Introduction: There have been many reports in the literature demonstrating successful restoration of ocular anatomy post pars Plana Vitrectomy (PPV) in patients with cytomegalovirus (CMV) retinitis induced retinal detachment. We aim to report a rare case of complete visual rehabilitation with best corrected visual acuity (BCVA) reaching 20/20 post PPV in a patient with complicated CMV retinitis and macular involvement.

Case presentation: We present a case of a 45-year-old Lebanese male patient with newly diagnosed human immunodeficiency virus (HIV) infection. Findings suggestive of CMV retinitis bilaterally were found on fundus examination. Appropriate systemic and intravitreal treatment was started. At 4 months follow up, patient developed a secondary retinal detachment in left eye (OS) and surgery was performed (PPV with silicone oil and scleral buckle) after a latency of 3 weeks. Patient had a smooth recovery with BCVA reaching 20/20 after silicone oil removal.

Conclusion: HIV patients with macula-off retinal detachment post CMV retinitis may retain BCVA of 20/20 even with delayed surgical procedure. Close follow up and appropriate timely interventions play important role for improved final outcomes.

Objective: The objective of this study was to report initial experience using aspiration thrombectomy with the Indigo Aspiration System, as the first line treatment for acute iliofemoral deep vein thrombosis (DVT).

Methods: This study is a retrospective case review of patients with acute symptomatic iliofemoral DVT who underwent aspiration thrombectomy using the Indigo Aspiration System between December 2015 and January 2018 at three centres. Data on patient demographics, adjunctive treatments, and intraprocedural complications were collected from electronic patient records. Technical success was defined as antegrade flow and maximal luminal stenosis of 30% assessed following the use of Indigo System. Clinical and imaging follow-up was conducted at 30 days and 12-months.

Results: A total of 35 patients (20 females; median age 43 years) met study criteria. Technical success was achieved in 80% (28/35) of patients, with the Indigo System alone. There were no intra-procedure or immediate post-procedure complications. Adjunctive interventions included venous stents (with post-dilatation) in 97.1% of patients, thrombolytics in 37.1% of patients, and caval filters in 14.2% of patients. No DVT recurrence, pulmonary embolism, or deaths occurred over 12 months of follow-up except for one patient with active neo-plastic disease. Moderate to severe post-thrombotic syndrome occurred in two patients.

Conclusion: This study provides evidence that aspiration thrombectomy using the Indigo System is an effective treatment for acute iliofemoral DVT. There were no procedural complications and complication rates over the 12-month follow-up period were low.

Objectives: The aim of our study was to evaluate safety and efficacy of percutaneous vacuum-assisted thrombectomy (VAT) for treatment of acute thrombosis or thromboemboli of the superior mesenteric artery (SMA).

Methods: This study is a retrospective review of data from a multi-national registry, including consecutive patients with acute thrombosis or thromboemboli of the SMA who underwent VAT at 11 international study centers. Technical success was defined as successful removal of acute thrombus material without the need for alternative thrombectomy devices, systemic thrombolysis, or other revascularization strategies such as vascular surgery. Safety endpoints were in-hospital major adverse events e.g. intestinal gangrene or death. Mean follow-up period was 9.5 (3-16) months.

Results: A total of 98 patients (53 females; mean age 73 years; range 55-93 years) were included. Symptom onset defined as initial occurrence of abdominal pain to treatment time ranged from 8 hours to 7 days. Thromboemboli affected a native SMA vessel in all cases. Mean occlusion length was 20 mm (Range 18 to 22 mm). Technical success was achieved in 100% of cases. There was no relevant dissection, vessel rupture or peripheral embolization reported. Provisional stenting was required in 5 cases to treat underlying atherosclerotic stenosis. Mortality in the first 24 hours was 0%. Two deaths on day 27 and 28, following cardiac arrest from other co-morbidities were reported. Bowel resection was performed in 4 cases due to delayed intestinal gangrene.

Conclusions: Endovascular management using vacuum-assisted thrombectomy proved to be a safe and effective option for acute thrombotic SMA occlusion.

Purpose: To demonstrate the effectiveness of alkalinized local anaesthetic (LA) over plain LA in interventional radiology (IR) procedures, in terms of pain experienced by patient, and times of onset of LA action.

Materials and Methods: 34 patients requiring 2 endovascular access sites, within the same procedure (arterio-venous fistula salvage or bilateral iliac angioplasty/ stenting) were included in the study, 17 patients for each intervention. Alkalinized LA was infiltrated at one site, and plain LA at the other. Pain experienced (on the National Institute of Health numeric pain scale) was compared on LA infiltration and sheath placement for endovascular access, and the time of anesthesia onset was measured.

Results: A statistically significant difference was demonstrated in the amount of pain experienced by the patients, with a preference for alkalinized LA, which was also observed to have a quicker onset of action.

Conclusion: Use of alkalinized LA in IR procedures is effective, inexpensive and safe

Background: Nepal comes in the low-income nation with the health system working in very strenuous situation. Most of the health care is borne by the individual themselves. Even though geographically sitting close to China (where COVID-19 cases started) and India (where COVID-19 cases surged to the highest level), Nepal has been facing COVID-19 infection only recently. The exponential rise in cases, have brought the health system to the chaotic level. The late appearance of COVID-19 in Nepal has allowed us to understand more of the COVID-19 squeal.

Methods: A retrospective cases series of patients diagnosed with COVID-19 using reverse transcriptase polymerase chain reaction (rt-PCR) in nasopharyngeal swabs, who either first came with neurological symptoms or other symptoms were analyzed. The neurological disorder was diagnosed clinically with positive laboratory or imaging evidence. Results: Four patients were identified, median age 43.5 (range 28-57). Neurological disorders that were noted were seizure, ischemic stroke, and GuillainBarre syndrome (GBS).All patientshad history of taking antihypertensive drugs. None of them had any family history and were otherwise healthy. The blood work up of all these patientswas within normal limits, except in one patient who had marginally high glycosylated hemoglobin (HbA1C 7.2%).

Conclusion: COVID-19 can present with different kinds of symptoms. We believe this case series is first being reported from Nepal. Recently neurological disorder has been reported quite often. Hence, it is imperative that regardless of etiology,COVID-19 should be considered in the differential diagnosis for patients presenting with neurological disorder during the pandemic. Early consideration of COVID-19 thus may lead to earlier detection and appropriate precautions.

Background: Left atrial accessory appendages (LAAA) and left atrial diverticula (LAD) may be caused by structural remodeling. The aim of our study is therefore to investigate the relation between the occurrence of LAAA/LAD, different types of atrial fibrillation (AF) and cardiovascular risk factors affecting the atrial structure including age, diabetes mellitus, hypertension, and hypercholesterolemia, body mass index (BMI) and sex. To our knowledge, the relation between the occurrence of LAAA and LAD and cardiovascular risk factors has not yet been studied.

Methods: Cardiac CT scans were obtained from patients with sinus rhythm (N=402, SR) and a history of AF (N=422, AF) for evaluation of either coronary artery disease or atrial anatomy prior to pulmonary vein isolation (PVI) and were screened for the presence of LAD and LAAA. Clinical characteristics including cardiovascular risk factors were retrieved from the electronic medical records and correlated with the presence of LAAA/LAD.

Results: In 91 (22.6%) SR patients, a total of 90 LAAA and 4 LAD were detected and in the AF group (N=74, 17.5%), 75 LAAA and 2 LAD. LAAA/LAD prevalence did not differ between SR and AF patients (P=.067) nor between patients with paroxysmal and persistent AF (P=0 .924) Also, there was no relation was detected between LAAA/LAD prevalence and cardiovascular risk factors (P > .05).

Conclusion: The prevalence of LAAA/LAD in a large patient cohort was not associated with clinical profiles including AF subtypes and cardiovascular risk factors affecting atrial structure. Hence, it is unlikely that LAAA/LAD play an important role in the pathophysiology of AF.

Abbreviations: A: Anterior, AF: Atrial Fibrillation, AO: Aorta, BMI: Body Mass Index, CT: Computed Tomography, L: Left, LA: Left Atrium, LAA: Left Atrial Appendage, LAAA: Left Atrial Accessory Appendage, LAD: Left Atrial Diverticula, LSPV: Left Superior Pulmonary Vein, LIPV: Left Inferior Pulmonary Vein, P: Posterior, R: Right, RSPV: Right Superior Pulmonary Vein, RIPV: Right Inferior Pulmonary Vein, SR: Sinus Rhythm.