Missed Anterior Inferior Cerebellar Artery Aneurysm Mimicking Vestibular Neuritis-Clues to Prevent Misdiagnosis.

We discuss a case with combined vestibulocochlear and facial neuropathy mimicking a less urgent peripheral vestibular pattern of acute vestibular syndrome (AVS). With initial magnetic resonance imaging read as normal, the patient was treated for vestibular neuropathy until headaches worsened and a diagnosis of subarachnoid hemorrhage was made. On conventional angiography, a ruptured distal right-sided aneurysm of the anterior inferior cerebellar artery was diagnosed and coiled. Whereas acute vestibular loss usually points to a benign peripheral cause of AVS, combined neuropathy of the vestibulocochlear and the facial nerve requires immediate neuroimaging focusing on the cerebellopontine angle. Imaging should be assessed jointly by neuroradiologists and the clinicians in charge to take the clinical context into account.

Synthesis of a hexahydropyrrolo indole (HPI) compound library.

Scaffolds of natural products represent promising starting points for the development of focused compound libraries. Here, we describe the development of a synthetic route to a compound library based on the hexahydropyrrolo indole (HPI) scaffold, the denoting structural motif of the HPI natural product family. To this end, a two-step approach consisting of a batch synthesis of an advanced functionalizable HPI intermediate followed by the establishment of reaction conditions that allow derivatization of this scaffold at three different positions is described. Subsequently, the optimized methods were applied to the synthesis of a 276-member library.

Prevalence and risk factors for chronic kidney disease in a rural region of Haiti.

BACKGROUND: In the Caribbean region chronic kidney disease (CKD) is an increasing challenge. High rates of non-communicable and infectious diseases and the rise in people suffering from diabetes and hypertension explain the observed and further expected increase of CKD. However, data about the magnitude of the problem are rare and in some countries such as Haiti completely lacking. The aim of our study was to generate data about the prevalence and risk factors for CKD in a rural region in Haiti. METHODS: In this prospective cross-sectional study, adult patients visiting the medical outpatient clinic of the Hôpital Albert Schweitzer (HAS) in Deschapelles Haiti were included. CKD was assessed by estimated glomerular filtration rate (eGFR) and measurement of proteinuria by dipstick test. Risk factors for CKD were assessed by clinical examinations and questionnaires. RESULTS: Overall 608 patients were screened for CKD, of whom 27% had CKD. CKD stages 1 to 2 were found in 15.3% and stages 3 to 5 in 11.7%. The prevalence of hypertension and diabetes mellitus was 49.2% and 36.3%, respectively. Risk factors independently associated with CKD were hypertension (p = 0.0002) and HIV infection (p = 0.019) and age >60 years (p = 0.0052), whereas diabetes mellitus was not independently associated (p = 0.72). CONCLUSION: Our data show a high prevalence of CKD and traditional risk factors, and their association with CKD in Haiti. These findings have now to be confirmed in other regions in longitudinal analyses as a basic step to build up screening and prevention programmes for CKD.

A prospective emergency department-based study of pattern and outcome of neurologic and neurosurgical diseases in Haiti.

OBJECTIVE: To perform the first prospective survey of neurologic and neurosurgical emergency department (ED) admissions in Haiti. METHODS: Data of all ED admissions at 3 Haitian hospitals for 90 consecutive days per site were collected prospectively. Patients who were given a diagnosis of a neurologic or neurosurgical disorder by the ED physician were entered in a deidentified database including demographics, presenting symptoms, brain imaging (when available), requests for neurosurgical consultation, and outcome. RESULTS: Of the 7628 patients admitted to the ED during this study, 1243 patients had a neurologic disorder, yielding an ED-based neurologic disease prevalence of 16%. The 3 most common neurologic diseases were cerebrovascular disease (31%), neurotrauma (28%), and altered mental status (12%). Neurosurgical pathologies represented 19% of all neurologic admissions with a combined ED-based disease prevalence of 3%. Mortality rate was 9%. The most common neurosurgical disease was neurotrauma (87%), caused by motor vehicle accidents (59%), falls (20%), and assault (17%). Neurosurgical procedures were performed in 14 of 208 patients with a mortality rate of 33%. CONCLUSIONS: This prospective survey represents the first study of neurosurgical or neurologic disease patterns in Haiti. The results suggest specific disease priorities for this population that can guide efforts to improve Haitian health care and conduct more comprehensive epidemiologic studies in Haiti.

Cholera management and prevention at Hôpital Albert Schweitzer, Haiti.

In October 2010, Hopital Albert Schweitzer Haiti treated some of the first patients with cholera in Haiti. Over the following 10 months, a strategic plan was developed and implemented to improve the management of cases at the hospital level and to address the underlying risk factors at the community level.

An unexpected and easy way of freezing the configuration of a triaryl phosphane oxide.

Configurationally stable triaryl phosphane oxides are important for reactions with transfer of chiral information. Apart from introducing bulky substituents to suppress fast inversion of helicity at room temperature, the use of a second chiral element which induces chirality in the triaryl phosphane oxide, so that it adopts only one configuration, is suitable. With regard to chirality transfer, C(2)-symmetric imidazole cyclopeptides were tested for obtaining a configurationally stable phosphane oxide. Density functional calculations showed almost equal energies of the three possible triaryl phosphane oxides (MMM)-1, (PPP)-1, and (MP)-1. Surprisingly, after synthesis only the MMM conformer is present in solution, and its configurational stability was proved by variable-temperature and 2D NMR experiments as well as CD measurements. In view of the results of the DFT calculations, formation of stable (MMM)-1 cannot be explained thermodynamically but by kinetic reaction control. This concept of freezing the conformation of a triaryl phosphane oxide can in future be used to easily prepare configurationally stable stereoisomeric propellerlike compounds.

A unidirectional open-close mechanism of metal-ion-driven molecular hinges with adjustable amplitude.

A basic requirement for each molecular system that is supposed to perform work is a synchronized and unidirectional movement. Unidirectionality can be achieved by a change of configuration or conformation that is controllable by external stimulation. Molecular hinges based on a bipyridine unit work unidirectionally and are able to reach an amplitude of motion that amounts to about 180 degrees. To analyze if it is possible to adjust the height of the unidirectional amplitude of motion, three planar chiral molecular hinge systems with a 2,2'-bipyridine unit as functional element were designed and stimulated with various divalent metal ions in different solvents. The configurations of the hinges were determined by DFT calculations using B3LYP and the 6-31G* basis set and experimentally verified by 2D NMR NOESY spectra. Circular dichroism (CD) and UV spectroscopy were used to study the properties of the hinges by the addition of metal ions (primarily Zn(2+) and Hg(2+)) in dichloromethane and methanol. The choice of metal ions and solvents determines whether or not and how far the hinges are closed. Furthermore, a drastic change in the height of the amplitude of motion can be reached by modifying the position of the bipyridine unit in the hinge. Amplitude values from 45 up to 190 degrees were obtained from quantum mechanical calculations. This control of the amplitude of motion can in the future be used for more complex switching processes of molecular machines.