Penetrating Chest trauma with right atrium rupture - A case report.

Background: Penetrating chest trauma can have lethal consequences. Anterior chest wall penetrating injury can cause fatal lacerations over the chest wall, lungs, pericardium, and the heart. There are few reports on these kinds of injuries and operative management. Purpose: To describe a case of penetrating chest trauma with right atrium ruptured, after a fall from height. The patient was successfully managed with prompt resuscitation and definitive surgical intervention. Case presentation: A 48-years-old gentleman presented with history of fall from height and right sided penetrating chest injury. The patient had a penetrating injury to the right-fourth intercostal space in parasternal region. Chest X-ray showed massive right-sided hemothorax and chest tube drained more than 1700 ml upon insertion. Emergency right thoracotomy was performed, after initial resuscitation with fluids and blood transfusion in the emergency department. He had injury to the intercostal arteries, lacerations of the pericardium and the right atrium ruptured, which was managed successfully with definitive repair. Conclusion: Survival is rare after penetrating chest trauma with right atrium ruptured if not intervened on time. Prompt diagnosis and resuscitation, along with the definitive surgical repair were the key elements for successful management of the patients.

Correlation of Duplex Ultrasonographic Parameters with Glomerular Filtration Rate in Chronic Kidney Disease.

BACKGROUND: Chronic kidney disease encompasses a spectrum of different pathophysiological processes associated with abnormal renal function and a progressive decline in glomerular filtration rate. Duplex ultrasonography is widely available and important imaging investigation required in the work?up of chronic kidney disease. The objective of the study was to assess correlation of renal duplex ultrasonographic parameters with decreased glomerular filtration rate in patients with chronic kidney disease. METHODS: This was a crosssectional hospital-based study. A total of sixty-two patients with chronic kidney disease referred for ultrasonography were included in the study. Patients were evaluated by duplex ultrasonography. Correlation of renal length, parenchymal thickness, cortical thickness, cortical echogenicity, peak systolic velocity, end diastolic velocity pulsatility index and resistive index with glomerular filtration rate was evaluated by using Pearson's correlation coefficient. RESULTS: Chronic kidney disease was seen more prevalent in 41-50 years of age group. The major risk factors associated with Chronic kidney disease was Hypertension and Diabetes Mellitus. A significant positive correlation of renal length, parenchymal thickness, cortical thickness (p value < 0.01) and end diastolic velocity (p value < 0.05) with eGFR and significant negative correlation of cortical echogenicity, resistive index and pulsatility index (p value < 0.01) with eGFR was derived. CONCLUSIONS: Duplex sonographic findings of renal length, parenchymal thickness, cortical thickness, cortical echogenicity, end diastolic velocity, pulsatility index and resistive index are found to be useful parameters in evaluation of chronic kidney disease.

Clinical Patterns and Computed Tomography Findings in Patients with Cranio-Cerebral Trauma in Tertiary Hospital in Eastern Nepal.

BACKGROUND: Head injury is a common problem encountered in emergency department. Among various neurological diseases, cranio-cerebral trauma ranks high in order of frequency and gravity. In acute setting, computed tomography is modality of choice because of its high accuracy in detecting intracranial lesions. The study was done to analyze computed tomography findings in cerebral trauma in regards to sociodemographic characteristics and find out associations of Computed tomography findings with mechanism of injury and clinical manifestations. METHODS: The study was carried in Department of Radiology, BPKIHS, over a period of one year from Aug. 2015 to Aug. 2016. 450 patients were included in our study and findings noted on structured pro forma. Analysis was done using SPSS version 20 applying simple descriptive statistical methods. RESULTS: Among 450 patients, 220 patients (48.9%) had various cranio-cerebral injuries. Most were in age group of 20-29 years (49.5%) and most common mode was road traffic accident (44.6%).Most patients presented with altered sensorium (39.2%) and Glasgow Coma Scale score of ?13 (70.9%). Scalp lesion was the most common finding (24%) followed by bone fractures (19.8 %). Patients with road traffic accident (59.7%) and fall from height (46.7%) had more positive computed tomography findings than from physical assault (28.2%). Glasgow Coma Scale showed significant statistical association with computed tomography findings (p<0.001). CONCLUSIONS: Road traffic accident is the most common mode of head injury in young adults patients presenting in our hospital. Glasgow Coma Scale can be considered as an important clinical marker for predicting positive computed tomography findings. Also computed tomography is an important initial investigation to evaluate the various craniocerebral injury in trauma patients.

Prevalence of Dangerous Ethmoid in a Tertiary Center in Eastern Nepal.

INTRODUCTION: Endoscopic sinus surgery is a well-known approach for sino-nasal pathologies. Due to close proximity to the brain and orbit, the surgeon should be aware of the sino-nasal anatomy and its associated variations. Detailed preoperative assessment of the sinus computed tomography scans reduces the frequency of severe complications in patients undergoing an endoscopic sinus surgery. So, the aim of this study is to find the prevalence of dangerous ethmoid in a tertiary center in eastern Nepal. METHODS: A descriptive cross-sectional study was performed in a Computed tomography scan of 50 patients with chronic sinusitis undergoing endoscopic sinus surgery from February 2018 to August 2018 in the department of Otolaryngology and Radiology of BP Koirala institute of health sciences after taking ethical approval from Institutional Review Committee of the institute. Measurements are taken in the coronal plane. The depth of the lateral lamella of the cribriform plate was defined according to the Keros classification which defines the dangerous ethmoid. and side. Data entered in MS excel. Statistical analysis was performed in SPSS version 11.5. RESULTS: Keros type I, II, and III were noted in 17 (17%), 54 (54%) and 29 (29%) of cases respectively. The mean width of the olfactory fossa, medial orbital wall distance and distance from medial nasal concha were 3.57mm, 8.77mm & 17.78mm respectively. CONCLUSIONS: The most common type of dangerous ethmoid was keros type II. CONCLUSIONS: The most common type of dangerous ethmoid was keros type II.

Pattern of glomerular disease and clinicopathological correlation: A single-center study from Eastern Nepal.

The pattern of glomerular disease varies worldwide. In the absence of kidney disease/kidney biopsy registry in Nepal, the exact etiology of different forms of glomerular disease is primarily unknown in our country. We analyzed 175 cases of renal biopsies performed from September 2014 to August 2016 in Internal Medicine Ward at B.P. Koirala Institute of Health Sciences. The most common indication for renal biopsy was nephrotic syndrome (34.9%), followed by systemic lupus erythematosus (SLE) with suspected renal involvement (22.3%). Majority of patients were in the 30-60 years' bracket (57.2%), with the mean age of the patients being 35.37 years. The average number of glomeruli per core was 13, with inadequate sampling in 5.1%. Immunoglobulin A (IgA) nephropathy (17%) was found to be the most common primary glomerular disease, followed by membranous nephropathy (14.6%) and focal segmental glomerulosclerosis (14.6%). The most common secondary glomerular disease was lupus nephritis (LN). Complications associated with renal biopsy were pain at biopsy site in 18% of cases, hematuria in 6%, and perinephric hematoma in 4% cases. Although the most common primary glomerular disease was IgA nephropathy, significantly higher population of SLE with LN among Nepalese in comparison with other developing countries warrants further evaluation. As an initial attempt toward documentation of glomerular diseases in the national context, this study should serve as a stepping stone toward the eventual establishment of a full-fledged national registry of glomerular diseases in Nepal.