Steroid Treatment Causes Weakness in Spinal Dural Arteriovenous Fistula

Introduction: Spinal dural arteriovenous fistula (SDAVF) is an abnormal connection between the arterial and venous system creating an increase in blood flow and pressure into the spinal veins1 at an estimated frequency of 5-10 cases per million per year.2 Activities that increase intrathoracic and venous pressure such as Valsalva, abdominal compression and steroids2 can lead to a venous infarction, subarachnoid hemorrhage, paraplegia or tetraplegia.3 SDAVF is difficult to diagnose as it presents similarly to other neurologic disorders, but if diagnosed early, deficits can be prevented and reversed with intervention.1 Case Description: A 54-year-old male presented with lower limb progressing to upper limb weakness over months. Examination was significant for 2/5 hip flexion, 3/5 knee extension, 1/5 dorsiflexion, 4/5 plantarflexion, brisk reflexes and intact sensation up to the T4 dermatome. Cervical spine MRI demonstrated a longitudinal T2 hyperintensity along the cervical and upper thoracic cord. After intravenous steroid treatment for presumed transverse myelitis, the patient developed worsening weakness in the lower limbs, which improved days after discontinuing steroids. One month earlier, the patient noted back pain and weakness after carrying heavy tools and experienced transient increased weakness after oral steroid treatment. MRA revealed a SDAVF at the craniocervical junction. The patient ultimately underwent retrosigmoid craniotomy for ligation of the fistula. While initially recommended for comprehensive inpatient rehabilitation, the patient progressed from minimal assistance to supervision and was discharged home. Discussion: SDAVFs cause congestive myelopathy because the arteriovenous shunt increases venous pressure. The presentation can mimic transverse myelitis, and patients are often treated with steroids. Steroids are hypothesized to exacerbate neurologic symptoms by increasing venous congestion through fluid retention, resulting in congestive myelopathy which improves as the hypervolemia resolves. Studies show that treatment with steroids can cause worse outcomes in the acute and chronic period when looking at gait disturbance, neurogenic bowel and neurogenic bladder. To our knowledge, there are only a few cases of acutely worsening weakness after steroid administration leading to an eventual diagnosis of SDAVF. Conclusion: Due to their rarity and nonspecific clinical and radiological findings, SDAVFs are often misdiagnosed, resulting in inappropriate steroid treatment. SDAVFs should be cautiously considered as a differential diagnosis for a patient presenting with progressive weakness, as steroid treatment can lead to worse outcomes and early diagnosis and treatment can minimize disability.https://jdc.jefferson.edu/rmposters/1014/thumbnail.jp

SARS-COV-2 Testing Guidelines for Patients Admitted to MRH for Inpatient Rehabilitation

We implemented a clinical algorithmic approach with an emphasis on symptoms and risk to stratify patients into 3 groups: Acutely Ill COVID Rule Out/PUI Stable COVID Rule Out/PUI COVID OB

Mídia digital na educação em saúde: Uma forma de enfrentamento da pandemia da COVID-19

A pandemia de Covid-19 veio associada à disseminação de grande volume de informações, verdadeiras e falsas, sobre a doença, com potencial impacto no seu controle, por interferir em comportamentos e condutas preventivas e terapêuticas. Motivados pela necessidade de produzir informações confiáveis e combater ‘fakenews’, professores e alunos da Universidade Federal de Minas Gerais desenvolveram projeto de extensão abordando a Covid-19, com o propósito de divulgar materiais educativos para a população em geral, por meio de postagens científicas e realização de webconferências. As plataformas digitais utilizadas foram Instagram e YouTube. O objetivo deste estudo é descrever a ação extensionista e discutir as mídias sociais como estratégia de educação em saúde. As métricas do Instagram foram analisadas de maio a fevereiro de 2022, com média mensal de alcance de 1.928 e engajamento de 552 pessoas. Tivemos um total de 649 seguidores, sendo a maioria mulheres (80,8%) e adultos jovens até 34 anos (38,4%), provenientes da cidade de Belo Horizonte (57,4%). As webconferências abordaram os temas: retorno às atividades escolares presenciais, saúde mental infantil, aspectos bioéticos e direito à vacinação, testagem e atualização sobre vacinas contra Covid-19 para crianças. Em conjunto, houve mais de 6.000 visualizações. A estratégia de educação em saúde por meio de mídias digitais e transmissões on-line constitui importante ferramenta no cenário de distanciamento e do isolamento social imposto pela pandemia, contribuindo para a disseminação do conhecimento científico de qualidade. Palavras-chave: Educação em saúde, Coronavírus, Redes Sociais, Extensão Universitária Digital media in health education: A means to face the COVID-19 pandemic Abstract: The Covid-19 pandemic was associated with disseminating a large volume of true and false information, potentially impacting disease control by interfering with preventive and therapeutic behaviors and conduct. Motivated by the need to produce reliable information and mitigate "fake news," professors and students of the Federal University of Minas Gerais developed an extension project on Covid-19 to disseminate educational materials to the general population through scientific posts and web conferencing. The digital platforms used for this purpose were Instagram and YouTube. This study aimed to describe the extensionist action and discuss social media as a health education strategy. Instagram metrics were analyzed from May to February 2022, with a monthly average reach of 1,928 and an engagement of 552 people. We had a total of 649 followers, most of them women (80.8%) and young adults up to 34 years old (38.4%) from the city of Belo Horizonte (57.4%). The web conferences addressed the topics: of return to face-to-face school activities, child mental health, bioethical aspects, and the right to vaccination, testing, and updating on vaccines against Covid-19 for children. Altogether, there were over 6,000 views. The health education strategy through digital media and online broadcasts is a crucial tool in the scenario of distancing and social isolation imposed by the pandemic, contributing to disseminating reliable scientific knowledge. Keywords: Health education, Coronavirus, Social Networks, University Extensio

Transfusion-transmitted infections

Although the risk of transfusion-transmitted infections today is lower than ever, the supply of safe blood products remains subject to contamination with known and yet to be identified human pathogens. Only continuous improvement and implementation of donor selection, sensitive screening tests and effective inactivation procedures can ensure the elimination, or at least reduction, of the risk of acquiring transfusion transmitted infections. In addition, ongoing education and up-to-date information regarding infectious agents that are potentially transmitted via blood components is necessary to promote the reporting of adverse events, an important component of transfusion transmitted disease surveillance. Thus, the collaboration of all parties involved in transfusion medicine, including national haemovigilance systems, is crucial for protecting a secure blood product supply from known and emerging blood-borne pathogens

Comprehensive molecular characterization of gastric adenocarcinoma

Gastric cancer is a leading cause of cancer deaths, but analysis of its molecular and clinical characteristics has been complicated by histological and aetiological heterogeneity. Here we describe a comprehensive molecular evaluation of 295 primary gastric adenocarcinomas as part of The Cancer Genome Atlas (TCGA) project. We propose a molecular classification dividing gastric cancer into four subtypes: tumours positive for Epstein–Barr virus, which display recurrent PIK3CA mutations, extreme DNA hypermethylation, and amplification of JAK2, CD274 (also known as PD-L1) and PDCD1LG2 (also knownasPD-L2); microsatellite unstable tumours, which show elevated mutation rates, including mutations of genes encoding targetable oncogenic signalling proteins; genomically stable tumours, which are enriched for the diffuse histological variant and mutations of RHOA or fusions involving RHO-family GTPase-activating proteins; and tumours with chromosomal instability, which show marked aneuploidy and focal amplification of receptor tyrosine kinases. Identification of these subtypes provides a roadmap for patient stratification and trials of targeted therapies

Monitoring the Morphology of M87* in 2009–2017 with the Event Horizon Telescope

The Event Horizon Telescope (EHT) has recently delivered the first resolved images of M87*, the supermassive black hole in the center of the M87 galaxy. These images were produced using 230 GHz observations performed in 2017 April. Additional observations are required to investigate the persistence of the primary image feature—a ring with azimuthal brightness asymmetry—and to quantify the image variability on event horizon scales. To address this need, we analyze M87* data collected with prototype EHT arrays in 2009, 2011, 2012, and 2013. While these observations do not contain enough information to produce images, they are sufficient to constrain simple geometric models. We develop a modeling approach based on the framework utilized for the 2017 EHT data analysis and validate our procedures using synthetic data. Applying the same approach to the observational data sets, we find the M87* morphology in 2009–2017 to be consistent with a persistent asymmetric ring of ~40 μas diameter. The position angle of the peak intensity varies in time. In particular, we find a significant difference between the position angle measured in 2013 and 2017. These variations are in broad agreement with predictions of a subset of general relativistic magnetohydrodynamic simulations. We show that quantifying the variability across multiple observational epochs has the potential to constrain the physical properties of the source, such as the accretion state or the black hole spin

First M87 Event Horizon Telescope Results. VI. The Shadow and Mass of the Central Black Hole

We present measurements of the properties of the central radio source in M87 using Event Horizon Telescope data obtained during the 2017 campaign. We develop and fit geometric crescent models (asymmetric rings with interior brightness depressions) using two independent sampling algorithms that consider distinct representations of the visibility data. We show that the crescent family of models is statistically preferred over other comparably complex geometric models that we explore. We calibrate the geometric model parameters using general relativistic magnetohydrodynamic (GRMHD) models of the emission region and estimate physical properties of the source. We further fit images generated from GRMHD models directly to the data. We compare the derived emission region and black hole parameters from these analyses with those recovered from reconstructed images. There is a remarkable consistency among all methods and data sets. We find that >50% of the total flux at arcsecond scales comes from near the horizon, and that the emission is dramatically suppressed interior to this region by a factor >10, providing direct evidence of the predicted shadow of a black hole. Across all methods, we measure a crescent diameter of 42 +/- 3 mu as and constrain its fractional width to b

First M87 Event Horizon Telescope Results. IV. Imaging the Central Supermassive Black Hole

We present the first Event Horizon Telescope (EHT) images of M87, using observations from April 2017 at 1.3 mm wavelength. These images show a prominent ring with a diameter of similar to 40 mu as, consistent with the size and shape of the lensed photon orbit encircling the "shadow" of a supermassive black hole. The ring is persistent across four observing nights and shows enhanced brightness in the south. To assess the reliability of these results, we implemented a two-stage imaging procedure. In the first stage, four teams, each blind to the others' work, produced images of M87 using both an established method (CLEAN) and a newer technique (regularized maximum likelihood). This stage allowed us to avoid shared human bias and to assess common features among independent reconstructions. In the second stage, we reconstructed synthetic data from a large survey of imaging parameters and then compared the results with the corresponding ground truth images. This stage allowed us to select parameters objectively to use when reconstructing images of M87. Across all tests in both stages, the ring diameter and asymmetry remained stable, insensitive to the choice of imaging technique. We describe the EHT imaging procedures, the primary image features in M87, and the dependence of these features on imaging assumptions

First M87 Event Horizon Telescope Results. VI. The Shadow and Mass of the Central Black Hole

We present measurements of the properties of the central radio source in M87 using Event Horizon Telescope data obtained during the 2017 campaign. We develop and fit geometric crescent models (asymmetric rings with interior brightness depressions) using two independent sampling algorithms that consider distinct representations of the visibility data. We show that the crescent family of models is statistically preferred over other comparably complex geometric models that we explore. We calibrate the geometric model parameters using general relativistic magnetohydrodynamic (GRMHD) models of the emission region and estimate physical properties of the source. We further fit images generated from GRMHD models directly to the data. We compare the derived emission region and black hole parameters from these analyses with those recovered from reconstructed images. There is a remarkable consistency among all methods and data sets. We find that >50% of the total flux at arcsecond scales comes from near the horizon, and that the emission is dramatically suppressed interior to this region by a factor >10, providing direct evidence of the predicted shadow of a black hole. Across all methods, we measure a crescent diameter of 42 +/- 3 mu as and constrain its fractional width to be <0.5. Associating the crescent feature with the emission surrounding the black hole shadow, we infer an angular gravitational radius of GM/Dc(2) = 3.8 +/- 0.4 mu as. Folding in a distance measurement of 16.8(-0.7)(+0.8) gives a black hole mass of M = 6.5. 0.2 vertical bar(stat) +/- 0.7 vertical bar(sys) x 10(9) M-circle dot. This measurement from lensed emission near the event horizon is consistent with the presence of a central Kerr black hole, as predicted by the general theory of relativity