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Background Osteoporosis is a prevalent condition leading to an increased risk of bone fractures . Osteoporosis poses a worldwide public health concern, impacting over 200 million individuals and resulting in a staggering 1.66 million hip fractures each year. Opportunistic osteoporosis screening can be employed during CT scans to assess bone mineral density (BMD) through Hounsfield units (HU) without the need for additional imaging, radiation exposure, or appointments. This study aimed to investigate a CT scan's diagnostic value in the opportunistic osteoporosis screening through L1 vertebra densitometry and compare it with dual-energy x-ray absorptiometry (DXA) findings. Results One hundred forty-nine patients with an average age of 67.70 ± 10.94 years were included in the study. The age of osteoporotic patients was significantly higher than osteopenic ( p = 0.001) and normal individuals ( p < 0.001). The HU of osteoporotic patients was found to be significantly lower compared to both osteopenic ( p = 0.023) and normal individuals ( p < 0.001). According to the ROC curve for osteoporosis prediction using the HU (AUC = 0.793 and p < 0.001), with a cut-off of 103 HU, the CT scan had a sensitivity of 69% and a specificity of 74% for the diagnosis of osteoporosis. Conclusion Individuals with osteoporosis exhibit a significantly lower average HU compared to both osteopenic and healthy individuals. A CT scan can serve as an effective predictor of osteoporosis in patients. The CT images obtained for reasons unrelated to osteoporosis diagnosis can be employed to discern patients with osteoporosis without incurring the added cost or radiation exposure.

Background The coronavirus disease 2019, also known as COVID-19, imposed various challenges to healthcare and became a pandemic accompanied by a high rate of mortality. This infection has many manifestations and affects nearly all body systems. The circulatory and coagulation systems also seem to be affected. Studies show elevated rates of thrombotic events within COVID-19 patients such as disseminated intravascular coagulation (DIC), deep vein thrombosis (DVT), and pulmonary embolism (PE). Incidences of such coagulopathies were correlated to poor patient prognosis and mortality. Given the importance, complication, and mortality caused by thrombotic events (TEs) in COVID-19 patients, the goals of this study are to collect and analyze data on coagulopathy in COVID-19 patients and the pathophysiology and molecular events behind it. We also aim to bring attention to the role of d -dimer in COVID-19 infection by presenting the most recent information available from research studies evaluating d -dimer as a potential biomarker for disease severity, as well as mortality in COVID-19 patients. Main body Various mechanisms are described for COVID-19 coagulopathies such as endothelial cell dysfunction, fibrinolysis inhibitor overexpression, immuno-thrombosis, and imbalance between pro- and anticoagulants, to name a few. d- dimer which is a degradation product of fibrin is a helpful diagnostic tool for the assessment of clots and thrombosis. Given the pro-thrombotic nature of COVID-19 infection, within the current narrative review, we studied the diagnostic value of d- dimer for PE prediction. Several studies utilized d- dimer as a predictive tool for detecting PE, and the results were varied. Different cutoff points are proposed ranging from 0.5 up to over 4 mg/L with varying sensitivity and specificity. Although CT pulmonary angiography (CTPA) is the standard model for the prediction of PE, radiation exposure, contrast nephropathy, higher cost, and lack of adequate access can shift our diagnosis into models based on d- dimer. Short conclusion In summary, various coagulopathies have been associated with COVID-19 infection, and a safe and early diagnosis is needed. d- dimer showed various successes in PE prediction and can be a good candidate for further research and diagnostic model and algorithm development.

Background and Aim Rheumatoid arthritis (RA) is an autoimmune chronic inflammatory disease affecting 0.5%−1% of adults worldwide. The carotid intima‐media thickness (CIMT) is a simple, reliable, noninvasive marker for subclinical atherosclerosis. The aim of this study was to compare the intima‐media thickness of the common carotid artery in patients with RA with that of healthy patients. Methods In this case‐control study, subjects were recruited from the patients who presented to a private rheumatology clinic. RA was documented by a rheumatologist. All subjects underwent an ultrasound examination of the carotid artery to assess CIMT. Subjects with RA filled out the disease activity score (DAS28) questionnaire. Results Sixty‐two subjects (31 subjects with RA and 31 healthy subjects) took part in the study. The mean age of the subjects in the RA and the control groups was 42.39 ± 12.98 and 44.48 ± 13.56 years, respectively. Values of CIMT were significantly greater in RA subjects compared with their healthy counterparts (p < 0.001). The CIMT increased significantly with increased disease severity (r = 0.73). Subjects were divided into two age groups (≤40 and >40 years). A comparison of CIMT in the mentioned subgroups revealed a remarkable difference in CIMT values between those of the RA patients and those of their control counterparts in both age groups (p = 0.002 and p < 0.001 for those below and above 40 years, respectively). Conclusion CIMT could be used as an efficient clinical index for identifying the early stages of atherosclerosis and predicting cardiovascular events following atherosclerosis in RA patients.

Background Idiopathic intracranial hypertension (IIH) is a rare medical condition in children. Based on the different radiological findings reported in various studies in pediatric IIH, this study was conducted to determine the diagnostic value of MRI findings in diagnosing IIH in children. Methods In this retrospective study, the medical records of all children aged 1 to 18 years who visited Ghaem Hospital in Mashhad, Iran, between 2012 and 2022 and were diagnosed with IIH were gathered. Forty-nine cases of children with IIH and 48 control cases of children with the first unprovoked seizure with no indications of increased intracranial pressure for comparison were selected. Patient demographic information and MRI findings were extracted. The comparison between different MRI findings in the case and control groups was conducted using statistical tests. Results In the case group, the mean diameter of the subarachnoid space expansion around the optic nerve was 5.96 ± 1.21, compared to 4.79 ± 0.33 in the control group, with statistically significant difference ( P  < 0.001). All the patients with flattening of the posterior globe or transverse sinus stenosis were in the case group, and the frequency of these findings in the case group was significantly higher than in the control group ( P  < 0.001). The majority of patients (95.5%) classified under category 3 and 4 of empty sella were part of the case group, and the statistical test results indicated a significant difference between the two groups ( P  < 0.001). The optic nerve sheath diameter cut-off of 5.35 mm, when used for expansion of the subarachnoid space around the optic nerve, with a sensitivity of 82% and a specificity of 100% in diagnosing IIH. Conclusion The most reliable diagnostic indicators for diagnosing IIH in children are perioptic subarachnoid space expansion with high sensitivity, and posterior globe flattening and transverse sinus stenosis with high specificity.

Purpose Axillary lymph node assessment is an essential component of staging invasive breast cancer. One of the crucial issues in determining prognosis and treatment is the number of lymph nodes found by the pathologist. It is difficult to identify small lymph nodes among the surrounding fat. Fat-dissolving solutions have been introduced to dissolve fat, but their clinical benefit has yet to be evaluated. In this study, we compare 10% buffered formalin fixation and Carnoy's solution in revealing the axillary lymph node counts in modified radical mastectomy specimens. Method Fifty axillary tail specimens, taken from patients with invasive breast cancer who underwent modified radical mastectomy surgery, were randomly fixed in Carnoy’s solution or 10% buffered formalin. After 24–48 h of fixation, the total number and size of separated lymph nodes were examined by an expert pathologist. Result The average number of lymph nodes found in Carnoy and formalin solutions was 8 and 7.52, respectively, and the average number of metastatic lymph nodes found in these two solutions was 2.77 and 1.8, respectively. Moreover, the average size of the Carnoy group's lymph nodes was smaller than the formalin group, with no significant differences. Conclusion Compared to the formalin solution, taking into account the overall advantages of Carnoy's solution such as the same time of the preparation process, reduced carcinogenicity with only a slightly increased cost, using Carnoy's solution seems to be cost-effective in better staging and changing the patient's need for adjuvant treatments.

Background Pyeloplasty currently stands as the standard treatment for UPJO. Our study aimed to assess the diagnostic value of sonographic parameters following Lasix administration in patients who underwent pyeloplasty to predict the recurrence of obstruction and the need for reoperation. Methods The study included 70 children with UPJO who underwent pyeloplasty. Renal ultrasound was performed on patients three to six months after pyeloplasty. Following the Lasix administration, the changes in ultrasound parameters at the 18th and 30th minute were documented. Within two weeks, patients underwent radioisotope renography. Diuretic ultrasound's diagnostic value in predicting the need for reoperation was assessed through a comparison with radioisotope renography. Results The average age of the patients was 3.94 ± 3.52 years. Anteroposterior diameter of the renal pelvis (APD) changes at 18 and 30 min, and the average APD after surgery at 18 and 30 min was significantly higher in patients requiring reoperation. The best cutoff point of APD changes in the 18th minute was 9.50 (sensitivity = 91.7%, specificity = 82.8%). The best cutoff point of APD after surgery in the 18th minute was 25.90 (sensitivity = 91.7%, specificity = 81.0%). The best cutoff points of the resistive index (RI) in the 18th and 30th minutes were reported as 0.70 (sensitivity = 41.7%, specificity = 50.0%) and 0.71 (sensitivity = 41.7%, specificity = 37.9%), respectively. Conclusions The assessment of ultrasound findings following pyeloplasty has revealed that changes in APD can serve as a reliable means for assessing the efficacy of the operation.