COVID-19 Unveiling Heart Failure in the Realm of Rheumatic Heart Disease.

The global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in various clinical manifestations, including cardiovascular complications. This case report focuses on a unique instance where COVID-19 infection exacerbated heart failure and induced atrial fibrillation in a previously asymptomatic young male with undiagnosed rheumatic heart disease (RHD). RHD, a prevalent cause of valvular abnormalities in developing countries, poses an additional risk for severe outcomes when coexisting with COVID-19 infection, highlighting the need for prompt and tailored interventions.

The Unrepaired Tetralogy of Fallot: A Tale of Delayed Presentation and Limited Access to Care.

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease characterized by four distinct anatomical features. While surgical repair has significantly improved long-term outcomes, some individuals, particularly those from low socioeconomic backgrounds who lack access to medical care, may suffer from complications such as pulmonary hypertension (pHTN) and heart failure. We present a case report of a young female with unrepaired TOF who presented with acute-on-chronic hypoxic respiratory failure and heart failure, highlighting the complex nature and challenges associated with this condition.

Recurrent Spontaneous Pneumothorax in a Young Male With Duchenne Muscular Dystrophy Following COVID-19 Infection.

Duchene muscular dystrophy (DMD) is a genetic disorder primarily affecting males. It is characterized by progressive muscle tissue degeneration. Patients with DMD are at an increased risk of respiratory infections, including coronavirus disease 20019 (COVID-19), due to weakened respiratory muscles. We present a case of a young male with DMD who experienced recurrent pneumothorax 10 months after recovering from a COVID-19 infection. The patient required prompt medical intervention, including a chest tube, multiple surgeries, and mechanical pleurodesis. This case highlights the importance of recognizing recurring pneumothorax as a potential complication of COVID-19, particularly in patients with underlying neuromuscular disorders, as it is a medical emergency requiring prompt treatment to prevent respiratory compromise.

Role of ECG in the Accidental Finding of an Atrioventricular Septal Defect in an Asymptomatic Patient Undergoing Cosmetic Surgery.

Electrocardiogram (ECG) is an important diagnostic tool in identifying congenital heart disease (CHD), as demonstrated by this case of a 48-year-old female who presented for a preoperative evaluation for cosmetic surgery. ECG showed a right bundle branch block (RBBB) and first-degree atrioventricular (AV) block, and further testing revealed a primum atrial septal defect (ASD) with mitral valve anterior leaflet cleft and a membranous ventricular septal defect (VSD). She underwent successful surgical repair and was discharged home without complications. This case highlights the importance of performing additional tests like echocardiography or other imaging modalities in cases of abnormal ECG findings to accurately diagnose the underlying heart condition and ensure proper treatment.

Climate change, risk perception, and protection motivation among high-altitude residents of the Mt. Everest region in Nepal.

Mountain ecosystems are considered vulnerable to early impacts of climate change. Whether and how local residents of these areas perceive these changes, however, remain under-studied questions. By conducting a household survey in the Khumbu region of Nepal, this study assessed local residents' experience-based perception of changes in climate trends and patterns, perceived risk, and attitudes towards climate issues. Multivariate cluster analysis based on residents' climate change beliefs revealed three segments: "Cautious," "Disengaged," and "Alarmed." A comparison of these segments along key psychosocial constructs of Protection Motivation Theory (PMT) revealed significant inter-segment differences in residents' perception of severity, vulnerability, response efficacy, self-efficacy, and response cost associated with engaging in mitigating behavior. Results shed light on how residents of high elevation areas that are considered to be exposed to early impacts of climate change perceive the risk and intend to respond. These findings could also assist stakeholders working in other similar mountain ecosystems in understanding vulnerability and in working towards climate readiness.

Rifampicin-resistant Mycobacterium tuberculosis by GeneXpert MTB/RIF and Associated Factors Among Presumptive Pulmonary Tuberculosis Patients in Nepal.

BACKGROUND: Mycobacterium tuberculosis(MTB) remains a major public health problem worldwide, and emergence of drug-resistant TB has become a significant obstacle to effective TB control. However, the rate of MTB and rifampicin resistant-MTB (RR-MTB) in the Nepalese setting has not been studied extensively. Therefore, the present study aims to assess the rate of MTB and RR-MTB and further determine the factors associated with it. METHODS: A retrospective cross-sectional study, among national representative data of 990 consecutive presumptive TB resister of patients subjected to the GeneXpert test that presented to the tuberculosis referral hospital, was conducted over a one year period from February 2018 to January 2019. Significance for the difference for categorical data was performed by Chi-square test and factors associated with MTB and RR-MTB were assessed using binary logistic regression yielding OR with 95%CI. RESULTS: Of total 990 presumptive tuberculosis analyzed cases, median ages of the patients were 39±19.09 years and two-thirds of the patients were male 653 (66.0%). The estimated prevalence of MTB in presumptive TB patients was 13.8% (95%CI: 11.88%-16.16%), and risk for MTB was significantly associated with previously treated patients: OR: 10.4 (P<0.001). The estimated prevalence of RR-MTB in MTB confirmed patients was 10.2% (4.97%-15.1%). Our study confirmed no association of RR-TB with age, sex, ethnicity, geographical diversity and previous history of treatment failure (P>0.05). CONCLUSION: The overall prevalence of MTB and RR-MTB was high in Nepalese study population,  and that being previously treated with anti-TB drug remained significant predictors for MTB; proactive measures are urgently needed to address the challenge of prompt diagnosis, early management and improved monitoring of treatment to limit the emergence drug-resistant MTB strains in the community.