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Journal of Veterinary Internal Medicine 2024Iatrogenic blood contamination during cerebrospinal fluid (CSF) centesis is common, which can limit the diagnostic usefulness of the sample. A novel ultrasound-guided...
BACKGROUND
Iatrogenic blood contamination during cerebrospinal fluid (CSF) centesis is common, which can limit the diagnostic usefulness of the sample. A novel ultrasound-guided CSF collection technique is described in horses, by which CSF is obtained from the atlantoaxial (AA) space.
HYPOTHESIS/OBJECTIVES
To compare ultrasound-guided AA centesis with lumbosacral (LS) centesis in South American camelids (SAC). The hypotheses were that AA centesis would yield samples with less blood contamination although being technically more challenging than LS centesis.
ANIMALS
Eight clinically healthy adult SAC from a university-owned teaching herd.
METHODS
Single-blinded, randomized, 4-way, 4-period crossover study in which 2 veterinarians each performed both centesis techniques on each animal once. Cytological sample analysis was performed, and the technical difficulty of sample acquisition was assessed.
RESULTS
The CSF was collected successfully and without complications by either technique during all collection attempts. Aspects of technical difficulty and concentrations of CSF analytes did not vary significantly between techniques. Median total nucleated cell and red blood cell counts were 1/μL and 0.5/μL and 167.5/μL and 155/μL for AA and LS techniques, respectively. The median total protein concentration was 32.9 mg/dL and 38 mg/dL for AA and LS centeses. A median of 1 attempt was necessary for both centesis techniques and the median number of needle repositioning events was 1 for AA and 0 for LS.
CONCLUSION AND CLINICAL IMPORTANCE
Depending on clinical circumstances, ultrasound-guided AA centesis appears to be an acceptable alternative to other techniques for collection of CSF from SAC.
Topics: Humans; Horses; Animals; Paracentesis; Cross-Over Studies; Ultrasonography; Erythrocyte Count; South America; Cerebrospinal Fluid
PubMed: 38407387
DOI: 10.1111/jvim.17023 -
Future Healthcare Journal Nov 2023
PubMed: 38406720
DOI: 10.7861/fhj.10-3-s115 -
Therapeutic Advances in Cardiovascular... 2024Misplacement of pericardiocentesis catheter in central veins is a rare complication that can be managed with several methods. In this case, we report a percutaneous...
Misplacement of pericardiocentesis catheter in central veins is a rare complication that can be managed with several methods. In this case, we report a percutaneous image-guided plug-assisted management of a misplaced pericardiocentesis catheter into the inferior vena cava through a transhepatic tract successfully occluded. This minimally invasive technique was not previously described in this setting and had a favorable long-term outcome.
Topics: Humans; Vena Cava, Inferior; Pericardiocentesis; Veins; Catheters
PubMed: 38400698
DOI: 10.1177/17539447241234655 -
BMC Medical Genomics Feb 2024Copy number variation (CNV) of X chromosome can lead to a variety of neonatal abnormalities, especially for male fetuses. In recent years, due to the high sensitivity... (Review)
Review
BACKGROUND
Copy number variation (CNV) of X chromosome can lead to a variety of neonatal abnormalities, especially for male fetuses. In recent years, due to the high sensitivity and high specificity of NIPS, its application has gradually expanded from chromosome aneuploidy to CNV. Few prenatal cases involving the detection of Xq duplication and deletion by NIPS have been reported, but it is of great significance for genetic counseling.
CASE PRESENTATION
A 36-year-old woman was referred for prenatal diagnosis and genetic counseling at 17 weeks of gestation because of abnormal result of noninvasive prenatal screening (NIPS). Multiple congenital malformations, hydrocephalus, and enlarged gallbladder were observed by prenatal ultrasound. Amniocentesis revealed the karyotype of the fetus as 46, XN, add(X) (p22.2) and the result of chromosomal microarray analysis was arr[hg19] Xq27.1q28(138,506,454-154896094) × 2 and arr[hg19] Xp22.33p22.32(168,551-5,616,964) × 1. CNV-seq showed that the mother shares a 16.42 Mb duplication in the Xq27.1-q28 region and a 2.97 Mb deletion in the Xp22.33-p22.32 region. After genetic counseling, the couple chose to terminate the pregnancy.
CONCLUSION
The combination of NIPS and CMA would be of values in detection of subchromosomal duplications and/or deletions at fetal stage. The detection of X chromosome aberration in a male fetus should give suspicion of the possibility of maternal inheritance.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Male; Adult; DNA Copy Number Variations; Prenatal Diagnosis; Amniocentesis; Karyotyping; Aneuploidy
PubMed: 38383389
DOI: 10.1186/s12920-024-01824-8 -
Journal of General Internal Medicine May 2024Disparities in life-saving interventions for low-income patients with cirrhosis necessitate innovative models of care.
BACKGROUND
Disparities in life-saving interventions for low-income patients with cirrhosis necessitate innovative models of care.
AIM
To implement a novel generalist-led FLuid ASPiration (FLASP) clinic to reduce emergency department (ED) care for refractory ascites.
SETTING
A large safety net hospital in Los Angeles.
PARTICIPANTS
MediCal patients with paracentesis in the ED from 6/1/2020 to 1/31/2021 or in FLASP clinic or the ED from 3/1/2021 to 4/30/2022.
PROGRAM DESCRIPTION
According to RE-AIM, adoption obtained administrative endorsement and oriented ED staff. Reach engaged ED staff and eligible patients with timely access to FLASP. Implementation trained FLASP clinicians in safer, guideline-based paracentesis, facilitated timely access, and offered patient education and support.
PROGRAM EVALUATION
After FLASP clinic opened, significantly fewer ED visits were made by patients discharged after paracentesis [rate ratio (RR) of 0.33 (95% CI 0.28, 0.40, p < 0.0001)] but not if subsequently hospitalized (RR = 0.88, 95% CI 0.70, 1.11). Among 2685 paracenteses in 225 FLASP patients, complications were infrequent: 39 (1.5%) spontaneous bacterial peritonitis, 265 (9.9%) acute kidney injury, and 2 (< 0.001%) hypotension. FLASP patients rated satisfaction highly on a Likert-type question.
DISCUSSION
Patients with refractory ascites in large safety net hospitals may benefit from an outpatient procedure clinic instead of ED care.
Topics: Humans; Ascites; Safety-net Providers; Poverty; Male; Female; Liver Cirrhosis; Middle Aged; Healthcare Disparities; Ambulatory Care Facilities; Paracentesis; Emergency Service, Hospital; Adult; Los Angeles; Aged
PubMed: 38378980
DOI: 10.1007/s11606-024-08675-0 -
Cureus Jan 2024Born in a wealthy family with a tradition in science, Henry Ingersoll Bowditch (1808-1882) with studies at Harvard Medical School and in Europe had succeeded in leaving... (Review)
Review
Born in a wealthy family with a tradition in science, Henry Ingersoll Bowditch (1808-1882) with studies at Harvard Medical School and in Europe had succeeded in leaving his mark in the American history of medicine. He had been a pioneer in the stethoscope's use, which was promoted and suggested to all physicians of his era. He had widely used thoracentesis, an ancient procedure, for pleuritic effusions, diagnosed with a stethoscope. Inside his most popular treatise "The Young Stethoscopist," he had given a plethora of data concerning the auscultation of the lungs, heart, and vessels; obstetrics; and veterinary. To help younger physicians, he demonstrated through figures local anatomy and positions for auscultation, providing information for various types of stethoscopes being in use during the mid-19th century. He was a humanist and reformer for public hygiene. This historical vignette aims to present Henry Ingersoll Bowditch and his work concerning the thorax. For his contributions to education and public hygiene, he should be celebrated as one of the most important figures of the eve of American medicine.
PubMed: 38371003
DOI: 10.7759/cureus.52582 -
BMC Palliative Care Feb 2024Patients with incurable cancer are frequently hospitalized within their last 30 days of life (DOL) due to numerous symptoms and concerns. These hospitalizations can be...
BACKGROUND
Patients with incurable cancer are frequently hospitalized within their last 30 days of life (DOL) due to numerous symptoms and concerns. These hospitalizations can be burdensome for the patient and the caregivers and are therefore considered a quality indicator of end-of-life care. This retrospective cohort study aims to investigate the rates and potential predictors of hospitalizations and re-hospitalizations within the last 30 DOL.
METHODS
This register data study included 383 patients with non-curable cancer who died in the pre-covid period between July 2018 and December 2019. Descriptive statistics with Chi-squared tests for the categorical data and logistic regression analysis were used to identify factors associated with hospitalization within the last 30 DOL.
RESULTS
A total of 272 (71%) had hospitalizations within the last 30 days of life and 93 (24%) had > 1 hospitalizations. Hospitalization was associated with shorter time from palliative care unit (PCU) referral to death, male gender, age < 80 years and systemic anticancer therapy (SACT) within the last 30 DOL. The most common treatment approaches initiated during re-hospitalizations remained treatment for suspected or confirmed infection (45%), pleural or abdominal paracentesis (20%) and erythrocytes transfusion (18%).
CONCLUSION
Hospitalization and re-hospitalization within the last 30 DOL were associated with male gender, age below 80, systemic anticancer therapy and suspected or confirmed infection.
Topics: Humans; Male; Aged, 80 and over; Retrospective Studies; Neoplasms; Terminal Care; Palliative Care; Hospitalization; Death
PubMed: 38350961
DOI: 10.1186/s12904-024-01370-1 -
Journal of Medical Case Reports Feb 2024Chiari malformation is one of the most common Central nervous system (CNS) abnormalities that can be detected in routine fetal scanning. Chiari malformation type I (CMI)...
BACKGROUND
Chiari malformation is one of the most common Central nervous system (CNS) abnormalities that can be detected in routine fetal scanning. Chiari malformation type I (CMI) is a congenital defect characterized by a displacement of the cerebellar tonsils through the foramen magnum. The etiology of CMI has not been well established and suggested having multifactorial contributions, especially genetic deletion. Clinical characteristics of this anomaly may express in different symptoms from neurological dysfunction and/or skeletal abnormalities in the later age, but it is rarely reported in pregnancy.
CASE PRESENTATION
We present a case in which the Chiari malformation type I was diagnosed with comorbidities of facial anomalies (flatting forehead and micrognathia) and muscular-skeletal dysmorphologies (clenched hands and clubfeet) at the 24 weeks of gestation in a 29-year-old Vietnamese pregnant woman. The couple refused an amniocentesis, and the pregnancy was followed up every 4 weeks until a spontaneous delivery occurred at 38 weeks. The newborn had a severe asphyxia and seizures at birth required to have an emergency resuscitation at delivery. He is currently being treated in the intensive neonatal care unit. He carries the novel heterozygous NFIA gene mutation confirmed after birth. No further postnatal malformation detected.
CONCLUSION
CMI may only represent with facial abnormalities and muscle-skeletal malformations at the early stage of pregnancy, which may also alert an adverse outcome. A novel heterozygous NFIA gene mutation identified after birth helps to confirm prenatal diagnosis of CMI and to provide an appropriate consultation.
Topics: Male; Pregnancy; Female; Infant, Newborn; Humans; Adult; Arnold-Chiari Malformation; NFI Transcription Factors; Prenatal Diagnosis; Amniocentesis; Mutation; Magnetic Resonance Imaging
PubMed: 38347602
DOI: 10.1186/s13256-024-04361-1 -
BMC Pregnancy and Childbirth Feb 2024Chimerism results from the fusion of two zygotes in a single embryo, whereas mosaicism results from mitotic errors in a single zygote. True human chimerism is rare, with...
Chimerism results from the fusion of two zygotes in a single embryo, whereas mosaicism results from mitotic errors in a single zygote. True human chimerism is rare, with fewer than 100 cases reported in the literature. Here, we report a case in which the fetus was identified as having tetragametic chimerism based on short tandem repeat - polymerase chain reaction analysis of the family observed during amniocentesis for advanced maternal age. The chimerism occurred via the fertilization of two ova by two spermatozoa, followed by the fusion of early embryos. The genotypes of the two amniotic fluid samples obtained successively by one puncture were completely different, and the sex chromosomes were XY. Karyotyping and copy number variation sequencing showed no abnormalities. The fetus was delivered at term and the phenotype of the newborn was normal.
Topics: Female; Humans; Infant, Newborn; Male; Pregnancy; Amniocentesis; Chimerism; DNA Copy Number Variations; Karyotyping; Phenotype
PubMed: 38347456
DOI: 10.1186/s12884-024-06321-5 -
World Journal of Gastrointestinal... Jan 2024Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis (SAP). However, there is still an ongoing...
BACKGROUND
Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis (SAP). However, there is still an ongoing debate regarding the optimal timing for abdominal paracentesis catheter placement and drainage.
AIM
To explore the influence of different timing for abdominal paracentesis catheter placement and drainage in SAP complicated by intra-abdominal fluid accumulation.
METHODS
Using a retrospective approach, 184 cases of SAP complicated by intra-abdominal fluid accumulation were enrolled and categorized into three groups based on the timing of catheter placement: group A (catheter placement within 2 d of symptom onset, = 89), group B (catheter placement between days 3 and 5 after symptom onset, = 55), and group C (catheter placement between days 6 and 7 after symptom onset, = 40). The differences in progression rate, mortality rate, and the number of cases with organ dysfunction were compared among the three groups.
RESULTS
The progression rate of group A was significantly lower than those in groups B and groups C (2.25% 21.82% and 32.50%, < 0.05). Further, the proportion of patients with at least one organ dysfunction in group A was significantly lower than those in groups B and groups C (41.57% 70.91% and 75.00%, < 0.05). The mortality rates in group A, group B, and group C were similar ( > 0.05). At postoperative day 3, the levels of C-reactive protein (55.41 ± 19.32 mg/L 82.25 ± 20.41 mg/L and 88.65 ± 19.14 mg/L, < 0.05), procalcitonin (1.36 ± 0.51 ng/mL 3.20 ± 0.97 ng/mL and 3.41 ± 0.98 ng/mL, < 0.05), tumor necrosis factor-alpha (15.12 ± 6.63 pg/L 22.26 ± 9.96 pg/L and 23.39 ± 9.12 pg/L, < 0.05), interleukin-6 (332.14 ± 90.16 ng/L 412.20 ± 88.50 ng/L and 420.08 ± 87.65ng/L, < 0.05), interleukin-8 (415.54 ± 68.43 ng/L 505.80 ± 66.90 ng/L and 510.43 ± 68.23ng/L, < 0.05) and serum amyloid A (270.06 ± 78.49 mg/L 344.41 ± 81.96 mg/L and 350.60 ± 80.42 mg/L, < 0.05) were significantly lower in group A compared to those in groups B and group C. The length of hospital stay in group A was significantly lower than those in groups B and group C (24.50 ± 4.16 d 35.54 ± 6.62 d and 38.89 ± 7.10 d, < 0.05). The hospitalization expenses in group A were also significantly lower than those in groups B and groups C [2.70 (1.20, 3.55) ten-thousand-yuan 5.50 (2.98, 7.12) ten-thousand-yuan and 6.00 (3.10, 8.05) ten-thousand-yuan, < 0.05). The incidence of complications in group A was markedly lower than that in group C (5.62% 25.00%, < 0.05), and similar to group B ( > 0.05).
CONCLUSION
Percutaneous catheter drainage for the treatment of SAP complicated by intra-abdominal fluid accumulation is most effective when performed within 2 d of onset.
PubMed: 38328315
DOI: 10.4240/wjgs.v16.i1.134