The aim of this study was to determine the frequency and origin of fever in patients admitted with acute stroke and the characteristics associated with the development of fever.This was a cross sectional observational study involving 151 patients admitted with acute stroke. The various attributes associated with the development of fever were documented and their characteristics were analyzed.Fever was noted in 21.2% of 151 patients; 11.9% had a documented infection and 9.3% had no documented infection. Older age was associated with the presence of fever (P = 0.009). The development of fever was associated with haemorrhage rather than ischemic infarct (P = 0.0001), presence of mass effect (P =0.03), and larger size of ischaemic infarct and haemorrhage (P = 0.002 and 0.0001, respectively). Patients with fever had lower scores on admission on the Glasgow Coma Scale (GCS) (P = 0.009) and higher score on the National Institute of Health Stroke Scale (NIHSS) (P = 0.0001). The development of fever was associated with prior use of an invasive technique (P =0.0001), particularly urinary catheterization and endotracheal intubation (P = 0.0001 and 0.0001). In multivariate analysis, age, NIHSS and endotracheal intubation were found to be significantly associated with fever (P = 0.018, P = 0.001 and P = 0.0001, respectively). Patients with fever without documented infection had an earlier onset than those with infection (P = 0.012).Fever in acute stroke patients is associated with older age, severity of stroke and the use of invasive techniques. Urinary tract and respiratory infections are the most common infections. Fever starts earlier where a focus of infection is not identified.Nepal Journal of Neuroscience 12:20-25, 2015

The objective of this study was to explore the outcome differences among is chemic stroke sub types based on “Trial of ORG 10172 in Acute Stroke Treatment (TOAST)” system in a tertiary referral hospital. A hospital based prospectiv elongitudinal study was conducted involving 182 patients. Modified Rank in Scale (MRS) was used to assess functional out come, Kaplan-Meierproduct- limit method and Coxproportional hazards regression analys is were used to evaluate rates and identify predictors of survival and recurrent stroke. MRS were statistically different across stroke subtypesat 30 days and 6 months (p<0.0001 and (p<0.0001) respectively). Lacunar stroke was associated with milder deficits. Estimated rates of recurrent stroke were significantly different at 30 days (p<0.0001) and at 6 months (p=0.009). Before adjusting forage, sex, stroke severity, and diabetes mellitus, infarct subtype was not an independent determinant of recurrent stroke within 30 days (p=0.057);but was at 6 months (p=0.024), how ever after same adjustment it was independent determinant both at 30 days (p=0.030) and at 6 months (p=0.025). Estimated death rates were significantly different both a t 3 0 days (p=0.026) and at 6 months (p=0.009). Ischemic stroke subtype was an independent determinant of 6-month survival both before (p=0.016) and after (p=0.027) adjustment for different parameters; however, was not of 30-day survival both before (p=0.054) and after (p=0.993) same adjustment. Early recurrencerates were highest among large artery atherosclerotic stroke. Lacunar stroke has better post stroke functional status. Survival is poorest among cardioembolic stroke.

Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT). Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity. Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p <0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p <0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels). Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.

The purpose of this study was to examine the plain AP radiograph of foot and lateral radiograph of knee in order to determine the prevalence and size of sesamoid bone in different part of foot and on the posterior aspect of the knee joint. A cross-sectional study was performed in Department of Radiology and Imaging, Tribhuvan University Teaching Hospital from July to September 2014. A total of 206 radiographs of foot (55) and knee (155) were collected. 121 (58.7%) were female and 85 (41.3%) were male. The most common site of sesamoid bone in foot was in the first metatarsal joint (96.4%) whereas the sesamoid bone in knee joint, fabella was found in 12.3% of total cases. The prevalence is more common in female than in male. The length and breadth of the sesamoid bones were measured and then area of bones was calculated. The size of medial and lateral sesamoid bone in the first MTP Joint was measured 0.6225 cm2 and 0.8261 cm2 respectively. The mean size of sesamoid bone of knee, fabella was 0.2818 cm2.

Introduction: CT guided biopsy is essential for histopathological diagnosis of suspicious lung nodule, which are not amenable for either bronchoscopic or sonography guided sampling. Methods: Twenty eight patients with suspicious lung nodules not amenable for bronchoscopic or sonography guided sampling who underwent CT guided lung biopsy with 18 G coaxial semiautomatic core biopsy needle in one year were retrospectively studied for diagnostic yield and complications. Results: Out of 28 patients, who underwent CT guided lung nodule biopsy, 18 were male and 10 were female. The age ranged from 22 to 80 years. Lesion size ranged from one cm to four cm and depth of lesion from pleura ranged from zero cm to five cm. Diagnostic yield of our core needle biopsy was 26(92.3%). Clinically significant complication was low. Massive pneumothorax which needed intercostal drainage was 7.14% (2 patients). Pulmonary hemorrhage manifesting as hemoptysis was seen in 14.3 %( 2 patients). No hemothorax or air embolism was noted in any of the patient. Conclusion: CT guided lung lesion biopsy with 18 G coaxial semi-automatic core biopsy needle is a safe procedure with good diagnostic yield and relatively low incidence of clinically significant complications.