Volume of Enlarged White Matter of Thalamus among Individuals with Depression on Magnetic Resonance Image: A Study of BrainSuite Segmentation.

Background: The thalamus, located in the diencephalon, regulates emotions and memories. If there is a problem in this area of the brain, it can cause an amnestic syndrome characterized by difficulties in remembering and recognizing things. The objective of this study was to identify changes in the volume of the thalamus while contrasting them among individuals with depression. Materials and Methods: The study involved measuring the volumes of the white matter of the thalamus in 79 patients with depression (42 males and 37 females) between 20 and 40 years (24 ± 5.51). This was compared to a control group of 53 individuals (24 ± 4.91) consisting of 29 males and 24 females, who were comparable in terms of sex and age. The measurements were taken employing BrainSuite version 18a. 021 Win 64bit software on a Philips 1.5 Tesla Magnetom Avanto Vision System magnetic resonance imaging (MRI). The Magnetization Prepared Rapid Acquisition (MPRA) was utilized to acquire three-dimensional images with T1 weighting. Results: The volume of white matter in the respective right and left thalamus was 5.09 cm3 and 4.58 cm3 (±standard deviation (SD) = 6.43 and 4.74) among individuals with depression. In the control group, the volume of white matter in the right and left thalamus was 3.66 cm3 and 4.16 cm3 (±SD = 3.99 and 5.06), respectively. The P-value is more than 0.05. The average volume of white matter in the right and left thalamus of females with depression and controls was 6.47 cm3 and 6.77 cm3 (with SD of 4.17 and 4.3), and 3.25 cm3 and 3.13 cm3 (with SD of 6.55 and 6.77), respectively. Conclusions: Our data suggest that individuals with depression exhibit an augmentation in the white matter of the thalamus, particularly in female patients where there is an upsurge in white matter volume. Depression appears to be linked to a decrease in volume on the left side of the brain.

Evaluating the Appropriateness of ENT Emergency Clinic Referrals to Enhance the Quality of Healthcare Provision in the National Health Service (NHS).

Background Ear, Nose, and Throat (ENT) services in the National Health Service (NHS) face escalating pressure, exacerbated by the COVID-19 pandemic, resulting in prolonged waiting times and increased referrals. Understanding the factors driving pressure on ENT services is crucial for enhancing patient care and resource allocation. Methods A retrospective single-centre cohort study was conducted at Queen's Medical Centre, Nottingham, UK, over five weeks. A total of 156 referrals to the ENT Emergency Clinic (E-Clinic) were analyzed, assessing the appropriateness of referrals and healthcare professionals' involvement in reviewing cases. Results The analysis revealed 28 distinct case categories, with certain conditions being predominant in specific reviews (e.g., otitis externa, nasal fractures, epistaxis). Notably, 21.8% of cases were deemed unsuitable or inappropriate for E-Clinic assessment. Strategic restructuring was suggested, distributing cases among healthcare professionals based on expertise and complexity. Discussion The findings underscore the need for a refined referral process and appropriate allocation of cases, emphasising the importance of nurse-led reviews for certain conditions and the necessity for senior review in complex cases. Improving the primary-secondary care interface and educating healthcare professionals on appropriate referrals are crucial for refining the system. Conclusion Optimising the quality of referrals and allocation of cases within ENT E-Clinics can alleviate workload pressures and enhance patient care. Strategic distribution of cases based on expertise and complexity, alongside refined referral processes, can significantly improve clinic efficiency and patient outcomes in the NHS.

Glandular Fever Testing in Patients Presenting With Tonsillitis: A Retrospective Study.

BACKGROUND: Tonsillitis, the inflammation of the palatine tonsils, typically arises from infections and predominantly affects children of primary school age. Most cases stem from viral or bacterial infections. Glandular fever, a subtype, is primarily caused by the Epstein-Barr virus (EBV). This specific type of tonsillitis can lead to severe complications, including splenic rupture, encephalitis, chronic fatigue, and acute acalculous cholecystitis. As a result, early identification is vital to establish proper safety measures and prevent the onset of these potentially dangerous complications in patients. OBJECTIVES: This study aims to determine the number of missed glandular fever cases diagnosed as simple tonsillitis and raises considerations in managing these patients. METHODS: A 12-month retrospective single-centre cohort study was carried out in Lincoln County Hospital, Lincoln, England. A total of 185 patients diagnosed with tonsillitis were included, along with their presenting symptoms and investigations, including liver blood tests and glandular fever screening. RESULTS: Among the 185 patients, averaging 26 years old, 112 were screened for EBV infection, revealing 35 positive cases (31.3%). Notably, 74% of these positive cases (26 out of 35) displayed abnormal liver function test results. CONCLUSION: Applying the percentage of EBV-positive cases to the 73 unscreened patients results in a likelihood of 23 missed cases of EBV infection. These form 12% of the study group, indicating a significant potential missed number of cases. Given the associated risks and complications with EBV, we note the importance of screening to identify cases and apply relevant considerations in their management.

The Financial Burden Associated With Conservatively Managed Epistaxis.

AIM: Each year, approximately 25,000 patients present to NHS hospitals in the UK with epistaxis. This study aims to investigate the financial implications of epistaxis, focusing on cases managed conservatively. Specifically, the research explores the average cost of hospital bed stays, the length of hospitalization, and the impact of blood thinners on healthcare expenses.  Methods: A retrospective study spanning June 2022 to June 2023 collected data from electronic health records at our local district general hospital. Patients meeting inclusion criteria were analyzed for demographic information, duration of hospital stay, use of blood thinners, and outcomes. Statistical software (SAS and Excel) was used for data analysis. RESULTS: Out of 126 patients, conservatively managed epistaxis cases (n = 119) had an average age of 73.9 years, with 53.6% males. The mortality rate was 4.5%. The average hospital stay was 2.92 days. Approximately 57% of patients were taking blood thinners. The average cost of a hospital bed stay for epistaxis patients was £1,712.84, with a £259.69 difference between those on blood thinners and those not. CONCLUSION: Epistaxis imposes a significant financial burden on hospitals, with conservatively managed cases incurring substantial costs. Recognizing and addressing the financial implications of epistaxis is essential for healthcare providers and policymakers. Investment in preventative medicine and patient education can potentially reduce the incidence of epistaxis and alleviate the financial burden on healthcare systems.

Analysis of Variables Influencing Short-Term Complications in Geriatric Patients Undergoing Emergency General Surgery (EGS): A Retrospective Cohort Study.

BACKGROUND: Emergency general surgery (EGS) encompasses a wide range of acute surgical conditions that pose significant risks to patient life and well-being. Understanding the factors that contribute to short-term complications in geriatric patients undergoing EGS is crucial for improving patient outcomes. This retrospective single-center cohort study aimed to evaluate the impact of various variables on short-term complications in geriatric patients undergoing EGS. METHODS: A total of 212 patients aged 65 and above who underwent emergency abdominal surgery between 2017 and 2018 were included in the study. The analysis focused on several variables, including age, sex, body mass index (BMI), beta-blocker use, open abdomen treatment, blood transfusions, anticoagulant therapy, and vasopressor use. Univariate and multivariate analyses were conducted to assess the association between these variables and short-term complications. RESULTS: Among the analyzed variables, blood transfusions and vasopressor use demonstrated a statistically significant association with short-term complications. Patients who received blood transfusions had a significantly higher risk of complications, with an odds ratio (OR) of 3.01 (95% confidence interval, CI: 1.28-7.06, p-value = 0.011). Similarly, the use of vasopressors was strongly correlated with increased short-term complications, with an OR of 14.61 (95% CI: 4.86-43.89, p-value < 0.001). CONCLUSION: These findings emphasize the importance of minimizing blood transfusions and careful consideration of vasopressor use in geriatric patients undergoing EGS to reduce the risk of short-term complications. Further research is warranted to explore additional factors and optimize perioperative management strategies to improve outcomes in this vulnerable patient population.

Endoscopic unilateral anterior ethmoid artery flap with or without cartilage graft for nasal septal perforation repair.

The septal perforation is a challenging condition that faces the otolaryngologist. The aim of our work was to evaluate this endoscopic repair of this septal perforation using a unilateral anterior ethmoid artery flap with or without a cartilage graft. Patients and methods: The authors conducted a retrospective cohort study between June 2020 and June 2022. Our study included all adult patients with septal perforation due to trauma (operative and self-induced) lasting for more than one year. Patients underwent an endoscopic repair of a perforation and a questionnaire regarding subjective quality of life was completed at 3 months postoperatively. Results: A total of 18 patients were included in our study. The main symptoms were crusting (100%), bleeding (38.85%), whistling (16.6%), anosmia (16.6), and nasal obstruction sensation (11%). The mean perforation size was 13.6 mm, ranging between 4 mm and 28 mm. Number of years with the perforation (ranged between 2 and 16 years) with a mean of 4.876±1.645 years and a mode of 2 years. All cases were repaired using an endoscopic unilateral anterior ethmoid artery flap with or without cartilage.There were no intraoperative complications but postoperatively, these included pain, ranging between a score of 2 and 8 on the pain score chart, (the mean score was five and mode was four, appeared in six patients), which was treated with over-the-counter painkillers. In addition, there was one patient (5%) with a residual small perforation (2 mm). All patients were happy to fill out postoperative patient satisfaction questionnaires after 3 months. The mean was 21.8889 ±1.655 points and the mode, 25 points (highest possible score), appeared four times. The lowest scoring questionnaire summated to 15 points. Conclusions: The endoscopic unilateral anterior ethmoid artery nasal flap with or without cartilage graft has proven to be a reliable and a valuable graft that, with proper planning, can provide excellent results with minimal morbidity for nasal septal perforation repair.

Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population.

Introduction Numerous scoring systems have been created to predict the risk of morbidity and mortality in patients undergoing emergency general surgery (EGS). In this article, we compared the different scoring systems utilized at Humanitas Research Hospital and analyzed which one performed the best when assessing geriatric patients (>65 years of age). The scoring systems that were utilized were the APACHE II (Acute Physiology and Chronic Health Evaluation II), ASA (American Society of Anesthesiologists), ACS-NSQIP (American College of Surgeons-National Surgical Quality Improvement Program), Clinical Frailty Score, and the Clavien-Dindo classification as control. Materials and Methods We compiled a database consisting of all patients over the age of 65 who underwent EGS in a consecutive 24-month period between January 1, 2017 and December 31, 2018. We used the biostatistical program "Stata Version 15" to analyze our results. Results We found 213 patients who matched our inclusion criteria. Regarding death, we found that the ACS-NSQIP death calculator performed the best with an area under the curve of 0.9017 (odds ratio: 1.09; 95% confidence interval: 1.06-1.12). The APACHE II score had the lowest discriminator when predicting death. Considering short-term complications, the Clavien-Dindo classification scored highly, while both the APACHE II score and Clinical Frailty Score produced the lowest results. Conclusion The results obtained from our research showed that scoring systems and classifications produced different results depending on whether they were used to predict deaths or short-term complications among geriatric patients undergoing EGS.

Incidental detection of paranasal sinuses abnormalities on CT imaging of the head in Saudi adult population.

The paranasal sinuses are hollowed, air-filled cavities surrounding the nasal cavity. Many pathological processes affect the sinuses, but inflammatory conditions are the commonest, even in asymptomatic patients who undergo head imaging for other indications showing one or more abnormalities of the sinuses. Our research aims to determine the prevalence of incidental paranasal sinuses abnormalities seen among patients who undergo head CT scanning. In addition, it provides baseline information for further investigations required. The study was designed to evaluate all patients who underwent head CT scanning for any reason unrelated to paranasal sinuses abnormalities. 1849 cases were selected and retrospectively analyzed from the elective and emergency CT in the last nine months, from August 2020 to April 2021. In order to meet the inclusion criteria, indications for imaging must not be sinus-related. The study was conducted on 1849 cases who had undergone head CT scans for pathology, 1204 (65%) were male and 645 (35%) were female. Abnormalities of the sinuses were found in about 617 (33%) of all patients, with a higher rate in males (22.23%) than females (11.14%). In addition, these abnormalities were found in younger patients at a higher rate than in middle and old ages 19.74%, 7.19%, and 6.44%, respectively. Our findings revealed that the prevalence of paranasal sinuses abnormalities in asymptomatic Saudi patients was high (33%). Most of the affected sinuses were the maxillary. The male patients were more affected than females in all findings.

Erratum: Addendum: Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population.

[This corrects the article DOI: 10.1055/s-0042-1756461.].

Digital Pathology During the COVID-19 Outbreak in Italy: Survey Study.

BACKGROUND: Transition to digital pathology usually takes months or years to be completed. We were familiarizing ourselves with digital pathology solutions at the time when the COVID-19 outbreak forced us to embark on an abrupt transition to digital pathology. OBJECTIVE: The aim of this study was to quantitatively describe how the abrupt transition to digital pathology might affect the quality of diagnoses, model possible causes by probabilistic modeling, and qualitatively gauge the perception of this abrupt transition. METHODS: A total of 17 pathologists and residents participated in this study; these participants reviewed 25 additional test cases from the archives and completed a final psychologic survey. For each case, participants performed several different diagnostic tasks, and their results were recorded and compared with the original diagnoses performed using the gold standard method (ie, conventional microscopy). We performed Bayesian data analysis with probabilistic modeling. RESULTS: The overall analysis, comprising 1345 different items, resulted in a 9% (117/1345) error rate in using digital slides. The task of differentiating a neoplastic process from a nonneoplastic one accounted for an error rate of 10.7% (42/392), whereas the distinction of a malignant process from a benign one accounted for an error rate of 4.2% (11/258). Apart from residents, senior pathologists generated most discrepancies (7.9%, 13/164). Our model showed that these differences among career levels persisted even after adjusting for other factors. CONCLUSIONS: Our findings are in line with previous findings, emphasizing that the duration of transition (ie, lengthy or abrupt) might not influence the diagnostic performance. Moreover, our findings highlight that senior pathologists may be limited by a digital gap, which may negatively affect their performance with digital pathology. These results can guide the process of digital transition in the field of pathology.

Congenital radioulnar synostosis presenting in adulthood - a case report.

Congenital radioulnar synostosis is a rare developmental skeletal malformation of the upper limb, characterized by the fusion of the proximal ends of the radius and ulna from birth. The failure of prenatal longitudinal segmentation of the adjacent radius and ulna results in a fibrous bony bridge between the radius and ulna. We present a 23-year-old female who presented with pain and restricted mobility of the left elbow joint for 7 years. A plain X-ray was performed for the patient, revealing a diagnosis of congenital radio-ulnar synostosis. Careful evaluation of the anatomical relations and spatial orientation of bony structures is required for the diagnosis and treatment of such cases.

The influence and impact of smoking on red blood cell morphology and buccal microflora: A case-control study.

BACKGROUND: Tobacco smoking is a major health issue worldwide. In addition to several health problems, smoking can also cause buccal cavity ulcers and buccal cavity cancer in case of chronic smoking. Tobacco smoking may also lead to deranged morphology of red blood cells (RBCs), which results in reduced oxygen carrying capacity of the blood. AIM: (a) To investigate and compare the changes in the RBC morphology of smokers and nonsmokers. (b) To investigate and compare the normal buccal flora of smokers and nonsmokers. METHODOLOGY: A total of 81 men were included in the study. Study population was divided into two groups: group 1; smokers (n = 50) and group 2; nonsmokers, which served as control (n = 31). After informed written consent from the study participants, a 5 mL of venous blood was drawn under sterile conditions for complete blood analysis and RBC morphology. Samples from buccal cavity were collected by cotton swab and cultured in sterile petri dishes to identify the bacterial growth. Data of RBC morphology and buccal microbiota were compared between smokers and nonsmokers. RESULTS: Buccal microflora results showed heavy growth in smokers compared with nonsmokers. Mean values of RBCs, Platelets, WBCs, HGB (hemoglobin), and MCV (mean corpuscular volume) did not differ between smokers and nonsmokers. Mean red cell distribution (RDW) width significantly was lower in smokers than nonsmokers. Macrocytic RBCs was more in smokers (60%) compared with nonsmokers (4%). CONCLUSIONS: Our results showed an increase in the percentage of macrocytic RBCs and a decrease in the red cell distribution width (RDW) in smokers compared with nonsmokers. Buccal Microflora was significantly higher in smoker group in contrast to nonsmoker group.

Role of liver biopsy in hepatocellular carcinoma.

The role of liver biopsy in the diagnosis of hepatocellular carcinoma (HCC) has been challenged over time by the ability of imaging techniques to characterize liver lesions in patients with known cirrhosis. In fact, in the diagnostic algorithm for this tumor, histology is currently relegated to controversial cases. Furthermore, the risk of complications, such as tumor seeding and bleeding, as well as inadequate sampling have further limited the use of liver biopsy for HCC management. However, there is growing evidence of prognostic and therapeutic information available from microscopic and molecular analysis of HCC and, as the information content of the tissue sample increases, the advantages of liver biopsy might modify the current risk/benefit ratio. We herein review the role and potentiality of liver biopsy in the diagnosis and management of HCC. As the potentiality of precision medicine comes to the management of HCC, it will be crucial to have rapid pathways to define prognosis, and even treatment, by identifying the patients who could most benefit from target-driven therapies. All of the above reasons suggest that the current role of liver biopsy in the management of HCC needs substantial reconsideration.

Is there a misuse of computed tomography in the diagnostic workup of headache? A retrospective record-based study in secondary health-care facility in Saudi Arabia.

INTRODUCTION: Headache disorders are one of the most prevalent global public-health problems that require placing high demand on health-care Services. Since it is one of the most frequent complaints in clinical practice worldwide, it causes a considerable burden in terms of the social cost. The study aimed to give a guide for the decision on the utilization of computed tomography (CT) in the diagnostic workup and identify if patients require neurological imaging (CT) for proper diagnosis or not. MATERIALS AND METHODS: The study was carried out in the Radiology Department in King Khalid Hospital, Al Kharj, Saudi Arabia from October 15, 2016, to February 15, 2017. A retrospective record-based study conducted using the documented CT reports in the files of patients whom were referred to the radiology department complaining of any type of a headache. RESULTS: The data included 210 patients 51% were males and 49% were females. The patients were distributed into age groups; the mean age was 38.46 standard deviation ± 13.56. Among Saudi population, the etiology of headache was varying; the most prevalent type of headache was tension headache 25.71% of the total headache patients followed by cluster 25.24% and the migraine with the lowest proportionality. The majority of the patients' headache pain was mild 60%. Moreover, the CT reports for most of the patients were normal. Spearman Correlation test was used to see if there is a significance in using the CT for any patient who comes with symptoms including headache, and the results have shown that there is no association and clinical significance in using the CT for patients with headache without suspecting other clinical condition (P = 0.177). CONCLUSION: Headache disorders must be on the public-health agenda. Tension, migraine, and cluster-type headaches represent the majority of primary headaches. Statistically no significance or need to obtain CT if there are no life-threatening conditions expected or trauma presented.

An accessory extensor pollicis longus tendon: a case report of rare anatomical variant / Tendón accesorio del músculo extensor largo del pulgar: reporte de caso de una rara variación anatómica

SUMMARY: Variation in the morphology of the extensor pollicis longus muscle is very rare. The muscle is considered as one of the deep group of dorsal forearm muscles. It passes through the dorsal radiocarpal ligament in a detached compartment. It inserts at the base of the distal phalanx of the thumb. The muscle might have double tendons where they run either in one, or in separate compartments. In this study, we report an extremely rare condition for a 38-year-old male where some of the tendon fibers split at the base of the proximal phalanx and the two tendons insert at the sides of the base of the distal phalanx. We also noticed a high range of hyperextension where the action was painless and showed no sign of discomfort. We believe that the way the tendons get inserted might have a role in this wide range of extension.

RESUMEN: La variación en la morfología del músculo extensor largo del pulgar es muy rara. Es considerado perteneciente al grupo profundo de los músculos del dorso del antebrazo. Su tendón pasa a través del ligamento radiocarpiano dorsal en un compartimiento separado. Se inserta en la base de la falange distal del pulgar. El músculo puede tener tendones dobles que pasan a través de un solo compartimiento, o en compartimentos separados, del ligamento radiocarpiano dorsal. En este estudio se reporta una variación extremadamente rara en un hombre de 38 años de edad, donde algunas de las fibras del tendón se dividen en la base de la falange proximal y los dos tendones se insertaban a los lados de la base de la falange distal del pulgar. También observamos un alto grado de hiperextensión siendo la acción indolora y no mostrando ningún signo de malestar. Creemos que la forma en que los tendones se insertan podrían tener un papel en este amplio rango de extensión.