ABSTRACT
Background: The non-contrast computed tomography (CT) isa routine brain imaging modality for stroke diagnosis. However,the multiparametric magnetic resonance imaging (MRI) isincreasingly being used for acute stroke diagnosis owing to itsbetter sensitivity in detecting ischaemic brain infarcts.Objectives: To evaluate the best available evidence on thecomparative diagnostic test accuracies between CT andmultimodal MRI for the diagnosis of acute haemorrhagic andischaemic strokes in patients presenting to the emergencydepartment within 6 hours after the onset of stroke-likesymptoms.Methods: MEDLINE-Ovid, AMED, CINAHL and ENBASEelectronic bibliographic databases were searched in Englishfrom January 2004 to August 2014 and supplemented withmanual bibliographic hand search. Prospective andretrospective cohort studies, which directly compared thediagnostic test accuracies between CT (as reference standard)and DW-MRI or GRE-MRI in detecting ischaemic orhaemorrhagic stroke in the same patient population within 6hours after the onset of stroke-like symptoms, were consideredin the review. Only studies with diagnostic outcomes in termsof sensitivity and specificity of MRI versus CT in detectingacute stroke were considered. The quality of the selectedstudies in terms of risk of bias and clinical applicability wereappraised using the QUality Assessment of DiagnosticAccuracy Studies-2 (QUADAS-2) tool.Results: A total of 780 patients were evaluated in the fourselected cohort studies. Three and two studies contributeddata on the diagnosis of acute ICH and ischaemic stroke,respectively. Three studies were of good quality while one wasof poor quality. GRE-MRI exhibited high sensitivity of 83-100%(95% CI) in detecting acute ICH compared to 100% for CTused as the reference standard. CT exhibited poor sensitivity(12-81%) but better specificity (88-100%) in detecting acuteischaemic stroke as compared to DW-MRI, which had asensitivity of 73% (95% CI) and specificity of 92% (95% CI).Conclusions: It appears that GRE-MRI has comparablesensitivity as CT in detecting acute ICH. Similarly, DWI isexcellently sensitive and specific in detecting acute ischaemiclesions. These strongly suggest that MRI is sufficientlyaccurate for routine evaluation of patients with suspected acutestroke in the emergency setting. However, the studiesgenerally lack applicability aspects to the general populationand current clinical practice therefore, warranting furtherresearch. In the meantime, CT and/or MRI tests can be usedfor routine assessment of patients with suspected stroke in theemergency setting.
ABSTRACT
Background: Carpal tunnel syndrome [CTS] is a constellation of symptoms and signs resulting from the local compression of the median nerve inside the carpal tunnel at the wrist. In advanced cases of CTS where the course is unnoticed, atrophy of the thenar muscles may occur, which can be irreversible
Objective: The aim of the present study was to estimate prevalence and severity of CTS in patients with type 2 diabetes mellitus in South Western region of the Kingdom of Saudi Arabia [KSA] and to identify specific at risk groups within these populations by using nerve conduction study
Methods: This cross-sectional study was conducted in Asir Central Hospital, Abha, KSA. The study randomly included all patients with type 2 diabetes mellitus with their place of birth and permanent residence being in Abha or Mohyel cities. History, physical examination, and laboratory data about fasting blood glucose, HbA1c, and lipid profile were collected. Additionally, nerve conduction study of both hands was performed
Results: Out of 131 included subjects, 107 patients [81.7%] had CTS. Approximately one-third [35.1%] of the study subjects had unilateral CTS, and it affected both hands in 46.6% of them. In the majority of cases CTS was of very mild or mild severity [27.5% and 26.7% respectively]. A significant association was found between gender, hypertension, hypothyroidism, ischemic heart disease and the development of CTS
Conclusion: High prevalence of unilateral and bilateral CTS was found among patients with type 2 diabetes mellitus in South Western Saudi Arabia. Different grades of CTS were detected, but the severity of functional impairment was relatively mild. Development of CTS was associated with hypertension, ischemic heart disease, and hypothyroidism. Health care professionals should be aware of this high prevalence, and it will be useful to perform electrodiagnostic studies in diabetic patients in whom CTS is suspected