Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis

BACKGROUND Differential diagnosis,comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder(ASD),but clinical assessments often omit screening for personality disorders(PD),which are especially common in individuals with high-functioning ASD where there is less need for support.AIM To summarize the research findings on PD in adults with ASD and without intellectual disability,focusing on comorbidity and differential diagnosis.METHODS PubMed searches were performed using the key words“Asperger’s Syndrome”,“Autism”,“Personality”,“Personality disorder”and“comorbidity”in order to identify relevant articles published in English.Grey literature was identified through searching Google Scholar.The literature reviews and reference sections of selected papers were also examined for additional potential studies.The search was restricted to studies published up to April 2020.This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.RESULTS The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria:16 evaluated personality profiles or PD in ASD(comorbidity),five compared ASD and PD(differential diagnosis)and one performed both tasks.There were significant differences in the methodological Cluster A and cluster C PD are the most frequent co-occurring PD,but overlapping features should be considered.Data on differential diagnosis were only found with cluster A and cluster B PD.CONCLUSION ASD in high-functioning adults is associated with a distinct personality profile even if variability exists.Further studies are needed to explore the complex relationship between ASD and PD.

A delayed diagnosis of unsuspected retinoblastoma in an in vitro fertilisation infant with retinopathy of prematurity

Dear Editor,I am Dr.Tian Tian,from the Department of Ophthalmology,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.I write to present a rare case report of a delayed diagnosis of unsuspected retinoblastoma（RB）in an in vitro fertilisation（IVF）infant with retinopathy of prematurity.

Hypothesis on supine sleep,sudden infant death syndrome reduction and association with increasing autism incidence

AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.

Gene diagnosis of infantile neurofibromatosis type I:A case report

BACKGROUND Neurofibromatosis is an autosomal dominant genetic disorder with various manifestations.Systemic multiple neurofibromatosis is rare in infancy.The disease is difficult to identify in the early stage,and it is prone to misdiagnosis and missed diagnosis.In the presence of lower limb swelling with subcutaneous nodules of unknown cause,café-au-lait spots,and axillary freckles,this disease must be considered.This report presents the clinical manifestations,early detection,diagnosis and treatment,and prognosis of infantile neurofibromatosis type I(NF1).CASE SUMMARY The clinical manifestations,imaging examinations,and gene results of a 3-mo-old male infant with NF1 were analyzed retrospectively.He had“swelling of both legs”at the onset and developed café-au-lait spots,axillary freckles,and multiple neurofibromas later.He had a family history of similar conditions.Gene detection showed a heterozygous mutation of c.4537C>T in the NF1 gene,leading to a nonsense mutation of amino acids(p.R1513x),which originated from the mother of the infant.He was diagnosed with NF1.CONCLUSION Gene diagnosis plays an important role in the early diagnosis of NF1.

Early Infant Diagnosis (EID) of HIV: An Experience at a Tertiary Care Hospital in India

Introduction: Early infant diagnosis (EID) confers substantial benefit to HIV infected and HIV uninfected infants and to programmes providing prevention of mother to child transmission (MTCT), but has been challenging to implement in resource limited settings. Objectives: To find out the rate of perinatal transmission in infants born to HIV positive mothers, to study the effect of various predisposing factors on HIV transmission and to evaluate the utility of dried blood spot (DBS) specimen for EID of HIV. Methods: Infants born to HIV positive mothers were tested according to National AIDS Control Organization (NACO) guidelines. Infants of 6 weeks to 6 months of age (n = 84) were diagnosed by DBS PCR;DBS positive results were confirmed by whole blood PCR. Infants 6 - 18 months (n = 47) were subjected to antibody test and if positive were confirmed by DNA PCR. Detailed history including type of delivery, single dose nevirapine (SDN) and breast feeding was taken. Results: The HIV transmission rate was 10.69%. In children ≤ 6 months, who did not receive SDN the positivity was 44.44% (4/9) whereas in those who received SDN it was 6.66% (5/75), (P = 0.0063). In children > 6 months the positivity rate was significantly higher in breast fed 42.85% (3/7) as compared to non breast fed 5% (2/40) children (P = 0.0187). There was 100% concordance between DBS and whole blood PCR. Conclusions: In resource limited settings, though HAART should be considered to further reduce MTCT during pregnancy and to prevent the emergence of resistance, SDN should be kept as an option for mothers coming directly in labour. Also, extended ART should be provided to mothers who want to breast feed their children. Early infant diagnosis using DBS specimens will further reduce the morbidity and mortality in these children.

Biomarkers for early diagnosis of autism obtained through bioinformatics analysis of human blood sample

Objective:autism spectrum disorder(ASD),a serious disorder that begins early in life,con-tinues throughout the lifespan.Children with ASD who are diagnosed early are more responsive to therapeutic interventions and have less social and language impair-ment than children diagnosed later;however,current di-agnostic measures are mostly applied to children older than one year and lack the appropriate biological markers for early diagnosis of ASD.Using bioinformatic analy-sis,this study explores the molecular information mech-anism of ASD.Method:in this study,we used dataset GSE6575 from Gene Expression Omnibus(GEO)to an-alyze the mRNA expression profile of ASD,including 35 ASD samples and 12 normal control samples looking for different genes and we did enrichment analysis of those genes.We then used the STRING database to construct a protein-protein interaction(PPI)network of differential genes.Finally,Cytoscape plug-in cytoHubba was used to search for hub genes.The diagnostic value of the hub genes was verified by subject operating characteristic curves.Result:we looked for 50 different genes and did an enrichment analysis of those genes.The results of the enrichment analysis showed that these differential genes were mainly concentrated in the response to viruses,the immune regulation of inflammation and energy metabo-lism.Using Cytoscape plug-in cytoHubba,we found ten different genes.We drew ROC curves for all ten genes among which two genes,interleukin 2 receptor subunit beta(IL2Rβ)and perforin 1(PRF1),had good sensitivity and specificity for the early diagnosis of autism.The ar-eas under the ROC curves were 0.855,0.830 for IL2Rβ,PRF1.Conclusion:data analysis using the GEO data-base can provide new insights into the etiology of ASD as well as some possible biomarkers and therapeutic targets for early diagnosis and treatment of ASD.

Early infant diagnosis of HIV in India—Early results and sero-positivity determinants

Introduction: PMTCT under NACP-III cover ex-posed children born to sero-positive mothers. Baby’s sero-status could be confirmed only at 18 months. Under EID, by DBS and/or WB collection, DNA-PCR can be performed earlier, with subsequent ART-linkage and 18-months-con- firmation. In Ahmedabad, with 55,000 annual pre- gnancy-HIV-testing, sero-prevalence is 0.27%. Methodology: Entry-points in EID are at 6 weeks, 6 months or 12 months. Cohort of 213 exposed children since EID roll-out (June 2010-December 2011) at all tertiary care hospitals under Ahme-dabad Municipal Corporation was assessed for sero-positivity-prevalence, DBS validity and assessment of baby’s sero-status-determinants. De-identified, secondary data were captured under routine public-health-program. Necessary permissions taken. Results: 144 HIV sero-positive deliveries took place. 213 exposed children were enrolled in EID. Cumulatively, 18 (8.45%) were tested positive at all entry-points. Out of sero-positives confirmed at 18 months, 60% children’s mothers were detected either in second or third trimester. In 40%, mothers remained undiagnosed intra-partum. Mothers were not on ART intra-partum in 80% (RR 1.8). Peri-partum ARV prophylaxis-single-dose-Nevirapine (sdNVP) was not given in 60%. [RR 18, CI 3.69 to 87.70 at 95% (p < 0.0003)]. In 60%, mode of delivery was vaginal, deliveries were handled in emergency. History of exclusive breastfeeding was in 60%. Discussion: Rise in yield of sero-positivity with age, highest proportion of sero-positivity and highest number of entrants at 6 weeks call for efforts targeted towards increasing earliest EID uptake clubbed with immunization visits. Feasibility, validity and early-ART-linkage to reduce mortality are features of DBS. Results justify its use in national program. Earliest pregnancy-HIV detection, HIV-testing for emergency deliveries, intra-partum sdNVP to both mother and baby, ART-linkage of eligible mothers and following infant feeding guidelines remain cornerstone of PMTCT success.

Deoxyribonucleic Acid-Polymerase Chain Reaction Status of HIV Exposed Infants in a Sub Regional Prevention of Mother-to-Child Transmission of HIV Programme during the Period 2009-2020

Introduction: Transitioning to more efficacious Antiretrovirals for HIV infected pregnant women and infant prophylaxis has reduced Mother to child transmission of HIV significantly. This study aimed to determine HIV infection status in HIVexposed infants who had their first DNA polymerase chain reaction test in our molecular Laboratory. Subjects, Materials and Methods: Dried Blood Spots for HIV DNA results from 5 states between 2009 and 2020 were analyzed in the PCR laboratory of the Federal Teaching Hospital, Gombe. Results: Nine thousand eight hundred and twenty-three Human Immunodeficiency Virus Deoxyribonucleic acid polymerase Chain Reaction results were analysed;4937 (50.2%) were males. During the study period, there was an overall declining trend in the mother-to-child transmission rate from 3.8% in 2009 to 1.0% in 2020. 6120 (62.3%) of HIV + mothers received Highly active antiretroviral therapy HAART before pregnancy. 7845 (76.2%) of the infants received Nevirapine prophylaxis. Dried blood spot samples were collected from 4077 (41.5%) at 6 - 8 weeks. 8438 (85.9%) received cotrimoxazole. 9469 (96.4%) were ever breastfed. Of the 9823 HIV DNA PCR results, 255 (2.6%) were positive while 69/4077 (1.7%) and 109/2662 (4.1%) were positive for HIV DNA at 6 - 8 weeks and > 12 weeks respectively. (p = 0.001). 86/747 (11.5%) of infants whose HIV-positive mothers received no ARVS were HIV DNA positive. (p = 0.001). 106/884 (12.0%) of infants who had no Antiretroviral prophylaxis had positive HIV DNA results;7/413 (1.7%) with Zidovudine/Nevirapine prophylaxis had positive results. (p = 0.001). 246/9469 (2.6%) of infants that were ever breastfed were positive for HIV DNA;11/354 (3.0%) that never breastfed had positive HIV DNA. Conclusion: Lack of maternal/infant ARVs and prolonged breastfeeding increased the risk of infant HIV infection.

Differential diagnosis between autism spectrum disorder and other developmental disorders with emphasis on the preschool period

Background Neurodevelopmental disorders are a heterogeneous group of conditions that manifest as delays or deviations in the acquisition of expected developmental milestones and behavioral changes.Autism spectrum disorder(ASD)is a neurodevelopmental disorder characterized by deficits in communication and social interaction and by repetitive and restricted patterns of behavior,interests and activities.The aim of this review is to discuss the clinical features of the differential diagnoses of ASD that are prevalent among preschoolers,focusing on their similarities and disparities.Data sources The international medical literature search was conducted using PubMed and was revised regarding the subject using single and/or combined keywords as follows:differential diagnosis,preschoolers,diagnostic challenge,attention deficit hyperactivity disorder,intellectual disability,high abilities/giftedness,childhood apraxia of speech,social communication disorder,Landau–Kleffner syndrome,stereotyped movement disorder and excessive screen time.Results We describe conditions commonly found in clinical practice,taking ASD as a reference.We addressed converging and divergent aspects of behavior,cognition,communication,language,speech,socialization,and stereotypes for the diagnosis of ASD and other disorders identified as potential differential or comorbid diagnoses.Conclusions The ranking and characterization of symptoms appear to be essential for better understanding the underlying common ground between children with developmental disorders and children with ASD,thus properly diagnosing and directing social,professional,or medication interventions.This detailed discussion adds to the literature since,although ASD differential diagnoses are frequently mentioned and discussed in textbooks and journal articles,they rarely occupy a prominent place as we aimed herein.

Clinical analysis of 114 cases of bronchiolitis in infants

BACKGROUND Bronchiolitis is a common lower respiratory tract infection in infants and young children.Severe cases may be accompanied by obvious dyspnea and oxygen saturation decline.AIM To summarize the clinical features,standard diagnosis,and treatment of bronchi-olitis.METHODS This is a retrospective analysis of 114 pediatric patients(74 males,40 females)who were first diagnosed as having bronchioles at the Department of Pediatrics of Tongling Maternal and Child Health Hospital from January 2019 to December 2019.The clinical features,imaging features,treatment,and other clinical data were recorded and analyzed.RESULTS The age of onset of the disease was mainly from 1 mo to 6 mo(75.4%),and the time to hospital visit was mostly from the 2nd day to the 4th day of the course of the disease(75.4%).Lung imaging examination showed increase in lung texture,fuzzy(93.8%).The main treatment was atomization therapy:Budesonide combined with terbutaline(45.6%)and budesonide combined with salbutamol(38.5%).The average hospitalization time was 7.1±2.4 d,and the overall cure rate was 94.7%.In patients without bacterial infection,the use of antibiotics significantly prolonged the length of hospital stay(7.8±2.5 d vs 5.7±1.8 d)and improved the cure rate(98.3%vs 87.9%,P<0.05).CONCLUSION Infants with bronchiolitis are mainly male and tend to have a good prognosis.However,the unneeded use of antibiotics may prolong the length of hospital stay significantly,which imposes the burden both on the patients and hospital system.CONCLUSION Bronchiolitis is a common acute respiratory infectious disease in infants and young children.It mainly affects male children and the age onset is between 1 to 6 mo.The standard use of antibiotics should be emphasized in view of the prolonged average length of hospital stay between the antibiotic treatment group and the non-antibiotic treatment group.When the course of disease is more than 7 d or the treatment effect is poor,active anti-infective treatment is needed to improve the long-term prognosis.Very few children have recurrent cough and wheezing symptoms within 1 year,which may be related to the risk of later asthma attack.FOOTNOTES Author contributions:Shi C and Wu MH contributed to study conception and design,and provision of study materials or patients;Shi C contributed to administrative support;Zuo A,Yang MM,and Jiang RR contributed to data collection and assembly;Shi C contributed to data analysis and interpretation,and manuscript writing;all authors contributed to the final approval of the manuscript.Institutional review board statement:The study was conducted in accordance with the Declaration of Helsinki(as revised in 2013).The study was approved by Institutional Review Board of Tongling Maternal and Child Health Hospital.

Rare Etiology of Reversible Hypokinetic Dilatated Heart Disease in Infants: Bland-White-Garland Syndrome (ALCAPA)

Bland-White-Garland syndrome or ALCAPA is an abnormality of birth of the left coronary artery from the pulmonary artery. It is a diagnostic and therapeutic emergency because it is a curable cause of hypokinetic dilated heart disease in infants. We report through this clinical case, the fourth case of infantile ALCAPA diagnosed in Senegal in a 7-month-old infant. The symptomatology began around the age of 2 months, with a grumpy state associated with more marked crying and moaning during feedings and bowel movements. The mother reported hospitalization for a severe lung infection when she was 6 months old. The examination noted an infant in poor general condition, retarded growth and weight, and a 3/6th holosystolic murmur at the apex. Troponinemia was positive at 43.90 ng/L. The electrocardiogram showed Q waves on the lower side, a sub endocardial lesion on the upper side and a ST segment elevation in aVR. Doppler echocardiography showed dilated cardiomyopathy with a mean alteration of systolic function of the left ventricle at 37%, a mean mitral insufficiency and a strong suspicion of a birth anomaly of the left coronary artery. The CT scan confirmed the diagnosis of ALCAPA. Surgicalreimplantation of the left coronary artery at the aortic level was performed at 10 months of life with a favourable outcome at D50 postoperative.

Fournier gangrene in an infant, complicated with severe sepsis and liver dysfunction: A case report

BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated with this disease is dependent on the timing of medical care.CASE SUMMARY A 3-month-old boy was admitted to our pediatric intensive care unit in critical condition after a 5-day history of fever and scrotal erythema with breaching skin lesions and swelling.Despite ambulatory antibiotic treatment,the child’s clinical condition deteriorated.At the time of admission,the child had necrotizing scrotal fasciitis that had spread to the abdomen.Following reanimation,the surgeon decided on an immediate intervention to rule out testicular torsion and to debride the affected area.Despite optimal antibiotic and supportive therapy,the patient developed severe sepsis with liver dysfunction,making treatment more challenging.CONCLUSION Recognizing Fournier gangrene,prompt referral to pediatric surgery,and appropriate antibiotic coverage are critical for avoiding sepsis and multiorgan dysfunction.

Understanding Autism Spectrum Disorder(ASD)Unraveling the Mysteries(A Short Review)

Autism Spectrum Disorder(ASD)is a multifaceted neurodevelopmental condition characterized by a spectrum of symptoms and behaviors,challenging to fully comprehend due to its variability.This article provides an overview of ASD,including its characteristics,prevalence,diagnosis,and causes.The prevalence of ASD has been on the rise,with improved awareness and diagnostic tools.While genetics and environmental factors play a role,the exact causes remain elusive.Early intervention and various therapies are crucial for improving outcomes,although there is no cure.Ongoing research aims to uncover the complexities of ASD and develop effective treatments.Embracing diversity and fostering inclusion is essential for supporting individuals with ASD.As we continue to unravel the mysteries of ASD,we move closer to a more understanding and inclusive society.This article explores the role of Transcranial Magnetic Stimulation(TMS)in the treatment of Autism Spectrum Disorder(ASD).TMS,a non-invasive neurostimulation technique,is gaining attention as a potential therapy to address specific aspects of ASD.

Sex Differences in Diagnosis and Clinical Phenotypes of Chinese Children with Autism Spectrum Disorder

The aim of this study was to explore the differences between boys and girls in the diagnosis and clinical phenotypes of autism spectrum disorder（ASD） in China＇s mainland. Children diagnosed with ASD（n = 1064, 228 females） were retrospectively included in the analysis. All children were assessed using the Autism Diagnostic Interview-Revised（ADI-R） and Autism Diagnostic Observation Schedule（ADOS）. The results showed that girls scored significantly higher in ADI-R socioemotional reciprocity than boys, and also scored lower in ADI-R and ADOS restricted and repetitive behaviors（RRBs）. Meanwhile, the proportions of girls who satisfied the diagnostic cut-off scores in the ADI-R RRBs domain were lower than in boys（P ／ 0.05）. Our results indicated that girls with ASD show greater socio-emotional reciprocity than boys. Girls also tended to show fewer RRBs than boys, and the type of RRBs in girls differ from those in boys. The ADI-R was found to be less sensitive in girls, particularly for assessment in the RRBs domain.

Multi-Scale Attention-Based Deep Neural Network for Brain Disease Diagnosis

Whole brain functional connectivity(FC)patterns obtained from resting-state functional magnetic resonance imaging(rs-fMRI)have been widely used in the diagnosis of brain disorders such as autism spectrum disorder(ASD).Recently,an increasing number of studies have focused on employing deep learning techniques to analyze FC patterns for brain disease classification.However,the high dimensionality of the FC features and the interpretation of deep learning results are issues that need to be addressed in the FC-based brain disease classification.In this paper,we proposed a multi-scale attention-based deep neural network(MSA-DNN)model to classify FC patterns for the ASD diagnosis.The model was implemented by adding a flexible multi-scale attention(MSA)module to the auto-encoder based backbone DNN,which can extract multi-scale features of the FC patterns and change the level of attention for different FCs by continuous learning.Our model will reinforce the weights of important FC features while suppress the unimportant FCs to ensure the sparsity of the model weights and enhance the model interpretability.We performed systematic experiments on the large multi-sites ASD dataset with both ten-fold and leaveone-site-out cross-validations.Results showed that our model outperformed classical methods in brain disease classification and revealed robust intersite prediction performance.We also localized important FC features and brain regions associated with ASD classification.Overall,our study further promotes the biomarker detection and computer-aided classification for ASD diagnosis,and the proposed MSA module is flexible and easy to implement in other classification networks.

Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review

Background:Continuing progress in the global pediatric human immunodeficiency virus(HIV)response depends on timely identification and care of infants with HIV.As countries scale-out improvements to HIV early infant diagnosis(EID),economic evaluations are needed to inform program design and implementation.This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases(Embase,MEDLINE and EconLit)and grey literature for economic analyses of HIV EID in low-and middle-income countries published between January 2008 and June 2021.We extracted data on unit costs,cost savings,and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats.We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records,we included 29 studies:17 cost analyses and 12 model-based cost-effectiveness analyses.Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests.All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective.Most studies reported costs of EID testing strategies;however,few studies assessed the same intervention or reported costs in the same way,making comparison of costs across studies challenging.Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV,while not directly comparable across studies,covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving.Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.

Diagnosis and treatment experience of COVID-19 in a three-month-old baby

The three-month-old infant, born in Xiaogan City, Hubei Province , was hospitalized due to fever for 4 hours on January 26, 2020 .The throat swab test was positive for SARS-CoV-2 nucleic acid, and the final diagnosis was COVID-19. The condition was improved after 17 days hospitalization treatment, the infant was cured and discharged. The infant had fever, cough and foaming at the mouth. Physical examination: lipstick, no cyanosis, pharyngeal congestion, stable breathing, clear breath sounds in both lungs, no obvious rales. The infant was from Hubei, the epidemic area, with fever and respiratory symptoms. The peripheral blood leukocyte was not high. The chest X-ray showed that the right lung texture was slightly thickened, which seems to be a bit of sheet shadow. The throat swab COVID-19 nucleic acid test was positive. The diagnosis of COVID-19 was established and complied with general type. The infant was treated with paramivir, azithromycin and ceftazidime, ambroxol, atomization and sputum suction. The infant was cured and discharged On February 11,2020.

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration:A case report

BACKGROUND The term sudden unexpected infant death(SUID)is not always properly invoked.It refers to a broad range of conditions that sometimes defy classification.There is not only a strong emotional impact on the family,but such cases are also quite complex.Underlying causes may be multiple,not always readily apparent,and have potential repercussions,especially in terms of forensics.CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest.The parents had immediately rushed their child to the hospital,stating the baby was found prone and not breathing.Total-body postmortem computed tomography(PMCT)was performed,revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change.At autopsy,the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material.There was widespread airspace reduction due to parenchymal collapse.Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells.Immunohistochemical studies were performed,targeting CD15,CD68,and alpha-lactalbumin.Ultimately,the focus was on alpha-lactalbumin(milk protein),which showed marked immunopositivity within alveolar spaces.Cytoplasmic staining of macrophages was also particularly prominent.CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances.PMCT is a useful tool in this setting,given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases.These findings,later confirmed by immunohistochemical investigations,were indicative of active pneumonia due to aspirated milk.The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern.PMCT is a very valuable aid in cases of forensic interest,as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options

Since the documented observations of Kanner in1943, there has been great debate about the diagnoses, the sub-types, and the diagnostic threshold that relates to what is now known as autism spectrum disorder（ASD）.Re？ecting this complicated history, there has been continual re？nement from DSM-III with ‘Infantile Autism＇ to the current DSM-V diagnosis. The disorder is now widely accepted as a complex, pervasive, heterogeneous condition with multiple etiologies, sub-types, and developmental trajectories. Diagnosis remains based on observation of atypical behaviors, with criteria of persistent de？cits in social communication and restricted and repetitive patterns of behavior. This review provides a broad overview of the history, prevalence, etiology, clinical presentation, and heterogeneity of ASD. Factors contributing to heterogeneity, including genetic variability, comorbidity, and gender are reviewed. We then explore current evidencebased pharmacological and behavioral treatments for ASD and highlight the complexities of conducting clinical trials that evaluate therapeutic ef？cacy in ASD populations.Finally, we discuss the potential of a new wave of research examining objective biomarkers to facilitate the evaluation of sub-typing, diagnosis, and treatment response in ASD.