Absence Of Edema Research Articles

An innovative multicomponent compression system in a single bandage for venous leg ulcer and/or oedema treatment: a real-life study in 343 patients

Objective: This study aimed to evaluate the performance of an innovative multicomponent compression system in a single bandage (UrgoK1, Laboratoires Urgo, France) in the treatment of patients with venous leg ulcers (VLUs) and/or lower limb oedema in everyday practice. Method: A prospective, observational, clinical study with the evaluated compression system was conducted in 39 centres in Germany between March 2022 and July 2023. Main outcomes included a description of the treated patients, changes in wound healing and oedema progression, local tolerance and acceptability of the compression system. Results: In total, 343 patients were treated with the evaluated compression system for a mean period of 48±30 days; 196 had a VLU and 275 had oedema, mostly of venous origin. By the final visit, 49% of VLUs healed (75% in absence of oedema and 61% in VLUs of ≤1 month's duration). Oedema was completely resolved or greatly improved in 87% of patients, with significant reduction in calf and ankle circumferences. Improvement in pruritus, pain, age-related ankle mobility and skin changes were also reported in patients who experienced them at baseline. The system was judged ‘very easy’ to apply (median: 108 seconds, three times a week), ‘extremely useful’ and ‘very well accepted’ by most patients who reported an improvement in comfort compared with previous systems. Similar results were observed when patients and/or their relatives were involved in the bandage application between the study visits. During the study, three cases of local intolerance related to the system and five early terminations (unrelated to the system) were reported. Conclusion: These results are consistent with the previous clinical evidence available on this new compression system and further support its good efficacy, tolerability, acceptability and usefulness in the treatment of patients with VLUs and/or oedema. Declaration of interest: This study was supported by a grant from Laboratoires Urgo, France. EH, UM and LT are employees of Laboratoires Urgo. CS, TB, WK, MS and JD provide advisory and speaking services to pharmaceutical and other healthcare organisations including, but not limited to, Laboratoires Urgo. Data management and statistical analyses were conducted independently by INPADS GmbH, Germany.

Hemodialysis Intervention to Improve Patient Quality of Life in Mr. A with Chronic Renal Failure

Patients with chronic renal failure require treatment that can replace kidney function in the human body. One such treatment is hemodialysis, which aims to filter fluids, electrolytes, and metabolic waste in order to improve the patient's quality of life. This study aims to describe the nursing care provided to patients with chronic renal failure undergoing hemodialysis, with a focus on improving their quality of life. This research used a qualitative case study approach, with instruments such as observation sheets, interviews, and document analysis. The research subject was a patient, Mr. A, who was diagnosed with chronic renal failure at Gunung Jati General Hospital, Cirebon City. The results showed that the management of nursing problems such as ineffective renal perfusion and hypervolemia was successfully carried out, as indicated by the absence of edema, a more stable increase in body weight, and a decrease in serum creatinine levels. Despite the improvement, the patient still requires hemodialysis to maintain kidney function. This study confirms the importance of continuous care through hemodialysis in improving the quality of life of patients with chronic renal failure. The findings also highlight the important role of nursing interventions in managing complications and improving patient health outcomes.

In steroid-resistant nephrotic syndrome that meets the strict definition, monogenic variants are less common than expected

BackgroundIn patients with steroid-resistant nephrotic syndrome (SRNS), the presence of monogenic variants influences therapeutic strategies. Large cohort studies reported the detection of monogenic variants in approximately 30% of patients with SRNS. However, these cohorts included many patients, such as those with symptomatic proteinuria, who did not meet the strict diagnostic criteria for pediatric nephrotic syndrome (NS). Therefore, we investigated the proportion of causative monogenic variants detected in patients who strictly met the diagnostic criteria of SRNS and explored their clinical characteristics.MethodsWe examined pediatric SRNS cases with genetic analysis conducted in our hospital. Cases satisfying all of the following criteria were included: (1) age at onset 1–18 years, (2) serum albumin at onset ≤ 2.5 g/dl, (3) persistent heavy proteinuria, and (4) no complete remission after 4 weeks of steroid monotherapy.ResultsThe proportion of detected monogenic variants was 12% (22/185) among all patients. The proportion was only 7% (9/129) in patients with edema at disease onset compared with 38% (9/24) in those without (p < 0.0001). Monogenic variants were rare in patients with acute kidney injury associated with NS (1% (1/11)) or a history of complete remission (4% (2/51)).ConclusionsOur study revealed a monogenic cause in 12% of individuals with strictly defined SRNS, a much smaller proportion than previously reported. The presence or absence of edema at the onset was an important factor to distinguish SRNS with monogenic cause from SRNS without. Our results provide further evidence of the SRNS types attributable to monogenic causes.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

The Role of Magnetic Resonance Imaging in Risk Stratification of Patients with Acute Myocarditis.

Cardiac magnetic resonance (cMRI) is often used to diagnose acute myocarditis (AM). It is also performed after 6 months to monitor myocardial involvement. However, the clinical and predictive relevance of the 6-month cMRI is uncertain. We used cMRI to assess the morphology and heart function of patients with AM, the correlation between left ventricular remodeling and biomarkers of heart dysfunction and myocardial fibrosis, and the involvement of myocardial fibrosis initially and 6 months after the acute episode. We conducted a prospective study of 90 patients with the clinical suspicion of AM, where cMRI was performed within the first week after symptom onset and repeated after 6 months. Non-ischemic late gadolinium enhancement (LGE) was present in 88 (97.7%) patients and mainly involved the septum and inferior wall. cMRI at 6 months was associated with significantly reduced abnormalities of segmental kinetics (p < 0.001), myocardial edema (p < 0.001), presence of LGE (p < 0.05) and LGE mass (p < 0.01), native T1 mapping (p < 0.001), and presence of pericardial collection (p ≤ 0.001). At 6 months, signs of myocardial edema appeared in 34.4% of patients, and a complete cure (absence of edema and LGE) was found in 8.8% of patients. LGE disappeared in 15.2% of patients, and the mean number of myocardial segments involved decreased from 46% to 30%, remaining unchanged in 13% of patients. Patients with LGE without edema had a more severe prognostic condition than those with persistent edema. Patients with increased LGE extension on the control cMRI had a worse prognosis than those with modified or low LGE. The most significant independent predictive parameters for major cardiovascular events (MACEs) were LGE mass (adjusted OR = 1.27 [1.11-1.99], p < 0.001), myocardial edema (OR = 1.70 [1.14-209.3], p < 0.001), and prolonged native T1 (OR = 0.97 [0.88-3.06], p < 0.001). The mid-wall model of LGE and the presence of edema-free LGE were MACE-independent predictors. LGE, myocardial edema, and prolonged native T1 were predictors of MACEs. LGE does not necessarily mean constituted fibrosis in the presence of edema and may disappear over time. LGE without edema could represent fibrosis, whereas the persistence of edema represents active inflammation and could be associated with the residual chance of complete recovery. cMRI should be performed in all patients with AM at 6 months to evaluate progress and prognosis.

IMMU-13. TUMOR INFLAMMATION-ASSOCIATED NEUROTOXICITY (TIAN): A TOXICITY SYNDROME IN PATIENTS TREATED WITH IMMUNOTHERAPY FOR CENTRAL NERVOUS SYSTEM TUMORS

Abstract BACKGROUND Immunotherapies are increasingly being explored as potential therapeutic modalities for the treatment of central nervous system (CNS) tumors and have unique toxicity profiles. Toxicity syndromes such as cytokine release syndrome (CRS) and immune effector-cell associated neurotoxicity (ICANS) were identified through experiences with chimeric antigen receptor (CAR) T-cell therapies for B cell malignancies; the creation of grading scales for these toxicities standardized the reporting and enabled management. METHODS From our collective experiences in treating patients with immunotherapies for CNS tumors, we have identified a localized neurotoxicity syndrome, distinct from the systemic toxicities of CRS and ICANS, termed tumor inflammation-associated neurotoxicity (TIAN). RESULTS TIAN develops secondary to localized inflammation at the tumor site. From a mechanistic perspective, we identified two types of TIAN: 1) type 1 TIAN arises in the setting of mechanical space constraints when peritumoral edema results in tissue shifts and increased intracranial pressure, which if untreated, can lead to a life-threatening herniation syndrome and 2) type 2 TIAN occurs when local neuronal dysfunction causes transient worsening/new neurological deficits. Whereas type 1 TIAN encompasses the concept of “pseudoprogression,” type 2 TIAN can occur in the absence of edema when neural-immune interactions disrupt local neural function. Patients can have both type 1 and type 2 TIAN simultaneously; understanding the type of TIAN can inform management. To facilitate the uniform reporting and management of TIAN, we created a TIAN grading scale that applies to both types of TIAN. Although, type 1 TIAN is generally associated with higher-grade toxicity, high-grade type 2 TIAN can occur when local inflammation compromises respiratory or autonomic functions. CONCLUSIONS Recognizing TIAN as a distinct, local neurotoxicity syndrome is critical to guiding clinical management and prognostication when treating patients with CNS tumors with immunotherapies.

Prognostic factors of idiopathic hypereosinophilic syndrome: A nationwide survey in Japan.

Idiopathic hypereosinophilic syndrome (iHES) is a condition wherein persistent hypereosinophilia associated with end-organ damage occurs without any known causes. Due to the rarity of the disease, insufficient knowledge has been accumulated. We therefore conducted a retrospective, multicentre, nationwide survey on iHES in Japan. A total of 57 patients were identified. For 43 patients who received any treatment, all cases were first treated with corticosteroids. An eosinophil percentage of less than 30% in the bone marrow and the absence of oedema were identified as factors associated with steroid dependency. The 5-year overall survival was 88.2%, and five patients died during follow-up; factors associated with worse overall survival were age >50, haemoglobin <12 g/dL, activated partial thromboplastin time >34 s, the presence of dyspnoea, the presence of thrombotic tendency and the presence of renal failure. Given the rarity of fatalities in our cohort, time-to-next-treatment (TTNT) was further analysed; the presence of renal failure, splenomegaly and lung abnormalities were associated with worse TTNT. Our nationwide study not only demonstrated clinical characteristics and the outcome of patients with iHES but also for the first time revealed clinical factors associated with steroid dependency and duration of first-line corticosteroid efficacy.

Growth monitoring and nutritional outcome of severe acute malnutrition children in the presence and absence of edema: a facility based retrospective study

Background: Severe acute malnutrition (SAM) is the leading cause of death in children. SAM affects approximately 20 million preschool children, mainly in Africa and South Asia. Children with severe acute malnutrition and severe edema (+++) have an increased risk of death compared with children with severe acute malnutrition and no edema. This study evaluated the nutritional outcome of SAM patients in the presence and absence of edema. Methods: This retrospective study was conducted in malnutrition treatment centre, JK Lon Hospital attached with Govt Medical College, Kota from January 2021 to December 2022 on children of age 6 months to 59 months, with clinical diagnosis of severe acute malnutrition. Ethics committee approval was not required as the study was a retrospective observational study. Patients were divided into three categories, viz. recovered, defaulted and non-responders. Results: A total of 270 patients were selected for this study on the basis of date made available through past records. Of the total patients studied, 32.2% (87) had bilateral edema while the rest (183) were non edematous. From edematous arm, 79.9% children recovered, 9.1% defaulted, and 11% were non-respondents. Conversely, of those without oedema 55.7% recovered, 7.0% defaulted, and 37.3% were non-respondents. Conclusions: Severe acute malnutrition is a preventable and treatable cause of childhood morbidity and mortality. The determinants of SAM include illiteracy, low socio-economic status, malnourished mother, low birth weight, ignorance about specific nutritional requirements of infants and young children, repeated infections, etc. In this study, we documented that the edematous children in the study area had a better likelihood of recovery as compared to those with severe wasting.

Formulation and Development of Polyherbal Ointment containing Clerodendrum serratum, Solanum xanthocarpum, and Nyctanthes arbortristis Extracts and Assessment of Anti-inflammatory Activity in Carrageenan-Induced Paw Edema Model

In this study, our objective was to explore the phytochemical constituents of Clerodendrum serratum (CS), Solanum xanthocarpum (SX), and Nyctanthes arbortristis (NA) and evaluate their anti-inflammatory activity. Subsequently, we aimed to develop a polyherbal ointment formulation incorporating these extracts. The phytochemical screening of the CS extract showed carbohydrates, steroids, terpenoids, flavonoids, saponins, and tannins. Similarly, the SX extract exhibited the presence of all these constituents, along with the additional presence of alkaloids. The NA extract demonstrated the presence of alkaloids, tannins, glycosides, and flavonoids. CS roots exhibited notable inhibition of inflammation at the given doses and periods of 1 to 5 hours, surpassing the effectiveness of the standard anti-inflammatory drug, indomethacin. The polyherbal ointments were found to be greenish, non-transparent, and with acceptable pH. F3 formulation demonstrated excellent viscosity of 1200 cp, making it easy to apply on the skin. Furthermore, formulation F3 demonstrated exceptional spreadability, covering a diameter of 1.8 cm, surpassing the other formulations. Importantly, all polyherbal formulations were non-irritant when applied to the skin, as evidenced by the absence of edema or erythema upon application to rat skin. F3 formulation indicated no physicochemical variations in comparison to initial results in stability studies. Even after the 6-month stability study, the ointment formulation maintained a smooth and greenish consistency, signifying its durability and stability. These findings suggest that the developed polyherbal ointment formulation can be stored at room temperature without any additional requirements. Overall, this polyherbal ointment formulation represents a promising alternative approach to existing topical formulations for the effective treatment of inflammatory conditions.

Ameliorative effect of aqueous extract of Carica papaya Linn. leaves on Acetic acid induced Ulcerative Colitis in Male Albino Wistar rats

Ulcerative colitis (UC) manifests as chronic inflammation of the colon. The bowel inflammation is due to alteration in the immune response to gut micro flora, oxidative stress and hereditary genetic factors. Leaf extract of papaya Carica papaya Linn. contain vitamin A, C, alkaloids, saponins, glycosides, tannins and flavonoids which have antispasmodic, analgesic, antibacterial and antioxidant properties. The main aim of the study was to detect the efficacy of Carica papaya leaf extract (PLE) on ulcerative colitis in Wistar Albino rats with objectives to explore the possible mechanism involved in its efficacy and to look for prebiotic activity. The project was initiated after the approval of Institutional Animal Ethics Committee. Thirty adult Wistar rats were randomly assigned into seven groups of six rats each. Group I-control, Group II-UC disease control, Group III-Disease with standard Sulfasalazine 100mg/kg, Group IV and Group V, UC disease model receiving PLE of 250mg/kg and 500 mg/kg respectively. Ulcerative colitis was not induced in Group VI and Group VII which received PLE of 500mg/kg and 700 mg/kg respectively. All the drugs were administered orally for 15 days. UC was induced by acetic acid on the 8th day. Blood sample was collected for biochemical analysis for antioxidant levels. Histopathological analysis of distal colon was performed to look for inflammatory features. Microbial analysis was done for group VI and group VII. There was significant reduction in body weight in UC induced groups when compared to control. The weight loss in Group IV and V (PE1 and PE2) was not as extreme as seen in the UC alone group. The treatment groups IV and V showed significant increase in protein levels, increased catalase and decreased malondialdehyde levels when compared to Group I, II and III. On histopathological analysis, the severity and extent of inflammation was less in 500mg/kg dose of leaf extract (Group V) than 250mg/kg of leaf extract (Group IV) and 100mg/kg of sulfasalazine (Group III). Tissue sections of Group V showed only few inflammatory infiltrates with absence of oedema and crypt abscess in the submucosal area. On examining the pathogenic versus beneficial bacterial load in the control and Group VI (PE 3) and Group VII (PE 4), papaya leaf extracts depicted antibacterial property and probiotic activity. In the present study, 500mg/kg of papaya leaf extract was efficacious in relieving oxidative stress and reducing inflammation in acetic acid induced ulcerative colitis in rats. Carica papaya leaf extracts have a potential role to modify gut microbe with respect to its prebiotic activity.

P167 CARDIAC ARREST IN SUSPECTED LONG QT: APPROACH TO ARRHYTHMIC MITRAL VALVE PROLAPSE

Abstract Mitral valve prolapse is a common condition. It affects 1–3% of the population. Clinical manifestations range from the absence of symptoms to sudden cardiac death. The arrhythmogenic mechanism is related to fibrotic changes in myocardial posterior caused by valve prolapse. ECG abnormalities indicative of high risk are inverted or biphasic T waves, ST depression, QT prolongation or dispersion, and BEV originating from the left outflow tract or papillary muscles. The echocardiogram allows the identification of mitral prolapse and disjunction of the mitral annulus (MAD), while MRI shows fibrosis. ICD implantation should be considered in high–risk patients with documented ventricular arrhythmias. Clinical case A 29–year–old woman with a family history of sudden cardiac death reported a state of absolute well–being until September 2022 when she presented with syncope with referred pulse failure for which she underwent cardiac massage, without defibrillation, by family members. At the arrival of 118 the patient presented bigeminal ventricular extrasystole with superior axis and BBsx type morphology (Fig.1). When she arrived at the hospital, ECG showed long QT (484 ms) associated with hypokalemia (2.8 mmol / l). During hospitalization, the coronary angiography was normal, while the cardiac MRI showed a globular and dilated left ventricle with preserved EF, thickening of the mitral leaflets, prolapse of both leaflets more evident at the level of P2/P3, MAD more evident in P3 with separation maximum end–systolic of 12 mm and absence of edema (Fig. 2). The patient underwent ICD implantation. In the presence of hypertelorism, prognathism, and flat feet, even in the absence of anomalies affecting the aorta and epiaortic vessels, scarring defects or ease to joint sprain, genetic screening was started for channelopathies and collagen diseases. Conclusions The approach to the patient with cardiac arrest and typical facies must be based on a systemic overview of the patient, whose phenotypic characteristics may suggest involvement of connective tissue diseases. In the future, the cardiologist must develop adequate knowledge to fully collect the information that the patient provides not only during instrumental examinations but also during an adequate clinical objective examination and facies, possibly supported by artificial intelligence.

P316 CHEST PAIN: ONE, NONE AND A HUNDRED THOUSAND DIAGNOSES. A CASE REPORT

Abstract A 62–year–old woman, with a history of systemic hypertension, smoking habit and paroxysmal atrial fibrillation treated with Flecainide, was admitted to the ER of our Hospital for chest pain. She reported that the symptoms appeared after an emotional stress at work. Troponin I was of 895 pg/mL. The electrocardiogram showed: negative T waves in the inferior leads and an early repolarization pattern/ ST elevated in the antero–lateral leads. The patient underwent transthoracic echocardiography which showed: EF 45%, akinesia of the posterior and inferior segments of the septum. Invasive coronary angiography showed absence of lesions. CMR presented: EF 51% and mild hypokinesia of the mid septum and inferior segment; signs of oedema affecting the left ventricular myocardium in the apex, the mid inferior segment and in the lower apical wall, with subendocardial hypoperfusion layer in the mid inferior septum (microvascular dysfunction?). The patient was dismissed with the diagnosis of M.I.N.O.C.A. A month later, she was admitted again to our ER suffering from a new episode of acute chest pain; she also reported a short episode of atrial fibrillation (documented by an EKG) lasting about 10 minutes occurred the day before. The EKG showed: negative T waves in anterolateral leads. TnI was of 2052,5 pg/ml. The patient underwent a transthoracic echocardiogram which demonstrated: reduced global systolic function (EF 35%), akinesia of the apex, mid–anterior septum and mid– anterior wall. The day after the echo was repeated and it demonstrated a gaining of Vsx EF which was of approximately of 50%. Invasive coronary angiography showed absence of lesions. A methylergometrine test was negative for vasospasm on anterior descending artery. The CMR showed: EF 58%, signs of oedema in the basal and mid anterior wall, mid–anterior septum. LGE intra wall of the apical septum and of the basal part of the anterior wall (coronary spasm? Vasculitis?) Absence of edema. The final diagnosis was of Tako Tsubo. Discussion and conclusions This case offers the inspiration to reflect on differential diagnosis of chest pain with undamaged coronary arteries. In addition to this, it should be considered coronary emboli arisen through various mechanisms including left atrial appendage thrombi due to atrial fibrillation, so that also anticoagulation therapy is suggested as discharge treatment.

The Role of Manual Detorsion in Pediatric Testicular Torsion During the Global COVID-19 Pandemic: Experience From 2 Centres

To evaluate the role of emergency manual detorsion as first line management for testicular torsion in the context of the COVID-19 pandemic. This retrospective observational study includes 90 pediatric patients ≤14 years old with diagnosis of testicular torsion made at 2 tertiary centers between October 2020 and June 2022. Variables examined included age, presentation delay, surgical wait time, number of attempts at manual testicular detorsion, and manual testicular detorsion success. All patients finally underwent surgery, including contralateral testicular fixation. Outcomes included predictors of successful manual detorsion, testicular findings at surgery, and operation time. Mean (SD) age at diagnosis was 11.51 (2.64) years. Mean presentation delay was 11.76 (13.79) hours. Detorsion was attempted in 72 (80%) patients, resulting successful in 58 (80.5%). Surgical wait time after successful manual detorsion was 22.85 (16.94) hours. On multivariable analysis, successful manual detorsion was associated with a presentation delay<6 hours (odds ratios [OR] 0.154, 95% confidence intervals (CI) 0.036-0.655, P = 0.01) and absence of scrotal edema (OR 0.171, 95% CI 0.038-0.769, P = 0.02). Vice versa, a heterogeneous echo-texture (OR 0.57, 95% CI 0.007-0.461, P = 0.007) and absent blood flow on Doppler ultrasound scan (OR 0.256, 95% CI 0.067-0.971, P = 0.045) were significantly associated with the likelihood of manual detorsion failure. In our experience, manual detorsion provided safe and effective emergency treatment for pediatric testicular torsion, especially in absence of edema and when presentation delay is <6 hours. This maneuver should be more widely attempted immediately after diagnosis as temporizing rescue.

"SARCOPENIA MEASURED BY ULTRASOUND IN HOSPITALIZED OLDER ADULTS" (ECOSARC): multi-centre, prospective observational study protocol

BackgroundMeasurement of muscle mass and function, and thereafter, screening and diagnosis of sarcopenia, is a challenge and a need in hospitalized older adults. However, it is difficult in complex real-world old patients, because usually they are unable to collaborate with clinical, functional, and imaging testing. Ultrasound measurement of quadriceps rectus femoris (QRF) provides a non-invasive, real-time assessment of muscle quantity and quality, and is highly acceptable to participants with excellent inter-rater and intra-rater variability. However, normative data, protocol standardization, and association with longitudinal outcomes, needs further research and consensus.MethodsProspective exploratory multicenter study in older adults admitted to Acute Geriatric Units (AGUs) for medical reasons. 157 subjects from 7 AGUs of Spain were recruited between May 2019 and January 2022. Muscle ultrasound measurements of the anterior vastus of the QRF were acquired on admission and on discharge, using a previously validated protocol, using a Chieson model ECO2 ultrasound system (Chieson Medical Technologies, Co. Ltd, Wimxu District Wuxi, Jiangsu, China). Measurements included the cross-sectional area, muscle thickness in longitudinal view, intramuscular central tendon thickness, echogenicity, and the presence or absence of edema and fasciculations. Functional, nutritional, and DXA measurements were provided. Clinical follow-up was completed at discharge, and 30 and 90 days after discharge. Variations between hospital admission and discharge ultrasound values, and the relationship with clinical variables, will be analyzed using paired t-tests, Wilcoxon tests, or Mc Nemar chi-square tests when necessary. Prevalence of sarcopenia will be calculated, as well as sensitivity and specificity of ultrasound measurements to determine sarcopenia. Kappa analysis will be used to analyze the concordance between measurements, and sensitivity analysis will be conducted for each participating center.DiscussionThe results obtained will be of great interest to the scientific geriatric community to assess the utility and validity of ultrasound measurements for the detection and follow-up of sarcopenia in hospitalized older adults, and its association with adverse outcomes.Trial registrationNCT05113758. Registration date: November 9th 2021. Retrospectively registered.

Assessing the feasibility of mapping the tibialis anterior muscle with navigated transcranial magnetic stimulation in neuro-oncologic patients

Mapping the lower extremity with navigated transcranial magnetic stimulation (nTMS) still remains challenging for the investigator. Clinical factors influencing leg mapping with nTMS have not been fully investigated yet. The aim of the study was to identify factors which influence the possibility of eliciting motor evoked potentials (MEPs) from the tibialis anterior muscle (TA). Patient records, imaging, nTMS examinations and tractography were retrospectively evaluated. 48 nTMS examinations were performed in 46 brain tumor patients. Reproducible MEPs were recorded in 20 patients (41.67%). Younger age (p = 0.044) and absence of perifocal edema (p = 0.035, Cramer’s V = 0.34, OR = 0.22, 95% CI = 0.06–0.81) facilitated mapping the TA muscle. Leg motor deficit (p = 0.49, Cramer’s V = 0.12, OR = 0.53, 95%CI = 0.12–2.36), tumor entity (p = 0.36, Cramer’s V = 0.22), tumor location (p = 0.52, Cramer’s V = 0.26) and stimulation intensity (p = 0.158) were no significant factors. The distance between the tumor and the pyramidal tract was higher (p = 0.005) in patients with successful mapping of the TA. The possibility to stimulate the leg motor area was associated with no postoperative aggravation of motor deficits in general (p = 0.005, Cramer’s V = 0.45, OR = 0.63, 95%CI = 0.46–0.85) but could not serve as a specific predictor of postoperative lower extremity function. In conclusion, successful mapping of the TA muscle for neurosurgical planning is influenced by young patient age, absence of edema and greater distance to the CST, whereas tumor entity and stimulation intensity were non-significant.

Clinical and cardiovascular magnetic resonance predictors of early and long-term clinical outcome in acute myocarditis

Abstract Background/Introduction The natural history of acute myocarditis (AM) remains partially unknown and predictors of outcome are debated. Purpose We sought to assess the impact of various cardiac magnetic resonance (CMR) parameters on early and long-term prognosis in a population of patients with AM. Methods In a two-centre longitudinal study, we included consecutive patients with diagnosis of AM based on CMR and without haemodynamic compromise. The primary endpoint was the occurrence of an event in the acute phase (≤15 days). Secondary endpoints were the occurrence of major adverse cardiac events (MACE) and recurrence of AM during follow-up. Results Three hundred and eighty-eight patients were included (mean age 38.5 years, 77.3% male, mean ejection fraction [EF]:56%) of which 82% (317) presented with chest pain. CMR was performed 4±2 days after index presentation. Overall, 38 patients (9.8%) had an event at the acute phase, 41 (10.6%) presented at least one MACE during follow-up (median 7.5 years, 6.6–8.9) and 30 (7.7%) experienced a recurrence of AM. By multivariate analysis, the independent predictors of initial complications were absence of chest pain (OR [95% CI] = 0.35 [0.15–0.82]), presence of syncope/pre-syncope (OR [95% CI] = 3.56 [1.26–10.02]), lower EF (OR [95% CI] = 0.94 [0.91–0.98] per %), myocardial extent of late gadolinium enhancement (LGE) (OR [95% CI] = 1.05 [1.002–1.100] per %) and absence of edema (OR [95% CI] = 0.44 [0.19–0.97]). Only age (HR [95% CI] = 1.021 [1.001–1.041] per year) and an initial alteration of EF (HR [95% CI] = 0.94 [0.91–0.97] per %) were associated with MACE during follow-up. Factors independently associated with AM recurrence were myocarditis prior to the index episodes (HR [95% CI] = 5.74 [1.72–19.22]) and viral syndrome at the index episode (HR [95% CI] = 4.21 [1.91–9.28]). Conclusion In routine consecutive hemodynamically stable patients with diagnosis of AM based on CMR, absence of edema, reduced EF, and extent of LGE were associated with early adverse outcome. Only age and EF were associated with long-term events. Funding Acknowledgement Type of funding sources: None.

Misclassification rate of the angiographically identified culprit lesion in NSTEMI

Abstract Background Correct identification of the culprit lesion in NSTEMI is essential, in particular for patients in whom a culprit-only strategy is attractive (e.g., elderly and frail patients). However, when identifying the culprit lesion in NSTEMI, angiography can be ambiguous and correct culprit identification can therefore be challenging when based on angiography, ECG- and echocardiographic changes alone (standard-of-care). In fact, this challenge remains unresolved and is a continuous limitation in guidelines and in the few clinical trials investigating the revascularization strategy in NSTEMI. Purpose We aimed to investigate the agreement between angiography and cardiac magnetic resonance (CMR) and optical coherence tomography (OCT) in identifying the culprit lesion in non-ST segment elevation myocardial infarction (NSTEMI). Methods In two centres we prospectively enrolled 104 patients. CMR was performed prior to angiography. Operators, blinded to CMR, identified a culprit lesion based on angiography and standard-of-care. OCT was subsequently performed on operator-suspected culprit lesions and stenoses ≥50% diameter. CMR and OCT were reviewed blinded to angiographic culprit identification. Myocardial oedema on CMR was considered the reference standard for a culprit. In the absence of oedema, OCT was used. In case of multiple suspected OCT-lesions, hierarchical criteria for culprit identification were used: acute thrombus &amp;gt; plaque rupture with a cavity &amp;gt; organising thrombus &amp;gt; dissection &amp;gt; calcific nodule. Results The majority of included patients were male (75%) at a mean 63 years of age. Obstructive disease was observed in 85 (82%) patients, of which 53 (51%) had multivessel disease. On a patient-level, angiography identified a culprit lesion in 90 (87%) patients, of which CMR/OCT only identified a culprit in 74 (82%) patients. This constituted a moderate overall positive predictive value of angiography, which was found inferior to CMR/OCT in identifying the culprit lesion. On a lesion-level, CMR/OCT identified a different culprit lesion than angiography in 12 (16%) patients. Of these, only one patient did not receive revascularization of the true culprit lesion. Moreover, in the 14 patients without an angiographic culprit, CMR/OCT identified a culprit in 7 (50%) patients. Thus, angiography including standard-of-care falsely identified the culprit lesion in overall 35 (34%) patients: 7 false negatives, 16 false positive at patient-level, and 12 misclassified angiographic culprits on lesion-level (Figure 1). Specifically, OCT identified 13% misclassified culprit lesions in proximal segments, and provided an added diagnostic value. Conclusions Angiography misclassified the culprit lesion in one in three patients with NSTEMI with respect to both presence and location. OCT complemented angiography in ambiguous cases which underscores the value of OCT in aiding treatment and diagnosis in NSTEMI. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Research Grant at Rigshospitalet, Copenhagen University Hospital, DenmarkNovo Nordisk Foundation, Denmark

Gastroprophylactic Effects of p-Cymene in Ethanol-Induced Gastric Ulcer in Rats

The prevalence of gastric ulcers has increased in recent years, mainly because of non-steroidal anti-inflammatory drug utilization. Therefore, the current study investigates the gastroprotective effect of p-Cymene on absolute ethanol-induced acute gastric mucosal hemorrhagic lesions in rats. Thirty Sprague Dawley rats were randomly separated into five groups: normal control, ulcer control, reference, and two experimental groups. The normal and ulcer control groups were orally fed with 0.5% carboxymethylcellulose (CMC). The reference group was fed orally with 20 mg/kg omeprazole. The experimental groups were fed with 30 mg/kg and 60 mg/kg p-Cymene, respectively. After one hour, the normal group was fed with 0.5% CMC, and groups 2–5 were given absolute alcohol. After another hour all rats were sacrificed. The ulcer control group showed severe superficial hemorrhagic gastric mucosal lesions with decreased gastric mucus secretion and pH of gastric content. p-Cymene significantly reduced ethanol-induced gastric lesions, as evidenced by increased mucus and pH of gastric content, decreased ulcer area, reduced or absence of edema, and leucocyte infiltration of the subcutaneous layer. In gastric mucosal homogenate, p-Cymene displayed a significant increase in superoxide dismutase (SOD), catalase (CAT) activities, prostaglandin E2 (PGE2), and significantly reduced the malondialdehyde (MDA) level. In addition, p-Cymene increased the intensity of periodic acid–Schiff (PAS) stain of the gastric epithelium, and produced up-regulation of the HSP 70 protein and down-regulation of the Bax protein of the stomach epithelium, as well as a reduction in the levels of tumor necrotic factor-alpha and interleukin-6, while the level of interleukin-10 was increased. p-Cymene decreased the level of TNF-a and IL-6, and increased the level of IL-10. Acute toxicity with a higher dose of 500 mg/kg p-Cymene did not manifest any toxicological signs in rats and could enhance defensive mechanisms against gastric mucosal lesions. p-Cymene showed gastroprotective effects that could be attributed to its antioxidant nature, or its ability to increase mucus secretion, increase endogenous enzymes (SOD, CAT, PGE2), reduce MDA level, up-regulate HSP 70 protein, down-regulate Bax protein, and modulate inflammatory cytokines.

Diamagnetic Therapy in a Patient with Complex Regional Pain Syndrome Type I and Multiple Drug Intolerance: A Case Report

Complex regional pain syndrome (CRPS) is a neurologic chronic pain condition hard to diagnose and treat, and able to significantly impact the quality of life. Currently, the available multimodal, individualized treatments (i.e., pharmacological and non-pharmacological therapies including invasive procedures) are aimed only at symptom control. Herein, we report a 69-year-old Caucasian female who came to our attention due to a 3-year history of severe (10/10) burning pain in her right ankle, along with oedema and local changes in skin color and temperature, which occurred after the ankle sprain. Previous pharmacological attempts failed due to multiple drug intolerance. Clinical examination confirmed the CRPS type I diagnosis, and a weekly diamagnetic therapy protocol was started since the patient refused further medications and interventional procedures. After 10 weeks of treatment, a significant (p &lt; 0.01) reduction in pain severity and absence of oedema (difference in ankles’ circumference: from 3 cm to 0) were observed, with consequent improvements in quality of life and no adverse events. Although high-quality clinical evidence is still lacking, our case report suggests further investigating the potential use of diamagnetic therapy as a non-invasive and safe adjunctive treatment for CRPS, and as an alternative when patients did not benefit from drugs and/or refuse invasive procedures.

Clinical and Cardiovascular Magnetic Resonance Predictors of Early and Long-Term Clinical Outcome in Acute Myocarditis.

IntroductionThe natural history of acute myocarditis (AM) remains partially unknown and predictors of outcome are debated. We sought to assess the impact of various cardiac magnetic resonance (CMR) parameters on early and long-term prognosis in a population of patients with AM.Materials and MethodsIn a two-center longitudinal study, we included consecutive patients with diagnosis of AM based on CMR and without hemodynamic compromise. The primary endpoint was the occurrence of an event in the acute phase (≤15 days). Secondary endpoints were the occurrence of major adverse cardiac events (MACE) and recurrence of AM during follow-up.ResultsThree hundred and eighty-eight patients were included [mean age 38.5 years, 77.3% male, mean ejection fraction (EF):56%] of which 82% (317) presented with chest pain. CMR was performed 4 ± 2 days after index presentation. Overall, 38 patients (9.8%) had an event at the acute phase, 41 (10.6%) presented at least one MACE during follow-up (median 7.5 years, 6.6–8.9) and 30 (7.7%) experienced a recurrence of AM. By multivariate analysis, the independent predictors of initial complications were absence of chest pain (OR [95%CI] = 0.35 [0.15–0.82]), presence of syncope/pre-syncope (OR [95%CI] = 3.56 [1.26–10.02]), lower EF (OR [95%CI] = 0.94 [0.91–0.98] per%), myocardial extent of late gadolinium enhancement (LGE) (OR [95%CI] = 1.05 [1.002–1.100] per%) and absence of edema (OR [95%CI] = 0.44 [0.19–0.97]). Only age (HR [95%CI] = 1.021 [1.001–1.041] per year) and an initial alteration of EF (HR [95%CI] = 0.94 [0.91–0.97] per%) were associated with MACE during follow-up. Factors independently associated with AM recurrence were myocarditis prior to the index episodes (HR [95%CI] = 5.74 [1.72–19.22]) and viral syndrome at the index episode (HR [95%CI] = 4.21 [1.91–9.28]).ConclusionIn routine consecutive hemodynamically stable patients with diagnosis of AM based on CMR, absence of edema, reduced EF, and extent of LGE were associated with early adverse outcome. Only age and EF were associated with long-term events.

Nutrition status and morbidity of Ethiopian children after recovery from severe acute malnutrition: Prospective matched cohort study.

After recovery, children with severe acute malnutrition (SAM) remain vulnerable to sub-optimal growth and malnutrition relapse. Although there is an increased interest in understanding these problems, data are scarce, and contextual factors can cause variability. We prospectively followed a cohort of Ethiopian children (215 post-SAM cases and 215 non-wasted controls), monthly for one year. The post-SAM cases were: age 6-59 months at admission into the community management of acute malnutrition (CMAM) program and being successfully discharged from CMAM (MUAC>11.0cm, weight gain of 20%, absence of oedema and clinically stable for two consecutive weeks). The controls were apparently healthy children from same village who had no history of an episode of AM and were matched 1:1 to a post-SAM child by age and sex. The primary outcomes were: cumulative incidence of acute malnutrition; growth trajectory; cumulative incidence of reported common morbidities, and cumulative proportion and incidence of deaths. The burden of common morbidities was higher among post-SAM than controls; post-SAM children had more frequent illness episodes (Incidence Rate Ratio of any illness 1.39, 95% CI: 1.14, 1.71; p<0.001). The prevalence of SAM was consistently higher among post-SAM cases than the control group, having a 14 times higher risk of developing SAM (Incidence Rate Ratio: 14.1; 95% CI: 3.5, 122.5; p<0.001). The divergence in weight and growth trajectory remained the same during the study period. Our results advocate for the design of post-discharge interventions that aim to prevent the reoccurrence of acute malnutrition, reduce morbidity and promote catch-up growth. Research is needed to define the appropriate package of post-discharge interventions.