Abdominal and Chest Ultrasonography: A predictor for disease progression in nonsevere dengue.

Background: Dengue is one of the most rapidly spreading arboviral infections in the world. Ultrasound is well established in abdomino-thoracic evaluation of patients with dengue infection. The aim of this study was to explore the role of ultrasound in predicting occurrence of severe infection in dengue patients and in predicting deterioration in patients with nonsevere dengue. Methods: The serologically proven dengue patients who reported to hospital during the study period were divided into three categories based on the dengue infection severity score. Ultrasound findings of abdomen and chest in these patients were noted in the initial, as well as follow-up scans and inferences drawn. Results: 61% belonged to the category of Dengue Fever, 35% were in Dengue Hemorrhagic Fever category, and 4% had Dengue Shock Syndrome. Positive ultrasound findings were seen to be significantly higher in patients with severe dengue. Logistic regression analysis revealed the presence of pericholecystic fluid to be significantly associated with the severe disease, while the presence of gall bladder wall edema, ascites, and any ultrasound finding were significantly associated with the disease progression. The odds of a patient with severe dengue having gall bladder wall edema, ascites, or any ultrasound finding were 2.74, 2.04, and 2.619 times, respectively. Conclusion: Our study indicates that positive findings on ultrasound are significantly higher in severe dengue and also that ultrasound can be reliably used to identify the patients with nonsevere dengue who are likely to progress to severe dengue.

Pigmented villonodular synovitis in a child: A missed diagnosis.

Paediatric joint pain and swelling is a frequent presentation. The clinical profile and relevant laboratory investigations often lead to the correct diagnosis; however some patients present a diagnostic conundrum. Pigmented villonodular synovitis (PVNS) is a rare entity that may afflict children and be easily missed.

The "heart appearance" sign in bilateral pontine infarction.

BACKGROUND: Although rarely seen, bilateral anteromedial infarction of the pons demonstrates the characteristic "heart appearance" sign on magnetic resonance imaging (MRI). This sign has hitherto been described in only 2 patients before this article. This typical pattern can be attributed to atherosclerotic or thrombotic involvement of bilateral paramedian and short circumferential pontine arteries supplying the anteromedial pons. METHODS AND RESULTS: A 60-year-old man, a known patient of primary hypertension and diabetes mellitus, presented with a posterior circulation stroke. Urgent computerized tomography and MRI revealed a "heart-shaped" area of acute infarction in the anteromedian mid-pons. A few scattered infarcts were also noted in the posterior and inferior part of the right cerebellar hemisphere. The basilar artery appeared normal with preserved flow void on MRI, and there were no signs of hemorrhage. These findings were consistent with acute nonhemorrhagic infarcts involving bilateral paramedian and short circumferential pontine arteries and the right posterior inferior cerebellar artery. A repeat MRI performed after a week disclosed hemorrhagic transformation and enhancement of the pontine infarction. The basilar artery appeared normal on magnetic resonance angiography. CONCLUSIONS: Recognizing the "heart appearance" sign in a stroke-like episode may be helpful in differentiating bilateral anteromedial pontine infarction from other pathologic processes involving the pons.

A rare occurrence of hepatic portal venous gas in emphysematous pyelonephritis.

Hepatic portal venous gas (HPVG) is an uncommon radiological sign and often portends significant underlying abdominal disease. A number of conditions may produce this sign and identifying the underlying etiology is essential for management. The advent of ultrasonography-color Doppler imaging and computerized tomography has led to more frequent recognition of this condition. This article describes the very rare association of HPVG in a patient with emphysematous pyelonephritis.

D-dimer in the diagnostic workup of suspected pulmonary thrombo-embolism at high altitude.

BACKGROUND: Pulmonary thrombo-embolism (PTE) is relatively common in high altitude areas where radiological diagnostic facilities are usually not available. So this study was undertaken to use the results of D-dimer assay to determine the need for imaging studies in patients suspected of having PTE at high altitude. METHODS: A total of 101 patients at an altitude of > 3,000 m suspected of having PTE were evacuated. D-dimer and imaging studies were carried out to confirm the diagnosis. RESULTS: A total of 101 patients suspected of having PTE underwent D-dimer level estimation and imaging studies for PTE. Sixty-eight of these had negative findings) on D-dimer assay. All these patients with negative findings on D-dimer assay had negative findings on pulmonary imaging studies also. So this test is very sensitive with very high negative predictive value (NPV). Whereas, 17 out of 33 patients positive for D-dimer, had positive findings on imaging studies, indicating a relatively less specific test. CONCLUSION: Clinical assessment in combination with D-dimer assay can be used for timely differentiation of PTE from other conditions such as high altitude pulmonary oedema (HAPO) especially at isolated high altitude areas/military posts, so that patients could be evacuated as early as possible by fastest means to save the precious lives and in hospital settings this test identifies patients to whom anticoagulant therapy should not be given or patients who should not be subjected to invasive imaging tests.

Artificial intelligence in cancer diagnostics and therapy: current perspectives.

Artificial intelligence (AI) has found its way into every sphere of human life including the field of medicine. Detection of cancer might be AI's most altruistic and convoluted challenge to date in the field of medicine. Embedding AI into various aspects of cancer diagnostics would be of immense use in dealing with the tedious, repetitive, time-consuming job of lesion detection, remove opportunities for human error, and cut costs and time. This would be of great value in cancer screening programs. By using AI algorithms, data from digital images from radiology and pathology that are imperceptible to the human eye can be identified (radiomics and pathomics). Correlating radiomics and pathomics with clinico-demographic-therapy-morbidity-mortality profiles will lead to a greater understanding of cancers. Specific imaging phenotypes have been found to be associated with specific gene-determined molecular pathways involved in cancer pathogenesis (radiogenomics). All these developments would not only help to personalize oncologic practice but also lead to the development of new imaging biomarkers. AI algorithms in oncoimaging and oncopathology will broadly have the following uses: cancer screening (detection of lesions), characterization and grading of tumors, and clinical decision-making and prognostication. However, AI cannot be a foolproof panacea nor can it supplant the role of humans. It can however be a powerful and useful complement to human insights and deeper understanding. Multiple issues like standardization, validity, ethics, privacy, finances, legal liability, training, accreditation, etc., need to be overcome before the vast potential of AI in diagnostic oncology can be fully harnessed.

An autopsy series of an oft-missed ante-mortem diagnosis: hemophagocytic lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and potentially fatal syndrome resulting from a hyperactivated immune system. Diverse patient profiles and clinical presentations often result in misdiagnosis. This article describes the varied clinical presentations and autopsy findings in three patients with this entity. The etiopathogenesis of HLH, its disparate and confounding clinical features, the diagnostic criteria, and management principles are also briefly reviewed.

Uncommon affliction of a common disease - primary tuberculosis of thyroid gland.

Tuberculosis (TB) continues to be a major public health problem in India. With an annual incidence rate of 2.8 million new cases, India accounts for a quarter of the global TB burden. Primary thyroid TB still remains a rare entity even in this era of global TB pandemic. Here we discuss a case of primary thyroid TB in a 22-year-old immunocompetent male patient presenting with a thyroid swelling followed by non-healing sinus tract after fine-needle aspiration cytology (FNAC) procedure. TB is a known common cause for development of chronic sinuses and ulcers. However, the primary involvement of thyroid gland along with formation of non-healing sinus tract post FNAC make it a most unusual case posing a diagnostic challenge to the unsuspecting physician.

Artificial intelligence and the radiologist: the future in the Armed Forces Medical Services.

Artificial intelligence (AI) involves computational networks (neural networks) that simulate human intelligence. The incorporation of AI in radiology will help in dealing with the tedious, repetitive, time-consuming job of detecting relevant findings in diagnostic imaging and segmenting the detected images into smaller data. It would also help in identifying details that are oblivious to the human eye. AI will have an immense impact in populations with deficiency of radiologists and in screening programmes. By correlating imaging data from millions of patients and their clinico-demographic-therapy-morbidity-mortality profiles, AI could lead to identification of new imaging biomarkers. This would change therapy and direct new research. However, issues of standardisation, transparency, ethics, regulations, training, accreditation and safety are the challenges ahead. The Armed Forces Medical Services has widely dispersed units, medical echelons and roles ranging from small field units to large static tertiary care centres. They can incorporate AI-enabled radiological services to subserve small remotely located hospitals and detachments without posted radiologists and ease the load of radiologists in larger hospitals. Early widespread incorporation of information technology and enabled services in our hospitals, adequate funding, regular upgradation of software and hardware, dedicated trained manpower to manage the information technology services and train staff, and cyber security are issues that need to be addressed.

Kimura disease with nephrotic syndrome in a child- A rare association.

Lymphadenopathy along with various systemic manifestations is commonly encountered in pediatric patients, tuberculosis being the commonest etiology. Occasional patients may present a diagnostic conundrum. Here, the authors report an unusual manifestation of Kimura disease (KD) presenting as nephrotic syndrome associated with mesenteric lymphadenitis in an 11-year-old male child. KD is a chronic inflammatory disorder of unknown etiology. It typically affects young adult males in the age range of 27-40 years and usually presents as painless itchy nodular masses in the head and neck region. The involvement of mesenteric lymph nodes along with a very young age of presentation makes it a rare case, posing a diagnostic challenge for the unsuspecting physician.