Definite Cause Research Articles

Stapled Transanal Resection of Rectum (STARR) Procedure for Obstructed Defecation Syndrome Caused by Rectocele and Rectal Intussusception: An Initial Experience

Background: Obstructed defecation syndrome (ODS) is a troublesome condition for the patient which affect the quality of life. It is difficult to determine the single effective modality of treatment of ODS. Though ODS is more common in the women than men, rate of diagnosis of ODS in female is lower due to shyness of patient to visit to doctor. Objective: Study was conducted to see the effectiveness of stapled transanal resection of rectum (STARR) procedure for obstructed defecation syndrome caused by internal rectal prolapse and anorectocele. Methods: This prospective study was done including 37 patients (female 35 and male 02). These patients had undergone STARR procedure from January 2015 to September 2023 in Rangpur medical college and two private hospitals. Only those patients had undergone STARR procedure who suffered from ODS due to internal rectal prolapse or rectocele and failed to response to adequate first line medical therapeutics. Patients were diagnosed by careful evaluation of history, Longo's ODS score, DRE, proctoscopy, colonoscopy, cinedefecography and MR defecography. Patients were followed up at 1, 3 and6 months after surgery. During follow up patientssatisfaction was evaluated by comparing preoperative and postoperative score. Results: Average time needed for each procedure was 45±10 minutes and average hospital stay was 4 days. No patient needed readmission for any complication, but 3 patients came back for minor bleeding, 3 patients for increasing frequency of defecation and 1 patient for persistent anal pain where no definite cause was detected. At 6 months follow up significant improvement in Longo's ODS score, constipation score and quality of life was observed. Mean Longo’s ODS score was 15.75±1.98 and 7.05±5.70 at preoperative and six months post operative folowup respectively (p=<0.001). Conclusion: STARR may be a safe and effective treatment modality for ODS due to internal rectal prolapse or rectocele, if done with appropriate indication and adequate skill. Patient selection is crucial point in achieving better postoperative outcome. Long term postoperative follow up is needed to make clear cut comment on STARR procedure for internal rectal prolapse or rectocele associated ODS. J Rang Med Col. September 2024; Vol. 9, No. 2: 38-43

Clinical application value of simultaneous plasma and bronchoalveolar lavage fluid metagenomic next generation sequencing in patients with pneumonia-derived sepsis

BackgroundDespite the increasing use of metagenomic next-generation sequencing (mNGS) in sepsis, identifying clinically relevant pathogens remains challenging. This study was aimed to evaluate the clinical utility of simultaneous plasma and bronchoalveolar lavage fluid (BALF) detection using mNGS.MethodsThis retrospective study enrolled 95 patients with pneumonia-derived sepsis (PDS) admitted to the intensive care unit (ICU) between October 2021 and January 2023. Patients were divided into two groups: mNGS group (n = 60) and the non-mNGS group (n = 35), based on whether simultaneous plasma and BALF mNGS were conducted. All patients underwent conventional microbiological tests (CMT), including bacterial/fungal culture of peripheral blood and BALF, as well as sputum culture, detection of 1, 3-beta-D- glucan in BALF and RT-PCR testing. The clinical data of the enrolled patients were collected, and the detection performance and prognosis of plasma mNGS, BALF mNGS and CMT were compared.ResultsThe mNGS group exhibited a lower mortality rate than the non-mNGS group (35.0% vs. 57.1%, P = 0.034). Simultaneous detection in dual-sample resulted in a higher proportion of microorganisms identified as definite causes of sepsis alert compared to detection in either plasma or BALF alone (55.6% vs. 20.8% vs. 18.8%, P<0.001). Acinetobacter baumannii, Stenotrophomonas maltophilia, Candida albicans, and human mastadenovirus B were the primary strains responsible for infections in PDS patients. Patients with lower white blood cells and neutrophil indices had a greater consistency in dual-sample mNGS. Patients in the mNGS group had more antibiotic adjustments compared to the non-mNGS group (85.71% vs. 33.33%, P<0.001). The percentage of neutrophils was a risk factor for mortality in PDS patients (P = 0.002).ConclusionDual sample mNGS has the advantage of detecting and determining the pathogenicity of more pathogens and has the potential to improve the prognosis of patients with PDS.

AI neurotechnology compatibility with Alzheimers Disease Treatment: A Review

Alzheimers Disease (AD) is one of the most ordinary kind of dementia, yet no definitive cause or cure for it is found. Currently, there are only developments in drugs or technology that can slowly help to minimize the symptoms of AD through treatment or aid in the diagnosis of this disease. The main problem is that the treatment and diagnosis of AD administered through medical professionals are prone to errors. This has created a need for methods that make the process of diagnosing AD and concluding the most effective treatment both efficient and highly accurate. This brings focus to studies in AD, more specifically neurotechnology that uses Artificial Intelligence (AI) to aid in diagnosis and process of treatment. AI has the potential to diagnose and can even work hand in hand with different AD treatments, as it is expected to analyze the best approach for individual patients for course of treatment which could lead to the cure of Alzheimers. Studies on Neurotechnologies that use AI, such as systems like Machine Learning, Deep Learning, and have yielded promising results of the potential accuracy of these systems, proving its ability to diagnose AD with high accuracy while being more efficient. With the wide variety of potential treatments of AD, it is in these situations where AI neuro technology can play a role in the deciding factor of treatment. This paper will be a comparison on these diverse types of AI systems, and which may be the best in terms of diagnosis and treatment of AD.

Factors influencing the variability in performance of cattle grazing tropical pasture

Context Whereas it is known that there is variation in liveweight gain (described as performance in this paper) within a group of grazing cattle, the causes of this variation are not well understood. Aim A 2-year grazing study in northern Queensland was conducted to understand the relative influence of diet selection, grazing behaviour and rumen fermentation on variation in performance of growing cattle. Methods Eighty-nine Bos taurus × B. indicus (~6 months old) growing steers were grazed as a group on mixed tropical pasture for 23 months. Pasture was characterised for biomass, species and nutrient composition. Cattle were ranked according to overall liveweight (LW) gain and the top (high performance, HP) 20 and bottom (low performance, LP) 20 head were compared for diet composition, rumen fermentation and grazing behaviours. Results Pasture biomass, and nutritive value of pasture and diet varied between seasons and years of study. The HP cattle achieved overall LW gains 20% greater than those of the LP cattle mainly due to higher rates of gain in the wet season. However, the nutritive value and rumen fermentation characteristics were similar for both LP and HP cattle, although there was evidence that crude protein and digestibility were modestly higher in diets of HP cattle, especially in the first wet season. Activity, measured as distance travelled, declined as pasture biomass declined, and cattle appeared to favour pasture with higher legume content. Conclusion It is concluded that divergence in performance of cattle on tropical pasture could not be fully explained by measurements taken in this study. Diet selection for plant components with improved nutritive value probably played a small role. Differences in initial LW between the LP and HP groups may have been a contributory factor. Implications Despite comprehensive measurements of factors that influence efficiency and performance on pasture, we were unable to identify definitive causes. Genetic variation in feed intake or efficiency of digestion needs to be investigated.

Patient-Reported Factors Impacting Memory and Cognition Among Women Currently or Previously Receiving Treatment for Breast Cancer.

Objectives Cognitive impairments associated with cancer and cancer treatments have yet to determine definitive causes, gold-standard assessments, or effective treatments to offset or mitigate symptoms. The purpose of the current study was to determine relationships between women with breast cancer and the negative memory impact of treatment and other factors. Materials and methods This online study included 171 participants receiving at least one type of treatment for breast cancer. This descriptive correlational study used two measures to assess memory and one for stress. The survey included demographics, treatments received, and memory. Results Results indicated increased perceived impairments among variables of age, stress, surgery, chemotherapy, radiation, and hormonal treatment modalities. Discussion This study established relationships between memory/cognitive impairments and the variables of age, four treatment modalities, three agents, and stress. Conclusion The results from this study demonstrate the importance of developing standardized assessments to identify the presence and severity of cancer and treatment-related cognitive impairments. The study will be used as a first step to developing a memory support strategy using a web-based nursing intervention considering the impact of stress.

Impact of genetic factors on antioxidant rescue of maternal diabetes-associated congenital heart disease.

Congenital heart disease (CHD) affects ~1% of live births. Although genetic and environmental etiologic contributors have been identified, the majority of CHD lacks a definitive cause, suggesting the role of gene-environment interactions (GxE) in disease pathogenesis. Maternal diabetes mellitus (matDM) is among the most prevalent environmental risk factors for CHD. However, there is a substantial knowledge gap in understanding how matDM acts upon susceptible genetic backgrounds to increase disease expressivity. Previously, we reported a GxE between Notch1 haploinsufficiency and matDM leading to increased CHD penetrance. Here, we demonstrate a cell lineage specific effect of Notch1 haploinsufficiency in matDM-exposed embryos, implicating endothelial/endocardial derived tissues in the developing heart. We report impaired atrioventricular cushion morphogenesis in matDM exposed Notch1+/- animals and show a synergistic effect of NOTCH1 haploinsufficiency and oxidative stress in dysregulation of gene regulatory networks critical for endocardial cushion morphogenesis in vitro. Mitigation of matDM-associated oxidative stress via SOD1 overexpression did not rescue CHD in Notch1 haploinsufficient mice compared to wildtype littermates. Our results show the combinatorial interaction of matDM-associated oxidative stress and a genetic predisposition, Notch1 haploinsufficiency, on cardiac development, supporting a GxE model for CHD etiology and suggesting that antioxidant strategies maybe ineffective in genetically-susceptible individuals.

Social Media and Pathology: A Powerful Intersection for Visibility

Abstract Introduction/Objective The employment of social media usage for visibility efforts in the field of pathology is a relatively new practice, yet this strategy for both individual practitioners and departmental promotion is growing each day. Social media is being implemented for use in recruiting faculty, staff, and trainees, sharing cases and educational resources, establishing communities, and serving as a source of news for research breakthroughs and accolade recognition. A deeper look into one pathology department’s usage of social media across several platforms lends broad insight into the distinction of which forms of content perform well more consistently on each platform, and how these analytics continue to expand. The current study will examine the growth of one pathology department over the course of six months and determine which content forms made the most impact in increasing departmental visibility. Methods/Case Report The use of Instagram, X, LinkedIn, and Facebook is examined over the course of six months. Two reporting periods of three-month intervals are used for comparison: October–December 2023 and January–March 2024. The social media management system Sprout Social is used to gather reports of change in metrics over these periods. Results (if a Case Study enter NA) The audience growth rate increased 4.3% in the second reporting period (January-March 2024), with a 34.7% increase in net audience growth rate (total gained followers), an 8.6% increase in published posts, a 16.1% increase in impressions and a 55.3% increase in engagements. Conclusion Based on the data analysis provided above, trainee content and cases of the week perform best on X. On Instagram, reels excel in performance. On LinkedIn, faculty accolades, research news, and group photos perform best. People-centered content and educational resources increase audience, impressions, engagement, and, in turn, departmental visibility. A focus on this content and an increase in total posts is the definitive cause for growth in the second reporting period.

Prevalence of poststroke fatigue and its relationship with clinical characteristics among community-dwelling stroke survivors: A cross-sectional survey

Background and objectivePoststroke fatigue is widely overlooked due to a lack of awareness, definite cause, and cure. It is influenced by cultural variance in psychosocial factors and stroke epidemiology patterns across different countries. To date, the prevalence of poststroke fatigue has not been determined in the Indian setting. Hence our objective was to estimate the prevalence of fatigue among community-living late subacute and chronic stroke survivors. Additionally, we determined the association between poststroke fatigue and participants’ clinical and demographic data. MethodsA cross-sectional survey was conducted among first-time stroke survivors following discharge from two tertiary care hospitals. Medical records were screened and included if they met the criteria for age >18 years, able to follow a two-step command with no existing neurological or systemic conditions that would influence fatigue scores. Telephonic consent was obtained, and an interview was conducted to obtain the scores for fatigue, daytime sleepiness, depression, functional mobility, and disability. ResultsA total of 323 participants (mean age: 60.3 ± 12.6 years, mean stroke duration: 8.6 ± 4.4 months) completed the interview. Poststroke fatigue was reported in 11.8 % (n = 38) of the population. Occupational status (χ2 = 5.73), functional mobility (χ2 = 5.84), and disability scores (χ2 = 8.00) were significantly associated (p < 0.05) with fatigue scores. Individuals with disability exhibited five times (OR = 5.00, CI: 1.45–17.23, p = 0.01) higher odds of experiencing fatigue than those without disability. ConclusionOur study reported a relatively lower prevalence of fatigue among community-living late subacute and chronic stroke survivors. Implementing strategies to address these contributing factors could effectively ease fatigue in individuals recovering from stroke.

6661 Critical Limb Ischemia - An Unusual Presentation Of A Pheochromocytoma

Abstract Disclosure: S. Hassan: None. Background: Pheochromocytomas can lead to vasoconstriction and its various clinical manifestations due to excess catecholamine release. Critical limb ischemia as a clinical manifestation of pheochromocytoma has been reported sparsely. Clinical Case: A 43 year old female with a past medical history of type 2 diabetes mellitus, Turner syndrome, and hypertension presented to the emergency department with acute on chronic left leg pain. She underwent workup with a CT angiography of the abdomen with runoff for evaluation of her vessels, which revealed an occlusion of her left superficial femoral artery with chronic stenosis of the right femoral system. Multiple unsuccessful attempts were made at revascularization of her left lower extremity, including femoropopliteal bypass, with eventual left above knee amputation, multiple fasciotomies, and angiogram and stenting of multiple vessels. The patient was on a combined OCP (norethindrone-ethinyl estradiol) for hormone replacement for Turner syndrome for the past 30 years, and did not have a personal or family history of clotting disorders. She underwent a hypercoagulable workup which was negative. Echocardiogram was negative for thrombi and was otherwise unremarkable. Incidentally discovered on her initial CT angiography was a heterogeneously enhancing right adrenal mass, which was further delineated on a dedicated CT of the adrenals, which showed a 3.7 cm right adrenal mass with pre-contrast Hounsfield units measuring 46. Biochemical workup revealed a normal plasma renin activity and aldosterone, plasma metanephrine elevated to 5.20 nmol/L (range 0.00 – 0.49 nmol/L), plasma normetanephrine elevated to 4.95 nmol/L (range 0.00 – 0.89 nmol/L), 24 hour urine metanephrine elevated to 3830 ug/d (range 36-229 ug/d), and 24 hour urine normetanephrine 1733 ug/d (range 95 – 650 ug/d). She reports a diagnosis of hypertension at age 36, with no secondary workup pursued; she had suboptimal control on three separate medications, lisinopril, metoprolol, and hydrochlorothiazide. Her blood pressure and heart rate were noted to be labile during her aforementioned surgery. Alpha blockade with doxazosin was started based on her significantly elevated plasma and urine metanephrines and normetanephrines, with improvement in her blood pressure control. She was not found to have a definitive cause of her critical limb ischemia; she was noted to have atherosclerosis in the vessels of her lower extremities, and her chronic oral contraceptive use may also have played a role. However, OCPs are often reported to cause venous rather than arterial thrombi. Therefore, it can be inferred that the catecholamine excess from her presumed pheochromocytoma caused vasoconstriction which may have played a role in the development of her critical limb ischemia. Conclusion: Catecholamine excess that is resultant from a pheochromocytoma may manifest as critical limb ischemia. Presentation: 6/1/2024

Transthyretin amyloidosis prevalence and characteristics in Korean patients with heart failure with preserved or mildly reduced ejection fractions

The diagnosis and awareness of transthyretin amyloidosis cardiomyopathy (ATTR-CM) in heart failure with left ventricular ejection fraction (LVEF) > 40% remains under-recognized. This study aimed to investigate the prevalence and characteristics of ATTR-CM in patients with heart failure with LVEF > 40%. Patients with LVEF > 40% and maximal left ventricular wall thickness (MWT) > 10 mm who underwent bone scintigraphy were retrospectively investigated. Patients with a definite cause of heart failure were excluded. ATTR-CM was diagnosed when grade 2 or 3 myocardial uptake was observed on scintigraphy. Among 97 patients (male, 62.5%; median age, 69 years), 13 (13.4%) were diagnosed with ATTR-CM (wild type, 69.2%; hereditary type, 30.8%). Age or biomarker levels did not differ significantly; however, all patients with ATTR-CM were male. The ATTR-CM group had a significantly higher prevalence of polyneuropathy or carpal tunnel syndrome than the non-ATTR-CM group, accompanied by a longer PR interval, thicker MWT, larger left atrial volume index, and higher E/e′. Accordingly, ATTR was present in a substantial number, particularly among men. Clinicians should suspect ATTR when a male patient exhibits neurologic symptoms, diastolic dysfunction, and a long PR interval.

Laying the foundations for high-quality mortality surveillance in Sierra Leone: Early learnings from the Child Health and Mortality Prevention Surveillance (CHAMPS) Network

Background More than four million child deaths occur annually; most are neither adequately documented nor investigated. The Child Health and Mortality Prevention Surveillance (CHAMPS) program was launched in Sierra Leone (SL) to generate high-quality data to determine definitive causes of stillbirths and under-five mortality (U5M) to inform decision-makers. Despite the multiple challenges of a greenfield research site, we highlight the experience of setting up a high-quality mortality surveillance (MS) system, including the viability of Minimal Invasive Tissue Sampling (MITS). Methods To establish the MS program, we implemented qualitative research and community entry, a sensitive system for timely identification and notification of deaths and followed CHAMPS standard operating procedures for investigating deaths and assigning accurate and definitive causes of death. CHAMPS in SL was implemented in four phases during 2017-2019 by a consortium. Enrolled stillbirths and U5M underwent verbal autopsy, clinical-data-abstractions, MITS, microbiology, molecular and histopathological diagnoses, and Determination of Cause of Death (DeCoDe). Results CHAMPS achieved a 93% consent rate, capitalizing on existing Ministry of Health infrastructure, community involvement, and local ownership. As of December 2022, 3,433 deaths were registered, with 1,056 (31%) eligible for enrolment. Of 439 cases DeCoDed, 402 (92%) of case-families had received feedback on the cause of death. Using findings and recommendations from the DeCoDe experts, CHAMPS is implementing interventions to reduce stillbirths and U5M at CHAMPS SL, including clinical review meetings, provision of emergency drugs and routine child death audits. Conclusion Implementing innovative MS in a challenging context, such as SL, is possible. Building on local knowledge and infrastructure has enabled the CHAMPS project to achieve remarkably high consent rates, given the cultural, religious and sensitivity challenges surrounding seeking consent for MITS from caregivers who have just lost a child. The programme has invested significantly in upscaling local technical capacity for surveillance and laboratory diagnostics.

Genetic variation and molecular profiling of congenital malformations of the female genital tract based on whole-genome sequencing.

Congenital malformations of the female genital tract (CM-FGT) are characterized by abnormal development of the fallopian tubes, uterus, and vagina, often accompanied by malformations in the urinary system, bones and hearing. However, no definitive pathogenic genes and molecular genetic causes have been identified. We present the largest whole-genome sequencing study of CM-FGT to date, analyzing 590 individuals in China: 95 patients, 442 case-controls, and 53 familial controls. Among the patients, 5.3% carried known CM-FGT-related variants. Pedigree and case-control analyses in two dimensions of coding and non-coding regulatory regions revealed seven novel de novo copy number variations, 12 rare single-nucleotide variations, and 10 rare 3' untranslated region (UTR) mutations in genes related to CM-FGT, particularly highlighting ASH1L as a pathogenic gene. Single-cell sequencing data showed that the majority of CM-FGT-related risk genes are spatiotemporally specifically expressed early in uterus development. In conclusion, this study identified novel variants related to CM-FGT, particularly highlighting ASH1L as a pathogenic gene. The findings provide insights into the genetic variants underlying CM-FGT, with single-cell sequencing data revealing spatiotemporal specific expression patterns of key risk genes early in uterine development. This study significantly advances the understanding of CM-FGT etiology and genetic landscape, offering new opportunities for prenatal screening.

Exploring the Intersections of Cultural Constructs and Parental Beliefs: Autism Spectrum Disorder in Indian Families

Autism spectrum disorder (ASD) is a complex developmental disorder whose prevalence has continually increased over the years but its definitive cause remains unknown and thereby parental perceptions and beliefs about its cause are shaped by existing cultural notions. However, research has rarely focused on understanding the nature of these beliefs and their influence on parenting behaviors. India is home to several culturally diverse groups, but little attention is put toward understanding the diversity in cultural beliefs and perceptions of parents of children with autism. Drawing on semi-structured, in-depth interviews, this study demonstrates the cultural beliefs about ASD and elucidates the experiences of 20 parents who have a child with ASD from Chandigarh-Tricity, India. The study employs a qualitative methodology, and the analysis revealed different themes that are explored in the article.

Prevalence and characteristics of patients with incidental cardiac uptake on bone scintigraphy

BackgroundBone scintigraphy is emerging as a confirmatory diagnostic tool for transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to investigate the frequency and clinical characteristics of patients with incidental cardiac uptake and incidental ATTR-CA on bone scintigraphy.MethodsAll bone scintigraphic studies performed at a tertiary teaching hospital between 2011 and 2022 were reviewed retrospectively. Patients who underwent bone scintigraphy to confirm ATTR-CA were excluded. Patients with cardiac uptake of grade 2 or 3 were included and divided into two groups: possible ATTR-CA group and noncardiac amyloidosis (non-CA) group.ResultsOf the 61,432 bone scintigraphic studies performed on 32,245 patients, 23 (0.07%) had grade 2 or 3 cardiac uptake. Nine of 23 patients (39.1%) were assigned to the non-CA group because they showed cardiac uptake from definite other causes or focal uptake that did not match CA. The remaining 14 patients (60.9%) were classified as the possible ATTR-CA group, and five patients were referred to cardiologists and finally diagnosed with ATTR-CA. Two patients were treated with tafamidis. Patients in the ATTR-CA group were significantly older and had a less frequent history of end-stage renal disease than those in the non-CA group. Other characteristics were comparable in both groups.ConclusionsAlthough incidental ATTR-CA in patients undergoing bone scintigraphy for noncardiac reasons is uncommon, if cardiac uptake is observed in elderly patients without metastatic calcification associated with end-stage renal disease, further diagnostic work-up for ATTR-CA as a cause of undiagnosed heart failure should be considered.

The discovery of in situ thrombus attached to the patent foramen ovale channel in myocardial infarction with normal coronary arteries

Objective: Paradoxical embolism caused by a patent foramen ovale (PFO) is a rare cause of myocardial infarction (MI) in individuals presenting with normal coronary arteries on angiography; however, the deduction is often made due to the inability to identify the exact thrombus that penetrates the atrial septum. Previous studies using optical coherence tomography (OCT) have reported in situ thrombi attached to PFO tunnel in patients with cryptogenic stroke. However, the presence of such thrombi in patients with cryptogenic MI (without a definite cause) remains uncertain. Method: We retrospectively analyzed OCT data collected from February to July 2023 on PFO tunnels in MI adults with normal coronary arteries on angiography. Results: Three patients diagnosed with cryptogenic MI and a PFO underwent OCT examination. These patients exhibited varying OCT findings. White thrombi and endocardial abnormalities in the channel were observed in two patients with MI. No thrombus or anomalous morphology on the endocardial surface was noted in the third patient. PFO closure was performed on all patients, and follow-up was completed by October 1, 2023. None of the patients reported recurrence of chest pain. Conclusion: In situ thrombus was identified within the PFO channel in patients with cryptogenic MI, potentially serving as a novel etiological factor for coronary thrombosis.

Causes of mortality in military working dog from traumatic injuries.

This study aimed to identify the pathophysiologic causes of death following traumatic injuries in military working dogs (MWDs) and determine the risk factors associated with mortality in MWD following traumatic injuries. The results of this study will allow for better targeting of interventions to ameliorate these pathophysiologic causes of death and inform research priorities directed at the pathophysiology that leads to the death of MWDs. The final dataset for this study was compiled by using two previously established datasets. Based on review of available data and supplemental records (when available), MWDs in which a definitive cause of death could be determined were included in the study population. These MWDs were assigned a cause of death based on categories previously identified in studies evaluating service member casualties. A group of MWDs who survived their traumatic injury and had similar mechanisms of injury and types of injury to the deceased MWDs were included to allow for comparison and establishment of risk factors associated with MWD death. Variables collected included breed, age, sex, mechanism of injury, survival/non-survival, type of trauma, mechanism of injury, pathophysiology that led to death and pre-hospital care provided. Statistical analysis included Fishers exact test for categorical variables and univariable and multivariable logistic regression to identify factors associated with the MWD death. A total of 84 MWDs (33 non-survivors and 51 survivors) were included in this study. Of the 33 MWDs that died, 27 (81.8%) were noted to be dead on arrival. The pathophysiologic causes of death were found to be hemorrhage (45.5% [n = 15]), head trauma (21.2% [n = 7]), catastrophic tissue destruction (15.2% [n = 5]), pneumothorax (9.1% [n = 3]) and one (3% [n = 1]) of each of the following: septic shock, asphyxiation and burns. Military working dogs that did not receive non-DVM care were 3.55 times more likely to die than those that did receive non-DVM care (95% CI 1.03-12.27). The majority of MWDs died of their injuries before reaching veterinary care. To increase the survival of MWDs on the battlefield, further research should focus on developing new interventions and techniques to mitigate the effects of the pathophysiology noted to cause MWD death. Furthermore, given that care by a non-DVM was found to be associated with survival, the implementation of pre-hospital care and early resuscitation techniques should be a continued priority for those treating MWDs at both the point of injury and in the prehospital setting.

This pain drives me crazy: Psychiatric symptoms in women with interstitial cystitis/bladder pain syndrome

BACKGROUND Interstitial cystitis/bladder pain syndrome (IC/BPS) is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic, abdominal, and/or pelvic pain. Although the term cystitis suggests an inflammatory or infectious origin, no definite cause has been identified. It occurs in both sexes, but women are twice as much affected. AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS. METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS, we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy: ("interstitial cystitis" OR "bladder pain syndrome") AND ("mood disorder" OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk). RESULTS On September 27, 2023, the PubMed search produced 223 articles, CINAHL 62, and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36. Search on ClinicalTrials.gov produced 14 studies, of which none had available data. Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS, i.e. 63 articles spanning from 2000 to October 2023. These studies identified depression and anxiety problems in the IC/BPS population, along with sleep problems and the tendency to catastrophizing. CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS. Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.

Forensic utility of carboxyhemoglobin levels in postmortem spleen specimens in South Korea

In order to determine whether CO poisoning was the definitive cause of death, the concentration of carboxyhemoglobin (COHb) in spleen specimens was analyzed using a gas chromatography-thermal conductivity detector. 125 cases of forensic autopsy reports containing COHb analysis requests were analyzed and subdivided into two groups, improbable and highly probable of CO intoxication. In the first group which consists of 100 cases, the results of COHb analysis were negative, and the circumstances of death, as well as the postmortem findings could not validate the exposure to CO. In the second group which consists of 25 cases, the results of COHb were positive, and both postmortem findings and circumstances of death confirmed the exposure to CO. In the cases of indoors and vehicle fires or those including the use of briquettes, COHb levels reached 43.1–97.5 %, whereas in individuals without any feature of CO poisoning had COHb level high as 29.8 %. However, certain cases without any connection to fire nor CO exposure also contained significant amount of CO based on post-mortem analysis. This study focuses on cases without any relationship to fire or CO and proves that COHb levels below 30 % may be considered as a contributing factor to but not exclusively as the cause of death.

Infection and Pediatric Arterial Ischemic Stroke Presumably Related to Focal Cerebral Arteriopathy: Data From the COVID-19 Pandemic.

Infection may trigger pediatric arterial ischemic stroke (PAIS), notably when related to focal cerebral arteriopathy. Community- and individual-level nonpharmaceutical interventions during the COVID-19 pandemic resulted in a major decrease in pediatric viral infections. We explored the consequences on the incidence of PAIS. Using national public health databases, we identified children hospitalized between 2015 and 2022 with PAIS. Using an age proxy (29 days to 7 years) and excluding patients with cardiac and hematologic conditions, we focused on children with PAIS presumably related to focal cerebral arteriopathy or with no definite cause. Considering the delay between infection and PAIS occurrence, we compared a prepandemic reference period, a period with nonpharmaceutical interventions, and a post-nonpharmaceutical intervention period. Interrupted time-series analyses of the monthly incidence of PAIS in this group showed a significant decrease in the nonpharmaceutical intervention period compared with the prepandemic period: -33.5% (95% CI, -55.2%, -1.3%); P=0.043. These data support the association between infection and PAIS presumably related to focal cerebral arteriopathy.

Vaginal or Fecal Contamination Which Contributes to Parasite Existence in Urine Sediment

Aims: intended to deepen our knowledge to date regarding parasites that might found in urine sediment as consequences of vaginal or fecal contamination during voiding Discussion: Urine in the bladder is a sterile waste product composed of water soluble nitrogen products. But during voiding, the passage of the urine through lower/outer portion of the urinary tract might come across normal microbiota which function in maintaining the urothelial integrity and preventing urinary tract infection (UTI), as well as promoting local immune function. Parasites and parasitic ova may be seen in urinary sediments as a result of fecal or vaginal contamination. Identification of parasites in centrifuged deposits of urine sediment is a relatively rare occurrence in clinical practice but still must be considered carefully, whether as a consequence of contamination or definite causes of infection. Two of the common parasite found in urine sediment are Trichomonas vaginalis and Enterobius vermicularis. Urine collection procedure must be explained briefly to the patient along with appropriate informed consent prior obtaining the sample. Conclusion: The possibility of parasites being found in urine sediment remain to happen. An in-depth analysis needs to be carried out to determine whether this occurs due to vaginal or rectal contamination or whether it is due to a definitive infection occurring in the urinary tract.