Olfactory Neuroblastoma: Diagnostic Difficulty

Olfactory neuroblastoma is an uncommon malignant tumor of sinonasal tract arising from the olfactory neuro epithelium. The olfactory neuroblastomas presenting with divergent histomorphologies like, epithelial appearance of cells, lacking a neuro fibrillary background and absence of rosettes are difficult to diagnose. Such cases require immunohistochemistry to establish the diagnosis. We describe the clinical features, pathological and immunohistochemical findings of grade IV Olfactory neuroblastoma in a 57 year old ma

A quantitative framework for estimating water resources in India

While issues related to water attract considerable attention in all spheres of life in India, very little quantitative information is available on the water budget of the country. There are primarily two reasons for this lacuna: first, the dearth of information on the variables associated with hydrology, and second, the absence of an easily accessible quantitative framework to put these variables in perspective. In this article, we discuss a framework that has been assembled to address both these issues. At the core of the framework is a hydrological routing model (HYDRA) that has been used to study the water balance of basins on various scales, ranging from a few square kilometres to continents. The basic data needed for implementing the framework are a suitable digital elevation model (DEM) and data on precipitation and evapotranspiration. Available discharge data can be used to validate the performance of the model. We demonstrate the viability of the framework by applying it to the hydrology of the Mandovi river on the western slopes of the Sahyadris; it is typical of the rivers along the Indian west coast. Most of the catchment area of the river is in Goa, but parts of the river also flow through Karnataka and Maharashtra. We use a 30" -resolution (∼ 1 km) DEM (GLOBE) and HYDRA to show that the model output mimics the observed discharge well, providing indirect validation for the surface run-off and sub-surface drainage values on which no data are available

Oral fenofibrate in neonatal hyperbilirubinemia: A randomized controlled trial

Objective: To evaluate the role of oral fenofibrate for lowering neonatal hyperbilirubinemia as compared to placebo. Design: Doubleblind,randomized, placebo-controlled trial. Setting: NICU of tertiary care hospital of North India. Subjects: 50 neonates with neonatalhyperbilirubinemia. Neonates (≥35 weeks of gestation), birth weight (1.5-3.5 kg), jaundice beginning at day 3-11 after birth, totalbilirubin level between 15 and 21 mg/dl, and clinically stable vital signs. Intervention: Neonates were assigned randomly to receiveeither single dose of oral fenofibrate at 10 mg/kg/dose on day 1 of admission and distilled water on the following next day or a singledose of oral glucose solution on day 1 and distilled water on the following next day. Malloy-Evelyn method was used to estimatethe serum total bilirubin levels. All newborns enrolled in this study, received phototherapy. The cases were divided into two groups,i.e. study (fenofibrate) group and control group. Measurement of Primary Outcome: Duration of phototherapy. Results: Mean valuesfor total serum bilirubin in fenofibrate group at 36 and 48 h after starting of phototherapy were significantly lower in the study groupthan those in the control group (p<0.00001). The mean time needed for phototherapy was also shorter in the study group than controlgroup (p<0.0002). No side effects of fenofibrate were observed after a single dose administration. Conclusion: Fenofibrate appears tobe an effective and safe drug for the treatment of neonatal hyperbilirubinemia. This decreases the duration of phototherapy and thusshortens the length of hospital stay

Feasibility of cardiac MR thermometry at 0.55 T

Radiofrequency catheter ablation is an established treatment strategy for ventricular tachycardia, but remains associated with a low success rate. MR guidance of ventricular tachycardia shows promises to improve the success rate of these procedures, especially due to its potential to provide real-time information on lesion formation using cardiac MR thermometry. Modern low field MRI scanners (<1 T) are of major interest for MR-guided ablations as the potential benefits include lower costs, increased patient access and device compatibility through reduced device-induced imaging artefacts and safety constraints. However, the feasibility of cardiac MR thermometry at low field remains unknown. In this study, we demonstrate the feasibility of cardiac MR thermometry at 0.55 T and characterized its in vivo stability (i.e., precision) using state-of-the-art techniques based on the proton resonance frequency shift method. Nine healthy volunteers were scanned using a cardiac MR thermometry protocol based on single-shot EPI imaging (3 slices in the left ventricle, 150 dynamics, TE = 41 ms). The reconstruction pipeline included image registration to align all the images, multi-baseline approach (look-up-table length = 30) to correct for respiration-induced phase variations, and temporal filtering to reduce noise in temperature maps. The stability of thermometry was defined as the pixel-wise standard deviation of temperature changes over time. Cardiac MR thermometry was successfully acquired in all subjects and the stability averaged across all subjects was 1.8 ± 1.0°C. Without multi-baseline correction, the overall stability was 2.8 ± 1.6°C. In conclusion, cardiac MR thermometry is feasible at 0.55 T and further studies on MR-guided catheter ablations at low field are warranted

Automatic image-based tracking of gadolinium-filled balloon wedge catheters for MRI-guided cardiac catheterization using deep learning

IntroductionMagnetic Resonance Imaging (MRI) is a promising alternative to standard x-ray fluoroscopy for the guidance of cardiac catheterization procedures as it enables soft tissue visualization, avoids ionizing radiation and provides improved hemodynamic data. MRI-guided cardiac catheterization procedures currently require frequent manual tracking of the imaging plane during navigation to follow the tip of a gadolinium-filled balloon wedge catheter, which unnecessarily prolongs and complicates the procedures. Therefore, real-time automatic image-based detection of the catheter balloon has the potential to improve catheter visualization and navigation through automatic slice tracking.MethodsIn this study, an automatic, parameter-free, deep-learning-based post-processing pipeline was developed for real-time detection of the catheter balloon. A U-Net architecture with a ResNet-34 encoder was trained on semi-artificial images for the segmentation of the catheter balloon. Post-processing steps were implemented to guarantee a unique estimate of the catheter tip coordinates. This approach was evaluated retrospectively in 7 patients (6M and 1F, age = 7 ± 5 year) who underwent an MRI-guided right heart catheterization procedure with all images acquired in an orientation unseen during training.ResultsThe overall accuracy, specificity and sensitivity of the proposed catheter tracking strategy over all 7 patients were 98.4 ± 2.0%, 99.9 ± 0.2% and 95.4 ± 5.5%, respectively. The computation time of the deep-learning-based segmentation step was ∼10 ms/image, indicating its compatibility with real-time constraints.ConclusionDeep-learning-based catheter balloon tracking is feasible, accurate, parameter-free, and compatible with real-time conditions. Online integration of the technique and its evaluation in a larger patient cohort are now warranted to determine its benefit during MRI-guided cardiac catheterization

Differential expression of MUC genes in endometrial and cervical tissues and tumors

BACKGROUND: Mucin glycoprotein's are major components of mucus and are considered an important class of tumor associated antigens. The objective of this study was to investigate the expression of human MUC genes (MUC1, MUC2, MUC5B, MUC5AC and MUC8) in human endometrium and cervix, and to compare and quantitate the expression of MUC genes in normal and cancerous tissues. METHODS: Slot blot techniques were used to study the MUC gene expression and quantitation. RESULTS: Of the five-mucin genes studied, MUC1, MUC5B and MUC8 showed high expression levels in the normal and cancerous endometrial and cervical tissues, MUC2 and MUC5AC showed considerably lower expression. Statistically, higher levels of MUC1, MUC5B and MUC8 were observed in endometrial adenocarcinomas compared to normal tissues. In contrast, only MUC1 levels increased with no significant changes in expression of MUC5B and MUC8 in cervical tumors over normal cervical tissues. CONCLUSION: Endometrial tumors showed increased expression of MUC1, MUC5B and MUC8 over normal tissues. Only MUC1 appears to be increase, in cervical tumors. All the studied tissues showed high and consistent expression of MUC8 mRNA. Low to neglible levels of MUC2 and MUC5AC were observed in all studied endometrial and cervical tissues

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p