Moderate Edema Research Articles

INNV-25. POST-OPERATIVE LOW DOSE VERSUS STANDARD DOSE DEXAMETHASONE FOR MANAGEMENT OF CEREBRAL EDEMA: A RANDOMIZED, DOUBLE-BLINDED FEASIBILITY STUDY IN PATIENTS WITH PRIMARY OR METASTATIC BRAIN TUMORS UNDERGOING CRANIOTOMY FOR TUMOR RESECTION

Abstract INTRODUCTION Although dexamethasone is effective for controlling cerebral edema during the peri-operative period, its immunosuppressive properties can inhibit responses to immunotherapy. We hypothesized that patients with mild to moderate cerebral edema could be safely managed post-operatively with lower doses of dexamethasone. METHODS Eligible patients with brain tumors who had less than 10 mm of midline shift on their pre-operative brain MRIs were randomized 1:1 to the standard or low dose dexamethasone arm, each tapering double blinded through post-op day 8. The double blind was maintained using equivalent volumes for IV doses and capsules containing dexamethasone or placebo. By post-op day 9, participants received the same dose of dexamethasone and continued tapering to off by day 14. Additional doses of dexamethasone were allowed if needed, based on specified symptom criteria. Lack of feasibility was defined as a participant requiring 18 mg or more of dexamethasone in addition to the planned total dose of dexamethasone (low dose: 49 mg; standard dose: 112 mg). Brain MRIs were performed on post-operative days 1, 3, and 8 to evaluate changes in cerebral edema. Manual segmentation and computer-assisted techniques were used to quantitatively measure cerebral edema volume. RESULTS Twenty-six patients were randomized and treated within tumor type strata (primary versus metastatic), of which 25 were evaluable. None of the participants on the low dose dexamethasone arm met the criteria for lack of feasibility. The quantitative assessment of differences in cerebral edema between the arms is ongoing and will be presented. CONCLUSIONS Administration of lower doses of dexamethasone post-operatively to brain tumor patients with mild to moderate cerebral edema is feasible. Treatment with lower doses of dexamethasone post-operatively should be considered in this patient population when peri-operative administration of immunotherapy is planned.

Purified L-glutaminase effects against multidrug-resistant Pseudomonas aeruginosa in experimental vaginosis model: An immunological and histopathological observation

The antimicrobial activity of crude and purified L-glutaminase (EC 3.5.1.2), obtained from Lactobacillus gasseri, was evaluated against multidrug-resistant Pseudomonas aeruginosa in the in vivo vaginosis condition. The L-glutaminase possessed significant antimicrobial and anti-biofilm formation activity against multi-drug resistance P. aeruginosa, which were confirmed in the BALBc rat vaginosis model, together with its effects on the immunological and histopathological aspects. The untreated animals showed heavy vaginitis, characterized by sub-epithelial edema and infiltration of mononuclear leukocytes, perivascular heavy inflammatory cells infiltration in the vaginal tissue, and moderate stromal edema. However, the L-glutaminase treatment exhibited no changes in vaginal tissue structure with normal appearance of the epithelium and lamina propria with marked repair of the vaginal section when compared with normal, uninfected, control group A. The immunomodulatory actions of the L-glutaminase were confirmed by observance of higher concentrations of tumor necrosis factor-γ (TNF-γ), and interleukin −12 (IL-12) in treated animals, while the interleukin-10 (IL-10) was higher in the infected, untreated animals' sera samples. Therefore, the L-glutaminase showed corrective and healing actions, which were observed through histopathological observations of the vaginal tissue. The investigations led to imply that L-glutaminase may have the potential to be an effective antimicrobial agent for preventing and inhibiting bacterial growth, as well as inhibiting the biofilm formation in the P. aeruginosa-originated vaginosis. The observations may be of promising value for future clinical use.

AYURVEDIC MANAGEMENT OF AVASCULAR NECROSIS WITH CHANDAN BALA LAKSHADI TAIL AND LAKSHADI GUGGUL

Avascular Necrosis (AVN) is a progressive degenerative condition of bone that mainly affects the bone of the lower region. It is more common in the hip joint. Avascular necrosis of the femoral head refers to the death of osteocytes with subsequent structural changes due to impaired blood supply. People between 30 and 50 years of age are usually affected. It is associated with excessive alcohol intake and long-term use of high-dose steroidal medications. On the contrary, Ayurvedic treatment provides long-term relief and prevents disease progression without drawbacks. it is Vata Pradhana Tridoshaja Vyadhi with Vikruti of Asthi-Majja Dhatu. In modern medicine, no specific treatment other than surgery is available. The present case study is upon a 45year male patient, diagnosed with avascular necrosis involving nearly 50 percent of the femoral head with moderate marrow oedema (stage 3rd) femoral head with complaints of pain in the bilateral hip region since one and half years, which was associated with difficulty in doing normal daily activities such as walking, sitting, squatting along with a change in the gate.

Intraventricular hemorrhage secondary to ruptured arteriovenous malformation: A case report

Introduction: An arteriovenous malformation (AVM) is a lesion in which the feeding artery and the draining vein are connected by a coiled, tortuous vascular link. This nidus is where arteriovenous shunting occurs. While pediatric AVM is uncommon, there has been evidence of possible impairments and an increased risk of hemorrhage. This study aimed to elaborate on a rare case of pediatric arteriovenous malformation with intraventricular hemorrhage. Case report: A male patient, fifteen years of age, was referred from P hospital due to a severe headache that was accompanied by nausea and vomiting two days prior to hospital admission. Chief Computed Tomography Digitizing and Angiographic Images In the left lateral ventricle, the posterior horn of the right lateral ventricle, the third ventricle, and the left pericallosal area AVM (Spletzer Martin grading: 2), intraventricular hemorrhage (IVH), and moderate cerebral edema were all seen during an angiography. AVM was managed conservatively with head positioning 30o, analgesics, and ranitidine. Phenytoin was given as a precaution for seizure in intracerebral hemorrhage. The headache improved gradually during the hospital stay. Upon follow-up at the outpatient clinic, headache and other neurological symptoms were absent, and the patient had typical vital signs. Conclusion: AVM rupture can cause IVH that occurs more often in young patients. Management of pediatric AVM requires discussion among pediatric neurologists, neurosurgeons, and interventional radiologists to decide the best care for the patient. AVM patients who received conservative treatment had a higher risk of bleeding and, therefore, required routine monitoring.

Cannabidiol ameliorates lipopolysaccharide-induced cardiovascular toxicity by its antioxidant and anti-inflammatory activity via regulating IL-6, Hif1α, STAT3, eNOS pathway.

Systemic inflammation causes several organ damage by activating the intracellular signaling mechanisms. Heart and aorta tissues are the structures mostly affected by this situation. By examining underlying processes, this study sought to determine whether cannabidiol (CBD) may have protective effects against the cardiovascular damage brought on by lipopolysaccharide (LPS). A total of 32 female rats were randomly allocated to one of four groups: control, lipopolysaccharide (LPS) (5mg/kg, i.p., single dose), LPS + CBD (5mg/kg, i.p., single dose), and CBD groups. The rats were killed six hours after receiving LPS, and tissues from the heart and aorta were taken. Histopathological and immunohistochemical analyzes were performed. Oxidative stress was evaluated biochemically by spectrophotometric method. Expression levels of genes were studied by RT-qPCR method. Histopathological analysis of the LPS group showed moderate hyperemia, hemorrhages, edema, inflammation, and myocardial cell damage. There was a slight to moderate increase in Cox-1, G-CSF, and IL-3 immunoexpressions, along with enhanced expressions of IL-6, Hif1α, and STAT3 genes, and decreased expressions of eNOS genes. Additionally, there were increased levels of TOS and decreased TAS levels observed biochemically. CBD treatment effectively reversed and improved all of these observed changes. CBD protects the heart and aorta against systemic inflammation through its antioxidant and anti-inflammatory activity via regulating IL-6, Hif1α, STAT3, and eNOS intracellular pathways.

Мікрорівнева адаптація окремих органів і тканин стерляді (Acipenser ruthenus Linnaeus, 1758) в умовах теплового стресу

Purpose. To evaluate the variability of the histological parameters of individual organs and tissues of sterlet, to establish the level of effect of heat stress on the physiological status of fish and the degree of their adaptation. To determine the perspective of using histological monitoring data in fish farming practice. Methodology. The primary materials were obtained in aquarium conditions of the Aquatic Bioresources Laboratory of the Kherson State Agrarian and Economic University. The laboratory processing of histological samples was performed according to generally accepted methods and manuals. Histological studies were carried out using the author’s equipment and original methods, specially intended for the diagnostics of fish tissues. The obtained results were processed by methods of variational statistics using a package of appropriate MS Excel applications, with emphasis on the standard error. Findings. Microanatomical studies of sterlet showed that under conditions of heat stress, the most significant changes occur in adipose tissue, somatic and cardiac muscle tissue, thyroid gland and renal tissue, which can conditionally be considered as bioindicative zones. Under the potential influence of the thermal factor, the response of sterlet is expressed in a decrease in the lipid content in the accompanying muscles of adipose tissue. The effect is visualized in the fragmentation and subsequent shredding of lipid vacuoles, which leads to variability in adipocyte shape from stellate to spindle-shaped. The obtained results indicate a decrease in the excretion of thyroid hormones into the bloodstream by the thyroid gland and is expressed in a gradual increase in the diameter of the thyroid follicles (by 16.0 µm and 26.5 µm) and a corresponding decrease in the height of the follicular cells (by 1.1 µm and 2.0 µm), which is statistically significant. Intensive development of “additional” follicles inside existing ones indicates the prevention of thyroid intoxication of the body, which indicates the development of an adaptive reaction of the body. Comparative studies of the ventricular myocardium of fish allowed establishing certain morphological differences in the form of moderate interstitial edema of the tissue and intracellular edema of cardiomyocytes. In the final phase of the experiment, karyopyknosis was locally observed in the ventricular cardiomyocytes of 50% of stressed fish. Somatic muscle tissue is generally resistant to stress, but the rate of its development at elevated temperatures slows down. Characteristic signs of the histological picture of muscle stress are approximately the same ratio of stromal and parenchymal components, the central orientation of the nuclei within a single muscle fiber and insufficient filling of the fibers with the fibrillar component. Antidiuretic hormone is forcedly released in fish under conditions of heat stress, which leads to a decrease in the volume of the primary filtrate. Evidence is a narrow gap in the urinary space between the visceral and parietal layers of the renal corpuscle. Originality. New data are presented and existing data on the histological structure of individual organs and tissues of sterlet under stress loads are significantly expanded. For the first time, a detailed histological analysis of the structure of muscle, adipose tissue, as well as the kidney and thyroid gland of sterlet under heat stress conditions was carried out. The comparative analysis, current and updated information on compensatory changes in tissues demonstrate their adaptive potential, which was developed during the evolution of the species. Practical Value. The information obtained is of value in morphophysiological studies as well as in fish farming practice in connection with the modern problem of a decrease in the life status of fish under stress. The use of the obtained data allows a qualitative assessment of the physiological state and can be used in the process of developing corrective measures in order to consolidate hereditary resistance, which is ultimately aimed at preventing diseases of valuable aquaculture objects. Keywords: sterlet, heat stress, adaptation, muscle tissue, thyroid gland, myocardium, adipose tissue, renal tissue.

Tongue edema as an adverse drug reaction to low-dose olanzapine in a cancer patient receiving palliative care.

Olanzapine is an atypical neuroleptic indicated for treatment of various psychiatric disorders, but it has also several indications in palliative care (PC) patients: opioids misuse, nausea not related to chemotherapy, anorexia-cachexia syndrome, and sleep and mood disorders. Peripheral and facial edema are a rare side effect of the treatment with olanzapine. I report a case of an advanced cancer patient cared receiving PC who developed moderate tongue edema on day 1 of a low dose of olanzapine. A patient with advance and metastatic colon cancer presented moderate tongue edema on day 1 of a low dose (2.5 mg) of olanzapine for the treatment of his nausea, anorexia-cachexia syndrome, and mood disorder (mainly anxiety). The patient discontinued the drug with resolution of the edema. The day after he called our outpatients' service, a prompt physical examination, together with blood tests, excluded other differential diagnosis. To the best of our knowledge, this is the second case reporting head and neck localized edema due to olanzapine treatment in a patient with advanced cancer receiving PC. Considering the increasing use of olanzapine as off-label treatment in these patients (often for cluster symptoms), our report could help clinicians in daily practice and researchers on put a deeper focus on indications for olanzapine in PC.

Hyperbaric Oxygen Therapy and Late Local Toxic Effects in Patients With Irradiated Breast Cancer

Hyperbaric oxygen therapy (HBOT) is proposed as treatment for late local toxic effects after breast irradiation. Strong evidence of effectiveness is lacking. To assess effectiveness of HBOT for late local toxic effects in women who received adjuvant radiotherapy for breast cancer. This was a hospital-based, pragmatic, 2-arm, randomized clinical trial nested within the prospective UMBRELLA cohort following the trials within cohorts design in the Netherlands. Participants included 189 women with patient-reported moderate or severe breast, chest wall, and/or shoulder pain in combination with mild, moderate, or severe edema, fibrosis, or movement restriction 12 months or longer after breast irradiation. Data analysis was performed from May to September 2023. Receipt of 30 to 40 HBOT sessions over a period of 6 to 8 consecutive weeks. Breast, chest wall, and/or shoulder pain 6 months postrandomization measured by the European Organization for Research and Treatment of Cancer QLQ-BR23 questionnaire. Secondary end points were patient-reported fibrosis, edema, movement restriction, and overall quality of life. Data were analyzed according to intention-to-treat (ITT) and complier average causal effect (CACE) principles. Between November 2019 and August 2022, 125 women (median [range] age at randomization, 56 [37-85] years) with late local toxic effects were offered to undergo HBOT (intervention arm), and 61 women (median [range] age at randomization, 60 [36-80] years) were randomized to the control arm. Of those offered HBOT, 31 (25%) accepted and completed treatment. The most common reason for not accepting HBOT was high treatment intensity. In ITT, moderate or severe pain at follow-up was reported by 58 of 115 women (50%) in the intervention arm and 32 of 52 women (62%) in the control arm (odds ratio [OR], 0.63; 95% CI, 0.32-1.23; P = .18). In CACE, the proportion of women reporting moderate or severe pain at follow-up was 32% (10 of 31) among those completing HBOT and 75% (9.7 of 12.9) among control participants expected to complete HBOT if offered (adjusted OR, 0.34; 95% CI, 0.15-0.80; P = .01). In ITT, moderate or severe fibrosis was reported by 35 of 107 (33%) in the intervention arm and 25 of 49 (51%) in the control arm (OR, 0.36; 95% CI, 0.15-0.81; P = .02). There were no significant differences in breast edema, movement restriction, and quality of life between groups in ITT and CACE. In this randomized clinical trial, offering HBOT to women with late local toxic effects was not effective for reducing pain, but was effective for reducing fibrosis. In the subgroup of women who completed HBOT, a significant reduction in pain and fibrosis was observed. A smaller than anticipated proportion of women with late local toxic effects was prepared to undergo HBOT. ClinicalTrials.gov Identifier: NCT04193722.

Surgical correction of congenital megaprepuce: a pilot study.

Congenital megaprepuce (CMP) is a rare penile deformity that usually requires surgical correction. This study was performed to examine the efficacy of the modified Sugita procedure for repairing CMP in pediatric patients. We retrospectively analyzed the clinical data of pediatric patients with CMP treated by a surgeon using the modified Sugita procedure in our hospital from January 2019 to April 2021. Twenty patients were enrolled, and their median age at surgery was 70.5 months (range, 60-96 months). All surgeries were successful, and no complications occurred during the operation. The postoperative foreskin had moderate edema in five patients, and soaking in 10% hypertonic saline resulted in disappearance of the edema within 4 to 8 weeks. The follow-up duration was 6 to 20 months (median, 10 months). No other complications occurred, such as dehiscence or hematoma. The modified Sugita procedure for correction of CMP produces excellent cosmesis and a low complication rate. Our study indicates that the modified Sugita procedure is a safe and feasible treatment option.

Scheimpflug Tomography as a Predictor of Corneal Edema After Phacoemulsification in Fuchs Endothelial Corneal Dystrophy.

To determine if Scheimpflug tomography pachymetry map and posterior elevation map patterns can predict the occurrence of corneal edema following uneventful phacoemulsification surgery in Fuchs endothelial corneal dystrophy (FECD). Observational prospective case-control study. Fifty FECD eyes (50 patients) with visually significant cataract: 25 with subclinical corneal edema (SCE) versus 25 without SCE. Preoperatively, FECD was clinically assessed, and only patients devoid of clinical corneal edema were enrolled. Utilizing the Mayo Clinic classification for subclinical corneal edema (SCE), eligible FECD eyes were stratified based on Scheimpflug imaging pachymetry map and posterior elevation map characteristics, including loss of regular isopachs, displacement of the cornea's thinnest point, and the presence of posterior surface depression, into two groups: Group A representing FECD with SCE, and Group B: FECD without SCE. One week postoperatively, clinical and tomographic evaluation was performed. Regression analysis was conducted to evaluate predictors of corneal edema after uneventful phacoemulsification surgery in both groups. All patients were successfully imaged before and 1 week after surgery. Visual acuity was significantly improved in both groups (P < 0.001). No postoperative clinical edema was observed in Group B, while 23 (92%) had mild edema and 2 (8%) had moderate edema in Group A. Both groups showed a significant increase in postoperative central corneal thickness (CCT) and thinnest corneal thickness (TCT) (both P < 0.001). Compared to Group B, Group A showed a significant central flattening of the anterior corneal surface (P = 0.007 and P = 0.04 for K1 and K2 respectively), and a significant increase in the postoperative posterior surface depression. Multivariate analysis showed that 94% of postoperative corneal edema could be predicted by the presence of preoperative posterior surface depression (P = 0.04, ARR = 5.8 (1.89-35.7)). Scheimpflug tomography pachymetry map and posterior elevation map patterns can predict corneal edema after uneventful phacoemulsification surgery in FECD with subclinical corneal edema.

Investigation of breast cancer molecular subtype in a multi-ethnic population using MRI.

Accurate subtyping of breast cancer is crucial for its diagnosis, management, and prognostication. This study aimed to determine the association of magnetic resonance imaging (MRI) breast features with the molecular subtype and aggressiveness of breast cancer in a multi-ethnic population. Treatment-naive patients with invasive breast carcinoma were included in this retrospective study. Breast MRI features were recorded based on the American College of Radiology-Breast Imaging Reporting and Data System (ACR-BIRADS) criteria, with tumour size, and apparent diffusion coefficient value (ADC). The statistical association was tested with Pearson Chi-Square Test of Independence for categorical data or the Kruskal-Wallis/ Mann Whitney U test for numerical data between the MRI features and molecular subtype, receptor status, tumour grade, lymphovascular infiltration (LVI) and axillary lymph node (ALN). Multinomial logistic regression was used to test the predictive likelihood of the significant features. The breast cancer subtypes were determined via immunohistochemistry (IHC) and dual-color dual-hapten in-situ hybridization (D-DISH). The expression statuses of ER, PR, and HER-2, LVI, and ALN were obtained from the histopathology report. The ER / PR / HER-2 was evaluated according to the American Society of Clinical Oncology / College of American Pathologists. The study included 194 patients; 41.8% (n = 81) Chinese, 40.7% (n = 79) Malay, and 17.5% (n = 34) Indian, involving 71.6%(n = 139) luminal-like, 12.9%(n = 25) HER-2 enriched, and 15.5%(n = 30) Triple-negative breast cancer (TNBC). TNBC was associated with rim enhancement (p = 0.002) and peritumoral oedema (p = 0.004). HER-2 enriched tumour was associated with larger tumour size (p = 0.041). Luminal-like cancer was associated with irregular shape (p = 0.005) with circumscribed margin (p = 0.003). Other associations were ER-negative tumour with circumscribed margin (p = 0.002) and PR-negative with round shape (p = 0.001). Tumour sizes were larger in ER-negative (p = 0.044) and PR-negative (p = 0.022). Rim enhancement was significantly associated with higher grade (p = 0.001), and moderate peritumoral oedema with positive axillary lymph node (p = 0.002). Certain MRI features can be applied to differentiate breast cancer molecular subtypes, receptor status and aggressiveness, even in a multi-ethnic population.

Ultrastructural changes in the rat retina in the presence of long-term opioid exposure

Purpose: To determine the features of the untrastructural reorganization in the rat retina by the end of week 4 and week 6 of experimental opioid exposure. Material and Methods: Forty-eight adult male albino rats (weight, 200-250 g; age, 4.5 months) were used in this study. They received nalbuphine hydrochloride intramuscularly daily for 42 days. Particularly, the drug was administered daily at a dose of 0.212 mg/kg for weeks 1 and 2, 0.225 mg/kg for weeks 3 and 4, and 0.252 mg/kg for weeks 5 and 6. In this way, we experimentally created the conditions of chronic opioid exposure. Animals were divided into three groups. Group 1 (19 animals) received nalbuphine for 28 days, and group 2 (19 animals), for 42 days. Group 3 (control group) comprised 10 animals. Of these, 5 animals were treated with normal saline at a dose of 0.22 mg/kg intramuscularly daily for 28 days, and the rest were treated in a similar manner for 42 days. Transmission electron microscopy studies of the rat retina were conducted in a routine manner. Results: By the end of week 4 of experimental opioid exposure, there was an increase in the number of retinal microvessels with signs of hyperemia and degenerative changes in retinal pigment epithelium (RPE) cells, increase in the destruction of membranous discs of photoreceptor outer segments, necrobiotic changes in the nuclei of individual photoreceptors, axonal degeneration in the outer and inner plexiform layers, degenerative changes in retinal horizontal neurons, and the appearance of necrotic structural changes in the cytoplasm of bipolar and amacrine cells. By the end of week 6, there was a further increase in hyperemia of retinal vessels and degenerative and necrotic changes in individual RPE cells and photoreceptor outer segments. In addition, we observed destruction and shortening of mitochondrial cristae of photoreceptor inner segments, necrotic nuclear changes in individual photoreceptors, degeneration of axons of the outer and inner plexiform layers, degenerative and necrotic changes in bipolar and amacrine cells, hypertrophic Müller cell processes, degeneration of ganglion cells, and vascular hyperemia and moderate perivascular edema in the outer and inner plexiform layers. Conclusion: Therefore, in the current rat study, after a 4-week exposure to daily nalbuphine injections at a dose ranging 0.212 to 0.253 mg/kg, there was ultrastuctural evidence of destructive processes in the RPE and photoreceptor outer segments, axonal degeneration in the outer and inner plexiform layers, degenerative and necrotic changes in bipolar and amacrine cells, hypertrophic Müller cell processes, ganglion cell degeneration and hyperemia due to an impaired retinal microcirculatory ultrastructure. At week 6 of the experiment, there was evidence of increased destructive and degenerative processes in structural components of the retina.

Abstract 17521: Esmolol-Associated Skin Necrosis: An Uncommon Adverse Reaction

Background: We report a case of a patient admitted to the cardiac care unit for evaluation of a non-ST-elevation myocardial infarction (NSTEMI) in the setting of atrial flutter (2:1) who developed a bullae and skin necrosis secondary to esmolol infusion. Case presentation: A 48-year-old male with a past medical history of hypertension presented with exertional chest pain with associated shortness of breath and palpitations and was being evaluated for NSTEMI. Vitals were significant for blood pressure of 191/115 and heart rate of 125. Labs were significant for troponin I of 33.16 (&lt;=0.15 ng/mL), which peaked at 38.24, and creatinine of 2.5. Electrocardiogram demonstrated atrial flutter 2:1 conduction with a rapid ventricular response. While in the cardiac critical unit, he was placed on an esmolol drip for rate control. Twenty-four hours after administration of the esmolol through a peripheral intravenous line (PIV), the patient began to feel pain with moderate edema around the site of the injection. The PIV was removed, and cold compresses were applied. Approximately 5-7 hours later, the patient developed multiple ring-like bullae around the injection site. Physical examination was noted for cold and tenderness to palpation with paresthesias. General surgery was consulted for compartment syndrome, which was ruled out. The cutaneous changes progressively worsened through admission, persisting in size and appearance with rupture and ulceration, and necrosis one week later (see image 1). Conclusion: Although rare, esmolol can lead to skin necrosis and early identification is necessary for appropriate intervention including cessation of the culprit agent.

TO THE ISSUE OF A DIFFERENTIATED, BIOPATHOGENETIC APPROACH TO THE SELECTION OF INTERVENTION FOR VARIOUS CLINICAL AND ANATOMICAL FORMS OF SEVERE TRAUMATIC BRAIN INJURY

The work, based on many years of experience and in-depth analysis of significant clinical material - 3500 surgical interventions for various clinical and anatomical forms of severe traumatic brain injury (TBI), carried out in 1515 cases in the pre-computer period and in 1990 - in the post-computer period, shows the evolution views on neurotrauma and the advantage of a differentiated approach to the choice of intervention, taking into account the biomechanism and neuropathomorphological features of various clinical and anatomical forms of TBI; shows how they have changed, with the introduction of adequate diagnostic tools and neuroimaging (CT and MRI) approaches to the choice of interventions depending on and taking into account the biomechanism and pathomorphological basis of various clinical and anatomical forms of severe traumatic brain injury. With the introduction of computer diagnostics, the possibilities of various methods of intervention were revised: if possible, preference was given to osteoplastic trephination, which, in case of swelling and prolapse of the brain - in case of gross violations of the craniocerebral volume-capacitive relationships, in the computer period, the intervention ended with decompressive craniotomy with subcutaneous preservation bone flap – in 1096 cases out of 1990 interventions. In the remaining 894 cases, the intervention was completed using the osteoplastic method. In 217 of them, it was carried out in an improved, modified form: a wide bone flap, with moderate cerebral edema, was not removed. On top of the plastically extended hard shell, it was guided to the sawing site, as if in the form of an “apron,” and loosely fixed with periosteal sutures. When the edema subsided, the bone flap was placed in place, and if necessary, it was easily connected with ligatures passed through microholes along the edge of the craniotomy and in symmetrical places of the sawed bone flap and brought out. In case of inertial injuries, with multihemispheric-multifocal brain damage and with a volumetric hemorrhagic component, in 939 cases one was performed - and in 157 observations - two-sided optimally extended decompressive craniotomy, among which in 49 cases bilateral hemicranectomy was successful. After 1096 decompressive interventions, 554 (41.4%) of the victims died; in the remaining 894 cases, a wide traditional and modified craniotomy with loose fixation of the bone flap was also performed, involving the parabasal sections of the anterior and middle cranial fossa; in 84 cases - bifrontal craniotomy with falxotomy, in 593 - extended traditional osteoplastic trepanation, and in 217 cases - also extended, but modified osteoplastic craniotomy. Death was noted in 27 (32.1%), 110 (18.5%) and 11 (5.1%) cases, respectively. The overall mortality rate in this group - among 894 cases with osteoplastic craniotomy - was 16.6%. Postoperative mortality among all 1990 interventions for various clinical and anatomical forms of TBI in the post-computer period amounted to a total of 30.3%. Thus, taking into account the biomechanism and pathomorphological basis of TBI, a differentiated, biopathogenetic approach to the choice of intervention, it was possible to reduce, from year to year, postoperative mortality from 36-38% in the pre-computer period, to 29-30% in the computer period, at 35-45 % according to various neurosurgical clinics.

Effect of CPAP therapy on the reperfusion lung injury after transluminal balloon angioplasty of the pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension

Aim. To evaluate the effect of non-invasive ventilation (NIV) in CPAP (continuous positive airway pressure) mode on the development of reperfusion pulmonary edema after percutaneous balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Materials and methods. The study included 70 patients with CTEPH who underwent the first stage of BPA. Prevention of reperfusion edema was carried out using NIV in the CPAP mode starting from the early postoperative period in combination with oxygen and diuretic therapy (as nedeed). The presence and severity of pulmonary edema was assessed based on clinical signs and data from computed tomography or chest radiography.Results. Patients after BPA were on CPAP therapy: average pressure: 10.0±0,7 hPa. During 1st day, the average time of use was: 990±417 minutes. Prolongation of CPAP therapy &gt;1 day occurred in 26 (37%) patients. Depending on the severity of reperfusion edema to the lungs, patients were divided into 2 groups: group 1 (grade 1, n=42) and group 2 (grade 3-4, n=12). During the observation period, there were no cases of severe reperfusion edema (grade 5), and no cases required the use of invasive ventilation or extracorporeal membrane oxygenation. No complications of CPAP therapy were recorded. The number of PA segments and ΔPFG did not differ, but the PEPSI index was higher in group 2: 41,9 [16,0; 57,9] vs 80.5 [52,5; 111,25], p=0,0146. The number of days before discharge after BPA in patients of group 2 was higher: 4.0 [3,9; 5,5] vs 7,0 [4,6; 10,0] days, p=0,013. Despite the development of reperfusion edema, before discharge the SpO2 values in group 2 were comparable to the baseline: 93,0 [89,9; 94,2] vs 93,0 [89,7; 94,4]Conclusion. Preventive use of NIV in the CPAP mode, starting from the early postoperative period, is safe and makes it possible to achieve optimal clinical results in patients even with moderate and severe lung reperfusion edema after large volumes of surgical intervention.

Evaluation of in vivo bond strength and skin irritation test for new skin adhesive

ObjectivesThis study developed a new skin-deproteinized natural rubber latex (DNRL) silicone adhesive for adhering to silicone prostheses and compared the properties with a commercial Daro-Hydrobond adhesive. Materials and methodsThe new DNRL skin adhesive formulation was made from non-vulcanized natural rubber-based adhesives consisting of DNRL, 20% polyvinyl alcohol, cumarone resin, 2% methylcellulose, and Wingstay L. The peel bond strength of the adhesives was tested using a 90-degree peel test. Biocompatibility was accessed using in vitro keratinocyte cell viability. Animals (rabbits) and humans were tested for skin irritation tests. Results were analyzed using SPSS Version 24 and compared between the two adhesives. ResultsThe peel bond strength of the new DNRL skin adhesive was 103.61 ± 23.18 N/m whereas that of the Daro-hydrobond adhesive was 131.52 ± 21.72 N/m. There was no significant difference (p>0.05) between the peel bond strengths of the two test adhesives. Cell proliferation under the DNRL skin adhesive-soaked medium showed higher cell viability than the positive control (p<0.05). The DNRL skin adhesive produced moderate erythema and edema on rabbit skins, however, the skin lesions recovered within 14 days. Two volunteers showed mild irritation at the first hour of the contact which was reduced within an hour without any therapy. The patient satisfaction with the DNRL skin adhesive ranged from slightly satisfied to completely satisfied. ConclusionThe new DNRL skin adhesive showed comparable peel bond strength and patient satisfaction to those of commercial adhesives. The adhesive was biocompatible and can be used carefully.

FRI552 Orbitopathy As The Sole Manifestation Of Hashimoto’s Thyroiditis In A Euthyroid Patient: A Case Report

Abstract Disclosure: C. Labib: None. Z. Saeed: None. M. Trabulsi: None. F. Ramharrack: None. INTRODUCTION: Thyroid associated ophthalmopathy (TAO) is caused by an autoimmune process involving the orbital tissue, however, its etiopathogenesis is still largely unclear. It is common in hyperthyroid patients with Graves’ disease and has also been reported in euthyroid and hypothyroid Graves’ patients with positive thyroid receptor antibodies (TRAb). However, only 5% of patient with Hashimoto’s thyroiditis (HT) develop orbitopathy. Here we report an unusual case of a male patient, clinically and biochemically euthyroid, who had severe bilateral exophthalmos due to underlying Hashimoto’s thyroiditis. CASE PRESENTATION: A 68-year-old male patient was evaluated for worsening bilateral eye protrusion associated with redness and grittiness for many years. The patient was otherwise asymptomatic; denied fatigue, any change in weight, constipation, joint/muscle pain or any other symptoms. On physical examination he was noted to have bilateral moderate periorbital edema, conjunctival injection along with mildly enlarged thyroid. Initial labs showed normal TSH 4.10 mIU/L (0.4-5.0mIU/L) and free T4 0.8 ng/dL (0.8-1.8 ng/dL). Further labs were notable for normal antithyrotropin antibody (TRAb) 1.09 IU/l and normal TSI less than 89%. Anti-thyroid peroxidase antibody (anti-TPO) level was as high as 12 IU/mL (less than 9 IU/mL). Thyroid US showed multinodular goiter with bilateral nodules. A Subsequent FNA was benign. The degree of exophthalmos on the Hertel ophthalmometer was 30 mm bilaterally. Orbital magnetic resonance imaging (MRI) showed proptosis of the left and right globes as well as prominence of intraorbital fat. Extraocular musculature was symmetric bilaterally and only minimally prominent but diffuse. Treatment with teprotumumab infusion was started with improvement in the patient’s symptoms. CASE DISCUSSION: Usually mild eye symptoms are seen in Hashimoto’s thyroiditis such as dryness, blurred vision, upper eyelid retraction and loss of lateral third of eyebrows. In rare cases it can cause orbitopathy similar to that seen in Graves’ disease. Like Graves’ orbitopathy, in addition to reversing the underlying thyroid abnormalities, moderate-to-severe orbitopathy is treated with corticosteroids or teprotumumab. This case sheds the light on exophthalmos being an atypical presentation of Hashimoto’s thyroiditis in a clinically and biochemically euthyroid patient. Physicians should be cognizant of this rare manifestation for prompt recognition and early treatment which can prevent corneal involvement and blindness due to optic nerve compression. Presentation: Friday, June 16, 2023

In-vivo anti-inflammatory effects of Roman Chamomile (Chamaemelum nobile) aqueous extracts collected from the National Park of El-Kala (North-East, Algeria).

The aim of our study is to evaluate anti-inflammatory effect of Chamaemelum nobile. Aqueous extracts were administrated to Wistar rats in bronchial-inflammation experimentally induced by an allergen and ovalbumin, administered intraperitoneally / intranasally (20mg/kg/day). Experimentation showed disturbances in bronchoalveolar fluid with increased leukocyte and lymphocyte levels as well as IL-4 concentration in the lungs and erythrocytes associated with high lipid peroxidation. There were disturbances in enzymatic and non-enzymatic antioxidant defense system. Lungs histopathological showed an inflammatory lymphoplasmacytic infiltrate, moderate edema of alveoli, vascular congestion and suffusion hemorrhage. Administration of aqueous extract to OVA-sensitized rats caused a significant and very highly significant improvement of MDA levels in lungs, erythrocytes, GSH, GPx, GST, catalase and SOD. We notice a decrease in IL-4 in LBA and lungs alongside reduced inflammatory cell infiltration, mild bronchiolar dilation, mild alveolar edema and normal cell morphology allowing us to conclude on the effectiveness of anti-inflammatory activity of Roman chamomile.

A Case of Hypertensive Anterior Uveitis with Endotheliitis of the Cornea Following COVID-19 Pneumonia

Purpose: We report a patient diagnosed with COVID-19-associated hypertensive anterior uveitis and endotheliitis of the cornea.Case Summary: A 71-year-old male visited our hospital with decreased visual acuity, ocular pain, eyelid swelling of in his right eye, and headache for 8 days. He had been diagnosed with COVID-19 pneumonia 10 days before the visit. The best-corrected visual acuity was 0.04 in his right eye and 0.15 in his left eye. Severe conjunctival injection, moderate corneal edema with Descemet membrane folding, diffuse keratic precipitates and mild anterior chamber reaction were observed in the right eye, which were not present in the previous examination. Pupils in both eyes were moderately dilated and slow to react in response to direct light. The density of endothelial cells in the right eye was 711 cells/mm&lt;sup&gt;2&lt;/sup&gt; and an owl’s eye morphology of endothelial cells was observed via specular microscopy. During follow up, elevated intraocular pressure (IOP) in the right eye was noted. Polymerase chain reaction (PCR) examination of the aqueous humor for cytomegalovirus was negative. After 2 weeks of applying prednisolone eye drops and anti-glaucoma eye drops, corneal edema decreased, and his vision improved to 0.5. However, the density of the corneal endothelium remained low.Conclusions: Although there have been worldwide case reports of conjunctivitis, keratitis, or uveitis after COVID-19 infection, this study presents the first reported case of COVID-19 associated hypertensive anterior uveitis and endotheliitis of the cornea.

Gastro-protective Effect of Corn Diet against Indomethacin Induced Ulceration in Experimental Rats

Introduction: One of the most prevalent gastrointestinal ailments is gastric ulcer, which is caused by an imbalance between protective and aggressive factors. Zea mays Corn is a significant cereal crop containing natural phytochemical substances that are sources of nourishment. The methanolic extract of Corn, according to a previous study, lowers stomach acidity and inhibits the percentage of gastric ulceration with no knowledge on the mechanisms involved.&#x0D; Aim: This study investigated the underlying gastroprotective mechanisms of the Corn diet (ZD).&#x0D; Materials and Methods: Sixty male Wistar rats were used, randomly grouped into 6; 1(Normal control), 2(Ulcerated control), 3, 4, 5 (prefed with ZD -55%, 65%, 75%) and 6 (cimetidine- 25mg/kg) for 28 days. Gastric ulcer was induced by oral administration of indomethacin (40mg/kg) and animals were sacrificed after 4 hours. The stomach was excised and cleaned, it was then homogenized and centrifuged for biochemical assays.&#x0D; Results: There is a significant reduction in gastric ulcer area in all treated groups. Significant increase in gastric tissue mucin content and gastric mucosal SOD, NO and PGE2 levels and significant reduction in the MDA was observed in the ZD and cimetidine group. Histological evaluation showed tubular glands closely packed and separated from each other by laminar propia, however there is mild presence of inflammatory cells within the laminar propia in the ZD groups compared to ulcerated control group that showed moderate oedema with infiltration of inflammatory cells with mild vascular congestion in the mucosa. There is significant reduction in the macroscopic gastric mucosal lesions with percentage inhibition of 90%, 92%, 90% and 92% in the ZD (55%, 65% and 75%) and cimetidine group respectively.&#x0D; Conclusion: Results obtained from this study suggests that Zm diet may have anti-ulcerogenic properties by enhancing antioxidant enzymes as well as, nitric oxide and prostaglandin E2 mechanisms.