Home Sleep Apnea Testing for Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA) is a major public health problem affecting almost one billion individuals worldwide. Ninety percent of patients with OSA are still undiagnosed. Although an attended polysomnography (PSG) testing is the gold standard to diagnose OSA, it is time-consuming and is associated with higher costs. The Home Sleep Apnea Testing (HSAT) is now available to diagnose OSA. Understanding the indications and limitations of HSAT is important to avoid misdiagnosis and improve patient outcomes.

The Significance of LRDA With Bilateral Involvement Compared With GRDA on EEG in Critically Ill Patients.

PURPOSE: Lateralized rhythmic delta activity (LRDA) is highly associated with seizures but generalized rhythmic delta activity (GRDA; symmetric by definition) has no known seizure association. A subset of LRDA includes patterns that are "bilateral asymmetric LRDA" (LRDA-ba), falling between purely unilateral LRDA and GRDA. The significance of this finding has not been previously addressed. METHODS: Clinical, EEG, and imaging findings were reviewed in all patients with >6 hours of continuous EEG and LRDA-ba between 2014 and 2019. They were compared with a control group of patients with GRDA, matched 1:1 for prevalence, duration, and frequency of the predominant rhythmic pattern. RESULTS: Two hundred fifty-eight patients with LRDA-ba and 258 matched controls with GRDA were identified. Statistically significant findings included that patients with LRDA-ba were more likely to have presented with an ischemic stroke (LRDA-ba 12.4% vs. GRDA 3.9%) or subdural hemorrhage (8.9% vs. 4.3%); those with GRDA were more likely to have a metabolic encephalopathy (GRDA 10.5% vs. LRDA-ba 3.5%) or "altered mental state" without clear etiology (12.5% vs. 4.3%). Patients with LRDA-ba were significantly more likely to have a background EEG asymmetry (LRDA-ba 62.0% vs. GRDA 25.6%) or focal (arrhythmic) slowing (40.3% vs. 15.5%), and acute (65.5% vs. 46.1%) or focal (49.6% vs. 28.3%) abnormalities on computed tomography scan. Patients with LRDA-ba were more likely to have focal sporadic epileptiform discharges (95.4% vs. 37.9%), lateralized periodic discharges (32.2% vs. 5.0%), and focal electrographic seizures (33.3% vs. 11.2%); however, patients with LRDA-ba alone (i.e., without sporadic epileptiform discharges or PDs) showed only a trend toward increased seizures (17.3%) compared with a matched group of patients with GRDA alone (9.9%, P = 0.08). CONCLUSIONS: Patients with LRDA-ba had a higher proportion of acute focal abnormalities compared with a matched group of patients with GRDA. The LRDA-ba was associated with additional evidence of focal cortical excitability on EEG (sporadic epileptiform discharges and lateralized periodic discharges) and seizures but with only a trend toward increased seizures when other signs of focal excitability were absent.

Expect the Unexpected: A Rare Case of Isolated Superior Mesenteric Artery Vasculitis.

Vasculitis of the mesenteric vessels is considered rare and typically occurs as a part of systemic inflammation. Isolated mesenteric artery vasculitis without systemic involvement is rarely reported in the literature. Clinical presentation is usually nonspecific which can range from abdominal pain, nausea and vomiting to gangrene and intestinal perforation in severe cases. Recognizing mesenteric artery vasculitis as a potential cause of abdominal pain can be challenging, and delay in diagnosis can lead to significant mortality and morbidity. Herein, we present a case of a 19-year-old male who initially presented with abdominal pain. Later, isolated superior mesenteric artery (SMA) vasculitis was confirmed by CT angiography. Treatment with systemic steroids alone resulted in a marked improvement in the patient's symptoms as well as in radiographic findings.

The Effects of NLY01, a Novel Glucagon-Like Peptide-1 Receptor Agonist, on Cuprizone-Induced Demyelination and Remyelination: Challenges and Future Perspectives.

Recent evidence suggests that the glucagon-like peptide-1 receptor (GLP-1R) agonists have neuroprotective activities in the CNS in animal models of Parkinson's disease, Alzheimer's disease, and multiple sclerosis (MS). This study aimed to investigate whether a novel long-acting GLP-1R agonist, NLY01, could limit demyelination or improve remyelination as occurs in MS using the cuprizone (CPZ) mouse model. Herein, we assessed the expression of GLP-1R on oligodendrocytes in vitro and found that mature oligodendrocytes (Olig2+PDGFRa-) express GLP-1R. We further confirmed this observation in the brain by immunohistochemistry and found that Olig2+CC1+ cells express GLP-1R. We next administered NLY01 twice per week to C57B6 mice while on CPZ chow diet and found that NLY01 significantly reduced demyelination with greater weight loss than vehicle-treated controls. Because GLP-1R agonists are known to have anorexigenic effect, we then administered CPZ by oral gavage and treated the mice with NLY01 or vehicle to ensure the dose consistency of CPZ ingestion among mice. Using this modified approach, NLY01 was no longer effective in reducing demyelination of the corpus callosum (CC). We next sought to examine the effects of NLY01 treatment on remyelination after CPZ intoxication and during the recovery period using an adoptive transfer-CPZ (AT-CPZ) model. We found no significant differences between the NLY01 and vehicle groups in the amount of myelin or the number of mature oligodendrocytes in the CC. In summary, despite the promising anti-inflammatory and neuroprotective effects of GLP-1R agonists that have been previously described, our experiments provided no evidence to support a beneficial effect of NLY01 on limiting demyelination or enhancing remyelination. This information may be useful in selecting proper outcome measures in clinical trials of this promising class of drugs in MS.

A genetic Study of the Ghanaian Population Using 15 Autosomal STR Loci.

Autosomal short tandem repeat (STR) population data collected from a well characterized population are needed to correctly assigning the weight of DNA profiles in the courtroom and widely used for ancestral analyses. In this study, allele frequencies for the 15 autosomal short tandem repeat (STR) loci included in the AmpFlSTR® Identifiler® plus kit (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, VWA, TPOX, D18S51, D5S818, FGA) were obtained by genotyping 332 unrelated individuals of Ghanaian origin. Statistical tests on STR genotype data showed no significant departure from Hardy-Weinberg equilibrium (HWE). The overall match probability, combined power of exclusion and combined power of discrimination for these loci were 1 in 3.85 × 1017, 0.99999893 and 0.99999998, respectively. Polymorphic information content (PIC) greater than 0.70 was observed for all loci except TH01 and D13S317. These statistical parameters confirm that this combination of loci is valuable for forensic identification and parentage analysis. Our results were also compared with those for 20 other human populations analyzed for the same set of markers. We observed that the Ghanaian population grouped with other African populations in two-dimensional principal coordinate (PCO) and a neighbor-joining (N-J) data mapping and placed closest to Nigerians. This observation reflects cultural similarities and geographical factors, coupled with the long history of migration and trading activities between Ghana and Nigeria. Our report provides what we believe to be the first published autosomal STR data for the general Ghanaian population using 15 loci genotyped using the AmpFlSTR® Identifiler® plus kit methodology. Our data show that the loci tested have sufficient power to be used reliably for DNA profiling in forensic casework and help to elucidate the genetic history of people living in the country.

Cerebral, ocular, dental, auricular, skeletal anomalies (CODAS) syndrome: First case reported in Saudi Arabia.

CODAS syndrome (cerebral, ocular, dental, auricular, skeletal anomalies) is a rare autosomal recessive inherited multisystemic disease that carries an incidence rate of less than 1 in 1,000,000 children worldwide. It has an infancy, neonatal age of onset, characterized by deformities of the central nervous system, eyes, ears, teeth, and skeleton. A 1-year-old female of non-consanguineous parents, first time presented to our pediatrics clinic on November 6, 2021 when she was 4 months of age with developmental delay, as the patient could not support her head and made no eye contact on examination. Microcephaly was observed. She had a positive family history; her sister died at the age of 3 days with microcephaly and diaphragmatic hernia. We recommend that a wider range of centers to get encouraged to report cases of CODAS they might encounter due to the lack of sufficient amounts if solid literature on the topic. To our knowledge, this is the first case to be reported in the literature from Saudi Arabia.

Evaluating the Mechanical and Tribological Properties of 3D Printed Polylactic-Acid (PLA) Green-Composite for Artificial Implant: Hip Joint Case Study.

Artificial implants are very essential for the disabled as they are utilized for bone and joint function in orthopedics. However, materials used in such implants suffer from restricted mechanical and tribological properties besides the difficulty of using such materials with complex structures. The current study works on developing a new polymer green composite that can be used for artificial implants and allow design flexibility through its usage with 3D printing technology. Therefore, a natural filler extracted from corn cob (CC) was prepared, mixed homogeneously with the Polylactic-acid (PLA), and passed through a complete process to produce a green composite filament suit 3D printer. The corn cob particles were incorporated with PLA with different weight fractions zero, 5%, 10%, 15%, and 20%. The physical, mechanical, and tribological properties of the PLA-CC composites were evaluated. 3D finite element models were constructed to evaluate the PLA-CC composites performance on a real condition implant, hip joints, and through the frictional process. Incorporating corn cob inside PLA revealed an enhancement in the hardness (10%), stiffness (6%), compression ultimate strength (12%), and wear resistance (150%) of the proposed PLA-CC composite. The finite element results of both models proved an enhancement in the load-carrying capacity of the composite. The finite element results came in line with the experimental results.

Combined Methylprednisolone Pulse Therapy plus Rituximab for Treating a Rare Juvenile Steroid-Resistant Nephrotic Syndrome with Cerebral Venous Sinus Thrombosis: A Case Report.

Background: Cerebral venous sinus thrombosis (CVST) secondary to nephrotic syndrome (NS) is rarely reported. Additionally, treating steroid-sensitive nephrotic syndrome (SSNS) that changes to steroid resistance (SRNS) is difficult, with many relapses and side effects. Case presentation: A 32-month-old SSNS male child turned into SRNS and developed cerebral venous sinus thrombosis (CVST), a rare complication of NS. As a result of the administration of combined pulse methylprednisolone and IV Rituximab (RTX) therapy, the patient showed marked improvement, the results of urine analysis were remarkably improved, and the child started to respond to treatment. Conclusion: Successful treatment of a rare case of juvenile SSNS behaving as SRNS with the development of CVST could be established using combined steroid pulse therapy, Enoxaparin, and the B lymphocytes monoclonal antibodies RTX.

Thermohydraulic analysis of covalent and noncovalent functionalized graphene nanoplatelets in circular tube fitted with turbulators.

Covalent and non-covalent nanofluids were tested inside a circular tube fitted with twisted tape inserts with 45° and 90° helix angles. Reynolds number was 7000 ≤ Re ≤ 17,000, and thermophysical properties were assessed at 308 K. The physical model was solved numerically via a two-equation eddy-viscosity model (SST k-omega turbulence). GNPs-SDBS@DW and GNPs-COOH@DW nanofluids with concentrations (0.025 wt.%, 0.05 wt.% and 0.1 wt.%) were considered in this study. The twisted pipes' walls were heated under a constant temperature of 330 K. The current study considered six parameters: outlet temperature, heat transfer coefficient, average Nusselt number, friction factor, pressure loss, and performance evaluation criterion. In both cases (45° and 90° helix angles), GNPs-SDBS@DW nanofluids presented higher thermohydraulic performance than GNPs-COOH@DW and increased by increasing the mass fractions such as 1.17 for 0.025 wt.%, 1.19 for 0.05 wt.% and 1.26 for 0.1 wt.%. Meanwhile, in both cases (45° and 90° helix angles), the value of thermohydraulic performance using GNPs-COOH@DW was 1.02 for 0.025 wt.%, 1.05 for 0.05 wt.% and 1.02 for 0.1 wt.%.

Hybrid Effect of Steel Bars and PAN Textile Reinforcement on Ductility of One-Way Slab Subjected to Bending.

Textile reinforced concrete (TRC) has gained attention from the construction industry due to several characteristics such as its lightweight, high tensile strength, design flexibility, corrosion resistance and remarkably long service life. Some structural applications that utilize TRC components include precast panels, structural repairs, waterproofing elements and façades. TRC is produced by incorporating textile fabrics into thin cementitious concrete panels. However, in order to use this strengthening method in construction practice, a design model is required. Investigating the combined effect of conventional steel and textile reinforcement on the ductility behavior of composite TRC/RC one-way slab is vitally important. Therefore, the current study describes the proper methods of calculating the ductility of the composite concrete reinforced by a direct combination of conventional steel and textile reinforcement. Four methods are presented to calculate the ductility of the three considered one-way slab specimens. The three slabs having dimensions 1500 mm × 500 mm × 50 mm were reinforced by steel bars (SRC), by steel with one layer of carbon fabric (SRC + 1T), and by steel with two layers of carbon fabric (SRC + 2T). The three slab specimens were cast by the hand lay-up method, removed from the molds, cured, and then tested in flexure after 28 days using the four-point bending method. The obtained results and calculations revealed the non-reasonability of using the conventional method based on yielding of steel reinforcement as the only criterion in the ductility determination. The results also confirmed the suitability of using the energy-based method over other discussed methods in the calculation of the ductility for the hybrid reinforced members.

Cardiovascular Predictors of Intracerebral Hematoma Expansion.

BACKGROUND: There is limited evidence on the effect and relevance of cardiovascular parameters on the cerebrovascular system when an intracerebral hemorrhage (ICH) occurs. While recent studies evaluating this relationship are conflicting, one evaluating the effect of systolic cardiac function on clinical outcomes in ICH patients, found low cardiac ejection fractions to be associated with poor clinical outcomes. Our primary objective was to study such correlations and identify various cardiovascular disease states that may be associated with hematoma expansion. METHODS: This is an IRB-approved single-center retrospective study utilizing our institutional "Get with the Guidelines"-Stroke registry between 2013 and 2017. Patients included were older than 18 years of age, admitted with an acute ICH, and had an echocardiogram during their hospitalization. Univariate and multivariate logistical regression analyses were used to identify cardiovascular predictors of hematoma expansion. RESULTS: Two-hundred forty-nine patients were identified from our GWTG-S registry that met initial inclusion criteria. Of these patients, a history of peripheral arterial disease (PAD) (p = 0.015), presence of aortic stenosis (AS) on the echocardiogram (p = 0.025), and a positive spot sign on the CT-angiogram (CTA) of the head (p < 0.001) were found to be independently associated with ICH expansion. Both a history of hypertension and elevated blood pressure on presentation were not significant predictors. Additionally, patients with a history of congestive heart failure had decreased odds of hematoma expansion (p = 0.027). CONCLUSION: This exploratory study highlights potential novel cardiac predictors of hematoma expansion, including PAD and AS, which warrant further study. Larger prospective studies are needed to further investigate such associations to ultimately optimize cardio-cerebral health.

A Rare Case of Pulmonary Embolism in a Patient With Interrupted Inferior Vena Cava and Polysplenia.

Interrupted inferior vena cava (IVC) with azygos continuation is one of the anomalies of the inferior vena cava (AIVCs) where venous drainage of the lower extremities is accomplished through a dilated azygos system and is usually accompanied by other congenital malformations such as polysplenia. AIVCs are more common in patients younger than 40 presenting with deep venous thrombosis (DVT). However, pulmonary embolism (PE) in association with AIVCs remains underreported. In this article, we describe a rare case of a 23-year-old male who presented with syncope secondary to sub-massive pulmonary embolism in the setting of an interrupted vena cava draining directly into the azygous vein.

Sleep Spindles and K-Complexes Are Favorable Prognostic Biomarkers in Critically Ill Patients.

SUMMARY: In this narrative review, we summarize recent research on the prognostic significance of biomarkers of sleep in continuous EEG and polysomnographic recordings in intensive care unit patients. Recent studies show the EEG biosignatures of non-rapid eye movement 2 sleep (sleep spindles and K-complexes) on continuous EEG in critically ill patients better predict functional outcomes and mortality than the ictal-interictal continuum patterns. Emergence of more complex and better organized sleep architecture has been shown to parallel neurocognitive recovery and correlate with functional outcomes in traumatic brain injury and strokes. Particularly interesting are studies which suggest intravenous dexmedetomidine may induce a more biomimetic non-rapid eye movement sleep state than intravenous propofol, potentially providing more restorative sleep and lessening delirium. Protocols to improve intensive care unit sleep and neurophysiological studies evaluating the effect of these on sleep and sleep architecture are here reviewed.

COVID-19 Associated Wake-Up Stroke Treated With DWI/FLAIR Mismatch Guided Intravenous Alteplase: A Case Report.

INTRODUCTION: Wake-up strokes are challenging to manage due to unknown time of onset. Recently, the wake-up trial demonstrated that recombinant tissue plasminogen activator (rtPA) could be administered based on the magnetic resonance imaging (MRI)- diffusion weighted imaging/fluid attenuated inversion recovery mismatch. Many still doubt the safety results due to the higher rate of hemorrhagic conversion reported. Although it was statistically insignificant, the study was terminated early. Furthermore, Corona virus disease-19 is associated with coagulopathy and a higher risk of hemorrhagic conversion. CASE REPORT: A 46-year-old fully functioning male presented with a wake-up right hemiparesis, right facial droop, and expressive aphasia. His National Institute of Health Stroke Scale was 4 upon arrival. Last known well state was >4.5 hours. He tested positive for SARS-CoV-2 viral infection. He had left distal-M2 occlusion. He was deemed not a candidate for rtPA. Hyperacute-MRI protocol showed diffusion weighted imaging/fluid attenuated inversion recovery mismatch. The patient received rtPA at 6.5 hours from the last knwn well state. Follow-up MRI-susceptibility weighted imaging revealed fragmented clot. The stroke burden was less than that shown on the initial computed tomography-perfusion scans implying saved penumbra. There was no hemorrhagic conversion despite low fibrinogen levels. CONCLUSION: The hyperacute-MRI protocol for wake-up COVID-19 associated strokes might be a safe option.

Heat Transfer and Hydrodynamic Properties Using Different Metal-Oxide Nanostructures in Horizontal Concentric Annular Tube: An Optimization Study.

Numerical studies were performed to estimate the heat transfer and hydrodynamic properties of a forced convection turbulent flow using three-dimensional horizontal concentric annuli. This paper applied the standard k-ε turbulence model for the flow range 1 × 104 ≤ Re ≥ 24 × 103. A wide range of parameters like different nanomaterials (Al2O3, CuO, SiO2 and ZnO), different particle nanoshapes (spherical, cylindrical, blades, platelets and bricks), different heat flux ratio (HFR) (0, 0.5, 1 and 2) and different aspect ratios (AR) (1.5, 2, 2.5 and 3) were examined. Also, the effect of inner cylinder rotation was discussed. An experiment was conducted out using a field-emission scanning electron microscope (FE-SEM) to characterize metallic oxides in spherical morphologies. Nano-platelet particles showed the best enhancements in heat transfer properties, followed by nano-cylinders, nano-bricks, nano-blades, and nano-spheres. The maximum heat transfer enhancement was found in SiO2, followed by ZnO, CuO, and Al2O3, in that order. Meanwhile, the effect of the HFR parameter was insignificant. At Re = 24,000, the inner wall rotation enhanced the heat transfer about 47.94%, 43.03%, 42.06% and 39.79% for SiO2, ZnO, CuO and Al2O3, respectively. Moreover, the AR of 2.5 presented the higher heat transfer improvement followed by 3, 2, and 1.5.

COVID-19 Associated Reversible Cerebral Vasoconstriction Syndrome Successfully Treated with Nimodipine and Aspirin.

There have been limited cases linking SARS-CoV-2 infection with the development of reversible cerebral vasoconstriction syndrome (RCVS). We hereby report a rare case of RCVS in the setting of mild SARS-CoV-2 respiratory infection successfully treated with nimodipine and aspirin. SARS-CoV-2 attacks the ACE2-receptors, which are expressed in various body organs including the lungs, kidneys, and blood vessels. Vasoconstriction can result from down-regulation of the ACE2-receptors that can lead to sympathetic hypertonia of the cerebral blood vessel walls and/or over-activation of the renin-angiotensin axis.

Population data and genetic characteristics of 12 X-STR loci using the Investigator® Argus X-12 Quality Sensor kit for the Kedayan population of Borneo in Malaysia.

DNA profiling of X-chromosomal short tandem repeats (X-STR) has exceptional value in criminal investigations, especially for complex kinship and incest cases. In this study, Investigator® Argus X-12 Quality Sensor (QS) kits were successfully used to characterize 12 X-STR loci in 199 unrelated healthy Kedayan individuals living in Sabah and Sarawak, Malaysia. The LG1 haplogroup (DXS8378 - DXS10135 - DXS10148) has the largest HD (0.9799) as compared with all other closely linked haplotype groups examined (LG2; DXS7132-DXS10074-DXS10079, LG3; DXS10103-DXS10101-HPRTB and LG4; DXS10134-DXS7423-DXS10146). Data from statistical analysis showed that high combined of PDM, PDF, MEC_Krüger, MEC_Kishida, MEC_Desmarais, and MEC_Desmarais_duo values (0.999999994405922, 0.99999999999999, 0.999990463834938, 0.999999975914808, 0.999999975985006, and 0.999996491927194, respectively) in the Kedayan. In a two-dimensional scaling (MDS) plot and dendrogram constructed using allele frequencies at the 12 X-STR loci, Kedayan appear to be most closely related to their other Austronesian populations including the Malays and Filipinos as compared with other reference population groups. Findings from the present study thus demonstrate high genetic variability across the 12 tested X-STR loci and can be used for population studies and forensic applications.

Favorable outcome of repeat mechanical thrombectomy in a geriatric patient: illustrative case.

BACKGROUND: The authors presented their experience with a case of repeat thrombectomy in a 93-year-old patient who showed a favorable outcome after recurrent large vessel occlusion treated with emergency mechanical thrombectomy. OBSERVATIONS: Mechanical thrombectomy has been proven to be effective in treating large vessel occlusion types of ischemic stroke. Most of the patient populations involved in the thrombectomy-related studies were younger than 80 years. In addition, recurrent mechanical thrombectomy is not a common procedure in clinical practice. This unusual case demonstrated the potential to achieve a favorable outcome with thrombectomy even in a patient older than 85 years with recurrent large vessel occlusion. LESSONS: There can be a favorable neurological outcome after one or repeat thrombectomies for geriatric patients older than 90 years, and age should not be a deterrent to treatment.

Covid-19 systemic infection exacerbates pre-existing acute disseminated encephalomyelitis (ADEM).

Acute disseminated encephalomyelitis (ADEM) is an uncommon diagnosis in adults. It is known to be due to an abnormal immune response to a systemic infection rather than direct viral invasion to the central nervous system. There have been few reports of ADEM diagnosed in the setting of COVID-19 systemic infection. However, we report a case of Coxsackie induced ADEM that remitted but got exacerbated by COVID-19 infection. The patient contracted the COVID-19 infection shortly after being discharged to a rehabilitation facility. Direct COVID-19 neuroinvasion was ruled out via CSF PCR testing for the virus. The patient responded well to pulse steroid therapy and plasmapheresis in both occasions. We hypothesize that COVID-19 infection can flare-up a recently remitted ADEM via altering the immune responses. It is known now that COVID-19 infection can produce cytokine storming. Cytokine pathway activation is known to be involved in the pathology of ADEM. Caution regarding discharging immune suppressed patient to the inpatient rehabilitation facility should be made in the era of COVID-19 pandemic.