Amiodarone-Induced Liver Attenuation on CT Scan: Alarming Signal for Toxicity and Prompt Discontinuation.

Amiodarone, a class III antiarrhythmic drug, is commonly used for the management of life-threatening ventricular arrhythmias, atrial fibrillation, and other refractory supra-ventricular arrhythmias. Factors like a large volume of distribution, lipophilic property, deposition in tissues in large amounts, etc. have led to the development of amiodarone-induced multisystem adverse events. We report a case of amiodarone-induced hepatic attenuation on computed tomography (CT) of the abdomen in an elderly female patient. Amiodarone with a composition of 40% iodine by weight deposits in the liver, leading to characteristically increased radiodensity reported as increased attenuation on CT scan. Surprisingly, the severity and extent of hepatic attenuation on CT scans do not necessarily correlate with the total exposure to amiodarone over time. Individual factors may influence the liver's response to the drug, leading to varying degrees of hepatic changes. To minimize the risk of adverse events associated with amiodarone, clinicians should carefully adjust the dosage to the lowest effective level and regularly monitor liver function tests in patients. This proactive approach enables early detection of liver dysfunction and facilitates timely adjustments or discontinuation of amiodarone, thereby reducing potential harm.

Liver injury in COVID-19: prevalence and its associated factors in Nepal - A retrospective cross-sectional study.

Liver impairment has been reported as a common clinical manifestation in patients with Severe Acute Respiratory Syndrome Coronavirus 2 infection, with varying degrees of severity ranging from a mild elevation of liver enzymes to acute liver failure. However, the prevalence and clinical significance of liver injury in Coronavirus Disease 2019 (COVID-19) patients, particularly in low- and middle-income countries such as Nepal, remains poorly understood. To investigate the hepatic injury related to this disease and its clinical significance, the authors conducted a retrospective study that included adult patients with COVID-19 infection in security hospitals of Nepal. Methodology: The authors performed a retrospective chart review on 1007 COVID-19-positive patients who underwent a liver function test during their admission in two COVID-19 dedicated hospitals in Nepal from April 2021 to January 2022. The data were collected and entered into Microsoft Excel before being exported to SPSS version 24 for analysis. Univariate and multivariate logistic regression were used to determine factors associated with liver injury. We reported adjusted odds ratios (aOR) with 95% CI. Results: Of the total, 549 (54.5%) patients had an acute liver injury. Among 549 patients, 68.1% were mild, 27.9% were moderate, and 5.0% were severe. Out of 1007 patients, 1.4% had cholestatic liver injury. Most patients with mild, moderate, and severe liver injury had greater than or equal to 10 C-reactive proteins (CRP). In multivariate logistic regression, sex, and CRP were significantly associated with the presence of liver injury. Males had 1.78 times higher odds of having a liver injury compared to females (aOR:1.78; 95% CI: 1.37-2.30, P-value:<0.001). Similarly, patients who had CRP greater than 10 had higher odds of having liver injury compared to those who had CRP less than 10 (aOR: 1.84; 95% CI: 1.41-2.39; P-value: <0.001). Conclusions: The present study reveals that COVID-19 infection is commonly associated with mild increased liver enzymes. However, the likelihood of developing acute liver injury was found to be higher in patients with an inflammatory state indicated by CRP levels greater than 10. Furthermore, the study highlights the sex-based difference in the prevalence of liver injury, with males demonstrating a higher predisposition.

Propofol Infusion Syndrome: A Rare Complication From a Common Medication.

Propofol infusion syndrome (PRIS) is a multifactorial condition that, upon propofol administration, can interrupt critical cellular processes. This can lead to cellular damage that translates as multi-organ system failure that has the potential to be life-threatening. Due to the rarity of this condition, we report a case of PRIS in a 46-year-old male to help bring awareness to this severe condition caused by a relatively common medication. This patient was brought in due to unresponsiveness secondary to multi-substance abuse and respiratory disease and initially had elevated creatinine kinase levels that eventually subsided with appropriate management. However, after prolonged infusion of propofol, his creatinine kinase levels began to drastically rise, alluding to the development of propofol infusion syndrome. Once the offending agent was discontinued, the patient's creatinine kinase levels once again began to normalize.

Use of Venous Thromboembolism Prophylaxis in Hospitalized Patients: Knowledge and Practice Among Physicians in Nepal.

Introduction: Despite the importance of Venous Thromboembolism (VTE) prophylaxis in hospitalized patients, audits have shown inadequate use of VTE prophylaxis methods around the world. We aimed to assess knowledge, attitudes, and behaviors regarding VTE prophylaxis among clinicians in Nepal. Methodology: A cross-sectional questionnaire-based survey was conducted using an online survey platform. Results: 199 (60.7%) of the respondents were aware of the risk factors-based risk stratification approach to VTE prophylaxis in hospitalized patients. Only 154 (47%) of the physicians reported institute-based protocols for VTE prophylaxis. Conclusion: We found a significant lack of awareness on risk factors-based stratification strategy for VTE prevention practices among Nepalese physicians. We recommend educational efforts for Nepalese physicians on the overall impact of VTE on mortality and morbidity of hospitalized patients. Our study highlights the needs for adoption of institution-based protocols for VTE prophylaxis and prevention.

Emergency Stay Duration of Patients in Emergency Department of A Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Emergency department of a hospital is responsible for providing medical and surgical care to patients arriving at the hospital in need of immediate care. Emergency department is not staffed or equipped to provide prolonged care. Duration of stay in the Emergency department directly affects the quality of patient care. Longer length of stay is associated with Emergency department overcrowding, decline in patient care, increased mortality and decreased patients satisfaction. The main aim of this study is to find the mean stay duration of patients in the emergency department of a tertiary care hospital in Nepal. METHODS: This is a descriptive cross-sectional study which was conducted in a tertiary care teaching hospital from Jan 15,2019 to Jan 30, 2019. Ethical clearance was obtained from Kathmandu Medical College- Instutional Review Committee. The calculated sample size was 587. Consecutive sampling technique was used. The data thus obtained was entered in SPSS version 20 and necessary calculations were done. RESULTS: The mean emergency stay duration was obtained to be 3.18 hours at 95% confidence interval (C.I and standard deviation was 2.51 hours. Female had longer mean duration of stay (3.25 hours) compared to male (3.11 hours). The maximum length of stay was 15.3 hours. Most of the patients attending the emergency department were discharged right through the emergency department 398 ( 67.8%). Mean duration of stay was longest (5.06 hours) for the referral group. CONCLUSIONS: The mean stay duration in Emergency Department of tertiary care hospital in Nepal is getting shorter compared to similar study done previously.

Circular RNA hsa_circ_0076248 promotes oncogenesis of glioma by sponging miR-181a to modulate SIRT1 expression.

Glioma is one of the most common primary malignancies of the central nervous system, which has aggressive clinical behavior and a poorer prognosis. MicroRNAs (miRs) are a class of small noncoding RNAs that function as mediators of gene expression, which can be sponged by circRNA provided with a closed circular structure. Dysregulations of circular RNAs (circRNAs) and miRs have been implicated in the development and progression of glioma. In the current study, we investigated the role of circular RNA hsa_circ_0076248 in mediating the oncogenesis of glioma by sponging miR-181a to modulate silent information regulator 1 (SIRT1) expression in vitro and in vivo. The quantitative real-time polymerase chain reaction results showed that the expression of miR-181a was significantly decreased in glioma tissues and cell lines compared with normal brain tissues and normal gliocyte, respectively, and the expression of hsa_circ_0076248 and SIRT1 demonstrated the opposite. Bioinformatics analysis identified hsa_circ_0076248 could sponge miR-181a, and miR-181a could target the mRNA of SIRT1. Our results verified that downregulating hsa_circ_0076248 or upregulating miR-181a could depress the proliferation and invasion of glioma in vitro and in vivo. The experiment also showed that downregulating hsa_circ_0076248 or upregulating miR-181a could remarkably promote the temozolomide chemotherapy sensitivity. Furthermore, Western blot analysis testified that downregulating hsa_circ_0076248 or upregulating miR-181a could promote the expression of p53 and SIRT1. In summary, our study sheds light on the regulatory mechanism of hsa_circ_0076248 in glioma growth and invasion via sponging miR-181a, which downregulates the SIRT1 expression and also suggests that hsa_circ_0076248, miR-181a, and SIRT1 may serve as potential therapeutic targets for glioma.

YouTube lens to attention deficit hyperactivity disorder: a social media analysis.

OBJECTIVE: Social media has provided an online environment for patients to discuss regarding their health and seek medical information. The primary aim of our study was to analyze the quality of information shared on YouTube regarding attention deficit hyperactivity disorder (ADHD). RESULTS: More than half of the videos, 91 (57.23%) had duration of fewer than 5 min. Only 8 (5.03%) videos were rated as highly useful whereas 61 (38.36%) videos were misleading. Interestingly, there was a significant higher (1203.38 ± 395) likes in the misleading group of videos, compared to 162.13 ± 169.63 likes in the very useful group, P = 0.012. Only a small fraction of videos had very useful information on ADHD. There is a need for high-quality, evidence-based, educational videos on ADHD for patient education.

Prospective Series of Nine Long Noncoding RNAs Associated with Survival of Patients with Glioblastoma.

OBJECTIVE: To analyze the long noncoding RNA (lncRNA) expression profile of glioblastoma multiforme (GBM) and identify prognosis-related lncRNAs, as well as their related protein-coding genes and functions. METHOD: The lncRNA expression profiles were obtained by microarray in six samples each of GBM and normal brain tissue. The lncRNAs expressed were significantly different between the two groups and used to detect their associations with patient survival time by downloading the related data from The Cancer Genome Atlas (TCGA). The total RNA-sequencing data of 152 patients diagnosed GBM level 3 with complete clinic information was downloaded. The survival time-dependent lncRNAs were identified by multivariate Cox regression analysis. For the survival time-dependent lncRNAs, we used the Pearson correlation coefficient and z test to search their associated protein-coding genes downloaded from TCGA. Functions of these genes were annotated by the Database for Annotation, Visualization, and Integrated Discovery (DAVID) for gene ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. RESULTS: More than 1,000 antisense lncRNAs and enhancer lncRNAs were selected for analysis in this study. Data from 152 cases with RNA-seq of GBM level 3 with complete information on GBM were downloaded from the TCGA database. Univariate Cox regression analysis revealed 19 lncRNAs with survival time dependency. These nine lncRNAs were used to construct our survival model via multivariate Cox regression analysis: TP73-AS1, AC078883.3, RP11-944L7.4, HAR1B, RP4-635E18.7, HOTAIR, SAPCD1-AS1, AC104653.1, and RP5-1172N10.2. The nine lncRNAs associated with them were inputted into the DAVID database for gene ontology and KEGG function enrichment analysis. The result showed these genes were enriched with ion binding, transport, cell-cell signaling, plasma membrane parts, and more, and they were mainly related to neuroactive ligand-receptor interaction pathway, calcium signaling pathway, and the mitogen-activated protein kinase signaling pathway. CONCLUSION: The nine lncRNAs were a set of biomarkers for the prognosis of patients with GBM, enabling a more accurate prediction of survival and revealing more biological functions.

The Surgical Treatment of Posttraumatic Skull Base Defects with Cerebrospinal Fluid Leak.

Objectives The objective was to explore further the surgical treatment of posttraumatic skull base defects with cerebrospinal fluid (CSF) leak and to identify the most common factors affecting the surgical treatment of posttraumatic skull base defect with CSF leak retrospectively. Materials and Methods This study included 144 patients with head trauma having skull base defect with CSF leak who had been surgically treated at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from 1998 to June 2016. There were 113 (78.5%) males and 31 (21.5%) females, with age ranging from 1 to 78 years and mean age of 26.58 ± 14.95 years. We explored the surgical approaches for the treatment of the skull base defect and the graft materials used and also measured the association among surgical approaches; location, size, and type of skull base defects; presence or absence of associated intracranial pathologies; postoperative complications; outcome; age; Glasgow outcome score (GOS) at discharge; and days of hospital stay. Results The location, size, and types of skull base defect and the presence of associated intracranial pathologies were the common factors identified not only for choosing the appropriate surgical approach but also for choosing the materials for defect repair, timing of the surgery, and the method used for the defect as well as leak repair. The statistically significant correlation with p < 0.001 was found in this study. Conclusion From this study, we could conclude that size, location, and types of the defect and the presence of associated intracranial injuries were the common factors that affected the surgical treatment of posttraumatic skull base defect with CSF leak. Hence, the importance of careful evaluation of these factors is essential for proper selection of the surgical approach and for avoiding unnecessary hassles.

Comparison of smith-petersen osteotomy, pedicular subtraction osteotomy, and poly-segmental wedge osteotomy in treating rigid thoracolumbar kyphotic deformity in ankylosing spondylitis a systematic review and meta-analysis.

BACKGROUND: This study aimed to compare Smith-Petersen osteotomy (SPO), poly-segmental wedge osteotomy (PWO) and pedicular subtraction osteotomy (PSO) in patients with rigid thoracolumbar kyphosis primarily caused by ankylosing spondylitis. The efficiency, efficacy and safety of these three osteotomies have not been compared systematically, and no illness-oriented surgical type selection strategy for the treatment of ankylosing spondylitis related to non-angular kyphosis has been reported. METHODS: The inclusion and exclusion criteria were defined, and 19 electronic databases were searched for eligible studies without language limitations. For the included studies, data extraction, bias analysis, heterogeneity analysis and quantitative analysis were performed to analyze the correction of kyphosiskyphosis and the incidence of complications. RESULTS: Nine comparative studies that met the standards were included with a total of 539 patients that underwent SPO (n = 120), PWO (n = 119), or PSO (n = 300). The correction of kyphosis by PSO was 8.74° [95% CI: 0.7-16.78] greater than SPO. The correction of kyphosis by PWO was 13.88° [95 % CI: 9.25-18.51] greater than SPO. For local biomechanical complications, the pooled risk ratio of PWO to PSO was 1.97 [95 % CI: 1.03-3.77]. For blood loss, PSO was 806.42 ml [95% CI: 591.72-1021.12] greater than SPO and 566.76 ml [95 % CI: 129.80-1003.72] greater than PWO. CONCLUSIONS: To treat rigid thoracolumbar kyphosis, PSO showed higher efficiency and efficacy than SPO, and PWO had a higher efficacy than SPO. The risk of local biomechanical complications was greater in PWO than PSO. Bleeding was more severe in PSO than in SPO or PWO. The incidence of neural complications and systemic complications was similar.