Ultrasound Doppler findings of a Twin Reversed Arterial Perfusion Sequence (TRAP).

Twin reversed arterial perfusion (TRAP) sequence is a rare pregnancy complication occurs in an identical twin pregnancy that share a single placenta. TRAP sequence is a twin's pregnancy includes a normal-developed viable pump fetus and an abnormal usually nonviable acardiac fetus. The nonviable acardiac fetus depends on the pump fetus for his blood supply and put the pump fetus at risk of high cardiac output heart failure and congenital anomalies with high mortality rate. Gray-scale ultrasound and color and pulsed Doppler imaging is a noninvasive accessible imaging modality for the diagnosis of TRAP sequence. Early diagnosis of such conditions is mandatory in order to apply the proper therapeutic measures and to help the normal developed pump fetus to survive. The main goal of management is to interrupt blood supply to the nonviable acardiac fetus to reduce the strain on the heart of the pump fetus thus, increase the chance of survival.

Clinical presentation and angiographic findings of acute myocardial infarction in young adults in Jazan region.

BACKGROUND: There is a paucity of information about the clinical features and angiographic findings in young patients with acute myocardial infarction (MI), especially in the Arab Peninsula countries. OBJECTIVE: The aim of this study was to assess the proposed risk factors, clinical presentation, and angiographic findings of acute myocardial infarction in young adults. METHODS: This prospective study included young (range, 18 to 45 years) patients who presented with acute MI based on clinical evaluation, laboratory investigation, and electrocardiogram, and they underwent a coronary angiography procedure. KEY FINDINGS: Data of 109 patients with a diagnosis of acute MI were collected. Patients' mean age was 39.98 ± 7.52 years (range, 31 to 45 years), and 92.7% (101) were male. Smoking was the highest risk factor in 67% of patients, obesity and overweight in 66%, sedentary lifestyle in 64%, dyslipidaemia in 33%, and hypertension in 28%. Smoking was the most common risk factor for acute MI in males (p = 0.009), whereas sedentary lifestyle was the most common risk factor in females (p = 0.028). Chest pain typical of acute MI was the most common presenting symptom in 96% of patients (p < 0.001). On admission, 96% of patients were conscious, and 95% were oriented. On angiography, the left anterior descending artery (LAD) was affected in 57%, the right coronary artery (RCA) was affected in 42%, and the left circumflex artery (LCX) was affected in 32% of patients. The LAD was severely affected in 44%, the RCA was severely affected in 25.7%, and the LCX was severely affected in 19.26% of patients (p < 0.001). CONCLUSION: Smoking, obesity, sedentary lifestyle, dyslipidaemia, and hypertension were the most common risk factors for acute MI. Smoking was the most common risk factor in males and sedentary lifestyle in females. The LAD was the most commonly affected coronary artery, followed by the RCA and LCX arteries, with the same order for severity of stenosis.

Neurofibromatosis Type-2 presenting with vision impairment.

Neurofibromatosis Type-2 (NF2) is an autosomal dominant genetic tumour-predisposing condition caused by mutations in the NF2 gene located on chromosome 22q12. It is characterized by multiple benign tumours of the central and peripheral nervous systems and meninges, causing high morbidity. Herein, presentation of a rare case of NF2 in a 36-year-old female who presented with right eye visual disturbances, followed by tinnitus with hearing impairment. The visual disturbance developed into blindness. Magnetic resonance imaging (MRI) was performed, which showed a right-side cerebellopontine angle vestibular schwannoma and multiple meningiomas around the brain. According to the MRI findings, the patient was diagnosed with NF2. This case report aims to elucidate the importance of early brain imaging in any visual disturbances in young adults and to highlight the key role of medical imaging in the diagnosis of rare cases. Moreover, this describe the MRI features and the diagnostic accuracy for the tumours occurring in NF2 in detail.

Investigation Study of Ultrasound Practitioners' Awareness about Artefacts of Hepatobiliary Imaging in Almadinah Almunawwarah.

Objectives: To investigate the knowledge and awareness of ultrasound practitioners' concerning ultrasound artefacts in evaluating the hepatobiliary system. Methods: This electronic questionnaire-based comparative study involved the ultrasound practitioners' who work in the radiology departments in Almadinah Almunawwarah governmental hospitals during the period from 1 November 2020 to 30 April 2021. Spearman's rho correlation test was used to correlate between knowledge and job, academic qualification, and years of experience. A T-test and cross tabulation test were done to compare the knowledge about artefacts among radiologists and radiologic technologists. Results: This study involved 94 participants distributed as 22 (23.4%) radiologists and 72 (76.6%) radiologic technologists. The results shows that 85%, 71%, 73%, 69%, 54% and 53% of the participants assigned the acoustic shadowing, acoustic enhancement, ring down, side lobe, reverberation and mirror artefacts, as artefacts respectively. However, 68%, 53%, 19%, 19%, 18%, and 40% of the participants gave correct final diagnosis of acoustic shadowing, acoustic enhancement, ring down, side lobes, reverberation, and mirror artifacts, respectively. Spearman's rho correlation test shows significant correlation between participants with more than three years experience and knowledge related mirror artefacts (r=0.328, p=0.001). It shows significant correlation between radiologists with knowledge related mirror artefacts (r=0.367, p<0.001). A significant correlation was found between highly qualified participants and knowledge related mirror artefacts (r=0.336, p=0.001) and side lobe artefacts (r=0.237, p=0.008). Conclusion: The questionnaire-based comparative study of knowledge about artefacts of hepatobiliary ultrasound imaging reveals a high level of Ultrasound practitioners' knowledge in differentiating artefacts from pathology with a high level of knowledge in identifying hepatobiliary acoustic shadowing and acoustic enhancement artefacts. However, insufficient knowledge was noted in identifying mirror, side lobe, reverberation and ring down artefacts. A direct link was found between academic qualification, years of experience and practioners' knowledge among.

Subtle morpho-functional kidney changes in type-2 diabetes mellitus patients: A duplex ultrasound assessment.

Objectives: Diabetes mellitus (DM) is a common endocrine disease with serious effects on multiple organs including the kidneys. This study aimed to investigate the subtle effects of type 2 DM (T2DM) on the kidneys. Methods: This was a prospective case-control study conducted in the Radiology Department of University of Science and Technology Hospital (USTH) campus, Sana'a, Republic of Yemen, from 1 January 2020 to 31 November 2020. The renal length (RL), renal width (RW), resistive index (RI), and pulsatility index (PI) were prospectively measured in patients with T2DM and healthy controls. The results were compared using the independent samples t-test. Comparisons were likewise performed between patients with controlled DM and patients with uncontrolled DM. Results: A total of hundred individuals, 50 diabetic patients and 50 controls, were enrolled in this study. Their mean age was 54 ± 7.88 years (range: 40-75 years). The RL, RI, and PI of both kidneys were significantly higher in T2DM than in the control group. Moreover, the RL, RI, PI and creatinine were slightly higher in patients with uncontrolled than in those with controlled DM. Conclusion: T2DM has significant accentuating effects on the RL, RI and PI associated with low effective renal plasma flow, even before acute kidney injury or chronic kidney disease diagnosis, which may be attenuated by careful regulation of DM. Ultrasound Doppler is a highly valuable imaging modality for evaluating the subtle effects of T2DM on kidney dimensions and blood flow. The RI can be implemented as a tool for the early diagnosis of kidney disease and contribute to slowing the disease progression and preventing renal failure.

Etiology of Hydronephrosis in adults and children: Ultrasonographic Assessment in 233 patients.

OBJECTIVES: Hydronephrosis (HN) is dilatation of the collecting system of the kidney due to obstruction of urine outflow. This study intended firstly, to investigate the efficacy of ultrasound (US) imaging to determine the cause of HN, and secondly, to list the causes of HN. METHODS: In this retrospective study, 233 patients with HN were scanned to determine the cause of the HN in the period from 1st January 2016 to 31st October 2017. Categorical results were written as frequencies and percentages. RESULTS: Out of 233, 91.41% were adults and 8.58% were children (P<0.001), 66.10% were male and 33.90% were female (P<0.001). In 55.36%, HN was in the right kidney and 44.64% was in the left (P=0.116). Exactly 58% of patients were suffering from grade-2, 21.5% grade-3, 11.6% grade-1, and 8.2% grade-4 HN. US imaging can determine the cause of HN in 70.4% of patients. Kidney or ureteric calculi were the cause of HN in 54.1% of cases, reflux was in 7.3%, and pelviureteric junction (PUJ) stenosis was in 3.9%.In cases of calculi induced HN, 25.3% of the calculi were in the vesicoureteric (VUJ) junction, 21.5% were in the renal pelvis, 6.4% were in the PUJ or upper ureter, and only 0.9% were in the middle ureter. CONCLUSION: Ultrasound imaging can determine the cause of HN in more than two thirds of patients. Calculi are the most common cause of HN even in children and are most common in the VUJ junction.

Incidentally discovered Kawasaki disease in an adult man.

Kawasaki disease (KD) is a systemic vasculitis of unknown cause which usually diagnosed in small children. However, KD can be present as coronary disease in adults even with no history of the disease in childhood. Here, we describe a case of KD in a 42-year-old male patient presented with severe retrosternal chest pain radiating to the left arm and provisionally diagnosed as acute coronary disease. Coronary artery ectasia and multiple aneurysms have been confirmed by coronary angiography that led to the diagnosis of KD. The patient was treated with Aspirin 81 mg orally once daily, Apixapan 5 mg orally twice daily, Rosuvastatin 40 mg orally once daily, Bisoprolol 5 mg orally once daily, and omeprazole 20 mg orally once daily. The patient was improved and discharged with anticoagulant drugs for life. Physicians should be aware that KD can be present as coronary disease in adults even with no history of the disease in childhood and has a limited treatment options due to unfavorable coronary anatomy.

Multivalvular destruction as the primary presentation of aggressive infective endocarditis with subaortic valve membrane.

Multivalvular destruction may be a clinical manifestation of infective endocarditis (IE), which is a devastating infection of the heart either alone or superimposed with congenital subaortic membrane as in this case report. Here, we report a case of multivavular destruction with severe vegetation presented as a manifestation of infective endocarditis (IE) in a neglected case of 18-year-old male with previous rheumatic heart disease. Transesophageal echocardiography is an important imaging modality for diagnosis of superimposed aortic and heart lesions. Early necessary investigation and correct diagnosis is mandatory to prevent bad complications.

The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography.

BACKGROUND AND OBJECTIVES: Ejection fraction (EF) is a measurement of heart function that reflects the portion of pumped out blood from the filled left ventricle per each heartbeat. The current study aimed to investigate the prevalence of left ventricular thrombus in patients with EF lower than 35% by using Transthoracic Echocardiography (TTE). METHODS: In this prospective study, 82 cardiac patients underwent TTE procedure in order to assess the presence of left ventricular thrombus (LVT) from January 1st to December 31st 2017 at the Military Cardiac Centre in Sana'a, Yemen. RESULTS: Out of 82 patients enrolled in this study, the mean age was 49.13 ± 14.8 years and 87.8% were male. The mean of EF was 31.16% and LVT was found in 6.1%. The spontaneous contrast was seen in 25.6% of patients indicating strong relationship with low EF (p < 0.001). Among patients with low EF, ischemic heart disease (IHD) was identified in 50%, hypertension in 30.5%, diabetes mellitus (DM) type 2 in 23.2%, and hyperlipidemia 12.2%. Exactly 80% of LVT were detected in IHD patients with dilated cardiomyopathy (DCMP) and 80% of detected LVT were apical in site. CONCLUSION: Cardiac patients with low ejection fraction developed left ventricular thrombosis, and most of the affected patients were ischemic heart disease with dilated cardiomyopathy. Interestingly, spontaneous contrast was found high significantly in these patients, which may reflect the continuous process of thrombus formation.

Histopathological analysis of sinonasal lesions associated with chronic rhinosinusitis and comparison with computed tomography diagnoses.

BACKGROUND &OBJECTIVE: Chronic rhino sinusitis (CRS) is an inflammatory condition of the paranasal sinuses and the nasal passage lasting more than three months either with or without sinonasal polyps. This study aimed to report the common sinonasal lesions associated with CRS according to the histopathology results, to compare between clinical and histopathological diagnoses, and to compare between radiological and histopathological diagnoses of the sinonasal lesions. METHODS: A retrospective study of the electronic records of 82 patients diagnosed with CRS with nasal polyps. All patients underwent endoscopic sinus surgery and histopathological examination of surgical biopsies. The collected data were analyzed using SPSS program. Coparison between clinical and histopathological diagnoses was done. This study was conducted at Alsafwa Consultative Medical center (ACMC) in Almukalla city, Hadhramout province in Republic of Yemen. RESULTS: Out of 82 patients, the ages ranged from 4 to 90 years (mean: 34.48±17.74 years), and 54.88% were females. Inflammatory polyps were the most common lesion (31.4%), then allergic polyps (30.5%). Nasopharyngeal carcinoma (NPC) was reported in 9.8% of the lesions and all were unilateral. The results revealed strong compatibility between clinical and histopathological diagnoses (p<0.001, kappa= 0.215), and significant compatibility between radiological and histopathology diagnoses (p=0.007). CONCLUSION: Inflammatory and allergic polyps are the most common benign bilateral lesions associated with chronic rhinosinusitis, which can be correctly diagnosed clinically in most cases. Unilateral nasal polyps have high rates of malignancies and should be check carefully by endoscopy and histopathology. Computed tomography has some pitfalls in diagnosing of fungal sinusitis.

Diagnostic accuracy of ultrasonography versus fine-needle-aspiration cytology for predicting benign thyroid lesions.

BACKGROUND AND OBJECTIVE: Thyroid nodules (TNs) are abnormal growths of thyroid cells that form masses within the thyroid gland. TNs are common, and the importance lies in need to exclude thyroid cancer. This study was intended to evaluate the diagnostic accuracy of ultrasonography for differentiating benign from malignant thyroid lesions in comparison with fine-needle aspiration cytology (FNA cytology). METHODS: This study involved 133 patients with thyroid lesions. All patients underwent thyroid ultrasonography and ultrasound (US)-guided-FNA cytology and results were compared. RESULTS: Out of 133 patients included in this study, the mean age was 41.2±15 years, and 113 (85%) were female. Thyroid lesions were benign in 126 cases (94.7%) and malignant in nine cases (5.3%). Among 124 patients with thyroid lesions diagnosed as benign with US, 122 (98.38%) were confirmed to be benign with FNA cytology, and only 2 (1.6%) were proved to be malignant. Among nine patients with thyroid lesions diagnosed as malignant by US, 5 (55.6%) were confirmed to be malignant by FNA cytology, and 4 (44.4%) were proved to be benign. The US diagnosed benign thyroid lesions with a sensitivity, specificity, positive predictive value, and negative predictive value of 98.38%, 71.42%, 98.38%, and 55.55%, respectively. The results revealed strong compatibility between diagnosis of benign thyroid lesions by the US and proved diagnosis by FNA cytology (p<0.001). CONCLUSION: B-mode ultrasonography is a valuable tool in differentiating benign from malignant thyroid lesions. It can almost always predict the benign nature of thyroid lesions with excellent diagnostic accuracy.

Association between grades of Hydronephrosis and detection of urinary stones by ultrasound imaging.

OBJECTIVE: To correlate between hydronephrosis grades and detection of urinary stones by B-mode ultrasound imaging. METHODS: This study included 210 ultrasound reports of patients who underwent abdominal ultrasound imaging in the period from 1st January 2016 to 31st October 2017, and diagnosed as hydronephrosis. Data collected from the ultrasound reports. The detection rates of stones using B-mode ultrasound imaging compared in different grades of hydronephrosis. Chi-square test and Odds Ratio (OR) were performed to assess the relationship between variables. RESULTS: Of 210 patients, hydronephrosis was unilateral in 91.8% of patients and bilateral in 8.1%. It was distributed in grade 2, grade 3, grade 1 and grade 4 in 58.57%, 20%, 12.38% and 9.1% of the patients respectively. B-mode ultrasound imaging determined the cause of hydronephrosis in 65.2% of cases. Urinary stones were the cause in 60% of the patients. The detection rate of urinary stones was 50%, 61% and 71.4% for grades 1, 2 and 3 hydronephroses respectively. On simple logistic regression analysis, urinary stones detected in Grade-3 were four times more compared to that in grade 4 (P=0.016) (OR 4.125, 95% CI 1.29-13.136%). CONCLUSION: Detection of urinary stones as the cause of hydronephrosis increases with increasing the grade of hydronephrosis from Grade-I to Grade-III and decrease in Grade-IV. Urinary stones were the cause of hydronephrosis in 60% of the patients in this study.

Tuberculous Meningitis, Vasculitis, and Pericarditis presented by deep coma.

A 32 years old male patient presented to the emergency room with complete loss of consciousness since three hours. This was after two weeks of night fever, sweating and considerable loss of weight with self-treatment by antipyretic drugs. In the last two days, the patient develops confusion and altered behavior. Clinical examination revealed high-grade fever and coma. CXR revealed mild cardiomegaly. Treatment started with intravenous fluids, antipyretics, and antibiotics. On the next day , Echocardiography revealed mild Mitral regurgitation (MR), mild pericardial effusion with thickening of the pericardial membrane that suggested pericarditis. ESR was significantly elevated (57 mm/hour). After three days of treatment without improvement, Tuberculosis (TB) proposed and laboratory investigations implemented. Brain MRI T1 weighted images with Gadolinium injection revealed basal meningeal enhancement with multiple tiny cerebral granulomas.FLAIR-weighted images revealed multiple small high signal intensity foci in bilateral temporal lobes and the basal ganglia strongly suggesting vasculitis and ischemic lesions. CSF sample and culture was done, and anti-tuberculous drugs started with IV fluids, corticosteroids, and other supportive drugs. The results of CSF culture confirmed the diagnosis of Tuberculous meningitis. After two months of continuous anti-tuberculous treatment, the patient seemed to regain consciousness. The patient continued Rifampicin tab 700 mg, Isoniazid tab 350 mg, Ethambutol tab 400 mg, Pyridoxine tab 80 mg, Aspirin tab 100 mg and other supportive drugs for six months. The patient regained full health without any mental or motor disabilities.

Knowledge and Attitudes Regarding Crimean-Congo Hemorrhagic Fever Among Slaughterhouse Workers in Sana'a and Dhamar Cities-Yemen: A Cross-Sectional Study.

Background: Crimean-Congo Hemorrhagic Fever (CCHF) is a viral infection spread through tick bites or contact with secretions from infected animals or humans, posing a risk to slaughterhouse workers. This study aimed to evaluate the knowledge and attitudes of slaughterhouse workers in Yemen towards CCHF. Methods: A cross-sectional study conducted on 173 adults working at slaughterhouses in Sana'a and Dhamar cities, Yemen using a multi-stage sampling. The questionnaire used in the study was a reliable survey instrument (with a Cronbach's alpha coefficient of 0.71) employed for the purpose of data collection. The questionnaire encompassed three distinct sections: 1)- demographic inquiries pertaining to age, gender, marital status, level of education, and occupation; 2)- knowledge-based inquiries consisting of 27 items;3)- the attitude section consisted of 11 questions. After completing the questionnaire, the data were analyzed by SPSS version 24, using percentages, chi-square test, and Spearman correlation coefficient. Results: The mean age of the participants was 30.6 years with a SD of 11.2 years, with 84.4% male and 15.6% female. Most slaughterhouse workers were butchers (78.6%) and some were shepherds (21.4%). The participants had poor knowledge (86.7%) and attitude (72.3%) towards CCHF. There exists a noteworthy association between the knowledge scores and the gender, education level, and occupation (P=0.035, P=0.039, P=0.001). A significant positive correlation was identified between knowledge and attitude scores (r = 0.715, P<0.001). Conclusion: The majority of respondents had poor knowledge of CCHF. Educational programs are essential for increasing community awareness, with involvement of technical experts crucial for disseminating information on preventing and managing CCHF.

Burnout Among Saudi Radiographers.

Introduction: Burnout research is limited in Saudi Arabia, particularly among radiographers. Burnout among Saudi radiographers may have a negative impact on the services offered. Objective: This study aims to assess the burnout among radiographers in Medina hospitals. Materials and Methods: This quantitative cross-sectional study included 104 radiographers from government and private Medina hospitals. The Maslach Burnout Inventory-Human Services Survey for Medical Personnel, which consists of 22 questions, was used to measure the burnout level. The data were evaluated descriptively using the Statistical Package for the Social Sciences (version 25), and independent t-tests and analysis of variance were applied to assess group differences and linear regression analysis to evaluate associations between the burnout level and sociodemographic variables (ie sex, age, experience, and department). Results: The emotional exhaustion (EE) and depersonalization (DP) scores were moderate, while the personal accomplishment (PA) score was high, with total scores of 23.53 (9.32), 7.29 (5.95), and 29.70 (1.35), respectively. The DP score was influenced by the participants' experience. Specifically, an experience of 1-5 years yielded a substantially higher burnout score than did an experience of >10 years (p>0.05). Conversely, sex, age, and department did not affect the DP score (p<0.05). Similarly, the EE and PA scores were not influenced by sex, age, experience, or department (p<0.05). Conclusion: Burnout is prevalent among radiographers in Medina hospitals in Saudi Arabia. The EE and DP scores are moderate, while the PA score is high, indicating a suitable work environment. Policymakers should take the required steps to identify the variables contributing to employee burnout and enhance the work environment.

Identifying cerebral microstructural changes in patients with COVID-19 using MRI: A systematic review.

Coronavirus disease 2019 (COVID-19) is an epidemic viral disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the excessive number of neurological articles that have investigated the effect of COVID-19 on the brain from the neurological point of view, very few studies have investigated the impact of COVID-19 on the cerebral microstructure and function of the brain. The aim of this study was to summarize the results of the existing studies on cerebral microstructural changes in COVID-19 patients, specifically the use of quantitative volumetric analysis, blood oxygen level dependent (BOLD), and diffusion tensor imaging (DTI). We searched PubMed/MEDLINE, ScienceDirect, Semantic Scholar, and Google Scholar from December 2020 to April 2022. A well-constructed search strategy was used to identify the articles for review. Seven research articles have met this study's inclusion and exclusion criteria, which have applied neuroimaging tools such as quantitative volumetric analysis, BOLD, and DTI to investigate cerebral microstructure changes in COVID-19 patients. A significant effect of COVID-19 was found in the brain such as hypoperfusion of cerebral blood flow, increased gray matter (GM) volume, and reduced cortical thickness. The insula and thalamic radiation were the most frequent GM region and white matter tract, respectively, that are involved in SARS-CoV-2. COVID-19 was found to be associated with changes in cerebral microstructures. These abnormalities in brain areas might lead to be associated with behaviors, mental and neurological alterations that need to be considered carefully in future studies.

Assessment of the Knowledge and Practice of Infection Control among Radiographers in Saudi Arabia: A Cross-Sectional Survey Study.

Effective control of healthcare-associated infections (HAIs) involves a collaborative effort among various healthcare stakeholders, including healthcare workers, patients, and professionals. Radiographers, as essential members of the healthcare team, play a crucial role in HAI prevention by diligently adhering to standard infection control precautions (SICP) and maintaining a high level of knowledge regarding infection control procedures. The study aimed to assess the knowledge and practice of radiographers concerning infection control in radiology departments in Saudi Arabia. METHODS: A descriptive cross-sectional study was conducted in Saudi Arabia in the period from February to May 2022, with data collected using an online survey in the form of a google forms questionnaire disseminated through social media as an electronic link and including the patient's demographic characteristic such as age, gender, education level, experience, and prior infection control training and multiple closed ended questions to assess knowledge of standard infection control precautions and the practice of infection control. Overall, 113 participants responded to the survey and entered their responses directly, and the data were analyzed using the SPSS (statistical package for social science). RESULTS: The study revealed that the mean score of knowledge and awareness of the practice of infection control among radiographers in Saudi Arabia was (63.0 and 61.9, respectively), which were considered moderate levels. Females were significantly more knowledgeable about infection control and more aware of the practice than males (p-values = 0.019). The participants who previously attended courses of infection control training had a significantly higher score with a mean rank of (60.9) than those who had not (43.4), (p-value = 0.013). The radiographers' level of experience, age, and academic qualification had no significant influence on overall knowledge and practice of infection control (p-values > 0.05). CONCLUSIONS: In Saudi Arabia, radiographers have a moderate level of knowledge and practice of infection control. There is a need for an ongoing training and education program for practicing radiographers to ensure they perform better in infection control measures.

Hydatid Disease: A Radiological Pictorial Review of a Great Neoplasms Mimicker.

Hydatid cyst is a common name for the larval stage of a tapeworm species of Echinococcus granulosus, which is transmitted from animals to humans via the fecal-oral route. Hydatid cysts predominantly affect the liver (75%), followed by the lung (15%), and they can affect many organs in the human body. Medical imaging modalities are the keystone for the diagnosis of hydatid cysts with high sensitivity and specificity. Ultrasound imaging with high resolution is the first choice for diagnosis, differential diagnosis, staging, establishing a role in interventional management, and follow-up, and it can differentiate Type I hydatid cysts from simple liver cysts. Unenhanced computed tomography (CT) is indicated where or when an ultrasound is unsatisfactory, such as with chest or brain hydatid cysts, when detecting calcification, and in obese patients. Magnetic resonance imaging (MRI) is superior for demonstrating cyst wall defects, biliary communication, neural involvement, and differentiating hydatid cysts from simple cysts using diffusion-weighted imaging (DWI) sequences. According to the phase of growth, hydatid cysts occur in different sizes and shapes, which may mimic benign or malignant neoplasms and may create diagnostic challenges in some cases. Hydatid cysts can mimic simple cysts, choledochal cysts, Caroli's disease, or mesenchymal hamartomas of the liver. They can mimic lung cystic lesions, mycetoma, blood clots, Rasmussen aneurysms, and even lung carcinomas. Differential diagnosis can be difficult for arachnoid cysts, porencephalic cysts, pyogenic abscesses, and even cystic tumors of the brain, and can create diagnostic dilemmas in the musculoskeletal system.

Healthcare workers' compliance with the catheter associated urinary tract infection prevention guidelines: an observational study in Yemen.

BACKGROUND: Catheter-associated urinary tract infection is a global problem but it can be prevented with the appropriate implementation of evidence-based guidelines. This study was conducted to assess the level of compliance of healthcare workers with the catheter-associated urinary tract infection prevention guidelines during the insertion of a urinary catheter. METHODS: An observational study using a descriptive cross-sectional design was conducted at Sana'a City hospitals, Yemen. All the nurses and physicians from the governmental, teaching, and private hospitals were eligible to participate in the study. The data collection was performed through convenience sampling from March 2020 to December 2020, using a structured observational checklist prepared specifically for this study. RESULTS: The majority of the urinary catheter insertions were performed by nurses. There were no written policy or procedures for an urinary catheter insertion and no in-service education or training departments in the majority of the hospitals. The overall mean score of compliance was 7.31 of 10. About 71% of the healthcare workers had a high or acceptable level of compliance and 29% had an unsafe level of compliance. Compliance was low for maintaining aseptic technique throughout the insertion procedure, using a single use packet of lubricant jelly, performing hand hygiene immediately before insertion, and securing the urinary catheter once inserted. Factors affecting the healthcare workers compliance were gender, the working ward/unit of the healthcare workers, the availability of a written policy/procedure and a department or unit for in-service education. CONCLUSION: Yemeni healthcare workers' overall compliance was acceptable but it was unsafe in several critical measures. There is an urgent need for developing, implementing, and monitoring national guidelines and institutional policy and procedures for catheter-associated urinary tract infection prevention. Periodical in-service education and training programs and adequate access to the necessary materials and supplies are paramount.

Diagnostic features of tuberous sclerosis complex: case report and literature review.

Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic syndrome that is caused by mutations in the tumour suppressor genes TSC1 or TSC2 which causes multiorgan growths. TSC presents at any age as a wide range of clinical and phenotypic manifestations with varying severity. The main goal of this article was to state two cases of TSC and review the most commonly reported major and minor diagnostic clinical features and the most common features that led to an investigation of possible TSC diagnosis. Herein, we report two cases of TSC, which both presented with seizures during the first 6 months of life. Case 1 presented with multiple types of seizures from 6 months of age and was diagnosed by multiple calcified subependymal nodules (SENs) detected by computed tomography and magnetic resonance imaging (MRI). Case 2 presented with seizures from 3 months of age and was diagnosed prenatally when a tumour was seen in her heart during antenatal ultrasonography. In conclusion, the literature review revealed that neurological manifestations (mainly seizures) were the main feature that led to investigation and diagnosis of TSC followed by abdominal manifestations (mainly renal features) and antenatal follow-up imaging. Other manifestations in skin, chest, eyes, teeth and heart rarely led to TSC diagnosis. In some cases, TSC was incidentally discovered by medical imaging. The cortical tubers, SENs, and subependymal giant cell astrocytomas brain lesions were the most commonly reported major features. Skin features including angiofibromas, ungual fibromas and shagreen patch were the second most common major features reported in the literature. However, skin manifestations were not a common led to investigation and diagnosis of TSC. Renal features, mainly angiomyolipomas (AMLs), were the third most common major feature reported. Medical imaging plays an essential role in diagnosis of TSC, and clinical features are important clues that lead to investigation for the disease.