Recurrent Isolated Sixth Nerve Palsy in Childhood—Review on a Rare Phenomenon

Sixth nerve palsy is an ominous sign in pediatric neurology. Due to the long and tortuous course of the sixth (abducens) nerve, it is generally considered a sign of intracranial pathology. Sixth nerve palsy is associated with increased intracranial pressure and neoplasms, among other less frequent causes. In ∼5 to 15% of cases, no cause can be identified. These cases are classified as idiopathic or “benign” and recovery is typically complete. A recurrence of symptoms is very rare. We provide a rare case report of recurrent benign sixth nerve palsy in a 5-year-old child. In addition, we provide an overview of all earlier published cases of recurrent isolated sixth nerve palsy. To date, only 72 pediatric patients with recurrent isolated sixth nerve palsy have been reported. Young females with left-sided sixth nerve palsy and recent immunization are at risk of recurrence. Pathophysiological mechanisms have been discussed, but have yet to be clarified. Recurrent isolated sixth nerve palsy is only rarely associated with severe causes and the need for extensive investigation may be questioned.

Rare Case of Chagas Disease

Chagas is a multisystem disease transmitted from Trypanosoma cruiz, not uncommon in Latin America. This disease causes parasympathetic failure resulting in cardiac failure, arrhythmogenic, cardiomyopathy, sudden death, mega esophagus and mega colon. In this article, we present a case of chronic Chagas disease who had extensive investigation prior to reaching a correct diagnosis. We will highlight the symptomatology and treatment.

A case report of ChAdOx1 nCoV-19 vaccine–associated encephalitis

Background Vaccination against COVID-19 continues apace, but side-effects, both common and severe, continue to be reported. We report here the first published case of COVID-19 vaccine-related encephalitis. Case presentation A young woman presented with acute neuropsychiatric symptoms following recent ChAdOx1 nCoV-19 vaccination. Extensive investigation did not identify alternative causes. Conclusions This difficult case is here described, including presentation, investigation, and management. Further study on neuropsychiatric side-effects of COVID-19 vaccination, including investigation as to whether there may be a causal link, is required.

New Halogenated Secondary Metabolites from Red Algae of the South Pacific

<p>An NMR- and MS-directed study led to the isolation and structure elucidation of several halogenated secondary metabolites from a New Zealand and a Tongan red alga. An extensive investigation was carried out on the New Zealand red alga Rhodophyllis membranacea following mass spectrometric evidence for an unusual tetrahalogenated indole with the exceptionally rare inclusion of bromine, chlorine and iodine within a fraction of a semi-purified extract. Due to the difficulty associated with the structure elucidation of proton deficient molecules, a strategic isolation and structure elucidation of several polyhalogenated indoles was employed in order to unequivocally assign the halogen positions on the indolic core. This resulted in the isolation and characterisation of 11 new tetrahalogenated indoles (123–133), four of which contain bromine, chlorine and iodine (124 and 129–131) and represent the first isolation of such compounds. Additionally, four new pentahalogenated indoles (134–137) and an uncharacterised tribromotrichloroindole were isolated. The synthetically known compound 4-chloroisatin (138) was isolated as a new marine natural product, while 4-chloro-3-hydroxyl-3-(2-oxopropyl)-2-oxindole (139) was established to be an artefact of isolation. Several compounds were found to exhibit antifungal properties against Saccharomyces cerevisiae. A detailed examination of the Tongan alga Callophycus serratus led to the isolation of six new meroditerpenoids: callophycol C (227), iodocallophycols E (228) and F (229), iodocallophycoic acid B (230), deiodocallophycoic B (231) and callophycoic acid I (232). The relative configurations in compounds 228–231 are proposed to differ from closely related compounds in the literature. Iodocallophycol E (228) exhibited moderate cytotoxicity against the HL-60 cell line with an IC50 value of 6.0 μM.</p>

New Halogenated Secondary Metabolites from Red Algae of the South Pacific

<p>An NMR- and MS-directed study led to the isolation and structure elucidation of several halogenated secondary metabolites from a New Zealand and a Tongan red alga. An extensive investigation was carried out on the New Zealand red alga Rhodophyllis membranacea following mass spectrometric evidence for an unusual tetrahalogenated indole with the exceptionally rare inclusion of bromine, chlorine and iodine within a fraction of a semi-purified extract. Due to the difficulty associated with the structure elucidation of proton deficient molecules, a strategic isolation and structure elucidation of several polyhalogenated indoles was employed in order to unequivocally assign the halogen positions on the indolic core. This resulted in the isolation and characterisation of 11 new tetrahalogenated indoles (123–133), four of which contain bromine, chlorine and iodine (124 and 129–131) and represent the first isolation of such compounds. Additionally, four new pentahalogenated indoles (134–137) and an uncharacterised tribromotrichloroindole were isolated. The synthetically known compound 4-chloroisatin (138) was isolated as a new marine natural product, while 4-chloro-3-hydroxyl-3-(2-oxopropyl)-2-oxindole (139) was established to be an artefact of isolation. Several compounds were found to exhibit antifungal properties against Saccharomyces cerevisiae. A detailed examination of the Tongan alga Callophycus serratus led to the isolation of six new meroditerpenoids: callophycol C (227), iodocallophycols E (228) and F (229), iodocallophycoic acid B (230), deiodocallophycoic B (231) and callophycoic acid I (232). The relative configurations in compounds 228–231 are proposed to differ from closely related compounds in the literature. Iodocallophycol E (228) exhibited moderate cytotoxicity against the HL-60 cell line with an IC50 value of 6.0 μM.</p>

Significant Subgraph Mining for Neural Network Inference with Multiple Comparisons Correction

We describe how the recently introduced method of significant subgraph mining can be employed as a useful tool in network comparison. It is applicable whenever the goal is to compare two sets of unweighted graphs and to determine differences in the processes that generate them. We provide an extension of the method to dependent graph generating processes as the occur for example in within-subject experimental designs. Furthermore, we present an extensive investigation of error-statistical properties of the method in simulation using Erdos-Renyi models and in empirical data. In particular, we perform an empirical power analysis for transfer entropy networks inferred from resting state MEG data comparing autism spectrum patients with neurotypical controls. From this analysis one may estimate that the appropriate sample size for similar studies should be chosen in the order of n=60 per group or larger.

Can patients with mild post-operative hyponatraemia following elective arthroplasty be discharged safely? A large-scale service evaluation suggests they can

Background Post-operative hyponatraemia is common following arthroplasty. Clinical hyponatraemia guidelines lack detail on when treatment is necessary, and there is a paucity of literature to guide best practice. Methods Data were collected within retrospective service evaluations over two time periods in a single high throughput joint unit. The hospital’s electronic database identified 1000 patients who were admitted electively between February 2012 and June 2013 and again between November 2018 and April 2019 for primary total hip, total knee or uni-compartmental knee arthroplasty. Hyponatraemia and non-hyponatraemia groups were compared. Logistic regression analysis was used to identify independent predictors of post-operative hyponatraemia, length of stay (LOS), re-attendance or re-admission to hospital. Results Between 2012–2013 and 2018–2019, 32.1% and 25.7% of patients, respectively, developed post-operative hyponatraemia (serum sodium (s[Na]) ≤135 mmol/L). Those with post-operative hyponatraemia were significantly older, weighed less, were more comorbid and had lower pre-operative sodium. Multivariate analysis showed that increased age, knee surgery and lower pre-operative s[Na] independently predicted post-operative hyponatraemia. Post-operative hyponatraemia did not independently predict LOS, re-attendance or re-admission to hospital, within 90 days, in either cohort. Conclusion Post-operative hyponatraemia is common and may be a marker of pre-operative vulnerability. In these cohorts, it was not independently associated with LOS, re-attendance or re-admission to hospital. We suggest that otherwise well patients with mild hyponatraemia can be safely discharged earlier than is often the case and may not require extensive investigation. Further examination and research is required to develop a pre-operative approach to predict which patients will develop significant post-operative hyponatraemia.

“Goodbye Moscow, Hello Brussels”: The City Diplomacy of Chișinău Mayor Dorin Chirtoacă

This article argues that post-Soviet mayors are foreign policy actors that deserve more attention from area studies and foreign policy analysis scholars. Mayors have their own diplomatic preferences and goals – rooted in geopolitical and ethnonationalist views – that they can enact using city hall institutions and networks. They can work either in harmony or in opposition with central authorities by bolstering or compromising the executive’s diplomatic goals and actions. These claims are explored in a case study of the foreign policy of Chișinău mayor Dorin Chirtoacă (2007–2017), whose diplomatic endeavors consolidated the Moldovan capital’s ties with Romania and the European Union and minimized interactions with countries in the former Soviet Union, including Russia. At times, the mayor’s actions abroad ran afoul of central authorities as he created an alternative foreign policy that undermined central foreign policy. The findings suggest that a more extensive investigation of how mayors interact with foreign actors would refine our understanding of foreign policy-making in the former Soviet Union and in Central and Eastern Europe more broadly.