Stent retrievers have the potential to achieve a high rate of recanalization and functional independence whilst being relatively safe. They should be assessed in well-designed randomized controlled trials to determine their efficacy and assess whether they compare favourably with 'standard treatment' in stroke.
Over the past 3 years, gadolinium-based contrast agents have been linked to MRI signal changes in the brain, which have been found to be secondary to gadolinium deposition in the brain, particularly in the dentate nuclei and globus pallidus even in patients having an intact blood-brain barrier and a normal renal function. This tends to occur more in linear agents than with macrocyclic agents. Nonetheless, there has been no significant evidence that this has any clinical consequence. We reviewed the current evidence related to this new phenomenon and the precautionary approach taken by regulatory agencies.
IntroductionContinuous positive airway pressure (CPAP) is the standard treatment for
obstructive sleep apnoea (OSA), with limited data about the prevalence of
respiratory infections and microbial colonization in these patients.ObjectivesThe aim of this study was to determine if CPAP use is associated with
respiratory infections and to identify the organisms that colonize or infect
these patients.MethodA retrospective, case-controlled study in patients diagnosed with OSA was
carried out. 137 patients were recruited and interviewed using a
questionnaire. A nasal swab was taken from each patient. Patients using CPAP
machines had swabs taken from masks and humidifiers.Results66 (48.2%) patients received CPAP treatment with 60.6% of them having a
heated humidifier. 78.8% were male, with the majority using a full face mask
(63.6%). No significant difference was seen in the prevalence of
rhinosinusitis, lower respiratory tract infections and hospital admissions
for pneumonia between CPAP and non-CPAP treated patients. The presence of a
humidifier did not influence the prevalence of infections. Commensal flora
was predominantly cultured from nasal swabs from both patient groups.
Coagulase Negative Staphylococci and Diphtheroids were the main organisms
cultured from masks and humidifiers respectively.ConclusionsThis study shows that the use of CPAP, choice of mask and humidifier have no
significant impact on the prevalence of infections and micro-organisms
isolated. This is very reassuring to the physician prescribing CPAP therapy
and users.
Purpose To determine whether the sensitivity and specificity of four-dimensional CTA (4D-CTA) are equivalent to digital subtraction angiography (DSA) in the detection of underlying vascular abnormalities in patients with intracerebral haemorrhage (ICH). Methods A systematic review of studies comparing 4D-CTA with DSA in the detection of the underlying structural causes of ICH was performed on the literature published between 1998 and 2019. Results We identified a total of 237 articles from PubMed, SCOPUS and Web of Science using the following Medical Subject Headings (MeSH) terms: primary intracerebral haemorrhage, 4D-CTA, DSA, cerebral haemorrhage, angiography, digital subtraction, arteriovenous malformations, 4D, CTA, dynamic-CTA and time-resolved CTA. Following the removal of duplicate publications and articles failing to meet our inclusion criteria, there were four articles potentially viable for analysis. Therefore, there were not sufficient studies to provide a statistically meaningful meta-analysis. Conclusion The review of current literature has demonstrated that there are few published studies comparing 4D-CTA with DSA in spontaneous ICH, with only four suitable studies identified for potential analysis. However, due to the restricted number of patients and high sensitivity and specificity of 3 studies (100%), performing a meta-analysis was not meaningful. Qualitative analysis of the data concluded that 4D-CTA has the diagnostic potential to replace invasive DSA in certain cases with vascular abnormalities. However, further research studies directly comparing 4D-CTA with DSA using larger prospective patient cohorts are required to strengthen the evidence base. Key Points • Two hundred and thirty-seven manuscripts were initially identified comparing the accuracy of four-dimensional CTA (4D-CTA) with intra-arterial digital subtraction angiography (IA-DSA) in the identification of vascular abnormalities in spontaneous ICH. • Following study screening, only 26 manuscripts remained for further analysis. • Few studies were available that met the inclusion criteria for performing a meta-analysis (n = 4). • Qualitative analysis of the data has concluded that 4D-CTA has the diagnostic potential for replacing IA-DSA in many cases with vascular abnormalities. • Further large-scale studies are required to be performed that directly compare the sensitivity and specificity of 4D-CTAwith IA-DSA in patients with spontaneous ICH to improve the evidence base.
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