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1.
J Clin Neurosci ; 129: 110858, 2024 Oct 03.
Article in English | MEDLINE | ID: mdl-39366127

ABSTRACT

INTRODUCTION: Tolosa-Hunt Syndrome (THS) stands as a rare headache disorder distinguished by painful ophthalmoplegia, accompanied by headaches and cranial nerve palsies. The syndrome was initially identified by Eduardo Tolosa in Spain in 1954. He observed granulomatous inflammation surrounding a carotid siphon in a patient with an intracavernous carotid aneurysm. The objective of this systematic review is to consolidate and summarize existing studies on THS, providing a comprehensive evaluation of its clinical findings and outcomes. METHODS: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. Systematic searches were conducted on PubMed and Scopus databases to identify literature examining the sociodemographics, clinical findings, cranial nerve palsies, laboratory and radiological data, treatment, and outcomes of THS. The study followed a pre-established protocol registered on the PROSPERO database (ID: CRD42023494249). RESULTS: Out of 1115 studies screened, 11 met the predefined inclusion and exclusion criteria. The studies predominantly focused on Asian populations, emphasizing unilateral orbital headaches as a common clinical feature. Ophthalmological findings, including restriction of eye movements, diplopia, ptosis, and vision loss, were prevalent. Studies also highlighted some cases presenting atypically without ophthalmoplegia but with acute vision changes. Oculomotor nerve palsy, followed by abducens and trochlear nerve palsies, were the most frequently reported. Laboratory investigations across the studies often showed normal cerebrospinal fluid findings and varying levels of inflammatory markers like ESR and CRP. Inflammation of the cavernous sinus and orbital apex was noted most frequently. Treatment strategies were consistent across the studies, with steroids (both IV and oral) being the mainstay treatment for managing THS. Despite the use of steroids, the studies reported varied outcomes in terms of pain relief and recovery from cranial nerve deficits, with some cases showing rapid improvement while others had prolonged or incomplete recovery. Other immunosuppressants and steroid sparing agents are used with varying levels of success. Recurrence rates ranged from 9% to 71% across studies. CONCLUSION: This review discusses the varied constellation of symptoms associated with THS, with headaches and cranial nerve findings being consistently observed. High and low doses, as well as both intravenous and oral steroids, have proven to be effective in managing THS. Overall, the prognosis appears favorable, with a limited number of cases showing recurrence.

2.
Mol Neurobiol ; 2024 Sep 26.
Article in English | MEDLINE | ID: mdl-39325101

ABSTRACT

L-type amino acid transporter 1 (LAT1) is integral to the transport of large neutral amino acids across the blood-brain barrier (BBB), playing a crucial role in brain homeostasis and the delivery of therapeutic agents. This review explores the multifaceted role of LAT1 in neurological disorders, including its structural and functional aspects at the BBB. Studies using advanced BBB models, such as induced pluripotent stem cell (iPSC)-derived systems and quantitative proteomic analyses, have demonstrated LAT1's significant impact on drug permeability and transport efficiency. In Alzheimer's disease, LAT1-mediated delivery of anti-inflammatory and neuroprotective agents shows promise in overcoming BBB limitations. In Parkinson's disease, LAT1's role in transporting L-DOPA and other therapeutic agents highlights its potential in enhancing treatment efficacy. In phenylketonuria, studies have revealed polymorphisms and genetic variations of LAT1, which could be correlated to disease severity. Prodrugs of valproic acid, pregabalin, and gabapentin help use LAT1-mediated transport to increase the therapeutic activity and bioavailability of the prodrug in the brain. LAT1 has also been studied in neurodevelopment disorders like autism spectrum disorders and Rett syndrome, along with neuropsychiatric implications in depression. Its implications in neuro-oncology, especially in transporting therapeutic agents into cancer cells, show immense future potential. Phenotypes of LAT1 have also shown variations in the general population affecting their ability to respond to painkillers and anti-inflammatory drugs. Furthermore, LAT1-targeted approaches, such as functionalized nanoparticles and prodrugs, show promise in overcoming chemoresistance and enhancing drug delivery to the brain. The ongoing exploration of LAT1's structural characteristics and therapeutic applications reiterates its critical role in advancing treatments for neurological disorders.

3.
Arch Gynecol Obstet ; 2024 Sep 16.
Article in English | MEDLINE | ID: mdl-39285011

ABSTRACT

Limb-girdle muscular dystrophy (LGMD) poses unique challenges for women during pregnancy, necessitating comprehensive care and tailored management strategies. The present narrative review aims to examine the unique challenges and management strategies required for women with LGMD during pregnancy. With over 30 genetic subtypes identified and the potential for additional discoveries through advanced diagnostic techniques, preconception counseling plays a crucial role in informing prospective parents about reproductive risks and available options. Baseline assessments, including cardiac and pulmonary evaluations, are essential to guide antenatal care, alongside genetic testing for precise diagnosis and counseling. Optimizing maternal health through respiratory exercises, cardiac monitoring, and individualized exercise and nutrition plans is paramount to avoid potential complications. During pregnancy, close monitoring of maternal and fetal well-being is important, with collaborative care between obstetricians and specialists. An individualized approach to delivery mode considering factors such as muscle strength, pelvic size, and fetal presentation is crucial. While vaginal delivery has been proven to be possible, the need for an emergency cesarean delivery should always be kept in mind. Regional anesthesia is preferred, with proactive planning for potential respiratory support. Bupivacaine has been shown to be effective with epidural catheters that may be used for prolonged relief with opioids like morphine and fentanyl, while also evaluating the patients' respiratory function. Postpartum considerations include pain management, mobility support, breastfeeding assistance, and emotional support. Early mobilization and tailored physiotherapy regimens may promote optimal recovery, while comprehensive breastfeeding guidance is needed to address challenges related to muscle weakness. Access to mental health resources and support networks is essential to helping individuals cope with the emotional demands of parenthood alongside managing LGMD. By addressing the unique needs of pregnant individuals with LGMD, healthcare providers can optimize maternal and fetal outcomes while supporting individuals in their journey to parenthood.

4.
Gen Thorac Cardiovasc Surg ; 72(10): 621-640, 2024 Oct.
Article in English | MEDLINE | ID: mdl-39090433

ABSTRACT

OBJECTIVE: Shone's complex comprises of a combination of congenital cardiac anomalies causing obstructions in the left ventricle's inflow and outflow tracts. This systematic review aims to evaluate the clinical features and surgical outcomes of Shone's complex. METHODS: An electronic literature search of PubMed and Scopus was performed to identify relevant studies related to the presentation, management, and outcomes of Shone's complex. Two reviewers independently performed selection. Data on study characteristics, participant demographics, interventions, outcomes, and follow-up durations were extracted and analyzed. RESULTS: A total of 691 papers were identified, with 18 studies included in the final analysis. The majority of the studies (n = 12) focused on the pediatric age group. The most common clinical presentations were coarctation of the aorta (n = 17) and mitral stenosis (n = 12). Surgical interventions often involved staged approaches, prioritizing outflow before inflow obstructions. Mitral valve repair was preferred over replacement due to better long-term outcomes (n = 8). Biventricular repair was recommended due to improved postoperative outcomes, but often needed reoperations. Reoperations were common, primarily due to recurrent coarctation (n = 10), subaortic stenosis (n = 8), and mitral valve dysfunction (n = 7). Pulmonary hypertension (n = 10) and arrhythmias (n = 11) were significant complications. Most patients were in modified Ross/NYHA functional class 1 on follow-up. Mortality rates ranged from 4 to 28%, with better outcomes associated with early and strategic surgical interventions. CONCLUSION: Early diagnosis and biventricular repair were associated with better outcomes while transplantation was often an eventuality. Standardized diagnostic criteria, long-term follow-up, and consensus guidelines are needed to improve the management of this congenital heart disease.


Subject(s)
Cardiac Surgical Procedures , Heart Defects, Congenital , Humans , Aortic Coarctation/complications , Aortic Coarctation/diagnosis , Aortic Coarctation/mortality , Aortic Coarctation/surgery , Cardiac Surgical Procedures/adverse effects , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/mortality , Heart Defects, Congenital/surgery , Reoperation , Risk Factors , Treatment Outcome , Ventricular Outflow Obstruction/diagnosis , Ventricular Outflow Obstruction/etiology , Ventricular Outflow Obstruction/mortality , Ventricular Outflow Obstruction/surgery
5.
Eur J Ophthalmol ; : 11206721241272251, 2024 Aug 07.
Article in English | MEDLINE | ID: mdl-39110014

ABSTRACT

INTRODUCTION: The rise in popularity of chatbots, particularly ChatGPT by OpenAI among the general public and its utility in the healthcare field is a topic of present controversy. The current study aimed at assessing the reliability and accuracy of ChatGPT's responses to inquiries posed by parents, specifically focusing on a range of pediatric ophthalmological and strabismus conditions. METHODS: Patient queries were collected via a thematic analysis and posed to ChatGPT 3.5 version across 3 unique instances each. The questions were divided into 12 domains totalling 817 unique questions. All responses were scored on the response quality by two experienced pediatric ophthalmologists in a Likert-scale format. All questions were evaluated for readability using the Flesch-Kincaid Grade Level (FKGL) and character counts. RESULTS: A total of 638 (78.09%) questions were scored to be perfectly correct, 156 (19.09%) were scored correct but incomplete and only 23 (2.81%) were scored to be partially incorrect. None of the responses were scored to be completely incorrect. Average FKGL score was 14.49 [95% CI 14.4004-14.5854] and the average character count was 1825.33 [95%CI 1791.95-1858.7] with p = 0.831 and 0.697 respectively. The minimum and maximum FKGL scores were 10.6 and 18.34 respectively. FKGL predicted character count, R²=.012, F(1,815) = 10.26, p = .001. CONCLUSION: ChatGPT provided accurate and reliable information for a majority of the questions. The readability of the questions was much above the typically required standards for adults, which is concerning. Despite these limitations, it is evident that this technology will play a significant role in the healthcare industry.

6.
Indian J Thorac Cardiovasc Surg ; 40(5): 633-644, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39156066

ABSTRACT

Hazard modeling in cardiothoracic surgery, crucial for understanding patient outcomes, utilizes survival analysis like the Cox proportional hazards model. Kaplan-Meier curves are employed in survival analysis to represent the probability of survival over time. While Cox assumes proportional hazards, the Fine-Gray model deals with competing risks. Parametric models (e.g., Weibull) specify survival distributions, unlike Cox. Bayesian analysis integrates prior knowledge with data. Machine learning, including decision trees and support vector machines, enhances risk prediction by analyzing extensive datasets. However, it is important to note that whatever new approaches one may adopt will enhance the quality of risk assessment and not the risk assessment as such. Preprocessing is vital for data quality in complex cardiovascular datasets, alongside robust validation methods like cross-validation for model reliability across patient cohorts.

7.
Curr Probl Diagn Radiol ; 53(6): 723-727, 2024.
Article in English | MEDLINE | ID: mdl-39019712

ABSTRACT

OBJECTIVES: Patients undergoing medical procedures often experience heightened anxiety, which can affect their experience and overall health. The current study aimed at looking at a quality improvement initiative to compare written and audiovisual information delivery methods to reduce anxiety prior to Computed Tomography (CT). METHODS: In this prospective interventional study, we assessed state and trait anxiety in patients scheduled for their first CT scan. Three PDSA cycles were carried out over six months, with each cycle lasting for two months each. The participants were divided into three groups, the baseline, written, and audiovisual intervention groups. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire. State anxiety is a temporary emotional response, while trait anxiety reflects enduring personality characteristics. RESULTS: The mean age of participants was 43.26 years (SD 15.07) in the baseline group, 39.9 years (SD 14.72) in the written group, and 48.59 years (SD 13.54) in the audiovisual group. For state anxiety, the baseline mean was 58.4 (SD 6.9), notably reduced to 43.2 (SD 5.5) with written intervention and to 38.6 (SD 7.7) with audiovisual intervention (p < 0.001). Trait anxiety scores remained relatively stable in all groups (p = 0.31). CONCLUSION: Both written and audiovisual interventions successfully alleviate pre-imaging anxiety in patients undergoing CT scans. The findings underscore the superior efficacy of audiovisual materials in achieving a more substantial reduction in state anxiety compared to written information. These findings are particularly relevant in resource limited settings where simple interventions show significant improvements.


Subject(s)
Anxiety , Tomography, X-Ray Computed , Humans , Female , Male , Anxiety/prevention & control , Prospective Studies , Adult , Tomography, X-Ray Computed/methods , Middle Aged , Surveys and Questionnaires , Patient Education as Topic/methods , Quality Improvement
8.
Anesth Pain Med (Seoul) ; 19(3): 194-208, 2024 Jul.
Article in English | MEDLINE | ID: mdl-39069647

ABSTRACT

Managing hemophilia in patients undergoing joint replacement surgery requires a comprehensive approach encompassing preoperative assessment, meticulous intraoperative care, and tailored postoperative management. Evaluation of joint integrity, bleeding history, and inhibitor presence guides surgical planning and hemostatic therapy selection to optimize outcomes. During surgery, careful attention to factor replacement, antibiotic prophylaxis, anesthetic techniques, and orthopedic strategies minimizes bleeding risk and enhances surgical success. Postoperatively, effective pain management, continued hemostatic therapy, and individualized rehabilitation programs are vital for facilitating recovery and preventing complications. Close monitoring for potential complications, such as periprosthetic joint infection and recurrent hemarthrosis, allows for prompt intervention when necessary. Overall, a collaborative approach involving hematologists, orthopedic surgeons, anesthesiologists, and rehabilitation specialists ensures comprehensive care tailored to the unique needs of patients with hemophilia undergoing joint replacement surgery, ultimately optimizing outcomes and improving quality of life. This holistic approach addresses the multifaceted challenges posed by hemophilia and joint replacement surgery, providing patients with the best possible chance for successful outcomes and long-term joint function. By integrating specialized expertise from multiple disciplines and implementing evidence-based strategies, healthcare providers can effectively manage hemophilia in the context of joint replacement surgery, mitigating risks and maximizing benefits for patients.

10.
Indian J Ophthalmol ; 72(10): 1471-1477, 2024 Oct 01.
Article in English | MEDLINE | ID: mdl-38770617

ABSTRACT

PURPOSE: The caruncle is a unique anatomical site in the human body, comprising various structures derived from the surface ectoderm and mesoderm. Caruncular lesions can range from benign to malignant and present challenges in accurate diagnosis and timely management due to their hidden nature and proximity to the lacrimal sac. This study aims to provide a comprehensive description of caruncular lesions, presenting the first Indian case series on this topic. METHODS: Ethical approval was obtained, and data collection was conducted at a tertiary care center in India. A retrospective analysis was performed on 44 patients with caruncular lesions treated between 2013 and 2020. Detailed patient histories, clinical examinations, slit lamp imaging, and excision biopsies were conducted. Histopathological examination of the specimens was carried out. RESULTS: The study included 42 cases of caruncular lesions, with a mean age of 31.09 years. The majority of cases were male (54.54%). Benign lesions accounted for 84.09% of the cases, while premalignant and malignant lesions accounted for 11.36% and 4.54%, respectively. Papilloma and nevus were the most common lesions, with 11 cases each. All caruncular lesions were successfully and completely excised without complications. Histopathological examination confirmed the accuracy of the diagnoses, with an 84.09% concordance rate between clinical assessment and pathological diagnosis. CONCLUSION: This case series reveals a predominance of benign lesions among individuals in their early thirties. The successful excision of all lesions with a high concordance rate between clinical assessment and histopathological diagnosis underscores the importance of timely and accurate management.


Subject(s)
Eye Neoplasms , Humans , Male , Retrospective Studies , Female , Adult , Middle Aged , Adolescent , Child , Young Adult , Biopsy , India/epidemiology , Child, Preschool , Aged , Eye Neoplasms/diagnosis
12.
Mol Neurobiol ; 2024 Apr 13.
Article in English | MEDLINE | ID: mdl-38613648

ABSTRACT

Prevotella species, notably Prevotella copri, significantly populate the human gut. In particular, P. copri is prevalent among non-Western populations with diets high in fiber. These species show complex relationships with diverse health aspects, associating with beneficial outcomes, including reduced visceral fat and improved glucose tolerance. Studies implicate various Prevotella species in specific diseases. Prevotella nigrescens and Porphyromonas gingivalis were linked to periodontal disease, promoting immune responses and influencing T helper type 17 (Th17) cells. Prevotella bivia was associated with bacterial vaginosis and a specific increase in activated cells in the vaginal mucosa. In contrast, they have shown substantial potential for inducing connective tissue degradation and alveolar bone resorption. Prevotella's role in neuroinflammatory disorders and autoinflammatory conditions such as Alzheimer's disease and Parkinson's disease has also been noted. The complex relationship between Prevotella and age-related conditions further extends to neurobiological changes in aging, with varying associations with Alzheimer's, Parkinson's, and other inflammatory conditions. Studies have also identified Prevotella to be implicated in cognitive decline in middle aged and the elderly. Future directions in this research area are anticipated to explore Prevotella-associated inflammatory mechanisms and therapeutic interventions. Investigating specific drug targets and immunomodulatory measures could lead to novel therapeutic strategies. Understanding how Prevotella-induced inflammation interacts with aging diseases would offer promising insights for treatments and interventions. This review urges ongoing research to discover therapeutic targets and mechanisms for moderating Prevotella-associated inflammation to further enhance our understanding and improve health outcomes.

13.
Korean J Radiol ; 25(5): 493-498, 2024 May.
Article in English | MEDLINE | ID: mdl-38627875
14.
J Egypt Natl Canc Inst ; 36(1): 13, 2024 Apr 22.
Article in English | MEDLINE | ID: mdl-38644430

ABSTRACT

BACKGROUND: Glioblastoma (GBM) is a fatal, fast-growing, and aggressive brain tumor arising from glial cells or their progenitors. It is a primary malignancy with a poor prognosis. The current study aims at evaluating the neuroradiological parameters of de novo GBM by analyzing the brain multi-parametric magnetic resonance imaging (mpMRI) scans acquired from a publicly available database analysis of the scans. METHODS: The dataset used was the mpMRI scans for de novo glioblastoma (GBM) patients from the University of Pennsylvania Health System, called the UPENN-GBM dataset. This was a collection from The Cancer Imaging Archive (TCIA), a part of the National Cancer Institute. The MRIs were reviewed by a single diagnostic radiologist, and the tumor parameters were recorded, wherein all recorded data was corroborated with the clinical findings. RESULTS: The study included a total of 58 subjects who were predominantly male (male:female ratio of 1.07:1). The mean age with SD was 58.49 (11.39) years. Mean survival days with SD were 347 (416.21) days. The left parietal lobe was the most commonly found tumor location with 11 (18.96%) patients. The mean intensity for T1, T2, and FLAIR with SD was 1.45E + 02 (20.42), 1.11E + 02 (17.61), and 141.64 (30.67), respectively (p = < 0.001). The tumor dimensions of anteroposterior, transverse, and craniocaudal gave a z-score (significance level = 0.05) of - 2.53 (p = 0.01), - 3.89 (p < 0.001), and 1.53 (p = 0.12), respectively. CONCLUSION: The current study takes a third-party database and reduces physician bias from interfering with study findings. Further prospective and retrospective studies are needed to provide conclusive data.


Subject(s)
Brain Neoplasms , Glioblastoma , Humans , Glioblastoma/diagnostic imaging , Glioblastoma/pathology , Male , Female , Middle Aged , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Aged , Adult , Multiparametric Magnetic Resonance Imaging , Magnetic Resonance Imaging/methods , Prognosis , Retrospective Studies , Radiomics
15.
Arq Gastroenterol ; 61: e23107, 2024.
Article in English | MEDLINE | ID: mdl-38511794

ABSTRACT

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive and lethal form of cancer with limited prognostic accuracy using traditional factors. This has led to the exploration of innovative prognostic models, including convolutional neural networks (CNNs), in PDAC. CNNs, a type of artificial intelligence algorithm, have shown promise in various medical applications, including image analysis and pattern recognition. Their ability to extract complex features from medical images makes them suitable for improving prognostication in PDAC. However, implementing CNNs in clinical practice poses challenges, such as data availability and interpretability. Future research should focus on multi-center studies, integrating multiple data modalities, and combining CNN outputs with biomarker panels. Collaborative efforts and patient autonomy should be considered to ensure the ethical implementation of CNN-based prognostic models. Further validation and optimisation of CNN-based models are necessary to enhance their reliability and clinical utility in PDAC prognostication. BACKGROUND: •Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with limited prognostic accuracy through traditional methods. BACKGROUND: •Convolutional neural networks (CNNs) are being explored for prognostic models in PDAC. BACKGROUND: •They can extract complex features from images, aiding PDAC prognostication. BACKGROUND: •Further validation and optimization of CNN-based models are needed for better reliability and clinical utility in PDAC.


Subject(s)
Carcinoma, Pancreatic Ductal , Pancreatic Neoplasms , Humans , Prognosis , Artificial Intelligence , Reproducibility of Results , Pancreatic Neoplasms/pathology , Carcinoma, Pancreatic Ductal/pathology , Neural Networks, Computer
16.
Ophthalmic Plast Reconstr Surg ; 40(4): e121-e125, 2024.
Article in English | MEDLINE | ID: mdl-38534076

ABSTRACT

Ocular malakoplakia, a rare inflammatory disorder characterized by Michaelis-Gutmann bodies, is presented in 2 unique cases involving uncommon anatomical sites-the orbit and caruncle. The first case describes a 10-year-old girl with localized subconjunctival swelling near the caruncle, prompting surgical excision, and revealing characteristic malakoplakia features. Despite medical management, surgical intervention provided symptom relief. The second case involves a painless swelling below the lower lid in a 23-year-old female, initially suggestive of lymphoma. Excision biopsy confirmed malakoplakia, emphasizing the potential for clinical misdiagnosis. Histopathological examination showcased Michaelis-Gutmann bodies, von Hansemann cells, and chronic inflammation, confirming the ocular malakoplakia diagnosis. These cases underscore the rarity of ocular malakoplakia, particularly in pediatric patients, and highlight the importance of accurate diagnosis and appropriate management.


Subject(s)
Malacoplakia , Humans , Female , Child , Malacoplakia/diagnosis , Malacoplakia/surgery , Young Adult , Ophthalmologic Surgical Procedures/methods , Biopsy , Orbital Diseases/diagnosis , Orbital Diseases/surgery
17.
Arq. gastroenterol ; Arq. gastroenterol;61: e23107, 2024.
Article in English | LILACS-Express | LILACS | ID: biblio-1557110

ABSTRACT

ABSTRACT Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive and lethal form of cancer with limited prognostic accuracy using traditional factors. This has led to the exploration of innovative prognostic models, including convolutional neural networks (CNNs), in PDAC. CNNs, a type of artificial intelligence algorithm, have shown promise in various medical applications, including image analysis and pattern recognition. Their ability to extract complex features from medical images makes them suitable for improving prognostication in PDAC. However, implementing CNNs in clinical practice poses challenges, such as data availability and interpretability. Future research should focus on multi-center studies, integrating multiple data modalities, and combining CNN outputs with biomarker panels. Collaborative efforts and patient autonomy should be considered to ensure the ethical implementation of CNN-based prognostic models. Further validation and optimisation of CNN-based models are necessary to enhance their reliability and clinical utility in PDAC prognostication.


RESUMO Contexto O adenocarcinoma ductal pancreático (ACDP) é uma forma de câncer altamente agressiva e letal com precisão prognóstica limitada usando fatores tradicionais. Isso levou à exploração de modelos prognósticos inovadores, incluindo redes neurais convolucionais (CNNs), no ACDP. As CNNs, um tipo de algoritmo de inteligência artificial, mostraram promessa em várias aplicações médicas, incluindo análise de imagem e reconhecimento de padrões. Sua capacidade de extrair características complexas de imagens médicas as torna adequadas para melhorar o prognóstico no ACDP. No entanto, a implementação de CNNs na prática clínica apresenta desafios, como a disponibilidade de dados e a interpretabilidade. Pesquisas futuras devem se concentrar em estudos multicêntricos, integrando múltiplas modalidades de dados e combinando saídas de CNN com painéis de biomarcadores. Esforços colaborativos e autonomia do paciente devem ser considerados para garantir a implementação ética de modelos prognósticos baseados em CNN. Mais validação e otimização de modelos baseados em CNN são necessárias para aumentar sua confiabilidade e utilidade clínica na prognostico do ACDP.

18.
Eur J Ophthalmol ; : 11206721231221590, 2023 Dec 13.
Article in English | MEDLINE | ID: mdl-38092690

ABSTRACT

BACKGROUND: Tolosa Hunt Syndrome (THS) was first delineated in 1954 and is caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. In this study the different clinical and diagnostic findings of THS are discussed. METHODS: Case records of patients diagnosed with THS using the International Classification of Headache Disorders 3rd edition criteria from January 2016-July 2022 were considered for the current study. Demographic, Clinical, Laboratory and Radiological data of all patients fulfilling the inclusion and exclusion criteria was collected from the patient case records through the Medical Records Department of BMCRI Super Specialty Hospital. RESULTS: A total of 60 patients were included in the study with mean age with SD, 50.9 years (13.9) and were predominantly male (66.6%). Restriction of eye movements was the most common symptom affecting 31 (51.7%) patients. Oculomotor nerve (IIIrd Cranial Nerve) palsy was the most common nerve palsy, affecting 36 (60%) patients. Contrast enhancing lesions or T2/FLAIR Hyper-intense areas were seen in the Magnetic Resonance Imaging (MRI) of 59 (98.3%) patients. Cavernous sinus involvement, was the most common site of involvement, in 25 (41.6%) of the patients. All patients were treated with intravenous methyl prednisolone injections and responded well. CONCLUSION: Restriction of eye movements was the most common symptom, along with cavernous sinus being the most common site of involvement in THS. MRI scans are important diagnostic tools for THS.

19.
Trop Doct ; 53(4): 460-463, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37287278

ABSTRACT

Post-hypoxic myoclonus (PHM) is a rare neurological complication having two different variants depending on acute or chronic onset after cardiopulmonary resuscitation following cardiac arrest: myoclonic status epilepticus (MSE) and Lance-Adams syndrome (LAS) respectively. Clinical and simultaneous electro-encephalographic (EEG) and electromyographic (EMG) tracing can distinguish between the two. Anecdotal treatment with benzodiazepines and anaesthetics (in the case of MSE) have been tried. Although limited evidence is available, valproic acid, clonazepam and levetiracetam, either in combination with other drugs or alone, have shown to control epilepsy associated with LAS effectively. Deep brain stimulation is a novel and promising advance in LAS treatment.


Subject(s)
Cardiopulmonary Resuscitation , Myoclonus , Humans , Myoclonus/diagnosis , Myoclonus/drug therapy , Myoclonus/etiology , Hypoxia/complications , Hypoxia/therapy , Clonazepam/therapeutic use , Cardiopulmonary Resuscitation/adverse effects , Valproic Acid/therapeutic use , Syndrome
20.
Rom J Ophthalmol ; 67(4): 345-353, 2023.
Article in English | MEDLINE | ID: mdl-38239414

ABSTRACT

Introduction: Head and neck cancers (HNCs) present a significant global health burden, especially in India, where oral cavity cancers, notably affecting the tongue, are prevalent. A substantial portion of global HNCs (57.5%) is concentrated in Asia, India contributing with 30%. Despite advancements, challenges persist due to HNCs' invasive nature and metastatic potential. This study aims to explore the link between HNCs and ocular manifestations. Methods: A cross-sectional study was conducted at Bangalore Medical College and Research Institute involving 47 patients with diagnosed HNCs and ocular complaints. Clinical evaluations encompassed visual acuity, anterior and posterior segment examinations, and specialized investigations when necessary. Results: A diverse range of malignancies were observed, with SCC maxilla and xeroderma pigmentosa, each accounting for 10.63% of cases. Ocular examinations unveiled visual acuity challenges, anterior segment findings like masses, exotropia, pigmented lesions, and varied fundus abnormalities. The anterior segment findings encompassed masses often accompanied by protrusion or relative afferent pupillary defect (RAPD). Additionally, exotropia, pigmented lesions, and other conditions were observed. Fundus examination revealed a spectrum of findings, including media haziness (10.63%), lack of view (17.02%), and pale discs (6.38%). Treatment plans were diverse, including excision biopsies (42.55%), exenteration procedures, Mitomycin-C applications, and referrals for chemotherapy and radiotherapy. Conclusion: The present study underscores the significance of ophthalmological assessment and investigations in patients with diagnosed HNCs, emphasizing the value of early detection and intervention. Abbreviations: HNC = Head and Neck Cancer, OCT = Optical Coherence Tomography, WNL = Within Normal Limits, SCC = Squamous Cell Carcinoma, MRI = Magnetic Resonance Imaging, CT = Computed Tomography, RAPD = Relative Afferent Pupillary Defect, XP = Xeroderma Pigmentosa.


Subject(s)
Exotropia , Head and Neck Neoplasms , Ichthyosis , Pupil Disorders , Humans , Cross-Sectional Studies , Tertiary Care Centers , India/epidemiology , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology
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