Hirayama disease : neutral and flexion magnetic resonance imaging and utility of inter-segmental angle of flexion

Purpose: Hirayama disease (HD) is a rare disease that was commonly mis-diagnosed in the past. The importance of neutral and flexion magnetic resonance imaging (MRI) in its accurate diagnosis has been emphasized along with utility of the inter-segmental angle of flexion. Aim of the study was to observe MRI findings of HD in neutral and flexion position and measure the inter-segmental angle of flexion. Material and methods: Cervical MR images of 17 patients of suspected HD were evaluated retrospectively for loss of attachment (LOA) of posterior dura, lower cervical cord atrophy, T2 hyperintensity, loss of cervical lordosis, enhancement of posterior epidural venous plexus, and inter-segmental angle of flexion on neutral and flexion MRIs. Results: Flexion MRI showed LOA of posterior dura (most commonly and maximum at C6 vertebral level) and intense enhancement in posterior epidural space in almost all patients. The mean inter-segmental angle of flexion at C5-C6 was 9.2°, and at C6-C7 it was 6°. Neutral MRI revealed LOA in 64.7%, lower cervical cord atrophy in all patients, T2 hyperintensity in the lower cervical cord in 35.2% of patients, and loss of cervical lordosis in 58.8% of patients. Conclusions: Flexion MRI is the gold standard for diagnosis of HD; however, certain imaging attributes, i.e. loss of attachment of posterior dura, asymmetrical lower cervical cord atrophy, T2 hyperintensity, and loss of cervical lordosis, can be seen on neutral MRI as well, which subsequently prompts the radiologist to include flexion MRI for confirmation. The inter-segmental angle of flexion is increased in patients with HD, which plays a role in planning timely surgical intervention

Complete situs inversus: A variation in left-right asymmetry during embryogenesis

Complete situs inversus is a very rare anomaly featured with the total inversion of all abdominal and thoracic organs. During the normal embryonic development laterality (left-right-sidedness) is featured by a cascade of signal molecules and genes. Any disturbance in the establishment of normal anatomical left- right asymmetry during this period results in left-right axis malformations which may express as complete situs inversus, incomplete situs inversus or situs ambiguous. A cadaver was detected with complete situs inversus during the routine dissection in the Anatomy Department of G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India. The anomaly is very rare and may not be diagnosed until later in life when people seek medical attention because of unrelated medical problem and undergo radiographic investigation. The cadaver was carefully dissected. The literature was reviewed concerning the underlying cause of the anomaly during the embryonic period and the clinical implications of the condition. Special emphasis was given to the genetic cause of the condition. A literature search was performed in Pubmed, Scopus, Web of Science and Google Scholar databases, including studies published up to March 2016, with no lower data limit

Energy Use Patterns of Pearl Millet (<i>Pennisetumglaucum</i> (L.)) Production in Haryana, India

Pearl millet (Pennisetumglaucum (L.)) is the fifth most important cereal crop in the world after rice, wheat, maize and sorghum. A resolution adopted by the UN General Assembly on 3 March 2021 decided to declare 2023 as the International Year of Millets. Millet has been promoted due to its nutritional value and low irrigation requirement. In this study, pearl millet was selected for energy auditing, and its production amount is a direct function of energy input. The production of pearl millet needs to be augmented to fulfill an increasing demand. Pearl millet is produced using various sources of energy. This study was conducted to examine the energy use pattern of different categories of farmers, such as small, medium and large, for pearl millet production in Hisar district, Haryana, India. The energy was distributed in different operations, including preparatory tillage, sowing, interculture, fertilizer, irrigation, pesticide, harvesting, threshing and transportation. The source-wise energy (direct and indirect) and operation-wise energy consumption were calculated for all categories of farmers. The average energy input of small, medium and large farmers was 2849.09 MJ.ha−1, 3027.21 MJ.ha−1 and 4021.50 MJ.ha−1, respectively. The highest energy was consumed in fertilizer application (52%), with the lowest in seed (2%). The energy ratios of small, medium and large farmers were 3.92, 9.40 and 13.80, respectively. This study could improve the agricultural production systems of pearl millet regarding the energy values of the inputs and outputs

Morphometric and Topographic Study of Foramen Ovale in Indian Skulls

Foramen ovale is an important foramen for neurosurgeons and used for percutaneous trigeminal rhizotomy in trigeminal neuralgia. The present study was undertaken to study anatomic variations in appearance, dimensions of foramen ovale and its location in relation to the zygomatic arch. The study was conducted on 50 dry human skulls of known sex, available in the museum of Anatomy Dept. in G.S.V.M. Medical College, Kanpur.&nbsp; The shape of foramen ovale and presence of any accessory bony structure like spur, spine, tubercle or bony plate were observed on both sides. The length and width of foramen ovale and its distance from articular tubercle and the anterior root of&nbsp; Zygomatic Arch was&nbsp; measured on both sides.&nbsp; The metric data was statistically analysed for bilateral symmetry and sexual dimorphism. The shape of foramen ovale was typically oval in most of the skulls (66%). In 40% sides any accessory bony structure was not seen while bony plate in 45% sides, spine in 6% and bridge like bony septa dividing the foramen into two compartments in 2% was observed. The mean length and width of foramen ovale in male skulls was 7.50+/-0.90 mm and 4.20+/-0.70 mm and 7.7+/-1.00 mm and 3.9+/-0.80 mm in the female skulls.&nbsp; The mean distance of foramen ovale from articular tubercle on Zygomatic arch was 32.8 +/- 2.8 mm in males and 31.1 +/- 2.4 mm in females. The mean distance from anterior root of Zygomatic arch was 21.4 +/- 1.9 mm in males and 21.6 +/- 1.7 mm in females. There was no significant difference in measurements of various metric parameters between right and left sides of foramen ovale (p&gt;0.05) but highly significant difference was observed between male and female dimensions of all metric parameters.(p&lt;0.001). Thus the foramen ovale does not exhibit bilateral symmetry but the sexual dimorphism is evident. The data is helpful for surgical practices. &nbsp

Challenges faced in the management of complicated Boerhaave syndrome: a tertiary care center experience

Spontaneous esophageal perforation is rare and is associated with high morbidity and mortality. A spectrum of various surgical modalities ranging from primary surgical repair to esophagectomy is available for its management. The optimal management of patients presenting late in a hemodynamically stable condition is not clearly defined in the literature. A retrospective review of all patients with Boerhaave syndrome managed by a single surgical team in a tertiary care center between 2008 and 2019 was performed (n = 16). Eleven patients were initially managed in the medical intensive care unit (MICU) as non-esophageal cause and 5 patients were referred after failed management (conservative/endoscopic). Demographics, clinical presentation, characteristics of perforation, initial diagnosis, and treatment were analyzed. All patients were males with a mean age of 42.2 years. A history of ethanol use was present in 6 patients. The median delay in diagnosis and referral was 16 days (range: 11-40 days). The common presenting symptoms were chest pain (n=11), dyspnoea (n=10), vomiting (n=4) and cough (n=2). The perforation was directed into right, left, and bilateral pleural cavities in 6, 8, and 2 patients respectively. The location of perforation was distal esophagus except for one patient. One patient was successfully treated with conservative management. The remaining patients underwent esophagectomy as a definitive surgical procedure. There was no significant postoperative morbidity and mortality. Esophagectomy can be done as a one-stage definitive procedure for patients with Boerhaave syndrome who present late in a hemodynamically stable condition with acceptable morbidity and good long term outcome

Value of a confidential COVID-19 helpline for nursing home staff.

We hosted a confidential helpline to address concerns about COVID-19 prevention among staff in 12 nursing homes in Orange County, California. We fielded 301 inquiries from April 2021-April 2022, most commonly involving questions about vaccines (40%), nursing home COVID-19 prevention (28%), SARS-CoV-2 variants (18%), symptom reporting (10%), and home and community COVID-19 prevention (5%). During COVID-19 surges, staff dominantly expressed fear, anger, and exhaustion. During nadirs, sentiment shifted towards optimism and acceptance

Emergency Carotid Endarterectomy Instead of Carotid Artery Stenting Reduces Delayed Hemorrhage in Thrombectomy Stroke Patients

Purpose!#!Data in the literature suggest that thrombectomy with emergency carotid artery stenting (CAS) in acute stroke is associated with an increased hemorrhage rate. As we perform thrombectomy with the patient under general anesthesia, we avoid emergency CAS and perform emergency carotid endarterectomy (CEA) as an alternative to CAS in the same anesthesia session in our angiography suite whenever needed and possible.!##!Methods!#!We compared 27 thrombectomy patients with emergency CEA and 62 thrombectomy patients with emergency CAS and glycoprotein (Gp) IIb/IIIa inhibitors and/or dual antiplatelet therapy (DAPT) in the same time span.!##!Results!#!The symptomatic hemorrhage rate was 0% (0/27) in the CEA group and 8% (5/62) in the CAS group (p = 0.317). The parenchymal hemorrhage rate (PH2) was 7% (2/27) in the CEA group and 16% (10/62) in the CAS group (p = 0.333). Both cases of PH2 in the CEA group occurred during the intervention and were diagnosed on immediate postinterventional imaging, whereas in the CAS group only 2/10 cases of PH2 occurred during the intervention and the remaining 8 PH2 occurred within 3 days after the intervention (p = 0.048). Clinical outcome at 90 days was comparable with 39% of CEA and 51% of CAS patients achieving good clinical outcome (modified Rankin scale, mRS 0-2, p = 0.452).!##!Conclusion!#!The use of CEA is a feasible alternative to CAS in acute stroke and has the advantage that DAPT/GpIIb/IIIa inhibitors are not needed. All PH2 in CEA patients occurred during the intervention, implying that hemorrhage in this group is likely to be caused by reperfusion injury, whereas delayed hemorrhage is likely to be caused by DAPT/GpIIb/IIIa inhibitors

390. Can Testing the Environment for SARS-CoV-2 Be a Signal for Staff Infections in Nursing Homes (NHs)?

Abstract Background Federal mandate requires NHs to perform weekly COVID-19 testing of staff. Testing is effective due to barriers to disclosing mild illness, but it is unclear how long the mandate will last. We explored if environmental samples can be used to signal staff COVID-19 cases as an alternative screening tool in NHs. Methods We conducted a cross sectional study to assess the value of environmental sampling as a trigger for COVID-19 testing of NH staff using data from currently performed weekly staff sweeps. We performed 35 sampling sweeps across 21 NHs from 6/2020-2/2021. For each sweep, we sampled up to 24 high touch objects in NH breakrooms (N=226), entryways (N=216), and nursing stations (N=194) assuming that positive samples were due to contamination from infected staff. Total staff and positive staff counts were tallied for the staff testing sweeps performed the week of and week prior to environmental sampling. Object samples were processed for SARS-CoV-2 using PCR (StepOnePlus) with a 1 copy/mL limit of detection. We evaluated concordance between object and staff positivity using Cohen’s kappa and calculated the positive and negative predictive value (PPV, NPV) of environmental sweeps for staff positivity, including the attributable capture of positive staff. We tested the association between the proportion of staff positivity and object contamination by room type in a linear regression model when clustering by NH. Results Among 35 environmental sweeps, 49% had SARS-CoV-2 positive objects and 69% had positive staff in the same or prior week. Mean positivity was 16% (range 0-83%) among objects and 4% (range 0-22%) among staff. Overall, NPV was 61% and Cohen’s kappa was 0.60. PPV of object sampling as an indicator of positive staff was 100% for every room type, with an attributable capture of positive staff of 76%, with values varying by room type (Table). Breakroom samples were the strongest indicator of any staff cases. Each percent increase in object positivity was associated with an increase in staff positivity in entryways (7.2% increased staff positivity, P=0.01) and nursing stations (5.7% increased staff positivity, P=0.05). Conclusion If mandatory weekly staff testing ends in NHs, environmental sampling may serve as an effective tool to trigger targeted COVID-19 testing sweeps of NH staff. Disclosures Gabrielle Gussin, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Raveena Singh, MA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Raheeb Saavedra, AS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic products) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products

Emergence of carbapenem-resistant Enterobacteriaceae in Orange County, California, and support for early regional strategies to limit spread.

BackgroundThe east-to-west spread of carbapenem-resistant Enterobacteriaceae (CRE) represents an opportunity to explore strategies to limit spread in nonendemic areas. We evaluated CRE emergence and regional support for containment strategies.MethodsA 17-question cross-sectional survey was administered to infection prevention programs in Orange County, CA (31 hospitals serving 3 million residents), between January and September 2014. Questions addressed newly detected hospital- and community-onset CRE cultures (2008-2013), current CRE control strategies, and support for prevention strategies for a hypothetical regional intervention.ResultsAmong 31 hospitals, 21 (68%, representing 17 infection prevention programs) completed the survey. CRE was scarcely detected between 2009-2010; within 4 years, 90% of hospitals reported CRE, with 2.5-fold higher community-onset than hospital-onset CRE. Between 2011 and 2013, annual CRE incidence increased 4.7-fold (1.4-6.3 cases/10,000 admissions). Support for a regional CRE prevention bundle was unanimous. Although 22% bathed patients positive for CRE with chlorhexidine gluconate and 11% actively screened for CRE, 86% and 57%, respectively, would consider these strategies in a regional intervention.ConclusionsCRE epidemiology in Orange County parallels early progression previously seen in now-endemic areas, representing an opportunity to consider interventions to prevent endemic spread. Many facilities would consider proactive strategies, such as chlorhexidine bathing, in the setting of a regional collaborative