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BACKGROUND AND PURPOSE: Spiral MR imaging has several advantages compared with Cartesian MR imaging that can be leveraged for added clinical value. A multicenter multireader study was designed to compare spiral with standard-of-care Cartesian postcontrast structural brain MR imaging on the basis of relative performance in 10 metrics of image quality, artifact prevalence, and diagnostic benefit. MATERIALS AND METHODS: Seven clinical sites acquired 88 total subjects. For each subject, sites acquired 2 postcontrast MR imaging scans: a spiral 2D T1 spin-echo, and 1 of 4 routine Cartesian 2D T1 spin-echo/TSE scans (fully sampled spin-echo at 3T, 1.5T, partial Fourier, TSE). The spiral acquisition matched the Cartesian scan for scan time, geometry, and contrast. Nine neuroradiologists independently reviewed each subject, with the matching pair of spiral and Cartesian scans compared side-by-side, and scored on 10 image-quality metrics (5-point Likert scale) focused on intracranial assessment. The Wilcoxon signed rank test evaluated relative performance of spiral versus Cartesian, while the Kruskal-Wallis test assessed interprotocol differences. RESULTS: Spiral was superior to Cartesian in 7 of 10 metrics (flow artifact mitigation, SNR, GM/WM contrast, image sharpness, lesion conspicuity, preference for diagnosing abnormal enhancement, and overall intracranial image quality), comparable in 1 of 10 metrics (motion artifacts), and inferior in 2 of 10 metrics (susceptibility artifacts, overall extracranial image quality) related to magnetic susceptibility (P < .05). Interprotocol comparison confirmed relatively higher SNR and GM/WM contrast for partial Fourier and TSE protocol groups, respectively (P < .05). CONCLUSIONS: Spiral 2D T1 spin-echo for routine structural brain MR imaging is feasible in the clinic with conventional scanners and was preferred by neuroradiologists for overall postcontrast intracranial evaluation.

The objective of this study was to quantify the hemodynamic parameters using first pass analysis of TMRI of the breast was performed in 50 women (mean age, 44±11 [SD] years; range: 26-75) years with a total of 15 benign and 35 malignant breast lesions. After pre-processing, TAll quantitative parameters except leakage volume (Ve), qualitative (type-I and III) and semi-quantitative curves (type-I and III) provided significant differences (P0.05) between benign and malignant lesions. Kinetic parameters, particularly volume transfer coefficient (KQuantitative parameters, particularly rBBVcorr and K

To study the incidence, clinical presentation, and the response of anti-fungals in cases of fungal endophthalmitis following open globe injury.This is a prospective study of eight cases of post-traumatic fungal endophthalmitis among 110 patients who presented to us with open globe injury between August 2003 and January 2005. Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin.Two patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%. Aspergillus sp. and Fusarium sp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 microg/ml for all organisms except for Paecilomyces lilacinus and Fusarium solani, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better.Fungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal. Aspergillus fumigatus was found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except P. lilacinus, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.

Poisonings, stings and bites continue to be important cause of pediatric morbidity and hospitalization. The toxic product involved in the poisoning varies in different geographical areas and in same area over time. A retrospective study was conducted amongst the children of the age group up to 12 years admitted to a tertiary care hospital in Kolkata from January 2005 to December 2008. Total number of admissions was 17019 and that for accidental poisoning was 451 (2.65%). Kerosene constituted the largest group (54.55%). Mosquito coil and refill liquid were the new additions to the list of poisons and their ingestion was cause for admission of 15 (3.33%) children. The number of admissions due to stings and bites was 108 (0.63% of all admissions) during the above period. Of all the cases, 9 (1.83%) cases of accidental poisoning and 4 (3.7%) cases of stings and bites died.

The management of recurrent pleural effusion or pneumothorax has always been a cause for serious concern among chest physicians. Among the wide variety of agents that are available for pleurodesis, povidone iodine is now perhaps the most sought after agent as it is cheap, easily available, effective and safe. This study was conducted to establish the efficacy and safety of povidone iodine as an agent for pleurodesis in patients with recurrent pleural effusion and pneumothorax.A total of 38 consecutive patients with symptomatic malignant or recurrent pleural effusion and pneumothorax received povidone iodine for pleurodesis over a period of 18 months. The mean follow-up period was 10.2 months, with a standard deviation of 2.9 months.Out of the 38 patients, 29 had malignant pleural effusion, eight had recurrent pneumothorax and one had tubercular pleural effusion which was nonresponsive to antitubercular therapy. A complete response with no recurrence during follow-up was obtained in 34 (89.5 percent) patients. All the cases of failure had malignant pleural effusion. Three (7.9 percent) patients experienced intense chest pains after the installation of sclerosing agent, but they recovered with immediate symptomatic management.Recurrent pleural effusion or pneumothorax due to any cause may be managed effectively and safely by chemical pleurodesis with povidone iodine. It may be considered as the agent of choice to achieve pleurodesis, especially in resource constrained countries like India, as it is inexpensive and easily available.

This community-based cross-sectional study was carried out to determine the prevalence of hypertension and variation of blood pressure with age among adolescents in an urban slum of Chetla, Kolkata, India. A total of 1081 adolescents aged 10-19 years were involved in the study. The prevalence of hypertension was 2.9% (31) and highest prevalence (5.6%) was observed in the age group of 18-19 years. The mean systolic and diastolic blood pressure was higher in males than females. Among males and females, average increase of mean systolic blood pressure was found to be 2.26mmHg and 1.95mmHg per year respectively. The mean diastolic blood pressure increased by 1.55 mmHg and 1.42mmHg per year, respectively. The age spurt of rise in mean systolic blood pressure in males was found at 10-11, 13-14, and 16-17 years age groups, whereas in females it was observed in 12-13, and 17-18 years age groups. The age spurt of rise in mean diastolic blood pressure in males was observed in the age group 16-17 years and in females it was noted in the age group 11-12, and 17-18 years. In conclusion, blood pressure measurement should be done routinely during health check up of adolescents to initiate secondary level of prevention at the earliest.

To study the catch up growth among low birth weight infants in relation to the normal birth weight counterparts in first six months of age.A longitudinal community based study was done in 2004 -05 in an urban slum of Chetla, Kolkata among 126 singleton live born babies. Growth pattern of these babies was followed up at 15+/-5 days interval by house visit till six months of age.The incidence of low birth weight babies was 28.6%. 86.1% LBW infants caught up in length at 3rd month, 63.9% in chest circumference at 4th month, 66.7% in head circumference at 5th month, while 72.2% in weight at 6th month. Regular growth monitoring is essential for LBW babies to detect signs of growth faltering at the earliest.

Routine UIP coverage status in the state of West Bengal and three selected Municipal Corporation areas (Calcutta, Howrah and Siliguri) were studied during 1997-98 and 1998-99. Also, UIP coverage status in the 'high risk' areas of the State (areas which reported Polio cases during 1998) was studied during 1998-99. UIP coverage in the state of West Bengal was only 54.3% in 1997-98, which further declined to 48.1% in 1998-99. In the three urban areas, UIP coverage ranged between 57.3%-70.9% in 1997-98, which further declined to 29.6%-47.1% in 1998-99. Antigenwise coverage revealed very poor performance with DPT3, OPV3, and Measles in 1997-98 and further decline in 1998-99. Dropout rate was also very high. In 1998-99 drop-out rate ranged between 30.1% to 54.2% in different studied areas. Some other studies suggested that PPI activities, which are very visible and targetted programme, may adversely affect routine UIP services. There is urgent need for further probing to identify the reasons for such poor state of affairs, keeping PPI angle in mind and to initiate remedial measure urgently.

An evaluation of the Pulse Polio Immunisation Programme (PPI), 1995-96 in West Bengal was undertaken. It was observed that the PPI coverage (with two rounds) was 84.1%. Variations in the PPI coverage level were documented in relation to age, sex, residential status and parental literacy status of the beneficiaries. However, significantly lower PPI coverage was observed among Muslims (p0.001) and Scheduled Tribes (p0.01). The principal agency responsible for disseminating information about PPI was identified to be the multipurpose health workers. Some of the major reasons for non-acceptance of PPI were lack of information, illness of the child, absence of the child on the "PPI day", lack of faith in immunisation and fear of adverse reaction.

A 5 year sentinel surveillance (1989-93) of paralytic poliomyelitis and neonatal tetanus was undertaken at a rural Medical College Hospital at Burdwan, West Bengal. Poliomyelitis incidence showed an overall declining trend, which corroborated with the increased OPV coverage over the years. Incidence was more in males than females. Male:female ratio varied between 2.31:1 to 1.2:1. From 1989 to 1992, age-shift in poliomyelitis was observed when more cases were occurring above 1 year subjects. Cases were reported to be high during the months June to September every year. Incidence of neonatal tetanus (NNT) also showed a declining trend during the 5 year study period. A male preponderance was observed. NNT cases were more prevalent during the months between August and November. In an attempt for eradication of paralytic poliomyelitis and elimination of NNT, containment and other public health measures were undertaken a part of surveillance activities. The obstacles encountered in the surveillance system, as well as lacunae identified in undertaking appropriate health measures was discussed.The authors report on the 5-year sentinel surveillance (1989-93) of paralytic poliomyelitis and neonatal tetanus (NNT) undertaken at the rural Medical College Hospital at Burdwan, West Bengal. Overall, the incidence of poliomyelitis showed a declining trend in relation to increased OPV coverage over the years. From 1989 to 1992, an age shift in poliomyelitis was observed among children over 1 year old. Similarly to poliomyelitis, NNT also showed a declining trend during the 5-year study period. The NNT cases were observed to increased during the months from August to November. While performing the surveillance activities, a number of obstacles were encountered in data collection, data recording, and data transmission. Some of these problems include lack of motivation with concerned personnel, shortage of manpower particularly in the pediatric department and erroneous recording of address, nonrecording of immunization status and final diagnosis in the admission registry. As part of the surveillance activities, public health measures were undertaken to eliminate paralytic poliomyelitis and NNT.

The performance of the Diarrhoeal Training cum Treatment Unit (DTTU) of NRS Medical College and Hospital, Calcutta, in a 2-year period was evaluated by record analysis. The study revealed that 73.6% cases out of a total 4349 could be successfully managed at the oral rehydration therapy (ORT) area and only 16.5% cases required indoor admission. Rest of the cases (9.9%) with "no dehydration" were sent home with advice. There were 84.7% cases out 3919 dehydration cases who could be successfully treated by ORT and only 15.3% required intravenous (i.v.) therapy. A definite decline was also evident in the proportion of diarrhoea cases requiring antibiotic therapy (13.5% in 1991 to 6.8% in 1992). The case fatality rate due to diarrhoea was 1.7% in 1992. Had all cases of diarrhoea with dehydration being admitted and treated with i.v. fluids and antibiotics, the estimated cost would have been Rs 14.2 lakhs, which with ORT, actually cost Rs 2.4 lakhs. Thus estimated total cost reduction was to the extent of Rs 11.8 lakhs in a 2-year period.The Diarrheal Training with Treatment Unit (DTTU) was established in the Department of Pediatrics, NRS Medical College and Hospital, in Calcutta, India, in 1990, to promote use of oral rehydration therapy (ORT) in diarrhea in children 0-5 years of age. To evaluate the success of this effort, a retrospective review was conducted of the 4349 child diarrhea cases presenting to DTTU in 1991-92. 3919 children (90.1%) were dehydrated at admission; the nondehydrated cases received counseling only and were discharged. 3202 children (73.6%) with diarrhea-related dehydration were successfully treated with ORT; intravenous fluids were administered in 598 (15.3%) of these cases. 717 children (16.5%) required hospital admission; 83.4% of these children received intravenous fluids. The proportion of diarrhea cases requiring antibiotics decreased from 13.5% in 1991 to 6.8% in 1992. Case fatality was 1.8% in 1991 and 1.7% in 1992. The actual cost of treatment was Rs. 1,50,048 in 1991 and Rs. 91,178 in 1992. These amounts represent savings of Rs. 6,00,912 and 5,77,867, respectively, over what would have been the costs if all cases had been treated on an inpatient basis with intravenous fluids and antibiotics. These findings confirm the effectiveness of DTTU's strategy of ORT management of children with diarrheal dehydration combined with proper training and motivation of both mothers and health workers.

A 5-year sentinel surveillance of diphtheria from 1989 to 1993 was undertaken at a rural medical college hospital. No significant change in the number of diphtheria cases was observed in spite of sustained high level of diphtheria, pertussis, tetanus vaccine-3 doses (DPT3) coverage. Most of the diphtheria cases occurred during July to November. Age distribution of diphtheria cases showed that more than 75% occurred above 2 years age (except in 1989) and around 65% cases above 3 years age. The age shift in diphtheria signified success of primary diphtheria immunisation, as well as indicated the lack of coverage with booster doses at appropriate ages. Because of high coverage with primary diphtheria immunisation there was decrease in circulating toxigenic C diphtheriae resulting in less natural boosting of antibody titre. Thus, in absence of booster immunisation, the older children and adults were more vulnerable to diphtheria. The findings of the study justified the need of emphasising importance of booster diphtheria immunisation at appropriate ages for effective control of diphtheria.

The incidence of stillbirths in "one year period" was studied by record analysis in a teaching hospital. A stillbirth rate of 38.4 per 1000 live births was observed. On admission 96.3% cases had some adverse foetal conditions detected readily. Leading factor detected was intra-uterine growth retardation (45.4%). Other major conditions observed were intra-uterine hypoxia (18.4%), malpresentation (11.9%), multiple pregnancy (8.3%). Birth weight was below 2000 g in 53.1% cases. Records showed 78.5% mothers had not received antenatal care.The Government of India has set the goal of reducing perinatal mortality from its present level of 46/1000 live births to under 35/1000 by the year 2000. This study investigated the characteristics of stillbirths at a teaching hospital in Calcutta, India, in 1993. During the 12-month study period, there were 8488 live births and 326 stillbirths (38.4/1000 live births). In 314 stillbirths (96.3%), there was some adverse fetal condition at hospital admission. These included intrauterine growth retardation (45.4%), fetal distress and intrauterine hypoxia (18.4%), malpresentation or malposition (11.9%), and multiple pregnancy (8.3%). Of the 309 stillborns in whom birth weight was recorded, 79.5% were below 2500 g and 53.1% were below 2000 g. Finally, in 218 (78.5%) of the 278 cases for which records were available, women received no antenatal care. These findings suggest that more widely accessible antenatal care, with special emphasis on intrauterine growth retardation, is essential to a reduction in the incidence of perinatal mortality in India.

Study of perinatal mortality in a Medical College Hospital revealed stillbirth rate as 38.4, early neonatal death rate as 29.3 and overall perinatal morality rate as 67.7 per 1000 live births. More than half (53.6%) of the perinatal deaths were in primipara and another 22.8% in mothers of parity more than 3. Most mothers (85.9%) did not receive adequate antenatal care services. On admission 35.1% mothers presented with some risk factors. The major risk factors identified were toxaemia of pregnancy (14.8%), severe anaemia (13%) and antepartum haemorrhage (2.6%).A study conducted at the NRS Medical College in Calcutta, India, reviewed all perinatal deaths recorded in 1993. There were 575 such deaths in 8488 live births, for a perinatal mortality rate of 67.7 per 1000 live births. This is substantially higher than the all-India perinatal mortality ratio of 42.3, because the Calcutta hospital serves as a major referral center for complicated pregnancies. There were 326 stillbirths (38.4 per 1000 live births) and 249 early neonatal deaths (29.3 per 1000 live births). 53.6% of the perinatal deaths involved primiparas and 22.8% involved mothers of parities above 3. 35.1% of mothers in perinatal mortality cases presented with pregnancy-related risk factors, including toxemia (14.8%), severe anemia (13%), and antepartum hemorrhage (2.6%). In 494 (85.9%) of the 575 deaths, antenatal care was absent or inadequate. Improved antenatal coverage is essential to the early detection and treatment of risk factors for perinatal mortality.

An assessment of the "One Day AIDS Awareness Program" for I.C.D.S. functionaries was done. The pre-training knowledge level scores were 55.3%, 39.3% and 60.4% of the total score, in 24-Parganas (S), Burdwan and Calcutta districts respectively. However, the post-training assessment scores were observed to be 91.9%, 84.9% and 94.8% in 24-Parganas (S), Burdwan and Calcutta districts respectively. The percentage increase in mean scores was found to be 66.5%, 115.8% and 57.1% in 24-Parganas (S), Burdwan and Calcutta districts respectively.

Use of ORT is saving 1 million diarrhoeal deaths each year among children. C.S.S.M. programme aims at preventing 70% diarrhoeal deaths, through widespread use of ORT. The present study was carried out to find out the extent of the problem of diarrhoea and utilisation of ORT in three districts of West Bengal. The results showed that the utilisation of ORT was 80.8%, 70.7% and 65% in Howrah, Hooghly and 24-Parganas (South) respectively, during attacks of diarrhoea. The continuing feeding rates were 60.1%, 62.7% and 55.5% in Howrah, Hooghly and 24-Parganas (South) respectively.In the early 1990s, a baseline survey was conducted in 3 districts of West Bengal, India, to determine the magnitude of diarrhea among children less than 5 years old and the rates of oral rehydration therapy (ORT) use and continuing feeding rate. The districts included Howrah, Hooghly, and 24-Parganas (South). Diarrhea prevalence was much lower in Hooghly than in Howrah and 24-Parganas (S) (5.9% vs. 14.2% and 14.5%, respectively; p 0.05). Since the survey was conducted during the non-monsoon season in Hooghly when diarrhea incidence tends to be low, the difference was likely due to seasonal variation. ORT use rates were 80.8% in Howrah, 70.7% in Hooghly, and 65% in 24-Parganas (S) which were much higher than those in Hibar (13%), Orissa (27%), and Assam (10%) in 1987 (p 0.05). Children in Howrah were much more likely to receive WHO recommended ORS than those in Hooghly and 24-Parganas(S) (40.9% vs. 28% and 29.6%, respectively; p 0.05). ORS access rates ranged from 24.9% in 24-Parganas(S) to 36.3% in Howrah, which are lower than the WHO targeted access rate of oral rehydration salts (ORS) (80%). The continuing feeding rates were 60.1% in Howrah, 62.7% in Hooghly, and 55.5% in 24-Parganas (S). The proportion of children who received either less food or no food during a diarrheal episode were still rather high (38.9% in Howrah, 37.3% in Hooghly, and 42.4% in 24-Parganas(S) but lower than those in other Indian districts (57-66%) in 1987. These findings show that India's Child Survival and Safe Mother Programme has much to accomplish to reach the goal of 70% reduction of deaths and 25% reduction of cases by the year 2000.