Peripheral blood and bone marrow abnormalities in patients with HIV related disease

Between February 1983 and April 1986 we studied peripheral blood and bone marrow samples from 20 patients with human immunodeficiency virus (HIV) related disease. 14 patients had AIDS, three had ARC, two had PGL and one had ITP as a sole manifestation of HIV related disease. Peripheral blood abnormalities included marked anisocytosis and poikilocytosis, rouleaux formation, neutropenia, lymphopenia, monocytopenia, a left shift in the granulocyte series and, in the patients with AIDS, vacuolated monocytes. The most frequent bone marrow abnormalities were reticuloendothelial iron block, dyserythropoiesis, megaloblastic change and erythroid hypoplasia. Excess histiocytes were noted in four marrows, one exhibiting haemophagocytosis. None of the bone marrows showed lymphopenia. Eight of the 20 marrows were difficult or impossible to aspirate. None of the trephine biopsies showed increased reticulin. The causes of these abnormalities are probably multiple and include opportunistic infections, drug therapy, immune mechanisms and possibly direct insult by the HIV virus.

A randomized study of VAD therapy with either concurrent or maintenance interferon in patients with newly diagnosed multiple myeloma

This randomized study was designed to determine whether response to VAD chemotherapy could be prolonged by using rh alpha-2b-interferon (IFN) at a dose of 3 mU three times per week, either concurrently with VAD (VIC) or as maintenance after completion of VAD (VIF). Maintenance IFN was given for 9 months in order for the duration of IFN therapy to be similar in both groups. 72 patients were randomized between December 1988 and August 1993. The majority of patients had poor prognostic features. The objective response rate was similar in each arm, 78% in VIF and 77% in VIC. Of the 56 responders, 33 have relapsed, three died in remission, and 18 proceeded to high-dose therapy, withdrew for other reasons or were lost to follow-up and were censored from analysis at the relevant time point. Only two patients remain in remission (both in partial remission). Median PFS was 15 months for both VIF and VIC, compared with 16.5 months for a historic control group treated with VAD alone (n.s.). The estimated median survival in VIF was 43 months and in VIC 22 months, compared with 45 months in the historic controls (n.s.). These findings indicate that neither maintenance nor concurrent IFN prolongs response to VAD.

Treatment of immune thrombocytopenic purpura in homosexual men

Over the past 3 yr we have treated 6 homosexual men (age 22-55 yr) with immune thrombocytopenic purpura. 4 of the 6 have antibody to HTLV-III in their serum, 1 of these patients has the acquired immune deficiency syndrome (AIDS), 1 has AIDS-related-complex (ARC), and a 3rd has persistent generalised lymphadenopathy (PGL). The platelet count at presentation was between 2 and 35 X 10(9)/l and in each case a bone marrow confirmed active platelet production. Antiplatelet antibodies were demonstrated in 3 of 4 patients tested. 3 of the 6 patients showed a partial response to prednisolone, 2 showed little or no response and the 6th showed a good response. 2 patients received high dose i.v. immunoglobulin - 1 had an excellent response prior to splenectomy, the other showed no response. 5 of the 6 patients had a splenectomy. 3 had a lasting remission (12-27 months after splenectomy), 1 of these has HTLV-III antibodies; 1 had a remission lasting 1 yr, followed by fluctuating thrombocytopenia (21-130 X 10(9)/l) and 1 showed no response.

Mutation of the von Hippel-Lindau gene alters human cardiopulmonary physiology

Intracellular responses to hypoxia are coordinated by the von Hippel-Lindau--hypoxia-inducible factor (VHL-HIF) transcriptional system. This study investigated the potential role of the VHL-HIF pathway in human systems-level physiology. Patients diagnosed with Chuvash polycythaemia, a rare disorder in which VHL signalling is specifically impaired, were studied during acute hypoxia and hypercapnia. Subjects breathed through a mouthpiece and ventilation was measured while pulmonary vascular tone was assessed echocardiographically. The patients were found to have elevated basal ventilation and pulmonary vascular tone, and ventilatory, pulmonary vasoconstrictive and heart rate responses to acute hypoxia were greatly increased, as were heart rate responses to hypercapnia. The patients also had abnormal pulmonary function on spirometry. This study's findings demonstrate that the VHL-HIF signalling pathway, which is so central to intracellular oxygen sensing, also regulates the organ systems upon which cellular oxygen delivery ultimately depends.

Cognitive behavioural therapy for chronic pain in people with an intellectual disability: a case series using components of the Feeling Better programme

BACKGROUND

Cognitive behavioural therapy (CBT) has been shown to be effective in assisting people to cope with chronic pain. However, this approach has not been systematically evaluated with people with an intellectual disability (ID). This pilot study sought to examine the feasibility and clinical utility of CBT for people with an ID, using elements of a manualised CBT pain management programme called Feeling Better.

METHOD

Five people with chronic pain who were functioning within the mild range of ID received a modified, individual eight-session cognitive behavioural intervention aimed at development of pain management skills. The participants' scores on a range of measures (pain management knowledge, pain self-efficacy, use of pain coping strategies and effectiveness of coping strategies) were compared pre-intervention, post-intervention and at 1-month follow-up.

RESULTS

The results indicated that participant scores on pain management knowledge, wellness-focused coping and effectiveness of coping increased following the intervention. However, these gains were generally not maintained at follow-up.

CONCLUSION

We concluded that CBT has potential utility for pain management in people with an ID, but that it requires a trial of a more intensive and prolonged intervention with the systematic involvement of care givers.

Alcohol consumption among 11-16 year olds: 'getting around' structural barriers?

This paper presents qualitative data from Irish children and adolescents on their experiences in relation to alcohol consumption. A sample of 78 participants (average age 11.5 years) was selected. A proportion of this initial sample were interviewed at intervals over a period of 3 years. The participants' consumption patterns were analyzed and four categories were generated: covert unsanctioned, overt unsanctioned, overt sanctioned, and peer unsanctioned. As the children got older, peer drinking became a stronger feature of the data; however, it mediated other patterns of behavior. Although the children displayed agency in circumventing adult rules relating to alcohol consumption, the participants were subjected to structural constraints by virtue of their status as children. Moreover, the agentic powers of the participants were procured through their social network rather than arising from an essentialist agency possessed by each individual child. The impact of childhood as a structural dimension weakened to some extent as the participants got older and had more freedom to circumvent adult-defined barriers to alcohol consumption.

A method for the prescription of inexpensive spectacles by non-specialist healthcare workers: S-Glasses

PURPOSE

Globally, 153 million people are visually impaired from uncorrected refractive error. The aim of this research was to verify a method whereby autorefractors could be used by non-specialist health-workers to prescribe spectacles, which used a small stock of preformed lenses that fit frames with standardised apertures. These spectacles were named S-Glasses (Smart Glasses).

PATIENTS AND METHODS

This prospective, single-cohort exploratory study enrolled 53 patients with 94 eligible eyes having uncorrected vision of 6/18 or worse. Eyes with best-corrected vision worse than 6/12 were excluded. An autorefractor was used to obtain refractions, which were adjusted so that eyes with astigmatism less than 2.00 dioptres (D) received spherical equivalent lenses, and eyes with more astigmatism received toric lenses with a 2.50 D cylindrical element set at one of four meridians. The primary outcome was to compare S-Glasses vision with the WHO definition of visual impairment (6/18). Where astigmatism was 2.00 D or greater, comparison with spherical equivalent was made. Mixed-model analysis with repeated effect was used to account for possible correlation between the vision of fellow eyes of the same individual.

RESULTS

S-Glasses corrected 100% of eyes with astigmatism less than 3.00 D and 69% of eyes with astigmatism of 3.00 D or greater. Spherical equivalent lenses corrected 25% of eyes with astigmatism of 2.00-2.99 D and 11% with astigmatism of at least 3.00 D.

DISCUSSION

S-Glasses could be beneficial to resource-poor populations without trained refractionists. This novel approach, using approximate toric lenses, results in superior vision for astigmatic patients compared with the practice of providing spherical equivalent alone.

Characterisation of tissue-specific trans-acting factor binding to a proximal element in the rat growth hormone gene promoter

Using an exonuclease III protection assay, tissue-specific binding of rat pituitary tumour cell (GH3 cell) nuclear factors to a proximal region (-68 to -138) of the rat growth hormone gene promoter has been detected. The binding is particularly strong between the borders -68 to -102. The binding is eliminated in the presence of excess unlabelled rat growth hormone gene promoter sequences but also by proximal (-423 to +38) or distal (-1960 to -1260) rat prolactin gene promoter sequences and simian virus 40 enhancer/promoter sequences. Extracts of rat pituitaries showed identical binding characteristics. Methylation interference analysis indicated that the contact points between the pituitary-specific factor and the proximal rat growth hormone gene promoter-binding element (-65 to -95) are over a conserved sequence which occurs twice in the rat growth hormone gene promoter and at least eight times in the rat prolactin gene 5'-flanking sequences. This sequence has previously been proposed to constitute the binding site for the somatotroph/lactotroph tissue-specific transcription factor. Gel-retardation and exonuclease III competition analysis showed that three of the rat prolactin gene promoter elements (-46 to -71, -156 to -180 and -174 to -204) share the ability to bind the pituitary-specific factor. The binding to the most proximal rat prolactin gene promoter element (-46 to -71) was clearly more avid than to the rat growth hormone gene promoter (-65 to -95) proximal element. However, both these elements displayed the formation of two gel-retarded complexes while the more distal rat prolactin gene binding elements (-156 to -180 and -174 to -204) formed only the smaller of the two complexes. Finally, we demonstrated by co-transfection competition analysis that plasmids containing the most proximal rat prolactin gene promoter binding element completely inhibited transcription from the rat growth hormone gene promoter while rat growth hormone gene promoter sequences only partially inhibited transcription from the rat prolactin gene promoter. This suggests that the higher affinity for factor binding displayed by the proximal rat prolactin gene promoter binding site in vitro is reflected in factor binding activity in vivo.

Chemically modified and unmodified anti-D (Rho) reagents in the micro Du procedure

The ability of anti-D (Rho) reagents containing chemically modified and unmodified IgG molecules to detect fetal-maternal hemorrhages was compared using mixtures of Rh negative adult red blood cells and Rh positive cord red blood cells. No significant differences among reagents were observed in this small study. These results do confirm the reported lack of sensitivity of the micro Du method as a fetal red blood cell screening test.

Vitreoretinal large B- cell lymphoma (VR- LBCL): Clinical and pathological features and treatment outcomes

CONTEXT

Vitreoretinal large B- cell lymphoma (VR- LBCL) is a type of non- Hodgkin lymphoma confined to the eye and central nervous system (CNS). The clinical manifestations of intraocular lymphoma can precede, occur simultaneously with, or follow disease at CNS sites. It differs from other forms of extra-nodal lymphoma; in that it does not involve systemic sites other than CNS.

OBJECTIVES

To analyse the clinical and pathological features, and treatment outcomes of a cohort of patients diagnosed with vitreoretinal lymphoma (VRL) in Royal Victoria Eye and Ear Hospital, Ireland between 2010 and 2024.

METHOD

Retrospective review of medical records and pathology specimens of patients with ocular involvement in VR- LBCL over 14-year period and a review of the literature.

RESULTS

Eight patients were included. All of them underwent pars plana vitrectomy and were confirmed to have VR- LBCL. The median age at diagnosis was 71 years. Three were men and five were women. Six had bilateral disease and two unilateral. Four of four patients had MYD88 L265P mutation present. Four patients showed a high interleukin-10 (IL-10) to interleukins-6 (IL-6) ratio in keeping with the diagnosis of VRL. Three patients had primary CNS lymphoma with subsequent eye involvement, despite systemic chemotherapy treatment. Of the five patients who presented with ocular lymphoma, two patients had CNS involvement after primary vitreoretinal lymphoma was diagnosed. Of those, one was initially treated with local intravitreal chemotherapy. Three patients had no CNS recurrence. At the time of this study, seven patients of eight are alive, four are disease free and two are on a first- line local chemotherapy treatment. One underwent treatment for CNS relapse. One patient died of the disease before commencing targeted therapy.

CONCLUSION

This case series demonstrated excellent treatment outcomes for seven patients, alive at the time of the study. Both local radiotherapy and intravitreal chemotherapy achieved good ocular control with acceptable side effects and no significant difference in visual outcome. VRL is a difficult diagnosis and vitreous cytology should be prioritised in cases of vitritis unresponsive to treatment. Analysis of MYD88 L265P mutation and IL- 10: IL- 6 ratio >1 are useful adjuncts in the diagnosis of VR- LBCL, particularly in cases where limited vitreous material makes cytological evaluation challenging.

Emergency Presentations of Coronavirus Disease (COVID-19): A Review of the Literature and Radiologic Perspective

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the debilitating global pandemic known as Coronavirus disease (COVID-19). In this paper, we highlight the widespread manifestations and complications across disease systems. In addition, we present their relevant imaging findings to inform appropriate investigations and management in patients presenting to the Emergency Department with COVID-19 and its respective sequalae. Of note, we outline considerations for diagnosis of long COVID, an important medium to long term sequalae in patients with previous COVID-19 infections.