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Krüger L, Kamp O, Alfen K, Theysohn J, Dudda M, Becker L. Pediatric Carotid Injury after Blunt Trauma and the Necessity of CT and CTA-A Narrative Literature Review. J Clin Med 2024; 13:3359. [PMID: 38929887 PMCID: PMC11203821 DOI: 10.3390/jcm13123359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Blunt carotid injury (BCI) in pediatric trauma is quite rare. Due to the low number of cases, only a few reports and studies have been conducted on this topic. This review will discuss how frequent BCI/blunt cerebrovascular injury (BCVI) on pediatric patients after blunt trauma is, what routine diagnostics looks like, if a computed tomography (CT)/computed tomography angiography (CTA) scan on pediatric patients after blunt trauma is always necessary and if there are any negative health effects. Methods: This narrative literature review includes reviews, systematic reviews, case reports and original studies in the English language between 1999 and 2020 that deal with pediatric blunt trauma and the diagnostics of BCI and BCVI. Furthermore, publications on the risk of radiation exposure for children were included in this study. For literature research, Medline (PubMed) and the Cochrane library were used. Results: Pediatric BCI/BCVI shows an overall incidence between 0.03 and 0.5% of confirmed BCI/BCVI cases due to pediatric blunt trauma. In total, 1.1-3.5% of pediatric blunt trauma patients underwent CTA to detect BCI/BCVI. Only 0.17-1.2% of all CTA scans show a positive diagnosis for BCI/BCVI. In children, the median volume CT dose index on a non-contrast head CT is 33 milligrays (mGy), whereas a computed tomography angiography needs at least 138 mGy. A cumulative dose of about 50 mGy almost triples the risk of leukemia, and a cumulative dose of about 60 mGy triples the risk of brain cancer. Conclusions: Given that a BCI/BCVI could have extensive neurological consequences for children, it is necessary to evaluate routine pediatric diagnostics after blunt trauma. CT and CTA are mostly used in routine BCI/BCVI diagnostics. However, since radiation exposure in children should be as low as reasonably achievable, it should be asked if other diagnostic methods could be used to identify risk groups. Trauma guidelines and clinical scores like the McGovern score are established BCI/BCVI screening options, as well as duplex ultrasound.
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Affiliation(s)
- Lukas Krüger
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, 45147 Essen, Germany; (L.K.); (O.K.)
| | - Oliver Kamp
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, 45147 Essen, Germany; (L.K.); (O.K.)
| | - Katharina Alfen
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine and Pediatric Neurology, University Hospital Essen, 45147 Essen, Germany;
| | - Jens Theysohn
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany;
| | - Marcel Dudda
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, 45147 Essen, Germany; (L.K.); (O.K.)
- Department of Orthopedics and Trauma Surgery, BG-Klinikum Duisburg, 47249 Duisburg, Germany
| | - Lars Becker
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, 45147 Essen, Germany; (L.K.); (O.K.)
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Wickbom F, Calcagnile O, Marklund N, Undén J. Validation of the Scandinavian guidelines for minor and moderate head trauma in children: protocol for a pragmatic, prospective, observational, multicentre cohort study. BMJ Open 2024; 14:e078622. [PMID: 38569695 PMCID: PMC11146355 DOI: 10.1136/bmjopen-2023-078622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Mild traumatic brain injury is common in children and it can be challenging to accurately identify those in need of urgent medical intervention. The Scandinavian guidelines for management of minor and moderate head trauma in children, the Scandinavian Neurotrauma Committee guideline 2016 (SNC16), were developed to aid in risk stratification and decision-making in Scandinavian emergency departments (EDs). This guideline has been validated externally with encouraging results, but internal validation in the intended healthcare system is warranted prior to broad clinical implementation. OBJECTIVE We aim to validate the diagnostic accuracy of the SNC16 to predict clinically important intracranial injuries (CIII) in paediatric patients suffering from blunt head trauma, assessed in EDs in Sweden and Norway. METHODS AND ANALYSIS This is a prospective, pragmatic, observational cohort study. Children (aged 0-17 years) with blunt head trauma, presenting with a Glasgow Coma Scale of 9-15 within 24 hours postinjury at an ED in 1 of the 16 participating hospitals, are eligible for inclusion. Included patients are assessed and managed according to the clinical management routines of each hospital. Data elements for risk stratification are collected in an electronic case report form by the examining doctor. The primary outcome is defined as CIII within 1 week of injury. Secondary outcomes of importance include traumatic CT findings, neurosurgery and 3-month outcome. Diagnostic accuracy of the SNC16 to predict endpoints will be assessed by point estimate and 95% CIs for sensitivity, specificity, likelihood ratio, negative predictive value and positive predictive value. ETHICS AND DISSEMINATION The study is approved by the ethical board in both Sweden and Norway. Results from this validation will be published in scientific journals, and a tailored development and implementation process will follow if the SNC16 is found safe and effective. TRIAL REGISTRATION NUMBER NCT05964764.
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Affiliation(s)
- Fredrik Wickbom
- Department of Clinical Sciences, Malmö, Lund University Faculty of Medicine, Lund, Sweden
- Department of Operation and Intensive Care, Halland Hospital Halmstad, Region Halland, Halmstad, Sweden
| | - Olga Calcagnile
- Department of Paediatric Medicine, Halland Hospital Halmstad, Halmstad, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences, Lund University, Lund University, Lund, Sweden
- Department of Neurosurgery, Skåne University Hospital Lund, Lund, Sweden
| | - Johan Undén
- Department of Operation and Intensive Care, Halland Hospital Halmstad, Region Halland, Halmstad, Sweden
- Lund University, Lund, Sweden
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Ma K, Dong Q. Association between sleep quality and benign prostate hyperplasia among middle-aged and older men in India. BMC Public Health 2023; 23:1147. [PMID: 37316942 DOI: 10.1186/s12889-023-15972-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The association between sleep quality and benign prostate hyperplasia (BPH) has rarely been studied. The aim of this study was to examine the relationship between sleep quality and BPH among middle-aged and older men in India. METHODS This study used data from men over 45 years old in Wave 1 (2017-2018) of the Longitudinal Aging Study in India (LASI). Benign prostate hyperplasia was self-reported, and sleep symptoms were assessed using five questions modified from the Jenkins Sleep Scale. A total of 30,909 male participants were finally included. Multivariate logistic regression analysis, subgroup analysis, and interaction tests were performed. RESULTS Total 453 (1.49%) men reported benign prostatic hyperplasia and have higher sleep quality score (9.25 ± 3.89 vs. 8.13 ± 3.46). The results revealed that the sleep quality score and risk of benign prostatic hyperplasia were significantly correlated after adjusting for all confounding factors (OR:1.057, 95% CI: 1.031-1.084, p < 0.001]. After dividing people into four groups based on the quartile of sleep quality scores, compared with the first quartile group, the third quartile group was 1.32 times, and the fourth quartile group was 1.615 times more likely to develop benign prostate hyperplasia. A significant interaction effect of alcohol consumption was observed. (p for interaction < 0.05). CONCLUSION Worse sleep quality was significantly associated with a higher incidence of benign prostatic hyperplasia among middle-aged and older Indian men. A further prospective study is needed to clarify this association and explore potential mechanisms.
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Affiliation(s)
- Kai Ma
- Department of Urology, institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Qiang Dong
- Department of Urology, institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China.
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Al Mukhtar A, Bergenfeldt H, Edelhamre M, Vedin T, Larsson PA, Öberg S. The epidemiology of and management of pediatric patients with head trauma: a hospital-based study from Southern Sweden. Scand J Trauma Resusc Emerg Med 2022; 30:67. [PMID: 36494828 PMCID: PMC9733190 DOI: 10.1186/s13049-022-01055-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a common cause of morbidity and mortality in children worldwide. In Scandinavia, the epidemiology of pediatric head trauma is poorly documented. This study aimed to investigate and compare the epidemiology and management of pediatric patients with isolated head trauma (IHT) and head trauma in connection with multitrauma (MHT). METHODS We conducted a retrospective review of medical records of patients < 18 years of age who attended any of the five emergency departments (ED) in Scania County in Sweden in 2016 due to head trauma. Clinical data of patients with IHT were analyzed and compared with those of patients with MHT. RESULTS We identified 5046 pediatric patients with head trauma, 4874 with IHT and 186 with MHT, yielding an incidence of ED visits due to head trauma of 1815/100,000 children/year. There was male predominance, and the median age was four years. Falls were the dominating trauma mechanism in IHT patients, while motor vehicle accidents dominated in MHT patients. The frequencies of CT head-scans, ward admissions and intracranial injuries (ICI) were 5.4%, 11.1% and 0.7%, respectively. Four patients (0.08%) required neurosurgical intervention. The relative risks for CT-scans and admissions to a hospital ward and ICI were 10, 4.5 and 19 times higher for MHT compared with IHT patients. CONCLUSION Head trauma is a common cause of ED visits in our study. Head-CTs and ICIs were less frequent than in previous studies. MHT patients had higher rates of CT-scans, admissions, and ICIs than IHT patients, suggesting that they are separate entities that should ideally be managed using different guidelines to optimize the use of CT-scans of the head.
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Affiliation(s)
- Ali Al Mukhtar
- grid.411843.b0000 0004 0623 9987Departments of Surgery, Skåne’s University Hospital, Carl-Bertil Laurells Gata 9, 214 28 Malmö, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Bergenfeldt
- grid.413823.f0000 0004 0624 046XHelsingborg Hospital, Helsingborg, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marcus Edelhamre
- grid.413823.f0000 0004 0624 046XHelsingborg Hospital, Helsingborg, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Tomas Vedin
- grid.411843.b0000 0004 0623 9987Departments of Surgery, Skåne’s University Hospital, Carl-Bertil Laurells Gata 9, 214 28 Malmö, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Per-Anders Larsson
- grid.416029.80000 0004 0624 0275Skaraborg Hospital, Skövde, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Stefan Öberg
- grid.413823.f0000 0004 0624 046XHelsingborg Hospital, Helsingborg, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Lund, Sweden
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Huang LY, Chiang CC, Li YL, Lai HY, Hsieh YC, Wu YH, Tsai YY. Corneal Complications after COVID-19 Vaccination: A Systemic Review. J Clin Med 2022; 11:jcm11226828. [PMID: 36431307 PMCID: PMC9698276 DOI: 10.3390/jcm11226828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Multiple vaccines are now being used across the world, and several studies have described cases of corneal graft rejection following the administration of the COVID-19 vaccine. The purpose of this article is to review the corneal adverse event that occurred following COVID-19 vaccine administration. The literature search was conducted in March 2022 using MEDLINE, PubMed, and the Cochrane Database of Systematic Reviews. A total of 27 articles, including 37 cases, have documented corneal adverse events that occurred following COVID-19 vaccination. The mean age was 60 ± 14.9 years (range, 27-83 years). The most common events were acute corneal graft rejection (n = 21, 56.8%), followed by herpes zoster ophthalmicus (n = 11, 29.7%) and herpes simplex keratitis (n = 2, 5.4%). The mean time from vaccination to the event was 10 ± 8.5 days (range, 1-42 days) after the first or second dose of vaccine. All patients with corneal graft rejection, immune-mediated keratolysis, and peripheral ulcerative keratitis (PUK) (n = 24, 64.9%) were managed topically with or without oral corticosteroids. Patients with herpes zoster ophthalmicus and herpes simplex keratitis were managed with oral antiviral agents. Two patients received penetrating keratoplasty due to keratolysis after invalid topical treatment. Disease resolution was noted in 29 patients (78.3%), whereas 3 (8.1%) had persistent corneal edema after graft rejection, 1 (2.7%) had corneal infiltration after HZO, and 4 (10.8%) were not mentioned in the articles. Corneal adverse events could occur after COVID-19 vaccination. After timely treatment with steroids or antiviral agents, most of the events were mild and had a good visual outcome. Administrating or increasing steroids before vaccination may be useful for the prevention of corneal graft rejection. However, the prophylactic use of antiviral treatments in patients with a herpes viral infection history is not recommend.
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Affiliation(s)
- Li-Ying Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Chun-Chi Chiang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406040, Taiwan
- Department of Optometry, Asia University, Taichung 413305, Taiwan
| | - You-Ling Li
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Hung-Yin Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Yi-Ching Hsieh
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Ying-Hsuen Wu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406040, Taiwan
- Department of Optometry, Asia University, Taichung 413305, Taiwan
- Correspondence: ; Tel.: +886-4-22052121 (ext. 1141); Fax: +886-4-22059265
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Pan L, Li Z, Li C, Dong X, Hidru TH, Liu F, Xia Y, Yang X, Zhong L, Liu Y. Stress hyperglycemia ratio and neutrophil to lymphocyte ratio are reliable predictors of new-onset atrial fibrillation in patients with acute myocardial infarction. Front Cardiovasc Med 2022; 9:1051078. [PMID: 36440053 PMCID: PMC9681791 DOI: 10.3389/fcvm.2022.1051078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The occurrence of new-onset atrial fibrillation (NOAF) post-acute myocardial infarction (AMI) is associated with worse outcomes. In this study, we sought to assess the predictive effect of stress hyperglycemia ratio (SHR) and neutrophil to lymphocyte ratio (NLR) to predict NOAF in patients with AMI. Materials and methods We recruited 3,194 individuals with AMI but free of atrial fibrillation (AF). AMI cases were stratified into groups according to SHR and NLR quartiles and were further categorized based on diabetes status. High SHR and high NLR were defined as the highest quartile of SHR and NLR. A nomogram incorporating risk factors for NOAF was constructed using multivariate logistic regression analyses. The performance of the novel nomogram was tested for predictive performance, agreement between the actual and predicted probability, and clinical utility using area under the curve (AUC), bootstrapped calibration curves, and decision curve analysis, respectively. Result A total of 245 (7.67%) patients developed NOAF post-AMI. The NOAF cases had higher values of SHR and NLR than non-NOAF patients after AMI regardless of diabetes status. After adjusting for potential confounders, high SHR and NLR were independently associated with NOAF post-AMI. Moreover, the novel nomogram incorporating high NLR and high SHR for NOAF risk estimation in patients with AMI showed satisfactory performance assessed by the AUC, calibration curves, decision curve analysis. Conclusion SHR and NLR were independently associated with NOAF in AMI patients. The constructed novel nomogram that incorporates SHR and NLR might assist in NOAF risk stratification post-AMI.
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Wu Z, Qian S, Zhao L, Zhang Z, Song C, Chen L, Gao H, Zhu W. Metabolomics-based study of the potential interventional effects of Xiao-Xu-Ming Decoction on cerebral ischemia/reperfusion rats. JOURNAL OF ETHNOPHARMACOLOGY 2022; 295:115379. [PMID: 35595221 DOI: 10.1016/j.jep.2022.115379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Xiao-Xu-Ming Decoction (XXMD) is a classical Chinese medicinal compound for the treatment of ischemic stroke, which has good efficacy in clinical studies and also plays a neuroprotective role in pharmacological studies. AIM OF THE STUDY The purpose of this study is to investigate the potential and integral interventional effects of XXMD on cerebral ischemia/reperfusion rat model. MATERIALS AND METHODS In this study, 1H NMR metabolomics was used, combined with neurological functional assessments, cerebral infarct area measurements, and pathological staining including Nissl staining, immunofluorescence staining of NeuN and TUNEL, and immunohistochemical staining of MCT2, to analyze the metabolic effects of XXMD in the treatment of an ischemia/reperfusion rat model. RESULTS It's observed that XXMD treatment could improve the neurological deficit scores and reduce the cerebral infarct areas on cerebral ischemia/reperfusion rat model. The pathological staining results performed that XXMD treatment could improve the decrease of Nissl bodies and the expression of NeuN and MCT2, reduce the high expression of TUNEL. In 1H NMR study, it revealed that the metabolic patterns among three experimental groups were different, the level of lactate, acetate, NAA, glutamate, and GABA were improved to varying degrees in different brain area. CONCLUSION Our findings indicated that XXMD has positive effect on neuroprotection and improvement of metabolism targeting cerebral ischemic injury in rats, which showed great potential for ischemic stroke.
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Affiliation(s)
- Ziqian Wu
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Wenzhou, China
| | - Shiyan Qian
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Liangcai Zhao
- Institute of Metabonomics & Medical NMR, School of Pharmaceutical Sciences, Wenzhou Medical University, China
| | - Zaiheng Zhang
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengcheng Song
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Wenzhou, China
| | - Ling Chen
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Wenzhou, China
| | - Hongchang Gao
- Institute of Metabonomics & Medical NMR, School of Pharmaceutical Sciences, Wenzhou Medical University, China.
| | - Wenzong Zhu
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Wenzhou, China.
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