Assessment of Waste Glass Incorporation in Asphalt Concrete for Surface Layer Construction

The growing need to preserve natural resources and minimize landfill waste has led to an increased consideration of incorporating waste materials in road construction and maintenance. This study focuses specifically on utilizing waste glass as part of the aggregates in hot asphalt, particularly in Asphalt Concrete (AC) for surface layers, known as "Glassphalt". Glass, due to its poor adhesion to bitumen, presents challenges when used in asphalt mixtures. Two types of waste glass, monolithic and tempered, were incorporated at two distinct contents, 10% and 15%, into the AC. Several properties such as stiffness, resistance to permanent deformation (evaluated through cyclic compression tests), indirect tensile strength, and the indirect tensile strength ratio (ITSR) were assessed for all Glassphalt mixtures, as well as the conventional mixture. Additionally, the Solar Reflectance Index (SRI) was measured to evaluate the reflectivity of the resulting Glassphalts. The findings indicate that the incorporation of both types of waste glass resulted in reduced stiffness and resistance to permanent deformation. Regarding water sensitivity (ITSR), the Glassphalts containing 15% waste glass, regardless of the glass type, exhibited ITSR values below the accepted threshold of 80%. The addition of waste glass did not yield significant changes in SRI measurements.

Intralesional photodynamic therapy induces apoptosis in basal cell carcinoma and Bowen's disease through caspase 3 and granzyme B

BACKGROUND

Photodynamic therapy (PDT) is used to treat cutaneous cancers. It may induce cell death through direct and indirect means, including apoptosis, inflammation and certain immune mechanisms, with the depth of penetration as a potential modifying factor.

OBJECTIVES

To examine the pathways of apoptosis in the intralesional PDT of basal cell carcinoma (BCC) and intraepidermal squamous cell carcinoma (Bowen's disease).

METHODS

Sixteen patients with superficial or nodular BCC and Bowen's disease were treated with intralesional aminolevulinic acid-PDT. Biopsies were taken at baseline and 24 h post-PDT, and sections were examined by immunohistochemistry for the expression of markers of apoptosis, such as caspase 3, involved in the intrinsic apoptotic pathway, granzyme B, a caspase-independent apoptotic mediator, and the proapoptotic markers BAX and BAK.

RESULTS

Apoptotic cells stained with TUNEL showed statistically significant staining at 24 h post PDT (p < 0.01 in both BCC and Bowen's lesions). Caspase 3 (p < 0.01 in BCC and p < 0.05 in Bowen's) and granzyme B (p < 0.01 in BCC and p < 0.01 in Bowen's) were significantly increased at 24 h post-PDT. BAX expression was apparently increased compared to baseline in Bowen's lesions at 24 h post-PDT, whereas Bak was upregulated both in BCC and Bowen's disease at baseline and at 24 h post-PDT.

CONCLUSION

Intralesional PDT induces apoptosis in BCC and Bowen's disease via common and alternative apoptotic pathways involving granzyme B. Proapoptotic factors Bak in both BCC and Bowen and Bax in Bowen's disease appear to increase by intralesional PDT at 24 h.

Self-efficacy, stress levels and daily style of living among older patients with type 2 diabetes in a rural primary care setting: a cross-sectional study

Aims

To identify to what extent stress and self-efficacy may be associated with specific features in the elderly with type 2 diabetes, such as lifestyle habits, multi-morbidity, sleep quality and duration, and treatment regimen.

Methods

A cross-sectional study of 92 out of 103 recruited patients ≥65 year old with a diagnosis of type 2 diabetes was conducted at a rural primary care unit in Northern Greece. The General Self-Efficacy Scale (GSES), the Short Anxiety Screening Test (SAST) and an original questionnaire to assess health habits and disease monitoring information were completed after structured personal interviews.

Results

In the multiple linear regression analysis, patients with higher education, with more night sleeping hours and physical exercise weekly had a higher GSES score than their counterparts (p<0.05). Stress levels assessed with SAST were shown mostly associated with poor sleep quality, fewer days of meat and legumes consumption, increased body mass index and multi-morbidity (p<0.05), as emerged from the multiple linear regression analysis. Glycemic control in the elderly does not have a significant correlation with stress levels or general self-efficacy.

Conclusions

Self-efficacy and stress levels are not predictors for glycemic control, but can indirectly be seen as co-determinants, contributing to the overall daily life quality among patients with diabetes. Mental health well-being, expressed by higher self-efficacy and less stress scale rating, showed positive interferences with eating, sleep and daily life attitudes among elderly with diabetes.

Vascular risk factors as predictors of epilepsy in older age: The Framingham Heart Study

OBJECTIVE

Stroke is the most common cause of epilepsy in older age. Subclinical cerebrovascular disease is believed to underlie some of the 30%-50% of late-onset epilepsy without a known cause (Li et al. Epilepsia. 1997;38:1216; Cleary et al. Lancet. 2004;363:1184). We studied the role of modifiable vascular risk factors in predicting subsequent epilepsy among participants ages 45 or older in the Framingham Heart Study (FHS), a longitudinal, community-based study.

METHODS

Participants of the Offspring Cohort who attended FHS exam 5 (1991-1995) were included who were at least 45-years-old at that time, had available vascular risk factor data, and epilepsy follow-up (n = 2986, mean age 58, 48% male). Adjudication of epilepsy cases included review of medical charts to exclude seizure mimics and acute symptomatic seizures. The vascular risk factors studied included hypertension, diabetes mellitus, smoking, and hyperlipidemia. The role of the Framingham Stroke Risk Profile score was also investigated. Cox proportional hazards regression models were used for the analyses.

RESULTS

Fifty-five incident epilepsy cases were identified during a mean of 19 years of follow-up. Hypertension was associated with a near 2-fold risk (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.10-3.37, p = .022) of developing epilepsy, even after adjustment for prevalent and interim stroke. In secondary analysis, excluding patients with normal blood pressure who were receiving anti-HTN (anti-hypertensive) treatment (n = 2613, 50 incident epilepsy cases) the association was (HR: 2.44, 95% CI: 1.36-4.35, p = .003).

SIGNIFICANCE

Our results offer further evidence that hypertension, a potentially modifiable and highly prevalent vascular risk factor in the general population, increases 2- to 2.5-fold the risk of developing late-onset epilepsy.

Bone Mineral Density Measurements and Association With Brain Structure and Cognitive Function: The Framingham Offspring Cohort

BACKGROUND

Bone mineral density (BMD) is a potential surrogate marker of lifetime estrogen exposure previously linked to increased risk of Alzheimer dementia among elderly women. We examine the association between BMD in the "young old" with imaging biomarkers of brain aging and cognitive performance.

METHODS

Offspring participants (N=1905, mean age 66) of a population-based cohort who had BMD, brain imaging and detailed cognitive assessment were included in the study. Sex-stratified, linear, and logistic regression models were used for analysis.

RESULTS

Higher femoral neck BMD was associated with lower white matter hyperintensity burden and better performance on Trails B-A in both sexes, even after adjustment for cerebrovascular risk factors. Among women, the positive association with Trails B-A performance was seen only in APOE4 allele carriers. Higher BMD measurements were linked to better visual reproductions test performance in men. Finally, among women, higher femoral trochanter BMD was associated with better logical memory and Hooper visual organization test performance.

CONCLUSION

Among the "young old," higher BMD is associated with less white matter hyperintensity burden and better, domain-specific, cognitive performance. This suggests that lifetime estrogen exposure may modulate the degree of cumulative vascular brain injury independent of cerebrovascular risk factors.

Red mud-molten salt composites for medium-high temperature thermal energy storage and waste heat recovery applications

Red mud (RM) is an industrial waste of the aluminum industry with presently estimated worldwide legacy-site stockpiles of 4 billion tones. RM is typically disposed in the sea, dams or dykes, posing a significant environmental hazard due to its high alkalinity and traces of heavy metals. Despite recent valorization efforts, only 15% of RM deposits are currently utilized. In this work, a novel use of RM to formulate composite phase change materials (CPCMs) is proposed. The CPCM is formulated by milling nitrate salts with RM, compressing and subsequent sintering of the two. Overall good performance over the temperature range of 25-400 ℃ is observed. Maximum latent heat of the CPCMs is 58 J/g, while average thermal conductivity and C_p are in the range of 0.77-0.83 W/mK and 1.03-1.31 J/g ℃, respectively. No variations in the melting point or latent heat are observed after 48 cycles. Energy storage density is calculated to be up to 1396 MJ/m³. The working temperature of this novel CPCM make it ideal for waste heat recovery of medium-high temperature waste heat streams providing a valorization pathway and valorization for RM as a by-product for energy-related applications.

Mental Health Issues in Transition-Age Adolescents and Young Adults With Epilepsy

Mental health disorders are prevalent in patients with epilepsy, and adolescents are at particularly high risk. The reason for higher rates of anxiety, depression and suicide in young patients with epilepsy is likely multifactorial, and therefore the approach to treatment has proven challenging. In this review, we discuss important mental health topics for adolescents and young adults with epilepsy, as well as evidence for management. In the past several years, advances have been made in the transition of epilepsy care from pediatric to adult providers, creating a promising method for epilepsy patient engagement and empowerment. Future research into the mental health outcomes from these transition programs may lead to better strategies to support young patients with epilepsy.

Reproductive and Sexual Health Concerns in Transition-Age Adolescents and Young Adults With Epilepsy

A plethora of hormonal and physical changes occur as adolescents grow into adulthood. These changes pose additional challenges for youth with epilepsy. Providers, parents, and patients must be well educated about the hormonal influences, both intrinsic and pharmaceutical, on seizures and antiepileptics (AEDs). In addition, they must be made aware of safe/effective contraception, the importance of pregnancy planning, and potential menstrual and sexual health disturbances related to epilepsy and AEDS. Reproductive and sexual health should be an integral component of transition education and planning for all youth, but is especially important for the youth with epilepsy. While many clinicians will collaborate with adolescent gynecologists or pediatricians, it is important for all child neurologists to be aware of these issues.

Bi-directional association between epilepsy and dementia: The Framingham Heart Study

OBJECTIVE

To assess the risk of incident epilepsy among participants with prevalent dementia and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS).

METHODS

We analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy, we used separate, nested, case-control designs and matched each case to 3 age-, sex- and FHS cohort-matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and APOE ε4 allele status in modifying the association between epilepsy and dementia.

RESULTS

A total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls, there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded a hazard ratio (HR) of 1.82 (95% confidence interval 1.05-3.16, p = 0.034). Among 43 participants with epilepsy and 129 epilepsy-free controls, there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded a HR of 1.99 (1.11-3.57, p = 0.021). In this group, among participants with any post-high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR 4.67 [1.82-12.01], p = 0.001) compared to controls of the same educational attainment.

CONCLUSIONS

There is a bi-directional association between epilepsy and dementia. with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.

Long-Term Behavior and Durability of Alkali-Activated Clay Mortars

The need to increase the durability of clay-based materials, due to their inherent low strength and vulnerability in contact with water, led researchers to examine different options. In this paper, clay mortars were produced using four different activating solutions. Alkali hydroxides, alkali carbonates, and alkali silicates activating solutions were used. Interest is given to long term properties while their behavior to wetting–drying and freeze–thaw cycles is recorded. In total, the results of the experiments indicated the positive effect of the potassium metasilicate on mechanical characteristics presenting, however, low performance at wetting–drying. The combination of sodium metasilicate with sodium hydroxide solution has also presented a positive effect on both mechanical and physical properties. In contrast, sodium carbonate acted better in enhancing physical properties and granting water-resistant abilities. Moreover, the performance of the specimens mixed with water–glass addition presented excellent volume stability and low mass loss in durability tests.

The Effects of Two New Amphetamine-like Derivatives on the Phagocytic Ability of the Protozoan, Tetrahymena pyriformis

Six new amphetamine-like molecules (2-[2,3-dihydro-4 H-1,4-benzoxazine-4-yl]-1-methyl-2-[l-methyl-2-phenylethylamino] ethanamines) were synthesised and their physico-chemical behaviour was studied. The log P values (index of lipophilicity) of the derivatives were calculated according to Rekker's fragmental system. One derivative representative of each series (C-5508 and C-5512) was selected, and their biological effects on the phagocytic ability of the protozoan, Tetrahymena pyriformis, were studied as a basic functional test for an amphetamine-like action. Furthermore, the action of both derivatives when administered concomitantly with haloperidol was also investigated. The data indicate that both derivatives significantly increased the phagocytic ability of the protozoan (p < 0.001), presumably via an alternative pathway to that of one of the dopamine monoaminergic pools. The administration of haloperidol significantly suppressed phagocytosis (p < 0.001). However, cultures exposed to the derivatives and to haloperidol indicated quantitatively different reactions. The lipophilic behaviours of the derivatives provide & possible explanation for such distinct effects.

Pruritic annular and vesicular eruption on trunk and extremities

We report a case of linear IgA bullous dermatosis, a rare autoimmune blistering disorder that usually presents with the abrupt onset of tense bullae. We also emphasize the importance of direct immunofluorescence for the definitive diagnosis.

Hydroxychloroquine-induced erythema multiforme

Hydroxychloroquine is a commonly used medication and rarely may result in development of erythema multiforme. This potential cutaneous side effect should be highlighted in information given to patients prior to hydroxychloroquine commencement.

Beware of anal fissures: pemphigus vulgaris of the anal canal

A case of anal pemphigus vulgaris in a 49-year-old female suffering from pemphigus vulgaris of the oral cavity is reported. The oral manifestations were in remission until she presented with episodes of anal pain and bleeding on defecation, initially mimicking anal fissures. Inspection revealed prominent painful erosions in the anal canal with external hemorrhoids and strands of sloughing skin and maceration in the anal verge. Histology and direct immunofluorescence test were consistent with pemphigus vulgaris. The disease was refractory to treatment and complete remission was only achieved with the combination of rituximab and corticosteroids. Anal involvement seems to be an uncommon or underreported manifestation of pemphigus vulgaris. Gastroenterologists should be aware of this entity, especially in areas with a high incidence of the disease, for appropriate diagnosis and management.

Willingness to pay and quality of life in patients with pruritic skin disorders

Pruritic dermatosis is a frequent and burdensome disease. The objectives of this study were (1) to assess the willingness to pay (WTP) and the health-related quality of life (HRQoL) in patients with pruritic dermatoses and (2) to compare the results with data on socio-demographic data, and clinical features/symptoms of the patients. One hundred and three patients with pruritic dermatosis had participated in a non-interventional, cross-sectional study. Socio-demographic data, clinical features/symptoms, a health-related quality of life (HRQoL)-based and a dermatology-specific instrument (SF-6D and DLQI, respectively), and two utility indicators such as rating scale (RS) and time-trade-off (TTO) as well as willingness to pay (WTP) were recorded. In our study, there was a significant correlation between DLQI scores and WTP (p < 0.001). Time-trade-off (TTO) was also statistically correlated with SF-6D (p = 0.001). Regression models showed that daily duration and pruritus intensity were associated with lower HRQoL. Furthermore, WTP was the only measure revealing demographic and socio-economic characteristics such as age, education level, family status and income as predicting factors. No significant differences between groups of varying skin diseases were observed. HRQoL and WTP proved to be valid tools to assess the burden of disease in patients with pruritic dermatosis. However, further research with a larger number of patients is needed to validate the present findings.

Scanning Mortars to Understand the Past and Plan the Future for the Maintenance of Monuments

The effect of microstructure on macroproperties of building materials was the initiation in order to use microscopic techniques for studying the materials' behavior. Primer role among the different techniques has the scanning electron microscope (SEM) as it provides much information in an easy and understandable way. SEM has been used in almost every study of the last decades, dealing with historic and repair materials to complete the analysis performed. In the case of historic mortars, it is a unique technique as it requires a small representative sample and without any intense treatment important information derived from an almost unknown sample including damage detection, phase identification, and microanalysis. It is usually a complementary method of analysis but a precious one as the gained results from the analysis of old mortars are used for designing compatible repair materials for restoration purposes. In the paper, the long-term use of SEM in studying both old authentic and innovative repair mortars is presented.

Toxicological Investigation of Drug-Related Cases in Greece: Interpretation of Analytical Findings

The process of toxicological analysis of postmortem specimens can reveal some special difficulty compared to the clinically derived specimens. Many drugs are not stable and the chemical changes that occur in the specimens, due to the hydrolysis processing, the time passed, the drug metabolism, and matrix effect, even when the postmortem interval is short, may affect the interpretation of the toxicological results. This interpretation may be critical, not only to the thorough investigation of different kind of forensic cases, but also to clinical or other cases as it provides very significant challenges to the scientists. This article reviews (a) particular toxicological issues associated with some toxic substances responsible for common lethal or nonlethal poisonings, such as opiates, cannabis, and cocaine and the vast number of factors that affect drug concentration; and (b) focuses on toxicological issues associated with the analytical findings of certain postmortem specimens. The toxic substances cited in the present paper are the most commonly found in forensic cases in Greece. The investigation of these drug-related deaths has revealed that heroin, alone or in combination with other psychoactive substances, such as cannabis and cocaine, is the main drug involved in these deaths.

An experimental bioactive dental ceramic for metal-ceramic restorations: Textural characteristics and investigation of the mechanical properties

The aim of this study was the evaluation of the textural characteristics of an experimental sol-gel derived feldspathic dental ceramic, which has already been proven bioactive and the investigation of its flexural strength through Weibull Statistical Analysis. The null hypothesis was that the flexural strength of the experimental and the commercial dental ceramic would be of the same order, resulting in a dental ceramic with apatite forming ability and adequate mechanical integrity. Although the flexural strength of the experimental ceramics was not statistically significant different compared to the commercial one, the amount of blind pores due to processing was greater. The textural characteristics of the experimental ceramic were in accordance with the standard low porosity levels reported for dental ceramics used for fixed prosthetic restorations. Feldspathic dental ceramics with typical textural characteristics and advanced mechanical properties as well as enhanced apatite forming ability can be synthesized through the sol-gel method.

Mycobacterium avium Auricular Infection in an Apparent Immunocompetent Patient: A Case Report

INTRODUCTION

Soft tissue infections with Mycobacterium avium complex are more likely to appear in immunocompromised patients. However, they may rarely arise in non-immunosuppressed individuals.

AIM

To present the case of an ear infection with Mycobacterium avium in the absence of demonstrable immunosuppression.

CASE REPORT

Clinical case description, blood tests, routine histology and tissue cultures.

DISCUSSION

A female, apparent immunocompetent patient presented with a 6-month reddish, oedematous and painless lesion with fine scaling in the right ear. Histology showed numerous granulomas, composed of epithelioid histiocytes without central necrosis. Cultures grew Mycobacterium avium. An unusual accidental ear injury was the portal of microbial entry. The patient's lesion fully regressed after a 9-month course of antibiotics.

CONCLUSION

Although M. avium infections are rare in immunocompetent patients, the possibility of such infections should be considered even in these subjects, when relevant clinical features and exposure to risk factors are present.

Bioanalytical LC-MS Method for the Quantification of Plasma Androgens and Androgen Glucuronides in Breast Cancer

The physiological and pathological development of the breast is strongly affected by the hormonal milieu consisting of steroid hormones. Mass spectrometry (MS) technologies of high sensitivity and specificity enable the quantification of androgens and consequently the characterization of the hormonal status. The aim of this study is the assessment of plasma androgens and androgen glucuronides, in the par excellence hormone-sensitive tissue of the breast, through the application of liquid chromatography-mass spectrometry (LC-MS). A simple and efficient fit-for-purpose method for the simultaneous identification and quantification of dehydroepiandrosterone sulfate (DHEAS), androstenedione (A4), androsterone glucuronide (ADTG) and androstane-3α, 17β-diol-17-glucuronide (3α-diol-17G) in human plasma was developed and validated. The presented method permits omission of derivatization, requires a single solid-phase extraction procedure and the chromatographic separation can be achieved on a single C18 analytical column, for all four analytes. The validated method was successfully applied for the analysis of 191 human plasma samples from postmenopausal women with benign breast disease (BBD), lobular neoplasia (LN), ductal carcinoma in situ and invasive ductal carcinoma (IDC). DHEAS plasma levels exhibited significant differences between LN, IDC and BBD patients (P < 0.05). Additionally, ADTG levels were significantly higher in patients with LN compared with those with BBD (P < 0.05).

Recycled sand in lime-based mortars

The increasing awareness of the society about safe guarding heritage buildings and at the same time protecting the environment promotes strategies of combining principles of restoration with environmentally friendly materials and techniques. Along these lines, an experimental program was carried out in order to investigate the possibility of producing repair, lime-based mortars used in historic buildings incorporating secondary materials. The alternative material tested was recycled fine aggregates originating from mixed construction and demolition waste. Extensive tests on the raw materials have been performed and mortar mixtures were produced using different binding systems with natural, standard and recycled sand in order to compare their mechanical, physical and microstructure properties. The study reveals the improved behavior of lime mortars, even at early ages, due to the reaction of lime with the Al and Si constituents of the fine recycled sand. The role of the recycled sand was more beneficial in lime mortars rather than the lime-pozzolan or lime-pozzolan-cement mortars as a decrease in their performance was recorded in the latter cases due to the mortars' structure.

Neuroimaging the epileptogenic process

Epilepsy is one of the most common chronic neurological conditions worldwide. Anti-epileptic drugs (AEDs) can suppress seizures, but do not affect the underlying epileptic state, and many epilepsy patients are unable to attain seizure control with AEDs. To cure or prevent epilepsy, disease-modifying interventions that inhibit or reverse the disease process of epileptogenesis must be developed. A major limitation in the development and implementation of such an intervention is the current poor understanding, and the lack of reliable biomarkers, of the epileptogenic process. Neuroimaging represents a non-invasive medical and research tool with the ability to identify early pathophysiological changes involved in epileptogenesis, monitor disease progression, and assess the effectiveness of possible therapies. Here we will provide an overview of studies conducted in animal models and in patients with epilepsy that have utilized various neuroimaging modalities to investigate epileptogenesis.

Immunotoxicity of cocaine and crack

The toxicity of cocaine and crack was studied on the protozoan Tetrahymena pyriformis, using several endpoints, such as the DNA content of the macronuclei and the phagocytic ability. Both forms induced an increase in the DNA content of the protozoan, which indicates the stimulation of the mitotic process. In contrast, the phagocytic activity, of the protozoan was decreased after the administration of cocaine, an effect that was more extensive after the administration of crack. These results, derived from previous experiments, suggest a possible relationship between the observed immunosuppression in cocaine abusers and the immunosuppression found in the protozoan. This suppression subsequently may play a role in the development of other opportunistic infections in drug abusers. This paper, based on in vivo experiments with the protozoan Tetrahymena, suggests the compromised immune response in cocaine addicts and assures the reported effects of cocaine on immune cell function.

Pure motor upper limb weakness and infarction in the precentral gyrus: mechanisms of stroke

BACKGROUND

Pure arm monoparesis is an uncommon presentation of stroke. Localization of the lesions is variable, including cortical, subcortical or deep brain infarcts. No particular risk factors or unifying mechanisms have been clearly identified.

METHODS

Seven patients (5 women, 2 men) presented with isolated arm weakness and brain magnetic resonance imaging (MRI) documented an infarct in the precentral gyrus. All were evaluated for stroke risk factors, had telemetry monitoring, transthoracic echocardiogram (TTE) and magnetic resonance angiography (MRA) of the head and neck. Transesophageal echocardiogram (TEE) was performed in three cases. Hyper-coagulable work-up was performed in one case. Trans-cranial Doppler was performed in one case.

RESULTS

Mean age was 73 years (range 55-88 years). Arm weakness in all patients was ranging from mild (-5/5) to moderate (2/5) and was predominantly distal (without plegia). None of the patients complained of limb pain or sensory deficit. Infarcts affected one gyrus (5/7) or, less often, 2 adjacent gyri (2/7), along the most distal aspect of the middle cerebral artery (MCA) territory. Risk factors included hypertension (6/7), diabetes (2/7), hyper-lipidemia (7/7), smoking (1/7) and prior TIA/stroke (3/7). The mechanisms of ischemic stroke were determined to be large artery atherosclerosis (2/5), cardioembolic (2/5), other determined etiology [hypoperfusion (1/5)] and undetermined etiology (2/5).

CONCLUSIONS

Our series of patients with small cortical infarcts and pure motor arm weakness show heterogeneous etiologies of stroke mechanisms and related long term outcomes. The risk factors appear to distribute as in most stroke populations, without a pattern specific to this unusual clinical presentation.

Biomarkers of opiate use

The interpretation of toxicological findings is critical for the thorough investigation of the use and abuse of psychoactive substances. A positive analytical result for a sample taken could usually result in criminal proceedings and a punitive outcome for the defendant whose sample was analysed. The detection of markers of illicit opiate misuse is important both in the management of substance misuse and in the postmortem identification of illicit opiate use. The aim of this study was to emphasise the role of opiate biomarkers available at the laboratory and in the clinical environment. Urine remains the biological tool of choice for qualitative detection of illicit drug use in a clinical setting, while quantitative accuracy remains strictly the domain of blood. Accurate interpretation of the screening tests within a clinical setting alongside other relevant information remains the key to the usefulness of any test. Moreover, the finding of a morphine/codeine concentration ratio in blood exceeding unity is a strong evidence that the person had used heroin, as opposed to having taken a prescription analgesic drug containing codeine.

Fundamental issues in forensic semen detection

Sperm detection can be an important factor in confirming sexual assault in cases of rape. A large number of cases received in a forensic laboratory involve sexual offenses, making it necessary to examine exhibits for the presence of seminal stains. The objective of this paper is to provide an overview of the most important methods and tests used in the identification of spermatozoa or constituents of seminal fluid during the investigation of alleged sexual assault cases in forensic medical practice. Furthermore, this paper focusses on the basic knowledge that is necessary to the graduate students who wish to specialize in forensic sciences.

Primary cutaneous nocardiosis in 2 patients on immunosuppressants

Two female cases of primary cutaneous nocardiosis due to Nocardia brasiliensis are described. The first was associated with polymyositis and the second with chronic immune thrombocytopenic purpura. Both patients had received corticosteroids. In both cases the responsible actinomycetes were sensitive to trimethoprim/sulfamethoxazole. This drug was administered to both patients with excellent results. Treatment was continued for 3 months to prevent recurrence, a common consequence of short-term therapy. N. brasiliensis should be included in the differential diagnosis of any case of nodular lymphangitis, especially in immunocompromized patients.

Clinical and radiological features of brainstem variant of hypertensive encephalopathy

BACKGROUND

The "posterior reversible leukoencephalopathy" syndrome, generally observed in the setting of severe, acute hypertension, often correlates with radiological abnormalities that involve the occipital lobes and other hemispheric areas. A predominant involvement of the brainstem in this syndrome is rare.

PATIENTS

We report three patients with previously known or newly diagnosed severe hypertension, who presented with a combination of headache and visual disturbances, along with diffuse abnormalities demonstrated on magnetic resonance imaging in the brainstem and cerebellum. The absence of clinical features of brainstem or cerebellar dysfunction contrasted with the severity of the radiological abnormalities.

CONCLUSIONS

We discuss the pathophysiological, clinical, and radiographic features of this variant of posterior reversible leukoencephalopathy.

DNA content of Tetrahymena pyriformis as a biomarker for different toxic agents

The toxicity of different substances was studied on the protozoan Tetrahymena pyriformis, using as an endpoint the DNA content of the macronucleus. Substances from various chemical classes were administered to the Tetrahymena cultures and then the DNA content of the protozoan macronuclei was measured by means of Image Analysis System. The increase in the DNA content of the nuclei is indicative of the stimulation of the mitotic process. Since mitogenic stimuli can substantially alter susceptibility to chemical carcinogenesis, the results of such experiments, which are cheap and easy to run, may contribute to the investigation of the toxic action of several substances on cellular level.