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Frailty Prevalence and Evaluation of the FRAIL Scale Questionnaire in Patients with Inflammatory Bowel Disease.
No full textBACKGROUND: Inflammatory bowel disease (IBD) predisposes individuals to frailty, linked with adverse outcomes. While the Fried Frailty Index (FFI) is a well-established phenotypic tool to assess frailty, its administration is cumbersome. The FRAIL scale, simpler but not widely used in patients with IBD, presents an alternative. We aimed to assess the prevalence of frailty and compare the FRAIL scale with the FFI.
METHODS: A cohort of patients with IBD underwent assessment using both the FFI and the FRAIL scale. Patients were categorized as non-frail, pre-frail, or frail. The primary outcome was frailty prevalence, while secondary outcomes included comparison of FFI and FRAIL scale and associations between frailty and disease-related factors. Statistical analyses included chi-square tests, ANOVA, Kruskal-Wallis tests, and ROC curve analysis using SPSS v27, with p \u3c 0.05 indicating significance.
RESULTS: Among participants (53.5% female, median age 44), 37% were non-frail, 50% pre-frail, and 13% frail. The FRAIL scale exhibited strong correlation with the FFI for all three categories. Age showed no significant association with frailty. Frail individuals displayed higher inflammatory markers and more severe clinical disease, with frailty more prevalent in patients with UC than CD. Frail individuals also exhibited lower hemoglobin, creatinine, and albumin levels.
CONCLUSION: Frailty and pre-frailty are prevalent in patients with IBD and not necessarily linked with older age. The FRAIL scale demonstrated excellent correlation with the FFI, offering a practical tool for identifying frailty in IBD without physical measurements. Future studies should explore multivariable models incorporating frailty risk factors and interventions to mitigate adverse outcomes in patients with IBD
Uncharted Territory: The First Case of Cardiac Myxoma in a Patient With NF2.
No full textBACKGROUND: Cardiac myxoma is a benign tumor, typically originating in the left atrium, and is often linked to Carney complex. In our literature review, there are no case reports of cardiac myxoma in patients with neurofibromatosis type 2 (NF2).
CASE SUMMARY: A 60-year-old man presented with dizziness and was found to have meningioma and vestibular schwannoma, consistent with NF2. Cardiac myxoma was incidentally diagnosed through echocardiography and confirmed by cardiac magnetic resonance imaging and tissue pathology. The mass was surgically resected. The patient was offered genetic testing; however, he decided to not undergo further testing.
DISCUSSION: NF2 is an inherited autosomal dominant disorder associated with vestibular schwannoma, meningioma, ependymoma, cataract, lenticular opacities, and retinal hamartomas.
TAKE-HOME MESSAGE: Further research is needed to investigate the potential risk of cardiac myxoma in patients with NF2 and the benefit of routine screening for myxomas in this population
Statins and middle meningeal artery embolization: a literature review in the treatment of chronic subdural hematoma.
No full textChronic subdural hematoma (cSDH) presents a multifaceted challenge in contemporary neurological practice, necessitating innovative therapeutic strategies. This comprehensive review explores the convergence of two promising interventions: statins and middle meningeal artery (MMA) Embolization. With cSDH incidence on the rise, particularly among the aging population and those with long-term anticoagulant usage, the traditional surgical avenues face limitations in recurrence rates and associated risk factors. Statins, heralded for their anti-inflammatory, vasculogenic, and angiogenic properties, are emerging as potential allies in cSDH management. Concurrently, MMA embolization offers a nuanced approach to target the neomembrane\u27s blood supply, with evidence supporting its efficacy and safety. However, the synthesis of MMA embolization with statins remains relatively unexplored, presenting a complex interplay between inflammation modulation and blood supply interruption
Cerclage for Short Cervix ≤20mm before 24 weeks in Singleton Gestations without Prior Spontaneous Preterm Birth Decreases Preterm Birth: a Meta-analysis of Randomized Controlled Trials using Individual Patient-level Data.
No full textOBJECTIVE: To evaluate the efficacy of cervical cerclage in preventing preterm birth (PTB) in asymptomatic singleton pregnancies without prior spontaneous PTB and with a mid-trimester short transvaginal ultrasound cervical length (TVU CL).
DATA SOURCES: MEDLINE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials were searched for the following terms: \u27cerclage,\u27 \u27cervical cerclage,\u27 \u27salvage,\u27 \u27rescue,\u27 \u27emergency,\u27 \u27ultrasound-indicated,\u27 \u27short cervix,\u27 \u27cervical length,\u27 \u27ultrasound,\u27 and \u27randomized trial,\u27 from inception of each database until November 2024. No language restrictions were applied.
STUDY ELIGIBILITY CRITERIA: We included all randomized controlled trials (RCTs) of asymptomatic singleton pregnancies without prior spontaneous PTB screened with TVU CL, found to have a midtrimester short CL ≤25.9mm, and then randomized to management with either cerclage or no cerclage. We contacted corresponding authors of all the included trials to request access to the data and perform a meta-analysis of individual patient data.
STUDY APPRAISAL AND SYNTHESIS METHODS: Individual patient data from the original RCTs were merged into a master database specifically constructed for the review. The primary outcome was PTB \u3c 37 weeks. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% confidence interval (CI). To obtain the pooled risk ratio estimate the random effects model of DerSimonian and Laird were used RESULTS: Six trials, including 507 asymptomatic singleton gestations without prior spontaneous PTB and with short mid-trimester TVU CL ≤25.9mm, were included in the meta-analysis. The overall risk of bias of the included trials was judged as low. The primary outcome, PTB \u3c 37 weeks, occurred in 89/266 (33.5%) vs 96/241 (39.8%) in the cerclage vs no cerclage group, respectively (RR 0.88, 95% CI 0.59-1.31). Planned subgroup analyses revealed that in patients with CL ≤20.9mm before 24 weeks, cerclage was associated with a significant decrease in PTB \u3c 37 weeks (56/181 (30.9%) vs 66/159 (41.5%); RR 0.75, 95% CI 0.56 to 0.99) and a significantly longer latency from randomization to delivery (p=0.049).
CONCLUSIONS: In individuals with singleton gestations, without prior spontaneous PTB and with a short TVU CL in the second trimester, cerclage is associated with a significant decrease in PTB \u3c 37 weeks and a significant longer latency at TVU CL ≤20.9mm before 24 weeks, but not an overall effect on TVU CL ≤25mm
