Feasibility and usefulness of ultrasonography in idiopathic intracranial hypertension or secondary intracranial hypertension

Transorbital sonography (TOS) has been proven to be able to non-invasively detect elevated intracranial pressure. In this condition TOS shows an increase in optic nerve sheath diameter (ONSD). It has been suggested that internal jugular vein valve insufficiency (IJVVI) may represent a factor contributing to the pathogenesis of idiopathic intracranial hypertension (IIH). The aim of this study was to investigate whether patients with IIH or secondary IH have higher ONSD values and higher frequency of IJVVI compared to subjects without IH

Longitudinal Assessment of Transorbital Sonography, Visual Acuity, and Biomarkers for Inflammation and Axonal Injury in Optic Neuritis

Background and Objective. To investigate the relationship between optic nerve sheath diameter, optic nerve diameter, visual acuity and osteopontin, and neurofilament heavy chain in patients with acute optic neuritis. Patients and Methods. Sonographic and visual acuity assessment and biomarker measurements were executed in 23 patients with unilateral optic neuritis and in 19 sex- and age-matched healthy controls. Results. ONSD was thicker on the affected side at symptom onset (median 6.3 mm; interquartile range 6.0–6.5) than after 12 months (5.3 mm; 4.9–5.6; p<0.001) or than in controls (5.2 mm; 4.8–5.5; p<0.001). OND was significantly increased in the affected side (3.4 mm; 2.9–3.8) compared to healthy controls (2.7 mm; 2.5–2.9; p<0.001) and was thicker at baseline than after 12 months (2.8 mm; 2.7–3.0; p<0.01). Visual acuity improved significantly after 12 months (1.00; 0.90–1.00) compared to onset of symptoms (0.80; 0.40–1.00; p<0.001). OPN levels were significantly higher in patients at presentation (median 6.44 ng/ml; 2.05–10.06) compared to healthy controls (3.21 ng/ml, 1.34–4.34; p<0.03). Concentrations of NfH were significantly higher in patients than in controls. Conclusion. ONSD and OND are increased in the affected eye. OPN and NfH are elevated in patients, confirming the presence of any underlying inflammation and axonal injury

Longitudinal assessment of transorbital sonography, visual acuity, and biomarkers for inflammation and axonal injury in optic neuritis

BACKGROUND AND OBJECTIVE: To investigate the relationship between optic nerve sheath diameter, optic nerve diameter, visual acuity and osteopontin, and neurofilament heavy chain in patients with acute optic neuritis. PATIENTS AND METHODS: Sonographic and visual acuity assessment and biomarker measurements were executed in 23 patients with unilateral optic neuritis and in 19 sex- and age-matched healthy controls. RESULTS: ONSD was thicker on the affected side at symptom onset (median 6.3\u2009mm; interquartile range 6.0-6.5) than after 12 months (5.3\u2009mm; 4.9-5.6; p < 0.001) or than in controls (5.2\u2009mm; 4.8-5.5; p < 0.001). OND was significantly increased in the affected side (3.4\u2009mm; 2.9-3.8) compared to healthy controls (2.7\u2009mm; 2.5-2.9; p < 0.001) and was thicker at baseline than after 12 months (2.8\u2009mm; 2.7-3.0; p < 0.01). Visual acuity improved significantly after 12 months (1.00; 0.90-1.00) compared to onset of symptoms (0.80; 0.40-1.00; p < 0.001). OPN levels were significantly higher in patients at presentation (median 6.44\u2009ng/ml; 2.05-10.06) compared to healthy controls (3.21\u2009ng/ml, 1.34-4.34; p < 0.03). Concentrations of NfH were significantly higher in patients than in controls. CONCLUSION: ONSD and OND are increased in the affected eye. OPN and NfH are elevated in patients, confirming the presence of any underlying inflammation and axonal injury

Candida auris Candidemia in Critically Ill, Colonized Patients: Cumulative Incidence and Risk Factors

open19Introduction: Candida auris (C. auris) is an emerging nosocomial pathogen, and a sharp rise in cases of colonization and infection has been registered in intensive care units (ICUs) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. The unfavorable resistance profile of C. auris and the potential high mortality of C. auris infections represent an important challenge for physicians. Methods: We conducted a single-center retrospective study including all patients admitted to ICUs with isolation of C. auris in any non-sterile body site between February 20, 2020, and May 31, 2021. The primary aim of the study was to assess the cumulative incidence of C. auris candidemia in colonized patients. The secondary aim was to identify predictors of C. auris candidemia in the study population. Results: During the study period, 157 patients admitted to ICUs in our hospital became colonized with C. auris; 59% of them were affected by COVID-19. Overall, 27 patients (17%) developed C. auris candidemia. The cumulative risk of developing C. auris candidemia was &gt; 25% at 60&nbsp;days after first detection of C. auris colonization. Seven patients with C. auris candidemia (26%) also developed a late recurrent episode. All C. auris blood isolates during the first occurring episode were resistant to fluconazole and susceptible to echinocandins, while 15 (56%) were resistant to amphotericin B. During late recurrent episodes, emergent resistance to caspofungin and amphotericin B occurred in one case each. In the final multivariable model, only multisite colonization retained an independent association with the development of C. auris candidemia. Conclusion: Candida auris candidemia may occur in up to one fourth of colonized critically ill patients, and multisite colonization is an independent risk factor for the development of candidemia. Implementing adequate infection control measures remains crucial to prevent colonization with C. auris and indirectly the subsequent development of infection.openBriano, Federica; Magnasco, Laura; Sepulcri, Chiara; Dettori, Silvia; Dentone, Chiara; Mikulska, Malgorzata; Ball, Lorenzo; Vena, Antonio; Robba, Chiara; Patroniti, Nicolò; Brunetti, Iole; Gratarola, Angelo; D'Angelo, Raffaele; Di Pilato, Vincenzo; Coppo, Erika; Marchese, Anna; Pelosi, Paolo; Giacobbe, Daniele Roberto; Bassetti, MatteoBriano, Federica; Magnasco, Laura; Sepulcri, Chiara; Dettori, Silvia; Dentone, Chiara; Mikulska, Malgorzata; Ball, Lorenzo; Vena, Antonio; Robba, Chiara; Patroniti, Nicolò; Brunetti, Iole; Gratarola, Angelo; D'Angelo, Raffaele; Di Pilato, Vincenzo; Coppo, Erika; Marchese, Anna; Pelosi, Paolo; Giacobbe, Daniele Roberto; Bassetti, Matte

Noi refertiamo così… voi? Guida rapida per la valutazione sonologica della stenosi carotidea.

Da oltre quarant’anni si utilizzano gli ultrasuoni per rilevare una placca carotidea e per seguire nel tempo la sua evoluzione. I protocolli terapeutici hanno ridotto enormemente il suo impatto sulla salute delle persone ma la scelta fra terapia medica e chirurgica si fonda su una valutazione clinica e strumentale che è solo apparentemente semplice. Nei referti di un esame ultrasonografico riportiamo il più delle volte delle percentuali di stenosi, a volte puntuali, a volte in termini di range oppure ci esprimiamo con aggettivi che descrivono la gravità della stenosi ma spesso ci facciamo confondere dai numeri e dalle differenti modalità di calcolo del range di stenosi ed è indubbio che, a volte, le conclusioni risultano ambigue ed estremamente dipendenti dall’interpretazione dell’operatore. Il problema è che l’angiografia digitale, gold standard diagnostico per la stenosi carotidea, adotta delle metriche non del tutto riproducibili con gli ultrasuoni. Con questo documento vogliamo condividere la ricerca di un linguaggio comune, a partire dal referto dei nostri esami. Noi refertiamo così… voi