Typical Complications Research Articles

ECPR-the evolving role in cardiac arrest.

Extracorporeal cardiopulmonary resuscitation (ECPR) describes the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to restore blood circulation in patients during refractory cardiac arrest. So far, ECPR is not the standard of care but has become part of clinical routine for select patients in many places. As ECPR is ahighly invasive support option associated with considerable risks for fatal complications, premature use in patients who may have return of spontaneous circulation should be avoided. However, the selection criteria for ECPR are still evolving, as the search for evidence is ongoing. Recent randomized controlled trials of different ECPR strategies support its use within integrated systems built around highly specialized ECPR centers. The ECPR caseload is an important predictor of patient survival, and continuous training is key for evidence-based quality of care. Typical complications after ECPR include vascular injury or malposition of cannulas, thrombotic complications, hemolysis, and bleeding events that require early detection and interdisciplinary management. When provided by highly specialized and well-trained expert teams in dedicated ECPR centers within integrated pre-hospital and intra-hospital emergency care systems, ECPR may improve survival in select patients with refractory cardiac arrest. This article is freely available.

Taiwan Chingguan Yihau may improve post-COVID-19 respiratory complications through PI3K/AKT, HIF-1, and TNF signaling pathways revealed by network pharmacology analysis.

The emergence of new SARS-CoV-2 variants with a higher contagious capability and faster transmissible speed has imposed an incessant menace on global health and the economy. The SARS-CoV-2 infection might reoccur and last much longer than expected. Thence, there is a high possibility that COVID-19 can cause long-term health problems. This condition needs to be investigated thoroughly, especially the post-COVID-19 complications. Respiratory tract disorders are common and typical complications after recovery. Until now, there has been a lack of data on specialized therapeutic medicine for post-COVID-19 complications. The clinical efficacy of NRICM101 has been demonstrated in hospitalized COVID-19 patients. This herbal medicine may also be a promising therapy for post-COVID-19 complications, thanks to its phytochemical constituents. The potential pharmacological mechanisms of NRICM101 in treating post-COVID-19 respiratory complications were investigated using network pharmacology combined with molecular docking, and the results revealed that NRICM101 may exert a beneficial effect through the three primary pathways: PI3K/AKT, HIF-1, and TNF signaling pathways. Flavonoids (especially quercetin) have a predominant role and synergize with other active compounds to produce therapeutic effectiveness. Most of the main active compounds exist in three chief herbal ingredients, including Liquorice root (Glycyrrhiza glabra), Scutellaria root (Scutellaria baicalensis), and Mulberry leaf (Morus alba). To our knowledge, this is the first study of the NRICM101 effect on post-COVID-19 respiratory complications. Our findings may provide a better understanding of the potential mechanisms of NRICM101 in treating SARS-CoV-2 infection and regulating the immunoinflammatory response to improve post-COVID-19 respiratory complications.

Abnormalities of the Conjunctiva, Sclera, Cornea, and Anterior Chamber in Pathological Myopia

Pathological myopia is characterized by typical complications in the fundus resulting from the progression of high myopia. These complications include posterior staphyloma, myopic maculopathy, and widespread choroidal atrophy. This review aims to understand the abnormalities of the conjunctiva, sclera, cornea, and anterior chamber associated with pathological myopia.Patients with pathological myopia are found to be more prone to the dry eye syndrome. This condition is explained by increased axial length, increased proptosis, and rapid evaporation of the tear film. Children with allergic conjunctivitis are shown to have a higher risk of developing myopia and that finding is explained with induced retinal inflammation promoting myopia progression. Posterior staphyloma is one of the diagnostic features of pathological myopia, which can lead to the development of myopic maculopathy. It occurs due to changes in the curvature of the sclera. It is challenging to find a direct relationship between pathological myopia and corneal or anterior chamber abnormalities. Besides, searches for components of pathological myopia have not yielded sufficient results. Understanding the anterior segment abnormalities associated with pathological myopia can play a significant role in the treatment and management of the disease. Future researches should focus on the etiology of axial elongation and factors related to the formation of posterior staphyloma. If the pathogenesis of staphylomas can be elucidated, more specific treatment methods may be developed.

Parâmetros bioquímicos e morfológicos em ratos diabéticos tratados com extratos de Ora-Pro-Nóbis (Pereskia aculeata)

Diabetes mellitus (DM) is a serious global public health problem. DM complications corroborate with high morbidity and mortality rates. Thus, several plant species have been studied regarding their medicinal properties with potential use in the treatment of DM and/or its complications. This study evaluated the effects of leaf (LE-OPN) and bark (BE-OPN) extracts from ora-pro-nóbis (Pereskia aculeata) on biochemical parameters (glycemia, triglycerides, total cholesterol, creatine, urea, AST and ALT, and lipid peroxidation) and histology (heart, liver and kidneys) in animals with DM. Induction of type 1 DM (glycemia > 200 mg/dl) in male Wistar rats was performed with Alloxane (150 mg/kg/ml). The animals were divided into 4 groups: (1) without DM, (2) with DM, (3) with DM treated with LE-OPN and (4) with DM treated with BE-OPN. The treatment was done by gavage (300 mg/kg/day) for 4 weeks. After this period the parameters were evaluated. BE-OPN prevented the increase in triglycerides, AST, ALT, and urea, in addition to lipid peroxidation (p < 0.05). The results suggest a potential for BE-OPN to prevent typical complications of DM, improving the lipid profile, liver, and kidney, as well as attenuating oxidative stress.

What Is the Optimal Method of Fixation for Scaphoid Nonunion Relative to the Location of the Lesion?

Scaphoid nonunion is a typical complication of scaphoid fractures, with the nonunion rate varying by the location of the scaphoid. The current widely used method for treating scaphoid nonunion, which is challenging for surgeons, is the headless compression screw (HCS). Various surgical approaches, such as the scaphoid plate, have been proposed to address the problem of screw fixation; however, no consensus exists regarding the optimal treatment method. This study focused on analyzing appropriate treatment methods based on the anatomical location of the scaphoid nonunion. Ninety-seven patients with scaphoid nonunion were treated between 2008 and 2023. All patients underwent treatment using 1 HCS or scaphoid volar locking plate with nonvascularized bone graft from the distal radius depending on the scaphoid's location. The scaphoid angle and bone union were confirmed using radiological examinations. The clinical evaluations included range of motion, pain, grip strength, and functional wrist scores. Fifty-seven patients were included in the final analysis. In the screw group, 26 patients (26/42 [62%]) obtained a bone union, and all 15 patients (15/15 [100%]) in the plate group obtained a union ( P = 0.005). In the waist group, 16 patients with screw (16/25 [64%]) and 8 using a plate (8/8 [100%]) showed bony healing. In the proximal group, 3 patients with HCS (3/9 [33%]) and 4 using plate (4/4 [100%]) showed bone union. In the distal group, 7 patients with a screw (7/8 [87%]) and 3 with the plate (3/3 [100%]) showed bone union. Significant differences were found in the waist ( P = 0.047) and proximal groups ( P = 0.026), but not in the distal group ( P = 0.521). All groups showed improved radiological angles associated with the scaphoid and better clinical outcomes postoperatively. Plate fixation was overall superior to screw fixation for scaphoid nonunion, especially in the waist and proximal poles, providing better union rates and stability. For the distal group, both methods are effective, with the choice depending on the surgeon's expertise and patient factors. The results highlight the importance of the lesion's anatomical location in selecting the appropriate fixation method.

The composition of the stent microbiome is associated with morbidity and adverse events during endoscopic drainage therapy of pancreatic necroses and pseudocysts.

Development of pancreatic necroses or pseudocysts are typical complications of pancreatitis and may require endoscopic drainage therapy using metal or plastic stents. Microbial infection of these lesions poses a major challenge. So far, the composition and significance of the microbial colonization on drainage stents are largely unknown although it may impact outcomes during endoscopic drainage therapy. A total of 26 stents used for drainage of pancreatic lesions were retrieved and the stent microbiome was determined by 16S rRNA gene sequencing. Additional analysis included comparison of the stent microbiome to the intracavitary necrosis microbiome as well as scanning electron microscopy (SEM) and micro-computed tomography (μCT) imaging of selected metal or plastic stents. The stent microbiome comprises a large proportion of opportunistic enteric pathogens such as Enterococcus (14.4%) or Escherichia (6.1%) as well as oral bacteria like Streptococcus (13.1%). Increased levels of opportunistic enteric pathogens were associated with a prolonged hospital stay (r = 0.77, p = 3e-06) and the occurrence of adverse events during drainage therapy (p = 0.011). Higher levels of oral bacteria were associated (r = -0.62, p = 8e-04) with shorter durations of inpatient treatment. SEM and μCT investigations revealed complex biofilm networks on the stent surface. The composition of the stent microbiome is associated with prolonged hospital stays and adverse events during endoscopic drainage therapy, highlighting the need for effective infection control to improve patient outcomes. In addition to systemic antibiotic therapy, antimicrobial stent coatings could be a conceivable option to influence the stent microbiome and possibly enhance control of the necrotic microflora.

Diabetic Cardiomyopathy: Role of Cell Death, Exosomes, Fibrosis and Epicardial Adipose Tissue.

Diabetic cardiomyopathy (DCM) represents one of the typical complications associated with diabetes. It has been described as anomalies in heart function and structure, with consequent high morbidity and mortality. DCM development can be described by two stages; the first is characterized by left ventricular hypertrophy and diastolic dysfunction, and the second by heart failure (HF) with systolic dysfunction. The proposed mechanisms involve cardiac inflammation, advanced glycation end products (AGEs) and angiotensin II. Furthermore, different studies have focused their attention on cardiomyocyte death through the different mechanisms of programmed cell death, such as apoptosis, autophagy, necrosis, pyroptosis and ferroptosis. Exosome release, adipose epicardial tissue and aquaporins affect DCM development. This review will focus on the description of the mechanisms involved in DCM progression and development.

Attenuation of esophageal anastomotic stricture through remote ischemic conditioning in a rat model

Anastomotic stricture is a typical complication of esophageal atresia surgery. Remote ischemic conditioning (RIC) has demonstrated multiorgan benefits, however, its efficacy in the esophagus remains unclear. This study aimed to investigate whether applying RIC after esophageal resection and anastomosis in rats could attenuate esophageal stricture and improve inflammation. Sixty-five male Sprague–Dawley rats were categorized into the following groups: controls with no surgery, resection and anastomosis only, resection and anastomosis with RIC once, and resection and anastomosis with RIC twice. RIC included three cycles of hind-limb ischemia followed by reperfusion. Inflammatory markers associated with the interleukin 6/Janus kinase/ signal transducer and activator of transcription 3 (IL-6/JAK/STAT3) and tumor necrosis factor-alpha/nuclear factor-κB (TNF-α/NF-kB) signaling pathways were evaluated with RNA and protein works. The RIC groups showed significantly lower stricture rates, lower inflammatory markers levels than the resection and anastomosis-only group. The RIC groups had significantly lower IL-6 and TNFa levels than the resection and anastomosis-only group, confirming the inhibitory role of remote ischemic conditioning in the IL-6/JAK/STAT3 and TNF-α/NF-kB signaling pathways. RIC after esophageal resection and anastomosis can reduce the inflammatory response, improving strictures at the esophageal anastomosis site, to be a novel noninvasive intervention for reducing esophageal anastomotic strictures.

Ameliorative effect of pedunculoside on sepsis-induced acute lung injury, inflammation and pulmonary fibrosis in mice model via suppressing AKT/NF-κB pathway.

Sepsis-induced acute lung injury (ALI) is the typical complications of sepsis with a high global incidence and mortality. Inhibition of inflammatory response is a crucial and effective strategy for sepsis-induced ALI. Pedunculoside (PE) has been shown to have an anti-inflammatory effect on various diseases. However, the effect and mechanism of PE on sepsis-induced ALI remain unknown. A mice model of sepsis-induced ALI was constructed by cecal ligation and puncture (CLP). The effect of PE on the CLP-induced mice were assessed using pathological staining, terminal deoxynucleotidyl transferase deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL), reverse transcription quantitative polymerase chain reaction (RT-qPCR), enzyme-linked immunosorbent assay (ELISA) and western blot assays. PE reduced pathological symptoms and scores, apoptosis and the W/D ratio of lung tissues in CLP-induced mice. Besides, PE decreased the level of interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α), pulmonary fibrosis and the expression of fibrosis markers. Mechanically, PE inhibited AKT/NF-κB signaling in CLP-induced mice. Activation of AKT/NF-κB pathway abolished the ameliorative effect of PE on the pathological symptoms, the release of inflammatory factors and pulmonary fibrosis of CLP-induced mice. PE improved inflammation and pulmonary fibrosis by inhibiting AKT/NF-κB pathway in CLP-induced mice.

The Interrelationship between Diabetes Mellitus and Emotional Well-Being: Current Concepts and Future Prospects.

Diabetes mellitus is a lifelong metabolic disorder that impacts people's well-being and biopsychosocial status. Psychiatric problems and diabetes mellitus have a complex, reciprocal interaction in which one condition affects the other. In this narrative review, we provide an overview of the literature on the psychological effects of diabetes, expound on the evaluation of emotional disorders in the setting of diabetes, and suggest interventions aimed at enhancing both mental and physical health. Diabetes can make daily life complicated and stressful. Frequent blood glucose testing, taking medications on a regular basis, adhering to a tight diet plan, and exercising are some examples of the suggested daily routine of subjects with diabetes. Furthermore, comorbid diseases and typical diabetic complications can have a detrimental impact on quality of life. When mental health conditions coexist with diabetes mellitus, there is a greater likelihood of medication noncompliance, a decreased commitment to diabetes-related self-care, increased functional impairment, inadequate glycemic control, a higher risk of complications, and overall higher healthcare expenses. Thus, evaluation of the mental health status of patients with diabetes is crucial. When treating psychological issues and psychiatric disorders, a comprehensive biopsychosocial approach should be taken, and where appropriate, psychopharmacological therapies or psychotherapy should be applied. The goal of continuous education and assistance for self-care is to give individuals with the disease the information and abilities they need to control their condition over time.

Unrecognised COVID-19 deaths in central Europe: The importance of cause-of-death certification for the COVID-19 burden assessment.

In Central Europe, the increase in mortality during the COVID-19 pandemic exceeded the number of deaths registered due to coronavirus disease. Excess deaths reported to causes other than COVID-19 may have been due to unrecognised coronavirus disease, the interruptions in care in the overwhelmed health care facilities, or socioeconomic effects of the pandemic and lockdowns. Death certificates provide exhaustive medical information, allowing us to assess the extent of unrecognised COVID-19 deaths. Data from 187,300 death certificates with a COVID-19 mention from Austria, Bavaria (Germany), Czechia, Lithuania and Poland, 2020-2021, was used. The two step analysis uses Cause of Death Association Indicators (CDAIs) and Contributing CDAIs to identify and measure the statistical strength of associations between COVID-19 and all other medical mentions. 15,700 deaths were reported with COVID-19 only as a contributing condition (comorbidity). In three cases out of four, a typical, statistically significant coronavirus complication or pre-existing condition was registered as the underlying causes of death. In Austria, Bavaria, Czechia and Lithuania the scale of COVID-19 mortality would have been up to 18-27% higher had COVID-19 been coded as the underlying cause of death. Unrecognised coronavirus deaths were equivalent to the entire surplus of excess mortality beyond registered COVID-19 deaths in Austria and the Czech Republic, and its large proportion (25-31%) in Lithuania and Bavaria. Death certificates with typical coronavirus complications or comorbidities as the underlying causes of death and contributing COVID-19 mentions were plausibly unrecognized coronavirus deaths.

Simultaneous correction of leg length discrepancy and angular deformity of the distal femur with retrograde Precice nails: a retrospective analysis of 45 patients.

Magnetically controlled motorized intramedullary lengthening nails (ILNs) can be employed for simultaneous correction of angular deformities of the distal femur and leg length discrepancy. This spares typical complications of external fixators but requires precise preoperative planning and exact intraoperative execution. To date, its results are insufficiently reported. We aimed to elucidate the following questions: (i) Is acute angular deformity correction and gradual femoral lengthening via a retrograde ILN a reliable and precise treatment option? (ii) What are the most common complications of treatment? Acute angular deformity correction and subsequent gradual lengthening of the distal femur with retrograde ILN was retrospectively analyzed in 45 patients (median patient age: 15 years, interquartile range [IQR] 13-19 and median follow-up: 40 months, IQR 31-50). Outcome parameters were accuracy, precision, reliability, bone healing, and complications of treatment. The median distraction was 46 mm (IQR 29-49), median distraction and consolidation index 0.9 mm/day (IQR 0.7-1.0) and 29 days/cm (IQR 24-43), respectively. The median preoperative mechanical axis deviation (MAD) was 30 mm (IQR 23-39) in the varus cohort and -25 mm (IQR -29 to -15) in the valgus cohort and reduced to a mean of 8 mm (standard deviation [SD] 8) and -3 (SD 10), respectively. Accuracy, precision, and reliability of lengthening were 94%, 95% and 96%, respectively. Accuracy and precision of deformity correction were 92% and 89%, respectively. In total, 40/45 of patients achieved distraction with a difference of less than 1 cm from the initial plan and a postoperative MAD ranging from -10 mm to +15 mm. In 13/45 patients unplanned additional surgeries were conducted to achieve treatment goal with nonunion being the most frequent (4/45) and knee subluxation (3/45) the most severe complication. Acute deformity correction and subsequent lengthening of the distal femur with retrograde ILN is a reliable and accurate treatment achieving treatment goal in 89% but unplanned additional surgeries in 29% of patients should be anticipated.

Clinical study on freehand of bicortical sacral screw fixation with the assistance of torque measurement device

BackgroundSacral screw loosening is a typical complication after internal fixation surgery through the vertebral arch system. Bicortical fixation can successfully prevent screw loosening, and how improving the rate of bicortical fixation is a challenging clinical investigation.ObjectiveTo investigate the feasibility of improving the double corticality of sacral screws and the optimal fixation depth to achieve double cortical fixation by combining the torque measurement method with bare hands.MethodsNinety-seven cases of posterior lumbar internal fixation with pedicle root system were included in this study. Based on the tactile feedback of the surgeon indicating the expected penetration of the screw into the contralateral cortex of the sacrum, the screws were further rotated by 180°, 360°, or 720°, categorized into the bicortical 180° group, bicortical 360° group, and bicortical 720° group, respectively. Intraoperatively, the torque during screw insertion was recorded. Postoperatively, the rate of double-cortex engagement was evaluated at 7 days, and screw loosening was assessed at 1 year follow-up.ResultsThe bicortical rates of the 180° group, 360° group, and 720° group were 66.13%, 91.18% and 93.75%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05).The rates of loosening of sacral screws in the 180° group, 360° group, and 720° group were 20.97%, 7.35% and 7.81%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05). The bicortical 360° group achieved a relatively satisfactory rate of dual cortical purchase while maintaining a lower rate of screw loosening.ConclusionManual insertion of sacral screws with the assistance of a torque measurement device can achieve a relatively satisfactory dual cortical purchase rate while reducing patient hospitalization costs.

Lemniscate intestinal loop through an internal hernia after Roux-en-Y gastric bypass cause of coecum mobile. A case report

The internal hernia is a typical complication after laparoscopic Roux‑en‑Y gastric bypass surgery. In most cases, there are chronic symptoms that only lead to a diagnostic laparoscopy during the diagnostic exclusion procedure. Less common is acute internal hernia with devastating pain, ileus symptoms and even the development of intestinal gangrene. Although this case describes a typical constellation, it posed a particular challenge because it resulted in mesenteric lemniscate‑like torsion through the Petersen pouch. Case presentation. A 29‑year‑old patient presented to our emergency department with abdominal pain, complained of sudden epigastric pain that lasted overnight, and radiated into the back with a permanent belching every 10 seconds. Four weeks ago, the patient received an abdominoplasty, complaining of postprandial nausea, meterorism and constipation afterwards. 19 months ago, a Roux‑en‑Y gastric bypass with a weight of 109 kg and a body mass index of 42.6 kg/m2 was done. The current body weight was 60 kg and the body mass index was 23.4 kg/m2. After focused assessment with sonography for trauma and the detection of dilated intestinal loops, an abdominal computer tomography (CT) was performed. Radiologically, the suspicion of mesenteric malrotation was confirmed. The SWELL (CT‑graphic swirl sign, excess weight loss &gt;95%, liquid in abdomen CT scan) score was positive with a CT‑graphic swirl sign and an excess weight loss of 108.9% (&gt; 95%), no chylus or ascites. We discussed an immediate, necessary diagnostic laparoscopy. Based on the ileocoecalpol, it was not possible to establish a proper assignment of the detached gastrointestinal tract. The exploration of the sigmoid colon as the only fixed point revealed that this was a complete fixed twisting of the right intestinal part with a twist of the caecum into the right upper abdomen through the Petersen space. This necessitated a laparotomy to manually cancel Bernoulli’s lemniscate‑like loop and perform a mesenteric defect suture of the mesenteric space of Brolin and the Petersen space with a non‑absorbable suture. The intestinal loops and patient recovered quickly. The dismission was on the 4th post‑operative day. Conclusions. The internal hernia after gastric bypass remains a diagnostic challenge despite advances in imaging. Due to the increasing number of patients undergoing bariatric surgery, this differential diagnosis must always be considered in the case of abdominal complaints. In addition to the excess weight loss of &gt;95%, this case shows that a recent abdominoplasty can also provoke an internal hernia.

SB-525334 ameliorates renal injury in diabetic kidney disease mouse model via suppressing inflammation

BackgroundDiabetic kidney disease (DKD; also known as diabetic nephropathy) is a typical complication of diabetes mellitus characterised by renal injury due to disturbances in glucose metabolism, in which renal tubular damage caused by chronic inflammation has been shown to be closely associated with the development of end-stage renal disease (ESRD). However, there are insufficient effective therapeutic agents to halt the progression of DKD. MethodsIn the present study, we screened differential gene expression profiles associated with DKD by mining the GEO database through differential and enrichment analyses. Furthermore, systemic in vivo and in vitro experiments were designed to explore the mechanism through which the potential therapeutic agent SB-525334 improves DKD. ResultsSB-525334 ameliorated DKD-induced kidney injury by regulating inflammatory cytokines (TGF-β1, IL-6, IL-10) as well as promoting the translation of M1 (iNOS) macrophage to M2 (CD206) macrophage. In addition, SB-525334 ameliorates kidney injury caused by DKD through inhibiting inflammation through regulating the expression of key proteins in the TGF-β1 /JNK and TGF-β1 /Smad signaling pathways. For studies in vitro, inflammation induced by LPS in vitro was inhibited significantly after the administration of SB-525334 through down-regulating pro-inflammatory cytokines, promoting macrophage conversion from M1 to M2, and inhibiting the activation of TGF-β1 /JNK and TGF-β1 /Smad pathways. ConclusionsThese results highlight that the target compound SB-525334 could serve as a novel potential therapeutic agent and ameliorate DKD in an inflammation-inhibiting manner.

The impact of post-stroke fatigue on inpatient rehabilitation outcomes: An observational study.

Post-stroke fatigue is a typical complication following stroke. However, existing research primarily focused on its underlying mechanisms, and its impact on rehabilitation outcomes has yet to be uncovered. This study aims to explore the impact of post-stroke fatigue on rehabilitation outcomes during hospitalization. This was a prospective multicenter observational study including 46 stroke patients receiving comprehensive rehabilitation treatment. Patients' basic information was recorded upon admission and patients' functional independence was assessed with Functional Independence Measure (FIM) both upon admission and discharge. One week after rehabilitation treatment, fatigue, positivity in daily activity, attention, and memory were assessed. Serum biochemical indicators and levels of C-reactive protein (CRP) were assessed weekly following admission. The pain scores were assessed during the first week of hospitalization to calculate the average. Correlation analysis, linear regression and propensity score matching (PSM) were used to analyze the impact of fatigue on FIM scores at discharge and length of hospital stay. The proportion of patients with low fatigue was 39.13% and significant improvement was revealed in FIM scores upon admissions and discharge [(50.67±18.61) vs. (75.13±21.04), P<0.05]. Positivity in daily activity, attention, and age are factors that influence post-stroke fatigue. After PSM, low-fatigue group (Fatigue score< 3) showed significant higher motor function independence at discharge [(54.39 ± 15.42) vs. (41.89 ± 14.90), P<0.05] and shorter hospital stay [(28.54±9.13)d vs. (37.32 ± 9.81)d, P<0.05] than high-fatigue group. There was a significant difference (P<0.05) in level of CRP between the first inpatient week and the third week, with declining trend. Post-stroke fatigue can affect the rehabilitation outcomes regarding motor function independence and length of hospital stay.

Loss and recovery of percutaneous femoral access during transcatheter aortic valve replacement. A case report

Loss and recovery of percutaneous femoral access during transcatheter aortic valve replacement. A case report

Medial End Clavicular Osteochondroma- An Unusual Case

Abstract Osteochondroma is the most common benign bone tumor, which could present as a sessile or pedunculated type and, in solitary or multiples, hereditary multiple exostoses (a genetic disorder, autosomal dominant inheritance). Clinical presentation is mostly asymptomatic, but if symptomatic, it presents in a wide spectrum, such as compression of adjacent vessels, nerves, deformities, fractures, bursa formation, and malignant transformation. Cancerous transformation is indicated by the thickness of the cartilage cap of &gt;3 cm in children, &gt;2 cm in adults, sudden onset of pain, and sudden/rapid growth of lesion (after growth plate closure). Surgical management is indicated for typical symptomatic lesions, complications, malignant transformation, and cosmetic reasons. The common treatment of choice is the excision of a tumor with a significant free margin.

Prevalence of HIV, hepatitis B and hepatitis C infections among patients with thalassemia attending a tertiary care (rural) hospital.

The Sunderban area of West Bengal is home to tribal and religious minorities inhabiting various islands. There is a high prevalence of thalassemia among poverty-stricken residents of this region living with meagre health care facilities. This work was planned to determine the proportion of four viral transfusion-transmitted infections (TTIs): HIV-1, HIV-2, hepatitis B virus (HBV) and hepatitis C virus (HCV) among thalassemia patients attending the sole rural medical college in the region. Thalassemia patients (n = 359, age ranging from 1 year to 60 years) attending the thalassemia clinic or being admitted to the indoor facilities for better management were included in the study. Only patients diagnosed with high-performance liquid chromatography (HPLC) and with classical clinical features were included in the study. Blood samples of these patients were tested for HIV as per NACO protocol. For HBV and HCV, samples were first tested serologically; reactive samples were collected and sent in the cold chain to a higher centre for nucleic acid amplification testing (NAAT) for qualitative and quantitative estimation. Clinical and laboratory data was collected, patients were followed up for complications and hospitalisation during the study period, and statistical analysis was performed. Majority of our patients had E-beta-thalassemia (245, 59.81%), followed by beta-thalassemia major (102, 28.30%). NAAT-confirmed HCV infection (14.21%) infection was the most common, followed by HBV (2.51%), and lastly by HIV-1 (0.58%) infection. Among infected thalassemia patients, the mean HCV RNA was 741063 ± 438514.67 IU/ml while the mean HBV DNA level was 4082863 ± 7298514 IU/ml. Co-infections of HIV-1 and HCV and that of HBV and HCV were noted in one patient each (0.28%). HCV-related liver disease (14.21%) and growth retardation (10.31%) were the most typical complication noted, and death occurred in five patients (1.39%) during the study period. Primary care physicians should know HCV infection is the most common TTI among thalassemia patients in rural eastern India.

RESTORATION OF CORONAL PART IN CHEWING TEETH WITH SIGNIFICANT LOSS OF HARD TISSUES BY POST AND CORE CROWN

The purpose of this study was to improve the quality of orthopedic treatment of hard dental tissues of chewing teeth destroyed below the level of the gums by a post and core crown using ashless modeling plastics.&#x0D; We examined 30 patients with severe destruction of the hard tissues of the crown portion of the teeth (IROPZ more than 80%) and concurrent periodontal diseases. A retrospective analysis revealed that teeth with deep subgingival defects restored by casts functioned as follows: for up to 1 year in 17 cases (14.2%), from 1 to 3 years in 36 cases (30.0%), from 3 to 5 years in 43 cases (35.8%), and for more than 5 years in 24 cases (20.0%).&#x0D; The results of a comparative evaluation of the effectiveness of tooth restoration with subgingival defects using ashless acrylic plastic "Modeplast" as a modeling material demonstrated the highest quality of such inserts, with most observed cases showing no signs of secondary caries. Complications, such as the dislodgement of metal inserts, were noted in 6.7% of cases, violation of marginal fit in 4.5%, and partial decementation of the structure in 8.3%. Incorrect positioning and suboptimal pin dimensions of the post and core crown occurred with approximately equal frequency: 3.5% and 3.2%, respectively. Destruction of the hard tissues of the tooth and caries relapse during restoration with metal inserts were noted in 13.3% and 29.1% of cases, respectively. Typical complications leading to tooth extraction included tooth root fractures (13.3%).&#x0D; The developed method of manufacturing post and core crowns using ashless acrylic plastic "Modeplast" at the modeling stage enables to gently remove tooth tissues and atraumatic fit of the post to the gums, prevents the accumulation of dental plaque and does not have a destructive effect on periodontal tissues.