Primarily depression manifestation of Wilson's disease-Case report

Wilson's disease is an inherited autosomal-recessive disorder of biliary copper excretion. It is characterized by hepatic, neurological and ophthalmic manifestations related to the accumulation of copper in the liver, the lenticular nuclei of brain and cornea. The authors present the case of a 29-year-old female with primarily depression manifestation of Wilson's disease. The patient also reported agitation, difficulties with concentration, slowdown of speech, and stuttering. In magnetic resonance imaging, in putamen, the globus pallidus, claustrum, the heads of caudate nucleus and thalamus areas demonstrated the increased signal in T2. A high copper content was obtained in daily urine collection and reduced level in serum. Similarly, ceruloplasmin level was decreased. Despite the antidepressant treatment with venlafaxine, no improvement was observed. Within a week of psychomotor slowdown, symptoms such as Parkinson's syndrome appeared. Due to the rapid progression of the disease symptoms, the patient was referred for further treatment at a specialistic center. After six month, despite the treatment, the progress of disease was so advanced that patient was transferred to the hospice. Two weeks later patient died. Wilson's disease might be consider in differential diagnosis of depression in young patients, especially if they present additional extrapyramidal symptoms and unspecific changes in magnetic resonance imaging.

Analysis of chosen SNVs in GPC5, CD58 and IRF8 genes in multiple sclerosis patients

PURPOSE

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system with a neurodegenerative compound. Heterogenetic background of autoimmunity pathway components has been suggested in the MS pathogenesis. The main aim of our study was to evaluate the association between selected polymorphisms of theCD58, IRF8 and GPC5 genes and treatment effectiveness in a group of relapsing-remitting MS patients. This is the first study of MS patients from Podlaskie Region in the Polish population.

MATERIALS AND METHODS

The study group comprised 174 relapsing-remitting MS patients diagnosed under 40 years of age. Genotyping was performed using ready to use TaqMan assays.

RESULTS

We demonstrate a strong association of the polymorphisms with sex, age of onset and response to the treatment applied. A significant correlation was observed in the presence of allele T of rs10492503 polymorphism inGPC5 gene with sex and age of MS onset. Logistic regression analysis revealed an increased risk of the interaction of rs17445836 in IRF8 gene with male sex and the type of treatment (OR = 3.80, p < 0.05), and a decreased risk in the interaction of female sex with disease progress according to the EDSS scale (OR=-2.33, p < 0.05).

CONCLUSIONS

The analysis of the correlation between different alleles, genotypes and clinical status confirmed the interaction between the genetic factors of age of onset and response to therapy. The study suggests that genetic variants inGPC5, CD58 and IRF8 genes may be of clinical interest in MS as predictors of age of onset and response to therapy.

Post-mortem detection of six human herpesviruses (HSV-1, HSV-2, VZV, EBV, CMV, HHV-6) in trigeminal and facial nerve ganglia by PCR

Background

Among over 100 types of Herpesviridae viruses, eight can infect humans: herpes simplex viruses (HSV-1, HSV-2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesviruses 6, 7, and 8 (HHV-6, HHV-7, HHV-8). After initial infection, the viruses remain latent for the lifetime of the host. The aim of this study was to determine the distribution of six different herpesviruses: HSV-1, HSV-2, VZV, EBV, CMV, and HHV-6 in trigeminal and facial nerve ganglia among a random group of Polish population.

Methods

The studied group consisted of 47 individuals (40 male, seven female); mean age of 47.4 ± 16.5 years) who died of independent causes (suicide, traffic accident, and poisoning, among others). Bilateral trigeminal and facial nerve ganglia of each cadaver were collected during the autopsy. Herpesviruses were detected using multiplex polymerase chain reaction technique.

Results

Herpesviruses were found in trigeminal and/or facial ganglia in 30/47 (63.8%) of cadavers. HHV-6 was the most prevalent of the herpesviruses and was found in nearly half of cadavers (n = 22; 46.8%), followed by HSV-1 (n = 7; 14.9%), VZV (n = 4; 8.5%), EBV (n = 4; 8.5%), HSV-2 (n = 2; 4.3%), and CMV (n = 1; 2.1%). Facial nerve ganglia (n = 23; 48.9%) were more often infected than trigeminal ganglia (n = 13; 27.7%).

Discussion

The results of this study have revealed a common presence of the herpesviruses in trigeminal and facial nerve ganglia among a random group of Polish population. Furthermore, the data also demonstrate simultaneous infection of the ganglia with different herpesviruses. This study has contributed to the knowledge of prevalence and localization of herpesviruses in different structures of the nervous system.

The FOXP3 rs3761547 Gene Polymorphism in Multiple Sclerosis as a Male-Specific Risk Factor

The FOXP3 gene encodes a transcription factor and is predominantly expressed in the CD4+CD25+ regulatory T cells which plays a pivotal role in the maintenance of immune homeostasis. The defect of FOXP3 gene may provide a critical link between autoimmunity and immune deficiency. The purpose of our study was to evaluate the association of chosen polymorphisms of FOXP3 gene (rs3761549, rs3761548, rs3761547) with different clinical multiple sclerosis (MS) data of our relapsing-remitting groups of patients and in control group. The study was performed on a group consisting of 174 relapsing-remitting MS patients, diagnosed under 40 years of life, and 174 healthy volunteers. Genotyping was performed using a real-time PCR-based method by TaqMan Assays. Significant differences in distribution of allele C rs3761547 were found in male MS patients in comparison to the male healthy group (p = 0.046, OR 1.95, CI 95%). No association between MS and the other two polymorphisms was observed in males and females of both studied groups. Our data may suggest that FOXP3 rs3761547 gene polymorphism are related notably with the increased risk of MS development in males patients. To our knowledge this is the first study which indicates gender-specific relation between rs3761547 FOXP3 gene polymorphism and multiple sclerosis.

Future Lawyers Support Organ Donation and Transplantation

In 2016 the total number of solid organ transplantations in Poland was 1469; the number of patients on waiting lists was approximately 1600 every month, and demand for organs is increasing every year. Transplantation has achieved increasing support and acceptance among Polish people; however, there are still many ethical, moral, and legal barriers related to this form of treatment of end-stage organ failure.

MATERIAL AND METHODS

The research method is a diagnostic survey of 347 law students from the Faculty of Law, University of Bialystok, Poland. The research tool was the authors' questionnaire.

RESULTS

Responders were 21.172 ± 1.34 years old (67.4% female, 74.4% urban residence). Organ procurement and transplantation from living donors are accepted by 95.6% of respondents; 97.4% are accepted from deceased donors. More than 80.4% of the respondents would agree to organ donation from their family members after death and to be donors after their death. The majority of students (80.1%) believe that the final decision of deceased organ donation should be made by the family. Despite positive attitude towards transplantation (97%), about 2% have submitted their objection to the central registry. Refusal of organ donation was associated mainly with emotions related to death (89%) and religion (47.6%). According to responders, the transplantation should be managed by patients and donors (42.1%) and universities (31.7%).

CONCLUSIONS

Law students generally accept procurement of organs from deceased and living donors, but in situations related to family members, their acceptance rates drop significantly. According to future lawyers, patients, donors, and universities should educate society about issues related to organ transplantation.

Opinions and Attitudes of Medical Students About Organ Donation and Transplantation

BACKGROUND

Although transplantation has gained more support and acceptance, there are still many ethical, moral, and legal barriers associated with this form of treatment. The demand for organs is higher than what can be accommodated. Current medical students are forming their views about transplantation.

METHODS

The aim of this study was to investigate the perspectives of 569 students from the Faculty of Medicine, Medical University of Bialystok, Poland, with regard to their beliefs about organ donation.

RESULTS

Respondents included in this study were 21.77 ± 2.03 years of age (73.6% female, 80.1% living in an urban setting). Organ procurement and transplantation from living donors was found to be acceptable by 97.54% of respondents, and 98.77% found deceased donor procurement to be acceptable. More than 90% of respondents agreed with organ donation from family members after death, and agreed to donation after their own death. However, only 54.77% indicated an agreement to donate in their lifetime for nonrelatives. It was found that 70.74% believe the final decision on cadaveric organ donation should be made by the family. A positive attitude toward organ transplantation was expressed by 96.47% of respondents, but 2% submitted an objection to placement on a central registry. Refusals for organ donation included emotions associated with death (88%), religious beliefs (42%), and lack of knowledge of medical terminology (24.78%). According to respondents, the concept of transplantation should be managed by patients and donors (65.38%), universities (49.56%), or the media (44.64%).

CONCLUSION

Medical students generally agree on procurement of organs from deceased and living donors. However, their enthusiasm for organ donation after death diminished with regard to their family members. An educational campaign promoting organ transplantation should be considered.

Cerebrovascular Manifestations of Lyme Neuroborreliosis-A Systematic Review of Published Cases

BACKGROUND

Lyme neuroborreliosis (LNB) is a disease caused by spirochete Borrelia burgdorferi, involving the nervous system. It usually manifests as lymphocytic meningoradiculitis, but in rare cases, it can also lead to cerebrovascular complications. We aimed to perform a systematic review of all reported cases of LNB complicated by central nervous system vasculitis and stroke or transient ischemic attack (TIA).

MATERIALS AND METHODS

We conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB.

RESULTS

This study included 88 patients with a median age of 46 years. The median interval from onset of symptoms suggesting Lyme disease to first symptoms of cerebrovascular manifestations of LNB was 3.5 months. The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by TIA (11.4%). The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously. The most common affected vessels were middle cerebral artery-in 19 cases, basilar artery-in 17 cases, and anterior cerebral artery-in 16 cases. A good response to antibiotic treatment was achieved in the vast number of patients (75.3%). The overall mortality rate was 4.7%.

CONCLUSION

Cerebral vasculitis and stroke due to LNB should be considered, especially in patients who live in or have come from areas with high prevalence of tick-borne diseases, as well as in those without cardiovascular risk factors, but with stroke-like symptoms of unknown cause.

Evaluation of visinin-like protein 1 concentrations in the cerebrospinal fluid of patients with mild cognitive impairment as a dynamic biomarker of Alzheimer's disease

BACKGROUND

The correlations between pathology of neurodegenerative diseases, especially Alzheimer's disease (AD), and concentrations of neuronal calcium sensor proteins, such as visinin-like protein 1 (VILIP-1), in cerebrospinal fluid (CSF) have been discussed in the literature but its utility as biomarker of AD in comparison with mild cognitive impairment (MCI) has not been studied yet.

OBJECTIVE

Therefore, the aim of our study was to assess the clinical utility of the measurement of CSF concentrations of VILIP-1 in patients with AD, MCI subjects, and non-demented controls. The clinical and neuropsychological diagnoses were supported by CSF biomarkers of neurochemical dementia diagnostics: decreased concentrations of Aβ1-42 and/or Aβ42/40 ratio and increased concentrations of Tau and pTau181 proteins.

METHODS

The study included 33 AD patients, 15 subjects with MCI, and 18 elderly individuals without cognitive deficits. The CSF concentrations of biomarkers tested were determined by using the ELISA method.

RESULTS

Concentrations of VILIP-1 in CSF were significantly higher in AD patients compared to the MCI subjects and elderly individuals without cognitive impairment. Increased concentrations of VILIP-1 correlated significantly with reduced Aβ42/40 ratio and higher pTau181 in AD group.

CONCLUSION

Our findings suggest that VILIP-1 may play a role in the AD pathophysiology and is a good candidate for dynamic biomarker of AD, although this issue requires further investigation.

Seroprevalence of parvovirus B19 antibodies among young pregnant women or planning pregnancy, tested for toxoplasmosis

INTRODUCTION AND OBJECTIVE

Acute parvovirus B19 (B19V) infection is a proven risk for pregnant women and fetus. The aim of this study was to determine the prevalence of B19V antibodies among pregnant women or planning pregnancy, who were referred for preventive toxoplasmosis screening.

MATERIAL AND METHODS

Between 2007-2010, 55 women in the age between 21 and 40 years were tested for both B19V IgG and IgM antibodies and sociodemographic information was collected.

RESULTS

Among the study group, the mean age was 30 years, 43.6% of women were positive only for B19V IgG antibodies, 9% were positive for both B19V IgG and IgM antibodies and 11% were positive only for B19V IgM antibodies. Women negative for B19 IgG antibodies (47.3%) were considered as a high-risk group of B19V viremia. The serological profile indicating infection with Toxoplasma gondii was considered as a risk factor for fetal distress. The T. gondii IgG antibodies were detected in 51% cases, in 32.7% antibodies were positive for both IgG and IgM, while in 16.3% cases both IgG and IgM were negative.

CONCLUSIONS

B19V infection and overlapping of other independent risk factors during pregnancy pose a significant hazard to fetus during development. Therefore, we recommend further broadening the epidemiological database of B19V infection prevalence among women. B19V infection should be taken into account during differential diagnosis as a cause of miscarriage.

Listerial rhombencephalitis in an immunocompetent woman

Listeriosis usually affects immunocompromised patients including elderly people and pregnant women, but it may also affect otherwise healthy individuals. In our report, we present a case of a rare and very severe form of listeriosis-rhombencephalitis in a 61-year-old female with no history of immunosuppression, who, because of history, clinical picture, and laboratory results as well as negative cultures, was at first diagnosed with viral encephalitis. This paper underlines that Listeria monocytogenes infection should be taken into consideration in case of lymphocytic encephalitis even in immunocompetent patients. Typical MRI picture may be crucial in establishing a proper diagnosis as the lab results may be misleading.

Infectious spondylodiscitis - a case series analysis

PURPOSE

We aimed to describe the clinical and laboratory features as well as diagnostic difficulties in the case series of spondylodiscitis.

MATERIALS/METHODS

We retrospectively reviewed 11 cases of spondylodiscitis. The diagnosis of spondylodiscitis was based on clinical, radiological and microbiological evidence and by the response to antimicrobial therapy.

RESULTS

There were 7 men and 4 women, and the age ranged from 21 to 74 years. Risk factors of spondylodiscitis were observed in 7 patients. The approximate time from onset of symptoms to diagnosis was from 2 to 7 months (median 45 days). Back pain was the most common symptom. The most frequent location of spondylodiscitis was lumbar spine. Pathogens were isolated in 6 cases and were as follows: Staphylococcus aureus (4 cases), Staphylococcus warneri (1 case) and Escherichia coli (1 case). After therapy, all patients had rapid regression of symptoms and no permanent neurological impairments and recurrence of infection were observed.

CONCLUSIONS

Diagnosis of spondylodiscitis is frequently delayed. This disease should be taken into consideration in differential diagnosis in patients with root syndromes accompanied by back pain and usually fever as well as increased values of CRP and ESR.

Vipera berus bites in Eastern Poland--a retrospective analysis of 15 case studies

INTRODUCTION AND OBJECTIVE

The common European adder (Vipera berus) is the only venomous snake that is found naturally in Poland. This study presents the epidemiological and clinical characteristics of V.berus bites in Eastern Poland and describes the methods of poisoning treatment.

MATERIALS AND METHODS

Medical documentation of 15 patients hospitalized at the Department of Infectious Diseases and Neuroinfections of the Medical University of Bialystok between 1998-2010 because of V.berus bite was analyzed retrospectively.

RESULTS

Most of the snakebites were accidental (86.7% of the cases). The bites usually took place in forests (66.7% of the cases). The majority of patients were bitten in the lower extremity (8 cases, 53.3%), most often in the area of ankle joint. The severity of poisoning was usually minor to moderate. The most common local symptom was oedema (93.3% of the cases) and associated extravasations (73.3% of the cases). One patient experienced shock. Transient hypertension was observed in 3 cases. Mild coagulation disorders were present in 4 cases. In 4 cases, leukocytosis was observed. 86.7% of patients received the specific antivenom. No fatal outcome and no adverse reactions after antivenom administration were reported.

CONCLUSIONS

In the majority cases of poisoning with V.berus venom, the poisoning takes a mild course, limited to local oedema, but sometimes it may lead to severe complications. The only specific method of the treatment is antivenom administration.