Us and Mri Neurography Assessment of Diagnostic Criteria in Patients With Carpal Tunnel Syndrome Using Electrophysiological Tests as Gold Standard: A Prospective Study

BackgroundPeripheral neuropathy evaluation depends mainly on physical examination, patient history, electrophysiological studies, with evoked potential abnormalities. High-resolution US has the advantage of being fast, non-invasive modality with nerve dynamic assessment allowing examination of long part of nerve. MR imaging serve better in examination of deeper nerves with higher contrast resolution. It shows great benefit in patient with atypical presentation, Equivocal diagnosis and suspicious of secondary cause and post-surgical relapse.MethodsThis study was conducted prospectively on 32 patients, presented with carpal tunnel syndrome diagnosed by electrophysiological tests. Superficial US of the wrist joint was done to all participants followed by MRI within 1 weeks of the US.We aimed to assess the measurements & criteria of both US & MRN in diagnosis of CTS, depending mainly on the three-measurement assessed by Buchberger et al., then to find the agreement between US & MR Neurography (MRN)ResultsUs proved to have higher rate of CTS prediction, the three main parameters CSA measurement, distal nerve flattening and flexor retinaculum bowing indices showed positive occurrence of 93.7%,59.4% &59.4% respectively. While we found that decreased nerve echotexture was positive in 90.6% of patients.Regarding MRI it showed less diagnostic ability when using CSA measurement as it was positive in 81.2% of patients, also distal tunnel nerve increased flattening and bowed flexor retinaculum positive results were slightly decreased to 56.2% for each. In contrast to high T2 signal of median nerve which was positive in 90.6% of patients.In agreement study, we found statically significant difference supporting US as the primary diagnostic modality of CTS depending mainly on the three measurement CSA, Flattening and bowing indices. Yet, for cases of secondary CTS and detection of underlying entrapping cause as well as innervated muscle early abnormality detection and better tissue characterization, MRI was better diagnostic modality with statistically significant difference. ConclusionsOur results proved that ultrasound examination can be used as first imaging modality after physician evaluation with comparable results to electrophysiological studies in evaluating CTS and try to find the cause. MRN examination came as second step in patients with suspected muscle denervation changes that could not be elicited by US or equivocal cases for detection of secondary cause in clinically suspected patient.

Imaging of Fibrosis in Chronic Pancreatitis

Chronic pancreatitis (CP) describes long-standing inflammation of the pancreas, which leads to irreversible and progressive inflammation of the pancreas with fibrosis. CP also leads to abdominal pain, malnutrition, and permanent impairment of exocrine/endocrine functions. However, it is difficult to assess CP pathologically, and imaging modalities therefore play an important role in the diagnosis and assessment of CP. There are four modalities typically used to assess CP. Pancreatic duct features are assessed with magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). However, ERCP is a rather invasive diagnostic modality for CP, and can result in adverse events such as post-ERCP pancreatitis. Computed tomography (CT) is often the most appropriate initial imaging modality for patients with suspected CP, and has high diagnostic specificity. However, CT findings typically only appear in advanced stages of CP, and it is difficult to detect early CP. Endoscopic ultrasonography (EUS) provides superior spatial resolution compared with other imaging modalities such as CT and magnetic resonance imaging (MRI), and is considered the most reliable and efficient diagnostic modality for pancreatic diseases. The EUS-based Rosemont classification plays an important role in diagnosing CP in clinical practice. Evaluation of tissue stiffness can be another option to assess the diagnosis and progression of CP, and MRI and EUS can be used to assess CP not only with imaging, but also with elasticity measurement. MR and EUS elastography are expected to provide new alternative diagnostic tools for assessment of fibrosis in CP, which is difficult to evaluate pathologically.

Electrocardiography Predictive Value on Coronary Slow Flow Phenomenon

Coronary Slow Flow Phenomenon (CSFP) is characterized by the slow flow of contrast in one or more epicardial coronary vessels without evidence of coronary artery stenosis during coronary angiography procedures. CSFP is fairly common at the time of elective angiography with an incidence of around 7% and accounts for about 4% of hospitalized unstable angina cases. Coronary angiography is currently still the only effective way to detect CSFP, but this procedure is an invasive procedure with high costs, there is a risk of allergy to contrast. Electrocardiography (ECG), as a widely available, inexpensive, and simple modality is felt to be an attractive alternative in early detection of this abnormality. The ECG parameters on CSFP discussed in this study include; p-wave dispersion, QT interval dispersion, QRS intrinsic (Tpeak-Tenddeflection duration), and QRS fragmentation. Further studies are needed on the ECG image in CSFP so that in the future ECG can be a cheaper and non-invasive diagnostic modality for CSFP compared to coronary angiography.

Automated Cerebral Infarct Detection on Computed Tomography Images Based on Deep Learning

The limited accuracy of cerebral infarct detection on CT images caused by the low contrast of CT hinders the desirable application of CT as a first-line diagnostic modality for screening of cerebral infarct. This research was aimed at utilizing convolutional neural network to enhance the accuracy of automated cerebral infarct detection on CT images. The CT images underwent a series of preprocessing steps mainly to enhance the contrast inside the parenchyma, adjust the orientation, spatially normalize the images to the CT template, and create a t-score map for each patient. The input format of the convolutional neural network was the t-score matrix of a 16 × 16-pixel patch. Non-infarcted and infarcted patches were selected from the t-score maps, on which data augmentation was conducted to generate more patches for training and testing the proposed convolutional neural network. The convolutional neural network attained a 93.9% patch-wise detection accuracy in the test set. The proposed method offers prompt and accurate cerebral infarct detection on CT images. It renders a frontline detection modality of ischemic stroke on an emergent or regular basis.

The patients view on genetics and functional imaging for precision medicine: a willingness-to-pay analysis

Purpose: Willingness-to-pay (WTP) analyses can support allocation processes considering the patients preferences in personalized medicine. However, genetic testing especially might imply ethical concerns that have to be considered. Methods: A WTP questionnaire was designed to compare preferences for imaging and genetic testing in cancer patients and to evaluate potential ethical concerns. Results: Comparing the options of imaging and genetics showed comparable WTP values. Ethical concerns about genetic testing seemed to be minor. Treatment success was the top priority irrespective of the diagnostic modality. In general, the majority of patients considered personalized medicine to be beneficial. Conclusion: Most patients valued personalized approaches and rated the benefits of precision medicine of overriding importance irrespective of modality or ethical concerns.

Re-decontamination of liquid mycobacterial cultures: Additional Mycobacterium tuberculosis yield in the era of Xpert MTB/RIF Ultra in Cape Town, South Africa

A retrospective review of liquid mycobacterial cultures was performed at a laboratory in South Africa from 01 January 2018 to 31 December 2018 to assess the increased yield in detecting Mycobacterium tuberculosis complex following sample re-decontamination. Only 9 of 99 (9%) re-decontaminated samples were culture positive for M. tuberculosis complex. Xpert MTB/RIF Ultra, concurrently performed on 7 of the 9 samples, detected M. tuberculosis complex in all but 1 sample. Re-decontamination of non-sterile samples did not increase the M. tuberculosis complex yield enough to offset the financial costs and additional labour in a laboratory that utilises the Xpert MTB/RIF Ultra system as a first-line diagnostic modality.

Digital Pathology Using Primary Case Sign-Out

The applicability of the identified findings and the potential impact on patient outcomes for any individual diagnostic setting was unclear. In the majority of the identified studies, the authors reported diagnostic accuracy and clinical utility outcomes that supported digital pathology systems as a valuable diagnostic modality, comparable to conventional microscopy. These studies lacked statistical power calculations, making the accuracy of these statements unclear. One systematic review and 1 diagnostic study reported clinical utility outcomes of digital pathology. This evidence supported digital pathology using primary case sign-out for accurate prognosis of patient outcomes; however, the clinical utility compared to conventional microscopy was unclear in the identified evidence. One systematic review and 13 diagnostic cohort studies reported on the diagnostic accuracy of whole slide image (WSI). The identified outcomes indicated that WSI is a valuable diagnostic modality; however, a large range of diagnostic accuracy in different settings, and a lack of clear statistical power in all studies make comparator conclusions to conventional microscopy unclear. One systematic review and 4 diagnostic cohort studies reported diagnostic areas that can present challenges for a digital pathology implementation, the most common being the interpretation and grading of dysplasia. One identified systematic review stressed the importance of whole-system validation to identify strengths and weaknesses of specific digital pathology implementations. The range of diagnostic accuracy across studies also indicated that implementation of digital pathology primary case sign-out systems is associated with unclear diagnostic accuracy until appropriately validated. No relevant cost-effectiveness evidence for digital pathology using primary case sign-out was identified.

Lefamulin in Patients with Community-Acquired Bacterial Pneumonia Caused by Atypical Respiratory Pathogens: Pooled Results from Two Phase 3 Trials

Lefamulin was the first systemic pleuromutilin antibiotic approved for intravenous and oral use in adults with community-acquired bacterial pneumonia based on two phase 3 trials (Lefamulin Evaluation Against Pneumonia [LEAP]-1 and LEAP-2). This pooled analysis evaluated lefamulin efficacy and safety in adults with community-acquired bacterial pneumonia caused by atypical pathogens (Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydia pneumoniae). In LEAP-1, participants received intravenous lefamulin 150 mg every 12 h for 5–7 days or moxifloxacin 400 mg every 24 h for 7 days, with optional intravenous-to-oral switch. In LEAP-2, participants received oral lefamulin 600 mg every 12 h for 5 days or moxifloxacin 400 mg every 24 h for 7 days. Primary outcomes were early clinical response at 96 ± 24 h after first dose and investigator assessment of clinical response at test of cure (5–10 days after last dose). Atypical pathogens were identified in 25.0% (91/364) of lefamulin-treated patients and 25.2% (87/345) of moxifloxacin-treated patients; most were identified by ≥1 standard diagnostic modality (M. pneumoniae 71.2% [52/73]; L. pneumophila 96.9% [63/65]; C. pneumoniae 79.3% [46/58]); the most common standard diagnostic modality was serology. In terms of disease severity, more than 90% of patients had CURB-65 (confusion of new onset, blood urea nitrogen > 19 mg/dL, respiratory rate ≥ 30 breaths/min, blood pressure <90 mm Hg systolic or ≤60 mm Hg diastolic, and age ≥ 65 years) scores of 0–2; approximately 50% of patients had PORT (Pneumonia Outcomes Research Team) risk class of III, and the remaining patients were more likely to have PORT risk class of II or IV versus V. In patients with atypical pathogens, early clinical response (lefamulin 84.4–96.6%; moxifloxacin 90.3–96.8%) and investigator assessment of clinical response at test of cure (lefamulin 74.1–89.7%; moxifloxacin 74.2–97.1%) were high and similar between arms. Treatment-emergent adverse event rates were similar in the lefamulin (34.1% [31/91]) and moxifloxacin (32.2% [28/87]) groups. Limitations to this analysis include its post hoc nature, the small numbers of patients infected with atypical pathogens, the possibility of PCR-based diagnostic methods to identify non-etiologically relevant pathogens, and the possibility that these findings may not be generalizable to all patients. Lefamulin as short-course empiric monotherapy, including 5-day oral therapy, was well tolerated in adults with community-acquired bacterial pneumonia and demonstrated high clinical response rates against atypical pathogens.

Diagnostic accuracy of point-of-care knee ultrasound for evaluation of meniscus and collateral ligaments pathology in comparison with MRI

Background Although magnetic resonance imaging (MRI) is often the “gold standard” for diagnosing knee problems, it has many limitations. Therefore, ultrasonography has been suggested as an effective rapid alternative in many knee abnormalities, especially after injuries of the meniscus and collateral ligaments. Purpose To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) in detecting injuries of the meniscus and collateral ligament compared to MRI. Material and Methods An observational cross-sectional blinded study was conducted of 60 patients with clinically suspicious meniscus and collateral ligament injuries who were planned for an arthroscopy and or operative procedure. These patients underwent both blinded POCUS and MRI of the knees before the intervention procedure and results of both imaging modalities were compared according to the operative and arthroscopic findings. Results The preoperative reliability of POCUS compared to MRI for the assessment of meniscus injuries was sensitivity (92.9% vs. 90.5%), specificity (88.9% vs. 83.3%), positive predictive value (PPV; 95.1% vs. 92.7%), negative predictive value (NPV; 84.2% vs. 79%), and overall accuracy (91.7% vs. 88.3%). However, for diagnosing collateral ligament injures, POCUS versus MRI assessed sensitivity (92.3% vs. 88.5%), specificity (100% vs. 97.1%), PPV (100% vs. 95.8%), NPV (94.4% vs. 91.7%), and overall accuracy (96.7% vs. 93.3%). Conclusion Ultrasonography is a useful screening tool for the initial diagnosis of meniscal and collateral ligament pathology compared to or even with potential advantages over MRI, especially when MRI is unavailable or contraindicated. As newly advanced portable ultrasonography becomes available, it could be considered as a point-of-injury diagnostic modality.