Pre-existing Pathology Research Articles

Investigating the Incidence of Pulmonary Abnormalities as Identified by Parametric Response Mapping in Patients With Lung Cancer Before Radiation Treatment

PurposeParametric response mapping (PRM) of high-resolution, paired inspiration and expiration computed tomography (CT) scans is a promising analytical imaging technique that is currently used in diagnostic applications and offers the ability to characterize and quantify certain pulmonary pathologies on a patient-specific basis. As one of the first studies to implement such a technique in the radiation oncology clinic, the goal of this work was to assess the feasibility for PRM analysis to identify pulmonary abnormalities in patients with lung cancer before radiation therapy (RT). Methods and MaterialsHigh-resolution, paired inspiration and expiration CT scans were acquired from 23 patients with lung cancer as part of routine treatment planning CT acquisition. When applied to the paired CT scans, PRM analysis classifies lung parenchyma, on a voxel-wise basis, as normal, small airways disease (SAD), emphysema, or parenchymal disease (PD). PRM classifications were quantified as a percent of total lung volume and were evaluated globally and regionally within the lung. ResultsPRM analysis of pre-RT CT scans was successfully implemented using a workflow that produced patient-specific maps and quantified specific phenotypes of pulmonary abnormalities. Through this study, a large prevalence of SAD and PD was demonstrated in this lung cancer patient population, with global averages of 10% and 17%, respectively. Moreover, PRM-classified normal and SAD in the region with primary tumor involvement were found to be significantly different from global lung values. When present, elevated levels of PD and SAD abnormalities tended to be pervasive in multiple regions of the lung, indicating a large burden of underlying disease. ConclusionsPulmonary abnormalities, as detected by PRM, were characterized in patients with lung cancer scheduled for RT. Although further study is needed, PRM is a highly accessible CT-based imaging technique that has the potential to identify local lung abnormalities associated with chronic obstructive pulmonary disease and interstitial lung disease. Further investigation in the radiation oncology setting may provide strategies for tailoring RT planning and risk assessment based on pre-existing PRM-based pathology.

Feasibility and accuracy of the 40-steps desaturation test to determine outcomes in a cohort of patients presenting to hospital with and without COVID-19

Desaturation on exercise has been suggested as a predictive feature for deterioration in COVID-19. The objective of this paper was to determine the feasibility and validity for the 40-steps desaturation test.A prospective observational cohort study was undertaken in patients assessed in hospital prior to discharge. One-hundred and fifty-two participants were screened between November 2020 and February 2021, and 64 were recruited to perform a 40-steps desaturation test. Patients who were able to perform the test were younger and less frail. Four patients were readmitted to hospital and one patient deteriorated within 30 days but no patient died.The majority of patients showed little change in saturations during the test, even with pre-existing respiratory pathology. Change in saturations, respiratory rate, heart rate and breathlessness were not predictive of death or readmission to hospital within 30 days. Of 13 patients who had a desaturation of 3% or more during exercise, none was readmitted to hospital within 30 days.Not enough patients with COVID-19 could be recruited to the study to provide evidence for the safety of the test in this patient group.The 40-steps desaturation test requires further evaluation to assess clinical utility.

Post-Stroke Cognitive Impairment and Dementia.

Poststroke cognitive impairment and dementia (PSCID) is a major source of morbidity and mortality after stroke worldwide. PSCID occurs as a consequence of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Cognitive impairment and dementia manifesting after a clinical stroke is categorized as vascular even in people with comorbid neurodegenerative pathology, which is common in elderly individuals and can contribute to the clinical expression of PSCID. Manifestations of cerebral small vessel disease, such as covert brain infarcts, white matter lesions, microbleeds, and cortical microinfarcts, are also common in patients with stroke and likewise contribute to cognitive outcomes. Although studies of PSCID historically varied in the approach to timing and methods of diagnosis, most of them demonstrate that older age, lower educational status, socioeconomic disparities, premorbid cognitive or functional decline, life-course exposure to vascular risk factors, and a history of prior stroke increase risk of PSCID. Stroke characteristics, in particular stroke severity, lesion volume, lesion location, multiplicity and recurrence, also influence PSCID risk. Understanding the complex interaction between an acute stroke event and preexisting brain pathology remains a priority and will be critical for developing strategies for personalized prediction, prevention, targeted interventions, and rehabilitation. Current challenges in the field relate to a lack of harmonization of definition and classification of PSCID, timing of diagnosis, approaches to neurocognitive assessment, and duration of follow-up after stroke. However, evolving knowledge on pathophysiology, neuroimaging, and biomarkers offers potential for clinical applications and may inform clinical trials. Preventing stroke and PSCID remains a cornerstone of any strategy to achieve optimal brain health. We summarize recent developments in the field and discuss future directions closing with a call for action to systematically include cognitive outcome assessment into any clinical studies of poststroke outcome.

Multibody Computer Model of the Entire Equine Forelimb Simulates Forces Causing Catastrophic Fractures of the Carpus during a Traditional Race.

Simple SummaryPalios are traditional horseraces held in the main square of few Italian cities. Due to peculiar features of such circuits, adapted to the square architecture and thus characterized by tight curves and unconventional footing surface, horses involved are at particular risk of accidents. Prevention of catastrophic musculoskeletal injuries is a significant issue and matter of debate during these events. In particular, the negotiation of the curves in the city circuits is a significative concern. An experiment was set up to build a model of entire forelimb at the point of failure in the context of a turn comparable to that in a Palio circuit. The model was informed by live data and the output compared to post-mortem findings obtained from a horse that sustained a catastrophic fracture of the carpus during this competition. The objective of this study is to determine the magnitude and distribution of internal forces generated across the carpus under which the catastrophic injury has occurred and describe related post-mortem findings.A catastrophic fracture of the radial carpal bone experienced by a racehorse during a Palio race was analyzed. Computational modelling of the carpal joint at the point of failure informed by live data was generated using a multibody code for dynamics simulation. The circuit design in a turn, the speed of the animal and the surface characteristics were considered in the model. A macroscopic examination of the cartilage, micro-CT and histology were performed on the radio-carpal joint of the limb that sustained the fracture. The model predicted the points of contact forces generated at the level of the radio-carpal joint where the fracture occurred. Articular surfaces of the distal radius, together with the proximal articular surface of small carpal bones, exhibited diffuse wear lines, erosions of the articular cartilage and subchondral bone exposure. Even though the data in this study originated from a single fracture and further work will be required to validate this approach, this study highlights the potential correlation between elevated impact forces generated at the level of contact surfaces of the carpal joint during a turn and cartilage breakdown in the absence of pre-existing pathology. Computer modelling resulted in a useful tool to inversely calculate internal forces generated during specific conditions that cannot be reproduced in-vivo because of ethical concerns.

Impact of the Psychiatric Comorbidities in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is one of the main causes of death with a significant impact on the quality of life and mental health of the patients as well as on the health system. The social costs of COPD are significant, because this pathology has a negative impact on patients's professional performance and daily activity. The major risk factors for COPD are age and smoking. Extrapulmonary comorbidities are frequently associated with COPD and may have an influence on the symptoms severity, and the frequency of the exacerbations, hospitalizations and mortality. Psychiatric disorders, especially anxiety and depression, have been observed in clinical trials with an increased prevalence of COPD. The relationship between anxiety, depression and COPD is complex. Psychiatric pathology is involved in influencing the pathophysiology of COPD with a proven impact on the patient's prognosis. COPD sleep disorders can aggravate pre-existing psychiatric pathology, the relationship between the two pathologies being bidirectional. The aim of this paper is to review the latest clinical trials on the existing evidence of psychiatric comorbidities impact on the evolution and prognosis of COPD and the therapeutic alternatives for their improvement. The conclusion of the present study is that anxiety and depression should be periodically assessed by a multidisciplinary team in order to provide a complete management (pharmacological, pulmonary rehabilitation and cognitive-behavioral therapy), improving the patient's quality of life and prognosis.

Enhanced expression of autophagy-related p62 without increased deposits of neurodegeneration-associated proteins in glioblastoma and surrounding tissue - An autopsy-based study.

Neurodegenerative diseases are a major health burden. The underlying causes are not yet fully understood, but different mechanisms such as cell stress and chronic inflammation have been described as contributing factors. Neurodegenerative changes have been observed in the vicinity of brain tumors, typically around slowly growing benign lesions. Moreover, in‐vitro data suggest a potential induction of pathological tau deposits also in glioblastoma, a highly malignant and proliferative brain cancer. The aim of this study was to evaluate neurodegeneration‐associated protein deposition and autophagy as well as microglial activation within and surrounding glioblastoma. Post‐mortem brain tissue of 22 patients with glioblastoma was evaluated immunohistochemically for phosphorylated tau, beta‐amyloid, alpha‐synuclein and phosphorylated TDP‐43. Additionally, the autophagy marker p62 and the microglial marker HLA‐DR were investigated. The data was compared to 22 control cases and ten cases with other space occupying brain lesions. An increase of p62‐immunoreactivity was observed within and adjacent to the glioblastoma tumor tissue. Moreover, dense microglial infiltration in the tumor tissue and the immediate surrounding brain tissue was a constant feature. Deposition of neurodegeneration‐associated proteins was found in the majority of cases (86.4%) but in distant sites. These findings suggested a preexisting neurodegenerative pathology, which followed a typical distributional pattern: ten cases with Alzheimer disease neuropathological changes, including two severe cases, eight cases with primary age‐related tauopathy, six cases with aging‐related tau astrogliopathy and one case with progressive supranuclear palsy. Collectively, our data suggests enhanced autophagy in glioblastoma tumor cells and the surrounding brain. The variety and distribution of distant neurodegeneration‐associated protein aggregates observed in the majority of cases, suggest a preexisting rather than a tumor‐induced neurodegenerative condition.

Long-term outcomes after repair for anomalous right coronary artery from the pulmonary artery.

Anomalous right coronary artery from pulmonary artery (ARCAPA) is a rare congenital heart disease that can lead to abnormal coronary perfusion and a need for surgical repair. Here, we report the outcomes of patients who underwent ARCAPA surgery within the Pediatric Cardiac Care Consortium (PCCC), a North American registry of interventions for paediatric heart diseases. We queried the PCCC for patients undergoing surgical repair for ARCAPA at <18 years of age between 1982 and 2003. Outcomes were obtained from the PCCC and after linkage with the National Death Index (NDI) and the Organ Procurement and Transplantation Network (OPTN) through 2019. Twenty-four patients (males: 15) were identified having surgery for ARCAPA at a median age of 5.8 (IQR 2.7-10.3) years. Of them, 23 cases were considered "simple" (without major intracardiac disease) and one "complex" (co-existing with tetralogy of Fallot). Five patients presented with symptoms [chest pain (1), dyspnoea on exertion (2) or history of syncope (2)]; while the remaining 19 patients were referred for evaluation of either murmur or co-existing CHD. There was no in-hospital mortality after the surgical repair. Fourteen patients had sufficient identifiers for NDI/OPTN linkage; among them, only one death occurred from unrelated non-cardiac causes within a median period of 19.4 years of follow-up (IQR: 18-24.6). Outcomes were excellent after reimplantation up to 25 years later and further longitudinal monitoring is important to understand the interaction of pre-existing coronary pathology with the effects of ageing.

Corneal Edema and Keratoplasty: Risk Factors in Eyes With Previous Glaucoma Drainage Devices

To assess risk factors contributing to corneal decompensation following glaucoma drainage device (GDD) implantation. Retrospective case control study. Records of 1610 eyes that underwent GDD implantation between June 1, 2009, and April 1, 2020, at the Johns Hopkins Wilmer Eye Institute were reviewed. Seventy-nine eyes (5%) developed corneal decompensation, of which 46 underwent keratoplasty. These 79 cases were matched with 220 controls. Cox proportional hazard models with robust standard error estimates to account for clustering at the matched-pair level were used to assess risk factors for corneal decompensation. Kaplan-Meier survival analysis analyzed time to corneal decompensation. The mean (SD) age of cases and controls was 68 (12.3) and 60.5 (15.9) years, respectively. The mean time from GDD implantation to corneal decompensation was 32 months, and the cumulative probability of developing decompensation at 3, 6, and 9 years was 4.7%, 9.2%, and 14.8%, respectively. Final visual outcomes in cases were worse, with a final mean ± SD visual acuity (logMAR) of 1.96±1.25 relative to a mean±SD visual acuity of 1.11±1.36 in controls (P < .001). In the multivariable model, significant risk factors for corneal decompensation were increased age (adjusted hazard ratio [AHR] 1.39, 95% CI 1.18, 1.63; P ≤ .001), history of Fuchs dystrophy or iridocorneal endothelial syndrome (AHR 9.18, 95% CI 5.35, 15.74; P ≤ .001), and postoperative complications such as hypotony (AHR 3.25, 95% CI 1.85, 5.72; P ≤ .001) and tube-cornea touch (AHR 6.37, 95% CI 3.77, 10.75; P ≤ .001). The risk of postoperative corneal decompensation is persistent over time. Patients receiving GDDs, particularly those with advanced age, preexisting corneal pathology, and postoperative complications, should be counseled regarding their increased risk for corneal decompensation.

Addressing Mental and Social Health in Workers' Compensation

Abstract Humans interpret and react to symptoms. We only seek care for a symptom when it becomes a concern.1 Variation in symptom intensity and magnitude of capability relates more to unhelpful thoughts, feelings of worry and despair regarding symptoms, and feelings of insecurity around role and livelihood (mental and social health opportunities) than pathophysiology.2 Work claims are meant to address pathology that results from injury. Injuries have predictable recovery trajectories. When the recovery trajectory seems off track, consider pre-existing non-trauma pathology and mental and social health opportunities. Appropriate management of new pathology under the work claim and pre-existing pathology and mental and social health opportunities outside the work claim, along with a supportive environment that anticipates these aspects of normal human illness behavior, can help people get and stay healthy in the context of workers' compensation.

Complications of Peripartum Cardiomyopathy at the Departmental University Hospital Teaching of Borgou (Benin) in 2022: About 3 Cases

Introduction: Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy occurring in the last month of pregnancy or the first five months postpartum without pre-existing cardiovascular pathology. It is a major cause of pregnancy-related heart failure with high morbidity and mortality. In severe forms (10% to 15% of cases), thrombo-embolic complications are the main cause. The initial hemodynamic evolution is totally unpredictable and sometimes extremely brutal and fatal. The objective of this work was to show the often pejorative evolution of PPCM in our country. Methods: We report in this work three serious clinical cases revealing the complications of this PPCM among patients admitted to the cardiology department of the CHUD-B/A in 2022 for heart failure. The data were collected according to the Declaration of Helsinki. Patients and Observations: The first case was a PPCM with severe left ventricular (LV) systolic dysfunction complicated by spontaneous left intraventricular contrast and right superficial sylvian ischemic stroke. The second case reports a global cardiac decompensation of a PPCM with severe LV systolic dysfunction complicated by an apical thrombus. The third case is that of a state of cardiogenic shock complicating a PPCM with severe LV systolic dysfunction. Among our 03 patients presenting these severe forms of PPCM, the evolution, in spite of the symptomatic and prognostic treatments of the heart failure, and even of the complications, was unfavourable with death in two of them. Conclusion: Complications of PPCM are frequent and fatal in Benin.

Complication of an Adult Oesophageal Foreign Body: Place of Cervicotomy

<i>Objectives</i>: Our work was aimed at exposing the methods of extraction of a foreign body enclosed in the cervical esophagus and specifying the place of cervicotomy in its management. <i>Observation:</i> We report the case of a 76-year-old patient admitted to the ENT emergency department for sudden onset dysphagia following the ingestion of a foreign body of dental prosthesis type (two teeth). The face and profile cervicothoracic radiography revealed a thickening of the oesophageal lumen associated with a prevertebral hyperclarity at the height of the C8 and D1 vertebrae. After two endoscopic extraction attempts to the rigid tube we performed a cervicothoracic CT that showed the dental prosthesis at the height of C8-D1 associated with a peripheral hyperclarity and a left pneumothorax. The hemoglobin level was 14 g/dl, the prothrombin rate was 84%, the activated partial thromboplastin time was 35 seconds. The cervicotomy allowed us to note a perforation of the esophagus at the height of C8-D1. We made an oesophagofissure that allowed us to extract the prosthesis. The reconstruction of the oesophageal lesion was done in two planes. <i>Conclusion:</i> Denture type foreign bodies carry a risk of perforation, especially when endoscopic extraction is difficult. This risk is all the more important when the extraction time is long, when there is a pre-existing oesophageal pathology and by forced extraction maneuvers. Standard surgery is the best way to prevent perforation and septic complications.

Comparison of Medial and Dorsal Approach for Talonavicular Fusion: A Cadaver Study

Category:Basic Sciences/Biologics; Hindfoot; OtherIntroduction/Purpose:Talonavicular (TN) joint arthrodesis is a common procedure for end stage arthritis. There are two common operative approaches used to expose the TN joint for articular preparation, the medial and dorsal. Classically, the medial approach has been the preferred method of TN joint fusion, but recent arguments have been made for the use of the dorsal approach. Articular surface preparation is a key tenant required for any joint fusion. To date no physical preparation studies have been done to compare the two approaches in terms of articular surface preparation.Methods:Ten fresh frozen cadaver specimens were obtained. Fluoroscopic radiographs were used to rule out any pre-existing pathology of the talonavicular joint. Specimens were assigned to receive either a dorsal or medial operative approach to the talonavicular joint. After joint preparation, the talonavicular joint was disarticulated and the amount of articular surface preparation was recorded using ImageJ software.Results:A total of 8 male and 2 female specimens were utilized with an average age of 64.5 +- 13.1. The dorsal approach had a higher average percentage of talar, navicular, and total talonavicular joint surface prepared. When examining joint surface area preparation regardless of approach used, the talar head was significantly less prepared than the navicular. The inter-observer correlation coefficient was excellent for both navicular and talar surface area prepared.Conclusion:The amount of articular surface preparation in the dorsal approach was consistently higher on average. Given the high rate of nonunion in isolated talonavicular and triple arthrodesis, surgeons should be aware that the dorsal approach may offer an increased amount of articular surface preparation. Our study adds to the growing body of evidence supporting the investigation and use of the dorsal approach when attempting talonavicular arthrodesis.

Searching for placenta percreta: a prospective cohort and systematic review of case reports

Placenta percreta is described as the most severe grade of placenta accreta spectrum and accounts for a quarter of all cases of placenta accreta spectrum reported in the literature. We investigated the hypothesis that placenta percreta, which has been described clinically as placental tissue invading through the full thickness of the uterus, is a heterogeneous category with most cases owing to primary or secondary uterine abnormality rather than an abnormally invasive form of placentation. We have evaluated the agreement between the intraoperative findings using the International Federation of Gynecology and Obstetrics classification with the postoperative histopathology diagnosis in a prospective cohort of 101 consecutive singleton pregnancies presenting with a low-lying placenta or placenta previa, a history of at least 1 prior cesarean delivery and ultrasound signs suggestive of placenta accreta spectrum. Furthermore, a systematic literature review of case reports of placenta percreta, which included histopathologic findings and gross images, was performed. Samples for histologic examination were available in 80 of 101 cases of the cohort, which were managed by hysterectomy or partial myometrial resection. Microscopic examination showed evidence of placenta accreta spectrum in 65 cases (creta, 9; increta, 56). Of 101 cases included in the cohort, 44 (43.5%) and 54 (53.5%) were graded as percreta by observer A and observer B, respectively. There was a moderate agreement between observers. Of note, 11 of 36 cases that showed no evidence of abnormal placental attachment at delivery and/or microscopic examination were classified as percreta by both observers. The systematic literature review identified 41 case reports of placenta percreta with microscopic images and presenting symptomatology, suggesting that most cases were the consequence of a uterine rupture. The microscopic descriptions were heterogeneous, and all descriptions demonstrated histology of placenta creta rather than percreta. Our study supported the concept that placenta accreta is not an invasive disorder of placentation but the consequence of postoperative surgical remodeling or a preexisting uterine pathology and found no histologic evidence supporting the existence of a condition where the villous tissue penetrates the entire uterine wall, including the serosa and beyond.

Allergic Bronchopulmonary Aspergillosis Progression to Chronic Pulmonary Aspergillosis

Abstract Allergic bronchopulmonary aspergillosis is a fungal infection of the lung causing a type 1 hypersensitivity reaction to Aspergillus fumigatus colonization. Patients with preexisting lung pathology are extremely susceptible to this organism and show clinical signs of bronchospasm, pulmonary infiltrates, and eosinophilia. In the following case report, we present an asthmatic patient diagnosed with allergic bronchopulmonary aspergillosis, who, despite treatment, progressed to chronic pulmonary aspergillosis with progressive lung damage requiring surgery.

Vascular Effects of Low-Dose ACE2 Inhibitor MLN-4760-Benefit or Detriment in Essential Hypertension?

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects host cells through angiotensin-converting enzyme 2 (ACE2). Concurrently, the product of ACE2 action, angiotensin 1–7 (Ang 1–7), binds to Mas receptors within the cardiovascular system and provides protective effects. Therefore, it is crucial to reveal the role of ACE2 inhibition, especially within pre-existing cardiovascular pathologies. In our study, we imitated the action of SARS-CoV-2 in organisms using the low dose of the ACE2 inhibitor MLN-4760 with the aim of investigating to what degree ACE2 inhibition is detrimental to the cardiovascular system of spontaneously hypertensive rats (SHRs), which represent a model of human essential hypertension. Our study revealed the complex action of MLN-4760 in SHRs. On the one hand, we found that MLN-4760 had (1) (pro)obesogenic effects that negatively correlated with alternative renin-angiotensin system activity and Ang 1–7 in plasma, (2) negative effects on ACE1 inhibitor (captopril) action, (3) detrimental effects on the small arteries function and (4) anti-angiogenic effect in the model of chick chorioallantoic membrane. On the other hand, MLN-4760 induced compensatory mechanisms involving strengthened Mas receptor-, nitric oxide- and hydrogen sulfide-mediated signal transduction in the aorta, which was associated with unchanged blood pressure, suggesting beneficial action of MLN-4760 when administered at a low dose.

Reactivation of Q fever: case report of osteoarticular infection developing at the site of a soft tissue injury

Coxiella burnetii , the causative agent of Q fever, is known to cause acute and persistent infection, but reactivation of infection is rarely reported. This case demonstrates reactivation of a distant, untreated Q fever infection after a relatively innocuous soft tissue injury in an adjacent joint without pre-existing pathology. A 52-year-old male abbatoir worker sustained an adductor muscle tear in a workplace injury. He was unable to walk thereafter, and developed a chronic, progressive, destructive septic arthritis of the adjacent hip with surrounding osteomyelitis of the femur and acetabulum. He had evidence of prior Q fever infection, with a positive skin test and serology 15 years beforehand. He was diagnosed with chronic osteoarticular Q fever on the basis of markedly elevated phase I antibodies, and symptomatic and serological response to prolonged antibiotic treatment with doxycycline and hydroxychloroquine. He required a two-stage hip arthroplasty. This case illustrates reactivation of latent C. burnetii infection at the site of a soft tissue injury. Clinicians need to be aware of this possibility in patients with previous Q fever infection, and in the setting of undiagnosed osteoarticular pathology following soft tissue injury.

Age-Adjusted Normative Values for Hip Patient-Reported Outcome Measures

Background: Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function, assisting in clinical decision making, and quantifying outcomes of surgical and nonsurgical management. However, PROMs are often designed using patients with preexisting pathology and typically assume that a patient without the pathology would have a perfect or near perfect score. This may result in unrealistic expectations or falsely underestimate how well a patient is doing after treatment. The influence of age on PROMs about the hip of healthy individuals has not been studied. Hypothesis: We hypothesize that in asymptomatic individuals hip-specific PROM scores will decrease in an age-dependent manor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In this multicenter survey study, volunteers who denied preexisting hip pathology and previous hip surgery completed 3 PROMs online or as traditional paper questionnaires. The International Hip Outcome Tool (iHOT), the modified Harris Hip Score (mHHS), and the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and HOS—Sport were completed. Analysis of variance with a Tukey post hoc test was used to analyze differences in PROMs among subgroups. An independent-samples Student t test and a χ2 test were used to analyze differences in continuous and categorical data, respectively. Results: In total 496, 571, 534, and 532 responses were collected for the iHOT, mHHS, HOS-ADL, and HOS–Sport, respectively. Respondents’ PROMs were scored and arranged into 3 groups by age: <40 years, 40 to 60 years, and >60 years. The iHOT, mHHS, HOS-ADL, and HOS–Sport of these asymptomatic respondents all decreased in an age-dependent manner: iHOT (<40, 94.1; 40-60, 92.4; >60, 87.0), mHHS (<40, 94.8; 40-60, 91.3; >60, 89.1), HOS-ADL (<40, 98.4; 40-60, 95.0; >60, 90.9), and HOS–Sport (<40, 95.7; 40-60, 82.9; >60, 72.9) (analysis of variance between-group differences, P < .05). Conclusion: This study demonstrated that the iHOT, mHHS, and HOS-ADL and HOS–Sport scores in asymptomatic people decrease in an age-dependent manner. It is important to compare a patient’s outcome scores with the age-normalized scores to establish an accurate reference frame with which to interpret outcomes.

An innovative 'Prop technique' of mouth opening in post-COVID-19 mucormycosis maxillectomy: Finding a new way with minimal efforts.

General anaesthesia is associated with damage to teeth, particularly during laryngoscopy. Dental injury is more probable when pre-existing dental pathology or risk factors are present. Post-coronavirus disease -2019 mucormycosis is a rare, fulminant, lethal, angio-invasive, opportunistic fungal disease and is increasingly recognised in diabetic and immunocompromised patients. Since the flange of the laryngoscope blade appears to be the source of tooth injury, alternate methods of wide mouth opening during laryngoscopy should be examined, especially when mouth opening is limited. In this case series, we have studied 12 cases of maxillectomies with an aim to improve restricted mouth opening by using the 'Prop technique' resulting in a minimum hinging force of the flange of the blade on teeth. Preoperatively, patients were warned about the possibility of dental injuries during anaesthesia or surgery.

Normative FJS-12 scores for the knee in an Asian population: a cross-sectional study

BackgroundThe Forgotten Joint Score is a patient-reported outcome measure validated in assessing patients post knee arthroplasty, anterior cruciate ligament (ACL) reconstruction surgery and patellar dislocation. A previous study had established the normative scores of a population in the USA but included knees with pathology. The aim of our study is to obtain normative Forgotten Joint Scores in young Asian adults without any pre-existing knee pathologies to increase the interpretability of the Forgotten Joint Score-12 (FJS-12) score.MethodsWe conducted a cross-sectional study across young healthy Asian adults via electronic platforms. Participants who had sought either Western medical consultation, physiotherapy or traditional medical therapies were excluded. Demographic data, occupation, type of sport played, and FJS-12 scores were collected. Scores were stratified into subgroups and analysed.ResultsThere were 172 participants who met our inclusion criteria for this study. The average age of participants in our study was 28.1 ± 10.5 years (range 14–70 years), with 83 (47.7%) participants falling into the ages 21–25 years. Average body mass index (BMI) was 21.9 ± 3.3 kg/m2 (range 14.7–36.3 kg/m2). The average FJS-12 score was 62.8 ± 25.6. The median FJS-12 was 63.5 with a range of 4.2–100. Nine participants (5.2%) scored the maximum score possible, and 56 (32.6%) participants scored below the midpoint score of 50. The percentiles for each subgroup of participants were tabulated and reported. Notably, males aged 46–70 years old scored the highest average FJS-12 score of 73.4 ± 5.5, and females aged 31–45 years old scored the lowest FJS-12 score of 57.1 ± 25.1. Females scored lower than males, although the difference was not statistically significant (p = 0.157). There were no significant correlations between BMI, age, or type of sport played with FJS-12; however, interestingly, we observed that women reported similar FJS-12 scores across all age groups, while men reported better scores with increasing age.Interestingly,we observed that women reported similar FJS-12 scores across all age groups,while men reported better scores with increasing age. ConclusionHaving normative values provides opportunities for benchmarking and comparing individuals against age- and gender-matched peers in the general population. Knowledge of normative values for FJS-12 scores would aid evaluating and tracking progress in patients recovering from injuries or undergoing post-surgery rehabilitation. This would help clinicians determine if they return to ‘normal’ post intervention.

Transient Global Amnesia (TGA): Younger Age and Absence of Cerebral Microangiopathy Are Potentially Predisposing Factors for TGA Recurrence.

Background: Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear etiology for a period of less than 24 h. TGA occurs as a single event in most cases. Prevalence rates of recurrent TGA vary widely from 5.4 to 27.1%. This retrospective study aimed to determine predictors for TGA recurrence.Methods: Cardiovascular risk profile and magnetic resonance imaging (MRI) of 340 hospitalized TGA patients between 2011 and 2020 were retrospectively analyzed. The median follow-up period amounted to 4.5 ± 2.7 years. Comparisons were made between TGA patients with and without subsequent recurrence.Results: TGA patients with subsequent recurrence were significantly younger (recurrent vs. single episode, 63.6 ± 8.6 years vs. 67.3 ± 10.5 years, p = 0.032) and showed a lower degree of cerebral microangiopathy compared to TGA patients without recurrence. The mean latency to recurrence was 3.0 years ± 2.1 years after the first episode. In a subgroup analysis, patients with at least five years of follow-up (N = 160, median follow-up period 7.0 ± 1.4 years) had a recurrence rate of 11.3%. A 24.5% risk of subsequent TGA recurrence in the following five years was determined for TGA patients up to 70 years of age without microangiopathic changes on MRI (Fazekas' score 0).Conclusion: Younger TGA patients without significant microangiopathy do have an increased recurrence risk. In turn, pre-existing cerebrovascular pathology, in the form of chronic hypertension and cerebral microangiopathy, seems to counteract TGA recurrence.