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An 80-year-old woman with history of hypertension presented to the emergency department following a fall. Her mental status quickly deteriorated and became obtunded. She was stuporous, and unresponsive to verbal stimuli. She had minimally reactive pupils and was moving extremities to painful stimuli. An MRI scan was performed following an unrevealing CT brain.

We report a case series of young adults who were admitted to hospital with seizures after regular kratom beverage consumption. This study aimed to determine kratom consumption habits and seizure characteristics and to explore whether chronic kratom ingestion without concomitant drug abuse leads to recurrent seizure or epilepsy. All patients underwent blood investigations, a brain computed tomography (CT) scan, electroencephalography, and urine testing for mitragynine and drug toxicology. Eleven participants who had a positive urine mitragynine test were included in the study. The longest duration of kratom consumption was 84 months: – most drank more than eight times per month (>200 mL/drink). Seizure developed within 10 minutes or up to 72 hours post-ingestion. Seizure occurred one to three times per year in most cases. Four patients had a focal to bilateral tonic-clonic seizure whereas the remaining participants had a generalized tonic-clonic seizure. Four patients mixed kratom with diphenhydramine syrup, and one patient took methamphetamine. Two patients had positive urine results for recreational drugs (opioid and amphetamine). This study provided indirect evidence that chronic kratom use with or without concomitant drug abuse can cause recurrent seizures in susceptible individuals, which may progress to epilepsy or require antiepileptic medication.

Cerebral venous sinus thrombosis (CVST) is caused by either acquired or inherited pro-thrombotic states. Hyperthyroidism is a less recognised predisposing factor of CVST, and the causality has been debated. We report a case of a life-threatening CVST in a 40-year-old woman, with uncommon dual risk factors: hyperthyroidism and advanced squamous cell carcinoma of the cervix. CVST should be considered as a differential diagnosis when a patient with hyperthyroidism presents with new-onset headache or other neurological symptoms. Further assessment to elucidate other covert risk factors may need to be continuously carried out, when the causal relationship of one apparent cause has not been well established.

Burkholderia pseudomallei is recognized to cause severe and fatal infections. Most of the infections caused by this facultative intracellular gram-negative bacterium are pneumonia, soft tissue, genito-urinary and central nervous system infection. We report an unusual case of primary prostatic abscess complicated by perianal abscess caused by Burkholderia pseudomallei. Melioidosis related anorectal infections have not been previously reported in the literature.

Granulosa cell tumors (GCT) of the ovary are rare, hormonally-active neoplasms characterized by endocrine manifestations, an indolent course and late relapse. Chemotherapy and hormonal therapy have proved to be of limited efficacy. Nuclear receptors (NR) have a central pathogenic role in endocrine malignancy and present as potential targets for therapeutic intervention. NR have established roles in granulosa cell biology but their roles in GCT remain largely unexplored. In order to systematically examine the NR family in GCT, we used ABI Taqman® Low Density Array microfluidic cards to analyse 14 GCT and two GCT-derived cell lines for expression of the 48 NR. The levels of expression were remarkably consistent across the GCT. We found that peroxisome proliferator-activated receptor gamma (PPARγ) had greater than ten-fold absolute expression when compared with either the NCBI tumour or brain reference RNA pools. PPARγ agonists are regarded as potential therapeutic agents in the treatment of inflammatory diseases and certain cancers. Given the high expression levels of PPARγ in GCT, we investigated whether the use of PPARγ and/or retinoid × receptor (RXR) agonists or antagonists have an effect on the GCT-derived cell lines, KGN and COV434. We used real-time cell analysis (RTCA) to investigate the cytotoxicity of the PPARγ agonist, troglitazone, and the RXR agonist, 9-cis-retinoic acid, by continuous monitoring of cell growth, proliferation and viability in the GCT-derived cell lines in real-time. We observed that a combination of troglitazone and 9-cis-retinoic acid significantly inhibited cell proliferation in the cell lines (56% compared to control). Because we have previously reported that steroid receptors are transrepressed in these GCT cells due to constitutive activation of the NF-κB signalling pathway, we tested the effect of troglitazone and 9-cis-retinoic acid in conjunction with a NF-κB inhibitor, BAY-117082. We observed a further decrease in cell proliferation (85% compared to control). This was a PPARγ-mediated effect as it was reversed by co-administration with the PPARγ antagonist, GW9662. The decrease in proliferation was due to cellular apoptosis. We also investigated whether PPARγ is transcriptionally active in these cells using a reporter construct, specific for PPARγ, and observed that GCT cells were not responsive to either PPARγ agonists or antagonists in vitro. This was found to be due to NF-κB transrepression; when NF-κB was inactivated, PPARγ signaling was restored. We conclude that, while the use of PPARγ agonists may have potential as therapeutic agents for treating GCT, a combination of therapies involving the abrogation of NF-κB signaling may be of greater efficacy. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4536. doi:10.1158/1538-7445.AM2011-4536