Intracranial compartment volumes and their distribution among clinically diagnosed patients with normal pressure hydrocephalus and brain atrophy in a Nigerian population

Normal pressure hydrocephalus is a form of non-obstructive hydrocephalus characterized by the triad of symptoms. These symptoms are typical or atypical. Because of its potential reversibility, researchers have paid attention to its diagnosis and in differentiating it with other forms of dementia such as brain atrophy. To determine the intracranial compartment volumes and their differences among patients with NPH and Brain Atrophy (BA). This was a cross-sectional study involving consenting patients diagnosed with NPH and BA who were referred for routine brain CT. Medical conditions known to influence intracranial volume were excluded. Age -matched normal control were clinically and radiologically confirmednormal and were also recruited. Intracranial volumes and CSF distribution determination was based on Cavalieri test point computation principle. Test point summation was on a locally developed software for this purpose. Overall, the values of BA recorded higher mean values for most of the intracranial compartment volumes. Intraventricular volume was consistently higher in NPH groups. Statistical difference exists among intraventricular and total intracranial CSF volume across patients with BA, NPH and control. A post hoc test revealed control-NPH comparison across these variables. Control-BA comparison was evident in total intracranial CSF volume only. Higher mean values of intracranialcompartment volumes were observed in patients with BA than among patients with NPH and their control. Anthropometric indices did not show any difference between patients with BA, NPH and their control. These indices can be used as basis in objectively differentiating NPH from BA.

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Comparative Stereological Analysis of Intracranial Volume fractions among Patients with Brain Atrophy and Normal Pressure Hydrocephalus from a Nigerian Population

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.779 ◽

2021 ◽

Vol 3 (2) ◽

pp. 192-196

Author(s):

Mohammed Abba ◽

Anthony Chukwuka Ugwu ◽

Azuoma L. Asomugha ◽

Hassan Ismail

Keyword(s):

Normal Pressure Hydrocephalus ◽

Brain Atrophy ◽

Matched Control ◽

Volume Fraction ◽

Normal Pressure ◽

Volume Estimation ◽

Diagnostic Methods ◽

Intracranial Volume ◽

Cross Sectional ◽

Volume Fractions

Background: Differentiation between symptoms of normal pressure hydrocephalus (NPH) and other neurodegenerative disorders such as Brain Atrophy (BA) are usually confusing. Available diagnostic methods are invasive while the few non-invasive methods did not take care of potential factors known to influence intracranial volumes. We, therefore, aim to determine and compare the intracranial volume fractions among patients with NPH and BA. Methods: This was a prospective, cross-sectional age-matched control study among consenting patients that were diagnosed with NPH, BA and healthy control in Aminu Kano Teaching Hospital from March 2018 to November 2020. Each patient was routinely examined with CT-Scan; However, control participants were from other reasons. Participants with a medical history known to influence the intracranial volume were excluded. Volume estimation was based on a stereological Cavalieri method and three volume fractions were determined mathematically for each of the group. Test-point computing was facilitated through a locally developed software (voXas_2018). Ethical approval was sort prior to the study. Results: Patients with NPH have higher total CSF: brain ratio, intraventricular volume: brain ratio and extra-ventricular: brain ratio. Similar pattern was exhibited according to age grouping, except in the older age category where BA volume fractions were higher. Conclusion: Age, gender and statue are known to influence intracranial volumes. We controlled their potential effects through age-matched control of participants between groups and the use of intracranial volume ratios for objective diagnosis of NPH and BA. However, Tcsf:Br and InV:Br volume fraction ratios were found to be reliable indices for distinguishing patients with NPH and BA.

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Ventriculoperitoneal Shunting of Idiopathic Normal Pressure Hydrocephalus Increases Midbrain Size: A Potential Mechanism for Gait Improvement

Neurosurgery ◽

10.1227/01.neu.0000232655.78335.d5 ◽

2006 ◽

Vol 59 (4) ◽

pp. 847-851 ◽

Cited By ~ 22

Author(s):

J Mocco ◽

Matthew I. Tomey ◽

Ricardo J. Komotar ◽

William J. Mack ◽

Steven J. Frucht ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Medical Center ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Cross Sectional ◽

Mean Values ◽

Shunt Placement ◽

Ventriculoperitoneal Shunting ◽

The Mean

Abstract OBJECTIVE: Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic clinical triad of symptoms, including dementia, urinary incontinence, and gait disturbance. Recent work has demonstrated that the maximal midbrain anteroposterior (AP) diameter is significantly smaller in patients with INPH than in healthy, age-matched controls. The current study was undertaken to determine the effect of ventriculoperitoneal shunt placement on midbrain dimensions in INPH patients. METHODS: Twelve consecutive INPH patients undergoing ventriculoperitoneal shunt placement with pre- and postoperative computed tomographic scans at the Columbia University Medical Center were enrolled. Each patient's pre- and postoperative maximum AP and left-to-right diameters of the midbrain at the pontomesencephalic junction were independently measured in a blinded fashion by two of the authors. The average value of each dimension was computed by calculating the mean values of the measurements of the two observers. RESULTS: Both the mean AP diameter (preoperative mean, 2.06 ± 0.04 cm; postoperative mean, 2.27 ± 0.05; P = 0.0007) and left-to-right diameter (preoperative mean, 2.80 ± 0.07; postoperative mean, 3.03 ± 0.08; P = 0.0029) increased from pre- to postoperative imaging. The approximate cross-sectional area determined as the product of AP and left-to-right diameters also increased from pre- to postoperative images (preoperative mean, 5.79 ± 0.22 cm2; postoperative mean, 6.90 ± 0.25 cm2; P = 0.00049). CONCLUSION: This study provides supportive evidence that midbrain cytoarchitecture may play a role in the pathophysiology and post-ventriculoperitoneal shunt gait improvement of INPH patients.

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Cerebrospinal fluid closing pressure-guided tap test for the diagnosis of idiopathic normal pressure hydrocephalus: A descriptive cross-sectional study

Surgical Neurology International ◽

10.25259/sni_380_2020 ◽

2020 ◽

Vol 11 ◽

pp. 315

Author(s):

Diego Fernando Gómez-Amarillo ◽

Luis Fernando Pulido ◽

Isabella Mejía ◽

Catalina García-Baena ◽

María Fernanda Cárdenas ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Cross Sectional Study ◽

Sectional Study ◽

Opening Pressure ◽

Cross Sectional ◽

Tap Test ◽

The Mean ◽

Closing Pressure

Background: Tap test improves symptoms of idiopathic normal pressure hydrocephalus (iNPH); hence, it is widely used as a diagnostic procedure. However, it has a low sensitivity and there is no consensus on the parameters that should be used nor the volume to be extracted. We propose draining cerebrospinal fluid (CSF) during tap test until a closing pressure of 0 cm H2O is reached as a standard practice. We use this method with all our patients at our clinic. Methods: This is a descriptive cross-sectional study where all patients with presumptive diagnosis of iNPH from January 2014 to December 2019 were included in the study. We used a univariate descriptive analysis and stratified analysis to compare the opening pressure and the volume of CSF extracted during the lumbar puncture, between patients in whom a diagnosis of iNPH was confirmed and those in which it was discarded. Results: A total of 92 patients were included in the study. The mean age at the time of presentation was 79.4 years and 63 patients were male. The diagnosis of iNPH was confirmed in 73.9% patients. The mean opening pressure was 14.4 cm H2O mean volume of CSF extracted was 43.4 mL. Conclusion: CSF extraction guided by a closing pressure of 0 cm H2O instead of tap test with a fixed volume of CSF alone may be an effective method of optimizing iNPH symptomatic improvement and diagnosis.

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INCIDENCE, DIAGNOSTIC CRITERIA AND OUTCOME FOLLOWING SHUNTING OF IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS IN MEMORY CLINIC POPULATION: PROSPECTIVE OBSERVATIONAL CROSS‐SECTIONAL STUDY

Internal Medicine Journal ◽

10.1111/imj.36_14849 ◽

2020 ◽

Vol 50 (S1) ◽

pp. 32-33

Keyword(s):

Diagnostic Criteria ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Cross Sectional Study ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Sectional Study ◽

Memory Clinic ◽

Cross Sectional ◽

Clinic Population

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ROLE OF PHARMACIST INTERVENTION ON COPD PATIENTS OF SELECTED AREAS IN CHITRADURGA: A KAP STUDY

Journal of Biomedical and Pharmaceutical Research ◽

10.32553/jbpr.v8i2.586 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Melvin K Mathews ◽

Abubaker Siddiq ◽

Bharathi D R

Keyword(s):

Illness Perceptions ◽

Pharmacist Intervention ◽

Cross Sectional Study ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Post Test ◽

Knowledge Practice ◽

And Control

Background: Chronic obstructive pulmonary disease (COPD) is preventable and treatable disease state characterized by air flow limitation that is not fully reversible. Severity of the symptoms is increased during exacerbations. Objectives: The purpose of the study is to assess and improve the knowledge regarding COPD among study subjects. Materials and Methods: A Cross-sectional interventional study was carried out among the peoples in selected areas of the Chitradurga city for a period of six months. Result: A total 207 subjects enrolled in the study in that 155 male and 52 females. In our study mean score of post test was more (5.87±1.68) when compare to pre-test (2.63±1.46) which show significant increase in their knowledge after educating them (p=0.000). A total of 207 subjects were enrolled into the study. SPSS Software was used to calculate the statistical estimation. Paired t-test was used to detect the association status of different variables. Conclusion: The relatively good level of COPD awareness needs to be maintained to facilitate future prevention and control of the disease. This study had identified that negative illness perceptions should be targeted, so that they will not avoid patients from seeking for COPD treatment and adhere to it. Key words: Cross sectional study, Knowledge, practice, COPD.

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Cut off value of plasma 25-hydroxyvitamin D concentration for predicting metabolic syndrome

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.6_7.10 ◽

2019 ◽

pp. 68-73

Author(s):

Trong Nghia Nguyen ◽

Thi Nhan Nguyen ◽

Thi Dua Dao

Keyword(s):

Metabolic Syndrome ◽

Medical Center ◽

Cross Sectional Study ◽

Control Group ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

The Metabolic Syndrome ◽

25 Hydroxyvitamin D ◽

Key Words Metabolic Syndrome ◽

And Control

Background: The metabolic syndrome is a constellation of cardiometabolic risk factors that tend to cluster together in affected individuals more often than predicted by chance. The presence of the metabolic syndrome substantially increases the risk of developing type 2 diabetes and cardiovascular disease, and is associated with a range of adverse clinical outcomes, many of which are closely associated with aging. Current estimates suggest that approximately 20 - 25% of the world’s population is affected by the metabolic syndrome. The prevalence of the metabolic syndrome rises with age and more than 45% of people aged over 60 years have the metabolic syndrome. Recent studies show that low vitamin D status is very common in the world and this is a risk factor of metabolic syndrome. Objective: (1) Plasma 25-hydroxyvitamin D concentration in subjects with metabolic syndrome. (2) Cut off value of plasma 25-hydroxyvitamin D concentration for predicting metabolic syndrome. Material and method: A cross-sectional study with control group on 318 adult subjects for health examinations at International Medical Center at Hue Central Hospital, including 139 subjects with metabolic syndrome and control group of 179 healthy subjects. Metabolic syndrome was defined according to the IDF, NHLBI, AHA, WHF, IAS, IASO (2009). Plasma hydroxyvitamin D concentration was measured using chemiluminescent microparticle immunoassay. Reciever operating characteristic (ROC) curve were generated to assess sensitivity and specificity for different cut off value of 25-hydroxyvitamin D concentration for predicting metabolic syndrome. Results: Plasma 25-hydroxyvitamin D concentration in subjects with metabolic syndrome was 26.4 ng/ml, incidence of plasma 25-hydroxyvitamin D deficiency (59.7%) was significantly higher than in control group (23.5%) (p < 0.001). The optimal cut off point for 25-OH-D concentration for predictor of metabolic syndrome as 26.4 ng/ml (AUC=0.657, sensitivity=53.4%, specificity=71.6%). Conclusion: In 139 subjects with metabolic syndrome, the plasma 25-hydroxyvitamin D concentration was 26.4 ng/ml and the incidence of 25-hydroxyvitamin D deficiency in the metabolic syndrome group was 59.7%. The optimal cut off point for plasma 25-hydroxyvitamin D concentration for predictor of metabolic syndrome as 26.4 ng/ml. Key words: Metabolic syndrome, 25-hydroxyvitamin D

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The effect of type of water supply on water quality in a developing community in South Africa

Water Science & Technology ◽

10.2166/wst.1997.0706 ◽

1997 ◽

Vol 35 (11-12) ◽

pp. 35-40 ◽

Cited By ~ 6

Author(s):

B. Genthe ◽

N. Strauss ◽

J. Seager ◽

C. Vundule ◽

F. Maforah ◽

...

Keyword(s):

Water Quality ◽

Water Supply ◽

Cross Sectional Study ◽

Cross Sectional ◽

E Coli ◽

Guideline Values ◽

Developing Communities ◽

Quality Guideline ◽

And Control ◽

The Relationship

Efforts to provide water to developing communities in South Africa have resulted in various types of water supplies being used. This study examined the relationship between the type of water supply and the quality of water used. Source (communal taps, private outdoor and indoor taps) and point-of-use water samples were examined for heterotrophic plate counts (HPC), total and faecal coliforms, E. coli, and coliphages. Ten percent of samples were also analysed for enteric viruses, Giardia and Cryptosporidium. Approximately 320 households were included in a case-control study. In addition, a cross-sectional study was conducted. Both studies examined the relationship between different types of water facilities and diarrhoea among pre-school children. The source water was of good microbial quality, but water quality was found to have deteriorated significantly after handling and storage in both case and control households, exceeding drinking water quality guideline values by 1-6 orders of magnitude. Coliphage counts were low for all water samples tested. Enteric viruses and Cryptosporidium oocysts were not detected. Giardia cysts were detected on one occasion in case and control in-house samples. Comparisons of whether in-house water, after handling and storage, complied with water quality guideline values demonstrated households using communal taps to have significantly poorer quality than households using private outdoor or indoor taps for HPC and E. coli (χ2 = 14.9, P = 0.001; χ2 = 6.6, P = 0.04 respectively). A similar trend (although not statistically significant) was observed for the other microbial indicators. The cross-sectional study demonstrated an apparent decrease in health risk associated with private outdoor taps in comparison to communal taps. This study suggests that a private outdoor tap is the minimum level of water supply in order to ensure the supply of safe water to developing communities.

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Infection control practices and challenges in Pakistan during the COVID-19 pandemic: a multicentre cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211012761 ◽

2021 ◽

pp. 175717742110127

Author(s):

Salma Abbas ◽

Faisal Sultan

Keyword(s):

Personal Protective Equipment ◽

Prevention And Control ◽

Infection Prevention ◽

Hospital Staff ◽

Cross Sectional Study ◽

Infection Prevention And Control ◽

Protective Equipment ◽

Cross Sectional ◽

Healthcare Facilities ◽

And Control

Background: Patient and staff safety at healthcare facilities during outbreaks hinges on a prompt infection prevention and control response. Physicians leading these programmes have encountered numerous obstacles during the pandemic. Aim/objective: The aim of this study was to evaluate infection prevention and control practices and explore the challenges in Pakistan during the coronavirus disease 2019 pandemic. Methods: We conducted a cross-sectional study and administered a survey to physicians leading infection prevention and control programmes at 18 hospitals in Pakistan. Results: All participants implemented universal masking, limited the intake of patients and designated separate triage areas, wards and intensive care units for coronavirus disease 2019 patients at their hospitals. Eleven (61%) physicians reported personal protective equipment shortages. Staff at three (17%) hospitals worked without the appropriate personal protective equipment due to limited supplies. All participants felt overworked and 17 (94%) reported stress. Physicians identified the lack of negative pressure rooms, fear and anxiety among hospital staff, rapidly evolving guidelines, personal protective equipment shortages and opposition from hospital staff regarding the choice of recommended personal protective equipment as major challenges during the pandemic. Discussion: The results of this study highlight the challenges faced by physicians leading infection prevention and control programmes in Pakistan. It is essential to support infection prevention and control personnel and bridge the identified gaps to ensure patient and staff safety at healthcare facilities.

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Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees

The American Journal of Sports Medicine ◽

10.1177/0363546520987819 ◽

2021 ◽

pp. 036354652098781

Author(s):

Mathias Paiva ◽

Lars Blønd ◽

Per Hölmich ◽

Kristoffer Weisskirchner Barfod

Keyword(s):

Trochlear Dysplasia ◽

Cross Sectional Study ◽

Magnetic Resonance Images ◽

Tibial Tubercle ◽

Control Group ◽

Trochlear Groove ◽

Sectional Study ◽

Cross Sectional ◽

Mean Values ◽

The Mean

Background: Tibial tubercle–trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. Purpose: To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. Results: The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group ( P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group ( P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group ( P < .01). Conclusion: The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.

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