Background: Hemorrhage from brain arteriovenous malformations (bAVMs) is estimated at 3% per annum. Features influencing risk of hemorrhage include perforator/posterior circulation supply, associated aneurysms, and deep drainage. Children are more likely to present with bAVM bleeds.
Objective: To analyze differences in bAVM angioarchitecture between children and adults and describe predictors of poor outcome.
Methods: Data were collected from adult and pediatric tertiary referral hospitals. Demographic data, bleed location, treatment, and follow-up modified Rankin Scale (mRS) were collected. Angioarchitectural assessment included aneurysm presence, nidus morphology, perinidal angiogenesis, intranidal shunting, steal phenomenon, venous ectasia, venous stenosis, venous reflux, and pseudophlebitic pattern. Regression analyses conducted to determine predictors of mRS > 2.
Results: A total of 270 adult and 135 pediatric ruptured bAVMs were assessed. Median age was 42 (adults) and 10.9 (children) yr. Intranidal aneurysms were more frequent in children (P = .012), whereas prenidal aneurysms were more common in adults (P < .01). Children demonstrated more perinidal angiogenesis (P = .04), whereas steal phenomenon was commoner in adults (P < .01). Venous ectasia (P < .01), reflux (P < .01), and pseudophlebitic pattern (P = .012) were more frequent in adults. Children had better outcome (mRS score ≤ 2) (P < .01). Older age (odds ratio [OR] = 1.02), eloquent location (OR = 2.5), multicompartmental hemorrhage (OR = 1.98), venous reflux (OR = 2.5), diffuse nidus (OR = 1.83), pseudophlebitic pattern (OR = 1.96), intranidal shunts (OR = 2), and no treatment (OR = 3.68) were significant predictors of mRS > 2.
Conclusion: Children are more likely to have intranidal aneurysms and perinidal angiogenesis, whereas adults have more prenidal aneurysms, venous ectasia, corticovenous reflux, and pseudophlebitic pattern. Eloquent location, diffuse nidus, intranidal shunts, venous reflux, and pseudophlebitic pattern predict poorer outcome.
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http://dx.doi.org/10.1093/neuros/nyab251 | DOI Listing |
Biol Trace Elem Res
December 2024
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Previous studies have proved trace mineral disorders to be related to changes in oxidative stress, inflammatory state, and immune response in asthmatics. However, there is a scarcity of studies that examine the correlation between copper intake with mortality in asthmatic people. The aim of this research was to investigate the effect of copper intake on the asthmatic population's mortality.
View Article and Find Full Text PDFEur J Pediatr
December 2024
Interdisciplinary Department of Medicine, Pediatric Section, Children's Hospital 'Giovanni XXIII', University of Bari "Aldo Moro", 70126, Bari, Italy.
BMC Health Serv Res
December 2024
School of Public Health, Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda.
Background: Loss to follow-up (LTFU) of patients with presumed tuberculosis (TB) before completing the diagnostic process (pre-diagnosis LTFU) and before initiating treatment for those diagnosed (pre-treatment LTFU) is a challenge in the realization of the End TB Strategy. We assessed the proportion of pre-diagnosis and pre-treatment LTFU and associated factors among patients with presumed TB and those diagnosed in the selected health facilities.
Methods: This was a retrospective cohort study involving a review of routinely collected data from presumptive, laboratory and TB treatment registers from January 2019 to December 2022.
Am J Med Genet A
December 2024
Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Diamond Blackfan anemia (DBA) is an autosomal dominant disorder with a heterogeneous clinical presentation which may include macrocytic anemia typically presenting in the first year of life, growth retardation, and congenital malformations in 30%-50% of patients. This phenotypic variability is partially explained by genotype-phenotype correlations, with several ribosomal protein genes implicated in this disorder. Most cases are due to de novo variants, but familial occurrences highlight variable expressivity and reduced penetrance.
View Article and Find Full Text PDFJ Pediatr Urol
December 2024
Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA; Pediatric Urology Research Enterprise, Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA.
Background: Significant efforts have been undertaken to decrease opioid prescribing, but there is little research into patient-specific factors presenting as barriers in the pediatric surgical population. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be a safe and effective alternative to opioids for pain control, however, concerns about their impact on renal function limit their use in patients with chronic kidney disease (CKD). Data is limited on the interplay of CKD on opioid prescribing.
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