Recent Developments in Medicine and Medical Research Vol. 9

Background and Objectives: Doppler velocimetry studies of placental and foetal circulation can provide crucial information about foetal well-being, allowing for better foetal outcomes. The current study sought to determine the role of foetal middle cerebral artery blood velocity waveforms, Systolic/Diastolic ratio (S/D), Pulsatility Index (PI), and Resistance Index (RI) as predictors of perinatal outcome in intrauterine growth restriction (IUGR) pregnancies in the second and third trimesters.

Methods: 50 cases of IUGR were investigated in the study group during the second and third trimesters. They underwent ultrasonography biometry first, followed by middle cerebral artery Doppler sonography.

Results: During the second to third trimester, the S/D ratio, PI, and RI in the middle cerebral artery decline in both the control and study groups.When compared to the control group, the research group's values were lower. As a result of the current research, it is predicted that: a) Lower PI values were suggestive of fetal hypoxia. b) The lower numbers are due to hypoxia-induced vasodilation, which allows more blood to reach the brain and protect it from the harmful consequences of hypoxia.As a result, the brain is spared from harm.

Interpretation and Conclusion: Doppler is a noninvasive technique that can be used to evaluate the fetomaternal and uteroplacental circulations. The indicators of the middle cerebral artery were found to be useful in predicting the outcome of IUGR pregnancies.

We report a rare B/T/myeloid MPAL case with MLL-AF4 gene rearrangement, successfully treated with an AML-oriented protocol, after failing leukemic blast clearing as a result of pre-phase steroid treatment.  MPAL diagnosis is based on the combined expression of lymphoid, either B- or T-, and myeloid markers, potentially showing a B/T lymphoid, B/myeloid, T/myeloid, or even and more rarely, a trilineage B/T/myeloid commitment. A 34-year-old Palestinian social worker was admitted at the Augusta Victoria Hospital on September 2018 because of pancytopenia, multiple bluish-to-purple skin lesions, gingival bleeding, fever and night sweats. The patient was readmitted two weeks later for consolidation chemotherapy with high dose cytarabine (HIDAC) 3000 mg/m2 days 1, 3, and 5. ALL- oriented chemotherapy has been reported to be a superior treatment, steroid response could guide to switching to an AML-based protocol.

Autism is a neurological condition that affects a person's capacity to communicate and relate to others. Current drugs are ineffective in treating the symptoms of autism spectrum disorder. Symptoms of autism spectrum disorder are frequently co-morbid with a diagnosis of epilepsy. Ketogenic diets are remarkably effective in treatments for epilepsy in children in the same time there are several studies showed the effectiveness of ketogenic in Autism and behavior asso- ciated with it.

This study tests the effects of ketogenic diet feeding in Autism and their behavior, a child with autism spectrum disorder. The child was started on ketogenic diet formulas starting at 5 years of age, diet protocols continued and performance of tests of sociability and re- petitive behavior was assessed. A ketogenic diet improved behavior- al characteristics of autism spectrum disorder. Ketogenic diet feed- ing improved multiple measures of sociability and reduced repetitive behavior in autism child. Positive gene mutation of autism may be an important factors in showing the response of high lipid diet in those children.

In this chapter previously presented and published the new hypothesis of my own for pathogenesis of ROP based on ambiguity of vitreoretinal interface, immaturity of internal limiting membrane and mis-retinalization is discussed in detail.

Maternal rhesus alloimmunization occurs when a rhesus- negative pregnant women develops antibody response to fetal red cell rhesus antigen. Rhesus alloimmunization causes fetal hemolysis, anemia and hydrops leading to stillbirth, neonatal morbidity or mortality. We describe successful management of two cases of Rh alloimmunization with high anti-D titers, by the ultrasound Doppler measurement of their peak systolic velocity in the middle cerebral artery (PSV-MCA) and multiple maternal administrations of intravenous immunoglobulin (IVIg).

The objectives of this study were to explore the effectiveness of a modified mindfulness intervention on the following factors: death anxiety, loss and grief symptoms  in a cancer patient. Specifically, while abundant literature exists as to the benefits of mindfulness-based interventions with cancer patients, few mindfulness interventions have been conducted about death and dying factors such as death anxiety, grieving and loss. This is a case report of a modified mindfulness intervention initiated as an urgent request for a hospitalized female patient with metastatic, rapidly advancing breast cancer. Scores for death anxiety, loss and grief symptoms were obtained during the seven-week intervention. Objective and subjective reports indicated improvement in death anxiety, while findings were mixed on loss and grief factors.

Objective: The long-term outcome of percutaneous transluminal angioplasties is mainly determined by restenoses, either by progression of the underlying disease or by intimal hyperplasia. Pharmacological substances on the one hand and the implantation of stents on the other have been developed with the intention of preventing precisely this complication. While patients are treated after PTA of peripheral vessels with different low-molecular-weight heparins, the indication for stent implantation is determined individually rather by experience. The role of risk factors in longterm outcomes after PTA has rarely been systematically investigated so far.  The aim of this study was todetermine gender-specific risk factors of long-term outcome after percutaneous transluminal angioplasty (PTA) of peripheral vessels with or without stentimplantation.

Methods: In the present study, we examined the long-term results of percutaneous transluminal angioplasty (PTA) of peripheral vessels.

Between 2007 and 2017, in total, 3,276 patients underwent PTA with or without stent implantation in our clinic. All patients were treated postinterventionally for 48 hours with 25,000 IU heparin (Unfractionated Heparin (UFH), heparinsodium-Braun, 25,000 I.E./5 ml, 2 ml/h) monitored by the partial thromboplastin time and subsequently underwent a control investigation every 6 months. The endpoint of the study was determination of symptomatic stenosis larger than 50% that required reintervention.

Results: 239 (68.2% with mean age 68.02 years) male patients and 111 female patients (31.71% with mean age 62.92 years) were evaluated with complete follow-up. A total of 470 PTAs were performed on male patients and 213 on female patients in multiple interventions. The majority of patients at the time of treatment were in stage IIb according to the classifi cation of Fontaine (81.6% of male patients and 68% of females). In our sample, peripheral arterial disease stage III and IV according to Fontaine classification occurred twice as frequently in female patients as in male patients (stage III in 12.6% in female versus 6.1% in male, and stage IV in 18% in female versus 8.9% in males). In both groups, the femoral superficialis artery was most frequently dilated (64 cases, 30% in female and 155 cases, 32.9% in male), followed by the iliacal communis artery (46 cases in female and 99 cases in male, both with 21.5%). A balloon angioplasty of the tibialis anterior and posterior arteries was performed twice as frequently in female patients as in male patients (28 cases with 13.1% of tibialis ant. artery in female versus 32 cases with 6.8% in male patients, and in 17 cases with 7.9% of tibialis post. artery in female versus 16 cases with 3.4% in male patients). In this study, without consideration of gender, patency rates of 79% after 2.5 years, 67% after 5 years, 49% after 7.5 years and 37% after 10 years were determined for PTA without stent implantation. Between the 7th and 10th year in follow-up, the cumulative patency rates for stent implantation was 49%, whereas it was 31% for PTA alone. The results of this study show that the stent assisted PTA`s of comm. artery and externaliliacal artery are significantly independent of risk factors better than the femoral vessels, and these in female patients better than in male patients. Male patients do not benefit significantly from stent implantation in the long term. As the COXI and II regression analyses show, gender-linked results are most evident for renal insufficiency and diabetes mellitus, and less pronounced also for the number of open lower leg vessels.

Conclusion: Under consideration of gender and risk factors, while male patients with diabetes mellitus, renal insufficiency and/or poor run-off did not benefit from stent implantation in the long-term, female patients with similar risk factors showed higher patency rates after stent therapy. In addition, the long-term results after PTA of femoral superficialis artery and poplitea artery are significantly worse than PTA of the pelvic vessels in both genders. This study suggest that gender-linked results are most evident for renal insufficiency and diabetes mellitus, and less pronounced also for the number of open lower leg vessels.

Stepwise covariate selection is a popular method for multivariable regression model building. A model with fewer covariates is numerically stable and easier to use. Based on the different significance levels pre-specified by statisticians, different covariates are included in the model. Further analyses with these models might introduce biases. This paper proposes a novel method to select covariates for stepwise proportional hazards regression without pre-setting a significance level. Multiple models containing different numbers of covariates were outputted for final model selection. A user-oriented SAS macro was developed. Users of the macro may determine the final models, based on estimated characteristic changes of the overall models, the variations of the covariate effects on the response variable and their special needs. With this method, model selections are much easier than with purposeful or the best subsets method. This method improved stepwise covariate selection processes. Broad applications are expected.

The localization and chemical nature of neurons immunoreactive to noradrenaline (NA) in the cat dorsal vagal complex (DVC) was examined, using immunohistochemistry for NA, dopamine-\(\beta\)-hydroxylase (DBH), dopamine (DA) and tyrosine hydroxylase, under different conditions.  The localization of NA-immunoreactive (-ir) and DBH-ir neurons in non-treated mice was highly overlapping. They were mostly found in nucleus of solitary tract (NTS) and a small number in dorsal motor nucleus of vagus. The commissural and ventral subnuclei of NTS contained the majority of NA-ir / DBH-ir neurons. A small number of weakly stained NA-ir cell bodies coexisted with numerous intensely stained DBH-ir cell bodies in the area postrema. Injection of a monoamine oxidase inhibitor (MAOI), pargyline, enhanced NA immunoreactivity in cells and axons of DVC and increased their number. Both DA and NA immunoreactivities were drastically reduced in a large number of axons after treatment with MAOI + parachlorophenylalanine, an inhibitor of tryptophan and phenylalanine hydroxylases, however NA immunoreactivity in DVC cell bodies remained detectable. Colchicine + MAOI treatment increased NA immunoreactivity exclusively in cell bodies in the locations mentioned above, where NA and DBH immunoreactivity was weak or undetectable. The physiological consequences were discussed referring to the previous reports.

Down’s syndrome (DS) is the most common chromosomal malformation affecting about 1:700 life born. Congenital heart disease is the most significant malformation in children with Down’s syndrome, it is responsible for most the mortality and morbidity associated with Down’s syndrome. Previous studies suggested that there are ethnic differences in the type of congenital heart disease.

There is no data available for the frequency and types of CHD in infants with Down’s syndrome in Sudan. The aim of this study was to determine the prevalence and the types of congenital heart defects in children with Down’s syndrome and to assess the impact of congenital heart disease the on nutritional status.

This was a prospective cohort study of infants with Down syndrome over a six month period. Congenital hear disease occurred in 43.1% of children with Down’s syndrome. The commonest lesion was Atrioventricular Septal defect (32%) followed by Ventricular Septal defect (26%), Patent Ductus Arteriosus (17%) and Atrial Septal Defect (15%). Over all under-nutrition was found in 56.9 %; 87.2% were in the children with congenital heart disease group and 33.9% in the group with normal hearts. The presence of congenital heart disease in children with Down’s syndrome had an influence on their nutritional status. Early recognition of the cardiac condition of neonates with Down’s syndrome by screening is justified.

When produced transiently and moderately, reactive oxygen species (ROS) are not just by-products of substrate oxidation, they are also chemicals involved in intracellular signalling. The objective of this review is to explore the intracellular signaling aspects of reactive oxygen species in influencing feeding behaviour. Substrates such as glucose and lipids promote the generation of reactive oxygen species, primarily through mitochondria and, to a lesser extent, through NADPH oxidases. Under the influence of substrate level, the level of ROS generated in hypothalamic neurons such as NPY/AgRP and POMC neurons directly influences their activity and, as a result, affects downstream neurons located in other parts of the hypothalamus such as the ventromedial nucleus (VMN), the paraventricular nucleus (PVN), and the lateral hypothalamus. The activation of the POMC neuronal population is caused by an increase in ROS levels, whereas the activation of the NPY/AgRP neurons is caused by a decrease in ROS levels. The activation of these neurons determines feeding behaviour, which can be satiety if POMC neurons are activated or increased food intake if NPY/AgRP neurons are activated.

Surgery for Grave’s disease is one possible option for definitive treatment. After establishing euthyroid status, a thyroidectomy is performed. Pre-operative preparation of the hyperthyroid patient is critical to avoid peri- and post-operative serious complications due to thyrotoxicosis, most notably thyrotoxic crisis and death.  The administration of anti-thyroid medications is the cornerstone of preparation. Occasionally, for special reasons, rapid pre-operative optimization is required  (intolerance or side effects to anti-thyroid drugs or an aggravated serious disease with thyrotoxicosis). Several regimens for this goal have been proposed, with protocols containing various combinations of iodine (as a Lugol's solution, or iopanoic acid, or ipodat sodium), steroids, usually dexamethasone, and beta blockers, as well as plasmapheresis, lithium, and exchange ionic resin. The indication for rapid optimization with the target thyroidectomy is poorly-controlled/non-response of disease to thionamides, intolerance or serious side effects to thionamides (allergy, agranulocytosis, hepatitis and vasculitis). The restoration of hyperthyroid Grave’s disease to euthyroidism in our patient was rapidly accomplished with iodine, dexamethasone and beta blockers (at seventh day without complications). For these circumstances, we propose a possible treatment protocol.

Excellent firm bonding between the biomaterials and bone tissue (osseointegration and osteo-conductivity) is very important for the stability of dental implants and artificial joints etc. Much has been learned about this concept, which has led to significant improvements in the design and surface modification of implants in the field of implant dentistry, orthopedic surgery.

For this issue, we have focused on the effects of low-intensity pulsed ultrasound (LIPUS) irradiation, investigated whether LIPUS could accelerate the osseointegration ability of bio-active material such as bioactive titanium and hydroxyapatite.

As samples, Bio-active pure titanium and hydroxyapatite (HA) were prepared, in vitro  simulation test and animal  experiment have performed.

In simulation test, the bone-like hydroxyapatite formation on material surface in simulated  body fluid (SBF) under the LIPUS were assessed. In animal test, the  bio-active samples implanted to the rabbits  femur, undertaken the irradiation of LIPUS were investigated by using Scanning Electron Microscope (SEM), X-ray diffraction (XRD) etc. and histological observation.

As a result, LIPUS irradiation showed the excellent enhancement of bone-material attachment by means of the crystal growth of bone-like apatite on sample materials surface, which suggested the application of LIPUS has  clinical potential to improve the osseointegration (osteointegration), bone-bonding  ability of  bio-active materials.

Objective: Biopsy is mandatory for final diagnosis of brain pathologies. For this, tissue is harvested by Stereotaxic or endoscopic biopsy which are hazardous and sometime life threatening. For this purpose a noninvasive method has been innovated.

Introduction: Attempt has been made to discriminate benign and malignant lesions of brain noninvasively from the T2 weighted MR image. Various data like Refractive Index(RI), T2 relaxation value, Apparent diffusion coefficient (ADC) values, metabolites of brain tissue determined by MR spectroscopy were assigned with the T2 weighted image (Ground truth image). These data after proper training by Support vector Machine (SVM) and or by Artificial Neural network (ANN), live predicting of the tissue could be possible. Principal Component Analysis (PCA) can also clusters the diseases.

Materials and Methods: RI of biopsy tissues were determined by Abbe refractometer. A relationship of RI of tissues and T2 values was established in MRI. T2 and RI map generated from the T2 weighted image with the help of RI and T2 shade. A false color RI shade helps in converting T2 image into color coded RI image characterizing benign and malignant tissue. ANN and SVM after proper training of the data can predict the diseases. PCA reduces the dimension of the data.

Results: From the relationship of RI and T2 values color coded map of the T2 weighted image discriminates various benign from malignant tissue. ANN and SVM live predict the disease. PCA diminishes the dimension of the data.

Conclusion: Almost 95% of diagnostic accuracy can be obtained non-invasively by RI color coded map and supervised machine learning.

Background: Chronic periodontitis is a chronic inflammatory condition of the oral cavity that affects the supporting structures of the teeth. It leads to attachment loss, bone loss and further tooth loss. Recent researches have proven that it is associated with various systemic conditions affecting the body like diabetes, cardio vascular disease, cerebrovascular disease, respiratory disease, obesity and pre-term low birth weight babies. Metabolic syndrome is a cluster of diseases that results in diabetes, stroke and cardio vascular disease. So in view of the above facts the present study was designed to determine the relationship between chronic periodontitis and metabolic syndrome.

Objective: The objectives of the study were

1. To compare the periodontal status of metabolic syndrome patients with general healthy individuals
2. To determine whether the periodontal status was consistent with the values of the metabolic components.

Methods: A total of ninety patients participated in this study. Group one consisted of forty-five patients who were confirmed to have metabolic syndrome and group two consisted of forty-five age and sex matched healthy controls. Plaque index, Gingival Bleeding Index (Ainamo & Bay), Probing Pocket Depth (PPD), Clinical Attachment Level (CEJ), total number of missing teeth and the reasons for extraction were also noted. Medical examination and blood investigations included measurement of height, weight, waist circumference, waist-hip ratio, Body-Mass Index (BMI), serum lipid profile, fasting blood glucose and blood pressure. Metabolic syndrome was defined according to NCEP ATP III definition. The results obtained were analysed statistically using SYSTAT html output.

Results: The results of the present study showed that the periodontal condition of group one patients were poor compared to group two patients. The periodontal conditioned worsened with an increase in the metabolic components.

Conclusion: Based on the results of our study, it can be concluded that that periodontitis and metabolic syndrome were confounding the systemic effects of each other. Dentists should counsel their patients regarding the health hazards of metabolic syndrome and periodontitis and motivate them to maintain good oral hygiene and follow healthy life-style.

Introduction: With the advent of minimal access surgery and standardized recovery protocols, patients with colorectal disease are recovering more quickly after surgery. Despite these significant advances, anastomotic leakage remains one of the most feared complications following colorectal surgery, with rates ranging from 3-27 percent depending on risk factors. Anastomotic leakage may be defined as clinical signs of peritonitis and/or clinical evidence of free fecal fluid within abdomen or emerging from drain site. Some studies concluded that biomarkers like lactate/pyruvate ratio and cytokines:IL-6, IL-10 and TNF-alpha were increased in patients who developed symptomatic anastomotic leakage before clinical symptoms were evident.

Aims and Objectives:

1. To assess sensitivity and specificity of systemic (CRP, leukocytes, pro calcitonin) and peritoneal drain-fluid bio-markers interleukin-6, interleukin-10, tumor necrosis factor-\(\alpha\) (IL-6, IL-10, TNF-\(\alpha\)) in early prediction of anastomotic leak following colo-rectal surgeries.
2. To co-relate rise in levels of biomarkers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.

Methodology: The current study was a prospective observational study conducted on 60 patients over a two-year period in the Postgraduate Department of Surgery, Government Medical College, Srinagar, after obtaining proper ethical clearance. All patients who under-went varied colo-rectal procedures for different indications were observed closely in post-operative period and their systemic as well as drain fluid markers were sent for estimation on days 1-7 post-operatively and results obtained there-of were analysed using SPSS V 22.

Results: The mean age was 54.87±11.901 years with 44 patients (73.3%) were males & 16 patients (26.7%) were females. Among systemic makers: the mean CRP level was 2.7800±0.500 mg/L, the mean total leukocyte count was 10.783±0.940 thousands & the mean serum procalcitonin level was 0.365±0.1385 ng/ml. Among peritoneal fluid drain bio-makers, the mean IL-6 level was 3551.066±1311.965 pg/ml, the mean IL-10 level was 628.533±460.358 pg/ml & the mean TNF-a level was 16.391±6.736 pg/ml. The anastomotic leak after colo-rectal surgery was noted in 16 patients (26.7%). In our study, there was a significant correlation between the rise in levels of peritoneal drain fluid biomarkers and the severity of clinical symptoms, but there was no significant correlation between the rise in levels of systemic markers and the severity of clinical symptoms in patients who had colo-rectal surgeries.

Conclusion: After colorectal surgery, systemic biomarkers are poor predictors of anastomotic leak. However, peritoneal fluid drain biomarkers have a high sensitivity and specificity in predicting anastomotic leak.  

Objective: Vitiligo is an ever increasing problem in all age groups globally. Different regimens are in practice including sun exposure, UVR, Oral and Topical psoralens. Our study presents an original work with a new idea where NEEDLING is combined with narrow band UVB exposure. Our hypothesis is that the Melanocytes in the normal skin around the vitiligo patch can be pushed into the vitiligo patch and subsequent UVB induced melanogenesis treats vitiligo.

Methods: A 30-G needle with short stem is softly pushed through the normal skin edge in to the vitiligo patch at the level of the D-E junction parallel to the skin. This needle push called NEEDLING drags epidermal cells including melanocytes as micro inoculation to produce multiple small population of melanocytes in the vitiligo area, which is then exposed to narrow band UVB to cause melanogenesis and hence repigmentaiton of the area. Multiple needle pushes are made through the edge into vitiligo patch one centimeter apart. All patients are having needling once weekly and UVB 3 times a week.

A study of this combination was done over 300 patients, in both sexes in different age groups from July 2009 to July 2016 and follow up still continued. A comparison was also done with UVB alone (without needling) in some of these patients at some patches. Inclusion and exclusion criteria, a result criteria and a study Performa with follow-up details was set. Photos of all the patients were taken at the start and then every 3-weeks. Biopsy of few patients performed to observe the effects of needling.

Results: This combination treatment has proved very safe and effective against vitiligo as compared to UVB alone in all age groups. All patients had fast repigmentation. The best results are on the face with more then 90% repigmentation in all age groups. Repigmentation is still good but slower towards peripheral parts. Repigmentation was specially noticed to start from the edge of the vitiligo patch (where needling is started) as tiny balck dots and further needling through these dots gradually repigmented the central areas. Repigmentaion is also good over areas with grey hair with this technique as needling uses melanocytes of the skin surrounding the vitiligo patch rather then the follicular cells. This further strengthened the idea of needling as a useful combination with UVB.

Background: Fine needle aspiration cytology is an indispensible technique, both as a modality of pre-therapeutic investigation and also in diagnosing recurrences. The role of fine needle aspiration cytology (FNAC) in the diagnosing malignant tumours is recorded. Yet it is not always possible to arrive at a definitive diagnosis based on FNAC alone. Certain pitfalls are there in conventionally assessed FNA smears. Often, they contain very less quantity of tissue material and the relative absence of recognizable tissue architecture in cytology smears often makes diagnosis very difficult.Fine needle aspiration (FNA) smears prepared through conventional method, often contain well preserved viable tissue fragments which are intact (tissue microbiopsies). Micro biopsies are defined as well preserved viable tissue fragments obtained on cytology smears. They will provide information on the tissue architecture and thereby contribute to the tumour ontogeny. This study was done to assess the significance of the presence of microbiopsies in conventional/guided FNAC in giving a more precise diagnosis.

Aim: To Study the Significance of Tissue Microbiopsies in Conventional/Guided Fine needle aspiration Cytology preparation and to assess the utility of the microbiopsy fragments in giving a precise cytological diagnosis.

Methods: A prospective study of significance of tissue microbiopsies in fine needle aspiration cytology were studied and interpreted during the period from June 2014 to June 2015 in the Cytopathology laboratory of the Department of Pathology, Tirunelveli Medical College, Tirunelveli. 100 cases with clinically palpable Swellings were studied.

Results: Out of 100 cases, 82% of cases were coming under the category of conventional FNAC, 10% of the cases were USG guided and 8% were falling under CT guided FNAC. Lymph nodes had the highest yield of microbiopsies, with 34 cases (34%), followed by breast 24 cases, thyroid 11 cases, lung 8 cases, salivary gland 7 cases, liver and bone and soft tissue 4 cases each, abdominal mass 3 cases, pancreas 2 cases, and ovary, spleen, and anterior mediastinum 1 case each. There were 56 percent malignant cases and 44 percent benign instances out of a total of 100 cases. There were 56 malignant tumours in total, with 41 (73.2%) being primary tumours and 15 (26.8%) being metastatic tumours.

Conclusion: FNA smears containing microbiopsies are of more help in establishing confirm diagnosis, typing of tumour, and predicting possible primary sites in cases of metastatic tumors which were not possible by cytology alone. Hence, this technique can be used to increase the diagnostic accuracy of FNAC, if put into practice in evaluation of routine cytology sample. Whatever be the types of FNAC, conventional, CT or USG guided, fine needle aspiration cytology aspirate with tissue microbiopsy is an effective tool in evaluating and diagnosing suspected lumps or masses.

Telomerase is an enzyme that extends and preserves telomeres, which are the ends of chromosomes. This reverse transcriptase function is critical for dividing cells that continuously shorten their telomeres. In addition to its canonical role in maintaining telomeres in dividing cells a number of TERT (Telomerase Reverse Transcriptase)-related non-canonical functions has been described. Importantly, the RNA component of telomerase, TERC, is downregulated early in development in human brain, resulting in the loss of telomerase activity in most brain cells except neural stem cells. In contrast, the presence of the telomerase protein TERT persists during lifetime in neurons of the human brain. This makes TERT the prominent telomerase subunit in the brain and is responsible for various protective mechanisms associated with improved stress responses and increased degradation of toxic proteins. The present review highlights some new findings for telomerase in brain and its possible implications for neurodegenerative diseases and potential novel treatment strategies.

Biological disease modifying anti-rheumatic drugs (bDMARDs) have improved outcome of rheumatoid arthritis (RA). Cutaneous vasculitis is a manifestation of RA. Besides, it has been described as a paradoxal effect of biotherapy. Vasculitis has been reported with anti-TNF (Tumor Necrosis Factor) agents among more than 140 cases according to the BIOGEAS study group (a Study Group on Autoimmune Diseases of the Spanish Society of Internal Medicine) but only in two cases with Tocilizumab (TCZ). We report the first case of cutaneous vasculitis occurring under both anti-TNF therapy and TCZ.