Background: Blunt traumatic brain injury (bTBI) and uncontrolled hemorrhagic shock (UCHS) are common causes of mortality in polytrauma. We studied the influence of fresh frozen plasma (FFP) resuscitation in a rat model with both bTBI and UCHS before achieving hemorrhage control.
Methods: The bTBI was induced by an external weight drop (200 g) onto the bare skull of anesthetized male Lewis (Lew/SdNHsd) rats; UCHS was induced by resection of two-thirds of the rats’ tails. Fifteen minutes following trauma, bTBI+UCHS rats underwent resuscitation with FFP or lactated Ringer’s solution (LR). Eight groups were evaluated: (1) Sham; (2) bTBI; (3) UCHS; (4) UCHS+FFP; (5) UCHS+LR; (6) bTBI+UCHS; (7) bTBI+UCHS+FFP; and (8) bTBI+UCHS+LR. Bleeding volume, hematocrit, lactate, mean arterial pressure (MAP), heart rate, and mortality were measured.
Results: The study included 97 rats that survived the immediate trauma. Mean blood loss up to the start of resuscitation was similar among UCHS only and bTBI+UCHS rats (P=0.361). Following resuscitation, bleeding was more extensive in bTBI+UCHS+FFP rats (5.2 mL, 95% confidence interval [CI] 3.7, 6.6) than in bTBI+UCHS+LR rats (2.5 mL, 95% CI 1.2, 3.8) and bTBI+UCHS rats (1.9 mL, 95% CI -0.2, 3.9) (P=0.005). Similarly, non-significant increases in blood loss were observed in UCHS+FFP rats (P=0.254). Overall mortality increased if bleeding was above 4.5 mL (92.3% versus 8%; P<0.001). Mortality was 83.3% (10/12) in bTBI+UCHS+FFP rats, 41.7% (5/12) in bTBI+UCHS+LR rats, and 64.3% (9/14) in bTBI+UCHS rats.
Conclusion: The bTBI did not exacerbate bleeding in rats undergoing UCHS. Compared to LR, FFP resuscitation was associated with a significantly increased blood loss in bTBI+UCHS rats.
During the past few years, thousands of articles have been published concerning medical cannabis useage. Unfortunately, most publications are case studies or small and poorly designed research projects. In attempting to understand the reasons behind this situation, the obstacles impeding the use of medical cannabis and related research merit more in-depth examination. This editorial looks at some of the issues.
Because of rising antivaccine activism and some key global policy missteps, we risk eroding more than 70 years of global health gains. This is occurring through an enabled and empowered antiscience ecosystem, with anti-Semitism and the targeting of Jewish biomedical scientists at its core.
Objective: In patients with acute hepatic porphyria (AHP), prolonged fasting is a known trigger of AHP attacks. Despite this, some Jewish AHP patients—mainly hereditary coproporphyria (HCP) and variegate porphyria (VP) patients—fast for 25 consecutive hours during the traditional Jewish holy day known as Yom Kippur. In this study, we evaluated the effect of the fast on these patients.
Methods: A retrospective study and survey of AHP patients in Israel was carried out. Patients were asked whether they have fasted and whether any symptoms were induced by this fast. Patients’ medical records were reviewed for an emergency department (ED) visit following YK between 2007 and 2019. Only 3 acute intermittent porphyria (AIP) patients reported fasting; they were excluded from analysis.
Results: A total of 21 HCP patients and 40 VP patients completed the survey; 30 quiescent patients reported they fast, while 31 did not fast. The majority of fasting patients (96.67%) reported no symptoms following a fast. We found no statistically significant association between ED visits 1 week (0.26% in both fasting and non-fasting patients) or 1 month (2.1% visits in non-fasting versus 0.78% in fasting patients) following Yom Kippur. Of the symptomatic ED visits following a fast, none were defined as severe attacks.
Conclusion: A 25-hour fast in stable HCP and VP patients did not increase the risk of an acute attack and can probably be regarded as safe.
Background: Parental caregivers of children with special needs manage their child’s daily tasks, taking on responsibilities such as making health and financial decisions, assisting with routine activities, and ensuring their safety from self-harm. The level of a child’s disability determines the amount of time and effort a caregiver must invest, with higher disability levels meaning greater dependency and thus requiring greater support. While rewarding, caregiving may also be highly demanding. The parental caregiver’s physical and mental health can decline due to stress, potentially leading to anxiety and depression, and may worsen pre-existing conditions. This research aimed to provide insights into the psychological well-being of parental caregivers, shedding light on their challenges and needs for better support and intervention.
Methods: This study examined the psychological health of parental caregivers of special needs children at a special education school in Puducherry, India. Following an orientation program, 66 parental caregivers volunteered and provided informed consent to participate. The mean age of the parents was 38.4 years (±6.6). Demographic details were collected, and psychological parameters were assessed using standardized scales: Zarit Burden Interview–Caregiver Burden Scale (ZBI-CBS), Depression, Anxiety, Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of Life—brief form (WHOQOL-BREF).
Results: The study findings revealed that most parents experienced caregiver burden and poor sleep quality, consistent with previous studies. Specifically, 93.9% of parents had poor sleep, while 84.8% reported caregiver burden. Additionally, 89.4% of the parents experienced depression, 89.4% have anxiety, and 86.4% have stress. Quality of life was low across all domains.
Conclusion: The stress of managing their child’s needs can negatively impact parental caregivers’ physical and psychological health. Providing counseling and promoting healthy lifestyle choices can significantly enhance caregivers’ overall well-being.
Purpose: This study was aimed at identifying biomarkers that could help exclude pulmonary embolism (PE) in patients aged 65 years and older, considering age-related challenges such as atypical clinical presentations and the presence of comorbidities.
Methods: This single-center cohort study retrospectively collected data on 28 potential markers from patients aged 65 years and older who underwent computed tomography scans for PE diagnosis in emergency or internal wards over a 2.5-year period.
Results: The study included 157 patients after exclusions, with 35 diagnosed with PE. Patients with PE exhibited higher D-dimer levels, lower platelet counts, and higher Padua scores. Six markers were selected based on likelihood ratio, each with an area under the curve above 0.7 and P-value below 0.05. Multiplying D-dimer levels with the Padua score (PaDd) improved specificity from 9% to 32% while maintaining 100% sensitivity in identifying PE. Further refinement by incorporating activated partial thromboplastin time (aPTT) into the Padua score multiplied by D-dimer (PaDd/aPTT) resulted in improved sensitivity and specificity.
Conclusion: The Padua score multiplied by D-dimer is a simple yet effective tool that enhances specificity while maintaining high sensitivity, potentially reducing computed tomography utilization in elderly patients. Prospective, multicenter studies are needed to validate these findings and integrate them into routine clinical practice.
Background: An odontogenic keratocyst is presently considered a cyst by the 2017 World Health Organization (WHO) classification, even though, at times, it shows highly aggressive behavior and a high recurrence rate. Ki-67 is a protein associated with the proliferative activity of the intrinsic cell populations. In tumors, Ki-67 is associated with tumor aggressiveness. This study aimed to compare the Ki-67 expression rates of odontogenic keratocysts to those of other odontogenic cysts and normal mucosa.
Materials and Methods: A retrospective cross-sectional study was conducted using pathology samples retrieved from the archives of a tertiary care center to evaluate Ki-67 expression. Histopathologically confirmed cases of odontogenic keratocysts, radicular cysts, dentigerous cysts, and ameloblastomas were selected. The standardized immunohistochemistry streptavidin–biotin detection system HRP-DAB method was employed for analysis.
Results: All the odontogenic keratocysts pathology samples demonstrated some degree of Ki-67 expres¬sion: mild, moderate, and severe Ki-67 expressions were identified in 26.7%, 53.3%, and 20.0% of the samples, respectively. Compared to the odontogenic keratocyst samples, the samples from dentigerous cysts, periapical cysts, ameloblastomas, and normal mucosa demonstrated no Ki-67 expression in 33.3%–66.7% of the samples, mild expression in 13.3%–40.0%, moderate expression in 0%–33.3%, and severe expression in none of the samples (P<0.001).
Conclusions: Ki-67 was either moderately or severely overexpressed in the majority of odontogenic keratocyst samples. The 2017 WHO classification, which reclassifies keratocystic odontogenic tumors as cysts, conflicts with our findings.
To the Editor:
We found the letter from Dr Munusamy and co-workers, titled “Optimizing Recovery in Oral Flap Surgeries: The Undervalued Role of Physiotherapy,” of great value and interest. The letter comprehensively addresses the true outcomes of a surgically treated oral cancer patient, mostly adjunct with postoperative radiotherapy.
Objective: This study examines the interplay between childhood trauma, war exposure, and maladaptive coping mechanisms, with a focus on post-traumatic stress disorder (PTSD) as a mediator and war exposure as a potential moderator in the relationship between childhood trauma and emotional eating.
Methods: Participants completed validated measures of childhood trauma, PTSD, and emotional eating. Statistical analyses included Pearson correlations, stepwise linear regression, and moderated mediation models, adjusting for age and gender.
Results: The study included 426 Hebrew-speaking Israeli adults (52.8% female, 47.2% male, mean age 40). Childhood trauma, particularly emotional abuse, was significantly associated with PTSD and emotional eating. The relationship between childhood trauma and emotional eating was fully mediated by PTSD, with a stronger effect observed for emotional abuse. War exposure significantly predicted PTSD but did not moderate the link between PTSD and emotional eating. Sex differences emerged, with female participants exhibiting higher PTSD levels than males.
Conclusions: The findings emphasize the enduring impact of childhood trauma, particularly emotional abuse, on maladaptive coping mechanisms like emotional eating, mediated by PTSD. While war exposure intensified PTSD symptoms, it did not significantly influence emotional eating. These results highlight the differential effects of early- and later-life traumas, offering insights for targeted interventions in trauma recovery.
Background: Xerostomia, or dry mouth, often intensifies oral health problems like dental caries and periodontitis. Smoking is a key factor influencing salivary flow, potentially leading to these issues. This study assesses the prevalence of xerostomia and reduced salivary flow (hyposalivation) among smokers.
Materials and Methods: As case and control groups, the study groups include 150 smokers and 150 healthy non-smokers. A detailed questionnaire was used to collect data on smoking behaviors and symptoms associated with xerostomia. A modified Schirmer test was conducted at 1, 2, and 3-minute intervals to measure unstimulated salivary flow. Descriptive statistics were calculated for age, sex, type, frequency, and duration of smoking. The Mann–Whitney test was done to compare the salivary flow between smokers and non-smokers and to compare smoking parameters with salivary flow. Correlation was also determined for salivary flow with age and smoking parameters.
Results: All the smokers were males, and most were cigarette smokers (86%). Xerostomia symptoms were reported by 19% of smokers and none by non-smokers, which was statistically significant (P<0.000). Salivary flow rates at 1, 2, and 3 minutes were significantly lower in smokers than in non-smokers. A comparison between the frequency and duration of smoking and salivary flow yielded statistically significant P values of 0.005 and 0.043, respectively. There was a weak negative correlation between age, frequency of smoking, duration of smoking, and salivary flow.
Conclusion: This study found a clear association between long-term smoking and xerostomia, with a notable decrease in unstimulated salivary flow. This highlights the adverse effect of smoking on oral health, which could be used in effective counseling for tobacco cessation.
