Effects of repetitive transcranial magnetic stimulation (rTMS) on chronic tinnitus

CONCLUSIONS: Preliminary results indicate that repetitive transcranial magnetic stimulation (rTMS) can suppress tinnitus for some people. However, several procedural questions need to be addressed before the results of TMS studies can be interpreted or applied. For example, the placebo effect might be a significant factor because it is easy for patients to distinguish between real and sham stimulation. OBJECTIVES: This study was undertaken to determine the following: Can rTMS reduce patients' perception of chronic tinnitus? Is ipsilateral or contralateral stimulation most effective at reducing patients' perception of tinnitus? What is the extent and duration of the change in tinnitus following rTMS? PATIENTS AND METHODS: Fifteen subjects rated the loudness of their tinnitus on a 1-10 scale (1 = very quiet, 10 = very loud) before and after sham or real TMS. Participants wore foam ear plugs during the following procedures. After the patient's motor threshold was established, a figure-of-eight stimulating coil was positioned over the temporal region of the head at a location that corresponds to International 10-20 electrode position T3 (left) or T4 (right). 'Sham' rTMS was then delivered to this region of the head, first on the ipsilateral side, then on the contralateral side from where participants perceived tinnitus. Sham TMS consisted of an audio recording of actual TMS stimulus sounds. Actual rTMS was next delivered to each side of the head, starting with the side ipsilateral to tinnitus perception. Stimulation intensity was 100% of the resting motor threshold. A train of 30 pulses at 10 Hz was delivered every minute for 5 min. RESULTS: Two subjects reported reductions in tinnitus loudness following sham stimulation. Actual TMS resulted in partial suppression of tinnitus for six subjects. The amount of suppression ranged from 19% to 86% (average 50%). The durations of tinnitus suppression for each of the six subjects were: 20 min, 30 min, 45 min, 60 min, and 1 and 4 days, respectively.     

Sildenafil as treatment for Human Immunodeficiency Virus-related pulmonary hypertension in a child

Human Immunodeficiency Virus (HIV)-related pulmonary hypertension is a relatively rare disease that can affect HIV sufferers. This is almost always associated with a poor outcome and death. An 18 month-old girl, probably the youngest on record, was diagnosed to have pulmonary hypertension (PHT) and retrospectively found to have HIV infection. Sildenafil was used to control her PHT and she remains alive even after 2 years.     

Measurement of pulmonary partial pressure of oxygen and oxygen depletion rate with hyperpolarized helium-3 MRI: a preliminary reproducibility study on pig model

RATIONAL AND OBJECTIVES: Pulmonary partial pressure of oxygen (pO(2)) and oxygen depletion rate (R) are two important parameters of lung function. The dependence of hyperpolarized (3)He (HP (3)He) T(1) on local oxygen concentration provides the basis for high-resolution mapping of the regional distributions of pO(2) and R in the lung. Although the oxygen-sensitive HP (3)He magnetic resonance imaging technique has been applied in human subjects and several animal species, reproducibility studies are rarely reported in the literature. This work presents a preliminary reproducibility study on a pig model. In this study, important scan parameters, such as measurement timing and flip angle, are optimized to minimize the noise-induced measurement uncertainty. MATERIALS AND METHODS: In the in vivo study, five normal pigs and one diseased pig with simulated pulmonary emboli were scanned with a small flip angle gradient echo sequence. The pulmonary oxygen measurement was repeated two to four times in each pig. In each measurement, a series of six images were acquired with optimal timing and flip angle. The parametric maps were generated using a bin-based data processing procedure that applied the multiple regression fitting method to extract the pO(2) and R. Variations of global mean, percentiles, and regions of interest were calculated from the maps to analyze reproducibility. RESULTS: The global statistical analyses show that average variation of global mean is 10.7% for pO(2) and 23.8% for R, and that the average variation of percentiles (10th, 25th, 50th, 75th, and 90th) and interquartile range is 14.8% for pO(2) and 30.4% for R. The region-of-interest analysis on the manually selected regions shows that the average variation of mean is 12.6% for pO(2) and 21.9% for R. CONCLUSION: In this work, a preliminary study on the reproducibility of measuring pO(2) and R with HP (3)He magnetic resonance imaging on a pig model is presented.     

An unusual case of complete ptosis and failure of elevation due to severe facial trauma

The authors describe the case of 49-year-old female teacher who had sustained severe facial lacerations following a minor fall on the kerb. The severe shearing force by which the flap was ripped off the forehead caused complete ptosis and complete failure of elevation of the left eye, which was presumed to be due to mechanical damage to the superior rectus and levator complex. The management by a multidisciplinary approach and clinical course of the patient are described with documentary photographs. This presentation is meant to highlight an unusual case of severe facial trauma resulting from a minor injury, and its successful management with gratifying results for both patient and the surgeon.     

Heterogeneity of Mycobacterium tuberculosis isolates in Sunamganj District, Bangladesh

A total of 111 Mycobacterium tuberculosis isolates from new pulmonary tuberculosis patients, living in the rural Sunamganj district in northern Bangladesh were characterized with IS6110 restriction fragment length polymorphism analyses and spoligotyping. Only 3 of the isolates belonged to the W-Beijing genotype of M. tuberculosis. A high degree of diversity indicated that the spread of M. tuberculosis, in this rural area, was not caused by closely related genotypes. The tuberculosis cases in the current study were less likely to represent recent transmission than what is commonly observed in urban parts of south-east Asia. It was indicated that the tuberculosis cases of this isolated area, of a high-incidence country, represented those of an established epidemic, not yet influenced by recently disseminated strains.     

The effect of increase in dielectric values on specific absorption rate (SAR) in eye and head tissues following 900, 1800 and 2450 MHz radio frequency (RF) exposure

Numerous studies have attempted to address the question of the RF energy absorption difference between children and adults using computational methods. They have assumed the same dielectric parameters for child and adult head models in SAR calculations. This has been criticized by many researchers who have stated that child organs are not fully developed, their anatomy is different and also their tissue composition is slightly different with higher water content. Higher water content would affect dielectric values, which in turn would have an effect on RF energy absorption. The objective of this study was to investigate possible variation in specific absorption rate (SAR) in the head region of children and adults by applying the finite-difference time-domain (FDTD) method and using anatomically correct child and adult head models. In the calculations, the conductivity and permittivity of all tissues were increased from 5 to 20% but using otherwise the same exposure conditions. A half-wave dipole antenna was used as an exposure source to minimize the uncertainties of the positioning of a real mobile device and making the simulations easily replicable. Common mobile telephony frequencies of 900, 1800 and 2450 MHz were used in this study. The exposures of ear and eye regions were investigated. The SARs of models with increased dielectric values were compared to the SARs of the models where dielectric values were unchanged. The analyses suggest that increasing the value of dielectric parameters does not necessarily mean that volume-averaged SAR would increase. Under many exposure conditions, specifically at higher frequencies in eye exposure, volume-averaged SAR decreases. An increase of up to 20% in dielectric conductivity or both conductivity and permittivity always caused a SAR variation of less than 20%, usually about 5%, when it was averaged over 1, 5 or 10 g of cubic mass for all models. The thickness and composition of different tissue layers in the exposed regions within the human head play a more significant role in SAR variation compared to the variations (5-20%) of the tissue dielectric parameters.     

The role of newborn gender in postpartum depressive symptoms among women in Upper Egypt

Objective

To assess the magnitude of postpartum depression among women in Upper Egypt, in addition to the role of newborn gender.

Methods

A cross-sectional study was conducted at the outpatient family-planning clinic of a university hospital. Women were enrolled if their first offspring was female and if they had 2 previous deliveries, the last within 3 months; no obstetric complications; regular marital life; middle social class or higher; and no past or family history of psychiatric illness. The Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) were used to assess the prevalence and severity of postpartum depressive symptoms.

Results

Of the 290 participants, 150 had a female second child (group 1) and 140 had a male second child (group 2). Overall, 113 (39.0%) women scored more than 13 on the EPDS: 70 in group 1 and 43 in group 2. Of the 113 women, 35 (31.0%) scored mild, 29 (25.7%) scored moderate, and 49 (43.4%) scored severe on the BDI. Significantly more women with a female second child had severe depression (P < 0.001).

Conclusion

Postpartum depressive symptoms were common among the present sample of women in Upper Egypt. Having female-only offspring is an important potential risk factor for postpartum depression and its severity.