Vertebral artery injuries account for approximately 19% of cerebral vascular injuries and are typically managed conservatively. However, some patients require operative intervention to gain control of an active hemorrhage, either via surgical ligation or endovascular intervention. We present a case of iatrogenic vertebral artery injury occurring during cervical spine surgery which was treated emergently with a self-expanding covered stent. A 58-year-old male presented for cervical traction, C5 and C6 corpectomy, and possible C4 to T2 posterior fusion following a motor vehicle accident. Intraoperatively, following drilling the C5 endplate, copious bleeding was observed from injury to the right vertebral artery resulting in pseudoaneurysm formation. The patient was loaded with ticagrelor and a self-expanding covered stent was placed via a transfemoral approach, resulting in obliteration of the pseudoaneurysm prior to completion of his cervical spine surgery. Emergent self-expanding covered stent placement for iatrogenic vertebral artery injury in the setting of an intraoperative injury is a safe and effective option. Ticagrelor is a viable alternative to traditional dual antiplatelet therapy for preventing thromboembolic complications in this urgent setting.

Vertebral artery injuries account for approximately 19% of cerebral vascular injuries and are typically managed conservatively. However, some patients require operative intervention to gain control of an active hemorrhage, either via surgical ligation or endovascular intervention. We present a case of iatrogenic vertebral artery injury occurring during cervical spine surgery which was treated emergently with a self-expanding covered stent. A 58-year-old male presented for cervical traction, C5 and C6 corpectomy, and possible C4 to T2 posterior fusion following a motor vehicle accident. Intraoperatively, following drilling the C5 endplate, copious bleeding was observed from injury to the right vertebral artery resulting in pseudoaneurysm formation. The patient was loaded with ticagrelor and a self-expanding covered stent was placed via a transfemoral approach, resulting in obliteration of the pseudoaneurysm prior to completion of his cervical spine surgery. Emergent self-expanding covered stent placement for iatrogenic vertebral artery injury in the setting of an intraoperative injury is a safe and effective option. Ticagrelor is a viable alternative to traditional dual antiplatelet therapy for preventing thromboembolic complications in this urgent setting.

BACKGROUND/AIMS: Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied. METHODS: We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors. RESULTS: Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007). CONCLUSIONS: Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure.
Barrett Esophagus ; Constriction, Pathologic ; Deglutition Disorders ; Endoscopy ; Esophageal Stenosis* ; Follow-Up Studies ; Humans ; Logistic Models ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers

Aluminium exposure has been linked with developmental neurotoxicity in humans and experimental animals. The study aimed to evaluate the ameliorative effect of Tamarindus indica on the developing cerebellar cortex, neurobehavior, and immunohistochemistry of the cerebellar cortex following prenatal aluminum chloride (AlCl 3 ) exposure. Pregnant timed Wistar rats were divided into 5 groups (n=4). Group I (negative control) was given distilled water, group II was treated with 200 mg/kg of AlCl 3 , group III were given 200 mg/kg of AlCl 3 and 400 mg/kg of ethyl acetate leaf fraction of Tamarindus indica (EATI), group IV were given 200 mg/kg of AlCl 3 and 800 mg/kg of EATI, and group V were treated with 200 mg/kg of AlCl 3 s/c and 300 mg/kg of vitamin E for 14 days (prenatal day 7–21) via the oral route. Male pups (n=6) were randomly selected and taken for neurobehavioral studies, and humanely sacrificed via intraperitoneal injection of thiopental sodium. The cerebellum was removed, fixed and tissue processed for histological and immunohistochemical studies. The results revealed that prenatal AlCl 3 exposure impacted neurodevelopment and neurobehaviour among exposed pups. Prenatal AlCl 3 exposure was marked with delayed cytoarchitectural development of the cerebellar cortex and increased GFAP expression in the cerebellar cortex. On the other hand, treatment with EATI and vitamin E were marked with significant improvements. The present study therefore concluded treatment with EATI shows an ameliorative effect to prenatal AlCl 3 exposure.

OBJECTIVE: The study aimed to evaluate the sound pressure levels of selected traffic enforcer sites in the City of Manila.

METHODOLOGY: A Brüel & Kjær Integrating Sound Level Meter type 2225 was used to measure sound pressure levels in dB(A) to estimate personal noise exposure of traffic enforcers designated at Quezon Boulevard near Quiapo Church and Recto - Rizal Avenue on a weekday and a weekend. Graphs were generated while appropriate measures were calculated for the noise exposure levels. The mean exposure levels were compared with the Philippine Occupational Safety and Health standards by computing the corresponding permissible exposure limit for each work shift using the Equal Energy Principle.17

RESULTS: Noise exposure levels at Quezon Boulevard ranged from 75.0 dB(A) to 91.5 dB(A) with mean noise exposure level of 84.3 ± 3.7 dB(A) and 82.5 ± 2.6 dB(A) for the weekday AM and PM shift, respectively. The mean noise exposure level at Quezon Boulevard for the weekend AM shift was 82.4 ± 2.6, whereas 80.4 ± 2.8 for the PM shift. The noise exposure levels at Recto - Rizal Avenue ranged from 81.5 dB(A) to 99.3 dB(A) with mean noise exposure level of 86.7 ± 2.6 dB(A) and 86.0 ± 2.1 dB(A) for the weekday AM and PM shift, respectively. The mean noise exposure level at Recto - Rizal Avenue for the weekend AM shift was 86.7 ± 2.3, whereas 89.0 ± 4.0 for the PM shift.

CONCLUSION: The study showed that traffic enforcers designated at Quezon Boulevard and Recto - Rizal Avenue are exposed to noise levels that do not exceed the Philippine Occupational Safety and Health standards.

Background: and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. Methods: This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6–24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0–2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality. Results: Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0–2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49–1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44–1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20–1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0–2 (aOR 0.99, 95% CI 0.96–1.01, for each hour delay) among patients presenting <24 hours. Conclusion EVT for acute TL-LVO treated within 6–24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.