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Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis
No full textPurpose: Pituitary dysfunction is reported to be a common complication following aneurysmal subarachnoid hemorrhage (aSAH). The aim of this meta-analysis is to analyze the literature on clinical prevalence, risk factors and outcome impact of pituitary dysfunction after aSAH, and to assess the possible need for pituitary screening in aSAH patients. Methods: We performed a systematic review with meta-analysis based on a comprehensive search of four databases (PubMed/MEDLINE, ISI/Web of Science, Scopus and Google Scholar). Results: A total of 20 papers met criteria for inclusion. The prevalence of pituitary dysfunction in the acute phase (within the first 6 months after aSAH) was 49.30 % (95 % CI 41.6–56.9), decreasing in the chronic phase (after 6 months from aSAH) to 25.6 % (95 % CI 18.0–35.1). Abnormalities in basal hormonal levels were more frequent when compared to induction tests, and the prevalence of a single pituitary hormone dysregulation was more frequent than multiple pituitary hormone dysregulation. Increasing age was associated with a lower prevalence of endocrine dysfunction in the acute phase, and surgical treatment of the aneurysm (clipping) was related to a higher prevalence of single hormone dysfunction. The prevalence of pituitary dysfunction did not correlate with the outcome of the patient. Conclusions: Neuroendocrine dysfunction is common after aSAH, but these abnormalities have not been shown to consistently impact outcome in the data available. There is a need for well-designed prospective studies to more precisely assess the incidence, clinical course, and outcome impact of pituitary dysfunction after aSAH
Infodemiological data of West-Nile virus disease in Italy in the study period 2004–2015
Full text linkAbstractGoogle Trends (GT) was mined from 2004 to 2015, searching for West-Nile virus disease (WNVD) in Italy. GT-generated data were modeled as a time series and were analyzed using classical time series analyses. In particular, correlation between GT-based Relative Search Volumes (RSVs) related to WNVD and “real-world” epidemiological cases in the same study period resulted r=0.76 (p<0.0001) on a monthly basis and r=0.80 (p<0.0001) on a yearly basis. The partial autocorrelation analysis and the spectral analysis confirmed that a 1-year regular pattern could be detected. Correlation between GT-based RSVs related to WNVD yielded a r=0.54 (p<0.05) on a regional basis. Summarizing, GT-generated data concerning WNVD well correlated with epidemiology and could be exploited for complementing traditional surveillance
Intraneural haemangioma of peripheral nerves
No full textHaemangiomas are rare benign tumors developing in cutaneous tissue and sometimes even in deep tissues. The existing literature reviewed, focusing on patients' age and gender, clinical features, diagnostics used, treatment, and, where available, follow-up data. Our review is the largest available at present time, including an additional case with a total of 41 patients
HERPES ZOSTER: UNA MALATTIA LA CUI LUNGA STORIA NON SI È ANCORA CONCLUSA
No full textHerpes Zoster, a disease imposing large economic and social costs,
is caused by a DNA virus, human herpesvirus 3, belonging to the Herpesvirales
order, Herpesviridae family. It is widespread throughout the world,
with a frequency of 120-350 cases per 100,000 persons/year. Herpes Zoster
is a disease with multiple names and multiple faces, which over the millennia
has been mistaken for the plague, typhoid, anthrax, erysipelas, syphilis,
gangrene, leprosy, and also for intoxication by rye. They are just some of the
avatars, as said by Ernest Wickersheimer, that this disease has taken over
time. This manuscript will investigate the cultural representation of this disease
throughout history
Prognostic factors in chronic subdural hematoma: results from a monocentric consecutive surgical series of 605 patients
No full textThe study of age-related diseases like chronic subdural hematoma (CSDH) is of high interest, considered the general ageing of the population. This investigation aimed to identify the main clinical characteristics of CSDH patients, to evaluate the impact of the disease on quality of life, its treatment and co-morbidities/complications and to compare our data with other surgical series published over the past 5 years
An Early Increase of Blood Leukocyte Subsets in Aneurysmal Subarachnoid Hemorrhage Is Predictive of Vasospasm
No full textObjective: Vasospasm is a severe complication in patients with aneurysmal subarachnoid hemorrhage (aSAH) and cannot be reliably predicted. Its pathophysiology remains elusive with the current body of evidence suggesting inflammation as one of the main driving forces. We here aimed to analyze circulating immune cell subsets over time in patients with aSAH with or without vasospasm. Methods: We performed a prospective observational study recruiting patients with spontaneous aSAH. Peripheral blood withdrawn at pre-specified time-points after aSAH, day 0, days 3-4, 6-8, 10-11, 13-15, and 18-21. Flow cytometry analysis, cell blood counts, and laboratory and diagnostic parameters were performed. Patients were monitored by transcranial Doppler for vasospasm as well as by advanced imaging and divided into a group with (VS) and without vasospasm VS (NVS). Results: We included 42 patients for study analysis, 21 VS and 21 NVS. An early significant increase at day 0 in platelet, leukocyte, neutrophil, lymphocyte, NK lymphocyte, monocyte, and CD 14++ CD16- DR+ monocyte counts was found in patients with later ensuing vasospasm. The early differences in platelets, leukocytes, lymphocytes, and NK lymphocytes remained significant on multivariate analysis. Conclusions: An early increase of immune cellular subsets in aSAH may contribute to predict VS
Systemic Inflammatory Response in Spontaneous Subarachnoid Hemorrhage from Aneurysmal Rupture versus Subarachnoid Hemorrhage of Unknown Origin
No full textOBJECTIVE: It is well known that spontaneous non-aneurysmal subarachnoid hemorrhage (SAH), also known as sine materia SAH (smSAH), has usually a better course and prognosis than its aneurysmal counterpart (aSAH). This might depend on different inflammatory mechanisms initiated by bleeding events of different origins. The aim of the present study was to explore the systemic inflammatory response in spontaneous SAH, comparing aSAH and smSAH. METHODS: We performed a prospective observational study over a consecutive series of patients with SAH. For these patients, we collected all clinical data and, furthermore, performed venous blood sampling over six time points to analyze blood cells. We further performed the analysis of lymphocytes and monocytes by means of flow cytometry to quantify common subtypes. Statistical analysis included a t-student test, Chi-square test, multivariate logistic regression, and ROC analysis. RESULTS: 48 patients were included: six (12.5%) with a diagnosis of spontaneous smSAH, and forty-two patients (87.5%) with aSAH. Significant differences on Day 0 were found for neutrophils and a systemic neuro-inflammatory index, namely, systemic inflammatory response index (SIRI). At the ROC analysis, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and SIRI exhibited satisfactory predictive power on day 0. At the multivariable logistic regression analysis, the combined index (NLR, LMR, SIRI at day 0) yielded an OR of 0.59 (95% CI 0.29–1.21]). LMR at day 0 yielded an OR of 1.25 ([95% CI 0.94–1.68]), NLR at day 0 exhibited an OR of 0.68 ([95% CI 0.42–1.09]), and SIRI at day 0 displayed an OR of 0.31 ([95% CI 0.06–1.49]). CONCLUSION: This preliminary study indicated a possible role of some inflammatory indices that point out the importance of innate and adaptive immunity in the etiopathogenetic mechanisms. Drugs modulating these responses could eventually counteract or, at least, reduce secondary damage associated with SAH
Infodemiology of status epilepticus: A systematic validation of the Google Trends-based search queries
No full textPeople increasingly use Google looking for health-related information. We previously demonstrated that in English-speaking countries most people use this search engine to obtain information on status epilepticus (SE) definition, types/subtypes, and treatment. Now, we aimed at providing a quantitative analysis of SE-related web queries. This analysis represents an advancement, with respect to what was already previously discussed, in that the Google Trends (GT) algorithm has been further refined and correlational analyses have been carried out to validate the GT-based query volumes. Google Trends-based SE-related query volumes were well correlated with information concerning causes and pharmacological and nonpharmacological treatments. Google Trends can provide both researchers and clinicians with data on realities and contexts that are generally overlooked and underexplored by classic epidemiology. In this way, GT can foster new epidemiological studies in the field and can complement traditional epidemiological tools
Pre-symptomatic cervical myelopathy: should we operate or should we observe? What is the chance of spinal cord injury from an accident?
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