Family medicine residents' skill levels in emergency chest X-ray interpretation.

BACKGROUND: Family medicine physicians may encounter a wide variety of conditions, including acute and urgent cases. Considering the limited access to diagnostic investigations in primary care practice, chest X-ray remains the imaging modality of choice. The current study assessed the competency of family medicine residents in the interpretation of chest X-rays for emergency conditions and to compare it with that of diagnostic radiology residents, general practitioners, and medical interns. METHODS: An online survey was distributed to 600 physicians, including family medicine residents, medical interns, general practitioners, and diagnostic radiology residents. The study included some background information such as gender, years in practice, training type, interest in pulmonary medicine and diagnostic radiology, and having adequate training on the interpretation of chest X-rays. The survey had 10 chest X-ray cases with brief clinical information. Participants were asked to choose the most likely diagnosis and to rate their degree of confidence in the interpretation of the chest X-ray for each case. RESULTS: The survey was completed by 205 physicians (response rate = 34.2%). The overall diagnostic accuracy was 63.1% with a significant difference between family medicine and radiology residents (58.0% vs. 90.5%; P < 0.001). The COVID-19 pneumonia (85.4%) and pneumoperitoneum (80.5%) cases had the highest diagnostic accuracy scores. There was a significant correlation between the diagnostic confidence and accuracy (rs = 0.39; P < 0.001). Multivariable regression analysis revealed that being diagnostic radiology residents (odds ratio [OR]: 13.0; 95% confidence interval [CI]: 2.5-67.7) and having higher diagnostic confidence (OR: 2.2; 95% CI: 1.3-3.8) were the only independent predictors of achieving high diagnostic accuracy. CONCLUSION: The competency of family medicine residents in the interpretation of chest X-ray for emergency conditions was far from optimal. The introduction of radiology training courses on emergency conditions seems imperative. Alternatively, the use of tele-radiology in primary healthcare centers should be considered.

Extrahepatic Mucinous Biliary Cystadenoma: A Case Report.

Biliary cysts refer to cystic dilatation in the biliary ductal system that may be congenital or acquired. Extrahepatic biliary cysts constitute less than 10% of biliary cysts. Extrahepatic mucinous cystadenoma represents an extremely rare clinical condition with less than 100 cases reported in the English medical literature. Herein, we report the case of a middle-aged woman who presented with a clinical picture of cholestatic jaundice. Laboratory findings revealed elevated bilirubin and alkaline phosphatase. After a thorough investigation, she was found to have a cystic lesion in the common bile duct near the cystic duction site. The patient underwent exploratory laparotomy, which revealed a 2.0 × 2.0 cm cystic lesion in the common bile duct that is exerting an obstructive effect on the biliary ducts. Complete en-block excision of the cystic lesion was performed with Roux-en-Y hepaticojejunostomy reconstruction. Histopathological examination revealed mucinous biliary cystadenoma. Although very rare, biliary cystadenoma should be kept in mind as a differential diagnosis of cholestatic jaundice particularly in patients with no history of biliary stones or cholecystectomy.

Non O1 Vibrio cholerae as a cause of bacteremic lower limb cellulitis: A case report.

INTRODUCTION: Self-limiting gastroenteritis and wound infections in immunocompetent patients are most of the cases involved with Non-O1, non-O139 Vibrio cholerae which its microorganism occasionally accountable for intestinal and extra-intestinal infections. Cellulitis is an infection of the skin and underlying soft tissue mostly affected by bacteria. Diabetic foot ulcer is the most costly and devastating complication of diabetes mellitus. CASE PRESENTATION: This following case describes a bacteremic soft tissue infection in a diabetic patient who is 54-year-old male with 6 years of type 2 diabetes mellitus. The patient was treated with surgical debridement of the foot ulcer, calf fasciotomy and medical therapy then he discharged. The next day readmitted with deteriorating of his condition the whole right leg to the level of the knee became ischemic and black with evidence of wet gangrene. A Guillotine above knee amputation was done. DISCUSSION: Upon review of literature, we only found few cases have been reported of cellulitis due to V. cholerae. A degree of hepatic impairment or immunocompromised state like Diabetes Mellitus, chronic infections, malignancies, and peripheral vascular disease are seen in the majority of non-gastrointestinal V. cholerae infections which suggests that it should be included in the differential diagnosis of bacteremic skin and soft tissue infections in patients with underlying illnesses. CONCLUSION: Cholerae should be included in the differential diagnosis of any bacteremic skin and soft tissue infections especially in elderly, comorbid and immune-compromised patients. Well-timed, proper antibiotic and surgical treatments are important in management of the infection to decrease morbidity and mortality.