Acute upper extremity flaccid paralysis in a 5 year old child secondary to enterovirus infection

The incidence of acute flaccid paralysis has been on a declining trend with the global efforts on eradication of polio virus. A few scattered clusters of acute flaccid paralysis associated with pathogens like enterovirus other than polio virus and flaviviruses have recently come to limelight. This is a case of acute onset flaccid paralysis of left upper extremity in a fully immunized 5 year old child in New York.     

Engineered antigen-specific regulatory T cells for autoimmune skin conditions

Regulatory T cells (Tregs) are a subset of T cells responsible for the regulation of immune responses, thereby maintaining immune homeostasis and providing immune tolerance to both self and non-self-antigens. An increasing number of studies revealed Treg numbers and functions in a variety of autoimmune diseases. Treg deficiency can cause the development of several autoimmune skin diseases including vitiligo, alopecia areata, pemphigoid and pemphigus, psoriasis, and systemic sclerosis. Many clinical trials have been performed for autoimmune conditions using polyclonal Tregs, but efficiency can be significantly improved using antigen-specific Tregs engineered using T cell receptor (TCR) or chimeric antigen receptor (CAR) constructs. In this review, we systematically reviewed altered frequencies, impaired functions, and phenotypic features of Tregs in autoimmune skin conditions. We also summarized new advances in TCR and CAR based antigen-specific Tregs tested both in animal models and in clinics. The advantages and limitations of each approach were carefully discussed emphasizing possible clinical relevance to patients with autoimmune skin diseases. Moreover, we have reviewed potential approaches for engineering antigen-specific Tregs, and strategies for overcoming possible hurdles in clinical applications. Thereby, antigen-specific Tregs can be infused using autologous adoptive cell transfer to restore Treg numbers and to provide local immune tolerance for autoimmune skin disorders.     

Down-regulation of PPARgamma1 suppresses cell growth and induces apoptosis in MCF-7 breast cancer cells

Background  

Peroxisome proliferator-activated receptor gamma (PPARγ) is a member of the nuclear hormone receptor superfamily and is highly expressed in many human tumors including breast cancer. PPARγ has been identified as a potential target for breast cancer therapy based on the fact that its activation by synthetic ligands affects the differentiation, proliferation, and apoptosis of cancer cells. However, the controversial nature of current studies and disappointing results from clinical trials raise questions about the contribution of PPARγ signaling in breast cancer development in the absence of stimulation by exogenous ligands. Recent reports from both in vitro and in vivo studies are inconsistent and suggest that endogenous activation of PPARγ plays a much more complex role in initiation and progression of cancer than previously thought.     

Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome

Carpal tunnel syndrome (CTS) has been associated frequently with physical factors and personal factors including smoking, obesity, diabetes mellitus, and hypothyroidism. The purpose of this retrospective case-control study was to evaluate the prevalence of personal factors in patients with CTS compared with a normal control group. The charts of 514 patients who underwent a carpal tunnel release procedure and 100 control subjects were examined for history of smoking, obesity, diabetes, and hypothyroidism. Compared with the control subjects, there were significantly less CTS patients who smoked (p < 0.001; odds ratio, 0.17). However, there were more CTS patients than control subjects who were obese (p = 0.02; odds ratio, 1.77), had diabetes (p = 0.03; odds ratio, 3.02), and had hypothyroidism (p = 0.02; odds ratio, 3.70). These results support previous reports that CTS is multifactorial, with such factors as obesity, hypothyroidism, and diabetes but not smoking to be more prevalent in this group of CTS patients.     

Accurate identification of adverse outcomes after cervical spine surgery

BACKGROUND: Retrospective clinical studies frequently utilize surgeon records as a source of outcomes data. The accuracy of data derived from surgeon records, however, is unknown. The purpose of the present study was to evaluate the accuracy of surgeon records in documenting the prevalence of subjective adverse outcomes. METHODS: Consecutive patients who had undergone anterior cervical arthrodesis by four spine surgeons during a ten-month period were included. Surgeon records from the routine six-week, three-month, and six-month postoperative visits were examined for documentation of persistent dysphagia and dysphonia. Patients completed surveys inquiring about the presence and magnitude of symptoms at these three time-points. Agreement between the surgeon records and the patient surveys was analyzed with use of the kappa coefficient. RESULTS: One hundred and sixty-six patients had 342 postoperative visits. Dysphagia was documented twenty-six times in the surgeon records, compared with 107 times on the patient surveys. Dysphagia was thus underreported in 80% of cases. Similarly, dysphonia was documented ten times in the surgeon records, compared with seventy-two times on the patient surveys. Poor correlation between the surgeon records and the patient surveys was observed regardless of symptom severity, previous anterior cervical surgery, anterior arthrodesis of three motion segments or more, arthrodesis cephalad to the fifth cervical level, and anterior cervical plate use. Poor correlation between the surgeon records and the patient surveys also was observed for each surgeon, regardless of subspecialty or institution. CONCLUSIONS: Correlation between the surgeon records and the patient surveys was consistently poor, regardless of the specific patient and surgeon factor analyzed. While we chose to study dysphonia and dysphagia, it is conceivable that the results may be generalizable to many situations in which office notes are utilized to ascertain the prevalence of subjective adverse outcomes. These results suggest that the prevalence of such outcomes may be seriously underreported in studies that rely on the retrospective analysis of surgeon records.     

Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents

PurposeInequitable attitudes toward men’s and women’s roles, rights, and responsibilities are associated with poor health–related outcomes, particularly for girls and women. Yet, we know relatively little about what interventions work to improve gender-equitable attitudes among adolescents in low-income countries. This study examines the impact of a government-implemented “cash plus” intervention on gender-equitable attitudes among adolescents in Tanzania. The intervention includes discussions and activities related to gender norms, embedded in broader life skills, livelihoods, and health training.MethodsThe study utilizes a cluster randomized design, using data from 1,933 males and females aged 14–19 years at baseline who took part in the baseline (2017), midline (2018), and endline (2019) surveys. Gender attitudes were measured using 24 items from the Gender-Equitable Men (GEM) Scale. We estimate intent-to-treat impacts on the GEM scale and four subscales (violence, sexual relationships, reproductive health, and domestic chores).ResultsThe “cash plus” intervention had a significant impact on the overall GEM scale at midline. The intervention increased gender-equitable attitudes on the domestic chores subscale at both midline and endline. The intervention improved gender-equitable attitudes among males on the overall GEM scale and three subscales at midline and on two subscales at endline, but it had no impacts among females.ConclusionsGender transformative social protection is currently being advocated as a way to address the gendered nature of poverty and its consequences. Initiatives such as the one studied here, which address the multifaceted drivers of gender inequities, could be a promising way forward.     

The influence of arterial flow on capillary refill in pediatric lower extremity

This study assesses the relationship between capillary refill time (CRT) and arterial blood flow (ABF) in the lower extremities of pediatric patients to determine if a correlation exists that would demonstrate CRT as an accurate means of monitoring tissue perfusion. The ABF and CRT were evaluated in 20 pediatric patients at four different pressures (0, (1/2) systolic blood pressure [SBP], SBP, and 1(1/2) SBP) using Doppler ultrasound and a stop-frame digital camera. While the mean ABF in the popliteal artery, dorsalis pedis, and posterior tibialis decreased dramatically with the increased pressure, the mean CRT showed only minor increases in duration. The >90% decrease in ABF between 0 and 1(1/2) SBP correlated to only a 0.8925-second change in CRT. Thus, at significantly decreased rates of blood flow, a possible inverse relationship exist between ABF and CRT in the lower extremities of this pediatric population. However, the change in CRT correlating to the decrease in ABF is too small to be considered practically useful for clinically monitoring tissue perfusion.     

Disrupted development of the dominant hemisphere following prenatal irradiation

One hundred children, exposed prenatally to radiation after the Chernobyl nuclear power plant accident, and 50 nonexposed classmates were examined between the ages of 11 and 13 years old using neuropsychiatric tests, WISC, EEG, and visual evoked potentials. Individual prenatal radiation doses were reconstructed for all examined children. The exposed children were found to have more neuropsychiatric disorders, left-brain neurological signs, lower full-scale and verbal IQ, IQ discrepancies with verbal decrement, disorganized EEG patterns, an excess of lateralized-to-left frontotemporal region delta and beta power with depression of theta and alpha power, and interhemispheric inversion visual information processing. Mothers' mental health, stress, and prenatal irradiation contributed to these effects, along with several confounding factors.