Novel features of degenerative retinoschisis identified using ultra-widefield multicolor channels: A review of 139 eyes

BACKGROUND/OBJECTIVE

To utilize ultra-widefield multimodal imaging (Optos PLC) to describe novel findings in degenerative retinoschisis.

METHODS

This retrospective, non-comparative case series of degenerative retinoschisis received a waiver of consent from Advarra IRB, Protocol 00066379. Initial ultra-widefield pseudocolour, colour-separated, autofluorescence, and peripheral OCT imaging were analysed for characterizing features.

RESULTS

In total, 139 eyes were included. A hyporeflective reticular pattern associated with retinoschisis was seen on pseudocolour images in 39% of cases, but visible in 53% on green-separated images. Fine hyper-reflective foci were observed in 49%. In 27%, retinoschisis was confirmed with OCT.

CONCLUSIONS

Ultra-widefield pseudocolour and green-separated images are valuable for the diagnosis and characterization of degenerative retinoschisis. The findings described may prompt the evaluation of subtle retinoschisis with peripheral OCT.

Characteristics and outcomes of women initiating ART during pregnancy versus breastfeeding in Option B+ in Malawi

BACKGROUND

Malawi adopted the PMTCT strategy 'Option B+' in 2011, providing life-long ART for all HIV-infected pregnant and breastfeeding women. We explored differences in characteristics and outcomes of women initiating ART during pregnancy versus breastfeeding.

METHODS

We conducted a retrospective cohort analysis of women in Zomba District, southern Malawi, from January 2012- September 2013. Data were extracted from the Zomba District Observational Cohort Study, a surveillance project collecting data from standardized Ministry of Health ART monitoring tools.

RESULTS

1986 (67.2 %) women initiated ART during pregnancy and 969 (32.8 %) during breastfeeding. Women initiating ART in breastfeeding were more likely to be > 30 years (aOR = 1.33, 95 % CI1.11-1.59, p = 0.003) and have WHO Stage 3/4 (aOR = 2.74, 95 % CI1.94-3.87, p < 0.001). Eighteen (0.6 %) deaths occurred and 942 (31.9 %) women defaulted ART. 'Early' death (< 30 days) occurred in 3 (0.1 %) women and 449 (16.4 %) women defaulted early. Death/default < 30 days was more likely among women initiating ART during pregnancy (aOR 1.62, 95 % CI1.28-2.05, p < 0.001) or < 30 years old (aOR 1.27, 95 % CI 1.02-1.57, p = 0.03) and was less likely among those with WHO Stage 3/4 (aOR 0.30, 95 % CI 0.15-0.60, p < 0.001). Using Kaplan-Meier estimators to investigate time to death/default, we showed a sharp drop in death/default-free survival probability at time zero, yet survival probability decreased in a nearly linear manner after this initial period of high default. Women under 30 years had increased rates of death/default over time (log rank test: p < 0.001), however no significant differences were observed in death/default over time associated with timing of ART initiation, documented clinical stage at initiation, health clinic size or adherence rates.

CONCLUSIONS

Many women in Malawi started ART during breastfeeding within Option B+ and were older and had more advanced WHO Clinical Staging. This represents a missed PMTCT opportunity to initiate treatment early in pregnancy. Early defaulting is identified as a challenge within Option B+, and was more likely among younger women and those initiating ART in pregnancy. Targeted research to understand factors associated with uptake of ART during pregnancy and retention in care could improve the efficacy of Option B+ in Malawi.

Histopathological and immunohistochemical diagnosis of infectious bursal disease in poultry birds

Aim:

The aim of the present study was to diagnose infectious bursal disease (IBD) using gross, histopathological, and immunopathological approaches and to compare efficacy of immunohistochemical techniques with conventional diagnostic techniques.

Materials and Methods:

A total of 33 samples were collected from the six different poultry farms from Ludhiana and the nearby districts. Upon gross analysis of the necropsied birds, the relevant tissue samples such as bursa, kidney, junction of proventriculus and gizzard, heart, and muscles were then processed for histopathological and immunohistochemical studies.

Results:

Varied macroscopic changes were noted in bursa, characterized as swollen, hemorrhages to atrophy in size. Nonetheless, hemorrhages over thigh muscles were rarely seen. Histologically, the bursa showed prominent fibrotic and atrophic changes. Rarefaction of bursal follicles with intermittent infiltration of lympho-mononuclear cells with chronic cystic changes was additional changes, considered to be paramount for IBD. Expression and localization of IBD specific viral antigens were noticed mainly intracellular to the rarefied areas of bursal follicle section(s), in conjunction to inner lining of the cystic cavities of affected follicles. In addition, the junction of proventriculus and gizzard, the heart muscle, respiratory ciliated epithelium, and proventriculus also revealed positive expression to IBD virus (IBDV) antigen. Advanced immunopathological techniques, i.e., immunofluorescence further testified the evidence of antigen as positive green signal within affected follicles. Further consideration to the reliability of various techniques employed, positive correlation (r=0.64623) was emerged out with conventional pathological scoring.

Conclusion:

It is concluded that the bursa acts as an organ of choice for demonstrating IBDV antigen for specific diagnosis of disease using immunohistochemistry (IHC), and IHC staining is a precise, specific, rapid, and reliable method to demonstrate the IBDV antigen in the altered tissues due to IBDV infection.

Updating a patient-level ART database covering remote health facilities in Zomba district, Malawi: lessons learned

SETTING

A non-governmental organization, Dignitas International, working in partnership with the Ministry of Health in Malawi, adopted innovative, low-technology methods to collect, capture, and manage patient-level antiretroviral therapy (ART) data in a district database covering 26 remote low-resource facilities in Zomba District, Malawi.

OBJECTIVE

To establish a longitudinal, observational database of routinely collected program data that could serve as a program monitoring and evaluation tool as well as a platform to conduct effective operational research.

DESIGN

This article describes the processes developed for digital capture of paper-based ART clinical records at health facilities and updating them in a central electronic database. It documents and focuses on lessons learned during the implementation and review of processes.

CONCLUSIONS

Data quality can only be ensured with regular review of, and compliance with, clearly delineated workflow protocols and adequate staffing and supervision. Through the implementation of this procedure, we expect to improve data quality, completeness, and use of routine ART clinical data in low-resource settings.

Reasons for accepting or refusing HIV services among tuberculosis patients at a TB-HIV integration clinic in Malawi

SETTING

In Malawi, human immunodeficiency virus (HIV) prevalence among newly registered tuberculosis (TB) patients is 60-70%. In 2008, an integrated TBHIV clinic was established at a central hospital in Zomba. Despite the integration of TB-HIV activities and improved HIV service uptake, unacceptably high proportions of HIV-positive TB patients are still not receiving antiretroviral therapy (ART).

OBJECTIVE

To identify factors that motivate or discourage TB patients from accepting HIV services.

DESIGN

Retrospective analysis of patients registered for TB treatment (not yet on ART) between April 2008 and March 2009; qualitative interviews of 99 patients on TB treatment.

RESULTS

Of 1773 newly registered TB patients who were not already on ART at the time of TB registration, 86% accepted HIV testing and counselling. Among HIV-positive TB patients, 38% started ART during or after anti-tuberculosis treatment. Young adults aged 15- 24 years were least likely to initiate ART. Motivation for accepting ART during TB treatment included prospects of regaining good health and longer life, and counselling by health care providers. Barriers to ART uptake included not being offered ART, high CD4 count, drug stockouts and fear of drug toxicities/interactions.

CONCLUSION

Several factors that undermine uptake of ART have been highlighted; targeted measures urgently need to be addressed by TB-HIV programmes to overcome these barriers.

Clinicopathological Studies on Vitamin D(3) Toxicity and Therapeutic Evaluation of Aloe vera in Rats

A study was conducted to examine the clinical signs, hematological, biochemical and histopathological changes in vitamin D₃ toxicity at a dose rate 2 mg/kg b.wt. of vitamin D₃ and to assess the protective effect of Aloe vera in vitamin D₃ toxicity. The clinical signs observed were anorexia, progressive weight loss, difficulty in movement and respiration, diarrhea, epistaxis, subnormal body temperature and nervous signs before death. Mortality was observed in treated rats between day 10 and day 19 of treatment. The gross postmortem changes observed were severe emaciation, white chalky deposits on epicardial surface of heart, pin point white deposits on cortical surface of kidneys with pale yellow discoloration and diffused white deposits on serosal surface of stomach and intestine with bloody ingesta in lumen. The hematological changes included non-significant increase in hemoglobin and total leukocyte count and significant increase in relative neutrophil count. The biochemical changes observed were significant increase in plasma concentration of calcium, phosphorus and blood urea nitrogen, whereas a significant decrease in the concentration of albumin and total plasma protein was observed. The histopathological lesions included calcification of various organs, viz., tongue, stomach, intestines, kidney, heart, aorta, larynx, trachea, lungs, spleen, choroid plexus arteries of brain and vas deferens. The Aloe vera juice (2.5% in drinking water) has no protective effect on vitamin D₃ toxicity (2 mg/kg b.wt.).

Chlorpyrifos chronic toxicity in broilers and effect of vitamin C

An experiment was conducted to study chlorpyrifos chronic toxicity in broilers and the protective effect of vitamin C. Oral administration of 0.8 mg/kg body weight (bw) (1/50 LD50) chlorpyrifos (Radar�), produced mild diarrhea and gross lesions comprised of paleness, flaccid consistency and slightly enlargement of liver. Histopathologically, chlorpyrifos produced degenerative changes in various organs. Oral administration of 100 mg/kg bw vitamin C partially ameliorated the degenerative changes in kidney and heart. There was insignificant alteration in biochemical and haematological profiles. It is concluded that supplementation of vitamin C reduced the severity of lesions induced by chronic chlorpyrifos toxicity in broilers.

Chlorpyrifos chronic toxicity in broilers and effect of vitamin C

An experiment was conducted to study chlorpyrifos chronic toxicity in broilers and the protective effect of vitamin C. Oral administration of 0.8 mg/kg body weight (bw) (1/50 LD50) chlorpyrifos (Radar(®)), produced mild diarrhea and gross lesions comprised of paleness, flaccid consistency and slightly enlargement of liver. Histopathologically, chlorpyrifos produced degenerative changes in various organs. Oral administration of 100 mg/kg bw vitamin C partially ameliorated the degenerative changes in kidney and heart. There was insignificant alteration in biochemical and haematological profiles. It is concluded that supplementation of vitamin C reduced the severity of lesions induced by chronic chlorpyrifos toxicity in broilers.

Female genital tuberculosis: early diagnosis by laparoscopy and endometrial polymerase chain reaction

OBJECTIVE

To evaluate the efficacy of laparoscopic visual inspection vs. endometrial tuberculosis (TB) polymerase chain reaction (PCR) for an early diagnosis and management of female genital TB (GTB) in India.

DESIGN

Observational case study.

RESULTS

Both laparoscopy and endometrial (endo) TB-PCR were performed on 162 infertile women: 52 endo TB-PCR-positive patients were diagnosed as definite GTB, of whom 44 (84.6%) also showed laparoscopic findings suspicious of TB (Type I). Subgroup analysis showed a similar PCR positivity of 54.5% (24/44) in the strongly suspicious and 54.1% (20/37) in the mildly suspicious patients. Using the Bayesian approach, the maximum likelihood estimates of the sensitivity and specificity of laparoscopy in diagnosing GTB were 0.96 and 0.93 and those of a positive PCR were respectively 0.59 and 0.92. Of the 52 women who were TB-PCR positive, 16 (30.8%) conceived following treatment.

CONCLUSIONS

Endo TB-PCR had high specificity to diagnose GTB, as did laparoscopy. Laparoscopy may therefore be avoided in TB-PCR-positive patients for diagnosis but may still be required to rule out GTB in PCR-negative cases.

Neuropathological studies of chickens following exposure to chlorpyrifos

The objective of this study was to determine the putative neuropathological effects in young chickens after administration of a single dose of 55 mg/kg bw chlorpyrifos. The gross lesions of the nervous system comprised of congestions in the brain. Microscopic examination of brain showed mild congestion of cerebral blood vessels and mild perivascular cuffing of lymphomononuclear cells in the cerebral cortex and necrosis of the neurons. The interesting findings were the presence of cytoplasmic vacuolations of cerebral neurons and swelling of the endothelial cell of the cerebral capillaries. Cerebellum showed congestion and hemorrhages in the granular layer and necrosis of Purkinje cell. Sciatic nerve exhibited mild edema, swelling and degeneration of axons, and swelling of Schwann cells. There was a significant inhibition of plasma cholinesterase enzyme activity in chickens administered with chlorpyrifos compared to chickens of control group. The study revealed that administration of chlorpyrifos produces neuropathological lesions in chickens shortly after exposure.

A protective effect of vitamin E and selenium in ameliorating the immunotoxicity of malathion in chicks

A study was conducted to determine whether a combination of vitamin E and selenium was able to counteract the immunosuppressive effects of chronic toxicity of malathion in chicks. The chicks were divided into three groups. The first group received malathion 10 mg/kg body weight; the second group received the same dose of malathion but was supplemented with vitamin E and selenium for 60 days; and the third group served as the control. The concentration of total immunoglobulins and circulatory immune complexes decreased following the administration of malathion, whereas the supplementation of the diet with vitamin E and selenium partially counteracted this effect. The histopathological changes in the bursa of Fabricius due to malathion were consistent with these findings. Supplementation with vitamin E and selenium partially ameliorated the degenerative changes in the bursa of Fabricius.

Effects of dietary supplements of selenium, vitamin E or combinations of the two on antibody responses of broilers

1. The effects of selenium and vitamin E supplementation on some immune parameters were investigated in broilers. 2. Broiler chicks were fed on maize-soybean diets with different concentrations of vitamin E (0-200 mg/kg) and selenium (0-0.2 mg/kg diet) either alone or in combinations from 1 to 42 d of age. 3. Chicks were immunised against Newcastle disease virus (NDV) vaccine at 21 d of age and haemagglutination inhibition (HI) titres were determined after 10 d. 4. Chicks receiving supplements of 200 mg vitamin E/kg and 0.2 mg selenium/kg produced significantly higher HI antibody titres. This was associated with an increased serum concentration of total immunoglobulins and circulatory immune complexes. 5. The chicks given 200 mg vitamin E/kg and 0.2 mg selenium/kg had significantly heavier spleen and bursa. 6. These results suggested that vitamin E and selenium have synergistic effects on immune responses.

Sequential clinical, haematological, biochemical, immunopathological and histopathological alterations in buffalo calves (Bubalus bubalis) intravenously infected with Absidia corymbifera

Absidiosis was produced experimentally in 18 buffalo calves by intravenous inoculation of spores of Absidia corymbifera. Infected animals exhibited dullness, depression, partial anorexia and an initial pyrexia and coughing during the first week and two animals died on each of 9, 13 and 16 days post infection (DPI). The haemoglobin concentration and total erythrocyte count showed no appreciable change from their basal values at any stage of the experiment. However, the erythrocyte sedimentation rate and total leukocyte count increased significantly in the infected animals. The differential leukocyte count revealed a relative neutrophilia from 5 to 20 DPI. There was a significant increase in the serum total proteins, blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, serum alkaline phosphatase, total immunoglobulins and circulating immune complexes in the infected animals as compared to the controls. In the sera of the infected animals, specific Absidia corymbifera IgM and IgG antibodies were detected from 3 DPI to 6 DPI respectively by Dot-EIA. Type I and type III skin hypersensitivity were detected from 10 DPI and type IV hypersensitivity from 15 DPI onwards. The gross and microscopic pathological lesions were seen mainly in the lungs, in all except one of the affected animals. This animal died 9 DPI and mycotic granulomas were also seen in its heart and kidneys. The microscopic lesions in the lung took the form of well-developed granulomas.

Manometric measurement of anal canal resting tone: comparison of a rectosphincteric balloon probe with a water-perfused catheter assembly

The purpose of this study was to compare the manometric measurements of a rectosphincteric balloon probe with a water-perfused catheter assembly on anal canal resting tone. Ten normal subjects (9 males, 1 female; mean age: 32 years; range 27-46 years) underwent station pull-through (0.5 cm/3 sec) beginning in the rectum with a water-perfused catheter assembly and a rectosphincteric balloon probe. Both the probe and the catheter were 5 mm in diameter. Three catheter side ports were perfused at 1 ml/min, and the rectal balloon was inflated with 5 ml of air. Measurements were taken on the same day in a counterbalanced manner. Data were analyzed on a computerized system. Mean (+/-SEM) values with the balloon were 82.3 (+/-8.9) mm Hg and 97.1 (+/-9.3) mm Hg with the catheter. These values were not significantly different (P=0.22). A significant order effect (P=0.04) was found where the first measure (101.3+/-10.2 mm Hg) was higher than the second measure (78.1+/-6.6 mm Hg), which was controlled for in the experimental design. A rectosphincteric balloon probe can accurately measure the resting tone of the anal canal compared to a water-perfused catheter assembly. Caution should be used when measuring anal canal resting tone early in an anorectal manometry assessment.

Glucose stimulates cAMP accumulation in the oral bacterium Actinomyces viscosus

Actinomyces viscosus T14V, a Gram-positive bacterium found in the oral cavity, was found to be insensitive to glucose-mediated catabolite repression. Basal levels of beta-galactosidase (18-26 U) were observed at all phases of growth regardless of the culture conditions. Further, beta-galactosidase could not be induced with lactose, or with a known inducer of the enzyme, isopropyl-beta-D-thiogalactoside, or with dibutyryl cAMP. Glucose, on the other hand, stimulated cAMP accumulation in a concentration-dependent manner. Fructose and sucrose mimicked the effects of glucose on cAMP accumulation, whereas galactose, mannose and maltose had lesser stimulatory effects. Other carbon sources, i.e., lactose, alpha-methylglucoside, ribose, xylose and succinate were without effect. Glucose and alpha-methylglucoside were found to stimulate cAMP accumulation in toluene-permeabilized cells, in the presence of the phosphodiesterase inhibitor, theophylline. Glucose did not stimulate cAMP levels in other Gram-positive bacteria including Streptococcus mutans, S. sanguis and S. salivarius but did cause cAMP accumulation in other strains of A. viscosus. The results suggest that glucose effects on cAMP metabolism are independent of the induction of beta-galactosidase as presently defined for Escherichia coli, and that the effects appear to be selective to the A. viscosus bacteria. The results also suggest that glucose stimulates cAMP accumulation via activation of adenylate cyclase.

Effect of sodium stibogluconate and pentamidine on in vitro multiplication of Leishmania donovani in peritoneal macrophages from infected and drug-treated BALB/c mice

The in vitro antileishmanial activity of sodium stibogluconate (SSG) and pentamidine in peritoneal macrophages from three different groups of animals (i.e. normal, Leishmania donovani-infected and drug-treated BALB/c mice) is reported. Peritoneal macrophages were extracted from all these animals and infected in vitro with L. donovani promastigotes. After 24 h, the infected macrophages (with amastigotes) were exposed to various concentrations of SSG (10-90 micrograms/mL) and pentamidine (0.1-5.0 micrograms/mL). The in vitro infection could be cured readily with 80 micrograms/mL of SSG and 4 micrograms/mL of pentamidine in macrophages from normal animals. But even higher dosages of these drugs added in vitro could not reduce the amastigote loads in macrophages from infected animals. In contrast, incubation in vitro of infected macrophages with very low dosages of these drugs (40 micrograms/mL of SSG and 1.0 mu/mL of pentamidine) could eliminate the parasites present within macrophages obtained from drug-treated animals. This was probably because the macrophages from drug-treated animals tackled the parasites themselves by their microbicidal mechanisms and the in vitro infection was tackled by the drug in vitro. This implies that a well-developed specific immunity in leishmaniasis helps in the antileishmanial activity of these drugs.

Effect of nifedipine on Leishmania donovani infection in-vivo and in-vitro: chemiluminescence responses of peritoneal macrophages and neutrophils

After peritoneal macrophages had been exposed to different concentrations of nifedipine (10-120 ng mL-1) there was a significant increase (P less than 0.001) in the percentage of Leishmania donovani infected macrophages compared with controls. Parasite load was also significantly increased (P less than 0.001) in nifedipine-treated, L. donovani infected, BALB/c mice, compared with untreated, infected mice, post-inoculation. Peak chemiluminescence responses were significantly depressed (P less than 0.001) in nifedipine-treated infected mice compared with untreated mice post-inoculation. It is suggested that availability of intracellular calcium is a factor in the defense mechanism of inflammatory cells in L. donovani infections.

Effect of sodium stibogluconate on the status of interleukin-I production in normal & Leishmania donovani infected BALB/c mice

Sodium stibogluconate, did not bring about significant increase in the production of IL-1, when both specific leishmanial antigen, or non specific Staphylococcus epidermidis was used as stimulus in normal uninfected animals. However, Staph. epidermidis was found to be a better stimulus as it brought about a significant increase (P less than 0.001) in IL-1 production when compared with leishmania antigen. In BALB/c mice infected with L. donovani there was a significant reduction (P less than 0.001) in IL-1 levels on various post infection days irrespective whether Staph. epidermidis or leishmanial antigen was used as stimulus when compared with controls. IL-1 levels were significantly increased (P less than 0.05) when L. donovani infected animals were treated with SSG, after 14 days post infection, irrespective of the stimuli used.

Placental pathology in pre-eclampsia eclampsia syndrome

Quantitative analysis of placental pathology was carried out on 20 placentae from various grades of pre-eclampsia eclampsia syndrome and 20 placentae from control group. Placental weights were lower in the study group. The gross abnormalities noted were the placental infarcts, retroplacental haematoma and calcification. The striking villous lesions observed in the study group were cytotrophoblastic cell proliferation, thickening of villous basement membrane and paucity of vasculosyncytial membrane and these findings correlated well with the severity of maternal disease. These vascular villous lesions were considered secondary to uteroplacental ischaemia.

Lymphokine mediated microbicidal activity of peritoneal macrophages from Leishmania donovani infected and drug treated BALB/c mice

The resident peritoneal macrophages from untreated mice develop potent microbicidal activity against amastigotes of Leishmania major and Leishmania donovani after in vitro exposure to lymphokines (LK) from mitogen stimulated spleen cells. However, to the best of our knowledge, the response of L. donovani infected peritoneal macrophages from already infected/treated animals to LK has not been investigated. Therefore in the present study, the effect of LK on infected macrophages from BALB/c mice following specific infection and subsequent treatment with sodium stibogluconate has been investigated. As the infection progressed, a decrease in percent microbicidal activity was noticed. An attempt was also made to treat the animals on different post infection days and reinfect them in vitro. Infection could not be produced in vitro in late treatment groups when the treatment was given on 14 days and 21 days post infection. Whereas, macrophages obtained from animals treated on 7 days post infection (early treatment) could be infected in vitro. However, only 50% of the cells got infection. This infection was eliminated when the cells were exposed to LK for 72 hours.