Mixed germ cell tumor of the pineal gland in a pediatric patient

Tumors of the pineal region are a rare clinical entity, comprising approximately 3%-8% of pediatric tumors. Based on their histopathological features, they are typically classified as pineal parenchymal tumors and germ cell tumors, with the latter being more prevalent. Clinical presentation is heterogeneous, with symptoms arising either due to tumor invasion or compression of adjacent neurovascular structures and increased intracranial pressure. Imaging studies are paramount in evaluating pineal region lesions and establishing an accurate diagnosis, with MRI representing the gold standard. Herein, we present the case of a 16-year-old boy presented with recurrent headaches. A head MRI revealed a pineal gland lesion. Histopathological examination confirmed the diagnosis, and the patient underwent a successful gross total resection (GTR) of the tumor. This case report seeks to draw attention to the elusive clinical presentation and management of this infrequently encountered tumor, as well as emphasize the importance of considering pineal gland tumors in the differential diagnosis of recurrent, chronic headaches in pediatric patients.     

Metrics and tools for consistent cohort discovery and financial analyses post-transition to ICD-10-CM

In the United States, International Classification of Disease Clinical Modification (ICD-9-CM, the ninth revision) diagnosis codes are commonly used to identify patient cohorts and to conduct financial analyses related to disease. In October 2015, the healthcare system of the United States will transition to ICD-10-CM (the tenth revision) diagnosis codes. One challenge posed to clinical researchers and other analysts is conducting diagnosis-related queries across datasets containing both coding schemes. Further, healthcare administrators will manage growth, trends, and strategic planning with these dually-coded datasets. The majority of the ICD-9-CM to ICD-10-CM translations are complex and nonreciprocal, creating convoluted representations and meanings. Similarly, mapping back from ICD-10-CM to ICD-9-CM is equally complex, yet different from mapping forward, as relationships are likewise nonreciprocal. Indeed, 10 of the 21 top clinical categories are complex as 78% of their diagnosis codes are labeled as “convoluted” by our analyses. Analysis and research related to external causes of morbidity, injury, and poisoning will face the greatest challenges due to 41 745 (90%) convolutions and a decrease in the number of codes. We created a web portal tool and translation tables to list all ICD-9-CM diagnosis codes related to the specific input of ICD-10-CM diagnosis codes and their level of complexity: “identity” (reciprocal), “class-to-subclass,” “subclass-to-class,” “convoluted,” or “no mapping.” These tools provide guidance on ambiguous and complex translations to reveal where reports or analyses may be challenging to impossible.Web portal: http://www.lussierlab.org/transition-to-ICD9CM/Tables annotated with levels of translation complexity: http://www.lussierlab.org/publications/ICD10to9     

Characterisation of ecto- and endoparasites in domestic cats from Tirana,Albania

During 2008 to 2011, faecal samples, ear swabs, and ectoparasites obtained by full body search and total body comb were collected from 252 cats originating from the greater Tirana area. Faecal samples were examined using the McMaster and Baermann techniques, and a subset of 58 samples was tested for Giardia-specific antigen using a coproantigen enzyme-linked immunosorbent assay (ELISA). The ear swabs were examined for the presence of parasitic mites. Overall, almost 93 % of the cats were identified harbouring one or more parasites: 59.1 % (95 % confidence interval (CI), 53.0–65.0) and 86.9 % (95 % CI, 82.7–91.1) of the cats tested positive for ecto- or endoparasites, respectively; 53.2 % of the cats had evidence for concomitant ectoparasite infestation and endoparasite infection. For ectoparasite infestation, prevalence was 52.0 % for total fleas (Ctenocephalides felis, 51.2 %; Ctenocephalides canis, 2.0 %; and Leptopsylla segnis, 0.4 %), 8.3 % each for Felicola subrostratus and Otodectes cynotis and 4.0 % for Rhipicephalus sanguineus sensu lato. The most prevalent endoparasites were Toxocara ascarids (48.0 %), followed by Aelurostrongylus lungworms (39.7 %), Capillaria spp. (31.7 %), hookworms (32.9 %), dipylidiid cestodes (27.8 %), Cystoisospora spp. (23.4 %) and taeniid cestodes (2.0 %). One animal was found shedding Pseudamphistomum truncatum eggs. Giardia-specific antigen was detected in 29.3 % of the 58 cats tested. Mixed infections with up to six endoparasites concurrently (excluding Giardia) and mixed infestations with two or three species of ectoparasites were recorded in 73.1 and 22.8 % of the parasite-positive cats, respectively. Cats ≤9 months of age were more frequently tested (p?Toxocara and Cystoisospora infections than cats >9 months while these cats tested more often (p?Aelurostrongylus-positive compared with the younger cats. The prevalence of infestation with ectoparasites did not differ between the cats of these two age groups. Given the impact that some of the parasites may have upon animal health as well as the zoonotic potential of some of them, measures should be taken to minimise the transmission of these parasites.     

Association between a complex insertion/deletion polymorphism in NOD1 (CARD4) and susceptibility to inflammatory bowel disease

The identification of the role of genetic variants within NOD2 (CARD15) in Crohn's disease and ulcerative colitis susceptibility highlight the role of the innate immune system in inflammatory bowel disease (IBD) pathogenesis. NOD1 (CARD4) is located on chromosome 7p14.3, in a region of known linkage to IBD and encodes an intracellular bacterial pathogen-associated molecular pattern receptor that is closely related to NOD2. We have identified strong association between haplotypes in the terminal exons of NOD1 and IBD (multi-allelic P = 0.0000003) in a panel of 556 IBD trios. The deletion allele of a complex functional NOD1 indel polymorphism (ND(1) + 32656*1) was significantly associated with early-onset IBD (P = 0.0003) in unrelated cases and controls. ND1 + 32656*1 was also associated with extra-intestinal manifestations of IBD (P = 0.04). These findings in two independent populations provide strong evidence for a role for NOD1 variants in IBD susceptibility and reinforce the role of the innate immune system in IBD pathogenesis.     

Principal intestinal parasites of dogs in Tirana,Albania

From 2004 to 2009, the digestive tracts of 111 dogs from suburban areas around Tirana, Albania, were examined for intestinal helminths. In addition, rectal faecal samples of all dogs were examined for protozoan infections and 48 faecal samples from dogs >6 months of age were processed with the Baermann technique to test for the excretion of lungworm larvae. The heart and pulmonary arteries of 30 dogs >6 months of age also were examined for nematode parasites. The intestinal parasite fauna of the dogs included three protozoan species (Cystoisospora canis, Cystoisospora ohioensis/burrowsi, Sarcocystis spp.), three cestode species (Dipylidium caninum, Taenia hydatigena, Echinococcus granulosus), five nematode species (Ancylostoma caninum, Uncinaria stenocephala, Toxocara canis, Toxascaris leonina, Trichuris vulpis) and one acanthocephalan (Centrorhynchus buteonis). Rates of infection were: 15.3% for C. canis, 31.5% for C. ohioensis/burrowsi, 1.8% for Sarcocystis spp., 65.8% for D. caninum, 16.2% for T. hydatigena, 2.7% for E. granulosus (genotype G1), 13.5% for A. caninum, 64.9% for U. stenocephala, 75.7% for T. canis, 0.9% for T. leonina, 21.6% for T. vulpis and 0.9% for C. buteonis. Up to six species of gastrointestinal parasites were found per dog. The 63 ≤6-month-old dogs harboured significantly (p < 0.001) fewer gastrointestinal parasite species concurrently (mean 2.65 ± 1.25 species per animal) than the 48 older animals (mean 3.77 ± 1.45 species per animal). Dogs >6 months of age harboured significantly (p < 0.05) more D. caninum, T. hydatigena, A. caninum, U. stenocephala and T. vulpis compared to younger dogs. Conversely, the younger dogs harboured significantly (p < 0.001) more T. canis than the older ones. There was no difference in the male and female dogs’ counts of individual intestinal helminth species apart from T. hydatigena in dogs >6 months of age: Male dogs harboured significantly (p < 0.05) more tapeworms than female dogs. Based on faecal examination, there was no indication for lungworm infection; however, two adult heartworms (Dirofilaria immitis) were found in the right ventricle of one dog.     

Tobacco smoking habits, beliefs, and attitudes among medical students in Tirana, Albania

BACKGROUND: Many surveys throughout the world have evaluated the smoking behaviors, beliefs, and attitudes of medical students, but no information is available from Albania. METHOD: A cross-sectional survey in classroom settings using a self-administered questionnaire was performed at the University of Tirana during October 2000. RESULTS: In the first and fifth years of medical school, 149 (68.5% women) and 185 (55% women) students, respectively, completed the questionnaire, with overall response rates of 82 and 92%. Tobacco smoking prevailed among males. The smoking rates among first-year medical students were 34% among men and 5% among women. Among fifth-year students, 55% of the men and 34% of the women smoked. The percentages of occasional smokers were 29 and 49%, respectively, among the first- and fifth-year students who smoked. Most medical students reported knowing the health hazards of tobacco. Most students in both groups believed that smoking should be restricted in hospitals. Slightly more than half of the students stated that they will regularly advise smokers against smoking in their future jobs. CONCLUSION: Tobacco smoking is common among medical students in Albania. Targeted antismoking training should be mandatory for medical students in Albania.     

Insulin-like growth factor-I receptor and estrogen receptor crosstalk mediates hormone-induced neurite outgrowth in PC12 cells

Estradiol (E(2)) and insulin-like growth factor-I (IGF-I) can act independently or in concert to promote neurite outgrowth in vivo and in cultured neurons. This study examined the role of crosstalk between estrogen receptor (ER)alpha and the IGF-I receptor as a critical mediator of hormone- and growth factor-dependent neurite outgrowth in a homogenous cell system. We used control PC12 cells and PC12 cells stably transfected with ER alpha, both of which express IGF-I receptor. Cells were treated for 1 week with vehicle, 1 nM E(2) or 100 ng/ml IGF-I alone or with E(2) or IGF-I in the presence of either the IGF-I receptor antagonist JB1 or the ER antagonist ICI 182,780. IGF-I significantly increased neurite outgrowth, as measured by the percentage of process-bearing cells, and absolute neurite length per cell in both control and ER alpha-transfected PC12 cells. In contrast, E(2) increased process formation and extension only in PC12 cells that were stably transfected with ER alpha. ICI 182,780 and JB1 blocked the IGF-I-induced increases in neurite length in both cell types. The efficacy of ICI 182,780 in control PC12 cells may have been due to the upregulation of ER alpha in these cells by the 7-day treatment with IGF-I. The ER and IGF-I receptor antagonists similarly blocked the E(2)-induced increase in neurite lengths in ER alpha-transfected cells. Immunofluorescent analysis of the cellular distribution of an axonal marker, phospho-neurofilament, verified that the processes extended by PC12 cells were neurites. These data suggest that receptor crosstalk between IGF-I receptors and ER alpha has an important role in neurite formation and extension even in a single-cell system.