bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved accuracy and confidence with multiple‐lead recordings from a single‐lead mobile electrocardiographic device
Authors: Frisch Daniel R. , Weiss Max , Dikdan Sean J. , Keith Scott W. , Sarkar Kumar
Published: August 2019

Background

Mobile electrocardiograms (mECGs) utilizing smartphone applications are an emerging technology. Typically, a Lead I rhythm strip is recorded. However, interpretation can be difficult in patients with sinus rhythm and low amplitude P‐waves (SR‐LAP) or atrial flutter (AFL). We hypothesized that patients could independently obtain multi‐lead tracings using a commercial mECG device, and that cardiologists who interpreted the multi‐lead tracings would make more accurate diagnoses and have more confidence in their interpretation compared to a single lead only.

Methods

Thirty sets of recordings were obtained from 10 patients with either SR‐LAP or AFL that was not apparent on Lead I on a standard ECG. Patients recorded Lead I, Lead II, and Lead V1 tracings using AliveCor's KardiaMobile mECG device. Twenty‐nine cardiologists reviewed each patient's Lead I tracing, multi‐lead tracings (Leads I, II, V1), and 12‐lead ECG. Accuracy was noted and each cardiologist rated their level of confidence in their interpretation.

Results

All patients were able to record their own single and multi‐lead tracings. Single lead, multi‐lead, and the 12‐lead ECG yielded 36.4%, 84.3%, and 97.7% agreement with the established diagnosis, respectively (P < .01 for each comparison). Overall mean confidence scores (out of a score of 5) were 2.95, 3.50, and 4.47 for single lead, multi‐lead, and the 12‐lead ECG, respectively (P < .01 for each comparison).

Conclusions

Patients were able to record their own multi‐lead mECG tracings. Compared to a single lead recording, multi‐lead mECGs significantly improved cardiologists’ diagnostic accuracy and confidence in their interpretation approaching that of a standard 12‐lead ECG.
Examination of retinal vascular trajectory in schizophrenia and bipolar disorder
Authors: Appaji Abhishek , Nagendra Bhargavi , Chako Dona M. , Padmanabha Ananth , Jacob Arpitha , Hiremath Chaitra V. , Varambally Shivarama , Kesavan Muralidharan , Venkatasubramanian Ganesan , Rao Shyam V. , Webers Carroll A. B. , Berendschot Tos T. J. M. , Rao Naren P.
Published: August 2019

Aim

Evidence suggests microvascular dysfunction (wider retinal venules and narrower arterioles) in schizophrenia (SCZ) and bipolar disorder (BD). The vascular development is synchronous with neuronal development in the retina and brain. The retinal vessel trajectory is related to retinal nerve fiber layer thinning and cerebrovascular abnormalities in SCZ and BD and has not yet been examined. Hence, in this study we examined the retinal vascular trajectory in SCZ and BD in comparison with healthy volunteers (HV).

Methods

Retinal images were acquired from 100 HV, SCZ patients, and BD patients, respectively, with a non‐mydriatic fundus camera. Images were quantified to obtain the retinal arterial and venous trajectories using a validated, semiautomated algorithm. Analysis of covariance and regression analyses were conducted to examine group differences. A supervised machine‐learning ensemble of bagged‐trees method was used for automated classification of trajectory values.

Results

There was a significant difference among groups in both the retinal venous trajectory (HV: 0.17 ± 0.08; SCZ: 0.25 ± 0.17; BD: 0.27 ± 0.20; P < 0.001) and the arterial trajectory (HV: 0.34 ± 0.15; SCZ: 0.29 ± 0.10; BD: 0.29 ± 0.11; P = 0.003) even after adjusting for age and sex (P < 0.001). On post‐hoc analysis, the SCZ and BD groups differed from the HV on retinal venous and arterial trajectories, but there was no difference between SCZ and BD patients. The machine learning showed an accuracy of 86% and 73% for classifying HV versus SCZ and BD, respectively.

Conclusion

Smaller trajectories of retinal arteries indicate wider and flatter curves in SCZ and BD. Considering the relation between retinal/cerebral vasculatures and retinal nerve fiber layer thinness, the retinal vascular trajectory is a potential marker for SCZ and BD. As a relatively affordable investigation, retinal fundus photography should be further explored in SCZ and BD as a potential screening measure.
Fast and Efficient Method to Obtain Tagitinin F by Photocyclization of Tagitinin C
Authors: Fernandes Victor Hugo Catricala , Viera Natalie de Barros , Zanini Luiza Beatriz Lima , Silva Aline de Fátima , Salem Paula Pio de Oliveira , Soares Marisi Gomes , Nicácio Karen de Jesus , de Paula Ana Claudia Chagas , Virtuoso Luciano Sindra , Oliveira Tiago Branquinho , Silva Eliane de Oliveira , Dias Danielle Ferreira , Chagas‐Paula Daniela Aparecida
Published: August 2019

There is some evidence in the literature of the photocyclization reaction of Tagitinin C (1) to Tagitinin F (2). Compound 2 has high pharmacological potential, but it is not easy to obtain, while compound 1 is easily obtained from a widespread plant, Tithonia diversifolia. Among different reaction conditions monitored, one was found that allowed the cyclization of 1 into 2 in <15 min in a photo‐dependent reaction. Scaling‐up the photocyclization of the pure compound 1 into 2 demonstrated 100% yield, and the isolation of 2 from a UV‐irradiated extract was eight‐fold higher than the quantity isolated from the non‐UV‐irradiated extract. We were also able to better understand the process of photoconversion and determine methods to isolate and quantify these compounds, which are known for their important antitumoral activities among other important pharmacological properties.
Evaluating success of various restorative interventions through drone‐ and field‐collected data, using six putative framework species in Argentinian Patagonia
Authors: Pérez Daniel R. , Pilustrelli Claudio , Farinaccio Fernando M. , Sabino Guillermo , Aronson James
Published: August 2019

Field data and unmanned aerial vehicles, also known as drones, were used to analyze a long‐term experiment in a severely degraded area of the “Monte,” one of the most arid and degraded biomes in Argentina. Field methods and drone orthoimages obtained from flights of a quadcopter at 20 and 40 m were used to compare plantation plots versus natural recovery on scarified sites, and the field performance of six putative framework species under four different treatments was evaluated. After 5 years of recovery in soils with almost no organic matter and mean annual rainfall averaging 145 mm, plantation plots had high survival rates (>65%) for all species as determined through both field survey and drone imagery. Three species were planted with a greater number of seedlings due to their availability in nurseries. For these species experimental treatments were studied statistically. Independently of treatment applied (control; 1/2 L hydrogel; 1 L hydrogel; 1 L of hydrogel + 1/2 kg of organic compost), highest survival rates were found for P. flexuosa var. depressa (88% ± 14.8) and A. lampa (84% ± 14.8). Drone images and field data both showed that these two putative framework species had the highest plant cover. In sharp contrast, mechanical scarification without planting or other treatments induced very low recovery (<2%). We demonstrate that drone imagery provides a new and very valuable tool for evaluating and monitoring restorative interventions in drylands.
Is gardening a useful metaphor for conservation and restoration? History and controversy
Authors: McEuen Amy B. , Styles Megan A.
Published: August 2019

As the wilderness metaphor has decreased in utility due to widespread human‐driven environmental change, conservationists and restorationists have struggled to find new ways to inspire nature conservation. Some have suggested gardening as a new metaphor, but many are wary of its implications, particularly for animals viewed as threats or pests. Others, however, point out positive attributes for the metaphor including its focus on stewardship of nature which allows for positive human agency in ecosystems. We argue a gardening metaphor may also allow increased flexibility in approaches to biodiversity conservation, in part by allowing goals to be fit to communities and their specific cultural contexts. Wild gardening would seek to preserve global biodiversity while acknowledging the pivotal role humans now play in that process. Here we review the use of the garden metaphor over the last 25 years and discuss what wild gardening might mean for restoration. Consistent with a long history of environmental thought, we suggest such a metaphor will work best if it is coupled with a civic/stewardship ethic and a good dose of humility on the part of all gardeners.
Validation and method comparison of the use of densitometry to quantify monoclonal proteins in canine sera
Authors: Harris Adam Dugger , Rout Emily , Avery Anne , Bolte Denise , Belling‐Kelly Erica , Moore A Russell
Published: August 2019

Background

Densitometric quantitation using serum protein electrophoresis (SPE) is used to monitor monoclonal proteins (M‐proteins) in human patients but has not been validated in the dog. Serum globulin concentrations, species‐specific radial immunodiffusion (RID), and ELISAs are currently used in veterinary medicine.

Objective

We aimed to compare four methods that quantify M‐proteins using densitometry and biuret protein (dM‐protein) measurements. We also validated the best performing method and compared it with the RID and ELISA methods for measuring canine serum M‐protein.

Method

Serum from six normal dogs and 83 serum samples from 46 dogs with confirmed monoclonal gammopathies were used. A spike and recovery experiment with purified monoclonal IgG and IgM, inter‐run and intra‐run variability, linearity under dilution, and lower limit of detection were performed. Results of commercial canine RID and ELISA kits for total class‐specific immunoglobulin were compared with dM‐proteins.

Results

The corrected perpendicular drop gating method had <20% error for IgG/γ‐globulin and IgM/β‐globulin M‐protein quantifications. Linearity (r > .99), intra‐run CV (1.1%‐2.3%), and inter‐run CVs (2.0%‐3.5%) were acceptable. Correlation between the RID and densitometry results ranged from r = .25 to r = .88, depending on the class. The RID result was greater than that of the biuret total protein in 26/63 (41%) IgA cases. A panel of IgG, IgA, and IgM RIDs failed to correctly identify an IgM paraproteinemia in 6/6 (100%) cases. Densitometry was not comparable with any other tested method.

Conclusion

Densitometric quantitation is a valid technique for measuring M‐proteins in the β‐ and γ‐globulin regions. Immunotyping via RID using the tested kit does not appear to detect IgM. Densitometry is recommended for measuring M‐proteins in canine patients.
Mechanisms of soil moisture availability in vadose zone of a sand dune system: Linking soil physical properties and rainfall patterns
Authors: Zhou Hong , Zhao Wen-zhi
Published: August 2019

Sand dune systems in the arid region of north‐western China are maintained by sand‐stabilizing vegetation, which provides critical ecosystem services. Limited knowledge of soil moisture recharge in these systems hinders sand stabilization efforts. To increase the understanding of soil moisture response to rainfall, we analysed soil water transport in the desert vadose zone of sand dunes and dune slacks following four natural rainfall events during the growing season of 2017. Rainfall was dominated by small rain events (<5.0 mm), accounting for 58% of total rainfall events. Soil moisture at 5–25 cm depth in dune slacks was significantly higher and more variable to 60 cm depth than in sand dunes. Soil moisture at 5 cm depth was replenished with rainfall amounts of <5 mm in dune slacks, but not in sand dunes. When rainfall amount reached 20 mm, soil moisture in dune slack and in sand dune increased, but was much higher in dune slack than in sand dune at depth of 5 cm; after the rain, soil moisture remained at a relatively high level in dune slack but not in sand dune. This was possible because dune slacks had higher silt contents and root biomass, which played a key role in improving soil water holding capacity or accelerating rainfall infiltration at 0–25 cm depth. Overall, the rainfall‐driven hydrological regime coupled with soil physical factors regulated spatial and temporal variability of soil moisture in a sand dune system.
Assessing rainwater harvesting systems and reliability analysis of storage tanks: a monitoring study and system simulation
Authors: Molaei Oweis , Kouchakzadeh Mahdi , Haghighi Fashi Fereshte
Published: August 2019

This study applied a simulation model to evaluate the reliability of rainwater harvesting systems (RWHs) and the potential for rainwater storage was investigated in three different buildings. The results indicated that the tank stores 97.7% of the run‐off from the gym roof. Modelling the volume of the tank connected to the gym roof showed that 100% reliability can not be achieved for a roof with a relatively small area. The reliability for a tank larger than 2600 L was independent of the size of the tank. Maximum reliability of the RWHs was 70% of the total days of the year for a tank volume of 10 000 L, 300 m2 roof area and daily demand of 300 L (60% demand). Minimum reliability was 3% of the total days of the year for a tank volume of 1000 L, 100 m2 roof area and a daily demand of 1000 L (80% demand).
Bacterial biofilm‐based nitrate and phosphate removal from rubber latex wastewater for sustainable water usage
Authors: Dey Sumon , Kumar Himanshu , Sinha Swapan Kumar , Goud Vaibhav V. , Das Surajit
Published: August 2019

Rubber latex wastewater contains high level of inorganic anions such as nitrate and phosphate which are more prevalent as groundwater contaminant. The applicability of biofilm forming bacterial isolates to treat rubber latex wastewater was investigated. Microscopic analyses (CLSM and SEM) evaluated that the major component of biofilm other than bacterial cell is EPS matrix. EPS was found to contain higher proportion of lipids and polysaccharide which are required for attachment and absorption of nutrients. ATR‐FTIR and 1H NMR revealed the functional groups present in EPS. Rhodococcus rhodochrous CTI‐14 showed robust biofilm followed by Cellulosimicrobium sp. CTB‐10. Out of six bacterial consortia tested, consortium‐D efficiently removed 95%

–N and 75%

. Taguchi method revealed the optimum parameters to remove the nutrients. The consortium‐D optimally reduced nitrate and phosphate at pH 7 at 37°C. Consortium‐D composed of Cellulosimicrobium sp. CTB‐10, Aeromonas veronii OS‐01, Lysinibacillus sphaericus RTA‐01 and Rhodococcus rhodochrous CTI‐14 was found to be the most efficient bacterial consortium to treat rubber latex wastewater.
Contribution of prostaglandins to exercise hyperaemia: workload, ethnicity and sex matter!
Authors: Aiku Abimbola O. , Marshall Janice M.
Published: August 2019

The contribution of prostaglandins (PGs) to exercise hyperaemia is controversial. In this review, we argue this is partly explained by differences in exercise intensity between studies. The effects of cyclooxygenase (COX) inhibition and PG assays indicate that PGs contribute more at moderate to heavy than at light workloads and are mainly released by low tissue O2. But, the release and actions of PGs also depend on other O2‐dependent dilators including ATP, adenosine and NO. K+ may inhibit the action of PGs and other mediators by causing hyperpolarization, but contributes to the hyperaemia. Thus, at lighter loads, the influence of PGs may be blunted by K+, while COX inhibition leads to compensatory increases in other O2‐dependent dilators. In addition, we show that other sources of variability are sex and ethnicity. Our findings indicate that exercise hyperaemia following rhythmic contractions at 60% maximum voluntary contraction, is smaller in young black African (BA) men and women than in their white European (WE) counterparts, but larger in men than in women of both ethnicities. We propose the larger absolute force in men causes greater vascular occlusion and accumulation of dilators, while blunted hyperaemia in BAs may reflect lower oxidative capacity and O2 requirement. Nevertheless, COX inhibition attenuated peak hyperaemia by ∼30% in WE, BA men and WE women, indicating PGs make a substantial contribution in all three groups. There was no effect in BA women. Lack of PG involvement may provide early evidence of endothelial dysfunction, consistent in BA women with their greater risk of cardiovascular disease.

image
Broadening vaccine strategies to induce HIV broadly neutralizing antibodies
Authors: Boyle Michelle
Published: August 2019

Vaccination with anti-idiotype antibodies can activate and target germline B cell precursors of HIV broadly neutralizing antibodies.
Development and Characterization of a Reverse-Genetics System for Influenza D Virus
Authors: Yu Jieshi , Liu Runxia , Zhou Bin , Chou Tsui-wen , Ghedin Elodie , Sheng Zizhang , Gao Rongyuan , Zhai Shao-lun , Wang Dan , Li Feng
Published: August 2019

Influenza D virus (IDV) is a new type of influenza virus that uses cattle as the primary reservoir and infects multiple agricultural animals. Increased outbreaks in pigs and serological and genetic evidence of human infection have raised concerns about potential IDV adaptation in humans. Here, we have developed a plasmid-based IDV reverse-genetics system that can generate infectious viruses with replication kinetics similar to those of wild-type viruses following transfection of cultured cells. Further characterization demonstrated that viruses rescued from the described RGS resembled the parental viruses in biological and receptor-binding properties. We also developed and validated an IDV minireplicon reporter system that specifically measures viral RNA polymerase activity. In summary, the reverse-genetics system and minireplicon reporter assay described in this study should be of value in identifying viral determinants of cross-species transmission and pathogenicity of novel influenza D viruses.
Acute Vector-Borne Viral Infection: Zika and MinION Surveillance
Authors: de Jesus Jaqueline Goes , Giovanetti Marta , Rodrigues Faria Nuno , Alcantara Luiz Carlos Junior
Published: August 2019

The MinION sequencer was launched by the Oxford Nanopore Technologies start-up as a disruptive technology for genome sequencing based on single-molecule synthesis. Its characteristics as a portable device, low cost, and simple library preparation have made it a good candidate for field researchers. MinION has been used to sequence a number of microorganisms, such as bacteria, viruses, and fungi. Based on the experience that characterized the Ebola virus genetic diversity in Guinea during the 2014-2015 outbreak, the ZiBRA (Zika in Brazil Real-time Analysis) project aimed to sequence a large number of Zika virus genomes during a mobile laboratory trip in northeast Brazil to provide important epidemiological information about the spread of this disease in this country. In response to the positive and rapid results obtained by the ZiBRA project, the Brazilian Ministry of Health and many leading institutions, such as the Pan American Health Organization and WHO, have shown interest in expanding the strategy used in this project to other countries dealing with arbovirus infection.*

This article is part of a curated collection.
Malaria Molecular Epidemiology: An Evolutionary Genetics Perspective
Authors: Escalante Ananias A. , Pacheco M. Andreína
Published: August 2019

Malaria is a vector-borne disease that involves multiple parasite species in a variety of ecological settings. However, the parasite species causing the disease, the prevalence of subclinical infections, the emergence of drug resistance, the scale-up of interventions, and the ecological factors affecting malaria transmission, among others, are aspects that vary across areas where malaria is endemic. Such complexities have propelled the study of parasite genetic diversity patterns in the context of epidemiologic investigations. Importantly, molecular studies indicate that the time and spatial distribution of malaria cases reflect epidemiologic processes that cannot be fully understood without characterizing the evolutionary forces shaping parasite population genetic patterns. Although broad in scope, this review in the
Microbiology Spectrum
Curated Collection: Advances in Molecular Epidemiology highlights the need for understanding population genetic concepts when interpreting parasite molecular data. First, we discuss malaria complexity in terms of the parasite species involved. Second, we describe how molecular data are changing our understanding of malaria incidence and infectiousness. Third, we compare different approaches to generate parasite genetic information in the context of epidemiologically relevant questions related to malaria control. Finally, we describe a few
Plasmodium
genomic studies as evidence of how these approaches will provide new insights into the malaria disease dynamics.

*

This article is part of a curated collection.
Protein Export into and across the Atypical Diderm Cell Envelope of Mycobacteria
Authors: van Winden Vincent J. C. , Houben Edith N. G. , Braunstein Miriam
Published: August 2019

Mycobacteria, including the infamous pathogen
Mycobacterium tuberculosis
, are high-GC Gram-positive bacteria with a distinctive cell envelope. Although there is a typical inner membrane, the mycobacterial cell envelope is unusual in having its peptidoglycan layer connected to a polymer of arabinogalactan, which in turn is covalently attached to long-chain mycolic acids that help form a highly impermeable mycobacterial outer membrane. This complex double-membrane, or diderm, cell envelope imparts mycobacteria with unique requirements for protein export into and across the cell envelope for secretion into the extracellular environment. In this article, we review the four protein export pathways known to exist in mycobacteria: two conserved systems that exist in all types of bacteria (the Sec and Tat pathways) and two specialized systems that exist in mycobacteria, corynebacteria, and a subset of low-GC Gram-positive bacteria (the SecA2 and type VII secretion pathways). We describe the progress made over the past 15 years in understanding each of these mycobacterial export pathways, and we highlight the need for research to understand the specific steps of protein export across the mycobacterial outer membrane.
A child in shock: carotid blowout syndrome
Authors: Stilwell Philippa Anna , Robertson Fergus , Bhate Sanjay , Sutcliffe Alastair G
Published: August 2019

Paediatricians commonly encounter neck lumps during their routine clinical practice; vascular abnormalities, such as (pseudo)aneurysms, are a rare cause of these. Pseudoaneurysms of the carotid artery in children are usually the result of blunt or penetrating trauma, infection or vasculitis/connective tissue disorders. They can present with a variety of symptoms including neck pain, as a pulsatile neck mass or with compressive symptoms (for example, cranial nerve palsies or dyspnoea). Pseudoaneurysms carry a risk of rupture in which case they are fatal, unless immediate treatment is provided.

We report a 17-month-old male child with idiopathic carotid artery blowout syndrome presenting with acute oropharyngeal haemorrhage leading to asystolic cardiac arrest. He was successfully resuscitated and emergency embolisation controlled the bleeding. Despite extensive left hemispheric infarct, he has survived.

Carotid artery blowout syndrome needs to be recognised as a potential cause of major haemorrhage in childhood. The purpose of this case report is to remind readers of the differential diagnosis and work-up of a child presenting with a neck lump, to highlight important aspects of the acute management of major haemorrhage and massive blood transfusion in paediatrics, to describe the aetiology, presentation and management of carotid artery pseudoaneurysm in children and to discuss long term rehabilitation in patients with consequent neurological sequelae (including the need for input from multiple specialty teams).
Use of paediatric early warning scores in intermediate care units
Authors: Lampin Marie Emilie , Duhamel Alain , Behal Hélène , Recher Morgan , Leclerc Francis , Leteurtre Stéphane
Published: August 2019

Objective

Paediatric early warning scores (EWS) were developed to detect deterioration in paediatric wards or emergency departments. The aim of this study was to assess the relationship between three paediatric EWS and clinical deterioration detected by the nurse in paediatric intermediate care units (PImCU).

Methods

This was a prospective, observational, multicentre study at seven French regional hospitals that included all children <18 years of age. Clinical parameters included in three EWS (Paediatric Advanced Warning Score, Paediatric Early Warning Score and Bedside Paediatric Early Warning System) were prospectively recorded every 8 hours or in case of deterioration. The outcome was a call to physician by the nurse when a clinical deterioration was observed. The cohort was divided into derivation and validation cohorts. An updated methodology for repeated measures was used and discrimination was estimated by the area under the receiver-operating curve.

Results

A total of 2636 children were included for 14 708 observations to compute a posteriori the EWS. The discrimination of the three EWS for predicting calls to physicians by nurses was good (range: 0.87–0.91) for the derivation cohort and moderate (range: 0.71–0.76) for the validation cohort. Equations for probability thresholds of calls to physicians, taking into account the time t, the score at time t and the score at admission, are available.

Conclusion

These three EWS developed for children in paediatric wards or emergency departments can be used in PImCU to detect a clinical deterioration and predict the need for medical intervention.
Rare cause of pulmonary hypertension – pulmonary tumour thrombotic microangiopathy
Authors: O’Brien Joseph , Jones Nicholas , Horrigan Mark , Al-Kaisey Ahmed M
Published: August 2019

Pulmonary tumour thrombotic microangiopathy (PTTA) is a rare but lethal cause of pulmonary hypertension (PHT). Its underlying mechanism is believed to be fibrocellular intimal proliferation and microthrombosis. It has been reported in association with gastric adenocarcinoma and breast, pancreatic and lung cancers. The diagnosis is often made on postmortem examination due to the absence of diagnostic criteria and its rare occurrence. We describe the case of a middle-aged man who presented with rapidly progressive PHT. He deteriorated into multiorgan failure despite aggressive medical therapy and died 4 weeks after his initial presentation. A postmortem examination confirmed the diagnosis of PTTA in addition to the finding of signet cell gastric adenocarcinoma. This case highlights the lethal nature of this rare condition, the ongoing challenges in making an antemortem diagnosis, and the importance of postmortem examination in determining the cause of death to provide closure for both, the treating physician and the family.
Resolution of necrolytic migratory erythema with somatostatin analogue in a patient diagnosed with pancreatic glucagonoma
Authors: Saavedra Cristina , Lamarca Angela , Hubner Richard A
Published: August 2019

A 70-year-old man reported progressive weight loss, fatigue and a generalised rash. The rash was consistent with necrolytic migratory erythema, further investigations were performed and the patient was diagnosed with a mass in the tail of the pancreas, in keeping with a localised glucagonoma. Somatostatin analogue therapy was started for symptom control, leading to complete resolution of the skin rash and an improvement in constitutional symptoms. Subsequently, the pancreatic lesion was excised, and pathology assessment confirmed the diagnosis of well-differentiated neuroendocrine tumour with high expression of glucagon compatible with glucagonoma.
Granulomatous interstitial nephritis: a rare diagnosis with an overlooked culprit
Authors: Figueiredo Ana Carolina , Rodrigues Luís , Sousa Vítor , Alves Rui
Published: August 2019

Granulomatous interstitial nephritis (GIN) is a rare entity identified in <1% of native kidney biopsies. The most frequent aetiology is drug-related, followed by systemic granulomatous conditions. Among drugs implicated in GIN, antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent. We report the case of a 45-year-old white man referred to a nephrology consult due to chronic kidney disease. He had a history of arterial hypertension with 10 years of evolution, hyperuricaemia, medicated with allopurinol and NSAID abuse for at least 20 years. Urine sediment was blunt, without proteinuria. Renal ultrasound was normal. A kidney biopsy revealed well-defined epithelioid granulomas with glomerular wrinkling and collapse. Infectious and systemic conditions were excluded, favouring the hypothesis of drug-induced GIN, probably related to NSAIDs. Kidney biopsy remains the gold standard for the diagnosis of GIN. Facing a patient with renal failure without significant proteinuria or active sediment, one should look for causes of tubulointerstitial injury.
Acrometastases to the hand in stomach carcinoma: a rare entity
Authors: Kumar Ashok
Published: August 2019

Acrometastasis caused by malignancy is a very rare phenomenon, and gastric malignancy metastasising to the hands is an even rarer entity. It accounts for only 0.1% of all metastatic osseous involvement, and may be a late manifestation of malignancy or may even be a presenting symptom. It is generally seen with lung primary, followed by kidney and breast, and less frequently with colon, liver, prostate, rectum and stomach primaries. The terminal phalanges are the most common sites of metastases, followed by the metacarpals and the proximal phalanges. We present a case of stomach carcinoma with metastases to the liver and adrenals which was managed with three lines of chemotherapy. He was lost to follow-up and reported after 1 year with swelling over his left hand, which was managed with palliative radiation to the hand in view of severe pain, followed by chemotherapy.
Brown recluse (L. rufescens) can bite in Northern Italy, too: first case report and review of the literature
Authors: Abbott David Michael , Brunetti Enrico , Barruscotti Stefania , Brazzelli Valeria
Published: August 2019

The brown recluse, or fiddleback (violin) spider, is a poisonous spider of theLoxoscelesgenus that resides in warmer regions and old structures making the warm Mediterranean climate a natural habitat for the European species,L. rufescens. Even in infested households, however, bites are rare, as they are nocturnal and unaggressive. In 2015, the first supposed death byL. rufescensoccurred in Italy, but before and even after such bite, the literature on these spiders has been under-represented. This case report documents a confirmed bite by a violin spider on a medical student in Pavia, Italy. The presentation in this case was initially with general systemic, flu-like symptoms, then as cellulitis with lymphangitis that persisted for nearly 2 weeks until resolving without prolonged or complicated pathology. We present the first documented case of aL. rufescensbite in Northern Italy, to the best of our knowledge.
Ankylosing spondylitis presenting with enthesitis at an uncommon site and fever of unknown origin
Authors: Kanda Naoki , Takeda Koichi , Hatakeyama Shuji , Matsumura Masami
Published: August 2019

A 58-year-old man presented with a 2-month history of arthralgia and bilateral temporal region pain, and a 1-month history of fever. He had had refractory neck pain since his 20s. Reduced cervical and lumbar mobility was observed. Radiographs of cervical and thoracic vertebrae disclosed syndesmophytes. Pelvic radiographs showed sclerosis in the right sacroiliac joint and ankylosis in the left sacroiliac joint. MRI with contrast enhancement showed enthesitis in the upper extremities and enhancement in the bilateral temporal muscle, which indicated enthesitis of temporal muscle. He was diagnosed with ankylosing spondylitis based on the limitation in mobility of the lumbar spine and radiographic findings. To the best of our knowledge, this is the first report describing enthesitis of the temporal muscle. This case highlights that ankylosing spondylitis can be accompanied with enthesitis at the temporal muscle and fever of unknown origin at the initial presentation.
LeHeR, a simple novel approach for difficult airway in non-trauma patients
Authors: Yezid Nur Hafiza , Poh Khadijah , Md Noor Julina , Arshad Afifi
Published: August 2019

Managing the difficult airway presents a great challenge to anaesthesiologists and emergency physicians. Although there are many methods and scoring systems available to predict and anticipate difficult airway, the dictum in emergency airway is to always expect the unexpected. We have encountered a novel simple method of improving laryngoscopic view in difficult airway. We report four cases of difficult airway encountered in our district hospital from November 2017 to December 2018, in which intubation was performed using a simple manoeuvre called supine left head rotation (LeHeR). In all these cases, LeHeR manoeuvre has proven to be successful after more than a single attempt at intubation using various methods. The manoeuvre improves drastically the laryngoscopic view of Cormack-Lehane from 3B and 4 to 1 and 2.
Hemophagocytic lymphohistiocytosis: a rare association with pulmonary cryptococcosis
Authors: Singh Pawan Kumar , Kodati Rakesh , Rohilla Manish , Sharma Prashant
Published: August 2019

Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory syndrome characterised by unregulated macrophage and T-lymphocyte activation, resulting in cytokine overproduction and subsequent histiocytic phagocytosis. Here we report a case of pulmonary cryptococcosis, in a 59-year-old diabetic patient, with no other risk factors whose clinical course was complicated by secondary hemophagocytosis. Even after addressing the primary underlying illness (pulmonary cryptococcosis), his clinical condition continued to worsen. After excluding the other causes of HLH and possible reasons of his clinical worsening, glucocorticoids were added following which the patient experienced a remarkable improvement in his clinical and laboratory parameters. To our knowledge, this is the first case report of HLH being caused by pulmonary cryptococcosis and only second case report of cryptococcosis being complicated with HLH (previous report being associated with meningoencephalitic cryptococcosis).
Granulomatosis with polyangiitis with intestinal involvement successfully treated with rituximab and surgery
Authors: Sato Hitoshi , Shima Kentaro , Sakata Hanae , Ohtoh Takashi
Published: August 2019

Intestinal perforation is a rare and life-threatening complication in granulomatosis with polyangiitis (GPA). A 55-year-old Japanese man who had been undergoing maintenance haemodialysis was diagnosed with GPA via a pathologically proven nasal granuloma and proteinase 3-antineutrophil cytoplasmic antibody-positive status. He was started on 60 mg prednisolone. Haematochezia was observed due to the colon ulcer after treatment initiation. Two doses of intravenous cyclophosphamide were administered every 2 weeks. Despite the treatment, there were two episodes of severe abdominal pain with peritonitis within a week. Perforation of descending colon and severe ischaemia of the ascending colon was observed during each emergency laparotomy, and ileostomy was performed. Vasculitis in the small vessels was confirmed. In conclusion, patient with severe intestinal involvement and who was unresponsive to conventional therapy was treated with surgery followed by rituximab administration, and remission was achieved.
Cervical intraepithelial neoplasia grade 3 in a patient following Gardasil vaccination
Authors: McLucas Bruce , Vail Eric , Chua Katherine Jane , Walt Gabriel
Published: August 2019

Essentially all cervical dysplasia is caused by human papilloma virus (HPV). Three HPV vaccines have been available, with Gardasil-9 being the most recently approved in the USA. Gardasil-9 covers high-risk HPV strains 16, 18, 31, 33, 45, 52 and 58 as well as low-risk strains 6 and 11. A 33-year-old woman (Gravida 2, Para 2) received Gardasil in 2006. Subsequently, her pap smear revealed low grade squamous intraepithelial lesion. Cervical biopsies performed in 2015 and 2016 revealed cervical intraepithelial neoplasia grade 1 (CIN 1). She underwent loop electrosurgical excision procedure for persistent CIN 1, which demonstrated CIN 3. Genotyping revealed HPV type 56 infection. The advancement of Gardasil-9 vaccine only offers 90% protection to patients against HPV-related disease. Lay literature may mislead patients to think they have no risk of HPV infection.
Worsening of movement disorder following treatment with electroconvulsive therapy in a patient with Huntington’s disease
Authors: Abeysundera Hesitha , Campbell Allan , Sarma Shanthi
Published: August 2019

This paper describes a patient who presented with treatment-resistant depression with comorbid anxiety symptoms in the context of Huntington’s disease (HD) and developed worsening movement disorder symptoms after commencing electroconvulsive therapy (ECT) for depression. The aim of this case report is to provide medical practitioners with a greater awareness of the possibility of worsening movement disorders when using ECT for depression in a patient with HD.
Removal of an inhaled stoma button distal to a reactionary tracheal stenosis: a difficult airway case
Authors: Gray Gillian , Adams Mark , Black Myles , Sidhu Pushpinder
Published: August 2019

We present the complex and rare case of an inhaled stoma button causing proximal tracheal stenosis in a laryngectomy patient. The patient was unaware he had inhaled his button and presented with increasing shortness of breath and noisy breathing. In this case we discuss the challenging management of the stenotic tracheal segment above the impacted stoma button and the surgical approach to this difficult airway. The distal foreign body was safely removed using rigid bronchoscopy and balloon dilatation. This difficult airway required multidisciplinary input from the ENT, cardiothoracic and anaesthetic teams.
Major imbalance of thyroid function after laparoscopic sleeve gastrectomy
Authors: Brutus Laurent , Poupard Armelle , Le Glatin Clément
Published: August 2019

In patients with substituted hypothyroidism, laparoscopic sleeve gastrectomy may interfere with thyroid balance by varying body weight or by altering the absorption of hormone therapy. A 58-year-old female patient presented with a major thyroid imbalance after sleeve gastrectomy, manifesting itself in large-scale changes in thyroid stimulating hormone (TSH) levels. The transition from a tablet treatment to a liquid form alleviated burden of treatment, unfortunately without normalising TSH. Our case emphasises the importance of the understanding of hypothalamic–pituitary–thyroid feedback control mechanisms together with good galenic choice, management of associated conditions and the elimination of other causes of variations of TSH levels during the management of hypothyroid patients after sleeve gastrectomy.
Cornea verticillata in Fabry disease: a comparative study between slit-lamp examination and in vivo corneal confocal microscopy
Authors: Leonardi Andrea , Carraro Gianni , Modugno Rocco Luigi , Rossomando Valentino , Scalora Tania , Lazzarini Daniela , Calò Lorenzo
Published: August 2019

Purpose

To compare the diagnostic power of slit-lamp examination with the in vivo corneal confocal microscopy (IVCM) as the gold standard in assessing the presence of corneal epithelial deposits in patients with Fabry disease (FD).

Methods

Fourteen patients with FD (4 males, 10 females; mean age, 46.8 years) and eight healthy controls (4 males, 4 females; mean age, 36.75 years) were included. All subjects underwent slit-lamp examination and IVCM of both central and peripheral corneal quadrants with the Heidelberg Retina Tomograph-III in combination with the Rostock Cornea Module.

Results

In patients with FD, 9 of 28 eyes (32%) showed the presence of cornea verticillata at the slit-lamp examination and 25 eyes (89%) showed the presence of epithelial hyper-reflective deposits at the IVCM. Of the 19 eyes negative at the slit-lamp examination, 16 eyes showed the presence of epithelial deposits at the IVCM. Compared with controls, patients with FD had a significantly reduced number, density and length of nerve fibres at the level of corneal sub-basal nerve plexus, but a significantly higher grade of fibres tortuosity.

Conclusions

The slit-lamp examination has a limited diagnostic power in the detection of epithelial deposits in patients with FD when compared with the IVCM. In fact, the slit-lamp examination suffers from a high number of false negative results and, consequently, from a low negative predictive value (16%). IVCM allows the detection of corneal microstructural changes in patients with FD and may represent a reliable tool for the early diagnosis and follow-up of the disease.
Acanthamoeba keratitis therapy: time to cure and visual outcome analysis for different antiamoebic therapies in 227 cases
Authors: Papa Vincenzo , Rama Paolo , Radford Cherry , Minassian Darwin C , Dart John K G
Published: August 2019

Aims

To test the hypothesis that Acanthamoeba keratitis (AK) outcomes differ for different topical antiamoebic therapies (AAT) and to provide the detailed patient outcome data.

Methods

A retrospective cohort study of 227 patients developing AK between 25 July 1991 and 10 August 2012. Inclusion criteria required a complete record of AAT treatment for both the primary outcome of a medical cure rate at 12 months and the secondary outcome of Snellen visual acuity ≤6/24 and/or surgical intervention. Analysis used multivariable regression to control for differences in baseline disease characteristics for both primary and secondary outcomes with unadjusted analyses for other outcomes. Subjects were categorised for analysis both by the AAT used at baseline and also by mutually exclusive AAT (patients exposed to all the drugs in each group, and no others, for some period). AAT categories were PHMB monotherapy, PHMB+diamidine, PHMB+chlorhexidine+diamidine, diamidine monotherapy and other AAT.

Results

Analysis by baseline AAT showed no notable difference between treatments for both a medical cure at 12 months in 60.79% (138/227) or for a poor outcome in 49.34% (112/227). When AATs were analysed by mutually exclusive groups, PHMB monotherapy provided the best outcomes. These findings are subject to bias requiring careful interpretation. Overall cure rates for the 214 subjects with resolved outcomes were 94.27% (214/227), median time to cure 5 months (IQR 3.25–9.00 months) and range 1–26.24 months.

Conclusion

PHMB 0.02% monotherapy for the initial treatment of AK is as effective as biguanide+diamidine combination therapy. Chlorhexidine monotherapy was too infrequent for comparison. The outcome data are the most detailed available.
One-year outcomes of anti-vascular endothelial growth factor therapy in peripapillary choroidal neovascularisation
Authors: Singh Sumit Randhir , Fung Adrian T , Fraser-Bell Samantha , Lupidi Marco , Mohan Sashwanthi , Gabrielle Pierre-Henry , Zur Dinah , Iglicki Matias , M López-Corell Paula , Gallego-Pinazo Roberto , Farinha Cláudia , Lima Luiz H , Mansour Ahmad M , Casella Antonio Marcello , Wu Lihteh , Silva Rufino , Uwaydat Sami H , Govindahari Vishal , Arevalo Jose Fernando , Chhablani Jay
Published: August 2019

Purpose

To report the visual and anatomical outcomes in eyes with peripapillary choroidal neovascularisation (CNV) through 12 months.

Methods

This was a multicentre, retrospective, interventional case series which included treatment-naïve cases of peripapillary choroidal neovascular membrane (CNVM) with a minimum follow-up of 12 months. Multimodal imaging which comprised optical coherence tomography (OCT), fluorescein angiography and/or indocyanine green angiography was performed at baseline and follow-up visits. OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and retinal and choroidal thickness at site of CNV. Patients were treated with anti-vascular endothelial growth factors (VEGF) onpro re nataprotocol, photodynamic therapy, laser photocoagulation or a combination. Main outcome measures were change in best corrected visual acuity (BCVA) and OCT parameters.

Results

A total of 77 eyes (74 patients; mean age: 61.9±21.8 years) with a mean disease duration of 9.2±14.1 months were included. BCVA improved significantly from 0.55±0.54 logMAR (20/70) at baseline to 0.29±0.39 logMAR (20/40) at 12 months (p<0.001) with a mean of 4.9±2.9 anti-VEGF injections. CMT, SFCT and retinal thickness at site of CNVM reduced significantly (p<0.001, <0.001 and 0.02, respectively) through 12 months. The most common disease aetiologies were neovascular age-related macular degeneration, and idiopathic, inflammatory and angioid streaks. Age (p=0.04) and baseline BCVA (p<0.001) were significant predictors of change in BCVA at 12 months.

Conclusion

Peripapillary CNVM, though uncommon, is associated with diverse aetiologies. Anti-VEGF agents lead to significant visual acuity and anatomical improvement in these eyes over long term irrespective of the aetiology.
Singapore Chinese Eye Study: key findings from baseline examination and the rationale, methodology of the 6-year follow-up series
Authors: Majithia Shivani , Tham Yih Chung , Chee Miao Li , Teo Cong Ling , Chee Miao-Ling , Dai Wei , Kumari Neelam , Lamoureux Ecosse Luc , Sabanayagam Charumathi , Wong Tien Yin , Cheng Ching-Yu
Published: August 2019

Background/aims

In order to address the eye care needs of the increasing numbers of elderly Chinese globally, there is a need for comprehensive understanding on the longitudinal trends of age-related eye diseases among Chinese. We herein report the key findings from the baseline Singapore Chinese Eye Study (SCES-1), and describe the rationale and methodology of the 6-year follow-up study (SCES-2).

Methods

3353 Chinese adults who participated in the baseline SCES-1 (2009–2011) were invited for the 6-year follow-up SCES-2 (2015–2017). Examination procedures for SCES-2 included standardised ocular, systemic examinations and questionnaires identical to SCES-1. SCES-2 further included new examinations such as optical coherence tomography angiography, and questionnaires to evaluate health impact and economic burden of eye diseases.

Results

In SCES-1, the age-adjusted prevalence of best-corrected low vision (VA<6/12, better-seeing eye) and blindness (VA<6/60, better-seeing eye) were 3.4% and 0.2%, respectively. The prevalence rates for glaucoma, age related macular degeneration, and diabetic retinopathy (among diabetics) were 3.2%, 6.8%, 26.2%, respectively. Of the 3033 eligible individuals from SCES-1, 2661 participated in SCES-2 (response rate=87.7%). Comparing with those who did not attend SCES-2, those attended were younger, had higher SES (all p<0.001), but less likely to be a current smoker, to have diabetes, hypertension, hyperlipidaemia (all p≤0.025).

Conclusions

Building on SCES-1, SCES-2 will be one of the few longitudinal population-based eye studies to report incidence, progression, and risk factors of major age-related eye diseases. Findings from this cohort may offer new insights, and provide useful reference information for other Chinese populations elsewhere.