Magnetic Resonance Imaging Evaluation of Suspected High-Altitude Cerebral Edema in Patients from High Altitude.

BACKGROUND: Trekkers in high altitude of Himalayas could lead to Acute Mountain Sickness and High Altitude Cerebral Edema. This study was conducted to evaluate magnetic resonance imaging findings among the clinically suspected High Altitude Cerebral Edema patients rescued from high altitudes in Nepal Himalayas. METHODS: 49 patients with clinically suspected High Altitude Cerebral Edema were retrospectively evaluated in this cross-sectional study who were sent for a brain magnetic resonance imaging. They were categorized in 3 groups according to the magnetic resonance imaging features in this study. RESULTS: There was a slight male preponderance. 6 patients (12.25%) had magnetic resonance imaging findings highly suggestive of High Altitude Cerebral Edema. 5 patients had T2 high signal intensity and restricted diffusion in the splenium of corpus callosum of which 3 had features of microhemorrhage. One patient with normal brain morphology and intensity in T1, T2, and FLAIR images showed innumerable variable-sized microhemorrhages in Susceptibility Weighted Imaging. 14 of patients showed various T2 and FLAIR white matter high signal intensity without restricted diffusion. And one patient had features of subacute lacunar infarcts. 28 patients (57.14 %) showed no abnormal signal changes in the magnetic resonance imaging scan. CONCLUSIONS: Typical magnetic resonance imaging features of cytotoxic edema in corpus callosum and microhemorrhage in the patients with High Altitude Cerebral Edema further support the findings in other similar studies. T2 white matter hyperintensities in deep, subcortical or periventricular location and lacunar infarcts could be seen in High Altitude Cerebral Edema. Normal magnetic resonance imaging of the brain is not infrequent.

Magnetic Resonance Imaging Findings in Spondylodiscitis.

BACKGROUND: Magnetic Resonance Imaging is the imaging modality of choice for imaging spinal infection due to its high sensitivity and specificity. This study aims to study the magnetic resonance imaging changes in patients with spondylodiscitis. METHODS: The study was a retrospective study carried in a multimodality imaging centre in Kathmandu. Magnetic resonance imaging records and clinical record of 3 years duration were reviewed and patients with clinical and radiological diagnosis of spondylodiscitis were included in the study. Three radiologists interpreted Magnetic Resonance Imaging with mutual consensus in disputed issues. Data analysis was done with Statistical Package for Social Sciences21.0. RESULTS: A total of 52 patients were included in the study. The mean age of the patients was 43.9 ± 17.6 years. Spondylodiscitis involved lumbar spine in 26(50%) case, cervical and thoracic spine in 13(25%) cases each. Multiple IV discs were involved in 24(46.2%) cases, which was most common in cervical spine and least common in thoracic spine. Only one vertebral end plate was involved in 16(30.8%) cases. Epidural collection was seen in 23(44.2%) cases and paravertebral collection was noted in 63(33.5%) cases. Statistical significant difference in region of spine involved (p=0.02) and epidural collection (p=0.04) was noted between genders. CONCLUSIONS: Lumbar spine was the most common level involved with spondylodiscitis, perivertebral enhancing soft tissue was present in all cases, and involvement of disc and the endplates were the most common pattern.

Tuberculosis in Staff and Students of Patan Hospital.

BACKGROUND: There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not routinely implemented. The aim of this study was to determine the prevalence of active tuberculosis among staff/students at Patan Hospital. METHODS: Participants were given a self-administered questionnaire and invited to undergo chest radiography. Cases were scored and reviewed based on predetermined criteria, and presumptive tuberculosis cases were invited to undergo sputum smear and culture. Participants were categorized according to the extent of patient contact and asked about history of tuberculosis medication. RESULTS: Among 560 participants, 76.8% had direct contact with patients. Fifty-eight (10.4%) gave history of cough >2 weeks. Based on symptom history and chest radiography, 20.0% (n=112) cases were reviewed, and 12.5% (n=14) of those reviewed had sputum tested for acid-fast bacilli. One participant had culture-positive tuberculosis. Fifty participants (8.9%) reported tuberculosis in the past, among which 42.0% (n=21) occurred after employment at Patan Hospital and 42.0% before joining Patan Hospital. Security staff, radiology technicians and ward cleaning staff had the highest proportion of cases with a history of tuberculosis.History of tuberculosis medication had no relation with age, sex, education, body mass index and smoking.The incidence rate of tuberculosis at Patan Hospital was 3.6 per 1000 person-years. CONCLUSIONS: Overall incidence of tuberculosis among healthcare workers is noteworthy. However, this study suggests when symptomatic tuberculosis occurs in healthcare worker at Patan Hospital, it is diagnosed and there is not a large pool of undiagnosed tuberculosis.

Correlation of gestational age by sonographic measurement of fetal parameters in women in eastern Nepal with existing standard normograms.

This is the prospective study carried out to correlate gestational age by sonographic measurements of fetal parameters by normograms of Frank P Hadlock with the gestational age by Last Menstrual Period (LMP) (considered our standard) in various trimesters of normal pregnant women of eastern Nepal. Seventy normal pregnant women with regular menstrual cycles of eastern Nepal were evaluated in this study. Gestational age was calculated by Rempen (in case of Mean Sac Diameter) and Hadlock (in case of Biparietal Diameter, Head circumference, Femoral Length and Abdominal circumference) normograms. Calculations of gestational age was also done by LMP at the same time. Correlation of gestational age by Rempen and Hadlock with average of different fetal parameters in different trimesters was done with gestational age by LMP applying paired t test. On applying paired t test between gestational age by Mean Sac Diameter and Crown-Rump Length in the first trimesters, mean difference was only -3.58 days (significance < 0.01). It showed statistically significant difference though difference is little. Paired t test application in second trimester showed significant difference (-5.06 days) with gestational age by LMP at < 001 significance level. In 3rd trimesters, paired t test showed significant difference with gestational age by LMP with mean of difference -7.86 days. Significant difference between average gestational age by Hadlock and gestational age by LMP in 2nd and 3rd trimesters of pregnancy indicates that we should stantardise our measurements of different fetal parameters for estimation of gestational age.

Correlation of gestational age by sonographic measurement of fetal parameters in women in eastern Nepal with existing standard normograms.

This is the prospective study carried out to correlate gestational age by sonographic measurements of fetal parameters by normograms of Frank P Hadlock with the gestational age by Last Menstrual Period (LMP) (considered our standard) in various trimesters of normal pregnant women of eastern Nepal. Seventy normal pregnant women with regular menstrual cycles of eastern Nepal were evaluated in this study. Gestational age was calculated by Rempen (in case of Mean Sac Diameter) and Hadlock (in case of Biparietal Diameter, Head circumference, Femoral Length and Abdominal circumference) normograms. Calculations of gestational age was also done by LMP at the same time. Correlation of gestational age by Rempen and Hadlock with average of different fetal parameters in different trimesters was done with gestational age by LMP applying paired t test. On applying paired t test between gestational age by Mean Sac Diameter and Crown-Rump Length in the first trimesters, mean difference was only -3.58 days (significance < 0.01). It showed statistically significant difference though difference is little. Paired t test application in second trimester showed significant difference (-5.06 days) with gestational age by LMP at < 001 significance level. In 3rd trimesters, paired t test showed significant difference with gestational age by LMP with mean of difference -7.86 days. Significant difference between average gestational age by Hadlock and gestational age by LMP in 2nd and 3rd trimesters of pregnancy indicates that we should stantardise our measurements of different fetal parameters for estimation of gestational age.