Introduction: Majority of stroke is due to ischemic infarction and occurs in carotid artery territory. The extra cranial parts of carotid arteries are the common sites for the atherosclerotic plaque formation. Ultrasonography is the first line of investigation for screening of the carotid artery diseases to localize and characterize the plaques. Objective was to study the morphological changes in extra cranial part of carotid arteries in cases of ischemic infarction using Ultrasonography. Methods: It was an institution based prospective study and convenience sampling method was used. Computed Tomography proven ischemic infarct, lacunar infarction and transient ischemic infarction cases were included in the study. Results: Fifty four cases were included in the study. Mean of Intimo-medial Complex Thickness was 0.89 mm and 0.88 mm in right and left side respectively. Sixty five percent cases had plaque in extra cranial part of carotid artery. Ninety three percent of plaque was found in and adjacent to the carotid bulb region. Ipsilateral plaque was found in 76% and 65% cases on right and left side respectively. Fifty three percent of cases had soft plaque. Majority of cases had less than 50% narrowing of the lumen diameter in term of cross-sectional area due to plaque. Thirteen (24%) cases had plaque in internal carotid artery. Conclusions: Carotid ultrasound can be used for screening of the asymptomatic but high-risk cases and following up of the symptomatic cases to plan for necessary management as required. Keywords: carotid artery, carotid ultrasonography, ischemic infarction, plaque.

Introduction: Chronic kidney disease (CKD) is common cause of renal failure. It involves a progressive loss in the structure and function of the kidneys over the course of months, with or without decreased glomerular filtration rate (GFR). CKD can be diagnosed by its pathological abnormalities, changes in the levels of renal function markers in the blood or urine, or by imaging investigations (E.g. USG etc). Objectives: The purpose of our study is 1) To correlate renal echogenicity with serum creatinine in order to determine the significance of renal echogenicity for identifying the progression of chronic kidney disease (CKD) and for the sonographic grading of CKD, 2) To study association of blood pressure, renal cortical cysts and renal size with grade of chronic renal disease. Methods: This hospital based cross sectional study was carried out at National Kidney Centre, Banasthali Kathmandu. Two hundred patients above 20 years, diagnosed with CKD according to the guidelines of the National Kidney Foundation and referred for USG, were included in the study. Patients with kidney transplant, on dialysis, with liver disease and renal tumors were excluded. Ultrasound of kidneys was performed by senior consultant radiologist who was blind to the patients’ serum creatinine levels. The relationship between grade of CKD with serum creatinine, kidney size, blood pressure and cortical cysts were assessed. Statistical analysis was performed by Kruskal wallis test using SPSS version 17. P values less than 0.05 were considered statistically significant. Results: Mean serum creatinine was 1.7 mg/dl for Grade 1 (range: 1.1- 4.7 mg/dl, STD 0.44), 2.38 mg/dl for Grade 2 (range: 1.8-3.9 mg/dl STD 0.40), 4.18 mg/dl for Grade 3 (range: 2.6-6.0 mg/dl, STD 0.88), and 5.65 mg/dl for Grade 4 (range: 3.1-12 mg/dl, STD 2.0. Conclusion: Renal echogenicity and its grading correlates better with serum creatinine in CKD than other sonographic parameters. Hence, renal echogenicity is a better parameter than serum creatinine for estimating renal function in CKD, and has the added advantage of irreversibility.

Introduction: There is great concern and risk of transmission of COVID-19 infection from the aerosolized smoke during laparoscopic surgery although there is a lack of enough literature to prove this. To minimize these risks and get the benefi t of laparoscopic surgery, we used a low-cost fi ltration system connected to an underwater seal bag fi lled with a 5% sodium hypochlorite solution.Materials and Methods: This is a retrospective study of prospectively maintained data of cases of laparoscopic surgeries using a low-cost fi ltration device system connected with an underwater seal bag fi lled with 5% sodium hypochlorite solution. Use of personal protective equipment, minimal staff in operative theatre, preoperatively testing of patients before admission for surgery was done. During surgery, minimal use of electrocautery in low power setting maintaining low pneumoperitoneum and cautious desuffl ation of smoke during and end of the procedure from one of the trocars fi tted to heat and moisture exchanger Filter, connected through a tube to 5 % sodium hypochlorite solution in underwater seal bag was performed.Results: During the lockdown from May 2020 to October 2020, 41 elective laparoscopic surgeries were done. All patients were tested negative before the procedure. No staff in operation theatre developed symptoms of COVID-19 or tested positive for COVID-19 infection for up to 2 weeks period.Conclusions: In this Pandemic situation, we have to co-habit with this SARS-Cov-2 virus. Minimally invasive surgeries can be continued with safety measures with modifications like the use of low-cost filtration devices for smoke filtration and evacuation.