Post-traumatic dissecting aneurysms of bilateral cervical carotid arteries with delayed complications

Carotid dissection is an uncommon complication of trauma. They can present with immediate or delayed complications. We describe the case of a young patient with bilateral carotid dissections and acute infarcts. Brief review of literature and treatment options are discussed.     

Serial quantitative diffusion tensor MRI of the term neonates with hypoxic-ischemic encephalopathy (HIE)

AIM: To determine the altered pattern of fractional anisotropy (FA) and mean diffusivity (MD) change in brain parenchyma in serially studied neonates with mild or moderate hypoxic ischemic injury (HIE) within 7 days after birth and again at the age of three months. METHODS: Serial diffusion tensor imaging (DTI) was performed at two-time points in term neonates with mild (n = 7) and moderate (n = 10) HIE and age/sex-matched controls (n = 7). Neurodevelopmental outcome was assessed at the time of the 2nd study. RESULTS: On comparing FA and MD changes over time using two-way analysis of variance between neonates with HIE and controls, we observed significant differences in age-related FA increase (p < 0.05) in anterior limb of internal capsule and periventricular white matter of parietal, occipital, and temporal lobes. Significant differences in age-related MD decrease (p < 0.05) was observed in the caudate nuclei, and temporal white matter among these groups. Significant positive correlation was observed between neurodevelopmental outcome and FA. CONCLUSION: The results suggest that abnormal FA and MD values help in early and more accurate assessment of microstructural damage in HIE that may have predictive value for long-term neurofunctional outcome in these neonates.     

The role of polymerase chain reaction in the management of osteoarticular tuberculosis

A dependable method for the rapid diagnosis of osteoarticular tuberculosis has become increasingly important, as routine methods are neither very sensitive nor very specific. The objective of this study is to verify the reliability of polymerase chain reaction (PCR) in the diagnosis and management of osteoarticular tuberculosis. This investigation was a prospective study conducted at the Kasturba Medical College, Manipal, India. Tissue samples of 74 patients suspected of osteoarticular tuberculosis were sent for PCR and histopathologic examination. Taking histopathology as the gold standard, PCR has a sensitivity of 73.07% and a specificity of 93.75% (with 95% confidence interval [CI] 62.97; 83.17).The positive agreement between histology and PCR was 0.693, indicating good agreement. PCR showed a sensitivity of 90% with spinal samples. It has a low false positivity of 13.63%. We conclude that conventional methods are neither sensitive nor specific enough and are also time consuming. PCR is an effective method for diagnosing tuberculosis and antitubercular treatment can be started if PCR is positive, since false-positive rates are very low.     

Misdiagnosed transverse testicular ectopia: a rare entity

A rare case of transverse testicular ectopia (TTE) in a 3-year-old child presenting to the department as bilateral undescended testis along with inguinal hernia is described. The patient was misdiagnosed at a peripheral health centre as a case of inguinal hernia and intersex. As TTE in such a condition is very uncommon, hence, it is being reported with a brief review of the relevant literature.     

Obturator hernia: a diagnostic challenge

We describe a case of an 82-year-old lady with groin pain secondary to an obturator hernia. She was a diagnostic challenge, and 6 years passed before the obturator hernia was discovered. She presented to hospital with symptoms of bowel obstruction, and a computer tomography (CT) scan of her pelvis revealed an incarcerated obturator hernia. Her surgical management included reinforcement of the obturator foramen with sutures. A recurrence of the obturator hernia 2 years later required an extra-peritoneal mesh repair of the defect in the obturator foramen with a good outcome.     

The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders

Autism spectrum disorders (ASD) often go undetected in toddlers. The Modified Checklist for Autism in Toddlers (M-CHAT) was used to screen 3,793 children aged 16–30 months from low- and high-risk sources; screen positive cases were diagnostically evaluated. Re-screening was performed on 1,416 children aged 42–54 months. Time1 Positive Predictive Value (PPV) was .36 for the initial screening and .74 for the screening plus follow-up telephone interview; values were similar for Time2 PPV. When separating referral sources, PPV was low for the low-risk sample but acceptable with the follow-up telephone interview. Children with ASD from the low-risk and high-risk samples were highly similar. Results indicate that the M-CHAT continues to be a promising instrument for the early detection of ASD.