The Association Between Gonarthrosis Pain Severity and Radiographic Findings on X-Ray: A Cross-Sectional Study.

INTRODUCTION: Knee osteoarthritis (KOA) is a degenerative joint disease that progresses over time due to articular cartilage loss. Orthopedic surgeons use plain radiography (X-ray) with an anteroposterior (AP) standing (weight-bearing) view, which is currently considered the gold standard modality, to diagnose KOA. They base this diagnosis on the clinical history and physical examination of the knee joint. However, many previous studies have reported a weak correlation between knee-joint structural abnormalities on X-rays and described pain. Therefore, our study aimed to assess the incompatibility between patients' pain-severity complaints and radiographic findings on standing AP view. No similar study has been recently published in the Middle East. METHODS: 158 participants were selected for the study from King Abdulaziz University Hospital, Jeddah, between March 2022 and August 2022. We graded the patients' AP knee radiographs using the Kellgren-Lawrence (KL) grading scale and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, by which we made phone calls to assess pain severity on a 0-10 pain subscale. RESULTS: We found a significant association between the 0-10 pain subscale and WOMAC questions describing difficulty in sitting (p < 0.05). Comparing KL scores on X-ray on a 0-10 pain subscale, we found a significant association between mild pain and severe radiological findings on X-ray and vice versa. In addition, the comparison between KL scores on X-ray and WOMAC questions describing difficulty in sitting showed a significant association between moderate difficulty in sitting and severe radiological findings and vice versa. CONCLUSION: Our results indicated that there was a significant relationship between mild pain and severe radiological findings on X-rays and vice versa. Additionally, there was a significant relationship, based on the KL score and the WOMAC item that assessed sitting difficulty, between moderate sitting difficulty and severe radiological findings and vice versa. This may suggest that central and peripheral sensitization could be one factor in the causes of pain.

Reference for Normal Diameters of the Abdominal Aorta and Common Iliac Arteries in the Saudi Population.

The abdominal aorta is the largest artery in the abdomen. It then bifurcates giving the two common iliac arteries. Knowing the normal abdominal aorta diameter is a basis for diagnosing abdominal aortic aneurysms (AAAs) and subsequently developing an optimal management plan. In order to diagnose AAA, one must have a reference for the normal abdominal aortic diameter that represents the anatomical variation in the population being studied. The aim of this research is to establish normal abdominal aortic diameters in the Saudi population.

Enhancement of Anemia Detection by Correlating Computed Tomography Findings of Abdominal Aorta and Inferior Vena Cava With Laboratory Investigations.

Anemia affects approximately a quarter of the global population, and improved detection may reduce the associated morbidity and mortality. This study investigated correlations between the results of laboratory hematological determinations of hemoglobin levels and attenuation values measured in the lumina of the abdominal aorta and inferior vena cava (IVC) via unenhanced computed tomography (CT) with the aim of expanding diagnostic options for anemia. The data of 423 patients who underwent abdominal unenhanced CT examinations and laboratory examinations at a tertiary hospital were retrospectively evaluated. CT data were collected using a standard abdominal protocol without contrast. The 151 patients who met the inclusion criteria were categorized by hemoglobin values as follows: <8 (severe anemia), 8-10.9 (moderate anemia), 10.9-12 (mild anemia in females), 10.9-13 (mild anemia in males), and >13 g/dL (non-anemic). The mean CT attenuation values in the aorta and IVC were 37.7 and 36.1 Hounsfield units (HU), respectively. A regression analysis performed to evaluate the correlation and predictability of hemoglobin-based aortic and IVC density yielded a coefficient of determination, R2: 0.42 (F ratio: 149.23, p < 0.0001). The highest contribution in the dependent variable (hemoglobin) was reported to IVC density, showing a significant positive correlation between hemoglobin and IVC density. Our study results demonstrate significant correlations between the densities of the aorta, IVC, and hemoglobin value. Accordingly, radiologists and clinicians can use these readily available values to facilitate diagnosis and patient care.

Outcome of Urinary Bladder Dysfunction in Children.

Bladder dysfunction in children is common, the most frequent underlying causes are neurologic bladder (NB), dysfunctional voiding syndrome (DVS), and the valve bladder syndrome (VBS). The aim of this study was to determine the 10-y survival rate and the associated morbidities in children with bladder dysfunction. One hundred ninety-nine children were included in the study; 60 with VBS, 75 DVS, and 64 NB. The mean age was 44 mo (CI: 37-50.9) and mean GFR 50.1 (CI 44.6-55.6) mL/min/1.73m2. The 10-y survival rate was 89%. Compared with patients with VBS, the mortality was 11 times higher among patients with NB (p = 0.02) but not significantly higher than patients with DVS (p = 0.2). GFR < 15 mL/min/1.73 m2 increases mortality rate by 6 times compared with normal GFR (p = 0.007). Late age at presentation (> 5 y) increases mortality risk and/or the need for renal replacement therapy (RRT) by almost 5 times (p = 0.013). It was concluded that the etiology of bladder dysfunction, baseline GFR, and the age at presentation significantly influence the survival rate and morbidities.

Voiding dysfunction in children causes, management, and prognosis: A single-center retrospective study.

OBJECTIVES: To review voiding dysfunction caused by 3 different etiologies; dysfunction voiding syndrome (DVS), neurogenic bladder secondary to spinal dysraphisim (NB), and valve bladder syndrome (VBS). METHODS: A single-center retrospective study on children with voiding dysfunction followed up at King Abdulaziz University Hospital, Jeddah, Saudi Arabia from 2005 to 2017. RESULTS: One hundred and ninety-nine children (67.3% boys) were included: Group 1 (n=75, DVS), Group 2 (n=64, NB), and Group 3 (n=60, VBS). Further classification according to the age at presentation; infants (46%), toddlers (27%) and school aged (28%). Management categories: 31% children needed observation only, 25% needed clean intermittent catheterization (CIC), 13% needed only surgery and 31% needed both surgery and CIC. Associated comorbidities: hydronephrosis (81%), vesicoureteral reflux (47%), pyelonephritis (37%) and renal scar (60%), all have negative impact on estimated glomerular filtration rate (eGFR). Urodynamic studies revealed poor bladder compliance in 57.6% and atonic bladder in 1.1%, progression to chronic kidney disease (22%), commenced on renal replacement therapy 11.5% and 4% died with ESKD. Overall improvement in the last eGFR is observed (p<0.001), but VBS group was the least to improve (p=0.021). There was a negative correlation between the last eGFR and age at presentation (p=0.002). CONCLUSION: Early diagnosis and management of childhood voiding dysfunction was associated with better prognosis. Children managed conservatively have better preservation of kidney function than those who needed surgery.

Magnetic resonance imaging in the management of Crohn's disease: a systematic review and meta-analysis.

OBJECTIVES: Crohn's disease (CD) is a condition that can occur in any part of the gastrointestinal tract, although usually forms in the colon and terminal ileum. Magnetic resonance imaging (MRI) has become a beneficial modality in the evaluation of small bowel activity. This study reports on a systematic review and meta-analysis of magnetic resonance enterography for the prediction of CD activity and evaluation of outcomes and possible complications. METHODS: Following the PRISMA guidelines, a total of 25 low-risk studies on established CD were selected, based on a QUADAS-II score of ≥ 9. RESULTS: A sensitivity of 90% was revealed in a pooled analysis of the 19 studies, with heterogeneity of χ2 = 81.83 and I2 of 80.3%. Also, a specificity of 89% was calculated, with heterogeneity of χ2 = 65.12 and I2 of 70.0%. CONCLUSION: It was concluded that MRI provides an effective alternative to CT enterography in the detection of small bowel activity in CD patients under supervision of radiologist for assessment of disease activity and its complications. Its advantages include the avoidance of radiation exposure and good diagnostic accuracy.

Clinicians' Behavior Toward Radiology Reports: A Cross-Sectional Study.

Background The radiology report is the way of communication between the radiologists and the clinicians of different specialties. Each part of the report is important and significant in the patient management plan. Therefore, knowledge of interpretation and behavior in understanding the final report is a variable crucial skill. Methods This is a cross-sectional survey study to explore the behavior and attitude of clinicians toward radiology reports in relation to their professional clinical demographic. A total of 107 physicians participated, including consultants, specialists, and residents among different specialties. Results Among the 107 responses, 58.9% were male and 41.1% were female. The majority of the physicians (78.5%) read the radiology report for every requested study for each patient, while 21.5% of participants didn't read the radiology report for the studies they requested, instead, they only read it occasionally. Gender played a significant factor, as female practitioners were more likely to read the complete radiology report (P = 0.033). In addition, the age of the practitioner was also significant as clinicians in the age group 40-60 years old were more likely to check the requested radiology image prior to reading the report compared to age groups 20-39 and >60 years (P = 0.035). Lastly, specialists were significantly more likely to read the entire radiology report compared to consultants and residents (P = 0.006). Conclusion More emphasis and awareness should be provided to clinicians on the importance of reading the entire radiology report as some information can be missed if not being read completely.

Radio-opacity of the Bones of Commonly Consumed Fish from the Red Sea.

Introduction Foreign body (FB) ingestion is one of the most common complaints presenting at an emergency department (ED), with fish bone impaction being a frequent cause of presentation. Fish bones might be challenging to identify on routine radiography and ED physicians are often left in a state of uneasiness owing to the fear of complications occurring if the fish bone is not removed. Objective This study aimed to establish the factors affecting the radio-opacity of fish bones on X-ray. Materials and methods The study involved the top three fish species consumed on Saudi Arabia's western coast. Fish bones from three specimens of each species were radiographically examined by hand-picking bones from different parts of the fish, with particular attention paid to bones that are difficult to spot. Bones were then arranged beside each other, and radiographs were taken for comparison. Inter-species and intra-species radio-opacity variation was tested. Further, the weight of each fish and method of cooking (baked vs. fried) were tested for their effect on radio-opacity. Results No significant difference in radio-opacity was found among and between different species, and the method of cooking did not alter the radio-opacity of fish bones. Significant differences in radio-opacity were noted with the difference in the diameter and size of the fish bones, which tended to be less radio-opaque in smaller-sized fish, regardless of the species. Conclusion The exact fish species and method of cooking did not alter the fish bone density on an X-ray. The size of the fish and the size of the fish bone are better predictors of higher fish bone density.

Determination of lumbosacral transitional vertebrae in kidney urinary bladder x-ray films in the Saudi population.

OBJECTIVES: To investigated the rate of occurrence of lumbosacral transitional vertebrae (LSTV), spinal variant, in kidney urinary bladder (KUB) plain radiographs in a Saudi population.  Methods: Between January 2012 to January 2015, KUB plain films obtained from patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, were reviewed, and the presence or absence of LSTV was documented and classified as incomplete or complete. Patients who had evidence of spinal surgery that would obscure the view were excluded.  Results: A total of 2078 patients underwent KUB examinations during the study period; LSTV anomalies were detected in 158 of these. Sacralization was present in 153 (96.8%) of this cohort, while lumbarization was present in 5 (3.2%). A total of 136 (86.1%) of the sacralized segments were of the incomplete type, whereas 17 (10.7%) were complete. Of the lumbarized vertebrae, 3 (1.8%) were incomplete, and 2 (1.2%) were complete. The most frequent type in men was type Ib (28.5%) for sacralized segments, and type IIb for lumbarized segments (0.6%). In women, type Ia was the most common form of sacralized segments (11.3%) and type IIb was the most common form of lumbarized segments (2.8%). Conclusion: The prevalence of LSTV in Saudi patients is 7.6%, with a higher incidence of sacralization than lumbarization. Further studies with larger sample sizes and longer follow-up time are needed to demonstrate the clinical significance thereof.

A preliminary exploration of ulnar variance in healthy wrists at a tertiary hospital in Jeddah.

OBJECTIVES: To gain preliminary insight by exploring ulnar variance changes in a Saudi-based sample.   METHODS: This 6-month (December 2013 to June 2014) cross-sectional study was conducted on a randomly selected healthy adult volunteers with a sample size of 104, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Posteroanterior (PA), anteroposterior (AP), and PA grip views are taken. The variables of interest were the PA, AP, and PA fist measurements of both right and left wrists. An independent t-test was used to compare means between groups. RESULTS: A total of 104 volunteers were recruited. Among 17 participants who had a negative ulnar variance on right PA views, a significantly high proportion (n=9; 56.2%) maintained a negative value on fist views; 7 participants (43.8%) had a neutral ulnar variance while none (0%) had a positive value (p less than 0.001). Similarly, a significant proportion of participants who had neutral, or positive values on right PA views maintained the same values on right fist views (p less than 0.001). On radiographs of the right wrist, the ulnar variance decreased with a change in wrist position, with an absolute difference in magnitude of 2.13 (p less than 0.001) between PA and AP views. Similarly, the ulnar variance on the left side decreased significantly between PA and AP views (absolute difference in magnitude, 1.68; p less than 0.001).   CONCLUSIONS: Ulnar variance changes in our sample are similar to what is reported in the literature.

Musculoskeletal injuries related to yoga: imaging observations.

OBJECTIVE: The purpose of this article is to describe the imaging appearances of musculoskeletal injuries related to yoga. We performed an automated search in the database of a large tertiary care center and conducted a retrospective analysis of the imaging findings in 38 patients over a 9-year period. CONCLUSION: The most frequently encountered musculoskeletal injuries were tendinous lesions, including tears of the supraspinatus, Achilles, and peroneus brevis tendons and fibrocartilaginous tears involving the medial meniscus, acetabular labrum, glenoid labrum, and lumbar disk with extrusion.

An overview of vertebroplasty: current status, controversies, and future directions.

Vertebroplasty is a cost-effective procedure for the relief of pain in appropriately selected patients when performed by a skilled practitioner. The currently accepted indications and contraindications for vertebroplasty are reviewed. The techniques routinely used by the authors are presented, including a discussion of recognized complications. Recent controversy has highlighted weaknesses in the practice of technology evaluation, and more robust studies will be required to address these issues across the board in the future more scientifically than has been done in the past.

Percutaneous vertebral augmentation: the status of vertebroplasty and current controversies.

Vertebroplasty is a cost-effective procedure for the relief of pain and suffering in the appropriate patient when done by a skilled practitioner under good image guidance. No study has ever shown any cost benefit of any balloon-based osteoporotic spine intervention over simple vertebroplasty. No study has ever shown any benefit of any intravertebral implant over vertebroplasty for osteoporotic compression fracture. Recent controversy has highlighted weaknesses in our practice of technology evaluation, and we need to address these issues across the board in the future more scientifically then we have done in the past.

CT Utilization in the Prospective Diagnosis of a Case of Swine-Origin Influenza A (H1N1) Viral Infection.

The purpose of this paper is to demonstrate the potential role of CT in the early diagnosis of swine-origin influenza A (H1N1) virus (S-OIV) pneumonia. We present a case of acute influenza-like illness in which the CT findings of peribronchovascular and subpleural ground-glass opacities and consolidation resembled organizing pneumonia, and lead the radiologist to prospectively and correctly suggest the diagnosis of S-OIV infection.

Ultrasound-guided interventional radiology in critical care.

Ultrasound-guided intervention is becoming an increasingly popular and valuable tool in the critical care setting. In general, image-guided procedures can expedite wait times and increase the accuracy, safety, and efficacy of many procedures commonly performed within intensive care units. In the intensive care unit setting, ultrasound has particular advantages over other imaging modalities such as computed tomography and fluoroscopy, including real-time visualization, portability permitting bedside procedures, and reduced exposure to nephrotoxic contrast agents. We review the technical and procedural aspects of a number of ultrasound-guided interventions appropriate for critical care patients. These include central venous catheter deployment, thoracentesis, paracentesis, and drainage of a wide variety of abscesses, and percutaneous nephrostomy, percutaneous cholecystectomy, and inferior vena cava filter placement. Although we believe ultrasound is significantly underutilized in critical care today, we anticipate that with the improvement of ultrasound technology and the innovation of new ultrasound-guided procedures, the role of ultrasound in the intensive care unit will continue to expand, with bedside ultrasound-guided interventions increasingly becoming the norm.