Conquering Mount Fuji: Resolution of Tension Pneumocephalus with a Foley Urinary Catheter

Tension pneumocephalus is the presence of air or gas in the cranium that is under pressure. It occurs due to disruption of the skull, including trauma to the head or face, after neurosurgical procedures and occasionally, spontaneously (Schirmer et al., 2010). Patients typically present with headache but can also have neurological deficits such as decreased mental status, numbness, and weakness (Schirmer et al., 2010). It is diagnosed by computerized tomography (CT) scan (Michel, 2010). The characteristic finding is that the two frontal poles of the brain are separated by air. After diagnosis, treatment is imperative for both symptomatic relief and preventing further compression. We present a case of a patient who presented with tension pneumocephalus and unconventional treatment that resulted in clinical improvement of his symptoms and radiographic resolution of his condition

Geni virulencije i antimikrobna osjetljivost izolata bakterije Escherichia coli dobijenih od krava s mastitisom u pokrajini Mashhad, Iran – kratko priopćenje

The purpose of this study was to determine the virulence genes and antimicrobial resistance patterns of Escherichia coli isolated from milk samples of cows with bovine mastitis. Forty-seven E. coli isolates from clinical mastitis milk samples, from five dairy farms in Northeast of Iran, were subjected to multiplex PCR to determine virulence genes stx1, stx2, eaeA, hlyA, sta, F4, F17, fliC, and rfbE. In addition, antimicrobial susceptibility was assessed by applying disk diffusion methods. The eaeA and stx1 genes were most frequently detected in 42 (89.3%) and 34 (72.3%) isolates, respectively. However, the least frequent gene was F41 as it was found in only one isolate (2.1%). Furthermore, 9 out of 47 isolates were hlyA positive, and four isolates harbored the sta gene. The antimicrobial susceptibility demonstrated the highest resistance against lincomycin (100%) and neomycin (91.4%). Since these bacteria represent a high-risk pathogen on farms, the emergence of multiple antibiotic-resistant and pathogenic E. coli strains should be of great concern for public health.Cilj je istraživanja bio odrediti gene virulencije i antimikrobnu rezistencije bakterije Escherichia coli izolirane iz uzoraka mlijeka krava s mastitisom. Ukupno 47 izolata bakterije E. coli iz uzoraka mlijeka krava s kliničkim mastitisom, s pet mliječnih farmi u sjeveroistočnom Iranu, podvrgnuto je protokolu multipleks PCR-a kako bi se odredili geni virulencije stx1, stx2, eaeA, hlyA, sta, F4, F17, fliC i rfbE. Antimikrobna je osjetljivost procijenjena primjenom disk-difuzijske metode. Najčešće određeni geni jesu gen eaeA, u 42 izolata (89,3 %) i gen stx1, u 34 izolata (72,3 %). Najrjeđi gen bio je F41, koji je pronađen u jednom izolatu (2,1 %). Nadalje, 9 od 47 izolata bilo je hlyA pozitivno, a četiri su izolata sadržavala gen sta. Procjena antimikrobne je osjetljivosti pokazala je najveću rezistenciju na linkomicin (100 %) i neomicin (91,4 %). Nalazi upućuju da se radi o visokorizičnim patogenima na farmama krava, stoga bi pojava višestruko rezistentnih i patogenih sojeva E. coli trebala izazvati veliku javnozdravstvenu zabrinutost

Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta-Analysis, and Network Meta-Analysis

BACKGROUND: Cerebral cavernous malformations are complex vascular anomalies in the central nervous system associated with a risk of intracranial hemorrhage. Traditional guidelines have been cautious about the use of antithrombotic therapy in this patient group, citing concerns about potential bleeding risk. However, recent research posits that antithrombotic therapy may actually be beneficial. This study aims to clarify the association between antithrombotic therapy, including antiplatelet and anticoagulant medications, and the risk of intracranial hemorrhage in patients with cerebral cavernous malformations. METHODS AND RESULTS: A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine single-center, nonrandomized cohort studies involving 2709 patients were included. Outcomes were analyzed using random-effects model, and a network meta-analysis was conducted for further insight. Of the 2709 patients studied, 388 were on antithrombotic therapy. Patients on antithrombotic therapy had a lower risk of presenting with intracranial hemorrhage (odds ratio [OR], 0.56 [95% CI, 0.45-0.7]; CONCLUSIONS: Our study explores the potential benefits of antithrombotic therapy in cerebral cavernous malformations. Although the analysis suggests a possible role for antithrombotic agents, it is critical to note that the evidence remains preliminary. Fundamental biases in study design, such as ascertainment and assignment bias, limit the weight of our conclusions. Therefore, our findings should be considered hypothesis-generating and not definitive for clinical practice change

Something Got Your Tongue? A Unique Cause of Hypoglossal Nerve Palsy

Introduction. The authors report a rare cause of isolated hypoglossal nerve palsy caused by a high cervical osteophyte. This case increases clinical knowledge of an underreported condition and teaches the clinician radiologic pearls in making the diagnosis. To their knowledge, this is the first case report showing surgical remediation of this condition. Symptoms and Clinical Findings. A 73-year-old female presented with several months of occipital headache, progressive dysarthria, dysphagia, and tongue deviation to the right. Her neurologic exam was significant for atrophy of the right hemitongue with tongue fasciculations. On protrusion, her tongue deviated rightward. Diagnosis and Therapeutic Intervention. Careful review of her initial head computed tomography (CT) imaging revealed that a high cervical osteophyte caused unilateral, isolated hypoglossal nerve palsy. Neurosurgery performed a right, far lateral approach for decompression of this osteophyte and over the ensuing months her symptoms improved. Conclusion. High cervical osteophyte is an underrecognized cause of isolated hypoglossal nerve palsy. The imaging investigation should be systematic and focus on the skull base with magnetic resonance imaging (MRI) or CT. This is a rare occasion when high resolution CT of the skull base can actually be the more helpful imaging modality. As shown in this case, an osteoarthritic cause can be surgically ameliorated

Comparison of Duffy Blood Group System Genotype in Kurdish Patients with Beta-Thalassemia Major in Kermanshah City: A Case-Control Study

Background and Ami: Identifying the genotype of blood groups in different communities will give the decision makers of the health system to take the necessary measures to prevent and identify the possible side effects of blood transfusion, including the production of alloantibodies. Duffy blood group has increased the possibility of alloantibody production in beta-thalassemia major patients who regularly need blood transfusion due to different types of genotype with different prevalence. However, no study has been conducted regarding the frequency of Duffy blood group distribution in beta-thalassemia Kurd patients dependent on blood transfusion. Materials and Methods: This case-control study was conducted on 100 patients with beta thalassemia major, as case group and 50 healthy individuals, as control group, in Bostan Clinic, Kermanshah University of Medical Sciences. After collecting peripheral blood samples from people participating in the study, DNA was extracted from peripheral blood mononuclear cells. Then, using PCR-RFLP and electrophoresis, Duffy genotypes including FYA/A, FYB/B and FYA/B were identified. Results: The results of Chi-square test showed that in the patient group, there is no statistically significant difference between the two genders in terms of the frequency of distribution of Duffy genotypes (P=0.588). On the other hand, in the healthy group too, there was no statistically significant difference between the two sexes in terms of the frequency of distribution of Duffy genotypes (P=0.707). According to nominal regression results, although the distribution ratio rate (95% confidence interval) of FYA/FYA and FYB/FYB genotypes as compared to FYA/FYB genotype (reference category) in the patient group as compared to healthy people was 2.42 (0.7 to 8.34) and 0.76 (0.36 to 1.64) respectively, but there was no statistically significant difference between the case and control groups in terms of the distribution frequency of these genotypes (P<0.05). Conclusion: The frequency distribution of Duffy genotypes in beta-thalassemia major patients is similar to that of healthy people, and there is no relationship between the distribution of Duffy genotypes and beta-thalassemia disease. FYB genotype has the highest frequency in both case and control group

Cognitive outcomes following aneurysmal subarachnoid hemorrhage: Rehabilitation strategies

Despite decreases in mortality rate, the treatment of cognitive deficits following aneurysmal subarachnoid hemorrhage (aSAH) remains a serious challenge for clinicians and survivors alike. Deficits in executive function, language, and memory prevent more than half of survivors from returning to their previous level of work and put a tremendous amount of stress on the individual and their family. New therapies are needed for survivors of aSAH in order to improve cognitive outcomes and quality of life. The aim of this review is to discuss the prevalence and contributing factors of cognitive deficits following aSAH, as well as areas for therapeutic intervention. Due to the limited research on cognitive rehabilitative strategies for aSAH, a literature search of traumatic brain injury (TBI) was used to explore therapies with the potential to improve cognitive outcomes in aSAH. Across cognitive domains, existing rehabilitative and pharmacotherapeutic strategies for TBI show promise to be useful for survivors of aSAH. However, further study of these therapies in addition to consistent assessment of cognitive deficits are required to determine their efficacy in survivors of aSAH

Stages of Behavior Change for Physical Activity in Airport Staff: a quasi-experimental study

Objective. This work sought to determine the effect of an educational intervention based on the stages of change in promoting physical activity in employees in the Mashhad airport in Iran. Methods. This was a quasi-experimental study conducted with the participation of 60 volunteers (30 in the intervention group and 30 in the control group) who were in the stages of contemplating or preparing for change in physical activity. The intervention consisted in educational activities provided during home visits, telephone calls, group training sessions, and delivery of printed material. To gather the information, the study used five questions on the stage in which they were for behavioral change in physical activity, according to the Theoretical Model by Marcus et al., (1. pre-contemplation, 2. contemplation, 3. preparation, 4. action, and 5. maintenance), and the International Questionnaire on Physical Activity. Changes in the stages were evaluated during three moments: upon entering the study, at the end of the intervention (8th month), and two months after the second evaluation (10th month). Results. During the 10th month evaluation, it was noted that 26.7% of the subjects from the intervention group versus 3.3% from the control group improved their physical activity and were in the action stage (p<0.01). Conclusion. Theeducational intervention based on stages of change is effective in promoting physical activity in the participants and may be used in educational programs that seek to improve physical activity in the employees studied.How to cite this article: Mahmoudi K, Taghipoor A, Tehrani H, Zomorodi Niat H, Vahedian-Shahroodi M. Stages of Behavior Change for Physical Activity in Airport Staff: a quasi-experimental study. Invest. Educ. Enferm. 2020; 38(1):e0

Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐Analysis

Background Cerebral cavernous malformations are complex vascular anomalies in the central nervous system associated with a risk of intracranial hemorrhage. Traditional guidelines have been cautious about the use of antithrombotic therapy in this patient group, citing concerns about potential bleeding risk. However, recent research posits that antithrombotic therapy may actually be beneficial. This study aims to clarify the association between antithrombotic therapy, including antiplatelet and anticoagulant medications, and the risk of intracranial hemorrhage in patients with cerebral cavernous malformations. Methods and Results A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Nine single‐center, nonrandomized cohort studies involving 2709 patients were included. Outcomes were analyzed using random‐effects model, and a network meta‐analysis was conducted for further insight. Of the 2709 patients studied, 388 were on antithrombotic therapy. Patients on antithrombotic therapy had a lower risk of presenting with intracranial hemorrhage (odds ratio [OR], 0.56 [95% CI, 0.45–0.7]; P<0.0001). In addition, the use of antithrombotic therapy was associated with lower risk of intracranial hemorrhage from a cerebral cavernous malformation on follow‐up (OR, 0.21 [95% CI, 0.13–0.35]; P<0.0001). A network meta‐analysis revealed a nonsignificant OR of 0.73 (95% CI, 0.23–2.56) when antiplatelet therapy was compared with anticoagulant therapy. Conclusions Our study explores the potential benefits of antithrombotic therapy in cerebral cavernous malformations. Although the analysis suggests a possible role for antithrombotic agents, it is critical to note that the evidence remains preliminary. Fundamental biases in study design, such as ascertainment and assignment bias, limit the weight of our conclusions. Therefore, our findings should be considered hypothesis‐generating and not definitive for clinical practice change

Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature.

ObjectiveDespite advances in the nonsurgical management of cerebrovascular atherosclerotic steno-occlusive disease, approximately 15-20% of patients remain at high risk for recurrent ischemia. The benefit of revascularization with flow augmentation bypass has been demonstrated in studies of Moyamoya vasculopathy. Unfortunately, there are mixed results for the use of flow augmentation in atherosclerotic cerebrovascular disease. We conducted a study to examine the efficacy and long term outcomes of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in patients with recurrent ischemia despite optimal medical management.MethodsA single-institution retrospective review of patients receiving flow augmentation bypass from 2013-2021 was conducted. Patients with non-Moyamoya vaso-occlusive disease (VOD) who had continued ischemic symptoms or strokes despite best medical management were included. The primary outcome was time to post-operative stroke. Time from cerebrovascular accident to surgery, complications, imaging results, and modified Rankin Scale (mRS) scores were aggregated.ResultsTwenty patients met inclusion criteria. The median time from cerebrovascular accident to surgery was 87 (28-105.0) days. Only one patient (5%) had a stroke at 66 days post-op. One (5%) patient had a post-operative scalp infection, while 3 (15%) developed post-operative seizures. All 20 (100%) bypasses remained patent at follow-up. The median mRS score at follow up was significantly improved from presentation from 2.5 (1-3) to 1 (0-2), P = .013.ConclusionsFor patients with high-risk non-Moyamoya VOD who have failed optimal medical therapy, contemporary approaches to flow augmentation with STA-MCA bypass may prevent future ischemic events with a low complication rate

Effect of 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (Voluven®) on complications after subarachnoid hemorrhage: a retrospective analysis

10.1186/2193-1801-2-314SpringerPlus211-