Dhulikhel Hospital Checklist Protocol for Temporal Bone Computed Tomography Scan Analysis: How We Do It?

The temporal bone is very complicated anatomical structure. Any disease process within this structure mandates thorough anatomical knowledge of the corresponding structure. The High resolution computed tomography (HRCT) temporal bone is the best way to look inside this complex bone. The importance of knowledge about how to read and look inside the CT scan temporal bone lead us develop the Dhulikhel Hospital Check list protocol. This protocol will help aspiring otologist and otolaryngologist to read and know details about the underlying structures.

Epidermoid Cyst of the Ear Lobule in Adult.

An epidermoid cyst is one of the most common benign cysts of the skin. The cyst is filled with keratin flakes and its wall is composed of keratinized, stratified, squamous epithelium. Epidermoid cysts can occur anywhere on the body, usually along the lines of embryonic fusion and mostly on the face, scalp, neck, chest, and upper back. Around 80% of the epidermoid cysts are seen in ovaries and testicles whereas, in the head and neck, they account for only about 7% and 1.6% of epidermoid cysts are reported in the oral cavity. The condition can be congenital or acquired. Congenital causes are rare and may be caused by the entrapment of ectodermal elements intradermally or subcutaneously during embryogenesis. Acquired causes of an epidermoid cyst may result from traumatic or iatrogenic implantation of epithelial cells into the dermal layer or from obstruction of a pilosebaceous unit in the hair follicle. Surgical excision completes the treatment.

Universal Neonatal Hearing Screening: An Experience at Tertiary Care Hospital.

Background Hearing loss among neonates is one of the important health issue in pediatric population which may remain unnoticed until the child reaches a certain age. The importance of universal early screening, diagnosis and intervention in reducing the negative impact of congenital hearing loss has been described all over the world. Objective To observe the outcome of hearing screening by Automated Auditory Brainstem Response (AABR) in newborns delivered in Dhulikhel Hospital and neonates admitted in an intensive care unit (NICU) of Dhulikhel Hospital. Method A prospective study was done in neonates who were born at Dhulikhel Hospital, Kathmandu University Hospital from February 15th, 2017 to October 30th, 2019. AABR was used for their hearing assessment within 24 hours of birth and again at about 6 weeks of age in those neonates who failed the initial test. All the neonates admitted in NICU were studied regarding the risk factors based on Joint committee on Infant Hearing. Those who failed the test for the second time were referred for detailed audiological diagnostic work up. Result The screening rate was 92.6% of the total deliveries. A total of 5517 neonates comprising of 2800 males and 2717 females were screened from total deliveries of 5956 neonates in the study period. Among them, NICU (sick) babies were 422 (7.7%) and well babies were 5095 (92.3%). Out of them, 1675 failed the test in the first screening and 374 failed in the second screening. So, the total number of referred babies in second screening was 6.7% (374) out of 5517 screened. Amongst them, well babies were 6.59% (336), out of 5095 screened and sick babies were 9% (38) out of 422 screened. Low birth weight and prematurity were found to be the commonest risk factor present among them, followed by the use of ototoxic medications, hyperbilirubinemia and prolonged use of mechanical ventilation. Conclusion Automated Auditory Brainstem Response (AABR) is a very useful tool for hearing screening which should preferably be done in all the neonates where possible. It should be done within one month of life and those with confirmed hearing loss should receive early appropriate intervention for better hearing in future.

Idiopathic Bilateral Optic Neuritis.

Idiopathic bilateral optic neuritis in adult has been reported very rarely. The objective of this report is to present a case of idiopathic bilateral optic neuritis in adult and treatment responses. A nineteen year old female presented with bilateral optic neuritis. It was characterized by decreased visual acuity, painful ocular motility and sluggish pupillary reaction with Relative Afferent Pupillary Defect (RAPD) in left eye, hyperemic and generalized optic disc swelling and central scotoma in Humphrey visual field of both eyes. MRI showed diffuse thickening and irregularly outlined optic nerves of both eyes. Idiopathic bilateral optic neuritis in adults is a rare presentation. Prompt treatment with optic neuritis treatment trial (ONTT) improved the visual outcome.

Lifespan Trajectories of White Matter Changes in Rhesus Monkeys.

Progress in neurodevelopmental brain research has been achieved through the use of animal models. Such models not only help understanding biological changes that govern brain development, maturation and aging, but are also essential for identifying possible mechanisms of neurodevelopmental and age-related chronic disorders, and to evaluate possible interventions with potential relevance to human disease. Genetic relationship of rhesus monkeys to humans makes those animals a great candidate for such models. With the typical lifespan of 25 years, they undergo cognitive maturation and aging that is similar to this observed in humans. Quantitative structural neuroimaging has been proposed as one of the candidate in vivo biomarkers for tracking white matter brain maturation and aging. While lifespan trajectories of white matter changes have been mapped in humans, such knowledge is not available for nonhuman primates. Here, we analyze and model lifespan trajectories of white matter microstructure using in vivo diffusion imaging in a sample of 44 rhesus monkeys. We report quantitative parameters (including slopes and peaks) of lifespan trajectories for 8 individual white matter tracts. We show different trajectories for cellular and extracellular microstructural imaging components that are associated with white matter maturation and aging, and discuss similarities and differences between those in humans and rhesus monkeys, the importance of our findings, and future directions for the field. Significance Statement: Quantitative structural neuroimaging has been proposed as one of the candidate in vivo biomarkers for tracking brain maturation and aging. While lifespan trajectories of structural white matter changes have been mapped in humans, such knowledge is not available for rhesus monkeys. We present here results of the analysis and modeling of the lifespan trajectories of white matter microstructure using in vivo diffusion imaging in a sample of 44 rhesus monkeys (age 4-27). We report and anatomically map lifespan changes related to cellular and extracellular microstructural components that are associated with white matter maturation and aging.

Advanced diffusion imaging for assessing normal white matter development in neonates and characterizing aberrant development in congenital heart disease.

Background: Elucidating developmental trajectories of white matter (WM) microstructure is critically important for understanding normal development and regional vulnerabilities in several brain disorders. Diffusion Weighted Imaging (DWI) is currently the method of choice for in-vivo white matter assessment. A majority of neonatal studies use the standard Diffusion Tensor Imaging (DTI) model although more advanced models such as the Neurite Orientation Dispersion and Density Imaging (NODDI) model and the Gaussian Mixture Model (GMM) have been used in adult population. In this study, we compare the ability of these three diffusion models to detect regional white matter maturation in typically developing control (TDC) neonates and regional abnormalities in neonates with congenital heart disease (CHD). Methods: Multiple b-value diffusion Magnetic Resonance Imaging (dMRI) data were acquired from TDC neonates (N = 16) at 38 to 47 gestational weeks (GW) and CHD neonates (N = 19) aged 37 weeks to 41 weeks. Measures calculated from the diffusion signal included not only Mean Diffusivity (MD) and Fractional Anisotropy (FA) derived from the standard DTI model, but also three advanced diffusion measures, namely, the fiber Orientation Dispersion Index (ODI), the isotropic volume fraction (Viso), and the intracellular volume fraction (Vic) derived from the NODDI model. Further, we used two novel measures from a non-parametric GMM, namely the Return-to-Origin Probability (RTOP) and Return-to-Axis Probability (RTAP), which are sensitive to axonal/cellular volume and density respectively. Using atlas-based registration, 22 white matter regions (6 projection, 4 association, and 1 callosal pathways bilaterally in each hemisphere) were selected and the mean value of all 7 measures were calculated in each region. These values were used as dependent variables, with GW as the independent variable in a linear regression model. Finally, we compared CHD and TDC groups on these measures in each ROI after removing age-related trends from both the groups. Results: Linear analysis in the TDC population revealed significant correlations with GW (age) in 12 projection pathways for MD, Vic, RTAP, and 11 pathways for RTOP. Several association pathways were also significantly correlated with GW for MD, Vic, RTAP, and RTOP. The right callosal pathway was significantly correlated with GW for Vic. Consistent with the pathophysiology of altered development in CHD, diffusion measures demonstrated differences in the association pathways involved in language systems, namely the Uncinate Fasciculus (UF), the Inferior Fronto-occipital Fasciculus (IFOF), and the Superior Longitudinal Fasciculus (SLF). Overall, the group comparison between CHD and TDC revealed lower FA, Vic, RTAP, and RTOP for CHD bilaterally in the a) UF, b) Corpus Callosum (CC), and c) Superior Fronto-Occipital Fasciculus (SFOF). Moreover, FA was lower for CHD in the a) left SLF, b) bilateral Anterior Corona Radiata (ACR) and left Retrolenticular part of the Internal Capsule (RIC). Vic was also lower for CHD in the left Posterior Limb of the Internal Capsule (PLIC). ODI was higher for CHD in the left CC. RTAP was lower for CHD in the left IFOF, while RTOP was lower in CHD in the: a) left ACR, b) left IFOF and c) right Anterior Limb of the Internal Capsule (ALIC). Conclusion: In this study, all three methods revealed the expected changes in the WM regions during the early postnatal weeks; however, GMM outperformed DTI and NODDI as it showed significantly larger effect sizes while detecting differences between the TDC and CHD neonates. Future studies based on a larger sample are needed to confirm these results and to explore clinical correlates.

Blood Splashes Risk During Otorhinolaryngology Surgery: A Tertiary Care Hospital Based Study.

Background ENT (Ear, Nose and Throat) surgeons are particularly at high risk of exposure with blood and body fluid related infections both in Outpatient and during surgical procedures. They do take precaution to avoid the needle stick injuries but few pay attention on blood or body fluid splashes into eye. Objective To find out the risk of blood splashes to both surgeon and assistant during otorhinolaryngology surgeries. Method This was an descriptive study and data were collected prospectively in Department of Ear, Nose and Throat-Head and Neck Surgery of Dhulikhel Hospital, Kathmandu University Hospital in 1 year period from 1st January 2017 to 1st January 2018. All the surgical cases were included in the study. The surgeon and assistant wore the glass and mask during the surgery. At the end of the surgery, the glass, mask and gown were inspected for any blood splashes and information was recorded. Result There were total 272 patients with male 119 and female 153. The amount of blood splatter in glass, mask and gown is most common in modified radical mastoidectomy surgery. Likewise, the blood splatter is most common in tonsillectomy in throat surgery and in head and neck surgery, the blood splatter is common in all head and neck surgery. Conclusion The blood splashes is high in various Ear, Nose and Throat surgeries. So it is important to take precaution by surgeon and assistant, like protective mask and glass worn during surgeries to protect from various blood-borne infection transmissions.

Prevalence of and associated risk factors for pterygium in the high altitude communities of Upper Mustang, Nepal.

OBJECTIVE: To determine the prevalenceof and associated risk factors for pterygiumin the high altitude communities of the Upper Mustang region of Nepal, near the Tibet border. MATERIALS AND METHODS: Six villages of the Upper Mustang were selected based on the concentration of population. All subjects were permanent residents aged 16 years and older, and recruited through a household census with mobilization of local monks who had been trained as interviewers, and people were invited to attend the eye clinic for a complete examination. A cross-sectional studywas conducted which included the parameters oflaterality, severity, occupation, age, sex and altitude of residence. RESULTS: The study population comprised 1,319 individuals of which 637 (48.29%) weremale and682 (51.71%) were female.The overall prevalence of pterygium, was 10.08% (133 of 1,319), with 42.86% for males and 57.14% for females. The mean age of the subjects was45.83 years and the mean SD 17.94. The majority of the subjects had a unilateral pterygium. The right eye(n=63) was predominately affected, in 57.80% of the total subjects. Farmers and construction workers, which comprised of 36.09% and 28.57% respectively, had a higher prevalence of pterygium. The most affected age group was the 66 to 75 years group (n=31: 23.31%). The prevalence increased linearly with age. The severe Grade III and Grade IV pterygium were predominant in the age group of 56-65 years, comprising 28.58% of all the cases;the less severe Grade I was also predominant in the same age group,with 23.56%, and Grade II (0-2 mm) was predominant in the age group of 46-55, with 31.03%. CONCLUSION: Pterygiumisa significant public health problem in the high altitude communities of Nepal. It is more prevalent amongst the farmers than in the other professionals.

Pattern of ocular trauma in the western region of Nepal.

INTRODUCTION: Ocular trauma is an important cause of unilateral blindness. OBJECTIVE: To determine the characteristics and visual outcome of ocular trauma in the western region of Nepal. MATERIALS AND METHODS: All cases of ocular trauma presenting in a one-year period to the Himalaya Eye Hospital were retrospectively reviewed. The demographic features, type and cause of trauma, time lapse before presenting to the hospital, management and results were noted. RESULTS: Eleven hundred eyes of 1,069 patients (31 bilateral injuries) were included in this study. Males were predominantly affected (69.3 %) compared to their female counterparts. The average age of the patients presenting with trauma was 28.3 years. On reviewing the causes of trauma, blunt trauma which accounted for 56.5 % was the commonest of all, followed by sharp injury accounting for 16.7 %. The commonest type of trauma was closed globe injury (73.3 %). The visual outcome was poorer in open globe injury as compared to closed globe injury. Of the total cases, only 52.9 % presented to the hospital within 24 hours.Over 7 % of them presented as late as one week. Among these patients, 74.8 % of them had regained normal vision (6/18) and 8 % of the total became blind (less than 3/60) according to the WHO criteria. CONCLUSION: Males are more prone to ocular trauma than the females. Open globe injury and late presentation are probably the worst prognostic factors for the visual outcome. There is a need of educating the community regarding the importance of seeking immediate medical care after ocular trauma in a country like Nepal.

Production and nutrient dynamics of reproductive components of teak trees in the dry tropics.

Dry matter production and nutrient dynamics were quantified in the reproductive components of 14- and 30-year-old teak (Tectona grandis L.) stands growing in a dry tropical region. Flower production per tree was positively related to tree size. Despite massive flower production (33 x 10(6) and 171 x 10(6) ha(-1) year(-1) in 14- and 30-year-old trees, respectively), only about 0.5-0.7% flowers developed into fruits. Immature fruit abscission totalled 34 and 58% of the total number of fruits initiated in the 14- and 30-year-old stands, respectively. The production of reproductive components (flowers, peduncles and fruits) was 245 kg ha(-1) year(-1) in the 14-year-old stand and 1122 kg ha(-1) year(-1) in the 30-year-old stand. In both stands, relatively greater amounts of dry matter and nutrients were allocated to reproductive parts in September than in other months. Toward the end of the fruit maturation period, considerable nutrient resorption occurred. More than 90% of the nutrients accumulated in the peduncle were resorbed. Smaller amounts, ranging from 21% for K to 58% for N, were resorbed from mature, winged indehiscent fruits.