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Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021. BJOG 2023. [PMID: 37156239 DOI: 10.1111/1471-0528.17510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN Descriptive multi-country secondary data analysis. SETTING Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION Liveborn infants. METHODS Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.
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Listeria Meningitis, one of your five a day? A case report of Listeria Monocytogenes Meningitis in a fit and well 62-year-old woman. Acute Med 2023; 22:101-105. [PMID: 37306136 DOI: 10.52964/amja.0942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Listeria Monocytogenes is transmitted via ingestion of contaminated food products and can cause invasive disease in susceptible hosts. Risk factors include immunocompromise; pregnancy; being elderly; and new-born. Listeriosis is uncommon but can occur in immunocompetent individuals and has a high mortality rate. We report a case of a 62-year-old female with no obvious risk factors who presented with atypical meningism. The patient was subsequently diagnosed with listeria meningitis and made a good recovery. The patient was a gardener regularly handling soil and ingested vegetables from her allotment patch; this case is reported to highlight less common risk factors and atypical ways in which listeria may present to the acute medical take.
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Effect of nutrients deficiency on biofilm formation and single cell protein production with a purple non-sulphur bacteria enriched culture. Biofilm 2022; 5:100098. [PMID: 36588982 PMCID: PMC9794892 DOI: 10.1016/j.bioflm.2022.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/27/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
Purple non-sulphur bacteria (PNSB) are of interest for biorefinery applications to create biomolecules, but their production cost is expensive due to substrate and biomass separation costs. This research has utilized fuel synthesis wastewater (FSW) as a low-cost carbon-rich substrate to produce single-cell protein (SCP) and examines PNSB biofilm formation using this substrate to achieve a more efficient biomass-liquid separation. In this study, PNSB were grown in Ca, Mg, S, P, and N-deficient media using green shade as biofilm support material. Among these nutrient conditions, only N-deficient and control (nutrient-sufficient) conditions showed biofilm formation. Although total biomass growth of the control was 1.5 times that of the N-deficient condition and highest overall, the total biofilm-biomass in the N-deficient condition was 2.5 times greater than the control, comprising 49% of total biomass produced. Total protein content was similar between these four biomass samples, ranging from 35.0 ± 0.2% to 37.2 ± 0.0%. The highest protein content of 44.7 ± 1.3% occurred in the Mg-deficient condition (suspended biomass only) but suffered from a low growth rate. Overall, nutrient sufficient conditions are optimal for overall protein productivity and dominated by suspended growth, but where fixed growth systems are desired for cost-effective harvesting, N-deficient conditions provide an effective means to maximize biofilm production without sacrificing protein content.
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LB1031 Using social media to elucidate the patient experience with common acne treatments. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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366 Comparing patient perspectives towards treatment for alopecia areata before and during COVID-19 using social media data mining. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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P-122 Optimising IUI; a systematic review and network meta-analysis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What is the effectiveness of add-on interventions to the standard intra-uterine insemination (IUI) protocol in improving reproductive outcomes?
Summary answer
Amongst the add-ons studied only luteal phase support and endometrial scratch were found beneficial for (LBR)/ongoing pregnancy rate (OPR) in IUI cycles.
What is known already
IUI is a fertility treatment offered to couples and single women for varied indications worldwide. Although cheaper and less invasive than in-vitro fertilization (IVF), it has received less attention and success rates remain low. Various add-ons have been introduced to boost IUI outcomes. However, their use remains largely empirical and is not standardized. Exploring the effectiveness of different protocol add-ons in comparisons with each other and with the standard protocol, could help develop evidence-based recommendations and optimize IUI treatment.
Study design, size, duration
We conducted a systematic review and meta-analysis aiming to assess the value of various IUI add-ons on clinical outcomes (PROSPERO registration number CRD42022300857). A computerized literature search was performed using EMBASE, MEDLINE, CINAHL and the Cochrane Central from database inception to October 2021. Two authors independently assessed the studies for quality and risk of bias. Studied add-ons included use of hydrotubation, endometrial scratch, trigger, double insemination, ultrasound guidance, bed rest, tocolysis and luteal phase support.
Participants/materials, setting, methods
Randomized controlled trials (RCTs) were included, reporting on one or more cycles of IUI with any protocol and indication using partner’s or donor sperm. We summarized the LBR or OPR when LBR was not available. We calculated odds ratios with 95% confidence intervals (CI) using random effects meta-analysis after transforming data using Freeman-Tukey double arcsine transformation. Heterogeneity was reported as I2 and Tau2 estimates.
Main results and the role of chance
Sixty one RCTs were included in the analysis. Amongst the add-ons studied, luteal phase support and endometrial scratch were found to increase chance of LBR/OPR by 1.48 times (CI 1.1243-1.9402, I2= 13.3%, Tau2= 0,0156 p = 0.330) and 1.58 times (CI 1.0992-2.2685, I2= 0.0%,Tau2=0,00 p = 0.510) respectively. No statistically significant difference was found for the use of hydrotubation (pooled OR 1.4192, CI 0.4936 - 4.0804, I2= 67.3%, Tau2=0,57 p = 0.047), trigger (pooled OR 0.6649, CI 0.2422- 1.8257, I2= 74.7%, Tau2=0,3972, p = 0.047), hCG versus agonist trigger (pooled OR 1.1570, CI 0.7501- 1.7847, I2=0.0%, Tau2=0.00, p = 0.502), ultrasound guidance (pooled OR 2.119, CI 0.8289-5.3809, p = 0.437), double IUI (pooled OR 0.9718, CI 0.5721-1.6508, I2=0.0%, Tau2=0.00, p = 0.567), and bed rest (pooled OR 1.1459, CI 0.4789-2.7418, I2=0.0%, Tau2=0.00, p = 0.005). No eligible studies were found on tocolytic agents. Two studies were identified for the use of misoprostol but the authors do not report results on the outcomes of interest.
Limitations, reasons for caution
The risk of bias was considered as “high”/“some concerns” for all included studies and the overall quality of evidence is low. Included studies randomized both per woman and per cycle and significant differences were noticed in ovarian stimulation protocols. More well-designed RCTs are needed in order to reach sound conclusions.
Wider implications of the findings
This meta-analysis provides evidence that luteal phase support and endometrial scratch provide clinical benefit for IUI success rates. However, it is possible that different add-ons could benefit specific patient groups. There is place for more research in the field to explore the value of add-ons in relation to subfertility background.
Trial registration number
n/a
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Analysis of 55 cases of adenomatoid odontogenic tumor in an Indian population and review of literature. Med Oral Patol Oral Cir Bucal 2022; 27:e85-e93. [PMID: 34874924 PMCID: PMC8719791 DOI: 10.4317/medoral.24977] [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: 07/01/2021] [Accepted: 11/04/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study reviews the demographic, clinical and radiographic features of adenomatoid odontogenic tumor(AOT) diagnosed in an Indian population over 50 years and also evaluate and compare follicular AOT(F-AOT) and extra-follicular AOT(EF-AOT). MATERIAL AND METHODS 55 diagnosed cases of AOT from 1971-2020 were studied retrospectively. The data regarding the age, sex, location, variant of AOT, duration, clinical features, radiographic appearance, treatment and recurrence were collected and analysed. RESULTS Of the 722 odontogenic tumors diagnosed, 7.6% were AOTs with higher prevalence of extra-follicular (67.3%) than follicular (32.7%) variant. All the tumors were intraosseous with a marked predilection for maxilla over mandible, ratio 2:1. The patients mean age was 19.8 years with slightly higher female predilection (male:female ratio - 1:1.5). The anterior region (76.4%) was more frequently affected and entire quadrant was involved in 21.8% cases. Clinically, asymptomatic, slow-growing swelling was seen in 81.8% cases with duration of 15 days to 10 years. Radiographically, AOT appeared as well-corticated radiolucent lesion. Canine was the most commonly impacted tooth. Recurrence was seen in 3 cases. CONCLUSIONS Interestingly, in this series extra-follicular was twice more common than follicular AOT. Few cases involved the entire quadrant or crossed the midline of either jaws.
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Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review. Curr Cardiol Rev 2021; 17:204-208. [PMID: 32525780 PMCID: PMC8226206 DOI: 10.2174/1573403x16666200611132045] [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: 02/03/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Biliary pericardial tamponade (BPT) is a rare form of pericardial tamponade, characterized by yellowish-greenish pericardial fluid upon pericardiocentesis. Historically, BPT reported to occur in the setting of an associated pericardiobiliary fistula. However, BPT in the absence of a detectable fistula is extremely rare. LEARNING OBJECTIVE A biliary pericardial tamponade is a rare form of tamponade warranting a prompt workup (e.g., MRCP or HIDA scan) for a potential fistula between the biliary system and the pericardial space. A pericardio-biliary fistula can be iatrogenic or traumatic. People with a history of chest wall trauma, abdominal surgery, or chest surgery are at increased risk. The use of HIDA scanning plays a salient role in effectively surveilling for the presence of a fistula - especially when MRCP is contraindicated. CASE PRESENTATION A 75-year-old Hispanic male presenting with dyspnea and diagnosed with cardiac tamponade is the subject of the study. Subsequent pericardiocentesis revealed biliary pericardial fluid (bilirubin of 7.6 mg/dl). The patient underwent extensive workup to identify a potential fistula between the hepatobiliary system and the pericardial space, which was non-revealing. The mechanism of bile entry into the pericardial space remains to be unidentified. LITERATURE REVIEW A total of six previously published BPT were identified: all were males, with a mean age of 53.3 years (range: 31-73). Mortality was reported in two out of the six cases. The underlying etiology for pericardial tamponade varied across the cases: incidental pericardio-biliary fistula, traumatic pericardial injury, and presence of associated malignancy. - Conclusion: Biliary pericardial tamponade is a rare form of tamponade that warrants a prompt workup (e.g., Hepatobiliary Iminodiacetic Acid - HIDA scan) for an iatrogenic vs. traumatic pericardio- biliary fistula. As a first case in the literature, our case exhibits a biliary tamponade in the absence of an identifiable fistula.
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427 Discerning patient perspectives towards specific treatments of alopecia areata using artificial intelligence. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection. Br J Surg 2021; 108:441-447. [PMID: 33615351 DOI: 10.1093/bjs/znaa117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/05/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse. METHODS A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further. RESULTS Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was -0.19 (95 per cent c.i. -0.39 to -0.12) and - 0.01 (- 0.17 to -0.03) respectively. CONCLUSION Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.
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Hydralazine-Induced ANCA Associated Vasculitis (AAV) Presenting with Pulmonary-Renal Syndrome (PRS): A Case Report with Literature Review. Curr Cardiol Rev 2021; 17:182-187. [PMID: 32418528 PMCID: PMC8226194 DOI: 10.2174/1573403x16666200518092814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 01/26/2023] Open
Abstract
Hydralazine, an arterial vasodilator, is a widely used medication for the management of hypertension and heart failure, especially for patients who cannot tolerate the use of ACEIs or ARBs. It is generally well-tolerated and has a safe profile in pregnancy. However, hydralazine can induce immune-mediated side effects, such as hydralazine-induced lupus and less commonly hydralazine- induced ANCA vasculitis. The latter most commonly affects the kidneys with or without other organ involvement. There are several cases reported in the literature of hydralazine-induced ANCA associated vasculitis (AAV) that have pulmonary manifestations, also known as hydralazine- induced pulmonary-renal syndrome (PRS), a condition with a high risk of mortality. We are reporting a case of Hydralazine-induced ANCA associated glomerulonephritis with severe diffuse alveolar hemorrhage (DAH). In addition, we will review the current literature and discuss the importance of prompt diagnosis and early management to decrease mortality and morbidity associated with this serious condition.
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Prospective correlation of the radiological, surgical and pathological findings in patients undergoing cytoreductive surgery for colorectal peritoneal metastases: implications for the preoperative estimation of the peritoneal cancer index. Colorectal Dis 2020; 22:2123-2132. [PMID: 32940414 DOI: 10.1111/codi.15368] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
Abstract
AIM The peritoneal cancer index (PCI) is one of the strongest prognostic factors in patients undergoing cytoreductive surgery (CRS) for colorectal peritoneal metastases. Using pathological evaluation, however, the disease extent differs in a large proportion of patients. Our aim was to study the correlation between the radiological (rPCI), surgical (sPCI) and pathological (pPCI) PCI in order to determine factors affecting the discordance between these indices and their potential therapeutic implications. METHOD From July 2018 to December 2019, 128 patients were included in this study. The radiological, pathological and surgical findings were compared. A protocol for pathological evaluation was followed at all centres. RESULTS All patients underwent a CT scan and 102 (79.6%) had a peritoneal MRI. The rPCI was the same as the sPCI in 81 (63.2%) patients and the pPCI in 93 (72.6%). Concordance was significantly lower for moderate-volume (sPCI 13-20) and high-volume (sPCI > 20) disease than for low-volume disease (sPCI 0-12) (P < 0.001 for sPCI; P = 0.001 for pPCI). The accuracy of imaging in predicting presence/absence of disease upon pathological evaluation ranged from 63% to 97% in the different regions of the PCI. The pPCI concurred with the sPCI in 86 (68.8%) patients. Of the nine patients with sPCI > 20, the pPCI was less than 20 in six. CONCLUSION The rPCI and sPCI both concurred with pPCI in approximately two thirds of patients. Preoperative evaluation should focus on the range in which the sPCI lies and not its absolute value. Radiological evaluation did not overestimate sPCI in any patient with high/moderate-volume disease. The benefit of CRS in patients with a high r/sPCI (> 20) who respond to systemic therapies should be prospectively evaluated.
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Clinical and Etiological Profile of Patients With Chronically OccludedCoronary Arteries( CTO): A SingleCenter Study from Mumbai. Indian Heart J 2020. [DOI: 10.1016/j.ihj.2020.11.053] [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] Open
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P406 SURVEY EXPLORING BARRIERS TO ALLERGY CLINIC VISITS IN AN URBAN PEDIATRIC SUBSPECIALTY CENTER. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.155] [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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C-reactive protein trajectory to predict colorectal anastomotic leak: PREDICT Study. Br J Surg 2020; 107:1832-1837. [PMID: 32671825 DOI: 10.1002/bjs.11812] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/17/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anastomotic leak is a common complication after colorectal surgery, associated with increased morbidity and mortality, and poorer long-term survival after oncological resections. Early diagnosis improves short-term outcomes, and may translate into reduced cancer recurrence. Multiple studies have attempted to identify biomarkers to enable earlier diagnosis of anastomotic leak. One study demonstrated that the trajectory of C-reactive protein (CRP) levels was highly predictive of anastomotic leak requiring intervention, with an area under the curve of 0·961. The aim of the present study was to validate this finding externally. METHODS This was a prospective international multicentre observational study of adults undergoing elective colorectal resection with an anastomosis. CRP levels were measured before operation and for 5 days afterwards, or until day of discharge if earlier than this. The primary outcome was anastomotic leak requiring operative or radiological intervention. RESULTS Between March 2017 and July 2018, 933 patients were recruited from 20 hospitals across Australia, New Zealand, England and Scotland. Some 833 patients had complete CRP data and were included in the primary analysis, of whom 41 (4·9 per cent) developed an anastomotic leak. A change in CRP level exceeding 50 mg/l between any two postoperative days had a sensitivity of 0·85 for detecting a leak, and a high negative predictive value of 0·99 for ruling it out. A change in CRP concentration of more than 50 mg/l between either days 3 and 4 or days 4 and 5 after surgery had a high specificity of 0·96-0·97, with positive likelihood ratios of 4·99-6·44 for a leak requiring intervention. CONCLUSION This study confirmed the value of CRP trajectory in accurately ruling out an anastomotic leak after colorectal resection.
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Acute Myocardial Infarction in Systemic Mastocytosis: Case Report With Literature Review on the Role of Inflammatory Process in Acute Coronary Syndrome. Curr Cardiol Rev 2020; 16:333-337. [PMID: 32228426 PMCID: PMC7903504 DOI: 10.2174/1573403x16666200331123242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Systemic Mastocytosis (SM) is a disorder of excessive mast cell infiltration in multiple organ tissues. Atherosclerosis is a major risk factor for developing acute coronary syndrome. In addition to lipid accumulation in the arterial wall, inflammation plays an important role in the pathogenesis of plaque rupture and activating the thrombosis cascade. The Mast cells contribution to plaque destabilization has been well established in multiple animal and human studies. In a recent study, SM has been proven to be associated with a higher incidence of acute coronary syndrome even with lower plasma lipids levels. The study showed that 20% of patients with SM had cardiovascular events compared to only 6% in the control group with adjustment to all cardiac risk factors. Case We presented a patient with no risk factors for heart disease other than old age and history of SM who developed acute myocardial infarction. Conclusion SM can be life-threatening and can result in ACS, anaphylactic reaction, syncope, or cardiac arrest. Clinicians should have a high index of suspicion of acute coronary syndrome (ACS) occurrence in the setting of inflammatory conditions, such as SM and KS, and vice versa, where SM should be considered or ruled out in patients who suffer from anaphylaxis and cardiac arrest or myocardial infarction.
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Characterization of cell fusion in an experimental mouse model of endometriosis†. Biol Reprod 2020; 100:390-397. [PMID: 30304517 DOI: 10.1093/biolre/ioy221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 02/01/2023] Open
Abstract
Cell fusion is involved in the development of some adult organs, is implicated in the pathogenesis of specific types of cancer, and is known to participate in repair/regeneration processes mediated by bone-marrow-derived cells (BMDCs). Endometriosis is a disease characterized by growth of functional endometrial tissue outside of the uterine cavity. Endometriosis shares some molecular properties with cancer and BMDCs home to endometriosis lesions in a mouse model. Our objective was to determine if cell fusion can occur in endometriosis and establish whether bone-marrow-derived cells participate in cell fusion events in lesions. We employed a Cre-Lox system to identify cell fusion events in a mouse model of endometriosis. Fused cells were detected in endometriotic lesions, albeit at a low frequency (∼1 in 400 cells), localized to the stromal compartment, and displayed restricted proliferation. Using 5-fluorouracil-based nongonadotoxic bone marrow transplantation model, we demonstrate that bone marrow cells represent a principal cell source for fusion events in lesions. Cell fusion progeny uniformly lacked expression of selected markers of hematopoietic, endothelial, and epithelial markers, though they expressed the mesenchymal/stromal markers Sca-1 and CD29. This study is the first to describe the phenomenon of cell fusion in endometriosis and points to a mesenchymal population derived from cell fusion events with limited proliferative activity, properties previously attributed to endometrial stem cells. Their putative role in the pathogenesis of the disease remains to be elucidated.
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44 Wirral's Teletriage Service. Age Ageing 2020. [DOI: 10.1093/ageing/afz185.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The Wirral Teletriage Service provides non-urgent clinical support to Wirral Care Homes in order to help avoid unnecessary hospital admissions for their residents. It also aims to provide quicker access to clinical assessment than via NHS 111 and to provide this care in the patient’s residence wherever possible.
Methods
Care homes call the Teletriage service when they have concerns about the health of one of their residents. The Teletriage nurse undertakes a clinical assessment of the resident remotely via Skype. Care Homes have been provided with a secure NHS email address to facilitate secure sharing of data. They have also been provided with iPads and training for their staff. After being assessed by Teletriage, residents are signposted to the most appropriate care pathway for their needs.
Results
76 Care Homes have signed up to the service. On average, the Teletriage Service receives 300-400 calls a month. In an 18 month period, the number of calls to NHS 111 have reduced by 76%. Out of all the calls to Teletriage, 22% of patients were managed by the Teletriage team with no onward referral, 57% were managed via community services e.g GPs, Community Geriatricians, and 10% were referred to the ambulance service. Emergency Health Care Plans (EHCPs), Preferred Priorities of Care and EOL (End of Life) wishes are taken into account.
Conclusions
The Teletriage project has reduced the number of phone calls to NHS 111 and the ambulance service, and subsequently has reduced the number of patients conveyed to hospital by 12%. The Teletriage nurses work very closely with various community services as well as GPs, NWAS and Community Geriatricians. The ongoing training and education provided to the Care Home Staff means that overall there has been good engagement with the project from the majority of the Wirral Care Homes.
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Incidence and Associated Risk Factors of Chemotherapy-Induced Cardiomyopathy in the African American and Afro-Caribbean Populations. INTERNATIONAL JOURNAL OF CLINICAL RESEARCH & TRIALS 2020; 5:154. [PMID: 33511317 PMCID: PMC7839991 DOI: 10.15344/2456-8007/2020/154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chemotherapy-induced cardiomyopathy (CICM) and heart failure are major complications of cancer therapeutics and can result in significant morbidity and mortality. There is limited data on the incidence and risk factors of CICM in African American and Afro-Caribbean patients. METHODS We performed a retrospective chart review to evaluate the baseline characteristics that may predispose to CICM. Patients were African American and Afro-Caribbean ethnicity. Data was collected between 2014 to 2018. Patients had transthoracic echocardiogram (TTE) or multigated acquisition scan (MUGA) prior to cancer therapy and every 3 months thereafter, until the end of the regimen. CICM was defined as a ≥16% reduction in LVEF or ≥10% reduction in LVEF to a value <50%. RESULTS A total of 230 patients were studied, with a mean age of 54±12 years with 91% were females, BMI 30±4, 81% were taking anthracyclines, 87% were on Trastuzumab while 5% were receiving both medications. The prevalence of comorbidities was as follows: hypertension 8%, diabetes mellitus 8%, ESRD 8%, dyslipidemia 8%, CAD 7%. The incidence of CICM was 7% overall, while it was 6% and 8% for patients taking Anthracyclines and Trastuzumab, respectively. CICM was associated with dyslipidemia (r= .22, p= .001), hypertension (r= .12, p= .05), baseline ejection fraction (r= -.21, p= .001) and concomitant use of radiation therapy (r= .147, p= .02), but not with age, gender, beta blocker use, angiotensin converting enzyme inhibitor use, number of chemotherapy cycles or stage of the malignancy. On multivariate analysis CICM was independently associated with baseline ejection fraction (β= -.193, P= .003) and dyslipidemia (β= -.20, P= .003). CONCLUSION The incidence of CICM in African Americans and Afro-Caribbean is higher than reported in the general population. Dyslipidemia and baseline ejection fraction were seen as the major risk factors associated with the higher incidence of CICM.
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Video-assisted anal fistula treatment (VAAFT) assisted seton placement - a video vignette. Colorectal Dis 2019; 21:1462. [PMID: 31400250 DOI: 10.1111/codi.14823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/29/2019] [Indexed: 02/08/2023]
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Large Right Ventricle Thrombus in Uhl's Anomaly: A Rare Presentation of Extremely Rare Disease. Cardiol Res 2019; 10:124-127. [PMID: 31019643 PMCID: PMC6469915 DOI: 10.14740/cr758w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022] Open
Abstract
Uhl’s anomaly is an extremely rare congenital cardiac malformation and is characterized by the partial or complete absence of right ventricular myocardium. The absence of myocardium may be the result of primary non-development of myocytes or a form of selective apoptosis. It is mainly sporadic although some familial occurrences have been reported. Congestive cardiac failure is the most common mode of presentation. Associated congenital cardiac malformations are also reported. We report a case of a 17-year-old male who presented with symptoms and signs of right heart failure, during evaluation found to have large right ventricle free wall thrombus.
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Abstract 105: Improving Compliance and Follow-Up for Chemotherapy-Induced Heart Failure in an Urban Underserved Tertiary Hospital. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Chemotherapy-induced cardiomyopathy and heart failure are major complications of cancer therapy and can result in significant morbidity and mortality. Unfortunately, there is a high risk of poor compliance and loss to follow-up in underserved areas.
Objective:
Create a pathway to improve detection and management of chemotherapy-induced cardiotoxicity and heart failure in patients undergoing chemotherapy treatment in an urban underserved hospital.
Description:
The project is performed at Kings County Hospital, a major cancer treatment center in Brooklyn, NY. Our findings indicate that over the past five years, patients with chemotherapy-induced cardiomyopathy were lost to follow-up with outpatient cardiology services. Therefore, we developed and applied a new collaborative protocol for patients who were diagnosed with any cancer undergoing treatment complicated by cardiomyopathy. The protocol is as follows; Firstly, patients are sent for a multigated acquisition (MUGA) scan prior to beginning chemotherapy, and every three months thereafter over the course of their chemotherapy treatment. The reading physician then identifies all patients with a 10% or more reduction in ejection fraction between MUGA scans, and notifies the Heart Health Center at Kings County Hospital to contact the patient with an appointment with cardiology services. At the Heart Health Center, the patient is then counseled on guideline-recommended treatment for heart failure. Further follow up with the nurse practitioner is done for medication reconciliation, education regarding activity, weight monitoring, dietary intake, and warning symptoms for heart failure exacerbations. The patient will receive follow-up with a nutritionist for guideline directed dietary recommendations for heart failure and social work services to ensure appropriate social conditions and support. The oncology service will monitor if the patient has followed up with outpatient cardiology before continuing chemotherapy. If the patient was lost to follow up, oncology will notify the Heart Health Center and assist with providing the patient with an appointment.
Conclusions:
We aim to improve compliance for follow up and guideline directed management for chemotherapy-induced heart failure in an urban underserved tertiary hospital.
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The use of 3D imaging to facilitate training during complex fistula surgery - a video vignette. Colorectal Dis 2019; 21:376. [PMID: 30624849 DOI: 10.1111/codi.14551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/21/2018] [Indexed: 02/08/2023]
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New Onset Right Bundle Branch Block In Acute Coronary Syndrome and High-Grade Stenosis: A Case Series. SCIFED JOURNAL OF CARDIOLOGY 2019; 3:23. [PMID: 31069343 PMCID: PMC6502265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Despite advances in diagnostic and therapeutic interventions, coronary heart disease remains as one of the leading causes of death in developed countries. ST-segment elevation myocardial infarction is associated with the highest mortality and is an indication for emergent reperfusion therapy. Current guidelines for emergent reperfusion not only include ST segment elevations but also consider evidence of a new onset Left Bundle Branch Block (LBBB). However, accumulating evidence indicates that RBBB is also associated with poor outcome in coronary artery disease. To-date, guidelines do not comment on the urgency of reperfusion therapy with sole evidence of a new onset Right Bundle Branch Block (RBBB). Particularly we question whether clinicians should focus on new-onset RBBB as a ST-segment elevation equivalent. If so, appropriate management of patients with the new onset RBBB during cardiac ischemia can have a significant impact on cardiac function and outcomes. In this series, we present four cases of new-onset acute RBBB associated with chest pain in the setting of acute myocardial infarction with critical lesions of the left anterior descending artery. We also highlight the need to consider new RBBB as an additional indication for acute reperfusion therapy in acute myocardial infarction. This will call for revision in the current guidelines by American Heart Association following the initiative recently implemented by the European Society of Cardiology 2018.
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Changing scenario of infective endocarditis, a retrospective study of 34 patients over 3 years. Indian Heart J 2018. [DOI: 10.1016/j.ihj.2018.10.289] [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] Open
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Large VSD with chronic constrictive pericarditis masquerading as Eisenmenger syndrome. Indian Heart J 2018. [DOI: 10.1016/j.ihj.2018.10.164] [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] Open
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Coronary artery disease in HIVinfected patients – A study of clinical profile, presentation, angiographic characteristics and outcome. Indian Heart J 2018. [DOI: 10.1016/j.ihj.2018.10.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Intravascular Ultrasound-Guided Management of Proximal Left Anterior Descending Artery Aneurysm With Covered Stent - A Case Report. Cardiol Res 2018; 9:318-323. [PMID: 30344831 PMCID: PMC6188050 DOI: 10.14740/cr764w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022] Open
Abstract
Coronary artery aneurysm is defined as the localized dilatation of a coronary artery segment more than 1.5 times the size of adjacent normal segments. The aneurysms of the coronary arteries are rare. Coronary aneurysms can be congenital or acquired. The majority are atherosclerotic in origin. The primary complication is myocardial ischemia or infarction, sudden cardiac death with rupture being rare. Some aneurysms are diagnosed incidentally in arteries other than the culprit artery. Treatment options include medical management with anticoagulation, percutaneous intervention with covered stents or surgery. We report a case of 67-year-old male who presented with acute coronary syndrome. Coronary angiogram showed a moderate size aneurysm of the proximal left anterior descending artery. This aneurysm was successfully managed percutaneously with a covered stent.
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Abstract
Congenital mitral stenosis involves the annulus, the zone immediately above and contiguous with the annulus, the leaflets, the chordae tendineae, and the papillary muscles. In a parachute mitral valve (PMV), all chordae tendineae which are usually shorter and thicker than normal type, inserted into this single papillary muscle. This condition restricts the motion of leaflets and obstructs the blood flow into the left ventricle during diastole. Here we present two cases of severe congenital mitral stenosis with severe pulmonary hypertension due to parachute mitral valve that allowed survival into adulthood without any specific treatment.
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Determination of Caries Lesion Activity: Reflection and Roughness for Characterization of Caries Progression. Oper Dent 2018; 43:301-306. [PMID: 29676973 DOI: 10.2341/16-236-l] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Caries lesion progression is difficult to determine with visual and tactile examinations. The hypothesis of this study was that reflection and roughness measurements could determine caries progression. Ground/polished sound human enamel specimens were analyzed at baseline (sound) and after two four-day demineralization periods for reflection using optical reflectometry (ORef) and for roughness using optical surface profilometry (SPro). Specimens were demineralized using a microbial- Streptococcus mutans aries model. Comparisons among the periods for ORef and SPro were performed using repeated measures analysis of variance. Two-sample t-tests were used for differences in transverse microradiography. The integrated mineral loss and depth of the four-day demineralization period were significantly smaller than those for the eight-day demineralization period ( p<0.01). With increased demineralization time, reflection was significantly decreased and roughness was significantly increased ( p<0.01). Correlation between ORef and SPro was moderate ( r=-0.63). Both reflection and roughness can be characterized for nondestructive longitudinal assessment of caries lesion progression.
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3:32 PM Abstract No. 7 Prostate artery embolization for chronic and recurrent urinary tract infections associated with benign prostatic hypertrophy. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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The STIM1 inhibitor ML9 disrupts basal autophagy in cardiomyocytes by decreasing lysosome content. Toxicol In Vitro 2018; 48:121-127. [PMID: 29337250 DOI: 10.1016/j.tiv.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/06/2018] [Accepted: 01/09/2018] [Indexed: 01/08/2023]
Abstract
Stromal-interaction molecule 1 (STIM1)-mediated store-operated Ca2+ entry (SOCE) plays a key role in mediating cardiomyocyte hypertrophy, both in vitro and in vivo. Moreover, there is growing support for the contribution of SOCE to the Ca2+ overload associated with ischemia/reperfusion injury. Therefore, STIM1 inhibition is proposed as a novel target for controlling both hypertrophy and ischemia/reperfusion-induced Ca2+ overload. Our aim was to evaluate the effect of ML9, a STIM1 inhibitor, on cardiomyocyte viability. ML9 was found to induce cell death in cultured neonatal rat cardiomyocytes. Caspase-3 activation, apoptotic index and release of the necrosis marker lactate dehydrogenase to the extracellular medium were evaluated. ML9-induced cardiomyocyte death was not associated with increased intracellular ROS or decreased ATP levels. Moreover, treatment with ML9 significantly increased levels of the autophagy marker LC3-II, without altering Beclin1 or p62 protein levels. However, treatment with ML9 followed by bafilomycin-A1 did not produce further increases in LC3-II content. Furthermore, treatment with ML9 resulted in decreased LysoTracker® Green staining. Collectively, these data suggest that ML9-induced cardiomyocyte death is triggered by a ML9-dependent disruption of autophagic flux due to lysosomal dysfunction.
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Weekend and Out of Hours Surgical Handover (WOOSH): A Checklist Format Improves Efficiency and Patient Safety. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.209] [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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An exploration of mammographers' attitudes towards the use of social media for providing breast screening information to clients. Radiography (Lond) 2017; 23:249-255. [DOI: 10.1016/j.radi.2017.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
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Putting LVOT VTI Impell-Spective: A Study to Assess LVOT VTI as a Weaning Parameter for the Impella Support System. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.341] [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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Mixed messages: An evaluation of NHS Trust Social Media policies in the North West of England. Radiography (Lond) 2017; 23:235-241. [PMID: 28687292 DOI: 10.1016/j.radi.2017.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/03/2017] [Accepted: 03/28/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Despite National Health Service (NHS) information strategy promoting the use of Social Media (SoMe) to encourage greater engagement between service users and providers, a team investigating online SoMe interaction between breast screening practitioners and clients found that practitioners alleged discouragement from employers' policies. This study aimed to investigate whether this barrier was genuine, and illuminate whether local policy differed from national strategy. METHOD The study used a qualitative grounded theory approach to generate a theory. Nine policies from the North West of England were analysed. A framework was derived from the data, and an analysis of policy tone followed by a detailed coding of policy content was undertaken. Comparative analysis continued by reviewing the literature, and a condensed framework revealed five broad categories that policies addressed. RESULTS The analysis revealed the policies varied in content, but not in tone, which was mostly discouraging. Coding the content revealed that the most frequently addressed point was that of protecting the employers' reputation, and after further analysis, the resultant condensed framework showed that policies were imbalanced and heavily skewed towards Security, Conduct & Behaviour and Reputation. CONCLUSION Practitioners within breast screening services are discouraged by overly prohibitive and prescriptive SoMe policies; with these varying tremendously in comprehensiveness, but with a narrow focus on security and employers reputation; in contrast with national strategy. Recommendations are that policy revision is undertaken with consultation by more than one stakeholder, and SoMe training is offered for all members of NHS staff.
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BLOCKED ARTERY, OR BLOCKED BOWEL?! J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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A RARE CAUSE OF MYOCARDIAL INJURY IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS: HYDROXYCHLOROQUINE INDUCED CARDIOMYOPATHY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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THE WAY TO A MAN'S HEART: THROUGH HIS QUADRICEPS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35759-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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A mouse 5-fluorouracil based submyeloablation model for the study of bone marrow-derived cell trafficking in reproduction. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pyomyelia presenting as acute flaccid paralysis. Oxf Med Case Reports 2016; 2016:omw052. [PMID: 29497549 PMCID: PMC5782478 DOI: 10.1093/omcr/omw052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/18/2022] Open
Abstract
We report an unusual case of a 10-month-old girl with intramedullary spinal cord abscess
who presented with fever and acute flaccid paraplegia. Nerve conduction study showed
demyelinating neuropathy after which she received intravenous immunoglobulin therapy. This
was followed by ascending paralysis and left-sided ptosis. Lumbar puncture revealed
purulent cerebrospinal fluid and magnetic resonance imaging (MRI) with gadolinium showed
intramedullary holocord abscess with a dermal sinus tract extending from skin to
intramedullary canal in the lumbosacral region. This tract was excised completely along
with drainage of pus. She was treated with broad-spectrum antibiotics for 6 weeks and
underwent neurorehabilitation after which there was significant neurological improvement.
Follow-up MRI shows good resolution of the intramedullary abscess.
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A Connection That Helps The Body, But Damages The Heart. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Prevalence of CTX-M resistance marker and integrons among Escherichia coli
and Klebsiella pneumoniae
isolates of clinical origin. Lett Appl Microbiol 2016; 62:419-27. [DOI: 10.1111/lam.12567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
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Percutaneous gastric remnant gastrostomy following roux-en-Y gastric bypass surgery: a single tertiary center’s twelve year experience. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.121] [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] Open
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Evidence of In Vivo Existence of Borrelia Biofilm in Borrelial Lymphocytomas. Eur J Microbiol Immunol (Bp) 2016; 6:9-24. [PMID: 27141311 PMCID: PMC4838982 DOI: 10.1556/1886.2015.00049] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/02/2015] [Indexed: 12/17/2022] Open
Abstract
Lyme borreliosis, caused by the spirochete Borrelia burgdorferi sensu lato, has grown into a major public health problem. We recently identified a novel morphological form of B. burgdorferi, called biofilm, a structure that is well known to be highly resistant to antibiotics. However, there is no evidence of the existence of Borrelia biofilm in vivo; therefore, the main goal of this study was to determine the presence of Borrelia biofilm in infected human skin tissues. Archived skin biopsy tissues from borrelial lymphocytomas (BL) were reexamined for the presence of B. burgdorferi sensu lato using Borrelia-specific immunohistochemical staining (IHC), fluorescent in situ hybridization, combined fluorescent in situ hybridization (FISH)–IHC, polymerase chain reaction (PCR), and fluorescent and atomic force microscopy methods. Our morphological and histological analyses showed that significant amounts of Borrelia-positive spirochetes and aggregates exist in the BL tissues. Analyzing structures positive for Borrelia showed that aggregates, but not spirochetes, expressed biofilm markers such as protective layers of different mucopolysaccharides, especially alginate. Atomic force microscopy revealed additional hallmark biofilm features of the Borrelia/alginate-positive aggregates such as inside channels and surface protrusions. In summary, this is the first study that demonstrates the presence of Borrelia biofilm in human infected skin tissues.
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A Systematic Review and Network Meta-Analysis of Pharmacological Therapies Used for Patients with Advanced Parkinson's Disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A390. [PMID: 27200898 DOI: 10.1016/j.jval.2014.08.856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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AB1060 Are There Gender-Specific Differences in Patient Characteristics at Initiation of Biologic Treatment in Ankylosing Spondylitis and Psoriatic Arthritis? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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AB0760 Real-World Validation of the Minimal Disease Activity Index in Psoriatic Arthritis: an Analysis from the Prospective, Observational Registry, Biotrac. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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THU0438 Is Skin Disease More Important to Patients or Physicians in the Assessment of Disease Activity in Psoriatic Arthritis? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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SAT0363 Validation of the Ankylosing Spondylitis Disease Activity SCORE (ASDAS) and Effectiveness of Infliximab in the Treatment of Ankylosing Spondylitis over 4 Years. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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