Study of computed tomography perfusion In traumatic brain contusion

Background: Brain ischaemia and infarction are the leading factors in morbidity and mortality of traumatic brain injury. TI1is study aimed to determine the perfusion status of pericontusional hypodense areas in traumatic cerebral contusion Method: Ten patients involved in motor vehicle accidents were enrolled in this study, and contusions were diagnosed from plain computed tomography scans of the brain. Subsequent computed tomography perfusion (en>) was performed to analyse the perfusion ofpericontusional hypodense areas, whicll were divided into 4 regions of interest (ROI). Results: Most ischaemic perfusion was found in ROI 6 (affecting 60% of patients), although the mean of the perfusion parameters were normal. A significant positive correlation was fonnd between the perfusion status in the pericontusional area nearest to the skull vault (ROI 3) and its distance/thickness to the skull vault (r = 0.698, P = 0.025). Two adjacent pericontusional hypodense areas (ROI 4 and ROI 5) showed a significant positive correlation with eacll other (r = 0.667, P = 0.035) in terms of perfusion status. The presence of a hypodense pericontusional area is suggestive of oedema and perfusion disturbances. Conclusion: en> is a useful, fast, and appropriate method in evaluating perfusion of pericontusional hypodensity area that may help the treating physician to provide an appropriate treatment to the patient

Sex Steroid Receptors in Polycystic Ovary Syndrome and Endometriosis: Insights from Laboratory Studies to Clinical Trials

Polycystic ovary syndrome (PCOS) and endometriosis are reproductive disorders that may cause infertility. The pathology of both diseases has been suggested to be associated with sex steroid hormone receptors, including estrogen receptors (ER), progesterone receptors (PRs) and androgen receptors (ARs). Therefore, with this review, we aim to provide an update on the available knowledge of these receptors and how their interactions contribute to the pathogenesis of PCOS and endometriosis. One of the main PCOS-related medical conditions is abnormal folliculo genesis, which is associated with the downregulation of ER and AR expression in the ovaries. In addition, metabolic disorders in PCOS are caused by dysregulation of sex steroid hormone receptor expression. Furthermore, endometriosis is related to the upregulation of ER and the downregulation of PR expression. These receptors may serve as therapeutic targets for the treatment of PCOS-related disorders and endometriosis, considering their pathophysiological roles. Receptor agonists maybe applied to increase the expression of a specific receptor and treat endometriosis or metabolic disorders. In contrast, receptor antagonist functions to reduce receptor expression and can be used to treat endometriosis and induce ovulation. Understanding PCOS and the pathological roles of endometriosis sex steroid receptors is crucial for developing potential therapeutic strategies to treat infertility in both conditions. Therefore, research should be continued to fill the knowledge gap regarding the subject

CFD analysis on mismatched end-to-end internal diameter of RSVG models

A digital arterial disease in upper extremity is uncommon happened compare to arterial disease in lower extremity. A surgical vein graft interposition is performed as revascularization procedure. However, mismatching between end-to-end internal diameter of reverse saphenous vein graft (RSVG) and existing digital artery cause blockage in RSVG vessel. In previous study, size discrepancy (small to large) in vessel causes the abnormal blood flow and will initiate the thrombosis formations as stated by Rory F. et al. Furthermore, their previous study is also supported by clinical theory as written in Wilmer W. et al. and Krishnan B. Chandran et al.s’ text books. The main goal of this study is to analyze the relationship the patterns of blood flow through mismatching between end-to-end internal diameter of RSVG models and existing digital artery (large to small) with effect to the initiation of thrombus formation in RSVG models. A Three-dimensional Computational Fluid Dynamic (3-D CFD) method is employed to investigate blood flow velocity, blood pressure gradient and wall shear stress (WSS) on ideal straight (well matched between internal diameter of RSVG and recipient arteries) and internal diameter mismatched of end-to-end RSVG models. In this experiment, we expect that steady state laminar blood flow demonstrates abnormal flow pattern in mismatched internal diameter RSVG models compared to an ideal straight model. As conclusion, any abnormal blood flow pattern will initiate the formation of thrombus and reduce the vein graft survival

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Study of computed tomography perfusion in traumatic cerebral contusion

Study of computed tomography perfusion (CTP) in traumatic cerebral contusion Head injury is listed as the sm principle cause of death in Ministry of Health (MOH) hospitals with percentage of 6.07% (Health Statistics MOH, 2004). The prevalence rate of cerebral contusion was recorded as 15.0%(Wintermark et al., 2004). Non-enhanced CT (NECT) brain is a sensitive primary diagnostic tool in the evaluation of patients with head injury. On NECT brain, pericontusional hypodensity area represents oedema. However, its perfusion disturbance could not be determined from plain CT scan. CTP provides information regarding ischaemic injuries related to the trauma and able to determine any evidence of pericontusional ischaemia. Reduction of perfusion can lead to unfavourable outcome. This study aims to determine perfusion status of pericontusional hypodensity area and correlation with clinical outcome. Ten patients involved in motor vehicle accidents (MV A) fulfilled the inclusion and exclusion criterias and hence enrolled in this study from July 2007 to November 2008 .. NECT scan of the brain was done on admission to confirm presence of contusion and followed by CTP. The data were analyzed at the CT workstation. Pericontusion areas were divided into four sections in relation to distance from the skull. Distance and size of contusion were measured from NECT scan. The region of interest were drawn based on hypodensity and CTP colour map. Each parameters of perfusion were produced by the perfusion software and were analyzed. CTP results were categorized as normal, ischaemia or infarct Clinical outcome was evaluated using GOS after 6 weeks post trauma

A boy with bluish neck swelling on screaming

A 5-year-old Malay boy was presented with a history of swelling on the right side of the neck for 6-month duration. It was noticeable everytime when the child screamed (Figures 1 and 2). There was no other associated symptom

A pulsating mass in the pre-auricular region

A 75-year-old lady presented with right preauricular swelling, which gradually increased in size during the past 13 years. However, in the last 2 years, she noticed the presence of pulsation. The swelling was painless and there was no history of bleeding or abscess formation. On examination, the swelling was observed in the right pre-auricular region measuring about 5x6x2 cm with well-defined margin (Figure 1). It was a pulsatile swelling with bluish discolouration of skin. There was no tenderness

A thyroid mass that moves with tongue protrusion: An ectopic thyroid gland

Thyroglossal duct cyst (TDC) is a developmental anomaly that usually appears in early childhood. The common presentation is midline swelling of the neck, which moves with both tongue protrusion and deglutition. Diagnosis is usually clinical and radiological. Fine needle aspiration cytology (FNAC) can be used as a tool for the exclusion of malignancy in adult patients. In some cases thyroid scan is done to rule out the presence or absence of the normal thyroid gland. A complete work-up is mandatory before cyst removal given that it contains only thyroid tissue. We report the case of a 32-year-old woman with only thyroid tissue in thyroglossal duct cyst

Computed Tomography Perfusion Imaging on Traumatic Cerebral Contusion: A Preliminary Report

Background: Brain ischaemia and infarction are the leading factors in morbidity and mortality of traumatic brain injury. This study aimed to determine the perfusion status of pericontusional hypodense areas in traumatic cerebral contusion. Methods: Ten patients involved in motor vehicle accidents were enrolled in this study, and contusions were diagnosed from plain computed tomography scans of the brain. Subsequent computed tomography perfusion (CTP) was performed to analyse the perfusion of pericontusional hypodense areas, which were divided into 4 regions of interest (ROI). Results: Most ischaemic perfusion was found in ROI 6 (affecting 60% of patients), although the mean of the perfusion parameters were normal. A significant positive correlation was found between the perfusion status in the pericontusional area nearest to the skull vault (ROI 3) and its distance/thickness to the skull vault (r = 0.698, P = 0.025). Two adjacent pericontusional hypodense areas (ROI 4 and ROI 5) showed a significant positive correlation with each other (r = 0.667, P = 0.035) in terms of perfusion status. The presence of a hypodense pericontusional area is suggestive of oedema and perfusion disturbances. Conclusion: CTP is a useful, fast, and appropriate method in evaluating perfusion of pericontusional hypodensity area that may help the treating physician to provide an appropriate treatment to the patient