Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Objectives To investigate perceptions of medical students on the role of online teaching in facilitating medical education during the COVID-19 pandemic. Design Cross-sectional, online national survey. Setting Responses collected online from 4th May 2020 to 11th May 2020 across 40 UK medical schools. Participants Medical students across all years from UK-registered medical schools. Main outcome measures The uses, experiences, perceived benefits and barriers of online teaching during the COVID-19 pandemic. Results 2721 medical students across 39 medical schools responded. Medical schools adapted to the pandemic in different ways. The changes included the development of new distance-learning platforms on which content was released, remote delivery of lectures using platforms and the use of question banks and other online active recall resources. A significant difference was found between time spent on online platforms before and during COVID-19, with 7.35% students before versus 23.56% students during the pandemic spending >15 hours per week (p Conclusions Online teaching has enabled the continuation of medical education during these unprecedented times. Moving forward from this pandemic, in order to maximise the benefits of both face-to-face and online teaching and to improve the efficacy of medical education in the future, we suggest medical schools resort to teaching formats such as team-based/problem-based learning. This uses online teaching platforms allowing students to digest information in their own time but also allows students to then constructively discuss this material with peers. It has also been shown to be effective in terms of achieving learning outcomes. Beyond COVID-19, we anticipate further incorporation of online teaching methods within traditional medical education. This may accompany the observed shift in medical practice towards virtual consultations.

https://bmjopen.bmj.com/content/bmjopen/10/11/e042378.full.pdf

Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students

Universal health coverage in Indonesia: concept, progress, and challenges

The publication of this book is timely. Although diffusion-weighted imaging is routinely available on most modern clinical MRI machines there are few resources that even approach a comprehensive evaluation in clinical practice. Whilst it was generally accepted that a diffusion-weighted abnormality represented irreversible ischaemia in the setting of acute stroke, subsequent work has shown that this tissue may be pathologically heterogenous and can even be reversible. This understanding is slowly filtering into books describing imaging in stroke. This book introduces the principles of diffusionweighted imaging, normal findings and, importantly, pitfalls and artefacts, the latter chapter being extremely helpful. There is then a chapter dedicated to the differentiation between cytotoxic and vasogenic oedema. The book then sequentially discusses infarction, haemorrhage, vasculopathies, epilepsy, demyelination, metabolic diseases, infection, trauma, neoplasia and paediatrics. All of these discussions are comprehensive and very well illustrated with numerous examples. One of the novelties of the book is the final section entitled ‘how to use this book’. This basically does the reverse of the previous chapters in that it is based primarily on the differences seen with the diffusionweighted image, the apparent diffusion coefficient (ADC) image and the T2 image, i.e., it discusses the differential diagnosis of an image, e.g., with increased diffusion weighting, low ADC and increased T2. This section is likely to be of great assistance to individuals seeing a combination of signal changes for the first time. There are very few negative points associated with the book, areas such as mislabelling of some of the figures in Chapter 14 which should have been picked up by the publisher. Overall the authors should be complimented for putting together such a rich resource of cases in such a balanced manner. The book is very accessible and will mainly be of interest to radiologists involved in reporting diffusion-weighted studies and should be a welcome addition to the reading room area for reference. There will be other individuals within clinical neuroscience who will also find the book of interest.

Diffusion-weighted MR Imaging of the brain

SARS-CoV-2 Testing in Obstetrical Patients Among 215 pregnant women who were admitted to a New York hospital for delivery and who underwent universal testing for SARS-CoV-2, more than one in eight ...

Universal Screening for SARS-CoV-2 in Women Admitted for Delivery

Background COVID-19 is an ongoing pandemic, for which appropriate infection prevention and control measures need to be adopted. Healthcare workers’ adherence to prevention and control measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we assessed the KAP among healthcare workers towards the COVID-19 during the ongoing pandemic. Method A self-developed piloted KAP questionnaire was administered to the recruited healthcare workers involved in the COVID-19 response at the Universal College of Medical Sciences Teaching Hospital (UCMSTH), in Bhairahawa, Nepal. The knowledge questionnaire consisted of questions regarding the clinical characteristics, prevention, and management of COVID-19. Assessment on attitudes and practices towards COVID-19 included questions on behaviour and change in practices made towards COVID-19 response. Knowledge scores were calculated and compared by demographic characteristics and their attitude and practices towards COVID-19. Data were analysed using bivariate statistics. Results A total of 103 healthcare workers participated in the study. The mean age of the participants was 28.24±6.11 years (range: 20–56); 60.2% were females; 61.2% were unmarried; 60.2% had a medical degree, and 39.8% were the nursing staff. The mean knowledge score was 10.59±1.12 (range: 7–13), and it did not vary significantly when adjusted for demographic characteristics. The attitude was positive for 53.4% of the participants with a mean knowledge score of 10.35±1.19 and negative for 46.6% participants with a mean knowledge score of 10.88±0.98 (p = 0.02). The practice was good (≥3 score) for 81.5% participants with a mean knowledge score of 10.73±1.12 and poor for 18.5% participants with a mean knowledge score of 10.46±1.13 (p = 0.24). The attitude of the participants improved with increasing age (29.55±7.17, p = 0.02). Conclusion There is comparably better knowledge regarding COVID-19 among healthcare workers. Appropriate practice correlates with better knowledge and positive attitude towards COVID-19 infection is seen with increasing age. Hence, training on protection and protective measures for having a positive attitude among healthcare workers is necessary against the fight with COVID-19 infection.

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Healthcare workers' knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal

Objectives The prevalence of non-communicable diseases is increasing in Nepal. Overweight and obesity are the major risk factors of many non-communicable diseases. Adolescence is a critical phase for development of overweight and obesity. Risk factors associated with overweight and obesity are not well understood in Nepal. The objective of the study was to identify the factors associated with overweight and obesity among adolescent students.

Setting A cross-sectional descriptive study was carried out on higher secondary school students in the Lalitpur sub-metropolitan city, Nepal.

Participants A random sample of 360 students aged 16–19 years from eight schools was included in the study.

Results The prevalence of overweight among adolescent students was 12.2% (95% CI 8.9 to 15.5). Factors associated with being overweight included being male (adjusted OR (AOR) 2.64, 95% CI 1.18 to 4.88), studying in private school (AOR 2.10, 95% CI 1.03 to 4.28), high socioeconomic status family (AOR 4.77, 95% CI 1.36 to 16.72), watching television for more than 2 h per day (AOR 8.86, 95% CI 3.90 to 20.11), and consuming fruit four times or less per week (AOR 3.13, 95% CI 1.39 to 7.01). There was no statistically significant association between adolescent overweight and age, ethnicity, mother's education level, mother's occupation, number of siblings or family type.

Conclusions Socioeconomic status, watching television for a longer time and consuming less fruit are major risk factors for overweight among adolescents in Nepal. Interventions are needed to increase awareness about the risk factors of adolescent overweight and obesity to decrease prevalence of overweight-associated non-communicable diseases.

https://bmjopen.bmj.com/content/bmjopen/6/5/e010335.full.pdf

Overweight and its associated risk factors among urban school adolescents in Nepal: a cross-sectional study

Nepal is a landlocked country bordering two most populous countries, India and China. Nepal shares open border with India from three sides, east, south and west. And, in north with China, where the novel coronavirus infection (CVOVID-19) began in late December 2019. The first confirmed imported case in Nepal was reported in 2nd week of January 2020. The initial response of Nepal to COVID-19 were comparably slow but country geared efforts after it was declared a 'global pandemic' by WHO on 11 March, 2020. Government of Nepal's steps from 18 March, 2020 led to partial lock down and countrywide lockdown imposed on 24 March, 2020. Government devised comprehensive plan on 27 March, 2020 for quarantine for peoples who arrived in Nepal from COVID-19 affected countries. This article covers summary of global status, South Asian Association of Regional Cooperation (SAARC) status, and Nepal's response to contain COVID-19 infection discussed under three headings: Steps taken before and after WHO declared COVID-19 a global pandemic and lab services regarding detection of COVID-19. Nepal has documented five confirmed cases of COVID-19 till the end of March 2020, first in second week of 15 January, 2020 and 2nd case 8-weeks thereafter and 3rd case two days later, 4th on 27 March and 5th on 28 March. Four more cases detected during first week of April. Non-Pharmacological interventions like social distancing and excellent personal habits are widely practiced. Country has to enhance testing and strengthen tracing, isolation and quarantine mechanism and care of COVID-19 patients as Nepal is in risk zone because of comparably weak health system and porous borders with India. The time will tell regarding further outbreak and how it will be tackled. Keywords: COVID-19; lockdown; Nepal; pandemic; response.

/pdf/nepal-s-response-to-contain-covid-19-infection-28fkzstif4.pdf

Nepal's Response to Contain COVID-19 Infection.

Background: Paintings have been used in Medical Humanities modules in Nepal at Manipal College of Medical Sciences and KIST Medical College. Detailed participant feedback about the paintings used, the activities carried out, problems with using paintings and the role of paintings in future modules has not been previously done. Hence the present study was carried out. Methods: The present module for first year medical students was conducted from February to August 2010 at KIST Medical College, Nepal. Paintings used were by Western artists and obtained from the Literature, Arts and Medicine database. The activities undertaken by the students include answering the questions ‘What do you see’ and ‘What do you feel’ about the painting, creating a story of 100 words about the scene depicted, and interpreting the painting using role plays and poems/songs. Feedback was not obtained about the last two activities. In August 2010 we obtained detailed feedback about the paintings used. Results: Seventy-eight of the 100 students (78%) participated. Thirty-four students (43.6%) were male. The most common overall comments about the use of paintings were “they helped me feel what I saw” (12 respondents), “enjoyed the sessions” (12 respondents), “some paintings were hard to interpret” (10 respondents) and “were in tune with module objectives” (10 respondents). Forty-eight (61.5%) felt the use of western paintings was appropriate. Suggestions to make annotations about paintings more useful were to make them shorter and more precise, simplify the language and properly introduce the artist. Forty-one students (52.6%) had difficulty with the exercise ‘what do you feel’. Seventy-four students (94.9%) wanted paintings from Nepal to be included. Conclusions: Participant response was positive and they were satisfied with use of paintings in the module. Use of more paintings from Nepal and South Asia can be considered. Further studies may be required to understand whether use of paintings succeeded in fulfilling module objectives.

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Student feedback on the use of paintings in Sparshanam, the Medical Humanities module at KIST Medical College, Nepal

Background The majority of patients with asthma and chronic obstructive pulmonary disease (COPD) have been known to perform inhaler technique inadequately. We aimed to evaluate the benefit of hospital pharmacy intervention on the current status of dry powder inhaler (Rotahaler®) technique in such patients and the factors associated with the correct use. Methods A pre-post interventional study was conducted at the outpatient pharmacy in a teaching hospital of the Central Development Region, Nepal, in patients with asthma and COPD currently using a Rotahaler device. Patients' demographics and Rotahaler technique were assessed before intervention. Those who failed to demonstrate the correct technique were educated and trained by the pharmacist, and their technique was reassessed after 2 weeks of intervention. Descriptive statistics, including Wilcoxon signed rank test, Mann-Whitney U test, Spearman's correlations and Kruskal-Wallis test, were performed for statistical analysis. Results Before intervention, only 5.7% (10 of 174) of the patients demonstrated the correct Rotahaler technique and the most common errors observed were failure to breathe out gently before inhalation (98.8%) and failure to hold breath for about 10 seconds after inhalation (84.8%). After the intervention (n=164), 67.1% of the patients showed their technique correctly (p≤0.001) and failure to breathe out gently before inhalation was the most common error (27.44%). Age (p=0.003), previous instruction (p=0.007), patient's education level (p=0.013) and source of instruction (p<0.001) were associated with an appropriate technique before intervention, while age (p=0.024), duration of therapy (p=0.010) and gender (p=0.008) were the factors correlated with correct usage after intervention. Conclusion The current status of Rotahaler technique is inadequate in patients with asthma and COPD attending the Chitwan Medical College Teaching Hospital in the Central Development Region, Nepal. However, a single hospital pharmacy intervention can significantly improve the correct use of the technique, highlighting the role of hospital pharmacies in the improvement of inhaler technique.

/pdf/benefit-of-hospital-pharmacy-intervention-on-the-current-5b90gb7jzr.pdf

Benefit of hospital pharmacy intervention on the current status of dry powder inhaler technique in patients with asthma and COPD: a study from the Central Development Region, Nepal.

Rano Mal Piryani

Papers

Healthcare workers' knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal

Overweight and its associated risk factors among urban school adolescents in Nepal: a cross-sectional study

Nepal's Response to Contain COVID-19 Infection.

Student feedback on the use of paintings in Sparshanam, the Medical Humanities module at KIST Medical College, Nepal

Benefit of hospital pharmacy intervention on the current status of dry powder inhaler technique in patients with asthma and COPD: a study from the Central Development Region, Nepal.