Background: The early diagnosis and treatment of rheumatoid arthritis (RA) are essential to prevent joint damage and enhance patient outcomes. Diagnosing RA in its early stages is challenging due to the nonspecific and variable clinical signs and symptoms. Our study aimed to identify the most predictive features of hand ultrasound (US) for RA development and assess the performance of machine learning models in diagnosing preclinical RA. Methods: We conducted a prospective cohort study with 326 adults who had experienced hand joint pain for less than 12 months and no clinical arthritis. We assessed the participants clinically and via hand US at baseline and followed them for 24 months. Clinical progression to RA was defined according to the ACR/EULAR criteria. Regression modeling and machine learning approaches were used to analyze the predictive US features. Results: Of the 326 participants (45.10 ± 11.37 years/83% female), 123 (37.7%) developed clinical RA during follow-up. At baseline, 84.6% of the progressors had US synovitis, whereas 16.3% of the non-progressors did (p < 0.0001). Only 5.7% of the progressors had positive PD. Multivariate analysis revealed that the radiocarpal synovial thickness (OR = 39.8), PIP/MCP synovitis (OR = 68 and 39), and wrist effusion (OR = 12.56) on US significantly increased the odds of developing RA. ML confirmed these US features, along with the RF and anti-CCP levels, as the most important predictors of RA. Conclusions: Hand US can identify preclinical synovitis and determine the RA risk. The radiocarpal synovial thickness, PIP/MCP synovitis, wrist effusion, and RF and anti-CCP levels are associated with RA development.

Background: Plantar fasciitis (PF) is a common enthesopathy in patients with ankylosing spondylitis (AS). Shear wave elastography (SWE) and the Belgrade ultrasound enthesitis score (BUSES) may detect PF, but their comparative diagnostic performance is unclear. Objective: To compare SWE with the BUSES for identifying PF in individuals with and without AS. Methods: In this cross-sectional study, 96 participants were stratified into AS and non-AS populations, each further divided based on the presence or absence of clinical PF. Demographic data, the American Orthopedic Foot and Ankle Society Score (AOFAS), and the BASDAI score were recorded. All subjects underwent grayscale ultrasonography, the BUSES scoring, and SWE assessment of the plantar fascia. Logistic regression models were constructed for each population, controlling for age, body mass index (BMI), and fascia–skin distance. ROC curve analyses were performed to evaluate diagnostic accuracy. Results: In both AS and non-AS groups, SWE and the BUSES were significant predictors of PF (p < 0.05). SWE demonstrated slightly higher diagnostic accuracy, with area under the curve (AUC) values of 0.845 (AS) and 0.837 (non-AS), compared to the BUSES with AUCs of 0.785 and 0.831, respectively. SWE also showed stronger adjusted odds ratios in regression models. The interobserver agreement was good to excellent for both modalities. Conclusions: Both SWE and the BUSES are effective for PF detection, with SWE offering marginally superior diagnostic performance, particularly in AS patients. SWE may enhance the early identification of biomechanical changes in the plantar fascia.

Objective: To evaluate the frequency and significance of brain imaging findings in methanol poisoning patients and to propose a criterion for prioritizing brain imaging.Methods: We retrospectively reviewed the data of 306 patients (286 men and 34 women, mean age 32.10 ± 9.9 years) with confirmed methanol poisoning who were admitted to two hospitals in Iran during the COVID‐19 pandemic. We analyzed their demographic, clinical, laboratory, and brain imaging data.Results: The main brain computed tomography (CT) scan findings were hypodensity in the putamen (11.1%), cerebellar nuclei (8.2%), diffuse cerebral edema (7.5%), and intracranial hemorrhage (ICH; 1.6%). These findings were associated with blood pH, Glasgow Coma Scale (GCS), renal failure, bicarbonate, oxygen, carbon dioxide, potassium, and glucose levels (p < 0.05). Poor prognosis was related to blindness, opium addiction, chronic alcohol use, hyperglycemia, and abnormal CT scans (p < 0.001 for all). The most predictive brain imaging findings for poor prognosis were hypodensity in the cerebellar nuclei, diffuse cerebral edema, and ICH.Conclusion: Brain imaging can provide valuable information for the diagnosis and management of methanol poisoning patients. We suggest that patients with severe acidosis, low GCS, low pH, low oxygen saturation, and high glucose levels should undergo brain CT scan as a priority.

Aphallia or penile agenesis is a rare case of the genitourinary system which has an association with upper urinary tract disorder. Failure of fetal genital tubercle formation in the embryonic period is the cause of this disorder. The incidence of aphallia according to previous studies is about 1 in 10-30 million births. We report a case of a child with the absence of the penis with associated kidney hypoplasia and vesicorectal fistula.