First report of iliacus abscess caused by Salmonella enterica serovar Othmarschen.

The non-typhoidal bacterium Salmonella enterica subspecies enterica serovar Othmarschen (Salmonella Othmarschen) is a rare human pathogen. Abscess formation due to non-typhoidal Salmonella infections is a very rare complication in this antibiotic era. We report the first case of iliacus abscess after a short period of gastroenteritis which was caused by non-typhoidal Salmonella enterica belonging to group C1, serovar Othmarschen in a patient without any underlying conditions. A young female presented in our hospital complaining of pain in right hip joint area. She gave a history of watery diarrhea 3 days before the onset of pain. On examination the patient was ill-looking and there was tenderness in the right hip joint area. S. enterica was identified using 16S rRNA gene amplification by PCR and serotyped to be serovar Othmarschen from the pus sample of iliacus abscess. This is the first reported case of iliacus abscess due to Salmonella serover Othmarschen infection. Our case suggests that S. enterica serovar Othmarschen can cause severe focal infections associated with gastroenteritis. The literature on the rare association of Salmonella enterica and abscess formation is reviewed.

Synergistic Antibiotic Activity of Ricini Semen Extract with Oxacillin against Methicillin-Resistant Staphylococcus aureus.

Resistant bacteria are emerging as a critical problem in the treatment of bacterial infections by neutralizing antibiotic activity. The development of new traditional mechanisms of antibiotics is not the optimal solution. A more reasonable approach may be to use relatively safe, plant-based compounds in combination with conventional antibiotics in an effort to increase their efficacy or restore their activity against resistant bacteria. We present our study of mixing Ricini Semen extract, or its constituent fatty acids, with oxacillin and testing the effects of each on the growth of methicillin-resistant Staphylococcus aureus. Changes in the cell membrane fluidity of methicillin-resistant S. aureus were found to be a major component of the mechanism of synergistic antibiotic activity of Ricini Semen extract and its constituent fatty acids. In our model, changes in cellular membrane fluidity disrupted the normal function of bacterial signaling membrane proteins BlaR1 and MecR1, which are known to detect oxacillin, and resulted in the incomplete expression of penicillin-binding proteins 2a and ß-lactamase. Utilizing the mechanism presented in this study presents the possibility of developing a method for treating antibiotic-resistant bacteria using traditional antibiotics with plant-based compounds.

Role of MR Neurography for Evaluation of the Lumbosacral Plexus: A Scoping Review.

Purpose: MR neurography (MRN) is an imaging technique optimized to visualize the peripheral nerves. This review aimed to discover an optimized protocol for MRN of the lumbosacral plexus (LSP) and identify evidence for the clinical benefit of lumbosacral plexopathies. Materials and Methods: We performed a systematic search of the two medical databases until September 2021. 'Magnetic resonance imaging', 'lumbosacral plexus', 'neurologic disease', or equivalent terms were used to search the literature. We extracted information on indications, MRN protocols for LSP, and clinical efficacy from 55 studies among those searched. Results: MRN of the LSP is useful for displaying the distribution of peripheral nerve disease, guiding perineural injections, and assessing extraspinal causes of sciatica. Three-dimensional short-tau inversion recovery turbo spin-echo combined with vascular suppression is the mainstay of MRN. Conclusion: Future work on the MRN of LSP should be directed to technical maturation and clinical validation of efficacy.

Coagulopathy and embolic signal in cancer patients with ischemic stroke.

OBJECTIVE: It has been reported that embolic signal (ES) detected by transcranial Doppler (TCD) has clinical significance, especially in patients with recent stroke attributable to arterial or cardiac embolism. Therefore, we conducted this study to determine whether the prevalence of ES is high in ischemic stroke patients with cancer and related to hypercoagulopathy. METHODS: We prospectively studied cancer patients with acute ischemic stroke within the middle cerebral artery (MCA) distribution on diffusion-weighted imaging. Conventional stroke mechanisms (CSMs) were determined using cardiologic and vascular studies. Additionally, the coagulation status was assessed based on the serum D-dimer levels, and TCD monitoring was performed on both MCAs for 30 minutes to detect ES. Clinical features including vascular risk factors, characteristics of ischemic stroke, and cancer and laboratory findings associated with the presence of ES were evaluated. RESULTS: A total of 74 patients were finally included in this study. ES was more commonly observed in patients without CSMs (22 of 38 patients, 57.9%) than in those with CSMs (12 of 36 patients, 33.3%) (p = 0.034). Moreover, ES was more commonly detected in patients with high D-dimer levels (p < 0.001), and D-dimer levels were significantly correlated with the number of ESs in patients without CSMs (r = 0.732, p < 0.001), but were poorly correlated in patients with CSMs (r = 0.152, p = 0.375). Higher levels of D-dimer (odds ratio [OR], 1.082 per 1 microg/ml increase; 95% confidence interval [CI], 1.014-1.154) and adenocarcinoma (OR, 3.829; 95% CI, 1.23-13.052) were independently associated with the presence of ES. The use of anticoagulants dramatically decreased the D-dimer levels. INTERPRETATION: A high prevalence of ES was observed in cancer patients with ischemic stroke, especially in those without CSMs. Elevated D-dimer levels were independently associated with ES, and decreased dramatically with the use of anticoagulants. ANN NEUROL 2010;68:213-219.

Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in Korea.

BACKGROUND AND METHODS: To assess the precise mechanisms of stroke in cancer patients, we analyzed the data for cancer patients with acute ischemic stroke registered from 6 centers in South Korea. Clinical features, risk factors, diffusion-weighted imaging lesion patterns, and laboratory findings including D-dimer levels were compared between patients with conventional stroke mechanisms (CSMs) and cryptogenic group. RESULTS: A total of 161 patients were included in this study: 97 (60.2%) patients in the CSM group and 64 (39.8%) in the cryptogenic group. Patients in the CSM group were older and vascular risk factors were more prevalent than in the cryptogenic group. Diffusion-weighted imaging patterns of multiple lesions involving multiple arterial territories were observed more frequently in the cryptogenic group than in the CSM group. In addition, levels of the D-dimer were higher in the cryptogenic group than in the CSM group (11.5+/-14.6 versus 3.6+/-10.3 microg/dL). In multivariate analysis, the diffusion-weighted imaging lesion pattern of multiple vascular territories (odds ratio, 11.2; 95% CI, 3.74 to 33.3), and D-dimer levels of >1.11 microg/dL (odds ratio, 10.6; 95% CI, 3.29 to 33.8) were associated independently with the cryptogenic group. CONCLUSIONS: Stroke outside of CSM occurred in a large number in cancer patients. In stroke patients with cancer, d-dimer levels and diffusion-weighted imaging lesion patterns may be helpful in early identification of non-CSMs (especially coagulopathy associated with cancer) and possibly in guiding preventive strategies for stroke.

Long-term outcomes of acute ischemic stroke in patients aged 80 years and older.

PURPOSE: Short life expectancy influences decision-making when treating very old patients with acute ischemic stroke (AIS). We investigated mortality and survival duration in very old AIS patients (>or= 80 years) who received hospital care. PATIENTS AND METHODS: Mortality data were obtained from medical records, structured telephone inquiries, death certificates from the Korean National Statistical Office, and social security data 5+/-1.9 years after stroke onset. Age, gender, vascular risk factors, and functional outcomes from modified Rankin scales (MRS) at discharge were analyzed as predictors of mortality. RESULTS: Among 134 patients, 92 (68.7%) died. On Kaplan-Meier analysis, duration of survival of patients aged 80-84 years was longer than those aged 85-89 or 90-94 (24+/-6.4, 8+/-7.3, 7+/-2.0 months, respectively, p=0.002). Duration of survival of patients discharged in a state of MRS 0-1 was longer than the remaining groups at 47+/-4.8 months (p<0.001). In Cox proportional hazard analysis, age and MRS at discharge were independent predictors of mortality. CONCLUSION: Long-term outcomes of very old patients with AIS are not uniformly grave, therefore predictors of mortality and estimated duration of survival should be considered during decision-making for treatment.

Diversity of rotavirus strain circulated in gwangju, republic of Korea.

OBJECTIVES: The introduction of new rotavirus vaccines into the public sphere makes it necessary to maintain constant surveillance and to heighten public awareness of the appearance of new rotavirus strains. We describe the molecular epidemiology of circulating rotavirus strains after vaccine introduction. METHODS: We collected a total of 1070 stool samples from children with gastroenteritis from January 2013 to June 2013. The antigenic prevalence of rotavirus group A was distinguished using enzyme immunoassay. The G and P genotypes of enzyme immunoassay-positive samples were determined with reverse transcription-polymerase chain reaction and nucleotide sequencing analysis. RESULTS: Of the 1070 samples collected, 277 (25.9%) tested positive for rotaviruses by enzyme-linked immunoabsorbent assay. The most prevalent circulating genotype G was G1 (51.3%), followed by G2 (34.7%) and G9 (10.8%). The predominant type of genotype P was P[8] (66.1%), followed by P[4] (31.4%). In this study, nine genotypes were found. G1P[8] was the most prevalent (51.8%), followed by G2P[4] (30.5%), G9P[8] (9.9%), and G2P[8] (4.0%). Several unusual combinations (G1P[4], G3P[9], G3P[8], G4P[6], and G9P[4]) were also identified. CONCLUSION: Molecular epidemiological knowledge of rotaviruses is critical for the development of effective preventive measures, including vaccines. These data will help us monitor the effectiveness of current rotavirus vaccines.

Ischemic stroke and cancer: stroke severely impacts cancer patients, while cancer increases the number of strokes.

BACKGROUND: Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. MAIN CONTENTS: This review covers the epidemiology, underlying mechanisms, and acute and preventive treatments for cancer-related stroke. First, the characteristics of stroke (clinical and radiological features) and systemic cancer (type and extent) in patients with cancer-specific stroke are discussed. Second, the role of laboratory tests in the early identification of patients with cancer-specific stroke is discussed. Specifically, serum D-dimer levels (as a marker of a hypercoagulable state) and embolic signals on transcranial Doppler (suggestive of embolic origin) may provide clues regarding changes in the levels of coagulopathy related to cancer and anticoagulation. Finally, strategies for stroke treatment in cancer patients are discussed, emphasizing the importance of preventive strategies (i.e., the use of anticoagulants) over acute revascularization therapy in cancer-related stroke. CONCLUSION: Recent studies have revealed that the characteristics of cancer-related stroke are distinct from those of conventional stroke. Our understanding of the characteristics of cancer-related stroke is essential to the correct management of these patients. The studies presented in this review highlight the importance of a personalized approach in treating stroke patients with cancer.