Effect of Radiographic Contrast Media Shortage on Stroke Evaluation in the United States

BACKGROUND AND PURPOSE

We performed this study to identify the effect of the nationwide iodinated contrast media shortage due to reduction in GE Healthcare production, initiated on April 19, 2022, on the evaluation of patients with stroke.

MATERIALS AND METHODS

We analyzed the data on 72,514 patients who underwent imaging processed with commercial software in a sample of 399 hospitals in United States from February 28, 2022, through July 10, 2022. We quantified the percentage change in the daily number of CTAs and CTPs performed before and after April 19, 2022.

RESULTS

The daily counts of individual patients who underwent CTAs decreased (a 9.6% reduction, P = .002) from 1.584 studies per day per hospital to 1.433 studies per day per hospital. The daily counts of individual patients who underwent CTPs decreased (a 25.9% reduction, P = .003) from 0.484 studies per day per hospital to 0.358 studies per day per hospital. A significant reduction in CTPs using GE Healthcare contrast media (43.06%, P < .001) was seen but not in CTPs using non-GE Healthcare contrast media (increase by 2.93%, P = .29). The daily counts of individual patients with large-vessel occlusion decreased (a 7.69% reduction) from 0.124 per day per hospital to 0.114 per day per hospital.

CONCLUSIONS

Our analysis reported changes in the use of CTA and CTP in patients with acute ischemic stroke during the contrast media shortage. Further research needs to identify effective strategies to reduce the reliance on contrast media-based studies such as CTA and CTP without compromising patient outcomes.

Future scenarios of marine resources and ecosystem conditions in the Eastern Mediterranean under the impacts of fishing, alien species and sea warming

Using a temporal-dynamic calibrated Ecosim food web model, we assess the effects of future changes on marine resources and ecosystem conditions of the Israeli Mediterranean continental shelf. This region has been intensely invaded by Indo-Pacific species. The region is exposed to extreme environmental conditions, is subjected to high rates of climate change and has experienced intense fishing pressure. We test the impacts of a new set of fishing regulations currently being implemented, a continued increase in sea temperatures following IPCC projections, and a continued increase in alien species biomass. We first investigate the impacts of the stressors separately, and then we combine them to evaluate their cumulative effects. Our results show overall potential future benefits of fishing effort reductions, and detrimental impacts of increasing sea temperature and increasing biomass of alien species. Cumulative scenarios suggest that the beneficial effects of fisheries reduction may be dampened by the impact of increasing sea temperature and alien species when acting together. These results illustrate the importance of including stressors other than fisheries, such as climate change and biological invasions, in an ecosystem-based management approach. These results support the need for reducing local and regional stressors, such as fishing and biological invasions, in order to promote resilience to sea warming.

Integrative approach revises the frequently misidentified species of Sardinella (Clupeidae) of the Indo-West Pacific Ocean

To deal with the difficulties of species differentiation and delimitation among the commercially important sardines from the genus Sardinella, an integrative approach was adopted, incorporating traditional taxonomy with four DNA markers (coI, cytb, 16s and nuclear rag2). Combining these methodologies has enabled a thorough re-description of three of the most common species of Sardinella of the Indo-west Pacific Ocean: white sardinella Sardinella albella, fringescale sardinella Sardinella fimbriata and the goldstripe sardinella Sardinella gibbosa, as well as a description of a new species, Gon's sardinella Sardinella goni, from the island of Boracay, Philippines. In addition, extensive widespread sampling of S. gibbosa reveals a significant genetic separation between the populations from the western Indian Ocean and the west Pacific Ocean, despite no supporting morphological differentiation. An updated morphological key of the species of Sardinella of the Indo-west Pacific Ocean is also provided in order to minimize future misidentifications within these economically important taxa. Finally, the genetic and morphological variabilities within and between the investigated species are used to discuss their biogeographical distribution and possible processes of speciation.

Distribution and population structure of the alien Indo-Pacific Randall's threadfin bream Nemipterus randalli in the eastern Mediterranean Sea

As part of a comprehensive study of trawl fishery catch off Israel (Ashdod) and Turkey (Iskenderun and Antalya) conducted during 2008-2011, the population explosion of Nemipterus randalli, first recorded in the Mediterranean Sea in the beginning of 2005, was documented. The smallest individuals occurred on deeper bottoms (120 m), significantly more individuals were collected at night, and juvenile recruitment to the commercial fishery occurred during November and December at 40 m depth.

Intravenous immune globulin in multiple sclerosis: clinical and neuroradiological results and implications for possible mechanisms of action

Extensive evidence exists indicating that immunoregulatory mechanisms are involved in the pathogenesis of Multiple Sclerosis (MS). Several possible mechanisms by which intravenous immune globulin (IVIG) modulates the course of the disease are related to limiting the inflammatory process and repairing the damage by enhancing remyelination. Presently, the evidence for the effect of IVIG in MS is based on the results of small open trials, some of which have been encouraging. In the current study, the positive impact of IVIG treatment on arresting disease progression was evident by decreased brain Magnetic Resonance Imaging (MRI) scores of the lesion area. In an effort to extend these findings, the authors initiated a multicentre, prospective, randomized, double-blind, placebo-controlled study. The trial was designed to compare the efficacy of IVIG treatment with placebo in relapsing-remitting patients (ages 20-55 years) with definite MS, disease duration of 2-10 years and frequency of exacerbations 1-3/year during the 2 years prior to the study. Patients were examined monthly and brain MRI studies scheduled at entry, and after the first and second years of the trial. The primary endpoints included the number of acute exacerbations and neurological disability. The secondary endpoints included change in the MRI lesion burden, evaluated by the number and area of lesions. The trial ended in June 1995.

The role of percutaneous transhepatic cholecystostomy in the management of acute cholecystitis in high-risk patients

A method recently developed that may be an appropriate solution for high-risk patients with acute cholecystitis is percutaneous sonography-guided cholecystostomy. We report our experience in 10 high-risk elderly patients with clinical and sonographic diagnosis of acute cholecystitis. Immediate regression and resolution of septic symptoms was achieved in all cases. One patient was operated on as soon as his clinical condition stabilized, with uneventful postoperative recovery. The other nine were considered inoperable; of these, two were readmitted within a few months with recurrence of symptoms who underwent surgery, with a long and complicated postoperative course. The only complication we observed was temporary septicemia in one patient immediately after completion of the procedure. In view of these findings, we consider percutaneous transhepatic cholecystostomy an effective and safe method of treatment for acute cholecystitis in critically ill patients. However, this procedure should be regarded as a preliminary measure only, to render the patient more suitable for a formal cholecystectomy. We report our results and discuss technical and principal matters concerning percutaneous transhepatic cholecystostomy in the light of the current literature.

Medical students' contribution to the development of a smoke-free hospital policy in a university medical centre: a relevant learning experience

In a research methodology course, second-year medical students conducted a survey on 'Enforcing a Smoking Ban in the Soroka Medical Center: a Survey of Hospital Employees on Facilitating Factors and Obstacles'. They defined the study objectives and design, developed the study instrument, carried out the survey, coded and entered the data into mainframe computers, analysed the computer output, and prepared oral and written reports. The aims of the project were twofold: to survey employees' attitudes to a hospital smoking ban and to train medical students in the planning and conduct of a research project on public health or preventive medicine. Twelve students conducted a cross-sectional survey of 208 hospital employees (10% of the hospital staff). Employees were surveyed regarding smoking status, interest in quitting smoking, knowledge of the law banning smoking in public places, knowledge of the health effects of passive smoking, attitudes towards a hospital smoking ban and potential obstacles to its implementation. The students rated the course as excellent. They gained important research skills, as well as practical medical and public health experience through active participation in the design and execution of a study project with public health implications. At the first meeting of the hospital committee appointed to enforce a smoke-free hospital, the students' findings were reported in full, and their recommendations have guided policy decisions.

Primary progressive freezing gait

Freezing gait is an incapacitating symptom often observed in patients with Parkinson's disease. It has been less frequently described in association with multi-infarct state, multisystem atrophies, and normotensive hydrocephalus. In our movement disorder clinic, we have diagnosed (and followed up to 3 years; median, 16 months), 18 patients in whom progressive freezing gait was the sole neurological dysfunction. These 15 men and 3 women (aged 60-82 years; 74 +/- 6) were subjected to an extensive neurological workup that included clinical evaluation, videotaping for grading of gait disability, comprehensive blood and cerebrospinal fluid (CSF) analysis, and brain computed tomography (CT) and magnetic resonance imaging (MRI). Mean disease duration was 2.5 +/- 1.9 years (range, 0.5-6). Neurological examination disclosed freezing gait, often associated with varying degrees of postural instability. The degree of freezing gait ranged from sudden motor blocks only when confronted with obstacles to severe disability with total inability to start walking requiring a walker, massive assistance, or a wheelchair. However, patients could mimic gait movements with absolutely no freezing when seated or lying prone, and most of them could overcome arrests by the "walking-over-lines" maneuver. Otherwise, neurological examination was normal with no signs of bradykinesia, rigidity, or tremor. Blood chemistry and CSF analysis were normal. Brain CT and MRI were normal or showed mild cortical atrophy in 12 and putative lacunes in 6 patients. Therapy with levodopa or dopamine agonists was ineffective. During the follow-up period, a gradual progression of the freezing gait was observed. However, it remained unaccompanied by any other neurological findings.(ABSTRACT TRUNCATED AT 250 WORDS)

The Agonistic Behaviour of the Three Male Morphotypes of the Freshwater Prawn Macrobrachium Rosenbergii (Crustacea, Palaemonidae)

Abstract

The agonistic behaviour of the freshwater prawn, Macrobrachium rosenbergii, was studied in the laboratory. One hour long contests were conducted between prawns matched to size in each of the three sexually mature male morphotypes of this species; Small Males, Orange Clawed males and Blue Clawed males. An agonistic ethogram was established, consisting of 18 different acts. These acts were classified into indicators of dominance or subordinance following the application of cluster analysis. Prawns contests consisted usually of 3 phases: pre-escalated fighting phase, escalated fighting phase and post-escalated fighting phase. Contest phases differed both in the frequency of several acts and in the distribution of acts between the eventual winner and loser. In addition, the relative orientation and elevation of the opponents changed across phases. The inter and intra-individual sequences of acts of the winner and loser during the escalated fight were studied. Despite the similarity found in the behaviour of the two opponents during the escalated fighting, the eventual winner could be predicted by the relative number and duration of nips or by the relative number of times in which Complete and Incomplete-Lifting (two major displays of fight) were performed simultaneously with the snapping of the claws. Differences found among morphotypes pointed out a tendency of shifting from interactions with physical contact towards ritualized interactions without physical contact. This was correlated with the morphotypic developmental pathway and the concomitant increase of claw size.

[The diagnostic value of CT and MRI studies in brain-stem tumors]

The combination of lower cranial nerve palsy and contralateral motor impairment, presenting subacutely and following a progressive course in a child or young adult, suggests the possibility of brain-stem tumor. However, if the CT scan is normal, the diagnosis of multiple sclerosis or a vasculitis is frequently considered. Since CT scans may miss lower brain-stem tumors, MRI is recommended as the definitive diagnostic test in such cases.

Hepatic infarction in a patient with the lupus anticoagulant

We describe a 31-year-old patient with missed abortion, thrombocytopenia, and clinical, laboratory, and radiologic evidence of hepatic infarction. On evaluation, she was found to have the lupus anticoagulant. The association between enhanced thrombosis and the lupus anticoagulant is discussed, and previously reported thrombotic complications are described. The etiology, clinical course, and radiologic features of liver infarction are summarized, and the importance of recognizing and treating this form of hypercoagulability is stressed. To our knowledge, this is the first description of liver infarction associated with the lupus anticoagulant.

Washington University Case Conference. Multiple myeloma and hypercalcemia?

We present a case of multiple myeloma with high values for total calcium. The case discussion focuses on the role of the laboratory in diagnosis and monitoring of multiple myeloma and on the causes of the associated hypercalcemia. We present evidence for calcium binding to the paraprotein as a cause for the "hypercalcemia" in this case and we document a difference in the results for total calcium among various methods when this patient's serum was analyzed.

Washington University Case Conference. Multiple myeloma and hypercalcemia?

We present a case of multiple myeloma with high values for total calcium. The case discussion focuses on the role of the laboratory in diagnosis and monitoring of multiple myeloma and on the causes of the associated hypercalcemia. We present evidence for calcium binding to the paraprotein as a cause for the "hypercalcemia" in this case and we document a difference in the results for total calcium among various methods when this patient's serum was analyzed.