Fibromuscular dysplasia: a rare cause of cilioretinal artery occlusion in childhood

OBJECTIVE: To report a case of cilioretinal artery occlusion with angiographic findings characteristic of the "string of beads" associated with renovascular hypertension secondary to fibromuscular dysplasia of the renal artery in a child. DESIGN: Case report. INTERVENTION: The patient underwent ex vivo renal artery reconstruction with saphenous vein graft and reimplantation. MAIN OUTCOME MEASURES: The main clinical outcomes were control of severe hypertension, reversible hypertensive retinopathy, and improvement of vision. RESULTS: Revascularization of the kidney improved renal function, and renovascular hypertension was clearly improved. Visual acuity improved to 20/200. CONCLUSIONS: A child with hypertensive retinopathy and arterial occlusion in the retina should undergo investigation to rule out a surgically curable hypertension. Magnetic resonance angiography of extrarenal vessels may reveal other sites of involvement of fibromuscular dysplasia. Evaluation and early diagnosis of renovascular hypertension will prevent severe end-organ damage.     

Intrathoracic gossypiboma: radiographic and CT findings

Intrathoracic gossypiboma, a retained surgical sponge in the thoracic cavity, is a rare but serious consequence following surgery. Because of its rare occurrence and non-specific clinical and radiographic presentations, the diagnosis is often missed. Herein we report a patient presenting with a chronic recurrent cough due to a retained surgical sponge in the pleural cavity. The patient has been misdiagnosed with bronchiectasis for 22 years. The characteristic spongiform appearance on CT and a history of previous thoracic surgery led to the diagnosis of a gossypiboma that was confirmed at surgery.     

Bangkok 2004. In Thailand, drug users have to fight for their rights

Injection drug users have been overlooked in the Thai government's response to HIV/AIDS, but not in its war on drugs. They experience constant police harassment and ineffective services, and face stigma and discrimination in society and in the health-care setting. Paisan Suwannawong, of the Thai Drug Users' Network, was scheduled to speak at the Opening Ceremonies of the XV International AIDS Conference in Bangkok on 11 July 2004. But he was placed last on a very long agenda that included Thai Prime Minister Thaksin Shinawatra, United Nations Secretary-General Kofi Annan, and Miss Universe. By the time he spoke, all the dignitaries and almost all the delegates had left the hall. In this edited version of his address, Paisan provides a personal testimonial about what it is like to be a drug user living with HIV/AIDS in Thailand, outlines the problems with the government's response, and describes other obstacles to delivering treatment and other services to drug users.     

Drug use patterns among Thai illicit drug injectors amidst increased police presence

Thailand has traditionally pursued an aggressive enforcement-based anti-illicit drug policy in an effort to make the country "drug-free." In light of this ongoing approach, we sought to assess impacts of enforcement on drug use behaviors among a cohort of injection drug users (IDU) in Thailand. We examined drug use patterns among IDU participating in a cross-sectional study conducted in Bangkok (n = 252). Participants were asked to provide data regarding patterns of drug use in the previous six months, including types of drugs consumed, method of consumption, frequency of use, and weekly income spent on drugs. We also conducted bivariate analyses to identify a possible effect of a reported increase in police presence on measures of drug use and related risk behaviors among study participants. One hundred fifty-five (61.5%) individuals reported injection heroin use and 132 (52.4%) individuals reported injection midazolam use at least daily in the past six months. Additionally, 86 (34.1%) individuals reported at least daily injection Yaba and Ice (i.e., methamphetamine) use. Participants in our study reported high levels of illicit drug use, including the injection of both illicit and licit drugs. In bivariate analyses, no association between increased police presence and drug use behaviors was observed. These findings demonstrate high ongoing rates of drug injecting in Thailand despite reports of increased levels of strict enforcement and enforcement-related violence, and raise questions regarding the merits of this approach.     

Preparation and electrochemical performance of nitrogen-enriched activated carbon derived from silkworm pupae waste

In this study, nitrogen-enriched activated carbon from silkworm pupae waste (P-AC) was successfully prepared and its electrochemical performances in aqueous and organic electrolytes were investigated. Silkworm pupae waste is beneficial because it is a nitrogen-enriched, inexpensive, and locally available material. The preparation process includes hydrothermal treatment of the silkworm pupae waste at 200 °C, and chemical activation using zinc chloride at activation temperatures of 700, 800 and 900 °C (P700, P800, and P900, respectively). The nitrogen content in the P-ACs was approximately 3.8–6.4 at%, decreasing with activation temperature, while the surface area was approximately 1062–1267 m² g⁻¹, increasing with activation temperature. Compared to a commercial AC, the P-ACs show higher nitrogen content but lower surface area. Furthermore, the P800 exhibited superior specific capacitance (154.6 and 91.6 F g⁻¹ in aqueous and organic electrolytes) compared to a commercial AC despite possessing smaller surface area. The high nitrogen content enhanced the pseudocapacitance and improved the electrical conductivity of the P-ACs. These properties were confirmed by relatively low series and charge transfer resistances, a capacity retention higher than 88% at a current density of 0.5 A g⁻¹ and excellent cycling stability demonstrated by maintaining 97.6% of its capacitance after 3000 cycles. These results demonstrate that silkworm pupae waste is a viable source of nitrogen-enriched AC for application in supercapacitors.

Nitrogen-enriched activated carbon from silkworm pupae prepared by hydrothermal treatment and chemical activation exhibited superior specific capacitance with excellent cycling stability.     

EVEREST STUDY: Efficacy and Safety of Verteporfin Photodynamic Therapy in Combination with Ranibizumab or Alone Versus Ranibizumab Monotherapy in Patients with Symptomatic Macular Polypoidal Choroidal Vasculopathy

PURPOSE:: To assess the effects of verteporfin photodynamic therapy (PDT) combined with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. METHODS:: In this multicenter, double-masked, primarily indocyanine green angiography-guided trial, 61 Asian patients were randomized to verteporfin PDT (standard fluence), ranibizumab 0.5 mg, or the combination. Patients were administered with verteporfin PDT/placebo and initiated with three consecutive monthly ranibizumab/sham injections starting Day 1, and re-treated (Months 3-5) as per predefined criteria. The primary endpoint was the proportion of patients with indocyanine green angiography-assessed complete regression of polyps at Month 6. Secondary endpoints included mean change in best-corrected visual acuity at Month 6 and safety. RESULTS:: At Month 6, verteporfin combined with ranibizumab or alone was superior to ranibizumab monotherapy in achieving complete polyp regression (77.8% and 71.4% vs. 28.6%; P < 0.01); mean change ± standard deviation in best-corrected visual acuity (letters) was 10.9 ± 10.9 (verteporfin PDT + ranibizumab), 7.5 ± 10.6 (verteporfin PDT), and 9.2 ± 12.4 (ranibizumab). There were no new safety findings with either drug used alone or in combination. CONCLUSION:: Verteporfin PDT combined with ranibizumab 0.5 mg or alone was superior to ranibizumab monotherapy in achieving complete regression of polyps in this 6-month study in patients with symptomatic macular polypoidal choroidal vasculopathy. All treatments were well tolerated over 6 months.     

The Effect of Exposures to Policing on Syringe Sharing Among People Who Inject Drugs in Bangkok, Thailand

While intensive drug law enforcement is recognized as a social-structural driver of HIV epidemics among people who inject drugs (IDU), few studies have investigated the effects of direct encounters with police, particularly in Asian settings. Using multivariate log-binomial regression, we examined the relationship between syringe sharing and exposures to two types of policing practices among IDU in Bangkok, Thailand: having been beaten by police and having been tested for illicit drugs by police. Between July and October 2011, 435 IDU participated in the study, with 75 (17.2 %) participants reporting syringe sharing in the past 6 months. In multivariate analyses, exposures to the two types of policing practices had an independent effect on syringe sharing, with experiencing both practices showing the greatest effect. These findings highlight the importance of addressing the policy and social environment surrounding IDU as a means of HIV prevention.     

Clinical heterogeneity and genotype‐phenotype correlations in hereditary spastic paraplegia because of Spatacsin mutations (SPG11)

Background: Autosomal recessive hereditary spastic paraplegia (ARHSP) with thin corpus callosum is a distinct and usually severe form of complex hereditary spastic paraplegia classified as SPG11. Recently mutations on SPG11 gene (KIAA1840), which is localized to chromosome 15q13‐q15, were shown to cause the majority of SPG11 cases. Methods: We analysed the 40 coding exons of this gene in the probands from eight families with complex ARHSP, four of these families had a thin corpus callosum and two has mild thinning. Results: Three families were identified with novel mutations in the SPG11 gene. One family was of Asian origin with a homozygous nonsense mutation and had a very severe phenotype but only very mild thinning of the corpus callosum. In the other two English families the parents were unrelated and the mutations were compound heterozygotes. In these two families the phenotype was mild and both probands had a thin corpus callosum. Conclusion: Given the probable mechanism of action of the mutations in the Spatacsin gene, we discuss the probable genotype phenotype correlations in these families. This study confirms the frequent occurrence of Spatacsin mutations in complex ARHSP with genotype phenotype effects and exposes the spectrum of clinical heterogeneity in SPG11.