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Introduction: Spinal cord injuries result in severe neurological impairments and disabilities. With an estimated 15.4 million cases globally in 2021, spinal cord injuries are more common in low- and middle-income countries, yet research in these areas is limited. This study aimed to find the pattern of spinal injuries and outcomes associated with spine injuries over a five-year duration at a tertiary trauma care center. Methods: This observational cross-section study was conducted at the National Trauma Center, Kathmandu from 2075 to 2080 B.S. with ethical clearance from the Nepal Health Research Council (Reference number: 968). Total-population sampling was used. A structured proforma was employed as the primary data collection tool. Data was analyzed using SPSS. Results: Of the 20843 patients, 2070 (9.93%) had spinal injuries. The median age was 43 (IQR 32-56) years, with 1391 (67.20%) male patients. The median hospital stay was 12 (IQR 7-20) days. Falls accounted for 1221 (58.99%) cases, and road traffic accidents for 195 (9.42%). Spinal fractures were present in 1076 (51.98%) patients with 456 (42.38%) in lumbar vertebra. There were 225 (10.87%) cases of subluxation with 214 (95.11%) in cervical level. Conclusions: The study provides insights into the patterns and outcomes of spinal injuries over five years of time. The mortality rate and cases of patients leaving against medical advice highlight areas for improvement in patient care and follow-up.

Introduction: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. Morbidity and mortality pattern is a reflection of disease burden. Detailed assessment of these parameters tends to aid in formulating pivotal aspects of in-hospital policies, standards of care and so consequently promoting efficient work systems. The aim of this study is to identify the pattern of mortalities in medical wards in a tertiary care hospital. Methods: This retrospective descriptive cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital focusing on all patients admitted to the medical wards (General Medical, Hepatology, Nephrology, Neurology, Endocrinology, Pulmonology, Cardiology and Gastrology) between January 1 to December 31, 2023 after obtaining ethical approval from Institutional Review Committee (Reference Number: 390/2080/81). Total population sampling was done. Data were analyzed using Microsoft Excel and SPSS. Results: Among 10124 admitted patients in medical wards, mortality was reported in 732 (7.22%). The number of deaths seen in general medical ward was 389 (53.14%) and in liver ward was 85 (11.61%). Systemic cause of death due to respiratory diseases was 157 (21.5%) and liver disease was 143 (19.6%). Conclusions: The respiratory disease is responsible for a higher proportion of deaths among admitted patients. However, the deaths due to liver disease are increasing because of the rise in cirrhosis of the liver in the younger age group.

Hydatid cyst of orbit is a rare cause of proptosis, even in endemic regions. So far, Hydatid cyst of the orbit, has not been reported from Nepal. We report a 7-year-old boy, who presented with initially painful, later painless axial proptosis of the right eye without ocular movements and perception of light. As the case was clinically diagnosed as retinoblastoma or rhabdomyosarcoma, the exenteration was carried out.The retroorbital cyst containing gel-like fluid was histopathologically examined and the diagnosis of hydatid cyst was confirmed. Although rare, orbital hydatid cyst should be considered as one of the differential diagnoses of unilateral severe proptosis. Key Words: Orbit, Hydatid cyst, Proptosis.

ABSTRACT Sickle cell diseases are inherited hematological diseases, prevalent in certain parts of the world. We report two cases of sickle cell diseases, first being sickle cell b-thalassaemia and second homozygous sickle cell disease (SS). Our first case was 5 year old boy presenting with hemolytic anaemia & hepatosplenomegaly having sickle cell b-thalassaemia disease . Second case was 17 years female presenting with hemolytic anaemia & joint pain having homozygous sickle cell disease. Key Words: Homozygous sickle cell disease, sickle cell b - thalassaemia, hemoglobin electrophoresis.

Introduction: Internal urethrotomy is recommended for the treatment of urethral strictures shorter than 1.5 cm but has been associated with high recurrence rates. The aim of this study was to evaluate the efficacy of use of triamcinolone ointment for clean intermittent self catheterization in the prevention of urethral stricture recurrence after internal urethrotomy. Methods: Total of 60 male patients undergoing internal urethrotomy were assigned into two groups and clean intermittent self catheterization was performed using either triamcinolone ointment or a water-based gel for lubrication of the catheter in this randomized clinical trial. Clean intermittent self catheterization regimen was continued for 6 months and patients were followed for 12 months. Urethrocystoscopic evaluation was done 6 and 12 months postoperatively. Results: The recurrence rates were compared between the two groups. There were no significant differences in patient characteristics and etiology of the stricture between the two groups. There was a 6 (22.22%) recurrence rate in the patients of the triamcinolone group against 13 (46.42%) in those of the control group after the first internal urethrotomy (P=0.04). After second internal urethrotomy, the urethra was stabilized in 5 (83.3%) of the patients in the triamcinolone group and 8 (61.5%) those in the control group (P=0.05). We also found a significant correlation between recurrence and stricture length (P=0.02) but the time to recurrence was not statistically significant (P=0.16). Conclusions: The use of triamcinolone ointment in patients on CISC regimen after internal urethrotomy significantly decreased the stricture recurrence rate.

Malignant teratoid medulloepithelioma is an uncommon unilateral intraocular tumor, occuring typically in children. This report concerns a 4-year-old boy, who presented with loss of vision, pain and proptosis of the left eye and showed mass in between eyelids. Histopathologically, the tumor was composed of pseudostratified primitive- appearing epithelium dispersed in cords, strands, tubules & glands, which were separated by a cystic spaces, filled with pale eosinophilic material. Foci of glial tissue, cartilage , bone, skeletal muscle and fatty tissue were recognized. In addition, scleral extension of tumor, Homer-Wright like and Flexner-Wintersteiner like rosettes and foci of necrosis were also present. The differentiation from retinoblastoma was discussed. Key Words: Malignant medulloepithelioma, eyeball, heteroplasia.

Gastric adenocarcinoma is of major importance worldwide as a cause of death from malignant disease. It is the commonest malignant tumor in T.U. Teaching Hospital. Helicobacter pylori infection is an important risk factor for the development of gastric cancer. This prospective study was carried out to correlate H. pylori infection with gastric adenocarcinoma. This study was done from January 1999 to January 2000; included 38 cases of gastric adenocarcinomas of which 28 (73.69%) cases were tubular type; 6 (15.79%) cases were signet-ring cell type; 2 (5.26%) cases were papillary type and 2 (5.26%) cases were mucinous type. Gastric adenocarcinomas were more common in male (73.68%) and after the age of 50 years. Giemsa staining revealed H. pylori in 30 cases (78.95%) of adenocarcinomas; whereas H. pylori seropositivity (IgG) was found in 29 (76.31%) cases. H. pylori were histologically detected in 88.3% cases of resected specimens and in 71.4% cases of endoscopic gastric biopsies. Both histological method and serological test showed positivity for H. pylori in 65.78% cases. Thus, H. pylori infection is associated with gastric carcinognesis Key Words: Gastric adenocarcinoma, Helicobacter pylori, Giemsa stain.