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Introduction: COVID-19 has emerged as a pandemic and has varied clinical presentation. Computed Tomography scans of the chest play an important role in evaluating the lung parenchymal changes and aids in better planning the management of COVID-19 patients. The purpose of this study was to find the prevalence of abnormal chest computed tomography findings among admitted symptomatic COVID-19 patients in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from 25 October 2020 to January 2021 in a tertiary care hospital. Ethical approval was taken from the Institutional Review Committee (Registration number: 348). Convenience sampling method was used. Chest computed tomography findings of the admitted symptomatic COVID-19 patients were evaluated for abnormal findings. Point estimate and 95% Confidence Interval were calculated. Results: Among 153 patients, abnormal chest computed tomography findings were seen in 147 (96.07%) (92.99-99.15, 95% Confidence Interval). The findings of ground-glass opacities with consolidations were seen in 78 (53.06%) patients. Conclusions: The prevalence of abnormal chest findings among symptomatic COVID-19 patients in our study was similar to the studies done in other countries in similar settings. Majority of the symptomatic COVID-19 patients showed abnormal chest computed tomography scan findings in the form of ground glass opacities and consolidations.

Introduction: Traumatic spinal injury is a major source of morbidity and mortality throughout the world. The number of spinal injuries is growing annually but epidemiological and demographic features may be different in different regions. This study aims to find out the prevalence of traumatic spinal injury among patients with spinal injuries admitted to the spine unit of a tertiary care centre. Methods: This was a descriptive cross-sectional study was done on a total of 102 traumatic spinal injury patients admitted to the spine unit of a tertiary care centre from 1st June, 2019 to 31st May, 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: 077/78-09). Demographic details, mode of injury, morphology, patterns of fractures, neurological level, and management methods in the hospital were recorded. Convenience sampling was done. Data were analysed using the Statistical Package for the Social Science version 24.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 130 spinal injury patients, the prevalence of traumatic spinal injury was found to be 102 (78.46%) (71.39-85.53 at 95% Confidence Interval). The most common mode of spinal injury was due to falls in 80 (78.43%) cases. Conclusions: The prevalence of traumatic spinal injury was higher when compared to the other studies done in similar settings.

Introduction: Total joint replacement of hip and knee is considered as one of the most successful orthopedic surgeries in the twenty-first century because of the only solution to end-stage arthritis of these joints. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to describe the demographic findings of the joint replacement surgeries among total lower limb surgeries in a tertiary care hospital. Methods: This cross-sectional survey was conducted using the hospital records of 73 total joint replacement surgeries of the lower limb in the Department of Orthopedics of a tertiary care hospital from November 2016 to November 2020. Ethical approval was taken from the Institutional Review Committee (reference number: 077/78-011). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: There were 73 total joint replacement of hips and knees. Of which, 32 (43.84%) total hip replacements were done in which one (3.13%) patient had a simultaneous bilateral hip replacement in single-stage and the other one (3.13%) had two-stage bilateral hip replacement. Forty one (56.16%) total knee replacements were done in which 18 (24.65%) had a simultaneous bilateral knee replacement and five (6.85%) had a unilateral knee replacement. Conclusions: Total joint replacements of the hip were more common among the lower limb surgeries.

Herniation of bladder mucosa through the bladder wall muscle layer is known as bladder diverticulum. The incidence of bladder diverticulum is 1.7. About 0.8 to 10% of the urinary bladder diverticulum develops carcinoma. Transitional cell carcinoma is the most common. Painless hematuria is the most common clinical presentation. Different imaging modalities along with cystoscopy are the key to accurate diagnosis and staging. High grade multifocal urothelial carcinoma in the bladder diverticulum is better managed by radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Here we report a case of a 66-year old gentleman of high grade multifocal urothelial carcinoma in bladder diverticulum managed with radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Such cases have been addressed adequately in the literature, but we did not find such cases from our country.

Introduction: Primary congenital glaucoma is a rare vision-threatening condition of children. Primary congenital glaucoma though a rare disease it is the most common cause of childhood glaucoma with potency to cause blindness. This study was undertaken to find the prevalence of the children with primary congenital glaucoma under 3 years of age in a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted at a tertiary eye center in Nepal in children (≤ 3 years) presented in the outpatient department of a tertiary eye hospital between June 2017 and June 2020. The study was approved by the hospital review committee and adhered to the declaration of Helsinki. A convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated with frequency distribution. Data analysis was conducted using Statistical Package for the Social Sciences. Results: Out of total children under 3 years who presented to the outpatient department, 46 (0.31%) at 95% Confidence Interval (0.30-0.32) had primary congenital glaucoma. Among them, 30 children (65.2%) had bilateral involvement. Mean intraocular pressure was 42.40±8.15mm Hg. The mean age of initial presentation, horizontal corneal diameter, and axial length were 12.07±8.9 months, 12.95±1mm, and 23.89±1.7mm respectively. Consanguinity was observed in 12 (26%) children. Conclusions: From the study, we conclude that there was a low prevalence of primary congenital glaucoma among children under 3 years of age who presented to the outpatient department in a tertiary care hospital.

Osteochondroma usually arises from the metaphyseal region of growing bones. The occurrence of extraskeletal osteochondroma is rare with very few case reports. Para-articular osteochondroma is a type of extraskeletal osteochondroma. It frequently occurs around the knee, usually at infrapatellar Hoffa’s fat pad. It is usually intracapsular but extrasynovial and arises from the capsule and connective tissues due to osteocartilaginous metaplasia. We present a case of 19-years male with anterior knee pain for 3 years, swelling, and deformity of the knee with flexion limitation for one year. Radiography revealed ovoid, corticated lesion free from adjoining bones. Mass interpreted as benign, so planned for excision. Well circumscribed nodule excised from the medial parapatellar approach. Histology revealed cartilaginous tissues surrounded by fibrous tissues with scattered enchondral ossification. Postoperatively and subsequent follow-up resulted in pain-free joint, complete recovery of range of motion with no clinicoradiological evidence of recurrence.

Introduction: Osteoporosis and resulting fracture is a major public health concern worldwide. With increase in life expectancy, osteoporosis and fragility fracture is expected to be more prevalent. It is associated with high patient morbidity, while hip and vertebral fractures have high mortality. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to find out the prevalence of osteoporosis among postmenopausal women visiting a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted among 89 postmenopausal women attending at Orthopedic Outpatient Department of Bharatpur Hospital from 1st January 2019 to 30th December 2019 with postmenopausal status. The ethical clearance was taken from the Institutional Review Committee of Bharatpur Hospital. Convenience sampling technique was used. Bone Mineral Density was estimated with dual energy x-ray absorptiometry scan Statistical Package for Social Science was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 89 postmenopausal women, 29 (32.58%) (Confidence Interval = 32.48-32.68) women had osteoporosis. The mean age and Bone Mineral Density were 62.16±8.17 years and 0.968±0.14 g/cm² respectively. Conclusions: Prevalence of osteoporosis was high. Women with history of fragility fracture are at increased risk of another fragility fracture. It is hence necessary to have awareness programs and early screening to minimize the magnitude of morbidity and mortality associated with osteoporosis.

A 38-year male presented with severe low back pain radiating towards right lower limb which was progressively increasing with decrease in motor power of the ipsilateral ankle dorsiflexion and toe extension. Magnetic Resonance study with gadolinium suggested dorsal epidural migration of the extruded disc at L4-L5 level compressing the thecal sac, which mimics the differential diagnosis epidural abscess, epidural hematoma, synovial cyst and extradural space-occupying lesion. Open lumbar discectomy was done, and the large, herniated disc was found dorsal to the thecal sac adhering dura mater, which was removed meticulously and the patient was symptomatically better postoperatively. The power of his lower limb gradually increased by physiotherapy in subsequent follow-up.

This study was carried to identify the causes of pancytopenia and to fi nd out the bone marrow morphology in cases of pancytopenia. It was a cross sectional study conducted over a period of two years in the Department of Pathology, Tribhuvan University Teaching Hospital. Bone marrow aspiration smears of patients fulfi lling the criteria of pancytopenia were examined. The data obtained were analyzed using measures of central tendency. One hundred and forty eight cases underwent bone marrow aspiration and it constituted 15.74% of total cases. Mean age was 30 years (range, 1-79 years). 42 cases were children (28.37%). Male: female ratio was 1.5:1. The commonest cause was hypoplastic bone marrow seen in 43 cases (29%) followed by megaloblastic anemia in 35 cases (23.64%), and hematological malignancy in 32 cases (21.62%). Erythroid hyperplasia was seen in 29 cases (19.6%) and normal bone marrow was seen in 5 cases (3.38%). There was one case each of Niemann-Pick disease and metastatic neuroblastoma in children and chronic pure red cell aplasia and leishmaniasis in adults. Acute leukemia was the commonest hematological malignancy. In children, commonest fi nding was hypoplastic bone marrow (38.1%) while in adults megaloblastic anemia (30.18%) was commonest fi nding followed by hypoplastic anemia (25.47%). In present study bone marrow examination was able to establish diagnosis in 77% of cases. Hypoplastic marrow was the commonest diagnosis, followed by megaloblastic anemia, and hematological malignancies. Key Words: Bone marrow aspiration, hypoplastic anemia, leukemia, megaloblastic anemia, pancytopenia

Introduction: The measurement of brain volume is an important aspect of the assessment of brain structure and function. However, limited data is available on brain volumetry in the Nepalese population. The study aimed to find the mean intracranial volume of the brain among patients with normal magnetic resonance imaging referred to the Department of Radiology and Imaging of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with normal magnetic resonance imaging referred to the Department of Radiology and Imaging in a tertiary care centre. All magnetic resonance imaging of the brain during the study period was reviewed by a radiologist. Magnetic resonance imaging with abnormal findings, clinical signs of neurological deficit, dementia and psychiatric symptoms were excluded from the study. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 285 Magnetic Resonance Imaging datasets, the mean intracranial volume was 1286.30±129.88 cc (1271.22-1301.38, 95% of Confidence Interval). The mean cerebral volume was 985.06±106.4 cc, cerebellar volume was 126.99±13.05 cc and brain stem volume was 19.97±2.54 cc. Conclusions: The mean intracranial volume of the brain among patients with normal magnetic resonance imaging was found to be lower than other studies done in similar settings.

Crossed testicular ectopia also known as transverse testicular ectopia is a rare anomaly of the testis which is ectopically located in contralateral hemiscrotum with absent testis in the ipsilateral hemiscrotum. Most case are incidentally discovered intraopeartively during operation of inguinal hernia and few case reports are available which have reported preoperative diagnosis of crossed testicular ectopia. We report a case of crossed testicular ectopia in 12 year old boy who presented with right undescended testis diagnosed preoperative on Ultrasound and Magnetic Resonance Imaging as crossed testicular ectopia. Keywords: crossed ectopia; MRI; testis; ultrasonography.

A substantial proportion of women with gonococcal infection are asymptomatic but symptomatic in male. Thus in developing countries, problem arises in active case detection where laboratory facilities for testing are limited. During the study, the diagnostic validity of the hierarchial clinical algorithm as well as that of a non-hierarchial scoring system were assessed among 102 patient visiting at Dermatology/ Venerology (DV) and Gynecology(Gynae) out patient department(OPD) of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. In the study period of 8 months, May –December 1999, 9 (8.82%) were infected with N. gonorrhoea& 2(1.96%) with Gram Negative intracellular diplococci. Age group of 20-30 years were found to be more infected followed by age groups 30-40 years & 40-50 years ( P< 0.10). The male were found to be predominantly infected than female and married were found to be more infected than unmarried. Among the infected people most of them had secondary level education and least of them had higher level education. Service holders were found to be more infected than farmers, drivers & others. But male service holders & housewives were equally infected. Antimicrobial susceptibility of N. gonorrhoeashowed 100% susceptible to Ceftriaxone, followed by Ciprofloxacin (88.88%) whereas 22.22% resistant to Tetracycline, 55.55% to Cotrimoxazole and 55.55% to Penicillin. Among isolates, 33.33% were ß- lactamase producer. Co-micro organisms like Candida sppand Staphylococcus sppwere also observed. Key Words: Gonococcal infection; Outpatient department, Antimicrobial susceptibility, Nepal.