Recurrent Bilateral Branch Retinal Artery Occlusion with Hearing Loss and Encephalopathy: The First Case Report of Susac Syndrome in Korea

We report the first case of Susac syndrome in Koreans, in a 23-yr-old female patient who presented with sudden visual loss and associated neurological symptoms. Ophthalmic examination and fluorescein angiography showed multiple areas of branch retinal artery occlusion, which tended to recur in both eyes. Magnetic resonance imaging showed dot-like, diffusion-restricted lesions in the corpus callosum and left fornix, and audiometry showed low-frequency sensory hearing loss, compatible with Susac syndrome. She received immunosuppressive therapy with oral steroid and azathioprine. Three months later all the symptoms disappeared but obstructive vasculitis have been relapsing. This patient demonstrated the entire clinical triad of Susac syndrome, which tends to occur in young females. Although this disorder has rarely been reported in Asian populations, a high index of suspicion is warranted for early diagnosis and timely treatment

La pertinencia de los proyectos de innovación e investigación: Entre lo global y lo local

Se hace una vez más significativo mencionar en este espacio la necesidad de repensar loscambios que requiere la Educación en nuestros países latinoamericanos

Early Attentional Modulation of the Neural Network Evoked with the Auditory Paired-click Paradigm: An MEG Study

AbstractAlthough numerous research studies have explored the functional attributes of the human duration perception, the spatio- temporal information on cortical networks underlying this process is still an open question. Moreover, the issue of possible differences in the nature of timing mechanisms responsible for perception of sub- and supra-second intervals requires the implementation of the functional brain imaging techniques with both high spatial and temporal resolution. Attention is very frequently used as a modulating factor for the perceived duration of a sensory stimulus. The non-attended stimuli appear to last shorter than the attended ones, increasing the perceived duration of a concurrent stimulus (Gorea, 2011). This study challenges the accepted model of early sensory responses, activated during the first 100ms after stimulus presentation, as preattentive, automatic processes which modulate the neural sensitivity to incoming stimuli (gating phenomena). We utilized Elekta Neuromag 306-channel whole-head system for magnetoencephalography (MEG) measurements and multi-dipole Calibrated Start Spatio Temporal (CSST) localization technique (Ranken et al., 2002) to investigate whether voluntary attention directed at the second tone of a pair in the standard paired-click paradigm could affect cortical networks underlying the gating out phenomenon. MEG recordings were obtained in a magnetically shielded room at the Biomagnetic Center in Jena, Germany. Two consecutive (ISI=500ms) identical short tonnes (S1 and S2; duration=20ms; f=1200Hz; ITI=8±1s) were used to evoke standard gating cortical responses in 19 healthy participants (21-38 years). In the second condition, the task was to direct attention toward the second tone and to respond to a rarely presented non-identical second tone of the pair (R=1300Hz, p(S1R)=0.3). MEG recordings showed transient early and middle latency responses with peak amplitudes over the temporo-parietal sensors followed by a peak of a sustained activity. Less prominent transient activity was recorded over the frontal sensors, accompanied with a more steady- state component from 100 until 400ms post-stimulus for both conditions. Preliminary results of the CSST spatio-temporal analyses revealed 4-6 brain regions activated during 20-500ms time interval including bilateral superior temporal gyrus (STG), bilateral and medial prefrontal (PF), bilateral parietal (PA) regions, and central motor cortex area. A cortical source underlying the steady-state component was identified in the left prefrontal region for S1 tone, and in central posterior regions (PA) for the repeated tone S2. During the standard paradigm the M50 gating suppression was observed only for bilateral STG sources while bilateral PF and PA sources did not show any reduction in the response during the first 100ms post-stimulus. Targeting the attention towards the second tone enhanced the M50 amplitude of the bilateral STG responses in respect to the repeated stimulus S2 and caused a change in the activated network evident by the emergence of a new generator in the medial PF area (orbitofrontal) instead of dorsolateral PF generators evoked in non-attended condition. These results demonstrate that voluntary attention can exert a topological and functional modulatory influence on the neural network even during early stages of auditory processing

Aggressive immunosuppressive treatment of Susac's syndrome in an adolescent: using treatment of dermatomyositis as a model

We describe aggressive immunosuppressive treatment of an adolescent with Susac's syndrome (SS), a disease of the microvasculature in the brain, retina, and inner ear. Because the immunopathogenesis of SS appears to have much in common with that of juvenile dermatomyositis (JDM), the patient was treated with an approach that has been effective for severe JDM. The patient's outcome provides evidence for the importance of prompt, aggressive, and sustained immunosuppressive treatment of encephalopathic SS

Patterns of Retinal Damage Facilitate Differential Diagnosis between Susac Syndrome and MS

Susac syndrome, a rare but probably underdiagnosed combination of encephalopathy, hearing loss, and visual deficits due to branch retinal artery occlusion of unknown aetiology has to be considered as differential diagnosis in various conditions. Particularly, differentiation from multiple sclerosis is often challenging since both clinical presentation and diagnostic findings may overlap. Optical coherence tomography is a powerful and easy to perform diagnostic tool to analyse the morphological integrity of retinal structures and is increasingly established to depict characteristic patterns of retinal pathology in multiple sclerosis. Against this background we hypothesised that differential patterns of retinal pathology facilitate a reliable differentiation between Susac syndrome and multiple sclerosis. In this multicenter cross-sectional observational study optical coherence tomography was performed in nine patients with a definite diagnosis of Susac syndrome. Data were compared with age-, sex-, and disease duration-matched relapsing remitting multiple sclerosis patients with and without a history of optic neuritis, and with healthy controls. Using generalised estimating equation models, Susac patients showed a significant reduction in either or both retinal nerve fibre layer thickness and total macular volume in comparison to both healthy controls and relapsing remitting multiple sclerosis patients. However, in contrast to the multiple sclerosis patients this reduction was not distributed over the entire scanning area but showed a distinct sectorial loss especially in the macular measurements. We therefore conclude that patients with Susac syndrome show distinct abnormalities in optical coherence tomography in comparison to multiple sclerosis patients. These findings recommend optical coherence tomography as a promising tool for differentiating Susac syndrome from MS

Visual Attention toward Human Face Recognizing for Autism Spectrum Disorder and Normal Developing Children: An Eye Tracking Study

© 2020 ACM. The paper discusses an eye tracking analysis study to let us understand the visual behavior and pattern of Normal Developing children and Autistic children while viewing human face stimulus. An eye tracking experiment consists of displaying different images with human face embedded in different locations (left, center and right) and the eye tracker captured and tracked the child\u27s eye gaze movements, then analyzed to identify where specifically in the stimulus is the child looking at. The finding indicates a significant difference was found between the two groups viewing patterns and behavior when they presented with a scene that have human face. The study also reveals that large percentage of Autistic participants expressed minimum interest and time looking at face area, evident by significant time spent fixations on non-face regions, comparing to the normal developing children. The results can be used to improve the life style of other children who have a risk to develop Autism as well as discover earlier signs of ASD

Antibiotic resistance of Pseudomonas aeruginosa strains isolated from patients

Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of Moldova, National Agency of Public Health, Chisinau, Republic of MoldovaIntroduction. Antimicrobial resistance represents a global burden and crisis but also a significant threat to public health nowadays. Healthcare-associated infections with multidrug resistant (MDR) bacteria lead to increased morbidity rates, with a continuous increasing incidence at global levels. The selective pressure created by the widespread use of antibiotics might be the main explanation of this burden. It is known that P. aeruginosa is one of the most frequent bacteria involved in the etiology of ventilator-associated pneumonia, with a relative high prevalence in patients admitted to intensive care units and a high mortality rate. Studies showed that the presence of MDR strains could be an important predictor of hospital death. The aim of this study was to evaluate antimicrobial resistance patterns of P. aeruginosa strains isolated from various clinical specimens of hospitalized patients Material and methods. We conducted a retrospective study during January–December 2020. Isolation of P. aeruginosa strains was performed on selective media for Gram-negative. Identification of strains was done both by conventional methods and by automated methods using Vitek®2 Compact. Antibiotic susceptibility testing was done using the Vitek®2Compact, but also by Kirby-Bauer method. Interpretation susceptibility was performed according to the EUCAST (European Committee on Antimicrobial Susceptibility Testing). Results. They were analyzed 118 isolates from patients hospitalized in surgical wards, 51.2% male, respectively 48.8% women. These strains were isolated from different pathological products: lower tract respirator (39.9%), pus (35.6%), urine (15.4%), central venous catheter insertion (2.7), blood (2.1%) and other secretions (4.3%). P. aeruginosa strains showed the following levels of antibiotic resistance, respectively, 70.7% to ticarcillin, 58.7% to piperacillin, while resistance to the penicillins combined with beta-lactamase inhibitors, piperacillin with tazobactam was 43.5%. Resistance to antipseudomonal cephalosporins was 37.9% to ceftazidime and 50.8% to cefepime, while the level of resistance to carbapenems was 55.9 % to imipenem and 27.1% to meropenem. Resistance to aminoglycosides was 51.9% to gentamicin, 58.4% to tobramycin and 34.4% to amikacin. 62.8% of strains showed resistance to fluoroquinolones (ciprofloxacin). Conclusion. Multidrug resistance is common and increasing. Occurrence of these MDR strain in clinical care settings makes them difficult and expensive to treat because these drug resistant strain are exhibit resistance to essentially all reliable antipseudomonal antibiotics. The available clinical solution for antibiotic resistance Pseudomonas aeruginosa infections requires a precise diagnostic and combination antibiotic therapy based on diagnostics. Judicious administration of antibiotics in combination with nosocomial infection control measures need to be introduced in hospitals to prevent the circulation of these multidrugresistant strains

Innovation in education. Commentary:teaching statistics using dance and movement and a case for neuroscience in mathematics education

Review: A commentary on Teaching statistics using dance and movement by Irving, L.T. (2015). Front. Psychol. 6:50. doi: 10.3389/fpsyg.2015.00050 A case for neuroscience in mathematics education by Susac, A., and Braeutigam, S. (2014). Front. Hum. Neurosci. 8:314. doi: 10.3389/fnhum.2014.0031