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Object: In order to monitor cerebral autoregulation status, a software package was developed to calculate a cerebral autoregulation index (pressure reactivity index, PRx). The aim of this study is to evaluate whether the application of this methodology is feasible and useful in the clinical setting.Design: Prospective observational study.Setting: NeuroIntensive Care Unit (NICU) of a university-affiliated teaching hospital.Patients and Participants: Twenty-six consecutive patients admitted to NICU requiring intracranial pressure (ICP) and invasive arterial pressure (AP) monitoring.Measurements and Results: Patient's data were collected for a total of 902 h. Mean PRx was calculated utilizing 2 h time window. CPP-PRx distribution graphs were calculated from CPP of 20 to 110 mmHg using 10 mmHg intervals. Autoregulation was preserved in 18% observations (83/451) and deranged in 49% observations (220/451). In 33% observations (148/451), autoregulation could not be clearly defined (0 < PRx < 0.2). Even if no clinical protocol was developed, autoregulation status information inserted in clinical decision pathway influenced clinical management. Mean CPP, calculated at maximum and minimum ICP every 2 h interval, resulted different between groups with good and poor reactivity (67 +/- 17.6 and 85 +/- 20.0 mmHg, respectively, for autoregulating observations and 60 +/- 19.1 and 67 +/- 19.4 mmHg, respectively, for nonautoregulating observations, P < 0.001, independent samples t-test). PRx values were normally distributed.Conclusions: Our study demonstrates that a daily bedside measure of cerebral autoregulation is feasible. PRx values can support clinicians in the identification of a targeted CPP in patients suffering from different intracranial pathologies and requiring an intensive monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Conclusive evidence of cerebral ischemia following head injury has been elusive. We aimed to use (15)O and (18)Fluorodeoxyglucose positron emission tomography (PET) to investigate pathophysiological derangements following head injury.Results: Eight patients underwent PET within 24 h of injury to map cerebral blood flow (CBF), cerebral oxygen metabolism (CMRO2), oxygen extraction fraction (OEF), and cerebral glucose metabolism (CMRglc). Physiological regions of interest (ROI) were generated for each subject using a range of OEF values from very low (<10), low (10-30), normal range (30-50), high (50-70), and critically high (> or =70%). We applied these ROIs to each subject to generate data that would examine the balance between blood flow and metabolism across the injured brain independent of structural injury.Discussion: Compared to the normal range, brain regions with higher OEF demonstrate a progressive CBF reduction (P < 0.01), CMRO2 increase (P < 0.05), and no change in CMRglc, while regions with lower OEF are associated with reductions in CBF, CMRO2, and CMRglc (P < 0.01). Although all subjects demonstrate a decrease in CBF with increases in OEF > 70%, CMRO2 and CMRglc were generally unchanged. One subject demonstrated a reduction in CBF and small fall in CMRO2 within the high OEF region (>70%), combined with a progressive increase in CMRglc.Conclusions: The low CBF and maintained CMRO2 in the high OEF ROIs is consistent with classical cerebral ischemia and the presence of an 'ischemic penumbra' following early head injury, while the metabolic heterogeneity that we observed suggests significant pathophysiological complexity. Other mechanisms of energy failure are clearly important and further study is required to delineate the processes involved. [ABSTRACT FROM AUTHOR]

Background: Nicotine is a psychostimulant drug with purported use in sports environments, though the use of nicotine among athletes has not been studied extensively., Objective: The aim of this study was to assess the nicotine positivity rate in 60,802 anti-doping urine samples from 2012 to 2020., Methods: Urine samples obtained in-competition at different national and international sports events held in Italy during the period 2012-2020 were analysed. All samples were from anonymous athletes that were collected and analysed at the WADA-accredited antidoping laboratory in Rome, Italy. Samples were analysed by gas chromatography coupled with mass spectrometry, with a cut-off concentration for nicotine of > 50 ng/mL. Results were stratified by year, sport and sex., Results: An overall mean of 22.7% of the samples (n = 13,804; males: n = 11,099; females: n = 2705) showed nicotine intake, with male samples also displaying higher positivity rates than female (24.1% vs 18.5%). Sample positivity was higher during 2012-2014 (25-33%) than 2015-2020 (15-20%). Samples from team sports displayed a higher positivity rate than those from individual sports (31.4 vs 14.1%)., Conclusions: The current data demonstrates that one in five samples from a range of 90 sports test positive for nicotine in-competition. There is a lower positivity rate in endurance versus power/strength athletes and higher positivity rate in team versus individual sports, probably accounted for by differences in physiological and psychological demands and the desire for socialisation. WADA, international and national sports federations should consider these findings with concern, proactively investigate this phenomenon and act in order to protect the health and welfare of its athletes., (© 2023. The Author(s).)

Introduction: Stroke is the second leading cause of mortality worldwide, accounting for approximately 5.5 million deaths each year. Due to demographic and health changes, the epidemiology of stroke is shifting from industrialized to low- and middle-income nations. Ethiopia is a developing country with a population that reflects this shift. Therefore, this systematic review and meta-analysis are aimed at evaluating the extent of in-hospital mortality of both ischemic and hemorrhagic stroke in Ethiopia and determining relevant factors associated with the mortality., Methods: Observational studies published as of July 15, 2020, that reported the magnitude, predictors, and causes of in-hospital mortality of stroke were systematically and comprehensively retrieved using the PRISMA 2020 criteria from databases such as PubMed/MEDLINE, Science Direct, and Google Scholar. The review papers were chosen based on the study methodology (facility-based observational), the study area (Ethiopia), the study population (adult patients with stroke), the outcome (in-hospital mortality), and the fact that they were published in English., Result: A total of 3709 patients with stroke were included in this systematic review and meta-analysis, which included 19 publications. In-hospital mortality was 14.03 percent on average in the studies, with reports ranging from 6.04 percent to 37.37 percent. Patients with hemorrhagic type stroke, admission Glasgow Coma Scale less than or equal to 12, impaired mental status, National Institutes of Health Stroke Scale stroke level greater than 13, prolonged hospital stay, any incontinence, pneumonia, and/or swallowing trouble had an increased risk of death after stroke., Conclusion: The magnitude of in-hospital mortality of patients with stroke in Ethiopia is high. The assessment of the level of consciousness is vital for clinical management and as an indicator of prognosis. Patients with unfavorable prognostic signs, such as entry Glasgow Coma Scale, National Institutes of Health Stroke Scale stroke level > 13, hemorrhagic stroke, pneumonia, incontinence, and dysphagia, should be given priority., Competing Interests: We have confirmed that the authors have no competing interests., (Copyright © 2022 Amare Abera Tareke et al.)

Background: Nutrition-related diseases have emerged at a faster rate in lower economic conditions before the battle against poverty and undernutrition has been won. In Ethiopia, the double burden of malnutrition seems to come sooner. The present study aims to determine the prevalence and identify the determinants of malnutrition among reproductive-age women using the 2016 Ethiopian Demographic and Health Survey dataset., Methods: Data from Ethiopian Demographic and Health Survey 2016 were used to identify individual and community-level associated factors of malnutrition among reproductive-age women. Nonpregnant, non-puerperal women aged 15-49 were included. Six hundred forty-two communities and 11,513 women were involved from this nationally representative data. The analysis was done using multi-level mixed-effects multinomial logistic regression to determine fixed effects of individual and community-level factors and random intercept of between characteristics., Results: Thirty-seven percent of the women had malnutrition generally. One-quarter of Ethiopian women were underweight and 11.8% were overweight/obese. Household wealth, women's age and contraceptive use were individual factors negatively associated with undernutrition. Region, place of residence and community-level wealth were cluster characteristics associated with undernutrition. On the other hand, the educational status of women, household wealth index, women's age, contraceptive use, breastfeeding, region and place of residence were the factors associated with overweight. Wealthier women had lowest of the odds for undernutrition OR = 0.84 (95% CI, 0.71, 0.98: P-value < 0.05). Middle-aged women had lower odds of being underweight, whereas reproductive-age extremities on both ends were prone to malnutrition. Modern contraceptive use had decreased the odds of being underweight OR = 0.71 (95% CI 0.63, 0.81 P-value <0.05). Women residing in rural areas had higher odds for undernutrition OR = 1.31 (95% CI 1.10, 1.56: p-value <0.001). In the same scenario, wealthier cluster had lower odds for undernutrition as rivalled with poorer clusters OR = 0.75 (95% CI 0.65, 0.87: P-value < 0.0001)., Conclusion: Nutritional paradox in the form of overweight/obesity and underweight exists in Ethiopian women. Underweight has a high prevalence and it is in a serious situation, whereas, the burden of overweight/obesity is rising. Both individual and community-level characteristics were significant predictors of malnutrition in Ethiopian women. Besides, the individual-level factors, interventions should also consider community-level associates in tackling malnutrition., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: In Ethiopia, large scale health care efforts had been done to promote infant health and survival. However, nationwide data is lacking on the survival status and proximate determinants of infant mortality in Ethiopia. Therefore, this study was aimed to identify the survival status and determinants of infant mortality in Ethiopia using Ethiopian Demographic and Health Survey (EDHS)., Methods: The data source for this study was the 2016 Ethiopian Demographic and Health Survey. Records of all 10,641 live births and survival informations of all 2826 infants born 5 years before the survey were reviewed. Kaplan-Meier method and Cox proportional hazards regression model were employed to identify the proximate determinants associated with the infant mortality., Results: The results of Kaplan-Meier estimation showed that the highest infant deaths occurred in the early months of life immediately after birth and declined in the later months of follow-up time. About 65% of infant deaths occurred during the first month's of life. Using the Cox proportional hazard model we found that: mothers' level of education, preceding birth interval, plurality, size of child at birth and sex of child as significant predictors of infant mortality. The risk of dying in infancy was lower for babies of mothers with secondary education (RR = 0.68, 95% CI: 0.56-0.98), higher education (RR = 0.51, 95% CI:0.45-0.80), for preceding birth interval longer than 47 months (RR = 0.51, 95% CI: 0.27, 0.92) and higher for birth interval shorter than 24 months (RR = 2.02, 95% CI:1.40-2.92), for multiple births (RR = 4.07, 95% CI: 1.14-14.50), for very small size of infants (RR = 3.74, 95% CI:1.73-8.12), for smaller than average size infants (RR = 3.23, 95% CI: 1.40-7.41) and for female infants (RR = 1.26, 95% CI: 1.01-1.56) compared to the reference category., Conclusions: A significant proportion of infants died during the study period of which nearly two third of deaths occurred during the first months of life. Thus, close monitoring and supporting reproductive age mothers to increase the uptakes of family planning and antenatal care and follow-up is highly recommended to increase the infant survival., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2020.)

Background: Family planning is one of the four pillars of safe motherhood initiative to reduce maternal death in developing countries. Despite progress in contraceptive use, unmet needs are wide open and fertility remains high. Ethiopia have a higher fertility rate which contributes to maternal and child health destitution, putting pressure on the already weak health system. This study examined individual and community-level factors associated with contraceptive use in Ethiopia., Methods: Data from Ethiopian Demographic and Health Survey 2016 were used to identify individual and community level associated factors among reproductive-age women. Non-pregnant, fecund and sexually active women aged 15-49 were included. Six hundred forty-two communities and 6854 women were involved from this two-stage cluster sampled data. The analysis was done using two-level mixed-effects logistic regression to determine fixed effects of individual and community-level factors and random intercept of between characteristics., Results: From the total eligible women for contraceptive use 2393 (34.9%) of them were users. Injectables were the commonest of all contraceptive methods. Various individual-level variables were associated with contraceptive use. Household wealth index, women's age, number of living children, husband's occupation, ever experience of a terminated pregnancy, current working status of the women, number of births in the last 3 years, and hearing of FP messages through different media were significantly associated individual-level variables after adjusting other factors. Community characteristics like region, place of residence, religion, and community-level wealth were the factors associated with contraceptive use., Conclusion: Both individual and community-level characteristics were significant predictors of use of contraceptives in Ethiopian women. Besides the individual-level factors, interventions should also consider community-level associates., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2019.)

Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. In SAH patients, plasma osteopontin (OPN) has been shown to independently predict poor outcome. The aim of the study is to investigate, in a selected population with severe SAH, OPN time course in cerebrospinal fluid (CSF) and plasma during the first week after aneurism rupture, and OPN prognostic value. We included 44 patients with the following criteria: (1) age 18 and 80 years, (2) diagnosis of SAH from cerebral aneurysm rupture, (3) insertion of external ventricular drain. Plasma and CSF were sampled at day 1, 4, and 8. OPN levels, in CSF and plasma, displayed a weak correlation on day 1 and were higher, in CSF, in all time points. Only in poor prognosis patients, OPN levels in CSF significantly increased at day 4 and day 8. Plasma OPN at day 1 and 4 was predictor of poor outcome. In conclusion, plasma and CSF OPN displays a weak correlation, on day 1. The higher levels of OPN found in the CSF compared to plasma, suggest OPN production within the CNS after SAH. Furthermore, plasma OPN, at day 1 and 4, seems to be an independent predictor of poor outcome.

Objective: Traumatic brain injury (TBI) is not a single insult with monophasic resolution, but a chronic disease, with dynamic processes that remain active for years. We aimed to assess patient trajectories over the entire disease narrative, from ictus to late outcome., Methods: Twelve patients with moderate-to-severe TBI underwent magnetic resonance imaging in the acute phase (within 1 week of injury) and twice in the chronic phase of injury (median 7 and 21 months), with some undergoing imaging at up to 2 additional time points. Longitudinal imaging changes were assessed using structural volumetry, deterministic tractography, voxel-based diffusion tensor analysis, and region of interest analyses (including corpus callosum, parasagittal white matter, and thalamus). Imaging changes were related to behavior., Results: Changes in structural volumes, fractional anisotropy, and mean diffusivity continued for months to years postictus. Changes in diffusion tensor imaging were driven by increases in both axial and radial diffusivity except for the earliest time point, and were associated with changes in reaction time and performance in a visual memory and learning task (paired associates learning). Dynamic structural changes after TBI can be detected using diffusion tensor imaging and could explain changes in behavior., Conclusions: These data can provide further insight into early and late pathophysiology, and begin to provide a framework that allows magnetic resonance imaging to be used as an imaging biomarker of therapy response. Knowledge of the temporal pattern of changes in TBI patient populations also provides a contextual framework for assessing imaging changes in individuals at any given time point., (© The Author(s) 2015.)

The presence of microorganisms in urine samples, under favourable conditions of storage and transportation, may alter the concentration of steroid hormones, thus altering the correct evaluation of the urinary steroid profile in doping control analysis. According to the rules of the World Anti-Doping Agency (WADA technical document TD2004 EAAS), a testosterone deconjugation higher than 5% and the presence of 5α-androstane-3,17-dione and 5β-androstane-3,17-dione in the deconjugated fraction, are reliable indicators of urine degradation. The determination of these markers would require an additional quantitative analysis since the steroids screening analysis, in anti-doping laboratories, is performed in the total (free+conjugated) fraction. The aim of this work is therefore to establish reliable threshold values for some representative compounds (namely 5α-androstane-3,17-dione and 5β-androstane-3,17-dione) in the total fraction in order to predict directly at the screening stage the potential microbial degradation of the urine samples. Preliminary evidence on the most suitable degradation indexes has been obtained by measuring the urinary concentration of testosterone, epitestosterone, 5α-androstane-3,17-dione and 5β-androstane-3,17-dione by gas chromatography-mass spectrometric every day for 15 days in the deconjugated, glucuronide and total fraction of 10 pools of urines from 60 healthy subjects, stored under different pH and temperature conditions, and isolating the samples with one or more markers of degradation according to the WADA technical document TD2004EAAS. The threshold values for 5α-androstane-3,17-dione and 5β-androstane-3,17-dione were therefore obtained correlating the testosterone deconjugation rate with the urinary concentrations of 5α-androstane-3,17-dione and 5β-androstane-3,17-dione in the total fraction. The threshold values suggested as indexes of urine degradation in the total fraction were: 10 ng mL(-1) for 5α-androstane-3,17-dione and 20 ng mL(-1) for 5β-androstane-3,17-dione. The validity of this approach was confirmed by the analysis of routine samples for more than five months (i.e. on a total of more than 4000 urine samples): samples with a concentration of total 5α-androstane-3,17-dione and 5β-androstane-3,17-dione higher than the threshold values showed a percentage of free testosterone higher than 5 of its total amount; whereas free testosterone in a percentage higher than 5 of its total amount was not detected in urines with a concentration of total 5α-androstane-3,17-dione and 5β-androstane-3,17-dione lower than the threshold values., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Childhood meningitis is associated with high mortality and morbidity. In selected cases, the prompt institution of invasive intracranial pressure (ICP) monitoring and therapy may improve survival but few studies have evaluated the indications for ICP monitoring in this specific neurological disease. This article examines the case of a five-year-old child who was comatose when admitted to the hospital with unilateral dilated pupil, neck stiffness and fever (T 39 degrees C). The initial brain computed tomography scan was unremarkable. Dexamethasone and empirical antibiotic therapy for suspected meningitis was started and a lumbar puncture (LP) was performed. The LP opening pressure was 45 mmHg. Cerebrospinal fluid microscopy demonstrated Meningococcal meningitis. The likelihood of raised ICP, associated with third nerve palsy, prompted insertion of an intraparenchymal catheter for ICP monitoring. Intracranial hypertension was treated with medical therapy. ICP was controlled within 72 hours. On day nine, the ICP device was removed. On the same day, the child started to obey commands, was rapidly weaned from mechanical ventilation and was extubated. He was discharged from the Department on day 13 and after two weeks went home with residual dysmetria and mild motor impairment. This study indicates that ICP-targeted treatment in children improves the outcome of severe cases of bacterial meningitis. ICP monitoring could particularly be useful to optimize brain perfusion and provide relief from severe neurological impairment, which is associated with the clinical signs of meningitis and increased ICP levels.

The incidence of the abuse of illicit drugs in sport may be a useful indicator of the extent of the phenomenon among the youth population. Many drugs of abuse are included in the WADA (World Anti-Doping Agency) Prohibited List, and are therefore routinely tested for in antidoping controls. This study presents the data obtained in tests carried out in the period 2003- 2007 at the Antidoping Laboratory of Rome, on 44781 samples analysed. The methods used are those developed by the Laboratory for routine antidoping analyses. The percentage of positive test results ranges from 1.1 to 2%, with a high incidence of stimulants and drugs of abuse. The substance most frequently found is THC metabolite, which accounts for 0.2-0.4% of the total, followed by cocaine metabolites, accounting for 0.1%. Other stimulants found are ephedrines, carphedon, modafinil, and anorexic compounds such as phendimetrazine and norfenfluramine. No amphetamines or amphetaminelike designer drugs have been detected. These data may be indicative of the widespread incidence of cocaine and cannabis abuse among the young Italian population, bearing in mind that the phenomenon is underestimated in this study, due to the fact that drugs of abuse are investigated only in samples involved in competitive sport, and especially to the fact that people doing such activities take more care of their health and are subject to greater control in their behaviour and habits with respect to the 'normal' population.

Therapeutic moderate hypothermia (32-34 degrees C) is currently recommended for patients with out-of-hospital cardiac arrest (OHCA) and for newborns exhibiting neonatal hypoxic/ischemic encephalopathy. Hypothermia as neuroprotective strategy has been extensively studied in other scenarios, mainly for traumatic brain injury. Despite a negative result reported by a multicenter trial conducted in 2001 by Clifton et al. regarding the use of hypothermia on head injury patients, several studies in both clinical and laboratory settings have continued to report positive outcomes with hypothermia use in neurocritical care. To date, no adequate consensus has been reached. Though the topic is still under debate, emerging data suggest that there may not be a clear-cut answer as to whether hypothermia is beneficial. However, new research may indicate what target populations can benefit most from this therapy. Furthermore, issues of timing (when and for how long hypothermia is applied) seem to be the primary drivers of the most unambiguous findings in this matter. For the time being, we conclude that further studies are needed to assess how to better administer this possibly beneficial therapy, and who might benefit most from the technique.

Introduction: The dural sheath surrounding the optic nerve communicates with the subarachnoid space, and distends when intracranial pressure is elevated. Magnetic resonance imaging (MRI) is often performed in patients at risk for raised intracranial pressure (ICP) and can be used to measure precisely the diameter of optic nerve and its sheath. The objective of this study was to assess the relationship between optic nerve sheath diameter (ONSD), as measured using MRI, and ICP., Methods: We conducted a retrospective blinded analysis of brain MRI images in a prospective cohort of 38 patients requiring ICP monitoring after severe traumatic brain injury (TBI), and in 36 healthy volunteers. ONSD was measured on T2-weighted turbo spin-echo fat-suppressed sequence obtained at 3 Tesla MRI. ICP was measured invasively during the MRI scan via a parenchymal sensor in the TBI patients., Results: Measurement of ONSD was possible in 95% of cases. The ONSD was significantly greater in TBI patients with raised ICP (>20 mmHg; 6.31 +/- 0.50 mm, 19 measures) than in those with ICP of 20 mmHg or less (5.29 +/- 0.48 mm, 26 measures; P < 0.0001) or in healthy volunteers (5.08 +/- 0.52 mm; P < 0.0001). There was a significant relationship between ONSD and ICP (r = 0.71, P < 0.0001). Enlarged ONSD was a robust predictor of raised ICP (area under the receiver operating characteristic curve = 0.94), with a best cut-off of 5.82 mm, corresponding to a negative predictive value of 92%, and to a value of 100% when ONSD was less than 5.30 mm., Conclusions: When brain MRI is indicated, ONSD measurement on images obtained using routine sequences can provide a quantitative estimate of the likelihood of significant intracranial hypertension.