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1.
Cell Biochem Funct ; 42(1): e3897, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38063410

ABSTRACT

Polycystic ovarian syndrome (PCOS) is an endocrinological disorder aroused due to hormonal disturbances. It is characterized by anovulation due to an excess of androgen and estrogen hormones, thus leading to the formation of multiple cysts, imposing life-threatening conditions. This manuscript aimed to introduce a natural estrogen receptor (ESR) inhibitors that can provide protection against PCOS. The computational analysis of Linum usitatissimum seeds  compounds against ESR alpha receptor was performed, and the binding affinities of the ligand compounds and receptor proteins were scrutinized. Nine lignin compounds were docked, and the results were compared with that of reference estrogen receptor inhibitors, clomiphene, and tamoxifen. The binding affinity scores for pinoresinol, lariciresinol, secoisolariciresinol, and matairesinol were -10.67, -10.66, -10.91, and -10.60 kcal mol-1 , respectively. These were comparable to the binding affinity score of reference compounds -11.406 kcal mol-1 for clomiphene and -10.666 kcal mol-1 for tamoxifen. Prime MM-GBSA studies showcased that Linum usitatissimum seeds compounds exhibit significant efficacy and efficiency towards receptor protein. Moreover, MD-simulation studies were performed and the results depict that the lignin compounds form stable complexes at 300 K throughout the simulation time. For further clarity, in-vitro experiments were carried out. The results exhibit the decline in cell proliferation in a concentration-dependent manner by extract 1 (ethyl acetate) EX1 and extract 2 (petroleum ether) EX2. Hence, providing evidence regarding the anti-estrogenic activity of the sample extracts. Collectively, these results showed that flax seed can reduce the levels of estrogen, which can induce ovulation and prevent cyst formation, and ultimately can provide protection against PCOS.


Subject(s)
Flax , Polycystic Ovary Syndrome , Humans , Female , Flax/chemistry , Flax/metabolism , Receptors, Estrogen/metabolism , Polycystic Ovary Syndrome/drug therapy , Lignin/analysis , Lignin/metabolism , Seeds/chemistry , Clomiphene/analysis , Clomiphene/metabolism , Estrogens , Tamoxifen , Plant Extracts/pharmacology
2.
J Craniofac Surg ; 34(1): 381-386, 2023.
Article in English | MEDLINE | ID: mdl-36102899

ABSTRACT

PURPOSE: Non/minimally irradiated Cadaveric Costal Cartilage (NCCC) is commonly used for grafts in nasal reconstruction; however, no information exists on its use in total ear reconstruction for type III microtia. In this case series we describe preliminary results from the novel use of NCCC for auricular framework construction in 7 ear reconstructions. METHODS: Patients requiring total ear reconstruction from August 2020 to October 2021 were eligible and underwent ear reconstruction using NCCC from MTF Biologics (Edison, NJ). Patients were evaluated for surgical site infection, skin necrosis, cartilage exposure, warping, and resorption during regular follow up visits. RESULTS: Seven ears were reconstructed using NCCC across 5 patients with type III microtia. Patients ranged from 5 to 51 years old at the time of surgery. Follow up time ranged from 12 to 78 weeks (mean: 46 wk). No patients experienced surgical site infections or significant cartilage resorption. All procedures were done outpatient, total time under anesthesia was <90 minutes in 5/7 cases and postoperative narcotics for pain management were not needed in 5/7 cases. Complications included minor skin necrosis that was repaired via primary closure, construct exposure in the immediate postoperative period, which was successfully salvaged with a local flap, and explantation of one construct after reconstruction for a complicated revision surgery involving a previous temporoparietal fascial flap. CONCLUSION: NCCC serves as an immediately available alternative to alloplastic and autologous materials for construction of auricular frameworks during ear reconstruction. Longer follow up times and a larger sample size will further elucidate long-term efficacy.


Subject(s)
Congenital Microtia , Costal Cartilage , Plastic Surgery Procedures , Soft Tissue Injuries , Humans , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Costal Cartilage/surgery , Congenital Microtia/surgery , Soft Tissue Injuries/surgery , Necrosis/surgery , Cadaver
3.
J Craniofac Surg ; 33(6): 1734-1738, 2022 Sep 01.
Article in English | MEDLINE | ID: mdl-35762609

ABSTRACT

BACKGROUND: Skull deformities may be seen in patients years after craniosynostosis correction. These deformities cause psychosocial distress in affected patients. In this series, the authors describe the use of patient specific polyether ether ketone (PEEK) implants for correction of skull deformities after cranial vault remodeling for craniosynostosis. METHODS: A chart review was conducted for 3 revision procedures performed by 1 plastic surgeon in collaboration with 1 neurosurgeon, both affiliated with Northwell Health. Preoperative computed tomography scans were used to design three-dimensional (3D) printed PEEK implants manufactured by KLS Martin. Implants were used to correct frontal and orbital asymmetry and skull deformities in each patient. Outcomes were assessed at 1 week, 1 month, and 3 months post-operation. RESULTS: Two males and 1 female, ages 13, 17, and 19, underwent revision cranioplasty or orbital rim reconstruction using a custom, single piece 3D printed PEEK implant. All 3 patients underwent cranial vault remodeling in infancy; 1 was treated for coronal craniosynostosis and 2 were treated for metopic craniosynostosis. Revision cranioplasty operative times were 90, 105, and 147 minutes, with estimated blood loss of 45 mL, 75 mL, and 150 mL, respectively. One patient went home on post op day 1 and 2 patients went home on post op day 2. All patients had an immediate improvement in structural integrity and cranial contour, and all patients were pleased with their aesthetic results. CONCLUSIONS: Custom 3D printed PEEK implants offer a single piece solution in revision cranioplasty surgery to correct skull deformities after cranial vault remodeling for craniosynostosis.


Subject(s)
Craniosynostoses , Dental Implants , Plastic Surgery Procedures , Benzophenones , Craniosynostoses/diagnostic imaging , Craniosynostoses/surgery , Esthetics, Dental , Ethers , Female , Humans , Ketones , Male , Polyethylene Glycols , Polymers , Plastic Surgery Procedures/methods , Retrospective Studies , Skull/surgery
4.
J Soc Pers Relat ; 39(11): 3252-3274, 2022 Nov.
Article in English | MEDLINE | ID: mdl-38603302

ABSTRACT

The COVID-19 pandemic's global scope and resulting social distancing measures have caused unprecedented economic, lifestyle, and social impacts to personal and relationship well-being. While lockdowns have prompted individuals to increase reliance on intimate partners for support, stressful external contexts can also interfere with partners' capacity to request and provide support, resulting in relationship dissatisfaction and even dissolution. Guided by a risk and resilience framework, this study examined the impact of perceived stress, social contextual factors, and dyadic coping on self-reported relationship satisfaction changes during the initial United States COVID-19 lockdown period. Participants were adults in romantic relationships who completed an online survey between April 13 and June 8, 2020. Overall, survey respondents (N = 1106) reported higher perceived stress levels than established population norms, and small but significant decrements in relationship satisfaction. Multivariable models revealed that higher perceived stress levels were associated with lower relationship satisfaction levels. Additionally, dyadic coping was found to moderate the impact of perceived stress on relationship satisfaction (B = .05, 95% CI = .02- .07), suggesting that engaging in dyadic coping buffered individuals from adverse effects of perceived stress on their relationships. Findings emphasize heightened stress experienced by individuals during the pandemic, potential detrimental effects of stress on couple relationships, and suggest dyadic coping may help buffer couples from adverse effects of the pandemic on their relationships. As such, dyadic coping may be an important target for future interventions designed to assist couples during the ongoing pandemic and future pandemics/natural disasters.

5.
J Sci Food Agric ; 101(4): 1530-1537, 2021 Mar 15.
Article in English | MEDLINE | ID: mdl-32869314

ABSTRACT

BACKGROUND: Cycas circinalis leaves are used to treat diabetes mellitus in local medicinal systems without any scientifically proved information on their medicinal potential and phytochemicals. In this study, the total phenolic contents, total flavonoid contents, and 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging and inhibitory effects on α-glucosidase and α-amylase were determined for optimized hydroethanolic leaf extracts. Secondary metabolites were identified using ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS/MS). In vivo studies on diabetic albino mice were also carried out to evaluate the impact of the most active extract on their blood glucose levels. RESULTS: The 60% ethanolic extract showed the highest extract yield (209.70 ± 0.20 g kg-1 ) and total phenolic (154.24 ± 3.28 mg gallic acid equivalent) and flavonoid (78.52 ± 1.65 mg rutin equivalent per gram dried extract) contents and exhibited the maximum DPPH scavenging activity (IC50 = 59.68 ± 2.82 µg mL-1 ). The IC50 values for inhibition of α-glucosidase (58.42 ± 2.22 µg mL-1 ) and α-amylase (74.11 ± 1.70 µg mL-1 ) were also significant for the 60% ethanolic extract. The untargeted UHPLC-QTOF-MS/MS-based metabolite profiling confirmed the presence of iridoid glucoside, gibberellin A4, O-ß-d-glucosyl-4-hydroxy-cinnamate, 3-methoxy-2-phyenyl-4H-furo[2,3-h]chromen-4-one, kaempferol, withaferin A, amentoflavone, quercitin-3-O-(6″-malonyl glucoside), ellagic acid, and gallic acid. Plant extract at a dose of 500 mg kg-1 body weight reduced the blood glucose level by a considerable extent and also improved the lipid profile of diabetic mice after a 28-day trial. CONCLUSION: The findings revealed the medicinal potential of C. circinalis leaves to treat diabetes mellitus and provided the nutraceutical leads for functional food development. © 2020 Society of Chemical Industry.


Subject(s)
Cycas/chemistry , Diabetes Mellitus, Experimental/drug therapy , Hypoglycemic Agents/administration & dosage , Plant Extracts/administration & dosage , Polyphenols/administration & dosage , Animals , Blood Glucose/metabolism , Chromatography, High Pressure Liquid , Diabetes Mellitus, Experimental/enzymology , Diabetes Mellitus, Experimental/genetics , Female , Glycoside Hydrolase Inhibitors/administration & dosage , Glycoside Hydrolase Inhibitors/chemistry , Humans , Hypoglycemic Agents/chemistry , Male , Mass Spectrometry , Mice , Plant Extracts/chemistry , Plant Leaves/chemistry , Polyphenols/chemistry , alpha-Amylases/antagonists & inhibitors , alpha-Amylases/metabolism , alpha-Glucosidases/metabolism
6.
Indian J Ophthalmol ; 71(12): 3633-3636, 2023 Dec 01.
Article in English | MEDLINE | ID: mdl-37991295

ABSTRACT

PURPOSE: Cycloplegic refraction is mandatory for children to know the eye's refractive status. In this study, we compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% by means of retinoscopy. METHODS: In this parallel-designed interventional study, we included 67 children aged between 4 and 17 years. After the initial retinoscopy under cyclopentolate 1% (used twice in each eye), we repeated it a week later under atropine ointment 1% (used twice a day for 3 days); both were done by the same trained optometrist masked to the drug. Each eye's refraction was converted to spherical equivalents (SEs), and the values averaged between the two eyes of each child under each drug. We compared SE with paired t-test (JASP 16.4). In addition, we performed correlational analysis, and looked for agreement using the Bland-Altman plot. Significance was set at P < 0.05. Wherever possible, 95% confidence intervals (CIs) are quoted. RESULTS: The mean SE with atropine was +1.93 ± 2.0 D, compared to +1.75 ± 1.95 D under cyclopentolate. On average, atropine induced greater cycloplegia by a mere 0.18 D (95% CI: 0.07 to 0.29 D, P value 0.002). The two cycloplegic refractions correlated significantly (Pearson's r: 0.975, P < 0.001). The Bland-Altman plot revealed the limits of agreement as 1.06 and -0.71 D. CONCLUSION: Our study suggests that cyclopentolate works for the most part as well as atropine to attain cycloplegia. Atropine may be considered for children less than 15 years of age with greater than 5.0 D of hyperopia. Cycloplentolate, with its advantages of quick action and short duration, should form the first go-to topical cycloplegic in busy outpatient clinics.


Subject(s)
Presbyopia , Pupil Disorders , Refractive Errors , Child , Humans , Child, Preschool , Adolescent , Cyclopentolate , Mydriatics , Atropine , Refraction, Ocular , Pupil
7.
Cureus ; 14(2): e22002, 2022 Feb.
Article in English | MEDLINE | ID: mdl-35282531

ABSTRACT

Introduction Mask ventilation is one of the key components in the management of airway during general anaesthesia, particularly when laryngoscopy is challenging. Adequate mask ventilation provides anaesthesiologists a safe time in case of unanticipated or anticipated difficult airway situations. The aim of this study was to determine the incidence of difficult bag-mask ventilation and intubation in patients having three or more predictors for difficult mask ventilation (DMV) in adult patients scheduled for elective surgery under anaesthesia. Methods A total of 294 patients requiring endotracheal intubation for elective surgical procedure having three or more risk factors were evaluated for the presence of difficulty in bag-mask ventilation and intubation by the anaesthesiologist. Chi-square test or Fisher's exact test and a multivariable stepwise logistic regression model were performed to identify predictors of DMV. Crude and adjusted odds ratio with 95% confidence interval were reported. Results In this study, the average age of the patients was 53.59±13.32 years with a 2:1 male-to-female ratio. DMV and difficult intubation (DI) were observed in 31.6% and 3% of patients, respectively. Multivariate analysis identified history of snoring, BMI (>35 kg/m2), presence of beard and Mallampati III or IV as independent predictors for DMV. Patients with multiple factors (≥3 factors) had a threefold (OR=2.57) increased risk of difficulty in mask ventilation and a nearly fivefold (OR=4.63) increased risk of difficulty with intubation. Conclusion  In our study, the incidence of DMV was observed in 93 (31.6%) patients and DI was found in 9 (3%) patients. A simple DMV risk score may help to predict DMV better, potentially improving safety during difficult airway management, decreasing morbidity and mortality associated with it.

8.
Gastro Hep Adv ; 1(2): 180-185, 2022.
Article in English | MEDLINE | ID: mdl-39131132

ABSTRACT

Background and Aims: Cholangiocarcinoma is a relatively rare malignancy with high mortality. In the U.S., incidence rates of cholangiocarcinoma have increased, particularly affecting younger age groups and Hispanic and Asian individuals. We investigated the incidence of cholangiocarcinoma in a largely under-represented, minority population. Methods: We performed a retrospective cohort study from 2005 to 2017 among adults in a county-funded healthcare system in Harris County, Texas. Incidence rate ratios were computed to compare age-standardized rates using U.S. standard population between 2 time periods: 2005-2011 and 2012-2017. Results: We identified 139 cholangiocarcinoma cases (64% intrahepatic, 36% extrahepatic). The median age at diagnosis was 57 years; 62% were Hispanic, and 56% were born outside the U.S. The incidence rate increased from 1.2 to 2.4 per 100,000 person-years (rate ratio 2.1 [95% confidence interval {CI}: 1.5, 3.0]). Hispanic individuals and those aged 40-69 years had the highest rate of incidence increase (respectively, rate ratio: 2.5 [95% CI: 1.6, 4.0] and rate ratio: 2.0 [95% CI: 1.2, 3.0]) between time periods. In 2012-2017, the risk of cholangiocarcinoma among patients with diabetes was 1.4 times relative to those without (relative risk: 1.4; 95% CI: 1.1, 1.5) and 1.2 times among those who were overweight/obese relative to those who were not (relative risk: 1.2; 95% CI: 1.1, 1.6). Conclusion: Incidence of cholangiocarcinoma doubled during the 12-year study period, with Hispanic and middle-aged individuals disproportionately affected. Individuals with diabetes mellitus and those who were overweight or obese had a high risk of being diagnosed with cholangiocarcinoma in the later time period. Further studies should focus on preventing and improving earlier diagnosis of cholangiocarcinoma among Hispanics.

9.
Am J Case Rep ; 22: e929002, 2021 Jan 25.
Article in English | MEDLINE | ID: mdl-33493142

ABSTRACT

BACKGROUND Apixaban is one of the newer direct oral anticoagulants (DOACs) being used to manage venous thrombosis. Skin toxicities are recognized adverse effects of the new DOACs, but are rare and usually associated with vasculitis. This report is of a 78-year-old man admitted to the hospital with pulmonary thromboembolism, who developed severe and extensive skin necrosis of both forearms 7 days after treatment with apixaban. CASE REPORT A 78-year-old man was admitted for pulmonary embolism and congestive heart failure exacerbation. He was started on therapeutic enoxaparin and diuresis. Later on, enoxaparin was substituted with apixaban. Seven days after starting apixaban, he suddenly developed skin changes that developed into skin necrosis on both forearms and the abdominal wall. A skin biopsy was not performed due to the high risk of bleeding. Skin necrosis was diagnosed based on clinical findings. A review of clinical data and the patient's medication profile did not reveal any other possible etiology or culprit medication. Clinical presentation and lab values were not consistent with infections or autoimmune etiologies. Apixaban was discontinued as it was perceived to be the likely cause of skin necrosis. The skin changes gradually improved within 1 week with supportive wound care, and the patient did not require a skin graft. The patient was discharged safely with subcutaneous low-molecular-weight heparin therapy. CONCLUSIONS This report shows that skin toxicity can be associated with apixaban and that with the increasing use of these newer DOACs, clinicians should be aware of these potential adverse effects.


Subject(s)
Pulmonary Embolism , Venous Thromboembolism , Aged , Anticoagulants/adverse effects , Factor Xa Inhibitors/adverse effects , Humans , Male , Necrosis/chemically induced , Pulmonary Embolism/chemically induced , Pulmonary Embolism/drug therapy , Pyrazoles , Pyridones/adverse effects
10.
Neuropsychopharmacology ; 45(12): 2120-2130, 2020 11.
Article in English | MEDLINE | ID: mdl-32726795

ABSTRACT

DNA methylation is a crucial epigenetic mark for activity-dependent gene expression in neurons. Very little is known about how synaptic signals impact promoter methylation in neuronal nuclei. In this study we show that protein levels of the principal de novo DNA-methyltransferase in neurons, DNMT3A1, are tightly controlled by activation of N-methyl-D-aspartate receptors (NMDAR) containing the GluN2A subunit. Interestingly, synaptic NMDARs drive degradation of the methyltransferase in a neddylation-dependent manner. Inhibition of neddylation, the conjugation of the small ubiquitin-like protein NEDD8 to lysine residues, interrupts degradation of DNMT3A1. This results in deficits in promoter methylation of activity-dependent genes, as well as synaptic plasticity and memory formation. In turn, the underlying molecular pathway is triggered by the induction of synaptic plasticity and in response to object location learning. Collectively, the data show that plasticity-relevant signals from GluN2A-containing NMDARs control activity-dependent DNA-methylation involved in memory formation.


Subject(s)
DNA Methylation , Synapses , Memory , Neuronal Plasticity , Neurons/metabolism , Receptors, N-Methyl-D-Aspartate/genetics , Receptors, N-Methyl-D-Aspartate/metabolism , Synapses/metabolism
11.
BMC Musculoskelet Disord ; 10: 163, 2009 Dec 21.
Article in English | MEDLINE | ID: mdl-20025761

ABSTRACT

BACKGROUND: Shoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production. The prevalence of neovascularity in patients with a clinical diagnosis of rotator cuff tendinopathy is unknown. As such the primary aim of this pilot study was to investigate if neovascularity could be identified and to determine the prevalence of neovascularity in the rotator cuff tendons and subacromial bursa in subjects with unilateral shoulder pain clinically assessed to be rotator cuff tendinopathy. The secondary aims were to investigate the association between the presence of neovascularity and pain, duration of symptoms, and, neovascularity and shoulder function. METHODS: Patients with a clinical diagnosis of unilateral rotator cuff tendinopathy referred for a routine diagnostic ultrasound (US) scan in a major London teaching hospital formed the study population. At referral patients were provided with an information document. On the day of the scan (on average, at least one week later) the patients agreeing to participate were taken through the consent process and underwent an additional clinical examination prior to undergoing a bilateral grey scale and colour Doppler US examination (symptomatic and asymptomatic shoulder) using a Philips HDI 5000 Sono CT US machine. The ultrasound scans were performed by one of two radiologists who recorded their findings and the final assessment was made by a third radiologist blinded both to the clinical examination and the ultrasound examination. The findings of the radiologists who performed the scans and the blinded radiologist were compared and any disagreements were resolved by consensus. RESULTS: Twenty-six patients agreed to participate and formed the study population. Of these, 6 subjects were not included in the final assessment following the pre-scan clinical investigation. This is because one subject had complete cessation of symptoms between the time of the referral and entry into the trial. Another five had developed bilateral shoulder pain during the same period. The mean age of the 20 subjects forming the study population was 50.2 (range 32-69) years (SD = 10.9) and the mean duration of symptoms was 22.6 (range .75 to 132) months (SD = 40.1). Of the 20 subjects included in the formal analysis, 13 subjects (65%) demonstrated neovascularity in the symptomatic shoulder and 5 subjects (25%) demonstrated neovascularity in the asymptomatic shoulder. The subject withdrawn due to complete cessation of symptoms was not found to have neovascularity in either shoulder and of the 5 withdrawn due to bilateral symptoms; two subjects were found to have signs of bilateral neovascularity, one subject demonstrated neovascularity in one shoulder and two subjects in neither shoulder. CONCLUSIONS: This study demonstrated that neovascularity does occur in subjects with a clinical diagnosis of rotator cuff tendinopathy and to a lesser extent in asymptomatic shoulders. In addition, the findings of this investigation did not identify an association between the presence of neovascularity; and pain, duration of symptoms or shoulder function. Future research is required to determine the relevance of these findings.


Subject(s)
Neovascularization, Pathologic/diagnostic imaging , Neovascularization, Pathologic/epidemiology , Rotator Cuff/blood supply , Rotator Cuff/diagnostic imaging , Shoulder Impingement Syndrome/diagnostic imaging , Shoulder Impingement Syndrome/epidemiology , Adult , Aged , Blood Vessels/diagnostic imaging , Blood Vessels/physiopathology , Comorbidity , Disability Evaluation , Female , Humans , Male , Mass Screening , Middle Aged , Neovascularization, Pathologic/physiopathology , Neurologic Examination , Pain Measurement , Prevalence , Range of Motion, Articular/physiology , Rotator Cuff/physiopathology , Shoulder Impingement Syndrome/physiopathology , Shoulder Pain/diagnostic imaging , Shoulder Pain/epidemiology , Shoulder Pain/physiopathology , Ultrasonography, Doppler, Color
12.
Neurologist ; 23(2): 67-70, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29494440

ABSTRACT

INTRODUCTION: Obstructive sleep apnea (OSA) and periodic limb movements (PLMs) have been associated with an increased risk of cardiovascular disease. There is limited data on the relationship between OSA and PLMs with atrial fibrillation and resistant hypertension in stroke and transient ischemic attack (TIA) patients. METHODS: Consecutive stroke and TIA patients referred by a vascular neurologist for diagnostic polysomnography (PSG) from September 1, 2012 to August 31, 2015 were included in a retrospective analysis. Baseline clinical characteristics, PSG results and outcomes were collected to identify the frequency of and factors associated with PLMs (mild 5 to 10/h; severe ≥15/h), PLM arousals (≥5/h) and moderate-severe OSA (apna-hypopnea Index ≥15) including atrial fibrillation and resistant hypertension. RESULTS: Among 103 patients (mean age, 60±15 y; 50% female; 61% nonwhites; 77% ischemic stroke; 23% resistant hypertension) who underwent PSG, 20% had mild PLMs, 28% had severe PLMs, 14% had PLM arousals, and 22% had moderate-severe OSA. Factors associated with moderate-severe OSA included older age (odds ratio, 1.06; 95% confidence interval, 1.02-1.11) and presence of atrial fibrillation (odds ratio, 4.26; 95% confidence interval, 1.17-15.44). Nonwhite race was associated with lower likelihood of mild and severe PLMs, whereas female sex was associated with lower likelihood of PLM arousals. OSA and PLMs were not associated with resistant hypertension. CONCLUSIONS: A significant number of stroke and TIA patients who underwent PSG have PLMs and moderate-severe OSA. Stroke and TIA patients with atrial fibrillation are more likely to have moderate-severe OSA and may benefit from PSG evaluation.


Subject(s)
Ischemic Attack, Transient/epidemiology , Nocturnal Myoclonus Syndrome/epidemiology , Sleep Apnea, Obstructive/epidemiology , Stroke/epidemiology , Adult , Aged , Comorbidity , Female , Humans , Male , Middle Aged , Retrospective Studies
13.
AJR Am J Roentgenol ; 187(1): W87-91, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16794144

ABSTRACT

OBJECTIVE: Creating transjugular intrahepatic portosystemic shunts (TIPS) requires accessing a portal vein branch from a metal cannula wedged in a hepatic vein. This initial step in shunt creation often requires multiple blind intrahepatic punctures and occasionally fails. We describe a method using sonographic guidance to serially puncture the portal vein and hepatic vein with a single transhepatic needle pass, after which the TIPS procedure is completed in the standard transjugular fashion. CONCLUSION: Sonographically guided transhepatic dual puncture of the portal and hepatic veins facilitates portosystemic shunt creation in a single needle pass and allows more controlled selection of the portal vein entry and hepatic vein landing sites in selected patients.


Subject(s)
Hepatic Veins/diagnostic imaging , Portal Vein/diagnostic imaging , Portasystemic Shunt, Transjugular Intrahepatic/methods , Ultrasonography, Interventional , Adult , Aged , Female , Humans , Middle Aged , Punctures/methods
14.
Trans R Soc Trop Med Hyg ; 109(3): 189-96, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25354850

ABSTRACT

BACKGROUND: Low birth weight is known to be associated with postnatal growth failure. It is not yet established that both conditions are determinants of psychomotor development. The study investigated whether or not low birth weight leads to delayed psychomotor development of a child, and whether it can be mitigated by adequate postnatal growth. METHODS: A cross-sectional study was conducted in 2002 in 15 rural and 11 urban communities of Sindh province, Pakistan. Assessment of 1234 children less than 3 years of age included Bayley's Scale of Infant Development II, socioeconomic questionnaire and anthropometry; WHO standards were used to calculate z-scores of height-for-age, weight-for-height and weight-for-age. The underlying study hypotheses were tested through multiple regression modelling. RESULTS: Out of 1219 children, 283 (23.2%) had delayed psychomotor development and 639 (52.4%) were undernourished according to the composite index of anthropometric failure. Strong negative associations with the psychomotor development index were detected between stunting and being underweight, with a larger magnitude of effect for stunting (p<0.001). The strong relationship persisted even when the analysis was restricted to non-malnourished children. The psychomotor index increased by 2.07 points with every unit increase in height-for-age z-score. CONCLUSIONS: The relationship between low birth weight and psychomotor development appears to be mediated largely by postnatal growth and nutritional status. This association suggests that among undernourished children there is significant likelihood of a group that is developmentally delayed. It is important to emphasize developmental needs in programmes that target underprivileged children.


Subject(s)
Failure to Thrive/epidemiology , Infant, Low Birth Weight , Psychomotor Disorders/epidemiology , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Anthropometry , Body Height , Body Weight , Child , Child Nutrition Disorders/complications , Cross-Sectional Studies , Epidemiologic Studies , Humans , Infant , Infant, Newborn , Nutritional Status , Pakistan/epidemiology , Socioeconomic Factors
15.
Saudi Med J ; 35(8): 872-5, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25129190

ABSTRACT

An 11-year-old female patient presented with left-sided nasal obstruction and upward displacement of the left eye of 3 months duration. Clinical examination revealed a firm mass in the left nasal cavity. A CT scan showed a massive tumor involving the left maxillary sinus with extension into the ethmoid sinus, and encroaching on the left orbit. Histopathological examination revealed trabecular juvenile ossifying fibroma, which was removed via a transnasal endoscopic surgery by the Otorhinolaryngology, Head and Neck and the skull base team. She tolerated the lengthy procedure well, and there was no recurrence postoperatively as the tumor was resected completely. There was no external scarring and no psychological trauma discerned. 


Subject(s)
Endoscopy , Fibroma/surgery , Paranasal Sinus Neoplasms/surgery , Child , Female , Fibroma/diagnosis , Humans , Magnetic Resonance Imaging , Paranasal Sinus Neoplasms/diagnosis , Tomography, X-Ray Computed
16.
Int J Gynaecol Obstet ; 120(2): 148-51, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23261127

ABSTRACT

OBJECTIVE: To determine whether the use of disposable clean delivery kits (CDKs) is effective in reducing neonatal tetanus (NNT) infection, regardless of the skills of birth attendants in resource-poor settings. METHODS: A secondary analysis was conducted on data from a matched case-control study in Karachi, Pakistan, involving 140 NNT cases and 280 controls between 1998 and 2001. Conditional logistic regression was performed to assess the independent effect on NNT of CDKs and skilled birth attendants (SBAs). RESULTS: After adjustment for socioeconomic factors, both CDKs (adjusted matched odds ratio [mOR] 2.0; 95% confidence interval [CI], 1.3-3.1) and SBAs (adjusted mOR 1.7; 95% CI, 1.1-2.7) were independently associated with NNT. The association with CDKs remained significant when additionally adjusted for SBAs (mOR 2.0; 95% CI, 1.0-3.9; P=0.05). The population attributable risk for lack of CDK use was 24% in the study setting. CONCLUSION: In the context of resource-poor settings in low-income countries with poor coverage of tetanus toxoid immunization, the use of CDKs seems to be an effective strategy for reducing NNT infection, irrespective of the skill levels of birth attendants. Approximately one-quarter of NNT cases could be prevented in low-income populations with the use of CDKs.


Subject(s)
Delivery, Obstetric/standards , Developing Countries , Parturition , Tetanus/prevention & control , Umbilical Cord/surgery , Adolescent , Adult , Case-Control Studies , Delivery, Obstetric/instrumentation , Disposable Equipment/statistics & numerical data , Female , Humans , Infant, Newborn , Male , Pregnancy , Sanitation , Umbilical Cord/microbiology , Young Adult
17.
Indian J Endocrinol Metab ; 16(4): 522-4, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22837909

ABSTRACT

In the month of Ramadan, patients with thyroid diseases, most of the time, do not need treatment adjustments and can fast safely without any health hazards. Patients with hypothyroidism taking thyroxine can take their tablets on an empty stomach at bedtime instead of half an hour before Sehr. Patients with hyperthyroidism, on methimazole/carbimazole can continue their dose in once or twice daily regimes, while those on propylthiouracil need to be switched. Hyperthyroid patients with severe symptoms should start treatment immediately and can avoid fast for few days after a consultation with their religious scholar.

18.
J Pediatr Urol ; 3(4): 264-7, 2007 Aug.
Article in English | MEDLINE | ID: mdl-18947752

ABSTRACT

OBJECTIVE: Since 1995 we have, at our centre, adopted a selective approach to performing micturating cystourethrograms (MCUGs) on patients with antenatally diagnosed hydronephrosis. This study reviews the outcome of this policy. METHODS: We carry out MCUGs only if any of the following features are present on ultrasound: bilateral hydronephrosis, ureteric dilatation, renal scarring, bladder wall thickness greater than 5mm, or presence of a duplex system or ureterocele. Patients with simple unilateral hydronephrosis are excluded, and are managed with 6 months' trimethoprim prophylaxis and ultrasound surveillance with a minimum of 3 years' follow up. RESULTS: Fifty-five patients were referred with an antenatal diagnosis of hydronephrosis between 1999 and 2002; 26 (47%) did not have an MCUG. Of these, five had increasing hydronephrosis and required surgery for pelvi-ureteric junction obstruction, and three had a multicystic dysplastic kidney on postnatal scanning. In the remaining 18 patients, the hydronephrosis resolved spontaneously, with no renal scars or asymmetry. During follow up, none of these patients had a urinary tract infection. CONCLUSION: We believe that vesico-ureteric reflux in most antenatally diagnosed hydronephrotic kidneys is physiological rather than pathological, and resolves with time without causing long-term renal damage. This is a separate entity from, rather than a precursor of, the pathological symptomatic refluxing kidney in older, mainly female children. Taking a more conservative approach to the postnatal investigation of antenatally diagnosed hydronephrotic kidneys has not resulted in any missed damaged kidneys, but has reduced the number of invasive investigations performed. A careful protocol and detailed postnatal ultrasonography are important to prevent missed pathological cases.

19.
J Vasc Interv Radiol ; 17(2 Pt 1): 373-8, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16517786

ABSTRACT

The authors describe a patient with bleeding varices due to chronic portal vein occlusion. A transjugular intrahepatic portosystemic shunt (TIPS) attempt failed because of cannulation of a low-pressure network of portal veins, which communicated only with the chronically thrombosed native portal vein. A second TIPS attempt was successful after transhepatic catheterization of a high-pressure portal system that was continuous with periportal collateral veins and mesenteric veins. After 8 months and one TIPS revision for hepatic vein stenosis, the patient has improved liver function, collapsed varices, and a patent TIPS on ultrasonogram. This case illustrates that cavernous transformation of the portal vein may result in variable intrahepatic portal perfusion and pressures and that TIPS in such cases requires careful selection of an intrahepatic portal vein to achieve adequate portal decompression.


Subject(s)
Hypertension, Portal/surgery , Portal Vein , Portasystemic Shunt, Transjugular Intrahepatic , Venous Thrombosis/surgery , Aged , Chronic Disease , Female , Humans , Hypertension, Portal/etiology , Radiography, Interventional , Venous Thrombosis/complications
20.
Cardiovasc Intervent Radiol ; 27(1): 9-15, 2004.
Article in English | MEDLINE | ID: mdl-15109221

ABSTRACT

PURPOSE: To assess the role of multislice computed tomography angiography (MCTA) in the evaluation of renal artery stents, using intra-arterial digital subtraction angiography (DSA) as the gold standard. METHODS: Twenty consecutive patients (15 men, 5 women) with 23 renal artery stents prospectively underwent both MCTA and DSA. Axial images, multiplanar reconstructions and maximum intensity projection images were used for diagnosis. The MCTA and DSA images were each interpreted without reference to the result of the other investigation. RESULTS: The three cases of restenosis on DSA were detected correctly by MCTA; in 19 cases where MCTA showed a fully patent stent, the DSA was also negative. Sensitivity and negative predictive value (NPV) of MCTA were therefore 100%. In four cases, MCTA showed apparently minimal disease which was not shown on DSA. These cases are taken as false positive giving a specificity of 80% and a positive predictive value of 43%. CONCLUSION: The high sensitivity and NPV suggest MCTA may be useful as a noninvasive screen for renal artery stent restenosis. MCTA detected mild disease in a few patients which was not confirmed on angiography.


Subject(s)
Renal Artery/diagnostic imaging , Renal Artery/surgery , Stents , Tomography, X-Ray Computed , Adult , Aged , Angiography, Digital Subtraction , Blood Vessel Prosthesis Implantation , False Positive Reactions , Female , Follow-Up Studies , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Renal Artery/physiopathology , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/physiopathology , Renal Artery Obstruction/surgery , Sensitivity and Specificity , Severity of Illness Index , Treatment Outcome , Vascular Patency/physiology
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