Bilateral cochlear implantation in a young patient with xeroderma pigmentosum (XP-D) and progressive sensorineural hearing loss-How to do it?

Xeroderma pigmentosum (XP), a rare genetic skin condition, causes ultraviolet (UV)-induced neoplasms and possible neurological deficits including sensorineural hearingloss. We present the first case in literature of bilateral cochlear implantation (CI) in a patient with XP-D with neurodegeneration. Multi-disciplinary team members (national XP team, dermatologist, anaesthetist, theatre team, biophysicists) were involved. UV exposure from equipment and areas where the 14-year-old patient would track was measured. Maximum possible surgery was performed under operating headlights to limit higher-UV microscope exposure. Its bulb light intensity was reduced to achieve safe UV level (0-10 µW/cm2). Skin was protected under surgical drapes. Challenges included drilling unpredicted hard thick bone under low-intensity light and requiring bulkier Nucleus®-7 processor due to unanticipated increased scarring. A delayed left facial weakness was resolved with steroids. He is undergoing hearing rehabilitation. This highlights challenges of CI in XP. Its impact in preserving cognition and on neurodegeneration should also be observed.

Feasibility study of the Vitom 3D exoscope in ENT surgery using an animal model: relevance to coronavirus disease 2019.

OBJECTIVE: The application of a 4K display resolution three-dimensional exoscope system (Vitom 3D) was evaluated to determine the feasibility of adopting the system in ENT surgery in the coronavirus disease 2019 era and beyond. METHODS: Eighteen ENT surgeons performed structured otological tasks on fresh-frozen sheep heads using the Vitom 3D. Structured feedback of the participants' experience was analysed. RESULTS: Seventy-four per cent and 94 per cent of participants reported that the Vitom 3D was ergonomic and comfortable to use respectively. Whilst colour fidelity and image quality were very good, 50 per cent of participants reported image distortion and pixilation at the highest magnification. All participants agreed that there was an increased educational value to exoscope technology. Half the participants preferred the microscope over the Vitom 3D for fine otological work, which may reflect the learning curve. CONCLUSION: The Vitom 3D exoscope is a promising and viable alternative for performing otological surgery when using full personal protective equipment in the coronavirus disease 2019 era.

A critical role of T follicular helper cells in human mucosal anti-influenza response that can be enhanced by immunological adjuvant CpG-DNA.

T Follicular helper cells (TFH) are considered critical for B cell antibody response, and recent efforts have focused on promoting TFH in order to enhance vaccine efficacy. We studied the frequency and function of TFH in nasopharynx-associated lymphoid tissues (NALT) from children and adults, and its role in anti-influenza antibody response following stimulation by a live-attenuated influenza vaccine (LAIV) or an inactivated seasonal virus antigen (sH1N1). We further studied whether CpG-DNA promotes TFH and by which enhances anti-influenza response. We showed NALT from children aged 1.5-10 years contained abundant TFH, suggesting efficient priming of TFH during early childhood. Stimulation by LAIV induced a marked increase in TFH that correlated with a strong production of anti-hemagglutinin (HA) IgA/IgG/IgM antibodies in tonsillar cells. Stimulation by the inactivated sH1N1 antigen induced a small increase in TFH which was markedly enhanced by CpG-DNA, accompanied by enhanced anti-HA antibody responses. In B cell co-culture experiment, anti-HA responses were only seen in the presence of TFH, and addition of plasmacytoid dendritic cell to TFH-B cell co-culture enhanced the TFH-mediated antibody production following CpG-DNA and sH1N1 antigen stimulation. Induction of TFH differentiation from naïve T cells was also shown following the stimulation. Our results support a critical role of TFH in human mucosal anti-influenza antibody response. Use of an adjuvant such as CpG-DNA that has the capacity to promote TFH by which to enhance antigen-induced antibody responses in NALT tissue may have important implications for future vaccination strategies against respiratory pathogens.

Does primary indication for tonsillectomy influence post-tonsillectomy haemorrhage rates in children?

INTRODUCTION: A significant risk in tonsillectomy that causes concern to surgeon and patient is post-tonsillectomy bleed. Secondary haemorrhage is mainly post-operative bleed presenting at or 24h after surgery. Classical teaching indicates infection as the cause. There are not enough published data to evaluate the post-tonsillectomy bleed rates in patients operated for obstructive sleep apnoea versus recurrent tonsillitis. We suspected secondary bleed rates to be higher in patients with recurrent tonsillitis. METHODS: A retrospective review of case-notes of patients presenting to Accident & Emergency department within 4 weeks of tonsillectomy or adeno-tonsillectomy was performed. 568 patients presented with post-operative complications over the 5-year period 2008-2013. Of these, 222 presented with post-operative secondary bleed. Electronic case records were used to identify indication of operation and matched with coding data. These coded data were also used to identify number of operations and primary indications over the 5-year period. RESULTS: The proportion of OSA patients receiving tonsillectomy or adenotonsillectomy surgery increased over the 5-year period. Secondary haemorrhage rate for recurrent tonsillitis surgery was around 4.9% and for OSA surgery was around 15.6%. Comparison of recurrent tonsillitis against OSA for post-operative bleed showed a relative risk of 0.31 (CI 0.24-0.41). The incidence of bleeding mirrored primary indication for each year. CONCLUSION: The bleed rate for OSA was unexpectedly higher than for recurrent tonsillitis. The primary indication for tonsillectomy affects secondary bleeding rate.

Endoscopic dilatation sinus surgery (FEDS) versus functional endoscopic sinus surgery (FESS) for treatment of chronic rhinosinusitis: a pilot study.

The objective of the present study was to compare the efficacy of functional endoscopic dilatation sinus surgery (FEDS) with functional endoscopic sinus surgery (FESS) in treatment of chronic rhinosinusitis in patients who failed medical therapy. We enrolled 24 patients suffering with chronic rhinosinusitis, who failed medical treatment and were proceeding to surgery, in a prospective, randomized controlled pilot study carried out between January and December 2008 following ethical committee approval. All patients completed sino-nasal outcome test (SNOT)-20 questionnaires and underwent saccharine test preoperatively and 24 weeks post operatively. Only trained surgeons performed surgery. The SNOT-20 questionnaire and saccharine clearance time (SCT) were used to measure outcomes. The SNOT-20 scores for both patient groups showed similar, consistent symptomatic improvement compared with baseline measures. SCT was reduced in both groups. No significant post-operative complications were recorded in either group. No patient in the FEDS group had any bleeding, and all were ready for discharge within hours of the procedure. Thus, FEDS is as effective as FESS in treatment of chronic rhinosinusitis. It is can be considered an additional tool in endoscopic surgery and has the potential to be undertaken as a day procedure.

Microscopic studies on the Aspergillus flavus infected kernels of commercial peanuts in Georgia.

This article describes the use of microscopy to prove the presence of the aflatoxin producing pathogen, Aspergillus flavus Link ex Fries in commercially available edible peanuts in Georgia. Light microscopy in combination with electron microscopy has been used to describe the infection course established by the fungus. The alkali maceration technique used in the study was successful and sufficient to detect the kernel infection of A. flavus and monitor the infection percentage in edible peanuts. Percentage of infected kernel varied from one commercial outlet to another in the region. Briefly, peanut seeds from Cartersville had the highest percentage of A. flavus infection. Electron microscopy confirmed the seed-borne infection of this mold. Mycelium established inside the host tissues both intercellularly and intracellularly aided by active, continuous branching of young hyphae. Establishment of mycelium was also detected in the xylem vessels of roots indicative of systemic infection. Thus, edible peanuts can form an important source of inoculum and facilitate the spread of the fungus from one peanut to another in commercial outlets and elsewhere. Present study provides strong evidence that A. flavus can escape detection at selling points and lands in commercial outlets via edible peanuts. That these contaminated peanuts could pose public health hazards is discussed.

Biochemical changes induced in liver and serum of diplodiatoxin (Stenocarpella maydis) treated male and female rats.

Present study was conducted to investigate the acute and sub-acute toxic effect of diplodiatoxin with special reference to biochemical membrane bound enzymes like aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and RBC acetylcholinesterase (AChE) in male and female rats. For acute study, rats were treated with a single oral dose of 5.7 mg/kg of diplodiatoxin, whereas for sub-acute study, the rats received 0.27 mg/kg/day for 21 days. Acute and sub-acute diplodiatoxin treatment caused loss in body weight and feed intake along with symptoms including irritation, dullness, tremors and convulsions. Diplodiatoxin caused a significant increase in serum ASAT and ALAT and a decrease in activity in the liver in both acute and sub-acute studies. This compound also significantly inhibited RBC AChE. Sexual dimorphism was observed when male rats were compared with female rats (p < 0.05). The enzyme alterations observed in the affected enzymes recovered to the normal levels by day 7 post treatment (withdrawal study) in both acute and sub-acute treated rats. A negative correlation was observed with regard to these enzymes when serum was compared with liver. These enzyme profiles show increases in serum with parallel decrease in liver, indicating necrosis of liver. These results suggest that diplodiatoxin has potential to affect hepatic end-points.

Endoscopic excision of Juvenile nasopharyngeal angiofibroma - A comprehensive approach.

OBJECTIVE: Endoscopie excision of Juvenile Nasopharyngeal Angiofibroma (JNA) was carried out with (he objective of minimizing blood loss and attempting a complete excision of the tumor under direct vision with the help of Hopkins telescopes. STUDY DESIGN: A prospective 4 year study of 23 cases of JNA treated by endoscopie excision is presented. Of these, 18 were treated by endoscopie excision alone. The remaining 5 were treated with a two staged approach either by mid-facial degloving followed by endoscopy or by 2 endoscopie procedures. RESULTS: The tumor was excised completely in 17 out of the total 18 cases that were treated exclusively by endoscopy. One case has shown a recurrence. The 5 cases treated by the staged approach represented very large tumours or tumours with intra-cranial extensions. In I of these cases, inoperable tumor remnant engulfing the internal carotid artery was treated by radiotherapy post-operatively. CONCLUSION: With successful excision of JNA in all but one case, we could reasonably conclude, that endoscopie excision of JNA could become a safer and a more precise alternative to open surgery provided it is practiced judiciously by surgeons who have considerable experience in endoscopie surgery and the necessary backup to convert to open surgery should the need arise.

Effect of diplodiatoxin (Stenocarpella maydis) on some enzymatic profiles in male and female rats.

Acute and subacute effects of diplodiatoxin were monitored with special reference to biochemical target enzymes like acid phosphatase (AcP), alkaline phosphatase (AkP), and acetylcholinesterase (AChE) in male and female rats. For acute toxicity study the rats were treated with single oral dose of 5.7 mg/kg of diplodiatoxin, whereas for subacute toxicity study the rats were orally treated with 0.27 mg/kg/day for 21 days. Diplodiatoxin caused loss in body weight and feed intake with other clinical symptoms. Due to the acute and subacute treatment of diplodiatoxin significant decreases were observed in serum AcP and AkP and also in liver AkP, whereas liver AcP increased in both male and female treated rats. Further, significant inhibition of brain AChE was observed in acute and subacute treated animals, indicating its effect on nerve synapsis. Sexual dimorphism was recorded when the activity of male rats was compared with female rats. The values were near those of controls on Day 7 (posttreatment), indicating recovery in the altered enzymes once the treatment was ceased. These results suggest that diplodiatoxin is toxic and has potential to affect the normal functioning of individuals and can cause changes in vital tissues such as liver.

Screening and in vitro production of diplodiatoxin from the isolates of Stenocarpella maydis and its toxigenic effect on bacterial strains.

Stenocarpella maydis from different maize growing regions in South Africa were collected and screened for the presence of diplodiatoxin. The presence of diplodiatoxin in these isolates was detected by thin layer chromatography and further confirmed by atomic pressure chemical ionization mass spectrometry. Samples containing diplodiatoxin showed a strong positive ion at m/z=307. MC34, MC35, MC43 and MC50 isolates of Potchefstroom region produced high amount of diplodiatoxin, whereas some of the isolates from Potchefstroom (D72, D74, D78, D79 and D80) and Cedara (CH3 and U3H) regions did not contain diplodiatoxin. Experiments were conducted to optimize in vitro production of diplodiatoxin using the isolate MC 43. A varied range of pH (3.0 to 5.0) and various culture media viz., PDB, CME, CLM and MSM were tested. Growth of mycelium and production of diplodiatoxin was maximum in PDB media at pH 4.5 and it was observed that diplodiatoxin was produced in detectable quantity in the cultures older than 6 weeks in this media. Further, diplodiatoxin was isolated and purified from 8-weeks-old cultures of MC43 isolate and confirmed by nuclear mass resolution. The standard and the compound purified showed similar NMR spectrum. Sixty-gram (fresh weight) mycelium yielded 19.52 mg of diplodiatoxin. Effect of diplodiatoxin on the growth of various bacterial strains in agar-gelled LB media was studied. They showed different range of tolerance to diplodiatoxin. The increasing order of tolerance to diplodiatoxin was Stenocarpella maydis < B. cereus < B. subtulus < P. fluorescense < E. coli. Further, the effect of different concentrations (4.88-49.70 microg/mL) of diplodiatoxin on the growth of S. aureus in LB liquid media was studied. Presence of diplodiatoxin in the media reduced cell growth as compared to the control thus, confirming anti-bacterial activity of diplodiatoxin.

Agrobacterium-mediated transformation and plant regeneration of Brassica oleracea var. capitata.

An efficient protocol for Agrobacterium tumefaciens-mediated transformation of four commercial cultivars of Brassica oleracea var. capitata is described. A strain of A. tumefaciens LBA4404 with the neomycin phosphotransferase gene (nptII) and a CaMV 35S-peroxidase gene cassette were used for co-cultivation. Preliminary selection of regenerated transgenic plants was performed on kanamycin-containing medium. The frequency of transgenic plants was calculated on the basis of GUS (ß-glucuronidase) activity detected by the histochemical X-gluc test. Tissue-specific GUS expression driven by the peroxidase gene promoter in transgenic plants was analysed by GUS staining. The transformation rates of the commercial cultivars of B. oleracea was higher than in previous reports. Southern blot analysis revealed that integration of marker genes occurred in single and multiple loci in the genome. All transgenic plants grew normally after a brief vernalization period and showed stable inheritance of the marker gene. The present study demonstrates that morphologically normal, fertile transgenic plants of B. oleracea can be obtained.

First Report of Downy Mildew Disease of Rose Caused by Peronospora sparsa in KwaZulu Natal, Southern Africa.

In October and November of 1996, typical downy mildew symptoms appeared on rose plants cultivated in many areas in KwaZulu Natal, South Africa. White mycelial mats were observed on the lower surface of young and mature leaves and on stems at the base of the plants and shoot apices. Leaves and stems developed purplish to black spots. Flowers and buds had downy mildew-like growth on peduncles, calyces, and petals. Plants were poorly developed and generally chlorotic, and several were stunted. The most severe symptoms included premature leaf drop followed by plant death. The fungus from leaf and stem lesions was identified microscopically as Peronospora sparsa based on the following characteristics: conidia, sub-elliptical ranging from 20 to 23 µm long and 14.0 to 18.0 µm wide; conidiophores 150 to 350 µm long and 6 to 10 µm wide. Conidiophores protruded through the stomata as bunches of slender structures bearing conidia at the tips. The optimum temperature for sporulation and germination was 18°C. Artificially inoculated healthy mature leaves and stems developed purplish to dark brown lesions similar to those described from the field samples. The fungus was confirmed on the artificially inoculated tissues to complete Koch's postulates. The disease has been reported in all rose growing regions in KwaZulu Natal and causes up to 100% losses in some areas since its first appearance towards the beginning of winter 1996. The president of the Natal Rose Society, KwaZulu Natal, predicts that in the year 2000 rose plants may be eliminated if immediate control measures for Peronospora sparsa are not implemented. Rose is grown for local needs and has high export value in South Africa. This is the first report of the downy mildew of rose caused by Peronospora sparsa in South Africa.