Publications by authors named "David Prentice"

56 Publications

Reply to chicken or the egg: an unusual presentation of Crohn disease.

Intern Med J 2022 Jul;52(7):1288

School of Medicine, Curtin University, Perth, Western Australia, Australia.

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http://dx.doi.org/10.1111/imj.15838DOI Listing
July 2022

Osmotic demyelination syndrome: novel risk factors and proposed pathophysiology.

Intern Med J 2022 Jun 19. Epub 2022 Jun 19.

Neurological Intervention & Imaging Service of WA (NIISwa), Royal Perth and Sir Charles Gairdner Hospitals, Perth, Western Australia.

Background: Osmotic demyelination syndrome (ODS) is non inflammatory demyelination in response to an osmotic challenge. It can be pontine or extrapontine in presentation AIM: Retrospective review of cases involving ODS and define the spectrum of causes, risk factors, clinical and radiological presentations, and functional outcomes.

Results: The study utilized data from 15 patients with a mean age of 53.6 years. Malnutrition 9 (60%) and chronic alcoholism 10 (66.7%) were the most common associated disorders. 2 patients (13.3%) had severe hyponatremia (<120 mmol/L). The average highest single-day change was 5.1mmol/L. Radiologically, 14 (93.3%) had pontine and 6 (60%) had extra-pontine lesions. Hypokalemia 14 (93.3%) and hypophosphatemia 9 (60%) were commonly associated. Common clinical manifestations include altered consciousness/encephalopathy 9 (60%), dysphagia 4 (26.7%) and limb weakness 4 (26.7%). At 3 months, 2 (14.3%) had died and 6 (42.9%) were functionally independent (modified Rankin scale 0-2).

Conclusion: We found that ODS occurred despite appropriate correction rates of hyponatremia. Factors such as malnutrition, chronic alcoholism, hypokalemia, and hypophosphatemia are thought to play a role in its pathogenesis. Approximately half of the patients survived and became functionally independent. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/imj.15855DOI Listing
June 2022

Clinical and neuroimaging features of a familial pathogenic ACTA2 variant as a model of a vascular neurocristopathy.

Neuroradiology 2022 Sep 14;64(9):1773-1780. Epub 2022 Apr 14.

Western Australian National Imaging Facility, The University of Western Australia (UWA), Royal Perth Hospital (RPH), 197 Wellington Street, Perth, WA, 6000, Australia.

The clinical and neuroimaging findings of a family with a variant ACTA2 gene (c351C > G), presenting with smooth muscle dysfunction in structures of neural crest derivation, are discussed. The combination of aortic abnormalities, patent ductus arteriosus, congenital mydriasis and distinctive cerebrovascular and brain morphological abnormalities characterise this disorder. Two sisters, heterozygous for the variant, and their mother, a mosaic, are presented. Brain parenchymal changes are detailed for the first time in a non-Arg179His variant. Radiological features of the petrous canal and external carotid are highlighted. We explore the potential underlying biological and embryological mechanisms.
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http://dx.doi.org/10.1007/s00234-022-02945-6DOI Listing
September 2022

Clonal cytopenia of undetermined significance and atypical Behçet's: the importance of zinc.

BMJ Case Rep 2022 Mar 29;15(3). Epub 2022 Mar 29.

Haematology, Royal Perth Hospital, Perth, Western Australia, Australia

Atypical Behçet's is recognised in myelodysplastic syndrome (MDS) cases and is associated with trisomy 8. Clonal cytopenia of undetermined significance (CCUS) is recognised as a precursor to MDS. Our case describes the presentation of atypical Behçet's, in association with CCUS, post a Streptococcal infection. A mutation of a zinc finger RNA spliceosome, ZRSR2, is also described. Our patient initially presented with macrocytic anaemia, together with neutropenia and lymphocytopenia on routine monitoring. Later gastrointestinal symptoms together with oral and anal ulcerations developed. He was treated with oral zinc therapy and had resolution of recurrent oral ulcerations and significant reduction in severity of anal ulcerations. The functional impact of ZRSR2 mutation on spliceosome assembly is yet to be defined, but has been previously reported in CCUS with a clinical phenotype of macrocytic anaemia.
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http://dx.doi.org/10.1136/bcr-2021-247154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966545PMC
March 2022

Anti-Müllerian hormone concentration is associated with central adiposity and reproductive hormones in expectant fathers.

Clin Endocrinol (Oxf) 2022 Mar 23. Epub 2022 Mar 23.

Medical School, University of Western Australia, Perth, Western Australia, Australia.

Objective: The role of the anti-Müllerian hormone (AMH) as an indicator of physical and reproductive health in men is unclear. We assessed the relationships between AMH and follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and metabolic parameters, in a cohort of expectant fathers.

Design: ORIGINS Project prospective cohort study.

Setting: Community-dwelling men.

Participants: Partners of pregnant women attending antenatal appointments.

Main Outcome Measures: Serum AMH, FSH, LH, testosterone, and metabolic parameters.

Results: In 485 expectant fathers, median age 33 years, median AMH was 40 pmol/L (quartiles 29, 56). AMH was inversely correlated with FSH, age, and body mass index (BMI) (correlation coefficients: -.32, -.24, and -.17 respectively). The age association was nonlinear, with peak AMH between 20 and 30 years, a decline thereafter, and somewhat steady levels after 45 years. The inverse association of AMH with FSH was log-linear and independent of age and BMI (β: -.07, SE: 0.01, p < .001). AMH was inversely correlated with waist circumference and directly associated with sex hormone-binding globulin. Testosterone was moderately correlated with AMH (correlation coefficient: .09, β: .011, SE: 0.004, p = .014): this association was mediated by an inverse relationship with BMI (mediated proportion 0.49, p < .001).

Conclusions: In reproductively active men, lower AMH is a biomarker for advancing age, and for poorer metabolic and reproductive health. The inverse association between AMH and FSH is independent of age and BMI, whereas the association of AMH and testosterone is mediated via BMI. The utility of AMH to predict reproductive and cardiometabolic outcomes in men warrants further investigation.
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http://dx.doi.org/10.1111/cen.14725DOI Listing
March 2022

Cough as a clinical manifestation of large vessel vasculitis.

Intern Med J 2022 Mar;52(3):488-490

Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.

Cough is not a widely recognised symptom of large vessel vasculitides. If not promptly diagnosed and treated, large vessel vasculitis can have serious clinical consequences. We present the case of a 76-year-old man who presented with a subacute history of persistent dry cough, was found to have extensive aortitis on imaging, and experienced rapid resolution of symptoms with immunosuppression.
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http://dx.doi.org/10.1111/imj.15710DOI Listing
March 2022

Alcoholic pontine myelinolysis: beware the stroke mimic.

BJR Case Rep 2021 Jul 23;7(4):20210005. Epub 2021 Mar 23.

Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia.

Central pontine myelinolysis (CPM), often referred to as osmotic demyelination syndrome, is most commonly seen in the setting of rapid correction of hyponatraemia. Although imaging is the key to diagnosis, conventional CT and MRI findings often lag the clinical manifestations and characteristic MRI changes may be delayed by up to 14 days. We present a case of a 45-year-old female with an extensive history of alcohol misuse and malnutrition who presented with left hemiparesis, initially suspected to be a stroke. This was following a recent hospital admission when she was managed for Wernicke's encephalopathy and treated with electrolyte and vitamin replacement. As part of a "code stroke" protocol, CT was initially performed. The initial non-contrast CT brain and CT angiogram of the intracranial arteries were normal, but a CT brain perfusion study demonstrated increased pontine blood flow. A subsequent MRI of the brain confirmed CPM, which was congruent with her clinical course. This case highlights the importance of osmotic demyelination as a stroke mimic. CPM should be considered in alcoholic patients with neurological impairment regardless of serum sodium. To our knowledge, this is the first published case which illustrates CT perfusion changes in CPM. MRI, however, remains essential for diagnosis.
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http://dx.doi.org/10.1259/bjrcr.20210005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749399PMC
July 2021

Intracerebral haemorrhage and Guillain-Barré syndrome: an exploration of potential pathophysiology.

BMJ Case Rep 2021 Aug 3;14(8). Epub 2021 Aug 3.

General Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.

Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy classically thought to be caused by infections through the process of molecular mimicry. We report a case of GBS caused by intracerebral haemorrhage and postulate potential theories for the development of GBS following intracerebral haemorrhage and other non-infectious aetiologies by association. We highlight that GBS is an important differential diagnosis in patients developing generalised paresis following intracerebral haemorrhage.
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http://dx.doi.org/10.1136/bcr-2021-243245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336193PMC
August 2021

Primary leptomeningeal melanoma: the prognostic significance of its genetic signature and embryological origin.

BMJ Case Rep 2021 May 24;14(5). Epub 2021 May 24.

Perron Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia.

Primary leptomeningeal melanomas are rare, comprising less than one percent of all brain tumours. They are aggressive and radioresistant tumours, with a poor prognosis. The mainstay of treatment is complete surgical resection and chemotherapy with limited success. Distinguishing a primary leptomeningeal melanoma from the more common metastatic disease can be difficult, and often requires the use of ancillary molecular testing. Primary central nervous system melanomas, including uveal melanomas, frequently exhibit mutations in GNAQ and GNA11, rare in the cutaneous and mucosal counterparts.A case of a primary leptomeningeal melanoma of the cerebellopontine angle is described. Molecular studies identified a GNA11 p.Q209L and a KIT p.M541L missense variant, with losses of chromosomes 1p and 3p demonstrated with cytogenetic studies. Complete surgical resection was not possible and leptomeningeal metastatic disease rapidly ensued despite immunotherapy. Further understanding of the molecular signature may translate to improved diagnosis, prognostication and development of targeted therapies.
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http://dx.doi.org/10.1136/bcr-2020-239496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154691PMC
May 2021

Human Fetal Tissue from Elective Abortions in Research and Medicine: Science, Ethics, and the Law.

Issues Law Med 2020 ;35(1):3-61

Charlotte Lozier Institute, Arlington, VA.

Since the U.S. Supreme Court issued its landmark decision in 1973 to legalize abortion, over 60 million preborn have been killed by elective abortion. While alive in the womb, these preborn are abandoned and not protected under current law. But once aborted, their body parts are a highly esteemed and prized commodity amongst certain members of the scientific community. Moral discourse is disregarded for the sake of science. The public have been lulled and lured into believing that this practice must continue in order to understand and develop cures for some of the most debilitating diseases of our day. But they are mistaken. This practice is not necessary, especially in light of numerous noncontroversial alternatives. Here, we expose and consider the false and misleading claims regarding human fetal tissue (HFT) in research from scientific, legal, and ethical points of view. We endeavor deeply to understand the depth of the injustice in this practice and what forces promote and maintain it; and by revealing and understanding these forces, we set forth how these inhumane practices can be ended. An accurate portrayal of the history of HFT use in research is provided, along with a close examination of the current state of this practice under existing laws. The serious societal implications are also discussed, which will worsen beyond comprehension if these practices are allowed to continue. The timeliness of this information cannot be overstated, and a thorough understanding is paramount for anyone who desires to know the facts about HFT in research and medicine and its detrimental impact for humanity.
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July 2021

Pramipexole-induced oedema: the importance of renal dopamine.

Intern Med J 2021 Apr;51(4):618-619

Department of General Medicine, St John of God Midland Hospital, Perth, Western Australia, Australia.

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http://dx.doi.org/10.1111/imj.15283DOI Listing
April 2021

Vascular Ehlers-Danlos Syndrome: Treatment of a Complex Abdominal Wound with Vitamin C and Mesenchymal Stromal Cells.

Adv Skin Wound Care 2021 Jul;34(7):1-6

At the Royal Perth Hospital, Perth, Western Australia, David Andrew Prentice, MBBS, FRACP, is General Physician, Department of Internal Medicine; Wendy Ann Pearson, MNg, is Clinical Nurse Consultant, Stomal Therapy Service; and Janice Fogarty, MSc, is Medical Scientist in Charge: Cell and Tissue Therapy Department. Acknowledgments: The authors thank Dr Benedict Carnley of Cell and Tissue Therapy at Royal Perth Hospital, along with the extended multidisciplinary team including psychiatry, dietetics, pain specialists, general surgeons, intensivists, gastroenterologists, palliative care, pastoral care, social work, and the multitude of nurses who cared for this patient during his extended inpatient stays. Special thanks also to his wife whose dedication brought the patient home. The authors have disclosed no financial relationships related to this article. Submitted June 26, 2020; accepted in revised form September 21, 2020; published online ahead of print April 5, 2021.

Abstract: Vascular Ehlers-Danlos syndrome (EDSv) can present with life-threatening surgical complications. The article describes the case of a patient with EDSv who developed total abdominal wound dehiscence and multiple enterocutaneous fistulas. Treatment with IV allogeneic mesenchymal stromal cells (MSCs) and high-dose vitamin C was trialed with success. Near-complete wound healing of the abdominal dehiscence with a 94% reduction in the size of the wound bed occurred. Maturation of the enterocutaneous fistulas also ensued.There is no current consensus on the management of large cutaneous wounds in EDSv. This article discusses the pathophysiology of wound healing with regard to nutrition requirements and growth factors with special reference to collagen deficits in EDSv. A potential therapy with IV vitamin C supplementation and MSCs is proposed following the patient's positive outcome. Medium-dose MSCs and high-dose IV vitamin C may offer significant benefits to complex and problematic wounds.
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http://dx.doi.org/10.1097/01.ASW.0000741524.79369.7aDOI Listing
July 2021

Retinal capillary rarefaction is associated with arterial and kidney damage in hypertension.

Sci Rep 2021 01 13;11(1):1001. Epub 2021 Jan 13.

Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia, Perth, Australia.

Microvascular disease and rarefaction are key pathological hallmarks of hypertension. The retina uniquely allows direct, non-invasive investigation of the microvasculature. Recently developed optical coherence tomography angiography now allows investigation of the fine retinal capillaries, which may provide a superior marker of overall vascular damage. This was a prospective cross-sectional study to collect retinal capillary density data on 300 normal eyes from 150 hypertensive adults, and to investigate possible associations with other organ damage markers. The average age of participants was 54 years and there was a greater proportion of males (85; 57%) than females. Multivariate, confounder adjusted linear regression showed that retinal capillary rarefaction in the parafovea was associated with increased pulse wave velocity (β = - 0.4, P = 0.04), log-albumin/creatinine ratio (β = - 0.71, P = 0.003), and with reduced estimated glomerular filtration rate (β = 0.04, P = 0.02). Comparable significant associations were also found for whole-image vascular-density, for foveal vascular-density significant associations were found with pulse wave velocity and estimated glomerular filtration rate only. Our results indicate that retinal capillary rarefaction is associated with arterial stiffness and impaired kidney function. Retinal capillary rarefaction may represent a useful and simple test to assess the integrated burden of hypertension on the microvasculature irrespective of current blood pressure levels.
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http://dx.doi.org/10.1038/s41598-020-79594-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806760PMC
January 2021

Nivolumab-associated myositis myocarditis and myasthenia and anti-striated muscle antibodies.

Intern Med J 2020 08;50(8):1003-1006

Respiratory Department, St John of God Midland Public Hospital, Perth, Western Australia, Australia.

An 82-year-old man was treated with neo-adjuvant nivolumab (programmed cell death protein 1 or PD-1 inhibitor) for local recurrence of melanoma developed myositis, myocarditis and a myasthenic-like syndrome with a fatal outcome. The occurrence of these three conditions may constitute a new immune checkpoint-induced syndrome. The relevance of the clinical features and the immunology is discussed. This case highlights the special role of anti-striated muscle antibodies as a predictor of mortality.
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http://dx.doi.org/10.1111/imj.14946DOI Listing
August 2020

Durvalumab-associated vasculitis presenting as 'the blue toe syndrome'.

BMJ Case Rep 2020 Nov 18;13(11). Epub 2020 Nov 18.

Internal Medicine, St John of Gods Hospital Midland, Perth, Western Australia, Australia.

Durvalumab is a selective, high-affinity human immunoglobulin monoclonal antibody in a class called check point inhibitors, that blocks PD-L1 on tumour cells. Despite clinical success in increasing progression-free survival rates in patients with stage III non-small-cell lung cancer, durvalumab has been associated with immune-related side effects such as pneumonitis and colitis. We present a case of an 84-year-old woman with acral vasculitis presenting as blue toe syndrome, associated with prolonged use of durvalumab. After 1 year of fortnightly durvalumab therapy postchemoradiation therapy, the patient came in with a left blue big toe, and later developed bilateral livedo racemosa. The diagnosis of durvalumab-associated vasculitis was made and treatment with prednisolone was started with clinical improvement.
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http://dx.doi.org/10.1136/bcr-2020-235886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677343PMC
November 2020

Paraneoplastic leukemoid reaction in a localised squamous cell oesophageal cancer with paracrine G-CSF production.

BMJ Case Rep 2020 Oct 10;13(10). Epub 2020 Oct 10.

Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.

A 51-year-old-man presented with symptoms and baseline investigations suggestive of an infective process. Most strikingly, there was a pronounced neutrophil predominant leucocytosis. Lack of a clinical and biochemical response to empirical antibiotic therapy, prompted imaging for a deep-seated infective process, incidentally uncovering a gastro-oesophageal junction tumour. Resection of the tumour was followed by rapid resolution of the leucocytosis. He remains in clinical remission since tumour resection and adjuvant chemotherapy. Cancer-associated leukemoid reactions in non-disseminated tumours are rare. The role of polymorphonuclear (PMN) leucocytes both in the peripheral blood and the tumour itself is discussed herein. There is increasing recognition of the importance of the non-cancer cellular components of the tumour microenvironment. Myeloid suppressor cells are a subset of PMN leucocytes which play a role in tumour progression.The role of these cells and granulocyte colony-stimulating factor is highlighted in this case.
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http://dx.doi.org/10.1136/bcr-2020-235069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552795PMC
October 2020

Tropomyosin autoantibodies associated with checkpoint inhibitor myositis.

Oncoimmunology 2020 08 12;9(1):1804703. Epub 2020 Aug 12.

School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.

This brief report details the measurement and identification of IgA antibodies to tropomyosin in a case of presumed ocular myositis with paraspinal myositis in a patient with metastatic uveal melanoma treated with checkpoint inhibitors. High-throughput functional protein microarray analysis and pathway analysis was conducted to identify IgG and IgA antibodies of interest. Antibody levels were compared to generic antibody screening results and levels of the antibodies in a cohort of melanoma patients without myositis (n = 100) at baseline prior to undergoing immunotherapy. The finding of specific muscle antibodies in this clinical case indicates the pathogenic potential of anti-tropomyosin IgA in the development of checkpoint inhibitor associated myositis and requires further investigation.
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http://dx.doi.org/10.1080/2162402X.2020.1804703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458639PMC
August 2020

Guillain-Barré syndrome and posterior reversible leukoencephalopathy syndrome: a rare association.

BMJ Case Rep 2020 Apr 20;13(4). Epub 2020 Apr 20.

Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.

A 69-year-old woman presented with headaches and visual disturbance in the context of marked hypertension secondary to non-compliance with antihypertensive medications. She developed seizures and hyperreflexia, and MRI brain showed changes consistent with posterior reversible encephalopathy syndrome (PRES). She was treated with antihypertensives with the resolution of symptoms. Over the following week, she developed progressive distal sensory loss, weakness and areflexia. The cerebrospinal fluid examination demonstrated albuminocytologic dissociation, and electrophysiological findings were in keeping with a diagnosis of Guillain-Barré syndrome (GBS). She was treated with intravenous immunoglobulin with gradual recovery. The co-occurrence of PRES and GBS has only been described in a handful of cases. In the majority of these, the dysautonomia of GBS leads to profound hypertension and subsequently PRES. This is a rare case of PRES preceding and possibly even triggering the onset of GBS. In this report, we review the literature and discuss the potential pathogenic mechanisms for this unusual association.
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http://dx.doi.org/10.1136/bcr-2019-234184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202739PMC
April 2020

High-resolution iris and retinal imaging in multisystemic smooth muscle dysfunction syndrome due to a novel Asn117Lys substitution in ACTA2: a case report.

BMC Ophthalmol 2020 Feb 24;20(1):68. Epub 2020 Feb 24.

Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, 6009, Australia.

Background: Congenital mydriasis and retinal arteriolar tortuosity are associated with the life-threatening multisystemic smooth muscle dysfunction syndrome (MSMDS) due to mutations in the gene, ACTA2, which encodes alpha-smooth muscle actin (α-SMA). Previous reports attributed MSMDS-related congenital mydriasis to the absence of iris sphincter muscle. Similarly, it has been hypothesized that abnormal proliferation of the vascular smooth muscle cells causes the marked tortuosity of retinal arterioles in MSMDS. In this report, high-resolution ocular imaging reveals unexpected findings that reject previous hypotheses.

Case Presentation: The proband is a 37-year-old female with a history of neonatal patent ductus arteriosus (PDA) ligation, left-sided choreiform movements at the age of 11 and a transient aphasia with right-sided weakness at the age of 30. Her older sister also had PDA ligation and congenital mydriasis but no neurological deficit up to age 41. Magnetic resonance angiogram demonstrated cerebrovascular lesions resembling but distinct from Moyamoya disease, characterised by internal carotid artery dilatation, terminal segment stenosis and absent basal collaterals. Their mother had poorly reactive pupils with asymptomatic cerebral arteriopathy resembling her daughters. All three had prominent retinal arteriolar tortuosity. The daughters were heterozygous and the mother was a somatic mosaic for a novel c.351C > G (p.Asn117Lys) transversion in ACTA2. Iris optical coherence tomography (OCT) showed a hyporeflective band anterior to the pigment epithelium indicating the presence of dysfunctional sphincter muscle. Adaptive optics retinal imaging showed no thickening of the arteriolar vessel wall whilst OCT angiography showed extreme corkscrew course of arterioles suggesting vessel elongation.

Conclusions: In addition to the known association between Met46, Arg179 and Arg258 substitutions and ACTA2-related arteriopathy, this case illustrates the possibility that Asn117 also plays an important role in α-SMA function within the cerebrovascular smooth muscle cell. MSMDS-related congenital mydriasis is due to reduced iris sphincter contractility rather than its absence. Retinal arteriolar tortuosity might be due to longitudinal proliferation of arteriolar smooth muscle cells. The described cerebrovascular and ocular signs are consistent with predicted effects of the novel Asn117Lys substitution in ACTA2.
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http://dx.doi.org/10.1186/s12886-020-01344-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038593PMC
February 2020

Shotgun metagenomic analysis of microbial communities from the Loxahatchee nature preserve in the Florida Everglades.

Environ Microbiome 2020 Jan 21;15(1). Epub 2020 Jan 21.

Boca Raton Community High School, Boca Raton, FL, 33486, USA.

Background: Currently, much is unknown about the taxonomic diversity and the mechanisms of methane metabolism in the Florida Everglades ecosystem. The Loxahatchee National Wildlife Refuge is a section of the Florida Everglades that is almost entirely unstudied in regard to taxonomic profiling. This short report analyzes the metagenome of soil samples from this Refuge to investigate the predominant taxa, as well as the abundance of genes involved in environmentally significant metabolic pathways related to methane production (nitrogen fixation and dissimilatory sulfite reduction).

Methods: Shotgun metagenomic sequencing using the Illumina platform was performed on 17 soil samples from four different sites within the Loxahatchee National Wildlife Refuge, and underwent quality control, assembly, and annotation. The soil from each sample was tested for water content and concentrations of organic carbon and nitrogen.

Results: The three most common phyla of bacteria for every site were Actinobacteria, Acidobacteria, and Proteobacteria; however, there was variation in relative phylum composition. The most common phylum of Archaea was Euryarchaeota for all sites. Alpha and beta diversity analyses indicated significant congruity in taxonomic diversity in most samples from Sites 1, 3, and 4 and negligible congruity between Site 2 and the other sites. Shotgun metagenomic sequencing revealed the presence of biogeochemical biomarkers of particular interest (e.g., mrcA, nifH, and dsrB) within the samples. The normalized abundances of mcrA, nifH, and dsrB exhibited a positive correlation with nitrogen concentration and water content, and a negative correlation with organic carbon concentration.

Conclusion: This Everglades soil metagenomic study allowed examination of wetlands biological processes and showed expected correlations between measured organic constituents and prokaryotic gene frequency. Additionally, the taxonomic profile generated gives a basis for the diversity of prokaryotic microbial life throughout the Everglades.
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http://dx.doi.org/10.1186/s40793-019-0352-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067648PMC
January 2020

Checkpoint inhibitor myasthenia-like syndrome and myositis associated with extraocular muscle atrophy.

J Clin Neurosci 2020 Jan 27;71:271-272. Epub 2019 Dec 27.

Perth Radiological Clinic, St John of God Midland Public Hospital, PO Box 1254, Midland, Western Australia, Australia.

A patient with metastatic melanoma developed myasthenia-like syndrome and paraspinal myositis with subsequent extraocular muscle atrophy associated with immune checkpoint inhibitor treatment. MRI scan of the ocular muscles on admission was normal, however 3 months later revealed significant extraocular muscle atrophy.
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http://dx.doi.org/10.1016/j.jocn.2019.11.038DOI Listing
January 2020

The Auckland alcohol detoxification outcome study: Measuring changes in quality of life in individuals completing a medicated withdrawal from alcohol in a detoxification unit.

Drug Alcohol Depend 2019 09 22;202:156-161. Epub 2019 Jul 22.

Planning, Funding and Outcomes, Waitemata and Auckland District Health Boards, 44 Taharoto Rd, Auckland, New Zealand. Electronic address:

Aim: To measure outcomes in Quality of Life in alcohol dependent patients' following a medicated withdrawal from alcohol.

Methods: 79 patients that were admitted to a detoxification unit in Auckland, New Zealand between March 2016 and September 2016 were assessed for severity of alcohol dependence using the Alcohol Use Disorders Identification Test (AUDIT) and Severity of Alcohol Dependency Questionnaire (SADQ) and Quality of Life (QOL) using the World Health Organisation Quality of Life-abbreviated version of the WHOQOL 100 New Zealand version (WHOQOL-BREF NZ). Patients were followed up at three months and 12 months and an estimate of drinking behavior and the WHO-QOL BREF NZ were completed via telephone interview. QOL domain scores were assessed from baseline to three months and baseline to 12 months in both relapse and abstinent groups. At three months, a single question was asked in order to collect qualitative data.

Results: At baseline, the study population had statistically significantly lower mean QOL domain scores than scores reported from the general population. QOL improved in patients following detoxification at three months and 12 months in both the relapse and abstinent groups; however, the change in scores from baseline was greater in the abstinent group compared to the relapse group. The majority of patients reported that the admission had been a positive experience.

Conclusion: QOL improves in individuals following a medicated withdrawal from alcohol regardless of whether individual's relapse; however, those that remain abstinent have greater improvements in quality of life.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.11.035DOI Listing
September 2019

A novel topical therapy for resistant and early peristomal pyoderma gangrenosum.

Int Wound J 2019 Oct 12;16(5):1136-1143. Epub 2019 Jul 12.

School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.

Peristomal pyoderma gangrenosum (PPG) is an under-recognised and difficult condition to treat. We describe a case series using a novel topical combination therapy that promotes wound healing and allows for adhesion of the stoma appliance. A crushed oral prednisolone tablet mixed with Stomahesive Protective Powder (ConvaTec) was applied topically to seven patients with PPG and resulted in pain relief and wound healing in six of seven patients. Only one patient experienced recurrence. The novel topical therapy we describe is cost-effective, readily available, and easily applied in any inpatient or outpatient setting.
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http://dx.doi.org/10.1111/iwj.13164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948605PMC
October 2019

Effect of Pupil Dilation with Tropicamide on Retinal Vascular Caliber.

Ophthalmic Epidemiol 2019 12 3;26(6):400-407. Epub 2019 Jul 3.

Perron Institute for Neurological and Translational Science, Perth, Australia.

: The retinal blood vessels reflect changes in the brain's micro-circulation and these changes have been shown to correlate with the incidence of diseases such as stroke, heart disease and Alzheimer's disease. Studies investigating the retinal vasculature routinely use pupil dilation with tropicamide to optimize image acquisition and quality. The aim of this study was to investigate the effects of tropicamide on retinal vascular parameters using retinal photography.: The study was performed on 41 healthy young subjects of both sexes, using tropicamide to dilate only the right pupil, leaving the left as a control. Pupil dilation with tropicamide resulted in reduced retinal vessel width measures based on standardized approaches, particularly reduced arteriolar caliber ( < .0005). However, closer investigation of the images revealed reduced fundus image magnification in the post-tropicamide images, based on reduced optic nerve head diameter ( < .0005) and longitudinal analysis with image registration and affine transformation ( < .0001). No change in vessel width parameters was observed after adjustment for image magnification. These results suggest that tropicamide does not change the width of the retinal vessels, however width parameters as measured by standard approaches may be reduced due to image magnification changes resulting from cycloplegia. In this study, improved optic nerve head segmentation for image scale conversion removed the magnification error. With this correction, the tropicamide intervention had no effect on vessel width parameters in young healthy people and could be utilized in future without affecting the results of retinal vascular analysis.
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http://dx.doi.org/10.1080/09286586.2019.1639198DOI Listing
December 2019

Hemidysgeusia, phantosmia and respiratory arrest: a case of CLIPPERS.

BMJ Case Rep 2019 May 30;12(5). Epub 2019 May 30.

Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia.

A 56-year-old man presented with a relapse of likely chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) after a reduction of steroid dose. MRI demonstrated new perivascular FLuid-Attenuated Inversion Recovery (FLAIR) signal hyperintensity involving the dorsal pontomedullary junction and progressing inferiorly into the dorsal medulla oblongata. His admission to hospital was complicated by a respiratory arrest.
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http://dx.doi.org/10.1136/bcr-2019-230094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557413PMC
May 2019

Cerebral embolism and carotid-hyoid impingement syndrome.

J Clin Neurosci 2019 Jun 12;64:27-29. Epub 2019 Apr 12.

Royal Perth Hospital, Western Australia, Australia. Electronic address:

Embolic stroke of undetermined source (ESUS) is not uncommon in young patients. Here, we describe two cases of stroke from an unusual aetiology; cerebral embolization from carotid artery injury presumed secondary to hyoid bone impingement. Both patients demonstrated angiographic evidence of hyoid bone impingement. Following resection of the greater cornu of the hyoid bone, neither patient had further strokes.
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http://dx.doi.org/10.1016/j.jocn.2019.03.040DOI Listing
June 2019

Recurrent abducens nerve palsy and hypophosphatasia syndrome.

BMJ Case Rep 2019 Apr 11;12(4). Epub 2019 Apr 11.

Department of Internal Medicine, Royal Perth Hospital, Perth, Australian Capital Territory, Australia.

A 47-year-old woman presented with six episodes of horizontal binocular double vision over a 2-year period. CT imaging was significant for extensive dural calcification in the spine and calcification of the skull base, likely involving Dorello's canal. Biochemical testing revealed a persistently low alkaline phosphatase level. Recurrent nerve palsy may possibly be induced by mechanical compression of the sixth cranial nerve in Dorello's canal from calcification due to hypophosphatasia syndrome.
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http://dx.doi.org/10.1136/bcr-2018-226895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506073PMC
April 2019

Adult Stem Cells.

Authors:
David A Prentice

Circ Res 2019 03;124(6):837-839

From the Advisory Board for the Midwest Stem Cell Therapy Center, University of Kansas Medical Center, Kansas City; and Charlotte Lozier Institute, Arlington, VA.

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http://dx.doi.org/10.1161/CIRCRESAHA.118.313664DOI Listing
March 2019

Lactation ketoacidosis: an easily missed diagnosis.

Intern Med J 2019 Feb;49(2):256-259

Department of Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.

Ketoacidosis is uncommon in non-diabetic women, but occurs in the postpartum period as a rare complication of continuing to breastfeed during periods of acute illness. We report a case of a lactating woman who presented with severe symptomatic ketoacidosis in the early postpartum period. We also review the pathophysiology and management of lactation ketoacidosis.
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http://dx.doi.org/10.1111/imj.14207DOI Listing
February 2019
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