Introduction: Rupture of intracranial aneurysm is a catastrophic event with a mortality rate of 25% to 50%. Despite recent advances in endovascular techniques, microsurgical clipping is the standard modality of treatment due to its relative low cost and feasibility. We prospectively analyzed the cases of microsurgically clipped aneurysms with an aim to evaluate the overall outcome and the pretreatment variables predicting outcomes. Materials and methods: This is the prospective study of 15 consecutive microsurgical clippings of ruptured intracranial aneurysms conducted in the Department of Neurosurgery at College of Medical Sciences Teaching Hospital, Chitwan, Nepal from April 2018 to March 2020. Patients were followed up for at least three months and assessed according to modified Rankin Scale (mRS). Results: The mean age of patients was 55.47 years with female predominance. The most common location of aneurysms was Middle cerebral artery bifurcation (53%). Favorable outcome (mRS score 1 to 3) was achieved in 60% of patients whereas 40% had unfavorable outcome (mRS score 4 to 6). Poor Hunt and Hess at presentation and presence of vasospasm/infarction were associated with poor outcome. Overall mortality rate was 27%. Three patients required VP shunt whereas three patients each had vasospasm/Delayed ischemic neurological deficit (DIND) and intra-operative rupture. Conclusion: Microsurgical clipping of aneurysms is a standard treatment modality with good results despite recent advances in endovascular techniques. Favorable outcome can be achieved in patients with good Hunt and Hess grade at presentation and without clinical vasospasm/DIND.

Introduction: Intracerebral hemorrhage (ICH) is a potentially devastating neurologic emergency with long-term functional independence achieved in only limited patients with good prognostic factors. The objective of this study is toidentify the predictors of functional outcome in terms of modified Rankin Scale (mRS) following craniotomy and evacuation of spontaneous supratentorial ICH.   Methodology: It is a prospective study of forty patients conducted at the College of Medical Sciences (CMS) from May 2019 to April 2020 with three months follow-up. Patients of spontaneous supratentorial ICH with features of raised ICP and deteriorating GCS underwent surgical evacuation. The various predictors of outcome like Glasgow Coma Score (GCS) and pupillary inequality at presentation, age, location of hematoma, clot volume, comorbidities, intra-ventricular extension and involvement of dominant hemisphere were documented and compared with outcome in terms of modified Rankin Scale (mRS).   Results: The mortality rate at three months was 25% (32% in deep seated and 13.3% in lobar ICH) and higher in patients with poor GCS and pupillary inequality at presentation, volume >100 ml, intra-ventricular extension and patients undergoing decompressive craniectomy. Twenty patients (50%) had a favorable outcome (mRS 1-3) at follow-up, while 20 (50%) had a poor outcome (mRS 4-6). Unfavorable outcome was significantly higher among deep seated hematoma, age>70 years, poor GCS and pupillary inequality at presentation, clot volume >100ml, pre-existing co-morbidity, patients undergoing decompressive craniectomy and involvement of dominant hemisphere.   Conclusion: Surgical evacuation of spontaneous supratentorial ICH is associated with high mortality in patients with poor GCS and pupillary inequality at presentation, and large clot volume with intraventricular extension. However, young patients with good pre-morbid status, moderate volume of hematoma, not involving dominant hemisphere and moderate to good GCS have good functional outcome.

Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. There is increasing burden of these diseases especially when it comes to a developing country like Nepal. The survey was done to determine the prevalence of Rheumatic heart disease and its burden. Methods: A Community based cross sectional study was done as a part of a demographic survey conducted among the residents of Mathagadi VDC of Palpa district. Cardiac auscultation and transthoracic echocardiography were performed. Abnormal findings on auscultation (murmurs, abnormal heart sounds) were further evaluated with the help of screening echocardiography by Cardiologist. Results: Out of total 2795 people screened, 37 individuals were found to have RHD, confirmed with a 2D echocardiographic findings. Mitral regurgitation was found to be the predominant lesion with 13 cases. Conclusion: The study revealed a large of proportion of cardiovascular diseases in Mathagadi VDC. It became clear that due to lack of proper health services, a large of number of cases may be either undiagnosed or under treated.