Clinical Audit in the Elderly by Assessing Hydration and Renal Functions Before and After Contrast CT Scans at District Headquarters Hospital, Dera Ismail Khan, Pakistan.

Introduction Contrast-induced nephropathy (CIN) is a serious risk involved in computed tomography (CT) scans, particularly for older people. The main idea of this clinical audit was to assess current practices regarding renal function tests (RFTs) and hydration status before and after contrast CT scans in older patients at District Headquarters Hospital (DHQ), Dera Ismail Khan, Pakistan, and to implement recommendations for improvement. CIN is a form of acute kidney injury that occurs after the administration of contrast dye used in imaging procedures and is characterized by a sudden deterioration in renal functions. Methods This clinical audit checked adherence to renal protection protocols in elderly patients undergoing contrast CT scans. Conducted over three cycles from July 5 to August 15, 2022, this clinical audit included 30 patients aged 75 and above. Each cycle had 10 patients, divided equally between males and females, and further categorized into age groups of 75-85 years and 86-95 years. Data collection involved reviewing patient files, medication charts, and CT scan reports. Compliance with RFT documentation and hydration before and after the CT scan was assessed against the standards set by Basildon and Thurrock University Hospitals NHS Foundation Trust. Data were analyzed using Microsoft Excel 2023 (Microsoft® Corp., Redmond, WA), and graphs were created using Microsoft Word 2023 (Microsoft® Corp., Redmond, WA). Results The mean age ± standard deviation (SD) for males was 81.8 ± 5.01 in the first cycle, 83.4 ± 6.46 in the second cycle, and 82.4 ± 4.72 in the third cycle. For females, the mean age ± SD was 83.2 ± 5.80 in the first cycle, 85.2 ± 6.41 in the second cycle, and 83.0 ± 6.12 in the third cycle. The first audit cycle revealed that, while all patients (100%) had their RFTs documented before the CT scan, only 20% were adequately hydrated pre-scan, and none (0%) had RFTs performed post scan. Post-scan hydration was also low at 20%. These findings highlighted gaps in adherence to renal protection protocols. The second cycle showed improvements, with pre-scan hydration adherence increasing to 80%, post-scan RFTs to 60%, and post-scan hydration to 70%. By the third cycle, full compliance (100%) was achieved across all standards, including pre- and post-scan renal functions test and hydration. Conclusion The clinical audit at District Headquarters Hospital, Dera Ismail Khan, addressed gaps in renal protection protocols for elderly patients undergoing contrast CT scans. The audit improved adherence over three cycles through targeted interventions, including staff training, implementation of checklists, patient education, modifying the reporting format, and providing instructions in the local language. It also highlighted the importance of continuous education and regular monitoring. The clinical audit would be expanded to another hospital within the medical teaching institute, Dera Ismail Khan. This measure will maintain and enhance patient care, prevent CIN, and improve the renal health of elderly patients.

What is the Link between Lung Involvement and Anti-CCP Antibodies in Rheumatoid Arthritis: A Cross-sectional Study.

BACKGROUND: In Rheumatoid Arthritis (RA), pulmonary involvement is one of the most frequent extra-articular manifestations. Several studies have demonstrated an association between RA-related lung disease and the positivity of anti-cyclic citrullinated peptide (anti-CCP) antibodies. OBJECTIVE: Our aim is to describe the frequency of pulmonary involvement in the RA population and investigate the association between anti-CCP antibodies and diverse lung compartment involvement in RA patients. METHODS: An observational retrospective cross-sectional study was conducted, during which data were collected from the medical records of the patients with RA who had been tested for anti-CCP antibodies and had thoracic high resolution computerized tomography (HRCT) evaluation from January 2011 to March 2022. The univariate and multivariate analyses using logistic regression models was performed to calculate odds ratios (ORs) with 95% CIs. RESULTS: A total of 390 patients with RA were included, the mean age of patients was 58.99 ± 12.44 years, with a predominance of females (85.9%). Two hundred and fifty-two (64.6%) patients were positive for anti-CCP antibodies. The frequency of RA-related lung diseases was 14.4% (n=56). The different manifestations observed in the thoracic HRCT included Nodules (67.9%), Interstitial lung disease (ILD) (28.6%), bronchiectasis (25%), fibrosis (21.4%), obliterative bronchiolitis (7.1%), and pleuritis (1.8%). In univariate and multivariate analysis, pulmonary involvement was associated with positive anti-CCP antibodies with an odds ratio (OR) of 5.25 (95% CI: 2.17-12.70, p < 0.0001). CONCLUSION: The study demonstrated a positive association between anti-CCP antibodies and pulmonary involvement in RA and highlighted the importance of tight monitoring in RA patients with positive anti-CCP for pulmonary complications.

Abdominal imaging and endoscopic characteristics of adult abdominal IgA vasculitis: a multicenter retrospective study.

BACKGROUND: IgA vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is an IgA-mediated systemic small vessel vasculitis that tends to be more severe in adults than in children. Early diagnosis of IgAV involving the gastrointestinal tract remains difficult, especially in patients who present with gastrointestinal symptoms before purpura. This study aims to systematically analyze the abdominal imaging and endoscopic features of adult patients with abdominal IgAV, providing assistance to clinicians in the early recognition of this condition. PATIENTS AND METHODS: This multicenter retrospective study was conducted in three large tertiary hospitals in China from January 2017 to January 2024. A total of 108 adult patients with abdominal IgAV, who had complete abdominal imaging and/or endoscopy results, were enrolled. The clinical manifestations, abdominal imaging findings, endoscopic characteristics, and serological indicators of the patients were analyzed. RESULTS: The median age of the patients was 40 years (IQR: 26-55), with a male-to-female ratio of 2:1. Acute abdominal pain was the most common presenting symptom (100 patients, 92.59%). Bowel wall thickening was the most frequent finding on abdominal imaging (50/86 patients, 58.14%). Gastrointestinal endoscopy showed findings of congestion and erosion (32/67 patients, 47.76%), and erosion with ulcers (21/67 patients, 31.34%). Among patients with both imaging and endoscopic results, the duodenum (28/51 patients, 54.90%) and ileum (28/51 patients, 54.90%) were the most commonly affected sites. Laboratory findings revealed elevated white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), D-dimer and fibrinogen levels, along with decreased albumin level. Comparing patients with gastrointestinal symptoms versus purpura as the initial symptom, those with gastrointestinal symptoms had higher levels of WBC (p < 0.05) and NLR (p < 0.01). CONCLUSIONS: The most common symptom in adult abdominal IgAV patients is acute abdominal pain. In the early stage of the disease, most patients exhibit elevated levels of WBC, NLR, CRP, D-dimer, and fibrinogen, along with decreased albumin level. The duodenum and ileum are the most commonly affected sites. By integrating these findings, clinicians can identify abdominal IgAV patients earlier and more accurately.

Adult abdominal IgAV is prevalent in middle-aged adults, with abdominal pain being the main presenting symptom. Abdominal imaging and endoscopy suggest that the duodenum and ileum are particularly susceptible to involvement. Laboratory tests typically show elevated white blood cell count, neutrophil-to-lymphocyte ratio, C-reactive protein, D-dimer and fibrinogen levels, along with decreased albumin level. These findings can aid in the early recognition of IgAV and facilitate timely treatment, thereby improving patient prognosis.

Trends in Radiation at a Level I Trauma Center.

Introduction Following traumatic injury, patients often require imaging modalities that subject them to large amounts of radiation. The current protocol for imaging workup in trauma patients includes plain radiographs and computed tomography (CT). Although these imaging modalities have improved quality and efficiency in trauma interventions, it is essential to understand their potential limitations and adverse effects. The large amounts of radiation from these imaging tests have raised concern for particularly vulnerable populations, including children and adolescents. Objective To evaluate the trends in radiation exposure in trauma assessment and imaging seen at a Level I trauma center. Methods This retrospective analysis used a de-identified dataset from the trauma registry at Desert Regional Medical Center Level I Trauma Center in Palm Springs, CA. Total radiation amounts were calculated based on the type of diagnostic modality. An effective radiation dose was assigned to each examination (radiograph and CT scan) based on the values provided by the American College of Radiology. Results There was a statistically significant positive correlation between injury severity score and effective radiation dose from imaging workup. From 2016 to 2021, radiation amount and year were found to be negatively correlated. There was a larger, statistically significant amount of radiation dosage among adult trauma patients (16.32 mSv) when compared to pediatric (6.32 mSv) and geriatric (12.67 mSv) groups. Conclusion Our Level I trauma center has observed a decline in radiation exposure with our current trauma protocols in place. On average, adult patients received the highest effective radiation dose to pediatric and geriatric patients. CT scans and radiography are essential tools in initial trauma workup and should be used only in appropriate patients.

Assessing the Effectiveness of Selective RET Inhibitors in RET-Positive Cancers through Fluorodeoxyglucose Uptake Analysis.

Selective RET inhibitors, such as selpercatinib and pralsetinib, have revolutionized the treatment of cancers with RET gene alterations. These inhibitors have shown remarkable clinical efficacy, particularly in RET-driven lung cancer, medullary thyroid cancer, and other solid tumors driven by RET gene fusions. The assessment of treatment response in oncology has been greatly enhanced by Fluorodeoxyglucose Positron Emission Tomography (FDG-PET), a valuable tool that measures tumor metabolism and provides early indicators of treatment effectiveness. This work explores the effectiveness of selective RET inhibitors in targeting RET-positive cancers and investigates the utility of FDG-PET in assessing treatment response. The paper includes insightful case studies that highlight the successful application of RET inhibitors in the treatment of RET-positive cancers. The findings suggest that FDG-PET has the potential to serve as a non-invasive biomarker for monitoring treatment response in patients with RET-positive cancers. However, further research is required to establish standardized criteria for interpreting FDG-PET scans in the context of selective RET inhibitors and to uncover the broader applications of FDG-PET in precision oncology.

Acute lung pathology in the immunocompromised child.

Children with compromised immune systems, whether due to primary or secondary immunodeficiencies, are susceptible to a broad spectrum of acute intrathoracic pathologies. These include infections, pulmonary edema, and malignancies. Pulmonary issues are common and perilous in this population, necessitating prompt and precise diagnosis for effective management. This review aims to provide an overview of such conditions, focusing on the imaging appearances of the most prevalent acute lung conditions affecting immunocompromised children. It emphasizes the critical importance of an integrated clinical and radiological approach when diagnosing these acute pulmonary disease states.

[18F]FDG PET/CT in Benign and Malignant Diseases Involving the Biliary Tract.

Role of FDG PET/CT in evaluation of biliary tract diseases remains relatively unexplored. PET/CT with FDG helps in evaluation of both infective / inflammatory as well as neoplastic diseases as increased glucose utilization is observed in both the conditions. In this article, we describe the spectrum of FDG PET/CT findings in various diseases affecting the biliary tract. Role of FDG PET/CT in neoplastic diseases involving the biliary duct has been described at the time of staging and response evaluation; in characterization of the intrahepatic mass (abscess v/s cholangiocarcinoma). In addition, we have discussed about the false positive FDG uptake along the biliary duct stent, which interfere with scan interpretation. Few of the benign conditions described are Langerhans cell histiocytosis and IgG4 related disease involving the biliary duct and adenomyomatosis and Xanthogranulomatous cholecystitis involving the gall bladder.

Development and Validation of a CT-Radiomics Nomogram for the Diagnosis of Small Prevascular Mediastinal Nodules: Reducing Nontherapeutic Surgeries.

RATIONALE AND OBJECTIVES: The preoperative diagnosis of small prevascular mediastinal nodules (SPMNs) presents a challenge, often leading to unnecessary surgical interventions. Our objective was to develop a nomogram based on preoperative CT-radiomics features, serving as a non-invasive diagnostic tool for SPMNs. MATERIALS AND METHODS: Patients with surgically resected SPMNs from two medical centers between January 2018 and December 2022 were retrospectively reviewed. Radiomics features were extracted and screened from preoperative CT images. Logistic regression was employed to establish clinical, radiomics, and hybrid models for differentiating thymic epithelial tumors (TETs) from cysts. The performance of these models was validated in both internal and external test sets by area under the receiver operating characteristic curve (AUC), while also comparing their diagnostic capability with human experts. RESULTS: The study enrolled a total of 363 patients (median age, 53 years [IQR:45-59 years]; 175 [48.2%] males) for model development and validation, including 136 TETs and 227 cysts. Lesions' enhancement status, shape, calcification, and rad-score were identified as independent factors for distinction. The hybrid model demonstrated superior diagnostic performance compared to other models and human experts, with an AUC of 0.95 (95% CI:0.92-0.98), 0.94 (95% CI:0.89-0.99), and 0.93 (95% CI:0.83-1.00) in the training set, internal test set, and external test set respectively. The calibration curve of the model demonstrated excellent fit, while decision curve analysis underscored its clinical value. CONCLUSION: The radiomics-based nomogram effectively discriminates between the most prevalent types of SPMNs, namely TETs and cysts, thus presenting a promising tool for treatment guidance.

Correlation between cancer-related cognitive impairment and resting cerebral glucose metabolism in patients with ovarian cancer.

Background: An increasing number of research have applied neuroimaging techniques to explore the potential neurobiological mechanism of Cancer-related cognitive impairment (CRCI). Purpose: To explore the correlation between resting brain glucose metabolism and CRCI using 18F-FDG PET/CT in ovarian cancer (OC) patients. Methods: From December 2021 to March 2022, 38 patients with OC were selected as the study group, and 38 healthy women of the same age (±1 year) who underwent routine physical examination using PET/CT were selected as the control group. Patients received further assessment with the Montreal Cognitive Assessment Scale (MoCA) and Perceived Deficit Questionnaire (PDQ). Independent sample t-test and Spearman correlation were conducted for data analysis. Results: The resting brain glucose metabolism in the OC group was significantly lower than in the healthy controls. 60.52 % patients had neuropsychological impairment and retrospective memory were the most serious perceived cognitive impairments. The resting brain glucose metabolism in OC patients did not significantly correlate with neuropsychological performance but had significant positive correlation with subjective cognitive evaluation. Discussion: Resting glucose metabolism was low in OC patients and associated with subjective cognitive impairment but not objective neuropsychological test results. 18F-FDG PET/CT can be used to evaluate brain function in OC patients and provide reliable imaging indicators for early recognition of and intervention for changes in cognitive function.

Ileocolonic Intussusception Secondary to Colon Cancer: A Rare Cause of Abdominal Pain In Adults.

Intussusception, defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one, is a rare cause of abdominal pain in the adult population due to underlying benign or malignant pathology. With the liberal use of CT in the evaluation of patients with abdominal pain, the diagnosis became more reliable. Resection of the bowel segment is the recommended treatment in most cases. We are presenting the case of a 76-year-old male patient who presented with a three-week history of abdominal pain and diarrhea. The evaluation was consistent with ileocolic intussusception. Robotic resection of the right colon was performed. Pathology revealed poorly differentiated adenocarcinoma of the cecum as the underlying pathology.

Deep Learning-Based System Combining Chest X-Ray and Computerized Tomography Images for COVID-19 Diagnosis.

Aims/Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for accurate and efficient diagnostic methods. This study aims to improve COVID-19 detection by integrating chest X-ray (CXR) and computerized tomography (CT) images using deep learning techniques, further improving diagnostic accuracy by using a combined imaging approach. Methods: The study used two publicly accessible databases, COVID-19 Questionnaires for Understanding the Exposure (COVID-QU-Ex) and Integrated Clinical and Translational Cancer Foundation (iCTCF), containing CXR and CT images, respectively. The proposed system employed convolutional neural networks (CNNs) for classification, specifically EfficientNet and ResNet architectures. The data underwent preprocessing steps, including image resizing, Gaussian noise addition, and data augmentation. The dataset was divided into training, validation, and test sets. Gradient-weighted Class Activation Mapping (Grad-CAM) was used for model interpretability. Results: The EfficientNet-based models outperformed the ResNet-based models across all metrics. The highest accuracy achieved was 99.44% for CXR images and 99.81% for CT images with EfficientNetB5. The models also demonstrated high precision, recall, and F1 scores. For statistical significance, the p-values were less than 0.05, indicating that the results are significant. Conclusion: Integrating CXR and CT images using deep learning significantly improves the accuracy of COVID-19 diagnosis. The EfficientNet-based models, with their superior feature extraction capabilities, show better performance than ResNet models. Grad-CAM Visualizations provide insights into the model's decision-making process, potentially reducing diagnostic errors and accelerating diagnosis processes. This approach can improve patient care and support healthcare systems in managing the pandemic more effectively.

Quantitative CT Morphometrics: A Novel Approach for Predicting the Bladder Cancer Grade.

Background and objective Bladder cancer (BC) is a common urothelial neoplasm, with non-muscle invasive forms comprising about 75% of cases and generally having better outcomes than muscle-invasive types. Accurate preoperative grading and staging of BC are essential for appropriate treatment planning. This study investigates the efficacy of computerized tomography (CT) in correlating the morphological features of tumors to predict the histopathological grades of BC.  Materials and methods This retrospective cohort involved 100 patients diagnosed with non-muscle invasive BC, who underwent transurethral resection of bladder tumor (TUR-BT) between January 2010 and August 2021. CT imaging, utilizing a 128-slice CT scanner, was employed to measure the tumor height (H) and contact length (CL). The study considered morphometric parameters across axial, coronal, and sagittal planes. Statistical analyses were conducted, comparing radiological findings with histopathological evaluations. Tumor grading was determined according to the 2004/2016 WHO classification. Results Among the 100 patients with primary bladder tumors, 15 were female and 85 were male, with a mean age of 65.28 ± 7.11 years. Furthermore, 58 had high-grade bladder tumors, while 42 had low-grade bladder tumors. Across all planes, high-grade tumors exhibited higher values for the tumor H, CL, and the tumor height-to-contact length (H/CL) ratio compared to low-grade tumors (p<0.05). Notably, the specificity, sensitivity, and diagnostic accuracy of the tumor CL were higher than those of the tumor H and the tumor H/CL ratio. A tumor CL exceeding 19.1mm measured in the axial plane demonstrated 83% sensitivity and specificity for high-grade tumors. Conclusion The measured CL of the tumor in the axial plane on computerized tomography urography has high sensitivity and specificity in detecting high-grade tumors.

A Japanese Case of Familial Hypercholesterolemia with a Protein-truncating Variant in LDLR and a PCSK9 Variant without Significant Atherosclerosis but Showing Remarkable Achilles Tendon Thickening.

The patient was a 54-year-old woman with familial hypercholesterolemia and remarkable Achilles tendon thickening. At 20 years old, the patient had a total cholesterol level of approximately 300 mg/dL. She started receiving rosuvastatin (5 mg/day) for low-density lipoprotein cholesterol (LDL-C) 235 mg/dL at 42 years old, which was increased to 10 mg/day at 54 years old, decreasing her serum LDL-C level to approximately 90 mg/dL. The serum Lp (a) level was 9 mg/dL. A computed tomography coronary angiogram showed no significant stenosis. Next-generation sequencing revealed a frameshift variant in LDL receptor (LDLR) (heterozygous) and a missense variant in proprotein convertase subtilisin/kaxin type 9 (PCSK9) (heterozygous). Continued statin therapy, in addition to low Lp (a) and female sex, can help prevent cardiovascular disease.

Multicenter, international study of CT practices and radiation doses from 10 African countries: An International Atomic Energy Agency (IAEA) baseline study.

PURPOSE: The objective of our IAEA-coordinated international study was to assess CT practices and radiation doses from multiple hospitals across several African countries. METHODS: The study included 13 hospitals from Africa which contributed information on minimum of 20 consecutive patients who underwent head, chest, and/or abdomen-pelvis CT. Prior to the data recording step, all hospitals had a mandatory one-hour training on the best practices in recording the relevant data elements. The recorded data elements included patient age, weight, protocol name, scanner information, acquisition parameters, and radiation dose descriptors including phase-specific CT dose index volume (CTDIvol in mGy) and dose length product (DLP in mGy.cm). We estimated the median and interquartile range of body-region specific CTDIvol and DLP and compared data across sites and countries using the Kruskal-Wallis H Test for non-normal distribution, analysis of variance. RESULTS: A total of 1061 patients (mean age 50 ± 19 years) were included in the study. 16 % of CT exams had no stated clinical indications for CT examinations of the head (32/343, 9 %), chest (50/281, 18 %), abdomen-pelvis (67/243, 28 %), and/or chest-abdomen-pelvis CT (24/194, 12 %). Most hospitals used multiphase CT protocols for abdomen-pelvis (9/11 hospitals) and chest CT (10/12 hospitals), regardless of clinical indications. Total median DLP values for head (953 mGy.cm), chest (405 mGy.cm), and abdomen-pelvis (1195 mGy.cm) CT were above the UK, German, and American College of Radiology Diagnostic Reference Levels (DRLs). CONCLUSIONS: Concerning variations in CT practices and protocols across several hospitals in Africa were demonstrated, emphasizing the need for better protocol optimization to improve patient safety.

Histomorphometric and microtomographic analysis of maxillary sinus augmentation surgeries with and without collagen membrane on the lateral window: A randomized clinical trial.

OBJECTIVE: To evaluate the histomorphometric and computerized microtomographic (Micro-CT) analysis of the regenerated bone tissue from maxillary sinus augmentation surgery, with and without using the collagen membrane on the external osteotomy window. MATERIALS AND METHODS: Twelve patients were selected for this prospective, controlled, and randomized study. The patients were submitted to bilateral maxillary sinus surgery in a split-mouth design. On the test side, the maxillary sinus augmentation procedure included using Geistlich Bio-Oss® and a Geistlich Bio-Gide® collagen membrane covering the lateral osteotomy window. On the control side, only Geistlich Bio-Oss® was used without the presence of the membrane. After 6 months, the surgeries for implant installation were performed. In this surgical phase, specimens of the regenerated tissue were collected for histological and Micro-CT analysis. RESULTS: In the histomorphometric evaluation, the mean (±SD) percentages of newly formed bone were 43.9% (±11.5) and 40.8% (±8.9) in the test and control groups, respectively. The corresponding values of the Micro-CT analysis were 36.6% (±3.4) and 37.2% (±4.7) in the test and control groups, respectively. There was no statistically significant difference between the test and control groups in the two methods. In addition, there was no statistically significant difference between the mean percentage of biomaterial remaining between the test and control groups. However, the mean percentage of newly formed bone was significantly higher and the mean percentage of remaining biomaterial was significantly lower in the histomorphometric analysis compared to the values obtained through microtomography. CONCLUSION: The additional use of collagen membranes in maxillary sinus surgery does not offer advantages in newly formed bone.

The Prevalence of the Middle Clinoid Process: A Cross-Sectional Comparative Study in Patients with and without Pathology of the Sella Turcica.

Background The middle clinoid process (MCP), particularly caroticoclinoid ring (CCR) type of the MCP, is an important part of the sphenoid bone for skull base surgery. Previous studies have shown a wide range of MCP prevalence affected by various factors. However, no study has investigated the association between the MCP and the presence of sellar lesions. Objectives The main aim of this study was to evaluate the prevalence of the MCP in the Thai population and factors associated with its presence. Materials and Methods We conducted a cross-sectional study on 400 sides from 200 patients (100 with and 100 without sellar lesions) using cranial computerized tomography scans. Demographic data and MCP characteristics were collected. The association between individual variables and the presence of the MCP was determined by univariate and multivariate analysis. Results The MCP was identified in 168 of 400 sides (42%). Patients with sellar lesions had a significantly lower prevalence of the MCP compared with normal controls (29.5% versus 54.5%, p < 0.001). Of all MCP only 6% were the CCR type. Univariate and multivariate analysis showed that the absence of the sellar lesion was the only factor significantly associated with presence of the MCP (odds ratio: 2.86; 95% confidence interval: 1.90-4.32; p < 0.001). Conclusion The prevalence of the MCP was relatively high in the Thai population, while the prevalence of the CCR was relatively low compared with previous studies. The absence of sellar lesions was the only factor associated with the presence of the MCP.

Internal Hernia Post-Single Anastomosis Gastric Bypass: Case Series with Review of Literature.

Obesity is an emerging worldwide health care issue. It has a direct and indirect bearing on health-related outcomes. Rates of overweight and obesity have grown manifold in the past few decades globally. Once considered a problem of the affluent societies only, obesity is now dramatically on the rise in low- and middle-income countries also. Single anastomosis gastric bypass (SAGB) is one of the combined bariatric procedures adopted for weight loss in patients failing maximal medical therapy. Internal hernia (IH) after SAGB is a less recognized clinical entity. We hereby report our experience with four such cases under light of current available literature. Bariatric procedures are associated with some short- and long-term limitations. IHs are among one of the dreaded complications associated with some bariatric procedures with rates reaching up to 16% after classic Roux-en-Y gastric bypass. The incidence of IH post-SAGB is comparatively rare and is very less frequently reported. Symptoms of IH post-SAGB are quite nonspecific and depend on the time and extent of herniation. The symptoms can vary from benign intermittent colicky pain to severe intra-abdominal pain presenting as a surgical emergency. Routine physical examination and biochemical investigations are nonspecific and unreliable in evaluating those patients. Computed tomography (CT) with intravenous and oral contrast is the most common imaging modality used for preoperative evaluation of those symptoms. The CT findings can be unremarkable in patients having intermittent symptoms/herniation. Diagnostic laparoscopy is the cornerstone for diagnosis and management of patients having high suspicion of IH.

Analysis of Imaging and Pathologic Features in Eosinophilic Solid and Cystic Renal Cell Carcinoma.

OBJECTIVE: Eosinophilic solid and cystic renal cell carcinoma (ESC-RCC) is rare and difficult to diagnose. Therefore, we aim to investigate the imaging and pathologic features of ESC-RCC. METHODS: Fifteen cases of ESC-RCC with pathologically confirmed diagnoses were retrospectively collected: CT was performed in 15 cases and MRI in 9 cases. RESULTS: In these patients (6 males and 9 females) (age: mean, 53.3 ± 14.7 years; range, 27-72 years), all tumors were unilateral, renal, and solitary with no clinical symptoms and were classified into-type 1: cystic-solid component, with equal cystic and solid components, was the most common (8/15, 53.3%); type 2: predominantly cystic with a small solid component (4/15, 26.7%); and type 3: predominantly solid (3/15, 20%). The solid component showed equal/slightly higher density on the CT-plain-scan, equal/slightly high signal on the T1-weighted image (T1WI), and low signal on the T2-weighted image (T2WI). Ten cases showed progressive enhancement, while 5 showed a fast-wash-in and fast-wash-out enhancement. One patient experienced hemorrhage, while the others showed no signs of hemorrhage, necrosis, fat, or calcification. Pathologically, the tumor showed cystic solidity, with eosinophilic cytoplasm and granular basophilic-colored spots with focal or diffuse expression of CK20. Ten patients had componential nephrectomy and 5 had radical nephrectomy. No recurrence or metastasis was noted in any case at the follow-up (8-49 months). CONCLUSION: This study describes the imaging and pathologic features of a rare type of renal cancer and proposes 3 imaging types to enhance physicians' diagnosis of this disease and guide clinical diagnosis and treatment.

Orbital complications of pediatric acute rhinosinusitis in the pneumococcal conjugate vaccine era.

OBJECTIVES: To evaluate the impact of the pneumococcal conjugate vaccines (PCVs) introduction on the orbital complications of acute rhino-sinusitis (OC-ARS). METHODS: A retrospective cohort study of all pediatric patients with OC-ARS during the period 2002-2019. Data included clinical, demographic, laboratory, and microbiology findings. Patients were divided into three groups: before PCV7 introduction (group 1), after PCV7 and before PCV13 (group 2), and after PCV13 (group 3). RESULTS: Of 265 enrolled patients, 117, 39, and 109 were assigned to groups 1, 2, and 3. During the study period, a significant decrease was recorded in the percentages of patients in Chandler classification severity category 1, with an increase in patients in category 3 (P = 0.011). The yearly incidence of OC-ARS decreased from 12.64 cases per 100,000 population in 2002 to 5.56 per 100,000 in 2008, and 2.99 per 100,000 in 2019 (P < 0.001). Patients aged 0-4 years showed a dramatic decrease from 29 cases per 100,000 population in 2002 to 4.27 per 100,000 in 2019 (P < 0.001). The pathogens retrieved from all cultures performed were Streptococcus pneumoniae (32.5%), non-typeable Haemophilus influenzae (27.5%), Streptococcus Species, (12.5%), and Staphylococcus aureus (20%), with no changes in distribution during the study periods. Surgery was performed in 28 (10.6%) patients. CONCLUSIONS: A significant decrease was seen in the overall incidence of OC-ARS, mainly attributable to the decrease in patients aged 0-4 years. An increase was recorded in the severity of the disease following PCVs introduction.

CT-based radiomic analysis for categorization of ovarian sex cord-stromal tumors and epithelial ovarian cancers.

PURPOSE: To evaluate the diagnostic potential of radiomic analyses based on machine learning that rely on contrast-enhanced computerized tomography (CT) for categorizing ovarian sex cord-stromal tumors (SCSTs) and epithelial ovarian cancers (EOCs). METHODS: We included a total of 225 patients with 230 tumors, who were randomly divided into training and test cohorts with a ratio of 8:2. Radiomic features were extracted from each tumor and dimensionally reduced using LASSO. We used univariate and multivariate analyses to identify independent predictors from clinical features and conventional CT parameters. Clinic-radiological model, radiomics model and mixed model were constructed respectively. We evaluated model performance via analysis of the receiver operating characteristic (ROC) curve and area under ROC curves (AUCs), and compared it across models using the Delong test. RESULTS: We selected a support vector machine as the best classifier. Both radiomic and mixed model achieved good classification accuracy with AUC values of 0.923/0.930 in the training cohort, and 0.879/0.909 in the test cohort. The mixed model performed significantly better than the model based on clinical radiological information, with AUC values of 0.930 versus 0.826 (p = 0.000) in the training cohort and 0.905 versus 0.788 (p = 0.042) in the test cohort. CONCLUSION: Radiomic analysis based on CT images is a reliable and noninvasive tool for identifying SCSTs and EOCs, outperforming experience radiologists.