BACKGROUND AND PURPOSE:Aqueductal CSF stroke volume (ACSV) measured by phase-contrast MR imaging is a tool for selection of surgical patients with idiopathic normal-pressure hydrocephalus (iNPH). The aim of the present study was to investigate whether there is a relationship between clinical outcome and changes in ACSV in patients with iNPH who have been shunted.

Background and Aims: Incidence of ST-elevation myocardial infarction (STEMI) is increasing in Nepal. We aim to describe the presentation, management, complications, and outcomes of patients admitted with a diagnosis of STEMI in Shahid Gangalal National Heart Centre (SGNHC), Nepal. Methods: Shahid Gangalal National Heart Centre-ST-elevation registry (SGNHC-STEMI) registry was a cross sectional, observational, registry. All the patients who were admitted with the diagnosis of STEMI from January 2018 to December 2018 were included. Results: In this registry, 1460 patients out of 1486 patients who attended emergency were included. The mean age of patients was 60.8±13.4 years (range: 20 years to 98 years) with 70.3% male patients. Most of the patients (83.2%) were referred from other hospitals and 16.8% of patients directly attended the SGNHC emergency. During the presentation, smoking (54%) was the most common risk factor, followed by hypertension (36.6%), diabetes mellitus (25.3%), and dyslipidemia (7.8%). After admission, new cases of dyslipidemia, HTN, Impaired Fasting Glucose (IFG), and Type 2 DM were diagnosed in 682 (51.3%), 182 (20.1%), 148 (10.3%) and 95 (8.9%) respectively. At the time of presentation, 73.3% were in Killip class I and 26.3% were above Killip class II with 5.1% in cardiogenic shock. Thirty-one percent of the cases received reperfusion therapy (Primary percutaneous intervention in 25.2% and fibrinolysis in 5.8%). Inferior wall MI was the most common type of STEMI. Among the patients who underwent invasive therapy, the multi-vessel disease was noted in 46.2% cases and left main coronary artery involvement in 0.7% cases. In-hospital mortality was 6.2% with cardiogenic shock being the most common cause. Aspirin (97.8%), clopidogrel (96.2%), statin (96.4%), ACEI/ARB (76.8%) and beta-blocker (76.8%) were prescribed during discharge. Conclusion: The SGNHC-STEMI registry provides valuable information on the overall aspect of STEMI in Nepal. In general, the SGNHC-STEMI registry findings are consistent with other international data.

Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patients with atrial fibrillation is a challenge as loss of atrial kick (A wave), beat to beat variability and left atrium enlargement despite normal atrial pressure make usual guideline based estimation difficult and inaccurate. Hence adoption of additional echocardiography parameters are necessary which are tricky and have varied results. Hence the aim of this study was to study various aspects of diastolic function in patients with atrial fibrillation. Methods: It was a hospital based prospective cross-sectional observational study conducted at cardiology unit, National Academy of Medical Sciences, Kathmandu and Shahid Gangalal National Heart Center, Kathmandu from 1st July 2018 to 30th June 2019. Results: Total of 92 patients were studied. About one third (34.8%) had diastolic dysfunction. Ratio of E/e’(14.65 ± 2.21 Vs 7.66 ± 1.18) , E/Vp (1.57 ± 0.14 Vs 1.20 ± 0.11), isovolumetric relaxation time (53.06 ± 13.82ms Vs 89.33 ± 9.88ms) and deceleration time of pulmonary venous diastolic wave (203.09 ± 26.13ms Vs 292.25 ± 36.32ms) were significantly different in patients with diastolic dysfunction compared to patients without diastolic dysfunction with sensitivity of 90.6%, 84.4%, 81.2% and 78.1% respectively. Conclusion: Diastolic dysfunction is a common entity in patients with atrial fibrillation. Echocardiography parameters like E/e’ ratio, isovolumetric relaxation time, E/Vp ratio and deceleration time of diastolic pulmonary wave were highly sensitive in detection of diastolic dysfunction.

Background and Aims: Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure of the MVA. Methods: This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were averaged to yield the MLSI. The index was compared with mitral valve area determined by planimetry method and PHT. Results: Of the 82 study subjects, majority were females 72 (85.4%). The mean age of study patients was 37.33±11.56 years. 30.5% had mild MS by planimetry, 31.7% had moderate MS and 37.8% had severe MS. There was a very strong correlation between MLS index and MVA by planimetry ( r = 0.89, p<0.001) and MVA by PHT (r=0.95, p<0.001). MLS index less than 0.73 cm can predict severe MS with 93.2% sensitivity and 89.3% specificity. On the other hand MLS index more than 1.035cm can predict mild MS with 70% sensitivity and 89.3% specificity. Strong correlation exists between MLS index and MV severity in presence atrial fibrillation (AF) (r=0.879) for planimetry and (r=0.835) for PHT and in presence of coexisting mitral regurgitation (MR) (r=0.89) for planimetry and (r=0.86) for PHT. Conclusion: MLSI has a strong correlation with MVA by planimetry and PHT. So, it can be used as a reliable method to assess severity of mitral stenosis and is a simple and easily obtainable. It has good correlation even in presence of AF and MR.

Background: Colorectal cancer is one of the most common cancers in the world and ranks among top ten cancer in Nepal. Limited data have been reported in the literature regarding the prevalence of Kristen Rat Sarcoma viral oncogene mutation in Nepalese patients with colorectal cancer. In a low income country such as Nepal where majority of cancer patient pay for treatment out-of-pocket, it is important to ascertain Kristen Rat Sarcoma viral oncogene mutation status before starting treatment with these agents.Methods: We analysed 22 colorectal cancer specimens diagnosed histopathologically. Real Time Polymerase Chain Reaction was performed on extracted DNA using RoterGene from Qiagen. US Food and Drug Administration approved kit was used for detection of Kristen Rat Sarcoma viral oncogene mutation i.e. TheraScreen: K-RAS Mutation Kit: The K-RAS Kit detects seven Kristen Rat Sarcoma viral oncogene mutations in codons 12 and 13 of the Kristen Rat Sarcoma viral oncogene.Results: Kristen Rat Sarcoma viral oncogene mutation was observed in 13 (59%) of the samples studied. All samples had point mutation on codons 12 while 5 samples (38%) also had a point mutation on codons 13. No association was found between the presence of Kristen Rat Sarcoma viral oncogene mutation and gender or age or sidedness of the cancer. Conclusions: Kristen Rat Sarcoma viral oncogene was commonly present in colorectal cancer specimens. Further efforts towards establishment of diagnostic test, generation of new database, development and scale up of laboratory services are needed throughout the nation. Keywords: Colorectal cancer; KRAS oncogene; mutation analysis; Nepal; risk factors for CRC