Sex estimation in a contemporary Turkish population based on CT scans of the calcaneus

Building a reliable biological profile from decomposed remains depends heavily on the accurate estimation of sex. A variety of methods based on every single skeletal element have been developed over the years for different populations employing both osteological and virtual methods. The latter seem to be a reasonable alternative in countries lacking osteological reference collections. The current study used 3D virtual models of calcanei from CT scans of living adults to develop a sex estimation method for contemporary Turkish. Four hundred and twenty eight calcanei CT scans were analysed. The sample was divided in two subsamples: an original (N = 348) and a validation sample (N = 80) with similar distribution of males and females. Nine classical measurements were taken using the 3D models of the calcanei and two different statistical methods (Discriminant function analysis and Binary logistic regression) were used. Classification accuracy ranged from 82% to 98% for the validation sample and it was consistently high using any of the two methods. Sex bias seems to be lower for most of the logistic regression equations compared to the discriminant functions. These results, however, need further testing to be verified. Based on the results of this study we recommend the use of both methods for sex estimation from the measurements of the calcaneus bone in a Turkish population. (C) 2017 Elsevier B.V. All rights reserved

Pott Puffy Tumor in Children: A Rare Emergency Clinical Entity

Objectives: Pott puffy tumor (PPT) is defined as soft tissue swelling of the forehead due to subperiosteal edema, accumulation of pus, or granulation tissue. It is associated with osteomyelitis of frontal bone secondary to frontal sinusitis. Pott puffy tumor can be complicated by preseptal and orbital cellulitis and intracranial infection

Multidetector CT angiography versus arterial duplex USG in diagnosis of mild lower extremity peripheral arterial disease: Is multidetector CT a valuable screening tool?

Objective: To prospectively compare the efficacy of 40-row multidetector computed tomography angiography (MDCTA) and duplex ultrasonography (DUS) to diagnose mild peripheral arterial occlusive disease (PAOD) in lower leg and to search whether MDCTA can be used as a screening tool. Methods: Forty-three patients with intermittent claudication and leg pain, diagnosed as mild PAOD, had undergone DUS and MDCTA of lower limb. The arteries of lower leg were initially scanned by DUS, followed by MDCTA. Both modalities were compared for detecting the obstructed and stenotic segments. Results: A total of 774 vessel segments were imaged by both modalities. When all arteries were considered, MDCTA detected obstructed or stenotic lesions in 16.8% of arteries, versus 11.1% compared to DUS. When suprapopliteal arteries alone were considered, MDCTA detected lesions in 15.0% of arteries, versus 11.0% with DUS. When infrapopliteal arteries only were considered, MDCTA detected lesions in 19.6% of arteries, versus 11.3% with DUS. MDCTA showed 5.7% (95% CI: [3.5%, 7.9%]) more lesions than DUS when all arteries were considered together, 8.3% (95% CI: [4.6%, 12.0%]) more lesions when only the infrapopliteal arteries were compared, and 4.0% (95% CI: [1.3%, 6.8%]) more lesions when only suprapopliteal arteries were compared (p < 0.01 for all comparisons). Conclusion: 40-row MDCTA may be used as a screening tool in patients with mild lower extremity PAOD as it is a non-invasive and more accurate modality when compared to DUS. (C) 2011 Elsevier Ireland Ltd. All rights reserved

A Case of Bronchiolitis Obliterans Secondary to Human Metapneumovirus Bronchiolitis

Human metapneumovirus (hMPV), formerly classified in Paramyxoviridae family is now moved into Pneumoviridae, which was described as a novel family. It causes upper and lower respiratory tract infections (LRTIs) usually in children younger than five years old. The recent epidemiological studies indicated that hMPV is the second most frequently detected virus in LRTIs of young children, following the respiratory syncytial virus (RSV). Bronchiolitis obliterans (BO) is a chronic obstructive lung disease characterized by fibrosis of the distal respiratory airways. It is usually a result of an inflammatory process triggered by a LRTI related to adenovirus, RSV, Mycoplasma pneumoniae, measles virus, Legionella pneumophila, influenza virus or Bordetella pertussis as a causative agent. In this report, a case of hMPV bronchiolitis complicated with BO has been reported to point out the complications and severity of the clinical progress belongs to this virus. A three-month-old female patient has admitted to our pediatric intensive care unit with the diagnosis of acute bronchiolitis and respiratory failure. She was born at term, weighing 2950 gram and had been hospitalized in newborn intensive care unit for 11 days with the diagnosis of transient tachypnea of the newborn and neonatal sepsis. On auscultation, there were bilateral crepitant rales, wheezing and prolonged expirium. Her oxygen saturation was 97-98% while respiratory support was given with a non-rebreathing reservoir mask. Complete blood count, procalcitonin and C-reactive protein levels were in normal ranges. The chest radiography yielded right middle lobe atalectasia, left paracardiac infiltration and bilateral air trapping. A nasopharyngeal swab sample was analyzed by a commercial multiplex real-time reverse transcriptase-polymerase chain reaction (Thermo Fisher Scientific (R), USA) developed for the detection of 15 respiratory viruses. Her sample yielded positive result for only hMPV. On the 4th day of hospitalization, the patient was intubated because of respiratory failure and carbon dioxide retention. She was extubated on the 19th day but could not tolerate. In the thorax computed tomography (CT), bilateral hyperinflation, patchy infiltration, mosaic perfusion and atelectasis especially bilateral posterior areas were detected. Bronchoscopy was normal except mild bronchomalacia in right middle lobe bronchus. The patient was diagnosed as BO secondary to hMPV bronchiolitis, according to the clinical, virological, bronchoscopic and thorax CT results. On the 76th day of admission, she was discharged with respiratory support with home ventilation via a tracheostomy cannula and medical treatments of oral metilprednisolone, nebulized salbutamol and budesonide. In conclusion, hMPV should not be undervalued especially in infants with severe LRTI that can be complicated with BO

İnsan Metapnömovirus Bronşiyolitine İkincil Gelişen Bronşiyolitis Obliterans Olgusu

Human metapneumovirus (hMPV), formerly classified in Paramyxoviridae family is now moved into Pneumoviridae, which was described as a novel family. It causes upper and lower respiratory tract infections (LRTIs) usually in children younger than five years old. The recent epidemiological studies indicated that hMPV is the second most frequently detected virus in LRTIs of young children, following the respiratory syncytial virus (RSV). Bronchiolitis obliterans (BO) is a chronic obstructive lung disease characterized by fibrosis of the distal respiratory airways. It is usually a result of an inflammatory process triggered by a LRTI related to adenovirus, RSV, Mycoplasma pneumoniae, measles virus, Legionella pneumophila, influenza virus or Bordetella pertussis as a causative agent. In this report, a case of hMPV bronchiolitis complicated with BO has been reported to point out the complications and severity of the clinical progress belongs to this virus. A three-month-old female patient has admitted to our pediatric intensive care unit with the diagnosis of acute bronchiolitis and respiratory failure. She was born at term, weighing 2950 gram and had been hospitalized in newborn intensive care unit for 11 days with the diagnosis of transient tachypnea of the newborn and neonatal sepsis. On auscultation, there were bilateral crepitant rales, wheezing and prolonged expirium. Her oxygen saturation was 97-98% while respiratory support was given with a non-rebreathing reservoir mask. Complete blood count, procalcitonin and C-reactive protein levels were in normal ranges. The chest radiography yielded right middle lobe atalectasia, left paracardiac infiltration and bilateral air trapping. A nasopharyngeal swab sample was analyzed by a commercial multiplex real-time reverse transcriptase-polymerase chain reaction (Thermo Fisher Scientific (R), USA) developed for the detection of 15 respiratory viruses. Her sample yielded positive result for only hMPV. On the 4th day of hospitalization, the patient was intubated because of respiratory failure and carbon dioxide retention. She was extubated on the 19th day but could not tolerate. In the thorax computed tomography (CT), bilateral hyperinflation, patchy infiltration, mosaic perfusion and atelectasis especially bilateral posterior areas were detected. Bronchoscopy was normal except mild bronchomalacia in right middle lobe bronchus. The patient was diagnosed as BO secondary to hMPV bronchiolitis, according to the clinical, virological, bronchoscopic and thorax CT results. On the 76th day of admission, she was discharged with respiratory support with home ventilation via a tracheostomy cannula and medical treatments of oral metilprednisolone, nebulized salbutamol and budesonide. In conclusion, hMPV should not be undervalued especially in infants with severe LRTI that can be complicated with BO

Cytotoxic lesions of the corpus callosum in children: Etiology, clinical and radiological features, and prognosis

Objectives: Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with entities like infection manifested by restricted diffusion on diffusion-weighted cranial magnetic resonance imaging. Our objectives are to evaluate the clinic-radiological spectrum of pediatric patients with cytotoxic lesions of the corpus callosum (CC). Methods: Children (0-18 years) admitted between February 2017 and May 2020 with splenial lesions showing diffusion restriction on MRI, either isolated or within involvement of other parts of the brain, were included retrospectively. The primary lesions of the CC (e.g. acute disseminated encephalomyelitis, acute ischemic infarction, and glioblastoma multiforme) were excluded. CLOCCs were divided into infection-associated, metabolic disorder-associated, and trauma-associated lesions, as well as CLOCCs involving other entities. Data were collected from the medical databases. Results: Forty-one patients were determined to have CLOCCs. Twenty-five (61%) were infection-associated, nine (22%) were trauma-associated, and three (7%) were metabolic disorder-associated cases, including 2 inherited disorders of metabolism. There were four (10%) patients with other entities, three with epilepsy, and one had an apparent life-threatening event. Six patients had a known etiology among the infection-associated group; one had multisystem inflammatory syndrome caused by COVID-19 and one had been infected by COVID-19 without any complications. All the infection-associated patients with isolated splenial lesions recovered totally, although six patients required intensive care hospitalization. Four trauma-associated patients had sequela lesions. Conclusions: CLOCCs are associated with a spectrum of diseases, including the new coronavirus, COVID-19 infection. Infection associated CLOCCs has the best prognosis, although severe cases may occur. Sequelae are possible based on the etiology. (C) 2021 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved

X-linked recessive TLR7 deficiency in ~1% of men under 60 years old with life-threatening COVID-19

Publisher Copyright: Copyright © 2021Autosomal inborn errors of type I IFN immunity and autoantibodies against these cytokines underlie at least 10% of critical COVID-19 pneumonia cases. We report very rare, biochemically deleterious X-linked TLR7 variants in 16 unrelated male individuals aged 7 to 71 years (mean, 36.7 years) from a cohort of 1202 male patients aged 0.5 to 99 years (mean, 52.9 years) with unexplained critical COVID-19 pneumonia. None of the 331 asymptomatically or mildly infected male individuals aged 1.3 to 102 years (mean, 38.7 years) tested carry such TLR7 variants (P = 3.5 × 10−5). The phenotypes of five hemizygous relatives of index cases infected with SARS-CoV-2 include asymptomatic or mild infection (n = 2) or moderate (n = 1), severe (n = 1), or critical (n = 1) pneumonia. Two patients from a cohort of 262 male patients with severe COVID-19 pneumonia (mean, 51.0 years) are hemizygous for a deleterious TLR7 variant. The cumulative allele frequency for deleterious TLR7 variants in the male general population is <6.5 × 10−4. We show that blood B cell lines and myeloid cell subsets from the patients do not respond to TLR7 stimulation, a phenotype rescued by wild-type TLR7. The patients’ blood plasmacytoid dendritic cells (pDCs) produce low levels of type I IFNs in response to SARS-CoV-2. Overall, X-linked recessive TLR7 deficiency is a highly penetrant genetic etiology of critical COVID-19 pneumonia, in about 1.8% of male patients below the age of 60 years. Human TLR7 and pDCs are essential for protective type I IFN immunity against SARS-CoV-2 in the respiratory tract.Peer reviewe