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In Nepal, over 1 million individuals have tested positive for SARS-CoV-2. We sought to describe the frequency of nonrecovery from this infection at 6 months and associated symptoms. We conducted a retrospective cohort study of 6142 women who had positive and negative PCR tests for this infection 6 months previously at 3 institutions in Kathmandu. In telephone interviews women provided information on 22 symptoms and their intensities, health status and history, and functional status. Of 3732 women who had tested PCR positive, 630 (16.9%) reported that they were unrecovered. These 630 unrecovered women were distinguished statistically from the 3102 recovered women by more frequent histories of allergies, rheumatoid disease, BCG immunization, Covid vaccination, strep throat and recent URIs, and both weight gain and weight losses of more than 5 kg in the 6 months following testing, and stressful events in the preceding year. Fatigue, pain, difficulty remembering, shortness of breath, heat and cold intolerance and unrefreshing sleep were reported in 41.9% to 10.5% of these 630 unrecovered women. Six months after confirmed SARS-CoV-2 infection 16.9% of Nepali women have long-COVID manifested as an immune, metabolic, and hormonal systems disruptive and dysfunction syndrome

The post-coronavirus disease 2019 (COVID-19) syndrome is defined as the persistence of symptoms after viral clearance and the emergence of new symptoms after a few months following recovery from COVID-19. This study aimed to assess the prevalence of post-COVID-19 syndrome and the risk factors that contribute to its development. This study was conducted prospectively in Tribhuvan University Teaching Hospital (TUTH), located in Maharajgunj, Kathmandu. The patients were followed up for three months. The post-COVID status of 300 patients admitted to the COVID emergency of TUTH was studied. The mean age of the patients was 46.6±15.7 years, and the proportion of male (56%) was slightly higher than female (44%). Most of the patients (81.7%) had fever on their presentation to the emergency which was followed by fatigue (81.3%) and cough (78.3%). During the post-COVID phase, fatigue was the most common persistent symptom, with 34% experiencing fatigue after 60 days and 28.3% even after 90 days from the onset of symptoms. Univariate logistic regression showed sore throat (OR 4.6; 95% CI (2.8-7.6)), rhinitis (OR 3.6; 95% CI (2.1-5.9)), fatigue (OR 3.7; 95% CI (1.8-7.6)), diarrhea (OR 4.1; 95% CI (2.4-6.9)), anosmia (OR 6.7; 95% CI (3.9-11.3)), ageusia (OR 7.8; 95% CI (4.5-13.4)) and shortness of breath (OR 14.9; 95% CI (1.8-119.6)) at admission were all predictors of post-COVID syndrome after three months. Even after recovering from COVID-19, people with COVID-19 may develop symptoms. As a result, COVID-19's long-term consequences should not be neglected, as they may lead to increased morbidity among patients, consumption of financial resources, and added burden on the health system.

Background The genetic make-up of local granulosa cells and their function in the pathophysiology of polycystic ovary syndrome (PCOS) is crucial to a full comprehension of the disorder. The major purpose of this study was to compare the Single Nucleotide Polymorphism (SNP) of cumulus granulosa cells (CGCs) and mural granulosa cells (MGCs) between healthy individuals and women with PCOS using genome-wide association analysis (GWA). A case–control study was conducted in a total of 24 women diagnosed with PCOS and 24 healthy non-PCOS women of reproductive age aggregated into 4 samples of 6 patients each. GWA studies entail several processes, such as cell separation, cellular DNA extraction, library preparation followed by interpretation using bioinformatics databases. SNP locations were identified by reference gene also involves the use of Matrix-assisted laser desorption/ionisation-time of flight (MALDI-TOF) mass spectrometry (MS) (MALDI-TOF-MS) for the first sorting. Hybridization with the gene chip was followed by reading the SNP genotypes according to the publications in the literature. TASSEL (Trait Analysis by aSSociation, Evolution and Linkage) program and methods were used for GWA studies. Results An aggregate of 21,039 SNP calls were obtained from our samples. Genes of autoimmune illnesses, obesity, inflammatory illnesses, nervous system diseases such as retinitis pigmentosa, autism, neural tube defects, and Alzheimer's disease; and various malignancies such as lung cancer, colorectal cancer, breast cancer were also identified in these cells. Gene ranking score reveals that granulosa cells carry key genes of neurological system and reproductive systems especially in brain and testis, respectively. Conclusions Mural and Cumulus Granulosa cells were shown to have the PCOS directly and indirectly related genes MMP9, PRKAA2, COMT and HP. We found that the expression of ARID4B, MUC5AC, NID2, CREBBP, GNB1, KIF2C, COL18A1 , and HNRNPC by these cells may contribute to PCOS. Graphical abstract Highlights Investigated genetic make-up of mural and cumulus granulosa cells Role of these cells in pathogenesis of PCOS studied Local and systematic effect of these genes were correlated

Background: The reproductive system is heavily dependent on ovarian follicles, which are made up of germ cells (oocytes) and granulosa cells (GCs), including cumulus granulosa cells (CGCs) and mural granulosa cells (MGCs). Understanding their normal and steroid-induced functions is the key to understanding the pathophysiology of endocrinal diseases in women. Objective: This study investigated the differentially expressed proteins by CGCs and MGCs of patients with polycystic ovarian syndrome (PCOS) and without subsequent exposure to dehydroepiandrosterone sulfate (DHEAS) and functional differentiation. Design: The present study was observational and experimental study carried out in hospital involving 80 female patients undergoing IVF for infertility. Methods: In this study, we isolated CGCs and MGCs from the follicular fluid of both PCOS and non-PCOS patients undergoing in vitro fertilization (IVF). The cells were cultured and treated with DHEAS for 48 hours, and these cells were extracted, digested, and analyzed by tandem mass spectrometry followed by processing of the results using open-source bioinformatics tools. Results: The present investigation discovered 276 and 341 proteins in CGCs and MGCs, respectively. DHEAS reduced the number of proteins expressed by CGCs and MGCs to 34 and 57 from 91 and 94, respectively. Venn results of CGCs revealed 49, 53, 36, and 21 proteins in normal CGCs, PCOS-CGCs, post-DHEAS, and PCOS-CGCs, respectively. Venn analysis of MGCs showed 51 proteins specific to PCOS and 29 shared by normal and PCOS samples after DHEAS therapy. MGCs express the most binding and catalytic proteins, whereas CGCs express transporter-related proteins. A protein pathway study demonstrated considerable differences between normal and PCOS samples, while DHEAS-treated samples of both cell lines showed distinct pathways. String findings identified important network route components such as albumin, actin, apolipoprotein, complement component C3, and heat shock protein. Conclusion: This is the first study to show how DHEAS-induced stress affects the expression of proteins by MGCs and CGCs isolated from normal and PCOS patients. Further studies are recommended to identify PCOS biomarkers from CGCs and MGCs expressed under the influence of DHEAS. Graphical abstract

Background and Aims Chronic Obstructive Pulmonary Disease (COPD) is associated with cognitive impairment, including memory loss, executive dysfunction and attention deficits all of which significantly affect quality of life. However, the prevalence and determinants of cognitive impairment among COPD patients in Nepal remain largely unexplored. Methods This cross‐sectional study included a total of 203 COPD patients admitted to a tertiary hospital in Nepal between August 2022 and June 2023. Sociodemographic, clinical, and biochemical data were collected from the patients. Cognitive functions were assessed using the Nepali‐translated Rowland Universal Dementia Assessment Scale. Logistic regression analysis was conducted to identify factors associated with cognitive impairment. Results The mean age of COPD patients was 68.4 ± 10.2 years, with most from the age group 65–75 years, and nearly 2/3rd (63.5%) were females. A majority (62.6%) lacked formal education, and 81.3% were smokers (current or former). Clinically, 45.3% of patients had grade III dyspnea, and 37.9% had pneumonia. Among the patients, 11.8% patients experienced more than five exacerbations in the past year, and 43.4% required more than one hospital admission during the previous year. Cognitive impairment was prevalent in majority of the patients, with 46.3% exhibiting mild cognitive impairment and 42.9% exhibiting dementia. Factors associated with cognitive impairment included increasing age of COPD patients (≥ 65 years) (OR 2.72; p = 0.003), having more than one COPD exacerbation in a year (OR 3.90; p = 0.002), years of living with COPD (≥ 10 years) (OR 0.47; p = 0.016), frequent COPD exacerbation related hospitalization (OR 0.29; p = 0.004), and lower blood PaCO2 levels (OR 0.26; p = 0.007). Conclusion Nearly 90% of COPD patients in Nepal had some form of cognitive decline. Age, exacerbation frequency, and PaCO₂ levels were significant predictors. Routine cognitive screening and targeted interventions like integrated rehabilitation strategies, including pulmonary rehabilitation and oxygen therapy are essential to enhance patient outcomes and reduce disease burden in future.

Key Clinical Message Pneumothorax and bronchopleural fistula (BPF) are potentially fatal complications that can occur in patients with COVID‐19 pneumonia. Early detection, appropriate treatment, and consideration of surgical intervention are necessary for optimum outcomes. Introduction Healthcare professionals face complex challenges as a result of the rare emergence of pneumothorax among the variety of COVID‐19 complications, including severe viral pneumonia. Case History A 57‐year‐old male with multiple comorbidities diagnosed with COVID‐19 pneumonia was admitted to our center and exhibited bilateral crepitations. During hospitalization, the patient developed right‐sided pneumothorax that persisted despite chest tube insertion was linked to the presence of BPF. Discussion The occurrence of pneumothorax in COVID‐19 patients is relatively rare risk factors for which are not yet fully understood, although smoking history may play a role. Conservative management is recommended for asymptomatic cases, while intercostal drainage is necessary for symptomatic patients. Surgical intervention may be required to manage the BPF in some instances. Conclusion Pneumothorax and BPF are rare but potentially life‐threatening complications in patients recovering from COVID‐19 pneumonia. Early recognition, appropriate treatment, and consideration of surgical intervention are crucial for optimizing patient outcomes. In a patient recovering from COVID‐19 Pneumonia, a chest X‐ray showed pneumothorax on the right in Figure (A). In contrast, in Figure (B), a chest X‐ray done four days before showed no pneumothorax with bilateral opacities without any subpleural bullae. HRCT Chest done later revealed a Bronchopleural Fistula leading to persistent pneumothorax in this patient.

The practice of manual siphoning of diesel from fuel tanks is common among automobile mechanics in Nepal. When an automobile mechanic with a history of diesel siphonage presents with respiratory symptoms, the diesel siphoner's lung diagnosis should be considered. Clinical suspicion confirmed by radiological findings can help in early management and prevention of permanent damage. The practice of manual siphoning of diesel from fuel tanks is common among automobile mechanics in Nepal. When an automobile mechanic with a history of diesel siphonage presents with respiratory symptoms, the diesel siphoner's lung diagnosis should be considered. Clinical suspicion confirmed by radiological findings can help in early management and prevention of permanent damage.

The effectiveness of coronavirus disease 2019 (COVID-19) vaccines in reducing symptoms, disease advancement, complications, and mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been well-established. This case-control study aimed to compare different blood parameters, and prognostic and survival outcomes of COVID-19 patients based on vaccination status. We performed a case-control study that included hospitalized patients with COVID-19 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Individuals who received vaccination were designated as cases and unvaccinated individuals as controls. Demographics, co-morbidity, clinical data, laboratory data, and disease outcomes were recorded for both groups. Multivariate, Cox, and linear regression were used for analysing blood parameters, hospital admission, survival, and hospital stay, respectively, between cases and controls. Out of 100 participants enrolled, 46 were vaccinated, and 54 weren't. At admission, ferritin and erythrocyte sedimentation rate (ESR) were significantly lower in cases. At discharge, cases showed a higher monocyte than controls. Ferritin, ESR, and d-imer showed excellent performance in determining the severity of symptoms. Significant correlation and regression of ferritin and ESR with the length of hospital stay was observed. Length of hospital stay was significantly lower in cases than in controls. No significant differences between cases and controls were observed in mortality. COVID-19 vaccines effectively reduced hospitalization duration. Ferritin and ESR were significantly lower in vaccinated individuals and showed the best utility in monitoring the disease.

Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG) developed by Bhabha Atomic Research Center (BARC) to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058) residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3%) was the commonest abnormality followed closely by old myocardial infarction (5.3%). Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas.

One of the main causes of death in the globe is cancer. It is uncontrolled proliferation of abnormal cell and can be malignant or non-malignant. Treatment of cancer via chemotherapeutic agents and radiation has been used since long. But due to their harmful effects and due to MDR (Multi Drug Resistance), use of herbal medicine has been the new approach. p53 (protein 53) gene also known as suppressor gene, is responsible for taking part in metabolic processes like apoptosis, DNA (Deoxyribonucleic Acid) repair and cell cycle arrest. The 393 amino acids that make up the p53 protein are divided into six domains. First is the N-terminal region, which is separated into two parts and contains the Transcription Activation Domain (TAD) (TD1 and TD2). The Proline-Rich Region (PRR), which is consistent in most p53s, comes in second. The DNA-binding portion of the central core domain (p53C), where more than 90% of human mutations occur, is ranked third. A nuclear localization signal domain comes in fourth. A tetramerization (TET) domain comes in fifth. The C-terminal domain (CT), a general DNA-binding domain, comes in at number six. So p53 is the target of many anti cancer drugs. Mutant versions of the tumor-suppressor p53 (mutp53) commonly develop tumor-promoting features in addition to losing their tumor-suppressive ones.The development of p53-targeted medications is particularly difficult since the agent must identify areas of improvement in mutp53 cancer cells while having no impact on healthy cells with wtp53 (wild type p53). Eupatorium adenophorum contains many chemical constituents like flavonoids, polyphenols, sesquiterpenoids, triterpenes etc which may show its effect in cancer treatment.