Radiological screening for neurocysticercosis in asymptomatic siblings of children with neurocysticercosis: An observational cohort study

Introduction: Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system and a leading cause of acquired epilepsy worldwide. Tuberculosis (TB) is transmitted through droplet infection to index pediatric case from only sputum acid-fast bacilli -positive patients while NCC in an index child can result from fecal–oral route from other family members who are Taenia carriers or through autoinfection as well. Objective: Similar to universal practice of TB screening of asymptomatic family members with chest X-ray which poses radiation hazard, radiation-free radiological screening by magnetic resonance imaging (MRI) brain of asymptomatic siblings of children with NCC was carried out in the present study in addition to evaluation of family members for taeniasis. Methods: Siblings (between 1 and 18 years of age) of children attending the pediatric NCC clinic at a tertiary care hospital in Chandigarh, India, with clinically suspected and radiologically confirmed the diagnosis of NCC, were enrolled. Contrast-enhanced MRI brain was obtained free of cost to detect the presence of asymptomatic NCC in siblings enrolled in the study. Stool analysis of family members of children with NCC was carried out to detect Taenia solium carriers. Results: Of 39 enrolled asymptomatic siblings, 4 (10.3%) children were detected to have solitary intraparenchymal NCC lesion. Of the aforementioned four siblings, 3 (75%) had viable lesions, while 1 (25%) had calcified lesion. Only 2 (1.7%) of 118 stool samples of family members tested were positive for T. solium eggs. Conclusions: The results from the present study suggest clustering of NCC cases in the family and that majority of children with NCC may continue to remain asymptomatic. Targeted family screening for NCC in asymptomatic family members of children with NCC may prove more cost effective than routine mass screening. Based on the results of this study, targeted deworming of community food handlers and caution in conducting routine deworming of children are suggested

Profile of congenital defects in foetuses: incidence and risk factors: a prospective observational study

Background: Perinatal outcome is one of the major indicators of evaluating health care system of a country. Congenital defects form important components of this parameter. The aim of the study was to determine the risk factors associated with congenital malformations in foetuses.Methods: All antenatal mothers whose foetuses were detected to have congenital defects on ultrasonography irrespective of period of gestation were enrolled for the study.Results: Eighty-six pregnant women with prenatally diagnosed fetal anomalies were enrolled for the study, out of which, 87.2% (N=75) belonged to 20-30 years age group. Majority of the subjects were educated till secondary school. Compared to primigravidae, the incidence of malformations was significantly higher in the multigravida group (69.8% vs 30.2% respectively). Thirty-eight (44.2%) mothers with malformed foetuses missed folic acid intake during early pregnancy. Only 40% mothers had prior history of abortions. Smoking was seen in 9% of subjects with malformations. Seven (8.3%) mothers had previous history of malformations and 5 (5.8%) reported a family history of malformations. Consanguineous marriage was observed in 4.7% of couples. Oligohydramnios or anhydramnios was associated with 11.6% foetuses, while polyhydramnios was seen in 53.5%. CNS malformations were seen in 57% of foetus, followed by genitourinary system malformations (9.2%).Conclusions: Tertiary level hospitals need to be upgraded with a dedicated multidisciplinary team of foetal medicine to cater to medical, clinical, surgical, preventive and therapeutic needs of malformed foetuses

Endoscopic balloon dilation for benign gastric outlet obstruction in adults

Gastric outlet obstruction (GOO) includes obstruction in the antropyloric area or in the bulbar or post bulbar duodenal segments. Though malignancy remains the most common cause of GOO in adults, a significant number of patients have benign disease. The latter include peptic ulcer disease, caustic ingestion, post-operative anastomotic state and inflammatory causes like Crohn’s disease and tuberculosis. Peptic ulcer remains the most common benign cause of GOO. Management of benign GOO revolves around confirmation of the etiology, removing the offending agent Helicobacter pylori (H. pylori), non-steroidal anti-inflammatory drugs, etc. and definitive therapy. Traditionally, surgery has been the standard mode of treatment for benign GOO. However, after the advent of through-the-scope balloon dilators, endoscopic balloon dilation (EBD) has emerged as an effective alternative to surgery in selected groups of patients. So far, this form of therapy has been shown to be effective in caustic-induced GOO with short segment cicatrization and ulcer related GOO. In the latter, EBD must be combined with eradication of H. pylori. Dilation is preferably done with wire-guided balloon catheters of incremental diameter with the aim to reach the end-point of 15 mm. While it is recommended that fluoroscopic control be used for EBD, this is not used by most endoscopists. Frequency of dilation has varied from once a week to once in three weeks. Complications are uncommon with perforation occurring more often with balloons larger than 15 mm. Attempts to augment efficacy of EBD include intralesional steroids and endoscopic incision

Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features

Corrosive ingestion is a common form of poisoning. Corrosive agents cause severe damage to the gastrointestinal (GI) tract. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury is life-long morbidity. Upper GI endoscopy is the test of choice for assessing severity in the acute phase of the disease. The long-term management is based on the site, length, number, location, and tightness of the stricture. This information is best provided by the barium contrast studies. In this pictorial review, a spectrum of findings in patients with corrosive injuries of the esophagus and stomach is illustrated. The role of various imaging modalities including barium studies, endoscopic ultrasound, computed tomography, and magnetic resonance imaging is discussed

Blunt traumatic diaphragmatic hernia: Pictorial review of CT signs

Blunt diaphragmatic rupture rarely accounts for immediate mortality and may go clinically silent until complications occur which can be life threatening. Although many imaging techniques have proven useful for the diagnosis of blunt diaphragmatic rupture, multidetector CT (MDCT) is considered to be the reference standard for the diagnosis of diaphragmatic injury. Numerous CT signs indicating blunt diaphragmatic rupture have been described in literature with variable significance. Accurate diagnosis depends upon the analysis of all the signs rather than a single sign; however, the presence of blunt diaphragmatic rupture should be considered in the presence of any of the described signs. We present a pictorial review of various CT signs used to diagnose blunt diaphragmatic injury. Multiplanar reconstruction is very useful; however, predominantly axial sections have been described in this pictorial review as the images shown are from dual-slice CT

Bilateral renal artery stenosis presenting as hypertensive retinopathy and choroidopathy.

This report describes a rare case of hypertensive retinopathy with choroidopathy secondary to bilateral renal artery stenosis in a young non-pregnant female patient

Serial profile of flow-mediated dilatation in primigravida for prediction of preeclampsia and gestational hypertension

Objective: Assessment of endothelial dysfunction for prediction of gestational hypertension/preeclampsia (GH/PE). Methods: Serial assessment of flow-mediated vasodilatation (FMD) of brachial artery was done in first, second, and third trimesters, and within 6 weeks of delivery in primigravida (n = 654). Logistic regression was used to assess the predictive value of FMD for the development of GH/PE. Results: Significant fall in FMD was observed from first trimester to third trimester but decrease in FMD in GH/PE group (57%) was more marked as compared to normal (39%) (p < 0.01). FMD (third trimester) was able to predict the development of GH/PE (OR = 1.303; 95% CI 1.088–1.562; p = 0.004). Conclusions: FMD can be used as a non-invasive marker to predict the development of GH/PE

Screening methods(clinical breast examination and mammography) to detect breast cancer in women aged 40–49 years

Objective: The aim of this study is to detect breast cancer rate, nodal status, tumor size, and associated risk factors using clinical breast examination (CBE) and mammography as screening tools in women aged 40–49 years. Materials and Methods: A total of 500 women were screened in a time period of 2 years, between the ages of 40–49 years for breast cancer. Screening tools used were CBE and mammography. Clinical history and risk factors related to breast cancer were recorded. CBE was performed to detect any breast pathology followed by mammographic screening. Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories were used for reporting breast imaging on mammography. For women with dense breasts or an inconclusive mammography report, ultrasonography was performed to assess the lesion/s. Suspicious lesion was subjected to fine-needle aspiration cytology or an open surgical biopsy for a confirmatory diagnosis. Women with history of breast cancer were excluded from the study. Results: CBE was normal in almost 90% of the women. Screening mammography revealed Breast Imaging Reporting and Data System (BI-RADS) I and BI-RADS II in 58.4% and 34.6% of women, respectively. Only 7% of women belonged to BI-RADS III and none in BI-RADS IV category. Conclusion: The study findings are in agreement with the recommendations of the World Health Organization, US preventive task force and UK guidelines that recommend screening mammography in women starting at 50 years