ROLE OF MRI IN EVALUATION OF EPILEPSY IN PEDIATRIC AGE GROUP IN A TERTIARY CARE CENTRE OF JHARKHAND, INDIA- A PROSPECTIVE STUDY.

Background: Childhood epilepsy is a prevalent neurological disorder. Imaging, especially MRI of the brain, plays a pivotal role in diagnosing the underlying cause. This study aimed to assess the frequency of causative factors of epilepsy detected in MRI. Materials and Methods: This hospital-based prospective observational study was conducted in the Radiology Department at Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India from November 2021 to October 2022 in 100 children of 0 to 12 years of age referred from Pediatrics department for an MRI brain scan. MRI of the brain was performed in all cases and findings were analyzed and causes of epilepsy were assessed. Magnetic resonance spectroscopy (MRS) was also done when required for confirmation of diagnosis. Results: Positive findings in MRI were detected in 87% of children, and no abnormalities were detected in 13%. The majority of children belonged to the age group of 10-12 years (37%) and were predominantly males (66%). The most common cause of epilepsy was infections (27%) followed by hypoxic ischemic encephalopathy (22%). Tuberculoma was the most common infective cause of epilepsy in 59.3%. These were further followed by temporal lobe epilepsy and congenital malformations (11% each). The rest were other miscellaneous and idiopathic causes. Conclusion: MRI findings were specific to various conditions, helping in the localization and characterization of etiologies and playing a significant role in the evaluation of children who were newly diagnosed with epilepsy, especially those with partial seizures. Recommendation: Further research with a larger sample size and meta-analysis is recommended for more conclusive results

Imaging spectrum of morphology of carcinoma gall bladder on MDCT

Background: In computed tomography (CT) a normal GB wall appears as a thin rim of soft tissue density that enhances post contrast. A thickened GB wall measures > 3mm.Few cases of GB carcinoma are identified incidentally on postoperative histopathology done for causes like cholelithiasis, cholecystitis etc. USG has high sensitivity in detecting advanced lesions while CT is used for detection of early malignant lesions and staging purposes. Aims and objectives: To characterize the various radiological appearances of carcinoma of the Gall bladderon MDCT imaging.Methodology: After Ethical approval MDCT findings from 30 cases of Cytologically proven cases of carcinoma GB were studied retrospectively in the Department of Radiology, Rajendra Institute of Medical sciences, Ranchi from April 2019 to October 2020. Manner of presentation and IHBR dilatation, Locoregional lymphadenopathy or infiltration, distant metastases etc were evaluated. Data was entered into excel sheet and analysed using SPSS from IBM.Results: Females constituted the majority (56.66%) (n=17). Male: female ratio being .07:1. Three types of presentations of GB carcinoma (wall thickening, mass replacing GB and intraluminal mass) were observed in the study on CT. These cases were histopathologically proven as GB carcinoma.CONCLUSION: Understanding the various GB carcinoma presentations can help optimize Noninvasive staging and treatment planning

Ultrasonography and Computed Tomography Evaluation of Gall Bladder wall Thickening and it’s Histopathological correlation

Background: Ultrasonography is usually the first preferred imaging modality for Gall bladder diseases. GB carcinoma is an important cause of thickening of the GB. USG is less sensitive in detecting GB malignancy, metastasis and staging than CT. Therefore, computed tomography (CT) is being increasingly used for early detection of GB carcinoma. Objective: Accuracy of Ultrasonography and contrast enhanced computed tomography (CECT) in correctly identifying the cause of GB wall thickening and comparing their findings with the histopathology. Methodology: After Ethical Approval this Prospective observational study was conducted in the Department of Radiology, Rajendra Institute of Medical Sciences, Ranchi over a duration of 18 months from April 2019 to October 2020. Data was entered in Excel sheet and analysed by SPSS. Results: 63 patients were enrolled, 43 were females (68.25%) and 20 were males (31.75%). Mean age of patients was 50.14 years with a standard deviation of 11.11. Mean GB wall thickness was 10.3 mm for malignant pathology with a standard deviation of 4.00. The association of focal/diffuse wall thickening with GB carcinoma was found to be significant (p− 0.001). Intra−hepatic biliary radical (IHBR) dilatation was observed in 11 patients (17.46%) and nine out of these eleven patients had GB carcinoma (p −0.002). The correlation of Loss of interface of thickened GB wall with liver parenchyma and malignancy was found to be significant (p−0.012). 7 (11.11%) patients with lymphadenopathy on Ultrasonography and CECT (p −0.0001) had a final diagnosis of malignancy on histopathology. The sensitivity of USG was found to be 70% while specificity was 66.60%. The sensitivity of CT was found to be 95.00% while specificity was 83.72%. Conclusion: Early detection of malignant cause is challenging because of identical presentations of benign and malignant conditions as wall thickening on imaging and vague clinical symptoms. Since carcinoma Gall bladder has very poor prognosis, early histopathological diagnosis following imaging diagnosis is crucial for reducing mortality and morbidity

Phase III Pivotal comparative clinical trial of intranasal (iNCOVACC) and intramuscular COVID 19 vaccine (Covaxin®)

Abstract One of the most preferable characteristics for a COVID-19 vaccine candidate is the ability to reduce transmission and infection of SARS-CoV-2, in addition to disease prevention. Unlike intramuscular vaccines, intranasal COVID-19 vaccines may offer this by generating mucosal immunity. In this open-label, randomised, multicentre, phase 3 clinical trial (CTRI/2022/02/40065; ClinicalTrials.gov: NCT05522335), healthy adults were randomised to receive two doses, 28 days apart, of either intranasal adenoviral vectored SARS-CoV-2 vaccine (BBV154) or licensed intramuscular vaccine, Covaxin®. Between April 16 and June 4, 2022, we enrolled 3160 subjects of whom, 2971 received 2 doses of BBV154 and 161 received Covaxin. On Day 42, 14 days after the second dose, BBV154 induced significant serum neutralization antibody titers against the ancestral (Wuhan) virus, which met the pre-defined superiority criterion for BBV154 over Covaxin®. Further, both vaccines showed cross protection against Omicron BA.5 variant. Salivary IgA titers were found to be higher in BBV154. In addition, extensive evaluation of T cell immunity revealed comparable responses in both cohorts due to prior infection. However, BBV154 showed significantly more ancestral specific IgA-secreting plasmablasts, post vaccination, whereas Covaxin recipients showed significant Omicron specific IgA-secreting plasmablasts only at day 42. Both vaccines were well tolerated. Overall reported solicited reactions were 6.9% and 25.5% and unsolicited reactions were 1.2% and 3.1% in BBV154 and Covaxin® participants respectively

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020