The global health crisis created by coronavirus disease in 2019, ie, COVID-19, is of serious concern to rheumatologists. The relationship of rheumatic diseases, their therapies, and COVID-19 with multiple genuine and malicious information available online can influence the knowledge and attitudes of rheumatic patients. This Google Forms study was conducted to understand the knowledge, attitudes, and practices of rheumatology patients with regard to COVID-19 in Nepal. Methods: A web-based cross-sectional study was conducted among patients with rheumatic diseases. A modified version of a questionnaire was used after consent had been obtained. It was then translated into Nepali for comprehensibility. The final questionnaire contained a total of 29 questions: six on demographic parameters and twelve, five, and six on knowledge, attitudes and practice, respectively. Simple descriptive statistics were used to describe the positive responses in each domain. Logistic regression analysis was done to observe demographic variables associated with knowledge, attitudes, and practice. Results: Among 380 participants, 63.2% were female, the majority (42.1%) aged 18-29 years, and all were literate. Most were aware of the clinical features of COVID-19 (91.6%), 71.5% had positive attitudes toward its control, some (31.5%) thought that they had a greater chance of contracting COVID-19 than others, and 18.9% believed that antirheumatic medications could increase their susceptibility to infection. A majority (>94.7%) of them practiced preventive measures. Conclusion: Patients with rheumatic diseases were aware of the general clinical features, routes of transmission, and general preventive measures regarding COVID-19 and did not significantly change their treatment practices.

Introduction/objectives: The global health crisis created by Coronavirus Disease (COVID-19) can be a serious concern to rheumatologists. The relationship of rheumatic diseases, their therapies, and COVID-19 with multiple genuine and malicious information available online can influence the knowledge and attitude of rheumatic patients. This web-based google-form study was conducted to understand the knowledge, attitude and practices of rheumatologic patients towards COVID-19 in Nepal. Methodology: A web based cross-sectional study was conducted among the patients with rheumatic diseases. Modified version of questionnaire prepared by Zhong BL et al was used after consent. It was then translated in Nepali language for comprehensibility. The final questionnaire contained a total of 29 questions; 6 for demographic parameters, 12, 5 and 6 for knowledge, attitude and practice behaviors, respectively. Simple descriptive statistics describing the positive responses in each domain. Multiple linear regression analysis done to observe demographic variables associated with the knowledge, attitude and practice. Results: Among 380 participants, 63.2% were female. Most of the participants were aware of the clinical features of COVID-19 (91.6 %), 71.5% had positive attitude towards its control, some (31.5 %) thought that they had greater chance of getting COVID-19 than others and 18.9 % believed that the anti-rheumatic medications could increase their susceptibility to infection. Majority (> 94.7%) practiced preventive measures.Conclusions: Patients with rheumatic diseases were aware of the general clinical features, route of transmission and general preventive measures regarding COVID-19.

Introduction: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly.Methods: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed.Result: Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste.Conclusion: The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future._______________________________________________________________________________________Keywords: abortion; pattern; socio-demographic.

Abstract. Examination of urate crystal in synovial fluid (SF) remains the gold standard for diagnosis of gout, but is not universally available. SF uric acid (UA) level may be measured by the uricase method with an automated analyzer. The present study aimed to evaluate the utility of SF to serum UA ratio (SSR) for diagnosis of gout. A cross-sectional study was conducted at the National Center for Rheumatic Diseases, Nepal. Patients presenting with acute (<1 day) joint pain and/or swelling were included. Aspiration was performed in all patients and fluid was subjected to testing for urate level, pH and cell counts and microscopy. Serum samples were also assessed for urate levels, and the SSR was calculated for each patient. A receiver operating characteristic curve was plotted to determine the cutoff value for indicating diagnosis of gout. The difference in SSR between gout and non-gout effusion was evaluated by one-way analysis of variance. A total of 181 patients were included of which 77 had gout. The remaining cases included osteoarthritis, pseudogout, rheumatoid arthritis and ankylosing spondylitis. SSR was significantly higher in gout patients than in any other group (P<0.05). An SSR of ≥1.01 had the highest sensitivity and specificity at 89.6 and 66.3%, respectively, for identifying gout effusion. The present results indicated that SSR may be used as an aid for gout diagnosis when polarizing microscopy is not available. IntroductionGout is among the most common inflammatory arthritides, characterized by deposition of monosodium urate (MSU) crystals in and around the joint and soft tissue (1-3). Persistent hyperuricemia is an important factor in the development of gout, but not all hyperuricemic patients develop gouty arthritis (4). The risk of supersaturation and crystal formation increases with increasing urate concentration. Alteration in various factors including pH and temperature also aggravates crystal formation and deposition in joints such as the first metatarsophalangeal (MTP) joint, a normally lower-temperature joint (5). The release of these preformed crystals initiates an intense inflammatory response in the synovium causing acute gouty arthritis (6).Worldwide prevalence of gout ranges from 0.1 to 10%, with an incidence of 0.3 to 6 cases per 1,000 person-years (7). However, Asian countries including India (8), Bangladesh (9) and Pakistan (10) have been reported as having low gout prevalence, with prevalence rates below 0.5% according to data published by the Community Oriented Programme for Control of Rheumatic Diseases (7).Gout typically presents in middle-aged men as severe pain and/or swelling with redness around joints, which may last from hours to days. Acute gouty arthritis usually has monoarticular presentation with a predisposition to develop in joints of lower extremities, particularly the first MTP joint. Other joints including the ankle and wrist may also be affected. Oligo-or polyarticular presentation may also occur, albeit rarely, typically in conditions such as chronic untreated...

Objective. To examine the efficacy of vitamin E in methotrexate- (MTX-) induced transaminitis in patients with rheumatoid arthritis (RA). Methods. A case-control study was conducted at a tertiary rheumatology center for 12 months. Patients with RA on MTX and deranged aminotransferases were included. Patients with previous liver diseases, baseline transaminitis before methotrexate initiation, alcohol intake, muscle diseases, under hepatotoxic drugs, and aminotransferases>3 times the upper normal limit were excluded. The patients were divided into treatment (vitamin E 400 mg bid for 3 months) and control groups (no vitamin E) using a random number table. The dose of MTX was unaltered. Follow-up was done after 3 and 6 months. Independent t-test was done to compare means of two groups. Paired t-test was done to compare differences in mean. Results. Among 230 patients, 86.5% were female with a mean BMI of 25.9±4.5 kg/m2. In the treatment group, SGPT and SGOT at baseline were 73.1±20.4 and 60.2±24.5 IU/L, respectively; at 3-month follow-up 44.6±34.2 and 38.3±20.8 IU/L, respectively; and at 6-month follow-up 40.4±35.7 and 34.2±21.9 IU/L, respectively. In the control group, SGPT and SGOT at baseline were 63.4±15.1 and 46.8±13.7 IU/L, respectively, and at 3-month follow-up 55.8±45.9 and 45.5±30.9 IU/L, respectively. Significant decrease in the level of aminotransferases was seen in the treatment group (p value < 0.001) and not in the control group (p values 0.161 and 0.728, respectively). The change in levels of SGPT and SGOT from baseline to 3 months of follow-up was statistically significant in between two study groups (p values 0.007 and <0.001, respectively). From the control group, 29 patients were crossed over to vitamin E for the next 3 months. SGPT and SGOT decreased from 97.6±44.1 to 46.1±40.9 and 69.3±34.9 to 29.1±11.6 IU/L, respectively (p values 0.031 and 0.017, respectively). Conclusion. Vitamin E significantly attenuates MTX-induced transaminitis.