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Stacey P, Mensinkai A, Bansal P, Hosseini SH, Lavigne A, Gwardjan B, Leylachian S, Deng Z(J, Chari V, Giles S, Nesathurai S. Using Nutraceuticals to Help Manage Traumatic Spinal Cord Injury. Pharmaceuticals (Basel) 2024; 17:71. [PMID: 38256904 PMCID: PMC10820888 DOI: 10.3390/ph17010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/26/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Traumatic spinal cord injury (TSCI) is a significant public health challenge that has an adverse impact on functional independence, quality of life, and life expectancy. Management of people's chronic conditions is a key aspect of contemporary medical practice. Our study was an open label, single arm, prospective pilot study to evaluate the feasibility of treating people with TSCI. The study intervention was treatment with oral selenium and vitamin E. Participants were 18 years or older and experienced a TSCI at least one year prior to enrollment. Daily doses of 50 mcg of selenium and 400 IU of vitamin E were administered. Participants had radiologic (MRI tractography) and clinical (ASIA) assessments prior to initiating treatment, and these assessments were repeated after one year of treatment. Four subjects completed the full twelve-month study. Adherence, based on pill counts, was approximately 75% in all subjects. There were no adverse events related to study medications. During the treatment period, subjects reported improvement in certain symptoms. There was no significant difference in ASIA scores before and after the intervention. Combination treatment with vitamin E and selenium has been demonstrated as safe for TSCI patients. It is possible to use DTI values to locate the epicenter of a lesion as well as gauge the extent of injury. MRI tractography may serve as a meaningful surrogate endpoint. The results of this study suggest that it is feasible to conduct a larger long-term clinical trial to evaluate the efficacy of combination treatment of TSCI.
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Affiliation(s)
- Paul Stacey
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Arun Mensinkai
- Department of Diagnostic Imaging, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
- Department of Medical Imaging, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Pankaj Bansal
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Seyed-Hossein Hosseini
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Andrew Lavigne
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Basia Gwardjan
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Sayna Leylachian
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Zhihui (Joy) Deng
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Vinjamuri Chari
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Sandra Giles
- Department of Medical Imaging, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Shanker Nesathurai
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
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Mrkobrada M, Chan MTV, Cowan D, Spence J, Campbell D, Wang CY, Torres D, Malaga G, Sanders RD, Brown C, Sigamani A, Szczeklik W, Dmytriw AA, Agid R, Smith EE, Hill MD, Sharma M, Sharma M, Tsai S, Mensinkai A, Sahlas DJ, Guyatt G, Pettit S, Copland I, Wu WKK, Yu SCH, Gin T, Loh PS, Ramli N, Siow YL, Short TG, Waymouth E, Kumar J, Dasgupta M, Murkin JM, Fuentes M, Ortiz-Soriano V, Lindroth H, Simpson S, Sessler D, Devereaux PJ. Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: a prospective international cohort study. BMJ Open 2018; 8:e021521. [PMID: 29982215 PMCID: PMC6042543 DOI: 10.1136/bmjopen-2018-021521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac surgery.NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function. SETTING AND PARTICIPANTS We are recruiting study participants from 12 tertiary care hospitals in 10 countries on 5 continents. PARTICIPANTS We are enrolling patients ≥65 years of age, requiring hospital admission after non-cardiac surgery, who have an anticipated length of hospital stay of at least 2 days after elective non-cardiac surgery that occurs under general or neuraxial anaesthesia. PRIMARY AND SECONDARY OUTCOME MEASURES Patients are recruited before elective non-cardiac surgery, and their cognitive function is measured using the Montreal Cognitive Assessment (MoCA) instrument. After surgery, a brain MRI study is performed between postoperative days 2 and 9 to determine the presence of acute brain infarction. One year after surgery, the MoCA is used to assess postoperative cognitive function. Physicians and patients are blinded to the MRI study results until after the last patient follow-up visit to reduce outcome ascertainment bias.We will undertake a multivariable logistic regression analysis in which the dependent variable is the change in cognitive function 1 year after surgery, and the independent variables are acute perioperative covert stroke as well as other clinical variables that are associated with cognitive dysfunction. CONCLUSIONS The NeuroVISION study will characterise the epidemiology of covert stroke and its clinical consequences. This will be the largest and the most comprehensive study of perioperative stroke after non-cardiac surgery. TRIAL REGISTRATION NUMBER NCT01980511; Pre-results.
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Affiliation(s)
| | | | - David Cowan
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - David Torres
- Clinica Santa Maria, Universidad de Los Andes, Santiago, Chile
| | | | | | - Carl Brown
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Ronit Agid
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Manas Sharma
- University of Western Ontario, London, Ontario, Canada
| | | | - Scott Tsai
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | - Shirley Pettit
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Ingrid Copland
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Simon C H Yu
- Chinese University of Hong Kong, Hong Kong, China
| | - Tony Gin
- Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | | | | | | | | | - John M Murkin
- University of Western Ontario, London, Ontario, Canada
| | - Maite Fuentes
- Clinica Santa Maria, Universidad de Los Andes, Santiago, Chile
| | | | | | - Sara Simpson
- University of British Columbia, Vancouver, British Columbia, Canada
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Koziarz A, Aref M, Vinh B, Mensinkai A, Almenawer SA, Reddy K. Sublaminar wire migration into the medulla oblongata: a case report. J Spine Surg 2017; 3:267-271. [PMID: 28744511 DOI: 10.21037/jss.2017.05.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atlantoaxial procedures have been developed in an effort to ensure solid C1-C2 fusion. However, techniques that involve sublaminar wiring have the potential for neural structure injury. We present the management of a patient who previously underwent Gallie fusion 10 years ago and is presenting with a dislodged titanium wire that has migrated into the medulla oblongata. A 52-year-old female patient known with rheumatoid arthritis presented with truncal ataxia and food regurgitation 10 years after undergoing a C1-C2 Gallie fusion. A computerized tomography (CT) scan revealed that a wire from her Gallie fusion procedure migrated into the medulla oblongata. The patient underwent foramen magnum decompression with C1 bilateral laminectomy, instrumentation, and removal of a migrated wire. Six months later, a CT scan showed that all occipital screws were pulled out. In the revision surgery, new occipital screws were placed with a resultant significant improvement in patient's gait postoperatively. Wire migration as a differential diagnosis should be considered in patients presenting with neurological dysfunction who underwent surgical treatment with sublaminar wire fusion techniques.
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Affiliation(s)
- Alex Koziarz
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Mohammed Aref
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Brian Vinh
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Arun Mensinkai
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Saleh A Almenawer
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
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