Depressive disorders are associated with the highest probability of suicide. Different cognitive factors raise the probability of suicide. Sleep disorders are closely related to depression and may play a role in suicide.

Bony and soft-tissue impingement syndromes are now increasingly being recognized as significant causes of chronic ankle pain.

Objective

To compare the diagnostic efficacy of MR arthrography with conventional MRI in evaluation of ankle impingement in correlation with clinical and arthroscopic findings.

Patients and methods

This study reviewed 23 patients who had preoperative MR imaging and MR arthrography and then underwent arthroscopy (as a gold standard), in the period from May 2019 till August 2021. The study is approved by the ethical committee of Faculty of Medicine of Assiut University.

Results

Conventional MRI and MR arthrography showed sensitivity, specificity, and an accuracy of 100.0% in diagnosing bony impingement. For diagnosing soft tissue impingement; MR arthrography was shown to be more superior to conventional MRI with a sensitivity of 88.2%, a specificity of 100.0%, and an accuracy of 94.4%.

Conclusion

MR arthrography is highly beneficial in diagnosing bony and soft impingement that expands the functionality of conventional MR imaging by taking advantage of the natural benefits of joint effusion.

Early Rehabilitation Program and Weaning outcomes In Critically Ill Chronic Obstructed airway disease :randamised trail

A randomise trial comparing the effects of electrical stimulation of the quadriceps muscle and decreased trigger sensitivity plus exercise breathing after discharge on

Background Gastrointestinal bleeding (GIB) is considered a dangerous trouble, an important etiology for hospital admissions, and has a rate of mortality of about 6%–10% for bleeding from the upper GI tract (GIT) and about 4% for bleeding from the lower GIT. It needs combined efforts involving gastroenterology, endoscopy, surgery, and radiology departments. Aim of the work To assess the role of multidetector computed tomography (CT) in diagnosing acute nonvariceal bleeding from the GI tract. Patients and methods Fifty patients presented by acute nonvariceal GIT bleeding after exclusion of cases that had impaired renal functions or with terminal liver failure, pregnancy, patients who have sensitivity to contrast medium, and patients who were diagnosed as variceal bleeding; they underwent Multi slice computed tomography (MSCT) angiography after resuscitation of patients with shock, monitoring for unstable patients. Images were acquired with slice thickness 5 mm for unenhanced phase and 1.25 mm for arterial phase and portovenous phases, pitch 1.375, 300 MA, 120 kVp, and rotation time 0.7 s. Images acquired were reconstructed for sagittal, coronal, Maximum intensity projection (MIP), and volume-rendering images. Results MSCT helped in the diagnosis of the source and/or the cause of bleeding in 66% of examined cases (n = 33), whereas CT could not detect the cause of bleeding in 34% of cases (n = 17). Conclusion CT angiography (CTA) can act as a good first‑line screening method in the localization and detection of GIB sites. CTA can be used to triage patients with active GIB and give an idea for required further examination. Keywords: computed tomography angiography, endoscopy, gastrointestinal hemorrhage/diagnosis, occult blood

Abstract:

Context:

 Patients in the intensive care unit (ICU) are at risk not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients.   Indeed, diagnosis of ventilator associated pneumonia (VAP) requires a high clinical suspicion combined with bedside examination, radiographic examination, microbiologic analysis of respiratory secretions, and blood test.

Aims: This study aimed to evaluate the effectiveness and accuracy of lung ultrasound for VAP diagnosis and follow-up.

Settings and Design: A prospective cohort study was done on 74 patients, with total number of 54 with high likelihood of VAP and 20 with low likelihood of VAP

Methods and Material:Mechanically ventilated patients for 48 hours or more were included. We calculated Clinical pulmonary infection score and Lung Ultrasound was performed within 24 hours.

Statistical analysis used:Data were collected and analyzed by using SPSS (Statistical Package for the Social Science, version 20, IBM, and Armonk, New York). Quantitative data were expressed as mean ± standard deviation (SD) and compared with Student t test. Nominal data were given as number (n) and percentage (%). Chi₂ test was implemented on such data.

Results:

Based on Clinical pulmonary infection score (CPIS) with cutoff point (≥ 6), the sensitivity of transthoracic ultrasound was 81.5%, the specificity was 82% and the accuracy was 81.6%. Regarding sonographic signs, the highest sensitivity was for sub-pleural dots of consolidation 82%, then B-lines 56%, followed by pleural effusion and air bronchogram both 19%. Highest specificity was for air bronchogram 100%, then B-lines and pleural effusion both 90%, followed by sub-pleural dots of consolidation 80%. Positive predictive value for transthoracic ultrasound was 92%, Area under the receiver operation characteristics (ROC) curve (AUC) for total ultrasound score was 0.82.

Conclusions: Transthoracic ultrasound is an easy bedside tool for diagnosis and follow up of ventilator associated pneumonia.

Key-words: Ventilator associated pneumonia, Clinical pulmonary infection score, Lung Ultrasounds, intensive care unit

Key Messages: 

Transthoracic ultrasound is a useful and convenient bed-side tool for diagnosis and follow up of ventilator associated pneumonia. It should be established as a reasonable tool in early diagnosis due to its availability, being easy to use and low cost. This helps in starting early treatment with antimicrobial therapy.