Patterns of ocular inflammation in patients with miliary tuberculosis

Background: Ocular morbidity associated with systemic tuberculosis is common. The clinical picture varies from anterior uveitis, intermediate uveitis and posterior uveitis to even panuveitis. There is little data on the correlation between specific systemic presentations and the ocular inflammation. We conducted a retrospective review of the ocular findings in the case records of patients admitted with a diagnosis of miliary tuberculosis. These patients were then referred for a more detailed ophthalmic evaluation. Methods: We analysed the case records of patients with a clinical diagnosis of miliary tuberculosis over a 10-year period at Lilavati Hospital and Research Center, Mumbai. Results: In total, 11 immunocompetent patients were identified. All 22 eyes showed normal findings on slit lamp examination. Dilated fundus examination showed single or multiple tubercles. In our cohort, the ocular findings were exclusively in the form of choroidal tuberculosis, either unilaterally or bilaterally. Slit lamp examination revealed no anterior segment inflammation Conclusions: We suggest that this pattern of choroidal/retinal tuberculosis in the absence of anterior and intermediate segment inflammation is specific for miliary tuberculosis and may be related to a specific immune response.

A CASE REPORT OF QUADRANGULAR INCA BONE. Un caso de hueso cuadrangular inca.

Los huesos wormianos son estructuras osificadas que se encuentran dentro de las suturas. En frecuencia que varían extensamente entre grupos étnicos diferentes hay más predominio entre mujeres. En el presente estudio reportamos el caso de un verdadero hueso cuadrangular interparietal o hueso inca en el cráneo humano adulto. Los huesos de wormian interparietal o los huesos epactal se diferencian de los huesos suturales sobre la base de su posición. Los huesos wormianos interparietales están localizados dentro de la región interparietal, mientras los huesos suturales son formados a partir de centros de osificación adicionales que pueden ocurrir en o cerca de las suturas. La osificación inadecuada de la región interparietal lleva a la formación de los huesos wormianos. Ellos también pueden estar relacionados con factores genéticos. El hueso interparietal es formado por la separación del segmento intermedio del plato lateral por la sutura occipital transversa, por lo tanto este hueso es formado por las placas intermedias y laterales que pueden ser únicas o múltiples. La localización de tales huesos está, sobre todo, en la parte central superior de la región interparietal. La ocurrencia de la variable del inca es rara es seres humanos. El conocimiento del hueso del inca puede ser útil a las clínicas, disciplinas de la neurocirugía, ortopedia, antropología, radiología y para los expertos forenses. Wormian bones are ossified structures that are found within the sutures. Incidence of which varies widely among different ethnic groups with more prevalence among females. In the present study we hereby report a case of single true quadrangular interparietal or inca bone in adult human skull. Wormian interparietal bones or epactal bones differ from the sutural bones on the basis of their location. The wormian interparietal bones are located within the interparietal region, while the sutural bones are formed from additional ossification centers that can occur in or near the sutures. Inadequate ossification of the interparietal region leads to the formation of interparietal or wormian bones. They may also be linked with genetic factors. The interparietal bone is formed by the separation of the intermediate segment from the lateral plate by the transverse occipital suture, hence this bone is formed by the medial and lateral plates which may be either single or multiple. The location of such bones is mostly in the upper central part of the interparietal region. The occurrence of inca bone variation is rare in humans. Knowledge of inca bone in human skulls may be useful to clinicians, disciplines of neurosurgery, orthopaedics, anthropology, radiology and for forensic experts.

Preliminary report on a new concept stent prototype designed for venous implant

Venous obstruction at iliocaval level in both forms, primary and secondary, is a significant cause of severe chronic venous insufficiency. A new therapeutic approach to this pathology emerged with the introduction of stenting procedures that proved effective, leading to good long-term results. However, at present, the majority of implanted stents have been designed for arterial implant and this can pose a limit in particular districts. The purpose of this preliminary acute study was to verify the deliverability and safety of a new stent specially designed for venous-vessel implant. We assess the safety and deliverability of two braided, self-expanding, nickel–titanium stents (Jotec GmbH, Hechingen, Germany) specially designed for endovascular implant in veins. The two stents, despite being based on the same concept, have a different design: stent A presents a proximal tapering shape specially designed to reduce migration, while stent B does not. Both of them are enlarged at their distal extremity and present variable radial force the length of the stent itself, the said force becoming very high in the intermediate segment. Stents were implanted in the internal jugular vein of a sheep, showing optimal deliverability. The completion venography showed the migration of stent B into the right atrium. Stent A maintained its location, confirmed by intravascular ultrasound examination. No scaffolding effect was detected and an adequate adherence and adaptability to the vein wall was obtained. In conclusions, the stent A design matches the characteristics required by vein implants. Stability is achieved even where difficult anatomical conditions apply, such as in the jugular vein. Deployment is easy and precise in a given landing zone. Radial resistive force is very high, as required in specific vein districts, but is also associated with good flexibility. Following this preliminary acute report, further studies are required.

Small Peptides Blocking Inhibition of Factor Xa and Tissue Factor-Factor VIIa by Tissue Factor Pathway Inhibitor (TFPI)

Tissue factor pathway inhibitor (TFPI) is a Kunitz-type protease inhibitor that inhibits activated factor X (FXa) via a slow-tight binding mechanism and tissue factor-activated FVII (TF-FVIIa) via formation of a quaternary FXa-TFPI-TF-FVIIa complex. Inhibition of TFPI enhances coagulation in hemophilia models. Using a library approach, we selected and subsequently optimized peptides that bind TFPI and block its anticoagulant activity. One peptide (termed compound 3), bound with high affinity to the Kunitz-1 (K1) domain of TFPI (Kd ∼1 nm). We solved the crystal structure of this peptide in complex with the K1 of TFPI at 2.55-Å resolution. The structure of compound 3 can be segmented into a N-terminal anchor; an Ω-shaped loop; an intermediate segment; a tight glycine-loop; and a C-terminal α-helix that is anchored to K1 at its reactive center loop and two-stranded β-sheet. The contact surface has an overall hydrophobic character with some charged hot spots. In a model system, compound 3 blocked FXa inhibition by TFPI (EC50 = 11 nm) and inhibition of TF-FVIIa-catalyzed FX activation by TFPI (EC50 = 2 nm). The peptide prevented transition from the loose to the tight FXa-TFPI complex, but did not affect formation of the loose FXa-TFPI complex. The K1 domain of TFPI binds and inhibits FVIIa and the K2 domain similarly inhibits FXa. Because compound 3 binds to K1, our data show that K1 is not only important for FVIIa inhibition but also for FXa inhibition, i.e. for the transition of the loose to the tight FXa-TFPI complex. This mode of action translates into normalization of coagulation of hemophilia plasmas. Compound 3 thus bears potential to prevent bleeding in hemophilia patients.

Comparative histological, histochemical and ultrastructural studies of the nephron of selected snakes from the Egyptian area

The present study was aimed to compare and contrast the histochemical, histological and ultrastructural variations (microanatomical differences) in the nephrons of selected snake species, Eryx jaculus (Boidae), Psammophis sibilans (Colubridae), Naja haje (Elapidae) and Echis pyramidum (Viperidae) from Egypt. The structural studies were carried out by conventional light and electron microscopy. The nephron, the renal unit of snakes, consists of renal corpuscle, proximal tubule, intermediate segment, distal tubule and collecting tubule. The renal corpuscles have large capillaries with clear and dark fenestrated endothelial cells. The proximal tubule showed long microvilli, cytoplasmic vacuoles, developed endoplasmic reticulum and abundant mitochondria. The intermediate segment was lined by ciliated cells. The lining cells of the distal tubules showed few microvilli, abundant dense mitochondria and clear vesicles of mucous appeared in the terminal portion. The collecting tubules consisted of mucous cells. In summary, the ultra-structure studies of nephrons revealed several interspecies similarities and also some intra-species differences in species of snakes.