يعد تشخيص الموت القلبي المفاجئ (SCD) تحديا للمختصين الطبيين. لهذا السبب، ولجعل التشخيص أسهل لأخصائيي الطب الشرعي، هناك حاجة إلى استخدام المعلمات الحيوية لتشخيص تلك الحالات. وعليه تركز هذه المقالة على ...المعلمات الحيوية المحتملة التي يمكن أن تستخدم في تشخيص وفيات القلب المفاجئة (SCD). أثبتت بعض المعلمات الحيوية مثل تروبنونات القلب Cardiac troponinsوبروتين سي التفاعلي عالي الحساسية high-sensitivity C-reactive protein والكرياتين كيناز-أم بي creatine kinase- MB أنها مفيدة جدا لهذا الغرض. أما إنزايمات اللاكتات Lactate dehydrogenase، والميوغلوبين myoglobin، وعامل النخر الورمي ألفا α tumor necrosis factor، رغم أنها مفيدة إلا أنها غير فعالة بما يكفي لإدراجها في قائمة المعلمات الحيوية لتشخيص وحالات موت القلب المفاجئ SCD.كما أعطت الدراسات السابقة نتائج إيجابية وأخرى سلبية لببتيدات الناتريوتريك natriuretic peptides، كمؤشر حيوي وهناك حاجة إلى المزيد من الدراسات لتأكيد استخدامه كمؤشر حيوي لتشخيص SCD في حالات التشريح. للأشخاص الذين على قيد الحياة فإن استراتيجية استخدام عدة معلمات تكون مفيدة في التنبؤ بخطر وفيات القلب والأوعية الدموية. ومن المقترح أنه من أجل تشخيص حالات موت القلب المفاجئ SCD، قد تكون استراتيجية استخدام معلمات متعددة أكثر كفاءة ولذا فإن المزيد من الدراسات مطلوبة لتأكيد ذلك.
A small molecule inhibitor of MAP/ERK kinase (MEK) was effective against human breast cancer cells with a basal-like gene expression signature. Antitumor activity was limited by both feedback ...upregulation of phosphatidylinositol-3 kinase (PI3K)/AKT upon inhibition of MEK as well as loss of the phosphatase PTEN. Therefore, MEK inhibitors should preferably be investigated in combination with PI3K inhibitors in basal-like breast cancers.
Background
Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune astrocytopathy, may share common clinico‐radiological features with Wernicke's encephalopathy (WE). A variant of NMOSD, known ...as area postrema syndrome (APS), that presents with intractable hiccups and associated vomiting, might lead to the depletion of nutrients if not detected and treated early. Autoimmune thyroid disorders (i.e., Graves’ disease) may be associated with NMOSD. Rarely, thyrotoxicosis can give rise to thiamine depletion and WE.
Case presentation
Here, we present a case of untreated hyperthyroidism in an Indian female who presented with thyrotoxicosis and later developed WE, possibly also contributed by NMOSD (APS)‐induced recurrent vomiting. The patient recovered with antithyroid drugs, parenteral thiamine, and immunomodulatory therapy. The possible pathogenic mechanisms have been discussed.
Conclusion
Our case establishes the importance of considering NMOSD variants in metabolic encephalopathy, especially if neuroimaging is suggestive and in the backdrop of another autoimmune disorder.
Neuromyelitis Optica Spectrum Disorder may share common clinico‐radiological features with Wernicke’s encephalopathy. We present a case of untreated hyperthyroidism in a female who presented with thyrotoxicosis and later developed Wernicke’s encephalopathy, possibly contributed by NMOSD‐induced recurrent vomiting. This case re‐establishes the importance of considering cerebral syndrome, diencephalon syndrome and area postrema syndrome variants of NMOSD while managing a case of metabolic encephalopathy, particularly if neuroimaging features are suggestive.
Hashimoto's Encephalopathy (HE), also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is a proteiform disorder known for its wide spectrum of presentations ...from subtle neuropsychiatric manifestations, movement disorders, seizures, stroke-like episodes to coma. Here, we report a case of HE which initially masqueraded as bipolar affective disorder (BPAD) and ultimately progressed to generalized tonic clonic seizures and coma. Although SREAT is characterized by exquisite responsive to steroid, in our case it was unresponsive to pulse methylprednisolone therapy. Rapid recovery was noted with intravenous immunoglobulin (IVIG) therapy. This case was also peculiar for its association with non-sydnromic retinitis pigmetosa (RP). To the best of our knowledge, this was the first reported case of HE which was associated with RP.
The oncogene DJ-1 has been associated with multiple cancers, including prostate cancer, where it can be stabilized by androgens and antiandrogens. However, little data exist on the expression pattern ...and function of DJ-1 in prostate cancer. To address the function of DJ-1 in prostate, a yeast two-hybrid screen was done to identify novel DJ-1 binding proteins. The androgen receptor (AR) was identified and confirmed as a DJ-1 binding partner. This is the first evidence that DJ-1 directly interacts with AR. We also show that modulation of DJ-1 expression regulated AR transcriptional activity. Importantly, both the subcellular localization of DJ-1 and the interaction with AR are regulated by androgens and antiandrogens. Additionally, immunohistochemical staining on two human prostate cancer tissue arrays was done providing the first large-scale expression analysis of DJ-1 in prostate. DJ-1 expression did not change with Gleason pattern but increased after androgen deprivation therapy, indicating that it may be involved in the development of androgen independence. These data provide a novel mechanism where DJ-1-mediated regulation of AR may promote the progression of prostate cancer to androgen independence.
Jaw clonus, a fascinating, yet uncommon clinical sign, is suggestive of supranuclear lesions of the trigeminal nerve. It has previously been reported in association with amyotrophic lateral ...sclerosis. Hereby, we report an index case of jaw clonus in a patient of neuromyelitis optica spectrum disorder with subsequent osmotic demyelination syndrome with pseudobulbar palsy due to the involvement of pontine corticobulbar fibres.
Rhinosporidiosis, a chronic inflammatory disease, which is caused by the aquatic microorganism Rhinosporidium seeberi, is endemic in India and in many other regions of the tropics. It primarily ...infects mucocutaneous surfaces of nose, nasopharynx, and conjunctiva through transepithelial invasion. However, over the centuries, atypical involvement of other body parts, especially viscera, bone, subcutaneous layers, genitals, the tracheobronchial tree, and even the skull has been, though rarely, reported. This chronic granulomatous infection is notorious for its propensity for recurrence following autoinoculation and poor response to most of the anti-microbials except dapsone. Surgical excision followed by cauterization remains the treatment of choice when an operation is feasible. We herein report a case of an immunocompetent person with primary disseminated dermato-pulmonary rhinosporidiosis, which created significant diagnostic dilemma at the beginning, got complicated due to dapsone-induced direct anti-globulin test-positive autoimmune hemolytic anemia, and finally responded to prolonged multidrug therapy with liposomal amphotericin B, ketoconazole and cycloserine. This report establishes the importance of tissue diagnosis in rhinosporidiosis and even, in resource-poor set-ups, a simple histopathological diagnosis can promote an early and affordable accurate diagnosis, and subsequently, a proper therapeutic intervention.
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