Harefuah
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Optic disc drusen (ODD) are benign calcified deposits, which are located at the head of the optic disc. Most ODD patients are asymptomatic. Ocular complications, related to ODD, are considered rare. ⋯ The clinical discrimination between ODD and papilledema may be a challenging task, and in many cases, especially in the pediatric population, an ocular ultrasound examination is needed. A fundus examination, in order to rule out papilledema, is a common daily task for the ophthalmologist and is considered perhaps the most common interface between pediatricians, neurologists, internal physicians and ophthalmologists. In this review, we focused on the pathogenesis, epidemiology, diagnosis and clinical implications of ODD.
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Obstructive sleep apnea syndrome (OSA) afflicts approximately 5% of the adult population and increases with age. The gold standard treatment is with the Continuous Positive Airways Pressure (CPAP) machine. Well-designed prospective trials to elucidate long term compliance with CPAP machine are rare. ⋯ Four years follow-up revealed that about two thirds of the OSA patients did not use the CPAP machine. Older age, higher scores on the ESS questionnaire and lower 02 saturation levels on the polysomnogram (PSG) predict better adherence to treatment with the CPAP machine. In light of our findings and high treatment costs, we suggest a better selection process for prescribing CPAP treatment based on the above mentioned criteria. Other treatment modalities may be considered for patients not compliant with CPAP treatment or those who refuse to use it. Ongoing medical and social support is needed in order to maintain good compliance.
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We report a case of intestinal perforation in a 20 month old girl following the ingestion of 2 small magnets. Ingestion of multiple magnets constitutes a unique problem. ⋯ Early surgical intervention should be considered when clinical symptoms develop, especially when, on sequential abdominal radiographs, there is no change in the magnets' location. Since toys with small magnets are ubiquitous, efforts should be made to increase parents' awareness on the one hand, and to alert toy manufacturers on the other hand.
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Inflammatory demyelinative diseases of the central nervous system are mostly idiopathic and represent the major cause of neurological disability in young adults. These diseases differ in terms of clinical symptoms, severity, pathological characteristics and epidemiology. However, there are also significant similarities between these diseases, which sometimes bring to a misleading diagnosis. Neuromyelitis optica (NMO) is a demyelinative disease in which the optic nerve and the spinal cord are predominantly affected. The detection of specific antibodies to aquaporin-4 (NMO-IgG) led to a modification of the diagnostic criteria for NMO. ⋯ The finding of NMO-IgG in patients with optic neuritis foreshadows a bad prognosis and relapses. These patients are at high risk of experiencing a second event in the central nervous system and fulfilling the clinical criteria for NMO. Due to the difference in the severity of inflammation of the optic nerve between NMO and MS, it is highly recommended to seek a laboratory check-up for NMO-IgG in serum, immediately after the first event, in order to determine the necessity and the kind of treatment for the patient.
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Prolonged sitting and sedentary behavior comprises a major part of the modern lifestyle: at work, leisure (watching television, Internet) and commuting/traveling. Studies have shown that adults spend about half of their time at work and even more sitting. Similarly, a significant part of the leisure time is spent doing sedentary activities usually in front of a screen (TV or a computer). ⋯ Recent emerging findings have shown that breaking up sedentary time potentially has a beneficial impact on cardiovascular health (independent of total sedentary time and moderate-to-vigorous intensity activity). In this article, we review the association between the time spent in various sedentary activities (occupational, leisure and commuting/transportation) and cardiovascular risk factors and cardiovascular morbidity and mortality. In addition, we review the suggested mechanisms that explain the empiric associations.