Blast Lung Injury in Children: Injury Patterns and Associated Organ Injuries.

BACKGROUND: Bombings are the most common cause of civilian deaths in wars, and unfortunately, a large proportion of civilian victims are children. OBJECTIVE: This study aimed to evaluate the frequency of blast lung injury (BLI), to evaluate lung injury patterns on tomographic images, and to document the relationship between blast lung and mortality in children exposed to the blast effect. METHODS: Thirty-six children (25.3% of pediatric patients brought to our hospital with blast injury) with BLI were included in the study. The pediatric trauma score evaluations made in the emergency department in the first admission were recorded. Lung injury findings in the computed tomography images of the patients were examined, and injuries detected in other systems were recorded. RESULTS: The most common lung injury pattern was contusion (right: 69.4%, left: 80.6%). The incidence of brain damage (52.4%) and intra-abdominal injury (76.2%) in children with low pediatric trauma score value was statistically significantly higher ( P = 0.049, P = 0.017, respectively). There was no statistically significant correlation between the presence of lung injury, injury patterns, and mortality. The incidence of brain damage in deceased patients (61.5%) was statistically significantly higher than the incidence of brain damage in surviving patients (26.1%) ( P = 0.036). Low pediatric trauma score was observed in 11 (84.6%) of the deceased children and in 10 (43.5%) of the survivors ( P = 0.016). The mean age of children with hemothorax in the right lung was statistically significantly lower than those without ( P = 0.014). CONCLUSION: Our findings revealed that pediatric BLI is common after a blast, that it is associated with other system injuries, and that a multimodal radiological approach is required in child victims.

Secondary blast injury: radiological characteristics of shrapnel injuries in children.

PURPOSE: The aim of this study is to examine the radiological images of child victims suffering from secondary blast injuries, to reveal organ-based injury patterns and their interrelationships, and to record mortality rates that may develop due to injured systems. METHODS: A total of 65 patients with secondary blast injury due to bomb explosion were included in the study. Injury findings due to shrapnel in radiologic images of the patients were examined. Injured systems and types of injuries were recorded. RESULTS: The most common injuries were intra-abdominal injuries (63%) and fractures (58.5%). Lung injury was observed in 4 (9.8%) of 41 patients with intra-abdominal injury, while 37 (90.2%) did not, and this was statistically significant (p = 0.003). The most common intra-abdominal organ injury was a small bowel injury in 23 (35.4%) patients. The coexistence of small bowel injury and large bowel injury was present in 8 patients (34.8%), and it was statistically significant (p = 0.019). A total of 14 (21.5%) of the patients died. There was no significant relationship between mortality and gender (p = 319). Brain damage was present in 10 (71.4%) of the 14 (21.5%) patients who died, which was statistically significant (p < 0.001). CONCLUSION: Our results showed that the most common injuries were intra-abdominal injuries, damage to different organs could occur at the same time, and deaths were especially associated with brain injuries. For this reason, it should not be forgotten that CT scans will have an important place in the triage of the patient, especially in victims with shrapnel at the abdominal and cranial levels in radiography examinations.

Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study.

RATIONALE AND OBJECTIVES: To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission. MATERIALS AND METHODS: For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density. RESULTS: Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001. CONCLUSION: in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.

Our clinical experience in pelvic magnetic resonance imaging with vaginal contrast.

OBJECTIVES: Magnetic resonance imaging (MRI) is an important modality for pelvic imaging. Vaginal distension is provided by the use of vaginal contrast in pelvic MRI, and it plays an important role in staging especially cervical and vaginal cancer. The aim of this study is to show whether the use of vaginal contrast material contributes to the diagnosis in pelvic examination. MATERIAL AND METHODS: Between October 1, 2016 and December 30, 2020, a total of 57 patients who underwent pelvic magnetic resonance imaging with vaginal contrast in the radiology clinic were included in the study and evaluated retrospectively. RESULTS: Cervical cancer was detected in 38 of the 57 patients included in the study, and when the vaginal pre- and post-contrast staging of the patients was performed, the pre-contrast stage was found to be high in six patients (15%). Eight of 38 patients diagnosed with cervical cancer underwent surgery. When the pathological and radiological staging of the patients who underwent surgery were compared, they were 100% compatible. CONCLUSIONS: The use of vaginal contrast material increases the diagnostic value of MRI in various pelvic pathologies, especially in cervical cancer staging.

COVID-19-Related Lung Involvement at Different Time Intervals: Evaluation of Computed Tomography Images With Semiquantitative Scoring System and COVID-19 Reporting and Data System Scoring.

INTRODUCTION: This study aimed to evaluate the frequency of typical and atypical thoracic CT findings in patient groups diagnosed during different periods of the pandemic, examine disease severity using radiological scoring methods, and determine the relationship between atypical CT findings and disease severity. MATERIALS AND METHODS: One hundred fifty-one patients with positive reverse transcription polymerase chain reaction (RT-PCR) test and thoracic CT scan were included in the study. The patients were divided into two groups as group 1 (March to August 2020) diagnosed in the first six months of the pandemic and group 2 (September 2020 to February 2021) diagnosed in the second six months. CT images of the patients were analyzed for the frequency of typical and atypical findings. Evaluation was made in terms of disease suspicion and severity by scoring methods, and the relationship between atypical findings and disease severity was examined. RESULTS: There was no statistically significant difference between the frequency and distribution patterns of typical CT findings observed in both groups. The most common atypical finding in both groups was nodular lesions. Central distribution, one of the atypical findings, was not seen in group 1, whereas it was present in nine patients in group 2 (p=0.001). The mean CT severity score was higher in group 2, and there was a statistically significant difference between the mean CT scores of both groups (p<0.001). In addition, six (7.2%) patients in group 1 and 34 (50%) patients in group 2 had CT scores above the cut-off value (p<0.001). There was no statistically significant relationship between atypical findings and severity score. CONCLUSION: Other diseases and atypical findings that may accompany COVID-19 pneumonia may increase the rate of misdiagnosis. In the diagnosis of the disease, clinical signs and symptoms and radiological findings should be evaluated together, and it should be kept in mind that lung findings in thorax CT change over time.

Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: A single-blind randomized prospective study.

OBJECTIVE: The aim of this study was to compare the efficacy and the safety of ultrasound (US)-guided vs. blind steroid injections in patients with carpal tunnel syndrome (CTS). DESIGN: This prospective randomized single-blind clinical trial included 46 patients with CTS (46 affected median nerves). The subjects were randomized-to either the US-guided or the blind injection group-before they received 40 mg of methylprednisolone. They were evaluated using the Boston Carpal Tunnel Questionnaire symptom/function at baseline and at 6 wks and 12 wks after injection, and the side effects were noted. RESULTS: The symptom severity and functional status scores improved significantly in both groups at 6 wks after treatment, and these improvements persisted at 12 wks after treatment (all P < 0.05). The improvement in symptom severity scores in the US-guided group at 12 wks was higher than in the palpation-guided group (P < 0.05). Average time to symptom relief was shorter in the US-guided group (P < 0.05). There was no significant difference between the two groups in terms of side effects (P > 0.05). CONCLUSIONS: Although both US-guided and blind steroid injections were effective in reducing the symptoms of CTS and improving the function, an earlier onset/better improvement of symptom relief suggests that US-guided steroid injection may be more effective than are blind injections in CTS.

Increased amount of visceral fat in patients with psoriasis contributes to metabolic syndrome.

BACKGROUND: Psoriasis is associated with obesity and metabolic syndrome. Metabolic syndrome is associated with visceral fat accumulation. There is no study on the accumulation of visceral fat in patients with psoriasis. OBJECTIVE: The aim of this study was to compare the visceral fat accumulation in patients with psoriasis and controls. SUBJECTS AND METHODS: 46 patients with psoriasis and 46 sex- and age-matched control patients were included in this study. The abdominal fat area [visceral fat area (VFA), subcutaneous fat area (SFA) and total fat area (TFA)] at the level of the umbilicus was evaluated by computed tomography. RESULTS: The mean VFA value and VFA/SFA ratio of the psoriasis patients were significantly higher compared with the control patients (123.4 +/- 80.3 vs. 81.2 +/- 59.8 cm(2) and 0.734 +/- 0.593 vs. 0.491 +/- 0.336; p = 0.005 and p = 0.017, respectively). Fasting blood sugar levels were also found to be significantly higher in psoriasis patients, compared with the control patients (101.8 +/- 43.5 vs. 83.4 +/- 9.1 mg/dl; p = 0.005). Multiple linear regression analysis indicated that waist-to-hip ratio, age, body weight, the presence of psoriasis and metabolic syndrome were significantly associated with VFA. CONCLUSION: Psoriasis patients had a higher amount of VFA, compared with the control patients.