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COVID-19 (Coronavirus disease 2019) is a contagious infection caused by novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). This novel virus was publicly announced as an infectious pathogen by the “Chinese Centre for Disease Control and Prevention” on 8 January 2020. The World Health Organization named COVID-19 a pandemic crisis all over the world on March 11, 2020. Aged people and medically compromised people like patients with diabetes, cardiovascular disease, chronic respiratory disease, and cancer are the vulnerable populations for developing an illness. A guideline has been postulated and described in the form of a journey map to avoid exposure of dental health care professionals to COVID-19. This review provides a comprehensive outlook for the current pandemic situation, its origin, spread, and preventive measures to be utilized in general and in dental practice.

Covid-19 is a disease caused by the SARS-CoV-2 virus that usually causes mild flu-like illness in majority of the cases, but it can cause severe pneumonia and multiple organ dysfunction even death especially in elderly patients who also have comorbidities like hypertension, diabetes, chronic obstructive airway disease (COAD), asthma, and cardiac disease. The central and peripheral nervous systems are not spared, and neurological complications are frequently reported in severely ill patients who have comorbidities. The SARS-CoV-2 virus has the potential to invade the brain and it enters the brain via a haematogenous route or olfactory system through angiotensinconverting enzyme -2 receptors, present on endothelial cells of cerebral vessels. The most neurological manifestations, seen in Covid-19 infection are altered sensorium (agitation, delirium, and coma), ischemic or haemorrhagic stroke, acute disseminated encephalomyelitis or acute necrotizing encephalopathy, headaches, Guillain-Barré syndrome. Here is a case of a 70-year-old hypertensive female who presented to us with complaints of fever, headache and vomiting of 3 days duration and after investigations, a diagnosis of Covid -19 with hypertension and subarachnoid haemorrhage was made.

Vertebral hemangiomas are incidental finding and most of the time do not necessitate immediate attention unless symptomatic. Vertebral hemangiomas can be very aggressive to the extent that they can produce cord compression and paraplegia/paraparesis. Such cases need evaluation with magnetic resonance imaging to assess the cause, extent, and mass effect on the spinal cord. Transcatheter embolization and decompression surgery are well established modes of treatment as single or combined approach. Pulmonary arteriovenous malformation (AVM) is caused by the direct communication of main pulmonary artery with pulmonary vein, leading to a high-flow right-to-left shunt. This usually presents clinically as hypoxia, cyanosis, and dyspnea. The clinical signs and symptoms vary depending on the size, number, and flow of fistula as well as the associated vascular malformations. Transcatheter embolization is a treatment of choice for pulmonary AVM. However, this method may result in incomplete resolution if the malformation is large in size or supplied by multiple feeding arteries. Surgical resection may be considered in those kinds of cases. As AVM can lead to hemodynamical instability, these lesions need to be addressed first. In this case, pulmonary AVM came to notice post surgical decompression. Here, we report a case of aggressive vertebral body hemangioma and a large pulmonary AVM in the same patient, which were treated by embolization in two different settings.

Bacterial meningitis is a disease with a potentially catastrophic outcome requiring immediate diagnosis and intervention. Bacteria can use several routes for migration into the intrathecal space. Lumbar puncture circumvents the normal central nervous system defence barrier and thus carries the potential for infection to be spread to the meninges. In sporadic cases, meningitis can occur, albeit very serious despite the meticulous aseptic techniques. Hence, meningitis finds an important place in the differential diagnosis of post-spinal headache in patients with complaints of intense headaches, fever, sensitivity to light, incoherent behaviour or muscular rigidity in the absence of any psychological disease in the postoperative or postpartum period. It is also mandated to rule out other vital conditions in the postpartum like pre-eclampsia, which can also have similar manifestations requiring urgent intervention. Adequate care given at the right time can halt disease progression, thereby limiting the damage caused, which often at times could be irreversible. The gravity of the disease should not be undermined in any scenario. Sharp and timely diagnosis is the key to prevent any adversity. Here we have documented a case of meningitis caused by the unpremeditated introduction of bacteria following spinal anaesthesia for Caesarean section and its subsequent management.

Background Chronic venous insufficiency (CVI) manifests as unilateral or bilateral lower-limb venous hypertension causing pain, swelling, edema, and skin changes, among other symptoms. CVI affects patients’ socioeconomic status, is particularly seen in the young, and, in its severe manifestation, may have a debilitating effect on patients’ quality of life (QoL). The authors wanted to evaluate change in pain and QoL among rural patients after endovenous laser ablation (EVLA) treatment in a pilot study. Methods Twenty patients having CVI who opted for 1,470-nm EVLA treatment were enrolled at the Interventional Radiology department between July 2018 and September 2018. The authors evaluated pain using the visual analog scale (VAS) before and after EVLA procedure (standard protocol) of the affected vein. They also assessed QoL using the Aberdeen Varicose Vein Questionnaire before and 6 weeks after EVLA. Results The authors observed significant reduction in pain postprocedure versus preprocedure. Majority of the patients had improvement in itching and stasis dermatitis after the procedure. Rash and skin ulcers remained uncommon before and after EVLA. Also, after EVLA, fewer patients than before reported that the appearance of their diseased veins caused them concern (35 vs. 65% before EVLA), influenced their choice of clothing (45 vs. 80%), interfered with their work (40 vs. 90%), and interfered with their leisure activities (30 vs. 80%). Conclusion EVLA 1470nm procedure may help patients with CVI attain improved QoL and significant pain reduction.

Ectopic pregnancy has emerged as an alarming problem for obstetricians worldwide. Live twin ectopic conception is rare to occur, and spontaneously conceived twin ectopic pregnancy is even more infrequent. A 32-years-old gravida 3, para 1, live 1, abortion 2, presented with a confirmation of pregnancy on a urinary pregnancy test kit along with pain in the right iliac fossa. Blood investigations revealed raised serum beta-human chorionic gonadotropin hormone. Transvaginal ultrasonography revealed twin ectopic conception in the right fallopian tube with both the embryos showing cardiac activity and no evidence of intrauterine gestational sac. The patient was managed with methotrexate-mediated ultrasound-guided fetal reduction and is doing well on follow-up presently. Hence, our case report highlights the importance of prompt diagnosis and management of twin ectopic pregnancies with the help of newly evolving interventional radiology procedures.

Extracranial carotid artery aneurysm is a rare vascular disease in the neck with variable presentation. Aneurysms are associated with significant mortality and morbidity and are associated with fatal complication secondary to spontaneous rupture or tracheal compression or laryngeal edema and distal embolization. A 43-year-old male patient presented with large aneurysm arising from proximal common carotid artery (CCA) causing tracheal obstruction leading to life-threatening respiratory symptoms. The endovascular interventional management is an emerging alternative for surgical option and providing promising results with almost similar safety and efficacy. Endovascular management of an extracranial carotid artery aneurysm using stent graft is minimally invasive and effective.

Background Ruptured intracranial aneurysm and nontraumatic subarachnoid hemorrhage (SAH) are synonyms and indicators of a high-risk medical emergency. They can be treated either with endovascular approach with interventional radiological (IR) coil embolization or by neuro-surgical (NS) approach by clipping with each having their own merits and demerits and time-tested applications either requiring perioperative expectant management to prevent or curb complications of SAH or post-procedure aiming to achieve better patient outcomes. We conducted this retrospective study to analyze and gain experience from our past cases managed at tertiary care super specialty center and serve as baseline study to implement further studies and have insight for future trends in rural hospital setup in management of critical cases aimed to improve and upscale clinical outcomes in these patients. Materials and Methods Study comprised patients belonging to either of two groups, depending on the management they underwent. Analysis was done by using descriptive and inferential statistics. Results The overall study population consisted of 29.83% males and 70.18% females in this study. The overall mean age was found to be 47.33 years (standard deviation [SD] 15.68 years). In IR group, the pre- and post-procedure modified Fisher's scale (MFS) values were 53 and 50, respectively, in 31 cases, whereas the same in NS group were 43 and 53, respectively, in 23 cases. The difference change in MFS for pre- to post-procedure in IR group was small (3) and showed decreasing trend (from 53 to 50 as well as in individual Fisher grade) whereas that in NS group was big (10) and showed increasing trends (from 43 to 53 as well as in the individual Fisher grade). Conclusion Endovascular coil embolization is the surgery of choice for management of intracranial aneurysm and is minimally invasive procedure with favorable comparative outcomes on MFS than NS clipping group in our study. We recommend undertaking further prospective comparative study, incorporating our study principles and observations with inclusion of prospective clinical scale—modified Rankin's scale (MRS).

Objectives To assess the use of proximal protection devices in consecutive patients as the preferred means of cerebral embolic protection for primary carotid stenting. Methods and Results This was a prospective single-center study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic (≥ 50%) and asymptomatic (≥ 70%) carotid stenosis. Proximal protection devices were used for embolic protection in 115 consecutive patients. No patients were excluded for anatomical reasons. The filter used was of diameters 6 mm in all cases (Emboshield NAV filter device, Abbotts Healthcare Pvt. Ltd. [Lake Bluff, Il]). In all cases, self-expanding closed-cell designed stent was used (X-act closed-cell self-expanding nitinol carotid-tapered stent, Abbotts Healthcare Pvt. Ltd.). Plaque characterization was done by using real-time high-resolution ultrasound (HR USG) equipment (Aloka Prosound Alpha 7 [Chiyoda, Tokyo, Japan]) using high-frequency linear transducers (> 7 MHz). Follow-up duration was 30 days. Mean age was 61.9 ± 8.27 years. There was male predominance observed in study accounting for 73 out of total 115 studied population. Fifty-six of 115 (48.89%) treated stenoses were symptomatic. Technical success was achieved in 115 of 115 (100%) cases. In both the cases, additional distal filter devices were used. Carotid stenting was successful in 115 (100%) lesions. This study observed higher number of debris in symptomatic and high-risk plaques. This study also observed higher sensitivity, specificity, and accuracy of updated classification for assessing risk of microembolism (captured debris) (sensitivity 73.91%, specificity 95.65%, positive predictive value [PPV] 91.89%, negative predictive value [NPV] 84.62%, accuracy 86.95%). In our study, minor stroke was seen in three (2.61%) patients within 48 hours, and no adverse events were seen within 48 hours to 1 month. Conclusion Proximal protection is a safe method as the first choice for embolic protection. It can be used with a high rate of technical success.

A 7-year- old male child presented with the complaints of tense abdominal distension and swelling over feet since 1 month. The patient had repeated episodes of similar complaints since last two years with partial or complete relief after taking various forms of allopathic therapy. On imaging, Budd-Chiari syndrome was diagnosed which was hallmarked by occluded Inferior venacava (IVC), caudate lobe enlargement and heterogeneous liver enhancement. Initially thrombolysis done leading to complete remission for the patient for 15 days, later on again the patient developed similar complaints for which balloon venoplasty and hepatic vein stenting was done.

Coarctation of Aorta (CoA) is a congenital cardiac defect which can present in adults. The usual presentation is hypertension. Though it has subtle clinical signs but they can go undetected if not sought for. One of the most catastrophic presentations can be severe hypertension with its complications. We report a case of a 40 year old female who presented to us with hypertensive encephalopathy and finally diagnosed as CoA

Jaundice is a common problem in society, it is important to discriminate between obstructive and non obstructive cause due to high morbidity in cases of obstructive jaundice, also non obstructive jaundice requires medical management while obstructive jaundice requires surgical intervention. Our study was done with aims to determine role of MRCP in cases of obstructive jaundice in correlation with ultrasonography keeping post surgical follow ups/ ERCP/ histopathology as gold standard for final diagnosis. All patients in our study undergone USG followed by MRCP. We had included total 100 patients out of which 58 females and 42 males. Out of all patients we have observed 56 malignant causes and 44 benign causes. We have observed benign conditions are seen more frequently in adults while increase in frequency of malignancy with increase in age thus there found to have direct relationship of malignant etiology with increase in age. Most common benign cause observed in our study was choledocholithiasis while most common malignancy was carcinoma head of pancreas. In our study we have concluded that MRCP is better modality with high sensitivity, specificity and diagnostic accuracy as compared to USG also with use of MRCP invasive procedures like ERCP can be avoided just for diagnostic purpose. We have also noticed few limitations of both USG and MRCP in process of diagnosis.

Pleomorphic adenoma (PA) can be defined as a benign mixed tumor composed of epithelial and myoepithelial cells arranged with wide cytomorphologic and architectural diversity and morphological patterns, demarcated from surrounding tissues by fibrous capsule. PA is one of the salivary gland tumors affecting both major and minor salivary glands. Parotid gland is the most commonly affected of the major group, and palate is the most common site of the minor salivary glands affected. The tumor has 3 components: an epithelial cell component; a myoepithelial cell component; and a mesenchymal component. The identification of these 3 components, which may vary quantitatively from one tumor to another, is essential to the recognition of pleomorphic adenoma. The tumor is also known as a benign mixed tumor. When these lesions affects the minor salivary glands on palate and if there is any involvement of the surrounding structures like maxillary antrum and nasal floor, then pre-operative imaging of these lesions is mandatory by 3-dimensional imaging modalities like CT or CBCT to evaluate the exact depth and the dimensions of the lesion. Following case of pleomorphic adenoma of palatal salivary glands which was evaluated with CT as well as CBCT pre- operatively.

Takayasu's Arteritis (TA) is an uncommon chronic inflammatory and stenotic disease of medium and large-sized arteries characterized by a strong predilection for the aortic arch and its major branches. We report a rare manifestation of TA in a 16-year-old female with no previous history of heart disease who presented with heart failure. She was found to have hypertension and discrepancies of pulses in upper and lower limbs. She developed ST elevated anterior wall myocardial infarction (MI) during hospitalization. Her aortography revealed narrowing of descending thoracic, upper abdominal and infrarenal aorta with significant stenosis of both renal arteries. She was diagnosed as a case of TA on the basis of her clinical profile and arteriography. Her coronary angiography did not reveal any stenosis or occlusion or aneurysm in coronary arteries or at coronary ostia which is in contrast to patients of TA with MI reported in the literature who had focal or diffuse stenosis or aneurysm in the coronaries.

No abstract availableDOI: http://dx.doi.org/10.3329/jom.v14i2.19695 J Medicine 2013, 14(2): 222-224

Background: Infertility is defined as inability to conceive even after 1 year of unprotected intercourse. Tubal blockage is one of the common causes of primary as well as secondary infertility in females. Fallopian tube recanalization (FTR) an interventional radiological procedure is one of the most promising, effective, minimally invasive and cost-effective technique in patients having infertility owing to tubal blockage. The aim is to study the cause, hysterosalpingography findings, and outcome of fallopian tube recanalization by interventional radiological procedure in patients with tubal-blockage presenting with infertility.Methods: This was a prospective observational study of women with primary or secondary infertility presenting to interventional radiology department. The patients either had already undergone hysterosalpingography (HSG) or came for HSG. Fallopian tube recanalization was done as per institutional protocol. Hysterosalpingography abnormalities, outcome and complications of fallopian tube recanalization procedure were studied.Results: In this study of 87 patients unilateral or bilateral tubal blockages were seen in 16 and 24 patients respectively. Majority of the patients had Segment I proximal block. Bilateral recanalization could be successfully done in 12 patients (24 tubes) with bilateral Proximal Tubal Blockage (PTO). Unilateral recanalization was possible in 12 patients (tubes) with unilateral proximal block and 8 tubes with bilateral proximal tubal block. 10 tubes with PTO could not be recanalized. 5 cases diagnosed with bilateral Distal Tubal Block (DTO), recanalization was not attempted and were referred for appropriate gynecological management. Minor complications were noted in 8 patients while no major procedure related complications were observed.Conclusions: Fallopian tube recanalization (by interventional radiology procedure) in patients with fallopian tube blockage diagnosed on HSG is found to be cost effective, minimally invasive and have low complication rate. It is associated with excellent outcome in terms of technical success and improved conception rate.

Traumatic diaphragmatic injury (DI) is a unique clinical entity that is usually occult and can easily be missed. Their delayed presentation can be due to the delayed rupture of the diaphragm or delayed detection of diaphragmatic rupture, making the accurate diagnosis of DI challenging to the trauma surgeons. An emergency laparotomy and thorough exploration followed by the repair of the defect is the gold standard for the management of these cases. We report a case of blunt DI in an elderly gentleman and present a comprehensive overview for the management of traumatic injuries of the diaphragm.

Objective The aim was to study the utility of color Doppler ultrasound (CDUS) in diagnosis of cervical lymphadenopathy in oral cancer patients. Study design In a prospective study, 70 cervical lymph nodes in 30 known primary oral cancer patients were evaluated with CDUS during a period of 8 months. The intranodal perfusion sites and vascular resistance were the key CDUS features used to differentiate between reactive and metastatic cervical lymph nodes. Histopathologic confirmations were obtained by excisional biopsy of the lymph nodes. The results of preoperative clinical palpation of cervical lymph nodes and CDUS evaluation were compared with histopathologic outcome. Results Clinical evaluation suspected 61 cervical lymph nodes to be malignant. According to the CDUS, out of 70 nodes, 49 lymph nodes showed features of benign lymphadenopathy and 21 lymph nodes showed features of malignant lymphadenopathy, whereas histopathologic evaluations were in favor of reactive for 57 (81.42%) and for malignant lymphadenopathy in 13 (18.57%). Conclusion The CDUS evaluation was found to be highly significant with a sensitivity of 92.90% and a specificity of 84.21%, after comparing the CDUS findings with histopathologic findings.

Renal arteriovenous malformation is a rare anomaly of the urinary system. We report an elderly patient aged 60 years who presented with gross hematuria due to left renal arteriovenous malformation. This case highlights the importance of careful diagnostic work-up in the evaluation of gross hematuria and emergency treatment with transcatheter arteriographically directed embolization.

Meralgia paresthetica presents as tingling sensation in the antero-lateral aspect of thigh. It occurs due to compression of the lateral cutaneous nerve of thigh. Proximal spinal lesions may present as meralgia paresthetica due to radiculopathy. We present a rare case of spinal hydatid with meralgia paresthetica.

Cavernous angiomas or hemangiomas or cavernomas are benign, vascular malformations of the central nervous system and classified as occult vascular brain lesions, usually present in adulthood. With the advent of computed tomography and magnetic resonance imaging, these lesions are increasingly recognized in children. We report two cases of pediatric brain cavernomas where the children presented with recurrent seizures. Imaging findings were suggestive of giant cavernous hemangioma. The lesions were excised completely and the patients recovered well without deficits with good control of seizures.

Objective: To investigate whether the application of thyroid collars (TCs) affects the results of cephalometric study. Study Design: The Steiner cephalometric analysis of the patients was performed using lateral cephalometric radiographs, which were taken twice for each patient: Once using TCs (TC group; n0 = 50) and once without using TCs (NTC group; n = 50). A randomized and observer-blinded diagnostic study with head films taken from the two aforementioned groups was performed and results were evaluated with the t-test and Z-test, using GraphPad® Prism 4 software. Results : Statistical analysis using t-test was performed. The values of the line angles used in Steiner cephalometric analysis were compared for which values of each angle remained unchanged when done using TCs and without TC to the same samples. Conclusions : Lead shielding of the thyroid gland does not affect landmark identification or the specific measurements of the angulations traced during cephalometric analysis. TCs should be routinely applied during cephalometric radiography if cephalometric analyses are limited to the structures above the second cervical vertebra.

Epithelioid hemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioid hemangioendothelioma and discuss the imaging findings. CT brain plain study revealed a poorly-defined, mixed density expansile and lytic lesion involving the occipital bone with extension to the left side with poorly defined trabecula formation. There was significant but irregular enhancement after intravenous administration of contrast material and also marked bone destruction. Microscopic examination of the fine needle aspiration cytology showed a tumor composed of vascular channels lined by plump endothelial cells, which had enlarged hyperchromatic nuclei. In view of the extensive infiltration the patient was submitted for the radiotherapy.

We present an illustrative case of osteoid osteoma of the femur, in an 11 year old male child where the clinical features were masquerading the diagnosis of tethered cord syndrome and lead to the delay in diagnosis.

Introduction. Patients presenting with massive hemoptysis in outpatient department (OPD) need urgent care. Conservative management of massive hemoptysis carries a mortality rate of 50%–100%. Bronchial artery embolization (BAE) has become an established procedure in the management of massive and recurrent hemoptysis. Here, we are presenting our experience of bronchial artery embolization in 11 patients presented in outpatient department with massive hemoptysis. Material and Methods. In our hospital-based cross-sectional study, 11 patients had undergone procedure for bronchial artery embolization in the Department of Interventional Radiology (TIFAC-CORE). Recruitment was done by using consecutive sampling in which the patients were chosen on a strict “first come, first chosen” basis and willing to undergo the procedure. Results. Bronchial arteriography and embolization were well tolerated by our patients. An immediate control of active bleeding was achieved with embolization in 10 cases (91%). 1 patient had recurrent hemoptysis after one month and ultimately required surgical resection for mycetoma. Conclusion. Patients with massive hemoptysis due to pulmonary TB can best be treated with BAE. Recurrence of massive hemoptysis is infrequent. However, if it does occur, then patients are best treated with surgery.

Rheumatiod arthritis (RA) is a multisystem connective tissue disorder. The predominant presentation is polyarticular, symmetric peripheral arthritis with relative sparing of axial skeleton. Inflammatory synovitis is the pathologic hallmark. Extra-articular manifestations of RA can involve several other organ systems and amongst them pulmonary manifestations occur commonly. We report a case of rheumatoid interstitial lung disease presenting as cor pulmonale.

Purpose To assess the diagnostic quality of images generated using the newly developed digital volume tomography (DVT) system and comparing them with conventional images from patients with maxillofacial trauma. Materials and Methods The study population included 22 male patients aged 18 to 60 years with a history of maxillofacial trauma. Each patient had undergone conventional radiographic and DVT examinations to analyze the number of fracture lines in the jaws and to compare the images for their diagnostic quality by an oral radiologist and a general radiologist using the χ2 test. Results A statistically significant difference was found between the number of fracture lines evaluated on the conventional radiographs and on DVT, especially for condylar head (7) and the midface (4.41 to 4.57), zygomaticomaxillary complex and Le Fort fractures, respectively. Conclusions The detection of fracture lines and visualization within the mandibular-maxillary area using DVT was superior to using conventional radiographs.

Cystic nephroma, also called multilocular cystic nephroma, is a relatively rare, nongenetic, benign, unilateral, renal multicystic lesion. The non-specific clinical findings and the poor contribution of imaging examinations make the preoperative diagnostic dilemma from other cystic renal neoplasia; thus nephrectomy seems to be the most preferable treatment. We report a case of cystic nephroma in 11 months old male child presented with asymptomatic lump in abdomen. After a series of examinations including abdominal ultrasound, intravenous pylography and computed tomography, he underwent radical nephrectomy and diagnosis is confirmed on histopathology.

Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal pathology characterized by paravertebral osteophyte formation and calcification and ossification of the anterior longitudinal vertebral ligament. It is being increasingly recognized as a cause of dysphagia and rarely leads to obstructive airway symptoms such as snoring, dyspnea on exertion, and laryngeal stridor. We report an unusual case presenting with acute respiratory distress due to obstructing laryngeal edema and bilateral arytenoid sclerosis, with the fixation of left cricoarytenoid joint in association with DISH.

Angiolymphoid hyperplasia with eosinophilia is a rare disease characterized by vascular proliferation of unknown origin. The lesions are mostly seen in the head and neck region and are characterized by papules or nodules. A 20-year-old man presented with a 1 year history of reddish papulo-nodular lesions overlying a pulsatile swelling on the left auricular area. Histopathology was suggestive of angiolymphoid hyperplasia with eosinophilia. B-mode ultrasonography, color Doppler and angiography revealed arterial ectasia and arteriovenous malformation of the left auricular artery. Such malformations have been reported previously, in association with angiolymphoid hyperplasia with eosinophilia. The cutaneous lesions responded well to transarterial embolization of the nidus.