Eye movement desensitisation and reprocessing (EMDR) treatment associated with parent management training (PMT) for the acute symptoms in a patient with PANDAS syndrome: a case report

BACKGROUND: The purpose of this report was to present the results of eye movement desensitisation and reprocessing (EMDR) therapy associated with parent management training (PMT) in a child with paediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS), who had previously only been treated with pharmacological treatment. CASE PRESENTATION: The case concerns an 11-year-old boy who presented with simple and complex vocal tics, motor tics, obsessive-compulsive traits and irritability from the age of 6 years, in addition to a positive result for streptococcal infection. The course of symptoms followed a relapsing-remitting trend with acute phases that were contingent on the infectious episodes. CONCLUSIONS: Following eight sessions of EMDR, preceded by training sessions with the parents, the child showed a significant reduction in symptoms and disappearance of the exacerbation. These results indicate the possibility of improving the treatment outcomes of patients with PANDAS by a combined approach using both antibiotic and EMDR therapies

National sentinel site surveillance for antimicrobial resistance in Klebsiella pneumoniae isolates in South Africa, 2010-2012

PKBackground: The increasing rates of antimicrobial resistance observed in the nosocomial pathogen Klebsiella pneumoniae are of major public health concern worldwide. Objectives: To describe the antibiotic susceptibility profiles of K. pneumoniae isolates from bacteraemic patients submitted by sentinel laboratories in five regions of South Africa from mid-2010 to mid-2012. Molecular methods were used to detect the most commonly found extended-spectrum beta-lactamase (ESBL) and carbapenemase resistance genes. Methods: Thirteen academic centres serving the public healthcare sector in Gauteng, KwaZulu-Natal, Free State, Limpopo and Western Cape provinces submitted K. pneumoniae isolates from patients with bloodstream infections. Vitek 2 and MicroScan instruments were used for organism identification and susceptibility testing. Multiplex polymerase chain reactions (PCRs) were used to detect blaCTX-M, blaSHV and blaTEM genes in a proportion of the ESBL isolates. All isolates exhibiting reduced susceptibility to carbapenems were PCR tested for blaKPC and blaNDM-1 resistance genes. Results: Overall, 68.3% of the 2 774 isolates were ESBL-positive, showing resistance to cefotaxime, ceftazidime and cefepime. Furthermore, 46.5% of all isolates were resistant to ciprofloxacin and 33.1% to piperacillin-tazobactam. The major ESBL genes were abundantly present in the sample analysed. Most isolates (95.5%) were susceptible to the carbapenems tested, and no isolates were positive for blaKPC or blaNDM-1. There was a trend towards a decrease in susceptibility to most antibiotics. Conclusion: The high proportion of ESBL-producing K. pneumoniae isolates observed, and the prevalence of ESBL genes, are of great concern. Our findings represent a baseline for further surveillance in SA, and can be used for policy and treatment decisions

Pseudomonas aeruginosa bacteraemia in an academic hospital in South Africa

This study aimed at determining the clinical manifestations, outcome and prognostic factors associated with P. aeruginosa bacteraemia at the Chris Hani Baragwanath Hospital during the period 1998-99; to describe and quantify resistance to anti-pseudomonal drugs, and characterization of bacteraemic isolates, investigate the genetic relationship among drug susceptible and multiply resistant strains in the hospital. Clinical and laboratory investigations, culture and antimicrobial susceptibility testing were performed. Bacteraemic isolates were typed by endonuclease macrorestriction. Those with ≥97% band pattern similarity were assigned genotype status. Of 91 P. aeruginosa blood isolates, 52 (57%) were nosocomially acquired. Underlying conditions associated with episodes were burns in 24 (26.4%) and HIV infection in 21 (23%). Multi-drug resistance was present in 14 isolates (15.4%). Outcome was poor and death was associated with 36 (45.56%) of episodes. Case fatality rates were 60% in adults and 27.3% in children. Being a child, receiving appropriate antimicrobial treatment and admission to specialized care units were significantly associated with improved prognosis. P. aeruginosa bacteraemia was associated with outbreaks caused by two multiply resistant genotypes. Eighteen, antimicrobial susceptible isolates from bacteraemic episodes in paediatric wards, 9 in HIV-seropositive children, could be linked to small outbreaks in both hospitalised and community-based children. South African Medical Journal Vol. 98 (8) 2008: pp. 626-62

Measurement of Interrupter Respiratory Resistance and Spirometry in Preschool Children: Influence of Respiratory Symptoms:

Pulmonary function tests play an important role in the diagnosis and management of respiratory diseases in children. The purpose of the study was to evaluate lung function using the interrupter resistance technique (Rint) and spirometry (flow-volume and volume-time) in preschool children and to correlate the findings with respiratory symptoms. We studied 103 children (65 males, 38 females; mean age 5.2±0.7 years; range 3.6–5.8). For each child we collected family history concerning: respiratory diseases, skin prick tests, smoking during maternal pregnancy, history of gestational and neonatal period. All children performed lung function tests (Rint and spirometry) and skin prick test for inhalant and food allergens. Twenty-eight subjects (27.2%) had respiratory symptoms (RS). Expiratory Rint were performed in all subjects and spirometry was carried out on 76 children (73.8%). Spirometric indices were not statistically different between subjects without respiratory symptoms (controls) and RS children except for FEF25–75 expressed as a percentage of the predicted value (RS: 81.5±13.7% vs controls: 94.5±15.8%; p <0.001). Rint mean values were significantly higher in RS children than in controls (RS: 135.6 ±24.8% vs controls: 102.4 ±21.7%; p< 0.0001). We found a statistically negative correlation between Rint and the following Spirometric indices: FEV0.5 (R= −0.696; p < 0.0001), FEV, (R= − 0.728; p < 0.0001) and FEF25–75 (R= −0.681; p < 0.0001). In preschool children with respiratory disease we found significantly higher mean values of Rint and lower FEF25-75 than in the control group and a significant negative relationship between Rint and Spirometric indices

Fault Detection and Identification Methods Used for the LHC Cryomagnets and Related Cabling

Several methods for electrical fault location have been developed and tested. As part of the electrical quality assurance program for the LHC, certain wires have to be subjected to a (high) DC voltage for the testing of the insulation. With the time difference of spark-induced electromagnetic signals measured with an oscilloscope, fault localization within ± 10 cm has been achieved. Another method used, and adapted for particular needs, is the synthetic pulse time-domain reflectometry (TDR) with a vector network analyzer (VNA). This instrument has also been applied as a low frequency sweep impedance analyzer in order to measure fractional capacitances of cable assemblies where TDR was not applicable

Vernal Keratoconjunctivitis: an update focused on clinical grading system

Vernal keratoconjunctivitis (VKC) is a severe disease with a prevalence of &lt; 1 case out of 10,000 in Europe, which occurs mainly in pediatric age and is characterized by a severe and often bilateral chronic inflammation of the ocular surface. The diagnosis is generally confirmed by the finding at the ocular examination of conjunctival hyperemia, papillary hypertrophy in the tarsal conjunctiva, giant papillae, papillae in the limbus region

Focus on cardiologic findings in 30 children with PANS/PANDAS. an italian single-center observational study

Objective: Cardiac involvement in PANS has not been clarified relying on the scientific literature available until today. It is known that streptococcal infections play a role in the etiology of a great number of diseases including Sydenham chorea and rheumatic fever, among others. Based on the suspected pathogenesis of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) reported in the medical literature, we decided to investigate the cardiologic involvement in children with a recent PANS/PANDAS diagnosis. Methods: The study population satisfies PANS (1) and PANDAS (2) criteria of diagnoses. Cardiologic assessment was performed through clinical examination, electrocardiography, and echocardiography. Results: In the selected pediatric population, a significant number of children presented mitral valve involvement, systolic murmurs and electrocardiographic abnormalities. High ASLOT levels did not seem to be associated to a cardiac involvement. Conclusions: Often PANS is difficult to diagnose because it is little known by physicians and most of the cardiologic findings described in this study are common among the healthy pediatric population. Also, ASLOT levels seems not to be predictive of cardiac involvement. Furthermore, the existence of PANDAS as a clinical entity is associated with a group of anti-neuronal autoantibodies found in Sydenham chorea is still controversial. We recommend a complete cardiologic evaluation in those children who meet the PANS/PANDAS diagnostic criteria

Le immunoglobuline per via endovenosa nel trattamento delle neuropatie infantili

Agli inizi degli anni ’80, l’avvento dei preparati di immunoglobuline per via endovenosa (IVIG) nella la terapia sostitutiva delle ipo-agammaglobulinemie, ha radicalmente cambiato la prognosi dei pazienti con immunodeficienze umorali 1. Fino ad allora infatti erano utilizzabili solo preparati per via intramuscolare, con importanti limitazioni legate ai volumi di liquido iniettabili per questa via e la sostituzione degli anticorpi carenti era perciò poco soddisfacente. La disponibilità delle IVIG (quindi la possibilità di somministrare grandi volumi = quantità di IgG) non solo ha consentito la completa sostituzione dei difetti anticorpali, ma ha anche aperto la strada ad altri impieghi sfruttandone le attività immunomodulanti e antinfiammatorie prima sconosciute e rivelatesi in modo del tutto occasionale. Fu Imbach che casualmente osservò in un paziente con difetto anticorpale e piastrinopenia non solo la normalizzazione delle IgG, ma anche del numero di piastrine, in corso di terapia con IVIG e intraprese il primo studio con IVIG in pazienti con porpora trombocitopenia idiopatica, dimostrandone una eccellente efficacia 2. Da allora i campi applicativi si sono estesi a tutte quelle malattie autoimmuni e infiammatorie per le quali i risultati della terapia classica erano insoddisfacenti e si è focalizzata l’attenzione sui meccanismi attraverso cui le IVIG esercitano la loro azione antinfiammatoria e immunomodulante. Si può dire che ad oggi pressoché tutte le malattie autoimmuni – e le malattie neuromuscolari in particolare per le loro caratteristiche invalidanti ed evolutive – sono state oggetto di tentativi terapeutici con IVIG. I risultati non sono stati sempre incoraggianti e, in considerazione dell’alto costo dei preparati, si è sentita e si sente l’esigenza di porre ordine e di rivedere criticamente tutta la letteratura sull’argomento per dare indicazioni più precise, in accordo ai criteri EBM, sull’impiego di tali preparati. Ormai sono numerose le indicazioni e le consensus redatte sia da Neurologi che da Immunologi; a queste si aggiungono le direttive ufficiali, emanate dagli organi di controllo statali (FDA, WHO, AIFA) che ne approvano le indicazioni per alcune malattie e ne coprono il costo a carico dei sistemi sanitari nazionali. Tuttavia la approvazione riguarda un numero estremamente esiguo di patologie e tuttora le IVIG vengono spesso utilizzate off label