Acetazolamide and bevacizumab combination therapy versus bevacizumab monotherapy in macular edema secondary to retinal vein occlusion.

PURPOSE: To determine and compare the efficacy of intravitreal bevacizumab (IVB) and oral acetazolamide (OA) combination therapy versus IVB monotherapy in patients with macular edema secondary to retinal vein occlusion (RVO). METHODS: This randomized clinical trial included 54 eyes of 52 patients with RVO central macular thickness (CMT) of more than 300µm, and best corrected visual acuity (BCVA) between 20/400 and 20/40. Eligible patients were randomly assigned to two groups: (I) IVB and OA (250mg twice daily) combination therapy or (II) IVB monotherapy. Ocular injections were repeated monthly for up to three months; BCVA and CMT were measured monthly. RESULTS: Both regimens resulted in significant reduction in CMT (534±150µm to 352±90µm in the IVB+OA group, P<0.001; and 580±175µm to 362±90µm in the IVB group, P<0.001); neither showed superiority in this regard. Likewise, BCVA showed significant improvement in both groups (0.87±0.56 to 0.53±0.28 LogMAR in the IVB+OA group, P=0.001; and 0.85±0.62 to 0.46±0.4 LogMAR in the IVB group, P<0.001), with no intergroup difference. CONCLUSION: Addition of oral acetazolamide to IVB in eyes with macular edema secondary to RVO may not result in additional short-term benefits regarding functional and anatomical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05290948, registered on March 22, 2022. https://clinicaltrials.gov/ct2/show/NCT05290948.

Primary extraskeletal Ewing's sarcoma presenting as an axillary mass: A case report and review of the literature.

Extraskeletal Ewing's sarcoma (EES) is a rare soft tissue tumor predominantly observed in adolescents and young adults, and is characterized by aggressive behavior. So far, only two cases of primary axillary soft tissue EES have been reported in the literature. One of them was a 29-year-old female patient who presented with a lump in her left axilla. Upon examination, an irregular, painless mass, measuring 5 cm × 5 cm × 3 cm, was noted in the left axilla. A histopathological examination of the mass revealed small, round, blue cells with scant cytoplasm, round nuclei, numerous mitosis, and necrosis. An immunohistochemistry (IHC) examination was positive for CD99 and negative for ER, PR, Her2neu, CK7, CK5/6, CD56, CD45, CK-pan, CKHMW, P63, desmin, S100, TdT, vimentin, myogenin, synaptophysin, and chromogranin A. The patient was diagnosed with primary axillary soft tissue EES and was started on neoadjuvant chemotherapy. Twelve months later, she is clinically free from the disease.

Potassium phosphate and potassium carbonate administration by feed or drinking water improved broiler performance, bone strength, digestive phosphatase activity and phosphorus digestibility under induced heat stress conditions.

Potassium phosphate (K2HPO4) and potassium carbonate (K2CO3) administration by feed or water were evaluated on broiler performance, bone strength, alkaline phosphatase activity (ALP), and phosphorus digestibility under heat stress and high chloride condition. Experimental groups include control; 15 cc/kg K2HPO4; 30 cc/kg K2HPO4; 15 cc/l K2HPO4; and 3.7 g/kg K2CO3. Body weight (BW), feed and water consumption, plasma potassium, phosphorus, and calcium concentration along with plasma and digestive ALP and intestinal digesta pH were measured during the trial. Tibia ash, calcium and phosphorus content, and breaking strength were measured on days 21 and 42 and phosphorus digestibility on day 36 of age. As a result of this, study feed and water consumption was increased by supplementation of the feed or water with K2HPO4 (P ≤ 0.001). K2HPO4 increased body weight at 42 days of age (P ≤ 0.001). Tibia ash and phosphorus content was increased by K2HPO4 supplementation (P ≤ 0.004; P ≤ 0.003). K2CO3 did increased tibia ash but not changed tibia phosphorus content significantly. Tibia shear force, shear energy, extension, and length were improved by K2HPO4 administration at 42 days of age (P ≤ 0.001). Administration of either feed or water with K2HPO4 increased plasma potassium, phosphorus, and calcium concentration at 21 days of age, whereas K2CO3 reduced plasma potassium at 21 days of age (P ≤ 0.05). Plasma ALP reduced by addition of 15 cc K2HPO4 and K2CO3 to diets at 42 days of age, whereas digestive ALP was increased by inclusion of K2HPO4 and not by K2CO3. Supplementation of either feed or water with K2HPO4 increased phosphorus digestibility, whereas K2CO3 reduced phosphorus digestibility (P ≤ 0.003). Jejunum and ileum pH was reduced by K2HPO4 or by K2CO3 at 21 and 42 days of age (P ≤ 0.006; (P ≤ 0.05). Over all, results of current study revealed that K2HPO4 can be a suitable potassium salt choice instead of KCL in hot weather conditions especially when the water or diet contains high levels of chloride.

Granular cell tumour of the breast in a young female: A case report and literature review.

A granular cell tumour (GCT) of the breast is a relatively uncommon lesion. Often, it mimics carcinoma on clinical and radiological examinations. The striking feature of GCT is the presence of abundant granular eosinophilic cytoplasm, which can easily lead to a misdiagnosis of apocrine carcinoma or a metastatic lesion and may result in unnecessary surgery. To obtain a correct diagnosis, immunohistochemistry with S100 is required. We present a case of a GCT of the breast in a 19-year-old female who presented with a firm mass in the upper inner quadrant of the left breast, which was reported on a mammogram as the Breast Imaging Reporting and Data System (BIRADS) Category 4C. This report is of interest due to the young age of the patient and the rarity of the lesion. To our knowledge, this is the second reported case in all of Saudi Arabia and the first from the Madinah region.

Hilus cell hyperplasia of fallopian tubes: a rare and incidental finding with uterine leiomyomas.

Hilus cells are ovarian counterpart of testicular leydig cells seen at hilar region of ovary. We present an interesting case of hilus cell hyperplasia in fallopian tube associated with multiple leiomyomata of uterus in a postmenopausal woman. To our knowledge very few cases reported the existence of hilus cells outside the ovary. We received a specimen of hysterectomy with bilateral salpingooopherectomy. On gross examination both the tubes showed multiple small yellowish nodules. Microscopic examination showed aggregation of hilus cells beneath a normal tubal epithelium. Hilus cell hyperplasia was not seen in the ovaries. On immunohistochemistry, hilus cell showed positivity for vimentin and calretinin. Co-existence of hilus cell hyperplasia of fallopian tube and leiomyoma is very rare and may be subjected to further research.

Methods of haemostasis during liver resection--a UK national survey.

BACKGROUND: Although haemorrhage is a major cause of morbidity and mortality in liver surgery, there is very little available guidance on its management. METHODS: The aim of this study was to identify current practice in the UK in this regard. An online survey was created and hepatobiliary (HPB) specialists who were members of a specialist society and others who were known practitioners were invited by e-mail to complete the survey anonymously. RESULTS: Fifty-one percent responded (n = 36/70), and most of these respondents worked at large HPB centres (>100 liver resections/year; n = 24, 66%). Not all questionnaires were fully completed by the individual surgeons. Thirty-eight percent of the surgeons routinely used Pringle's manoeuvre. Most surgeons used ligation of the inflow vessels (n = 16, 44%) and stapled the outflow vessels (n = 15, 42%). The Cavitron ultrasonic surgical aspirator (CUSA; 54%, 13/24) was preferred for parenchymal transection. The majority routinely used haemostatic adjuncts (n = 22, 62%), whilst 33% (n = 12) used them occasionally. Twenty-three (64%) felt manufactured haemostatic adjuncts played a major role in maintaining haemostasis and 19 preferred fibrin-based products. CONCLUSION: The Pringle manoeuvre is a popular technique amongst specialist UK liver surgeons and the CUSA is used by nearly half of the surgeons. Despite the absence of definitive evidence for their benefit, manufactured haemostatic adjuncts are still widely used, especially the fibrin-based adjuncts.

Modification of anodised aluminium surfaces using a picosecond fibre laser for printing applications.

The use of an ultrafast fibre laser at a wavelength of 1064 nm has allowed the surface modification of anodised aluminium plates coated with a 2 micron thick anodised layer for potential industrial applications. The micro- and nano-scale structuring of the anodised aluminium using picosecond pulses of approximately 25 ps duration at 200 kHz repetition rate was investigated. The interaction of the laser with the substrate created a hydrophilic surface, giving a contact angle of less than 10 degrees. On examination under a Scanning Electron Microscope (SEM), a morphology created due to laser induced spallation was observed. It has been found that these laser processed hydrophilic surfaces revert to a hydrophobic state with time. This has potential for application in the printing industry and offers reusability and sustainability of the process materials. This has been confirmed in initial trials.

Intra-operative tumour detection and staging in colorectal cancer surgery.

AIM: Surgical resection for colorectal cancer involves segmental resection and regional lymphadenectomy. The appropriateness of this 'one-size-fits-all' strategy is questioned as bowel cancer screening programmes result in a shift to earlier stage disease. Currently, the nodal status of a colorectal cancer can only be reliably determined by histopathological examination of the resected specimen. New methods of intra-operative staging are required to allow surgical resection to be tailored to the stage of the disease. METHOD: A literature search was performed of PubMed and Embase databases using the terms 'colon' OR 'colorectal' AND 'intra-operative detection' OR 'intra-operative staging' OR 'intra-operative detection' OR 'radioimmunoguided surgery'. Articles published between January 1980 and January 2012 were included. Technologies that have the potential to allow intra-operative staging and treatment stratification were identified and further searches performed. RESULTS: Established techniques such as sentinel lymph node mapping and radioimmunoguided surgery have benefited from combination with other technologies to allow real-time intra-operative staging. Intra-operative fluorescence, using naturally fluorescent biomarkers or fluorescent tumour probes, probably offers the most practical means of intra-operative lymph node staging and may be facilitated using nanotechnology. Optical coherence tomography and real-time elastography have the potential to provide an in vivo'virtual biopsy'. CONCLUSION: Technological advances may allow accurate intra-operative lymph node staging to facilitate tailored surgical resection. This may become the next paradigm shift in colorectal cancer surgery.

Pattern of pediatric poisoning and accident in Patan Hospital.

BACKGROUND: Kerosene, drugs, pesticides are chemicals used in home and farms. But because of parents' or caretakers' negligence, accidents and poisoning in children may take life of a child. OBJECTIVE: To study the common causes and outcome of pediatric accident and poisoning cases admitted in Patan Hospital. METHOD: A prospective (2068-69) and retrospective (2066-67) studies of pediatric accident and poisoning cases admitted in Patan Hospital (2066-chaitra 2069) were done. RESULT: Out of 44 registered cases total 35 cases were collected in last 4 years. Twenty one in prospective and 14 in retrospective study. Male female ratio was 1.2:1. Most vulnerable age group was 1-5 years (21) and 11-15 yrs (8). Most common poison was pesticide (11), kerosene (9) and drugs (7). Twenty percent were suicidal, 3% were homicidal and rest was accidental. Suicidal poisoning was common in 11-14 years. Accidental poisoning was: taking kerosene from mineral water bottle for water. Small children took drugs and pesticides due its easy availability or careless storing. Five common accidents were near drowning (2), hot water scald, hanging and fall from height. Outcome was 2 expired; 1 Organo-phosphorous and 1 food poisoning. Mortality was 6%. One hanging survived as vegetation. CONCLUSION: Accident and poisoning are preventable. We need to make our home and surrounding poison and accident proof. Small children should never be left unattended. Drugs, pesticides, hot things, and sharp instruments should be kept out of reach of children and in child proof container in separate places. Pesticide should not be sold to children.

Surface modification of anodised aluminium using a femtosecond laser.

Femtosecond laser pulses at 775 nm, combined with a scanning galvonometer system, have allowed the micro scale structuring of an aluminium plate coated with a 2 micron thick anodised aluminium layer for potential industrial applications. The micro-scale structuring of aluminium was investigated using ultrafast pulses of 180 fs duration at a repetition rate of 1 kHz. Under suitably optimised conditions, the interaction of the laser pulses with the substrate created a hydrophilic surface with a contact angle of less than 10 degrees. These surfaces revealed a 'lotus-leaf' like morphology when examined under a Scanning Electron Microscope (SEM). It has been found that these laser processed hydrophilic surfaces revert with time and they undergo this cycle of alternate hydrophilic/hydrophobic behaviour several times upon exposure to the laser pulses. Their potential application in the printing industries is strong due to their reusability and sustainability; initial trials on printing confirm this. This technology would offer extra advantages as a non-chemical process without the need for developer, thereby reducing the overall cost and time of printing.

Sex preferences among mothers delivering at Patan Hospital.

BACKGROUND: High sex ratios at birth (SRB) are seen in China, Taiwan, South Korea, parts of India and Vietnam. The imbalance is the result of son preference, accentuated by declining fertility. Prenatal sex determination and female feticides are common in many countries. It is reflected in sex ratio OBJECTIVE: To determine reasons for the preferences for different sex; to find out whether there is altered sex ratio at birth and to find out whether female feticide are common among women who had abortion. METHOD: It is a prospective study. Women who had previous history of abortion and had delivered at Patan Hospital in the year 2066 were interviewed as per questionnaires. RESULTS: Among 560 women with total live births of 965, (462 male and 503 female) during their life time the overall sex ratio was 92 male per 100 female birth; total abortions were 663. Preferences for male were 10%, female 15.4% and either was for 74%. The reason for male preference was to continue family lineage, to bring honor, old age security, and performing funeral rites while the reasons for daughter preferences were that they understand mothers pain, help in household work. The sex ratio of the babies born during the study period was 113 male per 100 female births. The Sex ratio at birth from 1st to 6th deliveries was 61, 79, 101, 210, 286 and 1100 male per 100 female birth respectively. Prenatal sex selection was 8% (by USG) but none had sex selected abortion. CONCLUSION: Sex ratio of those delivered during the study period was skewed (136 boys per 100 girls) towards male. There was shift in SRB in 4th and subsequent pregnancies in favor of boys. As the male sex ratio increased the number of induced abortion decreased in subsequent pregnancies.

Culture proven bacterial meningitis in children: agents, clinical profile and outcome.

BACKGROUND: Meningitis is a serious infection. Little is known about the bacterial agents and their antibacterial sensitivity in Nepalese children. OBJECTIVES: To study bacteriological agents, clinical profile and immediate outcome in patients admitted to children ward of Patan Hospital with meningitis. METHODS: Prospective observational study conducted in paediatric ward of Patan Hospital. All the children admitted to the ward, with the diagnosis of culture proven bacterial meningitis on discharge were eligible. RESULTS: Out of 7,751 children, 296 (3.8%) had meningitis. This was a group ranging from neonates to adolescents aged 18 years. Only 13 (4.4%) of cerebrospinal fluid samples taken from them yielded positive culture reports. The organisms were pneumococcus (6), Haemophilus influenza b (3), beta-hemolytic Streptococcus (1), a-hemolytic Streptococcus (1), N. meningitides (1) and Pseudomonas (1). Whereas Haemophilus influenza b was isolated from young infants, pneumococci were found in the young as well as the old. Fever, vomiting, high leukocyte count with left shift were all commonly present. All but one had cerebrospinal fluid pleocytosis. Low sugar and high protein was found in most specimens. Neuroimaging was done in six children of which three were abnormal (all young infants and pneumococci cases). Ceftriaxone was given to all but one child. Everybody recovered but three had complications, profound hearing loss and cortical atrophy with subdural collection in pneumococcal and septic arthritis with persistence of fever in Haemophilus influenzae b meningitis. CONCLUSION: The present study corroborates most of the epidemiological and clinical features of acute bacterial meningitis and sheds light on the causative agents of bacterial meningitis in Nepalese children.

GP3 is a structural component of the PRRSV type II (US) virion.

Glycoprotein 3 (GP3) is a highly glycosylated PRRSV envelope protein which has been reported as being present in the virions of PRRSV type I, while missing in the type II PRRSV (US) virions. We herein present evidence that GP3 is indeed incorporated in the virus particles of a North American strain of PRRSV (FL12), at a density that is consistent with the minor structural role assigned to GP3 in members of the Arterivirus genus. Two 15aa peptides corresponding to two different immunodominant linear epitopes of GP3 derived from the North American strain of PRRSV (FL12) were used as antigen to generate a rabbit monospecific antiserum to this protein. The specificity of this anti-GP3 antiserum was confirmed by radioimmunoprecipitation (RIP) assay using BHK-21 cells transfected with GP3 expressing plasmid, MARC-145 cells infected with FL12 PRRSV, as well as by confocal microscopy on PRRSV-infected MARC-145 cells. To test if GP3 is a structural component of the virion, (35)S-labelled PRRSV virions were pelleted through a 30% sucrose cushion, followed by a second round of purification on a sucrose gradient (20-60%). Virions were detected in specific gradient fractions by radioactive counts and further confirmed by viral infectivity assay in MARC 145 cells. The GP3 was detected in gradient fractions containing purified virions by RIP using anti-GP3 antiserum. Predictably, the GP3 was less abundant in purified virions than other major structural envelope proteins such as GP5 and M. Further evidence of the presence of GP3 at the level of PRRSV FL12 envelope was obtained by immunogold staining of purified virions from the supernatant of infected cells with anti-GP3 antiserum. Taken together, these results indicate that GP3 is a minor structural component of the PRRSV type II (FL12 strain) virion, as had been previously described for PRRSV type I.

Comparison of a dedicated children's seizure clinic to mixed general paediatric clinics.

BACKGROUND: In the light of recent recommendations regarding the current management of children with possible epilepsy in the UK, different models of care are compared using an existing validated audit tool. METHODS: The initial clinical assessment process, investigation, management and communication regarding children referred with suspected epilepsy to general paediatric clinics or a paediatric seizure clinic was compared using the British Paediatric Neurology Association (BPNA) audit tool. Results Ninety-three children were included in the comparison. The history and description of the episodes was better documented in the Seizure Clinic (SC). Children's early development (79% vs. 50%) and school performance (86% vs. 42%) were better documented in the SC. Documentation of possible side effects relating to newly prescribed anti-epileptic drugs was poor in both groups (33% vs. 15%). CONCLUSIONS: Differences between models of epilepsy care can be detected using audit tools although there are some methodological limitations of this particular study. Future similar studies as well as informing local practice can add to the debate on the appropriate way forward in improving the care for children with epilepsy.

Solution self-assembly of hybrid block copolymers containing poly(ethylene glycol) and amphiphilic beta-strand peptide sequences.

The self-assembly in aqueous solution of hybrid block copolymers consisting of amphiphilic beta-strand peptide sequences flanked by one or two PEG chains was investigated by means of circular dichroism spectroscopy, small-angle X-ray scattering, and transmission electron microscopy. In comparison with the native peptide sequence, it was found that the peptide secondary structure was stabilized against pH variation in the di- and tri-block copolymers with PEG. Small-angle X-ray scattering indicated the presence of fibrillar structures, the dimensions of which are comparable to the estimated width of a beta-strand (with terminal PEG chains in the case of the copolymers). Transmission electron microscopy on selectively stained and dried specimens shows directly the presence of fibrils. It is proposed that these fibrils result from the hierarchical self-assembly of peptide beta-strands into helical tapes, which then stack into fibrils.

Comparison of conventional and pattern discrimination perimetry in a prospective study of glaucoma patients.

PURPOSE: To determine whether pattern discrimination perimetry detects progression of glaucomatous visual fields earlier than conventional static automated perimetry. METHODS: One hundred nine eyes of 109 patients with open angle glaucoma were enrolled in a longitudinal prospective study. Each patient underwent visual field examinations with conventional and pattern discrimination perimetry using the 30-2 program of the Humphrey Visual Field Analyzer (Humphrey Instruments Inc., San Leandro, CA) and a custom program for the pattern discrimination perimeter, respectively at 6-month intervals. Progression of glaucomatous visual field damage was assessed separately at each visit by predetermined criteria for conventional and pattern discrimination perimetry. The time to progression from baseline was calculated and the hemifield that showed progression first was documented for both conventional and pattern discrimination perimetry. RESULTS: Patients were followed for a mean of 5.1 years and a mean of 11.6 visits. Sixty-eight (62.3%) patients did not show progression with either technique. Of the remaining 41 patients, 15 (36.5%) showed progression with conventional perimetry alone, 9 (21.9%) with pattern discrimination perimetry alone, and 17 (41.4%) showed progression with both techniques. Of these 17 patients, 11 (64.7%) were detected earlier by conventional perimetry, and 6 (35.2%) were detected earlier by pattern discrimination perimetry. CONCLUSIONS: This study suggests that pattern discrimination perimetry is less effective than conventional perimetry in evaluating progressive glaucomatous visual field damage.

The in vitro-synthesized RNA from a cDNA clone of hepatitis E virus is infectious.

Hepatitis E virus (HEV) is an important etiological agent of epidemic and sporadic hepatitis, which is endemic to the Indian subcontinent and prevalent in most of the developing parts of the world. The infection is often associated with acute liver failure and high mortality, particularly in pregnant women. In order to develop methods of intervention, it is essential to understand the biology of the virus. This is particularly important as no reliable in vitro culture system is available. We have constructed a cDNA clone encompassing the complete HEV genome from independently characterized subgenomic fragments of an Indian epidemic isolate. Transfection studies were carried out with HepG2 cells using in vitro-transcribed RNA from this full-length HEV cDNA clone. The presence of negative-sense RNA, indicative of viral replication, was demonstrated in the transfected cells by strand-specific reverse transcription-PCR and slot blot hybridization. The viral proteins pORF2 and pORF3 and processed components of the pORF1 polyprotein (putative methyltransferase, helicase, and RNA-dependent RNA polymerase) were identified in the transfected cells by metabolic pulse-labeling with [(35)S]methionine-cysteine, followed by immunoprecipitation with respective antibodies. The expression of viral proteins in the transfected cells was also demonstrated by immunofluorescence microscopy. Viral replication was detected in the transfected cells up to 33 days posttransfection (six passages). The culture supernatant from the transfected cells was able to produce HEV infection in a rhesus monkey (Macaca mulatta) following intravenous injection, indicating the generation of viable HEV particles following transfection of cells with in vitro-synthesized genomic RNA. This transient cell culture model using in vitro-transcribed RNA should facilitate our understanding of HEV biology.

Cloning, sequencing, and expression of the hepatitis E virus (HEV) nonstructural open reading frame 1 (ORF1).

Hepatitis E virus (HEV) causes enterically transmitted epidemic and sporadic viral hepatitis affecting millions of people in the developing world. Different geographical isolates of HEV show a high degree of homology at the nucleotide and amino acid levels. The approximately 7.2 kb RNA genome has three open reading frames of which ORF1 is predicted to code for the viral nonstructural polyprotein. The expression, processing and properties of the nonstructural ORF1 polyprotein have not been reported so far. In this study, the complete HEV ORF1 was reconstructed from overlapping fragments amplified by polymerase chain reaction (PCR) of total RNA isolated from the bile fluid of a rhesus monkey experimentally infected with HEV isolate from an epidemic. The complete assembled ORF1 was sequenced using HEV specific primers. The ORF1 polyprotein was expressed in E. coli, in a cell free translation system and in HepG2 cells, and was characterized by western blotting and immunoprecipitation using acute phase patient serum as well as polyclonal antibodies raised against defined parts of the ORF1 polyprotein. The nonstructural polyprotein of HEV was expressed as a 186 kDa protein. No processing was observed into discrete units, either in-vitro based on a kinetic analysis, or in HepG2 cells based on immunoprecipitation.