Anaerobes in cardiac infections: A decade experience from the tertiary care center

PurposeAnaerobic infections are common yet life-threatening. They are being recovered from all sites of the body, including the cardiovascular system. This study was aimed to determine the retrospective analysis on the isolation of anaerobes in cardiovascular samples received for a decade-long duration. It helps in knowing the frequency of isolation of anaerobic causes of cardiovascular infection.MethodsAll cardiovascular samples from the department of Cardio-thoracic vascular surgery from January 2010 to December 2020 were studied.ResultsOf 601 samples received, predominant samples were vegetations and valvular tissues of 258, followed by 98 samples of pericardial tissues, 92 samples of embolus, 90 samples of blood and post-operative collections, and 63 excised aneurysms and vascular grafts. Of the total, 15 samples grew anaerobes where Clostridium species were the predominant isolates. Clostridioides difficile was isolated in 2 samples.ConclusionsAnaerobes in cardiovascular samples are uncommon yet form a significant cause of morbidity and mortality. Most infections are from the contiguous spread, penetrating trauma, and hematogenous causing endocarditis or valvular infections. These conditions and samples form the seat of infectious focus and clinical suspicion towards the anaerobic cause of these conditions, especially in conventional routine culture-negative samples. Timely diagnosis of anaerobic infections plays a vital role in the good prognostic outcome of patients undergoing cardiothoracic and vascular surgery.     

Stafne’s bone defect with bicortical perforation: a need for modified classification system

Oral Radiology - Stafne’s bone defect (SBD) or salivary gland-related bone defects are asymptomatic bone cavities in the mandible caused by impingement by the salivary glandular tissue. The...     

Pharmacological treatment options for severe hypertriglyceridemia and familial chylomicronemia syndrome

Introduction: A spectrum of disorders, ranging from rare severe cases of homozygous null lipoprotein lipase deficiency (LPLD)–familial chylomicronemia syndrome (FCS) to heterozygous missense LPLD or polygenic causes, result in hypertriglyceridemia and pancreatitis. The effects of mutations are exacerbated by environmental factors such as diet, pregnancy, and insulin resistance.

Areas covered: In this review, authors discuss chronic treatment of FCS by ultra-low fat diets allied with the use of fibrates, omega-3 fatty acids, niacin, statins, and insulin-sensitizing therapies depending on the extent of residual lipoprotein lipase (LPL) activity; novel therapies in development target triglyceride (TG)-rich lipoprotein particle clearance. Previously, a gene therapy approach to LPL-alipogene tiparvovec showed that direct targeting of LPL function reduced pancreatitis events. An antisense oligonucleotide to apolipoprotein-C3, volanesorsen has been shown to decrease TGs by 70–80% and possibly to reduce rates of pancreatitis admissions. Studies are underway to validate its long-term efficacy and safety. Other approaches investigating the role of LPL modulating proteins such as angiopoietin-like petide-3 (ANGPTL3) are under consideration.

Expert opinion: Current therapeutic options are not sufficient for management of many cases of FCS. The availability of antisense anti-apoC3 therapies and, in the future, ANGPTL3 therapies may remedy this.     

Successes and failures of uterine leiomyoma drug discovery

Introduction: To-date, the only cure for symptomatic uterine fibroids (UFs) is surgical intervention. However, surgery may eliminate the hope of future pregnancies; moreover, the intrinsic risks of surgery make it a less favorable to women with UFs. Because of this, conservative medical therapies have become an attractive and prior option for those women. Leuprolide acetate (LA), a gonadotropin-releasing hormone (GnRH) agonist, is the only pharmacological agent currently approved for the short-term and pre-operative management of symptomatic UFs in the USA.

Areas covered: This systematic review covers the successes and failures of prominent drugs that have been researched for UFs in the past and agents that have shown promise in recent clinical trials. The most recent clinical trials and advances in drug therapy are presented in a comprehensive overview outlining the direction UF drug discovery is heading.

Expert opinion: Experts in the field are already on the forefront leading the responsibility to uncover potential drugs as long term fertility friendly viable options for non-invasive treatment/prevention of UFs. Indeed, a shift in the UF management is expected in the future.     

An ultrastructural study of alkaline phosphatase activity in normal and neoplastic human salivary glands

Alkaline phosphatase activity of normal human parotid and submandibular glands and four benign mixed tumours of the parotid gland was investigated by ultrastructural cytochemistry in order to identify myoepithelial cells and the extent of their participation in the histogenesis of such tumours. The results indicated that myoepithelial cells in the normal salivary glands were negative for alkaline phosphatase activity and, therefore, enzyme localization as a marker for identification of such cells in mixed tumours was not reliable. Occasional neoplastic cells in the more glandular parts of the tumours displayed surface membrane associated alkaline phosphatase reactivity. In addition, the luminal microvilli of some neoplastic cells were positive for the enzyme, thereby suggesting a resorptive or absorptive function for cells which were formerly secretory in nature.     

弱视儿童的临床概况和遮盖治疗结果

目的：研究弱视的临床表现,以及对弱视患者进行遮盖治疗的效果。

方法：纵向研究。收集2015-04/2016-04 Dhulikhel医院眼科1 092例患者数据。对检出的弱视60例患儿的视力、主诉、年龄、屈光状态、双眼屈光度和注视方式进行评估。并对检出的弱视患儿进行遮盖治疗。

结果：在研究期间接受检查的1 092例儿童中,60例(5.49%)为弱视患者,其中,女性35例(58.30%),男性25例(41.70%),平均年龄为8.87±3.29岁。在43.3%(n=26)的弱视儿童中,经线性弱视是最常见的亚型,其次是远视性屈光参差性弱视(20%,n=12)。最常见的屈光不正是散光,占58.30%,其次是远视(22.50%)和近视(7.50%)。配戴眼镜联合遮盖治疗和主动视觉训练的依从性为73.30%(n=44)。3mo后不同治疗策略对弱视眼视力有显著改善(P=0.002)。

结论：在尼泊尔等发展中国家,弱视发病率和相关的视力损害仍然是一个公共卫生问题。意识的缺乏,社区或学龄前儿童视力筛查的缺乏,会导致儿童较晚出现症状,并最终导致明显的视力损害。通过筛选就诊地点、及时转诊和适当的干预措施,这种状况可得到改善。     

Development and maturation of the fibrous components of the arterial roots in the mouse heart

The arterial roots are important transitional regions of the heart, connecting the intrapericardial components of the aortic and pulmonary trunks with their ventricular outlets. They house the arterial (semilunar) valves and, in the case of the aorta, are the points of coronary arterial attachment. Moreover, because of the semilunar attachments of the valve leaflets, the arterial roots span the anatomic ventriculo‐arterial junction. By virtue of this arrangement, the interleaflet triangles, despite being fibrous, are found on the ventricular aspect of the root and located within the left ventricular cavity. Malformations and diseases of the aortic root are common and serious. Despite the mouse being the animal model of choice for studying cardiac development, few studies have examined the structure of their arterial roots. As a consequence, our understanding of their formation and maturation is incomplete. We set out to clarify the anatomical and histological features of the mouse arterial roots, particularly focusing on their walls and the points of attachment of the valve leaflets. We then sought to determine the embryonic lineage relationships between these tissues, as a forerunner to understanding how they form and mature over time. Using histological stains and immunohistochemistry, we show that the walls of the mouse arterial roots show a gradual transition, with smooth muscle cells (SMC) forming the bulk of wall at the most distal points of attachments of the valve leaflets, while being entirely fibrous at their base. Although the interleaflet triangles lie within the ventricular chambers, we show that they are histologically indistinguishable from the arterial sinus walls until the end of gestation. Differences become apparent after birth, and are only completed by postnatal day 21. Using Cre‐lox‐based lineage tracing technology to label progenitor populations, we show that the SMC and fibrous tissue within the walls of the mature arterial roots share a common origin from the second heart field (SHF) and exclude trans‐differentiation of myocardium as a source for the interleaflet triangle fibrous tissues. Moreover, we show that the attachment points of the leaflets to the walls, like the leaflets themselves, are derived from the outflow cushions, having contributions from both SHF‐derived endothelial cells and neural crest cells. Our data thus show that the arterial roots in the mouse heart are similar to the features described in the human heart. They provide a framework for understanding complex lesions and diseases affecting the aortic root.