Search Results (234)

Background: Surgical management of trauma in the maxillofacial complex can result in iatrogenic nerve injuries, particularly involving the infraorbital, inferior alveolar, and mental nerves. Paresthesia is a common postoperative complication, often attributed to the anatomical positioning of these nerve structures, making them vulnerable to injury. Among current therapeutic options for nerve injuries, low-level laser therapy (LLLT) has shown promising results in published studies. Objectives: This prospective observational study evaluated the effects of LLLT on nerve recovery following maxillofacial trauma surgery. Methods: A total of 21 participants, with a median age of 35 years and no gender-based selection criteria, were enrolled. Cases included zygomaticomaxillary complex and mandibular osteosynthesis; analyses were within-subject across time. Postoperative laser therapy was administered to both groups using the DUO MMO device (MMOptics, São Carlos, Brazil), delivering infrared light along the pathways of the inferior alveolar, infraorbital, and mental nerves. Nerve function was assessed regularly using a Visual Analog Scale (VAS) and the Brush Stroke Direction (BSD) test to evaluate sensory recovery. Results: Compared with baseline (15 days post-op, pre-LLLT), VAS scores showed significant reductions at sessions 7 and 10, and BSD responses increased over time. Conclusion: After multiplicity control, only the session 10 comparison remained significant. These observational findings support the feasibility of multi-session LLLT after maxillofacial trauma; controlled trials are warranted to determine efficacy. Full article

Hospital readmission among stroke survivors is frequent, especially in contexts of social vulnerability, compromising recovery and overburdening health services. This study aimed to develop a predictive model of hospital readmission among socially vulnerable stroke survivors, based on the Chronic Conditions Care Model (CCCM). Machine learning algorithms were applied, specifically decision tree and logistic regression, with data split into training (70% and 80%) and testing (30% and 20%) sets. Analyses were conducted using Python, with accuracy evaluated through ROC curves, AUC, and the confusion matrix in Analyse-it^®, adopting a 5% significance level. The decision tree with an 80/20 partition achieved an accuracy of 92.45%. The variables most associated with readmission were falls, time since the first stroke, presence of a caregiver, and difficulty sleeping. In logistic regression, falls increased the risk by 235%, ischemic stroke by 155%, complications by 153.53%, COVID-19 by 132%, and time since stroke by 11.5% per year. The model proved to be feasible and robust, with the decision tree standing out, highlighting its potential to support preventive strategies and enhance care management. Full article

Background/Objectives: Downstream occlusion (DOC) is a commonly observed, yet frequently overlooked, angiographic event during mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). This phenomenon has the potential to complicate procedures and influence outcomes. However, its prevalence, predictors, and endovascular trajectories remain poorly understood. Methods: A retrospective analysis of 703 patients who underwent MT for acute intracranial LVO between 2010 and 2021 at a tertiary stroke center was conducted. DOC was angiographically identified as a newly developed occlusion in a downstream artery following recanalization of the primary occlusion. Multivariate logistic regression was employed to analyze the clinical and procedural predictors of DOC. Endovascular and clinical outcomes were compared between patients with and without DOC. The DOC trajectory, including immediate reperfusion status, subsequent recanalization attempts, and final outcomes, was analyzed based on the occlusion location. Results: DOC was identified in 254 patients (36.1%). Atrial fibrillation and proximal occlusion were independently associated with DOC. Despite DOC adversely affecting endovascular procedural details, patients with DOC demonstrated comparable rates of final successful recanalization (92.5% vs. 91.3%; p = 0.577) and 90-day functional independence (40.2% vs. 46.3%; p = 0.114). Notably, about half of the patients exhibited an immediate modified Thrombolysis In Cerebral Infarction (mTICI) grade 2b at the time of DOC. Further recanalization attempts were undertaken in 67.7% of DOC cases, resulting in enhanced mTICI grades in 76.7% of cases and achieving final successful recanalization in 94.2% of cases. The functional advantages of additional recanalization attempts varied depending on DOC location but were generally limited. Conclusions: Despite its procedural complexity, DOC did not significantly compromise final recanalization or functional outcomes. Many cases were effectively managed with additional endovascular treatment, highlighting the importance of achieving sufficient final recanalization. Full article

Antithrombotic therapy plays a pivotal role in reducing thromboembolic complications, including stroke and valve thrombosis, following Transcatheter Aortic Valve Implantation (TAVI). However, the benefits of such therapy must be balanced against the increased risk of major bleeding events. The optimal antithrombotic strategy in this setting remains a matter of ongoing debate, given the heterogeneity of patient profiles and procedural variables. Among TAVI recipients, women represent a growing proportion and exhibit distinct anatomical, physiological, and clinical characteristics that influence both thrombotic and bleeding risk. Compared to men, women more frequently experience vascular complications and major bleeding events, despite better survival outcomes. These differences are driven by smaller vessel caliber, higher vascular tortuosity, and altered platelet reactivity. Consequently, sex-specific risk stratification is essential when considering antiplatelet or anticoagulant regimens post-TAVI. This review provides a comprehensive synthesis of current evidence regarding antithrombotic strategies in the post-TAVI setting, with a dedicated focus on sex-related differences. Particular emphasis is placed on the female population, assessing ischemic and hemorrhagic outcomes and the implications for long-term management. Improving outcomes in women undergoing TAVI necessitates tailored antithrombotic strategies that balance efficacy and safety. Ongoing research and dedicated trials are essential to refine these strategies and to inform future guideline updates in this expanding patient population. Full article

Background and Objectives: Femoral neck fractures are common among elderly patients and are typically managed surgically to restore mobility and reduce complications. Total Hip Replacement (THR) and Hemiarthroplasty (HA) are standard interventions. While both procedures are widely used, the comparative risks of thromboembolic complications remain unclear. This study aimed to systematically compare the risk of Venous Thromboembolism (VTE), including Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Arterial Thromboembolic events in patients undergoing THR versus hemiarthroplasty for femoral neck fractures. Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Google Scholar, and OVID-Medline for studies published between 2000 and 2024. Eligible studies included patients aged ≥50 years with femoral neck fractures treated with THR or Hemiarthroplasty and reported thromboembolic outcomes. Risk of bias was assessed using the Newcastle–Ottawa Scale and the RoB 2 tools. Meta-analysis was performed using RevMan software (Version 5.4). Results: Twelve studies were included in the systematic review, and ten in the meta-analysis, encompassing over 160,000 patients. THR was associated with a significantly increased risk of DVT (RR = 1.53; 95% CI: 1.40–1.68, p = 0.00001) and combined VTE (RR = 1.48; 95% CI: 1.36–1.61, p = 0.00001) compared to HA. No significant difference was observed in PE risk. Interestingly, THR was linked to a lower risk of Arterial Thromboembolic events, such as Ischemic Stroke. Conclusions: Compared with Hemiarthroplasty, THR increases the risk of VTE, including DVT, with no increased risk of PE. Surgical decisions should be guided by individual patients’ risk factors for thrombotic and cardiovascular events. Full article

Background/Objectives: Impella 5.5 provides a higher flow rate than smaller microaxial pumps and has been increasingly adopted for cardiogenic shock (CS). This study aimed to evaluate whether its introduction into our Shock Team program in 2023 improved outcomes compared with a historical cohort supported with other mechanical circulatory support (MCS) devices. Methods: We retrospectively analyzed patients with CS treated with MCS between 2020 and 2024 at a tertiary center. The Impella 5.5 group (n = 17) included patients managed after device implementation, either as stand-alone or sequential therapy. The historical cohort comprised 40 patients treated with ECMO, Impella CP, CentriMag, or IABP prior to 2023. Propensity score matching (age, sex, etiology, lactate, SCAI stage) generated 17 matched pairs. The primary outcome was survival at discharge, 30 days, 3 months, and 6 months. Secondary outcomes included bridging to recovery, heart transplantation (HTx), durable LVAD, and major complications. Results: Impella 5.5 was associated with higher survival at discharge (94.1% vs. 58.8%, p = 0.039), 30 days (94.1% vs. 58.8%, p = 0.039), and 3 months (94.1% vs. 58.8%, p = 0.039). At 6 months, survival remained higher (88.2% vs. 58.8%) but did not reach statistical significance in point analysis (p = 0.118). Bridging occurred more frequently with Impella 5.5 (HTx 64.7% vs. 52.9% (p = 0.464), recovery 17.6% vs. 5.9% (p = 0.292)), while LVAD implantation rates were similar (11.8% vs. 17.6%, p = 1.0). Major bleeding (17.6% vs. 47.1%, p = 0.141), stroke/TIA (5.9% vs. 17.6%, p = 0.601), and the need for renal replacement therapy (5.9% vs. 23.5%, p = 0.335) were numerically lower with Impella 5.5. Conclusions: In this single-center, retrospective analysis, the introduction of Impella 5.5 was associated with higher short-term survival and favorable bridging metrics; estimates are imprecise due to small, heterogeneous samples. These hypothesis-generating findings warrant confirmation in larger, prospective multicenter cohorts Full article

Background: Stroke is a major cerebrovascular disease characterized by disrupted cerebral blood flow, leading to neuronal damage and significant physical, cognitive, and emotional sequelae. While advancements in acute stroke management have improved survival rates, long-term complications such as cognitive impairment and depression continue to hinder recovery. This study addresses these dimensions within the context of ischemic stroke. Aim: The aim of this study was to analyze the cognitive status, functionality, and depressive symptoms in patients with ischemic stroke, exploring interrelations between cognitive, functional, and emotional outcomes to prioritize clinical interventions. Design: This was an analytical, observational, cohort, and prospective study. Methods: The study included 81 subjects diagnosed with ischemic stroke admitted to the Neurology Department of Lucus Augusti University Hospital. Data were collected at three time points—admission, discharge, and follow-up—using validated instruments such as the National Institutes of Health Stroke Scale, Mini-Mental State Examination, Barthel Index, and Beck Depression Inventory. Statistical analyses included Spearman’s correlation, Kruskal–Wallis, and Mann–Whitney tests. Results: Patients with greater cognitive impairment at admission showed poorer functional recovery and higher depressive symptoms during follow-up. Depressive symptoms remained minimal in most cases, but correlations with cognitive and functional deficits were significant. NIHSS scores at admission strongly predicted both functional and emotional recovery, reinforcing its value in early prognosis and therapeutic planning. Conclusions: This study highlights the importance of integrating cognitive, functional, and emotional dimensions into stroke care protocols to optimize patient recovery and improve long-term outcomes. Full article

Background and Clinical Significance: Moyamoya disease (MMD) is a progressive intracranial vasculopathy characterized by stenosis or occlusion of the terminal internal carotid arteries and the development of fragile collateral networks. It predisposes patients to ischemic and hemorrhagic strokes. Although both direct and indirect revascularization procedures are recommended to restore cerebral blood flow, recurrent cerebrovascular events may still occur, and delayed hemorrhage following revascularization is particularly uncommon. Case Description: We report the case of a 42-year-old woman who presented with seizure, syncope, and aphasia. Cranial computed tomography (CT) revealed a large left temporal–insular intraparenchymal hematoma with a midline shift. Computed tomography angiography (CTA) demonstrated bilateral internal carotid artery narrowing and collateral vessel proliferation, without aneurysm. Her history indicated a hemorrhagic stroke 15 years earlier, at which time MMD was diagnosed by magnetic resonance angiography (MRA) and managed with multiple burr hole surgeries. She remained free of cerebrovascular events until the current presentation. The patient underwent emergent hematoma evacuation, followed by intensive care management. Postoperatively, she demonstrated neurological improvement, though with residual motor aphasia and right-sided weakness, and was discharged for rehabilitation. Conclusions: This case underscores the rare occurrence of delayed intracerebral hemorrhage 15 years after indirect revascularization in MMD. Although revascularization surgery remains the standard therapeutic approach, this report highlights the importance of sustained long-term surveillance, strict risk factor management, and careful postoperative follow-up. The key point is that late hemorrhagic complications, though uncommon, must be considered in the long-term care of MMD patients following revascularization. Full article

Atrial fibrillation (AF) is a prevalent heart arrhythmia, characterized by an irregularly irregular rhythm and the absence of identifiable P waves on ECG. Given the loss of effective atrial contraction, AF carries a risk of serious complications. If untreated, AF can promote thrombogenesis, leading to stroke, systemic embolism (e.g., limb or organ ischemia), and myocardial infarction. These serious complications highlight the importance of understanding AF and assessing stroke risk to guide optimal management of this chronic arrhythmia. Congruent with recent technological developments, advanced imaging has emerged as a modality to better understand AF. This review highlights advanced imaging techniques and their advantages, with a focus on 4D flow MRI, a novel modality that enables visualization of blood flow patterns in three dimensions and provides unique insights into cardiac hemodynamics. It also synthesizes the current literature on key hemodynamic markers identified by 4D flow MRI, including blood flow stasis, wall shear stress, and vorticity. Quantifying these markers has improved predictive accuracy of future stroke risk in AF patients, allowing clinicians to risk stratifying their patients and optimize management. Finally, the review discusses potential future markers that may further refine our understanding of AF and inform patient care. Full article

Coccidioidal meningitis (CM) is a rare but life-threatening complication of disseminated coccidioidomycosis, occurring in ~16% of cases, particularly among children in endemic regions such as the southwestern US and northern Mexico. Without timely diagnosis and antifungal therapy, pediatric CM is almost universally fatal within the first year. Hydrocephalus develops in up to 50% of cases. In 2000, Galgiani et al. established fluconazole as first-line therapy for CM. Subsequent guidelines refined management but did not specifically address pediatric patients (>1 month–≤19 years). No studies in the fluconazole era have systematically evaluated risk factors for complications in this population. We therefore conducted a systematic review and proportional synthesis of pediatric CM cases, focusing on CNS complications and outcomes. PubMed/MEDLINE, Embase (Ovid), and Web of Science were systematically searched (2000–2025). PROSPERO registration ID (1130290). Inclusion criteria encompassed epidemiological studies, case series, and case reports that described at least one pediatric case of CM or CNS involvement, confirmed by diagnostic methods. Cases in adults, neonates (<1 month), congenital infections, teratogenicity studies, reviews, or incomplete reports were excluded. Only cases with complete individual data (n = 48) were included. Methodological rigor was ensured using JBI Critical Appraisal Tools. Of 1089 studies, 31 met the inclusion criteria, representing 3874 pediatric cases. CM/CNS involvement was confirmed in 165 cases (4.25%; 95% CI: 3.6–4.9%), with hydrocephalus in 62 (37.5%). Among 48 case reports with complete data, fluconazole was first-line therapy in 65%. Serum CF titers ≥ 1:16 were associated with hydrocephalus plus stroke (p = 0.027) and independently predicted adverse outcomes (relapse/death; OR = 4.5, p = 0.037), whereas lifelong azole therapy was associated with improved outcomes (overall survival mean, 82 vs. 32 months; p = 0.002). Pediatric CM remains highly lethal, with hydrocephalus a frequent and severe complication. High serum CF titers (≥1:16) predict poor outcomes, emphasizing the urgent need for standardized, pediatric-specific diagnosis and management guidelines. Full article

Background: Left ventricular thrombus (LVT) remains a well-recognized complication following myocardial infarction (MI). Whilst vitamin K antagonists (VKAs) have traditionally been the cornerstone of management, direct oral anticoagulants (DOACs) have been increasingly utilized despite limited data to support this. We sought to perform an up-to-date meta-analysis of all randomized controlled trials (RCTs) comparing DOACs to VKAs for LVT resolution. Methods: A systematic search of major scientific databases was performed to identify RCTs published until May 2025. The primary efficacy endpoint was complete LVT resolution at 3 months. The risk ratio (RR) and 95% confidence intervals (CIs) of the individual RCTs were pooled via the inverse-variance method and random-effects model. Results: Seven RCTs involving 554 patients with a mean age of 54 years were included in the meta-analysis. At 3 months, there was no difference in the rate of LVT resolution between those in the DOAC arm and the warfarin arm (86% vs. 81%, RR 1.01 [95%CI 0.93–1.10], p = 0.76). There was low heterogeneity at I² = 15%. There was no difference in major or clinically significant bleeding or in the composite of stroke or thromboembolic complications, although the 95%CIs were wide. Conclusions: DOACs appear to be comparable to warfarin in achieving LVT resolution at 3 months. These findings support the consideration of DOACs as alternatives to VKAs in selected patients for LVT resolution. Further adequately powered trials and head-to-head comparisons between DOACs are required to confirm their safety. Full article

Background/Objectives: The frozen elephant trunk (FET) technique is a cornerstone procedure for complex thoracic aortic pathologies. This single-center retrospective study evaluates early and midterm outcomes of total arch replacement (TAR) using three generations of the E-vita Open hybrid prosthesis over 11 years. Methods: From January 2013 to June 2024, 51 patients underwent TAR with the FET technique using the E-vita Open prostheses. Exclusion criteria were isolated ascending or descending aortic replacement, partial arch replacement, TAR without FET, and use of other stent grafts. We analyzed outcomes including in-hospital mortality, survival, stroke, spinal cord injury, and renal complications across three prosthesis generations. Results: The cohort included 52.9% males, with a mean age of 61.5 ± 10.51 years. FET as reoperation was performed in 52.9% patients. In-hospital mortality was 7.8% and, unexpectedly, only occurred with the newest E-vita Open Neo (23.5%), despite this being the latest generation. Overall survival was 72.5% at one year, 60.8% at two years, and 54.9% at three years. Stroke occurred in 17.6% with marked variation by pathology: 0% in dissection, 31.6% in aneurysm, and 13.6% in combined disease. Spinal cord injury occurred in 7.8%. Re-operation was a significant risk factor for complications and was strongly associated with renal complications (85.7% of dialysis patients) but not mortality. Secondary endovascular procedures were required in 49% of patients. Conclusions: The FET technique with E-vita Open prostheses demonstrates acceptable outcomes in high-risk patients with complex aortic pathologies. While perioperative morbidity is significant, particularly in reoperative cases, it varies significantly by underlying pathology and prosthesis generation, with unexpected trends suggesting that technological advancement does not automatically translate into improved outcomes. Despite this, the procedure enables comprehensive management of extensive aortic disease through a staged approach. Full article

Background: Diabetic foot ulcers (DFUs) affect approximately 15% of diabetic patients and are the leading cause of non-traumatic lower extremity amputations worldwide. This study examines trends in DFU management, predictors of major amputation and in-hospital mortality, and the impact of comorbidities on outcomes. Methods: Using the Nationwide Inpatient Sample (NIS) database (2016–2019), we analyzed non-elective admissions of DFU patients categorized into four treatment groups: no surgery, debridement, minor amputation, and major amputation (below-knee or above-knee). Statistical analyses identified factors associated with major amputation and mortality. Results: A significant increase in minor amputations and debridement was observed between 2016 and 2019, while the number of major amputations declined (p < 0.001). Comorbidities varied significantly by treatment type, with dyslipidemia (49.4–51.0%), chronic kidney disease (30.1–44.2%), and hypertension (32.9–47.0%) being the most prevalent (p < 0.001). Major amputation was associated with the highest rate of in-hospital mortality (1.00%) and the longest hospital stay (11.2 days) (p < 0.001). Logistic regression identified sepsis (OR = 4.9, 95% CI: 4.3–5.6), stroke (OR = 3, 95% CI: 2.1–5.5), and pulmonary embolism (OR = 3.7, 95% CI: 2–6) as key predictors of major amputation, while myocardial infarction (OR = 956, 95% CI: 319–2857) and sepsis (OR = 25, 95% CI: 20–29) were the strongest predictors of mortality (p < 0.001). Conclusions: These findings underscore the impact of comorbidities on DFU outcomes and emphasize the need for early intervention to reduce severe complications. Future research should focus on optimizing management strategies for high-risk patients to improve clinical and surgical outcomes. Full article

Introduction: Hypertrophic olivary degeneration (HOD) is a rare form of trans-synaptic degeneration involving the Guillain–Mollaret triangle, characterized by enlargement of the inferior olivary nucleus—unlike the atrophy typical of most neurodegenerative processes. It is usually associated with stroke, surgical injury, or demyelination, but rarely follows hemorrhage from a cavernous malformation (CM). This report presents a case of HOD secondary to a mesencephalic CM hemorrhage, with emphasis on imaging findings and diagnostic considerations. Case Description: A 55-year-old woman presented with acute-onset, right-sided facial, torso, and limb hypoesthesia, along with gait instability. Neurological examination revealed sensory impairment in the right maxillary (V2) and mandibular (V3) trigeminal territories, as well as diminished pain and temperature sensation throughout the right hemibody. MRI revealed a hemorrhage in the posterior mesencephalon near the left red nucleus, leading to the diagnosis of a CM with an associated venous angioma. She was managed conservatively and improved clinically. Six months later, MRI showed hypertrophy and T2/FLAIR hyperintensity of the left inferior olive, consistent with developing HOD. At 1.5 years follow-up, olivary enlargement had progressed—now consistent with stage 2 HOD—and a bilateral palatal tremor was observed, more pronounced on the right side. DTI revealed asymmetric volume loss in the left brainstem fiber pathways at the level of the medulla oblongata, confirming trans-synaptic degeneration. Conclusions: This case highlights HOD as a rare but important complication of mesencephalic CM hemorrhage. Recognition of its characteristic imaging features—olivary hypertrophy with persistent T2/FLAIR hyperintensity—is essential for accurate diagnosis. DTI supports the trans-synaptic mechanism, helping distinguish HOD from other pathologies and preventing unnecessary investigations. Full article

Background/Objectives: Microvascular complications are a major source of disability in type 2 diabetes mellitus (T2DM). We investigated whether body composition indices derived from multifrequency bioelectrical impedance analysis (BIA) independently predict neuropathy, retinopathy, nephropathy, and stroke, and whether they improve risk discrimination beyond the established clinical variables. Methods: In this cross-sectional analytical study (March 2024–February 2025), 124 adults with T2DM ≥ 12 months attending the outpatient diabetes clinic of the Universidad Técnica de Ambato (Ecuador) were enrolled. After an overnight fast and 15 min supine rest, thirteen whole-body BIA metrics including skeletal muscle mass (SMM), intracellular water (ICW), phase angle (PhA), and visceral fat area (VFA) were obtained with a segmental analyzer (InBody S10). Complications were ascertained with standard clinical and laboratory protocols. Principal component analysis (PCA) summarized the correlated BIA measures; multivariable logistic regression (adjusted for age, sex, diabetes duration, HbA1c, BMI, and medication use) generated odds ratios (ORs) per standard deviation (SD). Discrimination was assessed with bootstrapped receiver-operating characteristic curves. Results: The first principal component, driven by SMM, ICW, and PhA, accounted for a median 68% (range 65–72%) of body composition variance across all complications. Each SD increase in SMM lowered the odds of neuropathy (OR 0.54, 95% CI 0.41–0.71) and nephropathy (OR 0.70, 0.53–0.92), whereas VFA raised the risk of neuropathy (OR 1.55, 1.22–1.97) and retinopathy (OR 1.47, 1.14–1.88). PhA protected most strongly against stroke (OR 0.55, 0.37–0.82). Composite models integrating SMM, PhA, and adiposity indices achieved AUCs of 0.79–0.85, outperforming clinical models alone (all ΔAUC ≥ 0.05) and maintaining good calibration (Hosmer–Lemeshow p > 0.20). Optimal probability cut-offs (0.39–0.45) balanced sensitivity (0.74–0.80) and specificity (0.68–0.72). Conclusions: A lean tissue BIA signature (higher SMM, ICW, PhA) confers independent protection against neuropathy, retinopathy, nephropathy, and stroke, whereas visceral adiposity amplifies the risk. Because the assessment is rapid, inexpensive, and operator-independent, routine multifrequency BIA can be embedded into diabetes clinics to triage patients for early specialist referral and to monitor interventions aimed at preserving muscle and reducing visceral fat, thereby enhancing microvascular risk management in T2DM. Full article