Thursday, 7 December 2017

Steatocystoma Multiplex: A Case Report of a Rare Disease Diagnosed in a Trauma Patient

Steatocystoma Multiplex is a rare, benign skin disorder that can manifest itself in the head and neck region and can be significantly disfiguring. There is minimal reference of this condition in oral and maxillofacial surgery literature. Steatocystoma Multiplex is characterized by multiple lesions of the skin in more than one location. The distribution of steatocystomas typically include the regions of the body that contain sebaceous follicles, most notably the face, anterior chest wall, and limbs [1, 2].However, steatocystomas can occur anywhere and have been reported on the oral mucosa and in the subdermal tissue. The prevalence of these lesions is not currently known, which is likely due to the fact that they are rarely reported. The lesions are smooth and round macroscopically, ranging in size from a few millimeters to several centimeters. This case report describes the work-up and diagnosis of a 35-year-old male with Steatocystoma Multiplex who was clinically triaged by the Emergency Department at Nassau University Medical Center on two separate occasions as having other epithelial pathologies.

On January 22, 2015, a 35-year-old African American male presented to Nassau University Medical Center status post-assault with the chief complaint of pain to the right malar region. The previous medical history of this patient included well-controlled hypertension and multiple lumps throughout the body described as neurofibromas, suggestive of neurofibromatosis type I (“NF1”). Evaluation of the patient’s chief complaint by examination and computed tomography revealed a moderately displaced right zygomaticomaxillary complex (“ZMC”) fracture. Subsequent evaluation of the patient revealed asymptomatic, non-inflamed, well-circumscribed, yellowish, raised lesions located throughout the body with increased frequencies in the head and neck.

The overlying epithelium was normal in appearance, with the largest lesion approximately 2 centimeters in diameter. The patient stated these lesions initiated around the time of puberty and that he believed they were related to his acne. In addition, he stated his mother had similar lesions on her cheeks, but they were significantly smaller and fewer in frequency. Routine laboratory tests and chest imaging were within normal limits (Figure 4). The patient elected to undergo an open reduction and internal fixation of his right ZMC fracture. A biopsy of a lesion was performed through the existing incision in the right lateral brow region and submitted for histological evaluation. The histologic diagnosis of the lesion was reported as a steatocystoma, but unfortunately not conveyed to the patient as he failed to follow-up.

Reading Glasses to Prevent Myopia

Preliminary experimental design using reading glasses at the U.S. Naval Academy at Annapolis are discussed. The conclusion is that (+) add lenses, used as reading glasses during study, can prevent the development of myopia for college students in pilot training.

Cheng et al. (2011, 2014) and Gwiazda et al. and Hyman et al. (2003, 2005,2014) present a comprehensive listing of modern studies to date in terms of using (+) Add reading glasses to prevent or slow the progression of myopia. Brown & Berger (1979), Brown & Young (1981), Schaeffel & Howland (1988), Medina & Fariza (1993), and Greene, Brown, Medina & Graupner (1996) use first order control theory to predict myopia development as a function of time. Thorn, Gwiazda & Held (2005) present a mathematical model of myopia development using the Gompertz function. Hung & Ciuffreda (2007) develop IRDT, incremental retinal defocus, to explain myopia during the growth phase. Medina et al. (2015, 2016) and Greene & Medina (2015, 2016) use control theory to explain myopia development, solved with digital and analog computer techniques to evaluate first-order equations. Viikari (2011) and Goldschmidt (2003) present comprehensive reviews of juvenile myopia, and various techniques used to control this myopia progression. Theories are many and varied, in terms of the causes of myopia. Figure 1a and 1b below show the nearwork demand problem, typical of college students, and the proposed optical solution to the problem, namely, custom reading glasses. 

Work done during the past twenty years has demonstrated that the accommodation system is a superb example of a physiological control system. It is a complex, sophisticated, and accurate system. We can logically expect that the normal eye will show equal competence in the design of its long-term control system. 

Wednesday, 6 December 2017

Chemistry, Origin, Antitumor and Other Activities of Fungal Homo-Dimeric Alkaloids

Homo-dimeric alkaloids produced by fungi, lichenized fungi and fungal endophytes are a structurally unique class of natural products with extensive biological activities that are presented in this article. More than 100 selected fungal metabolites have been confirmed to exhibit antitumor, antimicrobial, antibacterial, and other activities.

Alkaloids are nitrogen-containing metabolites found mainly in plant species; they are also found in fungi, microorganisms and marine invertebrates. Studies on bioactive alkaloids, done with respect to both their biological activity and the role of alkaloids in the introduction of new drugs, have gained considerable importance during the past fifty years, and have been received a prominent position in the field of organic and medicinal chemistry.

Homo-dimeric alkaloids produced by fungi are a structurally unique class of natural products with extensive biological activities that are presented in this article. This mini-review article is intended to provide an overview of the properties of homo-dimeric alkaloids produced by fungi, fungal endophytes, and lichenized fungi.

All dimeric alkaloids are complex molecules consisting of two structurally similar monomers linked by bonds that can be weak or strong, covalent or intermolecular. The term homodimer is used when the two monomer molecules are identical. The alkaloidal pigment necatarone, its dehydrodimer, which prevails in aged fruiting bodies, and its 10-deoxydehydrodimer are major pigments of the green-brown flesh and cap skin of Lactarius turpis.

endophytic fungus C. globosum. The culture broth of Chaetomium fusiforme, from liverwort Scapania verrucosa, afforded two azaphilone alkaloids called chaetofusins A and B. Both compounds have shown antifungal activity.

Tuesday, 5 December 2017

Medico Legal Case Commentary: Interface Between Clinical Opinion and Legal Case Reporting in Personal Injury Litigation


The history of clinical and medico-legal report case preparation is summarised. The development of an innovative medico-legal commentary is described as a method of exploring the interface between clinical opinions and legal case reports in the field of UK civil and criminal litigation. A pilot study to develop the process of documenting psychologically-relevant commentaries is illustrated with a subsequent plan for its development outlined.

The science of medicine and its related professions has an interesting relationship with the laws of evidence. Medical experts attempt to show the relevance of their clinical experience to litigation and occasionally the court room, drawing on their work in assessment and treatment within a clinical setting. Clinically, concepts of ‘proof’ and ‘causation’ exist but not to the same level of evidential stringency as they do in litigation. Effective treatment is predominantly linked to more accurate current symptoms assessment than to background history taking, although of course the latter is also important a motivated ‘patient’ with current symptoms can utilise therapeutic intervention to good effect despite its chronicity. However, as the clinician moves into the medical-legal context, the issues of causation, attribution and reliability come much more into sharp focus and, here, they have had much to learn from the legal colleagues. Whereas clinicians thrive on multiplicity of disease theories and treatments, lawyers typically aim for uniformity and avoidance of disparity, regarding numerous medical viewpoints as contradictory and confusing.

Clinicians are experienced in preparing clinical reports in order to communicate individual patient care findings to other clinicians, their patients and other appropriate organisations. These reports typically include symptom description, development and causation, diagnosis, course and duration, and prognosis and treatment. Guidelines for psychological clinical case reports, in particular, are available in the literature. Clinicians also communicate their clinical findings to other clinicians via case reports published in professional journals. Guidelines are frequently available on how to prepare these reports. When working in a medico-legal context either in civil or criminal proceedings, clinicians acting as ‘expert witnesses’ produce medico-legal reports attesting to the extent of physical or psychological injuries which may or may not have caused by a negligent act of another or others (e.g. road accident, work accident, medical accident). In the purely clinical report, emphasis is placed more on diagnosis and treatment. In the medico-legal report, requiring a more independent and impartial stance, greater emphasis may well be placed on causation and attribution, in addition to diagnosis, treatment and prognosis.  

Monday, 4 December 2017

Lung Cancer Drug, Nivolumab (Opdivo), Targets 'Hidden' HIV in French Patient


For a situation that specialists say is an initial, a lung malignancy medicate unmasked and after that assaulted the sort of HIV-tainted cells that standard antiretroviral treatment has been not able touch. The finding was accounted for on Dec. 1, which is likewise World AIDS Day, in the Annals of Oncology. While one AIDS master said the discoveries were promising, she noticed the medication did not "cure" the patient of HIV. The potential achievement fixates on the experience of a solitary 51-year-old French man, who has been getting treatment in Paris for cutting edge arrange non little cell lung disease for as far back as year. The patient - who is likewise HIV-positive - had experienced both surgery and chemotherapy for tumors that had at first been analyzed in 2015, preceding he encountered a backslide in 2016. 

Along these lines, French clinicians gave him the disease treatment nivolumb The medication is usually utilized for cutting edge melanoma and kidney growth, and additionally non-little cell lung malignancy. At the point when the patient started his nivolumab treatment, his HIV status - first analyzed in 1995 - was portrayed as "imperceptible." However, similar to all HIV patients in his circumstance, that implied just that all popular action identified with HIV was torpid. Such lethargy is far desirable over a dynamic viral status. However, it isn't a cure, in light of the fact that the patient's body isn't totally evident of the infection. Truth be told, torpid repositories of HIV-contaminated cells regularly prowl all through the safe arrangement of such patients, covered up (from both the insusceptible framework and antiretroviral treatment) over a variety of organs, for example, the bone marrow, genital tract and even the mind. 

Ought to antiretroviral treatment be stopped for reasons unknown, these shrouded cells start to duplicate and spread. "Inert HIV repositories are set up amid the most punctual phase of HIV contamination and over the span of the infection," contemplate creator Dr. Jean-Philippe Spano clarified in a news discharge. "At the point when an inactively contaminated cell is reactivated, the cell starts to deliver HIV once more." In any case, "progressively, specialists have been investigating the utilization of specific medications that seem to reactivate the inert HIV-tainted cells," noted Spano, who is leader of the medicinal oncology office at Pitie-Salpetriere Hospital AP-HP. "This could have the impact of making them obvious to the safe framework, which could then assault them." Enter nivolumab. The French malignancy understanding began accepting the growth sedate once like clockwork, beginning in December 2016. Spano's group noticed that the patient's beforehand imperceptible HIV status ended up plainly perceptible, as his HIV levels climbed. The ascent proceeded up until 45 days following the dispatch of his tumor treatment, and was joined by a comparable knock in the action of his T-cells, which fill in as the body's contender cells when an invulnerability risk is identified.