Programmatic implications of a sub-national TB prevalence survey in India.

Subnational TB estimates are crucial for making informed decisions to tailor TB control activities to local TB epidemiology.A cross-sectional survey was conducted among 143,005 individuals in Tamil Nadu, India. Participants were screened for symptoms and underwent chest X-ray (CXR). Participants with symptoms of TB and/or abnormal CXR were tested for TB using Xpert, smear, and liquid culture.The prevalence of microbiologically confirmed pulmonary TB (MCPTB) was 212 (95% CI 184-239) per 100,000 population. The prevalence-to-notification ratio (P:N) in the state was 2.05 (95% CI 1.8-2.29). Low body mass index and diabetes together had a population attributable fraction of 54.15 (95% CI 45.68-61.97). Approximately 39% of the TB cases were asymptomatic and were identified only by CXR screening. In the general population, only 26.9% sought care at a health facility among those with symptoms suggestive of TB.The programme needs to prioritise screening with CXR to potentially detect cases earlier and curtail the transmission and upscale molecular tests in the selected population to increase the yield of case finding. Innovative health education strategies must be devised to address health-seeking behaviour..

Development and Validation of Fast and Sensitive RP-HPLC Stability-Indicating Method for Quantification of Piroxicam in Bulk Drug.

A simple, rapid, sensitive, and cost-effective green solvent-assisted reverse-phase high-performance liquid chromatographic technique, coupled with a photodiode array detector, was developed and validated for the estimation of piroxicam (PRXM). The chromatographic separation was achieved by using a C-18 (250 × 4.6) mm, 5-µm stationary phase and a mobile phase consisting of methanol and 0.1% ortho-phosphoric acid in water in a ratio of (80:20) v/v at a flow rate of 1 ml/min. The detection was carried out at a wavelength of 254 nm with a constant injection volume of 10 µL throughout the analysis. The calibration curve was observed to be linear over the optimum concentration range of 50-300 µg mL-1, with an R2 value of 0.9995. The developed method was validated as per the International Council for Harmonisation (ICH) Q2 (R1) guideline. Various parameters like selectivity/specificity, accuracy/recovery, linearity, precision, detection limit, quantitation limit, robustness and stability of analyte in solution were performed for the method validation. The PRXM was evaluated under stressed conditions, including acidic, basic, oxidative, thermal and photolytic, as per ICH Q1 (R2) guidelines. Significant degradation was observed in acidic and basic degradation conditions. Conversely, the drug substance showed stability when exposed to oxidative, photolytic and thermal degradation conditions.

Extraction and characterization of novel fibers from Tecoma stans Linn bark for use as reinforcement in polymer composites.

Embarking on a pioneering investigation, this study unravels the extraordinary qualities of Tecoma stans Fibers (TSFs), freshly harvested from the rachis, establishing them as prospective reinforcements for biocomposites. Delving into their intricate characteristics, TSFs exhibit a unique fusion of physical resilience, with a density of 1.81 ± 0.39 g/cc and a diameter of 234.12 ± 7.63 µm. Complementing their physical prowess, their chemical composition boasts a harmonious blend of cellulose (70.1 ± 9.06 wt%), hemicellulose (13.56 ± 4.29 wt%), lignin (7.62 ± 2.39 wt%), moisture (4.21 ± 1.56 wt%), wax (2.37 ± 0.63 wt%), and ash (1.25 ± 0.36 wt%). In the realm of mechanical strength, TSFs showcase an impressive tensile strength of 639 ± 18.47 MPa, coupled with a robust strain at failure of 1.75 ± 0.13 % and a Young Modulus of 36.51 ± 1.96 GPa. Unveiling their crystalline intricacies, these fibers reveal a microfibril angle of 14.66 ± 0.15°, a crystalline index (CI) of 63.83 %, and a crystallite size (CS) of 9.27 nm. Beyond their mechanical marvels, TSFs exhibit unwavering thermal stability, enduring temperatures up to 297.36 °C, with a Tmax reaching an impressive 392.09 °C.

Molecular evolution of 2022 multi-country outbreak-causing monkeypox virus Clade IIb.

The monkeypox virus (Mpoxv) Clade IIb viruses that caused an outbreak in 2017-18 in Nigeria and its genetically related viruses have been detected in many countries and caused multi-country outbreak in 2022. Since the pandemic-causing Mpoxv Clade IIb viruses are closely related to Clade IIa viruses which mostly cause endemic, the Clade IIb Mpoxv might have certain specific genetic variations that are still largely unknown. Here, we have systematically analyzed genetic alterations in different clades of Mpox viruses. The results suggest that the Mpoxv Clade IIb have genetic variations in terms of genomic gaps, frameshift mutations, in-frame nonsense mutations, amino acid tandem repeats, and APOBEC3 mutations. Further, we observed specific genetic variations in the multiple genes specific for Clade I and Clade IIb, and exclusive genetic variations for Clade IIa and Clade IIb. Collectively, findings shed light on the evolution and genetic variations in the outbreak of 2022 causing Mpoxv Clade IIb.

Extraction of lignocellulosic fiber and cellulose microfibrils from agro waste-palmyra fruit peduncle: Water retting, chlorine-free chemical treatments, physio-chemical, morphological, and thermal characterization.

In this paper, lignocellulosic fibers and cellulose microfibrils (CMFs) were extracted from palmyra fruit peduncle waste and investigated as naturally derived cellulosic materials for their potential use as reinforcement materials in composite applications. The physicochemical, mechanical, and thermal properties of the extracted fiber were studied. Physical and morphological analysis results revealed an extracted fiber diameter of 82.5 µm with a very rough surface, providing excellent interfacial bonding performance with the polymer matrix. Chemical, mechanical, and thermal results showed that the fibers consist mainly of cellulose as their crystallized phase, with a cellulose content of 56.5 wt% and a tensile strength of 693.3 MPa, along with thermal stability up to 252 °C. The chemically extracted CMFs exhibit a short, rough-surfaced, cylindrical cellulose structure with a diameter range of 10-15 µm. These CMFs demonstrate excellent thermal stability, withstanding temperatures up to 330 °C. Furthermore, the formation of CMFs is evident from a substantial increase in the crystallinity index, which increased from 58.2 % in the raw fibers to 78.2 % in the CMFs. FT-IR analysis further confirms the successful removal of non-cellulosic materials through chlorine-free chemical treatments. These findings strongly support the potential use of extracted fibers and CMFs as reinforcement materials in polymers.

Production of hybrid AgNPs - TEMPO-mediated oxidation cellulose composite from jackfruit peduncle agro-waste and its thermal management application in electronic devices.

The urgent need for eco-friendly and cost-effective cellulose paper substrates in thermal management for biomedical electronic devices has driven the exploration of agro-waste materials. In this study, jackfruit peduncle waste was utilized as a precursor to produce a hybrid of AgNPs-tempo-mediated oxidation cellulose strands (AgNPs-TOCS) through acid hydrolysis, TEMPO oxidation, and an in-situ generation process. The resulting hybrid AgNPs-TOCS composite exhibited a cylindrical cellulose structure with a diameter of 27.3 µm, on which spherical AgNPs with a diameter of 16.3 nm were embedded. This hybrid AgNPs-TOCS displayed an impressive inhibition zone diameter against E. coli bacteria (15.2 nm) and exhibited excellent thermal stability up to 269 °C. Furthermore, the AgNPs-TOCS composite paper substrate was fabricated using non-solvent techniques, and its mechanical, thermal, and electrical properties were investigated. This composite paper substrate exhibits good tensile strength (65 ± 2 MPa), in-plane thermal conductivity (5.8 ± 0.2 W/(m·K)), and electrical resistivity (0.0575 KΩ·m). These findings strongly suggest that this type of composite paper substrate holds promise for applications in thermal management within the field of biomedical electronics.

Sign of APOBEC editing, purifying selection, frameshift, and in-frame nonsense mutations in the microevolution of lumpy skin disease virus.

The lumpy skin disease virus (LSDV), which mostly affects ruminants and causes huge-economic loss, was endemic in Africa, caused outbreaks in the Middle East, and was recently detected in Russia, Serbia, Greece, Bulgaria, Kazakhstan, China, Taiwan, Vietnam, Thailand, and India. However, the role of evolutionary drivers such as codon selection, negative/purifying selection, APOBEC editing, and genetic variations such as frameshift and in-frame nonsense mutations in the LSDVs, which cause outbreaks in cattle in various countries, are still largely unknown. In the present study, a frameshift mutation in LSDV035, LSDV019, LSDV134, and LSDV144 genes and in-frame non-sense mutations in LSDV026, LSDV086, LSDV087, LSDV114, LSDV130, LSDV131, LSDV145, LSDV154, LSDV155, LSDV057, and LSDV081 genes were revealed among different clusters. Based on the available complete genome sequences, the prototype wild-type cluster-1.2.1 virus has been found in other than Africa only in India, the wild-type cluster-1.2.2 virus found in Africa were spread outside Africa, and the recombinant viruses spreading only in Asia and Russia. Although LSD viruses circulating in different countries form a specific cluster, the viruses detected in each specific country are distinguished by frameshift and in-frame nonsense mutations. Furthermore, the present study has brought to light that the selection pressure for codons usage bias is mostly exerted by purifying selection, and this process is possibly caused by APOBEC editing. Overall, the present study sheds light on microevolutions in LSDV, expected to help in future studies towards disturbed ORFs, epidemiological diagnostics, attenuation/vaccine reverts, and predicting the evolutionary direction of LSDVs.

Reuse of used paper egg carton boxes as a source to produce hybrid AgNPs- carboxyl nanocellulose through bio-synthesis and its application in active food packaging.

The proper disposal of disposable synthetic plastic food packaging materials presents a significant challenge for both the environment and the solid waste management community. To address this issue, an antibacterial-based high-strength bio-composite serves as the optimal alternative to conventional packaging materials. This study aims to produce a hybrid material of AgNPs-carboxyl cellulose nanocrystals (AgNPs-CCNCs), obtained from used egg carton boxes (UECBs), through bio acid hydrolysis and an in-situ generation process. Furthermore, AgNPs- carboxyl cellulose nanofibers (AgNPs-CCNFs) will be synthesized through a combination of bio acid hydrolysis and ball milling, followed by an additional in-situ generation step. The AgNPs-carboxyl nanocellulose (AgNPs-CCNCs, and AgNPs-CCNFs) exhibited excellent crystallinity index, morphology, thermal, and antibacterial properties. The morphological analysis was performed by electron microscopy, and the results showed the uniform distribution and spherical form of AgNPs appearing over the carboxyl nanocellulose through the in-situ generation process, which was confirmed through XRD analysis. The study further explores the impact of AgNPs-carboxyl nanocellulose on the mechanical, chemical, antibacterial, and thermal properties of the PVA matrix. The results demonstrate that the bio-nanocomposite film offers opportunities for utilization in active packaging applications.

Development and Validation of Robust, Highly Sensitive and Stability-Indicating RP-HPLC Method for Estimation of Deferasirox and its Degradation Products.

A rapid, simple and highly sensitive stability-indicating reverse-phase high-performance liquid chromatographic technique, coupled with a photodiode array detector, was developed and validated for the estimation of Deferasirox (DFS). The chromatographic separation was achieved using a C-18 (250 × 4.6 mm, 5 µm) stationary phase and a mobile phase composed of 0.1% orthophosphoric acid and acetonitrile at a flow rate of 1 mL/min. The detection was carried out at a wavelength of 245 nm with a constant injection volume of 10 µL throughout the analysis. With an R2 value of 0.9996, the calibration curve was determined to be linear over an appropriate concentration range of 50-500 ng/mL. According to the International Conference on Harmonization (ICH) Q1 (R2) guideline, DFS was evaluated under stress conditions that included hydrolytic (acid, alkali and neutral), oxidative and thermal degradation. The findings demonstrated that significant degradation was observed in acidic degradation conditions, whereas drug substance was found to be stable when exposed to neutral, basic, oxidative and thermal degradation. The developed method was validated as per ICH guidelines. The developed method was employed successfully to estimate the amount of DFS in bulk and pharmaceutical formulation.

Unique Tandem Repeats in the Inverted Terminal Repeat Regions of Monkeypox Viruses.

The genetic diversity, especially in noncoding regions between clade I, clade IIa, and clade IIb monkeypox viruses (MPXVs), is still not fully understood. Here, we report that unique 16-nucleotide-length tandem repeats in MPXVs viruses are located in the noncoding regions of inverted terminal repeats (ITR), and the copy number of this repeat is different among clade I, clade IIa, and clade IIb viruses. It is noteworthy that tandem repeats containing these specific sequences (AACTAACTTATGACTT) are only present in MPXVs and are not found in other poxviruses. Also, the tandem repeats containing these specific sequences (AACTAACTTATGACTT) do not correspond to the tandem repeats present in the human and rodent (mice and rat) genomes. On the other hand, some of the reported tandem repeats in the human and rodent (mice and rat) genomes are present in the clade IIb-B.1 lineage of MPXV. In addition, it is noteworthy that the genes flanking these tandem repeats are lost and gained compared between clade I, clade IIa, and clade IIb MPXV. IMPORTANCE The different groups of MPXVs contain unique tandem repeats with different copy numbers in the ITR regions, and these repeats may be likely to play a role in the genetic diversity of the virus. Clade IIb (B) MPXV contains 38 and 32 repeats similar to the Tandem repeats reported in the human and rodent genome, respectively. However, none of these 38 (human) and 32 (rodent) tandem repeats matched the tandem repeats (AACTAACTTATGACTT) found in the present study. Finally, when developing attenuated or modified MPXV vaccine strains, these repeats in noncoding genomic regions can be exploited to incorporate foreign proteins (adjuvants/other virus proteins/racking fluorescent proteins such as green fluorescent protein) to carry out studies such as vaccine production and virus pathogenesis.

Nutraceuticals and phytotherapeutics for holistic management of amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis" (ALS) is a progressive neuronal disorder that affects sensory neurons in the brain and spinal cord, causing loss of muscle control. Moreover, additional neuronal subgroups as well as glial cells such as microglia, astrocytes, and oligodendrocytes are also thought to play a role in the aetiology. The disease affects upper motor neurons and lowers motor neurons and leads to that either lead to muscle weakness and wasting in the arms, legs, trunk and periventricular area. Oxidative stress, excitotoxicity, programmed cell death, altered neurofilament activity, anomalies in neurotransmission, abnormal protein processing and deterioration, increased inflammation, and mitochondrial dysfunction may all play a role in the progression of ALS. There are presently hardly FDA-approved drugs used to treat ALS, and they are only beneficial in slowing the progression of the disease and enhancing functions in certain individuals with ALS, not really in curing or preventing the illness. These days, researchers focus on understanding the pathogenesis of the disease by targeting several mechanisms aiming to develop successful treatments for ALS. This review discusses the epidemiology, risk factors, diagnosis, clinical features, pathophysiology, and disease management. The compilation focuses on alternative methods for the management of symptoms of ALS with nutraceuticals and phytotherapeutics.

LC and LC-MS/MS studies for identification and characterization of degradation products of d-tubocurarine chloride.

Forced degradation studies of d-tubocurarine (DTC) was carried out in hydrolytic (acidic, alkaline and neutral), thermal, photolytic and oxidative degradation conditions as per International Conference on Harmonization (ICH) guideline Q1A (R2). The present study revealed that DTC is highly sensitive to oxidative degradation conditions even at room temperature whereas the drug was found to be stable in hydrolytic, photolytic and thermal stress conditions. Separation of DTC and its four degradation products (DPs) (DP-I to DP-IV) formed during stress degradation conditions were achieved on Waters Acquity CSH C18 (1.7 µm, 2.1 mm × 100 mm) column using gradient elution with a mobile phase consisting of Eluent-A: 0.1 % Formic acid Eluent-B: acetonitrile achieved successfully. The detection was carried out at 210 nm wavelength and the flow rate was kept at 0.3 mL/min with a 5 µL injection volume. Also, a highly sensitive and robust HRMS/MS/TOF method was established for the identification and characterization of four DPs formed during the stress study. ESI +ve mode was used throughout the study for ionization of all the DPs. The degradation pathway was also established in the study that is never reported earlier.

Prognostic determinants in severe odontogenic space infections: a single-center retrospective analysis.

BACKGROUND: Odontogenic space infections are a common presentation in oral and maxillofacial surgery units worldwide. Multiple patient and treatment dependent variables may be used predict the outcomes of the disease process. This study was aimed at a retrospective evaluation of significant predictors of prognosis in terms of length of hospital stay and the need for re-exploration in cases of odontogenic space infections. METHODS: Patients who underwent incision and drainage of odontogenic space infections were identified from the hospital records of the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India. The variables assessed included Diabetic status, pyrexia on admission, topical rubefacient agent application, hot fomentation, recent tooth extraction, trismus, dysphagia or dyspnea on presentation, white blood cell count, number of spaces involved, antibiotics used, organisms isolated, severity of the infection and the anesthesia technique used (local anesthesia [LA], conscious sedation or general anesthesia). RESULTS: The sample consisted of 259 patients (110 male, 159 female) with a mean age of 41±16.9 years. Space infections were preceded by tooth extractions in 53 (20%) cases, rubefacient balm application in 130 (40%) and hot fomentation in 58 (22%) cases. Trismus was noted in 140 patients with an average mouth opening of 21±10.3 mm. Dyspnea and dysphagia were noted in 55 (21%) and 96 (37%) patients each. Sixty-six patients were diabetic. The average length of hospital stay was 5.8±3 days and re-exploration was required in 75 (29%) patients. Significant predictors of hospital stay were severity (P<0.001), number of spaces affected (P<0.001), hot fomentation (P=0.04), trismus (P<0.001), dysphagia (P<0.001) and dyspnea (P<0.001). Predictors of re-exploration are an increased primary surgery under LA (P<0.001), white blood cell count (P<0.001), rubefacient balm application (P=0.045), dysphagia (P<0.001), dyspnea (P=0.018), and reduced mouth opening (P<0.001). No significant correlation between diabetes and length of hospital stay or the need for re-exploration were found in this study. CONCLUSIONS: Poorer outcomes can be predicted based on the severity of the infection, the number of spaces involved, an increased white blood cell count as well as clinical signs and symptoms like trismus, dysphagia and dyspnea. Hot fomentation and Rubefacient agent application were identified as significant determinants of poor prognosis in this study. The presence of these indicators warrants a more aggressive approach towards management of space infections.

Genetic Diversity and Characterization of Circular Replication (Rep)-Encoding Single-Stranded (CRESS) DNA Viruses.

The CRESS-DNA viruses are the ubiquitous virus detected in almost all eukaryotic life trees and play an essential role in the maintaining ecosystem of the globe. Still, their genetic diversity is not fully understood. Here, we bring to light the genetic diversity of replication (Rep) and capsid (Cap) proteins of CRESS-DNA viruses. We divided the Rep protein of the CRESS-DNA virus into 10 clusters using CLANS and phylogenetic analyses. Also, most of the Rep protein in Rep cluster 1 (R1) and R2 (Circoviridae, Smacoviridae, Nanoviridae, and CRESSV1-5) contain the Viral_Rep superfamily and P-loop_NTPase superfamily domains, while the Rep protein of viruses in other clusters has no such characterized functional domain. The Circoviridae, Nanoviridae, and CRESSV1-3 viruses contain two domains, such as Viral_Rep and P-loop_NTPase; the CRESSV4 and CRESSV5 viruses have only the Viral_Rep domain; most of the sequences in the pCRESS-related group have only P-loop_NTPase; and Smacoviridae do not have these two domains. Further, we divided the Cap protein of the CRESS-DNA virus into 20 clusters using CLANS and phylogenetic analyses. The Rep and Cap proteins of Circoviridae and Smacoviridae are grouped into a specific cluster. Cap protein of CRESS-DNA viruses grouped with one cluster and Rep protein with another cluster. Further, our study reveals that selection pressure plays a significant role in the evolution of CRESS-DNA viruses' Rep and Cap genes rather than mutational pressure. We hope this study will help determine the genetic diversity of CRESS-DNA viruses as more sequences are discovered in the future. IMPORTANCE The genetic diversity of CRESS-DNA viruses is not fully understood. CRESS-DNA viruses are classified as CRESSV1 to CRESSV6 using only Rep protein. This study revealed that the Rep protein of the CRESS-DNA viruses is classified as CRESSV1 to CRESSV6 groups and the new Smacoviridae-related, CRESSV2-related, pCRESS-related, Circoviridae-related, and 1 to 4 outgroups, according to the Viral_Rep and P-loop_NTPase domain organization, CLANS, and phylogenetic analysis. Furthermore, for the first time in this study, the Cap protein of CRESS-DNA viruses was classified into 20 distinct clusters by CLANS and phylogenetic analysis. Through this classification, the genetic diversity of CRESS-DNA viruses clarifies the possibility of recombinations in Cap and Rep proteins. Finally, it has been shown that selection pressure plays a significant role in the evolution and genetic diversity of Cap and Rep proteins. This study explains the genetic diversity of CRESS-DNA viruses and hopes that it will help classify future detected viruses.

Extraction and characterization of natural lignocellulosic fibres from Typha angustata grass.

In recent years, efforts have been made to reduce deforestation to conserve the ecosystem. In the current scenario, agro-cultivated products are used instead of wood for engineering applications. Thus, natural lignocellulosic fibres are used as a reinforcing material and have been extremely attractive to industries and the scientific community during the past few decades. This study aimed to examine the use of natural fibres extracted from Typha angustata grass as reinforcement in polymer matrix composites. The density of the fibres was 1.015 g/cc. Chemical analysis confirmed that T. angustata fibres (TAFs) have a cellulose content of 73.54 wt%, a hemicellulose content of 10.11 wt%, a lignin content of 6.23 wt% and a wax content of 0.23 wt%. The crystallinity index (65.16 %) and crystalline size (6.40 nm) were identified by X-ray diffraction (XRD) analysis. The presence of functional groups in the TAFs was examined by employing Fourier-transform infrared spectroscopy (FTIR). The presence of cellulose at peak intensities of C2, C3 and C5 in the TAFs was confirmed using 13C nuclear magnetic resonance (NMR) spectroscopy. The single fibre tensile test revealed that the tensile strength was 665 ± 7 MPa and Young's modulus was 27.45 ± 3.46 GPa. The thermal stability of the TAFs was examined by thermogravimetric analysis (TGA), and the prominent peak was observed at 298.48 °C, with a kinetic activation energy of 67.99 kJ/mol. The surface roughness of the fibres was analysed by atomic force microscopy (AFM) with an accuracy of 1 nm. The above-mentioned outcomes indicated that the TAFs have desirable properties that are comparable to existing natural fibres and suggested to be utilised as the possible reinforcement to fabricate the fibre-reinforced polymer matrix composites.

Canine hepatic calodiosis with cirrhosis.

The nematode parasite Calodium hepaticum (Capillaria hepatica) has a global distribution and is commonly reported in rodents (definitive host), dogs, cats and wild animals. Humans especially children are more susceptible to the parasitic infection. This paper documents an incidental finding of hepatic calodiosis with cirrhosis in a stray dog and discusses the zoonotic implications. A non descript dog was brought for necropsy examination to the Department of Veterinary Pathology, Madras Veterinary College, Tamil Nadu, India. Liver appeared dark brown, mottled with multifocal random variably sized, grey white flat firm areas. Histopathologically, liver tissue revealed multiple random encysted large collection of eggs surrounded by mild inflammation with a few lymphocytes, macrophages and fine fibrosis. The eggs had characteristic barrel shape, bipolar ends, bilayered wall, cross striations between the walls, and yolk. Periodic acid Schiff stain demonstrated the glycolic wall of ova. Marked portal to portal fibrosis was demonstrated by Masson's trichrome (for collagen) and by Warthin-Starry (for reticulin) stains. The stage of parasitic infection was diagnosed as intermediate to chronic due to fibrosis. A need to study the prevalence of the disease in rodents, human and animals is emphasized. Improper burial of carcasses of rodents and dogs may contribute to spread of infection. Pets and stray animals may transmit infection to human and pose health risk.

Neuroimaging Profile of drug-resistant Epilepsy from a Tertiary Care Center in South India.

BACKGROUND AND AIMS: Drug-resistant epilepsy (DRE) is a common and important neurological problem to identify with scope for curative surgical treatment if underlying cause is delineated. There are very few prospective structured studies in our population. This study aimed to look at the neuroimaging profile of DRE presenting in a tertiary care center in South India. MATERIALS AND METHODS: All patients diagnosed clinically as DRE as per International League Against Epilepsy (ILAE) criteria and who underwent magnetic resonance imaging (MRI) over a period of 24 months were included in the study. Their clinical and MRI features were documented and analyzed. RESULTS: A total of 150 patients diagnosed with DRE were included in the study. Clinically, 96 of them presented with generalized tonic-clonic seizures (GTCS), 36 with complex partial seizures (CPS), 14 with simple focal seizures, and two each with atonic seizures and focal seizures with secondary generalization. Magnetic resonance imaging (done in 1.5 T) was normal in 32%. In those with abnormal MRI, mesial temporal sclerosis (MTS) was the commonest pathology seen in 41.3%, followed by cortical malformations (6.7%), tumors (2.6%), vascular malformations (2.7%), and other nonspecific lesions (12%). CONCLUSION: The clinical and neuroimaging profile of DRE showed that DRE is more common in younger age (of less than 30 years); presents mainly with GTCS or CPS; mesial temporal sclerosis is the commonest underlying pathology which was bilateral in 8.6%; temporal lobe lesions predominate (49.3% of all DRE); and cortical malformation, low-grade tumors, and vascular lesions are other important causes.

Evaluation of Acoustic Radiation Force Impulse Imaging in Differentiating Benign and Malignant Cervical Lymphadenopathy.

Background: The aim of this study was to assess the diagnostic role of acoustic radiation force impulse imaging (ARFI) in differentiating benign and malignant cervical nodes. Methods: This was a diagnostic accuracy cross-sectional study. All patients who underwent ultrasound-guided fine-needle aspiration cytology (FNAC) of cervical nodes were included. Patients without FNAC/biopsy and patients in whom cervical nodes were cystic or completely necrotic were excluded. FNAC was used as reference investigation to predict the diagnostic accuracy. In all cases, FNAC was carried out after the B-mode, color Doppler and the ARFI imaging. In patients with multiple cervical lymph nodes, the most suspicious node based on grayscale findings was chosen for ARFI. ARFI included Virtual Touch imaging (VTI), area ratio (AR), and shear wave velocity (SWV) for each node, and the results were compared with FNAC/biopsy. Results: The final analysis included 166 patients. Dark VTI elastograms had sensitivity and specificity of 86.2% and 72.1%, respectively, in identifying malignant nodes. Sensitivity and specificity of AR were 71.3% and 82.3%, respectively, for a cutoff of 1.155. Median SWV of benign and malignant nodes was 1.9 [95% confidence interval (CI), 1.56-2.55] m/s and 6.7 (95% CI, 2.87-9.10) m/s, respectively. SWV >2.68 m/s helped in identifying malignant nodes with 81% specificity, 81.6% sensitivity, and 81.3% accuracy. ARFI was found to be inaccurate in tuberculous and lymphomatous nodes. Conclusion: Malignant nodes had significantly darker elastograms, higher AR and SWV compared to benign nodes, and SWV was the most accurate parameter. ARFI accurately identifies malignant nodes, hence could potentially avoid unwarranted biopsy.

Unusual manifestations of extra-pulmonary tuberculosis: a pictorial essay.

Purpose: Tuberculosis is quite common in India. About 40% of all Indians are infected with mycobacterium tuberculosis, with 2.5 million active tuberculosis cases. Tuberculosis primarily affects the lungs, but it can affect any organ. Extra-pulmonary involvement occurs 15-20% of cases in immune-competent patients and in more than 50% in HIV patients. The most common extra-pulmonary sites are lymph nodes, pleura, abdomen, genitourinary tract, skin, joints and bones, or meninges. Case reports: In this pictorial review article we present 8 atypical cases of tuberculosis and describe their imaging features and histopathology. Conclusions: Extra-pulmonary tuberculosis can affect virtually any organ and can mimic various inflammatory and neoplastic disorders apart from other infective conditions. A strong index of suspicion is required particularly in those countries endemic to tuberculosis.