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Anesthesiology Research and Practice 2024Traumatic brain injury (TBI) is a disruption to normal brain functions caused by traumas such as collisions, blows, or penetrating injuries. There are factors affecting...
The Use of Corticosteroid Randomisation after Significant Head Injury (CRASH) Prognostic Model as Mortality Predictor of Traumatic Brain Injury Patients Underwent Surgery in Low-Middle Income Countries.
BACKGROUND
Traumatic brain injury (TBI) is a disruption to normal brain functions caused by traumas such as collisions, blows, or penetrating injuries. There are factors affecting patient outcomes that also have a predictive value. Limited data from low-middle income countries showed a high number of poor outcomes in TBI patients. The corticosteroid randomisation after significant head injury (CRASH) prognostic model is a predictive model that uses such factors and is often used in developed countries. The model has an excellent discriminative ability. However, there is still a lack of studies on its use in surgical patients in low-middle income countries. This study aimed to evaluate the CRASH model's validity to predict 14-day mortality of TBI patients who underwent surgery in low-middle income countries.
METHODS
This retrospective analytical observational study employed total sampling including all TBI patients who underwent surgery with general anesthesia from January to December 2022. Statistical analysis was performed by applying Mann-Whitney and Fisher exact tests, while the model's discriminative ability was determined through the area under the curve (AUC) calculations.
RESULTS
112 TBI patients were admitted during the study period, and 74 patients were included. Independent statistical analysis showed that 14-day mortality risk, age, Glasgow Coma Scale score, TBI severity, pupillary response, and major extracranial trauma had a significant individual correlation with patients' actual mortality outcome ( < 0.05). The AUC analysis revealed an excellent mortality prediction (AUC 0.838; CI 95%).
CONCLUSION
The CRASH prognostic model performs well in predicting the 14-day mortality of TBI patients who underwent surgery in low-middle income countries.
PubMed: 38948334
DOI: 10.1155/2024/5241605 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... May 2024To investigate the effects of intraoperative intravenous administration of dexmedetomidine (DEX) on the recovery quality of donors undergoing pure laparoscopic donor... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the effects of intraoperative intravenous administration of dexmedetomidine (DEX) on the recovery quality of donors undergoing pure laparoscopic donor hepatectomy.
METHODS
A total of 56 liver donors who were going to undergo scheduled pure laparoscopic donor hepatectomy were enrolled and randomly assigned to two groups, a DEX group ( =28) and a control group ( =28). Donors in the DEX group received DEX infusion at a dose of 1 μg/kg over 15 minutes through a continuous pump, which was followed by DEX at 0.4 μg/(kg·h) until the disconnection of the portal branch. Donors in the control group were given an equal volume of 0.9% normal saline at the same infusion rate and over the same period of time as those of the dex infusion in the DEX group. The primary outcome was the incidence of emergence agitation (EA). The Aono's Four-point Scale (AFPS) score was used to assess EA. The secondary observation indicators included intraoperative anesthesia and surgery conditions, spontaneous respiration recovery time, recovery time, extubation time, scores for the Ramsay Sedation Scale, the incidence of chills, numeric rating scale (NRS) score for pain, and blood pressure and heart rate after extubation.
RESULTS
The incidence of EA was 10.7% and 39.3% in the DEX group and the control group, respectively, and the incidence of EA was significantly lower in the DEX group than that in the control group ( =0.014). The APFS scores after extubation in the DEX group were lower than those in the control group (1 [1, 1] vs. 2 [1, 3], =0.005). Compared to the control group, the dosages of intraoperative propofol and remifentanil were significantly reduced in the DEX group ( <0.05). During the recovery period, the number of donors requiring additional boluses of analgesia, the blood pressure, and the heart rate were all lower in the DEX group than those in the control group ( <0.05). No significant differences between the two groups were observed in the spontaneous respiration recovery time, recovery time, extubation time, the incidence of chills, NRS score, scores for the Ramsay Sedation Scale, and the length-of-stay in postanesthesia care unit (PACU) ( >0.05).
CONCLUSION
DEX can reduce the incidence of EA after pure laparoscopic donor hepatectomy and improve the quality of recovery without prolonging postoperative recovery time or extubation time.
Topics: Dexmedetomidine; Humans; Hepatectomy; Laparoscopy; Male; Female; Adult; Living Donors; Liver Transplantation; Hypnotics and Sedatives; Anesthesia Recovery Period
PubMed: 38948292
DOI: 10.12182/20240560603 -
Imaging Science in Dentistry Jun 2024Ameloblastic fibrodentinoma (AFD) is a rare benign odontogenic tumor that resembles an ameloblastic fibroma with dysplastic dentin. This report presents a rare case of...
Ameloblastic fibrodentinoma (AFD) is a rare benign odontogenic tumor that resembles an ameloblastic fibroma with dysplastic dentin. This report presents a rare case of mandibular AFD with imaging features in a young patient. Panoramic radiography and computed tomography revealed a well-defined lesion with internal septa and calcified foci, causing inferior displacement of the adjacent molars as well as buccolingual cortical thinning and expansion of the posterior mandible. The lesion was surgically removed via mass excision, and the involved tooth was extracted under general anesthesia. During the 5-year follow-up period, no evidence of recurrence was observed. Radiologic features of AFD typically reveal a moderately to well-defined mixed lesion with varying degrees of radiopacity, reflecting the extent of dentin formation. Radiologists should consider AFD in the differential diagnosis when encountering a multilocular lesion with little dense radiopacity, particularly if it is associated with delayed eruption, impaction, or absence of involved teeth, on radiographic images of young patients.
PubMed: 38948190
DOI: 10.5624/isd.20230247 -
Avicenna Journal of Phytomedicine 2024Increased body mass index (BMI) seems to be a risk factor for migraine attacks. Cinnamon has anti-inflammatory, neuroprotective, and anti-obesity effects. This study...
OBJECTIVE
Increased body mass index (BMI) seems to be a risk factor for migraine attacks. Cinnamon has anti-inflammatory, neuroprotective, and anti-obesity effects. This study aimed to assess the effects of cinnamon on anthropometric indices and headache-related disability of patients with migraine.
MATERIALS AND METHODS
This study was conducted as a randomized, double-blind, placebo-controlled trial involving 50 migraine patients. Patients were randomized to receive either 600 mg cinnamon powder or placebo capsules for two months. Height, body weight (BW), waist circumference (WC), and hip circumference (HC) were measured.Furthermore, Minimal or Infrequent Disability (MIDAS) and Headache Daily Result (HDR) Questionnaires were recorded.
RESULTS
At the end of the treatment period, BW and BMI did not change in the intervention group; however, both factors were significantly increased in the placebo group (p=0.001). The change of WC, HDR and MIDAS was significantly different between the intervention and placebo groups (p<0.001). Furthermore, HC and WHR significantly decreased (p=0.001).
CONCLUSION
Cinnamon seems to have beneficial effects on anthropometric indices and headache disability of migraine patients.
PubMed: 38948170
DOI: 10.22038/AJP.2023.22874 -
Trauma Case Reports Aug 2024A 6-year-old male child was admitted to the hospital because of abdominal trauma and acute stomach pain. Computed tomography scan revealed a jejunal mesenteric hematoma...
A 6-year-old male child was admitted to the hospital because of abdominal trauma and acute stomach pain. Computed tomography scan revealed a jejunal mesenteric hematoma and an enhanced intestinal wall compressed by the hematoma. The patient presented with vomiting 10 days after the injury. He underwent upper endoscopy under tracheal intubation and general anesthesia 12 days after the injury. A double elementary diet tube was inserted endoscopically with the tip placed in the jejunum beyond the stenosis and the decompressed portion of the stomach. Stenosis was improving, and the patient was discharged on the 27th day after the injury. In conclusion, a double elementary diet tube can be effective for treating posttraumatic duodenal stenosis in pediatric patients.
PubMed: 38948103
DOI: 10.1016/j.tcr.2024.101060 -
Journal of Surgical Case Reports Jun 2024We report a rare case of a pedunculated calcified amorphous tumor (CAT) of the left ventricle attached by a stalk to the membranous septum in a 74-year-old woman who...
We report a rare case of a pedunculated calcified amorphous tumor (CAT) of the left ventricle attached by a stalk to the membranous septum in a 74-year-old woman who presented with a cerebrovascular accident. We believe this is the first report of a CAT attached to the membranous septum.
PubMed: 38947868
DOI: 10.1093/jscr/rjae430 -
Cureus May 2024Kyphoscoliosis is a well-known spinal deformity. The abnormal curvature in both the coronal and sagittal planes presents unique challenges during pregnancy. This...
Kyphoscoliosis is a well-known spinal deformity. The abnormal curvature in both the coronal and sagittal planes presents unique challenges during pregnancy. This case discusses the management of a 27-year-old primigravida with thoracolumbar kyphoscoliosis, who underwent an emergency cesarean section at 39.3 weeks of gestation. An interdisciplinary team consisting of an obstetrician, pulmonologist, orthopedic surgeon, anesthesiologist, and physiotherapist collaborated in her care. In such cases, successful outcomes require a tailored approach that prioritizes maternal-fetal well-being and minimizes potential complications associated with complex spinal deformity during pregnancy and childbirth.
PubMed: 38947712
DOI: 10.7759/cureus.61269 -
Cureus May 2024Osteoid osteoma (OO) is a common benign ossifying lesion that is most prevalent among youth. Usually, it attacks the diaphyseal or metaphyseal bones that are tubular....
Osteoid osteoma (OO) is a common benign ossifying lesion that is most prevalent among youth. Usually, it attacks the diaphyseal or metaphyseal bones that are tubular. The common hallmark of muscle pain is the reported occurrence of night pain that is nearly always present, yields satisfactory responses from nonsteroidal anti-inflammatory medications, and may be joined by complaints regarding physical activities. Also, it shows typical signs of study procedures like computed tomography (CT) and magnetic resonance imaging (MRI). A nidus, which is the primary marker in the diagnostic formation of shadowed images, is a crucial sign of an OO. This source is usually portrayed as an oval lytic lesion, measuring 1 cm flat and surrounded by a region of reactive ossification. It is laborious to diagnose OO since the condition is frequently confused with many other ones, and testing and therapy may be delayed and complicated as a result. There are still few studies on OO diagnosis and distinguishing of surrogate conditions. Unfortunately, either ablation or resection can be said to be the cure. Improved detection of OO shows the possibility for prompt diagnosis, fewer patient discomfort and side effects, less cost involved in unnecessary treatments, and a rightly diagnosed condition.
PubMed: 38947687
DOI: 10.7759/cureus.61332 -
Cureus May 2024In an earlier study of patients after cesarean delivery, the concurrent versus alternating administration of acetaminophen and non-steroidal anti-inflammatory drugs was...
Lateness of Acetaminophen and Non-steroidal Anti-inflammatory Drug Administrations in a Retrospective Cohort of Medication Administration Records Among Patients After Cesarean Delivery.
INTRODUCTION
In an earlier study of patients after cesarean delivery, the concurrent versus alternating administration of acetaminophen and non-steroidal anti-inflammatory drugs was associated with a substantial reduction in total postoperative opioid use. This likely pharmacodynamic effect may differ if the times when nurses administer acetaminophen and non-steroidal anti-inflammatory drugs often differ substantively from when they are due. We examined the "lateness" of analgesic dose administration times, the positive difference if administered late, and the negative value if early.
METHODS
The retrospective cohort study used all 67,900 medication administration records for scheduled (i.e., not "as needed") acetaminophen, ibuprofen, and ketorolac among all 3,163 cesarean delivery cases at the University of Iowa between January 2021 and December 2023. Barcode scanning at the patient's bedside was used right before each medication administration.
RESULTS
There were 95% of doses administered over a 4.8-hour window, from 108 minutes early (97.5% one-sided upper confidence limit 105 minutes early) to 181 minutes late (97.5% one-sided lower limit 179 minutes late). Fewer than half of doses (46%, P <0.0001) were administered ±30 minutes of the due time. The intraclass correlation coefficient was approximately 0.11, showing that there were small systematic differences among patients. There likewise were small to no systematic differences in lateness based on concurrent administrations of acetaminophen and ibuprofen or ketorolac, time of the day that medications were due, weekday, year, or number of medications to be administered among all such patients within 15 minutes.
DISCUSSION
Other hospitals should check the lateness of medication administration when that would change their ability to perform or apply the results of analgesic clinical trials (e.g., simultaneous versus alternating administration).
PubMed: 38947679
DOI: 10.7759/cureus.61433 -
Cureus May 2024Fat embolism syndrome is a common occurrence after orthopedic trauma and surgery. Cerebral fat embolism (CFE) may arise after fat globules enter the arterial...
Fat embolism syndrome is a common occurrence after orthopedic trauma and surgery. Cerebral fat embolism (CFE) may arise after fat globules enter the arterial circulation. The neurological manifestations of CFE vary and generally carries a favorable outcome. A small number of reports exist regarding patients with CFE who experienced severe neurological deficits and significant edema on radiographic studies, and subsequently underwent decompressive hemicraniectomy (DHC), some of which had full neurological recoveries. Here, we present the case of a 21-year-old male who presented after a motorcycle accident with multiple orthopedic injuries, who after fixation did not awake from anesthesia. The patient was ultimately found to have cerebral fat emboli, and developed significant edema and swelling. The patient underwent DHC with subsequent cranioplasty and returned to his neurological baseline seven months after his initial injury. DHC for CFE has been described in a few cases with some patients have had substantive recoveries, including the present case. This case emphasizes the importance of promptly recognizing and reversing elevated intracranial pressures and the possibility of promising recoveries.
PubMed: 38947672
DOI: 10.7759/cureus.61338