BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

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Background COVID-19 pandemic has created unprecedented health and economic impact. Psychological stress, anxiety and depression are affecting not only COVID-19 patients but also health professionals, and general population. Fear of contracting COVID-19, forced restrictive social measures, and economic hardship are causing mental trauma. Nepal is a developing country from South Asia where the COVID-19 pandemic is still evolving. This online survey has been carried out to understand impact of COVID- 19 on mental health of Nepalese community dwellers. Methods The COVID-19 Peritraumatic Distress Index (CPDI) questionnaire adapted from the Shanghai Mental Health Centre was used for online data collection from 11 April-17 May 2020. Collected data were extracted to Microsoft excel-13 and imported and analyzed using SPSS (Statistical Package for Social Sciences) version-22. An initial univariate analysis was conducted for all variables to assess the distribution. Logistic regression analyses were done to estimate the odds ratios of relevant predicting variables. Results A total of 410 participants completed the self-rated questionnaires. Mean age of study participants was 34.8 ± 11.7 years with male preponderance. 88.5% of the respondents were not in distress (score less than 28) while, 11% had mild to moderate distress and 0.5% had severe distress. The prevalence of distress is higher among age group > 45 years, female gender, and post-secondary education group. Health professional were more likely to get distressed. Respondents with post-secondary education had higher odds (OR = 3.32; p = 0.020) of developing distress as compared to respondents with secondary education or lower. Conclusion There is lower rate of psychological distress in city dwellers and people with low education. Adequate intervention and evaluation into mental health awareness, and psychosocial support focused primarily on health care workers, female and elderly individuals is necessary.

Background: Premenstrual syndrome is group of psychosomatic symptoms which occurs during second half of menstrual cycle. Significant number of reproductive aged females suffer from it with its impact on their daily activities. This study was conducted to assess the prevalence, severity and impacts of Premenstrual syndrome on female students of a teaching hospital of Kathmandu, Nepal.Methods: This cross-sectional study was conducted among female students of a teaching hospital from Kathmandu over a period of three months. Premenstrual Symptom Screening Tool was used to quantify the symptoms severity and their effect in activities. In addition; patient profile, socioeconomic status were recorded. The obtained information was entered in Statistical Package for Social Sciences and analyzed. Findings were then interpreted using chi-square test.Results: Out of the 285 respondents, 206 (72.3%) reported at least one premenstrual syndrome symptom of moderate to severe intensity among which 74 (25.9%) had at least one severe symptom. Six individuals (2.1%) fulfilled all criteria for Pre-Menstrual Dysphoric Disorder and 49 (17.2%) fulfilled the criteria for moderate to severe premenstrual syndrome and rest (80.7%) were having no or mild premenstrual syndrome with isolated symptoms. PMS was found to have significant association to menstrual bleeding (p?0.001) and severity of dysmenorrhea (p?0.001), family history of premenstrual syndrome (p=0.019) and physical activity (p=0.021). Conclusions: Premenstrual syndrome is common in female and has a considerable impact on day to day activities activities although its severe form Pre-Menstrual Dysphoric Disorder is less common.Keywords: Female students; Nepal; premenstrual syndrome.

This meta-analysis suggested that the I/D polymorphism of ACE gene would be a risk factor of asthma. To further evaluate gene-to-gene and gene-to-environment interactions between polymorphisms of ACE gene and asthma risk, more studies with large groups of patients are required.