COVID-19 and the heart: what we have learnt so far.

Since the outbreak of COVID-19 or coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 from Wuhan, China, the cardiology fraternity's interest has been drawn towards the pandemic with a high case fatality rate of 10.5% and 6% in patients with heart disease and hypertension, respectively. One of the postulated mechanisms for this high fatality rate is the possible abundance of ACE type 2 receptor in the cardiovascular system that strongly binds with the spike protein of COVID-19 and helps internalise into the cell resulting in acute cardiac injury (ACI). More than 7% of cases with COVID-19 are reported to have this type of ACI. A tenfold rise in mortality has been observed in patients with COVID-19 who experience a rise in high-sensitivity (hs)-troponin. All most half of the patients who died of COVID-19 had a rise in hs-troponin. More than 15% of cases with COVID-19 experienced different types of arrhythmias. All these statistics denote how important cardiovascular pathology is in patients with COVID-19. Controversies of renin-angiotensin-aldosterone system inhibitors usage in patients with COVID-19 and meticulous handling of case with acute coronary syndrome categorically stresses cardiologists to bust the myths hovering around and set a standard guideline to counterfeit the fatality with timely diagnosis and treatment of COVID-19-induced ACI. In this review, we sought to summarise the current evidence of COVID-19-associated cardiac injury and suggest the implications for its proper diagnosis and treatment.

Acute Kidney Injury in COVID-19 Patients Admitted at a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Coronavirus disease can affect the renal system in various forms ranging from mild proteinuria to acute kidney injury, some even needing renal replacement therapy. This study aimed to find out the prevalence of acute kidney injury in patients admitted with COVID-19 at a tertiary care centre. Methods: This descriptive cross-sectional study was done in patients admitted in COVID-19 ward in our hospital from July 2021 to June 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 066-077/078). The serum creatinine level was used for the diagnosis of acute kidney injury. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 80 patients with COVID-19, the prevalence of acute kidney injury was 25 (31.25%) (21.09-41.41, 95% Confidence Interval). Conclusions: The prevalence of acute kidney injury in COVID-19 patients was similar to other studies done in similar settings. Keywords: acute kidney injury; COVID-19; Nepal.

Prevalence of Depression in Patients with Chronic Kidney Disease Stage 5 on Hemodialysis at a Tertiary Care Center.

INTRODUCTION: Co-morbid depression impacts negatively on quality of life in Chronic Kidney Disease patients. This study was done to calculate prevalence of depression in patients on hemodialysis (HD) using Patient Health Questionnaire-9, Hamilton Rating Scale for Depression-17 and International Classification of Disease-10 classification of mental and behavioural disorders. METHODS: It was descriptive cross-sectional study conducted from November 2017 till June 2018. Ethical approval was taken from Ethical Review Board, Nepal Health Research Council. Informed and written consent was taken. Patients undergoing hemodialysis at Nepal Medical College for more than 3 months duration were included in study. Patients on hemodialysis were asked to fill validated Nepali translated version of Patient Health Questionnaire-9. Psychiatrist administered Max Hamilton Rating scale for diagnosis and categorization of depression and confirmed depression based on International Classification of Disease-10. Statistical Package for Social Sciences version 20 was used for statistical analysis. RESULTS: The study was done among 100 patients. Prevalence of depression was 78 (78%) using Patient Health Questionnaire-9 and 65 (65%) using Max Hamilton Rating scale and 51 (51%) using International Classification of Disease -10. Mean depression in males using Patient Health Questionnaire -9 was 7±4.33 and in females was 11.04±5.90. Median age was 47.5 years. The most common symptom was fatigue among 82 (82%). CONCLUSIONS: There is a high prevalence of depression in patients with Chronic Kidney Disease stage 5 on hemodialysis compared to general population.

Knowledge and Practice of Hemodialysis Amongst Dialysis Nurses.

INTRODUCTION: Dialysis nurses should have a good knowledge regarding hemodialysis treatment. The status of Nepalese dialysis nurses on this aspect is unknown. This study was done to assess the knowledge and practice on different aspects of the hemodialysis treatment. METHODS: We distributed validated questionnaires to the participants in a biannual conference in Kathmandu on 24th September as most of the dialysis nurses attend the event. We calculated mean and standard deviation for continuous variables and frequencies and percentage for the responses and compared counseling with different parameters. RESULTS: Total 94 out of 116 participants who were giving care to dialysis patients were in the study. Total 39 (42%) received formal nursing training in hemodialysis and 71 (78%) respondents always counseled patients regarding fluid intake. A total of 37 (96%) trained nurses always counseled the importance of regular dialysis. Seventy-six (81.7%) respondents did counseling on vaccination against Hepatitis B. Counseling on vaccination against influenza and pneumococcus was 47 (50%). When comparing educational status, respondents below bachelor level did more frequent counseling than level above (P=0.03). All the respondents knew the importance of hand washing and BP monitoring during hemodialysis. Ninety-one (96.7%) respondents knew how to deal with BP changes during hemodialysis. Seventy-three (77.6%) respondents were very confident on managing complications. Only 31 (33%) respondents knew how to deal with patients on continuous ambulatory peritoneal dialysis. CONCLUSIONS: Dialysis nurses have knowledge on basic procedures of hemodialysis but there is a space for improvement in dealing with complications to provide quality service to hemodialysis patients.