2 Minute Medicine ® - Neonatal/Perinatal Medicine

1. In this randomized controlled trial, brigatinib reduced the size of progressively growing tumors in patients with neurofibromatosis type 2-related schwannomatosis (NF2-SWN) . 2. In participants receiving brigatinib, hearing improvement occurred in some patients according to the audiologic testing, while pain severity decreased according to self-reported data. Evidence Rating Level: 1 (Excellent) Study Rundown: NF2-SWN is a tumor-suppressor syndrome that predisposes individuals to developing schwannomas, meningiomas, and ependymomas...

1. Carriers of the E280A variant of presenilin 1 (PSEN1E280A) who were heterozygous for the apolipoprotein E3 Christchurch variant (APOE3Ch) had a lower median age of onset of cognitive impairment and dementia compared to those without APOE3Ch. 2. Carriers of PSEN1E280A with APOE3Ch heterozygosity had limited tau pathologic findings and fewer vascular amyloid pathologic features based on autopsy and positron-emission tomography (PET). Evidence Rating Level: 2 (Good) Study Rundown: Individuals with PSEN1E280A, which involves a glutamic acid to alanine mutation at codon 280 in the presenilin 1 gene, are almost certainly destined to develop autosomal dominant Alzheimer’s disease by their mid-to-late 40s...

1. Transcranial direct current stimulation (tDCS) led to improvement in the learning of complex rhythmic movements via stimulation of the primary motor cortex Evidence Rating Level: 1 (Excellent) Motor learning is a key component of everyday functioning from simple tasks like pressing a button to more complex, coordinated tasks like playing an instrument. Motor skills can be learned during a single practice session (online) or after the session (offline). Various areas of the brain a responsible for motor learning depending on the task...

1. Treating intracerebral hemorrhage (ICH) with endoscopic evacuation or stereotactic aspiration results in more favourable outcomes 2. Stratifying outcomes by location of hemorrhage shows endoscopy and aspiration are preferred for supratentorial deep hemorrhages whereas no significant difference is seen in supratentorial lobar hemorrhages Evidence Rating Level: 1 (Excellent) Intracerebral hemorrhage (ICH) is the deadliest type of acute stroke. It is treated with small-bone flap craniotomy, endoscopic evacuation, or stereotactic aspiration...

1. In this randomized controlled trial, using the video laryngoscope significantly increased the success of first-attempt intubation in neonates compared to direct laryngoscopes. 2. Lowest oxygen saturation levels recorded were also higher with video laryngoscope use.  Evidence Rating Level: 1 (Excellent) Study Rundown: Typically when neonates are intubated, it is on an urgent basis, such as when they are experiencing respiratory failure in the neonatal intensive care unit (NICU) or the delivery room. Neonates who undergo repeated endotracheal intubation attempts have associations with greater adverse events, including severe oxygen desaturation and bradycardia...

1. In this randomized controlled trial, the body-fat percentage among preterm infants was similar between those who received parenteral nutrition and those who received dextrose solution. 2. The time to full enteral feeding was similar between preterm infants who received smell and taste exposure before gastric-tube feeding versus those who did not. Evidence Rating Level: 1 (Excellent) Study Rundown: Moderate-to-late-preterm infants, defined as infants born between 32 weeks zero days and 36 weeks six days gestation, are at increased risk for adverse health outcomes, including developmental delay, cardiometabolic disease, and death...

1. In this randomized controlled trial, patients with stroke symptoms who were given antihypertensives en route to the hospital did not have superior outcomes compared to those whose blood pressure management was postponed until the hospital.  2. Serious adverse events did not differ significantly between the two groups . Evidence Rating Level: 1 (Excellent) Study Rundown: Intracranial hemorrhage volume is one of the strongest predictors of functional outcomes after hemorrhagic stroke, which makes limiting hematoma expansion a critical treatment goal of standard bundled-care protocols...

1. Fewer patients in the decompressive craniectomy group had an mRS score of 5-6 compared to medical treatment alone, although this difference was not statistically significant. 2. Severe adverse events were comparable between both groups. Evidence Rating Level : 1 (Excellent) Study Rundown: Spontaneous intracerebral hemorrhage is commonly associated with strokes worldwide. Although decompressive craniectomy reduces mortality in people with large vessel infarction, its role in the management of severe deep supratentorial intracerebral hemorrhage remains unclear...

1. Adults with chronic low back pain (CLBP) randomized into a 6-week pain intervention education program were observed to have significantly relieved burden of pain-related disability and overall pain intensity when combined with the physiotherapeutic standard of care. 2. Measures of self-reported well being also improved significantly more in the pain education group compared to the control group.  Evidence Rating Level: 1 (Excellent) Chronic low back pain (CLBP) is a pervasive condition contributing significantly to pain-related disability worldwide...

1. Female infants had a greater association between experiences of early-life pain and altered neural connectivity as observed via magnetic resonance imaging.  2. Worse neurodevelopmental outcomes were associated with decreased brain connections.  Evidence Rating Level: 1 (Excellent) Study Rundown: Premature neonates are often subject to various lifesaving procedures. While receiving this care, they experience a period of rapid brain maturation, which may be vulnerable to environmental factors such as pain...

1. In post-stroke patients, endovascular thrombectomy (EVT) was associated with favourable outcomes on 5 separate cognitive tests that showed benefits to global cognitive function.  Evidence Rating Level: 2 (Good)  Endovascular thrombectomy (EVT) is a highly effective treatment for large vessel occlusion strokes that can improve functional neurologic outcomes. While EVT reduces infarct volume, cognitive outcomes have not been well-studied. To validate the quality of EVT therapy, patients were randomized to be treated either with the standard medical therapy or with standard medical therapy and EVT...

1. Serum neurofilament light chain (sNfL) elevations are a relatively specific biomarker of magnetic resonance imaging (MRI) disease activity in multiple sclerosis (MS) (82%–91.9% specificity) but have a low sensitivity (27.9%–42.6% sensitive) 2. Peak increase in sNfL was observed at an average of 9 weeks after the first Gd+ lesion was seen and remained high after resolution of Gd+ lesions in many participants.  Evidence Rating Level: 1 (Excellent)  Magnetic resonance imaging (MRIs) have been validated and included in the international guidelines for use as a prognostic marker in multiple sclerosis (MS)...

1. In this randomized controlled trial, l ixisenatide reduced motor disability progression in Parkinson’s patients . 2. Individuals in the lixisenatide group experienced greater gastrointestinal side effects rates than individuals in the placebo group. Evidence Rating Level: 1 (Excellent) Study Rundown: Dopaminergic replacement therapy has been used as the main treatment for Parkinson’s disease. However, it has been found to treat only the symptoms, not the progression. Some studies have shown an association between Parkinson’s disease and type 2 diabetes...

1. In this dose-escalation study, using intrathecal gene transfer with scAAV9/JeT-GAN demonstrated potential improvement in motor function. 2. Adverse events related to gene therapy included scoliosis, urinary tract infections, and upper respiratory tract infections. Evidence Rating Level: 2 (Good) Study Rundown: Giant axonal neuropathy is an autosomal recessive neurodegenerative disorder that results from loss of function mutations in the gene that codes for gigaxonin ( GAN ). Gigaxonin regulates the turnover of intermediate filaments, thus when it is absent, there is an accumulation of intermediate filaments leading to abnormal axonal swellings...

1. In this retrospective cohort study, exposure to antiseizure medications was associated with a higher incidence of autism spectrum disorder (ASD) compared to general population data. 2. Restricted to children born to mothers with epilepsy, valproate, but not topiramate and lamotrigine, was associated with an increased risk of ASD compared to no medication exposure. Evidence Rating Level: 2 (Good) Study Rundown: Most female adults with epilepsy receive antiseizure medications throughout pregnancy. Prenatal exposure to valproate is associated with neurodevelopmental disorders such as ASD and attention deficit hyperactivity disorder...

1. In this randomized controlled trial, patients who underwent minimally invasive surgical evacuation of a hematoma followed by medical management had lower disability scores than those who received medical management alone. 2. This effect was attributable primarily to intervention for lobar hemorrhages rather than hemorrhages in the basal ganglia. Evidence Rating Level: 1 (Excellent) Study Rundown: While evacuation of intracranial hematoma has many theoretical benefits, such as intracranial pressure reduction and secondary injury mitigation, randomized controlled trials of both conventional craniotomy and minimally invasive options have demonstrated largely mixed results concerning functional outcomes...

1. Patients in the thrombectomy plus medical care group reported a significantly lower mRS score at the 1-year follow-up compared to those in the medical care alone group. 2. 1-year mortality in the thrombectomy group was lower than in the medical care alone group. Evidence Rating Level: 1 (Excellent) Study Rundown: Endovascular thrombectomy is known to have good clinical outcomes in patients with ischemic stroke. However, limited data exists regarding its long-term efficacy. This randomized controlled trial aimed to compare the safety and efficacy of endovascular thrombectomy plus medical care versus medical care alone in patients with large-vessel occlusion...

1. Tissue density in the left caudate nucleus was significantly decreased in infants whose mothers had elevated pre-pregnancy body-mass indexes (BMI).  Evidence Rating Level: 2 (Good) Parental obesity, particularly maternal obesity prior to pregnancy, has been identified as a risk factor for offspring obesity by means of both heritable and environmental influences. The mechanisms by which this is thought to take place are complex and varied, but alterations in functioning of neurotransmitter signalling are believed to contribute...

1. In this large population-based study of adults in South Korea, there was an increased risk of developing encephalitis within 28 days of COVID-19 vaccination only for those who received the AstraZeneca (ChAdOx1-S) vaccine, but no increased risk of developing meningitis post-vaccination.  Evidence Rating Level: 2 (Good) Over 5.5 billion people worldwide have received at least one dose of a COVID-19 vaccine. Encephalitis and meningitis have been reported as rare but serious adverse events of special interest (AESIs)...

1. In a cohort of patients with traumatic brain injury, early fixation of extremity fractures within 24 hours of injury was not associated with greater rates of unfavourable functional outcomes at 6 months.  Evidence Rating: 2 (Good)  While extremity fractures are commonly seen in conjunction with traumatic brain injury (TBI), the ideal timing of fixation and definitive treatment of these fractures remain controversial. On one hand, there are those who argue in favour of earlier fixation to promote a shorter recovery course and decreased complication rates...