Intestinal Tuberculosis: A Rare Case of Massive Gastrointestinal Bleed in a Post-Renal Transplant Recipient

Massive rectal bleeding is an uncommon presentation of ileal tuberculosis (TB). We report an uncommon cause of anemia in a post-renal transplant patient due to massive lower gastrointestinal (LGI) bleed. The index case had a normal upper and LGI endoscopy, but the ⁹⁹technetium labeled red blood cell scan showed active bleeding from terminal ileum and caecum. Microscopic examination of the resected specimen revealed tubercular granuloma with acid-fast bacilli. Intestinal TB should be a differential diagnosis for massive LGI bleed in immunosuppressed patients in developing country.

Piloting of WHO Safe Childbirth Checklist using a modified version in Sri Lanka

OBJECTIVES

Data was gathered to study the impact of a context-specific modified WHO Safe Childbirth Checklist (mSCC) at two tertiary care settings in Sri Lanka, as a part of an implementation program.

DATA DESCRIPTION

We provide data sets of a prospective observational study which was conducted in the University Obstetrics Unit at De Soysa Hospital for Women (DSHW), Colombo and two Obstetric Units at Teaching Hospital, Mahamodara, Galle (THMG), Sri Lanka. These consist of demographic and checklist implementation details and data on the level of acceptance. The study was conducted over 8 weeks at DSHW and over 4 weeks at THMG. Checklists were kept attached to clinical records at admission and collected on discharge. Level of acceptance was assessed using a self-administered questionnaire. Outcome measures were adoption rate (percentage of deliveries where mSCC was used), adherence to practices (mean percentage of items checked in each checklist), response rate (percentage of staff members who responded to questionnaire) and level of acceptance (percentage of "strongly agree/agree" in Likert scale to five questions regarding acceptance of modified SCC).

Roles of the sire and dam quail in egg, yolk, albumen, and shell weight alterations due to the parthenogenetic trait

Infertile eggs from Chinese Painted quail exhibit parthenogenesis, and the 1st egg in a clutch sequence is more likely to develop a parthenogenetic embryo. Also, hens that exhibit parthenogenesis have shorter clutches and heavier egg weights. These larger eggs may be a result of the egg residing in the oviduct longer, allowing more time for the parthenote to develop. However, it is unknown which components of the egg are altered due to the parthenogenetic trait or the role of dams and sires from the parthenogenetic line of quails in these alterations. Therefore, our objective was to determine if the parthenogenetic trait in dams, sires, or both contributes to alterations in egg components, such as yolk, albumen, and shell weights. Two selected lines of quail, 1 line selected for parthenogenesis and 1 line that was unselected for the parthenogenetic trait (control), were utilized in a 2 x 2 factorial arrangement of dam and sire lines to create 4 breeding treatments: control dams + control sires (CC), control dams + parthenogenetic sires (CP), parthenogenetic dams + control sires (PC), parthenogenetic dams + parthenogenetic sires (PP). Daily, fresh eggs were collected, labeled, weighed, and the germinal disc was classified as fertile, unfertilized without development, or parthenote. Yolk, albumen, and shell weights were obtained, and their weights were also calculated as percentage of total egg weight. A dam main effect revealed heavier weights for total egg, yolk, albumen, and shell as well as a larger percentage of albumen and ratio of albumen to yolk in parthenogenetic line dams versus control line dams. However, the percentage of yolk was higher for control than parthenogenetic line dams. The increase in total egg and egg component weights due to the parthenogenetic trait suggests that the transit time of the egg through the oviduct is altered. Perhaps transit through the magnum and uterus is delayed the most yielding greater albumen and shell weights, respectively.

Parthenogenesis in birds: a review

Parthenogenesis or 'virgin birth' is embryonic development in unfertilized eggs. It is a routine means of reproduction in many invertebrates. However, even though parthenogenesis occurs naturally in even more advanced vertebrates, like birds, it is mostly abortive in nature. In fact, multiple limiting factors, such as delayed and unorganized development as well as unfavorable conditions developing within the unfertilized egg upon incubation, are associated with termination of progressive development of parthenogenetic embryos. In birds, diploid parthenogenesis is automictic and facultative producing only males. However, the mechanisms controlling parthenogenesis in birds are not clearly elucidated. Additionally, it appears from even very recent research that these mechanisms may hinder the normal fertilization process and subsequent embryonic development. For instance, virgin quail and turkey hens exhibiting parthenogenesis have reduced reproductive performance following mating. Also, genetic selection and environmental factors, such as live virus vaccinations, are known to trigger the process of parthenogenesis in birds. Therefore, parthenogenesis has a plausible negative impact on the poultry industry. Hence, a better understanding of parthenogenesis and the mechanisms that control it could benefit commercial poultry production. In this context, the aim of this review is to provide a complete overview of the process of parthenogenesis in birds.

Clinicopathological Spectrum of Glomerular Diseases in Adolescents: A Single-center Experience over 4 Years

The spectrum of biopsy-proven glomerular disease was studied from a single center in Northwestern India, among adolescents aged 13–19 years. From January 2009 to December 2012, a total of 177 patients with biopsy-proven glomerular disease were studied. The same pathologist reported all the biopsy specimens after subjecting to light, immunofluorescence, and electron microscopy. The clinical profile and laboratory findings of the patients were correlated with the histopathological spectrum of glomerular diseases. Males formed 71.19% (n = 126) and the remaining 28.81% (n = 51) were females. Lupus nephritis had a strong female predominance, whereas minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) had a male predominance. Nephrotic syndrome was the indication for biopsy in 65% of the cases. Rapidly progressive renal failure and acute nephritis were the next common indications accounting for 14% and 7%, respectively. FSGS was the most common glomerular disease in adolescents (n = 45, 25.4%). The next common were MCD and lupus nephritis each contributing 21.6% and 10.7%, respectively. Primary glomerular diseases accounted for 84.75% (n = 150) of the total. The remaining 15.25% (n = 27) were attributed to secondary glomerular diseases, of which lupus nephritis was the most common, i.e., in 70.4% patients (n = 19). FSGS was the most common histology in adolescent nephrotic participants (37%). MCD was the next common, found in 31% of nephrotic patients. Electron microscopy changed the diagnosis made by light microscopy and immunofluorescence in 5.6% cases only, and it confirmed the diagnosis in another 21.6%. Kidney biopsy in adolescents is a safe procedure. The spectrum of glomerular diseases in adolescents is different from that seen in adults and smaller children.

A new ab initio potential energy surface for the NH-He complex

We present a new three-dimensional potential energy surface (PES) for the NH(X³Σ^-)-He van der Waals system, which explicitly takes into account the NH vibrational motion. The NH-He PES was obtained using the open-shell single- and double-excitation coupled cluster approach with non-iterative perturbational treatment of triple excitations. The augmented correlation-consistent aug-cc-pVXZ (X = Q, 5, 6) basis sets were employed, and the energies obtained were then extrapolated to the complete basis set limit. Using this new PES, we have studied the spectroscopy of the NH-He complex and we have determined a new rotational constant that agrees well with the available experimental data. Collisional excitation of NH(X³Σ^-) by He was also studied at the close-coupling level. Calculations of the collisional excitation cross sections of the fine-structure levels of NH by He were performed for energies up to 3500 cm^-1, which yield, after thermal average, rate coefficients up to 350 K. The calculated rate coefficients are compared with available experimental measurements at room temperature, and a reasonably good agreement is found between experimental and theoretical data.

Spectrum of IgG4-related Kidney Disease at a Tertiary Care Center

IgG4-related kidney disease (IgG4 RKD) is increasingly reported with varied manifestations. The present study was carried out to study the spectrum of IgG4 RKD. All patients with renal manifestation associated with conditions known to be associated with IgG4-related diseases (IgG4 RDs), or renal imaging or histology suggestive of IgG4 RKD were included and evaluated further. Patients with known extrarenal IgG4RD were also screened for renal involvement. Out of 40 patients screened over a period of 15 months, IgG4 RKD was diagnosed in 8. Majority were male (87.5%) with mean age being 56 years. Disease spectrum ranged from normal renal function in one to renal failure requiring dialysis in another two patients. Significant proteinuria was uncommon (12.5%) while hematuria was not seen in any patient. Tubulointerstitial nephritis was seen in all four patients who underwent kidney biopsy. Two patients had associated glomerular lesions in the form of immune complex crescentic glomerulonephritis. The most common imaging abnormality was hypodense renal lesions seen in 2 patients. Elevated IgG4 levels had 87.5% sensitivity and 78.3% specificity for IgG4 RKD and levels did not correlate with disease severity. Of 4 patients treated with steroids, 3 showed improvement in renal function. IgG4 RKD is an uncommon disease even at a referral tertiary care center. Elevated IgG4 levels alone are neither sensitive nor specific for the diagnosis of IgG4 RKD, and a combination of clinical, imaging, serological, and histological features are required for diagnosis.

Synthesis of NiS–Graphene Nanocomposites and its Electrochemical Performance for Supercapacitors

The aim of this work is to synthesize nickel sulfide–graphene (NiS/G) nanocomposites with different compositions and to analyze the structural and electrochemical capacity and compatibility for their application as supercapacitor material with enhanced charge storage capacity and reduced impedance. NiS nanoparticles (NPs) loaded on graphene were synthesized at various concentrations of graphene by a simple hydrothermal route from nickel sulphate and graphene oxide as precursors in the presence of PVP as surfactant and thioacetamide (TAA) as sulfur source. The composites structural, morphological and physical properties were analyzed by X-ray diffraction (XRD), Field Emission Scanning Electron Microscopy (FE-SEM), Energy-dispersive X-ray spectroscopy, X-ray photoelectron spectroscopy (XPS) and Fourier Transform-infrared (FT-IR) analysis. SEM measurements showed the presence of surface attachment of the NiS NPs onto the graphene sheets. To assess the properties of the nanocomposites for their applicability in supercapacitors, electrochemical analysis was carried out in 6[Formula: see text]M KOH electrolyte. Three different samples with different graphene contents — GNiS-10 with 10 wt.%, GNiS-20 with 20 wt.% and GNiS-40 with 40 wt.% were prepared. The specific capacitances obtained for the nanocomposites were calculated to be 84.33[Formula: see text]F/g, 129.66[Formula: see text]F/g, 187.53[Formula: see text]F/g at 10[Formula: see text]mV/s scan rate, respectively. The EIS data showed that the loading of NiS NPs on graphene caused the reduction in impedance at high frequency and has a long cycle life (over 1000 cycles).

Effect of Thrombotic Microangiopathy on Clinical Outcomes in Indian Patients With Lupus Nephritis

INTRODUCTION

In addition to glomerular lesion, renal vascular lesion is also an important prognostic marker of lupus nephritis (LN). Among patients with various vascular changes, individuals with thrombotic microangiopathy (TMA) present with severe clinical manifestations and have a high mortality. The aim of the present study was to assess the spectrum and impact of TMA on the outcomes of LN. In a prospective observational study of 2.5 years' duration, clinical and renal histopathological data regarding biopsy-proven LN were noted, and evaluation for antiphospholipid syndrome (APS) as a cause of TMA in LN was also carried out.

METHODS

Study subjects were followed up actively for 6 months, and various outcomes were noted. Cases were divided into 2 groups as LN with TMA and LN without TMA, and various features were compared between the 2 groups. Outcomes recorded were complete response (CR), partial response (PR), treatment failure, and death.

RESULTS

Of the 197 patients with LN, 50 patients (25.4%) were diagnosed with co-existing renal TMA. Five patients (10%) were found to have concomitant APS. As compared to patients without TMA, those with TMA had significantly higher rates of oliguria (P = 0.035), advanced renal injury, that is, serum creatinine > 3mg/dl (P = 0.002), fibrocellular and fibrous crescents (P = 0.01), and tubular atrophy (P = 0.001). Outcomes included CR in 15 patients (30%), PR in 10 (20%), failure in 19 (38%), and death in 6 (12%). Patients with LN with TMA had higher rates of treatment failure (P = 0.02) compared to the group without TMA.

DISCUSSION

The presence of TMA in patients with LN is associated with adverse clinicopathological presentation and poor outcome.

Noise-induced cochlear synaptopathy in rhesus monkeys (Macaca mulatta)

Cochlear synaptopathy can result from various insults, including acoustic trauma, aging, ototoxicity, or chronic conductive hearing loss. For example, moderate noise exposure in mice can destroy up to ∼50% of synapses between auditory nerve fibers (ANFs) and inner hair cells (IHCs) without affecting outer hair cells (OHCs) or thresholds, because the synaptopathy occurs first in high-threshold ANFs. However, the fiber loss likely impairs temporal processing and hearing-in-noise, a classic complaint of those with sensorineural hearing loss. Non-human primates appear to be less vulnerable to noise-induced hair-cell loss than rodents, but their susceptibility to synaptopathy has not been studied. Because establishing a non-human primate model may be important in the development of diagnostics and therapeutics, we examined cochlear innervation and the damaging effects of acoustic overexposure in young adult rhesus macaques. Anesthetized animals were exposed bilaterally to narrow-band noise centered at 2 kHz at various sound-pressure levels for 4 h. Cochlear function was assayed for up to 8 weeks following exposure via auditory brainstem responses (ABRs) and otoacoustic emissions (OAEs). A moderate loss of synaptic connections (mean of 12-27% in the basal half of the cochlea) followed temporary threshold shifts (TTS), despite minimal hair-cell loss. A dramatic loss of synapses (mean of 50-75% in the basal half of the cochlea) was seen on IHCs surviving noise exposures that produced permanent threshold shifts (PTS) and widespread hair-cell loss. Higher noise levels were required to produce PTS in macaques compared to rodents, suggesting that primates are less vulnerable to hair-cell loss. However, the phenomenon of noise-induced cochlear synaptopathy in primates is similar to that seen in rodents.

Cockroach allergen serine proteinases: Isolation, sequencing and signalling via proteinase-activated receptor-2

BACKGROUND

Allergy to the German cockroach (Blattella germanica) is a significant asthma risk factor for inner-city communities. Cockroach, like other allergens, contains trypsin-like enzyme activity that contributes to allergenicity and airway inflammation by activating proteinase-activated receptors (PARs). To date, the enzymes responsible for the proteolytic activity of German cockroach allergen have not been characterized.

OBJECTIVES

We aimed to identify, isolate and characterize the trypsin-like proteinases in German cockroach allergen extracts used for clinical skin tests. For each enzyme, we sought to determine (1) its substrate and inhibitor enzyme kinetics (Km and IC50), (2) its amino acid sequence and (3) its ability to activate calcium signalling and/or ERK1/2 phosphorylation via PAR2.

METHODS

Using a trypsin-specific activity-based probe, we detected three distinct enzymes that were isolated using ion-exchange chromatography. Each enzyme was sequenced by mass spectometery (deconvoluted with an expressed sequence tag library), evaluated kinetically for its substrate/inhibitor profile and assessed for its ability to activate PAR2 signalling.

FINDINGS

Each of the three serine proteinase activity-based probe-labelled enzymes isolated was biochemically distinct, with different enzyme kinetic profiles and primary amino acid sequences. The three enzymes showed a 57%-71% sequence identity with a proteinase previously cloned from the American cockroach (Per a 10). Each enzyme was found to activate both Ca⁺⁺ and MAPK signalling via PAR2.

CONCLUSIONS AND RELEVANCE

We have identified three different serine proteinases from the German cockroach that may, via PAR2 activation, play different roles for allergen sensitization in vivo and may represent attractive therapeutic targets for asthma.