Browsing by Author "Mishra, D"
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Publication Assessment of anatomical variations of nose and paranasal sinuses in multidetector computed tomography(Institute of Medicine, 2017) Yadav, RR; Ansari, MA; Humagain, M; Mishra, DAbstract Introduction: Paranasal sinuses are a group of air filled spaces developed as an expansion of the nasal cavities, eroding the adjacent bone structures. Conventional radiology does not permit a detailed study of anatomical variations of nose and paranasal sinuses. Currently, MDCT scanning is the standard imaging modality in the evaluation of the paranasal sinuses and anatomical variations. Methodology: A cross-sectional hospital based study of 128 patients referred for CT scan of PNS was conducted from October 2015 to February 2016. CT scan was done in 128 slice Siemens Somatom Definition AS+ CT scanner machine applying standard protocol set by the department of radiology and imaging, Tribhuvan University Teaching Hospital, Maharajgunj. The images were evaluated for presence of any anatomical variants in paranasal sinuses. Results: The absolute frequency of anatomical variations are Agger Nasi cell (75.8%) and DNS (68%) along with Concha Bullosa (35.9%), Paradoxical middle turbinate (26.6%), Haller’s cell (15.7%) and Onodi cell (18.8%). In this study the most frequent type of olfactory fossa was Keros type 2 (63.3%). The typical orientation of uncinate process was found in both sides 199 (77.73%) whereas medial deviation in left side (20.3%) and right side was (18.8%) along with lateral deviation in left side was (3.9%) and right side was found in (1.6%) only. Conclusion: Anatomical variations of nose and paranasal sinuses are best depicted on MDCT scan of PNS on coronal plane with thin slice (3.0 mm) section along with bone algorithm. Agger nasi cell is the commonest anatomical variation (75.8%) followed by DNS, Concha bullosa, Paradoxical middle turbinate, Onodi cells and Haller’s cells. Keywords: Concha bullosa, Multidetector CT, Osteomeatal complex, Paranasal SinusesPublication Cold Abscess of the Thigh in an Infant(Kathmandu University, 2013) Mishra, D; Mohta, A; Arora, PABSTRACT Local and minor adverse reactions to diphtheria–pertussis–tetanus (DPT) vaccination are usually mild and appear within 48 hours of vaccination. We herein report a rare association with intramuscular DPT injection and discuss pertinent issues. Primary tuberculous abscess was the final diagnosis. KEY WORDS Abscess, child, tuberculosisPublication Evaluation of Hounsfield Unit in adult brain structures by CT(Institute of Medicine, 2016) Mishra, D; Ghimire, RK; Chand, RB; Thapa, N; Panta, OBAbstract Introduction: The purpose of study was to evaluate the Hounsfield unit (HU) values in adult brain structures by computed tomography (CT). Hounsfield units (HU) describe relative densities of structures by CT. Different pathological process causes the change in attenuation by different tissues resulting in change of HU of the tissues so we should know the normal HU values to track the changes. These HU values are correlated with different clinical condition and different slice thickness. Methods: A prospective study was done in 72 patients of age above 18 years. All CT scans were performed using 16 row multi-detector CT (Neusoft New Viz16). Two sets of images were reconstructed first one with 5 X 5 mm and second one with 3 X 3 mm slice thickness. For quantitative analysis, HU measurements were obtained by drawing elliptical/ circular region-of-interests (ROI) on various anatomical structures on both 5mm and 3mm slice images. Statistical analysis was done with t test,one way ANOVA and descriptive analysis. Results: HU values for different anatomical area were: thalamus 34.50±1.92, caudate nucleus 36.64±2.01, internal capsule 31.40±2.16, pons 32.70± 2.39, dentate nucleus 30.70±2.22, cerebellar peduncle 30.90±2.37, hemisphere 39.62±2.38, vermis36.77±2.39, lateral ventricle 9.86±2.60, putamen 36.66±1.65, globus pallidus, 36.68±1.87, juxta 28.28±2.42, periventricular 29.18±2.78, deep 27.13±2.06, cortex 34.26±2.25, subcortical 27.36±2.49, corpus callosum 28.71±1.98. There was significant difference in HU values of genu of internal capsule, caudate nucleus, periventricular white matter, dentate nucleus, cerebellar peduncle & hemisphere for the 5mm and 3mm slice thickness. Conclusion: HU of gray and white matter of brain were 34.54 ± 2.54 and 28.25 ±2.00 respectively Keywords: Attenuation, Brain, Computed Tomography, Hounsfield Unit, Slice thicknessPublication Evaluation of image quality in CT chest by 50% mAs reduction(Institute of Medicine, 2015) Thapa, N; Humagain, MP; Mishra, D; Shrestha, SI; Ansari, MAAbstract Introduction: Conventional chest CT is usually performed in the setting between 220-280 mAs. Increase use of CT in recent times has the potential to increase radiation burden to the general population. The purpose of this study was to evaluate the image quality in CT Chest with 50% mAs reduction. Methods: This prospective study was done in 101 patients with age above 18 years and BMI less than 25kg/m2 who were referred for CECT chest examination. A 16 slice multi detector CT scanner was used to acquire non contrast at 120 kVp and 140 mAs, a modified protocol with 50% reduction in mAsand contrast enhanced scan at standard protocol of 120 kVp and 280 mAs. The images of plain and contrast enhanced scans were evaluated by two expert radiologists and given the image quality score in 5 point scale (1-worst, 2-suboptimal, 3- adequate, 4-good, 5-excellent) to each. Im- age noise was measured in images of each patient. Patient weight, height and BMI were recorded and correlated with image quality score. Statistical analysis was done with relevant test. Results: The overall image quality with standard protocol was significantly better (p<0.05) than modified protocol. The modified protocol had acceptable image quality score for patients with weight< 60 kg, BMI<25kg/m2. The CTDIvol was 11.15 with reduced mAs and 22.15 with standard mAs resulting in significant reduction in radiation dose of about 49%. Conclusion: Image quality of modified protocol with 50% mAs reduction i.e.140 mAs is accept- for average built patients and not patients with large anthropometric parameters. Keywords: Computed Tomography, mAs reduction, Image quality, Noise, Radiation dosePublication Interaction between warfarin and tamoxifen: A case report(Kathmandu University, 2007) Mishra, D; Paudel, R; Kishore, PV; Palaian, S; Bista, D; Mishra, PWarfarin is a commonly used anticoagulant with documented reports of drug interactions. Tamoxifen is used in the adjuvant hormonal treatment of women with oestrogen-receptor- positive breast cancer. Warfarin and tamoxifen are known to interact with each other with a resultant increase in the bleeding tendency. These reports are mainly from the white population. We report a case of drug interaction between warfarin and tamoxifen with an acute onset. This report suggests that when these drugs are co administered, careful monitoring of the coagulation profile is needed. Key words: Drug interaction, Tamoxifen, WarfarinPublication Macrophage activation syndrome in an inadequately treated patient with systemic onset juvenile idiopathic arthritis(Kathmandu University, 2009) Juneja, M; Jain, R; Mishra, DAbstract Macrophage activation syndrome is a rare and potentially life threatening complication of childhood rheumatic disorders. It is described most commonly with systemic onset juvenile idiopathic arthritis (soJIA). The major clinical manifestations are non-remitting fever, hepatosplenomegaly, lymphadenopathy, bleeding diathesis, altered mental status and rash and may mimic a flare of soJIA. The characteristic laboratory findings are leucopenia, thrombocytopenia and dramatic elevation of urinary β2 microglobulin. Corticosteroids and Cyclosporine are the drugs commonly used in its management. Early diagnosis and prompt treatment can be life saving. We report a case of 12 year old female child with inadequately treated systemic onset juvenile idiopathic arthritis who developed fatal macrophage activation syndrome. The diagnosis and management of macrophage activation syndrome are discussed. Key words: Macrophage activation syndrome, systemic onset juvenile idiopathic arthritis, leucopenia, children.Publication Macrophage activation syndrome in an inadequately treated patient with systemic onset juvenile idiopathic arthritis(Kathmandu University, 2009) Juneja, M; Jain, R; Mishra, DAbstract Macrophage activation syndrome is a rare and potentially life threatening complication of childhood rheumatic disorders. It is described most commonly with systemic onset juvenile idiopathic arthritis (soJIA). The major clinical manifestations are non-remitting fever, hepatosplenomegaly, lymphadenopathy, bleeding diathesis, altered mental status and rash and may mimic a flare of soJIA. The characteristic laboratory findings are leucopenia, thrombocytopenia and dramatic elevation of urinary β2 microglobulin. Corticosteroids and cyclosporine are the drugs commonly used in its management. Early diagnosis and prompt treatment can be life saving. We report a case of 12 year old female child with inadequately treated systemic onset juvenile idiopathic arthritis who developed fatal macrophage activation syndrome. The diagnosis and management of macrophage activation syndrome are discussed. Key words: Macrophage activation syndrome, systemic onset juvenile idiopathic arthritis, leucopenia, children.Publication Pattern of poisoning cases in a teaching hospital in Western Nepal(Institute of Medicine, 2008) Kishore, PV; Palaian, S; Paudel, R; Mishra, D; Ojha, P; Alam, K; Mishra, PAbstract Introduction: Poisoning is a common problem in Nepal. Data from the Western region of Nepal are lacking. The present study analyzed the clinical profile and the management pattern of poisoning cases admitted to the Manipal Teaching Hospital (MTH). Methods: The poisoning cases treated at Manipal Teaching Hospital from January 2003 to June 2006 were studied. Results: A total of 98 poisoning cases (0.51% of Emergency department admissions) were treated (female 54.08 %) and age group 21-40 years (44.90 %). Nearly one third (32.65%) reached the hospital with in two hours of poison consumption. The median (interquartile range) duration of the hospital stay was 4 (2) days. The poisoning was intentional in 79.59% cases. The route of exposure was mainly oral (96.94%). Rat poison was the commonest poison (31.68%) followed by drugs (22.77%). Majority (83.67%) received symptomatic treatment. Secondary complications were observed in 28.57% and the overall fatality rate was 18.37%. Rat poison was responsible for 5 deaths. Nearly two thirds (65.31%) of the total cases received psychological counseling. Conclusion: Similar studies covering different hospitals conducted over a long period are needed to confirm our findings. Keywords: Drug over dosage, Poisoning profile, Rodenticide, Western Nepal