The Inter-Mammary Sticky Roll: A Novel Technique for Securing a Doppler Ultrasonic Probe to the Precordium for Venous Air Embolism Detection.

Venous air embolism is a devastating and potentially life-threatening complication that can occur during neurosurgical procedures. We report the development and use of the "inter-mammary sticky roll," a technique to reliably secure a precordial Doppler ultrasonic probe to the chest wall during neurosurgical cases that require lateral decubitus positioning. We have found that this noninvasive technique is safe, and effectively facilitates a constant Doppler signal with no additional risk to the patient

Updates in Mechanical Thrombectomy

Strokes are a major source of morbidity and mortality worldwide. The long-standing gold standard in stroke therapy, intravenous administration of tissue plasminogen activator (tPA), is limited by strict timing parameters and modest efficacy in large strokes caused by thrombi in the proximal cerebral vasculature. Multiple recent randomized controlled trials have demonstrated the efficacy of mechanical thrombectomy for patients with large vessel occlusions (LVOs). Recent clinical guidelines have been updated to include mechanical thrombectomy as a standard of care in properly selected stroke patients, with ongoing and future studies working to refine the optimal clinical and technical variables of this approach

Surgical Management of Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH), defined as bleeding within the brain parenchyma, remains a challenging and controversial neurosurgical entity to treat. ICH has a broad range of etiology—stemming from complications associated with traumatic head injury to complications of hemorrhagic stroke. The role of medical management lies in optimizing blood pressure and intracerebral pressure, preventing secondary injury from complications of the hematoma such as seizures, and correcting coagulopathy. Given the mass effect of a hematoma and the possibility of expansion, surgical interventions attempt to evacuate the clot to restore normal intracerebral pressure and prevent worsening neurologic injury. This chapter reviews the recent controversy associated with surgical evacuation of intracerebral hemorrhage placing particular emphasis on the size and location of the hemorrhage and the methods used to evacuate the expanding ICH. Moreover, this chapter reviews considerations and therapeutic goals of the preoperative and postoperative window to minimize complications and optimize patient care

Prevalence of meningitis among hospitalized neonates with urinary tract infection

Background: Bacteremia is relatively common in children with urinary tract infection (UTI). The aim of the present study was to determine the frequency of bacterial meningitis among neonates with laboratory-confirmed UTI. Methods: This retrospective cross-sectional study was performed on 163 hospitalized neonates in Ali Asghar and Shahid Akbarabadi hospitals affiliated to Iran University of Medical Sciences in Tehran, Iran. The demographic and clinical data of hospitalized neonates due to UTI during the recent 6 years (2010-2016) who were aged < 28 days and had cerebrospinal fluid (CSF) culture via lumbar puncture were extracted from medical records and recorded in some checklists. Results: A total of 163 neonates with laboratory-confirmed UTI with the mean age of 18.25±5.41 days were included. In this study, 54 of the neonates were male. Out of all neonates, 23 (14.1) cases had positive blood culture. The positive CSF culture was observed in only two (1.2) neonates. Positive voiding cystourethrogram (VCUG) test was reported in 50 of the neonates with positive CSF culture (P=0.047). Although abnormal ultrasound findings related to the urinary tract in positive CSF neonates were higher by approximately twofold, compared to those reported for negative CSF neonates, this difference was not statistically significant (50 and 24.2, respectively; P=0.432). Conclusion: The frequency of the concurrent occurrence of UTI and meningitis in our neonates was 1.2. Out of all indicators associated with meningitis occurrence, positive VCUG may be a risk factor. Further prospective studies are needed to approve these results. © 2020 Mashhad University of Medical Sciences. All rights reserved

Medical management of ankylosing spondylitis

In the following literature review the authors consider the available evidence for the medical management of patients with ankylosing spondylitis (AS), and they critically assess current treatment guidelines. Medical therapy for axial disease in AS emphasizes improvement in patients' pain and overall function. First-line treatments include individualized physical therapy and nonsteroidal antiinflammatory drugs (NSAIDs) in conjunction with gastroprotective therapy. After an adequate trial of therapy with two NSAIDs exceeding 3 months or limited by medication toxicity, the patient may undergo tumor necrosis factor-alpha blockade therapy. Response should occur within 6-12 weeks, and patients must undergo tuberculosis screening. Evidence does not currently support the use of disease modifying antirheumatic drugs, corticosteroids, or radiotherapy in AS

Neurosurgery and quantum dots: Part I – State of the art

This article represents the first of a 2-part exploration of quantum dots (Qdots) and their application to neurological surgery. Spanning from materials science to immunology, this initial review traces the marriage of imaging physics to biochemical specificity. Qdot science now stands poised to dramatically advance the diagnosis and therapy of neurosurgical conditions. Qdot research efforts currently involve several disciplines; this comprehensive review therefore considers multiple fields of inquiry. This first installment discusses 1) Qdot physical properties, 2) established biological and in vivo properties, 3) magnetic resonance imaging applications, and ( 4) existing cardiovascular and oncologic research. Finally, this review establishes the existing bounds of Qdot possibilities. The second concept article details future endovascular diagnostic and therapeutic methods derived from these seminal advances

The Implementation of Pain Management and Assessment in Neonatal Intensive Care Units of Teaching Hospitals Affiliated to Tehran University of Medical Sciences

BACKGROUND AND OBJECTIVE: Neonatal pain causes changes in the structure and function of brain in addition to acute physiologic symptoms and is followed by delayed development of infants. This study aims to determine the implementation of pain management and assessment in neonatal intensive care units. METHODS: This cross-sectional study was conducted among 138 nurses working in neonatal intensive care units through census. The data were collected using researcher – made questionnaire including two parts: pain management and assessment and demographic information. The minimum and maximum scores were 0 and 552, respectively, shown in the form of percentage. FINDINGS: At a response rate of 80.23%, the mean age of participants was 31.76±5.41 years and the mean experience of nurses working in a neonatal intensive care unit was 4.36 ± 3.58 years. The cases of implementation of pain management and assessment were as follows: care management for pain reduction (72.8%), allow parents to relieve pain (68.5%), swaddling (66.7%), pain assessment while implementing therapeutic and caring measures (62.9%), the use of sucrose solution (61.6%), teaching parents about observing pain symptoms in the infant’s face (58.7%), recording infant’s pain behaviors and the method for relieving the pain (52.4%), pain assessment at least every 4 hours (52.2%) and the use of valid tools for pain assessment (36.8%). CONCLUSION: According to the results of this study, pain management and assessment was implemented in more than half of the cases