Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis

Purpose

To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath diameter (ONSD) for assessment of intracranial hypertension.

Methods

Systematic review without language restriction based on electronic databases, with manual review of literature and conference proceedings until July 2010. Studies were eligible if they compared ultrasonography of ONSD with intracranial pressure (ICP) monitoring. Data were extracted independently by three authors. Random-effects meta-analysis and meta-regression were performed.

Results

Six studies including 231 patients were reviewed. No significant heterogeneity was detected for sensitivity, specificity, positive and negative likelihood ratios or diagnostic odds ratio. For detection of raised intracranial pressure, pooled sensitivity was 0.90 [95% confidence interval (CI) 0.80?C0.95; p for heterogeneity, p _het?=?0.09], pooled specificity was 0.85 (95% CI 0.73?C0.93, p _het?=?0.13), and the pooled diagnostic odds ratio was 51 (95% CI 22?C121). The area under the summary receiver-operating characteristic (SROC) curve was 0.94 (95% CI 0.91?C0.96).

Conclusions

Ultrasonography of ONSD shows a good level of diagnostic accuracy for detecting intracranial hypertension. In clinical decision-making, this technique may help physicians decide to transfer patients to specialized centers or to place an invasive device when specific recommendations for this placement do not exist.     

Cardioprotective effect of vitamin E: rescues of diabetes-induced cardiac malfunction, oxidative stress, and apoptosis in rat

AimThis study was designed to assess the effect of vitamin E on cardiac autonomic neuropathy, cardiomyocyte apoptosis, and the status of oxidative stress in the heart under hyperglycemic conditions, in vivo.MethodsWistar male rats (n=16) were made hyperglycemic by streptozotocin at 6 months of age. Normal Wistar rats (n=8) of the same age were used as the control group. Diabetic rats were divided into two groups, nontreated and those treated with vitamin E (300 mg/day). Stable hyperglycemic status was proved by levels of blood sugar and HbA_1c. Lipid peroxidation, protein oxidation, and cellular antioxidant defense were measured by 8-isoprotane, protein carbonyl content, and superoxide dismutase (SOD) activity, respectively.ResultsCardiac complications such as autonomic neuropathy as prolonged QT interval along with significant increases in level of 8-isoprotane, protein carbonyl content, and SOD activity were observed after 6 weeks. Structural abnormality was also observed as severe induction of apoptosis in cardiomyocytes.ConclusionSignificant decline in apoptosis, lipid peroxidation, protein oxidation, and QT interval resulted from vitamin E administration, which strongly implies that this radical scavenger may promote a convalescing effect on diabetic cardiomyopathy through the attenuation of oxidative stress and abrogation of apoptotic signals, which was verified by restoring normal QT interval.     

Nontuberculous Mycobacteria Among Patients Who are Suspected for Multidrug-Resistant Tuberculosis—Need for Earlier Identification of Nontuberculosis Mycobacteria

BackgroundIn this study, we intended to find the prevalence of nontuberculosis mycobacteria (NTM) among patients who are referred as suspected multidrug-resistant tuberculosis (MDR-TB) cases to the only referral center in Iran.MethodsAll patients referred to our center in 2002–2006 as MDR-TB with histories of treatment with standard and CAT II World Health Organization regimens were included in the study. Sputum smear and culture for acid-fast bacilli were performed for all patients 3 times. Sputum polymerase chain reaction was also performed for all patients. Mycobacterial identification was performed via polymerase chain reaction and routine identification tests for all culture-positive cases.ResultsOf the 105 patients in the study, 12 (11.43%) were identified to have NTM infection. The identified mycobacteria were classified in order of prevalence as Chelonae (8 cases), Simiae (2 cases), Aloei (1 case), and Farcinogen (1 case). Based on radiologic findings, most of the cases demonstrated bilateral nodularity (83.3%) and also multifocal bronchiectasis (75%). Notably, cavitary lesions were present in 41.7% of the cases.ConclusionBased on the findings of this study, it is essential that such cases be identified before commencing MDR-TB treatment.     

Semiautomated quantification of β‐zone parapapillary atrophy using blue light fundus autofluorescence

Purpose: To evaluate the reproducibility of measurements of area of β‐zone parapapillary atrophy (β‐PPA) using blue laser fundus autofluorescence (FAF) and confocal scanning laser ophthalmoscopy reflectance (CSLO) measurements and to assess agreement between the two imaging modalities. Methods: Sixty‐five eyes of 45 patients (mean age, 68.2 ± 11.3 years) with established or suspected glaucoma from the Diagnostic Innovations in Glaucoma Study (DIGS) were prospectively included. FAF scans were obtained with the Spectralis HRA+OCT and CSLO reflectance images with the HRTII (both from Heidelberg Engineering, Heidelberg, Germany). Two masked graders independently measured β‐PPA area on 3 consecutive scans using the semi‐automated BluePeak RegionFinder software (BPRF) and on CSLO reflectance images using the optic disc contour line. Reproducibility of β‐PPA area measurements was assessed using intraclass correlation coefficients (ICC). Results: Intragrader reproducibility was 0.997 (95% CI, 0.996–0.998) and 0.995 (95% CI, 0.992–0.996) for grader 1 and 2, respectively, using FAF‐BPRF, and by CSLO, it was 0.991 (95% CI, 0.986–0.994) and 0.988 (95% CI, 0.982–0.992). Intergrader agreement (ICC) was 0.53 (95% CI, 0.331–0.685) for FAF‐BPRF and 0.404 (95% CI, 0.149–0.601) for CSLO (comparison between ICC, p = 0.368). Agreement (ICC) between the two devices was worse for grader 1 (0.356; 95% CI, 0.129–0.549) than grader 2 (0.856; 95% CI, 0.774–0.910) (p < 0.001). Conclusions: Despite excellent intragrader reproducibility for β‐PPA measurements with FAF‐BPRF and CSLO, intergrader reproducibility is low to moderate. Measurements of β‐PPA area obtained with the two instruments are of moderate agreement and, therefore, are not interchangeable.     

Cardiac manifestations of subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is a devastating condition. It carries a high mortality rate, with 12% of patients dying before reaching the hospital. Aside from its neurological morbidities, SAH is associated with significant medical complications. Cardiac manifestations are common and can impact morbidity and mortality in SAH patients. This article will discuss the cardiac manifestations of SAH.     

First report on isolation and molecular characterization of clinical Mycobacterium setense isolates in Asia

We herein present the third set of documented clinical Mycobacterium setense cases. Three clinically unrelated isolates were identified and characterized using various key conventional and molecular diagnostic tests. Phenotypic and molecular data analysis, particularly 16S rDNA, hsp65, and rpoB sequencing, provided evidence of M. setense involvement in clinical infections in Iranian patients. Our findings may shed light on the capability of this rare Mycobacterium sp. to cause infection in both healthy and immunocompromised patients.     

The impact of one session resistance exercise on plasma adiponectin and RBP4 concentration in trained and untrained healthy young men

We designed this study, to investigate the predicting effect of a single resistance exercise session on serum level of RBP4 and adiponectin in trained and untrained subjects and to evaluate whether regular training may affect the response of these adipokines to exercise. Thirty four healthy young male students including 19 trained and 15 untrained participated in this study; each group was then randomly assigned to intervention and control groups. The exercise session prolonged 120 minutes intensive resistance program at 70%-80% of 1RM. The blood samples were collected just before the start of training program and 4 hours post exercise to evaluate concentration of adiponectin, RBP4 and CRP as well as other metabolic markers. The serum level of adiponectin, RBP4 and CRP was not significantly different between trained and untrained groups at baseline. More over four hours post exercise adipokines concentration and CRP didn't differ between groups. Adjusted regression model showed, basal adiponectin (β=0.59, p=<0.001) and HDL cholesterol (β=0.28, p=0.09) were the main predictors of post exercise adiponectin concentration. In addition, the basic level of RBP4 appeared to be the only predictor of after exercise RBP4 concentration (β=0.46, p=0.02). Neither one session of high intensity resistance exercise nor long term training had predicting effect on post exercise adiponectin and RBP4 concentration in healthy young men. In the other hand, the beneficial effect of acute resistance exercise training may not be reflected by changes in adiponectin, RBP4 and CRP concentration in healthy young individual no matter they trained or untrained.     

Appendicite aiguë et grossesse, une situation délicate : à propos de huit cas

Background

Abdominal pain in a pregnant woman suggests a diagnosis of appendicitis. However, many other pathologies also occur during pregnancy that could cause abdominal pain, and require suitable treatment. The aim of this work is to discuss the diagnostic, therapeutic and prognostic aspects of appendicitis during pregnancy.

Patients and methods

Eight patients were admitted for appendicitis during pregnancy and were prospectively studied over a 24-month period. Seven patients presented an appendical syndrome. The eighth patient presented a threat of premature childbirth with fever. The gestational age ranged from 12 to 30 weeks.

Results

All our patients were operated. Surgical exploration showed generalised purulent peritonitis in one patient. There were no complications for six of our patients. We reported a foetal death in one case and an abortion in another case. The histological examination showed appendicitis without specificity or malignancy in all eight cases.

Conclusion

The diagnosis of appendicitis in pregnant women is often difficult, and serious forms are frequent. This leads us to search immediately for appendicitis in pregnant women with abdominal pain and fever.