A Fatal Case of Cerebral Fat Embolism: A Case Report.

Fat embolism syndrome (FES) is a rare but serious multisystem syndrome that occurs after 0.9% to 2.2% of fractures, with long bone and pelvic fractures being the most common. The classic triad of FES consists of neurological impairment, respiratory insufficiency, and petechial rash, which develops 12-72 hours after the initial incident. We hereby present a case of a patient who developed persistent altered consciousness, seizures, and hypoxia secondary to a comminuted sacral fracture. Although the patient could not survive owing to multiple factors, imaging played a pivotal role in expediting the diagnostic process and aiding early management.

Utility of Dual-Energy Computed Tomography in Clinical Conundra.

Advancing medical technology revolutionizes our ability to diagnose various disease processes. Conventional Single-Energy Computed Tomography (SECT) has multiple inherent limitations for providing definite diagnoses in certain clinical contexts. Dual-Energy Computed Tomography (DECT) has been in use since 2006 and has constantly evolved providing various applications to assist radiologists in reaching certain diagnoses SECT is rather unable to identify. DECT may also complement the role of SECT by supporting radiologists to confidently make diagnoses in certain clinically challenging scenarios. In this review article, we briefly describe the principles of X-ray attenuation. We detail principles for DECT and describe multiple systems associated with this technology. We describe various DECT techniques and algorithms including virtual monoenergetic imaging (VMI), virtual non-contrast (VNC) imaging, Iodine quantification techniques including Iodine overlay map (IOM), and two- and three-material decomposition algorithms that can be utilized to demonstrate a multitude of pathologies. Lastly, we provide our readers commentary on examples pertaining to the practical implementation of DECT's diverse techniques in the Gastrointestinal, Genitourinary, Biliary, Musculoskeletal, and Neuroradiology systems.

Automatic brain-tumor diagnosis using cascaded deep convolutional neural networks with symmetric U-Net and asymmetric residual-blocks.

The use of various kinds of magnetic resonance imaging (MRI) techniques for examining brain tissue has increased significantly in recent years, and manual investigation of each of the resulting images can be a time-consuming task. This paper presents an automatic brain-tumor diagnosis system that uses a CNN for detection, classification, and segmentation of glioblastomas; the latter stage seeks to segment tumors inside glioma MRI images. The structure of the developed multi-unit system consists of two stages. The first stage is responsible for tumor detection and classification by categorizing brain MRI images into normal, high-grade glioma (glioblastoma), and low-grade glioma. The uniqueness of the proposed network lies in its use of different levels of features, including local and global paths. The second stage is responsible for tumor segmentation, and skip connections and residual units are used during this step. Using 1800 images extracted from the BraTS 2017 dataset, the detection and classification stage was found to achieve a maximum accuracy of 99%. The segmentation stage was then evaluated using the Dice score, specificity, and sensitivity. The results showed that the suggested deep-learning-based system ranks highest among a variety of different strategies reported in the literature.

A trend, analysis, and solution on women's representation in diagnostic radiology in North America: a narrative review.

Despite the demonstrated benefits of gender diversity in medicine, women in Radiology in North America are still underrepresented. We reviewed the literature to highlight the current status of women in Radiology in North America, identify the underlying causes of the gender gap, and provide potential strategies to close this gap. We conducted a narrative literature review using the terms ("Gender Disparity" OR "Gender Inequality") AND ("Radiology Department" OR "Radiology Residency"), searching data from April 2000 to April 2022 in Ovid Medline, Embase, PubMed, and Scopus. Our results indicate that Radiology in North America lacks gender diversity in its subspecialties, academic leadership, and research productivity, which the COVID-19 pandemic has further exacerbated. Challenges stemming from a dearth of women role models, limited preclinical contact, and a high rate of burnout contribute to the current gender inequality. Several complementary and supplementary steps can enhance gender diversity in Radiology. These include increasing education and exposure to Radiology at earlier stages and optimizing mentorship opportunities to attract a more diverse pool of talent to the discipline. In addition, supporting resident parents and enhancing the residency program's culture can decrease the rate of burnout and encourage women to pursue careers and leadership positions in Radiology.

A case report and treatment considerations for pyogenic liver abscess with biliary fistula.

INTRODUCTION AND IMPORTANCE: Pyogenic liver abscess (PLA) is a potentially life-threatening condition characterized by the formation of space-occupying lesions within the liver parenchyma. Despite advancements in diagnostic imaging and antibiotic therapies, complications such as biliary fistula formation can arise, posing challenges in management. CASE PRESENTATION: This case study presents a 23-year-old male patient with PLA complicated by a biliary fistula. Diagnostic imaging via CT scan and MRI confirmed a liver abscess and biliary dilation. The patient underwent a second drainage for ascitic fluid following the initial percutaneous liver catheter drainage. CLINICAL DISCUSSION: The patient responded positively to the treatment, with reduced abscess size and fistula resolution. While endoscopic interventions offer promising results, their limited availability necessitates alternative treatment strategies, such as percutaneous drainage and appropriate antibiotics. CONCLUSION: This case emphasises the importance of individualized management approaches for PLA complicated by biliary fistulas. Despite the challenges, successful outcomes can be achieved through careful management and appropriate treatment strategies.

Effect of adding thoracic manipulation for the management of patients with adhesive capsulitis: a randomized clinical trial.

BACKGROUND: Research is supporting thoracic spine manipulation (TSM) as an intervention in treating adhesive capsulitis (AC) when coupled with physical therapy interventions. PURPOSE: To investigate whether TSM improves AC outcomes when combined with physical therapy interventions. METHOD: A double-blinded, randomized, controlled trial with 40 patients assigned into two groups. The experimental group (EG) received physical therapy intervention and TSM; the control group (CG) had physical therapy with sham manipulation. Both groups received interventions biweekly for 12 weeks. Outcomes included Visual Analogue Scale (VAS), Shoulder Pain and Disability Index (SPADI), scapular upward rotation, and shoulder passive range of motion conducted at baseline, after 1 session, 6 and 12 weeks. RESULTS: Both groups improved significantly after 6 and 12 weeks in pain, disability (p = 0.01 for both; d = 1.53 and 1.46, respectively), scapular upward rotation, shoulder flexion (p = 0.02 for both; d = 2.2 and 0.92, respectively), abduction (p = 0.04; d = 0.07), and external rotation (p = 0.03; d = 0.7). However, CG showed no significant improvement in pain or disability after one session (p = 0.14 and p = 0.16, respectively; d = 0.46 for both). Between groups, results favored EG significantly in pain, disability, scapular upward rotation, shoulder flexion, and abduction (p = 0.02, p = 0.01, p = 0.02, p = 0.05, and p = 0.04, respectively) at 6 weeks (d = 0.81, d = 0.87, d = 0.67, d = 0.64, and d = 0.69, respectively). CONCLUSION: The results suggest that adding TSM yielded superior clinical benefits when compared to physical therapy interventions in AC patients. Nevertheless, it is imperative to acknowledge a specific limitation in our study is the omission of passive internal rotation assessment. This aspect represents a notable constraint in our research. CLINICAL TRIAL REGISTRY NUMBER: Pan African clinical trial registry "PACTR202303495421928".

Clinical value of 18F-PSMA-1007 PET/MRI in primary staging of patients with intermediate- to high-risk prostate cancer.

OBJECTIVE: To assess the utility of 18F-PSMA-1007 PET/MRI in initial staging of intermediate- to high-risk prostate cancer (HRPCa). METHODS: A total of 46 patients with pathologically verified intermediate and/or HRPCa who underwent 18F-PSMA-1007 PET/MRI with dedicated pelvic high-resolution multiparametric MRI (mpMRI) were included. RESULTS: PET/MRI showed 100% sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy in detecting seminal vesicle (SV) and rectal invasion, versus 87.5%, 100%, 100% 93.8%, 95.7% and 50%, 100%,100%, 95.5%, and 95.7% for mpMRI respectively. However, PET/MRI had poor SN (40% and 0%) but high SP (94.4% and 100%) in detection of UB and neurovascular bundle (NV) invasion compared to 100% SN and SP for mpMRI. PET/MRI demonstrated stronger TNM staging agreement with the gold standard than mpMRI-WBMRI. It demonstrated concordance with T, N, and M stages in 40, 41, and 36 patients (k 0.84, 0.60, and 0.68, respectively) versus 29, 33, and 31 patients (k 0.54, 0.22, and 0.50) with accurate over all staging of 38/46 patients versus 30/46 patients (K 0.52 versus 0.22). CONCLUSION: 18F-PSMA-1007 PET/MRI is a promising imaging modality with high diagnostic accuracy in staging intermediate- and HRPCa; it improves local tumour evaluation and provides precise TNM staging. ADVANCES IN KNOWLEDGE: 18F-PSMA-1007 PET/MRI could have high diagnostic accuracy as shown in the current study for staging HRPCa patients that is crucial for treatment selection. We think that our study will contribute to the body of knowledge and improve the literature surrounding the clinical uses of integrated 18F-PSMA-1007 PET/MRI.

Integrated neuromuscular inhibition technique versus spray and stretch technique in neck pain patients with upper trapezius trigger points: a randomized clinical trial.

OBJECTIVE: This study aimed to investigate the difference between the integrated neuromuscular inhibition technique (INIT) and spray and stretch technique in patients with neck pain and upper trapezius active trigger points. Methods: A convenience sample of 60 patients with neck pain and active trigger points were recruited from physiotherapy students and allocated randomly to three groups INIT plus stretching exercise spray and stretch technique plus stretching exercise, and stretching exercise only. Treatment was three times per week for four weeks. Pain intensity by visual analogue scale (VAS), pain pressure threshold (PPT), neck disability by Arabic neck disability index (ANDI), and muscle amplitude in the form of root mean square (RMS) by electromyography (EMG) were measured at baseline and after four weeks. Results: Between groups analysis; the results revealed statistical significant difference between three groups after four weeks of intervention as p =0.0001. Within the group analysis, post hoc tests reported improvement at all variables in both INIT and spray and stretch technique groups with mean differences 64.5 and 65.1 in VAS, 20 and 18.15 in ANDI, -1.45 and -0.81 in PPT, and 2.47 and 1.88 in muscle amplitude, respectively. But there was no statistically significant difference in stretching only group in all variables except VAS. CONCLUSION: Both INIT and spray and stretch techniques had a clinical and statistical effects on pain, function, PPT, and RMS. According to results, there were statistical significant differences between INIT and spray and stretch groups at post-treatment in all variables except VAS with more favor to INIT group, but there were no clinical differences between INIT and spray and stretch groups.

The prognostic value of bone marrow retention index and bone marrow-to-liver ratio of baseline 18F-FDG PET/CT in diffuse large B-cell lymphoma.

OBJECTIVE: To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase 18F-FDG PET/CT in a series of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. PATIENTS AND METHODS: This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase 18F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed. RESULTS: The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (p < 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (p = 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio [HR] = 4.02, p < 0.001, and HR = 3.23, p < 0.001, respectively) and (HR = 2.83, p = 0.030 and HR = 2.38, p = 0.041, respectively). CONCLUSION: Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients. CLINICAL RELEVANCE STATEMENT: Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. KEY POINTS: • Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients. • High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS). • RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients.

The Role of Dual-Energy CT in Solid Organ Injury.

The liver, spleen, and kidneys are the commonest injured solid organs in blunt and penetrating trauma. The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) is the most widely accepted system for categorizing traumatic injuries. Grading systems allow clear communication of findings between clinical teams and assign a measurable severity of injury, which directly correlates with morbidity and mortality. The 2018 revised AAST OIS emphasizes reliance on CT for accurate grading; in particular regarding vascular injuries. Dual-Energy CT (DECT) has emerged as a promising tool with multiple clinical applications already demonstrated. In this review article, we summarize the basic principles of CT attenuation to refresh the minds of our readers and we scrutinize DECT's technology as opposed to conventional Single-Energy CT (SECT). This is followed by outlining the benefits of various DECT postprocessing techniques, which authors of this article refer to as the 3Ms (Mapping of Iodine, Material decomposition, and Monoenergetic virtual imaging), in aiding radiologists to confidently assign an OIS as well as problem solve complex injury patterns. In addition, a thorough discussion of changes to the revised AAST OIS focusing on definitions of key terms used in reporting injuries is described.

Challenges in the Head and Neck Department in the Diagnosis and Surgical Treatment of Patients Presenting to a Single Tertiary Hospital of Somalia With Extreme War Injuries.

In this study, the authors aimed to share their experience with 46 patients who were wounded due to terrorism and war in Somalia. The authors also evaluated the etiological diversity of terror-related and war-related injuries. The study included 46 patients treated at the 150-bed Turkey-Somalia Tertiary Hospital between 2019 and 2021. The authors reviewed medical records including data regarding age, sex, trauma etiology, and type of fracture and trauma. For all patients, surgical technique and plate and screw applications were recorded. The authors also assessed complications and outcomes for the patients. The study included 5 women (10.9%) and 41 men (89.1%). The mean age was 30.36 years. It was found that 2 patients (4.35%) presented to the emergency department with stab injuries, 33 patients with blast injuries from improvised explosive devices (71.73%), and 11 patients with firearm injuries. There were 31 patients with maxillary and mandibular fractures, 17 of which had both maxillary and mandibular fractures. There were 14 patients with maxillary fracture alone, including 3 patients with tripod fracture and 7 patients with inferior and lateral rim fracture. There was a mandibular fracture in 17 patients, including 5 patients with parasymphysis fracture, 7 patients with ramus fracture, and 5 patients with multifocal comminuted fracture. It is a challenging process to treat terror-related injuries in our tertiary hospital in Somalia, where all resources are imported from foreign countries. In such settings, authorities should make protective equipment obligatory to prevent civil and military casualties. Trauma hospitals and experienced trauma surgeons should be available.

Lipid Profile Response to Acupuncture in Obese Patients with Subjective Tinnitus: a Randomized Controlled Trial.

Background: Blood lipid levels have been reported as novel biomarkers for chronic subjective tinnitus (CST), with their levels being higher in patients with CST. Objectives: This trial aimed to determine the change in lipid profile and tinnitus-related quality of life (TR-QoL) responses to 8-week acupuncture treatment in patients with CST. Methods: Sixty obese patients with CST were randomly assigned to group A (treatment group; n = 30; mean age = 44.10 ± 3.69 years) or group B (sham group; n = 30; mean age = 45.53 ± 3.62 years). Patients in group A (n = 30) received manual stimulation at the TE3, TE5, TE17, TE18, TE19, TE20, TE21, TE22, GB2, GB8, GB20, LI4, LI11, KI3, SP6, ST36, CV4, CV9, and CV12 acupoints through in-site acupuncture needles thrice weekly. Furthermore, the bilateral abdominal ST25 and GB28 acupoints were electrically stimulated through in-site acupuncture needles. Group B (n = 30) received the same acupuncture protocol as group A but the insertion of needles was a sham insertion. Anthropometrics such as body mass index (BMI) and waist circumference (WC), TR-QoL (assessed via tinnitus handicap inventory), blood lipid levels such as high-density lipoprotein (HDLs), low-density lipoprotein (LDLs), cholesterol (C), and triglycerides (TGs), and the visual analogue scale (VAS) score for tinnitus severity, were assessed prospectively. Results: Only group A showed significant within-group improvements. Except for HDLs, BMI, and WC, unpaired between-group comparisons showed significantly greater improvements in other outcome measures of all patients with tinnitus (TR-QoL, LDLs, TGs, C, and VAS) in group A than in group B. Conclusion: Safe acupuncture treatment not only improves anthropometrics and TR-QoL, but also helps resolve hyperlipidemia and reduces the severity of tinnitus in obese patients with CST.

Efficient Approach for Anomaly Detection in IoT Using System Calls.

The Internet of Things (IoT) has shown rapid growth and wide adoption in recent years. However, IoT devices are not designed to address modern security challenges. The weak security of these devices has been exploited by malicious actors and has led to several serious cyber-attacks. In this context, anomaly detection approaches are considered very effective owing to their ability to detect existing and novel attacks while requiring data only from normal execution. Because of the limited resources of IoT devices, conventional security solutions are not feasible. This emphasizes the need to develop new approaches that are specifically tailored to IoT devices. In this study, we propose a host-based anomaly detection approach that uses system call data and a Markov chain to represent normal behavior. This approach addresses the challenges that existing approaches face in this area, mainly the segmentation of the syscall trace into suitable smaller units and the use of a fixed threshold to differentiate between normal and malicious syscall sequences. Our proposed approach provides a mechanism for segmenting syscall traces into the program's execution paths and dynamically determines the threshold for anomaly detection. The proposed approach was evaluated against various attacks using two well-known public datasets provided by the University of New South Mexico (UNM) and one custom dataset (PiData) developed in the laboratory. We also compared the performance and characteristics of our proposed approach with those of recently published related work. The proposed approach has a very low false positive rate (0.86%), high accuracy (100%), and a high F1 score (100%) that is, a combined performance measure of precision and recall.

Dual Energy Computed Tomography Collagen Material Decomposition for Detection of Lumbar Spine Disc Extrusion and Sequestration: A Comparative Study With Greyscale Computed Tomography.

Purpose: To assess value of dual energy computed tomography (DECT) collagen material decomposition algorithm when combined with standard computed tomography (CT) in detection of lumbar disc extrusion and sequestration. Materials and Methods: Retrospective analysis of all patients with acute low back pain who had a diagnosis of lumbar spine disc extrusion and/or sequestration on Magnetic Resonance Imaging (MRI) (reference standard), and had undergone non-contrast DECT of the lumbar spine within 60 days of the MRI. Age and sex-matched control patients (n = 42) were included. Patients were grouped into standard, grey-scale CT only group and standard CT + DECT tendon images group. Two double-blinded radiologists reviewed both groups for presence of extrusion or sequestration. They also rated their diagnostic confidence on Likert 5-point scale. McNemar Chi-square test was used to compare diagnostic accuracy, unpaired t-test to compare reviewers diagnostic confidence, and Cohen's k (kappa) test for interobserver agreement. Results: The combined group showed higher overall sensitivity (96.6% vs 87.2%), specificity (99% vs 95.4%), and diagnostic accuracy (98.7% vs 94.5%) with a lower false positive rate (1.1% vs 4.6%). McNemar Chi-square test confirmed statistical significance (P = .03 and P = .02 for Reviewers R1 and R2, respectively). The mean diagnostic confidence was also significantly higher on combined group (R1: 3.74 ± 1.1 vs 3.47 ± 1.15 (P < .01) and R2: 3.91 ± 1.15 vs 3.72 ± 1.16 [mean ± SD] (P = .02)). Conclusion: Utilizing MRI as a reference standard, DECT tendon application combined with standard CT increases the sensitivity, specificity, and accuracy of detection of lumbar spine disc extrusion and sequestration, when compared to standard CT alone.

COVID-19 and Diabetes: will Novel Drugs for Diabetes Help in COVID-19?

COVID-19 is caused by the SARS-CoV-2 virus, which has afflicted more than 245.37 million individuals worldwide and resulted in more than 4.9 million deaths as of today, with a mortality rate of 2.1%. Diabetes mellitus (DM) and its secondary complications are the major serious global health concerns today due to its growth rate, and it is the fastest-growing non-communicable disease. According to International Diabetes Federation (IDF) data, one out of 11 adults is diabetic, and the projection says that the figure will reach 642 million by 2040 globally. The occurrence of DM and its secondary complications is also associated with the severity of COVID-19 and high mortality. People with DM have a weakened immune system owing to innate immunity defects affecting phagocytosis, neutrophil chemotaxis, and cellmediated immunity; however, the high prevalence of diabetes in serious cases of COVID-19 may reflect the higher prevalence of type 2 DM (T2DM) in older people. Moreover, DM is linked to cardiovascular illness in older people, which could underlie the correlation between COVID-19 and fatal outcomes. SARS-CoV-2 infects via the angiotensin-converting enzyme 2 (ACE2), which is found in pancreatic islets, and infection with SARS-CoV-1 has been linked to hyperglycemia in individuals who do not have DM. And hence diabetic patients need to take more precautions and maintain their blood glucose levels. Many pieces of research say that COVID-19 and DM, especially its secondary complications are interlinked. But it also needs more elaborative evidence on whether the anti-diabetic drugs can manage only blood glucose or SARS-CoV-2.

Effect of Benson's relaxation therapy alone or combined with aerobic exercise on cortisol, sleeping quality, estrogen, and severity of dyspeptic symptoms in perimenopausal women with functional dyspepsia.

OBJECTIVE: Besides repeated stress exposure, a sedentary lifestyle and low estrogen levels are risk factors for the development of functional dyspepsia (FD). The aim of this study was to find out the effect of adding aerobic exercise (5 sessions per week) to the daily application of a 40-minute Benson's relaxation therapy (BRT) (diaphragmatic breathing and progressive muscle relaxation applied for 20 minutes in the morning and evening) on Glasgow dyspepsia severity score (GDSS), cortisol, visual analogue scale (VAS) (for abdominal symptoms), estradiol (one of the endogenous estrogens), Pittsburgh sleep quality index (PSQI), and 42-item depression, anxiety, and stress scales (DASS-42) in 60 perimenopausal women with FD. PATIENTS AND METHODS: Women who consumed a daily dose of pantoprazole (40 mg tablet administered as a proton pump inhibitor drug) were randomly assigned to an 8-week study group (this group received aerobic exercise plus BRT, N=30) or an 8-week control group (this group received BRT only, N=30). RESULTS: Significant improvements were reported in all measured variables within women groups (except estradiol of the control group). Compared to the control group, the reported within-group significant improvements in GDSS, cortisol, VAS, PSQI, and DASS-42 were higher in the study group. CONCLUSIONS: Significant improvements in GDSS, cortisol, VAS, PSQI, and DASS-42 could be achieved after adding adjunctive therapies - aerobic exercise and BRT - to the medications of FD in perimenopausal women. Compared to BRT alone, physical exercise plus BRT significantly increases the levels of estradiol in perimenopausal women with FD.

The utility of technetium-99m pertechnetate thyroid scintigraphy assessing thyroid/salivary ratio as an alternative to thyroid uptake percentage in evaluation of thyroid function, with establishing normal reference values of both parameters: single Egyptian center study.

BACKGROUND/OBJECTIVE: Management of thyroid disorders depends on accurate clinical assessment, appropriate investigations and radionuclide imaging, which plays an established important role either qualitatively or quantitatively. The aim of this study was to assess the utility of the thyroid/salivary ratio (TSR) as an alternative to technetium-99m (Tc99m) pertechnetate thyroid uptake (TcU) percentage in the evaluation of thyroid function and in the same time to establish reference range for the thyroid uptake of Tc99m-pertechnetate and TSR among Egyptian populations. PATIENTS AND METHODS: This retrospective study enrolled 270 patients, out of which 250 with different thyroid disorders and 20 without thyroid diseases, as a control group who all underwent full clinical examination, thyroid function tests and Tc99m pertechnetate thyroid scintigraphy. The TcU percentage and TSR were calculated and then correlated to the thyroid hormonal profile. RESULTS: The normal reference ranges of TcU and TSR were 0.75-3.5% and 1.25-4.8%, respectively. The sensitivity and specificity of TSR to diagnose hyperthyroidism were slightly lower compared with TcU (84.5 and 92.3% vs. 86.2 and 98.3%, respectively) at TSR cutoff value of more than 4.8 and TcU cutoff value of more than 3.5. Meanwhile, they had comparable sensitivity and specificity to diagnose hypothyroidism (86.0 and 93.3% vs. 86.5 and 94.5%) at cutoff values <0.75 and <1.25, respectively. CONCLUSION: The current study established a reference range for TcU and TSR in our institution. TSR is comparable to TcU in the evaluation of thyroid function among hyper-and hypothyroid patients and TSR can be used in doubtful cases of mal-thyroid function for confirmation of the diagnosis.

Successful surgical management of a giant neck teratoma in a newborn Baby: A case report.

Neck tumors in newborns are very rare. Teratomas usually include all three germ cell layers, as well as tissues that are not native to the anatomic site of genesis. Teratomas of the head and neck make up a smaller percentage of congenital teratomas. Because of the external compression that oropharyngeal or neck masses produce, they can cause serious airway obstruction. In addition, the larynx or trachea may have an underlying lesion. We presented a mature, 1-day-old newborn with an isolated giant neck tumor and difficulty breathing. The intubation was successfully done and the entire mass was completely removed. Early neonatal life is explored to emphasize this challenge briefly with several interesting instances, including prenatal diagnosis, therapeutic alternatives, and ex-utero intrapartum therapy (EXIT) techniques.

Selective Spectrofluorimetric Approach for the Assessment of Two Antipsychotic Drugs through Derivatization with O-Phthalaldehyde.

A facile and sensible spectrofluorimetric approach for the measurement of two antipsychotic medications, aripiperazole (ARP) and clozapine (CLZ), was devised and validated. The approach involves reacting the examined medicines with o-phthalaldehyde in the presence of ß-mercaptoethanol in a borate buffer of pH 9.0 and pH 10 for ARP and CLZ, respectively, to produce a robustly fluorescent compound that is detected at 450 nm following excitation at 340 nm. The experimental variables influencing the performance and product stability were thoroughly investigated and optimized. Under optimal conditions, the intensity of the fluorescence was linear during a concentration range of 0.1-0.5 µg/mL, with a limit of detection (0.0391 and 0.0400 µg/mL) and limit of quantitation (0.1035 and 0.1332 µg/mL), respectively, for ARP and CLZ. The suggested approach was successful in analyzing commercialized tablets. A statistical investigation of the results produced by the suggested and standard methods showed no remarkable variation in the precision and accuracy of the two approaches. A chemical mechanism using o-phthalaldehyde was proposed.

Multi-Mobile Agent Trust Framework for Mitigating Internal Attacks and Augmenting RPL Security.

Recently, the Internet of Things (IoT) has emerged as an important way to connect diverse physical devices to the internet. The IoT paves the way for a slew of new cutting-edge applications. Despite the prospective benefits and many security solutions offered in the literature, the security of IoT networks remains a critical concern, considering the massive amount of data generated and transmitted. The resource-constrained, mobile, and heterogeneous nature of the IoT makes it increasingly challenging to preserve security in routing protocols, such as the routing protocol for low-power and lossy networks (RPL). RPL does not offer good protection against routing attacks, such as rank, Sybil, and sinkhole attacks. Therefore, to augment the security of RPL, this article proposes the energy-efficient multi-mobile agent-based trust framework for RPL (MMTM-RPL). The goal of MMTM-RPL is to mitigate internal attacks in IoT-based wireless sensor networks using fog layer capabilities. MMTM-RPL mitigates rank, Sybil, and sinkhole attacks while minimizing energy and message overheads by 25-30% due to the use of mobile agents and dynamic itineraries. MMTM-RPL enhances the security of RPL and improves network lifetime (by 25-30% or more) and the detection rate (by 10% or more) compared to state-of-the-art approaches, namely, DCTM-RPL, RBAM-IoT, RPL-MRC, and DSH-RPL.