Dupuytren's disease is a progressive fibrotic condition of the hand. The underlying pathomechanism is not fully known. Dupuytren's contracture can be seen in patients with diabetes mellitus, chronic alcoholism, smoking, or hand trauma. It is uncommon to affect the neurovascular supply causing clinical symptoms. We describe a patient with idiopathic Dupuytren's disease complicated with bilateral ulnar neuropathies and highlight the importance of such rare treatable complication.
A 37-year-old man with underlying systemic lupus erythematosus and lupus nephritis presented with an episode of generalized tonic seizure. He complained of poor concentration and forgetfulness for 1 week. He suffered a relapse of lupus nephritis 4 months ago and received a course of intravenous methylprednisolone followed by oral prednisolone and mycophenolate mofetil. Clinically, there was no focal neurological deficit. Retroviral screening was negative. Magnetic resonance imaging (MRI) of the brain revealed eccentric and concentric signs which confirmed the diagnosis of cerebral toxoplasmosis.
Transverse myelitis in multiple sclerosis is typically a short cord lesion with patchy distribution. Rarely, longitudinally extensive transverse myelitis can be seen in those with highly active disease or frequent relapses. The recognition of this uncommon phenotype in multiple sclerosis is important as the treatment is largely different from other demyelinating diseases. We describe a patient with highly active relapsing-remitting multiple sclerosis on interferon beta-1a who developed LETM after multiple relapses.
In this paper, we revisit the environmental Kuznets curve (EKC) hypothesis by using estimations that account for cross-sectional dependency (CSD) and asymmetry effect in 76 countries for the period 1971-2014. Our results lend moderate support to the EKC hypothesis. The country-specific results unfold that a total of 16 out of 76 countries support the EKC hypothesis using CCEMG estimator. Results from AMG reveal that the EKC hypothesis holds in 24 out of 76 countries. It is worth highlighting that 11 countries (Australia, China, Congo Dem. Rep., Costa Rica, Gabon, Hong Kong, India, Korea, Myanmar, Turkey, and Uruguay) exhibit an inverted U-shaped curve regardless of whether CCEMG or AMG is used. The asymmetry analysis using PMG is also able to support the EKC hypothesis. We conclude that the EKC hypothesis does not fit all countries. Policy implication and recommendation in designing appropriate energy and economic policies are provided.
Porcine reproductive and respiratory syndrome (PRRS) is a disease that is both highly contagious and of great economic importance in Malaysia. Therefore, reliable and improved diagnostic methods are needed to facilitate disease surveillance. This study compared PRRSV antibody responses in oral fluid versus serum samples following PRRS modified live (MLV) vaccination using commercial antibody ELISA kits (IDEXX Laboratories, Inc.). The study involved two pig farms located in Perak and Selangor, Malaysia. Both farms were vaccinated with PRRS MLV 1 month prior to sample collection. Thirty-five animals were used as subjects in each farm. These 35 animals were divided into 7 different categories: gilts, young sows, old sows, and four weaner groups. Oral fluid and serum samples were collected from these animals individually. In addition, pen oral fluid samples were collected from weaner groups. The oral fluid and serum samples were tested with IDEXX PRRS Oral Fluid Antibody Test Kit and IDEXX PRRS X3 Antibody Test Kit, respectively. The results were based on sample to positive ratio (S/P ratio of the samples). Results revealed a significant and positive correlation between serum and oral fluid samples for both farm A (p = 0.0001, r = 0.681) and farm B (p = 0.0001, r = 0.601). In general, oral fluids provided higher S/P results than serum, but the patterns of response were highly similar, especially for the sow groups. Thus, the use of oral fluids in endemic farms is effective and economical, particularly for large herds. In conclusion, the authors strongly recommend the use of oral fluids for PRRS monitoring in endemic farms.
Levodopa is the most effective medical treatment for Parkinson's disease (PD) to date. As dopamine is known to increase cardiac inotropism and vasomotor tone, peripheral dopamine decarboxylase inhibitor is coadministered to suppress the peripheral conversion of levodopa to dopamine. Levodopa poses potential cardiovascular risks, thus its use in patients with existing coronary artery disease needs to be carefully monitored. We report a case of an elderly male with newly diagnosed PD who developed non-ST-elevation myocardial infarction following levodopa (Madopar) initiation.
We report the case of a 23-year-old woman who presented with prolonged menstruation and multiple bruises on the limbs and trunk. Investigations revealed severe thrombocytopenia and deranged coagulation profile with markedly prolonged activated partial thromboplastin time (aPTT). Lupus anticoagulant, anti-cardiolipin antibody and anti-beta-2-glycoprotein 1 antibody were positive. She was diagnosed with Immune Thrombocytopenic Purpura (ITP) with positive antiphospholipid antibody serology and given a course of intravenous methylprednisolone and tapering doses of oral prednisolone. She was steroid free and had no bleeding or thrombotic event over two years follow up.
Obesity is a worldwide concern as it leads to adverse effects on human health. This study uses a panel of 165 countries and annual data from 2000 to 2014 to examine the obesity Kuznets curve (OKC) hypothesis. By using tests and estimators that are robust to cross-section dependence (CSD), our results support the OKC hypothesis. This indicates that obesity increases at the initial stage of economic development and eventually would decrease once the threshold is reached. In addition, we find that the role of global warming on obesity is not significant. Food production is found to be a contributing factor to obesity. Besides, one-way and two-way causalities are identified between the variables. This study provides important insights particularly about the relationship between (i) economic growth and obesity and (ii) environmental degradation and obesity. Implication of the results and policy recommendations are also provided to policymakers and health personnel in finding solutions to the obesity epidemic around the world.
OECD countries have encountered the challenges of improving the environmental sustainability while maintaining economic growth by not impairing employment. This study attempts to reexamine the environmental Kuznets curve (EKC) hypothesis by using ecological footprint as an indicator of environmental degradation. Besides, our study aims to test the validity of environmental Phillips curve (EPC) and role of clean energy on ecological footprint. Our data cover a panel of 36 OECD countries from 1995 to 2015. We adopt the second-generation panel unit root and cointegration test to account for the presence of cross-section dependence (CSD). Moreover, the long-run relationship is estimated using Common Correlated Effect Mean Group (CCEMG) and Augmented Mean Group (AMG) that are robust to CSD. Our findings reveal that the EKC hypothesis is not valid while EPC is confirmed in OECD countries. Though there is a trade-off between unemployment and environmental degradation in OECD countries, the development of new technologies, especially in the clean energy sector, could be a key factor contributing to sustainable growth and better environmental quality. Thus, it is recommended that OECD countries should focus on the development of innovative green technologies and strengthen the initiatives that promote renewable energy consumption.
Lithium is a medication with a variety of medical usage for various diseases including bipolar mood disorder. As the therapeutic window of lithium is narrow, its usage is commonly associated with toxicity. Lithium toxicity affects multiple systems especially the central nervous system, leading to neuropsychiatric complications. Haemodialysis is an effective method for lithium removal especially in severe lithium toxicity such as neurotoxicity with electroencephalogram changes. We describe a case of lithium neurotoxicity with electroencephalographic abnormalities which was reversed following haemodialysis.
Bickerstaff brainstem encephalitis (BBE) is a rare autoimmune encephalitis characterised by ataxia, ophthalmoplegia and altered consciousness. An overlap between BBE with Guillain-Barré syndrome (GBS) shows similar clinical and immunological features. We report a case of BBE with GBS overlap secondary to Chlamydia pneumoniae infection. The triad of altered consciousness, ataxia and ophthalmoplegia were present in the patient. The investigations included cerebrospinal fluid cytoalbuminological dissociation, nerve conduction test that showed prolonged or absent F wave latencies, hyperintensity in the left occipital region on brain MRI and diffuse slow activity on the electroencephalogram. The chlamydia serology was positive indicating a postinfectious cause of BBE syndrome. He required artificial ventilation as his consciousness level deteriorated with tetraparesis, oropharyngeal and respiratory muscle weakness. Immunotherapy with intravenous immunoglobulin and methylprednisolone was commenced. He made good recovery with the treatment. Prompt recognition of this rare condition following chlamydia infection is important to guide the management.