Lissencephaly and Advanced-Stage Congenital Cytomegalovirus Infection in a Neonate.

This case report investigates the management of a 24-week-old neonate with congenital cytomegalovirus (CMV) infection and its sequelae, including severe intrauterine growth restriction, thrombocytopenia, and brain anomalies, ultimately progressing to lissencephaly. The diagnostic challenges included delayed clinical suspicion of congenital CMV, which was not identified until after delivery through CMV DNA polymerase chain reaction, and differentiating its symptoms from other potential causes of the neonate's condition. Aggressive interventions included antibiotics, antiviral therapy with ganciclovir, and supportive measures such as intubation, CPR, respiratory support, blood transfusions, and management of coagulopathy. Despite these efforts, the patient deteriorated due to progressive hypoperfusion, hypoxemic cardiorespiratory failure, and disseminated intravascular coagulopathy. Due to the poor prognosis and extent of multiorgan damage, support was withdrawn per parental consent. This case highlights the complications encountered when managing an advanced-stage neonatal CMV infection and emphasizes the importance of a multidisciplinary and holistic approach to guide diagnosis and treatment.

The proportion of tumour stroma predicts response to treatment of immune checkpoint inhibitor in combination with chemotherapy in patients with stage IIIB-IV non-small cell lung cancer.

AIMS: Immunotherapy has brought a new era to cancer treatment, yet we lack dependable predictors for its effectiveness. This study explores the predictive significance of intratumour stroma proportion (iTSP) for treatment success and prognosis in non-small cell lung cancer (NSCLC) patients undergoing treatment with immune check-point inhibitors (ICIs) together with chemotherapy. METHODS AND RESULTS: We retrospectively collected data from patients with unresectable stage IIIB-IV NSCLC who were treated with first-line ICIs and chemotherapy. Each patient received a confirmed pathological diagnosis, and the pathologist evaluated the iTSP on haematoxylin and eosin (H&E)-stained sections of diagnostic tissue slides. Among the 102 H&E-stained biopsy samples, 61 (59.8%) were categorised as stroma-L (less than 50% iTSP), while 41 (40.2%) were classified as stroma-H (more than 50% iTSP). We observed that the stroma-L group exhibited a significantly better objective response rate (ORR) (72.1 versus 51.2%, P = 0.031) and deeper response depth (DpR) (-50.49 ± 28.79% versus -35.83 ± 29.91%, P = 0.015) compared to the stroma-H group. Furthermore, the stroma-L group showed longer median progression-free survival (PFS) (9.6 versus 6.0 months, P = 0.011) and overall survival (OS) (24.0 versus 12.2 months, P = 0.001) compared to the stroma-H group. Multivariate Cox proportional hazards regression analysis indicated that iTSP was a highly significant prognostic factor for both PFS [hazard ratio (HR) = 1.713; P = 0.030] and OS (HR = 2.225; P = 0.003). CONCLUSION: Our findings indicate that a lower iTSP corresponds to improved clinical outcomes and greater DpR in individuals with stage IIIB-IV NSCLC treated with first-line ICIs and chemotherapy. The iTSP could potentially serve as a predictive biomarker for ICIs therapy response.

Forensic investigation of Cisco WebEx desktop client, web, and Android smartphone applications.

Digital forensic analysis of videoconferencing applications has received considerable attention recently, owing to the wider adoption and diffusion of such applications following the recent COVID-19 pandemic. In this contribution, we present a detailed forensic analysis of Cisco WebEx which is among the top three videoconferencing applications available today. More precisely, we present the results of the forensic investigation of Cisco WebEx desktop client, web, and Android smartphone applications. We focus on three digital forensic areas, namely memory, disk space, and network forensics. From the extracted artifacts, it is evident that valuable user data can be retrieved from different data localities. These include user credentials, emails, user IDs, profile photos, chat messages, shared media, meeting information including meeting passwords, contacts, Advanced Encryption Standard (AES) keys, keyword searches, timestamps, and call logs. We develop a memory parsing tool for Cisco WebEx based on the extracted artifacts. Additionally, we identify anti-forensic artifacts such as deleted chat messages. Although network communications are encrypted, we successfully retrieve useful artifacts such as IPs of server domains and host devices along with message/event timestamps.

SARS CoV-2 infection in a patient with sickle cell disease - Atypical presentation.

Severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) infection causes the disease known as coronavirus disease that started in Wuhan (China) in December 2019, leading to the current COVID-19 pandemic. The common presenting symptoms include fever, dry cough, shortness-of-breath, while sore throat, diarrhea, and abdominal and chest pain are the least. The atypical presentation of SARS CoV-2 infection poses a challenge for family physicians to screen and manage such patients for COVID-19 and specifically those at high risk with underlying disease such a sickle cell disease. Herein, we report a case of SARS CoV-2 infection in a known patient of sickle cell disease (SCD) with an atypical presentation, in whom the course of the disease was mild to moderate, uncomplicated, and the patient had an uneventful recovery. Primary care physicians should be vigilant to screen and manage such patients with established protocols, especially in the ongoing COVID-19 pandemic.

Bochdalek hernia with retrocardiac spleen - Diagnostic dilemma for emergency care physicians-A case report.

INTRODUCTION: Physicians working as first-level responders in emergency departments (ED) often encounter patients, of any age group with shortness of breath (SOB). Definitive diagnosis is quite challenging once the underlying pathology is rare and unusual and/or the ED physicians recommend and rely on non-specific investigations. PRESENTATION OF CASE: A 29-year-old female presented to the emergency department with sudden onset of shortness of breath and upper abdominal pain radiating to the left shoulder. Diagnosis of Bochdalek hernia was made clinically coupled with radiological findings of CXR and computed tomography (CT) by the surgeon on-call, while it was missed by an emergency care physician on her first visit. DISCUSSION: Herniation of the abdominal contents into the thoracic cavity via the Bochdalek opening, commonly known as Bochdalek hernia is seen and diagnosed most commonly accidentally in early life. Adult cases of symptomatic Bochdalek hernia has been reported in the literature. These patients usually present with non-specific symptoms, thus pose a diagnostic challenge for an emergency care physician. CONCLUSION: The report of this case highlights the notion that such rare causes of acute onset dyspnea and upper abdominal pain pose a diagnostic challenge for novice emergency care physicians especially in situations where he/she does not ask for second-line help in general and recommend and rely on a non-specific investigation in specific.

Light-assisted removal of ear canal live insect-A noninvasive approach for first level responders.

Physicians, working in the primary care setting and/or emergency departments, encounter more often patients of any age group with foreign bodies in the external auditory canal (EAC) and urgent removal is crucial to avoid complications. The condition is more commonly managed on an urgent basis if the foreign body is a live insect that is more agonizing for the patient. Foreign body removal is quite challenging but an essential skill for first-level responders and different approaches, each with its own pros and cons, are used for EAC foreign bodies removal. Herein, we report two cases that were managed safely by a noninvasive approach by using light illumination of EAC in complete darkness. The approach, not reported in the available literature, can be used as first-level management before opting another alternative, in settings where otolaryngologist services are not readily available.

Renovascular Mistaken as Essential Hypertension due to Giant Hepatic Hydatid: A Rare Treatable Entity.

Renovascular hypertension is an unusual but treatable cause of refractory hypertension that is infrequently caused by external compression of the renal vasculature by a giant hydatid cyst, a parasitic infection, caused by Echinococcus granulosus in its larval stage which is endemic in many parts of the world including Saudi Arabia. The disease can produce a cyst in almost every part of the body with the liver and lungs being the most frequently targeted organs producing a variety of symptoms depending upon the site and size of the cyst. We report a case of giant hepatic hydatid cyst with the possibility of renovascular hypertension due to mass effect as evident by dramatic drop of the blood pressure to its normotensive state postoperatively.

A Case Report of Gastrointestinal Basidiobolomycosis Treated With Voriconazole: A Rare Emerging Entity.

INTRODUCTION: Basidiobolomycosis is an unusual fungal disease that rarely involves the visceral organs such as gastrointestinal tract. Gastrointestinal basidiobolomycosis (GIB) has been increasingly reported in the literature, and it is an emerging disease from arid regions worldwide, in particular, the south-western Saudi Arabia. We report a case of GIB in a 36-year-old Saudi Arabian male patient showing resistance to itraconazole and best treated with voriconazole. Computed tomography showed diffusely thickened small bowel with edematous change. CONCLUSIONS: As GIB presents diagnostic challenges due to lack of specific features, this case emphasizes the importance of considering GIB in the differential diagnosis in patients presenting with fever, abdominal pain with fast-growing abdominal mass.

Ochrobactrum anthropi induced retropharyngeal abscess with mediastinal extension complicating airway obstruction: a case report.

Retropharyngeal abscess with involvement of mediastinal abscess represents an uncommon complication of upper respiratory tract infections. We report a case presenting with a large retropharyngeal abscess with airway obstruction as the primary presenting symptom. Contrast-enhanced CT showed a large retropharyngeal abscess in the neck with extension to the upper and posterior mediastinal spaces. The abscess was surgically excised with 200 cc pus drained from the neck and mediastinal regions. We describe this case to assist physicians in making the difficult diagnosis when confronting a patient with airway obstruction, as early recognition of retropharyngeal abscess permits emergent airway management.

Factors associated with typhoid relapse in the era of multiple drug resistant strains.

INTRODUCTION: Typhoid has an estimated global burden of greater than 27 million cases per annum with a clinical relapse rate of 5% to 20%.  Despite the large relapse burden, the factors associated with relapse are largely unknown.  METHODOLOGY: We have followed a protocol for the diagnosis and management of pediatric typhoid since 1988.  We report factors associated with relapse of culture-proven enteric fever in 1,650 children presenting to the Aga Khan University Medical Center,  Karachi, Pakistan, over a 15-year period.  RESULTS: In those infected with multiple drug resistant (MDR) strains, factors associated with subsequent relapse include constipation at presentation and presentation within 14 days of fever onset.  Diarrhoea in those children infected with drug sensitive strains had an association with decreased subsequent relapse, as was quinolone therapy. CONCLUSIONS: Multiple clinical factors at presentation are associated with subsequent typhoid fever relapse.  These factors may be postulated to be associated with subsequent relapse due to alterations in the reticuloendothelial system organism load.  These data will be valuable in developing algorithms for clinical follow-up in children infected with MDR enteric fever.

Regulation of the cGMP-cPKG pathway and large-conductance Ca2+-activated K+ channels in uterine arteries during the ovine ovarian cycle.

The follicular phase of the ovine ovarian cycle demonstrates parallel increases in ovarian estrogens and uterine blood flow (UBF). Although estrogen and nitric oxide contribute to the rise in UBF, the signaling pathway remains unclear. We examined the relationship between the rise in UBF during the ovarian cycle of nonpregnant sheep and changes in the uterine vascular cGMP-dependent pathway and large-conductance Ca(2+)-activated K(+) channels (BK(Ca)). Nonpregnant ewes (n = 19) were synchronized to either follicular or luteal phase using a vaginal progesterone-releasing device (CIDR), followed by intramuscular PGF(2alpha), CIDR removal, and treatment with pregnant mare serum gonadotropin. UBF was measured with flow probes before tissue collection, and second-generation uterine artery segments were collected from nine follicular and seven luteal phase ewes. The pore-forming alpha- and regulatory beta-subunits that constitute the BK(Ca), soluble guanylyl cyclase (sGC), and cGMP-dependent protein kinase G (cPKG) isoforms (cPKG(1alpha) and cPKG(1beta)) were measured by Western analysis and cGMP levels by RIA. BK(Ca) subunits were localized by immunohistochemistry. UBF rose >3-fold (P < 0.04) in follicular phase ewes, paralleling a 2.3-fold rise in smooth muscle cGMP and 32% increase in cPKG(1alpha) (P < 0.05). sGC, cPKG(1beta), and the BK(Ca) alpha-subunit were unchanged. Notably, expression of beta(1)- and beta(2)-regulatory subunits rose 51 and 79% (P

Biochemical characterisation of some non fermenting, non arginine hydrolysing mycoplasmas of ruminants.

The pattern and kinetics of substrate oxidation by type and recent field strains of Mycoplasma agalactiae, Mycoplasma bovis, Mycoplasma bovigenitalium and Mycoplasma ovine/caprine serogroup 11 were investigated by measurement of oxygen uptake. Metabolism of a range of organic acids, sugars and alcohols was detected. All the test strains were unable to oxidise sugars, glycerol and the organic acids, fumarate, malate and alpha-ketoglutarate (1 mM). All strains oxidised organic acid l-lactate, 2-oxobutyrate and pyruvate and demonstrated the ability to oxidise alcohols, particularly isopropanol, which was oxidised at a high rate and high affinity (0.5 mol/mol isopropanol). Its oxidation was consistent with acetone formation, which may be of important in relation to pathogenicity. All strains oxidised similar substrates, however differences were observed between strains in terms of the relative rates and kinetic values for some substrates.

Close genetic and phenotypic relatedness between mycoplasma ovine/caprine serogroup 11 and Mycoplasma bovigenitalium.

Strains of Mycoplasma ovine/caprine serogroup 11, isolated from infertile sheep, were compared to the type strain, 2D, and to strains of the cattle pathogen M. bovigenitalium, including the type strain, PG11. Examination of these strains by growth inhibition and immune fluorescence tests showed strong serological cross reactivity between M. serogroup 11 and M. bovigenitalium but not with other ruminant mycoplasmas. Substrate oxidation and growth studies did not show any consistent differences between M. serogroup 11 and M. bovigenitalium strains; all strains assigned to both groups were adapted to the utilisation of a small range of organic acids as energy sources. DNA:DNA hybridisation, carried out between DIG labelled reference strains of M. serogroup 11 and M. bovigenitalium and field isolates of these two mycoplasmas showed a particularly close relationship with hybridisation rates all greater than 70% and, mostly, closer to 90%. Sequencing of the 16S ribosomal RNA gene region of the M. serogroup 11 and M. bovigenitalium strains as well as the respective type strains revealed very high overall homologies of 99.5%. In summary, the results showed a very close phenotypic and genotypic relatedness between these two ruminant mycoplasmas which justifies their classification into a single species.