Object:The incidence of hydrocephalus requiring shunts in children with myelomeningocele (MMC) is reported to be very high. Shunt-related complications are a significant cause of morbidity and mortality in this population. In order to minimize shunt placements, we used very rigid clinical selection criteria and followed them in all patients who had myelomeningocele and enlarged ventricles. The follow-up outcome of this retrospective study is reported.Methods:From 2000 to 2007, 23 patients with myelomeningocele and variable degree of hydrocephalus were treated at our institute with primary surgical closure of their myelomeningoceles without a CSF diversion procedure. Patients with severe hydrocephalus who required immediate shunt insertion, and those with no significant associated hydrocephalus were not included in this study. Data regarding the surgical results and complications, postoperative management, and the outcome at follow-up were obtained from their hospital records.Results:Initially increased size of the ventricular system was found to have decreased or stabilized in 17 (81%) patients postoperatively. However, ventriculomegaly continued to progress further in 4 (19%) out of 21 patients. Of 11 patients who presented with enlarged head, eight (73%) patients showed reduction or stabilization in their head circumference. Three (27%) children continued to have progressive head enlargement in the postoperative period and required shunt placement. Signs of raised intracranial pressure observed in six patients on admission, improved in two (33%) and persisted or worsened in four (67%) patients who eventually improved after the insertion of a shunt. Eight (35%) patients experienced wound-related complications following closure of the MMC, including CSF leak in four, wound infection in three, wound breakdown in three, and pseudomeningocele in two patients. Shunt placement was required in the postoperative period in 13 (56.5%) patients to treat raised intracranial pressure in 11 and CSF leak from the wound in two patients.Conclusions:Our experience suggests that the placement of shunts can be reduced by adopting a policy with strict clinical and radiographic criteria. Shunt insertion should be reserved for only those patients who have severe hydrocephalus with clinical features of elevated intracranial pressure. Mild to moderate ventricular dilatation, persistent ventriculomagaly, and some increase in ventricular size after myelomeningocele repair can be treated successfully without a shunt.

Hypertension is a common disease of the present world. Patient characteristics and use of anti-hypertensive agents directly affect the development and control of hypertension respectively. So, the objective of this study was to determine the patient demographics and drug prescription pattern among hypertensive patients of Pokhara valley. A community based descriptive cross-sectional study was conducted in different places of Pokhara valley. Performa was used for the collection of data and analysis was done using MS-excel and SPSS (version 17.0). The study showed that majority of the hypertensive patients were males of Brahmin and Newar community with susceptible age group of 60-69 years. Majority of the patients were non-vegeterian, non-alcoholic and non-smoker. The anti-hypertensive prescription pattern revealed that 80% of the patients were on monotherapy and calcium channel blockers were the mostly prescribed medication. Prescription of anti-hypertensive agents along with other medications for concomitant diseases was also observed. The prescription pattern was found to be rational and should be regularly monitored.

No abstract