Isolated tuberculosis of the spleen presenting with fever of unknown origin in a vaccinated child

Tuberculosis (TB) is one of the top 10 causes of death worldwide and is more common in developing countries. Isolated splenic TB is typically found in trauma, miliary TB and immunocompromised status. We present a very rare case of an immunocompetent child with an isolated primary TB in the spleen. The child only had fever of unknown origin (FUO), and mild anaemia. The diagnosis was not made until splenectomy was performed. The patient took the quadruple therapy for TB, and follow-ups showed no recurrence. This case is unique because this child was immunocompetent with no history of trauma or active TB. TB diagnosis should never be ignored in FUO as this might prevent unnecessary procedures to the patient. Although the child was vaccinated with Bacillus Calmette–Guérin that usually protects against severe TB in first 5 years of life, it did not prevent from affecting the spleen.

Hyper IgE syndrome (Job syndrome) in Syria: a case report

Hyper IgE syndrome (HIES) is a medical condition that can be sporadic or hereditary. It consists of multiple overlapping primary immunodeficiency conditions and is characterized by a classical triad of high immunoglobulin E (IgE) levels, recurrent pneumonia with pneumatocele and recurrent cold skin abscesses from staphylococcus infections. Eosinophilia is also common in HIES patients. HIES is often underdiagnosed in Syria as it cannot be confirmed without genetic testing, which is unavailable across Syria for HIES. We present the first case from Syria of a suspected child with HIES that has some additional distinct features. Other cases in a regional country carried atypical novel mutations, which may indicate that these mutations may exist in Syria as well. However, our case had findings that were not reported with other HIES cases. Determining these genes in the case presented was not possible, and future studies need to overcome this hurdle.

Pain Agreements and Time-to-Event Analysis of Substance Misuse in a Primary Care Chronic Pain Program

Background Types and correlates of pain medication agreement (PMA) violations in the primary care setting have not been analyzed. Methods A retrospective analysis was completed to examine patient characteristics and correlates of PMA violations, a proxy for substance misuse, over a 15-year period in an outpatient General Medicine Pain Service within the Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill. Patients who signed the PMA were managed for chronic pain from 2002 through 2017 (N = 1,210). The incidence of PMA violations was measured over a 15-year span. Substance misuse was defined a priori in the study as urine toxicology screen positive for illicit or nonprescribed controlled substances, patient engagement in prescription alteration, doctor-shopping, or diversion. Results Most patients received a prescription for a controlled substance (77.4%). During enrollment, 488 (40.3%) patients had one or more violations of their PMA. One-third (33.4%) of pain service patients had a violation within 365 days of signing the agreement. Active tobacco smokers had double the incidence of agreement violation within the first 30 days of enrollment. Almost one-half (49.8%) of violations were due to inconsistent use of controlled substances. Patients with any prior DWI/DUI or drug-related offense had a significantly increased rate of substance misuse (P < 0.0001). Conclusions PMA violations were common among a population of patients managed for chronic nonmalignant pain. Universal opioid prescribing precautions, including PMAs, require further investigation to assess their roles in mitigating the potential patient and societal harms associated with opioid prescribing.

Quantification of Core Antigen Monitors Efficacy of Combination Therapy of Sofosbuvir, Daclatasvir and Ribavirin in Egyptian Cirrhotic Patients with HCV Infection as an Alternative to PCR

Background Hepatitis C virus (HCV) is a major public health problem throughout the world. Acute HCV infection is asymptomatic in most cases, and only 15% of cases are symptomatic,but Chronic hepatitis C (CHC) shows a variable clinical course, ranging from mild histopathological changes to active hepatitis and the development of hepatic fibrosis, cirrhosis and HCC. The aim of this work is to detect accuracy of core antigen in Egyptian cirrhotic patients with HCV Infection treated with combination therapy of Sofosbuvir, Daclatasvir and Ribavirin as an alternative to PCR. Patients and methods: The study included20 Egyptian treatment-naïve chronic hepatitis C patients with cirrhosis (Cirrhosis was diagnosed on ultrasound basis) on Sofosbuvir, Daclatasvir and Ribavirin. Results Treatment with sofosbuvir plus Daclatasvir and Ribavirin for 12 weeks resulted in undetectable HCV RNA by PCR in 95% (19/20) of the patients at the end of treatment and only 5% (1/20) of the patients achieved SVR after 6 months not 3(both HCV RNA AND HCV Core Antigen tests were negative for all patients). Conclusion: In our study there was a correlation between HCV RNA and HCV core antigen results, so HCV core antigen can be used as an alternative marker to HCV RNA in treatment of HCV infected cirrhotic patients receiving Sofosbuvir, Daclatasvir and Ribavirin.during treatment and for monitoring its efficacy.

Enzymatically inactive OGG1 binds to DNA and steers base excision repair toward gene transcription

8‐Oxoguanine DNA glycosylase1 (OGG1)‐initiated base excision repair (BER) is the primary pathway to remove the pre‐mutagenic 8‐oxo‐7,8‐dihydroguanine (8‐oxoG) from DNA. Recent studies documented 8‐oxoG serves as an epigenetic‐like mark and OGG1 modulates gene expression in oxidatively stressed cells. For this new role of OGG1, two distinct mechanisms have been proposed: one is coupled to base excision, while the other only requires substrate binding of OGG1––both resulting in conformational adjustment in the adjacent DNA sequences providing access for transcription factors to their cis‐elements. The present study aimed to examine if BER activity of OGG1 is required for pro‐inflammatory gene expression. To this end, Ogg1 / OGG1 knockout/depleted cells were transfected with constructs expressing wild‐type (wt) and repair‐deficient mutants of OGG1. OGG1's promoter enrichment, oxidative state, and gene expression were examined. Results showed that TNFα exposure increased levels of oxidatively modified cysteine(s) of wt OGG1 without impairing its association with promoter and facilitated gene expression. The excision deficient K249Q mutant was even a more potent activator of gene expression; whereas, mutant OGG1 with impaired substrate recognition/binding was not. These data suggested the interaction of OGG1 with its substrate at regulatory regions followed by conformational adjustment in the adjacent DNA is the primary mode to modulate inflammatory gene expression.

Knowledge of Glaucoma Among Patients Attending Virtual and Face-to-Face Glaucoma Clinics

No significant difference in knowledge of glaucoma was found among patients attending virtual and face-to-face glaucoma clinics. Gaps in knowledge were identified in both groups highlighting the importance of incorporating patient education into glaucoma services.

Improving ceiling of care decisions and documentation for oncology patients

Characterization of hot water extract from Korean deer velvet antler (Cervus canadensis Erxleben)

Velvet antlers (VA) sourced from red (Cervus elaphus), sika (C. nippon), and elk (C. canadensis) deer have become increasingly popular in Chinese, Korean and Japanese traditional and oriental medicines as supplements for disease prevention. Therefore, this study aimed to determine the chemical components (proximate composition, amino, uronic, and sialic acids) and to characterize the bacterial profile of VA extract. The yield and contents of uronic and sialic acids extracted from VA at 98-100°C for 29-36 sec were determined to be 40.71%, 28.06 mg/g and 0.73 mg/g, respectively. Overall, proximate parameters were higher in extracts recovered at 100°C compared with 90°C, and these parameters were: moisture (4.66%), crude protein (86.63%), crude fat (3.23%), crude ash (4.1%), and carbohydrate content (5.43%). Alanine was the most abundant among the identified amino acids. Analysis of 16S rRNA sequence identified 12 bacterial species, including seven gram-positive and five gram-negative bacteria. Among all bacteria, Chryseobacterium indologenes, Shigella flexneri ATCC 29903, Staphylococcus equorum, Staphylococcus xylosus, Staphylococcus succinus, and Vagococcus fluvialis had 100% identity in the VA extract. The morphology of C. indologene, S. flexneri ATCC 29903, and V. fluvialis was bacilli, whereas S. equorum, S. succinus, and S. xylosus were cocci.

Non-invasive estimation of intracranial pressure by diffuse optics − a proof-of-concept study

Subcutaneous nanotherapy repurposes the immunosuppressive mechanism of rapamycin to enhance allogeneic islet graft viability