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The novel coronavirus COVID-19 (SARS-CoV-2) was first reported in 31 December 2019 in Wuhan City, China. The first case of COVID-19 was officially announced on 24 January, 2020, in Nepal. Nine COVID-19 cases have been reported in Nepal. We aim to describe our experiences of COVID-19 patients in Nepal. Keywords: COVID-19; experience; Nepal.

Background Approximately 5% of all fractures consists of proximal humeral fractures. In the elderly population, most of these fractures are related to osteoporosis. Internal fixation has led to unpredictable results, especially in patients with osteopenic bone and those with comminuted fractures. Objective To evaluate functional outcome and complications following proximal humerus fracture fixation using locking plate. Method This prospective observational study was conducted at Nepal Medical College and Teaching Hospital from February 2014 to June 2015. We reviewed 35 patients with proximal humerus fractures, who underwent open reduction and internal fixation with locking plate.Functional outcome was evaluated according to the ConstantMurley shoulder assessment. Result Fracture union was achieved in all cases with the mean time to union being 14.6 weeks (11-24 weeks). At the final follow up the mean constant murley score was 73.6 (48-94). There was total 8(22.85%) cases who developed complication. Conclusion Internal fixation with the locking plate for proximal humerus fractures provides stable construct with better functional outcome as it allows early shoulder mobilization.

Fracture neck of femur is most commonly encountered fractures in elderly population. Hemiarthroplasty is generally considered to be the treatment of choice in most active elderly patients. However, there is inadequate evidence to support the choice between unipolar or bipolar prosthesis. This study was conducted to analyze the outcome regarding pain, hip function, complication and acetabular erosion in patients randomly selected and treated with Austin Moore's or Bipolar hemiarthroplasty in our setup. The study included total of 40 patients (17 males and 23 females) with intracapsular neck of femur fractures with mean age of 67 years (55-85 years). 20 patients each were treated with Hemiarthroplasty using Austin Moore's and Bipolar prosthesis. The patients were followed up at intervals of 2 weeks, 6 weeks, 24 weeks and 1 year after the operation and evaluated clinically and radiologically. There were no significant differences between the groups regarding complication. The Harris hip score were 81.95% (SD - 2.99) in Austin Moore's hemiarthroplasty and 79.15% (SD - 2.94) in Bipolar hemiarthroplasty (p = 0.812), whereas acetabular erosion was 20.05% in Austin Moore's hemiarthroplasty and 5% in Bipolar hemiarthroplasty (p = 0.758) with no mortality seen during lyear follow up. The intracapsular neck of femur fracture in active elderly patients treated with Austin Moore's hemiarthroplasty had better outcome regarding pain and hip function whereas high acetabular erosion compared to patients treated with Bipolar hemiarthroplasty though the difference is statistically insignificant.

Background: Subclinical hypothyroidism itself is associated with serious complications and also there is a known risk of subclinical hypothyroidism patients getting converted into overt disease., Objectives: The objective of the present study was to fi nd out the prevalence of subclinical hypothyroidism in the suspected cases i.e. amongst the cases attending the thyroid laboratory at B.P. Koirala Institute of Health Sciences, Dharan, Nepal., Materials and Methods: It was a retrospective cross sectional study. Data of the free T3, free T4 and TSH estimations of the year 2007 of the Thyroid lab at BPKIHS, Dharan, Nepal was analyzed. ELISA based free T3, free T4 and TSH tests in the serum had been performed in all the cases., Results: Total cases were 1714 including 24.446% males and 75.554% females. Cases with raised TSH levels were 26.021%, cases with normal TSH levels were 54.66% and cases with low TSH levels were 19.316%. Total 350 cases (20.42 %) had subclinical hypothyroid dysfunction which includes 84 (4.901 %) males and 266 (15.519%) females. And the maximum percentage of cases in either gender was between the age groups 20 -59 years., Conclusion: The prevalence of subclinical thyroid hypothyroidism amongst the suspected cases was 20.42 % which is much higher compared to the other parts of the world. The highest percentage was found in the female age group 20 - 59 years. The routine screening of the whole population is not cost effective and on the basis of the present study it is suggested that there may be routine screening of the selected populations, especially women between 20 to 59 years of age in Nepal region. The preferred screening method advised is a sensitive ELISA based TSH test.

Unlabelled: Twenty five pairs (50 bones) of cadaveric femora were studied morphologically and radio logically using standardized techniques to obtain anthropometric data to evaluate the applicability of internationally designed implant and to generate a database for proximal femur to help in design for future implant if these were found unsuitable., Measurements: femoral head diameter, femoral neck diameter, diameter of proximal femur, canal width at above and below lesser trochanter and 7.5 cm below lower margin of lesser trochanter, endosteal and extracortical width, isthmus position from lesser trochanter, femoral neck anteversion, neck shaft angle and intramedullary axis of femur. The mean +/- SD of these values were calculated. These values were compared with those reported in the literature for Hong Kong Chinese, Caucasians and were found to be different. The implant designed for western population should be used judiciously and facture implant designed should be specific for (ours) bones. We found the pyriformis fossa is usually not in line with the intramedullary axis. Thus antegrade itramedullary nailing portal should be anterior and lateral to pyriformis fossa.

Introduction: A medical record is a systematic documentation of a patient's medical history and care for legal and future use. A poor quality medical record can negatively affect patient care and safety. The study aims to assess the adequacy of medical records in Bir Hospital, a central hospital., Methods: A cross-sectional study was conducted by analyzing consecutive discharge summaries of patients admitted during a 6 month period in a single unit of a tertiary care center. The discharge summary format of the hospital was taken as the standard and evaluation for adequacy of data entered was assessed. Descriptive statistics were used to analyze various statistical discrepancies., Results: Patient's condition at discharge was missing in 86 (66.15%). Patient's address was missing in 21 (16.1%) cases. Almost all the discharge sheets lacked mailing address. Total 96 (73.8%) had use of abbreviations diagnosis. Age and sex were missing in 1 (0.76%). Doctor's signature was illegible in 103 (79.3%) and missing in 2 (1.5%) summaries. Doctor's name and their level/position were missing in 118 (90.76%) and 125 (96.1%) respectively. Total 126 patients (96.9%) were not given any instructions on discharge., Conclusions: The discharge summaries analyzed were seen to be inadequate especially in documenting course during the hospital stay, condition at discharge, appropriate instructions and the treating physician's details. These can probably be addressed by introducing electronic medical records if feasible. Otherwise, the discharge summary should be standardized and doctors should be trained to write legible, complete discharge summaries.