Utility of Flexion and Extension MRI for Evaluating Isolated Cervical Spinal Cord Lesions: A Case Series.

The diagnosis of isolated spinal cord lesions is often challenging in clinical practice, and it is not uncommon for the etiology of such isolated lesions to remain unclear despite extensive workup and investigations. Magnetic resonance imaging (MRI) is extensively utilized for assessing spinal cord disease, despite certain radiological patterns suggesting certain pathologies, diagnostic uncertainty remains. Development of adjunct tests and techniques, radiographic or otherwise, is needed. Here, we present two cases in which flexion-extension cervical spine MRIs improved diagnostic ability by demonstrating dynamic cervical cord compression as an etiology for isolated intramedullary cervical spinal cord lesions.

On a finite strain modeling of growth in budding yeast.

Cell's ability to proliferate constitutes one of the most defining features of life. The proliferation occurs through a succession of events; the cell cycle, whereby the cell grows and divides. In this paper, focus is made on the growth step and we deal specifically with Saccharomyces cerevisiae yeast that reproduces by budding. For this, we develop a theoretical model to predict the growth powered by the turgor pressure. This cell is herein considered as a thin-walled structure with almost axisymmetrical shape. Due to its soft nature, the large deformation range is a priori assumed through a finite growth modeling framework. The used kinematics is based on the multiplicative decomposition of the deformation gradient into an elastically reversible part and a growth part. Constitutive equations are proposed where use is made of hyperelasticity together with a local evolution equation, this latter to describe the way growth takes place. In particular, two essential parameters are involved: a stress-like threshold, and a characteristic time. The developed model is extended to a shell approach as well. In a finite element context, representative numerical simulations examining stress-dependent growth are given and a parametric study is conducted to show the sensitivity with respect to the above mentioned parameters. Finally, a suggestion for natural contractile ring modeling closes this study.

Beyond Pain Relief: Is Opioids Use Safe in Clostridium difficile Infection?

BACKGROUND: Clostridium difficile infection (CDI) is a common condition in hospitalized patients. In the USA, there has been an alarming rise in the use of opioids for analgesia during hospitalization. Due to their antiperistalsis effect, opioids can increase absorption of bacterial toxins. Our study aimed to highlight any correlation between opioids use in CDI and morbidity, mortality, and duration of hospitalization. METHODS: A retrospective study was performed, and data were collected from 321 hospitalized patients with CDI. The dosage of opioids received in the first 4 days following diagnosis was calculated. Patients were divided into two groups (control group vs. opioid group). Reassessment of severity of disease on day 4 was performed. Complications, hospital mortality, readmissions for CDI within 3 months, length of stay, and disposition at discharge were compared. RESULTS: The opioid arm consisted of 169 patients, and 152 patients served as controls. On day 4, the number of patients with severe disease was significantly higher in the opioid group versus controls (78 (46.1%) vs. 37 (24%), respectively, P < 0.01), and complications including ileus, high white blood cell count, and need for vasopressors were significantly higher in the opioid group (27.8% versus 16.4%, P = 0.01). Control group patients were more likely to be discharged home (47% vs. 33%, P = 0.04), while opioid group required predominantly long-term facilities care after discharge. CONCLUSION: Opioid usage for analgesia in CDI increases the risk for severe disease, complications, longer hospitalization, readmission rates, hospital mortality and discharge to a long-term facility.

Risk of Serious Bleeding with Antiplatelet Therapy for Secondary Prevention Post Ischemic Stroke in Middle East Population.

Introduction Stroke is a devastating disease, causing significant mortality and long-term disability worldwide. Since the bulk of ischemic strokes is attributed to atherothrombosis, secondary prevention with antiplatelet agents is essential to decrease the recurrence of stroke. Aspirin, as well as clopidogrel monotherapy, has been shown to reduce the relative risk of recurrent stroke. However, concerns regarding the efficacy and safety of dual antiplatelet approach still exist. Stroke patients are particularly susceptible to bleeding complications, which might be due to advanced age and comorbidities. Our study assessed the risk of serious bleeding among adult patients on antiplatelet therapy for secondary prevention after stroke who were admitted to Mount Lebanon Hospital (MLH) between 2010 and 2015. It also studied the effect of the antiplatelet therapy, including dose and combination in increasing the risk of bleed. Methods A retrospective monocentric study included 454 patients who were admitted for ischemic cerebrovascular accident (CVA) between 2010 and 2015, and discharged on antiplatelet therapy for secondary prevention. Those patients' records were followed to assess the percentage of patients who developed a major bleed after initiation of antiplatelet therapy. Results The risk of serious bleed was highest with aspirin 100 mg monotherapy and dual antiplatelet therapy (DAPT) (Aspirin 100 mg + Clopidogrel 75 mg). Bleeding risk was high during the first three months of therapy. However, the highest risk of bleed exists during the duration extending between three months and one year for both aspirin 100 mg monotherapy and DAPT. Moreover, there was an established relation between patients' related factors and bleeding risk. Advanced age and smoking were found to contribute to increasing this risk. Conclusion Aspirin 100 mg monotherapy and DAPT are associated with the highest risk of bleeding. Although this exists regardless of the duration of antiplatelet therapy, it is highest during the duration extending between three months and one year post initiation of antiplatelet therapy.

Gastroduodenal Artery Pseudoaneurysm Rupture Post-Billroth II Surgery: Case Report.

Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are defined as more than a 1.5 fold increase in the normal diameter of the celiac, superior, or inferior mesenteric arteries and their branches. They represent a rare finding with an incidence ranging between 0.1% to 0.2%. Depending on the mechanism of formation, aneurysms can be divided into true aneurysms or pseudoaneurysms. True aneurysms involve all layers of the wall, which are usually thinned but remain intact and commonly result from vessel wall abnormalities. However, pseudoaneurysms occur after vascular injuries or nearby inflammatory process causing a tear in the vessel wall. Pancreatitis is the most common cause of pseudoaneurysm. Nevertheless, other conditions, such as autoimmune disorders, vascular interventions, laparoscopic cholecystectomy, and even hepatic transplantation, have been reported to increase the risk of pseudoaneurysm formation. Herein, we are reporting a case of a gastroduodenal artery pseudoaneurysm rupture in a patient with altered anatomy secondary to Billroth II surgery.

The pharmacoepigenetics of drug metabolism and transport in breast cancer: review of the literature and in silico analysis.

The focus of this manuscript is on DNA methylation and miRNA regulation of drug-metabolizing enzymes and drug transporters involved in the disposition of drugs commonly used in breast cancer. We start with a review of the available scant literature and follow with an in silico analysis of the CpG islands and miRNA binding sites of genes of interest. We make the case that there is room for further research to include more genes and miRNAs despite the extensive sharing of miRNA targets by candidate genes of interest. We also stress on the role of peripheral blood as a source of pharmacoepigenetic biomarkers, and point out the lack of toxicoepigenetic studies in breast cancer.

Pharmacogenovigilance: a pharmacogenomics pharmacovigilance program.

In this report, we review the importance of pharmacovigilance in detecting postmarketing adverse drug events and the potential for developing pharmacogenovigilance programs by integrating pharmacogenomics with pharmacovigilance. We propose to start developing such a program in primary healthcare systems that use basic features of electronic medical records and have access to large numbers of patients commonly prescribed drugs. Such programs, if carefully designed, may grow over time and hopefully enhance the collection and interpretation of useful data for the clinical applications of pharmacogenomics testing.