To assess whether it is feasible to establish specific cut-off values able to discriminate 'physiological' or 'pathological' brain volume rates in patients with multiple sclerosis (MS).
The study was ...based on the analysis of longitudinal MRI data sets of patients with MS (n=206, 87% relapsing-remitting, 7% secondary progressive and 6% primary progressive) and healthy controls (HC; n=35). Brain atrophy rates were computed over a mean follow-up of 7.5 years (range 1-12) for patients with MS and 6.3 years (range 1-12.5) for HC with the SIENA software and expressed as annualised per cent brain volume change (PBVC/y). A weighted (on the follow-up length) receiver operating characteristic analysis and the area under the curve (AUC) were used for statistics.
The weighted PBVC/y was -0.51±0.27% in patients with MS and -0.27±0.15% in HC (p<0.0001). There was a significant age-related difference in PBVC/y between HC older and younger than 35 years of age (p=0.02), but not in patients with MS (p=0.8). The cut-off of PBVC/y, as measured by SIENA that could maximise the accuracy in discriminating patients with MS from HC, was -0.37%, with 67% sensitivity and 80% specificity. According to the observed distribution, values of PBVC/y as measured by SIENA that could define a pathological range were above -0.52% with 95% specificity, above -0.46% with 90% specificity and above -0.40% with 80% specificity.
Our evidence-based criteria provide values able to discriminate the presence or absence of 'pathological' brain volume loss in MS with high specificity. Such results could be of great value in a clinical setting, particularly in assessing treatment efficacy in MS.
Introduction
In patients with Parkinson’s disease (PD), impulsivity is still a matter of investigation. It has been hypothesized that impulsive personality traits may favour impulse control disorder ...(ICD) onset during dopaminergic therapy. In healthy subjects, a relationship between the awareness of motor intention and impulsive personality traits assessed by the Barratt impulsivity scale (BIS-11) has been reported. The aim of this study was to evaluate the relationship between the awareness of voluntary action and impulsivity traits in PD.
Methods
Twenty-eight PD patients (stages I-III on the Hoehn and Yahr scale) underwent an impulsivity trait assessment by the BIS-11 scale and a task based on the Libet’s clock. Participants were requested to perform a self-initiated movement and report the time they first feel their intention to move (W-judgement) or the time of the actual movement (M-judgement).
Results
In patients with higher BIS-11 scores, the time lag between the W-judgement and the actual movement was significantly lower than in patients with lower BIS-11. No difference emerged in the M-judgement.
Conclusion
Data suggest that also in PD patients, the impulsive personality trait is related to a “delayed” awareness of motor intention and therefore to a shorter interval to allow a conscious “veto” of the impending action. Characterization of the temporal profile of awareness of motor intention could prove useful in identifying PD patients at risk of developing ICDs during dopaminergic treatment.
Many projects have been developed in the last years for the conservation of sea turtles. Young green turtles (
) often nest on the Brazilian coast. Because they nest in beaches along the coastline ...and islands, green turtles are susceptible to fishing and accidental ingestion of anthropogenic debris. Early detection of ingested debris is crucial for the survival of rescued sea animals. Ultrasound (US) has emerged as a viable imaging technique for visceral examination in veterinary medicine. Previous studies have suggested the left and right cervicobrachial, axillary, pre- and post-femoral areas as the only viable approaches for US examination, but the acoustic windows available for imaging of coelomic structures are limited. It is important to notice that a detailed evaluation of all gastrointestinal tracts, especially the duodenum, is crucial for detecting foreign bodies and intestinal obstructive processes, as well as obtaining essential information such as intestinal motility and heart frequency. Intestinal motility and heartbeats are not detected through radiographic examination or through the acoustic windows available so far. This study aimed to establish the viability of US examination of coelomic viscera through the plastron in stranded green turtles. Eleven young green turtles rescued by the GREMAR Institute were examined. Turtles were placed in the dorsal decubitus position during US examination, which did not require anesthesia. Even though the plastron is constituted of bones and cartilage, the present research has proven the viability of obtaining US images through it, making it possible to visualize structures undetectable through the acoustic windows previously suggested. The following organs were evaluated through the plastron: heart, stomach, duodenum, jejunum, colon, liver, gallbladder, kidneys, bladder, and spleen (in case of splenomegaly). US imaging through the plastron is a viable approach for detecting ingested artificial debris, which represents one of the leading causes of death among sea turtles.
Few data are available on age-related burden and characteristics of embolic stroke of undetermined source (ESUS) in the real world clinical practice. The aim of our study was to provide information ...about it. We retrospectively analyzed data of patients consecutively admitted to our Stroke Unit along 1 year (2017, November 1st–2018, October 31st). The etiology of ischemic stroke was defined at hospital discharge; ESUS was considered as a subset of cryptogenic stroke, and defined according to the 2014 international criteria. In the analyzed period, 306 patients, 52.3% females, mean age ± SD 77.9 ± 11.9 years, were discharged with diagnosis of ischemic stroke. Ischemic strokes of cardioembolic and lacunar origin were the most frequent subtypes: 30.1% and 29.4%, respectively. Cardioembolic strokes were particularly frequent in patients ≥ 75 years, and almost always associated with atrial fibrillation. Overall, in 80 patients (26.1%) the etiology of stroke was undetermined; in 25 (8.2%) it remained undefined because of death or severe comorbidity, making further diagnostic work-up not worthy. Cryptogenic stroke occurred in 55 patients (18%), and ESUS criteria were satisfied in 39 of them (12.7%). According to age, cryptogenic stroke was diagnosed in 21.1% (21.1% ESUS) of patients < 65 years, 24.2% (19.4% ESUS) of patients aged 65–74 years, 15.5% (9.2% ESUS) of patients ≥ 75 years. After diagnostic work-up, patent foramen ovale was most commonly associated with ESUS (17.9%), especially in patients < 65 years (62.5%); covert paroxysmal atrial fibrillation was detected in 10.5% of ESUS patients ≥ 75 years. In the real world clinical practice, the frequency of ischemic strokes of undetermined etiology, and of those satisfying ESUS criteria, is not negligible, especially in younger patients. A thorough diagnostic work-up, with an age-specific approach, is therefore necessary and of the utmost importance for the identification of stroke etiology, in order to optimize secondary stroke prevention strategies.
Dioctophyma renale is a helminth that preferably inhabits the definitive host's right kidney, but is also described in peri-renal tissues, ureters, bladder, ure-thra, scrotum, inguinal subcutaneous ...tissue, uterus, ovaries, mesenteric lymph nodes, mammary gland, thoracic cavity, pericardium, abdominal cavity, stomach and liver. By presenting progressive destructive behavior, it can lead to total loss of the affected organ. The symptoms are often unspecific, varying according to the af-fected region, and may often be non-existent. Its incidence is related to access to aquatic environments and feeding habits of the animal, such as fish or raw frog in-gestion. The objective of this study was to report a case of Dioctophyma renale in a dog inhabited in the city of Santos, a non-endemic area of the parasite, in order to alert the population, including veterinarians, of the possibility of research and risks of this disease. The reported patient is a female dog, with no defined breed of ap-proximately 3 years old, which began to present prostration and progressive hematu-ria observed in clinical consultation. Hemogram and abdominal ultrasonography ex-ams were requested; however the latter one was the exam that identified the nema-toid inside the right kidney. The nephrectomy was performed the day after the diag-nosis and the patient is currently well.
El Dioctophyma renale es un helminto que habita preferentemente el riñón derecho del huésped definitivo, pero también habita los tejidos peri-renales, uréteres, vejiga, uretra, bolsa escrotal, tejido subcutáneo inguinal, útero, ovarios, ganglios linfáticos mesentéricos, glándula mamaria, cavidad torácica, pericardio, cavidad abdominal, estómago e hígado. Por presentar comportamiento destructivo progresivo, puede lle-var a la pérdida total del órgano afectado. Los síntomas, son a menudo inespecífi-cos, variando de acuerdo con la región afectada, y muchas veces pueden ser inexis-tentes. Su incidencia está relacionada con el acceso a los ambientes acuáticos y los hábitos alimenticios del animal, como, por ejemplo, la ingestión de peces o ranas crudos. El objetivo de este trabajo fue relatar un caso clínico de Dioctophyma renale en un perro proveniente de la ciudad de Santos, área no endémica del parásito, a fin de alertar a la población, incluidos los médicos veterinarios, de la posibilidad de in-vestigación y riesgos de esta enfermedad. La paciente relatada era una perra criolla con edad de aproximadamente 3 años, que comenzó a presentar postración y hema-turia progresiva observados en consulta clínica. Se solicitó hemograma y ultrasono-grafía abdominal, siendo este último examen el cual identificó el nematodo en el in-terior del riñón derecho. La nefrectomía fue realizada al día siguiente del diagnósti-co y actualmente la paciente pasa bien.
O Dioctophyma renale é um helminto que habita preferenci-almente o rim direito do hospedeiro definitivo, mas descrito também em tecidos pe-ri-renais, ureteres, bexiga, uretra, bolsa escrotal, tecido subcutâneo inguinal, útero, ovários, linfonodos mesentéricos, glândula mamária, cavidade torácica, pericárdio, cavidade abdominal, estômago e fígado. Por apresentar comportamento destrutivo progressivo, pode levar à perda total do órgão afetado. Os sintomas são por muitas vezes, inespecíficos, variando de acordo com a região afetada, e muitas vezes po-dem ser inexistentes. Sua incidência está relacionada ao acesso a ambientes aquáti-cos e hábitos alimentares do animal, como por exemplo, ingestão de peixe ou rã cruas. Objetivou-se com esse trabalho, relatar um caso de Dioctophyma renale em um cão habitado na cidade de Santos, área não endêmica do parasito, a fim de aler-tar a população, incluindo os médicos veterinários, da possibilidade de investigação e riscos desta doença. O paciente relatado é uma cadela, sem raça definida, de apro-ximadamente 3 anos, que começou a apresentar prostração e hematúria progressiva observados em consulta clínica. Foi solicitado hemograma e ultrassonografia abdo-minal, sendo este último exame o qual identificou o nematoide no interior do rim di-reito. A nefrectomia foi realizada no dia seguinte ao diagnóstico e atualmente o pa-ciente passa bem.
Subclinical paroxysmal atrial fibrillation (AF) is one of the main occult causative mechanisms of embolic stroke of undetermined source (ESUS). Aim of this study was to identify AF predictors, and to ...develop a score to predict the probability of AF detection in ESUS.
We retrospectively analyzed ESUS patients undergoing 2-week external electrocardiographic monitoring. Patients with and without AF detection were compared. On the basis of multivariate analysis, predictors of AF were identified and used to develop a predictive score, which was then compared with other existing literature scores.
Eighty-two patients, 48 females, mean age±SD 72±10 years, were included. In 36 patients (43.9%) AF was detected. The frequency of age 75 years or above and arterial hypertension, and the median CHA 2 DS 2 -VASc score were significantly higher in patients with AF compared with those without. National Institutes of Health Stroke Scale (NIHSS) score ≥8 was the only independent variable associated with AF detection. We derived the Empoli ESUS-AF (E 2 AF) score (NIHSS ≥8 5 points, arterial hypertension 3 points, age 75 years or above 2 points, age 65 to 74 years 1 point, history of coronary/peripheral artery disease 1 point, left atrial enlargement 1 point, posterior lesion 1 point, cortical or cortical-subcortical lesion 1 point), whose predictive power in detecting AF was good (area under the curve: 0.746, 95% confidence interval: 0.638-0.836) and higher than that of CHA 2 DS 2 -VASc and other scores.
In our study NIHSS score ≥8 was the only independent predictor of post-ESUS-AF detection. The E 2 AF score appears to have a good predictive power for detecting AF. External validations are required.
Few data exists on predictive factors of hemorrhagic transformation (HT) in real-world acute ischemic stroke patients. The aims of this study were: (i) to identify predictive variables of HT (ii) to ...develop a score for predicting HT.
We retrospectively analyzed the clinical, radiographic, and laboratory data of patients with acute ischemic stroke consecutively admitted to our Stroke Unit along two years. Patients with HT were compared with those without HT. A multivariate logistic regression analysis was performed to identify independent predictors of HT on CT scan at 24 hours to develop a practical score.
The study population consisted of 564 patients with mean age 77.5±11.8 years. Fifty-two patients (9.2%) showed HT on brain CT at 24 hours (4.9% symptomatic). NIHSS score ≥8 at Stroke Unit admission (3 points), cardioembolic etiology (2 points), acute revascularization by systemic thrombolysis and/or mechanical thrombectomy (1 point), history of previous TIA/stroke (1 point), and major vessel occlusion (1 point) were found independent risk factors of HT and were included in the score (Hemorrhagic Transformation Empoli score (HTE)). The predictive power of HTE score was good with an AUC of 0.785 (95% CI: 0.749-0.818). Compared with 5 HT predictive scores proposed in the literature (THRIVE, SPAN-100, MSS, GRASPS, SITS-SIC), the HTE score significantly better predicted HT.
NIHSS score ≥8 at Stroke Unit admission, cardioembolism, urgent revascularization, previous TIA/stroke, and major vessel occlusion were independent predictors of HT. The HTE score has a good predictive power for HT. Prospective studies are warranted.
Posterior reversible encephalopathy syndrome (PRES) is a brain disorder characterized by acute onset of seizures, visual disturbances, and focal neurological deficits 1. PRES is often associated with ...an abrupt increase in blood pressure or endogen/hexogen toxins 1. Early diagnosis is of paramount importance, as complete recovery depends on removal of the causative factor. A typical neuroimaging finding is reversible vasogenic subcortical edema without infarction 1,2, We report PRES onset in a 32-year-old woman with autoimmune comorbidities and relapsing-remitting multiple sclerosis (MS-RR) lesions on magnetic resonance (MR) brain scan, which to our knowledge has never been described. Her autoimmune medical history started at age of 22 years, when she was diagnosed with psoriatic arthritis, treated by methotrexate (suspended at age 31 for liver toxicity). At age 23, she suffered retrobulbar optic neuritis, treated by intravenous methylprednisolone, followed 2 years lat...
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