Self-medication complicating pseudo membranous conjunctivitis

We aim to highlight the prevalence of using local medications for curing eye ailments in a rural population and the harmful consequence of resultant disease, ranging from something as mild as conjunctivitis to sight-threatening conditions. This case report will address one such incidence where in a local village, the doctor known as a registered medical practitioner) in the rural community, uses local remedies for his conjunctivitis and ends up in a condition where he cannot see anything beyond perceiving light. The membrane removal and treatment with topical antibiotic cured his infection, restoring complete recovery of vision. This incidence inspired the local village doctor to become an eye health educator. He was motivated to spread awareness about the ill effects of self-medication on eye health. He is also determined to bring all blind people and others who need eye care from his remote village to our centre.

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An illusion of septic shock: acute generalised exanthematous pustulosis with multiorgan dysfunction

Acute generalised exanthematous pustulosis (AGEP) is a rare cutaneous eruption, most often caused by commonly used antibiotics. It is characterised by an acute onset of non-follicular sterile pustular rash and erythema within hours or days of drug exposure and usually resolves spontaneously within 1–2 weeks once the drug is discontinued. Haemodynamic involvement in the form of shock is rare. Here, we present a severe case of AGEP, manifesting with systemic involvement and haemodynamic instability resulting in shock with multiorgan dysfunction. The associated drugs were erythromycin and fluconazole with a possible combined effect of these two drugs that resulted in systemic involvement. Our patient improved markedly, both haemodynamically and dermatologically, after discontinuation of the drugs and with systemic steroid therapy.

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Percutaneous valve in valve in the tricuspid position in a patient with Tetralogy of Fallot

Here, we describe a case of a successful percutaneous insertion of a transcatheter 29 mm Edwards Sapien XT valve into a tricuspid valve in a patient with repaired tetralogy of fallot.

Similar procedures have been performed with the Edwards Sapien valve and Melody valves; however, this is the first case described in the literature of an Edwards Sapien valve used in a patient with Tetralogy of Fallot.

With procedural safety being demonstrated, this case illustrates an important alternative treatment option for patients with congenital heart disease. Although long-term data is required to compare its efficacy with surgically replaced valves, percutaneous procedures can serve as a delay to surgical valve replacement which over a patients' lifetime with congenital heart disease, can minimise the amount of invasive surgeries and potential complications.

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Insidious enemy: downside to prolonged survival in prostate cancer

An 83-year-old man, a prostate cancer survivor of 10 years with multiple vertebral metastases presented with sudden onset of double vision. On examination he was found to have an isolated partial left abducens palsy with no other neurological deficits. Despite having microvascular risk factors, given his history of prostate cancer, aMRI brain scan was requested to look for a neurological cause. The scan revealed a metastatic lesion in the clivus encasing the cavernous sinus and carotid artery. He was referred to his oncologist for further management, however he opted out of further treatment and succumbed to his illness a month later. This case report includes a literature review of cases with clivus metastases secondary to prostate cancer. It highlights the importance of carefully examining eye movements and having a high index of suspicion for the subtlest sign that may suggest brain metastases in elderly patients with prostate cancer with prolonged survival.

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Dinosaur tail sign on spinal MRI in a patient with postdural puncture headache

Description

A 68-year-old man presented with cognitive impairment, urinary incontinence and short step gait. These symptoms, together with brain MRI finding, suggested idiopathic normal pressure hydrocephalus. After a spinal tap test to confirm the diagnosis, he suffered from postdural puncture headache. Despite an equivocal finding on spinal MR myelography (MRM), lumbosacral fat-suppressed T2-weighted image (FST2WI) clearly showed the characteristic 'Dinosaur tail sign' indicative of cerebrospinal fluid (CSF) leakage (figure 1).1 This pathognomonic sign disappeared on symptom improvement (figure 1).

Figure 1

Serial MRM and FST2WI before (A, D) and after a dural puncture (B, C, E, F). In contrast to subtle paraspinal hyperintensities on MRM (arrows, B), sagittal FST2WI shows characteristic dorsal epidural fat tissues demarcated by interspinous arched hyperintensities (dash lines, E) contributing to the 'Dinosaur tail sign' and slight epidural hyperintensity (arrowhead, E). Pathognomonic signal changes disappear on...

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Inactivation of Beclin-1-dependent autophagy promotes ursolic acid-induced apoptosis in hypertrophic scar fibroblasts

Abstract

A hypertrophic scar (HS) is caused by abnormal proliferation of dermal fibroblasts. Thus, promoting hypertrophic scar fibroblast (HSFB) apoptosis is an effective strategy for HS therapy. Ursolic acid (UA) has been widely used as an inducer of apoptosis in diverse cancers. However, whether UA plays an inhibitory role in HS formation is still unknown. In our study, UA was used to treat HSFBs and the cell viability, apoptosis, and collagen synthesis were determined by a Cell Counting Kit 8 (CCK8) assay, flow cytometry, and an H³-proline incorporation assay, respectively. Autophagy activity was detected by LC3 immunoblotting and electron microscopy, and siRNAs targeting Beclin-1 were used to inhibit autophagy. Western blotting was performed to investigate the molecular changes in HSFBs after various treatments. We found that UA inhibited collagen synthesis and induced cell apoptosis in HSFBs, evidenced by the deregulated expression of Bim, Bcl-2 and Cyto C. Furthermore, we demonstrated that US induced autophagy and inactivation of autophagy promoted UA-induced apoptosis and collagen synthesis inhibition in HSFBs. Molecular investigation indicated that UA induced autophagy through upregulation of Beclin-1 and knockdown of Beclin-1 prevent UA-induced autophagy. Overexpression of Bcl-2 prevent UA-induced autophagy, Beclin-1 upregulation, apoptosis and collagen synthesis inhibition in HSFBs. Collectively, our study demonstrated that UA is a novel agent for inhibiting HS formation by promoting apoptosis, especially in combination with an autophagy inhibitor. Our results provide strong evidence of the application of UA in clinical HS treatment.

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What about physical contacts between epidermal keratinocytes and sensory neurons?

Abstract

Recent studies have demonstrated that keratinocytes closely participate in sensory transduction, and therefore, intra-epidermal free nerve endings are not exclusive transducers of pain. This discovery implies the existence of close afferent communication from keratinocytes to sensory neurons. Although reciprocal interactions between keratinocytes and intra-epidermal free nerve endings via soluble mediators are well established, little attention has been paid to physical contacts between keratinocytes and intra-epidermal free nerve endings. This review proposes to consider the ultrastructural and functional knowledge of these contacts, in both human skin biopsies and keratinocyte-sensory neuron co-cultures to speculate on the possible existence of synaptic contacts.

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