Optic nerve sheath diameters in healthy adults measured by computer tomography

AIMTo measure optic nerve sheath diameters (ONSD) in different locations by computer tomography (CT) and to recommend the best location for cases when ONSD is used for intracranial pressure monitoring.METHODSIn a prospective cohort study, CT data of 300 healthy adults were analyzed (600 eyes). In all cases, the CT investigation was performed at the Emergency Department because of the various conditions that proved not to be connected with ophthalmological or neurological pathology. The ONSD were measured at 3 mm and 8 mm distance from the globe, and 3 mm from the anterior opening of the optic canal. The correlation analysis was performed with gender, age, and ethnic background.RESULTSThe right/left ONSD are 4.94±1.51/5.17±1.34 mm at 3 mm, 4.35±0.76/4.45±0.62 mm at 8 mm from the globe, and 3.55±0.82/3.65±0.7 mm at 3 mm from the optic canal. No significant differences correlated with gender of the patients, their age, and ethnic background were found.CONCLUSIONIn healthy persons, the ONSD varies from 5.17±1.34 mm to 3.55±0.82 mm in different locations within the intraorbital space. The most stable results with lesser standard deviation can be obtained if it is measured 8-10 mm from the globe.

Successful treatment of acute relapse of chronic eosinophilic pneumonia with benralizumab and without corticosteroids:A case report

BACKGROUND Currently,the mainstay of chronic eosinophilic pneumonia(CEP)treatment is corticosteroids,usually with a favorable response and good prognosis.However,relapse is common,requiring long-term use of corticosteroids,with risk of significant treatment-related complications.The dire need to develop new treatments for patients with CEP,who are dependent on,or resistant to corticosteroids has led to exploring novel therapies.We herein describe a patient with acute relapse of CEP,who was successfully treated with benralizumab,an IL-5 Rαantagonist that has demonstrated rapid anti-eosinophil action in patients with asthma.Currently,only three recent patient reports on CEP relapse,also demonstrated successful treatment with benralizumab alone,without corticosteroids.CASE SUMMARY A 31-year-old non-smoking woman presented in our hospital with a 3 wk history of shortness of breath,dry cough and fever up to 38.3℃.Laboratory examination revealed leukocytosis 10240 K/μL,eosinophilia 900 K/μL and normal values of hemoglobin,platelets,creatinine and liver enzymes.Computed tomography of the chest showed a mediastinal lymphadenopathy and consolidations in the right upper and left lower lobes.CEP was diagnosed,and the patient was treated with hydrocortisone intravenously,followed by oral prednisone,with prompt improvement.Three months later,she presented with relapse of CEP:aggravation of dyspnea,rising of eosinophilia and extension of pulmonary infiltrates on chest X-ray.She was treated with benralizumab only,with clinical improvement within 2 wk,and complete resolution of lung infiltrates following 5 wk.CONCLUSION Due to Benralizumab’s dual mechanism of action,it both neutralizes IL-5 Rαpro-eosinophil functions and triggers apoptosis of eosinophils.We therefore maintain benralizumab can serve as a reasonable therapy choice for every patient with chronic eosinophilic pneumonia and a good alternative for corticosteroids.

Vitamin D and autoimmune thyroid diseases

The role of vitamin D as an immune modulator has been emphasized in recent years,and low levels of the hormone were observed in several autoimmune diseases including multiple sclerosis and systemic lupus erythematosus.Vitamin D mediates its effect though binding to vitamin D receptor(VDR),and activation of VDR-responsive genes.While VDR gene polymorphism was found to associate with autoimmune thyroid diseases(AITDs),few studies examined levels of vitamin D in these patients and those that did yielded conflicting results.We therefore undertook to evaluate the levels of vitamin D in patients with AITDs compared to patients with non-AITDs and healthy controls.Serum vitamin D(25-OH)levels were measured in 50 patients with AITDs,42 patients with non-AITDs and 98 healthy subjects,utilizing the LIAISON chemiluminescence immunoassay(DiaSorin,Saluggia,Italy).VitaminD deficiency was designated at levels lower than 10 ng/ml.Antithyroid antibodies,thyroid functions and demographic parameters were evaluated in all patients.The prevalence of vitamin D deficiency was significantly higher in patients with AITDs compared with healthy individuals(72% versus 30.6%;P<0.001),as well as in patients with Hashimoto’s thyroiditis compared to patients with non-AITDs(79% versus 52%;P<0.05).Vitamin D deficiency also correlated to the presence of antithyroid antibodies(P=0.01)and abnormal thyroid function tests(P=0.059).Significantly low levels of vitamin D were documented in patients with AITDs that were related to the presence of anti thyroid antibodies and abnormal thyroid function tests,suggesting the involvement of vitamin D in the pathogenesis of AITDs and the advisability of supplementation.

Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma:An analysis of a National Trauma Registry database

Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well clarified.The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted.Patients with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without SCI.The collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and mortality.Statistical analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures.Combined thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,respectively.The overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures;although isolated lumbar fractures patients with SCI were more likely to have renal(3.4%vs.1.6%,p=0.02)or bowel injuries(2.3%vs.1.0%,p=0.04)than the non-SCI counterparts.Conclusion:SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI.However,in a subset of isolated lumbar fractures,SCI patient is associated with increased risks for renal and bowel injury.