Impact of highly active antiretroviral therapy on ophthalmic manifestations in human immunodeficiency virus / acquired immune deficiency syndrome

Highly active antiretroviral therapy (HAART) has changed the face of human immunodeficiency virus (HIV) acquired immune deficiency syndrome (AIDS) by leading to dramatic decreases in HIV-related morbidity and mortality in the developed as well as developing world. Since the introduction of HAART, the incidence of ocular opportunistic infections causing retinitis has dramatically decreased, and clinicians should be aware of changes in the clinical presentation of ocular manifestations of HIV. As studies of HIV disease after the introduction of HAART continue to become available, more thorough descriptions of treated patients with ocular opportunistic infections will include side-effects and toxicities of therapy. This review focuses on the impact of HAART on the ocular manifestations of HIV.

Relationship between blood groups and coronary artery disease

There are mounting evidences of relationship of different blood groups to disease. For many years, ABO blood group has been associated with predisposition to both arterial and venous disorders, such as venous thromboembolism, peripheral vascular disease and coronary artery disease. To evaluate the relationship of ABO and Rhesus blood groups with coronary artery disease. Total ninety five patients with coronary artery disease admitted in the Cardiac Surgery Department of Zarina Sikhder Women Medical College, Dhaka, and ninety five healthy stuff of same Medical College were studied. Their ABO and Rhesus Blood Groups were determined by standard method in the department of Transfusion Medicine, Zarina Sikhder Women Medical College, Dhaka, Bangladesh with full support from the department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. The results obtained in this study show that the prevalence of Coronary Artery Disease (CAD) in blood group O is invariably higher than in all other ABO blood groups (p<0.05). It is striking that despite the fact that the most prevalent blood group among Bangladeshi people is phenotype B, the prevalence of CAD risk is associated with phenotype O (Odd ratio 2.034, 95% confidence interval 1.127 to 3.67). This suggests that a certain CAD risk is associated with phenotype O. Thus we conclude that, in Bangladeshi people, blood group phenotype O is associated with a substantially increased risk for CAD.

Association of mycobacteria with Eales' disease

BACKGROUND & OBJECTIVES

Eales' disease is an idiopathic disease resulting in retinal neovascularization, recurrent haemorrhages, with or without retinal detachment predominantly affecting healthy young males (97.6%) in the Indian subcontinent. Inspite of several studies, the aetiology of Eales' disease is not clear. The isolation of Mycobacterium fortuitum from the aqueous humour of a patient with classical Eales' disease, led us to hypothesize that rapid growing nontuberculous mycobacteria (RGNTM), particularly M. fortuitum and M. chelonae could be associated with Eales' disease. We therefore undertook this study to detect DNA of these RGNTM and also of M. tuberculosis in vitreous fluids (VFs) from patients with Eales' disease and non-Eales' disease.

METHODS

We developed and optimized seminested polymerase chain reactions (SnPCRs) to detect DNAs of M. fortuitum and M. chelonae on archival ERMs (33) and VFs (19) of Eales' and control patients along with conventional mycobacteriological investigations.

RESULTS

In the retrospective study, 70 per cent ERM samples were positive for one or more Mycobacterium spp. tested by snPCR. M. fortuitum and M. chelonae were isolated from two VFs, which were also positive by sn PCR in the prospective study. Statistical evaluation of the results of both retrospective and prospective investigations showed a statistically significant association of Mycobacterium spp. with Eales' disease.

INTERPRETATION & CONCLUSION

The results of the present study suggested the involvement of Mycobacterium spp. in the aetiopathogenesis of Eales' disease. Further studies on a larger sample will be required to confirm these findings.

Planned conception in a hyper immunized rhesus-d negative mother by elective plasmapheresis

Here we report a case of planned pregnancy in a Hyper immunized Rh D negative Banker lady who was interested to have a healthy baby in her fourth Gestation as previous conceptions were ended by intra uterine death (IUDs) due to Rhesus Hemolytic diseases of new born (HDN) which is a condition where the lifespan of the infant's red cells is shortened by the action of specific antibodies derived from the mother by placental transfer. The disease begins in intrauterine life and is therefore correctly described as hemolytic disease of the fetus (HDF) and new born, but the simple term HDN has been used for a long time and can be taken to include hemolytic disease of the fetus (HDF). This hemolytic process takes place in utero and results in marked compensatory overproduction of young nucleated red cells in fetal erythropoietic sites. For this reason the disease also called erythroblastosis foetalis. Elective plasmapheresis done at the Transfusion Medicine Department of BSMMU, Dhaka on her, 800 ml. plasma were extracted in 4 different sessions during her antenatal period. One healthy male baby was delivered by LUCS at 32 weeks of pregnancy; the Baby has to receive 170 ml. O negative fresh Whole Blood as Exchange Transfusion to correct mild hyper bilirubinimia and anemia. Manual plasmapheresis may thus be practiced to all Hyper-immunized carrying mothers to prevent intra uterine death (IUD) in Rhesus D negative carrying mothers.

Diagnostic value of specific local antibody production and nucleic acid amplification technique-nested polymerase chain reaction (nPCR) in clinically suspected ocular toxoplasmosis

OBJECTIVE

The study was to evaluate the diagnostic efficacy of nested polymerase chain reaction (nPCR) using primers targeting B1 gene of Toxoplasma gondii (T. gondii) with Witmer Desmonts coefficient (WDC) technique in intraocular fluids of clinically suspected toxoplasma retino choroiditis (TRC) patients.

MATERIALS AND METHODS

Two hundred and seventy eight specimens from 189 patients (25 TRC patients and 164 controls) consisting of 189 serum samples and 89 intraocular fluids were included in the study. The clinical specimens were categorized into TRC patients (typical TRC lesion-group I & atypical TRC lesion-group II) and controls (voluntary blood donors-group III, patients undergoing uncomplicated cataract surgery-group IV, ocular inflammation of non-toxoplasma origin-group V). Detection of anti T. gondii IgG and IgM antibodies in serum samples and intraocular fluids were performed and WDC was calculated by the standard method. The standardized nPCR was applied on the 89 intraocular fluids.

RESULTS

Clinical diagnosis of TRC based on fundus examination was considered to be the "gold standard." Anti T. gondii IgG/IgM antibodies were detected in serum by ELISA in 95.6% of 25 clinically suspected TRC patients (gp I and II), 28% of gp III, 40.4% of gp IV, and in 58.3% of gpV. Witmer Desmont's coefficient was positive in 72.7% (16/22) and nPCR in 59.1% (13/22) of TRC patients (gp I and II). Both WDC and nPCR were negative in all the controls. The difference in sensitivity of WDC and nPCR was not statistically significant (p=0.5247).

CONCLUSIONS

Though both WDC and nPCR were reliable diagnostic techniques for ocular toxoplasmosis, nPCR is more acceptable because of the amount of specimen(s) required, rapidity, cost effectiveness, and direct evidence of T. gondii DNA in the intraocular fluids.

Is interferon-α and retinoic acid combination along with radiation superior to chemo-radiation in the treatment of advanced carcinoma of cervix?

Locally advanced cervical cancers comprise a large majority of the gynecologic cancers in India and other developing countries. Concurrent chemo-radiation has improved the survival of high risk stage I and stage II cervical cancers. There is no evidence that the same survival benefit has been achieved with chemo-radiation in stage III and stage IV disease. Interferon-alpha and Retinoic acid have synergistic anti-proliferative activity. In combination with radiation, they substantially enhance the sensitivity of the squamous carcinoma cells to radiation. Based on these observations from the in vitro studies, a few clinical trials have evaluated the combination of interferon-alpha and Retinoic acid, concomitant with radiation, to treat cervical cancers. The results from these early trials were encouraging and the combination had minimal toxicities. However, till date, no phase III randomized controlled trial has been done to evaluate this therapeutic modality.

Current perspectives of herpesviral retinitis and choroiditis

Vision-threatening viral retinitis are primarily caused by members of the herpesvirus family. The biology and molecular characterization of herpesviruses, clinical presentations of retinopathies, pathology and pathogenesis including the host responses, epidemiology and the laboratory methods of aetiological diagnosis of these diseases are described. Clinical syndromes are acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis, multifocal choroiditis and serpiginous choroiditis besides other viral retinopathies. Herpes simplex virus (HSV) retinitis is more common in immunocompetent persons while varicella zoster virus (VZV) affects both immunocompetent and immunosuppressed patients equally. CMV retinitis is most common among patients with AIDS. The currently employed laboratory methods of antigen detection, virus isolation and antibody detection by enzyme linked immuno-sorbent assay (ELISA) have low sensitivity. Polymerase chain reaction (PCR) has increased the value of diagnosis due to its high clinical sensitivity and absolute specificity in detection of herpesviruses in intraocular specimens.

Transporter associated protein expression in uveal melanoma

BACKGROUND/AIM

Transporter associated protein (TAP) is important for presenting peptides to major histocompatibility complex (MHC) class I molecules. Defects in TAP lead to decreased MHC class I expression. The immunoexpression of human leucocyte antigen (HLA) class I molecules and the TAP1 subunit were studied in primary uveal melanomas and correlated with the cell types and extrascleral extension.

METHODS

The HLA class I antigen and TAP1 subunit were analysed by immunoperoxidase staining with monoclonal antibodies on 45 primary uveal melanoma archival specimens. The tumours were divided into two groups-group A: tumours with no extrascleral extension; group B tumours with extrascleral extension/liver metastasis. Immunoanalysis was done by a semiquantitative method.

RESULTS

HLA class I antigen and TAP1 were decreased in 35 of 35 tumours with no extrascleral extension and positive in six of 10 tumours with liver metastasis. Decreased immunoexpression of HLA class I antigen and TAP1 in uveal melanomas with no extrascleral extension was significant (p<0.001). HLA class I antigen and TAP1 were negative in spindle cell melanomas (p<0.001).

CONCLUSIONS

HLA class I antigen and TAP1 expression were decreased in uveal melanomas with no extrascleral extension and in spindle cell melanomas. Decreased expression of TAP1 may lead to decreased expression of HLA class I antigen in uveal melanomas. This preliminary observation deserves further investigation, which may shed more light on the immune escape mechanisms of this tumour and thus enable novel therapeutic strategies.

Thrombosed orbital varix -- a correlation between imaging studies and histopathology

A thrombosed varix in the orbit is comparatively rare. Clinical examination alone is often inadequate for diagnosis. Radio-logical examination, such as a computed tomography (CT) scan of the orbit, is extremely important. Histopathological examination (HPE) after excision biopsy can confirm the diagnosis. The present authors describe a case of proptosis in the left eye of a 45-year-old man. CT-scan and HPE supported the diagnosis of a thrombosed orbital varix. This paper discusses the use of radiological investigations to supplement a clinical suspicion and make the diagnosis. This entity needs to be included in the differential diagnosis of proptosis and requires a coordinated approach for establishment of the diagnosis.

Boron compounds against human leukemic cells

Two new boron compoumds, dihydroxy(oxybiguanido) boron (iii) hydrochloride monohydrate (HB) and guanidine biboric acid adduct (GB) were used in this study to observe the antitumor effect. Leukemic blast cells isolated from chronic myeloid leukemia (CML) patients showed significant cell growth inhibition within twentyfour hours. IC50 of GB and HB was 2mg/ml. The metabolically active cells were found to be inhibited by drug treatment as assessed by MTT test. Inhibition of 3H Thymidine incorporation also supported the above result. In this study we investigated the molecular mechanisms by which HB and GB induce apoptosis in immature blast cells.

Gross photography of ophthalmic pathology specimens

Removal of the entire eyeball or a portion of it is required in many ophthalmic conditions. The gross features of such specimens provide valuable information. Gross photography of an intraocular tumour, ruptured eyeball or other pathological specimens including lid lesions, orbital tumors, intraocular lens implants, intraocular and extraocular parasites, retinal pathology such as haemorrhages and peripheral degenerations, establishes a permanent documentation. We herein describe the technique of gross photography of such valuable specimens, using a dissecting microscope with a special arrangement. This technique is currently used by us with gratifying results.

Status and distribution of golden langurs (Trachypithecus geei) in Assam, India

The distribution of golden langurs (Trachypithecus geei) is limited to a small area of western Assam in northeast India and Bhutan between the rivers Manas in the east, Sankosh in the west, and Brahmaputra in the south. It is one of the most seriously endangered primate species of India. A comparative analysis based on satellite images taken in 1988 and 1998 showed a 50% loss of original golden langur habitat. Data on population dynamics collected using line transect and total count methods are presented here. An average group size of 8.2 (range 4.0-22.0) individuals was recorded. A total of 1,064 individuals were counted living in 130 groups. The sex ratio was 1.9-2.5 adult females for each adult male. A low percentage of juveniles and infants suggests that the population is unstable. Most of the groups had only one adult male. Small group sizes, isolated distribution, proportionately few infants and juveniles, and degrading habitat are all causes of concern. Demographic trends indicate a decline in the golden langur population.

Presumed Eales' disease with neurologic involvement: report of three cases

PURPOSE

To report three cases of presumed Eales' disease with neurologic lesions.

METHODS

Case reports, systemic and neurologic evaluation, and magnetic resonance imaging.

RESULTS

All three patients were young men who had seizures in the past; two had migrainous headache. Magnetic resonance imaging showed putaminal infarct in two cases and edema in the white matter of temporal cortex was noticed in one case. Clinical features in all these patients were suggestive of Eales' disease.

CONCLUSION

Ischemic infarction of the brain can be seen in clinically suspected cases of Eales' disease.

Multiple cranial nerve palsy in an HIV-positive patient

We report the case of a 32 -year- old HIV-positive Indian male who presented with sixth nerve (bilateral), ninth, tenth and twelfth nerve palsies; cerebellar and posterior column involvement. CT scan showed gyriform enhancement in the right occipital lobe and nodular leptomeningeal enhancement in the left frontal lobe. Cytomegalovirus serology was positive and the patient was treated as presumed CMV. HIV can present with multiple cranial neuropathy and varied neurological involvement.