Transarterial embolization of acquired uterine artery pseudoaneurysm post cesarean section: A case report

We present a case report of 31 31-year-old woman with refractory secondary postpartum hemorrhage after 44 days of cesarian section. Patient was in shock and found to have a ruptured Uterine artery pseudoaneurysm (UAP) in computed tomography angiography (CTA). Emergency trans-arterial Uterine artery embolization (UAE) was performed, aiding in the stabilization and recovery of the patient. The benefits of early recovery, minimal invasiveness, and the option of preserving fertility are offered by UAE compared to uterine artery ligation or hysterectomy

Twin to Twin Transfusion Syndrome: A Case Report

Twin-twin transfusion syndrome occurs in multiple gestations and involves a chronic flow of blood from one twin to another twin and is a rare entity. We present a case of 32-years-old primigravida with a twin pregnancy who presented with increasing abdominal girth inappropriate with her gestational age at 21 weeks of her pregnancy. Ultrasound findings were suggestive of twin-twin transfusion syndrome. The patient was provided with treatment options but due to polyhydramnios and short cervix, the patient went into spontaneous labour the same day with a poor pregnancy outcome. Twin-twin transfusion syndrome leads to a high rate of perinatal morbidity due to its poorly understood aetiology and difficulty in diagnosing and treatment. Early diagnosis during antenatal ultrasound is important in reducing morbidity and mortality rates

The association of transradial access and transfemoral access with procedural outcomes in acute ischemic stroke patients receiving endovascular thrombectomy: A meta-analysis

Objective: There is an ongoing debate regarding the benefits of using transradial access (TRA) over transfemoral access (TFA) in endovascular therapies including endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) patients. This study sought to investigate the association of TRA and TFA with procedural success, access- site complications, first-pass reperfusion (FPR), puncture-to-recanalisation (PTR) time and hemorrhagic trans- formation (HT) by performing a meta-analysis. Materials and methods: PubMed, EMBASE and Scopus were searched. Studies with patients aged ≥ 18 years and head-to-head TRA vs TFA comparisons were included. Random-effects modeling was performed to obtain summary effects and forest plots were plotted to study the association of TFA with access site complications, FPR, HT, PTR time and procedural success. Results: Six studies encompassing 945 patients (347 TRA and 598 TFA) were included in the meta-analysis. Meta- analysis revealed that in AIS patients receiving EVT, TRA was significantly associated with a decreased risk of access-site complications (RR 0.17, 95% CI 0.05 0.54; p = 0.003, z = 2.957) and HT (RR 0.07, 95% CI 0.02 0.27; p < 0.0001, z = 3.8841). However, TRA was not significantly associated with procedural success (RR 20.96, 95% CI 0.90 1.01; p = 0.141, z = 1.473), FPR (RR 0.91, 95% CI 0.79 1.05; p = 0.194, z = 1.299) and PTR time (SMD 0.14, 95% CI 0.42 0.14; p = 0.323, z = 0.989). Conclusion: Our meta-analysis demonstrated that TRA is a safe alternative to TFA, in AIS patients receiving EVT, with significantly decreased access-site complications and HT with TRA, albeit with comparable procedural success, FPR and PTR time to TFA

Transsellar trans-sphenoidal encephalocele with cleft lip, cleft palate and agenesis of corpus callosum

Basal encephalocele is a rare congenital malformation. Among basal encephaloceles, the transsellar, trans-sphenoidal encephalocele is the least common subtype. We present the case of a newborn female, who presented to us with cleft lip and cleft palate. Diagnostic neuroimaging revealed the presence of transsellar trans-sphenoidal encephalocele along with agenesis of the corpus callosum. There are very few case reports of trans-sphenoidal encephalocele with corpus callosum agenesis in a patient with midline cleft lip and palate. In this report, we discuss the clinico-radiological findings of this extremely rare condition and present a brief review of the literature

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

Abstract Background With an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic review and meta-analysis to assess the status of stroke care in Nepal and identify areas that need dedicated improvement in stroke care. Methods A systematic literature review was conducted to identify all studies on stroke epidemiology or stroke care published between 2000 and 2020 in Nepal. Data analysis was done with Statistical Package for Social Sciences (SPSS) and Comprehensive Meta-analysis (CMA-3). Results We identified 2533 studies after database searching, and 55 were included in quantitative and narrative synthesis. All analyses were done in tertiary care settings in densely populated central parts of Nepal. Ischemic stroke was more frequent (70.87%) than hemorrhagic (26.79%), and the mean age of stroke patients was 62,9 years. Mortality occurred in 16.9% (13-21.7%), thrombolysis was performed in 2.39% of patients, and no studies described thrombectomy or stroke unit care. Conclusion The provision of stroke care in Nepal needs to catch up to international standards, and our systematic review demonstrated the need to improve access to quality stroke care. Dedicated studies on establishing stroke care units, prevention, rehabilitation, and studies on lower levels of care or remote regions are required