bluuebunny/crossref_metadata_2025 huggingface dataset:
Custom extracellular matrix cylinder mitral valve in a pediatric patient
Authors: Cua Clifford L. , Johnston Pace , Harmon Jill , Shelton Kathryn , McConnell Patrick I.
Published: September 2017

Mitral valve construction using extracellular matrix (ECM) is a relatively new procedure. In this case, a 15‐month‐old boy with a history of severe mitral valve regurgitation secondary to endocarditis underwent mitral valve surgery. Mitral valve repair was not possible, and thus, a 17 mm extracellular matrix cylinder valve (ECM‐CV) was constructed for valve replacement. The ECM‐CV is clearly imaged using echocardiography, especially three‐dimensional imaging, that helped define valve function. As the use of ECM for valve construction increases, echocardiography will play an essential role in evaluating the function and mechanics of these novel valves.
Early anthracycline‐induced cardiotoxicity monitored by echocardiographic Doppler parameters combined with serum hs‐cTnT
Authors: Zhang Chu‐Jie , Pei Xiao‐Li , Song Fei‐Yan , Guo Ye , Zhang Qun‐Ling , Shu Xian‐Hong , Hsi David H. , Cheng Lei‐Lei
Published: September 2017

Purpose

As growing numbers of long‐term cancer survivors faced with the cardiac side effects by anthracycline treatment, it is necessary to explore the optimal monitoring method for the early detection of cardiac toxicity.

Methods

We conducted a retrospective analysis of 82 consecutive patients with diffuse large B‐cell lymphoma treated with chemotherapy. Echocardiographic Doppler imaging‐derived Tei index and mitral annular peak systolic velocity (Sm) measured by tissue Doppler imaging TDI, serum high‐sensitivity cardiac troponin T (hs‐cTnT) levels, and left ventricular ejection fraction (LVEF) by multigated radionuclide angiography (MUGA) were obtained before, after 2–4, and after 6–8 chemotherapy cycles. Cardiotoxicity was defined as a relative reduction of LVEF ≥10% from the baseline or LVEF <50% as measured by MUGA.

Results

Following chemotherapy, 24 (29.3%) patients developed detectable cardiac abnormality during the treatment. Five (6.1%) patients' cardiac function changed from normal baseline LVEF to <50% after the chemotherapy. Echocardiographic pulse wave Doppler Tei index (PW Tei index) (baseline 0.347 ± 0.115 vs 2–4 cycles 0.459 ± 0.161 vs 6–8 cycles 0.424 ± 0.139, P = .000) inversely correlated with systolic (P < .001) and diastolic dysfunction (P < .001). Serum hs‐cTnT levels increased significantly following chemotherapy after 2–4 cycles of chemotherapy with anthracycline. The increase in PW Tei index of 0.095 [sensitivity, 69.2%; specificity, 64.5%; area under the curve (AUC) = 0.697; P = .005] and the Sm < 13.65 cm/s (sensitivity, 66.7%; specificity, 71%; AUC = 0.682; P = .009) combined with elevation of serum hs‐cTnT level of 0.0075 ng/mL (sensitivity, 69.2%; specificity, 83.9%; AUC = 0.790; P < .001) after 2–4 chemotherapy cycles from the baseline values can reliably predict cardiotoxicity.

Conclusions

We demonstrated that echocardiographic PW Doppler‐derived Tei index, and TDI‐derived Sm, combined with serum hs‐cTnT level can be obtained in outpatient settings to monitor early cardiac toxicity induced by anthracycline therapy.
Impact of acute left ventricular apical thrombus on cardioversion for atrial fibrillation
Authors: Vaidya Vaibhav R. , Prueksaritanond Suartcha , Bois John P. , Nadipalli Abhinav , Borgeson Daniel D. , Melduni Rowlens M.
Published: September 2017

Among patients undergoing cardioversion for atrial fibrillation, the presence of left ventricular thrombus is a relatively uncommon and challenging clinical dilemma. While left atrial appendage thrombus is a contraindication to cardioversion, there is paucity of data regarding the safety of cardioversion in with the presence of left ventricular apical thrombus. Also, thrombus characteristics such as protrusion and mobility on echocardiography are known risk factors for systemic embolism. In this article, we present a case highlighting the management of atrial fibrillation in the setting of left ventricular dysfunction, acute heart failure, and echocardiographic evidence of acute left ventricular apical thrombus.
Radiation exposure of cardiac sonographers working in an academic noninvasive cardiovascular imaging laboratory
Authors: Velez Michael R. , Orsinelli Maryellen H. , Orsinelli David A.
Published: September 2017

Background and Aim

Exposure to workplace radiation among cardiac sonographers has been felt to be low, and patient‐related sources have been considered negligible. Sonographers may be exposed to radiation from patient emitted sources as well as external sources in interventional laboratories. This study quantified radiation exposure to cardiac sonographers.

Methods

Cardiac sonographers, vascular imaging technologists, exercise physiologists, noninvasive nursing staff, and CT/MRI technologists were provided body dosimeter badges. Sonographers were provided dosimeter rings for their scanning hands. Radiation exposure was quantified from the dosimeter data, reported in millirems (mrem) for deep, eye, and shallow exposure, as well as shallow exposure data from the rings. Data were prospectively collected for 63 employees over a 12‐month period and retrospectively analyzed.

Results

The mean annual deep body exposure in sonographers was 8.2 mrem/year, shallow exposure 9.8 mrem/year, eye exposure 8.5 mrem/year, and ring exposure 207 mrem/year. There was a significant difference between body and ring exposure (P = .0002). When comparing exposure data between the vascular imaging technologists, CT/MRI technologists, noninvasive nursing staff, and the cardiac sonographers, there were no statistical differences (P > .23). Exercise physiologists had significantly higher exposure compared to sonographers (P < .03).

Conclusion

This single‐center experience demonstrates that, while exposure is low, cardiac sonographers are exposed to workplace radiation, most likely from patient emitted radiation. The finding that radiation exposure from rings exceeded body exposure supports this conclusion. Continued education and assessment of work flow practices should be employed to minimize staff radiation exposure.
Evidence of developmental niche construction in dung beetles: effects on growth, scaling and reproductive success
Authors: Schwab Daniel B. , Casasa Sofia , Moczek Armin P.
Published: September 2017

Niche construction occurs when organisms modify their environments and alter selective conditions through their physiology and behaviours. Such modifications can bias phenotypic variation and enhance organism–environment fit. Yet few studies exist that experimentally assess the degree to which environmental modifications shape developmental and fitness outcomes, how their influences may differ among species and identify the underlying proximate mechanisms. Here, we experimentally eliminate environmental modifications from the developmental environment ofOnthophagusdung beetles. We show that these modifications (1) differentially influence growth among species, (2) consistently shape scaling relationships in fitness‐related traits, (3) are necessary for the maintenance of sexual dimorphism, (4) influence reproductive success among females of at least one species and (5) implicate larval cultivation of an external rumen as a possible mechanism for environmental modification. Our results present evidence thatOnthophaguslarvae engage in niche construction, and that this is a fundamental component of beetle development and fitness.
Do biogenetic causal beliefs reduce mental illness stigma in people with mental illness and in mental health professionals? A systematic review
Authors: Larkings Josephine S. , Brown Patricia M.
Published: September 2017

Viewing mental illness as an ‘illness like any other’ and promoting biogenetic causes have been explored as a stigma‐reduction strategy. The relationship between causal beliefs and mental illness stigma has been researched extensively in the general public, but has gained less attention in more clinically‐relevant populations (i.e. people with mental illness and mental health professionals). A systematic review examining whether endorsing biogenetic causes decreases mental illness stigma in people with mental illness and mental health professionals was undertaken using the preferred reporting items for systematic reviews and meta‐analyses guidelines. Multiple databases were searched, and studies that explored the relationship between biogenetic causal beliefs and mental illness stigma in people with mental illness or mental health professionals were considered. Studies were included if they focussed on depression, schizophrenia, or mental illness in general, were in English, and had adult participants. The search identified 11 journal articles reporting on 15 studies, which were included in this review. Of these, only two provided evidence that endorsing biogenetic causes was associated with less mental illness stigma in people with mental illness or mental health professionals. The majority of studies in the present review (n = 10) found that biogenetic causal beliefs were associated with increased stigma or negative attitudes towards mental illness. The present review highlights the lack of research exploring the impacts of endorsing biogenetic causes in people with mental illness and mental health professionals. Clinical implications associated with these results are discussed, and suggestions are made for further research that examines the relationship between causal beliefs and treatment variables.
A matter of weight: Critical comments on the basic data analysed by Maestri et al. (2016) in Journal of Biogeography, 43, 1192–1202
Authors: Pardiñas Ulyses F. J. , Cañón Valenzuela Carola , Salazar‐Bravo Jorge
Published: September 2017

Recently, Maestri, Luza, et al. () assessed the effect of ecology and phylogeny on body size variation in communities of South American Sigmodontinae rodents. Regrettably, a cursory analysis of the data and the phylogeny used to address this question indicates that both are plagued with inaccuracies. We urge “big data” users to give due diligence at compiling data in order to avoid developing hypotheses based on insufficient or misleading basic information.
Biogeographical crossroad across the Pillars of Hercules: Evolutionary history of Psammodromus lizards in space and time
Authors: Mendes Joana , Harris D. James , Carranza Salvador , Salvi Daniele
Published: September 2017

Aim

To infer the biogeographical and evolutionary history of the Western Mediterranean Psammodromus lizards with the aim of assessing the role of vicariance and dispersal on the cladogenetic events within the palaeogeological dynamics of the Strait of Gibraltar.

Location

North Africa and Western Europe.

Methods

We built a dataset including all six species of Psammodromus using mitochondrial (12S, cytb, nd4) and nuclear (acm4, mc1r, pomc) gene fragments. Species tree and concatenation methods were used to infer phylogenetic relationships and divergence times. Phylogenies were used for biogeographical inference using S‐DIVA, DEC and BBM.

Results

Psammodromus probably originated in Iberia, with P. algirus diverging early. The ancestor of the African P. blanci and P. microdactylus dispersed to Africa through the Betic‐Rif massif, c. 10 Ma. The cladogenetic events within Africa and Iberia were probably due to vicariance mediated by habitat and climatic changes at the end of the Miocene (P. blanci and P. microdactylus) and during the Pliocene (P. occidentalis, P. hispanicus and P. edwardsianus). Psammodromus algirus shows three lineages, two in Iberia and one in Africa, the latter originated following a transmarine dispersal during the Middle Pleistocene (1.5 Ma).

Main conclusions

Over‐sea dispersal has played a major role in intercontinental exchange and divergence in Psammodromus, with two dispersal events towards Africa that occurred 10 and 1.5 Ma resulting in the African lineages. This study, combined with previous literature, provides compelling evidence that major biotic exchanges took place across the Strait of Gibraltar well before or long after the land connection during the Messinian Salinity Crisis (MSC, 5.9–5.33 Ma). These findings suggest caution in the application of the relatively short event of Atlantic flooding at the end of the MSC as cause for divergence in molecular clock calibrations, which is a popular approach in literature.
Elevational patterns of non‐volant small mammal species richness in Gyirong Valley, Central Himalaya: Evaluating multiple spatial and environmental drivers
Authors: Hu Yiming , Jin Kun , Huang Zhiwen , Ding Zhifeng , Liang Jianchao , Pan Xinyuan , Hu Huijian , Jiang Zhigang
Published: September 2017

Aim

Documenting the elevational species richness patterns of non‐volant small mammals and assessing the roles of pure spatial factors and spatial structured environmental factors in shaping the elevational richness patterns.

Location

Gyirong Valley in the Mount Qomolangma National Nature Reserve, located in the southern Himalayas, China.

Methods

Field surveys were conducted at each of twelve 300‐m elevational bands along a gradient from 1,800 to 5,400 m above sea level (a.s.l). For the pure spatial variables, we calculated area and the spatial null model named MDE (cf. below). For spatial structured environmental variables, we calculated mean annual temperature, mean annual precipitation, mean annual temperature range, potential evapotranspiration (PET), the normalized difference vegetation index, plant species richness and habitat heterogeneity. Multivariate models of species richness against eight factors (excluding PET) for different species groups were used to test the explanatory power of both the spatial structured environmental variables and the pure spatial variables. In addition, mean annual precipitation and potential evapotranspiration were used to test the water–energy dynamics model for each species groups.

Results

Seven hundred and fifty‐five individuals of 22 species were documented over 21,600 trap nights. The elevational species richness pattern for all non‐volant small mammals was hump‐shaped with the highest richness occurring at 2,700–3,300 m a.s.l. Endemic and non‐endemic species as well as two elevational range size categories of small mammals also generally showed hump‐shaped species richness patterns. In most data sets, spatial structured environmental variables played more important roles than the pure spatial variables in shaping the elevational species richness patterns than the pure spatial factors, while the MDE contributed to richness patterns for large‐ranged species. The water–energy dynamics model explained 66% of the variation in all the non‐volant small mammals, 56% for endemic species, 88% for the non‐endemic species, 59% for the large‐ranged species, and 53% for the small‐ranged species.

Main conclusions

Although no single key factor can explain all species richness patterns, we found that spatial structured environmental variables correlate well with the elevational species richness pattern of non‐volant small mammals. The water–energy dynamics model was found to explain non‐volant small mammal species richness along the Gyirong Valley.
Global Sensory Impairment Predicts Morbidity and Mortality in Older U.S. Adults
Authors: Pinto Jayant M. , Wroblewski Kristen E. , Huisingh‐Scheetz Megan , Correia Camil , Lopez Kevin J. , Chen Rachel C. , Kern David W. , Schumm Philip L. , Dale William , McClintock Martha K.
Published: September 2017

Objectives

To evaluate global sensory impairment (GSI, an integrated measure of sensory dysfunction) as a predictor of physical function, cognition, overall health, and mortality.

Design

Prospective study.

Setting

The National Social Life, Health, and Aging Project.

Participants

A national probability sample of 3,005 home‐dwelling older U.S. adults assessed at baseline (2005–06) and 5‐year follow‐up (2010–11).

Measurements

Gait speed, activity, disability, cognition, overall health, 5‐year mortality.

Results

At baseline, older adults with worse GSI were slower (Timed Up and Go times: odds ratio (OR) = 1.32, 95% confidence interval (CI) = 1.17–1.50) and had more activity of daily living deficits (≥2: OR = 1.26, 95% CI = 1.10–1.46). Five years later, they were still slower (timed walk: OR = 1.22, 95% CI = 1.05–1.42), had more disabilities (≥2 instrumental activities of daily living; OR = 1.45, 95% CI = 1.23–1.70), were less active (daytime activity according to accelerometry: β = −2.7, 95% CI = −5.2 to −0.2), had worse cognitive function (Montreal Cognitive Assessment; β = −0.64, 95% CI = −0.84 to −0.44), more likely to have poorer overall health (OR = 1.16, 95% CI = 1.03–1.31) and lose weight (>10%: OR = 1.31, 95% CI = 1.04–1.64), and have died (OR = 1.45, 95% CI = 1.19–1.76). All analyses were adjusted for relevant confounders at baseline, including age, sex, race and ethnicity, education, smoking, problem drinking, body mass index, comorbidities, and cognitive function.

Conclusion

GSI predicts impaired physical function, cognitive dysfunction, significant weight loss, and mortality 5 years later in older U.S. adults. Multisensory evaluation may identify vulnerable individuals, offering the opportunity for early intervention to mitigate adverse outcomes.
Causal relationship between crude oil price, energy consumption and carbon dioxide (CO2) emissions in Ecuador
Authors: Nwani Chinazaekpere
Published: September 2017

This study examines the causal relationship between crude oil price, energy consumption and CO2 emissions in Ecuador over the period 1971–2013 incorporating indicators of economic performance. ARDL bounds testing approach to cointegration provides evidence of cointegration between the variables in the presence of structural break in the series. The long‐run effect of energy consumption on CO2 emissions in the oil‐dependent economy is found to be positive and statistically significant. The long‐run and short‐run causal effects of crude oil price on energy consumption and CO2 emissions in the economy are found positive and statistically significant, suggesting that higher crude oil prices create economic conditions that generate more energy consumption and CO2 emissions in the Ecuadorean economy. The direction of causality among the variables examined using Toda‐Yamamoto Granger causality test procedure suggests that a unidirectional causality runs from crude oil price to energy consumption and economic growth, and bidirectional causality between energy consumption and CO2 emissions. A unidirectional causality that flows from CO2 emissions to economic growth through financial development is also observed in the economy.
Quality of life related to oral health of patients undergoing hemodialysis and associated factors
Authors: Lira e Silva Jéssica Antoniana , Bernardino Ítalo de Macedo , da Silva José Régis Cordeiro , Lima Tomas Lucio Marques de Almeida , Soares Renata de Souza Coelho , d’Ávila Sérgio
Published: September 2017

Purpose

To evaluate quality of life related to oral health (QoLROH) of Brazilians undergoing hemodialysis and to identify associated factors.

Material and methods

A cross‐sectional study was conducted with 226 patients undergoing hemodialysis at two reference medical centers. Participants answered a sociodemographic questionnaire and the Brazilian version of the Oral Health Impact Profile (OHIP‐14). Descriptive and multivariate statistics using Decision Tree Analysis by the Chi‐square Automatic Interaction Detector (CHAID) algorithm, as well as Ordinal Logistic Regression analyses were performed.

Results

The Decision Tree revealed that the impact on QoLROH could be explained by age (p = 0.002), tooth pain in the last 6 months (p = 0.026), and region of residence (p = 0.025).

Conclusions

The results suggest that being older, living in rural areas, and reporting tooth pain in the last 6 months may influence the QoLROH of patients undergoing hemodialysis.
Group-rearing did not affect the life table and predation rate of Phytoseiulus persimilis (Acari: Phytoseiidae) fed on Tetranychus urticae
Authors: Saemi Sahar , Rahmani Hasan , Kavosi Aurang , Chi Hsin
Published: September 2017

To better understand the effect of individual- and group-rearing conditions on predator performance, we studied the life table and predation rate of the predatory mite, Phytoseiulus persimilis Athias-Henriot, after the mites had been individually- or group-reared on two-spotted spider mites, Tetranychus urticae, eggs at 25±1°C, 65±5% RH and a photoperiod of 16: 8 (L:D) h. The net reproductive rate (R0), intrinsic rate of increase (r), net predation rate (C0), finite predation rate (ω) in the individually-reared predators were 40.61 offspring, 0.2594 d-1, 437.3 T. urticae eggs, and 4.8668 preys/d, respectively. Similar values were obtained when the predators were reared in groups (R0 = 43.10 offspring, r = 0.2837 d-1, C0 = 420.9 T. urticae eggs, and ω = 5.9054 preys/d). Mean adult longevities were 28.42 and 25.29 d for group-reared male and female predators, respectively; these values were significantly shorter than those of individual-reared mites (49.87 d for male and 36 d for female). Our results showed that P. persimilis mites could be group-reared in biological control programs without negative effect on their growth and predation potential.
Oribatid mites (Acari, Oribatida) inhabiting nests of the termite Trinervitermes trinervoides (Sjöstedt) in the Franklin Game Reserve (Bloemfontein, South Africa), with description of a new species of the genus Ceratobates (Tegoribatidae)
Authors: Ermilov Sergey G. , Hugo-Coetzee Elizabeth A. , Khaustov Alexander A.
Published: September 2017

The present study is based on oribatid mite material (Acari, Oribatida) collected from nests of the termite Trinervitermes trinervoides (Sjöstedt) of the Franklin Game Reserve on Naval Hill in Bloemfontein (South Africa). A list of identified taxa, including 38 species from 32 genera and 25 families, is presented. Of these, four species (Sellnickochthonius foliatifer, Sphaerochthonius splendidus, Phyllozetes alatus, Pheroliodes africanus), two genera (Sphaerochthonius, Phyllozetes) and one family (Sphaerochthoniidae) are recorded for the fauna of this country for the first time; four species (Liochthonius simplex, Transoribates agricola, Lepidozetes singularis, Anellozetes translamellatus) and four genera (Liochthonius, Ceratobates, Transoribates, Lepidozetes) are recorded in the Ethiopian region for the first time. A new species of the genus Ceratobates is described, namely C. monosacculatus sp. nov., which is distinguished from all species of the genus by the tridactylous legs (versus monodactylous). Some data on oribatid mites inhabiting nests of termites are summarized.
Redescription of adults and description of juvenile stages of bark beetle-associated mite Cercoleipus kuznetsovi Khaustov, 1997 (Acari: Mesostigmata: Cercomegistidae)
Authors: Trach Viacheslav , Khaustov Alexander A.
Published: September 2017

The first description of the juvenile stages and redescription of adults of the mesostigmatic mite Cercoleipus kuznetsovi Khaustov, 1997 (Acari: Cercomegistidae) from Crimea and Western Siberia are provided. This species is recorded in the North Asia for the first time. The association of Cercoleipus kuznetsovi with Ips typographus Linnaeus is recorded for the first time. The keys to the genera of the family Cercomegistidae and to the species of genus Cercoleipus are presented.
Re-examining the arterial cord blood gas pH screening criteria in neonatal encephalopathy
Authors: Vesoulis Zachary Andrew , Liao Steve M , Rao Rakesh , Trivedi Shamik B , Cahill Alison G , Mathur Amit M
Published: September 2017

Objective

Screening criteria for neonatal encephalopathy remain a complex combination of subjective and objective criteria. We examine the utility of universal cord blood gas testing and mandatory encephalopathy evaluation for infants with pH ≤7.10 on umbilical cord arterial blood gas (cABG) as a single screening measure for timely identification of moderate/severe encephalopathy.

Design, setting, patients

Infants born at a single centre between 2008 and 2015, who were ≥36 weeks, had no congenital anomalies and had a cABG pH ≤7.10 were identified for a retrospective cohort study. Maternal/perinatal and patient factors were collected.

Results

27 028 infants were born during the study period; 412 met all inclusion criteria. Of those, 35/85 infants with pH <7.00 and 34/327 infants with pH between 7.00 and 7.10 had moderate/severe encephalopathy. Encephalopathy was identified on the basis of pH and examination alone (no other perinatal criteria present) in 5/35 and 13/34 infants in the two pH groups, respectively.

A cABG pH threshold of ≤7.10 was associated with a sensitivity of 74.2% and a specificity of 98.7% for detection of moderate/severe encephalopathy. Based on these data, 25 infants with cABG pH between 7.00 and 7.10 will need to be screened to identify one neonate with moderate/severe encephalopathy, who might have otherwise been missed using conventional screening, a 15% increase in appropriate selection and treatment over current methods.

Conclusion

Universal cord blood gas screening with a pH threshold ≤7.10 and mandatory encephalopathy examination results in greater detection of infants with moderate/severe encephalopathy and timely initiation of therapeutic hypothermia.
Therapeutic hypothermia in mild neonatal encephalopathy: a national survey of practice in the UK
Authors: Oliveira Vânia , Singhvi Dev Prya , Montaldo Paolo , Lally Peter J , Mendoza Josephine , Manerkar Swati , Shankaran Seetha , Thayyil Sudhin
Published: September 2017

Although major cooling trials (and subsequent guidelines) excluded babies with mild encephalopathy, anecdotal evidence suggests that cooling is often offered to these infants. We report a national survey on current cooling practices for babies with mild encephalopathy in the UK. From 74 neonatal units contacted, 68 were cooling centres. We received 54 responses (79%) and included 48 (five excluded due to incomplete data and one found later not to offer cooling). Of these, 36 centres (75%) offered cooling to infants with mild encephalopathy. Although most of the participating units reported targeting 33–34°C core temperature, seven (19%) considered initiating cooling beyond 6 hours of age and 13 (36%) discontinued cooling prior to 72 hours. Babies were ventilated for cooling in two (6%) units and 13 (36%) sedated all cooled babies. Enteral feeding was withheld in 15 (42%) units and reduced below 25% of requirements in eight (22%) units. MRI and neurodevelopmental outcome evaluation were offered to all cooled babies in 29 (80%) and 27 (75%) units, respectively. Further research is necessary to ensure optimal neuroprotection in mild encephalopathy.
Stroke of the inferiomedial temporal lobe causing word agnosia
Authors: Hassan Hardi , Ehsanula Huq , Pattanshetti Mahendra
Published: September 2017

A 69-year-old man presented with sudden loss of ability to recognise written words and remember the meaning of words and names. He could not name the town he lived in nor name his children. It was difficult for him to remember the meaning of concrete and abstract nouns. His speech fluency and understanding of casual talks were normal. He remembered that he had a conversation with his family that morning, but not the exact content. He was referred to the transient ischaemic attack clinic by his general practitioner as he scored low on the abbreviated mental test score. He underwent a brain MRI scan (T2 weighted, diffusion weighted and fluid-attenuated inversion recovery) which showed an acute infarction in the left medial temporal region affecting the fusiform and parahippocampal gyri. He also noticed that it was easier to retrieve numbers, for example, his mobile number. He recovered on waking up the next day.
Severe asymptomatic rhabdomyolysis complicating a mycoplasma pneumonia
Authors: Gosselt Alex , Olijhoek Jobien , Wierema Thomas
Published: September 2017

Rhabdomyolysis is a very rare and serious extrapulmonary manifestation of aMycoplasma pneumoniaeinfection. We describe a case of a 47-year-old male patient who presented with progressive dyspnoea, hypoxaemia and cough during the last 3 days. He had no relevant muscular complaints but was diagnosed with severe rhabdomyolysis for which he was treated with hyperhydration. Molecular diagnostics confirmedM. pneumoniaeas the causative agent and our patient was successfully treated with doxycycline.

Only a few cases of rhabdomyolysis complicating aM. pneumoniaeinfection have been described, mostly in infants. In this case, typical suggestive complaints of rhabdomyolysis were absent suggesting that the complication might be underdiagnosed.
Silicone implant incompatibility syndrome (SIIS) in a 57-year-old woman with unilateral silicone breast implant
Authors: Schierbeck Juliane , Davidsen Jesper Rømhild , Grindsted Nielsen Sanne , Bille Camilla
Published: September 2017

Since the 1960s, silicone implants have been used for breast augmentations, both cosmetically and in reconstructive surgery. Tissue exposed to silicone can react with multiple adverse advents. Autoimmune/inflammatory syndrome induced by adjuvants due to silicone exposure from ruptured silicone implants can lead to different interstitial lung manifestations predominantly with granuloma evolvement, leading to the so-called silicone implant incompatibility syndrome (SIIS). This case describes a 57-year-old woman with multiple lung infiltrations and a left-sided breast implant. The implant had been replaced twice, once due to implant rupture 36 years ago. The nodular infiltrates could not be related to infection, malignancy, interstitial lung disease, vasculitis or connective tissue disorder, and it was concluded that the nodular infiltrations were of inflammatory origin due to an autoimmune response secondary to the silicone implants (SIIS). After explantation, the patient’s symptoms subsided and her physical condition has remarkably improved.
An unusual presentation of a benign pancreatic lesion containing amyloid
Authors: Kim David , Crook Terri , Ramzan Zeeshan
Published: September 2017

We present a unique case of a benign pancreatic lesion which was positive for amyloid in a 55-year-old female patient without systemic amyloidosis. Further testing revealed islet-type amyloid polypeptide (or amylin), a protein found in various diseases such as diabetes, insulinoma and pancreatic adenocarcinoma—none of which was seen in our patient.
Efficacy of new low-dose oral anticoagulants in recalcitrant livedoid vasculopathy
Authors: Furukawa Fumina , Mizawa Megumi , Makino Teruhiko , Shimizu Tadamichi
Published: September 2017

Livedoid vasculopathy (LV) is a thrombotic skin disease characterised by recurrent painful ulcerations and irreversible scar formation on the lower legs, which is caused by occlusion of the cutaneous microcirculation. Edoxaban is one of new oral anticoagulants. It directly inhibits factor Xa in the coagulation pathway and prevents thrombus formation. A 17-year-old Japanese male presented with a 1-year history of recalcitrant cutaneous ulcers and livedo racemosa on his lower extremities. Initially, the ulcers were treated with antiplatelets therapies; however, he experienced recurrence of ulcerations during summer time. A histological examination revealed dermal vessel thrombosis consistent with occlusive vasculopathy. These findings were diagnostic for LV. The patient was treated with oral low-dose edoxaban (15 mg/day). The skin ulcers were epithelised and livedo racemosa disappeared within 8 weeks. We herein report the successful treatment of recalcitrant LV with low-dose edoxaban in a patient with no identifiable coagulopathy.
Benign paroxysmal positional vertigo (BPPV) diagnosis and treatment in an elite professional football (soccer) player
Authors: Burrows Lisa , Price Rob
Published: September 2017

A 33-year-old male professional football player suffered from acute-onset dizziness following a lower limb soft tissue treatment in prone lying. Symptoms included spinning vertigo lasting for 30's, headache, visual vertigo and disorientation. Clinical examination of balance and vestibular systems confirmed a left posterior canalithiasis benign paroxysmal positional vertigo (BPPV) and excluded other central and peripheral causes of dizziness. Two cycles of a left Epley manoeuvre were performed. An Epley manoeuvre abolished the BPPV and negated the need for medication. The player was able to return to play without dizziness within 24 hours completely symptom free. BPPV can be successfully identified and treated in elite football players and they can see a return to training and games within 24 hours. There are no epidemiology studies for this group of elite athletes either male or female despite increased occupational risk factors.
Apical ballooning (takotsubo) syndrome with concurrent ST-segment elevation myocardial infarction
Authors: Hussain Mohsin A , Cox Andrew T , Bastiaenen Rachel , Prasad Abhiram
Published: September 2017

We present the case of a 61-year-old woman admitted with chest pain and an ECG demonstrating ST-segment elevation in the lateral leads. Emergency coronary angiography demonstrated an occluded obtuse marginal branch. Percutaneous intervention was unsuccessful as the lesion could not be crossed with a wire. Left ventriculography and transthoracic echocardiography demonstrated hypokinesis of the entire apex but preserved contractility of the basal segments, consistent with a diagnosis of apical ballooning syndrome (ABS). Cardiac MRI demonstrated myocardial oedema in all mid to apical segments, with a left ventricular ejection fraction (LVEF) of 38%. Repeat study at 5 months demonstrated an infarct in the distribution of the occluded artery with late gadolinium enhancement, consistent with a diagnosis of a lateral wall myocardial infarction and an improvement in the LVEF to 51%. The case illustrates the novel observation that ABS and acute myocardial infarction may rarely occur simultaneously.
Primary bilateral adrenal nodular disease with Cushing's syndrome: varying aetiology
Authors: Jarial Kush Dev Singh , Walia Rama , Nahar Uma , Bhansali Anil
Published: September 2017

Primary adrenal disorders contribute 20%â€“30% of patients with endogenous Cushing's syndrome. Most of the primary adrenal diseases are unilateral and include adenoma and adrenocortical carcinoma, whereas bilateral adrenal lesions are uncommon and include primary pigmented nodular adrenocortical disease, primary bilateral macronodular adrenocortical hyperplasia, isolated micronodular adrenocortical disease, bilateral adenomas or carcinomas, and rarely pituitary adrenocorticotropic hormone-dependent adrenal nodular disease. Cyclic adenosine monophosphate-dependent protein kinase A signalling is the major activator of cortisol secretion in primary adrenal nodular disorders. We report two cases of bilateral adrenal nodular disease with endogenous Cushing's syndrome, including one each of primary pigmented nodular adrenocortical disease and primary bilateral macronodular adrenocortical hyperplasia.
Silent tracheobronchial chondritis in a patient with a delayed diagnosis of relapsing polychondritis
Authors: Afridi Faraz , Frosh Seema
Published: September 2017

Relapsing polychondritis is a very rare autoimmune disease characterised by a relapsing inflammation of hyaline, elastic and fibrous cartilaginous tissues. The incidence is estimated to be between 3.5 and 4.5 per million people per year. Clinical signs and symptoms can be very subtle, and if left undiagnosed for a prolonged period, airway involvement can cause fibrosis of the tracheobronchial wall, leading to a fixed tracheobronchial stenosis. Eventually, this can progress to life-threatening tracheobronchomalacia due to irreversible damage and loss of tissue integrity. We report an elderly man who presented with recurrent bilateral ear inflammation and intermittent polyarthritis who was diagnosed with relapsing polychondritis with asymptomatic involvement of his large airways.
Unusual genitourinary tract activity
Authors: MacCraith Eoin , Davis Niall F , Forde James
Published: September 2017

A 23-year-old woman presented to the emergency department after manually inserting foreign bodies into the urinary bladder through her urethra. A plain abdominal film of the kidneys, ureters and bladder confirmed three radio-opaque densities in the urinary bladder. She was taken to the operating room where cystourethroscopy was performed. At cystoscopy 2 ‘corn-on-the-cob’ skewers and 1 battery were identified but were too large to be retrieved safely with a grasper through the protective sheath. The objects were grasped with a ‘sponge-holding forceps’ (placed alongside the cystoscope) and extracted one at a time. A psychiatric consultation was sought and the patient was diagnosed and treated for borderline personality disorder. Unusual genitourinary activity (UGUA) has been described for several centuries and is characterised by the deposition of foreign objects in the genitalia.1The most common incentive for UGUA is sexual stimulation, but psychiatric disorders and intoxication are also associated.2Management involves retrieval of foreign bodies and evaluation of psychosocial factors.
Awakening with amantadine from a persistent vegetative state after subarachnoid haemorrhage
Authors: Lehnerer Sophie Mirabell , Scheibe Franziska , Buchert Ralph , Kliesch Stefan , Meisel Andreas
Published: September 2017

We report the case of a 36-year-old woman with a subarachnoid haemorrhage (SAH) caused by a rupture of a right-sided middle cerebral artery aneurysm and subsequent malignant infarction of the right hemisphere leading to a persistent vegetative state and severe spastic tetraparesis with recurrent myocloni. Nine months after disease onset, the patient was transferred to our department for diagnostic and therapeutic re-evaluation. The poor clinical condition could not be explained by the brain lesion caused by the SAH or infarction. Moreover, glucose metabolism was normal in brain regions not affected by SAH and infarction as shown by positron emission tomography with18F-fluorodeoxyglucose. We terminated baclofen and reduced antiepileptics known to impair vigilance and cognitive functions. However, only after starting amantadine treatment we observed a stunning awakening of the patient fully orientated within days. Our findings warrant trials to investigate amantadine in the treatment of unresponsive wakefulness syndromes due to acute central nervous system diseases.
Loculated empyema due to tuberculosis in a child
Authors: Goussard Pierre , Morrison Julie , Appel Ilse Nadine , Andronikou Savvas
Published: September 2017

A 9-year-old girl from black ethnic origin presented with a history of fever, cough, loss of weight and right-sided chest wall pain for 2 weeks. Chest X-ray demonstrated an effusion, which was shown to be loculated on chest CT scan. She was not responding to medical treatment and at thoracotomy loculated pus was drained.Mycobacterium tuberculosis(TB) was cultured from the pus. TB is a rare cause of loculated empyema with an overlapping clinical and radiological picture with pyogenic infections.
Muscular sarcocystosis: an index case in a native Malaysian
Authors: Mohammad Nurashikin , Besari Alwi Muhd , Nair Pradeep Kumar , Wan Ghazali Wan Syamimee
Published: September 2017

A previously healthy 20-year-old man presented with prolonged intermittent low grade fever and cough for 6months. He had bilateral calf pain and lower limb weakness 2days prior to admission. Physical examination revealed multiple enlarged lymph nodes with hepatomegaly. There was bilateral calf tenderness with evidence of proximal myopathy. Full blood picture showed lymphocytosis with reactive lymphocytes and eosinophilia. Creatine kinase and lactate dehydrogenase were markedly elevated. Over 2 weeks of admission, patient was treated symptomatically until the muscle biopsy of right calf revealed eosinophilic myositis with muscular sarcocystosis. He was treated with albendazole and high-dose corticosteroids. Symptoms subsided on reviewed at 2weeks and the dose of corticosteroid was tapered down slowly over a month. Due to poor compliance, he was readmitted 1month later because of relapsed. High-dose corticosteroid was restarted and duration for albendazole was prolonged for 1month. His symptom finally resolved over 2weeks.
Paediatric chest wall trauma causing delayed presentation of ventricular arrhythmia
Authors: Tegethoff Angela M , Raney Emerald , Mendelson Jenny , Minckler Michael R
Published: September 2017

This report describes a paediatric patient presenting with haemodynamically stable non-sustained ventricular tachycardia 1 day after minor blunt chest trauma. Initial laboratory studies, chest X-ray and echocardiography were normal; however, cardiac MRI revealed precordial haematoma, myocardial contusion and small pericardial effusion. Throughout her hospital course, she remained asymptomatic aside from frequent couplets and triplets of premature ventricular contractions. Ectopy was controlled with oral verapamil. This case highlights how significant cardiac injury may be missed with standard diagnostic algorithms.
Atypical presentation of Parsonage-Turner syndrome confounded by surgical rotator cuff injury
Authors: Greenhill Dustin Adam , Abdelfattah Hesham , Torg Joseph S , Sewards Joseph Milo
Published: September 2017

Parsonage-Turner syndrome (PTS) is a rare neuropathy that commonly presents as unexpected severe shoulder and arm pain that eventually subsides while weakness or paralysis ensues. During exceptions to this classic presentation, confirming PTS can be challenging. Alternative causes of upper extremity pain may confound the diagnostic algorithm. Moreover, objective findings from necessary diagnostic tests depend on when those tests are performed. We present an atypical onset of PTS, whereby the initial presentation of severe neuropathic pain was preceded by mild shoulder pain that should decrease one’s clinical suspicion for PTS. This milder pain coincided with the presence of a rotator cuff injury, whereby surgical intervention preceded impending paralysis and hindered postoperative rehabilitation. Physicians should be aware of the possibility of atypical presentations of PTS in hopes of avoiding either untimely surgery or delays in diagnosis.
Q fever prosthetic joint infection
Authors: Weisenberg Scott , Perlada David , Peatman Thomas
Published: September 2017

Coxiella burnetiiis the causative pathogen of the zoonotic infection Q fever. Most patients with Q fever experience a non-specific febrile illness, hepatitis or pneumonia. Q fever has recently been described as a cause of prosthetic joint septic arthritis, but remains very uncommonly reported. We present a case of Q fever prosthetic joint septic arthritis that has responded to a combination of two-stage surgical exchange and prolonged medical treatment with doxycycline and hydroxychloroquine.
Lipoma of superior vena cava: a rare occurrence
Authors: Wahab Ahsan , Chaudhary Siddique , Munir Ahmad , Smith Susan Jane
Published: September 2017

Most benign primary cardiac tumours are myxomas; non-myxomatous tumours are less common but comprise a wide variety. Cardiac lipoma is a rare non-myxomatous variety. A 70-year-old Caucasian woman with right breast cancer status postpartial mastectomy underwent surveillance MRI of the breast and was found to have a possible right atrial (RA) mass. She also reported frequent headaches and palpitations. She underwent a transoesophageal echocardiogram which showed a 2.6×1.6×1.6 cm echogenic mass at the superior vena cava (SVC) and RA junction. She was anticoagulated for a possible thrombus without resolution. Surgical excision was undertaken in view of ongoing symptoms and partial occlusion of the SVC. Intraoperatively, a 2–3 cm smoothly textured lobulated mass was found and histopathology showed adipose tissue consistent with lipoma. The postoperative course was uneventful, and the patient was discharged in stable condition.
Case of a strangulated right paraduodenal fossa hernia in a malrotated gut
Authors: Ong Michelle , Roberts Matthew , Perera Marlon , Pretorius Casper
Published: September 2017

We report an unusual case of a strangulated internal hernia resulting from a right paraduodenal fossa hernia (PDH) in the context of bowel malrotation. There are few documented cases of PDHs associated with a concomitant gut malrotation. Emergency laparotomy was performed based on clinical and radiological. Intraoperatively, the proximal jejunum was seen to enter a hernia sac formed by an aberrant duodenojejunal flexure located to the right of the aorta. This was presumed to be a strangulated internal hernia of the paraduodenal recess in a malrotated gut. The hernia neck was widened and the sac obliterated to allow reduction of the contents. On reduction and warming, the insulted small bowel appeared viable and returned to the abdominal cavity without resection.
An unusual case of interstitial lung disease in a patient with cardiopulmonary syndrome as the initial presentation of Erdheim-Chester disease
Authors: Franco-Palacios Domingo , McDonald April , Aguillard R Neal , Berry Allen
Published: September 2017

Erdheim-Chester disease (ECD) is a very rare disorder with only approximately 600 cases reported in the literature. ECD has been recently reclassified as a histiocytic dendritic cell neoplasm. The clinical spectrum ranges from asymptomatic tissue accumulation of histiocytes to invasive tissue infiltration, which can cause fulminant multisystem failure. It typically presents with bone pain and constitutional symptoms. Extraosseous manifestations are not uncommon. ECD-associated interstitial lung disease has been described in 20%-35% of patients. Diagnosis is primarily by tissue biopsy and immunohistochemistry showing xanthogranulomas composed of foamy histiocytes that stain positive for CD68, CD14 and CD163 and negative for CD1á and langerin. We report a case of ECD in a young man with cardiopulmonary involvement who presented with haemoptysis and dyspnoea.
Importance of temporal changes in myocardial strain in Takotsubo cardiomyopathy
Authors: Tibrewala Anjan , Freed Benjamin Howard , Akhter Nausheen
Published: September 2017

Strain imaging is a sensitive marker of myocardial dysfunction and may be underused in Takotsubo cardiomyopathy (TC). We present a case of biventricular TC in which early improvement in left ventricular longitudinal strain predated subsequent improvement in ejection fraction. Early temporal patterns of strain of the left and right ventricles have not previously been described in TC. Our case illustrates how strain can be a sensitive marker for myocardial dysfunction and recovery in TC. Increased use of strain in TC may have further implications on prognosis and management.
A rare case of an ectopic pregnancy in the rudimentary tube of a patient with an isolated unicornuate uterus
Authors: Gnanasambanthan Sai , Uchil Dhiraj
Published: September 2017

Uterine anomalies are relatively uncommon and go undiagnosed in many cases. Ectopic pregnancies have been reported in such patients, although rarely, in the non-communicating rudimentary horns of unicornuate uteri. However, the case presented is of an ectopic pregnancy in the rudimentary fallopian tube related to an undescended ovary in a patient with an isolated unicornuate uterus, a phenomenon which is extremely rare.