Myoclonus secondary to withdrawal from transdermal fentanyl: case report and literature review.

Myoclonus is a common and well-described adverse effect of opioids. Most cases reported in the literature have been associated with opioid administration, rather than with opioid withdrawal. We describe a case of myoclonus secondary to withdrawal from transdermal fentanyl. We review the literature regarding myoclonus related to opioid therapy (opioid-induced myoclonus) and withdrawal (opioid withdrawal myoclonus), and discuss possible mechanisms and therapies for these phenomena.     

Posttransplant adenoviral enteropathy in patients with small bowel transplantation

Transplant patients on immunosuppression represent a risk group for opportunistic infections, including adenoviral infections. The clinical and histopathologic findings of posttransplant adenoviral enteropathy in 3 adult intestinal transplant patients are described. The histopathologic pitfalls for the differential diagnosis between intestinal adenoviral enteropathy and acute rejection are discussed. Adenoviral enteropathy is an opportunistic infection that may follow aggressive treatment for small bowel allograft rejection, but which may require no specific treatment. It is associated with mild mixed inflammation in the lamina propria and slight increase of crypt apoptosis, resembling low-grade acute rejection. The identification of characteristic viral inclusions in the surface or crypt epithelium points to the diagnosis of adenoviral enteropathy, in spite of the increased crypt apoptosis.     

Proliferative activity in oral carcinomas studied with Ag-NOR and electron microscopy

This study was conducted on 61 patients (27 males and 34 females). The age ranged from 27 to 81 years (mean 54 years). All suffered from oral squamous cell carcinoma and were treated by surgery and deep X-ray therapy (DXT). The UICC and TNM classification and staging recommendations were used for evaluation of the patients. All sections were stained with Ag-NORs stain for examination of the proliferative activity of the squamous cell carcinomas. Biopsies were also taken from another 6 cases--3 cases with normal striated muscle and 3 cases from normal oral mucosa--and served as controls. Statistical studies of Ag-NOR scores were classified into 3 scores: the p values of score I (ANOVA test) were .0001, score II (ANOVA test) was .0001, and score III (ANOVA test) was 06. Both scores I and II were highly significant and score III was significant. Electron microscopy (EM) showed tumor cells with irregular shape and size and with remarkable division of nuclei and chromatin clumps emarginated toward nuclear membrane, and some cases showed chromatin condensed at one pole of the nucleus. Few mitochondria with dilated cristae (?) and abundant rough endoplasmic reticulum (RER) were observed. Few apoptotic changes were noted. This study showed a high proliferation in poorly differentiated squamous cell carcinomas. The amount of Ag-NOR in poorly differentiated squamous cell carcinomas was a prognostic factor and represented an unfavorable prognostic feature in squamous cell carcinoma of the oral mucosa.     

Light and electron microscopic study on <Emphasis Type="Italic">Henneguya suprabranchiae</Emphasis> Landsberg, 1987 (Myxozoa: Myxosporea) infecting <Emphasis Type="Italic">Oreochromis niloticus</Emphasis>, a new host record

Out of 58 live tilapia fish, five Oreochromis niloticus were found to be naturally infected with Henneguya suprabranchiae (8.62%). Such infection was recorded only during winter season from Bahr Shebin, a tributary of the River Nile at Menoufia Governorate, Nile Delta, Egypt. Based on the structure and measurements of fresh spores, this parasite was identified as H. suprabranchiae. Spores are oval in shape and they measure 15 (13-16) x 5 (4-6) microm length by width. It has two polar capsules inside and they measure 4 (5-7) x 1 (2-3) microm length by width. Each polar capsule has spirally coiled (7-9 turns) polar filament. The plasmodia as well as all other parasitic stages were described using light and transmission electron microscopy and discussed regarding to those of other fish hosts especially those of Africa.     

Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy

OBJECTIVE

Early after Roux-en-Y gastric bypass (RYGB), there is improvement in type 2 diabetes, which is characterized by insulin resistance. We determined the acute effects of RYGB, with and without omentectomy, on hepatic and peripheral insulin sensitivity. We also investigated whether preoperative diabetes or postoperative diabetes remission influenced tissue-specific insulin sensitivity after RYGB.

RESEARCH DESIGN AND METHODS

We studied 40 obese (BMI 48 ± 8 kg/m²) participants, 17 with diabetes. Participants were randomized to RYGB alone or in conjunction with omentectomy. Hyperinsulinemic-euglycemic clamps with isotopic-tracer infusion were completed at baseline and at 1 month postoperatively to assess insulin sensitivity.

RESULTS

Participants lost 11 ± 4% of body weight at 1 month after RYGB, without an improvement in peripheral insulin sensitivity; these outcomes were not affected by omentectomy, preoperative diabetes, or remission of diabetes. Hepatic glucose production (HGP) and the hepatic insulin sensitivity index improved in all subjects, irrespective of omentectomy (P ≤ 0.001). Participants with diabetes had higher baseline HGP values (P = 0.003) that improved to a greater extent after RYGB (P = 0.006). Of the 17 participants with diabetes, 10 (59%) had remission at 1 month. Diabetes remission had a group × time effect (P = 0.041) on HGP; those with diabetes remission had lower preoperative and postoperative HGP.

CONCLUSIONS

Peripheral insulin sensitivity did not improve 1 month after RYGB, irrespective of omentectomy, diabetes, or diabetes remission. Hepatic insulin sensitivity improved at 1 month after RYGB and was more pronounced in patients with diabetes. Improvement in HGP may influence diabetes remission early after RYGB.Of the estimated 26 million people in the U.S. with type 2 diabetes and the 79 million with prediabetes (1), ∼80% are overweight or obese. Roux-en-Y gastric bypass (RYGB) surgery for treatment of obesity leads to long-term diabetes remission in ∼80% of patients (2), whereas very limited effects are observed with lifestyle intervention (3). Improvements in diabetes are reported to occur immediately after RYGB (4), with ∼30% of patients being discharged from the hospital with discontinuation of all diabetes medications (5).Impaired insulin sensitivity (insulin resistance) at the liver and in the periphery (primarily skeletal muscle) is an underlying mechanism of and precursor to diabetes (6). Several studies have described a long-term improvement in peripheral and hepatic insulin sensitivity 6 months to 1 year after RYGB (7–9), which is considered to occur secondary to weight loss. The mechanisms of the immediate improvement in diabetes after RYGB, before substantial weight loss, are not well delineated. Improvements in insulin sensitivity are reported early after RYGB, by hyperglycemic clamp at 1 and 4 weeks postoperatively (10) or by intravenous glucose tolerance tests (11) and homeostasis model assessment (HOMA) during the first week postoperatively (11,12). These approaches to measure insulin sensitivity, however, cannot distinguish between peripheral and hepatic insulin sensitivity. The hyperinsulinemic-euglycemic clamp method in conjunction with isotopically labeled tracer infusion allows measurement of peripheral (primarily skeletal muscle) insulin sensitivity as well as hepatic glucose production (HGP) and hepatic insulin sensitivity. Two studies have used this technique to assess insulin sensitivity early after RYGB, and interestingly, did not find a significant improvement in peripheral insulin sensitivity 2 to 4 weeks after RYGB; however, hepatic insulin sensitivity was not assessed (13,14). Recently, Camastra et al. (7) reported that peripheral and hepatic insulin sensitivity did not change at 2 weeks after RYGB in patients with and without diabetes.Increased visceral fat is considered an important risk factor for diabetes and insulin resistance (15). We recently reported, however, that surgical removal of the greater omentum (omentectomy) in conjunction with RYGB did not augment the improvement in insulin sensitivity long-term after RYGB (8). Here we report the acute effects of RYGB with or without omentectomy on hepatic and skeletal muscle insulin sensitivity. This was assessed by hyperinsulinemic-euglycemic clamp with tracer infusion at 1 month after RYGB. We also tested the hypothesis that an early remission of diabetes after RYGB is associated with improved hepatic and peripheral insulin sensitivity.     

Morphological and molecular biological characterization of <Emphasis Type="Italic">Pleistophora aegyptiaca</Emphasis> sp. nov. infecting the Red Sea fish <Emphasis Type="Italic">Saurida tumbil</Emphasis>

One hundred three out of 225 (45.8%) of the Red Sea fish Saurida tumbil were infected with microsporidian parasites. The infection was recorded as tumor-like masses (whitish macroscopic cysts) or xenomas often up to 2 cm in diameter and embedded in the peritoneal cavity. Generally, the infection was increased during winter 63.8% (86 out of 135) and fall to 18.9% (17 out of 90) in summer. Light microscopic study revealed that xenomas were encapsulated by a fibrous layer encircling numerous sporophorous vesicles filled with mature spores measuring 1.7 ± 0.6 (1.5–2.7 μm) × 1.5 ± 0.3 μm (1.2–1.8 μm) in size. Ultrastructural microscopic study showed the presence of smooth membranes of the sarcoplasmic reticulum forming a thick, amorphous coat surrounding various developmental stages of the parasite. The various recognizable stages of the parasite were uninuclear, binucleated, and multinucleated meronts followed by detachment of the plasmalemma of the sporont from the sporophorous vesicle producing sporoblasts. Mature spores consist of a spore coat and spore contents. The spore contents consist of the uninucleated sporoplasm and a posterior vacuole located at the posterior end. The polar tube consists of a straight shaft and a coiled region (26–32 coils) arranged in many rows along the inside periphery of the spore. The polaroplast consisted of an anterior region of closely and loosely packed membranes. Molecular analysis based on the small subunit rDNA gene was performed to determine the phylogenetic position of the present species. The percentage identity between this species and a range of other microsporidia predominantly from aquatic hosts demonstrated a high degree of similarity (>92%) with eight Pleistophora species. Comparison of the nucleotide sequences and divergence showed that the sequence of the present microsporidium was most similar to that of Pleistophora anguillarum (99.8% identity) differing in 13 nucleotide positions. So, the present species was recorded and phylogenetically positioned as a new species of Pleistophora.     

Neuronal activity in the human subthalamic nucleus encodes decision conflict during action selection

The subthalamic nucleus (STN), which receives excitatory inputs from the cortex and has direct connections with the inhibitory pathways of the basal ganglia, is well positioned to efficiently mediate action selection. Here, we use microelectrode recordings captured during deep brain stimulation surgery as participants engage in a decision task to examine the role of the human STN in action selection. We demonstrate that spiking activity in the STN increases when participants engage in a decision and that the level of spiking activity increases with the degree of decision conflict. These data implicate the STN as an important mediator of action selection during decision processes.     

Evaluation of serum adiponectin levels in diabetic nephropathy

IntroductionDiabetic nephropathy is one of the major microvascular complications of diabetes mellitus. Adiponectin is an adipose tissue-derived cytokine that was identified in a human adipose tissue cDNA library. Serum adiponectin levels are found to be reduced in various pathological states including obesity, diabetes mellitus, ischaemic heart disease and arteriosclerosis obliterans and elevated in end stage renal diseases. Objective: to assess the level of plasma adiponectin as an early predictor of microvascular complications in patients with type 2 diabetes mellitus.Methods44 patients with type 2 diabetes recruited from outpatient diabetes clinic in Kasr Alainy hospital. All patients were subjected to full laboratory work-up including: Fasting blood glucose and Post prandial blood glucose, Glycated haemoglobin A1C, Serum creatinine, Serum total cholesterol, Triglycerides, Low density lipoprotein, High density lipoprotein, C-reactive protein titre, serum adiponectin and Urinary albumin/creatinine (UAC) ratio.ResultsThe present study demonstrated that serum adiponectin concentrations had significant positive correlation with UAC ratio (r = 0.534, p = 0.0001). Adiponectin levels showed significant positive correlation in patients with diabetes and hypertension with microalbumiuria (p = .001) or normoalbumiuria (p = 0.004).ConclusionSerum adiponectin level can be a good predictor of diabetic nephropathy in patients with type 2 diabetes mellitus.