Role of Intravenous Magnesium in the Management of Moderate to Severe Exacerbation of Asthma: A Literature Review.

Asthma is a respiratory disorder marked by bronchial irritation and hyperresponsive airway smooth muscle. According to new research, magnesium's dual activity as an anti-inflammatory and bronchodilator may be important in asthma therapy. The goal of this study was to see how effective intravenous magnesium sulfate is in treating severe acute asthma. In addition to checking Clinicaltrials.gov, we ran a database search in Scopus, Google Scholar, PubMed, and Embase. Studies were chosen based on predetermined inclusion and exclusion criteria to prevent the chance of bias. Most researchers believed that intravenous magnesium sulfate improved symptoms and lung function significantly. Mortality and morbidity data were not available.

Myxomatous Liposarcoma of the Mediastinum: A Review of the Literature.

Myxomatous liposarcoma is an extremely rare type of mediastinal tumour that manifests in a manner comparable to other lung pathologies. Chest pain, shortness of breath, and dysphagia are the common presenting complaints. Radiological examinations or postoperative histological examinations provide the majority of the diagnostic evidence. The cornerstone of therapy consists of surgery and sometimes chemotherapy. Those who are afflicted have a better chance of experiencing favourable outcomes if they receive a diagnosis and treatment quickly.

Zipline Into a Case of Spontaneous Cerebrospinal Fluid Rhinorrhea.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea is an uncommon phenomenon. One of the complications associated with CSF rhinorrhea is meningitis, which is associated with high mortality. Therefore, the prompt diagnosis of CSF rhinorrhea is essential. We present a case of a patient, who after zip-lining, developed CSF rhinorrhea. She had no history of trauma and none of the conventional comorbidities associated with spontaneous CSF rhinorrhea. She was diagnosed with the help of radiological studies and biochemical tests. Our case is unique as there are no published case reports of spontaneous CSF rhinorrhea occurring after atraumatic zip-lining.

A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting.

The primary aim of this quality improvement initiative was to decrease the use of computerized tomography (CT) in the evaluation of pediatric appendicitis in a community general emergency department (GED) system by 50% (from 32% to 16%) in 1 year. METHODS: Colleagues within a State Emergency Medical Service for Children (EMSC) community of practice formed the quality improvement team, representing multiple stakeholders across 3 independent institutions. The team generated project aims by reviewing baseline practice trends and implemented changes using the Model for Improvement. Ultrasound (US) use and nondiagnostic US rates served as process measures. Transfer and "over-transfer" rates served as balancing measures. Interventions included a GED pediatric appendicitis clinical pathway, US report templates, and case audit and feedback. Statistical process control tracked the main outcomes. Additionally, frontline GED providers shared perceptions of knowledge gains, practice changes, and teamwork. RESULTS: The 12-month baseline revealed a GED CT scan rate of 32%, a US rate of 63%, a nondiagnostic US rate of 77%, a transfer to a children's hospital rate of 23.5%, and an "over-transfer" rate of 0%. Project interventions achieved and sustained the primary aim by decreasing the CT scan rate to 4.5%. Frontline GED providers reported positive perceptions of knowledge gains and standardization of practice. CONCLUSIONS: Engaging regional colleagues in a pediatric-specific quality improvement initiative significantly decreased CT scan use in children cared for in a community GED system. The emphasis on the community of practice facilitated by Emergency Medical Service for Children may guide future improvement work in the state and beyond.

Pancreatic Tuberculosis: A Diagnostic Dilemma.

Despite the high prevalence of tuberculosis (TB) in developing countries, pancreatic TB remains a rare disease. Pancreatic TB usually presents as fever, night sweats, and abdominal pain in an immunocompromised individual. We present a case of a patient with end-stage renal disease undergoing pre-transplant workup who had an incidental finding of a pancreatic mass and necrotic peri-pancreatic lymph nodes on a CT scan. The patient was diagnosed via endoscopic ultrasound-guided biopsy as pancreatic TB. Anti-TB therapy was started with positive results.

Blind spots on CT imaging of the head: Insights from 5 years of report addenda at a single institution.

BACKGROUND: Errors of detection ("misses") are the major source of error in radiology. There is sparse prior literature describing patterns of detection error on CT head imaging. PURPOSE: The objective of this study was to gain insight to areas on CT head imaging where radiologists are most likely to miss clinically relevant findings. METHODS: We performed a cross-sectional study of consecutive reports of CT imaging of the head at a single institution spanning 5/1/2013-5/1/2018 (5 years). Detection errors described in addenda were categorized according to anatomic location, type of pathology, and potential impact on management. Blind spots were defined by the most common sites of missed findings. RESULTS: A total of 165,943 reports for CT head imaging were obtained. Addenda were found in 1658 (~1%) of reports, of which 359 (21.7%) described errors of detection. Within the extracranial soft tissues (n = 73) the most common "misses" were at incidentally imaged parotid glands and the frontal scalp. Within osseous structures (n = 149), blind spots included the nasal and occipital bones. Vascular lesions (n = 47) which passed detection were most common at the distal MCA, carotid terminus and sigmoid sinus/jugular bulb. No predisposition was seen for anatomic subsites within the CSF space (n = 60) and brain parenchyma (n = 65). CONCLUSIONS: Consistent patterns of blind spots are revealed. Radiologic teaching and search patterns to account for these sites of error may accelerate trainee competence and improve accuracy in the practice of radiology.

Symmetric, bilateral upper and lower extremity lucent lesions in a patient with Gaucher's disease on enzyme replacement therapy.

We report a case of a 6-year old girl with known type 3 Gaucher's Disease on enzyme replacement therapy who developed bilateral, symmetric osteolytic lesions in her humeri and femurs. While this manifestation of Gaucher's disease has been previously documented, it is an exceedingly rare variation. We observe that this patient shares 2 commonalities with 3 other patients reported in the literature to present with this phenotype. First, the patient's L444P/L444P genotype, present in approximately 11% of all Gaucher's patients, was also seen in these other patients. Second, like the other patients, this patient was treated with enzyme replacement therapy. It is unknown whether there is a correlation between these 2 independent variables and this rare phenotype, and further investigation may be warranted.

Radiographic Manifestations of Diffuse Pulmonary Alveolar Derecruitment.

Pulmonary alveolar derecruitment is a process of alveolar collapse that occurs in critically ill patients. While the entity and its physiological manifestations are described in the anesthesiology and critical care literature, the radiographic manifestations of alveolar derecruitment have not yet been thoroughly described. This phenomenon can have a similar appearance to pulmonary edema; however, patients often have severe intravascular volume depletion. As the treatment for these 2 entities is essentially contradictory, it is important to be familiar with alveolar derecruitment and consider it as a differential diagnosis when clinically appropriate.

If You Twinkle When You Tinkle, Stones Are Found on Ultrasound.

Urolithiasis in children is an underrecognized cause of pediatric abdominal pain. Our case describes a child who presented to the emergency department with right lower quadrant pain, in whom a point-of-care ultrasound detected an ureterovesicular stone, which obviated the need for any further radiographic studies. We review the current literature on pediatric urolithiasis with a focus on sonographic diagnosis.

Challenges of pelvic imaging in obese women.

Obesity is a major global health concern affecting all ages, socioeconomic groups, and countries. Although men have higher rates of overweight, women have higher rates of obesity. In the United States, more than 60% of women are overweight or obese, with slightly more than one-third considered frankly obese. Obesity is a major risk factor for noncommunicable diseases such as diabetes mellitus, cardiovascular disease, hypertension, stroke, and specific cancers. Obesity is associated with increased mortality for all cancers, with the highest death rates occurring in the heaviest women. Obesity can contribute to missed diagnoses, nondiagnostic results of imaging studies, imaging examination cancellation because of weight or girth restrictions, scheduling of inappropriate examinations, and increased radiation dose exposure. The utility of the clinical examination is often limited in the obese woman, which results in an even greater reliance on imaging; however, the obese woman may experience a lowered quality of and less access to medical imaging. Recognition of equipment limitations, imaging artifacts, optimization techniques, and appropriateness of modality choices is critical to providing good patient care to this health-challenged group. The clinical indication, the patient's weight, and the body diameters are three key factors to consider when choosing the most appropriate examination. Familiarity with the optimization of imaging techniques across all modalities is important to convert potentially suboptimal examinations into diagnostic-quality studies. The aim of this review is to identify key areas in which obesity affects the imaging care of women with pelvic conditions and to outline strategies to address these areas.

Non-surgical periodontal therapy reduces coronary heart disease risk markers: a randomized controlled trial.

AIM: Periodontal disease elevates systemic inflammatory markers strongly associated with coronary heart disease (CHD) risk. The aim of this randomized controlled trial was to investigate the effect of non-surgical periodontal therapy on systemic C-reactive protein (CRP), fibrinogen and white blood cells in CHD patients. MATERIALS AND METHODS: Angiographically proven CHD patients with periodontitis (n = 317) were randomized to intervention (n = 212) or control group (n = 105). Primary outcome was reduction in serum CRP levels; secondary outcomes were reductions in fibrinogen and white blood cells. Periodontal treatment included scaling, root planing and oral hygiene instructions. Periodontal and systemic parameters were assessed at baseline and at 2-month follow-up. Intent-to-treat (ITT) analysis was performed. RESULTS: Study was completed by 246 subjects (intervention group = 161; control group = 85). Significant improvements in periodontal and systemic parameters were observed in intervention group. The number of subjects with CRP > 3mg/L in intervention group decreased by 38% and in control group increased by 4%. ITT analysis gave a significant (χ(2) =4.381, p = 0.036) absolute risk reduction of 12.5%. CONCLUSION: In CHD patients with periodontitis, non-surgical mechanical periodontal therapy significantly reduced systemic levels of C-reactive protein, fibrinogen and white blood cells.

The educational and career impact of using medical students for triaging off-hour diagnostic imaging requests at a major academic medical center.

OBJECTIVE: The purpose of this article is to evaluate the educational and career impact of using medical students for triaging off-hour diagnostic imaging requests at a major academic medical center. SUBJECTS AND METHODS: A survey of former and current medical students who participated in the Emergency Department Radiology Triage Program at the Yale University School of Medicine was conducted via e-mail. Results were reported using averages or percentages or both. RESULTS: Twenty-six (61.9%) of the 42 participants responded. Seventeen (65.4%) of the 26 respondents pursued an additional degree while in the program. The most important factor for joining was financial, with a mean importance of 4.0 on a scale of 1 (no importance) to 5 (most important). Eleven (42.3%) of the 26 respondents stated that their participation encouraged them to pursue a career in diagnostic radiology. Nine (34.6%) of the 26 respondents stated that the program had major or moderate importance on their specialty choice, whereas 20 of the 26 (76.9%) described the program as being of at least moderate help to their medical career. The most satisfying aspect of the program, on a scale of 1 (extremely dissatisfying) to 5 (extremely satisfying), was interacting with the junior radiology resident (mean rating, 4.5), whereas the least satisfying aspect was the Veterans Affairs triage component (mean rating, 2.9). CONCLUSION: The use of medical students for triaging off-hour diagnostic imaging requests has proven successful from an operational standpoint; it also appears to be favorably viewed concurrently and retrospectively by the growing cohort of students who have participated.

Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis.

BACKGROUND: The aim of this article is to analyze laparoscopic versus open repair of incisional/ventral hernia (IVH). METHODS: A systematic review of the literature was undertaken to analyze clinical trials on IVH. RESULTS: Five randomized controlled trials involving a total of 366 patients were analyzed. There were 183 patients in each group. Open repair of IVH was associated with significantly higher complication rates and longer hospital stays than laparoscopic repair. There was also some evidence that surgical times may be longer for open repair of IVH. However, statistically there was no difference in wound pain or recurrence rates. CONCLUSIONS: Laparoscopic repair of IVH is safe, with fewer complications and shorter hospital stays, and possibly a shorter surgical time. However, postoperative pain and recurrence rates are similar for both techniques. Hence, the laparoscopic approach may be considered for IVH repair if technically feasible, but more trials with longer follow-up evaluations are required to strengthen the evidence.

Infarcted splenule--a case report.

A 38-year-old woman presented with abdominal pain and left shoulder pain. A computed tomography scan was obtained, which demonstrated a rounded soft tissue density with surrounding stranding. It was interpreted as an infarcted splenule. Due to the increasing severity of the patient's symptoms, a laparoscopic exploration was performed. Pathology demonstrated an infarcted splenule. As infarcted splenules are rare, an understanding of its pathogenesis and familiarity with the corresponding imaging findings may be helpful for its diagnosis in the patient with the appropriate clinical scenario. It is important to recognize this entity as a cause of abdominal pain that can be managed nonsurgically.