Hepatic encephalopathy complicated by decompensated alcoholic liver cirrhosis in a Hispanic male

Introduction: Alcohol can directly affect the brain via neuroinflammation or alter the gut microbiome which concomitantly results in hepatic encephalopathy. Hepatic encephalopathy can cause altered mental status from liver dysfunction with or without portal-systemic blood shunting. Chronic alcohol use has been associated with dementia, cirrhosis, and hepatic encephalopathy. This case report highlights the prognosis of hepatic encephalopathy in the setting of decompensated liver cirrhosis complicated by acute alcohol intoxication. Case report: A 35-year-old Hispanic man with history of alcohol use disorder, decompensated alcoholic liver cirrhosis with ascites, severe anemia secondary to upper GI bleeding with underlying esophageal varices who was accompanied to the ED via EMS after being found obtunded and nonresponsive on the floor. Upon arrival to ED, ethanol level was 178. The patient was intubated for airway protection due to two episodes of large volume hematemesis. Two units of PRBCs were ordered and an upper EGD showed two nonbleeding varices which were banded; however, the source of bleeding was not confirmed or arrested. The patient’s ICU course included eleven units of PRBCs, two units of cryoprecipitate and ten units of fresh frozen plasma. Despite emergent dialysis and intensive care interventions, the patient has not been able to be extubated despite being off sedation and paralytics. Conclusion: Alcohol can directly affect the brain via neuroinflammation or alter the gut microbiome which concomitantly results in hepatic encephalopathy. In patients with acute alcohol intoxication, prompt assessment of ammonia levels and gastroenterology recommendations are warranted to improve patient outcome

High-Resolution Multiwavelength Surface Plasmon Resonance Spectroscopy for Probing

To date, surface plasmon resonance (SPR) spectroscopy identifies molecules via specific bindings with their ligands immobilized on a surface. We demonstrate here that a high-resolution multiwavelength SPR technique can measure the electronic states of the molecules and thus allow direct identification of the molecules. Using this new capability, we have studied the electronic and conformational differences between the oxidized and reduced states of cytochrome c immobilized on a modified gold electrode. When the wavelength of the incident light is far away from the optical absorption bands of the protein, a ∼0.008°d ecrease in the resonance angle, due to a conformational change, occurs as the protein is switched from the oxidized to reduced states. When the wavelength is tuned to the absorption bands, the resonance angle oscillates at the wavelengths of the absorption peaks, which provides electronic signatures of the protein

Upper Palaeolithic settlements in Buran-Kaya 3 (Crimea, Ukraine): new interdisciplinary researches of the layers 5-2, 6-1 and 6-2

Грот Буран Кая 3 (Крым, Украина) содержит уникальную стратиграфию литологических и культурных отложений, включающую индустрии среднего и верхнего палеолита. В частности, в слоях 5-2, 6-1, и 6-2 был обнаружен кремневый и костяной инвентарь, относящийся к эпиграветту. Эти же слои содержат многочисленные фаунистические остатки, а также антропологический материал. В данной статье публикуются некоторые результаты междисциплинарных исследований: техникотипологический анализ кремневого и костяного инвентаря; зооархеологическое изучение останков крупных млекопитающих; исследование технологии нанесения орнамента на кости; анализ палеоантропологических материалов. На основании полученных данных предлагается функциональная интерпретация стоянки, а также производится сравнение культурных характеристик эпиграветта Буран Каи 3 и памятников соседних территорий

Upper Palaeolithic settlements in Buran-Kaya 3 (Crimea, Ukraine): new interdisciplinary researches of the layers 5-2, 6-1 and 6-2

Грот Буран Кая 3 (Крым, Украина) содержит уникальную стратиграфию литологических и культурных отложений, включающую индустрии среднего и верхнего палеолита. В частности, в слоях 5-2, 6-1, и 6-2 был обнаружен кремневый и костяной инвентарь, относящийся к эпиграветту. Эти же слои содержат многочисленные фаунистические остатки, а также антропологический материал. В данной статье публикуются некоторые результаты междисциплинарных исследований: техникотипологический анализ кремневого и костяного инвентаря; зооархеологическое изучение останков крупных млекопитающих; исследование технологии нанесения орнамента на кости; анализ палеоантропологических материалов. На основании полученных данных предлагается функциональная интерпретация стоянки, а также производится сравнение культурных характеристик эпиграветта Буран Каи 3 и памятников соседних территорий

Imparting carrier status results detected by universal newborn screening for sickle cell and cystic fibrosis in England: a qualitative study of current practice and policy challenges

<p>Abstract</p> <p>Background</p> <p>Universal newborn screening for early detection of children affected by sickle cell disorders and cystic fibrosis is currently being implemented across England. Parents of infants identified as carriers of these disorders must also be informed of their baby's result. However there is a lack of evidence for most effective practice internationally when doing so. This study describes current or proposed models for imparting this information in practice and explores associated challenges for policy.</p> <p>Methods</p> <p>Thematic analysis of semi-structured interviews with Child Health Coordinators from all English Health Regions.</p> <p>Results</p> <p>Diverse methods for imparting carrier results, both within and between regions, and within and between conditions, were being implemented or planned. Models ranged from result by letter to in-person communication during a home visit. Non-specialists were considered the best placed professionals to give results and a similar approach for both conditions was emphasised. While national guidance has influenced choice of models, other factors contributed such as existing service structures and lack of funding. Challenges included uncertainty about guidance specifying face to face notification; how best to balance allaying parental anxiety by using familiar non-specialist health professionals with concerns about practitioner competence; and extent of information parents should be given. Inadequate consideration of resource and service workload was seen as the main policy obstacle. Clarification of existing guidance; more specific protocols to ensure consistent countrywide practice; integration of the two programmes; and 'normalising' carrier status were suggested as improvements.</p> <p>Conclusion</p> <p>Differing models for communicating carrier results raise concerns about equity and clinical governance. However, this variation provides opportunity for evaluation. Timely and more detailed guidance on protocols with clarification of existing recommendations is needed.</p

Novel mutation in the NHLRC1 gene in a Malian family with a severe phenotype of Lafora disease

We studied a Malian family with parental consanguinity and two of eight siblings affected with late-childhood-onset progressive myoclonus epilepsy and cognitive decline, consistent with the diagnosis of Lafora disease. Genetic analysis showed a novel homozygous single-nucleotide variant in the NHLRC1 gene, c.560A>C, producing the missense change H187P. The changed amino acid is highly conserved, and the mutation impairs malin's ability to degrade laforin in vitro. Pathological evaluation showed manifestations of Lafora disease in the entire brain, with particularly severe involvement of the pallidum, thalamus, and cerebellum. Our findings document Lafora disease with severe manifestations in the West African population

Levetiracetam-loaded biodegradable polymer implants in the tetanus toxin model of temporal lobe epilepsy in rats

Approximately one-third of people with epilepsy receive insufficient benefit from currently available anticonvulsant medication, and some evidence suggests that this may be due to a lack of effective penetration into brain parenchyma. The current study investigated the ability of biodegradable polymer implants loaded with levetiracetam to ameliorate seizures following implantation above the motor cortex in the tetanus toxin model of temporal lobe epilepsy in rats. The implants led to significantly shorter seizures and a trend towards fewer seizures for up to 1 week. The results of this study indicate that drug-eluting polymer implants represent a promising evolving treatment option for intractable epilepsy. Future research is warranted to investigate issues of device longevity and implantation site

Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets

Background: HIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed. Case presentation: A 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4(+) T cells and higher percentage of activated CD4(+) T cells at HAART initiation. The percentage of memory CD4(+) T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8(+) T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset. Conclusion: Although both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition.Portuguese Foundation for Science and Technology (FCT; PIC/IC/83313/2007) and co-financed by the Portuguese North Regional Operational Program (ON.2 - O Novo Norte) under the National Strategic Reference Framework (QREN) through the European Regional Development Fund (FEDER). A FCT fellowship was attributed to RRS (PD/BD/106047/2015; Inter-University Doctoral Program in Ageing and Chronic Disease) and to CN [SFRH/BPD/65380/2009; Programa Operacional Potencial Humano (POPH) through the Fundo Social Europeu (FSE)]info:eu-repo/semantics/publishedVersio