Pediatric Neuroradiology Pre-Call Primer

Pediatric neuroimaging can provide a challenge to radiology residents during call due to the fact that it is infrequently encountered in many institutions. The goal of this teaching tool is to provide radiology residents with background knowledge in pediatric brain anatomy and pathology in preparation for taking call. There is one teaching tool and one assessment tool with answers, all three of which are in PowerPoint format. Emergency neuroradiology topics discussed in this module are sutures, skull fractures, bleeds, sulci and mass effect, cisterns, and herniations. After implementing this teaching tool at our institution with all incoming residents and fellows, the error rate for cases on call dropped from 1.2% to 0.6%. This teaching tool provides radiology residents with background knowledge in pediatric brain anatomy and pathology in preparation for taking call. It was created to close a radiology residency knowledge gap in pediatric emergency neuroimaging. Not many residents have access to pediatric emergency care facilities to experience these cases routinely. This module helps to prepare for call at institutions with pediatric patient populations and/or somewhat substitute for a pediatric emergency call experience. AAMC MedEdPORTAL publication ID 10268. Link to origina

Aberrant brain functional connectivity in newborns with congenital heart disease before cardiac surgery

Newborns with congenital heart disease (CHD) requiring open heart surgery are at increased risk for neurodevelopmental disabilities. Recent quantitative MRI studies have reported disrupted growth, microstructure, and metabolism in fetuses and newborns with complex CHD. To date, no study has examined whether functional brain connectivity is altered in this high-risk population after birth, before surgery. Our objective was to compare whole-brain functional connectivity of resting state networks in healthy, term newborns (n = 82) and in term neonates with CHD before surgery (n = 30) using graph theory and network-based statistics. We report for the first time intact global network topology – efficient and economic small world networks – but reduced regional functional connectivity involving critical brain regions (i.e. network hubs and/or rich club nodes) in newborns with CHD before surgery. These findings suggest the presence of early-life brain dysfunction in CHD which may be associated with neurodevelopmental impairments in the years following cardiac surgery. Additional studies are needed to evaluate the prognostic, diagnostic and surveillance potential of these findings

Functional properties of resting state networks in healthy full-term newborns.

Objective, early, and non-invasive assessment of brain function in high-risk newborns is critical to initiate timely interventions and to minimize long-term neurodevelopmental disabilities. A prerequisite to identifying deviations from normal, however, is the availability of baseline measures of brain function derived from healthy, full-term newborns. Recent advances in functional MRI combined with graph theoretic techniques may provide important, currently unavailable, quantitative markers of normal neurodevelopment. In the current study, we describe important properties of resting state networks in 60 healthy, full-term, unsedated newborns. The neonate brain exhibited an efficient and economical small world topology: densely connected nearby regions, sparse, but well integrated, distant connections, a small world index greater than 1, and global/local efficiency greater than network cost. These networks showed a heavy-tailed degree distribution, suggesting the presence of regions that are more richly connected to others (\u27hubs\u27). These hubs, identified using degree and betweenness centrality measures, show a more mature hub organization than previously reported. Targeted attacks on hubs show that neonate networks are more resilient than simulated scale-free networks. Networks fragmented faster and global efficiency decreased faster when betweenness, as opposed to degree, hubs were attacked suggesting a more influential role of betweenness hub in the neonate network

Neonatal neurobehavioral abnormalities and MRI brain injury in encephalopathic newborns treated with hypothermia

Background Neonatal Encephalopathy (NE) is a prominent cause of infant mortality and neurodevelopmental disability. Hypothermia is an effective neuroprotective therapy for newborns with encephalopathy. Post-hypothermia functional–anatomical correlation between neonatal neurobehavioral abnormalities and brain injury findings on MRI in encephalopathic newborns has not been previously described. Aim To evaluate the relationship between neonatal neurobehavioral abnormalities and brain injury on magnetic resonance imaging (MRI) in encephalopathic newborns treated with therapeutic hypothermia. Study design Neonates with hypoxic ischemic encephalopathy (HIE) referred for therapeutic hypothermia were prospectively enrolled in this observational study. Neurobehavioral functioning was assessed with the NICU network neurobehavioral scale (NNNS) performed at target age 14 days. Brain injury was assessed by MRI at target age 7–10 days. NNNS scores were compared between infants with and without severe MRI injury. Subjects & outcome measures Sixty-eight term newborns (62% males) with moderate to severe encephalopathy underwent MRI at median 8 days (range 5–16) and NNNS at median 12 days of life (range 5–20). Fifteen (22%) had severe injury on MRI. Results Overall Total Motor Abnormality Score and individual summary scores for Non-optimal Reflexes and Asymmetry were higher, while Total NNNS Z-score across cognitive/behavioral domains was lower (reflecting poorer performance) in infants with severe MRI injury compared to those without (p \u3c 0.05). Conclusions Neonatal neurobehavioral abnormalities identified by the NNNS are associated with MRI brain injury in encephalopathic newborns post-hypothermia. The NNNS can provide an early functional assessment of structural brain injury in newborns, which may guide rehabilitative therapies in infants after perinatal brain injury

Abnormal glycosylation in Joubert syndrome type 10.

BACKGROUND: The discovery of disease pathogenesis requires systematic agnostic screening of multiple homeostatic processes that may become deregulated. We illustrate this principle in the evaluation and diagnosis of a 5-year-old boy with Joubert syndrome type 10 (JBTS10). He carried the OFD1 mutation p.Gln886Lysfs*2 (NM_003611.2: c.2656del) and manifested features of Joubert syndrome. METHODS: We integrated exome sequencing, MALDI-TOF mass spectrometry analyses of plasma and cultured dermal fibroblasts glycomes, and full clinical evaluation of the proband. Analyses of cilia formation and lectin staining were performed by immunofluorescence. Measurement of cellular nucleotide sugar levels was performed with high-performance anion-exchange chromatography with pulsed amperometric detection. Statistical analyses utilized the Student\u27s and Fisher\u27s exact t tests. RESULTS: Glycome analyses of plasma and cultured dermal fibroblasts identified abnormal N- and O-linked glycosylation profiles. These findings replicated in two unrelated males with OFD1 mutations. Cultured fibroblasts from affected individuals had a defect in ciliogenesis. The proband\u27s fibroblasts also had an abnormally elevated nuclear sialylation signature and increased total cellular levels of CMP-sialic acid. Ciliogenesis and each glycosylation anomaly were rescued by expression of wild-type OFD1. CONCLUSIONS: The rescue of ciliogenesis and glycosylation upon reintroduction of WT OFD1 suggests that both contribute to the pathogenesis of JBTS10

Thiamine pyrophosphokinase deficiency causes a Leigh disease like phenotype in a sibling pair: Identification through whole exome sequencing and management strategies

We present a sibling pair with Leigh-like disease, progressive hypotonia, regression, and chronic encephalopathy. Whole exome sequencing in the younger sibling demonstrated a homozygous thiamine pyrophosphokinase (TPK) mutation. Initiation of high dose thiamine, niacin, biotin, α-lipoic acid and ketogenic diet in this child demonstrated improvement in neurologic function and re-attainment of previously lost milestones. The diagnosis of TPK deficiency was difficult due to inconsistent biochemical and diagnostic parameters, rapidity of clinical demise and would not have been made in a timely manner without the use of whole exome sequencing. Molecular diagnosis allowed for attempt at dietary modification with cofactor supplementation which resulted in an improved clinical cours

Paternal attractiveness and the effects of differential allocation of parental investment

The differential allocation hypothesis (DAH) predicts that an individual should vary its reproductive investment according to the attractiveness of its mate. A recently revised version of the DAH makes explicit that investment can be positive, i.e. higher for the offspring of attractive males which should be of higher quality, or negative, i.e. higher for offspring of unattractive males, for example compensating for inheriting poor paternal genes. Moreover, investment can be made by the father and the mother. Here, we tested whether experimental manipulation of male attractiveness affected parental investment at different reproductive stages and thus influenced fitness-related traits in offspring. In two aviaries, all male zebra finches, Taeniopygia guttata, were given red leg rings to increase attractiveness and in two aviaries all males received green leg rings to decrease attractiveness. This controlled for assortative mating between treatments. Ring colour was merely an experimental manipulation of male attractiveness, not paternal quality, so we might expect additional investment to elevate offspring quality. Eggs were cross-fostered between and within treatments to allow differentiation of effects of investment in eggs and nestlings. Clutch and brood sizes were standardized. Both positive and negative investment were observed: Eggs from red-ringed fathers had higher yolk to albumen ratios than eggs from green-ringed fathers. Nestlings from eggs laid and incubated by parents in the red-ringed group had higher hatching masses than those in the green-ringed group. Both parents in the green-ringed group fed nestlings more frequently than red-ringed parents. Offspring performance was influenced by the treatment of both foster and biological parents, but combined effects of these different investment patterns on fitness-related traits were ambiguous. Male attractiveness appeared to affect patterns of reproductive investment but not consistently across all forms of reproductive investment suggesting that the costs and benefits of differential allocation vary among individuals and across contexts

Isolasi Dan Identifikasi Bakteri Aerob Yang Berpotensi Menjadi Sumber Penularan Infeksi Nosokomial Di Irina a Rsup Prof. Dr. R. D. Kandou Manado

: Nosocomial infection or Hospital Acquired Infection (HAI) is an infection caused by bacteria, parasite, or virus in the hospital, infection occur at least 72 hours since hospitalized. This infection occurs due to lack of hygiene of the environment causing microorganism infection from environment to human, infection can also occur due to transmission of microorganism from one patient to other patients. Inpatients potentially have very high risk of nosocomial infection occur due to continuous requiring treatment for more than 24 hours. Purpose: To determine the existence of aerobic bacteria that could potentially be the source of transmission of nosocomial infection in Irina A RSUP Prof. Dr. R. D. Kandou Manado. Method: This research was descriptive with cross sectional approach. Fourteen samples were taken from the surface of medical equipment, bed, floor, and wall of the treatment room and eight samples were taken from the air. Identification of bacteria was performed by culture on agar medium, staining gram, and biochemical test. Result: Bacillus subtilis found in nine samples (41%), Serratia liquefaciens found in five samples (22,7%), Lactobacillus found in two samples (9,1%), Staphylococcus found in two samples (9,1%), Coccus Gram negative found in two samples (9,1%), Enterobacter aerogenes found in one sample (4,5%), and Enterobacter agglomerans found in one sample (4,5%). Conclusion: Bacillus subtilis is the most bacteria which had been found in this research

Primary spinal cord tumors of childhood: effects of clinical presentation, radiographic features, and pathology on survival

To determine the relationship between clinical presentation, radiographic features, pathology, and treatment on overall survival of newly diagnosed pediatric primary spinal cord tumors (PSCT). Retrospective analysis of all previously healthy children with newly diagnosed PSCT at a single institution from 1995 to present was performed. Twenty-five pediatric patients (15 boys, average 7.9 years) were diagnosed with PSCT. Presenting symptoms ranged from 0.25 to 60 months (average 7.8 months). Symptom duration was significantly shorter for high grade tumors (average 1.65 months) than low grade tumors (average 11.2 months) (P = 0.05). MRI revealed tumor (8 cervical, 17 thoracic, 7 lumbar, 7 sacral) volumes of 98–94,080 mm3 (average 19,474 mm3). Homogeneous gadolinium enhancement on MRI correlated with lower grade pathology (P = 0.003). There was no correlation between tumor grade and volume (P = 0.63) or edema (P = 0.36) by MRI analysis. Median survival was 53 months and was dependent on tumor grade (P = 0.05) and gross total resection (P = 0.01) but not on gender (P = 0.49), age of presentation (P = 0.82), duration of presenting symptoms (P = 0.33), or adjuvant therapies (P = 0.17). Stratified Kaplan–Meier analysis confirmed the association between degree of resection and survival after controlling for tumor grade (P = 0.01). MRI homogeneous gadolinium enhancement patterns may be helpful in distinguishing low grade from high grade spinal cord malignancies. While tumor grade and gross total resection rather than duration of symptoms correlated with survival in our series, greater than one-third of patients had reported symptoms greater than 6 months duration prior to diagnosis