Prevalence and risk factors of low bone mineral density in patients with multiple sclerosis.

OBJECTIVES: To determine the prevalence and risk factors of low bone mineral density (BMD) in patients with multiple sclerosis (MS). METHODS: Patients with MS who had undergone a BMD evaluation via dual-energy X-ray absorptiometry (DXA) between January 2010 and December 2013 were included in the study. Descriptive data, BMD values, and risk factors for osteoporosis along with the details regarding MS, such as age at onset, duration of disease, clinical type of MS, expanded disability status scale (EDSS) scores, and lifetime steroid intake were obtained from the medical record database and telephone interview. RESULTS: The study group comprised 67 patients with a mean age of 41.1 ± 10.2 years. Of the patients, 20.9% revealed low BMD for chronological age. Vitamin D insufficiency (25(OH)D < 20  ng/ml) rate was 86.6%. Comorbidity and EDSS scores of patients with low BMD were significantly higher than those of the remaining patients (P = 0.000 and P = 0.015, respectively). Neck BMD was inversely correlated with comorbidity score, disease duration, relapse number, and lifetime steroid intake (r = - 0.270, r = - 0.263, r = - 0.359, and r = - 0.314, respectively). CONCLUSION: The current study revealed that low BMD and vitamin D insufficiency were common in patients with MS. Longer disease duration, higher comorbidity score, and severe disability level led to lower BMD values. In conclusion, it is of paramount importance for clinicians to pay more attention on bone health in MS and to tailor preventative measures meticulously.

Detection of recurrent and primary acquired cholesteatoma with echo-planar diffusion-weighted magnetic resonance imaging.

OBJECTIVE: To evaluate the diagnostic value of echo-planar diffusion-weighted magnetic resonance imaging in pre-operative detection of suspected primary acquired, residual and/or recurrent cholesteatoma. MATERIALS AND METHODS: Fifty-eight chronic otitis media patients with suspected cholesteatoma were thus evaluated two weeks pre-operatively, and divided into group one (41 patients, no previous surgery, suspected primary acquired cholesteatoma) and group two (17 patients, previous surgery, scheduled 'second-look' or revision surgery for suspected residual or recurrent cholesteatoma). Patients' operative, histopathology and radiological findings were compared. RESULTS: Cholesteatoma was found in 63 per cent of group one patients and 58 per cent of group two patients at surgery. Histopathological examination of surgical specimens indicated that imaging accurately predicted the presence or absence of cholesteatoma in 90 per cent of group one (37/41; 23 true positives, 14 true negatives) and 76 per cent of group two (13/17; seven true positives, six true negatives). Three patients in both groups were false negative diagnoses and one patient in both groups was a false positive. The sensitivity, specificity, and positive and negative predictive values of echo-planar diffusion-weighted magnetic resonance imaging of cholesteatoma were respectively 88, 93, 95 and 82 per cent in group one and 70, 85, 87 and 66 per cent in group two. CONCLUSION: Echo-planar diffusion-weighted magnetic resonance imaging is a valuable technique with high sensitivity and specificity for cholesteatoma imaging.