Mycobacterium marinum is an opportunistic pathogen inducing infection in fresh and marine water fish. This pathogen causes necrotizing granuloma like tuberculosis, morbidity and mortality in fish. The cell wall-associated lipid phthiocerol dimycocerosates, phenolic glycolipids and ESAT-6 secretion system 1 (ESX-1) are the conserved virulence determinant of the organism. Human infections with Mycobacterium marinum hypothetically are classified into four clinical categories (type I-type IV) and have been associated with the exposure of damaged skin to polluted water from fish pools or contacting objects contaminated with infected fish. Fish mycobacteriosis is clinically manifested and characterized in man by purple painless nodules, liable to develop into superficial crusting ulceration with scar formation. Early laboratory diagnosis of M. marinum including histopathology, culture and PCR is essential and critical as the clinical response to antibiotics requires months to be attained. The pathogenicity and virulence determinants of M. marinum need to be thoroughly and comprehensively investigated and understood. In spite of accumulating information on this pathogen, the different relevant data should be compared, connected and globally compiled. This article is reviewing the epidemiology, virulence factors, diagnosis and disease management in fish while casting light on the potential associated public health hazards.
Background: High levels of inflammatory markers such as C-reactive protein (CRP) and interleukin (IL)-6 are associated with worse outcome after ischemic stroke. Objectives: To study whether the level of IL-6 following ischemic stroke is related to the severity of stroke, infarct volume, stroke subtype, and its impact on stroke outcome. Materials and methods: A total of 90 patients of acute ischemic stroke were enrolled with calculation of infarct volume in MRI brain, and serum IL-6 samples were obtained within 24 h and also after 3 months from stroke onset. NIHSS and MRS were done at stroke onset and after 3 months. Results: The mean value of IL-6 was higher among patients with small vessel occlusion (8.47 pg/ml) with a significant positive correlation between IL-6 and National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (MRS) after 3 months. IL-6 was significantly higher in patients with recurrence with a cutoff IL-6 value above which recurrence is anticipated which is 7.75 pg/ml. Conclusion: Our study concluded that inflammation has an important role in the pathogenesis of acute ischemic stroke particularly small vessel occlusion and it provided evidence that IL-6 contributes to the determination of clinical outcome of acute ischemic stroke and prediction of recurrence.
Sonothrombolysis is a therapeutic option to improve the outcomes in patients with acute ischemic stroke due to MCA occlusion.
Background Carpal tunnel syndrome is the commonest entrapment neuropathy. The cut-off point of cross-sectional area to diagnose carpal tunnel syndrome may vary among populations. The objective of this study was to determine the best cut-off point of median nerve cross-sectional area to diagnose carpal tunnel syndrome among Egyptian population and to compare the difference of median nerve cross-sectional area in diabetic patients versus healthy individuals. Results Mean cross-sectional area was 7.78 ± 1.260 mm2 among healthy individuals and 8 ± 1.018 mm2 among diabetics. Cut-off cross-sectional area of median nerve above which compression is anticipated is 9.5 mm2. Conclusion Ultrasound can be used to diagnose carpal tunnel syndrome by measuring the median nerve cross-sectional area.
Background: Calcitonin-gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal nerve cells, and treatments targeting CGRP are effective in migraines. For headaches that do not respond to pharmacological treatment, minimally invasive techniques such as greater-occipital-nerve block (GONB) can help relieve the pain and reduce the frequency of headaches. Our study assessed the efficacy of ultrasound-guided greater-occipital-nerve block (USgGONB) in chronic migraines (CM) and its relationship to serum CGRP levels. Methods: Forty chronic migraineurs who underwent bilateral USgGONB using 40 mg triamcinolone and 1 mL lidocaine were recruited and interictal serum CGRP samples were collected immediately before and one month after GONB. The clinical response was evaluated using headache diaries before and one month after USgGONB. The patient response was determined after USgGONB according to the reduction in headache days as a good responder (>50% reduction), poor responder (<50%) or non-responder. Results: Monthly headache days after GONB showed a significant reduction (median, 10 days; range, 8–14.7) compared to before the block (median, 18 days; range, 17–22; p < 0.001). Across all patients, interictal serum CGRP levels after USgGONB were significantly lower than before the block (median, 40 pg/mL (range, 25–60) vs. 145 pg/mL (range, 60–380) (p = 0.001). The pre-treatment interictal CGRP levels showed a significant difference (p = 0.003), as their levels in non-responders (median, 310 pg/mL; interquartile range, 262–350) were significantly higher than those seen in responders, whether poor responders (median, 135 pg/mL; interquartile range, 100–200 pg/mL) or good responders (median, 140 pg/mL; interquartile range, 80–150 pg/mL). Conclusion: the study showed the beneficial effect of USgGONB in chronic migraines that was associated with lowering interictal CGRP levels, implying a potential role for CGRP in the mechanism of action of GONB in CM, and the interictal CGRP level may be used as a predictor for the response to GONB.
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