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The mean age of the patients was 56.6 ± 13.9 years (21 to 79 years) and male to female ratio was 1.11 (26 vs 23). Post-operative pancreatic fistula developed in 13/49 (26.5%) patients. On both univariate and multivariate analysis, pancreatic texture (p = 0.022), main pancreatic duct diameter at neck (p = 0.002) and pancreatic configuration index (p = 0.001) were significantly associated with development of post-operative pancreatic fistula. The sensitivity and specificity of pancreatic configuration index to predict post-operative pancreatic fistula are 92.3% and 91.7% with positive predictive value of 80% and negative predictive value of 97.1%.

Pancreatic configuration index is a useful preoperative predictor of post-operative pancreatic fistula after pancreaticoduodenectomy.

Pancreatic configuration index is a useful preoperative predictor of post-operative pancreatic fistula after pancreaticoduodenectomy.

The study assesses the perspective of doctors working in government hospitals of Nepal regarding hospital preparedness for infection prevention measures, isolation services provisions, critical care service readiness, and training of staff for COVID-19 pandemic management.

This cross-sectional study was done in central, provincial, and local level health centers of the Government of Nepal to assess the perspective of medical doctors regarding COVID-19 pandemic readiness in their facility. Nonprobability sampling was used to collect 56 responses from doctors working in different hospitals of Nepal. An online survey was performed using a questionnaire tool, which was adapted from the guidelines of the World Health Organization and the Centers for Disease Control and Prevention.

Most of the participants were medical officers with an MBBS degree (32) followed by anesthesiologists (10). Thirteen participants worked in central hospitals (23.2%), 24 in provincial hospitals (42.8%) and 19 in local health centergovernment hospitals of Nepal perceive that provision of facemask distribution, airborne isolation rooms, critical care preparedness, and hands-on training to staff were not adequate.Gram-negative isolates producing carbapenemase enzymes is a great public health problem in developing countries and their control is challenging task due to the involvement of multiple factors including the practice of self-medication, use of antibiotics on animal farms, poor hospital hygiene, etc. During this study, we searched various databases for relevant publication on carbapenemase-producing isolates in Nepal. Various classes of carbapenemases had been reported in Nepal. Most frequent was the New Delhi Metallo beta lactamase with many variants where NDM-1 was most prevalent. Similarly, Oxacillinase and Klebsiella pneumoniae carbapenemase producers were also prevalent in Nepal. While other carbapenemases like VIM, IPM, and DIM also detected. The isolates producing carbapenemases were extremely drug-resistant as they also co-produced various other carbapenemases, beta-lactamases, 16S rRNA methylase. Most isolates were resistant to many members of carbapenem, cephalosporin, quinolone, penicillin, aminoglycoside group of antibiotics. Such isolates had very few treatment options as only last line drugs like colistin, fosfomycin, and tigecycline was effective against most of these isolates. Carbapenemase production by almost all major human pathogens including E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter. Citrobacter, Proteus, Providencia is a matter of concern because some of these enzymes are located on plasmids and pose rapid dissemination among various gram-negative pathogens. Timely surveillance for carbapenemase producers throughout the nation, their proper treatment, and proper hospital hygiene to prevent nosocomial infections by carbapenemase producers, controlled use of carbapenems, educating health care workers, students and the general public about the adverse effects of antimicrobial resistance is imminent.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of coronavirus that causes coronavirus disease 2019 (COVID-19), a respiratory illness. COVID-19 has now become a global public health crisis causing alarming numbers of morbidity and mortality. Ever since the COVID-19 pandemic started scientists, researchers, universities, companies, and institutions all around the world have been endeavoring to discover a potential treatment for COVID-19. Numerous studies and clinical trials on vaccines and drugs for the prevention and treatment of COVID-19 are underway across the world. However, the uncertainty around the efficacy and safety of various treatment regimens have become one of the biggest challenges in the battle against the SARS-CoV-2. This paper is a narrative review of articles regarding the various treatments and vaccines being tested for the SARS-CoV-2, available in the PubMed database along with Google Scholar. There are ongoing clinical trials on potential drugs such as remdesivir, favipiravir, lopinavir/ritonavir, chloroquine, and hydroxychloroquine, corticosteroids tocilizumab, azithromycin, anakinra, etc. and other therapeutic modalities like convalescent plasma therapy. Likewise, vaccines against SARS-CoV-2 are being developed and tested, including mRNA, non-replicating viral vector, DNA, protein subunit candidate vaccines, etc. read more Although some early-stage clinical trials and studies on these drugs and vaccines have shown positive results, definitive and conclusive results are yet to be obtained. Keywords COVID-19; antiviral drugs; COVID-19 treatment; COVID-19 vaccine; SARS-CoV-2.N/A.BACKGROUND Use of renin-angiotensin-aldosterone system inhibitors in coronavirus disease 2019 (COVID-19) patients lacks evidence and is still controversial. This study was designed to investigate effects of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on clinical outcomes of COVID-19 patients and to assess the safety of ACEIs/ARBs medication. MATERIAL AND METHODS COVID-19 patients with hypertension from 2 hospitals in Wuhan, China, from 17 Feb to 18 Mar 2020 were retrospectively screened and grouped according to in-hospital medication. We performed 1 1 propensity score matching (PSM) analysis to adjust for confounding factors. RESULTS We included 210 patients and allocated them to ACEIs/ARBs (n=81; 46.91% males) or non-ACEIs/ARBs (n=129; 48.06% males) groups. The median age was 68 [interquartile range (IQR) 61.5-76] and 66 (IQR 59-72.5) years, respectively. General comparison showed mortality in the ACEIs/ARBs group was higher (8.64% vs. 3.88%) but the difference was not significant (P=0.