A Fatal Fungal Infection: Cryptococcus gattii (VGI) Meningitis in Texas.

Cryptococcus gattii is an underrecognized cause of meningitis, especially in nonendemic regions. This report details C gattii disease progression from admission to autopsy in an otherwise healthy 40-year-old male in Texas. It brings awareness to an often unsuspected organism that can cause severe infection requiring early recognition and treatment in immunocompetent individuals.

Management of BCG failure in non-muscle-invasive bladder cancer the present and the future.

Bladder neoplasms are still among the most common cancer types in the Czech Republic. Even though the majority (more than 90%) of bladder tumours are of urothelial origin, the group is vastly heterogeneous in terms of biological behaviour and thus also progression of the disease. Adequate adjuvant treatment is the cornerstone of the therapy in high-risk patients for disease recurrence, particularly those with a high risk of progression to a muscle-invasive disease (T2 and higher). Intravesical BCG immunotherapy still remains such a therapy. It is a standard therapy with well-established efficacy as regards the recurrence rate and a reduced risk of progression. Nevertheless, radical cystectomy is recommended in patients in whom this therapy fails. Considering the non-negligible morbidity and mortality associated with this type of surgery, intensive research efforts have been put forth to develop new bladder preserving strategies. This article outlines the main bladder preserving strategies that are currently explored.

Early Clinical Experience with Delafloxacin: A Case Series.

BACKGROUND: The most recently approved fluoroquinolone for use in the US and Europe, delafloxacin (DLX) provides broad-spectrum coverage, improved side effect profile, and excellent potency. Currently approved for the treatment of acute bacterial skin infections and community-acquired pneumonia, DLX may be useful in the treatment of other infections given the longstanding versatility of other fluoroquinolones. MATERIALS AND METHODS: This is a retrospective review of adult patients treated with DLX at The University of Texas Medical Branch, Galveston, TX from January 1, 2018 to February 1, 2020 using pre-existing electronic medical records. Simple statistics were calculated using Microsoft Excel. RESULTS: Five patients were prescribed DLX (median age 59 years, 40% female, 100% outpatient) with a median treatment duration of seven days. Prescriptions were initiated by infectious diseases specialists (2/5, 40%), emergency medicine physicians (2/5, 40%), and ophthalmologists (1/5, 20%).  The most common conditions treated were prosthetic joint infections (PJI) and acute skin and soft tissue infections (each n = 2). Both PJIs were caused by multi-drug-resistant Staphylococcus epidermidis. Off-label utilization was high (3/5, 60%). No patient experienced any documented treatment failure due to delafloxacin and there were zero reported adverse events. CONCLUSIONS: A new antibiotic with valuable characteristics, DLX treatment was highly successful in this case series, including with multiple off-label indications. Real-world clinical data with delafloxacin are currently scant. Prospective data would be useful for identifying future clinical niches for this new fluoroquinolone.

Extensively Drug-Resistant Acinetobacter baumannii Nosocomial Pneumonia Successfully Treated with a Novel Antibiotic Combination.

Extremely drug-resistant (XDR) Acinetobacter baumannii causes challenging nosocomial infections. We report the case of a patient with XDR A. baumannii pneumonia and septic shock successfully treated with cefiderocol and a novel antibiotic obtained via expanded access protocol. With focused research and drug development efforts, the poor outcomes associated with these infections may be mitigated.

[Genetically determined thrombophilia as a cause of acute abdomen]. / Geneticky podmienený trombofilný stav ako prícina náhlej brusnej príhody.

We report the case of a young patient with unknown, genetically caused thrombophilia in whom thrombosis of the main portal vein developed as well as of the hepatic branches and the superior mesenteric vein with necrosis of the small intestine. Partial resection of the small intestine was performed and conservative management of portal vein thrombosis with a therapeutic dose of LMWH was indicated. Key words: thrombophilia - thrombosis of the portal vein.

[Injury to the abdominal wall by a foreign body with a late perforation of the GIT]. / Poranenie brusnej steny cudzím telesom s neskorou perforáciou GITu.

The authors present the case of a patient with an abdominal puncture wound who developed, in two weeks, perforation of the colon with an unrecognized foreign body in the abdominal cavity.

[GIST as an acute abdomen]. / GIST ako náhla brusná príhoda.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. The authors present the rare common case localisation tumor in hepatal flexure of colon, witch presented as acute abdominal situation.

Social and emotional functioning following bilateral and unilateral neurosurgical prefrontal cortex lesions.

Alterations in emotional and social functioning such as impaired ability to recognize emotions in others, a lack of empathy and poor insight have commonly been reported following prefrontal cortex damage. This study sought to investigate the subtleties of such difficulties in 34 individuals with discrete unilateral and bilateral neurosurgical lesions encroaching on the orbitofrontal, medial, and dorsolateral regions of the prefrontal cortex. A specifically devised self- and informant report measure, the social-emotional questionnaire was used to examine five factors of functioning: emotion recognition; empathy; social conformity; antisocial behaviour; and sociability. There were some specific significant differences between the clinical and control groups' informant-ratings in certain domains of social and emotional functioning. Individuals with damage involving the orbitofrontal region were reported to display elevated levels of antisocial behaviour. Individuals with bilateral orbitofrontal lesions were rated as showing significantly reduced social and emotional functioning in comparison with individuals with unilateral lesions and controls. In addition, individuals with bilateral lesions had significantly less insight overall regarding their social-emotional abilities. The right unilateral lesion group showed significantly less insight into their abilities to recognize emotion in others in comparison with the left unilateral group. In conclusion, these results suggest that specific social-emotional and insight deficits may form separate constellations of impairment. The findings also indicate that marked changes in social and emotional functioning are more likely following bilateral damage, and unilateral lesions do not inevitably lead to impairments.

[Injuries of posterior duodenal wall]. / Poranenie zadnej steny duodena.

Traumatic injury to the back wall of the duodenum is a rare injury now. Due to rapid development of retroperitoneal flegmona from unknown damage to retroperitoneal wall of the duodenum it is necessary its early diagnosis. In the mentioned case we recall the perforating injury of the abdominal cavity with a back injury of the duodenal wall and its successful treatment by primary suture.

[Acute abdomen following duodenal biopsy]. / Náhla príhoda brusná po biopsii duodena.

One possibility of verifying malabsorbtion is by doing a biopsy of the duodenal mucosa for a histochemical examination. The authors present a complicated biopsy with a duodenal intramural haematoma, with caused signs of an ileus condition and of haemoperitoneum.

Reward-related reversal learning after surgical excisions in orbito-frontal or dorsolateral prefrontal cortex in humans.

Neurophysiological studies in primates and neuroimaging studies in humans suggest that the orbito-frontal cortex is involved in representing the reward value of stimuli and in the rapid learning and relearning of associations between visual stimuli and rewarding or punishing outcomes. In the present study, we tested patients with circumscribed surgical lesions in different regions of the frontal lobe on a new visual discrimination reversal test, which, in an fMRI study (O'Doherty, Kringelbach, Rolls, Hornak, & Andrews, 2001), produced bilateral orbito-frontal cortex activation in normal subjects. In this task, touching one of two simultaneously presented patterns produced reward or loss of imaginary money delivered on a probabilistic basis to minimize the usefulness of verbal strategies. A number of types of feedback were present on the screen. The main result was that the group of patients with bilateral orbito-frontal cortex lesions were severely impaired at the reversal task, in that they accumulated less money. These patients often failed to switch their choice of stimulus after a large loss and often did switch their choice although they had just received a reward. The investigation showed that bilateral lesions were required for this deficit, since patients with unilateral orbito-frontal cortex (or medial prefrontal cortex) lesions were not impaired in the probabilistic reversal task. The task ruled out a simple motor disinhibition as an explanation of the deficit in the bilateral orbito-frontal cortex patients, in that the patients were required to choose one of two stimuli on each trial. A comparison group of patients with dorsolateral prefrontal cortex lesions was in some cases able to do the task, and in other cases, was impaired. Posttest debriefing showed that all the dorsolateral prefrontal patients who were impaired at the task had failed to pay attention to the crucial feedback provided on the screen after each trial about the amount won or lost on each trial. In contrast, all dorsolateral patients who paid attention to this crucial feedback performed normally on the reversal task. Further, it was confirmed that the bilateral orbito-frontal cortex patients had also paid attention to this crucial feedback, but in contrast had still performed poorly at the task. The results thus show that the orbital prefrontal cortex is required bilaterally for monitoring changes in the reward value of stimuli and using this to guide behavior in the task; whereas the dorsolateral prefrontal cortex, if it produces deficits in the task, does so for reasons related to executive functions, such as the control of attention. Thus, the ability to determine which information is relevant when making a choice of pattern can be disrupted by a dorsolateral lesion on either side, whereas the ability to use this information to guide behavior is not disrupted by a unilateral lesion in either the left or the right orbito-frontal cortex, but is severely impaired by a bilateral lesion in this region. Because both abilities are important in many of the tasks and decisions that arise in the course of daily life, the present results are relevant to understanding the difficulties faced by patients after surgical excisions in different frontal brain regions.

Changes in emotion after circumscribed surgical lesions of the orbitofrontal and cingulate cortices.

To analyse the functions of different parts of the prefrontal cortex in emotion, patients with different prefrontal surgical excisions were compared on four measures of emotion: voice and face emotional expression identification, social behaviour, and the subjective experience of emotion. Some patients with bilateral lesions of the orbitofrontal cortex (OFC) had deficits in voice and face expression identification, and the group had impairments in social behaviour and significant changes in their subjective emotional state. Some patients with unilateral damage restricted to the OFC also had deficits in voice expression identification, and the group did not have significant changes in social behaviour or in their subjective emotional state. Patients with unilateral lesions of the antero-ventral part of the anterior cingulate cortex (ACC) and/or medial Brodmann area (BA) 9 were, in some cases, impaired on voice and face expression identification, had some change in social behaviour, and had significant changes in their subjective emotional state. Patients with unilateral lesions of the OFC and of the ACC and/or medial BA 9 were, in some cases, impaired on voice and face expression identification, had some changes in social behaviour, and had significant changes in their subjective emotional state. Patients with dorsolateral prefrontal cortex lesions or with medial lesions outside ACC and medial BA 9 areas (dorsolateral/other medial group) were unimpaired on any of these measures of emotion. In all cases in which voice expression identification was impaired, there were no deficits in control tests of the discrimination of unfamiliar voices and the recognition of environmental sounds. Thus bilateral or unilateral lesions circumscribed surgically within the OFC can impair emotional voice and/or face expression identification, but significant changes in social behaviour and in subjective emotional state are related to bilateral lesions. Importantly, unilateral lesions of the ACC (including some of medial BA 9) can produce voice and/or face expression identification deficits, and marked changes in subjective emotional state. These findings with surgically circumscribed lesions show that within the prefrontal cortex, both the OFC and the ACC/medial BA 9 region are involved in a number of aspects of emotion in humans including emotion identification, social behaviour and subjective emotional state, and that the dorsolateral prefrontal areas are not involved in emotion in these ways.

The role of the vertical meridian in visual memory for objects.

It is widely believed that, in human and nonhuman primates, visual memories of objects are stored in the temporal lobe. Electrophysiological results in monkeys, however, indicate that when a visual scene contains two or more objects, with at least one object in each visual hemifield, neurons in the temporal lobe of each hemisphere respond only to the objects that are in the contralateral visual hemifield, and their activity is unaffected by the objects in the ipsilateral hemifield. Putting these two premises together predicts that object memory should fail, or at least suffer a substantial decrement, when an object is presented for learning and retention as part of such a scene, but crosses the vertical meridian between the learning trial and the retention test. The effect of this change should be much greater than the effect of an equal retinal translation that crosses the horizontal rather than the vertical meridian. An experiment with normal human subjects verified this prediction under conventional conditions of tachistoscopic viewing, with a single constant fixation spot. A further condition in the same experiment, however, tested the same retinal translations in a more naturalistic condition, where the retinal changes were produced by varying the position on the display screen of the fixation spot rather than of the objects. Here, there was no significant special effect of crossing the vertical meridian. We conclude that visual memories are not stored exclusively in the temporal lobe.

Abstract reward and punishment representations in the human orbitofrontal cortex.

The orbitofrontal cortex (OFC) is implicated in emotion and emotion-related learning. Using event-related functional magnetic resonance imaging (fMRI), we measured brain activation in human subjects doing an emotion-related visual reversal-learning task in which choice of the correct stimulus led to a probabilistically determined 'monetary' reward and choice of the incorrect stimulus led to a monetary loss. Distinct areas of the OFC were activated by monetary rewards and punishments. Moreover, in these areas, we found a correlation between the magnitude of the brain activation and the magnitude of the rewards and punishments received. These findings indicate that one emotional involvement of the human orbitofrontal cortex is its representation of the magnitudes of abstract rewards and punishments, such as receiving or losing money.

Differential cognitive effects of colloid cysts in the third ventricle that spare or compromise the fornix.

A series of twelve cases, all of whom had received surgery for the removal of a colloid cyst in the third ventricle, was examined on a series of memory tests. The only consistent predictor of poor memory performance that could be detected from MRIs was the presence of bilateral interruption of the fornix, which occurred in three of the subjects. Although these three cases were poor on tests of learning and recall, there was evidence that recognition was less impaired. The subjects were also tested on a set of recognition and concurrent discriminations that closely matched tests given to non-human primates. Clear parallels were found between the apparent effects of fornix damage in these clinical cases and those observed following more selective surgery in non-human primates. These findings not only indicate that fornix damage is sufficient to induce anterograde amnesia but also support the validity of recent animal tests that are thought to capture aspects of episodic memory.

Counseling in audiology, or learning to listen: pre- and post-measures from an audiology counseling course.

Because of a "technology explosion," audiologists have more options than ever in providing for their patients' hearing needs. However, relatively few individuals with hearing loss seek out amplification, and those who do frequently report dissatisfaction with the quality of their interactions with audiologists. Most audiologists did not have coursework in counseling in their graduate programs, which may account for patient complaints. As part of a course development evaluation of an audiology counseling course, a preliminary study was conducted to examine two student learning objectives: to learn how to differentiate between content messages and affective messages and to learn how to respond to each type of message appropriately. Pre- and postcourse data collected from two cohorts of audiology graduate students indicated that (a) before taking the course, students were likely to provide informational responses to personal adjustment comments (a type of "communication mismatch"), and (b) at the end of the class, they were much more likely to match or mirror affective statements with affective responses.