Outcomes of CSF spectrophotometry in cases of suspected subarachnoid haemorrhage with negative CT: two years retrospective review in a Birmingham hospital.

AIM: The aim of this study was to evaluate the adherence to current guidelines for the investigation of suspected subarachnoid haemorrhage and the prevalence and outcome of computed tomography (CT)-negative aneurysmal subarachnoid haemorrhage. DESIGN: A retrospective review in a single large tertiary referral centre. SUBJECTS: A total of 796 patients, aged 16-90 years, who underwent lumbar puncture (LP) for suspected subarachnoid haemorrhage (SAH) following a negative or equivocal CT scan between January 2012 and November 2013 (23 months). METHODS: Xanthochromia reports were obtained using the hospital's department of biochemistry database and clinical data for these patients were reviewed using patient notes. RESULTS: Of 796 CSF reports reviewed, 728 (91%) were negative for xanthochromia, 31 (4%) were positive and 37 (5%) were equivocal. Only 2 out of the 31 patients with positive spectrophotometry results were subsequently found to have an underlying aneurysm on CT angiography. A further 9 out of these 31 patients underwent digital subtraction angiography, with no cerebral aneurysms being detected. Amongst the 37 patients with equivocal xanthochromia reports, 13 underwent CT angiography and only 1 cerebral aneurysm was detected. CONCLUSIONS: In patients with clinically suspected SAH but who have negative or questionable CT findings, CSF analysis is likely to be negative in the vast majority of cases, which was 91% in our series. In patients yielding positive or equivocal CSF results the likelihood of an aneurysm being detected is low, amounting to three out of 68 or approximately one in 23 (approximately 4%). Overall in suspected SAH cases where CT scan has been negative, the rate for the detection of cerebral aneurysm is three out of 796 cases (0.4%).

The relationship between visfatin and serum concentrations of C-reactive protein, interleukin 6 in patients with metabolic syndrome.

AIM: To evaluate the relationship between inflammatory and pro inflammatory markers, with obesity and visceral adiposity in male subjects with or without metabolic syndrome (MS). SUBJECTS AND METHODS: A total of 37 patients with MS and 37 age matched controls were included (mean age 46.35 ± 1.6 years). MS was defined by the criteria of the international diabetes federation 2005. Anthropometric and biochemical profiles, including high-sensitivity C-reactive protein (Hs-CRP), visfatin and interleukin 6 (IL-6), were measured. Data were compared between groups by using t test. Pearson's correlation was used to evaluate the relationship between variables. P values less than 0.05 were considered as statistically significant. RESULTS: In patients with MS, CRP and IL-6 were significantly correlated with body mass index, waist circumference and waist to hip ratio. Visfatin levels were significantly lower in patients with MS compared to controls (log visfatin: 1.74 ± 0.27 vs. 1.86 ± 0.13 ng/ml, MS vs. control group respectively). We cannot find any significant correlation between visfatin, CRP and IL-6. Also there were no correlation between visfatin levels and any anthropometric parameters in patients with MS or control groups. CONCLUSION: Serum visfatin was lower in patients with MS. Therefore it seems that visfatin could not be considered as a pro inflammatory adipocytokine in MS. The positive associations of obesity and visceral adiposity with elevated CRP and IL-6 levels suggest the importance of reducing visceral adiposity to prevent the risk of coronary disease.

Lack of renal protection of ultrafiltration during cardiac surgery: a randomized clinical trial.

AIM: The objective of this study was to determine the intraoperative ultrafiltration effect on postoperative AKI. METHODS: In this prospective randomized clinical trail, 159 patients scheduled for elective cardiac surgery, were randomly assigned to either hemofilter (N.=87) or control group (N.=72). The primary and secondary outcomes were AKI (defined as ≥50% increase in the serum creatinine level) and increased urinary neutrophil gelatinase-associated lipocalin (NGAL) in the postoperative period, respectively. RESULTS: The two groups were similar with respect to comorbidities and also surgical procedure, except ultrafiltration. The incidence of AKI was equal in the both groups (11% vs. 5%, P=0.2, respectively). Creatinine increased after surgery (P=0.00) without significant differences between the both groups (P=0.2). Urinary NGAL also showed no significant difference between the groups. Age, euroscore, hyperlipidemia, pulmonary disease and urinary volume during operation correlated with the development of AKI. Postoperative blood loss was less in the hemofilter than control group (820±550 mL vs. 1100±630 mL, P=0.04). There was no difference in the length of intubation and stay in intensive care unit. CONCLUSION: Routine use of ultrafiltration during cardiac surgery offers no advantages in renal protection and reduction of AKI incidence.

Prevalence and correlates of HIV infection among male injection drug users in detention in Tehran, Iran.

OBJECTIVE: To measure HIV prevalence and characterize associated risk behaviors among injection drug users (IDU) upon detention in Tehran, Iran. METHODS: A cross-sectional survey included 459 male IDU arrested by police during a police sweep in Tehran in 2006. A questionnaire was completed, and blood was collected for HIV testing. RESULTS: Overall HIV prevalence was 24.4% (95% confidence interval 20.5-28.6). Factors independently associated with HIV infection included history of using an opioid in jail (adjusted odds ratio 2.11, 95% confidence interval 1.26-3.53) and older age (adjusted odds ratio 2.79 for 25-34, 3.01 for 35-44, 4.62 for > or = 45 yr). CONCLUSIONS: This study supports that incarceration is contributing to the increased spread of HIV. Harm reduction programs should be urgently expanded, particularly among incarcerated IDU.

Vestibular schwannomas - when should conservative management be reconsidered?

OBJECTIVE: To document the natural history of vestibular schwannomas treated conservatively, and to find if there are any predictive factors for growth and need for active intervention. DESIGN: A retrospective review of patient notes and radiology, mostly MRIs. SUBJECTS: Eighty-eight patients managed conservatively for unilateral vestibular schwannoma and that have had at least two radiological investigations. OUTCOME MEASURES: Change in tumour size over time was evaluated. Linear and logistic regression, respectively, were used to determine which factors (of age, size at diagnosis, audiology at presentation, length of follow-up or growth within first year of follow-up) would predict overall growth and active intervention. Characteristics of those that required active intervention is also demonstrated. RESULTS: Of the 88 patients, the average size of schwannoma at diagnosis was 10.88 mm. The mean length of radiological follow-up was 3.65 years. 51.1% of schwannomas grew, 12.5% shrank and 36.4% remained the same size. The mean rate of growth was 1.24 mm per year. 25.0% failed conservative treatment, with 19 patients having stereotactic radiosurgery and three undergoing microsurgery. Only growth in the first year of follow-up was found to significantly predict total growth. Size at diagnosis and growth in first year of follow-up were significantly found to predict active intervention. CONCLUSIONS: There remains a place for conservative treatment in those with small tumours, the elderly and those with significant co-morbidities. Growth in the first year of follow-up should be considered in determining whether to treat actively or not.