ABSTRACT
Allgrove syndrome is a rare autosomal recessive condition characterized by adrenal insufficiency, achalasia, alacrima and occasionally autonomic disturbances. Mutations in the AAAS gene, on chromosome 12q13 have been implicated as a cause of this disorder. We present various manifestations of this syndrome in two related families each with two affected siblings in which several members had symptoms including reduced tear production, mild developmental delay, achalasia, neurological disturbances and also premature loss of permanent teeth in two of them. The importance of this report is dental involvement [loss of permanent teeth] in Allgrove syndrome that has not been reported in literature
Subject(s)
Humans , Male , Female , Child , Adolescent , Nerve Tissue Proteins , Syndrome , Nuclear Pore Complex Proteins , Tooth Avulsion , Family , Addison Disease , Esophageal AchalasiaABSTRACT
Reversible posterior leukoencephalopathy syndrome [RPLE] is an increasingly recognized disorder, most commonly associated with immunosuppressive and cytotoxic agent, malignant hypertension and toxemia of pregnancy. Neurological symptoms are headache, mental and visual disturbance, and seizures. Brain MRI findings are symmetrical bilateral hyper intense areas of occipital and parietal lobes in T2-weighted magnetic resonance [MR] images. This finding is reversible with prompt successful treatment which may take days to weeks for full reversal. We observed a case of status epilepticus which occurred 32 days after liver transplantation in a patient on regimen consisting of Tacrolimus [FK 506]. He had no history of neurologic disease or metabolic abnormalities. Typical findings of RPLE were present on brain MRI. The recurrence of seizures terminated after a few hours with adding Na-valproate to Phenytoin, Phenobarbital and Midazolam. The radiological finding of brain MRI gradually diminished after several weeks. A physician should be alert of seizures during early post transplant period of liver transplantation. He should bear in mind the diagnosis of RPLE and consider discontinuation of immunosuppressive drugs
Subject(s)
Humans , Male , Posterior Leukoencephalopathy Syndrome/etiology , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Status Epilepticus/drug therapy , Status Epilepticus/etiology , Status Epilepticus/diagnostic imaging , Liver Transplantation/adverse effects , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents , Magnetic Resonance Imaging/statistics & numerical data , Tacrolimus/adverse effects , Tacrolimus , Valproic Acid , Midazolam , Phenytoin , PhenobarbitalABSTRACT
The objective of this study was to assess the prevalence of hearing impairment by automated auditory brain stem response [AABR] in newborns admitted to an intensive and intermediate care unit and to analyze the associated risk factors. An observational cross-sectional study was conducted between January 2005 and January 2006. 834 newborns [62% boys and 38% girls] were assessed. Newborns had a mean [SD] gestational age of 36 [2.1] weeks with a mean [SD] birth weight of 2950 [1250] grams. The presence of the following neonatal pathologies was investigated: craniofacial malformations, hyperbilirubinemia [total bilirubin 20 mg/dl for all newborns], neonatal asphyxia, congenital infections, septicemia, birth weight [= 1500 g], meningitis, consanguinity, family history of congenital hearing loss and history of convulsion. Newborns who died before the age of 3 months and whose stay in the hospital lasted less than 48 hours were excluded. Chi-square test was used to identify the risk factors for hearing loss. Out of 834 neonates, 34 [4.07%] had sensory-neural hearing loss. The most common risk factors of hearing loss included hyperbilirubinemia [11%], asphyxia [8%], birth weight less than 1500 g [6%], septicemia [6%], convulsion [2%], and meningitis [1%]. There was a statistically significant association between hyperbilirubinemia [P=0.001], weight less than 1500 g [P=0.002], cesarean section [P=0.005] and impaired ABR results. There was no relation between family history of congenital hearing loss and craniofacial malformation as risk factors for hearing loss. This study showed statistically a relation between hyperbilirubinemia, weight less than 1500 g, cesarean section and impaired AABR results. The most common risk factors of hearing loss were hyperbilirubinemia, asphyxia, birth weight less than 1500 g, septicemia, convulsion, and meningitis