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Background: Snake bite is one of the most common animal bites in Nepal. Different species of snake cause different clinical presentations. The incidence of snakebite is very high in rural Nepal. The objectives were to assess the presenting pattern, demographic profile, outcome, and treatment profiles of snakebite victims admitted to the emergency ward. Materials and Methods: A retrospective cross-sectional study was conducted among the patients who presented in emergency department with alleged history of snake bites from 2015 to 2016. The patient's record files were reviewed and the relevant data were recorded on a self-designed proforma. Descriptive statistics were calculated using SPSS version 11.5. Results: Out of 137 snakebite victims, 73 (53.3%) were female. The mean age was 35.17 ± 18.27 years. The upper limb (59%) was the most common site for snake bites followed by the lower limb (35.1%). Fifty patients (36.2%) were bitten by snakes during night (20.00–2.59 AM). Twenty-eight (20.4%) patients presented with ptosis as the most common sign and symptom followed by diplopia (15.3%). Out of 137 patients, 39 (28.5%) were admitted, 65 (47.4%) discharged, and 12 (8.8%) patients expired. Antisnake venom was given to 30 patients among which 23 patients (76.7%) were improved. Conclusions: Snake bite is one of the major problems in rural Nepal. It can be easily managed if treatment is given properly and in a timely manner. The importance of effective first aid management and effective treatment have to be disseminated among the peoples in rural areas via social media and radio.

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Introduction: Domestic violence is certainly an important condition, and certainly carries significant health consequences. Screening is probably acceptable to most patients attending an emergency department. The objective of this study is to find out the frequency of domestic violence victims attending emergency department, to find out the factors related to domestic violence, type, and severity of injury and to identify the impact of domestic violence in the victims. Materials and Methods: This was a cross-sectional observational study done in the Department of General Practice and Emergency Medicine of BP Koirala Institute of Health Sciences from January 2014 to December 2014. Anyone presented with a physical injury intentionally caused by a relative, partner, or other household member (spouse, partner, sibling, ex-partner, child, and other wives/partner of spouse). Results: The total number of patient enrolled in this study was 423. Among which 71.9% were female and 28.1% were male. About 27% of female and 31.9% of male were in the age group of 20–30 years. Majority (42.4% females and 48% males) of the victim's family had agriculture for primary occupation. Among the study groups, 40.9% of cases were beaten by direct hit and 24.3 with weapon, 5% of cases were only reported as rape, and 23.6% as homicidal case. Conclusion: Domestic violence is particularly insidious form of gender-based violence. In the place where they should feel the greatest safety and security- the family-women often face terror form of physical, psychological, sexual, and economic abuse.

Introduction: Trauma is a major and increasing global health concern in the recent world is now the leading cause of death among people less than 18 years old. Methods: This is a retrospective cross sectional study done in Emergency Department of B.P.Koirala Institute of Health Sciences. Patients aged less than 16 years were included with history of Trauma from January 1st 2013 to 31st December 2013.The details of patient were taken from computerized medical records of the hospital. The data Demographic data, Pattern of injury, Mode of injury, Diagnosis and outcomes were tabulated in Microsoft excel. Results: Total 3958 pediatrics patient were enrolled in this study. Male: Female=3.6:1,Mean age 9.6±3.2 years, fall injury & RTAs common modes and fractures of limbs, soft tissue injuries and cut injuries were common patterns. Conclusions: Injury is a serious problem for children in Low Income countries like Nepal.

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment. Methods: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusions: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain. Keywords: analgesia; emergency; Nepal.

Objectives: Patient-centered communication teaching generally encourages doctors to inform patients of cancer diagnoses. In many countries, including Nepal, it is usually the patient′s family that is informed. Much of the evidence about patient preferences is from western studies. The objectives of this study are: To discover the attitudes of medical students and patients in Nepal toward disclosing a cancer diagnosis; and to identify the reasons for these attitudes. Materials and Methods: A cross-sectional survey was administered to medical students and patients in a teaching hospital in Nepal. The participants were asked about their attitudes toward and reasons for informing patients of a cancer diagnosis. The data were analyzed to compare students′ and patients′ attitudes and to look for differences between the first and fourth year students. Results: Fifty-four percent of the students would inform a patient even if the cancer was incurable, 6% would inform only if curable, and 40% would inform the family instead. Sixty-nine percent of the students and 51% of the patients wanted a close relative informed, even if the relative was incurable (P = 0.0016). There was no significant difference between students (83%) and patients (78%) wanting to be informed of their own diagnosis. The most important reasons for students not informing the patients were fears of loss of hope and of causing depression. Conclusion: The results confirmed the diverse attitudes about informing a cancer diagnosis to patients, in Nepal. Students wanted more information for themselves than they felt patients should be given. This information could enlighten the practice of doctors in Nepal and other similar cultures, as well as guide the communication training of future doctors.

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment. Methods: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusions: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain. Keywords: analgesia; emergency; Nepal.

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment. Method: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusion: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain. Key Words: Analgesia, Emergency, Nepal