The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33.1%), 33 (28%), and 32 (27.1%) patients, respectively. The findings in our study highlight the need for extended monitoring of post-COVID-19 patients following discharge, in order to understand and mitigate long-term implications of the disease.

Background COVID-19 is a viral respiratory disease that was recently recognized in humans. The number of COVID-19 cases has been gradually increasing in Nepal. The objective of this study was to evaluate knowledge, attitude and practice regarding COVID-19 among healthcare workers in Chitwan, one of the districts located in central Nepal. Methods It was a cross-sectional study conducted among healthcare workers from various health institutions located in Chitwan district of Nepal. A self-reported questionnaire was circulated online. Bivariate analyses were done using Spearman’s correlation coefficient, Pearson’s chi square test, and student’s t test as appropriate, whereas multivariate analyses were done using linear regression models. Results A total of 353 responses were analyzed, out of which 47% were nurses, 28.9% were doctors, 11.6% were health assistants, 2% were certified medical assistants, and the remaining 10.5% were categorized as others. The majorities were females (58.9%), were in the age group of 16–29 years (67.1%) and had work experience of less than 5 years (62%). The majority of healthcare workers obtained good to moderate knowledge and practice scores (n = 82.15%, 83.57%, respectively) and had positive attitude scores (n = 90.93%). Mean score values were 21.65 ± 4.71 out of 33 in knowledge section, 8.07 ± 1.49 out of 13 in attitude section and 13.89 ± 5.33 out of 20 in practice section. Mean knowledge and practice scores were significantly associated with job descriptions of healthcare workers (p value – 0.000, 0.007, respectively) with highest mean knowledge scores among doctors (23.70 ± 4.48) and highest mean practice scores among health assistants (15.10 ± 3.61). Higher practice scores (ß = 0.626) and infection prevention training (ß = 1.467) were significantly associated with higher knowledge scores; higher knowledge (ß = 1.366) and higher practice scores (ß = 0.110) were significantly associated with higher attitude scores; and higher knowledge scores (ß = 0.308) and higher attitude scores (ß = 0.265) were significantly associated with higher practice scores. Conclusion The majority of healthcare workers from Chitwan, Nepal, had good to moderate knowledge and practice scores and had a positive attitude toward COVID-19. There was a significant association between knowledge, attitude and practice scores regarding COVID-19 among healthcare workers.

Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low and middle income countries like Nepal. In view of the rising number of infections and prediction of multiple waves of this disease, mortalities due to COVID-19 need to be critically analyzed so that every possible effort could be made to prevent COVID-19 related mortalities in future. Main aim of this research was to study about the mortalities due to COVID-19 at a tertiary level hospital, in Nepal. This was a retrospective, observational study that included all inpatients from Sukraraj Tropical and Infectious Disease Hospital, who were reverse transcriptase polymerase chain reaction positive for SARS-COV-2 and died during hospital stay from January 2020 till January 2021. Medical records of the patients were evaluated. Out of 860 total admissions in a year, there were 50 mortalities in the study center. Out of 50 mortalities, majority were males (76%) with male to female ratio of 3.17:1. Most were above 65 years of age (72%) and had two or more comorbidities (64%). The most common comorbidities among the patients who had died during hospital stay were hypertension (58%) followed by diabetes mellitus (50%) and chronic obstructive airway disease (24%). The median duration from the symptom onset to death was 18 days, ranged from the minimum of 2 days till maximum of 39 days. D-dimer was found to be >1 mg/L in 58% cases and ferritin was >500 ng/ml in 42% patients at presentation. A total of 42% patients had thrombocytopenia, 80% patients had lymphocytopenia and 60% had Neutrophil to Lymphocyte ratio >11.75 with the mean NLR of 18.38. Of total mortalities, 16% patients also showed microbiological evidence of secondary infection; Male gender, age more than 65 years, multiple comorbidities with lymphocytopenia, elevated Neutrophil lymphocyte ratio and elevated inflammatory markers were risk factors found in majority of mortalities in our study. These findings could be utilized for early triage and risk assessment in COVID-19 patients so that aggressive treatment strategies could be employed at the earliest to reduce mortalities due to COVID-19 in future.

Background: The cases of Coronavirus disease-2019 (COVID-19) has been gradually increasing in Nepal. The objective of this study was to evaluate knowledge, attitude and practice regarding COVID-19 among healthcare workers in Chitwan, one of the districts located in central Nepal. Methods: It was a descriptive, cross-sectional study, conducted among healthcare workers from differ­ent health institutions of Chitwan, over the span of two weeks from 1st April, 2020 till 14th April, 2020. Bivariate analyses of knowledge, attitude and practice scores were done with different variables using appropriate tests in SPSS IBM version 25. Results: Out of 353 responses, 166 (47%) were nurses, 102 (28.9%) were doctors, 41 (11.6%) were health assistants, 7 (2%) were community medical assistants, and the remaining 37 (10.5%) were cat­egorized as others. 290 (82.2%) healthcare workers obtained moderate to good knowledge scores, 295 (83.6%) obtained moderate to good practice scores, and 321 (90.9%) had positive attitude scores. Doctors had highest mean knowledge scores (23.70 ± 4.48, p value- 0.000) and health assistants had highest mean practice scores (15.10±3.61, p value- 0.007). Positive correlation was obtained between knowledge and practice scores (r= 0.476, p value- 0.000); and attitude and practice scores (r= 0.238, p value- 0.000). Only 20.4% healthcare workers were confident to handle the pandemic in their health­care setup. Conclusions: The majority of healthcare workers had moderate to good knowledge and practice scores and had a positive attitude toward COVID-19. There was a significant association between knowledge, attitude and practice scores obtained by healthcare workers from Nepal.

Background: There are very few researches from Nepal that have evaluated clinical profile of end stage renal disease patients. Our main objective was to study the clinical profile of end stage renal disease patients, who were under maintenance hemodialysis for at least three months duration in two dialysis centers located in Chitwan Nepal.Methods: This was a descriptive, cross-sectional study conducted among 138 end stage renal disease patients, who were undergoing maintenance hemodialysis at two government centers located in Chitwan, Nepal. Results: Among 138 patients in our study, 42 (30.4%) patients had diabetic nephropathy and 11 (8%) patients had hypertensive nephropathy as the leading causes of end stage renal disease; however the cause could not be ascertained in 63 (45.7%) patients. 47 (34.1%) patients had started hemodialysis within one month of diagnosis of their kidney disease. Fatigue and musculoskeletal pain were the commonest symptoms found in 78 (56.6%) patients, whereas hypotension and fever were the two most common intra-dialytic complications found in 73 (52.9%) and 61 (44.2%) patients respectively. Anemia was present in 127 (92%) patients, 41 (29.7%) had hyperkalemia, 54 (39.1%) had hypocalcemia, 116 (84.1%) had hyperphosphatemia and 43 (31.2%) had hyperuricemia. Regular use of erythropoietin analogs was significantly associated with higher hemoglobin levels (p value- 0.000) and lesser frequency of blood transfusions (p value- 0.000) in our study.Conclusions: Diabetic nephropathy was the leading cause of end stage renal disease in our study. Cause of ESRD could not be ascertained in nearly half of the total patients. Keywords: Chronic renal failure; end stage renal disease; hemodialysis; Nepal

Introduction: Anaemia is an important comorbidity common in patients with heart failure and is associated with poor clinical status and worse outcomes. In Nepal few studies have evaluated anaemia amongst patients suffering from heart failure. We intended to find out the prevalence of anaemia in patients with heart failure in a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted among patients of heart failure presenting to tertiary care hospital in eastern Nepal from April 2017 to January 2018. Ethical approval was taken from the Institutional Review Committee of a tertiary care centre (reference number: IRC/0842/016). Using the convenience sampling method, 100 patients were enrolled in the study. Blood samples from the patients were taken for haemoglobin and serum iron studies. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Results: Among 100 patients with heart failure, 82 (82%) (74.47-89.53 at 95% Confidence Interval) had anaemia. Mean haemoglobin level of the study population was 10.40±2.73 g/dl. Fifty four (54%) of patients had iron deficiency status irrespective of presence or absence of anaemia. Conclusions: Prevalence of anaemia among patients of heart failure in our study was found to be higher than various other homologous international studies.