COVID-19 presenting with nystagmus

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15 days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

[COVID-19 presenting with nystagmus]

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15 days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

Worth the effort? Weighing up the benefit and burden of continuous positive airway pressure therapy for the treatment of obstructive sleep apnoea in chronic tetraplegia

STUDY DESIGN

Mixed methods OBJECTIVES: Continuous positive airway pressure (CPAP) therapy is the recommended treatment for obstructive sleep apnoea (OSA). The aim of this study was to estimate CPAP adherence in people with tetraplegia and OSA, and to explore the barriers and facilitators to CPAP use.

SETTING

Hospital outpatient department in Melbourne, Australia METHODS: People with chronic tetraplegia and OSA were commenced with auto-titrating CPAP and supported for 1 month. Semi-structured interviews were conducted with participants at one month and analysed thematically. CPAP usage was measured at 1, 6 and 12 months, with "adherent" defined as achieving more than 4 h average per night.

RESULTS

Sixteen participants completed the study (80% male; mean age 56 (SD = 15)). Mean nightly CPAP use at one month was 3.1 h (SD = 2.5; 38% adherent), and at 6 months and 12 months were 2.6 h (SD = 2.8; 25% adherent) and 2.1 h (SD = 3.2; 25% adherent). The perceived benefit/burden balance strongly influenced ongoing use. Burden attributed to CPAP use was common, and included mask discomfort, and physical and emotional problems. Adherent participants were motivated by the immediate daytime benefits to mood, alertness and sleepiness. There was a tendency to not recognise symptoms of OSA until after they were treated.

CONCLUSION

CPAP use is challenging for people with tetraplegia, who experience substantial burden from using the device. When tolerated, the proximate benefits are substantial. People with tetraplegia need more intensive support for longer to help them overcome the burdens of CPAP and benefit from the treatment.

Induced thiacloprid insensitivity in honeybees (Apis mellifera L.) is associated with up-regulation of detoxification genes

Honey bees, Apis mellifera, are markedly less sensitive to neonicotinoid insecticides containing a cyanoimino pharmacophore than to those with a nitroimino group. Although previous work has suggested that this results from enhanced metabolism of the former by detoxification enzymes, the specific enzyme(s) involved remain to be characterized. In this work, a pretreatment of honey bees with a sublethal dose of thiacloprid resulted in induced insensitivity to the same compound immediately following thiacloprid feeding. A longer pretreatment time resulted in no, or increased, sensitivity. Transcriptome profiling, using microarrays, identified a number of genes encoding detoxification enzymes that were over-expressed significantly in insecticide-treated bees compared with untreated controls. These included five P450s, CYP6BE1, CYP305D1, CYP6AS5, CYP315A1, CYP301A1, and a carboxyl/cholinesterase (CCE) CCE8. Four of these P450s were functionally expressed in Escherichia coli and their ability to metabolize thiacloprid examined by liquid chromatography-mass spectrometry (LC-MS) analysis.

Congenital disorder of glycosylation type Ia in a Malaysian family: clinical outcome and description of a novel PMM2 mutation

There are few reports of congenital disorders of glycosylation (CDGs) in the Asian population, although they have been reported worldwide. We identified a Malaysian infant female at 2 days of life with CDG type Ia. The diagnosis was suspected on the basis of inverted nipples and abnormal fat distribution. She had cerebellar hypoplasia and developed coagulopathy, hypothyroidism and severe pericardial effusion and died at 7 months of life. The diagnosis was supported by abnormal serum transferrin isoform pattern that showed elevated levels of the disialotransferrin isoform and trace levels of the asialotransferrin isoform. Enzyme testing of peripheral leukocytes showed decreased level of phosphomannomutase (PMM) activity (0.6 nmol/min per mg protein, normal range 1.6-6.2) and a normal level of phosphomannose isomerase activity (19 nmol/min per mg protein, normal range 12-25), indicating a diagnosis of CDG type Ia. Mutation study of the PMM2 gene showed the patient was heterozygous for both the common p.R141H (c.422T>A) mutation and a novel sequence change in exon 7, c.618C>A. The latter change is predicted to result in the replacement of the highly conserved phenylalanine residue at position 206 with a leucine residue (p.F206L) and occurs in the same codon as the previously reported p.F206S mutation. Analysis of 100 control chromosomes has shown that the p.F206L sequence change is not present, making it highly likely that this change is functionally important. To the best of our knowledge, this is the first report of CDG in the Malay population. Prenatal diagnosis was successfully performed in a subsequent pregnancy for this family.

A retrospective study of compliance (adherence) with a care pathway in periodontal therapy in a primary care setting

OBJECTIVE

Recently the issue of patient adherence with prolonged periodontal therapy and the importance of smoking and its influence as a significant co-factor in the outcome of treatment for patients with periodontal disease has been of interest to health care professionals. This paper is an audit of adherence in regard to both smoking cessation for those who admitted to a smoking habit at the initial examination and patient compliance with a periodontal treatment protocol.

DESIGN

During the initial examination, patients referred to the practice with periodontal problems were photographed both with and without lip retractors as part of their clinical record, and a charting of the teeth made with any 5 mm or greater probing depths recorded. Tooth mobility and furcation involvement of molar teeth were also charted. Two separate time periods (Series 1 and Series 2) were audited in this study. Patients enrolled in Series 2 were routinely asked about their smoking habits at the initial examination. Two time periods were audited, as the initial purpose of the investigation was to audit the success of the practice in treating this group of patients, and to identify any improvements that could be made in care provision as each audit cycle was completed.

SETTING

Primary care setting.

RESULTS

Patient adherence rates were high through all the various stages of periodontal therapy, even though the treatment protocol took over 18 months to complete. Approximately 55% of patients in both time periods presented for the one-year post treatment re-evaluation appointments. 56.5% of the patients reported they had smoked to within five years of their initial consultation, of which 38% reported that they had stopped by the time they had completed the initial hygiene phase of treatment.

CONCLUSIONS

With a comprehensive and clearly defined supportive periodontal care programme (SPC), this paper demonstrates that high adherence levels can be achieved in a primary care setting. The results suggest that treatment should include not only the teaching of an effective oral hygiene regime, but also include giving advice in relation to smoking cessation for those patients who admit to a smoking habit at the initial examination. Patients who smoked and chose to have treatment for their periodontal condition went on to report good adherence with smoking cessation advice. Continuing supportive smoking cessation (SSC) advice should be part of any effective SPC programme. New methods of treating periodontal disease that become available to practitioners in the future should use established benchmarks against which to evaluate the success of any new treatment strategy.

Displacement imprinted polymer receptor analysis (DIPRA) for chlorophenolic contaminants in drinking water and packaging materials

The preparation of a molecularly imprinted polymer (MIP) for pentachlorophenol is described together with two alternative reporter derivatives for use in a displacement imprinted polymer receptor analysis (DIPRA) format procedure. In this procedure, alternative reporter molecules were rebound to the synthetic receptor sites and their displacement by the target analyte was employed as the basis of a simple procedure for the measurement of chlorophenols in water and packaging material samples. Water samples were extracted using the standard procedure (EPA 528) and a detection limit of 0.5 microg l(-1) was achieved using the DIPRA detection method, with good agreement between the displacement technique and GC-ECD analysis. A variety of packaging materials, extracted using a buffered detergent solution were also analysed using the DIPRA procedure and showed good agreement with GC results. In addition, investigation of the cross-reactivity of a range of pesticides and materials commonly encountered in environmental analysis indicated the procedure gave good discrimination between pesticides bearing a chlorophenolic moiety and other materials. The procedure is considered highly suitable for use as a rapid field-test method or for incorporation into a test kit device.

The illness experiences of women with fibroids: an exploratory qualitative study

Previous research suggests that women attending gynaecology clinics experience high rates of psychological distress and psychiatric morbidity. Although the reasons for this are poorly understood, certain conditions appear to cause women particularly high levels of anxiety and depression. This paper reports a qualitative study, using Interpretative Phenomenological Analysis (IPA), to examine the illness experiences of women with the common gynaecological condition of fibroids. The study employs semi-structured interviews, guided by Leventhal's self-regulation model, to explore 18 women's understanding and experiences of having fibroids. Qualitative analysis revealed eight themes drawn into two higher-order themes - 'Managing uncertainty' and 'Struggling between defeat and optimism'. These higher-order themes illustrate the multiplicity of experiences and meanings used by women attempting to understand their condition, treatment options and future health outcomes. The differences in women's illness representations may account for differences in their relative distress levels. The findings indicate the importance of considering an individual's illness representations in order to facilitate the provision of appropriate medical and psychological care to women with fibroids.

Periodontal disease incidence, progression and rate of tooth loss in a general dental practice: the results of a 12-year retrospective analysis of patient's clinical records

One of the main objectives of a general dental practice is to teach its patients how to reduce their oral bacterial load. In other words, by teaching good oral hygiene habits, it is possible to reduce the number of bacteria and hence the number of species of bacteria present in each patient's mouth. Thus by achieving a high level of oral hygiene, the dental team hope to reduce each patient's future risk of periodontal problems, and dental caries.

A 12-year retrospective audit study of tooth loss in a general dental practice

OBJECTIVES

To determine the incidence of periodontal disease in a general dental practice, and to evaluate the effectiveness of treatment in preventing tooth loss over a period of 12 years.

DESIGN

This was a single centre retrospective analysis.

SETTING

A general dental practice in Bournemouth.

SUBJECTS AND METHODS

Over a 6-month period from February 1997 to August 1997 records were made of all patients attending at the practice who had presented for dental examination between September 1985 and September 1986. A database was constructed to record the number of teeth present at the beginning of the study, those which at their initial exam had probing depths of between 5 and 6 mm, and those with 7 mm and greater. If teeth were lost, the date of the extraction was recorded.

INTERVENTIONS

All patients were treated by conventional dental therapy.

MAIN OUTCOME MEASURES

Tooth loss was chosen as the end-point.

RESULTS

13% of the patients presenting initially had periodontal problems, and conventional treatment resulted in very few teeth being lost over the study period.

CONCLUSIONS

Periodontal disease affected only a small number of the patients in the general dental practice. Those patients affected responded well to conventional therapy, resulting in very few teeth being lost during the period of study.

Cord blood progenitor cells have greater transendothelial migratory activity and increased responses to SDF-1 and MIP-3beta compared with mobilized adult progenitor cells

When cord blood is used as a source of haemopoietic stem cells for transplantation, fewer cells are required per kg of recipient. This greater engraftment efficiency of cord blood cells may relate to an increased ability to traverse sinusoidal endothelium, a crucial step in the homing of stem cells. We report that freshly isolated cord blood progenitors migrated more efficiently than mobilized adult cells. Cord blood progenitors responded rapidly to growth factor stimulation with an increase in migratory ability within 24 h whereas mobilized adult cells responded only after 72 h (P < 0.01). Cord blood cells also exited G0/G1 rapidly; after 24 h of growth factor exposure, 20.2 +/- 1.2% of cord blood CD34+ cells were in S + G2/M compared to 6.9 +/- 1.2% of adult CD34+ cells (P < 0.01). Proliferating CFC migrated more efficiently (13.3 +/- 3.4% for GM-CFC) than non-proliferating CFC (1.4 +/- 0.5%, P < 0.01) as determined using a 3H-thymidine suicide assay. Cord blood progenitor cells also demonstrated a greater transmigratory response to chemokine stimulation compared with adult cells; this was manifested as a differential response of freshly isolated cells to SDF-1, and of growth factor activated cells to MIP-3beta. Finally, cord blood CD34+ cells express higher levels of the chemokine receptor for SDF-1, CXCR4, when compared with mobilized adult CD34+ cells (P < 0. 05).

An audit of oral and dental health regimens practised in the management of oropharyngeal cancer

The purpose of the present study was to find out what preventive care was offered to patients after radiotherapy, particularly if they were dentate. As the mean age of the population increases and the number of people who retain at least some of their teeth into old age also rises, it is likely that more and more people with a diagnosis of oral cancer will be dentate. The incidence of oropharyngeal cancer has also started to increase recently and is affecting more young and dentate people. It is of paramount importance to provide comprehensive management for these patients, not only to remove the disease and reconstruct the defect, but also to provide the patient with the opportunity of experiencing a good quality of life by having a comfortable mouth after treatment. A questionnaire was sent to all senior fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and the results analyzed. The results of this survey show that improvements could be made if some simple preventive measures were instigated in the early stages of treatment.

Waterborne outbreak of Campylobacter jejuni in Christchurch: the importance of a combined epidemiologic and microbiologic investigation

Campylobacter is a common cause of gastroenteritis in New Zealand; however, the source of infection usually remains unknown. Reports of two cases of Campylobacter jejuni enteritis at a camp and convention centre near Christchurch were investigated. Through interviews of persons living at or attending the camp, 42 additional cases were identified. Epidemiologic and microbiologic data strongly suggested the water supply as the source of infection. The combined epidemiologic and microbiologic investigation was useful in quickly defining the magnitude and source of the outbreak, allowing for rapid implementation of control measures.

The construction of Bacillus thuringiensis strains expressing novel entomocidal delta-endotoxin combinations

Using our recently reported method of electroporation to transform Bacillus thuringiensis [Bone & Ellar (1989) FEMS Microbiol. Lett. 58, 171-178], cloned B. thuringiensis entomocidal delta-endotoxin genes have been introduced into several native B. thuringiensis strains. In many cases the resulting transformants expressed both their native toxins and the cloned toxin, producing strains with broader toxicity spectra. The introduction of the var. tenebrionis toxin gene into B. thuringiensis var. israelensis resulted in a strain with activity against Pieris brassicae (cabbage white butterfly), an activity which neither parent strain possesses. We discuss further the possibility of synergism and also the problems associated with introducing cloned DNA by this method.

Genetic linkage analysis of epidermolysis bullosa dystrophica, Cockayne-Touraine type

Genetic linkage relationships between 27 informative marker loci and the locus for epidermolysis bullosa dystrophica, Cockayne-Touraine type (EBD-CT), were examined in a single large kindred. Linkage could not be demonstrated to any of the marker loci, further adding to the exclusion map for EBD-CT. The dominant forms of EBD so far delineated by clinical criteria and electron microscopy remain genetically undefined in terms of loci and allelism. Further investigation will be undertaken using restriction fragment length polymorphisms mapped to regions outside the existing exclusion map.

A search for linkage in families with fragile sites

Linkage relationships to unassigned and provisionally assigned genetic markers were examined from 53 families segregating for various fragile sites. Fragile sites were at Xq27, 2q13, 6p23, 9p21, 9p32, 10q23, 10q25, 11q13, 11q23, 12q13 and 16p12. No new assignments were made but extensive exclusion data are presented for the markers F13A, F13B, CHE2, K, TF, GPT, C3 and Lu arising from linkage comparisons with fragile sites and other genetic markers. Exclusions of at least 10 cM involving fragile site markers were made for F13A (6p23, 9q32, 10q25), F13B (10q23, 10q25, 16p12), CHE2 (16p12), K (10q23), TF (10q23, 10q25, 11q13), GPT (10q23, 10q25, 11q13), C3 (10q23, 10q25) and Lu (10q25, 11q13).

Distribution of the GC (group-specific component) subtypes in cord bloods and blood donors

The common allele, GC/1, was subtyped into GC*IF and GC*IS by isoelectric focusing, increasing the proportion of heterozygotes from 0.42 to 0.58. In a series of 200 blood donors and 200 cord bloods the allele frequencies were found to be: GC*IS = 0.59, GC*IF = 0.11, GC*2 = 0.30; and GC*IS = 0.54, GC*IF = 0.16, GC*2 = 0.30, respectively. These values were similar to frequencies obtained in studies of other Caucasian populations. The average probability of detecting non-paternity for this population is increased from 17% to 30% after subtyping GC 1.

Distribution of six TF C (transferrin) subtypes in cord bloods and blood donors

Isoelectric focusing was used to subtype the common TF C phenotype into C1, C2 and C3, increasing the proportion of heterozygotes from virtually zero to 0.31. Five of the six subtypes of TF C were found in a series of 200 blood donors and 200 cord bloods. The frequencies of the three alleles were: TF*C1 = 0.80, TF*C2 = 0.17 and TF*C3 = 0.03 from cord bloods; and TF*C1 = 0.84, TF*C2 = 0.13 and TF*C3 = 0.03 from blood donors. These frequencies were comparable with estimates from other Caucasian populations. The average probability of detecting non-paternity for this population is increased to 11% by subtyping C into C1 and C2, and further increased to 15% by subtyping C into C1, C2 and C3.