Delayed Treatment of Acute Myocardial Infarction With Ventricular Septal Rupture Due to Patient Fear During the COVID-19 Pandemic

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.     

Head movements of children in MEG: quantification, effects on source estimation, and compensation

Head movements during magnetoencephalography (MEG) recordings may lead to inaccurate localization of brain activity. This can be particularly problematic for studies with children. We quantified head movements in 8- to 12-year-old children performing a cognitive task and examined how the movements affected source estimation. Each child was presented auditory word stimuli in five 4-min runs. The mean change in the MEG sensor locations during the experiment ranged from 3 to 26mm across subjects. The variation in the head position was largest in the up-down direction. The mean localization error in equivalent current dipole (ECD) simulations was 12mm for runs with the most head movement, with the frontal cortex appearing to be most prone to errors due to head movements. In addition, we examined the effect of head movements on two types of source estimates, ECDs and minimum-norm estimates (MNE), for an auditory evoked response. Application of a recently introduced signal space separation (SSS) method to compensate for the head movements was found to increase the goodness-of-fit of the ECDs, reduce the spatial confidence intervals of the ECDs, and enhance the peak amplitude in the MNE. These results are indicative of the SSS method being able to compensate for the spatial smoothing of the signals caused by head movements. Overall, the results suggest that MEG source estimates are relatively robust against head movements in children, and that confounds due to head movements can be successfully dealt with in MEG studies of developmental cognition.     

Range of movements of lower limb joints in cross-legged sitting posture

Cross-legged sitting posture is integral to activities of daily living in Eastern and Asian cultures. This posture has not been studied or defined in any significant detail from an orthopedic view point. The movements of right lower limb joints were measured in cross-legged sitting posture in 44 volunteers from the Indian population with no prior history of problems related to the knee or hip joint. Flexion at the hip joint ranged from 82 degrees to 100 degrees , with a mean of 91 degrees . Abduction at the hip joint ranged from 19 degrees to 57 degrees , with a mean of 39 degrees . The external rotation ranged from 42 degrees to 58 degrees , with a mean of 49 degrees . Flexion at the knee ranged from 126 degrees to 142 degrees , with a mean of 135 degrees .Equinus at the ankle ranged from 17 degrees to 34 degrees , with a mean of 29 degrees . The resultant data would be useful in understanding kinematics of the knee and hip in the healthy and post-total joint arthroplasty population. The data could be used for design features of prosthetic joints, surgical technique, and rehabilitation protocols. Such data have not been available hitherto in any relevant published literature.     

Associated comorbidities in psoriasis and inflammatory bowel disease

Background The association between psoriasis and inflammatory bowel disease (IBD) has been previously reported although a great deal remains unknown about associated comorbidities. Objectives The aim of this study was to examine comorbidities in individuals diagnosed with both psoriasis and IBD, and to compare those with individuals diagnosed with psoriasis‐only. We also looked at differences within the IBD group by clearly defining that cohort. Methods We included 146 patients diagnosed with both psoriasis and IBD and 146 controls diagnosed of psoriasis‐only without previous records of IBD, matched by gender, ethnicity and age (±5 years). Patients were obtained from the research patient data repository of Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital. Controls were obtained from the psoriatic arthritis and psoriasis follow‐up study (PAFS) at BWH. The comparison between the two groups included socio‐demographics, comorbidities and laboratory inflammation parameters. Results Compared to individuals with psoriasis‐only, patients with both psoriasis and IBD had significantly higher rates of autoimmune thyroiditis (2.1% vs. 6.8%), hepatitis (0.7 vs. 6.2%) and diabetes (11.0% vs. 26.7%). In addition, of the 146 patients with psoriasis and IBD, 60 (41.1%) were diagnosed with seronegative arthritis. The average C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of the last visits in our clinics were significantly elevated compared to the individuals with psoriasis‐only (ESR, 33.5 vs. 4.0 mm/h; CRP, 9.1 vs. 2.3 mg/L; both P‐values <0.0001). Conclusions We found that patients with both, psoriasis and IBD have a number of further associated comorbidities, some at significantly higher levels than individuals with psoriasis‐only. Common inflammatory pathways and genetic predispositions for specific patterns in the immune response may play an important role in the evolution of associated conditions.     

Melanotic neuroectodermal tumor of infancy: A narrative review of dental aspects

Melanotic neuroectodermal tumors of infancy (MNTI) are a rare type of benign tumor that affects the head and neck region. MNTI represents (68–80%) of the tumors in the maxillary region. This tumor is usually located in the alveolar crest, skull, mandible, and brain. Although this tumor is considered benign, it can grow rapidly, with a high risk of recurrence and interference with functions of infancy, such as feeding and breathing. It is also frequently harmful to the surrounding soft and hard tissues or adjacent sensitive vital structures. This study aimed to review the pathological, clinical presentation, and treatment of melanotic neuroectodermal tumors in infancy and the role of dentists in these cases.