Role of magnetic resonance imaging, cerebrospinal fluid, and electroencephalogram in diagnosis of sporadic Creutzfeldt-Jakob disease

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly progressive dementia (RPD) that can be difficult to identify antemortem, with definitive diagnosis requiring tissue confirmation. We describe the clinical, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), and electroencephalogram (EEG) measures of a small cohort of 30 patients evaluated for RPD. Clinical and diagnostic measures were cross-sectionally obtained from 17 sCJD patients (15 definite, two probable), 13 non-prion rapidly progressive dementia patients (npRPD), and 18 unimpaired controls. In a subset of patients (nine sCJD and nine npRPD) diffusion tensor imaging (DTI) measures [fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD)] were also obtained for the caudate, corpus callosum, posterior limb of the internal capsule, pulvinar, precuneus, and frontal lobe. Differences among groups were assessed by an analysis of variance. Compared to npRPD individuals, sCJD patients had cerebellar dysfunction, significantly higher CSF tau, “positive” CSF 14-3-3, and hyperintensities on diffusion-weighted imaging (DWI) that met previously established imaging criteria for sCJD. EEG changes were similar for the two groups. In addition, sCJD patients had significant decreases in DTI measures (MD, AD, RD but not FA) within the caudate and pulvinar compared to either npRPD patients or unimpaired controls. Our results confirm that CSF abnormalities and MRI (especially DWI) can assist in distinguishing sCJD patients from npRPD patients. Future longitudinal studies using multiple measures (including CSF and MRI) are needed for evaluating pathological changes seen in sCJD patients.     

Intraocular cysticercosis: clinical characteristics and visual outcome after vitreoretinal surgery

PURPOSE: To report the clinical characteristics of, discuss the surgical options for, and analyze the factors affecting the anatomic and visual outcome of intraocular cysticercosis. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Forty-five eyes of 44 Indian patients with posterior segment intraocular cysticercosis. METHODS: The charts of 45 eyes, in which intraocular cysticercosis was removed by vitreoretinal surgery (either transscleral or transvitreal), were reviewed. MAIN OUTCOME MEASURES: These included the postoperative retinal status and the best-corrected Snellen visual acuity. RESULTS: Intraocular cysticercosis was present in the vitreous cavity of 27 eyes (60%) and in the subretinal space of 18 eyes (40%). Anterior segment inflammation was seen in 13 eyes (28.8%) and vitreous inflammation in 38 eyes (84.4%). Retinal detachment was observed in 22 eyes (48.8%), with proliferative vitreoretinopathy in 13 eyes (59.09%). Subretinal cysts anterior to the equator (4 eyes) were removed transsclerally, whereas subretinal cysts posterior to the equator and intravitreal cysts (41 eyes) were removed transvitreally. The mean follow-up was 10.5 months. At the last follow-up, the retina was attached in 39 eyes (86.6%); visual acuity of >/=5/200 was achieved in 67.5%. CONCLUSIONS: Current vitreoretinal surgical techniques enable removal of intraocular cysticercosis in all cases, with reattachment of the retina in 86.6% and recovery of ambulatory vision in approximately 67% of cases.     

Primary Meningoencephalitis by Naegleria fowleri: First Reported Case from Mangalore, South India

A fatal case of primary amebic meningoencephalitis (PAM) in a 5-month-old infant is described. The disease may have been contracted during bathing. The source of water was from an artificial well. The clinical presentation, the isolation of the ameba from the cerebrospinal fluid, the poor response to amphotericin B, and the ultimate fatal outcome are all consistent with the diagnosis of PAM. On the basis of its ability to grow at temperatures above 30 degrees C, the morphology of the trophozoite, and the presence of flagellate forms, the ameba was identified as Naegleria fowleri. Pathogenic N. fowleri amebae were recovered from samples of water from the well. To our knowledge this case represents the second case of PAM in an infant in the absence of the history of swimming.     

Early structural and functional neurovascular changes in the retina in the prediabetic stage

PurposeThis study was undertaken to investigate the neurovascular changes in the retina of prediabetic subjects.MethodsSubjects enroled in a prospective study were separated into prediabetic and normal control groups based on their glycosylated haemoglobin (HbA1C) levels, fasting and postprandial blood sugar levels and glucose tolerance test. All the subjects underwent detailed ophthalmic evaluation, which included fundus examination, fundus photography, optical coherence tomography angiography (OCTA), and multifocal electroretinogram (mfERG). Comparisons were done between the groups using the Wilcoxon signed rank test.ResultsThe median age was 48 years for the normal controls (n = 40), and 49.5 years for prediabetic subjects (n = 45) (p = 0.306). There was no difference in the vision, contrast sensitivity, thickness of the ganglion cell complex or the foveal avascular zone parameters between the groups. But the central foveal thickness and subfoveal choroidal thickness were significantly reduced in prediabetics (p < 0.01). The mfERG showed significant differences in the amplitude. The average amplitude was 35 ± 12 nv/deg² in the normals and 29 ± 11 nv/deg² in the prediabetics (p = 0.003). A weak positive correlation was noted between the mfERG and vascular parameters in the prediabetic group.ConclusionsThe prediabetic stage reveals earliest functional neuronal changes in the retina. The neuronal function seems to be affected much earlier than clinically appreciable structural changes in the ganglion cell complex and precedes vascular changes in the retina.Subject terms: Predictive markers, Blood flow     

810 nm diode laser for hair reduction with Chill-tip technology: prospective observational analysis of 55 patients of Fitzpatrick skin types III,IV,V

ABSTRACT

Background: Various light based technologies like Diode, long pulsed Nd:Yag and Intense Pulsed Light are used commonly for long-term hair reduction. The commonest indication is hirsutism.

Aim: 1. To evaluate efficacy and safety of 810 nm Diode laser in Fitzpatrick skin types III, IV and V.

2. To assess percentage of cases on the basis of indications, average number of sessions, fluence required, the long-term results and complications using diode laser in darker skin types.

Methods: A prospective observational study of 55 consecutive patients who came for laser hair reduction by 810 nm Light Sheer Diode laser with Chill tip technology was carried out. The sessions were conducted at an interval of 4–6 weeks and the patients were followed up over a period of 2 years. Data was analyzed using software SPSS (Statistical Package for Social Science. Ver.12, Inc. Chicago, USA).

Results: Fifty-five patients (51 females and 4 males) were studied. 67.3% (n = 37) had skin type IV. The most common area treated was chin (n = 23). The average growth reduction of terminal hair at the end of three sessions was 61.25%. Only 8% (n = 4) had short-term side effects.

Conclusion: Diode laser is highly effective for long-term hair reduction of terminal hair growth in Fitzpatrick skin type III, IV and V with no permanent side effects.

Abbreviations: LHR (Laser Hair Reduction)     

Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective

Patients with oral and oropharyngeal cancer (OOC) often delay presenting to their doctor or dentist. The aims of this study were to ask a consecutive cohort following treatment for OOC about their initial symptoms and the time spent before presentation to the healthcare profession. Also to discover their views on how to reduce delays in presentation. From a 2-year cohort treated within 2 years, 71 completed a short survey and 44 were subsequently interviewed by telephone. A non-healing ulcer or sore was the commonest symptom patients first related to having cancer. Around half interpreted their symptoms as something minor, staying much the same initially, and something that probably would get better by itself. Most would have sought advice earlier if they had been more aware of oral cancer. Although many patients talked about their symptoms to spouse, partner, family or friends, over one-third said they spoke to nobody about it. Our sample did not find that access to a doctor or a dentist was a barrier to seeking advice. This study highlights that from the patients perception they generally thought their symptoms were trivial, would get better by themselves and gave little thought as to whether it might be cancer. Patients commented they knew nothing more about the disease. In their views the best way to get patients to self refer earlier was through improved awareness of the disease, as many felt there was a gross lack of knowledge in this field of cancers compared to other cancers.     

Duloxetine Hydrochloride-Induced Oral Lichenoid Reaction: A Case Report

Objective

To report the first case of duloxetine hydrochloride (DH)-induced oral lichenoid drug reaction (OLDR).

Clinical Presentation and Intervention

A 57-year-old male patient presented with painful ulcerative lesions on the bilateral buccal mucosa of 2-year duration. The patient was on multiple drug therapy for his systemic ailments. After thorough evaluation for possible medical ailments and with the physician''s consent, withdrawal of DH was done. The oral lesions were resolved after 2 weeks.

Conclusion

In this case, DH induced OLDR.Key Words: Duloxetine hydrochloride, Drug-induced oral lichenoid reaction, Oral lichen planus