bluuebunny/crossref_metadata_2025 huggingface dataset:
The fecal microbiome and serum concentrations of indoxyl sulfate and p‐cresol sulfate in cats with chronic kidney disease
Authors: Summers Stacie C. , Quimby Jessica M. , Isaiah Anitha , Suchodolski Jan S. , Lunghofer Paul J. , Gustafson Daniel L.
Published: December 2018

Background

Intestinal dysbiosis has been documented in humans with chronic kidney disease (CKD) and is thought to contribute to production of the uremic toxins indoxyl sulfate (IS) and p‐cresol sulfate (pCS). Characteristics of the fecal microbiome in cats with CKD and correlation to serum concentrations of uremic toxins are unknown.

Objectives

To characterize the fecal microbiome and measure serum IS and pCS concentrations of cats with CKD in comparison to healthy older cats.

Animals

Thirty client‐owned cats with CKD (International Renal Interest Society stages 2‐4) and 11 older (≥8 years) healthy control cats.

Methods

Prospective, cross‐sectional study. Fecal samples were analyzed by sequencing of 16S rRNA genes andEscherichia coliquantitative PCR (qPCR). Serum concentrations of IS and pCS measured using liquid chromatography tandem mass spectrometry.

Results

Cats with CKD had significantly decreased fecal bacterial diversity and richness.Escherichia coliqPCR showed no significant difference in bacteria count between control and CKD cats. Cats with stage 2 (P = .01) and stages 3 and 4 (P = .0006) CKD had significantly higher serum IS concentrations compared to control cats. No significant difference found between stage 2 and stages 3 and 4 CKD. The pCS concentrations were not significantly different between CKD cats and control cats.

Conclusions and Clinical Importance

Decreased fecal microbiome diversity and richness is associated with CKD in cats. Indoxyl sulfate concentration is significantly increased with CKD, and cats with stage 2 CKD may suffer from a similar uremic toxin burden as do cats with later stage disease.
The current Indian epidemic of superficial dermatophytosis due toTrichophyton mentagrophytes—A molecular study
Authors: Nenoff Pietro , Verma Shyam B. , Vasani Resham , Burmester Anke , Hipler Uta‐Christina , Wittig Franziska , Krüger Constanze , Nenoff Kolja , Wiegand Cornelia , Saraswat Abir , Madhu Rengarajan , Panda Saumya , Das Anupam , Kura Mahendra , Jain Akshay , Koch Daniela , Gräser Yvonne , Uhrlaß Silke
Published: December 2018

The disease burden of chronic‐relapsing and therapy‐refractory superficial dermatophytosis dramatically increased in India within the past 5‐6 years. In order to evaluate the prevalence of this trend, 201 skin scrapings were collected from patients from all parts of India and were tested for dermatophytes using both fungal culture and aPCR‐ELISAdirectly performed with native skin scrapings. Fungal culture material was identified by genomic Sanger sequencing of the internal transcribed spacer (ITS) region and the translation elongation factor (TEF)‐1α gene. In total, 149 (74.13%) out of the 201 samples showed a dermatophyte‐positive culture result. Out of this, 138 (92.62%) samples were identified asTrichophyton(T.)mentagrophytesand 11 (7.38%) asTrichophyton rubrum. ThePCR‐ELISArevealed similar results: 162 out of 201 (80.56%) samples were dermatophyte‐positive showing 151 (93.21%)T mentagrophytes‐ and 11 (6.79%)T rubrum‐positive samples. In this study, we show for the first time a dramatic Indian‐wide switch fromT rubrumtoT mentagrophytes. Additionally, sequencing revealed a solely occurringT mentagrophytes“IndianITSgenotype” that might be disseminated Indian‐wide due to the widespread abuse of topical clobetasol and other steroid molecules mixed with antifungal and antibacterial agents.
BRAF V600E‐mutated central nervous system tumor with divergent morphological feature – Anaplastic pleomorphic xanthoastrocytoma‐like and astroblastoma‐like
Authors: Purkait Suvendu , Bansal Sumit , Malgulwar Prit B.
Published: December 2018

Mutational analysis of the BRAF gene (BRAF), especially BRAF V600E, is gaining much importance in neuro‐oncology practice due to its diagnostic, prognostic and therapeutic implications. This genetic alteration has been described in a wide morphological spectrum of central nervous system tumors. In the present report we describe a BRAF V600E‐mutated tumor with divergent morphological appearance comprising of anaplastic pleomorphic xanthoastrocytoma and astroblastoma. Both of these tumor entities are extremely rare and a combined morphology has not been described till now.
Lactose intolerance but not lactose maldigestion is more frequent in patients with irritable bowel syndrome than in healthy controls: A meta‐analysis
Authors: Varjú Péter , Gede Noémi , Szakács Zsolt , Hegyi Péter , Cazacu Irina Mihaela , Pécsi Dániel , Fábián Anna , Szepes Zoltán , Vincze Áron , Tenk Judit , Balaskó Márta , Rumbus Zoltán , Garami András , Csupor Dezső , Czimmer József
Published: December 2018

Background and Purpose

Irritable bowel syndrome (IBS) affects 10%‐20% of the adult population and is characterized by abdominal symptoms without relevant organic disease. There are numerous clinical trials available investigating the relationship between IBS, lactose maldigestion (LM), and lactose intolerance (LI), but there have been no meta‐analyses on this topic yet. We aimed to assess the prevalence of LM, objective and subjective (self‐reported) LI in IBS patients compared to healthy controls (HC) without IBS.

Methods

A systematic literature search was conducted up to 24 April 2018 in PubMed, Embase, and Cochrane Library. Adult IBS patients had to be diagnosed according to the Rome criteria or other well‐defined criteria system. We enrolled controlled studies including healthy adult participants without IBS, as control group. Odds ratios with 95% confidence intervals were calculated.

Key Results

Altogether 14 articles were suitable for statistical analyses. IBS patients reported themselves significantly more frequently lactose intolerant than HCs (odds ratio [OR] = 3.499; 95% confidence interval [CI] = 1.622‐7.551). Generally, there was no significant difference in the prevalence of LM based on ingested lactose dose (OR = 1.122; 95% CI = 0.929‐1.356) and test type (OR = 1.156; 95% CI = 0.985‐1.356). However, significantly more IBS patients had objective LI (OR = 2.521; 95% CI = 1.280‐4.965).

Conclusions and Inferences

Lactose intolerance, but not LM is more frequent among patients with IBS compared to HCs. According to our results, IBS among other functional bowel disorders is a possible contributing factor of LI in people with LM.
Twenty‐five years of research about adipogenic adenoviruses: A systematic review
Authors: Akheruzzaman Md , Hegde Vijay , Dhurandhar Nikhil V.
Published: December 2018

Infectious etiology is implicated in chronic diseases such as gastric ulcer or atherosclerosis. However, “infection” is a recent term in the field of obesity. Since the first report in 1982 of obesity due to infection, several microbes have been linked to obesity. Among the adipogenic microbes, avian adenovirus SMAM‐1 and human adenovirus Ad36 have been studied most extensively for the past 25 years. Here, we present a systematic review of literature about SMAM‐1 and Ad36. Reports from North America, Europe, and Asia reveal strong evidence that Ad36 causes obesity in animals and paradoxically improves glycemic control, and in vitro data provides mechanistic explanation. Considering that experimental Ad36 infection of humans is unlikely, its causative role in human obesity or glycemic control has not been demonstrated unequivocally. Nonetheless, most, but not all, observational studies in children and adults link Ad36 infection to obesity and improvement in glycemic control. The E4orf1 gene of Ad36 was identified as responsible for better glycemic control. Overall, 25 years have considerably advanced knowledge about the role of infection in obesity. Potential translational benefits include the development of vaccines to prevent Ad36‐induced obesity and drug development based on the E4orf1 protein to improve glycemic control.
Oral microbiomes in children with asthma and dental caries
Authors: Cherkasov Sergey V. , Popova Larisa Yu. , Vivtanenko Tatyana V. , Demina Rimma R. , Khlopko Yuri A. , Balkin Alexander S. , Plotnikov Andrey O.
Published: December 2018

Objective

Recently, a significant association between dental caries and the severity of bronchial asthma in children has been revealed. This finding indicates a possible relationship between the oral microbiome and the pathogenesis of asthma. The purpose of our study was to estimate differences in the dental plaque microbiota of asthmatic children with and without dental caries by 16S rDNA sequencing.

Material and methods

Dental plaque samples were obtained with a spoon excavator from the occlusal surface of one deciduous tooth (the second mandibular left molar in caries‐free children and the most affected tooth in caries‐affected children). Total DNA was extracted from dental plaque. DNA libraries were analysed by 16S rRNA gene sequencing on the MiSeq (Illumina) platform.

Results

There were no significant differences in the composition of bacterial communities from both caries‐affected and caries‐free children with asthma. The “caries‐enriched” genus was Veillonella (Veillonellaceae, Selenomonadales, Negativicutes). Relative abundance of Neisseria was significantly higher in caries‐free children with asthma (p < 0.05).

Conclusions

The most significant difference in compared bacterial communities was a higher relative abundance of Veillonella in caries‐affected plaques that suggests its involvement in pathogenesis of caries. Potential respiratory pathogens are present in oral cavity of both caries‐affected and caries‐free asthmatic children.
Accounting for non‐economic factors in demand for transportation fuels: a comparative study of South Korea and Indonesia
Authors: Sa'ad Suleiman , Dahoro Davo , Ahmed Mohammed Nma
Published: December 2018

This paper demonstrates the importance of capturing the influence of non‐economic factors such as changes in economic structure and life style in estimating energy demand functions for transportation fuels. Using annual time series data for South Korea and Indonesia from 1971 to 2016 in an Unrestricted Error Correction Model, the paper estimates the energy demand functions for transportation fuels as well as the growth of the underlying demand trend (which captured the effects of non‐economic factors). The estimated elasticities are in the range of 1.103 to 1.82 for long‐run income elasticity and −0.024 to 0.009 for price elasticity in the long‐run. However, the estimated coefficient of the linear trend variable ranged from −0.36 to 0.009. The overall result suggests that demand for transportation fuels are more elastic to changes in real income than real prices in the long run. The relative magnitude and sign on the coefficient of the trend variables (both linear and stochastic) suggest that South Korea is more efficient in transport sector energy consumption than Indonesia, on the other hand, Non‐technical exogenous factors (such as motorisation and traffic congestion) tend to outweigh energy efficiency improvements in Indonesia.
Using yield quantitative trait locus targeted SSR markers to study the relationship between genetic distance and yield heterosis in upland cotton (Gossypium hirsutum)
Authors: Li Xue , Shahzad Kashif , Guo Liping , Qi Tingxiang , Zhang Xuexian , Wang Hailin , Tang Huini , Qiao Xiuqin , Zhang Jinfa , Wu Jianyong , Xing Chaozhu
Published: December 2018

The objective of this study was to examine the relationship between heterosis and genetic distance in upland cotton (Gossypium hirsutum L.). Heterosis in the different environments was evaluated and the relationship between heterosis and genetic distance (GD) was determined based on SSR markers for yield quantitative trait loci (QTL). Yields of seed cotton and lint showed a linear relationship with mid‐parent heterosis (MPH) and better‐parent heterosis (BPH). The variation in heterosis for other traits and their correlation with GD may be due to environmental factors or the effort of QTLs tested in the present study may vary in different environments. The present findings provide a foundation for heterotic grouping of parental lines and breeding of new cotton hybrids with improved seed cotton yield. This study calls for more research with stable QTLs as well as advance molecular marker techniques may be used in predicting yield heterosis in a more precise and reliable manner.
Ultrastructural patterns of photoacclimation and photodamage to photosynthetic algae cell under environmental stress
Authors: Solovchenko Alexei , Baulina Olga , Ptushenko Oksana , Gorelova Olga
Published: December 2018

In oxygenic phototrophs including unicellular algae, acclimation to and damage by diverse environmental stresses induce profound changes in the ultrastructural organization of the cell. These alterations reflect acclimation of the photosynthetic apparatus to unfavorable conditions (mainly reduction of the chloroplast and its membranal system) and rewiring of the photo‐fixed carbon fluxes in the cell. These changes, eventually pursuing mitigation of the photooxidative damage risk, are manifested by the formation of diverse carbon‐rich inclusions. Although the physiological and molecular basis of these processes are well understood, the ultrastructural manifestations of the stress responses are often fragmented and frequently controversial. This minireview attempts to generalize on the ultrastructural patterns accompanying stresses in the photosynthetic cell, involving the concerted rearrangements of its assimilatory and storage compartments. The changes characteristic of normal functioning and emergency reduction of the chloroplast thylakoids under harsh stress are also addressed. Special attention is paid to the manifestations of the engagement of photoprotection via active (energy‐dependent non‐photochemical quenching) and passive mechanisms (e.g. optical shielding by secondary carotenoids). We also underline the potentially important role of autophagy‐like processes and provide a more integral view of ultrastructural rearrangements under stress.
Multiple Streams in Hawaii: How the Aloha State Adopted a 100% Renewable Portfolio Standard
Authors: Kagan Jennifer A.
Published: December 2018

Renewable portfolio standards (RPS) are an important policy tool for reducing carbon emissions and advancing the global shift toward renewable energy. As the U.S. federal government backs away from commitments to reduce greenhouse gas emissions, subnational governments play an increasingly important role in mitigating climate change. In June 2015, Hawaii became the first state in the United States to adopt a 100% RPS. Through understanding the conditions that gave rise to Hawaii’s RPS, policy actors will be better informed as they navigate policy processes in other states and jurisdictions. This study uses Kingdon’s Multiple Streams Framework (MSF) to explore the policy process that led to Hawaii’s 100% RPS. Data were collected during the summer of 2016 via interviews with 25 key policy actors and informants in Hawaii. Expectations based on the MSF are confirmed, and the results suggest factors that might be included or explored in future studies of RPS adoption.
Media, ‘Fat Panic’ and Public Pedagogy: Mapping Contested Terrain
Authors: Monaghan Lee F. , Rich Emma , Bombak Andrea E.
Published: December 2018

Discourses regarding a ‘global obesity crisis’ and alternative frames (e.g. weight‐inclusive approaches to health) have proliferated through various media of communication. These media range from traditional print and visual formats (e.g. newspapers and television shows) to digital media (e.g. Twitter, Facebook, YouTube), which enable different publics to produce, and not just consume, text, images and other data relating to the body. Reflecting a sociological understanding of educational practices as extending beyond formal schooling, mediated obesity discourse and counter‐movements have also been conceptualised as public pedagogies, which instruct people how to relate to their own and other's bodies, health and subjectivities. This article examines what is critically known about various media at a time when governments and agencies are reinvigorating the global war on obesity, with populations being ‘advised’ to become and remain conscientious weight watchers. In conclusion, the article underscores the salience of social studies of the media when seeking to rethink obesity, incorporating critical reference to moral panic theory and the need to better understand what media can ‘do’ as enactments of public pedagogy.
Long‐term effects of animal manure and mineral fertilizers on phosphorus availability and silage maize growth
Authors: Jing Jingying , Christensen Julie T. , Sørensen Peter , Christensen Bent T. , Rubæk Gitte H.
Published: December 2018

A better appraisal of the plant availability of soil phosphorus (P) added with animal manure is crucial to alleviate environmental impacts from over‐application of P. This study compares the availability of P to maize in the Askov long‐term experiments using unmanured plots and plots receiving corresponding rates of nitrogen (N), P and potassium (K) in mineral fertilizers or manure. Total‐P and water extractable P (Pw) in soil, and plant height, dry weight, P concentration and P uptake were determined in early August. Final yields were determined in late October. Soil Pw was similar for plots receiving corresponding rates of P in mineral fertilizer or manure form. With a strong relationship between Pw, and maize growth and final yields, Pw was a reliable indicator of P availability to maize. Plant dry weight, P concentration and P uptake in early August were 23%, 8% and 31% higher, respectively, for maize grown on soil receiving manure compared with mineral fertilizer, while final maize yield in late October was 13% higher. Plant height and dry weight determined in early August suggested that maize development at this growth stage defined final maize yield. We conclude that the availability of P was similar after long‐term application of corresponding rates of P in animal manure and mineral fertilizers, and that animal manure improves the growth of maize compared to mineral fertilizers. This is ascribed to micronutrients and residual N effects from previous additions of manure.
Detection of a novel HLA‐A*11 variant, A*11:292, in a Taiwanese individual
Authors: Yang K. L. , Lin P. Y.
Published: December 2018

One nucleotide substitution at residue 860 of HLA‐A*11:01:01:01 results in a novel allele, HLA‐A*11:292.
Influence of Upstream Exhaust Manifold on Pulsatile Turbocharger Turbine Performance
Authors: Lim Shyang Maw , Dahlkild Anders , Mihaescu Mihai
Published: December 2018

This research was primary motivated by limited efforts to understand the effects of secondary flow and flow unsteadiness on the heat transfer and the performance of a turbocharger turbine subjected to pulsatile flow. In this study, we aimed to investigate the influence of exhaust manifold on the flow physics and the performance of its downstream components, including the effects on heat transfer, under engine-like pulsatile flow conditions. Based on the predicted results by detached eddy simulation (DES), qualitative and quantitative flow fields analyses in the scroll and the rotor's inlet were performed, in addition to the quantification of turbine performance by using the flow exergy methodology. With the specified geometry configuration and exhaust valve strategy, our study showed that (1) the exhaust manifold influences the flow field and the heat transfer in the scroll significantly and (2) although the exhaust gas blow-down disturbs the relative flow angle at rotor inlet, the consequence on the turbine power is relatively small.
Source Term Based Modeling of Rotating Cavitation in Turbopumps
Authors: Vermes A. G. , Lettieri C.
Published: December 2018

The recent growth of private options in launch vehicles has substantially raised price competition in the space launch market. This has increased the need to deliver reliable launch vehicles at reduced engine development cost and has led to increased industrial interest in reduced order models. Large-scale liquid rocket engines require high-speed turbopumps to inject cryogenic propellants into the combustion chamber. These pumps can experience cavitation instabilities even when operating near design conditions. Of particular concern is rotating cavitation (RC), which is characterized by an asymmetric cavity rotating at the pump inlet, which can cause severe vibration, breaking of the pump, and loss of the mission. Despite much work in the field, there are limited guidelines to avoid RC during design and its occurrence is often assessed through costly experimental testing. This paper presents a source term based model for stability assessment of rocket engine turbopumps. The approach utilizes mass and momentum source terms to model cavities and hydrodynamic blockage in inviscid, single-phase numerical calculations, reducing the computational cost of the calculations by an order of magnitude compared to traditional numerical methods. Comparison of the results from the model with experiments and high-fidelity calculations indicates agreement of the head coefficient and cavity blockage within 0.26% and 5%, respectively. The computations capture RC in a two-dimensional (2D) inducer at the expected flow coefficient and cavitation number. The mechanism of formation and propagation of the instability is correctly reproduced.
A Hybrid Modeling Approach for Characterization and Simulation of Cryogenic Machining of Ti–6Al–4V Alloy
Authors: Shi Bin , Elsayed Ahmed , Damir Ahmed , Attia Helmi , M'Saoubi Rachid
Published: December 2018

A hybrid modeling approach based on computational fluid dynamics (CFD) and finite element method (FEM) is presented to simulate and study cryogenic machining (CM) of Ti–6Al–4V alloy. CFD analysis was carried out to study the characteristics of the fluid flow and heat transfer process of liquid nitrogen (LN2) jet used as a coolant in turning operation. The velocity, turbulence, gas volume fraction, and temperature of the impingement jet were investigated. Based on the analysis results, the coefficient of heat transfer (CHT) between the LN2 and cutting tool/insert was obtained and used in the FEM analysis to model the heat transfer process between the LN2 and the tool/chip/workpiece. A three-dimensional (3D) finite element (FE) model was developed to simulate a real CM operation. CM tests were carried out to validate the 3D FE model by comparing cutting forces and chip temperature. To evaluate LN2 cooling effect on tool temperature and tool wear, a two-dimensional (2D) FE model was developed for steady-state thermal analysis of cryogenic and dry machining. Based on the predicted temperatures, the tool wear was estimated, showing that LN2 cooling can significantly improve tool life.
Glycosyltransferase-Mediated Biofilm Matrix Dynamics and Virulence of Streptococcus mutans
Authors: Rainey Katherine , Michalek Suzanne M. , Wen Zezhang T. , Wu Hui
Published: December 2018

Tooth decay, a costly and painful disease affecting the vast majority of people worldwide, is caused by the bacterium
Streptococcus mutans
. The bacteria utilize dietary sugars to build and strengthen biofilms, trapping acids onto the tooth’s surface and causing demineralization and decay of teeth. As knowledge of our body’s microbiomes increases, the need for developing therapeutics targeted to disease-causing bacteria has arisen. The significance of our research is in studying and identifying a novel therapeutic target, a dynamic biofilm matrix that is mediated by a new virulence factor and membrane vesicles. The study increases our understanding of
S. mutans
virulence and also offers a new opportunity to develop effective therapeutics targeting
S. mutans
. In addition, the mechanisms of membrane vesicle-mediated biofilm matrix dynamics are also applicable to other biofilm-driven infectious diseases.
Reports from a Healthy Community: the 7th Conference on Beneficial Microbes
Authors: Mandel Mark J. , Broderick Nichole A. , Martens Eric C. , Guillemin Karen
Published: December 2018

The last two decades have seen an explosion in research about the beneficial microbial communities associated with plants and animals. Initially, this explosion was driven by technological advances that enabled explorations of microbiomes on unprecedented scales.
Immunologic Pathways in Protective versus Maladaptive Host Responses to Attenuated and Pathogenic Strains of Mycoplasma gallisepticum
Authors: Beaudet Jessica , Tulman Edan R. , Pflaum Katherine , Canter Jessica A. , Silbart Lawrence K. , Geary Steven J.
Published: December 2018

Mycoplasmas are small bacterial commensals or pathogens that commonly colonize host mucosal tissues and avoid rapid clearance, in part by stimulating inflammatory, immunopathogenic responses. We previously characterized a wide array of transcriptomic perturbations in avian host tracheal mucosae infected with virulent, immunopathologic
Mycoplasma gallisepticum
; however, mechanisms delineating these from protective responses, such as those induced upon vaccination, have not been thoroughly explored.
Simultaneous Visualization of Enzymatic Activity in the Cytoplasm and at Polyphosphate Inclusions in
Beggiatoa
sp. Strain 35Flor Incubated with
18
O-Labeled Water
Authors: Langer Simon , Vogts Angela , Schulz-Vogt Heide N.
Published: December 2018

Microbial organisms exert a large influence on the environment as they directly affect the turnover of essential elements. This is particularly true for polyphosphate-accumulating large sulfur bacteria, which can either accumulate phosphate as polyphosphate or degrade it and release phosphate into the environment, depending on environmental conditions. This study presents a new approach to simultaneously visualize general metabolic activity and enzymatic activity at polyphosphate granules by incubation with
18
O-labeled water as the only stable isotope tracer. For this purpose, the well-studied
Beggiatoa
sp. strain 35Flor was used as a model organism and was exposed to different stress regimes. General metabolic activity was strongly impaired during high-stress regimes. In contrast, intense intracellular polyP cycling was not restricted to favorable or stressful conditions, highlighting the importance of polyP for general cell physiology, especially during hostile conditions. The nanoSIMS approach adds a new tool to study microorganisms involved in phosphorus cycling in the environment together with the identification of general metabolic activity.
A Novel, Rapid, and Low-Volume Assay for Therapeutic Drug Monitoring of Posaconazole and Other Long-Chain Azole-Class Antifungal Drugs
Authors: Wiedman Gregory R. , Zhao Yanan , Perlin David S.
Published: December 2018

This work describes an effective assay for TDM of long-chain azole-class antifungal drugs that can be used in diluted human serum samples. This assay will provide a quick, cost-effective method for monitoring concentrations of drugs such as posaconazole that exhibit well-documented pharmacokinetic variability. Our rGO-aptamer assay has the potential to improve health care for those struggling to treat fungal infections in rural or resource-limited setting.
Acute mountain sickness (AMS) in a Nepali pilgrim after rapid ascent to a sacred lake (4380 m) in the Himalayas
Authors: Thapa Simant Singh , Basnyat Buddha
Published: December 2018

A 55-year-old female Nepali pilgrim presented to the Himalayan Rescue Association Temporary Health Camp near the sacred Gosainkund Lake (4380 m) north of Kathmandu, Nepal, with a complaint of severe headache, vomiting and light-headedness. She was diagnosed with severe acute mountain sickness. Intramuscular dexamethasone was administered. Paracetamol (acetaminophen in the USA and Canada) and ondansetron were given as supportive management for headache and nausea. Arrangements were made to have her carried down by a porter immediately. After the descent, all her symptoms resolved. High-altitude pilgrims are a more vulnerable group than trekkers and mountaineers. Pilgrims generally have a rapid ascent profile, have low awareness of altitude illness and are strongly motivated to gain religious merit by completing the pilgrimage. As a result, there is a high incidence of altitude illness among pilgrims travelling to high-altitude pilgrimage sites.
Difficult intubation in a neonate: a diagnostic dilemma
Authors: Mohanty Pankaj Kumar , Som Tapas Kumar , Purkait Suvendu , Satapathy Amit Kumar
Published: December 2018

Difficult intubation in neonates has innumerable aetiologies. It especially poses a formidable challenge to save a newborn baby immediately after birth where antenatal details are unavailable. A late preterm neonate was born limp and apnoeic. Several attempts to intubate the baby were unsuccessful. Possibility of subglottic obstruction was considered. The baby died of severe perinatal asphyxia. Autopsy showed a mass around the airway which turned out to be ectopic thymus on histopathology. Ectopic thymus can present as periglottic mass without externally visible cervical swelling and can cause difficult intubation which may lead to serious adverse outcome including death if not anticipated early and managed accordingly.
Does ocular inflammation play a role in xeroderma pigmentosum with endothelial dysfunction: an immunological study
Authors: Aslam Amreen , Gupta Noopur , Velpandian Thirumurthy , Sen Seema
Published: December 2018

We report a case of xeroderma pigmentosum (XP) with endothelial dysfunction where the analysis of tears revealed elevated levels of proinflammatory cytokines, even in the absence of active inflammation and neovascularisation of the ocular surface. Although the role of ultraviolet (UV) radiation-induced inflammation in the occurrence of ocular manifestations of XP is known, little is published on the molecular mechanisms and there are no reports quantifying the presence of inflammatory cytokines in the tears of patients with ocular involvement of XP. Tear analysis demonstrated an increase in inflammatory cytokines and chemokines, especially interleukin-8 (2.38 ng/µg), tumour necrosis factor alpha (0.87 ng/µg) and granulocyte monocyte colony stimulating factor (0.44 ng/µg) as compared with the control eye. Effective management of the underlying UV-induced inflammation and promoting DNA repair may play a vital role in managing ocular manifestations and its sequelae in patients of XP.
Case of olmesartan-associated enteropathy and transient positive antitissue transglutaminase serology
Authors: Ghaith Jenan , Raslan Ismail A , Szilagyi Andrew , Alameldin Mona
Published: December 2018

Olmesartan-associated enteropathy (OAE) is increasingly being recognised as a major differential diagnosis in patients with villous atrophy and negative coeliac disease (CD) serology. OAE and positive coeliac markers have rarely been reported. We report a case of diarrhoea and small bowel villous blunting associated with a transient elevation of antitissue transglutaminase antibody (ATTG). On discontinuation of olmesartan, symptoms improved, repeat biopsies were normal and levels of ATTG also returned normal. We discuss a possible explanation for the transient elevation in ATTG and the significance of considering OAE/CD overlap.
Neuro-ophthalmological presentation of giant intracavernous carotid artery aneurysm in a child
Authors: Buño Bonifacio Oliquino , Cruz Franz Marie
Published: December 2018

An otherwise healthy, 11-year-old boy presented with a long-standing history of right eye esotropia associated with a right head turn. Following a mild blunt facial trauma, he was brought to an ophthalmologist for binocular horizontal diplopia. Cranial CT scan revealed a large, enhancing lesion in the right cavernous sinus. Neuro-ophthalmological evaluation showed abduction deficit of the right eye, right corneal anaesthesia, right upper lid ptosis and a smaller right pupil suggesting involvement of the intracavernous segments of the right abducens nerve, ophthalmic nerve and oculosympathetic fibres. Cerebral angiography confirmed a large aneurysm involving the petrous, lacerum and cavernous segments of the right internal carotid artery. The child underwent successful clipping of the aneurysm by the neurosurgery service.
Tay-Sachs disease: a novel mutation from India
Authors: Khera Daisy , John Joseph , Singh Kuldeep , Faruq Mohammed
Published: December 2018

Lysosomal storage disorders or lipidoses are a wide spectrum of inherited diseases caused by deficiency of a specific lysosomal hydrolase. About 134 mutations have been described so far and this number is gradually increasing with newer mutations being reported. We report a 28-month-old child who presented to us with neurodevelopment regression, seizures and cherry red spot in both eyes. His hexosaminidase A enzyme activity was reduced and genetic testing revealed a homozygous novel variation in HEXA (hexosaminidase A) gene in the DNA sample of the patient.
Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances
Authors: Schuster Bruce Catherine , Rull Gurvinder , Sotiris Antoniou , Lobo Melvin D
Published: December 2018

A 61-year-old man with a 30-year history of uncontrolled hypertension was unable to tolerate conventional antihypertensive medications from all classes. At the time of referral to our centre he had discontinued all antihypertensive drugs and felt well. However, his average home blood pressure (HBP) reading was 179/125 mm Hg and echocardiography demonstrated moderate concentric left ventricular hypertrophy. A novel stratified medicines algorithm was used to guide treatment entailing transdermal clonidine patch therapy instead of tablet formulations. Sixteen months later, his average HBP was 147/106 mm Hg with no side effects and the left ventricular hypertrophy had completely regressed. Our experience has taught us that multiple drug intolerance is a common, often overlooked, cause of non-adherence to antihypertensive medication. This case demonstrates the benefit of a novel approach to optimise blood pressure control and emphasises the important role of hypertension specialists in managing complex, high-risk patients unable to tolerate guideline-based therapy.
Toxic shock syndrome: the great masquerader
Authors: Biswas Sagnik , Ray Animesh , Fazal Farhan , Mahajan Swati
Published: December 2018

Toxic shock syndrome is a rare but potentially lethal toxin-mediated illness that can be caused by streptococcal and staphylococcal species. It initially presents as a febrile illness that rapidly progresses to multiorgan dysfunction, hence a high index of suspicion coupled with rapid verification of the diagnosis and aggressive treatment is required to improve the outcome of the disease. A 23-year-old man presented with high-grade fever associated with headache, retro-orbital pain, gastroenteritis and gum bleeds. Treatment was initiated keeping in mind the possibility of dengue haemorrhagic fever. However, further clinical deterioration led us to re-examine our patient, revealing an old neglected wound. Microbiological confirmation of methicillin-resistantStaphylococcus aureusfrom the wound swab and prompt institution of appropriate treatment led to a favourable outcome in a case known to be associated with serious morbidity and mortality.
Olmesartan-associated severe gastritis and enteropathy
Authors: Shenbagaraj Lavanya , Swift Gillian
Published: December 2018

Olmesartan is an angiotensin II receptor antagonist, used in the treatment of hypertension. We report a case of olmesartan-associated severe gastritis with enteropathy in a 74-year-old woman who presented with mainly upper gastrointestinal symptoms. There was significant endoscopic improvement in the mucosal inflammation on stopping the drug. Subsequent gastroscopy showed mucosal healing and normal gastric and duodenal mucosa. To our knowledge, this is the first case report of olmesartan-associated gastritis and enteropathy predominantly involving and affecting the whole of stomach with limited small bowel involvement.
Foot drop post varicella zoster virus
Authors: Whitby Emma , Bateman Marcus
Published: December 2018

Leg pain and weakness can often be seen in a musculoskeletal physiotherapy outpatient setting. While the differential diagnoses for neuropathic pain and weakness is often spine related, this unusual cause for polyradiculopathy is less commonly seen. Shingles is not something routinely seen in a physiotherapy department but is usually associated with skin eruptions and pain but less so with motor loss. The purpose of this case report is to therefore raise awareness that this presentation can occur and should not be mistaken for spinal radiculopathy.
Possible association of influenza A infection and reverse takotsubo syndrome
Authors: Golfeyz Shmuel , Kobayashi Takaaki , Aoi Shunsuke , Harrington Matthew
Published: December 2018

We present a case of reverse takotsubo syndrome (rTS) in a 68-year-old woman who presented with acute chest pain and flu-like symptoms. She was found to have elevated troponin and abnormal ECG. Urgent coronary angiogram revealed non-obstructive mild coronary artery disease of the left anterior descending artery. Left ventriculography demonstrated hypokinesis of the left ventricular base with sparing of the mid-ventricle and apex. Nasal viral PCR was positive for Influenza A. The diagnosis was confirmed with repeat echocardiogram 2 weeks later revealing resolution of regional wall motion abnormalities. rTS is a type of TS, mimicking acute coronary syndrome. It is seen in younger patients and often occurs with intense emotional and physical stress. Though many triggers have been reported, rTS associated with influenza A has not been previously documented.
Successful treatment of congenital chylothorax with skimmed milk and long course octreotide
Authors: Sahoo Tanushree , Mangla Mukul Kumar , Sethi Amanpreet , Thukral Anu
Published: December 2018

Congenital chylothorax (CC) is a rare entity in neonatal period requiring multimodal management strategies. Despite optimum treatment, some cases remain refractory posing significant challenge to the treating physician. We here describe a 33-week preterm neonate presenting with refractory congenital chylothorax who needed treatment with combination of skimmed milk, high dose and prolonged duration octreotide for resolution. This case highlighted that octreotide has a good safety profile in newborn infants with congenital chylothorax and locally available skimmed milk fortified with medium chain triglyceride (MCT) oil is a cheap and safe alternative.
Pythium insidiosumandAcanthamoebakeratitis in a contact lens user
Authors: Raghavan Anita , Bellamkonda Prathyusha , Mendoza Leonel , Rammohan Ram
Published: December 2018

The oomycetePythiumand the protozoanAcanthamoebacan cause fulminant and recalcitrant keratitis, respectively. These infections are not only sight-threatening but can also threaten the structural integrity of the eye. A high index of suspicion is required to identifyPythiumkeratitis given its uncommon occurrence.Acanthamoebakeratitis is most commonly associated with contact lens wear. However, its coexistence withPythiumhas not been reported. We present the successful management of a case of contact lens-related keratitis, coinfected withPythiumandAcanthamoeba.
Rare cause of superior vena cava syndrome: a giant bulla
Authors: Batihan Guntug , Usluer Ozan , Kaya Seyda Ors
Published: December 2018

Superior vena cava syndrome (SVCS) is a group of symptoms caused by obstruction of superior vena cava. External compression caused by benign or malign processes is the most common physiopathology. We aim to present a 29-year-old man with non-productive cough, facial plethora and venous distention of the neck. Right apical tense bulla which was compress superior vena cava was detected and video-assisted thoracoscopic surgery applied. Our extensive search found out that only one report of SVCS secondary to bulla is available on Medline.
Recurrent bloody stools associated with visceral infantile haemangioma in a preterm twin girl
Authors: Krick Jeanne , Riehle Kimberly , Chapman Teresa , Chabra Shilpi
Published: December 2018

A premature twin infant girl was transferred to a level IV neonatal intensive care unit for recurrent bloody stools, anaemia and discomfort with feeds; without radiographic evidence of necrotising enterocolitis. Additional imaging after transfer revealed a large retroperitoneal mass in the region of the pancreas compressing the inferior vena cava and abdominal aorta, raising suspicion for neuroblastoma. Abdominal exploration and biopsy unexpectedly revealed that the lesion was an infantile capillary haemangioma involving the small bowel, omentum, mesentery and pancreas. The infant was subsequently treated with propranolol, with a decrease in the size of the lesion over the first year of her life and a drastic improvement in feeding tolerance. While cutaneous infantile haemangiomas are common, visceral infantile haemangiomas are less so and may present a significant diagnostic challenge for clinicians. This interesting case demonstrates that such lesions should be considered in the differential diagnosis for unexplained gastrointestinal bleeding or abdominal symptoms in newborns.
Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection
Authors: Skedros John G , Henrie Marshall K , Finlinson Ethan D , Trachtenberg Joel D
Published: December 2018

In September 2015, a male aged 61 years with poorly controlled diabetes (his only medical problem) had left shoulder surgery that included an arthroscopic acromioplasty with debridement of suture material from a rotator cuff repair done 10 years prior. A subacromial corticosteroid injection was given 7 months later for pain and reduced motion. Three weeks later a fulminate infection was evident. Cultures grewPropionibacterium acnes. Treatment included two arthroscopic debridement surgeries and 8 weeks of intravenous antibiotics (primarily daptomycin). Eight weeks after the cessation of the antibiotics, purulence recurred and tissue cultures then grewStaphylococcus epidermidis. Several additional surgeries were needed to control the infection. We failed to recognise that an abscess that extended from the subacromial space across the entire supraspinous fossa. We report this case to alert clinicians that a seemingly innocuous subacromial corticosteroid injection can lead to an atypical infection and also extend into the supraspinous fossa.
Atypical deep somatic soft-tissue leiomyoma of extrathoracic chest wall: first case of the literature
Authors: Batihan Guntug , Usluer Ozan , Kaya Seyda Ors , Aydogdu Zekiye
Published: December 2018

Leiomyomas are benign soft-tissue tumours which take origin from the smooth muscles. Pleura and chest wall are uncommon location for such tumours. Here, we report a case of a 26-year-old female patient presented with 3 months history of chest pain. Chest X-ray and CT showed a calcified mass of 6×12 cm in size in the left lateral of the chest wall. After resection of the mass, pathological examination diagnosed it as atypical deep somatic soft-tissue leiomyoma of extrathoracic chest wall. No pathological finding was detected during follow-up.
Wolf in the sheep’s clothing: intestinal angioedema mimicking infectious colitis
Authors: Mehmood Asif , Abdullah Hafez Mohammad Ammar , Inayat Faisal , Ullah Waqas
Published: December 2018

Hereditary angioedema (HAE) is a relatively rare clinical entity that can potentially cause life-threatening airway or intestinal oedema, patients with the latter usually presents with symptoms of gastroenteritis like vomiting, diarrhoea and abdominal pain. Here, we present a unique case of a less recognised type of HAE that is type III in a patient who presented with signs and symptoms consistent with infectious colitis. She previously had similar episodes and was managed multiple times with antibiotics, with no satisfactory response. There, she underwent extensive diagnostic evaluation. On the basis of findings of further investigations on the current visit, she was eventually diagnosed with intestinal angioedema. To the best of our knowledge, the present paper represents the third reported case of type III HAE-induced intestinal angioedema. Additionally, we undertake a literature review of HAE.
Rare complication of central venous catheter placement: bilateral hydrothorax
Authors: Batihan Guntug , Ceylan Kenan C , Kaya Seyda Ors
Published: December 2018

Central venous catheters (CVCs) are very useful tools in clinical medicine. It is important not only for the administration of medications or fluids but also the measurement of haemodynamic variables, especially in intensive care patients. CVC placement is a relatively safe procedure but may occasionally be associated with complications, such as pneumothorax, haemothorax, cardiac tamponade, sepsis and thrombosis. We aim to report an extraordinary case of bilateral hydrothorax due to CVC placement.
Metastatic lung adenocarcinoma- associated thrombotic microangiopathy in a renal transplant recipient
Authors: Vilayur Eswari , de Malmanche Jillian , Trevillian Paul , Ferreira David
Published: December 2018

Thrombotic microangiopathy (TMA) after renal transplantation can be a diagnostic challenge. TMA can occur with calcineurin inhibitors, allograft rejection, infection, mutations in complement regulatory proteins and autoimmunity. A 52-year-old male renal transplant recipient presented with extensive deep vein thrombosis. He developed transfusion-dependent microangiopathic haemolytic anaemia with thrombocytopenia. He did not respond calcineurin inhibitor cessation, eculizumab or plasma exchange. ADAMTS13 and complement levels were normal. Infection and autoimmune screens were negative. A diagnosis of metastatic adenocarcinoma was made on bone marrow biopsy. This represents a rare case of malignancy-associated TMA in a renal transplant recipient. Early diagnosis can facilitate the prompt initiation of chemotherapy which is the only treatment option.
Acute promyelocytic leukaemia presenting as necrotising fasciitis of the perineum (Fournier gangrene)
Authors: Furtado Vanessa Fiorini , Batalini Felipe , Staziaki Pedro , Prilutskiy Andrey , Sloan John Mark
Published: December 2018

We present a case of an unusual presentation of acute promyelocytic leukaemia (APML), which presented with Fournier gangrene (FG). A 38-year-old man presented with malaise, groin swelling, anal bleeding, fever and was found to have FG. Initial workup revealed pancytopaenia, borderline low fibrinogen, prolonged international normalized ratio (INR), which raised the suspicion for leukaemia. The peripheral blood differential revealed leucopaenia with absolute neutropaenia and a 5% abnormal promyelocytes but no blasts, suspicious for APML. Bone marrow biopsy was performed and fluorescence in situ hydridization (FISH), karyotype and PCR confirmed a t(15;17) translocation, establishing a diagnosis of APML. After 1 month of therapy for intermediate risk APML with All-trans retinoic acid (ATRA) and arsenic trioxide (ATO), repeat chromosomal analysis and repeat bone marrow biopsy revealed no evidence of residual APML. After the consolidation phase was started with ATRA and ATO regimen, the wound healed after 2 months and the patient achieved complete remission.