Tag: nevin manimala

Vet Rec. 2023 Mar 23:e2833. doi: 10.1002/vetr.2833. Online ahead of print.

ABSTRACT

BACKGROUND: Oedema is described in the soft palate of dogs affected by brachycephalic obstructive airway syndrome (BOAS). Activated mast cells (MCs) release vasoactive mediators that temporarily increase vascular permeability.

METHODS: Data and caudal soft palate tissue were prospectively collected from a population of dogs undergoing surgical management of BOAS and a control group of greyhound cadavers with no previous history of respiratory signs. Histological assessment was performed to quantify the number of MCs within the lamina propria of each group.

RESULTS: The mean number of MCs in the BOAS group (53 MCs/10 400× high-power fields [HPF]; standard deviation [SD] = 23) was significantly greater than that in the greyhound group (24 MCs/10 400×HPF; SD = 10).

LIMITATIONS: The small size of the control group and the heterogeneous nature of the dogs in the BOAS group limit the generalisability of the findings. The use of different surgical techniques in the BOAS group may have also affected the degree of inflammation present within the samples. The cohort was not screened for concurrent disease processes that could potentially increase the number of circulating MCs.

CONCLUSION: This study demonstrated a statistically significant difference between the numbers of MCs in the soft palate of brachycephalic dogs with clinically significant BOAS and the greyhound control group.

PMID:36951103 | DOI:10.1002/vetr.2833

J Intern Med. 2023 Mar 23. doi: 10.1111/joim.13633. Online ahead of print.

ABSTRACT

BACKGROUND: Although classic heat stroke (HS) is one of the most ancient conditions known to humans, the description of its early clinical manifestations, natural course, and complications remains uncertain.

OBJECTIVES: A systematic review of the demographics, clinical characteristics, biomarkers, therapy, and outcomes of HS during the Muslim (Hajj) pilgrimage in the desert climate of Makkah, Saudi Arabia.

METHODS: We searched the MEDLINE, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases from inception to April 2022. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics.

RESULTS: Forty-four studies, including 2,632 patients with HS, met the inclusion criteria. Overweight or obesity, diabetes, and cardiovascular disease were prevalent among cases of HS. Evidence suggests that extreme hyperthermia (pooled mean = 42.0°C [95%CI: 41.9, 42.1], range 40-44.8°C) with hot and dry skin (>99% of cases) and severe loss of consciousness (mean GCS<8 in 53.8% of cases) were the dominant clinical characteristics of classic HS. Hypotension, tachypnea, vomiting, diarrhea, and biochemical biomarkers indicating mild to moderate rhabdomyolysis, acute kidney, liver, and heart injury, and coagulopathy were frequent at the onset. Concomitantly, stress hormones (cortisol and catecholamines) and biomarkers of systemic inflammation and coagulation activation were increased. HS was fatal in 1 in 18 cases (pooled case fatality rate = 5.6% [95%CI: 4.6, 6.5]).

CONCLUSIONS: The findings of this review suggest that HS induces an early multiorgan injury that can progress rapidly to organ failure, culminating in death, if it is not recognized and treated promptly.

PROSPERO REGISTRATION: CRD42022325759. This article is protected by copyright. All rights reserved.

PMID:36951097 | DOI:10.1111/joim.13633

Stat Methods Med Res. 2023 Mar 23:9622802231160551. doi: 10.1177/09622802231160551. Online ahead of print.

ABSTRACT

Screening mammography is the primary preventive strategy for early detection of breast cancer and an essential input to breast cancer risk prediction and application of prevention/risk management guidelines. Identifying regions of interest within mammogram images that are associated with 5- or 10-year breast cancer risk is therefore clinically meaningful. The problem is complicated by the irregular boundary issue posed by the semi-circular domain of the breast area within mammograms. Accommodating the irregular domain is especially crucial when identifying regions of interest, as the true signal comes only from the semi-circular domain of the breast region, and noise elsewhere. We address these challenges by introducing a proportional hazards model with imaging predictors characterized by bivariate splines over triangulation. The model sparsity is enforced with the group lasso penalty function. We apply the proposed method to the motivating Joanne Knight Breast Health Cohort to illustrate important risk patterns and show that the proposed method is able to achieve higher discriminatory performance.

PMID:36951095 | DOI:10.1177/09622802231160551

Stroke. 2023 Mar 23. doi: 10.1161/STROKEAHA.122.041660. Online ahead of print.

ABSTRACT

BACKGROUND: Randomized controlled trials (RCTs) proved that short-term (21-90 days) dual antiplatelet therapy (DAPT) reduces the risk of early ischemic recurrences after a noncardioembolic minor stroke or high-risk transient ischemic attack (TIA) without substantially increasing the hemorrhagic risk. We aimed at understanding whether and how real-world use of DAPT differs from RCTs.

METHODS: READAPT (Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or TIA) is a prospective cohort study including >18-year-old patients treated with DAPT after a noncardioembolic minor ischemic stroke or high-risk TIA from 51 Italian centers. The study comprises a 90-day follow-up from symptom onset. In the present work, we reported descriptive statistics of baseline data of patients recruited up to July 31, 2022, and proportions of patients who would have been excluded from RCTs. We compared categorical data through the χ² test.

RESULTS: We evaluated 1070 patients, who had 72 (interquartile range, 62-79) years median age, were mostly Caucasian (1045; 97.7%), and were men (711; 66.4%). Among the 726 (67.9%) patients with ischemic stroke, 226 (31.1%) did not meet the RCT inclusion criteria because of National Institutes of Health Stroke Scale score >3 and 50 (6.9%) because of National Institutes of Health Stroke Scale score >5. Among the 344 (32.1%) patients with TIA, 69 (19.7%) did not meet the RCT criteria because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <4 and 252 (74.7%) because of age, blood pressure, clinical features, duration of TIA, presence of diabetes score <6 and no symptomatic arterial stenosis. Additionally, 144 (13.5%) patients would have been excluded because of revascularization procedures. Three hundred forty-five patients (32.2%) did not follow the RCT procedures because of late (>24 hours) DAPT initiation; 776 (72.5%) and 676 (63.2%) patients did not take loading doses of aspirin and clopidogrel, respectively. Overall, 84 (7.8%) patients met the RCT inclusion/exclusion criteria.

CONCLUSIONS: The real-world use of DAPT is broader than RCTs. Most patients did not meet the RCT criteria because of the severity of ischemic stroke, lower risk of TIA, late DAPT start, or lack of antiplatelet loading dose.

REGISTRATION: URL: https://www.

CLINICALTRIALS: gov; Unique identifier: NCT05476081.

PMID:36951052 | DOI:10.1161/STROKEAHA.122.041660

Emerg Med Australas. 2023 Mar 23. doi: 10.1111/1742-6723.14201. Online ahead of print.

ABSTRACT

OBJECTIVE: In Queensland, where a person experiences a major disturbance in their mental capacity, and is at risk of serious harm to self and others, an emergency examination authority (EEA) authorises Queensland Police Service (QPS) and Queensland Ambulance Service (QAS) to detain and transport the person to an ED. In the ED, further detention for up to 12 h is authorised to allow the examination to be completed. Little published information describes these critical patient encounters.

METHODS: Queensland’s Public Health Act (2005), amended in 2017, mandates the use of the approved EEA form. Data were extracted from a convenience sample of 942 EEAs including: (i) patient age, sex, address; (ii) free text descriptions by QPS and QAS officers of the person’s behaviour and any serious risk of harm requiring urgent care; (iii) time examination period commenced; and (iv) outcome upon examination.

RESULTS: Of 942 EEA forms, 640 (68%) were retrieved at three ‘larger central’ hospitals and 302 (32%) at two ‘smaller regional’ hospitals in non-metropolitan Queensland. QPS initiated 342 (36%) and QAS 600 (64%) EEAs for 486 (52%) males, 453 (48%) females and two intersexes (<1%), aged from 9 to 85 years (median 29 years, 17% aged <18 years). EEAs commonly occurred on weekends (32%) and between 2300 and midnight (8%), characterised by ‘drug and/or alcohol issues’ (53%), ‘self-harm’ (40%), ‘patient aggression’ (25%) and multiple prior EEAs (23%). Although information was incomplete, most patients (78%, n = 419/534) required no inpatient admission.

CONCLUSIONS: EEAs furnish unique records for evaluating the impacts of Queensland’s novel legislative reforms.

PMID:36951038 | DOI:10.1111/1742-6723.14201

Turk Neurosurg. 2023 Mar 17. doi: 10.5137/1019-5149.JTN.43361-23.4. Online ahead of print.

ABSTRACT

AIM: To evaluate the optimal timing and outcome of fluoroscopically guided transforaminal epidural steroid injections (TFESI) for the management of radicular pain due to extruded lumbar disc herniation (LDH).

MATERIAL AND METHODS: In this clinical study, 305 individuals received fluoroscopically guided TFESI for the management of radicular pain due to extruded LDH. Preprocedural and 12-week postprocedural Visual Analog Scale (VAS) scores measuring radicular pain were statistically compared. The neurological conditions of the patients and the complications of the procedure were also recorded.

RESULTS: The intensity of radicular pain evaluated by the mean preprocedural and 12-week postprocedural VASs were 87.65 ± 5.59 and 22.81 ± 4.01, respectively. The P value was p:0.001 (p 0.05) and t value was 119.01. A correlation was noted between the short duration of symptoms before the procedure and the effectiveness of the procedure. After 12 weeks of the procedure, 32 of the 58 patients showed improvement in a neurological deficit. There was no major complication. Nine patients required lumbar disc surgery after the procedure.

CONCLUSION: This clinical research demonstrated that TFESI for the management of extruded LDH may alleviate radicular pain and may decrease the neurological deficit and that it is more effective when performed at the earliest possible time point.

PMID:36951037 | DOI:10.5137/1019-5149.JTN.43361-23.4

Turk Neurosurg. 2023 Jan 18. doi: 10.5137/1019-5149.JTN.42463-22.2. Online ahead of print.

ABSTRACT

AIM: In the surgical treatment of intracranial arachnoid cysts (IACs), microsurgical fenestration (MF), endoscopic fenestration (EF), cystoperitoneal shunt (CPS), and combinations of these techniques can be used. This study aims to compare volumetric changes of IAC in different surgical techniques.

MATERIAL AND METHODS: Sixty-six patients who underwent IAC surgery in our department between 2010 and 2020 were studied retrospectively. Based on the surgical technique, clinical and volumetric changes, postoperative complications, recurrence rates, and length of hospital stay were statistically compared.

RESULTS: MF was performed on 32 (48.5%) patients, EF on 17 patients, CPS on 11 patients, and EF + CPS in six patients. The mean IAC volume change rate was 68.54 mL, and the mean cyst volume change rate was 40.68%. The MF technique produces a significantly greater mean cyst volume change than the EF technique. The mean volume change in sylvian IAC is 4.8 times greater than in posterior fossa IAC, a significant difference. The mean cyst volume change is four times greater in patients with skull deformity than in patients with balance loss, and this difference is statistically significant. In patients with cranial deformity, the mean cyst volume change is 2.6 times greater than in patients with neurological dysfunction. This difference is also statistically significant. The volume of IAC decreased more in patients with postoperative complications, with a significant difference between the postoperative complication and the change in IAC volume.

CONCLUSION: MF can achieve better volumetric reduction in IAC, particularly in patients with sylvian arachnoid cysts. However, more volumetric reduction increases the risk of postoperative complications.

PMID:36951036 | DOI:10.5137/1019-5149.JTN.42463-22.2

Turk Neurosurg. 2023 Jan 2. doi: 10.5137/1019-5149.JTN.40154-22.3. Online ahead of print.

ABSTRACT

AIM: To determine the clinically significant association between pneumatization types of the sphenoid sinus (SS) and protrusion/dehiscence of the optic nerve (ON) and the internal carotid artery (ICA).

MATERIAL AND METHODS: This prospective cross-sectional study was conducted between November 2020 and April 2021 at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi. This study examined 300 computed tomography (CT) PNS patients aged 18-60 years. The forms of SS pneumatization, extent of pneumatization to the greater wing (GW), anterior clinoid process (ACP), and pterygoid process (PP), as well as the protrusion/dehiscence of the ON and ICA were examined. A statistical relationship was identified between pneumatization type and protrusion/dehiscence of the ON and ICA.

RESULTS: The study included 171 men and 129 women with an average age of 39.28±10.9 years. The most commonly encountered pneumatization type was postsellar (63.3%), followed by sellar (27.3%), presellar (8.7%), and conchal (0.75%). The most frequent extended pneumatization was observed up to PP (44%), followed by ACP (31.33%), and GW (16.67%). The rate of dehiscence of the ON and ICA was less than that of protrusion of the same structures. The association between postsellar and sellar pneumatization types and protrusion of the ON and ICA was statistically significant (p 0.001), with the postsellar type showing more protrusions of the ON and ICA than the sellar type.

CONCLUSION: The pneumatization type of SS has a significant impact on the protrusion/dehiscence of adjacent vital neurovascular structures and should be mentioned in CT reports to alert surgeons for any disastrous intraoperative complications and outcomes.

PMID:36951035 | DOI:10.5137/1019-5149.JTN.40154-22.3

Turk Neurosurg. 2022 Nov 30. doi: 10.5137/1019-5149.JTN.42287-22.2. Online ahead of print.

ABSTRACT

AIM: The current study aims to elucidate the role of the TIR-domain-containing adaptor-inducing interferon-β (TRIF) dependent pathway in intervertebral disc degeneration (IVD).

MATERIAL AND METHODS: 88 adult male patients with low back pain (LBP) (+/- radicular pain) were further evaluated by magnetic resonance imaging (MRI) with surgical indication for microscopic lumbar disc herniation (LDH). Preoperatively, patients were classified according to Modic Changes (MC), use of nonsteroidal anti-inflammatory drugs (NSAIDs), and the presence of radicular pain additional to the LBP.

RESULTS: The age of the 88 patients ranged from 19 to 75 years (mean: 47.3 ± 19.6 years). 28 of the patients were evaluated as MC I (31.8%), 40 as MC II (45.4%), and 20 as MC III (22.7%). The majority of patients (81.8%) had radicular LBP, while 16 patients (18.1%) had only LBP. Predominantly, 55.6% of all patients were taking NSAIDs. Levels of all adaptor molecules were highest in the MC I group and lowest in the MC III group. The levels of IRF3, TICAM1, TICAM2, NF-kB p65, TRAF6, and TLR4 were significantly increased in the MC I group compared to the MC II and MC III groups. The variations of the individual adaptor molecules showed no statistically significant difference in the use of NSAIDs and radicular LBP.

CONCLUSION: As a result of the impact assessment, the current study clearly demonstrated for the first time that the TRIF-dependent signalling pathway plays a crucial role in the degeneration process in human lumbar intervertebral disc specimens.

PMID:36951033 | DOI:10.5137/1019-5149.JTN.42287-22.2

Turk Neurosurg. 2022 Jul 27. doi: 10.5137/1019-5149.JTN.40660-22.2. Online ahead of print.

ABSTRACT

AIM: To analyze changes in the lumbosacral angle in children with tethered cord syndrome before and after spinal cord untethering surgery, and to determine the clinical value of such changes at the last follow-up.

MATERIAL AND METHODS: We retrospectively analyzed 23 children over 5 years old who were treated with spinal cord untethering in our hospital from January 2010 to January 2021 and who had complete medical data. X-rays were used to examine the child’s spine preoperatively, postoperatively, and at follow-up with frontal and lateral radiographs, and lumbosacral angle data were measured and analyzed.

RESULTS: A total of 23 children aged 5-14 years had their lumbosacral angles measured and analyzed with a postoperative followup of 12-48 months. The mean preoperative lumbosacral angle was 70.30 ± 9.04°, the mean postoperative lumbosacral angle was 63.34 ± 5.60°, and the mean lumbosacral angle at the last follow-up was 61.61 ± 9.14°. There was a statistically significant reduction in the lumbosacral angle in the children postoperatively and at the last follow-up compared to the preoperative period (p=0.002; p=0.001).

CONCLUSION: Spinal cord untethering can improve the inclination of the lumbosacral angle in children older than 5 years with tethered cord syndrome.

PMID:36951019 | DOI:10.5137/1019-5149.JTN.40660-22.2