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Introduction: Low Back Pain (LBP) caused by Lumbar Disc Herniation (LDH) is a major cause of chronic disability worldwide. The management of LDH depends on clinical assessment and Magnetic Resonance Imaging (MRI) findings. Atrophy or fatty replacement of paraspinous muscles has a negative impact on the outcomes of both conservative and surgical treatment for LBP due to LDH. Aim: To analyse the morphological changes in paraspinous muscles using MRI in patients with chronic LBP and unilateral LDH. Materials and Methods: A cross-sectional study was conducted at Vardhman Mahavir Medical College and Safdarjung Hospital in New Delhi, India, from December 2020 to May 2022. A total of 59 patients, aged 21-65 years, with chronic LBP and unilateral LDH on MRI, were included in the study. The morphological changes in the Multifidus Muscle (MM) and Erector Spinae Muscle (EM) were analysed. The Cross-Sectional Area (CSA) of MM and EM, as well as the Signal Intensity (SI) of MM on the herniated side of the lumbar disc, were recorded and compared to the contralateral side at the same level. Continuous variables were expressed as mean±SD, median, and interquartile range, while categorical variables were presented as numbers and percentages. The Mann-Whitney test was used to compare continuous variables, and a p-value of

Ovarian hyperstimulation syndrome (OHSS) is a syndrome usually related to induction of ovulation for in-vitro fertilization. Its occurrence is rare in pregnant females. To our knowledge, only twelve cases of spontaneous OHSS (without any ovulation induction therapy) in non-pregnant women with primary hypothyroidism exist in the published literature. This case study illustrates the association of spontaneous OHSS with primary hypothyroidism in a 17 year old female, which showed complete resolution after initiation of thyroxine therapy. Hence, we need to emphasize the need for clinicians and radiologists to enlighten themselves with the clinical symptomatology and imaging findings of spontaneous OHSS in primary hypothyroidism, which is still not well-known medical and radiological condition. Sufficient knowledge of the clinical and imaging findings of OHSS helps in prompt diagnosis and avoids advancement to life threatening complications and unwanted surgery.

Abstract Land surface models such as the Community Land Model Version 5 (CLM5) are essential tools for simulating the behavior of the terrestrial system. Despite the extensive application of CLM5, limited attention has been paid to the underlying uncertainties associated with its hydrological parameters and how these uncertainties affect water resource applications. To address this long-standing issue, we use five meteorological datasets to conduct a comprehensive hydrological parameter uncertainty characterization of CLM5 over the hydroclimatic gradients of the conterminous United States. Key datasets produced from the uncertainty characterization experiment include: a benchmark dataset of CLM5 default hydrological performance, parameter sensitivities for 28 hydrological metrics, and large-ensemble outputs for CLM5 hydrological predictions. The presented datasets will assist CLM5 calibration and support broad applications, such as evaluating drought and flood vulnerabilities. The datasets can be used to identify the hydroclimatological conditions under which parametric uncertainties demonstrate substantial effects on hydrological predictions and clarify where further investigations are needed to understand how hydrological prediction uncertainties interact with other Earth system processes.

Abstract Background There are many causes for cyclic pelvic pain unresponsive to anti-spasmodic medications in young women. An uncommon, although significant, association in patients presenting with such symptoms is structural uterine anomalies with rudimentary functional cavities. Ultrasound is the first-line modality for the investigation of dysmenorrhea, and the radiologist may be the first person to identify such an underlying condition in the patient. However, transabdominal ultrasound may provide only limited information. Magnetic resonance imaging (MRI) is the imaging modality of choice in such situations due to its high soft tissue resolution and multiplanar capability. This case series is unique in that it primarily highlights the MR imaging of rare structural uterine anomalies in three young females suffering from severe dysmenorrhea, along with an imaging approach. Case presentation We present three cases of unresolving cyclic pain in young nulliparous females who were radiologically diagnosed with three rare uterine structural anomalies—accessory and cavitated uterine mass, Mayer–Rokitansky–Küster–Hauser syndrome, and functional non-communicating rudimentary horn in a hemiuterus or unicornuate uterus, which were treated with resection leading to symptom relief. Conclusion In young women with recurrent cyclic pelvic pain, uterine structural abnormalities with functioning cavities should be considered as an etiology and evaluated with MRI. Owing to the non-specific nature of causes of dysmenorrhea, a schematic approach to imaging is essential for identifying the various underlying gynecological conditions, thus aiding in the prompt management of the patient.

Abstract Land surface models such as the Community Land Model version 5 (CLM5) seek to enhance understanding of terrestrial hydrology and aid in the evaluation of anthropogenic and climate change impacts. However, the effects of parametric uncertainty on CLM5 hydrologic predictions across regions, timescales, and flow regimes have yet to be explored in detail. The common use of the default hydrologic model parameters in CLM5 risks generating streamflow predictions that may lead to incorrect inferences for important dynamics and/or extremes. In this study, we benchmark CLM5 streamflow predictions relative to the commonly employed default hydrologic parameters for 464 headwater basins over the conterminous United States (CONUS). We evaluate baseline CLM5 default parameter performance relative to a large (1,307) Latin Hypercube Sampling‐based diagnostic comparison of streamflow prediction skill using over 20 error measures. We provide a global sensitivity analysis that clarifies the significant spatial variations in parametric controls for CLM5 streamflow predictions across regions, temporal scales, and error metrics of interest. The baseline CLM5 shows relatively moderate to poor streamflow prediction skill in several CONUS regions, especially the arid Southwest and Central U.S. Hydrologic parameter uncertainty strongly affects CLM5 streamflow predictions, but its impacts vary in complex ways across U.S. regions, timescales, and flow regimes. Overall, CLM5's surface runoff and soil water parameters have the largest effects on simulated high flows, while canopy water and evaporation parameters have the most significant effects on the water balance.

The involvement of the neurological system by coronavirus has been well established. Since its onset, the systemic manifestations of coronavirus disease 2019 (COVID-19) have been evolving rapidly and imaging plays a pivotal role in diagnosing the various primary and secondary effects of the disease. As the pandemic continues to defy human civilization, secondary impacts of the disease and the treatment given to patients afflicted with the disease have stemmed up. Rhino-orbital-cerebral mucormycosis is one such potentially dangerous infection now commonly seen in COVID-19 patients, especially the ones treated with immunosuppressants. Early diagnosis is key for COVID-19-associated mucormycosis (CAM), and radiologists should be well aware of its alarming neurological manifestations from the involvement of parenchyma, meninges, vessels, cranial nerves, and skull base. This review highlights the magnetic resonance imaging features of neuraxial involvement in CAM.

Abstract Background The Ewing sarcoma family of tumors comprises a group of high-grade small round cell tumors, including Ewing sarcoma of bone, extra-skeletal Ewing sarcoma, peripheral primitive neuro-ectodermal tumor (PNET), and Askin tumor (thoraco-pulmonary PNET). They are more prevalent in young children and adolescents. Ewing's Sarcoma is an aggressive tumor majorly described in bones. Primary renal Ewing's sarcoma is an extremely rare entity, characterized by a very aggressive course, with very few reported cases in the literature. Case presentation We present an 18-year-old girl who presented with sudden onset left flank pain and hematuria. The patient had histopathology-proven primary renal Ewing's sarcoma, which was initially misdiagnosed as renal cell carcinoma on imaging. Conclusions Owing to its non-specific radiological appearance, a high index of suspicion and a systematic approach is essential for detection of renal Ewing’s Sarcoma.

Introduction: Few studies exist in current literature regarding imaging features in Transient Ischaemic Attack (TIA) and most of the previous studies on Computed Tomography Perfusion (CTP) have used old generation scanners with limited brain coverage. Aim: To study the spectrum of whole brain CTP parameters in patients presenting with TIA using a 256 slice CT scanner. Materials and Methods: This cross-sectional observational study was conducted on 15 patients, tertiary care centre in New Delhi, India over a period of 18 months from October 2017 till March 2019. All patients presenting with the first episode of TIA were evaluated with Non Contrast Computed Tomography (NCCT), Whole brain CTP, and Colour doppler of carotid vessels. Quantitative assessment and statistical analysis of the alteration of CT perfusion parameters was done in areas of visualised Focal Perfusion Abnormalities (FPA) and seven predefined locations in bilateral hemispheres on perfusion maps. Results: Five out of 15 patients had FPAs in the colour maps and there was a significant elevation of Cerebral Blood Flow (CBF) and Cerebral Blood Volume (CBV) in the FPA region (p-value=0.018) suggestive of postischaemic hyperperfusion. The mean hemispheric CBF was increased in the abnormal hemisphere compared to the normal hemisphere (p-value=0.04). Conclusion: CTP parameters are significantly altered in the patients with TIA with predominant increase in CBF and CBV in the patients who have FPA on CTP. CTP shows postischaemic hyperperfusion changes in the form of increased CBF in the hemisphere corresponding to the symptoms.

Abstract Background The aim of our study was to determine the value of single-voxel proton MR spectroscopy (1HMRS) in distinguishing benign from malignant focal bone lesions in the peripheral skeleton. MRI and 1HMRS was performed in 50 focal lesions (> 1 cm size) detected on radiographs of peripheral skeleton.1HMRS was performed at 1.5 T with TE of 144 ms with automatic shimming and water suppression. Qualitative analysis for a discrete choline peak at 3.2 ppm was done. Significance of the presence of choline peak on 1HMRS in distinguishing benign from malignant lesions was calculated using histopathology as a gold standard. Chi-square test was used and p value

Bioimage analysis of fluorescent labels is widely used in the life sciences. Recent advances in deep learning (DL) allow automating time-consuming manual image analysis processes based on annotated training data. However, manual annotation of fluorescent features with a low signal-to-noise ratio is somewhat subjective. Training DL models on subjective annotations may be instable or yield biased models. In turn, these models may be unable to reliably detect biological effects. An analysis pipeline integrating data annotation, ground truth estimation, and model training can mitigate this risk. To evaluate this integrated process, we compared different DL-based analysis approaches. With data from two model organisms (mice, zebrafish) and five laboratories, we show that ground truth estimation from multiple human annotators helps to establish objectivity in fluorescent feature annotations. Furthermore, ensembles of multiple models trained on the estimated ground truth establish reliability and validity. Our research provides guidelines for reproducible DL-based bioimage analyses.

The application of magnetic resonance imaging (MRI) in pregnancy faced initial skepticism of physicians because of fetal safety concerns. The perceived fetal risk has been found to be unwarranted and of late, the modality has attained acceptability. Its role in diagnosing fetal anomalies is well recognized and following its safety certification in pregnancy, it is finding increasing utilization during pregnancy and puerperium. However, the use of MRI in maternal emergency obstetric conditions is relatively limited as it is still evolving. In early gestation, ectopic implantation is one of the major life-threatening conditions that are frequently encountered. Although ultrasound (USG) is the accepted mainstay modality, the diagnostic predicament persists in many cases. MRI has a role where USG is indeterminate, particularly in the extratubal ectopic pregnancy. Later in gestation, MRI can be a useful adjunct in placental disorders like previa, abruption, and adhesion. It is a good problem-solving tool in adnexal masses such as ovarian torsion and degenerated fibroid, which have a higher incidence during pregnancy. Catastrophic conditions like uterine rupture can also be preoperatively and timely diagnosed. MRI has a definite role to play in postpartum and post-abortion life-threatening conditions, e.g., retained products of conception, and gestational trophoblastic disease, especially when USG is inconclusive or inadequate.

An 8-year-old girl presented with a scalp swelling. The swelling was recurrent, reappearing everytime after local excision. She underwent surgery and the histopathologic diagnosis was malignant hidradenoma. This very rare and aggressive tumor is known to occur in elderly population and is histopathologically distinct from its commonly occuring benign counterpart. Malignant hidradenoma is resistant to chemotherapy and radiotherapy. We empahsize that being cognizant of the possibility of this rare tumor would assist in timely action in the form of wide resection, with possible reduction in morbidity and mortality.

Background: Postural drainage is used exclusively or in combination with other airway clearance techniques in the management of chronic pulmonary diseases. Postural drainage therapy helps to prevent accumulation of secretions in patients who are at high risk for pulmonary complications. It also helps to remove accumulated secretions from the lungs.The role of body positioning on lung function and the clinical implications of postural drainage has been identified in a variety of settings including intensive care units. There is dearth in literature on effects on postural drainage on vital parameters. Thus the objective of the study was to measure the vital parameters at different postural drainage positions in healthy asymptomatic adults. Methods: Twenty healthy subjects participated in the study. The instruments used in the current study included a Pulse oximeter, Sphygmomanometer, Stethoscope, Postural drainage table.The outcome measures of interest were heart rate, respiratoryrate, oxygen saturation, blood pressure and Borg’s scale of rate of perceived exertion. The changes in the vital signs were recorded at different head down titling position of 0°, 15° & 30° in both supine and prone lying positions Results: Statistical significant difference was found for Systolic Blood Pressure in prone lying at different degrees of tilt (p=0.001) and Diastolic Blood Pressure in prone lying (p=0.000). Conclusion: Postural drainage positioning should be given with caution and under proper monitoring as there is a risk of change in the blood pressure even in asymptomatic elderly population. The monitoring of vital signs should be done during the therapy to decrease the risk of complications.

We present here a case of an uncommon complex uterine anomaly - Obstructed HemiVagina with Ipsilateral Renal Agenesis (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome in a 14-year-old girl along with sonographic (trans-abdominal and trans labial), and MRI findings. The patient underwent surgery wherein imaging findings were confirmed. An MRI has proved to be of great help in correct diagnosis avoiding surgical interventions/ laparoscopy, which were needed in past to diagnose this rare anomaly. We also discuss the development of this anomaly with the help of a relatively new theory of uro-genital development by Acien and review the literature.

Objectives: To determine the population at risk, risk factors, and outcome of occupational exposure to blood and body fluids in health care providers. Materials and Methods: Retrospective review of two and half year data of ongoing surveillance of occupational exposure to blood and body fluids in a tertiary care hospital. Results: 103 Health Care Providers (HCP) reported an occupational exposure to blood and body fluids during the period under review. These comprised 72 (69.9%) doctors, 20 (19.4%) nursing personnel, and 11 (10.6%) cleaning staff. Of the doctors, 65% were interns. 53.4% HCP had work experience of less than one year. Circumstances of exposure included clinical procedures (48%), sweeping/handling used sharps (29%), recapping (16%), and surgery (6.9%). 74.3% of the exposures were due to non-compliance with universal precautions and were thus preventable. The device most frequently implicated in causing injury was hollow bore needle (n=85, 82.5%). Human Immunodeficiency Virus (HIV) status of the source was positive in 6.8% cases, negative in 53.4% cases, and unknown in remaining 39.8% cases. Postexposure prophylaxis (PEP) was indicated in 100 (97.08%) cases and was initiated within 2 h of exposure in 26.8% HCP. In 23.2% HCP, PEP initiation was delayed beyond 72 h of exposure due to late reporting. Thirteen HCP received expanded and the remaining received basic regime. Of the 82 HCP followed up, 15 completed the full course, while 55 stopped PEP after the first dose due to negative source status. Twelve HCP with exposure to blood of unknown HIV status discontinued PEP despite counseling. Complete follow-up for seroconversion was very poor among the HCP. HIV status at 6 month of exposure is not known for any HCP. Conclusions: Failure to follow universal precautions including improper disposal of waste was responsible for majority of occupational exposures. HCP need to be sensitized regarding hospital waste management, management of occupational exposure, need for PEP, and continued follow-up.

A renal tumor in a 14-month- old child, who was initially diagnosed as mesoblastic nephroma, but on review post surgery was diagnosed as hyper-differentiated metanephric stromal tumor, with its excellent prognostic outcome. An attempt is made to document imaging features that may enable one to suspect this rare condition. The literature is reviewed with emphasis on its distinction from its look-alikes in the pediatric age group.

Hemangiomatosis is an uncommon entity in which there is diffuse infiltration of soft tissue or bone by hemangioma. Kasabach-Merritt syndrome is an uncommon complication of large hemangiomas, in which there is thrombocytopenia and coagulopathy. Plain radiographs, in addition to showing a soft tissue mass, also show a variety of findings in the bones. MRI is the investigation of choice. A case of a 2-year-old child suffering from hemangiomatosis and a resultant Kasabach-Merritt syndrome is presented.

Introduction: Low Back Pain (LBP) caused by Lumbar Disc Herniation (LDH) is a major cause of chronic disability worldwide. The management of LDH depends on clinical assessment and Magnetic Resonance Imaging (MRI) findings. Atrophy or fatty replacement of paraspinous muscles has a negative impact on the outcomes of both conservative and surgical treatment for LBP due to LDH. Aim: To analyse the morphological changes in paraspinous muscles using MRI in patients with chronic LBP and unilateral LDH. Materials and Methods: A cross-sectional study was conducted at Vardhman Mahavir Medical College and Safdarjung Hospital in New Delhi, India, from December 2020 to May 2022. A total of 59 patients, aged 21-65 years, with chronic LBP and unilateral LDH on MRI, were included in the study. The morphological changes in the Multifidus Muscle (MM) and Erector Spinae Muscle (EM) were analysed. The Cross-Sectional Area (CSA) of MM and EM, as well as the Signal Intensity (SI) of MM on the herniated side of the lumbar disc, were recorded and compared to the contralateral side at the same level. Continuous variables were expressed as mean±SD, median, and interquartile range, while categorical variables were presented as numbers and percentages. The Mann-Whitney test was used to compare continuous variables, and a p-value of <0.05 was considered statistically significant. Results: The mean age of the study participants was 39.17±12.82 years, with 59.3% male and 40.7% female participants. The CSA of MM on the side of disc herniation was 5.84±1.53 cm², compared to 6.52±1.69 cm² on the unaffected side (p=0.02). The CSA of EM on the side of unilateral disc herniation was 13.08±3.04 cm², compared to 14.29±3.22 cm² on the unaffected side (p=0.01). The SI of MM on the affected side was 175.84±100.99, compared to 147.70±83.50 on the unaffected side (p=0.02). Conclusion: Chronic LBP due to unilateral LDH resulted in a reduction in the Cross-Sectional Area (CSA) and fatty infiltration of the ipsilateral paraspinous muscles. [ABSTRACT FROM AUTHOR]