Can dynamic and static pupillary responses be used as an indicator of autonomic dysfunction in patients with obstructive sleep apnea syndrome?

Purpose

We aimed to reveal whether static and dynamic pupillary responses can be used for the detection of autonomic nervous system (ANS) dysfunction in patients with obstructive sleep apnea syndrome (OSAS).

Methods

We included in this study patients with OSAS, who were divided into three groups according to the apnea–hypopnea index (AHI) (group 1, mild [n?=?20]; group 2, moderate [n?=?20]; and group 3, severe [n?=?20]), and healthy controls (group 4, n?=?20). Pupillary responses were measured using a pupillometry system.

Results

Static (mesopic PD, P?=?0.0019; low photopic PD, P?=?0.001) and dynamic pupil responses (resting diameter, P?=?0.004; amplitude of pupil contraction, P?<?0.001; duration of pupil contraction, P?=?0.022; velocity of pupil contraction, P?=?0.001; and velocity of pupil dilation, P?=?0.012) were affected in patients with different OSAS severities. Also, AHI was negatively correlated with mesopic PD (P?=?0.008), low photopic PD (P?=?0.003), resting diameter (P?=?0.001), amplitude of pupil contraction (P?<?0.001), duration of pupil contraction (P?=?0.011), velocity of pupil contraction (P?<?0.001), and velocity of pupil dilation (P?=?0.001).

Conclusion

We detected pupil responses innervated by the ANS were affected in the OSAS patients. This effect was more significant in the severe OSAS patients. Therefore, the pupillometry system can be an easily applicable, noninvasive method to detect ANS dysfunction in the OSA patients.

     

Digoxin intoxication: An old enemy in modern era

Objectives Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era. Methods We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients. Results Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%. Conclusion This report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.     

Effects of diode laser photocoagulation treatment on ocular biometric parameters in premature infants with retinopathy of prematurity

AIM:To investigate the effects of diode laser treatment on ocular biometric parameters in premature infants with retinopathy of prematurity(ROP).METHODS:Premature infants who received diode laser treatment for ROP(n=68)and premature infants with spontaneous regressed ROP without treatment(n=50)were performed longitudinal ocular biometric measurements including anterior chamber depth,lens thickness and axial length as follows:1 d prior to laser treatment,and 3,6,9,and 12 mo after the laser treatment.RESULTS:The mean birth weight,gestational age and initial examination time values were 936.53±302.07 g,26.66±2.42 wk,36.26±2.73 wk in the treatment group and 959.78±260.08 g,27.28±2.10 wk,36.56±2.54 wk in the control group.There was no statistically significant difference in these demographic characteristics of the groups.Anterior chamber depth,lens thickness and axial length demonstrated statistically significant linear increases during the study period in the two groups(P<0.001 for each).There were no statistically significant differences between the two groups in terms of anterior chamber depth after laser treatment.Measurements of the lens thickness at 9 th and 12 th months(9 th month 3.70±0.22 vs 3.60±0.21 mm,P=0.017;12 th month 3.81±0.21 vs 3.69±0.22 mm,P=0.002)and the axial length at 12 th month(19.35±0.79 vs 19.13±0.54 mm,P=0.031)after laser treatment were statistically higher in the treatment group.CONCLUSION:Diode laser retinal photocoagulation treatment in premature infants seems to increase the lens thickness and axial length.     

Constricting wide abdominal burn scar and pregnancy

Abdominal burn scars and pregnancy are rare in literature. Loss of normal skin ability to stretch, scar-related uterine displacement, and maternal discomfort especially on the second half of pregnancy are the main problems. We present a case report of pregnancy with an abdominal burn scar due to scalded burn injury. Although the abdominal scar was constricting the abdominal wall severely, intensive follow-up of the pregnancy culminated in a healthy newborn via cesarean. There was enough expansion over the abdominal wall including the scar for a healthy delivery without any need for an operation. Level of Evidence: Level V, therapeutic study.     

Comparison of microscopic (pT3a) and gross extravesical extension (pT3b) in pathological staging of bladder cancer: analysis of patient outcomes

Objective

To determine the prognostic value of pT3 bladder urothelial carcinoma substaging in patients without lymphatic involvement.

Patients and methods

Pathologic and clinical data were reviewed on patients who underwent radical cystectomy for urothelial carcinoma between 1991 and 2010. Of the 460 reviewed patients, 74 patients were diagnosed with pathologic T3No urothelial carcinoma of the bladder. The impact of pathologic substaging (pT3a vs. pT3b) was examined to determine the effect on overall and disease-specific survival.

Results

Five years disease-specific and overall survival rates were 46.9 % and 39.6 % for patients with pT3aNo tumor, whereas these ratios were 34.4 and 30.3 %, respectively, for patients with pT3bNo tumor (p > 0.05). Mean disease-specific survival time was 43.94 ± 6.50 months for pT3aNo, while it was 39.01 ± 7.19 months for pT3bNo (p = 0.539). In multivariate cox regression analysis, age (p = 0.459), gender (p = 0.710), urinary diversion type (p = 0.088), and pT3 substaging (p = 0.554) were not noticed as an independent predictive factor for survival.

Conclusion

Macroscopic extravesical extension (pT3b) is not associated with a worse outcome than pT3a disease in lymph node-negative cases of bladder urothelial carcinoma.     

Obstruction of mechanical mitral valves by preserved posterior leaflet remnants

We report two cases of mechanical prosthetic mitral valve obstruction caused by remnants of the mitral valve posterior leaflet tissue preserved from the previous surgery. Both patients had rheumatic mitral stenosis causing New York Heart Association class III symptoms prior to mitral valve replacement.     

Parenting Styles,Parenting Stress and Hours Spent Online as Predictors of Child Internet Addiction Among Children with Autism

Journal of Autism and Developmental Disorders - The current study examined the association between hours spent online (HOS), positive parenting, negative parenting, autism parental stress and...