Bibliometric Analysis of Diagnostic Yield of CT Pulmonary Angiogram (CTPA) in the Diagnosis of Pulmonary Embolism (PE).

CT pulmonary angiography (CTPA) is the investigation of choice for diagnosing pulmonary embolism (PE). Due to the speed and ease of performing the CTPA scans, more clinicians are becoming overly reliant on them, even for patients without strong suspicion of PE. We conducted a bibliometric analysis on the PubMed database from 1990 to 2022 to investigate the literature on the diagnostic yield of CTPA in the diagnosis of PE. A total of 166 articles were published in 98 journals. The number of publications has steadily increased since 2010 and peaked in 2020. Authors from 24 countries contributed to these publications, with the overwhelming majority emanating from United States of America, totaling 66 articles. The authors' contributions were relatively well spread out, with the top four authors publishing the highest number of articles at six each. When we investigated the collaboration between the authors, we found limited multinational and multi-institutional collaborations on this topic. Therefore, more multinational and multi-institutional collaborations will be valuable in future studies. In conclusion, this bibliometric analysis summarizes the literature on diagnostic yield of CTPA in the diagnosis of PE and sheds light on the future pathway that researchers and institutions can focus on.

Efficacy of Sacroiliac Joint Injection With Anesthetic and Corticosteroid: A Prospective Observational Study.

Sacroiliac joint injection aims to provide pain relief, improve work status, and early return to work. We aimed to investigate the role of corticosteroid and anesthetic mixture to provide short- and long-term pain relief in patients with sacroiliac joint pain. This prospective observational study included 27 patients with sacroiliac joint dysfunction who received a combination of triamcinolone and ropivacaine for sacroiliac joint injection followed by three scheduled visits at four weeks, eight weeks, and six months. The pain was assessed using visual analogue scale (VAS), physician's assessment on the number of positive provocative tests, and patients' self-reported assessment to evaluate their functional outcome. At the four weeks and eight weeks follow up evaluations, the mean VAS reduced from 5.85 (±1.03) at baseline to 3.30 (±1.77) at four weeks, 3.30 (±1.86) at eight weeks, and 3.00 (±1.86) at six months. At each interval, improvement in terms of clinical assessment using a series of provocative tests was seen with a mean of 1.37 (±1.33), 1.63 (±1.31), and 1.48 (±1.05) at four weeks, eight weeks, and six months, respectively. For the functional effectiveness parameters (Roland-Morris questionnaires), the sacroiliac joint (SIJ) injected with these drugs combination showed a more significant improvement in symptoms and function, baseline (13.56±3.36), at four weeks (9.04±3.33), at eight weeks (9.07±4.13), and six months (8.26±4.92). Using the one-way repeated measures ANOVA, the SIJ pain, provocative test, and functional outcome significantly improved over time after injection with triamcinolone and ropivacaine (p<0.001). No complications of the administration of these medications were noted. Our findings support the intermediate-term (six months) effectiveness and safety of a combination of corticosteroid and anesthetic injection for patients with SIJ dysfunction who failed conservative treatment.

Malaysian Public Interest in Common Medical Problems: A 10-Year Google Trends Analysis.

Background An analysis of internet search has been performed to evaluate the public interest in health problems. Google Trends (GT) serves as a free platform to analyse the search traffic for specific terms in the Google search engine. This observational study aims to investigate the trend of Malaysian population in using the Google search engine on common medical problems and explore the geographical influence on the language used. Material and method Fifteen pairs of keywords, in Malay and English language, were chosen after going through forward and backward translation and vetting by a panel of experts. GT data for the selected keywords from 1st of January 2011 to 31st of December 2020 was extracted. Trend analysis was performed using paired t-test between the first half of the decade and the second half of the decade. The different languages used were analysed based on geographical variation using paired t-test. Results The public interest on those keywords was markedly increased in the second half of the decade with 29 out of 30 keywords showing statistically significant difference. Majority of the states preferred to use Malay keywords, especially those residing at the East Coast of Peninsular Malaysia. Conclusion This observational study illustrates the ability of GT to track healthcare interest among Malaysian population. GT provides a good platform to analyse specific healthcare interest in Malaysian population, but investigators have to bear in mind the geographical influence on the language used.

Diagnostic Accuracy and Adequacy of Computed Tomography Versus Fluoroscopy-Guided Percutaneous Transpedicular Biopsy of Spinal Lesions.

Background Transpedicular biopsy of spinal lesions is imperative for the generation of a definite diagnosis. Thus far, literature comparing the accuracy and adequacy between fluoroscopy-guided and computed tomography (CT)-guided transpedicular biopsy of spinal lesions is scarce. We aim to compare the accuracy and adequacy of samples collected with the two techniques at the largest tertiary hospital in Malaysia. Materials and methods A total of 60 patients (37 patients with spinal infection and 23 patients with spinal tumour) underwent percutaneous transpedicular biopsy of spinal lesions from January 2013 to December 2017 at a tertiary centre. Demographic data, biopsy method (fluoroscopy-guided and CT-guided), diagnosis, adequacy, and accuracy of samples obtained were assessed. Results Among the 60 samples obtained, only two samples (3.3%) were deemed inadequate. There were 10 biopsy samples (16.7%) that were inaccurate. There was no statistical difference between fluoroscopy-guided and CT-guided transpedicular biopsy in terms of accuracy (p = 0.731) and adequacy (p = 0.492). Conclusions Fluoroscopy-guided and CT-guided transpedicular biopsy of spinal lesions offer similar accuracy and adequacy. Fluoroscopy-guided biopsy of the spinal lesion will be an option for spine surgeons when CT-guided biopsy is not available.

Correlation Study Between Clinical Special Tests for Myelopathy and Static MRI Parameters in Patients of Malaysian Population Treated for Cervical Dysfunction.

INTRODUCTION: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Magnetic resonance imaging (MRI) remains the imaging modality of choice, but its findings are not completely specific for clinically significant CSM. This cross-sectional study aims to determine the pathoanatomy of CSM in patients and analyze the correlations between clinical key symptoms, myelopathic signs, and MRI findings. METHODS: Patients with CSM aged 30 to 80 years old with no previous cervical spine disease or injuries were recruited. Clinical parameters include myelopathic hand signs and other clinical-specific tests. The MRI findings were analyzed for level of compression, underlying degenerative pathology, and parameters for cord compression. RESULTS: Thirty patients were recruited. The most common myelopathic signs observed were positive Hoffmann's sign and the presence of reverse brachioradialis reflex. All patients had either degenerative or prolapse disc changes on MRI. There was a positive correlation between the clinical key features with MRI parameters for canal and cord diameter. The transverse cord diameter, cord compression ratio, and approximate cord area were the only independent variables related to almost all the positive clinical specific tests. All three have a moderate to strong correlation with the clinical findings. CONCLUSION: The MRI parameters such as canal and cord size of the cervical spine are an objective reflection of compression on the spinal cord. Correlations observed indicate cord compression that plays a major role in the pathophysiology of CSM. These measurements are sensitive indicators of canal stenosis and play a significant role in predicting the severity and outcome of CSM.

Primary B-cell Lymphoma of the Thoracic Spine: A Rare Cause of Spinal Cord Compression.

Primary non-Hodgkin lymphoma arising from the spine is exceedingly rare. Spinal cord compression can be the first presentation of a patient with primary spinal non-Hodgkin lymphoma. Due to its rarity and vague clinical presentation, the diagnosis can be confused with tuberculosis of the spine, a more common disease in this country. We present a case of primary thoracic spine B-cell lymphoma in a 45-year-old lady who presented with spinal cord compression. This case highlights the importance of obtaining histopathological samples for examination and the treating physician should be vigilant on this rare cause of spinal cord compression. Treatment can be initiated promptly once the diagnosis is established as primary spinal non-Hodgkin lymphoma carries a dire prognosis.