Prune belly syndrome – Case report and review of the literature

We describe a 2-year-old boy seen in Kenya who presented with fever, dysuria, foul smelling urine, anddiarrhea. His previous ultrasonography showed an overdistended bladder and hydronephrosis. Physicalexamination revealed a distended abdomen, loose abdominal wall muscles with thin, flabby, and wrinkledskin on the abdominal wall, hypoplastic scrotum, and bilateral cryptorchidism. A diagnosis of prune bellysyndrome was promptly made. The urinary tract infection was duly treated with intravenous ceftriaxoneand the child followed by pediatric urology

Stroke Patients with a Past History of Cancer Are at Increased Risk of Recurrent Stroke and Cardiovascular Mortality

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Severe Acute Respiratory Syndrome–associated Coronavirus Infection

Whether severe acute respiratory syndrome–associated coronavirus (SARS-CoV) infection can be asymptomatic is unclear. We examined the seroprevalence of SARS-CoV among 674 healthcare workers from a hospital in which a SARS outbreak had occurred. A total of 353 (52%) experienced mild self-limiting illnesses, and 321 (48%) were asymptomatic throughout the course of these observations. None of these healthcare workers had antibody to SARS CoV, indicating that subclinical or mild infection attributable to SARS CoV in adults is rare

Stroke patients with cancer are at increased risk of recurrent stroke and cardiovascular mortality

Background: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke. Methods: This was a single-centre, observational study of 1105 consecutive Chinese ischaemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality. Results: Among 1105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence, 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) [P < 0.01]. In a Cox regression model, cancer, age, and atrial fibrillation were the three independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval [CI], 1.54-3.80), 1.01 (1.00-1.03), and 1.35 (1.01-1.82), respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs 2.35%/year; P = 0.08). In Cox regression analysis, cancer (HR = 2.08; 95% CI, 1.08-4.02), age (HR = 1.04; 95% CI, 1.02-1.06), heart failure (HR = 3.07; 95% CI, 1.72-5.47), and significant carotid atherosclerosis (HR = 1.55; 95% CI, 1.02-2.36) were independent predictors for cardiovascular mortality. Conclusions: Cancer patients who develop ischaemic stroke are at increased risk of recurrent stroke and cardiovascular mortality.published_or_final_versio

Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct

Background: Both blood pressure (BP) and its variability (BPV) are established risk factors for development of atherosclerotic disease and are associated with an increased risk for cardiovascular and all-cause mortality. The prognostic implications of out-patient clinic visit-to-visit BPV among patients with lacunar infarction are nevertheless unknown. Methods: We prospectively followed up the clinical outcome of 281 patients with lacunar infarction. The mean BP and BPV, as determined by the standard deviation of the systolic and diastolic BP, were recorded during a mean of 13 ± 6 out-patient clinic visits. Results: The mean age of the population was 70 ± 10 years. After a mean of 78 ± 18 month’s follow-up, 65 (23%) patients died, 31% (20/65) were due to cardiovascular causes. 14% and 7% developed recurrent stroke and acute coronary syndrome, respectively. After adjusting for age, sex, mean systolic and diastolic BP, cardiovascular risk factors and co-morbidities, patients with a systolic BPV of the third tertile had significantly higher risk of all-cause (hazard ratio [HR] = 1.97; 95% confidence interval [CI], 1.02-3.80; P = 0.04) and cardiovascular mortality (HR = 7.64; 95% CI, 1.65-35.41; P < 0.01) compared to those with systolic BPV of the first tertile. Nevertheless, systolic BPV did not predict recurrent stroke or acute coronary syndrome. Diastolic BPV did not predict various adverse clinical outcomes. Conclusions: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality after lacunar infarct, independent of conventional risk factors including average BP control.published_or_final_versio

Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischaemic stroke

Background: Both blood pressure (BP) and its variability (BPV) are established risk factors for the development of atherosclerotic diseases and are associated with an increased risk of cardiovascular and all-cause mortality. The long-term prognostic implications of out-patient clinic visit-to-visit BPV among patients with ischaemic stroke are nevertheless unknown. Methods: We prospectively followed up the clinical outcome of 632 consecutive ischaemic stroke patients without atrial fibrillation. The mean BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean of 12 ± 6 outpatient clinic visits. Results: The mean age of the patients was 71 ± 11 years. After a mean of 76 ± 18 month’s follow-up, 161 (26%) patients died, 35% (56/161) were due to cardiovascular causes. 16% and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with a high systolic BPV were at significantly greater risk of cardiovascular mortality (hazard ratio [HR] = 2.36; 95% confidence interval [CI], 1.02-5.49; P < 0.05). A high systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI, 1.16-2.75; P < 0.05). There was no association between systolic BPV with non-fatal recurrent stroke nor non-fatal ACS. A raised diastolic BPV did not predict recurrent non-fatal stroke, non-fatal ACS nor mortality. Conclusions: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischaemic stroke without atrial fibrillation, independent of other conventional risk factors including average BP control.published_or_final_versio

Myasthenic crisis in patients with generalised myasthenia gravis

INTRODUCTION: Myasthenia gravis (MG) is an important autoimmune disease causing generalised weakness and even mortality, which is amenable to immunotherapies. Myasthenic crisis (MC) is the most serious presentation of MG typically requiring ventilator support under the care of intensive care unit. We studied factors which predict development of MC in generalised MG (gMG) patients and patients’ serum cytokine levels as potential biomarkers for MG exacerbation and crisis ...published_or_final_versio

Mimotope ELISA for Detection of Broad Spectrum Antibody against Avian H5N1 Influenza Virus

Science and Technology Foundation of Fujian Province [2009YZ0002]; National Natural Science Foundation of China [30901077]; National High Technology Research and Development Program [2010AA022801]Background: We have raised a panel of broad spectrum neutralizing monoclonal antibodies against the highly pathogenic H5N1 avian influenza virus, which neutralize the infectivity of, and afford protection against infection by, most of the major genetic groups of the virus evolved since 1997. Peptide mimics reactive with one of these broad spectrum H5N1 neutralizing antibodies, 8H5, were identified from random phage display libraries. Method: The amino acid residues of the most reactive 12mer peptide, p125 (DTPLTTAALRLV), were randomly substituted to improve its mimicry of the natural 8H5 epitope. Result: 133 reactive peptides with unique amino acid sequences were identified from 5 sub-libraries of p125. Four residues (2,4,5.9) of the parental peptide were preserved among all the derived peptides and probably essential for 8H5 binding. These are interspersed among four other residues (1,3,8,10), which exhibit restricted substitution and probably could contribute to binding, and another four (6,7,11,12) which could be randomly substituted and probably are not essential for binding. One peptide, V-1b, derived by substituting 5 of the latter residues is the most reactive and has a binding constant of 3.16x10(-9) M, which is 38 fold higher than the affinity of the parental p125. Immunoassay produced with this peptide is specifically reactive with 8H5 but not also the other related broad spectrum H5N1 avian influenza virus neutralizing antibodies. Serum samples from 29 chickens infected with H5N1 avian influenza virus gave a positive result by this assay and those from 12 uninfected animals gave a negative test result. Conclusion: The immunoassay produced with the 12 mer peptide, V1-b, is specific for the natural 8H5 epitope and can be used for detection of antibody against the broad spectrum neutralization site of H5N1 avian influenza virus

Performance of Detecting IgM Antibodies against Enterovirus 71 for Early Diagnosis

Enterovirus 71 (EV71) infection is more likely to induce severe complications and mortality than other enteroviruses. Methods for detection of IgM antibody against EV71 had been established for years, however, the performance of the methods in the very early diagnosis of EV71 infection had not been fully evaluated, which is especially meaningful because of the short incubation period of EV71 infection. In this report, the performance of an IgM anti-EV71 assay was evaluated using acute sera collected from 165 EV71 infected patients, 165 patients infected with other enteroviruses, and more than 2,000 sera from healthy children or children with other infected diseases. The results showed a 90% sensitivity in 20 patients who were in their first illness day, and similar sensitivity remained till 4 days after onset. After then the sensitivity increased to 95% to 100% for more than one month. The specificity of the assay in non-HFMD children is 99.1% (95% CI: 98.6–99.4), similar as the 99.9% specificity in healthy adults. The cross-reaction rate in patients infected with other non-EV71 enteroviruses was 11.4%. In conclusion, the data here presented show that the detection of IgM anti-EV71 by ELISA affords a reliable, convenient, and prompt diagnosis of EV71 infection

Exacerbated Innate Host Response to SARS-CoV in Aged Non-Human Primates

The emergence of viral respiratory pathogens with pandemic potential, such as severe acute respiratory syndrome coronavirus (SARS-CoV) and influenza A H5N1, urges the need for deciphering their pathogenesis to develop new intervention strategies. SARS-CoV infection causes acute lung injury (ALI) that may develop into life-threatening acute respiratory distress syndrome (ARDS) with advanced age correlating positively with adverse disease outcome. The molecular pathways, however, that cause virus-induced ALI/ARDS in aged individuals are ill-defined. Here, we show that SARS-CoV-infected aged macaques develop more severe pathology than young adult animals, even though viral replication levels are similar. Comprehensive genomic analyses indicate that aged macaques have a stronger host response to virus infection than young adult macaques, with an increase in differential expression of genes associated with inflammation, with NF-κB as central player, whereas expression of type I interferon (IFN)-β is reduced. Therapeutic treatment of SARS-CoV-infected aged macaques with type I IFN reduces pathology and diminishes pro-inflammatory gene expression, including interleukin-8 (IL-8) levels, without affecting virus replication in the lungs. Thus, ALI in SARS-CoV-infected aged macaques developed as a result of an exacerbated innate host response. The anti-inflammatory action of type I IFN reveals a potential intervention strategy for virus-induced ALI