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Introduction Any injury or ailment where investigations by the law-enforcing agencies are crucial are considered as medico-legal cases. The objective of this study was to describe the profile of medicolegal cases presenting to the Emergency Room (ER) of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods A retrospective review of medical records was done to include all medico-legal cases presented from July 2018 to June 2019. Results Medico-legal cases comprised 1805 (3.8%) of all cases (47,289) in the study period. The category of 25- 39 years was the commonest age group involved [659 (36.5%)] followed by 15-24 years group [582 (32.2%)]. Males were almost twice (65.8%) in number compared to females (34.2%). The top three reasons for the ER visit were road traffic accidents (RTAs) [757(41.94%)], physical assaults [356 (19.72%)] and poisoning [239 (13.24%)]. Other causes were burns, falls, sexual assaults, hanging, injuries (gunshot, electrical and machinery) and drug overdose. Conclusion There are significant numbers and wide varieties of medico-legal cases that present in the ER of TUTH. Young males are the most high-risk population and RTAs are the commonest etiology. This study will help the hospital in capacity strengthening of the ER, based on the volume of individual case types. [ABSTRACT FROM AUTHOR]

Introduction Scholarly journals publish various types of manuscripts. The objective of this study was to analyze the types of articles published in the Journal of Institute of Nepal (JIOM Nepal) from 2019 April to 2021 April and describe bibliometric characteristics. Methods Seven issues of JIOM Nepal published from April 2019 to April 2021 were analyzed for types of study, areas of medical science, the number of authors, gender of the primary author, contributing specialty, and author’s affiliation. Results Total articles published were 139, with a mean number of 19.8±4.4 articles per issue. More than half of the published articles were cross-sectional studies (93, 66.9%), followed by case reports (25, 17.9%). The majority of primary authors (94, 67.6%) were faculty from constituent campuses of the Institute of Medicine (IOM) Tribhuvan University. Thirty-eight (27.3%) contributing authors were females. Fifty-three (38.1%) articles published were diagnosis)related. Authors from surgical specialties were the most common article contributors [67 (48.2 %)], while basic science specialties contributed 13 (9.4%) publications. Conclusion Cross-sectional studies were the most commonly published articles and surgical specialties published more than half of the articles. The majority of the articles were related to diagnosis. Greater efforts are needed to produce further progress of the journal. A mixture of original articles, reviews, and case reports from different medical domains will be more interesting to the readers. [ABSTRACT FROM AUTHOR]

Introduction Spine pathology involves a wide spectrum of diseases and needs a multidisciplinary approach including surgery, rehabilitation and psychological support. It increases the burden to the family and society. This study describes diseases related to spine and spinal cord from a neurosurgical department of a tertiary hospital in Nepal. Methods This is a retrospective study of all spinal cases admitted between April 2019 to February 2019, in the Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All adult patients of ≥16 years, diagnosed with various spinal diseases were included. Based on the spectrum of causative pathologies, the study population was broadly categorized into trauma, degenerative, tumor, vascular and infection. Demographics, other variables, and outcome at 1 month were assessed. Results A total of 71 patients were included in this study. Male preponderance was observed in all categories. Twenty three patients (32.4%) had traumatic spine injury and fall from height was the most common mode of injury, accounting for two-third of the total spinal trauma patients. Cervical segment was involved in two-third patients. More than one-third of the spinal patients (36.6%) had a degenerative disorder involving lumbar (57.7%) and cervical regions (42.3%). Spinal infection was diagnosed in 11.2% of the patients with 62.5% diagnosed as Pott's spine. Overall complications were seen in 20%. Pain improved in all patients while overall good outcome was noted in 63.2% of the patients. Conclusion Our study demonstrated a large patient burden and a clinical profile dominated by preventable causes such as RTA and fall injury. With early treatment and rehabilitation, significant improvement can be achieved. Further large scale multicenter studies are required to generalize the findings of this study to the whole population of Nepal. [ABSTRACT FROM AUTHOR]

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. Methods A 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. Results Out 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%. Conclusion The 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. [ABSTRACT FROM AUTHOR]

Introduction Lipomeningomyelocele (LMM) is a common neural tube defect especially prevalent in low income countries. When they get appropriate care, long term result is generally good provided the patient receives good neurosurgical, paediatric and rehabilitation care. Surgery is the mainstay of treatment. Our aim was to analyze immediate and long-term results of lipomeningomyelocele repair in symptomatic patients presenting to TU Teaching Hospital, Kathmandu, Nepal. Methods Thirteen patients admitted to Department of Neurosurgery from January 2017 to December 2018 were evaluated. All patients underwent MRI of whole spine before surgery. Surgical procedures involved total excision of lipoma and repair in 10 patients and subtotal excision and repair in 3 patients. Division of filum terminale could be done in 8 patients. Follow up varied from 6 months to 2 years. Results This study included 8(61.5 %) patients of lumbosacral LMM, 3(23%) patients of sacral LMM and 2(15.38%) patients of thoracolumbar LMM. About 2 (15.38%) were operated before 3 months of age, 2 (15.38%) were operated between 3-6 months of age, 5 (38.46%) were operated between 6-12 months of age and 4 (30.7%) were operated after 1 year. All children except one presented with lump on back since birth and four presented with urinary incontinence, one presented with bilateral club foot. Four (30.7%) patients had weakness of one or both lower limbs. Two (15.38%) patients had improvement in urinary incontinence, two unchanged and one had developed urinary incontinence postoperatively. Four children with had weakness of lower limbs; one patient improved whereas three patients did not improve postoperatively. There was no development of postoperative hydrocephalus after LMM repair. Three (23%) patients developed wound infection who responded well with regular dressings and antibiotics. Conclusion Lipomeningomyelocele repair can be done with satisfactory outcome with total excision of lipoma and division of filum terminale. Patients with residual lipoma and undivided filum terminale should be observed closely for the development of progressive neurological deterioration. [ABSTRACT FROM AUTHOR]

Introduction: Neural tube defects are among the most common congenital malformations and a major cause of health problems in surviving children, especially in developing countries. Although the incidence of spinal dysraphism has signifi cantly decreased over the last few decades, all over the world; however, the incidence is much higher in developing countries with poor socioeconomic status. The social and economic impact of this disease is not well documented; however, up to 75% of adult survivors may be dependent on parents or other care providers. Aims and Objectives: The aim of this study is to review the demographic profile, clinical pretentions, surgical management and short term outcome of patients presenting with spinal dysraphism Methodology: This is a prospective observational study of cases of spinal dysraphism managed surgically over the period of 2 years from March 2014 to February 2016 in Department of Neurosurgery at Tribhuvan University Teaching Hospital (TUTH), Kathmandu Nepal. Results: Out of total 97 cases, there was male preponderance. In about 40% of population there was no history of proper ANC visit and most of them were from low economic status. Lump on the back was the commonest clinical fi ndings. Lumbar Myelomeningocele was the commonest anatomical location of dysraphism. More than one third of patients needed CSF diversion postoperatively. Conclusion: Myelomeningocele is a common NTDs. Open dysraphism may not always present as a lump. Delay in seeking medical attention may be due to illiteracy. None of the mother had taken folic acid prior to conception. [ABSTRACT FROM AUTHOR]

External Ventricular Drainage (EVD) related infection is one of the most dreaded infections in neurosurgical practice. The primary aim of this study was to assess the incidence of EVD infections in our hospital. In addition, we have made an attempt to evaluate the indication for EVD placement, influence of total drainage time in the risk of catheter infection, the most common bacterial spectra in cerebrospinal fluid (CSF) culture, and their antibiotic sensitivity pattern. This is a retrospective study of all patients who underwent EVD placement over a period of two years. Out of 60 patients who underwent EVD placement, 52 met the inclusion criteria for analysis. The ventricular catheters were in place from 1 to 23 days. Overall shunt infection rate was 36.5%. CSF cell count significantly correlated with the occurrence of a positive CSF culture (unpaired t test, p<0.05). The most common bacterial species isolated were Acinetobacter baumannii and Burkholderia cepacia. Despite many advances in care, there is still a significantly high incidence of EVD related infections. Contrary to earlier reports, the most common bacterial grown in our center were quite different and their antibiotic sensitivity varied accordingly. [ABSTRACT FROM AUTHOR]

Background Central nervous system (CNS) tumors are the most common cause of cancer-related death in children. Little is known about the demographics and treatment of pediatric brain tumors in low- and middle-income countries (LMICs). Methods We performed a retrospective chart review of all pediatric patients who presented to the neurosurgical service at Tribhuvan University Teaching Hospital in Kathmandu, Nepal from 2009–2014 and collected information on patients <18 years old who received a diagnosis of a CNS tumor. We analyzed age, gender, clinical presentation, extent of surgical resection, histopathology, and length of hospital stay. We also conducted a literature review using specific terminology to capture studies of pediatric neuro-oncologic epidemiology conducted in LMICs. Study location, length of study, sample size, study type, and occurrence of 4 common pediatric brain tumors were extracted. Results We identified 39 cases of pediatric CNS tumors, with 62.5% observed in male children. We found that male children (median = 13 years) presented later than female children (median = 8 years). The most frequently observed pediatric brain tumor type was ependymoma (17.5%), followed by astrocytoma (15%) and medulloblastoma (15%). Surgical resection was performed for 80% of cases, and gross total resection reported in 62.9% of all surgeries. More than half (54.1%) of patients had symptoms for more than 28 days before seeking treatment. Symptomatic hydrocephalus was noted in 57.1% of children who presented with CNS tumors. The literature review yielded studies from 18 countries. Study length ranged from 2–20 years, and sample sizes varied from 35–1948. Overall, we found more pronounced variation in the relative frequencies of the most common pediatric brain tumors, compared with high-income countries. Conclusions We present the first operative series of childhood CNS tumors in Nepal. Children often had delayed diagnosis and treatment of a tumor, despite symptoms. More comprehensive data are required to develop improved treatment and management algorithms in the context of a given country's demographics and medical capabilities for childhood CNS tumors. [ABSTRACT FROM AUTHOR]

Objects: There is a scarcity of data regarding childhood neurological injuries in developing countries such as Nepal. The epidemiology of acute pediatric neurotrauma in Kathmandu was studied to assess the implications of these data for injury prevention programs., Methods: The clinical records of patients