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Improving Emergency Department Care for Children with Epilepsy Presenting with Breakthrough Seizures: A Quality Improvement Initiative to Reduce Unnecessary Lab Testing
No full textCCKergic Tufted Cells Regulate Odor Sensitivity by Controlling Mitral Cell Output in the Mouse Olfactory Bulb.
No full textDespite the importance of odor detection to the survival of most animals, mechanisms governing olfactory sensitivity remain unclear, especially beyond the olfactory sensory neurons (OSNs). Here we leverage opto- and chemo-genetics to selectively modulate activities of CCKergic tufted cells (TCs) in the mouse olfactory bulb (OB) of either sex, which form the intrabulbar associational system (IAS) to link isofunctional glomeruli, to determine the functional impact on OB output via mitral cells (MCs) and odor detection in behaving animals. NMDA receptors in CCKergic TCs remarkably amplify the OSN-evoked monosynaptic responses in these excitatory neurons, which provide a long-lasting feedforward excitation to MCs via both chemical transmission and electrical synapses between their apical dendrites. NMDA receptors in MCs mediate late components of the dendrodendritic TC→MC transmission to significantly boost MC outcome. Congruently, optogenetic inhibition of the CCKerigic TCs dramatically reduces the OSN-evoked MC responses. Unexpectedly, optogenetic activation of the axons projecting from CCKergic TCs on the opposite side of the same bulb produces a mainly AMPA receptor-mediated excitatory responses in MCs, leading us to speculate that CCKergic TCs functionally synchronize MC output from mirror glomeruli. Furthermore, chemogenetic inhibition of CCKergic TCs reduces animal\u27s sensitivity to odors by elevating detection threshold, consistent with the key role of these TCs in functionally controlling MC output. Collectively, our results delineate the cellular and circuit mechanisms allowing the CCKergic TCs to regulate MC output from glomeruli on both medial and lateral side of each OB and the system\u27s sensitivity to odors possibly via the IAS
Enhanced recovery after surgery: Narrative review in gynecologic pelvic exenterations.
No full textIn this narrative review, we discuss enhanced recovery after surgery (ERAS) in pelvic exenterations from a gynecology oncology perspective. There is limited evidence regarding perioperative guidelines for this complex surgical procedure. We will review ERAS societal guidelines, collaborative reviews, expert opinions and provide tables summarizing the pre-admission, preoperative, intraoperative, and postoperative guidelines provided by these sources. We will look at how ERAS protocols have been used in published studies. Lastly, we discuss potential future directions for perioperative care in pelvic exenterations
Epilepsy in patients with pediatric brain tumors: Etiology, treatment & management.
No full textCentral nervous system (CNS) tumors are the most common solid tumor type seen in the pediatric population and may present with a variety of neurological presentations, with seizure being the second most common. Supratentorial tumors commonly associated with seizures include low-grade gliomas such as pilocytic astrocytoma, subependymal giant cell astrocytoma (SEGA), gangliogliomas, and dysembryoplastic neuroepithelial tumors (DNET). The etiology of seizures in pediatric brain tumor patients is often multifactorial, often the result of multimodal therapy and possible contributions from surgery, radiation therapy, chemotherapy, and other metabolic disturbances. Seizures can also be secondary to mass effect, hydrocephalus, or metastases. Additionally, tumor characteristics including its location in the temporal lobe, the presence of mixed neuronal and glial components, and the tumor\u27s size and growth rate influence the likelihood of seizures. Pediatric patients with a first lifetime unprovoked seizure should undergo further testing including electroencephalogram (EEG). MRI imaging is not warranted in all cases but should be strongly considered for children with focal presentation or EEG finding to identify possibly secondary causes such as brain tumors. The EEG can identify background activity alterations, epileptiform activity, and/or seizure activity, but sensitivity and specificity are limited and therefore, should be used in conjunction with neuroimaging like an MRI for a comprehensive evaluation. Anti-seizure medication (ASM) is not recommended to be started in patients with a brain tumor without seizures, but rather only in patients that were identified with brain tumor who presented with seizures. ASM choices are influenced by patient\u27s co-morbidities, drug interactions with chemotherapy, and the patient\u27s tolerance to potential adverse drug reactions. With its limited drug-drug interactions, the most commonly used ASM is levetiracetam. Ultimately, gross total resection of the tumor if feasible is often favored for both diagnostic and therapeutic benefits, as well as seizure control
Sex Differences in Cancer Risk Among Patients With Inflammatory Bowel Diseases Treated With Biologics: A Large Retrospective Analysis
No full textTrends and Disparities in Mortality from Comorbid Non-insulin Dependent Diabetes Mellitus and Myocardial Infarction (1999–2022)
No full text64656 52-Week Disease Control and Safety With As-Needed Application of Ruxolitinib Cream in Children Aged 2 to 11 Years With Moderate and/or More Extensive Atopic Dermatitis: Subgroup Analysis From the TRuE-AD3 Study Author links open overlay panel Lawrence F. Eichenfield MD ,
No full textThe Protective Role of Sirtuin Enzymes in the Development of Cardiac Ischemia in a Rat Model
No full textImpact of Psychiatric Comorbidities on Healthcare Resource Utilization in Patients Undergoing Venous Sinus Stenting for Idiopathic Intracranial Hypertension.
No full textBACKGROUND AND OBJECTIVES: Venous sinus stenting (VSS) is used to treat medically refractory idiopathic intracranial hypertension (IIH). Psychiatric comorbidities, including anxiety, depression, and personality disorders, are commonly seen in patients with IIH due to the chronic nature of their symptoms. Our study analyzes the impact of psychiatric comorbidities on healthcare resource utilization after VSS for IIH.
METHODS: This was a retrospective study using the TriNetX database to identify patients who underwent VSS for IIH. Patients were stratified based on the presence or absence of psychiatric comorbidities such as schizophrenia, affective disorders, anxiety, and behavioral syndromes associated with psychological disturbances and personality disorders. Propensity score matching was used to adjust for baseline differences between the two cohorts. Outcomes of interest were repeat surgical intervention, emergency department (ED) visits, and symptoms such as papilledema, headache, vision changes, or pulsatile tinnitus. Propensity score matching was used to adjust for baseline differences between the 2 cohorts.
RESULTS: Of 1468 patients who underwent VSS, 840 patients (57.2%) had psychiatric comorbidities and 628 patients (42.8%) did not have any psychiatric comorbidities. After propensity score matching for baseline demographics and preoperative symptoms of IIH, patients with psychiatric comorbidities had higher odds of repeat surgical interventions (odds ratio [OR] = 1.681, 95% CI 1.090-2.589, P = .017), ED visits (OR = 1.727, 95% CI: 1.250-2.386, P \u3c .001), and headaches (OR = 1.834, 95% CI: 1.235-2.722, P = .002) after VSS compared with those without psychiatric comorbidities. There were no significant differences in odds of papilledema (OR = 0.987, 95% CI: 0.719-1.355, P = .935), visual changes (OR = 1.186, 95% CI: 0.873-1.611, P = .274), or pulsatile tinnitus (OR = 1.314, 95% CI: 0.829-2.081, P = .243).
CONCLUSION: IIH patients with psychiatric comorbidities experience higher rates of ED visits, repeat surgical intervention, and headaches after VSS. These findings highlight the importance of considering psychiatric comorbidities during preoperative counselling and in planning postoperative care for this population
