Effects of Cervical Spinal Manipulation on Saccadic Eye Movements.

Quantifying saccadic eye movements can assist in identifying dysfunctional brain networks in both healthy and diseased people. Infrared Oculography is a simple and non-invasive approach to capturing and quantifying saccades, providing information that might aid in diagnosis and outcome assessments. The effect of spinal manipulation on quantified saccadic performance parameters has not been fully studied despite known post-manipulative effects on the brain and brainstem regions controlling them. This case study investigates spinal manipulation's immediate and long-term effects on saccadic eye movements by quantifying the saccades of a male patient diagnosed with post-concussion syndrome. The patient performed horizontal saccades that were quantified before and immediately following cervical spinal manipulation both at the case study's start and following a 2-week interim, during which the subject received six manipulative treatments. Immediate and long-term post-manipulative effects were observed, and the results revealed various post-manipulative effects across all quantified parameters in addition to between right and leftward saccades. The immediate post-manipulative effect was greatest at the case study's onset, while the long-term right and leftward saccadic symmetry were most affected. The observations in this case study demonstrate that cervical spinal manipulation influences saccadic eye movements, providing new insights into its central neurological effects and therapeutic applications beyond its most commonly known use in pain management. More importantly, it encourages scientists to undertake further clinical investigations on wider scales.

Amelioration of Motor Performance and Nigrostriatal Dopamine Cell Volume Using a Novel Far-Infrared Ceramic Blanket in an A53T Alpha-Synuclein Transgenic Parkinson's Disease Mouse Model.

We had attended a Parkinson's Disease (PD) patient for a non-healing wound who reported a marked decrease in his hand tremor and freezing of gait when his wound was exposed to a ceramic far-field infrared (cFIR) blanket. PD is the most frequent motor disorder and the second most frequent neurodegenerative disease after Alzheimer's Disease (AD). The tremor, rigidity, and slowness of movement associated with Parkinson's disease (PD) affect up to 10 million people throughout the world, and the major contributing factor to the pathogenesis of PD is the accumulation and propagation of pathological α-synuclein (α-Syn) and the death of dopaminergic cells in the Nigrostriatal system. Efforts to slow or stop its spreading have resulted in the development and use of dopaminergic drug replacement therapy. Unfortunately, there is a loss of about 70-80% of substantia nigral dopaminergic neurons in patients by the time they are diagnosed with PD, and various dopaminergic drugs provide only temporary relief of their motor symptoms. There are limitations in treating PD with many conventional medications, necessitating a combination of pharmaceutical and non-pharmacological therapy as an essential adjunct to better address the health and welfare of PD patients. We used male adult A53T alpha-synuclein transgenic mice exposed to a ceramic far-infrared blanket. Motor activity was assessed using the rotarod apparatus, and mouse brains were examined to quantify the fluorescence intensities of the immunostained samples. A53T alpha-synuclein transgenic mice had a significantly shorter time stay on the rotating bar than the wild-type mice (B6C3H). The rotarod performance was significantly improved in A53T alpha-synuclein transgenic mice exposed to cFIR as well as B6C3H healthy wild mice exposed to cFIR. There was a significant statistical and substantive increase in the cellular composition of the Striatum and substantia nigra of cFIR-treated mice. Improvement in motor performance is seen in PD mice and wild mice and is associated with increases in cell volume in the substantia nigra and striatum after treatment.

Surveillance of Vermont wildlife in 2021-2022 reveals no detected SARS-CoV-2 viral RNA.

Previous studies have documented natural infections of SARS-CoV-2 in various domestic and wild animals. More recently, studies have been published noting the susceptibility of members of the Cervidae family, and infections in both wild and captive cervid populations. In this study, we investigated the presence of SARS-CoV-2 in mammalian wildlife within the state of Vermont. 739 nasal or throat samples were collected from wildlife throughout the state during the 2021 and 2022 harvest season. Data was collected from red and gray foxes (Vulpes vulples and Urocyon cineroargentus, respectively), fishers (Martes pennati), river otters (Lutra canadensis), coyotes (Canis lantrans), bobcats (Lynx rufus rufus), black bears (Ursus americanus), and white-tailed deer (Odocoileus virginianus). Samples were tested for the presence of SARS-CoV-2 via quantitative RT-qPCR using the CDC N1/N2 primer set and/or the WHO-E gene primer set. Surprisingly, we initially detected a number of N1 and/or N2 positive samples with high cycle threshold values, though after conducting environmental swabbing of the laboratory and verifying with a second independent primer set (WHO-E) and PCR without reverse transcriptase, we showed that these were false positives due to plasmid contamination from a construct expressing the N gene in the general laboratory environment. Our final results indicate that no sampled wildlife were positive for SARS-CoV-2 RNA, and highlight the importance of physically separate locations for the processing of samples for surveillance and experiments that require the use of plasmid DNA containing the target RNA sequence. These negative findings are surprising, given that most published North America studies have found SARS-CoV-2 within their deer populations. The absence of SARS-CoV-2 RNA in populations sampled here may provide insights in to the various environmental and anthropogenic factors that reduce spillover and spread in North American's wildlife populations.

Neural Differentiation of Induced Pluripotent Stem Cells for a Xenogeneic Material-Free 3D Neurological Disease Model Neurulation from Pluripotent Cells Using a Human Hydrogel.

Alzheimer's Disease (AD) is characterized by synapse and neuronal loss and the accumulation of neurofibrillary tangles and Amyloid ß plaques. Despite significant research efforts to understand the late stages of the disease, its etiology remains largely unknown. This is in part because of the imprecise AD models in current use. In addition, little attention has been paid to neural stem cells (NSC), which are the cells responsible for the development and maintenance of brain tissue during an individual's lifespan. Thus, an in vitro 3D human brain tissue model using induced pluripotent stem (iPS) cell-derived neural cells in human physiological conditions may be an excellent alternative to standard models to investigate AD pathology. Following the differentiation process mimicking development, iPS cells can be turned into NSCs and, ultimately, neural cells. During differentiation, the traditionally used xenogeneic products may alter the cells' physiology and prevent accurate disease pathology modeling. Hence, establishing a xenogeneic material-free cell culture and differentiation protocol is essential. This study investigated the differentiation of iPS cells to neural cells using a novel extracellular matrix derived from human platelet lysates (PL Matrix). We compared the stemness properties and differentiation efficacies of iPS cells in a PL matrix against those in a conventional 3D scaffold made of an oncogenic murine-matrix. Using well-defined conditions without xenogeneic material, we successfully expanded and differentiated iPS cells into NSCs via dual-SMAD inhibition, which regulates the BMP and TGF signaling cascades in a manner closer to human conditions. This in vitro, 3D, xenogeneic-free scaffold will enhance the quality of disease modeling for neurodegenerative disease research, and the knowledge produced could be used in developing more effective translational medicine.

Surveillance of Vermont wildlife in 2021-2022 reveals no detected SARS-CoV-2 viral RNA.

Previous studies have documented natural infections of SARS-CoV-2 in various domestic and wild animals. More recently, studies have been published noting the susceptibility of members of the Cervidae family, and infections in both wild and captive cervid populations. In this study, we investigated the presence of SARS-CoV-2 in mammalian wildlife within the state of Vermont. 739 nasal or throat samples were collected from wildlife throughout the state during the 2021 and 2022 harvest season. Data was collected from red and gray foxes ( Vulpes vulples and Urocyon cineroargentus , respectively), fishers ( Martes pennati ), river otters ( Lutra canadensis ), coyotes ( Canis lantrans ), bobcats ( Lynx rufus rufus ), black bears ( Ursus americanus ), and white-tailed deer ( Odocoileus virginianus ). Samples were tested for the presence of SARS-CoV-2 via quantitative RT-qPCR using the CDC N1/N2 primer set and/or the WHO-E gene primer set. Our results indicate that no sampled wildlife were positive for SARS-CoV-2. This finding is surprising, given that most published North America studies have found SARS-CoV-2 within their deer populations. The absence of SARS-CoV-2 RNA in populations sampled here may provide insights in to the various environmental and anthropogenic factors that reduce spillover and spread in North American's wildlife populations.

Exercise improves depression through positive modulation of brain-derived neurotrophic factor (BDNF). A review based on 100 manuscripts over 20 years.

The aim of this review was to explore the relevant neurobiology and the association between peripheral levels of brain-derived neurotrophic factor (BDNF) and acute and short to long-term exercise regimes, as well as its relation to depression and antidepressant treatment. A 20-year literature search was conducted. The screening process resulted in 100 manuscripts. Antidepressants as well as acute exercise, particularly high-intensity, elevates BDNF in healthy humans and clinical populations, as evidenced from aerobic and resistance-based studies. Although exercise is increasingly recognised in the management of depression, acute and short-term exercise studies have failed to establish a relationship between the severity of depression and changes in peripheral BDNF. The latter rapidly returns to baseline, possibly indicating a quick re-uptake by the brain, aiding its neuroplasticity functions. The timescale of administration needed for the antidepressants to stimulate biochemical changes is longer than similar increases with acute exercise.

Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study.

BACKGROUND: Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction. PURPOSE: To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patient's outcome at 6-year follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. RESULTS: An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation (P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores (P < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years. CONCLUSION: Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.

Drug-induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2-year follow up.

Objective: To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA. Methods: This is a retrospective review of surgically naïve patients <18 years old with diagnosed moderate-severe OSA who underwent DISE at the time of initial sleep surgery. Patients included in final analysis had both preoperative and postoperative polysomnograms. Surgical success was defined as an oAHI decrease by at least one diagnostic category. Residual OSA was defined as any patient with postoperative oAHI >1. Results: A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p < 0.001). Surgical success occurred in 76.4% of patients. A postoperative oAHI of <5 was achieved in 57.7% of patients with moderate or severe OSA. The average BMI% of patients who met surgical success was 86.4, while the average BMI% of patients who did not was 90.8. A postoperative oAHI of <5 was achieved in 68.4% of patients with a BMI% < 85, compared with 55.2% of patients with a BMI% ≥ 85. Conclusion: This study supports the utilization of DISE during initial surgery for severe sleep apnea in the pediatric population. It was found to effectively aid in significantly reducing surgically naïve patients' mean oAHI. Level of Evidence: Level III.

Comparing Rates of Fusion and Time to Fusion in Viable Cellular Allograft and Autograft.

BACKGROUND: Autograft or allograft frequently are used to enhance bone union in foot and ankle surgery. Viable cellular bone allograft uses viable cells and bone scaffolding in a gel base, but uncertainty remains around allograft's greater efficacy than autograft regarding rates of fusion (ROF) and time to fusion (TTF). METHODS: Autograft, viable cellular allograft, and viable cellular allograft with autograft were compared in 199 forefoot, midfoot, and hindfoot arthrodeses performed over a 6-year period. Data collected from electronic medical records and radiographs were analyzed to determine ROF and TTF as well as rates of revision surgery for delayed or nonunion and compared among groups. RESULTS: Eighty-seven patients comprised the autograft group, 81 the allograft group, and 31 the combined group. No significant differences were noted in patient demographics among the groups. No statistically significant differences in ROF were noted among the 3 groups, with 86% (75 of 87) fusion in the autograft group, 93% (75 of 81) in the allograft group, and 84% (26 of 31) in the combined group (P = .20). After conducting a multivariate analysis, we found no statistically significant difference for allograft or combined graft on TTF (P = .1379 and .2311, respectively). No significant difference was found in rate of revision surgery for nonunion, which was 1.2% (1 of 81) in the allograft group, 3.4% (3 of 87) in the autograft group, and 6.5% (2 of 31) in the combined group (P = .3). CONCLUSION: No significant difference was found in ROF, TTF, or rate of revision surgery when comparing viable cellular allograft to autograft or combined allograft-autograft. Viable cellular allograft may be a reasonable alternative to the gold standard of autograft and should be considered an option in patients undergoing arthrodesis in foot and ankle surgery. LEVEL OF EVIDENCE: Level III, therapeutic.

Use of VOTE score in predicting outcomes in pediatric obstructive sleep apnea.

OBJECTIVES: Obstructive Sleep Apnea (OSA) affects 1-4% of the pediatric population in the U.S. Drug-Induced Sleep Endoscopy (DISE) is widely used to localize the level(s) of obstruction. The VOTE classification system is used to grade obstructions found at the velum, oropharynx, base of tongue, and epiglottis and has been validated in adults. This study aims to determine if the VOTE score has any predictive value in pediatric OSA postoperative outcomes. METHODS: A retrospective chart review of 129 patients from January 7, 2016 to 05/30/2020 was performed. Included patients were between the ages of 2 and 17, undergoing DISE, and if they had preoperative and postoperative polysomnography (PSG) data. Excluded patients did not meet one of the above or had other comorbidities contributing to their sleep apnea. 53 patients were included. RESULTS: Pearson's Correlation tests compared intraoperative VOTE score to postoperative BMI, AHI, and O2 nadir and their relationships. We found a weakly positive correlation between the VOTE and postoperative AHI with a coefficient of 0.35 and a p-value of 0.01. We found a relationship between postoperative O2 nadir and AHI, with a coefficient of -0.627 and a p-value <0.0001. Finally, a paired, two-tailed t-test compared the mean change between preoperative and postoperative BMIs (+1.6), oAHIs (-23.5), and O2 nadirs (+14), all with p-value <0.0001. CONCLUSION: We demonstrated a correlation between VOTE and improved postoperative AHI and a relationship between improved postoperative AHI and postoperative O2 nadir. The validity of VOTE may be proven with larger sample size. Alternatively, a different scoring system may be required for pediatric OSA.

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery.

BACKGROUND: Preoperative oral antibiotic use in patients undergoing foot and ankle surgery is standard practice, but no consensus has been reached regarding the efficacy of postoperative oral antibiotics. The purpose of this study was to determine whether postoperative oral antibiotics reduce the rate of surgical site infections (SSIs) in patients, with and without comorbidities, undergoing foot and ankle surgery. METHODS: A retrospective chart review was conducted identifying patients who underwent foot and ankle surgery by 4 fellowship-trained, foot and ankle orthopaedic surgeons between January 1, 2015, and January 1, 2019. Patients were divided into 2 groups: those who received postoperative oral antibiotics (group 1) and those who did not (group 2). Two surgeons routinely prescribed postoperative oral antibiotics, and 2 did not. Demographics, comorbidities, and procedure complexity based on surgical site and Current Procedural Terminology code were recorded from the charts. The primary outcome was postoperative infection (superficial or deep) within 6 months after surgery. Patients with antibiotic use prior to surgery, preoperative infection, or lack of follow-up >6 weeks were excluded. Multivariate logistic regression modeling was used to analyze differences in infection rate and severity. RESULTS: Chart review identified 3631 patients, 1227 of whom did not receive postoperative oral antibiotics whereas 2394 patients did. Routine postoperative oral antibiotic use did not significantly affect postoperative infection rates or severity. However, all covariates studied (diabetes, hypertension, obesity, tobacco use, alcohol use, rheumatoid conditions, and age) influenced postoperative infection rates and severity. CONCLUSION: The results of this study indicate that postoperative oral antibiotics are not associated with differences in infection rates or severity. We do not recommend routine use in foot and ankle surgery.

Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting.

BACKGROUND: Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described. PURPOSE: To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics. RESULTS: A total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group. CONCLUSION: Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.

Returning to Activity After Anterior Cruciate Ligament Revision Surgery: An Analysis of the Multicenter Anterior Cruciate Ligament Revision Study (MARS) Cohort at 2 Years Postoperative.

BACKGROUND: Patients with anterior cruciate ligament (ACL) revision report lower outcome scores on validated knee questionnaires postoperatively compared to cohorts with primary ACL reconstruction. In a previously active population, it is unclear if patient-reported outcomes (PROs) are associated with a return to activity (RTA) or vary by sports participation level (higher level vs. recreational athletes). HYPOTHESES: Individual RTA would be associated with improved outcomes (ie, decreased knee symptoms, pain, function) as measured using validated PROs. Recreational participants would report lower PROs compared with higher level athletes and be less likely to RTA. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: There were 862 patients who underwent a revision ACL reconstruction (rACLR) and self-reported physical activity at any level preoperatively. Those who did not RTA reported no activity 2 years after revision. Baseline data included patient characteristics, surgical history and characteristics, and PROs: International Knee Documentation Committee questionnaire, Marx Activity Rating Scale, Knee injury and Osteoarthritis Outcome Score, and the Western Ontario and McMaster Universities Osteoarthritis Index. A binary indicator was used to identify patients with same/better PROs versus worse outcomes compared with baseline, quantifying the magnitude of change in each direction, respectively. Multivariable regression models were used to evaluate risk factors for not returning to activity, the association of 2-year PROs after rACLR surgery by RTA status, and whether each PRO and RTA status differed by participation level. RESULTS: At 2 years postoperatively, approximately 15% did not RTA, with current smokers (adjusted odds ratio [aOR] = 3.3; P = .001), female patients (aOR = 2.9; P < .001), recreational participants (aOR = 2.0; P = .016), and those with a previous medial meniscal excision (aOR = 1.9; P = .013) having higher odds of not returning. In multivariate models, not returning to activity was significantly associated with having worse PROs at 2 years; however, no clinically meaningful differences in PROs at 2 years were seen between participation levels. CONCLUSION: Recreational-level participants were twice as likely to not RTA compared with those participating at higher levels. Within a previously active cohort, no RTA was a significant predictor of lower PROs after rACLR. However, among patients who did RTA after rACLR, approximately 20% reported lower outcome scores. Most patients with rACLR who were active at baseline improved over time; however, patients who reported worse outcomes at 2 years had a clinically meaningful decline across all PROs.

Treatment of sialorrhea with botulinum toxin injections in pediatric patients less than three years of age.

OBJECTIVE: To determine the patient demographics and the efficacy and safety profile of botulinum toxin (BTX) injections for sialorrhea control in patients under the age of three. METHODS: This is a retrospective chart review study. Patients under three years of age who received BTX injections for sialorrhea management from 2010 to 2021 were assessed. Patient demographics, comorbidities, medical and surgical histories, indications, BTX injection details, and post injection complications were documented. RESULTS: Forty-nine patients met inclusion criteria. The most common patient under three years of age with sialorrhea to receive BTX injections were white (51.0%) male (51.0%) with congenital (73.5%) and/or neurologic (53.1%) comorbidities. Thirty-six (73.5%) patients were from medically underserved areas/populations. Our patients on average received 1.7 injections, with 44.9% requiring multiple BTX injections. Bilateral parotid and bilateral submandibular glands (four-gland) BTX injections were associated with significant decrease in admissions for pneumonia and cessation of anticholinergics usage (both P < 0.05). Post BTX injections, 15 (30.6%) patients required additional surgeries for sialorrhea control. No adverse outcomes due to BTX injections were reported. CONCLUSIONS: Pediatric sialorrhea was commonly associated with congenital and/or neurologic comorbidities and disproportionately impacted medically underserved black patients. BTX injections offered multifaceted benefits for controlling sialorrhea in patients under the age of three. Four-gland BTX injections led to reduction of unnecessary hospitalization, usage of anticholinergics, and additional surgeries for sialorrhea management.

An Ideal Multidisciplinary Cleft Lip and Cleft Palate Care Team.

We emphasize the benefits of a multidisciplinary team approach to the systemic management of patients with cleft lip and cleft palate (CL/CP) and their families. An ideal team offers support to families at each stage of their child's development and adapts to address new issues that are encountered throughout growth. We suggest the addition of a registered dietitian to the initial phase of the care team to ensure the child consumes adequate macronutrient intake, and to maximize growth and development. An ideal cleft palate care team focuses on a comprehensive, collaborative, and family-centered approach to the complex medical and surgical needs of infants with CL/CP as they grow to young adulthood. Although care teams may differ slightly depending on context and location, there are central tenets that make an ideal team. After reviewing CL/CP care team guidelines and recommendations from a variety of different countries, this article reflects what an ideal organization structure and care team composition could be comprised of.

Digital Health Technology for Remote Care in Primary Care During the COVID-19 Pandemic: Experience from Dubai.

Introduction: We aimed to provide an insight on the feasibility and impact of telemedicine use among primary health care (PHC) providers and on nonurgent health care delivery during the coronavirus disease 2019 (COVID-19) outbreak in the United Arab Emirates (UAE). Methods: This observational study was conducted using telemedicine data from Dubai Health Authority from January 2020 to July 2021. Results: Of 123,944 individuals who booked an appointment for the telemedicine service, 106,408 (86%) showed up. Most patients were 19-59 years old, UAE nationals, female, and having government insurance. The telemedicine care volume grew from 188 visits in January 2020 to 11,757 in April 2020. The most common diagnosis was general health consultation (55,672; 52%), followed by COVID-19-related consultation (18,523; 17%) and laboratory test requests (11,064; 10%). Around 4,997 (5%) telemedicine consultations were for a medication refill. A multiple linear regression model predicting the types of diagnosis-related telemedicine needs by age and the interaction of gender and nationality was statistically significant for dermatology (p = 0.0000), respiratory (p = 0.0000), and cardiovascular (p = 0.0000) diseases. Conclusions: Virtual care services in PHC clinics have been highly successful in meeting the needs of patients during the COVID-19 pandemic. Telemedicine has enabled clinicians to continue providing care to patients while maintaining the necessary public health measures adopted in the fight against COVID-19. However, will the switch to telemedicine be sustainable in the long term and what will be the level and degree of telemedicine adoption beyond COVID-19? This requires more studies to explore how the PHC organizations will provide further support and guidance on the suitability of telemedicine in various circumstances and clinical conditions.

Postoperative Use of Ketorolac Improves Pain Management and Decreases Narcotic Use Following Primary Cleft Palate Surgery.

OBJECTIVE: To study the efficacy and safety profile of ketorolac in cleft palate surgery. DESIGN: Retrospective analysis of patients who underwent primary cleft palate surgery and received either postoperative ketorolac or opioids. SETTING: Tertiary care children's hospital. PATIENTS, PARTICIPANTS: Eighty-nine patients enrolled who were all younger than 36 months of age, not dependent on a gastrostomy tube, with no history of bleeding disorders, and had undergone their primary cleft palate procedure by one specific surgeon between January 2010 and June 2019. INTERVENTIONS: n/a. MAIN OUTCOME MEASURE: Morphine equivalent dose (MED), Face, Legs, Activity, Cry, Consolability (FLACC) score, length of stay (LOS), total oral intake (mL), total oral intake/LOS, and postoperative adverse events between ketorolac and no ketorolac groups. RESULTS: MED, FLACC score, and LOS were significantly lower in the ketorolac group compared to the no ketorolac group. One patient in the ketorolac group had a bleeding event. CONCLUSIONS: Use of ketorolac significantly decreased narcotic usage and pain scores as reported by the FLACC score. Moreover, postoperative bleeding was rare in both ketorolac and no ketorolac groups.

Factors associated with knowledge and practice of optimal breastfeeding among mothers in Dubai.

Although breastfeeding has been the primary source of nutrition for infants, many women do not choose to practise breastfeeding due to lack of knowledge, inability to do so or personal choices. This study aimed at determining the breastfeeding practices and examining the sociodemographic factors associated with optimal breastfeeding among mothers attending child welfare clinic at Dubai Health Authority. A structured questionnaire was designed consisting of sociodemographic data, knowledge, attitude and practice towards breastfeeding. The main reasons for not breastfeeding the baby within 30 min after delivery were having had a caesarean section, followed by separation of the baby from the mother. We found better practice among homemakers, non-United Arab Emirates (UAE) and married women, those with less monthly income, and those with standard delivery. There is a need for better education on optimal breastfeeding, especially in UAE national pregnant women, who have had caesarean sections, or having babies admitted in the intensive care unit.

Smooth Pursuit Eye Movements as a Biomarker for Mild Concussion within 7-Days of Injury.

AIM: Deficits in smooth-pursuit eye movements (SPEM) are often associated with mild traumatic brain injury(TBI). Eye tracking tests serve as a quick objective clinical tool to assess such predictive visual tracking. In this study, SPEM was assessed along circular, horizontal and vertical trajectories in adolescents with concussion and age-matched controls. METHODS: Ninety-one young adolescents with concussion and 140 visually healthy age-matched controls with a mean age of 14 years performed a computerized test of circular, horizontal and vertical tracking task using an eye tracker. Oculomotor tracking was assessed by computing the rate of fixation, saccades and SPEM made while performing the tasks. RESULTS: The predictive visual tracking task was able to differentiate the TBI group from the non-TBI group. The TBI group showed a significant difference in the fixation, saccades and SPEM percentages for circular tracking movement compared to the controls. There was a significant difference in fixation and SPEM % for horizontal and vertical tracking. CONCLUSIONS: Predictive visual tracking, assessed using eye tracking technology, is able to differentiate deficits in oculomotor functions in individuals with and without concussion. The eye tracking technology may serve as a quick objective tool to detect and monitor neural deficits due to TBI.

Combined MPFL reconstruction and tibial tubercle osteotomy for patellar instability: A retrospective review of 23 patients.

The primary objective of this retrospective study is to compare patient outcomes following a combined approach (MPFL reconstruction and TTT) to outcomes reported in the literature by patients who required either only an isolated TTT procedure to treat pathologic lateral patellar instability or isolated MPFL reconstruction to treat patellar dislocation due to MPFL insufficiency. Twenty-three patients (74%) were available for follow-up and are included in our analysis. MPFL reconstruction combined with TTT has a high rate of success for patients presenting with patellar instability and extensor mechanism mal-alignment. The risk of recurrence with this technique was low (4.3%).