The Role of Automated Infrared Pupillometry in Traumatic Brain Injury: A Narrative Review

Pupillometry, an integral component of neurological examination, serves to evaluate both pupil size and reactivity. The conventional manual assessment exhibits inherent limitations, thereby necessitating the development of portable automated infrared pupillometers (PAIPs). Leveraging infrared technology, these devices provide an objective assessment, proving valuable in the context of brain injury for the detection of neuro-worsening and the facilitation of patient monitoring. In cases of mild brain trauma particularly, traditional methods face constraints. Conversely, in severe brain trauma scenarios, PAIPs contribute to neuro-prognostication and non-invasive neuromonitoring. Parameters derived from PAIPs exhibit correlations with changes in intracranial pressure. It is important to acknowledge, however, that PAIPs cannot replace invasive intracranial pressure monitoring while their widespread adoption awaits robust support from clinical studies. Ongoing research endeavors delve into the role of PAIPs in managing critical neuro-worsening in brain trauma patients, underscoring the non-invasive monitoring advantages while emphasizing the imperative for further clinical validation. Future advancements in this domain encompass sophisticated pupillary assessment tools and the integration of smartphone applications, emblematic of a continually evolving landscape.

Synchronous cytomegalovirus and Clostridium difficile infection of the pouch: a trigger for chronic pouchitis?

Pouchitis occurs in up to one half of patients after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Cytomegalovirus (CMV) and Clostridium difficile are among the commonest secondary identifiable etiologies. A 17-year-old male with ulcerative colitis underwent IPAA due to refractory disease. Nine months later he experienced bloody diarrhea and fever. Laboratory testing and endoscopy confirmed pouch inflammation. Testing for C. difficile toxins A and B was positive. Histology revealed affluent inclusion bodies and immunohistochemistry detected reactivity against CMV protein. Treatment with metronidazole and vancomycin offered partial improvement, whereas the addition of gancyclovir led to a successful recovery. One month after completion of treatment symptoms recurred. Repeat testing precluded an identifiable infectious cause and the diagnosis of idiopathic chronic pouchitis was established. The patient is currently on maintenance treatment with the probiotic compound VSL#3.

Dysphoria and decision making: limited information use for evaluations of multiattribute targets

The hypothesis was that dysphoric relative to nondysphoric individuals use less available, relevant information in decision making because of reduced attentional resources. Dysphoric and nondysphoric Ss evaluated 70 jobs, each of which was described in terms of 5 dimensions (e.g., friendliness of co-workers); there were 5 possible values for each dimension. In both studies, dysphoric relative to nondysphoric Ss used a smaller subset of information, yet did not simplify what information was used and did not combine the information in a more simple manner. The limited information use was not due to dysphoric Ss' systematically ignoring certain dimensions and was evident in both initial and final portions of the task. Dysphoric Ss spent as much time and reported using as much information and investing as much effort as nondysphoric Ss. Reported effort alone was related to actual information use.

Dysphoria and decision making: limited information use for evaluations of multiattribute targets

The hypothesis was that dysphoric relative to nondysphoric individuals use less available, relevant information in decision making because of reduced attentional resources. Dysphoric and nondysphoric Ss evaluated 70 jobs, each of which was described in terms of 5 dimensions (e.g., friendliness of co-workers); there were 5 possible values for each dimension. In both studies, dysphoric relative to nondysphoric Ss used a smaller subset of information, yet did not simplify what information was used and did not combine the information in a more simple manner. The limited information use was not due to dysphoric Ss' systematically ignoring certain dimensions and was evident in both initial and final portions of the task. Dysphoric Ss spent as much time and reported using as much information and investing as much effort as nondysphoric Ss. Reported effort alone was related to actual information use.