Over recent years, there has been an increasing acknowledgment of the diversity that exists among Mycobacterium tuberculosis clinical isolates. To facilitate comparative studies aimed at deciphering the relevance of this diversity to human disease, an unambiguous and easily interpretable method of strain classification is required. Presently, the most effective means of assigning isolates into a series of unambiguous lineages is the method of Gagneux et al. (S. Gagneux et al., Proc. Natl. Acad. Sci. USA 103:2869-2873, 2006) that involves the PCR-based detection of large sequence polymorphisms (LSPs). In this manner, isolates are classified into six major lineages, the majority of which display a high degree of geographic restriction. Here we describe an independent replicate of the Gagneux study carried out on 798 isolates collected over a 6-year period from mostly foreign-born patients resident on the island of Montreal, Canada. The original trends in terms of bacterial genotype and patient ethnicity are remarkably conserved within this Montreal cohort, even though the patient distributions between the two populations are quite distinct. In parallel with the LSP analysis, we also demonstrate that "clustered" tuberculosis (TB) cases defined through restriction fragment length polymorphism (RFLP) analysis (for isolates with >6 IS6110 copies) or RFLP in combination with spoligotyping (for isolates with <6 IS6110 copies) do not stray across the LSP-defined lineage boundaries. However, our data also demonstrate the poor discriminatory power of either RFLP or spoligotyping alone for these low-IS6110-copy-number isolates. We believe that this independent validation of the LSP method should encourage researchers to adopt this system in investigations aimed at elucidating the role of strain variation in TB.Infection with Mycobacterium tuberculosis, the bacillus responsible for tuberculosis (TB), still results in almost 2 million global deaths each year despite the availability of effective chemotherapy and a partially effective vaccine (bacillus Calmette-Guérin [Mycobacterium bovis BCG]) for well over half a century (43). Even though there have been real advances in our level of understanding of M. tuberculosis metabolic pathways and in the identification of potential virulenceassociated molecules since the advent of the "postgenomic era" (8), significant improvements with respect to treatment, diagnosis, and prevention of TB still remain elusive. Recent descriptions of variably expressed virulence factors and disease outcomes that are associated with particular lineages of M. tuberculosis further emphasize the layers of complexity that need to be overcome in our efforts to combat this devastating disease (6,25,31,32,38).While the fact that TB phenotypic diversity exists is no longer in dispute, there is heightened interest in epidemiological circles in establishing the relevance of this diversity to human disease. Of particular note are the recent publications suggesting that strains belonging to the M. tuberculosis W/...
ObjectivesMicroembolic signals (MES) on transcranial Doppler (TCD) predict stroke and cognitive decline. Plasma levels of total homocysteine (tHcy), a prothrombotic factor, are higher in patients with microemboli in carotid stenosis and in patients with paradoxical embolism. In this study we assessed the association between the level of tHcy and the number of MES in patients with mechanical heart valves (MHVs).MethodsTCD monitoring was performed to detect MES before and after breathing 100% oxygen and repeated every 2–4 weeks up to six times.ResultsTwenty-five patients with MHVs (mean age: 63.60±10.15 years) participated in this study; 15 were men (66.47±7.25 years) and 10 were women (59.30±12.60 years). In total, there were 126 study visits. In multiple regression, higher tHcy was associated with more MES in both preoxygenation (OR 1.34 (95% CI 1.07 to 1.68, P=0.009)) and postoxygenation (OR 1.40 (95% CI 1.07 to 1.83, P=0.01)) phases. Current smoking and the length of time between the operation and monitoring also correlated with a higher number of MES before and after breathing oxygen, particularly in women.ConclusionsHigher tHcy and smoking were associated with a higher MES count in both preoxygenation and postoxygenation phases. Because smoking can be stopped and hyperhomocysteinaemia is treatable, these are clinically important findings.
Introduction: Paraneoplastic limbic encephalitis is a non-metastatic complication of malignant disease characterized by subacute neuropsychiatric symptoms and short-term memory deficits. Case: We present an atypical case of a 38-year-old, previously healthy female with recurrent seizures, severe persistent short-term memory loss, and emotional lability. The patient was diagnosed with autoimmune limbic encephalitis confirmed by magnetic resonance imaging findings and positive anti-Yo antibodies. She screened negative for occult malignancies. The patient responded to daily prednisone and intravenous immunoglobulins and her cognitive deficits were resolved. Conclusion: This is an unusual case of autoimmune encephalitis as anti-Yo antibodies are typically associated with cerebellar dysfunction. Our patient’s case adds to the one other published case showing induction of limbic encephalitis due to anti-Yo antibodies, and prompts consideration of paraneoplastic anti-Yo limbic encephalitis as a rare cause of symptoms in patients with limbic encephalitis-like symptoms and no known etiology.
An 82-year-old woman presented to the emergency department with a one-day history of vomiting and vertigo. She did not have a headache, neck pain or history of recent trauma. She reported jaw pain two months prior to presentation, which had spontaneously resolved.Her past medical history included type 2 diabetes mellitus, hypothyroidism, and hypercholesterolemia. She was taking metformin 500 mg twice daily, levothyroxine 25 mcg daily, simvastatin 40 mg daily and acetylsalicylic acid (ASA) 81 mg daily.She was a lifelong non-smoker. Physical ExaminationOn examination, she had right-beating nystagmus on right gaze. Power was normal with the exception of grade 4/5 strength in her left deltoid. There was finger-to-nose dysmetria on the left side, dysdiadochokinesia with the left hand, and an unsteady gait. The remainder of her physical exam was unremarkable. NEURORADIOLOGY: DR. LEEMagnetic resonance imaging (MRI) demonstrated bilateral posterior inferior cerebellar artery distribution infarcts (larger on the left) with diffusion restriction, as well as two small right pontine perforator infarcts. The 3D phase contrast magnetic resonance angiography (MRA) showed absence of identifiable flow in both distal vertebral arteries, and T2 MRI showed an absence of intradural flow void in the left vertebral artery ( Figure 1). Digital subtraction angiography (DSA) was not performed, considering the patient's age and the presence of a stroke. Collateral circulation to the basilar and vertebral arteries was presumed to be from both posterior communicating arteries, which were of reasonable calibre. CASE PRESENTATION: DR. MATTIAThe patient was admitted to hospital. Aspirin was discontinued, and she was started on clopidogrel (75mg daily). Investigations did not reveal a cardiac source for her stroke.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.