An epidemic outbreak of canine cutaneous leishmaniasis in Colombia caused by Leishmania braziliensis and Leishmania panamensis

The largest recorded outbreak of cutaneous leishmaniasis in Colombia's history occurred during 2005-2009 in soldiers of the Colombian Army, with ~40,000 cases. This outbreak was caused by the influx of military personnel into the jungle with the mission of combat illicit crops and the guerrilla. The soldiers remain for long periods within the rainforest and are exposed to the bite of infected sand flies. During the military activities, soldiers work with dogs specially trained to detect landmines, and therefore, dogs are also exposed to the infected sand flies and show high incidence of cutaneous leishmaniasis (CL). This work describes an epidemic outbreak of canine CL caused by Leishmania braziliensis and Leishmania panamensis in Colombia, South America. The clinical features of the disease and the response to treatment with pentavalent antimonials observed in 72 guard dogs from the Colombian Army are described. A program for prevention and control of canine CL is also discussed.     

Left anterior descending coronary artery pseudoaneurysm compressing the main pulmonary artery in a patient with Behçet's disease

Behçet's disease is a systemic inflammatory vascular disorder that may affect the cardiovascular system. Left anterior descending (LAD) artery aneurysm is a rare but potentially fatal complication of Behçet's disease. An accurate diagnosis of this clinical entity requires multimodal imaging (computerized tomography, angiography, and echocardiography) and is essential to guide appropriate therapeutic management. We report the case of a 22‐year‐old female with LAD pseudoaneurysm who underwent surgical repair with transesophageal echocardiography guidance. We describe the importance of the use of an alternative view to define the origin and location of this unusual pathology. (Echocardiography 2012;29:E91‐E93)     

Genetic variation in APOL1 and MYH9 genes is associated with chronic kidney disease among Nigerians

Purpose

A region of chromosome 22 which includes APOL1 and MYH9 genes was recently identified as a risk locus for non-diabetic forms of kidney disease, including idiopathic and HIV-associated focal segmental glomerular sclerosis and kidney disease clinically attributed to hypertension among African Americans. The purposes of the current study were, therefore, to examine the frequency of these variants and to determine whether they are associated with chronic kidney disease (CKD) among native Africans.

Methods

To investigate the possible evidence of association between variants in these genes and non-diabetic CKD among West Africans, we performed a case/control analysis in a sample of 166 Nigerians without history of European admixture. Our study included a total of 9 variants on APOL1 (n = 4) and MYH9 (n = 5) genes.

Results

We observed significantly strong associations with previously reported APOL1 variants rs73885319 and rs60910145, and their two-allele “G1” haplotype (P < 0.005). We did not observe significant evidence of association between non-diabetic CKD and any of the MYH9 variants or haplotypes after accounting for multiple testing in our sample.

Conclusions

In conclusion, APOL1 risk variants are associated with non-diabetic forms of CKD among Nigerians of Yoruba ethnicity. Further information on APOL1/MYH9 variants may lead to screening programs, which could lead to earlier detection and interventions for non-diabetic kidney disease.     

Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders

Background

Per oral endoscopic myotomy (POEM) is a novel treatment for esophageal motility disorders such as achalasia. To date, the extent of the myotomy has been determined based on the subjective assessment of the endoscopist. We hypothesized that the real-time measurement of esophagogastric junction (EGJ) distensibility using a novel functional lumen-imaging probe would enable objective evaluation of POEM.

Methods

Patients diagnosed with achalasia disorders electively underwent POEM. Using impedance planimetry with a transorally inserted functional lumen-imaging probe (EndoFLIP^®), cross-sectional areas (CSA) and distensibilities at the EGJ were measured intraoperatively immediately before and after the transoral myotomy (n = 4). All patients completed their 6-month follow-up and two patients had repeat distensibility tests at this time. Four healthy volunteers served as a control group.

Results

POEM was successfully performed in all patients (4/4). Premyotomy measurements (40-ml fill mode) showed a median diameter of 6.5 mm (range = 5.2–7.9 mm) at the narrowest location of the EGJ and was 10.1 mm (7.3–13.2 mm) following POEM. CSA increased from 41.5 mm² (20–49 mm²) to 86 mm² (41–137 mm²) at a similar median intraballoon pressure (40.3 vs. 38.6 mmHg). The increased EGJ distensibility (DI, 1.0 vs. 2.4 mm²/mmHg) was comparable to that of healthy volunteers (2.7 mm²/mmHg).

Conclusion

Functional lumen distensibility measures show that POEM can result in an immediate correction of the nonrelaxing lower esophageal sphincter, which appears similar to that of healthy controls. Intraoperative EGJ profiling may be an important tool to objectively guide the needed extent and completeness of the myotomy during POEM.     

Influence of intradiscal medication on nucleus pulposus cells

Background contextEugene Carragee was the first to prove that provocative discography may contribute to intervertebral disc degeneration. Disc degeneration can be induced either by mechanical trauma caused by the puncturing needle or as a pharmacological effect of the drugs instilled into the disc.PurposeThe aim of this study was to test the influence of cortisone, lidocaine, and iopamidol on nucleus pulposus cells under an in vitro setting.Study designControlled in vitro study is the design type.MethodsThe nucleus pulposus was excised from 12 bovine tail intervertebral discs and monolayer cell cultures were generated. The cultures were divided into four sample groups and incubated in either standard cell culture medium (control group) or medium supplemented with the test substances. The dose rate was adapted based on a total dose of 3 mL iopamidol, 1 mL lidocaine, and 10 mg cortisone per nucleus pulposus. Cell count, viability, proliferation, and differentiation features were analyzed. The study was supported by DePuy. No conflicts of interest arise from this support.ResultsAfter 24 hours, a significant decrease in cell counts was observed in all three test groups. Population doubling time was 16 hours in the control group cultured in standard medium and increased to 21 hours (cortisone), 25 hours (iopamidol), and 38 hours (lidocaine) after incubation in discography medication (p<.001). Cell viability was slightly, but not significantly decreased in all medication groups. Cells incubated in Lidocaine were significantly smaller (p<.01) and showed clearly reduced pseudopodia formation. Incubation in lidocaine and iopamidol also significantly reduced glycosaminoglycan synthesis.ConclusionAlthough only a small decrease in cell viability was observed in all three substances tested, cell count and proliferation decreased significantly. Incubation in lidocaine inhibited pseudopodia formation and might therefore interfere with intercellular signalling and cell migration. Glycosaminoglycan synthesis was significantly decreased after contact with lidocaine as well as Iopamidol. These observations suggest that all three medications tested might interfere with biological repair mechanisms of the intervertebral disc and therefore contribute to a further degeneration.