Safety and Feasibility of Percutaneous Gastrostomy Placement in Patients on Antiplatelet Therapy.

Background: Guidelines recommend the discontinuation of clopidogrel prior to gastrostomy tube placement. The aim of this study was to examine the safety and feasibility of performing radiologically inserted gastrostomy (RIG) tube placement in patients taking clopidogrel and/or aspirin. Methods: We performed an institutional review board-approved retrospective analysis of the medical records for 237 consecutive patients following RIG tube placement secondary to dysphagia from August 2017 to January 2019. Antiplatelet medications and RIG type placement techniques (push vs pull) were compared with bleeding complications. Complications were categorized based on the Society of Interventional Radiology clinical practice guidelines. Of the 237 patients with RIG tubes placed, 77 patients were on antiplatelet therapy: 55 on single antiplatelet therapy and 22 on dual antiplatelet therapy. Of the 55 patients on single antiplatelet therapy, 26 were taking clopidogrel and 29 were taking aspirin. Results: A total of 9 bleeding complications were observed. The most common complication was minimal bleeding or hematoma around the incision site (n=7). No statistically significant increase was seen in bleeding rates when comparing patients on any antiplatelet therapy regimen vs none (P=0.15), single antiplatelet therapy vs none (P=0.13), clopidogrel vs none (P=0.71), or dual antiplatelet therapy vs none (P=0.61). No significant increase in the bleeding complication rate was noted when comparing the aspirin-only regimen vs clopidogrel alone (P=0.34). Conclusion: These findings suggest that the risk of bleeding complications is not increased in patients taking clopidogrel and/or aspirin prior to RIG tube placement.

All means all: An introduction to the 2020 Global Education Monitoring Report on inclusion.

This article provides an overview of the 2020 Global Education Monitoring Report, which looks at social, economic, and cultural mechanisms that discriminate against disadvantaged children, youth, and adults, keeping them out of education or marginalized in it. Countries are expanding their vision of inclusion in education to put diversity at the core of their systems. Yet, implementation of well-meaning policies often falters. Released at the start of the Decade of Action to 2030, and during the Covid-19 crisis, which has exacerbated underlying inequalities, the report argues that resistance to addressing every learner's needs is a real threat to achieving global education targets. Inclusion and Education: All Means All identifies practices in governance and finance; curricula, textbooks, and assessments; teacher education; school infrastructure; and relations with students, parents, and communities that can unlock the process to inclusion. It provides policy recommendations to make learner diversity a strength to be celebrated, a force for social cohesion.

The presentation of lymph nodes in Hashimoto's thyroiditis on ultrasound.

BACKGROUND: Comprehensive neck ultrasound (US) examination has become an essential component of preoperative workup for patients with thyroid cancer. Regional cervical lymph nodes may be involved in cases of Hashimoto's thyroiditis (HT). This study seeks to examine the sonographic pattern of lymph nodes in patients with HT. METHODS: This is a retrospective study looking at patients with confirmed diagnoses of HT on final surgical pathology who underwent preoperative comprehensive neck US. We compared preoperative ultrasound for patients with HT to euthyroid patients with goiter. Data collected included number, size and ultrasonographic features of cervical lymph nodes. RESULTS: We included a total of 417 patients: 202 patients with HT in the study group, and 215 patients with goiter and euthyroid status in the control group. Patients with HT had a higher number of total cervical lymph nodes than the control group (2.00±2.35 vs. 0.76±1.36 mm; P<0.0001), most notably in cervical levels III and IV (P<0.05 for both). CONCLUSIONS: HT seems to be associated with an ultrasonographic pattern of increased number of enlarged cervical lymph nodes, particularly in levels III, and IV.

Penile Priapism, Clitoral Priapism, and Persistent Genital Arousal Disorder: A Contemporary Review.

INTRODUCTION: Priapism is a persistent erection that arises from a dysfunction of the normal regulatory mechanisms of penile tumescence, rigidity, and flaccidity. It is defined as an erection lasting longer than 6 hours that is not related to sexual stimulation. There are three types of priapism: ischemic, non-ischemic, and stuttering. Similarly, clitoral priapism may occur in females manifested by symptoms such as engorgement with pain and swelling of the clitoris and surrounding tissue. Persistent genital arousal disorder (PGAD) is uncontrollable genital arousal in females, with or without orgasms, that occurs spontaneously and without any sexual feelings. AIM: The aim of this article is to review the available literature on priapism, clitoral priapism, and PGAD. METHODS: A literature review was performed through PubMed regarding priapism, clitoral priapism, and PGAD. MAIN OUTCOME MEASURES: The main outcome is an assessment of the potential etiologies, pathophysiology, diagnostic tools, and management options (medical and surgical) for these conditions. RESULTS: Initial workup of priapism should include a thorough history, physical examination, and cavernous arterial blood gas measurement. Findings should guide further management depending on the etiology of priapism (ischemic vs. non-ischemic). For ischemic priapism, a widely used therapeutic algorithm has been described. For patients with stuttering priapism, multiple oral therapies are currently available. Most reported cases of clitoral priapism appear to be drug-induced, and the primary treatment is stopping the offending agent. Medications like phenylpropanolamine and phenylephrine can also be utilized. PGAD may be associated with anatomical abnormalities, such as Tarlov cysts for which an epidural anesthesia block may be considered. CONCLUSIONS: Early recognition and diagnosis of priapism is paramount to preserving erectile function. Current treatment regimens for ischemic priapism have room for innovation in both pharmacological and surgical therapies. Further investigation into the etiologies and treatment options for clitoral priapism and PGAD are required. Yafi FA, April D, Powers MK, Sangkum P, and Hellstrom WJG. Penile priapism, clitoral priapism, and persistent genital arousal disorder: A contemporary review. Sex Med Rev 2015;3:145-159.

Identification of a novel antiviral inhibitor of the flavivirus guanylyltransferase enzyme.

Arthropod-borne flavivirus infection causes serious morbidity and mortality worldwide, but there are currently no effective antiflaviviral chemotherapeutics available for human use. Therefore, it is critical that new therapeutics against virus-specific targets be developed. To identify new compounds that may be used as broadly active flavivirus therapeutics, we have performed a high-throughput screening of 235,456 commercially available compounds for small-molecule inhibitors of the dengue virus NS5 RNA capping enzyme. We identified a family of compounds, the 2-thioxothiazolidin-4-ones, that show potent biochemical inhibition of capping enzyme GTP binding and guanylyltransferase function. During the course of structure-activity relationship analysis, a molecule within this family, (E)-{3-[5-(4-tert-butylbenzylidene)-4-oxo-2-thioxo-1,3-thiazolidin-3-yl]propanoic acid} (BG-323), was found to possess significant antiviral activity in a dengue virus subgenomic replicon assay. Further testing of BG-323 demonstrated that this molecule is able to reduce the replication of infectious West Nile virus and yellow fever virus in cell culture with low toxicity. The results of this study describe the first inhibitor that targets the GTP-binding/guanylyltransferase activity of the flavivirus RNA capping enzyme.