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n countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities.The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients' priority for UGE.Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB.Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S.Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.

Purpose: To determine whether cone density, spacing, or regularity in eyes with and without diabetes (DM) as assessed by high-resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) correlates with presence of diabetes, diabetic retinopathy (DR) severity, or presence of diabetic macular edema (DME). Methods: Participants with type 1 or 2 DM and healthy controls underwent AOSLO imaging of four macular regions. Cone assessment was performed by independent graders for cone density, packing factor (PF), nearest neighbor distance (NND), and Voronoi tile area (VTA). Regularity indices (mean/SD) of NND (RI-NND) and VTA (RI-VTA) were calculated. Results: Fifty-three eyes (53 subjects) were assessed. Mean ± SD age was 44 ± 12 years; 81% had DM (duration: 22 ± 13 years; glycated hemoglobin [HbA1c]: 8.0 ± 1.7%; DM type 1: 72%). No significant relationship was found between DM, HbA1c, or DR severity and cone density or spacing parameters. However, decreased regularity of cone arrangement in the macular quadrants was correlated with presence of DM (RI-NND: P = 0.04; RI-VTA: P = 0.04), increasing DR severity (RI-NND: P = 0.04), and presence of DME (RI-VTA: P = 0.04). Eyes with DME were associated with decreased density (P = 0.04), PF (P = 0.03), and RI-VTA (0.04). Conclusions: Although absolute cone density and spacing don't appear to change substantially in DM, decreased regularity of the cone arrangement is consistently associated with the presence of DM, increasing DR severity, and DME. Future AOSLO evaluation of cone regularity is warranted to determine whether these changes are correlated with, or predict, anatomic or functional deficits in patients with DM.

Purpose: To utilize high resolution AOSLO to evaluate differences in cone density, reflectivity and regularity in eyes with and without diabetes (DM) and across a range of diabetic retinopathy (DR) severity. Methods: Cone mosaics at the fovea and 4 macular quadrants (1x1.2° area, mean+SD eccentricity = 4.2±0.4°) were imaged using AOSLO (2.5µm resolution). Contrast of aligned and averaged images was automatically standardized based on the 8-bit histogram. Cone counting was performed semi-automatically using ImageJ and manual correction by 2 independent graders masked to clinical data. Count differences >20% were adjudicated. Parameters including density, nearest neighbor (NN) and Voronoi tile measurements were calculated as well as mean reflectivity of each Voronoi tile. Results: Forty eyes of 40 subjects were assessed. For subjects, mean±SD age was 44±12yrs, 57% (N=12) were male, 78% (31) had DM, DM duration was 22±14yrs and 32% (10) had no DR, 19% (6) mild nonproliferative DR (NPDR), 29% (9) moderate NPDR, 10% (3) severe NPDR and 10% (3) PDR. No consistent relationship for DM or DR was seen with absolute cone density, NN measurements, or reflectivity. However, the reflectivity regularity index (RI) (Voronoi tile reflectivity mean/SD) decreased in all 5 macular regions with increasing DR severity and this decrease was statistically significant in the inferior regions of the macula (No DR: 4.6±0.9, mild NPDR: 4.5±0.8, moderate NPDR: 4.5±0.7, severe NPDR: 4.2±0.9, PDR: 3.8±0.9, p0.05). A significantly lower NN RI (NN mean/SD) was seen in macular quadrants in eyes with DM as compared with no DM (4.7±1.0 vs. 5.4±1.5, p0.04). Increasing age correlated with a decrease in mean cone density (35y: 11,567±2,848, 35-50y: 10,933±2,403, 50+y: 10,023±2,219 cones/mm2, p0.05) as well as an increase in reflectivity RI (4.1±0.9, 4.3±0.8, 4.8±0.8, respectively, p=0.002) in all regions. Conclusions: Although absolute cone density does not appear to change substantially in diabetes, decreases in regularity of cone spacing and reflectivity regularity are associated with presence of DM and increasing DR severity, respectively. If future studies demonstrate that these properties correlate with functional or metabolic alterations of the retinal photoreceptors, these assessments may provide novel predictors of visual or anatomic outcomes in the diabetic eye.

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Background: Rasagiline is a selective monoamine oxidase (MAO) B inhibitor which has been approved for treatment of Parkinson's disease (PD). Objectives: This study was performed to evaluate rotenone neurotoxicity in mice and to investigate the possible neuroprotective effect of rasagiline and its mechanism. Methods: Thirty six male mice were used and divided into three equal groups. The first group, the control group, received only sunflower oil intraperitoneally (IP) once daily at a volume of 4 ml/kg for 49 days. The second group was given rotenone (2 mg/kg/day; IP) for 49 days. The third group was given rasagiline (1 mg/kg, IP) which was administered 30 min prior to rotenone (2 mg/kg/day; IP) for 49 days. Behavioral tests were performed a day prior to drug administration and then once weekly along the duration of drugs or vehicle administration. At the end of the 49 days all animals were sacrificed and their midbrains were subjected to immunohistochemical analysis for dopaminergic neurons staining for anti-tyrosine hydroxylase (TH) antibodies. Midbrain tissues were also isolated for biochemical measurements. Results: Rasagiline administration significantly improved the mice activity. Pretreatment with rasagiline significantly attenuated rotenone-induced midbrain dopamine loss. Moreover, rasagiline treatment also significantly prevented the loss of TH immunoreactive neurons within the substantia nigra pars compacta (SNpc). Furthermore, rasagiline inhibited the remarkable decrease in total antioxidant capacity as well as the increase in the malondialdehyde (MDA) level and nitric oxide generation induced by chronic rotenone administration. Conclusion: These results suggest that chronic intraperitoneal administration of rotenone induced PD-like disorder in mice. Moreover, these results suggest that rasagiline had neuroprotective effect against the rotenone-induced PD. This neuroprotective effect was mediated even in part by the antioxidant properties of rasagiline.