Prevalence of major adverse cardiovascular events among Saudi patients with systemic lupus erythematosus compared with the general population: updates from the national SLE and PURE cohorts.

OBJECTIVE: This study examined the prevalence of major adverse cardiovascular events (MACE) among Saudi patients with SLE and the general population and considered factors associated with such outcomes were taken into consideration. METHODS: This is a cohort study evaluating the period prevalence of MACE from 2020 to 2023. The study used two datasets, namely the Saudi national prospective cohort for SLE patients and the Prospective Urban-Rural Epidemiology Study Saudi subcohort (PURE-Saudi) for the general population. Participants in both studies were monitored using a standardised protocol. MACE was defined as myocardial infarction (MI), stroke or angina. The analysis was adjusted for demographics, traditional cardiovascular risk factors and SLE diagnosis through logistic regression models. RESULTS: The PURE and national SLE cohorts comprised 488 and 746 patients, respectively. Patients with SLE from the SLE cohort were younger (40.7±12.5 vs 49.5±8.6 years) and predominantly female (90.6% vs 41.6%). The prevalence of traditional risk factors was greater in the PURE cohort compared with the SLE cohort. These factors included dyslipidaemia (28.9% vs 49.4%), obesity (63% vs 85%) and diabetes (7.8% vs 27.2%), but not hypertension (19.3% vs 18.8%). MACE (defined as MI or stroke or venous thromboembolism or heart failure) occurred more frequently in patients with SLE (4.3% vs 1.6%, p=0.004). Older age and lupus diagnosis were independently associated with MACE after adjusting for conventional risk factors. The odds of MACE were significantly related to age and lupus diagnosis (p=0.00 and p=0.00, respectively), but not cardiovascular disease (CVD) risk factors (p=0.83). CONCLUSION: Patients with SLE have a significantly higher risk of developing MACE than the general population. This risk is not well explained by traditional risk factors, which may explain the failure of CVD risk scores to stratify patients with SLE adequately. Further studies are needed to understand CVD risk's pathogenesis in SLE and mitigate it.

Targeting Induced Local Lesions in the Wheat DEMETER and DRE2 Genes, Responsible for Transcriptional Derepression of Wheat Gluten Proteins in the Developing Endosperm.

Wheat is a major source of energy and nutrition worldwide, but it is also a primary cause of frequent diet-induced health issues, specifically celiac disease, for which the only effective therapy so far is strict dietary abstinence from gluten-containing grains. Wheat gluten proteins are grouped into two major categories: high-molecular-weight glutenin subunits (HMWgs), vital for mixing and baking properties, and gliadins plus low-molecular-weight glutenin subunits (LMWgs) that contain the overwhelming majority of celiac-causing epitopes. We put forth a hypothesis that eliminating gliadins and LMWgs while retaining HMWgs might allow the development of reduced-immunogenicity wheat genotypes relevant to most gluten-sensitive individuals. This hypothesis stems from the knowledge that the molecular structures and regulatory mechanisms of the genes encoding the two groups of gluten proteins are quite different, and blocking one group's transcription, without affecting the other's, is possible. The genes for gliadins and LMWgs have to be de-methylated by 5-methylcytosine DNA glycosylase/lyase (DEMETER) and an iron-sulfur (Fe-S) cluster biogenesis enzyme (DRE2) early during endosperm development to permit their transcription. In this study, a TILLING (Targeting Induced Local Lesions IN Genomes) approach was undertaken to identify mutations in the homoeologous DEMETER (DME) and DRE2 genes in common and durum wheat. Lines with mutations in these genes were obtained that displayed reduced content of immunogenic gluten proteins while retaining essential baking properties. Although our data at first glance suggest new possibilities for treating celiac disease and are therefore of medical and agronomical interest, it also shows that inducing mutations in the DME and DRE2 genes analyzed here affected pollen viability and germination. Hence there is a need to develop other approaches in the future to overcome this undesired effect.

Proteomics Reveals the Changes that Contribute to Fusarium Head Blight Resistance in Wheat.

Fusarium head blight (FHB) is a devastating disease of wheat, causing yield losses and quality reduction as a result of mycotoxin production. In this study, iTRAQ (isobaric tags for relative and absolute quantification)-labeling-based mass spectrometry was employed to characterize the proteome in wheat cultivars Xinong 538 and Zhoumai 18 with contrasting levels of FHB resistance as a means to elucidate the molecular mechanisms contributing to FHB resistance. A total of 13,669 proteins were identified in the two cultivars 48 h after Fusarium graminearum inoculation. Among these, 2,505 unique proteins exclusively accumulated in Xinong 538 (resistant) and 887 proteins in Zhoumai 18 (susceptible). Gene Ontology enrichment analysis showed that most differentially accumulated proteins (DAPs) from both cultivars were assigned to the following categories: metabolic process, single-organism process, cellular process, and response to stimulus. Kyoto Encyclopedia of Genes and Genomes analysis showed that a greater number of proteins belonging to different metabolic pathways were identified in Xinong 538 compared with Zhoumai 18. Specifically, DAPs from the FHB-resistant cultivar Xinong 538 populated categories of metabolic pathways related to plant-pathogen interaction. These DAPs might play a critical role in defense responses exhibited by Xinong 538. DAPs from both genotypes were assigned to all wheat chromosomes except chromosome 6B, with approximately 30% mapping to wheat chromosomes 2B, 3B, 5B, and 5D. Twenty single nucleotide polymorphism markers, flanking DAPs on chromosomes 1B, 3B, 5B, and 6A, overlapped with the location of earlier mapped FHB-resistance quantitative trait loci. The data provide evidence for the involvement of several DAPs in the early stages of the FHB-resistance response in wheat; however, further functional characterization of candidate proteins is warranted.

Comparison Of Positivity Of Tuberculin Skin Test With Diagnostic Bcg In Children Suffering From Tuberculosis.

BACKGROUND: Tuberculosis is major public health problem in Pakistan and it is often unrecognized cause of morbidity and mortality in children living in endemic areas. Children with age less than 5 years, and especially those who are immune compromised, are at higher risk of developing tuberculosis following exposure. Tuberculosis in children is usually difficult to diagnose compare to adult patients due to its atypical presentation. Tuberculin skin test and Bacille Calmette-Guerin (BCG) are widely used as diagnostic tests for tuberculosis. It was a Cross sectional study carried out from May 2017 to Nov 2018 in the department of Paediatrics, Ayub Teaching Hospital Abbottabad.. METHODS: Both BCG and tuberculin skin test were performed at the same time by the same doctor. Personal data like age, gender and address, type of tuberculosis, positivity of tuberculin skin test and positivity of diagnostic BCG were recorded. The induration was read 48- 72 hours after administration. RESULTS: As per frequencies and percentages for positivity of tuberculin skin, 51 (67.10%) patients showed positivity for tuberculin skin while 71 (93.42%) patients showed positive results via BCG Test. CONCLUSIONS: In paediatric age group, diagnostic BCG test has got better diagnostic value over Tuberculin Skin Test in diagnosis of tuberculosis.

Biogenic synthesis of iron oxide nanoparticles via Skimmia laureola and their antibacterial efficacy against bacterial wilt pathogen Ralstonia solanacearum.

Plant diseases are threat to global food security. The excessive use of agrochemicals is the leading cause of pesticides resistance and toxicity to beneficial life forms. The quest for innocuous and alternate antimicrobial agent is crucial in order to overcome the pathogen resistance and the birth of nanotech offers pledge to combat pathogenic organisms. In this study, a facile benign biogenic approach was adopted for the synthesis of biocompatible iron oxide nanoparticles (Fe2O3-NPs) via Skimmia laureola leaf extract and the synthesized nanoparticles were evaluated for their antibacterial efficacy against bacterial wilt pathogen Ralstonia solanacearum in vitro and in planta. Physico-chemical characterization of the synthesized nanoparticles was performed through UV-Visible spectroscopy, Fourier Transform Infrared Spectroscopy, X-Ray Diffraction, Energy Dispersive X-ray Spectroscopy and Scanning Electron Microscopy. The results revealed polydisperse nanoparticles in the size range of 56 nm to 350 nm. The culture media containing 6 mg/mL of Fe2O3-NPs dramatically inhibited the bacterial growth in vitro. Scanning electron microscopy revealed degenerative characteristics including degraded, shriveled and concentrated cell walls. Diseases severity was effectively reduced with 6% w/v of Fe2O3-NPs treated root zone in planta. Plant shoots, root length and fresh biomass were enhanced with Fe2O3-NPs treatments. The results indicated that the biosynthesized Fe2O3-NPs have the potential to control agriculturally important phytopathogen Ralstonia solanacearum in vitro and in planta.

Congenital heart disease frequency in children undergoing MDCT angiography; a 4-year tertiary care hospital experience from Kabul, Afghanistan.

OBJECTIVES: Echocardiography and cardiac angiography are two main imaging modalities used for evaluating congenital heart diseases (CHDs). Evaluation of CHDs is now possible with Multidetector CT (MDCT) angiography in Afghanistan. To the best of researchers' knowledge, no published data is available on frequency of CHDs among children undergoing chest MDCT angiography in Afghanistan; hence, this study is first of its nature to be conducted in this context. To describe the frequency of CHDs among children who underwent chest MDCT angiography in radiology department at French Medical Institute for Mothers and Children (FMIC) from April 2010 to July 2014. METHODS & MATERIALS: A retrospective, cross-sectional descriptive study was conducted at radiology department FMIC in Kabul, Afghanistan. The study population consisted of all paediatric patients (aged 1 day-17 years) who underwent chest MDCT angiography at radiology department FMIC from April 2010 to July 2014. All examinations were performed in arterial phase by 128 slice Siemens scanner after intravenous administration of non-ionic water-soluble contrast material (Omnipaque 350) at a volume of 2 ml/Kg. CT setup included non-electrocardiogram gated CT, CT dose index 5-10 and dose-length product 120-200, with post-processing following initial scan. CT reports were reviewed from Radiology Information System. Data collection tool was developed and data were analysed using SPSS v. 22. Frequencies and proportion were calculated for various CHDs. RESULTS: A total of 942 cases of contrast enhanced chest MDCT examinations were performed during this period. Out of these, 212 cases with CHDs were recruited, from which 29 cases were excluded because of undergoing previous surgical procedures or had incomplete CT reports. Remaining 183 cases (n = 183) of CHDs were included for further analysis. A total of 107 patients (58.5%) were male and 76 (41.5%) were female. The patients aged 1 day-17 years (mean age 4.47 + 4.76 standard deviation). A total of 87 patients (47.5%) had solitary anomalies while 96 patients (52.5%) had more than one defect. In terms of location, 20 cases (10.9%) were isolated intracardiac anomalies, 116 cases (63.4%) were isolated extracardiac anomalies and 47 cases (25.7%) had mixed intra- and extracardiac anomalies. CONCLUSION: Given the frequency, it is clear that CHDs is a complex health problem in Afghan paediatric population. MDCT angiography can be considered as a non-invasive, readily available diagnostic tool in evaluation of complex cardiac anomalies after initial evaluation. ADVANCES IN KNOWLEDGE: MDCT evaluation of CHD as an alternative to echo/angiography has become more important in a country where there is severe shortage of interventional cardiologists.

Demonstration of a Tritiated Nitroxide Nuclear Battery.

Unattended, compact, terrestrial and space sensors require sources that have high energy and power densities to continuously operate for 3 to 99 years depending on application. Currently, chemical sources cannot fully satisfy these applications, especially in solid state form. Betavoltaic (ßV) nuclear batteries using ß--emitting radioisotopes possess energy densities 1000 times greater than conventional chemical sources. Their power density is a function of ß- flux saturation point relative to the planar (2D) configuration, ß- emission range, and the semiconductor converter, the betavoltaic (ßV) cell, properties. The figure of merit is the beta (ß-)-flux surface power density ( [Formula: see text] in µWn per cm2 footprint), where an optimal portion of incident beta particles penetrates the surrounding semiconductor depletion region. Tritiated nitroxides are favorable radioisotope sources with the potential to have the highest specific activity (Am in Ci/g) and [Formula: see text] for an organic compound in solid form. The goal of this research is to demonstrate a tritiated nitroxide nuclear battery using the planar (2D) coupling configuration. The reproducible tritiation procedure produced stable product with a Am of approximately 635 Ci/g, which was 70% of the theoretical Am. For the nuclear battery demonstration, the tritiated nitroxide, dissolved in methanol, was deposited on a 4H-SiC ßV and InGaP photovoltaic (PV) cell using a dispensing apparatus and micropipette. Both devices' characteristics were measured beforehand using a controlled electron beam source to approximate the surface radioactivity from the deposited radioisotope. The maximum power point (MPP) of the 4H-SiC and InGaP were 7.77 nW/cm2 and 1.63 nW/cm2 with 100 mCi and 67 mCi, respectively. The power and total efficiency were lower than expected due to partial solvent evaporation and droplet thickness. Numerical models using MCNP6 Monte Carlo code were used to simulate an optimal nuclear battery prototype. The models' accuracy was confirmed with the device calibration curves and a previous metal tritide model based on empirical results. Based on optimal model results, the tritiated nitroxide saturation layer thickness (D0.99) and [Formula: see text] (D0.99) were 10 µm and 558 nW/cm2, respectively, using a 4H-SiC.

Beta particle transport and its impact on betavoltaic battery modeling.

Simulation of beta particle transport from a Ni-63 radioisotope in silicon using the Monte Carlo N-Particle (MCNP) transport code for monoenergetic beta particle average energy, monoenergetic beta particle maximum energy, and the more precise full beta energy spectrum of Ni-63 were demonstrated. The beta particle penetration depth and the shape of the energy deposition varied significantly for different transport approaches. A penetration depth of 2.25±0.25µm with a peak in energy deposition was found when using a monoenergetic beta particle average energy and a depth of 14.25±0.25µm with an exponential decrease in energy deposition was found when using a full beta energy spectrum and a 0° angular variation. For a 90° angular variation, i.e. an isotropic source, the penetration depth was decreased to 12.75±0.25µm and the backscattering coefficient increased to 0.46 with 30.55% of the beta energy escaping when using a full beta energy spectrum. Similarly, for a 0° angular variation and an isotropic source, an overprediction in the short circuit current and open circuit voltage solved by a simplified drift-diffusion model was observed when compared to experimental results from the literature. A good agreement in the results was found when self-absorption and isotope dilution in the source was considered. The self-absorption effect was 15% for a Ni-63 source with an activity of 0.25mCi. This effect increased to about 28.5% for a higher source activity of 1mCi due to an increase in thickness of the Ni-63 source. Source thicknesses of approximately 0.1µm and 0.4µm for these Ni-63 activities predicted about 15% and 28.5% self-absorption in the source, respectively, using MCNP simulations with an isotropic source. The modeling assumptions with different beta particle energy inputs, junction depth of the semiconductor, backscattering of beta particles, an isotropic beta source, and self-absorption of the radioisotope have significant impacts in betavoltaic battery design.

Computed tomography features of supracardiac total anomalous pulmonary venous connection in an infant.

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital anomaly of the pulmonary veins drainage. In this entity, the pulmonary veins, instead of draining to left atrium, connect abnormally to the systemic venous circulation. A right-to-left shunt is obligatory for survival. Based on its type and degree of pulmonary venous obstruction, TAPVC may result in pulmonary hypertension and congestive heart failure. In severe cases, urgent diagnosis and surgical correction is essential to reduce morbidity and mortality. Echocardiography as the first and safest imaging modality for cardiovascular abnormalities may fail in complete depiction of some complex feature of TAPVC. Computed tomography angiography is then a noninvasive and sensitive choice for mapping the pulmonary veins without the need for invasive cardiac catheterization. Contrast-enhanced MR angiography can be a radiation-free alternative. Authors present a computed tomography-detected supracardiac TAPVC with small patent ductus arteriosus in a 2 months cyanotic infant.

Visual and otologic manifestation of Camurati-Engelmann's disease: a case report.

Camurati-Engelmann's disease (CED) is a rare disorder worldwide with just over 200 cases reported. No case of CED has been reported in Afghanistan till date. Most patients of CED (also known as progressive diaphyseal dysplasia and oeteopathica hyperostotica multiplex infantalis) present with extremity pain, muscle weakness, and waddling gait. It tends to be bilateral and symmetrical and can affect any bone but has greater affinity for long bones e.g., humerus, femur, tibia, ulna, and radius. Other common sites include skull and pelvis. Symptomatology relating to cranial nerve impingement is secondary to amorphous increase in the density of skull bones resulting in stenosis of various foramina/spaces within skull.

Diagnostic accuracy of ultrasonography in differentiating benign and malignant thyroid nodules using fine needle aspiration cytology as the reference standard.

BACKGROUND: In Pakistan thyroid cancer is responsible for 1.2% cases of all malignant tumors. Ultrasonography (US) is helpful in detecting cancerous thyroid nodules on basis of different features like echogenicity, margins, microcalcifications, size, shape and abnormal neck lymph nodes. We therefore aimed to calculate diagnostic accuracy of ultrasound in detection of carcinoma in thyroid nodules taking fine needle aspiration cytology as the reference standard. MATERIALS AND METHODS: A cross-sectional analytical study was designed to prospectively collect data from December 2010 till December 2012 from the Department of Radiology in Aga Khan University Hospital, Karachi, Pakistan. A total of 100 patients of both genders were enrolled after informed consent via applying non-probability consecutive sampling technique. Patients referred to Radiology department of Aga Khan University to perform thyroid ultrasound followed by fine-needle aspiration cytology of thyroid nodules were included. They were excluded if proven for thyroid malignancy or if their US or FNAC was conducted outside our institution. RESULTS: The subjects comprised 76 (76%) females and 24 males. Mean age was 41.8±SD 12.3 years. Sensitivity and specificity with 95%CI of ultrasound in differentiating malignant thyroid nodule from benign thyroid nodule calculated to be 91.7% (95%CI, 0.72-0.98) and 78.94% (0.68-0.87) respectively. Reported positive predictive value and negative PV were 57.9% (0.41-0.73) and 96.8% (0.88-0.99) and overall accuracy was 82%. Likelihood ratio (LR) positive was computed to be 4.3 and LR negative was 0.1. CONCLUSIONS: Ultrasonography has a high diagnostic accuracy in detecting malignancy in thyroid nodules on the basis of features like echogenicity, margins, micro calcifications and shape.

Endovascular embolisation of visceral artery pseudoaneurysms.

Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient age was 44.79 ± 13.9 years and mean pseudoaneurysm size was 35 ± 19.5 mm. Technical success rate for endovascular visceral pseudoaneurysm coiling was 93.47% (n = 43). Complication rate was 6.52% (n = 3). Followup was done for a mean duration of 21 ± 1.6 months (0.5-69 months). Complete resolution of symptoms or improvement in clinical condition was seen in 36 patients (80%) out of those 45 in whom procedure was technically successful. Conclusion. Results of embolization of visceral artery pseudoaneurysms with coils at our center showed high success rate and good short term outcome.

MDCT of Small Bowel Obstruction: How Reliable Are Oblique Reformatted Images in Localizing Point of Transition?

The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemar's test was used to detect any statistical difference in POT evaluation between datasets A and B. Kappa statistics were applied for measuring agreement between two readers. Results. There was a diagnostic improvement of 9.9% in the case of the less experienced radiologist in localizing POT by using oblique reformatted images. The more experienced radiologist showed diagnostic improvement by 12.9%.

Basic life support: a questionnaire survey to assess proficiency of radiologists and radiology residents in managing adult life support in cardiopulmonary arrest and acute anaphylactic reaction.

The aim of this paper is to assess proficiency of radiologists and radiology residents in managing adult life support in cardiopulmonary arrest and acute anaphylactic reaction.

Ovarian masses: is multi-detector computed tomography a reliable imaging modality?

BACKGROUND: Ovarian cancer continues to pose a major challenge to physicians and radiologists. It is the third most common gynecologic malignancy and estimated to be fifth leading cancer cause of death in women, constituting 23% of all gynecological malignancies. Multi-detector computed tomography (MDCT) appears to offer an excellent modality in diagnosing ovarian cancer based on combination of its availability, meticulous technique, efficacy and familiarity of radiologists and physicians. The aim of this study was to compute sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of 64- slice MDCT in classifying ovarian masses; 95% confidence intervals were reported. MATERIALS AND METHODS: We prospectively designed a cross-sectional analytical study to collect data from July 2010 to August 2011 from a tertiary care hospital in Karachi, Pakistan. A sample of 105 women aged between 15-80 years referred for 64-MDCT of abdomen and pelvis with clinical suspicion of malignant ovarian cancer, irrespective of stage of disease, were enrolled by non- probability purposive sampling. All patients who were already known cases of histologically proven ovarian carcinoma and having some contraindication to radiation or iodinated contrast media were excluded. RESULTS: Our prospective study reports sensitivity, specificity; positive and negative predictive values with 95%CI and accuracy were computed. Kappa was calculated to report agreement among the two radiologists. For reader A, MDCT was found to have 92% (0.83, 0.97) sensitivity and 86.7% (0.68, 0.96) specificity, while PPV and NPV were 94.5% (0.86, 0.98) and 86.7% (0.63, 0.92), respectively. Accuracy reported by reader A was 90.5%. For reader B, sensitivity, specificity, PPV and NPV were 94.6% (0.86, 0.98) 90% (0.72, 0.97) 96% (0.88, 0.99) and 87.1% (0.69, 0.95) respectively. Accuracy computed by reader B was 93.3%. Excellent agreement was found between the two radiologists with a significant kappa value of 0.887. CONCLUSION: Based on our study results, we conclude MDCT is a reliable imaging modality in diagnosis of ovarian masses accurately with insignificant interobserver variability.

Accuracy of CT cerebral perfusion in predicting infarct in the emergency department: lesion characterization on CT perfusion based on commercially available software.

This study aims to assess the diagnostic accuracy of a single vendor commercially available CT perfusion (CTP) software in predicting stroke. A retrospective analysis on patients presenting with stroke-like symptoms within 6 h with CTP and diffusion-weighted imaging (DWI) was performed. Lesion maps, which overlays areas of computer-detected abnormally elevated mean transit time (MTT) and decreased cerebral blood volume (CBV), were assessed from a commercially available software package and compared to qualitative interpretation of color maps. Using DWI as the gold standard, parameters of diagnostic accuracy were calculated. Point biserial correlation was performed to assess for relationship of lesion size to a true positive result. Sixty-five patients (41 females and 24 males, age range 22-92 years, mean 57) were included in the study. Twenty-two (34 %) had infarcts on DWI. Sensitivity (83 vs. 70 %), specificity (21 vs. 69 %), negative predictive value (77 vs. 84 %), and positive predictive value (29 vs. 50 %) for lesion maps were contrasted to qualitative interpretation of perfusion color maps, respectively. By using the lesion maps to exclude lesions detected qualitatively on color maps, specificity improved (80 %). Point biserial correlation for computer-generated lesions (R pb = 0.46, p < 0.0001) and lesions detected qualitatively (R pb = 0.32, p = 0.0016) demonstrated positive correlation between size and infarction. Seventy-three percent (p = 0.018) of lesions which demonstrated an increasing size from CBV, cerebral blood flow, to MTT/time to peak were true positive. Used in isolation, computer-generated lesion maps in CTP provide limited diagnostic utility in predicting infarct, due to their inherently low specificity. However, when used in conjunction with qualitative perfusion color map assessment, the lesion maps can help improve specificity.

Jejunoduodenogastric intussusception secondary to percutaneous gastrostomy tube in an adult patient.

Intussusception is the most common abdominal emergency in early childhood, but it is rare entity in adults. Jejenoduodenogastric intussusception is an exceedingly rare retrograde small-bowel intussusception. Percutaneous endoscopic gastrostomy (PEG) has become the preferred procedure for establishing enteral feeding in most clinical situations. Despite the fact that it is relatively safe, a number of complications can occur following PEG placement; jejenoduodenogastric intussusception is one of them, but it is a very rare entity. Here, we report a case of jejenoduodenogastric intussusception secondary to placement of a PEG tube in an adult patient. To our knowledge, this is the third case of isolated duodenogastric intussusception being reported.

Goldston syndrome.

Goldston syndrome is a rare entity describing the association of polycystic kidneys and Dandy Walker malformation with or without hepatic fibrosis. A 28 years old pregnant woman came to radiology department for the first antenatal scan. Ultrasound showed a single fetus corresponding to 27 week of gestation. The fetal brain revealed deficient vermis with a posterior fossa cyst communicating with the 4th ventricle suggestive of Dandy-Walker malformation (DWM). The kidneys were enlarged, and echogenic containing small cysts with associated amniotic fluid index of 5 cm suggestive of oligohydramnios. A diagnosis of Goldston syndrome was suggested. These findings were confirmed on post natal head and renal ultrasound.

Calcified pulmonary thromboembolism in a child with sickle cell disease: value of multidetector CT in patients with acute chest syndrome.

The incidence of pulmonary embolism in children is not clearly known, but is believed to be low. Risk factors for pulmonary thromboembolism include central venous catheter, malignancy, surgery, infection, trauma, and congenital hypercoagulable disorders. Children with sickle cell disease are prothrombotic and are at an increased risk of thromboembolism. The incidence of this event is unknown because these children are often not thoroughly imaged. We report here a case of a calcified pulmonary thromboembolism in a child with sickle cell disease and emphasize the use of multidetector CT in detection of pulmonary thromboembolism in children with sickle cell disease.