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Type 2 diabetes mellitus (T2D) is one of the most common metabolic diseases and is often associated with cervical radiculoplexus neuropathies. Magnetic resonance imaging is the modality of choice for evaluating the brachial plexus, however, the use of ultrasound for its evaluation has increased and has been shown to be an additional reliable method. We aimed to compare the cross-sectional areas of the C5, C6, and C7 nerve roots of the brachial plexus, at the interscalene groove, in asymptomatic patients with T2D to that of an asymptomatic control cohort without T2D. A total of 25 asymptomatic patients with T2D were recruited from outpatient clinics. A total of 18 asymptomatic subjects without T2D were also recruited from hospital staff volunteers to form the control cohort. High-resolution ultrasound imaging of the bilateral C5, C6, and C7 nerve roots of the brachial plexus was performed in the short axis, at the level of the interscalene grooves. The nerve root cross-sectional areas were recorded and compared. In the patients with T2D, HbA1c and fasting blood glucose (FBG) levels were obtained as well as the duration of T2D in years and correlated with cross-sectional areas. The cross-sectional areas of C6 and C7 were significantly smaller in the T2D cohort. Additionally, HbA1c, and FBG levels as well as the duration of T2D were negatively correlated with the C5, C6, and C7 cross-sectional areas. Our study demonstrated smaller brachial plexus nerve root cross-sectional areas in asymptomatic patients with T2D which negatively correlated with HbA1c, and FBG levels as well as the duration of T2D., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Diabetic neuropathy, including autonomic neuropathy is a serious complication related to type 2 diabetes mellitus (T2D). The vagus nerve (VN) is the longest nerve in the autonomic nervous system, and since diabetic neuropathy manifests first in longer nerves, the VN is commonly affected in early diabetic autonomic neuropathy. The use of high-resolution ultrasound for peripheral and cranial nerve imaging has significantly increased over the past 2 decades. The aim of the study is to compare the cross-sectional area of the VN in patients with T2D to that of a control cohort without T2D. A total of 52 VN cross-sectional areas were recorded from patients with T2D. A total of 56 VN cross-sectional areas were also recorded from asymptomatic subjects without T2D. In each subject, high-resolution ultrasound imaging of the bilateral VNs was performed in the short-axis between the common carotid artery and the internal jugular vein. The VN cross-sectional areas were recorded and compared. In the patients with T2D, HbA1c and fasting blood glucose levels were obtained as well as the duration of T2D in years and correlated with the cross-sectional areas. The bilateral VN cross-sectional areas were similar in both cohorts. Additionally, no correlation was seen between the VN cross-sectional areas, demographics, or clinical data of T2D. Our study demonstrated normal VN cross-sectional areas in patients with T2D without any significant relation with the patients' demographic or clinical data., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

The aim of this article is to utilize ultrasound to evaluate the normal cross-sectional area (CSA)of the vagus nerve (VN) in the carotid sheath. This study included 86 VNs in 43 healthy subjects (15 men, 28 women); mean age 42.1 years and mean body mass index 26.2 kg/m2. For each subject, the bilateral VNs were identified by US at the anterolateral neck within the common carotid sheaths. One radiologist obtained 3 separate CSA measurements for each of the bilateral VNs with complete transducer removal between each measurement. Additionally, for each participant, demographic information of age and gender as well as body mass index, weight, and height were documented. The mean CSA of the right VN in the carotid sheath was 2.1 and 1.9 mm2 for the left VN. The right VN CSA was significantly larger than the left VN (P < .012). No statistically significant correlation was noted in relation to height, weight, and age. We believe that the reference values for the normal CSA of the VN obtained in our study, could help in the sonographic evaluation of VN enlargement, as it relates to the diagnosis of various diseases affecting the VN., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: Limb salvage surgery is a surgical procedure for tumour resection in bone and soft-tissue cancers. Guidelines aim to preserve as much function and tissue of the limb as possible. Surgical outcome data is routinely available as part of surgical reporting processes. What is less known are important non-oncological outcomes throughout recovery from both clinical and patient perspectives. The objective of this review was to explore non-oncological outcomes in patients diagnosed with sarcoma around the knee following limb salvage surgery., Materials and Methods: A scoping review methodology was used, and results analysed using CASP checklists., Results: Thirteen studies were included and following appraisal and synthesis, three themes emerged as providing important measures intrinsic to successful patient recovery: (1) physical function, (2) quality of life and, (3) gait and knee goniometry. Specifically, patients develop range of motion complications that alter gait patterns and patients often limit their post-operative participation in sport and leisure activities., Conclusions: This study has shown the importance of exploring confounding factors, adopting a holistic view of patient recovery beyond surgical outcomes, proposing evidence-based guidance to support and inform healthcare providers with clinical decision-making. This review highlights the paucity and lack of quality of research available, emphasising how under-represented this population is in the research literature.IMPLICATIONS FOR REHABILITATIONPatients having undergone LSS often have limited participation in sport and leisure activities.Patients can develop range of motion complications, such as flexion contracture or extension lag, which may affect the pattern of gait.Clinical consideration should be given to walking ability and gait patterns during the rehabilitation phase to prevent poor functional outcomes during recovery.Variation of treatment protocols, outcome measurement and rehabilitative care has been identified as important in predicting the outcomes in recovery from LSS procedures.

Abstract: The aim of this work is to study the sonoelastographic features of the common fibular nerve in healthy adult subjects.This is an observational cross-sectional study. Shear wave elastography was used to evaluate the common fibular nerve. Crosssectional area and stiffness were measured in kilopascal (kPa) and meters/second (m/s).The study included 82 common fibular nerves in 41 healthy adult subjects. The mean cross-sectional area of the common fibular nerve at the fibular head was 8.7 mm2. Positive correlation was noted between stiffness measurements between short and long axes by both methods. The mean stiffness of the common fibular nerve in the short axis was 22.5 kPa, and in the long axis (LA) was 35.4 kPa. Positive correlation was noted between height and stiffness measured by both methods in both axes by kPa. In m/s, the mean stiffness of the common fibular in the short axis was 2.6 m/s, and while in the LA was 3.4 m/s. Height showed positive correlation with both axes for stiff measurements in m\s. Weight showed positive correlation with stiffness measurements by m/s in the LA.The results obtained in our study could be a reference point for evaluating stiffness of the common fibular nerve in research involving different pathologies., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: The aim of the study is to evaluate the reliability of shear wave elastography to assess the anterior and middle scalene muscles in healthy adult subjects.The study included 60 scalene muscles in 15 healthy subjects. High-resolution ultrasound and shear wave elastography were used to evaluate the anterior scalene and the middle scalene muscles. Stiffness values were measured.The mean shear elastic modulus showed the following values, right anterior scalene muscle 18.83 ± 5.32 kPa, left anterior scalene muscle 21.71 ± 4.8 kPa, right middle scalene muscle 12.84 ± 5.2 kPa, left middle scalene muscle 19.76 ± 5.30 kPa. Positive correlation was noted between the left middle scalene muscle and body mass index (P = .004). No difference in elasticity was noted between the right and left anterior scalene muscles; however, significant difference was noted between the right and left middle scalene muscles (P = .002).The results obtained in our study could be a reference point for future research considering different scalene muscle pathologies., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: The study included 38 ulnar nerves in 20 healthy subjects. High-resolution ultrasound and Shear wave elastography were used to evaluate the ulnar nerve at the mid forearm. The mean cross-sectional area of the ulnar nerve was 7.1 mm2. The mean shear elastic modulus of the nerve in the short axis was 27.4 kPa. The mean shear elastic modulus of the nerve in long axis was 24.7 kPa. No statistical relation could be noted between elasticity measurements in long and short axes. The ulnar nerve elastic modulus also showed no correlation with CSA neither in the long axis nor short axis. Age, height, weight, and body mass index showed no correlation with the ulnar elastic modulus in short or long axes. The elastic modulus of the ulnar nerve has been determined in healthy subjects and can serve as a reference for future assessment of compressive neuropathies of the ulnar nerve., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: This study was performed to examine the sonoelastographic features of the radial nerve in healthy subjects., Methods: In this observational cross-sectional study, shear wave elastography was used to evaluate the radial nerve. The cross-sectional area and stiffness were measured., Results: The study included 37 nerves in 20 healthy adult subjects. The mean cross-sectional area of the radial nerve at the arm was 6.1 mm 2 . The mean stiffness of the radial nerve in the short axis was 30.3 kPa, and that in the long axis was 34.9 kPa. The elasticity measurements were significantly different between the long axis and short axis., Conclusion: The elastic modulus of the radial nerve was studied in healthy subjects and can serve as a reference for future assessment of different radial nerve pathologies.

Objectives: To determine the cost-effectiveness of intensive blood pressure (BP) treatment in patients at high risk for cardiovascular disease (CVD) over their lifetime in Saudi Arabia., Methods: A Markov model was developed for the BP strategies to estimate the added lifetime costs and quality-adjusted life-years (QALYs) gained. These 2 items were then used to develop an incremental cost-effectiveness ratio (ICER). Event rates were estimated from the Systolic Blood Pressure Intervention Trial, and the other model inputs were retrieved from previous studies. Estimated costs were collected from 5 private hospitals in Riyadh, Saudi Arabia. The model used a lifetime framework adopting healthcare payer in Saudi Arabia. Sensitivity analysis was conducted using 1-way and probabilistic sensitivity analysis to evaluate the robustness and uncertainty of the estimates., Results: Over a 30-year period, intensive BP therapy would be cost-effective compared with the standard treatment with incremental costs per QALY, in US dollars, of $24 056. Probabilistic sensitivity analysis suggested intensive BP treatment would be cost-effective compared with standard treatment 86.7% of the time at a willingness-to-pay threshold of $$60 000 per QALY., Conclusion: The result of this study showed that intensive BP treatment appears to be a cost-effective choice for patients with a high risk of CVD in Saudi Arabia when compared with standard treatment., (Copyright © 2019 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

The aim of this study is to compare the distal femoral cartilage thickness of patients with type II diabetes mellitus with those of healthy subjects using ultrasonography. The study comprised 34 patients and 36 healthy subjects. Demographic characteristics of all the participants were recorded. The thickness of the femoral articular cartilage was measured using a 5-18MHzlinearprobe.Measurements were performed bilaterally from three points (intercondylar area, medial condyle, and lateral condyle). No significant difference could be found between patients and healthy subjects. Two demographic characteristics correlated positively with diabetic patients.

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Depression is common among MS patients. In patients without MS, lower vitamin D levels were associated with higher depression scores and severity. Supplementation of vitamin D was associated with significant improvement of depressive symptoms., Objective: to evaluate the relation between vitamin D levels and depression scores, and the effect of vitamin D replacement on the depressive symptoms in patients with MS., Methods: The study included 35 patients with relapsing remitting multiple sclerosis. Neurological, psychiatric, and radiological evaluations were done. Participants received 10,000 IU of cholecalciferol daily for 12 months., Results: Vitamin D level was low at baseline. Depressive symptoms were high at baseline and improved with vitamin D replacement although, Expanded Disability Status Scale (EDSS) score was not improving. Vitamin D levels correlated negatively with depressive symptoms at baseline and follow up periods., Conclusion: Lower vitamin D levels are associated with higher depressive scores, and vitamin D replacement could improve depressive symptoms in patients with relapsing remitting multiple sclerosis., (Copyright © 2019. Published by Elsevier B.V.)

Background: Traumatic brain injury (TBI) is the major public health problem worldwide, particularly in the Middle East. Diffuse axonal injury (DAI) is commonly found in TBI. Although DAI can lead to physical and psychosocial disabilities, its prognostic value is still a matter of debate. Magnetic Resonance (MR) is more sensitive for detecting DAI lesions., Objective: To identify the radiological and clinical factors associated with the functional capacity one year after the traumatic brain injury., Methods: The study included 251 patients with severe head trauma for whom Brain MRI was done within one month after injury. Demographic, clinical, and radiological data were collected during hospitalization. Neurocognitive and psychiatric evaluation were done one year thereafter., Results: DAI was more frequent in our patients. Psychiatric disorders, cognitive impairment, and poor functional outcome were more common in patients with DAI especially those with cerebral hemisphere and brain stem lesion, and mixed lesions. Duration of post traumatic amnesia (DPTA), lost consciousness and hospital stay (DHS) as well as the volume of diffuse axonal injury (DAI) were associated with poor neurocognitive outcome. DPTA, and DAIV may be considered independent factors that could predict the neurocognitive outcome., Conclusion: MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with poor long-term neurocognitive and psychiatric outcomes., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: Sonoelastography is an emerging technology that has been used to evaluate the musculoskeletal system including the brachial plexus of peripheral nerves, which has been only recently considered for study by shear wave elastography. The purpose of this study is to establish the normal sonoelastographic features of the C5-C7 nerve roots of the brachial plexus., Methods: Forty healthy individuals (21 males and 19 females) were enrolled in the study. Shear wave elastography was used to evaluate the C5-C7 nerve roots of the brachial plexus at the interscalene interval. Normal sonoelastographic values were obtained., Results: The mean shear elastic modulus of the C5 nerve root was 16.9 kPa (range 5.9-28.8 ± 4.9 standard deviation, SD), 15.7 kPa (range 5.4-26.3 ± 4.3 SD) for the C6 nerve root, and 16 kPa (range 8-29 ± 4.6 SD) for the C7 nerve root. There was a significant statistical difference between both sexes in the elastic modulus at the C6 and C7, but not at the C5 nerve roots. Significant inverse correlation with height was noted at the C6 nerve root. There was no statistical significant difference in tissue stiffness between right- and left-handed subjects, age, and body mass index., Conclusion: The elastic modulus of the C5-C7 nerve roots has been determined in asymptomatic individuals and can serve as a reference when studying pathological conditions of these structures., Abbreviations: BMI: body mass index; SWE: shear wave elastography.

The objective of this study is to determine whether the cross sectional area (CSA) measurement of the median nerve at the wrist differ between carpal tunnel syndrome (CTS) in diabetic patients with and without diabetic polyneuropathy (DPN).This study included 44 patients with type II diabete millitus (DM) with CTS, 32 patients with CTS and DPN, 46 patients with idiopathic CTS, and 42 healthy subjects. Ultrasonographic measurement of the CSA of the median nerve was made at the level of the wrist, together with nerve conduction studies.The median CSA at the wrist was significantly larger in all patient groups compared with healthy subjects. The median nerve CSA was significantly larger in diabetic patients with CTS than patients with idiopathic CTS. The median nerve CSA at wrist was significantly smaller in patients with CTS and DPN compared with diabetic patients with CTS only.The median nerve CSA at the wrist was larger in diabetic patients with CTS than patients with idiopathic CTS and CTS with DPN. Median nerve CSA can help to differentiate between diabetic patients with CTS with and without DPN.

Background: Idiopathic intracranial hypertension (IIH) is primarily a disorder of young obese women of unknown etiology. The clinical presentation of IIH is similar to that of sinus thrombosis. The incidence of transverse sinus stenosis (TSS) reaches up to 90% of patients with IIH compared with normal subjects, and venous sinus thrombosis was reported in 11.4% of patients previously diagnosed as having IIH. Patients with thrombosis showed an abnormal region of double- track pattern on gadolinium (Gd) - enhanced T1WI within the dural sinus., Aim: This study aims to evaluate whether double - track sign can differentiate primary TSS from thrombosed TSS in patients presumed to have IIH based on Gd - enhanced MRI., Methods: This study was a retrospective multicenter observational case control study. The clinical and radiological data for all adult patients with presumed IIH were collected. The diagnosis of TSS was made based on further evaluation by DSA or MRV., Results: Fifty-nine sinuses were diagnosed as a transverse sinus stenosis. Eight sinuses (13.6%) were partially occluded by recanalized thrombus. Double track sign was detected in seven (87.5%) of the thrombosed sinuses., Conclusion: The double track sign remains much sensitive for the detection of transverse sinus thrombosis (TST) and it might provide an early clue for the dural sinus thrombosis in patients presumed to have IIH.