Primary Alveolar Hydatid Disease: A Rare Case Series with Review of Imaging Findings

Alveolar hydatid disease is a rare but potentially fatal parasitic infection caused by Echinococcus multilocularis. To the best of our knowledge, only few cases have been reported from India till date. We present 6 cases of pathologically proven alveolar hydatid disease with review of imaging findings. The objective of this case series was to share our experiences of pitfalls in diagnosis of alveolar hydatid disease. Materials and Methods. The study was conducted in Post Graduate Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, Jammu and Kashmir. Our study was conducted between 6th January 2017 to 22nd May 2019. A total of 6 patients were taken up for study. The patients were evaluated clinically and investigated using the relevant imaging modalities. Diagnosis was confirmed by histopathologic examination following core biopsy of lesion. Results. There were two males and four females with most of patients in age group of 20 to 40 years. Imaging findings in our cases suggest that typical radiological appearance of alveolar hydatid disease can be summarized as an irregular hypoattenuating mass lesion having typical calcifications (can be peripheral, as well as central) with tiny cystic components

Nail fold capillaroscopy in patients of systemic sclerosis and its association with disease severity as evidenced by high resolution computed tomography lung: a hospital based cross sectional study

Background: The specific nail fold capillary (NFC) pattern found in systemic sclerosis (SSc), can be examined using a dermascope, which can prove as a simple and cost effective procedure for early diagnosis and proper management of patients with SSc.Methods: A case-control study was conducted on 65 subjects – 10 patients with primary raynauds phenomenon (RP), 40 patients with the SSc and 15 age and gender matched controls. Pattern of NFC using a dermascope was studied in all the subjects. HRCT lung was done in all the SSc patients and the findings were correlated with NFC pattern.Results: Out of the 65 subjects under study, Nail Fold Capillary (NFC) pattern was abnormal in (40/65) 61.54%. NFC changes were seen in all the (100%) patients of SSc. None of the patients with primary raynauds phenomenon had any positive findings on NFC. High resolution computed tomography (HRCT) lung in patients of SSc when correlated with NFC pattern revealed that overall 20 patients (50%) had interstitial lung disease (ILD). Only one patient with early sclerodermoid pattern of NFC showed ILD whereas 55% and 100% of the patients with active and late pattern of NFC respectively showed ILD on HRCT lungs.Conclusions: Our study serves to show that NFC pattern can be used as a screening tool in patients with history of RP for diagnosis of systemic sclerosis. The study has shown an association between advanced changes as observed in NFC pattern and systemic involvement in SSc patients as evidenced by HRCT lung.

Normal Adrenal Versus Adrenal in Acute Abdomen on MDCT

Background: Knowledge of the range of normal size and morphology is useful for adequate interpretation of computed tomography (CT) scans in patients with suspected adrenal pathology.Objective: To compare the size of normal adrenal glands with the cases of acute abdomen on Multidetector CT.Methods: A total of 256 Contrast enhanced CT scans of abdomen where observed. 108 of them were for evaluation of acute abdomen and the rest were reported as normal scans. Adrenal gland measurements were taken at body (at the level of maximum thickness of body), lateral limb and medial limb (a line perpendicular the limb) in both the cases and normal patients.Results: The mean maximum thickness (in mm) of the right adrenal gland body, medial limb, and lateral limb were 5.9 ± 1.6, 4.4 ± 1.4, and 4.8 ± 1.3, respectively, and the mean maximum thickness (in mm) of the left adrenal gland body, medial limb, and lateral limb were 6.7 ± 1.9, 4.9 ± 1.5, and 5.1 ± 1.6, respectively. In cases with acute abdomen mean maximum thickness (in mm) of the right adrenal gland body, medial limb, and lateral limb were 6.2 ± 1.5, 4.2 ± 1.3, and 4.9 ± 1.7, respectively, and the mean maximum thickness (in mm) of the left adrenal gland body, medial limb, and lateral limb were 7.1 ± 1.9, 4.9 ± 1.5, and 5.1 ± 1.9, respectively.Conclusion: There is no significant statistical difference between various measurements of adrenals of normal and cases with acute abdomen

Dual-Energy Multidetector Computed Tomography: A Highly Accurate Non-Invasive Tool for in Vivo Determination of Chemical Composition of Renal Calculi

Introduction. Computed tomography is more accurate than excretory urography in evaluation of renal stones due to its high sensitivity and temporal resolution; it permits sub-millimetric evaluation of the size and site of calculi but cannot evaluate their chemical composition. Dual-energy computed tomography allows evaluating the chemical composition of urinary calculi using simultaneous image acquisition at two different energy levels. The objective of the research was to determine renal stone composition using dual-energy multidetector computed tomography, and its correlation with post-extraction chemical analysis of stones. Materials and Methods. This prospective study was conducted in the Department of Radiodiagnosis and Imaging from September 2017 to March 2019. A total of 50 patients with urolithiasis at the age of 18-70 years were included in the study. Dual-energy computed tomography ratios of various stones were noted, and preoperative composition of calculi was given based on their colour and dual-energy computed tomography ratio. These results were compared with the post-extraction chemical analysis of stones (using Fourier infrared transform spectroscopy as the standard comparative method.) Results. The most common type of calculi in our study population was calcium oxalate stones (78%) followed by uric acid stones (12%), cystine stones (6%) and hydroxyapatite stones (4%). The dual-energy ratio of calcium oxalate, uric acid, cystine and hydroxyapatite stones ranged from 1.38-1.59, 0.94-1.08, and 1.20-1.28 and 1.52-1.57, respectively, with the mean dual-energy ratio of 1.43, 1.01, 1.25 and 1.55, respectively. Dual-energy computed tomography was found to be 100% sensitive and specific for differentiating uric acid stones from non‑uric acid stones. The sensitivity and specificity in differentiating calcium oxalate calculus from non‑calcium oxalate calculus was 97.5% and 90.9%, respectively, with 96% accuracy and kappa value of 0.883 suggesting strong agreement. Conclusions. Dual-energy computed tomography is highly sensitive and accurate in distinguishing between various types of renal calculi. It has vital role in management as uric acid calculi are amenable to drug treatment, while most of non-uric acid calculi require surgical intervention

Unique classification of parathyroid dysfunction in patients with transfusion dependent thalassemia major using nomogram: A cross sectional study

Introduction: Hypoparathyroidism is a rare complication of iron overload in patients with transfusion dependent β thalassemia major (β-TM). We aim to determine the prevalence of parathyroid dysfunction in patients with β-TM. Methods:Diagnosed cases of transfusion dependent β-TM between 5 and 17 years of age were recruited from outpatient clinics of a non-profit organization in Karachi, Pakistan. Blood and urine samples were collected in fasting to determine Ca, P, Alb, Mg, Cr 25OHD and iPTH. Patients were grouped on the basis of upper and lower levels of Ca, 25OHD and iPTH for assessing parathyroid dysfunction into primary hypoparathyroidism [low calcium (Ca) & intact parathyroid hormone (iPTH)], sub-clinical hypoparathyroidism [low iPTH and 25 hydroxy vitamin D (25OHD), low/normal Ca], normal functioning parathyroid gland [Normal Ca, iPTH and 25OHD] and secondary hyperparathyroidism [high iPTH, low/normal Ca and/or 25OHD]. Using PTH nomogram subject specific expected PTH (maxPTH) was calculated. Difference between maxPTH and measured iPTH was determined to assess the utility of nomogram in identifying parathyroid gland dysfunction. The statistical analysis was performed using the Statistical Package of Social Sciences (SPSS) version 20. Results: Median age of patients was 11 years (13-7) with males being 54.2% (n = 205).Based on Ca, 25OHD and iPTH, primary hypoparathyroidism was identified in 3.4% (n = 13) [median iPTH 11.3 pg/ml (12.6-7)], 52.3% (n = 192) had subclinical hypoparathyroidism [iPTH 40.4 pg/ml (52.7-28.7)], and 34% (n = 125) were identified as secondary hyperparathyroidism [iPTH 88.6 pg/ml (116-74.7)]. Normal response to Ca & 25OHD was seen in 10.6% (n = 39) [iPTH 44.2 pg/ml (53.8-33.4)] patients. High phosphorous was present in all groups. Difference between maxPTH & iPTH was highest in primary hypoparathyroidism, followed by subclinical and secondary hyperparathyroidism. Conclusion:Nomogram by Harvey et al. identify low secretion capacity of parathyroid gland that correlated with biochemical classification of patients. It requires clinical validation before using in clinical practice for assessing parathyroid dysfunction

Relationship of spot urine oxalate to creatinine ratio and 24 hours urinary oxalate excretion in patients with urolithiasis

Background: The evaluation of 24 h urinary oxalate excretion is the gold standard for diagnosing hyperoxaluria in patients with recurrent urolithiasis. However, 24 h urine sample collection is cumbersome. Therefore we aim to see if oxalate to creatinine ratio in random urine sample can be used as an alternative.Materials and methods: A cross-sectional study was conducted at Section of Chemical Pathology, Department of Pathology and Laboratory Medicine Aga Khan University Karachi from 1st February to December 31, 2019. A total of 62 adult patients, 18-60 years of age with history of kidney stones presenting to the clinical laboratory for 24 h urine oxalate estimation were invited to participate in the study after informed consent. Clinical details were recorded on a structured questionnaire and patients were guided to submit 24 h urine and a random spot urine sample. Urinary oxalate was measured on Micro lab 300 using a kit based on oxalate oxidase principle by Trinity Biotech plc, Wicklow, Ireland following standard operating procedures. Urinary creatinine was measured on ADVIA 1800 by Siemens, US using kinetic Jaffe reaction according to the manufacturer\u27s instructions. The data was analyzed on SPSS.Results: In a period of ten months, a total of 62 subjects were recruited; mean age was 32.4 ± 2.6 years. Males were 49 (79.0%) and females were 13 (20.9%). Correlation was found to be (r = 0.289) by Spearman correlation (p value \u3c 0.005). Taking 24 h urinary oxalate as gold standard the sensitivity, specificity, positive predictive value and negative predictive value of spot oxalate to creatinine ratio was 83.3%, 17.8%, 9.8% and 90.9% respectively.Conclusion: The random spot urine test cannot replace the 24 h urinary oxalate estimation in patients with urolithiasis

Determination of reference interval (RI) of spot urinary oxalate to creatinine ratio in children of Pakistani origin under six years of age: A cross-sectional study

Background: The gold standard screening method of hyperoxaluria in children is using 24-hour urine collection. Urine collection may be cumbersome and challenging for children. Reference intervals (RI) of oxalate for the Pakistani population are not readily available. Therefore we aimed to determine the oxalate to creatinine ratio (Ox: Cr) for Pakistani children \u3c6 years of age.Materials and methods: A cross-sectional study was conducted at Aga Khan University from June 2018 to October 2019. Random urine samples from apparently healthy children \u3c 6 years were collected and stored at -30°C until analysis after adding 6M HCl. Oxalate was measured on Micro lab 300 using a kit based on oxalate oxidase principle, while creatinine was measured by kinetic Jaffe reaction. Data was analyzed by EP evaluator and SPSS 23. Ox: Cr ratio was calculated and reported with 90% confidence interval (CI) and interquartile range (IQR).Results: The mean age of study subjects (n=120) was 29 ±22.3 months with an M: F ratio of 1:1. Children of various ethnicities were included from all over Karachi. The majority of the subjects were Urdu speaking (37.5%). Median Ox: Cr was 0.13(0.10). No significant difference was noted in the median Ox: Cr ratio between various ethnicities (p\u3e0.05). It was significantly different in group I to V which was 0.25 (IQR: 0.06), 0.19 (IQR: 0.11), 0.15 (IQR: 0.04), 0.11 (IQR: 0.06) and 0.08 (IQR: 0.04) respectively (pvalue \u3c0.001).Conclusion: The established RIs of Ox: Cr ratio was 0.05-0.34 (90% CI). Ox: Cr ratio showed a declining trend with age. Large scale reference interval studies are encouraged, taking diet and age into consideration

Comprehensive Review of the Literature on Existing Punctal Plugs for the Management of Dry Eye Disease

Numerous designs of punctal and canalicular plugs are available on the market. This variety presents challenges to ophthalmologists when choosing punctal plugs for the management of various ocular conditions. The aim of this literature review is to provide a classification system for lacrimal occlusive devices based on their location and duration of action as well as to identify different characteristics of each one of them. We want to give a comprehensive overview on punctal and canalicular plugs including their manufacturing companies, indications, and complications that have been reported in various articles. PubMed and Google Scholar were used to identify articles written in English as well as few articles written in Japanese, Chinese, Slovak, and Spanish that had abstracts in English. Nine different companies that manufacture punctal and canalicular plugs were identified and their plugs were included in this review. Punctal and canalicular plugs are used in the management of various ocular conditions including dry eye disease and punctal stenosis as well as in ocular drug delivery. Although they are a relatively safe option, associated complications have been reported in the literature such as infection, allergic reaction, extrusion, and migration

Correlation between correctly sized uncuffed endotracheal tube and ultrasonographically determined subglottic diameter in pediatric population

Background: The size of the airway varies greatly in pediatric patients, making it difficult to predict an appropriate size Endotracheal tube (ETT) for securing the airway. Several formulae are used to predict approximate ETT size. With the wider availability of ultrasonography (USG), many clinicians have suggested it as a useful tool for airway management and have used USG to measure tracheal dimensions in adults and children. Aims and Objectives: The primary aim of this study was to evaluate the usefulness of USG for the selection of correct sized uncuffed ETT in pediatric patients and the secondary aim was to correlate the age-based formula with ultrasound measured subglottic diameter for predicting the size of ETT. Materials and Methods: A total of 64 patients of either gender in the age group of 2–6 years were enrolled in the study. Standard anesthetic induction was done and transverse subglottic diameter was measured using USG. The minimal transverse subglottic diameter was measured and noted and the patient was intubated with the tube size as determined by modified Cole’s age-based formula. Results: Out of 64 patients, 33 were male and 31 female. Average age was 3.9 (±1.47) years, 42.2% belonged to the age group of (2–3) years, average weight of the patients was 20.3 (±10.45) kg. The mean ETT outer diameters (OD) based on age-based formula was 6.81 mm compared to 6.91 mm and 6.78 mm by USG based and actual ETT OD, respectively. Both the age based ETT OD and USG-based ETT OD showed good correlation with actual ETT OD used with r-value of 0.891 and 0.876, respectively. Conclusion: Although USG is a non-invasive, cost-effective, and reproducible technique its routine use for estimating ETT size in pediatric patients could not be justified over age-based formula as both of them have comparable results (statistically insignificant). The success rate of age-based formula and USG in precisely predicting ETT outer diameter is comparable with the size of actual ETT outer diameter (78% vs. 75%, P=0.86)

Association of Socio-Demographic and Clinicopathological Risk Factors with Oral Cancers: A 19-Year Retrospective Study

Objective: To determine the association of socio-demographic and clinic-pathological risk factors with oral cancer in Kelantan, Malaysia. Material and Methods: A 19-year cross-sectional survey was performed in Hospital Universiti Sains Malaysia (HUSM), Malaysia. Medical record of 301 oral cancer patients was retrieved from the Medical Records office. Results: The majority of the oral cancer cases were male (62.8%), non-smokers (57.5%), non-alcohol consumers (83.4%), non-betel quid chewers (96.7%), and belonged to Malay ethnicity (68.8%). At the time of diagnosis, most of the patients were at stage II (38.9%). Approximately one-third (30.6%) of the total OC patients experienced loco-regional/distant metastasis, whereas no metastasis was detected in around two-thirds of cases (69.4%). A combination of surgery and radiotherapy was the most commonly employed treatment modality (27.2%). At the time of this study, the survival status of most of the patients was alive (69.1%). The most frequently encountered oral cancer in the Kelantanese population was oral squamous cell carcinoma (70.1%), with the tongue being the most frequently involved oral cavity site (35.5%). Conclusion: More than three-fourths of the cases were alive at follow-up, which included the cases that did not undergo any form of treatment