Accuracy of Advanced Pediatric Life Support Intubation Depth Formula in Indian Children Aged 1 to 12 Years.

OBJECTIVE: To evaluate the accuracy of the Advanced Pediatric Life Support (APLS) endotracheal tube (ET) depth formula in Indian children aged 1 to 12 years. METHODS: We enrolled 86 children aged 1-12 years requiring intubation and ventilation. The ET depth was determined using the APLS formula, and chest X-rays were utilized to evaluate 'appropriate ET depth (accuracy)' based on 'vertebral level criteria' and 'safe distance between ET tip and carina.' RESULTS: Out of 86 cases, none had bronchial intubation. An accuracy of 37.2% (32 cases) was observed, with 57% (49 cases) showing deep placement. Among deep placements, 11 met 'vertebral level criteria' but not 'safe distance criteria.' Redefining deep placement based solely on 'safe distance criteria,' resulted in 50% accuracy. CONCLUSION: APLS formula effectively prevents bronchial intubation in Indian children, but tends to overestimate ET depth (50% cases) when considering the 'safe distance between ET tip and carina.'

Role of Permeability Surface Area Product in Grading of Brain Gliomas using CT Perfusion.

Purpose The aim of this study was to evaluate the role of permeability surface area product in grading brain gliomas using computed tomography (CT) perfusion Materials and Methods CT perfusion was performed on 33 patients with brain glioma diagnosed on magnetic resonance imaging. Of these, 19 had high-grade glioma and 14 had low-grade glioma on histopathological follow-up. CT perfusion values were obtained and first compared between the tumor region and normal brain parenchyma. Then the relative values of perfusion parameters were compared between high- and low-grade gliomas. Cut-off values, sensitivity, specificity, and strength of agreement for each parameter were calculated and compared subsequently. A conjoint factor (permeability surface area product + cerebral blood volume) was also evaluated since permeability surface area product and cerebral blood volume are considered complimentary factors for tumor vascularity. Results All five perfusion parameters namely permeability surface area product, cerebral blood volume, cerebral blood flow, mean transit time, and time to peak were found significantly higher in the tumor region than normal brain parenchyma. Among these perfusion parameters, only relative permeability surface area product and relative cerebral blood volume were found significant in differentiating high- and low-grade glioma. Moreover, relative permeability surface area product was significantly better than all other perfusion parameters with highest sensitivity and specificity (97.74 and 100%, respectively, at a cut-off of 9.0065). Relative permeability surface area product had a very good agreement with the histopathology grade. The conjoint factor did not yield any significant diagnostic advantage over permeability surface area product. Conclusion Relative permeability surface area product and relative cerebral blood volume were helpful in differentiating high- and low-grade glioma; however, relative permeability surface area product was significantly better than all other perfusion parameters. Grading brain gliomas using relative permeability surface area product can add crucial value in their management and prognostication; hence, it should be evaluated in the routine CT perfusion imaging protocol.

Corrigendum to "CT of primary undifferentiated pleomorphic sarcoma of small intestine with distant metastases presenting with intussusception" [Radiology Case Reports 15 (2020) 44-48].

[This corrects the article DOI: 10.1016/j.radcr.2019.10.015.].

CT of primary undifferentiated pleomorphic sarcoma of small intestine with distant metastases presenting with intussusception.

Undifferentiated pleomorphic sarcoma of bowel is very rare, only a few cases have been reported till date. A 29 year old male patient presented with acute abdominal pain due to intussusception, contrast enhanced computed tomography abdomen showed multiple endoluminal homogenously enhancing polypoidal lesions with distant metastasis. Radiologically our primary diagnosis was malignant gastrointestinal stromal tumor, however, histopathological evaluation turned out to be a small bowel undifferentiated pleomorphic sarcoma. Considering the multiplicity of lesion and early distant metastasis radiologist should also consider sarcoma involving bowel as one of the differential diagnosis.

Coarse particle (PM10-2.5) source profiles for emissions from domestic cooking and industrial process in Central India.

To develop coarse particle (PM10-2.5, 2.5 to 10µm) chemical source profiles, real-world source sampling from four domestic cooking and seven industrial processing facilities were carried out in "Raipur-Bhilai" of Central India. Collected samples were analysed for 32 chemical species including 21 elements (Al, As, Ca, Cd, Co, Cr, Cu, Fe, Hg, K, Mg, Mn, Mo, Na, Ni, Pb, S, Sb, Se, V, and Zn) by atomic absorption spectrophotometry (AAS), 8 water-soluble ions (Na+, K+, Mg2+, Ca2+, Cl-, F-, NO3-, and SO42-) by ion chromatography, ammonium (NH4+) by spectrophotometry, and carbonaceous fractions (OC and EC) by thermal/optical transmittance. The carbonaceous fractions were most abundant fraction in household fuel and municipal solid waste combustion emissions while elemental species were more abundant in industrial emissions. Most of the elemental species were enriched in PM2.5 (<2.5µm) size fraction as compared to the PM10-2.5 fraction. Abundant Ca (13-28%) was found in steel-rolling mill (SRM) and cement production industry (CPI) emissions, with abundant Fe (14-32%) in ferro-manganese (FEMNI), steel production industry (SPI), and electric-arc welding emissions. High coefficients of divergence (COD) values (0.46 to 0.88) among the profiles indicate their differences. These region-specific source profiles are more relevant to source apportionment studies in India than profiles measured elsewhere.

Neonatal Hypoxic-ischemic Encephalopathy: A Radiological Review.

Neonatal hypoxic-ischemic encephalopathy (HIE) is a devastating condition that may result in death or severe neurologic deficits in children. Neuroimaging with cranial ultrasound (US), computed tomography and magnetic resonance imaging are valuable tools in the workup of patients with HIE. The pattern of brain injury depends on the severity and duration of hypoxia and degree of brain maturation. Mild to moderate HI injury results in periventricular leukomalacia and germinal matrix bleed in preterm neonates, and parasagittal watershed infarcts in full-term neonates. Severe HI injury involves deep gray matter in both term and preterm infants. Treatment of HIE is largely supportive. The current article reviews the etiopathophysiology and clinical manifestations of HIE, role of imaging in the evaluation of the condition, patterns of brain injury in term and preterm neonates, the treatment and the prognosis.

Central Nervous System Tuberculosis: An Imaging Perspective.

The increasing prevalence of tuberculosis in both immunocompetent and immunocompromised individuals in recent years makes the disease a topic of universal concern. It has insidious onset and can affect virtually any organ system in the body, including the central nervous system (CNS). CNS tuberculosis (TB) is becoming more and more complex and atypical with onset of multidrug-resistant TB. Routine diagnostic techniques using serology and body tissue are time consuming and may delay the definitive management. Hence, it is important to be familiar with various radiologic features of CNS TB to ensure early and accurate diagnosis, thereby reducing high morbidity and mortality associated with the disease. The newer imaging techniques further help to improve the characterization and diagnosis of atypical CNS TB. The authors review the imaging characteristics of different forms of CNS tuberculosis involving the brain and spine and discuss the role of advanced imaging modalities in differentiating CNS TB from other disease process.

The diabetic pregnancy: An ultrasonographic perspective.

The incidence of congenital foetal anomalies and perinatal mortality in diabetic pregnancy is much higher than that in the normal pregnancy. The purpose of this review is to evaluate the role of ultrasound in the management of pregnancy complicated by diabetes. The ultrasound has been found to be very useful for foetal surveillance, assessment of diabetes related foetal complications, image guided interventions and in the obstetric management of the pregnancies complicated by diabetes.

Radiology and diabetes mellitus.

Diabetes mellitus (DM) is a major health concern globally, affecting almost every organ of the body. A major issue with DM is that a relatively large proportion of patients remain undiagnosed till the development of complications, many of which may cause permanent impairment. Therefore, early recognition of the radiological manifestations (of DM) is of utmost importance, so that the disease may be diagnosed and managed well in time. Some common and important radiological features encountered in practice are compiled in this article.

Comparison of Bone Mineral Density in Thalassemia Major Patients with Healthy Controls.

Chronic hemoglobinopathies like thalassemia are associated with many osteopathies like osteoporosis. Methods. This observational study was carried out to compare the bone mineral density (BMD) in transfusion dependent thalassemics with that of healthy controls. Thirty-two thalassemia patients, aged 2-18 years, and 32 age and sex matched controls were studied. The bone mineral concentration (BMC) and BMD were assessed at lumbar spine, distal radius, and neck of femur. Biochemical parameters like serum calcium and vitamin D levels were also assessed. Results. The BMC of neck of femur was significantly low in cases in comparison to controls. We also observed significantly lower BMD at the lumbar spine in cases in comparison to controls. A significantly positive correlation was observed between serum calcium levels and BMD at neck of femur. Conclusion. Hence, low serum calcium may be used as a predictor of low BMD especially in populations where incidence of hypovitaminosis D is very high.

Bilateral congenital absence of flexor pollicis longus with thumb hypoplasia and thenar atrophy.

Congenital absence of flexor pollicis longus with or without associated anomalies of thenar muscles and thumb is of rare occurrence. Inability to flex the interphalangeal joint of the thumb and absent dorsal wrinkles and flexion creases of the thumb are important clues to the diagnosis. Routine radiography and cross-sectional imaging help to confirm and document the condition. This article presents an extremely rare case of bilateral congenital absence of flexor pollicis longus tendon with thumb hypoplasia and thenar atrophy.

Hepatic cysticercosis: a rare entity.

Hepatic cysticercosis is a very rare entity; only four cases have been reported to date. High-resolution ultrasonography of the abdomen is the initial and most reliable modality for evaluation of hepatic cysticercosis. Medical therapy is the mainstay of treatment. We report a case of hepatic cysticercosis in a 28-year-old male who presented with right upper quadrant pain, fever, and jaundice. The article also describes the imaging patterns of hepatic cysticercosis based on different stages of evolution.