Introduction: Coronavirus disease pandemic has affected large number of peopleglobally and has continued to spread. Preparedness of individual nations and the hospitals isimportant to effectively deal with the surge of cases. We aimed to obtain nation wide data fromNepal, about hospital preparedness for COVID-19. Methods: Online questionnaire was prepared in accordance with the Center for Disease Controlrecommendations to assess preparedness of hospitals for COVID-19. The questionnaire wascirculated to the over 800 doctors across the nation, who are the life members of six medical societies. Results: We obtained 131 completed responses from all seven provinces. Majority of respondentshad anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that theirhospital had policy to receive suspected or proven cases with COVID-19. Presence of isolationward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presenceof airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124(94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6(4.6%) respondents. Conclusions: It is apparent that most of the hospitals are not well prepared for management ofpatients with COVID-19. Resource allocation and policy making should be aimed to enhance nationalpreparedness for the pandemic.

Abstract

FNO levels were higher in bronchial asthma (despite disease control) than in normal non-smoking adults and subjects with stable chronic obstructive pulmonary disease. Levels of FNO were similar between the chronic obstructive airway disease and normal groups.

Background: Birth asphyxia is one of the important causes of neonatal morbidity and mortality, accounting up to 30% of neonatal death in Nepal. It is also an important cause of long term neurological disability and impairment. Thompson encephalopathy score is a clinical score which can be used to assess the newborn with hypoxic ischemic encephalopathy for the prognosis and their neurodevelopmental outcome. The aim of the study was to assess the role of Thompson score in predicting the early outcome of neonates with birth asphyxia. Methods: A prospective study was conducted from May 2019 to April 2020 in Nepal Medical College. All the term babies during the period with Apgar score of less than seven at five minutes were considered to have birth asphyxia and included in the study. Neurological examination was done on first, second and third day using HIE score proposed by Thompson and severity of hypoxic ischemic encephalopathy was classified accordingly. Outcome was measured as normal, morbidity with encephalopathy, seizure, organ dysfunction and death. Results: Out of 391 newborn admitted to neonatal unit, 84 (21.4%) had birth asphyxia. Mild Thompson score on day 1,2,3 were 49(58.3%), 49 (58.3%), 51(60.7%); moderate Thompson score on day 1,2,3 were 21 (25%), 21 (25%), 18(21.4%) and severe Thompson score on day 1, 2, 3 were 14 (16.7%), 14 (16.7%), 15(17.9%) respectively. Out of 14 babies who had severe Thompson score on day 1, 11(91.7%) expired and 3 (16.7%) developed encephalopathy. Conclusions: There was strong correlation of severity of Thompson score with the outcome. Keywords: Birth asphyxia; hypoxic ischemic encephalopathy; thompson score

Bacterial endocarditis in neonates is a rare. Generally neonates who develop endocarditis have required the invasive intensive care monitoring necessary for the support and treatment of a high-risk nursery population.  Neonatal Infective endocarditis is usually reported as a fatal disease. With early diagnosis and treatment we can change prognosis to better side.

Atherosclerosis, stable myocardial infarction (MI), non-stable MI are the most common manifestations of coronary artery disease (CAD). CAD is one of leading causes of substantial morbidity and mortality in the global scenario. There are several biomarkers and methods for the diagnosis of CAD such as cardiac specific troponin, electrocardiogram (ECG), CT angiography. Recently, many studies have shown that miRNAs are involved in regulation of gene expression on post-transcriptional level by inhibiting translation protein from mRNA that miRNAs dysregulated in the plasma of patients with CAD (cases). These suggested miRNAs can be detected in circulating blood which might be a diagnostic and prognostic biomarker for CAD. Besides these studies, there is an additional need in studies about miRNAs family, so that miRNAs might serve as potential therapeutic target in the treatment of CAD, as well as other complex diseases. In this review, we have summarized some studies as miRNAs as diagnostic and assessment of prognosis biomarker in patients with CAD.

Introduction: In flexible bronchoscopy, absence of endobronchial abnormality blinds the bronchoscopist towards the location of the lung lesion. Guided techniques for bronchoscopy are not available in Nepal. Hence, diagnostic yield is very low. There is need to find the factors to improve yield. This study evaluates the radiological and bronchoscopic findings that can help in histo-pathological yield.Methods: This retrospective study included 557 bronchoscopies done for the evaluation of lung malignancy. Radiological, bronchoscopic and histo-pathological abnormalities were classified and evaluated. The study aimed at finding the radiological and bronchoscopic factors commonly associated with positive yield in histopathology.Results: Among 557 subjects, 490 had abnormal chest X-ray. Mass lesion was seen in 252(45.24%), cavity in 19(3.41%), collapse in 93(16.69%), consolidation in 81(14.54%), pleural effusion in 28(5.02%) and fibrosis in 17(3.05%) subjects. Total of 314(56.37%) abnormal bronchoscopies included: endobronchial growth 200(35.9%), narrowing 66(11.84%), obstruction 107(19.27%) and ulcer 16(2.8%). Histopathology was positive in 198(35.54%) including 179 (32.13%) lung malignancies. The diagnostic yield for getting positive histopathology for the study population was 35.54%, for mass lesion was 40.47% and for abnormal bronchoscopy was 54.78%. Significant correlation was identified among mass lesion, endobronchial abnormality and positive histo-pathology. Central mass lesion, collapse and consolidation showed significant association with lung malignancy. Significant association was also identified between histo-pathology and endobronchial growth, obstruction and ulcer. Conclusions: The diagnostic yield increases with positive endobronchial abnormality. Presence of central lung lesion, collapse and consolidation favour positive yield of histo-pathology. Endobronchial growth, obstruction and ulcer are likely to yield malignant histopathology reports.

Background: Pleural effusion is a common medical condition with many possible underlying etiologies. However, Tuberculosis is the most common cause of pleural effusion especially in countries like Nepal. Pleural fluid lymphocytosis is seen in tuberculosis, malignancy and few auto-immune diseases. Adenosine Deaminase activity (ADA) level in tubercular pleural effusion is markedly increased compared to non-tubercular effusions. ADA estimation being a simple colorimetric method is suitable for the rapid diagnosis of tubercular effusion. This study aims to correlate the diagnostic efficacy of ADA with the value of differential count (lymphocytosis) in establishing different etiology of pleural effusion. Materials and Methods:This is a cross sectional study of 50 cases with pleural effusion carried out in the department of Pathology, Green city hospital for the duration of Twenty one month's dating from October 2014 to July 2016 AD.Results: Of all, tubercular pleural effusion accounted for 26%. ADA level was raised (≥40U/L) in 92% of Tubercular pleural effusion. The sensitivity and specificity of ADA alone to diagnose tubercular pleural effusion was 92% each and when lymphocytosis alone was considered sensitivity was 85% with specificity of 32% whereas the combined effect of both ADA with lymphocytosis was 100% (sensitivity) and 87% (specificity), 83% (positive predictive value) and 100% (negative predictive value) respectively with statistically significant p value (<0.05). Conclusion:We can conclude that the combination of pleural fluid differential count (lymphocytosis >50%) and ADA level >40U/L provides with much more positive result than each component alone in differentiating tubercular effusion from other etiologies.