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AbstractBackgroundMethodsResultsConclusionsIndia relies primarily on direct smear microscopy for tuberculosis (TB) diagnosis. However, the low sensitivity of smear microscopy emphasizes the need to improve its performance. We recently described the development of ‘TBDetect’ kit which showed improved performance over direct smear microscopy at National Reference Laboratories (NRLs) in India.The present study was aimed to assess the operational feasibility of ‘TBDetect’ microscopy in field settings. This was evaluated by (i) assessing the performance of ‘TBDetect’ microscopy vs. LED-fluorescence microscopy (LED-FM) on consecutive presumptive pulmonary TB patients (n = 5300) who attended Designated Microscopy Centres (DMCs, n = 13) under 4 NRLs at Bhubaneswar, Bhopal, Chennai, and New Delhi, and (ii) obtaining feedback from Scientists (n = 10) and laboratory technicians (n = 42) using semi-structured questionnaires under the following parameters: feasibility of initiation of ‘TBDetect’ microscopy in DMCs, sample preparation and testing, training, time-to-result, logistics, and troubleshooting. A scoring questionnaire was also used to assess ‘TBDetect’ microscopy vs. LED-FM and statistical significance of the scores was calculated using paired t-test.The overall positivity of ‘TBDetect’ microscopy was 10.32% (547/5300) vs. 8.96% (475/5300) of LED-FM at all sites and the increment in positivity was significant (p = 0.019). In addition, ‘TBDetect’ microscopy yielded an increment in smear grade status over LED-FM (p = 0.043). The feedback from the study-in-charge and kit users indicated that ‘TBDetect’ microscopy was easily adapted in point-of-care settings. An analysis of scoring feedback suggested that it was easy to perform and observe in comparison to LED-FM (p < 0.005).This study established the feasibility of ‘TBDetect’ microscopy in field settings. [ABSTRACT FROM AUTHOR]

Tuberculous meningitis (TBM) is the most severe form of tuberculous with substantial mortality. In May 2015, 54 researchers from 10 countries met in Da Lat, Vietnam, to discuss advances in TBM. Among the attendees were researchers involved in pivotal studies on the use of Xpert MTB/Rif for TBM diagnosis. Attendees discussed the 2014 World Health Organization strong recommendation favoring the use of Xpert "in preference to conventional microscopy and culture as the initial diagnostic test for cerebrospinal fluid (CSF) if the sample volume is low or if additional specimens cannot be obtained to make a quick diagnosis." Attendees were concerned that the limitations of Xpert testing for TBM are not emphasized. Clear guidance is needed for the investigational pathway for TBM, including recommendations on the diagnostic package of investigations, which does not stop with Xpert testing. Second, emphasis on the large CSF volumes (ideally 8-10 mL) needed for Xpert testing is required. Guidelines should also emphasize that TBM is a medical emergency and early treatment reduces mortality.

Background: Some patients with focal cerebral calcification (FCC) have no seizure or a benign course of epilepsy, whilst others with a similar lesion have uncontrolled epilepsy. Aims: To look for [...]

Byline: Krishan. Jain, Shireesh. Mittal, Sunil. Kumar, Rakesh. Gupta Fungal infections of the central nervous system (CNS) are rare in the general population and are invariably secondary to primary focus [...]

Objective: Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) is a precise and safe technique that provides both radiological and pathological diagnosis with a better diagnostic yield and minimal adverse events. EUS-FNAC led to the remarkable increase in the detection rate of incidentaloma found during radiologic staging or follow-up in various malignancy or unrelated conditions. Aims: We did this preliminary study with an aim to evaluate the role of EUS-FNA in diagnosing and classifying adrenal lesions, clinical impact, and compare the outcome with the previously published literature. Materials and Methods: We included 32 consecutive cases (both retrospective and prospective) of EUS-guided adrenal aspirate performed over a period of 3.3 years. The indications for the aspirate in decreasing order were metastasis (most common carcinoma gall bladder) > primary adrenal mass > disseminated tuberculosis > pyrexia of unknown origin. On EUS, 28 cases revealed space occupying lesion or mass (two cases bilateral) and four cases revealed diffuse enlargement (two cases bilateral) with a mean size of 21 mm. Results: The cytology reports were benign adrenal aspirate (43.8%), metastatic adenocarcinoma (15.6%), histoplasmosis (9.4%), tuberculosis (9.4%), round cell tumor (6.2%), adrenocortical carcinoma (3.1%), and descriptive (3.1%). Three cases (9.4%) yielded inadequate sample. The TNM staging was altered in 22.23% of the cases by result of adrenal aspirate. Conclusions: EUS-FNA of the adrenal gland is a safe, quick, and sensitive and real-time diagnostic technique, which requires an integrated approach of clinician, endoscopist, and cytopathologist for high precision in diagnosis. Although the role of EUS-FNA for right adrenal is not much described, we found adequate sample yield in all the four patients that underwent the procedure. [ABSTRACT FROM AUTHOR]

Purpose: MRI is a useful method for discriminating low- and high-grade glioma using perfusion MRI and susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of T1-perfusion MRI and SWI in discriminating among grade II, III, and IV gliomas. Methods: T1-perfusion MRI was used to measure relative cerebral blood volume (rCBV) in 129 patients with glioma (70 grade IV, 33 grade III, and 26 grade II tumors). SWI was also used to measure the intratumoral susceptibility signal intensity (ITSS) scores for each tumor in these patients. rCBV and ITSS values were compared to seek differences between grade II vs. grade III, grade III vs. grade IV, and grade III+II vs. grade IV tumors. Results: Significant differences in rCBV values of the three grades of the tumors were noted and pairwise comparisons showed significantly higher rCBV values in grade IV tumors as compared to grade III tumors, and similarly increased rCBV was seen in the grade III tumors as compared to grade II tumors ( p < 0.001). Grade IV gliomas showed significantly higher ITSS scores on SWI as compared to grade III tumors ( p < 0.001) whereas insignificant difference was seen on comparing ITSS scores of grade III with grade II tumors. Combining the rCBV and ITSS resulted in significant improvement in the discrimination of grade III from grade IV tumors. Conclusion: The combination of rCBV values derived from T1-perfusion MRI and SWI derived ITSS scores improves the diagnostic accuracy for discrimination of grade III from grade IV gliomas. [ABSTRACT FROM AUTHOR]

Purpose Aim of this retrospective study was to compare diagnostic accuracy of proposed automatic normalization method to quantify the relative cerebral blood volume (rCBV) with existing contra-lateral region of interest (ROI) based CBV normalization method for glioma grading using T1-weighted dynamic contrast enhanced MRI (DCE-MRI). Material and methods Sixty patients with histologically confirmed gliomas were included in this study retrospectively. CBV maps were generated using T1-weighted DCE-MRI and are normalized by contralateral ROI based method (rCBV_contra), unaffected white matter (rCBV_WM) and unaffected gray matter (rCBV_GM), the latter two of these were generated automatically. An expert radiologist with > 10 years of experience in DCE-MRI and a non-expert with one year experience were used independently to measure rCBVs. Cutoff values for glioma grading were decided from ROC analysis. Agreement of histology with rCBV_WM, rCBV_GM and rCBV_contra respectively was studied using Kappa statistics and intra-class correlation coefficient (ICC). Result The diagnostic accuracy of glioma grading using the measured rCBV_contra by expert radiologist was found to be high (sensitivity = 1.00, specificity = 0.96, p < 0.001) compared to the non-expert user (sensitivity = 0.65, specificity = 0.78, p < 0.001). On the other hand, both the expert and non-expert user showed similar diagnostic accuracy for automatic rCBV_WM (sensitivity = 0.89, specificity = 0.87, p = 0.001) and rCBV_GM (sensitivity = 0.81, specificity = 0.78, p = 0.001) measures. Further, it was also observed that, contralateral based method by expert user showed highest agreement with histological grading of tumor (kappa = 0.96, agreement 98.33%, p < 0.001), however; automatic normalization method showed same percentage of agreement for both expert and non-expert user. rCBV_WM showed an agreement of 88.33% (kappa = 0.76,p < 0.001) with histopathological grading. Conclusion It was inferred from this study that, in the absence of expert user, automated normalization of CBV using the proposed method could provide better diagnostic accuracy compared to the manual contralateral based approach. [ABSTRACT FROM AUTHOR]

Background: Mediastinum is a "Pandora's box" with many neoplastic and nonneoplastic lesions. The purpose of this study was to analyze our institutional experience of mediastinal lesions on fine-needle aspiration cytology (FNAC) and/or biopsy. Materials and Methods: This study was an analysis of 144 patients who had undergone ultrasound-guided FNAC and/or core biopsy for mediastinal lesions. Results: A total of 144 cases of suspected mediastinal masses were seen, and in 139 cases, tissue diagnosis was attempted. Out of 139 cases, 93 cases were neoplastic in nature (67%), 32 were nonneoplastic (23%), and 14 remained inconclusive (10%). Among neoplastic mediastinal lesions, metastatic carcinoma (37.4%) was the most common neoplastic lesion, followed by non-Hodgkin's lymphoma (12.2%), Hodgkin's lymphoma (7.1%), thymic lesions (3.5%), etc. Among nonneoplastic conditions, tuberculosis was the most common lesion (20.1%). An accurate tissue diagnosis was made in 89.9% cases by FNAC or core biopsy of mediastinal lesions in this study. Procedure-related mortality was nil. Complications were mostly minor and included chest pain in 24.5%, small pneumothorax in 13.6% requiring closed tube thoracostomy in 1.4%, and scanty hemoptysis in 9.3% cases. Conclusion: Neoplastic mediastinal lesions are more common than nonneoplastic lesions, with metastatic carcinoma being the most common cause followed by tuberculosis. A wide variety of lesions observed in this study stress on the importance of cytohistological diagnosis in all cases of mediastinal lesions for the final diagnosis and management planning. A guided FNAC or core biopsy is still accurate, well tolerated, and devoid of major complications. [ABSTRACT FROM AUTHOR]

Purpose: Studies have shown that cellularity of glial tumors are inversely correlated to minimum apparent diffusion coefficient (ADC) values derived on diffusion-weighted imaging (DWI). The purpose of this prospective exploratory study was to evaluate whether temporal change in "minimum ADC" values during follow-up predict progressive disease in glial tumors post radiotherapy and surgery. Materials and Methods: Adult patients of glial tumors, subjected to surgery followed by Radiotherapy (RT), were included in the study. Serial conventional magnetic resonance imaging with DWI at the following time points - presurgery, pre-RT, post-RT imaging at 3, 7, and 15 months were done. For "minimum ADC" values, multiple regions of interest (ROI) were identified on ADC maps derived from DWI. A mean of 5 minimum ADC values was chosen as "minimum ADC" value. The correlation was drawn between histology and minimum ADC values and time trends were studied. Results: Fourteen patients were included in this study. Histologies were low-grade glioma (LGG) - 5, anaplastic oligodendroglioma (ODG) -5, and glioblastoma multiforme (GBM) - 4. Minimum ADC values were significantly higher in LGG and GBM than ODG. Presurgery, the values were 0.812, 0.633, and 0.787 × 10-3 mm2/s for LGG, ODG, and GBM, respectively. DWI done at the time of RT planning showed values of 0.786, 0.636, 0.869 × 10-3 mm-3/s, respectively. During follow-up, the increasing trend of minimum ADC was observed in LGG (P = 0.02). All these patients were clinically and radiologically stable. Anaplastic ODGs, however, showed an initial increase followed by the fall of minimum ADC in all the 5 cases (P = 0.00). Four of the five cases developed progressive disease subsequently. In all the 4 GBM cases, a consistent fall of minimum ADC values was observed (P = 0.00), and they all progressed in spite of RT. Conclusions: The DWI-derived minimum ADC values are an important yet simple quantitative tool to assess the treatment response and disease progression before they are evident on conventional imaging during the follow-up of glial tumors. [ABSTRACT FROM AUTHOR]

Kimura disease ( KD) is a rare chronic inflammatory disorder of unknown etiology, primarily seen in young Asian males. The disease is characterized by a triad of painless subcutaneous masses in the head and neck region, blood and tissue eosinophilia, and elevated serum immunoglobulin E levels. We report an unusual case of a 40-year-old woman found to have KD of the breast which presented clinically as carcinoma, leading to a diagnostic dilemma. To the best of our knowledge, this is the first case of KD in the breast to be documented in the literature. The patient also had scabies, which may have provided the stimulus for hypersensitivity, which is considered to be the pathogenetic mechanism responsible for development of KD. [ABSTRACT FROM AUTHOR]

Parry–Romberg syndrome (PRS) is a rare, poorly understood degenerative condition characterized by atrophic changes affecting one side of the face. The cause of these changes remains obscure. Migraine and facial pain such as trigeminal neuralgia are the most common neurological symptoms in this patient group. Sometimes, it causes epilepsy and rarely cerebral hemiatrophy, meningeal thickening, cortical dysgenesis, calcified lesions, aneurysms, and intracranial vascular malformations. Herein, the author reports the first case of PRS with multiple large intracranial cysts producing raised intracranial pressure. [ABSTRACT FROM AUTHOR]

Purpose: Oral, breast, and cervical cancers are amenable to early detection and account for a third of India's cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts.Methods: Indian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages.Results: Innovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences.Conclusions: Symposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival. [ABSTRACT FROM AUTHOR]

Parasellar chondrosarcoma is rare slowly growing intracranial tumors. A correct diagnosis of these tumors is challenging for clinician due to overlapping location and simulation of clinical presentations with much common pituitary adenomas. We are reporting three young patients diagnosed to have parasellar chondrosarcoma highlighting the pathological features of importance required for confirm diagnosis. [ABSTRACT FROM AUTHOR]

Scalp arteriovenous malformations are an exceptional group of vascular lesions with curious presentations and an elusive natural history. Their detection in the pediatric population is a rarer occurrence. We discuss our experience with five children suffering from this pathology and their surgical management carried at our institution from 2007 to 2013. The genesis in pediatric patients is, usually, spontaneous in contrast with the history of trauma seen in adults. Clinical symptoms, usually, range from an asymptomatic lesion, local discomfort, headaches to necrosis and massive hemorrhage. Selective angiography remains the cornerstone for investigation. Complete surgical excision, embolization or an approach combining the modalities is curative. [ABSTRACT FROM AUTHOR]

Epithelioid angiomyolipoma (EAML) is a rare variant of angiomyolipoma found to have malignant potential and poorer prognosis. It is characterized by the predominance of epithelioid cells and frequent association with tuberous sclerosis. Its usual age of presentation is between the fourth and fifth decades of life, and only a single case has been reported in the pediatric age group. In this study, we report a case of epithelioid angiomyolipoma in a 4-year-old child with features of tuberous sclerosis, which is the youngest age of presentation. [ABSTRACT FROM AUTHOR]

Patellar dislocations occurring about the vertical and horizontal axis are rare and irreducible. The neglected patellar dislocation is still rarer. We describe the clinical presentation and management of a case of neglected vertical patellar dislocation in a 6 year-old boy who sustained an external rotational strain with a laterally directed force to his knee. Initially the diagnosis was missed and 2 months later open reduction was done. The increased tension generated by the rotation of the lateral extensor retinaculum kept the patella locked in the lateral gutter even with the knee in full extension. Traumatic patellar dislocation with rotation around a vertical axis has been described earlier, but no such neglected case has been reported to the best of our knowledge. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of the present study was to identify the true prevalence of hemorrhage in the abscess using T2*-weighted angiography (SWAN) imaging and to study its influence on diffusion tensor imaging (DTI) metrics. Methods: Fifteen patients of brain abscess underwent conventional, SWAN, and DT imaging on a 3-T MRI followed by its confirmation with histology. DTI metrics were quantified by region-of-interest analysis on hemorrhagic and non-hemorrhagic regions of the abscess wall. Prussian blue staining was performed on excised abscess walls to confirm hemorrhage on histology. Results: Eleven of 15 patients showed evidence of hemorrhage on both Prussian blue staining as well as SWAN imaging. Fractional anisotropy (FA) and linear anisotropy (CL) values were significantly higher, while spherical anisotropy was significantly lower in hemorrhagic compared to non-hemorrhagic regions of the abscess wall. Conclusion: Hemorrhage in the abscess wall is a common feature and may not always indicate neoplasm. The presence of intracellular iron in addition to concentrically laid collagen fibers may have synergistic effect on FA and CL values in the abscess wall. Inclusion of SWAN to MRI protocol will define the true prevalence of hemorrhage in brain abscess. [ABSTRACT FROM AUTHOR]

Minimal hepatic encephalopathy (MHE) and hyperammonemia are seen in patients with extrahepatic portal venous obstruction (EHPVO). Inflammation has been shown to play an important role in the pathogenesis of hepatic encephalopathy in cirrhotics. This study assessed serum pro-inflammatory cytokines and their correlation with hyperammonemia, H-magnetic resonance (MR) spectroscopy-derived brain glutamine, and diffusion tensor imaging (DTI)-derived metrics in patients with EPHVO, with and without MHE. Neuropsychological tests, DTI, H-MR spectroscopy, and estimation of blood ammonia and pro-inflammatory cytokines (tumor necrosis factor-α[TNF-α] and interleukin-6 [IL-6]) were done in 20 patients with EHPVO and eight healthy controls. Pro-inflammatory cytokines (TNF-α and IL-6), blood ammonia, brain glutamine, and mean diffusivity were increased in both patient groups, as compared to controls. Patients with MHE (n-12) had significantly higher TNF-α, IL-6, blood ammonia, brain glutamine, and mean diffusivity, signifying brain edema, than controls. A significant, positive correlation was seen between TNF-α and IL-6 and between blood ammonia and TNF-α, IL-6, and brain glutamine. Significant, positive correlations of TNF-α, IL-6, and blood ammonia with mean diffusivity values were seen in various brain regions, including spectroscopy voxel-derived mean diffusivity. Patients with extrahepatic portal vein obstruction have inflammation and hyperammonemia made evident by higher blood TNF-α, IL-6, ammonia, and brain glutamine levels. A significant correlation between hyperammonemia, pro-inflammatory cytokines, and cerebral edema on DTI in various brain regions suggests that both these factors play a role in the pathogenesis of MHE in these patients. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to demonstrate age-related and gender-related changes in diffusion tensor imaging (DTI) indices of deep grey matter (GM) nuclei of the normal human brain. DTI was performed on 142 subjects (age: 10–52years). Regions of interest were placed on the caudate nucleus (CN), putamen, globus pallidus, frontal white matter (WM), occipital WM, anterior and posterior limb of internal capsule, genu of the corpus callosum and splenium in all participants. The quadratic regression model was used to describe age-related and gender-related changes in DTI indices for GM and WM. We observed increased fractional anisotropy (FA) values with age up to adulthood in GM, and a rise up to the third decade of life followed by a decrease in FA for WM. We observed higher FA values in males compared to females in CN and all WM regions. Decreased mean diffusivity with age was observed in GM and WM irrespective of gender. This normative data may be valuable in the diagnosis of neurodegenerative diseases. [ABSTRACT FROM AUTHOR]

Hepatic encephalopathy (HE) is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Overt HE occurs in approximately 30–45% of cirrhotic patients. Minimal HE (MHE), the mildest form of HE, is characterized by subtle motor and cognitive deficits and impairs health-related quality of life. The Indian National Association for Study of the Liver (INASL) set up a Working Party on MHE in 2008 with a mandate to develop consensus guidelines on various aspects of MHE relevant to clinical practice. Questions related to the definition of MHE, its prevalence, diagnosis, clinical characteristics, pathogenesis, natural history and treatment were addressed by the members of the Working Party. [ABSTRACT FROM AUTHOR]

Objectives: This study was planned to define the clinical profile of pulmonary tuberculosis (PTB) patients having renal amyloidosis, to identify the factors responsible for development of amyloidosis, to detect the time period between onset of amyloidosis and PTB, and analyze clinical features of amyloidosis in PTB patients for early diagnosis and timely assessment. Materials and Methods: Patients of PTB having pedal edema, proteinuria, and grossly diseased kidneys on ultrasound abdomen were subjected to renal biopsy and appropriate biochemical investigations. Clinical profi le of biopsy proven amyloidosis cases was analyzed. Results: There were 43 patients (32 males, 11 females, age range 20-65 years) having PTB with pedal edema, proteinuria, and renal medical disease on abdominal ultrasound where amyloidosis was confirmed by renal biopsy. The total duration of illness ranged from two months to seven years (mean 2.25 years) and was less than fi ve years in 93% patients. All patients had significant proteinuria. Nephrotic syndrome was seen in 23, hypertension in 19, hypoalbuminemia in 33, hypercholesterolemia in 29, and deranged renal functions in 32 patients. Ninety percent patients had moderate to far advanced pulmonary lesions on chest radiography with smear positivity in 21 patients. Conclusions: Renal amyloidosis is an important complication of PTB and should be suspected clinically in patients presenting with a triad of pedal edema, proteinuria, and medical renal disease on ultrasound. Contrary to general belief, renal amyloidosis may occur in PTB patients having disease for relatively shorter duration, and even if adequately treated. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to use diffusion tensor imaging (DTI) to search and quantify the extent of abnormality beyond the obvious lesions seen on the T2 and fluid-attenuation inversion recovery (FLAIR) magnetic resonance images in patients with chronic traumatic brain injury (TBI) with and without epilepsy. Methods: DTI was performed on 23 chronic TBI patients (with late posttraumatic epilepsy, n = 14; without epilepsy, n = 9) and 11 age-matched controls. The ratios of fractional anisotropy (FA) and mean diffusivity (MD) between the regions of interest beyond the T2/FLAIR-visualized abnormality and the corresponding contralateral normal-appearing region were calculated. FA and MD ratios were compared for relative changes in these parameters among the TBI subjects with and without epilepsy and controls. Tissue volumes exhibiting abnormalities on DTI also were measured in these patients. Results: The mean regional FA ratio was significantly lower, whereas the mean regional MD value was higher in patients with TBI compared with controls. The mean regional FA ratio was significantly lower in TBI patients with epilepsy (0.57 ± 0.059) than in those without epilepsy (0.68 ± 0.039). Although the regional MD ratio was higher in TBI patients with epilepsy (1.15 ± 0.140) relative to those without epilepsy (1.09 ± 0.141), the difference did not reach statistical significance. The tissue volume with low FA value also was found to be higher in TBI patients with epilepsy than without. Conclusions: Severity of injury as predicted by the DTI-derived increased volume of microstructure damage is associated with delayed posttraumatic epilepsy in TBI patients. These findings could be valuable in predicting epileptogenesis in patients with chronic TBI. [ABSTRACT FROM AUTHOR]

Synchronous intracranial germ cell tumor in the pineal and suprasellar region is rare. They represent only 5-10% of all intracranial germinomas. They are also known by the entity "double midline atypical teratoma" and are common in the second decade of life. We report a case of an 11-year-old girl having dual midline intracranial lesions with obstructive hydrocephalus treated by ventriculo-peritoneal shunt. Diagnosis of germinoma was made on the basis of imaging and elevated beta-human chorionic gonadotropin in cerebrospinal fluid. Radiotherapy was instituted, which resulted in the total disappearance of both the lesions. Clinical expression, diagnosis and management strategies are discussed. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the performance of the 'TB Detect ' kit-based bio-safe fluorescent microscopy filter (BioFM-Filter) microscopy in comparison with direct smear microscopy and culture for the detection of pulmonary tuberculosis (TB) in a multi-centric setting in India. The TB Detect kit enables sputum concentration through filtration using the BioFM-Filter for improved and bio-safe smear microscopy. We evaluated the performance of the TB Detect kit in a six-site multi-centric validation study on sputum collected from 2086 presumptive TB patients. The combined positivity of TB Detect microscopy performed on these sputum samples was 20% (n = 417/2086) vs 16.1% of light-emitting diode fluorescence microscopy (LED-FM, n = 337/2086) and 16% of Ziehl Neelsen (ZN) smear microscopy (n = 333/2086). The increment in positivity of TB Detect over both LED-FM and ZN smears was significant (p < 0.001). The overall sensitivity of TB Detect for six sites was ~55% (202/367, 95% confidence interval (CI): 50, 60%) vs 52% (191/367, 95% CI: 47, 57%) for LED-FM (p 0.14) and 50.9% (187/367, 95% CI: 46, 56%) for ZN smear (p < 0.05), using Mycobacterium Growth Indicator Tube culture (MGIT, n = 1949, culture positive, n = 367) as the reference standard. A bio-safety evaluation at six sites confirmed efficient sputum disinfection by TB Detect ; 99.95% samples (1873/1874) were sterile after 42 days of incubation. Scientists and technicians at the study sites indicated the ease of use and convenience of TB Detect microscopy during feedback. TB Detect added value to the smear microscopy test due to its improved performance, convenience and user safety. These findings indicate that equipment-free TB Detect technology has the potential to improve TB diagnosis in basic laboratory settings by leveraging on the existing nationwide network of designated microscopy centres and primary healthcare centres. [ABSTRACT FROM AUTHOR]

Primary osteogenic sarcomas of the breast are exceptionally uncommon. We describe such a case occurring in a 50 year-old woman who presented with a large painful mass in her left breast. Simple mastectomy of the left breast was performed. Microscopical and immunohistochemical findings established the diagnosis of primary osteogenic sarcoma. Similar to extremity osteosarcoma, adjuvant adriamycin and cisplatin based chemotherapy and external beam radiotherapy was given to the present case. She remained well 57 months later, without tumor recurrence. The current article made a literature search proving the rarity of this lesion type and discusses in detail the diagnostic implications and the treatment of this rare site tumor entity. [ABSTRACT FROM AUTHOR]

The article talks bout Small vessel central nervous system vasculitis (SVCNSV) and its diagnosis, which the author terms as challenging because of clinical presentations and a variable age of presentation. Use of susceptibility weighted image (SWI) with phase imaging and Magnetic resonance imaging (MRI) in the diagnosis and their advantages and limitations are mentioned.

Background: Coronary artery fistula, first described by Krause in 1865, is an abnormal communication between the coronary artery and one of the four chambers of the heart or one of the great vessels. The communications are often congenital but may also be acquired from trauma or invasive cardiovascular procedures. Half of the cases present with angina pectoris whereas the remaining half are incidentally detected on echocardiogram or angiogram performed for an unrelated reason. Takotsubo cardiomyopathy or stress-induced cardiomyopathy is characterized by transient left ventricular dysfunction with minimal elevation of cardiac biomarkers in the absence of underlying coronary artery disease. Almost 90% of reported patients are postmenopausal women with a history of recent emotional or physical stress.Case Presentation: We report an unusual case of a 64-year-old Hispanic woman presenting with typical symptoms suggestive of acute coronary syndrome after an extreme familial conflict. There was mild troponin elevation. Cardiac catheterization revealed microfistulas originating from the third portion of the left anterior descending artery draining to the left ventricular cavity. The ventriculogram demonstrated the apical ballooning. We postulate that high local concentration of catecholamine triggered by stress resulted in angina pectoris due to worsening coronary steal from the coronary fistula. Also, the stress-induced adrenergic stimulation unmasked the classical akinetic apex and apical ballooning characteristic of Takotsubo cardiomyopathy.Conclusions: This case report highlights the rare but important association between two uncommon conditions. To the best of our knowledge, only one similar case has been reported describing a patient with microfistulas to left ventricular cavity and concurrent Takotsubo cardiomyopathy. [ABSTRACT FROM AUTHOR]

Background Pediatric human immunodeficiency virus (HIV) is an important emerging diseaseandmany children are surviving into adulthoodwith effective antiretroviral therapy. Growth dysregulation is common in these children and endocrineabnormalities are likely to be a possible comorbidity. There is a paucity of data on these endocrinological abnormalities in this population. Against this background, a study to evaluate the endocrinological profile in HIV-infected children and its relationship with growth failure was performed. Methods A cross-sectional descriptive study was performed in children less than 18 years attending the pediatric HIV clinic at a tertiary care hospital in central India. Blood samples for T3, T4, thyroid-stimulating hormone (TSH), growth hormone (GH), dehydroepiandrosterone (DHEA), cortisol, and insulin-like growth factor-binding protein 3 (IGFBP3) were collected during routine visit, preserved at -70°C, and subsequently assayed. Statistical analysis for the data with respect to the endocrinological abnormalities and growth failure was performed. Results A total of 100 children were included in the study. The prevalence of growth failure was high. Nineteen percent children had height less than 3 standard deviation (SD) and 59% children had height less than 2SD. The prevalence of endocrinological abnormalities was also high. Fifty-four percent children had low T3 levels, 12% had low T4 levels, 4% had high TSH levels, 44% had low cortisol levels, and 25% had low DHEA. Fifty-eight percent children had low GH levels, while IGFBP3 levels were low in the entire cohort. There was a statistically significant association between growth failure and levels of T3 and GH. Conclusion Our results show a high prevalence of growth failure and endocrinological abnormalities in HIV-infected children. A significant association between growth failure and endocrine abnormalities was found for T3 and GH. [ABSTRACT FROM AUTHOR]

Background & Aims Data on minimal hepatic encephalopathy (MHE) in children is scarce. We aimed to study MHE in children with chronic liver disease (CLD) and to validate non-invasive objective tests which can assist in its diagnosis. Methods We evaluated 67 children with CLD (38 boys; age 13 [7–18] years) and 37 healthy children to determine the prevalence of MHE. We also assessed the correlation of MHE with changes in brain metabolites by magnetic resonance spectroscopy ( 1 HMRS), diffusion tensor imaging (DTI) derived metrics, blood ammonia and inflammatory cytokines (interleukin-6 [IL6], tumor necrosis factor alpha [TNF-α]). In addition, the accuracy of MR-based investigations for diagnosis of MHE in comparison to neuropsychological tests was analysed. Results Thirty-four (50.7%) children with CLD had MHE on neuropsychological tests. MHE patients had higher BA (30.5 [6–74] vs. 14 [6–66] μmol/L; p = 0.02), IL-6 (8.3 [4.7–28.7] vs. 7.6 [4.7–20.7] pg/ml; p = 0.4) and TNF-α (17.8 [7.8–65.5] vs. 12.8 [7.5–35] pg/ml; p = 0.06) than No-MHE. 1 HMRS showed higher glutamine (2.6 [2.1–3.3] vs. 2.4 [2.0–3.1]; p = 0.02), and lower choline (0.20 [0.14–0.25] vs. 0.22 [0.17–0.28]; p = 0.1) and myo-inositol (0.25 [0.14–0.41] vs. 0.29 [0.21–0.66]; p = 0.2) in MHE patients than those without MHE. Mean diffusivity (MD) on DTI was significantly higher in 6/11 brain areas in patients with MHE vs. no MHE. Brain glutamine had a significant positive correlation with blood ammonia, IL-6, TNF-α and MD of various brain regions. Neuropsychological tests showed a negative correlation with blood ammonia, IL6, TNF-α, glutamine and MD. Frontal white matter MD had a sensitivity and specificity of 73.5% and 100% for diagnosing MHE. Conclusions In children with CLD, 50% have MHE. There is a significant positive correlation between markers of hyperammonemia, inflammation and brain edema and these correlate negatively with neuropsychological tests. MD on DTI is a reliable tool for diagnosing MHE. Lay summary Fifty percent of children with chronic liver disease develop minimal hepatic encephalopathy (MHE) and perform poorly on neuropsychological testing. These children have raised blood ammonia, inflammatory cytokines and mild cerebral edema on diffusion tensor imaging as compared to children without MHE. The higher the ammonia, inflammatory cytokines and cerebral edema levels the poorer the performance on neuropsychological assessment. The estimation of mean diffusivity on diffusion tensor imaging is an objective and reliable method for diagnosing MHE. [ABSTRACT FROM AUTHOR]

Purpose Dynamic contrast enhanced (DCE) MRI is used to grade and to monitor the progression of glioma while on treatment. Usually, a fixed hematocrit (Hct) value for adults is assumed to be ~ 45%; however, it is actually known for individual variations. Purpose of this study was to investigate the effect of measured Hct values in glioma grading using DCE-MRI. Materials and methods Fifty glioma patients were included in this study. Kinetic and hemodynamic parameters were estimated for each patient using assumed as well as measured Hct values. To look the changes in Hct value over time, Hct was measured multiple times from 10 of these glioma patients who were on treatment. Simulation was done to look for the effect of extreme variations of Hct values on perfusion metrics. The data was compared to look for significant differences in the perfusion metrics derived from assumed and measured Hct values. Results The measured Hct value in patients was found to be (40.4 ± 4.28)%. The sensitivity and specificity of DCE-MRI parameters in glioma grading were not significantly influenced by using measured vis-a-vis assumed Hct values. The serial Hct values from 10 patients who were on treatment showed a fluctuation of 15–20% over time. The simulated data showed linear influence of Hct values on kinetic parameters. The tumor grading was altered on altering the Hct values in borderline cases. Conclusion Hct values influence the hemodynamic and kinetic metrics linearly and may affect glioma grading. However, perfusion metrics values might change significantly with large change in Hct values, especially in patients who are on chemotherapy necessitating its use in the DCE model. [ABSTRACT FROM AUTHOR]

Neurocysticercosis (NCC) is a parasitic infection of central nervous system (CNS). Expression of adhesion molecules, chemokines and matrix metalloproteinases (MMPs) were investigated on brain tissues surrounding viable ( n = 15) and degenerating cysticerci ( n = 15) of Taenia solium in swine by real-time RT-PCR and ELISA. Gelatin gel zymography was performed for MMPs activity. ICAM-1 (intercellular adhesion molecule-1), E-selectin, MIP-1α (macrophage inflammatory protein-1α), Eotaxin-1 and RANTES (regulated on activation, normal T cell expressed and secreted) were associated with degenerating cysticerci (cysts). However, VCAM-1 (vascular cell adhesion molecule-1), MCP-1 (monocyte chemotactic protein-1), MMP-2 and MMP-9 were associated with both viable and degenerating cysts. In conclusion, viable and degenerating cysticerci have different immune molecule profiles and role of these molecules in disease pathogenesis needs to be investigated. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Proton magnetic resonance spectroscopy (PMRS) has high sensitivity and specificity for the detection of pyogenic brain abscess and the categorization of bacteria. But the metabolite patterns failed to evaluate the etiology of disease when the culture results are sterile. The aim of the present study is to compare the multimodality techniques viz., conventional culture, MR spectroscopy and 16S rRNA PCR and sequencing for rapid diagnosis of etiology in brain abscess and evaluate the PMRS in culture sterile samples and also demonstrate the sensitivity and specificity of these techniques. Methods: Thirty five patients underwent MRI on a 3T MRI and in-vivo PMRS for the diagnosis and evaluation of various resonances of metabolites such as lipid (LIP), lactate (LAC), acetate (AC), amino acid (AC), succinate (SUC). Pus was collected for identification of etiologic agents by culture and molecular method. Results: In 35 samples, metabolite patterns were as follows: LIP/LAC/AA, n =17, LIP/LAC/AA/SUC with or without AC, n =17 and LIP/LAC/AA/AC, n =1. Culture showed bacterial growth in 22 samples (18 aerobic/facultative anaerobic, 9 anaerobic) whereas molecular method was detected 26 aerobic/facultative anaerobic, 13 anaerobic, 4 microaerophilic bacteria. Among the 13 sterile samples, molecular method detected 16 microorganisms along with 3 mixed infections and PMRS recognized metabolite patterns as LIP/LAC/AA, n = 5 and LIP/LAC/AA/SUC with or without AC, n =8. The sensitivity of in-vivo PMRS in sterile samples was 100% and 75%, and specificity was 75% and 100% for aerobic and anaerobic organisms respectively. Conclusion: Based on metabolite resonances, PMRS can detect slow growing and fastidious organisms and classify them into aerobic and anaerobic bacteria which are difficult to culture by conventional method. It can categorize microorganisms even in culture sterile samples with rational sensitivity and specificity which may allow early choice of targeted therapy. [Copyright &y& Elsevier]

Highlights: [•] Neck muscle, eyelid, and tongue were examined for diagnosis of swine cysticercosis. [•] In house ELISA was developed as sero-diagnosis tool. [•] ELISA with crude lysate is a good diagnostic tool for swine cysticercosis. [•] Neck muscle, eyelid and tongue examination can also be used for screening of swine. [ABSTRACT FROM AUTHOR]

Abstract: Background: The objective of this study is to evaluate the sensitivity and specificity of DWI in differentiating brain abscesses from other intracranial cystic lesions. Methods: One hundred fifteen patients with 147 cystic lesions (mean age, 26.4 year) were prospectively studied with DWI on a 1.5-T magnetic resonance imaging. Lesions appearing hyperintense on DWI with the ADC values of lower than 0.9 ± 0.13 × 10−3 mm2/s (mean ± SD) were considered as brain abscess, whereas hypointense lesions on DWI with the ADC values 2.2 ± 0.9 × 10−3 mm2/s were categorized as nonabscess cystic lesions. Results: Ninety-three of 97 brain abscess lesions were hyperintense on DWI, with significantly low (P = .0001) ADC value (0.87 ± 0.05 × 10−3 mm2/s) (mean ± SEM), compared with 48 nonabscess lesions (2.89 ± 0.05 × 10−3 mm2/s). Four of 97 brain abscess lesions in 65 patients were false negative, and 2 of 50 nonabscess lesions in 50 patients were false positive for the diagnosis of brain abscess. The ADC value of the tumor cysts (2.9 ± 0.05 × 10−3 mm2/s) was significantly lower (P = .02) compared with benign cysts and neurocysticercosis (3.2 ± 0.05 × 10−3 mm2/s) among nonabscess group. The sensitivity of DWI for the differentiation of brain abscesses from nonabscesses was 96%; specificity, 96%; positive predictive value, 98%; negative predictive value, 92%; and accuracy of the test, 96%. Conclusions: Diffusion-weighted imaging has high sensitivity and specificity for the differentiation of brain abscess from other nonabscess intracranial cystic lesions. [Copyright &y& Elsevier]