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.

Background: Early suspicion and diagnosis remains the cornerstone for the better outcome of patients and to decrease cross infection in cases of COVID-19 pneumonia. In a country like Nepal X-ray facilities are readily available radiological tool in most of the centers and can be important screening tool.  There is a lack of studies detailing the chest XR (C-XR) findings in these patients when compared to that dedicated to the CT features. Study aims to describe the patterns of the lung opacities in CXR in these patients.Methods: This is retrospective descriptive study conducted at NMCTH in COVID-19 patients from 12 September to 17 October 2020. Demographic characteristics, symptoms, co-morbidities and C-XR findings were studied. CXR findings were categorized according to BSTI classification.Results: Among 111 COVID-19 RT-PCR positive cases admitted 102 (91.9%) belonged to age group 18-65 years, 89 (80.2%) were males. Cough and fever were the commonest symptoms present in 109 (98.2%) patients. Ischemic heart disease and hypertension in 32 (28.8%) patients were the commonest co morbidities. According to British society of thoracic imaging (BSTI) COVID-19 CXR classification, six patients (5.4%) had normal chest X-rays. Classic/probable COVID-19 picture was present in 79 (71.17%) patients while (7.2%) had intermediate for COVID-19 X-ray findings. Among 79 patients with classic/probable COVID-19 CXR findings 71 (89.8%) had bilateral consolidation/ground glass haze, 72 (91.1%) had peripheral lung involvement while 66 (83.5%) had middle and lower zone involvement.Conclusions: Ground glass opacities/consolidations with bilateral location, peripheral distribution and middle- lower zone predominance were the commonest X-ray findings in our study.

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.

Background: Ischemic heart disease is the leading cause of CVD health loss globally, as well as in each world region, followed by stroke.  In Nepal, CVD was found to be the second most common non-communicable disease among indoor patients of the non-specialist hospital. Age, gender, smoking, obesity, dyslipidemia, physical inactivity, hypertension, and diabetes mellitus (DM) are established risk factors for CVD.  In Nepal, hypertension is found to be the most prevalent risk factor for CVD. Aims and Objectives: This study aimed to assess risk factors for coronary artery disease in patients undergoing coronary angiograms in Nepal. This study also investigated the socio-demographic characteristics of the participants and the nature of the involvement of coronary arteries. Materials and Methods: We examined in this cross-sectional study a total of 74 patients who underwent coronary angiography (CAG) at National Medical College between May 2020 and June 2021. Patients were grouped according to the number of major epicardial coronary arteries involved in SVD, DVD, and TVD. Patients were checked for risk factors like smoking, diabetes mellitus, hypertension, dyslipidemia, family history of coronary artery disease, and obesity. Microsoft Office Excel and SPSS version 21.0 were used for data analysis. The study was approved by the ethical committee. Results: Among 74 participants 53 were male. The mean age was 59.65±10.74 years. Premature coronary artery disease was present in six patients. SVD was the commonest CAD type. Hypertension was the commonest risk factor followed by Diabetes mellitus. Hypertension, Diabetes mellitus, Family history of premature CAD, and obesity were found to be statistically significant. Keywords: CAD, Risk factors for CAD, Premature CAD, Hypertension, Diabetes, obesity, family history of CAD, dyslipidemia, Smoking, SVD, DVD, TVD, Nepal

 Cardiovascular events are less commonly described in glomerular disease. However, thromboembolic events are quite commonly reported in glomerular disease with nephrotic range proteinuria. Here, we report a case of a 29 years old male with IgA nephropathy present with central chest pain radiating to the jaw. He was under mycophenolate, prednisolone and losartan with remission of proteinuria for two months. ECG showed extensive ST segment elevation in V1- V6 leads. His cardiac troponins were elevated. Coronary angiography showed complete thrombotic occlusion of mid left anterior descending artery which was successfully recanalized after primary percutaneous intervention. Though less commonly reported in literature, such incidence of coronary events in IgA nephropathy can rarely present with acute myocardial infarction.

Coronary artery perforation (CAP) is one of the most dreadful complications encountered during Percutaneous Coronary Intervention (PCI). Though being rare, the high mortality rate associated with CAP makes it one of the most important complications that should be well known to all the coronary interventionist. The treatment modalities range from balloon tamponade, reversal of anticoagulation, coils, microbeads, pericardiocentesis, covered stents and in desperate situations, coronary artery bypass graft. We present here a case of 65 year old male with extensive anterior wall myocardial infarction who developed CAP of proximal left anterior descending artery during PCI. The case was successfully managed with covered stent.

Background:Thyroid nodules are common presentation in patients having thyroid disorders. There is approximately 4-5% incidence of clinically apparent thyroid lesions in general populations.Thyroid nodules are about four times more common in females than in males. The present study aims to diagnose the thyroid lesions and evaluate to relation and diagnostic test of ultrasonography (USG) and Fine Needle Aspiration Cytology (FNAC) report. To determine the sensitivity of ultrasonography in detecting thyroid lesions.Method:This was hospital based prospective study carried in 94 patients who came to radiology department for USG neck, after clinical examination frommedicine, surgery and ENT department.Those patients with thyroid lesions were followed and advised for USG guided FNAC of thyroid swelling. The patients who were advised for FNAC, and gave consent for procedure were included in the study. The USG guided FNAC was done and wasfurther evaluated by pathologist. Results:Out of 94 cases, 85 were benign nodules and 9 were malignant nodules by USG which were further confirmed by FNAC with results of 87 benign and 7 malignant.The USG diagnosed the benign thyroid nodule with sensitivity of 96.55% and specificity of 85.71%, positive predictive value 98.82%, negative predictive value 66.67%, accuracy 95.74%. The result revealed that there is a strong relation between diagnoses of benign thyroid lesions by USG and final diagnosis by FNAC (P=0.001).Conclusion:High resolution grey scale imaging features can differentiate benign and malignant lesions. USG is very helpful for FNAC, characterization of nodules and provides differential diagnosis in those patients affecting with thyroid disorders.

Coronavirus disease 2019 (COVID-19) is a highly infectious disease. The acute phase of the disease has been focused upon and less importance is given to the long-term sequelae. A new term ‘long COVID’ is used to describe a diverse set of symptoms that persists for more than 12 weeks after a diagnosed COVID-19 infection with no alternative diagnosis. Predominant symptoms include persistent breathlessness, fatigue, cough, chest pain, palpitations, neurological and cognitive deficits, rashes, and gastrointestinal dysfunction. Risk factors for the development of long COVID are female gender, increased age, and increased BMI. Lung fibrosis is an important ailment in COVID survivors. Long COVID needs urgent attention for better understanding and specialized action plans to improve the quality of life in these patients and decrease their financial burden. Studies are warranted to investigate the early installation of antifibrotic agents in high-risk patients. Till we find better measures to counter long COVID, preventive measures and vaccination are the best available options. We are presenting here a case of long COVID who was admitted on multiple occasions for exacerbation of symptoms. He is now being managed on an outpatient basis.