New Strategies for Treatment of Sepsis

This book represents a collection of paper from different specialists involved in the management of septic patients, aimed to disseminate the knowledge in the field of sepsis, particularly to non-intensivists physicians

Radionuclide Imaging of Invasive Fungal Disease in Immunocompromised Hosts

Invasive fungal disease (IFD) leads to increased mortality, morbidity, and costs of treatment in patients with immunosuppressive conditions. The definitive diagnosis of IFD relies on the isolation of the causative fungal agents through microscopy, culture, or nucleic acid testing in tissue samples obtained from the sites of the disease. Biopsy is not always feasible or safe to be undertaken in immunocompromised hosts at risk of IFD. Noninvasive diagnostic techniques are, therefore, needed for the diagnosis and treatment response assessment of IFD. The available techniques that identify fungal-specific antigens in biological samples for diagnosing IFD have variable sensitivity and specificity. They also have limited utility in response assessment. Imaging has, therefore, been applied for the noninvasive detection of IFD. Morphologic imaging with computed tomography (CT) and magnetic resonance imaging (MRI) is the most applied technique. These techniques are neither sufficiently sensitive nor specific for the early diagnosis of IFD. Morphologic changes evaluated by CT and MRI occur later in the disease course and during recovery after successful treatment. These modalities may, therefore, not be ideal for early diagnosis and early response to therapy determination. Radionuclide imaging allows for targeting the host response to pathogenic fungi or specific structures of the pathogen itself. This makes radionuclide imaging techniques suitable for the early diagnosis and treatment response assessment of IFD. In this review, we aimed to discuss the interplay of host immunity, immunosuppression, and the occurrence of IFD. We also discuss the currently available radionuclide probes that have been evaluated in preclinical and clinical studies for their ability to detect IFD.</p

Case series of breast fillers and how things may go wrong: radiology point of view

INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging breast due to breastfeeding or aging as well as small breast size. Recent years have shown the emergence of a variety of injectable materials on market as breast fillers. These injectable breast fillers have swiftly gained popularity among women, considering the minimal invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know that the procedure may pose detrimental complications, while visualization of breast parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic challenges. We present a case series of three patients with prior history of hyaluronic acid and collagen breast injections. REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening shortness of breath, non-productive cough, central chest pain; associated with fever and chills for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases revealed non thrombotic wedge-shaped peripheral air-space densities. The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2- weeks duration. Previous collagen breast injection performed 1 year ago had impeded sonographic visualization of the breast parenchyma. MRI breasts showed multiple non- enhancing round and oval shaped lesions exhibiting fat intensity. CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well as limitations of imaging posed by breast fillers such that MRI is required as problem-solving tool

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

COPD as a risk factor for coronary artery disease (CAD): overview of 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment

We aimed to investigate the association between COPD and CAD (overview of 10-year risk of fatal cardiovascular event), and the relation to the severity of airflow limitation. Cross-sectional study including 220 patients with stable COPD as investigated group (IG), aged 40 to 75 years and 58 non-COPD subjects, matched by gender, age, BMI, smoking status, as control group (CG). All study subjects underwent pulmonary, cardiological evaluation, lipid and glycemic status. The analysis compared the 10-year established ASCVD risk between COPD stages (according to GOLD classification 1, 2, 3, 4) and between IG vs. CG. ASCVD score was classified as low (score <5%), borderline (5 to <7.5%), moderate (≥7.5 to <20) and high risk (score ≥20%). Results presented statistically significant difference between mean ASCVD value in IG 21,69±13,86% vs. CG 15,83±9,92% (p=0.0028). The median risk of ASCVD for fatal cardiovascular events was high in IG and moderate in CG. The mean and median values of 10-year ASCVD risk in the IG subgroups were: GOLD1 16,79±8,04% (50% of the subjects with risk >15,7%), GOLD2 22,67±16,49% (50% of the subjects with risk >20,6%), GOLD3 26,81±14,15% (50% of the subjects with risk > 27,6%) and GOLD4 20,70±13,52% (50% of the subjects with risk > 18,4%). The average ASCVD risk of fatal cardiovascular event was moderate in GOLD1 and GOLD4, and high in GOLD2 and GOLD3. We found higher risk for fatal cardiovascular outcome in patients with COPD, even in the early COPD stages (GOLD2), compared to non-COPD group. Our findings suggest that an urgent need to develop comprehensive strategies for prevention, screening and early treatment are needed