Role of multidetector computed tomography angiography in evaluation of peripheral arterial disease

Background: Diagnostic imaging plays an important role in the evaluation of peripheral arterial disease. Many imaging modalities are available ranging from conventional modalities to the cross-sectional modalities like Doppler ultrasound, DSA, CT and MRI. The main principles of imaging are to characterize the all lesions detected including type of plaques, no. of lesions, length of stenosis, diameter of vessel in pre-stenotic and post-stenotic segments, degree of wall calcification, assisting in pretreatment planning with respect to route of access, selection of balloon and demonstrates size, extent, neck dimention, and presence of thrombosis in cases with aneurysm.Methods: A Cross-sectional observational study was done in 30 patients. Clinically suspected patients of peripheral arterial disease based on history, sign and symptoms and patients diagnosed with peripheral arterial disease on color doppler were included in our study. Both modalities were compared for detecting the occlusion and stenotic segments.Results: A total of 476 vessel segments were imaged by both modalities. When all arterial segments were considered, MDCTA detected stenosis or occlusion lesions in 30% of arterial segments, versus 18.8% compared to DUS. MDCTA showed 9.8% (95% CI:[4.3%, 15.3%]) more lesions than DUS when all arterial segments were considered together, 11.2% (95% CI: [2.7%, 22.1%]) more lesions when only the iliac arteries were compared, 9.1% (95% CI: [3.2%, 17.2%]) more lesions when only the femoropopliteal arteries were compared, 8.9% (95% CI: [1.5%, 16.3%]) more lesions when only infrapopliteal arteries were compared and 13% (95% CI: [2.6%, 25.4%]) more lesions when only the upper limb arterial segments were compared, (p <0.05 for all comparisons).Conclusions: MDCTA may be used as a screening tool in patients with peripheral arterial disease as it is a non-invasive and more accurate modality when compared to DUS and plays important role in management

Role of diffusion: weighted magnetic resonance imaging in evaluation of renal masses

Background: Diffusion-weighted magnetic resonance imaging (DWI) is a valuable tool to narrow down the differential diagnosis of renal masses. Studies have shown that benign renal masses have higher Apparent diffusion coefficient (ADC) value than malignant renal masses. Aim of study was to evaluate the role of diffusion-weighted magnetic resonance imaging in the characterization of renal masses.Methods: The study was conducted in department of Radio diagnosis at ABVIMS and Dr. RML Hospital, New Delhi between June 2017 to March 2019. This was a cross-sectional observational study comprising of 28 patients. Patients found to have renal mass on ultrasound and computed tomography (CT) were evaluated further on 3T siemens Magnetic resonance imaging (MRI) scanner. In addition to routine sequences, DWI using b value of 0,500,1000 s/mm2 sequence was used to study to differentiate benign and malignant renal masses.Results: Of a total of 28 cases, the most common malignant mass was renal cell carcinoma (RCC). Angiomyolipoma (AML) was the most common benign masses. DWI showed low ADC values in most of the malignant masses and high ADC values in most of the benign masses. The cut-off level of ADC value for differentiation among benign and malignant renal masses was 1.08×10-3 mm2/s. DWI-MR findings were correlated with histopathological diagnosis.Conclusion: DWI with ADC measurements are a non-invasive, problem solving tool for characterization of renal masses helping to differentiate malignant from benign masses.

Antecedents of eKnowledge Usage by Medical Web Portal Visitors

Internet has spawned many portals disseminating health related literature. The growing trend of consumers to seek information about health related issues poses both opportunities and challenges. On the positive side, the internet provides the user with easy access to medical information and on the negative side; the internet may be providing the user with unreliable information and cause great harm. Our study explores the antecedents for the use of such information and proposes a model using theoretical underpinnings. It also looks at how users discern the validity of health related information they get on the web

Bolstering Teaching through Online Tools

This paper offers a compilation of technologies that provides either free or low-cost solutions to the challenges of teaching online courses. It presents various teaching methods the outlined tools and technologies can support, with emphasis on fit between these tools and the tasks they are meant to serve. In addition, it highlights various ethical, security and privacy considerations related to appropriate use of such tools. This integrated overview of various online teaching technologies can be easily leveraged to offer online as well as hybrid courses that are lively and more enriching to both the instructor and the students. Traditional in-person courses can also fruitfully use the tools and techniques mentioned in this paper to integrate recent innovations in online teaching technologies into the classroom

Knowledge and Attitudes about HIV/AIDS among Homoeopathic Practitioners and Educators in India

This study is designed to assess AIDS knowledge among Homeopathy educators and physicians in India, which has not been evaluated previously. India now has the largest number of HIV infected persons worldwide, with an estimated cumulative 5.1 million infections. Homeopathy is the dominant system among the nationally-recognized alternative or complementary systems of medicine, which collectively provide health care to around 600 million people in India. Homeopathy, with its holistic and patient-centered approach, has a wide reach to people at risk of contracting human immunodeficiency virus (HIV). Participants were 68 homeopathy physicians (34 educators and 34 practitioners) who completed a CDC questionnaire measuring HIV/AIDS Knowledge regarding AIDS. This study reports the current level of knowledge of, and attitudes about, HIV/AIDS among homeopathy educators and practitioners. These findings will assist in the development of an education module to equip homeopathic health care personnel to impart accurate AIDS information and prevention counseling to their patients in an efficient manner

EFFECT OF EDUCATIONAL INTERVENTION MEASURES ON KNOWLEDGE ABOUT RABIES AND ITS PREVENTIVE MEASURES AMONG FINAL YEAR NURSING STUDENTS OF A TERTIARY CARE HOSPITAL IN CENTRAL INDIA

Background: Rabies continues to be a major public health challenge with around 55,000 deaths every year. Amongst the health care providers nursing personnel are often the first point of contact and hence need to be well trained in the management of rabies cases. Methods: The present study was an educational intervention study conducted among 100 final year nursing students of a Medical College Hospital to assess the knowledge regarding rabies and its transmission, first aid measures undertaken, and pre and post exposure prophylaxis measures employed to prevent the infection. Results: 66% of the students knew about the signs and symptoms of the disease, post intervention this increased to 87%. Knowledge regarding animal bites which transmit rabies improved by 86 % mode of transmission by 49 % and first aid measures undertaken following an animal bite by 12%. 15% of the students knew about the correct site and route of PEP; post intervention 91% knew about it, 87% increase was observed as regards the dose of vaccine to be administered and 73% students correctly knew about the PEP schedule post educational intervention. Knowledge regarding groups / individuals who need to receive pre-exposure prophylaxis increased by 33% and that of the schedule of pre-exposure prophylaxis by 53%. The mean pre-intervention score was 6.95 and mean post-intervention score was 13.51; the results being statistically significant. Conclusion: Substantial improvement in knowledge about the disease was noted amongst the nursing students following the educational intervention session

A critical appraisal of mucormycosis in COVID- 19 patients in a tertiary care centre in India

Background and Purpose: Morbidity and mortality of opportunistic fungal infections in COVID-19 patients are less studied and defined. The patients receiving immunosuppressive therapy, broad-spectrum antibiotics, corticosteroids, and invasive and non-invasive ventilation are the high-risk groups.Materials and Methods: The demographic profile as well as clinical and radiological findings of all the patients with COVID-19 suspected of Mucormycosis (MM) were recorded. The tissue samples from all the patients were sent for microbiological (KOH mount and culture) and histopathological analysis for confirmation of MM.Results: In total, 45 COVID-19 patients suspected of MM were included in the study an MM was confirmed in 42 patients. The mean age of the patients was 50.30±14.17 years with a female: male ratio of 1.1:1. The most common symptom was headache (52.38%) followed by purulent nasal discharge (38.09%) and facial pain in 33.33% of the cases. The ocular symptoms included a diminution of vision (33.33%) and redness of the eye (2.38%).The most common site of involvement was rhino-orbital (42.85%) followed by sinonasal (23.80%) and rhino cerebral (19.04%). Majority (38.09%) of the patients were diagnosed with stage II of Rhino-orbital-cerebral Mucormycosis (ROCM) based on radiology. A history of diabetes mellitus and steroids was present in 97.61% and 85.71% of the cases, respectively. Moreover, KOH was positive for MM in 97.61% of the cases while the culture was positive in only 35.71% of the cases. In addition, on histopathology, MM was confirmed in 64.28 % of the cases. Mixed growth with Aspergillus species and Rhizopus species was observed in 14.28% of the cases in culture and 11.90% of the cases in histopathology test. Furthermore, angioinvasion was found in 23.80% of the cases according to the histopathology test.Conclusion: Based on the results, the most common conditions associated with MM in COVID-19 patients were diabetes mellitus and steroid therapy. A high level of clinical suspicion aided with diagnostic tests, including KOH mount, culture, histopathology, and radiology which helped the early detection of opportunistic fungal infection in COVID-19 patients to ensure timely treatment

Dipstick Test for Rapid Diagnosis of Shigella dysenteriae 1 in Bacterial Cultures and Its Potential Use on Stool Samples

International audienceBACKGROUND: We describe a test for rapid detection of S. dysenteriae 1 in bacterial cultures and in stools, at the bedside of patients. METHODOLOGY/PRINCIPAL FINDINGS: The test is based on the detection of S. dysenteriae 1 lipopolysaccharide (LPS) using serotype 1-specific monoclonal antibodies coupled to gold particles and displayed on a one-step immunochromatographic dipstick. A concentration as low as 15 ng/ml of LPS was detected in distilled water and in reconstituted stools in 10 minutes. In distilled water and in reconstituted stools, an unequivocal positive reaction was obtained with 1.6×10⁶ CFU/ml and 4.9×10⁶ CFU/ml of S. dysenteriae 1, respectively. Optimal conditions to read the test have been determined to limit the risk of ambiguous results due to appearance of a faint yellow test band in some negative samples. The specificity was 100% when tested with a battery of Shigella and unrelated strains in culture. When tested on 328 clinical samples in India, Vietnam, Senegal and France by laboratory technicians and in Democratic Republic of Congo by a field technician, the specificity (312/316) was 98.7% (95% CI:96.6-99.6%) and the sensitivity (11/12) was 91.7% (95% CI:59.8-99.6%). Stool cultures and the immunochromatographic test showed concordant results in 98.4 % of cases (323/328) in comparative studies. Positive and negative predictive values were 73.3% (95% CI:44.8-91.1%) and 99.7% (95% CI:98-100%). CONCLUSION: The initial findings presented here for a simple dipstick-based test to diagnose S. dysenteriae 1 demonstrates its promising potential to become a powerful tool for case management and epidemiological surveys