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1.
J Nepal Health Res Counc ; 19(4): 652-660, 2022 Mar 13.
Article in English | MEDLINE | ID: covidwho-1865755

ABSTRACT

BACKGROUND: Chronic Obstructive Pulmonary Disease is a common, preventable, and treatable disease. Here, we conducted a systematic review of Chronic Obstructive Pulmonary Disease and its risk factors in Nepal for the last two decades. METHODS: We systematically searched databases to find all relevant Chronic Obstructive Pulmonary Disease research papers from 2000 to 2020. Two reviewers screened the literature using Covidence based on the study protocol. Data extraction was done using Microsoft Excel from selected studies. Final data analysis was done using CMA v.3. Our review protocol is available in PROSPERO (CRD42020215486) on 20 November 2020. RESULTS: The database search revealed 1416 studies of which 13 were included in quantitative analysis. The prevalence of Chronic Obstructive Pulmonary Disease in the adult population was 22·7% (CI, 12·5-37·7) of whom 54·9% were female (CI, 51·9-57·9). Nearly three-fourth of the participants (73·1%) of Chronic Obstructive Pulmonary Disease patients had informal education (CI, 58·6-84·0). The commonest primary occupation was agriculture and farming in 39·4% (CI, 31·3-48·2), followed by homemaker (36·8%). It was observed that 28·5% of the Chronic Obstructive Pulmonary Disease patients were former smokers, 25·8% non-smokers, and 59·4% were current smokers. More than two-third (76·2%) of Chronic Obstructive Pulmonary Disease patients relied upon traditional firewood cooking, whereas only 14.6% was adopted fireless cooking. CONCLUSIONS: The pooled prevalence of Chronic Obstructive Pulmonary Disease in Nepal was significantly high with more cases in females compared to males. Smoking and traditional firewood cooking were major risk factors among Chronic Obstructive Pulmonary Disease cases in Nepal.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Adult , Female , Humans , Male , Nepal/epidemiology , Prevalence , Pulmonary Disease, Chronic Obstructive/epidemiology , Risk Factors , Smoking/adverse effects , Smoking/epidemiology
2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-321452

ABSTRACT

Background: COVID-19 pandemic has created unprecedented health and economic impact. Psychological stress, anxiety and depression are affecting not only COVID-19 patients but also health professionals, and general population. Fear of contracting COVID-19, forced restrictive social measures, and economic hardship are causing mental trauma. Nepal is a developing country from South Asia where the COVID-19 pandemic is still evolving. This online survey has been carried out to understand impact of COVID- 19 on mental health of Nepalese community dwellers. Methods: The COVID-19 Peritraumatic Distress Index (CPDI) questionnaire adapted from the Shanghai Mental Health Centre was used for online data collection from 11 April-17 May 2020. Collected data were extracted to Microsoft excel-13 and imported and analyzed using SPSS (Statistical Package for Social Sciences) version-22. An initial univariate analysis was conducted for all variables to assess the distribution. Logistic regression analyses were done to estimate the odds ratios of relevant predicting variables. Results: A total of 410 participants completed the self-rated questionnaires. Mean age of study participants was 34.8 ±11.7 years with male preponderance. 88.5% of the respondents were not in distress (score less than 28) while, 11% had mild to moderate distress and 0.5% had severe distress. The prevalence of distress is higher among age group >45 years, female gender, and post-secondary education group. Health professional were more likely to get distressed. Respondents with post-secondary education had higher odds (OR= 3.32;p=0.020) of developing distress as compared to respondents with secondary education or lower. Conclusion: There is lower rate of psychological distress in city dwellers and people with low education. Adequate intervention and evaluation into mental health awareness, and psychosocial support focused primarily on health care workers, female and elderly individuals is necessary.

3.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-321451

ABSTRACT

Background: The coronavirus, cause of COVID-19 is an enveloped, RNA virus that utilizes an enzyme RNA dependent RNA polymerase for its replication. Favipiravir (FVP) triphosphate, a purine nucleoside analog, inhibits that enzyme. We have conducted this systematic review and meta-analysis on efficacy and safety of drug FVP as a treatment for COVID-19. Methods Databases like Pubmed, Medline, Google Scholar, preprint sites, and clinicaltirals.gov were searched. Studies including FVP along with the standard of care (SOC) were taken in the treatment arm and SOC including other antivirals, and supportive care as control arm. Quantitative synthesis done using RevMan 5.4. Clinical improvement, negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), adverse effects, and oxygen requirement were studied. Results We identified a total of 824 studies after electronic database searching. Five in qualitative studies and three studies in quantitative synthesis meet the criteria. There was a significant clinical improvement on FVP arms on 14th day compared to control arms (RR 1.41, 1.10–1.80). Clinical deterioration rates was significantly unlikely in FVP group (OR 0.21, 0.08–0.58) at the endpoint of study. The meta-analysis showed no significant differences between two arms on virological clearance (Day 14: RR 1.03, 0.64–1.67), oxygen requirement (OR 0.47, 0.21–1.04), and adverse effects (OR 0.42, 0.03–6.05). There are 25 Randomized controlled trials (RCTs) registered in different parts of the world focusing FVP for COVID-19 treatment. Conclusion There is significant clinical and radiological improvement following treatment with FVP in comparison to the standard of care with no significant differences on virological clearance, oxygen support requirement and side effect profile.

4.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-321450

ABSTRACT

Background: Coronavirus disease (COVID-19) pandemic has been a global health threat. The specific treatment of this disease has not yet been approved. In this review, we aimed at assessing the role of hydroxychloroquine with/without macrolide in terms of efficacy and adverse effects against the standard of care. Methods: : Pubmed, Medline, Google Scholar, Cochrane Library, and Clinicaltrials.gov were searched for the quantitative and qualitative synthesis of 13 studies using PRISMA guidelines for a proper review. Assessment of heterogeneity was done using the I-squared (I 2 ) test and fixed/random effect analysis was done to determine the odds/risk ratio among the selected studies. Results: : Meta-analysis of our study demonstrated no significant differences in improvement for the virological cure (RR 0.95, 0.67-1.34), whereas a significant relationship was there in radiological progression (pneumonia resolution) (RR 1.40, 1.03-1.91) between the two arms. There are 1.52 times the odds of intubation during treatment (CI 0.61-3.77), 1.08 times the risk of mortality (CI 0.65-1.79), and about 2.21 times increased risk of development of adverse effect (OR 2.21, 0.95-5.17). Though overall it is of no statistical significance, clinical relevance to thinking while using the treatment for COVID-19 is advised. Among randomized controlled trials, the treatment group has 3.5 times (OR 3.48, 1.64-7.42) higher risk of developing adverse effects. There is 2.5 times the likelihood of severe arrhythmias and QT prolongation (OR 2.49, 1.67-3.70) on the treatment arm compared to control. Conclusion: Hydroxychloroquine with/without macrolide has shown no beneficial effect in viral clearance, survival rates while shows significant relation with the radiological improvement compared to standard of care but may increase the risk of intubation, overall side effects, and cardiac complications like arrhythmias and QT prolongation. Thus utilizing this treatment needs to be judged in clinical relevance and proper monitoring.

5.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-307428

ABSTRACT

Background: Due to a lack of definitive treatment, many drugs were repurposed for COVID-19 treatment, among them corticosteroid is one. However, its benefit or harm while treating COVID-19 is not fully studied. Thus, we conducted this meta-analysis to assess the rationality on the use of corticosteroids in COVID-19. Methods Pubmed, Medline, Clinicaltrials.gov, Cochrane library, and Preprint publisher were searched. In the qualitative synthesis, 41 and quantitative 40 studies were included using PRISMA guidelines. Assessment of heterogeneity was done using the I-squared (I 2 ) test and random/fixed-effect analysis was done to determine the odds/risk ratio. Results We found severely ill COVID-19 patients almost 5 (OR 4.78, 2.76-8.26) times higher odds of getting corticosteroids during their treatment. Similarly, the odds for corticosteroids in addition to standard of care (SOC) were approximately 4 (OR 4.09, 1.89-8.84) times higher among intensive care unit (ICU) patients than non-ICU ones. A higher mortality risk with corticosteroids receiving group compared with the SOC alone (RR 2.01, 1.12-3.63) was observed. Niether increased discharge rate (RR 0.79, 0.63-0.99) nor recovery/ improvement rate was shown among corticosteroids group (OR 0.24, 0.13-0.43). Approximately, the overall 4 days longer hospital stay was found among the treatment groups (MD 4.19, 2.57-5.81). For the negative conversion of reverse transcription- polymerase chain reaction (RT-PCR), approximately 3 days (MD 2.42, 1.31-3.53) delay was observed with corticosteroids treatment cases. Conclusion Our study concludes that more severe and critically ill patients tend to get corticosteroids and the mortality risk increases with the use of corticosteroids. With the use of corticosteroids, delayed recovery and a longer hospital stay were observed.

6.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-314012

ABSTRACT

Background: The global spread of COVID-19 and the lack of definite treatment has caused an alarming crisis in the world. Hydroxychloroquine (HCQ) and azithromycin (AZT) are considered a possible treatment option. We aimed to evaluate the outcome and potential harmful cardiac effects of AZT+HCQ compared to HCQ alone for COVID-19 treatment. Methods: : Pubmed, Medline, Google Scholar, Cochrane Library, and clinicaltrials.gov were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed and random effects for the pooling of studies. Result: In this systematic review and meta-analysis, the risk of mortality (RR 1.16;0.92-1.46) and adverse cardiac events (OR 1.06;0.82-1.37) demonstrated a small increment though of no significance. There are no increased odds of mechanical ventilation (OR 0.84;0.33-2.15) and significant QTc prolongation (OR 0.84, 0.59-1.21). Neither the critical QTc threshold (OR 1.92, CI 0.81-4.56) nor absolute ΔQTc ≥60ms (OR 1.95, CI 0.55-6.96) is increased to the level of statistical significance among HCQ+AZT arm compared to HCQ alone;but its slightly increased odds need to be considered in clinical practice. Conclusion: The combination of AZT+HCQ leads to small increased odds of mortality and cardiac events compared to HCQ alone. It is of no statistical significance for the critical QTc threshold and absolute ΔQTc ≥60ms, but increased odds with HCQ+AZT arm need to be considered in clinical relevance. Our result does not guide against the use of combination or HCQ alone based on the present level of evidence.

7.
Reprod Sci ; 2022 Jan 03.
Article in English | MEDLINE | ID: covidwho-1607891

ABSTRACT

INTRODUCTION: In the Western world today, urogenital fistula, including vesicovaginal fistula (VVF), is rare. However, while it remains significant in developing parts of the world due to prolonged and obstructed labor, in this study, we systematically reviewed the existing literature, discussing VVF occurrence, its etiology, and outcomes. MATERIAL AND METHODS: We used electronic databases to search relevant articles from 2010-2020. The screening was performed with the help of Covidence. Relevant data from included studies were extracted in excel sheets, and final analysis was done using CMA-3 using proportion with 95% confidence interval (CI). RESULTS: Fifteen studies reported the VVF among the fistula series. The pooled result showed 76.57% cases of VVF (CI, 65.42-84.96), out of which 27.54% were trigonal, 55.70% supra-trigonal, and the rest with a varied description like circumferential, juxta-cervical, juxta-urethral. Obstetric etiology was commonly reported with 19.29% (CI, 13.26-27.21) with cesarean section and 31.14% (CI, 18.23-47.86) with obstructed labor. Hysterectomy was the commonly reported etiology among gynecological etiology (46.52%, CI; 36.17-57.19). Among different surgical treatments employed for fistula closure, 49.50% were by abdominal approach (CI, 37.23-61.82), and 42.31% by vaginal approach (CI, 31.82-53.54). Successful closure of fistula was reported in 87.09% of the surgeries (CI, 84.39-89.38). CONCLUSION: The vesicovaginal fistula is the most common type of genitourinary fistula. Major causes of fistula are gynecological surgery, obstructed labor, and cesarean section. The vaginal approach and abdominal are common modalities of repair of fistula with favorable outcomes in the majority of the patients.

8.
JNMA J Nepal Med Assoc ; 59(244): 1313-1315, 2021 Dec 11.
Article in English | MEDLINE | ID: covidwho-1579278

ABSTRACT

After almost a year of declaring COVID-19 a global pandemic, unusual presentations of the disease continue to be reported. Very little is known about its association with pleural disease. Here, we present a case of empyema thoracis in a 39-year-old male admitted with COVID-19. The pleural fluid later turned serosanguinous and eventually bleeding from other sites also occurred. During his treatment, antibiotics were given, thoracocentesis was performed and later thoracotomy was done. He died on the 19th day of admission following a hemorrhagic stroke. Pleural disease, although considered atypical and unusual presentation of COVID-19, needs careful and prompt diagnosis and earliest intervention. COVID-19, being a disease that involves multiple systems, and presentation of the disease may eventually lead to circulatory dysfunction and hence should be kept under consideration.


Subject(s)
COVID-19 , Empyema, Pleural , Adult , Empyema, Pleural/diagnosis , Empyema, Pleural/etiology , Empyema, Pleural/therapy , Hospitalization , Humans , Male , SARS-CoV-2 , Thoracotomy/adverse effects
9.
Ann Med Surg (Lond) ; 73: 103221, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1588338

ABSTRACT

BACKGROUND: An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data. METHODS: A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3. RESULTS: We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4-7.3%) among hospitalized patients; 15.6% (11-21.8%) among critically ill patients; and 18.4% (13-25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS. CONCLUSION: COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies.

10.
Adv Virol ; 2021: 8554192, 2021.
Article in English | MEDLINE | ID: covidwho-1518182

ABSTRACT

The new coronavirus disease 2019 (COVID-19) was declared a global pandemic in early 2020. The ongoing COVID-19 pandemic has affected morbidity and mortality tremendously. Even though multiple drugs are being used throughout the world since the advent of COVID-19, only limited treatment options are available for COVID-19. Therefore, drugs targeting various pathologic aspects of the disease are being explored. Multiple studies have been published to demonstrate their clinical efficacy until now. Based on the current evidence to date, we summarized the mechanism, roles, and side effects of all existing treatment options to target this potentially fatal virus.

11.
Nutrients ; 13(10)2021 Oct 12.
Article in English | MEDLINE | ID: covidwho-1477977

ABSTRACT

BACKGROUND: Vitamin C is a water-soluble antioxidant vitamin. Oxidative stress and its markers, along with inflammatory markers, are high during critical illness. Due to conflicting results of the published literature regarding the efficacy of vitamin C in critically ill patients, and especially the concerns for nephrotoxicity raised by some case reports, this meta-analysis was carried out to appraise the evidence and affirmation regarding the role of vitamin C in critically ill patients. METHODS: We searched the database thoroughly to collect relevant studies that assessed intravenous vitamin C use in critically ill patients published until 25 February 2021. We included randomized controlled trials and observational studies with 20 or more critically ill patients who have received intravenous ascorbic acid (vitamin C). After screening 18,312 studies from different databases, 53 were included in our narrative synthesis, and 48 were included in the meta-analysis. We used the Covidence software for screening of the retrieved literature. Review Manager (RevMan) 5.4 was used for the pooling of data and Odds Ratios (OR) and Mean difference (MD) as measures of effects with a 95% confidence interval to assess for explanatory variables. RESULTS: Pooling data from 33 studies for overall hospital mortality outcomes using a random-effect model showed a 19% reduction in odds of mortality among the vitamin C group (OR, 0.81; 95% CI, 0.66-0.98). Length of hospital stay (LOS), mortality at 28/30 days, ICU mortality, new-onset AKI and Renal Replacement Therapy (RRT) for AKI did not differ significantly across the two groups. Analysis of data from 30 studies reporting ICU stay disclosed 0.76 fewer ICU days in the vitamin C group than the placebo/standard of care (SOC) group (95% CI, -1.34 to -0.19). This significance for shortening ICU stay persisted even when considering RCTs only in the analysis (MD, -0.70; 95% CI, -1.39 to -0.02). CONCLUSION: Treatment of critically ill patients with intravenous vitamin C was relatively safe with no significant difference in adverse renal events and decreased in-hospital mortality. The use of vitamin C showed a significant reduction in the length of ICU stays in critically ill patients.


Subject(s)
Ascorbic Acid/pharmacology , Critical Illness , Acute Kidney Injury/therapy , Clinical Trials as Topic , Critical Illness/mortality , Hospital Mortality , Humans , Intensive Care Units , Length of Stay , Renal Replacement Therapy
12.
World J Virol ; 10(5): 275-287, 2021 Sep 25.
Article in English | MEDLINE | ID: covidwho-1463968

ABSTRACT

BACKGROUND: Diabetes mellitus (DM) is associated with adverse clinical outcomes and high mortality in patients with coronavirus disease 2019 (COVID-19). The relationship between diabetes and COVID-19 is known to be bidirectional. AIM: To analyze the rate of new-onset diabetes in COVID-19 patients and compare the clinical outcomes of new-onset diabetes, pre-existing diabetes, hyperglycemic, and non-diabetes among COVID-19 patients. METHODS: We used the Meta-analysis of Observational Studies in Epidemiology statement for the present meta-analysis. Online databases were searched for all peer-reviewed articles published until November 6, 2020. Articles were screened using Covidence and data extracted. Further analysis was done using comprehensive meta-analysis. Among the 128 studies detected after thorough database searching, seven were included in the quantitative analysis. The proportion was reported with 95% confidence interval (CI) and heterogeneity was assessed using I 2. RESULTS: Analysis showed that 19.70% (CI: 10.93-32.91) of COVID-19 patients had associated DM, and 25.23% (CI: 19.07-32.58) had associated hyperglycemia. The overall mortality rate was 15.36% (CI: 12.57-18.68) of all COVID-19 cases, irrespective of their DM status. The mortality rate was 9.26% among non-diabetic patients, 10.59% among patients with COVID-19 associated hyperglycemia, 16.03% among known DM patients, and 24.96% among COVID-19 associated DM patients. The overall occurrence of adverse events was 20.52% (CI: 14.21-28.70) among COVID-19 patients in the included studies, 15.29% among non-diabetic patients, 20.41% among patients with COVID-19 associated hyperglycemia, 20.69% among known DM patients, and 45.85% among new-onset DM. Meta-regression showed an increasing rate of mortality among new hyperglycemic patients, known diabetics, and new-onset DM patients in comparison to those without diabetes. CONCLUSION: A significantly higher rate of new onset DM and hyperglycemia was observed. Higher mortality rates and adverse events were seen in patients with new-onset DM and hyperglycemia than in the non-diabetic population.

13.
J Nepal Health Res Counc ; 19(2): 230-238, 2021 Sep 06.
Article in English | MEDLINE | ID: covidwho-1456686

ABSTRACT

BACKGROUND: Hypertension, diabetes, glomerulonephritis, obesity, and family history of kidney diseases are major risk factors for chronic kidney disease. Due to the paucity of data on a national level regarding the prevalence, risk factors, and complications of chronic kidney disease, we performed this meta-analysis. METHODS: We searched online databases from January 2000 till October 2020. Two reviewers screened articles using Covidence software. Comprehensive Meta-Analysis Software version 3 was used for data analysis. RESULTS: Among chronic kidney disease patients, 35.96% were found to have high LDL, 34.22% had hypercholesterolemia, 39.18% had hypertriglyceridemia, and 42.23% had low HDL. Pigmentary changes were reported in 37.71%, pruritus in 30.96%; and xerosis in 48.55%. Among the reported nail problems, the brown nail was reported in 7.19%, half and half nail in 6.07%, and white nail in 20.65%. CONCLUSIONS: The prevalence of chronic kidney disease among high-risk cohorts in Nepal was significant among risk group with hypertension and diabetes being the most common risk factors. The most common stage of chronic kidney disease was Stage V, and the common complications were skin problems and dyslipidemia.


Subject(s)
Hypertension , Renal Insufficiency, Chronic , Humans , Hypertension/epidemiology , Nepal/epidemiology , Prevalence , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/etiology , Risk Factors
14.
Ann Hepatol ; 24: 100340, 2021.
Article in English | MEDLINE | ID: covidwho-1453997

ABSTRACT

The role of N-acetylcysteine (NAC) in the treatment of acetaminophen induced acute liver injury (ALI) is well established but its role in non-acetaminophen induced ALI is still elusive. We conducted this meta-analysis to evaluate the role of NAC in non-acetaminophen induced ALI. We searched electronic databases for studies published till Oct 25, 2020. We used RevMan v5.4 software to analyze the data extracted from selected studies by using Covidence systematic review software. Outcome estimation was done using Odds Ratio (OR) with 95% confidence interval (CI). The heterogeneity in various studies was determined using the I2 test. A total of 11 studies were included in quantitative analysis. Use of NAC in non-acetaminophen induced ALI showed 53% reduction in mortality compared to standard of care (OR, 0.47; CI, 0.29-0.75) and reduced mean duration of hospital stay by 6.52 days (95% CI, -12.91 to -0.13). Similarly, the rate of encephalopathy was 59% lower in the treatment group (OR, 0.41; CI, 0.20-0.83). However, the risk of developing nausea and vomiting (OR, 3.99; CI, 1.42-11.19), and the need for mechanical ventilation (OR 3.88; CI, 1.14-13.29) were significantly higher in the treatment group. These findings conclude use of NAC decreases mortality and hepatic encephalopathy compared to standard of care in patients with non-acetaminophen induced ALI. Although there is an increased risk of nausea and vomiting with the use of NAC, the majority of adverse events are transient and minor.


Subject(s)
Acetylcysteine/therapeutic use , Free Radical Scavengers/therapeutic use , Liver Failure, Acute/chemically induced , Liver Failure, Acute/drug therapy , Humans , Length of Stay , Liver Failure, Acute/mortality , Standard of Care , Survival Rate
15.
J Nepal Health Res Counc ; 19(2): 277-283, 2021 Sep 06.
Article in English | MEDLINE | ID: covidwho-1449546

ABSTRACT

BACKGROUND: COVID-19 is a highly contagious viral disease. The anxiety, misinformation about COVID-19, and the fear of being infected by the virus have led to widespread stigma in local communities. Thus, we conducted a study to evaluate the status of patients and disease-associated stigma of patients who recovered from COVID-19. METHODS: Status of discharged/ improved COVID-19 individuals were followed after their discharge within 2 months after COVID-19 status through telephonic interview. Data of interview was recorded in excel sheets, which was imported in Stata v. 15. Simple descriptive analysis performed and finding presented in appropriate tabulation. Further binomial logistic regression analysis was performed for post-treatment stigmatization. RESULTS: Among 365 case details retrieved, 262 cases contained contact details. Among them, 221 total phone calls were made, of which only 94 could reach for phone interview. 50 (53.19%) were male; 59 (62.77%) were married; and 85 (90.43%) were Hinduism by religion. Majority (n=74, 78.72%) were asymptomatic. The average hospital/isolation stay of patients was 11.23±4.75 days. Among interviewed individuals, 24 (25.81%) reported some type of stigmatization. Individuals with comorbidities and tested for travel purpose has less chance of stigmatization comparing than others. Higher the age in years and longer the duration of hospital/isolation stay; higher the odds of having stigmatization. CONCLUSIONS: High level of stigma was seen among COVID-19 survivors. The stigma associated with COVID-19 was shown to increase with age and length of hospital stay while the stigma decreased with the presence of co-morbidities and was tested for travel purposes.


Subject(s)
COVID-19 , Patient Discharge , Health Facilities , Humans , Male , Nepal , SARS-CoV-2
16.
JNMA J Nepal Med Assoc ; 59(240): 805-807, 2021 Aug 12.
Article in English | MEDLINE | ID: covidwho-1389984

ABSTRACT

Nepal started the COVID-19 vaccination on 27 January 2021 with AstraZeneca/Oxford Coronavirus Disease-19 AZD1222 (Covishield) vaccine to control the Coronavirus disease pandemic. The vaccine has a good safety profile, with cardiovascular complications being rare. Herein we report a rare case of cardiovascular complication following Covishield vaccination in a 33 years old female who had dizziness and elevated blood pressure immediately following vaccination and abnormal electrocardiogram showing T wave inversions followed by left bundle branch block. The patient was kept on observation, following which the blood pressure and electrocardiogram changes were normal by seven days. This cardiovascular complication following the vaccination demands further investigation into the adverse event of the vaccine. However, since the benefit of the vaccine outweighs the risk, World Health Organization has recommended the continuity of the vaccine as of now.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , Female , Humans , Nepal , SARS-CoV-2 , Vaccination
17.
J Nepal Health Res Counc ; 19(1): 1-9, 2021 Apr 23.
Article in English | MEDLINE | ID: covidwho-1209433

ABSTRACT

BACKGROUND: The global spread of COVID-19 and the lack of definite treatment have caused an alarming crisis in the world. We aimed to evaluate the outcome and potential harmful cardiac effects of hydroxychloroquine and azithromycin compared to hydroxychloroquine alone for COVID-19 treatment. METHODS: PubMed, Medline, Google Scholar, Cochrane Library, clinicaltrials.gov, and World Health Organization clinical trial registry were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed or random effects for the pooling of studies based on heterogeneities. RESULTS: The risk of mortality (RR=1.16; CI: 0.92-1.46) and adverse cardiac events (OR=1.06; CI: 0.82-1.37) demonstrated a small increment though of no significance. There were no increased odds of mechanical ventilation (OR=0.84; CI: 0.33-2.15) and significant QTc prolongation (OR=0.84, CI: 0.59-1.21). Neither the critical QTc threshold (OR=1.92, CI: 0.81-4.56) nor absolute ?QTc ?60ms (OR=1.95, CI:0.55-6.96) increased to the level of statistical significance among hydroxychloroquine and azithromycin arm compared to hydroxychloroquine alone, but the slightly increased odds need to be considered in clinical practice. CONCLUSIONS: The combination of hydroxychloroquine and azithromycin leads to small increased odds of mortality and cardiac events compared to hydroxychloroquine alone. The use of hydroxychloroquine and azithromycin led to increased odds of QT prolongation, although not statistically significant.


Subject(s)
Azithromycin/therapeutic use , COVID-19/drug therapy , Cardiovascular Diseases/chemically induced , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Azithromycin/adverse effects , COVID-19/mortality , Cardiovascular Diseases/mortality , Drug Therapy, Combination , Humans , Hydroxychloroquine/adverse effects , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , SARS-CoV-2
18.
Immunopharmacol Immunotoxicol ; 43(1): 30-36, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-990300

ABSTRACT

The novel coronavirus disease (COVID-19) has been declared a pandemic by the World Health Organization (WHO) and is ominously threatening the survival of humankind on the whole planet. With a quick spread of the outbreak from its origin, Wuhan, China, to almost all over the world, it has affected more than seven million people to date, hence it has devastated every part of the infrastructural skeleton of governance. Continuously escalating disease burden and lack of proven therapeutic approaches are mounting challenges to health scientists and ultimately to healthcare providers. Although recent studies have shown benefits in decreasing the severity and duration of the illness and there are more benefits compared to risks, plasma therapy cannot be considered as a standard of care until the ongoing trials are completed and they establish definite evidence on its therapeutic efficacy and safety. Though a beneficial aspect may be there, acquiring donors and adequate availability of plasma is equally challenging, and its associated untoward effects related to biological therapeutic agents. The rational practice of CP therapy guided by risk-benefit judgment from aspects of donor and recipient can be a therapeutic option in such a global health crisis.


Subject(s)
COVID-19/therapy , Humans , Immunization, Passive/adverse effects , Immunization, Passive/methods , Immunization, Passive/trends , Pandemics , Treatment Outcome
19.
PLoS One ; 15(11): e0242658, 2020.
Article in English | MEDLINE | ID: covidwho-992689

ABSTRACT

BACKGROUND: Hepatitis B imposes a major public health problem with an increased risk of occupational exposure among unvaccinated health care workers. This study was conducted to determine the Hepatitis B vaccination status, along with the knowledge, attitude, and practice regarding Hepatitis B, among preclinical medical students of a medical college in Nepal. MATERIALS AND METHODS: This descriptive study was conducted among preclinical students of a medical college in Kathmandu, Nepal from 6th July to 14th July 2020. The whole sampling technique was used. Data were collected using a pretested, self-administered questionnaire which was emailed to individuals and analyzed with the statistical package for social sciences version-22. RESULTS: A total of 181 students participated in the study out of 198, giving a response rate of 91.4%. Among the study participants, only 67 (37%) were fully vaccinated against Hepatitis B while 71 (39.2%) were never vaccinated. For the majority (74.6%) of the non-vaccinated participants, the main reason for not getting vaccination was a lack of vaccination programs. Half the study participants (n = 92, 50.8%) had good knowledge, attitude and practice regarding hepatitis B. The median knowledge, attitude and practice scores towards Hepatitis B were 61.00 (57.00-66.00), 20(18.00-21.00) and 21(19.00-23.00) respectively. CONCLUSIONS: The majority of preclinical medical students were not fully vaccinated against Hepatitis B and only half of them had acceptable knowledge, attitude and practice towards Hepatitis B, which makes them vulnerable to the infection. This might represent the situation of not only Nepal, but also all South Asian countries, and creates concern about whether students take the vaccination programs seriously. Since unavailability of vaccination program is the main cause of non-vaccination, we strongly recommend the provision of the Hepatitis B vaccination program to the preclinical medical students.


Subject(s)
Health Knowledge, Attitudes, Practice , Hepatitis B Vaccines/therapeutic use , Hepatitis B/prevention & control , Students, Medical , Surveys and Questionnaires , Vaccination , Adult , Cross-Sectional Studies , Female , Hepatitis B/epidemiology , Humans , Male , Nepal/epidemiology
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