Apocrine Hidrocystoma of the Nail: A Unique Case

ABSTRACT

Apocrine hidrocystomas are benign, cystic neoplastic lesions resulting from the apocrine secretory component of the sweat gland. They most commonly occur on the head and neck, with predilection to the periorbital area. Less frequent sites include the axilla, nipple, external auditory canal, foreskin, conjunctiva, lower lip, and fingers, among others. The authors report a unique case of a nail bed hidrocystoma in a 55-year-old woman, a site not previously described.

Myoglobin Cast Nephropathy Diagnosed on Renal Biopsy in a Patient Treated for Malarial Infection

Myoglobin cast nephropathy occurs in cases of acute renal injury in which large amounts of myoglobin accumulate in the renal tubules, presenting as muscle pain, reddish-brown urine, and elevated creatine kinase levels. Our case describes a 60-year-old male who came to the emergency department with fevers, mild abdominal pain, and constitutional symptoms one day after returning to the United States from a trip to Nigeria. Initial workup demonstrated an acute kidney injury and elevated aminotransferase levels and the patient was started onatovaquone-proguanil for possible malaria given a recent diagnosis in Nigeria. Two days later, the patient was found to have rhabdomyolysis, resulting in a renal biopsy that showed myoglobin cast nephropathy. Previous literature has suggested mechanisms for the development of rhabdomyolysis in malarial infection, including inflammatory processes, direct effect of parasite accumulation, and drug-induced toxicity. Our case further implicates antimalarial therapy as a cause of rhabdomyolysis and increases awareness of myoglobin cast nephropathy as a potential complication of malaria.

Evaluation of personal dose equivalents during positron emission tomography and computed tomography imaging

This study aimed to evaluate the annual occupational radiation exposure of technologists during PET/CT imaging in 2020 and 2021. Eleven nuclear medicine technologists were monitored at the PET/CT department. The personal dose equivalents (PDEs) for staff members, measured in terms of Hp (10) and Hp (0.07), were assessed annually, considering both deep and surface doses. PDEs were quantified using a thermoluminescent detector (LiF:Mg:Ti)). The average and range of PDEs and extremity doses (mSv) for the technologists were as follows: 4.5 (0.1-13.4) for Hp (10), 4.63 (0.1-13.9) for Hp (0.07), and 2.5 (0.2-17.5) for extremity, respectively. The results indicated that staff members are exposed to high-energy gamma rays while preparing radiopharmaceuticals, injections, and image acquisition. Therefore, proper handling of radiopharmaceuticals and patient management during the acquisition of parameters are crucial for maintaining the occupational dose within the defined limit.

Assessment of patient and occupational exposure and radiation risk from cath-lab procedure

Due to the extended localized fluoroscopy, many radiographic exposures, and multiple procedures that might result in tissue reaction, patients and personnel received a significant radiation dose during interventional cardiology (IR) procedures. This study aims to calculate the radiation risk and assess patient and staff effective doses during IC procedures. Thirty-two patients underwent a Cath lab treatment in total. Ten Cath lab personnel, including six nurses, two cardiologists, and two X-ray technologists. Optical stimulating-luminescent dosimeters (OSL) (Al2O3:C) calibrated for this purpose were used to monitor both occupational and ambient doses. Using an automated OSL reader, these badges were scanned. The Air Kerma (mGy) and Kerma Area Products (KAP, mGy.cm2) have a mean and standard deviation (SD) of 371 ± 132 and 26052, respectively. The average personal dose equivalent (mSv) and its range for cardiologists, nurses and X ray technologists were 1.11 ± 0.21 (0.96-1.26), 0.84 ± 0.11 (0.68-1.16), and 0.68 ± 0.014 (0.12-0.13), respectively. The current study findings showed that the annual effective dose for cardiologists, nurses, and X-ray technologists was lesser than the yearly occupational dose limit of 20 mSv recommended by national and international guidelines. The patients' doses are comparable with some previously published studies and below the tissue reaction limits.

T cell infiltration into the brain triggers pulmonary dysfunction in murine Cryptococcus-associated IRIS

Cryptococcus-associated immune reconstitution inflammatory syndrome (C-IRIS) is a condition frequently occurring in immunocompromised patients receiving antiretroviral therapy. C-IRIS patients exhibit many critical symptoms, including pulmonary distress, potentially complicating the progression and recovery from this condition. Here, utilizing our previously established mouse model of unmasking C-IRIS (CnH99 preinfection and adoptive transfer of CD4⁺ T cells), we demonstrated that pulmonary dysfunction associated with the C-IRIS condition in mice could be attributed to the infiltration of CD4⁺ T cells into the brain via the CCL8-CCR5 axis, which triggers the nucleus tractus solitarius (NTS) neuronal damage and neuronal disconnection via upregulated ephrin B3 and semaphorin 6B in CD4⁺ T cells. Our findings provide unique insight into the mechanism behind pulmonary dysfunction in C-IRIS and nominate potential therapeutic targets for treatment.

Paediatric effective radiation doses during brain computed tomography angiography procedure

In comparison to adults and paediatric are more sensitive to ionizing radiation exposure. Computed tomography (CT) is now the dominant source of medical radiologic tests for patients, accounting for more than 70% of total doses to the general public. Paediatric CT brain scans (with and without contrast) are routinely performed for a variety of clinical reasons. As a result, this parameter must be calculated in order to determine relative radiation risk. The goal of this study is to assess the radiation risk to children during CT brain diagnostic procedures. Three hundred fifty three child patients' radiation risk doses were assessed over the course of a year. The mean and ranged of the children's radiation doses were 40.6 ± 8.8 (27.8-45.8) CTDIvol (mGy) and 850 ± 230 (568.1-1126.4) DLP (mGy.cm) for the brain with contrast medium. For CT brain without contrast, the patients' doses were 40.9 ± 9.4 (14.27-64.07) CTDIvol (mGy), and 866.1 ± 289.3 (203.6-2484.9) DLP (mGy.cm). The characteristics related to the radiation dose were retrieved from the scan protocol generated by the CT system by the participating physicians after each procedure. Furthermore, optimizing the CT acquisition parameter is critical for increasing the benefit while lowering the procedure's radiogenic risk. The patients' radiation dose is comparable with the most previously published studies and international diagnostic reference levels (DRLs). Radiation dose optimization is recommended due to high sensitivity of the paediatric patients to ionizing radiation.

Recent Trends and Advancements in the Diagnosis and Management of Gastric Cancer

Gastric cancer is an enigmatic malignancy that has recently been shown to be increasing in incidence globally. There has been recent progress in emerging technologies for the diagnosis and treatment of the disease. Improvements in non-invasive diagnostic techniques with serological tests and biomarkers have led to decreased use of invasive procedures such as endoscopy. A multidisciplinary approach is used to treat gastric cancer, with recent significant advancements in systemic therapies used in combination with cytotoxic chemotherapies. New therapeutic targets have been identified and clinical trials are taking place to assess their efficacy and safety. In this review, we provide an overview of the current and emerging treatment strategies and diagnostic techniques for gastric cancer.

Updated clinical practice treat-to-target guidelines for JIA management: the Egyptian College of Pediatric Rheumatology initiative

Background

These updated guidelines aimed to provide appropriate and convenient guidelines for the treatment of various types of juvenile idiopathic arthritis (JIA).

Using the Delphi technique, this study was conducted to reach expert consensus on a treat-to-target management strategy for JIA. According to the PICO (patient/population, intervention, comparison, and outcomes) approach, the preliminary scientific committee identified a total of 17 key clinical questions. To assemble evidence on the advantages and dangers associated with JIA treatments, an evidence-based, systematic literature review was conducted. Researchers and clinicians with experience in JIA management were identified by the core leadership team. To establish a consensus on the management suggestions for JIA patients, a Delphi approach (2 rounds) was used.

Results

An online survey was applied to the expert panel (n = 27), and 26 of them completed both rounds. At the conclusion of round 2, a total of eighteen (18) recommendation items were gathered, which were divided into four sections to address the four key JIA categories. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 83.2 to 100% (average 86.8%). The phrasing of all 18 clinical standards identified by the scientific committee was agreed upon (i.e. 75% of respondents strongly agreed or agreed). Algorithms have been proposed for the management of JIA polyarthritis, oligoarthritis, and systemic JIA.

Conclusion

A wide and representative panel of experts initiated a consensus about the management of JIA. The created guidelines give a complete approach to the management of JIA for all healthcare professionals involved in its management, as well as a means of monitoring and evaluating these guidelines on a regular basis.

P063 Consensus-based recommendations for treat to target management of immunoglobulin A vasculitis

Background

IgAvasculitis (IgAV) is the commonest cause of vasculitis in childhood.

It is characterized by small vessel vasculitis of the skin, gastrointestinal tract, kidneys, joints, and, rarely, the lungs and the central nervous system. There is paucity of international guidelines for management of IgA V. the Objective is to develop guidelines specific for Egyptian children with IgA vasculitis.

Method

This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for IgA vasculitis using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. Delphi process was implemented (2-rounds) to reach a consensus.

Results

An online questionnaire were sent to expert panel (n = 26) who participated in the two rounds. At the end of round 2, a total of 20 recommendation items, categorized into 2 sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the management have been suggested.

Conclusion

This was an expert, consensus recommendations for the diagnosis and treatment of IgA V and IgA V nephritis, based on best available evidence and expert opinion.

P016 Updated Clinical Practice Guidelines for JIA management adopting Treat to Target approach: the Egyptian College of Paediatric Rheumatology initiative

Background

There is an unmet need from paediatric rheumatologists and rheumatologists, managing children with JIA, for a well formulated guidelines aiming at achieving better outcomes of their patients. To establish adequate and easily adopted guidelines in management of different variants of JIA in a relatively low resources country.

Method

This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for Juvenile Idiopathic Arthritis using Delphi technique. The preliminary scientific committee identified a total of 17 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the benefits and harms associated with JIA treatments. The core leadership team identified researchers and clinicians with expertise in JIA management in Egypt upon which Experts were gathered from different governorates and health centres across Egypt. Delphi process was implemented (2-rounds) to reacha consensus on the management recommendations of Egyptian JIA patients. Results: An online questionnaire were sent to expert panel (n = 27), of whom 26 participated in the two rounds. At the end of round 2, a total of eighteen (18) recommendation items, categorized into 4 sections to address the main 4 JIA categories, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.2–100% (average 86.8%). Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 18 clinical standards identified by the scientific committee. Algorithms for the management of JIA polyarthritis, oligoarthritis and systemic JIA have been suggested.

Conclusion

A wide and representative panel of experts established a consensus regarding the management of JIA in Egypt. The developed guidelines provide a comprehensive approach to the management of JIA for ll Egyptian healthcare professionals who are involved in its management for follow up and frequent evaluation of these guidelines.

P050 Consensus based practice guidelines for the management and treatment of Juvenile familial Mediterranean fever: the Egyptian College of Paediatric Rheumatology initiative

Background

Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease, with the highest prevalence amongst Mediterranean countries including Egypt (where there is high carrier rate of MEFV gene), characterized by recurrent attacks of fever and polyserositis. Mutations in the MEFV gene encoding pyrin has been associated with the disease, which causes exaggeration of the inflammatory response through uncontrolled interleukin production. Issuing updated treatment recommendations are vital for the treating healthcare professionals to get well acquainted with its diagnosis & treatment. To produce consensus-based recommendations to guide the early diagnosis, management and follow-up of patients with FMF.

Methods

The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by the core team.

A qualitative synthesis of scientific evidence based on systematic review and clinical experience was conducted to compile evidence for the diagnosis and management of FMF.

A consensus process was conducted among the expert panel to generate the final recommendations and grade their strength.

3 rounds of Delphi process were carried out.

Results

Following 3 Delphi rounds, recommendations were developed for: early diagnosis, who to treat, treatment targets, genetic testing and its interpretation in association with clinical presentation, treatment of FMF and dealing with acute attacks, monitoring of management, identify treatment response, systemic affection, persistent attacks or inflammation, resistant cases, protracted symptoms, as well as remission status.

Algorithm for patients’ diagnosis and management is provided.

The final document comprises 12 recommendations, each presented with its degree of agreement (0–10), Level of agreement, grade of recommendation and rationale. The degree of agreement was >7/10 in all instances.

Conclusion

This guideline provides comprehensive approach to the accurate diagnosis and effective management/monitoring of FMF. It also represents a model for the incorporation of medical genetics practice into the more traditional domains of general medicine.

Estimation of patient effective doses in PET/CT- 18F-Sodium Fluoride examinations

The positron emitters (¹⁸F-Sodium Fluoride (NaF)) and X-rays used in Positron emission tomography (PET) combined with computed tomography (PET/CT) imaging have a high radiation dose, which results in a high patient dose. The present research intends to determine the radiation dose and risks associated with PET/CT- 18F-Sodium fluoride examinations in patients. The 18F-NaF PET/CT was used to investigate the doses of 86 patients. Patient exposure parameters and ImPACT software were used to calculate mean effective doses. The administered activity of 185 MBq (5.0 mCi) per procedure has a mean and range based on the patient's BMI (BMI). The range of patient effective doses per procedure was found to be 4-10 mSv, with a radiation risk of 1 × 10^-5 per procedure. Patient doses are determined by the patient's size, scanner type, imaging protocol, and reconstruction method. For further dose reduction, proper justification and radiation dose optimization is required.

ASSESSMENT OF PATIENT'S RADIATION EXPOSURES RESULTED FROM PET/CT 18F-FCH AND 68GA-PSMA PROCEDURES

This study has sought to evaluate patient exposures during the course of particular diagnostic positron emission tomography and computed tomography (PET/CT) techniques. A total of 73 patients were examined using two types of radiopharmaceutical: 18F-fluorocholine (FCH, 48 patients) and 68Ga-prostate-specific membrane antigen (PSMA, 25 patients). The mean and range of administered activity (AA) in MBq, and effective dose (mSv) for FCH were 314.4 ± 61.6 (462.5-216.8) and 5.9 ± 1.2 (8.8-4.11), respectively. Quoted in the same set of units, the mean and range of AA and effective dose for 68Ga-PSMA were 179.3 ± 92.3 (603.1-115.1) and 17.9 ± 9.2 (60.3-11.5). Patient effective doses from 18F-FCH being a factor of two greater than the dose resulting from 68Ga-PSMA PET/CT procedures. CT accounts for some 84 and 23% for 18F-FCH and 68Ga-PSMA procedures, accordingly CT acquisition parameter optimization is recommended. Patient doses have been found to be slightly greater than previous studies.

Impact of Computerized Prescription on Medication Errors and Workflow Efficiency in Neonatal Intensive Care Units: A Quasi-Experimental Three-Phase Study

BACKGROUND

Neonates are highly vulnerable to preventable medication errors due to their extensive exposure to medications in the neonatal intensive care units (NICUs). These errors, which can be made by medical, nursing, or pharmacy personnel, are costly and can be life-threatening. This study aimed to investigate the newly developed computerized neonatal pharmaceutical health care system (NPHCS) in terms of its ability to (1) minimize neonatal medication prescription errors (NMPEs) and (2) improve workflow efficiency compared with the traditional manual prescribing approach.

METHODS

A computerized neonatal medication prescription system was designed, developed, and tested successfully through a pilot clinical trial for over 6 months in 100 neonates. A three phase quasi-experimental study was then conducted using standardized monitoring checklists for the assessment of NMPEs before and after utilization of the developed prescribing system.

RESULTS

The obtained result showed a high rate of NMPEs in both systems, especially for the antibiotic drug group. However, the use of newly developed NPHCS significantly improved workflow efficacy. The identified errors were significantly more common in the manual mode than in the computerized mode (158.8 vs. 55 per 100 medications). These errors were distributed among different categories, including the documentation of patient identity, birth weight, and gestational age, as well as statements of dose, unit, interval, and diagnosis. Analysis of variance across different categories showed a p-value of <0.05.

CONCLUSION

The use of the computerized NPHCS improved patient safety in NICUs by decreasing NMPEs. It also significantly reduced the time required for dose calculation, prescription generation, and electronic documentation of medical records, compared with the traditional handwritten approach.

2D QSAR studies on a series of (4S,5R)-5-[3,5-bis(trifluoromethyl)phenyl]-4-methyl-1,3-oxazolidin-2-one as CETP inhibitors

Cardiovascular disease (CVD) is one of the major causes of human death. Preliminary evidence indicates that the inhibition treatment of Cholesteryl Ester Transfer Protein (CETP) causes the most pronounced increase in HDL cholesterol reported so far. Merck has disclosed certain (4S,5R)-5-[3,5-bis(trifluoromethyl)phenyl]-4-methyl-1,3-oxazolidin-2-one derivatives, which show potent CETP inhibitory activity. Therefore, it would be desirable to develop computational models to facilitate the screening of these inhibitors. In the present work, quantitative structure-activity relationship (QSAR) models have been developed to predict the therapeutic potency of 108 derivatives of (4S,5R)-5-[3,5-bis(trifluoromethyl)phenyl]-4-methyl-1,3-oxazolidin-2-one: Multiple Linear Regression (MLR), Support Vector Regression (SVR) and Feedforward Neural Network using Particle Swarm Optimization (FNN-PSO). Six descriptors were selected using genetic algorithms, whereas, internal and external validation of the models was performed according to all available validation strategies. It was shown that CETP inhibitory activity is mainly governed by electronegativity, the structure of the molecule, and the electronic properties. The best results were obtained with the SVR model. The results obtained may assist in the design of new CETP inhibitors.

Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis

Chondrodermatits nodularis chronica helicis (CNCH), first described by Max Winkler in 1915, presents as a sore nodule on the helix or antihelix of the external ear. In this paper, we review the etiopathogenesis and management options of CNCH. This condition has a multifactorial etiology; however, sustained pressure from sleeping on one side is the favored theory. Currently, there are many surgical and non-surgical methods of treating CNCH. Most practitioners recommend conservative measures first in their patients, such as pressure-relieving prostheses, prior to surgical treatment. Surgery is the gold standard of therapy with cartilage and wedge excisions yielding recurrence rates of about 10%. Carbon dioxide laser and photodynamic therapy are newer treatment modalities for CNCH, yet they have recurrence rates similar to conservative therapy. In conclusion, due to the high rates of CNCH recurrence, wedge resection is the suggested treatment for CNCH after conservative measures fail.

Muscle-specific differences in expression and phosphorylation of the Janus kinase 2/Signal Transducer and Activator of Transcription 3 following long-term mechanical ventilation and immobilization in rats

AIM

Muscle wasting is one of the factors most strongly predicting mortality and morbidity in critically ill intensive care unit (ICU). This muscle wasting affects both limb and respiratory muscles, but the understanding of underlying mechanisms and muscle-specific differences remains incomplete. This study aimed at investigating the temporal expression and phosphorylation of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway in muscle wasting associated with the ICU condition to characterize the JAK/STAT proteins and the related changes leading or responding to their activation during exposure to the ICU condition.

METHODS

A novel experimental ICU model allowing long-term exposure to the ICU condition, immobilization and mechanical ventilation, was used in this study. Rats were pharmacologically paralysed by post-synaptic neuromuscular blockade and mechanically ventilated for durations varying between 6 hours and 14 days to study muscle-specific differences in the temporal activation of the JAK/STAT pathway in plantaris, intercostal and diaphragm muscles.

RESULTS

The JAK2/STAT3 pathway was significantly activated irrespective of muscle, but muscle-specific differences were observed in the temporal activation pattern between plantaris, intercostal and diaphragm muscles.

CONCLUSION

The JAK2/STAT3 pathway was differentially activated in plantaris, intercostal and diaphragm muscles in response to the ICU condition. Thus, JAK2/STAT3 inhibitors may provide an attractive pharmacological intervention strategy in immobilized ICU patients, but further experimental studies are required in the study of muscle-specific effects on muscle mass and function in response to both short- and long-term exposure to the ICU condition prior to the translation into clinical research and practice.

Time course analysis of mechanical ventilation-induced diaphragm contractile muscle dysfunction in the rat

Controlled mechanical ventilation (CMV) plays a key role in triggering the impaired diaphragm muscle function and the concomitant delayed weaning from the respirator in critically ill intensive care unit (ICU) patients. To date, experimental and clinical studies have primarily focused on early effects on the diaphragm by CMV, or at specific time points. To improve our understanding of the mechanisms underlying the impaired diaphragm muscle function in response to mechanical ventilation, we have performed time-resolved analyses between 6 h and 14 days using an experimental rat ICU model allowing detailed studies of the diaphragm in response to long-term CMV. A rapid and early decline in maximum muscle fibre force and preceding muscle fibre atrophy was observed in the diaphragm in response to CMV, resulting in an 85% reduction in residual diaphragm fibre function after 9-14 days of CMV. A modest loss of contractile proteins was observed and linked to an early activation of the ubiquitin proteasome pathway, myosin:actin ratios were not affected and the transcriptional regulation of myosin isoforms did not show any dramatic changes during the observation period. Furthermore, small angle X-ray diffraction analyses demonstrate that myosin can bind to actin in an ATP-dependent manner even after 9-14 days of exposure to CMV. Thus, quantitative changes in muscle fibre size and contractile proteins are not the dominating factors underlying the dramatic decline in diaphragm muscle function in response to CMV, in contrast to earlier observations in limb muscles. The observed early loss of subsarcolemmal neuronal nitric oxide synthase activity, onset of oxidative stress, intracellular lipid accumulation and post-translational protein modifications strongly argue for significant qualitative changes in contractile proteins causing the severely impaired residual function in diaphragm fibres after long-term mechanical ventilation. For the first time, the present study demonstrates novel changes in the diaphragm structure/function and underlying mechanisms at the gene, protein and cellular levels in response to CMV at a high temporal resolution ranging from 6 h to 14 days.

Lymphocytes apoptosis in patients with acute exacerbation of asthma

Asthma is characterized by airway inflammation, which can be now assessed by the analysis of induced sputum. Ten patients with asthma were investigated during acute exacerbation for the quantification of apoptosis, for Bcl-2 and Fas expression, in induced sputum lymphocytes. They were compared to 12 patients with chronic obstructive pulmonary disease (COPD), and 10 healthy controls. Spontaneous apoptosis was determined by staining nuclei with propidium iodide, and analyzed with a FACScan. Bcl-2 was measured by Western blotting, and results were obtained by densitometric scanning, done by the gel proanalyser. The investigation of Fas was performed using the streptavidin-biotin preroxidase-complex method. Patients with asthma and patients with COPD exhibited a significant increase of cellularity, percentage of neutrophils, eosinophils and lymphocytes when compared to healthy controls. Apoptosis in induced sputum mononuclear cells was found decreased in patients with asthma compared to COPD patients and healthy controls. The quantification of apoptosis was measured after exposure to anti-cytokine antibodies. Anti-TNF-alpha antibody blocked the apoptosis in both patients groups and healthy controls, suggesting that TNF-alpha acted as an inducer of apoptosis. Anti-IL-10 blocked apoptosis completely exclusively in patients with asthma. Bcl-2 expression was found to be increased in induced sputum mononuclear cells from patients with asthma, compared to healthy controls and patients with COPD. Expression of Fas could be detected in patients with asthma, at a lower level than COPD patients and healthy controls. Distinct mechanisms of apoptosis were found in patients with asthma and patients with COPD, characterized by different levels of Bcl-2 and Fas expression. Induction of apoptosis should be a beneficial process in allergic inflammation traduced in induced sputum mononuclear cells. The apoptosis process is assumed by two different mechanisms in asthma and COPD. Our findings indicated that in asthmatic patients, activated lymphocytes accumulate in the bronchi; because of their prolonged survival that maintains inflammation.

Group A beta-hemolytic streptococcal bacteremia in a patient with sickle cell anemia on penicillin prophylaxis

Serious invasive bacterial infections, particularly those due to Streptococcus pneumoniae and Hemophilus influenzae, are a well-known complication in patients with sickle cell disease. Early penicillin prophylaxis has been shown to prevent these infections and also to improve survival. This article describes a child with sickle cell anemia who, while on penicillin prophylaxis, developed a group A streptococcal bacteremia, a pathogen not commonly associated with bacteremia in sickle cell disease.

Blood pressure, coffee, tea and tobacco consumption: an epidemiological study in Algiers

The connections and possible interactions between coffee consumption, tobacco consumption, blood pressure (BP), age, and body mass index (BMI) were analysed in a cross-sectional epidemiologic study of 1098 men and 393 women of the Algiers district. Systolic blood pressure (SBP) was negatively and significatively correlated with cigarette smoking. Diastolic blood pressure (DBP) was positively and significantly associated with coffee consumption (P less than 0.001) and negatively and significantly with cigarette consumption (P less than 0.001). These associations remained significant after multivariate analysis including sex, age, BMI, physical exertion at work, athletic activity, rural versus urban residency, tobacco, tea and coffee consumption. Coffee consumption and cigarette smoking were positively associated (P less than 0.001). In the subgroup of men, the association between coffee consumption and DBP was significant only after adjustment for cigarette smoking. In the subgroup of women, containing a low percentage of smokers, this association was significant without such adjustment. This finding suggests that cigarette consumption might partly mask the association between coffee consumption and BP. The contradictory interactions observed between BP, cigarette consumption and coffee consumption might help to explain the conflicting reports concerning the association between coffee consumption and ischemic heart disease.

[The prognosis in primary chronic glomerulonephritis in the adult. 298 clinicopathological cases (author's transl)]

The study involved 298 cases of chronic glomerulonephritis (GN) in adults. The results of renal biopsy were used to classify the patients into four groups: Membranous GN, 81 cases; focal glomerulo sclerosis, 80 cases; Membrano-proliferative GN, 62 cases; GN with mesangial deposits of IgA, 75 cases. The patients were observed over a period ranging from 1 month to 36 years. The average period of surveillance for each category was between 4 and 6 years. The course in each histological type was assessed on the basis of actuarial tates of renal death, of moderate renal insufficiency (plasma creatinine greater than 1.5 mg%( and of hypertension. Renal survival at 10 years was was arounds 90% for membranous GN. 85% for GN with mesangial deposits of IgA, 70% for focal glomerulo sclerosis and 50% for membrano-proliferative GN. The prognosis should be based upon a combination of histological and clinical findings. Severity of prolonged nephrotic syndrome, regardless of the histological type of the nephropathy, is worthy of emphasis. In the group fo focal glomerulo sclerosis, prognosis differs greatly in relation to the presence or absence of a nephrotic syndrome. Complete remission may be seen in the group of focal glomerulo sclerosis, and in membrano-proliferative GN despite the persistence or worsening of histological lesions seen on repeated biopsies.

Clinical significance of circulating immune complexes detection in chronic glomerulonephritis

Sera from 168 patients with various types of chronic glomerulonephritis (GN) were assayed for immune complexes (IC) by two independent methods, a modification of the PEG precipitation test (PEG) and the inhibition of complement-dependent lymphocyte rosette formation (RI). Both assays had different reactivities, the RI being more sensitive than the PEG test. Higher percentages of positivity of these tests were observed in the GN groups than in normal controls. However serial measurements demonstrated that IC were present only intermittently in most instances. The presence of IC correlated with disease activity in patients with focal glomerulosclerosis membranous GN and membranoproliferative GN, while in lupus erythematosus it reflected the effects of different treatment regimens although it had no relationship with clinical symptoms. Nevertheless, our results suggest that these tests are of little help to the clinician to appreciate disease activity and monitor therapy in individual GN patients.