Availability and Use of Vaccines against COVID-19 in Pregnancy

Pregnant women when infected with SARS-CoV-2 infection are more at risk of having severe outcomes including ICU admission, adverse cardiac and thromboembolic events and preterm delivery. Immunization in pregnancy has certain ethical dilemmas and vaccination seems to be challenging. Preliminary data regarding the use of mRNA based vaccines against this virus in pregnant women is promising. Recently, RCOG and WHO have widened the scope of use of vaccines among pregnant women against COVID-19. Similarly, ACOG has also given the go-ahead to the use of two mRNA based and one viral vector based vaccine in pregnant women. The scope of vaccination among pregnant and lactating women being realized in developed part of world is a promising prospect in prevention of COVID-19 infections. However, developing nations require attention from private stakeholders, health and social care organizations to ensure right of health for all.

Laparoscopic cholecystectomy during COVID-19 pandemic- Retrospective analysis of tertiary care centre

INTRODUCTION: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure. During the COVID-19 pandemic, general recommendation worldwide is to postpone elective surgeries as far as possible to decrease the resource utilization and also aerosol-related transmission among hospital staff and patients. We conducted this study to see the burden of gallbladder disease, their management and outcomes of all patients who presented to our centre during first wave of COVID-19 pandemic. METHODS: We conducted a retrospective analysis of all patients who underwent laparoscopic cholecystectomy at the Hospital for Advanced Medicine and Surgery (HAMS) after the commencement of strict lockdown in the first wave of the COVID-19 pandemic. Ethical approval for the study was taken from Nepal Health Research Council. All the surgeries were performed as per HAMS interim policy for infection prevention and control during the COVID-19 pandemic. Data were extracted from the discharge sheet and outcomes in terms of duration of hospitalization, morbidity, mortality, and COVID -19 infection among patient and operating team staff after surgery were assessed. RESULTS: Out of 110 cases operated for gallbladder disease, 90 patients were included in the study with complete data. The most common presentations were dyspepsia (28) and biliary colic (22). Patients were managed with laparoscopic cholecystectomy (79), percutaneous cholecystostomy (4), laparoscopic subtotal cholecystectomy (5), open cholecystectomy (1). The median duration of hospitalization 22 hours. There was no COVID-19 transmission among staff and patients. CONCLUSIONS: Laparoscopic cholecystectomies are feasible during COVID-19 pandemic and safely performed following infection prevention guidelines. It can be still be performed in day case basis to decrease the bed occupancy and avoiding crowd in hospitals.

Quick-Wee method Versus Standard method for urine collection in infants 1-12 month old

BACKGROUND: Urinary Tract infections [UTI] often presents with fever and nonspecific findings in infants less than one year. So urine sample collection is mandatory for diagnosis or exclusion. Collecting Urine sample is very challenging in infants and choosing the method of collection must balance the reliability, speed and contamination. Clinical guidelines have different recommendations so there is a need for reliable collection method. Therefore this study was conducted to determine if a simple stimulation method (Quick–wee Method) increases the rate of clean catch voiding of urine within five minutes. METHODS: A prospective age and sex matched case control study in 1-12 months children conducted from June 2017 – June 2018 in Pediatric ward of Manipal college of medical sciences, Pokhara, after Ethical clearance from Institutional review Board [IRB]. The study population was randomized to either clean catch midstream urine with stimulation [Quick–Wee method] or without stimulation [Standard method]. The primary outcome was voiding of urine within 5 minute. Secondary outcome were waiting time for voiding, successful collection, parental satisfaction, and contamination. The analysis was done using SPSS version 20 and a ‘p’value <0.05 was considered statistically significant. RESULTS: Waiting time for voiding in Quick wee group was less and statistically significant compared to standard group. There was 10% increment in voiding within 5 minutes in Quick wee group . It had higher successful urine collection rate (91.4%), slightly higher contamination rate (14.28%) but better parental satisfaction. CONCLUSIONS: Quick wee method is easy, reliable, successful method of urine collection in infants with better parental satisfaction and slightly higher contamination rate.

Safe Contact Lens Practices during Coronavirus (COVID-19) Pandemic

World is threatened by different variants of Coronavirus to an extent that life has been jeopardized in all services including eye care facility. Contact lenses which are one of the preferred modes of vision correction are not an exception to COVID-19 infection. Recently there is confusion among practitioners and patients regarding the safety of contact lens use during COVID-19. This review article summarizes the current recommendations and findings regarding contact lens use during COVID-19. Though eye health professionals and contact lens users are at risk to contract Coronavirus, with proper care, maintenance and disinfection techniques, it would be safe to continue wearing contact lenses. There is currently no strong evidence to suggest that contact lenses are not safe to wear during COVID 19 times. Eye care practitioners responsible for contact lens application must wear special surgical masks, protective glasses or visors and disposable waterproof gloves. Regarding soft contact lenses, preferably daily disposable lenses should be used from the sterile packages. Similarly for rigid gas permeable lenses, lenses made up of fluoropolymer contained in sealed packages must be motivated for the individuals. Since the infected hands can bring the virus to the eyes, contact lens users should avoid touching the nose, mouth and eye unnecessarily. Contact lens after each use must be disinfected with hydrogen peroxide solutions with a special catalyst container. In the case of eye redness and Flu like symptoms, contact lens trial and wearing practices should be suspended or postpone till the condition becomes normal. To minimize the contact time between the patient and examiner soft copy of the instruction sheet, teleconsultation should be motivated. Though the eye is an unlikely site for Coronavirus infection, eye doctors should warn the contact lens wearers to follow scrupulous contact lens hygiene rules.

Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature

Gallstones disease are the most common biliary pathology. Its prevalence in Nepal is found to be 4.87%. Giant/large gallstones have a higher risk of complications and presents technical difficulties during laparoscopic cholecystectomy. Open cholecystectomy is preferred in most of the cases with giant gallstones. With the availability of experience laparoscopic surgeon and modern laparoscopic equipment, laparoscopic cholecystectomy is also feasible in large/giant gallstones. We report 2 cases, one large gallstone in 51 years old female and one giant gallstone in 39 years old female each of which were successfully managed laparoscopically with uneventful post-operative period.

Pattern and Outcome of Organophosphorus Poisoning Cases in Bheri Hospital, Nepal

BACKGROUND: Organophosphorus (OP) are frequently used as pesticides and the most common agents of poisoning in developing countries including Nepal. There is paucity of data about characteristics of organophosphorus poisoning in our localities. Therefore, we aimed to evaluate its clinical pattern and factors affecting outcome. METHODS: It was a cross-sectional study conducted in Bheri Hospital Nepalgunj between 15th July 2019 to 14th July 2020. The hospital records of patients of acute organophosphorus poisonings were collected. Data regarding age, gender, predisposing factors, duration of hospitalization and outcome of the patients were recorded. Data was analyzed using SPSS 20. RESULTS: A total of 53 patients out of which 22(41.5%) were male and 31(58.49%) were female with F:M ratio of 1.40: 1. The maximum number of the patients 25(47.16%) were in the age group of 20 to 40 years. Incidence of poisoning was more common in married patients 36(67.92%) The suicidal motive for poisoning was found in 49 cases (92.45%). The most commonly used organophosphorus poison was Dichlorvos 32(60.34%) followed by methyl parathion 14(26.41%). Domestic quarrel was the most common predisposing factor 32(60.37%). 45(84.90%) of the patients were discharged after successful treatment while there was mortality of 3 patients (5.66%). CONCLUSIONS: Organophosphorus poisoning is a common mode of suicidal attempts leading to morbidity and mortality every year. Strict policies against the free availability and sale of insecticides is required to control organophosphorus poisoning. Mental health education programme should be conducted for the prevention of suicide and poisoning.

Multiple meningiomas in different neuroaxial locations: report of a rare case

We report a rare case of multiple meningiomas in a 74 year old female who was brought to the hospital with spastic paraparesis and MRI of spine and brain revealed multiple enhancing meningiomas in brain and spines. The spinal intradural extramedullary (IDEM) meningioma at C7-D1 level was excised which had caused paraparesis and postoperatively patient became symptom free. We will discuss about the incidence, symptomatology, investigations and management of multiple meningiomas in different neuroaxial compartments at the same period of time and will review the literature.

A Study of the ST Changes in the aVR Lead on 12-Lead ECG to Identify Infarct - Related Artery (IRA) in Patients With Acute Inferior Wall Myocardial Infarction

BACKGROUND: Lead avR is a valuable but mostly ignored lead in clinical electrocardiography. Recently, ST-segment depression in lead aVR during an inferior wall myocardial infarction has been suggested as a predictor of LCX artery involvement. METHODS: This study was a single centre cross sectional observational study done in BPKIHS, Dharan from February 2018 to January 2020. Patients presenting to the OPD or emergency room of BPKIHS diagnosed as acute inferior wall myocardial infarction based on clinical symptoms, ECG and/or Cardiac tropinin I levels, and planned for coronary angiography, meeting the inclusion and exclusion criterias were included. RESULTS: Among 134 cases, male:female ratio was 1.3:1. Overall, 38 patients (28.4%) were found to have aVR depression and 96 patients (71.6%) were without aVR depression. The culprit artery was found to be the right coronary artery in 95 patients (70.9%), the LCx in 39 patients (29.1%). The sensitivity and specificity of ST-segment depression in lead aVR for LCx as the culprit artery were 92.3% and 97.9% respectively. Positive predictive and Negative predictive value for LCx as the culprit arteries were 94.74% and 96.87%. The sensitivity, specificity, positive predictive value and negative predictive value for RCA as the culprit artery were 97.89%, 92.3%, 96.89% and 94.73% respectively. CONCLUSION: Significant ST depression in aVR is associated with a higher specificity and good sensitivity for LCX lesions, the ST changes in this lead should be carefully examined in all patients who are suspected of having inferior wall myocardial infarction.

Trans abdominal Ultrasonography in Acute Pancreatitis: a cross sectional study

BACKGROUND: Acute pancreatitis (AP) is a common cause of acute pain abdomen. Contrast-enhanced Computed Tomography (CECT) of the abdomen is the imaging method of choice in acute pancreatitis. Ultrasonography can be used as the first, easily available imaging modality for the assessment of the pancreas. This study aims to study the transabdominal USG findings in patients with acute pancreatitis. It will also compare USG findings with CT findings in acute pancreatitis. METHODS: A hospital-based cross-sectional, prospective study comprising of consecutive 55 patients with acute pancreatitis was conducted over a study period of 15 months. Trans abdominal USG findings and CECT abdominal findings in acute pancreatitis were studied and compared. Data analysis was done using SPSS version 20 and a p-value of ≤0.05 was considered significant. RESULTS: Pancreas was visualized by USG in only 69%. Ultrasonography had some pancreatic and/or extrapancreatic findings in patients with acute pancreatitis in 84.2% of patients in whom the pancreas was visualized, whereas, it was 98.2% by CECT abdomen. USG was unable to demonstrate findings in 75% of patients with mild acute pancreatitis. CONCLUSION: Transabdominal ultrasonography detection of pancreatitis was inferior to the CECT. It had a limited role in detecting mild acute pancreatic cases. Nonetheless, detection of etiological factor such as gallstones, and assessment of extra pancreatic fluid collection like ascites and pleural effusion were better visualised with ultrasound. USG is readily available, cheap, noninvasive, and can be utilized as an initial diagnostic tool for acute pancreatitis and ruling out other causes of acute abdomen.

Sociodemographic factors associated with Covid-19 in Canada

BACKGROUND: Coronavirus disease or Covid-19 has caused more than 30 million documented infections and 1 million deaths worldwide as of Oct 2020. It was shown that several sociodemographic factors play a significant role in shaping the Covid-19 outcome and associated death rates across the globe. Thus the present study aims to study the sociodemographic parameters associated with the Covid-19 cases in Canada. MATERIAL AND METHODS: In this retrospective study, the data was collected from the Official data repository present in Canada. The patients' data were evaluated and sociodemographic parameters were checked and recorded. After the data was recorded they are categorized based on the different states and statistical analysis was done. RESULT:The present study reported that in Canada total cases as reported in the repository are 1,253,519 cases. This result indicates that maximum of the patients suffering from Covid-19 belonged to the younger age category. Compared to the males, females were more to suffer from Covid-19. Most of the patients who required hospitalization were in the 80+ year age group (28.5%). Only 1.7% of patients in the age group below 19 years are required to be hospitalized. The regional data variation showed that in Alberta female patients were more in all the age groups compared with the male patients. Saskatchewan also reported a higher number of death cases in older people. In Manitoba, in the younger age category (0-29 years) less number of female patients suffered Covid-19. Interestingly, this number reversed as the age group increased. In Ontario, 72.1% of people reported being admitted to ICU and required a ventilator. In British Columbia, the gender distribution showed no such difference among all the Covid-19 positive cases. In Quebec among the covid-19 positive cases, 47.2% were male and 52.8% were females. CONCLUSION: Age is a significant predictor of Covid-19 mortality and patients from both genders aged more than 75 years and more need to provide more care and increased medical supervision to decrease the Covid-19 casualty.