Tuberculosis masquerading as malignancy: a multimodality approach to the correct diagnosis – a case report

BACKGROUND: Extrapulmonary tuberculosis is one of the great mimickers of medicine, and often masquerades as malignancy. As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy. CASE PRESENTATION: We present the case of a 21 year old man with tuberculous osteomyelitis, who was referred to the Bone and Soft Tissue Sarcoma Service at our institution with a provisional diagnosis of malignancy. Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy. The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made. CONCLUSION: This case highlights the importance of remaining cognisant of the protean manifestations of extrapulmonary tuberculosis, and illustrates the advantage of a clinically directed multi-modality imaging approach to diagnosis.     

Control of allergic rhinitis and asthma test – a formal approach to the development of a measuring tool

Background

The concurrent management of allergic rhinitis and asthma (ARA) has been recommended by Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. However, a tool capable of assessing simultaneously the control of upper and lower airways diseases is lacking.

Aim

To describe the studies conducted to design the control of ARA test (CARAT) questionnaire.

Methods

We performed a literature review to generate a list of potentially important items for the assessment of control of ARA. A formal consensus development process, that used an innovative web-based application, was designed – 111 experts in ARA and 60 patients participated. At the final consensus meeting, 25 primary and secondary care physicians formulated the questions and response options. A qualitative feasibility study (n = 31 patients) was conducted to evaluate the comprehensibility of the questionnaire while testing two different designs.

Results

Thirty-four potentially important items were identified. All the steps of the consensus process were completed in 2.5 months. The opinions of experts and patients lead to the formulation of 17 questions. At the feasibility study the instructions and wording problems were corrected and a semi-tabular format was chosen.

Conclusion

A tool to measure the control of allergic rhinitis and asthma was developed using a comprehensive set of methodological steps ensuring the design quality and the face and content validity. Additional validation studies to assess the psychometric properties of the questionnaire have started.     

Methods to characterize the structure of food powders – a review

Food powders can exist in amorphous, crystalline or mixed structure depending on the order of molecular arrangement in the powder particle matrices. In food production, the structure of powders has a greatly effect on their stability, functionality, and applicability. The undesirable structure of powders can be accidentally formed during production. Therefore, characterization of powder structure as well as quantification of amorphous–crystalline proportions presenting in the powders are essential to control the quality of products during storage and further processing. For these purposes, many analytical techniques with large differences in the degree of selectivity and sensitivity have been developed. In this review, differences in the structure of food powders are described with a focus being placed on applications of amorphous powders. Essentially, applicability of common analytical techniques including X-ray, microscopic, vapor adsorption, thermal, and spectroscopic approaches for quantitative and qualitative structural characterization of food powders is also discussed.     

Hydrobiology of the Cochin backwater system – a review

On the south west coast of India, there is an extensiveestuarine system of backwaters, of which Vembanad Lake is the largest. The backwaters of Kerala support as much biological productivity and diversity as tropical rain forests. They are responsible for the rich fisheries potential of Kerala. Cochin backwaters situated at the tip of the northern Vembanad lake is a tropical positive estuarine system extending between 9° 40 and 10° 12N and 76° 10' and 76° 30 E with its northern boundary at Azheekode and southern boundary at Thannirmukham bund. The lake has a length of 80 km and the width varies between 500 and 4000 m. A channel, about 450 m wide at Cochin gut and another at Azheekode, make permanent connections with the Arabian Sea. The depth of the estuary varies considerably. While the shipping channels are maintained at a depth of 10–13 m, the major portion of the estuary has a depth range of 2–7 m. Water from two major rivers viz., Periyar and Muvattupuzha drain into this estuary. During south west monsoon, the estuary is virtually converted into a freshwater basin even in areas around barmouth where salt water penetration occurs below 5 m depth only. The major hydrological variable in the Cochin backwaters is salinity, similar to the situations encountered in estuaries with a gradual declension of salinity from 30 at the entrance of the estuary to 0.2 at the point of entry of the rivers. Salinity gradient in the Cochin backwaters supports diverse species of flora and fauna depending on their capacity to tolerate oligohaline, mesohaline or marine conditions. Low lying swamps and tidal creeks, dominated by sparse patches of mangroves with their nutrient rich physical environment, support larvae and juveniles of many economically important species. Backwaters also act as nursery grounds of commercially important prawns and fishes. The fields around the backwater are suitable for aquaculture. These areas support traditional, seasonal and perennial prawn fishery. The changes in the hydrology controlled by the seasons play an important role in regulating the migrant fauna of the estuary. The Cochin backwater supports a well established endemic fauna. The nutrients and pollutants introduced into the estuary control to a great extent the distribution and abundance of less tolerant species in ecologically sensitive areas in the backwaters. Cochin backwaters, widely regarded as one of the polluted estuaries in India, receive contaminated freshwater inputs and discharges of effluents and partially treated sewage from many points throughout its tidally mixed zone. Recently, changes brought about in the estuary like reclamation and consequent shrinkage of the backwaters and the discharge of pollutants have made an adverse impact on the potential of aquatic ecosystems that used to support high levels of bioproductivity and biodiversity. The construction of Thannirmukham bund and Thottapally spillway to prevent salt water penetration into the paddy fields during pre-monsoon has led to serious ecological problems by interrupting the natural ebb and flow of tides. The hydrography, floral and faunal composition – its spatial and temporal variation plus assessments of the impact of the anthropogenic activities are presented in this review. An attempt to critically evaluate the status of the estuary from the biological and pollutional stand point is also done.     

Control of fermenters – a review

Fermenter control has been an active area of research and has attracted more attention in recent years. This is due to the new developments in other related areas which can be exploited to overcome the inherent difficulties in fermenter control. Beginning with conventional regulatory control of operating variables such as temperature, pH and dissolved oxygen concentration, research in fermenter control has undergone significant changes including the recent neural network based approaches. The objective of the paper is to focus the attention of the researchers to the developments in the control of batch, fed-batch and continuous fermenters over the past few years.     

Arsenic toxicity,mutagenesis, and carcinogenesis – a health risk assessment and management approach

A comprehensive analysis of published data indicates that arsenic exposure induces cardiovascular diseases, developmental abnormalities, neurologic and neurobehavioral disorders, diabetes, hearing loss, hematologic disorders, and various types of cancer. Although exposure may occur via the dermal, and parenteral routes, the main pathways of exposure include ingestion, and inhalation. The severity of adverse health effects is related to the chemical form of arsenic, and is also time- and dose-dependent. Recent reports have pointed out that arsenic poisoning appears to be one of the major public health problems of pandemic nature. Acute and chronic exposure to arsenic has been reported in several countries of the world where a large proportion of drinking water (groundwater) is contaminated with high concentrations of arsenic. Research has also pointed significantly higher standardized mortality rates for cancers of the bladder, kidney, skin, liver, and colon in many areas of arsenic pollution. There is therefore a great need for developing a comprehensive health risk assessment (RA) concept that should be used by public health officials and environmental managers for an effective management of the health effects associated with arsenic exposure. With a special emphasis on arsenic toxicity, mutagenesis, and carcinogenesis, this paper is aimed at using the National Academy of Science's RA framework as a guide, for developing a RA paradigm for arsenic based on a comprehensive analysis of the currently available scientific information on its physical and chemical properties, production and use, fate and transport, toxicokinetics, systemic and carcinogenic health effects, regulatory and health guidelines, analytical guidelines and treatment technologies.     

Fishes and salinities in the St Lucia estuarine system—a review

The recorded salinity ranges of freshwater, estuarine and marine fish species in Lake St Lucia, a Ramsar and World Heritage Site, are documented. The freshwater group is most diverse and abundant under oligohaline conditions, although the Mozambique tilapia (Oreochromis mossambicus) was common under all salinity regimes. Estuary resident species also favoured oligohaline conditions but, in contrast to the freshwater taxa, were well represented in salinities up to 40 ‰. The marine group was most diverse and abundant within the salinity range 10–40 ‰, but a large number of species could also be found in salinities up to 70 ‰. Very few fish species were able to tolerate salinities between 70 ‰ and 110 ‰, with only O. mossambicus surviving for extended periods in salinities above 110 ‰. All the aquatic macrophytes and most of the zoobenthos within the lake appear to die out within the salinity range of 50–60 ‰, thus creating additional stress to those fish present under such conditions. The food resources least affected by extreme hypersalinity are the microphytobenthos and detritus food chains, with detritivorous fishes being dominant when the lake is in this state. Mass mortalities of fishes in Lake St Lucia have been recorded under both low (<5 ‰) and high salinity (>70 ‰) conditions. The fish kills are often triggered by exceptionally low or high water temperatures which affect the osmoregulatory abilities of these species. Hypersaline conditions and fish mortalities under the most recent closed estuary mouth conditions (2002–2005) are reviewed. If the surface area of St Lucia (35,000 ha) is compared to the total surface area of all South African estuaries (approximately 70,000 ha), then the possibility exists that the loss of the Lake St Lucia nursery area for estuary-associated marine fish species over the past few years may cause significant short-term declines in the future abundance of these taxa on both a local and regional scale.     

Response of phytoplankton communities to salinity changes – a mesocosm approach

The response of natural phytoplankton communities, originating from oligohaline brackish water systems, to salinity changes (3–12 PSU) has been studied in small-scale mesocosms. Simultaneously, their reaction on iron manipulations was tested. The experiments, each lasting 7 days, were repeated three times at different dates. Treatments were evaluated with respect to biomass development (Chl a concentration), photosynthesis behaviour, and rough taxonomic composition. The investigated phytoplankton communities were dominated by cyanobacteria. Salt addition was not effective for overall phytoplankton biomass development. Filamentous cyanobacteria, however, were promoted by NaCl enrichments. Dark yield and non-photochemical quenching of fluorescence (NPQ) analyses revealed differences for treatments in dependence on iron supplements. Iron partially seemed to dampen the effects of salt shocks, and iron addition reduced both, capacity and irradiance dependency of NPQ, irrespective of the NaCl treatment.     

Questions and answers to edibility problem of the Canavalia ensiformis seeds – A review

The seed of Canavalia ensiformis (jackbean), a highly productive large-seeded tropical legume, contains about 300 g crude protein and 600 g carbohydrates kg⁻¹ dry matter. It, however, contains toxic and antinutritional factors which limit its use as human food or animal feed. The trypsin inhibitors in the seed have, however, been reported to be easily inactivated by moist heat. The toxic alkaline non-protein amino acid, canavanine (present at about 50 g kg⁻¹ seed dry matter), a naturally occuring analog of l-arginine, has also been reported to induce reduced feed intake in non-ruminants but at the equivalent of about 300 g kg⁻¹ dietary level of the raw seed, or in the condition of dietary arginine deficiency. The concentrations of the specialized secondary plant biomolecules – cyanogenic glycosides, saponins, alkaloids and terpenoids – have also been shown to drop below detectable levels following 1 h of cooking. Urease and canatoxin which were isolated from the seed are highly toxic if injected into experimental animals but exert no toxic effects if orally administered, and thus cannot be classified as antinutritional factors. Concanavalin A (Con A), the most studied of plant lectins, appears to be the most important toxic and antinutritional factor in the seed, being highly resistant to heat treatments and to proteolytic digestion in the gut. It requires 3 h of cooking at 96°C or 45 min of pressure cooking; 48 h of soaking the seed in water prior to cooking for 2 h; 72 h of soaking in water prior to ordinary cooking for 1 h; pressure-cooking for 15 min, to completely eliminate it from the seed. Complete inactivation of Con A in the seed can, however, be easily achieved if the seed is broken into pieces and cooked for 1 h or pressure-cooked for 15 min.     

Genotoxicity and potential carcinogenicity of cyanobacterial toxins – a review

The occurrence of cyanobacterial blooms has increased significantly in many regions of the world in the last century due to water eutrophication. These blooms are hazardous to humans, animals, and plants due to the production of cyanotoxins, which can be classified in five different groups: hepatotoxins, neurotoxins, cytotoxins, dermatotoxins, and irritant toxins (lipopolysaccharides). There is evidence that certain cyanobacterial toxins are genotoxic and carcinogenic; however, the mechanisms of their potential carcinogenicity are not well understood. The most frequently occurring and widespread cyanotoxins in brackish and freshwater blooms are the cyclic heptapeptides, i.e., microcystins (MCs), and the pentapeptides, i.e., nodularins (NODs). The main mechanism associated with potential carcinogenic activity of MCs and NOD is the inhibition of protein phosphatases, which leads to the hyperphosphorylation of cellular proteins, which is considered to be associated with their tumor-promoting activity. Apart from this, MCs and NOD induce increased formation of reactive oxygen species and, consequently, oxidative DNA damage. There is also evidence that MCs and NOD induce micronuclei, and NOD was shown to have aneugenic activity. Both cyanotoxins interfere with DNA damage repair pathways, which, along with DNA damage, is an important factor involved in the carcinogenicity of these agents. Furthermore, these toxins increase the expression of TNF-α and early-response genes, including proto-oncogenes, genes involved in the response to DNA damage, cell cycle arrest, and apoptosis. Rodent studies indicate that MCs and NOD are tumor promotors, whereas NOD is thought to have also tumor-initiating activity. Another cyanobacterial toxin, cylindrospermopsin (CYN), which has been neglected for a long time, is lately being increasingly found in the freshwater environment. The principal mechanism of its toxicity is the irreversible inhibition of protein synthesis. It is pro-genotoxic, and metabolic activation by cytochrome P-450 enzymes is needed for its genotoxic activity. In metabolically competent cells, it induces DNA strand breaks and exerts clastogenic and aneugenic activity. In addition, CYN increased the expression of p53 regulated genes involved in cell cycle arrest, DNA damage repair, and apoptosis. It also has cell transforming potential, and limited preliminary rodent studies indicate that CYN could have tumor-initiating activity. In 2010, the International Agency for Research on Cancer (IARC) classified MCLR as possible human carcinogen (Group 2B). Although there is not enough available information for the classification of other cyanobacterial toxins, the existing data from in vitro and in vivo studies indicate that NOD and especially CYN may be even more hazardous than MCLR to human and animal health. In addition in the environment, cyanobacterial toxins occur in complex mixtures as well as together with other anthropogenic contaminants, and numerous studies showed that the toxic/genotoxic potential of the extracts from cyanobacterial scums is higher than that of purified toxins. This means that the mixtures of toxins to which humans are exposed may pose higher health risks than estimated from the toxicological data of a single toxin. Future research efforts should focus on the elucidation of the carcinogenic potential of NOD, CYN, and the mixture of cyanobacterial extracts, as well as on the identification of possible novel toxins.     

Paraneoplastic cerebellar degeneration as a presentation of breast cancer – a case report and review of the literature

Paraneoplastic cerebellar degeneration is part of a rare spectrum of neurological syndromes whereby gynaecological, lung or breast cancers present primarily with neurological manifestations. The presence of onconeural antibodies and PET scanning help in the challenging diagnosis of these conditions but despite the treatment of the primary cancer, the prognosis for the neurological symptoms is poor.     

Parametric analysis of the biomechanical response of head subjected to the primary blast loading – a data mining approach

Traumatic brain injury due to primary blast loading has become a signature injury in recent military conflicts and terrorist activities. Extensive experimental and computational investigations have been conducted to study the interrelationships between intracranial pressure response and intrinsic or ‘input’ parameters such as the head geometry and loading conditions. However, these relationships are very complicated and are usually implicit and ‘hidden’ in a large amount of simulation/test data. In this study, a data mining method is proposed to explore such underlying information from the numerical simulation results. The heads of different species are described as a highly simplified two-part (skull and brain) finite element model with varying geometric parameters. The parameters considered include peak incident pressure, skull thickness, brain radius and snout length. Their interrelationship and coupling effect are discovered by developing a decision tree based on the large simulation data-set. The results show that the proposed data-driven method is superior to the conventional linear regression method and is comparable to the nonlinear regression method. Considering its capability of exploring implicit information and the relatively simple relationships between response and input variables, the data mining method is considered to be a good tool for an in-depth understanding of the mechanisms of blast-induced brain injury. As a general method, this approach can also be applied to other nonlinear complex biomechanical systems.     

New methods to approach immunotherapy of cancer – and strategies of tumours to avoid elimination

Owing to the intense effort of numerous investigators, the number of tumour antigens potentially of use for clinical immunotherapy continues to increase. At the same time, further strategies employed by tumour cells to avoid destruction by the immune system are being uncovered. A combined onslaught to target tumour cells and prevent their “escape” will be required for successful immunotherapy. Progress in this area was the subject of a meeting supported by the European Cancer Research Consortium “EUCAPS”, which was held in London in February 2000. This conference was the second of a series, the first of which was summarised previously in this journal [Pawelec G et al. (1999) Cancer Immunol Immunother 48: 214]. Received: 14 March 2000 / Accepted: 30 March 2000     

Potential markers of preeclampsia – a review

Preeclampsia is a leading cause of maternal and fetal/neonatal mortality and morbidity worldwide. The early identification of patients with an increased risk for preeclampsia is therefore one of the most important goals in obstetrics. The availability of highly sensitive and specific physiologic and biochemical markers would allow not only the detection of patients at risk but also permit a close surveillance, an exact diagnosis, timely intervention (e.g. lung maturation), as well as simplified recruitment for future studies looking at therapeutic medications and additional prospective markers. Today, several markers may offer the potential to be used, most likely in a combinatory analysis, as predictors or diagnostic tools. We present here the current knowledge on the biology of preeclampsia and review several biochemical markers which may be used to monitor preeclampsia in a future, that, we hope, is not to distant from today.     

Production of pectolytic enzymes – a review

Pectolytic enzymes play an important role in food processing industries and alcoholic beverage industries. These enzymes degrade pectin and reduce the viscosity of the solution so that it can be handled easily. These enzymes are mainly synthesized by plants and microorganisms. Aspergillus niger is used for industrial production of pectolytic enzymes. This fungus produces polygalacturonase, polymethylgalacturonase and pectinlyase. This review mainly concerns with the production of pectolytic enzymes using different carbon sources. It also deals with the effect of operating parameters such as temperature, aeration rate, agitation and type of fermentation on the production of these enzymes.     

Recovery of citric acid – a review

The requirement of citric acid is increasing every year. Therefore, it is important to have an efficient recovery method following the production of citric acid. At present, most of the manufacturers use the classical method of citric acid recovery which is a precipitation technique using calcium salt followed by filtration and subsequently treated with sulphuric acid. This review focuses on the new developments of recovery of citric acid from the fermentation broth.     

The management of crop structure: a general approach to reversing the impacts of agricultural intensification on birds?

Agricultural intensification is accepted widely as a cause of bird population declines on farmland in Europe and North America. Although intensification is multivariate, one common theme is the impact on variation in crop structure, both within and between fields. Intensification creates simpler, more homogeneous and denser swards in both tillage crops and grassland. This influences predation risk, exposure to weather extremes and the diversity, abundance and accessibility of food. Birds trade off these pressures in different ways, so that the more uniform and dense the vegetation, the fewer the number of birds and range of species that are able to nest and forage successfully. Reversing recent trends towards dense, simplified and homogeneous swards will improve nesting and foraging habitat conditions for a wide range of species across farming systems, and may represent a cost-effective mechanism for the further improvement of agri-environment scheme options designed to assist the recovery of farmland bird populations.     

Live bacterial vaccines – a review and identification of potential hazards

The use of live bacteria to induce an immune response to itself or to a carried vaccine component is an attractive vaccine strategy. Advantages of live bacterial vaccines include their mimicry of a natural infection, intrinsic adjuvant properties and their possibility to be administered orally. Derivatives of pathogenic and non-pathogenic food related bacteria are currently being evaluated as live vaccines. However, pathogenic bacteria demands for attenuation to weaken its virulence. The use of bacteria as vaccine delivery vehicles implies construction of recombinant strains that contain the gene cassette encoding the antigen. With the increased knowledge of mucosal immunity and the availability of genetic tools for heterologous gene expression the concept of live vaccine vehicles gains renewed interest. However, administration of live bacterial vaccines poses some risks. In addition, vaccination using recombinant bacteria results in the release of live recombinant organisms into nature. This places these vaccines in the debate on application of genetically modified organisms. In this review we give an overview of live bacterial vaccines on the market and describe the development of new live vaccines with a focus on attenuated bacteria and food-related lactic acid bacteria. Furthermore, we outline the safety concerns and identify the hazards associated with live bacterial vaccines and try to give some suggestions of what to consider during their development.