19043 research outputs found
Sort by
Acute Ischemic Stroke in the Incarcerated: Comparison of Treatment Rates and Clinical Outcomes With the United States General Population
No full textUnderstanding Radiographic Parameters in Cervical Deformity
No full textStudy Design: Narrative review. Objective: To synthesize current knowledge on radiographic parameters, classification systems, and compensatory mechanisms essential to the diagnosis and surgical planning of cervical spine deformity (CD) correction. Summary of Background Data: CD encompasses a heterogeneous set of conditions associated with neurological impairment and impaired health-related quality of life. Surgical outcomes are closely linked to radiographic alignment, yet no framework exists that integrates all relevant metrics. Methods: This review evaluates contemporary literature to outline major cervical and global alignment parameters, classification systems, and compensatory mechanisms relevant to surgical planning. Results: Key parameters such as T1S-CL mismatch and cSVA remain essential for assessing sagittal imbalance in CD. However, cervical alignment is often influenced by global compensation, highlighting the need for full-spine evaluation. Classification systems offer structured, outcome-driven frameworks, while morphologic subtypes further guide surgical approach. Despite these tools, revision rates remain relatively high. Emerging metrics, such as upper cervical extension reserve (UER), may offer additional insight into patient-specific alignment capacity, serving as valuable adjuncts to better predict outcomes. Conclusions: Optimal surgical planning in CD requires a comprehensive approach that integrates regional and global alignment parameters, individualized modifiers, and morphologic considerations. Incorporating emerging metrics may improve long-term clinical outcomes
Direct Oral Anticoagulants versus Low-Molecular-Weight Heparin for Thromboprophylaxis in Cancer-Related Surgeries: A Meta-Analysis of Efficacy and Safety Outcomes
No full textBackground: Post-operative venous thromboembolism (VTE) remains a concern following cancer-related surgeries. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) compared to low molecular weight heparin (LMWH) for thromboprophylaxis after cancer-related surgeries. Methods: We systematically searched databases for studies comparing DOACs to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries. Primary outcomes were VTE incidence and bleeding events. Secondary outcomes included all-cause mortality and hospitalization rates. Subgroup analyses examined DOAC type, cancer type, and follow-up duration. A random-effects model calculated pooled risk ratios (RRs) with 95 % confidence intervals (CIs). Results: Analysis included 16 studies with 6400 participants in the DOAC group (mean age 62.05 years, 28.15 % male) and 5801 participants in the LMWH group (mean age 60.78 years, 34.65 % male). DOACs were non-inferior to LMWH for VTE prevention (RR = 0.81, 95 % CI 0.56 to 1.16) with no significant difference in bleeding rates (RR = 0.70, 95 % CI 0.70 to 1.18). Mortality and hospitalization rates were similar between groups. Subgroup analyses suggested possible VTE reduction with DOACs in urological cancer surgeries (RR = 0.52, 95 % CI 0.44 to 0.61) and lower bleeding trends with Apixaban (RR = 0.64, 95 % CI 0.44 to 0.94). Conclusions: DOACs appear non-inferior to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries, with comparable safety. The superior VTE prevention in urological cancer surgeries and Apixaban\u27s favorable safety profile warrant further investigation. Moreover, additional research is necessary to clarify the roles of specific DOACs and optimal prophylaxis strategies across various cancer types and surgical procedures
Focal to Bilateral Tonic–Clonic Seizures in Newly Diagnosed Focal Epilepsy
No full textPresence of focal to bilateral tonic–clonic seizures (FBTCS) in focal epilepsy is associated with increased morbidity and mortality. Risk factors for FBTCS are poorly understood, and little is known regarding FBTCS recurrence after treatment initiation. This study aimed to investigate factors related to FBTCS in newly diagnosed focal epilepsy and their recurrence after starting antiseizure medications (ASMs) in the Human Epilepsy Project (HEP) cohort. HEP was an international, prospective cohort study that enrolled people with newly diagnosed focal epilepsy within 4 months of treatment initiation and followed them for up to 6 years. Baseline characteristics, treatment choices, and seizure outcomes were collected. Descriptive and inferential statistical analysis was conducted to assess the differences between study participants who had FBTCS and those who never experienced FBTCS. A total of 443 participants were included in this analysis; 77% (n = 342) had FBTCS at some point prior to or within the study period. In participants with FBTCS, regardless of initial seizure type, diagnosis was mostly made after FBTCS (335/342, 98%). After treatment initiation, FBTCS did not recur in 57% (n = 194/342) of cases. A higher number of total pretreatment seizures (median = 16 vs. 11, p =.048, Mann–Whitney U-test), predominantly focal aware seizures (FAS) or focal impaired awareness seizures (FIAS; median = 15 vs. 10, p =.049, Mann Whitney U-test), was associated with no recurrence in FBTCS after treatment initiation. Of 108 participants without FBTCS prior to treatment, only seven (6%) developed FBTCS after treatment initiation. There was no significant difference in choice of initial ASM class (levetiracetam vs. sodium channel blockers) between participants who experienced FBTCS and those who did not. This study highlights the significance of FBTCS among individuals with newly diagnosed focal epilepsy. The majority of participants who experienced FBTCS were diagnosed with epilepsy after experiencing their first FBTCS despite preceding FAS/FIAS. The more frequent FAS/FIAS in participants whose FBTCS resolved may be a characteristic of their epilepsy
Does New Research Address Persistent Questions Since the Publication of the CDC’s 2018 Pediatric Mtbi Guideline
No full textBackground and objective: Due to the potential debilitating sequelae following pediatric mTBI, the CDC published the Guideline on the Diagnosis and Management of mTBI Among Children in 2018. However, the guideline identified several key gaps in our clinical knowledge to support several clinical recommendations. The objective of this review is to evaluate if subsequent research has addressed these gaps in clinical practice recommendations. Methods: A literature review was conducted in PubMed using keywords from the CDC guidelines for the years of July 2015–January 2021. Articles were screened by title and abstract so only studies with children \u3c 18 years of age and those focusing on mTBI were included. Results: A total of 531 articles were identified after screening. Forty-three percent was prospective; 24% were case reports, literature reviews, comments, or protocols; 19% were retrospective, 7% were cross-sectional, 4% were RCTs, and 4% were systematic reviews/meta-analyses. Forty-nine percent focused on diagnosis, 17% on prognosis, and 34% on treatment. The four most published topics were neuropsychological tools (28%), risk factors for intracranial injury and computed tomography (11%), cognitive/physical rest (11%), and return to school (10%). Conclusion: Since the release of the 2018 CDC guidelines, the majority of publications addressing pediatric mTBI have been prospective studies evaluating the clinical application of neuropsychological tools in concussion management. While these studies do address several of the clinical gaps noted by the CDC regarding the diagnosis and prognosis of pediatric mTBI, there remains a lack of high-quality studies focused on improving pediatric concussion treatment and outcomes
Relationship of Vitamin D to Pathogenesis and Outcomes of Hidradenitis Suppurativa: A Systematic Review
No full textHidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful sinus tracts and significant scarring. Recent evidence suggests that vitamin D deficiency may play a role in the pathogenesis and outcomes of HS. This systematic review aims to evaluate the relationship between vitamin D levels and HS, exploring potential therapeutic benefits of vitamin D supplementation. This systematic review followed PRISMA guidelines and was registered with PROSPERO (ID:CRD42024566092). A comprehensive literature search was conducted in PubMed, Medline (OVID), and Web of Science using the keywords “hidradenitis suppurativa” and “vitamin D.” Studies were screened for relevance, and non-randomized studies were assessed for quality using the MINORS score. Due to the heterogeneity of clinical outcome measures, a qualitative analysis was performed. A total of 77 records were identified, with 38 articles remaining after duplicates were removed. After full-text screening, 8 studies met the inclusion criteria. These studies, published between 2014 and 2024, included case-control, cross-sectional, and cohort studies. High prevalence rates of vitamin D deficiency (75–100%) were consistently observed among HS patients. Improved clinical outcomes with vitamin D supplementation were noted in several studies. There were significant correlations between vitamin D deficiency and higher clinical severity, and genetic alterations in vitamin D metabolism and keratinization pathways were identified in HS patients. This systematic review demonstrates a significant association between vitamin D deficiency and HS. Vitamin D’s role in immune regulation and anti-inflammatory processes suggests its potential as a therapeutic agent for HS. However, further research is needed to determine optimal dosing and assess the protective effects of vitamin D supplementation in HS management
Scratching the Surface: Biomarkers and Neurobiomarkers for Improved Allergic Contact Dermatitis Management
No full textAllergic contact dermatitis (ACD), also known as allergic eczema, is a common inflammatory skin disorder that affects millions of Americans and imposes significant physical, psychological, and economic burdens. Differentiating ACD from other forms of dermatitis remains a challenge, with patch testing as the gold standard. Despite its utility, patch testing can lack diagnostic accuracy, highlighting the importance of molecular biomarkers to refine diagnosis and treatment. Advances in transcriptomics and machine-learning have enabled the identification of biomarkers involved in ACD, such as loricrin (LOR), ADAM8, CD47, BATF, SELE, and IL-37. Moreover, biomarkers such as LOR, NMF, and TEWL, may have prognostic value in evaluating therapeutic response. Emerging neurological biomarkers (neurobiomarkers), including IL-31 and TRPV1, target pathways involved in the pruritic and inflammatory responses, offering novel therapeutic targets as well. This mini review summarizes current ACD treatments, biomarkers for targeted therapies, and emphasizes the role of neurobiomarkers in ACD treatment. Additional research on the validity of the therapeutic potential of these biomarkers is necessary to improve ACD treatment and outcomes
Impact of Treatment of Pudendal Neuralgia on Pain: A Systematic Review and Meta-Analysis
No full textIntroduction and Hypothesis: Pudendal neuralgia is chronic pelvic pain associated with the pudendal nerve. Unfortunately, the best treatment approach is unknown. Our objective was to systematically assess interventions for pudendal neuralgia for improvement in pain. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we retrieved studies from MEDLINE, EMBASE, and clinicaltrials.gov through May 27, 2024. Our population included patients with pudendal neuralgia. Our interventions included surgery (decompression and nerve stimulation), injections and pulse radiofrequency treatments. Outcomes included improvement in pain (usually on a visual analog scale (VAS)) and adverse events. GRADE criteria were used to assess quality. Differences between pre- and post-intervention pain scores were compared with a random effects REML model and reported as mean difference and 95% confidence intervals. Results: Six hundred eighty-seven abstracts were screened yielding 37 studies that met eligibility criteria. Treatments included 16 surgeries with 12 nerve decompressions and 4 nerve stimulator placements, 14 injections, and 7 pulse radiofrequency treatments. The majority, 95%, were Grade C. All treatments appear to provide relief to a similar extent (mean difference in VAS of 2.73 cm (1.77, 3.69), p \u3c 0.07, with high heterogeneity I2 = 98.18%), but no treatment was clearly superior for pain relief. Adverse events were inconsistently reported but more severe in the surgery group. Conclusions: There are many treatment approaches to pudendal neuralgia, but overall, the evidence includes heterogeneous patient populations, non-standardized treatments, poor-quality studies, variable pain measurement instruments, and short-term follow-up. All interventions improved pain with no statistically significant difference between groups
