Montelukast for bronchiolitis obliterans syndrome after lung transplantation: a pilot study

Bronchiolitis obliterans syndrome (BOS) remains the major hurdle to improve long‐term survival after lung transplantation, as its treatment remains troublesome. In this pilot study, we investigated the effect of montelukast (a leukotriene receptor antagonist) on the FEV₁ decline after diagnosis of BOS and compared this with a control group. In both groups, 11 patients were included with BOS stage <3 and bronchoalveolar lavage (BAL) neutrophilia <15%, already being treated or concurrently being started on azithromycin. Control patients were selected retrospectively. After adding montelukast (10 mg/day) to the immunosuppressive regimen, the FEV₁ decline significantly decreased from 112 ± 26 ml/month before BOS diagnosis to 13 ± 13 ml/month after 6 months of montelukast therapy (P = 0.001). In the control group, there was no significant change in the rate of FEV₁ decline: 103 ± 20 ml/month before BOS diagnosis to 114 ± 27 ml/month (P = 0.55). Adding montelukast may be a promising treatment option in patients with low neutrophilic (<15%) BOS after lung transplantation, already or concurrently being treated with azithromycin.     

Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review

The effectiveness of surgery in patients with sciatica due to lumbar disc herniations is not without dispute. The goal of this study was to assess the effects of surgery versus conservative therapy (including epidural injections) for patients with sciatica due to lumbar disc herniation. A comprehensive search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to October 2009. Randomised controlled trials of adults with lumbar radicular pain, which evaluated at least one clinically relevant outcome measure (pain, functional status, perceived recovery, lost days of work) were included. Two authors assessed risk of bias according to Cochrane criteria and extracted the data. In total, five studies were identified, two of which with a low risk of bias. One study compared early surgery with prolonged conservative care followed by surgery if needed; three studies compared surgery with usual conservative care, and one study compared surgery with epidural injections. Data were not pooled because of clinical heterogeneity and poor reporting of data. One large low-risk-of-bias trial demonstrated that early surgery in patients with 6–12 weeks of radicular pain leads to faster pain relief when compared with prolonged conservative treatment, but there were no differences after 1 and 2 years. Another large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2 years. Future studies should evaluate who benefits more from surgery and who from conservative care.     

COMT Val158Met-stress interaction in psychosis: role of background psychosis risk

Background: The interplay between the catechol‐O‐methyltransferase (COMT) Val158Met polymorphism and environmental stress may have etiological relevance for psychosis, but differential effects have been reported in healthy control and patient groups, suggesting that COMT Val158Met interactions with stress may be conditional on background genetic risk for psychotic disorder. Methods: Patients with a nonaffective psychotic disorder (n = 86) and control participants (n = 109) were studied with the experience sampling method (a structured diary technique) in order to assess stress, negative affect and momentary psychotic symptoms in the flow of daily life. Results: Multilevel analyses revealed significant three‐way interactions between group status (patient or control), COMT genotype and stress in the model of negative affect (χ²(2) = 13.26, P < 0.01) as well as in the model of momentary psychotic symptoms (χ²(2) = 6.92, P < 0.05). Exploration of the three‐way interaction revealed that in patients, COMT genotype moderated the association between stress and negative affect (χ²(4) = 11.50, P < 0.005), as well as the association between stress and momentary psychosis (χ²(4) = 12.79, P < 0.005). Met/Met genotype patients showed significantly increased psychotic and affective reactivity to stress in comparison to the Val/Met and Val/Val genotypes. In contrast, healthy controls did not display large or significant COMT Val158Met X stress interactions. Conclusions: Important differences exist in the effect of COMT Val158Met on stress reactivity, which may depend on background risk for psychotic disorder. Differential sensitivity to environmental stress occasioned by COMT Val158Met may be contingent on higher order interactions with genetic variation underlying psychotic disorder.     

A comprehensive in vitro study of image accuracy and quality for periodontal diagnosis. Part 2: The influence of intra-oral image receptor on periodontal measurements

The aim of the study was to determine the image receptors' influence on exposure levels, image accuracy, and quality for periodontal diagnosis. Periodontal defects from cadaver specimens were imaged using two intra-oral conventional films (E-, F/E-speed), four indirect receptors (Digora 8 bit, Vistascan 12 bit with/without filter, Vistascan 16 bit), and two solid-state sensors (Sigma 12 bit, VistaRay 14 bit) at rising exposure (20–160 ms). Three observers assessed the standardized radiographs for alveolar bone measurements (1,732, 31 sites) and for subjective rating of lamina dura, contrast, trabecularization, crater, and furcation involvements. The measurements were compared to the gold standard. For the imaging plates, highest measurement accuracy was found with Vistascan 16 bit (100% within 0.5 mm) and for solid-state sensors with VistaRay 14 bit (100%, 0.5 mm), although the latter are mostly not significantly different. Higher contrast resolution imaging plates require up to 50% less exposure time, but for solid-state sensors, the dose remains unchanged. For the latter, a higher bit depth does seem to provide more accurate depiction of the alveolar crest, counteracting blooming artifacts. The use of a dedicated periodontal filter contributes to higher accuracy at all exposure times (p < 0.05–0.0001). Accuracy of periodontal diagnosis increases with higher contrast resolution. Digital exposure levels are thus dependent of image receptor as well as X-ray generator.     

Methodological quality of studies on the measurement properties of neck pain and disability questionnaires: a systematic review

Objective

The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed.

Methods

A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study.

Results

A total of 47 articles were included on the measurement properties of 8 different questionnaires. The methodological quality of the included studies was adequate on some aspects (often, adequate statistical analyses are used for assessing reliability, measurement error, and construct validity) but can be improved on other aspects. The most important methodological aspects that need to be improved are as follows: assessing unidimensionality in internal consistency analysis, stable patients and similar test conditions in studies on reliability and measurement error, and more emphasis on the relevance and comprehensiveness of the items in content validity studies. Furthermore, it is recommended that studies on construct validity and responsiveness should be based on predefined hypotheses and that better statistical methods should be used in responsiveness studies.

Conclusion

Considering the importance of adequate measurement properties, it is concluded that, in the field of measuring neck pain and disability, there is room for improvement in the methodological quality of studies measurement properties.     

Randomized, crossover study evaluating patient preference and the impact on quality of life of urisheaths vs absorbent products in incontinent men

Study Type – Therapy (RCT) Level of Evidence 1b

OBJECTIVE

• ? To evaluate the impact of urisheaths vs absorbent products (APs) on quality of life (QoL) in men with moderate to severe urinary incontinence (UI).

PATIENTS AND METHODS

• ? A randomized, controlled, crossover trial in 61 outpatient adult men with stable, moderate to severe UI, with no concomitant faecal incontinence, was conducted from June 2007 to February 2009 in 14 urology centres.
• ? Participants tested Conveen Optima urisheaths (Coloplast, Humlebaek, Denmark) with collecting bags and their usual AP in random order for 2 weeks each.
• ? The impact of each on QoL was measured using the King’s Health Questionnaire (KHQ) and the short form‐12 acute questionnaire, and each patient’s preference was recorded.
• ? A 10‐item patient questionnaire was also used to assess the product main advantages on an 11‐point scale (0: worst; 10: best). A 72‐h leakage diary was used to record the number and severity of leaks and daily product consumption. Safety was measured as the number of local adverse events.

RESULTS

• ? All dimensions of the KHQ were scored lower with urisheaths, indicating an improvement in QoL. The greatest mean score reductions were in Limitations of Daily Activities (?10.24, P= 0.01) and Incontinence Impact (?7.05, P= 0.045).
• ? The majority (69%) of patients preferred Conveen Optima urisheaths to their usual AP (P = 0.002).
• ? Urisheaths scored significantly higher for all categories in the patient questionnaire (efficacy, self‐image, odour management, discretion, skin integrity) except ease of use.
• ? Safety was considered to be good.

CONCLUSIONS

• ? Conveen Optima urisheaths showed a positive impact on QoL (according to the KHQ results) in moderate to severe incontinent men, who were long‐term users of APs, and participants largely preferred urisheaths.
• ? Conveen Optima urisheaths should be recommended to incontinent men in preference to APs.

     

A 10-year review of assault-related open-globe injuries at an urban hospital

Background

To describe the demographics and outcomes of assault-related open-globe injuries (OGI) at University Hospital (UH), Newark, New Jersey over a ten-year period.

Methods

The medical records of all subjects presenting to a single university referral center with an OGI were retrospectively analyzed to identify prognostic factors for enucleation and final visual acuity (VA) of no light perception (NLP).

Results

One hundred and forty-eight eyes of 147 patients presented to UH with assault-related OGI. Eighty-two percent of patients were male, and the mean age was 35.9 years. The anatomic site of the wound was zone 3 in the majority (54.1 %) of eyes. Most common type of injury noted was rupture (57.4 %), followed by penetrating injury (35.1 %). Mean initial presenting and final VA in LogMAR were 2.38?±?0.12 and 2.18?±?0.16 respectively. Initial Snellen VA was no light perception (NLP) in 57 eyes (38.5 %); four eyes had an initial VA of ≥20/40 (2.7 %). Final VA was NLP in 68 eyes (45.9 %) of which 46 were enucleated (31.1 %); 18 eyes (12.2 %) had a final VA of ≥20/40. Fifty eyes (33.8 %) underwent pars plana vitrectomy (PPV). Significant risk factors of final VA of NLP or enucleation included initial VA of NLP, perforating or rupture type of OGI, and zone 3 injury. Eyes that sustained penetrating injuries were less likely to have final VA of NLP or require enucleation.

Conclusions

Assault-related OGIs carry an extremely poor visual prognosis and a high rate of enucleations. Only eighteen eyes (12.2 %) recovered VA ≥20/40. We found initial VA of NLP and zone 3 injury to be significant predictors of final VA of NLP or undergoing enucleation. Penetrating injuries were less likely to have a final VA of NLP or an enucleation.