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Human Herpesvirus 6-Associated Miller–Fisher Syndrome in a 5-Year-Old Child: A Case-Based Narrative Review of Pediatric Cases with Infectious Triggers
Background/Objectives: Miller–Fisher syndrome (MFS) is a rare Guillain–Barré variant defined by ophthalmoplegia, ataxia, and areflexia. Pediatric MFS is uncommon, and infectious triggers remain underrecognized. Human herpesvirus 6 (HHV-6) is neurotropic but rarely linked to immune-mediated neuropathies. In this paper, we describe a child with MFS associated with HHV-6 detected in cerebrospinal fluid (CSF) and review reported pediatric infections related to MFS. Methods: A 5-year-old girl presented with acute ophthalmoplegia, ataxia, and diminished reflexes. Neuroimaging, ophthalmologic tests, CSF analyses, and serologic andpolymerase chain reaction (PCR) assays were performed, including multiplex reverse transcription–PCR of cerebrospinal fluid using the BioFire® Meningitis/Encephalitis panel. A literature search was performed on Pubmed to identify pediatric (0–18 years) MFS cases with infectious triggers. Two reviewers independently screened and summarized the literature, and a PRISMA-style flow diagram was used to transparently report the study selection process. Results: HHV-6 DNA was detected via CSF PCR twice, while tests for other pathogens were negative. Anti-GQ1b and related antibodies were negative or borderline. The patient received intravenous immunoglobulin and corticosteroids, with full recovery after one month. Among 20 published pediatric cases (1997–2021), Campylobacter jejuni was most frequent, followed by Mycoplasma pneumoniae and influenza viruses. Anti-GQ1b IgM positivity and favorable outcomes were commonly reported, including cases managed conservatively. Conclusions: This case raises the hypothesis that HHV-6 may represent a potential post-infectious association in pediatric MFS. The review findings indicate that pediatric MFS generally follows infection, responds well to immunotherapy, and has an excellent prognosis. Viral testing may be considered in selected, hypothesis-generating contexts in atypical or seronegative pediatric MFS presentations.
Journal Article
Guillain–Barré and Miller Fisher syndromes—new diagnostic classification
Several distinct autoimmune neuropathies can be referred to collectively as Guillain–Barré syndrome (GBS). Wakerley and colleagues argue that confusing terminology hinders diagnosis, and they present a revised classification of 'classic' GBS, Miller Fisher syndrome and related conditions. This new approach to diagnosis might facilitate work-up, thereby helping to identify the correct treatment as quickly as possible.
Guillain–Barré syndrome (GBS) and its variant, Miller Fisher syndrome (MFS), exist as several clinical subtypes with different neurological features and presentations. Although the typical clinical features of GBS and MFS are well recognized, current classification systems do not comprehensively describe the full spectrum of either syndrome. In this Perspectives article, GBS and MFS are classified on the basis of current understanding of the common pathophysiological profiles of each disease phenotype. GBS is subclassified into classic and localized forms (for example, pharyngeal–cervical–brachial weakness and bifacial weakness with paraesthesias), and MFS is divided into incomplete (for example, acute ophthalmoparesis, acute ataxic neuropathy) and CNS subtypes (Bickerstaff brainstem encephalitis). Diagnostic criteria based on clinical characteristics are suggested for each condition. We believe this approach to be more inclusive than existing systems, and argue that it could facilitate early clinical diagnosis and initiation of appropriate immunotherapy.
Journal Article
Arthur Miller's global theater
No American playwright is more revered on the international stage than Arthur Miller. In Arthur Miller's Global Theater—a fascinating collection of new essays by leading international critics and scholars—readers learn how and why audiences around the world have responded to the work of the late theatrical icon. With perspectives from diverse corners of the globe, from Israel to Japan to South Africa, this groundbreaking volume explores the challenges of translating one of the most American of American playwrights and details how disparate nations have adapted meaning in Miller's most celebrated dramas. An original and engaging collection that will appeal to theater aficionados, scholars, students, and all those interested in Miller and his remarkable oeuvre, Arthur Miller's Global Theater illustrates how dramas such as Death of a Salesman, The Crucible, and A View from the Bridge developed a vigorous dialogue with new audiences when they crossed linguistic and national borders. In these times when problems of censorship, repressive regimes, and international discord are increasingly in the news, Arthur Miller's voice has never been more necessary as it continues to be heard and celebrated around the world.
eBook
The broken circle : a memoir of escaping Afghanistan
\"Before the Soviet invasion of 1980, Enjeela Ahmadi remembers her home--Kabul, Afghanistan--as peaceful, prosperous, and filled with people from all walks of life. But after her mother, unsettled by growing political unrest, leaves for medical treatment in India, the civil war intensifies, changing young Enjeela's life forever. Amid the rumble of invading Soviet tanks, Enjeela and her family are thrust into chaos and fear when it becomes clear that her mother will not be coming home. Thus begins an epic, reckless, and terrifying five-year journey of escape for Enjeela, her siblings, and their father to reconnect with her mother. In navigating the dangers ahead of them, and in looking back at the wilderness of her homeland, Enjeela discovers the spiritual and physical strength to find hope in the most desperate of circumstances.\"-- Provided by publisher.
Book
Antiganglioside antibody frequency in routine clinical care settings
Background and purpose Antiganglioside antibodies (AGAs) might be involved in the etiopathogenesis of many neurological diseases, such as Miller–Fisher syndrome (MFS) and Guillain–Barré syndrome (GBS). Available comprehensive reference data regarding AGA positivity rates and cross‐responsiveness among AGAs (where one line immunoblot is positive for ≥1 AGA) during routine clinical care are scant. Methods In this 10‐year monocentric retrospective study, 3560 immunoglobulin (Ig) G and IgM line blots (GA Generic Assays' Anti‐Ganglioside Dot kit) obtained using cerebrospinal fluid (CSF) and serum samples from 1342 patients were analyzed for AGA positivity in terms of 14 diagnosis categories and AGA cross‐responsiveness. Results Of all 3560 line blots 158 (4.4%) and of all CSF samples 0.4% (4/924) CSF line blots were AGA positive. For serum IgG, blots with positivity rates higher than the standard deviation of 15.6% were associated with MFS (GD3, GD1a, GT1a and GQ1b) and acute motor axonal neuropathy (AMAN) (GM1, GD1a and GT1a). For serum IgM, blots with positivity rates higher than the standard deviation of 8.1% were associated with AMAN (GM2, GT1a and GQ1b), MFS (GM1, GT1a and GQ1b), multifocal motor neuropathy (MMN) (GM1, GM2 and GQ1b) and chronic inflammatory demyelinating polyneuropathy (CIDP) (GM1). Cross‐responsiveness was observed in 39.6% of all positive serum AGA. Conclusions Testing for AGAs during routine clinical care rarely led to positive findings, both in serum and even less in CSF, except for the diagnoses AMAN, MFS, MMN and CIDP. Nonspecific findings found as cross‐responsiveness between different AGA samples occur frequently, impacting the positivity of most AGA subtypes.
Journal Article
Architectural concrete in detail : four buildings by Miller & Maranta
The architectural use of fair faced concrete and the technology of concrete are analysed and explained in a clear, in-depth way, using the examples of four buildings by the renowned Swiss architects Miller & Maranta.
Book
Overlapping Miller Fisher Syndrome, Bickerstaff Brainstem Encephalitis, and Guillain-Barré Syndrome without glycolipid antibodies-a case report and literature review
We present a rare case of a 56-year-old female presenting with overlapping features of Miller Fisher syndrome (MFS), Bickerstaff’s brainstem encephalitis (BBE) and Guillain-Barré syndrome (GBS), despite seronegativity for anti-GQ1b, GM1, GD1b, GT1a, and GT1b IgG antibodies. The patient developed sequential neurological deficits (ophthalmoplegia, ataxia, tetraparesis, and altered consciousness) following an upper respiratory infection. Electrophysiological studies confirmed acute motor-sensory axonal neuropathy, while cerebrospinal fluid analysis showed albuminocytological dissociation. Dual intravenous immunoglobulin (IVIG) courses and methylprednisolone therapy led to partial recovery, with independent ambulation achieved by day 76. This case underscores the complexity of overlapping anti-GQ1b antibody syndromes and highlights the need for alternative diagnostic biomarkers in seronegative patients.
•Rare Triple Overlap Syndrome: A case presented with concurrent features of MFS, BBE, and GBS, despite seronegativity for antibodies.•Unique Diagnostic Challenges: The case underscores the complexity of diagnosing overlap syndromes in seronegative patients, emphasizing the need for clinical vigilance beyond antibody testing.•Implications for Research: Highlights the potential role of non-ganglioside targets in seronegative cases, urging exploration of novel biomarkers.•Literature Context: Among only 8 reported triple overlap cases, this adds to evidence supporting a broader clinical spectrum of anti-GQ1b antibody syndromes.
Journal Article