SAFETY AND EFFICACY OF THYMIC PEPTIDES IN THE TREATMENT OF HOSPITALIZED COVID-19 PATIENTS IN HONDURAS

Coronavirus disease 2019 (Covid-19) active cases continue to demand the development of safe and effective treatments. This is the first clinical trial to evaluate the safety and efficacy of oral thymic peptides. ; We conducted a nonrandomized phase 2 trial with a historic control group to evaluate the safety and efficacy of a daily 250-mg oral dose of thymic peptides in the treatment of hospitalized Covid-19 patients. Comparisons based on standard care from registry data were performed after propensity score matching. The primary outcomes were survival, time to recovery, and number of participants with treatment-related adverse events or side effects by day 20. ; A total of 44 patients were analyzed in this study: 22 in the thymic peptide group and 22 in the standard care group. There were no deaths in the intervention group compared to 24% mortality in standard care by day 20 (log-rank P=0.02). Kaplan-Meier analysis showed a significantly shorter time to recovery by day 20 in the thymic peptide group than in the standard care group (median, 6 days vs. 12 days; hazard ratio for recovery, 2.75 [95% confidence interval, 1.34 to 5.62]; log-rank P=0.002). No side effects or adverse events were reported. ; In patients hospitalized with Covid-19, the use of thymic peptides resulted in no side effects, adverse events, or deaths by day 20. Compared with the registry data, a significantly shorter time to recovery and mortality reduction were measured.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Differences in physical activity in subjects with psychosis versus a control group

Introduction

Psychiatric illnesses are related with a reduced life expectancy and an increase of mortality rates (around 60%) mainly associated with cardiovascular diseases [1]. The high prevalence of obesity, metabolic syndrome, diabetes mellitus and tobacco use among these patients undoubtelly predispose to the impairment in physical health and mortaility increase. Regular physical activity in the general population is associated with a decrease in cardiovascular risk but litle is know about iss influence in some chronic and severe mental disorders like schizophrenia ^[2].

Objectives

To quantify the physical activity performed by a sample of subjects with psychosis, borth males and female, compared to a control group.

Methods

A sample composed of 141 patients with schizoprenia was compared to 103 healthy subjects as a control group. The International Physical Activity Questionnaire - Short Form (IPAQ) scale was applied to all participants. The time (minutes) of physical activity performed in a week (METs) was collected by each participant ^[3].

Results

The differences in the total physical activity Mets for the patients with schizophrenia were highly significant (p = 0.001), showing a lower degree of physical activity compared to the control group. A higher and significant percentage of sedentary lifestyle among the psychiatric group (64.5%), compared to 35.5% in the control group was found.

Conclusions

The group of pateints with Schizophrenia showed a significant higher sedentary lifestile including less physical activity. This finding could be highly related with a higher risk of cardiovascular disease and deterioration of the physical health.

Disclosure

No significant relationships.

Hormonal alterations due to antipsychotic-related hyperprolactinemia

Introduction

The use of antipsychotics (APS) is essential. Despite their great efficacy, some of them are associated with an increase in prolactin levels that can lead to hormonal changes needing to be identified and managed [1,2,3]. Hormonal changes use to have clinical implications including hypogonadism, infertility and sexual dysfunction

Objectives

To evaluate possible hormonal alterations and some clinical implications produced by hyperprolactinemia (HPRL) derived from the use of some antipsychotic compounds.

Methods

A complete fasting blood test was performed on a sample of 113 subjects (69 men and 44 women). 54% (n = 61) showed a normal prolactin level and 46% (n = 52) showed hyperprolactinaemia ( >50ng / ml). On the global sample, 39.8% (n = 45) was treated with some hyperprolactinemic drug , mostly risperidone and paliperidone.

Results

Some differences were found depending on the gender of the subjects. A highly significant inverse relationship between the values of prolactin and testosterone was found in males (p=0.020, r=-0.285). In females, increased prolactin level was significantly related to decreased cortisol values.

Conclusions

Antipsychotic-related Hyperprolactinaemia ( mainly risperidone and paliperidone) is related with a decrease in testosterone levels in males and with an increase in cortisol levels in females.

Disclosure

No significant relationships.

MRI features of presumed normal palatine tonsils in dogs

OBJECTIVE

To describe the MRI characteristics of normal palatine tonsils in dogs.

MATERIALS AND METHODS

Retrospective study of 95 dogs with presumed normal tonsils. Tonsillar margination, shape and signal intensity in pre- and postcontrast studies were assessed and the cross-sectional area was measured at the point of maximal size on transverse images.

RESULTS

In all cases the tonsils were located with their largest transverse cross-section at the level of the temporomandibular joints. Their margins were well-defined in all dogs; in 57 (60%) the borders were smooth and in 38 (40%) slightly irregular. The majority (96%) of the tonsils were rounded to oval in cross-section and the remainder were elongated. All tonsils were hyperintense to the medial pterygoid muscles in T1-weighted, T2-weighted, FLAIR and T2* gradient echo images and they showed either homogeneous (53%) or heterogeneous (47%) signal intensity. Contrast enhancement was marked (65%) or moderate (33%) in the majority of animals. Median tonsillar cross-sectional area was approximately 29 mm² (90% confidence interval: 10.0 to 64.4 mm² ). There was significant positive correlation between bodyweight and tonsillar cross-sectional area and a weak negative correlation between age and tonsillar cross-sectional area.

CLINICAL SIGNIFICANCE

MRI is of value in assessing normal palatine tonsils in dogs. This study could be used as a baseline for the investigation of the value of MRI in assessment of tonsillar disease in dogs.

Conservation and Divergence in the Candida Species Biofilm Matrix Mannan-Glucan Complex Structure, Function, and Genetic Control

Candida biofilms resist the effects of available antifungal therapies. Prior studies with Candida albicans biofilms show that an extracellular matrix mannan-glucan complex (MGCx) contributes to antifungal sequestration, leading to drug resistance. Here we implement biochemical, pharmacological, and genetic approaches to explore a similar mechanism of resistance for the three most common clinically encountered non-albicansCandida species (NAC). Our findings reveal that each Candida species biofilm synthesizes a mannan-glucan complex and that the antifungal-protective function of this complex is conserved. Structural similarities extended primarily to the polysaccharide backbone (α-1,6-mannan and β-1,6-glucan). Surprisingly, biochemical analysis uncovered stark differences in the branching side chains of the MGCx among the species. Consistent with the structural analysis, similarities in the genetic control of MGCx production for each Candida species also appeared limited to the synthesis of the polysaccharide backbone. Each species appears to employ a unique subset of modification enzymes for MGCx synthesis, likely accounting for the observed side chain diversity. Our results argue for the conservation of matrix function among Candida spp. While biogenesis is preserved at the level of the mannan-glucan complex backbone, divergence emerges for construction of branching side chains. Thus, the MGCx backbone represents an ideal drug target for effective pan-Candida species biofilm therapy.IMPORTANCECandida species, the most common fungal pathogens, frequently grow as a biofilm. These adherent communities tolerate extremely high concentrations of antifungal agents, due in large part, to a protective extracellular matrix. The present studies define the structural, functional, and genetic similarities and differences in the biofilm matrix from the four most common Candida species. Each species synthesizes an extracellular mannan-glucan complex (MGCx) which contributes to sequestration of antifungal drug, shielding the fungus from this external assault. Synthesis of a common polysaccharide backbone appears conserved. However, subtle structural differences in the branching side chains likely rely upon unique modification enzymes, which are species specific. Our findings identify MGCx backbone synthesis as a potential pan-Candida biofilm therapeutic target.

Ischemic Optic Neuropathy in a Dog with Acute Bilateral Blindness and Primary Systemic Hypertension

A 6-year-old neutered female Jack Russell terrier was investigated for sudden onset prechiasmatic bilateral blindness, left circling, reduced proprioception in the right pelvic limb and right facial allodynia. Electroretinography was normal. Magnetic resonance imaging (MRI) examination revealed that the right optic nerve and the optic chiasm were hyperintense on diffusion weighted imaging and hypointense on apparent diffusion coefficient map consistent with ischemic optic neuropathy. A concurrent lacunar infarct was detected in the left rostral colliculus. Primary systemic hypertension was diagnosed based on blood pressure measurement and no detectable abnormalities on hematology, comprehensive serum biochemistry, urinalysis including protein/creatinine and cortisol/creatinine ratios and thoracic/abdominal imaging. Prednisolone for 10 days and amlodipine long-term were administered. Vision was not recovered after 7 months. Repeat MRI supported the diagnosis of ischemic lesions and revealed a recent striatocapsular infarct. Ischemic optic neuropathy is a well-recognized cause of blindness in humans and should be included as a differential diagnosis for acute prechiasmatic blindness in dogs.

Is 22q11.2 deletion syndrome a genetic subtype of schizophrenia?

Introduction

22q11.2 deletion syndrome is a primary immunodeficiency due to micro-deletion on the large arm of chromosome 22. Patients suffer from several anomalies, including metal illness, that such the case we present, mean a warning sign for further study.

Methods

Twenty-one years-old male, with psychotic symptoms, typical of schizophrenia, behavioral disorders and mental confusion, plus epileptic episodes and psychomotor agitation. Two previous incomes with the diagnosis of psychotic disorder not otherwise specified. Treated with anti-psychotics at low doses with inter-episode stability.

Background

Prematurity, low birth weight, neonatal asphyxia, generalized seizures, otitis and recurrent urinary tract infections, hypernasal voice, poor academic performance, difficulty relating. Physical examination: hypernasal voice, furred tongue, dysmorphic faces, scoliosis, hipotanía, stereotypes, delusions, auditory hallucinationsd negative symptoms.

Results

We considered the possibility of a neurodevelopmental disorder, with a multidisciplinary approach, resulting in the diagnosis of paranoid schizophrenia and velocardiofacial syndrome, which had gone unnoticed. Mean doses of clozapine, haloperidol and topiramate were used. He accepted psychiatry and other specialties follow-up, since it requires a complex and multidisciplinary approach.

Conclusions

Definition of velocardiofacial Syndrome and lack of consensus on terminology:

– syndrome 22q11.2 DS as genetic subtype of schizophrenia? Opportunity to study the pathogenesis of schizophrenia;

– the importance of a comprehensive approach to early diagnosis, clinical improvement and preventing complications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Health-related quality of life in pediatric intestinal transplantation

To determine HRQOL after pediatric intestinal transplantation. Thirty-four IT survivors from 1999 to 2012 were asked to complete age-specific HRQOL non-disease-specific questionnaires: TAPQOL (0-4 yr), KINDL-R (5-7 yr; 8-12 yr; 13-17 yr), and SF-36v2 (>18 yr), all validated with Spanish population. Primary caregiver completed a SF-36 questionnaire and CBI. Thirty-one participants were included. Median age was 10.2 yr (1-29) and time after transplant 4.4 yr (0-13). Overall patient scores were 78.2 ± 10.6 (n = 8), 83.3 ± 9.7 (n = 6), 72.2 ± 9.21 (n = 6), 80.5 ± 12.4 (n = 7), and 82.2 ± 12.4 (n = 4) for each age group. Highest scores were obtained for vitality (group I), self-esteem (group IV), and physical and social functioning and emotions (group V). Lowest scores were obtained in appetite and behavior (I), family and school (III), and chronic disease perception (III, IV). No significant differences were found between caregivers and their children. CBI showed stress in 52%. SF-36 for caregivers was lower than general population. No significant differences were found depending on relevant clinical and sociodemographic data. HRQOL was acceptable and improved with age and time since transplantation. Parents had a slighter own QOL and worse perception of health than their children. When successful, intestinal transplantation allows a normal life in most patients and can be offered as an attractive option.

Search for gravitational waves associated with γ-ray bursts detected by the interplanetary network

We present the results of a search for gravitational waves associated with 223 γ-ray bursts (GRBs) detected by the InterPlanetary Network (IPN) in 2005-2010 during LIGO's fifth and sixth science runs and Virgo's first, second, and third science runs. The IPN satellites provide accurate times of the bursts and sky localizations that vary significantly from degree scale to hundreds of square degrees. We search for both a well-modeled binary coalescence signal, the favored progenitor model for short GRBs, and for generic, unmodeled gravitational wave bursts. Both searches use the event time and sky localization to improve the gravitational wave search sensitivity as compared to corresponding all-time, all-sky searches. We find no evidence of a gravitational wave signal associated with any of the IPN GRBs in the sample, nor do we find evidence for a population of weak gravitational wave signals associated with the GRBs. For all IPN-detected GRBs, for which a sufficient duration of quality gravitational wave data are available, we place lower bounds on the distance to the source in accordance with an optimistic assumption of gravitational wave emission energy of 10(-2)M⊙c(2) at 150 Hz, and find a median of 13 Mpc. For the 27 short-hard GRBs we place 90% confidence exclusion distances to two source models: a binary neutron star coalescence, with a median distance of 12 Mpc, or the coalescence of a neutron star and black hole, with a median distance of 22 Mpc. Finally, we combine this search with previously published results to provide a population statement for GRB searches in first-generation LIGO and Virgo gravitational wave detectors and a resulting examination of prospects for the advanced gravitational wave detectors.

Search for gravitational waves associated with γ-ray bursts detected by the interplanetary network

We present the results of a search for gravitational waves associated with 223 γ-ray bursts (GRBs) detected by the InterPlanetary Network (IPN) in 2005-2010 during LIGO's fifth and sixth science runs and Virgo's first, second, and third science runs. The IPN satellites provide accurate times of the bursts and sky localizations that vary significantly from degree scale to hundreds of square degrees. We search for both a well-modeled binary coalescence signal, the favored progenitor model for short GRBs, and for generic, unmodeled gravitational wave bursts. Both searches use the event time and sky localization to improve the gravitational wave search sensitivity as compared to corresponding all-time, all-sky searches. We find no evidence of a gravitational wave signal associated with any of the IPN GRBs in the sample, nor do we find evidence for a population of weak gravitational wave signals associated with the GRBs. For all IPN-detected GRBs, for which a sufficient duration of quality gravitational wave data are available, we place lower bounds on the distance to the source in accordance with an optimistic assumption of gravitational wave emission energy of 10(-2)M⊙c(2) at 150 Hz, and find a median of 13 Mpc. For the 27 short-hard GRBs we place 90% confidence exclusion distances to two source models: a binary neutron star coalescence, with a median distance of 12 Mpc, or the coalescence of a neutron star and black hole, with a median distance of 22 Mpc. Finally, we combine this search with previously published results to provide a population statement for GRB searches in first-generation LIGO and Virgo gravitational wave detectors and a resulting examination of prospects for the advanced gravitational wave detectors.

Dilated cardiomyopathy and mitochondrial dysfunction in Sirt1-deficient mice: a role for Sirt1-Mef2 in adult heart

The deacetylase Sirtuin-1 (Sirt1) is involved in the cardiac hypertrophic responses and cardiac embryo morphogenesis. However, the physiological function of Sirt1 deficiency in the postnatal development of the heart remains to be characterized. The aim of the study was to investigate the relevance of Sirt1 in the development and function of the myocardium. Hearts from Sirt1-deficient mice partially or totally lacking Sirt1 protein activity were analyzed. Loss of Sirt1 activity led to dilated cardiomyopathy in adult hearts, a phenotype accompanied by reduced cardiomyocyte size and the absence of fibrosis. Morphological and functional mitochondrial abnormalities were observed in the adult hearts lacking Sirt1, suggesting that mitochondrial dysfunction contributes to the progression of the observed cardiomyopathy. Moreover, gene expression analyses revealed that mitochondrial genes were the most affected in Sirt1-deficient mice, showing a reduction in their expression. No overt cardiac dilatation was observed in neonates lacking Sirt1 activity, but first signs of mitochondrial alterations were already present. Immunoblot analyses revealed that Sirt1 is highly expressed in the heart after birth, indicating the importance of Sirt1 in the neonatal period. Finally, Sirt1 deficiency affected the acetylation pattern of the myocyte enhancer factor 2 (Mef2) transcription factors, which are critical for normal heart development and mitochondrial integrity. Collectively, our findings indicate that Sirt1 is essential for the maintenance of cardiac mitochondrial integrity and normal postnatal myocardium development.

Abdominal radiographic and ultrasonographic findings in ferrets (Mustela putorius furo) with systemic coronavirus infection

Ferret systemic coronavirus infection (FSCV) is a systemic disease in ferrets that clinically and pathologically resembles the dry form of FIP. The present study describes abdominal imaging features of 11 ferrets with FSCV. Abdominal survey radiographs were available for eight ferrets and ultrasound examination for all cases. Loss of lumbar musculature, decreased peritoneal detail, presence of mid-abdominal soft-tissue masses and splenomegaly were the most significant radiographic signs in these patients. Ultrasonographic findings including peritonitis, abdominal lymphadenopathy, splenomegaly, abdominal soft-tissue masses, nephromegaly and changes in the renal cortex echogenicity were recorded in the majority of cases with FSCV. As an imaging modality, ultrasound is superior to radiology when abdominal contrast is reduced, as it frequently occurs in these cases. However, although imaging techniques provide additional information in the antemortem diagnosis, they can not replace the definitive diagnosis based on histological and immunohistochemical results.

Selective immobilization of oligonucleotide-modified gold nanoparticles by electrodeposition on screen-printed electrodes

Here, we describe a proof of concept procedure for the selective immobilization of oligonucleotides functionalized gold nanoparticle probes (affinity modules) on arrayed screen-printed gold electrodes. Current microarrays are using many different ways to address their DNA probes onto the transducer area. For that reason, we have mixed the electrodeposition of metals, which is a very well known process, in addition with the DNA-gold nanoparticles formation, which is an area of great interest in biosensing applications in the field of genomics, clinical and warfare applications. Combining these fields, we have developed a novel method for the immobilization of gold nanoparticles conjugated with oligonucleotides (affinity modules) onto screenprinting gold electrodes through electrodeposition at a current positive potential of 800mV vs. Ag/AgCl. The modules were selectively immobilized onto the electrode surface being, afterwards, ready for a successful hybridization. The gold colloids take the advantage of being a carrier that allows the immobilization of any kind of bioreceptor in the same conditions and the capability of quality control analysis before the electrodeposition procedure. With this system, we avoided non-specific interactions between the transduction layer and the bioreceptor and in the case of DNA oligonucleotides allowed us the immobilization of multiple sequences in a multimodular device for a further industrial process of cheaper biochip fabrication.

[Simulation of endoscopic procedures--an innovation to improve laparoscopic technical skills]

BACKGROUND

Laparoscopic surgery is a technically more demanding procedure compared to open surgery. Safe realistic training and unbiased quantitative assessment of technical skills are required for laparoscopic surgery. Virtual reality (VR) simulators may be useful tools for training and assessing basic and advanced surgical skills and procedures.

AIM

to assess the acquisition of laparoscopic skills using virtual reality simulators.

METHODS

systematic review of the literature.

RESULTS

(1) The simulator can be used to objectively assess the laparoscopic skills of surgeons and distinguish between novices and experienced laparoscopic surgeons. (Evidence level III-B) (2) The target group as well as the benefit of a three-day practical course for laparoscopic surgery can be determined by the simulator. (Evidence level III-C) (3) Novices in laparoscopic surgery seem to benefit mostly from simulation training. (Evidence level III-B) (4) Steepness and plateau of a learning curve may be more dependent on the level of performance required by the particular training session rather than the number of repetitions during a training session. (Evidence level III-B) (5) Clinical background and understanding of the clinical value of a training program lead to faster acquisition and improvement of laparoscopic skills as performed on the laparoscopy simulator. (Evidence level III-B) (6) Non technical skills such as visual-spatial perception and stress coping positively correlates with virtual laparoscopic skills. (Evidence level III-B).

CONCLUSION

To date, the best method for teaching laparoscopic surgery has not been defined. However, the use of virtual simulators for laparoscopy training is useful when learning basic techniques allow the surgeon to improve hand dexterity and coordination in laparoscopic surgery.

Long-term results of surgical treatment in Graves' disease orbitopathy. Is there a correlation between the extent of thyroidectomy and the course of orbithopathy?

The place of thyroidectomy in the management of the Graves' disease patients with endocrine orbitopathy (EO) is still controversial. The aim of this study was to evaluate the course of EO according to the extent of thyroid resection.

METHODS

A retrospective cross-sectional study was performed on a series of 171 cases of Graves'disease, operated in the period 1987-2002 in the Department of Surgery of the Philipps University, Marburg. The severity of EO at the time of operation was assessed according to NOSPECS classification and a structured telephone interview was conducted in order to appraise the long term results.

RESULTS

Complete data acquisition was possible in 153 patients (89%). There were 123 women with a median age of 36 years (range 10-75) and 30 men with a median age of 33 years (range 22-65). Concerning the severity of EO, 70 patients (45.8%) had no ocular symptoms (group I). The 83 patients with clinical eye disease were divided in group II--63 patients (76%) with moderate syndrome and group III--20 patients (24%) with marked symptoms of EO. 12 patients received total thyroidectomy, 96 had Dunhill-resection and in 45 patients subtotal resection was performed. A median follow-up period of 96 months (range 12-216 months) was recorded. Post-operatively, of the 83 patients with EO, 53 patients (63.8%) declared an improvement of EO, in 29 patients (34.9%) the disease was stable and only one patient declared the worsening of EO. The extent of thyroid resection did not correlate with the postoperative course of orbitopathy.

CONCLUSION

Thyroid surgery for GD improves the course of EO, independent of the extent of resection.

Negative Endoskopie sowie Mehrzeilendetektor-CT bei Patienten mit akuter unterer Gastrointestinalblutung

PURPOSE

To evaluate the clinical use of (99m)Tc red blood cell imaging (RBC imaging) in patients presenting with acute lower gastrointestinal (GI) bleeding and negative endoscopy and multislice computed tomography (MSCT) findings.

PATIENTS AND METHODS

In 31 consecutive patients with acute lower GI bleeding in whom the endoscopy findings were negative or the procedure was not feasible, dual-phase MSCT of the abdomen was performed [collimation 4x1 mm (arterial phase), 4x2.5 mm (venous phase)]. MSCT was followed by a (99m)Tc red blood cell scan in patients in whom no active bleeding was visible by CT. Images were created within 24 h after administration of the tracer, depending on the clinical symptoms. The results of the imaging modalities were correlated with clinical course and surgical treatment.

RESULTS

In 20 of 31 patients MSCT showed no active bleeding and a (99m)Tc red blood cell scan was performed. In 8 of 20 patients RBC imaging was also negative. Of these eight patients five were stable and did not require further diagnostic work-up; in the other three bleeding persisted and these patients required surgical treatment. In 12 of 20 patients active bleeding was demonstrated using a (99m)Tc red blood cell scan. Of 12 patients with positive RBC scintigraphy findings, 8 underwent surgery, where the site of bleeding was confirmed.

CONCLUSION

In patients with acute lower GI bleeding with negative or nondiagnostic endoscopy or MSCT findings, (99m)Tc red blood cell imaging is a useful tool in an emergency algorithm, improving the overall bleeding detection rate.

[Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage]

PURPOSE

There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy.

MATERIALS AND METHODS

58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment.

RESULTS

20 of the 58 patients (34 %) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100 % correlation regarding the bleeding site. In 38 of the 58 patients (66 %), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53 %) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention.

CONCLUSION

Compared to other diagnostic methods MSCT is a fast, widely-available and low-risk technique for the localization of active GI hemorrhage. The clinical use seems to be justified since in more than one third of the patients, MSCT demonstrates the site of bleeding and provides decisive information for further interventional therapy. Concerning those patients, in whom MSCT is negative (38 out of 58 patients), only every second patient requires any additional diagnostic work-up.

Portal vein erosion and acute abdominal hemorrhage as a complication of acute pancreatitis

The case of a 35-year-old male with portal vein erosion and acute life-threatening abdominal hemorrhage as a complication of acute pancreatitis is reported. Erosion of arterial walls is the most common complication of pancreatitis and pancreatic pseudocysts, and erosion of the portal vein leading to a fistula between the pancreas and the portal vein is very rare. Diagnosis was made by multislice spiral computed tomography, and nonsurgical treatment was elected, leading to complete recoverage.

Subdural Blood Patch for the Treatment of Persistent CSF Leak After Permanent Intrathecal Catheter Implantation: A Report of Two Cases

A CSF leak that persists despite conservative therapy may significantly increase the morbidity associated with implantable intrathecal drug delivery systems. This report presents 2 cases where the application of a subdural blood patch led to the satisfactory resolution of a persistent CSF leak after previous epidural blood patches had failed.

Specific immunoglobulins in serum of newborn lambs fed with a single dose of colostrum containing anti-peroxidase IgG

The apparent efficiency of absorption and the decrease of specific colostral IgG after its passage into the blood stream were determined in newborn lambs fed with a single dose of colostrum containing anti-peroxidase IgG at 30 minutes, 12 hours and 24 hours after birth. When colostrum was given at 30 minutes after birth, a value of 16.9+/-4.0 per cent of anti-peroxidase IgG ingested appeared in lamb circulation. This percentage was reduced to 9.8+/-0.8 per cent when the feeding was done at 12 hours after birth and no specific IgG was detected in lambs fed at 24 hours after birth. The concentration of anti-peroxidase IgG in lambs' serum declined quickly within 96 hours of age to about 48 per cent of the initial value, and afterwards the level decreased slowly reaching a value of 10 per cent at 32 days of age. This behaviour probably reflects the protein distribution and use of absorbed antiperoxidase IgG.

Distressing upper extremity phantom limb sensation during intravenous regional anesthesia

BACKGROUND AND OBJECTIVES

The objective of this article is to describe a case of distressing upper extremity phantom limb sensation during intravenous regional anesthesia (IVRA).

CASE REPORT

A 33-year-old American Society of Anesthesiologists (ASA) status I female with an uncomplicated intrauterine gestation presented for endoscopic carpal tunnel release. Following gravity-assisted exsanguination of the vertically positioned left upper extremity, she underwent an IVRA. Within minutes of her arm being repositioned for surgery she remarked that the arm felt as if it was still in the vertical position. This sensory disturbance was described as fatiguing and exhausting. Despite reassurance and medication with intravenous narcotics, her symptoms became intolerable. Her phantom sensation disappeared upon dissipation of the IVRA.

CONCLUSIONS

There are no previous reports regarding the development of phantom phenomena during an IVRA. The occurrence of distressing phantom sensations during an otherwise adequate IVRA may be interpreted as block failure and may lead to conversion to general anesthesia. Practitioners are encouraged to consider these phenomena when performing IVRA.

Meteorological phenomena affecting the presence of solid particles suspended in the air during winter

Winter is not traditionally considered to be a risky season for people who suffer from pollen allergies. However, increasing numbers of people are showing symptoms in winter. This prompted our investigation into the levels of solid material in the air, and some of the meteorological phenomena that allow their accumulation. This study showed a possible relationship between the phenomenon of thermal inversion, which occurs when very low temperatures, cloudless skies and atmospheric calms coincide, and an increase in the concentration of solid material in the atmosphere. Frequently, this situation is associated with other predictable phenomena such as fog, dew and frost. This may allow a warning system to be derived for urban pollution episodes. The effect caused by parameters such as wind and rainfall was also analysed. Solid material was differentiated into non-biological material from natural and non-natural sources (e.g. soot, dust, sand, diesel exhaust particles, partially burnt residues) and biological material. The latter mainly comprises pollen grains and fungal spores. Owing to its abundance and importance as a causal agent of winter allergies, Cupressaceae pollen was considered separately.

Perioperative management of glucose 6 phosphate dehydrogenase deficiency. A review of the literature

Glucose 6 phosphate dehydrogenase (G6PDH) deficiency is the most frequent cause of hemolytic anemias due to enzyme abnormality. Perioperative management must be careful to avoid the onset of hemolytic crisis. We present a complete review of the literature on this illness and describe the perioperative management of an adult with known G6PD deficiency and the pathogenesis and clinical manifestations of the disorder and its possible anesthetic implications are discussed. A 49-year-old patient had undergone varum osteotomy in her left knee due to genu valgum. She had been diagnosed as having G6PDH deficiency sixteen years earlier provoked by ingesting beans. The perioperative circumstances capable of causing autohemolysis are described and discussed. In spite of the fact that the pattern is self-limited, it provokes the onset of jaundice and anemia which can complicate the recovery. Simple elimination of those elements which precipitate with oxyhemoglobin will allow an uneventful anesthetic procedure.

Foetal lymphocytes are more sensitive to freezing than adult lymphocytes within a mononuclear cell environment

Previous studies have reported reduced natural killer (NK) cell activity in cord blood (CB) compared to adult blood mononuclear cell populations. We suggest that foetal NK cells have the capacity to kill, but this is suppressed in vitro. This hypothesis is strengthened by our observation that CB mononuclear cell populations had their NK activity restored by freeze/thawing, whereas adult PBMC had a reduced killing ability on freeze/thawing. Thus, either NK cells are activated to kill by the freeze/thawing or there is an NK cell suppressor factor in CB which is lost through freeze/thawing. This report shows clear differences between NK cells within the adult periphery and CB, and may help toward a better understanding of events occurring in vitro.

Fetal natural killer cell function is suppressed

Previous studies have reported reduced natural killer (NK) cell activity in cord blood (CB) compared with adult blood mononuclear cell populations. Using a non-radioactive killing assay, we have verified these findings suggesting that either the fetal NK cell function is suppressed or that these cells are functionally immature. We have shown that CB NK cells are functional, since activating them with cytokines known to activate adult NK cells [interleukin-2 (IL-2), IL-12 and IL-15] increased activation. However, resting the cells, which enhanced adult NK cell activity (P < 0.01), had no effect on fetal NK cells (P = 0.2). These results suggested that fetal NK cells have the capacity to kill, but this is suppressed in vitro. This hypothesis was strengthened by our observation that eight of nine CB mononuclear cell populations had their NK activity restored by freeze-thawing, whereas four of five adult peripheral blood mononuclear cells had a reduced killing ability on freeze-thawing. Freeze-thawing removes a population of cells that suppresses CB NK cell function. To determine which was the case we performed extensive phenotypic analysis of the CB populations pre- and post-freezing and found that the percentage of the CD3- CD56+ population within CB increased significantly (P < 0.0005 by paired t-test) with freezing, whereas freeze-thawing had no effect on this population within a normal adult peripheral blood mononuclear cell population. Our data suggest that within CB there is a population of cells, as yet undefined, which may be inhibiting NK cell function. This report therefore shows clear differences between NK cells within the adult periphery and in CB, and may lead to a better understanding of events occurring in vivo.

Influence of the HLA class II polymorphism in chronic Chagas' disease

Chagas' disease or American trypanosomiasis due to Trypanosoma cruzi has existed at least since the time of the Inca empire and contributes significantly to cardiovascular morbidity and mortality in several countries of this continent. Due to the fundamental role of human class II molecules polymorphic residues in the control of the immune response, a study was designed to define by DNA typing HLA class II alleles in a sample of 67 serologically positive individuals with and without cardiomyopathy and in 156 healthy controls of similar ethnic origin. Genomic DNA extraction, PCR amplification of the HLA-DRB1 and DQB1 second exon regions and hybridization to labelled specific probes were carried out following the 11th International Histocompatibility Workshop reference protocol. Comparison of DRB1 and DQB1 allele frequencies among the patients and control subjects showed a decreased frequency of DRB1*14 and DQB1*0303 in the patients, suggesting independent protective effects to the chronic infection in this population. Allele frequencies comparison between patients with and without cardiomyopathy showed a higher frequency of DRB1*01, DRB1*08 and DQB1*0501 and a decreased frequency of DRB1*1501 in the patients with arrhythmia and congestive heart failure. The results suggest that HLA Class II genes may be associated with the development of a chronic infection and with heart damage in Chagas' disease.

Effect of heat treatment on the antigen-binding activity of anti-peroxidase immunoglobulins in bovine colostrum

After intramammary immunization with horseradish peroxidase, bovine colostrum containing anti-peroxidase immunoglobulins (Ig) was obtained. Thermoresistance of the antigen-binding region of these Ig was studied using a direct competitive ELISA. This technique is based on the competition between the anti-peroxidase IgG coated to the plate and the anti-peroxidase IgG contained in the colostrum to bind peroxidase, the antigen, and the enzyme responsible for development of the color of the assay. Thus, the degree of denaturation of the antigen-binding region in the IgG molecule can be determined because this region is directly involved in the assay. The kinetic and thermodynamic parameters for heat induced denaturation of IgG in colostrum were determined over a temperature range of 69 to 81 degrees C. The denaturation of IgG was best described assuming an apparent reaction order of 1.5. D values, the time required to reduce the antigen-binding activity of IgG by 90%, were 8504, 1387, 285, and 152 s at 69, 72, 77, and 81 degrees C, respectively. Similarly, Z value, the degrees necessary to reduce the D value in one logarithmic cycle, was estimated to be 6.6 degrees C, and the activation energy value was 386.83 kJ/mol. These results should be taken into account in the design of heat treatments of milk in order to preserve the biological function of Ig.

Invasive aspergillosis in liver transplant recipients in the 1990s

Invasive aspergillosis occurred in 26 liver transplant recipients since 1990 at five liver transplant centers. The median time to onset was 17 days after transplantation. Twenty-seven percent of the patients had undergone retransplantation. Invasive aspergillosis occurred significantly earlier after transplantation in smokers than in nonsmokers (P=0.017). Patients with late-onset aspergillosis (occurring after posttransplant day 90) were more likely to have had prior cytomegalovirus infection than those with early-onset aspergillosis (occurring within 90 days of transplantation) (67% vs. 10%, respectively, P=0.013). Only 8% of the patients had received additional corticosteroids or OKT3, which suggests that augmented immunosuppression may not be a relevant risk factor for invasive aspergillosis in the 1990s due to less frequent use of these agents. The median serum bilirubin level of the patients was 21.8 mg/dl, 85% of the patients had renal insufficiency, and 54% were on dialysis before the onset of invasive aspergillosis, which suggest that overall severity of illness, including poorly functioning hepatic allograft and renal failure may be the major determinants of disease occurrence. Overall mortality was 92% (24/26). No difference in mortality could be shown for the patients who received amphotericin B versus liposomal amphotericin B preparations (100% vs. 89%); however, the mean time to death after the initiation of therapy was 20 days in patients who received amphotericin B and 43 days in those who received liposomal amphotericin B preparations.