Clinical spectrum of admitted patients undergoing Xpert MTB/RIF® testing for tuberculosis evaluation at a tertiary care hospital

Background: The introduction of Xpert MTB/RIF® has revolutionised the diagnosis of tuberculosis (TB) by reducing time to the identification and detection of drug resistance. Methods: We prospectively studied clinical profile of admitted patients who underwent Xpert MTB/RIF® for the diagnosis of TB in the Department of Medicine and Allied Specialties at our tertiary care teaching hospital in Ludhiana. Results: During the period from January to December 2018, 140 patients (mean age 55.7 ± 16 years; male: female = 1.5:1) were included. Type 2 diabetes mellitus was the most common comorbid disease (n = 37; 26.4%). The most common presenting complaints were fever, breathlessness and cough with expectoration. Overall, 61 admitted patients were discharged with a diagnosis of TB; 26/61 (42.6%) tested Xpert MTB/RIF® positive (bacteriologically confirmed); the remaining 35 (57.4%) were clinically diagnosed along with the ancillary supportive investigations. The remaining 79 patients had a non-TB diagnosis. In extrapulmonary TB, Xpert MTB/RIF® had low detection and positivity rate as compared to other ancillary investigations for TB. Conclusions: Xpert MTB/RIF® was useful in the diagnosis in 42.6% of cases. When Xpert MTB/RIF® was negative, TB was diagnosed empirically on the basis of clinical, radiological and ancillary laboratory investigations. Xpert MTB/RIF® positivity with the clinical background suggesting that TB makes the diagnosis rapidly and with a high degree of confidence

Role of GRE imaging in cerebral diseases with hemorrhage: A case series

Gradient recalled echo (GRE) T2 weighted imaging is more widely used as a standard magnetic resonance (MR) pulse sequence because of its exquisite sensitivity for detection of cerebral hemorrhages. Signal loss on GRE sequence is due to increased sensitivity of this sequence to magnetic susceptibility induced by static field inhomogeneities arising from paramagnetic blood breakdown products. T2 FNx01 signal intensity loss seen in GRE sequence is greater with longer TE, smaller flip angle, and larger magnetic field strength. The purpose of this review is to discuss the role of GRE imaging in cerebral disorders with bleed. Because of the sensitivity of this sequence to microbleeds, we describe its edge over baseline imaging sequences to provide insight in the etiology of certain diseases

Obstructive jaundice: Its etiological spectrum and radiological evaluation by magnetic resonance cholangiopancreatography

Background: Magnetic resonance cholangiopancreatography (MRCP) has reached a level of resolution and reliability where it may replace diagnostic endoscopic retrograde cholangiopancreatography. We studied the role of MRCP in adult patients with obstructive biliopathy to analyze its etiological spectrum and radiological findings. Materials and Methods: Total fifty patients referred for mrcp with a clinical diagnosis of obstructive jaundice were included in our study. Imaging findings were correlated with the final diagnosis made by histopathological or cytological findings and with the therapeutic outcome. Aim: To evaluate the role of MRCP in the determination of the etiological spectrum, to evaluate level and degree of biliary obstruction in cases of obstructive jaundice and to correlate findings on mrcp with surgical findings where possible. Results: Of fifty patients, 29 were benign lesions and 21 were malignant lesions. Among the benign lesions, 12 had choledocholithiasis and 16 had benign strictures. One case was of a choledochal cyst. Among the malignant lesions, 12 were gallbladder carcinoma, six were cholangiocarcinoma, two were periampullary carcinoma, and one was a case of metastatic deposit. The overall sensitivity of MRCP was 96.5%, specificity was 95.2%, and with an accuracy of 96% for benign lesions. The accuracy, sensitivity, and specificity of MRCP in the diagnosis of benign strictures was 92%, 93.7%, and 91.2%, for choledocholithiasis was 92%, 75%, and 97.3%, and for malignant lesions was 95.2, 96.5%, and 96%, respectively. Conclusion: MRCP is a relatively quick, accurate, and noninvasive imaging modality for the assessment of obstructive jaundice, in ruling out potentially correctable underlying cause

Dyke–Davidoff–Masson syndrome: Classical imaging findings

A 15-year-old female presented with seizures, right-sided hemiparesis, hemiatrophy of the right side of the body and mental retardation. MRI brain revealed characteristic features diagnostic of congenital type of cerebral hemiatrophy or Dyke–Davidoff–Masson syndrome

Bilateral optic nerve infarction in rhino-cerebral mucormycosis: A rare magnetic resonance imaging finding

Mucormycosis is an emerging disease in diabetes and immunocompromised patients. Rhino-orbito-cerebral mucormycosis is one of the common forms of the disease. Mucormycosis leading to ischemic optic neuropathy is a rare complication. The role of magnetic resonance imaging (MRI) in the diagnosis of ischemic optic neuropathy is limited and uncommonly reported. We report an unusual case of mucormycosis in which MRI revealed bilateral optic nerve infarction, in addition to perineural extension of the fungus along the trigeminal nerve, another uncommon imaging finding