Seventh Week Research Articles

Impact of Physiotherapy Absence in COVID-19 Pandemic on Neurological State of Patients With Parkinson Disease

The purpose of this study was to demonstrate the impact of COVID-19 pandemic restrictions on patients with Parkinson disease in the absence of physiotherapy interventions. We analyzed 42 patient surveys on motor and mental aspects in the neurological state. The survey was conducted in 3 primary care–level clinics specialized in neurological rehabilitation in the seventh week of COVID-19 restrictions, which started on March 13, 2020. A number of deteriorations, worsening of disorder, and emerging conditions were found. The absence of physiotherapy interventions in COVID-19 restrictions had a significant multidimensional impact on the neurological state of patients with Parkinson disease.

Effect of garlic rhizome (Allium sativum) powder supplemented diets on the haematology and serum biochemistry of broiler chickens at starter and finisher phases

This study was carried out to evaluate the effect of garlic rhizome powder on blood profile of broiler at different growth phases (starter and finisher phase). One hundred and twenty Abor acre broiler chicks were used for the study and the chicks were randomly distributed into four treatment groups and the treatment groups were then divided into different replicates with each replicate having 10 chicks i.e. 30 chicks in each treatment group. The garlic powder was included at different inclusion levels and the treatments were designed as T1: basal diet with no garlic powder, T2: basal diet supplemented with 0.5% garlic powder T3: basal diet supplemented with 1.0% garlic powder and T4 having 1.5% garlic powder. Starter diet was offered to the birds for the first four weeks of the feeding trial and finisher diet was also provided for the birds within 5th to 8th week. Daily feed intake and weekly body measurement were taken. At the end of the starter phase, blood was collected for haematological and serum biochemistry analysis also blood was collected for blood profile analysis at the seventh (8th) week of the experiment. The blood samples collected were analyzed for haematological parameters which include haemoglobin, Packed cell volume, Red blood cells, White blood cells, Mean corpuscular haemoglobin, Mean corpuscular volume, Mean corpuscular haemoglobin concentration, heterophils, lymphocytes, monocytes, eosinophils and serum biochemical parameters which include Aspartate aminotransferase, Alanine aminotransferase, Alkaline Phosphate, Cholesterol, Total protein, Albumin, Globulin, Uric acid and Creatinine. Results showed that the effect of feeding graded levels of garlic rhizome powder on the haematological and serum parameters were significant (P<0.05). The cholesterol levels of experimental birds dropped significantly with increasing levels of garlic in the diets. Inclusion of garlic powder on broiler feed had no significant difference (P>0.05) on the creatinine level. Therefore 1.5% inclusion of garlic should be added to broiler feed to enhance production of broiler lean meat with lowest cholesterol.

Short-term effects of NTI-tss and Michigan splint on nocturnal jaw muscle activity: A pilot study.

ObjectivesSleep bruxism is mostly assessed by reporting of tooth‐grinding or clenching during sleep and by clinical signs (tooth wear, cracks, or fractures). Parafunctional tooth damage is usually prevented by employing occlusal appliances mainly of the full arch covering type (Michigan splint) and of the partial type covering only central incisors (NTI‐tss). To date, the effects of occlusal appliances on sleep bruxism or jaw muscle activity during sleep are still controversial. The present study is a randomized controlled clinical trial that evaluated the effects of two different splint designs on jaw muscle activity in sleep bruxers otherwise healthy.Material and MethodsTen patients from a private dental practice were treated by a single operator. A Michigan splint and an NTI‐tss device were manufactured individually and used at random order. Electromyographic jaw muscle activity was recorded for four consecutive nights in the first, fourth, and seventh week with and without splint. Participants reported on splint comfort and side effects.ResultsMuscle activity decreased only while wearing the NTI‐tss device. Most patients preferred though the Michigan splint due to its greater wearing comfort.ConclusionsNTI‐tss devices proved more effective for the reduction of jaw muscle activity during sleep. The main advantage of the prefabricated NTI‐tss is its prompt availability in an acute phase of temporomandibular disorders associated with sleep bruxism. In long‐term therapies, patients should be informed of the possible risk of irreversible occlusal changes. Subjective preferences, wearing comfort, and costs should also be considered.

Comparison of The Effect of Breads Containing Milled Sesame or Flaxseed on Blood Pressure of Patient in Stage I Hypertension

Introduction: Flaxseed and sesame both are capable of reducing blood pressure, but no studies have been done to compare their effects on hypertension. The purpose of this study was to compare the effect of breads containing either milled sesame or flaxseed on blood pressure of patients with type I hypertension. Methods: This was a randomized, single blind clinical trial study. Demographic information was obtained from 100 eligible patients and they were randomly allocated to flaxseed or sesame groups. They received breads containing 30 g of either flaxseed or sesame for 14 weeks. Blood pressure, abdominal circumference, and BMI (body mass index) were measured at the beginning, seventh week, and at the end of study. Questionnaires regarding their eating habits and physical activities were also completed at these times. Data was analyzes by SPSS version 16 and independent sample t test and repeated measurement test. Results: Both sesame and flaxseed significantly reduced systolic and diastolic blood pressure (p=0.001) and there was no significant difference. On average, systolic pressure decreased by 9.5 mmHg with sesame and 10 mmHg with flaxseed. Likewise, diastolic blood pressure decreased by 5.05 mmHg with sesame and 5.8 mmHg with flaxseed. BMI and abdominal circumference reduced in both flaxseed (p= 0.001 and 0.001, respectively) and sesame (p=0.01 and 0.02, in order). No difference was observed between these groups. Conclusion: Both sesame and flaxseed could similarly decrease systolic and diastolic blood pressure, abdominal circumference, and BMI. Therefore, they could be used as supplements in reducing blood pressure.

Activity and Toxicity of Eleutherine palmifolia (L.) Merr. Extract on BALB/c Mice Colitis-Associated Colon Cancer Model.

Objective: Eleutherine palmifolia (L.) Merr. extract (EPE) containing isoliquiritigenin and oxyresveratrol is believed to be an anticancer agent. This study evaluates colon histopathology, TNF-α, TGF-β, and hepatotoxicity on BALB/c mice colitis-associated colon cancer (CAC) model treated with EPE. Methods:In vivo study was performed on BALB/c mice CAC model induced by 10 mg/kgBW AOM on the first day followed by administration that each cycle consisted of 5% DSS in water for seven days and regular water for seven days. The indicators of the formation of CAC were observed by a fecal occult blood test (FOBT) and serum amyloid α (SAA) test. The treatment was conducted once a week started from the seventh week up to the twentieth week with six treatment groups: I was administrated by regular water only (negative control), II was administrated by AOM and DSS only (positive control), III was administrated by doxorubicin, IV-VI were treated by EPE (0.25 mg/kg BW, 0.50 mg/kg BW, and 1.00 mg/kg BW) respectively. The colon and liver’s histopathology was observed using hematoxylin-eosin (HE) staining, TNF-α with immunohistochemistry (IHC), and level measurement of TGF-β colon with ELISA reader. The data were used one-way ANOVA followed by post hoc as statistical analysis. Results:The administration of EPE increased the expression of TNF-α, the total of goblet cells of the colon, and decreased the level of TGF-β. Administration of EPE 0.50 mg/20g BW decreased a liver histopathological score but induced a histopathological alteration of the liver at a dose of 1.00 mg/20g BW. Conclusion:This study indicate that EPE could be recommended as a colon anticancer through increase the goblet cells, induce apoptosis through increase TNF-α, and decrease TGF-β.

Gender-related time course of sleep disturbances and psychological symptoms during the COVID-19 lockdown: A longitudinal study on the Italian population

Italy was the first western hotspot of the COVID-19 pandemic. In order to contain the spread of the virus, the Italian Government imposed home confinement to the entire population for almost two months. The present study is the first large-scale longitudinal report of the sleep and mental health changes during the prolonged lockdown due to the COVID-19 outbreak. We focused on the gendered vulnerability in a sample of the Italian population since cross-sectional research identified women to be more at-risk than men during this unprecedented situation.A total of 2701 individuals (mean age ± standard deviation, 32.37 ± 11.62; range, 18–82) participated in a web-based longitudinal survey consisting of two measurements. Participants were first-time recruited on social networks and via telephone messages through a snowball sampling and tested during the third week of the lockdown period. Subsequently, a follow-up evaluation was carried out during the seventh week of restraining measures. The survey assessed sleep quality, insomnia and depression symptoms, perceived stress, and anxiety, using the following questionnaires: the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Beck Depression Inventory-second edition, the 10-item Perceived Stress Scale, and the State-Anxiety Inventory.Female gender showed the worst condition for all the examined dimensions in both the assessments. Nevertheless, at the follow-up women reported a reduction in insomnia and depression severity symptoms, perceived stress, and anxiety. On the other hand, male participants showed a worsening of sleep quality, insomnia symptoms, and perceived stress. Consequently, the gender prevalence gap of clinical conditions such as insomnia and depression was largely reduced under lockdown.Our investigation pointed to a different time course of sleep and mental health between genders during the home confinement period. Women seemed to show greater long-term resilience during the lockdown. Meanwhile, the male gender emerges as the most vulnerable category to the extension of the restraining measures. Our results suggest that there is no “weaker gender” after a prolonged lockdown. Indeed, the Italian population transversely presented signs of psychological suffering and significant sleep disturbances after the protracted and stressful lockdown period due to the COVID-19 pandemic.

Amphiphilic diblock copolymers inhibit the formation of encrustation on the surface of biodegradable ureteral stents in vitro and in vivo

Ureteral stents have been used to treat a variety of urinary diseases for decades. However, the complication of encrustation often impedes its therapeutic effectiveness and service after indwelling in human body. In the present study, in order to surmount this problem, amphiphilic block copolymer, methoxypoly (ethylene glycol)-b-poly (Ɛ-caprolactone) (mPEG-PCL), was used to endow poly (l-lactide-ran-Ɛ-caprolactone) (PLACL) with hydrophilicity by solvent blending. The hydrophilicity, degradability, anti-encrustation (both in vitro and in vivo) and biocompatibility of the developed ureteral stents were assessed using water contact angle, electronic universal material testing machine, SEM, EDS, ICP-OES, dynamic urinary circulation model and a rat model. A progressive increase in the water contact angle and degradation rate was observed with the increase in mPEG-PCL concentration from 1 % to 5 % w/w in the mPEG-PLACL blends. In addition, according to ICP-OES results, approximately 38.86 % Ca and 60.55 % Mg was inhibited after 7 days immersion in dynamic urinary circulation model. Also, in the seventh week of indwelling the developed ureteral stents in rat model, compared with the hydrophobic PLACL, 71 % Ca and 93 % Mg was inhibited. Moreover, histological evaluations showed that mPEG-PCL/PLACL blends decreased tissue inflammation with favorable biocompatibility. As a result, this developed hydrophilic ureteral stents had great potential to become an ideal urological medical device.

Physical Activity of Students During the Pandemic of the Disease Covid-19

In mid-March of 2020, contact teaching at universities was interrupted due to the global pandemic of the disease COVID-19. While the teaching of Physical education took place online students were offered several assignments to fulfil their obligation to the course and try to stay physically active. The research was conducted on 166 participants from the student population of the University of Zagreb who, during the seventh week of online classes, filled out an online questionnaire related to physical activity and online teaching of physical education. The aim of the research was to determine whether there was a difference in the level of physical activity of students before and during the COVID-19 pandemic and whether there was a difference in the level of physical activity according to the gender of the research participants. Furthermore, to determine whether students had the desire to be physically active during the COVID-19 pandemic, whether they were satisfied with online teaching of physical education, and whether online teaching of physical education helped them stay physically active, and whether or not gender differences relevant to the research existed. Wilcoxon rank test demonstrated increased activity of research participants during the COVID-19 pandemic (z=-4.61, p=0.00) with no gender difference. As many as 94,6% of the research participants expressed a desire for physical activity during the pandemic, and 80,1% of them believed that online learning of physical education courses helped them in that goal. A significant difference between male and female students, in favour of female students, was obtained by the χ2 independence test, precisely for the question whether they believed that online teaching of physical education helped them remain physically active. A total of 85,5% of research participants stated they liked online learning. Digital technology in teaching physical education is welcome, but is in no way a substitute for contact teaching. It could be considered as a sort of an intervention which could occasionally be used to refer students towards online assignments during the course of the academic year to enable them to gather additional points and thus, encourage them to take on additional physical activity.

Effect of Visual Experience on Spatial Learning of Rats

Background: Visual information acquired through observation plays a pivotal role in learning a movement pattern and motor control. Objectives: This study aimed to analyze the effect of visual deprivation on learning in rats. Methods: The study sample consisted of 12 male rats, divided into three groups. Group I consisted of four rats and was considered the control group. Transection of the two optic nerves was performed on rats of group II on the seventh day after birth and group III on the seventh week after birth to develop the early blind and late blind models, respectively. A T-shaped maze device was utilized to evaluate the learning behavior of rats. Rats of groups II and III were blinded by the optic nerve surgery. In total, 20 trials per day were conducted for nine consecutive days, in which the time and number of correct arm entries were recorded. The ANOVA and Kruskal-Wallis tests were employed to analyze the results in SPSS software (version 16.0). A p-value of less than 0.05 was considered statistically significant. Results: There was a significant difference between the three groups regarding the number of correct arm entries on days one, three, and seven (P<0.05). There was also a significant difference between the three groups regarding how long it took them to enter the target box on days two and three (P<0.05). Group III had a lower number of entries to the target box and it took them a significantly longer time to enter the target box, compared to the other groups. Conclusion: According to the results, visual deprivation may affect the learning of rats during the early days; however, their learning levels increased over the following days. Moreover, the early blinded rats had a higher level of learning than the lately blinded adult rats and the same level of learning as that of the sighted adult rats.

VAC (Vacuum assisted closure) in the management of chronic non-healing wounds: Institutional study

Background: The management of chronic non- healing wounds has always been a cause of concern for the patients and treating team as well. There had been a marked increase in patients presenting with chronic non -healing wounds of varied etiology. The conventional methods of treatment have been in use traditionally include different medicated dressing application since the long-time yet desired results are not achievable always and some other applications like collagen are mostly not affordable to the poor local population. Vacuum-assisted closure using negative pressure being considered as a suitable alternative management for treating chronic non-healing wounds and the results are comparatively better in relatively lesser time than the conventional techniques. Objective: To assess the impact of (VAC) in the management of non-healing Ulcers To compare the advantage of VAC over conventional dressings in ulcer management Methods: Prospective controlled study of 60 patients aged between 40 and 60 were randomly divided into two groups (Wagner grade 2-5) VAC dressing was kept for over 2-5 weeks. Ulcers were treated until the wound closed spontaneously, surgically or until completion of the 50 days, whichever was earlier. Results: By the seventh week, discharge disappeared in 94 % in VAC and only 56 % in conventional dressing group. Granulation tissue appeared in 100 % of patients in the VAC group and only 63 % in the conventional dressing group. The patients treated with VAC dressing in our study showed comparable wound reduction capabilities with an average wound size reduction of 58 % in comparison to conventional dressing group which had an average wound size reduction of 26 %. Majority of wounds in the VAC group got closed in 7 weeks. Patient satisfaction was very good in the VAC group compared to those patients managed with conventional dressing group. Conclusion: The application of VAC is feasible, reliable and affordable with a better outcome in the management of chronic non-healing ulcers.

Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.

AimsCardiovascular co‐morbidities like congestive heart failure (CHF) alter the course of coronavirus disease 2019. Factors associated with the outbreak and lockdown can exacerbate CHF.Methods and resultsWe analysed the answers of 124 randomly selected CHF outpatients (mean age 71.0 ± 14.0 years, 60.5% male) interviewed by phone during the sixth and seventh weeks of the lockdown. Most patients were treated for New York Heart Association class II (38.7%) and reduced ejection fraction HF (70.2%). Psychological distress (Kessler 6 score ≥ 5) was common (18.5%), and 21.8% felt worse than before the lockdown. Few patients (n = 10) adjusted their intake of HF medications, always on medical prescription. Decreased physical activity was common (41.9%) and more frequent in women (P = 0.025) and urban dwellers (P = 0.009). Almost half of respondents (46.0%) declared increased screen time, but only few declared more alcohol intake (4.0%). Weight gain was common (27.4%), and 44.4% of current smokers increased tobacco consumption. Adherence to recommended salt or fluid intake restrictions was reduced in 14.5%. Increase in HF symptoms was commonly reported (21.8%) and tended to be higher in women than in men (P = 0.074). Of the 23 patients who had a phone teleconsultation during the pandemic, 16 had initially planned an in‐person consultation that they switched for teleconsultation.ConclusionsDuring the lockdown, psychological distress and decreased well‐being were common in CHF outpatients, and there was an increase in unhealthy lifestyle behaviours. These changes may negatively impact short‐term and long‐term prognoses. Medication adherence was maintained, and limitations in access to care were partly counterbalanced by use of telehealth.

Effects of Food Protein Levels on Haematological Parameters of Growing Japanese Quails (Coturnix Coturnix Japonica Temminck & Schlegel, 1849)

The study aims to determine the impact of dietary crude protein levels on the hematological parameters of Japanese quail from growth to ovipositor. To this end, five feeds with different crude protein levels (18, 20, 22, 24 and 26%) were supplied to 700 quails of three weeks of age. These were subdivided into six batches, including three batches of females and three batches of males for each feed group. After subjecting the quails to diets containing the different protein levels, four samples were taken at the fourth, fifth, sixth and seventh week of age. The samples taken were analyzed using an SYSMEX XN 350 automated hematological analyzer. The results of this investigation indicated that non-significant differences (P > 0.05) were observed in hematological parameters in both female and male quails. This study showed that dietary crude protein levels had no impact on the health status of Japanese quails. Keywords: Japanese quails, Crude protein, Hematological parameters.

Effects of an Initial Muscle Strength Level on Sports Performance Changes in Collegiate Soccer Players.

The purposes of this study were to investigate effects of partial block periodized strength training on physical performance and to examine relationships between initial muscle strength measured with isometric mid-thigh pull (IMTP) and performance changes after 7 weeks of strength training. Seventeen collegiate male soccer players participated. Initial muscle strength was determined using IMTP while physical performance included 10 m and 20 m sprints and static vertical jump with a polyvinyl chloride pipe (SJ0), 20 kg barbell (SJ20), and barbell loaded to 40 kg bar (SJ40). Performance testing was performed at three points: before first week (baseline), fourth week (T1), and seventh week (T2). Statistically small to moderate changes were found from baseline to T2 in peak power (PP; p < 0.001, ES = 0.49), net impulse (NI; p < 0.001, ES = 0.49), peak velocity (PV; p < 0.001, ES = 0.62), allometrically scaled PP (PPa; p < 0.001, ES = 0.62) in SJ20 and jump height (JH) in SJ40 (p < 0.001, ES = 0.36). Moderate to large correlations were found between isometric peak force and the changes from baseline to T2 in SJ20 PP (p = 0.04, r = −0.49), SJ20 PF (p = 0.03, r = −0.52), PPa (p = 0.04, r = −0.50), and SJ20 allometrically scaled peak force (p = 0.04, r = −0.49). Properly structured strength training maximizes task-specific physical performance. Initial muscle strength negatively affects the magnitudes of adaptations to physical performance.

Dormancy of Bowdichia virgilioides Kunth seeds

The degree of maturity of fruits and seeds can influence the establishment of seed dormancy. Thus, the present study aimed to verify whether dormancy of B. virgilioides seeds depends on the degree of fruit maturity. Two ex­periments were carried out: in the first one, fruits at two maturity stages (green and brown) were collected from seven plants located in the municipality of Conceição da Feira, BA, Brazil. Germination tests were conducted in a completely randomized design in a 2 x 2 factorial scheme, with two levels of fruit maturity (yellowish green with purple edges and brown with blackish spots) and two treatments related to dormancy overcoming (without over­coming and with overcoming). For the second experiment, darkened fruits were collected from three plants located in the municipality of Cruz das Almas, BA, Brazil. Germination tests were conducted according to a com­pletely randomized design with two treatments, seeds with and without dormancy overcoming. Dormancy in B. virgilioides seeds depends on the degree of fruit maturity. Dormancy occurs after the seventh week of floral anthesis when the fruits are predominantly black, dry and brittle.

The Effects of Input Enhancement Techniques on ESP Learners' Microgenetic Development of Conjunction Production

Microgenetic design or microgenetic method is a scientific method in which the same setting is studied repeatedly in order toobserve possible changes in details. Reviewing the current literature, one can conclude that microgenetic methods havepositive effects of learning in general and language learning in particular. The main objective of the current study was toinvestigate the possible effects of implementing input enhancement techniques using microgenetic methods, on Iranian ESPlearners' conjunction production. To this end, a number of 40 Iranian ESP learners were participated in the study. During thefour-week period of the current study, the participants received the instructions and treatment, two sessions a week and eachsession lasted for an hour. After administering the pre-test before the instruction, using input enhancement techniques, anumber of the conjunctions were presented and taught to the learners in the first session. The data were collected afterinstructional sessions during the first, third, fifth, and seventh weeks through paragraphs focusing on conjunction productionwritten by the participants. The results indicated that, in the course of time, input enhancement techniques using microgeneticmethods, significantly affect Iranian ESP learners' conjunction production.

Effect of shengmai san on insulin resistance, tumor necrosis factor-alpha and oxidative stress in rats fed on a high-fat diet

Shengmai San (SMS) is a well-known traditional Chinese medicine formula prescribed for patients with coronary heart disease (CHD). Insulin resistance is the most likely explanation for the development and progression of this disease. To investigate the effect of SMS on high-fat diet-induced insulin resistance, inflammatory cytokine production and oxidative stress, male Wistar rats were fed with low-fat control diet, high-fat diet and high-fat diet supplemented with 4% SMS for eight weeks. An oral glucose tolerance test was conducted in the seventh week. Rats fed the SMS diet had significantly lower plasma fructosamine concentration (p < 0.05) and tended to have lower (p < 0.1) AUC values of plasma glucose and insulin concentrations after glucose challenge, compared to those fed the high-fat diet. Moreover, SMS reduced TNF-α and lipid peroxidation levels in the liver and heart. However, SMS had no effect on fasting plasma concentrations of glucose, insulin, triglyceride, non-esterified fatty acids, total cholesterol, HDL-cholesterol and insulin resistance index (homeostasis model assessment; HOMA) in rats. Our results show that SMS may have little or no significant effect on reducing insulin resistance, but display anti-oxidative and anti-inflammatory properties.

Yolk sac diameter as a prognostic factor for first trimester pregnancy outcome

Aims: To evaluate yolk sac diameter as a predictor of first trimester pregnancy outcome.&#x0D; Methods: This was a prospective observational study conducted at Paropakar Maternity and Women’s Hospital from October 2017 to October 2018. Pregnant women in between seven and ten weeks of gestation were enrolled. Transabdominal sonography was performed to measure yolk sac diameter and followed up till 12 weeks of gestation to see the outcome. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for yolk sac diameter with regards to abnormal pregnancy outcome.&#x0D; Results: There were 80 cases enrolled and a significant positive correlation was found between yolk sac diameter and gestational age. Abnormal yolk sac diameter, irrespective of gestational age, had sensitivity of 92.95%, specificity 66.66%, positive predictive value 95.6% and negative predictive value of 54.54% in predicting abnormal pregnancy outcome.&#x0D; Conclusions: The measurement of yolk sac diameter between seventh and tenth weeks of gestation can predict first trimester pregnancy outcome. This is useful while counseling pregnant women regarding risk of abnormal outcome and need for follow up ultrasonography.&#x0D; Keywords: first trimester; pregnancy outcome; prognostic factor; yolk sac diameter

The Yolk Sac: An Interesting Small Structure of the Human Embryonic Stage

The yolk sac is a small extraembryonic structure that plays a crucial role during the first trimester of pregnancy. It provides nutrients and performs endocrine, metabolic, and hematopoietic functions during embryogenesis, reaching its peak of functionality between the fourth and seventh weeks of embryonic life [1]. The size of the yolk sac ranges between 2 mm and 5 mm, and it continues to grow up to the 10th week of gestation. Abnormalities of the yolk sac are correlated with poor pregnancy outcomes [2,3].

P0494UNUSUAL CASE OF ACUTE KIDNEY INJURY (HISTOLOGICAL EVALUATION: COLLAPSING GLOMERULOPATHY) IN HEMOPHAGOCYTIC SYNDROME ASSOCIATED WITH NK/T LYMPHOMA

Abstract Background and Aims Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome induced by aberrantly activated macrophages and cytotoxic T cells. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity and immune regulation, is most common in children, whereas the secondary (acquired) form is most frequent in adults. Secondary HLH is commonly triggered by infections or malignancies but may also be induced by autoinflammatory/autoimmune disorders, in which case it is called macrophage activation syndrome. The diagnosis of HLH in adults should be based on the HLH-2004 diagnostic criteria in conjunction with clinical judgment and the patient’s history. Renal involvement has previously been reported in 24 adult cases, mostly as acute renal failure. Collapsing glomerulopathy is extremely rare with only six previous cases reported in the literature. Case presentation We report the case of an African man, 31 years old, presented with fever, acute kidney injury: serum creatinine 10.3 mg/dl; urine protein 600 mg/dl, macrohematuria, ANA/ANCA were negative, low serum C3, organomegaly, anemia, thrombocytopenia, hypertriglyceridemia, hypofibrinogenemia, hyperferritinemia, direct and indirect antiglobulin (Coombs) tests were negative, low haptoglobin; elevated LDH; normal partial thromboplatin time. Peripheral blood smear examination reveal few schistocytes. ADAMTS13 activity was found to be 25%. HBV-DNA and HIV were negative. Anticardiolipin antibodies were negative. Lab exam suggested the relapse of an EBV infection and primary mycoplasma infection. Because of uremic symptoms and persisting oliguria we started replacement therapy by hemodialysis. Plasmapheresis was started because of suspected thrombotic microangiopathy. Suprisingly the kidney biopsy was consistent with collapsing glomerulopathy with evidence of tubular injury while the bone marrow biopsy diagnosed an EBV NK/T-Cell lymphoma. During the course of his hospitalization, the patient suffered high fever. C-reactive protein, WBC and procalcitonin levels were elevated. Antimicrobial agents were initiated, starting with ceftriaxone then upgraded to piperacillin/tazobactam and then the shifted to teicoplanin and meropenem. Blood, urine and stool cultures were negative.VRE positive, IgM Mycoplasma pneumoniae were positive; EBV PCR on bone marrow blood was positive. Malaria screening was negative. The antibiotic therapy was finally switched to doxycycline as unique agent. Steroid therapy (dexamethasone daily 40 mg) and IVIG (daily 35g) were initiated then these drug were stopped. CHOP-like regimen ( Etoposide 75 mg/m2, twice a week for two weeks then once a week until the seventh week) and Rituximab (375 mg/m2, once a week for 4 weeks) were initiated and continued for two weeks. Later on the patient died because of sepsis and multi-organ failure. Conclusions The multidisciplinary approach is very important. Physicians should be aware of HLH, because early recognition may prevent irreversible organ damage and subsequent death.4,5 In adults, HLH-associated mortality remains high, especially in patients with underlying malignancies. Collapsing glomerulopathy is the most commonly reported finding on renal biopsy. Renal prognosis appears to be poor with most patients remaining dialysis-dependent. The increased awareness of HLH, together with a more rapid diagnostic workup and new therapeutic approaches, will improve the prognosis of HLH in adults.

ACCESSORY PERONEUS BREVIS TENDON - A CASE REPORT

Introduction: The development of limb musculature takes place between the fifth and seventh weeks of intrauterine life. The genes MYO-D and MYF5 regulate the limb musculature development and any defect in these may lead to either a partial or complete loss or an addition to the normal muscle morphology. This case report presents the observation of an accessory tendon of the Peroneus brevis muscle in the left lower limb of a 70 year old male cadaver during the routine dissection for undergraduate students at Government Medical College, Miraj. The variant insertion of the Peroneus brevis tendon on the calcaneal tubercle is clinically important to note in cases of lateral ankle pain and instability. The presence of an accessory tendon of the peroneus brevis muscle may also be a cause of the longitudinal splitting of the muscle which should be taken into consideration while making a diagnosis and planning surgeries around the lateral aspect of the ankle.