Publications by authors named "Omar Hussein"

26 Publications

  • Page 1 of 1

Ipsilateral Vocal Cord Paralysis After Acute Anterior Ischemic Stroke.

Perm J 2020 Dec;25

Department of Neurology, The New Mexico University Health Sciences Center, Albuquerque, NM.

Introduction: The vocal cord is innervated by the recurrent laryngeal nerve and the superior laryngeal nerve, which are branches of the vagus nerve. The nucleus ambiguous is a motor nucleus of the vagus nerve and it is located in the medulla. It receives supratentorial upper motor regulatory fibers. Commonly, this regulation is bilaterally represented in the brain. Less commonly, it is contralaterally represented. This case describes a rare presentation.

Case Presentation: We present a female patient in her early sixties with a past medical history significant for hypertension who presented with acute right-sided weakness and expressive aphasia (National Institutes of Health Stroke Scale = 20). Computed tomography (CT)-head was unremarkable but she was outside the window for chemical thrombolytic therapy. CT-angiogram revealed occlusion of the left extracranial and intracranial internal carotid artery and, thus, she was deemed not a candidate for mechanical thrombectomy. CT-perfusion scans (Rapid software) showed a large penumbra within the respective vascular territory affected including the operculum and the insula. The core infarction was relatively small and located in the left basal ganglia. After inducing therapeutic hypertension, the patient's aphasia improved. Surprisingly, this unmasked a moderate to severe hypophonic voice. The patient underwent flexible fiberoptic laryngoscopy which showed a paralyzed left vocal cord but without signs of inflammation.

Conclusion: Our case is a rare case of transient ipsilateral vocal cord paralysis associated with anterior unilateral cerebral ischemia. The paralysis resolved with improvement of the cerebral ischemic penumbra.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7812/TPP/20.104DOI Listing
December 2020

A new strain of Taylorella asinigenitalis shows differing pathogenicity in mares and Jenny donkeys.

Equine Vet J 2020 Nov 10. Epub 2020 Nov 10.

ANSES, Laboratory for Animal Health in Normandy, Physiopathology and Epidemiology of Equine Diseases Unit, Goustranville, France.

Background: Three horse mares inadvertently inseminated with semen from a Tayorella asinigenitalis-positive Jack donkey developed severe, purulent endometritis whereas two Jenny donkeys mated naturally to the same Jack donkey did not develop clinical signs of infection.

Objectives: To isolate and identify the causative agent.

Study Design: Case report.

Methods: Endometrial swabs from the infected mares were cultured on selective and non-selective media under aerobic and microaerophilic conditions. Isolates were subjected to Gram staining, oxidase and catalase tests, the Monotayl Latex Agglutination test and PCR to test for both T. equigenitalis and T. asinigenitalis. In vitro antimicrobial susceptibility testing was performed and the bacterial isolate was genotyped using MLST.

Results: A new sequence type of T. asinigenitalis was confirmed.

Main Limitations: A limited numbers of mares and donkeys are described.

Conclusions: This strain of T. asinigenitalis causes a severe venereal infection in mares but not in Jenny donkeys.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/evj.13382DOI Listing
November 2020

Lorazepam timing for acute convulsive seizure control (LoTASC).

Seizure 2020 Dec 6;83:41-47. Epub 2020 Oct 6.

The Ohio State University, Wexner Medical Center, Department of Neurology, United States. Electronic address:

Introduction: Guidelines specify early administration of benzodiazepines (BZD) for the management of convulsive status epilepticus. The distinction between acute convulsive seizure and status epilepticus can be misconstrued resulting in BZD administration prior to a patient meeting criteria of status epilepticus. Early BZD administration may theoretically lead to systemic vital instability. Our study aims to assess if administering lorazepam, for convulsive seizures <5 min, causes vital instability.

Methods: This is a retrospective study analyzing patients who presented with a seizure lasting <5 min between 2011 and 2016. Continuous variables of lorazepam receivers versus non- receivers were analyzed using t-test for parametric and Mann-Whitney U test for nonparametric data. Categorical variables were analyzed using Chi-Square Test. Subsequently, subjects were analyzed through univariate and multivariate regression models to determine predictors of vital instability.

Results: Out of 1052 subjects initially screened, 165 were included. Of these, 91 (55 %) received lorazepam, and 74 (45 %) did not. Through univariate and multivariate analyses, there was a significantly higher incidence of vital instability (defined as receipt of a vasopressor or intubation) in patients who received lorazepam (OR = 6.76, 95 % CI = 1.48, 30.95) (p = 0.014). This was dose-dependent (p < 0.0001). It was responsible for 22.5 % of the vital instability. Lorazepam administration significantly prolonged the intensive care unit (ICU) length of stay (0 days [IQR 0 - 0] vs [IQR 0-2.3]; p = 0.038).

Conclusion: Our study suggests that lorazepam administration for acute convulsive seizures not meeting convulsive status epilepticus criteria may lead to iatrogenic vital instability and need for ICU admission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.seizure.2020.09.024DOI Listing
December 2020

Relative Alpha Variability Changes Precede Alpha-Delta Ratio Changes in Cerebral Ischemia.

Authors:
Omar Hussein

J Stroke Cerebrovasc Dis 2020 Nov 2;29(11):105262. Epub 2020 Sep 2.

University of New Mexico Hospitals - Department of Neurology; MSC10 5620, Albuquerque, NM 87131, U.S.A.. Electronic address:

The utility of quantitative EEG in early detection of cerebral ischemia is still underappreciated in clinical practice. We present a case of aneurysmal subarachnoid hemorrhage complicated by vasospasm as detected by the cerebral angiogram. The patient was being monitored on electroencephalogram. It showed early signs of cerebral ischemia represented by decline in the Alpha-Delta-Ratio (ADR) and the Relative-Alpha-Variability (RAV). Surprisingly, the RAV changes preceded the ADR changes. This is a significant finding that can also apply to early reocclusion or reperfusion injuries after mechanical thrombectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105262DOI Listing
November 2020

Covid-19 systemic infection exacerbates pre-existing acute disseminated encephalomyelitis (ADEM).

J Neuroimmunol 2020 12 25;349:577405. Epub 2020 Sep 25.

University of New Mexcio Hospitals, Department of Neurology, MSC10 5620, Albuquerque, NM 87131, USA. Electronic address:

Acute disseminated encephalomyelitis (ADEM) is an uncommon diagnosis in adults. It is known to be due to an abnormal immune response to a systemic infection rather than direct viral invasion to the central nervous system. There have been few reports of ADEM diagnosed in the setting of COVID-19 systemic infection. However, we report a case of Coxsackie induced ADEM that remitted but got exacerbated by COVID-19 infection. The patient contracted the COVID-19 infection shortly after being discharged to a rehabilitation facility. Direct COVID-19 neuroinvasion was ruled out via CSF PCR testing for the virus. The patient responded well to pulse steroid therapy and plasmapheresis in both occasions. We hypothesize that COVID-19 infection can flare-up a recently remitted ADEM via altering the immune responses. It is known now that COVID-19 infection can produce cytokine storming. Cytokine pathway activation is known to be involved in the pathology of ADEM. Caution regarding discharging immune suppressed patient to the inpatient rehabilitation facility should be made in the era of COVID-19 pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jneuroim.2020.577405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518115PMC
December 2020

Role of Non-Perfusion Factors in Mildly Symptomatic Large Vessel Occlusion Stroke.

J Stroke Cerebrovasc Dis 2020 Oct 30;29(10):105172. Epub 2020 Jul 30.

The Ohio State University Wexner Medical Center, Department of Neurology, 410 W 10th Ave, Columbus, USA.

Introduction: Uncertainty regarding reperfusion of mildly-symptomatic (minor) large vessel occlusion (LVO)-strokes exists. Recently, benefits from reperfusion were suggested. However, there is still no strong data to support this. Furthermore, a proportion of those patients don't improve even after non-hemorrhagic reperfusion. Our study evaluated whether or not non-perfusion factors account for such persistent deconditioning.

Methods: Patients with identified minor LVO-strokes (NIHSS ≤ 8) from our stroke alert registry between January-2016 and May-2018 were included. Variables/ predictors of outcome were tested using univariate/multivariate logistic and linear regression analyses. Three month-modified ranking scale (mRS) was used to differentiate between favorable (mRS = 0-2) and unfavorable outcomes (mRS = 3-6).

Results: Eighty-one patients were included. Significant differences between the two outcome groups regarding admission-NIHSS and discharge-NIHSS existed (OR = 0.47, 0.49 / p = 0.0005, <0.0001 respectively).The two groups had matching perfusion measures. In the poor outcome group, discharge-NIHSS was unchanged from the admission-NIHSS while in the good outcome group, discharge-NIHSS significantly improved.

Conclusion: Admission and discharge NIHSS are independent predictors of outcome in patients with minor-LVO strokes. Unchanged discharge-NIHSS predicts worse outcomes while improved discharge-NIHSS predicts good outcomes. Unchanged NIHSS in the poor outcome group was independent of the perfusion parameters. In literature, complement activation and pro-inflammatory responses to ischemia might account for the progression of stroke symptoms in major-strokes. Our study concludes similar phenomena might be present in minor-strokes. Therefore, discharge-NIHSS may be useful as a clinical marker for future therapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105172DOI Listing
October 2020

Pearls & Oy-sters: Rapid progression of prion disease associated with transverse myelitis: A rare presentation.

Neurology 2020 04 12;94(15):e1670-e1672. Epub 2020 Mar 12.

From the Department of Neurology (O.H., A.A.E.), University of New Mexico Hospitals, Albuquerque; Department of Neurology (Z.J.), The Ohio State University Wexner Medical Center, Columbus; and Department of Neurology (A.S.), University of Michigan, Ann Arbor.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000009257DOI Listing
April 2020

Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study.

J Cardiovasc Comput Tomogr 2020 Sep - Oct;14(5):400-406. Epub 2020 Jan 30.

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.

Background And Aims: Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex.

Methods: The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAV) in mm [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAV were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed.

Results: The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAV, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAV) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAV (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex.

Conclusions: PAV was less affected by patient's body surface area then PV and TAV and may be the preferred method to report coronary atherosclerotic burden.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcct.2020.01.012DOI Listing
October 2020

Characteristics of diabetes diagnosis and control in toddlers and preschoolers from families with limited resources: A single center experience.

Diabetes Res Clin Pract 2020 Jan 2;159:107966. Epub 2019 Dec 2.

The General Pediatric Department, Children's Hospital, Cairo University, Cairo, Egypt.

Aim: To describe the characteristics of diabetes diagnosis, insulin therapy regarding type, dose and frequency also the degree of glycemic control achieved in toddlers and preschoolers coming from families with limited resources.

Methods: Over one year, 69 toddlers and preschoolers clinically diagnosed as type 1 diabetes were included. Data related to presentation at diagnosis, insulin therapy and glycemic control was reviewed from patients' care givers and medical records.

Results: Diabetic ketoacidosis (DKA) was recorded in 71% of the children at initial diagnosis. The mean time since diabetes diagnosis was 2 ± 1 years. Most of children (65/69, 94%) were on basal-bolus regimen while four (6%) were on basal insulin only. NPH and long acting analogues were used as basal insulin in (74%) and (26%). Regular insulin and rapid acting analogues were used as bolus insulin (27%) and (73%).The mean frequency of daily self monitoring of blood glucose was (2.9 ± 1). The arithmetic mean of HbA1c done over past 6 months to one year before inclusion in the study was 8.2 ± 1.5% (66 ± 12 mmol/mol) with 65% having HbA1c ≥ 7.5% (≥58 mmol/mol).

Conclusion: Toddlers and preschoolers with diabetes coming from families with limited resources frequently present with DKA at diagnosis and have suboptimal self-monitoring of blood glucose and glycemic control. NPH is more commonly used in this age group, combined with postprandial rapid analogues and less commonly preprandial regular insulin and that yields more favorable HbA1c but with a greater risk of hypoglycemia. The most common cause of hospital readmission was ketoacidosis and uncontrolled hyperglycemia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.diabres.2019.107966DOI Listing
January 2020

Intraosseous Administration of Hypertonic Saline in Acute Brain-Injured Patients: A Prospective Case Series and Literature Review.

Neurologist 2019 Nov;24(6):176-179

Neurocritical Care Unit, Ohio State University Wexner Medical Center, Columbus, OH.

Background: Central venous catheters are often used to administer hypertonic saline (HTS) but might be associated with serious complications. Intraosseous (IO) access is an alternative method of medication and fluid delivery which is not associated with life-threatening complications and can be inserted faster than CVCs.

Methods: A prospective case series was conducted on critically ill neurological patients that did not have central venous access, and for whom 3% HTS was indicated. Nonverbal indicators of pain were measured using the critical care pain observation tool. The pain score and serum sodium levels were collected at baseline, at 2, 6, 12, 18, and 24 hours after administration of 3% HTS using IO access. The area surrounding the IO insertion site was monitored for needle placement, extravasation, and tissue damage.

Results: Five patients were enrolled. Three had an IO placed in the proximal humerus and 2 in the proximal tibia. Most patients did not have nonverbal indicators of pain during insertion and initial bolus. Serum sodium levels increased appropriately, as determined by the care providers. There were no cases of device dislodgement, extravasation, infection, soft tissue injury, or other local complications.

Conclusions: In this prospective case series, IO administration of 3% HTS was feasible, well-tolerated on the basis of nonverbal indicators of pain in the majority of patients and resulted in an appropriate rise in serum sodium levels. IO fills a niche among vascular access options for HTS, in emergent neurological situations when central venous access is not readily available or peripheral intravenous access is difficult to obtain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/NRL.0000000000000248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839785PMC
November 2019

Acute Convulsive Seizures: When is It Too Early to Treat?

Authors:
Omar Hussein

Perm J 2019 ;23

Department of Neurology-Division of Neurocritical Care and Neurophysiology, the Ohio State University Wexner Medical Center, Columbus.

Acute convulsive seizures are overwhelming events that require immediate attention from clinicians and practitioners, especially when witnessed in a hospital setting. Adequate management of inpatient-witnessed seizures lies in understanding the time-related pathophysiologic stages of the seizure. The anatomical location of the seizure origin is as important as seizure stage but might not be easy to determine in the acute setting, especially if the seizure is nonfocal. Although investigating and treating the cause of a seizure has high priority, understanding the interplay between the pathophysiologic responses and the various bodily responses are crucial in treatment. This interplay has interesting dynamics that change within minutes. Knowing such dynamics allows clinicians and practitioners to choose their best treatment options in the best time interval when a seizure occurs in an acute care facility. Our commentary provides an overview of such dynamics and how they can change the misconceptions that many clinicians and practitioners have in dealing with an acute convulsive seizure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7812/TPP/18-129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499112PMC
February 2020

Ga-PSMA-11 PET/CT in newly diagnosed prostate cancer: diagnostic sensitivity and interobserver agreement.

Abdom Radiol (NY) 2019 07;44(7):2545-2556

Department of Pathology, Zagazig University, Zagazig, Egypt.

Purpose: To determine the diagnostic sensitivity and interobserver agreement of Gallium 68-prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-PSMA-11 PET/CT) imaging for diagnosis and staging of patients with newly diagnosed prostate cancer (PC).

Materials And Methods: One hundred and seventy-three men (mean age, 68 ± 7.7 years; range 46-84 years) with newly diagnosed, untreated PC were enrolled in this prospective study between January 2017 and August 2018. All patients underwent a Ga-PSMA-11 PET/CT examination. For each patient, we determined the disease stage, the Gleason score, and the maximum standardized uptake value (SUVmax) for primary prostatic tumor and extraprostatic metastases. The diagnostic sensitivity and interobserver agreement of Ga-PSMA-11 PET/CT for diagnosis and staging of PC were established by histopathology as the reference standard.

Results: Ga-PSMA-11 PET/CT examinations were interpreted as positive for PC in 166 of 173 patients (101 patients had primary prostatic tumor only, two patients had extraprostatic metastases only and 63 patients had combined lesions). The sensitivity of Ga-PSMA-11 PET/CT examination in the diagnosis of PC was 96%. Ga-PSMA-11 PET/CT produced a significant change of stage in 28.6% patients with an upstage in 17.9% patients and a downstage in 10.7% patients. The interobserver agreements were almost good to perfect (k = 0.63-0.89) for visual image interpretation, SUVmax measurement, and tumor staging.

Conclusion: Ga-PSMA-11 PET/CT is a valuable tool with high diagnostic sensitivity (96%) and high reproducibility for diagnosis and staging of patients with newly diagnosed PC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00261-019-02006-2DOI Listing
July 2019

The Significance of Contrast Density of the Computed Tomography-Angiographic Spot Sign and its Correlation with Hematoma Expansion.

J Stroke Cerebrovasc Dis 2019 Jun 1;28(6):1474-1482. Epub 2019 Apr 1.

The Ohio State University Wexner Medical Center, Department of Neurology - Cerebrovascular and Neurocritical Care Division, Columbus, Ohio, USA.

Background And Purpose: The computed tomography angiographic (CTA) spot sign has been shown to predict hematoma expansion in patients with intracranial hemorrhage (ICH), but the significance of the spot sign density (SSD) and the spot sign ratio (SSR) has not yet been explored.

Methods: Using the institutional Neurocritical care and Stroke registry, we retrospectively reviewed patients with ICH from January-2013 to June-2017. We selected patients who had baseline CT-head (CTH), CTA with positive-spot sign within 6 hours of last known well and at least one follow-up CTH within 24 hours. Baseline demographics and variables known to affect hematoma-volume were collected. Hematoma-volumes and SSR were calculated using computer-assisted 3D-volumetric measurement and the average of the surrounding hematoma density divided by the SSD, respectively. The 2-sample t test and the area-under-the-curve (receiver operating characteristic) were used to detect the association between hematoma expansion and outcome at discharge.

Results: A total of 320 patients were reviewed; 22 met the inclusion criteria. Significant hematoma expansion (volume expansion ≥12.5 cc or ≥33% compared to baseline) was noted in 14 (64%) subjects. SSD was significantly higher in subjects with hematoma expansion (216 ± 66) than those without (155 ± 52, P = .036). With a cut-off SSD of ≥150 HU, we had sensitivity of 86% and specificity of 75%. For SSR, lower ratios suggested a trend toward hematoma expansion, although it was not statistically significant (P = .12). There was no significant correlation between SSD or SSR and modified ranking scale at discharge and after 3-6 months.

Conclusion: SSD might be a good predictor of hematoma growth. Although SSR showed a trend toward expansion, results were not statistically significant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.020DOI Listing
June 2019

Role of Magnetic Resonance Imaging in Diagnosis of Motor Neuron Disease: Literature Review and Two Case Illustrations.

Perm J 2019 ;23

Department of Neurology, Ohio State University Wexner Medical Center, Columbus.

Motor neuron diseases (MNDs) are a group of devastating neurologic disorders that cause specific damage to the motor neuron cells. The current diagnosis of MND is based on results of the clinical examination and neurophysiologic studies. The length of time of referral to a neuromuscular neurologist and the lack of validated diagnostic criteria can delay diagnosis. Although the role of imaging is currently most useful in excluding other conditions, several attempts to incorporate neuroimaging in the diagnosis of the disease and assessment of progression have shown promising results.We conducted a literature review via searches in PubMed and The Cochrane Database using multiple relevant terms to the topic. Two cases with a challenging diagnosis of MND are described, with a thorough discussion of how the diagnosis was suggested on the basis of magnetic resonance imaging evidence in each case. Advanced magnetic resonance imaging findings can be useful tools that add to the diagnostic criteria of MNDs, especially in cases where reaching a definitive diagnosis is difficult. Such findings might enable clinicians to reach an early diagnosis that can improve the patient's quality of life and prolong survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7812/TPP/18-131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380476PMC
September 2019

The intraventricular-spot sign: prevalence, significance, and relation to hematoma expansion and outcomes.

J Neurol 2018 Oct 16;265(10):2201-2210. Epub 2018 Jul 16.

Cerebrovascular and Neurocritical Care Division, Department of Neurology, The Ohio State University Wexner Medical Center, 333 West 10 Avenue, Graves Hall, Columbus, OH, 43210, USA.

Background: The presence of the spot sign on computed tomography angiogram (CTA) is considered a sign of active bleeding, and studies have shown it can predict hematoma expansion in intraparenchymal hemorrhage (IPH). The spot sign in intraventricular hemorrhage (IVH) has not been explored yet. The purpose of this study is to estimate the prevalence of the intraventricular-spot sign, and its prediction of hematoma expansion and clinical outcomes.

Methods: We retrieved data of hemorrhagic stroke patients seen at our medical center from January 2013 to January 2018. A total of 321 subjects were filtered for the prevalence analysis (PA). We further excluded 114 subjects without a follow-up CT-head for the hematoma expansion analysis (HEA). Patients were grouped based on the location of hemorrhage into three groups: isolated IPH with the spot sign always in IPH (i-IPH), isolated IVH with the spot sign always in IVH (i-IVH), and combined IPH and IVH which would be further sub-grouped according to the location of the spot sign: in IPH only (IPH+/IVH) and in IVH only (IPH/IVH+). The prevalence, demographics, and incidence of hematoma expansion were compared between the groups using Pearson's chi-square test and Student's t test.

Results: The prevalence of the spot sign was 8, 20, 17, 5% in (i-IPH), (i-IVH), (IPH+/IVH), and (IPH/IVH+) groups, respectively. The rate of hematoma expansion were (42 vs. 13%), (33 vs. 31%), (80 vs. 22%), and (25 vs. 22%) in spot sign positive vs. negative subjects in each group, respectively (p values = 0.023, = 1, <0.001, and = 1).

Conclusion: We studied the prediction of spot sign on hematoma expansion and clinical outcomes in the different subtypes of ICH. Our study showed that spot sign is a good predictor in IPH but not IVH. Despite the rarity of IVH; the prevalence of spot sign was higher in IVH than IPH. This might be due to anatomical and physiological variations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00415-018-8975-8DOI Listing
October 2018

Clinical and epidemiological studies on screwworm infestation in Qassim region, Saudi Arabia.

Trop Biomed 2017 Dec;34(4):936-943

Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Saudi Arabia. P.O Box 6622, Saudi Arabia.

A prevalence study of skin myiasis in small ruminants was carried over a one year period. Animals, which were admitted to the Veterinary Teaching Hospital of Qassim region, Saudi Arabia, were examined for wound myiasis and the larvae collected were identified as Chrysomyia bezziana. Prevalence of 13.0% and 10.0% were recorded in sheep and goats respectively. Sites of infestation, gender and age were concerned during the investigation. Fixed flocks (animals reared completely indoors) showed higher prevalence than semi-fixed ones particularly in winter. No cases of myiasis was observed during summer. Female animals were more significantly infested (p = 0.0001) than males, age seems to have no role with infestation rates. Surgical and medicinal intervention were successfully carried out and recommendations were given to avoid repeated infestation.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2017

Hyperpyrexia as the Presenting Symptom of Intracranial Hypotension.

Neurocrit Care 2018 06;28(3):395-399

Cerebrovascular and Neurocritical Care Division, Department of Neurology, Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 7th Floor, Columbus, OH, 43210, USA.

Introduction: Hyperpyrexia is a severely elevated core body temperature secondary to an elevated hypothalamic set thermo-regulatory threshold. Hyperthermia is an elevated core body temperature beyond the normal hypothalamic set thermo-regulatory threshold. Intracranial hypotension can present with a wide variety of symptoms ranging from orthostatic headache up to coma. We report a rare case of hyperpyrexia associated with intracranial hypotension.

Methods: A case report of a 55-year-old female patient with a history of angiogram-negative subarachnoid hemorrhage status post-ventriculoperitoneal (VP) shunt placement six years prior to admission who suddenly developed encephalopathy and high fever. Conventional management of the fever was unsuccessful.

Results And Management: Brain magnetic resonance imaging revealed signs of significant intracranial hypotension. When the VP shunt was tapped, no cerebrospinal fluid (CSF) could be obtained. Once the VP shunt settings were adjusted, the patient's encephalopathy and hyperpyrexia resolved.

Conclusion: Hyperpyrexia might be a presenting symptom of intracranial hypotension, likely, secondary to hypothalamic dysfunction and compression. In our case, hyperpyrexia was reversible as the intracranial hypotension was emergently treated. Spontaneous intracranial hypotension might be difficult to diagnose, especially if it presented with non-classical symptoms like fever; thus, physicians should be aware of such association.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12028-017-0481-9DOI Listing
June 2018

Gentamicin- and Ciprofloxacin-Resistant Enterobacteriaceae in Cattle Farms in Israel: Risk Factors for Carriage and the Effect of Microbiological Methodology on the Measured Prevalence.

Microb Drug Resist 2017 Jul 9;23(5):660-665. Epub 2016 Nov 9.

1 National Center for Infection Control , Ministry of Health, Tel-Aviv, Israel .

Our objectives were to establish a methodology for surveillance of ciprofloxacin-resistant Enterobacteriaceae and gentamicin-resistant Enterobacteriaceae (CPRE and GNRE, respectively) in cattle and to study the prevalence and risk factors for carriage of these bacteria in a national survey. This was a point prevalence study conducted from July to October 2013 in Israel. Stool samples were collected from 1,226 cows in 123 sections of 40 farms of all production types. The number of CPRE- and GNRE-positive cows was highest in quarantine stations and fattening farms and was lowest in pasture farms (p < 0.01). The number of CPRE- and GNRE-positive cows was lowest in dairy farm sections containing adult cows (>25 months) and highest in calves (<4 months) (p < 0.001). In bivariate analysis, other variables that were significant risk factors for CPRE and GNRE carriage included fewer troughs, crowding, lack of manure cleaning, and recent arrival of new calves. Antimicrobial prophylaxis was given almost exclusively to calves and was associated with a higher prevalence of carriers (p < 0.001). Compared to the use of nonselective media (MacConkey agar alone), the use of selective media (MacConkey agar with 10 μg/ml of ciprofloxacin or 5 μg/ml of gentamicin) increased the sensitivity of screening for CPRE and GNRE by 6.6- and 13.5-fold, respectively. CPRE and GNRE were identified in 609 (49.7%) and 840 (68.5%) samples, respectively. This study provides novel data regarding both the epidemiology of CPRE and GNRE carriage in livestock and the microbiological methodology for their surveillance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/mdr.2016.0052DOI Listing
July 2017

Gigantobilharzia, possible cause of cercarial dermatitis: Case report.

Int J Health Sci (Qassim) 2016 Jan;10(1):147-50

Department of Dermatology, College of Medicine, Qassim University, Saudi Arabia.

Cercarial dermatitis (swimmer's itch) is a worldwide, often neglected parasitic skin disease characterized by strong maculopapular skin eruption accompanied by intensive itching. A fisherman suffered from forearm dermatitis. Clinical history associated with the recovery of the avian schistosome; Gigantobilharzia from little green bee-eater (Merops orientalis najdanus) and collected Lymnaea snails supported the authors' opinion that patient clinical signs are most likely due to the invasion of avian schistosome cercariae.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791165PMC
January 2016

Prevalence, Risk Factors, and Transmission Dynamics of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae: a National Survey of Cattle Farms in Israel in 2013.

J Clin Microbiol 2015 11 26;53(11):3515-21. Epub 2015 Aug 26.

National Center for Infection Control, Ministry of Health, Tel-Aviv, Israel.

Our objectives were to study the prevalence, risk factors for carriage, and transmission dynamics of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBLPE) in a national survey of cattle. This was a point prevalence study conducted from July to October 2013 in Israel. Stool samples were collected from 1,226 cows in 123 sections on 40 farms of all production types. ESBLPE were identified in 291 samples (23.7%): 287 contained Escherichia coli and 4 contained Klebsiella pneumoniae. The number of ESBLPE-positive cows was the highest in quarantine stations and on fattening farms and was the lowest on pasture farms (P = 0.03). The number of ESBLPE-positive cows was the lowest in sections containing adult cows (age, >25 months) and highest in sections containing calves (age, <4 months) (P < 0.001). Infrastructure variables that were significant risk factors for ESBLPE carriage included crowding, a lack of manure cleaning, and a lack of a cooling (P < 0.001 for each), all of which were more common in sections containing calves. Antimicrobial prophylaxis was given almost exclusively to calves and was associated with a high number of ESBLPE carriers (P < 0.001). The 287 E. coli isolates were typed into 106 repetitive extragenic palindromic (REP)-PCR types and mostly harbored blaCTX-M-1 or blaCTX-M-9 group genes. The isolates on the six farms with ≥15 isolates of ESBLPE were of 4 to 7 different REP-PCR types, with one dominant type being harbored by about half of the isolates. Fourteen types were identified on more than one farm, with only six of the farms being adjacent to each other. The prevalence of ESBLPE carriage is high in calves in cowsheds where the use of antimicrobial prophylaxis is common. ESBLPE disseminate within cowsheds mainly by clonal spread, with limited intercowshed transmission occurring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/JCM.01915-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609711PMC
November 2015

Persistence of Klebsiella pneumoniae ST258 as the predominant clone of carbapenemase-producing Enterobacteriaceae in post-acute-care hospitals in Israel, 2008-13.

J Antimicrob Chemother 2015 Jan 8;70(1):89-92. Epub 2014 Sep 8.

National Center for Infection Control, Tel Aviv, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University).

Objectives: To study the molecular characteristics of carbapenemase-producing Enterobacteriaceae (CPE) in post-acute-care hospitals (PACHs) in Israel and to analyse the temporal changes between 2008 and 2013.

Methods: CPE isolates were obtained during two cross-sectional, point prevalence national surveys of PACHs in Israel performed in 2008 and 2013. Surveillance cultures were collected by streaking rectal swabs onto selective media. Isolates were identified to species level and tested for blaKPC, blaNDM and blaOXA-48 by PCR and by the Carba NP test. Molecular typing was done by PCR for the pilv-l gene, designed for the ST258 KPC-producing Klebsiella pneumoniae (KPC-KP) clone, BOX-PCR and MLST.

Results: The prevalence of CPE carriage in the first survey was 184/1147 (16%); all of the isolates were KPC-KP. The prevalence of CPE carriage in the second survey was 127/1287 (9.9%); of these isolates, 113 (89%) were KPC-KP, 9 (7%) were other KPC-producing species and 5 (4%) were NDM- and OXA-48-producing CPE (n = 1 and 4, respectively). The proportion of the KPC-KP population represented by the ST258 clone increased from 120/184 (65%) in 2008 to 91/113 (80%) in 2013. In 58% (71/122) of the KPC-CPE carriers identified in the 2013 survey, the source of acquisition was determined to be the PACH itself. All four OXA-48 CPE were acquired either directly or indirectly from patients arriving from the Palestinian Authority or Syria.

Conclusions: Despite the decreased prevalence of CPE in Israeli PACHs, and the emergence of new types of CPE, the KPC-KP ST258 clone remains the predominant clone represented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jac/dku333DOI Listing
January 2015

Are recommendations for psychological treatment of borderline personality disorder in current U.K. guidelines justified? Systematic review and subgroup analysis.

Personal Ment Health 2014 Aug 2;8(3):228-37. Epub 2014 Jul 2.

Central and North West London NHS Foundation Trust, London, UK.

Current U.K. guidelines on the management of borderline personality disorder include specific recommendations about the duration of therapy and number of sessions per week that patients should be offered. However, very little research has been conducted to examine the impact of these aspects of treatment process on patient outcomes. We therefore undertook a systematic review to examine the impact of treatment duration, number of sessions per week and access group-based therapy on general mental health, depression, social functioning and deliberate self-harm. We identified 25 randomized trials for possible inclusion in the review. However, differences in outcome measures used meant that only 12 studies could be included in the analysis. Statistically significant reductions in self-harm and depression and improvement in social functioning were found for treatments that include more than one session per week and those that included group-based sessions but were not found for those that deliver in individual sessions or one or fewer sessions per week. Longer term outcomes of short-term interventions have not been examined. Further research is needed to examine the impact of shorter term interventions and to compare the effects of group-based versus individual therapies for people with borderline personality disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pmh.1264DOI Listing
August 2014

Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation.

Am J Physiol Lung Cell Mol Physiol 2013 Oct 30;305(7):L478-84. Epub 2013 Aug 30.

Mayo Clinic, Division of Pulmonary and Critical Care Medicine, 200 1st St. SW, Rochester, MN 55905.

Mechanical ventilation may cause harm by straining lungs at a time they are particularly prone to injury from deforming stress. The objective of this study was to define the relative contributions of alveolar overdistension and cyclic recruitment and "collapse" of unstable lung units to membrane wounding of alveolar epithelial cells. We measured the interactive effects of tidal volume (VT), transpulmonary pressure (PTP), and of airspace liquid on the number of alveolar epithelial cells with plasma membrane wounds in ex vivo mechanically ventilated rat lungs. Plasma membrane integrity was assessed by propidium iodide (PI) exclusion in confocal images of subpleural alveoli. Cyclic inflations of normal lungs from zero end-expiratory pressure to 40 cmH2O produced VT values of 56.9 ± 3.1 ml/kg and were associated with 0.12 ± 0.12 PI-positive cells/alveolus. A preceding tracheal instillation of normal saline (3 ml) reduced VT to 49.1 ± 6 ml/kg but was associated with a significantly greater number of wounded alveolar epithelial cells (0.52 ± 0.16 cells/alveolus; P < 0.01). Mechanical ventilation of completely saline-filled lungs with saline (VT = 52 ml/kg) to pressures between 10 and 15 cmH2O was associated with the least number of wounded epithelial cells (0.02 ± 0.02 cells/alveolus; P < 0.01). In mechanically ventilated, partially saline-filled lungs, the number of wounded cells increased substantially with VT, but, once VT was accounted for, wounding was independent of maximal PTP. We found that interfacial stress associated with the generation and destruction of liquid bridges in airspaces is the primary biophysical cell injury mechanism in mechanically ventilated lungs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1152/ajplung.00437.2012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798764PMC
October 2013

D-dimer and portal vein status in splenectomized Egyptian β-thalassemia major patients: a prospective single-thalassemia center experience.

Pediatr Hematol Oncol 2012 Apr;29(3):247-53

Department of Pediatric Hematology, Ain Shams University, Cairo, Egypt.

Splenectomy is a recognized cause of portal vein thrombosis. Thirty-six β-thalassemia major (β-TM) patients were followed up for 36 months to evaluate changes in D-dimer levels (as a possible marker for thrombosis development) and portal vein status (by portal duplex ultrasound) at both early and late postlaparoscopic splenectomy periods. They were classified into group I if they were splenectomized in the study period (n = 12), or group II if they were splenectomized during the 5 years preceding the period (n = 24). In group I, D-dimer was measured 5 times: 1 day presplenectomy, the 1st week, 6th week, and 6th month postsplenectomy, and at the study end, whereas in group II, D-dimer was measured twice: at the study entry and end. Portal duplex was done 1 week postsplenectomy (group I) and at study end in both groups. Presplenectomy D-dimer levels in group I were significantly higher compared with the 6th month (P = .042) and study end (P = .03), whereas 1st week (postsplenectomy) D-dimer levels had a high mean of 3497.3 ng/mL, lowered at the 6th week (P = .017), at the 6th month (P = .008), and at study end (P = .005). D-dimer levels in group II showed no difference between study entry and end (P = .104). Portal vein "diameter and flow" were within normal findings in both groups. In this 3-year prospective study, a subclinical hypercoagulable state was detected 1 day prior to splenectomy and in the early postsplenectomy period, as evidenced by high D-dimer levels. Laparoscopic splenectomy was not associated with portal venous thrombosis either clinically or by duplex sonography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/08880018.2011.645186DOI Listing
April 2012

Duplex Doppler sonographic assessment of the effects of diethylcarbamazine and albendazole therapy on adult filarial worms and adjacent host tissues in Bancroftian filariasis.

Am J Trop Med Hyg 2004 Oct;71(4):471-7

Department of Radiology, Department of Community, Environmental, and Occupational Medicine, and Research and Training Center on Vectors of Diseases, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

We used duplex Doppler sonography to assess effects of diethylcarbamazine and albendazole therapy (DEC/ALB) on adult Wuchereria bancrofti in vivo. The study was performed in clinically normal Egyptian adults with blood microfilaria counts > 80/mL. Motile adult worms were observed before treatment in dilated scrotal lymphatic vessels in 28 of 36 men (78%) and over the proximal extremities in 5 of 22 women (23%). Most worm nests were inactivated in the months following treatment (90% at 12 months). Circulating filarial antigen levels (a marker for living adult worms) also fell dramatically following treatment. Some men had intrascrotal calcifications and/or non-palpable hydroceles detectable by ultrasound before they were treated. New hydroceles and intrascrotal calcifications appeared after treatment in many cases. However, most of these were transient and of no clinical significance. Prevelance rates for hydrocele and intrascrotal calcifications 24 months after treatment were essentially the same as those prior to treatment. These results show that DEC/ALB is highly active against adult W. bancrofti. They also suggest that host responses to dying adult worms are important in the pathogenesis of filarial hydroceles.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2004