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Paraoesophageal hernias are an extremely rare variety of hiatal hernias commonly encountered in elderly. This article illustrates the case of a 3-year-old child with features of urinary tract infection but incidentally diagnosed with paraesophageal hiatal hernia with associated organoaxial gastric rotation and a preprandial intrathoracic stomach with no symptoms congruent with his diagnosis. The diagnosis was suspected initially on ultrasonography of the right hemithorax and confirmed with barium studies and computed tomography with oral contrast. Although an upper gastrointestinal endoscopy was advised by the clinician, the patient never underwent the procedure during our follow-up period. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acute appendicitis is a common cause of hospital admission and emergency laparotomy among children and young adults. Although the diagnosis is clinical, the use of radiological imaging has emerged over the past decades. Its principal use is as a problem-solving tool in equivocal cases. Owing to the increased use of imaging in the last few years, the negative appendicectomy rate has dropped significantly. In this prospective observational study, we compared the diagnostic accuracy of Ultrasonography and Non-Contrast Computed Tomography. METHOD: One hundred and eighteen patients with clinically suspected appendicitis followed a designed protocol. Patients underwent appendicectomy after a first performed positive ultrasonography or after a positive Non-Contrast Computed Tomography when Ultrasonography was equivocal or nonspecific. When any other diagnosis was apparent in either imaging modality which could explain the symptomatology in the patient, they were considered negative for acute appendicitis and treated accordingly. RESULTS: The respective sensitivity, specificity, and accuracy for Ultrasonography, Non-Contrast Computed Tomography, and the whole diagnostic pathway for the diagnosis of acute appendicitis were 70.73%,80.83%, and 78.54; 100%,100%,100%, and 83.6%; and 100%,83.33% and 94.92%. CONCLUSION: Using Ultrasonography as the first-line diagnostic tool and Non-Contrast Computed Tomography as a complementary second-line diagnostic tool, appendicitis can be diagnosed with high accuracy and the negative laparotomy rate can be brought down significantly without any increase in the risk of complications. Computed Tomography is superior to Ultrasonography for the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

The possibility that the etiology of late onset Alzheimer's disease is linked to viral infections of the CNS has been actively debated in recent years. According to the antiviral protection hypothesis, viral pathogens trigger aggregation of Aβ peptides that are produced as a defense mechanism in response to infection to entrap and neutralize pathogens. To test the causative relationship between viral infection and Aβ aggregation, the current study examined whether Aβ plaques protect the mouse brain against Herpes Simplex Virus 1 (HSV‐1) infection introduced via a physiological route and whether HSV‐1 infection triggers formation of Aβ plaques in a mouse model of late‐onset AD that does not develop Aβ pathology spontaneously. In aged 5XFAD mice infected via eye scarification, high density of Aβ aggregates did not improve survival time or rate when compared with wild type controls. In 5XFADs, viral replication sites were found in brain areas with a high density of extracellular Aβ deposits, however, no association between HSV‐1 and Aβ aggregates could be found. To test whether HSV‐1 triggers Aβ aggregation in a mouse model that lacks spontaneous Aβ pathology, 13‐month‐old hAβ/APOE4/Trem2*R47H mice were infected with HSV‐1 via eye scarification with the McKrae HSV‐1 strain, intracranial inoculation with McKrae, intracranial inoculation after priming with LPS for 6 weeks, or intracranial inoculation with high doses of McKrae or 17syn + strains that represent different degrees of neurovirulence. No signs of Aβ aggregation were found in any of the experimental groups. Instead, extensive infiltration of peripheral leukocytes was observed during the acute stage of HSV‐1 infection, and phagocytic activity of myeloid cells was identified as the primary defense mechanism against HSV‐1. The current results argue against a direct causative relationship between HSV‐1 infection and Aβ pathology. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a devastating fatal neurodegenerative disease. An alternative to the amyloid cascade hypothesis is that a viral infection is key to the etiology of late-onset AD, with ß-amyloid (Aß) peptides playing a protective role. In the current study, young 5XFAD mice that overexpress mutant human amyloid precursor protein with the Swedish, Florida, and London familial AD mutations were infected with one of two strains of herpes simplex virus 1 (HSV-1), 17syn+ and McKrae, at three different doses. Contrary to previous work, 5XFAD genotype failed to protect mice against HSV-1 infection. The region- and cell-specific tropisms of HSV-1 were not affected by the 5XFAD genotype, indicating that host-pathogen interactions were not altered. Seven-to ten-monthold 5XFAD animals in which extracellular Aß aggregates were abundant showed slightly better survival rate relative to their wild-type (WT) littermates, although the difference was not statistically significant. In these 5XFAD mice, HSV-1 replication centers were partially excluded from the brain areas with high densities of Aß aggregates. Aß aggregates were free of HSV-1 viral particles, and the limited viral invasion to areas with a high density of Aß aggregates was attributed to phagocytic activity of reactive microglia. In the oldest mice (12-15 months old), the survival rate did not differ between 5XFAD and WT littermates. While the current study questions the antiviral role of Aß, it neither supports nor refutes the viral etiology hypothesis of late-onset AD. [ABSTRACT FROM AUTHOR]

Objective: Hemophilia is a common X-linked recessive coagulopathy causing recurrent bleeding into the synovial joints and results in articular and periarticular abnormalities. To our knowledge, this is the first comprehensive study aimed at studying the clinico-radiological joint score evaluation in hemophilic arthropathy in children from a developing country and its possible impact on the quality of life. Methods: In this hospital-based, prospective, descriptive study, all children presenting to the pediatric rheumatology clinic were studied. The joint physical examination was scored using the Hemophilia Joint Health Score 2.1 (HJHS 2.1). The patients were then subjected to imaging of the most affected joint using ultrasonography (USG) and magnetic resonance imaging (MRI). Detailed USG and MRI radiological evaluation was recorded in the predesigned proforma using the Hemophilia Early Arthropathy Detection with Ultra Sound (HEAD-US) score and MRI DENVER score. The physical quality of life as per Functional Independence Score in Hemophilia (FISH) was noted. The clinical, radiological, and functional scores were analyzed with an appropriate statistical measure. Results: The mean age at presentation was 7.4 years (interquartile range 4.9-10), with the knee being the most common joint involved. All of the USG score, MRI score, and FISH score have a significant correlation (p<0.05), with the HJHS 2.1 score with correlation coefficients of 0.7086, -0.8916, and 0.8607, respectively. USG and MRI had a correlation coefficient of -0.7145 and -0.8326 with FISH, respectively. Conclusion: The degree of association between HJHS 2.1 score was found to be maximum with HEADUS score, whereas a negative correlation was seen evaluating FISH score with both HEAD-US and MRI DENVER scores. Use of these scores, specifically HEAD-US score, will result in consistent assessment of hemophilic joints, optimizing the management of the destructive changes. [ABSTRACT FROM AUTHOR]