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Vena cava inferior thrombosis diagnosed 12 years after interventional atrial septum defect closure in an infant. Acta Cardiol 2024; 79:70-71. [PMID: 36803388 DOI: 10.1080/00015385.2023.2177372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
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[Natural course of an aortic coarctation in a child]. REVUE MEDICALE DE LIEGE 2023; 78:403-406. [PMID: 37560949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Aortic coarctation is a frequent congenital heart disease that presents in form of two entities, the infant type and the child or adult type. The infant type is the most frequent and manifests acutely by heart failure or shock. The second one shows a slow and progressive course with no or few initial symptoms. For that reason, the diagnosis is usually missed until symptomatic arterial hypertension or hypertrophic cardiomyopathy develop. We report the case of an initially asymptomatic boy in whom the development of an aortic coarctation could be precisely documented over a period of 10 years by repeated bidimensional and Doppler echocardiography. The patient underwent successful balloon angioplasty of the aortic isthmus and stent implantation. This case points out the importance of strict follow-up in any young child in whom an even mild anomaly of the aortic arch is detected. This is critical in order not to miss an aortic coarctation that influences significantly morbidity in adulthood.
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Growing up with Idiopathic Pulmonary Arterial Hypertension: An Arduous Journey. Pediatr Rep 2023; 15:301-310. [PMID: 37218926 PMCID: PMC10204495 DOI: 10.3390/pediatric15020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Idiopathic pulmonary arterial hypertension (IPAH) is an uncommon and severe disease. We report the case of a 7-year-old boy investigated for cardiac murmur and exercise intolerance. Pulmonary hypertension (PH) was suspected at clinical examination and confirmed by echocardiography and cardiac catheterization. This case of pulmonary hypertension was classified as idiopathic given the negative etiological investigation. Vasoreactive testing with oxygen and nitric oxide was negative. Therefore, treatment with sildenafil (1.4 mg/kg/d) and bosentan (3 mg/kg/d) was initiated. This allowed the stabilization of, but not a decrease in, pulmonary artery pressure for the next 5 years, during which the patient's quality of life was significantly reduced. At a later follow-up, the estimated pulmonary pressure was found to have increased and become supra-systemic, with a consequent deterioration in the child's condition. This led to the decision to enter him into a clinical trial that is still ongoing. Idiopathic pulmonary arterial hypertension is a severe disease that can present with non-specific symptoms, such as asthenia and exercise limitation, which are important not to trivialize. The disease is associated with significantly decreased quality of life in affected children and carries a high burden in terms of mortality and morbidity. The current knowledge about IPAH in children is reviewed, with a particular focus on the future prospects for its treatment and the related quality of life of patients.
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P040 Estrogen-induced epigenetic regulation of matrisome-related genes in breast cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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[Complex congenital heart disease : about a case of Noonan syndrome]. REVUE MEDICALE DE LIEGE 2023; 78:130-136. [PMID: 36924149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
We present the case of a young girl in whom pre-natal echocardiography showed double outlet right ventricle associated with severe infundibular- and pulmonary valve stenosis. The genetic testing has shown a mutation on the LZTR1 gene, which confirms the diagnosis of a Noonan Syndrome, also present in the mother and an elder sister. The infant was born premature at 34 weeks and 5 days of gestational age. During the neonatal period, feeding difficulties are noted linked to oral aversion and exacerbated by difficulties in the mother-child bond. At 1 month of age, the child presented hypoxic spells caused by the infundibular stenosis which required emergency aorto-pulmonary anastomosis placement ensuring sufficient pulmonary blood flow. This anastomosis needed to be replaced by a larger one at 9th month of age. The child is now 4 years old and has undergone a complete surgical correction. The multidisciplinary management englobes not only follow up in cardiology, genetics, neurology, ophthalmology and hematology but also feeding support and psychomotor development support. The socio-economic precariousness of the family leads to a constant assistance to allow the best possible development of the child.
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Correction non uniforme de l’atténuation dans la TEMP/TDM de perfusion cérébrale et corrélation avec les données cliniques et les dosages des biomarqueurs du LCR. MÉDECINE NUCLÉAIRE 2023. [DOI: 10.1016/j.mednuc.2023.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Influence of hemodynamic overload with or without pressure overload on myocardial remodeling in children with congenital cardiac defect: Implication of exosomes and intracellular fibrosis activation pathways. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2022. [DOI: 10.1016/j.acvdsp.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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A late diagnosis of vascular ring: right-sided aortic arch with Kommerell diverticulum and aberrant left subclavian artery in an adolescent. Acta Cardiol 2022; 78:474-475. [PMID: 36043992 DOI: 10.1080/00015385.2022.2096706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Fatigue in multiple sclerosis and its relation with depression. Eur Psychiatry 2022. [PMCID: PMC9567434 DOI: 10.1192/j.eurpsy.2022.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). It can be defined as a subjective lack of physical and mental energy. Objectives To study the prevalence of fatigue in patients with MS and to determine the factors related to it, including depression. Methods This was a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It focused on patients with MS in remission phase. We used the Expanded Disability Status Scale (EDSS) to determine the degree of disability caused by MS, the Chalder Fatigue Scale to evaluate the fatigue, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms. Results The 93 patients included in the study had a mean age of 36.59 ± 10.69 years. The socio-economic level was low to medium in 52.7% of cases. The EDSS score ranged from 0 to 8 (median = 3.5). The total number of relapses ranged from 1 to 30 (median = 3.5). MS patients had fatigue in 72.4% of cases and depression in 26.9% of cases. Patients with a low to medium socio-economic level were more fatigued (p=0.027). High number of MS relapses, severity of disability on the EDSS, and presence of depression were associated with fatigue (p=0.014, p<10-3 and p=0.001, respectively). Conclusions In MS patients, fatigue is a common symptom. Patients with reduced physical activity and greater MS-related disability have more severe fatigue, which negatively affects psychosocial functioning, increasing the risk of depression. Disclosure No significant relationships.
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Alexithymia In Multiple Sclerosis: Relationship With Depression. Eur Psychiatry 2022. [PMCID: PMC9564250 DOI: 10.1192/j.eurpsy.2022.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Alexithymia, the lack of words to express emotions, is a common problem in multiple sclerosis (MS) patients. Objectives To investigate the prevalence of alexithymia in patients with MS and to evaluate the factors related to it, including depression. Methods We conducted a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It involved MS outpatients in remission phase. Data collection was done using a form exploring sociodemographic, clinical and radiological characteristics. We used the Expanded Disability Status Scale (EDSS) to evaluate neurological impairments, the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms. Results Our study included 93 patients. They were married in 57% of cases. The total number of relapses ranged from 1 to 30, with a median of 5. The EDSS score ranged from 0 to 8. A temporal lesion on brain imaging was found in 29% of cases. MS patients had alexithymia in 58.1% of cases and depression in 26.9% of cases. Alexithymia was more frequent in unmarried patients (p = 0.028). Among clinical and radiological factors, the number of relapses was higher (p = 0.035), and temporal lesion was more frequent in alexithymic patients (p = 0.045). In this study, alexithymic patients were more depressed (p < 10-3). Conclusions According to our results, depression and alexithymia were found to be significantly inter-related in MS. Future longitudinal studies might better clarify the nature of this relationship in MS patients. Disclosure No significant relationships.
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Quality of sleep in Tunisian patients with Multiple Sclerosis during the COVID-19 pandemic. Eur Psychiatry 2022. [PMCID: PMC9565436 DOI: 10.1192/j.eurpsy.2022.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction COVID-19 pandemic has affected human communities around the world, and there is fear that people with chronic diseases such as Multiple sclerosis(MS) are more vulnerable to negative psychological effects. Objectives The aim of the present study was to assess the quality of sleep in patients with (MS) in comparison with healthy controls(HCs), during the COVID-19 pandemic and to identify its associated factors. Methods This was a cross-sectional survey study conducted with patients followed at the neurology department of Hbib bourguiba university hospital in sfax(Tunisia), during the month of november2020. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index(PSQI). The PSQI is a questionnaire assessing participants’ sleep quality, sleep duration, and sleep disturbances and their severity during the past month.Participants with a PSQI ≤5 are classified as ‘good sleepers’. Results Fifty two patients were included in the study. The mean age was 33.69 years(SD=9.21 years)and the sex ratio(F/H)was 4.77. Overall, our patients had higher scores of(PSQI)compared to HC and these différences were statistically significant(p < 0.05). The mean score of(PSQI)was 11.04(SD=3.003)and 11.53%were classified as ‘good sleepers’. Unemployment was related to a poor sleep quality(p=0.0001). Patients with high EDSS(r=0.7;p=0.0001), high number of relapses(r=0.58 ;p=0.0001)were more likely to have sleep disturbance. There was a positive correlation between a poor sleep quality and the duration of disease(r=0.38;p=0.005). Conclusions We identified that during the COVID-19pandemic patients with(MS)had a worse sleep quality. The COVID-19pandemic poses a challenge to psychological resilience. More studies are warranted to better understand the long-term consequences of the pandemic on mental health of vulnerable people. Disclosure No significant relationships.
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Dimensions of alexithymia and their links to anxiety and depression. Eur Psychiatry 2022. [PMCID: PMC9564165 DOI: 10.1192/j.eurpsy.2022.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Anxiety and depression are among the most common psychiatric comorbidities in multiple sclerosis (MS) patients. These disorders could lead to significant emotional disturbances.
Objectives
To study the different dimensions of alexithymia in patients with MS and determine their relationship with anxiety and depression.
Methods
Our study, descriptive and analytical, focused on patients followed for MS at the neurology department in Sfax (Tunisia). In addition to collecting sociodemographic data, we used the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depressive symptoms and the Toronto Alexithymia Scale (TAS-20) to assess alexithymia and its three dimensions: difficulty identifying emotions (DIE), difficulty differentiating emotions (DDE), and externally oriented thinking (EOT).
Results
This study included 93 patients followed for MS. Our results showed a prevalence of 58.1% for alexithymia, 38.7% for anxiety and 26.9% for depression. The median score of the dimension DIE was 22. The median score of the dimension DDE was 17. The mean score for the dimension EOT was 26.96 ± 4.18. Alexithymic patients were more anxious and depressed (p = 0,002 and p < 10-3, respectively). Both dimensions DIE and DDE were associated with anxiety (p = 0.001 and p = 0.022, respectively) and depression (p < 10-3 and p < 10-3, respectively). Non-depressed patients had a higher score on the EOT dimension (p = 0.003).
Conclusions
Our results showed a relationship between depression, anxiety and alexithymia, hence the importance of looking for alexithymia in MS patients with anxiety or depressive symptoms.
Disclosure
No significant relationships.
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Antinuclear antibodies positivity is not rare during multiple sclerosis and is associated with relapsing status and IgG oligoclonal bands positivity. Rev Neurol (Paris) 2022; 178:812-816. [DOI: 10.1016/j.neurol.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
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Magnetic resonance imaging T1 indices of the brain as biomarkers of inhaled manganese exposure. Crit Rev Toxicol 2022; 52:358-370. [PMID: 36412542 DOI: 10.1080/10408444.2022.2128719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Excessive exposure to manganese (Mn) is linked to its accumulation in the brain and adverse neurological effects. Paramagnetic properties of Mn allow the use of magnetic resonance imaging (MRI) techniques to identify it in biological tissues. A critical review was conducted to evaluate whether MRI techniques could be used as a diagnostic tool to detect brain Mn accumulation as a quantitative biomarker of inhaled exposure. A comprehensive search was conducted in MEDLINE, EMBASE, and PubMed to identify potentially relevant studies published prior to 9 May 2022. Two reviewers independently screened identified references using a two-stage process. Of the 6452 unique references identified, 36 articles were retained for data abstraction. Eligible studies used T1-weighted MRI techniques and reported direct or indirect T1 measures to characterize Mn accumulation in the brain. Findings demonstrate that, in subjects exposed to high levels of Mn, deposition in the brain is widespread, accumulating both within and outside the basal ganglia. Available evidence indicates that T1 MRI techniques can be used to distinguish Mn-exposed individuals from unexposed. Additionally, T1 MRI may be useful for semi-quantitative evaluation of inhaled Mn exposure, particularly when interpreted along with other exposure indices. T1 MRI measures appear to have a nonlinear relationship to Mn exposure duration, with R1 signal only increasing after critical thresholds. The strength of the association varied depending on the regions of interest imaged and the method of exposure measurement. Overall, available evidence suggests potential for future clinical and risk assessment applications of MRI as a diagnostic tool.
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HP40: Aging: An influencing factor in large fibers neuropathy during idiopathic Parkinson disease. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2021.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Contribution of imaging modalities to eosinophilic myocarditis diagnosis: a case report. Eur Heart J Case Rep 2022; 6:ytac058. [PMID: 35295721 PMCID: PMC8922693 DOI: 10.1093/ehjcr/ytac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/28/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
Background Eosinophilic myocarditis (EM) is a relatively rare form of myocarditis that could progress to restrictive cardiomyopathy and might be fatal if left untreated. Although myocardial biopsy is considered to be the gold standard for the diagnosis of myocarditis, its use in paediatrics remains controversial and not easily applicable in routine practice. Case summary A 10-year-old girl with no prior medical history presented to the emergency department for fever, odynophagia, and gastrointestinal symptoms despite 48 h of antibiotics (Cefaclor). Physical examination revealed diffuse petechiae and abdominal tenderness but was otherwise unremarkable. Her vital signs were normal. She was found to have hypereosinophilia and increased cardiac markers on laboratory testing. Echocardiography showed diffuse left ventricular (LV) myocardial infiltrates, moderate LV dilatation, and mild systolic dysfunction. Bone marrow biopsy confirmed B cell acute lymphoblastic leukaemia. The diagnosis of EM was made. High doses of steroids and chemotherapy were initiated. Cardiac magnetic resonance imaging (MRI) identified eosinophilic infiltrates and sub-endocardial enhancement strongly suggestive of EM. Left ventricular function was slightly decreased. Intra-ventricular micro-thrombi were suspected, and warfarin was started. The outcome was favourable. Leucocyte and eosinophil counts were normalized within a month. At 6 months, cardiac MRI demonstrated a significant decrease in eosinophilic infiltration and micro-thrombi, normalization of LV function, and of sub-endocardial enhancement. Discussion This case demonstrates that non-invasive multi-modality imaging along with typical laboratory and clinical findings allow for appropriate diagnosis of EM while avoiding biopsy. It also highlights that an early diagnosis, timely treatment, and rigorous follow-up improve disease progression and outcome.
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Ritumixab efficacy in Treatment-resistant CIDP with tremor in an Antineurofascin155 seropositive pediatric case. Rev Neurol (Paris) 2021; 177:1310-1312. [PMID: 34256951 DOI: 10.1016/j.neurol.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 10/20/2022]
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The bidirectional relationship between epilepsy and depression. Eur Psychiatry 2021. [PMCID: PMC9471149 DOI: 10.1192/j.eurpsy.2021.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction The relationship between epilepsy and depression has been recognized for a long time. In fact, the presence of depression could worsen the disease outcome. Objectives we aimed to study the prevalence of depression in patients with epilepsy and to assess the determinant factors of its genesis. Methods 54 patients with epilepsy, aged more than 18 years, attending the neurology department of Habib Bourguiba Hospital, Sfax, Tunisia, were enrolled for the study. All patients were administered Mini-International Neuropsychiatric Interview (MINI) for evalution of psychiatric comorbid disorders especially depression. Socio-demographic and clinical data were collected. Results A total of 54 patients were included, of whom 63% (n =34) were men. Mean duration of epilepsy was 20.13 years. The most frequent type of seizure was generalized 72.7%. Depression was present in 7.3 % of patients. Alcoholism (p=0.027) was significantly associated with occurrence of depression. Drug resistence (p = 0.03) and longer duration of epilepsy (p = 0.046) were significantly associated with occurrence of depression. No significant association was found between type of seizure, seizure frequency, medication compliance and depression. Depression wasn’t associated with anti-epileptic drug. We didn’t find any association between depression and other psychiatric comorbidities. Conclusions Depression wasn’t frequent in our study contrary to literature. The possible explanations are the reduced simple size and the sensitivity of the used tool to assess depression in epilepsy. Pursuant to literature, we found significant association between Alcoholism, drug resistance and long duration of epilepsy.
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Gayet wernicke encephalopathy: Don’t miss this neuropsychiatric emergency! Eur Psychiatry 2021. [PMCID: PMC9470825 DOI: 10.1192/j.eurpsy.2021.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Gayet Wernicke Encephalopathy (GWE) is a diagnostic and therapeutic neuropsychiatric emergency due to thiamin deficiency (vitamin B1). Objectives The purpose of our work is to recall some clinical situations suspecting GWE, along with radiological and evolutionary profile. Methods We conducted a retrospective study concerning patients who were hospitalized in the neurology department of Habib Bourguiba Hospital between 2013 and 2020 for management of GWE. Results The median age of 7 patients was 39.57 years with sex ratio (H/F):1.33. The most common risk factor found is incoercible vomiting (5 patients), followed by chronic alcoholism (3 patients). Confusional state was the most frequent symptom found in 4 patients. The characteristic clinical triad of confusion, oculomotor disorders and ataxia was only found in 2 patients. Neuroimaging showed a typical aspect in 3 patients. The serum levels of thiamine were low in five patients and normal in two patients. After receiving parental than oral thiamin supplementation, three patients were independent after one month with a mRS score <3. Conclusions GWE is an acute neuropsychiatric emergency. Chronic alcoholism is recognized as its most common cause. The clinical triad is not constantly present. MRI shows typically bilateral symmetrical hyperintensities in periaqueductal area, periventricular region, thalami and mammillary bodies. Thiamin level can be normal since it does not accurately represent body thiamine status or in case of mutations in a thiamine-transporter gene. Thiamine therapy is warranted if any component of the GWE triad is present in an appropriate clinical setting to prevent irreversible neurological sequelae.
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An unusual case of acute myelopathy: Surfer's myelopathy in a teenage gymnast. Rev Neurol (Paris) 2021; 177:717-719. [PMID: 33478736 DOI: 10.1016/j.neurol.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 10/22/2022]
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Myocardial Expression of Estrogen Receptor-mRNA Is Associated With Lower Markers of Post-operative Organ Damage in Young Patients With Congenital Cardiac Defect. Front Pediatr 2021; 9:729198. [PMID: 34631625 PMCID: PMC8493930 DOI: 10.3389/fped.2021.729198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Estrogen receptors (ERs) relate to cardio-protection in adults, but their role in younger patients is not known. We aimed to assess the myocardial expression of ERα- and ERβ- mRNA in young patients with congenital cardiac disease and to analyze their putative protective role. Patients and Methods: Twenty children and young adults (seven females and 13 males) with a median age of 13.8 years (interquartile range: 12.3 years) were enrolled in this prospective study. The myocardial expression of ER-mRNA and genes involved in inflammation, growth, and stress response was assessed by real-time PCR and was correlated to post-operative (po) outcome. Results: ER-mRNA was detected in the myocardium of all patients, independently of gender and age. The expression of ER-mRNA correlated with that of mRNA coding for brain natriuretic peptide and for all cytokines tested. A higher ERα-mRNA expression correlated with lower troponin T concentrations at 24 h po (p = 0.032), higher PaO2/FiO2 ratio at 4 h po (p = 0.059), lower fluid retention at 4 h po (p = 0.048), and lower aspartate aminotransferase (AST) levels at 24 h po (p = 0.047). A higher ERβ-mRNA expression was also correlated with lower fluid retention at 24 h po (p = 0.048). Patients in whom the levels of ERα- and ERβ-mRNA were >P50 had lower troponin T (p = 0.003, respectively) and lower AST concentrations at 24 h po (p = 0.043, respectively) than the others. Conclusions: The expression of ERα- and ERβ-mRNA is present in the myocardium of children and young adults with congenital cardiac defect and is associated with lower markers of po organ damage. This suggests that ERs may provide perioperative organ protection in this population.
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Developmental venous anomalies and seizures: Coincidence or causation? Rev Neurol (Paris) 2020; 176:631-634. [DOI: 10.1016/j.neurol.2020.01.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 11/30/2022]
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ROHHAD(NET) Syndrome: Systematic Review of the Clinical Timeline and Recommendations for Diagnosis and Prognosis. J Clin Endocrinol Metab 2020; 105:5837124. [PMID: 32407531 DOI: 10.1210/clinem/dgaa247] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation and neural crest tumor (ROHHHAD[NET]) is a rare and potentially fatal disease. No specific diagnostic biomarker is currently available, making prompt diagnosis challenging. Since its first definition in 2007, a complete clinical analysis leading to specific diagnosis and follow-up recommendations is still missing. OBJECTIVE The purpose of this work is to describe the clinical timeline of symptoms of ROHHAD(NET) and propose recommendations for diagnosis and follow-up. DESIGN We conducted a systematic review of all ROHHAD(NET) case studies and report a new ROHHAD patient with early diagnosis and multidisciplinary care. METHODS All the articles that meet the definition of ROHHAD(NET) and provide chronological clinical data were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis individual patient data guidelines. The data were grouped into 7 categories: hypothalamic dysfunction, autonomic dysregulation, hypoventilation, NET, psychiatric symptoms, other clinical manifestations, and outcome. RESULTS Forty-three individual patient data descriptions were analyzed. The timeline of the disease shows rapid-onset obesity followed shortly by hypothalamic dysfunction. Dysautonomia was reported at a median age of 4.95 years and hypoventilation at 5.33 years, or 2.2 years after the initial obesity. A NET was reported in 56% of the patients, and 70% of these tumors were diagnosed within 2 years after initial weight gain. CONCLUSION Because early diagnosis improves the clinical management and the prognosis in ROHHAD(NET), this diagnosis should be considered for any child with rapid and early obesity. We propose guidance for systematic follow-up and advise multidisciplinary management with the aim of improving prognosis and life expectancy.
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Neuromyelitis optica spectrum disorders in South of Tunisia: A rare entity with low seroprevalence of anti-aquaporin 4 autoantibodies. Rev Neurol (Paris) 2020; 176:261-267. [DOI: 10.1016/j.neurol.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 12/27/2022]
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An unusual presentation of secondary central nervous system T cell lymphoma. Rev Neurol (Paris) 2020; 176:877-878. [PMID: 32303343 DOI: 10.1016/j.neurol.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
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Right Atrial Myocardial Remodeling in Children With Atrial Septal Defect Involves Inflammation, Growth, Fibrosis, and Apoptosis. Front Pediatr 2020; 8:40. [PMID: 32117843 PMCID: PMC7033500 DOI: 10.3389/fped.2020.00040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: Myocardial remodeling due to large atrial septum defect (ASD) is macroscopically characterized by dilation of the right-sided cardiac cavities secondary to volume overload, the cellular mechanisms of which are not yet understood. We postulated that inflammation, fibrosis, and cell death are actors of right atrial remodeling secondary to ASD. Patients and Methods: In 12 children with large ASD (median age: 63 months), expression of genes coding for proteins involved in the response to cell stress and -protection, inflammation, growth and angiogenesis, fibrosis, and apoptosis was assessed by RT-PCR in right atrial myocardial biopsies taken during cardiac surgery. The presence of cytokines in myocardial cells was confirmed by immunohistochemistry and effective apoptosis by TUNEL assay. Results: In all patients investigated, a cellular response to early mechanical stress with the initiation of early protective mechanisms, of inflammation (and its control), -growth, and -angiogenesis, of fibrosis and apoptosis was present. The apoptotic index assessed by TUNEL assay averaged 0.3%. Conclusions: In children with large ASD, macroscopic right atrial remodeling relates to cellular mechanisms involving the expression of numerous genes that either still act to protect cells and tissues but that also harm as they initiate and/or sustain inflammation, fibrosis, and cell death by apoptosis. This may contribute to long term morbidity in patients with ASD.
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Predictive value of C-reactive protein for the outcome after stroke. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A case series of Lewis-Sumner syndrome. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Multiple sclerosis with adrenal insufficiency mimicking adrenoleucodystrophy. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Who is the target population for shortening prehospital delay in acute stroke? J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Myotonic dystrophy type 1 and endocrine system involvement. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The value of functional imaging and CSF biomarkers for the diagnosis of degenerative dementia. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adult onset opsoclonus-myoclonus-ataxia syndrome, clinical features and diagnostic findings. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Incidence and predictors of post‐stroke epilepsy. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Secondary parkinsonian syndromes. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chorea-acanthocytosis: A Tunisian family. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Atypical course of Charcot-Marie-Tooth disease: what shall we be thinking of? J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Frontal presentation of Alzheimer’s Disease. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dyke Davidoff Masson syndrome a rare cause of schizoaffective disorder: A case report and review of the literature. Encephale 2019; 45:274-275. [PMID: 30879779 DOI: 10.1016/j.encep.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/14/2019] [Accepted: 01/22/2019] [Indexed: 11/24/2022]
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Abstract
INTRODUCTION Pediatric pulmonary arterial hypertension (PAH) remains a rare and severe disease with a poor prognosis. PAH may be idiopathic, heritable or associated with systemic conditions in particular associated with congenital heart disease. Areas covered: A thorough and extensive diagnostic approach is required for a correct diagnosis. The outcome has improved over the last decade with a better diagnostic approach and with the initiation of new targeted therapies. However, there is still significant progress to achieve as there is still no cure for this devastating disease. Expert opinion: Adapted clinical studies to define the best therapeutic approach are needed. Even if the treatment approach is still mainly derived from adult data and expert consensus, several studies and registries are currently underway and should deliver important information in the next future. This review aims to give an overview of the current diagnosis and treatment strategies of PAH.
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Vasoreactive Pulmonary Arterial Hypertension Manifesting With Misleading Epileptic Seizure: Diagnostic and Treatment Pitfalls. Front Pediatr 2019; 7:262. [PMID: 31334208 PMCID: PMC6621927 DOI: 10.3389/fped.2019.00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/10/2019] [Indexed: 11/13/2022] Open
Abstract
A 5-year-old girl presented with acute nocturnal episodes of loss of consciousness following abdominal pain and crying. Epilepsy was primarily diagnosed but the course of the disease was suggestive of pulmonary hypertension. An adapted invasive assessment of pulmonary pressure and pharmacological challenge allowed for diagnosing vasoreactive pulmonary arterial hypertension. Initial treatment with sildenafil was not effective. Thus, calcium channel blockers were introduced when positive vasoreactivity was confirmed and permitted to stop the occurrence of the syncope and dramatically improved clinical status. At 2 years follow-up she is well without any complaint and in functional class I. Echocardiography shows a slightly enlarged but not hypertrophied right ventricle with a nearly normalized estimated right ventricular pressure. The last catheterization shows subnormal values of pulmonary arterial pressure (mean pulmonary artery pressure: 24 mmHg) and pulmonary vascular resistance (5, 4 Wood units*m2), normalizing with inhaled Nitric Oxide (mean pulmonary artery pressure of 14 mmHg and pulmonary vascular resistance of 1.5 Wood units*m2). Vasoreactive pulmonary arterial hypertension is a rare entity in children but it should not be misdiagnosed with seizures due to the presence of syncopal episodes. According to current knowledge, this form seems to have a better prognosis than non-reactive pulmonary arterial hypertension and the treatment of choice remains as calcium channel blockers. The management of this case was characterized by successive mishaps and potentially harmful mistakes and underscores the potential risk with pediatric PH evaluation in non-expert centers.
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A study of clinical features, risk factors and short-term outcome of ischemic stroke in patients with and without atrial fibrillation in a North African population. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cervicocephalic arterial dissection. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Neuromyelitis optica: About 11 cases. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Normative data for verbal fluency task (VFT) in the adult Tunisian population. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Intracranial hypertension: A rare complication of Guillain Barre Syndrome. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Behavioral and psychological symptoms of Alzheimer’s disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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49
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Trail Making Test (TMT): Tunisian normative values from 339 normal adult controls. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Right-sided pulmonary venous return to the inferior vena cava: an exceptional malformation. Acta Cardiol 2017; 72:489-490. [PMID: 28705051 DOI: 10.1080/00015385.2017.1310800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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