Physiology and Anatomy

Persistent left superior vena cava (PLSVC) is a rare and benign congenital malformation. It results when the left superior cardinal vein caudal to the innominate vein fails to regress. It is often asymptomatic and usually diagnosed incidentally while performing imaging. The notation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. We report a rare case of a 56 year-old lady in whom we discover this anomaly because of dyspnea.

Diverticular disease of the small intestine is rare, much less common than diverticular disease of the colon. The most common symptom is non-specific abdominal pain and a feeling of bloating sensation. Major complications include diverticulitis, gastrointestinal bleeding and acute perforation. Radiological imaging now allows precise diagnosis, and new endoscopic and interventional radiological techniques have made it possible to limit the urgent surgical indication. Conservative treatment is suitable for most asymptomatic patients. Surgery is still necessary in case of perforation or diverticulitis. We describe the clinical case of an 80-years-old female patient with left flank pain, abdominal computed tomography scan revealed an ileal tumor but diagnostic laparoscopy revealed an uncomplicated small bowel diverticular disease.

Diabetes Mellitus is the major public health problems in developing nations like Nepal. To find out total number of Diabetes Mellitus cases in BPKIHS from 2012 to 2016 AD and to know the duration for which cases were admitted and improvement seen in them. The hospital based cross-sectional study was conducted in B. P. Koirala Institute of Health Sciences, Dharan, Nepal. The secondary data of Diabetes Mellitus was collected from the Medical Record Section of BPKIHS and analyzed. One thousand one hundred seventy six cases of Diabetes Mellitus were enrolled. Most of the cases were from Sunsari (43.1%), Morang (16%) and Jhapa (12.1%) District respectively. Most of the patients (74.7%) were admitted in Medicine wards. Almost 95.4% of admitted Diabetes Mellitus cases were improved in BPKIHS. The problem of Diabetes Mellitus is common and has become a key public health concern for all.

We report the case of an 18-month-old girl who presented a complex spinal dysraphism combining an intra dural lipoma and myelomemingocel. The coexistence of inradural lipoma and myelomeningocele is very rare. We will focus on the contribution of imaging to the diagnosis and follow-up of spinal dysraphim.

Anomalous coronary arteries are rare but potentially life-threatening abnormalities of coronary circulation. Most variations are benign; however, some may lead to a myocardial ischemia and/or a sudden cardiac arrest. The coronary angiography is the standard reference investigation with an excellent spatial and temporal resolution. However, the determination of the origin and pathological course of the coronary arteriesis sometimes difficult with the coronary angiography because it is a bidimensional exam; hence the importance of complementing it with a coronary scan. The coronary scan is the most widely used technology for specifying the anomalous course and the interactions with the large vessels. We report the case of an elderly woman who had a coronary angiography, followed by a coronary multi-detectors can for chest pain. The coronary angiography showed an anomalous origin whitout specifying the course and the interacts with the large mediastinal vessels. The multi-detectors can improved the diagnostic accuracy, especially in the visualisation of some pathological courses at risk of sudden death. Our case defend the complementarity of the coronary angiography and the multi-detector scan in the exploration of the coronary congenital anomalies. The coronary angiography is used in emergency situations, whereas the scanis deployed as part as the exhaustive assessment of a suspected anomaly after a cardiac catheterization.

A study of breast cancer cases using hospital clinical data was conducted in the state of Bihar, India. It was found that in the past ten years breast cancer incidence increased cumulatively by 642%. In this investigation main emphasis has been given on breast cancer patients. Five districts (Khagaria, Muzaffarpur, Samastipur, Sitamarhi and Vaishal) in the state of Bihar were selected for residual DDT analysis in serum and tissue of a sample population. Pesticides were estimated by using High Pressure Liquid Chromatography (HPLC). Total DDT level in serum samples ranged from 5 ppb to 25 ppb and in the tissue samples it ranged from 900 ppb to 4300 ppb. Maximum accumulated DDT residue in tissue was recorded in the district of Samastipur. Highest accumulation of pp’-DDE was found in the both serum and tissue samples followed by pp-DDT, op-DDT, and pp’-DDD. Increasing concentration of DDT residues in tissues was found to be directly proportional to the effect on estrogen receptors in tissues. This study demonstrates that high accumulation of DDT or DDE and negative effects on estrogen receptor is strongly correlated to carcinogenicity in breast cancer patients.

The most frequent extra-intestinal manifestations of IBD are articular, ocular and cutaneous, whereas respiratory involvement in IBD is rare and only recently identified [1]. The true incidence of respiratory involvement is poorly understood, and is estimated at 0.2% [2]. Airway inflammation is the most common manifestation of inflammatory bowel disease in the lungs [3].Some patients may develop chronic symptoms, particularly those who develop irreversible processes such as bronchiectasis [4]. Bronchial dilatation (BD) is the other most frequent pulmonary manifestation of IBD, with an estimated frequency of 22.6% [5].The aim of our work is to evaluate the prevalence of bronchiectasis and its management in IBD patients.

CBR as a strategy within community development for rehabilitation, equalization of opportunities, and social inclusion of all people with disabilities. The purpose of the study was Designing Community Based Rehabilitation Model using SEM. This study is a comparative-descriptive research that has been performed by factor analysis method. In the qualitative stage the process owners were 45 experts and in factor analysis stage, there were 564 CBR experts of Iran, CBR departments and rehabilitation deputies of 31 provinces and the CBR specialists and rehabilitation deputies of the CBR executing counties. The data collection tool was researcher-made questionnaire the content validity of which was determined through expert panel and its construct validity was determined through exploratory factor analysis by principal component analysis method with varimax rotation using SPSS16 software. Its reliability was also confirmed by test-retest and internal consistency method using Cronbach's Alpha (96%) and the most important community-based rehabilitation factors were identified through path analysis and structural equation modeling using LISREL software 8.8. In exploratory component analysis, 7 main components were identified; using semi-professional people with 9 variables, 43.1% variance, and 23.28 eigenvalue as the most important factor and social integration of the disabled people with 2 variables and 2.19% variance as the less important factor clarified the community-based rehabilitation changes; however, in the fitted model which is the most complete saturated model, 7 factors of subsistence with ß= 0.20, using semi-professional people with ß= 0.19, medical procedures with ß= 0.19, socio-political supports with ß= 0.18, social integration of the disabled people with ß=0.18, educational measures with ß= 0.16, and health practices with ß= 0.14 had the highest predictive power in the order of importance. Considering the cultural, economic, political, and social context of Iran, usage of the obtained factors can promote the dignity of the disabled people and their family in the society as well as empowering and equalization of their opportunities.

The hepatic localization of hydatid cysts classically occupies the first place in adults and alone accounts for approximately 2/3 of all hydatid localizations Hepatic hydatidosis is a reputedly benign disease, but can become serious at because of its complications. The most common complication is fistulization of the cyst in the bile ducts which constitutes a turning point in the evolution of the disease and which risks involving the life-threatening Our case is about a rupture of KHF in the bile ducts complicated by cholangitis in a patient admitted for treatment of severe sepsis on cholangitis

Posterior heel pain is a largely reported symptom caused by several diseases. Haglund syndrome is one of its uncommon etiologies. The deformity referred to as a prominent bursal projection of the calcaneus can be asymptomatic and clinical manifestations define the syndrome related to the inflammation it causes. We report the case of a 45-year-old man, with no medical history presenting to clinical examination for a swelling painful posterior heel in which MRI showed a Haglund syndrome. Through this case, we detail radiological findings of this disease and the main differential diagnoses. Posterior heel pain is a largely reported symptom caused by several diseases. Haglund syndrome is one of its uncommon etiologies. The deformity referred to as a prominent bursal projection of the calcaneus can be asymptomatic and clinical manifestations define the syndrome related to the inflammation it causes. We report the case of a 45-year-old man, with no medical history presenting to clinical examination for a swelling painful posterior heel in which MRI showed a Haglund syndrome. Through this case, we detail radiological findings of this disease and the main differential diagnoses.