Myelofibrosis and Pancytopenia Associated With Primary Hyperparathyroidism

Objective

Primary hyperparathyroidism (PHPT) has varied clinical presentations. Hematologic abnormalities secondary to PHPT have been described before. However, pancytopenia as the initial presentation has rarely been reported. We report a patient with PHPT who presented for evaluation of pancytopenia.

Methods

Histopathology of the bone marrow at presentation is described. Bone biochemistry results and the hematologic profile before and after curative parathyroidectomy are presented.

Results

A 48-year-old woman presented with pancytopenia (hemoglobin, 6.3 g/dL; total leucocyte count, 3000 cells/mm³; and platelet count, 60 000 cells/mm³), and her bone marrow study showed marrow fibrosis. Biochemical evaluation revealed hypercalcemia (15.5 mg/dL), hypophosphatemia (2.2 mg/dL), and elevated total alkaline phosphatase (4132 U/L). Bone mineral density assessment by dual-energy X-ray absorptiometry scan revealed osteoporosis at all 3 sites, which was more severe in the distal one third of the forearm. Further investigations confirmed the diagnosis of PHPT (serum parathyroid hormone, 2082 pg/mL). Following curative parathyroidectomy, in addition to normalization of calcium, there was restoration of all 3 hematologic cell lines at 3 months.

Conclusion

Pancytopenia may be a rare manifestation of PHPT. Thus, it may be prudent to evaluate the calcium profile in patients with chronic refractory anemia and pancytopenia.

Nematic fluctuations in the cuprate superconductor Bi2Sr2CaCu2O8+δ

Establishing the presence and the nature of a quantum critical point in their phase diagram is a central enigma of the high-temperature superconducting cuprates. It could explain their pseudogap and strange metal phases, and ultimately their high superconducting temperatures. Yet, while solid evidences exist in several unconventional superconductors of ubiquitous critical fluctuations associated to a quantum critical point, in the cuprates they remain undetected until now. Here using symmetry-resolved electronic Raman scattering in the cuprate \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathrm{Bi}}_2{\mathrm{Sr}}_2{\mathrm{CaCu}}_2{\mathrm{O}}_{8+\delta}$$\end{document}Bi2Sr2CaCu2O8+δ, we report the observation of enhanced electronic nematic fluctuations near the endpoint of the pseudogap phase. While our data hint at the possible presence of an incipient nematic quantum critical point, the doping dependence of the nematic fluctuations deviates significantly from a canonical quantum critical scenario. The observed nematic instability rather appears to be tied to the presence of a van Hove singularity in the band structure.

Solid evidence of quantum fluctuations associated to a quantum critical point in cuprate superconductors remains elusive. Here, Auvray et al. report Raman scattering evidence of enhanced electronic nematic fluctuations near the endpoint of the pseudogap phase in Bi\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${}_{2}$$\end{document}2Sr\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${}_{2}$$\end{document}2CaCu\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${}_{2}$$\end{document}2O\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${}_{8+\delta }$$\end{document}8+δ.

Dynamic trajectories of volatile and non-volatile specialised metabolites in 'overnight' fragrant flowers of Murraya paniculata

Ephemeral flowers, especially nocturnal ones, usually emit characteristic scent profiles within their post-anthesis lifespans of a few hours. Whether these flowers exhibit temporal variability in the composition and profile of volatile and non-volatile specialised metabolites has received little attention. Flowers of Murraya paniculata bloom in the evenings during the summer and monsoon, and their sweet, intense fragrance enhances the plant's value as an ornamental. We aimed to investigate profiles of both volatile and non-volatile endogenous specialised metabolites (ESM) in nocturnal ephemeral flowers of M. paniculata to examine whether any biochemically diverse groups of ESM follow distinct patterns of accumulation while maintaining synchrony with defensive physiological functions. Targeted ESM contents of M. paniculata flowers were profiled at ten time points at 2-h intervals, starting from late bud stage (afternoon) up to the start of petal senescence (mid-morning). Emitted volatiles were monitored continuously within the whole 20-h period using headspace sampling. The ESM contents were mapped by time point to obtain a highly dynamic and biochemically diverse profile. Relative temporal patterns of ESM accumulation indicated that the active fragrance-emitting period might be divided into 'early bloom', 'mid-bloom' and 'late bloom' phases. Early and late bloom phases were characterised by high free radical generation, with immediate enhancement of antioxidant enzymes and phenolic compounds. The mid-bloom phase was relatively stable and dedicated to maximum fragrance emission, with provision for strong terpenoid-mediated defence against herbivores. The late bloom phase merged into senescence with the start of daylight; however, even the senescent petals continued to emit fragrance to attract diurnal pollinators. Our study suggests that dynamic relations between the different ESM groups regulate the short-term requirements of floral advertisement and phytochemical defence in this ephemeral flower. This study also provided fundamental information on the temporal occurrence of emitted volatiles and internal pools of specialised metabolites in M. paniculata flowers, which could serve as an important model for pollination biology of Rutaceae, which includes many important fruit crops.

Teachers' competence, school policy and social context-HIV prevention needs of primary schools in Kagera, Tanzania

Sub-Saharan Africa carries a high burden of the HIV epidemic, with young adults being particularly affected. Well-designed school-based HIV prevention interventions can contribute to establishing protective behaviour. The aim of this study was to explore the needs of primary school students and teachers in the region of Kagera, Tanzania, regarding an HIV prevention intervention in the primary school setting. The needs assessment was structured according to the PRECEDE component of the PRECEDE-PROCEED model. Qualitative data was collected in six focus group discussions with primary school students and teachers. Key informant interviews with seven experts were conducted. We employed qualitative content analysis to analyse data in MAXQDA. The findings suggest that teachers need to be adequately trained to provide HIV and sex education and to support HIV-positive students. Enabling structural factors, such as an appropriate syllabus, are required. Stigmatization has been reported a major barrier to HIV prevention in schools. Teachers and students identified a more trustful relationship between each other as well as to legal guardians of children as a basis for HIV prevention. These findings will inform the development of a tailored HIV prevention intervention.

Die Anzahl verschlüsselter Diagnosen in einem dokumentationsgerechten Krankenblatt für internistische Patienten

Anfang 1963 wurde in der Medizinischen Universitäts-Klinik Greifswald die Krankenblatt-Dokumentation mit Maschinenlochkarten eingeführt; der dafür entwickelte Krankenblattkopf gestattet die Verschlüsselung von maximal 6 Diagnosen.

Die vorliegende Arbeit ist hauptsächlich statistischen Untersuchungen über die Verteilung der verschlüsselten Diagnosen auf Diagnosengruppen und Altersklassen gewidmet. Sie lassen nach Ansicht der Verfasser den Schluß zu, daß in einem dokumentationsgerechten Krankenblattkopf für internistische Patienten vier Diagnosen-Felder ausreichen.

Abschließend wird kurz das Problem der Krankenblattbearbeitung diskutiert und auf die Bedeutung von Dokumentationsfachkräften hingewiesen.

Co-morbidity of Obsessive-compulsive Disorder and Other Anxiety Disorders with Child and Adolescent Mood Disorders

OBJECTIVE

To assess the co-morbidity of obsessive-compulsive disorder (OCD) and other anxiety disorders in child and adolescent mood disorders.

METHODS

A total of 100 patients aged < 18 years with mood disorders according to the DSM-IV-TR were screened for OCD and other anxiety disorders using Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version.

RESULTS

The prevalence of co-morbid anxiety disorders was 22%; OCD was present in 4%, and subthreshold obsessive-compulsive symptoms were present in 2%. Among others, 8% had panic disorder, 7% had generalised anxiety disorder, 3% had separation anxiety disorder, and 1% had social phobia; multiple anxiety disorders were present in 3% of patients.

CONCLUSION

Co-morbid anxiety disorder was found in one-fifth of children and adolescents with mood disorder.

Collapse of the normal-state pseudogap at a Lifshitz transition in the Bi(2)Sr(2)CaCu(2)O(8+δ) cuprate superconductor

We report a fine tuned doping study of strongly overdoped Bi_{2}Sr_{2}CaCu_{2}O_{8+δ} single crystals using electronic Raman scattering. Combined with theoretical calculations, we show that the doping, at which the normal-state pseudogap closes, coincides with a Lifshitz quantum phase transition where the active holelike Fermi surface becomes electronlike. This conclusion suggests that the microscopic cause of the pseudogap is sensitive to the Fermi surface topology. Furthermore, we find that the superconducting transition temperature is unaffected by this transition, demonstrating that their origins are different on the overdoped side.

Emergent defect states as a source of resistivity anisotropy in the nematic phase of iron pnictides

We consider the role of potential scatterers in the nematic phase of Fe-based superconductors above the transition temperature to the (π, 0) magnetic state but below the orthorhombic structural transition. The anisotropic spin fluctuations in this region can be frozen by disorder, to create elongated magnetic droplets whose anisotropy grows as the magnetic transition is approached. Such states act as strong anisotropic defect potentials that scatter with much higher probability perpendicular to their length than parallel, although the actual crystal symmetry breaking is tiny. We calculate the scattering potentials, relaxation rates, and conductivity in this region and show that such emergent defect states are essential for the transport anisotropy observed in experiments.

Observation of incipient charge nematicity in Ba(Fe(1-x)Co(x))2As2

Using electronic Raman spectroscopy, we report direct measurements of charge nematic fluctuations in the tetragonal phase of strain-free Ba(Fe(1-x)Co(x))2As2 single crystals. The strong enhancement of the Raman response at low temperatures unveils an underlying charge nematic state that extends to superconducting compositions and which has hitherto remained unnoticed. Comparison between the extracted charge nematic susceptibility and the elastic modulus allows us to disentangle the charge contribution to the nematic instability, and to show that charge nematic fluctuations are weakly coupled to the lattice.

Prognostic and therapeutic relevance of FLIP and procaspase-8 overexpression in non-small cell lung cancer

Non-small cell lung carcinoma remains by far the leading cause of cancer-related deaths worldwide. Overexpression of FLIP, which blocks the extrinsic apoptotic pathway by inhibiting caspase-8 activation, has been identified in various cancers. We investigated FLIP and procaspase-8 expression in NSCLC and the effect of HDAC inhibitors on FLIP expression, activation of caspase-8 and drug resistance in NSCLC and normal lung cell line models. Immunohistochemical analysis of cytoplasmic and nuclear FLIP and procaspase-8 protein expression was carried out using a novel digital pathology approach. Both FLIP and procaspase-8 were found to be significantly overexpressed in tumours, and importantly, high cytoplasmic expression of FLIP significantly correlated with shorter overall survival. Treatment with HDAC inhibitors targeting HDAC1-3 downregulated FLIP expression predominantly via post-transcriptional mechanisms, and this resulted in death receptor- and caspase-8-dependent apoptosis in NSCLC cells, but not normal lung cells. In addition, HDAC inhibitors synergized with TRAIL and cisplatin in NSCLC cells in a FLIP- and caspase-8-dependent manner. Thus, FLIP and procaspase-8 are overexpressed in NSCLC, and high cytoplasmic FLIP expression is indicative of poor prognosis. Targeting high FLIP expression using HDAC1–3 selective inhibitors such as entinostat to exploit high procaspase-8 expression in NSCLC has promising therapeutic potential, particularly when used in combination with TRAIL receptor-targeted agents.

Orbital order and Hund's rule frustration in Kondo lattices

We analyze a microscopic origin of the Kondo effect-assisted orbital order in heavy-fermion materials. By studying the periodic two-orbital Anderson model with two local electrons, we show that frustration of Hund's rule coupling due to the Kondo effect leads to an incommensurate spiral orbital and magnetic order, which exists only inside the Kondo screened (heavy-electron) phase. This spiral state can be observed in neutron and resonant x-ray scattering measurements in U- and Pr-based heavy-fermion compounds, and realized in cold atomic gases, e.g., fermionic 173Yb.

Equivalence of single-particle and transport lifetimes from hybridization fluctuations

Single band theories of quantum criticality successfully describe a single-particle lifetime with non-Fermi liquid temperature dependence, but they fail to obtain a charge transport rate with the same dependence unless the interaction is assumed to be momentum independent. Here we demonstrate that a quantum critical material, with a long-range mode that transmutes electrons between light and heavy bands, exhibits a quasilinear temperature dependence for both the single-particle and the charge transport lifetimes, despite the strong momentum dependence of the interaction.

Acquired differential regulation of caspase-8 in cisplatin-resistant non-small-cell lung cancer

Failure to efficiently induce apoptosis contributes to cisplatin resistance in non-small-cell lung cancer (NSCLC). Although BCL-2-associated X protein (BAX) and BCL-2 antagonist killer (BAK) are critical regulators of the mitochondrial apoptosis pathway, their requirement has not been robustly established in relation to cisplatin. Here, we show that cisplatin can efficiently bypass mitochondrial apoptosis block caused by loss of BAX and BAK, via activation of the extrinsic death receptor pathway in some model cell lines. Apoptosis resistance following cisplatin can only be observed when both extrinsic and intrinsic pathways are blocked, consistent with redundancy between mitochondrial and death receptor pathways in cisplatin-induced apoptosis. In H460 NSCLC cells, caspase-8 cleavage was shown to be induced by cisplatin and is dependent on death receptor 4, death receptor 5, Fas-associated protein with death domain, acid sphingomyelinase and ceramide synthesis. In contrast, cisplatin-resistant cells fail to activate caspase-8 via this pathway despite conserving sensitivity to death ligand-driven activation. Accordingly, caspase-8 activation block acquired during cisplatin resistance, can be bypassed by death receptor agonism.

Magnetoelastic quantum fluctuations and phase transitions in the iron superconductors

We examine the relevance of magnetoelastic coupling to describe the complex magnetic and structural behavior of the different classes of the iron superconductors. We model the system as a two-dimensional metal whose magnetic excitations interact with the distortions of the underlying square lattice. Going beyond the mean field, we find that quantum fluctuation effects can explain two unusual features of these materials that have attracted considerable attention: first, why iron telluride orders magnetically at a non-nesting wave vector (π/2,π/2) and not at the nesting wave vector (π,0) as in the iron arsenides, even though the nominal band structures of both these systems are similar, and second, why the (π,0) magnetic transition in the iron arsenides is often preceded by an orthorhombic structural transition. These are robust properties of the model, independent of microscopic details, and they emphasize the importance of the magnetoelastic interaction.

Obatoclax induces Atg7-dependent autophagy independent of beclin-1 and BAX/BAK

Direct pharmacological targeting of the anti-apoptotic B-cell lymphoma-2 (BCL-2) family is an attractive therapeutic strategy for treating cancer. Obatoclax is a pan-BCL-2 family inhibitor currently in clinical development. Here we show that, although obatoclax can induce mitochondrial apoptosis dependent on BCL-2 associated x protein/BCL-2 antagonist killer (BAX/BAK) consistent with its on-target pharmacodynamics, simultaneous silencing of both BAX and BAK did not abolish acute toxicity or loss of clonogenicity. This is despite complete inhibition of apoptosis. Obatoclax dramatically reduced viability without inducing loss of plasma membrane integrity. This was associated with rapid processing of light chain-3 (LC3) and reduction of S6 kinase phosphorylation, consistent with autophagy. Dramatic ultrastructural vacuolation, not typical of autophagy, was also induced. Silencing of beclin-1 failed to prevent LC3 processing, whereas knockout of autophagy-related (Atg)7 abolished LC3 processing but failed to prevent obatoclax-induced loss of clonogenicity or ultrastructural changes. siRNA silencing of Atg7 in BAX/BAK knockout mouse embryonic fibroblasts did not prevent obatoclax-induced loss of viability. Cells selected for obatoclax resistance evaded apoptosis independent of changes in BCL-2 family expression and displayed reduced LC3 processing. In summary, obatoclax exhibits BAX- and BAK-dependent and -independent mechanisms of toxicity and activation of autophagy. Mechanisms other than autophagy and apoptosis are blocked in obatoclax resistant cells and contribute significantly to obatoclax's anticancer efficacy.

Prenatal infection decreases calbindin, decreases Purkinje cell volume and density and produces long-term motor deficits in Sprague-Dawley rats

The cerebellum is involved in the control of motor functions with Purkinje cells serving as the only output from the cerebellum. Purkinje cells are important targets for toxic substances and are vulnerable to prenatal insults. Intrauterine infection (IUI) has been shown to selectively target the developing cerebral white matter through lesioning, necrosis and inflammatory cytokine activation. Developmental and cognitive delays have been associated with animal models of IUI. The aim of this study was to determine if IUI leads to damage to Purkinje cells in the developing cerebellum and if any damage is associated with decreases in calbindin and motor behaviors in surviving pups. Pregnant rats were injected with Escherichia coli (1 × 10⁵ colony-forming units) or sterile saline at gestational day 17. Beginning at postnatal day (PND) 2, the pups were subjected to a series of developmental tests to examine developmental milestones. At PND 16, some pups were sacrificed and their brains extracted and processed for histology or protein studies. Hematoxylin and eosin (HE) staining was done to examine the general morphology of the Purkinje cells and to examine Purkinje cell density, area and volume. Calbindin expression was examined in the cerebellum via immunohistochemistry and Western blot techniques. The remaining rat pups were used to examine motor coordination and balance on a rotating rotarod at the prepubertal and adult ages. Prenatal E. coli injection did not significantly change birth weight or delivery time, but did delay surface righting and negative geotaxis in pups. Pups in the E. coli group also had a decrease in the number of Purkinje cells, as well as a decrease in Purkinje cell density and volume. HE staining demonstrated a change in Purkinje cell morphology. Calbindin expression was decreased in rats from the E. coli group as well. Locomotor tests indicated that while there were no significant changes in gross motor activity, motor coordination and balance was impaired in both prepubertal and adult rats from the E. coli group. In this model of IUI, we observed changes in Purkinje cell development which were associated with alterations in cerebellum-dependent motor behaviors. The decreases in calbindin and Purkinje cells were associated with developmental delays. These data further support the importance of IUI in brain development.

Kondo breakdown and hybridization fluctuations in the kondo-heisenberg lattice

We study the deconfined quantum critical point of the Kondo-Heisenberg lattice in three dimensions using a fermionic representation for the localized spins. The mean-field phase diagram exhibits a zero temperature quantum critical point separating a spin liquid phase where the hybridization vanishes and a Kondo phase where it does not. Two solutions can be stabilized in the Kondo phase: namely, a uniform hybridization when the band masses of the conduction electrons and the spinons have the same sign, and a modulated one when they have opposite sign. For the uniform case, we show that above a very small temperature scale, the critical fluctuations associated with the vanishing hybridization have dynamical exponent z=3, giving rise to a resistivity that has a TlogT behavior. We also find that the specific heat coefficient diverges logarithmically in temperature, as observed in a number of heavy fermion metals.

Quantum critical end point for the Kondo volume collapse model

The Kondo volume collapse describes valence transitions in f-electron metals and is characterized by a line of first order transitions in the pressure-temperature phase plane terminated at critical end points. We analyze the quantum critical end point, when the lower end point is tuned to T=0, and determine the specific heat, thermal expansion, and compressibility. We find that the inclusion of quantum critical fluctuations leads to a novel bifurcation of the first order phase line. Finally, we show that critical strain fluctuations can cause both, superconductivity and non-Fermi liquid behavior near the critical point.

Case-control study for risk factors for Q Fever in southwest England and Northern Ireland

Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumonia in the United Kingdom each year, and can result in serious complications such as endocarditis. Although outbreaks have frequently been reported worldwide, the causes are often not clearly identified and there have been few studies of risk factors in sporadic cases. We conducted a matched case-control study. Cases of acute Q fever in people aged over 15 years in southwest England and Northern Ireland were identified from January 2002 to December 2004. Controls were matched for age, sex and the general practice at which they were registered. Questionnaires asking about contact with animals, and leisure and work activities, were posted to cases and controls. Questionnaires were completed by 39/50 (78%) of the cases and 90/180 (50%) of the controls. In the single variable analysis, occupational exposure to animals or animal products was the only risk factor associated with cases at the 5% level (P=0.05, odds ratio (OR) 3.4). Long term illness appeared to be significantly protective (P=0.03, OR 0.3). In multivariable analysis the strength of association between occupational exposure and illness remained high (OR 3.6, 95% confidence interval (CI) 0.9 to 14.8) and smoking emerged as a possible risk factor. This is the first case-control study to identify occupational exposure to animals or animal products as the most likely route of infection in sporadic cases as opposed to outbreaks.

Pre-operative plasma erythropoietin concentration and survival following surgery for non-small cell lung cancer

BACKGROUND

Suppression of the effect of the hormone erythropoietin (EPO) on the bone marrow, and an inadequate EPO response to anaemia have been shown to be factors in the genesis of cancer related anaemia. Low haemoglobin (Hb) concentration pre-operatively has been shown to have prognostic significance in patients with surgically resected NSCLC. This study investigates the relationship between pre-operative EPO and survival in patients having surgery for NSCLC.

METHODS

Pre-operative plasma EPO concentration and haemoglobin concentration were analysed in patients undergoing surgery for NSCLC between April 1998 and January 1999. Full follow-up was available for all patients.

RESULTS

Forty two patients were included. Median EPO concentration was 9.4 mIU/ml, range (3.7-56.4) with 17 patients (40.4%) having values above the normal range. Median haemoglobin concentration was 13.3g/dl (range 8.5-16.8) with 15 patients (26%) anaemic pre-operatively. Pathological staging revealed 17 (40.4%) patients with stage I, 6 (14.3%) with stage II, 19 (45.3%) with stage III disease. Ten patients had irresectable disease. There was a significant difference in median EPO but not haemoglobin concentration, between the different pathological stages. Survival was significantly lower in patients with pre-operative EPO >10.5 mIU.

CONCLUSIONS

Raised pre-operative EPO is associated with reduced survival in patients having surgery for NSCLC. Its measurement should be considered in the pre-operative assessment of patients undergoing surgery for NSCLC. Further research is required to further investigate the biological relationship between EPO and NSCLC.

Case-control study for risk factors for Q fever in southwest England and Northern Ireland

Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumonia in the United Kingdom each year, and can result in serious complications such as endocarditis. Although outbreaks have frequently been reported worldwide, the causes are often not clearly identified and there have been few studies of risk factors in sporadic cases. We conducted a matched case-control study. Cases of acute Q fever in people aged over 15 years in southwest England and Northern Ireland were identified from January 2002 to December 2004. Controls were matched for age, sex and the general practice at which they were registered. Questionnaires asking about contact with animals, and leisure and work activities, were posted to cases and controls. Questionnaires were completed by 39/50 (78%) of the cases and 90/180 (50%) of the controls. In the single variable analysis, occupational exposure to animals or animal products was the only risk factor associated with cases at the 5% level (P=0.05, odds ratio (OR) 3.4). Long term illness appeared to be significantly protective (P=0.03, OR 0.3). In multivariable analysis the strength of association between occupational exposure and illness remained high (OR 3.6, 95% confidence interval (CI) 0.9 to 14.8) and smoking emerged as a possible risk factor. This is the first case-control study to identify occupational exposure to animals or animal products as the most likely route of infection in sporadic cases as opposed to outbreaks.

The social and family dynamics behind the uptake of cataract surgery: findings from Kilimanjaro region, Tanzania

AIMS

To describe and understand better the barriers that elderly cataract patients in Kilimanjaro region (Tanzania) experience at the family level in order to access surgery.

METHODS

A phenomenological study carried out in the catchment area of a teaching hospital in Kilimanjaro Region. 60 semi-structured interviews were conducted with patients and ex-cataract patients.

RESULTS

The perceived need for sight and for surgery appears partly socially constructed at the family level. It was found that women were less likely to express a need for sight for fear of being seen as a burden. Furthermore, young heads of family are more inclined to support old men than old women. The consensus is that asking children for help can be difficult. Going for cataract surgery must be seen as a social process where elderly patients might have to wait or negotiate support for weeks, months, or even years.

CONCLUSIONS

Eye programmes must promote the benefits of cataract surgery to all family members, not just to the patient. A changing social climate, changing expectations of vision, and evolving cost sharing systems will have significant, sometimes contradictory, impacts on use of eye care services. Strategies for reaching those without access to financial resources need to be strengthened.

Quantum correction to conductivity close to a ferromagnetic quantum critical point in two dimensions

We study the temperature dependence of the conductivity due to quantum interference processes for a two-dimensional disordered itinerant electron system close to a ferromagnetic quantum critical point. Near the quantum critical point, the crossover between diffusive and ballistic regimes of quantum interference effects occurs at a temperature T*=1/taugamma(E(F)tau)2, where gamma is the parameter associated with the Landau damping of the spin fluctuations, tau is the impurity scattering time, and E(F) is the Fermi energy. For a generic choice of parameters, T* is smaller than the nominal crossover scale 1/tau. In the ballistic quantum critical regime, the conductivity behaves as T1/3.

Perforation of the lower thoracic oesophagus following crush injury to the chest and abdomen

We report a case of perforation of the lower thoracic oesophagus following a crush injury to the chest and upper abdomen. A laparotomy was performed for abdominal injuries, and appropriately placed drains resulted in complete resolution of the oesophageal leak, 21 days following the injury. This case report demonstrates that a conservative approach to lower thoracic oesophageal perforations can be carried out successfully without the added morbidity of a thoracotomy, or risks of a direct repair.

Endoscopic transanal resection of rectal tumours using a urological resectoscope--still has a role in selected patients

INTRODUCTION

Transanal resection of rectal villous adenomas or adenocarcinomas can be carried out using various modalities such as operative excision, fulguration, laser coagulation or cryotherapy. Transanal endoscopic microsurgery is currently not widely available. Transanal resection can provide effective palliation for locally advanced rectal tumours in patients unfit for abdomino-perineal excision of rectum. A urological resectoscope can be safely and repeatedly used to resect advanced primary or locally recurrent rectal tumours by colorectal surgeons with urological expertise. This study reports our experience of treating rectal lesions with endoscopic transanal resection (ETAR) using the urological resectoscope.

METHODS

Patients were identified from one surgeons' prospectively collected operating data. Charts were retrieved and reviewed.

RESULTS

Over a 13-year period a total of 43 ETAR procedures were carried out in 20 patients (11 males; mean age 74 years; range 54-92 years) using the urological resectoscope. Twelve (60%) patients had a single resection; 8 (40%) patients required more than one resection; the mean number of procedures per patient was 2.2 (range 1-8). The median interval between resections for recurrent disease (excluding planned repeat resections) was 340 days (range 168-2337 days). Histopathology revealed rectal adenoma (with varying degrees of dysplasia) in 11 (55%) patients and adenocarcinoma in 9 (45%). The majority (30; 70%) of resections were carried out in patients with benign disease, with 13 (30%) in patients with rectal adenocarcinoma. Mean operating time per resection was 25 min. Thirteen (30%) resections were carried out under spinal anaesthetic. There was no procedure related mortality. There were no cases of haemorrhage, rectal perforation, 'TUR syndrome' or pelvic sepsis. No patients with benign disease subsequently developed an invasive carcinoma.

CONCLUSIONS

Accepting that this technique provides limited histopathological information regarding extent of resection and tumour clearance, our experience demonstrates that ETAR of rectal tumours using the urological resectoscope can provide a minimally invasive, effective and safe means of treating and palliating patients with benign and malignant rectal disease. There remains a place for this technique in selected patients.

Can tonic accommodation predict surgical performance?

BACKGROUND

Pilots undergo many visual tests for both selection and assessment, and we know that there are many similarities between pilots and surgeons. Hence, it would not be unreasonable to bring similar visual tests into surgery. Tonic accommodation (TA) is a stable parameter that is adopted by the eye in the absence of any stimulation. Over recent years, surgery has undergone change from traditional open surgery to minimally invasive procedures, bringing many advantages. However, not every surgeon has the ability to perform under conditions where the operative field is represented on a flat monitor.

METHOD

We determined the TA values in medical students and then correlated this with their performance on a virtual reality surgical simulator.

RESULTS

We found that TA values predicted the number of errors made with the dominant hand, accounting for 27% of the variance.

CONCLUSION

The data suggest that TA may play a role in the individual differences that are noted when surgeons perform laparoscopic surgery. Further studies are needed to evaluate the exact role of TA in surgical performance.

[Pilot study for the registration of acute myocardial infarction in the Liège area (Belgium)]

BACKGROUND

In 1998, a permanent registry of myocardial infarction was developed in the Liège area (Belgium) to provide updated, exhaustive and validated data on the morbidity and mortality from cardiovascular causes, to define the patients' profile, to identify myocardial infarction therapeutic strategies and to complete and make comparisons with data collected in other parts of the country through methodologically identical registers.

METHODS

All acute coronary events lethal or non lethal among individuals from both genders aged from 25 to 69 years and living in the area were registered according to the methodology developed for the MONICA project (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases) of WHO. The three main selected data sources were: death certificates, general practitioners and cardiologists, hospitals. The events were categorised according to symptoms, cardiac enzymes, electrocardiogram, history of chronic ischaemic heart disease and necropsy findings.

RESULTS

The coronary-event rates were 283/100,000 in men and 102/100,000 in women. The case fatality rate, 28 days after the onset of the symptoms, was 30.6% for men and 36.2% for women, and 77.5% of deaths occurred in the first 24 hours after the onset of the symptoms.

CONCLUSION

The development of a myocardial infarction register at a regional level requires the involvement of all health professionals dealing with that pathology. Such register has valuable public health interests, providing exhaustive and validated data on the pathology and its evolution as well as useful information for improving therapeutic strategies and developing adapted preventive measures.

Glycosylated molecular variants of C-reactive proteins from the major carp Catla catla in fresh and polluted aquatic environments

Elevated level of pollutant specific glycosylated molecular variants of C-reactive protein have been purified to electrophoretic homogeneity from the sera of major carp, Catla catla confined in freshwater (CRP(N)) and water polluted with nonlethal doses of cadmium (CRP(Cd)), mercury (CRP(Hg)), phenol (CRP(Ph)) and hexachlorocyclohexane (CRP(Hex)). These CRPs differ amongst themselves in electrophoretic mobility, and in their carbohydrate content ranging from 20-50%. CRPs interact with pneumococcal C-polysaccharide (CPS) showing different binding constants. Both phosphorylcholine (PC) and calcium are indispensable for binding. Studies on amino acid compositions, electrophoretic analysis, isoelectric focusing, binding to PC & CPS and secondary structures of the purified CRPs indicate, that, they differ from each other. However, they share the common properties of a CRP, including pentraxin structure revealed by electron microscopy. Taken together, our results provide a new structural insight regarding the connection between the presence of unique molecular variants and probably the toxicity therein combated.

[What is the role of aceclofenac in the therapeutic arsenal against chronic osteoarthritis pathologies?]

The aim of this article is to critically review the potential role of aceclofenac in the treatment of inflammatory pain and chronic osteoarticular disorder, based on its activity on the mediators of inflammation, its effect on cartilage remodeling and on the results of clinical studies comparing aceclofenac with other NSAIDs in these disorders. Aceclofenac has an outstanding anti-inflammatory profile, involving besides a classical inhibition of prostaglandins E2, a decrease in the expression of several cytokines including interleukin 1 and tumor necrosis factor alpha. It also inhibits activated oxygen species production and influences cells adhesion. Aceclofenac and its main metabolite, 4-hydroxyaceclofenac, has positive effects on cartilage anabolism combined with modulating effect of matrix catabolism. Clinically, aceclofenac has been consistently shown to have a similar efficacy than that of widely marketed NSAIDs and a tolerance profile at least as good, if not better than the profile observed for other NSAIDs in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. As of today, no head to head comparison between aceclofenac and coxibs have been performed, nor for efficacy neither for tolerance. The specific profile of aceclofenac makes this NSAID an interesting candidate for long-term treatment of chronic rheumatic disorders as well as for treatment of acute inflammatory episodes.

Mapping the distribution of 3-hydroxylipins in the Mucorales using immunofluorescence microscopy

The distribution of endogenous 3-hydroxylipins (3-OH oxylipins) in representatives of the Mucorales was mapped using immunofluorescence microscopy. Strains of each of the following genera were examined: Absidia, Actinomucor, Cunninghamella, Mortierella (subgenus Micromucor), Mortierella (subgenus Mortierella), Mucor and Rhizomucor. Immunofluorescence microscopy was carried out using an antibody that was raised against 3R-hydroxy-5Z,8Z, 11 Z, 14Z-eicosatetraenoic acid (3R-HETE), which cross-reacts with other 3-OH oxylipins. Subsequently, the occurrence and distribution of the antibody on the various reproductive stages of each fungus was noted. In Absidia, Actinomucor, Mortierella (subgenus Micromucor), Mucor and Rhizomucor, 3-OH oxylipins were found to be associated with the columellae and/or wall of the sporangium. In the representative of Cunninghamella, the 3-OH oxylipins were associated with the single-spored sporangiola. No 3-OH oxylipins were detected in the strains representing Mortierella (subgenus Mortierella).

A case of a persistent left vena cava superior with atresia of the right atrial ostium of the coronary sinus

A persistent left vena cava superior with an atretic ostium of the coronary sinus was found during the routine dissecting course in the embalmed cadaver of an 83-year-old woman who had died from cardiac infarction. The left vena cava superior was very narrow in diameter (4 mm), originated at the lateral part of the left vena brachiocephalica and ran down between the venae pulmonales sinistrae and the auricula sinistra. The vena cava opened into the sinus coronarius of the heart, which terminated as a blind sac due to an atretic ostium. The vena coronaria sinistra as well as the vena interventricularis posterior drained into the sinus coronarius. Congenital atresia of the coronary opening is a rare malformation and is usually associated with other anomalies. The congenital ostial atresia could be the cause of a persistent left vena cava superior, which then takes over the drainage of the cardiac veins.

Depressive vulnerability is not an independent risk factor for osteoporosis in postmenopausal women

Major depression has been repeatedly but not consistently reported to be associated with low bone mineral density (BMD) and to an increased risk for fracture in women. We have investigated, in healthy postmenopausal women, whether depressive symptomatology, assessed by the General Health Questionnaire (GHQ), was associated to a significant decrease in BMD, hence supporting the hypothesis of an independent pathogenetic link between the two disorders. We investigated 121 postmenopausal women, aged 48-77 years, spontaneously attending a screening visit for osteoporosis in an outpatient facility. BMD of the spine and the non-dominant hip (total and neck areas) were measured by Dual Energy X-Ray absorptiometry. All subjects completed to the 'General Health Questionnaire' translated and validated in French. No significant correlations were observed between the GHQ score and BMD of the spine (P = 0.54), the total hip area (P = 0.65), or the femoral neck area (P = 0.65). No differences in terms of spinal or femoral BMD were observed between women with GHQ score < 5 or > or = 5. When comparing values of BMD between women within the upper and the lower quartiles for GHQ score, no difference was observed for spine (P = 0.69), total hip (P = 0.80), or femoral neck (P = 0.93). Similarly, GHQ scores were not significantly different when comparing women in the upper and lower quartiles of BMD distribution at the spine or the hip. In conclusion, notwithstanding the clinical pattern of postmenopausal osteoporosis can lead to depression and, on the other hand, hormonal and behavioral disturbances reported in depression might be enhancing factors for accelerated bone loss, our present results do not support the hypothesis that otherwise healthy postmenopausal women with increased depressive complaints are also more prone to exhibit osteoporotic fractures.

Quantitative assessment of Ascaris lumbricoides infection in school children from a slum in Visakhapatnam, south India

An epidemiological study was conducted on 217 school children aged between 7-13 years, from Relliveedhi a slum in Visakhapatnam, Andhra Pradesh, south India, during August 1993 to August 1994. The children belonged to a socioeconomically backward community-parental occupation being fishing or waged labor. Intensity and prevalence estimations for Ascaris lumbricoides were done indirectly by formalin-ethyl-acetate sedimentation technic and directly by worm expulsions following albendazole administration at a single oral dose of 400 mg/child. Prevalence rate was 73% while the intensity of infection ranged between low to moderate. Boys had severe infection than girls due to their outdoor activities and behavioral habits. Nine year old children had the highest prevalence rates. Mean Ascaris worm intensity was 2.2 (+/-1.91) with an over-dispersed distribution of the parasite in the host population. Reinfection study over a period of nine month showed that the prevalence rates exceeded the pre-intervention level but the intensity of infection was very low. Dual species intensity correlation between Ascaris and Trichuris was consistently strong.

Intestinal helminth infections among school children in Visakhapatnam

A study was carried out between 1993-1994 to determine the prevalence and intensity of intestinal helminth infections among 217 primary school children in Relliveedhi, a slum area in Visakhapatnam. The children were between 7 to 13 years of age and belonged to lower socio-economic status. Stool samples collected were processed by modified formalin-ethyl acetate sedimentation technique to determine ova counts (EPG). One hundred and seventy seven children were infected with one or more of the intestinal parasites viz. Ascaris lumbricoides, Trichuris trichiura and hookworm. The overall prevalence of infection was eighty two per cent. Ascaris lumbricoides was the most common infection with a prevalence of 75% followed by T. trichiura (66%) and hookworm (9%). All infected children received a single dose of albendazole (400 mg/child). Single stool samples were examined over a period of nine months to study reinfection dynamics.

Ultrasound-assisted ankle arthrocentesis

Difficulty is frequently encountered in performing ankle arthrocentesis. This report describes an ultrasound-assisted technique that can be readily learned by emergency physicians. It involves using the ultrasound beam to accurately locate the tibiotalar joint, thereby increasing the probability of obtaining joint fluid on aspiration.