52426 research outputs found
Sort by
Outcomes of Bypass Surgery in Patients with Moyamoya Syndrome Secondary To Sickle Cell Disease: a Multicenter Study.
No full textBACKGROUND: Moyamoya syndrome (MMS) associated with sickle cell disease (SCD) is a severe vasculopathy that significantly increases stroke risk. While cerebral revascularization is increasingly considered in this population, concerns about perioperative safety and long-term outcomes have limited its use in clinical practice.
METHODS: We conducted a multicenter, retrospective cohort study of 553 patients with MMS who underwent surgical revascularization across 13 centers. Patients were grouped by SCD status (SCD-MMS vs. moyamoya disease (MMD)). Primary outcomes included perioperative stroke, perioperative complications, and functional status at discharge. Secondary outcomes included length of stay, and follow-up stroke.
RESULTS: Of 553 patients, 32 (5.8%) had SCD. There were no significant differences in overall perioperative stroke (OR 1.05, 95% CI 0.19 to 5.54), symptomatic perioperative stroke (OR 0.94, 95% CI 0.09 to 8.94), perioperative complications (OR 1.66, 95% CI 0.47 to 5.86), or follow-up stroke (OR 0.88, 95% CI 0.17 to 4.55). Functional outcomes at discharge were similarly favorable in both groups (mRS 0-1: OR 0.84, 95% CI 0.29 to 2.40). SCD was associated with a longer hospital stay (beta 2.78 days, 95% CI 0.60 to 4.96).
CONCLUSION: Surgical revascularization for MMS in patients with SCD does not confer additional procedural risk and yields outcomes comparable to those of patients without SCD. These findings support the role of bypass surgery as a viable treatment option in this high-risk population
Safety and Efficacy of Systemic Corticosteroids in Children With Orbital Complications of Acute Sinusitis.
No full textOBJECTIVE: To determine the safety and efficacy of systemic steroids for children with orbital complications of sinusitis.
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary children\u27s hospital, January 2017 to June 2023.
METHODS: Hospitalized children were classified by whether they received systemic corticosteroids, in addition to systemic antibiotics, prior to any surgery. Primary outcomes were length of admission, need for orbital/sinus surgery, readmission, vision loss, and fungal infection. Multivariable regression controlled for potential confounders, including severity of disease on initial imaging study.
RESULTS: Of 222 children with orbital cellulitis (mean age 8.6 years), 26 (12%) received steroids: 17 (65%) intravenous methylprednisolone or dexamethasone, 9 (35%) oral steroids; 16 (62%) 1 day and 10 (38%) 2 to 4 days of steroids. Children receiving steroids more often had proptosis (58% vs 37%, P = .045) and orbital abscess on CT (81% vs 69%, P = .004). Steroid use was associated with decreased orbital or sinus surgery (19% vs 37%; OR = 0.3, 95% CI: 0.1-0.9; P = .03). There were no differences in length of stay (P = .2), readmission (P = .4), or vision loss (no cases) between the study groups or fungal or secondary infection (no cases).
CONCLUSION: Systemic steroid use in children with orbital cellulitis was not associated with adverse outcomes, such as vision loss or readmission, and may offer potential benefits, including avoidance of surgery in some cases. A majority received only 1 day of steroids in our study; further research might evaluate the effects of longer courses and the subjective experience of children who have periocular swelling and pain
Amblyopia and adult health: a comprehensive analysis of long-term systemic, sensory and mental health comorbidities in a national cohort.
No full textAIMS: To evaluate the adult health consequences of amblyopia, including sensory deficits, mental health, physical activity and cardiovascular health.
METHODS: A cross-sectional study using data from the National Institutes of Health\u27s
RESULTS: Amblyopia was associated with increased odds of bilateral blindness (OR=2.96, 95% CI 2.54 to 3.44), obesity (OR=1.27, 95% CI 1.16 to 1.39), type 2 diabetes (OR=1.39, 95% CI 1.26 to 1.53) and cardiovascular disease (OR=1.92, 95% CI 1.69 to 2.19). Amblyopic individuals took fewer daily steps (5859 vs 6229; p=0.044), indicating decreased physical activity. Neuropsychiatric disorders were more common, including generalised anxiety (OR=1.57, 95% CI 1.43 to 1.72), substance use disorder (OR=1.40, 95% CI 1.25 to 1.55), bipolar disorder (OR=1.35, 95% CI 1.13 to 1.61), attention-deficit/hyperactivity disorder (OR=1.54, 95% CI 1.28 to 1.86), obsessive compulsive disorder (OR=1.82, 95% CI 1.31 to 2.54) and autism (OR=3.27, 95% CI 1.79 to 5.99). Schizophrenia was not associated (OR=1.00, 95% CI 0.70 to 1.42).
CONCLUSIONS: Amblyopia is associated with long-term systemic health conditions, suggesting either long-term effects of visual impairment or shared underlying risk factors. These findings underscore the need for early detection and intervention. Further research is needed to explore the neurodevelopmental pathways linking amblyopia and its comorbidities
Emerging technologies and strategies in epilepsy surgery: toward personalised medicine.
No full textEpilepsy surgery, the treatment of choice for drug-resistant focal epilepsy, is evolving rapidly. This progress is driven by a growing interest in the network theory of epilepsy, advances in data-driven models, and a focus on personalised treatment approaches. As a result, treatment options have expanded to include minimally invasive procedures, neurostimulation devices, and network-based interventions. Predicting surgical outcomes-such as seizure freedom and neuropsychological effects-remains challenging but is improving through advances in computational technology and molecular research, paving the way for more precise surgery. Despite these advancements, disparities in access to treatments persist, particularly in resource-scarce settings, highlighting the need for systemic solutions to improve access. Emerging research into genetic and multi-omic markers might assist in tailoring treatments and improving the prediction of outcomes. Future directions include integrating minimally invasive techniques, refining neuromodulation strategies, and leveraging molecular and computational tools to optimise patient care. Multidisciplinary collaboration will be essential to overcome challenges, reduce disparities, and advance surgical outcomes for patients with drug-resistant epilepsy worldwide
