An Auditory-Visual Conflict of Emotions - Evidence from McGurk Effect

Experiments such as the McGurk effect have supported the inter-dependence of the auditory and visual modalities. This perceptive reasoning is in line with the assumption that emotional expressions in the face and voice are processed by the same perceptual/cognitive mechanism. This research aimed to study the accuracy of the identification of intended emotions in the Kannada language using the auditory and/or visual modality; and also to study its perception using the McGurk paradigm. An emotionally neutral word “namaskara†was uttered by a native Kannada speaker in four basic emotions. Subjects were asked to identify the intended emotional expressions under the different experimental conditions (unimodal, bimodal-I, bimodal-II). The scores were recorded and analysed respectively. The results were in line with studies who also stated the over-reliance of visual over auditory modality when the subjects were presented with the McGurk stimuli thereby also perceiving a new different emotion. Key words: McGurk effect, bimodal, emotional, Kannada, stimul

Gallbladder malignancy an old soul revisited-ultrasonography and contrast enhanced computed tomography evaluation in tertiary care center in South West Bihar

Background: Gallbladder (GB) malignancy is the commonest biliary tract carcinoma. It ranks fifth among the malignancies of the gastrointestinal tract and in all encompasses about 1-3% of all malignancies. Its peak occurrence is in the 5th decade or older with a female predilection. The most cases of GB malignancy are seen along the Ganga river delta region in India. The median survival rate in GB malignancy is approximately 6 months. Methods: A cross-sectional observational study was conducted in the Department of Radiology, Narayan Medical College and Hospital Sasaram over a period of 12 months from August 2022 to September 2023. A total of 40 patients were included on the basis of signs and symptoms of gallbladder carcinoma and underwent USG and CT scan for preoperative radiological diagnosis, following operation all the resected specimens were sent for histopathological evaluation. The diagnostic accuracies of USG and CT scan were then compared against histopathological diagnosis by using Kappa statistics. Results: In the present study, the mean age of the patients was 60 (range: 40-80 years) with female preponderance. About 40% of the gall-bladder were contracted and reduced in size and 35% large and distended on USG examination, while 45% of the gall-bladder were contracted and reduced in size and 37.5% distended and large on CT examination. Approximately 37.5% had irregularly thickened wall and 25% diffusely thickened wall on USG and 25% of gallbladder wall were diffusely thickened and 45% irregularly thickened on CT scan. The present study showed hepatic parenchymal invasion to be 25% on USG and 37.5% on CT scan. The sensitivity and specificity of USG in diagnosing GB carcinoma were 94.2% and 71.4% respectively. Similarly, the sensitivity and specificity of CT scan in detecting GB carcinoma were 97.1% and 83.3% respectively. The test of agreement (Kappa test) revealed an almost 90% agreement between the two procedures meaning that the two diagnostic modalities are almost comparable in diagnosing gall bladder carcinoma. Conclusions: As the histopathological diagnosis of the present study correlated well with USG and CT scan findings in the diagnosis of gallbladder carcinoma; it can be concluded that both USG and CT scan are useful imaging modalities for diagnosing this disease. However, CT scan is more sensitive and specific in predicting gall bladder carcinoma as compared to USG

Pulmonary pleomorphic carcinoma masquerading as pulmonary tuberculosis: incidental autopsy finding

Pleomorphic carcinoma is a very rare subtype of pulmonary sarcomatoid carcinoma. It is an aggressive primary lung carcinoma that accounts for about <0.4% of lung tumors. The tumor usually recurs, resulting in a poor prognosis even after complete resection. Herein, we report an extremely rare case of an advanced pleomorphic carcinoma of the lung which was incidentally detected on autopsy as pulmonary tuberculosis. This patient did not have any clinical manifestations of either malignancy or tuberculosis when he was alive. This is extremely rare, being it an aggressive carcinoma that presents without any apparent symptoms

Correlation of diagnostic accuracy of computed tomography with magnetic resonance imaging in local staging of carcinoma rectum at tertiary care center

Background: Rectal cancer is third most common cancer related death worldwide. Cross sectional imaging techniques like computed tomography (CT) and magnetic resonance imaging (MRI) play a major role in preoperative staging. En-bloc resection of mesorectum and preoperative neoadjuvant chemoradiotherapy has significant role to reduce postsurgical recurrence. Methods: A cross-sectional observational study was conducted in the department of radiology, Narayan medical college and hospital Sasaram over a period of 12 months from August 2022 to September 2023. A total of 40 patients with biopsy proved rectal carcinoma were included, Local staging of carcinoma rectum was performed using MRI pelvis, MDCT abdomen and pelvis, the results were analysed and correlated. Results: The current study is aimed to correlate the diagnostic accuracy of CT with MRI in local staging of carcinoma rectum. Rectal cancer was more common in elderly mostly above 50 years of age. 65% of the cases showed irregular circumferential wall thickening and 35% showed polypoidal growth. On correlating with MRI, CT showed an overall good sensitivity, specificity, and accuracy in diagnosing tumor staging, mesorectal fascia (MRF) involvement and extramural vascular invasion (EMVI). CT can be considered as a reliable imaging modality for local staging of rectal cancer. Conclusions: MRI and MDCT both are complementary imaging modalities in preoperative staging of rectal cancer. MRI is the best available imaging modality for the local staging of patients and has the potential to play an important role in accurately differentiating which patients should receive preoperative chemoradiation prior to total mesorectal excision. CT can be considered as a reliable imaging modality for assessing local staging of rectal cancer

Role of magnetic resonance imaging in differentiating tuberculous spondylitis from pyogenic spondylitis in a TB endemic area

Background: Infectious spondylitis is an infection by a specific organism of one or more components of spine, namely the vertebra, intervertebral discs, paraspinal soft tissues, and epidural space. Magnetic resonance imaging (MRI) of the spine is gold standard in imaging to assess anatomical abnormalities of the spine and surrounding structures. Methods: This cross-sectional observational study was conducted in the Department of Radiology Narayan Medical College and Hospital Sasaram, Bihar (India), where tuberculosis is endemic from July 2022 to September 2023. It included 40 patients, purposively sampled, adhering to strict inclusion and exclusion criteria. Sensitivity, specificity and accuracy of MRI in discriminating tuberculous spondylitis from pyogenic spondylitis were compared against histopathological diagnosis and differences in MRI findings between these conditions were obtained. Results: In this study, 93% patients with tuberculous spondylitis had an enhanced signal with well-defined margins. Meanwhile, pyogenic spondylitis provided an ill-defined margins in 72.7% patients. Most of the patients 82.7% with tuberculous spondylitis showed thin and smooth wall paravertebral abscesses, while pyogenic spondylitis showed an irregular and thick wall paravertebral abscesses in 45% patients. A total of 72.4% patients with tuberculous spondylitis indicated involvement of ≥3 vertebral bodies. 100% patients with pyogenic spondylitis showed an abnormal contrast enhancement of the intervertebral discs. It was identified that tuberculous spondylitis had sensitivity, specificity, and accuracy values of 100%, 84.6%, and 95.2% respectively. For pyogenic spondylitis, the corresponding values were 84.6%, 96.6%, and 93%. Conclusions: MRI was accurate for differentiation of tuberculous spondylitis from pyogenic spondylitis. A well-defined paraspinal abnormal signal, a thin and smooth abscess wall, subligamentous spread to three or more vertebral levels, and less likely involvement of intervertebral discs were more suggestive of tuberculous spondylitis than pyogenic spondylitis

Comparison of ultrasound and computed tomography in the diagnosis of malignant ovarian tumours at tertiary care center

Background: Accurate diagnosis of ovarian tumours is a diagnostic challenge. Multiple modes are used for the early detection of ovarian tumours. Early detection provides a survival advantage. Ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) are important imaging modalities in this regard. This study aims to compare the diagnostic accuracy of USG and CT imaging in the detection of malignant ovarian tumours. Materials: An observational cross-sectional study is conducted in the department of radiodiagnosis of Narayan medical college and hospital, Bihar over a period of 18 months from August 2021 to March 2024. Fifty-three patients with suspected ovarian malignancy who were not pregnant or had contraindications for administration of contrast media were included in the study. USG, CT and histopathology reports were compared for diagnostic accuracy with respect to different components. Results: Mean age of the patients was seen to be 49.6±13.8 years. Abdominal pain was the most common presentation Majority of the patients had vascular lesions with a well-differentiated margin, heterogenous enhancement and septations. USG and CT agree almost perfectly in, identifying septations, calcification, and in differentiating margin of the tumours and very poorly for the identification of lymphadenopathy. CT had better sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) when compared to USG for diagnosis of ovarian malignancies Conclusions: CT has superior diagnostic accuracy compared to USG for diagnosis of ovarian tumours. However, USG provides similar diagnostic accuracy for identifying septations, calcification, and in differentiating margins of tumours

Ureteric endometriosis masquerading as ureteric neoplasm

Endometriosis is a disease seen in 10-15% of reproductive age women, which involves the pelvic cavity. The urinary tract is affected in 1% cases of pelvic endometriosis, while 0.1-0.4% of ureteric endometriosis which is extremely rare. Ureteric endometriosis poses a diagnostic challenge, as it can be asymptomatic or can present as renal colic. It can lead to a severe burden on kidneys like hydroureteronephrosis, renal atrophy, and irreversible renal failure. Authors report an extremely rare case of ureteric endometriosis in a postmenopausal female, who presented with complaints of lower backache. Radiologically diagnosed as neoplastic ureteric stricture

A study on adverse drug reactions to non-ionic contrast medium in an Indian population: a 1-year experience

Background: To the best of our understanding, very few studies focusing on the adverse drug reaction (ADR) profile of non-ionic contrast medium (NICM) has been carried out until date among the Indian population. Hence, this study was planned. We sincerely believe that the knowledge gathered from this study can improve safer usage of these agents among the patients of Indian origin. The objective was to evaluate the incidence and severity of ADRs of non-ionic radio contrast media (CM) used in tertiary care hospital in Eastern India.Methods: For the duration of 1-year from July 2011 to July 2012, we prospectively recorded all the ADRs associated with the administration of NICM (iohexol and ioversol) in 3708 patients of Indian origin undergoing computed tomography scan at the hospital. The average median age, weight, dose used; types of ADRs, concomitant medication, final diagnosis, reasons for use were recorded and analyzed with appropriate statistical tools. Causality assessment was performed using Naranjo scale.Results: Eleven of 3708 patients who received either ioversol or iohexol developed ADRs (i.e. 0.3% of patients). The most common ADR was rigor. The incidences of mild, moderate and severe reactions were 55%, 36% and 9%, respectively. Average median age, weight, and dose used were 35 years, 66 kg and 70 ml, respectively. All the ADRs were early (occurred within 1 hr of CM administration). Due to logical constraints, the follow-up of these patients was not possible and hence late ADRs were not captured. The common concomitant medication used was pantoprazole (63.63% of patients). The difference in the incidence of ADRs by age distribution (Group 1 - Iohexol, Group 2 - Ioversol) and weight distribution was not statistically significant (p=0.75 and p=0.18, respectively). Causality analysis revealed that all the ADRs were possible (Score of 4). Interestingly, the incidence of reactions was noted to be higher in patients with a history of gastro intestinal disorders (45.45%).Conclusions: This pilot study reveals that adverse reactions to NICM are rare and severe reactions are less common among the patients of Indian origin. However, a larger multicentric study across the country should be carried out to understand the safety profile of these CM better among the Indian population

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

The Big Gamble: The Migration of Eritreans to Europe. By Milena Belloni. University of California Press, 2019. pp. 228.

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