Atherogenic consequence of antiepileptic drugs: a study of intima-media thickness

We intended to evaluate the carotid intima-media thickness (CA-IMT) as a surrogate factor for atherogenesis in epileptic patients on enzyme inducer (EI) antiepileptic drugs (AEDs) or valproate (VA). The study included 71 patients with epilepsy (37 females) aged 27.7 ± 8.1 and 71 age- and sex-matched non-epileptic subjects. Patients with history of at least 2 years antiepileptic treatment were enrolled. Subjects with known history of cardiovascular risk factors were not included. Thirty-eight patients (21 females) were treated with EI medications and 33 (16 females) with VA. CA-IMTs were measured by a single sonography system in all participants. CA-IMT values were compared between patients with epilepsy and the controls and within the patients with epilepsy on VA or EI medications. Duration of epilepsy was 10.1 ± 7.1 years. Patients were treated with their current AED for 6.9 ± 4.8 years. The CA-IMT of patients with epilepsy was higher than non-epileptic control subjects on either left (0.502 ± 0.079 vs. 0.470 ± 0.073 mm; p = 0.012) or right side (0.524 ± 0.078 vs. 0.458 ± 0.068 mm; p < 0.001). Patients on VA were younger than those receiving EI medications (25.8 ± 7.1 vs. 29.4 ± 8.7 years). Age adjusted CA-IMT values of patients on VA did not differ from the values of patients receiving EI medications. Duration of drug administration did not correlate with CA-IMT values. Patients with epilepsy on AEDs are at higher risk for atherogenesis. In the population of this study the increased risk of atherogenesis was not attributable to the administered AED or duration of treatment.     

Gluteal region morphology: the effect of the weight gain and aging

The gluteal region is an important secondary sexual character itself and it has its place in the concept of the beauty in all communities. Interestingly, as far as we know, there is not any previous study addressing gluteal region morphology in an objective way in the aesthetic surgery literature. The aim of this study was to define the changes of the gluteal region morphology with aging and weight gain. Beside body weight, a total of five distances between predetermined anatomic points in gluteal region were measured on randomly selected 115 female volunteers, with their age ranging from 17 to 48 years (mean 22.7). All the records were analyzed by a correlation matrix using computer-based SPSS 7.5 program. As women grow older, the width of the gluteal region decreases and the gluteal sulcus elongates laterally and inferiorly. Contrary to aging, with weight gain the gluteal region becomes wider as the gluteal sulcus gets shorter. Although the subject does not sound new, our study is the first, documenting the changes in morphology of the gluteal region in relation to weight gain and aging in an objective way.     

Measuring mucosal damage induced by cytotoxic therapy

We scored oral mucositis and gut toxicity and measured sugar permeability testing among 56 recipients of a haematopoietic stem cell transplant (HSCT) given myeloablative conditioning with idarubicin, cyclophosphamide and TBI, and a group of 18 patients given cytotoxic chemotherapy for newly diagnosed acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS). Gut integrity was already disturbed in the AML/MDS group as measured by the lactulose/rhamnose ratio (L/R ratio=0.09) before therapy and was severely perturbed (L/R ratio >0.13) for a month after HSCT. Oral mucositis and to a lesser extent gut toxicity was only significantly correlated with disturbed permeability in the transplant group. The data suggest that sugar permeability, oral mucositis and gut toxicity measure different features of mucosal damage after intensive cytotoxic therapy.     

Comparison of Epinephrine to Salbutamol in Acute Bronchiolitis

Objective

An appropriate treatment of acute viral bronchiolitis can reduce the symptoms, hospitalization duration and exorbitant costs which is imposed on the families and insurance organizations. This study was conducted to determine the efficacy of epinephrine in comparison with salbutamol in the treatment of the disease.

Methods

Forty infants aged one month to 2 years with acute bronchiolitis in Amin and Al-Zahra hospitals, during 2008, were enrolled in this study. The participants were randomized in two treatment groups to receive epinephrine 0.1 ml/kg or salbutamol 0.15 mg/kg. Three doses of each medication were prescribed at intervals of 20 minutes and continued every 10 minutes after the third dose. The patients in both groups were monitored and rated by RDAI, number of the hospitalized days in the hospital, level of oxygen saturation and vital signs.

Findings

Mean hospitalization duration was 3.3±1.1 and 3±0.9 in the patients receiving salbutamol and epinephrine, respectively (P=0.03). There was a significant difference in assessing RDAI index between the two groups (P=0.03). There were no differences in SPO2, PR, or RR variables in the studied intervals in both groups (P>0.05).

Conclusion

Regarding the effect of epinephrine on reduction of hospitalization duration and the RDAI index in patients with acute bronchiolitis, it seems that using epinephrine instead of salbutamol could be more effective in the management of the disease.     

Common surgical pitfalls in the skull

BACKGROUND: A detailed knowledge of the morphologic variations in the ossicles, foramina, and ridges of the skull vault and skull base is vital to performing safe radical surgery. METHODS: A surgical reminder of possible pitfalls was composed based on the incidences of most of the minor variations such as the supraorbital notch, frontal foramen, metopism, foramen caecum, parietal foramina, bony defects in the fossa occipitalis cerebellaris, Inca bone, foramen lacerum anterius, incomplete posterolateral wall of the foramen ovale, absence of the medial or posterior wall of the foramen spinosum, foramen innominatus, foramen meningoorbitale, bony dehiscence of the internal carotid canal, bony ridge or torus in the floor of the external auditory meatus, foramen of Huschke, precondylar tubercle, foramen hypoglossi, anterior condylar canal, hypoglossal bridging, divided articular surface of the occipital condyle, high jugular bulb, paramastoid process, atlanto-occipital assimilation, ossicle of Kerkring, delta or keyhole shaped bony defects in the anterior border of foramen magnum, foramen of Vesalius, posterior condylar canal, mastoid emissary foramen and occipital foramen in 200 skulls. CONCLUSION: Recognition of these structures and their possible variations will help in distinguishing normal from potentially abnormal structures during computed tomography and magnetic resonance imaging examinations, and in avoiding misinterpretations that lead to confusion during surgical interventions. Instrumentation near potential bone gaps may traumatize important neural or vascular structures.     

The effect of hand preference on hand anthropometric measurements in healthy individuals.

This study was planned for the purpose of investigating the effect of hand preference on hand anthropometric measurements, with the participation of 393 healthy university students. The hand preference direction of the subjects was established according to the Edinburgh Inventory, and five hand preference determination groups were constituted after calculation of the laterality score. During performance of the hand anthropometric measurements, values for both hands were calculated, and seven parameters were evaluated for each hand. Hand width and shape index were found to be high for the right hand, but the palmar length/width ratio was found to be high for the left hand, for strong and weak right handers, respectively. No significant statistical values were obtained among ambidextrous subjects, although their parameters resembled these groups' values. Additionally, in the left-handed group, reverse direction asymmetric values were established, but significant statistical values were not obtained. An increase in right and left hand asymmetry was established going from the strong right hand preferent group to the strong left hand preferent group (on a decreasing scale of right hand preference). If the laterality score is evaluated without regard to groups, left hand shape index and right hand finger index may be accepted as phenotype indicators of hand preference. Left hand shape index and right hand finger index increased in correlation with the tendency for left hand and right hand preference, respectively. The findings reveal that, environmental factors such as hand activity, hormones, and brain asymmetry may play a role in the effect of hand preference on hand anthropometric measurements. In our study, we found no difference in asymmetry in regard to the sex of the subjects, generally.