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Odeh A, Alsuwaigh A, Albeladi AM, Busbaih Z, Alkhars AM, Khalid MO, AlAli AH, AlAbbad MT, Boumarah KA, Alkhars HM, Alammar ZA, Almohammedsaleh AH. Spontaneous Splenic Rupture as a Complication of Malaria and Incidental Acute Appendicitis: A Case Report. Cureus 2021; 13:e19028. [PMID: 34824938 PMCID: PMC8612066 DOI: 10.7759/cureus.19028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/19/2022] Open
Abstract
Malaria presents a challenge to healthcare systems globally. It is associated with severe complications, notably splenic rupture. The prognosis of malaria complicated by splenic rupture is poor and sometimes leads to death even with timely intervention. Here, we report the case of a patient who presented with complicated malaria with spontaneous splenic rupture and coincidental acute appendicitis. A 34-year-old man was successfully treated for a grade IV ruptured spleen and acute appendicitis with splenectomy and appendectomy. Postoperative care took place in the intensive care unit and the patient was shifted to the general floor on the fifth day. Upon discharge the next day, he was prescribed amoxicillin twice daily for one year. Malaria can present with life-threatening complications requiring prompt surgical intervention.
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Affiliation(s)
- Ahmad Odeh
- General Surgery, Prince Saud Bin Jalawi Hospital, Al Ahsa, SAU
| | | | | | - Zaki Busbaih
- General Surgery, Prince Saud Bin Jalawi Hospital, Al Ahsa, SAU
| | | | | | - Aminah H AlAli
- General Surgery, Prince Saud Bin Jalawi Hospital, Al Ahsa, SAU
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Banihashemi L, Peng CW, Verstynen T, Wallace ML, Lamont DN, Alkhars HM, Yeh FC, Beeney JE, Aizenstein HJ, Germain A. Opposing relationships of childhood threat and deprivation with stria terminalis white matter. Hum Brain Mapp 2021; 42:2445-2460. [PMID: 33739544 PMCID: PMC8090789 DOI: 10.1002/hbm.25378] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 12/12/2022] Open
Abstract
While stress may be a potential mechanism by which childhood threat and deprivation influence mental health, few studies have considered specific stress‐related white matter pathways, such as the stria terminalis (ST) and medial forebrain bundle (MFB). Our goal was to examine the relationships between childhood adversity and ST and MFB structural integrity and whether these pathways may provide a link between childhood adversity and affective symptoms and disorders. Participants were young adults (n = 100) with a full distribution of maltreatment history and affective symptom severity. Threat was determined by measures of childhood abuse and repeated traumatic events. Socioeconomic deprivation (SED) was determined by a measure of childhood socioeconomic status (parental education). Participants underwent diffusion spectrum imaging. Human Connectome Project data was used to perform ST and MFB tractography; these tracts were used as ROIs to extract generalized fractional anisotropy (gFA) from each participant. Childhood threat was associated with ST gFA, such that greater threat was associated with less ST gFA. SED was also associated with ST gFA, however, conversely to threat, greater SED was associated with greater ST gFA. Additionally, threat was negatively associated with MFB gFA, and MFB gFA was negatively associated with post‐traumatic stress symptoms. Our results suggest that childhood threat and deprivation have opposing influences on ST structural integrity, providing new evidence that the context of childhood adversity may have an important influence on its neurobiological effects, even on the same structure. Further, the MFB may provide a novel link between childhood threat and affective symptoms.
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Affiliation(s)
- Layla Banihashemi
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christine W Peng
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Timothy Verstynen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel N Lamont
- Petersen Institute of NanoScience and Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hussain M Alkhars
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fang-Cheng Yeh
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph E Beeney
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Banihashemi L, Bertocci MA, Alkhars HM, Versace A, Northrup JB, Lee VK, Schmithorst VJ, Samolyk A, Taylor M, English GE, Stiffler RS, Aslam HA, Bonar L, Panigrahy A, Hipwell AE, Phillips ML. Limbic white matter structural integrity at 3 months prospectively predicts negative emotionality in 9-month-old infants: a preliminary study. J Affect Disord 2020; 273:538-541. [PMID: 32560951 PMCID: PMC7367553 DOI: 10.1016/j.jad.2020.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/05/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little is known about how early alterations in white matter relate to clinically relevant behaviors such as emotional dysregulation. Thus, our goal was to examine how the white matter structural integrity of key limbic (i.e., uncinate fasciculus and cingulum) and commissural (i.e., forceps minor) bundles in 3-month-old infants prospectively predicts emotional regulation behaviors at 9 months. METHODS Three-month-old infants underwent multishell diffusion-weighted imaging. Following image processing, tractography was performed for each tract within each infant's native space (n=20). Measures of white matter integrity, including microstructure and morphology, were extracted from each tract. At 9 months, negative emotionality (NE) and positive emotionality (PE) were elicited using Laboratory Assessment of Temperament tasks. Elastic net regressions were performed for variable selection, which included white matter integrity variables from each of the 3 tracts, along with several covariates, including age, sex, use of public assistance, and the mother's depressive symptoms. Outcome variables were NE and PE composite scores evaluated in two separate models. RESULTS Notably, following hierarchical regression using elastic net-selected variables, uncinate structural integrity was the most robust predictor of NE (ß=-0.631, p=0.005). LIMITATIONS The sample size of our study is a limitation, however, as a preliminary study, our goal was to describe our findings to inform future, larger studies. CONCLUSIONS Greater uncinate structural integrity predicted lower NE, suggesting that greater uncinate structural integrity at 3 months allows greater emotional regulation capacity at 9 months. To our knowledge, this is the first study to demonstrate prospective brain-to-emotional behavior relationships in infants.
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Affiliation(s)
- Layla Banihashemi
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA.
| | - Michele A. Bertocci
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Hussain M. Alkhars
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Amelia Versace
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Jessie B. Northrup
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Vincent K. Lee
- UPMC Children’s Hospital of Pittsburgh, Department of Pediatric Radiology, Pittsburgh, PA
| | - Vincent J. Schmithorst
- UPMC Children’s Hospital of Pittsburgh, Department of Pediatric Radiology, Pittsburgh, PA
| | - Alyssa Samolyk
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Megan Taylor
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Gabrielle E. English
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Richelle S. Stiffler
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Haris A. Aslam
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Lisa Bonar
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Ashok Panigrahy
- UPMC Children’s Hospital of Pittsburgh, Department of Pediatric Radiology, Pittsburgh, PA
| | - Alison E. Hipwell
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Mary L. Phillips
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
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