Clinical and radiological assessment of rhinomaxillary syndrome in Hansen’s disease

Background: More than four million people today live with Hansen’s disease, and 200,000 new cases are diagnosed every year. Lifetime effects of Hansen’s disease manifest as changes to bones of the face, hands and feet, resulting in physical impairment, secondary complications and facial changes that can be detrimental to quality of life, particularly among the elderly. Aims: This study aimed to perform a detailed characterization of rhinomaxillary syndrome and its clinical manifestations in older persons treated in the past for Hansen’s disease. Methods: This was a cross-sectional study to characterize rhinomaxillary syndrome among older persons (age 60+ years) resident at Pedro Fontes Hospital, Cariacica, Espírito Santo, Brazil. Computed tomography images were examined with three-dimensional reconstructions to assess alterations to maxillofacial bones according to criteria for radiological rhinomaxillary syndrome. Participants were examined to assess facial alterations according to criteria for clinical rhinomaxillary syndrome. Results: Rhinomaxillary syndrome was investigated in 16 participants (ten females and six males), median age 70 (range 60–89) years, age at diagnosis 20 (6–43) years and time since diagnosis 46 (26–70) years. Four participants fully met radiological rhinomaxillary syndrome criteria, four partially. All participants with full radiological rhinomaxillary syndrome presented with facial changes which met criteria for clinical rhinomaxillary syndrome, including “saddle nose” (loss of nasal dorsal height and shortened length of nose, due to cartilaginous and/or bone collapse), concave middle third of the face with sunken nose, maxillary retrognathia and inverted upper lip. Limitations: Clinical histories were incomplete for some participants because records were lost at the hospital over time. Conclusion: Until Hansen’s disease is eliminated from endemic countries, persons affected will continue to present with rhinomaxillofacial alterations caused by Mycobacterium leprae infection. Clinical protocols for assessment and long-term care need to include otorhinolaryngological evaluation, mainly to prevent secondary complications. When rhinomaxillofacial bone changes are suspected, this evaluation should be supported by computed tomography imaging, if available.

Acroqueratoelastoidosis: reporte de un caso clínico / Acrokeratoelastoidosis: reportof a clinical case

Resumen La acroqueratoelastoidosis es una rara genodermatosis de herencia autosómica dominante, familiar o esporádica, siendo esta última la forma más frecuentemente reportada en la literatura. Fue descripta por el dermatólogo de origen brasileño Oswaldo Costa en el año 1953. Así las acroqueratodermias marginales son un subgrupo de queratodermiaspalmoplantares caracterizadas por la presencia de pápulas y placas queratósicas, con una disposición lineal, que asientan sobre el margen de transición entre la piel dorsal y palmar o plantar.Suelen iniciarse en la infancia, en la adolescencia o en la vida adulta temprana y tienen un curso crónico. Su diagnóstico diferencial con el resto de las acroqueratodermias es un gran desafío, siendo el hallazgo histológico de elastorrexis lo primordial para su correcto diagnóstico. Presentamos el caso de una mujer de 22 años con un cuadro compatible clínica e histopatológicamente con Acroqueratoelastoidosis.

Abstract Acrokeratolastoidosis is a rare genodermatosis of dominant autosomal, familial or sporadic inheritance, the latter being the most frequently reported form in the literature. It was described by the Brazilian dermatologist Oswaldo Costa in 1953. It is characterized by the presence of multiple hyperkeratotic papules, usually asymptomatic, located in the marginal area of the hands, feet or both. It usually begins in childhood, adolescence or early adult life and has a chronic course. Its differential diagnosis with the rest of the acrokeratosis is a great challenge, being the histological finding of elastorrexis the primary for its correct diagnosis. We present the case of a 22-year-old woman with a clinical and histopathology compatible with Acroqueratoelastoidosis.

Aortic valve replacement with a conventional stented bioprosthesis versus sutureless bioprosthesis: a study of 763 patients

Abstract Objective: The aim of this retrospective study was to compare early postoperative outcomes after aortic valve replacement (AVR) with sutureless bioprostheses and conventional stented bioprostheses implanted through median sternotomy. Methods: From January 2011 to December 2016, 763 patients underwent aortic valve replacement with bioprostheses; of these, 139 received a Perceval S sutureless valve (Group A) and 624 received a Perimount Magna Ease valve (Group B). These groups were further divided into A1 (isolated Perceval AVR), A2 (Perceval AVR with coronary artery bypass grafting [CABG]), B1 (isolated conventional stented bioprosthesis), and B2 (conventional stented bioprosthesis + CABG). Results: Patients in Group A were older (mean 74 years vs. 71 years; P<0.0001), predominantly women (53% vs. 32%; P<0.0001), had a higher logistic EuroSCORE (3.26 vs. 2.43; P<0.001), more preoperative atrial fibrillation (20% vs. 13%; P=0.03), and had a lower reopening rate for bleeding (2.1% vs. 6.7%; P=0.04). Compared to Group B1, Group A1 had shorter cross-clamp (mean 40 min vs. 57 min; P≤0.0001) and bypass times (mean 63 min vs. mean 80 min; P=0.02), and they bled less postoperatively (mean 295 ml vs. mean 393 ml; P=0.002). The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2. Conclusion: In our retrospective study of 763 patients, sutureless valve group patients are older, mostly women, more symptomatic preoperatively, and have higher logistic EuroSCORE. They have shorter cross-clamp and bypass times, less postoperative bleeding, and reduced incidence of reopening. Further studies are needed to evaluate the clinical benefits in short, mid, and long-terms.

Evaluation of Spatial Accessibility to Ohio Trauma Centers Using a GIS-Based Gravity Model.

Aims: Traumatic injury is one of the leading causes of death in all age groups. Ensuring adequate and effective access to trauma centers is key to improving the quality of care for injured patients. This study evaluates the spatial accessibility of Ohio trauma centers and identifies potentially underserved Ohio counties. Study Design: A gravity based accessibility model using a Geographic Information System (GIS) was implemented. Place and Duration of Study: The study was conducted in Nationwide Children’s Hospital in 2015. Methodology: A gravity based accessibility model using a Geographic Information System (GIS) was adapted to incorporate US census data, trauma center location data, and trauma center utilization data to quantify accessibility to trauma centers at both the zip code and county levels. An underserved index was developed to identify the location and clustering pattern of underserved regions within the state. Results: Most served counties were about 10 times more served than an average county while least served counties were about 4 times less served than an average county. Conclusion: Findings of this study are potentially useful for evaluating regionalized trauma care and provide evidence for trauma care system improvements.

Leaf Concentrate Fortification of Antenatal Protein- Calorie Snacks Improves Pregnancy Outcomes.

Ready-to-eat (RTE) snacks are routinely distributed to pregnant women in India. These provide protein and calories but are low in micronutrients. We investigated whether RTE snacks fortified with leaf concentrate (LC) could improve pregnancy outcomes, including maternal haemoglobin (Hb) concentrations and infants’ birthweight. This randomized controlled two-arm trial was conducted over 18 months: control (sRTE) group received standard 120 g RTE snack (102 g wheat flour, 18 g soya flour); intervention (lcRTE) group received the same snack fortified with 7 g LC. The study was conducted in Jaipur, Rajasthan, India. One hundred and five pregnant women aged 18-35 years were studied. Among the 105 women randomized to the two arms of the trial, 2 (1.9%) were severely anaemic (Hb ≤6.0 g/dL); 55 (53.4%) were moderately anaemic (Hb 6.0-8.0 g/ dL); 34 (33.0%) were mildly anaemic (Hb 8.6-10.9 g/dL); and 12 (11.7%) were not anaemic (Hb ≥11.0 g/dL). In the final month of pregnancy, 83.0% (39/47) of women in the sRTE group had Hb ≤8.5 g/dL compared to 37.8% (17/45) in the lcRTE group (p<0.001). After adjustment for age and baseline Hb concentration, the difference in Hb concentrations due to LC fortification was 0.94 g/dL (95% CI 6.8-12.0; p<0.001). Mean live birthweight in the lcRTE group was 2,695 g (SD 325 g) compared to 2,545 g (297 g) in the sRTE group (p=0.02). The lcRTE snacks increased infants’ birthweight by 133.7 g (95% CI 7.3-260.2; p=0.04) compared to sRTE snacks. Leaf concentrate fortification of antenatal protein-calorie snacks in a low-income setting in India protected against declining maternal haemoglobin concentrations and increased infants’ birthweight when compared with unfortified snacks. These findings require replication in a larger trial.

Prevalence of Hepatitis B e Antigen in Chronic HBV Carriers in North-central Nigeria.

Hepatitis B virus (HBV) is an important clinical problem due to its worldwide distribution and potential of adverse sequelae, including hepatocellular carcinoma (HCC). We studied the prevalence of hepatitis B virus e antigen (HBeAg) among individuals determined to be HBV surface antigen-positive (HBsAg+) and analyzed the gender/age category associated with more active HBV infection. A total of 572 HBsAg+ individuals, as determined by a double antibody sandwich ELISA method, participated in the study. They were tested for HbeAg, using a lateral flow chromatographic immunoassay. One hundred and ten individuals were found to be HBeAg-positive giving an overall prevalence of 19.2%. Of these 110 individuals, 20 (18.2%) were females, and 90 (81.8%) were males. Thus, the prevalence of HBeAg appears to be higher in males than in females (p<0.05). Our data also revealed that the prevalence of HBeAg was higher in patients between the age-group of 0-10 years and 11-20 years and appeared to decrease with increase in age. Taken together, our data show that approximately 1/5 of HBV-infected individuals are HBeAg+, suggesting that the virus is actively replicating and infecting liver-cells thereby ensuring an HBV-transmission pool within the Nigerian population. We suggest strengthening of the childhood HBV vaccination programmes, massive intervention activities, and treatment programmes, especially among young people to reverse the possible devastating effect of HBV infection. The success of these efforts will depend on our resolution to make the elimination of HBV infection a top priority on the public-health agenda as we start the second decade of this new century.

Economic Impact of Dyspepsia in Rural and Urban Malaysia: A Population-Based Study

BACKGROUND/AIMS: The economic impact of dyspepsia in regions with a diverse healthcare system remains uncertain. This study aimed to estimate the costs of dyspepsia in a rural and urban population in Malaysia. METHODS: Economic evaluation was performed based on the cost-of-illness method. Resource utilization and quality of life data over a specific time frame, were collected to determine direct, indirect and intangible costs related to dyspepsia. RESULTS: The prevalences of dyspepsia in the rural (n = 2,000) and urban (n = 2,039) populations were 14.6% and 24.3% respectively. Differences in socioeconomic status and healthcare utilisation between both populations were considerable. The cost of dyspepsia per 1,000 population per year was estimated at USD14,816.10 and USD59,282.20 in the rural and urban populations respectively. The cost per quality adjusted life year for dyspepsia in rural and urban adults was USD16.30 and USD69.75, respectively. CONCLUSIONS: The economic impact of dyspepsia is greater in an urban compared to a rural setting. Differences in socioeconomic status and healthcare utilisation between populations are thought to contribute to this difference.

Nest descriptions of Megalopta aegis (Vachal) and M. guimaraesi Santos & Silveira (Hymenoptera, Halictidae) from the Brazilian Cerrado / Descrição dos ninhos de Megalopta aegis (Vachal) e M. guimaraesi Santos & Silveira (Hymenoptera, Halictidae) do Cerrado

We present the first data on the nesting biology of Megalopta aegis and M. guimaraesi from southeastern Brazil. Nests were collected in the Área de Proteção Ambiental Água Limpa, Bauru, São Paulo state. Our data suggest that nest architecture is conserved throughout all species of Megalopta. Two nests of M. guimaraesi consisted of a single female with brood. Of three M. aegis nests, two contained single females with brood and the third nest contained three adult females, with three times more brood than any single female nest. This observation suggests that social behavior in M. aegis is facultative, as known for other Megalopta species.

Apresentamos os primeiros registros da biologia de nidificação de Megalopta aegis (Vachal) e de M. guimaraesi Santos & Silveira, do sudeste do Brasil. Os ninhos foram coletados na Área de Proteção Ambiental Água Limpa, Bauru, estado de São Paulo. Os dados sugerem que a arquitetura do ninho em Megalopta seja conservada entre suas espécies. Dois ninhos de M. guimaraesi continham apenas uma única fêmea com imaturos. Dos três ninhos de M. aegis, dois possuíam uma única fêmea com imaturos e o terceiro ninho continha três fêmeas adultas com três vezes mais imaturos do que nos ninhos com apenas uma fêmea. Essa observação sugere que o comportamento social em M. aegis seja facultativo, semelhante a outras espécies de Megalopta.

Antibacterial agents from the seeds of Peucedanum zenkeri L. [Umbelliferae]

In a search for natural substances with potential for the treatment of typhoid fevers and urogenital infections, the methylene chloride extract of the seeds of Peucedanum zenkeri was investigated. The extract was subjected to column chromatography leading to the isolation of seven compounds. Their structures were determined using modern 2D NMR techniques and by comparison with published NMR data. These compounds were tested against Salmonella typhi, Salmonella paratyphi B, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus, using both agar diffusion and broth dilution techniques. The compounds isolated were umbelliprenin [1], prangenin [2], imperatorin [3], isopimpinellin [4], bergapten [5], cnidilin [6] and stigmasterol [7]. Among the above seven compounds, only two [1 and 2] exhibited antibacterial activity. For compound 1, the MIC value was 300 micro g/ml against P. aeruginosa, S. aureus, S. typhi and S. paratyphi B. For compound 2, the MIC values varied between 200 and 300 micro g/ml against all the bacteria strains tested. These data suggest that Peucedanum zenkeri seed extract contains antibacterial agents which are active against Salmonella species causing typhoid and paratyphoid fevers, and some bacteria strains causing urogenital infections. The antibacterial activity of compound 2 appears to be due to the epoxide group present in its structure

Human immunonodeficiency virus, hepatitis B virus and hepatitis C virus: sero-prevalence, co-infection and risk factors among prison inmates in Nasarawa State, Nigeria

Background: Published data on HIV; HBV; and HCV in correctional facilities in Nigeria is scarce. We set out to establish the seroprevalence; co-infection; and risk factors for these infections for the first time among prison inmates in Nasarawa State; Nigeria. Methodology: In a cross-sectional study conducted between April and May; 2007; blood samples were collected from 300 male prisoners of a mean age of 29.2 years; in the state's four medium-security prisons (overall population: 587). Prior to the study; ethical clearance and informed consent were obtained and structured questionnaires were administered. Samples were analyzed for HIV; HBsAg; and HCV using anti-HIV 1 +2-EIA- avicenna; ShantestTM-HBsAg ELISA; and anti-HCV-EIA-avicenna; respectively. Specimens initially reactive for HIV were retested with vironostika microelisa. Data were analyzed using SPSS version 13.0. P values = 0.05 were considered significant. Results: Of the 300 subjects; 54 (18.0); 69 (23.0); and 37 (12.3) tested positive for HIV; HBV; and HCV; respectively. Co-infections were eight (2.7) for HIV/HBV and two (0.7) for HBV/HCV. Those aged 21-26 years were more likely to be infected with HIV and HBV; while those aged 33-38 years had the highest HCV infection. Associated risk factors included duration in prison; previous incarceration (for HIV; HBV and HCV); intra-prison anal sex; multiple sex partners (for HIV and HBV); ignorance of transmission modes; blood transfusion; and alcohol consumption (for HBV and HCV). No inmate injected drugs. Conclusions: The overall outcome represents the need for prison-focused intervention initiatives in Nigeria. Injected drug use is an unlikely major transmission mode among Nigerian inmates

Discinesia apical transitoria / Apical ballooning

La discinesia apical transitoria es una entidad infrecuente, de descripción reciente, que se presenta como un síndrome coronario agudo, generalmente ST pero sin lesiones coronarias significativas que lo justifiquen. Se presenta un caso clínico con revisión bibliográfica actualizada.

Human immunodeficiency virus infection in Nigeria

Study of the increasing epidemic of human immunodeficiency virus (HIV) infection in Nigeria provides insight into the magnitude of its spread, and allows identification of particular population groups which must be the target for preventive measures and increased public awareness campaigns. We have reviewed records documenting the disease in Nigeria since the first case was reported in 1986. Prevalence surveys have allowed identification of the rate of increase in the infection in various regions of Nigeria, and among various population groups: blood donors, those attending ante-natal care clinics (ANC), those attending sexually transmitted diseases clinics (SDT), commercial sex workers (CSW), and patients with tuberculosis. We also reviewed the success of campaigns to increse awareness of AIDS in Nigeria. There were over 2 million cases of HIV infection in Nigeria in 1996, based on a national prevalence of 3.8 percent. The highest prevalence of infection was in the Middle Belt region of the country with 9.6 percent positivity of those tested in 1992, and 33.6 percent in 1994. Among blood donors, the percentage of those infected rose from 0 percent in 1987, to 4.4 percent in 1992, in one medical center; and in 1995, in ANC the prevalence ranged from 0.2 percent to 12.9 percent of mothers (median 5.0 percent). High rates of infection were recorded among CSW (71.3 percent in one region), those attending STD clinics (27.4 percent in one region), long-haul truck drivers and policemen. Patients with tuberculosis also had a high prevalence of infection. Public awareness and adequate surveillance data remain inadequate in view of the magnitude of the problem. Increased funding and judicious expenditures are essential to obtain and distribute accurate information in order to begin to resolve this epidemic.

Response to heterologous leishmanins in cutaneous leishmaniasis in Nigeria - discovery of a new focus

A pilot study was undertaken to preliminary illustrate the leishmanin skin test (LST) positivity to distinct antigen preparations (derived from promastigote of either Leishmania major or L. amazonensis, or pooled L. mexicana, L. amazonensis and L. guyanensis) in cutaneous leishmaniasis (CL) patients and healthy subjects living in two endemic foci in Nigeria. The study was designed to provide insights into whether cross-species leishmanin, such as that prepared from New World Leishmania could be useful to detect cases of Old World leishmanial infection and to compare the results with LST using L. major-derived leishmanin. The overall LST positivity in individuals from Keana tested with the cross-major-derived leishmanin was 28.7 per cent (27/94), while the positivity rate in the subjects from Kanana tested with the same leishmanin was 54.5 per cent (6/11). Lower positivity values were obtained when L. major (12.5 per cent; 11/88) or L. amazonensis (15.8 per cent; 9/57) was tested as antigen in grossly comparable populations. Moreover, the pooled leishmanin identified most of the subjects (13/14; 92.9 per cent) with active or healed CL, and the maximum reaction sizes were found among positive subjects in this group. No healthy controls (10 total) showed specific DTH response. The LST was useful for assessing the prevalence of subclinical infection and for measuring CL transmission over time. We report for the first time the occurrence of CL in Kanana village of Langtang South local government area of Plateau State.

Disección aórtica aguda asociada con inhalación de cocaína / Acute aortic dissection associated with cocaine abuse

Se presenta el caso de un paciente de sexo masculino de 21 años de edad, con disección aórtica aguda, del tipo A de la clasificación de Daily, complicada con taponamiento cardíaco por hemopericardio, seguida de muerte. Adicto a la cocaína, había inhalado la misma hasta la internación. No presentaba hipertensión arterial y la necropsia no mostró necrosis quísticade la media aórtica. Se compara con otros casos similares hallados en la literatura

Alternativa de acceso vascular para diálisis / Alternative for vascular access for dialysis

El paciente que en la actualidad ingresa a hemodiálisis tiene una prolongada perspectiva de vida. Sin embargo, dicha expectativa se reducirá notablemente si se tuiliza la vasculatura sin una estrategia racional. Una situación común es la de aquellos pacientes renales crónicos que evidencian "falta de arterias" apropiadas para canulación arteriovenosa. Esto se aprecia con cierta frecuencia en diabéticos, obesos. arterioscleróticos, enfermos con esclerodemia y en la miloidosis...Con el uso de catéteres profundos colocados quirúgicamente en yugular o en safena interna se logra: a)no requerimiento de venas de miembros superiores ni arterias, b)uso inmediato, c)simplicidad de colocación quirúrgica, d)utilidad aún con severa hipotensión, e)prolongada viabilidad, f) satisfactoria recirculación, g)satisfactorio caudal sanguíneo efectivo, h)apropiados clearences, i)ausencia de hemólisis, trombosis e infección.

T-cell differentiation antigens and antigenic lymphocyte reactivity in pleural effusions.

Blood and pleural effusion mononuclear cells from thirteen patients were examined for the expression of T lymphocyte differentiation antigens as well as in vitro thymidine incorporation. The ratio of T4 to T8 cells was significantly greater among pleural effusion lymphocytes than among blood lymphocytes. Effusion lymphocyte responses to phytohaemagglutinin were less than those of blood lymphocytes. Unstimulated thymidine incorporation was greater in pleural effusion lymphocytes. Antigen-stimulated lymphocyte reactivity was not consistently greater in either blood or effusion lymphocytes. Lymphocytes from tuberculous effusions all reacted to tuberculin. Pleural effusion lymphocytes, regardless of the etiology of the effusion, possessed the same range of antigenic specificities as did blood lymphocytes. Therefore, effusion lymphocyte responsiveness to tuberculin does not prove the presence of tuberculous pleurisy but does indicate sensitisation to tuberculin.

Experiencia en diálisis peritoneal crónica / Experiences in chronic peritoneal dialysis

Conclusiones: Nuestra experiencia inicial con DPI resultó satisfactoria. Los resultados dependen fuertemente de la selección del paciente. Los resultados con DPCA son alentadores. Es preciso trabajar con materiales confiables. Se estima que una atinada selección de los candidatos es necesaria.