Isolated oculocutaneous sarcoidosis in a teenage male: a rare case report

Sarcoidosis is an inflammatory disease with multisystem involvement characterized by the presence of noncaseating granulomas. It can affect virtually every organ of the body, with lung involvement being most common occurring in >90% of patients. Other organs affected are skin, eye and liver. Skin involvement is common, affecting 25-35%. Here we present a rare case of a 15 year-old male with isolated oculocutaneous sarcoidosis without systemic involvement.

Acute gastrointestinal manifestation of situs inversus abdominus

PURPOSE

Whilst situs inversus is associated with intestinal malrotation and volvulus particularly in infants, this is the first known report of acute intestinal obstruction in an adult patient with a situs anomaly specifically due to a congenital transmesenteric hernia.

CASE

A 54-year-old woman presented with a 12-h history of progressive abdominal pain. Contrast-enhanced computed tomography scan of the abdomen revealed an incidental finding of situs inversus abdominus, ischemic small bowel obstruction and a potential occlusive thrombus of the superior mesenteric artery. At operation, the cause of intestinal obstruction was found to be secondary to herniation of the intestine through a congenital mesenteric defect. The hernia was reduced and a strong pulse was subsequently felt in the distal superior mesenteric artery. The patient required resection of a segment of compromised small bowel, and was later anastomosed at a planned second laparotomy. Her laparostomy was closed using an absorbable BioA mesh.

CONCLUSION

A high index of suspicion and low threshold for exploratory surgery should be maintained in patients with major congenital abdominal anomalies presenting with an acute abdomen.

Systemic lupus erythematosus presenting as fulminant lupus pneumonitis: a rare case report

We report a case of 19 year-old female patient diagnosed as systemic lupus erythematosus (SLE) presented with fever and diffuse cutaneous lesions. During the hospital stay she had acute pneumonia, pleural effusion and respiratory failure, which required intensive care unit (ICU) care and mechanical ventilator support. A fulminant course of the disease, decreased values of complement levels and positive antinuclear antibodies (ANA) in pleural fluid and repeated negative sputum for acid-fast bacillus, blood cultures enabled diagnosis of fulminant lupus pneumonitis. Fulminant lupus pneumonitis is a rare but potentially life threatening complication of SLE. Management requires involvement of multiple specialties and rigorous efforts in reviving the patient.

In vitro studies reveal antiurolithic effect of Terminalia arjuna using quantitative morphological information from computerized microscopy

PURPOSE

For most cases, urolithiasis is a condition where excessive oxalate is present in the urine. Many reports have documented free radical generation followed by hyperoxaluria as a consequence of which calcium oxalate (CaOx) deposition occurs in the kidney tissue. The present study is aimed to exam the antilithiatic potency of the aqueous extract (AE) of Terminalia arjuna (T. arjuna).

MATERIALS AND METHODS

The antilithiatic activity of Terminalia arjuna was investigated in vitro nucleation, aggregation and growth of the CaOx crystals as well as the morphology of CaOx crystals using the inbuilt software 'Image-Pro Plus 7.0' of Olympus upright microscope (BX53). Antioxidant activity of AE of Terminalia arjuna bark was also determined in vitro.

RESULTS

Terminalia arjuna extract exhibited a concentration dependent inhibition of nucleation and aggregation of CaOx crystals. The AE of Terminalia arjuna bark also inhibited the growth of CaOx crystals. At the same time, the AE also modified the morphology of CaOx crystals from hexagonal to spherical shape with increasing concentrations of AE and reduced the dimensions such as area, perimeter, length and width of CaOx crystals in a dose dependent manner. Also, the Terminalia arjuna AE scavenged the DPPH (2, 2-diphenyl-1-picrylhydrazyl) radicals with an IC50 at 13.1µg/mL.

CONCLUSIONS

The study suggests that Terminalia arjuna bark has the potential to scavenge DPPH radicals and inhibit CaOx crystallization in vitro. In the light of these studies, Terminalia arjuna can be regarded as a promising candidate from natural plant sources of antilithiatic and antioxidant activity with high value.

Chlamydia trachomatis: TLR4-mediated recognition by human dendritic cells is impaired following oestradiol treatment

Genital Chlamydia trachomatis infection creates a substantial reproductive health burden in women. The high incidence of asymptomatic infection often precludes timely antibiotic therapy to control the sequelae of infection, and therefore a vaccine is required. Dendritic cells (DC) are now being used as an adjuvant for vaccine development; however, the fate of C. trachomatis in human DC and differential regulation of cytokine secretion remains unclear. Hence, an in vitro study was performed using C. trachomatis (serovar D) elementary body (EB)-pulsed, monocytederived DCs co-cultured with autologous CD4+ T cells. Secreted cytokines were measured to assess the protective/pathogenic immune response. The effect of (beta-oestradiol in the modulation of DC function and on Toll-like receptor (TLR) gene expression was also studied. Elementary body-pulsed DCs showed induction of protective Th1 immune response with upregulation of TLR4 expression, secretion of interleukin (IL)-6, IL-12 and interferon (IFN)-y, together with upregulation of major histocompatibility complex (MHC) class II, CD83 and CD86. When co-cultured with autologous CD4+T cells, DCs presented chlamydial antigens efficiently, as shown by proliferation of T cells and secretion of IL-2 and IFN gamma, which provide a protective immune response. However; pretreatment of cells with oestradiol significantly reduced TLR4 expression and upregulated IL-10 secretion, modulating the Th1 immune response to a Th2-type response, which may lead to pathogenesis.

Kinetic and equilibrium studies of adsorptive removal of phenol onto eggshell waste

The aim of the present research is to develop economic, fast, and versatile method for the removal of toxic organic pollutant phenol from wastewater using eggshell. The batch experiments are conducted to evaluate the effect of pH, phenol concentration, dosage of adsorbent, and contact time on the removal of phenol. The paper includes in-depth kinetic studies of the ongoing adsorption process. Attempts have also been made to verify Langmuir and Freundlich adsorption isotherms. The morphology and characteristics of eggshell have also been studied using scanning electron microscopy, Fourier transform infrared spectroscopy, X-ray diffraction, and X-ray fluorescence analysis. At ambient temperature, the maximum adsorption of phenol onto eggshells has been achieved at pH 9 and the contact time, 90 min. The experimental data give best-fitted straight lines for pseudo-first-order as well as pseudo-second-order kinetic models. Furthermore, the adsorption process verifies Freundlich and Langmuir adsorption isotherms, and on the basis of mathematical expressions of these models, various necessary adsorption constants have been calculated. Using adsorption data, various thermodynamic parameters like change in enthalpy (∆H(0)), change in entropy (∆S(0)), and change in free energy ∆G(0) have also been evaluated. Results clearly reveal that the solid waste material eggshell acts as an effective adsorbent for the removal of phenol from aqueous solutions.

IKBKE is induced by STAT3 and tobacco carcinogen and determines chemosensitivity in non-small cell lung cancer

Serine/threonine kinase IKBKE is a newly identified oncogene; however, its regulation remains elusive. Here, we provide evidence that IKBKE is a downstream target of signal transducer and activator of transcription 3 (STAT3) and that tobacco components induce IKBKE expression through STAT3. Ectopic expression of constitutively active STAT3 increased IKBKE mRNA and protein levels, whereas inhibition of STAT3 reduced IKBKE expression. Furthermore, expression levels of IKBKE are significantly associated with STAT3 activation and tobacco use history in non-small cell lung cancer (NSCLC) patients examined. In addition, we show induction of IKBKE by two components of cigarette smoke, nicotine and nicotine-derived nitrosamine ketone (NNK). Upon exposure to nicotine or NNK, cells express high levels of IKBKE protein and mRNA, which are largely abrogated by inhibition of STAT3. Characterization of the IKBKE promoter revealed two STAT3-response elements. The IKBKE promoter directly bound to STAT3 and responded to nicotine and NNK stimulation. Notably, enforcing expression of IKBKE induces chemoresistance, whereas knockdown of IKBKE not only sensitizes NSCLC cells to chemotherapy but also abrogates STAT3- and nicotine-induced cell survival. These data indicate for the first time that IKBKE is a direct target of STAT3 and is induced by tobacco carcinogens through STAT3 pathway. In addition, our study also suggests that IKBKE is an important therapeutic target and could have a pivotal role in tobacco-associated lung carcinogenesis.

Carbamazepine-induced hepato-splenomegaly with erythematous rashes in a child

Carbamazepine is an antiepileptic drug. In clinical trials the total incidence of reported adverse reaction to this drug is 4.5 per million at defined daily doses, corresponding to 2.7 per million at prescribed daily doses. Among the adverse reactions of carbamazepine, most often reported are skin reactions (48%), hematological (14%), hepatic disorder (10%). Herein, we present a case with erythematous skin rashes and hepato-splenomegaly.

Assessment of chronic kidney disease in Nepalese people with hypertension

Hypertension is one of the leading causes to develop chronic kidney disease (CKD) and could be a risk factor for progression of CKD to end stage renal disease (ESRD).Uncontrolled hypertension worsens CKD. Hypertension control may contribute to prevent CKD in early stages and retards the progression of CKD stages to ESRD. Prevalence of CKD in people with diagnosed and chronic hypertension is known to be high, but little is known about the prevalence of CKD in those with newly diagnosed Hypertension. Present work was undertaken to see the prevalence of CKD among people with newly diagnosed hypertension. In this cross-sectional study, we accessed the CKD in newly diagnosed hypertensive patients and determined the association between hypertension and CKD. CKD was defined as either kidney dysfunction or kidney damage or both as per National Kidney Foundation Guidelines. 106 of newly diagnosed patients and 106 of normotensive controls were recruited in the study. 51.9% of newly diagnosed hypertensive patients and 23.6% of normotensive controls had CKD which was statistically significant (p-value <0.001). Difference in the mean value in eGFR and spot urine ACR (mg/mmol) between hypertensive patients and normotensive controls was statistically significant (p-Value <0.001). Both systolic BP and diastolic BP negative significantly correlated with eGFR (p-Value < 0.001 and 0.024 respectively) and positive significantly correlated with ACR (p-Value 0.003 and 0.003 respectively). The prevalence of CKD is high among people with newly diagnosed hypertension. Those, people might benefit from interventions aimed at preventing development and/or progression of both CKD and hypertension.

Systematic review and meta-analysis of cutting diathermy versus scalpel for skin incision

Background

Skin incisions have traditionally been made using a scalpel. Cutting diathermy, a more recent alternative, is thought to increase the risk of infection, impair healing and decrease cosmesis. Recent studies suggest otherwise, claiming that diathermy may offer potential advantages with respect to blood loss, incision time and postoperative pain. The aim of this meta-analysis was to compare skin incisions made by either scalpel or cutting diathermy.

Methods

A systematic literature search and review was performed for studies published from January 1980 until June 2011. Randomized clinical trials comparing scalpel and cutting diathermy for skin incisions of any operation were included. Primary outcomes included wound complication rate, blood loss, incision times and pain scores.

Results

Fourteen randomized trials met the criteria for inclusion in the meta-analysis, providing outcome data for a total of 2541 patients (1267 undergoing skin incision by cutting diathermy and 1274 by scalpel). The median length of follow-up across all studies was 6 weeks (range 4 days to 19 months). Compared with a scalpel incision, cutting diathermy resulted in significantly less blood loss (mean difference 0·72 ml/cm2; P &lt; 0·001) and shorter incision times (mean difference 36 s; P &lt; 0·001), with no differences in the wound complication rate (odds ratio 0·87; P = 0·29) or pain score at 24 h (mean difference 0·89; P = 0·05).

Conclusion

Skin incisions made by cutting diathermy are quicker and associated with less blood loss than those made by scalpel, and there are no differences in the rate of wound complications or postoperative pain.

Tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma

The incidence of tuberculosis (TB) is increasing worldwide and so are its consequences. Its oral manifestations are infrequent, occurring in approximately 3% of all cases. Although the primary lesion occurs as a pulmonary infection, the extrapulmonary infections have also shown an increase over the past few years. These infections generally involve the head and neck through haematogenous or lymphatic routes. The clinical presentation may be as an ulcer, granuloma, orofacial TB, TB of the salivary glands or tuberculous lymphadenitis. Rarely, secondary oral manifestations associated with pulmonary infection are seen, which can appear as lesions on the gingiva, palate, lips, tongue, buccal mucosa, frenulum and in the jaw bones. Owing to the rarity of orofacial TB, it seldom arouses clinical suspicion, especially when a positive history of a systemic infection or therapy is denied. Tuberculous involvement of the mandibular condyle is even rarer, and only two such cases are reported so far, both in English-language literature. Further, the diagnosis of such a case is extremely difficult as there are no specific signs pathogonomic of infection. The only manifestation may be a localized painful swelling of the jaw. The presented case is of osteomyelitis of the mandibular condyle in a 20-year-old male patient in whom TB was later suspected. In this case report the role of diagnostic techniques is emphasized as the osteomyelitis of the condyle has the risk of being easily missed owing to its atypical signs and symptoms and atypical radiographic appearance.