RECENT ADVANCES

Newer antitubercular drugs:

Delamanid (OPC-67683; nitrodihydro imidazooxazole
derivative) it inhibits mycolic acid synthesis with a great efficacy
against multidrug-resistant strains of M. tuberculosis. No
significant adverse events and no cross-resistance have been
reported.

Bedaquiline ( Sirturo; Janssen Therapeutics) diarylquinoline for

MDR &XDR TB, FDA Approved December 2012, it inhibits ATP
synthesis (energy production) by inhibiting ATP synthase. It may
produce arrhythmias and cardiac arrest.

Vertebroplasty is a minimally invasive, image-guided therapy

used to relieve pain from a vertebral body fracture. It has been
used for osteoporotic or malignant fractures. Initially, the major
indication was treatment of spinal hemangiomas With
experience, other indications have emerged. Vertebroplasty
can increase patient mobility, decrease narcotic needs, and
prevent further vertebral collapse.
Ice cream Time
Ice cream on MRI-- Acoustic Schwanomma.
Ice Cream cone on CT temporal bone: Incudomalleolar Joint.

Proton Beam Therapy for Pediatric malignancies — The

potential benefits of proton therapy are probably greatest in
pediatric cancer patients. In theory, the reduced radiation
exposure of normal tissues will yield lower rates of radiation-
induced second malignancies, as well as less damage to
developing organs. Pediatric tumors that arise in and near
critical structures are well suited to the use of proton
treatment; these include gliomas, medulloblastomas,
retinoblastomas, rhabdomyosarcomas, and pelvic sarcomas

The Rolando fracture is a comminuted intra-articular fracture

through the base of the first metacarpal bone (the bone located
just proximal to the thumb). It was first described in 1910 by
Silvio Rolando. This is a fracture consisting of 3 distinct
fragments; it is typically T- or Y-shaped.
valentine day special -
Panton-Valentine leukocidin (PVL) is a cytotoxin—one of the β-
pore-forming toxins. The presence of PVL is associated with
increased virulence of certain strains (isolates) of
Staphylococcus aureus. It is present in the majority of
community-associated Methicillin-resistant Staphylococcus
aureus (CA-MRSA) isolates studied and is the cause of necrotic
lesions involving the skin or mucosa, including necrotic
hemorrhagic pneumonia. PVL creates pores in the membranes
of infected cells. PVL is produced from the genetic material of a
bacteriophage that infects Staphylococcus aureus, making it
more virulent

What is triple Rule Out---Chest pain evaluation by MDCT--

Triple-rule-out (TRO) computed tomographic (CT) angiography
can provide a cost-effective evaluation of the coronary arteries,
aorta, pulmonary arteries, and adjacent intrathoracic structures
for the patient with acute chest pain..
Rose day special
Rose's sign is a clinical sign in which the skin of one leg feels
warm and stiff when pinched. It can occur in people with deep
vein thrombosis due to oedema in the affected leg

Terrible triad of Elbow is a traumatic injury pattern of the elbow

characterized by:

Posterolateral dislocation
Radial head fracture
Coronoid fracture

Panda Sign= facial uptake of Ga-67 in both parotid glands +

both lacrimal glands + nose- Sarcoidosis.
Aggrecan is the major space-filling proteoglycan in articular
cartilage that provides the tissue with mechanical properties of
reversible compressibility. In joint pathology such as that seen
in osteoarthritis and rheumatoid arthritis, aggrecan loss leads
to progressive cartilage degradation. Those enzymes
responsible for cartilage and collagen degradation are called
matrix proteinases because their chief site of action is in the
extracellular matrix.

Short-lasting Unilateral Neuralgiform headache attacks with

Conjunctival injection and Tearing (SUNCT) is a syndrome
predominant in males, with a mean age of onset around 50
years. The attacks are strictly unilateral, generally with the pain
persistently confined to the ocular/periocular area.

Update of the day ::Adult-onset Still's disease (ASD or AOSD) is

a rare multisystem inflammatory disorder characterized by
acute arthritis, characteristic rash, and quotidian or double-
quotidian fevers
Adult Still's disease is used to describe an adult patient who do
not fulfill the classic criteria of Rheumatoid arthritis but who
has features similar to Juvenile idopathic arthirits

Blount's Disease / Pathological Tibia Vara ::

It is a growth disorder of medial portion of proximal tibial
physis --
- - characterized by medial angulation& internal rotation of
proximal tibia
-- Etiology is related to repetitive trauma to posteromedial
proximal tibia physis from ambulating on a knee with varus
alignment . This is usually bilateral and associated with internal
tibial torsion

Ultrasound of an intussusception:: Figure shows a transverse

view. Alternating hyperechoic and hypoechoic concentric rings
are present within the lumen of a distended loop of bowel,
giving the typical "target" sign
Concept of MRI was given by Paul Lauterbur and Peter
Mansfield for which they were given Nobel prize in 2003. First
body MRI machine was patented by Raymond Damadian.

Supine film sign of pneumoperitoneum: tell tale triangle sign.

Characteristic abnormality seen in the posterior thalamic region

( “pulvinar sign”) on MRI is highly sensitive and specific for
variant CJD.