Safety and potential efficacy of expanded mesenchymal stromal cells of bone marrow and umbilical cord origins in patients with chronic spinal cord injuries: a phase I/II study.

BACKGROUND AIMS: Spinal cord injury (SCI) affects patients' physical, psychological, and social well-being. Presently, treatment modalities for chronic SCI have restricted clinical effectiveness. Mesenchymal stromal cells (MSCs) demonstrate promise in addressing nervous tissue damage. This single-center, open-label, parallel-group randomized clinical trial aimed to assess the safety and efficacy of intraoperative perilesional administration of expanded autologous bone marrow-derived MSCs (BMMSCs), followed by monthly intrathecal injections, in comparison to monthly intrathecal administration of expanded allogeneic umbilical cord-derived MSCs (UCMSCs) for individuals with chronic SCI. METHODS: Twenty participants, who had a minimum of 1 year of SCI duration, were enrolled. Each participant in Group A received perilesional BMMSCs, followed by monthly intrathecal BMMSCs for three injections, while Group B received monthly intrathecal UCMSCs for three injections. Safety and efficacy were evaluated using the American Spinal Cord Injury Association (ASIA) score for at least 1 year post the final injection. Statistical analysis was conducted using the Wilcoxon signed-rank test. RESULTS: Group A comprised 11 participants, while Group B included 9. The mean follow-up duration was 22.65 months. Mild short-term adverse events encompassed headaches and back pain, with no instances of long-term adverse events. Both groups demonstrated significant improvements in total ASIA scores, with Group A displaying more pronounced motor improvements. CONCLUSIONS: Our findings indicate that perilesional administration of expanded autologous BMMSCs, followed by monthly intrathecal BMMSCs for three injections, or monthly intrathecal UCMSCs for three injections appear to be safe and hold promise for individuals with chronic SCI. Nonetheless, larger-scale clinical trials are imperative to validate these observations.

Extensive Urinary Tract Fungal Bezoars Causing Anuria: A Case Report.

Fungal bezoar formation is a complication of fungal urinary tract infections that are usually caused by Candida species and other fungal types. They can form in any site along the urinary tract and may cause an obstruction to the urine flow that would require drainage by nephrostomy, a ureteric stent, and sometimes surgical intervention is needed. In this case report we discuss a case of an adult male who had an extensive fungal bezoar infection caused by Candida tropicalis causing him anuria and acute kidney injury. The bezoars were found in the bladder, the ureters, and both kidneys. The patient was treated with bilateral ureteric stent insertion and with fluconazole for 3 weeks. Bilateral ureteroscopy and urine culture were done after 2 months and they showed that the bezoars have been eradicated on both gross and microscopic levels.

Safe Reversal of Motor and Sensory Deficits by Repeated High Doses of Mesenchymal Stem Cells in a Patient with Chronic Complete Spinal Cord Injury.

BACKGROUND Spinal cord injuries (SCI) resulting from various types of accidents have a known onset, unlike other progressive neurological diseases. Nonetheless, in most cases, the resulting disability permanently affects the individual's quality of life due to the limited outcome of available treatment options. The neurological deficit associated with SCI results from primary injury induced by the physical trauma and secondary injury involving inflammation, spinal tissue degeneration, and scar formation. Stem cells of different origins and using different treatment protocols have been tried to minimize aspects of secondary injury in the spinal cord. CASE REPORT In this case report, we evaluated the safety and efficacy of intrathecal injections of Wharton's Jelly-derived mesenchymal stem cells (WJ-MSCs) in a patient with chronic traumatic complete SCI. The findings indicated that the treatment was safe with no serious adverse events related to the procedure or administration of stem cells. The long-term follow-up period showed sustained sensory and motor function improvements with enhanced quality of life scores. CONCLUSIONS The results imply a potential role of WJ-MSC in the treatment of chronic and severe SCI. As indicated by previous studies, the mechanism of action points mainly to the ability of MSCs to protect the neural elements that survived the initial mechanical insult by modulating the immune response and promoting neuronal regeneration.

AB Blood Group Confers Higher Risk for Primary Brain Tumors in Pediatrics.

PURPOSE: Our current study investigates the relationship between ABO blood groups and brain tumor incidence in the Jordanian pediatric population in a case-controlled manner. PATIENTS AND METHODS: This case-control study targeted pediatric primary brain tumor patients and tumor-free controls. Cases included patients younger than 18 when given a histologically confirmed diagnosis with a primary brain tumor, ascertained from two tertiary hospitals in Jordan. Controls were age- and gender-matched to cases and acquired from JUH pediatric clinics, with an exclusion for all patients with a personal history of tumors. Through using available records and calling guardians, our team obtained patients' and controls' blood groups. RESULTS: Our case control included 81 (35.4%) pediatric primary brain tumor patients and age- and gender-matched tumor-free controls 148 (64.6%). When compared to O blood group, patients with A and B blood groups were not at higher risk of developing pediatric primary brain tumors (P=0.742, P=1.000, respectively). However, Chi-square analysis revealed a 2.79-fold higher risk for pediatric primary brain tumors in AB blood group patients (P=0.024). Gender-specific analysis revealed a 3.42-fold higher risk for pediatric brain tumors in AB blood group males when compared to O blood group males. CONCLUSION: This work represents the first published study on the association between blood groups and pediatric brain tumors. With future research with larger samples and control of confounding factors, AB blood group may become a more established risk factor for pediatric brain tumors, aiding in screening.

Ancient Schwannoma affecting the intracranial portion of the trigeminal nerve: A case report.

BACKGROUND: Ancient trigeminal schwannomas are extremely uncommon benign tumors. Such tumors are longstanding, slow growing and may demonstrate seemingly malignant features irrespective of its benign nature. The tumor may involve the trigeminal nerve root, the trigeminal ganglion, or any of its peripheral branches. Its clinical presentation may include trigeminal neuralgia, blurry vision, diplopia, or even seizures. Surgical excision is the mainstay of treatment with definite diagnosis only by histopathology. CASE DESCRIPTION: We described a case of a 35-year-old female presenting with recurrent episodes of generalized seizure and left-sided weakness. Brain imaging showed a right temporal space occupying lesion. Results of histopathology were consistent with trigeminal schwannoma associated with ancient histopathological changes. Complete tumor excision was achieved by a two-stage craniotomy, which led to the patient's condition to dramatically improve. CONCLUSION: Ancient trigeminal schwannomas are easily diagnosed through histopathology and result in favorable clinical outcomes after total microscopic surgical excision. A high suspicion index of ancient schwannoma diagnosis should be derived from the patient's presenting clinical picture and the classical findings derived from neuroimaging.

Acute Macroglossia Post Craniotomy in Sitting Position: A Case Report and Proposed Management Guideline.

BACKGROUND: Macroglossia is a rare life-threatening postoperative complication in patients undergoing neurosurgical operations in a sitting position. It is difficult to identify the cause of macroglossia, which can be considered multifactorial in most patients. CASE PRESENTATION: We herein present a case of a 37-year-old female patient who was known to have a posterior occipital lesion (low-grade glioma with pilocytic features) and underwent occipital craniectomy followed by supratentorial approach for debulking of the tumor under general anesthesia in a sitting position. The patient developed upper airway edema along with extreme macroglossia immediately following extubation, with increasing difficulty in ventilation. Re-intubation was impossible, and urgent tracheostomy was performed. In the intensive care unit (ICU), the macroglossia worsened, and the patient developed sepsis with multi-organ failure and died 16 days postoperatively. CONCLUSION: Acute macroglossia can be a catastrophic postoperative complication, necessitating early identification and a systematic approach to this critical event, in addition to being fully prepared to deal with difficult airway should this complication occur.

Analysis of the Rate and Pattern of Ventriculoperitoneal Shunt Infection and Ventricular Catheter Culture Yield: A 10-Year Single-Institute Experience.

AIM: We aimed to study the rate and pattern of ventriculoperitoneal shunt (VPS) infections at the Jordan University Hospital (JUH) over 10 years and investigate the yield of ventricular catheter tip culture in the evaluation of shunt infection. PATIENTS AND METHODS: All patients operated on at our institution for ventriculoperitoneal shunt (VPS) insertion, reinsertion, and revision between 2009 and 2018 were included. Data (age, gender, pathology, and history of shunt infection) were collected from patients' files. Rates of infection and results of culture (cerebrospinal fluid and ventricular catheter tip) were obtained from laboratory records. RESULTS: According to our hospital database, 310 patients were eligible for this study. The rate of infection was 11.1% per ventriculoperitoneal procedure, and the most common -organism was coagulase-negative Staphylococcus (CoNS) which was the cause of infection in 51.4% of the cases. Twenty-one percent of proved shunt infection cases showed a positive ventricular catheter tip culture. CONCLUSION: The rate and pattern of shunt infections at our institution are comparable with the international figures and data. Methods of catheter tip culturing should be improved to increase the yield of this practice.

Psychometric testing of a short form, 11-item Tampa Scale of Kinesiophobia-Arabic version: TSK-AV-11.

To examine the psychometric properties of a short form TSK-AV in Arabic-speaking patients with chronic low back pain (CLBP).One hundred one CLBP patients recruited from Jordan University Hospital provided demographic information and completed the TSK-AV full version and measures of pain severity and disability. Explorative factor analysis was used to determine whether a generally accepted 2-factor model consisting of fewer TSK items applies to the TSK-AV and exhibits acceptable psychometric properties.A 2-factor model provided an adequate-to-good fit to our data, explaining 46.54% of the variance. Factor 1 (labeled as "activity avoidance") comprised items 1, 2, 7, 9, 14, 15, and 17. Factor 2 was labeled as "somatic focus" and comprised items 3, 6, 11, and 13. The 11-item TSK-AV comprised of the 2 factors (TSK-AV-11) as well as its subscales all remained independent significant (P < .001) predictors of pain disability in Jordanian patients with CLBP after accounting for factors such as age, gender, pain duration, and pain severity.The short, 11-item TSK-AV (TSK-AV-11) appears to be an ideal clinical and research tool for measuring fear of movement/re (injury) in Arabic-speaking patients.

Identification of Entamoeba histolytica in Patients with Suspected Amebiasis in Jordan Using PCR-based Assays.

BACKGROUND AND OBJECTIVE: Identification of Entamoeba histolytica (E. histolytica) by microscopy alone can be problematic because E. dispar and E. moshkovskii are morphologically similar to E. histolytica. Therefore, this study aimed to assess the performance of microscopy in the detection of E. histolytica in stool specimens with the help of PCR-based assays and enzyme-linked immunosorbent assay (ELISA). MATERIALS AND METHODS: Between September, 2017 and September, 2018, 200 stool specimens were obtained from Jordanian patients with suspected amebiasis. All specimens were subjected to microscopic analysis. DNA was extracted from the microscopy-positive stool samples. A conventional PCR and a duplex real-time PCR were performed to detect E. histolytica and E. dispar. RESULTS: By microscopy, 35% (70/200) of specimens were tested positive for Entamoeba complex. All 70 microscopic-positive Entamoeba complex samples were negative for the presence of E. histolytica by the NOVITEC® E. histolytica ELISA assay. All 70 samples positive by microscopy were negative for the presence of E. histolytica and E. dispar by PCR-based assays. CONCLUSION: We suspect some of these microscopy-positive stool specimens might contain a potentially novel species of Entamoeba that could not be detected by ELISA or PCR-based assays specific for E. histolytica and E. dispar. Diagnosis of amebiasis remains challenging here in Jordan and hence highlighting the need for improved diagnostic method.

The effects of caudal or intravenous dexmedetomidine on postoperative analgesia produced by caudal bupivacaine in children: a randomized controlled double-blinded study.

STUDY OBJECTIVES: The aim of this study was to compare the effects of caudal and intravenous (IV) dexmedetomidine (1 µg/kg) on postoperative analgesia after caudal bupivacaine in pediatric patients undergoing lower abdominal and perineal surgeries. DESIGN: A randomized controlled double-blind study. SETTING: University-affiliated teaching hospital. PATIENTS: Seventy-five American Society of Anesthesiologists I children, aged 1 to 6 years. INTERVENTION: Patients were randomly allocated to 3 groups. All patients received 1 mL/kg caudal 0.25% bupivacaine. In addition, those in group B (n=25) received 10-mL IV saline, those in group B-Dcau (n=25) received 1 µg/kg caudal dexmedetomidine and 10-mL IV saline, and those in group B-DIV (n=25) received 1 µg/kg IV dexmedetomidine in 10-mL saline. MEASUREMENTS: Intraoperative mean blood pressure, heart rate, peripheral oxygen saturation, end-tidal sevoflurane, and bispectral index as well as postoperative pain and behavior scores and time to first analgesia were assessed. MAIN RESULTS: Group B-Dcau had a significantly longer time to first rescue analgesia than groups B-DIV and B, with mean (SD) values of 14.4 (7.5), 9.18 (2.7), and 6.6 (2.5) hours, respectively (P<.05). Fewer patients in group B-Dcau (n=16) required rescue analgesia during the first 24 hours postoperatively compared to group B (n=24) and group B-DIV (n=20) (P<.05). Groups B-Dcau and B-DIV had lower pain and behavior scores than Group B. Eight patients Group B had agitation compared to 2 in Group B-DIV and 0 in Group B-Dcau. Four patients in Group B-DIV developed bradycardia and hypotension during surgery. CONCLUSIONS: Compared to IV administration, caudal administration of dexmedetomidine during caudal bupivacaine anesthesia provided prolonged postoperative analgesia and a greater analgesic sparing effect without significant side effects. This suggests a greater role of neuraxial compared to that of peripheral α-2 adrenoceptors in pain processing.