Bir Hospital

Variants of nasal septum and structures of nasal cavity are key in nasal surgeries, with some linked to certain pathologies. This study aims to determine their prevalence in the Nepali population at our hospital.

A retrospective, cross section study was conducted at a private hospital in Nepal with 342 adults (aged >13). Two radiologists assessed CT scans for variants of nasal septum, nasal septum deviation angles, and variants of the nasal turbinates and pneumatized uncinate process. Nasal septum deviations were graded from I to IV, and gender-specific prevalences and mean nasal septal deviation (NSD) angle were calculated. Statistical significance was tested using chi-squared test, t-tests, and ANOVA.

The prevalences were: nasal septum deviation (76.68%), septal spur (41.98%), septal pneumatization (40.23%), hypertrophied inferior turbinate (38.48%), lamellar concha (34.11%), concha bullosa (CB) (19.83%), supreme turbinate (9.33%), paradoxical middle turbinates (9.33%) and pneumatized uncinate process (8.45%). Nasal septum deviation was right-sided in 34.11%, left-sided in 34.40%, and S-shaped in 8.16%. The prevalences of nasal septum types were: type I (30.9%), type II (48.1%), type III (16.91%), and type IV (4.08%). The mean septal deviation angle was 6.77° (SD 4.52°).The mean septal deviation in deviated septum was 8.64° (SD 3.2°) Significant association were found between deviated septum and septal spur, CB, hypertrophied inferior turbinate, and paradoxical middle turbinate (P < 0.001, 0.012, 0.001, 0.016), as well as between variants of NSD and sides of CB, hypertrophied inferior turbinate, and septal spur (P = 0.006, <0.001, <0.001). The prevalence of CB was significantly high in female (P = 0.001). There was significant association of types of nasal septum with CB (P = 0.003). There was significant difference in deviation angle between variants of deviated nasal septum (P = 0.048), notably between septum deviated to left side and "S"-shaped nasal septum (P = 0.024).

Recognizing variants of nasal septum and nasal cavities is crucial to prevent surgical complications.

Acute ischemic stroke (AIS) is a major cause of hospital admission and is responsible for a large proportion of disabilities. The CHA2DS2-VASc score was developed to improve the accuracy of stroke risk stratification in patients with non-valvular atrial fibrillation. It includes major risk factors for ischemic stroke and may be useful in prognostic risk stratification before and after the event of acute ischemic stroke. This study was conducted to study the role of CHA2DS2-VASc score in severity and outcome prediction of acute ischemic stroke.

A cross-sectional study was conducted in a tertiary center in Nepal for the period of 12 months (June 2021 to June 2022) including patients more than 18 years presenting with symptoms of stroke and underwent neuroimaging studies at admission with the diagnosis of acute ischemic stroke. The National Institute of Health (NIH) stroke scale score, pre-stroke and current functional status according to modified Rankin scale (mRS) score were noted. The CHA2DS2-VASc score was calculated. Based on the result, patients were grouped into low-risk CHA2DS2-VASc score (0, 1) and high-risk CHA2DS2-VASc score. At discharge, patients were evaluated and their functional status was noted according to mRS score.

Seventy-five patients with acute ischemic stroke were enrolled in the study, in which 48 (64%) were male and only 35 (46.7%) of patients could reach the emergency department within 24 hours of onset of symptoms. The mean age of patients was 61.8 ± 16.04 years and 18 (24%) of patients were of age ≥75 years. Hemiplegia/paresis with UMN facial palsy was the most common presentation. Smoking and hypertension were the most common risk factors followed by diabetes mellitus. The severity of stroke as evaluated by NIH stroke scale score at the time of admission categorized as minor, moderate, moderately severe, and severe stroke was present in 7 (9.3%), 47 (62.7%), 11 (14.7%), and 10 (13.3%) patients, respectively. Low-risk CHA2DS2-VASc score (0, 1) was observed in 23 (30.7%) of patients, and a high-risk score (≥2) in the remaining patients. On evaluation of the functional status at the time of discharge, 28 (37.3%) patients had mRS scores of good outcome (0, 1, 2) and remaining had mRS score ≥3.

The CHA2DS2-VASc score demonstrates significant predictive value in evaluating both the severity and functional outcomes of acute ischemic stroke patients. In this study, a higher CHA2DS2-VASc score was associated with more severe stroke presentations and poorer discharge outcomes. Given its simplicity and reliance on readily available clinical data, the CHA2DS2-VASc score can serve as a practical, cost-effective tool for early prognostic stratification in AIS management.

Perinatal asphyxia is a common cause of neonatal morbidity and mortality especially in low resource developing countries like Nepal. Early intervention and appropriate management is very crucial for preventing mortality and long-term sequalae. This study aims to understand the severity of perinatal asphyxia and its correlation with umbilical cord blood pH. This hospital-based prospective study aimed to assess the correlation between cord blood pH and the severity of perinatal asphyxia, specifically its association with hypoxic-ischemic encephalopathy (HIE) and early neonatal outcomes. A total of 56 neonates out of which 40 were term and 16 were preterm were enrolled, and the data were analyzed using SPSS. Results showed that lower cord blood pH was significantly associated with the severity of HIE (P < .01). Neonates without HIE had a mean pH of 7.24, while those with severe HIE had a mean pH of 6.8. The analysis reveals a statistically significant negative correlation between Cord blood PH and HIE with a Pearson correlation coefficient of −0.634. A significant relationship was found between birth asphyxia, low birth weight, preterm gestation, severe HIE. Mortality occurred in 7% of the neonates, all within the severe HIE group. This study highlights the critical role of cord blood pH in predicting neonatal outcomes, emphasizing its potential as an early indicator for intervention in perinatal asphyxia.