Background:Transbulbar sonography for measuring optic nerve sheath diameter (ONSD) is noninvasive bedside technique for detection of raised intracranial pressure. This study aims to evaluate the number of sonographic evaluations required for a novice operator to learn proper measurement of ONSD after a formal training and supervised scanning session.Methods:Three novice operators and one expert operator measured ONSD of 27 healthy volunteers using linear array transducer HFL38x (frequency range of 6–13 MHz) (MicroMaxx®; SonoSite, USA). In each eye, ONSD was measured three times by each observer and mean value was determined. Correlation coefficient was calculated between the novice and the experienced operator and in between the novice operators. Number of scans, after which the significant correlation developed between novice and the experienced operator and between the novice operators, was analyzed.Results:Cronbach's alpha was tested to evaluate the reliability of the values obtained from intra- and interobservations. For all 27 cases, the value of Cronbach's alpha was high: 0.80–0.99 for the right eye and 0.69-0.97 for the left eye. The mean interobserver variations were plotted on a graph which fluctuated largely in the first 17 cases but oscillated around 0.5–0.30 in the last 10 cases.Conclusion:Learning curve for novice operators to measure ONSD is steep and they can be taught to measure ONSD in healthy volunteers by sonography in supervised clinical session with an acceptable clinical precision and accuracy comparable to an experienced operator.

Introduction: Non-invasive coronary calcium scoring predicts earliest atherosclerotic changes in the coronary arteries on the basis of amount of calcium deposited in the coronary arteries. This study was done to analyze calcium scores in-patient with different risk factors for coronary artery disease (CAD). Methods: This was a cross sectional study conducted from 1st November 2015 to 30th April 2016 at Kathmandu Medical College Teaching Hospital. Patient with cardiovascular risk factors were included in the study. These patients underwent coronary calcium scoring. Calcium scores were then compared with the presence of risk factors. Results: Total 467 participants were included in the study. There were 309 (62.2%) males and 158 (33.8%) females. Mean age of patient was 56.6 year (SD = 12.7). The difference in the scores observed with presence or absence of risk factors were statistically significant for gender, smoking, and hypertriglyceridemia (p<0.05) but not significant for impaired fasting glucose, hypertension, and body mass index. Conclusion: This study suggested that presence of traditional risk factors does not necessarily indicate high coronary calcium level.

Primary melanoma of the testis is very rare.  Melanoma of testis usually occurs as metastatic tumor. Here we present a case of 54 year old man with right testicular swelling proven to be primary malignant melanoma. Patient had right scrotal swelling of six months duration. With raised LDH and unremarkable Serum β-HCG and Alpha Feto Protein level and with a suscipicion of primary testicular tumor on MRI, right inguinal orchidectomy was done.  Its clinical presentation and histopathological examination is discussed here.