Primary septic arthritis of the acromio-clavicular joint: case report and review of literature

Primary septic arthritis of the Acromio clavicular joint is an uncommon disorder and is rarely seen even in an immunocompromised individual. We report a case of primary septic arthritis of the acromio-clavicular (A-C) joint caused by Staphylococcus aureus without any predisposing factors. The patient was admitted with left shoulder pain, restricted movements and fever. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Blood cultures were positive for Staphylococcus-aureus. Magnetic resonance imaging (MRI) using Gadolinium enhancement revealed marked effusion in the A-C joint. Aspiration from the A-C joint revealed a heavy growth of Staphylococcus-aureus. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection and return to full function.     

Elevated high sensitivity CRP levels in patients with mitral stenosis and left atrial thrombus

Stasis of blood in the left atrium (LA) due to mitral obstruction is the principal mechanism of LA thrombus formation in patients with mitral stenosis (MS). The purpose of this case-control study was to determine the additional contributions of abnormal homosysteine/folate/B12 levels, chronic inflammation and markers of a procoagulant state. We found that elevated hsCRP levels were associated with the presence of left atrial thrombus, independent of the influence of conventional parameters indicating the severity of MS and its consequences.     

Pathological speech signal analysis using time-frequency approaches

Acoustical measures of vocal function are important in the assessments of disordered voice, and for monitoring patients' progress over the course of voice therapy. In the last 2 decades, a variety of techniques for automatic pathological voice detection have been proposed, ranging from traditional temporal or spectral approaches to advanced time-frequency techniques. However, comparison of these methods is a difficult task because of the diversity of approaches. In this article, we explain a framework that holds the existing methods. In the light of this framework, the methodologic principles of disordered voice analysis schemes are compared and discussed. In addition, this article presents a comprehensive review to demonstrate the advantages of time-frequency approaches in analyzing and extracting pathological structures from speech signals. This information may have an important role in the development of new approaches to this problem.     

Nodding syndrome: origins and natural history of a longstanding epileptic disorder in sub-Saharan Africa

Background

Repetitive involuntary head nodding was first reported in the 1960s in the Wapogoro tribe of Tanzania.

Objectives

We describe the natural history of head nodding in the Wapogoro tribe, with special reference to the earliest reported dates of onset.

Methods

We analyzed clinical data from 150 historical patients seen between 1960 and 1971.

Results

Head nodding with or without grand mal convulsions was present in 33/150 (∼20%) cases, was mostly familial and equally distributed by gender. Age at onset of head nodding ranged from 2–22 years (mean: ∼10 years) in the period 1934–1962. Head nodding preceded onset of grand mal convulsions by up to 12 months, and motor and psychomotor deficits indicative of brain damage developed with time. Fourteen of the 33 cases died at 13–39 years of age (mean: ∼20 years) while nineteen aged 16–28 years (mean: ∼16 years) were still alive.

Conclusion

Historical accounts of head nodding (amesinzia kichwa, Swahili) among the Wapogoro tribe fit the August 2012 World Health Organization (WHO) case definition of probable Nodding Syndrome. Reported to have existed in this population for at least 80 years, Nodding Syndrome is a progressive seizure disorder that leads to generalized convulsions (kifafa), brain damage and death.     

Homocysteine levels are associated with MTHFR A1298C polymorphism in Indian population

An elevated level of homocysteine is an independent risk factor for cardiovascular diseases and is associated with other complex disorders. Homocysteine levels can be elevated due to dietary and/or genetic factors. A majority of Indian population have a low level of vitamin B12 (presumably due to vegetarian diet)—a critical nutritional factor, deficiency of which results in hyperhomocysteinemia. Hence, polymorphisms in the genes responsible for homocysteine metabolism can be perceived to have a greater impact in relation to hyperhomocysteinemia in Indian population. For this reason, the effects of diet and/or methylenetetrahydrofolate reductase (MTHFR) polymorphism were assessed in 200 individuals having varying homocysteine levels. Homocysteine levels were significantly elevated in individuals adhering to a vegetarian diet (P=0.019) or having MTHFR A1298C polymorphism (P=0.006). The minor allele frequency (MAF) of MTHFR C677T and A1298C was 0.15 and 0.44 respectively in this cohort. Since the MAF of these polymorphisms differed considerably from Caucasian and other Asian populations, frequencies of these polymorphisms were also determined in more than 400 individuals from different ethnic populations, selected from the entire country based on their geographical location and linguistic lineage, and was found to be similar to that of our cohort. The fact that MTHFR A1298C polymorphism is significantly associated with homocysteine levels, and that the CC genotype is present at a higher frequency in the Indian population, makes it extremely relevant in terms of its potential impact on hyperhomocysteinemia.