Normal sonographic measurements for kidney dimensions in Saudi adult population: A cross-sectional prospective study.

BACKGROUND: The use of ultrasound-based measurements to determine renal size has proven valuable in the diagnosis of renal function and associated disorders. The dimensions of the abdominal organs are affected by an individual's body age, height, sex, and weight. The objective of this study was to establish the standard sonographic parameters for renal dimensions and to determine the correlation between body measurements and renal dimensions in a population of healthy adults residing in Jazan City, Saudi Arabia. METHODS: The present study was a prospective study conducted at a single center located in Jazan City from February to August 2022. Ninety-five participants underwent abdominal ultrasonography. The process of measuring renal size through sonography entails the measurement of various dimensions of the kidney, such as renal length, width, and thickness. The demographic information of the participants, including their sex, age, height, and weight, was documented. All analyses were performed using Statistical Package for the Social Sciences v27 software. RESULTS: The dimensions of the right kidney, specifically the length, width, and thickness, had mean value of 9.79 centimeters (cm), 5.09 cm, and 4.10 cm, respectively. The left kidney had mean dimensions of 10.1 cm, 5.09 cm, and 4.10 cm for length, width, and thickness, respectively. The left kidney was larger than the right kidney. Furthermore, male participants exhibited larger kidney measurements than their female counterparts did. A noteworthy positive correlation was observed between the thickness of the left kidney and sex, whereas no significant correlations were found with age, weight, or height. CONCLUSION: The current study revealed that the kidney dimensions were observed to be larger in males as compared to females. The research findings indicate that there is no significant correlation between kidney dimensions and various demographic factors, such as age, height, weight, and sex. In addition, this study provides reference tables for further use.

Post-traumatic renal arteriovenous malformation failed endovascular embolization.

Renal arteriovenous malformations (AVMs) are abnormal connections between the renal arteries and venous system. Arteriovenous fistulas account for 70%-80% of renal arteriovenous abnormalities, often resulting from iatrogenic injuries. While most renal AVMs are asymptomatic, hematuria is a common symptom caused by AVM rupture into the renal calyces. Angiography is the gold standard for diagnosis, but noninvasive imaging techniques like ultrasound, computed tomography, or magnetic resonance imaging are commonly used for initial evaluation. Most renal AVMs are managed conservatively. Symptomatic patients typically undergo endovascular embolization, the preferred treatment, while surgery is reserved for unstable patients or those with complex vascular anatomy. We present a case of a 32-year-old man with renal AVMs following a motor vehicle accident. The patient initially received unsuccessful endovascular embolization but achieved successful treatment through open fistula ligation. This case highlights the challenges in managing renal AVMs and the importance of considering alternative interventions when initial treatments prove ineffective.

Varicocelectomy outcomes among patients with azoospermia and severe oligasthenoteratozoospermia.

Background: Varicocele is a reversible cause of male infertility. However, there are conflicting data available concerning the benefit of varicocele repair for patients with nonobstructive azoospermia (NOA) and severe oligoasthenoteratozoospermia (OAT). Objective: To address the benefit of varicocelectomy in patients with severe OAT and NOA with regard to their semen parameters and surgical sperm retrieval rate in those who underwent testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). Materials and Methods: This retrospective cohort study was conducted on a sample of 13 patients diagnosed with NOA and severe OAT who underwent varicocelectomy for infertility treatment with no prespecified exclusion criteria. Results: Thirteen patients were enrolled. Five patients were diagnosed with NOA; eight were diagnosed with severe OAT. For improvements in the semen parameters postoperatively, the semen concentration of all patients was significantly increased compared to the preoperative concentration (3.59 ± 10.0.8 vs. 0.25 ± 0.31, P = 0.02) and the remaining parameters were unchanged. Regarding sperm retrieval, three patients underwent TESE and two patients underwent TESA, in which all had positive results. Conclusion: Varicocele repair was found to improve the semen parameters in patients with NOA and severe OAT and produced a successful surgical sperm retrieval rate in all patients who underwent TESA or TESE.

The role of molecular imaging in detecting fibrosis in Crohn's disease.

Fibrosis is a pathological process that occurs due to chronic inflammation, leading to the proliferation of fibroblasts and the excessive deposition of extracellular matrix (ECM). The process of long-term fibrosis initiates with tissue hypofunction and progressively culminates in the ultimate manifestation of organ failure. Intestinal fibrosis is a significant complication of Crohn's disease (CD) that can result in persistent luminal narrowing and strictures, which are difficult to reverse. In recent years, there have been significant advances in our understanding of the cellular and molecular mechanisms underlying intestinal fibrosis in inflammatory bowel disease (IBD). Significant progress has been achieved in the fields of pathogenesis, diagnosis, and management of intestinal fibrosis in the last few years. A significant amount of research has also been conducted in the field of biomarkers for the prediction or detection of intestinal fibrosis, including novel cross-sectional imaging modalities such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). Molecular imaging represents a promising biomedical approach that enables the non-invasive visualization of cellular and subcellular processes. Molecular imaging has the potential to be employed for early detection, disease staging, and prognostication in addition to assessing disease activity and treatment response in IBD. Molecular imaging methods also have a potential role to enabling minimally invasive assessment of intestinal fibrosis. This review discusses the role of molecular imaging in combination of AI in detecting CD fibrosis.

Sonographic Assessment of Renal Transplantation in Adult Saudi Patients: A Cross-Sectional Retrospective Study.

Kidney transplantation stands as a practical and cost-effective treatment option for end-stage renal disease patients, offering an improved quality of life with reduced morbidity when compared with hemodialysis. To evaluate the status of transplanted kidneys in Saudi patients, we conducted a retrospective single-center study at Jazan, Saudi Arabia, involving 46 adult renal recipients enrolled randomly from 2015 to December 2022. Using high-frequency ultrasound, we performed Duplex ultrasound examinations to assess renal allografts. The study revealed that the renal grafts exhibited normal length, with preserved cortical medullary differentiation (CMD) in 84.8% of cases and poor CMD in 15.2%. The echogenicity of the grafts remained normal in 69.6% of instances. Interestingly, we observed a significant rise in resistance index values as the graft duration increased (P = .04), whereas patients with abnormal creatinine levels displayed decreased peak systolic velocity and end-diastolic velocity. Notably, sonographic graft assessments unveiled complications, including perinephric fluid accumulation (8.7%), simple renal cysts (10.86%), hydronephrosis (8.7%), and one case of graft rejection. Receiver operating characteristics analysis for serum blood creatinine levels and abnormal parenchymal findings yielded fair to poor predictive accuracy, with varying sensitivity and specificity measures that lacked statistical significance. In conclusion, our study revealed that most Saudi renal transplant recipients exhibited grafts with normal echogenicity, preserved CMD, and limited perinephric fluid. This investigation provides valuable insights into sonographic changes and Doppler parameters of renal grafts, potentially aiding in the early detection of graft rejection and facilitating diagnostic and therapeutic planning.

Differences in brain volume and thickness in patients with pulmonary or spine tuberculosis (TB) compared to non-TB individuals: A cross-sectional retrospective study.

Introduction: There is evidence showing that central nervous system TB (CNS-TB) causes meningitis, pachymeningitis, tuberculomas, and granulomas. However, the impact of pulmonary or spine TB on brain morphology and thickness is yet to be documented. TB is associated with increased levels of inflammatory biomarkers in specific brain regions. Objectives: The primary aim of this study was to compare cortical-brain volume and thickness between patients with pulmonary or spine TB and non-TB individuals and investigate the association between inflammatory biomarkers and brain volume or thickness among patients with pulmonary or spine TB. Methods: Participants ranging in age from 18 to 65 years (23 TB patients and 50 healthy controls), who were scanned using 1.5-T MRI at Jazan Hospital, were compared in terms of brain volumes and thicknesses. Brain volume and thickness were measured using FreeSurfer. Results: There were significant differences in the volumes of the bilateral and total amygdala and accumbens areas, right hippocampus and cerebellum, and CSF, and in the thickness of the right pericalcarine area between patients with pulmonary or spine TB and healthy controls. We also found significant associations between inflammatory biomarkers (CRP, WBC, and platelets) and brain volume but not thickness in patients with TB, p < .05. Conclusions: This study is the first to show that pulmonary or spine TB reduces brain size and thickness and suggests that TB may be better understood by considering the correlation between inflammatory biomarkers and brain volumes.

Radiologists' and Radiographers' Perspectives on Artificial Intelligence in Medical Imaging in Saudi Arabia.

INTRODUCTION: Artificial intelligence (AI) in medical imaging rapidly expands regarding image processing and interpretation. Therefore, the aim was to explore radiographers' and radiologists' perceptions and attitudes towards AI use in medical imaging technologies in Saudi Arabia. METHODS: The survey was distributed online, and responses were collected from 173 participants nationwide. Data analysis was performed using SPSS Statistics (version 27). RESULTS: The participants scored an average of 1.7, 1.6, and 1.8 on a scale of 1-3 for attitudinal perspectives on clinical application and the positive and negative impact of integrating AI technology in diagnostic radiology. Lack of knowledge (43.9%) and perceived cyber threats (37.7%) were the most cited factors hindering AI implementation in Saudi Arabia. CONCLUSION: The radiographradiology radiologists in this study had a favorable attitude toward AI integration in diagnostic radiology; nonetheless, concerns were raised about data protection, cyber security, AI-related errors, and decision-making challenges.

Investigation of Vitamin D Status, Age, and Body Mass Index as Determinants of Knee Osteoarthritis Severity Using the Kellgren-Lawrence Grading System in a Saudi Arabian Cohort: A Cross-Sectional Study.

Background Knee osteoarthritis (OA) is a common and disabling condition affecting millions worldwide. This cross-sectional study endeavors to investigate the relationship between vitamin D status, age, body mass index (BMI), and knee OA in a cohort of individuals in Saudi Arabia. Methods In this cross-sectional study, we assessed vitamin D serum levels, conducted knee radiographs, and evaluated the severity of knee OA using the Kellgren-Lawrence grading system (KLGS). The analysis incorporated both descriptive and inferential statistics, including chi-square tests and a regression model to investigate the relationship between KLGS grades as indicators of knee OA severity and vitamin D levels, considering demographics as covariants. Results The study included 93 participants with suspected knee OA, of which a substantial portion of the sample population presented with knee OA (58 [62.4%]). Knee OA exhibited a higher prevalence among females, comprising 47 (50.54%) of the total, while 11 (11.83%) were male. The largest age group with knee OA was those older than 58 years, 27 (29.03%), followed by the age group of 48-58 years, 19 (20.43%). Obesity was a prevalent factor among knee OA patients (36 [38.7%]), with grade 2 (17 [18.3%]) and grade 3 (24 [25.8%]) being the most frequent. Vitamin D deficiency was prevalent in 54 (58%) of patients. Among knee OA cases, bilateral involvement was predominant in 46 (79%), with a substantial portion, 36 (62%), presenting deficient vitamin D levels. The regression model revealed that age (95% CI: 0.54-1.03, p < 0.001) and BMI (95% CI: 0.01-0.60, p = 0.04) significantly predict higher KLGS grades, indicating that increasing age and higher BMI are associated with higher KLGS grades. However, Vitamin D levels did not show a significant impact on the severity of knee OA. Conclusions The findings from this study highlight the importance of monitoring and maintaining adequate vitamin D levels to potentially reduce the risk of knee OA and the need for early detection and intervention to manage knee OA, particularly in females, older poplulation, and obese adults. They may guide healthcare providers in developing comprehensive approaches to reduce the risk of this condition.

Conventional Versus Accelerated Ponseti in the Management of Cases of Idiopathic Clubfoot: A Systematic Review and Meta-Analysis.

This study aimed to compare the outcomes of the accelerated and standard Ponseti method for clubfoot pathology by constructing a systematic review and meta-analysis of relevant randomized controlled trials and nonrandomized comparative studies. A systematic search was conducted to identify the relevant studies through PubMed, Google Scholar, and Cochrane depending on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The keywords used included "accelerated" AND "standard" AND "Ponseti" AND "clubfoot" AND "Congenital Talipes Equinovarus" AND "CTEV" AND "prospective comparative design" AND "randomized trial." We conducted this analysis among 13 studies that met the criteria adopted in this review where eight studies were prospective comparative studies, and five studies were randomized prospective comparative studies which were published in the period between 2015 and 2022. Statistically, accelerated Ponseti showed superior impact over standard Ponseti considering the duration of treatment (22.53 days vs. 40.61 days, p<0.001). No significant difference was reported between the two methods considering final Pirani score (0.64 vs. 0.56, p=0.194), number of casts (5.23 vs. 5.25, p=0.425), rate of tenotomy (66.2% vs. 63.1%, OR=1.246, 95% CI: 0.86-1.80, p=0.245), relapse rate (9.51% vs. 8.54%, OR=1.126, 95% CI: 0.68-1.86, p=0.642) and complication rate (14.4% vs. 13.1%, OR=1.130, 95% CI: 0.58-2.19, p=0.717). We concluded that the accelerated Ponseti method could achieve comparable efficacy to the standard method in terms of post-procedure Pirani score, tenotomy rate, relapse rate, complications rate, and number of casts needed by the patients with advantage of requiring shorter duration of treatment which is associated with more patient's compliance.

Frequency of Knee Pain and Risk Factors and Its Impact on Functional Impairment: A Cross-Sectional Study from Saudi Arabia.

BACKGROUND: Adolescents frequently self-report pain, according to epidemiological research. The knee is one of the sites wherein pain is most commonly reported. Musculoskeletal disorders play a significant role in the prolonged disability experienced by individuals, leading to substantial global personal, societal, and economic burdens. Patellofemoral pain (PFP) is a clinical knee pain commonly affecting adolescents. This study aimed to estimate the frequency of knee pain in Saudi adolescents. METHODS: This cross-sectional survey was conducted from June to November 2022 and included 676 adolescents aged 10 to 18 years. The participants were questioned regarding their demographics, school habits, and the impact of these factors on back pain, musculoskeletal pain in the past 12 months, as well as quality-of-life scale and knee pain symptoms. The data were analyzed using descriptive statistics, with frequencies and percentages presented for categorical variables. Analysis of variance (ANOVA) was performed to compare means between groups, while the chi-squared test was used to compare categorical variables. Statistical significance was set at p < 0.05. RESULTS: A total of 676 adolescents participated in the study, with 57.5% females and 42.5% males. Among the participants, 68.8% were aged between 15 and 18 years. The prevalence of knee pain was notably higher among females (26%) compared to males (19.2%). Age and BMI were identified as significant predictors of knee pain. A significant association was also found between BMI classification and knee stiffness (p-value = 0.008). Furthermore, a significant difference was observed between adolescents who engaged in physical activities during leisure time and those who experienced difficulty bending (p-value = 0.03). CONCLUSIONS: Our study highlights a high prevalence of knee pain among Saudi adolescents, emphasizing the need for increased awareness about its risk factors. Preventive measures, including conservative approaches and lifestyle/activity modifications, can effectively mitigate adolescent knee pain.

An unusually high prevalence of isolated prostatic ductal adenocarcinoma among Saudi patients: A registry-based study.

Objective: We conduct a secondary analysis on the demographics, tumor characteristics, survival, and risk factors for mortality among patients with prostatic ductal adenocarcinoma (PDA) in the Kingdom of Saudi Arabia (KSA). Methods: This is a registry-based retrospective study that included all patients diagnosed with prostate cancer in the KSA. The data were collected from the Saudi Cancer Registry, which collects tumor data from all private, military, and health ministry hospitals in Saudi Arabia through five regional offices. Results: Among 3607 prostate cancer patients detected during the specified period, 209 (5.8%) had ductal adenocarcinoma. The median interquartile range age of patients was 72.0 years (64.0-78.0). Adenocarcinoma lesions were malignant among all the patients. Grade III tumors were most frequently apparent lesions (61.2%), followed by Grade II tumors (26.3%), Grade I tumors (7.2%), and Grade VI tumors (5.3%). A total of 33 patients died, representing 15.8% of the whole sample. The 1-year survival rate was 78.1%. More than a third of patients who were residing in the Western region deceased (38.0%), whereas no deaths were reported in other regions with a statistically significant difference based on regions (P < 0.001). Conclusion: To the best of our knowledge, this is the first registry-based study to investigate PDA in the KSA; these efforts were done to further understand this deadly condition and to further enhance patient care in the KSA.

Correction: Comparison of the Effects of Regular Periods of Immobilization and Prolonged Immobilization on Hand Function Post Distal Radial Fracture.

[This corrects the article DOI: 10.7759/cureus.30986.].

Prevalence and Associated Factors of Vitamin D Deficiency in High Altitude Region in Saudi Arabia: Three-Year Retrospective Study.

Background: Vitamin D has many functions in the human body, and its deficiency is associated with skeletal and non-skeletal diseases. Vitamin D deficiency (blood level of 25 (OH) vitamin D < 20 ng/mL) has been reported worldwide, including Kingdom of Saudi Arabia (KSA). Its prevalence and associated factors vary according to KSA region. Therefore, this study aimed to explore the prevalence and risk factors of vitamin D deficiency in the Taif region of KSA. Methods: This retrospective study included patients who attended outpatient clinics at the Alameen General Hospital from 2019 to 2021. Demographic, clinical, and laboratory data were collected using a hospital software system. Results: The study included 2153 patients and vitamin D deficiency was diagnosed in 900 (41.8%) of whom were diagnosed with vitamin D deficiency. It was more common in males (P=0.021), younger age (<0.001), and in patients without comorbidities. There was a positive correlation between 25 (OH) vitamin D levels and blood cholesterol, high-density lipoprotein, calcium, and vitamin B12 levels. In the binary logistic regression analysis, age was the most significant predictor (P<0.001), followed by the absence of thyroid disease (P=0.012) and asthma (P=0.030). Conclusion: Vitamin D deficiency is common in the Saudi population despite sunny weather in KSA. It is more prevalent among males, younger individuals, and those without comorbidities such as thyroid diseases and asthma.

A Systematic Review of the Relationship between Chest CT Severity Score and Laboratory Findings and Clinical Parameters in COVID-19 Pneumonia.

The COVID-19 virus has infected millions of people and became a global pandemic in 2020. The efficacy of laboratory and clinical parameters in the diagnosis and monitoring of COVID-19 has been established. The CT scan has been identified as a crucial tool in the prognostication of COVID-19 pneumonia. Moreover, it has been proposed that the CT severity score can be utilized for the diagnosis and prognostication of COVID-19 disease severity and exhibits a correlation with laboratory findings such as inflammatory markers, blood glucose levels, and clinical parameters such as endotracheal intubation, oxygen saturation, mortality, and hospital admissions. Nevertheless, the correlation between the CT severity score and clinical or laboratory parameters has not been firmly established. The objective of this study is to provide a comprehensive review of the aforementioned association. This review used a systematic approach to collate and assess the existing literature that investigates the correlation between CT severity score and laboratory and clinical parameters. The search was conducted using Embase Ovid, MEDLINE Ovid, and PubMed databases, covering the period from inception to 20 May 2023. This review identified 20 studies involving more than 8000 participants of varying designs. The findings showed that the CT severity score is positively associated with laboratory and clinical parameters in COVID-19 patients. The findings indicate that the CT severity score exhibits a satisfactory level of prognostic accuracy in predicting mortality among patients with COVID-19.

Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs among Saudi Athletes.

BACKGROUND: Anterior cruciate ligament (ACL) tear is a common medical condition that entails a stretch or sprain of the ACL, which is present in the knee joint. The incidence of ACL injury in the Kingdom of Saudi Arabia is estimated to be 31.4%. Prevention training programs (PTPs) can be used to reduce ACL injuries sustained during physical activity, as they primarily focus on improving strength, balance, and lower limb biomechanics and reducing landing impact. This study aimed to assess Saudi athletes' awareness of ACL injury PTPs. METHODS: A cross-sectional survey in the form of a self-administered questionnaire in the Arabic language was carried out from 22 December 2022 to 7 March 2023 and included 1169 Saudi athletes. Statistical analyses were performed on the collected data using frequency and percentages. Binary logistic regression was used for the adjusted analysis and determining associations between athletes playing high- and low-risk sports. RESULTS: Overall, 52% of participants were female athletes, and 48% were male athletes. The western region of the country had the highest response rate (28.9%). The most common sport played was football at 36.6%. Most participants (70.97%) reported that their information on ACL injury was taken by their coaches. When assessing whether participants were familiar with the concept of an ACL injury PTP, the majority of the participants answered no, representing 971 (662 high-risk, 309 low-risk), compared to those who answered yes, representing only 198 (167 high-risk, 31 low-risk), with a statistically significant difference (adjusted OR: 2.106; 95% confidence interval: 1.544-2.873; p-value < 0.001). CONCLUSION: In general, the level of awareness of ACL injury PTPs among Saudi athletes was poor.

The Role of Radiomics in Fibrosis Crohn's Disease: A Review.

Inflammatory bowel disease (IBD) is a global health concern that has been on the rise in recent years. In addition, imaging is the established method of care for detecting, diagnosing, planning treatment, and monitoring the progression of IBD. While conventional imaging techniques are limited in their ability to provide comprehensive information, cross-sectional imaging plays a crucial role in the clinical management of IBD. However, accurately characterizing, detecting, and monitoring fibrosis in Crohn's disease remains a challenging task for clinicians. Recent advances in artificial intelligence technology, machine learning, computational power, and radiomic emergence have enabled the automated evaluation of medical images to generate prognostic biomarkers and quantitative diagnostics. Radiomics analysis can be achieved via deep learning algorithms or by extracting handcrafted radiomics features. As radiomic features capture pathophysiological and biological data, these quantitative radiomic features have been shown to offer accurate and rapid non-invasive tools for IBD diagnostics, treatment response monitoring, and prognosis. For these reasons, the present review aims to provide a comprehensive review of the emerging radiomics methods in intestinal fibrosis research that are highlighted and discussed in terms of challenges and advantages.

MRI tagging of colonic chyme mixing in healthy subjects: Inter-observer variability and reliability of the measurement with time.

BACKGROUND: Magnetic resonance imaging (MRI) tagging techniques have been applied to the GI tract to assess bowel contractions and content mixing. We aimed to evaluate the dependence of a tagging measurement (for assessing chyme mixing) on inter-observer variability in both the ascending colon (AC) and descending colon (DC) and to investigate the temporal variation and hence reliability of the colonic tagging technique by acquiring multiple measurements over time on healthy participants. METHODS: Two independent datasets of healthy adults were used for the retrospective inter-observer variability (Study 1: 13 datasets and Study 2: 31 datasets), and ten participants were scanned for the prospective temporal variation study following a 1 L mannitol oral preparation. All colonic tagging data were acquired on 3 T MRI scanners. The mean and the standard deviation (SD) maps were generated pixel-by-pixel using custom-written software in MATLAB. The colonic regions of interest were defined using MIPAV software. Bland-Altman plots and scatter plots were used for the inter-observer variability. The mean and SD of all repeated measures for each subject were calculated along with a one-way ANOVA to test for variations with time. RESULTS: Scatter plots and Bland-Altman plots showed a large range of data with low variation and small limits of agreements (<5% CoV). The intraclass correlation coefficient of inter-rater reliability was excellent and 0.97 or above for the AC and DC measurements for both datasets. The temporal variation study shows that there was no significant difference found between the multiple measures with time (p = 0.53, one-way repeated measures ANOVA test). CONCLUSIONS: MRI tagging technique can provide an assessment of colonic chyme mixing. The inter-observer study data showed high inter-rater agreement. The temporal variation study showed some individual variations with time suggesting multiple measurements may be needed to increase accuracy.

A Systematic Review of PET Contrasted with MRI for Detecting Crossed Cerebellar Diaschisis in Patients with Neurodegenerative Diseases.

There has not been extensive research into crossed cerebellar diaschisis (CCD) in neurodegenerative disorders. CCD is frequently detected using positron emission tomography (PET). However, advanced MRI techniques have come forth for the detection of CCD. The correct diagnosis of CCD is crucial for the care of neurological patients and those with neurodegenerative conditions. The purpose of this study is to determine whether PET can offer extra value over MRI or an advanced technique in MRI for detecting CCD in neurological conditions. We searched three main electronic databases from 1980 until the present and included only English and peer-reviewed journal articles. Eight articles involving 1246 participants met the inclusion criteria, six of which used PET imaging while the other two used MRI and hybrid imaging. The findings in PET studies showed decreased cerebral metabolism in the frontal, parietal, temporal, and occipital cortices, as on the opposite side of the cerebellar cortex. However, the findings in MRI studies showed decreased cerebellar volumes. This study concludes that PET is a common, accurate, and sensitive technique for detecting both crossed cerebellar and uncrossed basal ganglia as well as thalamic diaschisis in neurodegenerative diseases, while MRI is better for measuring brain volume. This study suggests that PET has a higher diagnostic value for diagnosing CCD compared to MRI, and that PET is a more valuable technique for predicting CCD.

Cytokines' Role in the Pathogenesis and Their Targeting for the Prevention of Frozen Shoulder: A Narrative Review.

Frozen shoulder (FS) is a common name for shoulder movement limitation with different degrees of shoulder rigidity and pain. It is characterized by varying developmental courses, different levels of shoulder movement limitation, and background ambiguity due to the multiplicity of its causative factors. Systemic inflammatory cytokines monitoring and restraining is easy to apply, fast to conduct, and needs lower costs compared to invasive methods for frozen shoulder stage evaluation and early controlling of its progress to the stage that necessitates surgical intervention. The aim of this review was to assess the recent findings concerning the role of cytokines in FS pathogenesis and the possibility of preventing or controlling their progress through targeting these cytokines by the new drugs candidates, such as hyaluronan (HA), botulinum toxin type A (BoNT A), Tetrandrine, tumor necrosis factor-stimulated gene-6 (TSG-6), and cannabidiol. Searching the PubMed site, we encountered out of 1608 records, from which 16 original studies were included for the quantitative construction of this systematic review screening of the recent studies to investigate the different FS pathogenic pathways. Most of the scenarios are centered around the inflammatory and fibrotic process triggered by synovial and capsular fibroblast stimulation. This mechanism depends mainly on alarmins cytokines, including thymic stromal lymphopoietin (TSLP), interleukin-33 (IL-33), and interleukin-25 (IL-25), with the stimulation of interleukin-1 α (IL-1α), interleukin-1 ß (IL-1ß), tumor necrosis alpha (TNF-α), cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) in a joint capsule. Different pathways of transforming growth factor- ß (TGF-ß) stimulation, resulting in overexpression of the fibrotic factors as tenascin C (TNC), fibronectin 1, collagen I (COL 1) and collagen III (COL III), and matrix metalloproteinases (MMPs) in the capsular or synovial/capsular fibroblasts. The overall investigation of these studies led us to conclude that the new drug candidates proved their efficiency in controlling the common pathogenesis of the inflammatory and fibrotic pathways of frozen shoulder and therefore represent a prospect for easy and early controlling and efficiently treating this serious disease.

Glomus Tumor Within the Tensor Fascia Lata: A Case Report.

BACKGROUND Glomus tumors are rare, benign, soft-tissue lesions, usually occurring in the hand, but they can occur in other regions of the body, such as the thigh. Most of the time, extradigital glomus tumors are difficult to diagnose, and symptoms can persist for a long time. The usual clinical presentations consist of pain, tenderness at the site of the tumor, and hypersensitivity to cold. CASE REPORT We report a case of a GT of the proximal thigh in a 39-year-old man with left thigh pain without palpable mass for several years, without clear diagnosis. He had pain and hyperesthesia exacerbated by running. The patient was diagnosed initially by ultrasound imaging, which revealed a round, solid, hypoechoic, homogeneous mass in the left upper thigh. Magnetic resonance imaging (MRI) with contrast showed a well-defined intramuscular lesion in the tensor fascia lata. A percutaneous biopsy was done through ultrasound guidance, followed by excisional biopsy and immediate pain relief. CONCLUSIONS Glomus tumors of the thigh are a rare neoplasm, especially in the proximal thigh; they are difficult to diagnose and are associated with morbidity. Diagnosis can be made through a systematic approach and simple investigation, such as via ultrasonography. A percutaneous biopsy can help in drawing up a management plan, and malignancy must be considered if the lesion is suspicious. Symptoms can persist in case of incomplete resection or unrecognized synchronous satellite lesions; thus, symptomatic neuroma should be considered.