A large outbreak of Shiga toxin (Stx)-producing enteroaggregative Escherichia coli (EAEC) O104:H4 occurred in northern Germany. From this outbreak, at least 900 patients developed hemolytic uremic syndrome (HUS), resulting in more than 50 deaths. Thirty percent of the HUS patients showed encephalopathy. We previously established a mouse model with encephalopathy associated with blood brain barrier (BBB) damage after oral infection with the Shiga toxin (Stx) 2c-producing Escherichia coli O157: H- strain E32511 (E32511). In this model, we detected high expression of the Stx receptor synthase enzyme, glycosphingolipid globotriaosylceramide (Gb3) synthase, in endothelial cells (ECs) and neurons in the reticular formation of the medulla oblongata by in situ hybridization. Caspase-3 was activated in neurons in the reticular formation of the medulla oblongata and the anterior horn of the spinal cord. Astrocytes (ASTs) were activated in the medulla oblongata and spinal cord, and a decrease in aquaporin 4 around the ECs suggested that BBB integrity was compromised directly by Stx2c or through the activation of ASTs. We also report the effectiveness of azithromycin (AZM) in our model. Moreover, AZM strongly inhibited the release of Stx2c from E32511 in vitro.

Rats are known to be the most important reservoirs of Leptospira spp. However, the leptospiral dose and age at which rats become resistant to Leptospira infection are not yet well elucidated. Aimed to characterize leptospirosis in rat pups, we found that suckling pups (4-, 7-, and 14-day old) are susceptible to leptospires and resistance starts from the weaning age (23-day old). Susceptibility of rat pups was also affected by the infecting dose of the organisms. Jaundice, decrease in body weight, and neurological symptoms prior to moribundity was evident in infected suckling pups. However, 23-day-old infected pups did not manifest any pathological changes and were able to survive the infection similar to adult rats. Based on these results, we propose the suckling rat pup as a novel animal model of human leptospirosis to investigate pathogenesis, development of host resistance, and the mechanisms involved in rats becoming maintenance hosts for leptospires.

BACKGROUND:Nasopharyngeal Angiofibroma is a rare neoplasm in the sphenopalatine foramen. This tumour is histologically benign, but clinically malignant because it can erode the bone and surrounding structures, such as the pterygopalatine fossa, paranasal sinuses, and nasal cavity. It is a highly vascular tumour, sometimes from multiple Feeding arteries, and tends to bleed easily.CASE PRESENTATION:In these cases, series, we reported four cases of nasopharyngeal angiofibroma in children and one case in an elderly patient. The diagnosis was made by history taking, physical examination and Cerebral MSCT Angiography, as well as Digital Subtraction Angiography (DSA). After identification of the Feeding artery, we performed transarterial embolisation using polyvinyl alcohol (PVA) foam particles.CONCLUSION:Preoperative embolisation in the highly vascular tumour, such as nasopharyngeal angiofibroma, is very useful to reduce peri-operative complication of surgery. This procedure can reduce blood loss during resection of the tumour and gives better outcomes.

No abstract

Leptospirosis is a worldwide zoonosis. The importance of urban leptospirosis is recognized in Japan: urban rats carry pathogenic leptospires and people acquire these pathogens through contact with surface water or soil contaminated by the urine of the infected animals. To determine the current Leptospira carriage rate in urban rats, 29 wild rats were trapped in the central area of Fukuoka and strains isolated from their kidneys and urine analyzed. When semi-solid Korthof's medium containing 0.1% agar was used for isolation, 72.2% and 30.8% of the kidney and urine cultures, respectively, were found to be Leptospira-positive. The isolates belonged to Leptospira interrogans, and were classified into two groups (serogroups Pomona and Icterohaemorrhagiae) based on the results of gyrB sequence analysis and microscopic agglutination testing (MAT). Strains belonging to serogroup Icterohemorrhagiae grew well in liquid medium. On the other hand, serogroup Pomona isolates multiplied very little in liquid medium, but did grow in a semi-solid medium. Although strains belonging to serogroup Pomona have not been recognized as native to Japan, this strain may be widely distributed in urban rats. Representative strains from each group were found to be highly pathogenic to hamsters. Our findings should serve as a warning that it is still possible to become infected with leptospires from wild rats living in inner cities of Japan. Furthermore, the use of semisolid medium for culture will improve the isolation rate of leptospires from the kidneys of wild rats.

Aspilet dan Clopidogrel merupakan antiplatelet yang dapat digunakan tunggal maupun kombinasi, beberapa penelitian telah dilakukan dengan membandingkan efektivitas keduanya menunjukkan tidak ada perbedaan yang signifikan. Di Indonesia, belum pernah dilakukan penelitian mengenai manfaat dan efek samping penggunaan Clopidogrel tunggal maupun kombinasi Clopidogrel-Aspilet. Tujuan penelitian untuk mengetahui efektivitas penggunaan Clopidogrel tunggal dan kombinasi Clopidogrel-Aspilet untuk mencapai nilai normal Protrombin Time (PT) dan Activated Partial Thromboplastin Time (APTT) serta perbaikan klinis berdasarkan Barthel Index (BI) dan melihat efek samping penggunaan terapi terhadap gastrointestinal. Desain penelitian yang digunakan adalah penelitian observasional prospektif dan retrospektif. Jumlah sampel 26 pasien, terdiri dari penggunaan Clopidogrel tunggal (kelompok I) dan kombinasi Clopidogrel-Aspilet (kelompok II). Hasil pemeriksaan PT sebelum pemberian terapi, pada kelompok I (9,46+0,518) dan kelompok II (9,65+0,688) dengan nilai p=0,545, nilai APTT pada kelompok I (21,30+0,630) dan kelompok II (21,53+1,198), nilai p=0,920. Setelah memperoleh terapi tampak bahwa perubahan nilai PT terhadap kelompok I (11,38+1,120) dan kelompok II (11,00+0,912) memperlihatkan tidak ada perbedaan bermakna diantara keduanya (p=0,396). Demikian juga nilai APTT terhadap kelompok I (24,46+1,853) dan kelompok II (23,61+2,063), nilai (p=0.186). Outcome klinis berdasarkan BI pada kelompok I dan II memberikan efek yang sama dengan nilai p sebelum pemberian 0,685 dan setelah pemberian p=0,297. Berdasarkan kejadian efek samping pada kelompok I sebanyak 3 pasien (23,1%) dan kelompok II sebanyak 10 pasien (76,9%) mengalami nyeri ulu hati, dengan nilai p=0,006. Dari penelitian yang telah dilakukan disimpulkan bahwa, penggunaan terapi Clopidogrel 75 mg tablet tunggal lebih efektif dibandingkan dikombinasi dengan Aspilet 80 mg chewable

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is widely used in various neurological cases. rTMS is an effective method of restoration in patients with disability due to central nervous system disorder. AIM: This study aimed to determine the effect of high and low frequency of rTMS on serum brain-derived neurotropic factor (BDNF) levels and motoric abilities in ischemic stroke patients. METHODS: The study design was an experiment with a purposive sampling consecutive on 27 samples with the onset of ischemic stroke 6 months. The study was conducted from February to October 2018; samples were recruited from Neurology Ward of Wahidin Sudirohusodo hospital and its affiliating centers. The serial of rTMS intervention was delivered in “Brain” Clinic center. After fulfilling the inclusion criteria and the initial examination of serum BDNF and motor ability, samples were randomly divided into two groups, intervention group who received standard therapy with rTMS therapy (n = 14) and the control group who only received standard therapy (n = 13). rTMS was given for 2 min frequency of 1 Hertz (Hz) contralesion and 5 Hz ipsilesion every day for 10 days. Assessment of serum BDNF levels and motor skills was conducted on days 1 and 10 of the study. Serum BDNF levels were measured by the monoclonal antibody ELISA technique while motor skills were measured based on the score of the Stroke Rehabilitation Assessment of Movement (STREAM). Serum BDNF values and the STREAM delta score were compared between the two groups of samples. RESULTS: The results showed significant changes only occurred in motor abilities in both groups of samples after 10 days of rTMS therapy with the Wilcoxon test (p < 0.5). The Mann–Whitney U-test showed a more significant change (p < 0.5) in the treatment group than in the control (p = 0.5). CONCLUSION: rTMS has an effect on improving motor ability in ischemic stroke patients. This change in motor abilities is not related to serum BDNF levels in this study.

No abstract