Sex estimation is a critical component of human identification in forensic investigations, particularly when dealing with recovered skeletal remains. In South Africa, where crime rates remain high, the largest population group, Black South Africans, is disproportionately affected. Existing pelvic-based sex estimation standards were developed from cadaveric measurements and may not be fully applicable to contemporary populations. This study, therefore, evaluated the reliability of these previously established standards by applying them to three-dimensional computed tomography (3DCT)-derived pelvic measurements from a contemporary Black South African sample. Five of the six previously published standards yielded low overall accuracies (55–78
Budd-Chiari syndrome represents a rare vascular disorder defined by obstruction of hepatic venous outflow which, without timely intervention, may progress to portal hypertension, cirrhosis, and liver failure. Primary Budd-Chiari syndrome refers to intrinsic venous obstruction, which is most commonly associated with underlying prothrombotic states that predispose individuals to venous thrombosis. Interventional procedures are often required as a therapeutic modality when medical therapy alone is insufficient. Transjugular intrahepatic portosystemic shunt (TIPS) is commonly used to reduce portal hypertension in Budd-Chiari syndrome; however, it may not be feasible in the presence of hepatic vein thrombosis where cannulation of the hepatic vein, and thus, shunt creation may not be possible. In such cases, direct intrahepatic portosystemic shunt (DIPS) may provide an alternative route for portal decompression through the creation of a shunt directly between the inferior vena cava and the portal venous system. We describe a 34-year-old female presenting with autoimmune hepatitis and primary Budd-Chiari syndrome who underwent a successful ultrasound-guided direct intrahepatic portocaval shunt creation between the portal vein and the intrahepatic inferior vena cava, resulting in a significant reduction in portal venous pressure gradient and improved portal venous flow. This case highlights the feasibility of DIPS in a tertiary hospital setting and supports its role as an alternative endovascular approach for managing portal hypertension in Budd-Chiari syndrome.
Background and study aims:Accurate cancer detection in large non-pedunculated colorectal polyps (LNPCPs) remains challenging for general endoscopists. We evaluated whether teaching six gross morphological "blink" features could improve accuracy of cancer detection. Methods:This prospective interventional study assessed general endoscopists evaluating 20 LNPCP images (7 with histologically confirmed submucosal invasive cancer including four deep invasions ≥ 1000 µm, 13 benign). Participants assessed images before and after a 2-minute educational video introducing six blink features: spontaneous bleeding, depression, fold deformation, extra redness, ulceration, and chicken-skin mucosa. Primary outcome was change in miss-rate for cancer detection. Generalized linear mixed models accounted for clustering within raters and polyps. Results:The 165 participants included gastroenterology consultants (63.6%), trainees (21.2%), students (1.8%) and colorectal surgeons (13.3%) with median colonoscopy experience of 6.5 years. Post-intervention, the cancer miss rate decreased four-fold from 26.6% (95% confidence interval [CI] 13.4-46.0) to 5.7% (95% CI 2.4-12.8). The improvement was consistent across experience levels. The false alarm rate increased less than two-fold from 25.0% (95% CI 15.1-38.5) to 42.2% (95% CI 27.7-58.2). Multivariable analysis identified spontaneous bleeding (odds ratio [OR] 3.92; 95% CI 3.11-4.96), extra redness (OR 3.66; 95% CI 3.09-4.33), and depression (OR 3.06; 95% CI 2.58-3.64) as independent predictors of cancer among general endoscopists. Mean blink features per polyp were 1.08 (95% CI 0.82-1.40) for benign lesions vs 2.46 (95% CI 1.85-3.12) for cancers. Conclusions:Teaching six blink features to general endoscopists led to a four-times reduction in cancer miss rates in an image-based evaluation. Although specificity decreased, this trade-off favors patient safety because false positives trigger established clinical safeguards whereas missed cancers risk inappropriate endoscopic resection with potentially irreversible consequences.
