Validity of ultrasound with color Doppler to differentiate between benign and malignant ovarian tumours.

OBJECTIVE: To assess the utility of ultrasound and color Doppler and the Accuracy of International Ovarian Tumor Analysis (IOTA) group classification in the preoperative evaluation of ovarian neoplasms to assess benign or malignant histopathology in the diagnosis of ovarian tumors. METHODS: This observational longitudinal prospective analysis of 60 patients was performed over a period of 2 years (2017- 2019). The mean age of the patients was 43.75 years. Ultrasonography of ovarian masses were evaluated, and cancer antigen-125 (CA-125) levels were evaluated. Based on the IOTA classification, the B and M features of adnexal masses were studied. Color Doppler imaging was performed to evaluate the patterns of vascularity and indices. RESULTS: Sixty patients with 35 benign, 23 malignant, and two borderline lesions were included in the study. In malignant lesions, 17 women (73.9%) were above the age of 45. The CA-125 cut off was ≥35 internatioal units/mL. Based on the IOTA classification, 27/35 (77.1%) benign cases, were correctly identified as benign, 6/35 (17.1%) benign cases were incorrectly identified as malignant, and two (5.7%) were found to be inconclusive. In the malignant group, 17 of the 23 patients were identified as having malignancy. Color Doppler showed three (18.8%) benign tumors had a pulsatality index (PI) of <0.8 and 21 malignant tumors had a PI of <0.8. Four benign tumors had an resistive index (RI) of <0.6 and 100% of malignant tumors had an RI <0.6. CONCLUSION: The IOTA classification is a reliable scoring system for adnexal masses, and color Doppler can help to minimize interobserver variation.

Are antibiotics still relevant in acne? A review of the therapeutic conundrum.

Antibiotics have constituted the mainstay of acne therapy despite acne being classified as an inflammatory disorder. The indiscriminate usage of antibiotics over the years has thus fueled the issue of antimicrobial resistance. Cutibacterium acnes (C. acnes) can acquire resistance due to chromosomal mutation or genetic acquisition. C. acnes can transfer resistance to other resident flora, complicating the management of skin and soft tissue infections. It can also transfer resistant strains to other body sites and to immunocompromised and elderly patients thus putting them at risk of serious infections. Recent studies have highlighted the physiologic role of C. acnes in maintaining the normal homeostasis of the skin microbiome. The role of Malassezia in causation of acne has piqued interest in recent times. The efficacy of antibiotics in acne is attributed to their para-antibiotic, anti-inflammatory action rather than antimicrobial action. Thus, usage of low-dose antibiotics and alternatives to antibiotics has been advocated. Some alternative therapies showing efficacy in acne are probiotics, oral zinc, precision therapy using succinic acid, bacteriophages, and anti-biofilm therapy like myrtacin, topical azelaic acid, and salicylic acid. Using isotretinoin in early stages of acne can reduce the incidence of scarring and alleviate the need for antibiotics. Thus, a gradual shift from antibiotics to alternative therapies in acne is the need of the hour.

Computed Tomography and Cephalometric Evaluation of Obstructive Sleep Apnea Syndrome.

To examine the changes of upper airway cross sectional area in each phase of respiration in different degrees of severity of OSAS with computed tomography and cephalometry to decide on further treatment. A Prospective study was done in the Department of Radiology and Imaging, Kasturba Medical College, Mangalore, spanning over a period from March 2017 to December 2019. 50 patients were included in the study including control group. Patients who had at least 2-3 major symptoms of sleep apnea such as snoring, daytime somnolence, and apnea were included in this study. All patients were examined and then subjected to polysomnography(PSG) and upper airway CT. Patients with apnea-hypopnea index (AHI) of < 5 on Polysomnography were included in the control group and those with AHI of > 5 were categorized in to the study group Cross-sectional area of the airway at the level of the nasopharynx, oropharynx and the hypopharynx were obtained. Standard cephalometric measurements were made on a lateral radiograph of skull/ CT scanogram. Of the 36 patients in the study group, 31 patients were males and 5 were females. In the control group of 12 patients, 8 were males and 4 females. The cross sectional area at the lower border of the nasopharynx which is also the level of the nasopharyngeal sphincter was the most affected level in OSAS (p value of < 0.0001). Mean uvular diameter in the control group was 9.6 mm and in the OSAS group it was 11.2 mm. The mean length of the soft palate was 36.4 mm in the controls, 39.5 mm in the mild/moderate OSAS and 41.2 mm in the severe OSAS group. Obstructive sleep apnea is a complex disorder characterized by apneic episodes during sleep. In this study the most common site of obstruction is nasopharyngeal sphincter and the oropharynx. Although PSG is the diagnostic test of choice, imaging plays an important role in planning surgical and conventional treatment.

Postcontrast Fluid-Attenuated Inversion Recovery (FLAIR) Sequence MR Imaging in Detecting Intracranial Pathology.

BACKGROUND: Imaging sequences for detection of meningeal and parenchymal lesions are critical in intracranial pathology. Our study analysed FLAIR MRI sequence for evaluating postcontrast enhancement. OBJECTIVES: FLAIR imaging sequences have been used in evaluation of enhancement in the brain. We conducted a study of FLAIR imaging sequences to better delineate postcontrast enhancement. MATERIALS AND METHODS: In this prospective hospital-based observational study, postcontrast T1 MTC and delayed postcontrast T2 FLAIR and T1 FLAIR images of 66 patients with intracranial pathology were assessed by experienced radiologists from November 2017 to November 2019. RESULTS: 28 cases of meningeal enhancement were identified in delayed postcontrast T2 FLAIR images. Low-grade gliomas included in the study showed postcontrast enhancement on postcontrast T1 MTC images. Multiple sclerosis lesions were better seen on postcontrast T1 FLAIR. In extraaxial lesions of 11 cases of meningioma, brighter enhancement was seen on delayed postcontrast T2 FLAIR images. CONCLUSION: We found that delayed postcontrast T2 FLAIR was better in detection of meningeal enhancement in infectious meningitis and in meningitis carcinomatosis than T1 MTC images. In delayed postcontrast T2 FLAIR images, intra-axial parenchyma lesions appeared more conspicuous or similar to T1 MTC images. Delayed postcontrast T1 FLAIR images provided better anatomic delineation of intra-axial lesions.

Diagnostic dilemma of a thumb swelling: An unpropitious turn of events.

Benign and malignant bone tumors arise in small bones of the hands and feet. Nevertheless, secondary deposits at these sites are extremely rare. We report a peculiar case of an adult man who presented with thumb swelling, which was later discovered to be a metastasis from renal cell carcinoma. Such cases have a sinister prognosis with a survival rate of 6-12 months from the time of diagnosis. We intend to discuss the diagnostic dilemma and treatment of acrometastases.

Understanding the cryptic introgression and mixed ancestry of Red Junglefowl in India.

Red Junglefowls (RJFs), the wild progenitor of modern day chickens (DCs), are believed to be in genetic endangerment due to introgression of domestic genes through opportunistic matings with domestic or feral chickens. Previous studies from India reported rare hybridization of RJFs in the wild. However, RJF population genetic structure, pattern of gene flow and their admixture with DC populations are poorly understood at the landscape level. We conducted this study with a large sample size, covering the predicted natural distribution range of RJFs in India. We documented strong evidence of directional gene flow from DCs to free-ranging wild RJFs, with the Northeastern RJF population exhibiting the most genetic variants in their nuclear and mitochondrial genomes, indicating it to be the ancestral population from which early radiation may have occurred. The results provide evidence that landscape features do not act as a barrier to gene flow and the distribution pattern could not be explored due to physical sharing or exchange of wild birds in the past when forests were continuous across RJF range in India.

Clinical relevance of reporting fatty liver on ultrasound in asymptomatic patients during routine health checkups.

OBJECTIVE: Ultrasonography is an efficient technique for detecting fatty liver. Its sensitivity and specificity in detecting moderate to severe fatty liver are comparable to those of histology. Fatty liver is associated with abnormal lipid and lipoprotein metabolism and insulin resistance, metabolic syndrome, cardiovascular/renal disease, type 2 diabetes, and other conditions. This study was performed to compare the serum lipid profiles and serum glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), and glycosylated hemoglobin (HbA1c) levels in patients diagnosed with fatty liver on ultrasonography versus controls without fatty liver and evaluate the clinical relevance of an ultrasound diagnosis of fatty liver in routine health checkups. METHODS: This hospital-based cross-sectional study included 390 patients who underwent health checkups; 226 were diagnosed with fatty liver (cases) and 164 were not (controls). The lipid profile, serum GOT and GPT levels, and HbA1c level were compared between the cases and controls. RESULTS: The cases had considerably higher levels of lipids, liver enzymes (serum GOT and GPT), and HbA1c than controls. CONCLUSION: Ultrasonography is a noninvasive simple tool for early detection of fatty liver in asymptomatic patients and can help clinicians achieve early detection of metabolic syndrome.

Evaluation of carotid arteries in stroke patients using color Doppler sonography: A prospective study conducted in a tertiary care hospital in South India.

AIMS AND OBJECTIVES: Cerebral ischemic stroke is life-threatening and debilitating neurological disease, it is the third leading cause of death in the world. Studies have shown that there is a close relationship between carotid artery stenosis and ischemic cerebral vascular disease. This study is done to assess the carotid arteries with the help of color Doppler sonography and to correlate cerebrovascular accidents. MATERIALS AND METHODS: The prospective study was carried out on 50 patients using purposive sampling technique. Risk factors such as hypertension, diabetes mellitus, smoking, and family history were documented. The data gathered from color Doppler examination consisted of peak systolic velocity of common carotid artery (CCA) and internal carotid artery (ICA), velocity ratios between CCA and ICA and plaque characteristics as seen on real-time image. STATISTICAL ANALYSIS USED: The collected data were analyzed and presented in the form of tables, figures, graphs, and diagrams wherever necessary. As this study deals with the only frequency distribution of various factors, so no tests of significance were applied. RESULTS: The highest incidence of stroke was found in the male population in the age group of 60-69 years. Various risk factors included hypertension, diabetes mellitus, smoking, and family history. Of 50 patients, 12 patients showed significant stenosis (>60%). Atherosclerotic plaques were seen in 39 patients (78%). CONCLUSION: Color Doppler examination is an economic, safe, reproducible, and less time-consuming method of demonstrating the cause of cerebrovascular insufficiency in extracranial carotid artery system and will guide in instituting treatment modalities.

Genetics driven interventions for ex situ conservation of red junglefowl (Gallus gallus murghi) populations in India.

Genetics driven interventions (GDI) are imperative for ex situ conservation to exhort long-term sustenance of small and isolated populations in captivity as they are more prone to an increased extinction risk due to inbreeding and genetic drift. We investigated constitutive genetic attributes of four captive Red Junglefowl (RJF) populations in India, to facilitate the prioritization of the birds to formulate an effective breeding action plan. All the four RJF populations were found to be evident of significant inbreeding but none of them had exhibited any signature of bottleneck footprints in the recent past. Bayesian cluster analysis revealed three distinct groups among the four captive RJF populations. Interestingly, birds of Kufri population were assigned together with Gopalpur as well as with Morni populations, indicating their shared genetic ancestry. Among the four populations, Morni population displayed the richest genetic attributes and was therefore presumed as a key source of genetic variation. Nine birds of Morni population were relatively pure (q-value >0.98) and carried about 50% of the total private alleles of Morni population. Thus, being the foremost reservoir of allelic diversity, these nine birds may be selected for launching alien alleles to other RJF populations to rescue their loss of genetic diversity arising from inbreeding.