Introduction Total calcium (TC) and albumin-corrected calcium (ACC) are easily accessible AP severity tests in the Primary Health Care Center of Nepal. The aim of the study was to evaluate TC and ACC as prognostic severity markers in acute pancreatitis (AP). Methods All patients admitted in Tribhuvan University Teaching Hospital with the diagnosis of AP were studied prospectively over a period of one year from January 2015 to January 2016. TC and ACC were measured in the first 24 hours of admission in each patient. The modified Marshall score was determined at admission and at 48 hours and at any point of time during admission as per the need of the patient. Severity of acute pancreatitis was defined as per the Revised Atlanta Classification 2012. Results 80 patients of AP were included in the study. Among them, 14% were categorized as having severe AP. The mean total calcium was 8.22, 7.51, and 6.98 for mild, moderate, and severe AP, respectively, which was significant at 0.001. Conclusion TC and ACC, measured within the first 24 hours, are useful severity predictors in acute pancreatitis.
Juvenile variant ossifying fibroma of sinonasal region is an extremely rare benign fibro-osseous lesion which is locally aggressive. A 21-year-old male presented with significant proptosis of right eye with stony-hard lump in the middle upper aspect of the right orbit and base of the nose. CT scan of head revealed a non-enhancing expansile lesion in right ethmoidal cells consistent with chronic ethmoidal mucocele. However Magnetic Resonance Imaging of brain revealed enhancing lesion in right ethmoid and frontal sinus extending up to anterior cranial fossa. He underwent right frontal craniotomy with surgical excision of tumor wherein cystic brown tumor of frontal and ethmoidal sinus was found. The procedure was supplemented with endoscopic transnasal approach. Histopathology report suggested an ossifying fibroma. This case highlights the importance of clinical, imaging and histopathological features of ossifying fibroma occurring in the sinonasal tract for better diagnosis and treatment through a multidisciplinary approach.
Introduction Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. It results in a dramatic improvement in patient survival and neurological function but is associated with several complications requiring multiple shunt revisions throughout a patient’s lifetime. The main aim of the study was to evaluate the outcome especially complications of shunt surgery at our center. MethodsA single-institutional, retrospective observational study was conducted in 60 operated cases of congenital hydrocephalus with a minimum follow-up for up to 6 months. Parameters for analysis included demographic data, etiology of hydrocephalus, surgery time, and type of complications. ResultsOut of 86 patients, 60 patients who fulfilled the inclusion criteria were enrolled in the study. The mean age of the patients at the time of VP shunt placement was 3 months, range from 8 days to 15 years with male preponderance. The majority of the patients belonged to the 0-1-year age group (76.8%). The commonest etiology of hydrocephalus was congenital aqueduct stenosis. Fifteen patients (25%) developed complications within six months follow-up period. Eight patients (13.3%) developed clinical shunt infection with four cases having culture positive. Four (6.67%) had mechanical complications in the form of shunt obstruction. Three patients had ascites, subdural collection, and shunt extrusion from the anus. The shunt related mortality was 1.67%. ConclusionThe shunt infection and obstruction still remain the most important complications. Despite inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available.
Neurenteric cysts account for 0.7-1.3% of spinal axis tumors. These uncommon lesions results from the inappropriate partitioning of the embryonic notochordal plate and presumptive endoderm during the third week of human development. Heterotopic nests of epithelium reminiscent of gastrointestinal and respiratory tissue lead to eventual formation of compressive cystic lesions of the pediatric and adult spine. We report a 40-year-old male presenting with slow-progressive myelopathic manifestation and ovoid non-enhancing cysticintradural extramedullary lesion at C7 level on MRI, mimicking intraspinal arachnoid cyst, who underwent successful surgical excision. The histopathological examination prove it to be neurenteric cyst.
Introduction: Glasgow Coma Scale (GCS) and the pupillary response are the key indicators of the severity of traumatic brain injury (TBI). Glasgow coma scale- Pupil reactivity (GCS-P) score is a tool to incorporate pupil reactivity and GCS into a simple single index. The main aim of this study was to compare GCS and GCS- P scores in predicting mortality in TBI patients in our institution. Materials and Methods: All patients admitted to Tribhuvan University Teaching Hospital (TUTH) with moderate to severe head injury from May 2018 to April 2019 were included in the study. Both GCS and GCS- P scores were recorded separately at admission. Outcome was measured with Glasgow Outcome Scale (GOS) at the time of discharge and in three months. Diagnostic accuracy of both these scoring systems were calculated using receiver-operating characteristics (ROC) curve, and correlation between them was estimated by using Pearson correlation coefficient. Results: Out of 136 patients enrolled, 98 patients had favorable outcome, 38 patients had unfavorable outcome at discharge. The Pearson correlation coefficient between GCS and GOS at discharge was 0.721 and GCS-P and GOS was 0.740 showing a good correlation between the GCS and GOS and GCS-P and GOS. The areas under ROC curve for GCS for prediction of mortality was 0.856 (95% CI; p<0.001) and for GCS-P is 0.871(95%CI;p<0.001) suggesting good discriminatory ability of both models. However, on statistical analysis, the discriminatory ability of GCS-P was not superior to GCS for mortality. Conclusion: GCS-P is as good as but not superior to GCS in predicting mortality in traumatic brain injury patients.
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