The application of near-infrared oximetry to cerebral monitoring during aneurysm embolization: a comparison with intraprocedural angiography

Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rSO2) in patients at risk of cerebral desaturation during surgical and neurointerventional procedures. However, the quantitative capabilities of the method have been questioned, as has its validation compared with jugular bulb oximetry. Here, we compare NIRS data acquired during coil embolization procedures with incidence of vasospasm as detected from angiography. Thirty-two subarachnoid hemorrhage patients underwent embolization. Bilateral SomaSensor strips (Invos 4100, Somanetics) were affixed to the forehead at constant anatomic positions, avoiding frontal sinuses and scalp hair. Mean arterial pressure, SaO2, end-tidal pCO2, temperature and Hb were held within a narrow range during the procedure. Ipsilateral angiography was performed every 10 to 15 minutes. An independent neuroradiologist classified any vasospasm in the parent vessel as mild (25% baseline), moderate (50%), severe (75%), or total (100%). Of all, 15/32 (46.9%) patients developed spasm; in 2 it was severe or total. There was no significant association between World Federation of Neurological Surgeons grade and baseline rSO2 signal (either ipsilateral or contralateral to the side of the aneurysm) (P=0.598). There was no significant association between side of aneurysm and baseline rSO2 signal (P=0.243). However, episodes of angiographic spasm were strongly associated with reduction in trend ipsilateral NIRS signal (P<0.001); furthermore, the degree of spasm (especially more than 75% vessel diameter reduction) was associated with a greater reduction in same-side NIRS signal (P<0.001) (2-level random effects regression model, Stata 8.2, Stata Corp, TX). NIRS may have a useful role to play in the detection of cerebral desaturation secondary to vasospasm during neuroendovascular procedures.     

Lack of association between periodontal parameters and preeclampsia

BACKGROUND: It was hypothesized that periodontal diseases may increase the risk of preeclampsia. To test this hypothesis, this study was conducted to determine the association between periodontal parameters and preeclampsia among women in the north of Jordan. METHODS: A case-control study was conducted among women who gave birth at Princes Badea Teaching Hospital between September 2004 and May 2005. A total of 115 preeclamptic women and 230 randomly selected controls were analyzed. The number of teeth, restorations, decayed tooth surfaces, and clinical periodontal parameters were determined within 24 hours after delivery. Information regarding participants' demographics, antenatal history, and family history were collected through personal interviews. RESULTS: After adjustment for potential confounding factors, there were no statistical differences between preeclamptic cases and normotensive controls with regard to mean periodontal probing depth, mean clinical attachment loss, mean gingival recession, mean plaque index, and mean gingival index. In addition, there were no significant differences in the percentages of sites with periodontal probing depth >/=3 or >/=4 mm, percentages of sites with clinical attachment loss >/=3 mm, number of filled surfaces, and number of missing teeth. Only the number of decayed surfaces was found to be associated with increased odds of preeclampsia (adjusted odds ratio of 1.13; 95% confidence interval of 1.02 and 1.25). CONCLUSION: This study did not support the hypothesis of an association between periodontal parameters and preeclampsia.     

Ocular coloboma—a comprehensive review for the clinician

Typical ocular coloboma is caused by defective closure of the embryonal fissure. The occurrence of coloboma can be sporadic, hereditary (known or unknown gene defects) or associated with chromosomal abnormalities. Ocular colobomata are more often associated with systemic abnormalities when caused by chromosomal abnormalities. The ocular manifestations vary widely. At one extreme, the eye is hardly recognisable and non-functional—having been compressed by an orbital cyst, while at the other, one finds minimalistic involvement that hardly affects the structure and function of the eye. In the fundus, the variability involves the size of the coloboma (anteroposterior and transverse extent) and the involvement of the optic disc and fovea. The visual acuity is affected when coloboma involves disc and fovea, or is complicated by occurrence of retinal detachment, choroidal neovascular membrane, cataract, amblyopia due to uncorrected refractive errors, etc. While the basic birth anomaly cannot be corrected, most of the complications listed above are correctable to a great extent. Current day surgical management of coloboma-related retinal detachments has evolved to yield consistently good results. Cataract surgery in these eyes can pose a challenge due to a combination of microphthalmos and relatively hard lenses, resulting in increased risk of intra-operative complications. Prophylactic laser retinopexy to the border of choroidal coloboma appears to be an attractive option for reducing risk of coloboma-related retinal detachment. However, a majority of the eyes have the optic disc within the choroidal coloboma, thus making it difficult to safely administer a complete treatment.Subject terms: Retinal diseases, Eye abnormalities     

Linguatula serrata in the anterior chamber of the eye

We report a case of intraocular Linguatula in healthy young female who presented with a history of trivial trauma, dislocated lens, inflammation and secondary glaucoma. A mobile worm was seen in the anterior chamber. Pars plana lensectomy and vitrectomy was planned to remove both the cataractous lens and the parasite during which the worm disappeared from view but was later recovered from the cassette fluid. It was identified as the nymphal form of Linguatula serrata (tongue worm).     

Genetic diversity among Escherichia coli O157:H7 isolates and identification of genes linked to human infections

An Escherichia coli oligonucleotide microarray based on three sequenced genomes was validated for comparative genomic microarray hybridization and used to study the diversity of E. coli O157 isolates from human infections and food and animal sources. Among 26 test strains, 24 (including both Shiga toxin [Stx]-positive and -negative strains) were found to be related to the two sequenced E. coli O157:H7 strains, EDL933 and Sakai. However, these strains showed much greater genetic diversity than those reported previously, and most of them could not be categorized as either lineage I or II. Some genes were found more often in isolates from human than from nonhuman sources; e.g., ECs1202 and ECs2976, associated with stx2AB and stx1AB, were in all isolates from human sources but in only 40% of those from nonhuman sources. Some (but not all) lineage I-specific or -dominant genes were also more frequently associated with isolates from human. The results suggested that it might be more effective to concentrate our efforts on finding markers that are directly related to infection rather than those specific to certain lineages. In addition, two Stx-negative O157 cattle isolates (one confirmed to be H7) were significantly different from other Stx-positive and -negative E. coli O157:H7 strains and were more similar to MG1655 in their gene content. This work demonstrates that not all E. coli O157:H7 strains belong to the same clonal group, and those that were similar to E. coli K-12 might be less virulent.     

Biogeographical diversity of leaf-associated microbial communities from salt-secreting Tamarix trees of the Dead Sea region

The leaves of Tamarix, a salt-secreting desert tree, form an extreme niche that harbors a unique microbial community. In view of the global distribution of this tree, its island-like phyllosphere is highly suitable for studying microbial diversity along geographical gradients. Here we present an analysis of microbial community diversity using leaf surface samples collected at six different sites, on both sides of the Dead Sea, over a period of one year. Biodiversity analysis of denaturing gradient gel electrophoresis (DGGE) patterns of the bacterial 16S rRNA gene revealed a significant degree of bacterial community similarity within trees sampled at the same site, much higher than the similarity between trees from different geographical locations. Statistical analysis indicated that the degree of similarity was negatively correlated with the distance between sampling sites, and that a weak correlation existed between diversity and leaf pH.     

High alcohol intake in deceased donors has no effect on pancreas graft survival: a registry analysis

Outcomes of pancreas transplantation from donors with high alcohol consumption are poorly described. The UK Transplant Registry was used to determine whether donor alcohol intake influenced pancreas survival in simultaneous pancreas–kidney (SPK) transplants performed between 2006 and 2012 (n = 770). Recipients were stratified by donor alcohol intake: group I (n = 122)—high recent alcohol intake (>21 or >14 units of alcohol/week in males or females, respectively) or previous alcohol abuse and group II (n = 648)—low/unknown current intake and no previous alcohol abuse. Median current alcohol intake was higher in group I than group II: 36.3 vs. 10 units/week; P < 0.001. One‐ and five‐year pancreas graft survivals were 88.5% and 73.6% in group I, and 87% and 74.9% in group II. There was no difference in unadjusted graft survival between groups I and II (P = 0.76), and no difference between group II and a subgroup of group I with a donor history of alcohol abuse and high current intake (P = 0.26), or from donors with current alcohol consumption of >50 units/week (P = 0.41). Pancreas donors with past alcohol abuse or current high intake are common, and graft outcomes appear to be acceptable. This analysis suggests that high donor alcohol intake, by itself, should not exclude consideration of pancreas transplantation.     

Cutaneous leishmaniasis in the Jordanian side of the Jordan Valley: severe under-reporting and consequences on public health management

Objective To test if cutaneous leishmaniasis (CL) is under‐reported in the Jordanian Mid Jordan Valley, with resultant serious consequences for drug supply. Methods For 2001–2003, prescribed amounts of drug and laboratory log‐books were investigated to estimate CL cases reported in Jordanian Mid Jordan Valley. From April 2004 to May 2005, passive detection and focused active ‘index case cluster’‐directed detection were used. Results An average of 75/100 000 cases per year was estimated to have occurred 2001–2003, resulting in under‐reporting by a factor of 47. In 2004/2005, 313/100 000 cases per year were passively detected. Active case‐finding detected additional cases. Conclusion Cutaneous leishmaniasis is severely under‐reported in Jordanian Mid Jordan Valley, which impacts its eradication.