Regular resident becomes aggressive enemy: Diagnosed on cytology.

Actinomycosis, an oral cavity commensal, causes cervicofacial infection in patients associated with an immunosuppression state and local mucosal injuries. Bone involvement by this commensal is rare. In the present case, we report a case of left peri mandibular soft tissue, soft to firm, tender swelling in a 39-year-old immunocompetent male diagnosed as Actinomycosis infection on fine needle aspiration cytology (FNAC) and cell block preparation.

COVID-19 Pandemic: An Indian radiologist' perspective.

During the COVID-19 pandemic, differences in health-care system and policies among countries worldwide meant that each country had to come up with their own strategies for containment, diagnosis, and treatment of the disease - "no one size fits all." India being the second populous country in the world with modern and traditional systems of health care has its own challenges to face during the pandemic. Among the increased cacophony of information regarding the COVID-19 disease and controversies surrounding the usage of various radiological modalities for its diagnosis, we are trying to present a sane perspective from an Indian radiologist viewpoint. Knowing the strengths and shortcomings of the Indian health-care system, we have suggested plausible solutions which may be the answers to the issues raised by the Indian media.

WholeCellKB: model organism databases for comprehensive whole-cell models.

Whole-cell models promise to greatly facilitate the analysis of complex biological behaviors. Whole-cell model development requires comprehensive model organism databases. WholeCellKB (http://wholecellkb.stanford.edu) is an open-source web-based software program for constructing model organism databases. WholeCellKB provides an extensive and fully customizable data model that fully describes individual species including the structure and function of each gene, protein, reaction and pathway. We used WholeCellKB to create WholeCellKB-MG, a comprehensive database of the Gram-positive bacterium Mycoplasma genitalium using over 900 sources. WholeCellKB-MG is extensively cross-referenced to existing resources including BioCyc, KEGG and UniProt. WholeCellKB-MG is freely accessible through a web-based user interface as well as through a RESTful web service.

Multiple Lower Limb Fractures in a Child With Spinal Muscular Atrophy Type 2: A Preventable Complication.

Patients with spinal muscular atrophy (SMA) are at risk of poor bone health and fractures. We report a child with SMA type 2, presenting with acute pain and swelling of both lower limbs following physiotherapy, and found to have multiple fractures in both lower limbs. Literature on fractures in children with SMA is limited. Awareness of risk assessment and appropriate preventive measures among healthcare providers caring for children with SMA is essential.

Comparison of short-term outcomes of open and laparoscopic assisted pancreaticoduodenectomy for periampullary carcinoma: A propensity score-matched analysis.

Backgrounds/Aims: Postoperative pancreatic fistula is the key worry in the ongoing debate about the safety and effectiveness of total laparoscopic pancreaticoduodenectomy (TLPD). Laparoscopic-assisted pancreaticoduodenectomy (LAPD), a hybrid approach combining laparoscopic resection and anastomosis with a small incision, is an alternative to TLPD. This study compares the short-term outcomes and oncological efficacy of LAPD vs. open pancreaticoduodenectomy (OPD). Methods: A retrospective analysis of data of all patients who underwent LAPD or OPD for periampullary carcinoma at a tertiary care center in Northeast India from July 2019 to August 2023 was done. A total of 30 LAPDs and 30 OPDs were compared after 1:1 propensity score matching. Demographic data, intraoperative and postoperative data (30 days), and pathological data were compared. Results: The study included a total of 93 patients, 30 underwent LAPD and 62 underwent OPD. After propensity score matching, the matched cohort included 30 patients in both groups. The LAPD presented several advantages over the OPD group, including a shorter incision length, reduced postoperative pain, earlier initiation of oral feeding, and shorter hospital stays. LAPD was not found to be inferior to OPD in terms of pancreatic fistula incidence (Grade B, 30.0% vs. 33.3%), achieving R0 resection (100% vs. 93.3%), and the number of lymph nodes harvested (12 vs. 14, p = 0.620). No significant differences in blood loss, short-term complications, pathological outcomes, readmissions, and early (30-day) mortality were observed between the two groups. Conclusions: LAPD has comparable safety, technical feasibility, and short-term oncological efficacy.

Scrub typhus presenting with massive splenomegaly in an adolescent boy.

Scrub typhus is a serious public health problem in the Asia Pacific region. Early diagnosis and treatment can prevent complications and mortality. Splenomegaly in isolated scrub typhus is mostly mild or subclinical and rarely massive. We report an adolescent boy with scrub typhus presenting with fever, massive splenomegaly and severe anemia. Clinicians should be aware of atypical presentations of scrub typhus, which is easily treatable with minimal investigations.

Correlation of Prepontine Cisternal Space Thickness with the Severity of Neurovascular Conflict and its Role in Predicting Outcome of Medical Management in Cases of Trigeminal Neuralgia.

Background: Trigeminal neuralgia (TN) is a debilitating disorder that presents with sudden onset of severe, unilateral, paroxysmal, and lancinating pain usually lasting for few seconds to few minutes. Aims and Objectives: The main aim of our study was to correlate the prepontine cisternal space thickness, with a severity of neurovascular compression (NVC) and percentage reduction of pain (patient outcome). Materials and Methods: Ours is an observational prospective study of 40 patients presenting with TN for magnetic resonance imaging in our department. Patients were followed up on medical treatment and their pain severity evaluated on their follow-up visit. Patients were divided into two groups based on prepontine cisternal space (Group A: ≤4 mm, Group B: >4 mm) and into three groups based on the percentage reduction of pain, Group 1 (0-35%), Group 2 (36-70%), and Group 3 consisted of patients with pain reduction of more than 70%. Ipsilateral prepontine cisternal space thickness was correlated with grade of NVC and percentage reduction of pain. Results: Mean percentage of pain reduction in group A and group B was 34.12 and 60.68%, respectively. Approximately 23.80% of grade1 NVC were seen in group A and 76.20% in group B, while 80% of grade 3 NVC were seen in group A and only 20% were seen in group B. Conclusion: There was poor response to medical treatment, in patients with narrowed prepontine cisternal space thickness with an inverse relationship between the grade of NVC and cisternal space thickness.

An Unusual Case of Xanthoma of Bilateral Achilles Tendon with Gouty Infiltration: A Rare Case Report.

Achilles tendon xanthoma is a benign and rare disease with a high incidence in patients having familial hypercholesterolemia. Patients present with or without pain and thickened tendons. Gout is seen in patients with hyperuricemia. Coexistence of xanthoma and gout is extremely rare. We searched the PubMed literature with 'Xanthoma' and 'Gout' as keywords and could find only one case report. Imaging modalities such as radiography and ultrasonography, play a vital role in diagnosing this condition early, hence helping the patient to commence the use of potentially lifesaving lipid-lowering therapeutic agents. Magnetic resonance imaging is helpful in delineating the morphological changes, exact measurements, and eventually in treatment planning. It helps to rule out early involvement of other tendons by the same pathology. We present a case of a 25-year-old male patient who presented to our institute with bilateral large symmetrical swelling in the posterior aspects of ankles for 4 years, with normal serum and blood parameters. Bilaterality, enormous size and normal blood and serum parameters make this case unique.

3T MRI-SWI based volumetric analysis of the subthalamic and red nuclei in advanced Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease mainly involving the dopaminergic neurons of the substantia nigra. The subthalamic nucleus (STN) also plays an important role in the disease process and now is an important target for the surgical management of the disease. However, not much is known about its morphology as the disease progresses. The aim of this study was to evaluate the volume of STN and red nucleus (RN) on 3T MRI SWI and its possible correlation with the disease in patients with advanced Parkinson's disease. METHODS: A total of 30 patients were enrolled. They were evaluated by analysis of symptomatology, UPDRS III, MOCA. Radiological evaluation included volumetric SWI images in 3T MRI. The volumes of the STN and RN were measured on SWI coronal images. RESULTS: There were 24 (80%) males and 6 (20%) females. The mean volumes of STN and RN were 118.66 mm3 (80-170 mm3) and 379.66 mm3 (270-500 mm3). There was no significant difference between right and left STN volumes and RN volumes. There was a significant positive correlation between the disease duration and RN volumes (P=0.015) and STN volumes (in 6-13 years) (P=0.001). STN and RN volumes were negatively correlated with MOCA scores in males (P=0.008 and P=0.017), with no such correlation in females. In late-onset PD, there was a significant positive correlation between RN volume and UPDRS OFF and ON scores (P=0.028 and P=0.03). CONCLUSIONS: STN volumes show a positive trend as the disease duration increases and cognition declines. RN volumes also increase as the disease progresses.

How Visual Stimuli Evoked P300 is Transforming the Brain-Computer Interface Landscape: A PRISMA Compliant Systematic Review.

Non-invasive Visual Stimuli evoked-EEG-based P300 BCIs have gained immense attention in recent years due to their ability to help patients with disability using BCI-controlled assistive devices and applications. In addition to the medical field, P300 BCI has applications in entertainment, robotics, and education. The current article systematically reviews 147 articles that were published between 2006-2021*. Articles that pass the pre-defined criteria are included in the study. Further, classification based on their primary focus, including article orientation, participants' age groups, tasks given, databases, the EEG devices used in the studies, classification models, and application domain, is performed. The application-based classification considers a vast horizon, including medical assessment, assistance, diagnosis, applications, robotics, entertainment, etc. The analysis highlights an increasing potential for P300 detection using visual stimuli as a prominent and legitimate research area and demonstrates a significant growth in the research interest in the field of BCI spellers utilizing P300. This expansion was largely driven by the spread of wireless EEG devices, advances in computational intelligence methods, machine learning, neural networks and deep learning.

Extraarticular Synovial Osteochondromatosis in Baker's Cysts Bilaterally: a Rare Presentation.

Synovial osteochondromatosis is a rare benign pathology arising from the synovial membrane of the joints, synovial sheaths or uncommonly the bursae around the joints. Baker's cysts are fluid filled, synovium-lined lesions arising in popliteal fossa. Synovial chondromatosis involving the Baker`s cyst is extremely rare. The aim of this case report is to document this exceedingly rare extra articular synovial pathology involving Baker's cysts of bilateral knees and to emphasize the importance of radiographs and sonography in the diagnosis.

A Rare Case of Systemic Cystic Angiomatosis Involving the Bones, Spleen, Liver, and Lungs.

Systemic cystic angiomatosis (SCA) is a rare disorder, usually involving the visceral organs with incidental detection during its insidious course. On radiography, it can present as multiple cystic lesions. In rare instances, it can present as mixed lesions (lytic, sclerotic) as was the case with our patient. The disease has a better prognosis than most vascular neoplasms involving the bones. We present a rare case of this disease, involving multiple organs, and presenting with an insidious onset.

Correlation of Trigeminopontine Angle with Severity of Trigeminal Neuralgia due to Neurovascular Conflict over Medial Aspect of Nerve: Can We Prognosticate the Reduction in Pain in Patients on Medical Management?

Background Neurovascular conflicts (NVCs) are one of the major causative factors in patients presenting with trigeminal neuralgia (TN). We found a wide range of variation in degrees of acute angle formed between medial border of trigeminal nerve and anterior border of pons in patients with TN, i.e., medial trigeminopontine angle (mTPA), and tried to find its correlation with pain severity due to NVC over the medial aspect of nerve (mNVC). Aims and Objectives To correlate mTPA measurement with severity of TN due to mNVC. To calculate the reduction in pain in patients kept on medical management and its correlation with mTPA. Materials and Methods This was a retrospective observational study conducted between May 2018 and October 2020. A total of 41 patients presenting with TN and showing corresponding NVC were included in the study. Out of the total cases with NVC, 30 cases showed NVC over the medial surface of the nerve. All the patients were evaluated on MAGNETOM Skyra 3T magnetic resonance imaging (MRI; Siemens). Using the two-line Cobb angle method, the trigeminopontine angle was calculated. Pretreatment pain intensity and posttreatment pain relief of each patients were assessed by using the numeric rating scale (NRS) with numbers from 0 to 10 ("no pain" to "worst pain imaginable"). Relevant clinical details regarding pre- and posttreatment pain score, after a standard treatment plan of 600 mg of oxcarbazepine for 2 weeks, were collected. Results Patients showing response of more than or equal to 50% (≥50%) are considered as "good response" and those with response of less than 50% (<50%) are considered as "poor response." In our study with trigeminopontine angle threshold of 45 degrees, 7 out of 8 (87.5%) patients with >45° mTPA showed poor response and 15/22 (68.2%) patients with ≤45° showed good response to medical management for TN with statistical significance difference with a p -valve of 0.007. Conclusion We found a negative correlation between the mTPA and percentage pain relief in patients kept on medical management and realized that mTPA measurement could become an important tool for prognosticating pain relief for patients of TN on medical therapy; however, more evidence and multicentric studies are required for the same.

Improved Interobserver Reliability in Diagnosing and Staging Lesions of COVID-19 Between Radiologist and Emergency Medicine Physicians After an Online Course.

BACKGROUND: Chest radiographs are the most basic and readily available imaging modality for visualizing the lungs and are potentially useful for describing the disease severity in patients showing respiratory symptoms in COVID-19 patients. The early diagnosis of COVID-19 features on radiography helps in triaging and starting treatment. MATERIAL AND METHODS: Our study consisted of 145 radiographs, and these were reported by two radiologists, two emergency physicians and one intern working in the Emergency department. The scores given by them were correlated. A targeted short lecture for the scoring was imparted and after a sufficient latent period the scoring of chest radiographs was done again, and the scores correlated and compared. RESULTS: We observed agreement between radiologists with emergency medicine physicians was "none to slight" to "fair," before the dedicated online teaching course. Following the meeting, there was an increase in interobserver agreement in-between radiologists and between radiologists and emergency medicine physicians. CONCLUSIONS: We propose a focused online meeting, targeted at explaining radiological features of a specific pathology, in a pandemic situation like COVID, to our clinical counterparts in the emergency medicine department can help in increasing their interpretation skills. This can directly benefit triaging, admission/discharge and monitoring of the status of patients, in intensive care units and emergency medicine. This also helps in allaying the anxiety, while waiting for a final report from the Radiologist.

Beyond MELD Predictors of Post TIPSS Acute Liver Failure the Lesson Learned.

TIPSS is safe and effective procedure for relieving portal hypertension by creating a low resistance portosystemic shunt. TIPSS reduces portal perfusion by 80 to 100% which then gradually gets partially compensated by increased flow from hepatic artery. Post TIPSS liver function shows brief deterioration which tends to start recovering in few weeks. However, progressive liver failure requiring emergency transplant or death remains a serious concern after TIPSS creation. The causes of post TIPSS liver failure are diverse and difficult to predict. Due to its rarity the definition of post TIPSS liver decompensation is also not well described in literature. Till date MELDNa score has been considered as the most reliable predictor of post TIPSS liver decompensation. In common practice post TIPSS liver failure is less likely in patients with model for end-stage liver disease (MELD) score less than 18. We have experienced two unusual cases of post-TIPSS liver failure (PTLF) in patients with initial acceptable/low MELD score and the importance of non-MELD factors that may negatively influence post TIPSS outcome. Most of these can be routinely investigated prior to creating shunt thereby identifying patients at high risk of developing PTLF.

Prospective analysis of gross and fine motor manifestations following STN- DBS and their correlation with electrode position.

BACKGROUND: Deep brain stimulation (DBS) has been proven to be a safe, reversible, cost effective procedure for treatment of Parkinson's disease. Final electrode position remains a significant factor determining the outcomes of Subthalamic nucleus deep brain stimulation (STN-DBS). This study aims to analyze the final lead position in three-dimensional plane and its effect on gross and fine motor outcomes in cases of advanced Parkinson's disease operated for STN-DBS. METHODS: Patients who underwent bilateral STN DBS were prospectively followed for improvement in gross motor outcomes at 6 months. Improvement in dysgraphia was analyzed by Fahn-Tolosa-Marin Tremor Rating Scale Part B score. Postoperative outcomes were correlated with final electrode position. RESULTS: A total of 64 Patients (128 leads) were analyzed. Patients who were less than 65 years of age at time of surgery had more significant reduction in UPDRS III(p = 0.02). Cases with deviation of left x less than 3 mm had significant reduction in UPDRS III (p = 0.05) and speech sub-scores (p = 0.05). Deviation less than 2 mm in left x was associated with reduction in gait sub-scores (p = 0.04). Optimal placement of right y electrode was associated with reduction in UPDRS III (p = 0.02). Significant reduction in Fahn-Tolosa-Marin Tremor Rating Scale Part B score was noted after DBS(p =0.001). CONCLUSIONS: Subthalamic nucleus deep brain stimulation thus results in significantly improved functional outcome particularly in patients with age less than 65 years. Accurate final electrode position is associated with maximum clinical benefit and improvement in dysgraphia.

Volumetric analysis of subthalamic nucleus and red nucleus in patients of advanced Parkinson's disease using SWI sequences.

BACKGROUND: Parkinson's disease is associated with significant changes in morphometry of subthalamic nucleus (STN); however, not much is known as the disease progresses. The aim of present study was to investigate the volume of STN and Red nucleus (RN) on 3T-magnetic resonance imaging (MRI) and its possible correlation with disease progression in advanced Parkinson's disease patients. METHODS: Patients of advanced Parkinson's disease were prospectively followed for clinical details, motor severity scores, and radiological evaluation. Volumes of the STN and RN were measured on susceptibility weighted imaging, coronal sections in 3T MRI and were correlated with demographic and clinical features. RESULTS: A total of 52 patients were included in our study. There were 42 (80.77%) males and 10 (19.23%) females. Mean age of onset of Parkinson's disease was 49.48 + 10.90 years. Average duration of disease in the present cohort was 7.65 + 4.31 years. Average STN and RN volume were 103.46 + 21.17 mm3 and 321.73 + 67.66 mm3. Age of onset, disease duration and Unified Parkinson's Disease Rating Scale Part III scores were not found to be associated with changes in STN Volumes. Weak positive trend was noted between RN volume and disease duration (Pearson cor. 0.204, P = 0.14). Patients in early-onset Parkinson's disease group had significantly more volume of RN than patients in late-onset Parkinson's disease group (P = 0.014). CONCLUSION: Disease duration and early age of onset in Parkinson's disease can be associated with increased RN volume. Volume of STN shows relatively no change even with disease progression.