The Radiological Assessment of Carotid Space Lesions: A Case Series.

Carotid space lesions present diagnostic challenges due to their diverse etiology and varied clinical manifestations. This article critically reviews the anatomy of the carotid space and highlights the spectrum of pathologies within this complex region, illustrated by three case studies. The cases were examined with ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI). Schwannomas appeared heterogeneously hypodense on plain CT and partially hyperdense on contrast-enhanced CT (CECT), with displacement of adjacent vessels. Vagal-origin schwannomas caused the anteromedial displacement of the internal carotid artery. Paragangliomas were typically homogeneously hyperdense on CECT, with lateral displacement of the internal carotid artery when of carotid body origin. The management of carotid space lesions depends on the resectability of the tumors; unresectable tumors are managed with chemotherapy. This overview enhances clinical understanding and diagnostic accuracy, facilitating improved patient outcomes in managing carotid space lesions.

Unexpected Culprit: Unveiling a Unique Case of Appendicitis Triggered by a Foreign Object.

Appendicitis is a common surgical emergency marked by inflammation of the appendix, often due to blockage of the appendix lumen by fecoliths, lymphoid hyperplasia, or neoplasms. While various causes are known, appendicitis triggered by a foreign body (FB) is exceptionally rare. This case report highlights a rare presentation of appendicitis in a 32-year-old male with no significant medical history, who presented with acute lower right abdominal pain, fever, and vomiting. Initial evaluation suggested appendicitis, further supported by laboratory findings and diagnostic imaging revealing a retrocecal appendix with surrounding inflammation. Remarkably, an FB, a fish bone, was discovered lodged within the perforated appendix, elucidating the unusual etiology. Emergency laparotomy confirmed the diagnosis and facilitated prompt surgical intervention. This case underscores the importance of thorough evaluation and consideration of uncommon causes in patients presenting with acute abdominal pain, illustrating the critical role of detailed history-taking and clinical acumen in guiding management decisions and ensuring favorable patient outcomes.

Evaluating the Efficacy of Volume Isotropic Turbo Spin Echo Acquisition Versus T2-Weighted Turbo Spin Echo Imaging in the Diagnosis of Nerve Root and Perineuronal Pathologies in Spinal Disorders.

Background While two-dimensional (2D) turbo spin echo (TSE) sequences offer better through-plane resolution than three-dimensional (3D) isotropic TSE sequences images, with a narrower thickness of the slice, 3D isotropic TSE sequences are known to have a weaker in-plane resolution as well as blurring of the image. These elements may make it more difficult to distinguish between nearby structures that may affect nerve roots and small nerve roots during spinal imaging. This study aimed to analyze the accuracy of T2 TSE sequence and volumetric isotropic TSE acquisition in determining the indentation of nerve roots and perineural diseases such as nerve sheath tumors and Tarlov cysts. Methods Fifty patients who attended the Department of Radiodiagnosis for magnetic resonance (MR) spine participated in this prospective study. Routine MR lumbosacral (LS) spine sequences, such as survey, coronal T2 short-tau inversion recovery (STIR), sagittal T2 TSE, sagittal T1 TSE, and axial T2 TSE, were carried out after a localizer was acquired. More sequences from volume isotropic turbo spin echo acquisition (VISTA) were acquired. For both 2D and 3D sequences, the visibility ratings for perineural cysts, spinal canal stenosis, and nerve root indentation were evaluated. Visibility ratings ranged from zero to four. Results In the cases of perineural cyst, spinal canal stenosis, and nerve root impingement, the mean difference between the VISTA and T2 TSE visibility scores was 0.04, 0.54, and 0.56, respectively. The VISTA and T2 TS had standard deviation differences of 0.006, 0.026, and 0.06, respectively. The "t" values for nerve root impingement, spinal canal stenosis, and perineural cysts were, in order, 50, 180, and 70. Because the p-value was <0.01, a statistically significant variation has been observed. Conclusion In the diagnosis of neural and perineuronal disorders, the visibility scores for 3D T2 TSE (VISTA) were considerably better than those for 2D T2 TSE in identifying perineural cysts, spinal canal stenosis, and nerve root indentation.

Addressing the Global Threat of Multidrug-Resistant Infections: The Role of Ceftazidime-Avibactam Revisited.

Background and objective Bloodstream infections (BSIs) due to multidrug-resistant Gram-negative bacteria (MDR-GNB) pose a significant global health threat amid rising antimicrobial resistance (AMR). This study aimed to investigate the efficacy of ceftazidime-avibactam (CZA) as a therapeutic option for these infections, addressing the urgent need for novel treatments. Materials and methods This study was conducted over one year in the Department of Microbiology, JSS Medical College and Hospital, Mysuru, India, and employed a laboratory-based prospective design. From a total of 376 positive blood cultures, 147 multidrug-resistant (MDR) organisms were identified, and 100 were randomly selected for final analysis. Susceptibility testing via disk diffusion and minimum inhibitory concentration (MIC) determination was performed to evaluate CZA efficacy. Results Klebsiella pneumoniae (K. pneumoniae) was the predominant (78%) organism among the subsets, with varying susceptibility patterns observed across species. The overall CZA susceptibility was 45%, with significant discrepancies between disk diffusion and gold standard testing. Notably, there was limited efficacy against Pseudomonas aeruginosa (P. aeruginosa) Conclusions This study underscores the pressing need for reliable testing methods and novel treatment strategies in combating MDR infections. Further research with larger sample sizes is imperative to validate our findings and guide clinicians effectively in addressing this critical health challenge.

Radiological Insights From Two Distinct Cases of Pineal Region Meningioma: A Case Report.

This case report delineates the radiological evaluation and diagnostic intricacies of two unique cases of pineal region meningioma, underscoring the pivotal role of advanced imaging techniques in the accurate diagnosis and management of such rare tumors. Pineal region tumors represent a heterogeneous group of neoplasms, with meningiomas in this location being particularly uncommon, thereby posing significant challenges in diagnosis and therapeutic decision-making. The first case involves a 40-year-old female presenting with progressive headaches and visual disturbances with symptoms of increased intracranial pressure, whereas the second case describes a 30-year-old male presenting with headache, dizziness, difficulty with balance, and cognitive decline. Both patients underwent a comprehensive diagnostic workup, including magnetic resonance imaging (MRI), which revealed tumors in the pineal region exhibiting characteristics suggestive of meningioma. The MRI findings in both cases included well-defined mass lesions showing iso- to hypointense signal on T1-weighted images with robust contrast enhancement. Additionally, the radiological assessment was instrumental in differentiating these meningiomas from other pineal region tumors, such as germinomas or pineocytomas, based on their distinctive imaging features and the absence of dissemination. Surgical resection followed by histopathological examination confirmed the diagnosis of meningioma in both cases. This report highlights the critical role of radiological imaging in the early detection and differentiation of pineal region tumors, emphasizing the need for a multidisciplinary approach to achieve optimal patient outcomes.

A Study to Assess the Role of Date Syrup, Pineapple Juice, and Hematinic Syrup as Magnetic Resonance Oral Contrast Agents in Improving the Image Quality of Magnetic Resonance Cholangiopancreatography.

INTRODUCTION: Magnetic resonance cholangiopancreatography (MRCP) is an imaging technique that has advanced over the past few years. It still plays a crucial role in the study of numerous pancreaticobiliary diseases. This study aimed to evaluate the effects of hematinic syrup, date syrup, and pineapple juice on MRCP image quality. METHODOLOGY: This study involved a total of 90 participants, distributed evenly among three groups, with each group comprising 30 patients. Negative oral contrast solutions containing paramagnetic substances like Mn+2 and Fe+3, such as pineapple juice, date syrup, and hematinic syrup were imaged by 1.5 Tesla (T) magnetic resonance imaging (MRI) with T2-weighted (T2W) and MRCP sequences. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were computed. Ninety patients underwent MRCP 20-30 min after ingestion of 100 mL of date syrup, 30 ml of hematinic syrup diluted to 200 ml of water, and 200 mL of pineapple juice. MRCP images were taken to visualize various pancreaticobiliary structures (bile duct, stomach, and duodenum). RESULTS: The in vitro evaluation of the solutions showed that date syrup and hematinic syrup were hypointense in T2W sequences. The images obtained showed no significant difference in the CNR between the three solutions. However, the SNR was significantly higher for pineapple juice compared to date syrup and hematinic syrup in T2W and MRCP sequences. Images acquired post-administration of the oral contrast agents significantly improved the gastrointestinal tract signal suppression and increased visibility of the pancreaticobiliary structures (bile duct, stomach, and duodenum). No adverse events were observed among the participants. CONCLUSION: Pineapple juice was the best contrast agent. However, date syrup and hematinic syrup can also be used to improve the imaging quality.

Giant Paratesticular Myxoid Liposarcoma: A Case Report of a Rare Entity.

Paratesticular myxoid liposarcoma is an exceedingly rare malignancy originating from the spermatic cord or paratesticular tissues. We report a unique case of a 75-year-old male patient who presented with a painless scrotal swelling that had been growing for four years. Imaging investigations, including ultrasonography (USG) and contrast-enhanced computerized tomography (CECT), revealed characteristics consistent with paratesticular myxoid liposarcoma. The orchidectomy specimen confirmed a grade 2 right paratesticular myxoid liposarcoma. Despite its rarity, clinicians must consider this tumor in the differential diagnosis of painless scrotal swellings. Accurate diagnosis and comprehensive management, encompassing surgical resection with wide margins and potential adjuvant therapies, are pivotal. This case underlines the importance of collaborative research and long-term follow-up in understanding and managing paratesticular myxoid liposarcomas.

A Study Assessing the Role of Renal Grayscale Ultrasonography and Flowmetry in Correlation With Renal Function Tests Across Various Renal Diseases.

Background Renal insufficiency, a critical concern in native and transplant kidneys, necessitates effective screening modalities for evaluation and management. Grayscale sonography has been a cornerstone in renal diagnostics, providing basic anatomical insights such as renal length, cortical thickness, and collecting system dilatation. Despite technological advancements, its impact on the differential diagnosis or management of renal disease remains limited, often showing normal findings in the presence of severe renal dysfunction. On the other hand, Doppler sonography, particularly the Doppler resistive index (RI), has shown potential in enhancing the assessment of renal dysfunction by quantifying alterations in renal blood flow and correlating with various renal pathologies and prognoses. Thus, this study aims to assess and compare the sensitivity of transabdominal and Doppler sonography as a diagnostic modality to evaluate medical renal diseases with altered renal function tests (RFTs). Methodology Participants included patients visiting the ultrasonography (USG) room at our hospital for USG of the kidneys, ureters, and bladder (USG KUB) and USG of the whole abdomen (USG W/A) with altered RFTs. Each underwent renal grayscale USG and RI measurement, alongside standard RFTs, aiming to investigate the relationship between USG and RI findings and RFT outcomes to assess their predictive accuracy for renal function. Renal grayscale USG assessed parameters including renal dimensions, echogenicity, corticomedullary differentiation, and RI. Data management and charting were conducted with Microsoft Excel 2021 and Microsoft Word 2021. IBM SPSS Statistics for Windows, Version 24 (IBM Corp., Armonk, NY) was utilized for data analysis. The analysis of variance (ANOVA) test examined relationships between renal parameters and RI across diagnostic groups. Furthermore, the chi-square test evaluated associations of renal ultrasound findings with RFTs and their significance. Results The study analyzed 93 patients with altered RFTs. Chronic kidney disease (CKD) affected 68 patients, primarily males in their fifth and sixth decades, showing reduced renal dimensions, increased cortical echogenicity, and elevated Doppler RI mean (RIm) with 83% sensitivity. Acute kidney injury (AKI) was found in 12 patients, mainly in their fourth decade, displaying increased renal parameters and elevated RIm with 75% sensitivity. Glomerular diseases, including nephrotic syndrome (NS) and nephritic syndrome (NeS), occurred in 9 patients, predominantly males in their fourth decade, with heightened renal cortical echogenicity and elevated RIm with 55.5% sensitivity. Lupus nephritis (LN) was detected in 4 female patients, despite normal renal parameters, showing elevated serum creatinine levels. Conclusions Doppler assessment of renal vascular waveforms effectively identifies chronic renal changes, aiding in the diagnosis of altered RFTs and guiding prognosis. While it detects typical changes like decreased size and parenchymal atrophy, it may not be as indicative of diabetic nephropathy. Key ultrasound indicators such as changes in echotexture and size, along with associated findings like ascites and effusions, help recognize altered renal function and minimize unnecessary interventions.

Effectiveness of Multimodal Intervention to Improve Blood Culture Collection in a Tertiary Care Hospital.

Introduction and methods Blood culturing has become one of the backbone investigations for septicemia, fever of unknown origin, etc. This study was conducted to test the effect of multimodal interventions on the practical skills of healthcare workers (HCWs), raise awareness regarding the importance of aseptic blood culture collection practices, and increase compliance with the specific steps to be followed. Hence, this current interventional study was aimed at comparing the rate of isolation of contaminants grown among the blood culture specimens, assessing the knowledge, attitude, and practice (KAP) of HCWs collecting the blood culture specimen on various aspects of sample collection, educating the nursing staff regarding blood sample collection using a structured, pre-formed checklist, and emphasizing best practices for blood culture collection. All of the study's objectives were successfully met within the time frame specified. Using a pre-formed checklist and a Google form for KAP analysis eased the calculation. Results On analysis, the blood culture contamination rate in the pre-interventional phase dropped drastically from 6.16% to 3.03% in the post-interventional phase. The educational sessions conducted are a paramount reason for the reduction in the contamination rate. The HCWs were the least compliant towards the eighth step in the checklist (regarding palpation of skin); however, that too increased from 66.93% and 64.51% to a whopping 82.25% and 83.06%, respectively, with a chi-square value of 0.03 and a p-value of 0.85 (not significant). Conclusion Implementation of interventional studies as an audit like this in tertiary care hospitals can result in a significant reduction in blood culture contamination rates and can also improve the compliance of HCWs with blood culture protocols. This, in turn, can overall improve the effectiveness of blood culture (BC) testing and reduce mortality and morbidity in tertiary care hospitals. Further research can be conducted to brainstorm more methods to increase the compliance of HCWs. Better monitoring strategies can also be set to ensure low contamination rates. Additionally, some other methods can be derived to locate the source of contamination within the hospital environment and thus eliminate it. Similar interventions can be conducted for a longer duration of time to further reduce the blood culture contamination rate below 3% (as per the recommendations).

Neonatal Meningitis with Septicemia by Elizabethkingia meningoseptica : A Case Report.

Elizabethkingia is ubiquitary aerobic bacillus abundantly found in the community as well as hospital environments. Elizabethkingia meningoseptica is an emerging nosocomial pathogen with an elemental ability to acclimate and survive in diversified environmental circumstances. Prompt diagnosis and an early therapeutic intervention are preponderant in the management of these infections. We report a case of meningitis with septicemia caused by E. meningoseptica in a 1-day-old outborn neonate. The child was stabilized with anticonvulsants and, based on laboratory findings, the neonate was started on ciprofloxacin in addition to symptomatic management. The child responded well to the treatment and was discharged on day 7 after treatment initiation. Perceptive treatment protocols backed with accurate laboratory evidence remain instrumental to avert unpropitious outcomes while combatting rare multidrug-resistant opportunistic infections.

Severity of Periodontal Disease in Chronic Kidney Disease Patients: A Hospital-Based Study.

Background Periodontal disease is a chronic inflammatory condition of multifactorial origin. The inflammatory mediators released during the progression of disease may affect all the organs of the body. Renal disease is a chronic systemic disease which may influence the progression of periodontal disease. Therefore, this study was conducted to evaluate and compare the prevalence of periodontal disease among individuals with chronic kidney disease undergoing maintenance hemodialysis with healthy individuals. Methodology In this cross-sectional study including 150 participants, 75 patients with different renal diseases undergoing hemodialysis (Group I) and 75 healthy controls (Group II) were included. The general examination of the patients was done. Blood pressure, pulse, and body mass index were recorded, followed by biochemical investigations, in which serum urea, serum creatinine, and random blood sugar were evaluated for each participant. Plaque Index (PI) and Gingival Index (GI) scores were recorded. Probing pocket depth (PPD) and gingival recession GR were measured, and clinical attachment level (CAL) was calculated based on the obtained values. The subjects were then categorized into three groups, namely, no/mild, moderate, and severe periodontitis. Results Out of the total study participants, 68% were men and 32% were women, with a mean age of 47 years. Serum markers were significantly elevated in Group I compared to Group II. Poor oral hygiene and periodontitis were observed to be much higher in dialysis patients compared to the control group. The two groups also significantly differed in PI, GI, PPD, GR, and CAL, all of which were higher in Group I. Conclusions The results suggest that patients with renal disease must be screened for periodontal disease.

Facile and innovative catalytic protocol for intramolecular Friedel-Crafts cyclization of Morita-Baylis-Hillman adducts: Synergistic combination of chiral (salen)chromium(III)/BF3·OEt2 catalysis.

The chiral (salen)Cr(III)/BF3·OEt2 catalytic combination was found to be an effective catalyst for intramolecular Friedel-Crafts cyclization of electron-deficient Morita-Baylis-Hillman adducts. In presence of mild reaction conditions the chiral (salen)Cr(III)/BF3·OEt2 complex affords 2-substituted-1H-indenes from unique substrates of Morita-Baylis-Hillman adducts via an easy operating practical procedure.

Azidophosphonium salt-directed chemoselective synthesis of (E)/(Z)-cinnamyl-1H-triazoles and regiospecific access to bromomethylcoumarins from Morita-Baylis-Hillman adducts.

The direct transformation of Morita-Baylis-Hillman (MBH) adducts into molecules of interest is a crucial process wherein allylic hydroxy-protected or halogenated MBH adducts are commonly preferred. Herein, we report an azidophosphonium salt (AzPS)-catalysed straight forward protocol for synthesising structurally demanding (E)/(Z)-cinnamyl-1H-1,2,3-triazoles and halomethylcoumarins from MBH adducts. The novel methodology, efficient catalyst, and direct utilization of MBH adducts under mild reaction conditions qualify the reported procedures as powerful synthetic tools.

Antibody Profiling and Prevalence in the US population during the SARS-CoV2 Pandemic

BackgroundAntibody diagnostics play an important role in disease detection and can potentially aid in monitoring of the immune responses to see if an individual has developed immunity. Developing high throughput diagnostics which does not involve handling of infectious material becomes imperative in the case of pandemics such as the recent outbreak of SARS-CoV2. MethodsA protein microarray technology was used to detect the plurality of antibody response to four novel antigens namely S1 glycoprotein, Receptor binding domain (RBD), S2 glycoprotein and Nucleoprotein of the novel coronavirus named SARS-CoV2 using serum samples. A DBS card was additionally used to compare its performance with a venipuncture-based serum separator tube (SST) draw. ResultsThe three main subclasses of antibodies IgM, IgA and IgG were analyzed to see the variations in immune responses in the affected population and compared to their microbial RT-PCR based NP swab results. The clinical sensitivity and specificity were determined to be 98.1% and 98.6%. In the matrix comparison study, which would enable patients to test without risk of transmitting the virus, DBS matched with higher than 98% accuracy to a venipuncture-based SST collection. ConclusionMultiplex testing enables higher sensitivity and specificity which is essential while establishing exposure on a population scale. This flexible platform along with a discrete collection methodology would be crucial and broadly useful to scale up testing in current and future pandemics. Minimum sample volume that can be collected using DBS cards can be processed in this multiplex pillar plate format enabling the capacity to provide the reliability of high throughput analyzers while having the ease of collection similar to rapid tests.

Management and Disposal of Mercury and Amalgam in the Dental Clinics of South India: A Cross-Sectional Study.

CONTEXT: Dental offices are known to be one of the largest users of inorganic mercury in the preparation of amalgam-a restorative material which, if not handled and disposed through scientific methods, can pose grave threats to the biosphere. AIMS: The objective of this study was to assess and record the mercury management and disposal strategies of dental practitioners belonging to the two South Indian states, Kerala and Tamil Nadu. SUBJECTS AND METHODS: A questionnaire regarding the usage and disposal of a filling material containing mercury (amalgam) was designed and distributed online. The 150 dental practitioners partaking in this study responded anonymously. RESULTS: The results were statistically analyzed using chi-square test and the P value was evaluated. The usage of amalgam was correlated with the age of the practitioner and the nature of practice and it was found to be statistically significant. The number of fillings was correlated with the years of practice and locality of the clinic, which were found to be statistically significant. CONCLUSIONS: This study showed that mercury was widely preferred and utilized even today as a restorative material by dentists and dental specialists, despite the availability of other alternative strategies. Only a minor section of practitioners were found to be aware of the global changes in the guidelines pertaining to the handling and disposal of amalgam. We feel that Safe Mercury Amalgam Removal Technique, amalgam safety rules, and amalgam-free practice should be a part of the academic curriculum and continuing dental education.

Medico-legal autopsy of 1355 unclaimed dead bodies brought to a tertiary care hospital in Delhi, India (2006-2012).

In India, it is estimated that about 13 million people are homeless. As these individuals have no close acquaintances, in the event of death, their bodies remain unclaimed. These unclaimed corpses pose a major challenge for the local law enforcement agencies in identification and thus become an obstacle in solving the cases of missing persons. We sought to review the autopsy characteristics and causes of death in the unclaimed/unidentified bodies autopsied at the All India Institute of Medical Sciences (AIIMS) from 2006 to 2012. Among the total of 11,786 cases autopsied during the year 2006 to 2012, 1335 (11%) were unclaimed. Most of the cases were males (91%) with a male-to-female ratio of 9:1. Mean age of the cohort was 43 years (range, 1-85 years). Natural events were the foremost cause of death and were more commonly seen in males. While accidental, suicidal and homicidal modes were common in younger age groups; natural manner of death predominated in the elderly. Most of the cases were found dead on the roadside. This paper also compares with the previous study in the same set-up during the time period 2001 to 2005. The authors believe that knowledge about the existing healthcare facilities need to be reinforced and their utilisation promoted.

E-suicide note: A newer trend and its medico-legal implications in India.

Rapid advancements of information and communication technology in the form of electronic mails, mobile phones, social networking sites, etc have an increasing impact on people's day to day life. It has been observed that these readily available applications are used frequently to express suicidal intentions. There are many studies on conventional handwritten suicide notes but suicide note in electronic format is an emerging issue and an under-researched phenomena. The authors have termed it as "E-suicide note" and discuss its medico-legal implications in India with examples from their observations.

Suicide pact by drowning with bound wrists: a case of medico-legal importance.

Suicide pacts are uncommon and mainly committed by male-female pairs in a consortial relationship. The victims frequently choose methods such as hanging, poisoning, using a firearm, etc; however, a case of a suicide pact by drowning is rare in forensic literature. We report a case where a male and a female, both young adults, in a relationship of adopted "brother of convenience" were found drowned in a river. The victims were bound together at their wrists which helped with our conclusion this was a suicide pact. The medico-legal importance of wrist binding in drowning cases is also discussed in this article.

Cut wrists, electrocution and subsequent drowning in a water drum: an unusual combination of methods in complex suicide.

A 25-year-old male was found dead in a water drum inside the bathroom of his house one morning. Autopsy revealed a fatal right wrist cut, superficial cuts on middle phalanx of left index finger and features of ante mortem drowning. Investigation revealed the victim was an alcoholic and was depressed due to financial problems. On the previous night, under the influence of alcohol, he first tried to commit suicide by cutting wrist with razor blades, but death was not immediate. He then attempted electrocuting himself by touching a live wire, inside the bathroom, which failed and finally he drowned in a water drum. The victim had left a message, written with his blood on the floor of the room, reflecting his suicidal intentions. In complex suicide, many bizarre methods are used, but this combination of methods is unusual and not found in available forensic literature.