Usual vulval intraepithelial neoplasia in HIV-positive women - a case series

Usual or undifferentiated type vulval intraepithelial neoplasia (VIN) is more common in young women and is usually associated with high-risk human papillomavirus infection. It is associated with the development of basaloid or warty squamous cell carcinoma. Studies have shown that HIV-positive women have an increased risk of VIN and invasive vulval carcinoma, but there is a paucity of data about this cohort of women. The objective of this study was to describe the clinical features and treatment responses of HIV-positive women diagnosed with VIN in a specialist vulval dermatology clinic. HIV-positive women diagnosed with VIN from 2007 to 2013 were retrospectively identified. Data were collected on demographics, clinical features, treatments and outcomes. Seven cases were retrospectively identified. The median CD4 cell count at presentation was 500 cells/mm³ (range 59-761). Five had multifocal VIN. Five were treated with imiquimod alone, one had surgical excision and one patient was treated with imiquimod and surgery. Five of the seven had complete resolution of disease. HIV-positive patients with VIN had good responses to treatment with imiquimod. They were likely to be stable on combination antiretroviral therapy at presentation, have multifocal disease and concurrent vaginal, anal or cervical intraepithelial neoplasia.

Influence of feeding and UVB exposition on the absorption mechanisms of calcium in the gastrointestinal tract of veiled chameleons (Chamaeleo calyptratus)

The purpose of this study was to investigate the influence of feeding and UVB exposition on the occurrence and distribution patterns of vitamin D receptors (VDR) and calbindin D28k (Cb-D28k) in the gastrointestinal tract of veiled chameleons. Thus, 56 veiled chameleon hatchlings were divided into six treatment groups: UV (with UVB exposure); No (no supplements, no UVB exposure); CaAUV (with calcium (Ca), vitamin A supplementation, UVB exposure); CaA (with Ca, vitamin A supplementation); CaADUV (with Ca, vitamin A, vitamin D supplementation, UVB exposure); and CaAD (with Ca, vitamin A, vitamin D supplementation). Animals were reared under the suspected conditions for 6 months on locust-based diets. Tissue samples of stomach, duodenum, ileum and colon were taken, and semi-quantitative immunohistochemical methods (IHC) were performed to detect Cb-D28k and VDR. VDR immunoreactions were higher in the luminal epithelium of the duodenum than in that of the ileum. VDR immunoreactions in the luminal epithelium were higher at the base of the villi of the duodenum as compared to the tip. Cb-D28k immunoreactions were mainly observed in the luminal epithelium of the duodenum. The two groups treated with all dietary supplements (CaADUV, CaAD) exhibited a higher Cb-D28k immunoreaction as those with no supplements and UVB exposure only. No immunoreaction for both proteins could be detected in the stomach. This study suggests that the duodenum plays an important role in the active transcellular absorption of Ca in veiled chameleons as shown by the immunohistochemical detection of VDR and Cb-D28k. Expression of Cb-D28k, in particular, appears to be regulated by dietary supplementation of vitamin D and vitamin A. VDRs, however, tended to be upregulated when animals were not supplemented with Ca, vitamin D and vitamin A. This may be due to the decreased Ca concentrations which caused vitamin D activation in the skin without any supplementation, but UVB exposure.

Multi-test analysis and model-based estimation of the prevalence of Taenia saginata cysticercus infection in naturally infected dairy cows in the absence of a 'gold standard' reference test

The diagnostic values of seven serological tests (ELISAs) and of the obligatory European Union-approved routine visual meat inspection for the detection of Taenia saginata cysticercosis were investigated. A total of 793 slaughtered dairy cows were selected in three European Union approved abattoirs in Switzerland, an endemic area (apparent prevalence by enhanced meat inspection up to 4.5%) with typically low parasite burdens. ELISAs based on a somatic larval antigen, isoelectric focused somatic larval antigen, larval excretory/secretory antigens, peptide HP6-2, peptide Ts45S-10, pooled peptide solution and a monoclonal antibody antigen capture assay were initially screened. As there is no perfect diagnostic 'gold standard' reference test, the obligatory meat inspection and four selected serological tests were further analysed using Bayesian inference to estimate the "true" prevalence and the diagnostic test sensitivities and specificities. The ELISA for specific antibody detection based on excretory/secretory antigens showed highest sensitivity and specificity with 81.6% (95% credible interval: 70-92) and 96.3% (95% credible interval: 94-99), respectively. The Bayesian model estimated the specificity of the ELISA, based on the synthetic peptide Ts45S-10 as 55.2% (95% credible interval: 46-65) and sensitivity as 84.7% (95% credible interval: 82-88). The sensitivity of the ELISA based on mAbs, detecting circulating antigen, was 14.3% (95% credible interval: 9-23) with a specificity of 93.7% (95% credible interval: 92-96). The diagnostic sensitivity of the obligatory standard European Union meat inspection procedure for the detection of T. saginata cysticercus infection at the abattoir was estimated to be 15.6% (95% credible interval: 10-23). Based on these data, the modelled prevalence of cysticercosis in dairy cows presented at abattoirs in Switzerland was estimated to be 16.5% (95% credible interval: 13-21). These cattle also had a high prevalence of infection with Dicrocoelium dendriticum (60.8%) and Fasciola hepatica (13.5%).

The association between trunk muscle endurance and lumbo-pelvic stability in adolescent low back pain: A cross sectional study

Decreased trunk muscle endurance has been identified as a risk factor for adolescent LBP, and poor lumbo-pelvic stability has been found to be associated with LBP in the adult population. The aim of the study was to investigate the association between adolescent LBP, trunk muscle endurance and poor lumbo-pelvic stability. Design: A cross sectional study. Participants: 80 adolescents in grade 8 to grade 11, aged 12 to 17 years, at three high schools in Gauteng, who agreed to participate in the study. Method: Data was collected by means of a validated questionnaire and physical tests. The active straight leg raise test was used to record the lumbo-pelvic stabilising muscles. The Sorensen, Shirado and side-bridge tests were used to record trunk extensor, flexor and side flexor muscle endurance, respectively. Results: The results revealed a lifetime prevalence of LBP of 82.50%, one year prevalence of 78.80% and point prevalence of 23.80%. Adolescents with LBP demonstrated decreased trunk extensor muscle endurance but increased trunk flexor muscle endurance (p=0.044), compared to non-LBP adolescents. Poor lumbo-pelvic stability was not associated with adolescent LBP, but was associated with decreased extensor trunk muscle endurance (p=0.031). Conclusion: There was an association between trunk flexor muscle endurance and adolescent LBP, and between decreased trunk extensor muscle endurance and poor lumbo-pelvic stability. No association was found between LBP and poor lumbo-pelvic stability.

The effectiveness of physiotherapy in cervicogenic headache and concurring temporomandibular dysfunction: a case report

The aim of this case report is to describe the use of physio-therapy interventions in a patient diagnosed with cervicogenic headache(CGH) and temporomandibular dysfunction (TMD). This case study involveda 26 year old male. The subject’s cervical and temporomandibular joint(TMJ) active range of movement; passive accessory movements; headacheintensity, periodicity and response to analgesics; TMJ clicking and discomfort;Numerical Pain Rating Scale (NPRS) scores, were assessed on initial assessment and on discharge 14 weeks later. The physiotherapy interventionincluded cervical and TMJ mobilisation (Maitland approach); trigger pointtherapy and massage; strengthening of the deep cervical neck flexors and scapulothoracic muscles; and posture correction. The subject improved on all outcome measures and was discharged after nine physiotherapy sessions, withfull cervical and TMJ range of movement, improved muscle strength and decreased headache intensity and frequency.This case describes a positive outcome for a patient diagnosed with cervical headaches and temporomandibular dysfunction in which physiotherapy interventions aimed at correcting joint dysfunction, myofascial pain and decreased muscle strength were used effectively.

Testing for HER2 in breast cancer

HER2 is a paradigm of a molecular target whose appropriate assessment is pivotal in the targeting of novel therapies for breast cancer, notably including Herceptin/Trastuzumab. Determining the correct levels requires immunohistochemical and molecular biological skills that are reproducible and measurable, coupled with a knowledge of the appropriate morphological and pathobiological context. Attaining these goals is not easy and laboratories testing for HER2 should maintain a high level of throughput of tests and engage in a recognized external quality assurance scheme. Fluorescence in-situ hybridization testing remains a particular challenge and there is a range of testing strategies. This testing forms the model for the identification of other novel molecular targets. In the future rapid throughput techniques such as real-time quantitative polymerase chain reaction (rqPCR), tissue microarrays or both should bring significant economies of cost and scale.

Trial of heparin in viper bites

AIMS OF THE STUDY

Viper bites produce hematotoxicity and coagulopathy which may be either true disseminated intravascular coagulation (DIC) or DIC-like syndrome. Role of heparin is studied in the present study of viper bite cases as use of heparin provides a rational therapy for defibrination caused by viper envenomation.

METHODOLOGY

One hundred and twenty two patients with viper bite and incoagulable blood were randomised into test group and control group. Test group received heparin in addition to antisnake venom (ASV). Efficacy was assessed by monitoring bleeding time (BT), clotting time (CT), prothrombin time (PT), platelets, fibrinogen, blood urea (BU), serum creatinine, development of complications and overall outcome.

RESULTS

Heparin group showed favourable outcome in all parameters studied. But many of them were not statistically significant.

CONCLUSION

Heparin seems to be having a beneficial role which needs to be confirmed by larger trials and longer duration of heparin administration.

The distribution of Biomphalaria spp. in different habitats in relation to physical, biological, water contact and cognitive factors in a rural area in Minas Gerais, Brazil

A total of 256 sites in 11 habitats were surveyed for Biomphalaria in Melquiades rural area (State of Minas Gerais) in August and November 1999 and in March 2000. Of the 1,780 Biomphalaria collected, 1,721 (96.7%) were B. glabrata and 59 (3.3%) B. straminea. Snails were found in all habitats except in wells, with the largest mean numbers in tanks, seepage ponds and canals, and the smallest numbers in springs, rice fields and fishponds. People's knowledge of the occurrence of Biomphalaria at the collection sites and the presence of Biomphalaria ova were strongly correlated with the occurrence of snails, and distance between houses and collection sites, as well as water velocity were inversely correlated with Biomphalaria occurrence (p < 0.001). The strongest predictor o f Biomphalaria occurrence was the presence of tilapia fish in fishponds. Fourteen Biomphalaria (0.8% of all snails) found at 6 sites were infected with Schistosoma mansoni. Suggestions are made for the utilization of local people's knowledge in snail surveys and further studies are recommended on the possible use of tilapia for biological control of Biomphalaria in fishponds, as well as modeling of S. mansoni transmission and reinfection.

Unlocking the archive--gene expression in paraffin-embedded tissue

The histopathology archive represents a vast, well-characterized source of specimens covering virtually every disease and is available for molecular biological investigation. The archive has in recent years become widely used for molecular genetic analysis and DNA can be routinely extracted from formalin-fixed, paraffin-embedded tissue. More recently, archival specimens have become a source of material for extensive analysis of mRNA expression utilizing DNA microarrays, real-time quantitative reverse transcriptase polymerase chain reaction (PCR), and in situ hybridization and amplification techniques. These techniques will enable a greater understanding of the changes that occur in gene function during every stage of the development of disease and will lead to better diagnosis, better evaluation of prognosis, and better treatment through targeted therapeutic regimes.

A mathematical treatment of AIDS and condom use

In this paper we examine the impact of condom use on the sexual transmission of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) amongst a homogeneously mixing male homosexual population. We first derive a multi-group SIR-type model of HIV/AIDS transmission where the homosexual population is split into subgroups according to frequency of condom use. Both susceptible and infected individuals can transfer between the different groups. We then discuss in detail an important special case of this model which includes two risk groups and perform an equilibrium and stability analysis for this special case. Our analysis shows that this model can exhibit unusual behaviour. As normal, if the basic reproduction number, R0, is greater than unity then there is a unique disease-free equilibrium which is locally unstable and a unique endemic equilibrium. However, when R0 is less than unity two endemic equilibrium solutions can also co-exist simultaneously with the disease-free solution which is locally stable. Numerical simulations using realistic parameter values confirm this and we find that in certain circumstances the disease-free solution and one of the endemic solutions are both locally asymptotically stable, while the other endemic solution is unstable. This unusual behaviour has important implications for control of the disease as reducing R0 to less than unity no longer guarantees eradication of the disease. For a restricted special case of this two-group model we show that there is only the disease-free equilibrium for R0 < or = 1 which is globally stable. For R0 > 1 the disease-free equilibrium is unstable and there is a unique endemic equilibrium which is locally stable. We then attempt to fit the model to HIV and AIDS incidence data from San Francisco, USA. The paper concludes with a brief discussion.

Schistosomiasis

The trematode parasites in the family Schistosomatidae (phylum Platyhelminthes) infect a wide range of vertebrates. Three species of the genus Schistosoma are of major medical importance. This unit deals exclusively with the parasite Schistosoma mansoni, which is the species most frequently maintained in the laboratory. Among the far-ranging investigations in the immunology of schistosomiasis are studies in vaccine development, immunopathology of granulomatous inflammation and fibrosis, eosinophil function, and in vivo regulation of T(H)1 and T(H)2 responses. This unit describes maintenance and collection procedures for various stages of the schistosome that have immunologic interest, including infection of mice with cercariae, collection of cercariae, preparation of in vitro-derived schistosomules and in vivo-derived schistosomules, and collection of adult worms and eggs. Included also are techniques for preparing soluble egg antigen (SEA), one of the more commonly used schistosome antigenic preparations. A discussion is given of the basic steps that are important in maintaining the snail intermediate host, and infecting the snails with schistosome miracidia. The unit deals exclusively with the parasite Schistosoma mansoni, which is the species most frequently maintained in the laboratory. Since part of the life cycle of all schistosomes involves a snail host, a description of proper maintenance for the snails is provided. Often, problems in experiments can be traced back to improper snail and parasite maintenance, or lack of attention to detail during mammalian exposure to the infective stage (cercaria) of the parasite.

Three stage AIDS incubation period: a worst case scenario using addict-needle interaction assumptions

In this paper we develop and analyse a model for the spread of HIV/AIDS amongst a population of injecting drug users. We start off with a brief literature survey and review; this is followed by the derivation of a model which allows addicts to progress through three distinct stages of variable infectivity prior to the onset of full blown AIDS and where the class of infectious needles is split into three according to the different levels of infectivity in addicts. Given the structure of this model we are required to make assumptions regarding the interaction of addicts and needles of different infectivity levels. We deliberately choose these assumptions so that our model serves as an upper bound for the prevalence of HIV under the assumption of a three stage AIDS incubation period. We then perform an equilibrium and stability analysis on this model. We find that there is a critical threshold parameter R(0) which determines the behaviour of the model. If R(0)< or =1, then irrespective of the initial conditions of the system HIV will die out in all addicts and all needles. If R(0)>1, then there is a unique endemic equilibrium which is locally stable if, as is realistic, the time scale on which addicts inject is much shorter than that of the other epidemiological and demographic processes. Simulations indicate that if R(0)>1, then provided that disease is initially present in at least one addict or needle it will tend to the endemic equilibrium. In addition we derive conditions which guarantee this. We also find that under calibration the long term prevalence of disease in our variable infectivity model is always greater than in an equivalent constant infectivity model. These results are confirmed and explored further by simulation. We conclude with a short discussion.