Contracted Tuberculosis Research Articles

Novel germline variants of MUC3A in a patient with ER+ breast cancer and signet-ring cell stomach adenocarcinoma

BackgroundPrimary gastric cancer after breast cancer surgery and chemotherapy is rare and their genetic factors are poorly understood. In this case study, the exonic sequences of a gastric cancer (GC) patient with a previous history of breast cancer were explored. Materials and methodsThe study involves a 58-year-old diabetic patient from Mizoram, Northeast India underwent surgery and chemotherapy for estrogen receptor-positive breast cancer. The patient contracted tuberculosis and was later diagnosed with metastatic GC after 5 years and underwent subtotal gastrectomy followed by chemotherapy. Genomic DNA was isolated from the patient blood, whole exome sequencing was performed, and analyzed for germline variants. The variants were compared with exome data from additional 21 GC patients and 27 healthy controls. Statistical analysis was performed to compare the occurrence of variants between cancer and healthy control datasets. ResultsThe patient had CDH1, BRCA1, and BRCA2 mutations, while a rare variant rs750547893 in SMARCA4 was observed. Furthermore, an unusual phenomenon was observed in the MUC3A with 80 missense variants, including 19 novel variants. One-way ANOVA revealed a significant difference in the mean number of missense MUC3A variants observed between GC and healthy controls (F = 317.92, P = 1.50e-22). Fisher's exact test on the number of MUC3A missense variants in GC and healthy controls revealed 70 variants that were significantly associated with cancer (P < 0.05) and out of which 20 variants were present exclusively in the case, including 9 novel variants. ConclusionsThe rare variant, rs750547893 in SMARCA4 was not reported in the database of over 1000 healthy Indians (IndiGenomes database). Due to conflicting clinical interpretation, the variant is classified as the variant of uncertain significance (VUS), although it is reported for hereditary cancer predisposing syndrome in ClinVar. Furthermore, Statistical analysis revealed that these MUC3A variants could be a significant factor in cancer. The presence of such missense variants in MUC3A could affect the mucus integrity and might contribute to multiple types of cancer development in the patient. Due to the unavailability of pathogenicity information from the clinical point of view, the variants are classified as VUS. This is the first report of such a large number of variants in the MUC3A gene and future efforts may reveal the clinical significance.

Effectiveness of the Novel Anti-TB Bedaquiline against Drug-Resistant TB in Africa: A Systematic Review of the Literature.

Background: In 2018, an estimated 10.0 million people contracted tuberculosis (TB), and 1.5 million died from it, including 1.25 million HIV-negative persons and 251,000 HIV-associated TB fatalities. Drug-resistant tuberculosis (DR-TB) is an important contributor to global TB mortality. Multi-drug-resistant TB (MDR-TB) is defined as TB resistant to at least isoniazid (INH) and rifampin (RMP), which are recommended by the WHO as essential drugs for treatment. Objective: To investigate the effectiveness of bedaquiline addition to the treatment of drug-resistant TB infections on the African continent. Methodology: The search engine databases Medline, PubMed, Google Scholar, and Embase were used to obtain published data pertaining to DR-TB between 2012 and 2021 in Africa. Included studies had to document clinical characteristics at treatment initiation and outcomes at the end of treatment (i.e., success, failure, recurrence, loss to follow-up, and death). The included studies were used to conduct a meta-analysis. All data analysis and visualization were performed using the R programming environment. The log risk ratios and sample variances were calculated for DR-TB patients treated with BBQ monotherapy vs. BDQ and other drug therapy. To quantify heterogeneity among the included studies, random effect sizes were calculated. Results: A total of 16 studies in Africa from Mozambique (N = 1 study), Eswatini (N = 1 study), Democratic Republic of the Congo (N = 1 study), South Africa (N = 12 studies), and a multicenter study undertaken across Africa (N = 1 study) were included. In total, 22,368 individuals participated in the research studies. Among the patients, (55.2%; 12,350/22,368) were male while 9723/22,368 (44%) were female. Overall, (9%; 2033/22,368) of patients received BDQ monotherapy, while (88%; 19,630/22,368) patients received bedaquiline combined with other antibiotics. In total, (42%; 9465/22,368) of the patients were successfully treated. About (39%; 8653/22,368) of participants finished their therapy, meanwhile (5%; 1166/22,368) did not finish their therapy, while people (0.4%; 99/22,368) were lost to follow up. A total of (42%; 9265/22,368) patients died. Conclusion: Very few studies on bedaquiline usage in DR-TB in Africa have been published to date. Bedaquiline has been shown to enhance DR-TB results in clinical studies and programmatic settings. Hence, the World Health Organization (WHO) has recommended that it be included in DR-TB regimens. However, in the current study limited improvement to DR-TB treatment results were observed using BDQ on the continent. Better in-country monitoring and reporting, as well as multi-country collaborative cohort studies of DR-TB, can expand the knowledge of bedaquiline usage and clinical impact, as well as the risks and benefits throughout the continent.

Synthesis, Molecular Docking, and In vitro Antimycobacterial Studies on N'-arylidene-4-nitrobenzohydrazides.

Mycobacterium tuberculosis (Mtb) is an organism that causes tuberculosis (TB). In 2019, 10 million individuals worldwide contracted tuberculosis, with 1.4 million people dying from the disease each year (World Health Organization, 2021). Hydrazones- hydrazide-based drugs have been shown to be bactericidal against M. tuberculosis replication. We herein intended to synthesize a series of acid hydrazones (3a-3l) by condensing 4-nitrobenzohydrazine with substituted aromatic acids in ethanol at room temperature. All newly synthesized compounds were characterized by standard spectroscopic techniques. Synthesized compounds were then tested for anti-mycobacterial activity against H37Rv strains. Molecular docking analysis was performed for three crystal structures of 1ENY, 1TED and 2FUM Mycobacterium tuberculosis receptors. Among all tested molecules, 3i (MIC: 50 μg/mL) and 3b (MIC: 50 μg/mL) were found to be the best ligands for further development of new anti-TB drug. We found that our proposed molecules have higher docking scores, corresponding standard anti-TB agents, such as ciprofloxacin and isoniazid. Synthesized compounds were found to have druglikeness properties when tested with Lipinski's filter for drug-likeness. Our current study proposes N'-arylidene-4-nitrobenzohydrazides as anti-TB agents. Agents with such system can be developed in future for development into active lead molecules.

Familial Tuberculosis and its Prevention in Terms of Health Care Restructuring

Aim: To study the peculiarities of the course of familial tuberculosis, which includes tuberculosis revealed in someone in the family if there is a source of this infection. Materials and methods: We studied 199 families. One member of each family contracted pulmonary tuberculosis and later became a source of the disease for contactees. The examination was performed with standard clinical techniques using radiological, bacteriological, and immunological examination techniques. Results: We found that in 12-24 months, 207 people were diseased in these families. We also revealed the shift toward a younger age among the diseased contactees. Special emphasis should be paid to the disease of children under 18–52 people, while there was only one patient among the sources of tuberculosis. There were more cases of familial tuberculosis in urban than in rural areas. Females were more likely to suffer from these forms of tuberculosis. Conclusions: Considering the above, we believe that the development of familial tuberculosis occurs due to closer contact of TB source patients with family members, which is facilitated by bad habits of source patients and lack of isolation of contactees from sources and ill-considered reform of health care in general and tuberculosis particularly.

A MINI-REVIEW ON RESPIRATORY DISEASES- CHRONIC OBSTRUCTIVE PULMONARY DISEASE, TUBERCULOSIS, AND PNEUMONIA- A GLOBAL HEALTH ISSUE

The lungs are the crucial organ that can be infected or injured by airborne particles. Respiratory disorders are the main cause of mortality and morbidity worldwide. COPD affects around 65 million people globally and kills three million people annually, the world's third greatest reason for mortality. Pneumonia kills millions of citizens each year and is the top cause of mortality in kids under the age of five. Every year, about Ten million people contract tuberculosis (TB), and more than one million people die from it, ranking it as the most prevalent fatal infectious illness. "Prevention, control, and cure" of these disorders, as well as improvement of lung diseases, must be primary concerns in global health judgment. The current article will, without hesitation, raise global understanding about the major respiratory illnesses and spur actions among all stakeholders. This article presents a comprehensive study and highlights the recent changes in respiratory diseases such as Chronic Obstructive Pulmonary Disease, Tuberculosis, and Pneumonia considering the extent of a global problem, Epidemiology, Pathology and pathogenesis, preventive strategies, and treatment.

Waheed Arian: supporting health care in conflict zones

Waheed Arian is an accident and emergency doctor at Shrewsbury and Telford Hospital NHS Trust in the UK and an NHS Innovation Clinical Entrepreneur Fellow and Mentor. But his journey to becoming a doctor was challenging. Born in Kabul in 1983, the first 5 years of his life were spent in hiding from rockets, bombs, and shelling, until his family migrated to Pakistan for their safety. For the next 3 months their home would be the Babu refugee camp near the city of Peshawar. At the camp, Arian became malnourished and contracted malaria and tuberculosis. “Although refugee camps are safe from bombs, there is so much malnourishment, the conditions are ripe for disease”, he says. The care he received made an impact: “The more I was going back and forth to the doctor to be weighed and find out how my progression was, the more inquisitive I became. I saw I was getting healed…that medicine was the best way for me, maybe, in the future, through which I could help people as well.”

Comparative study of serum copper, zinc, Cu/Zn ratio in pulmonary tuberculosis patients with normal subjects

Introduction: Tuberculosis (TB) is an important global health problem. It has more impact on developing and underdeveloped countries. The impact of tuberculosis can be seen by the fact that in 1993, the world Health Organization (WHO) declared tuberculosis a Global Emergency. WHO estimated that tuberculosis infects about one-third of world’s population. Every year, 8 million people contract tuberculosis, of which 95% are in the developing world.1 Aims and Objectives: To estimate and compare serum Copper, Zinc levels, and Cu/Zn ratio in newly detected pulmonary tuberculosis patients with healthy volunteers. To estimate Total Protein and Albumin levels to rule out hypoproteinemia. Materials and Methods: The study included 40 newly detected sputum positive pulmonary tuberculosis patients and 40 healthy volunteers. Serum copper and zinc was estimated by colorimetric method using RA-50 semi autoanalyser. Total protein was estimated by biuret method and Albumin, by bromocresol green method using automated analyser. Results and Conclusions: There was a significant increase in serum copper levels in pulmonary tuberculosis patients when compared to control group (P) Keywords: Pulmonary Tuberculosis, Copper, Zinc, Cu/Zn Ratio, Total Protein, Albumin

Foster Swift: A guiding spirit in early American dermatology

Foster Swift (1833-1875) was a pioneer of early American dermatology. In 1866, he became one of the first lecturers on diseases of the skin in the United States at the Bellevue Hospital Medical College, New York. The following year, he was appointed one of our nation's first professors of dermatology at the same institution. In 1869, Swift helped to found the New York Dermatological Society, the first such organization in the world. He also contributed to the American Journal of Syphilography and Dermatology, the first dermatology journal to be published in the United States. Unfortunately, Swift contracted tuberculosis in 1870, curtailing his professional career, and he died of the disease five years later. This contribution tells the story of Foster Swift, a most remarkable physician, who guided and helped to shape American dermatology during its formative years.

Clinical trials and the COVID-19 pandemic.

Clinical trials and the COVID-19 pandemic.

The Diagnosis and Treatment of Tuberculosis.

Around 10 million people worldwide contract tuberculosis every year. According to the World Health Organization (WHO), approximately one-quarter of the world's population is latently infected with Mycobacterium tuberculosis. In Ger- many, the incidence of tuberculosis was in decline over several decades but rose in 2015 to 7.3 new cases per 100 000 persons. In 2018, a total of 5429 new cases were documented, corresponding to 6.5 new cases per 100 000 persons. This article is based on literature retrieved by a selective search in PubMed and on the authors' clinical experience. Tuberculosis involves the lungs in almost 75% of patients but can generally involve any organ. In Germany, the majority of patients come from high-incidence countries. If a patient's differential diagnosis includes tuberculosis, the main tests for the detection of the pathogen in sputum and tissue samples are culture (the gold standard), microscopy, and nucleic acid amplification tests. Imaging studies are also used for diagnosis and follow-up. The standard treatment consists of a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide, followed by a combination of isoniazid and rifampicin only. Liver damage is one of the more common adverse effects of this treatment, arising in 2.4% of patients. Multidrug-resistant tuberculosis, which is rare in Germany (around 100 cases per year), should be treated in special- ized centers. Rapid diagnosis and targeted treatment are essential to prevent an unfavorable course of the disease as well as its transmission to other individuals. In patients presenting with unclear symptoms, tuberculosis should always be considered as a differential diagnosis. The diagnosis of latent tuberculosis and decision-making regarding its treatment are difficult because of the lack of specific biomarkers and of relevant data from clinical trials.

Probing the Robustness of Inhibitors of Tuberculosis Aminoglycoside Resistance Enzyme Eis by Mutagenesis.

Each year, millions of people worldwide contract tuberculosis (TB), the deadliest infection. The spread of infections with drug-resistant strains of Mycobacterium tuberculosis (Mtb) that are refractory to treatment poses a major global challenge. A major cause of resistance to antitubercular drugs of last resort, aminoglycosides, is overexpression of the Eis (enhanced intracellular survival) enzyme of Mtb, which inactivates aminoglycosides by acetylating them. We showed previously that this inactivation of aminoglycosides could be overcome by our recently reported Eis inhibitors that are currently in development as potential aminoglycoside adjunctive therapeutics against drug-resistant TB. To interrogate the robustness of the Eis inhibitors, we investigated the enzymatic activity of Eis and its inhibition by Eis inhibitors from three different structural families for nine single-residue mutants of Eis, including those found in the clinic. Three engineered mutations of the substrate binding site, D26A, W36A, and F84A, abolished inhibitor binding while compromising Eis enzymatic activity 2- to 3-fold. All other Eis mutants, including clinically observed ones, were potently inhibited by at least one inhibitor. This study helps position us one step ahead of Mtb resistance to Eis inhibitors as they are being developed for TB therapy.

Targeting HIV-TB coinfection by developing novel piperidin-4-substituted imines: Design, synthesis, in vitro and in silico studies.

Tuberculosis is the "Achilles heel" of the human immunodeficiency (HIV) ministration. HIV-positive people are 16-27 times more prone to contract tuberculosis. But the adverse interaction between antiretroviral drugs and antitubercular drugs has made it necessary to look for a single drug regimen for HIV-TB coinfection. Piperidine derivatives have been reported as anti-HIV and anti-TB agents. This inspired us to design, synthesize, and characterize a series of 3,5-bis(furan-2-ylmethylidene)-piperidin-4-substituted imines (R1-R25) and these were further screened for in vitro antitubercular activity against Mycobacterium tuberculosis H37Rv and anti-HIV activity. Molecular docking studies showed energetically favorable binding interactions with both EACP reductase (1ZID.pdb) and reverse-transcriptase (1REV.pdb) targets. The compounds R7, R12, R17, R18, R19, R20 were found to be more potent as anti-TB agents than ethambutol (MIC 3.125 μg/ml). Compound R7 was found to be moderately active with an IC50 of 2.1 ± 0.04 μM in multicycle infection assays, in comparison with the standard drug, zidovudine (IC50 = 5.7 ± 0.04 nM), used as anti-HIV drug. The cytotoxicity assay was done on Vero, MT-2, and TZM-bl cells to assess the safety of these compounds and they were found to be safe. From the above results, R7 seems to be a promising lead for anti-HIV and anti-TB activity.

The Evil That Surrounds Us: The WWII Memoir of Erna Becker-Kohen by Erna Becker-Kohen

Reviewed by: The Evil That Surrounds Us: The WWII Memoir of Erna Becker-Kohen by Erna Becker-Kohen Alison Rose Erna Becker-Kohen, The Evil That Surrounds Us: The WWII Memoir of Erna Becker-Kohen. Edited and translated by Kevin P. Spicer and Martina Cucchiara. Bloomington: Indiana UP, 2017. 161 pp. With this publication, Kevin P. Spicer and Martina Cucchiara make Erna Becker-Kohen's moving account of her wartime experience as an intermarried German Jewish convert to Catholicism available to an English-speaking audience. Becker-Kohen deposited her manuscript with the Leo Baeck Institute in 1976. A German edition of her memoir was published with an epilogue in 1980. The new edition includes a translation of the memoir and the 1980 epilogue, an introduction explaining its historical context (including how mixed marriages were treated and categorized in Hitler's Germany, the Factory Action of 1943 during which Becker-Kohen was arrested, and the controversy over the actions and inactions of the Catholic hierarchy and individuals during the Holocaust), extensive notes identifying historical events and people mentioned in the text, and a heart-rending afterword by Becker-Kohen's granddaughter, Esther-Maria Nägele, telling of the tragic murder of her parents in Libya in 1994. Becker-Kohen's memoir is written in the form of a diary, although as Spicer and Cucchiara point out, it uses the literary format of a memoir. It is truthful but not neutral, written through the lens of Christianity (4–5) while chronicling nagging doubts and uncertainty about her conversion. It begins in 1937 when the couple was expecting their first (and only) child, Silvan, and [End Page 114] can be divided into roughly three sections: living in Berlin until 1943 in social isolation and fear, being a refugee in the formerly Austrian provinces of Tyrol and Vorarlberg chased from one small town to another, and the postwar period in which she came to terms with devastation, loss of family and home, and ultimately the death of her husband. The memoir sheds light on the impact of the Holocaust on intermarried families. Initially Becker-Kohen's marriage protected her from economic deprivation, deportation, and certain forms of persecution—such as wearing the yellow star. However, she was not spared from the hatred and malice of her neighbors. She was met with anti-Semitism in Berlin cloisters where she sought protection and in air raid shelters; she was subjected to Gestapo searches, denied a gas mask for herself and her son, and ultimately arrested but released during the Factory Action on March 6, 1943. On the run with Silvan, she faced hostile officials; a lack of reliable food, shelter, and transportation; a harsh and unfamiliar climate and landscape; and constant illness. Her husband, as a so-called race-defiler, in 1944 was put into forced labor where he contracted tuberculosis, causing him years of pain and suffering, which ultimately cost him his life. Becker-Kohen also hints at the way gender and motherhood figured into her experience. While motherhood added the responsibility for the well-being of her son, putting her in further danger, it also provided her with purpose, companionship, hope, and at times much-needed sympathy from strangers. She often comments on her connection with children. In April 1945, she writes that children were her greatest joy; she trusted them more than adults. She alludes to the threat of sexual violence she faced as a woman as she sought refuge at the hands of strangers and recalls her husband finding it "unmanly" to shop for food when she was subjected to limited rations and hours in which to shop. Several of her preoccupations, struggles, and experiences might be attributed to gender, as has also been shown in research on gender and the Holocaust. The overriding message of the text is one of ambivalence. She describes her internal turmoil over her conversion, her guilt over her husband's suffering as the price of her survival, the destruction of her family and the sorrow she caused them through her conversion, and the mixed reception she and Silvan received at the hands of the local population both in Berlin and in the Alpine villages. The title...

Systemic sclerosis due to crystalline silica exposure among jewelry workers in Korea: two case reports

BackgroundOccupational exposure to crystalline silica is a potential risk factor for various systemic autoimmune diseases including systemic sclerosis. The etiology of systemic sclerosis is not conclusively known, but there are epidemiological studies that show the relationship between exposure to crystalline silica and risk of systemic sclerosis. Here we report, for the first time, two cases of crystalline silica-related systemic sclerosis in patients who worked in crystal processing in the jewelry-manufacturing field.Case presentationCase 1 is a 57-year-old man who had worked mainly in crystal processing for multiple jewelry-processing companies for 17 years, since the age of 15 years. He contracted tuberculosis at the age of 25 years and showed Raynaud’s phenomenon of both the hands and feet at age 32 years. Digital cyanosis and sclerosis developed at approximately age 41 years. The patient was diagnosed with systemic sclerosis at age 48 years.Case 2 is a 52-year-old man who worked in crystal processing for various jewelry-processing companies for 7 years, since the age of 23 years. He first showed signs of cyanosis in the third and fourth digits of both hands at age 32 years, was diagnosed with Raynaud’s syndrome at age 37 years, and was diagnosed with systemic sclerosis at age 38 years.Crystal processing is a detailed process that involves slabbing and trimming the selected amethyst and quartz crystals, which requires close proximity of the worker’s face with the target area. In the 1980s and 1990s, the working hours were 12 h per day, and the working environment involved 15 workers crowded into a small, 70-m2 space with poor ventilation.ConclusionTwo workers who processed crystals with a maximum crystalline silica content of 56.66% developed systemic sclerosis. Considering the epidemiological and experimental evidence, exposure to crystalline silica dust was an important risk factor for systemic sclerosis. An active intervention is necessary to reduce exposure in similar exposure groups in the field of jewelry processing.

Obituary: A Remembrance of Francis M. Howard MD (1922-2016).

Obituary: A Remembrance of Francis M. Howard MD (1922-2016).

Histoplasmosis by Histoplasma capsulatum var. duboisii Observed at the Laboratory of Pathological Anatomy of Lomé in Togo.

Our study aimed to describe the epidemiological, clinical, and diagnostic aspects of African histoplasmosis in Togo through a descriptive and cross-sectional study on histological diagnosed African histoplasmosis in Pathology Department of Lomé from 2002 to 2016 (15 years). A total of 17 cases of African histoplasmosis were diagnosed. The sex ratio (M/F) was 1.8. The annual incidence was 1.1 cases. The mean age of the patients was 27.2 ± 0.4 years. All our patients were of social categories with a low socioeconomic level. HIV infection was known in 3 patients and one patient contracted tuberculosis. The clinical manifestations were cutaneous in 7 cases, cutaneous and mucous in 3 cases, cutaneous and lymph node in 3 cases, cutaneous and bone in 2 cases, and disseminated in 2 cases. The samples examined consisted of 14 cutaneous biopsies measuring 2-3 cm and 3 ganglionic biopsies each measuring 4 cm of major axis. Histologically, all cases were of chronic form made of granulomatous reaction with ovoid yeasts measuring between 1 and 2 microns. Despite the low frequency of this disease in our country, it should be kept constantly in mind before any granulomatous lesions, especially in the context of the HIV pandemic.

The ‘Best Breathed’ Knights in a Stertorous Age: Tuberculosis and Sidney Lanier’s The Boy’s King Arthur

Having contracted tuberculosis during the Civil War, Sidney Lanier valorized the ‘healthful’ qualities of medieval literature in his Reconstruction-era writings. This essay argues that Lanier prescribed his Boy’s King Arthur as a cure for disease-ridden bodies both politic and personal.

Ron Mann

Professor Dr Ronald Mann, the founding editor of Pharmacoepidemiology and Drug Safety, died on 19 November 2013 from cardiorenal failure. Ron, as he was universally known, spent a professional lifetime in a quest to improve the scientific quality of drug safety data by the application of epidemiological principles, which he helped formulate. The quality and present standing of this journal in the field bear ample testimony to the success of his efforts. Following graduation in medicine, Ron trained as a physician. He spent 6 years in general practice, developing skills particularly in obstetrics, before joining the pharmaceutical industry, where he was to spend 19 years in the UK, Japan, Hong Kong, the USA and Belgium. It was in this role that he first became aware of the inadequacies of then current practices in drug safety in industry and clinical medicine and so it was a logical move for him to join the Division of Medicines of the UK Department of Health as a Medical Assessor, where his remit was to improve the system of adverse reaction reporting. He was later to describe his frustration at his inability to handle what are now known as large databases relating to drug safety, but adequate technology was not yet available. Ron became the Head of Drug Safety and, in his efforts to apply the methods of epidemiology to drug safety in what is now known as pharmacoepidemiology, he found a willing ally in Dr Sue Wood, who was to succeed him at the Medicines Control Agency (MCA). At this time, controversy about the safety of oral contraceptive steroids was becoming a major issue, and much of their work was devoted to understanding the public health implications of their use. After a spell as Medical Secretary of the Royal Society of Medicine (where he was able to indulge his other passion, the history of therapeutics), Ron moved to the University of Southampton, succeeding Dr Bill Inman as Director of the Drug Safety Research Unit (DSRU), where the technique of prescription event monitoring (PEM) had been pioneered and which Ron developed greatly. Under his guidance, PEM took its place with spontaneous adverse reaction reporting as a powerful tool in what is now known as passive surveillance of drug safety. One of Ron's greatest strengths was as a communicator, and it was in this vein that he created this journal, which he entitled Pharmacoepidemiology and Drug Safety, embodying the two disciplines which he believed were inseparable. He was also a prolific writer; his two major books, Modern Drug Use (1984), of which he was the sole author, and Drug Safety (1992), the multi-author book, of which he was the founding editor, are both standard textbooks in the field. But as well as Ron's huge scientific achievements, it is also as a delightful colleague that we will remember him. His kindness and helpfulness to junior colleagues at the MCA and the DSRU are legion. Our friendship with Ron developed when we were both members of the Committee on Safety of Medicines, and to listen to his reminiscences of a long and varied career lightened many afternoons at Market Towers. As a medical student at Westminster Hospital Medical School, he was awarded the King's Scholarship, which had been established by the late King George VI. In this role, we understand that Ron's main duty was to accompany the King, annually, to a service in St George's Chapel and to find the appropriate place in the King's hymnal during the proceedings. While assisting, as a trainee physician, in a cisternal puncture in a patient with tuberculous meningitis, the glass syringe broke, showering Ron with tuberculous pus, from which he contracted pulmonary tuberculosis. After treatment with streptomycin and 2 years of bed rest at King Edward VII Hospital in Midhurst, West Sussex, he recovered, but he recalled to us that these 2 years in bed were the worst of his life. Ron Mann was one of the people who made a real difference. We salute his contributions to drug safety and to the public health, we thank him for the advice and guidance he gave us and we are grateful for being able to call him our friend.

Peritoneal Tuberculosis in a Pregnant Woman from Haiti, United States

Peritoneal Tuberculosis in a Pregnant Woman from Haiti, United States

Choroidal tuberculoma in a patient with ocular Behçet disease

Behçet disease is a chronic relapsing inflammatory disease affecting many different organs. Ocular involvement is quite common in the course of Behçet disease and is frequently manifested by bilateral panuveitis and retinal vasculitis. Medications such as corticosteroids and immunosuppressive agents are used to reduce inflammation in patients with posterior or panuveitis. Chronic immunosuppression is a risk factor for systemic infections. We report a case of choroidal tuberculoma associated with tuberculosis in a patient with ocular Behçet disease. A 25-year-old female with known ocular Behçet disease contracted tuberculosis 3 months earlier. She had been receiving methotrexate and oral steroids. Funduscopy of the left eye revealed a choroidal tuberculoma located superonasally to the optic disc. Fluorescein angiography showed a central area of hypofluorescence surrounded by a hyperfluorescent zone. Since she was already receiving antituberculosis treatment combined with oral steroids, the same treatment was continued. Diagnosis of the other diseases that may cause uveitis in patients with Behçet disease should not be missed. This is especially important since immunosuppressive drugs, that cause an increased incidence of systemic infections, are the common treatment of choice for patients with Behçet disease.