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Introduction: Any symptoms acquired after COVID-19 infection that persists beyond 12 weeks period and not explained by any other disease either already present or acquired after COVID-19 infection is termed as long COVID 19 by World Health Organisation. We tried to find out the prevalence of long COVID 19 in healthcare workers. Method: Questionnaire was made in google form based on COVID-19 Yorkshire Rehabilitation Screening Tool (COVID YRS Tool). Ethical approval was taken from IRC-PAHS. Data collected from all health care workers of PAHS from 2022/05/20 to 2022/07/20. Difference in Precovid and Postcovid status in different domains were compared by statistical tests. Result: The median age of our participants was 29 years. Prevalence of Long COVID 19 was 68.1%. 19 55.3% ha mild, 10.4% had moderate, 2.4% had severe symptoms. The most common symptom was fatigue (44%), anxiety (41%) and shortness of breath (36%). The COVID YRS Tool overall score was statically significant with p value

Introduction: Supraclavicular brachial plexus block is widely used for perioperative anesthesia and analgesia. Dexmedetomidine is highly selective alpha-2 receptor agonist which provides analgesia, sedation and anxiolysis. Our study aims to evaluate the effect of addtion of dexmedetomidine with bupivacaine and xylocaine with adrenaline in supraclavicular block in upper limb surgeries. Method: This was a comparative study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal among 44 patients randomly assigned in Group-I (N=22, bupivacaine and xylocaine with adrenaline 28 ml + dexmedetomidine 2 ml (1 mcg/kg), and Group-II (N=22, without dexmedetomidine) for ultrasound-guided supraclavicular block for upper limb surgeries. The study was approved by institutional review committee. Onset of sensory and motor block, duration of analgesia, demographics, hemodynamic parameters, and side effects of drug were compared. Pin-prick test and modified Bromage scale were used to evaluate sensory and motor block. Visual analogue scale was used for severity of pain. Statistical analysis was performed with SPSS v.16. Result: The median time for onsets of sensory and motor block were significantly shorter in group I (1 m and 3 m) than group II (5 m and 10 m). The duration of analgesia was s longer in group I (720 m) than group II (360 m). Two patients had bradycardia and one hypertension in dexmedetomidine group whch were managed successfully. Conclusion: Dexmedetomidine added to local anesthetics significantly prolongs the effect of supraclavicular block in upper limb surgeries.

Introduction: Hypotension and bradycardia are the most common complications during spinal anesthesia. Bradycardia decreases cardiac output, resulting in hypotension and even cardiac arrest. Glycopyrronium, an anticholinergic drug increases heart rate and prevents bradycardia during spinal anesthesia by blocking the effects of acetylcholine on the sinoatrial node. The study aims to measure the maternal hemodynamic effect of glycopyrrolate after spinal anesthesia for elective caesarean section. Method: An intervention, comparative study was conducted in Patan Hospital after approval from Ethical Committee. Eighty-two pregnant women scheduled for elective caesarean section were randomly assigned in two groups by sealed envelope method; Group I received glycopyrrolate 0.2mg intravenous, Group II did not receive glycopyrrolate. The patient’s heart rate, blood pressure, mean arterial pressure, a total dose of ephedrine, the occurrence of nausea, vomiting, and dry mouth were recorded. Independent-T test, chi-square test were used for statistical analysis. Result: Among 82 elective caesarean sections, 41 in each group, Group II (non-glycopyrrolate) reported increased heart rate compared to Group I (glycopyrrolate), but was statistically not significant. The highest recorded diastolic blood pressure was more in Group I compared to Group II and was statistically significant. The highest recorded Mean Arterial Pressure was high in the glycopyrrolate group and was statistically significant. The total dose of ephedrine was lower in the statistically significant glycopyrrolate group. The incidence of dry mouth was more in the glycopyrrolate group and the difference was statistically significant. Conclusion: Glycopyrrolate reduces the incidence of hypotension but not bradycardia and decreases the need for vasopressor.

Background: Epidemiological data on critically ill patients is crucial for understanding resource utilisation, gaps in quality of care and for supporting surveillance of endemic or emerging diseases. We report the epidemiology of critically ill patients from 17 intensive care units (ICUs) in Nepal using an established and standardised ICU registry. Methods: The ICU registry data is collected prospectively and includes data on case mix, severity, organ support and outcomes. We conducted a retrospective observational study with all adult (≥18 years) critically ill patients admitted to 17 ICUs in Nepal between September 2019 and September 2022. We report on case mix, treatment received, severity of illness, standardised mortality rates (SMR), discharge outcomes and ICU service activity. Descriptive statistics were used to report the findings. Results: Of the 18603 unique admissions, 14% were operative, with 35% emergency surgeries. Patients’ median age was 57 (IQR 40-71) and 59% were male. Hypertension and diabetes were common comorbidities and pneumonia accounted for 26% of all admissions. During the ICU stay, 39% of patients received mechanical ventilation, 29% received vasoactive medication and 10% received renal replacement therapy. The median predicted risk of death was 0.1 (IQR 0.1-0.3) using APACHE II and 0.2 (IQR 0.1-0.4) using eTropICS. The median SMR was 0.7 (IQR 0.5-0.8) and 0.8 (IQR 0.6-1.4) using eTropICS and APACHE II, respectively. Median length of stay was 4 days (IQR 2-7). Eighteen percent died in the ICU; of those alive at discharge, 12% went home, 84% went to another department and 3% went to another hospital. COVID-19 was the most common notifiable disease reported (12% of all admissions). Median ICU turnover was 9% (IQR 6-14) with bed capacity ranging from 43-278. Conclusions: These findings should guide forecasting and service planning to ensure ICUs can optimally care for critically ill patients in Nepal.

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and presents with fever, dry cough, fatigue, myalgia, and dyspnea. This study aims to is find out the understanding of COVID-19 among doctors at Patan Hospital. Method: A cross sectional was conducted among doctors at Patan Hospital, Patan Academy of Health Sciences, Nepal. The questionnaire in Google form consisted, part1 perception on COVID-19 and part2 understanding using multiple choice questions corresponding to the one to fifteen questionnaire in part1. Ethnical approval was obtained. Result: Sixty-one doctors participated in the study, of which 65.5% were directly involved in management of COVID-19. Perception and understanding regarding transmission status in country was 65.6% and 63.95% respectively, about case definition 90.1% and 62.2%, about when to do diagnostic tests 75.4% and 90.2%. Conclusion: There was difference in perception and understanding regarding COVID-19 among doctors, and areas to be reinforced were case definition, transmission classification, diagnostic tests. Keyword: COVID-19, doctors, perception, understanding

Coronavirus Disease has become a global pandemic after its emergence at the end of 2019 as a cluster of pneumonia. Apart from respiratory symptoms, neurologic complications are also common, mostly in hospitalized patients. More than 80 percent of patients have neurological symptoms during their disease course of which most common is encephalopathy. However, data on neurological complications like Guillain-Barré syndrome associated with coronavirus-2019 are scarce. Here, we report a case of a 64-years-old female patient with typical clinical and electrophysiological manifestations of Acute motor axonal neuropathy variant, who was reported positive with polymerase chain reaction for severe acute respiratory syndrome coronavirus-2, 13 days before the onset of acute bilateral weakness of extremities, areflexia, and normal sensory examination. Cerebrospinal fluid and electrophysiological examination were also suggestive. The neurological symptoms improved during treatment with immunoglobulins. Quick recognition of symptoms and diagnosis is important in the management of Guillain-Barré syndrome associated with coronavirus-2019.

Introductions: Spinal anesthesia is a safe and acceptable technique for patients undergoing caesarean section because it provides both excellent analgesia and muscle relaxation. Post Dural Puncture Headache (PDPH) is frequently reported complication after spinal anesthesia. This study evaluates the incidence of PDPH following early mobilization and recumbency after caesarean section. Methods: This prospective, randomized comparative interventional study included 100 parturients women of age 18 to 45 years, ASA I and II, randomly divided into two groups – Ambulatory ‘A’ and Recumbent ‘R’. At the end of caesarean section, patients were advised to either lie in recumbent position for 24 hours or mobilize as soon as they become ambulatory after spinal aneshthesia. Occurrence of headache were recorded at 24 hours, 72 hours and 7th day. Software SPSS 16, chi-square test was used for proportions like incidence and severity of PDPH; p

Introductions: Kidney biopsy is the standard tool to diagnose glomerular disease (GD). There is lack of national registry of kidney biopsy for the type, incidence and prevalence of GD. We aim to review kidney biopsy at Patan Hospital for profile of GD in local scenario. Methods: This was a chart review of patients who underwent kidney biopsy at Patan Hospital, Nepal, from October 2013 to September 2015. We analyzed the data for indication of kidney biopsy, types of GD and complication of biopsy. Results: There were 117 patients who had kidney biopsies. Immunoglobulin A Nephropathy was seen in 42 (35.8%) and Lupus Nephritis in 38 (32.5%). Sub nephrotic range proteinuria with or without active urinary sediments was found in 75 (64%). Blood transfusion was required in 3 (2.5%) patients after biopsy. There was no surgical intervention or mortality related to biopsy. Conclusions: IgA Nephropathy was the commonest glomerular disease. Kidney biopsy was a safe and effective procedure. Keywords: glomerular disease, kidney biopsy, nephropathy