IMPORTANCEEchocardiographic screening allows for early detection of subclinical stages of rheumatic heart disease among children in endemic regions.OBJECTIVE To investigate the effectiveness of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease.DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial included students 9 to 16 years of age attending public and private schools in urban and rural areas of the Sunsari district in Nepal that had been randomly selected on

Background & Objectives: Congenital heart diseases are neglected especially in world’s poorest nations and appear to be ignored and unexplored dimension of health. The exact prevalence and spectrum of congenital heart diseases in Nepal is largely unknown. The aim of this study was to describe the local experience on the magnitude and the pattern of congenital heart disease in order to increase the awareness of the public and health policy makers on its burden in Nepal.Materials & Methods: This is an observational hospital based study carried out in a tertiary care hospital in Eastern Nepal. The duration of this study was from April 2015 to July 2016. The echocardiography reports of all patients clinically suspected of having congenital heart disease were retrieved, and their diagnostic details were extracted. Only patients of day one of life to 14 years of age were included. Congenital heart diseases like bicuspid aortic valve, mitral valve prolapse and various inherited cardiomyopathies were excluded.Results: A total of 330 echocardiograms were performed for clinically suspected congenital heart disease.  The mean age of study population was 22.31±34.08 months with male to female ratio of 1.2:1. 23% of clinically suspected congenital heart disease cases turned out to have normal echocardiography. Acyanotic congenital heart disease was most common (81.5%) followed by cyanotic congenital heart disease (14.2%) and obstructive congenital heart disease (4.3%). Atrial septal defect was found to be the most common form of acyanotic congenital heart disease (52%) which was followed by ventricular septal defect (28.8%) and patent ductus arteriosus (14.8%). Tetralogy of Fallot and double outlet right ventricle were the most common form of cyanotic CHD representing 44.4% of all cyanotic patients. Pulmonary stenosis was the most common obstructive congenital heart disease observed in this study population (63.6%). Rarer entities, like d-transposition of great arteries, congenitally corrected transposition of great arteries, various types of total anomalous pulmonary venous drainage, double inlet left ventricle, interrupted aortic arch, Shone complex, etc. were also observed, however represented only the minority of the study population.Conclusion: The spectrum of congenital heart disease seen in this study very likely and only represents the tip of the iceberg. Public awareness programmes and training of health care personnel needs to be emphasized in order to facilitate its early diagnosis and improve its outcome.

Transthoracic echocardiogram (GE, Vivid E95, and Chicago, USA) was performed with use of 2D, M-mode, doppler modalities. Images were taken from the parasternal long axis, parasternal short axis, apical four chambers, and apical five-chamber views. The mitral valve area (MVA) was quantified based on planimetry and pressure half time (PHT) methods. Mitral stenosis (MS) was classified as mild for valve area between 1.6-2.0 cm2, moderate for 1.1-1.5 cm2, and severe for ≤1.0 cm2. Mitral and aortic regurgitation were evaluated

Introduction: Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. Methods: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. Results: A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. Conclusions: Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.

Introduction: Dyslipidemia is one of the major risk factors for acute coronary syndrome. Dyslipidemiawith an increase in total cholesterol, low-density lipoprotein cholesterol, triglycerides and decrease inhigh-density lipoprotein cholesterol is one of the major risk factors for the acute coronary syndromeand alone account for more than 50% of population attributable risk. This study was conducted tofind out the prevalence of dyslipidemia. Methods: This descriptive cross-sectional study was conducted in 105 patients admitted at thetertiary care center with a diagnosis of acute coronary syndrome from July 2018 to March 2019 afterapproval from the institutional review committee (Ref no. 205/2018). Fasting serum lipid profilewas obtained within 24 hours of hospitalization with the convenient sampling method. Data wereanalyzed with the help of the Statistical Package for Social Sciences version 20. Point estimation at95% Confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 105 people, dyslipidemia was present in 51 (48.6%). The mean age of the participantswas 59.19±12.69 years. The majority 81 (77.1%) were male. The mean total cholesterol, triglycerides,low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were 183.43±35.9 mg/dl, 140.59±46.83 mg/dl, 109.9±26.38 mg/dl and 41.17±4.78 mg/dl respectively. High total cholesteroland triglyceride were found in 34 (32.4%) each, low high-density lipoprotein in 31 (29.5%) and highlow-density lipoprotein in 22 (21%).  Conclusions: Dyslipidemia is a significant risk factor in patients with acute coronary syndromeand commonly associated with other risk factors. Careful attention to its management may help toreduce further events.