Radiological Approach to Diagnosis of Peribiliary Lesions

Peribiliary region is the anatomical space adjoining the intra and extrahepatic biliary system and comprises of portal vein, hepatic artery, nerves and lymphatics. This region is prone to several pathologies ranging from congenital, infective, inflammatory, traumatic and neoplastic. Due to the wide spectrum of abnormalities, it is often difficult to reach a final diagnosis. This review focusses to draw a roadmap to help reach a diagnosis of abnormalities encountered in this region by highlighting the characteristic imaging features associated with these abnormalities.

Assessment of pSOFA-L score in predicting the clinical outcome of critically ill children

Background: Recently Pediatric Sequential Organ Failure Assessment (pSOFA) score was adapted and validated in critically ill children to predict the clinical outcome. This study was aimed to evaluate the lactate level association with the outcome and thereby formulating pSOFA-L score to predict the clinical outcome better in critically ill children.Methods: This hospital based prospective, observational, analytical study was conducted in the Department of Paediatrics, A. J Hospital, Mangalore, Karnataka. Requirement of oxygen, inotrope support and other parameters were studied and compared the score with clinical outcome. A total of 75 cases were studied.Results: In this study total of 51 children had high serum lactate levels (68%). Out of 28 expired children 23 children had higher serum lactate levels that accounts for about 82.14% which is statistically significant (p<0.001). ROC curve of pSOFA-L score in predicting the mortality yielded AUC: 0.92 and cut off value: 10.5 which is statistically significant (p<0.001). In the present study mortality rate was 26.09% in children whose pSOFA-L score was less than 9 and mortality rate of 38.89% and 50.00% in children whose pSOFA-L score was 9 to 11 and more than 11 respectively.Conclusions: In this study increase in pSOFA-L score is associated with high mortality and poor outcome. The findings of the present study validate and emphasize that, pSOFA-L score helps in accurate prediction of mortality of critically ill children.

Clinical and imaging correlation of cerebral palsy: a retrospective study in a tertiary care centre

Background: Cerebral Palsy is the most common chronic motor disorder of childhood. Clinical spectrum is different in developing and developed countries. Aim of the study was to evaluate the clinical profile, co-morbidities and the imaging correlate of children with CP.Methods: Data was collected retrospectively from individual case records from March 2016 to October 2018. All children aged 2 years and above with clinical signs of cerebral palsy were included in the study.Results: A total of 78 children had the diagnosis of cerebral palsy, out of which 63 cases were included which satisfied the inclusion criteria. Most of the children were born out of singleton pregnancy (90.4%). The mean gestational age was 36.94'1.48 weeks. Most common type of cerebral palsy noted in present study was spastic quadriplegic type (n=34) followed by diplegic type (n=14). Epilepsy was associated in 36.5% (n=23) of children, and most commonly associated with spastic quadriplegic type of cerebral palsy(n=16). Other associated abnormalities included mental retardation, speech, hearing, cognitive, and behavioral abnormalities. Magnetic resonance imaging was normal in 60.3% (n=38) of children and abnormal in 39.68% (n=25) of children. Diffuse cerebral atrophy was the most common abnormal finding (n=9). Other abnormal findings included periventricular leucomalacia, basal ganglia lesions, cortical/subcortical lesion, focal infarcts and miscellaneous lesions.Conclusions: MRI helps in knowing the pathological basis of the disease, but clinical findings carry utmost importance. MRI positivity was seen in only 39.68% of cases. Hearing abnormalities being the most common association, proper screening tests and regular follow up is very essential.

Prevalence of vitamin D deficiency in children with lower respiratory tract infection

Background: Vitamin D has a role in lung growth, preserving lung function, and preventing pulmonary infection.Methods: Hospital based cross sectional prospective study was done for a period of one year from January 2017 to December 2017, at the AJ Institute of Medical Sciences, Mangalore. A total of 69 patients were admitted with LRTI during the duration of 1 year, which includes pneumonia and bronchiolitis. Out of 69 patients admitted with LRTI, 10 were excluded from the study as they were not fulfilled the criteria.Results: A total 59 children were enrolled in the study with LRTI, out of which 50 (84.7%) were vitamin D deficiency 6 (10.1%) were insufficiency and only 3 (5.08%) had normal vitamin D values, which was statistically highly significant with p value <0.05. Vitamin D deficiency is more common in less than 1 year and also in male child. Vitamin D deficiency is also common among preterm babies who were not on Vitamin D supplements, exclusively breast fed babies and among lower socio economic status especially in class 4. Authors found that 13 (22.03%) members were having a history of previous LRTI out of which 11 (84.6%), 2 (15.3%) had Vitamin D deficiency and insufficiency respectively. Among study group, 16 (27.11%) were diagnosed to have bronchiolitis, out of which 10 (62.5%), 4 (25%), 2 (12.5%) patients were found to have Vitamin D deficiency, insufficiency and normal values respectively. Children who diagnosed as pneumonia were 43 (72.88%), out of them 40 (93%), 2 (4.6%), 1 (2.3%) were having deficiency, insufficiency and normal values of Vitamin D respectively.Conclusions: Vitamin D deficiency is common in children with LRTI especially among exclusively breastfed, born preterm and children from lower socio economic status. Early recognition and treatment of Vitamin D deficiency can prevent morbidity associated with rickets and possibly frequent LRTI.

Norethindrone-induced masculinization and progeny testing in guppy, Poecilia reticulata (Peters 1859).

Norethindrone(NE) was evaluated for its efficacy on alteration of sex ratio of P. reticulata. Either the young fry or the brooders and the resultant fry were fed a commercial diet incorporated with NE at 0, 25, 50, 75 and 100 mg kg-1 diet (ppm) for 30-40 d in rectangular glass aquaria; this was followed by 40-60 d rearing on NE-free diet in out-door concrete tanks. In general, the androgen treatment altered sex ratio, leading to the production of a dose dependent increase in the percentage of males. The oral administration of the steroid at 75 ppm for 40 d or 100 ppmfor 30 or 40 d to first feeding fry, yielded 100% males. On the other hand, NE administration to brooders before parturition and the resultant fry also produced an all-male population of guppy. The sex ratio of the untreated control was almost 1:1. The survival of fish in all the trials was high, ranging between 67 and 100%. Mating masculinized males (“XX” male) with normal female resulted in an all-female progeny, while crossing normal male (XY) from treatment groups with normal female sired normal sex ratio (1:1), elucidating XX-XY sex determination system in the guppy.

Prevalence of anticardiolipin antibodies in various thrombotic conditions: a hospital-based study.

Thrombosis is one of the leading cause of death, globally, anticardiolipin antibodies (aCL) has been implicated as one of the most common acquired protein defect causing thrombosis. This study was undertaken to evince the incidence of aCL in various thrombotic settings. MATERIAL AND METHODS: Three hundred and two patients were retrospectively screened for the incidence of aCL The sera were screened for aCL IgG using enzyme linked immunosorbent assay. Detail clinical and epidemiological data were obtained from hospital records and clinical examination. RESULTS: Among the 302 patients, 134 (44.37%) were below the age of 40 years (juvenile-onset thrombosis), mean age being 35.3 years. High titres of aCL IgG was seen in 65 (20.77%) patients. Deep vein thrombosis (DVT), seen in 90 (29.8%) was the most common thrombotic condition. Other sites of thrombosis were coronary artery (19.2%), central nervous system territory arteries (17.21%) and peripheral arteries (5.29%); the incidence of aCL IgG in these sites were 13.79%, 25.0% and 18.75% respectively. CONCLUSION: aCL is the most common acquired thrombophilic defect. Epidemiological data of our population is required for evaluating the strategy for further research of thrombosis in this condition.