Volkmann’s contracture of the forearm due to an insect bite: a case report and review of the literature

Compartment syndrome affecting the upper limb is reported rarely in the literature and is usually limited to single case reports. Upper limb compartment syndrome secondary to envenomation is rare, especially in the UK. Worldwide, it has been reported resulting from snake and insect bites, mostly from snakes from the Viperidae family, and from insects such as bees and wasps. Reports from the UK are limited to one case of an adder bite.We present a case of a previously fit and well adult who developed an ischaemic contracture of the forearm after an insect bite. Surgical exploration revealed segmental necrosis and contracture of the superficial and deep flexors of the fingers, requiring fasciotomy and tendon-lengthening procedures. This is the first report of a compartment syndrome, or a late ischaemic contracture from an insect bite in the UK. Owing to the rarity of compartment syndrome of the upper limb secondary to envenomation, a delay in diagnosis and treatment can lead to irreversible changes in the muscular compartments of the forearm.     

The ubiquitous gp63-like metalloprotease from lower trypanosomatids: in the search for a function

Plant and insect trypanosomatids constitute the "lower trypanosomatids", which have been used routinely as laboratory models for biochemical and molecular studies because they are easily cultured under axenic conditions, and they contain homologues of virulence factors from the classic human trypanosomatid pathogens. Among the molecular factors that contribute to Leishmania spp. virulence and pathogenesis, the major surface protease, alternatively called MSP, PSP, leishmanolysin, EC 3.4.24.36 and gp63, is the most abundant surface protein of Leishmania promastigotes. A myriad of functions have been described for the gp63 from Leishmania spp. when the metacyclic promastigote is inside the mammalian host. However, less is known about the functions performed by this molecule in the invertebrate vector. Intriguingly, gp63 is predominantly expressed in the insect stage of Leishmania, and in all insect and plant trypanosomatids examined so far. The gp63 homologues found in lower trypanosomatids seem to play essential roles in the nutrition as well as in the interaction with the insect epithelial cells. Since excellent reviews were produced in the last decade regarding the roles played by proteases in the vertebrate hosts, we focused in the recent developments in our understanding of the biochemistry and cell biology of gp63-like proteins in lower trypanosomatids.     

Primary integumentary allograft reactivity in the American cockroach, Periplaneta americana

Previous reports have failed to demonstrate integumentary allograft rejection in insects. We realized however, that these studies may not have fully appreciated the structure of the insect exoskeleton. Since the subcuticlar epidermal layer constitutes the only living tissue associated with insect integument, its destruction would indicate that the animal recognized and responded to the foreign tissue. Thus, we investigated allograft reactivity in the American cockroach, Periplaneta americana, by observing the fate of the epidermal portion of the integument. Each animal in a pair received a 3 X 4-mm integumentary allograft from its partner, as well as a 3 X 4-mm control autograft. The transplants were then examined histologically for signs of epidermal destruction at 0, 1, 3, 5, 7, and 10-70 days (in 10-day increments) posttransplantation. The results indicated that significant rejection of the allografts began by day 3, with peak reactivity occurring by day 7 when 92% of the grafts were scored as rejected. At later periods (greater than 20 days), the graft sites showed signs of repopulation by host epidermal cells. The allograft reaction was found to lag behind the xenograft reaction, which showed peak activity after only 1 day posttransplantation. Even so, allograft rejection in this insect occurred quite rapidly (as compared with some other invertebrates), and would appear to be due to a cytotoxic reaction against the epidermal layer.     

Plasma membranes from insect midgut cells

Plasma membranes from insect midgut cells are separated into apical and basolateral domains. The apical domain is usually modified into microvilli with a molecular structure similar to other animals. Nevertheless, the microvillar structure should differ in some insects to permit the traffic inside them of secretory vesicles that may budd laterally or pinch-off from the tips of microvilli. Other microvillar modifications are associated with proton-pumping or with the interplay with an ensheathing lipid membrane (the perimicrovilllar membrane) observed in the midgut cells of hemipterans (aphids and bugs). The perimicrovillar membranes are thought to be involved in amino acid absorption from diluted diets. The microvillar and perimicrovillar membranes have densities (and protein content) that depend on the insect taxon. The role played by the microvillar and perimicrovillar proteins in insect midgut physiology is reviewed here trying to provide a coherent picture of data and highlighting further research areas.     

Comparative analysis of the biodiversity of fungal endophytes in insect-induced galls and surrounding foliar tissue

Insect-induced galls are abnormal plant growths that can provide food and shelter to their inhabitants, resulting in stressed plant tissue that may alter the conditions for the colonization or proliferation of endophytic fungi. We investigated the effect gall formation has on fungal endophyte communities and diversity. Using three closely-related gall-forming aphid species that specialize on poplars, we characterized fungal endophyte diversity in galls and surrounding petiole and leaf lamina tissue. A total of 516 fungal endophyte samples were isolated from 272 tissue samples (32 leaves, 31 petioles, and 209 galls), resulting in 23 distinct morphotypes. Despite sharing a common host plant and often forming spatially contiguous galls, the endophyte profiles within the galls of each aphid species were distinct, not only from the galls of the other species, but also from surrounding plant tissue. These results suggest that insect galls can affect the composition of fungal endophyte species in plant tissues, by altering either the colonization or proliferation of their endophytic mycobiota. Likewise, fungal endophytes may be important in the ecology and evolution of insect galls.     

An intense and unforgettable experience: the lived experience of malignant wounds from the perspectives of patients,caregivers and nurses

Malignant wounds occur infrequently, but are typically described as devastating and overwhelming. However, there has been little formalised research, and the vast majority of existing malignant wound literature comprises reports of health care professionals from their management of the physical symptoms. Few studies have investigated the lived experience from the perspectives of patients and nurses and none have investigated the experiences of lay caregivers caring for a patient with a malignant wound. As a result, there has been little mention in existing literature of the non physical issues associated with malignant wounds or how they might be addressed. The purpose of this study was to address this gap in knowledge by investigating the lived experience of malignant wounds from the perspectives of those living it. In‐depth interviews were conducted with patients, caregivers and nurses. The data were analysed thematically within a hermeneutic phenomenological methodology to show four themes: (i) malodour; (ii) new mode of being‐in‐the‐world; (iii) still room for hope and (iv) enduring memories. Although this study confirmed previous findings that malodour was one of the worst aspects of malignant wounds, it was significant that the other three themes occurred in the previously largely overlooked psychosocial domain.     

Rhodnius prolixus Malpighian tubules and control of diuresis by neurohormones

Rhodnius prolixus Malpighian tubules (MTs) are a good model for fluid and ion secretion studies in view of the dramatic postprandial diuresis, which follows its massive blood meals. Ingestion of a blood meal equals to 10-12 times their initial body mass, leads to rapid activation of high output by excretory system, which eliminates 40-50% of the fluid mass. Secretion of ions and water is stimulated 1000-fold by serotonin and diuretic hormone. These hormones cooperate synergistically to activate adenylate cyclase activity from MTs cells, which increase the level of intracellular cAMP. The anti-diuretic hormones have also an important role in the fluid maintenance of Rhodnius prolixus. Several hours after insect feeding occurs a reduction in urine flow, that has been thought to result from a decreased diuretic hormone release or from a novel mechanism of anti-diuresis involving insect cardioacceleratory peptide 2b (CAP2b) and cyclic GMP. In this article it is discussed how the hormone regulation of fluid transport is done in Rhodnius prolixus MTs.     

Genetic disease in South Africa. A molecular approach

The Department of Human Genetics, University of Cape Town, has accumulated data on more than 11,000 individuals with inherited disorders seen over the last 15 years. Clinical and radiographic data on these persons and their families have been documented and where appropriate they have been investigated in our genetic laboratories. In accordance with current trends, a molecular genetic laboratory has been developed. The approach to South African genetic disease using recombinant DNA techniques is described.     

Design of a burn dressing

One of the more important properties of a burn dressing is its ability to control fluid balance. This can be achieved by absorption and/or water vapour transmission. Unfortunately, the rate of fluid loss from a burn wound has not been thoroughly investigated, therefore 'ideal' quantitative values for dressing absorption and water vapour transmission have not been defined. However, when the data that is available regarding fluid loss from burn wounds is analysed, valuable information about dressings can be obtained which should benefit dressing design.     

Cutaneous furuncular myiasis: Human infestation by the botfly

Dermatobia hominis, the botfly, is indigenous to Central and South America. Its usual host is a mammal, often a horse or cow. Cutaneous furuncular myiasis, human infestation by the botfly, has rarely been reported. Symptoms of infestation include a locally painful, firm furuncular lesion, often with a centrally located pore. Due to their infrequent occurrence, these lesions are often misdiagnosed as cellulitis, leishmaniasis, furunculosis, staphylococcal boil, insect bite or sebaceous cyst – conditions with similar presentations. The present case reiterates the need to think of ‘zebras’ when hearing ‘hoof beats’ that may have originated in a different land.     

Blood transfusion and recurrent Crohn's disease

The effect of blood transfusion on the postoperative recurrence of Crohn's disease has been investigated. Clinical and pathological data from 197 patients treated by right hemicolectomy between 1947 and 1988 have been analysed. Symptomatic recurrences confirmed radiologically or histologically have been recorded and cumulative recurrence rates calculated for transfused and non-transfused patients. Perioperative blood transfusion does not influence the development of recurrent disease (log rank test, chi 2 = 0.112).     

Acute Kidney Injury in the Setting of Knee Arthroplasty: A Case Report and Discussion Investigating Angiotensin-Converting Enzyme Inhibitors as the Culprit

Total knee arthroplasty (TKA) has become the predominant treatment modality for severe degenerative joint disease. With recent advancements in surgical and anesthetic technique, patients with severe comorbidities are able to have this procedure; they would have been precluded from TKA only a matter of years ago. Although many studies have investigated risk factors and the causes of perioperative morbidity and mortality in the arthroplasty patient, few have linked risk factors with specific outcomes. We present a case report that illustrates the link between the use of angiotensin-converting enzyme inhibitors and the development of postoperative acute kidney injury. While this relationship has been extensively studied in cardiac and gastric bypass patient populations, it has never been examined in the setting of joint replacement.     

Zirconia as a sliding material: histologic, laboratory, and clinical data

Zirconia ceramics have been introduced in orthopaedic surgery as prosthetic femoral heads to solve the critical issue of femoral head fractures sometimes observed with alumina ceramics. In addition to outstanding mechanical properties, zirconia ceramics have, similar to other surgical grade ceramics, a high biocompatibility and a high resistance to scratching. The radioactivity of zirconia ceramic, which has been the subject of contradictory data, now is well understood and managed with appropriate standards. The long-term stability of zirconia ceramics recently has been studied extensively and precise models allow a good prediction of their long-term behavior. In vitro wear tests against polyethylene and clinical data confirm the low wear rate associated with the use of ceramic femoral heads. The use of zirconia femoral heads in ceramic-on-ceramic total hip prostheses also has been investigated and now is clinically effective.     

Detection of vaccine‐like lumpy skin disease virus in cattle and Musca domestica L. flies in an outbreak of lumpy skin disease in Russia in 2017

Since 2012, lumpy skin disease virus (LSDV) has been spreading from the Middle East to south‐east Europe and Russia. Although vaccination campaigns have managed to contain LSDV outbreaks, the risk of further spread is still high. The most likely route of LSDV transmission in short distance spread is vector‐borne. Several arthropod species have been suggested as potential vectors, but no proven vector has yet been identified. To check whether promiscuous‐landing synanthropic flies such as the common housefly (Musca domestica ) could be involved, we carried out entomological trapping at the site of a recent LSDV outbreak caused by a vaccine‐like LSDV strain. The presence of vaccine‐like LSDV DNA was confirmed by the assay developed herein, the assay by Agianniotaki et al. (2017) and RPO 30 gene sequencing. No evidence of field LSDV strain circulation was revealed. In this study, we discovered that M. domestica flies carried vaccine‐like LSDV DNA (C _t  > 25.5), whereas trapped stable flies from the same collection were negative for both field and vaccine LSDV . To check whether flies were contaminated internally and externally, 50 randomly selected flies from the same collection were washed four times and tested. Viral DNA was mainly detected in the 1st wash fluid, suggesting genome or even viral contamination on the insect cadaver. In this study, internal contamination in the insect bodies without differentiation between the body locations was also revealed; however, the clinical relevance for mechanical transmission is unknown. Further work is needed to clarify a role of M. domestica in the transmission of LSDV . To our knowledge, this is the first report demonstrating that an attenuated LSD vaccine strain has been identified in Russian cattle given the ban on the use of live attenuated vaccines against LSDV.     

An overview of the efficacy and safety of everolimus in adult solid organ transplant recipients

As the risk of graft loss due to acute rejection has declined, the goal of post-transplant management has switched to long-term preservation of organ function. Minimizing calcineurin inhibitor (CNI)-related nephrotoxicity is a key component of this objective. Everolimus is a mammalian target of rapamycin inhibitor/proliferation-signal inhibitor with potent immunosuppressive and anti-proliferative effects. It has been widely investigated in large randomized clinical studies that have shown it to have similar anti-rejection efficacy compared with standard-of-care regimens across organ transplant indications. With demonstrated potential to facilitate the reduction of CNI therapy and preserve renal function, everolimus is an alternative to the current standard-of-care CNI-based regimens used in de novo and maintenance solid organ transplantation recipients.Here, we provide an overview of the evidence from the everolimus clinical study program across kidney, liver, heart, and lung transplants, as well as other key data associated with its use in CNI reduction strategies in adult transplant recipients.     

An update on the important findings from the EUROSTAR EVAR registry

This article summarizes the important findings to emerge from the European Collaborators on Stent-Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROSTAR) Registry since its inception in 1996. The Registry is an open observational study of the outcomes from endovascular aneurysm repair (EVAR). Data have been contributed, on a voluntary basis, by 135 vascular centers from 18 European countries. Patients are registered prospectively, and data analysis is on an intention-to-treat basis. Results from the first generations of endograft were characterized by excellent early results but poor durability of abdominal aortic aneurysm repair. EUROSTAR data have played a vital role in informing the technical evolution of subsequent generations of endograft and their clinical application. The latest data from EUROSTAR show significant improvements in all outcome measures, most importantly, those relating to durability. EUROSTAR has tracked and informed the evolution of EVAR. Improving results confirm that substantial progress has been made since 1996. EUROSTAR continues to contribute to this ongoing process.     

Trichomeriaceae, a new sooty mould family of Chaetothyriales

Trichomerium is a genus of foliar epiphytes with the appearance of sooty moulds, mostly occurring on the surface of living leaves and apparently gaining their nutrients from insect exudates. Species have ascostromata with setae and develop on a loosely interwoven mycelial mass of dark brown hyphae, while asci have a bitunicate appearance with hyaline ascospores. In this study, we made 16 collections of Trichomerium from Thailand. All were isolated, and the LSU and ITS rDNA gene regions sequenced. Phylogenetic analysis indicated that the Trichomerium species form a monophyletic clade within Chaetothyriales and warrant the introduction of a new family Trichomeriaceae. Bootstrap support for the Chaetothyriales is 100?% and clearly separates Trichomeriaceae from Capnodiales which are morphologically very similar. A detailed account of Trichomerium is provided and we describe and illustrate three new species based on morphological and molecular data. We propose that T. foliicola is adopted as the generic type of Trichomerium because it has been impossible to obtain the holotype specimen of T. coffeicola and also no molecular data exists in worldwide databases for this species or genus.     

Telemedicine in the COVID-19 era: Taking care of children with obesity and diabetes mellitus

Severe acute respiratory syndrome coronavirus 2 infection was declared a pandemic in January 2020. Since then, several measures to limit virus transmission have been imposed; among them, home confinement has been the most severe, with drastic changes in the daily routines of the general population. The “stay at home” rule has impaired healthcare service access, and patients with chronic conditions were the most exposed to the negative effects of this limitation. There is strong evidence of the worsening of obesity and diabetes mellitus in children during this period. To overcome these issues, healthcare providers have changed their clinical practice to ensure follow-up visits and medical consultation though the use of telemedicine. Telemedicine, including telephone calls, videocalls, data platforms of shared telemedicine data platforms mitigated the negative effect of pandemic restrictions. Published evidence has documented good metabolic control and weight management outcomes in centers that performed extensive telemedicine services last year during the pandemic. This review discusses studies that investigated the use of telemedicine tools for the management of pediatric obesity and diabetes.     

Cardiotoxicity associated with trastuzumab (Herceptin) therapy in the treatment of metastatic breast cancer

Trastuzumab (Herceptin) is a humanised monoclonal antibody that specifically targets HER2-positive breast cancer cells. Safety data collected from pivotal trials with trastuzumab indicate that this therapy is generally well tolerated. However trials of the combination of trastuzumab plus chemotherapy, and in particular chemotherapy with anthracyclines, have revealed an elevated incidence of cardiotoxicity in some patients, which was not apparent in preclinical or early clinical studies. Analyses of the available data suggest that in most cases the cardiotoxicity observed may reflect an exacerbation of anthracycline-induced cardiotoxicity. The biological mechanism of the cardiotoxicity has been investigated in several studies, and current data indicate that the heregulin/HER2-signalling pathway may have an important role. It is of note that the cardiotoxicity is generally reversible and can usually be managed with standard medical treatment. Improvement in cardiac function is seen both in patients who continue trastuzumab and in those in whom further therapy is withdrawn, indicating that with careful management anticancer therapy can be continued.     

A simple method of measuring the electrical resistance of the skin

A simple device has been developed to measure skin resistance. Normal values have been established and the effect of changing measurement parameters has been investigated. Peripheral nerve blocks have also been applied and their effect upon the skin resistance reported.