Autonomic Dysreflexia in a Man With Multiple Sclerosis

Background/Objective:

To report manifestation of autonomic dysreflexia (AD) in a man with multiple sclerosis (MS).

Design:

Case report.

Findings:

A young man presented with a history of several admissions to the emergency department with complaints of hypertensive attacks, palpitations, difficulty in breathing, headaches, and flushing. The attacks were attributed to a previously diagnosed anxiety disorder. Onset of numbness of the left leg numbness prompted a more thorough study, which showed evidence of MS. AD was suspected as the cause of his recurrent attacks of hypertension. Bladder distension was identified as the cause of AD, and his hypertensive attacks were controlled by management of neurogenic bladder.

Conclusions:

This report emphasizes that AD can occur in MS. Somatic symptoms warrant thorough investigation before attributing them to psychosomatic causes.     

Correction of Septal and Midface Hypoplasia in Maxillonasal Dysplasia (Binder’s Syndrome) Using High-Density Porous Polyethylene

Background  Maxillonasal dysplasia (Binder’s syndrome) is a congenital malformation characterized by an extremely flat and retruded nose. Methods  This report describes an 18-year-old woman with maxillonasal dysplasia (Binder’s syndrome). The septal deficiencies and maxillary retrusion of the patient were corrected by using an L-shaped implant and a crescent-shaped high-density porous polyethylene implant through the oral vestibular sulcus via an external rhinoplasty approach. Results  After the operation, the tip of the nose had moved 5.5 mm anteriorly in the sagittal plane and 11.9 mm coronally in the vertical plane. Also, the nasolabial angle had increased after the surgery. Follow-up evaluation at 24 months showed good correction of the nasal and midface projection. Conclusions  High-density porous polyethylene implants are a good alternative for patients with Binder’s syndrome, especially those who will not accept costal cartilage grafts or orthognathic surgery and who have tendency for hypertrophic scarring.     

Determination of risk factors for hypertension through the classification tree method

Most current statistical strategies for determining risk factors for hypertension (HT) among certain populations have proved inconclusive. In this study, the classification tree method, which is more practical and easy to understand than other statistical methods, was used to determine the risk for HT among outpatients in a clinic in Denizli province, western Turkey, between January 2002 and July 2004. The effects of 14 risk factors (body mass index, waist-to-hip ratio, age, serum total cholesterol, serum triglycerides, sex, HT in first-degree relatives, diabetes mellitus, smoking, stress factors, alcohol consumption, dyslipidemia in first-degree relatives, dyslipidemia [previously diagnosed], and saturated fat consumption) on HT were evaluated in this population. In all, 1761 adults at the outpatient clinic were recruited for lipid and HT measurements. The classification tree method revealed 7 main risk factors (body mass index, waist-to-hip ratio, sex, serum triglycerides, serum total cholesterol, HT in first-degree relatives, and saturated fat consumption) for HT. The findings of the present study suggest that the classification tree is a valuable statistical method for evaluating multiple risk factors for HT.     

Do CCR5 (CCR5Δ32) and TLR3 (RS5743313) gene polymorphisms prevent chronic hepatitis B infection?

Hepatitis B virus (HBV) is still a significant health problem in human. HBV severity or sensitivity of patients may be based on the individual genetic factors significantly. The aim of this study is to investigate the association of CCR5 (CCR5Δ32), TLR3 (rs5743313) functional gene polymorphisms, interferon-gamma (IFN-ɣ) level in HBV infection, which are thought to play an important role in innate and acquired immunity in patients who have undergone HBV seroconversion and those who have chronic hepatitis B disease and receive treatment. One hundred patients who are became naturally immune against HBV infection (HBsAg negative, anti-HBc IgG, and anti-HBs IgG positive), and 100 patients with chronic hepatitis B infection (>6 months HBsAg positive) who are receiving oral antiviral therapy were compared for CCR5Δ32, TLR3 (rs5743313) genotypes and serum IFN-ɣ level. It was found that CCR5Δ32 polymorphism (Wt/Δ32 and Δ32/Δ32) was significantly higher in the chronic hepatitis B group (p = 0.048) but not for TLR3 gene polymorphism. However, serum IFN-ɣ level was significantly higher in the HBV seroconversion group (75 ± 89 ng/ml) than in the chronic hepatitis B group (4.35 ± 17.27 ng/ml) (p < 0.001). In conclusion, a higher CCR5Δ32 allele frequency in patients with chronic hepatitis B might be considered as a marker of progression to chronic hepatitis.     

Persistence of candiduria in ICU catheterized patients is not linked to adherence and proteolytic activities of<Emphasis Type="Italic"> Candida</Emphasis> strains

Objective In this study, the patients who developed asymptomatic candiduria in the intensive care unit were followed prospectively for the persistence of candiduria after the replacement of indwelling urethral catheter and the correlation between persistence and virulence factors (proteinase enzyme activity and epithelial adhesion) was assessed.Design Prospective study.Setting Intensive care unit and mycology laboratory at a university hospital.Patients Thirty-four patients with asymptomatic candiduria were included in the study.Results Candiduria persisted in 19 of 34 patients(56%; group 1) and cleared in 15 of 34 patients(44%; group 2) after urinary catheters were changed. When the virulence factors (epithelial adhesion and proteinase activity) and distribution of Candida spp. were compared between two groups, no statistically significant correlation was found.Conclusion The host immune response might be more important than virulence factors of Candida spp. for persistence of candiduria.     

Chromone–lipoic acid conjugate: Neuroprotective agent having acceptable butyrylcholinesterase inhibition,antioxidant and copper-chelation activities

PurposeAlzheimer’s disease (AD) is a multifaceted neurodegenerative disease. To target simultaneously multiple pathological processes involved in AD, natural-origin compounds with unique characteristics are promising scaffolds to develop novel multi-target compounds in the treatment of different neurodegenerative disease, especially AD. In this study, novel chromone-lipoic acid hybrids were prepared to find a new multifunctional lead structure for the treatment of AD.MethodsChromone-lipoic acid hybrids were prepared through click reaction and their neuroprotection and anticholinesterase activity were fully evaluated. The anti-amyloid aggregation, antioxidant and metal-chelation activities of the best compound were also investigated by standard methods to find a new multi-functional agent against AD.ResultsThe primary biological screening demonstrated that all compounds had significant neuroprotection activity against H2O2-induced cell damage in PC12 cells. Compound 19 as the most potent butyrylcholinesterase (BuChE) inhibitor (IC50 = 7.55 μM) having significant neuroprotection activity as level as reference drug was selected for further biological evaluations. Docking and kinetic studies revealed non-competitive mixed-type inhibition of BuChE by compound 19. It could significantly reduce formation of the intracellular reactive oxygen species (ROS) and showed excellent reducing power (85.57 mM Fe+2), comparable with quercetin and lipoic acid. It could also moderately inhibit Aβ aggregation and selectively chelate with copper ions in 2:1 M ratio.ConclusionCompound 19 could be considered as a hopeful multifunctional agent for the further development gainst AD owing to the acceptable neuroprotective and anti-BuChE activity, moderate anti-Aβ aggregation activity, outstanding antioxidant activity as well as selective copper chelation ability.Graphical abstractOpen in a separate windowA new chromone–lipoic acid hybrid was synthesized as anti-Alzheimer agent with BuChE inhibitory activity, anti-Aβ aggregation, metal-chelation and antioxidant properties.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40199-020-00378-1.     

Is the extraction by Whatman FTA filter matrix technology and sequencing of large ribosomal subunit D1–D2 region sufficient for identification of clinical fungi?

Although conventional identification of pathogenic fungi is based on the combination of tests evaluating their morphological and biochemical characteristics, they can fail to identify the less common species or the differentiation of closely related species. In addition these tests are time consuming, labour‐intensive and require experienced personnel. We evaluated the feasibility and sufficiency of DNA extraction by Whatman FTA filter matrix technology and DNA sequencing of D1–D2 region of the large ribosomal subunit gene for identification of clinical isolates of 21 yeast and 160 moulds in our clinical mycology laboratory. While the yeast isolates were identified at species level with 100% homology, 102 (63.75%) clinically important mould isolates were identified at species level, 56 (35%) isolates at genus level against fungal sequences existing in DNA databases and two (1.25%) isolates could not be identified. Consequently, Whatman FTA filter matrix technology was a useful method for extraction of fungal DNA; extremely rapid, practical and successful. Sequence analysis strategy of D1–D2 region of the large ribosomal subunit gene was found considerably sufficient in identification to genus level for the most clinical fungi. However, the identification to species level and especially discrimination of closely related species may require additional analysis.     

A newborn with widespread skin lesions and extremity anomalies

A variety of diseases can cause vesicular or pustular eruptions in newborns. A thorough clinical history and physical exam provide important clues for differential diagnosis. Goltz syndrome, also known as focal dermal hypoplasia, is a rare genodermatosis and generally diagnosed by the presence of the characteristic skin lesions. We present an infant with aplasia cutis, atrophic skin lesions, syndactyly and eye abnormalities who was diagnosed with Goltz syndrome soon after birth. Goltz syndrome should be considered in differential diagnosis of hypoplastic or aplastic skin lesions in neonates in the presence of skeletal or ophthalmic anomalies.     

Evaluation of resistive index using color Doppler imaging of orbital arteries in geriatric patients with hypertension

Background and Aim:

Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic disease. The purpose of this study was to evaluate the association between RI values of orbital arteries using the color Doppler imaging (CDI) in geriatric hypertensive patients with or without retinopathy.

Setting and Design:

Designed as a cross-sectional study.

Materials and Methods:

We evaluated 60 geriatric patients with hypertension (Group 1) and 30 healthy subjects (Group 2). Further, the patients with hypertension were grouped into two: Group 1a consisted of patients with retinopathy (n = 30), and group 1b consisted of patients without retinopathy (n = 30). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI.

Results:

Compared to group 2, group 1 had significantly higher mean resistive index of PCA levels (P = 0.017), whereas there were no statistical difference in mean resistive indexes of OA and CRA (both P > 0.05). Besides, there were no statistical difference in mean resistive indexes of OA, CRA, and PCA between the group 1a and group 1b (P > 0.05 for all). Mean resistive indexes of OA, CRA, and PCA were significantly correlated with the duration of hypertension (r = 0.268, P = 0.038; r = 0.315, P = 0.014; r = 0.324, P = 0.012, respectively).

Conclusions:

Our study indicates that RI might be a useful marker for the ocular hemodynamic of retinal vessels, provides morphologic and vascular information in hypertension and hypertensive retinopathy.