Browsing by Author "Kumar, Ishan"
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Publication A prospective randomized comparison of simultaneous integrated boost with sequential boost intensity-modulated radiotherapy in locally advanced head and neck cancer(Wolters Kluwer Medknow Publications, 2022) Mani, Nilesh; Aggarwal, Sushil K.; Kumar, Ishan; Mandal, Abhijit; Jaiswal, Garima; Ranjan, Rakesh; Jaiswal, Anil K.; Gupta, Neha; Singh, Ankita; Mourya, Ankur; Aggarwal, Lalit M.; Choudhary, SunilPurpose: A comparison of simultaneous integrated boost (SIB) with sequential boost (SEQ) using intensity-modulated radiotherapy along with concurrent cisplatin in locally advanced head and neck cancer (HNC) was made with regard to their survival outcomes and toxicity profile. Materials and Methods: A total of 34 patients were enrolled between October 2016 and March 2019. They were randomized into two arms, SIB and SEQB. All patients were treated with 6 MV photon beam on Linear Accelerator with weekly concurrent cisplatin at 35 mg/m 2. Overall survival (OS) and disease-free survival (DFS) were the primary end points and acute and late toxicities were the secondary end points. Results: The median follow-up period was 40.6 and 37.3 months for SIB and SEQB, respectively. At the end of 5 years, the median OS was 40.6 and 37.3 months (P = 0.947) and the median DFS was 35.1 and 37.3 months in the SIB and SEQB arms, respectively (P = 0.991).complete response at 3 months was 64.7% and 76.5% and partial response was 23.5% and 17.6%, whereas progressive disease was 11.8% and 5.9% in SIB and SEQB arms, respectively. Acute dermatitis, mucositis, dysphagia, and salivary gland toxicities were higher in the SIB arm compared to the SEQB arm. Conclusion: SIB and SEQ arms were comparable in terms of OS and DFS. However, the acute toxicities were higher in the SIB arm, although the difference was not significant, compared to the SEQB arm. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.Publication Acute Cardiac Events After ChAdOx1 nCoV-19 Corona Virus Vaccine: Report of Three Cases(Lippincott Williams and Wilkins, 2022) Singh, Rohit; Chakrabarti, Sankha Shubhra; Gambhir, Indrajeet Singh; Verma, Ashish; Kumar, Ishan; Ghosh, Soumik; Tiwari, Ashutosh; Chandan, Gourav; Chakrabarti, Sasanka; Kaur, Upinder[No abstract available]Publication Approach to Acute Respiratory Illness in Children with Hematological Malignancy: A Prospective Study Evaluating Utility of CT Scan(Georg Thieme Verlag, 2022) Aggarwal, Priyanka; Raipa, Tapish; Kumar, Ishan; Verma, Ashish; Shukla, Ram Chandra; Gupta, VineetaIntroduction Various pulmonary complications can occur in children with hematological malignancies including both infection and malignant disease infiltration of pulmonary parenchyma. Objectives To assess the role of CT scan in determining the etiology of acute pulmonary complications in children with hematological malignancies. Materials and Methods All children < 17 years with newly diagnosed hematological malignancy with respiratory symptoms (Group A) along with children who developed fever with persistent respiratory symptoms as well as worsening chest radiographs during treatment (Group B) and underwent CECT thorax, from February 2019 to July 2020 were enrolled. The final diagnosis was made on the basis of clinical history, laboratory as well as radiological investigations and treatment response. Results Thirty-seven children with mean age of 7.5 � 3.5 years and male to female ratio of 1.3:1 who underwent CECT thorax were included in our study. For newly diagnosed cases, i.e., Group A (n = 8), the most common cause of respiratory symptoms as identified on CECT thorax was pulmonary tumoral infiltration (n = 5) followed by tuberculosis (n = 3). However, in Group B (n = 29) the cause of persistent respiratory symptoms was identified as infection (n = 17) followed by leukemic infiltration (n = 12). Thus, chest CT could accurately identify pulmonary tuberculosis, fungal pneumonia, bacterial infection, and pulmonary tumoral infiltrates. Conclusion CT scan can be used as an adjunctive tool for prompt diagnosis and management of pulmonary complications in children with persistent respiratory symptoms as they are often non-specific. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.Publication Bone Mineral Metabolism during Chemotherapy in Childhood Acute Lymphoblastic Leukemia(Lippincott Williams and Wilkins, 2021) Maddheshiya, Sonal; Singh, Surya K.; Kumar, Ishan; Aggarwal, Priyanka; Gupta, VineetaObjective: The aim of this study was to evaluate levels of vitamin D, bone mineral density (BMD), and radiograph features at diagnosis and after 6 months of chemotherapy in patients with acute lymphoblastic leukemia (ALL). Vitamin D levels were also correlated with BMD and radiograph features. Materials and Methods: 25-Hydroxy vitamin D [25(OH)D] levels, BMD, and radiograph features were assessed in 50 newly diagnosed patients of ALL in the age group of 2 to 14 years. A total of 30 age-matched and sex-matched children were recruited as controls. Vitamin D deficiency was defined as 25(OH)D <10 ng/mL, Vitamin D insufficiency as 10 to 29 ng/mL, and Vitamin D sufficiency as =30 ng/mL. Enzyme immunoassay (EIA) was used for the quantitative measurement of 25(OH)D levels in plasma and a LUNAR DPX NT bone densitometer was used for the assessment of BMD. Results: The mean age of the patients was 6.3 years, with a male:female ratio of 1.38:1. The mean 25(OH)D levels were 31.90�16.90 ng/mL in patients at diagnosis against 41.63�20.50 ng/mL in controls (P=0.02). Levels were 18.50�11.10 ng/mL postchemotherapy (P=0.00). Female sex was a risk factor for deficient 25(OH)D levels. There was a significant decrease in BMD postchemotherapy in the age groups of 5 to 10 and above 10 years at the femoral neck. Osteopenic changes were observed in more number of patients after 6 months of chemotherapy. There was a significant correlation between vitamin D levels, BMD, and osteopenic changes. Conclusions: Vitamin D deficiency was common among ALL patients, which worsened after chemotherapy. This had a significant correlation with BMD and osteopenic changes in radiograph. � 2021 Lippincott Williams and Wilkins. All rights reserved.Publication Case Report: Nocardia amamiensis Infection Leading to Worsening of Chronic Obstructive Pulmonary Disease Symptoms in an Elderly Man(American Society of Tropical Medicine and Hygiene, 2023) Kanakan, Ahalya; Kumar, Amit; Kaur, Upinder; Narwade, Prity; Rain, Zinnu; Yadav, Nidhi; Kumar, Ishan; Kumar, Deepak; Chakrabarti, Sankha ShubhraNocardiosis is a rare opportunistic infection mostly affecting the lungs, brain, or skin of immunocompromised individuals. Most pulmonary nocardiosis patients present with nonspecific clinical features such as productive cough, exertional dyspnea, and fever. The disease is uncommonly suspected, especially in tuberculosis-endemic regions, and clinical diagnosis is often delayed, resulting in high mortality. Pulmonary nocardiosis in apparently immunocompetent individuals is uncommon. Here, we present the case of an elderly gentleman with a background history of poorly controlled diabetes but no history of systemic steroid use who presented with worsening symptoms of chronic obstructive pulmonary disease in the form of productive cough and dyspnea. The patient had diffuse crepitations in bilateral lung fields and an arterial oxygen saturation of 86% at admission. Sputum microscopy revealed gram-positive filamentous bacteria that could be successfully cultured and identified as Nocardia amamiensis on 16S ribosomal RNA sequencing. Contrast-enhanced computed tomography of the lungs revealed cavitary nodules and consolidation. The patient responded well to treatment with specific antibiotics based on sensitivity patterns. Because of the nonspecific clinical and radiological findings in pulmonary nocardiosis, a high index of suspicion is required, especially in tuberculosis-endemic regions. � 2023 American Society of Tropical Medicine and Hygiene. All rights reserved.Publication Child with Intellectual Disability and Seizures(Springer, 2022) Kumar, Ishan; Ranjan, Manoj; Singh, Ankur; Aggarwal, Priyanka; Verma, Ashish[No abstract available]Publication Comparison of T2-weighted and diffusion-weighted imaging for the diagnosis of placenta accreta spectrum abnormality(SAGE Publications Inc., 2023) Prakash, Adity; Kumar, Ishan; Verma, Ashish; Shukla, Ram CBackground: Diffusion-weighted imaging (DWI) is feasible in prenatal imaging, and it exhibits better contrast between the placenta and the myometrium compared to T2-weighted (T2W) images. Purpose: To compare magnetic resonance imaging (MRI) features of placenta accreta on T2W and DW imaging. Material and Methods: In this retrospective study, 42 pregnant patients who underwent prenatal MRI were included. MRI was performed on a Siemens 1.5-T scanner. T2W and DWI sequences in the axial, sagittal, and/or coronal planes were compiled for review. Two radiologists independently interpreted T2W and DW images for placenta accreta. T2W and DWI scores were calculated based on the presence of features and graded as low, intermediate, and high risk. The association between imaging features and placental invasion on pathology was calculated using chi-square tests. Sensitivity, specificity, and positive and negative predictive values (NPV) were compared between T2W and DWI interpretations. Inter-reader agreement between the two radiologists for T2W and DWI scores was calculated using Cohen's kappa coefficient. Results: Out of 42 pregnant patients, 10 were pathologically/surgically proven to have placenta accreta. There were no significant differences between T2W and DWI interpretations. Considering a cutoff >6 as positive, the T2W score had higher sensitivity (90% vs. 80%) and NPV (96.9% vs. 94.1%) than the DWI score. The specificity and positive predictive value were 100% for both scores. The inter-reader agreement of T2W score was higher (k = 0.943 vs. 0.882). Conclusion: T2W and DWI are comparable in diagnosing placenta accreta spectrum. T2W sequences have higher sensitivity, NPV, and inter-reader agreement than DWI. � The Foundation Acta Radiologica 2022.Publication Comparison of the effects of calcium channel blockers plus iron chelation therapy versus chelation therapy only on iron overload in children and young adults with transfusion-dependent thalassemia: A randomized double-blind placebo-controlled trial(John Wiley and Sons Inc, 2022) Gupta, Vineeta; Kumar, Ishan; Raj, Vibhesh; Aggarwal, Priyanka; Agrawal, VikasBackground: Myocardial iron deposition is a significant cause of morbidity and mortality in patients with transfusion-dependent thalassemia (TDT). Amlodipine, L-type calcium channel blocker with regular chelation therapy may reduce myocardial iron overload. Lack of randomized trials prompted this study to assess the effect of calcium channel blocker (amlodipine) in combination with iron chelation therapy on iron overload in patients with TDT. Methods: Sixty-four eligible patients were randomized to receive either amlodipine and chelation (group A) or chelation alone (group B) in double-blind placebo-controlled trial. Myocardial iron concentration (MIC) using T2* magnetic resonance imaging (MRI), liver iron concentration (LIC), left ventricular ejection fraction (LVEF), and serum ferritin were measured at baseline and 12�months. Results: In the amlodipine group, mean cardiac T2* value significantly increased from 18.11 � 8.47 to 22.15 � 7.61 (p�=.002) at 12�months, whereas in control group, there was a nonsignificant increase (p�=.62) in cardiac T2* value from 19.50 � 8.84 to 20.03 � 9.07. There was a significant decrease in MRI-derived MIC in the amlodipine group compared to control group (1.93 � 1.61 to 1.29 � 0.90, p�=.01). Changes in the LVEF (p�=.45), MRI-derived LIC (p�=.09), and serum ferritin (p�=.81) were not significant between the two groups. Conclusion: Amlodipine is safe and when combined with chelation therapy appears to be more effective in reducing cardiac iron overload than chelation only in children and young adults with TDT. � 2022 Wiley Periodicals LLC.Publication CT-Based Definition and Structured Reporting of Abdominal Lymph Node Stations(Georg Thieme Verlag, 2022) Kumar, Ishan; Sharma, Srishti; Prakash, Adity; Aggarwal, Priyanka; Shukla, Ram C.; Verma, AshishBackground Meticulous evaluation of abdominal lymph nodes on computed tomography (CT) is a fundamental task in radiological practice especially in oncological reporting. Although various reporting systems exist to define abdominal nodal stations for malignancies of individual abdominal organs, a complete and uniform framework for radiological reporting of abdominal lymph nodes does not exist in the literature. Purpose The goal of this review was to provide a step-wise reporting template and precise definitions of the radiological anatomy of abdominal lymph nodes and to generate a CT-based illustration of the lymph node stations of the abdomen. Conclusion This CT-based illustration and reporting template will help the radiologists to aptly describe the extent of the lymph nodal diseases and will help in comparison with posttherapy scans. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.Publication Early postnatal color Doppler changes in neonates receiving delivery room resuscitation with low 5 min Apgar score�a pilot study(Springer Nature, 2021) Kumar, Ishan; Singh, Shweta; Kumar, Ashok; Aggarwal, Priyanka; Shukla, Ram C.; Verma, AshishAims and objectives: To evaluate the Doppler changes in the intracranial arteries of neonates exposed to perinatal hypoxic insult and compare it with normal neonates. Materials and methods: Color Doppler of bilateral anterior and middle cerebral arteries was performed within 6 h of birth in 26 healthy neonates and 50 neonates who received delivery room resuscitation (DRR) for perinatal depression and had a 5 min Apgar score <7. Comparisons of resistive index (RI) and peak systolic velocity (PSV) were made between the (a) control group (b) patients with low 5 min Apgar score <7 who without clinical features of neonatal encephalopathy at 24 h (c) neonates with perinatal depression with a clinical evidence of disturbed neurological function at 24 h of birth and examination consistent with mild, moderate, or severe encephalopathy using modified Sarnat and Sarnat�s classification. Results: Significantly higher RI was observed in the neonates with to perinatal depression compared to the normal neonates. Significantly higher RI was seen in the patients with clinical features of neonatal encephalopathy (Group C) compared to group B. RI <0.6 and >0.82 was associated with severe neonatal encephalopathy. Differences in PSV were not statistically significant in the various groups. Conclusion: The study presents the changes in early cerebral Doppler parameters observed in neonates with low 5 min Apgar score following DRR compared to the normal neonates. We also present the relations of Doppler parameters with increasing severity of neonatal encephalopathy according to Sarnat classification. � 2020, The Author(s), under exclusive licence to Springer Nature America, Inc.Publication Enhancement of Sensorimotor Cortical Adaptation after Dental Implantation in Comparison to the Conventional Denture-Demonstration by Functional MRI at 1-5T(Wolters Kluwer Medknow Publications, 2021) Verma, Aprajita; Bhatnagar, Atul; Kumar, Ishan; Verma, AshishBackground and Purpose: Dental implantation is thought to be associated with enhancement of neuro-cortical sensorimotor activity which has been lost due to an edentulous state. Such changes are either feeble or absent after the placement of a conventional denture. In the present study, we test this hypothesis using blood oxygen level-dependent (BOLD) activity on functional MRI (fMRI) as a bio-surrogate. Materials and Methods: fMRI was performed in 12 consecutive edentulous subjects (mean age = 59.2 years) after the placement of a conventional complete denture (CD) and subsequently after intraoral dental implantation (IOD). The semi-quantitative data of the BOLD activity was compiled to depict the activation seen in both scenarios in six anatomical regions. Statistical analysis was done to evaluate the significance of enhancement in BOLD activity in these regions in patients having an IOD as compared to those having a CD. Results: The enhancement of BOLD activity on fMRI after placement of an IOD was much more significant as compared to that noted with CD. Using Wilcoxon's signed-rank test the nonparametric data showed a significant positive elevation in global and regional assigned mean ranks of BOLD activity. Conclusion: Intraoral implantation leads to a significant elevation in the BOLD activity of the sensorimotor cortex as compared to the placement of a conventional CD. � 2021 Wolters Kluwer Medknow Publications. All rights reserved.Publication Evaluation of Uterocervical Angle and Cervical Length as Predictors of Spontaneous Preterm Birth(Georg Thieme Verlag, 2022) Singh, Pramod Kumar; Srivastava, Resham; Kumar, Ishan; Rai, Sangeeta; Pandey, Saurabh; Shukla, Ram C.; Verma, AshishAim The aim of this article was to evaluate uterocervical angle (UCA) and cervical length (CL) measured at 16 to 24 weeks of gestation using transvaginal sonography (TVS) as predictors of spontaneous preterm birth. Methods In this prospective study, TVS was performed in 159 primigravidas with a singleton, uncomplicated pregnancy at 16 to 24 weeks of gestation to measure the anterior UCA and CL. All the cases were followed until labor to document gestational age at delivery. Results The risk of spontaneous preterm birth was higher in women with obtuse UCA (>95 degrees) with sensitivity of 86.7%, specificity of 93.0%, positive predictive value of 83.0%, negative predictive value of 94.6%, and p -value of <0.001. The difference between the means was statistically significant (p -value < 0.001). UCAs ?105degrees and 95 to 105 degrees were found to be significantly associated with spontaneous preterm births at <34 weeks and 34 to 37 weeks, respectively. CL <2.5 cm was found to predict spontaneous preterm births at <37 weeks with sensitivity of 31.1%, specificity of 95.6%, and p -value of <0.001. UCA was found to be a better predictor of spontaneous preterm birth with a higher coefficient of variation (56.4%) when compared with CL (16.9%). Conclusions UCA proved to be a novel ultrasound parameter that can serve as a better predictor of spontaneous preterm births in comparison to CL. A strong correlation exists between obtuse UCA and a risk of spontaneous preterm birth. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.Publication Factors Affecting Short-Term Outcome of Critically Ill Children with Malignancies Admitted in Pediatric Intensive Care Unit: A Retrospective Observational Study(Thieme Medical Publishers, Inc., 2021) Aggarwal, Priyanka; Kumar, Ishan; Rao, Sunil Kumar; Pradhap, K.; Gupta, VineetaIntroduction Pediatric cancer contributes <1% of all malignancies. Childhood cancer survival has improved dramatically with the use of more intensive chemotherapy regimens, better stratification, and improvement in supportive care with enhanced facilities in pediatric intensive care unit (PICU). Objective The aim of this study was to identify the risk factors responsible for poor outcome in critically ill children with malignancies admitted in PICU. Materials and Methods Sixty-four children with a primary diagnosis of malignancy admitted in PICU with disease or treatment related complications were enrolled retrospectively. The short-term outcome, that is, shifting from PICU to ward, was assessed in relation to the presence of febrile neutropenia, organ failure, hepatitis, acute renal failure as well as requirement of inotropes and mechanical ventilation. Death was considered as an adverse outcome in this study. Results The mean age of study population was 6.25 � 3.91 and M:F ratio 2.4:1. The majority of children had hematological malignancies (81.25%), that is, pre-B acute lymphoblastic leukemia (ALL) (45.3%), non-Hodgkin lymphoma (21.3%), acute myeloid leukemia (12.5%), T ALL (10.9%), and Hodgkin lymphoma (3.1%). Few children also had retinoblastoma (4.7%) and Langerhans cell histiocytosis (1.6%). The mean duration of PICU stay was 3.16 � 2.31 days. Sepsis (37.5%) was the most common indication for PICU admission, followed by metabolic disturbance (26.6%), respiratory failure (17.2%), neurological complaints (15.6%), and anaphylactic shock (3.1%). Children requiring mechanical ventilation (p < 0.001), inotrope support (p < 0.001), having acute renal failure (p = 0.001), and >1 organ failure (p < 0.001) were associated with adverse outcome. The overall survival at the time of discharge from PICU was 64%. Conclusion In the context of low- and middle-income countries, optimal resource utilization by early identification of risk factors for clinical deterioration is required to allow timely admission to PICU and delivery of life-saving therapy to salvageable patients. � 2021 Wolters Kluwer Medknow Publications. All rights reserved.Publication Gastrointestinal system(CRC Press, 2023) Verma, Ashish; Duggal, Sakshi; Kumar, IshanAbdominal imaging is commonly performed in the intensive care unit (ICU) in patients with abdominal obstruction, perforation, blunt trauma, bleeding etc. for confirming clinical diagnosis. It is also performed in postoperative patients, after intervention procedures, liver and gall bladder diseases, pancreatitis and suspected poisoning. Among the imaging procedures, USG and plain X-ray can be performed at the bedside while other procedures may require patient transfer to the radiology suite. The findings from USG and X-ray may get obtunded by bowel gas, wounds, catheters, edema etc. The intensivist should know the indications for different procedures and choose the right imaging after weighing the risk-benefit ratio. The chapter highlights the techniques for interpreting the findings after all types of abdominal imaging. � 2024 selection and editorial matter, Anirban Hom Choudhuri and Ashish Verma; individual chapters, the contributors.Publication Imaging in Critical Care Medicine(CRC Press, 2023) Choudhuri, Anirban Hom; Verma, Ashish; Kumar, IshanImaging in critically ill patients is a ubiquitous but challenging line of investigation for the physician as accurate interpretation is often difficult as patient cooperation during the procedure is grossly compromised, and the resultant image is often suboptimal. This book provides details on principles of imaging and the diagnostic hallmarks of common diseases to assist in correct interpretation. It contains guidance to overcome the deficiencies observed during the performance of bedside imaging and equipment handling and addresses the rationale for various procedural/management and imaging approaches. This is a useful companion for most doctors and trainees working in critical care settings. � 2024 selection and editorial matter, Anirban Hom Choudhuri and Ashish Verma; individual chapters, the contributors.Publication Initial comparative analysis of pulmonary involvement on HRCT between vaccinated and non-vaccinated subjects of COVID-19(Springer Science and Business Media Deutschland GmbH, 2022) Verma, Ashish; Kumar, Ishan; Singh, Pramod Kumar; Ansari, Mohammad Sharoon; Singh, Harsh Anand; Sonkar, Shashank; Prakash, Adity; Ojha, Ritu; Shukla, Ram ChandraObjectives: To compare the high-resolution computed tomography (HRCT)�derived severity score in COVID-19 patients between those who had earlier received the vaccine against the SARS-CoV-2 and those who did not. Methods: A retrospective cross-sectional analysis of HRCT of the chest was done in correlation with the vaccination status of clinically diagnosed COVID-19 patients. The variable under evaluation was the CT severity score, whereby differential analysis of the variability on this parameter between incompletely (single dose) vaccinated, completely (both doses) vaccinated, and non-vaccinated individuals was the outcome. Results: The analysis included 826 patients of which 581 did not receive any vaccination whereas 196 patients received incomplete (single dose) vaccination and 49 received complete vaccination. Mean CT severity score was lower in completely vaccinated patients (3.5 � 6.3) vis-�-vis incompletely vaccinated (10.1 � 10.5) and non-vaccinated (10.1 � 11.4) individuals. The mean CT score was significantly lower in completely vaccinated patients of lower ages (? 60�years) compared to patients above that age. The incidence of severe disease (CT score ? 20) was significantly higher in the incompletely vaccinated and non-vaccinated patients compared to that in the completely vaccinated group. Conclusions: CT severity scores in individuals receiving both doses of SARS-CoV-2 vaccination were less severe in comparison to those receiving a single dose of vaccine or no vaccine at all. Key Points: � Patients who received complete two doses of vaccination had significantly low mean CT scores compared to the partially vaccinated patients and non-vaccinated patients. � The mean CT scores were significantly lower in completely vaccinated patients of lower ages (< 60�years) while patients > 60�years did not show significantly different CT scores between the vaccinated and non-vaccinated groups. � Consolidations and ground-glass opacities were significantly lower in the group receiving complete vaccination as compared to the unvaccinated and incompletely vaccinated patients. � 2022, The Author(s), under exclusive licence to European Society of Radiology.Publication Magnetic resonance imaging spectrum of COVID-associated rhino-orbital-cerebral mucormycosis and assessment of anatomical severity(SAGE Publications Inc., 2023) Kumar, Ishan; Verma, Ashish; Dangwal, Jyoti; Singh, Pramod Kumar; Chandra Shukla, Ram; Chakravarty, JayaObjectives: To describe the extent and imaging findings of COVID-associated rhino-orbital-cerebral mucormycosis on magnetic resonance imaging and to evaluate the value of MRI severity score in grading the extent of involvement. Methods: Proven cases of ROCM with a history of concurrent or recently (<6�weeks) treated COVID-19 underwent MRI at the initial presentation. Findings were charted for each anatomical structure and the extent of involvement was scored for sinonasal, extra-sinus soft tissues, orbits, and brain. MR severity score was defined by summing up the individual scores of each compartment (sinonasal 20, orbital 20, soft tissue 10, and brain 10) and a total score out of 60 was assigned. Results: A total of 47 patients were included in our study with variable involvement of sinonasal compartment (n = 43), extra-sinus soft tissue (n = 25), orbits (n = 23), and brain (n = 17). In the sinonasal compartment, T2, DWI, and post-contrast T1 were the most useful sequences. A significantly higher mean sinonasal score was associated with mortality (p = 0.007). In the orbits, a combination of STIR (orbital fat and extraconal muscles), DWI (optic nerves), and post-contrast images (superior ophthalmic vein) were the most accurate sequences. A higher mean orbital score was associated with vision loss (p = 0.001). Patients with uncontrolled diabetes had greater extent of cranial involvement. Conclusion: A combination of magnetic resonance sequences is required to correctly evaluate the involvement of individual structures and thus to assign the correct MR scoring. The proposed MR severity score can effectively and objectively evaluate the severity of COVID-associated ROCM. � The Author(s) 2022.Publication Nervous system(CRC Press, 2023) Kumar, Ishan; Verma, Ashish; Ahuja, BhuvnaThe nervous system consists of the central and peripheral nervous systems. The central nervous system includes the brain and spinal cord while the peripheral nervous system includes all of the nerves that arise from the brain and spinal cord and innervate other parts of the body. Patients with brain and spinal cord dysfunctions are frequently admitted to the ICU for intensive management. While brain injuries following head trauma, stroke etc. Are routinely evaluated by CT of the head, the occurrence of meningitis, encephalitis etc. require MRI imaging. Imaging plays a crucial role in both the diagnosis and prognostication of illness. In addition, intervention radiology is useful in many conditions such as subarachnoid hemorrhage, tumor embolization etc. Therefore, correct interpretation of the radiological findings of the nervous system by the intensivists is essential for providing the right treatment. This chapter outlines the role and scope of neurological imaging and the means of identifying the key findings in patients with neurological diseases. � 2024 selection and editorial matter, Anirban Hom Choudhuri and Ashish Verma; individual chapters, the contributors.Publication Pediatric imaging(CRC Press, 2023) Kumar, Ishan; Verma, Ashish; Choudhuri, Anirban HomPediatric patients admitted with critical illness often need radiological imaging for definitive diagnosis and treatment. In all such cases, it is important to know the anatomical differences between children and adults producing image differences, the risk of radio sensitivity of the growing tissues and the need for sedation and general anesthesia during the procedure. There is a need for separate protocol for the procedure from that for adults. Since children are expected to have a long span, special care is needed to avoid overexposure to radiation and reduce the chances of long-term harmful effects. � 2024 selection and editorial matter, Anirban Hom Choudhuri and Ashish Verma; individual chapters, the contributors.Publication Performance of NI-RADS on CECT Alone to Predict Recurrent Head and Neck Squamous Cell Carcinoma after Chemoradiotherapy: Added Value of RECIST 11.(Georg Thieme Verlag, 2022) Kumar, Ishan; Reza, Syed O.; Choudhary, Sunil; Shukla, Ram C.; Mani, Nilesh; Verma, AshishBackground � The Head and Neck Imaging Reporting and Data System (NI-RADS) is a standardized reporting format for the categorization of the degree of suspicion for recurrent head and neck malignancies on positron emission tomography/computed tomography. Purpose � The purpose of our study was to analyze the efficacy of the NI-RADS rating scale and criteria for contrast-enhanced computed tomography (CECT) alone in predicting the local and regional recurrence of malignancies after chemoradiotherapy. Material and Methods � CECT of the patients with head and neck cancers receiving radiotherapy and concurrent chemotherapy as a primary treatment was obtained 3 months after the completion of radiotherapy and NI-RADS scoring was done using components of Response Evaluation Criteria in Solid Tumors (RECIST 1.1) criteria. Their management was guided according to the recommendations based on their NI-RADS score. Results � Thirty patients with squamous cell carcinoma of the neck were included in this study. The positive or negative status of the recurrent disease was based on biopsy results or follow-up protocol as recommended in NI-RADS rating scale. Fifteen patients had path proven recurrence at the primary tumor site. For primary tumor site, disease persistence rates of 4% for NI-RADS 1, 24% for NI-RADS 2, and 80% for NI-RADS 3 scores were seen. Five patients had recurrent lymph nodal disease. For lymph nodal assessment, NI-RADS categories 1, 2, and 3 revealed nodal disease recurrence rates of 5.3, 25, and 66.7%, respectively. Conclusion � CECT alone may be used to assign the NI-RADS rating scale using RECIST 1.1 criteria to predict the presence or absence of recurrent tumor in patients with neck malignancies. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.
