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Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis
No full textAutoimmune-encephalitis is a relatively new category of immune-mediated disease involving the central nervous system that demonstrates a widely variable spectrum of clinical presentations, ranging from the relatively mild or insidious onset of cognitive impairment to more complex forms of encephalopathy with refractory seizure. Due to its diverse clinical features, which can mimic a variety of other pathologic processes, autoimmune encephalitis presents a diagnostic challenge to clinicians. Imaging findings in patients with these disorders can also be quite variable, but recognizing characteristic findings with limbic structures suggestive of autoimmune encephalitis can be a key step in alerting clinicians to the potential diagnosis and ensuing a prompt and appropriate clinical work-up. In this article, we review antibody-mediated encephalitis and its various subtypes with a specific emphasis on the role of neuroimaging in the diagnostic work-up
Social Buffering of Posttraumatic Stress Disorder: Longitudinal Effects and Neural Mediators
No full textBACKGROUND: Posttraumatic stress disorder (PTSD) is a well-characterized psychiatric disorder that features changes in mood and arousal following traumatic events. Previous animal and human studies of social support during the peritraumatic window have demonstrated a buffering effect with regard to acute biological and psychological stress symptoms. Fewer studies have explored the magnitude of and mechanism through which early posttrauma social support can reduce longitudinal PTSD severity.
METHODS: In this study, we investigated the beneficial impact of social support on longitudinal PTSD symptoms and probed brain regions sensitive to this buffering phenomenon, such as the amygdala and ventromedial prefrontal cortex. In the multisite AURORA study, 315 participants reported PTSD symptoms (PTSD Checklist for DSM-5) and perceived emotional support (Patient-Reported Outcomes Measurement Information System) at 2 weeks, 8 weeks, 3 months, and 6 months post emergency department visit. Additionally, neuroimaging data were collected at 2 weeks posttrauma.
RESULTS: We hypothesized that early posttrauma social support would be linked with greater fractional anisotropic values in white matter tracts that have known connectivity between the amygdala and prefrontal cortex and would predict reduced neural reactivity to social threat cues in the amygdala. Interestingly, while we observed greater fractional anisotropy in the bilateral cingulum and bilateral uncinate fasciculus as a function of early posttrauma emotional support, we also identified greater threat reactivity in the precuneus/posterior cingulate, a component of the default mode network.
CONCLUSIONS: Our findings suggest that the neurocircuitry underlying the response to social threat cues is facilitated through broader pathways that involve the posterior hub of the default mode network
A Rare Case of Recurrent Renal Infarcts With Unique Etiologies in Different Kidneys Occurring Six Years Apart
No full textRenal infarcts are uncommon, difficult to diagnose, and can lead to long-term kidney disease. Because they have numerous etiologies and patients may present with nonspecific symptoms, renal infarcts may be mistaken for other common conditions. A 50-year-old woman presented to the emergency department (ED) with flank pain, nausea, and vomiting. Computed tomography (CT) revealed multiple right kidney infarcts, transthoracic echocardiography revealed mitral valve stenosis with no evidence of atrial fibrillation, and hypercoagulability tests were negative. High-intensity anticoagulation therapy resolved the infarcts and she was discharged on warfarin. Six years later, at the age of 56, the woman again presented to the ED with back pain, nausea, vomiting, and fever. She had undergone valvuloplasty to repair the mitral valve stenosis 1 month before this ED visit, and warfarin had been discontinued shortly after the procedure. CT imaging and ultrasonography showed no evidence of infarcts and electrocardiogram was normal. Although urinalysis was negative for infection, pyelonephritis was suspected per CT results. However, renal function and leukocytosis did not improve after 2 days of antibiotic therapy. Radioisotope renal scan then revealed infarcts in the left kidney. Anticoagulation therapy again led to recovery, and the patient was discharged back on warfarin. After the recurrent infarct, monitoring and cardiac care have led to adequate long-term management, and no evidence of atrial fibrillation has ever been observed. This case illustrates the challenging diagnosis of an unusual presentation of recurrent renal infarct, where each infarct was suspected to have a unique and independent etiology: mitral valve stenosis in the first and hypercoagulability from withdrawal of warfarin in the second. Because no clear risk or symptom profiles exist for renal infarcts, this unusual condition should be considered when patients do not respond to treatment for other renal problems, especially those with cardiovascular disease
Pregnancy Management and Outcomes in a Small Bowel, Pancreas, and Liver Transplant Recipient: A Case Report and Literature Review.
No full textBACKGROUND: Small bowel transplantation (SBT) is a rare but life-saving surgery. However, successful full-term pregnancies in individuals with SBT are exceedingly rare due to the nutritional and immunosuppression challenges this transplant poses for pregnancy. Therefore, clear guidelines for treating pregnant SBT recipients are unavailable. Here, we report the second case of a successful pregnancy in an individual with a triple organ transplant, including SBT, highlighting the need for careful immunosuppressive management and multidisciplinary care.
CASE REPORT: A 20-year-old woman in the third trimester of pregnancy with a history of small bowel, liver, and pancreas transplantation at age 1 year presented with elevated liver function test results. She had been taking tacrolimus, sirolimus, and prednisone before pregnancy, with no signs of organ rejection. While sirolimus and prednisone was discontinued upon conception, laboratory test results at presentation revealed low serum tacrolimus levels. The patient had an acute kidney injury and pulmonary edema during her hospitalization and received a diagnosis of preeclampsia. She underwent a successful cesarean delivery, due to labor induction complications; however, about 1 month after hospital discharge, the patient experienced elevated liver enzymes, which was treated with high-dose steroids and adjusted tacrolimus. Sirolimus was restarted, and the patient\u27s liver enzymes have been normalized to date.
CONCLUSIONS: Comprehensive multidisciplinary care, as well as monitoring and optimizing immunosuppression, are essential for pregnant SBT recipients throughout the prenatal, perinatal, and postpartum periods to mitigate risks, prevent graft rejection, and ensure positive maternal and fetal health outcomes
The Effectiveness of Exercise in Reducing Cardiovascular Risk Factors Among Adults: A Systematic Review and Meta-Analysis
No full textCardiovascular disease (CVD) remains one of the major causes of sickness and death in the world. However, lifestyle modifications, such as exercise, can significantly reduce the risk of this disease. This study aimed to assess the effectiveness of various forms of physical activity in reducing CVD risk factors among adults. A comprehensive search of the databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Excerpta Medica Database (EMBASE) databases was conducted between January 1, 2014, and May 31, 2024, as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs), cohort studies, and observational studies on the impact of aerobic, resistance, or combined training on cardiovascular risk factors in adults (≥18 years) were considered for inclusion. Data relating to primary outcomes, including stroke and myocardial infarction rates, BP, cholesterol levels, and BMI were collected. The Cochrane risk-of-bias tool and the Methodological Index for Non-Randomized Studies (MINORS) checklist were used for quality and bias assessment. Meta-analyses were performed using the RevMan software, with heterogeneity evaluated by I² statistics; 17 studies, including 11 RCTs and six cohort studies, met the inclusion criteria. There was a significant reduction in the mean systolic BP (SBP) by 3.32 mmHg [95% confidence interval (CI): 0.85-5.78 mmHg; p0.0001], although there was substantial heterogeneity in effect size across the studies (I² = 98%). Different types of physical activity (i.e., aerobic, resistance, or combined exercise) can effectively reduce key cardiovascular risk factors, including BP, cholesterol levels, and BMI values. Regular physical activity is still regarded as the most effective preventive measure against CVD, despite inconsistencies in research findings. Future studies should aim to identify optimal exercise programs and their long-term effects on diverse populations
Corticosteroid Prescribing Patterns in the Emergency Department for Acute COPD Exacerbations: A Retrospective Analysis Following an Educational Intervention
No full textINTRODUCTION: COPD is a progressive lung disease with marked airflow limitation. It has a large global prevalence and is managed with antibiotics, bronchodilators, and corticosteroids. Despite the prevalence, corticosteroid prescribing regimens differ widely amongst providers. This study aims to evaluate baseline corticosteroid prescribing patterns, the ability to change corticosteroid prescribing patterns with the utilization of an educational initiative, and to evaluate the effect of corticosteroid dose on length of stay, 30-day hospital readmission, mortality, and total hospital insulin dosing.
METHODS: This study was conducted via a retrospective observational study. Providers at a single institution answered a baseline questionnaire on COPD corticosteroid prescribing patterns and subsequently received an educational presentation regarding evidence-based corticosteroid recommendations. Data were then retrospectively obtained and analyzed evaluating corticosteroid prescribing patterns both pre- and post-educational intervention. Data were analyzed using IBM SPSS Version 25.
RESULTS: The provider survey revealed that most (95.3%) administered 125 mg of methylprednisolone to patients treated for AECOPD. The most common reason a particular dose of corticosteroid was administered was due to previous teaching or practice patterns. The mean initial steroid dose of methylprednisolone decreased following the educational initiative from 114.24 mg to 72.8 mg (p \u3c 0.01). This corresponded to a 69% (n=41) decrease of providers using 125 mg methylprednisolone (p \u3c 0.01), and increased prescribing of 62.5 mg methylprednisolone by 42.6% (n=66). The mean LOS following hospital admission for AECOPD in the pre-intervention group was 5.80 days, while the mean LOS following the targeted educational intervention decreased to 4.82 days (p = 0.01).
CONCLUSIONS: The implementation of an educational intervention may change provider corticosteroid prescribing patterns. Additionally, lower corticosteroid dose in the Emergency Department may decrease patient length of stay. Keywords: Corticosteroid, COPD, LOS, recommendations, steroid
Using Python to mint DOIs on demand for a DSpace Repository
No full textMinting DOIs using an online form can be a time-consuming task for repository librarians. DSpace can mint DOIs for all items in a repository but is not able to do so selectively, which is an issue in an institutional repository containing a mixture of original materials (dissertations, reports, data, etc.) and previously published materials such as journal articles and preprints. An institutional repository librarian and her librarian colleague with Python experience embarked on a pair programming project to create a script to mint DOIs on demand in DataCite for individual items in the institution’s Open Repository instance using the APIs from both platforms. The pair met for one hour each week to develop and test the script. The institutional repository librarian lent invaluable insight into both platforms and the metadata variations the code would need to account for. The project was also a great learning opportunity for both librarians to improve their Python coding skills. This project was evaluated in terms of how the time spent creating the code compares to the time it takes to mint DOIs manually as well as metadata enhancements and accuracy in DataCite. This presentation will share the final Python script and highlight the takeaways from this approach for both the institutional repository librarian and the coding librarian. We will also share forthcoming changes to the script due to the repository’s planned upgrade to the DSpace 7 version of Open Repository
The Future of Odontogenic Sinusitis.
No full textThis article discusses the exciting future of odontogenic sinusitis (ODS) in the context of recent advancements in ODS understanding. It emphasizes the importance of integrating ODS into the broader framework of sinonasal diseases and highlights the need for multidisciplinary collaboration among otolaryngologists and dental specialists to optimize clinical outcomes, research, and education. Key challenges include refining dental and sinus pathophysiologic understandings, establishing widely accepted diagnostic criteria, and optimizing multidisciplinary treatment pathways. The article provides also some tips for how to develop interdisciplinary networks both to improve clinical care and research endeavors
Clinicopathological Characteristics of Extranodal Rosai-Dorfman Disease: A Retrospective Case Series of 25 Patients
No full textRosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis, classically affecting the lymph nodes. Even rarer extranodal disease is diagnostically challenging due to overlapping histologic features with other entities and lack of a universally agreed set of biomarkers. Cyclin D1 immunohistochemistry (IHC) may serve as a useful adjunct in diagnosing extranodal RDD. We present a retrospective case series of patients diagnosed with extranodal RDD between January 2013 and December 2023. IHC staining for cyclin D1 was performed on archived tissue samples. Baseline IHC results for biomarkers supporting the RDD diagnosis were recorded along with patient demographic characteristics, clinical features, and disease outcomes. A total of 25 patients with extranodal RDD were included: 21 women (84 %) and 4 men (16 %). The mean age at diagnosis was 42.6 years. Cutaneous and deep tissue involvement was seen in 5 (20 %) and 20 (80 %) patients, respectively. 11 patients (44 %) had disease localized to the trunk and extremities, and 13 had disease in the head and neck region (52 %), of which 5 occurred in the nose and paranasal tissues. Available follow-up data showed most patients fully recovered (n = 11; 78.6 %). However, 1 patient had disease recurrence, 1 developed blindness, and 1 developed deafness. Cyclin D1 IHC was positive in all samples (100 %), consistent with previous studies. The clinicopathologic findings in this study highlight the spectrum of potential disease sites, possible morbid outcomes related to disease site, and the diagnostic utility of cyclin D1 IHC