The Diagnostic Value of Brain CT Scans in Evaluating Dizziness in the Emergency Department: A Retrospective Study.

BACKGROUND: Dizziness is a common presenting complaint to emergency departments (ED) worldwide, with causes ranging from benign to life-threatening incidents. Computerized tomography (CT) of the brain remains a common diagnostic tool used by emergency physicians; however, it appears to be of low diagnostic value, especially in patients with normal neurological assessment while carrying multiple negative implications on both the patients and the healthcare systems. Our study aims to evaluate the diagnostic value of brain CT scans in assessing patients presenting to the ED with acute dizziness. MATERIALS AND METHODS: Retrospective review of medical records of patients presenting with complaints of dizziness to the ED at Salmaniya Medical Complex (SMC) who underwent a brain CT scan from January to June 2023. Collected data included patients' demographic information, presenting complaints, and CT scan results. A multivariable analysis of factors associated with positive CT scans was performed. RESULTS: A total of 481 participants were enrolled in the study, representing diverse age groups as follows: 18-30 years (12.3%), 31-40 years (15.8%), 41-50 years (17.7%), 51-60 years (22.0%), and those aged over 60 years (32.2%). Among the participants, 56.3% identified as male and 43.7% as female. In terms of head trauma history, 7.1% of participants reported such incidents, while the majority (92.9%) had no history of head trauma. Exploring comorbidities, 43.5% of participants had at least one associated medical condition. Among the 481 study participants, brain CT scans revealed that the majority (93.1%) exhibited unremarkable results. The remaining cases exhibited acute events, including 5.4% with infarcts, 1.1% with hemorrhages, and 0.4% with space-occupying lesions. CONCLUSION: This study provides evidence of the limited value of brain CT scans in dizzy patients with unremarkable clinical examinations. As for clinicians, it can serve as a steppingstone toward the formulation of a policy and a set of guidelines for requesting brain CT scans in patients presenting to the ED with dizziness. Future studies are suggested to provide more insights into the cost-effectiveness and utility of head CT scans in providing valuable findings.

Malignant Solitary Fibrous Tumor of the Inguinal Region: A Case Report.

A solitary fibrous tumor (SFT) is a rare spindle cell neoplasm in adults, usually found in the pleural and thoracic cavities. We report an interesting case of a malignant solitary fibrous tumor in a 64-year-old male who presented with a history of swelling in his right inguinal region that gradually increased in size during the past three years. Computed tomography (CT) and magnetic resonance imaging (MRI) scans of the abdomen and pelvis showed a rounded solid mass originating from the right inguinal canal suggestive of sarcoma. Elective excision of the mass was done under general anesthesia with histopathology confirming the diagnosis of high-grade spindle cell sarcoma in keeping with a malignant solitary fibrous tumor. Postoperatively, the patient had no complications and was discharged on postoperative day 4. The patient was then treated with radiotherapy. He remained free of recurrence for two years postoperatively.

Abdominal Imaging Findings in Laboratory-Confirmed COVID-19 Patients: A Retrospective Observational Study.

BACKGROUND AND AIM: Coronavirus disease 2019 (CO-VID-19) is known to predominantly present with respiratory symptoms; however, a significant proportion of patients present with digestive symptoms. These symptoms are often non-specific and as such prompt the treating physician to request further imaging evaluation. Understanding the abdominal imaging findings in COVID-19 and their possible associations is thus crucial to direct patient care and prevent misdiagnosis. The aim of this study was to describe abdominal imaging findings on both computed tomography (CT) and ultrasound scans in cases with positive COVID-19 polymerase chain reaction (PCR) tests performed at our institution, and also, to evaluate the reason for requesting these imaging studies, and to correlate these findings with patients' demographics. METHODS: A retrospective observational study was conducted at Salmaniya Medical Complex, Bahrain, between February 2021 and March 2022. We examined the abdominal CT and ultrasound data for PCR-confirmed COVID-19 patients. The demographic data, reason for requesting imaging and imaging findings were gathered by reviewing the hospital's electronic health records and picture archiving and communicating system (PACS). RESULTS: The study included 97 patients, with the majority being male (57.7%). The most common reason for imaging was abdominal pain, as seen in over half of the patients (60.8%), followed by deranged liver enzymes (18.6%). More than 75% of imaging studies showed positive abdominal findings with the majority (19.6%) showing non-specific inflammatory findings, followed by gallbladder disease (13.4%). The CT studies were more likely to yield positive findings as compared to ultrasound, with only 7 (11.3%) CT scans yielding normal findings (χ2 = 14.65; P < 0.01). CONCLUSION: To our knowledge, the research conducted on the abdominal manifestations of COVID-19 is still limited, especially in our region. Our study showed that there are variable presentations of abdominal organ involvement in COVID-19 cases, and as such more data is required to direct choice of imaging study, protocol, and interpretation of findings to better guide patient management.

Left-Sided Acute Appendicitis in a Patient With Situs Inversus Totalis.

Acute appendicitis is one of the most common reasons for presentation to the emergency department that requires an emergency appendectomy. Clinical presentation with abdominal pain in the left lower quadrant is very uncommon but can occur with a congenital left-sided appendix or right-sided long appendix. We report a rare case of a 65-year-old man with incidental finding of situs inversus totalis who presented with left lower quadrant abdominal pain. A CT scan of the abdomen confirmed the diagnosis of left-sided acute appendicitis, and the patient underwent laparoscopic appendectomy with an uneventful postoperative course.

Osteoporosis Among Bahraini Women Based on Bone Mineral Density Measurements: A Retrospective Study.

Objectives The objective is to estimate the prevalence of osteoporosis among women in Bahrain who are aged ≥18 years. Methods In this retrospective study conducted at Salmaniya Medical Complex, a total of 590 Bahraini women were enrolled. Their bone mineral density measurements were obtained through dual-energy x-ray absorptiometry (DEXA) performed between January 2017 and December 2017. Six sites were chosen as the measurement targets. Patients were diagnosed with osteoporosis if their T-score was > -2.5 according to the World Health Organization guidelines. Results Osteoporosis was diagnosed in 27.1% of the patients; 53.2% had osteopenia, 0.3% had severe osteoporosis, and 19.3% had normal bone conditions. The prevalence of osteopenia as well as osteoporosis increased with age. Conclusion Osteoporosis and osteopenia are common among Bahraini women. This study provides useful information on the prevalence of osteoporosis among Bahraini women. Major steps by health authorities in the country are needed to reduce morbidity and improve the quality of life.

Renal hydatid cyst: A case report.

Hydatid disease is a parasitic infection commonly involving the liver, less frequently the lungs, and rarely the kidneys. Reports on renal hydatid disease are limited in literature. In this case study, we share a case of a 37-year-old female who presented with a 3-month history of left flank pain and following further evaluation with laboratory testing and radiological imaging was revealed to be a case of renal hydatid disease. The patient was successfully managed surgically with left total nephrectomy. The study will focus on the findings of renal hydatid disease in radiological imaging modalities.

Rates of cerebrospinal fluid infection and the causative organisms following shunt procedures in Saudi Arabia. A retrospective study based on radiological findings.

OBJECTIVES: To assess the incidence of infection following various cerebrospinal fluid (CSF) shunt procedures among patients with hydrocephalus and related conditions, based on the age of the patient, and to determine the types of pathogens responsible for shunt infections. Methods: This retrospective single center study reviewed the records of patients with culture-confirmed CSF shunt infection diagnosed between January 2012 and December 2017. Cases without central nervous system imaging investigations were excluded. Results: The incidence rate of shunt-related infections was 32.2%. Among the 189 patients whose records were included, Staphylococcus epidermidis (47.5%) and Acinetobacter baumannii (18%) were the most common causative organisms. The incidence of postoperative infection was higher among those who underwent external ventricular drain procedures (65%) than among those who underwent ventriculoperitoneal shunt procedures (24%). There were no intraoperative deaths. However, the postoperative death rate was 12.2% during hospital stay (mean duration = 9 days); 2% of these deaths occurred after shunt removal. Conclusion: The incidence of infections after CSF shunt procedures was high in our tertiary academic hospital during the study period, compared to those reported in similar clinical settings and before developing a detailed standardized protocol for infection control. Although gram-negative organisms were the most prevalent cause of CSF infections, S. epidermidis (a gram-positive organism) was the most commonly encountered causative agent. Shunt protocols should be implemented to address perioperative shortcomings and to reduce overall mortality and morbidity.

Small bowel intussusception due to inflammatory fibroid polyp: A case report.

Inflammatory fibroid polyp (IFP), or Vanek's tumor, is a rare benign lesion of the gastrointestinal tract. According to the location and the size of the lesion, patients present with different clinical manifestations. Our case describes a patient who presented with a picture of a small bowel obstruction. Computed tomography revealed ileoileal intussusception without a clear lead point. The patient underwent resection of the intussuscepted small bowel with primary anastomosis. A polypoid mass was identified as the pathologic lead point. Histopathologic analysis revealed an inflammatory fibroid polyp.