Crisis Standard of Care: Management of Infantile Spasms during COVID‐19

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156180/2/ana25792_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156180/1/ana25792.pd

THE ROLE OF AUTOLOGOUS HAMSTRING GRAFT IN IMPROVING FUNCTIONAL OUTCOME AFTER ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: PROSPECTIVE STUDY AT GGH KURNOOL

ABSTRACT:   Objectives: The prevalence of knee ligament injuries is on the rise due to increasing engagement in sports activities. Among the various ligaments present in the knee joint, the anterior cruciate ligament (ACL) is the most commonly injured. Several procedures have been described for the reconstruction of a torn ACL, ranging from open to arthroscopic techniques. In this particular study, we utilized an autograft from the hamstring muscle for ACL reconstruction. The graft was secured with an endo button on the femoral end and an interference screw at the tibial end. If necessary, cancellous screws or a suture wheel were used as well. Methods:  This is a 2-year prospective study conducted between April 2021 and March 2023 at GGH Kurnool, which included 20 cases of complete anterior cruciate ligament (ACL) tear. All patients underwent arthroscopic ACL reconstruction using a hamstring graft. Following the procedure, all patients were assessed using the Lysholm knee scoring questionnaire and were monitored at specific intervals, including 3 months, 6 months, and 1 year, to evaluate their progress. Results:  After 1 year, the Lysholm knee scoring questionnaire was used to evaluate the results of the ACL reconstruction with the hamstring graft. The findings revealed that 30%(6 cases) of the cases reported excellent results, 50%(10 cases) of the cases showed good results, 15%(3 cases) of the cases showed fair results, and 5%(1 case) of the cases obtained poor results. Additionally, 80% of patients achieved functional restoration to their pre-injury level. At 1 year follow-up, our study found that the average preoperative Lysholm score was 63.24, while the average postoperative score was 91.98, which showed a statistically significant improvement in the postoperative Lysholm score compared to the preoperative score (p<0.05). Conclusions: In conclusion, our study suggests that the use of a hamstring graft for the reconstruction of a torn ACL can result in excellent to good outcomes. However, it should be noted that proper patient selection and physiotherapy play a significant role in achieving favorable results

IMPROVING FUNCTION IN KNEE OSTEOARTHRITIS WITH PLATELET-RICH PLASMA THERAPY: A FUNCTIONAL OUTCOME EVALUATION

Objective: Osteoarthritis is a chronic and degenerative disease that commonly affects the knee joint. The effectiveness of using PRP injections in the knee joint for managing osteoarthritis symptoms, which include pain, disability, deformity, and reduced quality of life, is being studied. Methods: This is a two-year prospective study conducted between January 2019 and December 2020 at the Government General Hospital in Kurnool. The study focused on the management of osteoarthritis knee in 60 patients who received 3 ml autologous intra-articular platelet-rich plasma injections, with their pain, joint stiffness, and joint mobility being evaluated using the WOMAC score. The majority of participants were middle-aged women with grade KL 2 and 3 osteoarthritis knee. Results: The study included 60 cases with KL grade II (28 cases) and grade III (32 cases) of knee osteoarthritis. The pretreatment WOMAC score for KL grade II was 56.11±6.36, which showed significant improvement to 50.76±7.6 (p=0.000) at 2 w, 50.76±7.6 (p=0.001) at one month, 26.97±3.47 (p=0.001) at 3 mo, and 22.11±2.99 (p=0.001) at 6-month follow-up. Similarly, for KL grade III, the pretreatment WOMAC score was 59.21±5.63, which improved significantly to55.76±7.6 (p=0.000) at 2 w, 48.79±5.42 (p=0.001) at one month, 36.46±4.36 (p=0.001) at 3 mo, and 32.12±2.66 (p=0.001) at 6-month follow-up. Conclusion: PRP injection is a safe and cost-effective alternative for treating knee osteoarthritis, leading to pain relief and an enhanced quality of life, especially in the initial stages. Not only does PRP provide immediate relief, but it also results in gradual improvements over time. Overall, PRP is a viable option for individuals seeking alternative treatments for knee osteoarthritis

Virtual reality-based 3-dimensional localization of stereotactic EEG (SEEG) depth electrodes and related brain anatomy in pediatric epilepsy surgery

INTRODUCTION: The increasing use of stereoelectroencephalography (SEEG) in the USA and the need for three-dimensional (3D) appreciation of complex spatial relationships between implanted stereotactic EEG depth electrodes and surrounding brain and cerebral vasculature are a challenge to clinicians who are used to two-dimensional (2D) appreciation of cortical anatomy having been traditionally trained on 2D radiologic imaging. Virtual reality and its 3D renderings have grown increasingly common in the multifaceted practice of neurosurgery. However, there exists a paucity in the literature regarding this emerging technology in its utilization of epilepsy surgery. METHODS: An IRB-approved, single-center retrospective study identifying all SEEG pediatric patients in which virtual reality was applied was observed. RESULTS: Of the 46 patients identified who underwent an SEEG procedure, 43.5% (20/46) had a 3D rendering (3DR) of their SEEG depth electrodes. All 3DRs were used during patient-family education and discussion among the Epilepsy multidisciplinary team meetings, while 35% (7/20) were used during neuronavigation in surgery. Three successful representative cases of its application were presented. DISCUSSION: Our institution\u27s experience regarding virtual reality in the 3D representation of SEEG depth electrodes and the application to pre-surgical planning, patient-family education, multidisciplinary communication, and intraoperative neuronavigation demonstrate its applicability in comprehensive epilepsy patient care

Focal to bilateral tonic-clonic seizures predict pharmacoresistance in focal cortical dysplasia-related epilepsy

OBJECTIVE: Focal cortical dysplasia (FCD) is the most common etiology of surgically-remediable epilepsy in children. Eighty-seven percent of patients with FCD develop epilepsy (75% is pharmacoresistant epilepsy [PRE]). Focal to bilateral tonic-clonic (FTBTC) seizures are associated with worse surgical outcomes. We hypothesized that children with FCD-related epilepsy with FTBTC seizures are more likely to develop PRE due to lesion interaction with restricted cortical neural networks. METHODS: Patients were selected retrospectively from radiology and surgical databases from Children\u27s National Hospital. INCLUSION CRITERIA: 3T magnetic resonance imaging (MRI)-confirmed FCD from January 2011 to January 2020; ages 0 days to 22 years at MRI; and 18 months of documented follow-up. FCD dominant network (Yeo 7-network parcellation) was determined. Association of FTBTC seizures with epilepsy severity, surgical outcome, and dominant network was tested. Binomial regression was used to evaluate predictors (FTBTC seizures, age at seizure onset, pathology, hemisphere, lobe) of pharmacoresistance and Engel outcome. Regression was used to evaluate predictors (age at seizure onset, pathology, lobe, percentage default mode network [DMN] overlap) of FTBTC seizures. RESULTS: One hundred seventeen patients had a median age at seizure onset of 3.00 years (interquartile range [IQR] .42-5.59 years). Eighty-three patients had PRE (71%); 34 had pharmacosensitive epilepsy (PSE) (29%). Twenty patients (17%) had FTBTC seizures. Seventy-three patients underwent epilepsy surgery. Multivariate regression showed that FTBTC seizures are associated with an increased risk of PRE (odds ratio [OR] 6.41, 95% confidence interval [CI] 1.21-33.98, p = .02). FCD hemisphere/lobe was not associated with PRE. Percentage DMN overlap predicts FTBTC seizures. Seventy-two percent (n = 52) overall and 53% (n = 9) of patients with FTBTC seizures achieved Engel class I outcome. SIGNIFICANCE: In a heterogeneous population of surgical and non-operated patients with FCD-related epilepsy, the presence of FTBTC seizures is associated with a tremendous risk of PRE. This finding is a recognizable marker to help neurologists identify those children with FCD-related epilepsy at high risk of PRE and can flag patients for earlier consideration of potentially curative surgery. The FCD-dominant network also contributes to FTBTC seizure clinical expression

Inequities in Therapy for Infantile Spasms: A Call to Action

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172939/1/ana26363_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172939/2/ana26363.pd

Predictive value of early EEG for seizures in neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia.

OBJECTIVES: To assess the prognostic significance of an early normal/mildly abnormal conventional EEG (cEEG) on seizure risk in neonates undergoing therapeutic hypothermia. METHODS: We reviewed the video-EEG recordings from a large cohort of neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy from 2008 to 2017 in a single tertiary center. Continuous video-EEG was started as soon as possible (median 8.2 h) and continued throughout hypothermia and rewarming. We studied those neonates with a normal/mildly abnormal EEG during the first 24 h of monitoring. RESULTS: A total of 331 neonates were treated with hypothermia and 323 had cEEG recordings available for review; 99 were excluded because of a moderately/severely abnormal cEEG background and/or seizure during the first 24 h of recording, and an additional eight because of early rewarming. The remaining 216 had a normal/mildly abnormal cEEG in the first 24 h. None of these patients subsequently developed seizures. CONCLUSION: A normal/mildly abnormal cEEG during the first 24 h indicates a very low risk of subsequent seizures. This suggests that cEEG monitoring can be safely discontinued after 24 h if it has remained normal or excessively discontinuous and no seizures are detected, limiting the need for this resource-intensive and expensive tool

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update (vol 13, pg 353, 2019)

10.1007/s12072-019-09980-1HEPATOLOGY INTERNATIONAL136826-82