Scurvy in an autistic child: MRI findings

Scurvy results from a deficiency of vitamin C and is rarely seen in the United States. We describe the MRI findings of a case of scurvy in an autistic child with food-avoidant behavior. Advanced imaging is rarely performed in clinically well-understood disease entities such as scurvy. Typical radiographic findings are well described leading to definitive diagnosis, although the findings can be missed or misinterpreted given the rarity of scurvy in daily practice. To our knowledge, MRI features of scurvy in children in the US have been described in only one case report. This case of scurvy in an autistic child with food-avoidant behavior emphasizes that classic nutritional deficiencies, despite their rarity, must be included in the differential diagnosis of at-risk populations.     

Myroides pelagicus from the Gut of Drosophila melanogaster Attenuates Inflammation on Dextran Sodium Sulfate-Induced Colitis

Background and Aim

Probiotics are live microorganisms that confer a health benefit on the host when administered in adequate amounts. In the present study, the putative probiotic strain was identified from the gut of Drosophila melanogaster and assessed for its protective effect in inflammatory bowel disease.

Methods

Active probiotics were screened from the Drosophila melanogaster gut by the selection criteria of gastric juice tolerance, hydrophobic property, antimicrobial potential, adhesion, and invasion properties. The active probiotics were identified by 16s rDNA sequencing and the effect of these active probiotics was evaluated in a Dextran sulphate sodium (DSS)-induced mice model by estimating inflammatory markers and histopathological changes.

Results

Nine Gram-positive and bile salt tolerant bacterial isolates were obtained from the gut samples. The isolates PTH 2, PTH 4, and PTH 7 clearly showed significant activity in antimicrobial potential, hydrophobic (>74 %) property, and intestinal juice tolerance. Among these, PTH 7 was selected for further studies due to its significant low-invasion ability and it proved capable of reducing the secretion of proinflammatory cytokines. The 16s rDNA studies revealed that PTH 7 was Myroides pelagicus. Administration of M. pelagicus to the DSS-induced colitic animals significantly suppressed myeloperoxidase, ALP, and malondialdehyde levels, and also lowered levels of proinflammatory cytokine expression. Further, the recovery from the disease by the probiotic treatment was supported by histopathological and macroscopic observation. The treated animals did not show any adverse signs in their physiology or behavior.

Conclusion

Myroides pelagicus successfully prohibited inflammatory markers and acted as a potent probiotic. Future studies with this stain might prove its efficacy as a drug for the management of colitis.     

Role of magnetic resonance imaging in distinguishing fungal from nonfungal multiple brain abscesses

Cladophialophora bantiana is a neurotropic dematiaceous fungus known for affecting immunocompromised and immunocompetent hosts. We report a case of 24 year old immunocompetent male presenting with headache, fever and vomiting. MRI was suggestive of multiple fungal brain abscesses. He underwent total excision of abscesses. Pus culture was suggestive of brain abscess caused by C. bantiana. We report a culture proven case of C. bantiana emphasizing on specific MRI features which are critical in differentiating fungal from nonfungal brain abscesses.     

Abnormal ACTH and prolactin responses to fenfluramine in rats exposed to single and multiple doses of MDMA

The present study examined the persistent functional consequences associated with exposure to single and multiple doses of (±) 3,4-methylenedioxymethamphetamine (MDMA) as reflected by the neuroendocrine responses to d,l-fenfluramine (FEN). Adult male rats were administered a single dose of MDMA (20 mg/kg, SC) and challenged 2 weeks later with saline or FEN (2, 4, 6 and 8 mg/kg, SC). The corticotropin (ACTH) response to FEN (6 and 8 mg/kg) was blunted and the prolactin response to FEN (4 and 6 mg/kg) was enhanced in MDMA pre-treated rats. The ACTH and prolactin responses to FEN (6 mg/kg, SC) were then evaluated 4, 8 and 12 months after exposure to single and multiple doses MDMA (20 mg/kg, SC and 20 mg/kg, SC, bid, × 4 days, respectively). The ACTH response to FEN was significantly reduced at 4 and 8 months in both MDMA treatment groups, and at 12 months in the multiple dose group only. In contrast, the prolactin response to FEN was enhanced in both groups of MDMA treated rats at 4 months, but only in the multiple dose group at 8 months. By 12 months, the prolactin response to FEN had normalized. Following multiple doses of MDMA, 5-HT concentrations were reduced significantly in the frontal cortex at 4 and 12 months. The results indicate that exposure to single or multiple doses of MDMA can produce functional alterations which can persist for months, whereas the biochemical sequelae were less robust and shorter lived. Received: 12 November 1996/Final version: 14 January 1997     

An unusual case of a pleural effusion with an abdominal mass

A 38-year-old man presented to us with a left sided pleural effusion. Pleural fluid was aspirated and analysis revealed it to be an exudate with predominant lymphocytes and an elevated ADA level. He was discharged on antituberculous treatment. Patient returned with re-accumulation of pleural fluid. Computed tomography done in our institute picked up not only parenchymal disease in the lung which was not evident on chest radiographs but also picked up an abdominal mass in the left renal fossa. Pathological examination of excised mass revealed its tuberculous nature. The repeated recollection of pleural fluid was attributed to a "paradoxical response"; the patient was reassured and his anti-tuberculous treatment continued. Recognition of the fact that evidence of tuberculosis at distant sites may occasionally be needed to substantiate the diagnosis of tuberculous pleural effusion in a difficult and bacteriologically "negative" case prompted us to report this case.     

Comparison of acrylic and polymethyl methacrylate lenses in a pediatric population

PURPOSE: To compare the intra-patient incidence of posterior capsular opacification (PCO) and their post operative course, in children with bilateral cataract, following implantation of acrylic (Group 1) and polymethyl methacrylate (PMMA) (Group 2) intraocular lenses (IOLs). MATERIALS AND METHODS: This was a prospective, interventional intra-patient case series. Twenty-five children with bilateral cataract, 5 years and older, underwent cataract surgery and implantation of an acrylic (AcrySof MA30BA, Alcon, Fortworth, TX) in one eye and PMMA (Indo Am IAB 203, Ocular Vision, Inc.) IOL in the other eye of each patient. They were followed up for an average of 11.1 +/- 9.5 months to assess the incidence of clinically significant PCO and occurrence of postoperative complications. RESULTS: Twenty-three children (46 eyes), were included in this study. Post-operatively, 22(95.6%) patients with acrylic IOLs and 20 (86.9%) patients with PMMA IOLs, either maintained or improved their vision. In the acrylic and PMMA IOL groups respectively, the incidence of clinically significant PCO was 21% (4) and 75% (12) ( P =0.002), with a median onset at 2.9 months and 0.7 months. Other complications included pupillary capture in 2 (8.7%) eyes and uveal prolapse in 1 (4.3%) eye in the acrylic group and increased uveal inflammation in 6 (26.1%) eyes and presumed noninfectious endophthalmitis in 2 (8.7%) eyes in the PMMA group. CONCLUSION: Incidence of PCO and post operative uveal inflammation is significantly less with acrylic lenses and were safe to use in pediatric eyes.     

Upper Airway Sensory Function in Children with Obstructive Sleep Apnea Syndrome

Study Objectives:

Children with the obstructive sleep apnea syndrome (OSAS) have impaired responses to hypercapnia, subatmospheric pressure, and inspiratory resistive loading during sleep. This may be due, in part, to an impairment in the afferent limb of the upper airway sensory pathway. Therefore, we hypothesized that children with OSAS had diminished upper airway sensation compared to controls.

Design:

Case-control

Setting:

Academic hospital

Participants:

Subjects with OSAS aged 6–16 years, and age- and BMI-matched controls.

Interventions:

Two-point discrimination (TPD) was measured during wakefulness with modified calipers in the anterior tongue, right interior cheek, and hard palate.

Results:

Thirteen children with OSAS and 9 controls were tested. The age (mean ± SD) for OSAS and controls was 11 ± 4 vs. 13 ± 2 years (NS); OSAS BMI Z score 2.4 ± 0.5, controls 2.2 ± 0.5 (NS); OSAS apnea hypopnea index 31 ± 48, controls 0.4 ± 0.5 events/hour (P < 0.001). Children with OSAS had impaired TPD in the anterior tongue (median [range]) = 9 [3–14] mm, controls 3 [1–7], P = 0.002) and hard palate (OSAS 6 [3–9] mm, controls 3 [1–4], P < 0.001). TPD in the cheek was similar between the groups (P = 0.12).

Conclusion:

TPD in the anterior tongue and hard palate was impaired in children with OSAS during wakefulness. We speculate that this impairment might be due to a primary sensory function abnormality or secondary to nerve damage and/or hypoxemia caused by OSAS. Further studies after treatment of OSAS are needed.

Citation:

Tapia IE; Bandla P; Traylor J; Karamessinis L; Huang J; Marcus CL. Upper airway sensory function in children with obstructive sleep apnea syndrome. SLEEP 2010;33(7):968–972.     

Primary endoscopic stapedotomy using 3 mm nasal endoscope: Audiologic and clinical outcomes

ObjectiveTo report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy and clinical and audiological outcomes.Materials and methodsThirty patients diagnosed with primary otosclerosis underwent endoscopic stapedotomy that was performed using a 3 mm nasal endoscope (Karl Storz). At 6 months follow-up, the patients were evaluated for intraoperative findings, postoperative hearing outcomes and complications.ResultsCanaloplasty was performed in 2 (6.66%) patients, and no curettage of the canal wall was required in 12 (40%) patients. Transposition of the chorda tympani nerve was conducted in 11 (36.66%) patients. The average duration of surgery was 36 min (range 31–65 min). The air-bone gap (ABG) was 35 dB (range 24–50 dB) preoperatively and 14.63 dB (range 9–20 dB) postoperatively (p = 0.00). At 6 months follow-up, <20 dB ABG was achieved in 93.33% of the patients. No major intraoperative/postoperative complications were detected.ConclusionA 3 mm rigid nasal endoscope can be effectively used in stapedotomy to obtain adequate audiological outcomes. It can be considered as a better alternative to the standard microscope or 4 mm endoscope in preserving the posterior canal wall and chorda tympani nerve while minimizing operative time without causing significant complications.     

Pectoralis Major Myocutaneous Flap Reconstruction for the Mandibular Defects in Advanced Oral Cavity Malignancies: A Retrospective Study of 30 Cases

To evaluate the utility of the pectoralis major myocutaneous (PMMC) flap for the reconstruction of the mandible in advanced oral cavity malignancies in the Indian population. It was a retrospective study contained 30 patients with advanced oral cancer from July 2012 to August 2016. The PMMC reconstruction was done in all the patients to repair the bony defects in segmental/hemi mandibulectomy. The patients were followed up for a mean period of 6 months in the postoperative period and the utility of the PMMC flaps were evaluated. The mean age of the patients was 45 years (range 30–63 years). The average Karnofsky performance status score was 70 and majority of the patients had history of chronic medical illness. Of the 30 PMMC flaps, partial necrosis of the skin was noticed 2 (06.66%) patients. Orocutaneous fistula was detected in 2 (06.66%) patient and 3 (10%) patients presented with wound dehiscent in the immediate postoperative period. 3 (10%) patients had recurrence of the disease. PMMC flap can be a reliable option for advanced oral malignancies, especially in patients with poor status with the coexisting chronic illness. Due to the presence of a definite vascular pedicle, ease of harvesting the flap, quick surgical procedure, and the minimal postoperative morbidities, it can be considered as a valid alternative to the free flap to repair the bony defect, especially in patients with low socioeconomic corridor like India.