Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty

Objective  

Evaluate the efficacy of percutaneous vertebroplasty for severe vertebral body compression fractures.     

Translation into Arabic and validation of the Schedule for the Assessment of Insight–Expanded Version (SAI-E) for use in Tunisia

Background

The Schedule for the Assessment of Insight–Expanded Version (SAI-E) consists of 11 items that encompass: awareness of having a mental illness, ability to rename psychotic phenomena as abnormal, and compliance with treatment.

Aims

To translate into Arabic and validate the Tunisian version of this instrument.

Method

The Arabic translation of the SAI-E was obtained by the “forward/backward translation” method. Adaptations were made after a pilot study involving 20 outpatients with schizophrenia and after taking account the opinions of 15 experts in psychiatry.For validation, 150 outpatients suffering from schizophrenia were recruited by a random drawing in the psychiatric department in Sousse (Tunisia).For factor analysis, principal components analysis and Varimax rotation were adopted. Convergent validity was assessed by correlating the translated scale with the G12 item (lack of judgment and awareness of the disease) of the positive and Negative Syndrome Scale (PANSS).Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of intra-class correlation coefficient (ICC).

Results

Regarding construct validity, factor analysis revealed three factors that were responsible for 70.2% of the variance.As for concurrent validity, we found a negative correlation between the score of the SAI-E and that of the G12 item of the PANSS (r = − 0.82 and p < 10⁻³).The study of internal consistency between the 11 items was found to be good (α = 0.82). The test–retest reliability was satisfactory (r = 0.8, p < 10⁻³), and so was inter-rater reliability (ICC = 0.84).

Conclusion

In the Tunisian cultural context, the SAI-E presented three factors with good consistency and an inter-rater reliability compatible with the insight dimensions that are intended to be evaluated.     

Retroperitoneal paragangliomas: Report of 4 cases

We reviewed the data of all patients managed for retroperitoneal paragangliomas (PGLs) between June 2010 and June 2011 to present our experience concerning this uncommon entity to highlight diagnostic and therapeutic challenges of retroperitoneal PGLs. All patients were admitted to the department of general and hepatobiliary surgery in the regional hospital of Jendouba, Tunisia. The size of the tumor was taken at its largest dimension, as determined in a computed tomography (CT) scan and pathological reports. There were 4 patients (all women) with a median age of 48 years (range 46-56 years). Abdominal pain was the commonest presentation. CT showed and localized the tumors which were all retroperitoneal. All patients had successful surgical resection of the tumors under invasive arterial blood pressure monitoring. One patient underwent surgery for a presumed tumor of the pancreatic head. The fresh-mount microscopic study of the peroperative biopsy yielded inflammatory tissue without malignancy and no resection was performed. Final histological examination of the biopsy concluded PGL. A second laparotomy was performed and the tumor was entirely resected. The diagnosis was made after surgery by histology in all patients. The control of the blood pressure was improved after surgery in 3 patients. Paragangliomas are rare tumors. The retroperitoneal localization is uncommon. Complete surgical resection remains the only curative treatment but it is often challenging as these tumors are located near multiple vital blood vessels.     

Pergolide increases the efficacy of cathodal direct current stimulation to reduce the amplitude of laser-evoked potentials in humans

Transcranial direct current stimulation (tDCS) was recently reintroduced as a tool for inducing relatively long-lasting changes in cortical excitability in focal brain regions. Anodal stimulation over the primary motor cortex enhances cortical excitability, whereas cathodal stimulation decreases it. Prior studies have shown that enhancement of D2 receptor activity by pergolide consolidates tDCS-generated excitability diminution for up to 24 hours and that cathodal stimulation of the primary motor cortex diminishes experimentally induced pain sensation and reduces the N2-P2 amplitude of laser-evoked potentials immediately poststimulation. In the present study, we investigated the effect of pergolide and cathodal tDCS over the primary motor cortex on laser-evoked potentials and acute pain perception induced with a Tm:YAG laser in a double-blind, randomized, placebo-controlled, crossover study. The amplitude changes of laser-evoked potentials and subjective pain rating scores of 12 healthy subjects were analyzed prior to and following 15 minutes cathodal tDCS combined with pergolide or placebo intake at five different time points. Our results indicate that the amplitude of the N2 component was significantly reduced following cathodal tDCS for up to two hours. Additionally, pergolide prolonged the effect of the cathodal tDCS for up to 24 hours, and a significantly lowered pain sensation was observed for up to 40 minutes. Our study is a further step toward clinical application of cathodal tDCS over the primary motor cortex using pharmacological intervention to prolong the excitability-diminishing effect on pain perception for up to 24 hours poststimulation. Furthermore, it demonstrates the potential for repetitive daily stimulation therapy for pain patients.     

Association of the peroxisome proliferator-activated receptor-gamma2 Pro12Ala but not the C1431T gene variants with lower body mass index in Type 2 diabetes

The peroxisome proliferator-activated receptor-gamma (PPARgamma) is a nuclear receptor involved in lipid metabolism, adipocyte differentiation and regulation of insulin sensitivity, and is associated with Type 2 diabetes (T2DM). The association of the C1431T silent mutation and the Pro12Ala missense transversion within the PPARgamma gene with the development of T2DM or obesity has often yielded contradictory results. We examined the association of the PPARgamma Pro12Ala and C1431T gene variants and their haplotypes with the susceptibility to T2DM. This was a retrospective study involving 491 T2DM patients and 400 age- and gender-matched controls. Pro12Ala and C1431T genotyping was done by PCR-RFLP analysis. Comparable frequencies of the mutant 12Ala (0.07 vs 0.08, p=0.216) and 1431T (0.12 vs 0.10, p=0.189) alleles, and Pro12Ala (p=0.218) and C1431T (p=0.421) genotypes were seen between patients and in nondiabetic control subjects. While no difference was noted in the distribution of Pro12Ala- C1431T haplotypes and genotypes between patients and controls, the PPARgamma 12Ala, but not 1431T, allele was significantly associated with lower body mass index (BMI) (< or =25.0) among patients. Regression analysis confirmed the association of the Pro12Ala (odds ratio =5.340; 95% confidence interval =1.044-27.311) with normal (BMI<25.0) but not with overweight/obesity among T2DM patients. Despite its association with lower BMI among T2DM patients, the PPARgamma gene does not appear to markedly influence Type 2 diabetes among Tunisian subjects.