The Use of Bone Wax in Hemostatic Control for Total Knee and Hip Arthroplasties: A Systematic Review.

Background/Objectives: Blood loss can be a serious complication in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Various methods are used by surgeons to achieve hemostatic control in these patients. Complications are associated with perioperative blood loss. In this systematic review, we examined the efficacy of using bone wax to control bleeding in patients undergoing THA and TKA. Methods: The PRISMA model was used to systematically identify and aggregate articles for this study. The PubMed and EMBASE databases were used to search individual studies that examined the use of bone wax in THA or TKA. After applying the search term "bone wax", 2478 articles were initially identified. After inclusion and exclusion criteria were applied, three articles were aggregated for this systematic review. Results: The use of bone wax in THA and TKA decreased blood loss in patients undergoing these operations. Postoperative blood loss following surgery was lower in the bone wax groups compared to the control groups as well. Patients in the bone wax groups also required fewer blood transfusions than those who did not receive bone wax. Conclusions: Bone wax appears to be another modality that can be used by physicians to maintain hemostatic control in THA or TKA patients. Reduced blood loss and transfusion rates in surgery can increase patient outcomes. More studies are needed to examine the efficacy of bone wax in comparison with other hemostatic tools.

The Origins and Development of Pre-emptive Dermatologic Anesthesia: A Systematic Review.

This study delves into the historical trajectory of dermatological anesthesia, tracing its roots from ancient civilizations to modern times. It emphasizes the relentless pursuit of pain relief in dermatologic procedures and the transformative impact of anesthesia on surgical practices. A comprehensive analysis was conducted through an extensive literature review, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review model on the PubMed and Embase databases. A total of 1304 articles were initially identified, with six publications from these databases and 10 additional sources from the World Wide Web included in the study. This systematic approach allowed for a thorough examination of the historical journey of dermatological anesthesia. The historical trajectory outlined in this study highlights the progress in dermatological anesthesia, showcasing its impact on contemporary procedures with a continual emphasis on patient comfort and safety. As medical knowledge expands, the ongoing quest for enhanced pain control in dermatology remains a central focus.

Effectiveness of Radiofrequency Ablation for Treatment of Glossopharyngeal Neuralgia: A Systematic Review of the Current Literature.

BACKGROUND: Glossopharyngeal neuralgia (GPN) is a rare cause of facial pain that has an incidence of less than one per 100,000 people. The excruciating stabbing pain experienced by patients with GPN can be debilitating, leading to difficulties in activities of daily living, such as eating and speaking. As a result, there has been a recent increase in research on the effectiveness of radiofrequency ablation (RFA) for treating GPN. OBJECTIVE: The objective of our study was to evaluate the effectiveness of (RFA for treating GPN while examining its impact on patients' quality of life and assesses for any associated side effects. STUDY DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) model was employed to identify articles from 2 comprehensive medical databases. The patient outcomes and numbers from each article were aggregated and calculated in order to determine the percent efficacy of RFA for treating pain associated with GPN. METHODS: In this systematic review, the PRISMA review model was utilized to search through the PubMed and EMBASE databases. A comprehensive literature review was conducted. Of the initial 1,580 articles identified, 18 articles were included for analysis. Studies included in this systematic review encompassed idiopathic cases and secondary causes, such as an elongated styloid process, oropharyngeal cancers, and postsurgical/traumatic pain. RESULTS: Of the 288 patients treated with RFA, 231 experienced relief or complete resolution of pain, yielding an efficacy rate of 80.2%. Most of the patients experienced immediate pain relief after RFA; however, some patients reported numbness, dysphagia, and changes in taste. Our study examines the potential use of RFA as a minimally invasive and effective treatment for GPN. LIMITATIONS: Limitations of our study include the absence of comparisons between different types, modes, and settings of RFA procedures. The use of only 2 medical databases is another limitation. Finally, our systematic review does not include any randomized controlled trials. CONCLUSION: RFA is efficacious in treating GPN with over 80% of patients experiencing postprocedure pain relief. However, further research in the form of clinical and controlled trials is needed to contribute to a better understanding of RFA's long-term outcomes for patients with GPN.

Assessment and Recommendations for Website Platforms of Neuroanesthesiology Fellowship Programs.

BACKGROUND: Websites serve as recruitment and educational tools for many fellowship programs, including neuroanesthesiology. Since the COVID-19 pandemic, when interviews, conferences, and institutional visits were moved online, websites have become more important for applicants when deciding on their preferred fellowship program. This study evaluated the content of the websites of neuroanesthesiology fellowship programs. METHODS: Neuroanesthesiology fellowship program websites were identified from the websites of the International Council on Perioperative Neuroscience Training and the Society for Neuroscience in Anesthesiology and Critical Care. The content was assessed against 24 predefined criteria. RESULTS: Fifty-three fellowship programs were identified, of which 42 websites were accessible through a Google search and available for evaluation. The mean number of criteria met by the 42 fellowship websites was 12/24 (50%), with a range of 6 to 18 criteria. None of the evaluated fellowship websites met all 24 predefined criteria; 20 included more than 50% of the criteria, whereas 7 included fewer than 30% of the criteria. Having a functional website, accessibility through a single click from Google, and a detailed description of the fellowship program were the features of most websites. Information about salary and life in the area, concise program summaries, and biographical information of past and current fellows were missing from a majority of websites. CONCLUSION: Important information was missing from most of the 42 evaluated neuroanesthesiology fellowship program websites, potentially hindering applicants from making informed choices about their career plans.

Polymyalgia Rheumatica Originally Thought to Be Cervical Spinal Stenosis.

Polymyalgia rheumatica (PMR) is an inflammatory condition that causes joint pain and stiffness. This case report describes an atypical presentation of PMR that was initially misdiagnosed as cervical spinal stenosis, leading to surgery before correctly being diagnosed with PMR. Because of an absence of specific diagnostic tests and a presentation of symptoms that often overlap with other conditions, PMR can be difficult to diagnose. This case highlights the importance of clinical evaluation and awareness of PMR's clinical features to prevent unnecessary interventions and ensure appropriate management.

Onset of Guillain-Barre Syndrome and Transverse Myelitis Following COVID-19 Vaccination.

Guillain-Barre syndrome (GBS) and transverse myelitis (TM) are both neuro-inflammatory disorders that are attributed to dysfunctions of the peripheral nervous system and spinal cord, respectively. The two conditions involve immune-mediated destruction and inflammation of the nervous system and may present clinically as a weakness in the muscles, loss of normal sensations, and even paralysis of the body or extremities. Although the incidence of GBS and TM is quite rare, there have been reports of the two diseases developing in patients, either independently or concurrently, following COVID-19 vaccinations. In this case report, we present a patient (male) who lost functions and sensations in his lower extremities 60 days after he received the COVID-19 booster vaccine. The patient's blood work was unremarkable. Magnetic resonance imaging (MRI) of his thoracic spine and an electromyography study revealed evidence of nerve demyelination, which supports the diagnosis of GBS/TM overlap syndrome. He was ultimately treated with intravenous immunoglobulins (IVIGs) and gained back functions in his lower extremities.

Nevada's Healthcare Crisis: A Severe Shortage of Physicians and Residency Positions.

The state of Nevada is home to millions of people and a prominent entertainment industry. However, the state ranks among the lowest in terms of available primary care doctors and general surgeons per capita, resulting in limited access to essential healthcare services and an increased reliance on emergency departments and hospitals. Nevada also faces the challenges posed by an aging physician workforce and a significant proportion of inactive providers. The scarcity of residency positions in Nevada's medical schools drives many graduates to seek residency training opportunities elsewhere, leading to a reduced likelihood of their return to practice within the state. We propose potential solutions, including increased funding for residency positions, prioritizing the retention of medical school graduates through local residency training, and the establishment of interdisciplinary comprehensive academic health centers. These measures are essential to meet the escalating healthcare demands of Nevada's rapidly growing population and to ultimately enhance patient outcomes.

A Rare Case of Complete Perforation of Endometrial Tissue Through the Mucosa of the Sigmoid Colon.

Endometriosis is a disease that causes endometrial tissues to proliferate outside of the uterus. The condition is often attributed to estrogen imbalance and can lead to severe inflammation and bleeding, where it is believed that 10% of female patients experience this illness. Endometrial growth can occur in the ovaries, fallopian tubes, stomach, and gastrointestinal tract. Twelve percent of endometriosis cases can be seen in the intestines, with the rectosigmoid colon accounting for 72% of these cases. Patients with intestinal endometriosis may present with moderate symptoms, such as constipation, but they may experience more serious complications as well such as intestinal bleeding. Although the presence of endometrial tissue in the colon is already a rare phenomenon, it is even rarer for endometrial growth to perforate the entire mucosa of the sigmoid colon. A study in 2010 reported that only 21 of such cases have occurred since 1931. The patient in this case report had a gene (MUTYH) mutation that put her at risk for colorectal cancer, and she was ultimately treated with segmental resection of the sigmoid colon. The final pathology of the specimen revealed that the patient's lesion was endometrial growth. In this case report, we present a rare finding of endometrial tissue perforating through a patient's intestinal lumen, which was successfully treated with surgical intervention.

Genetic correlations between Alzheimer's disease and gut microbiome genera.

A growing body of evidence suggests that dysbiosis of the human gut microbiota is associated with neurodegenerative diseases like Alzheimer's disease (AD) via neuroinflammatory processes across the microbiota-gut-brain axis. The gut microbiota affects brain health through the secretion of toxins and short-chain fatty acids, which modulates gut permeability and numerous immune functions. Observational studies indicate that AD patients have reduced microbiome diversity, which could contribute to the pathogenesis of the disease. Uncovering the genetic basis of microbial abundance and its effect on AD could suggest lifestyle changes that may reduce an individual's risk for the disease. Using the largest genome-wide association study of gut microbiota genera from the MiBioGen consortium, we used polygenic risk score (PRS) analyses with the "best-fit" model implemented in PRSice-2 and determined the genetic correlation between 119 genera and AD in a discovery sample (ADc12 case/control: 1278/1293). To confirm the results from the discovery sample, we next repeated the PRS analysis in a replication sample (GenADA case/control: 799/778) and then performed a meta-analysis with the PRS results from both samples. Finally, we conducted a linear regression analysis to assess the correlation between the PRSs for the significant genera and the APOE genotypes. In the discovery sample, 20 gut microbiota genera were initially identified as genetically associated with AD case/control status. Of these 20, three genera (Eubacterium fissicatena as a protective factor, Collinsella, and Veillonella as a risk factor) were independently significant in the replication sample. Meta-analysis with discovery and replication samples confirmed that ten genera had a significant correlation with AD, four of which were significantly associated with the APOE rs429358 risk allele in a direction consistent with their protective/risk designation in AD association. Notably, the proinflammatory genus Collinsella, identified as a risk factor for AD, was positively correlated with the APOE rs429358 risk allele in both samples. Overall, the host genetic factors influencing the abundance of ten genera are significantly associated with AD, suggesting that these genera may serve as biomarkers and targets for AD treatment and intervention. Our results highlight that proinflammatory gut microbiota might promote AD development through interaction with APOE. Larger datasets and functional studies are required to understand their causal relationships.