Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis.

OBJECTIVE: To determine the diagnostic accuracy of panoramic radiography (PR) in detecting calcified carotid artery atheroma (CCAA) compared with Doppler ultrasonography or angiography (the reference standard). SOURCES: Cochrane, LILACS, PubMed, Scopus, Web of Science, Google Scholar, Open Grey, and ProQuest were searched. The reference lists of the included studies were also screened. DATA: Observational studies. METHODS: Only studies comparing the diagnostic accuracy of PR in detecting CCAA to Doppler ultrasonography or angiography (the reference standard) were included. The primary outcome measures were sensitivity and specificity. The secondary outcomes were negative predictive values, positive predictive values, diagnostic odds ratios, likelihood ratios (positive and negative), receiver operating characteristic curves, accuracy, and Youden's index. Two reviewers independently participated in the study selection, data extraction, and risk of bias assessment without language restriction. Risk of bias was assessed thought QUADAS-2, and the level of evidence was assessed through GRADE. RESULTS: A total of 773 citations were identified after duplicates were removed, and 12 studies including 1002 patients were included in the final study. The sensitivity and specificity of the different selected studies varied substantially, with sensitivity ranging from 0.31 to 0.95 and specificity from 0.19 to 0.99. CONCLUSIONS: Most studies reported excellent sensitivity and good specificity. The diagnostic accuracy of PR was good or excellent in 50% of the studies. CLINICAL SIGNIFICANCE: The identification of CCAA by PR can be a risk predictor for stroke when used as a secondary screening tool.

Aterosclerosis carotídea en el infarto cerebral aterotrombótico del territorio vascular homónimo / Carotid atherosclerosis in atherothrombotic cerebral infarction of the homonymous vascular territory

Introducción: El eco-Doppler carotídeo es la prueba de elección en el estudio inicial y de seguimiento del ictus aterotrombótico. Objetivo: Describir los hallazgos ecográficos en ambos ejes carotídeos en pacientes con infarto cerebral aterotrombótico del territorio vascular homónimo. Métodos: Se realizó una investigación observacional con todos los pacientes (63), que acudieron al Hospital Militar Central "Dr. Carlos J. Finlay", entre octubre del 2012 y septiembre del 2013, con diagnóstico clínico y tomográfico de infarto cerebral aterotrombótico de territorio anterior, a los que se les realizó eco-Doppler carotídeo. Resultados: Se contabilizaron mayor cantidad de placas de ateromas en el eje carotídeo homolateral al ictus aterotrombótico (54,3 por ciento) y la gran mayoría de estos fueron inestables (98,4 por ciento). La placa tipo III (50 por ciento), la irregularidad del contorno (54,1 por ciento) y la estenosis menor del 49 por ciento (57,6 por ciento) fueron los hallazgos ecográficos que dominaron en el eje contralateral al infarto. En ambas carótidas también fueron las placas tipo III (47,1 por ciento), la irregularidad de los contornos (51,6 por ciento), las estenosis no significativas (54,3 por ciento) y la inestabilidad de estas (94,4 por ciento), las que predominaron. Conclusiones: La aterosclerosis carotídea en el ictus aterotrombótico describe mayoritariamente placas tipo III irregulares, que provocan estenosis menores del 49 por ciento en ambos ejes carotídeos y la inestabilidad es casi constante, con una incidencia ligeramente mayor en el eje carotídeo homolateral al infarto. La frecuencia del resto de las cualidades de las placas de ateromas enunciadas, domina levemente en el eje carotídeo contralateral(AU)

Introduction: Carotid echo-Doppler is the test of choice in the initial and follow-up study of atherothrombotic stroke. Objective: To describe echographic findings in both carotid axes in patients with atherothrombotic cerebral infarction of the homonymous vascular territory. Methods: Sixty-three patients underwent an observational and cross-sectional investigation at Dr. Carlos J. Finlay Central Military Hospital from October 2012 to September 2013. They have a clinical and tomographic diagnosis of atherothrombotic cerebral infarct from the previous territory and the underwent a carotid echo-Doppler. Results: We recorded higher number of atheromatous plaques in the homolateral carotid axis at atherothrombotic stroke (54.3 percent) and the majority was unstable (98.4 percent). Type III plate (50 percent), irregularity of the contour (54.1 percent) and less than 49 percent stenosis (57.6 percent) were the echographic findings that dominated the axis contralateral to the infarction. In both carotids, type III plaques (47.1 percent), irregularity of the contours (51.6 percent), non-significant stenosis (54.3 percent) and instability (94.4 percent) predominated. Conclusions: Carotid atherosclerosis in atherothrombotic stroke mostly describes the presence of irregular, type III plaques that cause stenosis of less than 49 percent in both carotid axes. The instability of them is almost constant, with a slightly higher incidence in the homolateral carotid axis to infarction. The frequency of the rest of the qualities of the listed atheromatous plaques slightly dominates in the contralateral carotid axis(AU)

Inducción de placas ateromatosas en ratas Wistar crónicamente infectadas con Trypanosoma cruzi: alimentadas con dieta rica en grasas / Induction of atheromatous plaques in Wistar rats chronically infected with Trypanosoma cruzi: fed high fat diet

En el presente trabajo se investiga la inducción de placas ateromatosas en ratas albinas machos, cepa Wistar (Rattus norvegicus) crónicamente infectadas con Trypanosoma cruzi y alimentadas ad libitum con una dieta rica en grasas de origen vegetal, durante tres meses. La infección crónica evidenciada por pruebas sero-parasitológicas, reveló presenciade anticuerpos IgG anti- T. cruzi y ausencia de parasitemiaspatentes. La dieta rica en grasas produjo en las ratas infectadas (A) y sanas (C) un aumento significativo en el peso (P<0,05), en comparación con las ratas controles (B) y sanas (D) sometidas a la dieta normal. El estudio histopatológicode secciones de la arteria aorta de las ratas del grupo A (infectadas/dieta grasa), mostró abundantes depósitoslipídicos, procesos inflamatorios (vasculitis) y placas ateromatosas en formación. En las secciones de corazón y músculo esquelético se evidenció miocarditis y miositis con características de cronicidad sin parasitismo tisular. Las pruebas inmunohistoquímicas aplicadas a los cortes de arteria,corazón y músculo esquelético de las ratas infectadas A (infectadas/dieta-grasa) y B (infectadas/dieta-normal), mostraron abundantes depósitos antigénicos, lo que indica persistencia de antígenos parasitarios. En conclusión, las ratasinfectadas con T. cruzi alimentadas con la dieta rica en grasas, tienen una mayor propección a desarrollar placas ateromatosas.Los resultados demostraron que una dieta hiperlipídicaes un factor de riesgo para el desarrollo de enfermedadateromatosa en individuos con enfermedad de Chagas

This work is focused on the induction of atheromatous plaques in male albino rats (Rattus norvegicus), Wistar, chronically infected with Trypanosoma cruzi and fed ad libitum with diet rich in fats of vegetal origin, during three months. The chronic infection detected by serological and parasitological assays, revealed the presence of antibodies IgG anti- T. cruzi and the absence of patents parasitemias. The diet rich in fats produced in the group of infected rats (A) and the group of healthy rats (C) a significant increase in the weight (P<0,05), in comparison with the control group of infected rats (B) and the group of healthy rats (D), fed with a normal diet. The histopathological study of sections of the aorta arteryof the rats of the group (A) (infected/diet fat), showed abundants lipid deposits, inflammatory processes (vasculitis) and atheromatous plaques in development. The sections of the heart and skeletal muscle showed pictures of a myocarditis and myositis with features of chronic tissue without parasitism. The immunohistochemestry assays applied to the cuts of artery, heart and skeletal muscle of the infected rats A (diet/fat) and B (normal/diet), showed abundants antigen deposits. In conclusion, the rats chronically infected with T. cruzi and fed with a diet rich in fats, have a main propensity to develop atheromatous plaques. The results showed that a hyperlipidic diet is a risk factor for the development of atheromatous disease in individuals with Chagas`disease