Partially Improved Research Articles

Evaluation of Lower Urinary Symptoms Following Vaginal Reconstructive Surgery for Prolapse and Urinary Incontinence

Background: Urinary incontinence (UI) may be associated with symptoms of overactive bladder (OAB) that may persist after anti-incontinence surgery. Objectives: The present study was performed to evaluate the effect of prolapse and anti-incontinence reconstructive surgery in women who had the symptoms of OAB and UI at the same time. Methods: This descriptive cross-sectional study was performed on 56 women with OAB symptoms and stress UI (SUI)/urgency UI (UUI) with or without prolapse who were candidates for restorative and anti-incontinence surgery. At baseline, urinary symptoms, including urinary frequency, nocturia, SUI, and UUI, were recorded. Patients who finally underwent vaginal reconstructive surgery with anti-incontinence surgery were assessed for urinary symptoms six months after the operation. Results: A total of 28 patients underwent transobturator tape (TOT) surgery, of whom 23 patients were subjected to other anti-incontinence surgeries and 5 patients underwent restorative surgeries. There was no significant difference between the two groups (TOT and others) in terms of age, body mass index, number of deliveries, history of medical problems, and history of surgery or cesarean section. The urinary frequency and nocturia before surgery were observed in 46 (82%) and 20 (36%) patients, respectively, which were not significantly different between the two groups. Before the study, occult UI was observed in 2 patients (4%), UUI in 3 patients (5%), SUI in 18 patients (32%), and mixed UI in 33 patients (59%). Nocturia was completely improved in all 20 patients. Urinary frequency was partially or completely improved in 41 patients (89%), which was not significantly different between the two groups (P=0.051). Overall, 53 patients (95%) had partial or complete improvement in UI, which was not significantly different between the two groups (P=0.058). Both patients with occult UI and all three patients with UUI were completely improved. Sixteen out of 18 patients (89%) with SUI were completely improved and the other 2 patients were partially improved. Thirty patients (91%) with mixed UI had a complete or partial recovery that was not significantly different between the two groups (P=0.137). Conclusion: The findings of the present study showed that six months after anti-incontinence or reconstructive surgery, nocturia in all patients and urinary frequency in 89% of patients improved partially or completely. Various forms of UI partially or completely improved in 95% of patients, as well.

Role of Anakinra in the Management of Steroid Refractory High Grade Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) after Anti-CD 19 CAR-T Cell Therapy, a Single Center Experience

Background: Chimeric antigen receptor (CAR) T-cell immunotherapy is a paradigm shifting treatment option for multiple refractory hematologic malignancies. Immune effector cell-associated neurotoxicity syndrome (ICANS) is a serious adverse effect (AE) associated with CAR T-cell therapy. To date, corticosteroids remain the cornerstone treatment of ICANS. Recently, limited clinical data have suggested that the addition of anakinra may be beneficial in the treatment of corticosteroid refractory severe ICANS. Methods: We performed a retrospective chart review of patients with a diagnosis of refractory B cell lymphoma treated with CART-cell therapy at the University of Arizona Cancer Center (UACC), who subsequently developed severe ICANS (grade 3-4). We report five cases in which anakinra (at the dose of 100 mg daily) was used as an adjunct therapy to high dose steroid treatment in managing severe ICANS. Results: A total of 33 patients received CART-cell therapy at UACC from 01/2019-07/2022. The incidence of severe ICANS was 21% (7/33). Baseline characteristics of 7 patients who developed high grade ICANS are summarized in Table 1. The median age was 65 (range 51-70). 5 patients were treated with Tisagenlecleucel, 1 with Axicabtagene ciloleucel and 1 with Brexucabtagene autoleucel CAR-T cell therapy. The median time to onset of severe ICANS was 6 days (range 1-13 days). Two out of seven patients (29%) developed grade 3 ICANS which resolved quickly with corticosteroids in 1-3 days. Five out of seven patients (71%) developed grade 4 ICANS, requiring ICU admission and high dose corticosteroids. Patients received at least 3 days of high dose corticosteroids with methylprednisolone 500 mg IV twice a day before anakinra was added for steroid refractory ICANS. On average, patients received ~ 9 doses of corticosteroids prior to anakinra administration. After addition of anakinra, three patients had a complete resolution of ICANS, two patients had partial improvement in their ICANS (grade 1-2). For the three patients with complete resolution of ICANS, the median number of anakinra doses were 4, median duration of severe ICANS (post-anakinra) was 3 days and the median time in ICU was 3 days. Clinical course was complicated for the other two patients with acute hypoxic respiratory failure in one patient and E. coli bacteremia, fulminant pseudomembranous colitis s/p colectomy, and septic shock in the second patient leading to death on days +23 and +40 respectively. Conclusion: Although limited in number, our analysis suggests anakinra may be effective and safe in steroid refractory ICANS. ICANS resolved completely in three out of five patients following administration of anakinra who were refractory to high dose corticosteroids, and partially improved to grade 1-2 in two patients. No significant side effects attributed to anakinra were observed. Future randomized controlled studies are needed to better understand the overall efficacy and the ideal timeline for administration. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

COVID-19-related sudden sensorineural hearing loss.

Background: Sudden sensorineural hearing loss (SSNHL) can be a feature of COVID-19. It may present alone or with other symptoms of the disease. However, there is little written in the literature about its occurrence. We aimed to evaluate the socio-clinical characteristics and outcome of confirmed mild- to moderate COVID-19 cases with SSNHL in Tikrit city, Iraq.Materials and Methods: This descriptive study was conducted at the Otolaryngology Department, Tikrit General Hospital, Tikrit city, Iraq. The period of the study was from December 1, 2020 to June 30, 2021.Mild and moderate COVID-19 subjects confirmed by real-time polymerase reaction were included in the study. Detailed demographic (age, gender, and smoking habit) and clinical characteristics (onset and duration of deafness, side, severity, associated ear, nose, and throat symptoms, and comorbidity) were recorded for every patient. Outcomes following the steroid treatment protocol were also registered.Results: SSNHL was identified in 26 patients, of whom 20 (76.9%) were women, 20 (76.9%) were in the age group ≥ 30 years, and 21 (80.8%) were non-smokers. Around three-quarters of the subjects were identified within the first week of deafness occurrence. Bilateral (18/26) was more common than unilateral deafness (8/26); therefore, the total number of deaf ears was 44. Besides, bilateral symmetrical deafness (13/18) outnumbered the asymmetrical type (5/18). Around three-quarters were of moderate severity. The most common otological symptom was tinnitus (25/26). The most common nose and throat symptom was anosmia (6/26). The mean hearing threshold before and after treatment with oral steroids ± intratympanic steroids was 50.91 ± 11.777 dB and 40.24 ± 15.693, respectively. One patient with bilateral SSNHL was lost to follow-up; the remaining number of deaf ears was 42, and half of them were partially improved. The outcome of the treatment showed no statistically significant relation with the duration, side, and severity of SSNHL (p>0.05).Conclusion: The majority of COVID-19-related SSNHL cases presented within one week of onset, with bilateral outnumbering unilateral cases. Tinnitus was the most common associated symptom. Treatment with steroids achieved partial improvement in half of the cases, and this outcome was not affected by the duration, side, and severity of deafness.

Exercise tolerance and quality of life in hemodynamically partially improved patients with chronic thromboembolic pulmonary hypertension treated with balloon pulmonary angioplasty.

The efficacy of extensive balloon pulmonary angioplasty (BPA) beyond hemodynamic improvement in chronic thromboembolic pulmonary hypertension (CTEPH) patients has been verified. However, the relationship between extensive BPA in CTEPH patients after partial hemodynamic improvement and exercise tolerance or quality of life (QOL) remains unclear. We prospectively enrolled 22 CTEPH patients (66±10 years, females: 59%) when their mean pulmonary artery pressure initially decreased to <30 mmHg during BPA sessions. Hemodynamic and echocardiographic data, cardiopulmonary exercise testing, and QOL scores using the 36-item short form questionnaire (SF-36) were evaluated at enrollment (entry), just after the final BPA session (finish), and at the 6-month follow-up (follow-up). We analyzed whether extensive BPA improves exercise capacity and QOL scores over time. Moreover, the clinical characteristics leading to improvement were elucidated. The peak oxygen uptake (VO2) showed significant improvement at entry, finish, and follow-up (17.3±5.5, 18.4±5.9, and 18.9±5.3 mL/kg/min, respectively; P<0.001). Regarding the QOL, the physical component summary (PCS) scores significantly improved (32±11, 38±13, and 43±13, respectively; P<0.001), but the mental component summary scores remained unchanged. Linear regression analysis revealed that age and a low peak VO2 at entry were predictors of improvement in peak VO2, while low PCS scores and low TAPSE at entry were predictors of improvement in PCS scores. In conclusion, extensive BPA led to improved exercise tolerance and physical QOL scores, even in CTEPH patients with partially improved hemodynamics.

Adverse effects of maternal rheumatoid arthritis during pregnancy on children.

Adverse effects of maternal rheumatoid arthritis during pregnancy on children.

Rare concurrent ocular myasthenia gravis and Graves\u2019 ophthalmopathy in a man with Poland syndrome: a case report

BackgroundOcular myasthenia gravis and Graves’ ophthalmopathy are autoimmune diseases that are mediated by membrane receptors and share many identical clinical processes. Poland syndrome is a rare congenital deformity characterized by defects of the ipsilateral hand and the chest wall, and it is usually associated with hypoplasia of ipsilateral pectoral muscles and homolateral breast. However, to the best of our knowledge, the co-occurrence of these diseases has never been reported. In this study, we present a man with Poland syndrome who was diagnosed with Graves’ ophthalmopathy and ocular myasthenia gravis in succession.Case presentationA 43-year-old man presented with bilateral upper eyelid ptosis, bilateral eye protrusion, bilateral eye movement disorder and malformation of the right hand. Asymmetrical malformation of the chest wall and ipsilateral hand deformity were shown as Poland syndrome. He was diagnosed with ocular myasthenia gravis and Graves’ ophthalmopathy on the basis of clinical manifestations and laboratory examinations, including bilateral exophthalmos and progressive asymmetrical ophthalmoparesis without pupillary dysfunction, positive autoantibody tests, repetitive nerve stimulation tests, and computed tomography scans. Treatments with pyridostigmine bromide, thymectomy, and prednisone led to partial clinical improvement. After 13 months of follow-up, the symptoms of drooping eyelids were partially improved, but the eyeball protrusion and right hand deformity remained unchanged.ConclusionsWe report the first case of co-occurrence of ocular myasthenia gravis, Graves’ ophthalmopathy, and Poland syndrome. Genetic predisposition and immune dysregulation might be the pathogenesis of the association.

Body fat distribution and circulating adipsin are related to metabolic risks in adult patients with newly diagnosed growth hormone deficiency and improve after treatment

ObjectiveThe relationships between body fat distribution, the adipokine adipsin and metabolic risks were assessed in patients with adult growth hormone deficiency (AGHD) before and after growth hormone (GH) treatment. MethodsSixty newly diagnosed AGHD patients were included in our study, 24 of whom were evaluated after at least one year of GH treatment. Anthropometric parameters, glucolipid metabolism and the adipokine adipsin were measured. Visceral adipose tissue (VAT) and body composition were evaluated using a dual-energy X-ray-absorptiometry (DXA) scanner. ResultsAt baseline, the higher VAT group had worse glucolipid metabolism parameters. Basal GH was negatively associated with VAT (r=-0.277, p = 0.045), while minimal correlations were found with fat mass depots, such as limbs and trunk fat (all p > 0.05). Adipsin was correlated with total body fat (r = 0.543, p < 0.001), VAT (r = 0.563, p < 0.001) and insulin resistance (r = 0.353, p = 0.006). The effect of GH administration on fat distribution was mainly reflected in the reduction in VAT. Partial improvements were found in lipid profiles, including increased high-density lipoprotein (HDL) and decreases in triglycerides (TGs) and lipoprotein(a), while glucose metabolism showed little change. The adipsin level also decreased significantly. The best predictors of VAT at baseline were trunk fat and IGF-I, and after treatment, VAT was predicted by decreased adipsin and an increase in lean mass. Conclusions(1) VAT is an important metabolic risk factor for AGHD patients. (2) GH treatment decreased body fat predominantly in the visceral and central fat depots. (3) The lipid profiles partially improved after treatment, while glucose metabolism showed little change.

DON’T JUDGE A BOOK BY ITS COVER: UNUSUAL CASE OF MYASTHENIA GRAVIS

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Myasthenia gravis is an autoimmune disorder where auto-antibodies bind to the acetylcholine receptors present in the post-synaptic membrane of the neuromuscular junction. It typically presents with limb weakness but may also include ocular symptoms such as diplopia and ptosis or bulbar symptoms including dysphagia, dysphonia and dysarthria. We report an atypical case of myasthenia gravis that initially appeared to be consistent with the diagnosis of asthma. CASE PRESENTATION: The patient is a 78-year old female with a past medical history of remote deep venous thrombosis associated with pulmonary embolism, hypertension, rheumatoid arthritis, and polymyalgia rheumatica who was referred to pulmonology for eight months of exertional dyspnea and fatigue. Besides her progressive dyspnea, additional respiratory symptoms included chest tightness, non-productive cough, and wheezing. Her pulmonary function tests indicated a mixed obstructive and restrictive defect with FEV1/FVC ratio of 69% with FVC of 1.63L (62 % predicted) as well as a positive bronchodilatory response. She was started on a regimen of ICS/LABA, leukotriene inhibitor, and an as needed ß2-recptor agonist for presumed late-onset asthma in which her symptoms only partially improved. Given both the severity of her dyspnea and restrictive physiology on her pulmonary function testing in absence of parenchymal lung disease, the patient underwent additional neuromuscular evaluation. Her maximal inspiratory pressure (MIP) was 15% predicted and her maximal expiratory pressure (MEP) was 16% predicted in setting of a normal diaphragmatic fluoroscopy (SNIFF test). She subsequently underwent serological evaluation for neuromuscular weakness in which her acetylcholine binding antibody was positive, confirming the diagnosis of myasthenia gravis. The patient was started on acetylcholinesterase inhibitor and steroids with a mixed response. Due to progression of her illness, she eventually required ICU admission and was started on plasmapheresis with positive clinical response. DISCUSSION: Acetylcholine receptor antibody myasthenia gravis has a bimodal pattern with early onset prior to age of 50. It uncommonly can be seen in setting of other autoimmune disorders such as systemic lupus, thyroiditis, or as seen in our patient, rheumatoid arthritis. Our case is unique given the fact that patient initially presented with clinical features suggestive of late-onset asthma. However, given only partial improvement in symptoms and unexplained restrictive physiology on spirometry, further testing revealed diagnosis of myasthenia gravis. CONCLUSIONS: This case stresses the need for thorough evaluation for all patients with unexplained progressive dyspnea. Reference #1: Gilhus NE. Myasthenia Gravis. Longo DL, ed. N Engl J Med. 2016;375(26):2570-2581. doi:10.1056/NEJMra1602678 Reference #2: Marlowe FI, D’Angelo AJ. Respiratory failure as the initial presentation of myasthenia gravis. Ear Nose Throat J. 1989;68(6):472-473. Reference #3: Qureshi AI, Choundry MA, Mohammad Y, et al. Respiratory failure as a first presentation of myasthenia gravis. Med Sci Monit. 2004;10(12):CR684-689. DISCLOSURES: No relevant relationships by Shubham Adroja, source=Web Response No relevant relationships by Anthony Cucci, source=Admin input No relevant relationships by Urbee Haque, source=Web Response

Histological study of the effect of proton pump inhibitor (esomeprazole) on the renal cortex of adult male albino rats.

Background: Esomeprazole is one of the proton pump inhibitors used in the treatment of gastrointestinal disorders. In spite of its safety, it can induce many side effects, especially acute interstitial nephritis that may progress into acute renal failure. Aim: This work aimed to investigate the effect of proton pump inhibitor (esomeprazole) on the histological structure of the renal cortex of adult male albino rats, as well as the effect of stoppage of that exposure.Materials and methods: 30 adult male albino rats were divided into three groups (10 rats each); control, esomeprazole group: rats received 5 mg/kg/day esomeprazole orally for 4weeks, and recovery group by which rats received esomeprazole 5 mg/kg /day orally, then left for another 4 weeks without treatment. After that, the renal cortex obtained and processed for light and transmission electron microscopic examination.Results: Esomeprazole group showed shrunken glomeruli with widening of Bowman's space, vacuolated glomerular and tubular cells, with darkly stained nuclei, focal interruption of PAS reaction in the brush border of PCTs besides statistically significant decrease in the mean optical density for PAS when compared with control, and focal ultrastructural changes in renal corpuscles, proximal and distal convoluted tubules. In recovery group; partial improvement of the previous histopathological findings observed. Conclusion: Esomeprazole induced histopathological changes in the structure of the renal cortex of adult male albino rats, which could be partially improved if left to recover

Possible Protective Effect of Propolis on Cardiac Muscle Injury Induced by Liver Fibrosis in Adult Male Albino Rat: Histological Study

Introduction: Most chronic liver diseases lead to cirrhotic cardiomyopathy that occurs as a late complication in 56% of the hepatic patients. Propolis is considered as a tonic that increases the body resistance to aging. It also decreases the risk of cardiovascular diseases and atherosclerosis.Aim of the work: was to study the possible protective role of propolis on the histological changes occurred in cardiac muscle secondary to liver fibrosis.Materials and Methods: 40 healthy male albino rats were randomly divided into 4groups including: control group (group I), propolis treated group (group II) given 20mg propolis once daily orally for 4 weeks, (group III) received 0.2 ml/100 gm carbon tetrachloride by subcutaneous injection for 4 weeks and (group IV) received both carbon tetrachloride and propolis at the same dose of group IIand III for the same period. At the end of the experiment, all the rats were sacrificed, and cardiac muscle was obtained and processed for light and electron microscopic examination.Results: Group III revealed widely separated cardiomyocytes with excessive connective tissue nuclei between them. Cytoplasmic vacuolations and marked fibrillolysis were observed. Cellular infiltration and dilated blood vessels were found. Excessive collagen fibers were detected by Mallory stain. Ultrastructural changes included irregular sarcomeres, interrupted intercalated disks, degenerated mitochondria and dilated sarcoplasmic reticulum. Group IV showed partial improvement with regular arrangement of cardiac fibers and sarcomeres.Conclusions: Use of propolis partially improved the histological changes that occurred in the cardiac muscle as a result of liver fibrosis.

Phosphate Binder, Ferric Citrate, Attenuates Anemia, Renal Dysfunction, Oxidative Stress, Inflammation, and Fibrosis in 5/6 Nephrectomized CKD Rats.

Chronic kidney disease (CKD) causes anemia and impairs intestinal iron absorption. However, use of the phosphate binder ferric citrate (FC) increases body iron stores and hemoglobin levels in CKD patients. By intensifying oxidative stress and inflammation iron overload resulting from excessive use of intravenous iron can accelerate CKD progression. The present study explored the route of absorption and tissue distribution of iron with FC administration and its effect on renal function, histology, and inflammatory, oxidative, and fibrosis pathways in CKD rats. Male Sprague Dawley rats were randomized to sham-operated control (CTL) group and 5/6 nephrectomized (CKD) groups fed either regular or 4% FC-supplemented diets for 6 weeks. Animals were then sacrificed, and blood and target tissues were harvested and processed. The untreated CKD rats exhibited anemia, hypertension, upregulation of renal tissue inflammatory, oxidative, and fibrotic pathways, impaired nuclear translocation, and downregulation of Nrf2's target gene products and depletion of colonic epithelial tight junction proteins. FC administration raised serum iron, improved anemia, attenuated hyperphosphatemia, partially improved renal function, reduced oxidative stress, inflammation, and fibrosis, and restored colonic epithelial zonula occludens-1 protein abundance. Tissue iron staining detected presence of iron in epithelial cells and subepithelium of colon and in renal proximal tubules. In conclusion ferric citrate administration resulted in modest amelioration of renal function and histology and partial improvements of fibrosis, inflammation, and oxidative stress in the kidney tissues of CKD rats.

Prolonged Exposures to Intermittent Hypoxia Promote Visceral White Adipose Tissue Inflammation in a Murine Model of Severe Sleep Apnea: Effect of Normoxic Recovery.

Increased visceral white adipose tissue (vWAT) mass results in infiltration of inflammatory macrophages that drive inflammation and insulin resistance. Patients with obstructive sleep apnea (OSA) suffer from increased prevalence of obesity, insulin resistance, and metabolic syndrome. Murine models of intermittent hypoxia (IH) mimicking moderate-severe OSA manifest insulin resistance following short-term IH. We examined in mice the effect of long-term IH on the inflammatory cellular changes within vWAT and the potential effect of normoxic recovery (IH-R). Male C57BL/6J mice were subjected to IH for 20 weeks, and a subset was allowed to recover in room air (RA) for 6 or 12 weeks (IH-R). Stromal vascular fraction was isolated from epididymal vWAT and mesenteric vWAT depots, and single-cell suspensions were prepared for flow cytometry analyses, reactive oxygen species (ROS), and metabolic assays. IH reduced body weight and vWAT mass and IH-R resulted in catch-up weight and vWAT mass. IH-exposed vWAT exhibited increased macrophage counts (ATMs) that were only partially improved in IH-R. IH also caused a proinflammatory shift in ATMs (increased Ly6c(hi)(+) and CD36(+) ATMs). These changes were accompanied by increased vWAT insulin resistance with only partial improvements in IH-R. In addition, ATMs exhibited increased ROS production, altered metabolism, and changes in electron transport chain, which were only partially improved in IH-R. Prolonged exposures to IH during the sleep period induce pronounced vWAT inflammation and insulin resistance despite concomitant vWAT mass reductions. These changes are only partially reversible after 3 months of normoxic recovery. Thus, long-lasting OSA may preclude complete reversibility of metabolic changes.

Pomegranate juice causes a partial improvement through lowering oxidative stress for erectile dysfunction in streptozotocin-diabetic rat.

Erectile dysfunction (ED) is associated with diabetes mellitus (DM). Pomegranate juice (PJ) is a potent antioxidant in diabetes induced oxidative stress. The aim of this study was to evaluate whether the administration of PJ ameliorates ED in streptozotocin (STZ)-diabetic rat model. Adult male Sprague-Dawley rats were divided into three groups (n=10-12, each): (1) Control, (2) STZ (25-35 mg kg-1, intravenously, 10 weeks) induced DM, and (3) PJ (100 mg kg-1 day-1, 10 weeks) treated DM rats. The in vivo erectile [a ratio of intracavernosal pressure (ICP)/mean arterial pressure (MAP)] and ex vivo corpus cavernosum (CC) responses were evaluated. Immunohistochemistry and Masson's trichrome staining were performed. Malondialdehyde (MDA) levels were measured. The ICP/MAP value in diabetic rats was lower than controls, which was partially improved by PJ treatment. Electrical field stimulation (EFS)-induced relaxant responses in CC from the diabetic group were significantly decreased that were ameliorated by treatment. Phenylephrine- and EFS-induced contractions were not altered in diabetic rats. PJ treatment normalized raised MDA levels of diabetic CC samples. Although the intensities of endothelial nitric oxide synthase (NOS) and neuronal NOS enzymes were decreased, inducible NOS protein levels were stronger in diabetic slides than controls. This is the first study to show that PJ treatment ameliorates partially ED and completely oxidative stress and fibrosis in a diabetic rat model. Our results highlight the success of antioxidant mechanism of PJ in ED with diabetes and open the way for future understanding in alternative treatment combinations with PDE5 inhibitors.

Demographics of Tuberculosis of Spine and Factors Affecting Neurological Improvement in Patients Suffering from Tuberculosis of Spine - A Retrospective Analysis of 312 Cases

Objective The purpose of the study was to study demographics of tuberculosis of Spine and analyze factors that might affect neurological improvement in patients suffering from tuberculosis of spine. Materials: Of the 638 suspected cases of spinal tuberculosis, 312 cases with confirmed diagnosis with at least one year follow up were selected for retrospective analysis. 200 cases that presented with neurological deficit were further divided into three groups- completely improved, partially improved, and no improvement according to AIS (American Spinal Injury Association impairment scale) grading. All continuous variables and categorical variables were compared across groups. Results 66.99% patients had typical clinical presentation. 84.62% had typical MRI presentation. Thoracic levels (T1–10) were most commonly affected in 45.78% followed by thoracolumbar levels 27.52%(T11-L2). In 80.32% disease was restricted to one or two adjoining vertebrae. At presentation 35.89% patients were neurologically intact whereas 31% were AIS-D, 20.83% were AIS-C, 2.5% were AIS-B and 9.61% were AIS-A. The three groups of patients with complete improvement, partial improvement, and no improvement were significantly different in their levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration on statistical analysis. Conclusion Age, sex, radiological presentation, co–morbidities and presence of pulmonary tuberculosis has no significant effect on neurological improvement. Levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly effects the final neurological improvement in cases of tuberculosis of spine.

Histological study of the effect of potassium dichromate on the thyroid follicular cells of adult male albino rat and the possible protective role of ascorbic acid (vitamin C)

Occupational exposure to toxic heavy metals renders the industrial workers with various health problems. Many heavy metals act as endocrine disruptors. Chromium salts are commonly used in industries as asbestos brake lining, cement dust and food additives. Thyroid is a metabolically active important endocrine gland. Little is known about the toxic effects of chromium on thyroid. So, the aim of this study was evaluation of the histological changes induced by chromium on thyrocytes and the possible protective role of vitamin C. Forty adult male albino rats were divided into four equal groups: control group, vitamin C treated group, potassium dichromate treated group and the fourth group co treated with potassium dichromate and vitamin C. Potassium dichromate was given intraperitonially for 2 weeks at a dose 2mg/kg daily. Vitamin C was given at a dose 120mg/kg orally daily for the same period. Specimens were processed for light and electron microscopy. Apoptosis was evaluated immunohistochemically. Specimens of potassium dichromate group showed disturbance of the normal architecture of the gland with coalescence and degeneration of thyroid follicles and desquamated cells in its lumen. Disruption of the apical and basal membranes of some thyrocytes, flattened hyperchromatic nuclei, dilated RER and swollen degenerated mitochondria were also noted. Immunohistochemically, there were changes in the immune expression of Bcl2 in the cytoplasm of thyrocytes. Vitamin C supplemented group showed partial improvement of the previous changes. So, potassium dichromate induced structural changes in the thyroid follicular cells that were partially improved by vitamin C supplementation.

Simultaneous implant placement and bone grafting with particulate mineralized allograft in sites with buccal wall defects, a three-year follow-up and review of literature

ObjectivesTo assess the relationship between the vertical buccal defect size and the outcome of single-stage (non-submerged) implant placement and simultaneously augmentation of sites with mineralized particulate allograft (Puros Cancellous) using collagen membranes (Ossix Plus). Subjects and methodsRecords of 108 partially edentulous patients with localized, buccal bone defects in the posterior maxilla and/or mandible [156 tissue-level Straumann implants, 38 male, 70 female, average age = 46.7 (6.4) years] were used for this study. Sectional CBCT scans were used to evaluate ridge forms before implant placement and after bone grafting (36 ± 2.2 months). The initial vertical buccal wall defect was recorded by measuring the amount of vertical Implant Platform's Rough Surface Exposure (IPRSE) when implants were placed [small (<3 mm), medium (3–5 mm), and large (>5 mm)]. The ridge contour at 36 (±2.2) months was classified into 3 categories [completely corrected (no IPRSE seen on CBCT), partially improved (some IPRSE seen on CBCT), no difference/worse]. ResultsComplete defect correction occurred in 66 (61.1%) patients followed by improved ridge contours in 38 patients. Significant differences were observed in the outcome of simultaneous grafting of sites with different pre-treatment vertical defect sizes (chi-square = 69.394, df = 4, P < 0.001). Two graft failures (one needed regrafting) and 2 implant failures were also seen. Treatment was effective in complete correction of 100% and 79.3% of small and medium-sized vertical defects, respectively. Large-sized defects showed only partial improvement in 90% of cases, without any complete correction. Cumulative implant and graft survival was 98.1%. ConclusionsSingle-stage implant placement and simultaneous grafting with mineralized particulate allograft showed promising outcome in correcting small and medium sized vertical buccal wall bone defects (<5 mm).

Interleukin-1β causes fluoxetine resistance in an animal model of epilepsy-associated depression.

Depression represents a common comorbidity of epilepsy and is frequently resistant to selective serotonin reuptake inhibitors (SSRI). We tested the hypothesis that the SSRI resistance in epilepsy associated depression may be a result of a pathologically enhanced interleukin-1β (IL1-β) signaling, and consequently that the blockade of IL1-β may restore the effectiveness of SSRI. Epilepsy and concurrent depression-like impairments were induced in Wistar rats by pilocarpine status epilepticus (SE). The effects of the 2-week long treatment with fluoxetine, interleukin-1 receptor antagonist (IL-1ra), and their combination were examined using behavioral, biochemical, neuroendocrine, and autoradiographic assays. In post-SE rats, depression-like impairments included behavioral deficits indicative of hopelessness and anhedonia; the hyperactivity of the hypothalamo-pituitary-adrenocortical axis; the diminished serotonin output from raphe nucleus; and the upregulation of presynaptic serotonin 1-A (5-HT1A) receptors. Fluoxetine monotherapy exerted no antidepressant effects, whereas the treatment with IL-1ra led to the complete reversal of anhedonia and to a partial improvement of all other depressive impairments. Combined administration of fluoxetine and IL-1ra completely abolished all hallmarks of epilepsy-associated depressive abnormalities, with the exception of the hyperactivity of the hypothalamo-pituitary-adrenocortical axis, the latter remaining only partially improved. We propose that in certain forms of depression, including but not limited to depression associated with epilepsy, the resistance to SSRI may be driven by the pathologically enhanced interleukin-1β signaling and by the subsequent upregulation of presynaptic 5-HT1A receptors. In such forms of depression, the use of interleukin-1β blockers in conjunction with SSRI may represent an effective therapeutic approach.

Long-term efficacy of infliximab maintenance therapy for perianal Crohn’s disease

To assess the long-term efficacy of seton drainage with infliximab maintenance therapy in treatment of stricture for perianal Crohn's disease (CD). Sixty-two patients with perianal CD who required surgical treatment with or without infliximab between September 2000 and April 2010 were identified from our clinic's database. The activities of the perianal lesions were evaluated using the modified perianal CD activity index (mPDAI) score. The primary endpoint was a clinical response at 12-15 wk after surgery as a short-term efficacy. Secondary endpoints were recurrence as reflected in the mPDAI score, defined as increased points in every major element. The clinical responses were classified as completely healed (mPDAI = 0), partially improved (mPDAI score decreased more than 4 points), and failure or recurrence (mPDAI score increased or decreased less than 3 points). There were 43 males and 19 females, of whom 26 were consecutively treated with infliximab after surgery as maintenance therapy. Complete healing was not seen. Failure was seen in 10/36 (27.8%) patients without infliximab and 4/26 (15.4%) patients with infliximab (P = 0.25). Partial improvement was seen in 26/36 (72.2%) patients without infliximab and 22/26 (88.5%) patients with infliximab (P = 0.25). Short-term improvement was achieved in 48/62 (77.4%) patients. Although the mPDAI score improved significantly with surgery regardless of infliximab, it decreased more from baseline in patients with infliximab (50.0%) than in those without infliximab (28.6%), (P = 0.003). In the long-term, recurrence rates were low regardless of infliximab in patients without anorectal stricture. In patients with anorectal stricture, cumulative recurrence incidences increased gradually and exceeded 40% at 5 years regardless of infliximab. No efficacy of infliximab treatment was found (P = 0.97). Although the cumulative rate of ostomy creation was also low in patients without stricture and high in patients with stricture, no protective efficacy was found with infliximab treatment (P = 0.6 without stricture, P = 0.22 with stricture). Infliximab treatment was demonstrated to have short-term efficacy for perianal lesions. Long-term benefit with infliximab was not proven, at least in patients with anorectal stricture.

Long-Term Follow-Up Study of Patients With Refractory Obsessive-Compulsive Disorder

Long-Term Follow-Up Study of Patients With Refractory Obsessive-Compulsive Disorder

Radiographic evaluation of bones and joints in mucopolysaccharidosis I and VII dogs after neonatal gene therapy

Mucopolysaccharidosis I (MPS I) and MPS VII are due to deficient activity of the glycosaminoglycan-degrading lysosomal enzymes α- l-iduronidase and β-glucuronidase, respectively, and result in abnormal bones and joints. Here, the severity of skeletal disease in MPS I and MPS VII dogs and the effects of neonatal gene therapy were evaluated. For untreated MPS VII dogs, the lengths of the second cervical vertebrae (C2) and the femur were only 56% and 84% of normal, respectively, and bone dysplasia and articular erosions, and joint subluxation were severe. Previously, we reported that neonatal intravenous injection of a retroviral vector (RV) with the appropriate gene resulted in expression in liver and blood cells, and high serum enzyme activity. In this study, we demonstrate that C2 and femurs of RV-treated MPS VII dogs were longer at 82% and 101% of normal, respectively, and there were partial improvements of qualitative abnormalities. For untreated MPS I dogs, the lengths of C2 and femurs (91% and 96% of normal, respectively) were not significantly different from normal dogs. Qualitative changes in MPS I bones and joints were generally modest and were partially improved with RV treatment, although cervical spine disease was severe and was difficult to correct with gene therapy in both models. The greater severity of skeletal disease in MPS VII than in MPS I dogs may reflect accumulation of chondroitin sulfate in cartilage in MPS VII, or could relate to the specific mutations. Neonatal RV-mediated gene therapy ameliorates, but does not prevent, skeletal disease in MPS I and MPS VII dogs.