Evaluation of clinico-radiological, bacteriological, serological, molecular and histological diagnosis of osteoarticular tuberculosis

Background:

The diagnosis of osteoarticular tuberculosis is clinico-radiological in endemic areas. However every patient does not have the classical picture. Osteoarticular tuberculosis is a paucibacillary disease hence bacteriological diagnosis is possible in 10-30% of the cases. The present study is undertaken to correlate clinico-radiological, bacteriological, serological, molecular and histological diagnosis.

Materials and Methods:

Fifty clinico-radiologically diagnosed patients of osteoarticular tuberculosis with involvement of dorsal spine (n = 35), knee (n = 8), shoulder (n = 1), elbow (n = 2) and lumbar spine lesion (n = 4), were analyzed. Tissue was obtained after decompression in 35 cases of dorsal spine and fine needle aspiration in the remaining 15 cases. Tissue obtained was subjected to AFB staining, AFB culture sensitivity, aerobic/anaerobic culture sensitivity histopathological examination and polymerase chain reaction (PCR) using 16srRNA as primer. Serology was performed by ELISA in 27 cases of dorsal spine at admission and one and three months postoperatively.

Results:

AFB staining (direct) and AFB culture sensitivity was positive in six (12%) cases. Aerobic/anaerobic culture sensitivity was negative in all cases. Histology was positive for TB in all the cases. The PCR was positive in 49 (98%) cases. All dorsal spine tuberculosis cases showed fall of IgM titer and rise of IgG titer at three months as compared to values at admission.

Conclusion:

Histopathology and PCR was diagnostic in all cases of osteoarticular tuberculosis. The serology alone is not diagnostic.     

Stent Deployment Pressure Defines the Stent/Vessel Wall Relationship and has Important Implications for Early and Late Outcome

OBJECTIVE: This study evaluates the effect of stent deployment pressure on stent deployment, coronary vessel injury, subacute reclosure and foreign body reaction in a porcine coronary model. METHODS: Stainless steel coil stents were deployed in the right coronary artery of 30 pigs either using a deployment pressure of 4 atm (group I), 8 atm (group II), or 14 atm (group III). Serial quantitative angiographic studies together with morphometric analysis of the stented vessels were performed. RESULTS: Three pigs died within 48 hours due to subacute thrombosis (group I: n = 1, group II: n = 0, group III: n = 2). Another 4 stents were found occluded at day 7 (group I: n = 3, group II: n = 0, group III: n = 1). Imperfect stent alignment was found in 8 coronary arteries (group I: n = 7, group II: n = 1, group III: n = 0). Deep protrusion of stent filaments was found in 7 coronary arteries (group I: n = 0, group II: n = 1, group III: n = 6). Area stenosis at 6 weeks of the patent vessels was as follows: 75.7 +/- 15.2% in group I, 31.8 +/- 12.3% in group II, and 66.9 +/- 21.4% in group III, p < 0.001). CONCLUSION: In a porcine coronary model, stent deployment pressure resulting in an optimal alignment and a minimal coronary vessel injury leads to minimal neointimal hyperplasia.     

Recent updates on electronic cigarette aerosol and inhaled nicotine effects on periodontal and pulmonary tissues

E‐cigarette‐derived inhaled nicotine may contribute to the pathogenesis of periodontal and pulmonary diseases in particular via lung inflammation, injurious, and dysregulated repair responses. Nicotine is shown to have antiproliferative properties and affects fibroblasts in vitro, which may interfere in tissue myofibroblast differentiation in e‐cig users. This will affect the ability to heal wounds by decreasing wound contraction. In periodontics, direct exposure to e‐vapor has been shown to produce harmful effects in periodontal ligament and gingival fibroblasts in culture. This is due to the generation of reactive oxygen species/aldehydes/carbonyls from e‐cig aerosol, leading to protein carbonylation of extracellular matrix and DNA adducts/damage. A limited number of studies regarding the effects of e‐cig in oral and lung health are available. However, no reports are available to directly link the deleterious effects on e‐cigs, inhaled nicotine, and flavorings aerosol on periodontal and pulmonary health in particular to identify the risk of oral diseases by e‐cigarettes and nicotine aerosols. This mini‐review summarizes the recent perspectives on e‐cigarettes including inhaled nicotine effects on several pathophysiological events, such as oxidative stress, DNA damage, innate host response, inflammation, cellular senescence, profibrogenic and dysregulated repair, leading to lung remodeling, oral submucous fibrosis, and periodontal diseases.     

Experimental Evaluation of a New Single Wire Tantalum Coil Coronary Stent (Wiktor-iª)

To improve scaffolding properties, a new more densely woven Wiktor stent, the Wiktor-ia stent, was developed. Although the metal coverage remains still low compared to other stents, increased metal/vessel area raises the concern of increased thrombogenicity and neointimal hyperplasia. In this study we evaluated the Wiktor-i stent in a porcine peripheral and coronary model and compared the thrombogenicity and neointimal hyperplasia with the Wiktor-GX coronary stent. In a first study, a Wiktor-i and a Wiktor-GX coronary stent were implanted symmetrically in a preselected side branch of the right and left iliac artery of 10 healthy pigs. Quantitative vessel analysis showed comparable data before, immediately after and at follow-up. Hyperplasia measured by morphometry was also comparable in both groups (Wiktor-GX: 1.43 mm2 vs. Wiktor-i: 1.17 mm2, NS). Also, area stenosis was very similar (Wiktor-GX: 32% vs. Wiktor-i: 29%, NS). In a second study, 20 Wiktor (Wiktor-i: n=10, Wiktor-GX: n=10) coronary stents were implanted in the right coronary artery of 20 healthy pigs. Quantitative coronary analysis before, immediately after and at follow-up was comparable in both stents. The hyperplasia measured morphometrically was also comparable in both stents. (Wiktor-GX: 1.51 +/- 0.47 mm2 vs. Wiktor-i: 1.46 +/- 0.66 mm2, NS). Also the area stenosis was not significantly different (Wiktor-GX: 31% vs. Wiktor-i: 35%). In conclusion, this study shows that the increased metal/vessel area of the Wiktor-i stent does not result in an increased neointimal hyperplasia. Both stents show to be very biocompatible when implanted in porcine coronary and peripheral vessels.