Tubercular spondylitis: A review of MRI findings in 80 cases.

BACKGROUND: Tuberculosis of spine is known as tubercular spondylitis or Pott's spine. The vertebral involvement leads to various pathological processes such as abscess formation, cord compression, and gibbus deformity. Magnetic Resonance Imaging (MRI) is the imaging modality of choice which not only helps in diagnosing a case of Pott's spine but also gives valuable information about its impending complications, thereby, aiding in management of these cases. METHODS: In this study, MRI scans of 80 proven cases of tubercular spondylitis were studied retrospectively for the various pathological processes affecting the spine. RESULTS: Of the 80 cases included in this study, 68.8% of cases were male and 31.2% of cases were females. Majority of cases were seen in 21-40 yrs age group. Lumbar vertebrae were more commonly affected than the dorsal vertebrae. Contiguous two vertebral involvement was the most common pattern, and skip lesions were seen in 5% of cases. Pre-, paravertebral and epidural soft tissue component was seen in 96.25% and 62.5% of cases, respectively. Intervertebral disc Involvement was noted in 95% of cases, and cord edema was seen in 15% of cases. CONCLUSION: Tubercular spondylitis or Pott's spine is an extrapulmonary form of tuberculosis which affects the spine. MRI is the imaging modality of choice not only in diagnosing the condition but also in guiding the surgical management. The cases of spinal tuberculosis were systematically analyzed for various pathological lesions which are produced in the spine as the disease progresses.

Combat radiology: Challenges and opportunities.

Radiology services in a combat situation are essentially centred on assisting the battle field physicians/surgeons to save/salvage life and limb. Timely and accurate detection of type and mapping of extent of injury can aid in making imaging based triage which can be of immense help to the treating physicians/trauma surgeons. With the availability of rapid assessment (clinical as well as imaging based) and quick transport facility, the focus has gradually been shifting from merely limb-saving to life-saving strategies. Providing the right imaging modality at the right time for the right patient at the right place is the need of the hour and will dictate the success of combat casualty care. Although there are limitations in terms of terrain and hostility in a combat scenario, newer developments in the field of Radiodiagnosis and imaging can be optimally utilized for better casualty care services. Point of care Digital/Computed Radiography and basic Ultrasonography for trauma complemented by usage of multidetector computed tomography will go a long way in helping timely and accurate management of victims of blast and ballistic injury in a combat scenario. Following a rigid, easy to understand yet comprehensive protocol and radiology reporting system will be invaluable in the combat scenario despite various limitations.

Comparative analysis of changes in MR imaging of pre and post intrauterine progesterone implants in adenomyosis cases.

BACKGROUND: Magnetic Resonance Imaging (MRI) plays an important role in the evaluation and management of adenomyosis. In this study, we first diagnosed the adenomyosis on MRI and then we analyzed the MRI changes in the uterus in pre and post intrauterine progesterone implants cases. METHOD: All the patients with clinical diagnosis of menorrhagia or dysmenorrhea were screened by Ultrasonography (USG) of the pelvis. Patients with heterogeneous echo texture of the uterus were then evaluated by the MRI of the pelvis. All patients with MRI findings suggestive of adenomyosis formed the study group. RESULT: On MRI study 60 patients were diagnosed as adenomyosis, 68.33% had diffuse adenomyosis and 31.66% had focal adenomyosis. 83% of diagnosed adenomyosis cases had high intensity signal foci which were seen in 75% cases of diffuse adenomyosis and 100% cases of focal adenomyosis. 50 diagnosed adenomyosis cases were then reviewed after 03 months, 06 months and 12 months to see for any change in the MRI findings in the post intrauterine implant cases. On follow up MRI after post progesterone intrauterine implant, 50% of the cases showed reduction in the high intensity signals, 10% of the cases showed mild reduction in the junctional zone thickness with no significant change in the uterine size. CONCLUSIONS: It is inferred that MR imaging is not only helpful in diagnosing but also helpful in monitoring the effects of hormonal therapy in adenomyosis.

Assessing the Effectiveness of Clinical Skills Laboratory and Traditional Lecture in Teaching Basic Life Support and Performance Evaluation According to Different Domains of Revised Bloom's Taxonomy.

Sudden cardiac arrest out-side hospital is serious global concern. If non-medical people are taught to initiate the basic life support (BLS) training with cardiopulmonary resuscitation (CPR) then the mortality could be reduced significantly. This was a non-randomized controlled study to evaluate clinical skills laboratory (CSL) as teaching tool for basic life support (BLS) training in comparison to traditional lecture. Sample size was 68 and performed in Sylhet Women's Medical College from July 2022 to September 2022. All the participants were third year nursing students. They were enrolled in to two groups. Group-A were taught BLS by clinical skills laboratory (CSL) and Group-B were taught by traditional lecture (TL). At the end of the teaching all of them were tested by a vetted multiple choice question (MCQ) set. The questions were set according the 5 levels of revised Blood's taxonomy. Mean score of Group-A (CSL) were higher the TL group (p=0.0003). Among the revised Bloom's taxonomy understand, apply and evaluate domains were significantly better taught (p<0.05) by CSL. The sensitivity of CSL was 0.559 in comparison to TL for BLS training. In the modern medical education teaching and assessment should be focused on the higher levels of learning taxonomy. Introducing CSL in medical education could boost up the psychomotor and cognition both in the medical education.

Relationship between Cholesterol Level and Spontaneous Intracerebral Hemorrhage: A Case-Control Study in Bangladesh.

Spontaneous intracerebral hemorrhage is one of the leading causes of mortality and morbidity. Genetic factors play an important role in this disease. Among the non-genetic causes cholesterol level is one of the risk factors. The aim of the study was to evaluate the association between ICH (Intracerebral hemorrhage) and cholesterol level as well as to find out the risk of total cholesterol (TC), Triglyceride (TG), High-density lipoprotein (HDL) and Low-density lipoprotein (LDL) for the disease. This was a case-control retrospective study with 60 cases and 60 controls. The study place was in the Neurosurgery department of Sylhet Women's Medical College Hospital and the study period was 2 years (from January 2020 to December 2021). The mean age ±SD of the cases was 57.08±9.47 years and the highest number of participants was in the 51-60 year group. Commonest location of ICH was deep (67.0%) followed by intraventricular hemorrhage (IVH) (28.3%) and lobar (5.0%). The means of TC (p=0.0004), TG (p=0.00013) and LDL (p<0.00001) were significantly lower than those of control group. The mean of HDL (36.48) of cases was significantly (p=0.00003) higher than the mean HDL (28.9) of controls. TC participants had 52.0% less risk to develop ICH. Raised TG had 46.0% and raised LDL had 52.0% lower risk of ICH.

Cross-Sectional Analytic Study to Compare the Efficacy Between of Clinical Skill Learning (CSL) and Multimedia Lecture as Teaching Tool in Case of Endotracheal Intubation.

Clinical skill lab (CSL) is a part of simulation-based medical education (SBME) which now a days becomes an integral part of modern medical education. This cross-sectional analytic study was performed at Sylhet Women's Medical College, Sylhet, Bangladesh to assess the difference between CSL and traditional multimedia (MM) presentation in case of endotracheal intubation from January 2021 to February 2021. Total 78 first year nursing students were enrolled in study. Both groups were tested by same pre-tested multiple-choice questions. These 10 questions were set according to modified bloom's taxonomy domains. There was no significant difference in the mean scores of both groups. Male of CSL group had scored significantly better than the female of the same group. The top and bottom domains of modified bloom's taxonomy were significantly better taught in CSL group, whereas the others were better in the multimedia group.

Tec family kinases modulate thresholds for thymocyte development and selection.

Tec family kinases are implicated in T cell receptor (TCR) signaling, and combined mutation of inducible T cell kinase (Itk) and resting lymphocyte kinase (Rlk)/Txk in mice dramatically impairs mature T cell function. Nonetheless, mutation of these kinases still permits T cell development. While itk(-)(/)- mice exhibit mild reductions in T cells with decreased CD4/CD8 cell ratios, rlk(-)(/)-itk(-)(/)- mice have improved total T cell numbers yet maintain decreased CD4/CD8 ratios. Using TCR transgenics and an in vitro thymocyte deletion model, we demonstrate that mutation of Tec kinases causes graded defects in thymocyte selection, leading to a switch from negative to positive selection in rlk(-)(/)-itk(-)(/)- animals. The reduction in both positive and negative selection and decreased CD4/CD8 ratios correlates with decreased biochemical parameters of TCR signaling, specifically defects in capacitive Ca(2+) influx and activation of the mitogen-activated kinases extracellular signal-regulated kinase 1 and 2. Thus, Tec kinases influence cell fate determination by modulating TCR signaling, leading to altered thresholds for thymocyte selection. These results provide support for a quantitative model for thymic development and provide evidence that defects in negative selection can substantially alter thymic cellularity.

Requirement for Tec kinases Rlk and Itk in T cell receptor signaling and immunity.

T cell receptor (TCR) signaling requires activation of Zap-70 and Src family tyrosine kinases, but requirements for other tyrosine kinases are less clear. Combined deletion in mice of two Tec kinases, Rlk and Itk, caused marked defects in TCR responses including proliferation, cytokine production, and apoptosis in vitro and adaptive immune responses to Toxoplasma gondii in vivo. Molecular events immediately downstream from the TCR were intact in rlk-/-itk-/- cells, but intermediate events including inositol trisphosphate production, calcium mobilization, and mitogen-activated protein kinase activation were impaired, establishing Tec kinases as critical regulators of TCR signaling required for phospholipase C-gamma activation.

Aspergillus colonisation of pulmonary rheumatoid nodules: a rare cause of 'bull's eye' appearance.

Pulmonary rheumatoid nodules [PRNs] are a well described manifestation of rheumatoid arthritis [RA]. Fungal colonisation of these nodules is a rare phenomenon. We report a case of Aspergillus colonisation of multiple cavitary rheumatoid nodules in a young female patient with long-standing seropositive RA with 'bull's eye' appearance on computed tomography [CT]. The 'bull's eye' appearance inside PRNs should raise the suspicion of possible fungal colonisation. In patients with RA, a high index of suspicion for the fungal colonisation should be considered by the clinicians treating pulmonary cavitary nodules.

rlk/TXK encodes two forms of a novel cysteine string tyrosine kinase activated by Src family kinases.

Rlk/Txk is a member of the BTK/Tec family of tyrosine kinases and is primarily expressed in T lymphocytes. Unlike other members of this kinase family, Rlk lacks a pleckstrin homology (PH) domain near the amino terminus and instead contains a distinctive cysteine string motif. We demonstrate here that Rlk protein consists of two isoforms that arise by alternative initiation of translation from the same cDNA. The shorter, internally initiated protein species lacks the cysteine string motif and is located in the nucleus when expressed in the absence of the larger form. In contrast, the larger form is cytoplasmic. We show that the larger form is palmitoylated and that mutation of its cysteine string motif both abolishes palmitoylation and allows the protein to migrate to the nucleus. The cysteine string, therefore, is a critical determinant of both fatty acid modification and protein localization for the larger isoform of Rlk, suggesting that Rlk regulation is distinct from the other Btk family kinases. We further show that Rlk is phosphorylated and changes localization in response to T-cell-receptor (TCR) activation and, like the other Btk family kinases, can be phosphorylated and activated by Src family kinases. However, unlike the other Btk family members, Rlk is activated independently of the activity of phosphatidylinositol 3-kinase, consistent with its lack of a PH domain. Thus, Rlk has two distinct isoforms, each of which may have unique properties in signaling downstream from the TCR.

The Evolving, Multifaceted Roles of Autophagy in Cancer.

Autophagy is a lysosomal degradation process crucial for adaptation to stress and cellular homeostasis. In cancer, autophagy has been demonstrated to serve multifaceted roles in tumor initiation and progression. Although genetic evidence corroborates a role for autophagy as a tumor suppressor mechanism during tumor initiation, autophagy also sustains metabolic pathways in cancer cells and promotes survival within the harsh tumor microenvironment and in response to diverse anticancer therapies. Moreover, though traditionally viewed as an autodigestive process, more recent work demonstrates that autophagy also facilitates cellular secretion; the importance of these new functions of the autophagy pathway is being increasingly appreciated during cancer progression and treatment. In this review, we discuss how these evolving and diverse roles for autophagy both impede and promote tumorigenesis.

Oxidative pentose phosphate pathway inhibition is a key determinant of antimalarial induced cancer cell death.

Despite immense interest in using antimalarials as autophagy inhibitors to treat cancer, it remains unclear whether these agents act predominantly via autophagy inhibition or whether other pathways direct their anti-cancer properties. By comparing the treatment effects of the antimalarials chloroquine (CQ) and quinacrine (Q) on KRAS mutant lung cancer cells, we demonstrate that inhibition of the oxidative arm of the pentose phosphate pathway (oxPPP) is required for antimalarial induced apoptosis. Despite inhibiting autophagy, neither CQ treatment nor RNAi against autophagy regulators (ATGs) promote cell death. In contrast, Q triggers high levels of apoptosis, both in vitro and in vivo, and this phenotype requires both autophagy inhibition and p53-dependent inhibition of the oxPPP. Simultaneous genetic targeting of the oxPPP and autophagy is sufficient to trigger apoptosis in lung cancer cells, including cells lacking p53. Thus, in addition to reduced autophagy, oxPPP inhibition serves as an important determinant of antimalarial cytotoxicity in cancer cells.

Introduction of a loss-of-function point mutation from the SH3 region of the Caenorhabditis elegans sem-5 gene activates the transforming ability of c-abl in vivo and abolishes binding of proline-rich ligands in vitro.

We have introduced two loss-of-function point mutations from highly conserved regions of the src homology 3 (SH3) domains of the Caenorhabditis elegans sem-5 gene into the SH3 domain of the murine type IV c-abl tyrosine kinase proto-oncogene. One of the mutations, P131L, activated abl to transform fibroblasts while the other, G128R, did not. When combined with independent activating mutations in the c-abl kinase domain or NH2-terminus, the G128R mutation blocked transformation by the double mutant, suggesting that the G128R mutant was unable to transform cells for trivial reasons. The c-Abl G128R mutant, like wild type c-Abl protein, was localized to the nucleus and actin cytoskeleton and had normal tyrosine kinase activity in vitro, while the transforming c-Abl P131L protein was localized exclusively to the cytoplasm and exhibited decreased in vitro kinase activity. By real-time biospecific interaction analysis, the wild type Abl SH3 domain bound to two proteins containing proline-rich motifs with dissociation constants of 0.2 and 17 microM; the G128R mutant bound with 50-fold lower affinity, and no binding was detected by the P131L mutant. Both mutations completely abolished binding of the Abl SH3 domain to proline-rich target proteins in a filter-binding assay. These results suggest that the transforming activity of Abl is regulated in vivo by an inhibitor protein which associates with the SH3 domain via a proline-rich sequence.

Ultrasonography in Patients with Suspected Acute Appendicitis.

BACKGROUND: To evaluate the usefulness and limitations of graded compression ultrasonography in the diagnosis of clinically equivocal cases of suspected acute appendicitis at the setting of mid zonal military hospital of India. METHODS: A prospective study, graded compression ultrasonography with self localization was carried out with 3.5 MHz convex, 5 MHz convex and 7.5 MHz linear transducers (Wipro GE) in 69 clinically equivocal suspected cases of acute appendicitis. With maximal compression the anteroposterior diameter of appendix was measured from outer to outer wall. The main criterion for diagnosing appendicitis was demonstration of a non compressible appendix with anteroposterior dimension of 7mm or more. RESULT: Sonologically 36 (52%) cases were diagnosed as appendicitis. Anteroposterior outer diameter of inflamed appendices ranged from 7mm to 21mm (mean 10.5mm). 30 (83%) of 36 patients could accurately self localize the point of maximum tenderness. There were 01 false positive and 04 false negative cases. Sensitivity and specificity were 89.7% and 96.6% respectively. Positive and negative predictive values were 97.2% and 87.8% respectively. Alternative diagnoses were offered in 33 (47.8%) cases. Amongst these 33 cases, 14(42.4%) had abdominal pain of unknown origin. Gynaecologic, urologic and gastrointestinal aetiologies were established in 10(30.3%), 07(21.2%) and 02(6%) cases respectively. CONCLUSION: Graded compression ultrasonography superadded with self localization is an accurate means of diagnosing/excluding appendicitis in clinically equivocal cases of acute appendicitis and it is of great value in establishing alternative diagnoses.