Diagnostic accuracy of arterial spin labeling MR imaging in detecting cerebral arteriovenous malformations: a systematic review and meta-analysis.

Diagnostic accuracy of arteriovenous malformations (AVMs) is imperative for delineating management. The current standard is digital subtraction angiography (DSA). Arterial spin labeling (ASL) is an understudied noninvasive, non-contrast technique that allows angioarchitecture visualization and additionally quantifies cortical and AVM cerebral blood flow and hemodynamics. This meta-analysis aims to compare ASL and DSA imaging in detecting and characterizing cerebral AVMs. EMBASE, Medline, Scopus, and Cochrane databases were queried from inception to July 2022 for reports of AVMs evaluated by DSA and ASL imaging. Fourteen studies with 278 patients evaluated using DSA and ASL imaging prior to intervention were included; pCASL in 11 studies (n = 239, 85.37%) and PASL in three studies (n = 41, 14.64%). The overall AVM detection rate on ASL was 99% (CI 97-100%); subgroup analysis revealed no difference between pCASL vs. PASL (99%; CI 96-100% vs. 100%; CI 95-100% respectively, p = 0.42). The correlation value comparing ASL and DSA nidus size was 0.99. DSA and ASL intermodality agreement Cohen's k factor for Spetzler Martin Grading (SMG) was reported at a median of 0.98 (IQR 0.73-0.1), with a 1.0 agreement on SMG classification. A median of 25 arteries were detected by DSA (IQR 14.5-27), vs. 25 by ASL (IQR 14.5-27.5) at a median 0.92 k factor. ASL provides angioarchitectural visualization noninferior to DSA and additionally quantifies CBF. Our study suggests that ASL should be considered in the detection of AVMs, especially in patients with contrast contraindications or apprehension towards an invasive assessment.

Primary Squamous Cell Carcinoma of the Cecum: A Case Report.

Primary squamous cell carcinoma (SCC) of the colon is an exceptionally rare diagnosis. The etiology and pathogenesis of this entity remain unclear. It usually presents in patients as an emergency, typically with the tumor in the advanced stage. We report a case of SCC of the cecum presenting with perforation, initially diagnosed as SCC of unknown origin. The patient underwent a limited right hemicolectomy and end ileostomy outside our center. The patient was referred to us for further workup and possible adjuvant chemotherapy. She was assessed clinically and found to have had poor appetite and anorexia for a month, with an intermittent fever documented at 39 degrees. Thus, the patient was elected to get admitted for a septic workup and re-staging by CT scan and tumor biomarkers. CT showed a phlegmon and abscess formation at the right iliac fossa that was attached to surrounding structures, including the abdominal wall. Drain placement at the site of the phlegmon was attempted but failed due to bowel overlapping. Therefore, the patient was booked for surgical exploration and drainage, where all structures were resected en bloc. Histopathological examination revealed well-differentiated keratinized SCC with lymph node metastasis. The diagnosis of primary SCC of the cecum was confirmed after investigations to rule out primary sources were negative. Surgical resection remains the mainstay of management, with a possible role for chemotherapy and radiation therapy. The prognosis in these cases is usually poor. This warrants early diagnosis and management. Studies are needed to establish a management protocol for this entity.

Added sugar intake among the saudi population.

Diet is a contributor to the pathogenesis of many non-communicable diseases. Among contributors to poor diet is high added sugar consumption, which is unfortunately on the rise nowadays. The recommended sugar intake by The American Heart Association (AHA) is 24g/day and 36g/day for women and men, respectively. The study's aim is to assess added sugar intake among adults in Saudi Arabia. A cross-sectional study design was used via an online survey among adults in Saudi Arabia using convenience sampling, and social media platforms were used to collect the data. The authors conducted descriptive statistics to present demographic variables using Chi-square χ2 tests for categorical and t-tests for continuous variables. All statistical tests used a 95% confidence interval with a two-sided P-value <0.05 as significance level. A total of 1163 respondents were included in the study. The study has shown an overall added sugar intake average of 73 g/day. There was a significant difference in means of overall added sugar intake across genders for the age group 18-30 and the age group >60. Equivalently, there was a statistically significant difference in means of added sugar intake food across gender (P-value 0.008). Females tended to consume more added sugar in their food than males. The highest consumption was in the Northern region (123.71 g/day), followed by the Southern region (98.52 g/day), the Western region (86.14 g/day), and lastly, the Central and Eastern regions (66.95 and 62.02 g/day, respectively). The total added sugar intake of added sugar is extremely high in Saudi Arabia. Poor dietary habits lead to many adverse health consequences, including obesity and diabetes. Healthcare providers and public health officials are highly encouraged to shed light on added sugar consumption and create opportunities to promote healthy dietary patterns. The Saudi population is recommended to abide by the added sugar dietary recommendations to avoid future chronic medical conditions.