DTI derived indices correlate with immunohistochemistry obtained matrix metalloproteinase (MMP-9) expression in cellular fraction of brain tuberculoma

We performed in vivo diffusion tensor imaging (DTI) in a total of 33 patients with brain tuberculomas (BT). Thirteen of them had surgical excision of the lesion as it was clinically indicated, and in these samples matrix metalloproteinase-9 (MMP-9) expression was quantified. We correlated the results of DTI indices like fractional anisotropy (FA), mean diffusivity (MD), linear anisotropy (CL), planar anisotropy (CP) and spherical anisotropy (CS) with MMP-9 expression. In addition, the remaining 20 patients had serial DTI studies while on specific anti-tuberculous drug therapy and DTI indices in these patients were quantified. The FA, CL and CP significantly decreased while MD and CS significantly increased in BT compared to normal white matter. The FA, CL and CP showed negative correlation with MMP-9 while CS correlated positively. In serial follow-up studies in 20 patients FA, CL and CP showed significant increase while CS decreased significantly over time. We conclude that DTI indices show strong correlation with MMP-9 and these may be used as a surrogate marker of MMP-9 expression in BT. In addition, these indices may be of value in assessing the therapeutic response in patients with BT who are treated only with specific anti-tuberculous drugs.     

Comparative Evaluation of the Cerebral and Cerebellar White Matter Development in Pediatric Age Group using Quantitative Diffusion Tensor Imaging

Age-dependent changes in the normal cerebral white matter have been reported; however, there is no study on normal cerebellar white matter maturation in developing brain using diffusion tensor imaging (DTI). We performed DTI in 21 children who had normal neurological assessment along with no evidence of any abnormality on imaging. The aim of this study was to compare the age-related changes in fractional anisotropy (FA) and mean diffusivity (MD) quantified from cerebral white matter (splenium and genu of the corpus callosum and posterior limb of the internal capsule) and cerebellar white matter (middle cerebellar peduncles, superior cerebellar peduncles, and inferior cerebellar peduncles) regions in healthy children ranging in age from birth to 132 months. Log-linear regression model showed best fit to describe the age-related changes in FA and MD both for cerebral and cerebellar white matter. In cerebral white matter, an initial sharp increase in FA was observed up to the age of 24 months followed by a gradual increase up to 132 months. In cerebellar white matter, sharp increase in FA was observed up to 36 months, which then followed a gradual increase. However, MD showed a sharp decrease in cerebral white matter up to 24 months followed by a more gradual decrease thereafter, while in cerebellar white matter after an initial decrease (6 months), it followed a stable pattern. This study provides normative database of brain white matter development from neonates to childhood. This quantitative information may be useful for assessing brain maturation in patients with developmental delay of the cerebral and cerebellar white matter.     

Comparison of forehead and digit oximetry in surgical/trauma patients at risk for decreased peripheral perfusion

OBJECTIVE: Measurement of pulse oximetry (Spo(2)) is often impaired in critically ill patients. Forehead reflectance oximetry, the Max-Fast (Nellcor, Pleasanton, CA), may be less susceptible to poor tissue perfusion and could improve accuracy of oxygen saturation measurement. The objective of this study was to evaluate the use of forehead oximetry measures in critically ill surgical/trauma patients. METHODS: A prospective interventional study of 30 critically ill surgical/trauma patients at risk for decreased peripheral perfusion, as evidenced by need for vasopressor support (24 patients), transfusion of more than 6 unit packed cells in 24 hours (two patients), or an inability to obtain consistent saturation from a digit sensor (four patients), compared forehead and digit-based oximeter Spo(2) readings with co-oximetry (Sao(2)) measurements from arterial blood samples. Sao(2) values were converted to functional oxygen saturation (SO(2)) measurements for the final comparison. Patients were fitted with forehead (Nellcor Max-Fast) and digit (Nellcor Max A; digit 1) sensors connected to Nellcor OxiMax N-595 oximeters and a digit sensor (Nellcor Max A; digit 2) connected to a multiparameter monitor (Philips CMS [Andover, MA]). Three measurements of Sao(2) were obtained from each subject over a 24-hour time period, and simultaneous measurements of Spo(2) were recorded from the three monitors. RESULTS: The three Spo(2) measurements (forehead, digit 1, and digit 2) were compared with SO(2) values using the Bland-Altman method to assess agreement. Forehead measurements demonstrated a mean bias of -1.39, whereas digit 1 was -2.61 and digit 2 was -3.84. Pearson correlations (r) for forehead, digit 1, and digit 2 with SO(2) were .834, .433, and .254, respectively. There were fewer unsuccessful measurements with the forehead oximetry technique. CONCLUSIONS: Forehead sensors improve measurement of oxygen saturation in critically ill surgical/trauma patients at risk for decreased peripheral perfusion.     

REM behavior disorder (RBD) can be one of the first symptoms of childhood narcolepsy

More than one in three adult patients suffering from narcolepsy-cataplexy experience rapid eye movement (REM) behavior disorder (RBD), while RBD in childhood is extremely rare. We present the cases of two girls (aged 9 and 7 years old) with narcolepsy-cataplexy, in whom RBD was one of the first symptoms of the disease. The coincidence of RBD was seen by nocturnal video-polysomnography (v-PSG), and narcolepsy was diagnosed from short sleep latency and multiple sleep onset REMs (SOREMs) during a multiple sleep latency test (MSLT). Both girls were human leukocyte antigen (HLA)-DQB1 *0602 positive, and their cerebrospinal fluid (CSF) hypocretin level (Hcrt-1) was extremely low.     

Esophageal Doppler monitoring for hemodynamic assessment

This article reviews the importance of hemodynamic monitoring in adding to the clinical assessment of critically ill patients. The esophageal Doppler monitor (EDM) provides a less invasive way of obtaining hemodynamic information quickly and safely at the bedside. The concepts of Doppler signal acquisition and important nursing considerations are reviewed. Case studies are provided to understand how data from the EDM can impact patient care decisions at the bedside.     

Thymoquinone Inhibition of Acquisition and Expression of Alcohol‐Induced Behavioral Sensitization

Repeated low doses of alcohol have been shown to progressively enhance locomotor activity in mice, and this phenomenon is designated as behavioral sensitization. Thymoquinone, a major active component of Nigella sativa oil has been investigated in a number of studies for its neuroprotective effects against a variety of ailments. This study was conducted to explore the therapeutic potential of thymoquinone on the acquisition and expression of alcohol‐induced behavioral sensitization. Mice treated with alcohol (2.2 g/kg/day) or saline for 13 days and subsequently challenged with an acute alcohol dose (2.2 g/kg) 5 days later were orally administered acute doses of thymoquinone (10, 20 and 30 mg/kg). Thymoquinone subacute treatment with all doses throughout alcohol exposure significantly inhibited both the development and expression phases of alcohol behavioral sensitization in a dose‐dependent manner. However, acute treatment with thymoquinone (30 mg/kg) only reversed the expression phase of sensitization. These findings are explained in terms of the known GABA promoting action of thymoquinone in relation to the motive circuit within the limbic component of the basal ganglia. It is concluded that thymoquinone may be a potential therapeutic option for the treatment and prevention of alcohol induced behavioral sensitization. Copyright © 2015 John Wiley & Sons, Ltd.     

Neuro-cysticercosis with Japanese encephalitis: magnetic resonance imaging with diffusion and spectroscopy

Neuro-cysticercosis (NCC) and Japanese encephalitis (JE) are common in tropical countries. Two cases of NCC with coexistent JE are presented, which share same socio-demographic and ecologic factors and have the same intermediate host (pig). Patients were on treatment for NCC and presented in comatose state. Sudden clinical deterioration of a patient with NCC should warrant a search for coexistent JE. We report findings of magnetic resonance spectroscopy and diffusion-weighted imaging of the JE.