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COVID-19 pandemic has an impact on the socioeconomic , cultural, and health of people. There is increased morbidity if a patient with comorbidities (hypertension, diabetes) is infected with SARS-CoV 2. On the other hand, there are increased complications related to hypertension, diabetes, and unwanted pregnancies during this pandemic. We did a retrospective study in a district hospital in Nepal to see this effect. We found that there was an increased incidence of uncontrolled diabetes, hypertension, and safe abortions. So while making plans for overall health during this pandemics, proper management of non-communicable diseases and reproductive health services should be considered.

Introduction: Cesarean delivery is increasing throughout the globe. It is increasing here in Nepal too. There are inequalities in cesarean deliveries in urban and rural/remote areas. Through this study, we tried to see the Cesarean delivery rate in one of the remote districts of Nepal and audited the Cesarean deliveries as per the Robson classification system. Method: A retrospective cross-sectional study based on secondary data collection of sixteen months (Aug 2019 to Dec 2020) was designed for this purpose. We collected data from the health management and information system (HMIS) maternity registry and record files of inpatients located in District Hospital, Terhathum. We used the Robson classification system and Robson reporting table for the analysis purpose. Result: We included 495 participants. The overall Cesarean rate was 12.9%. Robson group 1 i.e. nulliparous, single, cephalic, >37 weeks of gestation contributed most (40.63%) in cesarean delivery followed by group 5 (17.19%) i.e. multiparous, single, cephalic, >37 weeks of gestation with previous Cesarean section (CS). Conclusion:  In our study, the main contributor to CS was Robson group 1 i.e. nulliparous, single, cephalic >37 weeks of gestation followed by group 5 i.e. multiparous, single, cephalic >37 weeks of gestation with previous CS. Though the CS rate is within the WHO recommendation, we need to intervene to decrease CS in low-risk groups and strengthen hospital facilities for vaginal birth after Cesarean (VBAC).

Introduction and importance: Osmotic demyelination syndrome (ODS) as a result of the hyperosmolar hyperglycemic state is rare and can present with variable neurological manifestation due to lysis of myelin sheath. Case presentation: A 44-year diabetic male presented with complaints of sudden onset, progressive bilateral weakness in lower limbs, and slurring of speech for the past 1.5 months. Cerebellar examination showed a bilaterally impaired finger nose test, dysdiadochokinesia, impaired heel shin test, and an impaired tandem gait. MRI brain (T2 and fluid-attenuated inversion recovery sequences) showed high signal intensity in the central pons and bilateral cerebellum. With a diagnosis of ODS with poorly controlled diabetes, he was treated with insulin, metformin, and supportive measures following which his symptoms subsided gradually. Clinical discussion: A rapid correction of hyponatremia is considered the most common cause of ODS. Variations in plasma glucose levels, a rare cause of ODS, can cause an abrupt osmolality change causing pontine and extrapontine myelinolysis. Prevention of rapid correction of hyponatremia and rapid changes in plasma osmolality in vulnerable patients is the mainstay of treatment. Conclusions: Clinical features, imaging studies, and monitoring of serum osmolality, serum glucose, and electrolytes aid in diagnosis and favorable outcomes for the patient.