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Introduction Overweight and obesity with their surrogate anthropometric markers like body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) have been shown to be strongly associated with Type 2 diabetes mellitus. Neck circumference (NC) though less used can be an equally effective alternative to diagnose overweight and obesity in patients with Type 2 diabetes mellitus in a resource limited setting. MethodsPatients who had Type 2 Diabetes Mellitus for 5 years or more and above 35 years underwent simple random sampling. Weight, height, WC and NC were measured. BMI was calculated and patients were graded into overweight and obesity based on the Asian cutoffs for BMI and abdominal obesity. ResultsAmong 100 patients enrolled in this study, 45% were men and the mean age was 53.05. Mean neck circumference was 36.55 ± 1.28 cm and 35.27 ± 1.78 cm for male and female respectively. NC was positively correlated with WC and BMI in both men and women (p ˂ 0.001). In the ROC curves, NC presented the largest area under the curve (AUC) for overweight in males (p ˂ 0.001), while NC presented a large AUC for central obesity in both genders. Furthermore, the cut off value of neck circumference for overweight was 35.6 cm in males vs 35.2 cm in females and for central obesity was 36.75 cm in males vs 34.75 cm in females. ConclusionNeck circumference was positively associated with overweight and central obesity in patients with type 2 diabetes mellitus.

Objectives: To compare the efficacy between endoscopic and open carpal tunnel release procedures for carpal tunnel syndrome patients. Design and setting: Randomised control study in a single neurosurgery department Participants: 30 patients aged 35-69 years with clinically diagnosed carpal tunnel syndrome Main outcome measures: Primarily - operative duration, bleeding, pain score on day one, requirement of non-steroidal anti-inflammatory drugs (NSAIDs), time spent in hospital and days taken to return to work. Other outcomes include infection, wound status/cosmesis, injury to median nerve, chronic regional pain syndrome and patient satisfaction. Results: 15 patients were allocated to open surgery, and the other 15 for endoscopic. The average operative duration for open surgery was 9.9 minutes compared to 52 minutes spent for the endoscopic procedure. Cauterization had to be performed 4:1 times in endoscopic compared to open. Pain scores rated 3x higher after open surgery and resulted in increased NSAIDs use. Time spent in hospital after open surgery was 0.7 hours compared to 2.2 in endoscopic, however patients were able to return to work an average of 10.6 days earlier after endoscopic surgery. Conclusions: In carpal tunnel syndrome, endoscopic surgery allowed patients to experience less post-operative pain and return to work several days sooner than in open surgery.

Unilateral hypertrophy of temporalis muscle (isolated type) is extremely rare and only 14 cases have been reported in English literature since 1990. Although no definitive etiology is identified, stress and bruxism are among the many factors are linked to it. Reported patient ages ranged from 7 years to 62 years and most of them are Caucasians. Here we report the first ever case of an Indo-Aryan ethnic patient who presented with painful swelling of the left temporal region. Temporalis muscle biopsy confirmed the diagnosis of isolated unilateral temporalis muscle hypertrophy. This case raises the importance of considering rare diagnoses such as isolated unilateral temporalis muscle hypertrophy despite the inadequate statistical data on ethnicity or geographic location of a condition.

Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients. Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared. Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days. Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

Hemostasis is one of the most essential measures in Neurological procedures. Surgicel (Oxidized cellulose) is one of the most frequently used hemostatic agent used worldwide during surgical procedures. We aim to present a case of radiological diagnostic dilemma of a ring enhancing brain lesion where brain abscess, intracranial hematoma and surgicelloma was identified as challenging differential diagnosis. In this paper, we present a case, where a complication occurred with the use of surgicel following craniectomy and evacuation of hematoma.

The pattern of improvement in Neurological status after disc surgery is different. The chronology of improvement in Medical Research Council (MRC) scores, sensory status and improvement in Straight Leg Raise (SLR) test degrees is beneficial in management part to surgeons, relatives and the patients.To assess pattern of neurological outcomes in patients with lumbar disc herniation after microdiscectomy in terms of muscle power, sensory status and SLR.A Quasi experimental study comprising 70 consecutive cases though non-probability purposive sampling technique of both the sexes admitted in Neurosurgery department, Mayo Hospital operated for the 1st time for any disc pathology with no other spinal lesions giving consent themselves or though legal guardians was conducted. Pain for leg and back was measured pre and post-operatively was done by VAS which had 42 days of follow up. Standard Neurological examinations were conducted pertaining to muscle power (by MRC), sensory status and SLR test pre and post-operatively. Variables according to their nature were expressed in the form of Mean±SD, Median (Range) and Frequency (percentage). Mc Neumer’s chi square test and paired t test were used to see association between preoperative and post-operative Neurological status depending on their nature viz: qualitative or quantitative respectively in SPSS version 15.Out of 70 patients 74% were male and 26% were females. Mean±SD of patients was 37.6±13.0 years. Majority were Laborers after housewives. Illiterates, Poor lifting techniques were the most common characteristics in the respective headings of education and employment. Most common level of disc herniation was L4-L5, L5- S1 level (96%) where Prolapse and extrusion were most common MRI findings. As compared to pre-operative (3.4) muscle power 1st and 42nd day power were respectively 4.0 and 4.7 (p=0.001). Pre-operatively only 32 (45.7%) had normal sensation which improved to 38 (54.3%) and 51 (72.9%) respectively in 1st and 42nd day of surgery (p=0.001). Pre-operative mean SLR improved to 98.6 degrees in 1st POD and continued to be the same till 42nd day (p=0.001). All the MRC findings, sensory status and SLR values in each post-operative days were statistically significant with the baseline by paired t test (p=0.001). MRC and Sensory status had same pattern of improvement (r=0.0. p=0.04) unlike SLR which total improvements were see in 1st POD itself.In conclusion, muscle power and sensory improvement follows same improvement pattern whereas maximum SLR improves in the 1st POD itself.Nepal Journal of Neuroscience, Vol. 14, No. 2, 2017 Page: 8-15

Introduction: The recent COVID-19 pandemic has revealed important obstacles in our health care systems, including online specialist consultations. Amidst mass lockdowns and social distancing, we observed the importance of developing a consistent method of performing effective neurological examinations that yield accurate results in a time efficient manner. Objectives: To describe our experience in the Maldives of performing effective online neurological examination. Methodology: We designed and implemented a platform for patients to register for online consultation, collected a comprehensive neurological history, including pictures/scroll-videos of past radiological reports, and guided the patient and their aide through neurological examination methods- both verbally through online video consultation and informative pictorials that depict exactly how-to perform said examinations. Conclusions: Neurological examinations are time consuming, detailed and require skill and expertise to be performed appropriately. Yet, can be customized and adapted to be performed remotely. Proper guidance by examiner and assistance by family or friend with use of pictorials can conclude a thorough online examination.

Background and Aims: The aim of this study was to assess the predictive value of different variables including the Model of End-stage Liver Disease (MELD) scores in hospitalized patients with spontaneous bacterial peritonitis (SBP) and its correlation with adverse outcomes. Methods: A cross-sectional study of 73 patients diagnosed with cirrhosis, ascites, and spontaneous bacterial peritonitis admitted to a gastroenterology department from February 2010 to November 2012. MELD scores were calculated using laboratory parameters and the United Network of Organ Sharing (UNOS) internet MELD tool. Results: Categorical variables and mortality status were analyzed for association by chi-square test. MELD scores and all-cause mortality were found to be positively correlated. Mortality was higher among the groups with MELD scores greater than 15. Upon stratification of the groups by mortality status, only age and urea level were novel and consistent predictors of mortality. Conclusions: In this Nepalese sample of cirrhotic patients, MELD scores along with age and urea level were confirmed as significant predictors of mortality. DOI: http://dx.doi.org/10.3126/jaim.v2i2.8776 J ournal of Advances in Internal Medicine 2013;02(02):47-51

Background Diabetes is a growing health problem in South Asia. Despite an increasing number of studies exploring causal pathways between diabetes and depression in high-income countries (HIC), the pathway between the two disorders has received limited attention in low and middle-income countries (LMIC). The aim of this study is to investigate the potential pathway of diabetes contributing to depression, to assess the prevalence of depression, and to evaluate the association of depression severity with diabetes severity. This study uses a clinical sample of persons living with diabetes sequelae without a prior psychiatric history in urban Nepal. Methods A cross-sectional study was conducted among 385 persons living with type-2 diabetes attending tertiary centers in Kathmandu, Nepal. Patients with at least three months of diagnosed diabetes and no prior depression diagnosis or family history of depression were recruited randomly using serial selection from outpatient medicine and endocrine departments. Blood pressure, anthropometrics (height, weight, waist and hip circumference) and glycated hemoglobin (HbA1c) were measured at the time of interview. Depression was measured using the validated Nepali version of the Beck Depression Inventory (BDI-Ia). Results The proportion of respondents with depression was 40.3%. Using multivariable analyses, a 1-unit (%) increase in HbA1c was associated with a 2-point increase in BDI score. Erectile dysfunction was associated with a 5-point increase in BDI-Ia. A 10mmHg increase in blood pressure (both systolic and diastolic) was associated with a 1.4-point increase in BDI-Ia. Other associated variables included waist-hip-ratio (9-point BDI-Ia increase), at least one diabetic complication (1-point BDI-Ia increase), treatment non-adherence (1-point BDI-Ia increase), insulin use (2-point BDI-Ia increase), living in a nuclear family (2-point BDI-Ia increase), and lack of family history of diabetes (1-point BDI-Ia increase). Higher monthly income was associated with increased depression severity (3-point BDI-Ia increase per 100,000 rupees, equivalent US$1000). Conclusions Depression is associated with indicators of more severe diabetes disease status in Nepal. The association of depression with diabetes severity and sequelae provide initial support for a causal pathway from diabetes to depression. Integration of mental health services in primary care will be important to combat development of depression among persons living with diabetes.