pH-Induced Biophysical Perspectives of Binding of Surface-Active Ionic Liquid [BMIM][OSU] with HSA and Dynamics of the Formed Complex.

The influence of pH on the human serum albumin (HSA) interaction with ionic liquid (IL)1-butyl 3-methylimidazolium octyl sulfate ([BMIM][OSU]) at its sub-micellar concentration of 5 mM (well below CMC ∼31 mM at 25 °C) in aqueous solution has been monitored employing different methods, viz., circular dichroism (CD), fluorescence, electrokinetic determination of the zeta potential (ZP), nuclear magnetic resonance (NMR), small-angle neutron scattering (SANS), and molecular docking (MD). CD analysis indicated a noticeable reduction of the α-helical content of HSA by IL at pH 3. A significant interaction of the anionic part of IL with HSA was evident from the 1H chemical shifts and saturation transfer difference (STD) NMR. A strong binding between IL and HSA was observed at pH 3 relative to pH 5, revealing the importance of electrostatic and hydrophobic interactions assessed from global binding affinities and molecular correlation times derived from STD NMR and a combined selective/nonselective spin-relaxation analysis, respectively. ZP data supported the electrostatic interaction between HSA and the anionic part of IL. The nature of IL self-diffusion with HSA was assessed from the translational self-diffusion coefficients by pulse field gradient NMR. SANS results revealed the formation of prolate ellipsoidal geometry of the IL-HSA complex. MD identified the preferential binding sites of IL to the tryptophan centers on HSA. The association of IL with HSA was supported by fluorescence measurements, in addition to the structural changes that occurred in the protein by the interaction with IL. The anionic part of IL contributed a major interaction with HSA at the pH levels of study (3, 5, 8, and 11.4); at pH > 8 (effectively 11.4), the protein also interacted weakly with the cationic component of IL.

Isolation and characterization of pseudo degradation products of acalabrutinib using ESI-HRMS/MS and NMR: Formation of possible geometrical isomers.

A forced degradation study of acalabrutinib (ACB), used to treat relapsed mantle cell lymphoma, was performed to identify and characterize all possible major degradation products formed under different stress conditions. The degradation products (DP) were separated using reverse phase UHPLC system on Kinetex EVO C18 column. Major DPs formed were isolated using semi-preparative HPLC and characterized by LC-ESI-HRMS/MS and NMR. ACB degraded to form seven major degradants (DP-I to DP-VII). DP-I and DP-V were formed under alkaline stress condition, whereas DP-II, DP-III, DP-VI and DP-VII were formed under both acidic and basic conditions. Further, DP-IV was formed when ACB drug was exposed to hydrogen peroxide stress condition. ACB was found to be stable when subjected to aqueous (neutral pH), thermal and UV radiation of 254 nm, as it has not shown any significant degradation under these conditions. Interestingly, two pairs of pseudo geometrical isomeric DPs (DP-II and DP-III, DP-VI and DP-VII) were observed. The plausible degradation pathway of ACB and fragmentation patterns of both ACB and major DPs were discussed.

Pigs lacking TMPRSS2 displayed fewer lung lesions and reduced inflammatory response when infected with influenza A virus.

Influenza A virus (IAV) infection is initiated by hemagglutinin (HA), a glycoprotein exposed on the virion's lipid envelope that undergoes cleavage by host cell proteases to ensure membrane fusion, entry into the host cells, and completion of the viral cycle. Transmembrane protease serine S1 member 2 (TMPRSS2) is a host transmembrane protease expressed throughout the porcine airway epithelium and is purported to play a major role in the HA cleavage process, thereby influencing viral pathogenicity and tissue tropism. Pigs are natural hosts of IAV and IAV disease causes substantial economic impact on the pork industry worldwide. Previous studies in mice demonstrated that knocking out expression of TMPRSS2 gene was safe and inhibited the spread of IAV after experimental challenge. Therefore, we hypothesized that knockout of TMPRSS2 will prevent IAV infectivity in the swine model. We investigated this hypothesis by comparing pathogenesis of an H1N1pdm09 virus challenge in wildtype (WT) control and in TMPRSS2 knockout (TMPRSS2 -/-) pigs. We demonstrated that TMPRSS2 was expressed in the respiratory tract in WT pigs with and without IAV infection. No differences in nasal viral shedding and lung lavage viral titers were observed between WT and TMPRSS2 -/- pigs. However, the TMPRSS2 -/- pig group had significantly less lung lesions and significant reductions in antiviral and proinflammatory cytokines in the lung. The virus titer results in our direct challenge model contradict prior studies in the murine animal model, but the reduced lung lesions and cytokine profile suggest a possible role for TMPRSS2 in the proinflammatory antiviral response. Further research is warranted to investigate the role of TMPRSS2 in swine IAV infection and disease.

Prognostic Significance of Magnetic Resonance Imaging in Detecting Diffuse Axonal Injuries: Analysis of Outcomes and Review of Literature.

Background: Diffuse axonal injury (DAI) is the brain injury characterized by extensive lesions in the white matter tracts over a widespread area. DAI is one of the most common and devastating types of traumatic brain injury and a major cause of unconsciousness and persistent vegetative state after head trauma. It occurs in about half of all cases with severe head trauma. Objective: This study was undertaken to evaluate the prognostic significance of magnetic resonance imaging (MRI) in detecting DAI and to determine which clinical factors provide prognostic information in patients with traumatic brain injuries. Materials and Methods: This prospective study was conducted in a tertiary care hospital between April 2017 to May 2019 on 52 patients admitted to the hospital with severe traumatic injuries of the head and clinical diagnosis of DAI. The clinical outcomes and findings of Thecomputerized tomography (CT)/magnetic resonance imaging (MRI) of the brain were assessed at 1 month, 3 months, 6 months, and 1 year on the basis of improvement in Glasgow Coma Scale (GCS), the time required to consciousness, and the duration of hospital stay. The patients were classified into three groups according to the MRI grading classification proposed by Adams. The outcomes at the 6 month follow-up time were dichotomized as non recovered (Glasgow Outcome Scale (GOS) score 1 or 2) or recovered (GOS score 3-5).The following factors were evaluated in relation to outcome: age, admission GCS score, the motor component of the GCS examination at admission and at 24 hours post admission, brainstem injury based on T2-weighted and gradient echo MRI sequences, presence of bilateral brainstem injuries, presence of DAIin the brainstem and the supra tentorial compartment (including the cortex, basal ganglia, and corpus callosum) on both CT and MRI, cerebral contusions, subarachnoid hemorrhage, epidural hematoma, subdural hematoma, and intraventricular hemorrhage. The statistical analysis was performed with x2 between various stages and between patients with and without hemorrhagic DAI. A separate analysis with x2 and Yates' correction was performed after grouping the patients with good recovery and moderate disability against patients with severe disability and vegetative state. Results: The correlation of patients GCS on admission, after 24 hours, and at discharge is statistically significant P < 0.001. Correlation among mean hospital stay in Grade I DAI, Grade II DAI, and Grade III DAI wass statistically significant (f = 70.22, P < 0.001). Correlation among mean time required for consciousness in Grade I DAI, Grade II DAI, and Grade III DAI was statistically significant (f = 181.92, P < 0.001). Based on anatomical location within the brainstem, the poorest outcomes occurred with injury to the medulla- with a 100% mortality rate. Poor outcomes were also associated with any injury to the pons. There was a significant correlation among brainstem injuries that crossed the midline, the motor component of the GCS examination, performed 24 hours after admission and at outcome. The median time to MRI was 1 day (range 0-35 days) among all, but 4 patients underwent MRI within 7 days after admission. Patients who did not recover underwent MRI at an average of 0.8 days after admission, whereas those who recovered underwent MRI at an average of 4.2 days after admission (P = 0.52). To determine if the time from admission to MRI had an influence on results, comparison was made between T2 and patient outcomes in relation to the interval between admission and MRI. Statistical analysis in the group of patients with different DAI stages showed a significant difference (P = 0.013). A statistically significant difference was also found between patients with hemorrhagic and non hemorrhagic DAI (P = 0.004). Conclusion: The current study showed a correlation between the mean time interval to recovery of consciousness in patients with DAI and the severity of injury grading on MRI. Hospital stay required for Grade I DAI was 2-3 weeks, for Grade II DAI was 3-4 weeks, and for Grade III DAI was 7-8 weeks. Apart from the well-known role of the Glasgow Coma Scale (GCS) in the prognosis of the outcome of patients with closed head injury, the presence of hemorrhage in DAI-type lesions and the association with traumatic space occupying lesions are additional poor prognostic signs established in this study. The analysis of outcomes were done for patients admitted with DAI and the current study established that poor outcomes were consistently seen in patients with brainstem injuries and poor results on 24-hour post admission GCS motor examinations.

Role of Bedside Transcranial Ultrasonography in the Assessment of Cerebral Hemodynamics in Decompressive Craniectomy Patients with Cranioplasty: A Single Centre Experience.

Background: Intracerebral hemorrhage is a leading cause of death and disability worldwide. After intracerebral hemorrhage, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post-injury. Identification of such hemodynamic disturbances can be used to predict outcome immediately post-injury when indices are measured using transcranial doppler ultrasonography (TCD). TCD permits non-invasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome. Aim: To investigate the effect of cerebral hemodynamics after cranioplasty in decompressive craniectomy patients using pre and postoperative TCD. Materials and Methods: This study is a prospective study of 3 years duration undertaken on 64 patients. All the patients were evaluated by TCDbefore and after decompressive craniectomy.All patients were evaluated by transcranial Doppler (TCD) 1 week before and 7-15 days after cranioplasty. TCD results were obtained though trans-temporal approach. Results: Statistically significant differences between the values before and after craniectomy were detected in Peak Systolic Volume (PSV) for the Anterior Cerebral Artery (ACA) (P = 0.001), in PSV for the Middle Cerebral Artery (MCA) (P < 0.004), in Mean Bloodflow Velocity (MV) for the MCA (P < 0.003), and in PSV for the Posterior Cerebral artery (PCA) (P = 0.001) on the ipsilateral side. There were statistically significant differences between the values before and after cranioplasty in PSV for the PCA (P = 0.004), on contralateral side.After decompressive craniectomy, the PI values for the MCA decreased, on average, to 31+/- 33% of the pre-surgical value in the treated side and to 28+/- 31% on the opposite side. On the other hand, the mean PI values for the extracranial ICA reduced to 34+/- 21% of the initial values in the treated side, and to 21+/- 31% on the opposite side.Cranioplasty improved CBF velocities in all major intracrainal arteries, not only on the side of the lesion adjacent to the cranioplasty, but also in distant regions, such as in the contralateral hemisphere. Conclusion: Decompressive craniectomy significantly improves cerebral hemodynamics both on ipsilateral and contralateral cerebral hemispheres.Concomitantly, PI values on TCD decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance. We conclude that cranioplasty improves neurological status and the mechanism of postoperative improvement of neurological status may be due to increased CBF velocity.

Sonological Appearance of Epidermoid Cyst of the Spleen: A Rarity.

Epidermoid cyst of the spleen is a rare, benign cystic lesion of congenital origin. Although most epidermoid cysts of the spleen are asymptomatic and detected incidentally on ultrasonography, the entity needs to be included in the differential diagnosis of cystic lesion mimics of the spleen, especially in patients with left hypochondriac pain. This case report describes the typical sonological appearance of epidermoid cyst of the spleen in a 31-year-old male.

Ectopic Cervical Thymus in an Adult: A Rare Presentation.

Ectopic cervical thymus is an essentially benign condition related to embryological development of the thymus and is exceedingly rare among the adult population. Precise and early diagnosis of the entity on high-resolution ultrasonography may help avoid further investigations and unnecessary surgical intervention. This case report describes the typical sonological appearance of ectopic cervical thymus in a 44-year-old male.

High-Resolution Ultrasonography of Renal Oncocytoma Presenting with Symptomatic Hematuria and Urinary Bladder Clot Retention-A Rare Occurrence.

Renal oncocytomas are asymptomatic, benign tumors often encountered incidentally on various imaging modalities. Renal oncocytomas comprise 5-7% of primary renal neoplasms and are derived from cells of the distal renal tubule. We present a case report of renal oncocytoma in a 22-year-old male having right-sided flank pain and symptomatic gross hematuria with a giant urinary bladder clot retention. The tumor was excised, and the patient underwent laparoscopic partial nephrectomy. Typical features of renal oncocytoma were observed upon histopathological examination of the resected specimen. The patient was catheterized, and bladder irrigation with clot retraction was performed.

Mass spectrometric-based investigation of differentially protected azatryptophan derivatives using Orbitrap mass spectrometry: Differentiation of positional isomers under protonation and alkali-cationization conditions.

RATIONALE: Differentiation and structural characterization of positional isomers of differentially protected azatryptophan derivatives using electrospray ionization high-resolution tandem mass spectrometry (ESI-HRMS/MS) is important from the perspective of drug discovery research. Also, these derivatives can be used as building blocks for the synthesis of various biologically active compounds and have attracted significant attention in the field of modern drug discovery, especially peptide-based drugs, protein folding and protein-protein interactions because of their interesting spectral properties. METHODS: ESI-HRMS/MS in positive ionization mode was used to differentiate and characterize positional isomers of protected azatryptophan derivatives. RESULTS: ESI-HRMS/MS of [M + H]+ and [M + Na]+ ions of positional isomers of differentially protected azatryptophan derivatives display distinct fragmentation patterns. The MS/MS of [M + H]+ ion of isomer 1 showed an additional ion at m/z 358.0846 ([M + H-Boc-C14 H10 -HF]+ ) which was not present for 4. The fragment ion at m/z 332.0857 was observed for 1 and not for 4 which would be formed by the expulsion of butyloxycarbonyl (Boc) and fluorenylmethyloxycarbonyl (Fmoc) groups. Moreover, the ions 422.0812 and 378.0912 are found to be relatively more abundant for isomer 4 which could be probably attributed to the formation of stable ions. Similarly, other positional isomers exhibited distinct fragmentation from one another. CONCLUSIONS: The present study demonstrates that ESI-HRMS/MS can be used for differentiation and structural characterization of positional isomers of protected azatryptophan derivatives. The MS/MS of [M + H]+ and [M + Na]+ ions of these positional isomers displayed differences in their fragmentation behaviour. The impact of different substitutions at different positions (1 and 6) of protected azatryptophan derivatives (1-6) on their fragmentation behaviour was also investigated in detail. Also, the nitrogen atom at different positions in the pyrrolopyridine ring led to different fragmentation patterns.

High-Resolution Ultrasonography in the Assessment of Lumbar Radiculoplexus Neuropathy in Diabetics: Preliminary Results of a Case-Control Study.

Background The traditional diagnosis of lumbar radiculoplexus neuropathy (LRN) is based on a classical sequence of symptoms and targeted electrodiagnostic examination by means of electromyography. Ultrasonography reliably indicates the level of lumbar radiculopathy by assessing edema mesial to the site of compression. Materials and Methods This case-control study was undertaken at a tertiary care hospital between July 2017 and June 2019 on 15 diabetic patients with symptoms of LRN. Fifteen healthy volunteers with no symptoms or clinical signs of LRN were included in the control group. The diameter (D) and transverse diameter (TD) of L1 nerve root (L1NR), L2NR, L3NR, and L4NR were measured, and their cross-sectional areas (CSAs) were calculated based on location in the lateral zone, where the NRs were visualized. On high-resolution ultrasonography, femoral nerve was localized lateral to the femoral artery in the femoral triangle beneath the inguinal ligament. Additionally, the CSA (calculated as CSA [mm 2 ] = D × TD × π/4), the diameter (mm), and transverse diameter (mm) of bilateral femoral nerves at the level of L3-L4 were calculated. Results The difference attributed to CSAs between affected NRs in LRN group and unaffected NRs in controls at levels L1-L4 was considered statistically significant ( p < 0.05). Receiver operating characteristic analysis revealed mean values to be 8 mm 2 (CSA) for L1NR, 11.2 mm 2 (CSA) for L2NR, 13.6 mm2 (CSA) for L3NR, and 17.8 mm 2 (CSA) for L4NR. There was significant difference between ΔCSA of LRN patients and controls at L1 to L4 levels ( p < 0.05). CSA measurements of lateral femoral cutaneous nerve (8 mm 2 ) and femoral nerve (58 mm 2 ) performed on high-resolution ultrasonography were significantly larger on the affected side as compared with the unaffected side. Conclusion Radiculoplexus neuropathy of the lumbar plexus can be reliably diagnosed on high-resolution ultrasonography that can reveal nerve thickening. The laterality of affected NRs was significantly greater in LRN group when compared with controls.

Diagnostic Accuracy and Prognostic Significance of Point-Of-Care Ultrasound (POCUS) for Traumatic Cervical Spine in Emergency care setting: A Comparison of clinical outcomes between POCUS and Computed Tomography on a Cohort of 284 Cases and Review of Literature.

BACKGROUND: The cervical spine is injured in approximately 3% of major trauma patients, and 10% of patients with serious head injury. Therefore, clearance of the cervical spine in multitrauma patients is a critically important task. This is particularly important, considering that there is a positive correlation between a Glasgow Coma Scale of <14 and cervical spine injury. Radiography is not sensitive enough to rule out cervical spine injury, especially as radiography done in the trauma setting is usually technically unsatisfactory. OBJECTIVE: The current study aims to assess the diagnostic accuracy and prognostic significance of using bedside point-of-care ultrasound (POCUS) in traumatic cervical spine injuries compared to computed tomography (CT) as the reference standard. MATERIALS AND METHODS: This comparative study enrolled 284 patients with severe multiple trauma at a tertiary care center between July 2017 and March 2020. The inclusion criteria included an indication of cervical spine CT scan, satisfaction of patients with participation in the study, and the lack of history of injury and severe traumatic events. The exclusion criteria were the history of a previous cervical spinal trauma, spondylosis, scoliosis, spinal tuberculosis, degenerative vertebral changes, and patients who refused to give consent to participate in research or CT scanning. The data were analyzed by SPSS software, and sensitivity, specificity, and positive predictive value (PPV)/negative predictive value (NPV) were determined based on CT findings. RESULTS: The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz). POCUS had a sensitivity of 78.5%, specificity of 98.4%, PPV of 93.2%, NPV of 92.8%, and accuracy of 93.2% in detecting all types of spinal injuries in comparison with CT scan as the standard modality. POCUS had a sensitivity of 100%, specificity of 92.3%, PPV of 62.3%, NPV of 100%, and accuracy of 91.7% in cases with the movement of injured particles. POCUS had a sensitivity of 32.2%, specificity of 100%, PPV of 100%, NPV of 91.4%, and accuracy of 90.8% in detecting the fracture of transverse process. POCUS had a sensitivity of 36.1%, specificity of 100%, PPV of 100%, NPV of 98.1%, and accuracy of 98.4% in ≤14-year age multitrauma patients. In comparison, the current study achieved a sensitivity of 79.4%, specificity of 95.7%, PPV of 92.1%, NPV of 86.3%, and accuracy of 88.6% in >14-year age multitrauma patients. CONCLUSION: POCUS for cervical spine is feasible using portable ultrasound machine and by neurosurgeons/radiologists/emergency physicians with basic training. It holds great potential in resource-starved settings and in unstable patients for ruling out unstable cervical spine injuries and injuries associated with the movement of fractured or dislocated particles. POCUS examination of the cervical spine was possible in the emergency setting and even in unstable patients and could be done without moving the neck. Future studies, ideally conducted as randomized control trials, are required to establish training and education standards, and to assess the feasibility and safety of POCUS as an alternative to radiography.

Review of lung ultrasound findings in coronavirus disease 2019 (COVID-19): Effectiveness, applications and approach to lung ultrasound during times of a pandemic.

As of 22 April 2020, there are 6 countries with >100,000 cases, 21 countries with 1000 to 10,000 confirmed cases and 53 countries with between 1000 and 10,000 confirmed cases of COVID-19. Six articles (5 research articles and 1 review article) with a total of 159 cases delineating the equipment, protocol, techniques, indications and follow-up management of COVID-19 were identified in a PUBMED search evaluating the role of lung Ultrasound. In the current review article, 55%-60% of the patients with COVID-19 were male; the median age has been reported between 34 and 59 years. Lung Ultrasound features of COVID-19 are related to the stage of the disease, the severity of lung injury, and comorbidities. This review article provides a summary of lung Ultrasound findings in COVID-19 and clinical guidance for the use and interpretation of lung ultrasound for patients with moderate, severe and critical COVID-19-related pulmonary syndrome.

Diagnostic accuracy and false-positive rate of chest CT as compared to RT-PCR in coronavirus disease 2019 (COVID-19) pneumonia: A prospective cohort of 612 cases from India and review of literature.

BACKGROUND: At present, the diagnosis of COVID-19 depends on real-time reverse transcriptase polymerase chain reaction (RT-PCT). On imaging, computed tomography (CT) manifestations resemble those seen in viral pneumonias, with multifocal ground-glass opacities and consolidation in a peripheral distribution being the most common findings. Although these findings lack specificity for COVID-19 diagnosis on imaging grounds, CT could be used to provide objective assessment about the extension of the lung opacities, which could be used as an imaging surrogate for disease burden. Chest CT scan may be helpful in early diagnosing of COVID-19. OBJECTIVE: The current study investigated the diagnostic accuracy and false-positive rate of chest CT in detecting COVID-19 pneumoniain a population with clinical suspicion using RT-PCR testing as reference standard. MATERIALS AND METHODS: In this prospective single centerstudy performed on 612 cases with clinical suspicion of COVID-19, all adult symptomatic ED patients had both a CT scan and a PCR upon arrival at the hospital. CT results were compared with PCR test (s) and diagnostic accuracy was calculated. RESULTS: Between February 15, 2020 to July 15, 2020, 612 symptomatic ED patients were included. In total, 78.5% of patients had a positive PCR and 82.8% a positive CT, resulting in a sensitivity of 94.2%, specificity 76.4%, likelihood ratio (LR) + 2.94 and (LR) - 0.18. The PPV was 76.7% and NPV 94.1%. The sensitivity of the CT tended to be higher (100.0%) in those with severe risk pneumonia than in patients with low/medium risk pneumonia (90.3%, P = 0.42). In patients with sepsis, sensitivity was significantly higher than in those without sepsis (99.5 vs. 63.5%, P < 0.001). The diagnostic ability of chest CT was found to be rather high with 92.1%, concordance rate between findings of CT and PCR. In 48 (7.8%) patients discordant findings between CT and PCR were observed. The positive predictive values (PPV) and accuracy of chest CT in diagnosing COVID-19 were higher in patients ≥60 years than that in patients <60 years (P = 0.001 and 0.004, respectively). The specificity and NPV of chest CT in diagnosing COVID-19 were greater for women than that for men (P = 0.007 and 0.03, respectively); and no difference existed for sensitivity, PPV and accuracy (P = 0.43, 0.69 and 0.31, respectively). In most cases, the CT scan was considered suspicious for COVID-19, while the PCR was negative (37/48, 70.8%). In the majority of these, the diagnosis at discharge was pulmonary infection (n = 26; 74.3%). The current study included repeated PCRs and explored discordant test results, which showed that in about 45.9% of patients with false-positive CT scans, other viral pathogens were detected. The false-positive rate of CT findings in the diagnosis of COVID-19 pneumonia was 7.2%. CONCLUSION: High diagnostic accuracy of chest CT findings with typical and relatively atypical CT manifestations of COVID-19 leads to a low rate of missed diagnosis. Normal chest CT can be found in RT-PCR positive COVID-19 cases, and typical CT manifestations can be found in RT-PCR negative cases. Therefore, a combination of both CT and RT-PCR for future follow-up, management and medical surveillance is recommended considering the false-positive results of chest CT in the diagnosis of COVID-19 pneumonia.

18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging review of benign lesions of the thorax.

2-deoxy-2-(Fluorine-18) fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been used exclusively to diagnose malignancies. However, increased 18F-FDG uptake is not always limited to malignant lesions. This imaging review demonstrates the physiological 18F-FDG uptake of normal structures in the thorax and illustrates many benign pathological lesions with standardized uptake value >2.5. These various conditions can be broadly categorized into three groups: infective lesions, active granulomatous diseases such as sarcoidosis, noninfectious/inflammatory, or proliferative conditions such as radiation pneumonitis, postlung transplant lymphoproliferative disorders, occupational pleuropulmonary complications, and postsurgical conditions, all of which can demonstrate varying degrees of 18F-FDG uptake on PET/CT based upon the degree of inflammatory activity. Familiarity of false-positive findings improves the PET/CT evaluation accuracy of benign lesions of the thorax. Radiation exposure and surgical history correlation along with imaging cross check evaluation of radiographs and magnetic resonance images for the anatomic location remains the mainstay of PET/CT characterization of positive findings.

Isolated Intramuscular Cysticercosis of the Biceps Diagnosed on High-Resolution Ultrasonography.

High-resolution ultrasound clinches the diagnosis of intramuscular cysticercosis which is a rare finding. Here, we present a case of isolated intramuscular cysticercosis diagnosed on high-resolution ultrasonography in a 46-year-old gentleman who presented with a linear swelling in the flexor aspect of the left arm in the long head of the biceps.

Embryological considerations and evaluation of congenital anomalies of craniovertebral junction: A single-center experience.

OBJECTIVES: Craniovertebral junction (CVJ) abnormalities constitute a group of treatable neurological disorders, especially in the Indian subcontinent. Thus, it is essential that clinicians should be able to make a precise diagnosis of abnormalities and rule out important mimickers on multidetector computed tomography (MDCT) as this information ultimately helps determine the management, prognosis, and quality of life of patients. CVJ is the most complex part of the cervical region. Congenital malformations of this region can cause serious neurological deficit and require a surgical intervention. The present study was undertaken to know the embryological basis of the CVJ and to identify commonly observed congenital CVJ abnormalities, their frequency, and mode of presentation. MATERIALS AND METHODS: Diagnosed cases of CVJ anomalies on dynamic MDCT head were reviewed at a tertiary care center between January 2014 to December 2019. Type of anomaly, clinical presentation, and associated malformations were recorded. Different types of variations were expressed in terms of percentage. RESULTS: Congenital anomalies were seen in 42 cases. Fifteen types of anomalies were detected. Anomalies were either singly or in combination. The CVJ anomalies were more common in young adults (28%), almost equal in both sexes. The most common anomaly was basilar invagination (52.3%), followed by atlanto-occipital assimilation (33.3%), and Arnold-Chiari malformation is the most common soft tissue anomaly. In fourteen cases, additional anomalies of other vertebrae were present. The most common symptoms were weakness of extremities, neck pain, paresthesia, torticollis, and gait disturbances. About 28 patients got improved, 8 patients had residual deficit as that of preoperative status, and 4 patients got deteriorated after surgery, at 1-month follow-up. About 34 patients had improved, 5 remained static, and 3 patients got worsened at the end of 3-month follow-up. About 37 patients had improved, 4 patients remained static, and 2 patients got deteriorated at 6 months of follow-up. The patients with increased atlantodens interval 3-5 mm showed 77% improvement after surgery. CONCLUSION: Congenital CVJ anomalies, though rare, are fatal. CVJ abnormalities constitute an important group of treatable neurological disorders with diagnostic dilemma. The atlantodental interval is the most important preoperative prognostic marker. Dynamic CT imaging can provide additional useful information to the diagnosis of CVJ instability. To prevent long-term neurological problems, early diagnosis and treatment of congenital bony CVJ anomalies is important.

Diagnostic accuracy of chest computed tomography in improving the false negative rate as compared to reverse transcriptase polymerase chain reaction in coronavirus disease 2019 pneumonia: A cross sectional analysis of 348 cases from India.

BACKGROUND: Early differentiation between emergency department (ED) patients with and without coronavirus disease 2019 (COVID-19) is very important. The diagnosis of COVID-19 depends on real-time reverse transcriptase polymerase chain reaction (RT-PCR). On imaging, computed tomography (CT) manifestations resemble those seen in viral pneumonias, with multifocal ground-glass opacities and consolidation in a peripheral distribution being the most common findings. Although these findings lack specificity for COVID-19 diagnosis on imaging grounds, CT could be used to provide objective assessment about the extension of the lung opacities, which could be used as an imaging surrogate for disease burden. We set out to investigate the diagnostic accuracy of chest CT scanning in detecting COVID-19 in a population with suspected COVID-19 patients. MATERIALS AND METHODS: In this cross-sectional single-center study performed on 348 cases with clinical suspicion of COVID-19, all adult symptomatic ED patients had both a CT scan and a PCR upon arrival at. CT results were compared with PCR test (s) and diagnostic accuracy was calculated. RESULTS: Between February 15, 2020, and June 30, 2020, 348 symptomatic patients were included. In total, 62.3% of patients had a positive PCR and 69.8% had a positive CT, resulting in a sensitivity of 94.2%, specificity of 76.7%, likelihood ratio (LR) of +2.94 and (LR) -0.18. The sensitivity of the CT tended to be higher in those with acute respiratory distress syndrome (100.0%, P = 0.017) and severe COVID-19 (98.5%, P = 0.027) than in patients with mild (82.5%, P = 0.047) and moderate COVID-19 (89.3%, P = 0.039). The diagnostic ability of chest CT was found to be high with 86.3% concordance between findings of CT and PCR. In 48 (13.7%) patients, discordant findings between CT and PCR were observed. In most cases, the CT scan was considered suspicious for COVID-19, while the PCR was negative (37/48, 77.0%). In the majority of these, the diagnosis at discharge was pulmonary infection (n = 26; 54.1%). CONCLUSION: The accuracy of chest CT in symptomatic COVID suspect patients is high, but when used as a single diagnostic test, CT cannot accurately diagnose or exclude COVID-19. Therefore, we recommend a combination of both CT and RT-PCR for future follow-up, management, and medical surveillance.