Idiopathic intracranial hypertension in a paediatric population: a retrospective observational study on epidemiology, symptoms and treatment.

Idiopathic intracranial hypertension (IIH) is a disorder of unknown origin, which is characterized by elevated intracranial pressure (ICP) without underlying etiological evidence of neurological disease. The purpose of the current study was to evaluate epidemiological features, clinical presentation, diagnostic findings and treatment of sixteen children (7 males and 9 females) with IIH. Medical records of the patients were obtained from the University Paediatric Hospital of Catania, Italy. Clinical features, investigations and treatment approaches were retrieved. The mean age of the sixteen children at onset of symptoms was 9 years (range: 4 to 16 years). Most of the patients were classified as pre-pubertal. Mean BMI was 28.9 kg/m2. In 93.75% of patients headache was the presenting clinical symptom; and in the same percentage papilledema was detected as the accompanied sign during diagnostic flow-chart. The mean lumbar puncture opening pressure (LPOP) was 350 mm H2O. Fifty percent of the cases had normal brain imaging, while 12.5% showed enlarged optic nerve diameter and one patient had an intraocular protrusion of the optic nerve on MRI. Two patients (12.5%) had venous sinus stenosis, and one case showed an abnormal spinal MRI. With regard to therapeutic approaches, 93.75% of the cases were successfully treated with Acetazolamide. None of the patients required surgical procedures, and all neuroimaging findings disappeared after receiving treatment. In the present study we investigated the association of IIH with venous sinus stenosis. We also found ocular ultrasound to be a useful non-invasive alternative method for determining papilledema in paediatric IIH, specifically in an emergency.

Rigid and remodelled: cerebrovascular structure and function after experimental high-thoracic spinal cord transection.

High-thoracic or cervical spinal cord injury (SCI) is associated with several critical clinical conditions related to impaired cerebrovascular health, including: 300-400% increased risk of stroke, cognitive decline and diminished cerebral blood flow regulation. The purpose of this study was to examine the influence of high-thoracic (T3 spinal segment) SCI on cerebrovascular structure and function, as well as molecular markers of profibrosis. Seven weeks after complete T3 spinal cord transection (T3-SCI, n = 15) or sham injury (Sham, n = 10), rats were sacrificed for either middle cerebral artery (MCA) structure and function assessments via ex vivo pressure myography, or immunohistochemical analyses. Myogenic tone was unchanged, but over a range of transmural pressures, inward remodelling occurred after T3-SCI with a 40% reduction in distensibility (both P < 0.05), and a 33% reduction in vasoconstrictive reactivity to 5-HT trending toward significance (P = 0.09). After T3-SCI, the MCA had more collagen I (42%), collagen III (24%), transforming growth factor ß (47%) and angiotensin II receptor type 2 (132%), 27% less elastin as well as concurrent increased wall thickness and reduced lumen diameter (all P < 0.05). Sympathetic innervation (tyrosine hydroxylase-positive axon density) and endothelium-dependent dilatation (carbachol) of the MCA were not different between groups. This study demonstrates profibrosis and hypertrophic inward remodelling within the largest cerebral artery after high-thoracic SCI, leading to increased stiffness and possibly impaired reactivity. These deleterious adaptations would substantially undermine the capacity for regulation of cerebral blood flow and probably underlie several cerebrovascular clinical conditions in the SCI population.

TestMeEast: a campaign to increase HIV testing in hospitals and to reduce late diagnosis.

Late diagnosis occurs in almost half of those diagnosed in the UK (HIV Prevention England, 2013. Retrieved June 22, 2014, from HIV Prevention England: http://www.hivpreventionengland.org.uk/Campaigns-Current/National-HIV-Testing-Week ). Testing occurs mainly in sexual health and antenatal clinics despite recommendations to test more broadly [Ellis, S., & Curtis, H. (2012). HIV diagnoses and missed opportunities. Results of the British HIV association (BHIVA) National Audit 2010. Clinical Medicine, 12(5), 430-434]. We report the findings of an HIV-testing week campaign to offer testing to those who have blood tests as part of routine care within outpatient clinics and emergency departments of six London hospitals. The campaign target was to test 500 patients a day during the 2013 National HIV Testing Week (NHTW). Clinic staff and medical students were trained to offer routine HIV testing. Linkage to care was arranged for those who tested HIV-positive. During NHTW we tested 2402 of the planned 2500 test target. 2402/4317 (55.6% 95% CI 54.1-57.1%) of those who had routine blood tests were tested for HIV. There were eight HIV-positive tests; three were new diagnoses (all linked to care). The campaign hashtag #TestMeEast achieved a total Twitter "reach" of 238, 860 and the campaign had widespread news coverage. Our campaign showed that staff and students could be trained and mobilised to do thousands of routine HIV tests during a campaign.

Headache, migraine and obesity: an overview on plausible links.

Headache can represent different disorders with different etiologies; including cardiac, cerebral, vascular, psychiatric, metabolic, neurologic diseases. Recent studies have highlighted that obesity is significantly associated with headache and disability in adults. This rule also applies to children. This review focuses on literature data studying any eventual relationship between headache, migraine and obesity [shown in Body Mass Index (BMI)] in children. Research data have highlighted that there is a relationship between headache physiopathology and central and peripheral mechanisms responsible for food assumption. In this regard, neurotransmitters such as serotonin, and peptides such as orexin and adipocytokines (adiponectin and leptin) seem to play a key role both in food assumption and in headache pathogenesis. These data further emphasize the potential association between headache and BMI. Therefore, those therapeutic strategies aiming to decrease BMI may represent a model of useful treatment to understand whether weight loss reduces the incidence and the severity of headache in obese children. In conclusion, considering the effects of obesity and weight loss on the natural history of headache, important changes are expected in therapeutic management of paediatric headaches.

Efficacy and safety of omalizumab in paediatric age: an update of literature data.

Immunoglobulin E (IgE) was discovered in 1966 and was found responsible for immune defense against helminths, type I hypersensitivity and allergic diseases. IgE mediates allergic responses by binding to Fc receptors (the high affinity Fc-epsilon receptor I and the low affinity Fc-epsilon receptor II or CD23) expressed on tissue mast cells and blood basophils. This binding leads to degranulation and release of pro-inflammatory mediators. Considering the pivotal role of IgE in allergic diseases, antibodies against IgE potentiate an array of new therapeutic strategies and in this regard omalizumab (rhuMAb-E25, Xolair) has been developed as a monoclonal biologic drug to block serum IgEs. Although the use of omalizumab has been studied vigorously in many adult populations with allergic diseases, there are few heterogenous studies on children. There are very few ongoing clinical trials with omalizumab exclusively on children, although some adult studies have concluded pediatric patients as a part of their studies. Nevertheless, in pediatric clinical trials omalizumab has been demonstrated to be effective and safe also in this age group. Herein, the authors present a systematic review of extensive literature data on the use of omalizumab in children and adolescents.

Spinal anesthesia reduces postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting.

We investigated the effect of high spinal anesthesia on postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting (CABG). The study was conducted in a tertiary referral university hospital on a population of 60 opium dependent patients undergoing CABG surgery. Patients were divided into two groups based on anesthesia protocol. One group were given general anesthesia (GA Group), the other group additionally received intrathecal morphine and bupivacaine (SGA Group). Postoperative delirium (POD) was defined as the main outcome of interest. Incidence of POD was significantly higher in patients of GA Group as compared with those in SGA Group (47% and 17% for GA and SGA respectively; P-value = 0.01). Time to extubation was on average 2.2 h shorter in SGA than in GA (7.1 h and 9.3 h respectively, P-value < 0.001). Intrathecal morphine and bupivacaine reduced the risk of POD after CABG in a population of opium dependent patients.

Phosphorus digestibility and relative phosphorus bioavailability in two dried black soldier fly larvae meals and a defatted black soldier fly larvae meal in broiler chickens.

Two chicken assays were conducted to determine P availability, using three different approaches, for 2 black soldier fly larvae meals (BSFL 1 and 3) and one partially-defatted BSFL. Experiment 1 was conducted to determine ileal P digestibility and total tract P retention. Three experimental diets containing a BSFL as the only source of P were fed to broiler chickens from 19 to 22 days of age. Each diet contained 0.25% total dietary P. Ileal digesta and excreta were collected on day 22. Ileal digestibility of P was 87%, 75%, and 88% for BSFL 1, BSFL 3, and partially-defatted BSFL, respectively. Total tract P retention was 87%, 73%, and 85% for BSFL 1, BSFL 3, and partially-defatted BSFL, respectively. The objective of experiment 2 was to determine the relative bioavailability of P in the 3 insect meals relative to KH2PO4 using a chicken bone ash bioassay. Chickens were fed one of nine dietary treatments from 8 to 22 days of age. These diets included a P-deficient cornstarch-dextrose-SBM based diet (0.14% nonphytate P) or that diet supplemented with 0.05% or 0.10% P from KH2PO4, 7% or 14% BSFL 1, 8%, or 16% BSFL 3, and 8% or 16% partially-defatted BSFL. The slope-ratio method using multiple regression for tibia ash regressed on supplemental P intake was used to calculate the relative bioavailability of P where values for BSFL 1, BSFL 3, and partially-defatted BSFL were 54%, 51%, and 57%, respectively, relative to KH2PO4. The results of this study indicated that availability of P in BSFL based on ileal P digestibility and total tract P retention values was high, whereas relative bioavailability values for P based on tibia ash were approximately 20 to 30 percentage units lower.

True metabolizable energy and amino acid digestibility in black soldier fly larvae meals, cricket meal, and mealworms using a precision-fed rooster assay.

Six precision-fed rooster assays were conducted to determine nutrient composition, nitrogen-corrected true metabolizable energy (TMEn) and standardized amino acid digestibility for three black soldier fly larvae meals (BSFL), one partially-defatted BSFL, one cricket meal and two mealworm meals. The TMEn values were determined in three 48-h rooster assays using conventional roosters and the standardized amino acid digestibility values were determined in three 48-h rooster assays using cecectomized roosters. Nutrient analysis (DM basis) of the meals indicated that the CP varied from 45 to 58% among the four BSFL, was 67% for the cricket meal and varied from 51 to 56% for the two mealworms. Crude fat (12-30%), total P (0.7-1.1%), Ca (0.04-3.6%), and neutral detergent fiber (10-36%) also varied among the insect meals. The TMEn values for the three BSFL were generally consistent and averaged 4079 kcal/kg DM. As expected, partially-defatted BSFL contained a lower level of TMEn. The TMEn of the cricket meal was 4223 kcal/kg DM. Due to their low fiber content and high fat content, the TMEn values for the two mealworms were high and in excess of 5000 kcal/kg DM. Amino acid concentrations of the various insect meals ranged from 0.69 to 1.1% for methionine, 0.57 to 0.73% for cystine, 3.3 to 4.5% for lysine, and 1.9 to 2.6% for threonine. Standardized amino acid digestibility values were generally high (most were 85-95%) for the four BSFL and two mealworms. Digestibility values for most amino acids were slightly lower for the cricket meal. Digestibility of cystine and valine were generally lower and more variable than other amino acids in the seven insect meals. The results of this study indicated that nutrient composition varies substantially among different insect meals, but all insect meals contained high levels of TMEn and digestible amino acids compared with feed ingredients commonly used in poultry diets.

Relationship between Pack Year and Lung Function Parameters in Asymptomatic Smokers.

Smoking has extensive effects on respiratory function. The rate of cigarette smoking among young people has continued to increase steadily. Exposure to cigarette smoking is usually measured in terms of 'Pack-Year'. The aim of the study was to observe the effect of pack years on pulmonary functions in apparently healthy asymptomatic smokers by measuring FVC, FEV1, FEV1/FVC ratio and PEFR value by digital spirometer. This cross-sectional observational study was conducted in the department of Physiology, Sylhet MAG Osmani Medical College in collaboration with department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from July 2016 to June 2017. A total number of 100 male smokers, age ranging from 18-60 years and BMI within normal limit (18.5-24.9kg/m²) were included in this study. Their pulmonary functions were studied by measuring FVC, FEV1, FEV1/FVC ratio and PEFR. Relationship between pack-year and pulmonary function test parameters was established by one way ANOVA test. In this study we found that lung function parameters shared an inverse relationship with pack year of smoking. The percentage of predicted values of FEV1, FEV1/FVC ratio and PEFR were significantly lower (p<0.001) in heavy smokers who smoked more than 30 pack years. Therefore, by this study we inferred that those who smoked more than 10 pack years are associated with accelerated decline in lung function.

Object Categorization in Finer Levels Relies More on Higher Spatial Frequencies and Takes Longer.

The human visual system contains a hierarchical sequence of modules that take part in visual perception at different levels of abstraction, i.e., superordinate, basic, and subordinate levels. One important question is to identify the "entry" level at which the visual representation is commenced in the process of object recognition. For a long time, it was believed that the basic level had a temporal advantage over two others. This claim has been challenged recently. Here we used a series of psychophysics experiments, based on a rapid presentation paradigm, as well as two computational models, with bandpass filtered images of five object classes to study the processing order of the categorization levels. In these experiments, we investigated the type of visual information required for categorizing objects in each level by varying the spatial frequency bands of the input image. The results of our psychophysics experiments and computational models are consistent. They indicate that the different spatial frequency information had different effects on object categorization in each level. In the absence of high frequency information, subordinate and basic level categorization are performed less accurately, while the superordinate level is performed well. This means that low frequency information is sufficient for superordinate level, but not for the basic and subordinate levels. These finer levels rely more on high frequency information, which appears to take longer to be processed, leading to longer reaction times. Finally, to avoid the ceiling effect, we evaluated the robustness of the results by adding different amounts of noise to the input images and repeating the experiments. As expected, the categorization accuracy decreased and the reaction time increased significantly, but the trends were the same. This shows that our results are not due to a ceiling effect. The compatibility between our psychophysical and computational results suggests that the temporal advantage of the superordinate (resp. basic) level to basic (resp. subordinate) level is mainly due to the computational constraints (the visual system processes higher spatial frequencies more slowly, and categorization in finer levels depends more on these higher spatial frequencies).

Hepatitis A surveillance in England--how many cases are not reported and does it really matter?

Underreporting of hepatitis A infection in England may be high and a number of outbreaks have occurred undetected by routine surveillance. We evaluated surveillance of hepatitis A cases by employing capture-recapture analysis on data from two distinct outbreaks of hepatitis A. The overall reporting of cases of hepatitis A was 81.7% (95% CI 55.3-95) in the first outbreak in North East England and reporting through Lab Base was 65.7% (95% CI 42.8-76.4). In the second outbreak in the East Midlands the overall reporting of hepatitis A cases was 27.8% (95% CI 19-38.7) and through Lab Base 16.6% (95% CI 11.4-23.1). Underreporting of hepatitis A cases is high. Public health interventions exist to prevent and control outbreaks of hepatitis A. The lack of reliable data on incidence and prevalence hampers effective public health management of this disease.

The changing emphasis of disasters in Bangladesh NGOs.

Bangladesh is one of the most disaster-prone countries in the world, affected by cyclones and floods, as well as chronic hazards such as arsenic poisoning. NGOs have played a major role in bringing concerns related to risk management on to the national agenda and promoting a shift of focus from mere relief response to disaster mitigation and preparedness. The government has, after earlier scepticism, now accepted NGOs as major partners in these tasks. Innovative approaches, such as the use of microfinance, have been applied; many of which are related to preserving the gains of development efforts as part of rehabilitation. NGOs have pressured for better coordination with government. Improved structures are now approved, but it is still too early to judge their impact. Despite progress, neither NGOs nor governmental agencies have clearly defined roles in the effort to link disaster management priorities. This will ensure that longer-term development efforts build on local capacities and reduce vulnerabilities.