Background: Choosing the most effective and accurate preoperative modality is one of the most significant tools in the clinical diagnosis of acute appendicitis (AA) to prevent negative appendectomies, diagnosis confusion, and delayed treatment. This decision making remains challenging to emergency physicians and surgeons which lead this study to determine the sensitivity and specificity of ultrasound (US) and computed tomography (CT) in predicting AA using pathology reports as a reference at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods: This study was conducted retrospectively at the Emergency Department, KAUH in Jeddah, Saudi, Arabia using 351 medical records with a clinical picture of acute appendicitis and no history of trauma. The sensitivity and specificity were calculated for ultrasound and computed tomography imaging. The positive predictive values (PPV) and negative predictive value (NPV) were also evaluated. Results: Out of the total 351 patients included in this study, 83 patients underwent surgical appendectomies and the pathology results revealed that 64 patients were diagnosed with AA while 19 showed a normal appendix. Of the 64 patients, 18 underwent US imaging while 62 underwent CT imaging. Compared to pathology results, US imaging results revealed that 12 out of 14 positive patients (85.7%) and only two out of four negative patients (50.0%) were correctly predicted while two out of 14 positive patients (14.3%) and two out of four negative patients (50.0%) were falsely diagnosed. On the other hand, CT imaging results revealed that 46 out of 49 positive patients (93.9%) and 9 out of 13 negative patients (69.2%) were correctly predicted while only three out of 49 positive patients (6.1%) and only four out of 13 negative patients (30.8%) were incorrectly diagnosed. Conclusion: Having an accuracy of 88.71%, sensitivity of 92.00%, and specificity of 75.00%, CT imaging was found to be more effective and accurate than US imaging which was only 77.78% accurate, 85.71% sensitive, and 50.00% specific. Statistical analyses also revealed that US results have a significant difference with pathology results (P= 0.130) while CT result has no significant difference (P <0.001).

Objective:Accounts of initial and follow-up chest X-rays (CXRs) of the Middle East respiratory coronavirus (MERS-CoV) patients, and correlation with outcomes, are sparse. We retrospectively evaluated MERS-CoV CXRs initial findings, temporal progression and outcomes correlation. Such insights may be valuable during the current coronavirus disease 2019 (COVID-19) pandemic, given the clinical and imaging similarities described in both entities.Methods:Fifty-three real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR)-confirmed MERS-CoV patients with CXRs were retrospectively identified from November 2013 to October 2014. Initial and follow-up CXR imaging findings and distribution were evaluated over 75 days. Findings were correlated with outcomes.Results:Twenty-two of 53 (42%) initial CXRs were normal. In 31 (68%) abnormal initial CXRs, 15 (48%) showed bilateral non-diffuse involvement, 16 (52%) had ground-glass opacities (GGO), and 13 (42%) had peripheral distribution. On follow-up CXRs, mixed airspace opacities prevailed, seen in 16 (73%) of 22 patients 21-30 days after the initial CXRs. Bilateral non-diffuse involvement was the commonest finding throughout follow-up, affecting 16 (59%) of 27 patients 11-20 days after the initial CXRs. Bilateral diffuse involvement was seen in 5 (63%) of 8 patients 31-40 days after the initial CXRs. A bilateral diffuse CXR pattern had an odds ratio for mortality of 13 (95% CI=2-78) on worst and 18 (95% CI=3-119) on final CXRs (P-value <0.05).Conclusion: Initially, normal CXRs are common in MERS-CoV patients. Peripherally located ground-glass and mixed opacities are common on initial and follow-up imaging. The risk of mortality is higher when bilateral diffuse radiographic abnormalities are detected.

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a common metabolic liver condition primarily managed through lifestyle modification. Obeticholic acid (OCA), a farnesoid X receptor agonist, has shown therapeutic benefits in steatohepatitis, yet its short‐term metabolic effects remain unclear. This study compared OCA plus lifestyle modification versus lifestyle intervention alone in adults with MASLD. Methods: This quasi‐experimental study included 360 adults aged 18–60 years with ultrasound‐diagnosed MASLD and insulin resistance (HOMA − IR > 2.0). Patients with diabetes mellitus, viral hepatitis, cirrhosis, advanced fibrosis, ischemic heart disease or LDL − C > 160 mg/dL were excluded. Participants received either OCA (10 mg/day) plus standardised lifestyle modification or lifestyle intervention alone for 3 months. Anthropometric, biochemical and hepatic parameters were evaluated at baseline and follow‐up, with ANCOVA performed to adjust for baseline covariates. Results: Baseline demographic and metabolic characteristics were comparable between groups. After 3 months, the OCA plus lifestyle group demonstrated significantly greater improvements in ALT (36.65 ± 20.57 vs. 48.19 ± 21.35 U/L; p < 0.001), fatty liver index (55.99 ± 12.60 vs. 63.08 ± 11.89; p < 0.001) and HEPAMET score (0.33 ± 0.13 vs. 0.41 ± 0.13; p < 0.001), along with a greater reduction in body weight (77.28 ± 12.07 kg vs. 80.19 ± 12.37 kg; p = 0.024). Postintervention HOMA‐IR was significantly lower with OCA plus lifestyle than lifestyle alone (2.46 ± 0.92 vs. 2.96 ± 1.06; mean difference 0.50; p < 0.001). LDL‐C increased significantly in the OCA group (139.50 ± 15.74 mg/dL vs. 131.96 ± 16.36 mg/dL; p < 0.001). Conclusion: Over 3 months, OCA combined with lifestyle modification improved liver enzymes, steatosis and fibrosis‐related surrogate indices, and modestly reduced insulin resistance. Careful lipid monitoring is recommended, and longer term studies are required to clarify the overall metabolic and cardiovascular implications.

Background: Obesity and infertility independently affect testicular function through hormonal disruption, oxidative stress, and endothelial dysfunction. Testicular microvascular perfusion, assessable via Doppler ultrasonography using Resistive Index (RI) and Pulsatility Index (PI), is critical for spermatogenesis and hormonal health. The combined effect of obesity and fertility status on testicular vascular and morphological parameters has not been systematically studied. Objectives: This study aimed to evaluate the independent effects and statistical interaction between obesity and infertility on testicular microvascular function and volume. Patients and Methods: A total of 172 men aged 25 - 45 years were recruited and stratified into four groups: Non-obese fertile (n = 64), non-obese infertile (n = 22), obese fertile (n = 45), and obese infertile (n = 41). Testicular volume and vascular parameters (RI, PI) were measured using color Doppler ultrasonography. Non-parametric Kruskal-Wallis tests with post-hoc comparisons, robust linear regression for interaction effects, and Spearman correlations were used for statistical analysis. Results: The Obese-Infertile group had the highest median RI (0.77) and PI (1.61) and the lowest median testicular volume (9.8 mL). PI and testicular volume differed significantly across groups (P < 0.001), while RI showed borderline significance (P = 0.054). Linear regression revealed a significant statistical interaction between obesity and infertility on PI (β = 0.318, P < 0.001), indicating that the association with higher PI was stronger in obese infertile men than would be expected from either factor alone. Obese men with preserved fertility maintained relatively normal testicular volume and vascular indices. Spearman correlation demonstrated a positive association between BMI and PI and a negative association between BMI and testicular volume (both P < 0.001). Conclusion: The combination of obesity and infertility was associated with the highest PI values and the lowest testicular volume among the groups studied. Pulsatility Index and testicular volume are the most sensitive indicators of this dysfunction, while RI is less informative. Obese men who remain fertile maintain relatively preserved testicular volume and vascular indices.