Hemophagocytic Lymphohistiocytosis in a Patient with Hodgkin Lymphoma, HIV, and Epstein-Barr Virus

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation. It occurs in many underlying conditions and all age groups due to severe and uncontrolled inflammatory reactions, with the resultant overproduction of immune cells and cytokines. This leads to multi-organ damage (if not detected early and treated properly) with a mortality of more than 55%. We present a case of a 38-year-old male patient who presented with HLH with concurrent HIV/AIDS, and Epstein-Barr virus (EBV)-related Hodgkin lymphoma. We aim to emphasize the importance of considering HLH and cancer in patients with HIV/AIDS.

Interleukin 1β and lipopolysaccharides induction dictate chondrocyte morphological properties and reduce cellular roughness and adhesion energy comparatively

Osteoarthritis (OA) is a whole joint disease marked by the degradation of the articular cartilage (AC) tissue, chronic inflammation, and bone remodeling. Upon AC's injury, proinflammatory mediators including interleukin 1β (IL1β) and lipopolysaccharides (LPS) play major roles in the onset and progression of OA. The objective of this study was to mechanistically detect and compare the effects of IL1β and LPS, separately, on the morphological and nanomechanical properties of bovine chondrocytes. Cells were seeded overnight in a full serum medium and the next day divided into three main groups: A negative control (NC) of a reduced serum medium and 10 ng/ml IL1ß or 10 ng/ml LPS-modified media. Cells were induced for 24 h. Nanomechanical properties (elastic modulus and adhesion energy) and roughness were quantified using atomic force microscopy. Nitric oxide, prostaglandin 2 (PGE2), and matrix metalloproteinases 3 (MMP3) contents; viability of cells; and extracellular matrix components were quantified. Our data revealed that viability of the cells was not affected by inflammatory induction and IL1ß induction increased PGE2. Elastic moduli of cells were similar among IL1β and NC while LPS significantly decreased the elasticity compared to NC. IL1ß induction resulted in least cellular roughness while LPS induction resulted in least adhesion energy compared to NC. Our images suggest that IL1ß and LPS inflammation affect cellular morphology with cytoskeleton rearrangements and the presence of stress fibers. Finally, our results suggest that the two investigated inflammatory mediators modulated chondrocytes' immediate responses to inflammation in variable ways.

In vitro effects of nutraceutical treatment on human osteoarthritic chondrocytes of females of different age and weight groups

The in vitro effects of four nutraceuticals, catechin hydrate, gallic acid, α-tocopherol and ascorbic acid, on the ability of human osteoarthritic chondrocytes of two female obese groups to form articular cartilage (AC) tissues and to reduce inflammation were investigated. Group 1 represented thirteen females in the 50-69 years old range, an average weight of 100 kg and an average body mass index (BMI) of 34⋅06 kg/m2. Group 2 was constituted of three females in the 70-80 years old range, an average weight of 75 kg and an average BMI of 31⋅43 kg/m2. The efficacy of nutraceuticals was assessed in monolayer cultures using histological, colorimetric and mRNA gene expression analyses. AC engineered tissues of group 1 produced less total collagen and COL2A1 (38-fold), and higher COL10A1 (2⋅7-fold), MMP13 (50-fold) and NOS2 (15-fold) mRNA levels than those of group 2. In comparison, engineered tissues of group 1 had a significant decrease in NO levels from day 1 to day 21 (2⋅6-fold), as well as higher mRNA levels of FOXO1 (2-fold) and TNFAIP6 (16-fold) compared to group 2. Catechin hydrate decreased NO levels significantly in group 1 (1⋅5-fold) while increasing NO levels significantly in group 2 (3⋅8-fold). No differences from the negative control were observed in the presence of other nutraceuticals for either group. In conclusion, engineered tissues of the younger but heavier patients responded better to nutraceuticals than those from the older but leaner study participants. Finally, cells of group 2 formed better AC tissues with less inflammation and better extracellular matrix than cells of group 1.

Hodgkin Lymphoma-Associated Superior Vena Cava Syndrome: A Case Report and Review of the Literature

Patient: Male, 53-year-old

Final Diagnosis: Hodgkin lymphoma • superior vena cava syndrome

Symptoms: Dry cough • dyspnea • facial edema • fatigue

Medication: —

Clinical Procedure: —

Specialty: Hematology • Oncology

Treatment efficacy and tolerability of intravesical bacillus Calmette-Guerin (BCG)-RIVM strain: induction and maintenance protocol in high grade and recurrent low grade non-muscle invasive bladder cancer (NMIBC)

Background

BCG-RIVM strain was used in many treatment protocols for non-muscle invasive bladder cancer only as induction courses. Cho et al. (Anticancer Res 2012) compared BCG-RIVM induction and 'standard' maintenance (Lamm et al., J Urol. 2000) to mitomycin C. They found no statistically significant differences regarding disease recurrence and progression. The purpose of our study was to determine the efficacy & tolerability of this specific BCG RIVM strain, using six-weekly, induction course and single monthly instillations as maintenance for one year, in high risk recurrent, multifocal low grade and multifocal high grade pTa/pT1, CIS transitional cell carcinoma of bladder.

Methods

From 2003 - 2012, BCG-naive patients treated with intravesical BCG-RIVM for high-risk multifocal NMIBC were identified. Transurethral resection of bladder tumor (TURBT) and re-staging TURBT within six weeks, was done for accurate staging and complete elimination of disease. A six-weekly induction course, started 2-3 weeks after the last TURBT, followed by monthly maintenance protocol for one year. Recurrence, progression, cystectomy free survivals, cancer specific and over-all survival were determined.

Results

Sixty evaluable patients - median age 63, median follow-up 3.98 years. Forty-two patients (70%) completed BCG-RIVM treatment as planned. BCG termination was necessary in 18 patients (30%). Recurrence occurred in 16 patients (26.7%) at a median follow-up of 24.2 months while progression occurred in five patients (8.3%) at a median follow-up of 33 months. Recurrence-free survival and progression-free survival rates were 73% and 92% respectively. Cystectomy was performed in seven patients (12%) with a cystectomy-free survival of 88%. There were no cancer specific deaths. Two patients died of other causes (3.3%). The overall survival rate was 97%.

Conclusions

Our study is the first to show the clinical efficacy and tolerability of BCG-RIVM strain in the management of high risk NMIBC when given in a schedule of six-weekly induction with monthly maintenance for one year. Our maintenance protocol, achieved equivalent recurrence-free, progression-free, disease specific survival and overall survival to the reported literature and the more intense three-years South West Oncology Group (SWOG) protocol.

Social anxiety disorder (SAD) among outpatients attending a tertiary care psychiatric service in eastern nile delta

Thirty patients suffering from generalized social anxiety disorder (SAD) and diagnosed according to DSM-IV criteria attending the psychiatric outpatient clinic of a University hospital in Egypt 2009–2010 were assessed by the Liebowitz Social Anxiety Scale to estimate the severity of symptoms.Anxiety and depressive symptoms were also assessed by Hamilton anxiety rating Scale and Montgomery-Asberg Depression Rating Scale (MADRS).

The Global assessment of functioning was completed following the appointment. Forty-seven percent of the patients were males, and 53% were females. The mean age of the sample was 22.5 years, with a mean duration of SAD of 5.6 years. Forty percent of patients had a positive family history for SAD. Forty percent of patients presented with co-morbid depressive disorder, whereas 24% presented with anxiety disorder and 31% with other disorders. The age of patients was found to correlate positively with total LSAS score, but it correlated negatively with the total depressive score. The severity of social anxiety symptoms was significantly greater in patients with co-morbid diagnoses and in depressive disorders than in anxiety disorders. High Correlations between MADRS and LSAS scores were observed in depressive disorders.

Limitations

Small size of convenience sample undergoing varying treatments within a single specialist tertiary referral centre. Early recognition and treatment of SAD, may ameliorate the occurrence of depression. Follow up studies are needed to investigate the risk factors that may lead to depression in SAD.

Saline irrigation and wound infection in abdominal gynecologic surgery

OBJECTIVE

To evaluate whether saline wound irrigation decreases the incidence of wound infection following abdominal gynecologic surgery.

METHOD

In this prospective randomized study, 104 patients underwent wound irrigation before wound closure following abdominal gynecologic surgery and 102 patients did not.

RESULTS

There were no significant differences between the 2 groups in patient characteristics or in factors influencing the incidence of wound infection after abdominal gynecologic surgery. The incidence of wound infection was 10.6% among women who underwent wound irrigation and 9.8% among those who did not, and the difference was not statistically significant.

CONCLUSION

Saline wound irrigation before abdominal wall closure is not helpful in decreasing the incidence of wound infection after abdominal gynecologic surgery.

Appendectomy in pregnancy: the experience of a university hospital

The files of pregnant patients who underwent appendectomy at our hospital over the period 1977-96 were studied retrospectively. Forty-six patients were operated upon amongst 52 108 deliveries over this period. Of those 27 had uncomplicated acute appendicitis and six had one of the complications of acute appendicitis (a prevalence of 0.063%). Thirteen had normal appendices (71.7% accuracy). Obstetric complications occurred in four patients, with three fetal losses (6.5%). Those with complicated appendicitis had significantly delayed presentation, in-hospital delay and prolonged postoperative stay. Recently we used diagnostic laparoscopy in two patients for diagnosis and to perform appendectomy in one. In conclusion, the incidence of acute appendicitis in pregnancy seems to be the same over the period of gestation and the diagnostic accuracy seems to be related both to the late presentation by the patient and to physician delay. Maternal morbidity and fetal loss are mostly limited to those with complicated appendicitis.

Improvement in severe insulin resistance with frequent injections of lispro insulin

Extreme insulin resistance is common in obese African Americans with type 2 diabetes. This case report describes an obese African-American woman who was treated with subcutaneous injections of lispro insulin every 2 hours with resultant decrease of mean daily blood glucose from 264.7 mg/dL to 111 mg/dL and in insulin requirement from 479 U/24 hours to 60 U/24 hours. This case demonstrates that extreme insulin resistance is reversible in the short term.

Percutaneous fixation of Maisonneuve and Maisonneuve-type fractures: a minimally invasive approach

We report five cases of Maisonneuve and Maisonneuve-type fractures which were treated with a single suprasyndesmotic percutaneous diastasis screw with good radiological and functional results. This is an effective and a minimally invasive procedure which we recommend.

Neurobehavioral changes among workers in some chemical industries in Egypt

This study investigates the long-term neuropsychiatric manifestations of single or combined chemicals: manganese; zinc phosphide; lead, mercury, and TNT; and pesticides among exposed industrial workers. We found that 75% of the exposed subjects as a whole and 50% of those exposed to each of Zinc phosphide and pesticides presented with more than one neuropsychiatric symptoms or signs. The main signs were mask faces, hyporeflexia, hyperreflexia, peripheral neuropathy, static tremors, radiculopathy, muscle weakness, mental changes, fasciculations and tremors, wasting, hypotonia, abnormal deep reflexes, and sensory hyposthesia. Neurological manifestations were confirmed by electromyography and their severity was related to the duration of exposure and confirmed as well by electroencephalography. These results are discussed and their implications high-lighted.