• Keto-on-the-Clock: A Survey of Dietetic Care Contact Time Taken to Provide Ketogenic Diets for Drug-Resistant Epilepsy in the UK

      Lambert, Bridget; email: bridgetlambert@vitaflo.co.uk; Lightfoot, Kathryn; email: kathryn.lightfoot@nhs.net; Meskell, Rachel; email: r.meskell@nhs.net; Whiteley, Victoria J.; email: victoria.whiteley@mft.nhs.uk; Martin-McGill, Kirsty J.; email: k.martinmcgill@chester.ac.uk; Schoeler, Natasha E.; orcid: 0000-0001-6202-1497; email: n.schoeler@ucl.ac.uk (MDPI, 2021-07-21)
      Medical ketogenic diets (KDs) are effective yet resource-intensive treatment options for drug-resistant epilepsy (DRE). We investigated dietetic care contact time, as no recent data exist. An online survey was circulated to ketogenic dietitians in the UK and Ireland. Data were collected considering feeding route, KD variant and type of ketogenic enteral feed (KEF), and the estimated number of hours spent on patient-related activities during the patient journey. Fifteen dietitians representing nine KD centres responded. Of 335 patients, 267 (80%) were 18 years old or under. Dietitians spent a median of 162 h (IQR 54) of care contact time per patient of which a median of 48% (IQR 6) was direct contact. Most time was required for the classical KD taken orally (median 193 h; IQR 213) as a combined tube and oral intake (median 211 h; IQR 172) or a blended food KEF (median 189 h; IQR 148). Care contact time per month was higher for all KDs during the three-month initial trial compared to the two-year follow-up stage. Patients and caregivers with characteristics such as learning or language difficulties were identified as taking longer. Twelve out of fifteen (80%) respondents managed patients following the KD for more than two years, requiring an estimated median contact care time of 2 h (IQR 2) per patient per month. Ten out of fifteen (67%) reported insufficient official hours for dietetic activities. Our small survey gives insight into estimated dietetic care contact time, with potential application for KD provision and service delivery
    • Keto-on-the-Clock: A Survey of Dietetic Care Contact Time Taken to Provide Ketogenic Diets for Drug-Resistant Epilepsy in the UK.

      Lambert, Bridget; Lightfoot, Kathryn; Meskell, Rachel; Whiteley, Victoria J; Martin-McGill, Kirsty J; Schoeler, Natasha E; orcid: 0000-0001-6202-1497 (2021-07-21)
      Medical ketogenic diets (KDs) are effective yet resource-intensive treatment options for drug-resistant epilepsy (DRE). We investigated dietetic care contact time, as no recent data exist. An online survey was circulated to ketogenic dietitians in the UK and Ireland. Data were collected considering feeding route, KD variant and type of ketogenic enteral feed (KEF), and the estimated number of hours spent on patient-related activities during the patient journey. Fifteen dietitians representing nine KD centres responded. Of 335 patients, 267 (80%) were 18 years old or under. Dietitians spent a median of 162 h (IQR 54) of care contact time per patient of which a median of 48% (IQR 6) was direct contact. Most time was required for the classical KD taken orally (median 193 h; IQR 213) as a combined tube and oral intake (median 211 h; IQR 172) or a blended food KEF (median 189 h; IQR 148). Care contact time per month was higher for all KDs during the three-month initial trial compared to the two-year follow-up stage. Patients and caregivers with characteristics such as learning or language difficulties were identified as taking longer. Twelve out of fifteen (80%) respondents managed patients following the KD for more than two years, requiring an estimated median contact care time of 2 h (IQR 2) per patient per month. Ten out of fifteen (67%) reported insufficient official hours for dietetic activities. Our small survey gives insight into estimated dietetic care contact time, with potential application for KD provision and service delivery.
    • Ketogenic diets for drug-resistant epilepsy

      Martin-McGill, Kirsty J; Bresnahan, Rebecca; Levy, Robert G; Cooper, Paul N (Wiley, 2020-06-24)
    • Kindle project at the University of Chester

      McLean, Fiona; Shepherd, Joanna; University of Chester (SCONUL, 2012)
      Towards the end of 2010, Learning and Information Services (LIS) at the University of Chester decided to undertake a pilot project which explored how useful e-readers are in a university setting and if they could help to resolve issues about resource availability.
    • Kite-Shaped Molecules Block SARS-CoV-2 Cell Entry at a Post-Attachment Step

      Chan, Shiu-Wan; email: shiu-wan.chan@manchester.ac.uk; Shafi, Talha; email: talha.shafi@manchester.ac.uk; Ford, Robert C.; orcid: 0000-0002-0958-1505; email: robert.ford@manchester.ac.uk (MDPI, 2021-11-19)
      Anti-viral small molecules are currently lacking for treating coronavirus infection. The long development timescales for such drugs are a major problem, but could be shortened by repurposing existing drugs. We therefore screened a small library of FDA-approved compounds for potential severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antivirals using a pseudovirus system that allows a sensitive read-out of infectivity. A group of structurally-related compounds, showing moderate inhibitory activity with IC50 values in the 2–5 μM range, were identified. Further studies demonstrated that these “kite-shaped” molecules were surprisingly specific for SARS-CoV-1 and SARS-CoV-2 and that they acted early in the entry steps of the viral infectious cycle, but did not affect virus attachment to the cells. Moreover, the compounds were able to prevent infection in both kidney- and lung-derived human cell lines. The structural homology of the hits allowed the production of a well-defined pharmacophore that was found to be highly accurate in predicting the anti-viral activity of the compounds in the screen. We discuss the prospects of repurposing these existing drugs for treating current and future coronavirus outbreaks.
    • Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder.

      Sookman, Debbie; email: debbie.sookman@mcgill.ca; Phillips, Katharine A; email: kap9161@med.cornell.edu; Anholt, Gideon E; email: ganholt@bgu.ac.il; Bhar, Sunil; email: sbhar@swin.edu.au; Bream, Victoria; email: victoria_bream@hotmail.com; Challacombe, Fiona L; email: fiona.challacombe@kcl.ac.uk; Coughtrey, Anna; email: anna.coughtrey.10@ucl.ac.uk; Craske, Michelle G; email: mcraske@mednet.ucla.edu; Foa, Edna; email: foa@mail.med.upenn.edu; Gagné, Jean-Philippe; email: jean-philippe.gagne@concordia.ca; et al. (2021-01-27)
      Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards. [Abstract copyright: Copyright © 2021 Elsevier B.V. All rights reserved.]
    • Knowledge and the Fall in American Neo-Calvinism: Toward a Van Til–Plantinga Synthesis

      Békefi, Bálint; email: balint.bekefi@gmail.com (Brill, 2021-09-17)
      Abstract Cornelius Van Til and Alvin Plantinga represent two strands of American Protestant philosophical thought influenced by Dutch neo-Calvinism. This paper compares and synthetizes their models of knowledge in non-Christians given the noetic effects of sin and non-Christian worldview commitments. The paper argues that Van Til’s distinction between the partial realization of the antithesis in practice and its absolute nature in principle correlates with Plantinga’s insistence on prima facie–warranted common-sense beliefs and their ultimate defeasibility given certain metaphysical commitments. Van Til endorsed more radical claims than Plantinga on epistemic defeat in non-Christian worldviews, the status of the sensus divinitatis, and conceptual accuracy in knowledge of the world. Finally, an approach to the use of evidence in apologetics is developed based on the proposed synthesis. This approach seeks to make more room for evidence than is generally recognized in Van Tilianism, while remaining consistent with the founder’s principles.
    • Knowledge, attitudes and experiences of self-harm and suicide in low-income and middle-income countries: protocol for a systematic review.

      McPhillips, Rebecca; orcid: 0000-0003-4296-5970; email: rebecca.mcphillips@manchester.ac.uk; Nafees, Sadia; orcid: 0000-0003-1553-3013; Elahi, Anam; Batool, Saqba; Krishna, Murali; Krayer, Anne; orcid: 0000-0003-1503-1734; Huxley, Peter; Chaudhry, Nasim; Robinson, Catherine (2021-06-22)
      Over 800 000 people die due to suicide each year and suicide presents a huge psychological, economic and social burden for individuals, communities and countries as a whole. Low-income and middle-income countries (LMICs) are disproportionately affected by suicide. The strongest risk factor for suicide is a previous suicide attempt, and other types of self-harm have been found to be robust predictors of suicidal behaviour. An approach that brings together multiple sectors, including education, labour, business, law, politics and the media is crucial to tackling suicide and self-harm. The WHO highlights that evaluations of the knowledge and attitudes that priority groups, not only healthcare staff, have of mental health and suicidal behaviour are key to suicide prevention strategies. The aim of this systematic review is to examine the knowledge, attitudes and experiences different stakeholders in LMICs have of self-harm and suicide. MEDLINE, Embase, PsycINFO, CINAHL, BNI, Social Sciences and Cochrane Library will be searched. Reviewers working independently of each other will screen search results, select studies for inclusion, extract and check extracted data, and rate the quality of the studies using the Strengthening the Reporting of Observational studies in Epidemiology and Critical Appraisals Skills Programme checklists. In anticipation of heterogeneity, a narrative synthesis of quantitative studies will be provided and metaethnography will be used to synthesise qualitative studies. Ethical approval is not required. A report will be provided for the funding body, and the systematic review will be submitted for publication in a high-impact, peer-reviewed, open access journal. Results will also be disseminated at conferences, seminars, congresses and symposia, and to relevant stakeholders. CRD42019135323. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.]
    • Knowledge, attitudes and experiences of self-harm and suicide in low-income and middle-income countries: protocol for a systematic review.

      McPhillips, Rebecca; orcid: 0000-0003-4296-5970; email: rebecca.mcphillips@manchester.ac.uk; Nafees, Sadia; orcid: 0000-0003-1553-3013; Elahi, Anam; Batool, Saqba; Krishna, Murali; Krayer, Anne; orcid: 0000-0003-1503-1734; Huxley, Peter; Chaudhry, Nasim; Robinson, Catherine (2021-06-22)
      <h4>Introduction</h4>Over 800 000 people die due to suicide each year and suicide presents a huge psychological, economic and social burden for individuals, communities and countries as a whole. Low-income and middle-income countries (LMICs) are disproportionately affected by suicide. The strongest risk factor for suicide is a previous suicide attempt, and other types of self-harm have been found to be robust predictors of suicidal behaviour. An approach that brings together multiple sectors, including education, labour, business, law, politics and the media is crucial to tackling suicide and self-harm. The WHO highlights that evaluations of the knowledge and attitudes that priority groups, not only healthcare staff, have of mental health and suicidal behaviour are key to suicide prevention strategies. The aim of this systematic review is to examine the knowledge, attitudes and experiences different stakeholders in LMICs have of self-harm and suicide.<h4>Methods and analysis</h4>MEDLINE, Embase, PsycINFO, CINAHL, BNI, Social Sciences and Cochrane Library will be searched. Reviewers working independently of each other will screen search results, select studies for inclusion, extract and check extracted data, and rate the quality of the studies using the Strengthening the Reporting of Observational studies in Epidemiology and Critical Appraisals Skills Programme checklists. In anticipation of heterogeneity, a narrative synthesis of quantitative studies will be provided and metaethnography will be used to synthesise qualitative studies.<h4>Ethics and dissemination</h4>Ethical approval is not required. A report will be provided for the funding body, and the systematic review will be submitted for publication in a high-impact, peer-reviewed, open access journal. Results will also be disseminated at conferences, seminars, congresses and symposia, and to relevant stakeholders.<h4>Prospero registration number</h4>CRD42019135323.
    • Labels and object categorization in six- and nine-month-olds: tracking labels across varying carrier phrases.

      Ferry, Alissa; email: alissa.ferry@manchester.ac.uk; Guellai, Bahia (2021-07-29)
      Language shapes object categorization in infants. This starts as a general enhanced attentional effect of language, which narrows to a specific link between labels and categories by twelve months. The current experiments examined this narrowing effect by investigating when infants track a consistent label across varied input. Six-month-old infants (N = 48) were familiarized to category exemplars, each presented with the exact same labeling phrase or the same label in different phrases. Evidence of object categorization at test was only found with the same phrase, suggesting that infants were not tracking the label's consistency, but rather that of the entire input. Nine-month-olds (N = 24) did show evidence of categorization across the varied phrases, suggesting that they were tracking the consistent label across the varied input. [Abstract copyright: Copyright © 2021 Elsevier Inc. All rights reserved.]
    • Lack of racial diversity within the palliative medicine workforce: does it affect our patients?

      Khiroya, Heena; orcid: 0000-0001-7613-1881; email: heenakhiroya@doctors.org.uk; Willis, Derek (2021-09-17)
    • Landslides in the Upper Submarine Slopes of Volcanic Islands: The Central Azores

      Chang, Yu‐Chun; orcid: 0000-0003-4941-5437; email: yu-chun.chang@manchester.ac.uk; Mitchell, Neil C.; orcid: 0000-0002-6483-2450; Quartau, Rui; orcid: 0000-0003-3148-7520 (2021-09-28)
      Abstract: Small landslides in the upper submarine slopes of volcanic islands present potential hazards locally because of their high frequency. We examine evidence for landsliding in high‐resolution bathymetric data from Faial, Pico, São Jorge, and Terceira islands of the Azores. Because the rugged morphology of the upper slopes makes landslides difficult to interpret, we develop two classification schemes for the 1,227 identified slope valleys. One scheme addresses how recognizable the valleys were as originating from landslides (whether scarps are prominent or indefinite), whereas the other scheme addresses valley types (whether apparently produced by single or multiple failures). Size distributions are used to assess the relative occurrence of large versus small landslides. Thirteen landslides are predicted to have generated tsunami heights at source of >1 m and one with height of >7 m. Some slopes have gradients far above 30°, the angle of repose of incohesive clastic sediment, so the seabed in those areas is strengthened perhaps by carbonate cementation, by seismic shaking or by the presence of coherent lava or lava talus. Using all types of slope valleys, Faial and Pico have smaller affected volumes per unit slope area than those of São Jorge and Terceira. These differences could be associated with varied seismic activity, with more frequent earthquakes beneath Faial and Pico preventing the build‐up of sediments on their slopes. Submarine landslide statistics are therefore potentially useful for assessing long‐term earthquake hazards of volcanic islands in seismically active environments such as the Azores.
    • Language evolution and healthiness for critical cyber‐physical systems

      Banach, Richard; orcid: 0000-0002-0243-9434; email: richard.banach@manchester.ac.uk; Zhu, Huibiao (2020-09-16)
      Abstract: In the effort to develop critical cyber‐physical systems, it is tempting to extend existing computing formalisms to include continuous behaviour. This may happen in a way that neglects elements necessary for correctly expressing continuous properties of the mathematics and correct physical properties of the real‐world physical system. A simple language is taken to illustrate these possibilities. Issues and risks latent in this kind of approach are identified and discussed under the umbrella of ‘healthiness conditions’. Modifications to the language in the light of the conditions discussed are elaborated, resulting in the language Combined Discrete and Physical Programmes in Parallel (CDPPP). An example air conditioning system is used to illustrate the concepts presented, and it is developed both in the original ‘unhealthy’ language and in the modified ‘healthier’ CDPPP. The formal semantics of the improved language is explored.
    • Large cell neuroendocrine lung carcinoma: consensus statement from The British Thoracic Oncology Group and the Association of Pulmonary Pathologists

      Lindsay, Colin R.; email: colin.lindsay@manchester.ac.uk; Shaw, Emily C.; Moore, David A.; Rassl, Doris; Jamal-Hanjani, Mariam; Steele, Nicola; Naheed, Salma; Dick, Craig; Taylor, Fiona; Adderley, Helen; et al. (Nature Publishing Group UK, 2021-09-06)
      Abstract: Over the past 10 years, lung cancer clinical and translational research has been characterised by exponential progress, exemplified by the introduction of molecularly targeted therapies, immunotherapy and chemo-immunotherapy combinations to stage III and IV non-small cell lung cancer. Along with squamous and small cell lung cancers, large cell neuroendocrine carcinoma (LCNEC) now represents an area of unmet need, particularly hampered by the lack of an encompassing pathological definition that can facilitate real-world and clinical trial progress. The steps we have proposed in this article represent an iterative and rational path forward towards clinical breakthroughs that can be modelled on success in other lung cancer pathologies.
    • Large cell neuroendocrine lung carcinoma: consensus statement from The British Thoracic Oncology Group and the Association of Pulmonary Pathologists.

      Lindsay, Colin R; email: colin.lindsay@manchester.ac.uk; Shaw, Emily C; Moore, David A; Rassl, Doris; Jamal-Hanjani, Mariam; Steele, Nicola; Naheed, Salma; Dick, Craig; Taylor, Fiona; Adderley, Helen; et al. (2021-09-06)
      Over the past 10 years, lung cancer clinical and translational research has been characterised by exponential progress, exemplified by the introduction of molecularly targeted therapies, immunotherapy and chemo-immunotherapy combinations to stage III and IV non-small cell lung cancer. Along with squamous and small cell lung cancers, large cell neuroendocrine carcinoma (LCNEC) now represents an area of unmet need, particularly hampered by the lack of an encompassing pathological definition that can facilitate real-world and clinical trial progress. The steps we have proposed in this article represent an iterative and rational path forward towards clinical breakthroughs that can be modelled on success in other lung cancer pathologies. [Abstract copyright: © 2021. The Author(s).]
    • Laser capture microdissection coupled mass spectrometry (LCM-MS) for spatially resolved analysis of formalin-fixed and stained human lung tissues

      Herrera, Jeremy A.; orcid: 0000-0003-4845-8494; email: Jeremy.Herrera@manchester.ac.uk; Mallikarjun, Venkatesh; Rosini, Silvia; Montero, Maria Angeles; Lawless, Craig; Warwood, Stacey; O’Cualain, Ronan; Knight, David; Schwartz, Martin A.; Swift, Joe; orcid: 0000-0002-5039-9094; email: Joe.Swift@manchester.ac.uk (BioMed Central, 2020-06-17)
      Abstract: Background: Haematoxylin and eosin (H&E)—which respectively stain nuclei blue and other cellular and stromal material pink—are routinely used for clinical diagnosis based on the identification of morphological features. A richer characterization can be achieved by laser capture microdissection coupled to mass spectrometry (LCM-MS), giving an unbiased assay of the proteins that make up the tissue. However, the process of fixing and H&E staining of tissues provides challenges with standard sample preparation methods for mass spectrometry, resulting in low protein yield. Here we describe a microproteomics technique to analyse H&E-stained, formalin-fixed paraffin-embedded (FFPE) tissues. Methods: Herein, we utilize heat extraction, physical disruption, and in column digestion for the analysis of H&E stained FFPE tissues. Micro-dissected morphologically normal human lung alveoli (0.082 mm3) and human lung blood vessels (0.094 mm3) from FFPE-fixed H&E-stained sections from Idiopathic Pulmonary Fibrosis (IPF) specimens (n = 3 IPF specimens) were then subject to a qualitative and then quantitative proteomics approach using BayesENproteomics. In addition, we tested the sensitivity of this method by processing and analysing a range of micro-dissected human lung blood vessel tissue volumes. Results: This approach yields 1252 uniquely expressed proteins (at a protein identification threshold of 3 unique peptides) with 892 differentially expressed proteins between these regions. In accord with prior knowledge, our methodology approach confirms that human lung blood vessels are enriched with smoothelin, CNN1, ITGA7, MYH11, TAGLN, and PTGIS; whereas morphologically normal human lung alveoli are enriched with cytokeratin-7, -8, -18, -19, 14, and -17. In addition, we identify a total of 137 extracellular matrix (ECM) proteins and immunohistologically validate that laminin subunit beta-1 localizes to morphologically normal human lung alveoli and tenascin localizes to human lung blood vessels. Lastly, we show that this micro-proteomics technique can be applied to tissue volumes as low as 0.0125 mm3. Conclusion: Herein we show that our multistep sample preparation methodology of LCM-MS can identify distinct, characteristic proteomic compositions of anatomical features within complex fixed and stained tissues.
    • Laser solid-phase synthesis of single-atom catalysts

      Peng, Yudong; Cao, Jianyun; Sha, Yang; Yang, Wenji; Li, Lin; Liu, Zhu; email: zhu.liu@manchester.ac.uk (Nature Publishing Group UK, 2021-08-18)
      Abstract: Single-atom catalysts (SACs) with atomically dispersed catalytic sites have shown outstanding catalytic performance in a variety of reactions. However, the development of facile and high-yield techniques for the fabrication of SACs remains challenging. In this paper, we report a laser-induced solid-phase strategy for the synthesis of Pt SACs on graphene support. Simply by rapid laser scanning/irradiation of a freeze-dried electrochemical graphene oxide (EGO) film loaded with chloroplatinic acid (H2PtCl6), we enabled simultaneous pyrolysis of H2PtCl6 into SACs and reduction/graphitization of EGO into graphene. The rapid freezing of EGO hydrogel film infused with H2PtCl6 solution in liquid nitrogen and the subsequent ice sublimation by freeze-drying were essential to achieve the atomically dispersed Pt. Nanosecond pulsed infrared (IR; 1064 nm) and picosecond pulsed ultraviolet (UV; 355 nm) lasers were used to investigate the effects of laser wavelength and pulse duration on the SACs formation mechanism. The atomically dispersed Pt on graphene support exhibited a small overpotential of −42.3 mV at −10 mA cm−2 for hydrogen evolution reaction and a mass activity tenfold higher than that of the commercial Pt/C catalyst. This method is simple, fast and potentially versatile, and scalable for the mass production of SACs.
    • Late diagnosis of isolated central diabetes insipidus secondary to congenital toxoplasmosis-case report.

      Omer, Tahir; orcid: 0000-0003-1832-6204; Khan, Mustafa; Western, Thomas (2020-11-24)
      Congenital toxoplasmosis is an uncommon infection. Hypothalamic/pituitary involvement leading to isolated central diabetes insipidus is extremely rare. Making a correct diagnosis of this condition, albeit challenging, is crucial for adequate management. We present a 54-year-old female who developed central diabetes insipidus as a complication of congenital toxoplasmosis. She had polydipsia and hypernatraemia on presentation and responded to intranasal desmopressin with normalization of above-mentioned findings. Magnetic resonance imaging and cranial X-ray's showed pronounced intracranial calcifications in both choroid plexuses. Thyroid function tests, serum cortisol level and anterior pituitary function were all normal. To the best of our knowledge, this is the first reported case of isolated diabetes insipidus due to congenital toxoplasmosis in literature diagnosed late in adulthood and gives an insight into the challenges of diagnosing central diabetes insipidus and the hypothalamic/pituitary involvement in cases of congenital toxoplasmosis. [Abstract copyright: © The Author(s) 2020. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.]
    • Late diagnosis of isolated central diabetes insipidus secondary to congenital toxoplasmosis—case report

      Omer, Tahir; orcid: 0000-0003-1832-6204; Khan, Mustafa; Western, Thomas (Oxford University Press (OUP), 2020-11-24)
      ABSTRACT Congenital toxoplasmosis is an uncommon infection. Hypothalamic/pituitary involvement leading to isolated central diabetes insipidus is extremely rare. Making a correct diagnosis of this condition, albeit challenging, is crucial for adequate management. We present a 54-year-old female who developed central diabetes insipidus as a complication of congenital toxoplasmosis. She had polydipsia and hypernatraemia on presentation and responded to intranasal desmopressin with normalization of above-mentioned findings. Magnetic resonance imaging and cranial X-ray’s showed pronounced intracranial calcifications in both choroid plexuses. Thyroid function tests, serum cortisol level and anterior pituitary function were all normal. To the best of our knowledge, this is the first reported case of isolated diabetes insipidus due to congenital toxoplasmosis in literature diagnosed late in adulthood and gives an insight into the challenges of diagnosing central diabetes insipidus and the hypothalamic/pituitary involvement in cases of congenital toxoplasmosis.