Clinico-Epidemioogical and Radiological Profile of Broncholitis at Sher-E-Bangla Medical College Hospital in Barishal, Bangladesh

Background: Bronchiolitis, caused mostly by Respiratory syncytial virus (RSV) virus is the leading cause of lower respiratory tract infection in infants. The disease is mostly presents with cough runny nose, fever, breathing difficulties and respiratory failure This infection usually affects children up to age of 24 months, with younger infants often more severely affected and is the most prevalent cause of hospitalization in infants under the age of 12 months. The treatment is supportive; therefore, epidemiology, clinical, laboratory, and radiologic findings can help to ensure appropriate diagnosis and proper treatment.Methods:This descriptive cross-sectional observation study was conducted at Paediatrics department of Sher-E-Bangla Medical College & Hospital (SBMCH), Barishal, Bangladesh between October 2018 to March 2019To find out the clinico-epidemiological and radiological profile of Bronchiolitis. Children below 24 months of age diagnosed as bronchiolitis were studied.Results:200 children were evaluated, including 150 boys and 50 girls; Infants below 6 months accounted for the highest proportion (60%). All the bronchiolitis patients had cough or cold with respiratory distress. Other symptoms were fever (98.0%), restlessness (63.0%), poor feeding (60%) and fast breathing. On examination lower chest indrawing and rhonchi were found in all cases. Hyperinflation was the most prevalent radiological finding (60%) and more than half (55%) patients had lymphocytosis on CBC.Conclusion:Most children present with typical clinical and radiological feature of bronchiolitis which can help the clinicians to clinically identify this disease more efficiently.

HISTOMORPHOLOGICAL FINDINGS AND CLINICO-RADIOLOGICAL CORRELATION OF INTESTINAL ATRESIA AT A TERTIARY CARE CENTRE

Background: An atresia is a congenital defect of a hollow viscus that results in complete obstruction of the lumen. Intestinal atresia is one of the most frequent causes of bowel obstruction in the newborn and can occur at any point in the gastrointestinal tract. This study was undertaken to study the histomorphological findings of intestinal atresia and to correlate it with different subtypes and clinico-radiological feature. Material and methods: This was a prospective observational study conducted in 24 months on the resected gastrointestinal tract of 40 neonatal intestinal obstruction cases admitted in Pediatric surgery ward received in the Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna. Control Group- A total of 5 cases of vitello-intestinal duct patency were taken as control and compared with the study group. Results: With respect to total 40 cases, there were six, i.e. 15.0% female babies and 34, i.e. 85.0% male babies studied. Out of that, 15 i.e. 37.50% were full term and 25, i.e. 62.5% were premature. Mucosa showed oedema, ulceration and flattening in 9 cases. Apart from flattening and oedema, mucosa was denuded at some places and also showed congestion and extravasated blood in 6 cases each. Abnormal villus configuration, calcium deposition in 4 cases each and hypertrophied mucosa were found in 3 cases. Luminal narrowing, loss of mucosa, duplication of mucosa and gangrenewere found in one case each. Sub mucosal changes showed congestion in 33 cases, oedema in 15, Fibrosis in 4, thickened submucosa in 2 cases and dilated irregular branching blood vessels, extravasted blood, calcification in 1 case each. Muscularispropria having changes i.e. thinning in 16 cases, congestion, hypertrophy in 4 cases each, focal loss in 3 cases, calcification in 2 cases and thinning in 2 cases. Similarly, histopathological changes in serosa shows serositis in 16 cases, congestion in 11 cases and thinning in 3 cases. Oedema and congestion were present in 2 cases, hypertrophy and calcification in 1 case each. Conclusion:In this study spectrum of histomorphological changes in the atretic segment has been described. Histomorphological changes at atretic segment can be valuable to surgeons in deciding the type of surgery and minimizing the postoperative intestinal dysmotility, which remains the most common complication of intestinal atresia.

NIMG-53. RATIO OF T1-WEIGHTED TO T2-WEIGHTED SIGNAL INTENSITY AND IDH MUTATION IN GLIOMA

INTRODUCTION Identifying IDH mutation status before treatment is essential for Lower-grade glioma (LrGG) treatment. We have previously revealed that IDH mutated LrGG consists of tumor tissues with significantly longer T1 and T2 relaxation time and is a useful radiological feature to identify IDH mutation status. The ratio of T1-weighted to T2-weighted signal intensity (rT1/T2) is a way to retrieve semi-quantitative relaxation time information of the tissue bypassing the need to perform relaxometry. This investigation aimed to elucidate the correlation between rT1/T2 and T1-, T2-relaxation time (-relax) in glioma tissue and to explore the possibility of rT1/T2 as a radiological surrogate marker to identify IDH mutation status in LrGG. MATERIALS AND METHODS We analyzed 8 LrGGs (IDHwt:4, IDHmt:2, IDHmt&1p19q-CODEL:2) in which relaxometry was performed. rT1/T2 maps were reconstructed as described in previous literature. Regions-of-interest were designed based on T2WI and FLAIR. The correlations between rT1/T2 and T1- and T2-relax were analyzed. Furthermore, We also investigated the correlation of IDH mutation status and rT1/T2. RESULTS 106,488 voxels were analyzed. The correlation between rT1/T2 and T1- and T2-relax were rT1/T2=1.6e-0.0003T1-relax and rT1/T2=1.2e-0.002T2-relax (R=0.77 and 0.70). rT1/T2 of IDH-wildtype tumor was significantly higher than that of IDH-mutant tumor (1.0 vs. 0.75, p< 0.0001). Voxel-wise analysis of rT1/T2 map was able to discriminate IDH-wildtype tumor from the mutant tumor with an AUC of 0.82. CONCLUSIONS rT1/T2, which can be calculated from MRI acquired during routine clinical practice, is a promising radiological surrogate marker to identify IDH mutation status in LrGG.

High prevalence of variants in skeletal dysplasia associated genes in individuals with short stature and minor skeletal anomalies

Objective: Next generation sequencing (NGS) has expanded the diagnostic paradigm turning the focus to the growth plate. The aim of the study was to determine the prevalence of variants in genes implicated in skeletal dysplasias in probands with short stature and mild skeletal anomalies. Design: Clinical and radiological data were collected from 108 probands with short stature and mild skeletal anomalies. Methods: A customized skeletal dysplasia NGS panel was performed. Variants were classified using ACMG recommendations and Sherloc. Anthropometric measurements and skeletal anomalies were subsequently compared in those with or without an identified genetic defect. Results: Heterozygous variants were identified in 21/108 probands (19.4%). Variants were most frequently identified in ACAN (n=10) and IHH (n=7) whilst one variant was detected in COL2A1, CREBBP, EXT1 and PTPN11. Statistically significant differences (p<0.05) were observed for sitting height/height (SH/H) ratio, SH/H ratio SDS and the SH/H ratio SDS >1 in those with an identified variant compared to those without. Conclusions: A molecular defect was elucidated in a fifth of patients. Thus, the prevalence of mild forms of skeletal dysplasias is relatively high in individuals with short stature and mild skeletal anomalies, with variants in ACAN and IHH accounting for 81% of the cases. An elevated SH/H ratio appears to be associated with a greater probability in detecting a variant, but no other clinical or radiological feature has been found determinant to finding a genetic cause. Currently, we cannot perform extensive molecular studies in all short stature individuals so detailed clinical and radiological phenotyping may orientate which are the candidate patients to obtain worthwhile results. In addition, detailed phenotyping of probands and family members will often aid variant classification.

Evaluation of Intracranial Hypertension in Traumatic Brain Injury Patient: A Noninvasive Approach Based on Cranial Computed Tomography Features

Background: Our purpose was to establish a noninvasive quantitative method for assessing intracranial pressure (ICP) levels in patients with traumatic brain injury (TBI) through investigating the Hounsfield unit (HU) features of computed tomography (CT) images. Methods: In this retrospective study, 47 patients with a closed TBI were recruited. Hounsfield unit features from the last cranial CT and the initial ICP value were collected. Three models were established to predict intracranial hypertension with Hounsfield unit (HU model), midline shift (MLS model), and clinical expertise (CE model) features. Results: The HU model had the highest ability to predict intracranial hypertension. In 34 patients with unilateral injury, the HU model displayed the highest performance. In three classifications of intracranial hypertension (ICP ≤ 22, 23–29, and ≥30 mmHg), the HU model achieved the highest F1 score. Conclusions: This radiological feature-based noninvasive quantitative approach showed better performance compared with conventional methods, such as the degree of midline shift and clinical expertise. The results show its potential in clinical practice and further research.