Liver injury at admission and outcomes in patients with COVID-19 disease: a prospective cohort study.

The liver is one of the common extrapulmonary organs involved in the coronavirus disease 2019 (COVID-19) infection. We aimed to find the prevalence of liver injury at hospital admission and its effects on outcomes. Methods: This is a single-center prospective observational study. All consecutive patients with COVID-19 admitted during the months of May to August 2021 were included in the study. Liver injury was defined as at least 2 times elevation of aspartate transaminase, alanine transaminase, alkaline phosphatase, and bilirubin above the upper limits on normal. The predictive efficacy of liver injury was measured as its effects on outcome variables, that is duration of hospital stay, requirement of ICU admission, mechanical ventilation, and mortality. Presence of liver injury compared with existing biomarkers markers of severe disease, that is lactate dehydrogenase, D-dimer, and C-reactive protein. Results: A total of 245 consecutive adult patients with COVID-19 infection were included in the study. Liver injury was present in 102 (41.63%) of patients. There was a significant association between the presence of liver injury and duration of hospital stay (10.74 vs. 8.9 days; P=0.013), the requirement of ICU admission (12.7 vs. 10.2%; P=0.018), mechanical ventilation (10.6% vs. 6.5%; P=0.003), and mortality (13.1% vs. 6.1%; P<0.001). Liver injury was significantly associated (P<0.001) with the corresponding elevation of serum biomarkers of severity. Conclusion: The presence of liver injury in patients with COVID-19 infection at the time of hospital admission is the independent predictor of poor outcomes and can also be used as the marker of disease severity.

Comparative study of Hg(ii) biosorption performance of xanthated and charred sugarcane bagasse from aqueous solutions.

The main target of this study was to evaluate the efficiency of charred xanthated sugarcane bagasse (CXSB) and charred sugarcane bagasse (CSB) in the removal of Hg(ii) ions from aqueous media. Batch experiments were performed to study the experimental parameters such as effects of pH, concentration, contact time and temperature. The adsorption velocity of Hg(ii) onto CSB and CXSB was fast and reached equilibrium within 60 minutes. Isotherm and kinetic studies showed that Hg(ii) uptake using both the biosorbents followed Langmuir isotherm and pseudo second order kinetics. The maximum adsorption capacity of Hg(ii) at optimum pH 4.5 onto CSB and CXSB was found to be 125 mg g-1 and 333.34 mg g-1, respectively. A negative value of ΔG° and positive ΔS° value (0.24 kJ mol-1 for CSB and 0.18 kJ mol-1 for CXSB) for both the biosorbents confirm the spontaneous nature of Hg(ii) adsorption. A positive value of ΔH° (52.06 kJ mol-1 for CSB and 30.82 kJ mol-1 for CXSB) suggests the endothermic nature of biosorption. The investigated results shows that CXSB compared to CSB can be used as a low cost and environmentally benign bio-adsorbent for the removal of Hg(ii) ions from aqueous solutions.

Comparison of Radial and Femoral Percutaneous Coronary Intervention.

BACKGROUND: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention. METHODS: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding. RESULTS: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629.  The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290). CONCLUSIONS: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal.

Right Ventricular Dimensions and Tricuspid Annular Plane Systolic Excursion among Medical Students of Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: The change in morphology and functions of the right ventricle is an important predictor of heart and lung disease. There is limited data on the normal dimension of the right ventricle. The study aimed to find the right ventricular diameter, its thickness, and tricuspid annular plane systolic excursion in healthy male medical students of a tertiary care hospital. METHODS: It is a descriptive cross-sectional study conducted in healthy medical students of Kathmandu Medical College and Teaching Hospital, from February-April, 2019. Ethical approval was taken from the institutional review committee (reference number 120720193). Convenient sampling method was used. We measured various dimensions of the right ventricle in different views. The data was analyzed in the Statistical Package for the Social Sciences. RESULTS: In the 96 male students included in the study, the mean right ventricular basal diameter was 36.45±3.49 mm, right ventricular mid cavity diameter was 29±3.63 mm, right ventricular longitudinal dimension was 65.72±7.52 mm, right ventricular outflow tract in parasternal long-axis view was 27.07±2.12 mm, proximal and distal right ventricular outflow in parasternal short-axis view was 25.33±2.57 mm and 20.08±1.99 mm, right ventricular thickness was 4.20±0.54 mm, and tricuspid annular plane systolic excursion was 23.02±3.54 mm. CONCLUSIONS: The study found that the values of right ventricular dimensions and the right ventricle's tricuspid annular plane systolic excursion among male medical students of a tertiary care hospital to be in accordance with the guidelines by the American Society of Echocardiography. The upper limits of the normal values of the right ventricle could be very helpful in clinical practice in determining the right ventricle dimension.

Prevalence of Atrial Fibrillation in Obstructive Sleep Apnea Patients in a Tertiary Care Center.

INTRODUCTION: Atrial fibrillation is the most common sustained arrhythmias.Recently there has been evidence of higher prevalence of atrial fibrillation in obstructive sleep apnea patients compared to the general population. The aim of this study was to find the prevalence of atrial fibrillation in patients of obstructive sleep apnea in a tertiary care center. METHODS: This descriptive cross-sectional study was done in Om Hospital and Research Centre from January 2016 to 2018 March after ethical clearance. Convenience sampling was done. Data was collected and entry was done in microsoft excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of atrial fibrillation in patients with obstructive sleep apnea is 7 (10.44%) at 95% Confidence Interval (6.70-14.17%). Apnoea-Hypopnoea Index of more than 30was present in 3 (42.8%) patients of atrial fibrillation. Atrial fibrillation was seen highest, 3 (42.8%) in patients with BMI more than 30 and lowest, 1 (14.28%) patients with BMI less than 23.5. Prevalence of atrial fibrillation was seen 5 (71.4%) in male patients and 2 (28.57%) in female patients. Sixty seven (75.28%) patients had obstructive sleep apnea in which male patients was predominant 48 (71.64%). CONCLUSIONS: Prevalence ofatrial fibrillation in patients of obstructive sleep apnea was found to higher than the similar studies done. It is important to obtain detail cardiac history in any patients with obstructive sleep apnea and look for arrhythmias speciallyatrial fibrillation.