The positive color Doppler sign post biopsy: effectiveness of US-directed compression in achieving hemostasis

Background  

Percutaneous biopsies of soft-tissue organs are frequently performed using US guidance. US permits visualization of blood flow on color Doppler imaging.     

Fluid Levels in Pediatric Imaging: A Pictorial Review

Fluid levels appearances are not uncommon findings in different diagnostic modalities including radiography, ultrasound, computed tomography, and magnetic resonance imaging. The significance of such signs varies according to the involved sites and the clinical settings. Familiarity with their imaging features and their diagnostic value as well as their clinical implication are of paramount importance for the radiologist and the clinician. We aim to review a spectrum of examples of fluid levels encountered with different modalities in paediatric imaging and discuss their appearances and clinical significances.     

Early seizures in stroke – frequency,risk factors,and effect on patient outcomes in a tertiary center in Saudi Arabia

Objectives:To determine the frequency, risk factors, and outcomes of Early seizure (ES) after stroke in a Saudi cohort.Methods:A retrospective study was conducted in King Abdulaziz Medical City, Riyadh, KSA. All stroke patients whether they had first or recurrent stroke were included from February 2016 to December 2017. Data were analyzed using the SAS software version 9.4.Results:Out of 665 patients, 456 (68.6%) were males and 564 (85.2%) were Saudis; the cohort’s mean age was 60.6±12.6 years. Fifty-one (7.7%) patients had ES, which were more common in women (p=0.0123). Loss of consciousness (p=0.0402) and confusion (<0.0007) were associated with ES, whereas unilateral weakness (p=0.001) and unilateral numbness (p=0.0317) at presentation decreased the risk of ES. Vascular risk factors did not differ between patients with and without ES. Hemorrhagic stroke was associated with ES (p=0.0054), whereas patients with small vessel disease were less likely to develop ES (p=0.0013). Patients with ES had more severe stroke (NIHSS >5) (p=0.0139), more ICU admissions (49% vs. 26.2%; p=0.0005), longer length of hospital stay (44.9 days vs. 24.9 days; p=0.0018), higher rates of stroke-related complications (e.g. recurrent stroke, pulmonary embolism, hospital acquired infections, and need for tracheostomy and gastrostomy tube placement) (p≤0.0001), and were likely to be more severely disabled defined as mRS 3–5 at discharge (47.7% vs. 40.8%; p=0.0055) or to die in hospital (11.8% vs. 4.6%; p≤0.0001).Conclusion:The ES after stroke were common in our cohort. Increased stroke severity and confusion were independent predictors of ES. The ES were associated with higher rates of in-hospital complications, longer length of hospital stay, and worse outcomes at discharge.

Stroke is one of the common causes of symptomatic seizures in the elderly. Post-stroke seizures (PSS) are commonly classified into early seizures (ES) and late seizures (LS). ¹ No specific cut-off point that delineates ES has been agreed upon, but most studies arbitrarily define ES as those that occur within 7–14 days of incident stroke. ^1-2 The PSS occurring beyond this period are considered LS. The incidence rate for ES after stroke is not well established, although it has been reported to be 2%–33%. ^2,3 A recent meta-analysis has found that ES incidence after ischemic stroke is 3.3%, whereas the LS incidence rate was found to be 18 per 1000 person-years. ¹ A study investigating seizures that occurred within 24 h of stroke onset has found an incidence of 3.1% in more than 6,000 stroke patients. ³ Not all patients with PSS develop epilepsy. Approximately 2-4% of patients develop epilepsy after stroke. ⁴ Data on the risk factors for ES after stroke are inconsistent. In some studies, cardioembolic stroke, cortical location of stroke, hemorrhagic transformation of ischemic stroke, increased severity of stroke, and history of coronary artery disease or atrial fibrillation were found to be the predictors of ES after stroke. ^2,4-5 The ES after stroke are associated with increased morbidity and mortality, and can affect the functional independence of stroke patients, resulting in poorer quality of life, as well as in increased resource utilization. ^3-6 However, evidence-based data on PSS and guidelines on PSS management remain lacking. ⁶ The PSS are not uncommon and are broadly classified into ES and LS. Not all patients with ES develop post-stroke epilepsy. ⁶ The pathophysiological mechanisms underlying ES and LS are widely different. Having a specific time window to define ES from LS is crucial, as this may help in predicting post-stroke epilepsy. In the acute phase of stroke, ionic shifts, excitotoxicity neurotransmitters, metabolic dysfunction, and changes in coagulation cascade can all contribute to the early onset of seizure after an ischemic event. ^7-8 By contrast, LS results from persistent structural changes and gliosis that occur in the late phase of stroke, causing disruption in neuronal firing, circuit dysfunction, and eventually epileptogenic changes. ^7-8 The PSS has been studied in different populations; considering the observed variations in incidence, risk factors, and outcomes of PSS, we find it important to investigate this condition in the Saudi population. Our study aimed to determine the frequency of post stroke seizures in our population, and to identify the predictors of ES. It also looked at the outcome of these patients. To the best of our knowledge, this is the earliest study to report data on ES after stroke in a Saudi cohort, and it may be useful in planning future large-scale studies on ES prevention and management.     

Effect of Different Wax Pattern Manufacturing Techniques on the Marginal Fit of Lithium Disilicate Crowns

Purpose: The present study evaluated the marginal gap of lithium disilicate crowns fabricated through three different wax pattern techniques; Conventional, Milling and 3D-printing. Materials and Methods: Thirty stone models were replicated from a stainless-steel model representing a prepared tooth; ten were sent to make conventional wax patterns while the remaining were sent to a digital dental scanner. The computer aided design was completed and STL (Standard Tessellation Language) files were sent to either milling or 3D-printing machines. All wax patterns (n = 30) were pressed, and a stabilizing instrument was used to secure the crowns on the master model. The marginal gap was measured at 18 points for each crown using a digital microscope (µm) (n = 540) and compared using One-way ANOVA (p ≤ 0.05). Results: There was a significant difference in the marginal gap value between all three groups (p < 0.01) where the milled group showed the least mean gap (28.87 ± 30.18 µm), followed by 3D printed (47.85 ± 27.44 µm), while the highest mean marginal gap was found in the conventional group (63.49 ± 28.05 µm). Conclusion: Milled and 3D-printed wax patterns produced better fitting crowns compared to conventional techniques.     

Effect of bariatric surgery on cardiac function in obese patients: An echocardiographic assessment

Objectives:To analyze the clinical and echocardiographic changes in individuals with morbid obesity who underwent bariatric surgery.Methods:In total, 59 obese patients with body mass index >35 kg/m ² were prospectively enrolled. We assessed baseline pre-operative and a 6-month post-operative lipid profile, hemoglobin A1c, echocardiography, lifetime, and a 10-year risks of atherosclerotic disease for all patients.Results:The mean patients’ age was 37±12 years, with 40 (67.8%) women. We found that the pre-operative total cholesterol (4.2±1.1 vs. 4.4±1.1, p=0.014) and triglyceride levels (1.4±0.7 vs. 1.8±0.8, p<0.0001) were significantly lower than post-operative levels, while post-operative high-density lipoprotein levels were significantly higher (1.5±0.5 vs. 1.2±0.3, p<0.0001). The calculated 10-year risk of atherosclerotic cardiovascular disease was significantly lower post-operatively (1.1±1.6% vs. 1.6±1.8%, p<0.0001). Echocardiography follow-up revealed that diastolic dysfunction was more prevalent pre-operatively than that post-operatively (41% vs. 10%, p<0.0001). Post-operative left ventricular (LV) mass was significantly lesser than the pre-operative mass (168±252 g vs. 187±255 g, p=0.019), whereas the post-operative LV diastolic (46.5±7 mm vs. 38.5±18 mm, p=0.002) and systolic dimensions (31±5 mm vs. 25±11 mm, p=0.001) were significantly smaller.Conclusion:Bariatric surgery resulted in a significant amelioration in lipid profile, reduction in LV mass, and LV cavity dimensions.     

A New Zn(II) Metal Hybrid Material of 5-Nitrobenzimidazolium Organic Cation (C7H6N3O2)2[ZnCl4]: Elaboration,Structure, Hirshfeld Surface,Spectroscopic, Molecular Docking Analysis,Electric and Dielectric Properties

The slow solvent evaporation approach was used to create a single crystal of (C₇H₆N₃O₂)₂[ZnCl₄] at room temperature. Our compound has been investigated by single-crystal XRD which declares that the complex crystallizes in the monoclinic crystallographic system with the P2₁/c as a space group. The molecular arrangement of the compound can be described by slightly distorted tetrahedral ZnCl₄²⁻ anionic entities and 5-nitrobenzimidazolium as cations, linked together by different non-covalent interaction types (H-bonds, Cl…Cl, π…π and C–H…π). Hirshfeld’s surface study allows us to identify that the dominant contacts in the crystal building are H…Cl/Cl…H contacts (37.3%). FT-IR method was used to identify the different groups in (C₇H₆N₃O₂)₂[ZnCl₄]. Furthermore, impedance spectroscopy analysis in 393 ≤ T ≤ 438 K shows that the temperature dependence of DC conductivity follows Arrhenius’ law. The frequency–temperature dependence of AC conductivity for the studied sample shows one region (E_a = 2.75 eV). In order to determine modes of interactions of compound with double stranded DNA, molecular docking simulations were performed at molecular level.     

A meta‐analysis showing the effect of surgical site wound infections and associated risk factors in neonatal surgeries

A meta‐analysis was performed to assess the effect of surgical site wound infections and risk factors in neonates undergoing surgery. A systematic literature search up to January 2022 incorporated 17 trials involving 645 neonates who underwent surgery at the beginning of the trial; 198 of them had surgical site wound infections, and 447 were control for neonates. The statistical tools like the dichotomous or continuous method used within a random or fixed‐influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the risk factors and influence of surgical site wound infections in neonates undergoing surgery. Surgical site wound infections had significantly higher mortality with OR value 2.03 at 95% CI 1.40–2.95 with P‐value <0.001, the longer length of hospital stay (MD, 31.88; 95% CI, 18.17–45.59, P < 0.001), and lower birthweight of neonates (MD, −0.30; 95% CI, −0.53 to −0.07, P = 0.01) compared with neonates with no surgical site wound infections undergoing surgery. However, no remarkable change was observed with surgical site wound infections in the gestational age at birth of neonates (MD, −0.70; 95% CI, −1.46 to 0.05, P = 0.07), and the preoperative antibiotic prophylaxis (OR, 1.28; 95% CI, 0.57–2.87, P = 0.55) compared with no surgical site wound infections for neonates undergoing surgery. Surgical site wound infections had significantly higher mortality, a longer length of hospital stay, and lower birthweight of neonates. However, they had no statistically significant difference in the gestational age at birth of neonates and the preoperative antibiotic prophylaxis compared with no surgical site wound infections for neonates undergoing surgery. Furthermore, evidence is needed to confirm the outcomes.     

Validation of Various Prediction Scores for Cardiac Surgery-Associated Acute Kidney Injury

Background and objectivesFollowing cardiac surgery, acute kidney injury (AKI) is a well-known complication that increases morbidity and mortality. This study was carried out to determine the factors associated with acute kidney injury and to assess the predictive value of three predictive scores for the development of AKI post-cardiac surgery in the Saudi community.MethodsIn this retrospective study, the medical records of patients aged 18 years and above who underwent cardiac surgery on cardiopulmonary bypass (CPB) at Saud Albabtin Cardiac Center between January 2018 and March 2021 were reviewed. The first stage of both Kidney Disease Improving Global Outcomes (KDIGO) criteria and the risk, injury, failure, loss, end-stage (RIFLE) criteria were used to define AKI. The predicting value for acute kidney injury following cardiac surgery (AKICS score) and Renal replacement therapy for acute kidney injury (RRT-AKI) (Cleveland score, and SRI) were evaluated by area under receiver operating characteristic curve (AUROC) for the discrimination and Hosmer–Lemeshow test for the calibration.ResultsAmong the 329 patients evaluated, the total postoperative incidence of acute kidney injury was 26.4%. Moreover, the incidence of RRT-AKI was 2.1%. Using multivariate logistic analysis, the factors independently associated with AKI were CABG on pump-beating heart, presence of chronic kidney disease, pre-operative anemia, prolonged bypass time, and post-operative exposure to inotropes or vasopressors. For the prediction of CSA-AKI, the discrimination of AKICS (AUROC = 0.689) was poor, while the calibration (x2 = 9.380, P = 0.311) was fair. For RRT-AKI prediction, the discrimination of Cleveland score (AUROC = 0.717) was fair while the discrimination of SRI (AUROC = 0. 681) was poor. On the other hand, the calibration for both of them was fair (Cleveland score x2 = 3.339, P = 0.342; SRI x2 = 7.326, P = 0.120).ConclusionIn this single-center study, SRI score demonstrated a reasonably good prediction of RRT-AKI incidence. However, further researches are required to investigate the perioperative factors in order to create a unique risk score model that may be used in a population with widespread comorbidities.