Prevalence of Significant Tricuspid Regurgitation in Patients Planned for Mitral Valve Surgery in a Tertiary Center of Nepal.

Background Tricuspid regurgitation is frequently present in patients with mitral valve disease and most of this tricuspid regurgitation present are significant. Objective To find out the prevalence of tricuspid regurgitation in adult patients present in our hospital who are planned for isolated mitral valve surgery for mitral stenosis, mitral regurgitation or both. Patients with moderate and severe tricuspid regurgitation were considered as significant. Method This was the retrospective cross-sectional study performed at Shahid Gangalal National Heart Center of Nepal. All cardiac surgical patients scheduled for isolated mitral valve surgery during the 3 years' period from 2017 to 2020 were enrolled in the study and presence or absence of significant tricuspid regurgitation were recorded and analysed. Result Out of total patients 65% (663) of the cases with mitral valve pathology had significant tricuspid regurgitation. Out of the total mitral stenosis cases 70% were associated with significant tricuspid regurgitation, 62.6% of the cases of mitral regurgitation had significant tricuspid regurgitation and 64.8% of patients with combined mitral stenosis and regurgitation were associated with significant tricuspid regurgitation. Conclusion Significant tricuspid regurgitation is present in most of the cases with isolated mitral valve pathology. So routine tricuspid valve evaluation and repair if needed during mitral valve surgeries is recommended.

Clinical and epidemiological features of COVID-19 deaths in Nepal.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has taken more than 1 million lives globally. This study, based on the official media releases of the Government of Nepal, analyses the clinical and epidemiological features of the individuals who died as a result of COVID-19 in Nepal from 23 January to 10 August 2020. We found that nearly half of the deaths were among people less than 50 years of age and being female increased the risk of death. The majority of deaths were associated with co-morbidities, the most common being cardiovascular diseases and diabetes followed by respiratory diseases. With the approaching festive season and relaxed lockdown, both government and citizens need to be more cautious about the severity of COVID-19 and take appropriate action.

COVID-19: the current situation in Nepal.

The recent global pandemic of novel coronavirus disease 2019 (COVID-19) is increasingly alarming. As of 21 June 2020, there are more than 8.7 million cases worldwide, with 460 000 deaths. Nepal is not an exception to COVID-19 and is currently facing a challenge to prevent the spread of infection. The analysis of the detected cases, severity and outcomes of the cases within a country is important to have a clear picture of where the pandemic is heading and what measures should be taken to curb the infection before it becomes uncontrollable. We collected data regarding all the cases, recoveries and deaths attributed to COVID-19 in Nepal starting from the first case on 23 January to 21 June 2020. At present, COVID-19 has spread all over Nepal, with a rapid increase in the number of new cases and deaths, which is alarming in a low-income country with an inadequate healthcare system like Nepal. Although the government implemented early school closure and lockdown, the management to contain COVID-19 does not appear to be adequate. Understanding the current situation regarding COVID-19 in Nepal is important for providing a direction towards proper management of the disease.

Multi-drug Resistant and Extended Spectrum ß-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples.

Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting. Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center. Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery. Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension.Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%. Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

Usefulness of dyssynchrony indices based on two-dimensional speckle tracking echocardiography in a canine model of left bundle branch block.

INTRODUCTION: Determine the usefulness of dyssynchrony indices derived from two-dimensional speckle tracking echocardiography for the detection of mechanical dyssynchrony in a canine model of left bundle branch block. ANIMALS: Ten healthy beagles. MATERIALS AND METHODS: Segmental, time-radial strain curves were obtained using two-dimensional speckle tracking echocardiography. The maximum difference and standard deviation of the time to peak radial strain for six predefined segments (MaxD-TpSR and 6SD-TpSR) were calculated, together with the left ventricular dyssynchrony by radial strain (DysSR), before and after ablation of the left bundle branch block. Receiver operating characteristic curve analysis was performed using dogs after ablation as positive controls. RESULTS: After ablation, all dogs showed multiple peaks in at least one segment on the time-radial strain curve, while all dyssynchrony indices increased significantly (MaxD-TpSR from 16.25 ± 16.04 [mean ± standard deviation] to 44.4 ± 26.18 ms, 6SD-TpSR from 7.59 ± 7.40 to 19.62 ± 11.91 ms, and DysSR from 4.20 ± 2.12 to 10.87± 2.92%, p<0.05). In receiver operating characteristic curve analysis, the areas under the curve for MaxD-TpSR, 6SD-TpSR, and DysSR were 0.825, 0.800, and 0.980, respectively. CONCLUSIONS: Left ventricular dyssynchrony by radial strain can detect mechanical dyssynchrony with higher sensitivity and specificity than dyssynchrony indices, based on the time to peak radial strain.

Fontan Failure and Thrombosis of Total Cavo-Pulmonary Connection Conduit.

The immediate postoperative period of Fontan operation is frequently complicated by hemodynamic instability, sometimes requiring fenestration of the conduit. Thrombosis of total cavo-pulmonary connection conduit warrants early intervention to prevent systemic and pulmonary embolism. We report a case of Fontan failure requiring fenestration; which was further complicated by thrombosis of total cavo-pulmonary connection conduit and managed with anticoagulants.