Pigment Deposition Research Articles

Long-term prospective assessment of subconjunctival triamcinolone acetonide in addition to topical therapy in the management of chronic superficial keratitis

Chronic superficial keratitis (CSK) is a progressive inflammatory disease in adult dogs, associated with corneal vascular proliferation, edema and melanic pigment deposition. In the absence of a curative therapy, the current approach for the management of CSK aims to control disease progression and eventually decrease the severity of corneal lesions. Subconjunctival injections of corticosteroids may be effective in severe cases, where topical therapy alone is inadequate. The aim of this study was to comprehensively evaluate the effectiveness of subconjunctival triamcinolone acetonide (TA) injection in addition to topical steroid treatment for the long-term management of CSK, in dogs unresponsive to conventional topical steroids. Treatment efficacy was assessed in 11 dogs with bilateral CSK by periodic evaluation of the cornea in terms of vascularization, edema and pigmentation for up to 120 weeks. Clinically significant reductions in corneal pigmentation (P<0.0001), vascularization (P<0.0001) and edema scores (P<0.0001) were achieved during therapy. The greatest reduction was exhibited by corneal edema, closely followed by vascularization. Corneal pigmentation was less responsive and complete regression has not been achieved in any of the dogs. Severely affected corneas exhibited greater improvements in terms of pigmentation, whereas moderately affected corneas showed a slight decrease. Corneal edema and vascularization were adequately controlled, whereas corneal pigmentation exhibited a lower decrease in severity and was more difficult to manage on a long-term basis. This study suggests that subconjunctival injection of TA in addition to topical steroids could represent an effective option for long-term management of CSK in dogs unresponsive to topical steroids alone

Clinical and Surgical Outcome of a Supplementary Multifocal Intraocular Lens Implanted with a Bag-In-the-Lens Intraocular Lens: 5-Year Follow-Up

Introduction: To assess the postoperative outcome and patient-reported satisfaction, spectacle independence, and dysphotopsia after implantation with the mutifocal Rayner Sulcoflex supplementary intraocular lens (sIOL). Materials and Methods: We analyzed the outcome of all patients implanted with a multifocal sIOL between 2009 and 2011. In all cases, the sIOL was the Rayner Sulcoflex IOL (type 653F) and the primary IOL was a bag-in-the-lens (BIL) IOL. The data were obtained through a retrospective analysis of the patient records and by means of a questionnaire, 5 years after sIOL implantation. Results: This study included 31 eyes of 20 patients. In 13 eyes, the sIOL needed explantation (n = 13, 41.94%). Dysphotopsia is a frequent complaint (12/15 patients: 80.0%) after sIOL implantation. In 13 out of 31 eyes (41.94%), pigment deposits were found on the sIOL with variable clinical complaints. Five eyes required additional surgery because of clinically significant deposits. Discussion/Conclusion: Patients with a multifocal sIOL in combination with a BIL implantation have a higher incidence of dysphotopsia compared to previously published studies. Dysphotopsia was the main complaint and reason for explantation. We encountered a high incidence of pigmented IOL deposits. The sIOLs can be safely removed even years after implantation.

Gross and Histopathological Study of the Genitalia in Goats: 2. Tubular Genital Organs (Uterine tubes and Uterus)

The aim of this study was to detect the microscopic and macroscopic lesions in uterine tubes and uterus in Sluaimani abattoir, Kurdistan region/Iraq. The total samples collected were 340 genitalia of does of pregnant and non-pregnant. 37.05% (126/340) of the samples were pregnant and 37.35% (127/340) of the samples were observed without gross lesions and 2.23% (10/340) were noticed with uterine tube gross abnormalities and the remaining 34 (12.941%) samples were recorded as anatomical lesions and pathological lesions of uterus. The a numbers of uterine tubes abnormalities were 11 out of 340 specimens (3.235%), and the most common lesions were; salpingitis 6 cases (7.64%); 1 case from each of hydrosalpinx and Pyosalpinx, respectively (0.294%). Microscopically, the lesions of salpingitis were sloughing off the part of the epithelium and infiltration of inflammatory cells. Three specimens of cyst on uterine tubes (0.882%). The numbers of uterine lesions were 44 specimens which shared 12.941% of abnormalities out of the 340 collected specimens. The most common diseased genital cases were; endometritis and metritis which 21 cases (6.176%), which were histopathologically characterized by a significant increase in the endometrial thickness due to diffuse infiltration of inflammatory cells mainly lymphocytes, the proliferation of fibroblasts with deposition of extracellular matrix. Five pyometra (1.470%), which was histolopatholgically characterized by definite increase in the uterine wall thickness, especially in the endometrium due to infiltration of light pinkish fibrinous inflammatory exudates with mild inflammatory cell proliferation. Three Hydrometra specimens (0.882%), and five endometrial cystic hyperplasia (1.470%). The microscopic lesions for them include massive cystic dilatation of the uterine gland that contains pinkish granular secretion, infiltration of light pinkish edematous fluid in the endometrial stroma associated with inflammatory cells. Two specimens of uterine wall with cysticercus tenuicolis (0.588%), and one uterine melanoma (0.294%), The histopathological features for the uterine melanoma include; deposition of the dark black melanin pigment within the phagocytic cells. Uterine leiomyosarcoma was one specimens (0.294%), which histologically, appear as pleomorphic cells variable in shape and size with different nuclear size randomly oriented in different directions, some of these cells were hyperchromatic with an abnormal mitotic figure. One case of cyst on the uterine wall was found (0.294%), and five cervicitis (1.470%). Finally, it could be concluded that uterine tubes, and uterus abnormalities constitute a percentage (3.235%, and 12.941%), respectively. In this study, uterine melanoma, and uterine leiomyosarcoma were firstly recorded in this study in Iraq and Kurdistan region.

Idiopathic acquired haemophilia with inhibitors to factor VIII and IX in an elderly female: a case report

The AMJ is a peer-reviewed, biannual health journal published by Anuradhapura Clinical Society (ACS). The Journal strives to be a forum for all health professionals to publish original research and review articles in their area of expertise. The AMJ publishes articles in clinical medicine, public health and health promotion. Our priority is given to manuscripts on health related issues which affects the communities living in rural tropical communities. Established as a journal in 2006 as a publication parallel to ACS annual scientific sessions, the journal was relaunched as a proper journal in 2013. Anuradhapura Medical Journal is a member of COPE and is included on DOAJ. Cover Image:Mixed cholesterol gallstonesLight microscopic appearance of a cross-section of a mixed cholesterol gallstone. The distinct light and dark layers demonstrate cholesterol and pigment deposits respectively. Bottom right: Morphological characteristics of mixed cholesterol gallstones. The cross-sections of mixed cholesterol gallstones show multiple cholesterol layers deposited around a pigment nidus in the center. Dr. Harshi Weerakoon

Donkey genomes provide new insights into domestication and selection for coat color

Current knowledge about the evolutionary history of donkeys is still incomplete due to the lack of archeological and whole-genome diversity data. To fill this gap, we have de novo assembled a chromosome-level reference genome of one male Dezhou donkey and analyzed the genomes of 126 domestic donkeys and seven wild asses. Population genomics analyses indicate that donkeys were domesticated in Africa and conclusively show reduced levels of Y chromosome variability and discordant paternal and maternal histories, possibly reflecting the consequences of reproductive management. We also investigate the genetic basis of coat color. While wild asses show diluted gray pigmentation (Dun phenotype), domestic donkeys display non-diluted black or chestnut coat colors (non-Dun) that were probably established during domestication. Here, we show that the non-Dun phenotype is caused by a 1 bp deletion downstream of the TBX3 gene, which decreases the expression of this gene and its inhibitory effect on pigment deposition.

Surgical Management for Silicone Oil Barrier of Traumatic Aniridia with Aphakia: Suturing of Temporary Iris-Diaphragm Prior to Final Iris-Lens-Diaphragm Implantation.

PurposePatients with traumatic aniridia, aphakia and retinal complications can require silicone oil endotamponade. In the absence of compartmentalization, there is a risk of silicone oil migrating to the anterior chamber which can cause long-term complications. We report a two-step procedure in trauma cases, using sutures for silicone oil retention in primary care and subsequently prior to secondary artificial iris (AI) and intraocular lens (IOL) implantation, to achieve a reconstruction of the anterior and posterior chamber.Material and MethodsSeven patients with loss of the iris-lens-diaphragm after an ocular trauma and the need for silicone oil endotamponade underwent a primary intervention including wound closure, placement of silicone oil retention sutures and silicone oil filling. Four of those underwent secondary reconstruction with silicone oil removal and AI and IOL implantation and could be included in this retrospective observational study. All main outcome measures were evaluated after the first and after the second surgery. The main outcome measures were morphological findings, subjective impairment from glare, subjective cosmetic disfigurement, patient satisfaction and intraocular pressure (IOP) as well as best-corrected distance visual acuity and objective refraction.ResultsThe retention sutures could effectively prevent silicone oil migration into the anterior chamber in the first surgery. Silicone oil emulsifications in the anterior chamber were observed in one patient. In two patients, pigment deposition at the sutures was seen. Subjective impairment from glare and subjective cosmetic disfigurement could be reduced after the second surgery compared to the evaluation after the first surgery. IOP and best-corrected distance visual acuity remained stable. No eye needed silicone oil refilling after the secondary reconstruction surgery.ConclusionOur two-step approach is viable and provides good functional and aesthetic results. We observed a high patient satisfaction.

A case of dense pigment deposition of the posterior lens capsule

BackgroundPigment dispersion syndrome (PDS) is a well-known entity which can lead to pigmentary glaucoma (PG). This case report presents a rare presentation of PG with bilateral dense pigment deposits of the posterior lens capsule.Case presentationA 72-year-old male came for his first appointment due to an asymmetric worsening of visual acuity. The examination showed unilaterally severely increased intraocular pressure, bilateral dense pigment deposition of the posterior lens capsule, and a shallow unilateral optic disk excavation. Gonioscopy revealed moderate pigmentation of the angle and a concave configuration of the peripheral iris in both eyes. The standard slit lamp examination showed no transillumination defects of either iris. Optical coherence tomography showed retinal nerve fiber layer (RNFL) thinning in the peripapillary and macular regions. An antiglaucoma medication was prescribed with a good lowering effect.ConclusionPigment deposition of the posterior lens capsule, which has been rarely reported, is a possible important sign of PDS or PG.

Clinical and Genetic Analysis of 63 Families Demonstrating Early and Advanced Characteristic Fundus as the Signature of CRB1 Mutations

To reveal the characteristics of ocular changes in patients with biallelic CRB1 mutations. Comparative exome sequencing and retrospective case series on clinical data. Seventy-four patients from 63 families with biallelic potential pathogenic variants in CRB1 were selected from our in-house exome sequencing. The clinical data were reviewed and evaluated in detail, including best-corrected visual acuity, fundus photography, optical coherence tomography (OCT), and electroretinogram (ERG). Biallelic CRB1 variants, involving 45 variants including 23 novel, were identified in 40 novel families based on exome sequencing. Analyzing clinical data of the 74 individuals from 63 families revealed the following CRB1-associated phenotypes: (1) early-onset reduced visual acuity with congenital nystagmus; (2) 2 types of characteristic retinal changes including yellowish geographic macular degeneration (YMD) or nummular pigment deposits (NPD) at posterior retina with bone-spicule pigmentation at midperipheral retina; (3) undetectable rod and cone responses on ERG; (4) cystoid macular edema or macular atrophy on OCT. YMD and NPD are unique and CRB1-associated. Long-term follow-up examination as well as age- and variant-dependent phenotypic analysis suggested YMD is the early fundus change that would gradually progress to NPD. YMD and NPD are 2 major characteristic CRB1-associated fundus changes and the former one will advance to the latter with age. Recognizing such characteristic signs associated with biallelic CRB1 variants may be of value in areas without widespread access to genetic testing where a more targeted approach is needed and might be biomarkers for evaluation of effects for future intervention.

Anatomical Distribution of Ochronotic Pigment in Alkaptonuric Mice is Associated with Calcified Cartilage Chondrocytes at Osteochondral Interfaces

Alkaptonuria (AKU) is characterised by increased circulating homogentisic acid and deposition of ochronotic pigment in collagen-rich connective tissues (ochronosis), stiffening the tissue. This process over many years leads to a painful and severe osteoarthropathy, particularly affecting the cartilage of the spine and large weight bearing joints. Evidence in human AKU tissue suggests that pigment binds to collagen. The exposed collagen hypothesis suggests that collagen is initially protected from ochronosis, and that ageing and mechanical loading causes loss of protective molecules, allowing pigment binding. Schmorl’s staining has previously demonstrated knee joint ochronosis in AKU mice. This study documents more comprehensively the anatomical distribution of ochronosis in two AKU mouse models (BALB/c Hgd−/−, Hgd tm1a−/−), using Schmorl’s staining. Progression of knee joint pigmentation with age in the two AKU mouse models was comparable. Within the knee, hip, shoulder, elbow and wrist joints, pigmentation was associated with chondrons of calcified cartilage. Pigmented chondrons were identified in calcified endplates of intervertebral discs and the calcified knee joint meniscus, suggesting that calcified tissues are more susceptible to pigmentation. There were significantly more pigmented chondrons in lumbar versus tail intervertebral disc endplates (p = 0.002) and clusters of pigmented chondrons were observed at the insertions of ligaments and tendons. These observations suggest that loading/strain may be associated with increased pigmentation but needs further experimental investigation. The calcified cartilage may be the first joint tissue to acquire matrix damage, most likely to collagen, through normal ageing and physiological loading, as it is the first to become susceptible to pigmentation.

Cuticle darkening correlates with increased body copper content in Drosophila melanogaster

Insect epidermal cells secrete a cuticle that serves as an exoskeleton providing mechanical rigidity to each individual, but also insulation, camouflage or communication within their environment. Cuticle deposition and hardening (sclerotization) and pigment synthesis are parallel processes requiring tyrosinase activity, which depends on an unidentified copper-dependent enzyme component in Drosophila melanogaster. We determined the metallomes of fly strains selected for lighter or darker cuticles in a laboratory evolution experiment, asking whether any specific element changed in abundance in concert with pigment deposition. The results showed a correlation between total iron content and strength of pigmentation, which was further corroborated by ferritin iron quantification. To ask if the observed increase in iron body content along with increased pigment deposition could be generalizable, we crossed yellow and ebony alleles causing light and dark pigmentation, respectively, into similar genetic backgrounds and measured their metallomes. Iron remained unaffected in the various mutants providing no support for a causative link between pigmentation and iron content. In contrast, the combined analysis of both experiments suggested instead a correlation between pigment deposition and total copper body content, possibly due to increased demand for epidermal tyrosinase activity.

S1909 Black Esophagus: A Syndrome of Acute Esophageal Necrosis

INTRODUCTION: Black esophagus, also known as acute esophageal necrosis (AEN) syndrome is a rare entity characterized by patchy or diffuse circumferential black pigmentation of esophageal mucosa from ischemic necrosis and may present with life threatening upper gastrointestinal hemorrhage (UGIH) resulting in high mortality in immunocompromised patients. CASE DESCRIPTION/METHODS: A 56-year-old female with diabetes mellitus (DM), gastroesophageal reflux disease (GERD), and alcohol abuse (8–10 drinks daily) presented with multiple episodes of coffee ground emesis and epigastric abdominal pain for two days. The pain was sharp epigastric, 10/10 in severity, non-radiating, precipitated with ingestion of oral intake, without alleviating factors. On examination, she was tachycardic (120/minute) and hypotensive (80/50 mm of Hg), had oropharyngeal erythema with white spots on its posterior wall, and significant ptyalism. She had epigastric tenderness and unremarkable digital rectal examination. Laboratory workup revealed lactic acidosis (>15 mmol/L), acute kidney injury with creatinine 2.21 mg/dL, leukocytosis (18 k/dL), and transaminitis. A computed tomography (CT) of abdomen and pelvis without contrast was unremarkable. The hospital course was complicated by hematemesis, dysphagia, and melena. After initial resuscitation, esophagogastroduodenoscopy (EGD) was performed which revealed inflammation of the epiglottis, arytenoid cartilages, and dark mucosal pigmentation of distal 2/3 of the esophagus with associated hiatus hernia (Figure 1). A biopsy of esophageal mucosa demonstrated fragments of fibrinopurulent exudate and necrotic tissue with pigment deposition (Figure 2). Evidence of helicobacter pylori, cytomegalovirus, herpes simplex virus, candida albicans infections, and malignancy was not found on further testing. She was managed with strict NPO, total parenteral nutrition, proton pump inhibitors, and analgesics. Serial EGDs showed complete resolution of the lesion in 4 weeks and was transitioned to an oral diet. DISCUSSION: In this case, vascularity of the distal esophagus was compromised due to uncontrolled DM, GERD, and binge alcohol drinking, complicated with acute UGIH due to mucosal tears from persistent vomiting. Acute UGIH is alarming for AEN in patients with multiple co-morbidities and a high index of clinical suspicion is required for pursuing EGD for early diagnosis. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease.Figure 1.: Distal two-thirds of the esophagus showing black pigmentation of mucosa due to ischemic necrosis.Figure 2.: A biopsy of esophageal mucosa demonstrating fragments of fibrinopurulent exudate and necrotic tissue with pigment deposition (arrow).

Structure of the Envelopes Formed around the Metacercariae of the Trematode Podocotyle atomon (Rudolphi, 1802) in the Second Intermediate Host

The structure of Podocotyle atomon metacercariae cysts and their surrounding capsules in the second intermediate hosts Locustogammarus locustoides (Brandt, 1851) and Spinulogammarus ochotensis (Brandt, 1851) was assessed using light and transmission electron microscopy. A single, amorphous layer represents the cyst formed by the parasite. The capsules formed by the host consist of two layers: an electron-light, loose inner layer, and an electron-dark, unstructured outer layer, including a small amount of intact and fragmented host cells. The inner capsule layer may have been formed by the degeneration and transformation of the muscle tissue of amphipods surrounding the larva. The outer layer of the capsule contained deposits of pigment.

S3172 Pseudomelanosis Coli: A Historical Review and Explanation for Increased Incidence in the Western World

INTRODUCTION: Pseudomelanosis coli is the brown-black pigmentation of colon and rectum as a consequence of laxative use secondary to increasing dependency on narcotics. However, there are reports of Pseudomelanosis in the absence of laxatives and pigmentation in areas other than colon. Recently it has also been linked to colon cancer. METHODS: A selective review of existing literature on Psuedomelanosis coli was performed in PubMed. RESULTS: Early studies speculated that the pigment is melanin or an anthracene derivative. Now it is widely accepted that the pigment is actually lipofuscin. Lipofuscin predominantly accumulates in the macrophages of the lamina propria, usually in the colon. Electron microscopic examination of the pigment granules in the duodenum has revealed lysosomal bodies containing iron sulfide with traces of minerals from antacids, food additives and dental fillings. Electron microscopy of ileum revealed the pigment granule laden macrophages containing predominantly magnesium and aluminum-rich silicates. Pseudomelanosis is characteristically absent in colonic neoplasms. The area of the melanotic colon with cancer association has reduced or even lack of pigment laden macrophages. Pseudomelanosis is sometimes encountered in colonoscopy without a history of laxative use. This means that either chronic inflammation or a rapid intestinal transit in inflammation can cause pigmentation. Based on studies in guinea pigs, it is hypothesized that non-anthraquinone laxatives have the potential to cause microscopic pigment deposition, which may not result in gross discoloration on endoscopic evaluation. CONCLUSION: Pseudomelanosis coli has increased in incidence in the United States due to increasing incidence of chronic pain syndromes causing opioid dependence and secondary laxative use and with abundant purine intake. Non-anthracene Pseudomelanosis coli has a different pathogenesis and may be missed by endoscopists due to the grossly normal appearing colon. The pathogenesis of Pseudomelanosis coli in the setting of laxative naïve patients is not well understood. Interestingly, chronic colitis may have an association with Pseudomelanosis coli. There is no established correlation between Pseudomelanosis coli and cancer, but it is unclear if chronic colitis causing Pseudomelanosis has any role in carcinogenesis in these patients. Lastly, melanosis can occur in other parts of the gastrointestinal system, but is usually due to other pigments rather than lipofuscin. Further studies are needed.

Changes of body colour and tissue pigments in greenlip abalone ( Haliotis laevigata Donovan) fed macroalgal diets at different temperatures

In Australia, commercially farmed greenlip abalone (Haliotis laevigata Donovan), fed formulated diets display a faint lip and dark foot colour in comparison with wild abalone. This study evaluates the impact of macroalgal diets and water temperatures on the colour and tissue pigment deposition in farmed greenlip abalone. Three diets are (a) fresh Ulva sp., (b) a commercial diet and (c) a formulated diet of 30% of dried Ulva sp. meal supplement were used to feed 3-year-old greenlip abalone at either 22 or 26°C for 38 days. Abalone fed 30% dried Ulva sp. meal supplement had significantly higher the shell colour saturation than those fed fresh Ulva sp. The lip colour was deeper in abalone fed fresh Ulva sp. and was significantly more pronounced than those fed the diet containing 30% Ulva sp. meal. Abalone at 22°C had a significantly higher lip colour saturation value than those at 26°C. The foot of abalone fed fresh Ulva sp. was light gold, whereas abalone fed the 30% Ulva sp. meal or the commercial diet had a dark brown foot at 22°C. The foot colour was paler in abalone at 26°C than at 22°C. The content of β-carotene was significantly higher in abalone fed fresh Ulva sp. than those fed the other diets. Abalone contained a higher amount of β-carotene at 22°C than at 26°C. This study indicates that high water temperatures make foot colour paler and the fresh Ulva sp. diet can make the foot colour lighter at 22°C.

Impeding Minocycline Induced Hyperpigmentation by Pomegranate Extracting the Epidermis of Guinea Pig

Objective: This study was planned over the hypothesis that pomegranate extract rich in ellagic acid used with minocycline could decrease its adverse effect and prolong its therapeutic use and efficacy. Study design and Setting: This experimental study was done in the department of anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center, Karachi, Methodology: We acquired 40 guinea pigs (male, adult, 450 – 550 gm), randomly divided them into 4 groups.Group B received 0.0003mg/g bodyweight of minocycline only, group C was given 0.0003mg/g bodyweight of minocycline with 0.4mg/g bodyweight of pomegranate, group D was given 0.4mg/g bodyweight pomegranate only; with keeping group A with no intervention at laboratory diet for 8 weeks. After the experimental period, the animals were sacrificed, H & E and DOPA-OXIDASE staining was done on harvested skin tissues for morphometric observations under light microscopy. Results: The results showed that minocycline induced reduction in mean thickness of epidermis and increased melanin pigment deposition. Mean number of melanocytes decreased with pomegranate use though the difference was insignificant (P-value > 0.05) but consistent and measurable. Conclusions: It was proven that by including pomegranate in our daily diet, the process of hyperpigmentation of skin induced by the broad spectrum tetracycline particularly minocycline, can be slow down by decreasing the activity of tyrosinase enzyme, thus it provides a novel pathway to fight against any other drug induced hyperpigmentation occurring due to increase activity of tyrosinase enzyme

Chloasma uterinum

Chloasma uterinum consists of an abnormal deposition of skin pigment without dysfunction of the skin in the epidermis itself or immediately below it, and appears as large yellowish or blackish-brown spots on the face and trunk. Patients are almost always sure that they suffer from the liver and with complaints of an abnormal liver go to the doctor. It is very rare to observe the appearance of chloasma before puberty or after menopause. Usually it develops in the prime of sexual activity.

Macroscopic and Histopathologic Findings From a Mass Stranding of Rough-Toothed Dolphins (Steno bredanensis) in 2005 on Marathon Key, Florida, USA.

On March 2, 2005 ~70 rough-toothed dolphins (Steno bredanensis) mass stranded along mud flats and associated canals on the Atlantic Ocean side of Marathon Key, Florida. Forty-six were necropsied and placed into two groups for analysis: Group-1 animals (N = 34; 65%) that died prior to medical intervention and rehabilitative efforts and Group-2 animals (N = 12; 35%) that died in rehabilitation. Thirty-four animals were females (18 adults, 5 juvenile/subadult, 7 calves, and 4 of undetermined age) and 12 were males (6 adults, 4 juvenile/subadults, 1 calf, and 1 of undetermined age). Body condition overall was fair to good in Group-1 and fair to poor in Group-2. Lesions were observed in multiple body systems. Greater than 90% of animals in both groups had respiratory lesions. Verminous sinusitis and bronchopneumonia were 2–3 times more prevalent in Group-2. Capture/exertional rhabdomyolysis was observed in Group-2 (42%). Vacuolar hepatopathies were observed in both groups including hepatic lipidosis (Group-1) and mixed etiologies (Group-2). Pancreatic and gastrointestinal tract pathologies were prevalent in Group-2 animals 56 and 75%, respectively, and included gastritis, gastric ulceration, enterocolitis, pancreatic atrophy, and pancreatitis related to physiologic stress. Group-2 more frequently had evidence of hemorrhagic diathesis present which included increased extramedullary hematopoiesis in various organs, increased hemosiderosis, and hemorrhage and hemorrhagic drainage in various organs. Central nervous system disease, primarily edema, and mild inflammation were equally prevalent. Renal proteinuria, tubular necrosis, and pigmentary deposition were observed in Group-2. Dental attrition was observed in ~40% of the groups. Gammaherpesviral-associated pharyngeal plaques were observed in 46 and 54% of Group-1 and 2 animals, respectively. Other lesions observed were mild and incidental with a frequency rate <20%. The findings from this Steno stranding provide a unique window into baseline individual and population clinical conditions and additional perspective into potential clinical sequelae of rehabilitation efforts.

CHRONIC ENDOMETRITIS: WHAT IS THE PREVALENCE AMONG HEALTHY CONTROLS?

To evaluate the prevalence of chronic endometritis (CE) in women with unexplained recurrent pregnancy loss (RPL) and healthy controls. Cohort Study. IRB approval was obtained. The RPL group included women with ≥ two pregnancy losses, endometrial biopsy (EMB) between 1/2016 and 12/2018, TSH values < 4 mU/L, negative antiphospholipid antibodies and normal uterine anatomy. The control group included volunteers without a history of RPL, infertility, uterine fibroids, polyps, pelvic inflammatory disease or retained pregnancy tissue recruited between 5/2019 and 2/2020. Women 18-50 years of age were included. H&E and CD138 immunohistochemical staining were performed on all endometrial biopsies. A single pathologist blinded to patient history recorded the number of plasma cells per 10 high power fields (HPF) and the presence of endometrial stromal changes (spindling, edema, breakdown, pigment deposition, areas of hypercellularity, and presence of inflammatory cells). Assuming a 3% prevalence of CE in controls and 30% in RPL, 25 controls and 50 women with RPL were needed to detect a difference in the rate of CE with 80% power and alpha of 0.05. 76 women were included, 50 with RPL and 26 controls. The cohort had a mean age of 34.6 (SD 4.1) years and mean BMI of 26.0 (SD 6.2) kg/m2. Women with RPL had a mean of 3.1 (SD 0.9) prior pregnancy losses, while controls had no prior pregnancy losses. When the presence of plasma cells alone was used to define CE, the prevalence among women with RPL was 56% (28/50) with ≥ 1 plasma cell, 44% (22/50) with ≥ 2 plasma cells and 26% (13/50) with ≥ 5 plasma cells by CD138 staining. Using these same criteria, the prevalence of CE among controls would be 31% (8/26) with ≥ 1 plasma cell, 27% (7/26) with ≥ 2 plasma cells and 8% (2/26) with ≥ 5 plasma cells. However, when both endometrial stromal changes and plasma cells were required for CE diagnosis, there were no cases of CE in the control group. Using this definition, the prevalence in the RPL group was 30% (15/50) with ≥1 plasma cells, 28% (14/50) with ≥2 plasma cells and 16% (8/50) with ≥5 plasma cells by CD138 staining, and was statistically significantly higher in women with RPL compared to controls (P=0.0015, 0.0016, and 0.04, respectively). Establishing specific diagnostic criteria for CE is necessary for both research and evidence-based treatment guidelines. We demonstrate that while rare plasma cells were found in EMB samples from healthy controls, the presence of plasma cells and endometrial stromal changes was isolated to the RPL cohort. Given that no controls were found to have both plasma cells and endometrial stromal changes, we propose that the definition of CE include 1 or more plasma cells in addition to the presence of endometrial stromal changes. Cases in which endometrial stromal changes are visualized, but no plasma cells are identified by H&E, would benefit from CD138 staining to identify plasma cells. We demonstrate that when using strict criteria to define CE, women with RPL have a significantly higher rate of CE compared to controls. An EMB should be considered as part of the evaluation for RPL.

Egg spottiness reflects female condition, physiological stress, and ornament expression in a common rallid species

Lay Summary • There is equivocal support for direct associations between maternal quality and deposition of protoporphyrin pigmentation (dark spots and blotches) in avian eggshells. • Research on protoporphyrin eggshell pigmentation has primarily focused on a single avian order (Passeriformes). • We examined associations of protoporphyrin-based eggshell pigmentation with female phenotypic and genetic traits in a non-passerine species, the Eurasian Coot. • Deposition of protoporphyrin in eggshells (total number per area of egg spots) positively correlated with female condition and expression of a putative bare-part ornament (frontal shield), while it was negatively associated with the level of physiological stress. • Protoporphyrin-based eggshell pigmentation acts as a reliable signal of female phenotypic (but not genetic) traits in the Eurasian Coot. • Signaling properties of protoporphyrin-based egg coloration are likely to largely differ between different evolutionary lineages of birds.

Alkaptonuria presenting as ochronotic spondylo-arthropathy in siblings with low back pain: a case report

Low back pain is one of the commonest symptoms for an orthopaedic consultation. It is also the common first presentation of a rare disorder alkaptonuria. Accumulation of homogentisic acid in connective tissues causes progressive deposition of bluish black pigment causing degenerative changes in ochronotic spine. In this case report, two brothers of Dravidian origin present with alkaptonuria, with clinically more recognizable axial spondyloarthropathy resembling Ankylosing Spondylitis (AS), and the history, clinical presentation, diagnostic techniques, and distinctive diagnosis are reviewed. We suggest for surveillance in clinical practice for this rare, but important cause of back pain. Keywords: Ochronotic Spondyloarthropathy, Alkaptonuria, Familial Ochronosis.