Benchmarking hospital practices and policies on intrahospital neurocritical care transport: The Safe-Neuro-Transport study

An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income level. Variability between high-income (HIC) and low/middle-income (LMIC) groups, as well as variability between hospitals within countries, were expressed as counts/percentages and intracluster correlation coefficients (ICCs) with a 95% confidence interval (CI). A total of 246 hospitals (67% response rate

Olfactory gyrus intracerebral hemorrhage in a patient with COVID-19 infection

Since the outbreak with novel corona virus in December 2019, a myriad of different neurological manifestations in patients with COVID-19 infection have been reported. We present a case of non-traumatic intracranial hemorrhage in the olfactory gyrus in a patient who tested positive for SARS-COV-2. The area of hemorrhage is not a common location for spontaneous hemorrhage. Given that loss of smell is considered a relatively common symptom of this pandemic, it is an intriguing association of COVID-19 and olfactory gyrus ICH for neurotropism of SARS-CoV2 for olfactory bulb and glia cells through nasal mucosa. Future studies will need to elucidate the exact mechanism of anosmia from COVID-19 and potential mechanisms leading to ICH

Therapeutic targeting of Toll-like receptors in cutaneous disorders

INTRODUCTION: The role of skin, as a part of the immune system has long been elucidated. Toll-like receptors (TLRs), a group of pattern recognition receptors, are involved in the recognition of invading pathogens, initiation of immune responses and regulation of both innate and adaptive immune systems. There is a growing body of evidence supporting the role of TLRs in the pathophysiology of several skin conditions, which mandates the development and study of therapeutic strategies that target TLRs. AREAS COVERED: With regards to the role of TLRs in pathogenesis of diverse cutaneous conditions, recent advances, as well as the future prospects of therapeutic implications of TLRs in cutaneous disorders is reviewed in this article. EXPERT OPINION: Although non-specific therapeutic strategies seem to reduce the symptoms in majority of patients, a considerable proportion remain untreated or have to deal with inevitable adverse effects of such therapies. Since TLRs regulate many patholophysiological processes, they could be good candidates for more specific therapeutic approaches. TLR targeting as the first recipient of invading pathogens is a growing concept in this field

The Role of Doppler Sonography in Distinguishing Malignant from Benign Breast Lesions

The use of color Doppler ultrasound (CDUS) for characterizing breast lesions has increased in recent years. The aim of this study was to assess the value of CDUS and resistance index (RI), in evaluating solid breast masses. Methods: In total, 38 cases with one or more solid breast masses were enrolled. CDUS was performed for each participant, evaluating RI, and all of them underwent a tissue biopsy. The results were categorized and compared with pathology results. Results: Malignant breast lesions were more vascular than the benign lesions. Blood vessels were detected in 97.4% of the malignant group and only 35% of the benign group. The mean values of RI in benign lesions and malignant lesions were 0.65 ± 0.065 (range, 0.52–0.89) and 0.71 ± 0.093 (range, 0.57–0.75), respectively. The difference was just short of statistical significance (p = 0.061). Conclusion: Hypervascularity of a breast mass is the most reliable sign in Doppler ultrasound to predict its possibility of malignancy. However, it appears that the use of RI alone has little value in differentiating between malignant and benign breast lesions. Pathological findings are still the gold standard for diagnosing the type of breast nodules

Development and validation of osteoporosis prescreening model for Iranian postmenopausal women

BACKGROUND: Studies have indicated that the commonly used osteoporosis prescreening tools are not appropriate for use in every nation. This study was designed to develop and validate a prescreening model for bone mineral densitometry among Iranian postmenopausal women. METHODS: From 13613 individuals who were referred for bone mineral densitometry in Shariati hospital in Tehran, 8644 postmenopausal women were considered for the study after excluding men and premenopausal women. Questionnaires regarding the risk factors for osteoporosis were filled for each individual. Bone mineral density at the lumbar vertebrae (L2-L4), femoral neck and total femur was measured by dual X-ray absorptiometry. Using holdout validation, the study sample was divided into two parts; training set (5705) and test set (2939). Logistic regression analysis was performed on the training set. A scoring model was developed and tested in the test set. RESULTS: Based on the training set, a seven-variable model named OPMIP (Osteoporosis Prescreening Model for Iranian Postmenopausal women) was developed with C statistics (area under curve) of 0.72. Using a cut-off of -2.5 for the model, the sensitivity, specificity, positive predictive value and negative predictive value were 72%, 59.5%, 64% and 69% respectively. The model performance was tested in the test set. OPMIP correctly classified 67.10% of cases with a sensitivity and specificity of 73.2% and 61%. CONCLUSIONS: In order to appropriately refer patients for a bone mineral densitometry, OPMIP can be used as a prescreening tool in Iranian Postmenopausal women

Structural Findings in the Brain MRI of Patients with Acute Carbon Monoxide Poisoning

Background: Carbon monoxide (CO) poisoning may lead to hypoxic/anoxic injury and eventually ischemic encephalopathy. Magnetic resonance imaging (MRI) has a well-recognized role in assessment of the severity of brain damage caused by CO poisoning. In this study, we aimed to present and analyze the structural abnormalities in the brain MRI and especially in diffusion weighted MRI (DWI) images in a series of patients with acute CO poisoning. Methods: This cross-sectional observational study was performed on patients with moderate to severe CO poisoning admitted to Mashhad Medical Toxicology Center of Imam Reza Hospital, Mashhad, Iran, during autumn and winter 2013. After stabilization, patients underwent brain MRI. T1 weighted, T2 weighted and FLAIR images in sagittal, axial and coronal sections, and DWI in axial sections were performed for each patient. Results: Eighteen patients (77.8% men) were enrolled in this study with median age of 29.5 years. Eleven patients (61.1%) had abnormal MRI signals and in 7 cases no abnormality or nonspecific abnormalities were detected. The most common involved region in brain MRI was white matter (38.9%) followed by globus pallidus (33.3%). Patients with signal abnormality in brain MRI had significantly longer duration of exposure to CO compared to those without signal changes (10.6 ± 6.2 h vs. 3.4 ± 2.8 h, P = 0.011). Nine patients had restricted diffusion in DWI. Patients with restricted diffusion in DWI had also longer duration of exposure to CO compared to patients with normal DWI (12.1 ± 5.5 h vs. 3.5 ± 2.9 h, P = 0.001). Conclusion: The white matter and globus pallidus were the most common affected regions in brain following acute CO poisoning. Signal abnormalities and restricted diffusion in MRI were correlated with duration of exposure to CO but not with the carboxyhemoglobin levels

Radiographic appearance of leptomeningeal disease in patients with EGFR-mutated non-small-cell lung carcinoma treated with tyrosine kinase inhibitors: a case series

EGFR is frequently mutated in non-small-cell lung carcinomas (NSCLCs). Clinically available tyrosine kinase inhibitors (TKIs) are effective in treating EGFR-mutant NSCLC. In this case series, we present five patients with TKI-treated EGFR-mutated NSCLC who developed leptomeningeal disease (LMD) lacking characteristic imaging findings. All five patients received TKIs prior to development of cytology-confirmed LMD. Clinical signs of LMD preceded radiographic evidence by 2-12 months. T790M, the most common resistance mutation to first-generation EGFR inhibitors, was identified in four cases. These cases illustrate that in patients with EGFR-mutant NSCLC, TKIs may effectively control LMD, creating a lag between onset of symptoms and observation of radiographic findings

Clinical performance of seven prescreening tools for osteoporosis in Iranian postmenopausal women

This study was designed to evaluate seven prescreening osteoporosis models in postmenopausal Iranian women. This study was performed on 8644 postmenopausal women who have been referred for bone mineral densitometry (BMD) in BMD center of Shariati hospital in Tehran between 2001 and 2011. Diagnostic properties of seven prescreening instruments were evaluated. With regard to area under curve (AUC), these models have low accuracy (AUC a parts per thousand currency sign 0.65). Considering only femoral neck or total femur area, these models had low accuracy but were more sensitive. Except for three models with sensitivities of a parts per thousand currency sign65 % in both osteoporosis and fracture threshold, other models were around 70 % sensitive. However, these models were not considered clinically useful regarding their positive predictive values (PPV) especially in BMDs a parts per thousand currency sign02.5. With regard to different measures of diagnostic property, none of these models were good screening tools for osteoporosis or fracture threshold. Although some of them are sensitive, considering other measures such as PPV indicates that they are not completely useful for clinical use. Attempts should be made for developing newer prescreening methods and calibration of the existing models with regard to the studied population

Nervous system involvement in clinical peripheral inflammation: A description of three pediatric cases

Latest research data have emphasized the interaction between the nervous and the immune systems. In this regard, it has been demonstrated that the disruption of the blood–brain barrier (BBB) secondary to peripheral inflammation may play a key role in this relationship. This assumption is linked to recent findings according to which units that constitute the BBB are not only simply neurologic but have also been reconsidered as “neurovascular” elements, through which immune system molecules are vehiculated within the central nervous system (CNS). Herein, we report two cases of food allergy (FA) and one case of infective gastroenteritis, associated with a spectrum of neurologic disorders involving both the CNS and the peripheral nervous system (PNS), postulating some etiopathogenic hypotheses to explain the link between peripheral inflammation and diseases of the nervous system (NS). Three pediatric cases of secondary NS involvement after gastrointestinal (GI) inflammation of different nature have been reported. The first case highlights the link between FA and CNS; the second one is based on a description of a link between GI infection and CNS involvement while the third one describes the relationship between FA and PNS. The importance of these reports relies on the clinical demonstration of a link between the immune system and the NS. The relationship between immune system and NS seems to have pleiotropic aspects, involving different areas of the NS, such as CNS and PNS, which also seem to be in some way interconnected