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OBJECTIVE: To present an interesting cause of pre-auricular swelling. CASE REPORT: We report the case of a 39-year-old woman who presented to the ENT department as an emergency with swelling in the left pre-auricular region. The patient had recently travelled to Central America, where the botfly is endemic. On examination, there was a raised, indurated area with a central orifice. A botfly larva was suspected. The larva was suffocated with paraffin paste, allowing removal without remnants being retained. CONCLUSION: Suffocation of botfly larvae is favoured to surgical removal, due to the possibility of larval remnants being retained and acting as a nidus for infection. The increasing frequency of exotic travel means doctors need to be more aware of tropical medicine.

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Over the past century, studies of development and reproductive biology have transcended our understandings of what constitutes heritability and the acquisition of phenotypic traits from one generation to the next. While our early research defined “particulate genetic inheritance” as a primary mechanism for the heritability of traits, more recent work in past decades in lower eukaryotes and early mammalian species have included “epigenetic” (or “upon the genome”) modifications to the genomic backbone as a primary mechanism in the complex series of molecular interactions which ultimately enabling coordinate regulation of development. In recent years such investigations have evolved to focus on the role of epigenetic modifications to DNA and core histones in higher mammalian developmental processes. What are epigenetic modifications? While almost all cells of an individual bear near identical genomic constitutions, phenotype is ultimately determined by the gene expression profile. Gene expression is maintained by two major mechanisms: (1) transcription factors and post-transcriptional modifiers, and (2) epigenetic modifications, in particular DNA and core-histone modifications, that can be inherited during mitosis from one cell generation to another. This epigenetic code is essential in directing the tremendous number of gene expression changes that must occur for a cell to leave its pluripotent state and become fully differentiated to then function in adaptive homeostasis processes of the organism. It may therefore be stated that one’s epigenetic signatures are the net outcome of genotype, developmental lineage, and environmental exposures. These epigenetic signatures are stable and/or heritable patterns of gene activity and expression that do not result from changes in the genomic sequence. Covalent modifications to histones (i.e., histone H3 acetylation and methylation) and DNA methylation (meCpG) are examples of such epigenetic events which collectively...

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Over the past century, studies of development and reproductive biology have transcended our understandings of what constitutes heritability and the acquisition of phenotypic traits from one generation to the next. While our early research defined “particulate genetic inheritance” as a primary mechanism for the heritability of traits, more recent work in past decades in lower eukaryotes and early mammalian species have included “epigenetic” (or “upon the genome”) modifications to the genomic backbone as a primary mechanism in the complex series of molecular interactions which ultimately enabling coordinate regulation of development. In recent years such investigations have evolved to focus on the role of epigenetic modifications to DNA and core histones in higher mammalian developmental processes. What are epigenetic modifications? While almost all cells of an individual bear near identical genomic constitutions, phenotype is ultimately determined by the gene expression profile. Gene expression is maintained by two major mechanisms: (1) transcription factors and post-transcriptional modifiers, and (2) epigenetic modifications, in particular DNA and core-histone modifications, that can be inherited during mitosis from one cell generation to another. This epigenetic code is essential in directing the tremendous number of gene expression changes that must occur for a cell to leave its pluripotent state and become fully differentiated to then function in adaptive homeostasis processes of the organism. It may therefore be stated that ones epigenetic signatures are the net outcome of genotype, developmental lineage, and environmental exposures. These epigenetic signatures are stable and/or heritable patterns of gene activity and expression that do not result from changes in the genomic sequence. Covalent modifications to histones (i.e., histone H3 acetylation and methylation) and DNA methylation (meCpG) are examples of such epigenetic events which collectively...(AU)

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AIMS: IgA nephropathy (IgAN) is the most frequent glomerulonephritis around the globe, but its incidence in the United States is unknown. The disease has a preponderance for certain racial/ethnic groups. Our goals were to retrospectively analyze a series of IgAN biopsies from the state of New Mexico and to calculate an estimated incidence. Then we compared the racial/ethnic composition of our patient cohort to the composition of the New Mexico population and examined the three main racial/ethnic groups for differences in clinical and pathologic parameters. MATERIALS AND METHODS: Renal biopsies and clinical data from IgAN cases newly diagnosed in New Mexico between 2000 and 2005 were reviewed. We compared the racial/ethnic composition of our patient cohort to the demographic composition of the New Mexico population. Demographic, clinical, and histopathologic variables were analyzed with respect to the patients' race/ethnicity. RESULTS: The incidence of IgAN in New Mexico was 10.2 cases per million persons per year (9.3 when Henoch-Schönlein purpura cases were excluded). American Indians were twice as frequent in our patient cohort when compared to their demographic representation, with the reverse finding for Non-Hispanic Whites. Hispanics more frequently had nephrotic range proteinuria than Non-Hispanic Whites and American Indians. On renal biopsy, endocapillary proliferative glomerulonephritis was the most common glomerular abnormality, followed by the focal segmental glomerulosclerosis (FSGS)-like pattern. The FSGS-like pattern was more frequent in American Indians and Hispanics than in Non-Hispanic Whites. CONCLUSIONS: This is the first report of an incidence figure of IgAN for an entire state in the US. American Indian and Hispanic patients had a stronger representation in our cohort than Non-Hispanic Whites, when compared to the general New Mexico population.

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Although intraocular pressure (IOP) is considered the main risk factor for the development of glaucoma and the only parameter subject to treatment, there is sufficient evidence to suggest that glaucoma may continue to progress despite lowering patients' IOP to targeted levels. Several studies have implicated vascular risk factors in the pathogenesis of glaucoma. Among them, blood pressure (BP) and ocular perfusion pressure have become increasingly important. Although clinicians cannot currently visualise ocular blood flow directly, they can easily measure glaucoma patients' BP and IOP to calculate their ocular perfusion pressure and quantify the vascular changes. The purpose of this review article is to discuss the relationship between BP and IOP, BP and glaucoma, and perfusion pressure and glaucoma. We discuss the importance of autoregulation to maintain the adequate perfusion of the optic nerve head, and suggest that ocular perfusion pressure and its fluctuation may be parameters that need to be measured in glaucoma patients.

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Brucellosis is still a widespread zoonotic disease. Very little is known about the interaction between Brucella abortus and trophoblastic cells, which is essential for better understanding the pathogenesis of the Brucella-induced placentitis and abortion, a key event for transmission of the disease. The goal of this study was to evaluate the profile of gene expression by bovine trophoblastic cells during infection with B. abortus. Explants of chorioallantoic membranes were inoculated with B. abortus strain 2308. Microarray analysis was performed at 4 h after infection, and expression of cytokines and chemokines by trophoblastic cells was assessed by real-time reverse transcription-PCR at 6 and 12 h after inoculation. In addition, cytokine and chemokine expression in placentomes from experimentally infected cows was evaluated. Expression of proinflammatory genes by trophoblastic cells was suppressed at 4 h after inoculation, whereas a significant upregulation of CXC chemokines, namely, CXCL6 (GCP-2) and CXCL8 (interleukin 8), was observed at 12 but not at 6 h after inoculation. Placentomes of experimentally infected cows had a similar profile of chemokine expression, with upregulation of CXCL6 and CXCL8. Our data indicate that B. abortus modulates the innate immune response by trophoblastic cells, suppressing the expression of proinflammatory mediators during the early stages of infection that is followed by a delayed and mild expression of proinflammatory chemokines, which is similar to the profile of chemokine expression in the placentomes of experimentally infected cows. This trophoblastic response is likely to contribute to the pathogenesis of B. abortus-induced placentitis.

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Heterozygous familial hypercholesteremia type II is a recessive autonomic disease with a population incidence

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Video assisted thoracoscopic surgery (VATS) is now an established technique for diagnostic and therapeutic intervention in patients with thoracic pathology at the Queen Elizabeth Hospital (QEH). This article reviews the experience with 50 patients over the period May 1996 to February 2003, looking at various factors and outcomes in an attempt to ascertain the viability of this procedure at this institution. It serves as a follow-up article to the publication of the initial experience in 1999 (1). There were 24 males and 26 females included in the study. Video assisted thoracoscopic surgery was used for diagnosis in 27 cases (54%), therapeutic indication in 17 cases (34%) and as both a diagnostic and therapeutic modality in six cases (12%). In 92% of cases, the operations were completed thoracoscopically with a conversion rate of 8%. The morbidity and mortality rates were 18% and 2% respectively. Video assisted thoracoscopic surgery is an effective tool for the treatment and investigation of selected thoracic pathology at the QEH with complications and mortality rates comparable to other institutions (2, 3).

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Video assisted thoracoscopic surgery (VATS) is now an established technique for diagnostic and therapeutic intervention in patients with thoracic pathology at the Queen Elizabeth Hospital (QEH). This article reviews the experience with 50 patients over the period May 1996 to February 2003, looking at various factors and outcomes in an attempt to ascertain the viability of this procedure at this institution. It serves as a follow-up article to the publication of the initial experience in 1999 (1). There were 24 males and 26 females included in the study. Video assisted thoracoscopic surgery was used for diagnosis in 27 cases (54), therapeutic indication in 17 cases (34) and as both a diagnostic and therapeutic modality in six cases (12). In 92of cases, the operations were completed thoracoscopically with a conversion rate of 8. The morbidity and mortality rates were 18and 2respectively. Video assisted thoracoscopic surgery is an effective tool for the treatment and investigation of selected thoracic pathology at the QEH with complications and mortality rates comparable to other institutions (2, 3).

La cirugía toracoscópica asistida por video (CTAV) es ya una técnica establecida para el diagnóstico y la intervención terapéutica de pacientes con patologías toráxicas en el Hospital Queen Elizabeth. Este articulo pasa revista a nuestra experiencia con 50 pacientes en el transcurso del período de mayo de 1996 a febrero de 2003, prestando atención a varios factores y resultados en un intento por corroborar la viabilidad de ese procedimiento en nuestra institución. El trabajo sirve como un artículo de seguimiento a la publicación de nuestra experiencia en el año 1999(1). El estudio abarcó 24 hombres y 26 mujeres. La CTAV se usó para el diagnóstico en 27 casos (54%), como indicación terapéutica en 17 casos (34%), tanto en la modalidad de diagnóstico como en la terapéutica en seis casos (12%). En el 92% de los casos, las operaciones fueron completadas toracoscópicamente con una tasa de conversión de 8%. Las tasas de morbilidad y mortalidad fueron 18% y 2% respectivamente. La CTAV resultó ser un instrumento efectivo para el tratamiento y la investigación de patologías toráxicas seleccionadas en nuestra institución, con complicaciones y tasas de mortalidad comparables a la de otras (2) (3).

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To evaluate and compare the outcome of open-heart surgery in elderly patients with a concurrent group of younger patients in a developing country, data of all adult patients who underwent open-heart surgery during the period of 3 years from January 1999 to December 2001 were collected prospectively. Demographic data such as age and gender, other data such as preoperative diagnoses, comorbid illnesses, type of surgery, time of cardio-pulmonary bypass, length of stay and hospital outcome were recorded. The characteristics of patients above the age of 65 years were compared with a concurrent cohort of patients aged less than 65 years. One hundred and forty-five adult patients underwent open-heart surgeries in 3 years, and the overall mortality rate was 4.8%. The much common surgeries were coronary artery bypass grafting, valve repair/replacement surgery and surgery for adult congenital heart diseases. Forty-five (31%) patients were above the age of 65 years. The mortality rate was 2.2% for patients who were aged 65 years and above, in comparison with that of the concurrent cohort of younger patients (6%). This was probably because of more number of surgeries for congenital heart diseases in the latter group. However, even with other surgeries such as coronary artery bypass grafting, the elderly group of patients did equally well as the younger group. Elderly patients tolerate cardiac surgery well, and age should not be an exclusive criterion to decide against open-heart surgery.

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To evaluate and compare the outcome of open-heart surgery in elderly patients with a concurrent group of younger patients in a developing country, data of all adult patients who underwent open-heart surgery during the period of 3 years from January 1999 to December 2001 were collected prospectively. Demographic data such as age and gender, other data such as preoperative diagnoses, comorbid illnesses, type of surgery, time of cardio-pulmonary bypass, length of stay and hospital outcome were recorded. The characteristics of patients above the age of 65 years were compared with a concurrent cohort of patients aged less than 65 years. One hundred and forty-five adult patients underwent open-heart surgeries in 3 years, and the overall mortality rate was 4.8 per cent. The much common surgeries were coronary artery bypass grafting, valve repair/replacement surgery and surgery for adult congenital heart diseases. Forty-five (31 per cent) patients were above the age of 65 years. The mortality rate was 2.2 per cent for patients who were aged 65 years and above, in comparison with that of the concurrent cohort of younger patients (6 per cent). This was probably because of more number of surgeries for congenital heart diseases in the latter group. However, even with other surgeries such as coronary artery bypass grafting, the elderly group of patients did equally well as the younger group. Elderly patients tolerate cardiac surgery well, and age should not be an exclusive criterion to decide against open-heart surgery.

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Cystic fibrosis patients from Rio de Janeiro, Brazil, were screened for mutations in exons 11 and 16 of the cystic fibrosis transmembrane conductance regulator gene (CFTR) by a nonradioactive single-stranded conformational polymorphism (SSCP) analysis technique. This procedure was used to evaluate the undefined mutations in one or both alleles of 64 cystic fibrosis patients. Unusual SSCP profiles were investigated further by sequence analysis. Two patients were shown to carry the G542X mutation (exon 11) and five had the splicing mutation 3120+1G-->A(intron 16), one of them being homozygous for the mutation. This is the first report of the 3120+ IG-->A mutation in Brazil. where it appears to be a frequent disease-associated molecular alteration in the CFTR gene.

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Numerous methods to analyze biogenic amines in biological materials have been described. A versatile and rapid methodology to analyze these compounds in feedstuffs, complete feeds, and animal tissues, however, has not been reported. The current method was developed to address this need. Biogenic amines in feedstuffs, complete animal feeds, and animal tissues were extracted with 10% trichloroacetic acid, reacted with O-phthaladehyde using high-performance liquid chromatographic employing a cation exchange column. Detection limits were 50 pmol/mL for tyramine, histamine, putrescine, and spermine; 40 pmol/mL for cadaverine; and 25 pmol/mL for spermidine. Extraction efficiency of biogenic amines in feedstuffs, duodenum, liver, ileum + jejunum, and whole shrimp and shrimp hepatopancreas ranged between 99-105, 93-135, 80-85, 65-102, 88-98, and 88-97%, respectively. It can be concluded that the current method can be applied to individual feedstuffs, complete feeds, and animal tissues for the rapid and accurate determination of concentration of biogenic amines.

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