ABSTRACT
Objectives@#Patients with coronavirus disease 2019 (COVID-19) present with a variety of oral manifestations. Therefore, we conducted a systematic review to estimate the prevalence of oral lesions among COVID-19 patients. @*Methods@#An extensive literature search of several electronic bibliographic databases (PubMed, Scopus, Science Direct, Litcovid) was conducted to retrieve all articles published in the English language from January 1, 2020 to March 31, 2023 that reported the prevalence of oral manifestations among COVID-19 patients. A meta-analysis of pooled prevalence was performed using Jamovi ver. 2.3 (2022). The I2 and Q statistics were used to assess heterogeneity between studies, and p-values < 0.01 were considered statistically significant. @*Results@#In total, 79 studies with data from 13,252 patients were included. The articles were predominantly published in 2020 (n = 33), and Italy was the most common country (n = 14). Most of the affected patients more than 50 years old and women (56.6%). The most common sites of involvement were the tongue (n = 65), followed by the oral mucosa (n = 37) and lips (n = 19). High heterogeneity was found between studies. The most common oral manifestation was taste alteration, followed by xerostomia and ulceration, showing pooled prevalence rates of 48%, 35%, and 21%, respectively. @*Conclusion@#COVID-19 patients show various oral manifestations that may help clinicians identify the disease promptly. Recognition of the signs and symptoms of COVID-19 is critical for an early diagnosis and better prognosis.
ABSTRACT
Background@#Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD. @*Methods@#Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out. @*Results@#A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11. @*Conclusions@#In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.
ABSTRACT
Historically, obesity has been identified as one of the most important risk factors for developing cardiovascular diseases including stroke; however, a theory called “The Obesity Paradox” has been recently considered. The paradoxical theory is that obese or overweight patients (according to body mass index score) can have better outcomes compared to leaner or malnourished patients. The paradox was initially discovered in patients with heart failure. The purpose of this manuscript was to investigate whether this paradox also applies to stroke patients, according to information available in the current literature.
ABSTRACT
Flow diverters have become a critical instrument for complex aneurysms treatment. However, limited data are currently available regarding short and long-term outcomes for the Silk flow diverter. The objective of the study is to determine neurological prognosis and mortality rates for the Silk flow diversion device used in intracranial aneurysms. A systematic review with meta-analysis was performed using databases. The following descriptors were used for the search: “SILK”, “Flow Diverter”, “Mortality”, and “Prognosis”. The following data were extracted: mortality, good functional outcome, Glasgow outcome scale, complete or near-complete occlusion rates, rate of retreatment, and complications (thromboembolic and hemorrhagic complications). A total of 14 studies were selected. Among the 14 studies, 13 were retrospective observational cohort studies and 1 was a prospective observational cohort study. The mortality rate was 2.84%. The clinical good outcomes rate was 93.3%. The poor outcome rate was 6.6%. The overall thromboembolic complication rate was 6.06% (95% confidence interval [CI] 0.00–6.37, P=0.12, I2=3.13%). The total hemorrhagic complication rate was 1.62% (95% CI 0.00–5.34, P=0.28, I2=1.56%). The complete aneurysm occlusion rate was 80.4% (95% CI 8.65–9.38, P<0.0001, I2=9.09%). The Silk diverter device has a good safety and efficacy profile for treating intracranial aneurysms with high complete occlusion rates.
ABSTRACT
Background@#Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD. @*Methods@#Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out. @*Results@#A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11. @*Conclusions@#In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.
ABSTRACT
Objective: To compare the shock index [SI . which is the ratio of heart rate to systolic blood pressure] and Age SI [Age in years multiplied by SI] with survival outcome of the patients across multicenter trauma registry in India
Methods: Study is based on Towards Improved Trauma Care Outcomes [TITCO] project. Records with valid details of age, heart rate, systolic blood pressure, Injury Severity Scale [ISS] and Glasgow Coma Scale [GCS] score was considered. SI was categorized into four groups; Group I [SI<0.6] as no shock, group II [SI>/=0.6 to <1.0] as mild shock, group III [SI >/=1.0 to <1.4] as moderate shock and group IV [SI>/=1.4] as severe shock. Age SI was categorized decade wise into six groups. Mortality was dependent variable. GCS and ISS were considered as secondary variables
Results: 10843 participants from TITCO registry satisfying inclusion-exclusion criteria were considered for study. Mean SI score in group I to IV was increasing with 0.53 to 1.72 respectively. Age SI was seen to be increasing across its six groups. Gender wise no difference was found among SI group. For severe ISS and critical ISS, mortality in SI group IV was 50% and 56 % respectively. Mortality was increasing across mild to severe GCS among all SI groups
Conclusion: The categorized SI and Age SI had shown increase in death percentages from mild to severe severity of injuries. Similar to GCS and ISS, SI and Age SI should also be calculated and categorized in all health care and further plan for management aspects
ABSTRACT
Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma
ABSTRACT
Chiari malformation Type I [CM-I] is a congenital disorder, which is basically a tonsillar herniation [>/=5 mm] below the foramen magnum with or without syringomyelia. The real cause behind this malformation is still nknown. Patients may remain asymptomatic until they engender a deteriorating situation, such as cervical trauma. The objective of this case report is to give a broad perspective on CM-I from the clinical findings obtained in a patient with asymptomatic non-communicating syringomyelia associated with a CM-I exacerbated within 2 years of a TBI, and to discuss issues related to that condition
ABSTRACT
Craniocerebral gunshot injuries [CGI] are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately, more prevalent condition in developing countries, with major armed conflicts which is still persisting, since the main trigger is violence at the national or state level. Management goals of CGI should focus on aggressive resuscitation and correction of coagulopathy; those with stable vital signs should undergo CT scan head at the earliest possible opportunity. Neuroimaging is vital for planning of surgical management, especially to determine the type of surgery, routes of the approach to the surgical target area and extraction of the impacted foreign bodies, however, surgical management is not always indicated. Although subset of such cases may be managed even with non-surgical management. The treatment comprises of immediate life salvaging resuscitative measures including control of the persistent bleeding, care of associated injury, management of raised intracranial pressure, prevention of cerebrospinal fistula formation by primary watertight dural repair and prevention of infection, through extensive debridement of contaminated, macerated or ischemic tissues; preservation of nervous tissue and restoration of anatomic structures through the hermetic sealing of dural and scalp defect. Recently, only few studies of craniocerebral penetrating injuries are published that too involving smaller patients sample sizes; although classic studies in the military and civil situation noticed associated relatively very high mortality and morbidity and psychological as well as economic impact on the affected individual, the family and the health system in providing ongoing care to the sufferers and society at large. Currently various measures are advocated with aim to reduce the incidence of CGI especially in civilian populations. It is highly necessary and immensely urgent to promote research in a neurocritical care of CGI to provide positive impact on improvement of the quality of life and further providing better care and reduction of overall health care cost
ABSTRACT
Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor.
Subject(s)
Incidental Findings , Magnetic Resonance Imaging , Spine , Tarlov CystsABSTRACT
Paraquat [1, r-dimethyl-4,4'-bipyridium dichloride], a brown syrupy liquid is an effective herbicide that has low chronic toxicity because of its rapid deactivation on contact with soil. A high dose of paraquat or severe poisoning has a poor prognosis. At present there is no specific antidote to paraquat poisoning, hence the need to focus on prevention and in case of exposure or ingestion, aggressive decontamination to prevent further absorption. Although uncommon, paraquat ingestion can lead to severe and often fatal toxicity. However, despite its widespread availability, reports of this herbicide poisoning in India are uncommon
Subject(s)
Humans , Female , Suicide , Review Literature as TopicABSTRACT
Only few reported cases of tectocerebellar dysraphia with occipital encephalocele have been reported in the literature. Three month baby boy, the first child of healthy, consanguineous parents presented with a small swelling over the occipital region since birth. The child also used to have apneic spells without cyanosis and spontaneous recovery. CT scan showed absence of the cerebellar vermis, absence of tectum and the 4[th] ventricle communicating with the occipital menigocoele sac and an occipital bone defect. The excision of the encephalocoele sac was performed, however the child continued to have apneic spells and did not do well. In our child irregular respiration probably was the manifestation of the tectocerebellar dysraphia syndrome complex and associated shunt malfunction followed by seizures decompensated the physiology of the child leading to fatal outcome
Subject(s)
Humans , Male , Infant , Meningocele , Cerebellum/abnormalities , Nevus , Funnel Chest , Dandy-Walker SyndromeABSTRACT
Hemihydranencephaly is a rare disorder of the brain characterized by complete or almost complete unilateral absence of cerebral cortex with preservation of meninges, basal ganglia, pons, medulla, cerebellum, and falx. Thirteen year-old male child presented with left sided upper and lower limb weakness with facial asymmetry since the age of six months. His magnetic resonance imaging [MRI] scans demonstrated a nearly complete absence of the right cerebral hemisphere including basal ganglion, which was replaced by cerebrospinal fluid with a small residual rim of the occipital cortex. The imaging features were suggestive of right-sided hemihydranencephaly. Patients with hemihydranencephaly provide an experiment of nature with potential implications for normal cognitive development and illustrate how much there is still to be learned about human development
Subject(s)
Humans , Male , Hydranencephaly/diagnostic imaging , Paresis , Facial Asymmetry , Brain/abnormalities , Carotid Arteries/abnormalities , Magnetic Resonance Imaging , Magnetic Resonance AngiographySubject(s)
Humans , Male , Punctures , Sutures/adverse effects , Subcutaneous Tissue , Cerebrospinal Fluid , HydrocephalusABSTRACT
Dermoid cyst with dermal sinus in occipital region is extremely rare occurrencl and still rarer in asterion region. We report a case of dermoid cyst with dermal sinus at the asterion probably the second case of world literature and discuss the findings. 16 year-old female patient with mental retardation and inability to speak since childhood presented with history of progressive increasing swelling since childhood over the left side of occipital region. Local examination and investigations were suggestive of extracranial cystic lesion. The lesion was excised completely. When excision of such lesions is contemplated, careful attention must be paid during exploration. Failure to recognize intracranial communication in such lesions may result in fatal consequences. Pre-operative suspicion of such a connection helped us to identify the underlying defect intra-operatively and facilitated safe excision
Subject(s)
Humans , Female , Intellectual Disability , Cutaneous Fistula , MutismABSTRACT
The temporal bone is the most complex bone in the human body and a tremendous force is required to fracture the temporal bone. Temporal bone fractures secondary to blunt trauma typically occur along structurally weakened points and can injure many vital structures, including the cochlear and vestibular end organs and the facial nerve, carotid artery, and jugular vein either alone or in combination. With the advent of advanced imaging techniques there has been better understanding of the temporal bone fractures. One should remember that temporal bone fractures are one of the serious conditions after head injury and can be associated with devastating complication if not identified and managed properly