The eyes see what the mind knows – Interpretation of magnetic resonance imaging

Background: In 1978, the advent of magnetic resonance imaging (MRI) was a remarkable volte-face in the world of diagnostics. Employing the phenomenon of nuclear resonance enables us to exploit the properties of differential protons in living tissues. The ability of providing higher and variable contrast and the absence of ionizing radiations make it superior to computed tomography. Being the diagnostic tool of choice, it is an indispensable part of assessment of the location and characteristics of different ocular and orbital pathologies (vascular, inflammatory, and neoplastic). Purpose: The intrinsic and extrinsic properties of MRI provide multi-parametric imaging, making it of paramount importance in ophthalmological evaluation. Also, MRI-dynamic color mapping provides non-invasive and quantitative assessment of soft tissues in motion. An in-depth knowledge of the basic principle and technique of MRI aids in diagnosing as well optimal planning of surgical interventions. Synopsis: In this video, we shall be displaying the anatomical, clinical, and radiological aspects of MRI with an overlap to make it easier to understand the implications of this miraculous invention. Highlights: A good understanding of MRI analysis makes the ophthalmologists independent and helps in ruling out the differential diagnoses, exact extent and invasion, precise surgical planning and therefore, avoiding tragic outcomes. This video is an attempt to simplify and emphasize on the importance of MRI interpretation for an ophthalmologist.

Hypertension control in Kerala, India: A prescription-based study at primary and secondary level health care institutions

Objective: We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India. Methods: This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression. Results: Totally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50e2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy. Conclusions: In this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.

The non-formal healthcare provider dilemma ? to hate the player or the game?

The case study by Bevin Vijayan draws attention to a well-recognised public health problem – trauma and the lack of formal trauma care services in India.

Image-Guided Retrieval Of Foreign Body In The Abdomen - A Case Report

The presence of retained surgical blade as a foreign body is uncommon and poses significant patient safety challenge issues. Most common etiologies for the presence of such foreign bodies are accidental, traumatic, or iatrogenic. Here, we report a successful management of the case with a rare foreign body in the abdomen, that is, surgical blade accidentally left during pigtail procedure of the liver abscess. Most of the iatrogenic injuries are preventable. In our case, a misfit of a blade in the handle might have been responsible for the complication. The use of radiological guidance for localization and removal of the foreign bodies embedded in the soft tissues is well established. With imaging guidance retrieval of a foreign body in the abdomen, laparotomy was prevented and facilitated early recovery.

Intraventricular hydatid cyst in a child.

Hydatid disease is caused by the infestation of the larvae of tapeworms of the genus Echinococcus. The definitive hosts of Echinococcus are various carnivores, the common being the dog. All mammals (more often sheep and cattle) are intermediate hosts. Humans get infected through the feco-oral route by ingestion of food or milk contaminated by dog feces containing ova of the parasite or by direct contact with dogs. The most common sites of infestation are the liver (75%) and lungs (15%). Various authors state a frequency of hydatidosis of the brain ranging between only 0.2-4% of cases. [1],[2],[3] The prognosis following surgical intervention is good, especially in pediatric age. [2],[3] Hence early diagnosis of this condition is crucial. We report a rare case of a child with a large intraventricular hydatid cyst that had an excellent recovery following surgery.

Microsurgical anatomy of the posterior circulation.

CONTEXT: The microsurgical anatomy of the posterior circulation is very complex and variable. Surgical approaches to this area are considered risky due to the presence of the various important blood vessels and neural structures. AIMS: To document the microsurgical anatomy of the posterior circulation along with variations in the Indian population. MATERIALS AND METHODS: The authors studied 25 cadaveric brain specimens. Microsurgical dissection was carried out from the vertebral arteries to the basilar artery and its branches, the basilar artery bifurcation, posterior cerebral artery and its various branches. Measurements of the outer diameters of the vertebral artery, basilar artery and posterior cerebral artery and their lengths were taken. RESULTS: The mean diameter of the vertebral artery was 3.4 mm on the left and 2.9 mm on the right. The diameter of the basilar artery varied from 3-7 mm (mean of 4.3 mm). The length varied from 24-35 mm (mean of 24.9 mm). The basilar artery gave off paramedian and circumferential perforating arteries. The origin of the anterior inferior cerebellar artery (AICA) varied from 0-21 mm (mean 10.0 mm) from the vertebrobasilar junction. The diameter of the AICA varied from being hypoplastic i.e., CONCLUSIONS: The authors have documented the various anomalies as well as the differences of the anatomy in this area in the Indian population as compared to the Western literature.