A complicated prosthetic valve endocarditis due to methicillin resistant Staphylococci treated with linezolid and ciprofloxacin: a case report.

BACKGROUND: Prosthetic valve endocarditis (PVE) due to methicillin resistant Staphylococcus aureus (MRSA) is a rare disease with significant mortality and morbidity. With the emerging resistance and adverse effect profile of vancomycin which is the standard treatment, there is a compelling necessity of an effective alternative for vancomycin. Linezolid is proved as such an agent for infections caused by MRSA in other sites. However to-date the evidence for successful use of linezolid for MRSA prosthetic valve endocarditis is limited only for few case studies. We here present the third case reported as effective treatment of PVE by MRSA with linezolid and probably the first case reported with successful treatment with linezolid in a patient with multiple complications who is a candidate for surgery in standard guidelines. CASE PRESENTATION: A 45 years old male from Kandy Sri Lanka, who had undergone prosthetic valve replacement 10 years back, presented with prosthetic mitral valve endocarditis caused by MRSA. He failed to respond to vancomycin and cotrimoxazole while sustaining cerebral haemorrhages, as well as life threatening ventricular arrhythmias. Treatment with intravenous linezolid and ciprofloxacin resulted in a complete response with disappearance of the vegetations and sterilization of blood cultures. CONCLUSIONS: Linezolid can be considered as a good option for treating PVE by MRSA infections who are not responding to vancomycin and may negate the need for a surgery in patients awaiting an early surgery. Further studies including randomized controlled trials are needed to assess the efficacy of linezolid in PVE due to MRSA.

A case of Berardinelli-Seip syndrome presenting with cirrhosis.

Berardinelli-Seip congenital lipodystrophy (BSCL) is a rare autosomal recessive disorder of generalised lipoatrophy, characterised by the absence of functioning adipocytes, with lipid being stored in muscles, the liver and the pancreas. The usual presentation is in adulthood, with manifestations of insulin resistance, hypertriglyceridaemia and liver steatosis. Cirrhosis as the first presentation of BSCL in a young adult is rare. We describe a patient with BSCL presenting with cirrhosis. To the best of our knowledge this is the first case of BSCL reported in a Sri Lankan patient.

Biopattern analysis and subject-specific diagnosis and care of dementia.

Worldwide, the number of people that develop Alzheimer's disease and other types of dementia is rapidly rising and will create a considerable financial burden on the health and social services. The availability of new drugs that may slow or even halt the disease progression makes accurate early detection crucial. Objective methods are needed to support clinical diagnosis and care for patients; to quantify severity, monitor progression and response to new treatments. Electrophysiological markers have an important role to play in the objective assessment and care for dementia. The EEG provides a measure of brain dysfunction and EEG changes could be detected fairly early in the dementing process. Subject-specific EEG analysis offers the possibility of using objective methods to assess and care for dementia on an individual basis. The main objectives of this paper are: (i) to introduce the concepts of subject-specific EEG analysis as a basis for improving diagnosis and care for dementia; and (ii) present two novel methods for deriving suitable subject-specific electrophysiological markers analysis of fractal dimension and zero crossing interval density of the EEG. We present findings that indicate that the methods are potentially good candidates for the development of individualized, low-cost, easy to administer and reasonably accurate methods for detecting dementia within the growing at risk population.

Nonlinear methods for biopattern analysis: role and challenges.

An important trend in medical technology is towards support for personalised healthcare, fuelled by developments in genomic-based medicine. New computational intelligent techniques for biodata analysis will be needed to fully exploit the vast amounts of data that are being generated. Non-linear signal processing methods will form an important part of such computational intelligent techniques. This paper introduces some non-linear methods which are likely to play a role in the emerging area of biopattern and bioprofile analysis that will underpin personalized healthcare. We highlight their application to clinical problems involving EEG and fetal ECG and heart rate analysis, and issues that arise when they are applied to real world problems. The clinical problems include dementia assessment, drug administration and fetal monitoring. The potential role and challenges in the application of non-linear signal analysis of biopattern and bioprofile are highlighted within the context of a major EU project, BIOPATTERN.

Quantitative surface EMG in the diagnosis of neuromuscular disorders.

This paper describes a non-invasive quantitative method for the diagnosis of neuromuscular disorders using surface EMG (sEMG). We found sEMG to be a reliable method that can be used to differentiate neuropathic and myopathic patients from the normal subjects. The multivariate discriminant analysis of sEMG data assisted in separating myopathic from neuropathic disorders. Nevertheless sEMG is not robust enough to replace needle EMG as a stand-alone diagnostic tool. However quantitative sEMG that is described in this paper could be adopted as a simple, rapid and non-invasive technique to be used in the out patients clinic by EMG-naive clinicians as a screening method for neuromuscular disorders, before referring the patients for detailed clinical neurophysiological examinations.

Down's syndrome is strongly associated with coeliac disease.

BACKGROUND: There is evidence of an increased prevalence of coeliac disease in Down's syndrome. AIMS: To investigate the association, patients with Down's syndrome and matched controls were examined. METHODS: Fifty nine patients with Down's syndrome residing in government institutions in the Hunter region of New South Wales were studied. Four were excluded (terminally ill = 1, uncooperative = 3). Each of 55 patients was matched for age, sex, and residence with a control patient. Patients with both positive IgA and IgG antigliadin antibodies were considered for endoscopical duodenal biopsy. RESULTS: Twenty one patients and two controls had raised IgA and IgG antibodies (chi 2 = 19.4; p < 0.001). Tissue was obtained in 18 patients. Two had characteristic flat, five pronounced lymphocytic infiltration not diagnostic of coeliac disease, two giardiasis, and eight were normal. In one the tissue was not suitable for analysis. There were few differences between the subgroups in their anthropomorphic, biochemical, or haematological findings. CONCLUSIONS: The prevalence of coeliac disease in these 51 patients with Down's syndrome is at least two (3.9%; 95% confidence interval (95% CI) 0%-9.2%) and could be as many as seven (13.7%; 95% CI 4.3%-23.2%). In this community the prevalence of coeliac disease in Down's syndrome is increased more than 100-fold (x135-473).

Non-invasive quantitative EMG.

The EMG information obtained by surface recording is compared to needle derived data processed in an identical manner. Such quantitative analysis of EMG activity has been undertaken using needle electrodes and is a well recognised technique for clinical purposes (16). Results of a study comparing data collected simultaneously by surface and needle electrodes from normal healthy volunteers are presented as a preliminary to a similar study of neuropathic and myopathic patients. The EMG interference pattern during maximum voluntary contraction was analysed for turns and zero crossings as well as from frequency spectral data, and the results displayed on-line using an inexpensive novel transputer aided PC. It was found that quantitative studies of surface and needle data were directly comparable in one muscle such as tibialis anterior but very different in another, such as rectus femoris, where there were changes in signal characteristic at different depths. The variability between individuals appeared to be less marked when surface electrodes were used. Data from surface recordings also show a high degree of repeatability when collected over a period of time.

Measurement of diffusing capacity in pulmonary embolism.

Pulmonary function tests were carried out in 20 consecutive patients with pulmonary embolism (PE), diagnosed on the basis of a positive ventilation-perfusion lung scan carried out within 72 h of admission. Changes in forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and arterial blood gas tensions were too variable to be helpful diagnostically. In contrast, transfer factor (diffusing capacity) of the lung (TLCO) was significantly reduced in all cases and, in spite of a period of anticoagulation, tended to remain subnormal during a follow-up period of up to 3 years. Lung scans, however, tended to return to normal within 3 months of the incident. Thus, a reduction of TLCO to below 75% of the predicted normal was found in all cases with abnormal lung scans and such measurements provide a useful and simple screening test for PE; a normal TLCO would effectively exclude such a diagnosis. The failure of TLCO to return to normal in the majority of cases suggests persistence of the underlying physiological defect, in spite of normalization of symptoms and lung scans following anticoagulation.