Total hip arthroplasty for adult patients with hip arthritis in Jordan: clinical profiles and patient characteristics.

PURPOSE: Total Hip Arthroplasty (THA) is one of the most commonly performed orthopaedic surgeries, with hip arthritis being the main indication. This procedure is usually performed when other non-surgical methods fail to relieve patients' hip pain and improve their quality of life. However, limited information exists to identify and compare the demographics and clinical characteristics of patients undergoing this procedure in Jordan. This study aims to identify these demographic and clinical characteristics and compare the findings in terms of gender differences. METHODOLOGY: This is a retrospective study that analysed the hospital records of 650 patients undergoing THA in tertiary referral hospital in Jordan over a four-year period from January 2019 to December 2022. The collected data were classified into three categories: demographic characteristics, perioperative variables, and patients' related health profiles. IBM's Statistical Package for the Social Sciences (SPSS) version 23 software (IBM, USA) and descriptive analysis were used for data analysis. RESULTS: Two-thirds of the sample studied were female (63.4%). In terms of bleeding profiles, the mean intraoperative blood loss was 542 millilitres. The major indication for THA was degenerative hip arthritis (50.5%), followed by hip dysplasia (40.3%).. Comparing the findings of the two gender groups, females were more likely to have degenerative and dysplastic hip arthritis (221 and 157, p = 0.04 and p = 0.1, respectively) when compared to males. Although males were more likely to lose more blood during the surgery (557 ml vs. 533 ml, p = 0.33, females needed more blood transfusions both during (21 vs. 6 patients, p = 0.12) and after the surgery (57 vs. 16 patients, p = 0.006). Furthermore, females were more likely to have comorbidities such hypertension (293 vs. 179 patients, p = 0.20), and hypothyroidism (313 vs 187, p = 0.36), and diabetes (85 vs. 38 patients, p = 0.15), among many other health conditions. However, in the study sample, male smokers outnumbered female smokers (132 vs. 63). CONCLUSION: Gender highly impacted the immediate surgical outcomes of patients who underwent THA. Females were more likely to need blood transfusions both during and after the surgery and had lower post-operative haemoglobin readings. In addition, females had more comorbidities and degenerative hip osteoarthritis. We believe that raising awareness about comorbidity management, preoperative smoking cessation, and perioperative blood transfusion management can improve medical and surgical outcomes.

The Use of Splinted Versus Nonsplinted Prosthetic Design in Dental Implants: A Literature Review.

The choice of a splinted or nonsplinted implant-supported prosthesis should be based on solid scientific evidence that considers the conditions and needs of each patient. This review elaborates on the factors that directly influence clinical decisions between splinted or nonsplinted dental implants. Digital and manual searches of the published literature were conducted to identify studies that examined splinted prostheses (SPs) and nonsplinted prostheses (NSPs). The search terms used, alone or in combination, were "splinting prosthesis," "nonsplinting prosthesis," "prosthetic design," "stress distribution in dental implant," "implant loading," "implant occlusion," and "crestal bone resorption." Ninety-four studies were selected to compare and address the details emphasized in this study. Thirty-four reported articles were not directly related to restoration design but were reviewed to better understand the influence of mechanical risk factors, finite element analysis limits, and criteria for implant survival and treatment success. There are advantages and disadvantages of splinting implants together. NSPs are the ideal choice because they resemble natural teeth. Splinting a restored implant will cause the implant to appear as part of one unit and is indicated in more compromised situations, unfavorable conditions, or when pontic spaces and cantilevers are needed in implant prostheses.

The outcomes of total hip arthroplasty in developmental dysplasia of hip versus osteoarthritis: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to compare the outcomes of total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) and those with osteoarthritis (OA). METHODS: Four databases were searched from inception till February 2023 for original studies that compared the outcomes of THA in DDH and OA. The primary outcome was the revision rate; the secondary outcomes were dislocation and failure modes (i.e. aseptic loosening, PJI, instability, and periprosthetic fractures), hospital stay and costs. This review was conducted as per PRISMA guidelines, and the risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS: A total of 9 observational studies with 575,255 THA (469,224 hips) were included, with a mean age of 50.6 years and 62.1 years for DDH and OA groups, respectively. There was a statistically significant difference in revision rate between DDH and OA patients in favour of OA (OR, 1.66; 95% CI 1.11-2.48; p-value, 0.0251). However, dislocation rate (OR, 1.78, 95% CI 0.58-5.51; p-value, 0.200), aseptic loosening (OR, 1.69; 95% CI 0.26-10.84; p-value, 0.346) and PJI (OR, 0.76; 95% CI 0.56-1.03; p-value, 0.063) were comparable across both groups. CONCLUSION: A higher revision rate following total hip arthroplasty was associated with DDH compared with osteoarthritis. However, both groups had similar dislocation rates, aseptic loosening and PJI. Consideration of confounding factors, such as patient age and activity level, is crucial when interpreting these findings. LEVEL OF EVIDENCE : III. TRIAL REGISTRATION: PROSPERO registration: CRD42023396192.

Epidemiology of proximal femur fractures in the young population of Qatar.

PURPOSE: To review the epidemiological characteristics of proximal femur fractures in the young population (< 60 years) of Qatar between 2017 and 2019. METHODS: All patient treated for proximal femur fractures at Hamad General Hospital (HGH), a level one trauma center, were retrospectively reviewed between Jan 2017 and Dec 2019. All adults (18-60 years) with proximal femur fracture (femur head, femur neck, intertrochanteric and subtrochanteric fractures) were included with no restriction to the AO/OTA classification or fractures subtypes. Excluded cases were pathological fractures, cases with insufficient documentation or no radiographs. RESULTS: A total of 203 patients with a mean age of 40.07 ± 11.76 years were included, of who 89.9% were males. The incidence of proximal femur fracture was 3.12/100,000/year. Fall from height (48.1%) followed by road traffic accidents (26.9%) were common cause of injury. The most common fracture type was intertrochanteric fracture (36.1%) followed by femur neck fractures (33.7%). CONCLUSION: This study provides the initial insights into the proximal femur fractures in the young population of Qatar. This is the first study to investigate of the epidemiology of such fractures in this particular patient group. Contrary to the existing literature on older age groups, the majority of the injuries were observed in males. Falls from height followed by road traffic accidents were the primary mechanisms leading to these fractures. Improved understanding of the profile of these injuries can aid in their prevention by implementing more effective safety measures.

Repeated closed-head mild traumatic brain injury-induced inflammation is associated with nociceptive sensitization.

BACKGROUND: Individuals who have experienced mild traumatic brain injuries (mTBIs) suffer from several comorbidities, including chronic pain. Despite extensive studies investigating the underlying mechanisms of mTBI-associated chronic pain, the role of inflammation in long-term pain after mTBIs is not fully elucidated. Given the shifting dynamics of inflammation, it is important to understand the spatial-longitudinal changes in inflammatory processes following mTBIs and their effects on TBI-related pain. METHODS: We utilized a recently developed transgenic caspase-1 luciferase reporter mouse model to monitor caspase-1 activation through a thinned skull window in the in vivo setting following three closed-head mTBI events. Organotypic coronal brain slice cultures and acutely dissociated dorsal root ganglion (DRG) cells provided tissue-relevant context of inflammation signal. Mechanical allodynia was assessed by mechanical withdrawal threshold to von Frey and thermal hyperalgesia withdrawal latency to radiant heat. Mouse grimace scale (MGS) was used to detect spontaneous or non-evoked pain. In some experiments, mice were prophylactically treated with MCC950, a potent small molecule inhibitor of NLRP3 inflammasome assembly to inhibit injury-induced inflammatory signaling. Bioluminescence spatiotemporal dynamics were quantified in the head and hind paws, and caspase-1 activation was confirmed by immunoblot. Immunofluorescence staining was used to monitor the progression of astrogliosis and microglial activation in ex vivo brain tissue following repetitive closed-head mTBIs. RESULTS: Mice with repetitive closed-head mTBIs exhibited significant increases of the bioluminescence signals within the brain and paws in vivo for at least one week after each injury. Consistently, immunoblotting and immunofluorescence experiments confirmed that mTBIs led to caspase-1 activation, astrogliosis, and microgliosis. Persistent changes in MGS and hind paw withdrawal thresholds, indicative of pain states, were observed post-injury in the same mTBI animals in vivo. We also observed enhanced inflammatory responses in ex vivo brain slice preparations and DRG for at least 3 days following mTBIs. In vivo treatment with MCC950 significantly reduced caspase-1 activation-associated bioluminescent signals in vivo and decreased stimulus-evoked and non-stimulus evoked nociception. CONCLUSIONS: Our findings suggest that the inflammatory states in the brain and peripheral nervous system following repeated mTBIs are coincidental with the development of nociceptive sensitization, and that these events can be significantly reduced by inhibition of NLRP3 inflammasome activation.

The outcomes of total hip replacement in osteonecrosis versus osteoarthritis: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to compare the outcomes of THA in patients with osteonecrosis (ON) and those with osteoarthritis (OA). METHODS: Four databases were searched from inception till December 2022 for original studies that compared the outcomes of THA in ON and OA. The primary outcome was the revision rate; the secondary outcomes were dislocation and Harris hip score. This review was conducted in line with PRISMA guidelines, and the risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS: A total of 14 observational studies with 2,111,102 hips were included, with a mean age of 50.83 ± 9.32 and 55.51 ± 8.95 for ON and OA groups, respectively. The average follow-up was 7.25 ± 4.6 years. There was a statistically significant difference in revision rate between ON and OA patients in favour of OA (OR: 1.576; 95%CI: 1.24-2.00; p-value: 0.0015). However, dislocation rate (OR: 1.5004; 95%CI: 0.92-2.43; p-value: 0.0916) and Haris hip score (HHS) (SMD: - 0.0486; 95%CI: - 0.35-0.25; p-value: 0.6987) were comparable across both groups. Further sub-analysis adjusting for registry data also showed similar results between both groups. CONCLUSION: A higher revision rate, periprosthetic fracture and periprosthetic joint infection following total hip arthroplasty were associated with osteonecrosis of the femoral head compared with osteoarthritis. However, both groups had similar dislocation rates and functional outcome measures. This finding should be applied in context due to potential confounding factors, including patient's age and activity level.

Real time optic nerve sheath diameter measurement during lumbar puncture.

Measurement of optic nerve sheath diameter (ONSD) using point of care ultrasound has been used to indirectly assess the intracranial pressure (ICP) particularly in conditions where it is raised. Direct pressure measurements using probes reaching the ventricle system correlated with ONSD using ultrasound. Attempts were made to measure the ONSD pre and post lumbar puncture (LP) after draining cerebrospinal fluid (CSF) as well as post ventricular shunt placement. We report ONSD measurement and demonstrate dynamic changes during LP in a patient with known idiopathic intracranial hypertension (IIH).

Hydrodynamic Hunters.

The Gram-negative Bdellovibrio bacteriovorus (BV) is a model bacterial predator that hunts other bacteria and may serve as a living antibiotic. Despite over 50 years since its discovery, it is suggested that BV probably collides into its prey at random. It remains unclear to what degree, if any, BV uses chemical cues to target its prey. The targeted search problem by the predator for its prey in three dimensions is a difficult problem: it requires the predator to sensitively detect prey and forecast its mobile prey's future position on the basis of previously detected signal. Here instead we find that rather than chemically detecting prey, hydrodynamics forces BV into regions high in prey density, thereby improving its odds of a chance collision with prey and ultimately reducing BV's search space for prey. We do so by showing that BV's dynamics are strongly influenced by self-generated hydrodynamic flow fields forcing BV onto surfaces and, for large enough defects on surfaces, forcing BV in orbital motion around these defects. Key experimental controls and calculations recapitulate the hydrodynamic origin of these behaviors. While BV's prey (Escherichia coli) are too small to trap BV in hydrodynamic orbit, the prey are also susceptible to their own hydrodynamic fields, substantially confining them to surfaces and defects where mobile predator and prey density is now dramatically enhanced. Colocalization, driven by hydrodynamics, ultimately reduces BV's search space for prey from three to two dimensions (on surfaces) even down to a single dimension (around defects). We conclude that BV's search for individual prey remains random, as suggested in the literature, but confined, however-by generic hydrodynamic forces-to reduced dimensionality.

Flap Designs for Implant-Related Surgical Procedures: A Review.

PURPOSE: The objective of this study was to compare the reliability and results of 2 flap techniques, flapless (FL) and full-thickness (FT) flap, during implant placement. MATERIALS AND METHODS: Online and hand searches of the literature published were conducted to identify studies examining different flap techniques on clinical and histological outcomes. The search terms used, alone or in combination, were "flapless," "full-thickness flap," "crestal bone resorption," "gingival blood circulation," and "biological width." RESULTS: Fifty studies were selected for comparison and to address the points highlighted in this study. Fourteen articles and 1 book were not directly related to flap design but were included for understanding the process of soft tissue healing. Five articles discussed the principles of oral surgery and flap design. CONCLUSION: This review revealed that the FL technique might be more appropriate in immediate implant loading cases. This specific technique results in shallower biological width, reduced inflammation, less morbidity with guided implant placement, and better esthetics in comparison with the FT technique. The implant survival rates are not significantly different between the 2 flap techniques. With respect to crestal bone resorption in FL and FT, it is inconclusive, depending on the study type (human or animal).

Interdental Implant Papillae Grow up with Temporary Abutment displaced at Monthly Intervals.

Interdental papillae regeneration remains a challenge in implant dentistry in cases in which papillae are lost following tooth extraction. This report presents an implant case with missing 1st and 2nd premolars and total papillary loss. We performed immediate provisionalization to the first premolar implant with a temporary abutment and crown, whereas the second premolar was submerged. Crown contouring and modifications to the shape and size were performed once every month (the temporary abutment and crown disconnected three times during the 3-month healing period). At the end of the 3-month healing period, papillae regeneration was observed between the implant and the adjacent tooth and between the adjacent implants. Papillae regeneration is possible with temporary abutment and a composite material crown that is properly contoured and polished, even with several abutment removals during the healing period.

Optimizing Recovery After Carpal Tunnel Syndrome Release Surgery: The Role of Counseling in Pain Management and Perioperative Functional Enhancement.

Background: Preoperative patient education is pivotal in improving patient outcomes during the perioperative phase, involving a thorough explanation of what patients can expect. This enhances adherence and reduces perioperative anxiety. In orthopedics, carpal tunnel syndrome, a common and painful hand condition, is effectively managed through surgical release under local anesthesia. Inadequate counseling before such procedures may intensify intraoperative anxiety and increase pain responses. Thus, this research aims to investigate the effects of comprehensive preoperative counseling on various parameters in carpal tunnel release surgery. Methods: A case-control study design was adopted for this study. A retrospective analysis of patients who underwent carpal tunnel release surgery was performed. These patients were categorized into two distinct groups: one group received comprehensive counseling during their clinic visits, while the other group reported receiving less effective counseling. Evaluation encompassed patient-related factors, disease-related aspects, and perioperative variables for both groups. Results: The study comprised 681 participants, with 526 (77.2%) being females, 421 (61.8%) undergoing surgery on the right side, and 519 (76.2%) employed in non-manual occupations. Moreover, 559 (82.1%) were non-smokers, while approximately two-thirds of the cohort had both diabetes and hypertension. The average age of participants was 52 years, and they reported a mean functional disability score of 7.2 out of 10. The comprehensive preoperative counseling group consisted of 333 patients, while the other group included 348 patients. The analysis revealed statistically significant differences between the two groups, including reduced intra-procedural anxiety (p = 0.043), decreased intraoperative pain (p = 0.005), lower rates of wound complications (p = 0.022), and improved self-reported pain relief (p = 0.3). Conclusion: Our study emphasizes the crucial role of preoperative counseling in improving patient experiences during perioperative care, leading to reduced anxiety, milder pain responses, fewer complications, decreased reliance on postoperative pain medication, and increased self-reported pain relief. Level of Evidence: Level III, Case-control retrospective study.

The correlation between crestal bone resorption and implant stability during healing period using resonance frequency analysis.

PURPOSE: To detect the correlation between crestal bone resorption and implant stability during healing period using resonance frequency analysis (RFA). MATERIALS AND METHODS: Twenty-two International Team for Implantology Straumann implants were placed in the posterior maxilla or mandible in 9 patients. RFA reading was taken immediately after implant placement. Periapical radiographs were taken, and the distance from the shoulder of the healing cap to the first bone-implant contact was measured, and the average mesial and distal distances were taken. Patients were followed up at 6 and 12 weeks for data collection. RESULTS: At 6 weeks, the correlation between crestal bone resorption and implant stability was significant (Spearman correlation test, P < 0.05) and negative correlation coefficient (r) was -0.522. At 12 weeks, the correlation between crestal bone resorption and implant stability was not significant (Spearman correlation test, P > 0.05) and negative correlation coefficient (r) was -0.119. CONCLUSIONS: There was a significant negative correlation between the crestal bone resorption and implant stability at 6 weeks, whereas the negative correlations between the crestal bone resorption and implant stability at 12 weeks were nonsignificant.

Repeated mild traumatic brain injury in mice elicits long term innate immune cell alterations in blood, spleen, and brain.

Mild traumatic brain injury is an insidious event whereby the initial injury leads to ongoing secondary neuro- and systemic inflammation through various cellular pathways lasting days to months after injury. Here, we investigated the impact of repeated mild traumatic brain injury (rmTBI) and the resultant systemic immune response in male C57B6 mice using flow cytometric methodology on white blood cells (WBCs) derived from the blood and spleen. Isolated mRNA derived from spleens and brains of rmTBI mice was assayed for changes in gene expression at one day, one week, and one month following the injury paradigm. We observed increases in Ly6C+, Ly6C-, and total monocyte percentages in both blood and spleen at one month after rmTBI. Differential gene expression analysis for the brain and spleen tissues uncovered significant changes in many genes, including csf1r, itgam, cd99, jak1,cd3ε, tnfaip6, and nfil3. Additional analysis revealed alterations in several immune signaling pathways over the course of one month in the brain and spleen of rmTBI mice. Together, these results indicate that rmTBI produces pronounced gene expression changes in the brain and spleen. Furthermore, our data suggest that monocyte populations may reprogram towards the proinflammatory phenotype over extended periods of time after rmTBI.

The gut-brain connection: Inflammatory bowel disease increases risk of acute ischemic stroke.

OBJECTIVES: Chronic inflammation of the gastrointestinal tract is a hallmark of inflammatory bowel disease (IBD). This increased inflammation is thought to induce a hypercoagulable state that increases the risk for stroke. However, few studies have examined the association between IBD and acute ischemic stroke (AIS). Thus, this study aims to investigate the incidence, treatments, complications, and outcomes of AIS in patients with IBD. MATERIALS & METHODS: ICD-9-CM and ICD-10-CM codes were used to query the National Inpatient Sample for AIS and IBD diagnosis. Baseline demographics, clinical characteristics, complications, treatments, and outcomes were assessed through descriptive statistics, multivariate regression, and propensity score matching (PSM) analysis. Acute stroke severity was assessed using the National Institute of Heath's Stroke Severity Score (SSS) as a template. RESULTS: 1,609,817 patients were diagnosed with AIS between 2010 through 2019. 7468 (0.46%) had concomitant diagnoses of IBD. AIS patients with IBS were younger, more likely to be white and female, but less likely to be obese. Although IBD patients had comparable stroke severities (p = 0.64) to their non-IBS counterparts, they received stroke intervention at statistically different rates than their non-IBD counterparts. Additionally, IBD patients had higher rates of in-hospital complications (p < 0.01) and longer lengths of stay (LOS) (p < 0.01). CONCLUSIONS: IBD patients develop AIS at a younger age with similar rates of stroke severity to their non-IBD counterparts, but receive higher rates of tissue plasminogen activator administration and decreased rates of mechanical thrombectomy. Our research shows that patients with IBD are at risk for AIS at an earlier age and are more likely to have complications. This underlies a connection between IBD and a hypercoagulable state that could predispose patients to AIS.

Comparison of flapless and conventional flap and the effect on crestal bone resorption during a 12-week healing period.

UNLABELLED: There is evidence suggesting that flapless, or minimally invasive, procedures can preserve bone vascularization because they will not disturb the periosteum of the alveolar bone. The aim of this randomized, controlled clinical trial study is to compare the effect of flapless (FL) and full-thickness flap (FT) techniques on crestal bone resorption during healing periods. METHODS: Twenty-two implants were placed by FL and FT flap in nine patients in split mouth design; each patient received two implants, except for two patients who received four implants. A periapical radiograph was taken at implant placement, as well as 6- and 12-week intervals. Crestal bone level was compared between FL and FT during these intervals and compared between intervals for each group. RESULTS: Median (IQR) crestal bone level at implant placement for the FL was 2.70 (0.60) and for the FT was 2.60 (1.20). At six weeks, median (IQR) for the FL was 3.55 (0.70) and for the FT was 3.40 (0.75). At 12 weeks, median (IQR) for the FL was 3.60 (0.30) and for the FT was 3.75 (0.85). Statistically insignificant differences were obtained between the two techniques at implant placement, as well as 6- and 12-week intervals, and were p = 0.894, p = 0.477, p = 0.755, respectively. There was a significant difference between the bone level at implant placement and at the 6-week interval for both the FL (p = 0.006) and FT (p = 0.045), whereas there was no significant difference between the bone level at 6- and 12-week intervals for the FL (p = 0.722) and for the FT (p = 0.229). Conclusions Based upon this study of nine patients with 22 implants, there was no significant difference in crestal bone resorption between FT and FL techniques during a three-month healing period. The preservation of periosteum in the FL group resulted in early progressive bone resorption.

Less morbidity with flapless implant.

UNLABELLED: Flapless implant placement requires punch removal of the gingiva without flap reflection, suggesting this technique will be less invasive, and with less tissue destruction, than comparable alternative techniques. METHODS: Eleven implants were placed with flapless (FL) technique and 11 implants were placed with full-thickness flap (FT) technique in split mouth technique. FL technique was done with dermal tissue puncture, while FT was performed with crestal incision, including the papillae. Patients were followed-up postoperatively for clinical and morbidity evaluation in both groups. RESULTS: There was no pain, and there were only mild signs of inflammation, at the sites of flapless implant placement in the 11 patients studied. In contrast, there were complaints of mild to moderate pain and signs of inflammation at the site of full-thickness flap implant placement in the 11 patients studied. In addition, there was gingival overgrowth over the healing cap noted in this group. CONCLUSIONS: FL technique may be recommended for the apprehensive or hyperalgesic patient because of the absence of pain it conveys, as well as the decreased postoperative swelling. Periosteal disruption is responsible for the patient's morbidity postoperatively.

Social vulnerability, medical care access and asthma related emergency department visits and hospitalization: An observational study.

BACKGROUND: The Social Vulnerability Index (SVI) is a publicly available dataset to identify communities in greatest need of resources. OBJECTIVE: To examine the utility of using the county-level SVI as predictors of asthma-related outcomes. METHODS: We used the American Community Survey-derived SVI and the National Environmental Public Health Tracking Network - Query Tool to retrieve data for all counties with available SVI data and at least one matched outcome of interest. Then, we tested SVI as a predictor for emergency department visits (EDV) and hospitalizations, with investigating disparities in primary care physician (PCP) density and emergency department physicians (EDP) density. Linear and logistic regression models were used. RESULTS: Compared to counties of the lowest SVI quartile, counties of mid-low, mid-high, and highest SVI quartiles had 1%, 4%, and 5% higher odds of asthma-related EDV per 10,000 population, respectively, and 4%, 21%, and 24% higher odds of asthma-related hospitalization per 10,000 population, respectively. Moreover, the data showed an apparent resources mismatch between the EDP densities per 10,000 populations and the SVI quartiles, and the effect of the county level SVI on the asthma-related EDV and hospitalization is not strongly affected by PCP or EDP densities. CONCLUSION: The counties with the highest SVI -and the most vulnerable to asthma hazards- have a lower coverage of PCP and EDP. Interventions directed to address persistent social vulnerability would offer the opportunity of primary prevention with less exhaustion for the medical resources.

Posterior Reversible Encephalopathy Syndrome Presenting Atypically as a Non-Convulsive Seizure.

BACKGROUND Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy, is a neurotoxic state with multiple etiologies characterized by altered mental state, headaches, visual abnormalities, and seizures. This clinico-radiological syndrome is rare, and a high index of suspicion is needed to diagnose, provide adequate treatment, and prevent irreversible neurological sequelae. CASE REPORT We present a case of a woman with end-stage renal disease (ESRD) who presented with acute confusion and non-convulsive seizures and was later diagnosed with PRES. In this case, altered mental status was initially thought to be secondary to uremic encephalopathy. A diagnosis of PRES was subsequently made after she had several sessions of HD without significant improvement in her mental state, prompting magnetic resonant imaging (MRI) for further evaluation. Specific risk factors for PRES, including blood pressure fluctuations, were targeted and she made significant clinical recovery but had residual functional impairment. CONCLUSIONS This case underscores the need for a high index of suspicion, especially in cases with atypical presentation, as delayed diagnosis can lead to suboptimal outcomes.

Impaired Glutamate Receptor Function Underlies Early Activity Loss of Ipsilesional Motor Cortex after Closed-Head Mild Traumatic Brain Injury.

Although mild traumatic brain injury (mTBI) accounts for the majority of TBI patients, the effects and cellular and molecular mechanisms of mTBI on cortical neural circuits are still not well understood. Given the transient and non-specific functional deficits after mTBI, it is important to understand whether mTBI causes functional deficits of the brain and the underlying mechanism, particularly during the early stage after injury. Here, we used in vivo optogenetic motor mapping to determine longitudinal changes in cortical motor map and in vitro calcium imaging to study how changes in cortical excitability and calcium signals may contribute to the motor deficits in a closed-head mTBI model. In channelrhodopsin 2 (ChR2)-expressing transgenic mice, we recorded electromyograms (EMGs) from bicep muscles induced by scanning blue laser on the motor cortex. There were significant decreases in the size and response amplitude of motor maps of the injured cortex at 2 h post-mTBI, but an increase in motor map size of the contralateral cortex in 12 h post-mTBI, both of which recovered to baseline level in 24 h. Calcium imaging of cortical slices prepared from green fluorescent calmodulin proteins-expressing transgenic mice showed a lower amplitude, but longer duration, of calcium transients of the injured cortex in 2 h post-mTBI. Blockade of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid or N-methyl-d-aspartate receptors resulted in smaller amplitude of calcium transients, suggesting impaired function of both receptor types. Imaging of calcium transients evoked by glutamate uncaging revealed reduced response amplitudes and longer duration in 2, 12, and 24 h after mTBI. Higher percentages of neurons of the injured cortex had a longer latency period after uncaging than that of the uninjured neurons. The results suggest that impaired glutamate neurotransmission contributes to functional deficits of the motor cortex in vivo, which supports enhancing glutamate neurotransmission as a potential therapeutic approach for the treatment of mTBI.

The influence of endodontic treatment on blood pressure reduction in patients with vital irreversible pulpitis.

BACKGROUND: During endodontic treatment, endodontists must be aware of the various factors that may decrease or increase blood pressure. This study aimed to assess the mean percentages of systolic, diastolic, and arterial blood pressure (MSBP, MDAP, MABP) reduction in patients with vital irreversible pulpitis in teeth and who were treated at three visits to endodontists in three age groups (20-34 years, 35-50 years, 51-65 years). MATERIALS AND METHODS: A total of 100 teeth with vital irreversible pulpitis from 100 patients were included. All patients underwent 3 visits for endodontic treatment. The 1st visit included removal of vital pulp tissue and a determination of working length, the 2nd visit included canal preparation and widening, and at the 3rd visit the canal was obturated and sealed by gutta percha and sealer. Blood pressure for all patients was checked and documented once before starting treatment and three times during treatment at different intervals during all visits. RESULTS: There were significantly higher percentage reductions in MSBP, MDBP, and MABP at the 1st visit for endodontic treatment in comparison to other visits (2nd and 3rd) for all patients. Additionally, there were significantly higher percentage reductions in MSBP, MDBP, and MABP at the 1st visit for endodontic treatment in comparison to other visits in males and females, for all age groups, both anesthesia injection-type groups (infiltration and block), and all treated tooth types except mandibular anterior teeth, and there were nonsignificant differences among groups. However, there were nonsignificant differences in MSBP, MDBP, and MABP between males and females, between infiltration and block injection groups and in relation to teeth types at all visits. CONCLUSIONS: The reduction of blood pressure in patients undergoing endodontic treatment of vital teeth with irreversible pulpits is common, especially at the 1st visit for pulp extirpation.