[Medico-surgical management of intravitreal hemorrhage in diabetic patients]. / Gestion médicochirurgicale de l'hémorragie intravitréenne chez le patient diabétique.

Vitreous hemorrhage (VH) is the main complication of proliferative diabetic retinopathy and remains the primary indication for vitrectomy in diabetic patients. The objective of our study is to compare our medical and surgical management of VH with data from the literature and to report the functional results of our series. We studied a series of 284 cases collected over 2 years in two tertiary care centers. In our series, 90.1% of patients had type 2 diabetes, and 70% had glycosylated hemoglobin greater than 7.5%. On fundus examination, 35.2% presented with stage 1 VH, 42.6% with stage 2, 3.6% with stage 3 and 5.2% with stage 4. Ocular ultrasound performed when fundus exam was difficult diagnosed an associated tractional retinal detachment in 8.8% of patients. Medical treatment was sufficient in 77.8% of patients, while 22.2% of our patients underwent vitrectomy, argon laser endophotocoagulation and postoperative anti-VEGF injection. Peeling of tractional fibrovascular membranes and or associated epiretinal membranes was performed in 69.8% of cases. Iatrogenic tears were noted in 11.8% of patients. In this study, 31.5% of patients underwent intraocular gas tamponade, while 23.8% of cases underwent silicone oil tamponade. Postoperative visual acuity improved by at least 2 lines in 60% of our patients, and the VH recurred in 24.2% of cases after surgery.

A Pilot Randomized Sham-Controlled Trial of MC5-A Scrambler Therapy in the Treatment of Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN).

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) affects 30% to 40% of patients with cancer with long-lasting disability. Scrambler therapy (ST) appeared to benefit patients in uncontrolled trials, so we performed a randomized sham-controlled Phase II trial of ST. METHODS: The primary end point was "average pain" after 28 days on the Numeric Rating Scale. Each received ten 30-minute sessions of ST on the dermatomes above the painful areas, or sham treatment on the back, typically at L3-5 where the nerve roots would enter the spinal cord. Outcomes included the Brief Pain Inventory (BPI)-CIPN and the EORTC CIPN-20 scale. Patients were evaluated before treatment (day 0), day 10, and days 28, 60, and 90. RESULTS: Data regarding pain as a primary outcome were collected for 33 of the 35 patients. There were no significant differences between the sham and the "real" ST group at day 10, 28, 60, or 90, for average pain, the BPI, or EORTC CIPN-20. Individual responses were noted during the ST treatment on the real arm, but most dissipated by day 30. There was improvement in the sensory subscale of the CIPN-20 at 2 months in the "real" group (P = .14). All "real" patients wanted to continue treatment if available. DISCUSSION: We observed no difference between sham and real ST CIPN treatment. Potential reasons include at least the following: ST does not work; the sham treatment had some effect; small sample size with heterogeneous patients; misplaced electrodes on an area of nonpainful but damaged nerves; or a combination of these factors.

Efficacy of removing Candida albicans from orthodontic acrylic bases: an in vitro study.

BACKGROUND: This study evaluated the efficacy of four methods in removing Candida albicans from the acrylic base material used to fabricate removable orthodontic appliances. METHODS: Heat-processed bars of orthodontic acrylic were incubated in a suspension of C. albicans for 2 h at 37 °C. Samples were allocated into five groups (five bars per group) according to the cleaning method: (1) manual brushing using a toothbrush; (2) soaking in a commercial denture cleaning solution; (3) soaking in a commercial mouthwash solution; (4) using an ultrasonic cleaner; and (5) soaking in distilled water as a negative control. Yeast remaining attached to the bars after cleaning were removed by vortexing in growth medium and plated on Sabouraud dextrose agar. The reduction in yeast colony count after cleaning was calculated and expressed as the number of colony forming units per acrylic bar (CFU/bar). The experiment was carried out three times. RESULTS: All four cleaning methods resulted in a significant decrease in viable yeast cells associated with the acrylic bars compared to the control group. The mean percentage reduction in viable yeast cells affected by the cleaning methods was: brushing 89.9%; chlorhexidine 95.8%; ultrasonic cleaning 99.9%; and denture tablet 100%. CONCLUSIONS: All four methods evaluated in this study were effective, to some extent, in removing C. albicans from orthodontic acrylic samples. The most effective, and readily available, cleaning method was the use of commercial denture sterilizing tablets.

An evaluation of two types of nickel-titanium wires in terms of micromorphology and nickel ions' release following oral environment exposure.

BACKGROUND: This study aimed to compare superelastic and heat-activated nickel-titanium orthodontic wires' surface morphology and potential release of nickel ions following exposure to oral environment conditions. METHODS: Twenty-four 20-mm-length distal cuts of superelastic (NiTi Force I®) and 24 20-mm-length distal cuts of heat-activated (Therma-Ti Lite®) nickel-titanium wires (American Orthodontics, Sheboygan, WI, USA) were divided into two equal groups: 12 wire segments left unused and 12 segments passively exposed to oral environment for 1 month. Scanning electron microscopy and atomic force microscopy were used to analyze surface morphology of the wires which were then immersed in artificial saliva for 1 month to determine potential nickel ions' release by means of atomic absorption spectrophotometer. RESULTS: Heat-activated nickel-titanium (NiTi) wires were rougher than superelastic wires, and both types of wires released almost the same amount of Ni ions. After clinical exposure, more surface roughness was recorded for superelastic NiTi wires and heat-activated NiTi wires. However, retrieved superelastic NiTi wires released less Ni ions in artificial saliva after clinical exposure, and the same result was recorded regarding heat-activated wires. CONCLUSIONS: Both types of NiTi wires were obviously affected by oral environment conditions; their surface roughness significantly increased while the amount of the released Ni ions significantly declined.

Through our eyes: exploring African-American men's perspective on factors affecting transition to manhood.

BACKGROUND: Premature mortality and disparities in morbidity observed in African-American men may be associated with factors in their social, economic, and built environments that may be especially influential during the transition to adulthood. OBJECTIVE: To have young, African-American men from Los Angeles County identify and prioritize factors associated with their transition to manhood using photovoice methodology and pile-sorting exercises. DESIGN: Qualitative study using community-based participatory research (CBPR) and photovoice PARTICIPANTS: Twelve African-American men, ages 16-26 years, from Los Angeles County, California. APPROACH: We used CBPR principles to form a community advisory board (CAB) whose members defined goals for the partnered project, developed the protocols, and participated in data collection and analysis. Participants were given digital cameras to take 50-300 photographs over three months. Pile-sorting techniques were used to facilitate participants' identification and discussion of the themes in their photos and selected photos of the group. Pile-sorts of group photographs were analyzed using multidimensional scaling and hierarchical cluster analysis to systematically compare participants' themes and identify patterns of associations between sorted photographs. Sub-themes and related quotes were also elicited from the pile-sorting transcripts. The CAB and several study participants met periodically to develop dissemination strategies and design interventions informed by study findings. KEY RESULTS: Four dominant themes emerged during analysis: 1) Struggles face during the transition to manhood, 2) Sources of social support, 3) Role of sports, and 4) Views on Los Angeles lifestyle. The project led to the formation of a young men's group and community events featuring participants. CONCLUSIONS: CBPR and photovoice are effective methods to engage young, African-American men to identify and discuss factors affecting their transition to manhood, contextualize research findings, and participate in intervention development.

The C terminus of lettuce mosaic potyvirus cylindrical inclusion helicase interacts with the viral VPg and with lettuce translation eukaryotic initiation factor 4E.

Recessive resistance to lettuce mosaic virus (LMV) is conferred in lettuce by the mo1 gene, encoding the eukaryotic translation initiation factor 4E (eIF4E). The C terminus of the viral cylindrical inclusion helicase (CI-Cter), together with the VPg, is involved directly in overcoming mo1 resistance. In this study, recombinant LMV VPg and CI-Cter proteins from wild-type or resistance-breaking isolates were expressed and purified from Escherichia coli. The allelic forms of eIF4E from susceptible or resistant lettuce cultivars were produced similarly and these proteins were used in ELISA-based assays to demonstrate the in vitro binding of the various forms of LMV CI-Cter to both lettuce eIF4E and LMV VPg proteins. All combinations tested displayed significant and specific interactions, and the interaction between the C-terminal part of the LMV CI and eIF4E was confirmed in vivo in bimolecular fluorescence complementation assays. Higher interaction signals for both CI-eIF4E and CI-VPg were observed for LMV-E, indicating that the eIF4E interaction network involving CI and VPg appears to be stronger in the case of this resistance-breaking isolate. This could suggest the need for a minimal interaction threshold for infection success in resistant lettuce, but more precise measurement of the interaction parameters linking eIF4E, VPg and CI is needed in order to reinforce such a hypothesis.

Cervical spinal cord injury due to fall while carrying heavy load on head: a problem in Bangladesh.

STUDY DESIGN: Observational study. SETTING: Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh. METHODS: This observational study was conducted on 84 patients of Cervical spinal cord injury (CSCI) due to fall while carrying heavy load on head. They were admitted at the CRP, Dhaka, Bangladesh between January 1999 and December 2001. Relevant personal information, neurological status, types of bony injuries and x-ray findings were noted down in pre-structured questionnaire. In addition, each subject was interviewed to find out the cause of accidental fall while carrying heavy load on head. RESULTS: Age of the studied subjects ranged between 10 to 50 years. All were male of whom 79 (94%) subjects were farmers and/or low cost daily laborers. In all, 72% percent of the subjects were carrying 60-80 kg weight on their head when fall occurred. A total of 48 (57%) subjects had complete neurological lesion. The most common vertebral levels were C5 and C6. So far the mechanism of injury is concerned hyper flexion of the cervical spine predominated (61%) over hyperextension (36%). CONCLUSION: Fall while carrying heavy load on head is a common cause of CSCI in Bangladesh. The victims are mostly young farmers or unskilled day laborers who were not habituated to carry heavy load on head.

Germline mutations in CDH1 are infrequent in women with early-onset or familial lobular breast cancers.

BACKGROUND: Germline mutations in CDH1 are associated with hereditary diffuse gastric cancer; lobular breast cancer also occurs excessively in families with such condition. METHOD: To determine if CDH1 is a susceptibility gene for lobular breast cancer in women without a family history of diffuse gastric cancer, germline DNA was analysed for the presence of CDH1 mutations in 318 women with lobular breast cancer who were diagnosed before the age of 45 years or had a family history of breast cancer and were not known, or known not, to be carriers of germline mutations in BRCA1 or BRCA2. Cases were ascertained through breast cancer registries and high-risk cancer genetic clinics (Breast Cancer Family Registry, the kConFab and a consortium of breast cancer genetics clinics in the United States and Spain). Additionally, Multiplex Ligation-dependent Probe Amplification was performed for 134 cases to detect large deletions. RESULTS: No truncating mutations and no large deletions were detected. Six non-synonymous variants were found in seven families. Four (4/318 or 1.3%) are considered to be potentially pathogenic through in vitro and in silico analysis. CONCLUSION: Potentially pathogenic germline CDH1 mutations in women with early-onset or familial lobular breast cancer are at most infrequent.

Assessment of a modification of Brückner's test as a screening modality for anisometropia and strabismus.

BACKGROUND: Current amblyopia screening methods are not cost effective. AIM: To evaluate the diagnostic capability of a modified Brückner test (MBT) for amblyopiogenic risk factors. MATERIALS AND METHODS: We applied the MBT using the streak retinoscope to identify anisometropia and strabismus by noting an inter-ocular difference in movement and glow, from children who failed 6/9 Snellen on community vision screening, followed by comprehensive eye examination. STATISITICS: Data were analyzed by 2 × 2 tables for diagnostic test parameters (95% CI). RESULTS: From 7998 children vision-screened, 392 failed 6/9 VA and were referred. Since 34 failed to reach the centers, and 15 were excluded due to poor/ no glow, data from 343 was analyzed. The prevalence of anisometropia of 0.5D was 17%, of 1D was 11% and of strabismus 5%. For the MBT the accuracy was ≥ 90% (95%CI 89% to 97%) over the three outcomes. The sensitivity, specificity, NPV and +LR for anisometropia of 0.5D were: 0.57 (0.48, 0.64), 0.97 (0.95, 0.98), 0.92 (0.90, 0.93) and 18 (9.7, 35); for 1D: 0.74(0.60, 0.82), 0.95 (0.94, 0.97), 0.97 (0.95, 0.98) and 16 (9.3, 28); and for strabismus: 0.5 (0.32, 0.66), 0.98 (0.97, 0.98), 0.97 (0.96, 0.98) and 20 (9.1, 42). CONCLUSION: Our data suggests that the MBT is highly accurate and useful for ruling in anisometropia and strabismus in children who fail 6/9 Snellen. The MBT needs further validation, both by different care givers and on differing populations. It offers an affordable, portable, and clinically useful tool to detect anisometropia and strabismus. We suggest that performing an MBT prior to uniocular retinosocpy should be a routine practice.

Heterogeneity of breast cancer and implications of adjuvant chemotherapy.

Historically, in selecting adjuvant chemotherapy for patients with breast cancer, anatomy, including tumor size and nodal status, has played the primary role. As a result of analyses of genomic and clinical data, breast cancers are now thought to be a family of diseases. Major subtypes of breast cancer include HER-2 positive disease, basal-like or triple negative tumors, and at least two types of hormonally sensitive cancers. Using the nomenclature developed in the gene expression array studies, these two types are often referred to as luminal A and luminal B. Estrogen receptor negative tumors relapse earlier than estrogen receptor positive tumors. In general, estrogen receptor negative cancers are also more responsive to chemotherapy. In contrast, estrogen positive tumors appear to be somewhat less responsive to chemotherapy, but endocrine therapy can be of substantial benefit in decreasing the risk of disease recurrence. Women with HER-2 positive disease derive significant benefit with the use of trastuzumab. The role of chemotherapy in preventing disease recurrence in patients with estrogen receptor positive tumors is being reevaluated. Recent data suggests that chemotherapy has the greatest benefit in those patients with estrogen receptor positive cancers whose tumors are HER-2 positive disease, weakly ER positive, and/or have high nuclear grade. In the future, breast cancer treatment will be more targeted to the tumor and tailored to the individual with the use of genomic and clinical data.

Toxoplasmosis: the innocent suspect of pregnancy wastage in Duhok, Iraq.

To identify the true contribution of toxoplasmosis to fetal loss and bad obstetric history, we tested 310 women, 77.4% of whom had had single or multiple fetal loss, for evidence of infection. The study was conducted in Duhok, northern Iraq, from July 2002 till September 2003. All the women were examined for the presence of toxoplasma-specific IgM antibodies by enzyme-linked immunofluorescent assay; only 3 (0.97%) tested positive. We also tested 187 of the women by latex agglutination test; 55 tested positive. Histopathological examination was done for 9 pregnant women who tested positive by the latex agglutination test but we found no evidence of toxoplasma infection. The results indicate that the contribution of toxoplasmosis to fetal loss in our region is greatly overestimated.

Toxoplasmosis: the innocent suspect of pregnancy wastage in Duhok, Iraq

To identify the true contribution of toxoplasmosis to fetal loss and bad obstetric history, we tested 310 women, 77.4% of whom had had single or multiple fetal loss, for evidence of infection. The study was conducted in Duhok, northern Iraq, from July 2002 till September 2003. All the women were examined for the presence of toxoplasma-specific IgM antibodies by enzyme-linked immunofluorescent assay; only 3 [0.97%] tested positive. We also tested 187 of the women by latex agglutination test; 55 tested positive. Histopathological examination was done for 9 pregnant women who tested positive by the latex agglutination test but we found no evidence of toxoplasma infection. The results indicate that the contribution of toxoplasmosis to fetal loss in our region is greatly overestimated

Early relapse of thrombotic thrombocytopenic purpura during therapeutic plasma exchange associated with Acinetobacter anitratus bacteremia.

Thrombotic thrombocytopenic purpura (TTP)/Hemolytic-uremic syndrome (HUS) is a syndrome characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, renal failure and neurologic manifestation. Almost all cases are idiopathic. However, secondary TTP/HUS associated with viral, bacterial and mycobacterial infections, drugs, connective tissue disease, solid tumors, bone marrow transplantation and pregnancy have been described. Early relapse associated with infection is a rare occurrence. The patient we report had a classic case of postdiarrheal TTP/HUS that responded to plasmapheresis but relapsed during treatment as reflected by the increased schistocytosis, decreased hematocrit, increased lactate dehydrogenase, and decreased platelet counts. This relapse may be attributed to Acinetobacter anitratus bacteremia, secondary to central line infection. Administration of antimicrobial treatment resulted initially in a mild improvement. However, this was followed by a fatal relapse. The importance of monitoring the possible bacterial colonization of an indwelling catheter is thus emphasized.

Reactive hemophagocytic syndrome associated with thrombotic thrombocytopenic purpura during therapeutic plasma exchange.

Hemophagocytic lymphohistiocytosis (HLH) is characterized by fever, cytopenia, splenomegaly, and lymphohistiocytic proliferation with hemophagocytosis. Sporadic, familial, and reactive HLH varieties exist. The latter, also termed the reactive hemophagocytic syndrome (RHS), has been associated with a variety of infectious and noninfectious etiologies. Activation of monocytes in RHS is due to stimulation by high levels of activating cytokines. RHS has not been associated previously with thrombotic thrombocytopenic purpura (TTP). TTP is a multisystem disorder characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal impairment, and fever. We report on a 33 year old male patient with a classic picture of TTP who initially responded to therapeutic plasma exchange but then became refractory to treatment and developed RHS. It is likely that a specific pathophysiology involving the activation of neutrophils during TPE is present for the development of cytokine-induced hemophagocytosis during TTP treatment. The consequent development of RHS possibly caused early TTP relapse.

The infertile couple: a cohort study in Duhok, Iraq.

From January 2000 to May 2001 causes of infertility were studied for 250 couples, 193 (77.2%) of whom had primary infertility and 57 (22.8%) had secondary infertility. Male infertility was found in 36.8% of cases. The most common cause of female infertility was ovulation disorders (41%) while tubal obstruction contributed to only 5% of cases. Only 15% of the couples had unexplained infertility. Galactorrhoea and/or increased serum prolactin was seen in 60% of cases. Ultrasonographic detection of mature follicles was consistent with the results of cervical mucus study and endometrial biopsy in 90% of cases.

The infertile couple: a cohort study in Duhok, Iraq

From January 2000 to May 2001 causes of infertility were studied for 250 couples, 193 [77.2%] of whom had primary infertility and 57 [22.8%] had secondary infertility. Male infertility was found in 36.8% of cases. The most common cause of female infertility was ovulation disorders [41%] while tubal obstruction contributed to only 5% of cases. Only 15% of the couples had unexplained infertility. Galactorrhoea and/or increased serum prolactin was seen in 60% of cases. Ultrasonographic detection of mature follicles was consistent with the results of cervical mucus study and endometrial biopsy in 90% of cases

Role of mycoplasma in male infertility

We trace the evidence-based evolution of ureaplasmal male infertility as an established clinical entity. We review epidemiology data, possible pathogenic mechanisms of Ureaplasma urealyficurn in infertility, and the results of isolation studies and therapeutic trials. Future developments are outlined