SIDAM--A structured interview for the diagnosis of dementia of the Alzheimer type, multi-infarct dementia and dementias of other aetiology according to ICD-10 and DSM-III-R

The SIDAM--a new instrument for the symptomatic diagnosis and measurement of dementia according to DSM-III-R and ICD-10--is described. It comprises a brief structured clinical interview, a range of cognitive tests (e.g. including the Mini-Mental State (Folstein et al. 1975)) which constitute a short neuropsychological battery and a section for clinical judgement and third party information. All items rely on DSM-III-R and ICD-10 algorithms. The SIDAM has a high overall test-retest reliability which equally holds true on the diagnostic, criterion and item level. It is a brief (average of 28 min), practical and easily scored diagnostic instrument, which reliably separates subjects with DSM-III-R and ICD-10 dementia from those without such a disorder. Good congruence was found between SIDAM diagnoses and corresponding ICD-9 expert diagnoses. Furthermore, the SIDAM-Score (SISCO) allows a detailed measurement of even low levels of cognitive impairment and provides quantification of severity grading of cognitive dysfunction.     

The B-APNEIC score: distilling the STOP-Bang questionnaire to identify patients at high risk for severe obstructive sleep apnoea

The STOP-Bang questionnaire is an established clinical screening tool to identify the risk of having mild, moderate or severe obstructive sleep apnoea using eight variables. It is unclear whether all eight variables contribute equally to the risk of clinically significant obstructive sleep apnoea. We analysed each variable for its contribution to detecting obstructive sleep apnoea; based on the results, we investigated whether the STOP-Bang questionnaire could be abbreviated to identify patients at high risk for severe obstructive sleep apnoea. We recruited patients with suspected obstructive sleep apnoea who were referred for overnight polysomnography. We used multivariable logistic regression to investigate the association of STOP-Bang parameters with severe obstructive sleep apnoea based on clinical and polysomnography data. Regression estimates were used to select variables to create the novel B-APNEIC score. We constructed receiver operating characteristic curves for the STOP-Bang questionnaire and B-APNEIC scores to identify patients with severe obstructive sleep apnoea and compared the areas under the curve using the DeLong method. Of the 275 patients enrolled, 32% (n = 88) had severe obstructive sleep apnoea. Logistic regression demonstrated that neck circumference (OR 2.20; 95%CI 1.10–4.40, p = 0.03) was the only variable independently associated with severe obstructive sleep apnoea. Observed apnoea during sleep, blood pressure and body mass index were the three next most closely trending predictors of severe obstructive sleep apnoea and were included along with neck circumference in the B-APNEIC score. Receiver operating curves demonstrated that the areas under the curve for STOP-Bang vs. B-APNEIC were comparable for identifying patients with severe obstructive sleep apnoea (OR 0.75; 95%CI 0.68-0.81 vs. OR 0.75; 95%CI 0.68–0.81: p = 0.99, respectively). Our results suggest that the B-APNEIC score is a simplified adaptation of the STOP-Bang questionnaire with equivalent effectiveness in identifying patients with severe obstructive sleep apnoea. Further studies are needed to validate and build on our findings.     

Short-term Effects of Sleeve Gastrectomy on Type 2 Diabetes Mellitus in Severely Obese Subjects

Background Data on the effectiveness of sleeve gastrectomy (SG) in improving or resolving type 2 diabetes mellitus (T2DM) are scarce. Methods A 4-month prospective study was conducted on the changes in glucose homeostasis in 35 severely obese T2DM subjects undergoing laparoscopic SG (LSG) and 50 subjects undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP), matched for DM duration, type of DM treatment, and glycemic control. Results At 4-months after surgery, LSG and LRYGBP operated subjects lost a similar amount of weight (respectively, 20.6 ± 0.7% and 21.0 ± 0.6%). T2DM had resolved respectively in 51.4% and 62.0% of the LSG and LRYGBP operated subjects (P = 0.332). A shorter preoperative DM duration (P < 0.05), a preoperative DM treatment not including pharmacological agents, and a better pre-surgical fasting plasma glucose (P < 0.01) or HbA1c (P < 0.01), were significantly associated with a better type 2 DM outcome in both surgical groups. Conclusions Our data show that LSG and LRYGBP result in a similar rate of type 2 DM resolution at 4-months after surgery. Moreover, our data suggest that mechanisms beyond weight loss may be implicated in DM resolution following LSG and LRYGBP.     

Mycotic keratitis in Paraguay

Patients with corneal ulcer, residing mainly in rural areas of Paraguay, were controlled for mycotic eye infections. In 26 cases out of 45 (58%) presence of filamentous fungi was observed (Fusarium sp. (11), Aspergillus sp. (5), Cladosporium sp. (3), Alternaria sp. (2), Acremonium sp. (1), Curvularia sp. (1), culture negative (3)). In 17 cases also pathogenic bacteria were present. Most of the patients were farmers and belonged to the low income class. These data indicate that mycotic keratitis may be a frequent cause for eye infections in developing countries.     

Cerebellar microgyria

Summary The fine structure of the small vessels of the subarachnoid spaces in the rat and mouse cerebral and cerebellar cortices was examined. Small vessels with lumen under 7 and whose walls consisted of a single layer of endothelial cells were found. These vessels are regarded as true capillaries.