Ultrasound-guided injection and aspiration of small joints: techniques, pearls, and pitfalls.

Ultrasound (US)-guided musculoskeletal intervention of small joints or joints other than the shoulder, elbow, hip, knee, and ankle can be technically challenging. Small joints produce a narrower landing zone for the needle and a smaller target that may be made even more inaccessible by bulky osteophytes. Sonographic (US) guidance offers important advantages including near-field visualization of the joint and soft tissues, ease of access, portability, ability to compare with the contralateral side, and lack of ionization radiation. This review article focuses on the performance of US-guided injections and aspirations involving small joints (joint capacity < 2 mL and/or typically evaluated or injected with a compact linear transducer). For each joint (temporomandibular, acromioclavicular, sternoclavicular, distal radioulnar, symphysis pubis, and joints of the digits of the hands and feet), a brief overview of the relevant anatomy, indications, procedural description, pearls and pitfalls will be highlighted. This article demonstrates the various approaches to diagnostic or therapeutic injection and aspiration of small joints with the aid of US images, cines and graphic illustrations, emphasizing joint positioning, anatomic landmarks, and needle trajectory for a safe and efficacious procedure. A brief review of available literature for each joint will also be provided.

Dorsal Wrist Carpal Boss Impingement-Dynamic Ultrasound to the Rescue!

The "carpal boss" is a variant present in 19% of the population according to cadaveric studies but becomes symptomatic in only 1% of cases. With the rising popularity of "yoga," which includes prolonged hyperextension at the wrist joint with weight bearing, an increasing number of individuals with silent carpal boss present with dorsal wrist pain due to impingement over the dorsal soft tissues by this innocuous bony protuberance. This warrants the attention of radiologists and clinicians while dealing with wrist pain. It can be challenging to identify this bossing on routine radiographs, necessitating special views. We describe the use of dynamic ultrasound in diagnosing "symptomatic" carpal boss, the effects of which become even more evident on imaging during hyperextension-the triggering movement.

An Insight into Multisystem Inflammatory Syndrome in Adults Associated with Recent SARS-COV-2 Infection: A Case Series.

IMPORTANCE: Multisystem inflammatory syndrome-adults (MIS-A) occur in the postacute coronavirus disease 2019 (COVID-19) period with a diverse clinical presentation. A high index of suspicion, early recognition, diagnosis, and treatment of MIS-A might alleviate COVID-19-related morbidity and mortality. OBJECTIVE: To report seven cases of MIS-A with evidence of recent COVID-19 infection. This is a case series-based study and presents bona fide experiences in terms of main findings and treatment options. MATERIALS AND METHODS: It is a retrospective observational study. We retrospectively collected data on all patients who were diagnosed and treated for MIS-A during the period after the second wave of COVID-19 in India, that is, from June 2021 to November 2021and who were hospitalized in the author's unit. All patients fulfilled the morbidity and mortality weekly report (MMWR) criteria for multisystem inflammatory syndrome in adults. The presenting symptoms, clinical and laboratory parameters, management, and outcome of these seen cases are discussed in this case series-based review.. RESULTS: Data from seven patients were analyzed. Six of them were male, and one patient was female. The median age was 65 years. Four patients had a history of vaccination for COVID-19, three had a history of COVID-19 symptomatic infection in the past, and one patient had contact with COVID-19 in the previous 12 weeks. None of them tested positive for COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) test, and all had positive COVID-19 serology. The commonest extrapulmonary organ involved were the cardiovascular and renal systems, followed by the gastrointestinal and central nervous systems (CNS). All had evidence of hyperinflammation. Intravenous immunoglobulin (IVIg) was used in four patients, and steroids were used in all seven patients. The median length of stay (LOS) was 11 days. One patient succumbed to multiorgan failure. CONCLUSIONS: Multisystem inflammatory syndrome (MIS) can affect children (MIS-C) as well as adults (MIS-A). MIS-A is a serious, life-threatening, hyperinflammatory febrile syndrome associated with recent COVID-19 infection and involves multiple organs like the heart, lungs, kidneys, brain, gastrointestinal organs, skin, eyes etc. Clinical suspicion and testing for evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are needed to identify and treat adults suspected to have MIS-A. This case series demonstrates that even the elderly population can be affected and that administration of IVIg and steroids are effective options in management in addition to the usual "standard of care" treatment. Early recognition and prompt treatment of MIS-A could improve clinical outcomes and reduce the mortality rate.

A Review of Materials and Medications with Religious or Dietary Significance in the Interventional Radiology Suite.

A holistic approach to patient-centered care should include cultural and religious considerations. Certain cultural groups have beliefs that may restrict the use of particular animal-derived products and chemicals. A working knowledge of ingredients commonly used in the interventional suite with religious and cultural connotations may be helpful. This review article highlights medications and medical devices with cultural or religiously sensitive ingredients used in interventional radiology departments and provides a framework for addressing this common scenario.

Carbon nanosheets to unravel the production of bioactive compounds from microalgae: A robust approach in drug discovery.

The conglomeration of active pharmaceutical ingredients (APIs) has influenced the development of life-saving drugs. These APIs are customarily synthetic products, albeit with adverse side effects. Thus, to overcome the bottlenecks associated with synthetically derived APIs, the approach of photocatalytically obtaining bioactive compounds from natural ingredients has emerged. Amid the pool of photoactive nanomaterials, this short review emphasizes the intelligent strategy of exploiting photoactive carbon nanosheets to photocatalytically derive bioactive compounds from natural algal biomass to treat many acute or chronic medical conditions. Carbon nanosheets result in phototrophic harvesting of bioactive compounds from microalgae as a result of their being an effective biocatalyst that increases the rate of photosynthesis. To understand the clinical translation of bioactive compounds, the pharmacodynamics of algal bioactive compounds are highlighted to determine the practicality and feasibility of using this green approach for pharmaceutical drug discovery.

It Is Not Only the Meniscus That Flips-A Case of TFCC Tear with a Flipped Fragment in the Distal Radioulnar Joint.

Acute wrist injuries with ongoing ulnar-sided wrist pain warrant a magnetic resonance imaging (MRI) to diagnose ligamentous injuries. Triangular fibrocartilage complex (TFCC) tears have been classified and described in the literature but complex tear patterns have limited representation. Bucket-handle tears of the TFCC represent only 0.5% of TFCC tears and have recently been identified, posing a diagnostic and management challenge. Preoperative diagnosis is possible with MRI and necessary for optimal and early surgical management. The authors describe a unique case of a flipped tear of the central disc of the TFCC, where the fragment was flipped into the distal radioulnar joint, a site hidden during routine arthroscopy.

Ultrasound-guided cutaneous nerve chemo-ablation for severe access site neuropathic pain-A case report.

Neuropathic pain at the cannulation site is challenging, both for the patient and the dialysis team. We present a case of a middle-aged man on chronic hemodialysis, who developed excruciating pain at the cannulation area without incident, limiting his dialysis sessions. Multidisciplinary collaboration allowed identification of the cutaneous nerve-the inferior lateral cutaneous nerve of the arm, relaying his pain. Subsequent ultrasound-guided phenol chemoablation resulted in the complete resolution of his pain and allowed continued use of the well-functioning fistula for dialysis.

CT-guided scapulothoracic bursal injection-technical considerations in planning needle trajectory and confirming bursal distribution.

OBJECTIVE: To describe a technique of targeted CT-guided scapulothoracic bursal injections in an illustrated and step-wise manner. MATERIALS AND METHODS: This technical report describes the authors' experience in using CT guidance for targeted scapulothoracic bursal injections in 8 patients with suspected scapulothoracic bursitis over an 18-month period. RESULTS: The outcome of the image-guided injection was retrospectively assessed in 8 patients. None of the patients had any complications related to the procedure. Symptomatic improvement was achieved in 62.5% of the patients while 25% of patients did not report any benefit from the injection. CONCLUSION: In providing a record of needle tip position and contrast distribution, CT-guided scapulothoracic bursal injections provide an objective record of the procedure, which may assist in further treatment planning.

An Unusual Presentation of a Completely Transected Aorta Presenting As Acute Limb Ischemia With Intramural Thrombus.

Contrast-enhanced multidetector computed tomography is currently the preferred imaging modality to diagnose acute traumatic aortic injury (ATAI). Rarely, ATAI can present with atypical findings that make the diagnosis and further management exceptionally challenging. Furthermore, ATAI can also be associated with inferior vena cava injury showing only indirect signs on later imaging. We present an unusual case of traumatic aortic disruption mimicking acute limb ischemia.

Carbon Quantum Dots for Stem Cell Imaging and Deciding the Fate of Stem Cell Differentiation.

Nanotechnology advancements and applications have paved the way for new possibilities in regenerative medicine and tissue engineering. It is a relatively new field that has the potential to improve stem cell differentiation and therapy greatly. Numerous studies have demonstrated that nanomaterials can function as a physiological niche for the formation and differentiation of stem cells. However, quantum dots (QDs), such as carbon quantum dots (CQDs) and graphene quantum dots (GQDs), have shown considerable promise in the field of regenerative medicine. To date, most research has focused on stem cell tracking and imaging using CQDs. However, their interaction with stem cells and the associated possibility for differentiation by selectively focusing chemical signals to a particular lineage has received scant attention. In this mini-review, we attempt to categorize a few pathways linked with the role of CQDs in stem cell differentiation.

Hydrogel nanosheets confined 2D rhombic ice: a new platform enhancing chondrogenesis.

Nanoconfinement within flexible interfaces is a key step towards exploiting confinement effects in several biological and technological systems wherein flexible 2D materials are frequently utilized but are arduous to prepare. Hitherto unreported, the synthesis of 2D hydrogel nanosheets (HNSs) using a template- and catalyst-free process is developed representing a fertile ground for fundamental structure-property investigations. In due course of time, nucleating folds propagating along the edges trigger co-operative deformations of HNS generating regions of nanoconfinement within trapped water islands. These severely constricting surfaces force water molecules to pack within the nanoscale regime of HNS almost parallel to the surface bringing about phase transition into puckered rhombic ice with AA and AB Bernal stacking pattern, which was mostly restricted to molecular dynamics studies so far. Interestingly, under high lateral pressure and spatial inhomogeneity within nanoscale confinement, bilayer rhombic ice structures were formed with an in-plane lattice spacing of 0.31 nm. In this work, a systematic exploration of rhombic ice formation within HNS has been delineated using high-resolution transmission electron microscopy, and its ultrathin morphology was examined using atomic force microscopy. Scanning electron microscopy images revealed high porosity while mechanical testing presented young's modulus of 155 kPa with ∼84% deformation, whereas contact angle suggested high hydrophilicity. The combinations of nanosheets, porosity, nanoconfinement, hydrophilicity, and mechanical strength, motivated us to explore their application as a scaffold for cartilage regeneration, by inducing chondrogenesis of human Wharton Jelly derived mesenchymal stem cells. HNS promoted the formation of cell aggregates giving higher number of spheroid formation and a marked expression of chondrogenic markers (ColI, ColII, ColX, ACAN and S-100), thereby providing some cues for guiding chondrogenic differentiation.

Exploring the Role of Carbon-Based Nanomaterials in Microalgae for the Sustainable Production of Bioactive Compounds and Beyond.

An enchanting yet challenging task is the development of higher productivity in plants to meet the ample food demands for the growing global population while harmonizing the ecosystem using front-line technologies. This has kindled the practice of green microalgae cultivation as a driver of key biostimulant products, targeting agronomic needs. To this end, a prodigious and economical strategy for producing bioactive compounds (sources of secondary metabolites) from microalgae using carbon-based nanomaterials (CNMs) as a platform can circumvent these hurdles. Recently, the nanobionics approach of incorporating CNMs with living systems has emerged as a promising technique to develop organelles with new and augmented functions. Herein, we discuss the importance of 2D carbon nanosheets (CNS) as an alternative carbon source for the phototrophic cultivation of microalgae. CNS not only aids in cost reduction for algal cultivation but also confers combinatorial innate or exogenous functions that enhance its programmed biosynthetic metabolism, proliferation, or tolerance to stress. Moreover, the inherent ability of CNS to act as efficient biocatalysts can enhance the rate of photosynthesis. The primary focus of this mini-review is the development of an economic route for enhanced yield of bioactive compounds while simultaneously serving as a heterogeneous platform for enhancing the sustainable production of biostimulants including bioactive compounds from algal biomass for pharmaceutical and nutraceutical applications.

Bony Cyst in a Ground Glass Matrix: A Rare Case Report of Craniofacial Fibrous Dysplasia with Secondary Aneurysmal Bone Cyst.

Fibrous dysplasia has various ways of presentation including syndromic associations and secondary changes within the lesion. We present a case of a 21-year-old female with craniofacial fibrous dysplasia, presenting with proptosis and intermittent blurring of vision due to focal fibrous dysplasia involving the frontal bone with secondary aneurysmal bone formation that was provisionally diagnosed on imaging and confirmed on histopathology. This case demonstrates the typical imaging findings of fibrous dysplasia with seldom encountered secondary aneurysmal bone cyst formation and also discusses about the pathology and management of the craniofacial fibrous dysplasia.

Molar Tooth in the Knee - A Case of Simultaneous Medial and Lateral Bucket Handle Tear with Arthroscopic Correlation and a Review of Literature.

Introduction: Simultaneous bucket handle tear of both lateral and medial menisci is a rarely encountered entity. MR imaging helps in pre-operative diagnosis for optimal operative planning. However, as this condition is not seen in routine practice, awareness of various imaging signs is essential to identify this condition. Few signs on coronal and sagittal images have been described in the literature but none so far on axial images. Case Presentation: We propose a novel "molar tooth sign" in the knee on axial MRI images, in which we identified in the case of a young male with recurrent knee locking after a fall from height. Conclusion: Different modes of injury can lead to different patterns of meniscal and ligament tears. Having an allied sign which is, furthermore, easy to imagine will help, not only the radiologists but also the surgeons, to identify rare types of meniscal tears similar to the index case.

Graphene quantum dot-porphyrin/phthalocyanine multifunctional hybrid systems: from interfacial dialogue to application.

Engineered well-ordered hybrid nanomaterials are symbolically at a pivotal point, just ahead of the long-anticipated transformation of the human race. Incorporating newer carbon nanomaterials like graphene quantum dots (GQDs) with tetrapyrrolic porphyrins (Pp) and phthalocyanines (Pc) is crucial for achieving exquisite molecular nanoarchitectures that are superior to their individual components. The outcomes of this, particularly in the case of graphene quantum dot-porphyrin/phthalocyanine (GQD-Pp/Pc) hybrids, remain comprehensively unexplored to date. Interestingly, GQD-Pp/Pc hybrids provide a modern strategy to regulate matter by utilising intramolecular and organisational properties to create well-defined nanocomposites via a synergistic enhancement effect. The high molar absorption coefficient and enhanced energy transfer, hole and electron transfer abilities capabilities allow Pp and Pc to exhibit a wide spectrum of photophysical and photochemical features. However, their low biostability, non-specific tumor-targeting properties, hydrophobicity, and low cellular internalisation efficiency limit their extensive biomedical utility. Conjugating Pp/Pc to nanocarriers such as GQDs improves their targeted delivery, immunological tolerance, and longevity. Due to the zero-order release kinetics of GQDs, they can assist in maintaining a steady rate of photosensitiser (PS) delivery at the desired site. To completely rationalise the functionalization of GQD-Pp/Pc species at interfaces, we investigate the current prominence and future potential of porphyrin-related graphene nanosystems, especially GQDs, for the development of various applications. This encouraging report demonstrates how GQD-Pp/Pc species can be used to examine new phenomena at the multidisciplinary level. Notably, a customised hybrid system optimises amendable and diverse functional properties, yielding a ray of hope in the fields of photodynamic therapy (PDT), photocatalysis, solar cells, sensing, and beyond via various photo-physicochemical approaches such as electron transfer, catalytic transformation, light-harvesting, and axial/peripheral ligation of adducts. Gratifyingly, the covalent and non-covalent coupling of functional molecular units at interfaces enable new properties to be generated in hybrid systems.

Exotic Hydrogel Matrix as an Efficient Platform for Sustainable Production of Biomass and Lipid from Chlorella sorokiniana.

Concerning the climate crisis, energy disaster, and greenhouse effects, microalgae have paved the way for consideration as a biofuel feed material. The advent of polymeric materials with unique architecture at nanoscale, in combination with microalgae, has given direction for the bioeconomic yield of highly valued compounds, essentially lipid. Herein, we discuss the paramount significance of exotic hydrogel matrix (HM) with efficient violet light absorption, far-red emission, CO2-adsorbing capability and catalyst-free condition that could increase the photosynthesis activity, alleviating the microalgal growth for the effective augmentation of lipid, protein, and chlorophyll. The intrinsic morphological and structural features of HM were revealed by a suite of characterizations that confirm its hollow tubular architecture. Fluorescence intensity measurement confirmed the electron transfer from HM to Chlorella sorokiniana, accelerating the photosynthetic rate for the improved production of lipids (98%), proteins (60%), and chlorophyll a (121%), compared to untreated C. sorokiniana control cells. Moreover, by visualizing the Nile red (NR) fluorescence response from C. sorokiniana/HM cells, a high lipid content was observed with a larger cell size (14.6 µm) compared to control cells (8.7 µm). Fatty acid methyl esters (FAMEs), obtained from C. sorokiniana/HM, were noted with a large-scale volume of C16:C18 fatty acids (>80%). We, therefore, envisage that HM plays a significant role in enhancing the generation of lipids and proteins from C. sorokiniana. These outcomes assure a qualitative transit in the bioenergy domain.

Tuberculosis of the gallbladder-another one of its many faces.

Abdominal tuberculosis is not uncommon in developing countries which usually presents as involvement of ileo-caecal junction. Involvement of gall bladder by tuberculosis is rare and thus, imaging diagnosis is unlikely. The diagnosis is confirmed only on histopathology. We present a case of a middle-aged Indian female with tuberculosis of gall bladder who was diagnosed after image guided biopsy and was managed with anti-tubercular treatment.