Introduction: Fear and anxiety is a natural response during crisis. From constant worry of getting infected, death of loved ones, transitioning of lifestyle to loss of social connection; there can be several psychological triggers. The effect on mental health on the general population could be greater than those affected by the infection itself during the pandemic. Among medical students, who already have several other psychological afflictions, these triggers might be detrimental. Hence, this study aims to find out the prevalence of composite anxiety-depression among medical undergraduates in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted among medical undergraduates in a tertiary care hospital from 20th December 2020 to 5th January 2021. Ethical approval was taken from the Institutional Review Committee. The sample size was calculated and convenient sampling was done. The data were entered in International Business Machines Statistical Package for Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 315 participants on the Patient Health Questionnaire-Anxiety and Depression Scale, severe composite anxiety-depression was seen in 10 (3.17%) at 95% Confidence Interval (1.23-5.1) participants, moderate in 35 (11.11%) at 95% Confidence Interval (7.63-14.58) and mild in 98 (31.11%) at 95% Confidence Interval (25.99-36.22). And 172 (54.6%) at 95% Confidence Interval (49.1-60) were normal. Conclusions: The rapid rise of apprehension among people amidst infectious outbreaks can ensue and medical students are no exception. So, at this time of crisis, there is a need to protect their mental health and it should be emphasized and endorsed.

A secondary level of prophylaxis has proven to be the most successful in Nepal, a country with an endemic rate of rheumatic heart disease, in combating the severe issues associated with rheumatic heart disease. The use of benzathine penicillin G in secondary prophylaxis of rheumatic heart disease, recommended by several guidelines, has been increasingly abandoned in Nepal due to a lack of national guidelines and the termination of the prior programs. The use of oral penicillin and alternative oral antibiotics, which are less effective in preventing the recurrence of acute rheumatic fever, is on the rise. Nepal urgently needs to develop new national guidelines and ensure their effective implementation in order to slow the increase in the number of rheumatic heart disease patients. In this article, we explore the limitations, challenges, and advantages of using the consensus-supported intramuscular benzathine penicillin G as the first-line drug for the secondary prevention of rheumatic heart disease.

Rheumatic Heart Disease (RHD) is a preventable disease which occurs years or decades after the onset of Acute Rheumatic Fever (ARF) in childhood. The prevalence of RHD is still high in Nepal, with most cases of latent RHD concentrated in the rural, resource-limited setting. The sequelae of latent RHD cases often manifest decades later, causing a significant burden on the health system. Training of non-experts with simple protocols in such remote setting for screening of latent RHD is showing promising results worldwide. Screening of latent RHD is advocated in RHD endemic areas where early detection by echo screening can alleviate a massive burden on morbidity and mortality in the future. More research is needed to explore this possibility in the context of an endemic country like Nepal to tackle the burden of RHD.

Background: Cardiac arrest is a common cause of morbidity and mortality. In out-of-hospital setting, early recognition of cardiac arrest and bystander-initiated cardiopulmonary resuscitation (CPR) improves both the chance of survival and quality of life. Objectives: The study aimed to explore awareness regarding cardiac arrest and knowledge of CPR among visitors of patients at a tertiary level hospital. Design: Cross sectional study. Method: The validated and tested self-administered questionnaire were distributed among 394 visitors of the patients admitted at Alka Hospital Pvt. Ltd, Lalitpur, Nepal. Results: Our study demonstrated that 221 (56.1%) of the respondents have knowledge regarding CPR and 201 (51.0%) of respondents have awareness about cardiac arrest through medias (37.8%) like movies and television. We found a significant difference among age group, occupation and geographical location regarding awareness of cardiac arrest. People with greater age and education knew better about cardiac arrest. There was, however, no significant difference amongst groups regarding knowledge of CPR. Very little respondents have heard about automated external defibrillators (AED). Conclusions: There is paucity in knowledge of cardiac arrest and CPR among respondents. Similarly, there is a general lack of knowledge regarding AED. Effective programs to raise the awareness of cardiac arrest and knowledge of CPR needs to be undertaken at the community level to reinforce bystander-initiated CPR and potentially save lives in the scenario of out-of-hospital cardiac arrest. Bangladesh Crit Care J September 2022; 10(2): 82-87