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Lyme disease-related intracranial hypertension in children: clinical and imaging findings

The objective of this study is to evaluate the history, clinical findings, CSF analysis, and brain imaging results in pediatric patients with increased intracranial pressure secondary to LD. A retrospective database search was performed using the International Classification of Diseases (ICD) 9/10 codes to identify patients diagnosed with LD and IH between 2004 and 2014 at a tertiary referral pediatric hospital. Clinical, laboratory and neuroimaging data for each patient were reviewed. Seven patients met inclusion criteria; mean age was 9.6 years (standard deviation 4.0 years); 4/7 patients were male. Average body mass index was 18.8 kg/m2 (standard deviation 3.0 kg/m2). Fever was present in four patients. Four had a history of LD related erythema migrans. All had elevated CSF opening pressure with leukocytosis and lymphocytic predominance. MRI obtained in six patients showed contrast enhancement of various cranial nerves. Tentorial enhancement was noted in all patients. In addition, patients had widening of the optic nerve sheath (ONS), optic nerve protrusion, and flattening of the posterior globe consistent with increased intracranial pressure. All patients had resolution of their symptoms after initiation of antibiotic therapy. In endemic areas, LD should be included in the differential of IH. MRI can help distinguish IH due to LD from its idiopathic form due to the presence of tentorial and cranial nerve enhancement in the former in addition to abnorma...
Source: Journal of Neurology - Category: Neurology Source Type: research

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Authors: Rill JS, Lev-Tov H, Liu G, Kirby JS Abstract BACKGROUND: Systemic antibiotics are often used to treat rosacea and tetracyclines are the most common antibiotic prescribed; however, there is ambiguity among clinical guideline suggestions. Importantly, there is an increasing call to all clinicians to curtail antibiotic use. OBJECTIVE: Investigate the utilization and cost of long-term oral antibiotic use for the treatment of rosacea, including ocular rosacea. METHODS: This was a retrospective cohort study of MarketScan® Commercial Claims and Encounters database, from January 1, 2005 through Decembe...
Source: Journal of Dermatological Treatment - Category: Dermatology Tags: J Dermatolog Treat Source Type: research
This study clearly demonstrated that the voltammetric assay is an efficient alternative technique for the rapid discrimination of β-lactamases-producing Enterobacteriaceae in blood culture. In contrast to the approved routine assays, the electrochemical test did not require isolated colonies to be performed and was thus carried out in less than 3 h which could allow early administration of an appropriate antibiotic therapy. PMID: 29674034 [PubMed - in process]
Source: Talanta - Category: Chemistry Authors: Tags: Talanta Source Type: research
I just read a Clinical Problem Solving case from the New England Journal of Medicine (NEJM). It was entitled “Stream of Consciousness“and it told the story of a 65-year-old man who was a patient at the Brigham and Women’s Hospital of Harvard Medical School, arguably one of the finest medical institutions in the world. These cases are presented in single paragraphs to a clinical expert physician who then comments about his or her thought processes and discusses how he or she would have handled the situation. In this narrative, the patient presented to a different hospital in New England with kidney failure...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Hospital-Based Medicine Neurology Source Type: blogs
CONCLUSION: The increased or decreased activity of these two genes as a result of genetic changes and the development of thrombosis are a challenging and contradictory matter, and the study of genetic variability in ADAMTS13 and vWF genes may be helpful in the diagnosis of thrombotic disorders. PMID: 29669506 [PubMed - as supplied by publisher]
Source: Cardiovascular and Hematological Disorders Drug Targets - Category: Drugs & Pharmacology Tags: Cardiovasc Hematol Disord Drug Targets Source Type: research
CONCLUSION: This observation involves professional stress in pseudo pheochromocytoma. PMID: 29673919 [PubMed - as supplied by publisher]
Source: Revue de Medecine Interne - Category: Internal Medicine Tags: Rev Med Interne Source Type: research
Authors: Ha KH, Kim B, Shin HS, Lee J, Choi H, Kim HC, Kim DJ Abstract BACKGROUND AND OBJECTIVES: To compare cardiovascular disease (CVD) risk associated with 5 different dipeptidyl peptidase-4 inhibitors (DPP-4is) in people with type 2 diabetes. METHODS: We identified 534,327 people who were newly prescribed sitagliptin (n=167,157), vildagliptin (n=67,412), saxagliptin (n=29,479), linagliptin (n=220,672), or gemigliptin (n=49,607) between January 2013 and June 2015 using the claims database of the Korean National Health Insurance System. A Cox proportional hazards model was used to estimate hazard ratios (HRs)...
Source: Korean Circulation Journal - Category: Cardiology Tags: Korean Circ J Source Type: research
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin. On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 29. Cardiac examination reveals a grade 2/6 early-peaking syst...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Cardiology Diabetes Source Type: blogs
Conclusions:Zika can induce GBS after a brief viral illness. Neuropathy can be a mixture of demyelinating and axonal. Dysautonomia may also be present including severe dysphagia, orthostatics and retention.Zika RNA has a short detection window in serum and CSF making a diagnosis time sensitive. Serological assays using IgM and IgG cross-react with other flaviviruses making them unable to differentiate between recent Zika exposure and cross reactivity with Dengue and Chikungunya. Our pt likely had prior exposure to Dengue, being from an endemic area. Prior Dengue exposure may possibly modulate the response to Zika via antib...
Source: Neurology - Category: Neurology Authors: Tags: Zika, Chikungunya, West Nile Virus, and Other Viral Infections I Source Type: research
Discussion Humans are opportunistic hosts to Babesia when bitten by nymph or adult ticks; the most known ticks are Ixodes. Babesiosis should be considered in patients who have a malaria-like illness in areas endemic for Babesia infection. The symptoms usually begin 2–4 weeks after a tick bite. The presentation includes constitutional symptoms, abdominal pain and dark urine. Labs finding include hemolytic anemia and elevated liver enzymes. Urinalysis reveals hemoglobinuria without red blood cells. The diagnosis of Babesiosis is usually established by microscopic examination of Giems or Wright-stained blood smears, ind...
Source: Journal of Investigative Medicine - Category: Research Authors: Tags: Infectious Disease Source Type: research
CONCLUSIONS: The reported incidence of LD in Poland, in our opinion, may be biased by overreporting and overdiagnosis. Nonspecific musculoskeletal and joint pain are the most frequent cause of LD suspicion and hospitalization. There is a necessity of better tests for active LD confirmation (especially in patients with musculoskeletal pain) as seroprevalence of anti Borrelia burgdorferi antibodies is high in endemic regions. PMID: 26641887 [PubMed - as supplied by publisher]
Source: Advances in Medical Sciences - Category: Biomedical Science Authors: Tags: Adv Med Sci Source Type: research
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