Microaneurysm turnover is a biomarker for diabetic retinopathy progression to clinically significant macular edema: findings for type 2 diabetics with nonproliferative retinopathy

PURPOSE

To examine the relationship between microaneurysm turnover (formation rate), using a new semi-automatic method (MA-Tracker) based on color fundus photographs, and diabetic retinopathy (DR) progression to clinically significant macular edema (CSME).

METHODS

In total, 113 patients/eyes with nonproliferative DR (NPDR) were followed up every 6 months for 2 years as controls of the DR clinical trials, and by conventional general and ophthalmological care for the next 8 years (over a total of 10 years' follow-up). Microaneurysm turnover for the 2 first years was computed using the MA-Tracker.

RESULTS

The 17 patients that developed CSME over the 10 years of follow-up presented a microaneurysm formation rate of 9.2 +/- 18.2 microaneurysms/year (mean +/- SD) during the first 2 years, which was statistically higher than the eyes that did not develop CSME (0.5 +/- 1.2 microaneurysms/year, p < 0.001). These 17 patients also presented higher HbA(1C) levels at baseline (8.5 +/- 1.2%) compared to the patients who did not develop CSME (7.3 +/- 1.2%, p = 0.001).

CONCLUSIONS

A high microaneurysm formation rate on color fundus photographs appears to be a good biomarker for DR progression to CSME in type 2 diabetic patients with NPDR.

Ceftriaxone-induced acute reversible encephalopathy in a patient treated for a urinary tract infection

Encephalopathy is a rare side effect of third- and fourth-generation cephalosporins. Renal failure and previous disease of the central nervous system predispose to this neurotoxicity. We describe a case of encephalopathy with generalised triphasic waves in a patient with pre-existent cerebrovascular disease who was treated with ceftriaxone for a urinary tract infection. Early recognition of this complication is relevant given that ceftriaxone discontinuation reverted the neurological syndrome.

“Full Moon Fits”: Focal Temporal Epilepsy Presenting as First Episode Psychosis

Introduction:

Epilepsy rarely presents as psychosis; this is reportedly more common in temporal lobe epilepsy, particularly mesial temporal lobe sclerosis (MTLS). in first psychotic episodes, epilepsy is often a neglected diagnosis. Also, distinguishing ictal behavioral manifestations from postictal psychosis may be troublesome, hindering adequate management.

Case report:

26-year-old female without known psychiatric or neurological disorder, brought to the emergency department due to rapidly progressive behavioral disturbance, with Capgras and persecutory delusions, marked aggressiveness and disorientation. Hallucinations were absent. According to her mother, she experienced several “fits” during the previous 2 days, and she also invariably sustains these every month, around “the full moon days”. Blood and urine tests and a brain CT scan were normal. She was treated with risperidone and lorazepam, with symptom remission in two days. Further exploration revealed a two year history of undiagnosed partial complex and generalized seizures; MRI disclosed right MTLS. Interictal EEG and video-EEG were normal (with a negative psychogenic induction trial). the symptoms are successfully controlled with oxcarbazepine.

Discussion:

Although the EEG was not carried out acutely, this seems to be a case of postictal psychosis; this diagnosis is also supported by the clinical progression. the differential diagnoses include toxic psychosis and non-convulsive status epilepticus; a brief review of epilepsy-related psychosis will be conducted. A low suspicion threshold must be kept in these situations, and a meticulous multidisciplinary approach seems advisable.

Expression of Cox-1 and Cox-2 in Canine Mammary Tumours

The aim of this study was to investigate immunohistochemically the expression of cyclooxygenase-1 (Cox-1) and cyclooxygenase-2 (Cox-2) in canine mammary tumours of different histological types. Cox-1 and Cox-2 enzyme expression was evaluated in 70 mammary samples (four normal, six hyperplastic, 60 neoplastic [21 benign and 39 malignant]). Cox-1 expression was identified in all the samples, and Cox-2 in all the mammary lesions except ductal hyperplasia. Two of the four normal mammary gland samples showed focal immunoreactivity for Cox-2. Cox-1 immunoexpression did not differ significantly between benign and malignant lesions (P=0.272). Cox-2 immunoexpression was higher in malignant tumours than in benign counterparts (P<0.001). Of the malignant tumours, carcinosarcomas and tubulopapillary and squamous cell carcinomas had the highest Cox-2 scores. The study showed that malignant tumours had the highest values of Cox-2 expression, and Cox-2 immunolabelling was particularly intense in histological types classically associated with high malignancy. This suggests that nonsteroidal anti-inflammatory drugs (NSAIDs), particularly Cox-2 inhibitors, may have a useful role to play in the treatment of canine malignant mammary tumours.

Primary and secondary tumours occurring simultaneously in the brain of a dog

Primary brain tumours of a single histological type and metastatic brain tumours are well described in dogs in the current veterinary literature. However, the concurrent presence of a primary and secondary tumour in the brain of a dog has never, to the authors' knowledge, been previously reported. The clinical and pathological features of a nine-year-old, female boxer with an oligodendroglioma and metastases from a mammary gland adenocarcinoma occurring simultaneously in the brain are described in this case report. Information in the veterinary literature on multiple malignancies affecting the central nervous system is very limited; therefore, a discussion about comparative situations in human medicine has been included.

Writing epilepsy: a neurophysiological, neuropsychological and neuroimaging study

Writing epilepsy is a rare reflex syndrome in which seizures are triggered by writing. We describe a 33-year-old, right-handed man, with a history of juvenile absence epilepsy in remission and a family history of epilepsy, in whom myoclonic jerks precipitated exclusively by writing started at the age of 30. Intensive video/EEG monitoring during neuropsychological tests revealed, at about 1 minute after starting to write, a dystonic posture, followed by myoclonic jerks involving the right hand that shortly after became generalized. Concomitantly, the ictal EEG documented generalized hypersynchronous polyspike-wave discharges, maximal over the right parietocentral area. SPECT revealed an ictal hyperperfusion and interictal hypoperfusion over right parietofrontal regions, and fMRI showed extensive and intense left frontal, supplementary motor area activation, induced by writing. This case study provides some evidence supporting the hypothesis that the mechanism underlying writing-triggered seizures may be a generalized seizure process, with a focal cortical trigger zone, presumed to be the left frontal lobe as suggested by clinical and fMRI data. A relevant role played by the right hemisphere (right parietofrontal region) is postulated in the full-blown expression of reflex epileptogenesis, as supported by EEG and SPECT findings.

Eating seizures and emotional facial paresis: evidence suggesting the amygdala is a common anatomophysiological substratum

The medial basotemporal lobes (hippocampus, amygdala, parahippocampal gyrus) are considered to be parts of the system responsible for nonvolitional facial movements. In patients with temporal lobe epilepsy, lower facial weakness during emotional expression has been found to occur almost exclusively contralateral to the temporal lobe with the epileptogenic focus. Repetitive and chronic stimulation of the amygdala during eating has also been postulated as a probable mechanism for eating seizures. The authors present the illustrative aspects of both facial asymmetry and eating seizures in a case of mesial temporal lobe epilepsy (MTLE). This report provides evidence that the amygdala may be the common anatomical basis for three different aspects of this patient: emotional facial paresis, eating seizures, and sleep paroxysmal microarousals.

Alterations of retinal capillary blood flow in preclinical retinopathy in subjects with type 2 diabetes

BACKGROUND

To identify alterations of retinal capillary blood flow in the papillomacular area in preclinical diabetic retinopathy using the Heidelberg scanning laser Doppler flowmeter.

METHODS

Ten eyes from ten patients with type 2 diabetes and no lesions visible on fundus photography (level 10 of Wisconsin grading) and ten eyes from ten healthy subjects of similar age range were examined with the HRF. Intravisit reproducibility of retinal capillary blood flow measurements was assessed in normal subjects and in type 2 diabetic patients, comparing different measurement areas and different analysis procedures: (a) 10x10 pixel box with original software, (b) 10x10 pixel box with SLDF software, and (c) whole-scan analysis with SLDF software (automatic full-field perfusion image analysis).

RESULTS

Intravisit reproducibility for the whole-scan analysis in the papillomacular area was 3.52%, 4.81% and 4.60% for volume (VOL), flow (FLW) and velocity (VEL) respectively. Using this method, mean and SD values for retinal capillary blood-flow are 13.25+/-2.87, 214.58+/-55.30 and 0.74+/-0.17, for VOL, FLW and VEL for healthy eyes, comparing with 19.85+/-6.22, 360.87+/-158.70 and 1.20+/-0.48 in eyes with preclinical diabetic retinopathy (P<0.010, P<0.019 and P<0.015 respectively).

CONCLUSIONS

The HRF shows acceptable reproducibility when using whole-scan analysis in the papillomacular area. Retinal capillary blood VOL, FLW and VEL were particularly increased in five of the ten diabetic eyes examined, with values over the mean + 2SD of the control population, suggesting that eyes showing increased retinal capillary blood flow may indicate risk of progression.

Retinal thickness in eyes with mild nonproliferative retinopathy in patients with type 2 diabetes mellitus: comparison of measurements obtained by retinal thickness analysis and optical coherence tomography

OBJECTIVE

To compare measurements of retinal thickness in eyes with mild nonproliferative retinopathy in patients with type 2 diabetes mellitus using 2 different techniques: the retinal thickness analyzer (RTA) and optical coherence tomography (OCT).

METHODS

Twenty-eight eyes from 28 patients with type 2 diabetes mellitus and mild nonproliferative retinopathy were classified according to the Wisconsin grading system by 7-field stereoscopic fundus photography. Ten eyes were classified as level 10 (absence of visible lesions) and 18 as level 20 or 35 (minimal retinopathy). All eyes were examined by the RTA and OCT. Healthy populations were used to establish reference maps for the RTA (n = 14; mean age, 48 years; age range, 42-55 years) and OCT (n = 10; mean age, 56 years; age range, 43-68 years). Reference maps were computed using the means + 2 SDs of the values obtained for each location. Increases in thickness were computed as a percentage of increase over these reference maps.

RESULTS

The RTA detected increases in thickness in 1 or more locations in 24 of the 28 diabetic eyes examined, whereas OCT detected increases in only 3 eyes. The percentages of increase detected by the RTA ranged from 0.3% to 73.5%, whereas OCT detected percentages of increase of 0.3% to 4.8%.

CONCLUSION

Optical coherence tomography is less sensitive than the RTA in detecting localized increases in retinal thickness in the initial stages of diabetic retinal disease.

Effects of acetylcholine and spermineNONOate on erythrocyte hemorheologic and oxygen carrying properties

PURPOSE OF THE STUDY

To determine the effects of acetylcholine and spermineNONOate--a NO donor--on RBC membrane and oxygen carrying properties.

MATERIAL AND METHODS

Aliquots of venous blood from eleven healthy subjects were incubated with ACh 10(-3) M, ACh 10(-5) M, spermineNONOate 10(-5) M and spermineNONOate 10(-4) M. The following parameters were determined: erythrocyte aggregation and deformability, hematocrit, plasma pH, osmolality, K(+), Na(+), Ca(2+) concentrations, hemoglobin, oxyhemoglobin, carboxyhemoglobin and methemoglobin concentrations, oxygen saturation of hemoglobin, oxygen and carbon dioxide partial pressures and p50.

RESULTS

In presence of ACh there is an increase of erythrocyte deformability, decrease of erythrocyte aggregation, plasma pH, K(+) and Na(+) concentration, increase of Ca(2+) concentration and p50. In presence of spermineNONOate there is an increase of erythrocyte deformability, plasma pH, decrease of Na(+) and Ca(2+) concentration, increase of metHb concentration and decrease of p50.

CONCLUSION

Acetylcholine and spermineNONOate are able to induce changes on RBC membrane and oxygen carrying properties.

Antimicrobial activity of Terminalia macroptera root

Terminalia macroptera Guill et Perr. (Combretaceae) is a medicinal plant used in Guinea-Bissau and other West African countries to treat infectious diseases. The ethanol extract from T. macroptera decorticated root and their liquid-liquid partition fractions, were screened for antimicrobial activity, by the twofold serial microdilution assay against seven reference bacterial strains and against Candida albicans. The extract and fractions showed some activity against at least one of the test microorganisms. The best results were obtained against Shigella dysenteriae and Vibrio cholerae. The minimum inhibitory concentrations (MIC) of T. macroptera ethanol extract were also determined for about 100 clinical strains of Campylobacter sp., Escherichia coli, Salmonella sp., Shigella sp. and Vibrio cholerae. The ethanol extract activity against Campylobacter strains is similar to co-trimoxazole, higher than sulfamethoxazole but lower than tetracycline, erythromycin, ampicillin and streptomycin. Ellagitannins are the major compounds in the extract and active fractions. The obtained results suggest a potential importance of this medicinal plant in the treatment of enteric diseases, particularly in Campylobacter infections.

Cryptolepis sanguinolenta activity against diarrhoeal bacteria

Cryptolepine is the main alkaloid of Cryptolepis sanguinolenta (Lindl.) Schlechter, a plant used in traditional medicine in West Africa. The minimal inhibitory concentrations (MICs) of cryptolepine, ethanol and aqueous extracts of Cryptolepis sanguinolenta root were determined for 65 strains of Campylobacter jejuni, 41 strains of Campylobacter coli isolated from sporadic cases of gastroenteritis in Portugal and 86 strains of Vibrio cholerae isolated from patients with enteric infections in Angola, Brazil and Portugal. The ethanol extract activity against Campylobacter strains (MIC90% = 25 micrograms/ml) is higher than that of co-trimoxazole and sulfamethoxazole and Campylobacter strains susceptibility for cryptolepine (MIC90% = 12.5 micrograms/ml) is equal for ampicillin. The ethanol extract and cryptolepine show some activity against the Vibrio cholerae strains, although their activities are lower than that of tetracycline. The results suggest that these roots could be a therapeutic alternative for bacterial etiologic diarrhoea in West Africa.

Prevalence, biotypes, plasmid profile and antimicrobial resistance of Campylobacter isolated from wild and domestic animals from northeast Portugal

The incidence of Campylobacter jejuni and Campylobacter coli in wild and producing animals has been studied to evaluate their importance as potential reservoirs of campylobacter infection. These organisms were isolated from: 59 chicken (60.2%), 65 swine (59.1%), 31 black rats (57.4%), 61 sparrows (45.5%), 21 ducks (40.5%), 32 cows (19.5%) and 27 sheep (15.3%). Biotypes, plasmid and resistance profiles were studied in order to characterize the isolates. Biotypes I and II of C. jejuni were predominant in all reservoirs except swine, where C. coli I was more frequent. Plasmid prevalence was higher in strains isolated from swine (53.8%) and rats (45.5%). The size of the plasmids ranged from 1.3 to 82 MDa. A 2.3 MDa plasmid was the most frequent, detected in all the reservoirs except ducks. Antimicrobial susceptibility testing revealed that 5.5% of the strains were resistant to ampicillin, 5.5% to tetracycline, 12.6% to erythromycin and 23.5% to streptomycin. Resistance to erythromycin (26.2%) and to streptomycin (58.4%) was particularly high in isolates from swine. Tetracycline resistance was encoded by a 33 or a 41 MDa plasmid and transferred by conjugation.

Campylobacter enteritis in Portugal: epidemiological features and biological markers

From 1984 to 1989, stool samples from 2811 gastroenteritis cases were examined for the presence of Campylobacter jejuni and C. Coli, Salmonella, Shigella and Yersinia species. Isolation rates were: Campylobacter jejuni and C. Coli, 5.3%, Salmonella spp., 14.8%, Shigella spp., 4.6% and Yersinia enterocolitica, 1.1%. Age group distribution analysis shows a higher Campylobacter isolation rate in children under one year of age. Seasonal distribution revealed a peak incidence in winter as in other Mediterranean countries. Predominant biotypes were C. jejuni I (51%), C. jejuni II (21.5%) and C. coli I (18.8%). Antimicrobial susceptibility testing did not reveal resistance to erythromycin. Thirty of the strains harboured plasmids with 7 different profiles.