Background: The aim of this study was to evaluate the clinical reliability of ultrasound (US) examination using relative laryngeal movement of 40% as a cutoff point to diagnose pharyngeal abnormalities of swallowing using ultrasonographic examination in dysphagic cerebral palsy (CP) patients and comparing its results with a flexible fiberoptic endoscope. Methods: Twenty-five cerebral palsy children suffering from clinical dysphagia were included in this study. The rest distance between the thyroid cartilage and the hyoid bone and the shortest distance between them during swallowing were measured by ultrasound, then the approximation distance and the percentage of relative laryngeal movement were calculated. All children also have been submitted for flexible fiberoptic endoscopy (FEES). Results: The mean value of the percentage of relative laryngeal movement was significantly less in the CP children with pharyngeal phase abnormality diagnosed by the flexible fiberoptic endoscope (p < 0.001). The mean of relative laryngeal movement in CP patients with and without pharyngeal abnormality diagnosed by the flexible fiberoptic endoscope was 20.10 ± 13.73 and 66.19% ± 3.42 respectively. Conclusion: Ultrasound can efficiently measure the relative laryngeal movement, and as it gives a numerical value, it can be used as a follow-up bedside test in children suffering from dysphagia.

To evaluate the role of CT pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) severity and the related CT cardiac changes, reflecting the clinical status of the patients and predicting the outcome. A prospective study of 184 patients presented with suspicious acute PE. All patients underwent CTPA followed by ECHO. Pulmonary artery obstructive index (PAOI) using Qanadli Score was calculated and cardiac changes recorded. The patients' outcome was followed up for 30 days. Only 150 patients completed the study; 26.7% needed ICU admission while 13.3% died during follow-up. There was a significant relationship between the PAOI and the risk classification, right ventricular dysfunction (RVD) diagnosed by ECHO and the patients' short outcome. We found PAOI cut off value 45% for mortality and 35% for ICU admission and 27.5% for RVD with 60, 75 and 90% sensitivity and 80, 73.3 and 68.6% specificity respectively. CT RV/LV ratio was the most sensitive parameter to predict RV dysfunction followed by pulmonary artery diameter. CTPA is not only used for diagnosis but also to assess the severity of PE, the effect on the right ventricular function and subsequently the need for ICU admission and prediction of the outcome.

Background Coronavirus disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization on March 11, 2020. COVID-19 infection is considered a multi-system disease with neurological, digestive, and cardiovascular symptoms and complications. It can trigger acute and diffuse endothelial dysfunction, resulting in a cytokine storm, most likely induced by the interleukin-6 (IL-6) amplifier. The peripheral and central neurological complications may explain some clinical manifestations such as vagus nerve palsy. The known main CT chest findings of COVID-19 pneumonia include ground glass patches, pulmonary consolidations, inter-lobar septal thickening, crazy paving appearance, and others. We presented our experience in the incidental discovery of phrenic nerve paralysis as atypical chest finding in patients with a known history of COVID-19-associated pneumonia, proved by RT-PCR and coming for evaluation of the lung changes. Patients with evidence of diaphragmatic paralysis underwent close follow-up with a re-evaluation of the phrenic nerve palsy at their routine follow-up for COVID-19 pneumonia. The association of the phrenic nerve palsy was correlated with the CT chest severity score. Results Among 1527 scanned patients with known COVID-19 pneumonia, we had recognized 23 patients (1.5%) with unilateral diaphragmatic paralysis, accidentally discovered during CT chest examination. Twenty-one patients had shown complete recovery of the associated diaphragmatic paralysis during their follow-up CT chest with regression or the near-total resolution of the pulmonary changes of COVID-19- pneumonia. No significant correlation between the incidence of unilateral diaphragmatic paralysis and CT severity score with p value = 0.28. Conclusion Phrenic paralysis is considered a serious but rare neurological complication of COVID-19 pneumonia. No significant correlation between the CT severity score and the incidental discovery of unilateral diaphragmatic paralysis. The majority of the cases show spontaneous recovery together with the improvement of the pulmonary changes of COVID-19 pneumonia. The association of phrenic paralysis with anosmia and dysgeusia could suggest a direct viral attack on the nerve cells.

KEYWORDSRemodeling index (RI); Coronary artery disease (CAD); Left anterior descending (LAD); Right coronary artery (RCA); Left circumflex artery (LCX) Abstract Purpose: To emphasis the role of MSCT utilizing the remodeling index in assessment of positive coronary remodeling which was associated with plaque rupture and vulnerability. Methods and material: Studied group included 35 patients with positive coronary remodeling. One lesion per patient was assessed, either a solitary lesion or the most significant one. All patients were subjected to history taking and radiological evaluation using a contrast-enhanced 64 MSCT then post processed. Assessment of the plaque causing positive remodeling regarding the site, number (single, kissing, or multiple), relative composition and predominant type in H.U. was performed. Specific measurements at the reference and remodeling segment were taken. Calculation of remodeling index was done. Two comparative groups were made between subjects with remodeling index (RI) < 1.5 and RI P 1.5. Results: A strong correlation was noted between lipid plaque area, plaque cross sectional area and multiplicity of plaques with remodeling index (p value < 0.001). There was no correlation between the RI with either the patient coronary risk factors or symptomatology. Conclusion: Previous studies had shown that most acute coronary syndromes were initiated by sudden changes of mildly stenotic lesions, commonly found in positively remodeled vessels. Promising comparative results between MSCT and IVUS allowed consideration of MDCT as a useful tool in the noninvasive detection of potentially threatening coronary lesions. In our study, RI P 1.5 showed a strong correlation between the lipid plaque area, multiplicity of the plaques, and cross sectional area which were prognostic factors for plaque rupture and vulnerability, and thus, early detection of coronary artery disease. Modulation and prevention of positive remodeling by statin could promote to start medical treatment especially in cases where RI exceeds 1.5 and their follow up non-invasively by MDCT to detect reversal of remodeling and response of treatment.

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