Estimation of ventricles size of human brain by Magnetic Resonance Imaging in Nepalese Population: A retrospective study

Background and Objective: Magnetic resonance imaging (MRI) provides image acquisition of three-dimensional data and measurement in any chosen imaging plane. Objective of this study is to assess the size of ventricles of the brain of normal Nepalese people and establish the range of size of the ventricular system and compute the ventricular dimensions among different age and gender. Materials and methods: This is a cross-sectional retrospective study done at Gandaki Medical College, Pokhara. A total of 106 MRI scan data of healthy individuals were collected over a period of seven months between March to September 2019. Patients ranged between eight and eighty years of age with 58 males and 48 females. Measurements of the mean of bifrontal diameter (BFD), bihemispheric diameter (BHD), third ventricle transverse dimension (TVTD), fourth ventricle antero-posterior dimension (FVAP), fourth ventricle width (FVW), and frontal horn ratio (FHR) were done. Result: The mean of BFD, BHD, TVTD, FVAP, FVW, and FHR were found to be 3.05 ± 0.10 cm, 10.11 ± 0.40 cm, 0.43 ± 0.11 cm, 0.90 ± 0.11 cm, 1.22 ± 0.12 cm, and 0.30 ± 0.01 cm, respectively. The mean width of fourth ventricle in males and females was observed to be 1.23 ± 0.12 cm and 1.19 ± 0.11 cm respectively. There was a significant correlation of TVTD, FVAP, FHR and BFD with age with Pearson correlation coefficient 0.393 (P value <0.01), 0.259 (P value <0.01), 0.34 (P value <0.01), and 0.219 (P value <0.05) respectively. However, BHD and FVW have no correlation with age. Conclusion: Third Ventricle Traverse Dimension, FVP, FVW and FHR show almost similar or slight difference in measurement according to gender. However, BFD shows larger difference in measurement according to gender. Similarly there is no such significant difference according to age in measurement of BFD, BHD, FVAP, FVW and FHR, while TVTD measurement shows slight increased measurement according to age

Outcome of diagnosed cases of appendicitis and diagnostic accuracy of ultrasound of the appendix

Background: Acute appendicitis is the most common condition requiring an emergency ultrasound scan as well as surgery. Several scoring systems for acute appendicitis has been suggested to improve diagnostic accuracy and decrease the negative appendectomy rate. In this study, we have evaluated the diagnostic performance of ultrasound on the diagnosis of acute appendicitis, other appendicular pathology, and correlate with surgical outcome. Material and methods: This retrospective study included 776 cases of ultrasound scan reports in which the appendix was visualized and not visualized or equivocal. Data were collected from October 2014 to April 2019 from different department and wards of Gandaki Medical College Teaching Hospital and Research Center (GMCTHRC). All the cases with diagnosed acute appendicitis, appendicular lump, and appendicular abscess were included and were followed for its surgical outcome. The surgical note or post-operative findings served as the reference standard for determining whether perforation was present or not. Result: There were 776 ultrasound scans for suspected appendicitis out of which 423 (54.5%) were diagnosed as appendicular pathology. Out of 423 diagnosed cases, 192 (45.4%) were males and 231 (54.6%) were females, with age ranging from 24 months to 87 years. Sonographic findings, in these positive subjects, suggested acute appendicitis, appendicular lump, abscess, and amount of free fluid in right iliac fossa (RIF) and pelvic cavity. Frank acute appendicitis was present in 378 (89.3%) cases, eight (1.9%) cases had an appendicular abscess, 23 (5.4%) had an appendicular lump and 14 (3.3%) had perforated appendicitis. Conclusion: We conclude that ultrasound is a good modality for visualization of appendicitis with other appendicular pathology. We could follow a structured report and identify pathology more specifically. Ultrasound is an easy and non-invasive test to investigate

Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial

Introduction. Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods. This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results. Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. Conclusion. Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm

Clinicopathological Pattern of Penile Cancer in a Tertiary Care Centre in Nepal

Introduction: Carcinoma of penis is an uncommon entity. The higher incidence in developing country may be because of poor hygiene, less common practice of circumcision and unsafe sexual practice. Timely diagnosis and intervention gives the patient a chance of cure. Data on penile cancer is sparse from Nepal so treatment of penile cancer in our centre is presented here. &#13; Methods: This was a retrospective cross-sectional study done at Urology unit of Department of Surgery of Tribhuvan University Teaching Hospital, Nepal from November, 2007 to December, 2013. Data was retrieved from case records and those with penile carcinoma were included. Patient demographics, lesion characteristics, mode of treatment with outcome measures were noted and analyzed. &#13; Results: Total 17 patients underwent treatment for primary penile lesion. Mean age of the patients was 51.5 years. Penile growth was the most frequent presentation with five patients coming with more than one symptom. The most common site was over glans of penis (n=13) with the mean size of 3.55 cm. Partial penectomy was offered in 16 with one patient undergoing circumcision only. Inguinal lymph node dissection was done in four patients. Squamous cell carcinoma was the histological diagnosis in 15 patients. &#13; Conclusions: Penile carcinoma is primarily a disease of old. Growth over glans penis is the most common presentation and partial penectomy is feasible in most of the patients to allow oncological cure while preserving the organ for its native function. &#13; Keywords: inguinal lymph node dissection; partial penectomy; penile cancer

<span style="font-size:11.0pt;mso-bidi-font-size: 12.0pt;font-family:" times="" new="" roman";mso-fareast-font-family:"times="" roman";="" mso-ansi-language:en-gb;mso-fareast-language:en-us;mso-bidi-language:hi;="" mso-bidi-font-style:italic"="" lang="EN-GB">E<span style="font-size:11.0pt; mso-bidi-font-size:12.0pt;font-family:" times="" new="" roman";mso-fareast-font-family:="" "times="" roman";mso-ansi-language:en-gb;mso-fareast-language:en-us;="" mso-bidi-language:hi"="" lang="EN-GB">valuation of vaccine candidate potential of Δ<i style="mso-bidi-font-style:normal">aro</i>A, Δ<i style="mso-bidi-font-style: normal">htr</i>A and Δ<i style="mso-bidi-font-style:normal">aro</i>AΔ<i style="mso-bidi-font-style:normal">htr</i>A mutants of <i style="mso-bidi-font-style: normal">Salmonella enterica</i> subspecies <i style="mso-bidi-font-style:normal">enterica</i> serovar Abortusequi in guinea pigs </span></span>

280-287Salmonella enterica subspecies enterica serovar Abortusequi (S. Abortusequi), a host adapted Salmonella causes abortions, still births and foal mortality in equids. Though known since more than 100 years, it is still a problem in many of the developing countries including India. There is dearth of really good vaccine affording immunity lasting at least for one full gestation. In search of a potential vaccine candidate, three defined deletion mutants (ΔaroA, Δ<i style="mso-bidi-font-style: normal">htrA and ΔaroAΔhtrA) of S. Abortusequi were tested in guinea pig model for attenuation, safety, immunogenicity, humoral immune response, protective efficacy and persistence in host. The ΔhtrA and Δ<i style="mso-bidi-font-style: normal">aroAΔhtrA mutants were found to be safe on oral inoculation in doses as high as 4.2×109 cfu/animal. Also through subcutaneous inoculation Δ<i style="mso-bidi-font-style: normal">aroAΔhtrA mutant did not induce any abortion in pregnant guinea pigs. All the three mutants did not induce any illness or death in 1-2 week-old baby guinea pigs except ΔhtrA mutant which caused mortality on intraperitoneal inoculation. Inoculation with mutants protected against challenge and increased breeding efficiency of guinea pigs. After >4.5 months of mutant inoculation, guinea pigs were protected against abortifacient dose of wild type S. Abortusequi and mother guinea pigs also conferred resistance to their babies to the similar challenge. Early humoral immune response of S. Abortusequi mutants was characteristic. Faecal excretion of ΔaroA and <i style="mso-bidi-font-style: normal">htrA mutants was detected up to 45 days of inoculation in guinea pigs while ΔaroAΔ<i style="mso-bidi-font-style: normal">htrA mutant could not be detected after 21 days of inoculation. The results indicated that the double deletion mutant (Δ<i style="mso-bidi-font-style: normal">aroAΔhtrA) was the most effective and safe candidate for vaccination against S. Abortusequi through mucosal route of inoculation. </span

Renal Metastasis of Osteosarcoma with IVC Thrombus

Renal metastasis from osteosarcoma is a rare entity, and tumour thrombus is even rarer. To date, only 15 cases of osteosarcoma with tumour thrombus have been reported in the literature. We present a case of an 18-year-old female diagnosed as having right distal femur osteosarcoma, later presenting with renal osteosarcoma with IVC thrombus