4 research outputs found
Incidental Findings of Dextrocardia in Patient with Cerebellar Arteriovenous
No full textCerebral arteriovenous malformations (AVMs) have a congenital origin, and the diagnosis rate during infancy and youth is only 18-20%. The clinical presentation of intracranial haemorrhage is observed in 75-80% of paediatric patients. The introduction of novel agents for endovascular management has led to enhanced surgical outcomes by preoperative AVM embolization. Dextrocardia with situs inversus is also a rare congenital abnormality in children. A significant proportion of individuals diagnosed with dextrocardia remain oblivious to their condition due to the prevalence of asymptomatic cases. We are documenting a case involving a 12-year-old girl who was presented with an altered state of consciousness and vomiting. Her Neuroimaging showed posterior fossa bleed and diagnosed with cerebellar arteriovenous malformation (AVM). Endovascular embolization of AVM was done and an incidental finding of dextrocardia with situs inversus was noted during the procedure. This case report aims to find if there is any association between Brain AVMs and Dextrocardia in the paediatric population.
Keywords: Dextrocardia, Arteriovenous Malformatio
Prevalent distribution of conscious processes on either side of the brain
No full textObjectives. The brain has an intrinsic tendency for the lateralization of its functions. For instance, the left hemisphere assists in the comprehension and motor expression of language. What remains uncertain is whether conscious processes are also more prevalent in one hemisphere of the brain than the other. The epistemic goal of this research was to address this particular issue. Materials and Methods. We observed the rare pathological event of proximal occlusion of the middle cerebral artery (MCA), which halts blood flow to the central two-thirds of a hemisphere, and examined its effects on consciousness. We aggregated individual scores for eyes-opening and limb-motor responses from the Glasgow Coma Scale (GCS) to determine the conscious level, and used brain computed tomography imaging to identify the whole-territory infarcts of MCA. Results. Being a rare condition, we managed to recruit 35 patients from two centers (average age: 64.54 ± 13 years, 45.71% females). Whole-territory infarcts of the MCA occurred more frequently in the left hemisphere (22 versus 13, frequency: 62.85%). Unconsciousness was also more common with left hemisphere infarctions (16 versus 2 unconscious patients of the right hemisphere, Frequency: 72%, GCS: 2/10=3/22 cases, GCS: 5/10=1/22 cases, GCS: 6-7/10=12/22 cases). The difference in unconsciousness proved significant in Fisher’s exact analysis (p-value = 0.001) and remained independent of age (p-value=0.7247) and gender (p-value=0.3145). Moreover, six conscious patients with left hemisphere involvement exhibited a loss of conscious control for normal responses, implying a strong link between consciousness and cognition. Unconsciousness also correlated with stroke outcomes (16 Unconscious: 56.25% deceased within the hospital). Conclusion. Conscious processes are more predominant in the brain\u27s left hemisphere. Our observations indicate that only a gross unilateral insult to the brain can lead to unconsciousness
Frequency of Tension-Type Headache in Patients with Migraine: A Single-Center Cross-Sectional Study
No full textABSTRACT Background and objective: Migraine is a common headache disorder characterized by recurrent episodes of moderate to severe headaches which are usually unilateral. Migraine is the second most common headache disorder after tension-type headache. The objective of this study was to determine the frequency of tension-type headache in patients with migraine. Methods: This cross-sectional study was carried out at Pakistan Institute of Medical Sciences, Islamabad for a period of six months between 1st July 2018 and 31st December 2018. This study enrolled patients above the age of 12 years that were diagnosed with “Migraine without aura” or “Migraine with aura”. The patients were subsequently asked for presence of features of tension-type headache. The criteria published by International Headache Society, ICHD-3 was used for making the diagnosis of migraine and tension-type headache. The data was analyzed using SPSS version 17. In the case of numerical variables, the mean and standard deviation were calculated. In the case of categorical variables, the frequency and percentage were calculated. All data were presented in tables and figures. Results: One-hundred-forty-two patients participated in the study. The age range was between 14 and 72 years. The mean age was 30.12 years. Female patients were 76.1 percent. Eighty patients were married, and 15.5 percent patients did not receive education; 72.5 percent patients were from urban background. Seventy-five (52.8%) patients had migraine with aura while 67 (47.2%) patients had migraine without aura. Twenty-nine (20.4%) patients of migraine had coexistent tension-type headache while 113 (79.6%) patients of migraine did not have tension-type headache. Conclusion: Tension type headache was an infrequent finding in our study population of migraine patients
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
No full textBackground: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.
Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.
Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.
Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population
