Introduction: Lipomeningomyelocele (LMM) is a common neural tube defect especially prevalent in low income countries. When they get appropriate care, long term result is generally good provided the patient receives good neurosurgical, pediatric and rehabilitation care. Surgery is the mainstay of treatment. Our aim was to analyze immediate and long-term results of lipomeningomyelocele repair in symptomatic patients presenting to TU Teaching Hospital, Kathmandu, Nepal. Methods: Thirteen patients admitted to Department of Neurosurgery from January 2017 to December 2018 were evaluated. All patients underwent MRI of whole spine before surgery. Surgical procedures involved total excision of lipoma and repair in 10 patients and subtotal excision and repair in 3 patients. Division of filum terminable could be donein 8 patients. Follow up varied from 6 months to 2 years. Results: This study included 8 (61.5 %) patients of lumbosacral LMM, 3 (23%) patients of sacral LMM and 2 (15.38%) patients of thoracolumbar LMM. About 2 (15.38%) were operated before 3 months of age, 2 (15.38%) were operated between 3-6 months of age, 5 (38.46%) were operated between 6-12 months of age and 4 (30.7%) were operated after 1 year. All children except one presented with lump on back since birth and four presented with urinary incontinence, one presented with bilateral club foot. Four (30.7%) patients had weakness of one or both lower limbs. Two (15.38%) patients had improvement in urinary incontinence, two unchanged and one had developed urinary incontinence postoperatively. Four children with had weakness of lower limbs; one patient improved whereas three patients did not improve postoperatively. There was no development of post operative hydrocephalus after LMM repair. Three (23%) patients developed wound infection who responded well with regular dressings and antibiotics. Conclusion: Lipomeningomyelocele repair can be done with satisfactory outcome with total excision of lipoma and division of filum terminale. Patients with residual diploma and undivided filum terminale should be observed closely for the development of progressive neurological deterioration.
Pityriasis versicolor (PV) also known as Tinea versicolor is a benign, chronic superficial fungal infection of the skin caused by Malassezia furfur. It is characterized by dyspigmented macules with fine branny scales. The purpose of this study was to assess the epidemiological profile and clinical pattern of PV in a group of patients visiting a tertiary care centre of Nepal. A descriptive cross-sectional study was carried out including 150 patients diagnosed to have PV at the outpatient dermatology department of Nepal Medical College Teaching Hospital. Patients with the diagnosis of PV were included in the study. A detailed history was taken and it was followed by a thorough clinical examination. The findings of history and clinical examinations were documented in a predesigned proforma. Statistical Package for the Social Sciences (SPSS) version 16 was used to tabulate the data and analyze the results. There was a slight male preponderance with maximum patients of the age group 11 -20 years. A majority of patients were students. Forty three (28.7%) patients had similar problem in close contacts and 42% had recurrent disease. Wearing of occlusive synthetic clothing was the commonest predisposing factor. Upper chest and upper back were the most involved sites. Hypopigmented macules were the commonest lesions in 72.7%. Coexisting seborrheic dermatitis (commonly pityriasis capitis ) was present in 44.67% of patients. Clinicoepidemiological profile of PV in our setting is similar to many studies done mostly in India. But few findings differ which indicates the need for further studies in Nepal especially from Terai regions where the prevalence is expected to be more.
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