MRI evaluation of tissue iron burden in patients with β-thalassaemia major

β-Thalassaemia major is a hereditary haemolytic anaemia that is treated with multiple blood transfusions. A major complication of this treatment is iron overload, which leads to cell death and organ dysfunction. Chelation therapy, used for iron elimination, requires effective monitoring of the body burden of iron, for which serum ferritin levels and liver iron content measured in liver biopsies are used as markers, but are not reliable. MRI based on iron-induced T2 relaxation enhancement can be used for the evaluation of tissue siderosis. Various MR protocols using signal intensity ratio and mainstream relaxometry methods have been used, sometimes with discrepant results. Relaxometry methods using multiple echoes achieve better sampling of the time domain in which relaxation mechanisms take place and lead to more precise results. In several studies the MRI parameters of liver siderosis have failed to correlate with those of other affected organs, underlining the necessity for MRI iron evaluation in individual organs. Most studies have included children in the evaluated population, but MRI data on very young children are lacking. Wider application of relaxometry methods is indicated, with the establishment of universally accepted MRI protocols, and further studies, including young children, are needed

A six stage approach for the diagnosis of the Alzheimer’s disease based on fMRI data

AbstractThe aim of this work is to present an automated method that assists in the diagnosis of Alzheimer’s disease and also supports the monitoring of the progression of the disease. The method is based on features extracted from the data acquired during an fMRI experiment. It consists of six stages: (a) preprocessing of fMRI data, (b) modeling of fMRI voxel time series using a Generalized Linear Model, (c) feature extraction from the fMRI data, (d) feature selection, (e) classification using classical and improved variations of the Random Forests algorithm and Support Vector Machines, and (f) conversion of the trees, of the Random Forest, to rules which have physical meaning. The method is evaluated using a dataset of 41 subjects. The results of the proposed method indicate the validity of the method in the diagnosis (accuracy 94%) and monitoring of the Alzheimer’s disease (accuracy 97% and 99%)

Pedagogical leadership: A comparative study from England, Greece and Sweden

Current international research addresses the complexities, challenges and barriers that impact formal accountable leadership in the field of Early Childhood Education and Care (ECEC) as well as its conceptualisations (e.g. Nicholson and Maniates 2016, Caroll-Lind et al 2016, Nicholson et al 2020). For example, a literature review of English ECEC found that there is a distinction between organisational leadership and pedagogical leadership (Pascal et al 2020). Pedagogical leaders are the ones who might not have any organisational responsibilities but lead the direct interactions between children and adults and the educational elements that constitute the pedagogy. They also highlight that in England there is no clear route to a leadership qualification for staff in ECEC

Acute Haemophilus parainfluenzae endocarditis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Numerous pathogens can cause infective endocarditis, including <it>Haemophilus parainfluenzae</it>. <it>H. parainfluenzae</it> is part of the <it>H. aphrophilus, Actinobacillus actinomycetemcomitans</it>,<it> Cardiobacterium hominis</it>,<it> Eikenella corrodens</it>, and <it>Kingella kingae</it> group that may cause about 3% of the total endocarditis cases, and is characterized by a subacute course and large vegetations.</p> <p>Case presentation</p> <p>Acute <it>H. parainfluenzae</it> endocarditis developed in a 54-year-old woman, with no underlying predisposing factors. The patient presented with fever of 3 days duration and a severe headache. Magnetic resonance imaging of the brain revealed multiple cerebral emboli with hemorrhagic foci. Upon suspicion of endocarditis, cardiac transesophageal ultrasonography was performed and revealed massive vegetations. The patient underwent emergency mitral valve replacement, and was further treated with ceftriaxone. Blood cultures grew <it>H. parainfluenzae</it> only after valve replacement, and a 6-week course of ceftriaxone was prescribed.</p> <p>Conclusion</p> <p>We underline the typical presentation of large vegetations in <it>H. parainfluenzae</it> endocarditis, which are associated with embolic phenomena and resulting severity. Although the majority of the few cases reported in the literature are subacute in progress, our case further underlines the possibility that <it>H. parainfluenzae</it> endocarditis may develop rapidly. Thus, awareness of the imaging characteristics of the pathogen may enhance early appropriate diagnosis and therapeutic response.</p

Fibromatous Uterus in a 16-Year-Old Girl: A Case Report

Although uterine leiomyomas are the most common neoplasms of the female genital tract, this is not the case when referring to women under the age of 20. Only a few cases of uterus leiomyomas have been reported in this age. Preoperative imaging evaluation is mandatory in adolescent women for the accurate detection, localization, and characterization of uterus leiomyomas. We report a case of a 16-year-old girl admitted to our hospital for pain and abdominal distention. The patient underwent multidetector CT examination of the abdomen and MR examination of the pelvis. Both imaging modalities revealed uterine enlargement and the presence of innumerable variably sized leiomyomas. Histopathologic examination following exploratory laparotomy confirmed the presence of uterus leiomyomas. The patient underwent laparoscopic myomectomy two years after the first operation, following MR examination of the pelvis

Case Report Neuroendocrine Cell Carcinoma of Unknown Primary Arising in Long Standing History of Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease that targets myelinated axons in the central nervous system (CNS). Cancer of unknown primary site (CUP) is a well-recognised clinical disorder, accounting for 3-5% of all malignant epithelial tumors. CUP is clinically characterised as an aggressive disease with early dissemination. Studies of cancer risk in MS patients have shown inconsistent findings. An increased risk of malignancy in patients with MS has been suggested, but recently serious questions have been raised regarding this association. Use of disease-modifying therapies might contribute to an increased cancer risk in selected MS patients. The concurrence of MS and CUP is exceptionally rare. Here we describe the case of a neuroendocrine carcinoma of unknown primary diagnosed in a male patient with a nine-year history of MS. The discussion includes data from all available population-based register studies with estimates of certain malignancies in patients with MS