History Of Accident Research Articles

Primary Intracranial Hemorrhage: Characteristics, Distribution, Risk Factors, and Outcomes-A Comparative Study between Jewish and Arab Ethnic Groups in Northern Israel.

Background and purpose: This study aimed to investigate the differences in intracerebral hemorrhage (ICH) between Jews and Arabs residing in northern Israel, focusing on risk factors, hemorrhage volume, and functional outcome. Methods: A retrospective analysis was conducted utilizing a population-based registry to investigate intracerebral hemorrhage (ICH) characteristics, risk factors, and outcomes. The registry consisted of inpatients diagnosed with hemorrhagic stroke. Due to the wide variation in data on ICH characteristics and the limited availability of population-based data on predictors of ICH survival and functional outcomes, we collected retrospective data on all adult patients admitted to the Galilee Medical Center with a diagnosis of ICH. Data were obtained from the registry covering the period from 2013 to 2019. Ethnic differences and risk factors associated with intracranial hemorrhage (ICH) were examined within a diverse population of 241 patients, comprising 52.70% Jews (n = 127) and 47.30% Arabs (n = 114). Results: The results of this study revealed significant differences in age, obesity rates, and intracerebral hemorrhage (ICH) location between the two ethnic groups. Hypertension emerged as the most prevalent condition among ICH patients in both ethnic groups (76.70%), followed primarily by anticoagulant use (63.60%), dyslipidemia (60.70%), diabetes (44.60%), obesity (30.60%), smoking (24.60%), and a history of cardiovascular disease (21.80%). Furthermore, 20.90% of the patients had a history of previous cerebrovascular accidents (CVA). Arab patients with ICH were generally younger (62.90 ± 16.00 years) and exhibited higher rates of obesity (38.70%) compared to Jewish patients with ICH (70.17 ± 15.24 years, 23% obesity; p = 0.001, p = 0.013, respectively). Hemorrhage volume was identified as a crucial determinant of patient outcomes, with larger volumes associated with poorer Modified Rankin Scale (mRS) scores at discharge and higher mortality rates. Interestingly, patients without hypertension had higher hemorrhage volumes compared to those with hypertension. The extent of hemorrhage into the ventricles did not significantly correlate with mRS at discharge in our dataset. Conclusions: This study highlights significant differences in the characteristics and outcomes of intracranial hemorrhage (ICH) between Jews and Arabs in northern Israel. The findings reveal variations in age, obesity rates, and ICH location between the two groups. While hypertension was the most prevalent risk factor for both populations, other risk factors differed. Notably, hemorrhage volume emerged as a crucial prognostic factor, aligning with previously published data. These findings underscore the necessity for tailored approaches that consider ethnic-specific factors in the risk assessment, prevention, and management of ICH. Further research is warranted to elucidate the underlying mechanisms and develop interventions aimed at improving outcomes and enhancing healthcare practices in ICH management.

Identifying patients at risk of prolonged hospital length of stay after total knee arthroplasty: A real-world study on the creation and validation of a cloud estimator.

Accurate prediction of the length of stay for patients undergoing total knee arthroplasty (TKA) is critical for efficient medical resource allocation. This study aimed to create a user-friendly model to assist this estimation process. A secondary analysis was conducted on 2676 patients who underwent elective primary TKA at a tertiary academic medical center in Singapore from January 2013 to June 2014. The eligible patients (n = 2600) were randomly divided into a training cohort (n = 2081) and a validation cohort (n = 519), at a ratio of 4:1. A prolonged hospital stay was defined as exceeding six days. Multivariable logistic regression was used to develop a prediction model, and an online calculator was created to facilitate its application. The model's discrimination power, goodness-of-fit, and clinical applicability were evaluated. Additionally, models using other statistical methods were developed for performance comparison. The model includes predictors such as age, operation duration, history of cerebrovascular accidents, creatinine levels, procedure site, the American Society of Anesthesiologists Physical status, hemoglobin levels, and primary anesthesia type. The model demonstrated robust discrimination power with a C statistic of 0.70 (95% confidence interval, 0.64 to 0.75), satisfactory goodness-of-fit (Hosmer-Lemeshow test, P=0.286), and was applicable when thresholds were between 0.08 and 0.52, based on decision curve analysis. A predictive model was developed that can be used to identify patients who are likely to require an extended stay following TKA. This could assist in planning bed availability and guiding therapeutic decisions.

Management of Endo-Perio Lesion using Collagen Membrane: A Case Report

This case report describes the management of endo-perio lesion. A 40 year old patient reported with pain and discolored tooth with history of road traffic accident a year ago. Intraoral examination of tooth 11 revealed the presence of restorative material and a sinus tract opening with probing depth of 6mm. Following full mouth scaling, access opening and biomechanical preparation was done during which intra-canal irrigant was seen oozing through the sulcus of tooth 11. Multiple RVGs were taken as there was difficulty in negotiating the canal which suggested the presence of communication. Surgical intervention was carried out were root perforation was noted. Canal was negotiated and perforation was repaired using biodentine. Collagen membrane was placed as a barrier. Patient was recalled after 2 weeks, 1 month and at 3months. At the end of three months there was complete reduction in probing depth with satisfactory soft tissue healing. Proper diagnosis of the endo-perio lesion is the key to success. The multidisciplinary approach with accurate diagnosis contributed to the favorable therapeutic outcome.

A Hospital-Based Case-Control Study on Whole- and Refined-Grain Intake and Risk of Stroke.

The aim of the present study was to ascertain the correlation between the intake of whole and refined grains and the risk of stroke in the Iranian adult population. This hospital-based case-control study was conducted at Alzahra University Hospital, Isfahan, Iran, in 2008. The cases (n=195) were stroke patients admitted to the neurology ward, and the controls (n=195) were patients admitted to other wards in this center, with no prior history of cerebrovascular accident or any neurological disorders. The usual dietary intakes of the study participants during the previous year were assessed using a validated semi-quantitative food frequency questionnaire. Whole and refined grains were defined according to the definition of the American Association of Cereal Chemists International; foods that contained at least 8 g per 30 g of their weight were considered as whole grains. The mean age of the case and control groups was 68.0 (±13.5) and 61.5 (±10.5) years, respectively; 40% of the cases and 53.3% of the controls were female. The total intake of whole grains (27.8±4.3 vs. 29.4±3.6 g/d, P=0.77) and refined grains (264±11 vs. 296±13 g/d, P=0.07) was not significantly different between the cases and controls. After adjusting for potential confounders, individuals in the second tertile of refined grain intake had a two-fold higher odds of stroke (OR: 2.02; 95% CI: 1.08-3.71), compared to those in the first tertile. Furthermore, no significant relationships were observed between the consumption of whole grains and the risk of stroke, before or after adjustment for confounding variables. No significant trend was found between the tertiles of refined or whole grain intake and the risk of stroke. The authors did not find a statistically significant association between the intake of whole and refined grains and the risk of stroke. Further prospective studies on the relationship between both whole and refined grains and stroke are warranted.

Characteristics of re-admitted adult patients infected with severe acute respiratory syndrome Coronavirus 2 After initial hospitalization at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.

To describe the clinical characteristics and possible risk factors associated with re-hospitalization within 30 days of discharge among hospitalized adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This is a retrospective cohort study conducted at King Salman Armed Forces Hospital (KSAFH), Tabuk, Saudi Arabia over the period between March to November 2020. The study was conducted over 237 patients who had confirmed SARS-CoV-2 and fulfilled the study inclusion criteria (at least 14 years old, with subsequently discharged alive from the hospital) were included. The commonest presenting symptoms were cough, fever, and dyspnea. The most frequent reported comorbid diseases were diabetes mellitus and hypertension. Half of cases were regarded as severe cases whereas 14.8% were critical cases. The rate of readmission was 5.9%. Older patients were more likely to be readmitted compared to younger patients. Regarding clinical characteristics, critically ill patients were more likely to be readmitted than less severe cases. Patients with unilateral lung shadow in chest x-ray, and those with positive history of Intensive care unit (ICU) admission were more likely to be readmitted compared to their peers. Regarding medical history, the only factor significantly associated with readmission were history of cerebrovascular accident (CVA), as 22.2% of those with CVA history compared to only 1.5% of those without CVA history were more likely to be readmitted. Among laboratory findings, high lymphocytic count (>3 per microliter) was significantly associate with likelihood for readmission. Readmission rate or patients hospitalization initially for Covid-19 was comparable to rates reported by most of other similar international studies. Further longitudinal larger multicentric study is warranted to have clearer image of the situation.

Effect of Prevention Focus on the Relationships Among Driving Accident History, Risk Perception, and Consumers’ Automobile Insurance Coverage Decisions

The primary aim of our research was to examine the moderating role of prevention focus (PRE) and the mediating role of risk perception (RP) on the relationship between driving accident history (DAH) and insurance coverage (IC) decisions to test this moderated mediation mechanism. We collected survey data from 808 newly eligible voluntary automobile liability insurance policyholders in Taiwan and analyzed the data using PROCESS macro. The estimated results showed that PRE moderated the indirect effect of DAH on IC through RP. In general, a worse DAH would increase the RP of people who were high prevention-focused, thereby increasing their willingness to purchase a higher IC. Conversely, a worse DAH would not increase the RP of people who were low prevention-focused, and such people would not increase or would even decrease their IC. The results provide an explanation for the inconsistent paths from DAH to IC in the literature. From a marketing perspective of psychographic segmentation, our research helps insurance companies to determine what types of consumers they should pay more attention to and to formulate marketing strategies. JEL: D91 G52 E21

Tenecteplase: A Review of Its Pharmacology and Uses.

Tenecteplase: A Review of Its Pharmacology and Uses.

Serum Levels of Ferritin, Iron, and Total Iron Binding Capacity in Cerebral Venous Sinus Thrombosis

Background: Cerebral venous sinus thrombosis (CVST) is a potentially life-threatening condition with a wide range of clinical presentations, from localized headache (the most common symptom) to mental status disturbances, seizures, and coma. Objectives: The main purpose of this study was to evaluate serum levels of ferritin, iron, and total iron binding capacity (TIBC) and their possible relationship with different parameters in CVST patients. Methods: Thirty patients with a definitive diagnosis of CVST based on brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) results participated in the study. During the first 24 hours after admission, 5 cc of blood sample was collected from each patient and delivered to the laboratory to measure serum ferritin, iron, and TIBC levels. Results: Twenty-four women and six men (mean age: 42.6 ± 16.33 years) participated in the study. The mean levels of serum iron, TIBC, and ferritin were within normal ranges (99.40 ± 29.97 mg/dL, 324.50 ± 49.57 mg/dL, and 87.36 ± 88.84 ng/mL, respectively). There were no significant relationships between serum ferritin, iron, TIBC levels, oral contraceptive pills consumption, history of CVST or cerebrovascular accident (CVA), underlying diseases, and the involved sinus. Conclusions: The current study showed no possible benefits of using serum ferritin, iron, and TIBC indices in CVST patients.

SCREENING RATES FOR PRIMARY ALDOSTERONISM ARE UNSATISFACTORY EVEN IN HYPERTENSION EXCELLENCE CENTERS. A CALL FOR COMPULSORY SCREENING FOR ALL HYPERTENSIVE PATIENTS

Objective: The Endocrine Society guidelines recommend screening for primary aldosteronism (PA) in high risk hypertensive patients. These include patients with sustained blood pressure (BP) above 150/100 mmHg, patients with resistant hypertension (HTN), hypertensive patients with spontaneous or diuretic-induced hypokalemia, adrenal incidentaloma, sleep apnea, family history of early onset HTN or cerebrovascular accident at a young age and all hypertensive first-degree relatives of patients with PA. Even though guidelines are clear and screening is simple, compliance rates among clinicians are extremely low ranging between 0.1% to 2.7%. This results in underdiagnosis of early disease, leading to an enormous extra-burden of advanced chronic kidney disease, heart failure, atrial fibrillation, and stroke. We aimed to examine the screening rate, according to the abovementioned guidelines, at our recently recognized Hypertension Excellence Center in Assuta Ashdod University Hospital. Design and method: A retrospective cohort study. We analyzed all hypertensive patients, eligible for screening between 01/18 and 12/20. We calculated screening rates and in univariate and multivariate regression analyses, looked at parameters that influence screening. Results: Of 661 patients over 18 years of age with HTN, 218 patients (33%) met the Endocrine Society guidelines for PA screening. However only 46 of them (21.1%), were referred for screening. A multivariate regression analysis, demonstrated that advanced age and male gender were associated with lower rates of screening referral. Odds ratio for age was 0.945 for every year (95% CI 0.915-0.975). Conclusions: A 21% screening rate in a Hypertension Excellence Center, although higher than prior published studies, suggests that many cases of PA are likely missed, more often in elderly population in whom adrenal micro as well as macronodular-hyperplasia is extremely common and can be the cause of secondary HTN. We therefore advocate for PA screening at least once of all hypertensive patients, preferably before the patient is started on multiple anti-hypertensive medications. This should be done regardless of patients’ age and gender, as the absolute risk for cardiovascular events in both hypertensive and PA patients increases with rising age, and treatment with mineralocorticoid receptor antagonists can be lifesaving.

Adherence to standard precautions by nursing professionals in a public university hospital: a cross-sectional study.

The aim of this study was to analyze the adherence to standard precautions by nursing professionals in a public university hospital, and to identify associated factors. This was a cross-sectional study with the nursing staff of a public university hospital. The participants provided sociodemographic and immunization data, training data on standard precautions and occupational accident history, and responded to the questionnaire on adherence to standard precautions (QASP). Descriptive data analysis and Pearson's Chi-square test (χ²) were performed, followed by Fisher's exact test to verify the association between the adherence to standard precautions (total score ≥ 76 points) and the sample characterization variables. Additionally, binary logistic regression indicated the odds ratio (OR) of the sample characterization variables for adherence to standard precautions. A p value ≤ 0.05 was considered statistically significant. The average score for adherence to standard precautions, through QASP, by nursing professionals evaluated was 70.5 points. Association between the adherence to standard precautions and the professionals' sample characterization variables was not identified. However, it was observed that experienced professionals (≥15 years of experience in the institution) were more likely to adhere to standard precautions (OR 0.062; IC95% [0.006-0.663]; p = 0.021). In general, the adherence to standard precautions by nursing professionals working in health service in this study can be considered inadequate, highlighting major weaknesses in hand hygiene practices, use of personal protective equipment (PPE), recapping of used needles, and conduct after suffering occupational accidents. Experienced professionals were more likely to adhere to standard precautions.

Comprehensive Evaluation of Occupational Accidents in a Hospital Setting: Insights from L-Type Matrix and Fine-Kinney Risk Assessment Methods

Objective: The objective of this study was to comprehensively evaluate occupational accidents in a hospital setting using the L-Type matrix and Fine-Kinney risk assessment methods. The aim was to assess the frequency, severity, and associated risks of different types of accidents. Methods: This single-center observational study analyzed occupational injuries that occurred to hospital employees between January 2018 and December 2022 in Arnavutköy State Hospital. Data were obtained from hospital records using a hospital information management system. Demographic characteristics, accident types, previous accident history, incapacity reports, L-Type matrix scores, and Fine-Kinney method scores were recorded. Risk scores were categorized based on predefined criteria. Results: The study included 249 occupational accidents, with a mean age of 30.94±9.69 years. Needle stick injuries in the hand were the most common type of accident (72.7%), followed by falls and bumps (16.1%). The L-Type matrix assessment showed that 90% of accidents were mild, and none were severe. According to the Fine-Kinney method, 0.8% of accidents were in the very high-risk group. Multiple accidents were observed among 23.7% of employees, and 11.6% resulted in work disability reports. Conclusion: Occupational accidents pose a significant risk to the safety and well-being of healthcare workers in hospitals. Needle stick injuries and falls or collisions were the most prevalent accidents. The use of risk assessment methods such as the L-Type matrix and Fine-Kinney approach allows for a comprehensive evaluation of occupational risks.

Association of carotid atherosclerosis and peripheral artery disease in patients with type 2 diabetes: risk factors and biomarkers

BACKGROUND: Carotid atherosclerosis (CA) and lower extremity peripheral artery disease (PAD) is a common and potentially life-threatening comorbidity in diabetes.AIM: to determine risk factors and biomarkers of the association of CA and PAD in patients with type 2 diabetes.MATERIALS AND METHODS: A single-center cross-sectional comparative study was carried out. Three hundred ninety one patients with type 2 diabetes were included. Duplex ultrasound of carotid and low limb arteries, screening/monitoring of diabetic complications and associated diseases, and assessment of glycemic control, biochemical and coagulation parameters were performed. Factors involved in vascular wall remodeling, including calponin-1, relaxin, L-citrulline, matrix metalloproteinase-2 and -3, were measured in blood serum by ELISA.RESULTS: The signs of CA and PAD were observed in 330 and 187 patients respectively. In 178 patients, both CA and PAD were revealed. The risk of combined involvement of carotid and lower extremity arteries was higher in patients with diabetic retinopathy (OR=2.57, p<0.001), chronic kidney disease (OR=4.48, p<0.001), history of myocardial infarction (OR=5.09, p<0.001), coronary revascularization (OR=4.31, p<0.001) or cerebrovascular accident (OR=3.07, p<0.001). In ROC-analysis, age ≥65.5 years (OR=3.43, p<0.001), waist-to-hip ratio ≥0.967 (OR=3.01, p=0.001), diabetes duration ≥12.5 years (OR=3.7, p<0.001), duration of insulin therapy ≥4.5 years (OR=3.05, p<0.001), duration of arterial hypertension ≥16.5 years (OR=1.98, p=0.002), serum L-citrulline ≥68 µmol/l (OR=3.82, p=0.003), and mean amplitude of glucose excursions ≥3.72 mmol/l (OR=1.79, p=0.006) were the risk factors for atherosclerosis of two vascular beds. In multivariate logistic regression analysis, age, diabetes duration and waist-to-hip ratio were independent risk factors for association of CA and PAD (p=0.005, p=0.0003, and p=0.004 respectively).CONCLUSION: In subjects with type 2 diabetes, carotid and lower extremity atherosclerotic disease is associated with age, diabetes duration, abdominal obesity, microvascular and macrovascular complications, glucose variability, and high serum levels of L-citrulline.

Management of Diaphragmatic Palsy in a Patient with Past History of Cerebrovascular Accident? Case Report

Management of Diaphragmatic Palsy in a Patient with Past History of Cerebrovascular Accident? Case Report

Dynamic Suzuki frame for the interphalangeal joint fracture: A case report

Proximal interphalangeal (PIP) joint injuries are one of the common injuries of hand. Most common in motor vehicle accidents and sports injury. Various treatment modalities are available to treat such fractures like buddy strapping with or without extension block splint, CRPP, ORIF with interfragmentary screws, Schenck dynamic traction, Hynes and Giddings device and many other modalities. This is one of the challenging fractures as there is high incidence of stiffness, loss of function and deformity leading to disability following the treatment. The pins and rubber traction frame (Suzuki frame) system is one of the novel technique to reduce the disability.Case: 66 years old male with history of motor vehicle accident, presented with comminuted intra-articular fracture of base of middle phalanx (PIP joint) extending distally to DIP joint of the fourth finger of left hand. We used Suzuki frame for the treatment of the fracture.Suzuki frame technique is a simple, minimally invasive, soft tissue sparing, cost effective, dynamic external fixation technique, can be done at minimal resource setting, which allows early ROM at PIP and DIP joint, enabling good bone and joint remodeling and good function of the finger, leading to disability free hand with minimal complication rate.

A Systematic Review of PPE Recommendations for First Responders, and Medical Professionals to Nuclear Radiological Events at Nuclear Power Plants

Introduction:Due to climate change, many countries are exploring nuclear power as a clean, sustainable, and alternative energy source. However, radiophobia stemming from a history of major accidents at nuclear power plants (most recently Fukushima Daiichi) inhibits the expansion of this industry. In an unlikely event of a large-scale accident, the risks posed to humans are minimal when mitigation measures are followed. This includes appropriate Personal Protective Equipment (PPE) for first responders, and medical professionals responding to these emergencies. An examination of the PPE recommendations for these scenarios will highlight best practices for minimizing exposures, and the effects of radiation.Method:A systematic literature review will provide a historical baseline of the PPE worn during previous nuclear power plant events. Additionally, current recommendations for PPE levels in response to these emergencies will be explored. Five databases will be utilized for this study, including PubMed, Web of Science, and SCOPUS.Results:Many studies examine different types of nuclear radiological exposures, but few focus on nuclear power plant scenarios. More than 5,000 articles emerged from a preliminary survey of the five databases. However, less than 1% of them satisfied the extraction criteria, and reviewed PPE for nuclear power plant accidents. Medical responders caring for “exposed” individuals who present at Emergency Departments have minimal exposure once they’re decontaminated, and everyday PPE is maintained. However, data on PPE recommendations for on-site response remains unexplored. Airtight suits and full-face respirators emerged as industry gold standard for protection, but a closer examination of these types of suits, and responders' self-efficacy utilizing the gear would clarify their actual protective qualities.Conclusion:While nuclear power plant accidents do not occur often, many remain fearful of their impact. Maintaining proper PPE (including respiratory habiliment) for event responders is one way to minimize the adverse health effects of these nuclear radiological exposures.

Difficult Tracheostomy in Calcified Tracheal Rings - Surgical Case Series

Background: Surgical airway management in an acute setting of road traffic accident can be difficult, even in the context of an anatomically normal airway. Tracheostomy, as a surgery is dependent on the exposure and removal of upper tracheal rings. When these rings are found calcified, it leads to further difficulties or complications in management, at times even resulting in surgical emphysema. Methods: A series of 6 adults, all males, aged between 32-45 years, presented to us individually between Nov 2021 to Nov 2022, with history of road traffic accidents causing poly trauma and requiring immediate airway stabilization. Results: None of them had prior history of neck trauma or endotracheal intubation or chronic cough. Chest x ray was normal in all of these individuals. Elective tracheostomy under general anesthesia was performed on day 5 of endotracheal intubation. During the procedure of conventional tracheostomy, after retracting the thyroid isthmus upwards, and prior to making a tracheal window, tracheal rings 3 and 4 were found to be calcified, which prolonged the time taken to remove a piece of cartilage. Conclusion: A junior surgeon needs to be well versed with the surgical anatomy of the region, the surgical procedure and management of possible complications with confidence and ease. A lack of knowledge amongst junior medical staff coupled with unskilled assistance when managing such cases lead to increased operative times and hence complications. Keywords: Tracheostomy, Calcified tracheal rings, adult, surgical

Management of critical patient infected with extended spectrum beta-lactamase (ESBL) producing Escherichia Coli

Introduction : Antibiotics has been widely used in medical practices nowadays. Antibiotics usage is often massively performed and sometimes not as indicated. Un-judicious and overuse of antibiotics that is not correlated with clinical pathways could result in antimicrobial resistance. Extended Spectrum Beta-Lactamase (ESBL) is an enzyme that has a capability of hydrolysing and deactivate Penicillin group antibiotics, 1st, 2nd, 3rd generation cephalosporin, as well as Monobactam antibiotics, further will cause resistance to those antibiotics. These matters will make it difficult to choose antibiotics. This article will discuss patients with Escherichia coli infection with ESBL in septic shock and its management. Case Presentation: Thirty five years old female with BMI 22 Kg/m2 was admitted to ICU with septic shock caused by infected sacral pressure sore. She has a history of traffic accidents and was mechanical ventilated 6 months ago. We performed septic shock management according to the Surviving Sepsis Campaign recommendation along with other supportive management. Macro (temperature, heart rate, mean arterial blood pressure) and micro haemodynamic (lactate, pCO2 gap, central venous pressure, vena cava inferior diameter) changed on day 3. We change the antibiotic according to the culture result. Escherichia Coli was found in blood culture with ESBL. The antibiotics were Amikacin combined with Tigecycline. Improvement was seen on the fifth day, then stopped the vasopressor, on day six weaned the mechanical ventilation. Conclusion: Resuscitation and rapid source control of infection focus, combined with appropriate antibiotic choice become the key principle in managing patients with septic shock caused by Escherichia coli with ESBL.

Клинические и нейрофизиологические корреляты когнитивных нарушений у пациентов с атеросклеротическим поражением сонных артерий

INTRODUCTION: Cognitive disorders often do not come to the fore in the interpretation of clinical manifestations in hemodynamically significant stenoses of brachiocephalic arteries. In this regard, the objectification of cognitive disorders based on a battery of tests, as well as of their neurophysiological correlates, is an important task of both angiology and neurology. Endogenous evoked potential P300 is a frequently used neurophysiological phenomenon characterizing the psychophysiological functions of perception, attention, and thinking. AIM: To study the dynamics of cognitive functions and their neurophysiological correlates in patients with hemodynamically significant carotid artery stenosis before and after carotid endarterectomy. MATERIALS AND METHODS: An open prospective study included 60 patients divided to two groups. Group A included 30 ‘symptomatic’ patients with a hemodynamically significant lesion (stenosis) of the internal carotid artery and a history of acute cerebrovascular accident. Group B included 30 ‘asymptomatic patients’ without a history of cerebrovascular events. Within the study, before surgery for carotid stenosis and 6 months after, the following parameters were assessed: cognitive status (according to the MMSE, FAB, MoCA, NIHSS scales), and also clinical and neurophysiological correlates of cognitive functions (P300 evoked potential). RESULTS: In the group of patients with neurological disorders (group A), a reliably greater number of errors (p = 0.048), as well as a decrease in the amplitude (p = 0.006) and increase in latency (p = 0.022) of P2 component of P300 cognitive evoked potential were determined. Based on the parameters of P300 event-related potential, a logit regression model was created that permitted to classify patients to the above-mentioned groups. The cluster analysis of dynamics of cognitive functions was additionally performed before and after surgery. In cluster 1, there were 45% of symptomatic patients, 55% of asymptomatic ones, in cluster 2 — 58% and 32%, respectively, no reliable differences were found (chi-square 0.58; p = 0.445). Cluster 1 was characterized by initially higher level of test performance with some increase in this parameter after surgery; Cluster 2 was characterized by a lower level of these parameters, with the greatest differences found in frontal assessment battery (FAB) characteristics. Reliable differences in the level of P300 were found only after surgery: the greatest differences were recorded in the amplitude of P2, P3, N2 components. CONCLUSION: The factor of cognitive impairment is a separate phenomenon, not closely related to focal neurological syndrome in patients with carotid atherosclerosis. An objective neurophysiological criterion for cognitive impairment in these patients is the endogenous evoked potential P300. With this, the greatest differences between the neurophysiological correlates of cognitive disorders are determined 6 months after the operation for carotid stenosis.

Laparoscopic Repair of a Right-Sided Diaphragmatic Hernia: A Technical Report.

Introduction: Occult diaphragmatic hernias after trauma are relatively rare and may present months to years after the traumatic event. Clinical presentations range from asymptomatic incidental findings on imaging to life-threatening incarceration of abdominal visceral organs. This study presents a case of a patient with a symptomatic diaphragmatic hernia secondary to a trauma >30 years prior. A literature review of this defect was performed examining the pathophysiology, presentation, and operative considerations. Case Presentation: A 58-year-old male with a history of multiple traumatic motor vehicle accidents 30 years prior presented with abdominal pain and obstructive symptoms. Axial imaging demonstrated a right-sided diaphragmatic hernia defect containing small intestine, colon, and omentum. He ultimately underwent a transabdominal laparoscopic repair of the defect with mesh buttressing. Postoperative the patient recovered well and was discharged without complications. Conclusion: Limited data outside of case reports exist for surgical management of occult diaphragmatic hernias secondary to trauma. Reported management options include open and minimally invasive thoracic as well as open and minimally invasive abdominal approaches; each with advantages and disadvantages. Depending on the defect size, both primary repair and repair with mesh reinforcement are appropriate options. More data comparing the approach and repair technique are needed to determine the best technique.

Health-related quality of life of daily-life-affected benign essential blepharospasm: Multi-center observational study.

To compare Thais' health-related quality of life (HRQOL) and severity grading, efficacy and safety in daily-life-affected benign essential blepharospasm (BEB) patients at baseline and after Botulinum toxin type A (BTX-A) treatment. Prospective-observational study. BEB patients with Jankovic rating scale (JRS) at least 3 in both severity and frequency graded from 14 institutes nationwide were included from August 2020 to June 2021. Demographic data, HRQOL evaluated by the Thai version of EQ-5D-5L and NEI-VFQ-25 questionnaires, and severity grading score evaluated by Jankovic rating scale (JRS) at baseline, 1, and 3 months after the treatment were collected. The impact of the BTX-A injections and their complications were recorded. 184 daily-life-affected BEB patients were enrolled; 159 patients (86.4%) had complete data with a mean age of 61.40±10.09 years. About 88.05% were female, and 10.1% were newly diagnosed. Most of the patients had bilateral involvement (96.9%) and 12.6% had history of BEB-related accident. After BTX-A treatment, HRQOL improved significantly in 4 dimensions of EQ-5D-5L, except self-care. The EQ_VAS (mean±SD) was 64.54±19.27, 75.13±15.37, 73.8±15.85 (p<0.001) and EQ-5D-5L utility score was 0.748±0.23, 0.824±0.19 and 0.807±0.19 at baseline, 1, 3 months after treatment, respectively. From NEI-VFQ-25, HRQOL also improved in all dimensions, except eye pain. The JRS improved in all patients. Self-reported minor adverse events were 22.6%, which mostly resolved within the first month. Daily-life-affected BEB impacted HRQOL in most dimensions from both generic and visual-specific questionnaires. BTX-A treatment not only decreased disease severity, but also improved quality of life.