ABSTRACT
Background: Spindle cell lesions of gastro-intestinal tract (GIT) are relatively uncommon tumours compared to epithelial tumours. The anatomic location of spindle cell tumour is important, whether the tumour is located in mucosa, submucosa or muscularis propria.Methods: Authors endeavoured to study the histopathological spectrum of spindle cell lesions for a period of one year from January 2018 to December 2018 in our hospital.Results: This was a prospective study of 1 year starting from January 2018 to December 2018. A total of 30 cases of spindle cell lesions of gastrointestinal tract were seen. Out of 30 cases 23 were gastrointestinal stromal tumours (GIST), 2 cases were schwannomas, 2 cases were of leiomyomas, 1 case was fibromatosis, 1 case was inflammatory fibroid polyp, and one case was inflammatory myofibroblast tumour.Conclusion: GISTs are the commonest spindle cell tumours of GIT. Besides GIST, there are other spindle cell tumours which range from benign to malignant, and need to be differentiated from GIST for proper management
ABSTRACT
Background:The skin is the largest organ of the body, comprising of epidermis, dermis and hypodermis. Thus, a wide range of diseases can develop from the skin ranging from infectious diseases to malignancy, some of which may present as non-healing ulcers. Skin biopsy forms the fundamental basis for differentiation of similar looking lesions, thus helping the pathologists to make a definitive diagnosis and more so to the clinician for better management of patients. The objective was to study the histopathological spectrum of chronic non healing ulcers of skin for proper management and treatment.Methods:This was a hospital-based study which was conducted in SKIMS,Soura, a tertiary care hospital of Kashmir valley for a period of 1year extending from January 2018 to December 2018. All the patients who presented with the complaint of non-healing ulcer for more than 4 to 6 weeks were subjected to skin biopsy and histopathological examination.Results:A total of 260 biopsies were examined. Out of 260 patients 146 were males and 114 were females. Ninety out of 260cases (34.61%) and 170 (65.39%) were diagnosed as malignant and benign ulcers respectively.Diabetic ulcer was the second most common cause ofnon-healing ulcers followed by bacterial infections and tuberculosis. Squamous cell carcinoma was the most common neoplastic pathology. Conclusions: It was concluded from the study that non-healing skin ulcers can be encountered at any age in daily medical practice
ABSTRACT
Background:The gold standard for pulmonary artery pressure measurement is right heart catheterization but its invasive nature precludes its routine use. Main pulmonary arterial trunk calibreincrease is a strong indicator of underlying pulmonary arterial hypertension. MDCT can accurately measure the diameter of main pulmonary artery. The objective of the study was to establish the normative values of main pulmonary artery caliber using contrast enhanced CT and try to ascertain any significant difference in main pulmonary artery calibers between two genders and correlation of age and main pulmonary artery diameter. Methods:Contrast enhanced CT images of 462 subjects were analysed on a PACS workstation monitor and widest diameter perpendicular to long axis of the main pulmonary artery as seen on reformatted axial image was measured with electronic caliper tool at the level of the main pulmonary artery bifurcation.Results:The mean main pulmonary artery diameter in females was 22.54±2.19 mm and 23.34±3.06 mm in males. The mean pulmonary artery diameter in males was larger than females with statistically significant difference seen (p<0.05). The correlation coefficient between age of whole sample and their mean main pulmonary artery was found to be 0.1006 with no statistically significant difference.Conclusions:There is a statistically significant difference in the mean main pulmonary artery calibre between males and femaleswith no strong correlation between the age and mean main pulmonary artery calibre. Further studies are warranted to find the complex interaction between main pulmonary artery diameter and sex, age and body mass index
ABSTRACT
Background: Change in tracheal bifurcation angle (subcarinal angle) is an indirect marker of various cardiac, pulmonary and mediastinal pathologies. Helical computed tomography (CT) allows acquisition of volumetric set of data of the chest and can be used for accurate measurements of subcarinal angle using reconstructed images on a workstation using minimum intensity projection (MinIP).The objective of this study was to estimate normal subcarinal angle (SCA) of trachea by computed tomography and to assess its relationship with gender.Methods: This was an observational study comprising a study cohort of 552 patients comprising of 312 males and 240 females who were subjected to CT chest for various indications in our department. Patients with no underlying cardiac, mediastinal or pulmonary disease were included in the study. Spiral CT scan of chest was performed on 64-slice seimens CT SOMATOM and images were reconstructed with thickness of 1.5mm and the images were viewed in coronal reformatted minimum intensity projection (MinIP) for determination of subcarinal angle using the angle measuring tool provided in the workstationResults: The mean subcarinal angle (SCA) in males was (67.60±14.55). The mean subcarinal angle (SCA) in females was (78.90±11.04). Females had a higher mean SCA compared to males with a statistically significant difference (p-value <0.05).Conclusions: The mean SCA in females was higher compared to males with a statistically significant difference between the two. This study holds practical relevance with regard to the performance of invasive trachea-bronchial procedures like bronchoscopy and tracheal/bronchial intubation.
ABSTRACT
Background: The sphenoid sinus shows multitude of variations in pneumatization, size and pattern of septations leading to differences in its segmentation. Pre-operative knowledge of their attachment especially to posterolateral bony walls covering vital structures is of utmost importance for a safe trans-sphenoidal approach for various surgical procedures involving skull base. Non-contrast computed tomography (NCCT) with its ability to provide multiplanar reformations (MPR) with sharp algorithms is now a reference standard for visualization of these intra-sphenoid sinus septations preoperatively. The objective of this study was to determine the number and attachment of intra-sphenoid sinus septations in a Kashmiri population sample.Methods: NCCT head images of 591 patients in the age range of 16 to 75 years were analyzed retrospectively. Individuals with age less than 16 years, previous surgery involving skull base/sphenoid sinus, trauma causing hem sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. On the CT workstation multi-planar coronal, sagittal and axial reconstructions were performed and subsequently examined.Results: The age range was 16 to 75 years with mean age of 43.56 years of which 453 (76.6%) were males and 138 (23.4%) were females. Single intra-sphenoid septation was the most common anatomic variant in present study (79.7%) being complete in 71.7% and partial or incomplete in 8% of the examined subjects. Double septa were found in 11% inpresent study and more than 2 septae in 3.4%. After sellar attachment (51%) the next most common site of attachment was to the carotid canal (29.5%) (23% to left ICA and 6.5% to the right ICA).Conclusions: Intricate knowledge about sphenoid sinus, its pneumatization and anatomical variations in intra-sphenoid sinus septations and its relationship with the surrounding vital structures is of utmost importance before performing any endoscopic/open surgery involving skull base via trans-sphenoidal approach. The present study shows that a significant percentage of septal attachment to the carotid canal makes main sphenoidal septum as not so reliable landmark for endoscopic procedures as used to be in the pre-imaging era. Thus, preoperative CT is mandatory to avoid injuries to para-sellar neurovascular and glandular structures.
ABSTRACT
Background: An accidently ingested foreign body may get lodged within the lumen of gastrointestinal tract, pass uneventfully with feces or may migrate extraluminally into the surrounding tissues in which case it may lead to suppurative or vascular complications. The aim of the endeavor was to study the spectrum of imaging findings in patients with accidental ingestion of foreign bodies with trans-gastric migration of metallic foreign bodies.Methods: Total 33 patients with history of accidental ingestion of foreign bodies were subjected to preliminary radiograph of neck, chest and abdomen followed by upper gastrointestinal endoscopy. Failure to retrieve/ localize foreign body endoscopically from upper gastrointestinal tract with check radiograph reiterating the presence of foreign body in upper abdomen were subjected to computed tomography of abdomen.Results: A total of 33 patients comprising of 27 females and 6 males with mean age of 23.76 years with history of foreign body ingestion were studied. Ingested foreign bodies were lodged in pharynx (n=7), esophagus (n=3), stomach (n=13) or duodenum (n=3). In 7 patients in whom endoscopy failed to locate and/or retrieve foreign body, computed tomography confirmed the presence of trans-gastrically migrated foreign body in the surrounding structures. The location of migrated foreign bodies was in lesser sac (n = 2), greater omentum (n = 3), lesser omentum (n = 1) and transmural (n = 1). Two patients had evidence of collection formation around the migrated foreign bodies.Conclusions: Sharp or pointed metallic foreign bodies may migrate trans-luminally with various implications. Though radiography is the preliminary workhorse for the confirmation of ingested foreign bodies, computed tomography owing to its volumetric data acquisition helps in exact localization of migrated foreign bodies and should precede any therapeutic intervention for retrieval of migrated foreign bodies.
ABSTRACT
Background: PACS (Picture archiving and communication systems) and digital imaging (DI) has revolutionized radiology bringing about a paradigm shift in the way radiodiagnosis is perceived and practiced with a slew of benefits like elimination of the need for manual handling of films, helping in long term storage of digital images, easy transfer and retrieval of radiographic images. The objective of this study was to analyse the influence of PACS and digital imaging on the workflow in the radiology, performance of the radiographer and image storage and retrieval capabilities.Methods: It was a questionnaire-based study in which questions were asked to the radiographers working in our hospital at five different working sites. Each questionnaire was aimed to evaluate the effect of digital imaging on radiology workflow, improvement in the performance of radiographers, reduction in the work-related frustration levels due to use of digital imaging and finally the utility of digital imaging in image storage, query and retrieval.Results: Among the 50 questionnaires 41 were completed and retrieved. Among the respondents, 90.24% indicated that digital imaging has obviated the need for repeat examinations, 95.12% agreed with the fact that it resulted in the reduction of the number of reject images, 95.1% said it helped them in improving their performances, 92.6% of the respondents said they did not face any issue with its use and 95.1% of the participants agreed that the image query and retrieval could be accomplished in a hassle-free manner.Conclusions: The digital imaging technique not only improves the performance of the radiographers but also increases the workflow of the health care hospitals or clinics. The digital imaging reduces the number of rejected images thus reducing radiation exposure to the patients. Further, it is highly cost-effective and time-saving.
ABSTRACT
Introduction: Vertebral artery dissection (VAD) is animportant cause of posterior circulation stroke in youngpatients and presents with a host of clinically varied symptomsdepending upon the type and site of dissection. Currentresearch aimed to study the spectrum of magnetic resonanceimaging findings in vertebral artery dissection.Material and methods: This was an observational studywhere a cohort of 193 patients of posterior circulation strokewere evaluated with magnetic resonance imaging and amongthem 17 patients having vertebral artery dissection wereselected and magnetic resonance imaging findings werestudied using spin echo, diffusion weighted imaging and 3Dtime of flight MR angiography sequences.Results: Of the total 17 patients imaged with age range of23-59 years (mean age 38 years), 11 were males and 6 werefemales. V3 was the commonest site of dissection (n=10)followed by V4 (n=4) and V2 (n=3). The most commonpattern of dissection was steno-occlusive (n=15), whereas2 patients had aneurysmal type of dissection. T1W imagesrevealed intra-arterial thrombus in all the 17 patients. T2Wrevealed absent flow in vertebral artery in 5 patients. 3D TOFMRA revealed narrowed lumen in 10 patients and completeocclusion in 5 patients. One patient revealed intimal flap on3D TOF MRA.Conclusion: MRI is an excellent non-invasive modality forevaluation of posterior circulation stroke. MRI in conjunctionwith MR angiography helps clinch the diagnosis of VAD andthus helps in planning management and subsequent follow upof these patients.
ABSTRACT
Introduction: Encephalitis is defined as inflammation of thebrain parenchyma. Study was done to determine the role ofDWI/ADC in the early diagnosis of acute viral encephalitis.Material and methods: 26 patients with clinical andlaboratory (CSF, blood culture) evidence of encephalitis wereprospectively evaluated with MRI, DWI/ADC and SWI withpatients divided into three groups on the basis of durationbetween the onset of clinical symptoms and timing of MRIbrain.Results: Of the total 26 patients imaged with age range of 3-70years (mean age 45 years), 20 were males and 6 were femaleswith a male to female ratio of 3.3:1. Group 1 comprised 8patients, group 2 and group 3 comprised 9 patients each. Pvalues were significant (p<0.05) between mean ADC valuesand their respective groups. We also found statisticallysignificant difference between group 2 and group 3 (p=0.041)with no statistically significant difference between groups 1and 2; and groups 1 and 3.Conclusion: MRI plays vital role in patients of acuteencephalitis in not only excluding intracranial space occupyinglesions but also in early diagnosis and specific treatment, thusreducing disease related morbidity and mortality. DWI/ADCis now an essential sequence in the colossal armamentariumof MRI sequences which not only helps in early diagnosis ofacute viral encephalitis but also has prognostic implications.
ABSTRACT
Background: Pneumatisation of various bones around the nasal cavity results in the formation of paranasal sinuses. Varying degrees of pneumatisation result in multiple variations of paranasal sinuses some of which are important from clinical, pathological and surgical perspective. Objective: Determining the prevalence of various sinonasal anatomical variations on multi-detector computed tomography. Materials and methods: 852 patients with various symptoms of active rhinosinusitis were subjected to non-contrast enhanced CT examinations of the paranasal sinuses and nasal cavity. Multi-planar reconstructions were done in axial, coronal and sagittal plane and the reconstructed CT images were evaluated for the presence of anatomic variants of the sinonasal cavities and the prevalence of each variant was calculated. Results: Deviated nasal septum (DNS) was the most common anatomic variant of the paranasal sinuses and nasal cavity seen in 724 patients (85%), if minimal septal deviation (<1 mm) was also taken into account. The second most common variant was prominent ethmoid bulla which was present in 392 of 852 patients (46%). Dehiscent lamina papyracea (0.9%) and pneumatised crista galli (11.7%) were the least commonly seen sinonasal anatomic variants. Conclusion: Sinonasal anatomic variants are a rule rather than an exception, being present in a majority of population. These variations should be diagnosed and documented on CT examinations of paranasal sinuses to avoid any unforeseen complication during functional endoscopic sinus surgery and other skull base surgeries.
ABSTRACT
Background: Ultrasonography (USG) is a cheap, easily available and painless modality for the diagnosis of carpal tunnel syndrome. However, the main sonographic criteria of cross sectional area (CSA) and flattening ratio (FR) of median nerve show a wide normal variation which warrants establishment of normal range of variability in the dimensions of median nerve in different populations. Objective: The main aim of this study was to calculate the mean cross sectional area (CSA) and flattening ratio (FR) of median nerve at wrist in asymptomatic adults. Materials and methods: This prospective observational study included asymptomatic adults visiting our tertiary care hospital for unrelated heath conditions with no symptoms to suggest carpal tunnel syndrome. Ultrasound examination of both wrists was carried out by high frequency linear array transducer with frequency of 10MHz with the arm in supine neutral position on LOGIQ P5 (GE Healthcare, Chicago, Illinois, USA) ultrasound machine. The cross-sectional area (CSA) and flattening ratio (FR) of the median nerve was measured at the level of carpal tunnel inlet and mean values with standard deviation were calculated. Results: Three hundred seventy six (376) wrists of 188 subjects were examined. 36 wrists were excluded owing to presence of anatomic variations of the median nerve in them. 340 wrists of 170 patients were included in the study. Mean cross sectional area of median nerve was 9.2 mm2 (±1.2). Arshed Hussain Parry, Abdul Haseeb Wani, Naseer Ahmad Choh, Tariq Ahmad Gojwari. High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults. IAIM, 2019; 6(4): 144-149. Page 145 Mean value of flattening ratio was 2.4 (±0.6). Mean CSA (9.26 ±1.2 mm2 ) and FR (2.41 ±0.6) of males was not significantly different from mean CSA (9.16 ±1.2 mm2 ) and FR (2.4±0.55) of females. However, mean CSA of right wrist (9.4 ±1.2 mm2 ) was significantly different from mean CSA of left wrist (9.10 ±1.1 mm2 ). Conclusion: We found a higher mean cross sectional area (CSA) of 9.2 mm2 of median nerve in our population. There was a significant difference in the cross sectional area of median nerve between right and left wrists. However, we did not find statistically significant difference in the CSA and FR between the males and females. Establishment of normative data for the dimensions of median nerve is essential for different populations given the wide range of variations in the dimensions of median nerve
ABSTRACT
Background: An enormous number of artefacts are encountered in magnetic resonance imaging (MRI) which jeopardize the image quality. A comprehensive knowledge of the sources and the remedial measures needed is pivotal to enhance and optimize the image quality in magnetic resonance imaging (MRI). Objectives: The primary objectives of the study were to identify different MRI artefacts, to find the reason/cause of these artefacts and to find methods for correction of these artefacts. Materials and methods: This was a prospective study which included all the patients that were referred to our department for various MRI examinations. The study was carried at 1.5 tesla Magnetom Avanto Siemens, Germany. All the MRI examinations were performed by trained technologist in presence of an experienced radiologist. The MR images acquired were studied for the presence of any artefacts during the performance of MRI examination, the MR parameters at which the artefacts appeared and subsequently the remedial measures undertaken. Results: A total of 209 patients comprising 95 females and 114 males, referred to our department for MRI examinations of various body parts were studied. The commonest artefact observed was motion artefact in 43 (20.6%) patients followed by susceptibility artefact and aliasing artefact. Less common artefacts observed were chemical shift artefact, herring bone artefact, Gibb’s artefact, Moiré fringe artefact, zipper artefact and magic angle phenomenon. Arshed Hussain Parry, Abdul Haseeb Wani, Abdul Momin Jan, Tariq Ahmad Gojwari. Artefacts in magnetic resonance imaging (MRI) and their remedies. IAIM, 2019; 6(4): 122-130. Page 123 Conclusion: Thorough understanding of the sources of magnetic resonance imaging (MRI) artefacts and the mechanism of their production enables
ABSTRACT
Background Although blood urea nitrogen (BUN), creatinine (Cr) and electrolytes are not the mainstay of diagnosis in acute coronary syndrome (ACS) patients but they may have a role in providing a more detailed view of the complications and mortality rates. The aim of this study was to determine the efficacy of these parameters in the diagnosis and mortality risk-assessment of patients with ACS. Methodology A total of 200 patients with ACS were recruited in this prospective study. The relationship of serum BUN, Cr and electrolytes with cardiac enzymes, Global Registry of Acute Coronary Events (GRACE) and mortality was assessed during a 6-months follow-up. Statistical test like multivariate linear regression and binary logistic regression analysis were applied. Results On multivariate linear regression analysis, serum potassium (K) (Unstandardized Coefficient B = −3.77; p = 0.04) showed significant negative association with Creatine Kinease and serum BUN (Unstandardized Coefficient B = 0.52; p = 0.001) showed significant positive association with Troponin I. The patients with GRACE > 105 had significantly higher levels of serum BUN and Cr. Receiver operating characteristic curves showed that area under curve (AUC) of BUN (0.7) was higher than AUC of Cr (0.5). Multiple adjusted model showed that patients with BUN > 32.5 mg/dl were almost 20 times more likely to be associated with mortality as compared to reference group. Conclusion In addition to cardiac enzymes, K along with BUN and Cr may serve as important aid in diagnosis of ACS. BUN and Cr may also serve as important tools in mortality-risk assessment of ACS patients.
ABSTRACT
Background: Depression is a common debilitating illness contributing to increase in morbidity and mortality worldwide. 20% of all depressed patients are refractory to treatment with available antidepressants at adequate doses. Momordica charantia commonly known as Karela is widely used in Indian cuisine. This study was carried out to evaluate its lesser known Antidepressant activity. The objective of this study is to evaluate the Antidepressant activity of Aqueous extract of Momordica charantia leaves.Methods: This study was done in Department of Pharmacology, JNMC, AMU. Tail Suspension test and 5-Hydroxytrytophan induced Head Potentiation was evaluated in Swiss Albino mice. Forced swim test, Learned Helplessness test and Spontaneous motor activity was noted in Albino Wistar rats respectively at doses of AEMC (Aqueous extract of Momordica charantia leaves) 100mg/kg, 200mg/kg and 300mg/kg.Results: AEMC at all three doses 100mg/kg, 200mg/kg and 300mg/kg exhibited antidepressant activity by significantly decreasing the immobility time in Tail Suspension test and except 100mg/kg. In forced swim test psychostimulant activity of AEMC was ruled out in Spontaneous motor activity. Number of Escape failures was decreased in Learned Helplessness test at doses of AEMC 200mg/kg and 300 mg/kg. Increase in Head twitches was seen only with AEMC 300mg/kg in 5-Hydroxytrytophan induced Head Potentiation in mice.Conclusions: Aqueous Extract of Momordica Charantia leaves exhibits Antidepressant activity in animal models of Depression.
ABSTRACT
Background Recent studies have shown that complete blood count (CBC) parameters can effectively predict long-term mortality and re-infarction rates in acute coronary syndrome (ACS). However, the role of these parameters in predicting short term mortality has not been studied extensively. The main objective of this study was to determine whether CBC parameters can predict 30-days mortality and the incidence of major adverse cardiac event (MACE) in ACS patients. Methodology A total of 297 patients with ACS were recruited in this prospective study. The relationship of baseline white blood cell (WBC) to mean platelet volume ratio (WMR) with MACE and mortality was assessed during a 30-days follow up. The patients were divided into two groups: Group A [WMR < 1000] and Group B [WMR > 1000]. Multivariate COX regression was performed to calculate hazard ratios (HR). Results WMR had the highest area under receiver operating characteristics curve and highest discriminative ability amongst all CBC parameters in predicting mortality. Patients in Group B had a higher mortality rate (p < 0.001) than patients in Group A. WBC count (p = 0.02), platelet count (p = 0.04), WMR (p = 0.008), platelet to lymphocyte ratio (p < 0.001) and neutrophil to lymphocyte ratio (p = 0.03) were significantly higher in the MACE-positive group as compared to MACE-negative. In multivariate cox regression analysis, WMR > 1000 (HR = 2.9, 95% confidence interval 1.3–6.5, p = 0.01) was found to be strongest biochemical marker in predicting mortality. Conclusion WMR is an easily accessible and an inexpensive indicator, which may be used as a prognostic marker in patients with ACS.
ABSTRACT
Rheumatoid arthritis [RA] is an autoimmune disorder characterized by inflammation of synovium, cartilage damage and co-occurring of various other disorders. Significant improvement has been achieved in RA therapeutics in last two decades. However, newer, more efficient and more cost-effective therapeutic applications are still needed to be developed. Current therapies in RA are mostly acting to restrict inflammation. Non steroidal anti inflammatory drugs [NSAIDs] and disease modifying antirheumatic drugs [DMARDs] are conventionally used in RA therapy. Studies showed higher efficacy of anticyfokine therapy such as anti-IL-6 and anti-TNF. Rituximab, targeting B cells, after establishing its potential was approved to be used in combination with methotrexate in 2006. Abatacept, CLTA-4-IgGl, has been developed to block CD28 and CD80 or CD86 interaction leading to the termination T cell activation. Molecular inhibitors are relatively new in RA therapeutics such as tocilizumab, tofacitinib and baricitinib. PDA has approved tofacitinib to be used as a treatment for moderate and severe RA. Future holds promising therapeutic options based on numerous studies. IL-12, IL-17 and IL-23 are the targets of future anticytokine therapies. Several lymphocyte targeting agents including ofatumumab, ocrelizumab and veltuzumab have been developed and are currently in phase II and phase III clinical trials. There is a vast range of potential targets in RA enabling us to expand the therapeutic options over the next decade