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Association Between MRI Findings of Facet Arthropathy and Synovitis With Health-Related Outcome and Pain Scores Following Therapeutic Lumbar Facet Injections.
Get PDFLow back pain is a common complaint among adults. The facet joint is a major source of lumbar pain, and therapeutic facet injections have gained popularity as a minimally invasive treatment option. In addition, magnetic resonance imaging (MRI) utilization for diagnosing low back pain has increased significantly over the past few decades. Facet synovitis is an entity characterized by edema and inflammatory changes affecting the facet joints, adjacent bone marrow, and surrounding soft tissues. Although its underlying etiology remains poorly understood, recent reports suggest a high incidence in patients with arthropathy and arthritis. It is essential to explore potential correlations between specific MRI findings and outcomes after lumbar facet injections. This investigation is particularly relevant for facet synovitis, given its inflammatory nature and the common use of anti-inflammatory agents in facet injections. We investigated associations between MRI evidence of facet arthropathy and/or synovitis and the degree of improvement in health-related outcome and pain scores after therapeutic facet injections. The review was conducted on patients who received bilateral therapeutic facet injections, excluding those with prior lumbar spinal surgery or transitional segments. Facet arthropathy and synovitis were assessed on MRI by two neuroradiologists, and postprocedure outcomes such as pain and function were compared using univariate and multivariate analyses based on MRI findings. Our retrospective review indicates that patients receiving facet injections experience greater mean reduction in daily activity and workability burden scores from back pain when facet synovitis is a known portion of their pathology. The authors pose that further study could help identify patient populations that are the best candidates for therapeutic intervention. This may ultimately improve delivery of care, cost efficacy, and patient satisfaction
Understanding the Impact of COVID-19 on Yoga Instruction: Examining Teaching Methodology, Class Components, and Injury Patterns in the Northeastern US
Get PDFOBJECTIVES: This study aimed to examine the impact of COVID-19 on the perspectives of yoga instructors (YIs) regarding teaching methodology, class components, and yoga-related injuries among their clients DESIGN: A cross-sectional design in this study.
SETTING: A total of 407 YIs from Northeastern United States completed a customized, web-based survey.
MAIN OUTCOME MEASURES: Chi-square tests were carried out to determine changes in yoga teaching format before and during the pandemic, as well as the counts of yoga related injuries between face-to-face (FtoF) and online teaching format. Independent t tests were used to compare the characteristics of yoga teaching elements.
RESULTS: During the pandemic, 47 % of YIs adopted online teaching, followed by a mixed (45.9 %) format and FtoF (7.1 %) instruction. Both online and FtoF classes showed similar trends, with most reporting class sizes of 4-6, followed by 7-9 and then 1-3 students. Regardless of the teaching format, most YIs performed sun salutations and practiced mixed yoga styles. Among the YIs teaching yoga online, 84.6 % expressed their willingness to continue offering online classes post-pandemic and perceived the quality of online yoga teaching as high. Importantly, the number of injuries was low, and there were no significant differences in injury counts between FtoF (3.6 %) and online (4.2 %) teaching formats (p \u3e 0.05). The most common injury in all forms of teaching yoga was a sprain/strain (42.9 %).
CONCLUSIONS: These findings could inform the development of research studies to examine the long-term feasibility and effectiveness of delivering online yoga since short-term benefits, safety, and YI acceptance appear favorable
The Impact of Changes in Depression on Cardiovascular Outcomes in Patients With Coronary Heart Disease.
Get PDFBACKGROUND: Depression is associated with major adverse cardiovascular events (MACE). Whether longitudinal changes in depression affect MACE in patients with coronary heart disease (CHD) remains unknown.
OBJECTIVES: The authors evaluated the hypothesis that increasing or persistent depression predicts MACE in patients with CHD.
METHODS: At baseline, 3,483 Emory Cardiovascular Biobank participants (median age 65.5 years, 31.6% female) completed the Patient Health Questionnaire 8 (PHQ8) for depression evaluation. At 1 year, 2,639 of these event-free participants repeated the questionnaire. Depression was defined as a PHQ8 score \u3e9 and change in depressive symptoms (Δ role= presentation \u3e PHQ8) was year 1 score minus baseline PHQ8 scores. We categorized participants into never depression (both PHQ8 \u3c10), new depression (baseline PHQ8 \u3c10; 1-year PHQ8 \u3e9), remitted depression (baseline PHQ8 \u3e9; year 1 PHQ8 \u3c10), and persistent depression (both PHQ8 \u3e9) groups. Fine-Gray models with noncardiovascular death as the competing event and adjusted for demographics, CHD, and depression related factors evaluated how changes in depression affect MACE (cardiovascular death and MI).
RESULTS: Overall, the incidence of MACE was 14%, with 8.7% of those with follow-up PHQ8 having MACE. 2.9% had persistent depression, 4.5% had new depression, 10.8% had remitted depression, and 81.8% never had depression. Increasing depressive symptoms independently predicted MACE (Δ role= presentation \u3e PHQ8 subdistribution HR: 1.06 [95% CI: 1.02-1.09], P \u3c 0.001). Correspondingly, the incidence of MACE was higher in those with persistent (20.8%) or new depression (11.9%) than in those with remitted (9.4%) or never depression (8%) (P \u3c 0.001). Compared to never depression, persistent depression independently predicted MACE (subdistribution HR: 2.78 [95% CI: 1.2-6.5], P = 0.017).
CONCLUSIONS: Increasing or persistent depression predicts MACE in individuals with CHD
Utilizing Microwave Ablation in Combination with Vertebroplasty Is an Effective Method in Reducing Cancer Related Back Pain, Disability, and Opioid Use: A Systematic Review and Meta-Analysis
Get PDFBackground: It is estimated that metastases from primary malignant neoplasms affect the spine around 30%-70% of the time. Many times, these osteolytic tumors will cause the degradation of the vertebrae, leaving patients in a tremendous amount of pain, disability, and dependence on opioids as analgesics. Microwave ablation (MWA) followed by vertebroplasties (VP) has been a developing treatment for such a condition; however, there are no systematic reviews or meta-analyses examining the method’s effectiveness thus far.
Purpose: This systematic review and meta-analysis analyzes the 4-week and 12-week outcomes of patients with metastatic spinal cancer treated with the combinatorial treatment of microwave ablation followed by a vertebroplasty.
Methods: The systematic review and meta-analysis followed the 2020 PRISMA guidelines. Five online databases (Cochrane, Embase, PubMed, Web Of Science, Scopus) were screened. Included were studies that included 4-week and 12-week Visual Analogue Scales (VAS) scores, Oswestry Disability Index (ODI) measures, and Daily Morphine Consumption (DMC). Four studies fit our inclusion criteria, yielding a sample size of 117 patients.
Results: Our results portray strong clinically significant results of utilizing MWA with VP at both 4-weeks and 12-weeks. At 4-weeks, the effect size for the reduction of VAS, ODI, and DMC were Cohen’s d = 4.00, Cohen’s d = 3.29, Cohen’s d = 4.50, respectively. At 12-weeks, the reduction in VAS and DMC had an effect size of Cohen’s d = 4.34 and Cohen’s d = 4.56, respectively. Comparing the 4-week and 12-week VAS scores, there was a difference in Cohen’s d = 0.34, in favor of 12-weeks, signifying a possible clinical significance of even further reduction of VAS scores as time progresses.
Conclusion: Utilizing microwave ablation in combination with a vertebroplasty greatly reduced pain, disability, and opioid consumption in patients with metastatic spinal cancer over a 4-week and 12-week timeline. However, with only 117 patient data available to be analyzed, future studies are needed in order to increase the available sample size. Furthermore, comparative randomized controlled trials assessing the significance of utilizing MWA with VP, compared to VP alone could further exemplify the importance of MWA to the treatment
A Case of Isolated SMA Dissection with Failed Initial Conservative Management
Get PDFIsolated superior mesenteric dissection (ISMAD) is an uncommon condition, often diagnosed incidentally for presentations of acute abdominal pain. Early identification and treatment are crucial as complications such as bowel ischemia or vessel rupture can occur. There remain no established treatment guidelines, making surgical and endovascular indications controversial. A 60-year-old male presented with acute abdominal pain, and was diagnosed with ISMAD via computed tomography imaging. He was initially managed conservatively which progressed to worsening abdominal pain, hypertensive crisis, and hemoperitoneum on follow-up computed tomography angiography (CTA). A mesenteric angiogram revealed a pseudoaneurysm in the superior mesenteric artery (SMA) which was subsequently treated with coil embolization. The absence of long-term evidence on relapse rates questions the overall effectiveness of nonoperative therapy. Further research is needed to establish clear guidelines and to determine whether early intervention might be more advantageous in managing complications and preventing recurrence
Letter to Early Do-Not-Attempt Resuscitation Orders and Neurological Outcomes in Older Out-Of-Hospital Cardiac Arrest Patient: A Multicenter Observational Study
Get PDFWe enjoyed reading the article by Kohri et al., titled “Early do‐not‐attempt resuscitation orders and neurological outcomes in older out‐of‐hospital cardiac arrest patients: A multicenter observational study” and would like to offer additional commentary on the article. We hope these perspectives may provide insight into areas that may require further research and improvement
Impact of Sphenopalatine Ganglion Block on Septoplasty: A Meta-Analysis
Get PDFObjective: This Meta-Analysis aims to explore the impact of sphenopalatine ganglion block on intraoperative blood loss, duration of surgery, and postoperative pain.
Background: Sphenopalatine ganglion block (SPGB) is a form of regional anesthesia that could be coupled with general anesthesia in Septoplasty. Septoplasty is one of the three most common procedures Otolaryngologists perform, which is commonly performed endoscopically. There is lack of research on benefits of Sphenopalatine ganglion block on septoplasty. One of the most common complications of septoplasty is excessive bleeding which may impact endoscopic visualization. Additionally, postoperative pain management is vital to decreasing hospital stay and reducing systemic analgesic use. However, there have been conflicting studies on whether SPGB has an impact on postoperative pain.
Methods: Five databases (Pubmed, Embase, Web of Science, Cochrane Library, and Scopus) were used for the Systematic Search to perform a meta-analysis following the 2020 PRISMA guidelines. A total of 88 studies were extracted for review, 42 were duplicates, 46 papers were reviewed by two authors to be considered for analysis and by a third when a tie breaker was needed. Four randomized controlled trials were used for the final meta-analysis.
Results: After SPGB there was a significant decrease in Intraoperative blood loss (IOBL) (Cohen’s D= -6.80), a slight increase in Surgical duration time (Cohen’s d=0.66), a significant decrease in pain measured by visual analogue scale (VAS) measured at post-anesthesia care unit (PACU) and 24 hours (Cohen’s D=-3.07 and D=-4.1 respectively).
Conclusion: SBPG has shown a significant reduction in intraoperative blood loss in addition to a decrease in postoperative pain ranging up to 24 hours when compared with saline controls. However, there was a slight increase in the duration of surgery
INJECTABLE HYDROGELS THAT CAN MEASURE RADIATION AT BODY TEMPERATURE
Get PDFHydrogel-based radiation dosimeters are used to calibrate and validate radiation delivered by linear accelerators used in radiotherapy. Specifically, Fricke hydrogel-based dosimeters containing ferrous ion complexes oxidize upon exposure to radiation, leading to a change in optical density that can be measured via a color change in a photometric reagent. While gelatin-based Fricke hydrogels are routinely used to measure radiation, these hydrogels are unstable at body temperature, and it is currently not possible to noninvasively measure radiation dose inside a patient. This study reports the synthesis and characterization of self-forming hydrogels containing Fricke components that are stable at body temperature. The effects of varying individual Fricke hydrogel components on the sensitivity (measured by change in optical density) to radiation dose were systematically studied. Self-forming hydrogels were prepared using xylenol orange (XO) in the range of 0.05 to 0.5 mM, ferrous ammonium sulfate (Mohr’s salt) in the range of 0.1 to 1 mM, and sulfuric acid (H2SO4) in the range of 0 to 100 mM. The minimum concentration of Fricke components to create self-forming hydrogels that are sensitive to radiation dose (0 to 40 Gy) at room and body temperature was found to be XO (0.2 mM), H2SO4, (25 mM) and Mohr’s salt (0.5 mM). To assess self-forming hydrogel biocompatibility, human mesenchymal stem cells (MSCs) cultured in medium were exposed to cylindrical hydrogels containing Fricke components, and MSCs co-cultured with self-forming hydrogels containing the optimized formulation remained highly viable. Plans for a preclinical study using a rodent tumor model are underway, bringing this technology one step closer to clinical practice
An Introduction to Open-Source Geographic Information Systems (GIS): QGIS
Get PDFIn general, Geographic Information Systems (GIS) provide a framework for gathering, organizing, and analyzing spatial data, that is visualized through maps. By arranging spatial information into coincident layers, GIS analyses help reveal deeper insights into a study area by identifying not only where features of interest are located, but also why patterns or processes are occurring. However, a number of various GIS software and online mapping platforms exist, each with a different range of analysis capabilities, but also with different accessibility limitations in terms of user cost (e.g., open-source vs. commercial). In this introductory workshop, participants will become familiar with popular GIS platforms’ capabilities and limitations (e.g., Google, OpenStreetMap, ArcGIS Pro, Terrset), as well as gain experience in the open-source software, QGIS
Cutaneous Adverse Effects From Diabetes Devices in Pediatric Patients With Type 1 Diabetes Mellitus: Systematic Review
Get PDFBACKGROUND: Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance.
OBJECTIVE: This systematic review aims to explore the current literature surrounding dermatologic complications of CGM and CSII as well as the impact on patient outcomes.
METHODS: A systematic review of the literature was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines using 5 online databases. Included articles were those containing primary data relevant to human participants and adverse reactions to CGM and CSII devices in pediatric populations, of which greater than 50% of the sample size were aged 0-21 years. Qualitative analysis was chosen due to the heterogeneity of outcomes.
RESULTS: Following the application of exclusion criteria, 25 studies were analyzed and discussed. An additional 5 studies were identified after the initial search and inclusion. The most common complication covered is contact dermatitis, with 13 identified studies. Further, 7 studies concerned lipodystrophies, 5 covered nonspecific cutaneous changes, 3 covered unique cutaneous findings such as granulomatous reactions and panniculitis, and 2 discussed user acceptability.
CONCLUSIONS: The dermatologic complications of CGM and CSII pose a potential risk to long-term glycemic control in T1D, especially in young patients where skin lesions can lead to discontinuation. Increased manufacturer transparency is critical and further studies are needed to expand upon the current preventative measures such as device site rotation and steroid creams, which lack consistent effectiveness