Magnetic resonance neurography techniques in the pediatric population.

The use of magnetic resonance imaging (MRI) in the evaluation of the central extracranial nervous system, namely the brachial and lumbosacral plexuses, is well established and has been performed for many years. Only recently after numerous advances in MRI, has image quality been sufficient to properly visualize small structures, such as nerves in the extremities. Despite the advances, peripheral MR Neurography remains a complex and difficult examination to perform, especially in the pediatric patient population, in which the risk for motion artifact and compliance is always of concern. Thus, technical aspects of the MR imaging protocol must be flexible but robust, to balance image quality with scan time, in a patient population of varying sizes. An additional important step for reliably performing a successful MR Neurography examination is the non-technical pre-imaging preparation, which includes patient/family education and open communication with referring teams. This paper will discuss in detail the individual technical and non-technical/operational aspects of peripheral MR Neurography, to help guide in building a successful program in the pediatric population.

Knowledge, attitude, and practice regarding diabetic foot care among Saudi and non-Saudi diabetic patients in Alkharj.

CONTEXT: There is a high prevalence of diabetes mellitus in Saudi Arabia. Also, the diabetic foot complication rate is alarmingly high with many patients ending in amputation. AIMS: To assess the knowledge, attitude, and practices regarding diabetic foot care among Saudi and non-Saudi diabetic patients in Alkharj. SETTINGS AND DESIGN: It is a cross-sectional study conducted from May 22nd, 2019 to April 1st, 2020 at Diabetic clinic, Military Hospital in Alkharj. METHODS AND MATERIALS: Non-randomized, non-probability convenience sampling technique was used to collect data from 224 patients by using a validated and confidential questionnaire in either face-to-face interviews or as an electronic survey. All adult patients over 18 years of age of both sexes having type 1 and 2 diabetes mellitus were included. The patients who were unable to provide the requested information were excluded. STATISTICAL ANALYSIS: The data were analyzed using SPSS version 24. RESULTS: The mean age of patients was 49.37 years with 58.5% male and 41.5% female patients. About 58% of patients had diabetes for more than 10 years. More than half of the patients reported some foot problems, while 9.4% have had active or healed ulcerations. The mean scores for knowledge, attitude, and practice were 8.576, 4, and 13, respectively, all statistically significant. CONCLUSIONS: Our study population has sufficient knowledge about diabetes and its foot complication, and they also had a positive attitude towards its management. However, they were lagging in the practices required for diabetic foot management.

Pediatric emergency gastrointestinal ultrasonography: pearls & pitfalls.

Ultrasonography is an essential tool in pediatric imaging, particularly in the emergency setting. Although ultrasound is often the favored initial modality for abdominal imaging in children, it is highly operator-dependent and therefore prone to misinterpretation which can lead to false positive or negative exams, or even incorrect diagnoses. Conditions discussed in this series include ileocolic intussusception, hypertrophic pyloric stenosis, appendicitis, and ingested foreign bodies. We will review diagnostic criteria, highlight crucial findings, and illustrate commonly-encountered difficulties and mimics.

Bile leak after transjugular liver biopsy in a cholecystectomy patient.

INTRODUCTION: Transjugular liver biopsy (TJLB) is a minimally invasive procedure performed to obtain hepatic tissue in patients whom standard percutaneous liver biopsy is contraindicated due to abnormal coagulation profile and/or severe ascites. Additionally, it has the advantage of simultaneously measuring the hepatic venous pressures. CASE PRESENTATION: 61-year-old male with history of pulmonary fibrosis, cholecystectomy and Hepatitis C underwent transjugular liver biopsy (TJLB) as part of his lung transplant workup. Shortly after the procedure, the patient developed sharp right upper abdominal pain. Immediate CT of the abdomen and pelvis showed small foci of contrast and gas in the gallbladder fossa and porta hepatis indicating hepatic capsular penetration without perihepatic hematoma or other evidence of hemorrhage. Follow up CT of the abdomen and HIDA scan confirmed the presence of bile leak. Sphincterotomy and stent placement through ERCP was performed. CONCLUSION: Bile leak after a TJLB is a rare, however, potential complication. ERCP and biliary stent seems an effective treatment for persistent symptomatic bile leak post TJLB.