The performance of ultrasound and upper gastrointestinal study in diagnosing malrotation in children, with or without volvulus.

BACKGROUND: Rapid diagnosis is crucial for pediatric patients with midgut volvulus and malrotation to prevent serious complications. While the upper gastrointestinal study (UGIS) is the traditional method, the use of ultrasound (US) is gaining prominence. OBJECTIVES: To assess the diagnostic sensitivity and specificity of US compared to UGIS for malrotation and midgut volvulus. METHODS: A cross-sectional study was performed on 68 pediatric patients who underwent US and/or UGIS before surgery for suspected midgut volvulus or malrotation in Kuala Lumpur (PPUKM and HTA), referencing surgical outcomes as the gold standard. RESULTS: US demonstrated a higher specificity (100%) than UGIS (83%) for diagnosing malrotation, with a slightly lower sensitivity (97% vs. 100%). For midgut volvulus, US surpassed UGIS in sensitivity (92.9% vs. 66.7%) while maintaining comparable specificity. The SMA/SMV criteria showed better sensitivity (91.1%) than the D3 assessment (78.9%) on US, though both had high specificity. CONCLUSION: US is equivalent to UGIS for identifying malrotation and is more sensitive for detecting midgut volvulus, supporting its use as a primary diagnostic tool. The study advocates for combined US and UGIS when either yields inconclusive results, optimizing diagnostic precision for these conditions.

Brain functional alteration and cognitive performance in cardiovascular diseases: a systematic review of fMRI studies.

Background: Functional magnetic resonance imaging (fMRI) is a useful tool to evaluate brain inefficiencies secondary to cardiovascular diseases (CVDs); nevertheless, limited fMRI studies have been conducted to investigate the effect of CVDs on brain functional changes and cognitive function. This systematic review aims to explore, synthesise, and report fMRI outcomes (resting state and task-based) and cognitive performance in patients with CVDs. Methods: Two reviewers independently searched published literature until April 2024 on ScienceDirect, PubMed, Web of Science, and ClinicalTrials.gov adhering to the PRISMA protocol. A total of 26 eligible studies were considered for full-text screening, of which 10 were included in this review. The methodological quality was assessed by mixed methods appraisal tool and was reported as empirically fair. Results: Among 336 subjects with CVDs, aged between 49.90 ± 6.10 to 72.20 ± 5.70 years, the majority had coronary artery diseases (n = 177, 52.68%) and hypertension (n = 200, 59.52%), and approximately half of them were females (n = 169, 50.30%). Based on the qualitative synthesis, subjects with CVDs demonstrated an increased cognitive decline (reduced Mini-Mental State Examination/Montreal Cognitive Assessment mean values) and attenuated task performance (lower mean 2-back task scores and slower reaction time). Results also indicated impaired brain activity at the supplementary motor area associated with poor ejection fraction; reduced default mode network suppression linked to high low-density lipoprotein cholesterol; lower regional homogeneity and amplitude of low-frequency fluctuation values; and reduced functional connectivity. In summary, alterations in brain networks connectivity may have contributed to an impaired cognitive performance in patients with cardiovascular diseases. Conclusion: It can be extrapolated that CVDs tend to alter the brain network connectivity and result in cognitive impairment and poorer task performance. However, for future imaging studies, more stringent and homogenous demographic data are highly recommended.

Systematic review of cardiovascular magnetic resonance imaging T1 and T2 mapping in patients with Takotsubo syndrome.

Background: Current imaging advancements quantify the use of cardiovascular magnetic resonance (CMR) derived T1 and T2 tissue characterization as robust indicators for cardiomyopathies, but limited literature exists on its clinical application in Takotsubo syndrome (TTS). This systematic review evaluated the T1 and T2 parametric mapping to delineate the current diagnostic and prognostic CMR imaging outcomes in TTS. Methods: A comprehensive literature search until October 2023 was performed on ScienceDirect, PubMed, Web of Science, and Cochrane Library by two independent reviewers adhering to the PRISMA framework. The Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of studies. Results: Out of 198 results, 8 studies were included in this qualitative synthesis, accounting for a total population of 399 subjects (TTS = 201, controls = 175, acute myocarditis = 14, and acute regional myocardial oedema without infarction = 9). Approximately 50.4 % were TTS patients aged between 61 and 73 years, whereof, females (n = 181, 90.0 %) and apical variants (n = 180, 89.6 %) were significantly higher, and emotional stressor (n = 42; 20.9 %) was more prevalent than physical (n = 27; 13.4 %). The NOS identified 62.5 % of studies as moderate and 37.5 % as high quality. Parametric tissue mapping revealed significantly prolonged T1 and T2 relaxation times at 1.5T and 3T respectively in TTS (1053-1164 msec, 1292-1438 msec; and 56-67 msec, 60-90 msec) with higher extracellular volume (ECV) fraction (29-36 %), compared to healthy subjects (944-1211 msec, 1189-1251 msec; and 46-54 msec, 32-68 msec; 23-29 %) and myocarditis (1058 msec, 60 msec). Other significant myocardial abnormalities included increased left ventricular (LV) end-systolic and diastolic volume and reduced global longitudinal strain. Overall, myocardial oedema, altered LV mass and strain, and worse LV systolic function, with higher native T1, T2, and ECV values were consistent. Conclusions: Future research with substantially larger clinical trials is vital to explore the CMR imaging findings in diverse TTS patient cohorts and correlate the T1 and T2 mapping outcomes with demographic/clinical covariates. CMR is a valuable imaging tool for TTS diagnosis and prognostication. T1 and T2 parametric mapping facilitates the quantification of oedema, inflammation, and myocardial injury in Takotsubo.

Relationship between carotid intima-media thickness and white matter hyperintensities in non-stroke adults: a systematic review.

Introduction: Literature suggests a common pathophysiological ground between carotid atherosclerosis (CAS) and white matter alterations in the brain. However, the association between carotid intima-media thickness (CIMT) and white matter hyperintensities (WMH) has not been conclusively reported. The current systematic review explores and reports the relationship between CIMT and WMH among asymptomatic/non-stroke adults. Methods: A recent literature search on PubMed, SCOPUS, and Web of Science databases was conducted in compliance with the PRISMA protocol. The pre-defined Population-Intervention-Comparison-Outcome-Study (PICOS) criteria included observational studies investigating the CIMT-WMH association among non-stroke adults undergoing magnetic resonance imaging and carotid ultrasound. Results: Out of 255 potential results, 32 studies were critically assessed for selection, and finally, 10 articles were included, comprising 5,116 patients (females = 60.2%; males = 39.8%) aged between 36-71 years. The included studies earned high quality ratings (6-9) based on the Newcastle-Ottawa-Scale criteria. Qualitative synthesis showed a significantly parallel relationship between increased CIMT and greater WMH burden in 50% of the studies. In addition, significant risk factors related to the CIMT-WMH association included older age, hypertension, depression, migraine, Hispanic ethnicity, and apolipoprotein E (ɛ4) in postmenopausal women. Conclusion: Overall, the cumulative evidence showed a consistent CIMT-WMH association in asymptomatic middle-aged and older non-stroke adults, indicating that CAS may contribute to the progression of pathologically hyperintense white matter in the brain. However, further research is warranted to infer the plausible relationship between CIMT and WMH in the absence of stroke.