Coincidence of pollen season with the first fetal trimester together with early pet exposure is associated with sensitisation to cat and dog allergens in early childhood: a Finnish population-based study

Abstract

Background

Children whose 11^th fetal week falls in pollen season (spring) reportedly have an increased risk of sensitisation to food allergens. No such finding has been reported for pet allergens.

Objective

The aim of the study was to 1) evaluate the incidence of pet (dog and cat) sensitisation according to the season of the 11^th fetal week and 2) whether the association between pet exposure and respective sensitisation is modified by the coincidence of the 11^th fetal week with pollen season.

Methods

The study population comprised all children (born between 2001 and 2006) in the province of South Karelia, Finland (N=5920). Their data of IgE and skin prick tests to pet allergens (N=538) were collected from patient records and linked with questionnaire data on pet exposure.

Results

The seasonal incidence peak of cat sensitisation was observed in children whose 11^th fetal week occurred in June (7.4%) and that of dog sensitisation in April (3.8%) and June (4.7%). The relative rate (RR) for cat sensitisation was 2.92 (95% CI 1.40-6.08) in children with cat exposure alone, 8.53 (4.07−17.86) in children with cat and fetal pollen exposures, and 0.61 (0.20−1.83) in children exposed to pollen alone, compared with children without these exposures. The respective RRs for dog sensitisation were 2.17 (1.13-4.19), 4.40 (2.19−8.83) and 1.65 (0.77−3.53).

Conclusions and clinical relevance

Coincidence of the first fetal trimester with pollen season strengthens the association between pet exposure and respective sensitisation. Pollen exposure at early pregnancy may deviate immune system towards Th2 type reactivity promoting development of specific allergy in case allergen exposure occurred. Therefore, primary prevention of allergic diseases may need to begin during early pregnancy.

This article is protected by copyright. All rights reserved.

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Confirmed Ceylon krait (Bungarus ceylonicus) envenoming in Sri Lanka resulting in neuromuscular paralysis: a case report

Ceylon krait (Bungarus ceylonicus) is a venomous elapid snake endemic to Sri Lanka. It inhabits shaded home gardens and forests in the wet zone of Sri Lanka and might creep into houses in the night. Despite frequ...

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Oral keratinocytes synthesize CTACK: a new insight into the pathophysiology of the oral mucosa

Abstract

The skin-associated chemokine CTACK plays a key role in many inflammatory conditions and could be instrumental in the pathophysiology of tissue-specific immunological diseases such as oral lichen planus (OLP). In the present study, we investigated by RT-PCR, ELISA, chemotaxis assays, and fluorescence-activated cell sorting (FACS) the production of CTACK in oral keratinocytes, its expression in tissues from normal and OLP patients, and its role in T cell recruitment. CTACK was produced by the oral epithelium and it affects chemotaxis of memory CLA+ cells to the oral epithelium. CTACK mRNA was expressed constitutively in primary oral epithelium and was increased during pro-inflammatory IFN-γ treatment. We found a constitutive production of CTACK at a protein level in oral primary cells that increased after IFN-γ treatment. Moreover, we confirmed that CTACK attracts memory T cells and those T cells that express CLA above the level of basal migration.

This article is protected by copyright. All rights reserved.

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Prevalencia de alteraciones en el complejo estilohioideo y tonsilolitos en la tomografía computarizada de haz cónico realizada en individuos con fisura labiopalatina

Publication date: Available online 23 November 2017
Source:Acta Otorrinolaringológica Española
Author(s): Eymi Valery Cazas-Duran, Izabel Regina Fischer Rubira-Bullen, Otávio Pagin, Bruna Stuchi Centurion-Pagin
Introducción y objetivosLos tonsilolitos y alteraciones en el complejo estilohioideo pueden presentar similar sintomatología a otras de diferente etiología. Los individuos con fisura labiopalatina describen similares síntomas en razón de las repercusiones anatómicas propias de esta anomalía. El objetivo de este estudio fue determinar la prevalencia de alteraciones del complejo estilohioideo y tonsilolitos en exámenes de tomografía computarizada de haz cónico en individuos con fisura labiopalatina.MétodosSegún criterios de inclusión y exclusión fueron analizadas 66 tomografías de 2.794 tomografías, en el software i- Cat visión ® con índice Kappa 0,8 intraexaminador.ResultadosLa prevalencia total de osificación del complejo estilohioideo incompleto en individuos con fisura labiopalatina fue de 66,6%, la prevalencia de estos hallazgos en el género femenino fue de 75% y 61,9% en el género masculino. La prevalencia total de tonsilolitos fue de 7,5%.ConclusiónEs de relevancia constatar en el informe radiológico la presencia de la calcificación del complejo estilo-hioideo y tonsilolitos. Debido a la proximidad anatómica y similar sintomatología clínica con otras alteraciones orofaciales presentes en los individuos con fisura labiopalatina, haciendo énfasis en individuos con fisura labiopalatina del género femenino, pacientes con fisura tipo transformen incisivo y posforamen incisivo por presentar mayor prevalencia. Conocer más sobre la morfometría anatómica de individuos con fisura labiopalatina coadyuva relevantemente en la elección de conductas clínicas y calidad de vida de estos pacientes, teniendo presente que la fisura labiopalatina es una de las anomalías más comunes.Introduction and objectivesTonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate.MethodsAccording to the inclusion and exclusion criteria, 66 CT scans out of of 2,794 were analysed, on i- Cat ® vision software with 0.8 index Kappa intra-examiner.ResultsThe total prevalence of ossification of the incomplete stylohyoid complex in individuals with cleft lip and palate was 66.6%; the prevalence of these findings in females was 75% and 61.9% in males. The total prevalence of tonsilloliths was 7.5%.ConclusionIt is important to ascertain calcification of the stylohyoid complex and tonsilloliths in the radiological report, due to the anatomical proximity and similarsymptomatology to other orofacial impairments inindividuals with cleft lip and palate, focusing on females with oral cleft formation, patients with incisive trans foramen cleft and incisive post foramen cleft because they are more prevalent. Greater knowledge of the anatomical morphometry of individuals with cleft lip and palate greatly contributes towards the selection of clinical behaviours and the quality of life of these patients, since cleft lip and palateis one of the most common anomalies.



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Immunological differences between insect venom-allergic patients with and without immunotherapy and asymptomatically sensitized subjects

Abstract

Background

Currently available tests are unable to distinguish between asymptomatic sensitization and clinically relevant Hymenoptera venom allergy. A reliable serological marker to monitor venom immunotherapy (VIT) does also not exist. Our aim was to find reliable serological markers to predict tolerance to bee and vespid stings.

Methods

We included 77 asymptomatically-sensitized subjects, 85 allergic-patients with acute systemic sting reactions, and 61 allergic-patients currently treated with VIT. Levels of sIgE and sIgG₄ to bee and vespid venom, rApi-m-1 and rVes-v-5 were measured immediately after allergic sting-reactions or before sting-challenges and four weeks later. All sting challenges were tolerated. The inhibitory activity was determined using BAT-inhibition and ELIFAB-assay.

Results

Median sIgG₄ levels were 96-fold higher in VIT patients (p<0.001) while sIgE/sIgG₄ ratios were consistently lower (p<0.001). The ELIFAB-assay was paralleled by low sIgE/sIgG₄ ratios in VIT-patients, showing markedly higher allergen-blocking capacity (p<0.001). An almost complete inhibition of the basophil response was seen in all patients treated with vespid venom, but not in those treated with bee venom. Four weeks after the sting, sIgE and sIgG₄ levels were increased in allergic and asymptomatically-sensitized patients, but not in VIT-patients.

Conclusion

Immunological responses after stings varied in bee and vespid venom allergic patients. In patients under VIT, sIgE and sIgG₄ remained completely stable after sting-challenges. Monitoring VIT efficacy was only possible in vespid venom allergy and the sIgG₄ threshold for rVes-v-5 had the highest sensitivity to confirm tolerance. The BAT-inhibition test was the most reliable tool to confirm tolerance on an individual basis.

This article is protected by copyright. All rights reserved.

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Impact of hydration and nutrition on personal performance in the clinical workplace

As clinicians we sometimes fail to look after ourselves at work. We often do not drink enough during the day or miss lunch breaks while caring for patients, and this can be particularly evident during an all-day operating list when procedures are long and complex. Some operating theatre staff do not even eat breakfast regularly. Inadequate intake of fluids or nutrition can impair performance, lead to tiredness and headaches, and may compromise both our own health and the care we provide to patients.

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Evaluation of the morphology of the genial tubercle using cone-beam computed tomography

The genial tubercle is a sharp projection of bone on the internal face of the mandible above the inferior border.1

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Is routine holistic assessment with a prompt list feasible during consultations after treatment for oral cancer?

The head and neck cancer Patient Concerns Inventory (PCI-HN) is a holistic, self-reported list of items that can help patients to disclose their needs and concerns during routine follow-up consultations. The aim of this study was to report how often it was used during the first three years of follow up after treatment for oral cancer, and the range of issues that were raised. The sample comprised consecutive patients treated over a three-year period with curative intent. All clinic attendances were reviewed until October 2015 or until patients had a recurrence, a subsequent primary, metastases, or were discharged home or to follow up at a peripheral hospital, or started palliative care.

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Corrigendum to “Schneider membrane thickness classification evaluated by cone-beam computed tomography and its importance in the predictability of perforation. Retrospective analysis of 200 patients” [Br. J. Oral Maxillofac. Surg. 54 (10) (December 2016) 1106–1110]

The authors regret the errors in the membrane thickness in Table 1 of the above referenced paper. The correct table can be found below.

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An exploratory open-label, investigator-initiated study to evaluate the efficacy and safety of combination sonidegib and buparlisib for advanced basal cell carcinomas

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Management of hypogammaglobulinemia and recurrent infections in a chronic lymphocytic leukemia patient receiving ibrutinib

Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative disorder characterized by the progressive accumulation of monoclonal and functionally incompetent lymphocytes; it also is the most common adult leukemia in Western countries.1 In CLL, hypogammaglobulinemia is the predominant inherent immune defect and is often further exacerbated by immunosuppressive treatment.2 Nevertheless, neither antibiotic prophylaxis nor prophylactic immunoglobulin (Ig) replacement therapy (IRT) is routinely recommended for CLL.

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Editorial Board

Publication date: November 2017
Source:Journal of Oral Biosciences, Volume 59, Issue 4





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The temporospatial pattern of energy metabolism coordinates the interactions between the bones and other organ systems

Publication date: Available online 11 November 2017
Source:Journal of Oral Biosciences
Author(s): Ziyi Wang, Hiroshi Kamioka
BackgroundBones adapt to loads by changing their structure. This biomechanical interaction and the formation/maintenance of bones are orchestrated by three major cell types residing in the bones: osteoblasts, osteocytes, and osteoclasts. Recent findings suggest that, in addition to their biomechanical interactions, bones and other organ systems may also communicate biochemically.HighlightThis brief review will discuss the interaction between the bones and the nervous system, vasculature, muscle, and fat tissues, with an emphasis on the role of the energy metabolism in these interactions.ConclusionStudies on the connections between bones and other organ systems indicate the possible existence of a temporospatial pattern of energy metabolism through the cellular biorhythm and migration.



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Oral tolerance modulates the skin transcriptome in mice with induced atopic dermatitis

Abstract

Defective gut immune reactions have been implicated in the development of atopic dermatitis (AD), whereas oral tolerance (OT), i.e., the immune unresponsiveness induced by oral antigen administration, protects mice against AD. To investigate this protective role of OT, the transcriptomic profiles of skin were obtained by RNA sequencing from mice that were epicutaneously sensitized, orally tolerized prior to epicutaneous sensitization, or neither (control). OT inhibited the upregulation of keratin- and allergic inflammation-associated genes that occurred in the epicutaneously sensitized group. Compared to the controls, mice that were orally tolerized and epicutaneously sensitized showed an upregulation of genes that regulate inflammation or keratinocyte differentiation. Knocking down two of those genes, SCGB1A1 and TSC22D3, upregulated Th2 inflammatory mediators and downregulated a cornified cell envelope-related gene. Based on our findings, OT may protect skin against allergic inflammation by promoting the expression of genes that regulate Th2 inflammatory responses and skin barrier function.

This article is protected by copyright. All rights reserved.

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Early life origin of type 1 diabetes

Abstract

Type 1 diabetes (T1D) is perceived as a chronic immune-mediated disease with a subclinical prodromal period characterized by selective loss of insulin-producing beta cells in the pancreatic islets in genetically susceptible subjects. The incidence of T1D has increased manifold in most developed countries after World War II in parallel with a series of other immune-mediated diseases. T1D results from gene-environmental interactions. The appearance of disease-associated autoantibodies into the peripheral circulation is the first detectable sign of the initiation of the disease process leading to clinical T1D. The first autoantibodies may appear already before the age of 6 months and the seroconversion rate peaks during the second year of life. This implies that exogenous factors involved in the pathogenesis of T1D must be operative in early life, some of them most likely already during pregnancy. Here, we discuss putative endogenous factors that may contribute to the development of T1D during fetal and early postnatal life. Many environmental factors operative in early life have been implicated in the pathogenesis of T1D, but relatively few have been firmly confirmed.

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Immunity and immunopathology in early human life

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Sensitization to PR-10 proteins is indicative of distinctive sensitization patterns in adults with a suspected food allergy

The extent of co-sensitization within and between food protein families in an adult population is largely unknown. This study aimed to identify the most frequently recognized components in the PR-10 and storag...

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Molecular characterization of Helicobacter pylori resistance to rifamycins

Abstract

Introduction

Antibiotic resistance is a major contributing factor in treatment failure of Helicobacter pylori eradication. Rifabutin (RB) is a rescue treatment and rifampicin (RP) is used to screen RB resistance in vitro. The aim of this study was to evaluate the rate of rifamycins resistance and to determine the mutations in the rpoB gene conferring resistance to discuss the current break point.

Methods

Antimicrobial susceptibility to RP was first determined by E-test for 1015 H. pylori isolates. RP and RB MICs were then determined by agar dilution method for strains with MIC of RP > 1 mg/L, and the rpoB gene was sequenced.

Results

Overall, 54 of 1015 strains exhibited a RP MIC > 1 mg/L by agar dilution method. Among these 54 strains, 10 had MICs of RP > 4 mg/L and RB ≥ 1 mg/L. They all carried at least one mutation in the rpoB gene at codons 530, 538, 540, 525 in the RP resistance-determining region (RRDR). Implication of the mutation L547F was confirmed by site-directed mutagenesis experiment. In contrast, among the 44 H. pylori isolates with a MIC of RP comprised between 2 and 4 mg/L, only 4 of 44 (9%) strains exhibited a mutation in rpoB, but outside RRDR (codons 470, 499, 636, or 657). For 31 of 44 tested strains, the RB MICs were ≤0.064 mg/L.

Conclusion

These results suggest that H. pylori isolates should be classified as resistant to RP for MICs > 4 mg/L. We considered that the optimal cut off for RB was ≥0.125 mg/L. We report a new mutation responsible for rifamycins, resistance, L547F.

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Unilateral erythaema nodosum: atypical presentation in paediatrics

Description

A previously healthy 12-year-old boy was observed in the emergency department due to pain and erythaema in the left shin for the past 2 weeks. He was discharged with flucloxacilin for cellulitis. One week later, he returned with oedema and erythaema of the left shin, with palpable nodules and purple discolouration (figure 1). The right leg was normal. Oropharyngeal hyperaemia was observed.

Figure 1

Erythaema, oedema and nodules in the left shin.

Complementary study revealed  erythrocyte sedimentation rate of 12 mm/hour and antistreptolysin O titre was 985 UI/mL (normal range 0–408 UI/mL). C reactive protein was <2.90 mg/dL; autoimmunity study, infectious serologies (hepatitis B virus and Epstein-Barr virus, EBV, Mycoplasma pneumoniae and Salmonella spp.) rapid strep test and Mantoux test were negative. Ultrasound showed subcutaneous oedema. Biopsy revealed septal panniculitis, compatible with erythaema nodosum (figure 2). He was discharged.

Figure 2

Incisional biopsy....

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ANCA-positive IgA nephropathy without necrotising or crescentic glomerulonephritis: a clinical conundrum

IgA nephropathy, the most prevalent form of primary glomerular disease, usually portends a favourable outcome. Antineutrophil cytoplasmic autoantibodies (ANCAs) have been reported in association with IgA nephropathy in a small subset of patients, mostly presenting with rapidly progressive glomerulonephritis and necrotising crescentic lesions. Herein, we describe a case of IgA nephropathy, positive serum cytoplasmic and perinuclear ANCAs with anti-myeloperoxidase antibody, and preserved renal function without any histological evidence of necrotising or crescentic glomerulonephritis. Based on available mechanistic and clinical data, we opine that such patients could benefit from close monitoring of renal function.

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Twist on a classic: vitamin D and hypercalcaemia of malignancy

Malignancy is the most common cause of hypercalcaemia in the inpatient setting. Most cases are caused by tumour production of parathyroid hormone-related protein and osseous metastases. In less than 1% of cases, hypercalcaemia is driven by increased production of 1,25-dihydroxyvitamin D (1,25(OH)₂D), a mechanism most commonly seen in haematological malignancies. Here, we describe a woman with metastatic small cell cervical carcinoma who developed hypercalcaemia secondary to paraneoplastic overproduction of 1,25(OH)₂D, a finding that, to our knowledge, has not been previously associated with this cancer. We also review the current cases of solid tumours reported to have this mechanism of hypercalcaemia and the evidence behind multiple therapeutic approaches.

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A regressing spindle cell tumour of Reed

Description

Spindle cell tumour of Reed is a benign melanocytic naevus which usually presents as a deeply pigmented mole. It is more commonly found on the lower extremities of young girls. It is an uncommon naevus but its incidence and prevalence are not known. A Reed naevus typically goes through a rapid initial growth phrase before stabilising in size and then regresses over time.1 Awareness of Reed naevus has been demonstrated to be low, even among dermatology doctors.2

The main dermoscopic patterns (when observed under magnification using a dermatoscope) observed are the starburst pattern (50.6% of cases), pattern of dotted vessels (19.3%), globular pattern (17%) and atypical pattern (9.0%).3

Figure 1A illustrates a 7 mmx5 mm symmetrical deeply pigmented plaque on the right knee of a 5-year-old girl. Figure 1B shows the dermatoscopic symmetrical starburst pattern with regular pigment network....

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Dental implants in a patient with suspected leucocyte adhesion deficiency

Aggressive periodontitis and premature tooth loss in leucocyte adhesion deficiency (LAD) have adverse functional and psychological consequences on affected individuals. Dental implant rehabilitation might become necessary to overcome the functional and psychological adverse effects of LAD periodontitis, especially in patients with milder forms who are expected to have a relatively normal life expectancy. Outcome of dental implants in patients with LAD has not been previously reported; we describe the dental rehabilitation of a 24-year-old man with clinical features of LAD using endosseous dental implants.

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Multiple hybrid sutures of bucket handle injury on the lateral and medial meniscus of the knee

The objective of the study is to show possibilities of several combinations of suture techniques in a rare bicompartmental bucket handle injury. According to specific injury characteristics, combined suturing techniques were used. The option for different meniscal suture techniques in the two knee compartments allowed the patient, after completing the treatment, to return to his activities with a preserved meniscus. Although meniscectomy continues to be a chosen technique in bucket handle injury, we attempted to show a case of bicompartmental meniscal suture with different techniques. In this, which could be a case of rapid resolution and quick return to activities with bicompartmental meniscectomy, we chose to preserve the menisci with more complex techniques and longer rehabilitation, believing that the preservation of this structure could be extremely valuable in the long term.

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Eosinophilic myocarditis as a first presentation of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

We present the case of a 28-year-old man who presented with chest pain and elevated cardiac biomarkers, with no evidence of acute ischaemia. He had a pronounced eosinophilia, abnormal echocardiographic, cardiac MRI and CT findings. He underwent transbronchial biopsy of carinal lymph nodes and of lung parenchyma. Endomyocardial biopsy yielded an eosinophilic infiltrate. He was treated with high dose glucocorticoids and made a rapid recovery. Testing for FIP1L1-PDGFRA and other BCR-ABL1 mutations was negative. Ultimately, he was diagnosed with eosinophilic granulomatosis with polyangiitis, also known as Churg-Strauss syndrome.

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Dysosmia and dysgeusia associated with duloxetine

Common adverse effects of serotonin–norepinephrine reuptake inhibitors are nausea, dry mouth, dizziness and headache. We describe the case of a patient with dysosmia and subsequent dysgeusia associated with duloxetine. A 68-year-old Japanese woman with a history of type 1 diabetes mellitus, hypertension, insomnia and reflux esophagitis presented to a local hospital with bilateral leg pain; she was treated with duloxetine. However, after 4 weeks, she sensed rotten egg smell, experienced nausea and vomiting and was admitted to our hospital. We diagnosed dysosmia using the T&T olfactometer threshold test and dysgeusia using filter paper disk method. Taste was assessed using electrogustometry. We suspected that dysosmia and dysgeusia were adverse effects of duloxetine. After stopping duloxetine, her symptoms gradually subsided and the above test results improved, despite continuing the other ongoing medication. To the best of our knowledge, this is the first case report of dysosmia and dysgeusia associated with duloxetine.

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Kikuchi-Fujimoto disease: an unusual presentation of meningitis in a returning traveller

A 19-year-old, previously healthy woman developed a pruritic erythematous maculopapular rash on her bilateral palms and wrists, right-sided tender cervical lymphadenopathy and nightly fevers and headaches 5 days after returning from a 1-month trip to Cambodia. She presented 2 weeks after her trip due to ongoing nightly fevers to a maximum of 38.8°C. She was given empiric doxycycline for possible rickettsial disease, though an extensive infectious workup returned without positive findings. Lumbar puncture was performed on hospital day 4, and spinal fluid analysis was consistent with aseptic meningitis. On hospital day 5, core biopsy and fine-needle aspiration were performed on the largest anterior cervical lymph node. Her fever curve gradually improved, and she was discharged on hospital day 6. Results of the lymph node biopsy were finalized 5 days after discharge and were compatible with Kikuchi's lymphadenitis. Symptoms had completely resolved on follow-up with infectious disease and rheumatology.

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False-positive phencyclidine (PCP) on urine drug screen attributed to desvenlafaxine (Pristiq) use

We report a likely false-positive phencyclidine (PCP) result detected with a urine drug screen (UDS) (Medtox, St Paul, Minnesota, USA) in the setting of therapeutic desvenlafaxine (Pristiq) use. Desvenlafaxine (O-desmethylvenlafaxine) is the active metabolite of venlafaxine (Effexor). Prior reports have confirmed venlafaxine use resulting in a false-positive for PCP on a UDS. However, there has been a paucity of reporting of commercially available desvenlafaxine formulations (Pristiq, Khedezla) resulting in false-positives for PCP on a UDS.

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Wernickes encephalopathy secondary to gestational hyperthyroidism

Background

Wernicke's encephalopathy is a neurological disorder secondary to the deficiency of vitamin B1 (thiamine). The classic symptoms consist of nystagmus, ophthalmoplegia, ataxia and mental status changes.1 Initially, this was described by Carl Wernicke in 1881 as acute haemorrhagic polioencephalitis.2

Wernicke's encephalopathy is mostly described in association with malnutrition and alcoholism.1 However, it has been increasingly being noted in various other settings. There is also evidence that this may be an underdiagnosed condition as several cases may not manifest the classical triad of symptoms. Prompt diagnosis and treatment are essential as any delay or undertreatment can result in irreversible complications.

We report a case of gestational hyperthyroidism causing Wernicke's encephalopathy. To our knowledge, there have been only four previous cases of gestational hyperthyroidism causing Wernicke's encephalopathy in the literature.3–7

Case presentation...

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Muscle fasciculation detected by ECG

A 79-year-old man presented to hospital with scald burns to the perineum after a syncopal episode while in a hot bathtub. Admission ECG was misdiagnosed as possible ventricular fibrillation with high-frequency irregular waveforms in lead V2 at a rate exceeding 1000 cycles per minute, corresponding to intervening skeletal muscle contractions unrelated to the heart. Follow-up ECG showed full resolution of the irregular waveforms. Muscle fasciculations are a benign cause of ECG artefact and can easily be mistaken for serious cardiac arrhythmias. While most muscle fasciculations detected on ECG are benign, in the correct clinical circumstance these waveforms indicate an underlying neuromuscular disorder. The patient underwent surgical skin grafting with no perioperative cardiac complications and no further syncope in hospital.

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Schizophrenia and anaesthesia

Administering anaesthesia for elderly patients with chronic schizophrenia has always been a great challenge to anaesthetists. These patients will usually be on multiple antipsychotic drugs for many years and may lead to delayed awakening, cardiovascular instability, arrhythmias and sudden cardiac death during general anaesthesia. This case report is about the perioperative anaesthetic management of an elderly schizophrenic patient undergoing removal of femur implant. This article will explore important drug interactions and available options for a successful anaesthesia.

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Panuveitis simulating ocular Behcets in cases of chronic myelogenous leukaemia in remission

We report two patients with chronic myelogenous leukaemia (CML) in remission phase who developed panuveitis simulating Behcet's disease. A 26-year-old man presented with bilateral panuveitis (hypopyon in the right eye, bilateral anterior segment inflammation, vitritis and retinitis). He was on imatinib for CML which was in remission. He gave a history of recurrent oral ulcers. The panuveitis responded to oral and topical steroids but recurred after the steroids were stopped. His ocular condition again stabilised on restarting oral steroids and azathioprine. The second patient, a 28-year-old man, presented with bilateral anterior segment inflammation, vitritis, exudative retinal detachment and hypopyon in the right eye. He was also on imatinib with the CML being in remission. The uveitis and exudative retinal detachment improved on systemic and topical steroids. The vision of this patient did not improve as optic atrophy ensued. The panuveitis seen in our patients with CML responded favourably to oral steroids/immunosuppressant therapy.

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Rare presentation of cementoblastoma associated with the deciduous maxillary second molar

Cementoblastoma is a benign odontogenic neoplasm accounting for less than 0.69%–8% of all odontogenic tumours and is characterised by the presence of sheets of cementum-like tissue demonstrating large number of reversal lines. It shows an unlimited growth potential and a recurrence rate as high as 37.1%. It most commonly affects the permanent mandibular molars. This paper presents the third reported case of cementoblastoma affecting the deciduous maxillary posterior dentition. A 12-year-old male patient reported to the Department of Oral and Maxillofacial Pathology with a chief complaint of pain and swelling in relation to the deciduous maxillary left second molar.

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Large, extra-abdominal leiomyoma of the round ligament with carneous degeneration

Round ligament tumours represent a rare entity that can present similarly to an incarcerated hernia. Basic understanding and appropriate preoperative management is imperative in order to differentiate between the two diagnoses. Leiomyoma is the most common type of round ligament tumour. It is associated with oestrogen exposure and is more common in the presence of uterine leiomyomas. Here we discuss a 68-year-old woman who presented with a palpable left inguinal mass that progressively grew in size, associated with pelvic pressure and discomfort. On surgical resection, the mass was found to be derived from the round ligament at the entrance of the external inguinal ring. Pathology confirmed a round ligament leiomyoma, measuring 25x9x8.5 cm. This case is the largest round ligament leiomyoma recorded to date and the first to exhibit carneous degeneration. A review of the current literature is also provided.

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A case of large right MCA stroke with hyperdense MCA sign in CT imaging

Description

A 76-year-old woman with no significant medical history was brought to the emergency department with complaints of sudden onset of left-sided weakness and facial drooping 1 hour prior to the arrival. On physical examination, patient had profound left-sided neglect and conjugate deviation of the eyes to the right side. Motor examination showed grade 0 power on left upper and lower extremities, and she had 3+ reflexes on the left and 2+ reflexes on the right. Babinski was positive on the left side. She was sent for a CT scan which showed increased density of M1 segment of middle cerebral artery (MCA) with loss of grey white differentiation of MCA territory (figure 1). Alberta Stroke Programme Early CT Score was 8. Patient's initial National Institutes of Health Stroke Scale score was 17 and was immediately given tissue plasminogen activator (TPA) as the family adamantly refused endovascular procedure; however, her post-TPA score was also 17 as...

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Characteristic imaging findings in pulmonary fat embolism syndrome (FES)

Description

A 21-year-old male presented to the hospital following a road accident. He was riding a motorcycle when he flung into a roadside drain. On arrival, his Glasgow Coma Scale was 15/15 and vital signs were stable. On examination, there was tenderness and deformity of the left thigh. The diagnosis of closed comminuted fractures of the left femur was confirmed following plain radiography. Chest radiograph was normal (figure 1). He was admitted and planned for interlocking nail (ILN) insertion at the left femur. Two days after admission, his blood oxygen saturation (SpO₂) became low at 92% despite 3 L of oxygen. He was febrile and tachycardic. On day 3, he developed chest pain, palpitations and tachypnoea. Oxygen support was escalated to intubation and mechanical ventilation. Chest radiograph then showed diffuse air space opacities bilaterally (figure 1). CT pulmonary angiogram showed diffuse ground-glass opacities and consolidations in both lung...

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The rare occurrence of cutaneous and mucosal lichen planus in HIV infection

Description

A 36-year-old man, a rickshaw driver by profession, who was diagnosed with HIV infection 3 years back, was on regular antiretroviral therapy consisting of zidovudine, lamivudine and nevirapine. He presented with complaints of a pruritic rash on both his legs since 7 months, which started as a single lesion and gradually spread to the current state over the next 6 weeks. Barring his antiretroviral therapy, he did not have any other drug history. He did not consume alcohol, did not chew tobacco and did not smoke. His CD4-positive cell count at the time of presentation was 336/mm³, serology for hepatitis C virus and hepatitis B virus was negative and other laboratory parameters such as complete blood count, liver and renal function tests were normal.

On examination, he had polygonal, planar, purple papules over the anterior aspect of legs (figure 1), and also white lacy lines (with a reticular pattern) in the left buccal mucosa (figure 2), which were suggestive of Wickham striae.

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Tenon patch graft for corneal fistula: a rare entity treated by a simple technique

A 50-year-old patient presented with dull aching pain with some discomfort in his right eye for the past 2 weeks. History revealed the patient had a past episode of infective keratitis managed medically in a local hospital. The last follow-up record suggested a diagnosis of healed keratitis with corneoiridic scar. On examination, the patient had visual acuity of hand movement and a corneoiridic scar of 7x7 mm with an inferotemporal translucent cystic area measuring 3x4 mm in size with underlying uveal tissue visible. Seidel test was found to be positive confirming leakage. For this, a tenon patch over the area of defect along with anterior chamber formation was done. On postoperative day 1, the graft was well attached and anterior chamber was formed with no leak on Seidel test. Intraocular pressure was 16 mm Hg.

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Specific Immunotherapy in LAR: a randomized, double-blind placebo controlled trial with Phleum pratense subcutaneous allergen immunotherapy

Abstract

Background

Allergen immunotherapy has been shown to be an effective treatment for local allergic rhinitis (LAR) to house dust mites. Studies with pollen allergen immunotherapy are limited to observational studies. The aim of this study was to evaluate the clinical efficacy and safety of Phleum pratense subcutaneous immunotherapy (Phl-SCIT) in LAR.

Methods

In a randomized double-blind placebo-controlled study, 56 patients with moderate-severe LAR to grass pollen received Phl-SCIT with a depigmented-polymerized pollen vaccine or placebo for the first year, and Phl-SCIT the second one. The blind was maintained throughout the study. Primary outcome was combined symptoms-medication score (CSMS) during grass pollen season (GPS). Secondary clinical outcomes included organ-specific symptoms, medication free days, rhinitis severity, and asthma control. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal allergen provocation test (NAPT), skin testing, serum levels of specific-IgG4 and specific-IgE, and safety were also evaluated.

Results

SCIT had a short-term and sustained effect with significant improvements of all primary and secondary clinical outcomes and RQLQ score. SCIT significantly increased serum sIgG4 levels and allergen tolerance, from the 6^th to 24^th months of treatment. At the end of the study 83% of patients treated with ≥6 months of SCIT tolerated a concentration of Phl over 50 times higher than baseline, and 56% gave a negative NAPT. SCIT was well-tolerated; six mild local reactions occurred, and there were no serious adverse events related to the study medication.

Conclusions

Subcutaneous immunotherapy with depigmented-polymerized allergen extracts is a safe and clinically effective treatment for LAR to Phleum pratense.clinicaltrials. gov identifier: NCT02126111.

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Herpes simplex type 1 pneumonitis and acute respiratory distress syndrome in a patient with chronic lymphatic leukemia: a case report

Pulmonary pathogenicity of herpes simplex virus type 1 in patients in intensive care without classic immunosuppression as well as the necessity of antiviral treatment in the case of herpes simplex virus detect...

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Percutaneous bone anchored hearing system implant survival after 550 primary implant surgeries

Abstract

The Bone Anchored Hearing System (BAHS) has become an established option for rehabilitation of several type of hearing impairment such as conductive hearing loss, mixed hearing loss and single sided deafness ¹. Overall good outcomes have been reported. Nevertheless, complications such as inflammation of the skin around the percutaneous abutment, pain and implant loss are related to BAHS ².

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Postoperative efficacy analysis of patients with facial nerve palsy associated with cholesteatoma otitis media: Our experience with 32 patients

Abstract

Patients who underwent surgery within 4 weeks after facial palsy had better outcomes than those who had surgery later.

The results of partial and near-complete decompression were good, with no difference between the two methods.

Even if the symptom duration of facial paralysis was > 4 weeks, surgery still had an impact.

Unlike in surgery for facial paralysis due to other causes, the integrity of the sheath membrane should be preserved.

There is a lag in the electroneurography test results.

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Noise exposure while commuting in Toronto - a study of personal and public transportation in Toronto

With an increasing proportion of the population living in cities, mass transportation has been rapidly expanding to facilitate the demand, yet there is a concern that mass transit has the potential to result i...

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Safety of transtympanic application of probiotics in a chinchilla animal model

Chronic suppurative otitis media can be recalcitrant and difficult to treat, particularly with the increasing occurrence of antibiotic resistance. Lactobacillus plantarum is a probiotic that has been shown to dec...

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