Unravelling the mysteries of gout by multimodality imaging

Gout is a common inflammatory arthritis that manifests as an aggregate of variably symptomatic monosodium urate crystals (MSU) in the joints and surrounding tissues in addition to multisystem involvement such as genitourinary and cardiovascular systems. In recent decades, there has been a documented increase in the prevalence and incidence of gout. Risk factors for gout include obesity, dietary influences, hypertension, renal impairment, and diuretic use. A prompt diagnosis followed by uric acid lowering treatment prior to the onset of bone destruction is the goal in any suspected case of gout. Advanced imaging modalities, such as dual energy computed tomography (DECT) and ultrasonography (US), employed for the diagnosis of gout are each accompanied by advantages and disadvantages. Conventional radiography (CR), although useful in visualizing joint erosions and mineralization, is limited in its ability to diagnose gout flare. Although synovial fluid aspiration remains the gold standard for MSU crystal visualization, less-invasive imaging modalities are preferred to avoid potential complications. DECT and US in particular are useful in the diagnosis of gout. In this review, we will discuss the current state and role of imaging in the detection of gout.

Unravelling the Mysteries of Traumatic Diaphragmatic Injury: An Up-to-Date Review

Traumatic diaphragmatic injury (TDI) is an underdiagnosed condition that has recently increased in prevalence due to its association with automobile collisions. The initial injury is often obscured by concurrent thoracic and abdominal injuries. Traumatic diaphragmatic injury itself is rarely lethal at initial presentation, however associated injuries and complications of untreated TDI such as herniation and strangulation of abdominal viscera have serious clinical consequences. There are 2 primary mechanisms of TDIs: penetrating TDI which tend to be smaller, more difficult to detect, and result in fewer complications; and blunt TDIs which are larger and have higher overall mortality due to associated injuries or delayed complications. The anatomy of thoracic and abdominal cavities distinguishes the epidemiology, pathophysiology, symptoms, treatment, and prognosis of right versus left TDI. Although there is no definitive radiologic sign for diagnosing TDI, many signs have been introduced in the literature and the concurrent presence of multiple signs increases the sensitivity of TDI detection. Conservative versus surgical management depends on mechanism of TDI, side, and most importantly the associated injuries.

Lack of Gender Disparity Among Administrative Leaders of Canadian Health Authorities

Background: Gender distribution within the managing bodies of the Canadian health authorities has not been studied despite their integral role in the health care system. The purpose of this study is to quantify gender differences and to craft a geographic gender analysis of such distribution. Methods: Retrospective data collection of all Canadian health authorities at the provincial, territorial, regional, and first nations levels was conducted. The dependent variable was gender, and other covariates, where applicable, included province/territory, region, leadership position, education (PhD or Master's), honorary degree, and primary occupation. Any member within the executive managing body or board of directors of a Canadian health authority was included, unless their gender could not be determined, in which case they were excluded. Results: Quantitative analysis of the 67 health authorities revealed 1346 individuals with identifiable gender (710 women; 636 men). Thematic distribution showed no significant difference in the gender distribution by provinces/territories (chi square = 14.248; p = 0.28), by leadership position (chi square = 1.88; p = 0.75), by education (chi square = 1.85; p = 0.17), or by primary occupation (chi square = 1.53; p = 0.46). Conclusion: The overall number of females exceeded that of males and there were no gender disparities. Critical analysis of probable causes was discussed. Further studies should be conducted to examine the policies and programs within the Canadian health authorities that successfully tackle the retention, recruitment, and promotion of females.