Characterizing hepatitis B virus infection in children in the Democratic Republic of Congo to inform elimination efforts.

Objective: Despite global reductions in hepatitis B virus (HBV) prevalence, an estimated 6.2 million children are infected, two-thirds of whom live in the WHO Africa region. We sought to characterize childhood HBV to inform elimination efforts in the Democratic Republic of Congo (DRC), one of the largest and most populous African countries.

Postoperative Complications of Transsphenoidal Pituitary Adenectomy: A Single Institution Based Experience.

Background Inside a cranium, pituitary gland seats in an area of complex anatomical construct. Further it holds a very important physiological role to maintain all bodily function. Pituitary adenoma being one of the commonest tumors of that intricate area is preferably tackled with transsphenoidal approach.

Cheiro-Oral Syndrome.

Cheiro-Oral Syndrome (COS) is a very rare neurological syndrome associated with varied etiology. We report a 53-year-old man presented with left sided perioral and ipsilateral hand/fingers burning sensation for a one-month duration. On examination, he had hypesthesia over left perioral and distal palmar aspect of all five fingers.

Transcranial doppler ultrasonography cerebral blood flow dynamics study of neurosurgical patients in peri-agonal period with fixed dilated or non-reacting pupils.

Introduction: Fixed dilated and unreactive pupils are a harbinger of imminent death in neurosurgical patients, signifying that the brainstem is not functioning. Transcranial Doppler (TCD) ultrasonography is a noninvasive, bedside method of determining the flow velocities in the basal cerebral arteries, used extensively in various neurosurgical conditions.

Aims And Objectives: To study the cerebral blood flow dynamics of neurosurgical patients in peri-agonal period with fixed dilated or non reacting pupils using TCD.

Contributing Factors for Coagulopathy in Traumatic Brain Injury.

Context: In traumatic brain injury patients, coagulation disorder causes secondary brain injury, thereby increasing mortality and morbidity.

Aims: The aim of this study is to identify the factors responsible for coagulopathy in traumatic brain injury.

Settings And Design: This prospective longitudinal study from June 2012 included 100 patients with moderate and severe head injury presenting to National Institute of Neurological and Allied Sciences, Kathmandu, over 1-year period.

Renal impairment in stroke patients: A comparison between the haemorrhagic and ischemic variants.

Renal impairment is regularly seen in hospitalized stroke patients, affecting the outcome of patients, as well as causing difficulties in their management. A prospective cohort study was conducted to assess the trend of renal function in hospitalized ischemic and haemorrhagic stroke patients. The incidence of renal impairment in these subgroups, the contributing factors and the need for renal replacement in renal impaired patients was evaluated.

Isolation of Multidrug Resistant Bacteria from Patients Medical Charts.

Background: Patient's medical charts in hospitals are potentially contaminated by pathogenic bacteria and might act as vehicles for transmission of bacterial infections.This study was aimed to determine the rate of contamination of medical charts by multidrug resistant bacteria.

Methods: Sampling of total 250 patient's medical charts from different wards was done with the help of cotton swabs soaked in sterile normal saline.

Excision of an anterior intradural arachnoid cyst of the cervical spine through central corpectomy approach.

Anterior cervical intradural arachnoid cyst is a rare entity which has been mostly approached posteriorly, commonly resulting in incomplete resection. Incomplete resection is associated with recurrence; hence, we describe the anterior central corpectomy approach with complete neurologic recovery in a twenty year old with an anterior cervical intradural arachnoid cyst in front of the third and fourth cervical vertebra, who had presented with spastic quadriparesis.

Cerebral Venous Sinus Thrombosis during Everest Expedition: A Case Report and Review of the Literature.

Cerebral venous sinus thrombosis (CVST) is a rare but serious disorder that is associated with a poor clinical outcome. We report a 35-year-old man who had a severe headache and diplopia while climbing Mount Everest. His MR venography showed right transverse and right sigmoid sinus thrombosis.

Chorea-acanthocytosis: a case report.

Neuroacanthocytosis is a group of rare disorders. We report a 36-year-old right-handed female who presented with gradually progressive abnormal facial movements, generalized weakness, and lower-lip biting starting 4 years ago. On examination, she had lower-lip ulcer, orofacial dyskinesias, and peripheral neuropathy.

Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal.

Background: Stroke is the major cause of morbidity and mortality worldwide. The number of stroke patients receiving recombinant tissue plasminogen activator (rt-PA), also known as Alteplase, in the developing world is extremely low. We aim to study the feasibility and efficacy of thrombolysis for the 1(st) time in our country.

Nosocomial Isolates and Their Drug Resistant Pattern in ICU Patients at National Institute of Neurological and Allied Sciences, Nepal.

Multidrug resistant organisms are increasing day by day and the cause is poorly known. This study was carried out from June 2011 to May 2012 at National Institute of Neurological and Allied Sciences Kathmandu, Nepal, with a view to determining drug resistant pathogens along with detection of extended spectrum β-lactamase (ESBL), AmpC β-lactamase (ABL), and metallo-β-lactamase (MBL) producing bacteria causing infection to ICU patients. A standard methodology was used to achieve these objectives as per recommendation of American Society for Microbiology.

β -Lactamase-Producing Multidrug-Resistant Bacterial Pathogens from Tracheal Aspirates of Intensive Care Unit Patients at National Institute of Neurological and Allied Sciences, Nepal.

The widespread use of tracheal intubation and mechanical ventilation to support the critically ill patients increases the risk of development of tracheobronchitis and bronchopneumonia. This cross-sectional study was conducted with an aim to isolate and identify bacterial pathogens from tracheal aspirates producing extended-spectrum β -lactamase (ESBL), AmpC β -lactamase, and metallo- β -lactamase (MBL) from August 2011 to April 2012 at National Institute of Neurological and Allied Sciences (NINAS), Kathmandu, Nepal. ESBL was detected by combined disk assay using cefotaxime and cefotaxime with clavulanate, AmpC β -lactamase by inhibitor-based method using cefoxitin and phenylboronic acid, and MBL by Imipenem-EDTA combined disk method.

Outcome of head injury patients undergoing surgical management: a tertiary level experience.

Background: Head injury is the major cause of death in a neurosurgical patient.

Objective: To find the outcome, and treatment modality affecting the outcome in patients with head injury.

Methods: Nine hundred eighty seven patients presenting to National Institute of Neurological and Allied Sciences, Kathmandu, with head injury from September 2009 to October 2010 were included in the study.

Hyponatremia in patients with traumatic brain injury: etiology, incidence, and severity correlation.

Background: Hyponatremia is common in patients with traumatic brain injury (TBI). This study aims at ascertaining the incidence of hyponatremia in TBI with its etiologic diagnosis, biochemical confirmation, and severity correlation with initial Glasgow Coma Scale (GCS) score and computed tomography (CT) abnormality.

Methods: All patients more than 20 years old with severe and moderate TBI and the mild ones with CT abnormality were included.

Hearing preservation in 2.7 cm vestibular schwannoma.

Hearing preservation is exceedingly difficult in vestibular schwannoma surgery, especially with increasing tumor size. We herein report a case of hearing preservation in a 2.7 cm vestibular schwannoma, where the patient maintained her pre-operative hearing threshold of 55 dB till a year after surgery.

Traumatic brain injury in children.

This article provides a clinical overview of traumatic brain injury in children. It concentrates on the current management guidelines from initial assessment in the accident and emergency department through to specialist critical care.

Predictors of unfavourable seizure outcome in patients with epilepsy in Nepal.

Background: Despite optimal medical therapy, a sizeable number of patients continue to have persistent seizures. We evaluated the association of pretreatment and treatment variables with unfavorable seizure outcome.

Methods: Patients with follow-up over 12 years in the Nepal Epilepsy Association were evaluated.

Minimally invasive open lumbar discectomy: An alternative to microlumbar discectomy.

Background: Lumbar disc surgery has come a long way since its fi rst description by Dandy in 1929. Evolving through the transdural approach and a laminectomy for the removal of a disc, it now surpasses the primal technique with essentially a minimally invasive procedure, an extradural approach without laminectomy.

Objective: The objective of this study is to ascertain the effectiveness of Minimally Invasive Open Lumbar Discectomy in the treatment of lumbar disc prolapse.

Superior sagittal sinus thrombosis presenting as a continuous headache: a case report and review of the literature.

Cerebral venous sinus thrombosis is a rare but dangerous condition, occurring with an incidence of 3-4 cases/million/year. Cerebral venous sinus thrombosis presents a diagnostic challenge due to its varied presentation patterns. We report a case of a 42 year old Nepali man diagnosed with cerebral venous sinus thrombosis after presenting with a week long history of continuous headache.

Single burr hole drainage for chronic subdural haematoma.

Chronic subdural haematoma is a common neurosurgical condition and surprisingly surgical treatment ranges from twist drill craniostomy to more radical membranectomy. However, the outcome is generally favourable with appropriate therapy. This retrospective study is aimed at analyzing the result of single burr hole drainage of such haematoma under local anaesthesia over a period of fifteen years.

Role of repeat CT scan head in initially inoperable cases of traumatic head injury.

The CT scan has become popular in cases of head injury. In this study 71 cases (M:48; 68.0% and F:23; 32.

Result of surgery for ruptured intracranial aneurysms in Nepal.

Although aneurysmal subarachnoid haemorrhage appears to be fairly common in the developing countries, the data on the results of management appear to be relatively sparse. This is a retrospective study of 40 patients with 44 intracranial aneurysms operated upon at the National Neurosurgical Referral Centre in Kathmandu, Nepal from 1991 to 1999. The female male ratio was 1.

The management of brain abscess in a developing country: are the results any different?

A retrospective study of 57 surgically-managed brain abscesses at the Neurosurgical Unit, Bir Hospital during a 6-year period from October 1990 is presented. Detailed hospital case notes could be traced in only 37 cases, consisting of 25 males and 12 females with age range from 5 months to 60 years. Cryptogenic abscess was the commonest category followed by abscess caused by chronic ear infection.