Correlation of Cerebral Atrophy and White Matter Hyperintensity Burden in MRI with Clinical Cognitive Decline

Objective: Dementia is a disease of gradual memory and cognitive loss that affects an individual’s day-to-day activities and is caused by permanent brain damage. Majority of patients are from the elderly population and only2 to 10 % of affected population is less than 65 years.Materials and Methods: We obtained a correlation of severity of white matter hyperintensity (WMH) burden in MRI with severity of clinically assessed cognitive decline. And also analysed the severity of cerebral atrophy in MRI with severity of clinically assessed cognitive decline.Results: In our study Fazekas scoring for WMHs showed a sensitivity of 87.5% and specificity of 83.3% on correlation with clinical cognitive decline assessed by ADAS-Cog. Also, MTA scale for cerebral atrophy showed a sensitivity of 72% and specificity of 88% on correlation with clinical cognitive decline assessed by ADAS-Cog. Significant P-value have been obtained for both the above visual rating scales of MRI (Fazekas and MTA) by linear regression, on correlation with clinically assessed cognitive decline.Conclusion: White matter disease assessed by Fazekas scale and cerebral atrophy by MTA scale on MRI brain correlated well with cognitive decline clinically assessed by neuropsychological tests.

Case Report- A rare case of giant hyperplastic polyp

Giant gastric hyperplastic polyps are the most common benign epithelial tumors in the stomach. These are non-neoplastic epithelial proliferations of the stomach which are strongly associated with inflammatory conditions like chronic gastritis, helicobacter pylori gastritis, reactive or chemical gastritis. A 60 years old gentleman presented with history of two bouts of hematemesis preceded by multiple intermittent episodes of epigastric pain, nausea and few episodes of non-bilious vomiting without any history of previous gastrointestinal bleed, loss of appetite or significant weight loss. Work up with ultrasonography of abdomen, upper gastrointestinal endoscopy, contrast enhanced computed tomography abdomen, laboratory investigations followed by biopsy and histopathology was done which confirmed the diagnosis. Giant hyperplastic polyps are benign epithelial tumor of stomach often resulting from excessive regenerative hyperplasia in areas of chronic inflammation with no site predilection and nearly no malignant potential. Usually asymptomatic, these are incidentally detected on upper gastrointestinal endoscopy with characteristic appearance of such polyps on double contrast barium study followed by upper gastrointestinal endoscopy and biopsy is definitive for diagnosis.

Primary gastric Hodgkin's lymphoma: A rare coincidence

Mostly primary gastric lymphomas are of the non-Hodgkin variety. Primary Hodgkin lymphoma (HL) of the stomach is an unusual entity that may be a big challenge in diagnosis. We reporter are case presenting as gastric outlet obstruction, which was later diagnosed as primary Hodgkin's Lymphoma of the stomach. Its rare coincidence makes it worth to be reported to sensitize clinicians as well as pathologists for the uncommon extra nodal site of Hodgkin's Lymphoma.

Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals

Objective

Intussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children.

Methods

Intussusception in children 2–23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected.

Results

Among the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2–6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients’ died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions.

Conclusion

Intussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities.