Collateral estimation by susceptibility-weighted imaging and prediction of functional outcomes after acute anterior circulation ischemic stroke

To determine the value of susceptibility-weighted imaging (SWI) for collateral estimation and for predicting functional outcomes after acute ischemic stroke. To identify independent predictors of favorable functional outcomes, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline diffusion-weighted imaging (DWI) lesion volume, site of steno-occlusion, SWI collateral grade, mode of treatment, and successful reperfusion were evaluated by multiple logistic regression analyses. A total of 152 participants were evaluated. A younger age (adjusted odds ratio (aOR), 0.42; 95% confidence interval (CI) 0.34 to 0.77; P < 0.001), a lower baseline NIHSS score (aOR 0.90; 95% CI 0.82 to 0.98; P = 0.02), a smaller baseline DWI lesion volume (aOR 0.83; 95% CI 0.73 to 0.96; P = 0.01), an intermediate collateral grade (aOR 9.49; 95% CI 1.36 to 66.38; P = 0.02), a good collateral grade (aOR 6.22; 95% CI 1.16 to 33.24; P = 0.03), and successful reperfusion (aOR 5.84; 95% CI 2.08 to 16.42; P = 0.001) were independently associated with a favorable functional outcome. There was a linear association between the SWI collateral grades and functional outcome (P = 0.008). Collateral estimation using the prominent vessel sign on SWI is clinically reliable, as it has prognostic value.

Procalcitonin Level Can be a Useful Indicator of When Antibiotics Should be Stepped up in Children with Cancer and Fever without Source

Objective: To assess whether procalcitonin (PCT) levels can be a reliable indicator of when it is unnecessary to step up antibiotics in children with cancer and fever without source (FWS). Material and Methods: The medical records of children with hematologic-oncologic malignancies aged 3 months-15 years who had FWS ≥4 days and were admitted to Songklanagarind Hospital from December 2016 to February 2019 were reviewed. Results: FWS was identified in 89 patients. PCT levels were tested in 43 patients; 21 and 22 patients had low PCT (PCT <0.5 nanograms per milliliter (ng/mL)) and high PCT (PCT ≥0.5 ng/mL) levels, respectively. The baseline characteristics of the patients including age, sex, risk of serious bacterial infection, and duration of antibiotic(s) among the 3 groups (low-PCT, high-PCT and PCT-not-tested) were not significantly different. The proportions of patients who had had their antibiotics stepped up after 4 days with conventional treatment were 65.0%, 90.9%, and 95.7% and who were stepped up to carbapenem were 38.1%, 68.2%, and 73.9% in the low-PCT, high-PCT, and PCT-not-tested groups, respectively, significantly lowest in the low-PCT group. High PCT levels were associated with sepsis with sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 57.1%, 31.8%, and 95.2%, respectively. Conclusion: We suggest that cancer children who have FWS without sepsis and low PCT levels do not need to have their antibiotics stepped up; however, as the sample size of this study was quite small, further studies are needed to confirm our findings and conclusion.

Evaluation of Coronary Artery Calcification and Gremlin-1 Serum Level Correlation in Patients with Chronic Ischemic Heart Disease

Background: Available evidences have shown that bone morphogenetic proteins (BMPs), particularly BMP 2 and BMP 4, are involved in vascular calcification. Gremlin 1 is one of the important endogenous inhibitors of BMPs. This extracellular antagonist of bone morphogenic proteins has a very complex and cysteine-rich chain and establishes non-colonial transmissions to the members of the family with varying degrees of dependence and prevents them from binding to the receptor, thereby inhibit their function. The main objective of this study was clinical evaluation of the correlation between Gremlin-1 serum concentration and Coronary Artery Calcification. Methods: Eighty-four patients with coronary artery disease from cardiology ward of Razavi Hospital, Mashhad, Iran, who completed the inclusion criteria, entered in the study between November 2015 and March 2016. CT-Angiography was performed to define coronary artery calcium score and Gremlin-1 serum concentrations were measured by an ELISA kit. Results: Eighty-one patients, with mean age of 57.19±10.18 years were included to the study. The mean serum level of Gremlin-1 was 10.92±8.46 pg/mL. There was a reverse significant correlation between Gremlin-1 serum concentration and Coronary Artery Calcification of Right coronary artery(RCA) (P<0.05), in contrast to total Coronary Artery Calcification score, left artery Descending (LAD), Left Main (LM) and Circumflex (CX). However, there was no evidence that age and sex risk factor, hypertension, diabetes mellitus, hyperlipidemia, positive family history, current smoking and high BMI to be associated with serum level of Gremlin-1. Conclusion: Based on the results, Gremlin-1 serum concentration may be a suitable biomarker for predication coronary artery calcification severity. However, more researches on larger population are necessary for its validation.

Epidemiology of West Nile Virus Infections in Humans, Italy, 2012–2020: A Summary of Available Evidences

In Italy, human cases of West Nile virus (WNV) infection have been recorded since 2008, and seasonal outbreaks have occurred almost annually. In this study, we summarize available evidences on the epidemiology of WNV and West Nile neuro-invasive disease (WNND) in humans reported between 2012 and 2020. In total, 1145 WNV infection cases were diagnosed; of them 487 (42.5%) had WNND. A significant circulation of the pathogen was suggested by studies on blood donors, with annual incidence rates ranging from 1.353 (95% confidence intervals (95% CI) 0.279–3.953) to 19.069 cases per 100,000 specimens (95% CI 13.494–26.174). The annual incidence rates of WNND increased during the study period from 0.047 cases per 100,000 (95% CI 0.031–0.068) in 2012, to 0.074 cases per 100,000 (95% CI 0.054–0.099) in 2020, peaking to 0.377 cases per 100,000 (95% CI 0.330–0.429) in 2018. There were 60 deaths. Cases of WNND were clustered in Northern Italy, particularly in the Po River Valley, during the months of August (56.7%) and September (27.5%). Higher risk for WNND was reported in subjects of male sex (risk ratio (RR) 1.545, 95% CI 1.392–1.673 compared to females), and in older age groups (RR 24.46, 95% CI 15.61–38.32 for 65–74 y.o.; RR 43.7, 95% CI 28.33–67.41 for subjects older than 75 years), while main effectors were identified in average air temperatures (incidence rate ratio (IRR) 1.3219, 95% CI 1.0053–1.7383), population density (IRR 1.0004, 95% CI 1.0001–1.0008), and occurrence of cases in the nearby provinces (IRR 1.0442, 95% CI 1.0340–1.0545). In summary, an enhanced surveillance is vital for the early detection of human cases and the prompt implementation of response measures.

Social network characteristics and alcohol use by ethnic origin: An ego-based network study on peer similarity, social relationships, and co-existing drinking habits among young Swedes

The study explores how social network determinants relate to the prevalence and frequency of alcohol use among peer dyads. It is studied how similar alcohol habits co-exist among persons (egos) and their peers (alters) when socio-demographic similarity (e.g., in ethnic origin), network composition and other socio-cultural aspects were considered. Data was ego-based responses derived from a Swedish national survey with a cohort of 23-year olds. The analytical sample included 7987 ego-alter pairs, which corresponds to 2071 individuals (egos). A so-called dyadic design was applied i.e., all components of the analysis refer to ego-alter pairs (dyads). Multilevel multinomial-models were used to analyse similarity in alcohol habits in relation to ego-alter similarity in ethnic background, religious beliefs, age, sex, risk-taking, educational level, closure in network, duration, and type of relationship, as well as interactions between ethnicity and central network characteristics. Ego-alter similarity in terms of ethnic origin, age and sex was associated with ego-alter similarity in alcohol use. That both ego and alters were non-religious and were members of closed networks also had an impact on similarity in alcohol habits. It was concluded that network similarity might be an explanation for the co-existence of alcohol use among members of peer networks.

A Comparison of BTA stat and NMP 22 as Non-Invasive Screening Methods for Bladder Cancer. A Systematic Review.

BackgroundThe purpose of this study was to systematically review the effects of bladder tumor antigen (BTA) stat and nuclear matrix protein (NMP) 22 as a screening method in an asymptomatic population. Methods We evaluated 381 international studies by selecting randomized controlled trials (RCTs). We descriptively evaluated and summarized all of the 381 studies to identify their strengths and weaknesses in terms of the use of BTA stat and NMP 22. ResultsWe did not identify any RCTs that used BTA stat or NMP 22 as a pure screening tools. We also did not identify any studies that used an asymptomatic population. Different cut-off values and individualized methods were discussed for NMP 22 based on age, sex, risk factors, and history of bladder cancer, introducing significant heterogeneity and bias. Interestingly, the use of NMP 22 demonstrated only in men younger than 65 years positive results. ConclusionsRCTs are needed to show a reliable sensitivity and specificity of using BTA stat or NMP 22 as a screening test. It may be worth investigating in future studies whether it would be useful to offer NMP 22 to only a certain profile of patients. Based on our findings and in consent with national and international guidelines, a screening recommendation using NMP 22 and/or BTA stat can not be given for bladder cancer in an asymptomatic population.

Comparing Activity Trackers With vs. Without Alarms to Increase Postoperative Ambulation: A Randomized Control Trial

Early ambulation is a key component to postoperative recovery; however, measuring steps taken is often inconsistent and nonstandardized. This study aimed to determine whether an activity tracker with alarms would increase postoperative ambulation in patients after elective colorectal procedures. Forty-eight patients were randomly assigned to either trackers with 5 daily alarms or activity trackers alone. Over 223 total patient days, the trackers recorded a complete data set for 216 patient days (96.9%). Increasing the postoperative day significantly affected the number of steps taken, while age, sex, Risk Analysis Index score, and approach (laparoscopic versus open) did not show a significant effect. The mean steps per day in the intervention group were 1468 (median 495; interquartile range (IQR) 1345) and in the control group was 1645 (median 1014; IQR 2498). The use of trackers with alarms did not significantly affect the number of daily steps compared to trackers alone (ANOVA, P = .93). Although activity trackers with alarms did not increase postoperative ambulation compared with trackers with no alarms, we demonstrated a strategy to operationalize the use of trackers into postoperative care to provide a quantitative value for ambulation. This enables quantification of a key component in the Enhanced Recovery After Surgery protocol.

Not always eosinophilic esophagitis – intramural pseudodiverticulosis of the esophagus – a case report and literature review

Background Intramural pseudodiverticulosis of the esophagus (EIPD) is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult, and the disease can be confounded with eosinophilic esophagitis (EoE). We present a patient with esophageal intramural pseudodiverticulosis and a literature review. Case report The 45-year-old white caucasian woman with a history of nicotine and alcohol abuse had progressive hoarseness and severe dysphagia for solid food. Esophagogastroduodenoscopy (EGD) showed proximal esophageal stenosis, thrush esophagitis, and mucosal alteration with trachealization suspicious of EoE. However, repeated bouginage EGD and barium swallow revealed typical signs of esophageal intramural pseudodiverticulosis (EIPD). The patient was treated successfully by bougingage, acid suppression, and antifungal therapy. The literature analysis revealed the characteristics of EIPD according to age, sex, risk factors, and therapy modalities. Conclusion The case report and the literature overview suggest that EIPD can be confounded with EoE.

CLINICO-PATHOLOGICAL STUDY OF SINONASAL MASSES

INTRODUCTION The nose is the most prominent part of the face with substantial aesthetic and functional significance. It is one of the few organs of body invested with an aura of emotional and cultural importance. Anatomical location of the nose and it passage have been regarded as the direct avenue to the brain, man’s source of intelligence and spirituality. AIMS AND OBJECTIVES To study the incidence, clinical presentation and pathological profile of various types of sinonasal masses at Tata Main Hospital, Jamshedpur, Jharkhand. To detect the variation of clinical presentation of sinonasal masses in relation to Age, Sex, Risk factors and Occupation, clinical presentation and the histopathological diagnosis of sinonasal masses. Compare the results of this study with the results of the previous workers. MATERIAL & METHODS: This Prospective, observational study was done in the department of Otorhinolaryngology, Tata Main Hospital, Jamshedpur, Jharkhand. 90 patients presenting with the features of nasal obstruction, nasal discharge, headache, anosmia / hyposmia, epistaxis, facial deformity, ear & eye symptoms will be evaluated by taking history and thorough ENT and head and neck examination(including nasal endoscopy) and subjecting them for the procedure. RESULT Out of 90 patients, 59(65.56%) were males and 31(34.44%) were females. In our study, among non neoplastic masses 34 were male and 26 were female. For non-neoplastic lesions the average age of presentation was 36.2 years. Mean age of presentation was 37.21 years. CONCLUSION Emergence of newer surgical, medical and radiological intervention have open up a new chapter with these type of patients. . Awareness regarding the disease process and health education should be provided to people regarding smoking, maintenance of hygienic condition and utilization of health facilities.