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   2019| November-December  | Volume 39 | Issue 6  
    Online since November 14, 2019

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Tremors as an atypical presentation of cervical myelopathy
Melinda Hui Si Goh, Arun-Kumar Kaliya-Perumal, Jacob Yoong-Leong Oh
November-December 2019, 39(6):296-298
Tremors are common especially in the elderly population. However, tremors occurring secondary to cervical myelopathy are rarely reported. We report the case of a 91-year-old gentleman who was admitted to the neurology service with chief complaints of bilateral upper- and lower-limb tremors. This had progressed rapidly over 2 weeks to the extent that he was not able to feed himself and was unable to walk without support. An initial working diagnosis of Parkinson's disease was made but was later dismissed because of the atypical features. A magnetic resonance imaging of cervical spine was subsequently performed which revealed a large disc herniation at C3–C4 level, causing severe spinal canal stenosis and cord compression. Given this radiological presentation and the absence of other objective pathologies on further investigations, we correlated his symptoms to the underlying cervical cord compression. He underwent anterior cervical discectomy and fusion which led to complete resolution of tremors by 8 weeks postsurgery. His unsteadiness eventually resolved, and there was no recurrence of tremors throughout our follow-up period. This case highlights a rare atypical presentation of cervical myelopathy as peripheral limb tremors. The diagnostic dilemma, management strategies, and hypothesis to explain this phenomenon are discussed.
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Predictors of hand hygiene behavior among nurses: A theoretical cross-sectional study
Giti Rahimi, Aziz Kamran, Elham Sharifian, Hamed Zandian
November-December 2019, 39(6):278-283
Background and Aims of the Study: Given the effectiveness of handwashing in preventing nosocomial infections and key role of nurses as a care provider in ensuring the well-being of individuals and society, this study aimed to determine the predictive power of BASNEF model constructs on this behavior. Materials and Methods: This descriptive analytical study was conducted on a total of 498 nurses working at hospitals based in Ardabil and Khalkhal during 2018. The participants were selected through a multistage sampling method. The data were collected by a valid and reliable questionnaire based on the BASNEF model constructs and analyzed through the SPSS 18, using statistical tests including t-test, ANOVA, Pearson's correlation, and multiple linear regressions, considering the significant level lower than 5%. Results: There was a significantly negative correlation between age/work experiences with hand hygiene (HH) behavior. Moreover, the attitude toward behavior showed a significantly positive correlation with the enabling factors and a significantly negative correlation with the subjective norms. The results of multiple linear regression indicated that the BASNEF model components had a predictive power of 3%, which was raised to 21.8% as age and work experience were added to the regression model. Hence, age and work experience were two important factors in predicting the hygiene behavior. Conclusions: The BASNEF model components cannot predict HH behavior among nurses, but age and work experience were two important factors in predicting the hygiene behavior.
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Living kidney donor evaluation: A simplistic approach
Akbar Mahmood
November-December 2019, 39(6):255-261
Donating an organ is donating a new life. This is a remarkable act of the donor, and due to this donated organ, transplantation has become a routine practice with miraculous results, but the process of organ procurement, donation, and harvesting is not a simple one as organ transplantation sounds fascinating. This is a major undertaking and serious responsibility which rests on the shoulders of the medical community, involved in the human organ transplantation, especially from the live donors to safeguard donor health. Kidney donation principle is candid which states that one person on dialysis is better than two on dialysis. Live kidney donors are superior to the cadavers. There are exhaustive protocols for kidney donor evaluation, and guidelines vary among different countries. This article will outline the practical approach of donor evaluation by employing conventional tools of basic medical practice and help this complex process be simplified and swift and practicable. Detail history, meticulous physical examination, and thorough laboratory and radiological workup must be adopted by the transplant centers which has maximum beneficial outcome by aiding pickup donor health issues. Evaluation process can be extended further based on the abnormality detected during this workup which guides appropriate action to rectify the problem, thus protecting donor by precluding donation cost-effectively. Major point to be stressed through this article is protecting the donor health not only during the postoperative period but also providing lifelong donor follow-up.
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Plasma growth arrest-specific protein 6 expression in uremic patients with type 2 diabetes
Sheng-Chiang Su, Yu-Juei Hsu, Chieh-Hua Lu, Chang-Hsun Hsieh, Yi-Jen Hung, Jhih-Syuan Liu, Peng-Fei Li, Pei-Hung Shen, Chien-Hsing Lee
November-December 2019, 39(6):272-277
Background: Diabetic kidney disease is a major cause of uremia worldwide; recently, controversial roles for growth arrest-specific protein 6 (GAS 6) have been revealed in the pathogenesis of diabetic nephropathy. A better understanding of the association between GAS6 and diabetic nephropathy may lead to the development of novel therapeutic approaches for the prevention and treatment of diabetic uremia. Objectives: The aim of this study was to investigate the levels of GAS6 and its role in uremic patients with Type 2 diabetes. Materials and Methods: A total of 109 adults were recruited, of whom 23 had Type 2 diabetes and uremia and 56 had newly diagnosed Type 2 diabetes without remarkable nephropathy; thirty individuals with normal glucose tolerance without significant clinical comorbidities served as controls. Plasma GAS6 concentration and common anthropometric and biochemical variables were analyzed. Results: Plasma GAS6 levels were significantly lower in patients with Type 2 diabetes than in controls regardless of nephropathy (P < 0.001). A trend in declined level of GAS6 among the three groups was also observed. In addition, GAS6 levels were significantly inversely correlated with plasma creatinine, blood urea nitrogen, and uric acid levels in all patients (P < 0.01 for all comparisons). In multivariate logistic regression analysis, higher plasma GAS6 concentration was significantly associated with decreased risk of diabetic uremia, even after adjusting for age, sex, and fasting glucose (C-statistic, 0.72; 95% confidence interval 0.57–0.92; P < 0.01). Conclusions: Our results suggest that plasma GAS6 levels are associated with Type 2 diabetes and may play a role in development of diabetic uremia.
  1,297 184 -
Establishment of primary human epithelial ovarian cancer cells and their application to cytotoxicity assessment
Chun-Kai Wang, Cheng-Kuo Lin, Li-Chun Huang, Ssu-Jen Chou, Chi-Kang Lin, Cheng-Chang Chang
November-December 2019, 39(6):262-266
Background: Ovarian carcinomas are highly metastatic tumors and the most lethal gynecological malignancies in the world. Treatment of human epithelial ovarian cancer (hEOC) is based on the combination of surgery and chemotherapy. The acquisition of resistance is a major obstacle to the clinical use of platinum drugs for 75% of high-grade serous ovarian cancer treatment. Hence, the urgent strategy is to develop platform to predict the resistance to targeted therapy after surgery and to screen the potential monotherapy, including platinum, in clinical treatment. Materials and Methods: Our laboratory tried to take advantage of ascites from hEOC patients to understand the mechanism of platinum-based resistance and screen the potential monotherapy choice via the primary culture strategy. We first established the culture conditions for ascites of the ovarian cancer patients. Results: We showed that we could culture these primary cells up to 13th generation. We further treated these primary cells with various steroid hormones for the epithelial-to-mesenchymal transient and regular monotherapy, including cisplatin, docetaxel, and doxorubicin, for the cytotoxicity. Finally, we also demonstrated the responsiveness of this monotherapy with antibodies against cell cycle, autophagy, or other survival-related factors. Conclusion: Our screening platform will provide us to further examine the resistance mechanism of any monotherapy in a different individual patient. We hope that our primary culture system used for standard monotherapy screening might provide the alert to drug resistance and the better combinatory therapy for personalized therapy.
  1,131 213 -
Can zinc supplementation widen the gap between control and complications in head and neck cancer patients treated with concurrent chemo-radiotherapy
Mohsin Khan, Shahid A Siddiqui, Mohd Akram, Mohd Shadab Alam
November-December 2019, 39(6):267-271
Introduction: Zinc as an antioxidant can attenuate the effects of ionizing radiation. Contrary to theoretical radiobiological concepts, studies have pointed to the differential effects of zinc on normal and tumor cells, respectively. Therefore the present study was conducted to highlight the effects of zinc supplementation on adverse events and response rates of head and neck cancer patients who had undergone definitive concurrent chemo-radiotherapy (CCRT). Materials and Methods: Case records of patients with head and neck cancer who underwent definitive chemo-RT were analyzed from July 2015 to July 2018. Those who received zinc supplements were categorized as Arm A and those who did not as Arm B. All patients received a total of 6600–7000 cGray RT with weekly cisplatinum. Radiation Morbidity Scoring System was used to summarize data on adverse events. Computed tomogram scans were compared for documenting response rates. Results: Data were collected from 95 patients under Arm A and 107 in Arm B. 15.8% in Arm A and 21.5% in Arm B had RT interrupted for >1 week. Although the results were not statistically different for > Grade 2 toxicities, patients in Arm A fared better than those in Arm B. Interestingly, when the two groups were analyzed for salivary gland adverse events, 74 patients in Arm B complained of ≥ Grade 2 toxicities as compared to 37 in Arm A, the results being statistically significant (P = 0.000017). Overall, response rates were 88.4% in Arm A and 92% in Arm B. Conclusions: Zinc supplementation lends some of its radioprotective effects in normal tissues with salivary glands deriving the major benefits.
  1,100 204 -
Fabry disease and general anesthesia: A case report and literature review
Tsai-Shan Wu, Wei-Cheng Tseng, Hou-Chuan Lai, Yi-Hsuan Huang, Jyh-Cherng Yu, Zhi-Fu Wu
November-December 2019, 39(6):289-292
Fabry disease (FD) is an X-linked lysosomal storage disease. FD presents with a variety of symptoms such as corneal clouding, reduced sweating, abdominal pain, neuropathic pain, angiokeratoma, sleep-disordered breathing, renal failure, cardiovascular diseases, and stroke. Severe organ damage may occur, and its gravity differs between individuals, usually being more serious in males and elders. According to previous reports, possible complications include hypertension, hypotension, bronchospasm, and intubation difficulty. Therefore, identifying FD patients carefully and performing detailed preoperative assessments, such as for cardiovascular, pulmonary, and renal functions, are both critical to increasing the chances of a positive treatment outcome. Advanced hemodynamic monitoring was recommended to prevent severe cardiovascular and respiratory impairment during surgery of advanced FD patients. To the best of our knowledge, there are only four reports on FD treatment, none being from Taiwan. Here, we report on a case of FD treatment undergoing general anesthesia in Taiwan and provide a literature review.
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A very rare case of mirror syndrome presenting with concurrent posterior reversible encephalopathy syndrome
Halil Onder, Cihan Comba
November-December 2019, 39(6):284-288
The objective is to present clinical and neuroimaging findings of a very rare patient diagnosed with mirror syndrome and associated posterior reversible encephalopathy syndrome (PRES). A 19-year-old Syrian, primigravida in the 38th week of gestation was admitted with a severe headache and consciousness impairment developing within a 1-day period. At admission, she was confused and noncooperative, and she developed two consecutive seizures. After prompt cesarean section, the patient recovered completely within 3 days. However, the fetus was hydropic and had deep anemia. The fetus died 5 h after birth due to cardiopulmonary insufficiency. A retrospective evaluation yielded the diagnosis of mirror syndrome. On the other hand, further investigations due to the neurological manifestations of the mother yielded the diagnosis of PRES in association with mirror syndrome. Mirror syndrome should be kept in mind as an important differential diagnosis in circumstances of preeclampsia-like presentations. In addition, to our knowledge, this case also constitutes the first report illustrating a patient with mirror syndrome and concurrent PRES.
  1,071 130 -
Atherosclerosis or nonatherosclerotic vasculopathy? Moyamoya disease in a mid-aged adult
Yu-Kuen Wang, Yu-Huei Li, Chih-Wei Wang, Fu-Chi Yang
November-December 2019, 39(6):293-295
All causes of cerebrovascular disease should be considered in any patient presenting with ischemic stroke, despite the patient have concomitant risk factors for atherosclerosis. Here, we reported a case of Moyamoya disease (MMD) at a rather old age and with the presence of multiple risk factors for atherosclerosis. It is difficult to consider MMD at first glance, and it is easy to choose the wrong treatment in the first place. The key radiological feature for differentiation is the bilateral intracranial stenosis, rather than atherosclerotic changes, which are characterized as plaques with an uneven surface.
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Neuropsychiatric manifestations of cognitively advanced idiopathic normal pressure hydrocephalus?
Halil Onder
November-December 2019, 39(6):299-300
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