Day-care center attendance and risk of Asthma—A systematic review

Publication date: Available online 7 July 2018

Source: Allergologia et Immunopathologia

Author(s): Carlos Ochoa Sangrador, Alba Vázquez Blanco

Abstract

Introduction and Objectives

Asthma and other wheezing disorders are common chronic health problems in childhood. We aim to evaluate whether the attendance by children under three years of age to day-care centers is a protector or risk factor in the development of recurrent wheezing or asthma in the following years of their lives.

Methods

Systematic review of published cohort or cross-sectional studies, without any time limitation. We searched in PubMed, Cinhal, Cuiden and Scopus (EMBASE included). The quality of the studies was evaluated using the Newcastle-Ottawa Scale. Disagreements were solved by mutual consensus. Weighted odds ratio (ORs) were estimated using RevMan 5.3, following random effects models.

Results

We selected 18 studies for qualitative analysis, nine cohort studies and nine cross-sectional studies. Day-care center attendance is associated with an increased risk of early recurrent wheezing (four studies; 50,619 subjects; adjusted OR 1.87 [1.21 to 2.88]; I² 91%) and asthma before the age of six (five studies; 5412 subjects; adjusted OR 1.59 [1.26 to 2.01]; I² 0%), but not later (five studies; 5538 subjects; adjusted OR 0.86 [0.55 to 1.32]; I² 76%).

Conclusions

Children attending day-care center during the first years of life have a higher risk of recurrent wheezing during the first three years and asthma before the age of six, but not later. This risk must be taken into account to inform parents in order to choose what kind of care children should have throughout infancy and to implement preventive measures to reduce its impact.

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A reproductive and developmental screening study of the fungal toxin ochratoxin A in Fischer rats

Abstract

The presence of the mycotoxin ochratoxin A (OTA) in cereal grains is due to the growth of toxigenic Penicillium mold on stored crops. Human exposure to OTA is higher in infants, toddlers, and children than in adolescents and adults, based on exposure assessments of ng OTA consumed/kg body weight/day. Ochratoxin A is nephrotoxic and teratogenic in animals, but its effects on juveniles exposed during the reproduction and development period have not been studied. To address this, Fischer rats were exposed to 0, 0.16, 0.4, 1.0, or 2.5 mg OTA/kg diet throughout breeding, gestation, and lactation and its adverse effects were assessed in adult rats and their offspring on postnatal day (PND) 21. There were no effects on implantation but post-implantation fetotoxicity was observed in the 2.5 mg/kg dose group, corresponding to a calculated dose of 167.0 μg/kg bw/day in dams. Adverse effects on body and kidney weights and on clinical parameters indicative of renal toxicity were significant in adult rats exposed to 1.0 mg OTA/kg diet (55.2 and 73.3 μg/kg bw/day in adult males and females, respectively) and in PND21 rats at the 0.4 mg/kg dose (33.9 μg/kg bw/day in dams), suggesting that weanling rats were more sensitive to OTA than adults. Overall, nephrotoxicity was the primary effect of OTA in weanling rats exposed throughout gestation and lactation at sub-fetotoxic concentrations in diet.

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Novel minor HLA DR associated antigens in type 1 diabetes

Publication date: Available online 7 July 2018

Source: Clinical Immunology

Author(s): Denise Müller, Tanja Telieps, Anne Eugster, Christina Weinzierl, Manja Jolink, Anette-Gabriele Ziegler, Ezio Bonifacio

Abstract

Type 1 diabetes is an autoimmune disease leading to insulin deficiency. Autoantibodies to beta cell proteins are already present in the asymptomatic phase of type 1 diabetes. Recent findings have suggested a number of additional minor autoantigens in patients with type 1 diabetes. We have established luciferase immunoprecipitation systems (LIPS) for anti-MTIF3, anti-PPIL2, anti-NUP50 and anti-MLH1 and analyzed samples from 500 patients with type 1 diabetes at onset of clinical disease and 200 healthy individuals who had a family history of type 1 diabetes but no evidence of beta cell autoantibodies. We show significantly higher frequencies of anti-MTIF3, anti-PPIL2 and anti-MLH1 in recent onset type 1 diabetes patients in comparison to controls. In addition, antibodies to NUP50 were associated with HLA-DRB1*03 and antibodies to MLH1 were associated with HLA-DRB1*04 genotypes.

Graphical abstract

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Silicone-Induced Foreign Body Reaction: An Unusual Differential Diagnosis of Posterolateral Hip Pain

Background. Silicone injection is commonly used for soft tissue augmentation for esthetic purposes. It is not without complications. Case presentation. We present a case of a 31-year-old woman presenting with refractory left lateral hip pain. Magnetic resonance imaging of the patient's pelvis revealed innumerable small low signal foci throughout the gluteus maximus and overlying subcutaneous fat bilaterally consistent with injectable material, possibly silicone. Conclusions. This case report emphasizes that silicone-induced granulomatosis must be considered in the differential diagnosis of hip pain when evaluating a patient who has had access to plastic surgery or clandestine operators.

https://ift.tt/2KWLUMc

Scientific Scholarly Communication: The Changing Landscape

Tomicic, A; (2018) Scientific Scholarly Communication: The Changing Landscape. [Review]. International Journal of Communication , 12 pp. 260-263. Green open access

https://ift.tt/2lYIkpM

Promoting a healthy cities agenda through indicators: development of a global urban environment and health index

Pineo, H; Zimmermann, N; Cosgrave, E; Aldridge, RW; Acuto, M; Rutter, H; (2018) Promoting a healthy cities agenda through indicators: development of a global urban environment and health index. Cities & Health 10.1080/23748834.2018.1429180 . (In press). Green open access

https://ift.tt/2zjV5oC

Top ten research priorities for brain and spine cavernous malformations

Salman, RA-S; Kitchen, N; Thomson, J; Ganesan, V; Mallucci, C; Radatz, M; (2016) Top ten research priorities for brain and spine cavernous malformations. [Letter]. The Lancet Neurology , 15 (4) pp. 354-355. 10.1016/S1474-4422(16)00039-9 . Green open access

https://ift.tt/2m35dso

Comparing F-18-AV-1451 with CSF t-tau and p-tau for diagnosis of Alzheimer disease

Mattsson, N; Smith, R; Strandberg, O; Palmqvist, S; Scholl, M; Insel, PS; Hagerstrom, D; ... Hansson, O; + view all Mattsson, N; Smith, R; Strandberg, O; Palmqvist, S; Scholl, M; Insel, PS; Hagerstrom, D; Ohlsson, T; Zetterberg, H; Blennow, K; Jogi, J; Hansson, O; - view fewer (2018) Comparing F-18-AV-1451 with CSF t-tau and p-tau for diagnosis of Alzheimer disease. Neurology , 90 (5) e388-e395. 10.1212/WNL.0000000000004887 . Green open access

https://ift.tt/2ub5g9h

The Life Skills of Older Americans: Association with Economic, Psychological, Social, and Health Outcomes

Steptoe, A; Jackson, SE; (2018) The Life Skills of Older Americans: Association with Economic, Psychological, Social, and Health Outcomes. Scientific Reports , 8 , Article 9669. 10.1038/s41598-018-27909-w . Green open access

https://ift.tt/2lYqi7f

Low Gain Servo Control During the Kohnstamm Phenomenon Reveals Dissociation Between Low-Level Control Mechanisms for Involuntary vs. Voluntary Arm Movements

De Havas, J; Ito, S; Haggard, P; Gomi, H; (2018) Low Gain Servo Control During the Kohnstamm Phenomenon Reveals Dissociation Between Low-Level Control Mechanisms for Involuntary vs. Voluntary Arm Movements. Frontiers in Behavioral Neuroscience , 12 , Article 113. 10.3389/fnbeh.2018.00113 . Green open access

https://ift.tt/2ueuLX9

Genetic and environmental factors affecting birth size variation: a pooled individual-based analysis of secular trends and global geographical differences using 26 twin cohorts

Yokoyama, Y; Jelenkovic, A; Hur, Y-M; Sund, R; Fagnani, C; Stazi, MA; Brescianini, S; ... Silventoinen, K; + view all Yokoyama, Y; Jelenkovic, A; Hur, Y-M; Sund, R; Fagnani, C; Stazi, MA; Brescianini, S; Ji, F; Ning, F; Pang, Z; Knafo-Noam, A; Mankuta, D; Abramson, L; Rebato, E; Hopper, JL; Cutler, TL; Saudino, KJ; Nelson, TL; Whitfield, KE; Corley, RP; Huibregtse, BM; Derom, CA; Vlietinck, RF; Loos, RJF; Llewellyn, CH; Fisher, A; Bjerregaard-Andersen, M; Beck-Nielsen, H; Sodemann, M; Krueger, RF; McGue, M; Pahlen, S; Bartels, M; van Beijsterveldt, CEM; Willemsen, G; Harris, JR; Brandt, I; Nilsen, TS; Craig, JM; Saffery, R; Dubois, L; Boivin, M; Brendgen, M; Dionne, G; Vitaro, F; Haworth, CMA; Plomin, R; Bayasgalan, G; Narandalai, D; Rasmussen, F; Tynelius, P; Tarnoki, AD; Tarnoki, DL; Ooki, S; Rose, RJ; Pietiläinen, KH; Sørensen, TIA; Boomsma, DI; Kaprio, J; Silventoinen, K; - view fewer (2018) Genetic and environmental factors affecting birth size variation: a pooled individual-based analysis of secular trends and global geographical differences using 26 twin cohorts. International Journal of Epidemiology 10.1093/ije/dyy081 . (In press).

https://ift.tt/2lYYJKZ

Management of glucocorticoid replacement in adrenal insufficiency shows notable heterogeneity - data from the EU-AIR

Murray, RD; Ekman, B; Uddin, S; Marelli, C; Quinkler, M; Zelissen, PMJ; the EU-AIR Investigators, ; (2017) Management of glucocorticoid replacement in adrenal insufficiency shows notable heterogeneity - data from the EU-AIR. Clinical Endocrinology , 86 (3) pp. 340-346. 10.1111/cen.13267 . Green open access

https://ift.tt/2ue0KGL

Comprehensive Cancer-Predisposition Gene Testing in an Adult Multiple Primary Tumor Series Shows a Broad Range of Deleterious Variants and Atypical Tumor Phenotypes

Whitworth, J; Smith, PS; Martin, J-E; West, H; Luchetti, A; Rodger, F; Clark, G; ... Maher, ER; + view all Whitworth, J; Smith, PS; Martin, J-E; West, H; Luchetti, A; Rodger, F; Clark, G; Carss, K; Stephens, J; Stirrups, K; Penkett, C; Mapeta, R; Ashford, S; Megy, K; Shakeel, H; Ahmed, M; Adlard, J; Barwell, J; Brewer, C; Casey, RT; Armstrong, R; Cole, T; Evans, DG; Fostira, F; Greenhalgh, L; Hanson, H; Henderson, A; Hoffman, J; Izatt, L; Kumar, A; Kwong, A; Lalloo, F; Ong, KR; Paterson, J; Park, S-M; Chen-Shtoyerman, R; Searle, C; Side, L; Skytte, A-B; Snape, K; Woodward, ER; NIHR BioResource Rare Diseases Consortium, ; Tischkowitz, MD; Maher, ER; - view fewer (2018) Comprehensive Cancer-Predisposition Gene Testing in an Adult Multiple Primary Tumor Series Shows a Broad Range of Deleterious Variants and Atypical Tumor Phenotypes. The American Journal of Human Genetics , 103 (1) pp. 3-18. 10.1016/j.ajhg.2018.04.013 . Green open access

https://ift.tt/2m62wGF

MEG-BIDS, the brain imaging data structure extended to magnetoencephalography

Niso, G; Gorgolewski, KJ; Bock, E; Brooks, TL; Flandin, G; Gramfort, A; Henson, RN; ... Baillet, S; + view all Niso, G; Gorgolewski, KJ; Bock, E; Brooks, TL; Flandin, G; Gramfort, A; Henson, RN; Jas, M; Litvak, V; T Moreau, J; Oostenveld, R; Schoffelen, J-M; Tadel, F; Wexler, J; Baillet, S; - view fewer (2018) MEG-BIDS, the brain imaging data structure extended to magnetoencephalography. Scientific Data , 5 , Article 180110. 10.1038/sdata.2018.110 . Green open access

https://ift.tt/2zkfrhx

Minocycline reduces chronic microglial activation after brain trauma but increases neurodegeneration

Scott, G; Zetterberg, H; Jolly, A; Cole, JH; De Simoni, S; Jenkins, PO; Feeney, C; ... Sharp, DJ; + view all Scott, G; Zetterberg, H; Jolly, A; Cole, JH; De Simoni, S; Jenkins, PO; Feeney, C; Owen, DR; Lingford-Hughes, A; Howes, O; Patel, MC; Goldstone, AP; Gunn, RN; Blennow, K; Matthews, PM; Sharp, DJ; - view fewer (2018) Minocycline reduces chronic microglial activation after brain trauma but increases neurodegeneration. Brain , 141 pp. 459-471. 10.1093/brain/awx339 . Green open access

https://ift.tt/2m62pLf

Mobile learning in medicine: an evaluation of attitudes and behaviours of medical students

Chase, TJG; Julius, A; Chandan, JS; Powell, E; Hall, CS; Phillips, BL; Burnett, R; ... Fernando, B; + view all Chase, TJG; Julius, A; Chandan, JS; Powell, E; Hall, CS; Phillips, BL; Burnett, R; Gill, D; Fernando, B; - view fewer (2018) Mobile learning in medicine: an evaluation of attitudes and behaviours of medical students. BMC Medical Education , 18 , Article 152. 10.1186/s12909-018-1264-5 . Green open access

https://ift.tt/2zlhkdM

Sparsity-Driven Micro-Doppler Feature Extraction for Dynamic Hand Gesture Recognition

Li, G; Zhang, R; Ritchie, M; Griffiths, H; (2018) Sparsity-Driven Micro-Doppler Feature Extraction for Dynamic Hand Gesture Recognition. IEEE Transactions on Aerospace and Electronic Systems , 54 (2) pp. 655-665. 10.1109/TAES.2017.2761229 . Green open access

https://ift.tt/2lZo5IB

Simultaneous data collection of small maritime targets using multistatic radar and forward scatter radar

Ritchie, M; Fioranelli, F; Woodbridge, K; Griffiths, H; Daniel, L; De Luca, A; Hristov, S; ... Cherniakov, M; + view all Ritchie, M; Fioranelli, F; Woodbridge, K; Griffiths, H; Daniel, L; De Luca, A; Hristov, S; Gashinova, M; Cherniakov, M; - view fewer (2017) Simultaneous data collection of small maritime targets using multistatic radar and forward scatter radar. IET Radar, Sonar & Navigation , 11 (6) pp. 937-945. 10.1049/iet-rsn.2016.0526 . Green open access

https://ift.tt/2zlhjXg

Sparsity-based dynamic hand gesture recognition using micro-Doppler signatures

Li, G; Zhang, R; Ritchie, M; Griffiths, H; (2017) Sparsity-based dynamic hand gesture recognition using micro-Doppler signatures. In: 2017 IEEE Radar Conference (RadarConf). (pp. 0928-0931). IEEE Green open access

https://ift.tt/2m29zzQ

Performance Analysis of Centroid and SVD Features for Personnel Recognition Using Multistatic Micro-Doppler

Fioranelli, F; Ritchie, M; Griffiths, H; (2016) Performance Analysis of Centroid and SVD Features for Personnel Recognition Using Multistatic Micro-Doppler. IEEE GEOSCIENCE AND REMOTE SENSING LETTERS , 13 (5) pp. 725-729. 10.1109/LGRS.2016.2539386 .

https://ift.tt/2uebC7z

Experimental analysis of multistatic wind turbine radar clutter statistics

Fioranelli, F; Ritchie, M; Balleri, A; Griffiths, H; (2016) Experimental analysis of multistatic wind turbine radar clutter statistics. [Letter]. Electronic Letters , 52 (3) pp. 226-227. 10.1049/el.2015.3907 . Green open access

https://ift.tt/2m62n65

In situ compression and X-ray computed tomography of flow battery electrodes

Jervis, R; Kok, MDR; Neville, TP; Meyer, Q; Brown, LD; Iacoviello, F; Gostick, JT; ... Shearing, PR; + view all Jervis, R; Kok, MDR; Neville, TP; Meyer, Q; Brown, LD; Iacoviello, F; Gostick, JT; Brett, DJL; Shearing, PR; - view fewer (2018) In situ compression and X-ray computed tomography of flow battery electrodes. Journal of Energy Chemistry 10.1016/j.jechem.2018.03.022 . (In press).

https://ift.tt/2ziSGKN

Demonstration of Real Time Bandwidth Compressed Signal Transmission at 2.4 GHz using Software Defined Radio (SDR)

Xu, T; Ghannam, H; Ozan, W; Darwazeh, I; (2018) Demonstration of Real Time Bandwidth Compressed Signal Transmission at 2.4 GHz using Software Defined Radio (SDR). [Exhibition]. Kalamata, Greece. 25-28 June 2018. Green open access

https://ift.tt/2m29wEa

Next-generation sequencing of a large gene panel in patients initially diagnosed with idiopathic ventricular fibrillation

Visser, M; Dooijes, D; van der Smagt, JJ; van der Heijden, JF; Doevendans, PA; Loh, P; Asselbergs, FW; Visser, M; Dooijes, D; van der Smagt, JJ; van der Heijden, JF; Doevendans, PA; Loh, P; Asselbergs, FW; Hassink, RJ; - view fewer (2017) Next-generation sequencing of a large gene panel in patients initially diagnosed with idiopathic ventricular fibrillation. Heart Rhythm , 14 (7) pp. 1035-1040. 10.1016/j.hrthm.2017.01.010 . Green open access

https://ift.tt/2ucYxeR

Semilobar holoprosencephaly with cebocephaly associated with maternal early onset preeclampsia: a case report

The term holoprosencephaly was proposed by DeMyer and Zeman. It is a developmental defect of the embryonic forebrain with heterogeneous etiology including genetic and environmental factors. It is commonly asso...

https://ift.tt/2ziO07H

Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: two rare case reports

We report two cases of innocuous dentoalveolar infections which rapidly progressed to deep neck abscesses complicated by descending mediastinitis in a resource-constrained rural mission hospital in the Cameroon.

https://ift.tt/2lZptuX

Editorial Board

Publication date: September 2018

Source: Archives of Oral Biology, Volume 93

Author(s):

https://ift.tt/2zhoGil

In silico analysis of virulence genes in an emerging dental pathogen A.baumannii and related species

Publication date: Available online 7 July 2018

Source: Archives of Oral Biology

Author(s): J. Vijayashree Priyadharsini, A.S. Smiline Girija, A. Paramasivam

ABSTRACT

Objectives

Acinetobacter baumannii is an opportunistic pathogen which has recently been categorized as a high risk pathogen by World Health Organisation (WHO). The microbe has stealthily entered the oral cavity and has established itself as a potential pathogen by acquiring drug resistance and expression of several virulence genes. Surveillance on the type of virulence factors harboured by the organism will enable us to comprehend the mechanism of pathogenesis. The study was performed to screen for the presence of crucial virulence factors associated with Acinetobacter spp. as reviewed from the literature by employing computational tools.

Design

Nineteen genome sequences of Acinetobacter spp. with the predominance of different strains of A. baumannii were classified phylogenetically into clusters using in silico restriction digestion and pulse field gel electrophoresis (PFGE). Further, the frequency of common virulence genes in the genome of various Acinetobacter spp. was recorded using in silico PCR analysis.

Results

Based on PFGE pattern and phylogenetic tree the genomes of A. baumannii were clustered into 4 genotypes (G1-G4). Two species were excluded from the list since they were negative for almost all the virulence genes tested. Frequency of virulence genes in each of the 17 genomes analysed, found ompA and smpA to be the major virulence factors in A.baumannii and related species. Acinetobacter spp. belonging to genotypes 2 and 3 were found to harbour 1-15 and 6-10 potential genes encoding virulence factors respectively.

Conclusions

The present study showed numerous virulence genes in genomes analysed. In silico analysis of these virulence genes can be used as candidates to build novel therapeutic targets against the pathogen. An extensive study on the functional role of these genes could aid in stalling the propagation and dissemination of A.baumannii among susceptible individuals.

https://ift.tt/2u2tHq8

Evaluation of Multimodality Management of Adenoid Cystic Carcinoma of the Head and Neck

Abstract

Adenoid cystic carcinoma is a relatively rare tumour arising from salivary glands of head and neck region. Surgery and radiotherapy form standard treatment modalities in the management of this tumor. In this analysis we present results of multimodality treatment in our cohort of patient. This retrospective analysis evaluated results of treatment in forty patients diagnosed with adenoid cystic carcinoma of the head and neck. Evaluation was done to identify prognostic factors affecting the disease free survival. A median disease free survival of 34 ± 2.42 (Median ± SE) versus 10 ± 5.45 months was seen in patients undergoing surgery followed by post operative radiotherapy versus radiotherapy alone (P = 0.01). A radiotherapy dose more than 60 Gy was associated with a better disease free survival compared with patients receiving less than 60 Gy (P = 0.01). Positive surgical margins and perineural invasion were associated with a poor treatment outcome (P = 0.02) Patients with c-kit positive status showed a poor local control rate (P = 0.05).

https://ift.tt/2NBXjCW

Leukocyte- and platelet-rich fibrin: a new graft material in endoscopic repair of spontaneous CSF leaks

Abstract

Background

Spontaneous CSF leak is a challenging condition, with frequent recurrences following attempted surgical closure. The selection of graft materials depends on the experience of the operating surgeon. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation platelet concentrate that has currently invaded every surgical specialty. To our knowledge, no previous reports about the use of L-PRF in repair of CSF leak were published. The study was conducted to assess the potential role of L-PRF in spontaneous CSF leaks repair.

Methods

This prospective controlled study was conducted on 40 patients who were randomly divided into 2 groups: In group A, L-PRF was used in addition to another layer, while patients in group B underwent multilayer repair using traditional graft materials.

Results

Preoperative HRCT scan showed bony dehiscence (n = 30) and opacity in a nearby sinus (n = 9). MRI findings varied between empty sella in 28 patients, and meningocele in 19 patients. Mean preoperatively measured CSF pressure was 26.6 cm H₂O. Cribriform plate was identified as the commonest site of leaks. Multiple skull defects were detected in 2 cases. Failure of repair was found in 3 patients (15%) of group B and 1 patient (5%) of group A, this difference was statistically insignificant (P value = 0.28). Significance correlation between recurrence of CSF leak and elevated intracranial pressure was observed (P value; 0.04).

Conclusion

L-PRF was found to be a good adjunct material in endoscopic spontaneous CSF leaks repair. It helps in decreasing the number of layers needed for defect closure.

https://ift.tt/2ueikue

Association of the infiltration of tumor-associated macrophages, expression of Smad7 protein and prognosis in oral squamous cell carcinoma

Publication date: Available online 7 July 2018

Source: Archives of Oral Biology

Author(s): wei Wei, Chen Hujie

Abstract

Objective

To explore the association between Smad7 expression and tumor-associated macrophage (TAM), and their relationship with clinicopathological features and prognosis in patients with oral squamous cell carcinoma (OSCC).

Methods

This study collected cancer tissues from 314 OSCC patients from May 2002 to May 2012 at our hospital. Immunohistochemistry was carried out to detect the density of CD68⁺ cells and Smad7.

Results

The densities of CD68TF_Mean and CD68TF_Hotspot shared a significant negative correlation with the immunoscore (IS) of Smad7, indicated that Smad7 was evidently increased with the decrease densities of CD68TF_Mean and CD68TF_Hotspot in OSCC tissues. Besides, low differentiation degree together with high TNM, T and N stage of OSCC patients presented decreased densities of CD68TF_Mean and CD68TF_Hotspot but increased expression of Smad7. Kaplan-Meier univariate survival analysis showed that the prognosis of OSCC patients was associated with differentiation degree, clinical stages, Smad7 expression, as well as densities of CD68TF_Mean and CD68TF_Hotspot. Cox regression analysis results demonstrated that N staging, the densities of CD68TF_Mean and CD68TF_Hotspot and Smad7 expression were independent risk factors influencing the survival rate of OSCC patients.

Conclusion

Decreased densities of CD68TF_Mean and CD68TF_Hotspot were negatively correlated with the increased Smad7 expression in OSCC tissues, both of which linked to clinicopathological features and prognosis of OSCC.

https://ift.tt/2lXace2

Pediatric neuroanesthesia

Purpose of review Pediatric neuroanesthesia is a fascinating, yet challenging branch of anesthesia. This review highlights some of the recent insights into pediatric neuroanesthesia from the past 18 months. Recent findings Although there are incontrovertible evidences in animals suggesting that prolonged exposure to general anesthesia causes long-term neurological impairment, the translational relevance of these findings in humans is debatable. Early surgery for pediatric drug-refractory epilepsy is supported by emerging literature, but poses unique perioperative problems for the treating neuroanesthesiologist. Similarly, minimizing intraoperative blood loss and blood transfusion concerns every anesthesiologist managing small children. The usefulness of tranexamic acid in children is further enhanced by some studies in spine surgeries. Some pertinent issues related to intraoperative neuromonitoring are also discussed in the text. Summary There are several logistical and ethical problems of carrying out high-quality prospective studies in children but important findings on prevention of anesthetic neurotoxicity; minimizing intraoperative blood loss, intraoperative neurophysiological monitoring, examining optimal doses and choices of anesthetic agents in epilepsy surgery have been published recently. Correspondence to Dr Girija P. Rath, MBBS, MD, DM, Professor, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Tel: +91 9810602272; e-mail: girijarath@yahoo.co.in Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Catheterisation of a persistent left superior vena cava

We present a case of a 62-year-old woman with end-stage renal disease who displayed a persistent left superior vena cava detected following placement of haemodialysis catheter through the left internal jugular vein (IJV). The diagnosis was confirmed by left internal jugular vein cathetogram, computed tomography (CT) thorax and transthoracic echocardiography. The catheter was removed without immediate complications. She remained well during the outpatient follow-up.

https://ift.tt/2m0ZweD

Atypical presentation of cat scratch disease: Parinauds oculoglandular syndrome with facial nerve paresis

A 28-year-old man presented to our clinic over the course of 3 weeks with symptoms that progressed from mild headaches to fever, fatigue, myalgia and an enlarged right preauricular lymph node with ipsilateral conjunctivitis and upper eyelid weakness. Our differential included Epstein Barr Virus/Cytomegalovirus mononucleosis, bacterial conjunctivitis and lymphoma. We evaluated with CBC, EBV IgM Ab, lactate dehydrogenase level and a CMV IgG Ab which were all within normal limits. During his third visit, we discovered our patient had been scratched by two stray kittens he had adopted 2 months prior. We confirmed the diagnosis with a positive Bartonella henselae IgG level and diagnosed him with cat scratch disease presenting as Parinaud's oculoglandular syndrome. He was treated with a 5-day course of Azithromycin 250 mg with definitive improvement.

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Squamous cell carcinoma of scrotum mimicking as scrotal abscess

Description 

A 60-year-old man was referred to our urology department with complaints of non-healing scrotal wound for the last three months. He initially presented to a primary care centre with complaints of painful scrotal swelling and discharging scrotal wound for 15 days. The discharge card given to the patient mentioned that the patient was provisionally diagnosed as scrotal abscess and underwent incision and drainage. On local examination, an irregular appearing, ulcerated scrotal wound with everted margins was present (figure 1). The local examination of inguinal region and general physical examination was normal. Routine blood/urine investigations were within normal limits. Wedge biopsy from wound margins was performed under local anaesthesia. The histopathology came as a surprise to us as it revealed proliferating squamous epithelial cells disposed of as nests and solid masses suggestive of well-differentiated squamous cell carcinoma (figure 2). Further workup including contrast-enhanced CT abdomen/pelvis and chest X-ray...

https://ift.tt/2lZDpF5

Hungry bone syndrome secondary to prostate cancer successfully treated with radium therapy

A 50-year-old man with a history of prostate cancer with extensive bone metastasis and hypocalcaemia presented with muscle aches and cramps. Physical exam was significant for Chvostek's and Trousseau's sign. Laboratory assessment was consistent with profound hypocalcaemia. This was believed to be due to hungry bone syndrome secondary to advanced prostate cancer. He was treated with intravenous calcium, vitamin D and calcitriol. He also received three doses of radium²²³ therapy. After therapy, hypocalcaemic episodes resolved. Follow-up after 2.5 years showed continued resolution of hypocalcaemia.

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IgG4-related disease coexisting with autoimmune haemolytic anaemia

An 85-year-old man presented with a pale appearance and generalised pruritic papules. Laboratory investigations disclosed eosinophilia, autoimmune haemolytic anaemia, mixed hyperbilirubinaemia, cholestasis and elevated serum IgG4 levels. Abdominal sonography and CT showed progressive dilatation of biliary trees, with diffuse pancreatic enlargement and a subtle capsule-like low-density rim around the pancreatic head and body. Endoscopic retrograde cholangiopancreatography found no stone-related biliary obstruction, while endoscopic transpapillary biopsy demonstrated chronic inflammation only. Nevertheless, the diagnosis of IgG4-related disease with coexisting autoimmune haemolytic anaemia was presumed. The clinical picture and laboratory abnormalities improved after administration of moderate dose of methylprednisolone.

https://ift.tt/2lXJxhb

Perimesencephalic non-aneurysmal subarachnoid haemorrhage

Description 

A 51-year-old woman, without any relevant personal or family history, presented to the emergency department with acute severe occipital headache.

She has no focal neurological deficits or meningeal signs on examination.

Her funduscopy was normal.

Routine bloods including full blood count, renal profile, coagulation screening and cardiac enzymes were unremarkable.

Her baseline chest X-ray and ECG were also normal.

An initial non-contrast CT of the brain was reported as normal.

However, her subsequent CSF analysis at 12 hours post onset of symptoms revealed the presence of red blood cells (14 800/cmm in Tube 1 and 15 000/cmm in Tube 3) and xanthochromia, which raised the suspicion that a careful check of the CT images is needed.

The subtle perimesencephalic haemorrhage was seen on the subsequent review of the axial view (figure 1A) and sagittal view (figure 1B) of the CT brain, with a characteristic distribution of cisternal...

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Management of prematurely erupted teeth in newborns

The majority of natal and neonatal teeth are prematurely erupted primary teeth, whereas few are supernumerary in origin. They most commonly occur in mandibular central incisor region and often can lead to difficulty to the mother during breast feeding and tongue ulceration in newborn. Moreover, since majority of these have poorly developed roots and are mobile, there is always a fear of aspiration into respiratory passage. Extraction therefore is the most commonly rendered treatment for these teeth. This paper comprises cases of natal and neonatal teeth describing about their clinical characteristics and sequel. This paper has also highlighted the factor which needs to be considered during the management of natal/neonatal teeth and protocol followed at our centre.

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Hypomelanosis of Ito with gynaecomastia and dental anomaly

Hypomelanosis of Ito is a rare neurocutaneous syndrome. Cutaneous involvement is characterised by streaks and swirls of hypopigmentation arranged in a Blaschkoid pattern. Neural involvement along with other systemic features are seen. We report a case of a 13-year-old boy who presented with the characteristic skin involvement of hypomelanosis of Ito, mental retardation, teeth abnormalities and gynaecomastia along with psoriasis.

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Laws of attraction: management of magnetic foreign body ingestion

Description 

An 11-year-old girl with global developmental delay presents with a 4-day history of nausea, vomiting and abdominal pain after the ingestion of multiple foreign bodies. She was haemodynamically stable with no gross abnormalities on laboratory tests. An abdominal X-ray was obtained which demonstrated two radio-opaque foreign bodies in the left lower quadrant without free air (figure 1A). On physical examination the patient had significant point tenderness in the left lower quadrant with guarding. The decision was made to proceed to the operating room where a diagnostic laparoscopy was performed. On entering the abdomen, there was no significant free fluid or gross contamination. After running the bowel, two magnets were identified in adjacent loops of small intestine with evidence of bowel wall ischaemia in-between. Approximately 15 cm of jejunum was inspected and the foreign bodies which included two magnets and an earring (figure 1B) were...

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Papillary thyroid cancer nodal metastases mimicking a slow-flow lymphatic malformation

Description 

A 28-year-old Caucasian man was referred to the head and neck clinic with a 2-year history of a right-sided neck lump, which had started to cause discomfort. Physical examination revealed two discrete non-tender neck masses in the region of the right sternocleidomastoid muscle, with no bruit or palpable pulse.

CT demonstrated multiple right-sided thin-walled cystic lesions within the upper to lower jugular chain and posterior triangle (levels II–V) forming a multiloculated cystic lesion measuring 10 cm in craniocaudal dimension. Ultrasound assessment suggested a multiloculated cystic mass with thin walls and no intralesional flow, extending along the posterior margin of the right sternocleidomastoid muscle, posterolateral to the right internal jugular vein. The thyroid and major salivary glands appeared unremarkable. Fine-needle aspiration cytology (FNAC) proved inconclusive. The abnormality was presumed to be a slow-flow lymphatic malformation; however, injection sclerotherapy did not result in resolution, confirmed on an MRI scan performed...

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Gastrointestinal beriberi: a forme fruste of Wernickes encephalopathy?

Gastrointestinal symptoms, such as anorexia, nausea, vomiting and abdominal pain, are very common in patients with Wernicke's encephalopathy (WE). Mild thiamine deficiency may have only gastrointestinal symptoms. We are reporting two patients with thiamine deficiency who predominantly had gastrointestinal symptoms. Case 1: a 38-year-old man had gastrointestinal problems for about 2–3 years. It gradually became severe. The patient came to the neurology outpatient department for his recent-onset vertigo and headache. Clinical examinations fulfilled Caine's criteria of WE. Gastrointestinal symptoms responded dramatically to intravenous thiamine. Case 2: a 21-year-old woman developed drug-induced hepatitis and gastritis. Associated nausea, vomiting and abdominal pain progressively increased over the weeks. The patient responded only to intravenous thiamine administration.

We suggest that a suspicion for gastrointestinal beriberi should arise if gastrointestinal symptoms (anorexia, nausea, vomiting and abdominal pain) are refractory to the usual therapies.

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Plane palsy: a case of transient facial weakness during an aircraft flight

Changes in atmospheric pressure have been reported to cause a transient lower motor neuron weakness of the facial nerve. We report the case of a passenger on an international flight who developed a unilateral facial weakness after take-off which resolved within 45 min. The effect is thought to be due to an ischaemic neuropraxia of the facial nerve caused by increased middle ear pressure compressing the facial nerve in an exposed facial canal. The condition has been commonly reported in scuba-divers but less frequently in airline passengers. Treatment is not necessary.

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Arterial fragility in kyphoscoliotic Ehlers-Danlos syndrome

Pathogenic variants in the lysyl-hydroxylase-1 gene (PLOD1) are responsible for the kyphoscoliotic type of Ehlers-Danlos syndrome (EDS). The disease is classically responsible for severe hypotonia at birth, progressive kyphoscoliosis, generalised joint hypermobility and scleral fragility. Arterial fragility is an important feature of the disease, but its characterisation remains limited. We report the clinical history of a 41-year-old woman who presented repeated arterial accidents, which occurred in previously normal medium size arteries within a limited time span of 2 years. Molecular investigations revealed compound heterozygosity for two PLOD1 gene deletions of exons 11–12 and 14–15. Arterial fragility is an important characteristic of kyphoscoliotic EDS. It manifests as spontaneous arterial rupture, dissections and dissecting aneurysms which may occur even during early childhood. This fragility is particularly likely to manifest during surgical intervention. Early medical management and surveillance may be indicated, but its modalities remain to be defined.

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Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes

A young female vaper presented with insidious onset cough, progressive dyspnoea on exertion, fever, night sweats and was in respiratory failure when admitted to hospital. Clinical examination was unremarkable. Haematological tests revealed only thrombocytopenia, which was long standing, and her biochemical and inflammatory markers were normal. Chest radiograph and high-resolution CT showed diffuse ground-glass infiltrates with reticulation. She was initially treated with empirical steroids and there was improvement in her oxygenation, which facilitated further tests. Since the bronchoscopy and high-volume lavage was unyielding, a video-assisted thoracoscopicsurgical biopsy was done later and was suggestive of lipoid pneumonia. The only source of lipid was the vegetable glycerine found in e-cigarette (EC). Despite our advice to quit vaping, she continued to use EC with different flavours and there is not much improvement in her clinical and spirometric parameters.

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