Journal Issue:
Editorial, Volume 7, Issue 4 Editorial, Volume 7, Issue 4

No Thumbnail Available
Volume
Number
4
Issue Date
2016-04-01
Journal Title
Journal ISSN
Journal Volume
Articles
Publication
Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study
( 2007-03-01)
BACKGROUND: Adjunctive dexamethasone increases survival from tuberculous meningitis, but the underlying mechanism is unclear. We aimed to determine the effect of dexamethasone on cerebral MRI changes and their association with intracerebral inflammatory responses and clinical outcome in adults treated for tuberculous meningitis. METHODS: Cerebral MRI was undertaken, when possible, at diagnosis and after 60 days and 270 days of treatment in adults with tuberculous meningitis admitted to two hospitals in Vietnam. Patients were randomly assigned either dexamethasone (n=24) or placebo (n=19) and received 9 months of treatment with standard first-line antituberculosis drugs. We assessed associations between MRI findings, treatment allocation, and resolution of fever, coma, cerebrospinal fluid inflammation, and neurological outcome. FINDINGS: 83 scans were done for 43 patients: 19 given placebo, 24 given dexamethasone. Basal meningeal enhancement (82%) and hydrocephalus (77%) were the most common presenting findings. Fewer patients had hydrocephalus after 60 days of treatment with dexamethasone than after placebo treatment (p=0.217). Tuberculomas developed in 74% of patients during treatment and in equal proportions in the treatment groups; they were associated with long-term fever, but not relapse or poor clinical outcome. The basal ganglia were the most common site of infarction; the proportion with infarction after 60 days was halved in the dexamethasone group (27%vs 58%, p=0.130). INTERPRETATION: Dexamethasone may affect outcome from tuberculous meningitis by reducing hydrocephalus and preventing infarction. The effect may have been under-estimated because the most severe patients could not be scanned.
Description
The Journal of Financial Therapy would not exist without the time and efforts of our excellent reviewers. You may be asking, ΓÇ£what does a reviewer do?ΓÇ¥ JFT is a unique scholarly publication because papers require the rigor of academic standards, but also must be translatable to non-researchers. It is not uncommon for researchers and practitioners to fail to communicate effectively with one another because the two groups speak what seems like different languages. Therefore, it is the goal of JFT to publish quality scholarly research and to emphasize the practicality of the research.
Keywords
Financial Therapy
editorial
Journal of Financial Therapy
peer review