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Abstract Background To analyze preoperatively the composition of renal calculi using dual-energy computed tomography (DECT) and compare it with reference standard biochemical stone analysis. Methods Eighty-one participants who were diagnosed with renal calculi underwent DECT at 80 kVp and 140 kVp. Spectral analysis was performed, and the energy map generated was used to classify the calculus based on available preset data. Average Hounsfield units (HU) were calculated for the two energy levels, and ratio of HU was derived (DE ratio) and calculus was categorized into different stone compositions. Hounsfield units of each calculus was measured at 120 kVp standard dose CT, and Hounsfield density (HU/largest transverse diameter) was derived. Comparison of results of spectral analysis and DE ratio was done and correlated with the biochemical laboratory analysis as reference standard wherever available. Results Spectral analysis and CT prediction of stone were performed for all 81 patients. CT prediction of stone based on DE ratio into “uric acid,” “struvite,” “calcium oxalate” and “calcium carbonate apatite” was performed. Assessment of stone composition by biochemical analysis was done for 65 patients who eventually underwent PCNL for stone extraction. Both DE ratio and spectral analysis were able to differentiate calculus into various types based on composition with statistically significant p values. However, spectral analysis proved to be marginally better in renal stone characterization particularly for mixed stones. The DE ratio for uric acid stones was derived as 0.9–1.1, 0.9–2.3 for mixed stones and 1.0–2.4 for calcium stones. Conclusions Spectral analysis promises a practical approach to predicting calculus composition preoperatively, thereby avoiding unnecessary surgical intervention.

Introduction: Diffusion-weighted image or DWI is commonly used to provide valuable and diverse information on acute stroke in tertiary care hospitals. DWI is a sensitive and accurate method for identifying the infarct core and can expose the area of cerebral infarction within a few hours of onset. This systematic review is planned to evaluate the measurement of stroke volume on DWI and correlate it with functional outcomes (modified ranking scale). Method: We have adhered to the PRISMA-P checklist to report this systematic review protocol. PubMed, Web of Science, Scopus, and TRIP (Turning Research into Practice) databases will be searched. Two independent reviewers will screen the records, extract data, and critically appraise the studies. A checklist for critical appraisal will be applied for data abstraction, and data extraction will be done using predictive modeling for systematic reviews. The risk of bias will be measured by the Prediction Model Risk of Bias Assessment Tool (PROBAST). The meta-analysis will be considered only if included studies have adequate data, and STATA statistical package version 13.1 will be used for performing a meta-analysis. A narrative synthesis will be performed if meta-analysis is not possible. Ethics and Dissemination: As this review will focus on secondary information, there is no ethical consideration required. We will disseminate our findings by publishing our analysis in a peer-reviewed journal. Protocol Registration: In Prospective Register of Systematic Reviews (CRD42019141840).

Background: The liver is primarily or secondarily involved by numerous vascular, metabolic, infectious, and neoplastic processes resulting in formation of focal liver masses, and the detection of such focal liver lesions is frequently accomplished with sonography. However, the categorization a liver mass as benign or malignant on ultrasound has always been a diagnostic dilemma. Objective: This study aimed to assess if the addition of compression sonoelastography to conventional B-mode ultrasound aided in diagnostic accuracy of the focal hepatic lesions. Materials and Methods: We evaluated B-mode characteristics of 52 liver lesions followed by calculation of their strain values on compression sonoelastography. The lesions were categorized as benign or malignant by ascertaining a cutoff strain value and the comparison was made with the histopathological diagnosis/contrast-enhanced computed tomography characteristics of the lesions. Results: The mean strain index value of malignant hepatic lesions (2.12 ± 1.06) was statistically higher than the benign lesions (0.92 ± 1.06) with 2-tailed P = 0.002. The sensitivity, specificity, and positive and negative predictive values of compression sonoelastography in diagnosing a malignant pathology were 74.4%, 88.9%, 94.6%, and 46.7%, respectively, and the additional evaluation of B-mode features yielded higher sensitivity (95.4% vs. 83.7%) and negative predictive value (75% vs. 46.7%). Conclusion: Compression sonoelastography is an efficient and beneficial complementary tool to B-mode imaging in evaluating solid liver lesions.

The human nasal cavity develops from birth with size anatomical changes. This study aims to evaluate the flow parameters and particle deposition parameters. Neonatal and infant nasal cavities are developed using MIMICS 21.0, and the flow is evaluated by ANSYS 2021 R2 using CFD to evaluate velocity, pressure, micro- and nanoparticle depositions under sedentary breathing conditions. Neonatal nasal valve velocity was recorded 3.5 times higher compared to the infant for 1.8 LPM and 2.7 times for 3 LPM. Neonatal vestibular depositions up to 10 µm were 6.6%, which increased to 76% for 60 µm for 1.8 LPM and increased to 21.3% for 10 µm and 79% for 60 µm for 1.8 LPM. The neonatal nasal valve showed maximum depositions of around 35% for 20 µm for both flow rates. Maximum depositions of nanoparticles are in the mid-nasal region. Infant nasal cavities deposit around 1% to 2% for nanoparticles below 20 nm for both flow rates. Neonatal overall microparticle depositions doubled with an increase in flow rate up to 10 µm. The overall deposition efficiency of nanoparticles increases 1.5 times with increasing flow rate. This study will help with the medical administration of aerosol-based medications in the patient and age-specific nasal cavity. [ABSTRACT FROM AUTHOR]

Objective: The nasal cavity effectively captures the particles present in inhaled air, thereby preventing harmful and toxic pollutants from reaching the lungs. This filtering ability of the nasal cavity can be effectively utilized for targeted nasal drug delivery applications. This study aims to understand the particle deposition patterns in three age groups: neonate, infant, and adult. Materials and methods: The CT scans are built using MIMICS 21.0, followed by CATIA V6 to generate a patient-specific airway model. Fluid flow is simulated using ANSYS FLUENT 2021 R2. Spherical monodisperse microparticles ranging from 2 to 60 µm and a density of 1100 kg/m3 are simulated at steady-state and sedentary inspiration conditions. Results: The highest nasal valve depositions for the neonate are 25% for 20 µm, for infants, 10% for 50 µm, 15% for adults, and 15% for 15 µm. At mid nasal region, deposition of 15% for 20 µm is observed for infant and 8% for neonate and adult nasal cavities at a particle size of 10 and 20 µm, respectively. The highest particle deposition at the olfactory region is about 2.7% for the adult nasal cavity for 20 µm, and it is <1% for neonate and infant nasal cavities. Discussion and conclusions: The study of preferred nasal depositions during natural sedentary breathing conditions is utilized to determine the size that allows medication particles to be targeted to specific nose regions. [ABSTRACT FROM AUTHOR]

Background: A high dose of statin is used to obtain an intensive lipid-lowering in stroke patients, even in patients with normal lipid levels. There are limited data on effect of dosage of statins and functional outcome in stroke patients. Objectives: 1. To compare serum cholesterol levels with severity of stroke measured by infarct volume. 2. To compare functional outcome measured by mRS at day 90 with the dose of statin. Materials and Methods: This retrospective observational study was conducted in KMC Hospital Manipal, India between 2016 and 2018. Result: A total of 100 consecutive patients were included in the study, out of which 60 (60.0%) were males. Hyperlipidemia was present in 65 (65.0%) patients. On comparing the serum cholesterol levels with infarct volume using MRI, patients with low volume of =70 ml had higher mean serum total cholesterol concentration (223.83 mg/dl), whereas patients with high volume of >70 ml had low mean cholesterol level (218.70 mg/dl). The patients were divided into those who received low dose (=20 mg) versus high dose (=40 mg equivalent) of Atorvastatin. On comparing the mRS values at baseline and on day 90 with the dose of statins, patients who received a higher dosage had a statistically significant fall in mRS (p-0.045) at day 90. Conclusion: It was found that serum cholesterol levels were inversely related to the stroke severity. However, a higher the dose of statins resulted in better functional outcome and survival in post-stroke patients, possibly due to its neuroprotective effect. [ABSTRACT FROM AUTHOR]

The airflow behaviour and particle deposition before and after the maxillary expansion are evaluated using the computational fluid dynamics method. A pediatric patient was subjected to maxillary expansion and the CT scans of pre and post were recorded. The procured CT scans were developed into 3D models using Materialise MIMICS 21.0 (Materialise, Ann Arbor, MI). The analysis was performed using ANSYS FLUENT 2020 R2 with three different flow rates defined at the nostril inlet as 5, 10, and 15 LPM. The surface area and nasal volume increased by 5.1% and 16.5%, respectively, for the post-maxillary expansion case. The velocity profiles show a maximum value at the nasal valve regions followed by a decreased velocity in the mid-nasal region with an 85% lower velocity observed at the nasal valve for the post-maxillary expansion case. The nasal resistance and pressure drop decrease by 46% to 66% in post-maxillary expansion cases. The maximum WSS at the nasal valve region is observed which is reduced by around 47% for postmaxillary expansion cases. Particle deposition studies show a reduction in particle depositions in post cases indicating a greater number of inhaled particles reaching the lungs. The pressure drop and the nasal resistance values were reduced by more than 50% for post-maxillary expansion. The particle deposition studies show increased depositions at higher flow rates for both cases. [ABSTRACT FROM AUTHOR]

Introduction: Dental age estimation using third molars is a reliable method for estimating the age of individuals. Recently, magnetic resonance imaging (MRI) of the head and neck has been found to be applicable for age estimation of third molar teeth. In the present study, we aimed to apply the Modified Demirjian method of age estimation to magnetic resonance (MR) image sections for dental age estimation by determining the mineralization patterns of the maxillary third molars., Methods: MRI scans of the patients were performed using SIGNA™ 3.0Tesla MRI GE Healthcare (Chicago, USA) with a moving, multifunctional coil. Two expert radiologists with more than three years of experience independently analyzed the image sections using the open-source Digital Imaging and Communications in Medicine (DICOM) viewer software. The age and sex of the patients whose images were included in the study were recorded using a specially designed proforma. The stage of development of the maxillary third molars was determined using the modified Demirjian method. Inter observer agreement was calculated using the intra class correlation coefficient. Simple linear regression analysis was used to predict the actual age at the third molar development stage., Results: There was excellent agreement between observers (ICC =0.99 (95% CI = 0.98-0.99)). There was also a significant association between the maxillary third molar tooth development stage and chronological age of the individual (P=0.001; B=1.54; 95% CI = 0.71-2.37)., Discussion: The findings from the present study establish that the Modified Demirjian method can also be reliably applied for dental age assessment in MR sections., Competing Interests: Komal Smriti and Mathangi Kumar are co-first authors. The authors report no conflicts of interest in this work., (© 2024 Smriti et al.)

To validate the Manipal Bedside Swallowing Screening Test (MBSST) for assessing aspiration in individuals with tracheostomy using Video Fluoroscopic Swallow Study (VFSS). A total of 53 tracheostomized participants were screened for aspiration at bedside and VFSS across different consistencies. Penetration Aspiration Scale (PAS) was used to substantiate the severity of aspiration if present. The test demonstrated both high sensitivity (91%; 95% confidence interval = 70.8-98.9) and diagnostic accuracy (96%; 95% confidence interval = 87.0-99.5) for detecting aspiration in individuals with tracheostomy. The Manipal Bedside Swallowing Screening Test is an easy to administer tool that has sufficient sensitivity to detect aspiration in individuals with tracheostomy. The MBSST will be an easy to administer tool and will help in screening for aspiration at bedside without any instrumental examination., Competing Interests: Competing interestsThe authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Face cups form a vital component of breathing, assisting with devices that aid in artificial breathing for neonates. This study aims to evaluate the flow parameters in the nasal cavity for two different types of face cups. The neonatal nasal cavity model was developed from CT scans using MIMICS 21.0. Two face cups, one hemispherical and the other anatomical shaped cups are developed around the nasal cavity and the airflow is simulated using ANSYS 2021 R2. Results are compared with a nasal-only model. At the nasal valve region, the highest velocity is seen for the nasal-only model which is 16.3% higher than that of the hemispherical face cup and 15.2% superior to the anatomical-shaped face cup. In addition, the decrease in pressure across the nasal-only model is 7.4 and 6.6% below that of the hemispherical cup and anatomical cup masks. The nasal resistance values across the nasal cavity are the lowest for the nasal-only model, 7.7 and 6.7% lower respectively than the hemispherical and anatomical-shaped cups. There were very minor changes in the flow parameters such as velocity, pressure and wall shear stress when comparing the hemispherical and anatomic-shaped masks for the airflow inside the nasal cavity.

Ureters are essential components of the urinary system and play a crucial role in the transportation of urine from the kidneys to the bladder. In the current study, a three-dimensional ureter is modelled. A series of peristaltic waves are made to travel on the ureter wall to analyse and measure parameter effects such as pressure, velocity, gradient pressure, and wall shear at different time steps. The flow dynamics in the ureters are thoroughly analysed using the commercially available ANSYS-CFX software. The maximum pressure is found in the triple wave at the ureteropelvic junction and maximum velocity is observed in the single and double wave motion due to the contraction produced by the peristalsis motion. The pressure gradient is maximum at the inlet of the ureter during the single bolus motion. The contraction produces a high jet of velocity due to neck formation and also helps in urine trapping in the form of a bolus, which leads to the formation of reverse flow. Due to the reduction in area, shear stress builds on the ureter wall. The high shear stress may rupture the junctions in the ureter., (Creative Commons Attribution license.)

We read with great interest the article "the deadly duo of hypertension and diabetes in India: further affirmation from a new epidemiological study" by Metri et al. 1 They rightly pointed out that the prevalence of hypertension in Indian patients with type 2 diabetes patients is high and therefore early screening and management of hypertension should be included in the treatment of patients with type 2 diabetes. We wish to share our study findings on the prevalence of hypertension in newly onset diabetes mellitus (DM). We find that the prevalence of hypertension in all males and females with DM was 44.59, 44.34, and 45.16%, respectively. 2 ., (© Journal of the Association of Physicians of India 2023.)

Introduction: Diffusion-weighted image or DWI is commonly used to provide valuable and diverse information on acute stroke in tertiary care hospitals. DWI is a sensitive and accurate method for identifying the infarct core and can expose the area of cerebral infarction within a few hours of onset. This systematic review is planned to evaluate the measurement of stroke volume on DWI and correlate it with functional outcomes (modified ranking scale)., Method: We have adhered to the PRISMA-P checklist to report this systematic review protocol. PubMed, Web of Science, Scopus, and TRIP (Turning Research into Practice) databases will be searched. Two independent reviewers will screen the records, extract data, and critically appraise the studies. A checklist for critical appraisal will be applied for data abstraction, and data extraction will be done using predictive modeling for systematic reviews. The risk of bias will be measured by the Prediction Model Risk of Bias Assessment Tool (PROBAST). The meta-analysis will be considered only if included studies have adequate data, and STATA statistical package version 13.1 will be used for performing a meta-analysis. A narrative synthesis will be performed if meta-analysis is not possible., Ethics and Dissemination: As this review will focus on secondary information, there is no ethical consideration required. We will disseminate our findings by publishing our analysis in a peer-reviewed journal., Protocol Registration: In Prospective Register of Systematic Reviews (CRD42019141840)., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Annals of Indian Academy of Neurology.)

This study aims to investigate public sentiment on laryngeal cancer via tweets in 2022 using machine learning. We aimed to analyze the public sentiment about laryngeal cancer on Twitter last year. A novel dataset was created for the purpose of this study by scraping all tweets from 1st Jan 2022 that included the hashtags #throatcancer, #laryngealcancer, #supraglotticcancer, #glotticcancer, and #subglotticcancer in their text. After all tweets underwent a fourfold data cleaning process, they were analyzed using natural language processing and sentiment analysis techniques to classify tweets into positive, negative, or neutral categories and to identify common themes and topics related to laryngeal cancer. The study analyzed a corpus of 733 tweets related to laryngeal cancer. The sentiment analysis revealed that 53% of the tweets were neutral, 34% were positive, and 13% were negative. The most common themes identified in the tweets were treatment and therapy, risk factors, symptoms and diagnosis, prevention and awareness, and emotional impact. This study highlights the potential of social media platforms like Twitter as a valuable source of real-time, patient-generated data that can inform healthcare research and practice. Our findings suggest that while Twitter is a popular platform, the limited number of tweets related to laryngeal cancer indicates that a better strategy could be developed for online communication among netizens regarding the awareness of laryngeal cancer., Competing Interests: Conflict of interestAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (© The Author(s) 2023.)

Computed tomography (CT) scan has been an integral part of the diagnostic workup for patients with head and neck squamous cell carcinoma. Our study was designed to find out the incidence of distant metastasis and second primary tumor and to correlate the cost-effectiveness of CT thorax in detecting the same. This study was conducted among 326 cancer patients who visited our center with curative intent in the year 2021, with lesions in various head and neck subsites. Data were collected based on their pathological TNM staging and the presence of distant metastasis as evident on their CT thorax imaging with various variables related to the disease. Incremental cost-effectiveness ratio (ICER) was calculated for detecting a single metastatic deposit and second primary tumor in terms of Indian currency and was correlated to each subsite and stage of disease at presentation. Out of these 326 patients, 281 patients were included in our study after considering the inclusion criteria, and among these 281 patients, 235 of them underwent CT thorax for metastatic workup. No patient was found to have a second primary. Metastases were found in 12 patients. The site of primary lesion and clinical tumor (cT) staging were found to be significantly influencing the incidence of metastasis on CT thorax. ICER was least for larynx, pharynx, and paranasal sinuses and was highest for oral cavity primaries and early-stage disease. As per our observations and results of ICER, CT thorax is indeed a valuable modality but should be used judiciously when it comes to initial diagnostic workup., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) 2022.)