Treatment with intravenous immunoglobulins in systemic lupus erythematosus: a single-center experience with 63 patients

BACKGROUND

Intravenous immunoglobulin (IVIG) is prepared using purified human plasma. IVIG therapy has immunomodulatory effects on autoimmune diseases, including severe systemic lupus erythematosus (SLE). However, reports of its effects on large cohorts are scarce.

METHODS

This single-center retrospective study included SLE patients treated with at least one IVIG cycle for SLE complications. Demographic data, indications, cycle numbers, and clinical improvement with IVIG were evaluated. SLE Disease Activity Index 2000 (SLEDAI-2K) scores were calculated at admission and after IVIG treatment in order to measure clinical improvement.

RESULTS

Sixty-three SLE patients treated with IVIG (median age: 29 years; interquartile range 21-36 years; 84.13% female) were included, who received 2 g/kg IVIG for two to five days. Main indications were immune thrombocytopenia, hypogammaglobulinemia, infection during a SLE flare, bicytopenia, and immune hemolytic anemia. Seven patients received more than one IVIG cycle without severe adverse effects. Significant differences were found in SLEDAI-2K scores when the indications were immune thrombocytopenia and hypogammaglobulinemia, with a trend for hemolytic anemia. Patients with concomitant infection, myopathy, and gastrointestinal involvement showed a considerable reduction in their last SLEDAI-2K scores. Fourteen patients died during hospitalization, mainly due to septic shock and active SLE.

CONCLUSIONS

IVIG showed adequate tolerance and effectiveness in selected severe SLE manifestations, mainly hematological involvement. It was useful for concomitant infection.

Production and characterization of a biosurfactant produced by Streptomyces sp. DPUA 1559 isolated from lichens of the Amazon region

Surfactants are amphipathic compounds containing both hydrophilic and hydrophobic groups, capable to lower the surface or interfacial tension. Considering the advantages of the use of biosurfactants produced by microorganisms, the aim of this paper was to develop and characterize a biosurfactant produced by Streptomyces sp. DPUA1559 isolated from lichens of the Amazon region. The microorganism was cultured in a mineral medium containing 1% residual frying soybean oil as the carbon source. The kinetics of biosurfactant production was accompanied by reducing the surface tension of the culture medium from 60 to values around 27.14 mN/m, and by the emulsification index, which showed the efficiency of the biosurfactant as an emulsifier of hydrophobic compounds. The yield of the isolated biosurfactant was 1.74 g/L, in addition to the excellent capability of reducing the surface tension (25.34 mN/m), as observed from the central composite rotational design when the biosurfactant was produced at pH 8.5 at 28°C. The critical micelle concentration of the biosurfactant was determined as 0.01 g/mL. The biosurfactant showed thermal and pH stability regarding the surface tension reduction, and tolerance under high salt concentrations. The isolated biosurfactant showed no toxicity to the micro-crustacean Artemia salina, and to the seeds of lettuce (Lactuca sativa L.) and cabbage (Brassica oleracea L.). The biochemistry characterization of the biosurfactant showed a single protein band, an acid character and a molecular weight around 14.3 kDa, suggesting its glycoproteic nature. The results are promising for the industrial application of this new biosurfactant.

Differentiation between the two types of amiodarone-associated thyrotoxicosis using duplex and amplitude Doppler sonography

PURPOSE

To evaluate the usefulness of Doppler parameters in the differentiation between the two types of amiodarone-associated thyrotoxicosis (AAT).

MATERIAL AND METHODS

One hundred thirty-seven individuals were selected at our institution. They were divided into four groups: 84 normal subjects (N), 30 euthyroids taking amiodarone (A), 14 AAT type 1 patients (AAT1), and nine AAT type 2 patients (AAT2). Each AAT type was classified according to (131)I uptake and clinical outcome. Blindly, the resistance and pulsatility indexes (RI, PI), systolic peak velocity, and color pixel density (CPD) were calculated.

RESULTS

AAT1 had greater CPD than AAT2 (P = 0.02). The latter group had similar vascularization to the N and A groups (P = 0.45). The area under the receiver operating characteristic (ROC) curve showed that systolic peak velocity in the inferior thyroid arteries and CPD were the best parameters in the differentiation between AAT type 1 and AAT type 2 (Az = 0.83 and 0.84, respectively). Impedance indexes were useless.

CONCLUSION

Our results demonstrate that objective tests such as systolic peak velocities in the thyroid arteries and CPD are reliable parameters for differentiating between the two types of AAT.

In vivo estimation of sheep carcass composition using real-time ultrasound with two probes of 5 and 7.5 MHz and image analysis1

Ultrasonic measurements were taken on 46 sheep using a real-time ultrasound machine equipped with 2 probes (5 and 7.5 MHz). Measurements of subcutaneous fat thickness (SC) and muscle LM depth (MD) and area (MA) were taken at 2 locations: over the 13th thoracic vertebra (SC13, MD13, and MA13, respectively) and at the interval between the third and fourth lumbar vertebrae (SC34, MD34, and MA34, respectively). Fat thickness was also measured over the third sternebra of the sternum. The relationship between carcass and in vivo ultrasound measurements was high for all the measurements (r(2) between 0.54 and 0.96, P < 0.01). Concerning MD and SC, the 7.5 MHz probe estimates were consistently more precise than the 5-MHz estimates (r(2) increased between 0.09 and 0.13), but the reverse occurred with the MA estimates, although to a lesser extent. Estimates of carcass composition for muscle, subcutaneous fat, intermuscular fat, internal fat, and total fat based on BW explained a large amount of variation in muscle (87%), subcutaneous fat (85%), intermuscular fat (79%), internal fat (74%), and total fat (87%). In most cases (55 of 70) the introduction of one ultrasound measurement in addition to BW in the multiple regression equations further improved the explanation of variation for weight of carcass tissues, internal fat, and total fat. For carcass muscle estimation, the ultrasound measurements of muscle provided an increase of r(2) between 0.05 and 0.10 (P < 0.01). The SC13 and SC34 gave the best improvements in estimating subcutaneous fat, intermuscular fat, internal fat, and total fat (r(2) increased between 0.05 and 0.17; P < 0.01). Prediction of the proportions of the carcass components (internal and total fat from BW) was clearly lower than the prediction of the absolute amounts of these traits. Inclusion of one or more ultrasound measurements in addition to BW increased the predictive ability of the equations. Both probes were useful to estimate carcass muscle depth and area and fat depth, but the 7.5-MHz probe showed a greater ability to estimate depth. For all traits, the stepwise procedure demonstrated that the best fit was obtained with BW and one or more ultrasound measurement with the 7.5-MHz probe.

Salivary testing for human immunodeficiency virus type 1 infection in children born to infected mothers in Sao Paulo, Brazil. The Sao Paulo Collaborative Study for Vertical Transmission of HIV-1

OBJECTIVE

To validate a method for salivary testing for HIV infection in children older than 12 months.

METHODS

Oral fluid samples were collected via sponge foam swabs from children born to HIV-positive mothers and were tested for antibodies to HIV-1 and HIV-2 with an IgG antibody capture enzyme-linked immunosorbent assay and a modified Western blot for confirmation. In each child serum antibody status was the standard used to validate the salivary antibody test.

RESULTS

We obtained 331 oral fluid samples from children born to HIV-positive mothers. The specificity and sensitivity of salivary testing compared with results on sera were both 100% (297 of 297 (95% confidence interval 98.8 to 100%) and 34 of 34 (95% confidence interval 89.7 to 100%), respectively). Compliance in the study population increased from 91% to 97% when mothers were offered the opportunity to provide oral fluid from their children instead of blood specimens.

CONCLUSION

Salivary testing provides an accurate and acceptable noninvasive method for assessing the HIV infection status of children born to infected mothers by using IgG antibody capture enzyme-linked immunosorbent assay alone with a strategy of duplicate retesting of reactive specimens.

Simultaneous nitrification and denitrification using immobilized microorganisms

Nitrogen removal from wastewaters is a multiple step process in which nitrification is often a problem due to the slow growth rates of the nitrifying bacteria. By immobilization of these bacteria, nitrification can be efficiently accomplished in compact reactors. In this paper, the possibilities of integrated nitrification and denitrification within a single reactor system are evaluated. Two main systems are studied: a) Nitrosamines europaea and Pseudomonas denitrificans co-immobilized in a a gel bead and operated in an air-lift reactor; b) the same bacteria separately immobilized and operated in different compartments of a multiple gas-lift reactor.

[Occurrence of a new case of human syngamiasis in São Paulo, Brazil]

Os autores relatam um caso de Singamose humana pela espécie Syngamus laryngeus, RAILLIET, 1899, eliminada espontaneamente durante forte acesso de tosse. A presente nota registra o 12° caso humano dessa parasitose no Brasil e o 2." em São Paulo.

[Sinusitis in the child. Evaluation and indication for surgical treatment]

Sinusitis in children is a frequent problem in pediatric otorhinolaryngology. Medical treatment is often incomplete or inadequate, creating the need for proper surgical therapy. In a 3 year period (1972-1975), at the E.N.T. Dept. of the "Hospital Infantil de México", a total of 51 patients, from 2 to 16 years age, underwent sinus surgery. The clinical diagnosis was completed with radiological and bacteriological studies. Chronic ethmoidal-maxillary and maxillary sinusitis were the most frequent types seen. Besides, considering E.N.T. sphere, other problems were present, mostly: tonsilloadenoiditis, important rhinoseptal deformity, and chronic otitis media. Also, dental caries, anemia, secondary to malnutrition and intestinal parasitosis, were additional frequent medical problems, among others. Allergic rhinosinusitis was suspected in at least 50% of them and clinically diagnosed in 15%. Bilateral nasoantral windows (antrostomy), and unilateral Caldwell-Luc procedure, were the surgical procedures most frequently performed. Adenoamygdalectomy, septorhinoplasty and mastoidectomy, were other frequent E.N.T. procedures. A total of 57% of the patients showed positive surgical findings at the time of sinus surgery; this is coincident with the work of other authors. Results of surgical and complementary medical management showed 39% of recovery rate. A high percentage of patients (31%), were lost to follow-up after initial surgery. The point of necessary conservative sinus surgery in children, is stressed in this paper.