- Speech-language pathology aspects in a pediatric case of head and neck arthrogryposis. [Journal Article]
- CCodas 2018; 30(2):e20170181
- Arthrogryposis is a rare, multiple, congenital syndrome of non-progressive nature characterized by a series of genetic malformations, as well as stiffness and joint contractures. This is a clinical c...
Arthrogryposis is a rare, multiple, congenital syndrome of non-progressive nature characterized by a series of genetic malformations, as well as stiffness and joint contractures. This is a clinical case study whose objective is to describe speech-language pathology disorders through the evaluation process in a case of arthrogryposis in Pediatrics. The medical records of a patient were analyzed from birth. A complete clinical evaluation of pediatric dysphagia was performed, establishing a diagnosis of severe oropharyngeal dysphagia evidenced by functional and structural impairments. Hearing loss was detected in association with this condition.
- Enterococcus gallinarum meningitis: a case report and literature review. [Journal Article]
- BIBMC Infect Dis 2018 May 21; 18(1):231
- CONCLUSIONS: Central nervous system infections caused by E. gallinarum are rare, but should be suspected, particularly inpatients with impaired immune function or ineffective treatment. Avoiding long-term invasive treatment and improving immunity are helpful to reduce the occurrence of E. gallinarum infections. Early detection and diagnosis, as well as rational antibiotic use, are the keys to achieve satisfactory efficacy.
- An Elderly Lady with Neurobrucellosis and Multiple Co-morbid Conditions. [Journal Article]
- MMMymensingh Med J 2018; 27(2):412-416
- Neurobrucellosis is a rare (1.7-7.0% of prevalence) neurological complication of brucellosis which has neither a typical clinical picture nor specific cerebrospinal fluid (CSF) findings and mimics ot...
Neurobrucellosis is a rare (1.7-7.0% of prevalence) neurological complication of brucellosis which has neither a typical clinical picture nor specific cerebrospinal fluid (CSF) findings and mimics other neurological disorders leading to clinical diagnostic dilemmas. This study describes one elderly patient of neurobrucellosis with fever, irrelevant behavior, sweating, fatigue, drowsiness, neck stiffness inability to speak and reduced activity for about 10 days hailing from Beanibazar, Sylhet, Bangladesh admitted in Mount Adora Hospital, Sylhet, Bangladesh on 16th October 2016. The diagnosis was depended on history, clinical examination, positive brucella test, CSF examination and CT of the brain. Cerebrospinal fluid (CSF) showed an abnormal finding regarding increased cell count, elevated protein levels and low glucose while blood serology was highly reactive. The patient received a combination antibiotic therapy; meropenem (3gm/day) for 15 days, streptomycin for 21 days, doxycycline 200mg/day for 6 weeks and rifampicin 600mg/day for 3 months. The complete improvement in patient's condition after a long lasting and difficult to diagnose illness motivated author to report this case. As neurobrucellosis is a fatal condition if remained untreated and should be considered as one of the differential diagnoses in unusual cases of neurologic and psychiatric disorders and in cases of neurological dysfunction in absence of any other suitable alternative diagnosis.
- Epithelial-mesenchymal transition softens head and neck cancer cells to facilitate migration in 3D environments. [Journal Article]
- JCJ Cell Mol Med 2018 May 04
- The biological impact and signalling of epithelial-mesenchymal transition (EMT) during cancer metastasis has been established. However, the changes in biophysical properties of cancer cells undergoin...
The biological impact and signalling of epithelial-mesenchymal transition (EMT) during cancer metastasis has been established. However, the changes in biophysical properties of cancer cells undergoing EMT remain elusive. Here, we measured, via video particle tracking microrheology, the intracellular stiffness of head and neck cancer cell lines with distinct EMT phenotypes. We also examined cells migration and invasiveness in different extracellular matrix architectures and EMT-related signalling in these cell lines. Our results show that when cells were cultivated in three-dimensional (3D) environments, the differences in cell morphology, migration speed, invasion capability and intracellular stiffness were more pronounced among different head and neck cancer cell lines with distinct EMT phenotypes than those cultivated in traditional plastic dishes and/or seated on top of a thick layer of collagen. An inverse correlation between intracellular stiffness and invasiveness in 3D culture was revealed. Knock-down of the EMT regulator Twist1 or Snail or inhibition of Rac1 which is a downstream GTPase of Twist1 increased intracellular stiffness. These results indicate that the EMT regulators, Twist1 and Snail and the mediated signals play a critical role in reducing intracellular stiffness and enhancing cell migration in EMT to promote cancer cells invasion.
- Simulation of the upper airways in patients with obstructive sleep apnea and nasal obstruction: A novel finite element method. [Journal Article]
- LILaryngoscope Investig Otolaryngol 2018; 3(2):82-93
- CONCLUSIONS: Hyperelastic FE models both in the homogeneous and layered model represent a novel method of evaluating soft tissue biomechanics of the upper airway. The obstruction occurs mainly at the level of the lateral attachments to the pharyngeal wall, and the width of the soft palate is an indicator of the degree of critical closing pressure. A less negative closing pressure corresponds to small total transverse strain. The effect of nasal surgery on OSA is most likely not explained by change in soft palate biomechanics.
- Acute Headache in the Emergency Department: Is Lumbar Puncture Still Necessary to Rule Out Subarachnoid Hemorrhage? [Journal Article]
- AEAdv Emerg Nurs J 2018 Apr/Jun; 40(2):78-86
- The purpose of the Research to Practice column is to review current primary journal articles that directly affect the practice of the advanced practice nurse (APN) in the emergency department. This r...
The purpose of the Research to Practice column is to review current primary journal articles that directly affect the practice of the advanced practice nurse (APN) in the emergency department. This review examines the findings of Carpenter et al. (2016) from their article, "Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds." The authors concluded that although no history or physical examination finding can be used to rule in or rule out spontaneous subarachnoid hemorrhage (SAH), the complaint of neck stiffness can increase the likelihood of SAH. In addition, the authors concluded that noncontrast head computed tomography (CT) is accurate in ruling out/in SAH when performed within 6 hr of symptom onset in adults with symptoms consistent with SAH and that the traditional gold standard of confirmatory lumbar puncture after a negative head CT scan is only helpful in patients with a very high pretest probability of SAH. By applying the evidence-based criteria presented in this study, the emergency department APN can confidently rule out SAH and reduce patient risks from unnecessary invasive and costly testing.
- Neurosyphilis: mighty imitator forays with benign presentation and unique neuroimaging findings. [Journal Article]
- SHSex Health 2018 Apr 30
- Background: Common causes of temporal lobe hyper intensities are central nervous system infections like herpes simplex encephalitis, Lyme disease, limbic encephalitis and vascular pathology like Cer...
Background: Common causes of temporal lobe hyper intensities are central nervous system infections like herpes simplex encephalitis, Lyme disease, limbic encephalitis and vascular pathology like Cerebral Autosomal Dominant Arteriopathy with Subcortical infarcts and Leukoencephalopathy. Methods: Personal assessment, laboratory data analysis and neuroimaging for the patient who was admitted to a central Pennsylvania tertiary care referral centre were conducted. Results: A 52-year-old male presented with a 1-year history of diffuse dysesthesia in upper and lower extremities with associated intermittent headaches and neck stiffness. Evaluation with lumbar puncture revealed increased nucleated cells (50ul) with lymphocytic predominance (96%) and an elevated protein level of 109mg/dl. Magnetic resonance imaging (MRI) of the brain showed T2/FLAIR hyper intensity in bilateral subcortical temporal white matter, left-greater-than-right and associated volume loss in cerebral parenchyma. Additional abnormal work up included reactive serum reactive plasma regain and Treponema pallidum antibody particle agglutination. Diagnosis of neurosyphilis was made and the patient was treated with intramuscular (IM) penicillin for 3 weeks. At the time of discharge, his headache and neck stiffness resolved and dysesthesias were decreased in intensity. Conclusions: The diagnosis of neurosyphilis is intricate, and no reference standard exists. Neuroimaging findings of neurosyphilis commonly are cerebral infarctions, leptomeningeal enhancement or non-specific white matter lesions. Less common features on fluid-attenuated inversion recovery (FLAIR) sequences are cortical atrophy and mesial temporal parenchymal signal changes. It is prudent to keep neurosyphilis in differential of mesial temporal lobe white matter changes, as early diagnosis and treatment results in better prognosis.
- Effects of continuous positive airway pressure on cardiovascular biomarkers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. [Journal Article]
- SBSleep Breath 2018 Apr 22
- CONCLUSIONS: Among patients with OSA, CPAP improves inflammatory marker hs-CRP, arterial stiffness marker AIx, and endothelial function marker FMD. These biomarkers may provide information related to response to treatment. Future studies will need to clarify the efficacy of these biomarkers in assessing cardiovascular risk reduction among OSA treated with CPAP.
- Comparison of femur stiffness measured from DXA and QCT for assessment of hip fracture risk. [Journal Article]
- JBJ Bone Miner Metab 2018 Apr 18
- Femur stiffness, for example axial and bending stiffness, integrates both geometric and material information of the bone, and thus can be an effective indicator of bone strength and hip fracture risk...
Femur stiffness, for example axial and bending stiffness, integrates both geometric and material information of the bone, and thus can be an effective indicator of bone strength and hip fracture risk. Femur stiffness is ideally measured from quantitative computed tomography (QCT), but QCT is not recommended for routine clinical use due to the public concern about exposure to high-dosage radiation. Dual energy X-ray absorptiometry (DXA) is currently the primary imaging modality in clinic. However, DXA is two-dimensional and it is not clear whether DXA-estimated stiffness has adequate accuracy to replace its QCT counterpart for clinical application. This study investigated the accuracy of femur stiffness (axial and bending) estimated from CTXA (computed tomography X-ray absorptiometry) and DXA against those directly measured from QCT. Proximal-femur QCT and DXA from 67 subjects were acquired. For each femur, the QCT dataset was projected into CTXA using CTXA-Hip (Mindways Software, Inc., USA). Femur stiffness at the femoral neck and intertrochanter were then calculated from QCT, CTXA and DXA, respectively, and different elasticity-density relationships were considered in the calculation. Pearson correlations between QCT and CTXA/DXA measured stiffness were studied. The results showed that there were strong correlations between QCT and CTXA derived stiffness, although the correlations were affected by the adopted elasticity-density relationship. Correlations between QCT and DXA derived stiffness were much less strong, mainly caused by the inconsistence of femur orientation in QCT projection and in DXA positioning. Our preliminary clinical study showed that femur stiffness had slightly better performance than femur geometry in discrimination of hip fracture cases from controls.
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- Meningitis due to scrub typhus: the importance of a differential diagnosis in an endemic area. [Journal Article]
- BCBMJ Case Rep 2018 Apr 13; 2018
- A patient with fever and neck stiffness was treated as partially treated bacterial meningitis based on history, examination and cerebrospinal fluid analysis. After initial improvement with ceftriaxon...
A patient with fever and neck stiffness was treated as partially treated bacterial meningitis based on history, examination and cerebrospinal fluid analysis. After initial improvement with ceftriaxone, vancomycin and dexamethasone, symptoms recurred. Fever resolved promptly after treatment was started with doxycycline, when scrub typhus immunoglobulin M test came positive. Meningitis is a well-known complication of scrub typhus. However, scrub typhus is seldom considered in the differential diagnosis of meningitis in the Indian subcontinent. Early diagnosis and prompt institution of doxycycline therapy may lead to early cure of scrub typhus even when features of meningitis supervene. However, ceftriaxone which is commonly used to treat bacterial meningitis is suboptimal in the treatmenwgt36t of scrub typhus.