Background: Corona virus disease 2019 (COVID-19) is a highly infectious disease. It is caused by a novel virus belonging to a family known as corona virus. This virus was first identified in the month December 2019 in Wuhan, China Hubei province. Since its first identification it has spread globally. It was declared a public health emergency of international concern on January 30, 2020 by WHO. Despite all efforts the virus continues to spread and WHO declared it a pandemic on March 11, 2020. In Nepal the first case was tested positive on23rd January and ever since numbers are increasing as days passed by. Residents of the country are the most important stakeholders to control the spread of such viruses. Nepal is a land locked country situated between India and China and is one of the vulnerable areas among SAARC nations. In spite of being such a vulnerable nation there was a lack of previous studies detecting the degree of awareness among Nepalese residents towards COVID 19. Aims and Objectives: This study aims to assess the current level of awareness towards COVID 19 among Nepalese residents and to analyze their attitudes and practices towards COVID 19 which is very important for people’s active participation to control this pandemic. In this study we investigated Nepalese residents KAP towards COVID-19. Material and Methods: This is cross sectional online study. A self-developed online questionnaire was completed by the participants. There were a total 29 questions among which 15 questions assessedknowledge, 6 questions assessed attitude and remaining 8 questions assessed practice. Results: Among the respondents (n=760), 65.7 % were male, 50.3 % were healthcare workers, overall range of correct answers for knowledge questionnaire was 60.0-98.7%, that for attitude was 77.9-96.4% and for practice was 78.2-95.0 %. Participants with a medical degree had statistically significant better practice against COVID 19 compared with the general population. Conclusion: Findings of this study show that knowledge among people of Nepal about COVID 19 is satisfactory. Yet a significant number of participants are lacking confidence when compared to other countries. Better practice against COVID requires a sense of responsibility, though the respondents with medical background had better sense of act against COVID prevention practice.

Malnutrition remains one of the most pressing global health crises, exacerbating paediatric mortality in low- and middle-income countries. It has long-term implications, from immediate health concerns to weakened immune function and reduced economic productivity. Despite decades of progress driven by international collaboration, contemporary global disruptions have counteracted the gains in combating malnutrition. The US Agency for International Development (USAID) abruptly withdrew support, aggravating the situation, which previously funded large-scale nutrition programmes and health interventions across more than 50 countries. USAID tailored its assistance to nutritional rehabilitation, maternal-child health and healthcare infrastructure, significantly curbing child malnutrition in countries like Pakistan, South Sudan and Yemen. The dissolution of these programmes has placed millions of vulnerable children at increased risk of malnutrition. This editorial accentuates the urgency of addressing the funding gap left by USAID’s cessation and calls for coordinated policy interventions, increased domestic investment in nutrition programmes and global collaboration through alternative funding sources. Strengthening food security initiatives, bolstering healthcare supply chains and launching public awareness campaigns on maternal and child nutrition are critical in preventing a worsening public health crisis.

Background: In the United States (US), cardiac arrest is still the important cause of fatality, yet there is limited exploration of mortality linked to hyperkalemia. This study aimed to analyze the trends and regional variations in the mortality of cardiac arrest due to hyperkalemia in people aged 15 years and older. Methods: The study examined mortality from cardiac arrest related to hyperkalemia in people aged 15 years and older via the CDC WONDER database, which spans from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and the annual percent change (APC) per 100 000 individuals were calculated, with strata based on year, sex, age groups, urbanization, race and geographic region. Results: Between 1999 and 2020, 36 840 cardiac arrest deaths related to hyperkalemia were reported among those aged 15 years and above. The overall AAMR declined from 5.9 in 1999 to 4.9 in 2007, followed by increases to 7.7 and 9.5 in 2018 and 2020, respectively. Males consistently presented higher AAMRs than females, and the highest AAMR was found in NH Black or African American patients. Crude mortality rate (CMR) was higher among people of age 85 years and above. Conclusion: Since 2007, mortality due to cardiac arrest related to hyperkalemia in individuals aged 15 years and above has increased. Interventions to manage hyperkalemia are essential to limit rising mortality rates, especially among specific demographic groups and geographic regions.

BACKGROUND Obese patients (body mass index ≥ 30 kg/m²) undergoing isolated aortic valve replacement (AVR) face increased surgical risks due to comorbidities. Partial upper sternotomy (PUS), a minimally invasive approach, may reduce complications compared to full median sternotomy (FMS). We hypothesize that PUS improves outcomes over FMS in obese patients undergoing AVR. AIM To compare the efficacy and safety of PUS vs FMS in obese patients undergoing isolated AVR. METHODS This systematic review and meta-analysis followed PRISMA guidelines, searching PubMed, EMBASE, and Cochrane databases for observational studies comparing PUS vs FMS in obese patients undergoing AVR. Outcomes were analyzed using odds ratios (OR), mean differences (MD), 95% confidence intervals (CI), I ² statistic, and Newcastle-Ottawa Scale was used for quality assessment. RESULTS Four observational studies involving 677 patients were analyzed. PUS reduced intensive care unit stay (MD -2.67 days, 95%CI: -4.43 to -0.90, P = 0.003, I ² = 78%) but increased cardiopulmonary bypass time (MD 5.62 minutes, 95%CI: -0.36 to 11.59, I ² = 55%). No differences were observed in renal failure (OR 1.13, 95%CI: 0.63-2.94, I ² = 0%), atrial fibrillation (OR 0.81, 95%CI: 0.43-1.54, I ² = 30%), reexploration (OR 1.09, 95%CI: 0.48-2.47, I ² = 0%), postoperative bleeding (OR 1.48, 95%CI: 0.53-4.15, I ² = 60%), wound infection (OR 1.23, 95%CI: 0.70-2.14, I ² = 0%), hospital stay (MD 0.51 days, 95%CI: -4.13 to 5.15, I ² = 90%), or cross-clamp time (MD 4.03 minutes, 95%CI: -0.75 to 8.80, I ² = 50%). CONCLUSION PUS is safe and effective for obese patients undergoing AVR, reducing intensive care unit stay and enhancing recovery, provided surgical expertise is available.

Organophosphorous poisoning is a very common poisoning. Intermediate syndrome with respiratory failure is a highly fatal complication. We report a case of 20 year old male who developed intermediate syndrome despite adequate atropinisation . Early clinical recognition of the syndrome and institution of mechanical ventilation along with ongoing atropine therapy was instrumental in saving the patient’s life. Patient was discharged on day 10 after successful treatment.

Introduction: Delphinium species are commonly used as medicinal herbs, with a wide range of implications for medical conditions. The injudicious use of this plant has been known to cause devastating side effects, including cardiac arrhythmias. Case presentation: Here, the authors present an 80-year-old male with incessant ventricular tachycardia after ingestion of this herb. The sinus rhythm was restored after electrical cardioversion and aggressive intravenous antiarrhythmics. Clinical discussion: To the best knowledge of the authors, no case of a ventricular storm following ingestion of Delphinium has been reported till now, probably rendering this case the first one. Conclusion: This report aims to present the rare case using theoretical concepts from the discipline and to share our approach in the hope of achieving a better understanding of similar cases.