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Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with high morbidity and mortality. AF treatment is guided by a patient–provider risk–benefit discussion regarding drug versus ablation or combination. Thermal ablation has a high rate of adverse events compared to pulsed field ablation (PFA). In this systematic review, we aimed to determine the safety and efficacy of PFA. Methods: The electronic search for relevant articles in English was completed in PubMed, PubMed Central, Cochrane library, Scopus, and Embase databases till July 2022. The screening was completed via the use of Covidence software. The risk of bias assessment and data extraction from the included studies was performed, and the narrative synthesis was performed accordingly. Results: A total of six studies were selected for review and 1897 patients receiving PFA were involved in these studies. Our review was focused on pulmonary vein isolation success, major adverse events, and arrhythmia recurrence. Successful pulmonary vein isolation (PVI) was completed in 100% of cases except in two studies. In one of them, six out of seven patients (86%) in the epicardial cohort had successful PVI. In the MANIFEST-PF survey, the acute PVI success rate was 99.9%. The major complications were rare and included pericardial tamponade, vascular complications requiring surgery, and stroke. The atrial arrhythmia recurrence was higher in the thermal group than in the PFA group (39% vs. 11%). Conclusions: The success rate of PVI by PFA is high, and major adverse events are low. PFA is found to decrease the recurrence of atrial arrhythmia compared to thermal ablation. Substantial randomized controlled trials (RCTs) are needed to validate the efficacy and safety of PFA over conventional methods.

Background: Coronavirus disease 2019 (COVID-19) emerged as a challenging pandemic globally. The clinical manifestations range from asymptomatic infection to severe respiratory failure. In-hospital mortality varies from 18.9% to 20.3%. Old age, male gender, co-morbidities, lower oxygen saturation, lymphopenia, raised C-reactive protein, and d-dimer levels increase the risk of critical illness and death. The objective of this study was to compare the clinical characteristics of COVID-19 patients and associated outcomes in a tertiary level hospital in Nepal. Methods: An analytical cross-sectional study was conducted in laboratory-confirmed COVID-19 patients admitted in a tertiary center of Nepal during the peak of the second wave of the pandemic. A non-probabilistic consecutive sampling technique was adopted. Data were analyzed using Statistical Package for the Social Sciences (IBM-SPSS), version-23. Mortality (yes/no) was the primary outcome of interest, and accordingly, the cases were divided into two groups, survivors and non-survivors. Bivariate and multivariate analyses were performed. Results: The overall in-hospital mortality was 84 (19.58%), and Intensive Care Unit (ICU) mortality was 36 (58.06%). The death rate was higher in cases presenting with shortness of breath and anorexia. Hypoxemic respiratory failure (16.08%) and acute respiratory distress syndrome (8.62%) were the most common complications associated with higher mortality. Patients with older age had higher odds of mortality (adjusted OR, 1.077; p<0.001). The risk of mortality was higher in severe to critically ill patients (adjusted OR, 5.861; p=0.001), and those who were under mechanical ventilation (adjusted OR, 39.059; p<0.001). Likewise, the duration of hospital stay was significantly associated with mortality (adjusted OR, 0.795; p<0.001). Conclusions: The non-survivors of COVID-19 tended to be of older age, severe to critically ill at presentation, require mechanical ventilation, and have a shorter duration of hospital stay, compared to survivors. So, these groups of patients need special care and support during hospital admission.

Background Headache is a common neurological disorder, with a global prevalence of around 50%. It may affect people of any age, gender, education, socioeconomic status and occupation. Tension headache, migraine headache and cluster headache are commonly encountered headache types. The prevalence of headache problems is higher among medical students. This could potentially affect their academic performance and quality of life. The objective of this study is to find out the prevalence of headaches and their clinical characteristics among students of a medical college. Materials and methods An online, single-centre, cross-sectional study was conducted among undergraduate medical students in Nepal. Stratified sampling followed by a simple random sampling technique was adopted depending upon the academic years of students. For data collection, pre-tested semi-structured questionnaire was used. The data entry and analysis were done by using Statistical Package for the Social Sciences (IBM-SPSS), version-23. The prevalence of headache and its subtypes were calculated. All the clinical characteristics associated with headaches were also studied. Results The prevalence of headache disorder was 65 (26.86%), with tension headache (69.23%) being the commonest one. It was highest among fourth-year students (37.84%) followed by first-year students (33.33%). Anxiety/stress (75.40%) was the most common precipitating factor. This problem stopped most of the students (63.09%) from doing daily activities. More than half of them (53.85%) practised self-medication in case of non-resolution of pain, and non-steroidal anti-inflammatory drugs (NSAIDs) were frequently used. Conclusion Headache was fairly prevalent among medical students. Anxiety/stress in medical life has led to headaches in the majority of students. The headache disturbed their daily activities and promoted self-medication practice. So, this problem should be properly looked into and addressed in time by the concerned authority.