Myalgia is one of the most common symptoms of COVID-19 infection. With the progression of the COVID-19 pandemic, emerging cases of COVID-related myositis have been reported. However, COVID-19-related ...myositis of the paraspinal muscle is uncommon. We present a 66-year-old female who was admitted to the hospital for hemorrhagic shock secondary to gastrointestinal bleeding. She developed COVID-19 respiratory tract infection symptoms on the second day of admission with reported severe lower back pain 3 days later. Serum creatinine kinase level was slightly elevated, and magnetic resonance imaging (MRI) revealed paraspinal myositis.
Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder characterised by an accumulation of monoclonal B lymphocytes, with an increased risk of secondary cancers. The coexistence of CLL ...and chronic myeloid leukaemia (CML) is a rare phenomenon, with three main types being classified: CML preceding CLL, CLL preceding CML and simultaneous occurrence. The coexistence of these chronic leukaemias poses a complex clinical challenge, with the underlying mechanisms of their association remaining enigmatic. Here, we present a report of an elderly male with a long history of CLL, who was subsequently diagnosed with secondary CML.
The development of chronic myeloid leukaemia (CML) subsequent to chronic lymphocytic leukaemia (CLL) is an uncommon occurrence, challenging conventional expectations of disease evolution in chronic leukaemia.Extensive and appropriate testing is necessary to promptly identify secondary CML in CLL patients.Targeted therapy with dasatinib, a tyrosine kinase inhibitor, may demonstrate efficacy in reducing leukocytosis and
levels in patients with coexisting CLL and CML.
Cardiopulmonary resuscitation (CPR) performed by lay rescuers can increase a person's chance of survival. The COVID-19 pandemic enforced prevention policies that encouraged social distancing, which ...disrupted conventional modes of health care education. Tele-education may benefit CPR training during the pandemic.
Our aim was to compare CPR knowledge and skills using tele-education vs. conventional classroom teaching methods.
A noninferiority trial was conducted as a Basic Life Support workshop. Participants were randomly assigned to a tele-education or conventional group. Primary outcomes assessed were CPR knowledge and skills and secondary outcomes assessed were individual skills, ventilation, and chest compression characteristics.
Pretraining knowledge scores (mean ± standard deviation SD 3.50 ± 2.18 vs. 4.35 ± 1.70; p = 0.151) and post-training knowledge scores (7.91 ± 2.14 vs. 8.52 ± 0.90; p = 0.502) of the tele-education and conventional groups, respectively, had no statistically significant difference. Both groups’ training resulted in a significant and comparable gain in knowledge scores (p < 0.001). The tele-education and conventional groups skill scores (mean ± SD 78.30 ± 6.77 vs. 79.65 ± 9.93; p = 0.579) had no statistical difference. Skillset scores did not differ statistically except for the compression rate and ventilation ratio; the conventional group performed better (p = 0.042 vs. p = 0.017). The tele-education and conventional groups’ number of participants passed the skill test (95.5% and 91.3%, respectively; p = 1.000).
Tele-education offers a pragmatic and reasonably effective alternative to conventional CPR training during the COVID-19 pandemic.
This study aimed to evaluate the prevalence and risk of malignant neoplasm in primary hyperparathyroidism (PHPT) patients. Potentially eligible studies were retrieved from PubMed and Embase databases ...from inception to November 2023 using search strategy consisting of terms for “Primary hyperparathyroidism” and “Malignant neoplasm”. Eligible study must report prevalence of malignant neoplasm among patients with PHPT or compare the risk of malignant neoplasm between patients with PHPT and comparators. Point estimates with standard errors were extracted from each study and combined using the generic inverse variance method.A total of 11,926 articles were identified. After two rounds of systematic review, 50 studies were included. The meta-analysis revealed that pooled prevalence rates of overall cancer was 0.19 (95%CI: 0.13–0.25;
I
2
94%). The two most prevalent types of malignancy among patients with PHPT ware papillary thyroid cancer (pooled prevalence: 0.07; 95%CI: 0.06–0.08;
I
2
85%) and breast cancer (pooled prevalence: 0.05; 95%CI: 0.03–0.07;
I
2
87%). Subgroup analysis of studies focusing on patients undergoing parathyroidectomy reported a fourfold higher prevalence of papillary thyroid cancer than the remaining studies (0.08 versus 0.02). The meta-analysis of cohort studies found a significant association between PHPT and overall cancer with the pooled risk ratio of 1.28 (95%CI: 1.23–1.33;
I
2
66.9%).We found that the pooled prevalence of malignant neoplasm in PHPT was 19%, with papillary thyroid cancer and breast cancer being the most prevalent types. The meta-analysis of cohort studies showed that patient with PHPT carried an approximately 28% increased risk of malignancy.
Abstract only
Introduction:
While cirrhotic patients increase risk of hemorrhagic and thrombotic events, association of liver stiffness with stroke remaines unclear.
Hypothesis:
Severity of liver ...stiffness is associated with higher prevalence of stroke.
Methods:
A cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 included adult participants aged 21 to 79 years. Association between prevalence of self-reported stroke and liver stiffness stratified for 4 fibrosis scores measured by Fibroscan
™
were analyzed by multivariate logistic regression.
Results:
A total of 8,416 patients with Fibroscan results were identified (mean age 49
+
16 years old; 52% female; 32% white). Overall, 377 patients (4.5%) had a stroke. The number of participants stratified by 4 fibrotic stages of mild (F0F1), moderate (F2), severe fibrosis (F3), and cirhosis (F4) were 6,243 (74.2%), 826 (9.8%), 122 (1.4%), and 155 (1.8%) patients, respectively. In multivariate logistic regression, after controlling for age, race, gender, diabetic status, body mass index (<25 vs
>
25 kg/m
2
), and high systolic blood pressure (
<
130 vs >130 mmHg), individuals with severe fibrotic liver (F3 and F4) were significantly more likely to have a stroke (adjusted odds ratio (OR) 1.64; p= 0.044; 95% confidence interval (CI) 1.01, 2.65; Figure 1). Furthermore, we found that patients with cirrhosis (F4) were the most at risk to have a stroke (adjusted OR 1.91; p= 0.037; 95% CI 1.04, 3.49; Figure 1).
Conclusions:
In this cross-sectional data, there is a graded association between severe fibrotic liver disease measured by Fibroscan
™
and elevated prevalence of stroke. Longitudinal studies including additional risk factors of stroke such as hyperlipidemia, hypertension and atrial fibrillation need to be further evaluated.
Abstract only
Introduction:
Although inadequate sleep is known to associate with cardiovascular (CV) outcomes including stroke, association between sleep duration and stroke is unclear.
Hypothesis:
...Shorter sleep duration is associated with higher risk of stroke.
Methods:
A retrospective cross-sectional analysis of the 2017-2020 National Health and Nutrition Examination Survey (NHANES) included adult participants aged 21 to 79 years with self-reported history of stroke and sleep duration was studied. Association of sleep duration, stratified into short (<6 hours) and normal sleep durations (≥6 hours), and stroke was evaluated by multivariate logistic regression.
Results:
A total of 8,416 participants were identified, of which mean age was 48.25±16 years old, 51.5% were female and mean sleep duration was 7.529 ± 1.651 hours. Overall, 377 patients (4.5%) had a stroke, of which mean sleep duration was 7.545 ± 2.132. Mean sleep duration of non-stroke population was 7.528 ± 1.626. The difference of mean sleep duration between these two groups was statistically significant (0.017 hours; P < 0.001; 95% Cl -0.156,0.189; Figure1). The majority of the study participants reported a normal sleep duration (7426 participants, 88.2%) and the remaining 913 participants (10.8%) had a short sleep duration. Compared with the normal sleep duration group, participants with the short sleep duration had significantly lesser the odds of stroke (adjusted odds ratio 0.574; P < 0.001; 95% CI 0.424,0.777) after adjusted for baseline risk factors including age, gender, ethnicity, body mass index (<25 vs. ≥25 kg/m
2
), history of hypertension and diabetes.
Conclusions:
Contrary to previous reports, this study shows that sleep duration is positively associated with risk of stroke. Further long-term studies that focus on understanding the pathophysiology using non-self-reported method are required to elucidate effect of sleep quality and optimal sleep duration on the adverse CV outcomes.
Background
Hypertrophic scars and keloids are postsurgery problems. Some studies showed that onion extract and aloe vera might be beneficial for postoperative scars. However, few of the randomized ...clinical trials were investigated.
Aims
To compare the efficacy of silicone gel containing onion extract and aloe vera (SGOA) to silicone gel sheets (SGS) to prevent postoperative hypertrophic scars and keloids.
Methods
The prospective randomized assessor‐blind controlled trial was conducted with 40 patients who had undergone surgery. The patients were divided into two groups: one treated with SGOA, the other with SGS. The patients were evaluated after 1, 2, and 3 months. The objective assessment was to determine the incidences of scarring, erythema, and melanin values using Mexameter, and pliability through Cutometer. The subjective assessment consisted of the patient and observer scar assessment scale (POSAS) and patient satisfaction.
Results
After the 12‐week follow‐up, there was no statistically significant difference in the scarring incidence rate of both groups. There were no statistical differences in the POSAS score, erythema, and melanin value between both groups. Using objective assessment, pliability in the SGOA group was statistically significantly higher compared to the SGS group. Pain and itchiness significantly decreased in both groups. No adverse effects were reported in either group.
Conclusion
Silicone gel containing onion extract and aloe vera is effective as SGS for postoperative scar prevention.
Abstract only Background: Abnormal kidney function is one of the risk factors for cardiovascular diseases. Whether the association between a wide range of kidney functions from normal to advanced ...chronic kidney disease and stroke risk is unclear. Methods: A cross-sectional study involving participants (≥ 18 years old) in the 2017 - 2020 NHANES was examined for the association between serum creatinine (SCr) and history of stroke informed by a doctor or other health professional by multiple logistic regression analysis. Results: Of 9,211 participants, the mean±SD age was 51±18 y/o and 52% were female. White accounts for 35% followed by Black (27%), Asian (12%), Mexican American (11%), Hispanic (10%), and others (5%). Up to 485 participants (5%) ever had a stroke. Median (IQR) SCr was 0.84 (0.71 - 1.01) mg/dL. Stratified SCr among 7,865 participants with SCr data into quartile (Q), mean SCr were 0.62, 0.78, 0.92, and 1.34 mg/dL, respectively (Figure 1A). Compared to participants in Q1, strokes were 1.72 and 3.45 times as likely to occur in those in Q3 and Q4, respectively (Q3: 95%CI 1.24, 2.39, P 0.001; Q4: 95%CI 2.55, 4.67, P <0.0001); while participants in Q2 were 1.41 times as likely to have strokes but not statically significant (95%CI 0.99, 2.00, P 0.055; Figure 1B). After adjusting for age, gender, race, BMI, only participants in Q4 were 1.64 times as likely to have a stroke compared to those in Q1 (95%CI 1.09, 2.45, P 0.017); while strokes were 1.158 and 1.21 times as likely to occur among participants in Q2 and Q3, respectively but not statically significant (Q2: 95%CI 0.78, 1.72, P 0.468; Q3: 0.81, 1.80, P 0.348). There were effect modifications between SCr in Q4 and some races (Hispanic, White, and others; P interaction 0.04, 0.013, and 0.011, respectively). Conclusions: SCr was positively associated with the likelihood to have a stroke. Longitudinal cohort studies are required to further elucidate the relationship.
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