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Interpretation of Chest X Ray (CXR) in relation to sputum smear microscopy can be useful in early diagnosis of pulmonary TB. The study aimed to compare the CXR findings in pulmonary TB cases with positive sputum microscopy and negative sputum microscopy. Patients with presumptive pulmonary TB were grouped into smear positive pulmonary TB and smear negative pulmonary TB groups based on CXR and sputum smear microscopy. CXR findings in the two groups were compared using chi square and students- t test. A total of 225 patients with presumptive pulmonary TB were evaluated. Of these, 174 subjects were included in the study: 129 (74.2%) in smear positive pulmonary TB group and 45(25.8%) in smear negative pulmonary TB group. Parenchymal involvement was the most common finding in both smear positive and smear negative groups seen in 118 (91.5%) and 42 (93.3%) subjects, respectively. The area of parenchymal involvement was significantly more in smear positive group as compared to smear negative group (p CXR could detect 25.8% smear negative pulmonary TB cases. Extensive parenchymal infiltration and cavitation were more commonly associated with smear positive patients whereas nodal involvement was significantly more common in smear negative patients.

Supratentorial glioblastoma is a common primary intracranial tumor in adults. High-grade glioma in cerebellopontine angle (CPA) is rare. We describe a case of adult-type diffuse high-grade glioma of CPA in a 49-year-old female that was managed surgically at our institute. Glioblastoma is an infiltrating type of glioma (WHO grade 4). MRI helped in characterizing the lesion; however, diagnosis was confirmed on histopathology. This report aims at the imaging pattern of primary adult-type diffuse high-grade glioma (WHO grade 4) at cerebellopontine angle.

Objectives: The performance of shear wave elastography (SWE) for peripheral nerve pathology, predominantly compressive neuropathy, has been studied with the median nerve, sciatic nerve, and tibial nerve. However, studies for ulnar nerve are limited in literature. The aim of the study was to study the performance of SWE for ulnar nerve in arm by analyzing the correlation of elasticity value by two transducers of the same ultrasound system. Material and Methods: This was a prospective observational study. Elasticity of ulnar nerve was measured in the mid-arm and supracondylar region in longitudinal and transverse planes with two different transducers of the same ultrasound system. The reliability of measurement was assessed by interclass correlation of values obtained. Results: Ninety-two ulnar nerve measurement sets were analyzed. The ages of the patients ranged from 14 years to 76 years, with a median age of 50. The SWE values obtained by two probes showed a weak interclass correlation coefficient value Conclusion: Quantitative SWE measurements of the ulnar nerve in the arm by two transducers showed a weak interclass correlation. It should be used with caution as a diagnostic tool with a universally acceptable cut off values.

Introduction: Inflammatory back pain (IBP) is a prominent clinical symptoms in patients with spondyloarthropathy (SpA) affecting young adults and is an important cause of morbidity in the productive age group. SpA characteristically involves sacroiliac joints (SIJs). For the diagnosis of early sacroiliitis, though magnetic resonance imaging (MRI) is the preferred method, conventional radiography has been routinely used for the evaluation of sacroiliitis. Active inflammation in SIJs cannot be assessed on radiographs and they usually appear normal in the early phase of IBP. This study aims to study the clinical and radiographic patterns of IBP in Indian scenario. Materials and Methods: Treatment naive patients with low back pain and subsequently diagnosed with IBP as per Calin criteria were identified. The clinical and laboratory parameters of these patients were recorded. SIJ radiographs of these patients were analyzed. Results: Fifty-two patients were registered with 57% of subjects being female. The mean age of onset of symptoms was 32–33 years with a mean duration of symptoms being 40.9 months. No significant difference was noted in the age of onset or duration of illness in males and females. Human leukocyte antigen-B27 (HLA-B27) positivity rate was only 8.7%. About 38.4% of cases demonstrated active inflammation at presentation. Most of the cases (94.2%) though presented for the first time had radiographic evidence of sacroiliitis. A maximum number of cases (38.4%) were seen in Grade 2, followed by Grade 3 (30.8%). Cases with symmetrical sacroiliitis were more (57.1%) as compared to asymmetrical/unilateral sacroiliitis. HLA-B27 positivity in symmetric cases was 10.9% as against 12.5% in asymmetric cases. Conclusions: There is often delay in the diagnosis of sacroiliitis. This is, in contrast, to profile in developed nations where early detection of the disease occurs ultimately leading to the usefulness of early therapy. Appropriate measures need to be taken in the health-care sector to increase awareness among people and treating physicians and sensitize them to IBP and its associated morbidities. In the present scenario, where the majority of cases are presenting in the chronic stage of the disease, radiography may be advocated in resource poor areas to decrease burden and cost related to the use of MRI.

Introduction: The paucibacillary nature presents a major challenge in the diagnosis of tuberculosis (TB) in children. The utilization of cartridge-based nucleic acid amplification test (CBNAAT) for the diagnosis of TB presents itself with added advantages such as detection to resistance to rifampicin and short turnaround time. Objectives: The aim of the study is to evaluate the diagnostic yield of CBNAAT in various body fluids and to compare with BACTEC-MGIT 960 and acid-fast bacilli (AFB) microscopy in children with suspected TB and to see the prevalence of rifampicin resistance in the study population using CBNAAT. Materials and Methods: This cross-sectional study included participants

Objectives: The aim of this observational study was ultrasound evaluation of peripheral nerves cross-sectional area (CSA) in subjects with probable diabetic peripheral sensorimotor neuropathy (DPN). CSA was analyzed with reference to clinical and nerve conduction study’s (NCS) parameters for early diagnosis and pattern of involvement. Methods: A total of 50 patients with probable DPN due to Type 2 diabetes and 50 age-matched healthy controls underwent sonographic examinations of ulnar nerve at the lower arm, median nerve proximal to carpal tunnel, the common peroneal nerve proximal to fibular head, tibial nerve proximal to the tarsal tunnel, and sural nerve at lower third leg. Results: CSA was increased in cases of DPN as compared to healthy controls. Area changes were more marked with demyelinating pattern. Probable DPN cases with normal NCS had significantly higher number of peripheral nerves showing increased CSA as compared to healthy control. A cut-off of >4 nerve thickening showed a sensitivity of 86 %, and specificity of 56%. The neuropathy pattern in the lower limb was axonal, whereas in the upper limb, it was demyelinating with the majority showing sonographic feature of associated compressive neuropathy. Conclusion: There is an increase in CSA of peripheral nerve in diabetic patients. It can be used as a morphological marker for classifying DPN with changes being picked up earlier to NCS abnormality. Clinical neurological presentation in probable DPN can also be due to compressive neuropathy in early phases, and ultrasound can be a useful tool. Advances in knowledge: Early pick up of DPN cases shall be useful for early therapy and motivating the patients to actively participate in the treatment. Morphological changes on ultrasonography precedes the electrodiagnostic change in DPN. Symptoms of DPN is not only due to metabolic changes but also compressive neuropathy.

Esophageal lung is a rare variety of communicating bronchopulmonary foregut malformation with anomaolous communication between an isolated portion of respiratory tissue and esophagus. Children present in early life with recurrent cough and pneumonia. Majority of the reported cases are associated with other anomalies like tracheoesophageal fistula. We report a case of a 7-month-old girl with right sided esophageal lung who was misdiagnosed as dextrocardia with right sided pneumonitis.

ObjectivesTo evaluate pharmacokinetics of first-line antitubercular drugs, isoniazid (INH) and pyrazinamide (PZA), with revised WHO dosages and to assess its adequacy in relation to age and nutritional status.DesignObservational study.SettingThis study was conducted at Sarojini Naidu Medical College, Agra, and National Institute for Research in Tuberculosis, Chennai.Patients40 subjects diagnosed with tuberculosis were registered in the study and started on daily first-line antitubercular regimen based on the revised WHO guidelines.InterventionsBlood samples were collected at 0, 2, 4, 6 and 8 hours from these subjects after 15 days of treatment for drug estimations.Main outcome measureThe measurement of drug concentrations (maximum peak concentration (Cmax) and area under the time –concentration curve (AUC0–8 hours)) for INH and PZA. Appropriate statistical methods were used to evaluate the impact of age and nutritional status on pharmacokinetic variables.ResultsFor INH, the difference in drug exposures in children max 3.18 µg/mL and AUC0–8 hours15.76 µg/mL hour) and children >3 years (Cmax3.05 µg/mL and AUC0–8 hours 14.37 µg/mL hour) was not significant (P=0.94, P=0.81, respectively). The drug levels in children with low body mass index (BMI) (Cmax3.08 µg/mL; AUC0–8 hours14.81 µg/mL hour) were also comparable with their normal counterparts (Cmax3.09 µg/mL, P=0.99; AUC0–8 hours 14.69 µg/mL hour, P=0.82). PZA drug exposures obtained in children less than 3 years (Cmax29.22 µg/mL, AUC0–8 hours 155.45 µg/mL hour) were significantly lower compared with drug levels in children above 3 years (Cmax 37.12 µg/mL, P=0.03; AUC 202.63 µg/mL hour, P value=0.01). Children with low BMI had significantly lower drug concentrations (Cmax 31.90 µg/mL, AUC0–8 hours167.64 µg/mL hour) when compared with normal counterparts (Cmax 37.60 µg/mL, P=0.02; AUC0–8 hours 208.77 µg/mL hour, P=0.01).ConclusionsThe revised WHO drug dosages were found to be adequate for INH with respect to age and nutritional status, whereas PZA showed significantly lower drug levels in children

Introduction: Globus pharyngeus is a common condition affecting around 46% of healthy individuals. Most common symptom is feeling of lump in throat. It is a diagnostic challenge and is difficult to treat. Barium swallow is one of the investigations which can rule out organic pathology. It is a safe procedure with rare complications. Aim: To assess the utility of barium swallow in patients with globus like symptoms and normal Ear, Nose, Throat (ENT) examination. Materials and Methods: A prospective study was done at a tertiary care hospital in the state of U.P. in India on 100 patients who came to the ENT Out-Patient Department (OPD) with complaints of throat pain, sticking sensation in the throat or a feeling of lump in the throat. Patients were examined clinically which included an indirect laryngoscopy examination. They were advised routine blood investigations and a barium swallow. The association between chief complaints of the study participants i.e., symptoms reported and findings of barium swallow (normal/ abnormal) were analysed using cross-tabulations and chisquare test where p-value

To find out the prevalence of latent tuberculosis (TB) infection and TB disease among pediatric household contacts of adult drug resistant (MDR) and drug susceptible (DS) TB patients and to identify the risk factors for occurrence of TB infection in the contacts. Pediatric household contacts (less than 15 y age) of adult TB patients (both MDR and DS) were included in the study. They were categorized as latent TB infection (LTBI), TB disease and TB exposed based on the results of tuberculin skin testing (TST), clinical examination and chest X-ray. Various factors (age, gender, socioeconomic status, BCG immunization etc.) were evaluated to assess their association with TB transmission. A total of 271 household contacts were included in the study. Prevalence of LTBI was 20.3% (31% in MDR TB group and 14% in DS TB group); difference was significant (p value = 0.0018). TB disease was seen in 3 subjects in DS group while none in MDR group developed TB disease. Lower socioeconomic status was significantly associated with risk of TB infection in MDR group (p value =0.0027). In DS TB group, male gender, BCG non-immunization was significantly associated with risk of developing TB (p value 0.0068 and 0.0167 respectively). Prevalence of latent TB infection was found to be high in household pediatric contacts especially in contacts of MDR TB patients. Risk factors identified for occurrence of TB included lower socioeconomic status, BCG non-immunization and male gender. The study focuses on the importance of contact screening and the need for its implementation in TB control programs.

Embryonic remnant of the cloaca and the allantois present after birth as a midline fibrous cord is usually detected in infancy and childhood. Failure to obliterate results in urachal disease is rare in adults. Varied remnants of the urachus have been reported. In this case report the usefulness of basic high resolution sonography for initial screening & usefulness of MRI in delineating the length of tract in an adult has been highlighted.DOI: http://dx.doi.org/10.3126/njr.v4i1.11371 Nepalese Journal of Radiology, Vol.4(1) 2014: 56-58

We present a case series of 6 children of Megalencephalic leukoencephalopathy with subcortical cysts. It is a very rare leukodystrophy that is characterized by macrocephaly , a slowly progressive clinical course and fatal outcome. Clinical presentation and MRI scans are the mainstay of diagnosis. 6 of 7 children from the same parents were affected suggesting variation from autosomal recessive pattern.

In this article, we emphasize the usefulness and cost-effectiveness of non-contrast MRI as the primary imaging modality in the evaluation of non-febrile pediatric seizure, illustrate the MR spectrum of different structural lesions causing pediatric seizures, and finally describing the main MR imaging features of these disorders. Among 366 cases of pediatric epilepsy studied over a period of fifteen years the commonly detected structural malformations are mesial temporal sclerosis unilateral and bilateral, heterotopias, cortical dysplasia, neurocutaneous syndromes and few neoplasms. MRI showed hippocampal atrophy and increased signal intensity of the hippocampus on T2-weighted images in mesial temporal sclerosis, cortical thickness and sulcation are decreased in microcephaly, enlarged dysplastic cortex in hemimegalencephaly, and focal cortical dysplasia shows ipsilateral focal cortical thickening with radial hyperintense bands. MRI detects smooth brain in classic lissencephaly, the ectopic position of gray matter in heterotopias, and the nodular cortex with cobblestone cortex in congenital muscular dystrophy. MRI can detect polymicrogyria and the related syndromes, as well as schizencephaly types. In conclusion, MR imaging is essential to demonstrate the morphology, distribution, and extent of different disorders causing seizures in children as well as the associated anomalies and related syndromes to guide patient for further surgical treatment and counseling.

There is an increasing incidence of abdominal tuberculosis with the advent of HIV infection. This study was aimed at determining the pattern of presentation of abdominal tuberculosis on ultrasonography (USG) in HIV positive patients.This retrospective study was carried at the ART Centre, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, between March 2005 to July 2007. HIV positive patients (n=2453) with prolonged fever, abdominal pain/distension, altered bowel habits and diarrhoea underwent ultrasonography for tuberculosis of abdomen. The different ultrasonological findings in abdominal tuberculosis were noted. CD4 counts of these patients were also recorded.Of the total 2453 patients, 244 showed findings suggestive of abdominal tuberculosis. Lymphadenopathy with predominantly hypoechoic/necrotic echotexture was seen in 158/244 (64.8%) patients. Splenomegaly was seen in 68 patients with 61 of them (89.7%) showing multiple hypoechoic lesions in the parenchyma. 53 of 244 (21.7%) showed extensive abdominal involvement. Liver enlargement was seen as a part of extensive abdominal involvement. A total of 203 patients completed antitubercular treatment, of which 198 (97.5%) showed resolution of lesions in USG. CD4 counts in patients with extensive abdominal involvement were lowest compared to CD4 count in patients with others USG findings.Ultrasonological findings like lymphadenopathy (or=1.5 cm) with hypoechoeic/necrotic echotexture, hypoechoic splenic lesions and extensive abdominal involvement in HIV infected patients may be suggestive of abdominal tuberculosis.

Shoulder joint pain is one of the most common complaints that are encountered in orthopedic outpatient department. Clinical examination of the shoulder joint does not provide adequate cause of the shoulder pain. Although magnetic resonance imaging (MRI) is said to be the gold standard for imaging of shoulder joint, with the recent advances in ultrasonography, results of imaging of shoulder joint pathologies are similar or in some cases more precise for the diagnosis compared to MRI. In this pictorial essay, we are presenting a spectrum of various positive findings in patients with painful shoulder based on high-resolution sonographic study of 90 patients at our institute.