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2.
Cureus ; 16(1): e52541, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38371165

RESUMEN

Background Benign prostatic hyperplasia (BPH) is a disorder that is characterized by the hyperplasia of the cellular elements of the prostate, leading to an enlarged prostate. One of the parameters affecting urinary outflow is intravesical prostatic protrusion (IPP). It is a phenomenon wherein the enlargement of the prostate protrudes into the bladder along the plane of least resistance. This condition can lead to various clinical effects, including symptoms such as the feeling of incomplete void and weak, interrupted urine stream. Hence, investigating the potential associations between different grades of IPP and clinical urological outcomes holds crucial implications for optimizing patient care, refining risk stratification, and enhancing treatment approaches. Methodology We examined patients who were following up at the urology outpatient clinics due to BPH between June 1, 2021, and December 31, 2022. All patients included in this study were required to undergo a transabdominal prostate ultrasound. Patient records were reviewed for various factors, including demographic stratification, the presence of urine routine or culture with evidence of urinary tract infection (UTI) within the past two years, and whether patients were scheduled for surgical intervention. The radiological parameters were recorded by viewing the midsagittal and transverse ultrasound images retrospectively by two specialist radiology physicians. The parameters measured included IPP Grade, prostate volume (PV), presence of bladder stones, anatomical abnormalities (such as bladder diverticulum), and post-void volume. Results The total sample size was 184 patients. Out of these, 53 (28.8%) had IPP Grade I, 72 (39.1%) were classified as Grade II, 42 (22.8%) had Grade III, and 17 (9.2%) were categorized as Grade IV. The data collected also showed that 12 (6.5%) patients had bladder stones on ultrasound examination. Additionally, 17 (9.2%) patients had bladder diverticulum. Furthermore, when controlled for age and PV, multivariate analysis using logistic regression models to calculate the odds ratio (OR) showed that increasing IPP Grade is associated with an increased risk of developing UTIs, acute urinary retention, and the need for surgical intervention. The highest risk group of patients is IPP Grade IV, with odds ratios (ORs) of 6.8, 7.2, and 6.4 for developing UTIs, experiencing acute urinary retention, and requiring surgical intervention, respectively. Conclusions The results provide compelling evidence of the adverse relationships between higher grades of IPP and worsening urological outcomes and patient morbidity. Hence, we recommend further studies be conducted on the clinical effects of IPP and that these measurements should be considered as part of routine ultrasound prostate imaging to aid in the management of BPH cases.

3.
Injury ; 55(2): 111177, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37972486

RESUMEN

OBJECTIVES: To explore the utility of legacy demographic factors and ballistic injury mechanism relative to popular markers of socioeconomic status as prognostic indicators of 10-year mortality following hospital discharge in a young, healthy patient population with isolated orthopedic trauma injuries. METHODS: A retrospective cohort study was performed to evaluate patients treated at an urban Level I trauma center from January 1, 2003, through December 31, 2016. Current Procedure Terminology (CPT) codes were used to identify upper and lower extremity fracture patients undergoing operative fixation. Exclusion criteria were selected to yield a patient population of isolated extremity trauma in young, otherwise healthy individuals between the ages of 18 and 65 years. Variables collected included injury mechanism, age, race, gender, behavior risk factors, Area Deprivation Index (ADI), and insurance status. The primary outcome was post-discharge mortality, occurring at any point during the study period. RESULTS: We identified 2539 patients with operatively treated isolated extremity fractures. The lowest two quartiles of socioeconomic status (SES) were associated with higher hazard of mortality than the highest SES quartile in multivariable analysis (Quartile 3 HR: 2.2, 95% CI: 1.2-4.1, p = 0.01; Quartile 4 HR: 2.2, 95% CI: 1.1-4.3, p = 0.02). Not having private insurance was associated with higher mortality hazard in multivariable analysis (HR 2.0, 95% CI: 1.3-3.2, p = 0.002). The presence of any behavioral risk factor was associated with higher mortality hazard in univariable analysis (HR: 1.8, p < 0.05), but this difference did not reach statistical significance in multivariable analysis (HR: 1.4, 95%: 0.8-2.3, p = 0.20). Injury mechanism (ballistic versus blunt), gender, and race were not associated with increased hazard of mortality (p > 0.20). CONCLUSION: Low SES is associated with a greater hazard of long-term mortality than ballistic injury mechanism, race, gender, and medically diagnosable behavioral risk factors in a young, healthy orthopedic trauma population with isolated extremity injury.


Asunto(s)
Traumatismos de la Pierna , Alta del Paciente , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Cuidados Posteriores , Clase Social , Traumatismos de la Pierna/cirugía
4.
Orthopedics ; 47(1): e19-e25, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37216565

RESUMEN

The aim of this study was to develop and validate risk prediction models for deep surgical site infection (SSI) caused by specific bacterial pathogens after fracture fixation. A retrospective case-control study was conducted at a level I trauma center. Fifteen candidate predictors of the bacterial pathogens in deep SSI were evaluated to develop models of bacterial risk. The study included 441 patients with orthopedic trauma with deep SSI after fracture fixation and 576 control patients. The main outcome measurement was deep SSI cultures positive for methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S aureus (MRSA), gram-negative rods (GNRs), anaerobes, or polymicrobial infection within 1 year of injury. Prognostic models were developed for five bacterial pathogen outcomes. Mean area under the curve ranged from 0.70 (GNRs) to 0.74 (polymicrobial). Strong predictors of MRSA were American Society of Anesthesiologists (ASA) classification of III or greater (odds ratio [OR], 3.4; 95% CI, 1.6-8.0) and time to fixation greater than 7 days (OR, 3.4; 95% CI, 1.9-5.9). Gustilo type III fracture was the strongest predictor of MSSA (OR, 2.5; 95% CI, 1.6-3.9) and GNRs (OR, 3.4; 95% CI, 2.3-5.0). ASA classification of III or greater was the strongest predictor of polymicrobial infection (OR, 5.9; 95% CI, 2.7-15.5) and was associated with increased odds of GNRs (OR, 2.7; 95% CI, 1.5-5.5). Our models predict the risk of MRSA, MSSA, GNR, anaerobe, and polymicrobial infections in patients with fractures. The models might allow for modification of preoperative antibiotic selection based on the particular pathogen posing greatest risk for this patient population. [Orthopedics. 2024;47(1):e19-e25.].


Asunto(s)
Coinfección , Fracturas Óseas , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Humanos , Estudios Retrospectivos , Estudios de Casos y Controles , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/epidemiología , Staphylococcus aureus , Fracturas Óseas/cirugía , Infecciones Estafilocócicas/epidemiología , Bacterias , Fijación de Fractura , Meticilina , Antibacterianos , Bacterias Gramnegativas , Factores de Riesgo
5.
Influenza Other Respir Viruses ; 17(11): e13194, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37964990

RESUMEN

Background: Several countries, including Bahrain, used wastewater surveillance for disease activity monitoring. This study aimed to determine the presence of SARS-CoV-2 in untreated wastewater and to correlate it with the disease spread. Methods: A retrospective review was conducted for all wastewater samples tested for SARS-CoV-2 in public health laboratories from November 2020 to October 2022. Samples were collected weekly between February and October 2022 from different areas across Bahrain. Real-time polymerase chain reaction was used to test for the presence of SARS-CoV-2 in wastewater, and the results were correlated with the number of COVID-19 cases in the same area. Results: Of 387 wastewater samples, 103 (26.6%) samples tested positive for SARS-CoV-2. In late 2020, of 42 samples collected initially, four (9.5%) samples tested positive for SARS-CoV-2 in the four locations that hosted COVID-19 isolation facilities. Between February and October 2022, 345 specimens of wastewater were tested, and 99 (28.7%) were positive. The highest detection rate was in February, June, and July (60%, 45%, and 43%, respectively), which corresponded to COVID-19 peaks during 2022, and the lowest detection rate was in August and September (11% and 0%, respectively), corresponding to the low number of COVID-19 cases. Conclusion: The detection rate of SARS-CoV-2 in wastewater samples from Bahrain was high and was significantly correlated with the number of reported COVID-19 cases. Wastewater surveillance can aid the existing surveillance system in monitoring SARS-CoV-2 spread.


Asunto(s)
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/epidemiología , Aguas Residuales , Bahrein/epidemiología , Pandemias , Monitoreo Epidemiológico Basado en Aguas Residuales , ARN Viral
6.
SAR QSAR Environ Res ; 34(10): 831-846, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37885432

RESUMEN

The horse herd optimization algorithm (HOA), one of the more contemporary metaheuristic algorithms, has demonstrated superior performance in a number of challenging optimization tasks. In the present work, the descriptor selection issue is resolved by classifying different essential oil retention indices using the binary form, BHOA. Based on internal and external prediction criteria, Z-shape transfer functions (ZTF) were tested to verify their efficiency in improving BHOA performance in QSPR modelling for predicting retention indices of essential oils. The evaluation criteria involved the mean-squared error of the training and testing datasets (MSE), and leave-one-out internal and external validation (Q2). The degree of convergence of the proposed Z-shaped transfer functions was compared. In addition, K-fold cross validation with k = 5 was applied. The results show that ZTF, especially ZTF1, greatly improves the performance of the original BHOA. Comparatively speaking, ZTF, especially ZTF1, exhibits the fastest convergence behaviour of the binary algorithms. It chooses the fewest descriptors and requires the fewest iterations to achieve excellent prediction performance.


Asunto(s)
Aceites Volátiles , Relación Estructura-Actividad Cuantitativa , Caballos , Animales , Algoritmos
7.
J Physiol ; 2023 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-37702572

RESUMEN

Astrocytes are increasingly recognised as partaking in complex homeostatic mechanisms critical for regulating neuronal plasticity following central nervous system (CNS) insults. Ischaemic stroke and traumatic brain injury are associated with high rates of disability and mortality. Depending on the context and type of injury, reactive astrocytes respond with diverse morphological, proliferative and functional changes collectively known as astrogliosis, which results in both pathogenic and protective effects. There is a large body of research on the negative consequences of astrogliosis following brain injuries. There is also growing interest in how astrogliosis might in some contexts be protective and help to limit the spread of the injury. However, little is known about how astrocytes contribute to the chronic functional recovery phase following traumatic and ischaemic brain insults. In this review, we explore the protective functions of astrocytes in various aspects of secondary brain injury such as oedema, inflammation and blood-brain barrier dysfunction. We also discuss the current knowledge on astrocyte contribution to tissue regeneration, including angiogenesis, neurogenesis, synaptogenesis, dendrogenesis and axogenesis. Finally, we discuss diverse astrocyte-related factors that, if selectively targeted, could form the basis of astrocyte-targeted therapeutic strategies to better address currently untreatable CNS disorders.

8.
Cell Rep Med ; 4(9): 101187, 2023 09 19.
Artículo en Inglés | MEDLINE | ID: mdl-37659411

RESUMEN

The long-term clinical outcomes of severe obesity due to leptin signaling deficiency are unknown. We carry out a retrospective cross-sectional investigation of a large cohort of children with leptin (LEP), LEP receptor (LEPR), or melanocortin 4 receptor (MC4R) deficiency (n = 145) to evaluate the progression of the disease. The affected individuals undergo physical, clinical, and metabolic evaluations. We report a very high mortality in children with LEP (26%) or LEPR deficiency (9%), mainly due to severe pulmonary and gastrointestinal infections. In addition, 40% of surviving children with LEP or LEPR deficiency experience life-threatening episodes of lung or gastrointestinal infections. Although precision drugs are currently available for LEP and LEPR deficiencies, as yet, they are not accessible in Pakistan. An appreciation of the severe impact of LEP or LEPR deficiency on morbidity and early mortality, educational attainment, and the attendant stigmatization should spur efforts to deliver the available life-saving drugs to these children as a matter of urgency.


Asunto(s)
Leptina , Obesidad Mórbida , Niño , Humanos , Estudios Transversales , Morbilidad , Estudios Retrospectivos
9.
SAR QSAR Environ Res ; 34(4): 285-298, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37157994

RESUMEN

One of the recently developed metaheuristic algorithms, the coyote optimization algorithm (COA), has shown to perform better in a number of difficult optimization tasks. The binary form, BCOA, is used in this study as a solution to the descriptor selection issue in classifying diverse antifungal series. Z-shape transfer functions (ZTF) are evaluated to verify their efficiency in improving BCOA performance in QSAR classification based on classification accuracy (CA), the geometric mean of sensitivity and specificity (G-mean), and the area under the curve (AUC). The Kruskal-Wallis test is also applied to show the statistical differences between the functions. The efficacy of the best suggested transfer function, ZTF4, is further assessed by comparing it to the most recent binary algorithms. The results prove that ZTF, especially ZTF4, significantly improves the performance of the original BCOA. The ZTF4 function yields the best CA and G-mean of 99.03% and 0.992%, respectively. It shows the fastest convergence behaviour compared to other binary algorithms. It takes the fewest iterations to reach high classification performance and selects the fewest descriptors. In conclusion, the obtained results indicate the ability of the ZTF4-based BCOA to find the smallest subset of descriptors while maintaining the best classification accuracy performance.


Asunto(s)
Antifúngicos , Coyotes , Animales , Relación Estructura-Actividad Cuantitativa , Algoritmos , Área Bajo la Curva
10.
Diabetes ; 72(9): 1228-1234, 2023 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-37083980

RESUMEN

We previously demonstrated that 50% of children with obesity from consanguineous families from Pakistan carry pathogenic variants in known monogenic obesity genes. Here, we have discovered a novel monogenetic recessive form of severe childhood obesity using an in-house computational staged approach. The analysis included whole-exome sequencing data of 366 children with severe obesity, 1,000 individuals of the Pakistan Risk of Myocardial Infarction Study (PROMIS) study, and 200,000 participants of the UK Biobank to prioritize genes harboring rare homozygous variants with putative effect on human obesity. We identified five rare or novel homozygous missense mutations predicted deleterious in five consanguineous families in P4HTM encoding prolyl 4-hydroxylase transmembrane (P4H-TM). We further found two additional homozygous missense mutations in children with severe obesity of Indian and Moroccan origin. Molecular dynamics simulation suggested that these mutations destabilized the active conformation of the substrate binding domain. Most carriers also presented with hypotonia, cognitive impairment, and/or developmental delay. Three of the five probands died of pneumonia during the first 2 years of the follow-up. P4HTM deficiency is a novel form of syndromic obesity, affecting 1.5% of our children with obesity associated with high mortality. P4H-TM is a hypoxia-inducible factor that is necessary for survival and adaptation under oxygen deprivation, but the role of this pathway in energy homeostasis and obesity pathophysiology remains to be elucidated.


Asunto(s)
Obesidad Mórbida , Obesidad Infantil , Humanos , Niño , Obesidad Mórbida/genética , Obesidad Infantil/genética , Mutación , Homocigoto , Mutación Missense , Linaje
11.
Braz J Biol ; 84: e267874, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36722679

RESUMEN

Otitis media with effusion (OME) is a type of otitis media (OM) characterized by the presence of fluid behind intact tympanic membrane and is one of the most common diseases of early childhood. It is an infectious disease associated with the presence of many pathogenic bacteria in the middle ear of affected individuals. This study was aimed to determine the prevalence of Gram-positive bacteria from the middle ear of OME patients in the population of Southern Punjab, Pakistan. The incidence of OME under comprehensive healthcare setting was investigated in patients who consulted at the department of ear, throat and nose, Bahawal Victoria Hospital (BVH), Bahawalpur, from December, 2019 to May, 2021. Ear swabs were taken from affected and normal individuals. After culturing bacteria from the ear swabs, microscopic analysis and biochemical tests were performed to characterize the cultured Gram-positive bacteria. Out of 352 patients examined, 109 (30.9%) patients had OME. Age of the participants ranged from 14 to 50 years; individuals between the ages of 14 and 22 years had the highest infection rates, while individuals between 40 and 50 years had the lowest rate of infection. Tympanic membrane perforation, fever, cough, sore throat, ear pain and hearing problem showed association with symptoms of OME. Microscopic analysis and biochemical characterization showed the presence of streptococci and staphylococci in all the studied samples. The most frequently isolated bacteria were Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus with percentage of 53.3%, 20% and 13.3% respectively. Enterococcus faecalis (6.6%) and Staphylococcus epidermidis (6.6%) were also identified in the studied samples. This study will help in the better medical administration of OME affected individuals.


Asunto(s)
Otitis Media con Derrame , Preescolar , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Otitis Media con Derrame/epidemiología , Pakistán/epidemiología , Prevalencia , Bacterias Grampositivas , Pueblos Indígenas
12.
Microorganisms ; 11(2)2023 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-36838320

RESUMEN

Viruses are obligate intracellular parasites that, throughout evolution, have adapted numerous strategies to control the translation machinery, including the modulation of post-transcriptional modifications (PTMs) on transfer RNA (tRNA). PTMs are critical translation regulators used to further host immune responses as well as the expression of viral proteins. Yet, we lack critical insight into the temporal dynamics of infection-induced changes to the tRNA modification landscape (i.e., 'modificome'). In this study, we provide the first comprehensive quantitative characterization of the tRNA modificome in the marine bacterium Shewanella glacialimarina during Shewanella phage 1/4 infection. Specifically, we show that PTMs can be grouped into distinct categories based on modification level changes at various infection stages. Furthermore, we observe a preference for the UAC codon in viral transcripts expressed at the late stage of infection, which coincides with an increase in queuosine modification. Queuosine appears exclusively on tRNAs with GUN anticodons, suggesting a correlation between phage codon usage and PTM modification. Importantly, this work provides the basis for further studies into RNA-based regulatory mechanisms employed by bacteriophages to control the prokaryotic translation machinery.

13.
J Orthop Trauma ; 37(6): 282-286, 2023 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-36729009

RESUMEN

OBJECTIVE: To determine the effectiveness of vancomycin powder in preventing infection after plate and screw fixation of tibial plateau fractures considered at low risk of infection. DESIGN: Retrospective cohort study. SETTING: Single, Level I trauma center. PATIENTS/PARTICIPANTS: This study included 459 patients with tibial plateau fractures (OTA/AO 41-B/C) who underwent open reduction and internal fixation from 2006 to 2018 and were considered at low risk of infection based on not meeting the "high risk" definition of the VANCO trial. INTERVENTION: Vancomycin powder administration on wound closure at the time of definitive fixation. MAIN OUTCOME MEASUREMENTS: Deep surgical site infection with at least 1 gram-positive bacteria culture. RESULTS: Vancomycin powder administration was associated with reduction in gram-positive infection from 4% to 0% (odds ratio, 0.12; 95% confidence interval, 0.04-0.32; P < 0.01). No significant effect was reported in gram-negative only infections, which were observed in 0.3% in the control group, compared with 0.9% in the intervention group (odds ratio, 2.71; 95% confidence interval, 0.11-69; P = 0.54). Methicillin-resistant Staphylococcus aureus was the most common organism isolated in the control group, growing in 9 of 18 infections (50%). CONCLUSIONS: Among patients with low-risk tibial plateau fractures, vancomycin powder at the time of definitive fixation showed a reduction in the incidence of gram-positive deep surgical site infection. The observed relative effect was relatively larger than that observed in a previous randomized trial on high-risk fractures. These data might support broadening the indication for use of vancomycin powder to include tibial plateau fractures at low risk of infection. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Staphylococcus aureus Resistente a Meticilina , Fracturas de la Tibia , Fracturas de la Meseta Tibial , Humanos , Fijación Interna de Fracturas/efectos adversos , Polvos , Estudios Retrospectivos , Infección de la Herida Quirúrgica/epidemiología , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/epidemiología , Resultado del Tratamiento , Vancomicina
14.
Cureus ; 14(11): e31443, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36523714

RESUMEN

Cancer is a major health problem with a significant impact on society and healthcare systems. In 2018, approximately 18.1 million cases of cancer were diagnosed and 9.6 million deaths were documented. Urological cancers account for 12.9% of new cases recorded and 8% of deaths due to cancer worldwide. The latest cancer registries covering the Gulf Cooperation Council (GCC) countries report that 4078 cases of renal cell carcinoma were diagnosed from 1998 to 2012. Urological cancers comprised 9.4% of all cases with an incidence rate of 16.1% in males and 3.2% in females. All renal cancer cases documented in Salmaniya Medical Complex (SMC) from 2014 to 2018 were reviewed. Data collected for all patients from the electronic health record system included age at diagnosis, gender, laterality of cancer (where applicable), histological type, and TNM (tumor, node, metastasis) classification and staging. Furthermore, World Health Organization (WHO) grade and data were collected for kidney cancer cases. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp, Armonk, NY). From 2014 to 2018, there were 65 documented cases of kidney cancer with an average caseload of 13 cases per year. The mean age at diagnosis was 57.6 years. Clear cell carcinoma was the most common histological subtype (37.5%). Stage 1 was the most common stage at diagnosis (35.4%) and the age-standardized mortality rate for males and females were 4.59 and 4.58 in 100,000, respectively. Kidney cancer is a urological malignancy that can pose a burden on both the patient and the healthcare system. There should be a national effort to better understand the etiology and epidemiology of this disease entity with regard to our population. Such efforts would make data regarding diagnosis, management, and follow-up more accessible and would add positively to our healthcare system.

15.
Heliyon ; 8(11): e11493, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36468087

RESUMEN

The elemental composition, mineral phases, and crystalline structure of nephrite jade were investigated using calibration-free laser-induced breakdown spectroscopy (CF-LIBS), Raman spectroscopy, and X-ray diffraction (XRD). For compositional analysis, the laser-induced plasma was generated on the surface of nephrite jade. The plasma emissions were then acquired and analyzed, which revealed several elements in the sample, including Si, Mg, Ca, Li, Fe, Al, Na, K, and Ni. The plasma temperature was extracted from the Boltzmann plot before and after two-step self-absorption correction, and used in CF-LIBS calculations to get the elemental concentration. After self-absorption correction, the quantitative results obtained using CF-LIBS were found to be in close agreement with ICP-OES. The Raman spectrum of nephrite jade exhibits Si-O and M-OH stretching vibrations in the regions of 100 cm-1 to 1200 cm-1 and 3600 cm-1 to 3700 cm-1, respectively, whereas the XRD spectrum revealed the monoclinic crystalline phase of tremolite.

16.
OTA Int ; 5(3): e206, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36425089

RESUMEN

Objective: To quantify patient preferences towards time to return to driving relative to compromised reaction time and potential complication risks. Design: Cross-sectional discrete choice experiment. Setting: Academic trauma center. Patients: Ninety-six adult patients with an operative lower extremity fracture from December 2019 through December 2020. Intervention: None. Main Outcome Measurement: Patient completed a discrete choice experiment survey consisting of 12 hypothetical return to driving scenarios with varied attributes: time to return to driving (range: 1 to 6 months), risk of implant failure (range: 1% to 12%), pain upon driving return (range: none to severe), and driving safety measured by braking distance (range: 0 to 40 feet at 60 mph). The relative importance of each attribute is reported on a scale of 0% to 100%. Results: Patients most valued a reduced pain level when resuming driving (62%), followed by the risk of implant failure (17%), time to return to driving (13%), and braking safety (8%). Patients were indifferent to returning to driving at 1 month (median utility: 28, interquartile range [IQR] -31 to 80) or 2 months (median utility: 59, IQR: 41 to 91) postinjury. Conclusion: Patients with lower extremity injuries demonstrated a willingness to forego earlier return to driving if it might mean a decrease in their pain level. Patients are least concerned about their driving safety, instead placing higher value on their own pain level and chance of implant failure. The findings of this study are the first to rigorously quantify patient preferences toward a return to driving and heterogeneity in patient preferences. Level of Evidence: V.

17.
Cureus ; 14(7): e27506, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-36060396

RESUMEN

Testicular torsion is a relatively common urological emergency, which involves the twisting of the spermatic cord and its contents leading to ischemia to the testes, which usually presents as sudden, severe scrotal pain. In comparison, testicular neoplasms are far less commonly encountered in the emergency department as they often present as painless hard masses that grow slowly over longer periods of time. Extremely rare cases of testicular neoplasms present as sudden scrotal pain that causes a challenging task in the emergency department as physical examinations and ultrasound findings could vary and not be specific enough in confirming the diagnosis. In this case, we report a 22-year-old male who was referred from the emergency department (ED) as a case of testicular torsion from the presenting history; however, his physical examination and Doppler ultrasound findings were suspicious of testicular malignancy. The patient presented with a history of right scrotal pain for a few hours with no predisposing factors; however, examination and imaging were highly suspicious of an underlying neoplasm. The patient underwent an inguinal orchidectomy, and histology confirmed the presence of a germ cell tumor of varying components. In conclusion, a high index of suspicion for testicular torsion should always be present when a patient presents with sudden onset testicular pain; however, the differential diagnosis including testicular neoplasms should not be overlooked as it can change the management and outcome.

18.
Cureus ; 14(7): e26696, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35949756

RESUMEN

Renal cell carcinoma (RCC) constitutes about 2% of all adult malignancies and is the most common malignant renal neoplasm with bony metastases occurring in up to 50% of patients with RCC. In this case, we report a 42-year-old male who presented with chronic back pain and had a sudden episode of paraplegia. The patient was initially referred to the orthopedics service. He had a lumbar X-ray done followed by a CT of the spine that showed a burst fracture of the L1 vertebra with incidental finding of a right renal mass suspicious of RCC. Upon further investigations, the patient was found to have a large heterogeneous renal cortical mass with multiple cystic changes and necrosis invading the Gerota's fascia as well as a tumor thrombus extending into the right renal vein and inferior vena cava. Although it has been well established that RCC metastasizes to bones and it is not uncommon for vertebral column involvement, sudden paraplegia and incontinence resulting from lumbar fracture due to metastatic RCC has not been widely published. Conclusively, RCC is a common malignancy in which a significant number of patients have metastatic disease upon presentation and this can lead to initial confusion and delay in diagnosis, hence it should be part of the differential diagnosis when investigating chronic bony pain and pathological fractures.

19.
Neurochem Res ; 47(12): 3682-3696, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35951202

RESUMEN

Ischemic stroke remains a devastating cerebrovascular disease that accounts for a high proportion of mortality and disability worldwide. MicroRNAs (miRNAs) are a class of small non-coding RNAs that are responsible for regulation of post-transcriptional gene expression, and growing evidence supports a role for miRNAs in stroke injury and recovery. The current study examined the role of miR-182 in experimental stroke using both in vitro and in vivo models of ischemic injury. Brain levels of miR-182 significantly increased after transient middle cerebral artery occlusion (MCAO) in mice and in primary astrocyte cultures subjected to combined oxygen-glucose deprivation/reperfusion (OGD/R) injury. In vivo, stroke volume and neurological score were significantly improved by pre-treatment with miR-182 antagomir. Astrocyte cultures stressed with OGD/R resulted in mitochondrial fragmentation and downregulation of cortactin, an actin-binding protein. Inhibition of miR-182 significantly preserved cortactin expression, reduced mitochondrial fragmentation and improved astrocyte survival after OGD/R. In parallel, lipopolysaccharide (LPS)-induced nitric-oxide release in astrocyte cultures was significantly reduced by miR-182 inhibition, translating to reduced injury in primary neuronal cultures subjected to conditioned medium from LPS-treated astrocytes. These findings identify miR-182 and/or cortactin as potential clinical targets to preserve mitochondrial structure and mitigate neuroinflammation and cell death after ischemic stroke.


Asunto(s)
Isquemia Encefálica , MicroARNs , Daño por Reperfusión , Accidente Cerebrovascular , Animales , Ratones , Apoptosis/genética , Astrocitos/metabolismo , Isquemia Encefálica/metabolismo , Cortactina/metabolismo , Glucosa , Inflamación/prevención & control , Inflamación/genética , Accidente Cerebrovascular Isquémico , Lipopolisacáridos , MicroARNs/metabolismo , Oxígeno/metabolismo , Daño por Reperfusión/metabolismo , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/genética
20.
Braz J Biol ; 84: e262697, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35976350

RESUMEN

Garlic (Allium sativum) is an important cash food crop, and the biotechnology industry has considerable interest in the plant because of its medicinal importance. These medicinal properties are attributed to organosulphur compounds as the accumulation of these compounds varies according to genotype, locality, light quality, and cultivation practices. In this study, we compared a newly developed garlic variety NARC-G1 by National Agricultural Research Centre (NARC), Islamabad, Pakistan with three different garlic cultivars and highlighted the distinctive attributes like phenotypic characteristics, the content of allicin, elemental profile, and gene polymorphism. Phenotypic analysis showed NARC-G1 has significantly higher bulb weight (66.36g ± 18.58), single clove weight (5.87g ± 1.041), and clove width (17.41mm ± 0.95) which directly correlates to the size of the garlic. The analytical analysis showed the highest allicin content (4.82 ± 0.001) in NARC-G1. Genotyping of the alliinase in all four cultivars showed indels in the gene resulting in distinguishable changes in organosulphur compounds' profile. NARC-G1 is unique from other garlic cultivars and could be the best choice for mass production with proper cultivation and irrigation management. Moreover, for Pakistan NARC-G1 could be a potential contender to earn the industrial benefits with inland cultivation instead of importing garlic alleviating the economic burden.


Asunto(s)
Ajo , Antioxidantes , Disulfuros , Ajo/química , Ajo/genética , Humanos , Ácidos Sulfínicos/análisis
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