Neglected and (re-)emergent infections of the CNS i n low-/middle-income countries

Low- and middle-income countries (LMIC) have suffered from long-term health system deficiencies, worsened by poor living conditions, lack of sanitation, a restricted access to health facilities and running water, overcrowding, and overpopulation. These factors favor human displacement and deepen marginalization; consequently, their population endures a high burden of infectious diseases. In this context, the current epidemiological landscape and its impact on health and economic development are not promissory, despite the commitment by the international community to eradicate neglected tropical infections - especially tuberculosis and malaria, by 2030. Neglected and (re)-emerging infectious diseases affecting the central nervous system (CNS) are a major public health concern in these countries, as they cause a great morbidity and mortality; furthermore, survivors often suffer from severe neurological disabilities. Herein, we present a retrospective review focused on some neglected and (re)-emerging infectious diseases, including neurocysticercosis, malaria, rabies, West Nile virus encephalitis, tuberculosis, neuroborreliosis, and SARS-CoV-2 in LMIC. A retrospective review of studies on selected neglected and (re)-emerging infectious diseases in LMIC was performed, including reports by the World Health Organization (WHO) published within the last five years. Data on infection by SARS-CoV-2 were provided by the John Hopkins University Coronavirus Resource Center. CNS neglected and (re)-emerging infectious diseases remain as important causes of disease in LMIC. An alarming increase in the prevalence of malaria, tuberculosis, and cysticercosis is observed in the region, compounded by the recent COVID-19 pandemic. The WHO is currently supporting programs/efforts to cope with these diseases. Herein, we highlight the epidemiological burden of some CNS infections in LMIC, and their clinical and neuroimaging features, to facilitate an accurate diagnosis, considering that most of these diseases will not be eradicated in the short term; instead, their incidence will likely increase along with poverty, inequality, and related socioeconomic problems.

Evaluation of endothelial function and subclinical atherosclerosis in patients with HIV infection

The aim of this study was to analyse the association between human immunodeficiency virus (HIV) related clinical and analytical parameters and the presence of subclinical atherosclerosis as well as endothelial dysfunction. This was a prospective cohort study of HIV-positive patients who underwent intima media thickness (IMT) determination and coronary artery calcium scoring to determine subclinical atherosclerosis. To detect endothelial dysfunction, the breath holding index, flow-mediated dilation and the concentration of endothelial progenitor cells (EPCs) were measured. Patients with an IMT ≥ 0.9 mm had an average of 559.3 ± 283.34 CD4/μl, and those with an IMT < 0.9 mm had an average of 715.4 ± 389.92 CD4/μl (p = 0.04). Patients with a low calcium score had a significantly higher average CD4 cell value and lower zenith viral load (VL) than those with a higher score (707.7 ± 377.5 CD4/μl vs 477.23 ± 235.7 CD4/μl (p = 0.01) and 7 × 10⁴ ± 5 × 10⁴ copies/ml vs 23.4 × 104 ± 19 × 104 copies/ml (p = 0.02)). The number of early EPCs in patients with a CD4 nadir < 350/µl was lower than that in those with a CD4 nadir ≥ 350 (p = 0.03). In HIV-positive patients, low CD4 cell levels and high VL were associated with risk of developing subclinical atherosclerosis. HIV patients with CD4 cell nadir < 350/µl may have fewer early EPCs.

Maxillary Giant Cell Granuloma: A Long-Term Follow-Up

This is a case of a 32-year-old female with a known diagnosis of Turner syndrome who presented with complaints of chronic progressive right-sided facial pain and sinus pressure, and who was afebrile. On physical examination, there was eye proptosis on the right and significant increased fullness in the right infraorbital and maxillary regions. Computed tomography and magnetic resonance imaging demonstrated a large expansile space-occupying lesion in the right maxillary area, that histologically turned out to be a giant cell reparative granuloma. The lesion was completely removed and of interest, the patient was followed up both clinically and on imaging for 10 years with no signs of recurrence. A discussion on this entity, as well the clinical and imaging differential diagnoses, is carried out.

Maxillary Giant Cell Granuloma: A Long-Term Follow-Up

A case of a 32-year-old female with a known diagnosis of Turner syndrome who presented with complaints of chronic progressive right-sided facial pain and sinus pressure and who was afebrile. On physical examination, there was eye proptosis on the right and significant increased fullness in the right infraorbital and maxillary regions. Computed tomography and magnetic resonance imaging demonstrated a large expansile space-occupying lesion in the right maxillary area that histologically turned out to be a giant cell reparative granuloma. The lesion was completely removed, and of interest, the patient was followed up both clinically and on imaging for 10 years with no signs of recurrence. A discussion on this entity, as well the clinical and imaging differential diagnoses, is discussed.

Effect of marine by-product meals on hen egg production parameters, yolk lipid composition and sensory quality

The effect of including 5% marine by-product meals in feeds of laying hens on egg production, composition and sensory characteristics was tested. Marine by-product meals were prepared using two methods: (i) cooking (100°C/10 min) followed by drying (60°C/24 hr) or (ii) grinding followed by drying. The raw materials used for meal production were scallop or squid viscera, shrimp heads or whole mackerel. A total of 108 laying hens were allocated to nine diet treatments; one control diet (corn and soya bean based) and eight experimental diets, containing 95% of the control feed and 5% of the experimental meal for three weeks. Daily intake was higher in hens fed the dried mackerel and cooked shrimp meals. All the experimental treatments showed significantly higher concentration of n-3 HUFA in yolk reserves and phospholipids compared to the control (0.12-0.13 g per 100 g), especially those with scallop or squid prepared by both methods (0.53-0.95 g per 100 g). Scallop, squid and shrimp meal inclusion in the feed produced eggs with more astaxanthin (0.22 mg per 100 g) while this carotenoid was absent in the control and mackerel treatments. Visual evaluation of raw yolk colour increased with the inclusion of marine by-product meals with higher values in hens fed shrimp heads (13), followed by scallop viscera (11), squid viscera (9), and with similar values for mackerel and control (4). The taste, aroma, texture and colour of cooked eggs from different treatments were not statically different when evaluated by a panel of 60 untrained people. These results suggest that meals from marine by-products are a better alternative for improving egg yolk composition by increasing n-3 HUFA when compared to fishmeal as they also increase astaxanthin and yolk pigmentation without affecting egg sensory characteristics.

[MIII2MII3] n+ trigonal bipyramidal cages based on diamagnetic and paramagnetic metalloligands

A family of five [MIII2MII3] n+ trigonal bipyramidal cages (MIII = Fe, Cr and Al; MII = Co, Zn and Pd; n = 0 for 1-3 and n = 6 for 4-5) of formulae [Fe2Co3L6Cl6] (1), [Fe2Zn3L6Br6] (2), [Cr2Zn3L6Br6] (3), [Cr2Pd3L6(dppp)3](OTf)6 (4) and [Al2Pd3L6(dppp)3](OTf)6 (5) (where HL is 1-(4-pyridyl)butane-1,3-dione and dppp is 1,3-bis(diphenylphosphino)propane) are reported. Neutral cages 1-3 were synthesised using the tritopic [MIIIL3] metalloligand in combination with the salts CoIICl2 and ZnIIBr2, which both act as tetrahedral linkers. The assembly of the cis-protected [PdII(dppp)(OTf)2] with [MIIIL3] afforded the anionic cages 4-5 of general formula [MIII2PdII3](OTf)6. The metallic skeleton of all cages describes a trigonal bipyramid with the MIII ions occupying the two axial sites and the MII ions sitting in the three equatorial positions. Direct current (DC) magnetic susceptibility, magnetisation and heat capacity measurements on 1 reveal weak antiferromagnetic exchange between the FeIII and CoII ions. EPR spectroscopy demonstrates that the distortion imposed on the {MO6} coordination sphere of [MIIIL3] by complexation in the {MIII2MII3} supramolecules results in a small, but measurable, increase of the zero field splitting at MIII. Complete active space self-consistent field (CASSCF) calculations on the three unique CoII sites of 1 suggest DCo ≈ -14 cm-1 and E/D ≈ 0.1, consistent with the magnetothermal and spectroscopic data.

Osmotic Demyelination Syndrome Revisited: Review With Neuroimaging

Osmotic demyelination syndrome (ODS) is a general term that has become commonplace in the practice of medicine, encompassing both central pontine myelinolysis and extrapontine myelinolysis. Historically ODS arises as a serious complication of rapid correction of hyponatremia, yet its manifestations seem to be influenced by a multifactorial process. Further understanding of this rare demyelinating disease has elucidated the significant role of other electrolyte disturbances and the presence of chronic comorbidities as disease risk factors. This review discusses the current research regarding the pathophysiology, clinical manifestations, neuroimaging features, patient management, and prognosis of osmotic demyelination syndrome. We hope that this review will further endorse and aid in the proper diagnosis of ODS and its suitable management through the understanding of clinical and imaging correlations and outcomes, and the comorbid factors that may predispose the development of ODS in certain patient populations.

Radiology Case Of The Month: Mental Disturbance for 4 days

A 56 year old African-American man presented to the emergency department with dyspnea and dysphagia with drooling. On his initial evaluation, disproportionate obesity of the face, neck and shoulders were noted. The patient's history was significant for obstructive sleep apnea, end-stage renal disease, alcoholic liver disease, pulmonary hypertension and alcoholic cardiomyopathy. He had multi-decade history of heavy alcohol abuse, but quit drinking two years previously.

Rare primary mucosal melanoma of the larynx

Few cases of primary mucosal melanoma of the larynx have been documented in the literature, so only a limited amount of data exists regarding its diagnosis and treatment. The prognosis is poor, as patients often present at a late stage with regional or distant metastases. We describe the case of a 66-year-old man who presented with hoarseness and dysphagia. Laryngoscopy identified a dark discoloration of the supraglottic larynx and incomplete mobility of the right vocal fold; an excisional biopsy confirmed the diagnosis. We discuss the epidemiology, clinical features, diagnosis, interpretation of imaging findings, and management of this rare malignant melanoma.

Modulation of Postnatal Neurogenesis by Perinatal Asphyxia: Effect of D1 and D2 Dopamine Receptor Agonists

Perinatal asphyxia (PA) is associated to delayed cell death, affecting neurocircuitries of basal ganglia and hippocampus, and long-term neuropsychiatric disabilities. Several compensatory mechanisms have been suggested to take place, including cell proliferation and neurogenesis. There is evidence that PA can increase postnatal neurogenesis in hippocampus and subventricular zone (SVZ), modulated by dopamine, by still unclear mechanisms. We have studied here the effect of selective dopamine receptor agonists on cell death, cell proliferation and neurogenesis in organotypic cultures from control and asphyxia-exposed rats. Hippocampus and SVZ sampled at 1-3 postnatal days were cultured for 20-21 days. At day in vitro (DIV) 19, cultures were treated either with SKF38393 (10 and 100 µM, a D₁ agonist), quinpirole (10 µM, a D₂ agonist) or sulpiride (10 μM, a D₂ antagonist) + quinpirole (10 μM) and BrdU (10 μM, a mitosis marker) for 24 h. At DIV 20-21, cultures were processed for immunocytochemistry for microtubule-associated protein-2 (MAP-2, a neuronal marker), and BrdU, evaluated by confocal microscopy. Some cultures were analysed for cell viability at DIV 20-21 (LIVE/DEAD kit). PA increased cell death, cell proliferation and neurogenesis in hippocampus and SVZ cultures. The increase in cell death, but not in cell proliferation, was inhibited by both SKF38393 and quinpirole treatment. Neurogenesis was increased by quinpirole, but only in hippocampus, in cultures from both asphyxia-exposed and control-animals, effect that was antagonised by sulpiride, leading to the conclusion that dopamine modulates neurogenesis in hippocampus, mainly via D₂ receptors.

Radiology Case of the Month: Gliomatosis Cerebri

A 71 year-old female with a past medical history significant for hypertension, hyperlipidemia, diabetes, and strokes, presented initially to the stroke service with a sudden onset of right facial droop, right-sided weakness, dysarthria, and seizures that had gotten progressively worse for six weeks.

Fungal Infections of the Central Nervous System: A Pictorial Review

Fungal infections of the central nervous system (CNS) pose a threat to especially immunocompromised patients and their development is primarily determined by the immune status of the host. With an increasing number of organ transplants, chemotherapy, and human immunodeficiency virus infections, the number of immunocompromised patients as susceptible hosts is growing and fungal infections of the CNS are more frequently encountered. They may result in meningitis, cerebritis, abscess formation, cryptococcoma, and meningeal vasculitis with rapid disease progression and often overlapping symptoms. Although radiological characteristics are often nonspecific, unique imaging patterns can be identified through computer tomography as a first imaging modality and further refined by magnetic resonance imaging. A rapid diagnosis and the institution of the appropriate therapy are crucial in helping prevent an often fatal outcome.

Paragangliomas of the head and neck: imaging assessment

Paragangliomas are uncommon tumors that arise from the parasympathetic neuroectodermal ganglionic cells and have been described in numerous anatomic locations, most commonly in the abdomen. Head and neck paragangliomas are classified into carotid body (most common), vagal, and jugulotympanic types. Computed tomography is the initial imaging modality of choice for the preoperative assessment of the extent of paragangliomas. Magnetic resonance imaging and selective angiography provide more detail of the surrounding tissues and vasculature. Surgical resection is the treatment of choice.

Diversidad genética de la gallina criolla del Suroccidente Colombiano

En Colombia, la gallina Criolla es socialmente importante por su aporte nutricional, fácil reproducción, adaptabilidad y rusticidad. Por lo tanto, ha sido necesario conocer cómo es su diversidad, relaciones y estructura genética. El objetivo de este estudio fue ccontribuir al conocimiento de la biodiversidad del país y al desarrollo agropecuario sostenible, mediante el estudio de la diversidad genética de aves criollas. Se analizaron 224 muestras de ADN de gallina Criolla colombiana provenientes de los departamentos del Cauca, Caldas, Chocó, Nariño y Valle del Cauca, y 20 de líneas comerciales, mediante 17 marcadores microsatélites, realizándoles extracción de ADN por el método de Salting Out y posteriormente amplificando por reacción en cadena de la polimerasa (PCR). El análisis estadístico para evaluar la diversidad genética se realizó a través de los programas ARLEQUIN v. 3.5, GENALEX v. 6.5, Microsatellite Toolkit y FSTAT. La estructura de las poblaciones se determinó por el programa STRUCTURE v. 2.3.4. Se encontraron 79 alelos para las poblaciones. El número promedio de alelos para la gallina Criolla fue de 4,65±1,66. La heterocigosidad esperada fue mayor que la observada y varió de 0,59 en Chocó a 0,62 en el Valle del Cauca. El FIS fue de 0,40 (p

Radiology Case Of The Month: Brain Magnetic Resonance Imaging with Bilateral Hyperintensities in the Globus Pallidi

An MRI of the brain and spine of an 11-year-old male revealed the following abnormality which is consistent with his chronic condition.

Erratum

In Ear Nose Throat J 2015;94(4-5):150-2, an editing error was made in the title. The correct title is “Perineural spread of cutaneous squamous cell carcinoma along the great auricular nerve.”

Pitfalls in imaging the submandibular glands with PET/CT

Imaging of the submandibular glands can provide vital information about malignant neoplastic processes. One of these modalities, fluorine-18 fluorodeoxyglucose-positron-emission tomography/computed tomography (FDG-PET/CT), has become very important in the detection of malignancies because it provides functional and metabolic information as well as anatomic localization. However, there are several pitfalls associated with FDG-PET/CT in terms of salivary gland imaging. For example, a normal increase in the uptake of radiotracer might be mistaken for a neoplastic process. Other routine findings may include normal physiologic uptake in some structures, benign tumors and medical conditions, and iatrogenic abnormalities. We review a case in which compensatory hypertrophy of a submandibular gland was suspected to be a possible malignancy.

Radiology Case of the Month: A Case with Relapsing Episodes of Weakness and Seizures

A 23-year-old man presented to the clinic with a oneweek history of left upper and lower extremity numbness, starting in his left hand and progressing to his left foot. He then experienced intermittent difficulty walking and left-sided drooling. The patient also reported having a left arm abscess one week earlier, for which he received penicillin and oxycodone and acetaminophen. He denied any weakness, seizure, headache, fever, nausea, vomiting, or focal neurological deficit, as well as any recent history of immunization or upper respiratory infection symptoms. During the initial visit, magnetic resonance images were obtained. Over the course of the next year, the patient presented to the hospital six times for additional symptoms including weakness, slurred speech, and seizures. During this period, brain biopsy, serology tests, and MR spectroscopy were performed confirming the initial diagnosis. Moreover, multiple MR images were performed showing progression and relapsing.

RADIOLOGICAL DIAGNOSIS

Multiphasic Acute Disseminated Encephalomyelitis.

Computed axial tomography in otorhinolaryngology

The value of computed tomography in ORL and its applications have been briefly discussed. Better soft tissue detail and its relationship to bony structures is obtained. At the present time this modality may be utilized as a screening test in some suspected cases or as an adjunct of conventional methods. With the technical refinements that are constantly being made, better diagnostic information will be obtained in CT scanning.

RADIOLOGY OF THE MONTH: Vocal Cord Dysfunction with Multiple Cranial Neuropathies

A 67-year-old female presented to our institution with a progressive history of hoarseness for the past six months. The patient also referred shoulder weakness and cough during the same period of time. She denied weight loss and tobacco use. Past medical history was negative for squamous cell carcinoma of the head and neck region. Physical examination demonstrated asymmetry of the sternocleidomastoid and trapezius muscles. Flexible laryngoscopy was performed and revealed complete unilateral vocal cord paralysis on the right. Magnetic Resonance (MR) of the brain with intravenous contrast (Figure 1) and computer tomography (CT) of soft tissue of the neck with contrast (Figure 2) were performed for further evaluation.