Priya Ps

: Pulmonary melioidosis is frequently mistaken for pulmonary tuberculosis because of overlapping clinical and radiological features, often delaying appropriate treatment. We conducted a retrospective comparative cohort study at a tertiary care center in southern India between January 2018 and August 2025 to compare chest computed tomography (CT) features of microbiologically confirmed melioidosis and tuberculosis in diabetic adults who underwent CT within 30 days of symptom onset. A total of 151 patients were included: 46 with melioidosis and 105 with tuberculosis. Cavitation ( n = 81/105 [77.1%] versus n = 20/46 [43.5%], P n = 11/105 [10.5%] versus n = 0/46 [0%], P = 0.019) were more common in tuberculosis. In contrast, when compared with tuberculosis, melioidosis was associated with more frequent bilateral lung involvement ( n = 37/105 [35.2%] versus n = 26/46 [56.5%], P = 0.015), pleural effusion ( n = 28/105 [26.7%] versus n = 23/46 [50.0%], P = 0.005), and hilar lymphadenopathy ( n = 6/105 [5.7%] versus n = 8/46 [17.4%], P = 0.032). Despite these differences, there was substantial overlap in CT findings, with upper-lobe predominance, centrilobular nodules, and mediastinal lymphadenopathy seen in both groups. In multivariable analysis, cavitation was associated with significantly lower odds of melioidosis than tuberculosis (adjusted odds ratio: 0.25, 95% CI: 0.12–0.54, P <0.001). Pulmonary melioidosis and pulmonary tuberculosis, therefore, show substantial overlap on chest CT in diabetic patients, and imaging should be interpreted as an adjunct to targeted microbiological diagnosis rather than a substitute for it.

Background: Degenerative cervical spine disease (DCSD) is a major cause of neck pain and disability worldwide. Although conservative interventions are widely used as first-line management, their comparative effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate and compare the effectiveness of conservative interventions on pain and disability outcomes in patients with DCSD. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in accordance with PRISMA 2020. PubMed, Scopus, Web of Science, Embase, and CINAHL were searched for studies published from 2006 to 2026. Eligible studies included adults with degenerative cervical spine disease (DCSD) receiving conservative interventions. Random-effects meta-analyses using standardized mean differences (SMDs) with 95% confidence intervals (CIs) were performed. Primary analyses were stratified by comparator type, with intervention-specific subgroup and moderator analyses conducted as secondary exploratory analyses. Results: Eighteen RCTs involving 2,378 participants were included, with 15 (2098 participants) RCTs contributing to the quantitative synthesis. Across comparator categories, conservative interventions were associated with significant reductions in pain (SMD = − 0.67, 95% CI: −0.97 to − 0.37; I² = 87.20%) and disability (SMD = − 0.60, 95% CI: −0.97 to − 0.24; I² = 91.56%). Acupuncture and exercise-based interventions demonstrated significant reductions in pain and disability, whereas manual therapy showed no significant pooled benefit. Intervention-type moderator analyses demonstrated significant omnibus differences in pain (QM(5) = 12.11, p = 0.033) and disability (QM(5) = 23.97, p = 0.0002). However, individual contrasts with acupuncture were not significant for pain, while adjunctive rehabilitation and exercise-based interventions differed significantly from acupuncture for disability. The certainty of evidence was low for both outcomes. Conclusions: Conservative interventions may improve pain and functional disability in DCSD. Although intervention-type moderator analyses indicated variation in treatment effects, these exploratory findings do not establish the superiority of any specific intervention. Substantial heterogeneity, limited comparisons within some intervention categories, and low certainty of evidence warrant cautious interpretation. Further high-quality RCTs with standardized protocols and longer follow-up are needed. Trial registration: PROSPERO CRD420261328638.

Background: Computed tomography urography (CTU) is widely used for evaluating urinary tract disorders, but the optimal number of acquisition phases remains uncertain because additional phases increase radiation exposure. This study aimed to evaluate the diagnostic accuracy of single-, tri-, and four-phase CT urography and to synthesize available evidence on radiation dose characteristics and dose-reduction strategies. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. PubMed, Scopus, Embase, Web of Science, and CINAHL were searched for studies published between January 2000 and July 2026. From 2,247 identified records, 38 studies (26 diagnostic accuracy and 12 radiation dose studies) met the inclusion criteria. Diagnostic accuracy was pooled using a bivariate random-effects model, with phase-wise subgroup analyses where feasible. Radiation dose metrics (CTDI _vol and dose–length product) were synthesized using random-effects models. Study quality was assessed using QUADAS-2 for diagnostic accuracy studies and the Joanna Briggs Institute checklist for radiation dose studies. Results: For urothelial carcinoma, pooled sensitivity and specificity were 0.88 and 0.93, respectively. Compared with single-phase CTU (specificity 0.87), specificity increased to 0.95 for both tri-phase and four-phase CTU, while sensitivity remained high across protocols. For renal cell carcinoma, pooled sensitivity and specificity were 0.90 and 0.97, respectively; however, phase-wise comparisons were not feasible because of the limited number of eligible studies. Tri-phase CTU demonstrated a pooled CTDI _vol of approximately 9 mGy, with reported values ranging from 5 to 16 mGy across studies. Low-dose strategies, including phase reduction, low tube voltage, and advanced reconstruction techniques, achieved radiation dose reductions of 20–72% while maintaining diagnostic performance. Conclusions: CT urography provides high diagnostic accuracy across urinary tract pathologies. For urothelial carcinoma, tri-phase CTU provides the most favorable balance between diagnostic performance and radiation exposure. In contrast, single-phase CTU may be appropriate for patients with microscopic haematuria and a low pre-test probability of urothelial malignancy, whereas four-phase CTU may be reserved for patients with a high pre-test probability of urothelial carcinoma or equivocal findings requiring further characterization. Indication-based protocol selection and dose-optimization strategies should be adopted to minimize radiation exposure while maintaining diagnostic quality. Study registration: The review was developed and recorded in accordance with the PRISMA guidelines and has been registered with PROSPERO (CRD420251163062).

* Background Cervical Spondylotic Myelopathy is a progressive degenerative condition that causes spinal cord compression and is a major cause of spinal cord dysfunction in adults. Conventional magnetic resonance imaging (MRI) is effective for demonstrating anatomical compression but may fail to detect early microstructural damage. Diffusion kurtosis imaging (DKI), through mean kurtosis (MK), provides a quantitative assessment of tissue complexity and may improve the detection of early spinal cord changes. Objective To evaluate changes in mean kurtosis (MK) in Cervical Spondylotic Myelopathy and assess its potential as a quantitative biomarker of spinal cord microstructural integrity. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases, including PubMed, Scopus, Web of Science, Embase, and CINAHL, were searched for studies published between 2005 and 2025. Studies reporting MK values in patients with CSM were included. Standardized mean differences (SMD; Hedges’ g) were calculated using a random-effects model. Subgroup analyses were performed for gray matter (GM) and white matter (WM). Results Six studies were included in the qualitative synthesis, with three studies contributing six effect sizes to the meta-analysis. MK values were significantly lower in patients with CSM than in controls (SMD = −0.50, 95% CI: −0.72 to −0.28; I 2 = 0%). Subgroup analyses demonstrated significant reductions in both GM (SMD = −0.56) and WM (SMD = −0.43), with no significant difference between tissue types. Qualitative findings further supported associations between reduced MK and disease severity. Conclusion MK is significantly reduced in CSM and reflects underlying microstructural changes of the spinal cord. These findings support its potential as a quantitative imaging biomarker, although further large-scale, standardized studies are required to confirm its clinical utility.

Background: Primary angiitis of the central nervous system (PACNS) is a rare, idiopathic vasculitis limited to the CNS, with a wide spectrum of clinical and radiological manifestations. Its diagnosis is often delayed due to overlap with infectious, demyelinating, and neoplastic conditions. Neuroimaging plays a crucial role in raising suspicion and guiding further investigation. Case presentation We report the case of a 38-year-old man who presented with subacute cognitive decline, behavioral changes, and gait disturbance. Magnetic resonance imaging (MRI) of the brain revealed bilateral periventricular and subcortical white matter hyperintensities with prominent perivascular miliary/punctiform enhancement on post-contrast 3D T1-weighted imaging. Extensive laboratory evaluation ruled out infectious, autoimmune, and neoplastic causes. A definitive diagnosis of PACNS was established through brain biopsy, which demonstrated transmural inflammation of small- to medium-sized leptomeningeal and intraparenchymal vessels. The patient was treated with corticosteroids, resulting in progressive improvement. Conclusion: This case highlights the diagnostic value of high-resolution MRI (3D T1-weighted sequences) in demonstrating punctiform perivascular enhancement and associated microhemorrhages in PACNS, findings that may be overlooked on conventional 2D post-contrast imaging. A high index of suspicion, in combination with histopathological confirmation, is essential for timely diagnosis. Early immunosuppressive therapy can lead to favorable clinical outcomes.

Introduction: Paragangliomas are rare neuroendocrine tumours arising from neural crest–derived paraganglionic cells and form part of the pheochromocytoma–paraganglioma (PPGL) spectrum. The World Health Organization (WHO) 5th edition classification emphasizes autonomic origin, distinguishing sympathetic from parasympathetic paragangliomas, and recognizes that all paragangliomas possess metastatic potential. Objectives: To evaluate the clinicopathological features of paragangliomas diagnosed over a 5-year period at a single tertiary care centre. Methods: Twenty histologically confirmed cases of paraganglioma resected between 2018 and 2023 were retrospectively reviewed. Hematoxylin and eosin (H&E) and immunohistochemistry (IHC) slides were re-evaluated, and relevant clinical and radiological data were extracted from hospital records. Results: The cohort showed a female predominance (male-to-female ratio 1:1.8) with a median age of 49 years. The most common tumour site was the jugulotympanic region (30%), followed by intradural extramedullary (IDEM) locations (15%) and the retroperitoneum (15%). Two patients (10%) had metastatic disease involving the spine. Radiological findings were concordant with histology in 50% of cases. IHC was performed in 75% of cases and aided differentiation from histologic mimics. The Ki-67 proliferation index ranged from 1 to 2% in most cases, with one exception (4%). Follow-up data were available for 13 patients; one case showed local recurrence, and no syndromic associations were identified. Conclusion: Histological features alone are insufficient to predict tumour behaviour. Metastasis remains the only definitive criterion for malignancy, particularly when identified at sites lacking normal chromaffin tissue. Comprehensive clinicopathological assessment, incorporating radiology and immunohistochemistry, is essential for accurate diagnosis and management, and integration of molecular markers may further refine risk stratification in future studies.

Background/Objectives: Lung cancer remains the leading cause of cancer-related deaths worldwide, with Non-Small Cell Lung Cancer (NSCLC) accounting for the majority of cases, primarily Squamous Cell Carcinoma (SCC) and Adenocarcinoma (ADC). The aim of this systematic review is to summarise and critically appraise the performance of machine learning (ML)-based radiomics models in the differential diagnosis and overall survival analysis for lung SCC and ADC. Methods: PRISMA standards were followed in conducting the review. The quality of the studies was assessed using the Radiomics quality score (RQS) tool. Results: A total of 11 studies were included, demonstrating that deep learning and radiomics-based machine learning models significantly improve the non-invasive classification of lung squamous cell carcinoma and adenocarcinoma. Deep learning systems achieved an accuracy of 67–97%, and machine learning models showed an accuracy of 75–87%. The integration of radiomic features further enhanced diagnostic precision, showing strong potential for reliable histologic subtype differentiation. Conclusions: Machine learning-based radiomics models and deep learning significantly enhance the non-invasive, accurate differentiation of lung squamous and adenocarcinoma cell carcinoma when combined with clinical and pathological data.

Rapid differentiation between variceal and non-variceal upper gastrointestinal hemorrhage (UGIH) in the emergency department (ED) is critical for guiding vasoactive therapy, antibiotic use, and timely endoscopy. However, endoscopy is often delayed, deferring these key management decisions and potentially impacting patient outcomes. We aimed to study the utility of portal vein ultrasound by the emergency physician for the prediction of variceal etiology in UGIH. We also studied the diagnostic accuracy of laboratory markers and fibrosis scores for differentiating between variceal and non-variceal hemorrhage. In our prospective observational study, we enrolled patients with UGIH presenting to the ED. Portal vein indices were studied using bedside point-of-care ultrasound (POCUS) by the emergency physician. Laboratory results were noted, and fibrosis scores were calculated. The upper gastrointestinal endoscopy findings were noted for the presence and grade of varices. Out of 181 patients included in the study, 106 patients (58.56%) had varices. Multivariable logistic regression analysis identified spleen diameter, platelet count, PT, ascites, and portal vein flow velocity (PVFV) were significant predictors of variceal etiology. SCoPE score (Splenomegaly, Coagulopathy, PVFV Evaluation) which is a composite that includes spleen diameter, PT, and PVFV is a useful ED-based tool for early identification of variceal bleed (AUC = 0.843, OR = 1.633). Fibrosis scores (AAR, APRI, Fib-4, King, Lok) were also useful in identifying variceal hemorrhage ( p < 0.001). Integrating POCUS parameters and laboratory markers into clinical decision algorithms may enhance the ability of emergency physicians to predict variceal etiology of UGIH. Novel ED-based composite SCoPE score can help the physicians predict varices and enable them to tailor the management plan and optimize resuscitation strategies.