) identified 39 activities and 11 facility-specific goals to improve care. To support implementation of the ECSA facility-based goals, this pilot study used the World Health Organization's (WHO) Hospital Emergency Unit Assessment Tool (HEAT) to evaluate key functions of emergency care at tertiary hospitals in Kathmandu, Nepal. METHODS: This cross-sectional study used the standardized HEAT assessment tool. Data on facility characteristics, human resources, clinical services, and signal functions were gathered via key informant interviews conducted by trained study personnel. Seven tertiary referral centers in the Kathmandu valley were selected for pilot evaluation including governmental, academic, and private hospitals. Descriptive statistics were generated, and comparative analyses were conducted. RESULTS: All facilities had continuous emergency care services but differed in the extent of availability of each item surveyed. Academic institutions had the highest rating with greater availability of consulting services and capacity to perform specific signal functions including breathing interventions and sepsis care. Private institutions had the highest infrastructure availability and diagnostic testing capacity. Across all facilities, common barriers included lack of training of key emergency procedures, written protocols, point-of-care testing, and ancillary patient services. CONCLUSION: This pilot assessment demonstrates that the current emergency care capacity at representative tertiary referral hospitals in Kathmandu, Nepal is variable with some consistent barriers which preclude meeting the ECSA goals. The results can be used to inform emergency care development within Nepal and demonstrate that the WHO HEAT assessment is feasible and may be instructive in systematically advancing emergency care delivery at the national level if implemented more broadly.

Surgical Delay due to Ethylenediaminetetraacetic Acid-Induced Pseudothrombocytopenia.

Automated hematology analyzer uses the Coulter principle leading to different cell types based on their size. Despite being rapid and convenient, it can result in spurious outcomes like ethylenediaminetetraacetic acid (EDTA)-induced pseudothrombocytopenia. EDTA-induced pseudothrombocytopenia is an immunologically mediated phenomenon resulting from a change in the configuration of glycoprotein (GP) IIb/IIIa by EDTA. The consequence is an exposure of hidden epitope that reacts with certain autoantibodies resulting in spuriously low platelet counts when the blood samples are evaluated by automated blood analyzers. Although it is a rare cause of thrombocytopenia, if not recognized, it can result in unnecessary investigations and treatments. In this case, EDTA-induced psuedothrombocytopenia delayed laparoscopic cholecystectomy planned for symptomatic cholelithiasis in a 58-year-old male. The presence of large platelet clumps on peripheral smear and normal manual platelet counts confirmed the diagnosis. Pseudothrombocytopenia should be suspected when there is no correlation between clinical and laboratory findings in a patient with a low platelet count. Reperforming counts with other anticoagulants and if necessary, manual count in the peripheral blood smear is suggested.

Different Methods of Resection of Solid Pseudopapillary Neoplasm of the Pancreas: A Case Series of Three Patients.

Solid pseudopapillary neoplasm of the pancreas is one of the rarest forms of pancreatic neoplasm. It was also known as Franz's tumor or Hamoudi tumor until the World Health Organization (WHO) labeled it as a solid pseudopapillary tumor in 1996. It typically affects young non-Caucasian females in their second or third decade of life. Treatment involves complete excision of the tumor which results in a complete cure in most of the cases. Three cases of solid pseudopapillary neoplasm (diagnosis confirmed by cytology) in young females, each presenting with different symptoms were studied. Each of the three cases was found to have the neoplasm at different sites of the pancreas and was subjected to different resection procedures. The cases were followed up for at least a year and evaluated for recurrences/metastases. Solid pseudopapillary neoplasm remains one of the most misdiagnosed tumors. The diagnosis depends on radiology and cytology. With a very high five-year survival rate, surgical resection remains the treatment of choice. The type of surgical procedure depends on the site, size and local invasion of the tumor.