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We present a case of Anti-IgLON 5 encephalitis with Lewy body dementia.

Context Excess hepatic and pancreatic fat may contribute to hyperglycemia. Objective The objective of this study was to examine the effect of dapagliflozin (an SGLT2 inhibitor) on anthropometric profile, liver, and pancreatic fat in patients with type 2 diabetes mellitus (T2DM). Methods This is an observational interventional paired study design without a control group. Patients (n = 30) were given dapagliflozin 10 mg/day (on top of stable dose of metformin and/or sulfonylureas) for 120 days. Changes in anthropometry (circumferences and skinfold thickness), surrogate markers of insulin resistance, body composition, liver, and pancreatic fat (as measured by magnetic resonance imaging (MRI)-derived proton density fat fraction [FF]) were evaluated. Results After 120 days of treatment with dapagliflozin, a statistically significant reduction in weight, body mass index (BMI), body fat, circumferences, and all skinfold thickness was seen. A statistically significant reduction in blood glucose, glycated hemoglobin A1c, hepatic transaminases, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and postprandial C-peptide was noted, while HOMA-β, postprandial insulin sensitivity, and fasting adiponectin were statistically significantly increased. There was no change in lean body mass. Compared to baseline there was a statistically significant decrease in mean liver FF (from 15.2% to 10.1%, P Conclusion Dapagliflozin, after 120 days of use, reduced pancreatic and liver fat and increased insulin sensitivity in Asian Indian patients with T2DM.

Purpose The aims of this study were to evaluate Tc-TRODAT-1 SPECT imaging patterns and to assess their correlation with disease severity in clinically diagnosed patients of Parkinson disease (PD). Methods The study included 241 patients with clinically diagnosed idiopathic Parkinson disease who underwent Tc-TRODAT-1 SPECT/CT scan. Binding ratios were calculated for each striatum, caudate, and putamen individually, by drawing region of interest. Occipital cortex region of interest was taken for background correction. Correlation of binding ratio with increasing clinical stage was derived, as described by modified Hoehn and Yahr scale. Results Median binding ratio was least in the contralateral putamen for all stages of modified Hoehn and Yahr. A statistically significant negative correlation was found between increasing disease severity and binding ratio in all subregions of striatum. Patients were clinically categorized into postural instability and gait disorder group and tremor-dominant PD group. No significant asymmetry was found between the left and right striatum in patients belonging to postural instability and gait disorder group and in those with bilateral tremors without lateralization. Conclusions Tc-TRODAT-1 SPECT is useful in early detection and in assessing disease severity of PD. A significant asymmetry with the contralateral side being affected more than the ipsilateral side can be attributed to tremor-dominant patients. The binding ratio of the ipsilateral striatum may serve useful as a marker of remaining functional dopaminergic neuronal reserve in the striatum.

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

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.

Due to repeated heavy loads, environmental conditions and non-frequent monitoring, the rail is subjected to heavy damage resulting in sudden failure. Hence, a frequent, faster, and efficient monitoring strategy is required. This paper attempts to investigate the application of guided wave (GW) generated through surface-bonded piezo-electric wafer transducer (PWT) to detect damages in rail at high frequencies. Firstly, a combined experimental and simulation study is presented in an effort to understand the dispersion characteristics of guided wave and its interaction with head damages in a relatively small rail specimen. The numerical simulation results are validated with those obtained from the experiments showing a good agreement between them. Secondly, a framework based on the machine learning algorithm is proposed to efficiently detect damage in rail head. Numerous inseparable guided wave modes are observed at higher frequencies implying the inability to detect damage through specific mode. Therefore, a machine learning framework is trained using time, frequency, and time–frequency domain features of the signal. Total 672 numerical simulations of different types of damage with different severity and location in the rail head are carried out to train and validate the model. It is found that GW generated through surface bonded PWTs is able to detect minimum defect size of 5% of head area with 1 mm thickness. Finally, the proposed framework is tested using simulation and experiment results of arbitrary damage in the rail head. The error in estimating severity was found to be in the range from 2.00% to 16.67%.

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)

Engineering education has been experiencing a paradigm shift from chalk and talk towards digital aids. This paper presents one such android application to predict the performance of an induction machine. The application presented calculates the performance parameters: rotor resistance, rotor reactance, shaft torque and efficiency, of any arbitrary induction motor based on the name plate details provided on the machine. The application is also able to simulate and present the torque-slip characteristics of the machine under consideration.

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.

Autoimmune encephalitis is a diverse group of neuropsychiatric disorders, which are difficult to diagnose clinically. The disorder presents acutely or subacutely with alteration of consciousness, cognitive decline, seizures, and abnormal movements. Autoantibodies are directed against intracellular antigens or extracellular domains of cell surface proteins, critical for neuronal excitability. F-FDG PET/CT has been used to diagnose the metabolic derangement in the brain due to various antibodies. Here we describe a case where acute and subacute phase of disease was visualized on serial F-FDG PET/CT.

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.

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.

Rationale and Objectives To explain predictions of a deep residual convolutional network for characterization of lung nodule by analyzing heat maps. Materials and Methods A 20-layer deep residual CNN was trained on 1245 Chest CTs from National Lung Screening Trial (NLST) trial to predict the malignancy risk of a nodule. We used occlusion to systematically block regions of a nodule and map drops in malignancy risk score to generate clinical attribution heatmaps on 103 nodules from Lung Image Database Consortium image collection and Image Database Resource Initiative (LIDC-IDRI) dataset, which were analyzed by a thoracic radiologist. The features were described as heat inside nodule -bright areas inside nodule, peripheral heat continuous/interrupted bright areas along nodule contours, heat in adjacent plane -brightness in scan planes juxtaposed with the nodule, satellite heat - a smaller bright spot in proximity to nodule in the same scan plane, heat map larger than nodule bright areas corresponding to the shape of the nodule seen outside the nodule margins and heat in calcification. Results These six features were assigned binary values. This feature vector was fedinto a standard J48 decision tree with 10-fold cross-validation, which gave an 85 % weighted classification accuracy with a 77.8% True Positive (TP) rate, 8% False Positive (FP) rate for benign cases and 91.8% TP and 22.2% FP rates for malignant cases. Heat Inside nodule was more frequently observed in nodules classified as malignant whereas peripheral heat, heat in adjacent plane, and satellite heat were more commonly seen in nodules classified as benign. Conclusion We discuss the potential ability of a radiologist to visually parse the deep learning algorithm generated “heat map” to identify features aiding classification.

We aimed to compare C-peptide levelsmeasures of insulin resistance in non-leannon-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.Non-lean, non-obese (BMI19 and 25 kg/mIn 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 0.001), Fasting Insulin Resistance Index (r = 0.42, p 0.001), Bennett's Index (r = 0.38, p 0.05), and volumes of SCAT and IAAT only in cases. The independent predictors of higher fasting C-peptide level were IAAT volume (β = 0.057; p = 0.002), liver span (β = 0.057, p = 0.005) and fasting insulin levels (β = 0.35, p = 0.02).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.

We present the case of a 53-year-old man with left hydroureteronephrosis who underwent Tc-DTPA renography for functional assessment of bilateral kidneys. Tc-DTPA renography of the patient showed diffusely increased extrarenal Tc-DTPA uptake in the visualized lumbosacral vertebrae and in the pelvic bones, on the blood flow and functional phase of the renography, which was suggestive of disseminated skeletal disease. Subsequent MRI lumbosacral spine and F-FDG PET/CT revealed extensive skeletal metastases corresponding to the increased extrarenal Tc-DTPA uptake in the lumbosacral vertebrae and the pelvic bones from primary left lung mitotic lesion.

Aim: In the less dense bone, it is difficult to obtain implant anchorage. The present study was undertaken to determine the survival rate of Maestro TM implants placed in d3 and d4 bones. Materials and Methods: Fourteen patients (10 males and 4 females) were selected for the study and implants were evaluated for posttreatment changes in at 3, 6, 9 and 12 months from implant placement. The implant probing depth and mobility were recorded 3 and 6 months after prosthesis placement. Also, peri-implant bone level was assessed at the baseline and 12 months postoperatively, followed by a statistical analysis. Results: The mean plaque and gingival indices showed a reduction at repeated intervals. The mean sulcular bleeding showed a slight reduction which was statistically significant. An overall mean bone loss was observed after 12 months follow-up, which was statistically not significant. The overall survival rate of implants was reported as 92.3%. Conclusion: The specific implant used in the study is advantageous in the soft bone condition. Clinical Significance: Although, there is a great evidence of implant failure in compromised jaw quality, the newer designs and approaches suggest that the poor quality is not a contraindication.

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.

This paper focuses on decoding the process of face verification in the human brain using fMRI responses. 2400 fMRI responses are collected from different participants while they perform face verification on genuine and imposter stimuli face pairs. The first part of the paper analyzes the responses covering both cognitive and fMRI neuro-imaging results. With an average verification accuracy of 64.79% by human participants, the results of the cognitive analysis depict that the performance of female participants is significantly higher than the male participants with respect to imposter pairs. The results of the neuro-imaging analysis identifies regions of the brain such as the left fusiform gyrus, caudate nucleus, and superior frontal gyrus that are activated when participants perform face verification tasks. The second part of the paper proposes a novel two-level fMRI dictionary learning approach to predict if the stimuli observed is genuine or imposter using the brain activation data for selected regions. A comparative analysis with existing machine learning techniques illustrates that the proposed approach yields at least 4.5% higher classification accuracy than other algorithms. It is envisioned that the result of this study is the first step in designing brain-inspired automatic face verification algorithms.

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.

Background Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/β-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane. Methods A total of 15 patients reported for tooth extraction were enrolled in this study. Implants were placed in average 5.2 ± 2 months after socket grafting. At this visit, Cone Beam CT (CBCT) images and core biopsies were taken. Implant stability (ISQ) was assessed at the insertion as well as at the day of final restoration. Results CBCT data revealed 0.79 ± 0.73 mm ridge width reduction from grafting to implant placement. Histomorphometric analysis of core biopsy samples revealed in average 21.34 ± 9.14% of new bone in the grafted sites. Primary implant stability was high (ISQ levels 70.3 ± 9.6) and further increased until final restoration. Conclusions The results of this study show that grafting of intact post-extraction sockets using a biphasic in situ hardening bone graft substitute results in an effective preservation of the ridge contour and sufficient new bone formation in the grafted sites, which is imperative for successful implant placement.

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.

Rehabilitation of patients with disabilities of head and neck region, due to either congenital or acquired defects is a challenging task. These defects range from minor cosmetic discrepancies to major functional limitation. The prosthodontics management of these patients should aim at not only restoring the functional and esthetic handicap, but also ensure psychological well being. For facial rehabilitation assessment of materials used in maxillofacial prosthesis is necessary. Till date we have come a cross various materials which exhibit some excellent properties but also have many deficiencies. This article will review various materials used in maxillofacial prosthesis.

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%

Background: In patients with extensive tooth loss, restoration of masticatory function and aesthetics is main concern for a prosthodontist. Aim of Study: This study aimed to evaluate and compare differences in masticatory efficiency of patients treated with complete dentures made with either high impact or flexible resins. Setting and Design: The sample size consisted of 10 study subjects. Two sets of dentures first conventional followed by flexible dentures were fabricated for each subject and both the sets of dentures were accessed for masticatory performance and efficiency. Materials and Methods: This study compared the masticatory performance and efficiency of dentures by means of standardized mesh sieves. Masticatory efficiency was calculated by recording the total number of chewing cycles and time required to completely swallow a standardized food item. A patient satisfaction questionnaire was given and evaluated. Statistical Analysis Used: The statistical analyses were performed using Z-test of Proportion and Paired t-test. Results: The masticatory performance ratio was found to be more for hard food in conventional dentures. The values of masticatory performance ratios for soft food, time and number of masticatory strokes were indicating better masticatory efficiency of conventional dentures. Conclusion: Though masticatory efficiency and performance were found to be better for patient’s dentures made with Polymethyl methacrylate (PMMA), a statistically significant number of patients reported that the flexible dentures were more satisfying than the conventional dentures.

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.

Background: Immunization is one of the most cost-effective interventions to prevent the suffering that comes from avoidable sickness, disability and death. In India, though immunization coverage has improved over the past few years, the country still accounts for the largest number of children who are not immunized i.e. 7.4 million. So, this study was taken up to assess the immunization coverage among children in District Gautam-Budh Nagar of Uttar Pradesh and to decipher the causes behind the partial immunization/non- immunization. Methods: A cross-sectional study was conducted during June-August 2015 in an urban resettlement colony of District Gautam-Budh Nagar in Uttar Pradesh among 210 children aged 12-23 months selected using WHO 30X7 cluster sampling technique. Results: A total of 210 children were covered, of which 72.9% children were fully immunized, 19.0% children were partially immunized, whereas, 8.1% children did not receive even a single dose of any vaccine, thus constituting a total of 27.1% children with partial/no immunization. On bi-variate analysis, significant associ­ation was observed between immunization status among children and caste (p=0.047), mother’s education (p=0.01), father’s education (p=0.000) and socio-economic status (p=0.003). On multi-variate analysis, however, only father’s educational status was found to be significantly associated. The major reasons for partial/non-immunization among children were Ignorance (80.7%) followed by unavailability of vaccines (7.0%). Conclusions: Immunization coverage found in the present study is still way short of the target of universal coverage. Therefore, health planners and policy makers in our country should develop a comprehensive strategy to achieve universal immunization coverage.

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

Statement of Problem: The fracture of complete denture is a common occurrence in the field of prosthodontics. Often if all other criteria are met such as good aesthetics, occlusion, and functionality; denture repair is acceptable. Once denture fractures, we would want the joint surface strength to be as good as original. Purpose: The purpose of this study was to determine the effect of different repair surface design on the transverse strength of repaired acrylic denture resin. Materials and Methods : Sixty specimens of heat‑cured acrylic resin of dimension 65 mm × 20 mm × 2.5 mm were prepared using a special die. Transverse strength of 15 samples was calculated which serves as a control group. Three different types of joint surface contours were prepared each having 15 samples each as butt, round, and rabbet joint. Transverse strength of three joint contours was then compared with control group and also they were compared with each other and result was statistically analyzed with one‑way analysis of variance (ANOVA) and Post‑hoc ANOVA Tukey’s HSD test at 5% level of significance. Z‑test of proportion was also done for types of failures. Result: Transverse strength of original specimen was higher than that of repaired specimens. Transverse strength of round joint was higher than the butt and rabbet joint. Conclusion : Methods of repair have significant effect on strength of repaired denture. Round joint design of repair technique was far superior. Key words : Autopolymerizing resin, rabbet joint, transverse strength

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.

Background: The Government of India launched the National Vitamin A Prophylaxis Program in 1970. Currently, under this program, a total of nine doses of vitamin A should be given to the children orally, with the first dose at 9�12 months of age, followed by biannual doses at 6-monthly interval up to the age of 5 years. Objective: To evaluate all dose vitamin A supplementation (VAS) coverage and its associated factors and decipher reasons for poor coverage in children aged 12�59 months. Materials and Methods: This study was a cross-sectional survey conducted in Bhangel area of district Gautam-Budh Nagar, Uttar Pradesh, India. The WHO 30-cluster sampling technique was used to select the study subjects. Study subjects included 210 children in the age group of 12�59 months. On the basis of documentary evidence/recall of mothers, the data were recorded in the prestructured pro forma. Bivariate analysis using X2-test was applied to study the association between variables, and multivariate analysis was applied on variables found to be significant on bivariate analysis. Result: Only 6.2% (13/210) children received all doses of Vitamin A due for respective age. The factors found to be significantly associated with VAS coverage were age, religion, and immunization status for VPDs on bivariate analysis and only age group on multivariate analysis. The most common reason for missing the doses of vitamin A was ignorance among parents, which was found in 84.8% (167/197) subjects. Conclusion: Appropriate measures should be taken to improve the national coverage of all dose VAS.

GS Chandu,1 BS Hema,2 Harsh Mahajan,1 Antriksh Azad,2 Ipsita Sharma,3 Anurag Azad4 1Department of Prosthodontics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India; 2Department of Conservative Dentistry, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India; 3Department of Oral Pathology, RKDF Dental college and Research centre, Bhopal, Madhya Pradesh, India; 4Department of Oral and Maxillofacial Surgery, Bhabha College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India Aim: To evaluate retention of complete denture base with different types of posterior palatal seals. Material and methods: Ten male patients between the age group of 50 years to 60 years were selected for the study. After the primary and secondary impressions were taken, five casts were made including a cast without posterior palatal seal, a cast with single bead posterior palatal seal, a cast with double bead posterior palatal seal, a cast with butterfly shaped posterior palatal seal, and a cast with posterior palatal seal with low fusing compound by functional method. Results: It was observed that retention increased up to 108% in the posterior palatal seal with low fusing compound with functional method and the posterior palatal seal that was obtained by using functional method provided greater retention than a denture base without posterior palatal seal. Conclusion: It was concluded that the incorporation of a posterior palatal seal is important for obtaining optimum retention of the maxillary complete denture. Keywords: posterior palatal seal, denture base, complete denture, functional method

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.