Neurobrucellosis with transient ischemic attack, vasculopathic changes, intracerebral granulomas and basal ganglia infarction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Central nervous system involvement is a rare but serious manifestation of brucellosis. We present an unusual case of neurobrucellosis with transient ischemic attack, intracerebral vasculopathy granulomas, seizures, and paralysis of sixth and seventh cranial nerves.</p> <p>Case presentation</p> <p>A 17-year-old Caucasian man presented with nausea and vomiting, headache, double vision and he gave a history of weakness in the left arm, speech disturbance and imbalance. Physical examination revealed fever, doubtful neck stiffness and left abducens nerve paralysis. An analysis of his cerebrospinal fluid showed a pleocytosis (lymphocytes, 90%), high protein and low glucose levels. He developed generalized tonic-clonic seizures, facial paralysis and left hemiparesis. Cranial magnetic resonance imaging demonstrated intracerebral vasculitis, basal ganglia infarction and granulomas, mimicking the central nervous system involvement of tuberculosis. On the 31st day of his admission, neurobrucellosis was diagnosed with immunoglobulin M and immunoglobulin G positivity by standard tube agglutination test and enzyme-linked immunosorbent assay in both serum and cerebrospinal fluid samples (the tests had been negative until that day). He was treated successfully with trimethoprim and sulfamethoxazole, doxycyline and rifampicin for six months.</p> <p>Conclusions</p> <p>Our patient illustrates the importance of suspecting brucellosis as a cause of meningoencephalitis, even if cultures and serological tests are negative at the beginning of the disease. As a result, in patients who have a history of residence or travel to endemic areas, neurobrucellosis should be considered in the differential diagnosis of any neurologic symptoms. If initial tests fail, repetition of these tests at appropriate intervals along with complementary investigations are indicated.</p

The epidemiology and survival of extrapulmonary small cell carcinoma in South East England, 1970–2004

<p>Abstract</p> <p>Background</p> <p>Extrapulmonary small cell carcinoma (EPSCC) is a rare cancer and few studies describe its epidemiology. Our objectives were to compare the incidence and survival of EPSCC in South East England with small cell carcinoma of the lung (SCLC), to determine the most common anatomical presenting sites for EPSCC and to compare survival in EPSCC by disease stage and site of diagnosis.</p> <p>Methods</p> <p>We used data from the Thames Cancer Registry database for South East England between 1970 and 2004 to determine the incidence, most common anatomical sites, and survival by site, and stage of EPSCC. 1618 patients registered with EPSCC were identified. We calculated the age-standardised incidence rate for EPSCC using the European standard population and compared this to that for SCLC. We calculated survival using the Kaplan-Meier method for EPSCC and SCLC, and reported 3-year survival for different EPSCC anatomical sites and disease stages.</p> <p>Results</p> <p>The incidence of EPSCC was much lower than for SCLC, similar in males and females, and stable throughout the study period, with incidence rates of 0.45 per 100,000 in males and 0.37 in females during 2000–2004. In general, patients with EPSCC had a better 3-year survival (19%) than SCLC (5%). The most common anatomical sites for EPSCC were oesophagus (18%), other gastrointestinal (15%), genitourinary (20%), head and neck (11%), and breast (10%). Breast EPSCC had the best 3-year survival (60%) and gastrointestinal EPSCC the worst (7%).</p> <p>Conclusion</p> <p>This study suggests that EPSCC has a stable incidence and confirms that it presents widely, but most commonly in the oesophagus and breast. Site and extent of disease influence survival, with breast EPSCC having the best prognosis. Further studies using standardised diagnosis, prospective case registers for uncommon diseases and European cancer registries are needed to understand this disease.</p

Long-Term Mortality in Patients with Tuberculous Meningitis: A Danish Nationwide Cohort Study

Background: With high short-term mortality and substantial excess morbidity among survivors, tuberculous meningitis (TBM) is the most severe manifestation of extra-pulmonary tuberculosis (TB). The objective of this study was to assess the long-term mortality and causes of death in a TBM patient population compared to the background population. Methods: A nationwide cohort study was conducted enrolling patients notified with TBM in Denmark from 1972–2008 and alive one year after TBM diagnosis. Data was extracted from national registries. From the background population we identified a control cohort of individuals matched on gender and date of birth. Kaplan-Meier survival curves and Cox regression analysis were used to estimate mortality rate ratios (MRR) and analyse causes of death. Findings: A total of 55 TBM patients and 550 individuals from the background population were included in the study. Eighteen patients (32.7%) and 107 population controls (19.5%) died during the observation period. The overall MRR was 1.79 (95%CI: 1.09–2.95) for TBM patients compared to the population control cohort. TBM patients in the age group 31–60 years at time of diagnosis had the highest relative risk of death (MRR 2.68; 95%CI 1.34–5.34). The TBM patients had a higher risk of death due to infectious disease, but not from other causes of death. Conclusion: Adult TBM patients have an almost two-fold increased long-term mortality and the excess mortality stems fro

Using ambulance service records to examine non fatal heroin overdoses

Overdoses are a preventable health hazard associated with heroin use. In the first study of its kind, we examined the records on nonfatal overdoses of the Australian Capital Territory (ACT) Ambulance Service from August 1990 to July 1993. There was a dramatic increase in the number of overdoses in the second half of 1992 and the first half of 1993, but the reasons for the increase are not clear. Most overdoses occurred in men aged under 30, indoors, and many cases were taken to hospital. Often there was no information on why the overdose occurred; when information was available, about half the cases were attributed to taking heroin in combination with other drugs. Suggestions for improving the quality of the data collected are made. These include more systematic recording by ambulance officers of the drug involved in the overdose and whether the drug was used alone or in combination with others, and linkage of ambulance service records with survey data and information from analysis of heroin purity

An experimental study on waxy bitumens

10th International Conference on the Bearing Capacity of Roads, Railways and Airfields, BCRRA 2017 -- 28 June 2017 through 30 June 2017 -- -- 220519Almost all bitumen obtains from crude oil by refining process but only certain crude oils contain good quality bitumen for asphalt pavement. Naphthenic-base crude oils often give a large amount of bitumen that may be good quality, while paraffinic crude oils may give bitumen of good quality or yield bitumen not suitable for asphalt pavement. Wax in bitumen has been referred to as petroleum wax and is obtained from refining of paraffinic crude oils. In spite of the fact that high wax contents have been considered as a negative effect on the quality of the bitumen, there is no common agreement among the scientists regarding the effect on bitumen rheology and asphalt performance. The scope of this study is to evaluate the rheological properties of waxy bitumens obtained from different sources. Following the determination of wax contents by two different methods, various conventional methods were performed. The high temperature performance levels of bitumen were also determined according to Superpave system by Dynamic Shear Rheometer (DSR) test on samples before and after aging processes. The intermediate temperatures performances levels of bitumen were also performed by DSR. Rutting performance of bitumens has been evaluated using Zero Shear Viscosity (ZSV) and Multiple Stress Creep Recovery (MSCR) tests. © 2017 Taylor & Francis Group, London

Successfully treated Mycobacterium abscessus mastitis: A rare cause of breast masses

Rapidly growing mycobacteria are pathogens responsible for cutaneous or subcutaneous infections especially occurring after injection, trauma or surgery. We describe a patient with Mycobacterium abscessus mastitis that presented as a mass lesion and haemorrhagical discharge. It was initially diagnosed and treated as fibrocystic disease and non-specific abscess. Full recovery was obtained with combination therapy of clarithromycin, linezolid and amikacin without surgical debridement followed by several abscess aspirations. Atypical mycobacteria should be considered in diagnosis of chronic breast lesions in endemic areas. This is the first reported case of mastitis due to M. abscessus in Turkey

Ticks biting humans in the urban area of Istanbul

A passive surveillance for tick bites in humans was undertaken in the city of Istanbul (Turkey) in the summer and autumn of 2006. From 1,054 reported tick bites, most were females of Ixodes ricinus (27%) and nymphs of Hyalomma aegyptium (50%). A few adults of Hyalomma m. marginatum, Rhipicephalus sanguineus and Dermacentor marginatus were also recorded. We investigated potential risk factors for I. ricinus and H. aegyptium with spatial statistics. Climate features at 1-km resolution (monthly minimum temperatures in late summer and autumn and rainfall) and vegetation features at high resolution (density and heterogeneity of forest-type vegetation as well as distance of reporting site to these vegetation features) are useful variables explaining high reporting clusters for both Ixodes and Hyalomma. While Ixodes is highly reported in dense highly heterogeneous vegetation patches, Hyalomma is commonly found in areas far from forest-type features and in the small, relatively dry vegetation patches within the urban fabric

Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study

PubMedID: 25634680Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients’ data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1–3 were assigned to the variables in the severity scale, which included scores of 1–6. The distribution of mortality for the scores 1–6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis. © 2015, Springer-Verlag Berlin Heidelberg