Journal of Universal College of Medical Sciences

A Young Female with Trichobezoar: A Case Report

2023-08-28T06:16:28+00:00

Trichobezoars are rare mass of hair usually located in the stomach, but may extend into the small intestine and sometimes up to large bowel. It is usually associated with a history of psychiatric disorders such as trichophagia and trichotillomania. We present a case of trichobezoar in a 14-year-old female with decreasing density of hair, abdominal pain, vomiting and history of trichophagia. The diagnosis was conﬁrmed by CT scan. The patient was managed by exploratory laparotomy with gastrotomy.

Rare Co-occurrence of Ocular Myasthenia Gravis in Hyperthyroidism: A Case Report

2023-08-28T06:26:54+00:00

A rare clinical presentation of ocular myasthenia gravis (OMG) with thyroid disorders, has been reported and documented in the past. There is similarity in the presentation of patients with OMG and thyroid opthalmopathy as a complication of thyrotoxi- cosis. The tendency of myasthenia gravis to get overlooked as separate entity despite having thyrotoxic presentation con-comit- tantly necessitates knowledge, thorough examination, and an experienced approach, to aid in its diagnosis. We have discussed two cases in a thyrotoxic state, with symptoms of ocular myasthenia gravis and clinical approach in our setting.

Is It Not The Right Time To Consider Trivalent Mumps Vaccine (MMR) In The National Immunization Programme of Nepal? If Not Now, Then When?

2023-08-20T07:18:18+00:00

Vaccination is the process of administration of a vaccine to help the immune system develop immunity from a disease resulting in reduction of child mortality, morbidity and disability in vaccine preventable diseases. Nepal started its pilot vaccination program in 1979 (2034 B.S) and after a decade (1989), the Expanded Program on Immunization (EPI) was followed to the whole country with the aim of universal vaccination in children.

National immunization programme (NIP) provides vaccination services free of cost to the children living in marginalized communities and geographical regions difﬁcult to reach through outreach sessions. Although many more vaccines have been added to the NIP of Nepal since then, vaccination against mumps is still missing. Nepalese children are being vaccinated with MR vaccine (measles and rubella) at 9 completed months and a booster at 15 months in spite of MMR (measles, mumps and rubella) vaccine. The time to re-think and consider mumps vaccine (MMR) in the immunization schedule of Nepal by the government of Nepal has arrived now. Including MMR vaccine in the national immunization schedule would ultimately result in the reduction of the outbreaks and associated morbidity that occur annually along with the economic beneﬁts.

Tenets of Specimen Management in Diagnostic Microbiology

2023-08-28T06:00:20+00:00

The interpretation of microbiological results depends, to a large extent, on the quality of the samples received for investigations. Even with the advancements in laboratory automation and integration of molecular diagnosis in microbiology, interpretation of results still depends on the quality of specimens received. Therefore, an appropriate management of the samples is necessary to achieve an optimal diagnosis in microbiology laboratory. Recently, clinical microbiologists have begun to promote specimen management as a process critical to diagnostic success. Microbiology laboratory results that are accurate, signiﬁcant and clinically relevant depend almost entirely on specimen management process. This article review the specimen management process, special skills and precise concepts required to collect the specimens for effective methods in diagnosis.

Blunt Pulmonary Contusion: Admission Computed Tomography Scan Predicts Mechanical Ventilation

2023-08-23T06:25:26+00:00

INTRODUCTION Road trafﬁc injury is one of the fastest growing health problems in Nepal with increasing number every year leading to morbidi- ty and mortality. Blunt pulmonary contusion may not be seen in the initial plain radiographs as they evolve over 12-24 hours. Thus CT (Computed Tomography) scan can provide detailed information about the contusion and predict the need for mechanical ventilation.

MATERIAL AND METHODS This is a prospective, observational longitudinal study conducted at Universal College of Medical Sciences, Bhairahawa from 1st January 2020 to 31st December 2020. The predictors for requirement of mechanical ventilation like Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), GCS score and number of fractured ribs at the time of admission were recorded.

RESULTS In this study, 100 cases with blunt pulmonary contusion were evaluated. Average age of patients with blunt pulmonary contusion was around 39.10±17.56 years with male predominance (82%). Total of 7 patients required mechanical ventilation among whom the AIS chest was 3.0±0.82, ISS score was 29.14±6.89, and GCS 9.14±3.13. The ROC curve showed that ISS score predicted signiﬁcantly about the requirement of mechanical ventilation with sensitivity of 85.5% and speciﬁcity of 99.8 %.

CONCLUSION Initial CT done in patients can show the presence or absence of pulmonary contusion and associated thoracic injuries and along with AIS, ISS and GCS scores we can predict early the requirement of mechanical ventilation.

Functional Outcomes of Close Reduction and Percutaneous Pinning in Proximal Humerus Fractures

2023-08-23T07:01:13+00:00

INTRODUCTION Proximal humerus fractures are usually sustained from trivial fall in elderly. These fractures are usually associated with severe degree of comminution and deformity. Therefore, anatomical reduction of fracture fragments, and early mobilization are key factors for optimal outcomes of involved limb. This study was intended to evaluate the functional outcomes of proximal humer- us fractures in adults managed by closed reduction and percutaneous pinning (CRPP).

MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2021 to June 2023. All patients with proximal humerus fractures who fulﬁlled the inclusion criteria and who underwent closed reduction and percutaneous pinning were enrolled in the study and functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months.

RESULTS In this study of 60 cases, the mean age group was 53.08±13.10 years and male patients outnumbered female patients (37 males and 23 females). Forty one cases (68.3%) were of right side and 19 (31.7%) were of the left side. Majority of the fractures were due to fall injury (53.3%), followed by road trafﬁc accident (40%). The mean Constant Murley Score was 76.95 ± 5.53 and VAS (visual analogue score) was 1.97 ± 0.97.

CONCLUSION Closed reduction and percutaneous pinning is simple, less invasive and effective procedure for proximal humerus fracture providing good functional outcome.

Maternal and Fetal Outcome in Cases of Preeclampsia and Eclampsia in Tertiary Care Center of Nepal

2023-08-23T07:14:17+00:00

INTRODUCTION Hypertensive disorders of pregnancy includes Gestational Hypertension, Preeclampsia and Eclampsia, Chronic Hypertension and Preeclampsia superimposed in Chronic Hypertension. These condition complicates around 5 to 10 percent of pregnancies and have signiﬁcant contributions on maternal and fetal adverse outcome. This study was done to ﬁnd out the maternal and fetal outcome in cases of Pre-eclampsia and Eclampsia.

MATERIAL AND METHODS It was a hospital based cross sectional observational study done in department of Obstetrics and Gynecology of Universal College of Medical Sciences from August 2021 to June 2022. Maternal and fetal outcome in Preeclampsia and eclampsia were studied in 116 cases.

RESULTS Incidence of diseases was 5.94%, preeclampsia 33(28.4%), eclampsia 23(19.8%) and severe preeclampsia 60 (57.7%). Adverse maternal outcome were HELLP (Hemolysis, Elevated liver enzyme and Low platelets counts) syndrome 15 (12.93%), Abruption placenta 7(6.03%), need of blood transfusion 20 (17.24%), Pulmonary Oedema 3(2.58%), Post-Partum Hemorrhage 3(2.58%) and one case had maternal death. Total 121 babies were born, 42(36.20%) admitted in NICU, 10(8.26%) were intra uterine fetal death (IUFD), 3 (2.48%) were neonatal death (NND), 10(8.26%) refused treatment and leave against medical advice. Common fetal morbidities were intra uterine growth restriction (IUGR) 29 (23.76%), preterm Low birth weight 22(18.18%), anomalous baby 3(2.48%) and congenital pneumonia 1 (0.83%).

CONCLUSION Proper Antenatal care and screening, timely referral and prompt management favoured the outcome in positive way.

Quality of Life in Patient with Acne Vulgaris

2023-08-23T07:31:29+00:00

INTRODUCTION Acne Vulgaris is one of the common skin disease which can impair the quality of life of the individual. This study is done to assess the quality of life in patient with acne using Dermatology life quality index (DLQI) and Cardiff acne disability index (CADI).

MATERIAL AND METHODS This was a cross-sectional, questionnaire-based study in 101 patients of acne vulgaris at dermatology and Venerology OPD of Universal College of Medical Science, Bhairahawa, Nepal. The participants were given DLQI and CADI to assess the quality of life. The severity of acne was assessed by simple grading system.

RESULTS There was some effect in quality of life in patient with acne but there was no signiﬁcant relation with severity of acne and quality of life.

CONCLUSION Psychological assessment should be done in patient with acne vulgaris as it can have negative effect in quality of life.

Clinical Profile of Patients with Anemia in a Tertiary Care Hospital

2023-08-25T05:51:22+00:00

INTRODUCTION Anemia is a common health problem with nonspeciﬁc symptoms often overlooked leading to adverse health outcomes. This study aims to assess the clinical proﬁle, types, and etiologies of anemia.

MATERIAL AND METHODS In this hospital based cross-sectional study, patients with anemia were enrolled through convenience sampling. Relevant history, physical examination, and investigations were performed. Statistical package for social sciences software version 20 was used to enter and analyze the data. Categorical variables were expressed as frequencies and percentages. Continuous variables were expressed as median (range). The associations were analyzed by using Fisher's exact test or Chi-square test, as appropriate.

RESULTS Out of 193 patients, 151 (78.2%) were females. The median age was 49 years (range 18-87 years). Most frequent symptoms were easy fatiguability (76.2%), breathlessness on exertion (30.1%), and light headedness (21.8%). Most frequent signs were pallor (75.6%), tachycardia (23.8%), glossitis (16.1%), and nail changes (15.5%). Majority (79.3%) had moderate and 17.1% had severe anemia. Iron deﬁciency (59.1%) and anemia of inﬂammation (28%) were common etiologies. Iron deﬁciency anemia was most commonly due to nutritional deﬁciency. Age was signiﬁcantly associated with the type and etiology of anemia.

CONCLUSION Moderate anemia was the most common presentation. Easy fatiguability, breathlessness on exertion, and light headedness were most common symptoms, while pallor, tachycardia, glossitis, and nail changes were the most common signs. Iron deﬁciency anemia and anemia of inﬂammation were most common etiologies. Iron deﬁciency anemia was more common in younger patients, while anemia of inﬂammation was more common in older patients.

Valuation of Mast Cells in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma Staining With Toluidine Blue Stain: A Histochemical Study

2023-08-25T06:04:50+00:00

INTRODUCTION Mast cells present in the connective tissue stroma release pro inﬂammatory and mitogenic cytokines. The mast cell in tumor act as a host immunologic anti tumor response. More than 90% of oral cancers are squamous cell carcinomas with oral epithelial dysplasia being the most common potentially malignant disorder. Mast cells play an important role in tumourigenesis.n some studies, with different granules of mast cell is closely related with angiogenesis and tumor invasion. In this study we used toluidine blue for the staining because it reveals mast cells as large, purple, oval and granulated cells.

MATERIAL AND METHODS 30 cases of oral epithelial dysplasia, 30 cases of Oral squamous cell carcinoma (OSCC) and 10 cases of Normal oral mucosa (NOM) were studied for mast cell number using toluidine blue. Mast cells were counted using an Olympus CX41 microscope ﬁtted with an Olympus oculometer grid. Counting was carried out at ×40 by two independent observers and was done in six non overlapping ﬁelds in each slide. Mast cells were identiﬁed on the basis of the purple color attained by the granules after toluidine blue staining, but the nucleus of these cells appeared blue.

RESULTS Highly signiﬁcant increase of mast cells in oral epithelial dysplasia on comparison with OSCC whereas there was only a signiﬁcant increase in mast cells in OSCC on comparison with NOM.

CONCLUSION Mast cells can be used an indicator of increased angiogenesis and can help in the prediction of carcinogenesis, its progression, and also in the prognosis of the malignant lesions.

Fetomaternal Outcome of Obstructed Labor in a Tertiary Care Centre

2023-08-25T06:22:57+00:00

INTRODUCTION Obstructed labor is the leading cause of hospitalization. It is a preventable obstetric complcation. However, it is a major cause of maternal and perinatal morbidity and mortality. The main objective of the study was to ﬁnd feto-maternal outcome in obstructed labor at tertiary care hospital UCMS-TH, Bhairahawa.

MATERIAL AND METHODS Eighty seven women admitted with features of obstructed labor at our hospital were studied. By clinical examination, diagnosis of cephalopelvic disproportion, malpresentation, malposition, obstruction in birth canal, overdistended bladder, hematuria, rupture uterus and supermoulding of fetal head was detected. Demographic proﬁle of patients, mode of delivery, time interval between referral and admission, intervention done, intrapartum and postpartum complications, maternal and fetal outcome were evaluated.

RESULTS There were 87 cases of obstructed labor among 1655 total deliveries. Most common cause for obstructed labor was cephalopelvic disproportion (34.4%) followed by malpresentation (19.5%) and non progress of labor (17.2%). Majority of the patients were primigravida (43.6%) followed by multiparous (35.6%) and grand multipara (20.6%). Most of cases were unbooked and referral from primary health centers (80.4%). PPH (41.2%), extension of uterine incision (17.4%), followed by sepsis, pyrexia and uterine rupture were common complications. Perinatal morbidity due to obstructed labour requiring NICU admission was (33.9%) and perinatal mortality was (21.7%) mainly due to meconium aspiration, respiratory distress and septicemia.

CONCLUSION Cephalopelvic disproportion and primigravida were the commonest cause of obstructed labour and associated with PPH, extension of uterine incision, uterine rupture, sepsis and neonatal ICU admission and even neonatal death.

Overweight Among Medical Students in Universal College of Medical Sciences: A Descriptive Cross Sectional Study

2023-08-25T06:34:49+00:00

INTRODUCTION Overweight is a lifestyle disorder affecting both physical and psychological health of a person. The rate of overweight index is rising in people from all walks of life. The main aim of this study is to ﬁnd out the prevalence of overweight among medical students in a tertiary care center creating self-awareness in them.

MATERIAL AND METHODS This is a descriptive cross-sectional study done in 385 students in a tertiary care hospital from 15th August 2022 to 30th Novem- ber 2022.The sample was collected by simple random sampling method after the approval from the Institutional Review Committee of Universal College of Medical Sciences (reference number UCMS/IRC/100/22). Height in meter and weight in kilogram of students were measured to calculate body mass index and grouped according to Asian Criteria categories normal BMI is between 18.5 to 22.9 kg/m², BMI 23 to 24.9 kg/m² would be considered as overweight and BMI > 25 kg/m² would be considered as obese. Data was analyzed by using Statistical Package of Social Science software version 16.

RESULTS Among 385 students, 70 (18.1%) were found to be overweight with 95% Conﬁdence Interval. Overweight males were 37 (9.6%) and females were 33 (8.5%) respectively out of the total number of male 173 (44.93%) and female 212 (55.07%). The mean age of the students and the mean BMI was found to be 21.01 ± 2.01 and 22.39 ± 3.54 respectively.

CONCLUSION The current study shows the prevalence of overweight among medical students is slightly higher than in studies done in similar settings.

Coronary Angiography in Dilated Cardiomyopathy Patients Presenting to Cardiac Hospital at Lumbini Province Nepal

2023-08-25T06:43:32+00:00

INTRODUCTION Dilated cardiomyopathy is one of the common cause of patients presenting with symptoms of heart failure. It is often treated as respiratory disease in the absence of speciﬁc evaluation. We wanted to evaluate the presence of coronary artery disease in dilated cardiomyopathy patients.

MATERIAL AND METHODS It was a prospective observational study conducted at Gautam Buddha Community Heart Hospital. One hundred sixty patients with the diagnosis of dilated cardiomyopathy were evaluated with coronary angiography.

RESULTS Distribution of patients was males 68.1% and females 31.9%. Most patients (61.2%) were in the age group 45 to 65 years. Dyspnea (80.6%), fatigue (25%), cough (20%), chest discomfort (16.9%), edema (15%) and palpitation (11.9%) were common symptoms. Majority of patients were smoker 41.9%. Coronary artery disease was found in 44.4% with signiﬁcant stenosis in
36.3%. Among the patients with signiﬁcant coronary artery stenosis two vessel disease was present in 54%, one vessel disease in 32% and three vessel disease in 14%.

CONCLUSION Coronary artery disease was frequently present in dilated cardiomyopathy patients. Optimization of management becomes easier with thorough evaluation of DCM patients including coronary angiography.

Formulation and In-Vitro Evaluation of Fast Dissolving Oral Films of Promethazine

2023-08-27T04:46:15+00:00

INTRODUCTION Fast disintegrating/dissolving medicine delivery devices are oral ﬁlms that swiftly disintegrate or adhere in the mouth. It includes the ability to administer systemic medications without having any ﬁrst-pass effects. A ﬁrst-generation antihistamine from the phenothiazine family is promethazine HCl. It is effective in treating motion sickness but it has a poor oral bioavailability. The study aims is to formulate promethazine fast dissolving oral ﬁlm using natural and synthetic polymers and compare the formulations.

MATERIAL AND METHODS This experimental study was conducted in the Pharmaceutic laboratory of Department of Pharmacy at Universal College of Medical Sciences, Bhairahawa, Nepal from February 2022 to July 2022. Fast dissolving oral ﬁlms of promethazine were prepared by solvent casting method using polymers and plasticizers in varying concentrations. Weight variation, thickness variation, surface pH, folding endurance, swelling index, disintegration duration, dissolution study and medication content were among the several in vitro assessment criteria that were identiﬁed.

RESULTS When examined for physical characteristics, thickness, weight uniformity, in vitro disintegration time, folding durability, drug content, and an in vitro drug release, ﬁlms were determined to be adequate. The ﬁlms of the F2 formulation demonstrated an increased rate of drug dissolution with a drug content of 99.17%, a disintegration time of 38 sec, and a drug release of more than 99% within 16 min.

CONCLUSION Synthetic polymer (Hydroxypropyl methyl cellulose) showed better result in comparison to natural polymer (Sodium alginate).

Relationship between Parenting Styles and Academic Performance among Adolescents in Selected Schools of Rupandehi

2023-08-27T04:58:39+00:00

INTRODUCTION Children spend most of the time at home and parent’s attitude, behaviours, life standards and communication with children has greater inﬂuence on child growth and development. Parenting styles are representation of how parents respond and demand to their children. The present study aimed to investigate the relationship between the parenting styles and academic performance among adolescents.

MATERIAL AND METHODS Cross-sectional study was conducted among 364 adolescents to ﬁnd out the relationship between parenting styles and academic performance at schools of Rupandehi by using non- probability convenience sampling technique. Socio-demographic data were collected using self-structured questionnaire. Parenting style was assessed by using Parental Authority Questionnaire and academic performance was measured by taking the average percentage obtained in the previous 3 annual examinations (7th, 8th and 9th standard). The data were analyzed by using descriptive and inferential statistics with Statistical Package for Social Sciences software version 20.

RESULTS The results showed that 67.3% and 64.8% of the respondents reported that their mother and father adopted authoritative parenting style respectively. More than half (62.6%) of the respondents’ academic performance was good as they scored ﬁrst division in the previous annual examination. The results also showed that there is a weak positive correlation between mother and father authoritative parenting style with academic performance among adolescents.

CONCLUSION Based on the ﬁndings, it is concluded that parenting style does not inﬂuence the academic performance among adolescents. Hence, there can be other contributing factors which may affect the academic performance among adolescents.

In-Vitro Anti-Diabetic Activity and Phytochemical Screening of Ethanolic extract of Calotropis gigantea (Linn)

2023-08-27T05:20:08+00:00

INTRODUCTION Diabetes Mellitus (DM) is metabolic disorder characterized by hyperglycaemia due to defect insulin release from pancreas and insulin resistance. The present study was aimed to screen the phytoconstituent present in leaf extract and evaluate α- amylase inhibitory activity of ethanolic extract of Calotropis gigantea leaf. Calotropis gigantea also known as crown ﬂower is rich in phytochemicals like alkaloids, saponins, steroids, ﬂavonoids and glycosides. It is used for asthma, bronchitis and dyspepsia, dried whole plant is a good tonic.

MATERIAL AND METHODS About 58.45g coarse powder of Calotropis gigantea leaves was extracted with ethanol using Soxhlet apparatus. Then the phytochemical screening of ethanolic extract was done. Different concentration (0.1mg/ml to 1mg/ml) of ethanolic extracts of leaves, acarbose, sitagliptin and metformin was prepared, and all the concentration were evaluated for α- amylase inhibitory activity through spectrophotometric method.

RESULTS Maximum inhibition of α- amylase was shown by acarbose at concentration of 1mg/ml and found to be 78.787 ± 0.00240 % whereas plant extract at concentration of 1mg/ml showed inhibition of α- amylase activity 54.6296 ± 0.00282 %. Percentage inhibition of α-amylase activity by plant extract was found to be dose dependent.

CONCLUSION It was concluded that Calotropis gigantea leaves possess some bioactive compounds which were responsible for controlling blood glucose level by inhibiting α-amylase and its identiﬁcation, isolation and characterization may lead to development of newer drugs with lesser side effects.

Knowledge, Attitude and Practice on Physical Activities among Undergraduate Medical Students of Devdaha Medical College Teaching Hospital

2023-08-27T05:34:07+00:00

INTRODUCTION Physical activities are one of the major contributors to one’s physical ﬁtness and health. Physical activities are known to prevent many globally leading non-communicable diseases. Medical students are even taught in their curriculum about these diseases and the role of physical activities in their prevention. They might be adopting different types of physical activities in their daily life and some might be ignoring or being deprived of practicing physical activities due to various reasons.

MATERIAL AND METHODS A descriptive cross-sectional study using pre designed questionnaire was conducted among ﬁrst to ﬁnal year medical students of Devdaha medical college to assess knowledge, attitude and practice on physical activities where 162 students were selected purposively and thus obtained data were analyzed using IBM SPSS version 24.

RESULTS Majority of the students had a good knowledge of physical activity and a positive attitude towards physical activities. Most of them (97.67%) have performed physical activities in their life and a majority of them (79.07%) were currently involved in physical activities. Cardio training was the most practiced physical activity followed by sports and yoga practices. Lack of company and lack of time were identiﬁed as factors abstaining physical activities among them who left practicing physical activities.

CONCLUSION This study was done to explore knowledge, attitude and practice on physical activities of medical students. The majority of the students had a good knowledge regarding beneﬁts of physical activities, and positive attitude towards physical activities, however only a moderate number of students practiced physical activities.

Effectiveness of Teaching Programme on Knowledge and Attitude of Mothers Regarding Play of Under Five Children

2023-08-28T05:45:50+00:00

INTRODUCTION Play is essential for healthy growth and development of children as it fosters their cognitive, physical, social, and emotional well-being. This study aims to ﬁnd out the effectiveness of teaching program on knowledge and attitude of mothers regarding play of under ﬁve children in a selected municipality of Rupandehi district, Nepal.

MATERIAL AND METHODS This was a community based one group pretest and posttest interventional study conducted from December 2020 to May 2021 among 255 mothers of under ﬁve children from randomly selected 3 wards out of the total of 13 wards of Siddharthanagar municipality of Rupandehi district in Nepal. Pretest was followed by educational intervention on play of under ﬁve children and after seven days of educational intervention, posttest was done among same mothers.

RESULTS The study found that before intervention, level of knowledge regarding play of under ﬁve children was inadequate among 98.4% of the mothers and attitude was unfavorable among more than three-fourth (76.1%) of the mothers. After the teaching program level of the knowledge was adequate among 100% of the mothers and attitude was favorable among 100.0 % of the mothers. The post-test knowledge mean score was higher than the pretest knowledge mean score with a mean difference of 17.90. The calculated “t” value (-52.92) was highly signiﬁcant with p value < 0.001. Similar to this, there was a mean difference of 21.38 between the mean attitude scores before and after the intervention. The calculated "t" value (-146.80) was highly signiﬁcant with p value < 0.001.

CONCLUSION The study concludes that teaching program tends to be effective in enhancing mothers’ knowledge and attitudes towards play of under ﬁve children. Thus, community health nurses should implement such education program on play therapy to mothers of children under ﬁve.

Role of Social Media in Medical Education

2023-08-28T06:10:01+00:00

Social Media has become a revolution. More than half of the world’s population use social media. Covid 19 pandemic increased the use of social media for medical education. Different online platforms using Web 2.0 technology has come up with innova- tive ideas for medical education. An enhanced online presence has the potential to make positive contributions to professional development, education and collaborations, potentially opening doors to academic opportunities. Journal clubs have evolved from traditional classroom based to online platforms such as twitter. Tutorials have become tweetorials. Academic achieve- ments from impact factor-based publication have now become alternative metrics score (Altmetrics). Here, in this article we discuss different aspect of social media to enhance education, research and clinical practice in modern medicine.