Adult presentation of subacute necrotizing encephalomyelopathy in two siblings

Subacute necrotizing encephalomyelopathy (SNE) or Leigh syndrome is a rare progressive neurodegenerative mitochondrial disorder typically manifesting in the pediatric age group with variable clinical presentation and genetic heterogeneity. Late-onset varieties are extremely rare and only few cases have been reported globally. Neuroimaging however shows characteristic symmetrical necrotic lesions in the basal ganglia and/or brainstem. We report cases of two siblings who had history of seizures, but presented to us in adulthood. They had similar clinical presentation and radiological features on magnetic resonance imaging (MRI) and were subsequently diagnosed with SNE primarily based on imaging

Lumbar artery pseudoaneurysm following renal biopsy.

Lumbar artery pseudoaneurysms have previously been described as rare iatrogenic complications following percutaneous interventional procedures involving the flanks. We describe a case of a 71-year-old man who became unstable and dropped 3 grams of hemoglobin within 24 hours following renal biopsy. A post-biopsy hemorrhage was suspected, and a pseudoaneurysm of his second right lumbar (L2) artery was found on computed tomography angiogram (CTA). Successful coil embolization was performed in the right L2 artery. This case discusses the diagnostic and therapeutic challenges of this unusual complication as well as the anatomical and technical factors involved in the embolization of the lumbar arteries

Imaging patterns of encephalopathy in patients with COVID-19

The aim of this retrospective observational study was to describe the neuroimaging manifestations of patients with COVID-19. This study was conducted at Aga Khan University Hospital, Karachi, Pakistan from March to July 2020. COVID-19 patients with neurological symptoms and positive neuroimaging were included after confirmation of COVID-19 by polymerase chain reaction test (PCR). In the 12 included patients, seizures and altered mentation were predominant neurological manifestations. Three cases had acute watershed infarcts (25%), two cases had posterior cerebral artery territorial infarcts (16.7%), two cases had periventricular corona radiata infarcts (16.7%), three cases had hypoxic ischemic encephalopathy (25%), two cases had posterior reversible encephalopathy syndrome (16.7%), and there was one case each of cerebral venous sinus thrombosis, pontine infarct, and bithalamic lesions (8.3%). This study highlights the diagnostic approaches in COVID-19-associated encephalopathy and the variable imaging features that clinicians and neuroradiologists should be aware of, as the pandemic progresses. Key Words: COVID-19, Neuroimaging, Encephalopathy, Magnetic resonance imaging, Coronavirus

Adoption of robotic assisted partial nephrectomies: a population-based analysis of U.S. surgeons from 2004-2013

The advent of minimally invasive and robotic techniques has resulted in the rapid adoption of this novel technology, with the field of urology at the forefront. Since the first Robotic‐Assisted Laparoscopic Radical Prostatectomy (RALP) was performed in 2000 using  the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA), surgeons have rapidly incorporated robotic technology for the use of radical prostatectomies for prostatic carcinoma. Prior to 2005, only a minority of surgeons‐‐fewer than 2.5%‐‐performing radical  prostatectomies utilized robotic assistance.  However, robotic assistance has become the predominant approach for radical prostatectomies, increasing from 22% to 85% between the years 2002 to 2013, representing a nearly five‐fold increase in utilization

MELAS: a complex and challenging diagnosis

Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) is a rare multisystem disorder and is the most common maternally inherited mitochondrial disease. This condition has a special predilection for the nervous system and muscles. Typical findings on brain imaging include stroke-like areas, calcification of basal ganglia and brain atrophy. This accounts for the disease being, both clinically and radiologically, mistaken for ischemic stroke. The differentiation features from stroke include comparatively young age of the patients, site of the lesions, and relative overlap between the cerebral vasculature territories. In this case report, we discuss a 16-year male with clinical and radiological features highly suggestive of MELAS syndrome. Since this disease is rare and its clinical presentation is complex, it is among the most challenging to diagnose. It is particularly difficult to differentiate between ischemic stroke and MELAS. Magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI), susceptibility weighted imaging (SWI) sequences and MR spectroscopy may aid in establishing the diagnosis. A particularly characteristic feature of MELAS syndrome is that recurrence may occur in locations different than previously noted, which was also seen in our patien

Context Aware Dynamic Traffic Signal Optimization

Conventional urban traffic control systems have been based on historical traffic data. Later advancements made use of detectors, which enabled the gathering of real time traffic data, in order to reorganize and calibrate traffic signalization programs. Further evolvement provided the ability to forecast traffic conditions, in order to develop traffic signalization programs and strategies precomputed and applied at the most appropriate time frame for the optimal control of the current traffic conditions. We, propose the next generation of traffic control systems based on principles of Artificial Intelligence and Context Awareness. Most of the existing algorithms use average waiting time or length of the queue to assess an algorithms performance. However, a low average waiting time may come at the cost of delaying other vehicles indefinitely. In our algorithm, besides the vehicle queue, we use fairness also as an important performance metric to assess an algorithms performance

Utility and accuracy of primary and secondary ultrasonographic signs for diagnosing acute appendicitis in pediatric patients

Introduction Making an accurate diagnosis of acute appendicitis (AA) is vital to prevent the morbid complications associated with untreated AA. This is challenging in up to 30% of pediatric patients which is a significantly high number. Ultrasound (US) has been generally used as the initial mode of imaging in pediatric patients due to the lack of ionizing radiation. Given its variable accuracy, adjuvants such as secondary signs can be used to aid the radiologist in making an accurate diagnosis. Materials and methods Patients between the ages of two and sixteen years with acute abdominal pain suspicious for AA, who underwent right lower quadrant US between 2003 and 2016, were retrospectively identified. Corresponding computed tomography (CT) and histopathology findings were noted. Based on the presence of primary and secondary signs, results were classified into three groups to determine accuracy. Group 1 included all patients with a normal appendix or if the appendix was not visualized, no secondary signs were present. Group 2 patients were those in which the appendix was not clearly seen and they had one or more secondary signs of AA. Group 3 included all patients with primary signs of AA. The number of secondary signs and cases with perforated appendices were also correlated with sonographic accuracy. Results One thousand one hundred and fifteen patients met the inclusion criteria of which 29% had confirmatory AA. The positive appendectomy rate was 89% (337/380). Using a 3-category classification of US results, the sensitivity was 79%, specificity 97%, positive predictive value was 93%, negative predictive value was 91% and the overall accuracy was 91%. The presence of two or more secondary signs had a high likelihood of appendicitis. The perforation rate was 10% with the highest percentage seen in Group 2 patients. Conclusion Despite inescapable limiting factors, US should be used as first-line imaging for suspected appendicitis in pediatric patients especially since its accuracy rivals CT when the appendix is visualized. The use of secondary sonographic signs has solid potential to aid the radiologist in making an accurate diagnosis with our study demonstrating a proportional relationship between the number of secondary signs and the likelihood of true appendicitis. However, further investigation is needed to determine the individual accuracy of secondary signs and whether a certain combination of secondary signs has a higher association with appendicitis

A Curious Case of Intermittent Left Bundle Branch Block Associated with Cough

A handful of cases of voluntary control of left bundle branch block (LBBB) have been described in the literature. We report the case of a middle-aged man who was found to have LBBB on baseline electrocardiogram (ECG) which disappeared on coughing and then reappeared with the same maneuver. Subsequent myocardial perfusion scan showed reduced count in the anteroseptal region likely attributed to LBBB. It is possible that the intermittent conduction changes may be due to the alteration in the vagal tone associated with cough as reflected in the change in the PR interval on the ECG

Non-surgical retrieval of dislodged or misplaced intravascular/ ndoluminal foreign objects.

Abstract Interventional procedures involving the use of intravascular or endoluminal objects have rapidly increased over the years with advancements in minimally invasive techniques. These foreign objects such as endovascular coils, guidewires, and endoluminal catheters, if lost or malpositioned, are a potential threat, which can result in complications such as embolization, perforation, infections, and arrhythmias. Therefore, timely removal of these foreign bodies is essential. In this technical report, we have described our experience with different scenarios in which percutaneous interventional techniques for retrieval of such foreign bodies were performed at our institute