Subdiaphragmatic bronchogenic cyst masquerading as an "adrenal incidentaloma"

A subdiaphragmatic, retroperitoneal bronchogenic cyst arising from the stomach is reported in a patient who was referred for evaluation of what was thought to be an adrenal tumor. To our knowledge, less than 20 cases of retroperitoneal bronchogenic cyst have been reported in the English literature. A bronchogenic cyst may be indistinguishable from an adrenal tumor and, although rare, should be considered in the differential diagnosis of a retroperitoneal mass.     

Endoscopic Repair of Acquired Encephaloceles, Meningoceles, and Meningo-Encephaloceles: Predictors of Success

Meningoceles, encephaloceles, and meningo-encephaloceles may develop through defects associated with congenital anomalies or through defects produced by tumor, trauma, or surgery. Their initial management, surgical indications, and repair techniques are not universally accepted. We undertook this study to compare the contributions of different surgical techniques and materials to the success of endoscopic repairs of acquired meningo-encephaloceles. We also examined whether characteristics of the patient, the meningo-encephalocele, or the adjunctive treatment influenced the outcome of the repair.We retrospectively reviewed the clinical charts of all patients undergoing transnasal endoscopic repair of acquired meningo-encephaloceles at our academic hospitals. We encountered 17 patients with meningo-encephaloceles of the anterior fossa and parasellar area; 15 were repaired immediately using transnasal endoscopic techniques. Two persistent leaks associated with hydrocephalus were repaired during a second endoscopic attempt, which was rapidly followed by ventriculoperitoneal shunting. Location and size of the skull base defect, its etiology, and the technique and choice of material used for repair did not significantly affect surgical outcomes. However, the presence of hydrocephalus was significantly related to poor surgical outcomes.     

Circulating nitric oxide and C-reactive protein levels in Indian kala azar patients: correlation with clinical outcome

Interferon gamma (IFN-gamma) and nitric oxide (NO) are the major players of the host defense against Leishmania. In the present study circulating levels of IFN-gamma, NO, interleukin (IL)-6 and C-reactive protein (CRP) were compared in kala azar (KA), post-kala azar dermal leishmaniasis (PKDL) and healthy controls. A significantly elevated level of these parameters was evident in KA compared to PKDL or control. Further, significantly elevated levels of IFN-gamma, NO and CRP were observed in sodium antimony gluconate (SAG) unresponsive cases compared to responsive cases. In PKDL cases, NO was significantly elevated while other parameters were comparable to control. At post-treatment stage, KA patients showed a significant decrement in all the parameters, however, IL-6 and CRP remained above control level. Hence, data implies that the parasites survive in spite of the presence of effector molecules, and the excessive release of IFN-gamma and NO could be associated with the progression of the disease.     

CCR5 Levels and Expression Pattern Correlate with Infectability by Macrophage-tropic HIV-1, In Vitro

Chemokine receptors serve as coreceptors for HIV entry into CD4⁺ cells. Their expression is thought to determine the tropism of viral strains for different cell types, and also to influence susceptibility to infection and rates of disease progression. Of the chemokine receptors, CCR5 is the most important for viral transmission, since CCR5 is the principal receptor for primary, macrophage-tropic viruses, and individuals homozygous for a defective CCR5 allele (Δ32/ Δ32) are highly resistant to infection with HIV-1. In this study, CCR5-specific mAbs were generated using transfectants expressing high levels of CCR5. The specificity of these mAbs was confirmed using a broad panel of chemokine receptor transfectants, and by their non-reactivity with T cells from Δ32/Δ32 individuals. CCR5 showed a distinct pattern of expression, being abundant on long-term activated, IL-2–stimulated T cells, on a subset of effector/memory T cells in blood, and on tissue macrophages. A comparison of normal and CCR5 Δ32 heterozygotes revealed markedly reduced expression of CCR5 on T cells from the heterozygotes. There was considerable individual to individual variability in the expression of CCR5 on blood T cells, that related to factors other than CCR5 genotype. Low expression of CCR5 correlated with the reduced infectability of T cells with macrophage-tropic HIV-1, in vitro. Anti-CCR5 mAbs inhibited the infection of PBMC by macrophage-tropic HIV-1 in vitro, but did not inhibit infection by T cell–tropic virus. Anti-CCR5 mAbs were poor inhibitors of chemokine binding, indicating that HIV-1 and ligands bind to separate, but overlapping regions of CCR5. These results illustrate many of the important biological features of CCR5, and demonstrate the feasibility of blocking macrophage-tropic HIV-1 entry into cells with an anti-CCR5 reagent.     

Isolated native tricuspid valve endocarditis caused by viridans streptococcus.

The present report describes a case of native tricuspid valve endocarditis caused by viridans group streptococcus in a 43-year-old man who had recently undergone dental extraction. The patient had no history of intravenous drug use, heart disease or right heart catheterization. Although there have been scattered reports of unusual organisms, to the authors' knowledge, this is the first case of viridans group streptococcal endocarditis involving only the tricuspid valve after dental manipulation.     

Autosomal Recessive Nonsyndromic Arrhythmogenic Right Ventricular Cardiomyopathy without Cutaneous Involvements: A Novel Mutation

The arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a genetic disease frequently associated with desmosomal mutations, mainly attributed to dominant mutations in the Plakophilin‐2 (PKP2) gene. Naxos and Carvajal are the syndromic forms of ARVD/C due to recessive mutations. Herein, we report an autosomal recessive form of nonsyndromic ARVD/C caused by a mutation in the PKP2 gene. After examination and implementation of diagnostic modalities, the definite diagnosis of ARVD/C was confirmed by detection of ventricular tachycardia with a left bundle branch configuration and a superior axis, T‐wave inversion in right precordial leads (i.e., V1‐V3) in a 12‐lead electrocardiogram, and a right ventricle outflow tract dilatation. Neither cutaneous involvement nor other abnormalities were observed. Genetic testing was performed during which an intronic mutation of c.2577+1G>T in the PKP2 gene was observed homozygously. The c.2577+1G>T disrupts PKP2 mRNA splicing and causes a nonsyndromic form of ARVD/C.     

The status of blood safety in ECO member states

Background

Access to the information concerning blood safety is essential for managing problems and overcoming the challenges that are faced in any given region. Information on the availability and safety of blood in countries of the Economic Cooperation Organisation (ECO) is largely lacking. To address this problem, the Iranian Blood Transfusion Organisation, in collaboration with other ECO member states, initiated a research project in 2009 to collect, analyse and compare statistics on blood safety in the region.

Materials and methods

A modified and summarised version of the Global Database on Blood Safety (GDBS) questionnaire was used to collect data. The questionnaire was sent to all ten countries in the ECO region. The heads of the national transfusion services or focal points were requested to complete the form. Related literature and websites were also reviewed.

Results

Only three countries (Afghanistan, Iran and Turkey) completed the questionnaire, while other countries provided their available data on some parts of the questionnaire. The number of donations per year varied from 5 to 27/1,000 population. The rate of donors positive for human immunodeficiency virus ranged from 0.003% to 0.2%. The rate of donors positive for hepatitis C virus antibody varied from 0.05% to 3.9% while that of hepatitis B virus surface antigen ranged from 0.15% to 3.91% respectively.

Discussion

There is very clear diversity in blood transfusion services among ECO member states. Most countries in the region do not have a data-recording system. It is generally estimated that the need for blood is much higher than the supply in this region. Deficiencies in donor screening and a high prevalence of transfusion-transmitted infections are other important challenges.     

Varicose veins of the legs among nurses: Occupational and demographic characteristics

This study aims to determine the relationship between occupational and demographic hazards that characterize varicose veins (VV) in the legs and their intensity among nurses.A cross‐sectional study was carried out among 203 nurses from three general hospitals in Amol, Iran. The required subjects' information was collected through a self‐filled questionnaire and the physical examination of the VV intensity was based on the Clinical finding using the Etiology, Anatomic finding, Pathophysiological standards. The prevalence of VV, with different degrees, was 72.4% (95% CI 65.7–78.4), with women having a higher prevalence compared with men (77.9% vs. 56.9%, P = 0.004). The other non‐interventional risk variable was having longer years of service. Interventional variables were long‐standing hours, overtime work and body mass index status. This study had determined the occupational risk variables on VV which could be interventional in improving the working nurses' environment and quality of life for their long‐term career.