Actinomycosis as a neglected diagnosis of mediastinal mass

Thoracic actinomycosis is a rare disease in children. Diagnosis is typically delayed, since the presentation can be very similar to that of malignant tumors, tuberculosis, and fungal infections. We here present the case of a 9-year-old girl who was treated for tuberculosis at the first presentation, for non-Hodgkin's lymphoma at the second presentation, and for chronic granulomatous disease at the third presentation before actinomycosis was finally diagnosed by culture.     

Effect of month of vaccine administration on antibody responses in The Gambia and Pakistan

OBJECTIVE: To explore the relationship between calendar month of administration and antibody (Ab) response to vaccination in subjects from The Gambia and Pakistan, two countries with distinct patterns of seasonality. METHODS: Three cohorts were investigated: Responses to rabies and pneumococcal vaccine were assessed in 472 children (mean age 8 years, males 53%) from rural Gambia. Responses to tetanus, diphtheria and hepatitis B (HBsAg) were investigated in 138 infants also from The Gambia (birth to 52 weeks of age, males 54%). Responses to rabies and Vi typhoid vaccines were assessed in 257 adults from Lahore, Pakistan (mean age 29.4 years, males 57%). RESULTS: In Gambian children, significant associations were observed between month of vaccination and Ab response for the pneumococcal and rabies vaccines. As no consistent pattern by month was observed between the responses, it is assumed that different immunomodulatory stimuli or mechanisms were involved. In Pakistani adults, a significant pattern by month of vaccination was observed with both rabies and typhoid vaccine. No monthly influences were observed in the infant study to the tetanus, diphtheria or the HbsAg vaccines. CONCLUSIONS: Antibody responses to certain specific vaccines are influenced by month of administration. Further research is required to elucidate the precise mechanisms explaining these observations, but a co-stimulatory effect of seasonally variable environmental antigens is a likely cause. Future studies of Ab response to vaccination in countries with a seasonally dependent environment should consider month of vaccination when interpreting study findings.     

Deficiency in the Wiskott-Aldrich protein induces premature proplatelet formation and platelet production in the bone marrow compartment

The pathophysiology of microthrombocytopenia in the Wiskott-Aldrich syndrome (WAS) and its milder form, X-linked thrombocytopenia (XLT), is unclear. Although quantitative defects are correctable by splenectomy, residual platelet abnormalities are suggestive of intrinsic disturbances of production. In contrast to human patients, murine models of WASp deficiency exhibit only mild thrombocytopenia, and platelets are of normal size. Here, we have identified a critical role for WASp during murine platelet biogenesis. By electron microscopy, WASp-deficient MKs appeared to have shed platelets ectopically within the bone marrow space. WASp-deficient megakaryocytes (MKs) also displayed defects in response to fibrillar collagen I (CI) in vitro, the major matrix component of bone. These included a loss of normal CI receptor (alpha2beta1 integrin)-mediated inhibition of proplatelet formation, a marked abrogation of SDF-1-induced chemotactic migration of CD41+ MKs adherent to CI, and an almost complete lack of actin-rich podosomes, normally induced by interaction between CI and its receptors GPVI or alpha2beta1 integrin. These findings highlight the central and highly specialized role of WASp in MKs during platelet biogenesis, and may provide a mechanism for the mild thrombocytopenia observed in WASp-deficient mice. In addition, they suggest a novel explanation for some of the platelet abnormalities characteristic of patients with WAS.     

Double-blind placebo-controlled trial of pentoxifylline added to risperidone: Effects on aberrant behavior in children with autism

Background

There are several lines of evidence to indicate that the immune system plays an important role in the pathophysiology of autism. The objective of this study was to access the effects of pentoxifylline plus risperidone in the treatment of autistic disorder.

Methods

Forty children between the ages 4 and 12 years with a DSM IV-TR clinical diagnosis of autism were recruited. The children presented with a chief complaint of severely disruptive symptoms related to autistic disorder. Patients were randomly allocated to pentoxifylline + risperidone or placebo + risperidone for a 10-week, double-blind, placebo-controlled study. The dose of risperidone was titrated up to 3 mg/day, pentoxifylline was titrated to 600 mg/day. Patients were assessed at baseline and after 2, 4, 6, 8 and 10 weeks of starting medication. The measure of the outcome was the Aberrant Behavior Checklist-Community (ABC-C).

Results

The difference between the two protocols was significant as the group that received pentoxifylline had greater reduction in ABC-C subscale scores for Irritability, Lethargy/Social Withdrawal, Stereotypic Behavior, Hyperactivity/Noncompliance and Inappropriate Speech.

Conclusion

The results suggest that combination of atypical antipsychotic medications and pentoxifylline might have synergistic effects in treatment of behavioral problems of children with autism.     

Imaging characteristics of extrapulmonary tuberculosis lesions on dual time point imaging (DTPI) of FDG PET/CT

Introduction: This study aimed to evaluate the diagnostic value of dual time point imaging (DTPI) of 18F‐fluorodeoxyglucose (FDG) positron emission tomography/CT (PET/CT) for detecting the infective lesions in patients with extrapulmonary tuberculosis (EPTB). Methods: Eleven patients were consecutively recruited and evaluated. After the intravenous injection of 369 ± 153 MBq of FDG, all patients underwent FDG PET/CT imaging at two different time points: early scan at 57 ± 23 min and delayed scan at 136 ± 42 min. The maximum standardized uptake values (SUVmax) were recorded for both time points (early scan: SUVmax1 and delayed scan: SUVmax2). Results: In total, 30 lesions were detected. The SUVmax2 in 22 of the lesions in confirmed EPTB patients were significantly higher than the SUVmax1 (7.9 ± 3.2 vs. 6.8 ± 2.5; P = 0.001). The SUVmax for another eight non‐EPTB lesions also showed a significant increasing pattern of change (6.2 ± 2.6 vs. 6.5 ± 2.8; P = 0.044). However, there was insignificant difference between the mean percentage difference of SUVmax (%ΔSUVmax) of EPTB and non‐EPTB lesions (P = 0.06). Conclusion: Our study demonstrates that early whole body PET/CT imaging may be sufficient for the detection of the EPTB lesions and DTPI of PET/CT may also not be a useful technique in differentiating between EPTB and non‐EPTB lesions. However, our findings are based on a limited number of patients, and therefore, further investigations in larger series of patients are warranted.     

Human papillomavirus infection in women with and without cervical cancer in Tehran, Iran

No data exist on the population prevalence of, or risk factors for, human papillomavirus (HPV) infection in Iran or the Middle East. Cervical specimens were obtained from 825 married women aged 18-59 years from the general population of Tehran, Iran and from 45 locally diagnosed invasive cervical cancers (ICC) according to the standardized protocol of the International Agency for Research on Cancer HPV Prevalence Surveys. HPV was detected and genotyped using a GP5+/6+ PCR-based assay. HPV prevalence in the general population was 7.8% (95% confidence interval: 6.0-9.8) (5.1% of high-risk types), with no significant variation by age. HPV positivity was significantly higher among divorced women, women in polygamous marriages and those reporting husband's absence from home for >7 nights/month. HPV16/18 accounted for 30 and 82.2% of HPV-positive women in the general population and ICC, respectively. Cervical cancer prevention policies should take into account the relatively low HPV prevalence in this population.     

Alternaria in patients with allergic rhinitis

Inhalation of fungal spores is shown to participate in the development of allergic rhinitis symptoms. In this study, relation between presence of Alternaria in the human nasal cavity and allergic rhinitis is assessed. In a case-control study, 58 allergic rhinitis patients were compared with a well-matched control group of fifty healthy volunteers for sensitization to Alternaria (by skin prick test) and detection of Alternaria in their nasal mucous by conventional methods (microscopy with Methylene Blue stain and culture in Sabourad dextrose agar). Severity of the disease was determined according to the ARIA classification. Pearson chi-square test was applied to compare the proportional difference between the study groups for detection of Alternaria in the nasal cavity, and sensitization to Alternaria. Relation between detection of Alternaria and allergic rhinitis was significant [OR = 18.18 (4.02-82.50)] In addition, sensitization to Alternaria showed a significant relation with the disease [OR = 2.8 (2.1-3.8)]. There was a significant relation between the presence of Alternaria in the nasal cavity and sensitization to Alternaria [OR = 10.4 (3.8-28.3)]. Both sensitization to Alternaria and presence of Alternaria in the nasal cavity did not have a significant relation with the severity of allergic rhinitis. This study suggests Alternaria as a major allergen that its presence in the nasal cavity and subsequent development of sensitization have significant role in the induction of allergic rhinitis.     

Bilateral paediatric optic neuropathy precipitated by vitamin B12 deficiency and a novel mitochondrial DNA mutation

We present an 11-year-old girl with sudden, severe, sequential optic neuropathy. Investigations revealed severe vitamin B12 deficiency, and identified a novel mitochondrial ND5 variant. She was treated with steroids followed by plasma exchange, but the vision continued to deteriorate to eventual bilateral blindness over the next few months. Vitamin B12 deficiency can rarely cause severe irreversible visual loss secondary to optic neuropathy. The significance of the concurrent mitochondrial ND5 variant remains undetermined.