A rare complication of measles infection presented with subacute sclerosing panencephalitis: Report of two cases in India

Rationale:Subacute sclerosing panencephalitis(SSPE)is a progressive neurological disorder caused by persistent measles virus infection.SSPE predominantly affects children and adolescents.The symptoms usually develop 6-15 years after measles infection and ultimately leading to death in many cases.Patient concerns:Patient 1 presented with cognitive decline and myoclonus and the Patient 2 presented with diminution of vision with myoclonic jerks.Diagnosis:Based on the clinical features with a characteristic electroencephalogram pattern and the presence of a high titer of anti-measles IgG in serum and cerebrospinal fluid,these patients were diagnosed as SSPE.Interventions:Antiepileptics were started for controlling myoclonus along with supportive treatment.Outcomes:Both patients were discharged on antiepileptics and supportive care.Lessons:Whenever there are unusual clinical manifestations with unknown vaccination status,SSPE can be suspected and the cerebrospinal fluid should be examined for anti-measles antibodies.Our case study also highlights the importance of universal coverage of measles vaccination.To reduce the incidence of measles and associated deaths,it is important to maintain a high level of immunization coverage for the measles vaccine and to strengthen all the integral components of the national immunization program.

Susceptibility of dairy cows to subacute ruminal acidosis is reflected in both prepartum and postpartum bacteria as well as odd-and branched-chain fatty acids in feces

Background:The transition period is a challenging period for high-producing dairy cattle.Cows in early lactation are considered as a group at risk of subacute ruminal acidosis(SARA).Variability in SARA susceptibility in early lactation is hypothesized to be reflected in fecal characteristics such as fecal pH,dry matter content,volatile and odd-and branched-chain fatty acids(VFA and OBCFA,respectively),as well as fecal microbiota.This was investigated with 38 periparturient dairy cows,which were classified into four groups differing in median and mean time of reticular pH below 6 as well as area under the curve of pH below 6.Furthermore,we investigated whether fecal differences were already obvious during a period prior to the SARA risk(prepartum).Results:Variation in reticular pH during a 3-week postpartum period was not associated with differences in fecal pH and VFA concentration.In the postpartum period,the copy number of fecal bacteria and methanogens of unsusceptible(UN)cows was higher than moderately susceptible(MS)or susceptible(SU)cows,while the genera Ruminococcus and Prevotellacea_UCG-001 were proportionally less abundant in UN compared with SU cows.Nevertheless,only a minor reduction was observed in iso-BCFA proportions in fecal fatty acids of SU cows,particularly iso-C15:0and iso-C16:0,compared with UN cows.Consistent with the bacterial changes postpartum,the lower abundance of Ruminococcus was already observed in the prepartum fecal bacterial communities of UN cows,whereas Lachnospiraceae_UCG-001 was increased.Nevertheless,no differences were observed in the prepartum fecal VFA or OBCFA profiles among the groups.Prepartum fecal bacterial communities of cows were clustered into two distinct clusters with 70%of the SU cows belonging to cluster 1,in which they represented 60%of the animals.Conclusions:Inter-animal variation in postpartum SARA susceptibility was reflected in post-and prepartum fecal bacterial communities.Differences in prepartum fecal bacterial communities could alert for susceptibility to develop SARA postpartum.Our results generated knowledge on the association between fecal bacteria and SARA development which could be further explored in a prevention strategy.

Inhibition of Notch 1 signaling in the subacute stage after stroke promotes striatal astrocyte-derived neurogenesis

Inhibition of Notch1 signaling has been shown to promote astrocyte-derived neurogenesis after stroke.To investigate the regulatory role of Notch1 signaling in this process,in this study,we used a rat model of stroke based on middle cerebral artery occlusion and assessed the behavior of reactive astrocytes post-stroke.We used theγ-secretase inhibitor N-[N-(3,5-diuorophenacetyl)-1-alanyl]-S-phenylglycine t-butylester(DAPT)to block Notch1 signaling at 1,4,and 7 days after injury.Our results showed that only administration of DAPT at 4 days after stroke promoted astrocyte-derived neurogenesis,as manifested by recovery of white matter fiber bundle integrity on magnetic resonance imaging,which is consistent with recovery of neurologic function.These findings suggest that inhibition of Notch1 signaling at the subacute stage post-stroke mediates neural repair by promoting astrocyte-derived neurogenesis.

Coordinated response of milk bacterial and metabolic profiles to subacute ruminal acidosis in lactating dairy cows

Background Bovine milk is an important source of nutrition for human consumption,and its quality is closely associated with the microbiota and metabolites in it.But there is limited knowledge about the milk microbiome and metabolome in cows with subacute ruminal acidosis.Methods Eight ruminally cannulated Holstein cows in mid lactation were selected for a 3-week experiment.The cows were randomly allocated into 2 groups,fed either a conventional diet(CON;40%concentrate;dry matter basis)or a high-concentrate diet(HC;60%concentrate;dry matter basis).Results The results showed that there was a decreased milk fat percentage in the HC group compared to the CON group.The amplicon sequencing results indicated that the alpha diversity indices were not affected by the HC feeding.At the phylum level,the milk bacteria were dominated by Proteobacteria,Actinobacteria,Bacteroidetes,and Firmicutes both in the CON and HC groups.At the genus level,the HC cows displayed an improved proportion of Labrys(P=0.015)compared with the CON cows.Results of both the principal components analysis and partial least squares of discriminant analysis of milk metabolome revealed that samples of the CON and HC groups clustered separately.A total of 31 differential metabolites were identified between the two groups.Of these,the levels of 11 metabolites decreased(α-linolenic acid,prostaglandin E2,L-lactic acid,L-malic acid,3-hydroxysebacic acid,succinyladenosine,guanosine,pyridoxal,L-glutamic acid,hippuric acid,and trigonelline),whereas the levels of the other 20 metabolites increased in the HC group with respect to the CON group(P<0.05).Conclusion These results suggested that subacute ruminal acidosis less impacted the diversity and composition of milk microbiota,but altered the milk metabolic profiles,which led to the decline of the milk quality.

Subacute osteomyelitis due to Staphylococcus caprae in a teenager:A case report and review of the literature

BACKGROUND Staphylococcus caprae(S.caprae)is a human commensal bacterium which can be detected in the nose,nails,and skin.It can be responsible for heterogeneous infections such as bacteremia,endocarditis,pneumonia,acute otitis externa,peritonitis,and urinary tract infections.Bone and joint infections due to S.caprae have also been reported,but most of them resulted from the infection of orthopedic devices,especially joint prostheses and internal osteosynthesis devices.Rare cases of primary osteoarticular infections caused by S.caprae have been described,including osteitis,arthritis,or spondylodiscitis.CASE SUMMARY We report an unusual case of subacute osteomyelitis in a toe phalanx caused by S.caprae in a 14.5-year-old girl.CONCLUSION Subacute S.caprae osteomyelitis is a little-known and probably underestimated community-acquired infectious disease.This microorganism’s pathogenicity should be seen as more than a classic nosocomial orthopedic device infection.

Low-dose metformin treatment in the subacute phase improves the locomotor function of a mouse model of spinal cord injury

Metformin,a first-line drug for type-2 diabetes,has been shown to improve locomotor recovery after spinal cord injury.However,there are studies reporting no beneficial effect.Recently,we found that high dose of metformin(200 mg/kg,intraperitoneal)and acute phase administration(immediately after injury)led to increased mortality and limited locomotor function recovery.Consequently,we used a lower dose(100 mg/kg,i.p.)metformin in mice,and compared the effect of immediate administration after spinal cord injury(acute phase)with that of administration at 3 days post-injury(subacute phase).Our data showed that metformin treatment starting at the subacute phase significantly improved mouse locomotor function evaluated by Basso Mouse Scale(BMS)scoring.Immunohistochemical studies also revealed significant inhibitions of microglia/macrophage activation and astrogliosis at the lesion site.Furthermore,metformin treatment at the subacute phase reduced neutrophil infiltration.These changes were in parallel with the increased survival rate of spinal neurons in animals treated with metformin.These findings suggest that low-dose metformin treatment for subacute spinal cord injury can effectively improve the functional recovery possibly through anti-inflammation and neuroprotection.This study was approved by the Institute Animal Care and Use Committee at the University of Texas Medical Branch(approval No.1008041C)in 2010.

Changes of resting cerebral activities in subacute ischemic stroke patients

This study aimed to detect the difference in resting cerebral activities between ischemic stroke pa- tients and healthy participants, define the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efficacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunc- tion and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage （15 days to 11.5 weeks） and 15 age-matched healthy participants. A rest- ing-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental findings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely po- tential targets for the neural regeneration of subacute ischemic stroke patients.

Changes in feed intake, nutrient digestion, plasma metabolites, and oxidative stress parameters in dairy cows with subacute ruminal acidosis and its regulation with pelleted beet pulp

The objectives of this study were to 1） determine the variation of nutrient digestion, plasma metabolites and oxidative stress parameters triggered by induced subacute ruminal acidosis （SARA）; and 2） evaluate the ability of pelleted beet pulp （BP） as a replacement for ground corn to alleviate SARA. Eight Holstein-Friesian cows were fed four diets during four successive17 day periods： 1） total mixed ration （TMR） containing 0% finely ground wheat （FGW） （WO）; 2） TMR containing 10% FGW （W10）; 3） TMR containing 20% FGW （W20）; and 4） TMR containing 10% BP as a replacement for 10% ground corn （BP10）. The SARA induction protocol reduced the mean ruminal pH from 6.37 to 5.94, and the minimum ruminal pH decreased from 5.99 to 5.41 from baseline to challenge period. Mean ruminal pH increased from 5.94 to 6.05, and minimum daily ruminal pH increased from 5.41 to 5.63, when BP was substituted for corn. The apparent digestibility of nutrients was not affected by the dietary treatments, except that the digestibility of neutral detergent fibre （NDF） and acid detergent fibre （ADF） was reduced in cows fed the W20 diet compared with cows fed the W0 and W10 diets, and cows fed the BP10 diet had higher NDF and ADF digestibility than the cows fed the W20 diet. Cows fed the W20 diet had a lower plasma concentration of 13-hydroxybutyrate （BHBA）, non-esterified fatty acids （NEFA）, cholesterol, triglyceride, and total antioxidative capacity （TAC）, and a higher plasma concentration of glucose, insulin, malonaldehyde （MDA）, super oxygen dehydrogenises （SOD）, and glutathione peroxidase （GSH-Px） than cows fed the W0 diet. Substitution of BP for corn increased concentrations of plasma BHBA and TAC, but decreased concentrations of plasma MDA. Our results indicate that reduction of fibre digestion; the concomitant increase of plasma glucose and insulin; the decrease of plasma BHBA, NEFA, cholesterol, and triglyceride; and changes of plasma oxidative stress parameters are highly related to SARA induced by W20 diets. These variables may be alternative candidates for SARA diagnosis. We also suggest that the substitution of BP for corn could reduce the risk of SARA, increase fibre digestion, and improve the antioxidant status in dairy cows.

Dose optimization of intrathecal administration of human umbilical cord mesenchymal stem cells for the treatment of subacute incomplete spinal cord injury

Human umbilical cord mesenchymal stem cells(hUC-MSCs)are a promising candidate for spinal cord injury(SCI)repair owing to their advantages of low immunogenicity and easy accessibility over other MSC sources.However,modest clinical efficacy hampered the progression of these cells to clinical translation.This discrepancy may be due to many variables,such as cell source,timing of implantation,route of administration,and relevant efficacious cell dose,which are critical factors that affect the efficacy of treatment of patients with SCI.Previously,we have evaluated the safety and efficacy of 4×10^(6) hUC-MSCs/kg in the treatment of subacute SCI by intrathecal implantation in rat models.To search for a more accurate dose range for clinical translation,we compared the effects of three different doses of hUC-MSCs-low(0.25×10^(6) cells/kg),medium(1×10^(6) cells/kg)and high(4×10^(6) cells/kg)-on subacute SCI repair through an elaborate combination of behavioral analyses,anatomical analyses,magnetic resonance imaging-diffusion tensor imaging(MRI-DTI),biotinylated dextran amine(BDA)tracing,electrophysiology,and quantification of mRNA levels of ion channels and neurotransmitter receptors.Our study demonstrated that the medium dose,but not the low dose,is as efficient as the high dose in producing the desired therapeutic outcomes.Furthermore,partial restoration of theγ-aminobutyric acid type A(GABAA)receptor expression by the effective doses indicates that GABAA receptors are possible candidates for therapeutic targeting of dormant relay pathways in injured spinal cord.Overall,this study revealed that intrathecal implantation of 1×10^(6) hUC-MSCs/kg is an alternative approach for treating subacute SCI.

Subacute Effect of Decabromodiphenyl Ethane on Hepatotoxicity and Hepatic Enzyme Activity in Rats

Information regarding decabromodiphenyl ethane （DBDPE） effects on hepatotoxicity and metabolism is limited. In the present study, Wistar rats were given oral DBDPE at different doses. DBDPE induced oxidative stress, elevated blood glucose levels, increased CYP2B2 mRNA, CYP2B1/2 protein, 7-pentoxyresorufin O-depentylase （PROD） activity, and induced CYP3A2 mRNA, CYP3A2 protein, and luciferin benzylether debenzylase （LBD） activity. UDPGT activity increased with its increasing exposure levels, suggesting that oral DBDPE exposure induces drug-metabolizing enzymes in rats via the CAR/PXR signaling pathway. The induction of CYPs and co-regulated enzymes of phase II biotransformation may affect the homeostasis of endogenous substrates, including thyroid hormones, which may, in turn, alter glucose metabolism.

Subacute Thyroiditis as Seen Initially in ENT Department—— A Reportof30 Cases

To assess the pharyngeal presentations and the diagnostic value of thyroid SPECT and thyroid fine needle aspiratory biopsy (FNAB) in subacute thyroiditis (SAT) as seen initially in ENT department, 30 patients, during the course of SAT, were examined for pharyngeal symptoms and tested for serum T 3, T 4 level. The thyroid SPECT imaging or thyroid FNAB were performed. Our results showed that, of the 30 patients, 21 had sore throat of various degrees, and 9 had abnormal sensation of throat. Six were diagnosed as having SAT by only SPECT, in the remaining 24, the final diagnoses was established by SPECT combined with FNAB. Two of them were finally diagnosed as having SAT by trial treatment with oral prednisone. It is concluded that sore throat and abnormal sensation of pharynx are the important presentations of SAT, and thyroid SPECT imaging and thyroid FNAB are valuable in diagnosing SAT.

Effect of Combined Low-frequency Repetitive Transcranial Magnetic Stimulation and Virtual Reality Training on Upper Limb Function in Subacute Stroke:a Double-blind Randomized Controlled Trail

The effect of combined low-frequency repetitive transcranial magnetic stimulation（LF r TMS） and virtual reality（VR） training in patients after stroke was assessed. In a double-blind randomized controlled trial, 112 patients with hemiplegia after stroke were randomly divided into two groups： experimental and control. In experimental group, the patients received LF r TMS and VR training treatment, and those in control group received sham r TMS and VR training treatment. Participants in both groups received therapy of 6 days per week for 4 weeks. The primary endpoint including the upper limb motor function test of Fugl-meyer assessment（U-FMA） and wolf motor function test（WMFT）, and the secondary endpoint including modified Barthel index（MBI） and 36-item Short Form Health Survey Questionnaire（SF-36） were assessed before and 4 weeks after treatment. Totally, 108 subjects completed the study（55 in experimental group and 53 in control group respectively）. After 4-week treatment, the U-FMA scores [mean difference of 13.2, 95% confidence interval（CI） 3.6 to 22.7, P〈0.01], WMFT scores（mean difference of 2.9, 95% CI 2.7 to 12.3, P〈0.01）, and MBI scores（mean difference 16.1, 95% CI 3.8 to 9.4, P〈0.05） were significantly increased in the experimental group as compared with the control group. The results suggested the combined use of LF r TMS with VR training could effectively improve the upper limb function, the living activity, and the quality of life in patients with hemiplegia following subacute stroke, which may provide a better rehabilitation treatment for subacute stroke.

Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction

OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.

Removal of refractory thrombus by 5F child catheter in patients with subacute myocardial infarction

No-reflow phenomenon is common in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI),and it is strongly associated with adverse clinical prognosis.Previous studies have shown that heavy thrombus burden could predict the development of no-reflow in PCI.Manual and mechanical thrombus aspiration catheters are widely used;however,there is still residual refractory thrombus left after the routine use of thrombectomy,especially in patients with subacute myocardial infarction(SMI).In our practice,child catheter aspiration has been used as a safe and effective approach to solve the residual thrombus in SMI patients.We described this technique in detail by a series of cases.

Long-term effect of subacute ruminal acidosis on the morphology and function of rumen epithelial barrier in lactating goats

Grain-induced subacute ruminal acidosis(SARA)impairs rumen epithelial barrier function,but it is yet to be determined if SARA can cause persistent damage to the morphology and function of the rumen epithelial barrier.The objective of the present study was to investigate if SARA has persistent effects on the morphological structure and permeability of ruminal epithelium and the expression of the genes involved in epithelial barrier function using a lactating goat model.Twelve mid-lactating Saanen goats with rumen cannulas were randomly assigned to 1 of 2 groups:control group(Ctrl,n=4)fed a basal diet with a non-fiber carbohydrate(NFC)to neutral detergent fiber(NDF)ratio of 1.40,and SARA group(SARA,n=8)fed the same basal diet but with increasing NFC to NDF ratio from 1.4 to 1.79,2.31,and 3.23 overtime to induce SARA.At the end of the SARA challenge(post-SARA),4 goats were randomly selected from the SARA group and fed only hay mixture ad libitum for another 4 weeks to allow for restitution(post-SARA).Ruminal pH was continuously recorded to monitor the severity of SARA.Samples of the ventral ruminal epithelium were collected after slaughter to examine the structural and functional changes of the ruminal epithelium using transmission electron microscopy(TEM),Ussing chambers,qRT-PCR,and Western bolt analyses.Compared with the Ctrl group,ruminal papilla length,width,surface area and thickness of stratum corneum increased(P<0.05),while stratum spinosum and basale thickness,and total depth of the epithelium decreased(P<0.05)in the SARA group.These changes diminished or tended to return to the levels of the Ctrl group in the post-SARA group(P>0.05).The SARA challenge also decreased cellular junction and widened the intercellular space between epithelial cells.Rumen transepithelial short-circuit current(Isc),tissue conductance(Gt),and mucosa-to-serosa flux of paracellular horseradish peroxidase(HRP)all increased(P<0.05)both in the SARA and post-SARA groups,which indicates that SARA can induce a sustained increase in epithelial permeability and barrier dysfunction.Moreover,the mRNA and protein expressions of CLDN1,OCLN and ZO-1 were down-regulated(P<0.01)in both the SARA and post-SARA groups.The results of this study showed that SARA could result in sustained epithelial barrier dysfunction,at both structural and functional levels,which is associated with decreased expression of rumen epithelial tight junction proteins,and the restitution of rumen epithelial barrier function is slower than that of its morphology.

Reassessment subacute MPTP-treated mice model of Parkinson disease

OBJECTIVE(1) To estimate the value of the subacute MPTP mouse model in aspects of behavioral performance,biochemical changes and pathological abnormalities.(2) To find effective positive drugs.METHODS Male C57 BL/6 mice were injected with MPTP(30 mg·kg^(-1)·d^(-1),ip) for 5 consecutive days.Three days before MPTP injection,the mice were orally administered selegiline(3 mg·kg^(-1)·d^(-1)),pramipexole(3 mg·kg^(-1)·d^(-1)),or medopar(100 mg·kg^(-1)·d^(-1)) for 18 d.Behavioral performance was assessed in the open field test,pole test and rotarod test.Neurotransmitters in the striatum were detected using HPLC.Protein levels were measured by Western blot.Pathological characteristics were examined by immunohistochemistry.Ultrastructure changes were observed by electron microscopy.RESULTS The subacute MPTP treatment did not induce evident motor defects despite severe injuries in the dopaminergic system.Additionally,MPTP significantly increased the α-synuclein levels and the number of astrocytes in the striatum,and destroyed the blood-brain barrier(BBB) in the substantianigra pars compacta.Both selegiline and pramipexole were able to protect the mice against MPTP injuries.CONCLUSION The subacute MPTP mouse model does not show visible motor defects;it is not enough to evaluate the validity of a candidate just based on behavioral examination,much attention should also be paid to the alterations in neurotransmitters,astrocytes,α-synuclein and the BBB.In addition,selegiline or pramipexole is a better choice than medopar as an effective positive control for the subacute MPTP model.

ACUPUNCTURE TREATMENT OF SUBACUTE THYROIDITIS WITH HYPERTHYROIDISM AT THE LATE STAGE

Causes inducing subacute thyroiditis have been unclear, but clinically it is treated mostlywith cortical hormones. In the present paper, it was reported that one case of subacute thyroiditis withhyperthyodism at the late stage was cured with acupuncture at Renying (ST 9), Fengchi (GB 20),Jiaji ponts on the neck and other points. In the treatment, differentiation of symptoms and signs wascombined with differentiation of disease, selection of proximal acupoints was combined with selectionof distal acupoints. The patient was treated in accordance with his physique. Therefore, the therapeu-tic effects were obtained rapidly.

Diffuse unilateral subacute neuroretinitis in children:Report of three cases

Rationale:Diffuse unilateral subacute neuroretinitis is a form of posterior uveitis and has a few clinical presentations according to the onset of presentation.Patients’concern:A girl(5-year-old)and 2 boys(both 12-year-old)were included in this report.Upon presentation,the visual acuity ranges from 6/12 to 6/60.All three cases had different symptoms(case 1:floaters;case 2:eye redness and pain;case 3:central scotoma).All of them had variable posterior uveitis features(case 1:vitritis and focal retinitis;case 2:subretinal larva track;case 3:choroiditis).Diagnosis:Diffuse unilateral subacute neuroretinitis.Intervention:All 3 patients were treated with oral albendazole.Outcome:All patients showed remarkable resolution of inflammatory reactions of the eye and also improvement of vision.Lesson:High index of suspicion should be made for children and young adults who are previously healthy but presented with suddenly onset of reduced vision with clinical features of posterior uveitis of variable degree.Clinical features together with a full blood picture can help to diagnose the problem when other parameters are negative.

Tricuspid Valve Reconstruction in a Patient with Ventricular Septal Defect and Subacute Endocarditis

Objective Tricuspid valve reconstruction was advocated as the operative method for the treatment of tricus-pid valve endocarditis recently. Many people accept that valve replacement therapy should be performed if more than two valve leaflets are involved. The aim of the study to discuss if reconstructive surgery could be done to treat two valve leaflets involved in tricuspid valve endocarditis. Methods A 17-year-old boy with ventricular septal defect (VSD) and tricuspid valve subacute endocarditis was surgical treated through extra-corporeal circulation. two-thirds of the defective septal cusp, and half of the defective anterior cusp were ex-cised during operation. The tricuspid valve was reconstructed with autologous pericardial strip, cusp com-missuroplasty and 4-0 prolene sutures made as chordae tendineaes. VSD was repaired using a pericardial patch. Results The patient was discharged post-operation with excellent restoration of the tricuspid valve ac-tivity. Cardiac ultrasound revealed normal tricuspid valve activity and low degree of regurgitation two years follow-up. Conclusions It seems that tricuspid valve reconstruction could be performed for two defective leaflets or half of the tricuspid valve.

Retrospective Demographic Analysis of Neurovascular Syndrome—Secondary to: A) Endemic Subacute (Fruits Borne) Viral Infection, Consequent to Global Aborted Blood, Contraceptives Menstrual Blood Pollution;B) Consumption of Waterliving Toxinous Mammals

15 patients after the middle of 2018, during the initial onset of the epidemic of identified Nipah viral infection (fruits borne virus) in adjacent state, presented with fever, acute coma, delirium, movement disorders, required referral to district headquarters hospital, for virology confirmation, and management. 135 mostly afebrile patients, who refused referral to government hospital, for virology confirmation, presented with symptoms of mainly subacute pan encephalitis, over the past 14 months;90% presented with conglomeration of vertigo, staring, personality changes, imbalance in gait, difficulty to walk, bilateral drooling of saliva, tremors, confusion, altered sensorium, nausea, vomiting;83% presented with dysarthria, 28% presented with symptoms of raised intracranial pressure-mimicking accelerated, malignant hypertensive emergencies, bradycardia, vomiting;decreased vision in 4.6%, myoclonic jerks in 58%, choreoathetosis in 8%. All of them could not afford INR 10000 for virology confirmation. Fruits borne viral subacute pan encephalitis, can present as subacute neurovascular syndrome, simulating ischemic stroke, mediated by Hapten triggered autoimmune angiopathy (blood borne) with resultant bilateral, asymmetrical multifocal, infarcts, cerebritis with consequent edema, requiring recognition, successful treatment with acyclovir, antiedema, antiepileptic measures and not antiplatelets, since the etiology is inflammatory and not degenerative. Promoting awareness to steam cook, pressure cook, cook with coconut oil (pie) fruits, steaming fresh fruit juices, before consumption will prevent incidence of fruits borne, tobacco leaves borne, and endemic viral infection. Economical screening card tests for Nipah fruits borne virus, will enable early detection, authenticate notification, early recognition treatment of subacute pan encephalitis presenting as neurovascular syndrome, mimicking ischemic stroke Global aborted blood pollution, contraceptive menstrual blood pollution, documented by rising environmental estrogen, beta human chorionic gonadotropins, alpha fetoprotein, favours emergence, virulence, drug resistance of microbes, including the recent fruits borne virus;global eradication of contraception, abortion (—non-evidence-based medical practice, without therapeutic indication, therapeutic protocols, therapeutic policies), to be replaced by global baby boom (promoting childbirth >10 - 20 children per family) will prevent further emergence, virulence of microbial infections, including Nipah, oncoming Ebola corona. Over the past 5 years, consumption of water living without scales, gills, fins,-toxin containing mammals, presented as cortical venous, sigmoid sinus thrombosis, in 3.5%, choreoathetosis in 12.5%, unresponsive but restless in 12.5%, quadriparesis, hemiparesis in 37.5% mimicking neurovascular syndrome, ischemic stroke;treatment with methylprednisolone, immunoglobulin reverted.