A Rare Case of Familial Methemoglobinemia with Congenital Heart Disease.

Methemoglobinemia is a rare dyshemoglobin disorder which can either be congenital or acquired. Dyshemoglobin disorders can be asymptomatic or symptomatic. We narrate the case of a 12-year-old girl who presented with a fever, cough, and oxygen saturation of 85%. She was diagnosed with COVID-19, along with a large atrial septal defect and pulmonary arterial hypertension. Arterial blood gas analysis revealed normal partial pressure of oxygen and on 100% exposure to oxygen, blood color turned chocolate brown. After the resolution of COVID-19 in 10 days, the patient was treated with oral ascorbic acid and successful atrial septal defect repair. It is important to suspect dyshemoglobin disorder in a patient who presents with hypoxia/hypoxemia.

A case of tubercular meningoencephalitis with transverse myelitis.

Central nervous system tuberculosis accounts for approximately 1% of all tuberculosis cases. Transverse myelitis is an extremely rare manifestation of central nervous system tuberculosis, involving 1 or more vertebral segments of the spinal cord. However, it may extend to involve 3 or more segments of the cord, which would then be designated as longitudinally extensive transverse myelitis. Tubercular transverse myelitis may occur in isolation or in association with adjacent meningitis. We present a case of 39-year-old male, who presented with fever, headache, and bilateral lower limb weakness and was eventually diagnosed with tubercular meningoencephalitis with transverse myelitis. The diagnosis was made based on imaging findings correlated with cerebrospinal fluid analysis and microbiological reports. The patient showed significant clinical and radiological improvement following the antitubercular therapy. This case highlights that tuberculosis should always be considered in our differential diagnosis for any pathology with extensive involvement of the meninges, brain and spinal cord, especially in regions with a high prevalence.

Is there an elephant in the room? A study of convergences and divergences of adult attachment measures commonly used in clinical studies.

Objective: In view of the persisting conceptual confusion related to the convergence of attachment measures, we investigated several common measures within a clinical and a non-clinical sample, tested the convergence/divergence of different measures, and tried to find a dimensional model. Method: 175 patients with panic disorder/agoraphobia and 143 matched non-clinical individuals completed seven self-report attachment measures/ clinical self-reports and were interviewed by applying the Adult Attachment Interview (AAI), the Adult Attachment Rating (AAR) and the Adult Attachment Projective (AAP). Results: The categorical and most dimensional attachment measures differentiated between the samples. The convergence of the categorical measures was low, whereas we found moderate to high correlations between similar scales in the dimensional self-report measures. Expectedly, the convergence of dimensional and categorical attachment measures was low. In a factorial (exploratory as well as confirmatory) model, four independent dimensions were extracted reflecting self-rated attachment anxiety and avoidance, the categories of the AAI and those of the AAP, indicating significant differences between the measures. Discussion: Measures of adult attachment are only partially convergent, underlining the need for clarification of which aspect of attachment is actually being assessed in individual clinical investigations. The question remains whether the different measures are in fact related to one construct.

Movement and Emotional Facial Expressions during the Adult Attachment Interview: Interaction Effects of Attachment and Anxiety Disorder.

INTRODUCTION: Adult attachment is commonly associated with emotion regulation. Less is known about the nonverbal embodiment of adult attachment. OBJECTIVE: We hypothesized that dismissing attachment is related to less movement and fewer facial expressions of emotions, whereas preoccupied attachment is associated with more negative emotional facial expressions. Moreover, the interaction of attachment and the presence of an anxiety disorder (AD) was explored. METHODS: The sample included 95 individuals, 21 with AD without comorbidity, 21 with AD and comorbid major depression (AD-CD), and 53 healthy controls. We analyzed nonverbal behavior during a part of the Adult Attachment Interview (AAI) asking about the family and parental figures. The movements of the interviewees were captured via Motion Energy Analysis. Facial expressions were coded according to the Facial Action Coding System using the OpenFace software. We compared individuals with secure, dismissing, and preoccupied states of mind (assessed with the AAI) with regard to the frequency and complexity of movements and the frequency of the facial expressions such as happy, sad, and contemptuous. RESULTS: As expected, dismissingly attached individuals moved less often and with lower complexity than securely attached. For emotional facial expressions, a main effect of the disorder group and interaction effects of attachment by disorder were found. In the AD-CD group, dismissingly attached patients showed comparatively fewer happy facial expressions than securely attached individuals. CONCLUSIONS: Reduced movement specifically seems to be related to dismissing attachment when interviewees talk about significant parental figures. Facial expressions of emotions related to attachment occurred when maladaptive emotion regulation strategies were intensified by a psychological disorder.

Incongruence Between Implicit Attachment Schemes and Unconscious Attachment Representations.

Assessments based on reaction time and language-based interviews postulate that unconscious attachment processes be measured. Nevertheless, a possible empirical equivalence of these two approaches has not yet been investigated. To fill this void, the Adult Attachment Interview and the Implicit Association Test were implemented with a group of patients with panic disorder (n = 157, mean age = 29, SD = 2.47) based on the Structured Clinical Interview for DSM-IV, axis I and II disorders and a group of healthy individuals (n = 138). In total, the securely attached individuals showed significantly more positive attitudes toward their mother than the insecurely attached individuals. In the healthy individuals, the secure and disorganized classifications showed significantly more positive attitudes toward the mother in comparison with the insecure attachment classification, as well as the patient group. In summary, implicit attachment patterns based on reaction times are not equivalent to an attachment representation based on language markers. For the disorganized attachment representation, no differences were present between the information processing of the memory/association network and the autobiographic memory function.

Studies on the glycoprotein modification in erythrocyte membrane during experimental cerebral malaria.

Plasmodium berghei ANKA (Pb ANKA) is a lethal strain of malaria that causes experimental cerebral malaria (ECM) in rodent models. Pathology of the disease is associated with the sequestration of the infected rbc (irbc) in the micro vessels of brain. In the present study, we analyzed the nature of the glycoprotein modification occurring in irbc membrane during erythrocytic stages of Pb ANKA infection. Titration of naturally occurring glycoproteins with concanavalin A (Con A) and wheat germ agglutinin (WGA) lectins revealed an enhanced lectin binding ability for the irbc membrane preparations. Partial characterization of the Con A specific determinants (alpha-d-methyl mannoside specificity) by lectin affinity chromatography followed by 2D electrophoresis and WGA specific determinants (sialic acid specificity) by Western analysis revealed the association of novel lectin specific determinants in irbc membrane. To correlate the biochemical changes with the morphological changes, SEM of irbc, and TEM of sequestered irbc were performed. These ultra structural studies revealed variable and irregular surface protrusions and deep surface indentations on irbc. These observations implicate that altered glycoprotein profiles may lead to cytoarchitectural changes in irbc membrane and such changes may be essential to establish contact with the host endothelial cells. These observations may be central to the microvascular sequestration and pathology of ECM.