Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress

Early stages of avascular necrosis of the femoral head (AVNFH) can be conservatively treated with hyperbaric oxygen therapy (HBOT). This study investigated how HBOT modulates inflammatory markers and reactive oxygen species (ROS) in patients with AVNFH. Twenty-three male patients were treated with two cycles of HBOT, 30 sessions each with a 30 days break between cycles. Each session consisted of 90 minutes of 100% inspired oxygen at 2.5 absolute atmospheres of pressure. Plasma levels of tumor necrosis factor alfa (TNF-α), interleukin 6 (IL-6), interleukin 1 beta (IL-1β) and ROS production were measured before treatment (T0), after 15 and 30 HBOT sessions (T1 and T2), after the 30-day break (T3), and after 60 sessions (T4). Results showed a significant reduction in TNF-α and IL-6 plasma levels over time. This decrease in inflammatory markers mirrored observed reductions in bone marrow edema and reductions in patient self-reported pain

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Bilateral 6th Nerve Palsy as Presenting Sign of Adenoid Cystic Carcinoma

Adenoid cystic carcinoma (ACC) is a rare and malignant neoplasm most commonly affecting the salivary glands and other glandular head and neck tissue. The most common cause of bilateral 6th nerve palsy in descending order is trauma, vascular lesions, and tumors. We present the first case of ACC causing bilateral 6th nerve palsy

Successful Thrombolysis in a COVID-19 Patient With Acute Cortical Blindness

Since late 2016 there have been several members of the U.S. Embassy in Cuba that exhibited a wide array of unexplainable neurological symptoms including tinnitus, visual disturbances, and cognitive impairment. 40 patients were described which led to the controversial notion of exposure phenomena known as Havana Syndrome. A report was released in 2020 proposing that the mechanism of injury was consistent with a directed, pulsed radio-frequency energy. However, given the sensitive nature of the issue, there have been several critics that believe certain information has been withheld. Our goal was to present a case explaining our findings of a patient that presented to our clinic that was included in the Havana study

Effect of acute coronary syndrome patients’ education on adherence to dual antiplatelet therapy

Purpose: To assess the effect of acute coronary syndrome (ACS) patients’ education on their adherence to dual antiplatelet therapy (DAPT) and on lifestyle modifications. Methods: Patients who were prescribed acetyl salicylic acid and clopidogrel DAPT within 15 days of having an ACS event were enrolled in this study. Patients were randomized into two arms: the first arm received the study intervention, which consisted of education on coronary artery disease and the importance of sustained platelet inhibition, whereas the second arm was the control group. Both arms received education on lifestyle modifications. Patients completed six visits over 1 year. At each visit, pill count was used to assess adherence to DAPT, data on lifestyle modifications were collected, and changes in weight and waist circumference were recorded. Cardiovascular risk factors were recorded at baseline and the occurrence of new events was monitored throughout the study. Results: There were 153 patients in Arm 1 and 168 in Arm 2. At Month 6, 99.3% of patients in Arm 1 were adherent compared with 94.4% in Arm 2 (p = 0.016). At Month 12, 303 (94.4%) patients from the overall population were adherent to DAPT and there was no significant difference between the two arms (p = 0.443). In addition, no statistically significant difference was found in mean change in weight (3 kg vs. 2 kg, p = 0.064) or mean change in waist circumference (3.5 cm vs. 2.6 cm, p = 0.071) between the two arms. There was a significant decrease in the percentage of smokers (p < 0.001) and a significant increase in the percentage of physically active patients (p < 0.001) within each arm between baseline and Month 12, but the percent change in smokers (z = 1.72, p = 0.085) and percent change in physically active patients (z = 0.76, p = 0.447) between the two arms were not significantly different. Fourteen myocardial infarctions and two strokes occurred throughout the study period. Conclusion: Patient education on DAPT showed short-term effect on adherence to treatment. More effective education methods should be developed to improve long-term DAPT adherence

Y Electroretinographic Findings in Melanoma-Associated Retinopathy Treated by Intravitreal Dexamethasone Implant

A 63-year-old male with a history of bladder cancer in remission presented with progressive vision loss during a period of 2 years. Slit-lamp and funduscopic examination were unremarkable. Electroretinogram (ERG) revealed an unrecordable scotopic response and a moderately decreased photopic response. Computed tomography of the chest, abdomen, and pelvis showed a new duodenal mass. Subsequent biopsy disclosed malignant melanoma, and a diagnosis of melanoma-associated retinopathy (MAR) was made. The patient was then treated with a dexamethasone intravitreal implant 0.7 mg in his left eye. Two months after the implant, the patient reported a mild symptomatic improvement in his left eye, and ERG testing performed after the implant insertion revealed partial improvement in several scotopic and photopic ERG parameters. Repeat spectral-domain optical coherence tomography disclosed an improvement in retinal thickening. To the best of the authors' knowledge, this is the first report illustrating potential subjective visual improvement, improvement in retinal thickening, and ERG changes following treatment by intravitreal dexamethasone implant for MAR

Assessment of Soil Pollution Levels in North Nile Delta, by Integrating Contamination Indices, GIS, and Multivariate Modeling

The proper assessment of trace element concentrations in the north Nile Delta of Egypt is needed in order to reduce the high levels of toxic elements in contaminated soils. The objectives of this study were to assess the risks of contamination for four trace elements (nickel (Ni), cobalt (Co), chromium (Cr), and boron (B)) in three different layers of the soil using the geoaccumulation index (I-geo) and pollution load index (PLI) supported by GIS, as well as to evaluate the performance of partial least-square regression (PLSR) and multiple linear regression (MLR) in estimating the PLI based on data for the four trace elements in the three different soil layers. The results show a widespread contamination of I-geo Ni, Co, Cr, and B in the three different layers of the soil. The I-geo values varied from 0 to 4.74 for Ni, 0 to 6.56 for Co, 0 to 4.11 for Cr, and 0 to 4.57 for B. According to I-geo classification, the status of Ni, Cr, and B ranged from uncontaminated/moderately contaminated to strongly/extremely contaminated. Co ranged from uncontaminated/moderately contaminated to extremely contaminated. There were no significant differences in the values of I-geo for Ni, Co, Cr, and B in the three different layers of the soil. According to the PLI classification, the majority of the samples were very highly polluted. For example, 4.76% and 95.24% of the samples were unpolluted and very highly polluted, respectively, in the surface layer of the soil profiles. Additionally, 14.29% and 85.71% of the samples were unpolluted and very highly polluted, respectively, in the subsurface layer of the soil profiles. Both calibration (Cal.) and validation (Val.) models of the PLSR and MLR showed the highest performance in predicting the PLI based on data for the four studied trace elements, as an alternative method. The validation (Val.) models performed the best in predicting the PLI, with R2 = 0.89–0.93 in the surface layer, 0.91–0.96 in the subsurface layer, 0.89–0.94 in the lowest layers, and 0.92–0.94 across the three different layers. In conclusion, the integration of the I-geo, PLI, GIS technique, and multivariate models is a valuable and applicable approach for the assessment of the risk of contamination for trace elements, and the PLSR and MLR models could be used through applying chemometric techniques to evaluate the PLI in different layers of the soil

Effectiveness of Messenger RNA Vaccines against SARS-CoV-2 Infection in Hemodialysis Patients: A Case–Control Study

Patients with end-stage kidney disease (ESKD) are at increased risk for SARS-CoV-2 infection and its complications compared with the general population. Several studies evaluated the effectiveness of COVID-19 vaccines in the dialysis population but showed mixed results. The aim of this study was to determine the effectiveness of COVID-19 mRNA vaccines against confirmed SARS-CoV-2 infection in hemodialysis (HD) patients in the State of Qatar. We included all adult ESKD patients on chronic HD who had at least one SARS-CoV-2 PCR test done after the introduction of the COVID-19 mRNA vaccines on 24 December 2020. Vaccinated patients who were only tested before receiving any dose of their COVID-19 vaccine or within 14 days after receiving the first vaccine dose were excluded from the study. We used a test-negative case–control design to determine the effectiveness of the COVID-19 vaccination. Sixty-eight patients had positive SARS-CoV-2 PCR tests (cases), while 714 patients had negative tests (controls). Ninety-one percent of patients received the COVID-19 mRNA vaccine. Compared with the controls, the cases were more likely to be older (62 ± 14 vs. 57 ± 15, p = 0.02), on dialysis for more than one year (84% vs. 72%, p = 0.03), unvaccinated (46% vs. 5%, p p < 0.0001). The effectiveness of receiving two doses of COVID-19 mRNA vaccines against confirmed SARS-CoV-2 infection was 94.7% (95% CI: 89.9–97.2) in our HD population. The findings of this study support the importance of using the COVID-19 mRNA vaccine in chronic HD patients to prevent SARS-CoV-2 infection in such a high-risk population