Results: Among all patients enrolled in the study 88.7% had anemia, 64.2 % systolic murmurs, 62.26 % pedal edema, 73.6 % fatiguability, 71.7 % angina, 24.4 % palpitations and 13.2 % had breathlessness on exertion. 62.26% of the patients had hypertension and 13.20 % had diabetes. In the electrocardiogram, prolonged QTc was observed in 10.4%, followed by T wave inversion in 9.4 % and finally low voltage complex comprised 7.6 %. The echocardiogram showed left ventricular diastolic dysfunction in 58.5 %, left ventricular hypertrophy (overall type) 49 % and valvular lesion like mitral regurgitation and tricuspid regurgitation 83 % and 58.5 % respectively. Conclusion: Cardiac co-morbidities are common in patients diagnosed with ESRD on maintenance hemodialysis.

Minimal change disease is an important cause of nephrotic syndrome in children, however, few cases are seen among adults. There is very little literature regarding the occurrence of minimal change disease in adults. We reported a case of a 63-year-old male who presented with the complaint of swelling around the eyes mostly during the morning for 18 days and frothing of urine for 7 days. On examination, the patient was ill-looking and had edema around the eyes and over the ankles. After preliminary investigations, renal biopsy was performed and electron microscopy revealed diffuse effacement of foot processes of visceral epithelial cells suggesting minimal change disease (podocytopathy). The patient has been treated with tablet prednisolone 60 mg per oral once daily, tablet ramipril 2.5 mg per oral once daily, and tablet torsemide 20 mg per oral twice daily. Hence, minimal change disease should also be considered as a differential diagnosis in adults presenting with the features of nephrotic syndrome.

Introduction: Excessive Daytime Sleepiness is a significant health problem among medical students worldwide which can impair their cognitive and academic performances. Our study aims to determine the prevalence of Excessive Daytime Sleepiness among the first to fourth year undergraduate students of the Nepalese Army Institute of Health Sciences-College of Medicine. Methods: Following the ethical approval from the Institutional Review Committee with registration no. 317, a descriptive cross-sectional study was conducted among the first to fourth year medical students of the Nepalese Army Institute of Health Sciences-College of Medicine from 4" to 10" August 2020. Two hundred and thirty-two students were selected for the study using the stratified random sampling technique. Epworth Sleepiness Scale was used to obtain data on daytime sleepiness among the study participants. The data were entered into Google spreadsheets and later analyzed. Point estimate at 95% Confidence Interval was calculated along with the frequency and proportion for binary data. Results: The prevalence of Excessive Daytime Sleepiness among the first to fourth year undergraduate students of the Nepalese Army Institute of Health Sciences-College of Medicine is found to be 67 (31.02%) at 95% Confidence Interval (24.85-37.19). It was found to be highly prevalent among the fourth year undergraduate medical students 20 (35.09%) and least prevalent among the first year students 13 (26.00%). Excessive Daytime Sleepiness was found to be slightly higher among females 23 (34.85%) than males 44 (29.33%). Conclusions: Excessive Daytime Sleepinessis highly prevalent among medical students in our study as suggested by various international studies.

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Introduction: Paediatric patients with respiratory symptoms having skin lesions are often referred from Paediatric to Dermatology Department. Knowledge about skin and respiratory manifestations will lead to early diagnosis and proper management by the doctors of both the specialties. These dermatological conditions may or may not be related to respiratory illness or may hence be part of total disease process or may be completely separate entity. The aim of this study was to find out skin manifestations of various respiratory diseases and analyse dermatological disorders in children referred from Paediatric Department having respiratory symptoms. Methods: An observational cross sectional hospital based study involving inpatients and outpatients referred from Paediatrics to Dermatology Department having respiratory illness and skin lesions was undertaken between January 2019 to December 2020. Details of skin disease were recorded. The descriptive statistical analysis was expressed in frequency and percentage and Chi square test was applied to determine significance among variables. Results: Total 437 patients were included in the study. The most common diagnosis made by Paediatric {160 (36.6%)} and Dermatology Departments {246 (56.2%) was viral exanthema followed by atopic dermatitis {77 (17.6%)}. Out of total 65 patients who suffered from bronchial asthma, 59 (90.7%) patients had atopic dermatitis. Conclusions: Significant paediatric patients with respiratory illnesses have concomitant skin lesions. There is very high percentage of patients having atopic dermatitis among those who had asthma and hence clearly depicts relation between the two diseases.