Primary Effusion Lymphoma: A Rare and Challenging Diagnosis for Recurrent Pleural Effusion

Primary Effusion Lymphoma is an extremely rare and aggressive subtype of B-cell lymphoma, accounting for only <1% of all cases of this neoplasm. It has a unique clinical presentation because it has a predilection for appearing in body cavities, such as the pleural space, pericardium and peritoneum. It mainly affects immunocompromised individuals and may also affect individuals in the Mediterranean region and in areas endemic for human herpesvirus 8 (HHV-8). Herein, we report the case of an 83-year-old immunocompetent male complaining of coughing, fever and progressive dyspnea for 3 days. His past medical history revealed a recurrent pleural effusion for the last three years, as well as losing weight and malaise. A subsequent investigation revealed a PEL diagnosis of the pleura.

Polarization-controlled orbital angular momentum switching in nonlinear wave mixing

We demonstrate polarization-controlled switching of the orbital angular momentum (OAM) transfer in nonlinear wave mixing. By adjusting the input beam geometry, we are able to produce a three-channel orbital OAM, with arbitrary topological charges simultaneously generated and spatially resolved in the second-harmonic wavelength. The use of path and polarization degrees of freedom allows nearly perfect optical switching between different OAM operations. These results are supported by a theoretical model showing very good agreement with the experiments.

Arginine for gestating sows and foetal development: A systematic review

The use of functional amino acids during pregnancy has been linked to improved reproduction in mammals. In this context, arginine is a precursor in the synthesis of numerous molecules, such as nitric oxide and polyamines, which play an important role during reproduction. However, contradictory studies are found in the literature, particularly regarding the amount of supplementation and the period of pregnancy in which it is used. The objective of this study was to evaluate the effects of dietary arginine supplementation for pregnant sows on foetal development via a systematic review. The search for papers was performed during the month of December 2015, in the databases ISI Web of Science, Science Direct, Scopus, and SciELO. From a total of 5675 returned studies, only 13 papers were selected after applying selection criteria. Most (47%) of the studies that evaluated the effects of dietary arginine supplementation on foetal development in pigs used 1% arginine. Supplementation was initiated in the first third of pregnancy in 47% of tests, including in both primiparous and multiparous sows. These studies showed positive results for embryo survival and foetal development, evidenced by the increase in placental weight and the number and weight of piglets born alive. Of all evaluated studies, 53% showed benefits on foetal development. It is concluded that supplementing dietary arginine in gestating sows can benefit embryo survival and foetal development. However, to establish a supplementation plan with this amino acid, aspects related to the period of pregnancy, supplementation levels, and source of arginine must be well defined.

The influence of oral processing, food perception and social aspects on food consumption: a review

Eating is an essential activity to get energy and necessary nutrients for living. While chewing, the food is broken down by the teeth and dissolved by saliva. Taste, flavour and texture are perceived during chewing and will contribute to the appreciation of the food. The senses of taste and smell play an important role in selecting nutritive food instead of toxic substances. Also visual information of a food product is essential in the choice and the acceptance of food products, whereas auditory information obtained during the chewing of crispy products will provide information on whether a product is fresh or stale. Food perception does not just depend on one individual sense, but appears to be the result from multisensory integration of unimodal signals. Large differences in oral physiology parameters exist among individuals, which may lead to differences in food perception. Knowledge of the interplay between mastication and sensory experience for groups of individuals is important for the food industry to control quality and acceptability of their products. Environment factors during eating, like TV watching or electronic media use, may also play a role in food perception and the amount of food ingested. Distraction during eating a meal may lead to disregard about satiety and fullness feelings and thus to an increased risk of obesity. Genetic and social/cultural aspects seem to play an important role in taste sensitivity and food preference. Males generally show larger bite size, larger chewing power and a faster chewing rhythm than females. The size of swallowed particles seems to be larger for obese individuals, although there is no evidence until now of an 'obese chewing style'. Elderly people tend to have fewer teeth and consequently a less good masticatory performance, which may lead to lower intakes of raw food and dietary fibre. The influence of impaired mastication on food selection is still controversial, but it is likely that it may at least cause adaptation in food choice. Systemic conditions, such as high blood pressure, diabetes and cancer, with or without medicine use, tend to be associated with taste and chewing alterations. However, definite conclusions seem hard to reach, as research protocols vary largely.

Oral physiology, nutrition and quality of life in diabetic patients associated or not with hypertension and beta-blockers therapy

The relationship between type 2 diabetes oral physiology, nutritional intake and quality of life has not been fully elucidated. We assessed the impact of type 2 diabetes - exclusive or associated with hypertension with beta-blockers treatment - on oral physiology, mastication, nutrition and quality of life. This cross-sectional study was performed with 78 complete dentate subjects (15 natural teeth and six masticatory units minimum; without removable or fixed prostheses), divided into three groups: diabetics (DM) (n = 20; 45·4 ± 9·5 years), diabetics with hypertension and receiving beta-blockers treatment (DMH) (n = 19; 41·1 ± 5·1 years) and controls (n = 39; 44·5 ± 11·7 years) matched for gender, age and socioeconomic status. Blood glucose, masticatory performance, swallowing threshold, taste, food intake, stimulated and unstimulated salivary flow, pH and buffering capacity of saliva were assessed. Glycemia was higher in DM than in controls (P < 0·01). No differences were observed between DM and controls for nutrition and quality of life. Both stimulated and unstimulated salivary flow rate were lower in DMH (P < 0·01), which also presented the lowest number of teeth and masticatory units (P < 0·0001), and reduction in the number of chewing cycles (P < 0·01). Controls showed lower Decayed Missing Filled Teeth index (DMFT) scores in comparison with DMH (P = 0·021). Masticatory performance and saliva buffering capacity were similar among groups. Exclusive type 2 diabetes did not alter oral physiology, nutrition or quality of life. However, when hypertension and beta-blockers treatment were associated with diabetes, the salivary flow rate, chewing cycles and number of teeth decreased.

Efficacy of fish embryo vitrification protocols in terms of embryo morphology - a systematic review

BACKGROUND

Embryo cryopreservation has been used for the creation of genetic banks with diploid resources, and among different techniques, vitrification is considered as the most promising method.

OBJECTIVE

The goal is to evaluate the major aspects of the existing vitrification techniques and to evaluate their efficacy in terms of embryo morphology.

METHODS

Electronic searches in the PubMed and ScienceDirect databases were performed with the keyword combination: fish, embryo and vitrification. Pubmed retrieved 26 articles and Science Direct resulted in 464 articles. For this review, only studies that developed and tested vitrification protocols in fish embryos were included. Research regarding cryoprotectant toxicity and permeability were excluded. There were no restrictions on publication date or language. With these criteria, a total of ten articles were evaluated.

RESULTS

In these articles, the major aspects to be considered for the development of new vitrification protocols are: the cryoprotectants' toxicity, the embryos' development stage, the exposure to and the permeability of the cryoprotectants, vitrification devices and vitrification-warning cycle.

CONCLUSION

The survival were limited, however, the preservation of embryonic morphology after thawing indicates the possibility of preserving fish embryos via the vitrification technique.

Metabolic parameters in rats receiving different levels of oral glycerol supplementation

The use of glycerol in the diets for animals is of interest because it is a residue of biodiesel production and rich in energy. Thus, this study aimed to evaluate metabolic and physiological parameters of rats receiving supplemental pure glycerol by gavage. We used 30 Wistar rats (initial weight 202.7 ± 29.98 g) receiving 0 (control/saline), 200, 400, 800 and 1600 mg glycerol/kg of body weight (bidistilled glycerine, 99.85% glycerol) beside food and water ad libitum for 28 days. We used a completely randomised design with five treatments and six replicates. At the end of the experiment, the animals were killed, and the results showed that there was no change (p > 0.05) in the intake and excretion of water, the average daily weight gain, dry matter, ash and crude protein in the carcass or plasma triacylglycerols. There was a beneficial effect (p < 0.05) up to a dose of 800 mg/kg glycerol on feed intake, percentage of carcass fat, plasma levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), high-density lipoprotein (HDLc) and low-/very low-density lipoprotein (LDLc + VLDLc). The levels of total cholesterol and glucose were increased with up to a dose of 800 mg/kg glycerol (but remained within the normal range); they were reduced with the dose of 1600 mg/kg. The total leucocyte count tended to be reduced, although it was within the reference values for rats. There were no renal or pancreatic lesions. In conclusion, glycerol presented as a safe supplement at the studied doses, even having some beneficial effects in a dose-dependent manner in rats.

Masticatory performance and taste perception in patients submitted to cancer treatment

The aim of this study was to analyse mastication and the sense of taste in 39 patients submitted to cancer treatment in different areas of the body and to compare these variables with those of 44 control individuals within the same age range. The following aspects were assessed: dental status (DMFT); stimulated and non-stimulated salivary flow; sense of taste (salty, sweet, bitter and sour); and masticatory performance (MP), through the calculation of X(50). Logistic regression models were established to test the association between the independent variables and cancer treatment. Cancer patients had lesser stimulated salivary flow, a smaller number of teeth and occlusal units, worse MP, higher salty, sweet and sour taste scores and a lower bitter taste score (P < 0·05). A significant positive correlation was found between MP and the DMFT index in both groups (P < 0·05), meaning that a lower DMFT index value denoted a smaller X(50) value (better masticatory performance). The logistic regression model revealed that patients who had undergone cancer treatment had a greater probability of exhibiting a smaller number of teeth, higher salty and smaller bitter taste scores (P < 0·05). It was concluded that patients who were submitted to cancer treatment presented oral physiology alterations when compared with control subjects at the same age range.

Evaluation of facial asymmetry and masticatory muscle thickness in children with normal occlusion and functional posterior crossbite

AIM

The aim of this study was to evaluate facial asymmetry and the thickness of the masticatory muscles in young children with normal occlusion and functional posterior crossbite.

METHODS

The sample comprised 72 children of both genders (64.71±7.04 months) in the primary and early mixed stage of dentition, divided into four groups: primary-normal occlusion (PriN; N=19), primary-crossbite (PriC; N=19), mixed-normal occlusion (MixN; N=27), and mixed-crossbite (MixC; N=16). The thickness of the masseter and anterior portion of the temporalis muscle at rest and during maximal clenching were assessed by ultrasonography. Facial morphology and asymmetry were evaluated by standardized front-view photographs, in which the following measurements were recorded: anterior face height (AFH), bizygomatic facial width (BFW), angle of the eye (AE) and angle of the mouth (AM) (interpupillary and commissure planes in relation to mid-sagittal plane, respectively).

RESULTS

The results showed that muscle thickness did not differ significantly between the sides of the dental arches in all groups (paired t-test). Only the groups with normal occlusion presented significant positive correlation between AE and AM (Pearson's correlation test). In PriN, only body weight was significantly related to masseter thickness; in MixN, facial morphology contributed significantly to masseter thickness at rest and maximal clenching, while the covariates weight, height and age did not relate to muscle thickness (stepwise backward multiple regression).

CONCLUSION

In the studied sample, children with crossbite presented greater facial asymmetry than those with normal occlusion, and a greater masseter thickness was related to larger faces in the mixed dentition.

Self-perception regarding the need for orthodontic treatment among impoverished schoolchildren in Brazil

AIM

The objectives of the present study were to assess predictive factors associated to self-perception regarding the need for orthodontic treatment among 170 impoverished schoolchildren.

MATERIALS AND METHODS

A cross- sectional study was conducted in public schools in the city of Belo Horizonte-MG (Brazil). Children's self-perception regarding the need for treatment was assessed using the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) and a questionnaire addressing biopsychosocial factors. The chi-square test and multiple logistic regression were used in the data analysis.

RESULTS

The predictive factors for the self-perception of orthodontic treatment need on the part of the impoverished schoolchildren included ridicule from persons close to the children regarding the appearance of the teeth (OR 2.81; 95%CI 1.2 to 6.4), dissatisfaction with oral aesthetics due to the alignment of the teeth (OR 2.45; 95%CI 1.1 to 5.4) and missing teeth (OR 3.02; 95%CI 1.0 to 9.23).

CONCLUSION

The alignment of the teeth, missing teeth and ridicule from others regarding the appearance of the teeth are the factors that most strongly influence self- perception regarding the need for orthodontic treatment among impoverished schoolchildren.

Molar bite force and its correlation with signs of temporomandibular dysfunction in mixed and permanent dentition

The aim of the study was to evaluate molar bite force (BF) magnitude and its correlation to the signs of temporomandibular dysfunction (TMD), gender, weight, height and age in 101 students ranging in age from 6 to 18 years (32 boys/21 girls with mixed dentition and 23 boys/25 girls with permanent dentition). TMD clinical signs were evaluated using the Craniomandibular Index (CMI), and two subscales, the Dysfunction Index (DI) and the Palpation Index (PI). BF was determined with a pressurized tube connected to a sensor (MPX5700-Motorola SPS). anova, Tukey's test, and Pearson's and Spearman's coefficients were evaluated. BF was higher in the permanent dentition (P < 0.05). There was no difference in BF between genders within the groups, but boys with permanent dentition had higher values than children with mixed dentition (P < 0.05). The girls with permanent dentition presented negative correlation in BF with PI and CMI (P < 0.05). BF was positively correlated with weight, height and age in the permanent dentition group (P < 0.05). It was concluded that BF increased from mixed to permanent dentition, with an assumed enhancing influence of body variables and ageing. The TMD signs in older girls were correlated to decreasing BF, suggesting an influence of muscle tenderness preventing subjects from exerting maximum BF.

Salivary cortisol levels in young adults with temporomandibular disorders

AIM

Causes of temporomandibular disorders (TMDs) are multifactorial, involving both physical and psychological factors. The aim of this study was to evaluate the salivary cortisol levels in young adults with TMDs.

METHODS

The Research Diagnostic Criteria (RDC)/TMDs were used to establish the diagnosis of TMDs regarding the physical (axis I) and psychological factors (depression and somatization; axis II). Young adults of both genders composed the TMDs males (21.7+/-2.21 years, n=10) and females (22.7+/-1.95 years n=10) groups, and 20 healthy matched controls composed the control male (22.5+/-1.96 years n=10) and female (22.4+/-2.17years n=10) groups. Saliva samples were collected immediately on awakening and at bedtime. The cortisol levels were measured by enzyme immunoassay.

RESULTS

The female group with TMDs showed a significantly higher cortisol level (2.890+/-0.411 mg/dL) than the corresponding control group in the morning evaluation (2.470+/- 0.486 mg/dL). The depression scores were significantly higher for the female group with TMDs (1.3+/-0.18) in comparison with the control female (0.72+/-0.18) and male groups (0.51+/-0.13). The groups with TMDs showed significantly higher somatization scores (0.69+/-0.16 for males and 1.38+/-0.23 for females) in comparison with the controls (0.23+/-0.10 for males and 0.78+/-0.15 for females), these also being significantly higher for the females than males.

CONCLUSION

It was concluded that cortisol levels are higher in TMDs in females, who had elevated depression and somatization scores. The results infer that the evaluation of salivary cortisol could be a promising tool in the diagnosis of TMDs associated with psychological factors.

Erythematous candidosis in patients with complete dentures and HIV+/AIDS

This investigation was designed to evaluate the frequency of erythematous candidosis (EC) and Candida species, proteinase and phospholipase exoenzyme production, and to compare clinical features in patients with complete dentures and HIV+/Acquired Immunodeficiency Disease Syndrome (AIDS). Fifty-one patients were selected from a total of 285 with EC: denture wearers (n = 30) and HIV+/AIDS (n = 21). The yeast prevalence and the production of exoenzymes, such as proteinase and phospholipase by Candida species were evaluated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) electrophoresis. The frequency of Candida albicans was significantly higher (P < 0.05) in both groups although other yeast species (Candida glabrata, Candida krusei, Candida parapsilosis, Candida guilliermondi and Candida tropicalis) were also found. Candida albicans showed greater levels of proteinase production in the denture wearers, when compared with the HIV+/AIDS group. There was no difference between groups with regard to phospholipase production. The protein bands presented similar molecular weights, showing the presence of proteinases in both groups. It could be concluded that the clinical manifestation of EC may be related to its proteinase production capacity. Combination therapies using proteinase inhibitors play an important role in inhibiting exoenzyme production by Candida species, mainly C. albicans.

Ultrasound and tomographic evaluation of temporomandibular joints in adolescents with and without signs and symptoms of temporomandibular disorders: a pilot study

OBJECTIVES

Condylar position in the glenoid fossa has been linked to temporomandibular disorders (TMDs); however its importance in TMD aetiology is still unclear. The purpose of this study was to determine joint spaces and condylar position in adolescents with TMDs using ultrasound static images and linear corrected tomograms at the mandibular rest position.

METHODS

Craniomandibular index (CMI) and a symptom questionnaire were assessed in 217 subjects aged 12-18 years. Those with the lowest and the highest scores were divided into control (n=20) and SSTMD (presence of signs and symptoms of TMD) groups (n=20). Ultrasound images and tomography were used to measure the distance between the capsule and the lateral surface of the condyle and to determine the condyle location at the mandibular resting position, respectively.

RESULTS

The mean distances obtained from ultrasound images did not correlate with CMI scores and they did not differ between the two groups (P>0.05). Posterior positioned condyles were determined on tomograms, and they were more prevalent both in the SSTMD group (P=0.05) and in girls (P<0.05).

CONCLUSIONS

Even though there was a significant difference in condyle position between the control and SSTMD groups, determined by axially corrected tomograms, it cannot be inferred that posteriorly positioned condyles can predict TMDs. In addition, there was no association between the articular capsule and the lateral condyle surface distances measured by ultrasound using a 10 MHz linear transducer and the clinical diagnosis of TMD. Further studies in diagnostic imaging of TMJs with ultrasound should be encouraged, since it has some useful diagnostic applications and does not require special facilities.

Oral physiology and mastication

Mastication is a sensory-motor activity aimed at the preparation of food for swallowing. It is a complex process involving activities of the facial, the elevator and suprahyoidal muscles, and the tongue. These activities result in patterns of rhythmic mandibular movements, food manipulation and the crushing of food between the teeth. Saliva facilitates mastication, moistens the food particles, makes a bolus, and assists swallowing. The movement of the jaw, and thus the neuromuscular control of chewing, plays an important role in the comminution of the food. Characteristics of the food, e.g. water and fat percentage and hardness, are known to influence the masticatory process. Food hardness is sensed during mastication and affects masticatory force, jaw muscle activity, and mandibular jaw movements. When we chew for instance a crispy food, the jaw decelerates and accelerates as a result of resistance and breakage of food particles. The characteristic breakage behaviour of food is essential for the sensory sensation. This study presents a short review of the influence of oral physiology characteristics and food characteristics on the masticatory process.

Bite force determination in adolescents with and without temporomandibular dysfunction

The aims of this study were to compare bite force in adolescents with and without temporomandibular dysfunction (TMD), and to investigate the influence of gender, age, height and weight on bite force magnitude. The TMD was evaluated using a self-report questionnaire and the Craniomandibular Index, which has two subscales, the Dysfunction Index and the Palpation Index. Subjects with lower and upper extremity values were used to integrate the control (Group I -n = 20) and TMD (Group II -n = 20) groups, respectively. In addition, the TMD group should have at least one subjective symptom. Bite force was determined with a transducer, which consisted of a pressurized rubber tube connected to a sensor element (MPX 5700 - Motorola SPS, Austin, TX, USA). Analysis of covariance, Pearson's coefficient, Mann-Whitney and t-tests were applied to analyse the data. The results showed that Group II presented smaller values for bite force than Group I and boys had greater values than girls in Group II (P < 0.05). Bite force values were significantly smaller for girls between groups (P < 0.05), whereas for boys there was no statistical difference. Weak positive correlation between bite force and weight, height and age (P > 0.05) and significant negative correlation between bite force and Palpation and Craniomandibular Indexes (P < 0.05) were found. It was concluded that decreased bite force was correlated with TMD in girls, primarily with muscle tenderness.

Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition

The aim of this study was to evaluate the relationship between nutritive and parafunctional habits and the presence of temporomandibular dysfunction (TMD) in children with primary dentition.

METHODS

Ninety nine children, aged 3-5 years, were examined to check for the presence or absence of signs and symptoms of TMD (headache, preauricular pain, earache, masticatory muscle tenderness, deviation on opening, occlusal interference and asymmetric movement of the mandible), oral parafunctions (bruxism, nail biting, finger/thumb sucking, speech alteration, mouth breathing, pacifier and atypical swallowing) and nutritive habits (breast- or bottle-feeding) through interview and clinical examination. The results were submitted to descriptive statistical analysis and Fisher's exact test.

RESULTS

The results showed that only atypical swallowing was positively related to TMD (P < 0.0001); other oral parafunctional and nutritive habits were not related to TMD.

CONCLUSIONS

It was concluded that parafunctional habits, with the exception of atypical swallowing, and feeding methods were not determinants for the presence of signs and/or symptoms of TMD in the sample of children included in the study.

Cyclophosphamide in the treatment of focal segmental glomerulosclerosis

Prednisone is the initial treatment of primary focal segmental glomerulosclerosis. However, when immunosuppressive agents in combination with steroids are used in the treatment of prednisone-dependent and prednisone-resistant patients the remission rate is variable. We report a long-term trial using cyclophosphamide (2.0 to 3.0 mg/kg body weight for 12 weeks) in combination with prednisone (1.0 to 2.0 mg/kg body weight), as compared with prednisone alone for the treatment of prednisone-resistant and frequently relapsing nephrotic syndrome and focal segmental glomerulosclerosis. Fifty-four patients (34 males and 20 females) with a diagnosis of idiopathic nephrotic syndrome and focal segmental glomerulosclerosis, followed-up for an average of 86.1 +/- 82.4 months, were evaluated. Complete remission occurred in 20.4% and partial remission in 14.8% of the patients treated with steroids and in 26.7 and 20.0% of the patients treated with cyclophosphamide + prednisone, respectively. Of the 24 prednisone-resistant patients treated with steroids in combination with cyclophosphamide, 33.3% obtained a complete/partial response. At the time of final evaluation, 25% of the patients treated with prednisone and 10.0% of those treated with prednisone in combination with cyclophosphamide had reached end-stage renal disease. Persistent nephrotic syndrome and progressive renal insufficiency were more frequently observed among the patients treated with prednisone alone (50.0 vs 33.3% and 33.3 vs 16.7%, respectively). The treatments were well tolerated and no patient experienced adverse reactions requiring discontinuation of medications. Although open-label and non-randomized, the present trial showed that cyclophosphamide is a reasonable choice for the treatment of primary focal segmental glomerulosclerosis and prednisone-resistant nephrotic syndrome.

Primary focal segmental glomerulosclerosis in children: prognostic factors

To study the clinical course and the predictors of outcome in children and adolescents, 39 patients with nephrotic syndrome and primary focal segmental glomerulosclerosis (FSGS) were followed for a mean of 84.6 months. Thirty-six patients were treated with prednisone, either alone or in conjunction with cyclophosphamide. The clinical course was one of sustained remission in 4 patients, frequent relapse in 13, persistent nonnephrotic proteinuria in 5, and persistent nephrotic syndrome in 17; 2 patients had stable renal failure and 8 had progressive renal failure, 5 of them evolving to end-stage renal failure (ESRF). Resistance to prednisone was recorded in 76.6% of patients. The use of cyclophosphamide plus prednisone was of benefit in 42.8% of patients; 22.2% of the prednisone-resistant patients achieved remission of the nephrotic syndrome. A Kaplan-Meier analysis revealed a survival rate of 92% after 5 years, 86% after 10 years, and 76% after 15 years. Using both univariate and multivariate analysis, persistent nephrotic syndrome was associated with progression to ESRF and the remission of proteinuria with maintenance of renal function. As the outcome of the nephrotic syndrome in FSGS is significantly improved by remission of proteinuria, it is conceivable that immunosuppressive medication may be used in conjunction with prednisone in patients with steroid resistance.

An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts

Five protocols for surgical handwashing (scrubbing) were evaluated for their efficiency of removal of micro-organisms and their drying effect on the skin. The scrubbing protocols tested were: (1) an initial scrub of 5 min and consecutive scrubs of 3.5 min with chlorhexidine gluconate 4% (CHG-5); (2) an initial scrub of 3 min and consecutive scrubs of 2.5 min with chlorhexidine gluconate 4% (CHG-3); (3) an initial scrub of 3 min and consecutive scrubs of 2.5 min with povidone iodine 5% and triclosan 1% (PI-3); (4) an initial scrub of 2 min with chlorhexidine gluconate 4% followed by a 30 s application of isopropanol 70% and chlorhexidine gluconate 0.5%, and a 30 s application of isopropanol 70% and chlorhexidine gluconate 0.5% for consecutive scrubs (IPA); and (5) an initial scrub of 2 min with chlorhexidine gluconate 4% followed by a 30 s application of ethanol 70% and chlorhexidine gluconate 0.5%, and a 30 s application of ethanol 70% and chlorhexidine gluconate 0.5% for consecutive scrubs (EA). A convenience sample of 23 operating theatre nurses completed each scrub protocol for one week in a randomized order. A week of normal work activities intervened between each protocol. Subjects were assessed before commencing and after completing the week of each protocol to determine changes in the microbial counts and skin condition of the hands. Specimens for microbial analysis were collected before, immediately after and 2 h after an initial scrub, and 2 h after a consecutive scrub. The CHG-5, CHG-3 and PI-3 protocols, which used detergent-based antiseptics only, were compared with protocols incorporating an alcohol-based antiseptic (IPA and EA). The protocols incorporating alcohol-based antiseptics and the CHG-5 protocol were generally associated with the lowest post-scrub numbers of colony forming units (cfu). No difference between the CHG-5 protocol and the alcohol-based antiseptics was found at the beginning of the test week, but after exclusive use of the respective protocols for a week, the alcohol-based antiseptics were associated with significantly lower cfu numbers in two out of the three post-scrub samples (P = 0.003, P = 0.035). Although virtually no statistically significant differences in skin condition were found, many subjects reported the alcohol-based antiseptic protocols to be less drying on the skin. The findings of this study support the proposition that a scrub protocol using alcohol-based antiseptics is as effective and no more damaging to skin than more time-consuming, conventional methods using detergent-based antiseptics.

Clinical effects of intermittent, intravenous cyclophosphamide in severe systemic lupus erythematosus

To evaluate the clinical effectiveness of intermittent intravenous cyclophosphamide in the treatment of severe systemic lupus erythematosus, 20 patients with systemic lupus erythematosus (SLE) and evidence of severe renal involvement or systemic vasculitis, consecutively admitted to the hospital were studied. Cyclophosphamide was administered intravenously at a dosage of 1.0 g/m2 monthly, during 6 months and maintained every 3 months during 12 additional months. Of 10 patients with active lupus nephritis, a reduction or disappearance of proteinuria and maintenance of normal renal function was recorded in 6. Improvement of renal function was observed in 4 out of 7 patients with renal insufficiency at initial evaluation; resolution of renal insufficiency was more frequently observed in patients with recent onset renal failure. At the end of the follow-up (18.0 +/- 14.5 months) disappearance or reduction of nephrotic range proteinuria was recorded in 6 out of 14 patients; there was progression toward renal failure in 4 patients (20%). Response to intravenous cyclophosphamide therapy was observed in 4 of 5 patients with severe extrarenal SLE. Side effects, recorded in 12 patients, were mild and transient and in no patient was the treatment discontinued. Four patients died during the follow-up, although in 2 of them the deaths were not attributable to therapy. Even though this was an open and uncontrolled study, intermittent, intravenous cyclophosphamide was an effective therapy for severe, steroid refractory SLE.

Clinical course of focal segmental glomerulosclerosis associated with hepatosplenic schistosomiasis mansoni

To analyze the clinical course and response to therapy 15 patients (9 male and 6 female) with the hepatosplenic form of schistosomiasis mansoni and focal segmental glomerulosclerosis (FSGS) were prospectively studied (mean follow-up = 115.8 +/- 93.2 months). Nephrotic syndrome was the most frequent clinical presentation, followed by abnormalities of urinalysis. The clinical course was progressive: at final evaluation 9 patients (60%) had developed renal failure. Hypertension or/and renal insufficiency at initial evaluation and persistence of the nephrotic syndrome were associated with progression toward advanced renal failure. Response to immunosuppressive therapy was recorded in 30% of the patients; all responsive patients still had normal renal function at final evaluation. The treatment of the Schistosoma mansoni infection did not influence the clinical course of the renal disease. It is concluded that FSGS in patients with hepatosplenic schistosomiasis mansoni is a disease progressing to advanced stage independently of the presence of the parasite.

Renal involvement in prolonged Salmonella bacteremia: the role of schistosomal glomerulopathy

Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged Salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia.

The effect of surgical handwashing routines on the microbial counts of operating room nurses

Many factors may affect the efficiency of handwashing techniques. This study examined two interdependent factors: the time taken to wash the hands and the type of antiseptic solution used. A 3-minute initial scrub and 30-second consecutive scrub regimen was compared with a current standard regimen of a 5-minute initial scrub and a 3-minute consecutive scrub. Chlorhexidine gluconate 4% and povidone-iodine 7.5% were the antiseptics used in the two regimens. The sample (n = 34) was drawn from nurses employed in the operating room suite of a 950-bed hospital. Chlorhexidine gluconate was found to be responsible for lower numbers of colony-forming units of bacteria than povidone-iodine. The duration of the scrub had no significant effect on the numbers of bacteria when povidone-iodine was used. The optimal regimen was found to be the 5-minute initial and 3-minute consecutive scrubs with chlorhexidine gluconate.

The influence of anti-parasitic therapy on the course of the glomerulopathy associated with Schistosomiasis mansoni

Although several aspects of the association between S. mansoni infection and renal disease are well known, the influence of the anti-parasitic therapy on the clinical course of the glomerulopathy remains undefined. With the aim of studying this aspect, 16 patients with glomerulopathy associated with schistosomiasis mansoni were evaluated (proteinuria and levels of BUN and creatinine) before therapy, 1 week, 1 month, 2-3 months and 6 months after therapy of the parasitic infections. During the follow-up of such cases no benefit could unquestionably be demonstrated in the patients. Also, no permanent deterioration of renal function related to anti-parasitic therapy could be documented. It is concluded that the treatment of the S. mansoni infection, once the consequent glomerulopathy is clinically apparent, does not influence the clinical course of the disease.