Positive susceptibility vessel sign on SWI-MRI sequence imaging might differentiate patients had silent brain ischemia among apparently neurologically-free patients

Background: The susceptibility-weighted imaging (SWI) is an essential MRI sequence in the assessment of acute ischemic stroke. Silent cerebrovascular disease is five times more prevalent than symptomatic brain infarcts and is associated with future risk for stroke and dementia.Objectives: Evaluation of the diagnostic performance of susceptibility-weighted magnetic resonance sequence imaging (SWI) for early diagnosis of silent brain infarction (SBI) in apparently neurologically-free patients presented by transient neurological manifestations.Patients and Methods: The study included 218 patients who were clinically evaluated for demographic, clinical data concerning presence of chronic medical diseases, presenting symptoms and its frequency and severity. Routine lab investigations and lipid profile were performed and the plasma atherogenic index (PAI) for oncoming cardiovascular insults was calculated. MRI scan was performed using 1.5 T MRI scanner (Toshiba Vantage) with a head coil. Results: 102 patients (46.8%) had chronic medical diseases and hypertension (HTN) and diabetes mellitus (DM) are the most common. The commonest complaint was occasional amnesia, slurred speech and weak handgrip. PAI defined 53 patients at high, 101 patients at intermediate and 64 patients at low risk of cardiovascular insults. Susceptibility vein sign (SVS)+ were detected in 78 SWI scans and showed positive significant correlation with smoking, multiple co-morbidities, presence of chronic kidney disease, DM, hypertension and with PAI.Conclusion: The presence of SVS in SWI during MRI examination is pathognomonic sign for the presence of SBI. The incidence of SBI on SWI scans of apparently neurologically free patients who presented by transient neurological manifestations is high and was found to be associated with the presence of chronic medical diseases especially in obese dyslipidemic patients

The role of transcranial grayscale and Doppler ultrasound examination in diagnosis of neonatal hypoxic-ischemic encephalopathy

Background: The role of transcranial grayscale ultrasound (TC-GSUS) and transcranial color Doppler (TCD) in the diagnosis and prognosis of neonatal hypoxic-ischemic encephalopathy (HIE) is still questionable.Objective: This study targeted to evaluate the role of TC-GSUS and TCD in diagnosis and prediction of the outcome of neonates with suspected HIE in comparison to Sarnat's clinical scoring.Patients and methods: 26 neonates with suspected HIE were clinically evaluated and the severity of HIE was categorized according to Sarnat's clinical staging. Then, all neonates underwent sonographic examinations. TC-GSUS was performed at levels of anterior, mastoid, and posterior fontanelles and the level of the temporal window.Results: Cranial biometry had negative and positive rates for HIE of 7.7% and 92.3%, respectively. Using TC-GSUS, periventricular leukomalacia, intraventricular hemorrhage, brain edema, and hydrocephalus were detected in 17, 19, 14, and 16 patients, respectively. According to the resistive index (RI) of intracranial vessels, TCD excluded HIE in 11 patients and assured diagnosis of HIE with varying severity in 15 patients. Five neonates died and four developed neurological affection during follow-up. The outcome was correlated with Sarnat’s scoring, ventricular-hemispheric ratio, and abnormalities of RI. Statistical analyses defined severity of HIE as judged by RI as the significant predictor for mortality and abnormal RI of anterior cerebral (ACA) and internal carotid arteries (ICA) are the most significant predictors of outcomes.Conclusion: TCD can diagnose HIE in neonates with high sensitivity and specificity and abnormal RI of ICA and ACA might be used as valuable diagnostic and prognostic tests

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially