Renal resistive index by point of care ultrasound to predict sepsis associated acute kidney injury in critically ill children.

BACKGROUND: Sepsis associated acute kidney injury (AKI) is linked with adverse outcomes in the PICU. Doppler-based renal resistive index (RRI) has shown promising results in adults for prediction of AKI. We aimed to explore the performance of RRI in children with sepsis. METHODS: This prospective observational study (March - November 2022) included children aged 1-12 years with sepsis admitted to the PICU. RRI and urine neutrophil gelatinase associated lipocalin (NGAL) were measured within 12 h of admission. Children were followed up for 3 days. AKI (new and persistent) was defined as any child with KDIGO stage 2 or 3 AKI on day 3. RESULTS: We enrolled 90 children but included 79 in final analysis. Two thirds (n = 53, 67%) had septic shock. Median (IQR) age was 6.2 years (4.1-9.2). RRI decreased with increasing age. Twenty-six (33%) children had AKI on day 3. Mean (SD) RRI was higher in the AKI group [0.72 (0.08) vs. 0.65 (0.07), p < 0.001].The area under ROC curve for RRI to detect AKI among the 1-4 year old group was 0.75 (95% CI:0.51, 0.98; p = 0.05) and among the 5-12 year old group was 0.76 (0.62, 0.89; p = 0.001). An RRI 0.71 predicted AKI with 100% sensitivity and 46.2% specificity among the 1-4-year-old group and RRI 0.69 predicted it with 70% sensitivity and 77.5% specificity in the 5-12-year-old group. RRI and eGFR at admission were independent predictors of AKI on multivariable analysis. Urine NGAL 94.8 ng/ml predicted AKI with 76.9% sensitivity and 77.4% specificity and AUROC was 0.74 (0.62, 0.86) among the 1-12-year-old group. CONCLUSIONS: RRI values varied with age. RRI showed good diagnostic accuracy to detect new/persistent AKI on day 3 in children with sepsis; however, it was less precise as an independent predictor.

Clinical, immunological and molecular profiles of DOCK8 deficiency in six patients from a tertiary care centre in North India.

BACKGROUND: Dedicator of cytokinesis protein 8 (DOCK8) deficiency is an autosomal recessive form of combined immunodeficiency. This rare disorder is characterized by an increased predisposition to allergy, autoimmunity and malignancies. OBJECTIVES: To analyse clinical, immunological and molecular profiles of patients with DOCK8 deficiency. METHODS: Clinic records of all patients attending the primary immunodeficiency clinic from 2018 to 2021 were reviewed. Six patients from five families were found to have DOCK8 deficiency. RESULTS: Median age at diagnosis was 7.5 years (range 2-13), with a male/female ratio of 5 : 1. Among the six patients, recurrent eczematous skin lesions were the predominant cutaneous manifestation, present in five patients (83%). Warts and molluscum contagiosum were evident in two patients (33%) and one patient (16%), respectively. Two patients had recalcitrant prurigo nodularis lesions and two had epidermodysplasia verruciformis-like lesions. Food allergies and asthma were reported by one patient each. Of the six patients, recurrent sinopulmonary infections were detected in five (83%). Epstein-Barr virus-driven non-Hodgkin lymphoma with liver metastases was the only case of malignancy, in a 4-year-old boy. IgE was elevated in all patients. Lymphopenia and eosinophilia were observed in three patients (50%) and five patients (83.3%), respectively. Genetic analysis showed DOCK8 pathogenic variants in all patients: homozygous deletion mutations in two patients, compound heterozygous deletion mutations in one, and homozygous nonsense mutations in two. A novel pathogenic homozygous missense variant in the DOCK8 gene was identified in one patient. CONCLUSIONS: DOCK8 deficiency should be considered as a possibility in any patient with early onset eczema, cutaneous viral infections and increased predisposition to allergy, autoimmunity and malignancy.

Increased prevalence of metabolic syndrome and non-alcoholic fatty liver disease in children with atopic dermatitis: A case-control study from northern India.

BACKGROUND/OBJECTIVES: Atopic dermatitis (AD) is a chronic inflammatory skin disorder that affects children worldwide, with potential associations to metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD). Limited research exists on the interplay between AD, MetS, and NAFLD in the pediatric population. This study aimed to investigate the prevalence and potential relationships among AD, MetS, and NAFLD in children. METHODS: A case-control study design was employed, recruiting 50 children with AD (median age: 9.5 years) and 50 age- and sex-matched healthy controls (median age: 11.5 years, p = .051). Data on demographic characteristics, clinical features, disease severity, treatment history, anthropometric measurements, and laboratory evaluations were collected. MetS and NAFLD were diagnosed based on established criteria. RESULTS: The prevalence of MetS was significantly higher in children with AD compared with controls (24% vs. 2%, p = .002). Significant differences for systolic blood pressure (p < .001), diastolic blood pressure (p = .012), and waist circumference (p = .040) were observed between AD patients and controls. Children with AD had higher triglyceride levels (p = .005). NAFLD was exclusively seen in moderate to severe AD cases (6% vs. 0%, p = .242). AD severity showed associations with increased body mass index (p = .020). CONCLUSION: This study highlights the increased prevalence of MetS and the potential association with NAFLD in children with AD. The findings suggest that AD may contribute to the development of metabolic abnormalities at an early age. Further research is needed to elucidate the underlying mechanisms and explore preventive strategies for these interconnected conditions.

Canal of nuck hernia with uterus and ovary presenting as inguinal swelling in a female infant.

Canal of nuck hernia is rarely reported in pediatric population. We report one such case of a canal of nuck hernia in a 2-month-old girl containing uterus, ovary and small bowel diagnosed on ultrasonography, and which was later confirmed and treated surgically.

miRNAs are now starring in "No Time to Die: Overcoming the chemoresistance in cancer".

Cancer is a leading cause of death globally, with about 19.3 million new cases reported each year. Current therapies for cancer management include-chemotherapy, radiotherapy, and surgery. However, they are loaded with side effects and tend to cause toxicity in the patient's body posttreatment, ultimately hindering the response towards the treatment building up resistance. This is where noncoding RNAs such as miRNAs help provide us with a helping hand for taming the chemoresistance and providing potential holistic cancer management. MicroRNAs are promising targets for anticancer therapy as they perform critical regulatory roles in various signaling cascades related to cell proliferation, apoptosis, migration, and invasion. Combining miRNAs and anticancer drugs and devising a combination therapy has managed cancer well in various independent studies. This review aims to provide insights into how miRNAs play a mechanistic role in cancer development and progression and regulate drug resistance in various types of cancers. Furthermore, next-generation novel therapies using miRNAs in combination with anticancer treatments in multiple cancers have been put forth and how they improve the efficacy of the treatments. Exemplary studies currently in the preclinical and clinical models have been summarized. Ultimately, we briefly talk through the challenges that come forward with it and minimize them.

Uncommon histopathological features of cytomegalovirus encephalitis and measles inclusion body encephalitis on autopsy in two patients with primary immunodeficiency.

PURPOSE: To describe the neuropathological findings in two patients with primary immunodeficiency who had fatal viral encephalitis. MATERIALS AND METHODS: Severe combined immunodeficiency (SCID) was confirmed in case 1 by genetic testing, while case 2 had features suggestive of combined immunodeficiency; however, whole exome sequencing showed no pathogenic variants. Autopsies were performed in both cases after an informed consent. A detailed sampling of the brain including extracranial organs was conducted. Immunohistochemistry and electron microscopy was also performed to confirm the presence of viruses. RESULTS: Besides evidence of cystic encephalomalacia observed in both cases, the brain in case 1 revealed cytomegalovirus (CMV) ventriculoencephalitis accompanied by an exuberant gemistocytic response in the entire white matter. Nuclei of gemistocytes were loaded with several CMV nuclear inclusions, which was confirmed by immunohistochemistry. Case 2 demonstrated features of measles inclusion body encephalitis with several viral inclusions within neurons and astrocytes. Rare giant cells were also seen. Measles virus was confirmed on immunohistochemistry and electron microscopy. Plausibly, there was paucity of microglial nodules in both cases. Superadded bacterial pneumonia with diffuse alveolar damage was also seen in both cases. CONCLUSION: These cases add to the spectrum of unusual histological features of viral encephalitis seen in patients with underlying primary immunodeficiency diseases.

Cross-sectional study to estimate the prevalence and risk factors of nonalcoholic fatty liver disease in children and adolescents with psoriasis.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent comorbidity in adult patients with psoriasis, but there is a paucity of data on NAFLD in paediatric patients with psoriasis. AIM: To estimate the prevalence of NAFLD in children and adolescents with psoriasis compared with age- and sex-matched healthy controls (HCs) and to evaluate risk factors for NAFLD in paediatric psoriasis. METHODS: This was a cross-sectional study performed from July 2019 to December 2020 in a single tertiary care centre, which enrolled 52 children/adolescents aged 2-18 years diagnosed with psoriasis at least 6 months previously, and 52 HCs matched for age and sex. Anthropometric, metabolic and radiological assessment was performed for all participants. NAFLD prevalence was determined by liver enzyme (serum glutamic pyruvic transferase) levels, ultrasonography, shear wave elastography and aspartate aminotransferase/platelet index. Multivariate analysis was performed to determine the independent risk factors for NAFLD. RESULTS: The frequency of NAFLD was found to be 28·8% in patients with paediatric psoriasis compared with 3·8% in HCs. Logistic regression showed that greater disease severity (Psoriasis Area and Severity Index ≥ 10), obesity and decreased high-density lipoprotein cholesterol (HDL-C) level were independently associated with NAFLD, and thus can be considered risk factors for NAFLD. CONCLUSION: Patients with paediatric psoriasis have a higher prevalence of NAFLD compared with HCs. Children who are obese or have moderate to severe psoriasis or decreased HDL-C levels are at a higher risk of developing NAFLD.

Two-dimensional Shear Wave Elastography: Utility in Differentiating Gallbladder Cancer From Chronic Cholecystitis.

OBJECTIVE: To study the utility of 2D shear wave elastography (SWE) and ascertain cut-off values of shear wave elasticity (SWe) to differentiate benign and malignant thickening of the gallbladder wall. METHODS: This study was a prospective study of patients with symptomatic gallstone disease (GSD, n = 51) and gallbladder cancer (GBC, n = 46) and controls without any biliary disease (n = 46). All the participants underwent 2D USG and SWE of the gallbladder. Grey-scale ultrasound and SWE were done in the different regions in the gallbladder. RESULTS: The median age of the patients with GSD was 49 years (interquartile range [IQR]: 33-55), GBC was 55 years (IQR: 46-65), and controls was 37 years (IQR: 27-48.25). In patients with GBC, asymmetrical mural thickening was the predominant imaging pattern (n = 24, 52.2%). The mean SWe of the abnormal area in GBC (34.99 ± 17.77 kPa [n = 46]) was significantly higher than that of the uninvolved region (18.27 ± 8.12 kPa [n = 35]; P < .01). The mean SWe of the uninvolved region in GBC (18.27 ± 8.12 kPa [n = 35]) was also significantly higher (P < .01) than that of GSD (12.27 ± 4.13 kPa [n = 51]) and controls (10.52 ± 3.75 kPa [n = 46]). On ROC analysis, AUC of 0.927, at a cut-off of 20 kPa, sensitivity was 91.3%, specificity was 83.5%, positive likelihood ratio was 5.54, and negative likelihood ratio was 0.10 to diagnose GBC. CONCLUSION: The 2D SWE is a reliable adjunctive tool to grey-scale USG in differentiating the malignant from benign gallbladder wall and may help to pick up early malignancy in GSD.

Ultrasound and magnetic resonance imaging in thoracic tuberculosis in the pediatric population: moving beyond conventional radiology.

Imaging is crucial in the diagnostic work-up and follow-up after treatment in children with thoracic tuberculosis (TB). Despite various technological advances in imaging modalities, chest radiography is the primary imaging modality for initial care and in emergency settings, especially in rural areas and where resources are limited. Ultrasonography (US) of the thorax in TB is one of the emerging applications of US as a radiation-free modality in children. Magnetic resonance imaging (MRI) is the ideal radiation-free, emerging imaging modality for thoracic TB in children. However, only limited published data is available regarding the utility of MRI in thoracic TB. In this pictorial review, we demonstrate the use of US and rapid lung MRI in evaluating children with thoracic TB, specifically for mediastinal lymphadenopathy and pulmonary complications of TB.

Estimation of iron overload with T2*MRI in children treated for hematological malignancies.

Iron overload may contribute to long-term complications in childhood cancer survivors. There are limited reports of assessment of tissue iron overload in childhood leukemia by magnetic resonance imaging (MRI). A cross-sectional, observational study in children treated for hematological malignancy was undertaken. Patients ≥6 months from the end of therapy who had received ≥5 red-cell transfusions were included. Iron overload was estimated by serum ferritin (SF) and T2*MRI. Forty-five survivors were enrolled among 431 treated for hematological malignancies. The median age at diagnosis was 7-years. A median of 8 red-cell units was transfused. The median duration from the end of treatment was 15 months. An elevated SF (>1,000 ng/ml), elevated liver iron concentration (LIC) and myocardial iron concentration (MIC) were observed in 5 (11.1%), 20 (45.4%), and 2 (4.5%) patients, respectively. All survivors with SF >1,000 ng/ml had elevated LIC. The LIC correlated with SF (p < 0.001). MIC lacked correlation with SF or LIC. Factors including the number of red-cell units transfused and duration from the last transfusion were associated with elevated SF (p = 0.001, 0.002) and elevated LIC (p = 0.012, 0.005) in multiple linear regression. SF >595 ng/ml predicted elevated LIC with a sensitivity of 85% and specificity of 91.6% (AUC 91.2%). A cutoff >9 units of red cell transfusions had poor sensitivity and specificity of 70% and 75% (AUC 76.6%) to predict abnormal LIC. SF >600 ng/ml is a robust tool to predict iron overload, and T2*MRI should be considered in childhood cancer survivors with SF exceeding 600 ng/ml.

Role of Shear Wave Elastography of Thyroid Gland in Children With Newly Diagnosed Hashimoto's Thyroiditis: Preliminary Study.

OBJECTIVES: The data on the use of shear wave elastography (SWE) in children with thyroid disorders is limited. We aimed to assess the role of SWE in the evaluation of the thyroid gland in children newly diagnosed with Hashimoto's thyroiditis (HT). METHODS: The thyroid gland was evaluated in 18 children (5 boys and 13 girls, age range: 5-12 years) with newly diagnosed HT and 27 (21 boys and 6 girls, age range: 4-12 years) healthy controls using grayscale ultrasound followed by SWE. The values of SWE (in kPa) were compared between cases and controls and were also correlated with various demographic variables and serum thyroid hormone concentrations. RESULTS: The overall median of SWE values in cases and controls was 20.6 kPa (IQR = 19.16-26.94) and 10.7 kPa (IQR = 9.9-16.32), respectively, and the difference was statistically significant (W = 438.5, P < .001). There was a moderate positive correlation between serum triiodothyronine concentrations and SWE (ρ = 0.57, P = .016) and a moderate negative correlation between serum thyroid stimulating hormone concentrations and SWE (ρ = -0.54, P = .020). A significant difference (W = 61.0, P = .003) was also seen in median SWE of the thyroid gland between boys (median: 29.63 kPa, IQR = 27.53-32.88) and girls (median: 19.43 kPa, IQR = 18.88-21.32). CONCLUSION: There is a significant difference between SWE values of thyroid in normal children and children with newly diagnosed HT. Hence, SWE may be used as a noninvasive imaging technique in distinguishing normal and abnormal thyroid gland at an early stage. We suggest larger studies to confirm our preliminary findings of SWE in pediatric HT.

Evaluation of coronary arteries in congenital heart disease in children: diagnostic comparison of electrocardiogram-gated and non-electro-cardiogram-gated computed tomography cardiac angiography.

Purpose: To compare the visualization and anatomy of coronary arteries in children (≤ 2 years) with congenital heart disease (CHD) on non-electrocardiogram (ECG)-gated and ECG-gated computed tomography angiography (CTA). Material and methods: In this retrospective study, approved by the Ethics Committee of our institute, evaluation of coronary arteries in CHD was performed in 40 children on non-ECG-gated CTA and in 42 children on ECG-gated CTA. The origin and course of the right coronary artery (RCA), left main coronary artery (LMCA), left anterior descending (LAD) artery, and left circumflex (LCX) artery were evaluated by 2 paediatric radiologists independently. Results: ECG-gated CT scans yielded increased (additional) visualization of all the coronary arteries, when compared to non-ECG-gated CT scans. The RCA, LMCA, LAD artery, and LCX artery were visualized in 47.5%, 62.5%, 55%, and 32.5% of children, respectively, on non-ECG-gated studies, while they were visualized in 64.3%, 92.8%, 80.9%, and 62% children, respectively, on ECG-gated studies. The coronary artery anatomical variations were also supplementarily detected more in the ECG-gated group (23.8%) than in the non-ECG gated group (2.5%). Conclusions: ECG-gated CT cardiac angiography studies yield enhanced diagnostic outcomes for the evaluation of the coronary arteries in comparison to non-ECG-gated studies.

Prospective Evaluation of Free-Breathing Fast T2-Weighted MultiVane XD Sequence at 3-T MRI for Large Airway Assessment in Pediatric Patients.

OBJECTIVE. The purpose of our study was to prospectively evaluate the technical feasibility of the free-breathing fast T2-weighted MultiVane XD sequence (sequence with non-Cartesian k-space filling using radial rectangular blades) at 3-T MRI for large airway assessment in pediatric patients. SUBJECTS AND METHODS. Forty consecutive pediatric patients (23 boys and 17 girls; age range, 5-15 years) referred for MRI examination for indications not related to neck, chest, or large airway disorders were enrolled in this prospective research study. All children underwent MRI in three planes using a free-breathing fast T2-weighted MultiVane XD sequence at 3-T MRI. The MR images were assessed by two pediatric radiologists independently for visualization of the large airways at six levels. The quality of the MR images was assessed and graded. Interobserver agreement between two radiologists was assessed using the kappa test, McNemar test, and intraclass correlation coefficients. RESULTS. High-quality MR images of the large airways were obtained in at least one plane in 38 MRI examinations (95.0%) by reviewer 1 and 37 MRI examinations (92.5%) by reviewer 2. Best-quality MR images with the least artifacts were seen in the sagittal plane followed by the coronal plane and the axial plane. The kappa test of agreement showed almost-perfect agreement between the two radiologists for MR image quality in the sagittal (κ = 1), coronal (κ = 0.96), and axial (κ = 0.81) planes. The McNemar test and intraclass correlation coefficients revealed similar results. CONCLUSION. The free-breathing fast T2-weighted MultiVane XD sequence at 3-T MRI is a technically feasible and promising new MRI technique for evaluating the large airways of pediatric patients in daily clinical practice.

Outcome of percutaneous drainage in patients with pancreatic necrosis having organ failure.

BACKGROUND: Percutaneous catheter drainage (PCD) is an effective way of drainage in acute pancreatitis (AP) and its role in persistent organ failure (OF) has not been studied. This study assessed the outcome of severe AP managed with PCD. METHODS: We retrospectively analysed outcome of AP patients undergoing PCD for persistent OF with respect to success of PCD, etiology, severity scores, OF, imaging features and PCD parameters. Success of PCD was defined as resolution of with PCD and survived without surgical necrosectomy. RESULTS: Between January 2016 and May 2018, 83 patients underwent PCD for persistent OF at a mean duration of 25.59 ± 21.2 days from pain onset with successful outcome in 47 (56.6%) patients. Among PCD failures, eleven (13.25%) patients underwent surgery. Overall mortality was 31 (37.3%). On multivariate analysis, pancreatic necrosis <50% and absence of extrapancreatic infection (EPI) predicted the success of PCD. Presence of infected necrosis did not affect the outcome of PCD in organ failure. CONCLUSION: PCD improves the outcome in patients with OF even when done early irrespective of the status of infection of necrosis. Therefore, PCD may be considered early in the course of patients with OF.

Model-based iterative reconstruction in paediatric head computed tomography: a pilot study on dose reduction in children.

PURPOSE: To evaluate the potential of model-based iterative reconstruction (MBIR) on dose reduction and image quality in children undergoing computed tomography (CT) head examinations. MATERIAL AND METHODS: This prospective study was approved by the institutional ethics committee. A total of 88 children (age range of 5 to 16 years) with a history of seizures underwent contrast-enhanced CT scan. Forty-one children underwent CT study according to the MBIR technique, while 47 children underwent CT of the head with the non-MBIR protocol. Images were reviewed by 2 blinded paediatric radiologists in a random order. Mean dose-length product, CT dose index (CTDI) volume, and mean effective dose were recorded for both groups. Image quality, image noise, and diagnostic acceptability of 2 image sets were also recorded. RESULTS: In the MBIR group, the mean dose-length product was reduced by 79.8%; the mean CTDI volume was reduced by 88.5%, while the mean effective dose was reduced by 81% when compared to the non-MBIR group. No significant difference was seen in diagnostic acceptability, image noise, and image quality between the 2 groups. CONCLUSIONS: MBIR technique is highly effective in reducing radiation dose in paediatric head CT examinations without any significant difference in image quality, image noise, and diagnostic acceptability.

Paediatric acute pancreatitis: Clinical profile and natural history of collections.

BACKGROUND & AIMS: Acute Pancreatitis (AP) tends to have a benign course in children. However there is a paucity of information with respect to severity of AP in children, the categorization of collections viz., walled off necrosis (WON)& pseudocyst and their natural history & outcomes. METHODS: A retrospective medical record review of 187 children with pancreatitis diagnosed and managed at our centre was performed. RESULTS: 101 children (59% boys, Median age 9yrs) had AP of which 37.6%, 60.4% and 2% had mild, moderately severe and severe AP. 61.4%(62) had PFC at diagnosis; 34%(21) acute pancreatic fluid collections (APFC) and 66%(41) acute necrotic collections (ANC). 52.3%(11of21) of APFC evolved into pseudocysts & 68.2%(28of41) of ANC into WON's. Drainage was required in 31%(12of39) of persisting collections, more frequently in children with traumatic AP. Percutaneous catheter drainage (PCD) was done in 6 children and endoscopic ultrasound (EUS) guided cystogastrostomy with placement of plastic or self expanding metal stents (SEMS) in 6 children. CONCLUSIONS: Moderately severe AP is common in hospitalized children with AP with PFC developing in 61.4%, majority being APFC. 48% of APFC and 32% of ANC will resolve and the rest evolve into pseudocyst or WON. Spontaneous resolution is more likely in children with non -traumatic AP having pseudocysts rather than WON's.

Diagnostic accuracy of 3-T lung magnetic resonance imaging in human immunodeficiency virus-positive children.

BACKGROUND: More than 70% of human immunodeficiency virus (HIV)-positive children sustain respiratory diseases in their lifetime. Imaging plays an important role in establishing early and correct diagnosis. OBJECTIVE: To evaluate the diagnostic accuracy of 3-Tesla (T) thorax MRI in HIV-positive children, using chest CT as the gold standard. MATERIALS AND METHODS: We included 25 children with confirmed HIV-positive status and pulmonary complaints who were referred for chest CT. All children had 3-T thorax MRI using T2-W turbo spin-echo sequence, steady-state free precession gradient echo sequence, T2-W turbo spin-echo MultiVane XD sequence, and T1-weighted modified Dixon sequences. We evaluated the images for various pulmonary and mediastinal findings and calculated the sensitivity and specificity of 3-T thoracic MRI. RESULTS: Sensitivity of 3-T MRI was 100% for detecting nodules >4 mm (95% confidence interval [CI] 66.3-100%), pleural effusion (CI 29.2-100%) and lymphadenopathy (CI 81.5-100%). It demonstrated a specificity of 100% for nodules >4 mm (CI 79.4-100%), pleural effusion (CI 84.6-100%) and lymphadenopathy (CI 59-100%). For consolidation/collapse, sensitivity and specificity were 93.8% (CI 69.8-99.8%) and 88.9% (CI 51.8-99.7%), respectively. The sensitivity and specificity for detecting bronchiectasis were 75% (CI 42.8-94.5%) and 100% (CI 75.3-100%), respectively, while for ground-glass opacity, sensitivity and specificity were 75% (CI 34.9-96.8%) and 94.1% (CI 71.3-99.9%), respectively. Nodules <4 mm were not well detected on MRI, with sensitivity of 35% (CI 15.4-59.2%). CONCLUSION: Thoracic MRI at 3 T demonstrates a high sensitivity and specificity for detecting nodules >4 mm, effusion and lymphadenopathy in HIV-positive children.

Prospective audit of sedation/anesthesia practices for children undergoing computerized tomography in a tertiary care institute.

BACKGROUND AND AIMS: The aim of the study was to enumerate the sedative drugs used, assess the efficacy of sedative drugs, and determine the incidence of adverse events. MATERIAL AND METHODS: A prospective audit of children sedated for computerized tomography (CT) by anesthesiology team was conducted for a period of 4 months. The data included patient demographic variables, fasting period, medications administered, adequacy of sedation, imaging characteristics, adverse events, and requirement for escalated care. RESULTS: A total of 331 children were enrolled for sedation by the anesthesia team. The drugs used for sedation were propofol, ketamine, and midazolam. Twenty-two percent children received one sedative drug, 60% children were administered two drugs, and 5% children required a combination of all three drugs for successful sedation. Sedation was effective for successful conduct of CT scan in 95.8% patients without the requirement of a repeat scan. Twelve (5%) children experienced adverse events during the study period. However, none of the adverse events necessitated prolonged postprocedural hospitalization or resulted in permanent neurologic injury or death. CONCLUSIONS: The current practice of sedation with propofol, ketamine, and midazolam, either single or in combination was efficacious in a high percentage of patients. The incidence of adverse events during the study period was low.

Prospective Comparison of MRI and Contrast-Enhanced MDCT for Evaluation of Pediatric Pulmonary Hydatid Disease: Added Diagnostic Value of MRI.

OBJECTIVE. The objective of our study was to prospectively investigate the diagnostic accuracy and added value of fast MRI for evaluating pulmonary hydatid disease in children by comparing fast MRI findings with MDCT findings. SUBJECTS AND METHODS. Twenty-eight consecutive children (24 boys and four girls; mean age ± SD, 8.93 ± 3.1 years; range, 5-17 years) with clinically suspected pulmonary hydatid disease were enrolled in this prospective research study for the period from October 2012 to July 2018. Fast MRI without contrast material and contrast-enhanced MDCT of the chest were performed within 48 hours of each other in all children. Two pediatric radiologists independently evaluated the lungs for the presence of consolidation, nodule, and mass (solid vs cyst). Cysts were further evaluated for the presence of fluid, air, and an internal membrane. The accuracies of fast MRI and MDCT for detecting pulmonary hydatid disease were obtained and compared. Interobserver agreement was measured with the kappa coefficient. RESULTS. The accuracy of fast MRI and MDCT for detecting pulmonary hydatid cyst was 92.86%. There was no difference between fast MRI and MDCT for accurately detecting pulmonary hydatid cyst (p < 0.001). Internal membranes were detected in 11 of 28 patients (39.28%) with fast MRI and three of 28 patients (10.71%) with MDCT. Almost perfect interobserver agreement was present between the two independent reviewers (κ = 1). CONCLUSION. Fast MRI without contrast material is comparable to contrast-enhanced MDCT for accurately detecting lung cysts in pediatric patients with pulmonary hydatid disease. However, fast MRI provides added diagnostic value by showing internal membranes of cysts, which is specific to pulmonary hydatid disease.