A new rosette in retinoblastoma

Retinoblastoma, the most common primary malignant intraocular tumor of childhood is a great success story in pediatric and ocular oncology. Pathology of retinoblastoma is important to guide the treatment modalities. Differentiated retinoblastoma is commonly seen in younger age group. Since a hundred years, we have been observing two typical true rosettes in retinoblastoma in the form of Flexner-Wintersteiner (FW) and Homer Wright (HW) rosettes and in many occasions pseudorosettes have been documented. In the present case report, a third new type of rosette was identified in a differentiated retinoblastoma which had an unusual anterior segment involvement.     

Evolocumab and lipoprotein apheresis combination therapy may have synergic effects to reduce low‐density lipoprotein cholesterol levels in heterozygous familial hypercholesterolemia: A case report

A 49 years old woman (weight 68 kg, BMI 27.3 kg/m²) with heterozygous familial hypercholesterolemia (HeFH) and multiple statin intolerance with muscle aches and creatine kinase elevation, presented at the Outpatient Lipid Clinic of Verona University Hospital in May 2015. Hypercholesterolemia was firstly diagnosed during adolescence, followed in adulthood by a diagnosis of Cogan's syndrome, a rheumatologic disorder characterized by corneal and inner ear inflammation. No xanthomas, corneal arcus, or vascular bruits were detectable at physical examination. Screening for macrovascular complications did not reveal relevant damages. Ongoing medical therapy included salicylic acid, methylprednisolone, methotrexate, and protonic‐pump inhibitor. In the absence of specific lipid‐lowering therapy, plasma lipid levels at first visit were: total‐cholesterol = 522 mg/dL, LDL‐cholesterol = 434 mg/dL, HDL‐cholesterol = 84 mg/dL, triglycerides = 120 mg/dL, Lp(a) = 13 mg/dL. On December 2015, evolocumab 140 mg sc every 2 weeks was initiated. After a 24‐week treatment, the LDL‐cholesterol levels decreased by an average of 21.2% to 342 ± 22 mg/dL (mean ± SD). On May 2016, LDL‐apheresis (H.E.L.P.system) was started as add‐on therapy. Compared to the average levels obtained during the evolocumab monotherapy period, the LDL‐cholesterol was reduced by 49.4%, thus reaching an inter‐apheresis level (mean ± SD) of 173 ± 37 mg/dL. This report suggests that a combination therapy with evolocumab and lipoprotein‐apheresis may have synergic effects on circulating lipid levels. Its relevance as a highly effective treatment option for hyperlipidemia in HeFH patients warrants further investigation in larger datasets.     

Studies on Theileriidae (Sporozoa) in Tanzania. X. A large-scale field trial on immunization against cattle Theileriosis.

50 cattle immunized by an infection and treatment method with 3 strains of Theileria parva (Mugaga, Kiambu 5 and Serengeti transformed), together with 19 controls, were exposed to natural tick infestation in Tanzania, in a site where a continuous influx of infected ticks from different regions of the country may be expected to occur. Exposure lasted for 2 months, monitoring continued for 3 more weeks after exposure ended. All 19 controls contracted East Coast Fever and died. 40 of the 50 immunized animals survived the whole period of monitoring; the other 10 died of accidents (2), heartwater (3) and unidentified causes (5); none died of ECF. It is recommended that this method of immunization be routinely applied to protect valuable animals at risk. An attempt to immunize against pathogenic Theileria mutans, by injecting blood containing piroplasms of a strain of low pathogenicity, showed that this method may protect against high parasitaemias caused by natural tick-borne infections and may be useful in eliminating the confusing factor of T. mutans in future trials on East Coast Fever.     

What Does a Mathematical Model Tell About the Impact of Reinfection in Korean Tuberculosis Infection?

Objectives

According to the Korea Centers for Disease Control and Prevention, new active tuberculosis (TB) cases have increased since 2001. Some key factors explain and characterize the transmission dynamics of Korean TB infection, such as a higher ratio of latent individuals and a new reporting system implemented in 2001, among others.

Methods

We propose a mathematical TB model that includes exogenous reinfection to gain a better understanding of the recent trend for TB incidence. We divide the simulation time window into two periods, 1970–2000 and 2001–2012, according to the implementation date of a new TB detection system.

Results

Two sets of parameters, including the transmission rate, the latent period, the recovery rate, and the proportion of exogenous reinfection, are estimated using the least-squares method and calibrated to data on the incidence of active TB.

Conclusion

Among some key parameters in the model, the case finding effort turned out to be the most significant impacting component on the reduction in the active TB cases.     

Effects of demeclocycline on psychiatric polydipsia in schizophrenic patients]

Excess intake of water by schizophrenic patients is referred to as psychiatric polydipsia. This symptom causes incontinence, vomiting and hyponatremia, and may sometimes lead to death. We have no effective therapeutic methods other than administrating sodium chloride solution and diuretics, or restricting the intake itself. A case was reported stating that demeclocycline, used in case where there is the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), was effective for the treatment of psychiatric polydipsia. We administered demeclocycline to 8 schizophrenic patients with psychiatric polydipsia, and noticed improvement in incontinence, vomiting and hyponatremia. There was also a decrease of polydipsic behavior. Demeclocycline inhibits the antidiuretic effect of vasopressin on the distal renal tubule. Considering the function of demeclocycline and the relevance of vasopressin to the central nervous system, it has been suggested that demeclocycline has effects on the central nerve through vasopressin or cyclic AMP.     

Indium-111-oxine labeled leukocyte uptake in Ki-1-positive anaplastic large cell lymphoma

Indium-111-oxine labeled leukocyte (¹¹¹In-WBC) scintigraphy is well known for its ability to localize in areas of active infection, but not in areas of lymphomatous involvement. We present a case of Ki-1-positive anaplastic large-cell lymphoma that was initially thought to be a case of multifocal osteomyelitis because of positive uptake on a ¹¹¹In-WBC scan. The areas of abnormal uptake on the indium scan were demonstrated histopathologically to be sites of lymphomatous involvement in bone. Received: 31 March 1998 Accepted: 29 December 1998     

Non-medical factors influencing access to renal transplantation

Considering the scarcity of available donor kidneys and the increasing number of patients with end-stage renal disease (ESRD) who would potentially benefit from renal transplantation, objective and equitable patient selection and equitable access to renal transplantation bear substantial importance. Inequalities in access to renal transplantation have been extensively documented over the last 2 decades with regard to age, gender, ethnicity, socioeconomic and psycho-social factors. In this paper we review a wide spectrum of social, patient and system-related factors along the transplantation process that may be associated with disparities, and we aim to describe the complex interrelationship between these factors that might influence treatment decisions by patients and health-care professionals. Understanding potentially modifiable barriers to kidney transplantation may allow designing targeted interventions in order to guarantee fair recipient selection and equal access to renal transplantation.     

Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi

A cross sectional study was conducted among 129 medical interns of Maulana Azad Medical College, New Delhi for assessing the perceived levels of risk of acquiring HIV infection in the health care settings among medical interns, reasons for the same and their exposure to situations having potential of HIV transmission. Majority of the interns (68.3%) perceived themselves to be at a very high/high risk of acquiring HIV infection during their medical career. The common reasons for perceived risk of acquiring HIV infection were getting injuries due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/ secretions of patients (28.5%) and insufficient availability of gloves (17.6%). Some (23.2%) were of the opinion that students in future might lose interest in the medical profession due to increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for the same reason. Majority of the interns (72.9%) had experienced needle pricks and more than half (53.7%) of them even had had blood splashes in their eyes/ nose/ mouth during surgical procedures. The findings of the study call for efforts for bringing a reduction in the risk perception of the interns through awareness campaigns and reorientation trainings, ensuring availability of gloves and other items necessary for observing universal work precautions and proper disposal of potentially contaminated articles.