Ruptured vertebral artery dissecting aneurysm is more prone to re-bleeding and thus needs immediate surgical management. We present a case of 47 years old male with ruptured vertebral artery dissecting aneurysm which was immediately treated by endovascular surgery. Coil occlusion of the vertebral artery at the aneurysm site was performed. As emergency open surgery is often not possible, this case shows that endovascular surgery is an effective and helpful alternative.

The objective of this study was to describe and compare the quality of clinical guidelines for Type 2 diabetes mellitus (T2D) from Kenya, Zimbabwe, Tanzania and Nepal. Alumni from “peoples-uni” were invited to review and evaluate T2D clinical management guidelines used in their settings. The “Appraisal of Guidelines for REsearch & Evaluation II” (AGREE II) instrument was used to evaluate the guidelines. Each guideline was randomly allocated to three assessors, who evaluated the guidelines separately and allocated scores for items on the AGREE II tool. The guidelines from Zimbabwe and Kenya scored generally better than the Tanzania and Nepal guidelines. The main areas that needed the most improvement across all the guidelines were rigour of development (41%), applicability (40%) and editorial independence (35%). There is a need to improve several aspects of T2D clinical guidelines, which is a useful starting point to improve management of these patients.

BACKGROUND: Thyroid dysfunction (TD) and metabolic syndrome (MetS) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of MetS. It is possible that coexistence of these two disease entities and unrecognized TD in patients with MetS might substantially increase ASCVD risk. Moreover, little is known about the relationship between TD and the components of MetS. Thus, the purpose of this study was to evaluate the pattern of TD in patients with MetS and its relationship with components of the MetS. METHODS: A total of 358 previously diagnosed patients with MetS were recruited in the study. The thyroid function test parameters were measured to classify TD at Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Statistical analyses were performed using SPSS version 16.0 to evaluate pattern and relationship. RESULTS: The overall prevalence of TD in patients with MetS was 31.84% with high prevalence of subclinical hypothyroidism (29.32%). We found no evidence of a relationship between TD and components of MetS, although there was significant difference in waist circumference between four groups of TD. CONCLUSION: Patients with MetS had subclinical hypothyroidism greatly. Although there was no evidence of any relationship between thyroid status and all components of MetS, TD should be taken into account when evaluating and treating patients with MetS to reduce the impending risk.
Blood Pressure ; Cardiovascular Diseases ; Humans ; Hypothyroidism ; Lipid Metabolism ; Nepal ; Prevalence ; Risk Factors ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Hormones ; Waist Circumference