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Objectives: The study aimed to evaluate the relationship between maxillary sinus volume and various sinonasal anatomical variants, as detected by multi-detector computed tomography, and their associations with chronic rhinosinusitis (CRS). Material and Methods: A case–control study was conducted with 103 patients presenting with chronic sinonasal symptoms (cases) and 50 asymptomatic individuals (controls). A 128-slice computed tomography scanner was used to measure maxillary sinus volume and assess anatomical variants, such as a deviated nasal septum (DNS), concha bullosa (CB), and agger nasi cells. Exclusion criteria included previous sinonasal surgery, malignancy, craniofacial trauma, and lack of consent. Statistical analysis was performed using t -tests for continuous variables and Chi-square tests for categorical data. Receiver operating characteristic curve analysis was utilized to determine a DNS angle cutoff for predicting CRS. Results: Anatomical variants were significantly more frequent in cases than in controls. The left-sided DNS was predominant in cases, while the right-sided DNS was more common in controls. The mean DNS deviation angle was notably larger in cases (10.84° ± 7.87) than in controls (5.55° ± 5.02). Maxillary sinus volume was significantly smaller in cases (9.69 cc on the left side and 10.23 cc on the right side) compared to controls (18.57 cc and 18.46 cc, respectively), with female patients exhibiting smaller volumes than males. Agger nasi cells were detected in 51.5% of cases versus 8.0% of controls. A strong association was found between CB and contralateral DNS. The optimal DNS deviation angle cutoff for predicting CRS was identified as 12.7°. Conclusion: This study shows that CRS is linked to smaller maxillary sinus volumes, with males having larger sinus volumes than females. A DNS and larger deviation angles were associated with a higher risk of sinus inflammation, with angles over 12.7° predicting the onset of the condition. The presence of CB and agger nasi cells also contributed to the development of CRS. [ABSTRACT FROM AUTHOR]

To evaluate and measure the mean cross-sectional area of the tibial and median nerves in patients with diabetic peripheral neuropathy, and to study the association between high-resolution ultrasonographic findings in diabetic peripheral neuropathy with the duration of illness, glycosylated haemoglobin values, random blood sugar levels, and aesthesiometry (using monofilament examination).

Introduction: Neuroimaging plays an important role in the assessment of meningitis, but conventional Magnetic Resonance Imaging (MRI) is insensitive for early and specific diagnosis. Diffusion Tensor Imaging (DTI) can illustrate disturbances in white matter integrity before they become obvious on conventional MRI. Aim: To determine DTI parameters, specifically Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC), in patients with meningitis and compare them with controls. Materials and Methods: This case-control study was conducted over a period of 18 months at Teerthanker Mahaveer Medical College and Research Centre in Moradabad, Uttar Pradesh, India. The study included a total of 61 clinically diagnosed meningitis patients, aged 18 years and above, who were referred to the Department of Radiodiagnosis for an MRI Brain. Additionally, 61 controls were included. Conventional MRI images were obtained followed by DTI. FA and ADC values were calculated by placing Regions Of Interest (ROI) at different levels for both groups. DTI parameters for different causative organisms (bacterial, viral, tubercular, and fungal) were compared. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 24.0, and Analysis of Variance (ANOVA) test was used to identify significant differences. The p-value <0.05 was considered as statistically significant. Results: FA values were significantly lower in cases compared to controls at all levels in the brain (mean whole brain FA value of 0.30±0.036 in cases vs 0.43±0.030 in controls). ADC values were significantly higher in cases at the cerebellum, brainstem, and whole brain levels compared to controls (mean whole brain ADC value of 0.812±0.095 in cases vs 0.758±0.026 in controls) (p-value<0.05 considered statistically significant). These differences were evident in patients with clinically proven meningitis who had a normal appearance on conventional MRI, demonstrating the superiority of DTI over conventional MRI for the diagnosis of meningitis. Statistically significant differences were also found among different aetiological agents, highlighting the potential utility of DTI in the differential diagnosis of meningitis cases (mean whole brain FA of 0.31±0.038 in bacterial cases, 0.029±0.037 in viral cases, 0.299±0.034 in tubercular cases, and 0.27±0.00 in fungal cases vs. 0.43±0.030 in controls (p-value <0.01) and mean whole brain ADC values of 0.80±0.051 in bacterial, 0.85±0.14 in viral, 0.79±0.058 in tubercular, 1.03±0.00 in fungal cases vs. 0.758±0.026 in controls (p-value <0.01)). Conclusion: DTI is more sensitive than conventional MRI and is a useful early indicator of inflammatory process in patients with meningitis. [ABSTRACT FROM AUTHOR]

Background: Pain in the shoulder is the third-most prevalent musculoskeletal pain type. Most frequently involved in tendinopathy/tendon tears is the supraspinatus tendon, followed by a combination of the supraspinatus and infraspinatus tendon. At present, gray-scale ultrasound and MRI are used to determine the tear size, gross morphology, and postsurgical tendon repair. However, they are unable to determine the material characteristics of the muscle or tendon. Aims and Objectives: The aim of this study is to assess the role of ultrasound elastography in the evaluation of the rotator cuff tendon and to compare gray scale ultrasound and shear wave elastography (SWE) findings of the supraspinatus tendon with MRI in patients with shoulder pain. Materials and Methods: This prospective observational study included 50 patients. They were examined using a 1.5-T MRI machine and the ACUSON S3000 (Siemens Medical Solution) machine. The radiologist performing the ultrasound was blinded by the results of the MRI. Results: Age varied from 19 to 75 years. The majority (34%) were in the range of 31-40 years. Males were predominately affected. In MRI, the most common type of injury was mild tendinosis (34%), followed by moderate/severe tendinosis (26%). About 30% were diagnosed with moderate/severe tendinosis, 24% with mild tendinosis, 22% with partial tears, and 18% with full-thickness tears in gray-scale ultrasound. When SWE was combined, 32% were diagnosed with moderate/severe tendinosis, 28% with mild tendinosis, 20% with a partial tear, and 14% with a full-thickness tear. Conclusion: SWE showed better diagnostic performance than gray-scale ultrasound in the detection of supraspinatus tendinopathy. [ABSTRACT FROM AUTHOR]

Introduction: Spinopelvic malalignment causes continual backache. Intervertebral Disc Degeneration (IDD) is a leading cause of low backache. Understanding the relationship between spinopelvic parameters and IDD can help with better diagnosis and treatment and avoid unnecessary investigations. Aim: To measure radiographic spinopelvic parameters of patients diagnosed with varying grades of IDD in the lumbosacral spine on Magnetic Resonance Imaging (MRI), and to compare them with radiographs of the asymptomatic population (controls). Materials and Methods: A hospital-based retrospective observational study was done from January 2021 to August 2022 at a tertiary care hospital in Uttar Pradesh, India with 80 patients diagnosed with IDD on MRI and 80 controls. Cases were defined as patients diagnosed to have IDD on MRI and controls were those individuals who did not have disc degeneration on MRI. Lateral lumbosacral spine radiographs were taken, and spinopelvic parameters {Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), lumbo-sacral angle, and sacral horizontal angle} were measured using Surgimap Spine Software. T-test and Chi-square test were used for comparison between cases and controls. Results: Six patients had asymmetric disc bulge, 11 had symmetric disc bulge, 18 had disc extrusion and 45 had disc protrusion. Mean PT in patients with IDD was 11.05±3.84°, and control was 8.65±3.19°, p-value=0.009. Mean SS in case group was 38.38±3.03° and control was 36.56±3.43°, p-value=0.031. The mean PI of cases was 49.44±8.39° and control 46.19±9.01°, p-value=0.02. LL angle was higher in IDD at 46.34°, and was 45.36° in healthy individuals, without statistically significant difference. The mean lumbo-sacral angle in both study groups was similar. The mean Sacral Inclination Angle (SIA) was found to be 43.99° and 44.96° in the case and control group respectively without showing significant differences. A statistically significant difference was found only for the comparison of PT between different grades of IDD (p-value=0.039). Conclusion: Using Surgimap Spine Software, one can predict the individuals that possess a greater propensity of developing degeneration of disc and chronic low back pain in a more costeffective manner. [ABSTRACT FROM AUTHOR]

Low levels of HOMA2-B were observed mainly in patients with poor metabolic control and longer disease duration, whereas almost 100% of -cell functionality was observed in newly diagnosed patients with HbA1c <53.0 mmol/mol (7%) (Figure 2). HOMA2-B values from treated patients with T2DM showed an almost linear and uniform trend, whereas in treatment-naïve patients, a minor trough just after diagnosis was seen, indicating a higher HOMA2-B value and the trend was similar to treated patients after 3 years (Figure S3). The Lowess smoothing curve showed better HOMA2-B values in treatment-naïve versus treated patients with T2DM, especially in those with a disease duration <3 years. Keywords: disease duration; HbA1c; HOMA2-B; treatment-naïve; type 2 diabetes mellitus; -cell function EN disease duration HbA1c HOMA2-B treatment-naïve type 2 diabetes mellitus -cell function 1403 1407 5 04/04/23 20230501 NES 230501 INTRODUCTION Progressive decline of -cell function is a hallmark of disease progression in type 2 diabetes mellitus (T2DM). [Extracted from the article]

Introduction: Despite advancements in cross-sectional aging techniques, ultrasonography continues to remain the first-line imaging modality for the preoperative assessment of pelvic adnexal masses. Ultrasound strain elastography is a novel technique that can characterise adnexal lesions based on their tissue stiffness and when used in conjunction with conventional USG, it may increase the precision of diagnosis and can act as a cost-effective viable ancillary tool. Aim: To assess the role of strain sonoelastography in characterising the adnexal lesion as benign or malignant. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthankar Mahaveer Medical College and Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India, for a period of 18 months (January 2020 to June 2021) and consisted of 110 patients with clinical suspicion of adnexal mass, who were evaluated on SIEMENS Acuson S 3000 scanner (from the total of 130 cases). Various morphological features of mass (size, laterality, consistency, echogenicity and internal contents) were assessed on Gray scale and vascularity was assessed on colour doppler Ultrasonography (USG). Subsequently, real time strain elastography (eSie touch) was performed to assess the tissue stiffness. Elasticity was indicated on a colour-coded elastogram map, with blue areas denoting hard tissue, green areas suggesting intermediate tissue, and red portions denoting soft tissues. The sonographic findings were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for Gray scale sonography in combination with Doppler (conventional ultrasound techniques) and in conjunction with elastography. The Chi-square test was applied for comparing the frequency and p-value less than 0.05 was considered to be significant. Results: The mean age of study population was 36.35±14.82 years. On histopathology out of 110 patients, 95 (86.36%) had benign adnexal lesions and 15 (13.64%) had malignant adnexal lesions. The youngest patient was 16-year-old and eldest was 70 years and the mean age of the study population was 36.35 years. When conventional ultrasound technique was used alone for differentiating benign and malignant adnexal masses the sensitivity was 96.7%, specificity was 83%, PPV was 96.7% and NPV was 83% while on addition of sonoelastography the sensitivity increased to 98.9%, specificity increased to 93%, PPV increased to 98.9% and NPV increased to 93.7%. Conclusion: Conventional ultrasound techniques should be combined with sonoelastography in a diagnostic system to achieve better characterisation and differentiation of benign and malignant adnexal masses. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine whether high-resolution ultrasonography (HRUS) can provide information, on signs of inflammation and destruction, due to rheumatoid arthritis (RA). The focus was on the wrist joint, during early and late disease and compared the findings to those with magnetic resonance imaging (MRI). Materials and Methods: The study was based on 31 RA patients, with joint involvements, who were selected from those attending the outpatient rheumatology clinic. The patients completed both HRUS and MRI examinations, and their results were compared. Results: The HRUS and MRI images had near-perfect agreement, for detecting joint anomalies, in those RA patients. While comparing the overall performance of the HRUS and MRI studies, it was observed that HRUS was equal or nearly equal, demonstrating 90.83%, 100.0% and 94.93%, diagnostic sensitivity, specificity, and accuracy, respectively, for diagnosing RA pathologies. Conclusion: The early diagnosis of RA with HRUS and MRI examinations is very important, in the early treatment of RA. The HRUS examinations demonstrated a sensitive and reliable diagnostic method for assessing inflammatory activity and destructive changes in the joints of these RA patients, with HRUS findings comparable to those of MRI. [ABSTRACT FROM AUTHOR]

Sonoelastography is a comparatively new and developing technology in the field of salivary gland imaging. Nevertheless, it has the potential to distinguish between various types of lesions by calculating the degree of strainrelated deformation under the externally applied force. With this background, the present study was undertaken to evaluate the role of sonoelastography in characterising salivary gland lesions as benign or malignant. The aim: To evaluate and characterize salivary Gland lesions on the Gray scale and Colour doppler ultrasonography and sonoelastography and to correlate these findings with the clinico-pathological diagnosis. Methodology: This prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre, Moradabad (U.P.), from Aug 2021 to Nov 2022. All patients referred to the radiology department for imaging with clinical suspicion of having salivary gland lesions were enrolled in the study and evaluated on the SIEMENS ACUSON S3000 machine. Gray scale USG was done first to assess various morphological features of lesions, and then a Doppler assessment was done to determine vascularity within the lesion. Subsequently, real-time strain elastography (eSie touch) was performed to assess the tissue stiffness. The elastogram image of the detected lesions was evaluated using colour coding ranging from blue (soft) through green (intermediate/average hardness) and red (hard). After strain elastography, shear wave elastography of the lesion was also performed using Virtual Touch Quantification (VTQ) and Virtual Touch Imaging Quantification (VTIQ) software. The sonographic findings were correlated with histopathological diagnosis. The acquired data were subjected to statistical analysis using the software SPSS version 20. Sensitivity, specificity, PPV and NPV were calculated for conventional ultrasound techniques alone & in combination with elastography. Results: Out of the 50 salivary gland lesions included in the study, 44 (88 %) were benign, whereas 6 (12 %) were malignant on cytology. The age of the study population ranged from 16 to 75 years, with a mean age of 38.82 years. Pleomorphic adenoma (60 %) was the most frequent lesion, followed by Warthin's tumour (28 %). The Conventional USG showed 66.67 %, sensitivity, 52.27 %, specificity, 16.00 %, PPV, 92.00 % NPV and 54.00 % accuracy in differentiating benign from malignant lesions while USG-Elastography combined showed higher diagnostic performance with 83.33 %, sensitivity, 79.55 %, specificity, 35.71 % PPV, 97.22 % NPV and 80.00 %, accuracy. The specific cut-off scores for the sonoelastography score, eSie touch, VTQ, and VTIQ were also determined to diagnose a lesion as malignant or benign, and the difference was found to be statistically significant. Conclusions: Sonoelastography alone cannot be solely relied upon to distinguish between malignant & benign salivary gland abnormalities. However, it can be combined with conventional USG for better differentiation and characterization of these lesions. [ABSTRACT FROM AUTHOR]

Byline: Mritunjay. Kumar, Gaurav. Batra, Madhukar. Maletha, Ankur. Malhotra Urinary bladder and the rectum share a common embryological origin, and the anatomical proximity of these two organs suggest that a [...]

Background: Pregnancy-induced hypertension (PIH) is associated with significant maternal as well as fetal morbidity and untreated cases may be associated with poor pregnancy outcomes. It brings about various histological and morphological changes in the placenta such as infarcts, fibrosis, and calcification thereby affecting the well-being of fetus. Detection of it at an early stage is important from the point of view of management as early intervention is associated with improved maternal and fetal outcome. Shear wave elastography (SWE) of placenta is a non-invasive investigation that can detect changes in placental elasticity during the pregnancy. Aims and Objectives: The aim of the study was to assess and compare the difference in values of placental elasticity in normal pregnancy and in clinically diagnosed cases of PIH and to study its association with uterine artery-pulsatility index (UtA-PI) and fetal outcome. Materials and Methods: This was a prospective and observational study in which pregnant females with gestational age of 20–34 weeks who were referred to radiology department for routine sonography including the clinically diagnosed pregnancies with PIH were included on the basis of a predefined inclusion and exclusion criteria. A total of 106 individuals were included in the study, B-mode sonography, uterine artery Doppler, and placental SWE were performed in all these patients. All these pregnancies were followed up for the fetal outcome. Results: The mean gestational age of the studied cases was found to be 26.51±4.415 weeks. Higher SWE values were found, as compared to the normal pregnancies, in pregnancies complicated by PIH and the difference was found to be statistically highly significant (P<0.001). Placental SWE showed a strong association with UtA-PI and fetal outcome. Incidence of adverse fetal outcome such as preterm deliveries, intrauterine death, stillbirths, and small for gestational age babies was more commonly seen in PIH group and the difference was statistically significant (P<0.005). Incidence of birth asphyxia (as determined by low APGAR score) and neonatal intensive care unit admissions was more in neonates born to patients with PIH as compared to those in healthy women and the difference was statistically significant (P<0.005). Conclusion: SWE has the potency to detect the changes in placental morphology and can help with diagnosis of pregnancies complicated with PIH. It does have a synergistic role to play alongside the uterine artery Doppler and clinical parameters to predict the pregnancies with PIH. [ABSTRACT FROM AUTHOR]

Introduction: Identification of the nature of lymph nodes is one of the most important parameters for diagnosis in any oncological setting. The lymph nodes help in staging and this directly affects the prognostic outcome and treatment decision. Ultrasound is the preferred imaging method for distinguishing between benign and malignant superficial lymph nodes given ease of availability and its low cost. However, there is no reliable and definitive sonographic criterion in ultrasound to categorise lymph nodes as benign or malignant. Aim: To evaluate the role of sonography and sonoelastography in characterisation of cervical lymphadenopathy and to associate the imaging findings with cytopathology. Materials and Methods: This was a cohort study, conducted over a period of one year in Teerthankar Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India, constituting a total of 60 patients with enlarged cervical lymph nodes and evaluated on B-mode ultrasound and elastography in this study. The ultrasonography was performed using either Acuson S3000 ultrasound system (Siemens Medical Solutions, Mountain View, CA) with a 4 to 9 MHz linear transducer for conventional sonography and Acoustic Radiation Force Impulse (ARFI) imaging. Results of radiological findings were tabulated, evaluated and collated with pathological findings. Results: ARFI imaging displayed a sensitivity and specificity of 80% and 97.5% respectively with a Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 94.1% and 90.7% respectively in distinguishing malignant from benign cervical lymphadenopathy with the diagnostic accuracy being 91.67%. Using Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) of 0.925, a cut-off value for shear wave velocity of 2.98 m/s was obtained. Conclusion: ARFI is a novel technique which can be used to characterise the nature of cervical lymph nodes. Present study demonstrated high diagnostic accuracy (91.67%) in comparison with histopathological findings, ARFI elastography may help in distinction of benign from malignant nodes in adjunct to the grey scale. [ABSTRACT FROM AUTHOR]

Objectives To determine the most preferable endoluminal contrast agent among mannitol, polyethylene glycol (PEG), iohexol, and water by comparing various qualitative (distension, fold visibility, and homogeneity) and quantitative parameters (distension) along with artifacts and patient feedback for computed tomography enterography (CTE). Methods This was a prospective study including 120 patients of age more than or equal to 18 years who were randomized equally into four groups. Group 1 was given 1500 mL of 3% mannitol solution, group 2 was given 1500 mL of PEG, group 3 was given 20 mL of iohexol dissolved in 1500 mL of water, and group 4 was given 1500 mL of plain water. CTE was done and images were evaluated in axial and coronal planes. Various quantitative and qualitative parameters were taken at the level of second part of duodenum, jejunum, ileum and ileocecal junction (ICJ). Artifacts and patient feedback were also taken into consideration. Results The quantitative distension and grading, qualitative distension, fold visibility, and homogeneity of the second part of duodenum, jejunum at the level of superior mesenteric artery, inferior mesenteric artery and renal artery on both sides of abdomen, ileum at the level of aortic bifurcation, common iliac bifurcation, and deep pelvis on both sides of abdomen and ICJ were significantly more in PEG group as compared with mannitol group, followed by iohexol and water group. The results were calculated by ANOVA test using p-value. In terms of patient feedback and artifacts, water was the best agent. Conclusions PEG is the most suitable contrast agent to carry out CTE. Distension, fold visibility, and homogeneity are the essential features for a better diagnostic out-come of CTE, which was better with PEG. [ABSTRACT FROM AUTHOR]

Objective: Magnetic resonance imaging (MRI) has been established as the gold standard imaging technique for assessing knee joint pathologies. However, high-resolution sonography (HRS) is affordable, easily available, cost-effective, and can be used for knee joint assessment. This study was conducted to assess the diagnostic yield of HRS in the evaluation of knee joint pathologies compared with MRI. Materials and Methods: In the study, 103 patients, with symptomatic knee pain, were included. HRS was performed followed by MRI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Kappa values were calculated to assess the performance of HRS compared with MRI. Results: The most frequent pathologies observed on HRS were knee joint effusion (84%) followed by medial meniscal (43%) and lateral meniscal (26%) tear. Conclusion: HRS demonstrated good diagnostic accuracy in diagnosis of knee joint pathologies as compared with MRI. Therefore, HRS could be utilized as a screening tool for detection of knee joint pathologies. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a global health problem and the second most common infectious cause of death. High-resolution computed tomography (HRCT) is far more superior to chest radiography as well as conventional CT for analyzing the pulmonary parenchyma. This study aimed to evaluate the role of HRCT in pulmonary tuberculosis (PTB) with respect to disease activity and complication after anti-tubercular therapy (ATT). Methods: This prospective observational study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre (TMMC&RC) for a period of 1.5 years. A total of 50 cases of newly diagnosed TB were included in the study and a standard six-month ATT was given to the patients. Pulmonary involvement was evaluated by HRCT (128 slice multi-detector PHILIPS INGENUITY CT scanner), twice for each patient (first scan after diagnosis and second after treatment completion). The acquired HRCT images were reconstructed on a highresolution lung algorithm and parenchymal, bronchial, and extra parenchymal findings were recorded systematically. Results: Out of the 50 patients, 5 died within two months of the initiation of treatment and four were lost to follow-up. Thus, post treatment follow-up sample size was reduced to 41 patients. Ill-defined nodules (96%), tree-in-bud pattern (74%), consolidation (86%), cavitary lesions (98%), and ground glass opacities (58%) were the main imaging features of active cases of TB on HRCT. Resolution to thin-walled cavitary lesions (36.5%), bronchiectasis (41.5%), and fibrotic (parenchymal) bands (66%) were common complications or sequelae which were observed after completion of treatment. Conclusion: HRCT thorax is a sensitive modality for evaluation of parenchymal and airway manifestations in cases of PTB and can aid in differentiation of active disease from healed disease. It allows early identification of post-treatment complications and sequelae in patients of PTB. [ABSTRACT FROM AUTHOR]

Objective: The incidence of malignancy in thyroid nodules is infrequent, but this trend may be reversing. The present study was conducted to emphasize the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging, in addition to conventional gray-scale ultrasonography (US), for differentiating benign and malignant thyroid nodules. Methods: A total of 141 patients with thyroid nodules (≥10 mm) were included in the study and were evaluated with US, Doppler, and ARFI elastography using Siemens S2000 Acuson ultrasound equipment. Results: The sonographic patterns most predictive and indicative of malignancy included irregular margins and presence of microcalcifications. The Doppler findings in isolation were not extremely sensitive in the detection of malignancy. The shear wave velocity cutoff value on ARFI imaging using receiver operating characteristic curves for differentiation of benign and malignant nodules were noted at 2.87 m/s. ARFI imaging performed better than US and Doppler with sensitivity of 75%, specificity of 96%, and accuracy of 94%. Conclusion: ARFI elastography could be utilized as a reliable initial screening test for detection of malignancy in thyroid nodules. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral Microbleeds (CMBs) are increasingly recognised as an important predictor of small vessel disease and cannot be detected on routine Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) sequences. Aim: This study was aimed at evaluating CMBs on MRI and to compare the sensitivity of SWI and T2* GRE sequences in detection of these microbleeds. In addition, we also sought to evaluate association between topography (size, number and location) of CMBs and various risk factors. Materials and Methods: This Prospective observational analytical study comprised of 67 patients with CMBs who were evaluated with Siemens 1.5 Tesla MRI machine. T2*-weighted gradient recalled echo sequence and Susceptibility-Weighted Imaging (SWI) were taken in all the patients in addition to routine MRI sequences. Two observers blinded to clinical information, independently interpreted the T2*GRE and SWI sequences. Both observers recorded the topographical details of CMBs which included presence, number, size and location and their association with various risk factors (hypertension, diabetes, smoking and hyperlipidemia). Inter-rater agreement for the number of CMBs on SWI and on T2*GRE was calculated using Cohen’s Kappa (κ) as measure of agreement. Intra-Class Correlation Coefficient (ICC) for reliability index in test-retest, intra-rater and interrater reliability was also analysed. The intra-rater reliabilities of each rater were compared. The Correlations between CMBs and risk factors was performed with Pearson’s correlation Coefficient (r). The p-value <0.05 was considered statistically significant. Results: The SWI with its Reverse Phase (RP) detected more number of CMBs as compared to T2*GRE. Majority of the subjects (71.6%) had more than 5 CMBs. CMBs ≥5 mm had a strong correlation with both hypertension and diabetes as compared to CMBs <5 mm. There was a higher frequency of patients with lobar CMBs (89.6%) followed by the deep location (70.1%). An almost perfect agreement was found between both observers for number of CMBs on RP SWI with ‘κ’ value of 0.97a (0.96-0.98) in contrast to a weak agreement on RP T2*GRE with κ=0.52a (0.40-0.64). For SWI, an almost perfect reliability was found (ICC=0.998) as compared to a moderate reliability on T2*GRE (ICC=0.6826). An excellent reliability was seen for size of CMBs <5 mm on RP SWI (ICC 0.998). Conclusion: SWI offered greater reliability and sensitivity for CMB detection as compared to the T2*GRE sequence and is presently the gold standard sequence of MRI for quantifying CMBs. The burden of CMBs may further indicate inappropriately treated hypertension and diabetes. [ABSTRACT FROM AUTHOR]

Byline: Shraddha. Pore, Suman. Sardesai, Vinay. Tapare, Meghana. Kulkarni, Ankur. Malhotra, Chandrashekhar. Chavan Sir, The role of surgical chemoprophylaxis in caesarean section is well established, [sup][1] but the recommendations about [...]

Introduction: Vocal Cord Palsy (VCP) is a common clinical presentation and must be considered as a sign of underlying disease, rather than simply a diagnosis unto itself. Despite of idiopathic causes in nearly half of the cases, imaging studies are still indispensible for evaluating the varied aetiologies. Most of the signs of VCP are clearly demonstrable on axial Computed Tomography (CT) sections except one i.e., flattening of ipsilateral subglottic arch which needs specific evaluation only on coronal reformatted images. The diagnostic value of this sign is still debatable. Aim: To evaluate any additional advantage offered by coronal reformatted images in cases of unilateral VCP especially those with confusing/equivocal findings and to find out most reliable signs of unilateral VCP on axial CT sections. Materials and Methods: This retrospective study comprised of patients with clinical suspicion of VCP who were referred for CT neck and thorax in Department of Radiology at tertiary care hospital in the previous 36 months (July 2014 to June 2017). Only the cases with laryngoscopically confirmed unilateral VCP were included. The cases with laryngeal malignancy were excluded. Various imaging signs of unilateral VCP were evaluated on both axial and coronal reformatted images. Spearman's rho (ρ) correlation coefficient was calculated to assess correlation between most frequent signs of unilateral VCP individually and also with flattening of ipsilateral subglottic arch (evaluated on coronal reformatted images). Results: Thickening and medialisation of ipsilateral aryepiglottic fold was uniformly present in all the cases of unilateral VCP. Two other most frequent signs which correlated strongly with unilateral VCP were dilatation of ipsilateral laryngeal ventricle (n=29, 93.5%) and dilatation of ipsilateral pyriform sinus (n=27, 87%). Flattening of ipsilateral subglottic arch on coronal reformatted images was seen in only 26% patients. This sign was absent in all four cases with equivocal and contralateral findings in present study. Conclusion: The coronal reformatted images failed to demonstrate any additional advantage over axial sections in diagnosing unilateral VCP even in equivocal or difficult cases. The thickening and medialisation of ipsilateral aryepiglottic fold on routine axial CT images is probably the most reliable and consistent sign for diagnosing unilateral VCP with dilatation of ipsilateral laryngeal ventricle and ipsilateral pyriform sinus as two other major supportive signs. [ABSTRACT FROM AUTHOR]

Introduction: Successfully detecting and managing Liver Fibrosis (LF) at an early phase can significantly improve the prognosis of patients in clinical practice, therefore, accurately assessing the degree of fibrosis when the disease is at an early stage is extremely important. However, the normal range of Liver Stiffness (LS) on Point Shear Wave Elastography (PSWE) is not well established. Aim: The present study aimed to quantitatively evaluate and compare sonoelastographic values of liver stiffness in healthy individuals without any clinical complaints. Materials and Methods: A prospective cross-sectional study was done from November 2014 to January 2017 in a tertiary care hospital in Uttarakhand region. The mean kilopascal value of 10 consecutive measurements were used as representative value for each healthy individual. The effects of potential confounding factors (age, gender, hepatic steatosis, and BMI) on liver elasticity was evaluated. Results were evaluated using SPSS© for windows™ Vs 23 (IBM™ Corp NY) and Microsoft excel™ 2007(Microsoft® Inc USA). Student's t-test was used to check the significance of difference between two parameters. ANOVA followed by Tukey's HSD test was used to test the significance of difference between more than two parameters in parametric data. Results: A total of 207 healthy individuals out of which 59 had fatty liver (incidentally detected) formed part of this study. Reference range of liver stiffness in total study population was 4.48±0.78 kPa. Liver stiffness in males was4.56±0.76 kPa and in females was 4.32±0.80 kPa. Reference range of liver stiffnessfor fatty liver was 4.59±0.84 kPa and for healthy liver was 4.47±0.75. Conclusion: Normal reference range of liver stiffness in healthy individuals in Uttarakhand region was 4.48±0.78 kPa. Of all the confounding factors only males have significant higher liver elasticity as compared to females. Other confounding factors have no significant effect on liver elasticity. [ABSTRACT FROM AUTHOR]

Introduction: Differentiating calcification from chronic microbleeds on imaging may have important clinical implications. Aim: The present study aimed to evaluate the role and relative advantages of Magnetic Resonance Imaging (MRI) in the detection and differentiation of intracranial calcifications and chronic microbleeds. Materials and Methods: The retrospective study comprised of 100 patients having either intracranial calcifications or microhaemorrhages selected on the basis of Computerized Tomography (CT) and MRI using predefined criteria. Two independent blinded observers evaluated the images qualitatively and quantitatively. Single pixel values were taken in the circular Region of Interest (ROI) on magnitude SWI, phase Susceptibility Weighted Imaging (SWI) and Diffusion Weighted Imaging (DWI) for quantitative analysis. Results: Fifty patients with 76 focal calcifications and another 50 patients with 245 chronic microbleeds formed part of the study. Overall sensitivity of SWI in detection of calcification was 93.9% with good inter observer agreeability (k= 0.7) on phase SWI. All the chronic microbleeds were seen on SWI but there was only moderate inter observer agreeability in evaluation of signal on phase component (k= 0.5). Average pixel values of calcifications and chronic microbleeds were -312.5±187 SD and 541.9±301.7 SD respectively on phase SWI, (p=0.0001, <0.05). Conclusion: SWI can play a pivotal role in the detection of intracranial calcifications and chronic microbleeds and resolving the ambiguity in their diagnosis. [ABSTRACT FROM AUTHOR]

We propose an ab initio method, named DiscoverR, for finding common patterns from two RNA secondary structures. The method works by representing RNA secondary structures as ordered labeled trees and performs tree pattern discovery using an efficient dynamic programming algorithm. DiscoverR is able to identify and extract the largest common substructures from two RNA molecules having different sizes without prior knowledge of the locations and topologies of these substructures. We also extend DiscoverR to find repeated regions in an RNA secondary structure, and apply this extended method to detect structural repeats in the 3′-untranslated region of a protein kinase gene. We describe the biological significance of a repeated hairpin found by our method, demonstrating the usefulness of the method. DiscoverR is implemented in Java; a jar file including the source code of the program is available for download at http://bioinformatics.njit.edu/DiscoverR. [ABSTRACT FROM AUTHOR]

The available evidence suggests positive health outcomes associated with early treatment intensification in Type 2 diabetes mellitus (T2DM). Our study estimated the productivity effects arising from improved health correlated with early intensified treatment in T2DM in Korea. Using a recently published methodology and model, we investigated the association between early intensified treatment and the probability of experiencing fewer diabetes-related complication events. Treatment strategies leading to better health outcomes are expected to be associated with social value through increased participation in paid and unpaid work activities. Therefore, we translated the lower incidence of complications into monetary terms related to productivity for the Korean population. We quantified productivity by considering (a) absenteeism, (b) presenteeism, (c) permanent loss of labor force, and (d) activity restriction. Deterministic and probabilistic sensitivity analyses in the base case parameter were performed. Approximately, 1.7 thousand (standard deviation [SD] ±580 events) micro- and macrovascular complication events could potentially be avoided by early treatment intensification. This led to a societal gain attributed to increased productivity of 23 million USD (SD ± $8.2 million). This article demonstrates the likelihood of achieving better health and productivity through early intensified treatment in diabetes., Competing Interests: Declaration of Conflicting InterestsThe author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: F. Tsotra, P. Peristeris, I. Athanasiou, M. Müller are employees of WifOR institute. G. Bader, A. Malhotra are employees of Novartis.

Aim: The current study estimates the societal impact of early intensified treatment compared with initial monotherapy with subsequent treatment intensification in newly diagnosed adults with type 2 diabetes mellitus in Mexico. Methods: An individual patient-level simulation and a static cohort model were employed to simulate the treatment pathway and the probability of experiencing complications of diabetes. The avoided number of events was translated into avoided productivity losses, which were monetized using wages. Results: Patients on early intensified treatment experienced approximately 13,000 fewer complication events over 10 years. This was translated into a societal impact of $54 million (USD). Conclusion: Early treatment intensification is likely to be of particular benefit to health outcomes and productivity losses.