Neuroendocrine Tumour in a Patient with Neurofibromatosis Type 1 and HIV

We report the case of an HIV-positive female patient with neurofibromatosis type 1 who was treated for recurrent peptic ulcer disease and later developed diabetes mellitus and chronic diarrhoea. A metastasising somatostatinoma was histologically proven and evidence of a concomitant gastrin-producing neuroendocrine tumour was found. Neuroendocrine tumours (NETs) are very rare neoplasms originating from a wide variety of endocrine and nervous system tissue with the ability to produce different hormones. A somatostatin- and gastrin secreting NET in a patient with HIV has not been reported in the literature, to the best of our knowledge. We discuss oncogenic pathomechanisms related to the underlying conditions and propose stringent monitoring for tumours in HIV-positive patients with phakomatoses as well as initiation of antiretroviral therapy

Autoimmune encephalitis: Epidemiology, pathophysiology and clinical spectrum (part 2)

Autoimmune encephalitis (AE) represents a growing number of severe autoimmune-inflammatory diseases affecting both the white and grey matter of the brain. In part 1 of this series we focused on the epidemiology, pathophysiology and clinical presentation of this condition, with two illustrative cases. In this part, we will introduce the clinical criteria for AE, particularly for the diagnosis of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, which were developed to facilitate immune treatment in suspected cases before antibody results are available. We subsequently discuss the work up, differential diagnosis and treatment options for patients with this disease.

Acute obstructive hydrocephalus in posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is an uncommon, subacute neurological disorder that presents radiologically with a pattern of bilateral parieto-occipital areas of vasogenic oedema. Conditions commonly associated with PRES include autoimmune disorders, cytotoxic drugs, metabolic abnormalities and, most frequently, hypertensive emergencies. Clinically, headache, visual disturbances, seizures and an altered level of consciousness are often reported. The outcome is favourable if the underlying cause is addressed. Posterior fossa involvement resulting in obstructive hydrocephalus is a rare presentation and may be misdiagnosed as a mass lesion or infection, leading to delayed or unnecessary treatment. We describe the clinical presentation, findings on neuroimaging and conservative management of a man with PRES resulting in severe cerebellar oedema and acute obstructive hydrocephalus. This case illustrates that awareness of atypical neuroimaging in PRES is important for the management of these patients and to avoid morbidity and mortality

Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – a retrospective cohort study

AIM : This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient's socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy. METHODS : Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients' mortality risk. RESULTS : A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2-81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6-131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7-23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters. CONCLUSION : Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk.http://www.uk.sagepub.com/journals/Journal202185hb2017Neurolog

Composite Materials with Combined Electronic and Ionic Properties

In this work, we develop a new type of composite material that combines both electrocatalytic and ionic properties, by doping a silver metal catalyst with an anion-conducting ionomer at the molecular level. We show that ionomer entrapment into the silver metallic structure is possible, imparting unique properties to the catalytic character of the metallic silver. The novel composite material is tested as the cathode electrode of fuel cells, showing significant improvement in cell performance as compared with the undoped counterpart. This new type of material may then replace the current design of electrodes in advanced fuel cells or other electrochemical devices. The possibility to merge different properties into one composite material by molecular entrapment in metals can open the way to new materials, leading to unexplored fields and applications

Acute obstructive hydrocephalus in posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is an uncommon, subacute neurological disorder that presents radiologically with a pattern of bilateral parieto-occipital areas of vasogenic oedema. Conditions commonly associated with PRES include autoimmune disorders, cytotoxic drugs, metabolic abnormalities and, most frequently, hypertensive emergencies. Clinically, headache, visual disturbances, seizures and an altered level of consciousness are often reported. The outcome is favourable if the underlying cause is addressed. Posterior fossa involvement resulting in obstructive hydrocephalus is a rare presentation and may be misdiagnosed as a mass lesion or infection, leading to delayed or unnecessary treatment. We describe the clinical presentation, findings on neuroimaging and conservative management of a man with PRES resulting in severe cerebellar oedema and acute obstructive hydrocephalus. This case illustrates that awareness of atypical neuroimaging in PRES is important for the management of these patients and to avoid morbidity and mortality.http://www.samj.org.zaam2023NeurologyRadiolog

Absolute proper motions for the calibration of the HIPPARCOS proper motion system

Absolute proper motions of 48 Hipparcos stars in nine fields distributed over the northern hemisphere are presented. The proper motions have been recently used as part of the Bonn program for the extragalactic link of the Hipparcos proper motion system. We describe methods which have led to the absolute proper motions of the major part of the Bonn fields for the link. For six fields the extragalactic calibration was achieved using the bright quasar in the centre of the field. In addition, data of three fields of globular clusters were included. For these fields the link to an extragalactic reference system was performed by stars, whose absolute proper motions with respect to galaxies were determined on plates of the Lick astrograph. In addition, we used for the link in one field plates from the ESO Schmidt telescope in combination with measurements from glass copies of the Palomar Sky Survey. The accuracy of a single proper motion is of the order of 2 to 3 mas/a for each coordinate

Neurological manifestations of late onset efavirenz toxicity: a cross-sectional study of 41 patients form Pretoria, South Africa

https://drive.google.com/file/d/12qJKGjKzl95mFi9sNlWOXHRAEmCmEHMO/view?usp=sharinghttps://drive.google.com/drive/folders/1fsC_NpSTXuvTzLt0jIkHprfzdDkBJWbz?usp=sharinghttps://drive.google.com/drive/folders/10wT-Ex5avbkGINXfJ1TdD_FbVrLE5MMb?usp=sharin

Absolute Proper And Space Motions Of Globular Clusters

Absolute proper motions of ten globular clusters with respect to the Hipparcos system are presented. Our new data led to orbits in the Milky Way with smaller apogalactic distances. They are therefore in better agreement with the actual distribution of the globular clusters in the Milky Way. The kinematics of our clusters with respect to the metallicity is discussed. Key words: reference stars; kinematics of globular clusters. 1. INTRODUCTION Globular clusters are important tracers of the chemical evolution and dynamics of the Milky Way. Of special interest are the kinematics of globular clusters, which, however, require accurate absolute proper motions of these objects. We have started a program for the determination of space motions of globular clusters (e.g. Geffert 1987, Brosche et al. 1991) using plates of our refractor in combination with extragalactic calibrated proper motions of stars determined on plates of the Lick astrograph. Several other groups were also active in the deter..