Characterization of thunderclap headache in a reversible cerebral vasoconstriction syndrome case series.

OBJECTIVES: To empirically address how thunderclap headache (TCH) is described in a relevant real-world setting. BACKGROUND: TCH refers to a highly recognizable description of a severe headache that reaches maximum severity within 1 minute and endures for at least 5 minutes. The use of a numerical rating scale (NRS) to appraise TCH severity, as well as assessment of TCH progression in patients with pre-existing headache at the time of TCH onset has not been previously evaluated. METHODS: This was a retrospective case series of adults with a diagnosis of reversible cerebral vasoconstriction syndrome (RCVS), identified through a search of the electronic health record. Individuals meeting International Classification of Headache Disorders, 3rd Edition criteria for acute headache attributed to RCVS were included. Attacks described using a verbal descriptor scale (VDS), NRS, or both were recorded to evaluate acute headache characteristics. RESULTS: In all, 56 individuals with available descriptions of 120 acute headaches were included in the study analysis. Patients were female (35, 62.5%) with a median age of 46 (range: 19-67). The majority of patients reported a RCVS trigger (39, 69.6%). Acute headaches were characterized using a VDS (52, 43.3%), NRS (51, 42.5%), or both (17, 14.1%). Acute headaches were always described as severe when a VDS was utilized, and with a median NRS of 10 (range: 4-10). Four patients (7%) did not have a single headache characterized as either severe or with a NRS 8 or greater. In the 10 cases for which there was a pre-TCH baseline headache, it was either rated as mild or with a median NRS of 3 (range: 2-6). CONCLUSIONS: TCH in RCVS can be recognized using either VDS or NRS, with a broader range of peak intensities than previously recognized. TCH remains recognizable despite pre-existing baseline headache.

Retraction: Giant Traumatic Diaphragmatic Hernia: A Report of Delayed Presentation.

[This retracts the article DOI: 10.7759/cureus.20315.].

Inter-Arm Blood Pressure Difference an Indicator of Coronary Artery Disease.

INTRODUCTION: Considering the scarcity of the literature on the association between inter-arms blood pressure difference (IABPD) and coronary artery disease (CAD). AIM: We performed this study to investigate the prevalence of IABPD within the Jordanian population and to assess if it has an association with CAD. METHODS: We sampled patients visiting the cardiology clinics at the Jordan University Hospital between October, 2019 and October 2021 into two groups. Participants were divided into two groups; patients with severe CAD and control group who had no evidence of CAD. RESULTS: We measured the blood pressure for a total of 520 patients. Of the included patients, 289 (55.6 %) had CAD while 231 (44.4%) were labeled as controls who were normal. A total of 221 (42.5%) participants had systolic IABPD above 10 mmHg, while 140 (26.9%) had a diastolic IABPD above 10 mmHg. Univariate analysis demonstrated that patients with CAD were significantly more likely to be older (p < 0.001), of the male gender (p < 0.001), hypertensive (p < 0.001), and having dyslipidemia (p < 0.001). Moreover, they had significantly higher IABPD differences in terms of both systolic and diastolic blood pressure (p < 0.001 and p = 0.022, respectively). Multivariate analysis showed that CAD was a positive predictor of abnormal systolic IABPD. CONCLUSION: In our study, elevated systolic IABPD was associated with a higher prevalence of severe CAD. Patients with abnormal IABPD might be subjected to more specialist investigation as IABPD consistently predicts coronary artery disease, peripheral arterial disease or other vasculopathy throughout the literature.

Giant Traumatic Diaphragmatic Hernia: A Report of Delayed Presentation.

Diaphragmatic rupture is an uncommon injury after blunt abdominal trauma. The diaphragmatic defect may not be obvious in imaging studies immediately after the initial injury. Patients may have delayed presentation when the diaphragmatic defect enlarges and allows abdominal content to herniate into the thoracic cavity. Here, we present the case of a 30-year-old man who presented with the emergency department complaining of shortness of breath at rest for two days duration. He reported having shortness of breath for the last five years, but he attributed it to his smoking. The shortness of breath was associated with cough productive and vague abdominal pain. The patient had an unremarkable relevant medical history. He reported having a motor vehicle accident five years ago that was severe but he did not sustain any significant injuries or fractures. Upon examination, the patient appeared in respiratory distress. Respiratory examination revealed diminished air entry on the left hemithorax and the abdominal examination revealed increased generalized tenderness with increased bowel sounds. The patient underwent a thoracic computed tomography scan, which unexpectedly demonstrated a huge left-sided diaphragmatic defect with bowel loops observed to occupy the left hemithorax completely. The patient was stabilized and shifted to emergency laparotomy during which the hernia content was reduced and the defect was closed with a mesh. The patient reported the resolution of his symptoms after the surgery. Intensive chest physiotherapy exercises were performed. After six months of follow-up, the patient remained asymptomatic with no active complaints. The diaphragmatic hernia may have delayed presentations after several years of blunt abdominal trauma. The case highlighted the importance of initial imaging studies after blunt trauma may not identify the diaphragmatic defect.

An in vitro and in vivo evaluation of bioactive titanium implants following sodium removal treatment.

OBJECTIVE: The aim of this study was to evaluate the effect of dilute HCl as a sodium removal treatment of grit blasted/NaOH/heat treated cp titanium implants on the in vitro bioactivity and the in vivo interface shear resistance at different healing periods. METHODS: Cylindrical implants were machined from cp titanium bars. Half of the implants were blasted by AL(2)O(3) particles followed NaOH/heat treatment. The other half received similar treatment except, dilute HCl was additionally used as a sodium removal treatment. Implants surfaces topography was characterized by AFM before and after immersion in simulated body fluid (SBF) for 3 and 7 days. The implants resistance to interfacial shear force was evaluated at 2, 4, and 8 weeks implantation periods in experimental rabbits. RESULTS: Sodium removal treatment significantly increased surface roughness (Sa parameter), valley fluid retention index and surface area before and after immersion in SBF, however, it significantly decreased core fluid retention index. Calcium and phosphorus containing surface deposits, of larger surface area, were precipitated on implants received the sodium removal treatment after 3 and 7 days in SBF. The implant-bone interface resistance to shear force was significantly increased at 2 weeks healing period after the use of the sodium removal treatment. SIGNIFICANCE: The sodium removal treatment showed to be effective in improving the early bone-implant interface resistance to shear force. Topographical changes, after dilute HCl etching, seem to contribute to the different in vitro and/or in vivo responses observed.