The novel coronavirus (COVID-19) cause various symptoms such as pneumonia, fever, breathing difficult and lung infection. Till now, total 9 cases are reported in Nepal and 4 cases from this province. This case series is to describe the initial clinical features of COVID-19 among the patients admitted in isolation ward of Seti Provincial Hospital. Oropharyngeal swab was taken from all four patients and sample was transfer to national reference laboratory. Three patients were coming from infected country and one is local transmission. Age of patients was range from 20 to 40 years of age with male preponderance. The patient coming from United Arab Emirate was presented with mild symptoms and others were asymptomatic. More tests, contact tracing and keeping them in quarantine are the necessitated action need to be taken by government of Nepal.Keywords: COVID-19; local transmission; oropharyngeal swab

Background: Health care workers are at greater risk of infection during COVID 19 pandemic.  This study was carried out to assess the knowledge and attitude toward COVID-19 among healthcare workers at working at Seti Zonal Hospital. Methods: A cross-sectional study was performed between April and May 2020 at Seti Zonal Hospital with purposive sampling technique and self-administered questionnaire of the knowledge and attitude of healthcare workers regarding COVID-19. The demographic characteristics mean knowledge and attitude score of healthcare workers were identified and inferential statistics t-test, ANOVA and Spearman’s correlation were used to show the relationship between variables. Results: A total of 230 healthcare workers (92% response rate) had a mean score of knowledge and attitude of 8±0.88 and 7.88±1.32, respectively with good knowledge and a low positive attitude. Majority (94.7%) were familiar with the sign and symptoms, agreed that chronic diseases patients and HCWs are at a higher risk (97%) and (87.8%) respectively while knowledge related to COVID 19 vaccination, isolation period and treatment by antibiotics was poor with low positive attitude towards information availability about COVID 19 (41%), government ability to control the epidemic (49%), and the family members might get infection (60%). There was a positive correlation between knowledge scores and attitude scores (r=0.28, p<0.0001). Conclusions: We identified a significant gap in information source, sufficient knowledge and low positive attitude about COVID 19 among health care workers. Greater educational efforts about prevention should be directed to different level of health workers. Keywords: Attitude; COVID-19; health care worker; knowledge.

Background: Breastfeeding has been accepted as the most vital intervention for reducing infant mortality and ensuring optimal growth and development of children. The current study aimed to assess the knowledge and practice regarding breastfeeding among mothers attending immunization clinic. Methods: A cross sectional study was mothers having children under 1 year of age, who attended their children for vaccination and for the treatment of other minor illnesses. The purposive sampling technique was used for selecting the study subjects. Information regarding patients' demographics, knowledge and practice towards breastfeeding were collected from these mothers on a pre-designed and pretested questionnaire. Results: A total of 208 women with children between 6 months and 12 months were included in the study. Their age ranged between 18 and 37 years with the mean of 24.9±4.1. Overall mother's breastfeeding knowledge was good among 35% and excellent among 22% of them while it was unsatisfactory among 43% of the mothers. Breastfeeding in the first 6 months was practiced by 42% of the participated mothers. Only 23% practiced exclusive breast feeding. Among those who breastfed their babies, 51% initiated breastfeeding in the first hour of birth, 21% between 2-4 hours and only 20% initiated it after 24 hours. Only 73% of mother had not given any prelacteal feeding to their babies. No enough breast milk (47.9%), crying hungry (31.5%), work-related problems (13.7%) & mothers' illness (6.8%) were the commonly reported barriers against exclusive breastfeeding. Conclusion: The prevalence of EBF for up to 6 months of age was still low as per WHO recommendations. The mother's perception of "insufficient breast milk" was also the main reason for introducing other foods. Optimal breastfeeding promotion campaigns need to be carried out within the existing health care system such as the antenatal, after delivery and vaccination clinics.

Introduction: COVID-19 has spread all around the world with huge toll of human lives and suffering since it evolved in China. Nepal had slow rise in morbidity due to COVID 19 in early days but has been gripped by the pandemic's exponential growth lately. This study was conducted with the aim to describe the clinical and epidemiological features of Nepali children in early phase of the pandemic. Methods: This was an observational study conducted at 11 COVID care centres designated by the Government of Nepal with availability of supervision by paediatricians between January and August 2020 in children under 18 years of age diagnosed with COVID 19. Data was collected based on definitions outlined in data collection resources available at WHO-ISARIC Global COVID-19 clinical resources platform and analysed. Results: One hundred and twenty one children diagnosed with COVID 19 who presented to the designated centres were enrolled. Majority of children (83.4%) were identified as a part of contact tracing, 28.1% had an identified contact to a person with COVID 19 prior to their diagnosis and 20.7% had another household member diagnosed with COVID 19. The mean age of admitted children was 8.8 years (SD 5.6 years) with the largest proportion being adolescents (40.5%).  Male (58.7%) children were more commonly affected. There were 15 (12.4%) infants and 8 (6%) of them were under two months of age. Most children (87, 71.9%) were asymptomatic, 21 (22.3%) had mild symptoms and six (4.9%) had moderately severe symptoms. Fever (18.2%) was the most commonly reported symptom. All children were discharged after a median of 14 days of hospitalisation. Conclusions: Nepali children of all ages are affected by COVID 19 and present with asymptomatic or mildly symptomatic infection. Fever and respiratory symptoms are the most commonly reported symptoms.  Most children do not develop complications. Continued surveillance in larger population of children as the pandemic unfolds will generate more stringent observations.

Background: Very Low Birth Weight (VLBW) infants weigh <1500 grams and Extremely Low Birth Weight (ELBW) infants weigh <1000 grams. They are predominantly premature but may also be associated with Intrauterine Growth Restriction (IUGR). The VLBW rate is an accurate predictor of infant mortality rate.Objective: The study was aimed to find out the hospital incidence of VLBW and ELBW babies and outcome of these babies, till they were discharged from the hospital/NICU.Methods: A descriptive study was conducted among 109 cases who weighed less than 1500 grams. The babies were evaluated for mortality and various morbidities till they were discharged from the hospital. Descriptive statistics was applied using SPSS 21.0 to show antenatal profile and immediate outcome. Results: Out of 109 cases, ELBW were 30.2% and VLBW were 69.8%. Among the ELBW babies, 30.3% survived and 75% in VLBW. The mortality rate in ELBW and VLBW babies were 69.7% and 25% respectively. Among the ELBW, common morbidities were NNJ (94%), Presumed NNS (87.8%), RDS (82.6%), Hypoglycemia (56.5%), Hypothermia (26%), Birth Asphyxia (15.1%). In the VLBW group, common morbidities were Presumed NNS (86.4%), NNJ (82%), RDS (46.5%), Hypoglycemia (30.2%). The mean duration of hospital stay was 8.6 days (SD ± 3.38).Conclusions: Common immediate morbidities were NNS, RDS, Hypothermia, Anemia, Shock, CHD, Birth Asphyxia and NEC. Well trained staff in the NICU and medical facilities like availability of Surfactant therapy, more number of mechanical ventilators could improve the survival of these babies in our setting.Journal of Nepalgunj Medical College Vol.12(1) 2014: 32-34

Background: Pneumonia is the single largest cause of death in children worldwide. Malnutrition increases the incidence and severity of ALRI and similarly it contributes to malnutrition. By identifying and treating the cases of malnutrition will decrease disease burden.  Objective: To identify malnutrition as a risk factor of lower respiratory tract infection among children of under five years.Methods and Materials: A case control study was conducted at Nepalgunj Medical College, Kohalpur Teaching Hospital, Kohalpur, Nepal from June 2014 to November 2014. All diagnosed case of ALRI as per WHO were selected for case group. The controls were healthy children presented in OPD, pediatric ward and immunization clinic. The predesigned case performa with check list was the tool to identifying risk factor of ALRI. All data were entered in SPSS version 19. Descriptive and analytic statistics were used for analysis of data with level of significance at p value <0.05.Results: 107 cases and 107 controls were enrolled with age and sex matched. Male to female ratio was 1.6:1 vs 1.8:1 and the proportion of infants, 70.1% vs 68.3% in cases and controls respectively. Moderate wasting was present on 36.4% (39) of case group and 16.8% (18) of control group and It was significantly associated with ALRI (p=0.003). 10.3% (11) of case group children were moderately stunted while 6.5% (7) of control group. It was not statistical associated with ALRI (p=0.325).Conclusions: Wasted children were more prone to suffer from ALRI as compare to stunted children. As it is modifiable risk factor, we should focus on effective community education and public health measures to prevent malnutrition.JNGMC Vol. 12 No. 2 December 2014. Page : 2-5

Introduction: This study was conducted to find out if indoor air pollution has any risk in occurrence of acute lower respiratory tract infection (ALRI) in children. Materials and methods: It was a case control study conducted on total 214 children 107 cases and 107 controls fulfilling the inclusion criteria with age and sex matched. Detailed history and physical examination was done after taking informed consent. History of upper respiratory tract infection in the family members and siblings, history of smoking by various family members , details of cooking fuel and indoor pollution was also recorded. Results: Those families using wood as a cooking material were associated with higher risk of ALRI (p=0.0001). Exposure to domestic animal was significantly positively associated (p=0.0001) and seven times higher risk to develop ALRI as compared to control group. Those children of case group who did not have separate kitchen were having nine times higher risk of ALRI (p=0.001). Family history of smoking was associated with six times increased risk of ALRI (p=0.001). With the use of kerosene lamps risk of ALRI was increased by 1.44 times (p=0.012).Conclusions: The significant environmental risk factors for ALRI were wood as cooking material, presence of domestic animal, place for cooking, family history of smoking, absence of windows and kerosene lamp as a source of light.

Background: Skin is the largest and most visible organ in the body. It undoubtedly determines to a great extent our appearance and plays a major role in socio-sexual communication. More than one third of diabetic patients have some type of dermatologic 1 manifestations during the course of their chronic disease . The association of certain skin diseases with diabetes mellitus has been 2 3 fairly well recognized with an incidence rate ranging from 11.4% to 66% . At least 30% of patients with diabetes mellitus have some 4 5 type of cutaneous involvement during the course of their chronic disease . Skin sugar levels run parallel to the blood sugar levels . Skin changes generally appear subsequent to the development of DM but may be the first presenting sign or even precede the 6 diagnosis by many years. Among the many skin manifestations in DM, none is pathognomonic of this disease . Cutaneous findings in DM can be classified into four categories: (1) skin disease with strong association and others with less distinct association with DM, A total of 100 patients were included in the study. History and clinical examinations were performed and the data were recorded and analyzed. Results: The age of the patients ranged from 20 years to 85 years with the mean age of 51.7+12.13 years. The most common age groups were 46-55 years (36%) followed by 56-65 years (24.7%) and 36-45 years (17.3%), 66-75 years (9.3%), 76-85 years (12.7%). Among the 100 patients of diabetes mellitus, there were 44(44%) males and 56 (56%) females. Among the cutaneous disorders commonly associated with diabetes, infections were the most prevalent. 59(59%) out of 100 patients had skin infections. Conclusions: Patients with Diabetes can present with array of cutaneous disorders. Cutaneous infections formed the largest group of dermatoses in this study. Increased incidence of cutaneous infections mainly fungal and bacterial was noticed in majority diabetics emphasizing the need for more aggressive management of diabetes mellitus. Among infective dermatoses, fungal infections were the most common, with Candidal infections being more common than dermatophytosis.