Pandey, Prativa, Benu Lohani, and Holly Murphy. Pulmonary embolism masquerading as high altitude pulmonary edema at high altitude. High Alt Med Biol. 17:353–358, 2016.—Pulmonary embolism (PE) at high altitude is a rare entity that can masquerade as or occur in conjunction with high altitude pulmonary edema (HAPE) and can complicate the diagnosis and management. When HAPE cases do not improve rapidly with descent, other diagnoses, including PE, ought to be considered. From 2013 to 2015, we identified eight cases of PE among 303 patients with initial diagnosis of HAPE. Upon further evaluation, five had deep vein thrombosis (DVT). One woman had a contraceptive ring and seven patients had no known thrombotic risks. PE can coexist with or mimic HAPE and should be considered in patients presenting with shortness of breath from high altitude regardless of thrombotic risk.

Abstract:Objective: To correlate the portal vein pulsatility pattern with severity of liver disease in patients with cirrhosis of liver and portal hypertension. Subjects and methods:Doppler signals from the main portal vein of 36 healthy adults and 52 cirrhotic patients with portal hypertension were studied. Severity of liver disease was graded using modified Child-Pugh classification. Pulsatility of portal flow was quantified using portal venous pulsatility index and complete spectral widening was defined as absence of window below the wave base. The Doppler findings were correlated between the study groups.

COVID-19 has rapidly emerged as a pandemic threatening lives and healthcare systems worldwide.With the emergence of the disease in Nepal, all faculties of medicine need to be well prepared toface the challenge. Fortunately, now plenty of research is available to facilitate our preparednessin the war against COVID-19. The reverse transcriptase-polymerase chain reaction is the currentgold standard diagnostic test and chest Computed Tomography scan for screening the disease isconsidered inappropriate by most society recommendations. The Nepal Radiologists’ Associationhas proposed its guidelines which have been endorsed by the Nepal Medical Council. This articleaims to summarize the role of imaging focusing on chest X-ray and Computed Tomography scanincluding the indications, specific findings, and important differentials. Imaging needs to be donetaking necessary precautions, to minimize disease transmission, protect health care personnel, andpreserve health care system functioning.

Department of R adiology and Imaging, Institute of M edicine, T rib huv an Univ ersity T eaching H ospital, K athmandu, Nepal.Correspondence address: Dr. Benu L ohani, Department of R adiology and Imaging, Institute of M edicine, T rib huv an Univ ersity T eaching H ospital, K athmandu, Nepal. E-mail: b enulohani@ yahoo.com AbstractIntroduction: Acute appendicitis is the most common acute condition of the ab domen requiring surgery in b oth adults 1,2 and children. 3-5 T he ov erall frequency of appendicitis for symptomatic patients younger than 20 years is 41%; the frequency for those older than 20 years is 59%.

Introduction: The purpose of this study was to categorize new reference ranges for measurements of commonly used umbilical artery and fetal middle cerebral artery Doppler indices (Pulsatility Index, Resistance Index, and Systolic: Diastolic ratio) in uncomplicated third trimester pregnancy. Methods: This was a prospective cross sectional study involving 101 singleton uncomplicated pregnancies of 30 to 37 weeks of gestation. Umbilical artery indices were obtained from free floating loop and middle cerebral Doppler indices were obtained from the proximal third of the artery with flow towards the probe. Regression equations were used to categorize reference ranges and percentile fitted Normograms were obtained for all the parameters. Results: Among 101 singleton pregnancies between 30 and 37 weeks of gestation, 65 (64.35%) were primigravida women and 36 (34.65%) were multigravida. Mean maternal age was 23.12years (range 16 to 35 years). Maximum number of pregnancies (18.81%) was at 34 weeks of gestation. The established percentiles of Doppler indices showed a continuous reduction of all the measured indices as pregnancy increases (p<0.0001). Conclusions: Reference ranges were obtained for the middle cerebral artery and umbilical artery Doppler indices. These ranges are consistent with similar studies done by other authors. Keywords: Doppler study; fetal Middle cerebral artery; pulsatility index; resistance index; systolic; diastolic ratio; umbilical artery DOI: http://dx.doi.org/10.3126/joim.v32i3.4953 Journal of Institute of Medicine, December, 2010; 32:3 5-13