Does age at the onset of narcolepsy influence the course and severity of the disease?

ObjectiveThe aim of the study is to compare the course and severity of narcolepsy in relation to different ages at the disease onset.MethodsClinical interviews with the completion of the Stanford questionnaire, Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT) were evaluated in 105 patients (44 males, 61 females, mean age 45.4 ± 19.2, BMI 29.2 ± 5.8) suffering from narcolepsy.ResultsThe severity of the disease was judged by clinical complaints, ESS value and MSLT results. No relations with the age at onset and clinical tetrad were found, however, smoking may be associated with an increased risk of hypnagogic hallucinations. There was no correlation between the number of sleep and cataplectic attacks and the age at onset, nor did subjective ESS show any significant dependence. However, earlier onset of the disease correlated with shorter MSLT mean latency. A correlation was found between the BMI and narcolepsy sleepiness rating in the elderly and between degree of education attained and subjective complaints.ConclusionsThe clinical severity of narcolepsy does not depend on the age at onset.     

The Sonoma Water Evaluation Trial: A Randomized Drinking Water Intervention Trial to Reduce Gastrointestinal Illness in Older Adults

Objectives. We estimated the relative rate of highly credible gastrointestinal illness (HCGI) per year associated with active versus sham household water filtration devices among older adults in a community receiving tap water meeting current US standards.Methods. We conducted a randomized, triple-blinded, crossover trial in 714 households (988 individuals), which used active and sham water filtration devices for 6 months each. We estimated the annual incidence rate ratio of HCGI episodes and the longitudinal prevalence ratio of HCGI days at population and individual levels with a generalized estimating equation (GEE) and generalized linear mixed models (GLMMs), respectively, adjusted for covariates associated with outcome.Results. The incidence rate ratios (active versus sham) were 0.88 (95% confidence interval [CI] = 0.77, 1.00) and 0.85 (95% CI = 0.76, 0.94) HCGI episodes per year estimated by GEE and GLMM models, respectively. The corresponding longitudinal prevalence ratios were 0.88 (95% CI = 0.74, 1.05) and 0.84 (95% CI = 0.78, 0.90) HCGI days per person per year.Conclusions. We observed reductions in population- and individual-level measures of HCGI associated with use of the active filtration device. These findings suggest the need for further research on the impact of drinking water on the health of sensitive subpopulations.Widespread outbreaks of gastrointestinal infectious illness have occurred in the United States at times when public water treatment systems have failed.^1,2 This has led to intense public interest in whether the microbial content of drinking water might present a health risk even when public water treatment systems are believed to be functioning properly.^3–5Several randomized intervention trials with supplemental in-home drinking water treatment have been reported in general populations^6–10; none focused on older individuals. Estimates of the annual number of cases of acute gastrointestinal illness related to drinking water in the United States, drawn from a variety of data sources and study designs, vary from 1.8 million to 16.4 million cases per year in the general population.^11–13 The US Environmental Protection Agency has called attention to the differential burden of drinking water–related disease among those who may be at increased risk of infection and serious illness from exposure to microbial pathogens, such as the elderly, children, and persons who are immunocompromised by infection, malignancy, or chemotherapy.^14–16 Older adults may be particularly susceptible to gastrointestinal infections and to severe illness once infected.^17–19We conducted the first drinking water trial exclusively studying older adults (aged ≥ 55 years). The study, performed in Sonoma County, California, was a randomized, controlled, triple-blinded (participants, investigators, analysts), crossover intervention trial. Our goal was to estimate the efficacy of an in-home water filter to reduce the risk of highly credible gastrointestinal illness (HCGI) among older adults living in a community whose tap water met or exceeded current US drinking water standards.     

A comparison of polysomnographic and actigraphic evaluation of periodic limb movements in sleep

OBJECTIVE: As a standard method, periodic limb movements in sleep (PLMS) are detected by means of polysomnography (PSG). Actigraphic detection of PLMS is a recently developed method for performing of multiple-night recordings in an outpatient setting. The aim of our study was to assess sensitivity-related parameters of actigraphic detection of PLMS in comparison to the PSG, when mounted at ankles and at the base of the big toe. METHODS: We simultaneously performed PSG and actigraphic recordings at both ankles and at the bases of both big toes (Cambridge Actiwatch AW-64) for 40 nights. The PLM index (PLMI), number of periodic movements per hour of sleep, was the primary output of both methods. RESULTS: We have proven significant correlation of all resulting parameters when comparing actigraphy at either position to the PSG; however, the PLMI values obtained by the actigraphy at toes were significantly higher than by PSG (sign test, p<0.0001). At bases of the big toes, threshold of PLMI=7.6 was used as a cut off for positivity, while PLMI=5 at ankles was used for PSG. Comparing ankle versus toe actigraphic placement, sensitivity was 67% versus 94%, specificity was 95% versus 91% and negative predictive value was 78% versus 95%. The correlation of the results from actigraphy and PSG was not affected by presence of respiratory events. DISCUSSION: Our results suggest good validity of actigraphic PLM evaluation at the base of big toe using AW-64 devices and therefore, actigraphy seems suitable for screening purposes in both clinical and research usage.     

MR imaging assessment of the breast after breast conservation therapy: distinguishing benign from malignant lesions

Dynamic contrast material-enhanced magnetic resonance (MR) imaging has emerged as a valuable tool in evaluation of women who have undergone lumpectomy and whole-breast radiation therapy for breast cancer. Early diagnosis of local recurrence by means of close clinical and imaging follow-up is an important component of a breast-conserving strategy, as it may improve survival. In the post-breast conservation therapy (BCT) breast, resolving edema, fat necrosis, a small focal area of non-masslike enhancement (NMLE), and thin linear NMLE at the lumpectomy site can all be expected findings. In contrast, masslike enhancement or NMLE of ductal or segmental distribution can indicate recurrence. Therefore, at MR imaging of the post-BCT breast, it is important to identify lesions that are benign or appropriate for short-interval imaging surveillance to minimize unnecessary intervention, as well as to discern suspicious lesions and optimize the diagnosis of recurrence.     

Cerebral diffusion tensor imaging and in vivo proton magnetic resonance spectroscopy in patients with fulminant hepatic failure

Background and Aim:  Cerebral edema is a major complication in patients with fulminant hepatic failure (FHF). The aim of this study was to evaluate the metabolite alterations and cerebral edema in patients with FHF using in vivo proton magnetic resonance spectroscopy (MRS) and diffusion tensor imaging, and to look for its reversibility in survivors.
Methods:  Ten FHF patients along with 10 controls were studied. Five of the 10 patients who recovered had a repeat imaging after three weeks. N-acetylaspartate, choline (Cho), glutamine (Gln), glutamine/glutamate (Glx), and myoinositol ratios were calculated with respect to creatine (Cr). Mean diffusivity (MD) and fractional anisotropy (FA) were calculated in different brain regions.
Results:  Patients exhibited significantly increased Gln/Cr and Glx/Cr, and reduced Cho/Cr ratios, compared to controls. In the follow-up study, all metabolite ratios were normalized except Glx/Cr. Significantly decreased Cho/Cr were observed in deceased patients compared to controls. In patients, significantly decreased MD and FA values were observed in most topographical locations of the brain compared to controls. MD and FA values showed insignificant increase in the follow-up study compared to their first study.
Conclusions:  We conclude that the Cho/Cr ratio appears to be an in vivo marker of prognosis in FHF. Decreased MD values suggest predominant cytotoxic edema may be present. Persistence of imaging and MRS abnormalities at three weeks' clinical recovery suggests that metabolic recovery may take longer than clinical recovery in FHF patients.