Can dynamic and static pupillary responses be used as an indicator of autonomic dysfunction in patients with obstructive sleep apnea syndrome?

Purpose

We aimed to reveal whether static and dynamic pupillary responses can be used for the detection of autonomic nervous system (ANS) dysfunction in patients with obstructive sleep apnea syndrome (OSAS).

Methods

We included in this study patients with OSAS, who were divided into three groups according to the apnea–hypopnea index (AHI) (group 1, mild [n?=?20]; group 2, moderate [n?=?20]; and group 3, severe [n?=?20]), and healthy controls (group 4, n?=?20). Pupillary responses were measured using a pupillometry system.

Results

Static (mesopic PD, P?=?0.0019; low photopic PD, P?=?0.001) and dynamic pupil responses (resting diameter, P?=?0.004; amplitude of pupil contraction, P?<?0.001; duration of pupil contraction, P?=?0.022; velocity of pupil contraction, P?=?0.001; and velocity of pupil dilation, P?=?0.012) were affected in patients with different OSAS severities. Also, AHI was negatively correlated with mesopic PD (P?=?0.008), low photopic PD (P?=?0.003), resting diameter (P?=?0.001), amplitude of pupil contraction (P?<?0.001), duration of pupil contraction (P?=?0.011), velocity of pupil contraction (P?<?0.001), and velocity of pupil dilation (P?=?0.001).

Conclusion

We detected pupil responses innervated by the ANS were affected in the OSAS patients. This effect was more significant in the severe OSAS patients. Therefore, the pupillometry system can be an easily applicable, noninvasive method to detect ANS dysfunction in the OSA patients.

     

Fetal intracranial hemorrhage related to maternal autoimmune thrombocytopenic purpura

Background

Maternal autoimmune thrombocytopenic purpura (AITP) can cause fetal intracranial hemorrhage.

Case report

A 19-year-old primigravida was referred to our institution for prenatally detected ventriculomegaly at 30th week of gestation. Her personal and family histories were unremarkable. Her platelet count was 54?×?109/L. Fetal neurosonography showed intraparenchymal hemorrhage. AITP was diagnosed in the mother and platelet count decreased at 34?×?109/L. Patient was treated with methylprednisolone and intravenous immunoglobulin. She delivered a 2,340-g infant at 37 weeks with elective cesarean section. The platelet count of the newborn was 181?×?109/L and coagulation tests were normal. No antiplatelet specific antibodies were detected in cord blood. Postnatal MRI evaluation confirmed grade IV intracranial hemorrhage. The newborn baby has suffered from mild spasticity and seizures.

Conclusions

Clinicians must be vigilant about the catastrophic fetal complications of maternal AITP; a close follow-up with a multidisciplinary cooperation between obstetricians, hematologists, and neonatologists must be warranted.     

Syntheses and biological evaluation of indole-2 and 3-carboxamides: new selective cyclooxygenase-2 inhibitors

A series of indol-2 and 3-carboxamides were prepared and evaluated for their ability to inhibit cyclooxygenase-2 (COX-2) and cyclooxygenase-1 (COX-1). Substitution on indol nitrogen with benzyl and p-fluorobenzyl group of indole-2 carboxamides 8, 10, 11 provides fairly active COX-2 enzyme inhibitors.     

Neuropsychological Performance in Posttraumatic Epilepsy

Performances on the Wechsler-Bellevue Intelligence Scale and on Halstead's neuropsychological measures were investigated in two groups of adult subjects with posttraumatic seizures. One of the groups, in addition to seizures, had abnormal and persistent focal cortical signs. The other group had seizures only and no other known deficits or complications. The results suggest that posttraumatic epilepsy, whether or not accompanied by abnormal and persistent focal cortical signs, is associated with significant psychological impairment. Patients with posttraumatic epilepsy alone perform somewhat better than those whose epilepsy is accompanied by independent evidence of cortical damage. However, the performance difference between such patients is not major, nor is it statistically significant on most measures such as those used in the present study. Possible reasons for the performance deficit in this group were discussed.     

Risk of developing fibroadenoma with the use of cyclosporine A in renal transplant recipients

To investigate the effect of cyclosporine A (Cyc A) on the development of fibroadenomas, 30 renal transplant patients and 20 chronic renal failure patients on dialysis were breast examined with ultrasonography and/or mammography. Of the renal transplant patients, 17 were receiving Cyc A-based combination therapy for immunosuppression. All patients were female with the age range of 29.7+/-9.2 years in the transplant group and 33.95+/-9.91 in the dialysis group. Eight of the 17 patients receiving Cyc A had fibroadenomas, 5 of them having bilateral lesions. None of the other patients, those on dialysis and on non-Cyc A combination therapy had fibroadenomas. A significant difference for fibroadenoma incidence in patients receiving Cyc A combination immunosuppression was found.