A case of leukoencephalopathy, cerebral calcifications and cysts

Triad of leukoencephalopathy, cerebral calcifications and cysts (LCC) is a recently reported rare disease named ‘Labrune syndrome’ after the first case was reported in 1996 by Labrune et al. Herein, we report a case of a 36-year-old man with mild right-sided weakness and seizures for 5 years. CT of brain revealed extensive calcification involving bilateral basal ganglia, right thalamus and bilateral deep cerebellar nuclei. A supratentorial cystic lesion with blood fluid level was seen in left occipitotemporal region. MRI examination revealed diffuse symmetric white matter hyperintensity suggesting leukoencephalopathy. On follow-up, patient reported improvement in the weakness and no further seizure episodes. However, follow-up of MRI revealed persistence of lesions. Differential diagnosis considered were parasitic infections (hydatid, cysticercosis), Coat''s plus disease and causes of diffuse cerebral calcification like Fahr''s disease and post-radiotherapy/chemotherapy. Serology for parasitic infections was negative. No history of radiotherapy or chemotherapy in the past could be elicited in the history. Another close differential is Coat''s plus disease which can mimic LCC pathologically.     

Diagnostic accuracy of dual-echo (in- and opposed-phase) T1-weighted gradient recalled echo for detection and grading of hepatic iron using quantitative and visual assessment

Objectives

Detection and quantification of hepatic iron with dual-echo gradient recalled echo (GRE) has been proposed as a rapid alternative to other magnetic resonance imaging (MRI) techniques. Co-existing steatosis and T1 weighting are limitations. This study assesses the accuracy of routine dual-echo GRE.

Methodology

Between 2010 and 2013, 109 consecutive patients underwent multi-echo (ME) MRI and dual-echo GRE for quantification of hepatic iron. Liver iron concentration (LIC) was calculated from ME-MRI. Relative signal intensity (RSI) and fat signal fraction (FSF) were calculated from dual-echo GRE. Four radiologists subjectively evaluated dual-echo GRE (±subtraction). Diagnostic accuracy was compared between techniques and correlated with biopsy using Fisher’s exact test, Spearman correlation and regression.

Results

The sensitivity of visual detection of iron ranged from 48 to 55 %. Subtraction did not increase sensitivity (p?<?0.001). Inter-observer variability was substantial (κ?=?0.72). The specificity of visual detection of iron approached 100 % with false-positive diagnoses observed using subtraction. LIC showed a higher correlation with histopathological iron grade (r?=?0.94, p?<?0.001) compared with RSI (r?=?0.65, p?=?0.02). Univariate regression showed an association between RSI and LIC (B?=?0.98, p?<?0.001, CI 0.73-1.23); however, the association was not significant with multi-variate regression including FSF (p?=?0.28).

Conclusions

Dual-echo GRE has low sensitivity for hepatic iron. Subtraction imaging can result in false-positive diagnoses.

Key Points

? Routine liver MRI studies cannot effectively screen patients for iron overload. ? Concomitant hepatic steatosis and iron limits diagnostic accuracy of routine liver MRI. ? Dual-echo GRE subtraction imaging causes false-positive diagnoses of iron overload. ? Dedicated MRI techniques should be used to diagnose and quantify iron overload.     

Voriconazole-induced psychosis in a case of acute myeloid leukemia with febrile neutropenia

Voriconazole-induced psychosis is a rare side effect. It is important that clinicians are made aware of voriconazole-induced potential psychosis. We report a case of voriconazole-induced psychosis that responded to haloperidol.KEY WORDS: Haloperidol, psychosis, voriconazole     

Acute coronary syndrome following snake bite: a report of three cases from a tertiary care hospital in rural southern India

Snake bite is a common cause of preventable death in rural India which is often due to neurological complications and coagulopathy. We report on three patients who presented with bites and later developed acute coronary syndrome during the course of their stay in hospital. Such patients have to be managed conservatively because of their coexistent coagulopathy.     

In vitro antibacterial activity of Desmodium gangeticum (L.) DG

ObjectiveTo identify the antibacterial activity of Desmodium gangeticum (D. gangeticum).MethodsAntibacterial activity of D. gangeticum was tested with various solvents viz., methanol, ethanol, chloroform and aqueous extract against various bacterial pathogens such as Klebsiella pneumoniae, Escherichia coli, Salmonella typhi, Streptococcus mutants and Pseudomonas aeruginosa. Antibiotic sensitivity assay was performed with amoxicillin, kanamycin, tetracyclin, ciprofloxacin and penicillin.ResultOf the selected several extract, the methanolic extract showed maximum zone of inhibition (24±2.3mm) against S. mutants and minimum zone of inhibition was observed with aqueous extract against P. aeruginosa (7±0.08). In addition the antibiotic sensitivity was observed with kanamycin, tetracyclin, ciprofloxacin against all bacterias.ConclusionsThe methonalic extract of D. gangeticum be able to use as potential antibacterial source for various infective pathogens.     

CNS aspergilloma mimicking tumors: Review of CNS aspergillus infection imaging characteristics in the immunocompetent population

Background and purpose

CNS Aspergillosis is very rare and difficult to diagnose clinically and on imaging. Our objective was to elucidate distinct neuroimaging pattern of CNS aspergillosis in the immunocompetent population that helps to differentiate from other differential diagnosis.

Direct Preparation of Nanoscale Thin Films of Poly(vinylidene fluoride) Containing β‐Crystalline Phase by Heat‐Controlled Spin Coating

Nanoscale thin films of PVDF containing the β‐crystalline phase were directly prepared by heat‐controlled spin coating without the influence of external stimuli either in the form of additives or post‐treatments. Sample preparation was carried out at different temperatures, ranging from 10 to 70 °C. At elevated temperatures (40, 50, 60 and 70 °C), PVDF was crystallized into the β‐phase, while at near‐ambient conditions (20 and 30 °C) it was crystallized into the α‐phase. Some samples exhibited a phase‐segregated morphology, with varying particle sizes depending on the preparation temperature. The ferroelectric nature of a typical sample, prepared at 40 °C, was visualized by piezoresponse imaging studies.

     

8q24 and 17q Prostate cancer susceptibility loci in a multiethnic Asian cohort

ObjectivesRecently, several genome-wide association studies have demonstrated a cumulative association of 5 polymorphic variants in chromosomes 8q24 and 17q with prostate cancer (CaP) risk in Caucasians, particularly those harboring aggressive clinicopathologic characteristics. The purpose of this study was to evaluate the influence of these variants on CaP susceptibility in Singaporean Asian men.Materials and methodsWe performed a case-control study in 289 Chinese CaP patients and 412 healthy subjects (144 Chinese, 134 Malays, and 134 Indians), and examined the association of the 5 single nucleotide polymorphisms (SNPs) with CaP.ResultsIn the healthy subjects, rs16901979 A-allele frequency was highest amongst Chinese (0.32) compared with Malays (0.13; P < 0.0001) or Indians (0.09; P < 0.0001); rs6983267 G-allele was highest in Indians (0.51) compared with Chinese (0.42; P = 0.041) or Malays (0.43; P = 0.077); whereas rs1859962 G-allele frequency was highest amongst Indians (0.56) compared with Chinese (0.40; P = 0.0002) or Malays (0.38; P < 0.0001). Individuals with the rs4430796 TT genotype were at increased CaP risk in the Chinese via a recessive model (odds ratios (OR) = 1.56, 95% CI = 1.04–2.33). Significant associations were observed for rs4430796 TT with Gleason scores of ≥7 (OR = 1.76, 95% CI = 1.14–2.73) and prostate-specific antigen (PSA) levels of ≥10 ng/ml at diagnosis (OR = 1.63, 95% CI = 1.01–2.63), as well as for rs6983267 GG with stage 3–4 CaPs (OR = 1.91, 95% CI = 1.01–3.61). A cumulative gene interaction influence on disease risk, which approximately doubled for individuals with at least 2 susceptibility genotypes, was also identified (OR = 2.18, 95% CI = 1.10–4.32).ConclusionsThis exploratory analysis suggests that the 5 genetic variants previously described may contribute to prostate cancer risk in Singaporean men.