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Introduction: Radical prostatectomy (RP) and radical radiotherapy (RT) are well established primary curative options for localized prostate cancer. Despite technical improvements, prostate-specific antigen (PSA)-recurrence after RP and RT is a common clinical scenario. We aimed to assess the role of 68Gallium (68Ga) prostate-specific membrane antigen positron emission tomography computed tomography (PSMA PET/CT) in patients with biochemical recurrence of prostate cancer after RP or RT for the detection and localization recurrent and metastatic disease. Materials and Methods: We ambispectively (70 retrospective and 100 prospective) analyzed the data of men with biochemical recurrence post-RP and post-RT who were evaluated by 68Ga PSMA PET/CT at our institute. We aimed to assess the relationship between serum PSA levels and the probability of having a positive scan in patients with recurrent prostate cancer. Results: The study included 170 men, all had adenocarcinoma of the prostate, 124/170 had previous RP and 46/170 had prior RT. The median serum PSA in the RP group was 1.8 ng/ml and 5.2 ng/ml in the RT group. In the post-RP cohort, the detection rate of 68Ga PSMA PET/CT was 39.3% for PSA 0.2 to

New onset refractory status epilepticus (NORSE), is a rare, neurological condition characterised by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals. Anatomical imaging like MRI and serology is usually unremarkable. In patients who have underlying etiology as auto-immune encephalitis without any evidence of auto-antibodies FDG PET may help in early diagnosis and treatment response as it tends to accumulate in the neuronal tissue whenever there is increased blood flow, metabolic demand or increased electrical activity which reverts back with clinical recovery.

FTLD (Frontotemporal lobar degeneration) is a clinically and pathologically heterogeneous group of degenerative disorders, characterized by predominantly asymmetric degeneration of frontal and temporal lobes with selective neuronal loss and gliosis. The disease presents with variable degrees of impairment in behavior, language, executive control, and motor symptoms with progressive loss of cognition. On the basis of presenting clinical symptoms, FTLD is further divided into behavioral variant, nonfluent/agrammatic variant primary progressive aphasia (PPA), semantic variant PPA, logopenic variant PPA, progressive supranuclear palsy, and corticobasal ganglionic degeneration. Here we illustrate the utility of FDG PET with statistical parametric analysis for evaluation of these patients.

PURPOSE To study the imaging patterns of Posterior cortical atrophy (PCA) and Dementia with Lewy bodies (DLB) on fluoro-deoxyglucose positron emission tomography computed tomography ([F]FDG PET/CT), identify areas of overlap and differences and to develop a prediction model to assist in diagnosis using univariate and multivariate analysis. METHODS A retrospective analysis of 72 patients clinically suspected of having posterior dementia was done. All patients underwent [FF]FDG PET/CT of the brain and dopamine transporter imaging with [[Tc]TRODAT-1 SPECT scan on separate days. The patients were divided into PCA with normal TRODAT uptake (n=34) and DLB with abnormal TRODAT uptake (n=38). The FDG PET/CT uptake patterns were recorded and areas of significant hypometabolism by z score analysis were considered as abnormal. Receiver operator characteristics (ROC) curve analysis was used to determine cutoff z scores and binary logistic regression analysis was used to determine the Odds ratio of being in the predicted groups. RESULTS Significantly hypometabolism was found in parieto-temporo-occipital association cortices and cingulate cortices in PCA patients. DLB patients showed significantly reduced uptake in the visual cortex. No significant difference was found between z score of occipital association cortex which showed hypometabolism in both groups. The cut-off z-score values derived from the ROC curve analysis were as follows- parietal association (cut-off-3, sensitivity-65.6%, specificity - 68.7%), temporal association (cut-off-2, sensitivity-78%, specificity-75%) and posterior cingulate (cut-off-0.5, sensitivity-93.7%, specificity-40.6%), their respective Odds ratio (with 95% confidence interval) for being in the PCA group as derived from univariate logistic regression were 3.66 (1.30-10.32), 10.71 (3.36-34.13) and 7.85 (1.57-39.17). The cut-off z score of primary visual cortex as derived from ROC curve was zero with sensitivity of 87.5%, specificity of 71.9%, and the Odds ratio for being the in the DLB group was 24.7 with 95% confidence interval of 5.99-101.85. CONCLUSION [F]FDG PET may be useful as a non-invasive diagnostic modality in differentiating the two posterior cortical dementias, despite significant overlap. Primary visual cortical hypometabolism can serve as an independent diagnostic marker for DLB, even in the absence of TRODAT imaging.

Background: Fluorine-18-fluorodeoxyglucose (18F-FDG)-positron emission tomography/computed tomography (PET/CT) is emerging as a useful imaging modality in suspected large-vessel vasculitis (LVV), owing to its ability to accumulate at the sites of inflammation within the arterial walls. However, there remains scope for standardization of reporting criteria to ensure reproducibility. Recently, a semiquantitative scoring system called “total vascular score” (TVS) has been suggested as a method to standardize and harmonize FDG PET/CT evaluation in LVV patients. The purpose of this study was to assess the clinical utility of the proposed semiquantitative grading scale in LVV patients. Materials and Methods: Patients presenting with clinical symptoms of vasculitis, who had undergone a baseline FDG-PET/CT were evaluated. 18F-FDG uptake in the major vessels was quantified with standardized uptake values (SUVsmax) using four-point scale by three independent nuclear physicians. TVS was calculated based on the calculation of the vascular uptake values with respect to mediastinal blood pool and liver uptake and the number of vessels involved. Results: A total of 106 PET-positive patients (74 males and 32 females) were evaluated. The most frequently involved vessels were thoracic aorta >abdominal aorta >subclavian arteries with mean SUVmax values of 4.05, 3.12, and 2.70, respectively. Mean TVS was 13.18 ± 3.4 (range 03–19) among 276 involved vessels. TVS showed significant positive correlation with erythrocyte sedimentation rate (r = 0.82; P < 0.005). 18 patients showed periarticular FDG uptake, with shoulder joint being the most commonly involved joint. Conclusion: The simplified visual and semiquantitative grading scale for interpretation and reporting classification provides better objectivity in diagnosis, communication with referring clinicians, and planning in patients of LVV.

Aims To explore the impact of incorporating a faster cardiac magnetic resonance (CMR) imaging protocol in a low–middle-income country (LMIC) and using the result to guide chelation in transfusion-dependent patients. Methods and results A prospective UK–India collaborative cohort study was conducted in two cities in India. Two visits 13 months apart included clinical assessment and chelation therapy recommendations based on rapid CMR results. Participants were recruited by the local patient advocate charity, who organized the patient medical camps. The average scanning time was 11.3 ± 2.5 min at the baseline and 9.8 ± 2.4 min (P Conclusion For thalassaemia patients in an LMIC, a simplified CMR protocol linked to therapeutic recommendation via the patient camp model led to enhanced chelation therapy and a reduction in cardiac iron in 1 year.

Background and objectives We aimed to compare C-peptide levels & measures of insulin resistance in non-lean & non-obese Asian Indian patients with type 2 diabetes (T2DM) vs. non-lean, non-diabetic controls and to correlate with anthropometric measures, volumes of abdominal adipose tissue depots, pancreas, & liver span. Methods Non-lean, non-obese (BMI >19 and Results In cases, the mean values of HbA1c, fasting and post prandial insulin and C-peptide levels, and 3 measures of insulin resistance were significantly higher than controls, but not for HOMA-B. Higher fasting C-peptide levels correlated significantly with HOMA-IR (r = 0.42, p Conclusion Higher fasting and post-prandial C-peptide levels and surrogate measures of insulin resistance in non-obese Asian Indian patients with T2DM are independently associated with IAAT volume and liver span.

Aims and Objectives: To study “Honeycomb” pattern of gallbladder wall thickening (GBWT) in dengue fever (DF) and to assess its clinical significance in early diagnosis of severe DF. Materials and Methods: A total 244 patients of DF were studied, 84 patients were classified as severe DF, 61 patients as DF with warning signs, and 99 patients as DF without warning signs. Abdominal ultrasound was performed for assessment of GBWT patterns, hepatomegaly, splenomegaly, pancreatic enlargement, ascites, pleural effusion, and other additional findings were recorded in severe DF cases. Statistical comparison between “Honeycomb” pattern of GBWT and clinically severe DF was done using Pearson correlation test. Results: Out of 244 patients, 145 patients were males and 99 patients were females, belonging to various age groups ranging from 1 to 81 years and 14.34% (35 patients) among them included in pediatric group. In total, 65.57% (160 patients) were non-severe DF cases and 34.42% (84 patients) were severe DF cases. A total of 84 patients of severe DF, 92.85% patients showed GBWT, and out of which, 71.42% patients had “Honeycomb” pattern, whereas a total of 160 patients of non-severe DF patients, 45% patients had GBWT and out of which, only 5.6% patients showed “Honeycomb” pattern.”Honeycomb” pattern of GBWT shows sensitivity of 71.4%, 94.37%, Positive predictive value of 86.95%, and Negative predictive value of 86.28% in severe DF. Conclusion:”Honeycomb” pattern of GBWT is significant finding in severe DF. Its sensitivity and specificity are high in severe DF with significant statistical correlation. It can aid in early diagnosis of severe DF.

Aim: To elucidate the patterns of characteristic hypometabolism on 18F- fluorodeoxyglucose( 18F-FDG) positron emission tomography/computed tomography (PET/CT) in multisystem atrophy (MSA) and their correlation with the patterns of uptake on dopamine transporter imaging with 99mTc TRODAT-1 SPECT. Material and Methods: A retrospective analysis of 67 patients with clinically diagnosed MSA was performed. All the subjects underwent 99mTc TRODAT-1 SPECT and 18F-FDG PET/CT scanning on two separate days. The 99mTc-TRODAT-1 scans were analyzed visually for asymmetry and rostro-caudal gradient. The FDG uptake patterns were recorded, and areas of hypometabolism that were two standard deviations from the mean were considered abnormal. Results: All the subjects had an abnormal pattern of FDG uptake on PET scan, both on a visual inspection and semiquantitative analysis. In MSA-P subjects (n = 29), diffuse predominant hypometabolism of the globus pallidus-putamen complex was noted, with relative sparing of the caudate nuclei. In MSA-C subjects (n = 25), characteristic hypometabolism was noted in the cerebellum and brainstem. In mixed subtypes (n = 13), variable involvement of the basal ganglia, cerebellum, and brainstem was noted with frontoparietal hypometabolism. A statistically significant difference between MSA-P and MSA-C for gradient reduction and asymmetry with gradient reduction was observed. Conclusion: Dopamine transporter imaging with 99mTc TRODAT-1 SPECT not only helps in confirmation of parkinsonian disorders but also demonstrates varying patterns of distribution in different subtypes of MSA. Characteristic patterns of hypometabolism in 18F-FDG PET may help in the differentiation of the subtypes of MSA in the presence of clinically overlapping symptoms.

Background: Survival in transfusion dependent thalassemia is closely linked to iron overload with severe cardiac iron causing heart failure. MRI guided chelation improves survival in high income countries. We explored the use of rapid MRI to guide therapy in a Lower Middle Income Country (LMIC), India, via locally organized thalassemia patient medical camps. Methods: Rapid cardiac MRI (rCMR) was implemented at two sites with clinical assessment and therapy recommendations based on rCMR findings. Investigations and clinical reassessment were repeated at 13 months. Findings: The baseline visit was attended by 103 patients, the second by 86. Average time of scanning was 10 minutes. At baseline 29% had a cardiac T2* = 17ms). At 13 months more patients were taking 2 oral chelators (21% to 37%, p

The coronavirus disease of 2019 (COVID-19) pandemic exposed a limitation of artificial intelligence (AI) based medical image interpretation systems. Early in the pandemic, when need was greatest, the absence of sufficient training data prevented effective deep learning (DL) solutions. Even now, there is a need for Chest-X-ray (CxR) screening tools in low and middle income countries (LMIC), when RT-PCR is delayed, to exclude COVID-19 pneumonia (Cov-Pneum) requiring transfer to higher care. In absence of local LMIC data and poor portability of CxR DL algorithms, a new approach is needed. Axiomatically, it is faster to repurpose existing data than to generate new datasets. Here, we describe CovBaseAI, an explainable tool which uses an ensemble of three DL models and an expert decision system (EDS) for Cov-Pneum diagnosis, trained entirely on datasets from the pre-COVID-19 period. Portability, performance, and explainability of CovBaseAI was primarily validated on two independent datasets. First, 1401 randomly selected CxR from an Indian quarantine-center to assess effectiveness in excluding radiologic Cov-Pneum that may require higher care. Second, a curated dataset with 434 RT-PCR positive cases of varying levels of severity and 471 historical scans containing normal studies and non-COVID pathologies, to assess performance in advanced medical settings. CovBaseAI had accuracy of 87% with negative predictive value of 98% in the quarantine-center data for Cov-Pneum. However, sensitivity varied from 0.66 to 0.90 depending on whether RT-PCR or radiologist opinion was set as ground truth. This tool with explainability feature has better performance than publicly available algorithms trained on COVID-19 data but needs further improvement.

1.AbstractSeveral studies have been published in the past few months describing the CT features of Coronavirus Disease 2019 (COVID-19). There is a great degree of heterogeneity in the study designs, lesion descriptors used and conclusions derived. In our systematic analysis and meta-review, we have attempted to homogenize the reported features and provide a comprehensive view of the disease pattern and progression in different clinical stages. After an extensive literature search, we short-listed and reviewed 49 studies including over 4145 patients with 3615 RT-PCR positive cases of COVID-19 disease. We have found that there is a good agreement among these studies that diffuse bilateral ground-glass opacities (GGOs) is the most common finding at all stages of the disease followed by consolidations and mixed density lesions. 78% of patients with RT-PCR confirmed COVID-19 infections had either ground-glass opacities, consolidation or both. Inter-lobular septal thickening was also found to be a common feature in many patients in advanced stages. The progression of these initial patchy GGO’s and consolidations to diffuse lesions with septal thickening, air bronchograms in the advanced stages, to either diffuse “white-out” lungs needing ICU admissions or finally resolving completely without or with residual fibrotic strips was also found to be congruent among multiple studies. Prominent juxta- lesional pulmonary vessels, pleural effusion and lymphadenopathy in RT-PCR proven cases were found to have poor clinical prognosis. Additionally, we noted wide variation in terminology used to describe lesions across studies and suggest the use of standardized lexicons to describe findings related to diseases of vital importance.

This chapter offers a comprehensive summary of applications of advanced diffusion encoding methods in MRI within a narrowly defined area of in vivo human measurements with imaging read-out and voxel-by-voxel data analysis. The list of methods comprises tensor-valued encoding to investigate cell densities, shapes, and orientations in heterogeneous tissues, time/frequency-dependent encoding for estimating structural length scales, adjustable velocity-encoding to monitor flow in the microcapillary network, double encoding with varying mixing times to assess diffusional exchange between distinct tissue microenvironments and across cell membranes, and relaxation-diffusion correlation to resolve and separately characterize tissue microenvironments in terms of their local chemical composition and microstructure. The shown examples include proof-of-concept measurements on healthy volunteers, pilot investigations of pathologies, and clinical research involving 10-100 subjects. Studied organs include brain, breast, prostate, liver, kidney, placenta, muscle, and peripheral nerve, with examples of pathologies from tumors, schizophrenia, multiple sclerosis, stroke, neurocysticercosis, pre-eclampsia, and chronic exertional compartment syndrome. (Less)

A 57-year-old man, on octreotide treatment for metastatic neuroendocrine tumor pancreas, was referred for whole-body Ga-DOTANOC PET/CT scan to evaluate treatment response. PET/CT scan revealed DOTANOC-avid lesion in the head of the pancreas with multiple tracer-avid soft tissue lesions in the liver, bilateral adrenal glands, and periportal lymph nodes. In addition, diffuse intense DOTANOC-avid mural thickening with intraluminal polypoidal mass formation was noted within the stomach causing significant luminal compromise, histopathological examination of which turned out be hypertrophic hypersecretory gastropathy. This case highlights the possibility of overexpression of somatostatin receptors in gastric hypertrophy, which has been little explored in literature.

We report a case of 34-year-old woman presenting with complaints of abnormal posturing of hand and tonic-clonic seizures of few days' duration, which soon progressed to psychotic episodes and injuries secondary to fall/abnormal movements. She underwent F-FDG PET for a suspicion of encephalitis, which revealed increased FDG uptake in the bilateral parietotemporal lobes (right more than left), anterior cingulate cortex, bilateral basal ganglia, thalami, and cerebellum. This atypical pattern did not conform to any known pattern of encephalitis, which was later attributed to the presence of both anti-NMDAr and anti-GAD antibodies in blood and cerebrospinal fluid.

A 63-year-old man, recently diagnosed with carcinoma of the prostate (Gleason's score 4+4), with serum prostate-specific antigen 189.2 ng/mL, underwent Ga PSMA PET/CT scan for pretreatment staging. The study revealed abnormal tracer uptake in the prostatic bed region, the pelvic, abdominal, and mediastinal lymph nodes and diffuse metastases to the bilateral lungs. The lung metastasis was proved to be metastatic adenocarcinoma from analysis of bronchoalveolar lavage.

Acute appendicitis is one of the commonest surgical emergencies worldwide. There is considerable variation in prevalence of appendicoliths with appendicitis. Most of the patients with appendicoliths are asymptomatic and they are not pathognomic for acute appendicitis. However, appendicoliths show increased association with perforation and abscess formation. Appendicolith are quite common, being present in 3% of general population and in nearly 10% cases of appendicitis. However, giant appendicoliths measuring over 2 centimeters (cms) are extremely rare. Computed Tomography (CT) has increased their pre-operative diagnosis considerably. Use of spectral analysis can give us the details of composition of the stone pre-operatively. We present a young male diagnosed pre-operatively on Non-Contrast Computed Tomography (NCCT) to have a giant calcium struvite appendicolith. On laparoscopy he had a 3 cm stone and an incidental Meckel's diverticulum and underwent appendectomy. The case is presented for the unique size of the appendicolith alongwith review of literature.

We aimed to correlate plasma glucagon levels with anthropometric measures and abdominal adipose tissue depots. Nonobese males (n=81; BMI 2) with T2DM of less than one-year duration and nonobese males without diabetes (n=30) were evaluated for the following: anthropometry (BMI, waist circumference, W-HR, and truncal skinfolds), whole-body DEXA (for body fat and fat-free mass), and MRI scan (for volumes of subcutaneous abdominal adipose tissue (SCAT) including superficial and deep, intra-abdominal visceral adipose tissue (including intraperitoneal adipose tissue (IPAT), retroperitoneal adipose tissue, liver span and fatty liver, and pancreatic volume)). Plasma glucose and glucagon, serum insulin, hepatic transaminases, and lipid profile were measured. Significantly higher levels of fasting and postprandial glucagon (p<0.001) and fasting and postprandial insulin (p<0.001) were seen in patients with T2DM. The mean values of fasting and postprandial plasma glucagon levels were higher in T2DM patients with NAFLD (n=37) as compared to T2DM patients without NAFLD (n=44). Four independent predictors were derived for fasting glucagon levels in patients with T2DM, namely, W-HR, suprailiac skinfold thickness, IPAT, and deep SCAT (p<0.05; r2=0.84). These observations in Asian Indians may have significance for diabetes therapies which impact glucagon levels.

A 28-year-old female presented with an incidentally detected mediastinal mass, found on routine chest X-ray. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) was advised to plan course of further management. FDG-PET/CT findings were suggestive of an FDG-avid soft-tissue mass in the left posterior mediastinum in paravertebral location with left pleural effusion. Overall, PET/CT scan findings favored the possibility of a nerve sheath tumor. However, histopathology along with immunohistochemistry confirmed the diagnosis of Castleman disease.

Early diagnosis is imperative for adequate management of patients with osmotic demyelination syndrome (ODS), which is usually a result of rapid shifts of osmolality secondary to rapid correction of hyponatremia. Magnetic resonance imaging (MRI) with its special sequences is the investigation of choice for early detection of the osmotic changes in the brain. We report a case of clinically suspected ODS with noncontributory MRI and positive fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) scan with statistical parametric mapping (SPM) analysis, which localized the focal hypermetabolism in the basal ganglia, thalamus, pons, and cerebellum.

Loss of anterior tooth due to any reason like root resorption, trauma, periodontal disease or endodontic failure can be a deeply traumatic situation for most patients & needs immediate attention. An immediate replacement is necessary in order to avoid aesthetic, masticatory & phonetic difficulties. This paper describes the immediate replacement of lateral incisor using composite resin with the natural tooth crown as pontics. It is a simple and economical method. It requires minimal or no tooth preparation tooth & also it is a reversible technique with no additional lab costs.

Neuroendocrine tumours (NETs) are rare, heterogeneous group of tumours which usually originate from small, occult primary sites and are characterized by over-expression of somatostatin receptors (SSTRs). Positron emission tomography/computed tomography (PET/CT) using Ga-68-labeled-somatostatin-analogues have shown superiority over other modalities for imaging of NETs. The objective of the study was to retrospectively evaluate the efficacy of Ga-68 DOTANOC PET/CT imaging in detecting the primary site in patients with metastatic NETs of unknown origin and its impact on clinical decision making in such patients.Between December 2011 and September 2014, a total of 263 patients underwent Ga-68 DOTANOC PET/CT study in our department for various indications. Out of them, 68 patients (45 males, 23 females; mean age, 54.9±10.7 years; range, 31-78 years) with histopathologically proven metastatic NETs and unknown primary site (CUP-NET) on conventional imaging, who underwent Ga-68 DOTANOC PET/CT scan as part of their clinical work-up were included for analyses. Histopathology (wherever available) and/or follow-up imaging were taken as reference standard. Quantitative estimation of SSTR expression in the form of maximal standardized uptake value (SUVmax) of detected primary and metastatic sites was calculated. Follow-up data of individual patients was collected through careful survey of hospital medical records and telephonic interviews.Maximum patients presented to our department with hepatic metastasis (50 out of 68 patients) and grade I NETs (50%). Ga-68 DOTANOC PET/CT scan identified primary sites in 40 out of these 68 patients i.e., in approximately 59% patients. Identified primary sites were: small intestine [19], rectum [8], pancreas [7], stomach [4], lung [1] and one each in rare sites in kidney and prostate. In one patient, 2 primary sites were identified (one each in stomach and duodenum). Mean SUVmax of the detected primary sites was 25.1±18.0 (median: 16.25; range, 2.1-150). Significant positive correlation was found between SUVmax of detected primary site and SUVmax of the histopathologically proven sites of metastasis (r=0.662; P0.0001). Based on the findings of the Ga-68 DOTANOC PET/CT scan, 3 out of 40 patients underwent definitive treatment for their primary tumour (1 gastric, 1 ileal and 1 prostatic tumour). One patient was being planned for resection of primary rectal lesion at the time of data-collection. Thirty-six out of 68 patients were started on long-acting somatostatin analogues or chemotherapy or targeted therapy. Two patients underwent multiple cycles of peptide receptor radionuclide therapy (PRRNT) using (90)Y and (177)Lu labeled somatostatin analogues.Our findings indicate that Ga-68 DOTANOC PET/CT is a promising imaging modality in patients with metastatic NETs of unknown origin for detection of the primary site and in guiding their therapeutic management.

Introduction: This article presents an insight on little known fact regarding orthodontic treatment in pregnancy and to find literature support in favor regarding orthodontic treatment during pregnancy. Literature was reviewed extensively to get results dental and orthodontic treatment during pregnancy. Discussion: Nowadays there are many adult patients seeking orthodontic treatment because of increase in awareness. In these adult patients, there are many pregnant females coming to orthodontist for treatment or a lady getting pregnant during the treatment. ‘Can a pregnant woman continue with orthodontic treatment or can she start with orthodontic treatment during pregnancy?’ This is a difficult question to answer but ‘Yes’, pregnant women can go for orthodontic treatment but with precautions. Present article gives us the information how to go about the treatment in pregnant women, the precautions to be taken, effect of drugs and hormonal changes on orthodontic treatment. Conclusion: Pregnant women can go for orthodontic treatment but with some precaution and some systemic and local condition limit the treatment modalities.

Aim To evaluate circulating plasma dipeptidyl peptidase-4 (DPP4) levels in non-obese Asian Indians with type 2 diabetes mellitus (T2DM), and to correlate these with metabolic profile and measures of anthropometry, skinfolds, abdominal adipose tissue depots, pancreatic volume, and liver span. Methodology Non-obese (body mass index (BMI)

Introduction: Cerebral palsy (CP) is caused by abnormalities in the developing brain leading to an impairment of muscle coordination and movement control in the body. Neonatal hypoxic-ischemic brain injury and hypoxic ischemic encephalopathy (HIE) are major causes of CP. Neurodegenerative disorders can be treated with human embryonic stem cells (hESC). Magnetic resonance imaging (MRI), positron emission tomography and single photon emission computed tomography (SPECT) scan are some of the imaging modalities for CP, but among all SPECT scan is more sensitive in detecting abnormalities in the brain. SPECT scan is an effective tool for the detection of cerebral blood flow, cerebral impairment and local brain metabolism. The present study was conducted to evaluate the diagnostic modality of SPECT scan that can assess the patient with CP before and after hESC therapy. Methodology: The study included the patients with CP for whom SPECT scan was performed before and after the therapy. Technetium-hexa methyl propylene aminoxime (Tc-HMPAO) SPECT scan was analyzed to assess the number of hypoperfused lesions/ areas in the brain and the percentage of improvement by hESC treatment. The patients were scored clinically using GMFCS scores. Results: Overall, 88 patients aged 2 months to 18 years with clinical manifestations of CP had SPECT scan performed before and after the therapy. The total treatment days varied from 31 to 310 days. All the subjects showed improvement in SPECT scan. Majority of subjects (n=58) had significant SPECT scan (>60%) change, followed by moderate SPECT scan (>30% 10%

Cysticercosis is a common problem world wide. However, disseminated cysticercosis is rare. Still rarer is asymptomatic disseminated cysticercosis. We are reporting here a rare case of asymptomatic disseminated cysticercosis which involved brain, face, orbit, lungs, heart, pancreas and spleen in a young Nigerian male, who sought medical attention for dysphagia which was diagnosed as achalasia cardia. Despite widespread dissemination of cysticercosis which involves multiple organs, the individual was asymptomatic for the same. Pancreatic and splenic involvement in disseminated cysticercosis has extremely rarely been reported in literature.

Perinatal/congenital tuberculosis is a rare entity, even in human immunodeficiency virus (HIV) endemic populations, and is uniformly fatal if untreated. The liver and the lungs are the most commonly involved organs in this variety of tuberculosis and the spine is a rare site. We report the first case of spine tuberculosis with paravertebral abscess in a neonate who was only 3 weeks of age. The imaging studies, namely radiography, sonography, computed tomography (CT)-guided aspiration and magnetic resonance imaging (MRI), facilitated rapid diagnosis and early institution of chemotherapy. We highlight the role of imaging evaluation in the diagnostic armamentarium for tuberculosis of the newborn, as early diagnosis followed by appropriate treatment resulted in an excellent recovery in our patient.

Context: Oral cancer is the sixth most common cause of cancer-related deaths worldwide. In the Indian scenario, oral cancer is the second most common cancer. The presence of metastatic cervical lymphadenopathy is of particular importance as with every single nodal metastasis, survival of the patient is reduced by one half. Thus, regional metastasis is one of the most important factors in the prognosis and treatment planning of patients with head and neck squamous cell carcinomas. The inaccuracies in clinical examination have been well documented and the diagnostic imaging modalities have been shown to have superior diagnostic accuracy in detecting occult nodal metastasis Considering the numerous uncertainties regarding the progression, management and outcome of oral cancers, an attempt was made to detect the role of tumor size as a predictive indicator for lymph node metastasis using magnetic resonance imaging (MRI). Aim of the Study: The aims of the present study was to evaluate tumor size and its relation to cervical lymph node metastasis and its significance as a prognostic indicator for oral squamous cell carcinomas (OSCCs); and to identify and evaluate inaccuracies of the clinical diagnostic criteria with the help of magnetic resonance imaging (MRI). Materials and Methods: A total number of 27 patients (12 oral cancer-alveolus, 8 oral cancer-tongue, 7 oral cancer-buccal mucosa) attending as out-patients were included in the study. The patients clinically diagnosed and histopathologically proven to have oral squamous cell carcinoma were examined and were evaluated for the tumour size and lymph node status with the help of MRI. Statistical Analysis Used: Values of sensitivity, specificity, positive and negative predictive values and accuracy were calculated. Paired t-test was performed for evaluating size of the tumor and lymph node recorded on clinical and imaging findings. Results: 40% cases were found to be true positive for detecting metastasis using clinical diagnostic criteria whereas 55% cases were found to be true positive for detecting metastasis using imaging criteria. The paired t-test value for the difference in tumor size between clinical and imaging staging was statistically significant (P

Intracranial aneurysms in early childhood are rare. Mycotic aneurysms as a cause of pyrexia of unknown origin has never been reported. We present a 9-month-old immunodeficient boy who had a long history of irregular fever from neonatal period and presented to us with subarachnoid hemorrhage. Investigation revealed a basilar top aneurysm. We present the clinicoradiological profile and discuss the management strategies.

The aim of this case report is to describe the oral rehabilitation of a young patient of hypohidrotic ectodermal dysplasia (ED) with maxillary and mandibular complete dentures. Such patients often present with poor aesthetics, mastication, and social behavior. Treatment resulted in an improvement of esthetics, function and psychology of the patient. Children with EDs do not have normal patterns of growth and a risk and benefit analysis must be made to access the value of implant placement. Replacement of teeth by implants is usually restricted to patients with completed craniofacial growth.

Introduction: Care during Antenatal period is very important for the positive outcome of pregnancy. This study was conducted to study the antenatal practices in a rural population; role of various health functionaries in promoting healthy antenatal practices and factors affecting it. Methodology: The present study is a descriptive, community based field study done in Bisrakh block of district Gautam Budh Nagar. The study was conducted in all the villages of two randomly selected sub-center areas each from two randomly selected PHCs of Bisrakh Block. Observations: 40% of pregnant women visited 3 or more times for antenatal care (ANC), 12 % took 100 iron folic acid (IFA) tablets and 81% took Tetanus Toxoid (TT). Education of pregnant women was an important factor significantly associated with higher consumption of IFA tablets and higher number of visits for ANC. Conclusions: Major proportion of pregnant women do not avail the facilities provided by the Government. Education of pregnant women has a very strong bearing on their health care seeking behavior.

Ten patients with biopsy-proved synovial sarcoma were evaluated by magnetic resonance (MR) imaging on a 1.5-T unit. The lesions showed intermediate signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images. Tumors were well-demarcated from normal tissues. Additional information included adjacent bone involvement (one case), femoral vein invasion by tumor (one case), and hemorrhage within the tumors (one case). Four patients underwent a repeat MR examination following chemotherapy. This showed a decrease in size and increase in the signal intensity of three tumors on T2-weighted images, proven to be due to necrosis in one. These changes correlated with clinical regression of disease. While MR in synovial sarcoma does not have any specific signal intensity, it proved to be useful in defining the extent of disease and in determining the response to chemotherapy.

The magnetic resonance imaging (MRI) changes in 39 patients with malignant fibrous histiocytoma (MFH) were reviewed retrospectively. Twenty-one sarcomas were in the lower extremity, five each in the upper extremity and trunk, two each in the neck and heart, and one each in the maxillary sinus, sella turcica, tongue, and spermatic cord. The examinations were performed with spin-echo sequences on a 1.5 Tesla Signa Scanner (GE, Milwaukee WI). Twenty-two tumors exhibited intermediate signal intensity on T 1 -weighted images and 23 were of high signal intensity on T 2 -weighted images. There was no significant difference in signal intensity of 12 preoperative and 13 recurrent neoplasms. Twelve of 13 patients were correctly diagnosed as having postoperative changes. The MR sensitivity and specificity for detecting a neoplasm were 96% and 83% respectively, but the signal changes were nonspecific for MFH. When compared to CT in 14 patients, MR better defined the extent of the MFH, its relationship to surrounding tissues and vessels, and best differentiated residual or recurrent disease from postoperative changes when examined at least 3 months after surgery.