Orbital pseudotumour masquerading as Wegener’s granulomatosis

A twenty-two year old female patient presented with new onset bilateral hard orbital masses and progressively worse tear lake problems. Computed tomography of the orbits revealed poorly differentiated bilateral orbital masses. Laboratory investigation revealed ANCA positivity. Routine biochemical investigations were all within normal limits. CXR was also normal. Biopsy of the orbital masses revealed non-specific histological findings. An initial diagnosis of Granulomatosis with Polyangitis (GPA) was postulated. Oral steroids were given followed by a rapid response to steroid therapy. The working diagnosis of GPA was abandoned and a diagnosis of idiopathic orbital inflammation (IOI), or orbital pseudotumour was made owing to the benign, non-infective, inflammatory pathology with no evident systemic or local cause. Tailoring off of steroids resulted in repeated flare ups, resulting in the initiation of methotrexate therapy. The patient is in remission and is currently on combined steroid and methotrexate treatment. IOI is a diagnosis of exclusion and a rapid response to steroids serves as a diagnostic aid but is not in itself diagnostic.peer-reviewe

Assessing the analgesic benefit of phacoemulsification under topical anesthesia using pre-operative nepafenac 0.1%

Background: To compare the intra-operative analgesic benefit of cataract surgery under topical anesthesia with and without pre-operative NSAIDs, namely nepafenac 0.1% (Alcon Laboratories Inc, Nevanec® , Fort Worth, TX, USA) Method: In a study carried out at Mater Dei Hospital, Ophthalmic department, Malta, 199 patients with a cataract were divided into two groups. 100 eyes received nepafenac 0.1% pre-operatively while 99 eyes did not. Intra-operative discomfort was judged by assessing facial grimacing, restlessness, irritability and distress and the results were noted. Patients were divided into refractive error groups, namely myopic, hypermetropic and emmetropic. Results: Pre-operative nepafenac 0.1% produced significantly more pain free cataract surgeries, resulting in a discomfort rate of 9% vs 28% in the group where pre-operative nepafenac 0.1% was not used. Pain was also most evidently observed on insertion of the phaco handpiece. This may be said for patients in all refractive errors groups. Conclusions: The analgesic efficacy of nepafenac 0.1% pre-operatively is significant in reduced intra-operative discomfort during cataract surgery repair under topical analgesia.peer-reviewe

Primary CNS lymphoma with intravitreal metastasis : using vitreous cavity samples to monitor response to therapy

A fifty-eight year old male patient presented to the ophthalmic department with a 3 day history of reduced visual acuity, blurred vision and floaters, associated with recent lethargy, headaches and behavioural changes. Fundal examination revealed a bilateral vitritis. Steroid therapy was started. MRI of the brain revealed multiple hypodense and hyperdense lesions. Vitrectomy was performed in view of the poor response to steroids. A biopsy showed non-hodgkin B-Cell lymphoma. The patient was started on intravenous Methotrexate and Cytarabine. Repeat vitreous cavity biopsies were performed in order to assess response to therapy. All biopsies to date have revealed evidence of on-going lymphoma.peer-reviewe

A retrospective study on the Maltese population of the outcome of retinal detachment repair after the removal of silicone oil

Background: Silicone oils of different viscosities are used in the treatment of retinal detachments of varying pathology. Method: Seventy-two cases of retinal detachments managed with silicone oil were reviewed in a retrospective chart analyses. Eighty nine patients were reviewed from which data on primary pathology, type of silicone oil, duration of oil “in situ” and complications (including emulsification, increased intraocular pressure (IOP), re-detachment, cataract and presence of CME) were compiled. Of this number, 72 patients with post- operative follow-up of two years or more and documentation of the above parameters were included. The data was carefully analysed in an effort to determine the primary factor or factors of the varying silicone oil substitutes utilized responsible for the successful or non-successful re- attachment of the retina. Results: Retinal re-detachment rate is greater when Silicone Oil (SO) is removed before 12 months. Complex vs non-complex retinal re- detachments in sub-group analysis indicates superiority of retention of SO for greater than 12 months. Emulsification is greater in low viscosity SO (1300cts). Conclusion: The complication rates witnessed in this retrospective study are comparable to the findings of published studies present in the ophthalmic literature on an international scale. The findings of this study support the hypothesis that it is the duration of the SO “in situ” as opposed to the viscosity or other SO attributes which ultimately influences the re-detachment rate.peer-reviewe

Sudden bilateral loss of vision in a 19-year-old man

Introduction: Posterior Reversible Leukoencephalopathy Syndrome (PRES) is caused by ischaemia commonly affecting the posterior cerebral vasculature. It presents with sudden decreased vision, headaches, nausea, vomiting, seizures, and altered mental status. Case presentation: A 19-year-old male presented to the ophthalmic emergency complaining of sudden bilateral loss of vision, which was down to light perception He reported headaches, nausea, and drowsiness since the previous day. He was a known case of hypertension secondary to IgA nephropathy. Magnetic resonance imaging (MRI) with STIR and FLAIR sequences showed foci of hyperintensity within the occipital lobes bilaterally. This confirmed the suspected diagnosis of PRES. Discussion: Aetiological factors of PRES include sudden increase in blood pressure, eclampsia, porphyria, renal disease, and Cushing syndrome. These lead to blood-brain barrier injury either by hyper- or hypoperfusion, endothelial dysfunction, changes in blood vessel morphology, hypocapnea, or immune system activation. Histopathological changes in PRES include activated astrocytes, scattered macrophages and lymphocytes, often in the absence of inflammation or neuronal damage. Conclusion: PRES is usually a reversible neuroophthalmological condition, however prompt recognition and appropriate management is important to prevent permanent brain injury or even death.peer-reviewe

The state of SQL-on-Hadoop in the cloud

Managed Hadoop in the cloud, especially SQL-on-Hadoop, has been gaining attention recently. On Platform-as-a-Service (PaaS), analytical services like Hive and Spark come preconfigured for general-purpose and ready to use. Thus, giving companies a quick entry and on-demand deployment of ready SQL-like solutions for their big data needs. This study evaluates cloud services from an end-user perspective, comparing providers including: Microsoft Azure, Amazon Web Services, Google Cloud, and Rackspace. The study focuses on performance, readiness, scalability, and cost-effectiveness of the different solutions at entry/test level clusters sizes. Results are based on over 15,000 Hive queries derived from the industry standard TPC-H benchmark. The study is framed within the ALOJA research project, which features an open source benchmarking and analysis platform that has been recently extended to support SQL-on-Hadoop engines. The ALOJA Project aims to lower the total cost of ownership (TCO) of big data deployments and study their performance characteristics for optimization. The study benchmarks cloud providers across a diverse range instance types, and uses input data scales from 1GB to 1TB, in order to survey the popular entry-level PaaS SQL-on-Hadoop solutions, thereby establishing a common results-base upon which subsequent research can be carried out by the project. Initial results already show the main performance trends to both hardware and software configuration, pricing, similarities and architectural differences of the evaluated PaaS solutions. Whereas some providers focus on decoupling storage and computing resources while offering network-based elastic storage, others choose to keep the local processing model from Hadoop for high performance, but reducing flexibility. Results also show the importance of application-level tuning and how keeping up-to-date hardware and software stacks can influence performance even more than replicating the on-premises model in the cloud.This work is partially supported by the Microsoft Azure for Research program, the European Research Council (ERC) under the EUs Horizon 2020 programme (GA 639595), the Spanish Ministry of Education (TIN2015-65316-P), and the Generalitat de Catalunya (2014-SGR-1051).Peer ReviewedPostprint (author's final draft

Biomarkers of Alzheimer\u27s disease risk in peripheral tissues; focus on buccal cells

Alzheimer\u27s disease (AD) is a progressive degenerative disorder of the brain and is the most common form of dementia. To-date no simple, inexpensive and minimally invasive procedure is available to confirm with certainty the early diagnosis of AD prior to the manifestations of symptoms characteristic of the disease. Therefore, if population screening of individuals is to be performed, more suitable, easily accessible tissues would need to be used for a diagnostic test that would identify those who exhibit cellular pathology indicative of mild cognitive impairment (MCI) and AD risk so that they can be prioritized for primary prevention. This need for minimally invasive tests could be achieved by targeting surrogate tissues, since it is now well recognized that AD is not only a disorder restricted to pathology and biomarkers within the brain. Human buccal cells for instance are accessible in a minimally invasive manner, and exhibit cytological and nuclear morphologies that may be indicative of accelerated ageing or neurodegenerative disorders such as AD. However, to our knowledge there is no review available in the literature covering the biology of buccal cells and their applications in AD biomarker research. Therefore, the aim of this review is to summarize some of the main findings of biomarkers reported for AD in peripheral tissues, with a further focus on the rationale for the use of the buccal mucosa (BM) for biomarkers of AD and the evidence to date of changes exhibited in buccal cells with AD

Automation and validation of micronucleus detection in the 3D EpiDerm™ human reconstructed skin assay and correl

Recent restrictions on the testing of cosmetic ingredients in animals have resulted in the need to test the genotoxic potential of chemicals exclusively in vitro prior to licensing. However, as current in vitro tests produce some misleading positive results, sole reliance on such tests could prevent some chemicals with safe or beneficial exposure levels from being marketed. The 3D human reconstructed skin micronucleus (RSMN) assay is a promising new in vitro approach designed to assess genotoxicity of dermally applied compounds. The assay utilises a highly differentiated in vitro model of the human epidermis. For the first time, we have applied automated micronucleus detection to this assay using MetaSystems Metafer Slide Scanning Platform (Metafer), demonstrating concordance with manual scoring. The RSMN assay's fixation protocol was found to be compatible with the Metafer, providing a considerably shorter alternative to the recommended Metafer protocol. Lowest observed genotoxic effect levels (LOGELs) were observed for mitomycin-C at 4.8 μg/ ml and methyl methanesulfonate (MMS) at 1750 μg/ml when applied topically to the skin surface. In-medium dosing with MMS produced a LOGEL of 20 μg/ml, which was very similar to the topical LOGEL when considering the total mass of MMS added. Comparisons between 3D medium and 2D LOGELs resulted in a 7-fold difference in total mass of MMS applied to each system, suggesting a protective function of the 3D microarchitecture. Interestingly, hydrogen peroxide (H2O 2), a positive clastogen in 2D systems, tested negative in this assay. A non-genotoxic carcinogen, methyl carbamate, produced negative results, as expected. We also demonstrated expression of the DNA repair protein N-methylpurine-DNA glycosylase in EpiDerm™. Our preliminary validation here demonstrates that the RSMN assay may be a valuable followup to the current in vitro test battery, and together with its automation, could contribute to minimising unnecessary in vivo tests by reducing in vitro misleading positives. © The Author 2014

Zinc supplementation influences genomic stability biomarkers, antioxidant activity and zinc transporter genes in an elderly Australian population with low zinc status

ScopeAn increased intake of Zinc (Zn) may reduce the risk of degenerative diseases but may prove to be toxic if taken in excess. This study aimed to investigate whether zinc carnosine supplement can improve Zn status, genome stability events, and Zn transporter gene expression in an elderly (65-85 years) South Australian cohort with low plasma Zn levels.Methods and resultsA 12-week placebo-controlled intervention trial was performed with 84 volunteers completing the study, (placebo, n = 42) and (Zn group, n = 42). Plasma Zn was significantly increased (p ConclusionZn supplementation may have a beneficial effect in an elderly population with low Zn levels by improving Zn status, antioxidant profile, and lowering DNA damage.Razinah Sharif, Philip Thomas, Peter Zalewski, and Michael Fenec

The Need for Compliance Verification in Collaborative Business Processes

Compliance constrains processes to adhere to rules, standards, laws and regulations. Non-compliance subjects enterprises to litigation and financial fines. Collaborative business processes cross organizational and regional borders implying that internal and cross regional regulations must be complied with. To protect customs’ data, European enterprises must comply with the EU data privacy regulation (general data protection regulation - GDPR) and each member state’s data protection laws. An example of non-compliance with GDPR is Facebook, it is accused for breaching subscriber trust. Compliance verification is thus essential to deploy and implement collaborative business process systems. It ensures that processes are checked for conformance to compliance requirements throughout their life cycle. In this paper we take a proactive approach aiming to discuss the need for design time preventative compliance verification as opposed to after effect runtime detective approach. We use a real-world case to show how compliance needs to be analyzed and show the benefits of applying compliance check at the process design stag