Cryptococcal infection of the ventriculoperitoneal shunt in an immunocompetent patient

Patient: Male, 52 Final Diagnosis: Cryptococcal ventriculoperitoneal shunt infection Symptoms: Confusion • fever • Lethargy Medication: Amphotericin B • Flucytosine Clinical Procedure: Ventriculoperitoneal shunt removal Specialty: Infectious disease OBJECTIVE: Rare disease BACKGROUND: Ventriculoperitoneal shunting is an effective treatment for hydrocephalus. Ventriculoperitoneal shunt (VPS) infection is a common complication. Cryptococcus neoformans as an implicated organism is rare. In this report, we describe a patient with cryptococcal VPS infection. CASE REPORT: A 52-year-old male with normal pressure hydrocephalus, status post implantation of VPS one year prior to the presentation; who was admitted with a fever, lethargy and confusion for three days. He was treated empirically with intravenous cefepime and vancomycin for VPS infection. The CSF analysis from both the lumbar puncture and the VPS was significant for a low white blood count, low glucose and high protein. Other work-up including India ink and cryptococcal antigen was unrevealing. He remained febrile despite antibiotic treatment for 5 days. The CSF from the shunt was sent for analysis again and it demonstrated similar results from the prior study, but the culture was now positive for Cryptococcus neoformans. The patient was started on oral flucytosine and intravenous liposomal amphotericin B. The VPS was removed and an externalized ventricular catheter was placed. The patient showed rapid resolution of the symptoms. CONCLUSIONS: To date, there was a total of nine reported cases of cryptococcal VPS infection upon review of the literature. Our presenting case and the literature review highlight the difficulties in making an accurate diagnosis of cryptococcal shunt infection. There were case reports of false negative cryptococcal antigen tests with culture proven cryptococcal meningitis. The CSF culture from the shunt remains a mainstay for identifying cryptococcal shunt infection. Cryptococcal shunt infections are rare and early diagnosis and treatment is essential for patient management which involves shunt replacement with concomitant administration of intravenous antifungal medication. High clinical suspicion is crucial and shunt culture preferably from the valve is recommended

Vowel duration in stressed position in central & northern varieties of standard Italian

We report the results of a pilot study investigating the effect of 2 regional accents on stressed vowel duration according to word-position and syllable type in Central v. Northern accents of Standard Italian. While there is overall convergence, we also find significant regional differences in some contexts, i.e. closed syllables, and antepenultimate position. We then consider the implications of our results for the phonological description and phonetic investigation of Italian

Stromatolites for Alto Saxophone and Live Electronics

This music score was submitted for Resonate 2024: An Open Access Call for Scores by the UCLA Music Library with Bent Frequency and Jan Berry Baker

Hemobilia from biliary angiodysplasia diagnosed with cholangioscopy

Biliary angiodysplasia is extremely rare. Our background search revealed only a few case reports in the English literature. We present a case of angiodysplasia of the proximal common bile duct in a patient with subacute upper gastrointestinal bleeding and symptomatic anemia. A standard esophagogastroduodenoscopy with subsequent dedicated duodenoscopy revealed blood-stained bile draining from the major ampulla orifice. A contrast-enhanced magnetic resonance cholangiopancreatography was unrevealing for any pancreaticobiliary pathology. The patient subsequently underwent an endoscopic retrograde cholangiopancreatography and SpyGlass® cholangioscopy, which demonstrated intermittent bleeding from angiodysplasia in the proximal common bile duct

Structure-Invading Pest Ants in Healthcare Facilities in Singapore

A survey of structure-invading pest ants was conducted at 17 healthcare facilities (HFs) in Singapore using the index card method. A total of 18 species (Anoplolepis gracilipes (Fr. Smith), Meranoplus sp., Monomorium destructor ( Jerdon), Monomorium floricola ( Jerdon), Monomorium pharaonis (L.), Monomorium sp., Odontomachus sp., Oecophylla smaragdina (F.), Pachycondyla sp., Paratrechina bourbonica (Forel), Paratrechina longicornis (Latreille), Paratrechina pubens (Forel), Pheidole megacephala (F.), Pheidole parva (Mayr), Pheidole sp., Tapinoma indicum (Forel), Tapinoma melanocephalum (F.) andTetramorium bicarinatum (Nylander)) were trapped. Of these, the most common species were P. parva (25.9%), P. megacephala (25.2%), P. longicornis (14.1%), M. pharaonis (9.6%), and T. indicum (8.1%). Most of these ant species were found in and around the premises

Structural Effects of Small Molecules on Phospholipid Bilayers Investigated by Molecular Simulations

We summarize and compare recent Molecular Dynamics simulations on the interactions of dipalmitoylphosphatidylcholine (DPPC) bilayers in the liquid crystalline phase with a number of small molecules including trehalose, a disaccharide of glucose, alcohols, and dimethylsulfoxide (DMSO). The sugar molecules tend to stabilize the structure of the bilayer as they bridge adjacent lipid headgroups. They do not strongly change the structure of the bilayer. Alcohols and DMSO destabilize the bilayer as they increase its area per molecule in the bilayer plane and decrease the order parameter. Alcohols have a stronger detrimental effect than DMSO. The observables which we compare are the area per molecule in the plane of the bilayer, the membrane thickness, and the NMR order parameter of DPPC hydrocarbon tails. The area per molecule and the order parameter are very well correlated whereas the bilayer thickness is not necessarily correlated with them.Comment: 8 pages, 3 figures, accepted to Fluid Phase Equilibri

Is there any differential performance by age and gender in the production of emotional words in children?

Thesis (B.Sc)--University of Hong Kong, 2010."A dissertation submitted in partial fulfillment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, June 30, 2010."Includes bibliographical references (p. 26-28).The study aimed to examine the effect of age and genders and their interaction in the production of two types of emotional words (basic and advanced). A total of 40 Cantonese-speaking children, age ranged from 5;06 to 8;06, were asked to produce emotional words after listening to a story scenario. Three way (gender x age x type of emotion) univariate analysis of variance (ANOVA) was carried out to analyze the main effect of these variables and their interaction. Children performed significantly better on basic emotional words and their ability grew with age. The main effect of gender effect was not significant. No interaction effect was observed among all the variables. These patterns were discussed with reference to the culture in Hong Kong and the experimental design. Clinical implications were also discussed.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Residents\u27 perceptions on touristifying Cantonese Opera in Hong Kong

This research aims to examine residents\u27 views on touristifying Cantonese Opera (hereafter CO) in Hong Kong. Developing cultural tourism is an emerging trend for destination marketing organizations across the globe, in which intangible cultural heritage (hereafter ICH) plays a crucial role. ICH represents a person-place bonding, which is important to the continuity and sustainability of ICH. Such bonding continues the affective connection of community members to specific place, giving people a sense of identity and continuity. Featuring the East-meets-West multicultural vibe, Hong Kong exhibits great potentials in employing ICH into tourism product. CO is featured on the Hong Kong Tourism Board’s website as a manifestation of the living culture of Hong Kong, signifying its tourism value to international tourists. Cantonese Opera was thus adopted as the study context. 20 in-depth interviews with Hong Kong citizens were interviewed from June to July 2019. Insights on sustaining Cantonese Opera and adopting it as tourism product were also discussed. Research finding was of significant importance to local destination marketing organization in the process of conserving and touristifying Cantonese Opera