A clinical review of hand manifestations of cervical myelopathy, cervical radiculopathy, radial, ulnar, and median nerve neuropathies.

Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or stiffness of the neck, and difficulty walking due to loss of balance. Brachial plexus (BP) neuropathies arise due to compression to any distal branches arising from C5-T1, whereas cervical radiculopathy involves compression at the nerve root in the neck. Such conditions can present with variable degrees of musculoskeletal pain, weakness, sensory changes, and reflex changes. The pronounced convergence in symptomatic manifestation within these conditions can pose a formidable challenge to clinicians, particularly in primary care. Thus, the primary objective of this paper is to enhance clarity and distinction among these pathological conditions. This objective is pursued through comprehensive delineation of the dermatomal and myotomal distributions characteristic of each condition. Furthermore, a meticulous examination is undertaken to elucidate physical indicators and maneuvers that exhibit a notably high sensitivity in detecting these conditions. Accurate diagnosis and treatment of each nerve pathology is important as long-term spinal cord compression and its roots may result in permanent disability and severely impact one's quality of life. As such, this systematic review serves as a guide that aids clinicians in differentiating the aforementioned conditions based on anatomy, physical exam findings, and imaging studies. Furthermore, this study aims to outline common peripheral nerve neuropathies in the upper extremities and ways to mitigate these pathologies using the least to most invasive treatment modalities.

Novel Model of Oxalate Diet-Induced Chronic Kidney Disease in Dahl-Salt-Sensitive Rats.

Diet-induced models of chronic kidney disease (CKD) offer several advantages, including clinical relevance and animal welfare, compared with surgical models. Oxalate is a plant-based, terminal toxic metabolite that is eliminated by the kidneys through glomerular filtration and tubular secretion. An increased load of dietary oxalate leads to supersaturation, calcium oxalate crystal formation, renal tubular obstruction, and eventually CKD. Dahl-Salt-Sensitive (SS) rats are a common strain used to study hypertensive renal disease; however, the characterization of other diet-induced models on this background would allow for comparative studies of CKD within the same strain. In the present study, we hypothesized that SS rats on a low-salt, oxalate rich diet would have increased renal injury and serve as novel, clinically relevant and reproducible CKD rat models. Ten-week-old male SS rats were fed either 0.2% salt normal chow (SS-NC) or a 0.2% salt diet containing 0.67% sodium oxalate (SS-OX) for five weeks.Real-time PCR demonstrated an increased expression of inflammatory marker interleukin-6 (IL-6) (p < 0.0001) and fibrotic marker Timp-1 metalloproteinase (p < 0.0001) in the renal cortex of SS-OX rat kidneys compared with SS-NC. The immunohistochemistry of kidney tissue demonstrated an increase in CD-68 levels, a marker of macrophage infiltration in SS-OX rats (p < 0.001). In addition, SS-OX rats displayed increased 24 h urinary protein excretion (UPE) (p < 0.01) as well as significant elevations in plasma Cystatin C (p < 0.01). Furthermore, the oxalate diet induced hypertension (p < 0.05). A renin-angiotensin-aldosterone system (RAAS) profiling (via liquid chromatography-mass spectrometry; LC-MS) in the SS-OX plasma showed significant (p < 0.05) increases in multiple RAAS metabolites including angiotensin (1-5), angiotensin (1-7), and aldosterone. The oxalate diet induces significant renal inflammation, fibrosis, and renal dysfunction as well as RAAS activation and hypertension in SS rats compared with a normal chow diet. This study introduces a novel diet-induced model to study hypertension and CKD that is more clinically translatable and reproducible than the currently available models.

Comparison of clinical features, management, and outcomes between children and adolescents diagnosed with multi-system inflammatory syndrome in children.

Background: The present study aimed to compare clinical features, management, and outcomes between children and adolescents admitted as cases of multi-system inflammatory syndrome in children (MIS-C) in Indira Gandhi Medical College (IGMC), Shimla. Material and Methods: We conducted a cross-sectional study for MIS-C from January to July 2021, in the pediatric ward of IGMC in Himachal Pradesh. All children admitted with a diagnosis of MIS-C were included in the study. Data regarding socio-demographic factors, clinical features, and treatment modalities were extracted and analyzed using Epi Info V7 software. Results: A total of 31 children diagnosed as cases of MIS-C were included. The mean age was 7.12 ± 4.78 years. 71% were in group 0-10 years, followed by 29% in 11-18 years. Although the duration of hospital stay, mortality, and Kawasaki disease cases were more in children as compared to adolescents, the difference was not significant. Similarly, fever, rash, cough, hematemesis, tachypnea, respiratory distress, hypotension, vomiting, bleeding diathesis, hematuria, seizure, encephalopathy, hepatomegaly, splenomegaly, and lymphadenopathy were greater in children as compared to adolescents but were not significant. Likewise, abnormalities in various biochemical, hematological, inflammatory, and cardiac markers were deranged to a greater extent in children as compared to adolescents, but there was no significant difference. The need for various treatment modalities such as IVIG, methylprednisolone, low-molecular weight heparin, aspirin, respiratory Support, O2, ventilatory support, and inotropic support was more in children as compared to an adolescent, but there was no significant difference. Conclusion: There was no significant difference in socio-demographic factors, clinical presentation, diagnostic test, mode of treatment, duration of stay, and mortality among children and adolescents.