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Antipsychotic drugs (APDs) are used to treat many psychiatric illnesses as schizophrenia. Typical antipsychotic drugs (TAPDs) are being used; however, they have many side effects. Atypical antipsychotic drugs (AAPDs) are newer medications with known fewer side effects. Aripiprazole (ARI) is an AAPD, recommended by healthcare providers, even during pregnancy. It can cross the placental barrier and enter fetal circulation, so it might be possible that ARI can adversely impair normal placental development and growth, if it is given prenatally. ARI was applied orally to pregnant female rats in two doses (3& 6 mg/kg body weight). On gestation day 20, the mothers were sacrificed, and the placentas were removed and processed for general histological and electron microscopic evaluations. Immunohistochemistry was done using anti-PCNA (proliferating cell nuclear antigen), anti-Bax (for apoptosis) and anti-vascular endothelial growth factor alpha (VEGFA). Morphological evaluation revealed degenerative changes in the placenta as dark nuclei, vacuolization, and cyst formation. Ultra-structurally, there was degeneration of cellular components including organelles and nuclei. These changes were found in different cells of the basal and labyrinth zones and were dose dependent. Immunohistochemistry revealed upregulation of Bax and VEGFA and downregulation of PCNA. Prenatal administration of the AAPD, ARI to pregnant female rats resulted in histological changes in the placenta. Additionally, there was a decrease in cellular proliferation and increase in apoptosis, and vascular impairment. This indicates placental atrophy and dysgenesis and might suggest possible teratogenic effects to ARI, which needs further evaluation., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Abstract: Percutaneous native kidney biopsies performed with ultrasound (US) or computed tomography (CT) guidance are important in the workup of medical renal disease, with modality choice often dependent on the performing institution, with various complication rates reported. We compared the complication rates and types of complication of US- versus CT-guided native parenchymal renal biopsy among hospitalized patients. One hundred five consecutive inpatient US- and CT-guided native parenchymal renal biopsies performed by radiologists at a tertiary care academic center between 2006 and 2020 were reviewed retrospectively. Complication rates of biopsy were calculated and compared between the 2 modalities. Comparisons with regard to types of complications were made using the Society of Interventional Radiology grading scale, American Society of Anesthesiologists score, and other clinical data. One hundred five hospitalized adult patients (58 women and 47 men; average age, 53 years) underwent native parenchymal kidney biopsy during the study period. Sixty-three (60%) were CT-guided and 42 (40%) were US-guided. Complication rates between CT- versus US-guided biopsies were 40% versus 19% ( P = 0.03), respectively. There were 7 major and 18 minor complications for CT-guided biopsies and 3 major and 5 minor complications for US-guided biopsies. No statistically significant difference was found in preprocedural American Society of Anesthesiologists Classification score, international normalized ratio, platelet count, or body mass index. Computed tomography-guided native parenchymal kidney biopsy was associated with a higher overall complication rate compared with US-guided biopsy for hospitalized patients. Most complications were minor, which required no treatment or additional follow-up., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The objective of our study was to explore the impact of COVID-19 pandemic on learning anatomy and to compare the students' perceptions of "face-to-face" and "online" anatomy teaching, and to assess their impact on student's performance. We used a descriptive, cross-sectional, questionnaire-based study that focused on a single cohort of undergraduate medial students who attended anatomy demonstrations, at the College of Medicine and Medical Sciences, Arabian Gulf University (CMMS-AGU), both pre-pandemic (face-to-face) during 2019-2020 and the pandemic (online) during 2020-2021. Students who participated in this study responded in favor of face-to-face demonstrations for better understanding of the spatial orientation of body organs and systems, the visualization of the anatomical relations between structures, understanding the difficult anatomical structures, understanding the clinical correlations, and making them more confident about their practical exams. On the other hand, students were in favor of online demonstrations for retaining key information, confidence levels on discussing anatomy learning needs, effective utilization of demonstration time, and lower stress associated with the online learning. Regarding anatomy exam scores, statistically significant difference was found between mean scores of online and onsite exams in one of the two analyzed multiple choice questions tests. However, there was a statistically significant difference between the mean scores of objective structured practical examination of online and onsite exams in the two analyzed tests. Furthermore, the majority of the students who participated in the survey prefer a mixture of both face-to-face and online anatomy demonstrations during the pandemic and also in the post-COVID-19 era., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To determine if preliminary radiology reports issued overnight (10 pm to 7 am) on adult trauma patients cause major changes of high clinical significance or patient harm., Methods: Following extraction of preliminary and final radiology reports from the report server, presence of changes was determined by an automated text differential checker. If text changes were present, reports were then subsequently manually graded by an attending radiologist and placed in category by degree of severity. 81 weeks of trauma report data were analyzed by two faculty radiologists., Results: Of the 6063 preliminary reports from 1214 separate overnight trauma patients, 65.5% had no changes in final report text. The remaining reports were graded: A 8.9% (503), B 17.2% (1005), C 7.0% (426), and D 1.3% (100). No reports demonstrated a major change of high clinical significance (E) or patient harm (F)., Conclusion: Most preliminary report changes were minor and had no clinical significance. Furthermore, the few that were deemed to be major changes were of little clinical significance, particularly in the setting of the other traumatic injuries that the patient may have sustained. No negative patient safety events were caused by an error in a radiology resident preliminary report., (© 2021. American Society of Emergency Radiology.)

When considering patients for a major hepatectomy, one must carefully consider the volume of liver to be left behind and if additional procedures are necessary to augment its volume. This review considers the optimal volume of the future liver remnant (FLR) and analyzes the techniques of augmenting this volume, the various growth parameters to assess adequate growth of the FLR, as well as further management when there has been inadequate growth of the FLR.

Objectives: In 2018, the ACGME (Accreditation Council for Graduate Medical Education) made a change to the maximum permissible number of consecutive nights a resident trainee can be on "night float," from six to seven nights. To our knowledge, although investigators have studied overall discrepancy rates and discrepancy rates as a function of shift length or perceived workload of a particular shift, no study has been performed to evaluate resident-faculty discrepancy rates as a quality/performance proxy, to see whether resident performance declines as a function of the number of consecutive nights. Our hypothesis is that we would observe a progressive increase in significant overnight resident - attending discrepancies over the 7 days' time., Methods: A total of 8,488 reports were extracted between 4/26/2019 to 8/22/2019 retrospectively. Data was obtained from the voice dictation system report server. Exported query was saved as a .csv file format and analyzed using Python packages. A "discrepancy checker" was created to search all finalized reports for the departmental standard heading of "Final Attending Report," used to specify any significant changes from the preliminary interpretation., Results: Model estimates varied on different days however there were no trends or patterns to indicate a deterioration in resident performance throughout the week. There were comparable probabilities throughout the week, with 2.17% on Monday, 2.35% on Thursday and 2.05% on Friday., Conclusions: Our results reveal no convincing trend in terms of overnight report discrepancies between the preliminary report generated by the night float resident and the final report issued by a faculty the following morning. These results are in support of the ACGME's recent change in the permissible number of consecutive nights on night float. We did not prove our hypothesis that resident performance on-call in the domain of report accuracy would diminish over seven consecutive nights while on the night float rotation. Our results found that performance remained fairly uniform over the course of the week., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Objective: We sought to compare variability in serum creatinine among inpatients in our institution receiving contrast imaging studies and among inpatients not receiving such studies., Materials and Methods: This retrospective, single-site, multiple-cohort study in a 550-bed academic medical center in October 2016 used the electronic medical record data to analyze the greatest absolute and relative changes in serum creatinine over periods no longer than 48 hours (1) during the admission for 1,134 patients who did not receive a contrast imaging study, (2) before the earliest contrast study for 155 patients who had not yet had a scheduled contrast examination, and (3) straddling the time when 266 patients received their earliest contrast study. We compared creatinine changes in the first cohort with those in the second and the third using histograms and t tests., Results: Among those who did not receive contrast, 18.3% had a creatinine increase of greater than 0.3 mg/dL, and before contrast, 14.2% had such increases (P = .22). After contrast, 6.4% had increases at least this great (P < .001). Patients with increases in creatinine before contrast tended to have such increases after as well (Pearson's 0.48, P < .001)., Conclusions: Physiological variability may explain the similar increases among patients who did not receive contrast versus patients who had not yet received contrast. Hydration therapy may explain the milder and fewer increases after contrast. Only a randomized clinical trial can determine whether acute kidney injuries are caused by contrast; these results support equipoise for such a trial., (Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the association between sarcopenia and sarcopenic obesity on clinical, perioperative, and oncologic outcomes in patients with upper-tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU)., Methods: Retrospective review of our institutional UTUC database was performed to identify all patients who underwent radical nephroureterectomy from 2002-2016. Skeletal Muscle Index (SMI) was measured at the L3 vertebral level and standardized according to patient height (cm 2 /m 2 ). Sarcopenia was defined as<55cm 2 /m 2 for men and<39cm 2 /m 2 for women. Sarcopenic obesity was also assessed in patients with BMI>30kg/m 2 . Unadjusted logistic regression and Wilcoxon rank sum tests examined the relationship between sarcopenia and variables., Results: A total of 100 patients (66 men and 34 women) with a mean age of 68 years, BMI of 30, Charlson comorbidity index of 4.0, tumor size of 3.5, and SMI of 50.8cm 2 /m 2 were included. Furthermore, 42 patients (42%) were sarcopenic, and 18 patients (18%) had sarcopenic obesity. Median EBL was 150ml, OR duration was 322 minutes, and length of stay was 5.0 days. Sarcopenia was associated with several clinical factors including decreasing BMI, male sex, and coronary artery disease, albeit without association with any perioperative or oncologic outcomes. Sarcopenic obesity was similarly associated with several clinical variables including male sex, diabetes mellitus, hyperlipidemia, as well as increased EBL (P = 0.047) and non-bladder cancer disease relapse (P = 0.049)., Conclusions: This contemporary cohort of patients undergoing RNU highlights the association of nonmodifiable risk factors with sarcopenia and disease relapse with sarcopenic obesity. Larger studies are necessary to further validate these observations., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: The use of three-dimensional (3D) printing allows for creation of custom models for clinical care, education, and simulation. Medical imaging, given the significant role it plays in both clinical diagnostics and procedures, remains an important area for such education and simulation. Unfortunately, the materials appropriate for use in simulation involving radiographic or ultrasound imaging remains poorly understood. Therefore, our study was intended to explore the characteristics of readily available 3D printing materials when visualized by computed tomography (CT) and ultrasound., Methods: Seven 3D printing materials were examined in standard shapes (cube, cylinder, triangular prism) with a selection of printing methods ("open," "whole," and "solid" forms). For CT imaging, these objects were suspended in a gelatin matrix molded to match a standard human CT phantom. For ultrasound imaging, the objects were placed in acrylic forms filled with a gelatin matrix. All images were examined using OsiriX software., Results: Computed tomography imaging revealed marked variation in materials' Hounsfield units as well as patterning and artifact. The Hounsfield unit variations revealed a number of materials suitable for simulation various human tissues. Ultrasound imaging showed echogenicity in all materials, with some variability in shadowing and posterior wall visualization., Conclusions: We were able to demonstrate the potential utility for 3D printing in the creation of CT and ultrasound simulation models. The similar appearance of materials via ultrasound supports their broad utility for select tissue types, whereas the more variable appearance via CT suggests greater potential for simulating differing tissues but requiring multiple printer technologies to do so.

Background: The Veridex CellSearch is an FDA-approved technology for enumerating circulating tumor cells in blood samples of metastatic colorectal cancer mCRC) patients and has prognostic value. It is important to understand how counts of circulating tumor cells (CTCs), which are advocated to be tools for "liquid biopsy" of tumors, correlate with clinical and pathologic variables of significance in these patients. In this study, we have attempted to make such correlations along with evaluating how CTC counts change during the course of chemotherapy., Patients and Methods: Following an IRB-approved protocol, blood samples were collected from 24 patients with mCRC along with relevant clinico-pathological data. Blood was collected at defined time-points both prior to as well as during the course of treatment with combination chemotherapy, and CTC counts were enumerated from 7.5 ml of blood., Results: Seventeen out of 24 patients with mCRC showed a CTC count of 2 or less cells in 7.5 ml of blood at base-line assessment before chemotherapy while 7 patients showed 3 or more cells in 7.5 ml of blood at that point. A correlation was found between high carcino-embryonic antigen (CEA) levels and high CTC counts (P = 0.018) although it was also found that some patients had elevated CTCs without an elevated CEA. No correlation with the time interval between detection of primary tumor and appearance of secondary (metastatic) tumor(s) was found. CTC counts did not correlate with the presence of lung or liver metastases, i.e. a number of mCRC patients with lung or liver metastases had a count of zero CTCs at baseline. We also noted no correlation between CTC number and the status of KRAS or BRAF mutation. CTC counts dropped immediately after the start of chemotherapy in 11 out of 21 patients, and also reduced from the baseline at the end of chemotherapy in 5 out of 10 patients. Six of 7 patients who started with 3 or more CTCs in 7.5 ml at baseline also showed a final CTC reduction at the end of the therapy assessment., Conclusions: Analysis of circulating tumor cells may be of use in monitoring response to therapy in mCRC, either in combination with CEA monitoring or alone when CTCs are elevated but CEA level is not.

We present the case of a 43-year-old-man with wild-type KRAS and BRAF colorectal adenocarcinoma that was metastatic to the liver and lung. The patient initially received neoadjuvant chemotherapy with FOLFOX and bevacizumab, followed by surgical resection of the primary tumor and hepatic metastases. His disease recurred shortly after surgery and he was treated with FOLFIRI plus the anti-EGFR antibody cetuximab. After this regimen failed to arrest his disease progression, treatment with FOLFIRI in combination with another anti-EGFR antibody, panitumumab was started. While on this therapy, the patient's lung nodules remained largely stable but metastatic lesions within the liver continued to progress. Our case highlights the differences between panitumumab and cetuximab, and contemplates the possible explanations for this patient's apparently heterogeneous disease progression within the liver despite stabilization of multiple pulmonary nodules.

Objective: The aim of this study was to compare the accuracy of liver magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) versus dynamic contrast enhancement (DCE) versus DWI and DCE in characterizing benign versus malignant lesions and in making correct diagnosis of focal liver lesions., Methods: Sixty-six adult patients with 115 lesions were evaluated by 2 readers for differentiating benign versus malignant lesions and for lesion diagnosis. The readers evaluated the lesions using unenhanced MRI with DWI and, 4 weeks later, using MRI with DCE and, subsequently, using MRI and DCE with DWI. The final pathologic diagnosis was reached by biopsy or with imaging follow-up., Results: The accuracy of differentiating benign versus malignant lesions of both readers 1 and 2 using DWI was 90.4%; using DCE, 91.3% and 90.4%, respectively; and using DCE with DWI, 98.3% and 95.7%, respectively. The accuracy of diagnosis of readers 1 and 2 using DWI was 83.5% and 80%; using DCE, 87% and 84.4%; and using DCE with DWI, 93.9% and 91.3%, respectively., Conclusions: Unenhanced MRI with DWI and MRI with DCE have similar accuracy for characterizing focal liver lesions. Magnetic resonance imaging with DCE and DWI has increased accuracy compared with either sequence alone.

Colorectal cancer patients with BRAF-mutant tumors have a more aggressive, rapidly progressing disease that is in critical need of novel therapeutic approaches. Indeed, whereas the median overall survival (OS) of colorectal cancer (CRC) patients receiving standard-of-care therapy is approximately two years or more if their tumors express wild-type BRAF and wild-type KRAS, median OS is less than twelve months with tumors expressing V600E-mutant BRAF and wild-type KRAS. Pro-apoptotic receptor agonists are a class of biologic agents under development to induce tumor-specific apoptosis and are being combined with classical chemotherapy or targeted agents in clinical trials. Herein, we present the case of a patient with bulky V600E-mutant BRAF hepatic flexure colon carcinoma, treated initially with FOLFOX plus bevacizumab neoadjuvant therapy and surgery. The patient had a rapid tumor relapse with metastatic disease to the liver and lung, and was enrolled in a phase 1b open-label clinical study, where he received the FOLFIRI regimen in combination with the pro-apoptotic receptor agonist dulanermin (rhApo2L/TRAIL). The patient maintained stable disease through 25 doses administered every two weeks before his disease progressed. After coming off study, the patient underwent surgical debulking and received intraperitoneal hyperthermic chemotherapy. He subsequently relapsed and was treated with FOLFIRI plus cetuximab. At the time of this report, the patient remains on active treatment. It is unclear what effect dulanermin may have had on the course of his disease, but it is noteworthy that the patient remained on FOLFIRI plus dulanermin therapy for a period that exceeded the median OS for patients with advanced, aggressive BRAF-mutant CRC. It is also noteworthy that at the time of this report the patient's overall survival since diagnosis has exceeded 30 months, which is beyond what is generally observed even for patients with CRC harboring wild-type BRAF and wild-type KRAS.

Objective: Simulation laboratories use realistic clinical scenarios to train physicians in a controlled environment, especially in potentially life-threatening complications that require prompt management. The objective of our study was to develop a comprehensive program using the simulation laboratory to train radiology residents in the management of acute radiologic emergencies., Materials and Methods: All radiology residents attended a dedicated simulation laboratory course lasting 3 hours, divided over two sessions. Training included basic patient management skills, management of a tension pneumothorax, massive hemorrhage, and contrast agent reactions. Participants were presented with 20 multiple-choice questions before and after the course. Pre- and posttest results were analyzed, and the McNemar test was used to compare correct responses by individual question., Results: Twenty-six radiology residents attended the class. The average pre- and posttest scores and the average difference between the scores for all residents were 13.8, 17.1, and 3.3, respectively (p < 0.0001). Incorrect answers on the pretest examination that were subsequently answered correctly concerned administration of epinephrine for severe reactions, management of a tension pneumothorax, oxygen therapy, ECG placement, cardiopulmonary resuscitation technique, and where to stand during a code situation. Persistent incorrect answers concerned vasovagal reactions and emergency telephone numbers at an off-site imaging center., Conclusion: Simulation laboratories can be used to teach crisis management and crisis resource management for radiology residents and should be part of the education toolbox. Defined objectives lead to a comprehensive course dealing with the management of acute radiologic emergencies. Such programs can improve the role of radiologists as members of the health care team.

Objective: The purpose of this study was to determine the effect of renal cyst size and location on pseudoenhancement in human subjects., Materials and Methods: Simple renal cysts obtained with 16-, 40-, and 64-MDCT scanners were analyzed for the presence of pseudoenhancement. Cyst size, location, and attenuation in the unenhanced and nephrographic phases were recorded. Pseudoenhancement was defined as an attenuation increase of 10 HU or more on nephrographic phase compared with unenhanced images., Results: The pseudoenhancement rate was 22% (51/233). There was a statistically significant increase in the pseudoenhancement rate of lesions smaller than 10 mm (38/233) compared with those 10 mm and larger (13/233) (odds ratio, 6.4; p<0.0001). Twelve of 62 cysts measuring 10-14 mm exhibited pseudoenhancement. There was a statistically significant increase in the pseudoenhancement rate of central (39/53) compared with peripheral (12/51) cysts (odds ratio, 2.7; p<0.0001). The pseudoenhancement rates for the 16-, 40-, and 64-MDCT scanners were 20%, 19%, and 26% with no statistically significant difference between them., Conclusion: Pseudoenhancement of renal cysts significantly correlates with size smaller than 1 cm and central location. Although pseudoenhancement increases with larger numbers of detectors, the correlation was not statistically significant. Cysts in the 1- to 1.5-cm range have a 19% likelihood of pseudoenhancement.

Peripheral primary neuroectodermal tumors (PNET) are uncommon tumors, with an overall incidence of 1% of all sarcomas. Renal PNET is extremely rare. It is an aggressive tumor, with a high incidence of local recurrence and early metastases. Radiological diagnosis can be challenging as it is often difficult to differentiate it from other primary renal neoplasms. Imaging features include a large heterogeneous mass with central low density areas due to necrosis. Intra tumor hemorrhage and calcification are rare. We present a rare case of a large PNET mimicking renal cell carcinoma in a 51 year old female that required arterial embolization and nephrectomy.

With the trend towards minimally invasive and nephron-sparing surgery for renal masses, laparoscopic partial nephrectomy and energy ablative techniques have become common approaches to treat low-stage tumours. Complications following such techniques are occasional, especially for ablation techniques. This review illustrates the imaging of these complications and of tumour recurrence, with the conclusion that imaging plays an important role in their diagnosis, and in the infrequent situation that intervention is needed, helps to plan subsequent management.

Ankylosing spondylitis is not an uncommon disease worldwide, yet is relatively rare in Bahrain. There is a typical pattern of joint involvement in cases of ankylosing spondylitis, but the presentation of discitis is rare. We present a case of a patient presenting with backache and was diagnosed to have discitis. The diagnosis of ankylosing spondylitis was made only after he was found to be Human Leukocyte Antigen-827 positive. This is the first case report of ankylosing spondylitis presenting as discitis in Bahrain.

Ankylosing spondylitis is not an uncommon disease worldwide, yet is relatively rare in Bahrain. There is a typical pattern of joint involvement in cases of ankylosing spondylitis, but the presentation of discitis is rare. We present a case of a patient presenting with backache and was diagnosed to have discitis. The diagnosis of ankylosing spondylitis was made only after he was found to be Human Leukocyte Antigen-B27 positive. This is the first case report of ankylosing spondylitis presenting as discitis in Bahrain.