Objective. The objective of this meta-analysis was to analyze the benefits and harms of treating the population with statins in those having mean low-density lipoprotein cholesterol (LDL-C) in the near-optimal (100 to 129 mg/dl) to borderline high (130 to 159 mg/dl) range and free of cardiovascular disease (CVD). Methods. We searched PubMed, PubMed Central, Cochrane Library, and Google Scholar databases for randomized controlled trials (RCTs) published between 1994 and July 2020. We included RCTs with greater than 90% of participants free of CVD. Two reviewers independently screened the articles using the Covidence software, assessed the methodological quality using the risk of bias 2 tool, and analyzed the data using the RevMan 5.4 software. Results. Eleven trials were included. Statin therapy was associated with a decreased risk of myocardial infarction (RR = 0.56, 95% CI: 0.47 to 0.67), major cerebrovascular events (RR = 0.78, 95% CI: 0.63 to 0.96), major coronary events (RR = 0.67, 95% CI: 0.57 to 0.80), composite cardiovascular outcome (RR = 0.71, 95% CI: 0.62 to 0.82), revascularizations (RR = 0.65, 95% CI: 0.57 to 0.74), angina (RR = 0.76, 95% CI: 0.63 to 0.92), and hospitalization for cardiovascular causes (RR = 0.74, 95% CI: 0.64 to 0.86). There was no benefit associated with statin therapy for cardiovascular mortality and coronary heart disease mortality. All-cause mortality benefit with statin therapy was seen in the population with diabetes and increased risk of CVD. Statin therapy was associated with no significant increased risk of myalgia, creatine kinase elevation, rhabdomyolysis, myopathy, incidence of any cancer, incidence of diabetes, withdrawal of the drug due to adverse events, serious adverse events, fatal cancer, and liver enzyme abnormalities. Conclusion. Statin therapy was associated with a reduced risk of cardiovascular disease and procedures without increased risk of harm in populations with mean LDL-C in the near-optimal to the borderline high range and without prior atherosclerotic cardiovascular disease.

Introduction: Posttraumatic seizures are the seizures that arise from traumatic brain injury and brain harm due to physical trauma. This study aims to study various clinic-demographic factors associated with post traumatic seizure in Western Nepal. Methods: A retrospective analytical study was carried out in a tertiary hospital of Nepal to determine factors associated with post traumatic seizures. Various parameters were tested for association with post traumatic seizure using student’s t test for quantitative and chi square or Fischer Exact test for categorical variables. All the variables showing significant association were subjected to binary logistic regression. P-value ≤0.05 was considered statistically significant. Results: There were 66 (21.02%) cases with post traumatic seizure in our study. Univariate analysis showed significant association of fall injury (p=0.004), loss of consciousness (p=0.001), post traumatic amnesia (p=0.012), severity of head injury (Glasgow coma scale) (p=0.011) and depressed fractures (p<0.001). A binary logistic regression was done amongst parameters with significant association with post traumatic seizure which showed patients with fall injury (OR 3.150, P=0.003, CI= 1.473-6.734) and depressed skull fractures (OR 26.278, p<0.001, CI= 12.155-56.809) had statistical significant association. Conclusion: Injuries secondary to fall, post traumatic amnesia, loss of consciousness, severity of head injury in terms of GCS and depressed skull fractures were significantly associated with post traumatic seizures in our study. On multiple regression model with adjusted odds of 3.15 (1.473-6.734) and depressed skull fractures with an adjusted odds of 26.278 (12.155-56.809) were significantly associated with post traumatic seizure.

Pseudoaneurysm of superficial femoral artery without any femoral fracture following blunt trauma is a rare clinical entity. Most cases of pseudoaneurysm of superficial femoral artery present to the hospital following penetrating injury, femoral fracture, and surgical procedures. Failure of management of pain despite taking analgesics should lead to suspicion of pseudoaneurysm.

Introduction: Understanding anatomy of the lumbar vertebrae is necessary to achieve clinical success during surgery, for the development of the spinal implants and instruments and to understand changes in elderly and in male and female patients. Methods: A cross-sectional study was done in 50 patients in Nepal to study the lumbar morphometric analysis of the vertebral body, intervertebral disc and spinal canal. Patients who underwent CT IVU for nephrolithiasis at our center were included for analysis of the lumbar morphometry. All the traumatic cases and pathological lesions, such as infection, tumor were excluded from the study. Patients having low backache due to probable intervertebral disc pathology were also excluded from the study. Data analysis was done from Microsoft excel and the mean, standard deviation and range were calculated. Results: The anterior-posterior diameter of the vertebral body, varied from 25.97 mm at L1 to 29.39 mm at L5. The transverse diameter of the body ranged from 31.55 mm at L 1 to 44.13mm at L5. There were changes in height of body. First from L1 - L3 there was increase in height and from L4-L5 there was decrease in height with least height at L5 (22.71mm). According to our study the L1 vertebra has narrowest transverse diameter of spinal canal(21.25mm) whereas L4 has narrowest antero-posterior diameter of spinal canal(12.37mm). Conclusion: In the lumbar area, detailed anatomical knowledge is critical for performing a safe operation. These findings give guidance to the surgeons during various approach while performing operative procedure like pedicle screws, vertebral body screws, cages and laminar hooks.

Objective: The objective of this meta-analysis was to analyze the benefits and harms of treating the population with statins in those having mean low-density lipoprotein cholesterol (LDL-C) in the near-optimal (100 to 129 mg/dl) to borderline high (130 to 159 mg/dl) range and free of cardiovascular disease (CVD). Methods: We searched PubMed, PubMed Central, Cochrane Library, and Google Scholar databases for randomized controlled trials (RCTs) published between 1994 and July 2020. We included RCTs with greater than 90% of participants free of CVD. Two reviewers independently screened the articles using the Covidence software, assessed the methodological quality using the risk of bias 2 tool, and analyzed the data using the RevMan 5.4 software. Results: Eleven trials were included. Statin therapy was associated with a decreased risk of myocardial infarction (RR=0.56, 95% CI: 0.47 to 0.67), major cerebrovascular events (RR=0.78, 95% CI: 0.63 to 0.96), major coronary events (RR=0.67, 95% CI: 0.57 to 0.80), composite cardiovascular outcome (RR=0.71, 95% CI: 0.62 to 0.82), revascularizations (RR=0.65, 95% CI: 0.57 to 0.74), angina (RR=0.76, 95% CI: 0.63 to 0.92) and hospitalization for cardiovascular causes (RR=0.74, 95% CI: 0.64 to 0.86). There was no benefit associated with statin therapy for cardiovascular mortality and coronary heart disease mortality. All-cause mortality benefit with statin therapy was seen in the population with diabetes and increased risk of CVD. Statin therapy was associated with no significant increased risk of myalgia, creatine kinase elevation, rhabdomyolysis, myopathy, incidence of any cancer, incidence of diabetes, withdrawal of the drug due to adverse events, serious adverse events, fatal cancer, and liver enzyme abnormalities. Conclusion: Statin therapy was associated with a reduced risk of cardiovascular disease and procedures without increased risk of harm in populations with mean LDL-C in the near-optimal to the borderline high range without prior atherosclerotic cardiovascular disease.