Selecting the right limb, at the right time, for the right reason: response to “A meta-analysis on anticoagulation after vascular trauma”

Author(s):  
Amila Ratnayake ◽  
Tamara J. Worlton
2012 ◽  
Vol 8 (3) ◽  
pp. 209
Author(s):  
Wouter Jacobs ◽  
Anton Vonk-Noordegraaf ◽  
◽  

Pulmonary arterial hypertension is a progressive disease of the pulmonary vasculature, ultimately leading to right heart failure and death. Current treatment is aimed at targeting three different pathways: the prostacyclin, endothelin and nitric oxide pathways. These therapies improve functional class, increase exercise capacity and improve haemodynamics. In addition, data from a meta-analysis provide compelling evidence of improved survival. Despite these treatments, the outcome is still grim and the cause of death is inevitable – right ventricular failure. One explanation for this paradox of haemodynamic benefit and still worse outcome is that the right ventricle does not benefit from a modest reduction in pulmonary vascular resistance. This article describes the physiological concepts that might underlie this paradox. Based on these concepts, we argue that not only a significant reduction in pulmonary vascular resistance, but also a significant reduction in pulmonary artery pressure is required to save the right ventricle. Haemodynamic data from clinical trials hold the promise that these haemodynamic requirements might be met if upfront combination therapy is used.


2019 ◽  
Author(s):  
Zachary Hawes ◽  
H Moriah Sokolowski ◽  
Chuka Bosah Ononye ◽  
Daniel Ansari

Where and under what conditions do spatial and numerical skills converge and diverge in the brain? To address this question, we conducted a meta-analysis of brain regions associated with basic symbolic number processing, arithmetic, and mental rotation. We used Activation Likelihood Estimation (ALE) to construct quantitative meta-analytic maps synthesizing results from 86 neuroimaging papers (~ 30 studies/cognitive process). All three cognitive processes were found to activate bilateral parietal regions in and around the intraparietal sulcus (IPS); a finding consistent with shared processing accounts. Numerical and arithmetic processing were associated with overlap in the left angular gyrus, whereas mental rotation and arithmetic both showed activity in the middle frontal gyri. These patterns suggest regions of cortex potentially more specialized for symbolic number representation and domain-general mental manipulation, respectively. Additionally, arithmetic was associated with unique activity throughout the fronto-parietal network and mental rotation was associated with unique activity in the right superior parietal lobe. Overall, these results provide new insights into the intersection of numerical and spatial thought in the human brain.


Author(s):  
Gemma Learmonth ◽  
Marietta Papadatou-Pastou

AbstractYoung adults exhibit a small asymmetry of visuospatial attention that favours the left side of space relative to the right (pseudoneglect). However, it remains unclear whether this leftward bias is maintained, eliminated or shifted rightward in older age. Here we present two meta-analyses that aimed to identify whether adults aged ≥50 years old display a group-level spatial attention bias, as indexed by the line bisection and the landmark tasks. A total of 69 datasets from 65 studies, involving 1654 participants, were analysed. In the meta-analysis of the line bisection task (n = 63), no bias was identified for studies where the mean age was ≥50, but there was a clear leftward bias in a subset where all individual participants were aged ≥50. There was no moderating effect of the participant’s age or sex, line length, line position, nor the presence of left or right cues. There was a small publication bias in favour of reporting rightward biases. Of note, biases were slightly more leftward in studies where participants had been recruited as part of a stand-alone older group, compared to studies where participants were recruited as controls for a clinical study. Similarly, no spatial bias was observed in the meta-analysis of the landmark task, although the number of studies included was small (n = 6). Overall, these results indicate that over 50s maintain a group-level leftward bias on the line bisection task, but more studies are needed to determine whether this bias can be modulated by stimulus- or state-dependent factors.


2021 ◽  
Vol 92 (8) ◽  
pp. A18-A18
Author(s):  
Maria Teixeira-Dias ◽  
Amber Kaur Dadwal ◽  
Graham Blackman

Objectives/AimsFregoli syndrome is a rare delusion characterised by the misidentification of an individual, typically of someone who the patient has an emotional link towards. The pathoaetiology of Fregoli syndrome remains largely a mystery, however, it has been described in patients experiencing either a primary or secondary (organic) psychosis. We sought to compare the neuropsychiatric features of Fregoli syndrome in primary and secondary psychosis.MethodsA patient-level meta-analysis was conducted. Five databases were searched for any descriptions of Fregoli syndrome. The patients and the psychotic episodes details alongside the co-occurring neuropsychiatric features and treatment responses were extracted. A risk of bias assessment was carried by scoring the methodological quality of all case studies. Random-effects models were used to pool the data and odds ratios and 95% confidence intervals were estimated for each of the neuropsychiatric features extracted between primary and secondary psychoses groups.ResultsA total of 119 patients (62 with primary psychosis, 50 with secondary psychosis and 7 with mixed or unknown aetiology) with Fregoli syndrome were identified in the English literature. Persecutory features were more likely to occur in patients with primary Fregoli syndrome (OR = 0.26, 95% CI[0.10;0.67], p < 0.01). In addition, Fregoli syndrome in the context of a first-episode psychosis (OR = 11.00, 95% CI [2.45;49.39], p < 0.01) and in the presence of neuroimaging abnormalities (OR = 20.19, 95% CI [4.36; 93.47], p < 0.01) was significantly associated with secondary aetiology. Patients in the secondary psychosis group (n=14) showed more right hemisphere lesions than patients in the primary psychosis group (n=1), however this trend was not significant (p = 0.10). Furthermore, no statistical differences between psychoses groups were found for the demographic, clinical and neurophysiological features analysed.ConclusionsThis is the first meta-analysis investigating the features of Fregoli syndrome in primary and secondary psychosis.Findings suggest that secondary causes of Fregoli syndrome are associated with a first-episode of psychosis and that neuroimaging abnormalities, particularly in the right hemisphere, are associated with a secondary organic cause.


2012 ◽  
Vol 2 (2) ◽  
pp. 69-73
Author(s):  
Sudhir M Naik

ABSTRACT Background/objectives Laryngeal paragangliomas are benign slow growing tumors with symptoms resembling squamous cell carcinoma. Hoarseness or dysphasia is the commonest presenting symptom and usually it presents as a submucosal mass on laryngoscopy. A total of 90% of these tumors occur in the supraglottic larynx and the rest in the glottis and the subglottic region. Functional activity is seen in a few (2.9%), none are associated with paraneoplastic syndromes. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 35-year-old male presented to us with hoarseness of voice since 4 months duration. Contrast arteriography demonstrated that the left superior thyroid artery supplied greater than 80% of the blood supply to the laryngeal mass. Superselective embolization was done from the right femoral under local anesthesia and sedation which was uneventful. Intervention The tumor was excised from lateral pharyngotomy approach with an elective tracheostomy. Microscopy suggested it to be paraganglioma and immunohistochemistry confirmed it. Conclusion Complete surgical resection or partial laryngectomy with meticulous dissection of surrounding tissues and preservation of neurovascular structures give an excellent prognosis as far as oncological clearance is concerned. Malignant paragangliomas of the larynx are rare and a major meta-analysis is necessary to provide a true biological behavior of this tumor. How to cite this article Naik SM. Supraglottic Laryngeal Paraganglioma: A Rare Clinical Entity managed by Lateral Pharyngotomy Approach. Int J Phonosurg Laryngol 2012;2(2): 69-73.


2021 ◽  
Author(s):  
Silvia Ruiz-Torras ◽  
Oscar Fernández-Vazquez ◽  
Cristina Cañete-Massé ◽  
Maribel Peró-Cebollero ◽  
Joan Guàrdia-Olmos

Abstract In the last few years, the field of brain connectivity has focused on identifying biomarkers to describe different health states and to discriminate between patients and healthy controls through the characterization of brain networks. A particularly interesting case, because of the symptoms' severity, is the work done with samples of patients diagnosed with schizophrenia. This meta-analysis aims to identify connectivity networks with different activation patterns between people diagnosed with schizophrenia and healthy controls. Therefore, we collected primary studies exploring whole brain connectivity by functional magnetic resonance imaging at rest in patients with schizophrenia compared to healthy people. Thus, we identified 25 high-quality studies that included a total of 1285 people with schizophrenia and 1279 healthy controls. The results indicate hypoactivation in the right precentral gyrus and in the left superior temporal gyrus of people with schizophrenia compared with the control group. These regions have been linked to deficits in gesticulation and the experience of auditory hallucinations in people with schizophrenia. A study of heterogeneity demonstrated that the effect size was influenced by the sample size and type of analysis. These results imply new contributions to the knowledge, diagnosis, and treatment of schizophrenia both clinically and in research.


Author(s):  
Tahere Sharifi ◽  
Ehsan Shamsi-Gooshki ◽  
Ali Mohammad Mosadeghrad ◽  
Ebrahim Jaafaripooyan

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights’ practices in healthcare organizations of Iran. Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights’ charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %). Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers.


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