Introduction: Any symptoms acquired after COVID-19 infection that persists beyond 12 weeks period and not explained by any other disease either already present or acquired after COVID-19 infection is termed as long COVID 19 by World Health Organisation. We tried to find out the prevalence of long COVID 19 in healthcare workers. Method: Questionnaire was made in google form based on COVID-19 Yorkshire Rehabilitation Screening Tool (COVID YRS Tool). Ethical approval was taken from IRC-PAHS. Data collected from all health care workers of PAHS from 2022/05/20 to 2022/07/20. Difference in Precovid and Postcovid status in different domains were compared by statistical tests. Result: The median age of our participants was 29 years. Prevalence of Long COVID 19 was 68.1%. 19 55.3% ha mild, 10.4% had moderate, 2.4% had severe symptoms. The most common symptom was fatigue (44%), anxiety (41%) and shortness of breath (36%). The COVID YRS Tool overall score was statically significant with p value <0.001. Pre COVID 19 and Post COVID 19, patients had statically significant in breathlessness, fatigue, nutrition, anxiety, usual activity, pain, anxiety and depression. Only 6% of our patients had severe COVID 19. Conclusion: People are still experiencing various symptoms after COVID 19 infection. Long COVID 19 has now been a health care problem.  Long COVID 19 patients have multisystem involvement and multi-speciality team is needed for their management and rehabilitation.

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and presents with fever, dry cough, fatigue, myalgia, and dyspnea. This study aims to is find out the understanding of COVID-19 among doctors at Patan Hospital.  Method: A cross sectional was conducted among doctors at Patan Hospital, Patan Academy of Health Sciences, Nepal. The questionnaire in Google form consisted, part1 perception on COVID-19 and part2 understanding using multiple choice questions corresponding to the one to fifteen questionnaire in part1. Ethnical approval was obtained. Result: Sixty-one doctors participated in the study, of which 65.5% were directly involved in management of COVID-19. Perception and understanding regarding transmission status in country was 65.6% and 63.95% respectively, about case definition 90.1% and 62.2%, about when to do diagnostic tests 75.4% and 90.2%. Conclusion: There was difference in perception and understanding regarding COVID-19 among doctors, and areas to be reinforced were case definition, transmission classification, diagnostic tests.

IntroductionInactivated, viral vector and mRNA vaccines have been used in the Nepali COVID-19 vaccination programme but there is little evidence on the effectiveness of these vaccines in this setting. The aim of this study is to describe COVID-19 vaccine effectiveness in Nepal and provide information on infections with SARS-CoV-2 variants.Methods and analysisThis is a hospital-based, prospective test-negative case–control study conducted at Patan Hospital, Kathmandu. All patients >18 years of age presenting to Patan Hospital with COVID-19-like symptoms who have received a COVID-19 antigen/PCR test are eligible for inclusion. The primary outcome is vaccine effectiveness of licensed COVID-19 vaccines against laboratory-confirmed COVID-19 disease.After enrolment, information will be collected on vaccine status, date of vaccination, type of vaccine, demographics and other medical comorbidities. The primary outcome of interest is laboratory-confirmed SARS-CoV-2 infection. Cases (positive for SARS-CoV-2) and controls (negative for SARS-CoV-2) will be enrolled in a 1:4 ratio. Vaccine effectiveness against COVID-19 disease will be analysed by comparing vaccination status with SARS-CoV-2 test results.Positive SARS-CoV-2 samples will be sequenced to identify circulating variants and estimate vaccine effectiveness against common variants.Measuring vaccine effectiveness and identifying SARS-CoV-2 variants in Nepal will help to inform public health efforts. Describing disease severity in relation to specific SARS-CoV-2 variants and vaccine status will also inform future prevention and care efforts.Ethics and disseminationEthical approval was obtained from the University of Oxford Tropical Ethics Committee (OxTREC) (ref: 561-21) and the Patan Academy of Health Sciences Institutional Review Board (ref: drs2111121578). The protocol and supporting study documents were approved for use by the Nepal Health Research Council (NHRC 550-2021). Results will be disseminated in peer-reviewed journals and to the public health authorities in Nepal.

Azathioprine (AZA) is commonly used as immunosuppressive therapy for autoimmune diseases, including systemic lupus erythematosus (SLE). Myelosuppression is a common side effect of AZA. Here we report a case of severe myelosuppression following AZA therapy in a 15-year-old girl despite a normal thiopurine methyltransferase (TPMT) level. She had been receiving AZA for SLE and presented with neutropenic fever and pancytopenia. AZA was stopped. After stopping AZA, her blood counts steadily improved. When TPMT genotyping results were normal, AZA was reintroduced. Pancytopenia reappeared after starting AZA, despite normal TPMT genotype. AZA was replaced with mycophenolate mofetil which consequently resulted in improvement of blood counts. It is essential to understand the temporal relationship between AZA use and pancytopenia onset in patients with normal TPMT activity. This case illustrates that regular monitoring of blood cell counts should be routine practice after starting AZA regardless of TPMT activity.azathioprine, systemic lupus erythematosus, thiopurine methyltransferase Key points• Azathioprine-induced myelosuppression can occur in patients with normal thiopurine methyltransferase (TPMT) activity. • Total cell counts should be evaluated on a frequent basis after initiating azathioprine even in patients with normal TMPT activity.

Introduction: Corona virus disease 2019(COVID-19) is an infectious disease caused by newly discovered coronavirus SARS CoV-2 (Severe acute respiratory syndrome coronavirus 2). Majority of the COVID-19 infections have mild symptoms in general populations but symptoms may be more severe in immunocompromised and elderly patients and may be in CML populations also. We expected most of CML patients in elderly age group may develop severe symptoms of COVID-19 and its severity may vary in different phases of the CML and different types of TKI being used. Method: From January 2020 to June 2021 all adult CML patients receiving treatment from Patan Hospital, identified with SARS Cov-2 infection were included in the study. Those patients who had final outcome from COVID-19 infection was taken. Result: The prevalence of SARS CoV-2 infection in CML population in our hospital is 2.60%. The COVID-19 infection was seen more on female population and younger age group less then 60 years old. Even though the infection rate was higher in the younger age group and infection rate was lesser in CML-CP group, mortality was higher in elderly and advances age group which was statically significant. Regardless of their symptoms, stages, severity of the symptoms, different TKI being used about 92% have fully recovered from COVID-19 infection. Conclusion: About 92% of CML patients had fully recovered from COVID-19 infection. In our study advanced stage and elderly age group were associated with more severity of the disease and higher mortality rate.