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.

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.

Introduction: Chronic kidney disease (CKD) patients are at increased risk of morbidity and mortality because of their native disease progression. Accumulation of other atherosclerotic risk factors associated with CKD multiplies their risks. This study aimed to evaluate cardiac structural and functional abnormalities in CKD patients undergoing Maintenance Hemodialysis (MHD) using Electrocardiography (ECG) and Echocardiography (Echo). Method: It was a prospective cross-sectional study containing all CKD patients undergoing MHD at Pokhara Academy of Health Sciences, Pokhara, Nepal was conducted between August 2020 to December 2020. All the relevant data were entered in Statistical Package for Social Science (SPSS) for analysis. Results: There was a total of 115 patients with a male: female ratio of 1.8:1 and a mean age of 47.25 ± 15.20 years. The mean duration of dialysis was 36 months and hypertension was the prime risk factor. Common ECG abnormalities were left ventricular hypertrophy, left ventricular strain pattern and poor R wave progression. Common Echo abnormalities were left ventricular diastolic dysfunction, left ventricular hypertrophy and regurgitation. Left ventricular systolic dysfunction was present in 20% of the patients. Conclusion: A spectrum of structural and functional cardiac abnormalities is common in CKD patients undergoing MHD. Early measures should be adopted to mitigate the risk.

Like the world over, Nepal was also hard hit by the second wave of COVID-19. We audited the clinical care provided to COVID-19 patients admitted from April to June 2021 in a tertiary care hospital of Nepal. This was a cohort study using routinely collected hospital data. There were 620 patients, and most (458, 74%) had severe illness. The majority (600, 97%) of the patients were eligible for admission as per national guidelines. Laboratory tests helping to predict the outcome of COVID-19, such as D-dimer and C-reactive protein, were missing in about 25% of patients. Nearly all (>95%) patients with severe disease received corticosteroids, anticoagulants and oxygen. The use of remdesivir was low (22%). About 70% of the patients received antibiotics. Hospital exit outcomes of most (>95%) patients with mild and moderate illness were favorable (alive and discharged). Among patients with severe illness, about 25% died and 4% were critically ill, needing further referral. This is the first study from Nepal to audit and document COVID-19 clinical care provision in a tertiary care hospital, thus filling the evidence gap in this area from resource-limited settings. Adherence to admission guidelines was excellent. Laboratory testing, access to essential drugs and data management needs to be improved.

Implantable subcutaneous chemoports are routinely employed for delivering chemotherapy in oncology. Spontaneous catheter dislodgement and embolization of the catheters are rare complications of the procedure. Herein, we report our experience with a patient presenting with spontaneous dislodgement and migration of the catheter to the pulmonary artery. The patient having familial adenomatous polyposis with adenocarcinoma of the right colon underwent total proctocolectomy and had placement of the chemoport through the internal jugular vein for adjuvant FOLFOX chemotherapy. The entrapped catheter was successfully managed by percutaneous retrieval by an interventional cardiologist.

During the time of COVID-19 outbreak there is dilemma in diagnosis of acute lung infections. This is further hindered among immunocompromised patients due to bizarre clinical and radiological findings. We report young male severely immunocompromised HIV infected ART naïve patient presenting with acute onset of pneumonia and hypoxemia with SARS CoV-2 PCR positive.