Examination Findings Research Articles

Imaging of Peripheral Intraneural Tumors: A Comprehensive Review for Radiologists

Background/Objectives: Intraneural tumors (INTs) pose a diagnostic challenge, owing to their varied origins within nerve fascicles and their wide spectrum, which includes both benign and malignant forms. Accurate diagnosis and management of these tumors depends upon the skills of the radiologist in identifying key imaging features and correlating them with the patient’s clinical symptoms and examination findings. Methods: This comprehensive review systematically analyzes the various imaging features in the diagnosis of intraneural tumors, ranging from basic MR to advanced MR imaging techniques such as MR neurography (MRN), diffusion tensor imaging (DTI), and dynamic contrast-enhanced (DCE) MRI. Results: The article emphasizes the differentiation of benign from malignant lesions using characteristic MRI features, such as the “target sign” and “split-fat sign” for tumor characterization. The role of advanced multiparametric MRI in improving biopsy planning, guiding surgical mapping, and enhancing post-treatment monitoring is also highlighted. The review also underlines the importance of common diagnostic pitfalls and highlights the need for a multi-disciplinary approach to achieve an accurate diagnosis, appropriate treatment strategy, and post-therapy surveillance planning. Conclusions: In this review, we illustrate the main imaging findings of intraneural tumors, focusing on specific MR imaging features that are crucial for an accurate diagnosis and the differentiation between benign and malignant lesions.

Retrospective analysis of the incidence and clinicopathological findings associated with ammonium urate urolithiasis in dogs with congenital portosystemic shunts: 363 cases (2010-2023).

To assess the incidence and clinical findings associated with the presence of ammonium urate urolithiasis in dogs with congenital portosystemic shunts. A retrospective review of dogs diagnosed with extrahepatic portosystemic shunts or intrahepatic portosystemic shunts in 15 referral hospitals between 2010 and 2023. Data including signalment, clinical signs, physical examination findings and clinicopathologic test results at the time of the diagnosis were collected, and the presence of ammonium urate urolithiasis was recorded. A total of 363 dogs were included. The overall incidence of ammonium urate urolithiasis was 19.3%. Dogs with extrahepatic portosystemic shunts were more likely to have urolithiasis compared to those with intrahepatic portosystemic shunts (32.2% vs. 8.0%). Dogs with urolithiasis were older (median 40 vs. 8 months) and more likely to be neutered males (51.4% vs. 9.8%). Ammonia was significantly lower in dogs with urolithiasis. Dogs with urolithiasis were more likely to have haematuria on dipstick analysis and sediment examination. Dogs with extrahepatic portosystemic shunts were more likely to have urolithiasis when compared to dogs with intrahepatic portosystemic shunts. Dogs with higher ammonia levels were less likely to have ammonium urate urolithiasis, and older dogs, neutered males, or those with evidence of haematuria had an increased incidence of urolithiasis.

Clinical characteristics of immunocompromised patients infected with COVID-19

Objective: To analyze the clinical features of COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. Methods: A single-center retrospective observational study was conducted on 213 inpatients diagnosed with COVID-19 in the Peking University People's Hospital between December 2022 and October 2023. They were divided into an immunocompromised group (102 patients, 47.9%) and an immunocompetent group(111 patients, 52.1%), and clinical data were compared between the two groups. The immunocompromised group was further divided into death group (18 cases, 17.6%) and non-death group (84 cases, 82.4%). The differences in laboratory examination findings were compared. Further analysis was performed on the lymphocyte subset differences between the death group(10 patients, 9.8%) and the non-death group (36 patients, 35.3%) with complete data. Results: The proportion of severe and critical cases and the mortality rate, were significantly higher in the immunocompromised group than the immunocompetent group (47.1% vs. 40.5%, 18.6% vs. 9.0%, 17.6% vs. 9.0%,P<0.05). The immunocompromised group had lower vaccination rate (26.5% vs. 44.1%, P<0.05). Hypertension, kidney disease and infections were more common in the immunocompromised group (63.7% vs. 48.6%, 30.4% vs. 9.0%, 49.0% vs. 19.8%, all P<0.05). CT findings of consolidation (40.2% vs. 18.9%), rate of antiviral treatment (48.0% vs. 30.6%) and the positive duration of viral nucleic acid [median 14(7.0, 19.3) days vs. 9(7.0, 18.0) days] were higher in the immunocomprised group (all P<0.05). Lactate dehydrogenase (LDH), procalcitonin (PCT), interleukin-6 (IL-6) and ferritin were higher in the immunocompromised group than those in the immunocompetent group (all P<0.05). In the death group, neutrophils (NEU), C-reactive protein (CRP), PCT, IL-6, ferritin and D-dimer were higher, while lymphocytes (LY), CD4+T-cells, CD8+T-cells, B-cell counts and hemoglobin (HGB) were significantly lower than those in the non-death group (all P<0.05). Conclusions: More than 60% of patients in the immunocompromised group were classified as severe or critical type, with a higher mortality rate and decreased ability to clear severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Decreases in total lymphocytes, CD4+T lymphocytes, CD8+T lymphocytes, and B lymphocytes, along with elevated levels of procalcitonin, ferritin, and D-dimer, indicated poor prognosis.

Ocular examinations before and after total ear canal ablation and bulla osteotomy can help recognize and prevent potential vision-threatening abnormalities in cats and dogs.

To report ocular examination findings before and after total ear canal ablation and lateral bulla osteotomy (TECALBO) and ventral bulla osteotomy (VBO) in cats and dogs. At The Ohio State University and MedVet Columbus, ophthalmic examinations were performed on client-owned animals for which a TECALBO or VBO was indicated. Examination findings and postoperative complications relating to ophthalmic and/or neuro-ophthalmic diseases were recorded prior to surgery (T0) and at 1 day (T1), 2 to 3 weeks (T14), and ± 2 months (T60) postoperatively. 28 dogs and 22 cats underwent 43 TECALBO and 20 VBO surgeries (63 ears). Reasons for surgery included otitis (52.4%), polyps (30.1%), and aural masses (17.5%). Facial nerve deficits were observed preoperatively in 5.7% of surgeries and postoperatively in 47.2% at T1 and 31.3% at T14. Horner syndrome was present preoperatively in 11.3% and postoperatively in 45.3% at T1 and 37.5% at T14. Keratoconjunctivitis sicca and corneal ulcers were noted, respectively, in 5.7% and 3.8% of cases at T0 and 5.7% and 17% at T1. Facial nerve deficits and Horner syndrome remained present in 29% (5 of 17) and 36% (5 of 14) at T60. One dog with preoperative facial nerve paralysis and Horner syndrome developed a descemetocele that required a conjunctival flap at T14. Overall, 64.2% of surgeries led to ocular and/or neuro-ophthalmic changes postoperatively. Cats and dogs undergoing TECALBO and VBO procedures should have thorough ophthalmic examinations preoperatively and postoperatively, as ocular and neuro-ophthalmic abnormalities are common in these patients. Ocular examinations are important in animals undergoing aural surgeries in order to reveal ocular abnormalities that could require follow-up care or lead to vision-threatening conditions.

Clinical presentation with consequences and laboratory diagnosis of multi and extensive drug resistance in typhoid cases

Background: Enteric fever is among the major problem in the health care settings of developing countries like Pakistan. Unjudicial use and over the counter availability of antibiotics lead to the emergence of multi drug resistant and extensive drug-resistant strains of salmonella outbreak which demonstrate severity of disease of the disease. Our objective is to determine the clinical presentation, consequences and antibiotic susceptibility patterns of Multi Drug Resistant (MDR) typhoid and Extensive drug resistance (XDR) typhoid cases. Methods: The study was conducted in the department of Microbiology, Dow Diagnostic Reference and Research Laboratory, Dow University of Health Sciences. All laboratory proven Salmonella positive cultures samples were selected from laboratory that were either fully or partially treated, or were taking anti-Salmonella. Clinical trends along with clinical outcomes were assessed from clinical presentation. Furthermore, Demographic details were noted. Detailed history about the presenting illness with examination findings and medications were recorded. Results: A total of 333 patients had positive blood culture for enteric fever, in which maximum number of XDR cases 84% (n=281) were observed in blood cultures followed by MDR salmonella in 16 % (n=52). Meropenem and azithromycin didn’t show any resistance in our study. Conclusion: Our study has demonstrated that pediatric population is more vulnerable for developing salmonella infection. Carbapenems and azithromycin are among the last choices for the treatment of XDR cases. Analysis of our results imply stress on the implementation of preventive measures for spread of enteric fever including proper diagnosis, vaccination and good sanitation system

On context specificity and management reasoning: moving beyond diagnosis.

Diagnostic error is a global emergency. Context specificity is likely a source of the alarming rate of error and refers to the vexing phenomenon whereby a physician can see two patients with the same presenting complaint, identical history and examination findings, but due to the presence of contextual factors, decides on two different diagnoses. Studies have not empirically addressed the potential role of context specificity in management reasoning and errors with a diagnosis may not consistently translate to actual patient care. We investigated the effect of context specificity on management reasoning in individuals working within a simulated internal medicine environment. Participants completed two ten minute back to back common encounters. The clinical content of each encounter was identical. One encounter featured the presence of carefully controlled contextual factors (CF+ vs. CF-) designed to distract from the correct diagnosis and management. Immediately after each encounter participants completed a post encounter form. Twenty senior medical students participated. The leading diagnosis score was higher (mean 0.88; SEM 0.07) for the CF- encounter compared with the CF+ encounter (0.58; 0.1; 95 % CI 0.04-0.56; p=0.02). Management reasoning scores were higher (mean 5.48; SEM 0.66) for the CF- encounter compared with the CF+ encounter (3.5; 0.56; 95 % CI 0.69-3.26; p=0.01). We demonstrated context specificity in both diagnostic and management reasoning. This study is the first to empirically demonstrate that management reasoning, which directly impacts the patient, is also influenced by context specificity, providing additional evidence of context specificity's role in unwanted variance in health care.

Improving vascular access knowledge and assessment skill of hemodialysis staff.

Vascular access malfunction and failure contribute to morbidity and hospitalization in hemodialysis populations. Although controversy still exists over the identification and appropriate management of access malfunction, recognition of sentinel signs during physical examination remains an efficient way to screen for access malfunction. Dialysis staff are on the front line of providing quality care to dialysis patients, often being the first ones who could detect early physical signs of access malfunction. The study's purpose is to determine the effect of an advanced vascular access educational module presented to hemodialysis nurses and technicians, focusing on physical examination findings to identify a dialysis access at risk for malfunction. Utilizing a quasi-experimental pretest and posttest group design with a nonequivalent comparison control group, the effect of an advanced vascular access education module to improve vascular access knowledge and skill in recognition of sentinel signs of access malfunction was studied in a group of hemodialysis nurses (registered nurses [RNs]) and certified patient care technicians (PCTs). Knowledge post-test scores (RN, M=94.44, SD=7.05; PCT, M=90.83, SD=7.93) were significantly higher than pretest scores (RN, M=79.54, SD=12.47; PCT M=80.67, SD=7.99) in the intervention group (p<0.001) but not in the comparison group. There were no statistically significant differences in mean skill scores between dialysis nurses (p=0.38) and PCTs (p=0.826) or between intervention and comparison groups (p=0.332). This study exposes a critical gap in the transition of vascular access knowledge to the practical skill of access assessment. The findings suggest the need for restructuring the clinical training of dialysis nurses and PCTs in vascular access management and care. Newer active learning educational strategies in physical assessment of hemodialysis vascular access should be explored to further support dialysis nurses and PCTs in providing optimal patient care.

Effects of infliximab biosimilar on retinal microvasculature in Crohn’s disease patients evaluated by optical coherence tomography angiography

Objective To compare the retinal microcirculation in Crohn’s disease cases under infliximab (IFX) biosimilar with controls that are age- and sex-matched in terms of disease severity. Background Crohn’s disease is a relapsing, remitting condition that affects the gastrointestinal tract. One approach to management is to use biological therapy. Patients and methods This cross-sectional case-control study was carried out at the outpatient clinic of the gastroenterology and hepatology departments of the Faculty of Medicine at Menofia University and was imaged at Shebin Elkom Ophthalmology Hospital. The study included 60 participants who were divided into three groups with no ophthalmologic history or symptoms. Results Regarding slit examination findings, within group A 14 (70%) cases had eye dryness, and six (30) had allergic keratoconjunctivitis; within group B 11 (55%) cases were normal, five (25%) cases showed dryness, and three (15%) had allergic keratoconjunctivitis; and there was anterior uveitis in one (5%) patient; in group C 10 (50%) patients were normal, seven (35%) patients showed dryness, and three (15%) had allergic keratoconjunctivitis. There was a significant increase in dryness and allergic keratoconjunctivitis within group A compared with groups B and C (P=0.04). Conclusion Our study concluded that patients with moderate to severe Crohn’s disease who received IFX biosimilar had higher eye dryness, allergic keratoconjunctivitis, and longer disease duration. Therefore, the use of IFX should be limited.

Heart Shaped Anterior Neck Lipoma Mimicking Thyroid Mass: A Case Report.

Lipomas, one of the most common benign tumors, rarely occur in the anterior neck, often misdiagnosed as thyroid masses. This case highlights the diagnostic challenge posed by such lesions. A 58-year-old male presented with a painless slowly progressive anterior neck swelling initially mistaken for a thyroid mass. Though clinical examination findings suggested lipoma, the location of swelling influenced the decision toward thyroid mass. The elevated thyroid stimulating hormone (TSH) level further inclined the diagnosis toward thyroid mass. But imaging and fine needle aspiration cytology shifted the diagnosis toward a lipoma. Surgical excision was performed successfully. The gross and histopathological examination confirmed the diagnosis of lipoma. Anterior neck lipomas pose diagnostic challenges due to their uncommon location. Thorough clinical examination and evaluation is crucial to differentiate them from other neck pathologies, primarily thyroid mass. Surgical excision remains the preferred treatment. Postoperative follow-up is important to monitor for recurrence and complications. Awareness of anterior neck lipoma is vital among clinicians for early diagnosis and optimal management. Early suspicion of this prevalent condition in the given unusual location can guide them towards appropriate diagnostic approach and treatment decisions, ultimately improving patient outcomes and reducing diagnostic complexity for healthcare professionals.

Assessing the usage of end-of-life tire pyrolysis oil as an alternative fuel in a diesel engine in the point of energy, exergy, exergoeconomic, exergoenviroeconomic, and sustainability parameters

ABSTRACT The present study examines the utilization of fuel blends comprising waste tire pyrolysis oil (WTPO) at varying ratios (10%, 20%, 30%, and 40%) in a compression-ignition (CI) engine at different loads (25%, 50%, 75%, and 100%). This is with a view to elucidating the performance and emission characteristics of the blends in detail. The performance and emission data were subjected to detailed analysis. Energy, exergy, exergoeconomic, exorgoenviroeconomic, and sustainability analyses were conducted with the objective of comparing the fuel blends. Based on these analyses, the energy dissipation of the engine, exergy losses, cost of power from the engine shaft, and sustainability index (SI) were calculated for each fuel at all operating conditions. As the fraction of WTPO in the fuel blends increased, fuel consumption increased and energetic efficiency declined owing to the lower energy content of the alternative fuel additive. As the percentage of WTPO in the fuel blends increased gradually, the exergy losses increased, resulting in a decline in exergy efficiency. At the highest load, the exergetic efficiency of TP20 was found to be 5.65% higher than that of TP40. Given that the cost of traditional diesel fuel (D100) was 73.3% higher than WTPO, the cost of power from the engine shaft decreased as the WTPO ratio ascended in the blends. Consequently, the aforementioned parameter for TP10 was calculated to be 144.55 $/GW at a load of 75% while 120.90 $/GW was found for TP40. The greatest quantity of CO2 released into the environment was 11,512.4 kg CO2/month in TP40 at the highest load. Under the same conditions, it was calculated as 5,958.2 kg CO2/month for D100. In the context of an SI based on load, a reduction of 5.89% was observed in the case of conventional D100 in comparison with TP40 in the CI engine operating at full load. The findings of the present examination indicate that WTPO may be a viable alternative fuel for CI engines running on D100.

A predictive model for electrical conductivity of polymer carbon black nanocomposites

AbstractAlthough many studies have investigated the percolation threshold and conductivity in the polymer carbon black (CB) nanocomposites (PCBs) by experimental data, the modeling in this field is a topic previously overlooked in literature. This paper suggests a simple equation for percolation threshold in PCBs by the surface properties of polymer and CB a well as interphase depth (t). Also, the electrical conductivity of PCBs is simulated by CB radius (R), tunneling distance (λ) and interphase depth. The offered model is validated by experimented findings of numerous samples and parametric examinations. A thicker interphase and a higher interfacial tension positively reduce the percolation onset. The smaller CBs, lower percolation threshold, and smaller tunnels enhance the electrical conductivity of PCBs. The low percolation threshold of 0.01 is obtained by the low R (15 nm) and the thick interphase (35 nm). Also, R = 15 nm and t = 35 nm maximize the PCB conductivity to 6 S/m. These results signify the important roles of CB radius and interphase depth in the percolation threshold and conductivity of PCBs. In addition, network fraction (f) of 0.7 and λ = 1 nm produce the uppermost PCB conductivity of 1.6 S/m, but the system is insulated at CB network fraction less than 0.35 or tunneling distance more than 2 nm. Therefore, high network fraction and low tunneling distance are needed to enhance the conductivity of PCBs.Highlights An equation for percolation onset of PCBs is proposed by CB radius and interphase depth. The offered model is validated by experimented data and parametric examinations. A thicker interphase and a higher interfacial tension positively reduce the percolation onset. Smaller CBs, lower percolation onset, and smaller tunnels enhance the PCB conductivity. CB radius and interphase depth significantly manage the conductivity of PCBs.

Urogenital Anomalies Identified on Examination of Pediatric Patients Before Circumcision

Abstract Object: Circumcision is included in European urology guidelines as a treatment choice only for severe phimosis, while it is a procedure routinely performed for socio-cultural reasons in many different countries. Parents bring their children to urology clinics requesting circumcision. Before circumcision, it is very important to perform full urogenital examination because many urogenital anomalies that require treatment may be identified so. In this study, we aimed to determine the urogenital anomalies identified in children before circumcision. Method: This study retrospectively investigated findings of 190 pediatric cases attending our urology for circumcision between September 2015 and September 2021. Each child had standard examinations of penis, urethra, testis and scrotum. The presence and laterality of undescended testis, presence and laterality of retractile testis, presence and degree of phimosis, presence and localization of hypospadias, presence and degree of buried penis, presence direction, and angle of penis chordee-curvature, presence of penoscrotal web, presence and laterality of hydrocele, presence of urethral stenosis, and presence of urethral duplication were recorded. Results: In our study assessing the examination findings of 190 pediatric cases attending our urology clinic for circumcision between September 2015 and September 2021, a total of 127 children had urogenital anomalies (66%). Buried penis (46 cases, 24%) was the most frequently encountered urogenital anomaly. Undescended testis was the second most common (19 cases, 10%), while retractile testis (15 cases, 7%) was the third most common anomaly. Accordingly, phimosis was identified in 11 cases, penile curvature in 6 cases, hypospadias in 3 cases, hydrocele in 3 cases, penoscrotal web in 1 cases and urethral meatus duplication in 1 case. Conclusion: Circumcision is performed for both medical reasons and socio-cultural reasons in many countries. However, these patients may have serious urogenital anomalies . Careful physical examination is very important for patients attending for circumcision.

Development of a prognostic scoring system for predicting hospitalization duration in postpartum endometritis

BackgroundWe aim to identify risk factors contributing to extended rehospitalizations in patients diagnosed with postpartum endometritis requiring intravenous antibiotics.MethodsThis retrospective cohort study examined postpartum endometritis patients readmitted for treatment from 2014 to 2022, comparing short (≤ 48 h) and prolonged hospitalization (> 48 h). Data included patient demographics, medical history, presentation parameters, vaginal examination findings, sonographic data, laboratory results, and details of the current labor to create a scoring system predicting prolonged hospitalization risk.ResultsDuring the study, 270 women with postpartum endometritis were hospitalized. Among them, 61 (22.6%) had hospital stays ≤ 48 h, while 209 (77.4%) experienced hospitalization > 48 h. Upon readmission, compared to the group with short stays, patients in the > 48 h group exhibited significantly elevated heart rates (97.9 ± 18.3 vs. 89.7 ± 12.9 bpm; p < 0.002) and CRP levels (13.8 ± 9.8 mg/dL vs. 8.1 ± 7 mg/dL; p < 0.001), respectively. Ultrasound revealed higher rates of pelvic hematoma or abscess in the > 48 h group (35.4% vs. 13.1%, respectively; p = 0.02). Multivariable logistic regression identified independent associations between hospitalization > 48 h and rupture of membranes > 14.5 h adjusted odds ratio (aOR 1.29, 95% CI 0.16–0.6, p = 0.016), temperature > 37.25 °C at readmission (aOR 1.31, 95% CI 0.013–0.42, p < 0.001), and CRP > 6.5 mg/dL at readmission (aOR 1.27, 95% CI 0.09–0.4, p = 0.002). A predictive scoring system was developed, indicating risks for prolonged hospitalization from 0.5 to 0.8.ConclusionThe scoring system developed to predict prolonged hospitalization in postpartum endometritis can provide clinicians with valuable insights for improved diagnosis and prognosis.

Knowledge, Attitude, and Perception Toward Evaluation of Acute Heart Failure Among Emergency Medicine Residents in Riyadh, Saudi Arabia.

Acute heart failure (AHF) poses significant challenges in clinical practice due to its varied clinical presentations and complex management strategies. Adequate confidence levels among medical residents in diagnosing and managing AHF are crucial for timely and effective patient care. This cross-sectional study aimed to assess medical residents' knowledge, attitude, and perception levels in diagnosing and managing AHF and explore factors influencing their confidence levels. A total of 52 medical residents from various specialties participated in the study. Based on different clinical parameters, participants completed a questionnaire assessing their confidence levels in diagnosing AHF. Descriptive statistics were used to summarize confidence levels, while chi-square tests explored associations between demographic/clinical factors and confidence levels. The majority of residents exhibited high confidence levels in diagnosing heart failure (HF) based on history and physical examination findings alone (22 (42.3%) and 16 (30.8%), respectively). However, confidence levels were lower when relying solely on laboratory tests and imaging modalities for diagnosis (17 (32.7%) and 18 (34.6%), respectively). Factors such as symptoms (e.g., dizziness) and availability of ultrasound equipment were associated with higher confidence levels (p < 0.05). However, demographic factors such as age, gender, and residency year did not significantly influence confidence levels (p > 0.05). Our study highlights variations in confidence levels among medical residents in diagnosing and managing AHF. While clinical assessment remains paramount, targeted educational interventions focusing on interpreting diagnostic tests and imaging findings are warranted to enhance residents' confidence levels and improve patient care.

A comparation of three different anti-VEGF drugs in development of persistent avascular retina in premature children

Our current prospective cross-sectional study aimed to investigate the effect of anti-vascular endothelial growth factor (VEGF) drugs used in the treatment of retinopathy of prematurity on retinal maturation and persistent avascular retina (PAR). Retinal imaging was performed with Optos confocal laser ophthalmoscopy for 100 patients aged 4 to 8 years who were screened and treated for retinopathy of prematurity (ROP) during the neonatal period. The ROP examination findings (stage and zone) and treatment history (age in weeks at time of treatment and anti-VEGF drug used) from the neonatal period were reviewed. Retinal vascularization was assessed in fundus images using the green filter on the Optos device and the presence of PAR was evaluated by two investigators. Relationships between the rate of PAR, age in weeks at time of treatment, and type of anti-VEGF drug used were analyzed statistically. The study included 196 eyes of 100 patients. Sixty-four eyes were analyzed in Group 1 (no ROP), 23 eyes in Group 2 (ROP, no treatment), and 108 eyes in Group 3 (treated group; anti-VEGF treatment of ROP with ranibizumab, bevacizumab, or aflibercept). The number of eyes with PAR in these groups was 2 (3.7%), 4 (17.4%), and 45 (41.7%), respectively. PAR was detected in 30 of 44 eyes treated with aflibercept. The rate of PAR was higher after aflibercept treatment (68.2%) with statistical significance (p = 0.000). This study showed that the prevalence of PAR differs between anti-VEGF drugs. Patients treated with aflibercept have a higher risk of late complications and should be followed closely.

Strangulation Using Cable Ties and a Suicidal Manner of Death: A Case Report and Literature Review Addressing an Atypical Suicidal Mode

Background: Strangulation by ligature, most frequently employed for homicidal purposes, is not a common suicide method. Even more infrequent is the use by the victim of cable ties as a tool of self-strangulation. Methods: We describe a case of a 50-year-old woman who was found dead with a cable tie tight around her neck. In our case, analysis of the circumstantial data and the psychopathological history of the victim—along with an external examination, an autopsy, and toxicological findings—was crucial in the differential diagnosis between death intentionally inflicted by a third person and suicide. Through a narrative review conducted by performing a literature search using online resources (PubMed, Google Scholar, and ScienceDirect). Results: we were only able to identify eight similar cases. Conclusions: These were compared with our case, to trace similarities and differences, useful in guiding the forensic doctor in the diagnosis of death in such circumstances.

Examining the Anatomy, Pathophysiology, and Clinical Presentation of Lower Extremity Neurologic Deficits: A Spine Surgeon's Guide to Foot Drop

Foot drop is relatively common and can be a notable source of patient dissatisfaction and even potential litigation. For the spine surgeon evaluating such a patient, the natural inclination is to investigate a spinal etiology; however, foot drop can develop from a multitude of distinct insults along several locations, extending from the cerebral cortex to the leg musculature itself. In-depth understanding of the relevant anatomy implicated in foot drop, as well as the pathologies that may impede those structures, is paramount to expanding a surgeon's differential diagnosis. Specific physical examination findings and diagnostic tests can further delineate the etiology of a patient's foot drop, guide treatment options, and help determine a patient's prognosis. Finally, clinical cases highlight how the application of a thorough grasp of relevant anatomy, a comprehensive physical examination, and appropriate diagnostic studies can accurately localize foot drop and enhance clinical decision making.

Thoracic and abdominal diagnostic imaging findings in dogs diagnosed with immune-mediated polyarthritis: 71 cases (2011-2023).

To describe thoracic and abdominal imaging findings in dogs with immune-mediated polyarthritis and to evaluate their impact on the decision to commence immunosuppressive therapy. Retrospective case series describing imaging findings in dogs with immune-mediated polyarthritis across modalities, including thoracic radiographs, abdominal ultrasound, computed tomography, and where available, echocardiography. Additionally, two internal medicine clinicians reviewed the signalment, clinical signs, clinicopathological findings and diagnostic imaging results on two separate occasions, reaching a consensus for each dog on whether immunosuppression would be their treatment of choice or whether their recommendations would be altered by the results of diagnostic imaging. Seventy-one dogs met the inclusion criteria. Abnormal diagnostic imaging findings were identified in 25.4% (18/71) of dogs. Thoracic radiography did not identify significant imaging findings in any of the dogs. Lymphadenomegaly was the most commonly reported finding on computed tomography (32/40) and abdominal ultrasound (13/34). Neoplasia was identified in three dogs (3/71). Four (4/13) dogs had echocardiography findings consistent with endocarditis. Immunosuppression without performing diagnostic imaging would have been considered in 41 of 71 (57.7%) dogs, based on the signalment, presenting signs, results of physical examination and clinicopathological testing. Of these, 10 dogs (24.3%) had diagnostic imaging findings suggestive of an underlying trigger, therefore changing the clinician's decision to proceed with immunosuppression. Abdominal imaging and echocardiography should be prioritised over thoracic radiography, in dogs with immune-mediated polyarthritis. Signalment, presenting complaint, physical examination findings and clinicopathological results are not reliable predictors of abnormal diagnostic imaging findings in dogs with immune-mediated polyarthritis.

MOUNTAINEER-03 phase III study design: first-line mFOLFOX6 + tucatinib + trastuzumab for HER2+ metastatic colorectal cancer.

Patients diagnosed with metastatic colorectal cancer (mCRC) have a poor prognosis with survival ranging 2-3 years. The prevalence of human epidermal growth factor receptor 2 (HER2) amplification is approximately 3-4% in mCRC and increases up to 8% in patients with KRAS/NRAS/BRAF wild-type (WT) CRC tumors. Tucatinib is a highly selective HER2-directed tyrosine kinase inhibitor that, in combination with trastuzumab, has demonstrated clinically meaningful activity in patients with chemotherapy-refractory, HER2-positive (HER2+), RAS WT mCRC in the MOUNTAINEER trial. The MOUNTAINEER-03 phase III trial is designed to investigate the efficacy and safety of first-line tucatinib in combination with trastuzumab and modified FOLFOX6 (mFOLFOX6) versus standard of care (mFOLFOX6 plus bevacizumab or cetuximab) in patients with untreated HER2+, RAS WT locally advanced unresectable or mCRC. MOUNTAINEER-03 will include two arms of approximately 400 patients randomized 1:1 to either treatment arm. The primary endpoint is progression-free survival per RECIST v1.1 by blinded independent central review (BICR). Key secondary endpoints are overall survival and confirmed objective response rate (according to RECIST v1.1 per BICR). Safety assessments will include surveillance and recording of adverse events, physical examination findings, vital signs, cardiac assessments, Eastern Cooperative Oncology Group performance status, concomitant medications, and laboratory tests.Clinical trial registration: NCT05253651 (ClinicalTrials.gov).

A Case Series of Adult Measles from a Tertiary Care Hospital in North India

Measles or rubeola is caused by an enveloped single-stranded RNA virus belonging to the genus Morbillivirus in the Paramyxoviridae family. Here, we present five adult measles patients. The laboratory confirmation of measles by serology/polymerase chain reaction (PCR) was carried out in the National Measles Laboratory as per WHO standard operating procedure at the Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. All of the patients presented with prodromal fever with rash. Diffuse erythematous maculopapular rash in a centrifugal manner was present. Measles was diagnosed based on clinical examination findings and positive serology or PCR reports from throat swab specimens. Two patients had a history of exposure; other patients denied any exposure. All of the patients were admitted and managed conservatively in the isolation ward during the period of infectivity.