Musical-verbal hallucinations and their correlation with electroencephalography and PET findings. Case report]

A case is reported of an organic auditory hallucinosis and depressive episode in a man aged 52. A new finding is the correlation of the musical hallucinosis to a central nervous disorder as shown by pathological sphenoidal EEG and 18FDG-PET-examination and not to acquired peripheral hearing deficit as often reported before.     

Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care

Objectives

Hospital-based surveillance of influenza and acute respiratory infections relies on International Classification of Diseases (ICD) codes and hospital laboratory reports (Standard-of-Care). It is unclear how many cases are missed with either method, i.e. remain undiagnosed/coded as influenza and other respiratory virus infections. Various influenza-like illness (ILI) definitions co-exist with little guidance on how to use them. We compared the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM) programme at a Berlin children's hospital with the Robert Koch Institute.

MR cisternography after intrathecal Gd-DTPA application

The purpose of this study was to establish and to evaluate MR cisternography after intrathecal Gd-DTPA administration to detect rhinobasal cerebrospinal fluid (CSF) fistulae in patients with suspected CSF rhinorrhoea. Ten patients with suspected CSF rhinorrhoea were examined. The MR cisternography included the following investigation steps: acquisition of nonenhanced fat-suppressed T1-weighted spin-echo (SE) scans of the skull base and the paranasal sinuses, lumbar puncture with administration of 1 ml Gd-DTPA solute with 4 ml NaCl and performance of MR cisternography with the same fat-suppressed T1-weighted sequences as used initially. In 10 patients with suspected CSF rhinorrhoea Gd-DTPA enhanced MR cisternography detected 5 CSF fistulae. In 3 of 5 CSF leaks were located in the cribriform plate and in 2 of 5 sphenoidal. Whereas 4 of these depicted leaks were confirmed surgically, in 1 case the CSF fistula closed spontaneously. In another case, CSF leakage after severe head injury was clinically highly suspected but ceased prior to MR cisternography with inability to detect the temporary fistula. In the remaining 4 patients with serous rhinorrhoea MR cisternography did not provide any evidences for CSF fistulae. Intrathecal Gd-DTPA injection was tolerated excellently. Clinical and EEG examinations showed no gross behavioural or neurological disturbances and no seizure activity, respectively. The MR cisternography after intrathecal administration of Gd-DTPA represents a safe, promising and minimally invasive method for detection of CSF fistulae. This MR investigation provides excellent depiction of CSF spaces and pinpoints CSF fistulae. Electronic Publication     

Seroprevalence of anti-hepatitis C virus antibodies among blood donors,Brazil

OBJECTIVE: To determine the seroprevalence of anti-hepatitis C virus antibodies (anti-HCV) in blood donors, and to describe the correlation between screening serological test results and confirmatory test. METHODS: Epidemiological and laboratorial records of 10,090 blood donors of the blood unit in the city of Apucarana, Brazil, from January 1997 to December 1999 were assessed. Anti-HCV serum antibodies were detected using enzyme-linked immunosorbent assay (ELISA). Serum reactive samples were tested using RIBA (recombinant immunoblot assay). Statistical analysis was performed using Chi-square test, Fischer's test and Kappa index of agreement. RESULTS: The results showed that of all the donors, 2,461 (24.4%) were females, 7,629 (75.6%) were males, with ages ranging from 18 to 65 years old. Of 10,090 serum samples tested using ELISA, 88 were reactive to anti-HCV, a seroprevalence of 0.9% that showed no association with either age groups (p=0.197) or sex (p=0.323). When the samples were tested using RIBA, 11 (12.5%) were positive, 14 (15.9%) were indeterminate, and 38 (43.2%) were negative. Statistical analysis revealed a high correlation (kappa index 0.939) between ELISA and RIBA test results. Poorly reactive samples in ELISA showed a high correlation with negative results in RIBA, and samples highly reactive in ELISA showed a high correlation with positive results in RIBA. CONCLUSIONS: The results stress the need of confirmatory tests for all anti-HCV reactive samples in screening tests. HVC infection confirmation is paramount for clinical, laboratorial, and histological evaluation of blood donors.     

Pharmacology of antiepileptic drugs in the gerbil—I. Pharmacokinetics

Pharmacokinetic data for antiepileptic drugs were determined in gerbils. The drugs had the following elimination half-lives: phenytoin 2.1 hr; phenobarbital 10.6 hr; carbamazepine 1.8 hr; valproate 0.69 hr; ethosuximide 1.4 hr and diazepam 1.15 hr. Diazepam was predominantly metabolized via 3-hydroxydiazepam to oxazepam which had the longest half-life (2 hr) of the metabolites.     

Evaluation of surrogate markers for human immunodeficiency virus infection among blood donors at the blood bank of "Hospital Universitário Regional Norte do Paraná", Londrina,PR, Brazil

This study evaluated the usefulness of the anti-HBc, hepatitis C virus antibodies (anti-HCV), human T cell lymphotropic virus I and II antibodies (anti-HTLV I/II), serologic tests for syphilis, and surface antigen of hepatitis B virus (HBsAg) as surrogate markers for the risk for HIV infection in 80,284 serum samples from blood donors from the Blood Bank of "Hospital Universitário Regional Norte do Paraná", Londrina, Paraná State, Brazil, analyzed from July 1994 to April 2001. Among 39 blood donors with positive serology for HIV, 12 (30.8%) were anti-HBc positive, 10 (25.6%) for anti-HCV, 1 (2.6%) for anti-HTLV I/I, 1 (2.6%) was positive for syphilis, and 1 (2.6%) for HBsAg. Among the donors with negative serology for HIV, these markers were detected in 8,407 (10.5%), 441 (0.5%), 189 (0.2%), 464 (0.6%), and 473 (0.6%) samples, respectively. The difference was statistically significant (p < 0.001) for anti-HBc and anti-HCV. Although the predictive positive values for these surrogate markers were low for HIV infection, the results confirmed the anti-HBc and anti-HCV as useful surrogate markers for HIV infection thus reinforcing the maintenance of them in the screening for blood donors contributing to the prevention of the small number of cases in which HIV is still transmitted by transfusion.     

Immune-inflammatory,coagulation, adhesion,and imaging biomarkers combined in machine learning models improve the prediction of death 1 year after ischemic stroke

Some clinical, imaging, and laboratory biomarkers have been identified as predictors of prognosis of acute ischemic stroke (IS). The aim of this study was to evaluate the prognostic validity of a combination of clinical, imaging, and laboratory biomarkers in predicting 1-year mortality of IS. We evaluated 103 patients with IS within 24 h of their hospital admission and assessed demographic data, IS severity using the National Institutes of Health Stroke Scale (NIHSS), carotid intima-media thickness (cIMT), and degree of stenosis, as well as laboratory variables including immune-inflammatory, coagulation, and endothelial dysfunction biomarkers. The IS patients were categorized as survivors and non-survivors 1 year after admission. Non-survivors showed higher NIHSS and cIMT values, lower antithrombin, Protein C, platelet counts, and albumin, and higher Factor VIII, von Willebrand Factor (vWF), white blood cells, tumor necrosis factor (TNF)-α, interleukin (IL)-10, high-sensitivity C-reactive protein (hsCRP), and vascular cellular adhesion molecule 1 (VCAM-1) than survivors. Neural network models separated non-survivors from survivors using NIHSS, cIMT, age, IL-6, TNF-α, hsCRP, Protein C, Protein S, vWF, and platelet endothelial cell adhesion molecule 1 (PECAM-1) with an area under the receiving operating characteristics curve (AUC/ROC) of 0.975, cross-validated accuracy of 93.3%, sensitivity of 100% and specificity of 85.7%. In conclusion, imaging, immune-inflammatory, and coagulation biomarkers add predictive information to the NIHSS clinical score and these biomarkers in combination may act as predictors of 1-year mortality after IS. An early prediction of IS outcome is important for personalized therapeutic strategies that may improve the outcome of IS.