Vacuolating Megalencephalic Leukoencephalopathy with Subcortical Cysts (Van der Knaap Leukoencephalopathy): A Case Diagnosed in Adulthood

Van der Knaap leukoencephalopathy is a rare vacuolating megalencephalic leukoencephalopathy with subcortical cysts. It is inherited autosomal recessively with MLC1 and GlialCAM mutations. The disease is usually diagnosed in the patient's first years of childhood and symptoms are severe in adulthood. In this case, a male patient aged 35 years presented with pathologic cerebellar and pyramidal findings. Magnetic resonance imaging revealed bilateral cystic degeneration in the anterior temporal lobes, swelling in the supratentorial white matter, and abnormal signal. There were no pathologic findings in the differential diagnosis tests. The patient was diagnosed as having Van der Knaap leukoencephalopathy according to the clinical and radiologic findings

Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity