Category: Nevin Manimala

Gastroenterol Hepatol Bed Bench. 2024;17(2):187-197. doi: 10.22037/ghfbb.v17i2.2893.

ABSTRACT

AIM: This study aimed to determine the distribution of enteric parasitic infections and related risk factors among rural communities of Guilan province, Northern Iran, and to compare the results with the situation in the past.

BACKGROUND: Intestinal parasitic infections are still considered as a major public health concern, particularly in human communities with poor economy and sanitation.

METHODS: This cross-sectional study was performed in rural areas of Masal and Shanderman district from February to December 2020. A total of 917 stool samples were collected and examined for presence of intestinal helminthes and protozoa using direct, formalin-ether and Kato-Katz techniques.

RESULTS: A total of 156 (17%) out of 917 examined individuals were infected with intestinal parasites. The overall prevalence of protozoa, helminths and mixed infections were 11.8% (108/917), 4.5% (41/917) and 0.8% (7/917), respectively. Blastocystis was the most prevalent intestinal protozoa (9.6%) followed by Giardia lamblia (1.9%), Endolimax nana (1.1%), E. coli (0.8%) and Entamoeba hartmani (0.1%). The highest prevalence of intestinal helminths belonged to Trichostongylus spp. (3.5%) and Strongyloides stercoralis (1.3%). Statistical analysis showed significant association between giardiasis and sex (P<0.03). On the other hand, prevalence of enteric helminths was influenced by close contact with livestock, keeping herbivorous animals at home, job, education, and consumption of uncooked vegetables (P<0.05).

CONCLUSION: The findings indicate a decreasing trend in the prevalence of intestinal parasitic infections in Guilan province in comparison to the past few decades. Hookworm infections, which was very prevalent in the area, are now rare, while trichostrongylosis showed a high prevalence in rural residents of the study area.

PMID:38994509 | PMC:PMC11234483 | DOI:10.22037/ghfbb.v17i2.2893

Gastroenterol Hepatol Bed Bench. 2024;17(2):180-186. doi: 10.22037/ghfbb.v17i2.2896.

ABSTRACT

AIM: The purpose of this investigation was to examine the potential association between non-alcoholic fatty liver disease (NAFLD) and adverse maternal and perinatal outcomes during pregnancy.

BACKGROUND: Gaining insights into the effect of NAFLD on pregnancy outcomes is essential to ensure the health and well-being of mothers and infants.

METHODS: This prospective cohort study was conducted at Imam Khomeini and Razi hospitals of Ahvaz City in 2022. Totally, 180 pregnant women in the NAFLD group to 180 in the control group. In this study, a researcher-made checklist was used to collect the background information, medical history, and lab data during their initial visit using. Follow-up continued until one week after delivery, with pregnancy outcomes assessed. Statistical analysis used student’s t-test and the Chi-Square test for group comparisons.

RESULTS: Significant differences were observed between the NAFLD, and control groups in terms of age (P=0.003), BMI (P=0.016), ALT and AST measures (P<0.001), and hypertensive complications (P=0.044). The NAFLD group had higher rates of gestational diabetes (P<0.001) and gestational hypertension (P=0.003). However, no significant differences were found in gestational age at delivery, early postpartum hemorrhage rates, birth weight, and neonatal Apgar scores (P>0.05).

CONCLUSION: The pregnant women with NAFLD may be at risk for various complications during pregnancy, including a higher prevalence of gestational diabetes, elevated liver enzymes, and higher blood pressure compared to healthy pregnant women. However, the research failed to identify any statistically significant disparities between infants born to mothers with NAFLD and those delivered to healthy mothers in relation to birth weight, Apgar scores, or neonatal mortality.

PMID:38994505 | PMC:PMC11234490 | DOI:10.22037/ghfbb.v17i2.2896

PNAS Nexus. 2024 Jun 14;3(7):pgae238. doi: 10.1093/pnasnexus/pgae238. eCollection 2024 Jul.

ABSTRACT

Densely packed, motile bacteria can adopt collective states not seen in conventional, passive materials. These states remain in many ways mysterious, and their physical characterization can aid our understanding of natural bacterial colonies and biofilms as well as materials in general. Here, we overcome challenges associated with generating uniformly growing, large, quasi-two-dimensional bacterial assemblies by a membrane-based microfluidic device and report the emergence of glassy states in two-dimensional suspension of Escherichia coli. As the number density increases by cell growth, populations of motile bacteria transition to a glassy state, where cells are packed and unable to move. This takes place in two steps, the first one suppressing only the orientational modes and the second one vitrifying the motion completely. Characterizing each phase through statistical analyses and investigations of individual motion of bacteria, we find not only characteristic features of glass such as rapid slowdown, dynamic heterogeneity, and cage effects, but also a few properties distinguished from those of thermal glass. These distinctive properties include the spontaneous formation of micro-domains of aligned cells with collective motion, the appearance of an unusual signal in the dynamic susceptibility, and the dynamic slowdown with a density dependence generally forbidden for thermal systems. Our results are expected to capture general characteristics of such active rod glass, which may serve as a physical mechanism underlying dense bacterial aggregates.

PMID:38994498 | PMC:PMC11238424 | DOI:10.1093/pnasnexus/pgae238

Rozhl Chir. 2024;103(6):208-218. doi: 10.33699/PIS.2024.103.6.208-218.

ABSTRACT

Pancreatic carcinoma is a relatively common malignant tumor with increasing incidence and mortality. The tumor is usually diagnosed at an advanced stage and generally has a poor prognosis, with only 5% of patients surviving 5 years from the time of diagnosis. The stage of the disease at the time of diagnosis is a crucial factor for the prognosis; 25% of patients with localized tumors survive 3 years from diagnosis, compared to only 1% of those with generalized tumors. Radical surgical removal of the tumor (partial or total pancreatectomy) is a key factor in improving survival. Therefore, the topic is highly relevant to surgeons. Statistics on pancreatic carcinoma mainly focus on ductal adenocarcinoma, which is the most common and least favorable malignant tumor of the pancreas. This review focuses on ductal adenocarcinoma, its variants, and precancerous lesions. The article summarizes information from the latest WHO classification of 2019, which was released 11 years after the previous edition. Compared to the previous version, this new WHO classification introduced rather minor changes in the field of ductal adenocarcinoma. The delineation of rare variants of ductal adenocarcinoma is justified based on genetic and morphological similarities and clinical relevance, as individual subtypes significantly differ in prognosis. The article also includes a description of macroscopic and microscopic precursors of ductal adenocarcinoma and their definitions. Genetic and immunohistochemical differential diagnostic aspects are briefly discussed, as these are more relevant to pathologists than to surgeons.

PMID:38991784 | DOI:10.33699/PIS.2024.103.6.208-218

AJNR Am J Neuroradiol. 2024 Jul 11:ajnr.A8380. doi: 10.3174/ajnr.A8380. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Prediction of aneurysm instability is crucial to guide treatment decisions and to select appropriate patients with unruptured intracranial aneurysms (IAs) for preventive treatment. High resolution four-dimensional magnetic resonance (4D MRI) flow imaging and 3D quantification of aneurysm morphology could offer insights and new imaging markers for aneurysm instability. In this cross-sectional study, we aim to identify 4D MRI flow imaging markers for aneurysm instability by relating hemodynamics in the aneurysm sac to 3D morphological proxy parameters for aneurysm instability.

MATERIALS AND METHODS: In 35 patients with 37 unruptured IAs, a 3T MRA and a 7T 4D flow MRI scan was performed. Five hemodynamic parameters -peak-systolic (WSS_MAX) and time-averaged wall shear stress (WSS_MEAN), oscillatory shear index (OSI), mean velocity, and velocity pulsatility index (vPI)-were correlated to six 3D morphology proxy parameters of aneurysm instability -major axis length, volume, surface area (all three size parameters), flatness, shape index, and curvedness -by Pearson’s correlation with 95% confidence intervals (CI). Scatterplots of hemodynamic parameters that correlated with IA size (major axis length) were created.

RESULTS: WSS_MAX and WSS_MEAN correlated negatively with all three size parameters (strongest for WSS_MEAN with volume (r = -0.70, 95% CI -0.83 to -0.49)) and OSI positively (strongest with major axis length (r = 0.87, 95% CI 0.76 to 0.93)). WSS_MAX and WSS_MEAN correlated positively with shape index (r = 0.61, 95% CI 0.36 to 0.78 and r = 0.49, 95% CI 0.20 to 0.70, respectively) and OSI negatively (r = 0.82, 95% CI -0.9 to -0.68). WSS_MEAN and mean velocity correlated negatively with flatness (r = -0.35, 95% CI -0.61 to -0.029 and r = 0.33, 95% CI -0.59 to 0.007, respectively) and OSI positively (r = 0.54, 95% CI 0.26 to 0.74). vPI did not show any statistically significant correlation.

CONCLUSIONS: Out of the five included hemodynamic parameters, WSS_MAX, WSS_MEAN, and OSI showed the strongest correlation with morphological 3D proxy parameters of aneurysm instability. Future studies should assess these promising new imaging marker parameters for predicting aneurysm instability in longitudinal cohorts of IA patients.

ABBREVIATIONS: IA = intracranial aneurysm; 3D = three dimensional; 4D MRI flow = four-dimensional Magnetic Resonance Imaging flow; TOF-MRA = Time-of-flight Magnetic Resonance Angiography; WSS = wall shear stress; WSS_MAX = WSS calculated at peak systole; WSS_MEAN = time averaged WSS; OSI = oscillatory shear index; vPI = velocity pulsatility index.

PMID:38991775 | DOI:10.3174/ajnr.A8380

AJNR Am J Neuroradiol. 2024 Jul 11:ajnr.A8409. doi: 10.3174/ajnr.A8409. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: A single aspiration maneuver using a large volume syringe is a common and effective technique for aspiration thrombectomy. Multiple aspiration cycles using large aspiration syringes has been proposed as a means to improve efficacy over single aspiration. In this study, we sought to investigate the efficacy of a “triple aspiration technique” where a large volume syringe is cycled three times prior to catheter retraction during aspiration thrombectomy.

MATERIALS AND METHODS: A 3D-printed adult vasculature was used as a benchtop thrombectomy platform. Fibrin-rich and red blood cell-rich clots were prepared in centrifuge tubes using human plasma, red blood cells, and calcium chloride. Next, clots were placed in the carotid terminus of the model, and the performances of three different aspiration techniques-triple syringe, single syringe, and continuous pump aspiration-were compared in a randomized manner (1:1:1). Outcomes of interest included first-pass efficacy (FPE), complete clot removal (final mTICI 2c/3), the number of thrombectomy attempts to achieve mTICI 2c/3, vacuum pressure, and distal embolization. The distal emboli were detected using a 70-micron cell strainer placed at the outflow of the model and quantified using an image processing algorithm. The vacuum pressures were measured using a pressure transducer (Honeywell, NC, USA).

RESULTS: A total of 102 replicates were performed, 34 for each technique. The triple aspiration technique provided a significantly higher rate of FPE than the syringe and pump aspiration techniques (67.6% vs. 41.1%, p= 0.02). Additionally, the triple aspiration technique achieved complete clot removal with a significantly lower number of thrombectomy attempts compared to single syringe aspiration (1.2 ± 0.5 vs. 1.8 ± 0.8, p=0.005). The triple aspiration technique generated significantly higher vacuum pressure than both the single syringe and vacuum pump aspiration (28.3 ± 0.2 vs. 27.2 ± 0.3 (p= 0.002) and 26.2 ± 0.4 (p=0.001), respectively). The differences in complete clot removal and distal embolization parameters were not statistically significantly different across the groups.

CONCLUSIONS: Our findings suggest that the triple aspiration technique can improve FPE rates and vacuum pressure in aspiration thrombectomy. Further studies are needed to examine the safety and efficacy of triple aspiration in the clinical setting.

ABBREVIATIONS: AcommA = anterior communicating artery; FPE = first pass efficacy; ICA = internal carotid artery; MCA = middle cerebral artery; MT = mechanical thrombectomy; mTICI = modified thrombolysis in cerebral infarction scale; PcommA = posterior communicating artery.

PMID:38991770 | DOI:10.3174/ajnr.A8409

AJNR Am J Neuroradiol. 2024 Jul 11. doi: 10.3174/ajnr.A8297. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: There is heterogeneity of white matter damage in Parkinson’s disease patients with different cognitive states. Our aim was to find sensitive diffusional kurtosis imaging biomarkers to differentiate the white matter damage pattern of mild cognitive impairment and dementia.

MATERIALS AND METHODS: Nineteen patients with Parkinson disease with mild cognitive impairment and 18 patients with Parkinson disease with dementia were prospectively enrolled. All participants underwent MR examination with 3D-T1-weighted image and diffusional kurtosis imaging sequences. Demographic data were compared between the 2 groups. Voxelwise statistical analyses of diffusional kurtosis imaging parameters were performed using tract-based spatial statistics. The receiver operator characteristic curve of significantly different metrics was graphed. The correlation of significantly different metrics with global cognitive status was analyzed.

RESULTS: Compared with the Parkinson disease with mild cognitive impairment group, the fractional anisotropy and mean kurtosis values decreased in 4 independent clusters in the forceps minor, forceps major, inferior fronto-occipital fasciculus, and the inferior and superior longitudinal fasciculus in patients with Parkinson disease with dementia; the mean diffusivity decreased in 1 cluster in the forceps minor. The fractional anisotropy value in the inferior fronto-occipital fasciculus and inferior longitudinal fasciculus would be the diffusional kurtosis imaging marker for the differential diagnosis of Parkinson disease with mild cognitive impairment and patients with Parkinson disease with dementia, with the best diagnostic efficiency of 0.853. The fractional anisotropy values in the forceps minor (β = 84.20, P < .001) and years of education (β = 0.38, P = .014) were positively correlated with the Montreal Cognitive Assessment.

CONCLUSIONS: The diffusional kurtosis imaging-derived fractional anisotropy and mean kurtosis can detect the different white matter damage patterns of Parkinson disease with mild cognitive impairment and Parkinson disease with dementia. Fractional anisotropy is more sensitive than mean kurtosis in the differential diagnosis; fractional anisotropy derived from diffusional kurtosis imaging could become a promising imaging marker for the differential diagnosis of Parkinson disease with mild cognitive impairment and Parkinson disease with dementia.

PMID:38991767 | DOI:10.3174/ajnr.A8297

J Nucl Med. 2024 Jul 11:jnumed.124.267446. doi: 10.2967/jnumed.124.267446. Online ahead of print.

ABSTRACT

Brain PET imaging often faces challenges from head motion (HM), which can introduce artifacts and reduce image resolution, crucial in clinical settings for accurate treatment planning, diagnosis, and monitoring. United Imaging Healthcare has developed NeuroFocus, an HM correction (HMC) algorithm for the uMI Panorama PET/CT system, using a data-driven, statistics-based approach. The HMC algorithm automatically detects HM using a centroid-of-distribution technique, requiring no parameter adjustments. This study aimed to validate NeuroFocus and assess the prevalence of HM in clinical short-duration ¹⁸F-FDG scans. Methods: The study involved 317 patients undergoing brain PET scans, divided into 2 groups: 15 for HMC validation and 302 for evaluation. Validation involved patients undergoing 2 consecutive 3-min single-bed-position brain ¹⁸F-FDG scans-one with instructions to remain still and another with instructions to move substantially. The evaluation examined 302 clinical single-bed-position brain scans for patients with various neurologic diagnoses. Motion was categorized as small or large on the basis of a 5% SUV change in the frontal lobe after HMC. Percentage differences in SUV_mean were reported across 11 brain regions. Results: The validation group displayed a large negative difference (-10.1%), with variation of 5.2% between no-HM and HM scans. After HMC, this difference decreased dramatically (-0.8%), with less variation (3.2%), indicating effective HMC application. In the evaluation group, 38 of 302 patients experienced large HM, showing a 10.9% ± 8.9% SUV increase after HMC, whereas most exhibited minimal uptake changes (0.1% ± 1.3%). The HMC algorithm not only enhanced the image resolution and contrast but also aided in disease identification and reduced the need for repeat scans, potentially optimizing clinical workflows. Conclusion: The study confirmed the effectiveness of NeuroFocus in managing HM in short clinical ¹⁸F-FDG studies on the uMI Panorama PET/CT system. It found that approximately 12% of scans required HMC, establishing HMC as a reliable tool for clinical brain ¹⁸F-FDG studies.

PMID:38991753 | DOI:10.2967/jnumed.124.267446

Inj Prev. 2024 Jul 11:ip-2023-045089. doi: 10.1136/ip-2023-045089. Online ahead of print.

ABSTRACT

BACKGROUND: Drowning is an important contributor to the burden of deaths in China. Exposure to open water is a risk factor for drowning, but few studies quantify its impact on drowning. The purpose of this study was to provide an up-to-date analysis of unintentional drowning in China, including impact of exposure to open water.

METHODS: Chinese provincial data from the Global Burden of Disease Study 2019 were used to describe the burden of unintentional drowning in 33 provinces and changes from 1990 to 2019. Provincial outdoor open water resource data were used to explore the relationship between outdoor open water resources and drowning burden using K-median clustering analysis.

RESULTS: Between 1990 and 2019, the unintentional drowning incidence, mortality and disability adjusted life years (DALY) rates declined by 31.2%, 68.6% and 74.9%, respectively, with differences by age, sex and province. In 2019, the DALY rate for drowning was relatively higher in children under 20 year, the elderly over 80 years than other age groups and was relatively higher in men. There was no statistical difference in overall incidence rate by sex. Provincial differences in unintentional drowning burden show a positive relationship with the availability and size of outdoor open water.

CONCLUSIONS: As expected availability of water increases drowning risk. There is a need to address drowning environmental risk especially among children and the elderly. Localised water safety plans which consider drowning burden and environmental risk factors are needed in China to ensure a sustained decline of unintentional drowning.

PMID:38991718 | DOI:10.1136/ip-2023-045089

Reg Anesth Pain Med. 2024 Jul 11:rapm-2024-105406. doi: 10.1136/rapm-2024-105406. Online ahead of print.

ABSTRACT

OBJECTIVE: An unwanted side effect associated with epidural analgesia is the reduction in blood pressure (BP) due to the sympathetic blockade. This study evaluated the hemodynamic effects of adding different epinephrine concentrations to epidurally injected local anesthetic solution to counteract sympathectomy. We hypothesized that epinephrine could mitigate the decrease in BP possibly caused by the local anesthetic, specifically decreasing the incidence of hypotension.

METHODS: Sixty-six patients were enrolled in a randomized, controlled, quadruple-blinded prospective study into three groups: epidural ropivacaine 0.2% without epinephrine (control) or with 2 µg/mL or 5 µg/mL epinephrine. Our primary outcome was the assessment of differences in hypotension between groups, defined as a >20% decrease in hypotension from baseline to the end of the intraoperative period.

RESULTS: Forty-seven patients completed the study, and 19 were withdrawn. Fifteen patients were in the control group, while 16 patients received 0.2% ropivacaine +2 µg/mL epinephrine, and 16 received 0.2% ropivacaine +5 µg/mL epinephrine. The overall rate of hypotension was 21.3% (10/47). There were no statistically significant differences in hypotension rates between the control group (33%) and groups receiving either +2 µg/mL (13%, p=0.165) or +5 µg/mL (19%, p=0.353) of epinephrine. In secondary analyses, respiratory rate showed greater decreases in control groups across the perioperative period compared with treatment groups (p=0.016) CONCLUSION: Adding epinephrine to the epidural local anesthetic did not significantly decrease the rate of hypotension. However, epinephrine mitigated decreases in respiratory rate across the perioperative period. Future studies will focus on increasing group size and higher epinephrine concentrations (10 µg/mL).

TRIAL REGISTRATION NUMBER: NCT02722746.

PMID:38991714 | DOI:10.1136/rapm-2024-105406