Pustular and Erythrodermic Psoriasis in Patients Treated With Oral Glucocorticoids: A Survey of United States Dermatologists.

Dermatology dogma has cautioned against the use of orally administered glucocorticoids (OAG) in the treatment of psoriasis, largely due to concerns of life-threatening generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). However, studies show that OAG are frequently used for psoriasis, often by dermatologists. Given the widespread use of OAG, we see an urgency in examining the relationship between OAG usage and the development of GPP and EP. This anonymous electronic survey of 50 US dermatologists examines OAG use in the management of psoriasis and the frequency at which dermatologists report seeing associated adverse outcomes of GPP and EP. Overall, 9 out of 50 (18%) respondents occasionally prescribe OAG to patients with psoriasis. Dermatologists who prescribe OAG tended to be younger than those who did not, with two-thirds in clinical practice for 0-10 years. Among all respondents, 16% (8/50) had experienced one or more patients developing GPP/EP in the context of OAG treatment for psoriasis. Our study suggests that OAG for the management of psoriasis is not uncommon among U.S. dermatologists, despite nearly universal awareness of its risks. Our observed low prevalence of GPP and EP emphasizes the need for prospective studies to better characterize OAG’s risk/benefit profile in psoriasis. J Drugs Dermatol. 2022;21(4):427-429. doi:10.36849/JDD.6242.

Chronic relapsing neutrophilic meningitis as the sole manifestation of nocardiosis in a patient with mixed connective tissue disease.

We describe a rare case of a patient with mixed connective tissue disease maintained on chronic oral corticosteroids, who was hospitalized on five occasions over five consecutive months due to persistent relapsing neutrophilic meningitis caused by Nocardia asteroides. Immunosuppression due to the chronic use of corticosteroids was identified as the underlying mechanism of susceptibility. Our report highlights the challenges associated with systemic Nocardiosis, particularly in the immunocompromised host.

Activation of the receptor tyrosine kinase RET improves long-term hematopoietic stem cell outgrowth and potency.

Expansion of human hematopoietic stem cells (HSCs) is a rapidly advancing field showing great promise for clinical applications. Recent evidence has implicated the nervous system and glial family ligands (GFLs) as potential drivers of hematopoietic survival and self-renewal in the bone marrow niche; how to apply this process to HSC maintenance and expansion has yet to be explored. We show a role for the GFL receptor, RET, at the cell surface of HSCs in mediating sustained cellular growth, resistance to stress, and improved cell survival throughout in vitro expansion. HSCs treated with the key RET ligand/coreceptor complex, glial-derived neurotrophic factor and its coreceptor, exhibit improved progenitor function at primary transplantation and improved long-term HSC function at secondary transplantation. Finally, we show that RET drives a multifaceted intracellular signaling pathway, including key signaling intermediates protein kinase B, extracellular signal-regulated kinase 1/2, NF-κB, and p53, responsible for a wide range of cellular and genetic responses that improve cell growth and survival under culture conditions.

A proteome-integrated, carbon source dependent genetic regulatory network in Saccharomyces cerevisiae.

Integrated regulatory networks can be powerful tools to examine and test properties of cellular systems, such as modelling environmental effects on the molecular bioeconomy, where protein levels are altered in response to changes in growth conditions. Although extensive regulatory pathways and protein interaction data sets exist which represent such networks, few have formally considered quantitative proteomics data to validate and extend them. We generate and consider such data here using a label-free proteomics strategy to quantify alterations in protein abundance for S. cerevisiae when grown on minimal media using glucose, galactose, maltose and trehalose as sole carbon sources. Using a high quality-controlled subset of proteins observed to be differentially abundant, we constructed a proteome-informed network, comprising 1850 transcription factor interactions and 37 chaperone interactions, which defines the major changes in the cellular proteome when growing under different carbon sources. Analysis of the differentially abundant proteins involved in the regulatory network pointed to their significant roles in specific metabolic pathways and function, including glucose homeostasis, amino acid biosynthesis, and carbohydrate metabolic process. We noted strong statistical enrichment in the differentially abundant proteome of targets of known transcription factors associated with stress responses and altered carbon metabolism. This shows how such integrated analysis can lend further experimental support to annotated regulatory interactions, since the proteomic changes capture both magnitude and direction of gene expression change at the level of the affected proteins. Overall this study highlights the power of quantitative proteomics to help define regulatory systems pertinent to environmental conditions.

Septicemia por Chromobacterium Violaceum en pediatría / Septicemia due to Chromobacterium Violaceum in pediatrics

Chromobacterium violaceum es una bacteria gram negativa anaerobia facultativa, que se encuentra ampliamente distribuida en el agua y el suelo en regiones tropicales y subtropicales, que se asocia con infecciones respiratorias, gastrointestinales, abscesos hepáticos, meningitis, endocarditis, síndrome hemofagocítico y sepsis fulminante. Se presentan 2 casos en niños: el primero es un varón de 8 años con lesiones en piel, fiebre y adenitis inguinal, que ingresó con un cuadro de sepsis severa, síndrome de distrés respiratorio agudo (SDRA) y falleció a las 3 h del ingreso. De los hemocultivos se aisló Chromobacterium violaceum. El segundo caso, es una niña de 12 años con antecedente de fiebre y adenopatía inguinal secundaria a herida cortopunzante en el pie homolateral, que ingresó con un cuadro de sepsis, con desarrollo de abscesos múltiples profundos. De la colección obtenida de piel y partes blandas y de un aspirado traqueal se aisló Chromobacterium violaceum. Recibió tratamiento antibiótico adecuado y posteriormente fue dada de alta. Se realizó una revisión bibliográfica de esta infección en niños y se encontraron 44 casos en todo el mundo. Algunos de éstos, se relacionaron con inmunodeficiencia de base, como la enfermedad granulomatosa crónica. La infección por esta bacteria es rara y se presenta como un cuadro grave que no responde a antibióticos habituales de uso empírico y tiene una alta tasa de mortalidad (AU)

Chromobacterium violaceum is a facultative anaerobic Gramnegative bacillus, widely distributed in water and soil in tropical and subtropical regions and associated with respiratory and gastrointestinal infections, liver abscesses, meningitis, endocarditis, hemophagocytic syndrome, and fulminant sepsis. Here two pediatric cases are presented: The first was an 8-year-old boy with skin lesions, fever, and inguinal adenitis, who was admitted with severe sepsis, acute respiratory distress syndrome (ARDS) and died three hours after. Chromobacterium violaceum was isolated from blood cultures. The second case was a 12-year-old girl with a history of fever and inguinal adenopathy secondary to a wound in the homolateral foot, who was admitted because of sepsis and multiple deep abscesses. From samples collected from the skin and soft tissues as well as tracheal aspirate Chromobacterium violaceum was isolated. Adequate antibiotic treatment was started and the patient was subsequently discharged. In a review of the literature, 44 cases worldwide were identified. Some of these cases were related to underlying immunodeficiency, such as chronic granulomatous disease. Infection with this bacterium is rare and presents with severe manifestations that do not respond to the common empirical antibiotics and are associated with a high mortality rate (AU)

Temperature regulates NF-κB dynamics and function through timing of A20 transcription.

NF-κB signaling plays a pivotal role in control of the inflammatory response. We investigated how the dynamics and function of NF-κB were affected by temperature within the mammalian physiological range (34 °C to 40 °C). An increase in temperature led to an increase in NF-κB nuclear/cytoplasmic oscillation frequency following Tumor Necrosis Factor alpha (TNFα) stimulation. Mathematical modeling suggested that this temperature sensitivity might be due to an A20-dependent mechanism, and A20 silencing removed the sensitivity to increased temperature. The timing of the early response of a key set of NF-κB target genes showed strong temperature dependence. The cytokine-induced expression of many (but not all) later genes was insensitive to temperature change (suggesting that they might be functionally temperature-compensated). Moreover, a set of temperature- and TNFα-regulated genes were implicated in NF-κB cross-talk with key cell-fate-controlling pathways. In conclusion, NF-κB dynamics and target gene expression are modulated by temperature and can accurately transmit multidimensional information to control inflammation.

Glutamate receptors of the A5 region modulate cardiovascular responses evoked from the dorsomedial hypothalamic nucleus and perifornical area

To assess the possible function of glutamate in the interaction between the dorsomedial hypothalamic nucleus-perifornical area (DMH-PeF) and the A5 pontine region (A5), cardiovascular and respiratory changes were studied in response to electrical stimulation of the DMH-PeF (1 ms pulses, 30-50 miA given at 100 Hz for 5 s) before and after the microinjection of kynurenic acid (non-specific glutamate receptor antagonist; 50 nl, 5 nmol), MK-801 (NMDA receptor antagonist; 50 nl, 50 nmol), CNQX (non-NMDA receptor antagonist; 50 nl, 50 nmol) or MCPG (metabotropic glutamate receptor antagonist; 50 nl, 5 nmol) within the A5 region. DMH-PeF electrical stimulation elicited a pressor (p < 0.001) and tachycardic response (p < 0.001) which was accompanied by an inspiratory facilitation characterised by an increase in respiratory rate (p < 0.001) due to a decrease in expiratory time (p < 0.01). Kynurenic acid within the A5 region decreased the tachycardia (p < 0.001) and the intensity of the blood pressure response (p < 0.001) to DMH-PeF stimulation. After the microinjection of MK-801 and CNQX into the A5 region, the magnitude of the tachycardia and the pressor response were decreased (p < 0.05 and p < 0.01; p < 0.001 and p < 0.05, respectively). After MCPG microinjection into the A5 region, a decrease in the tachycardia (p < 0.001) with no changes in the pressor response was observed during DMH-PeF stimulation. The respiratory response elicited by DMH-PeF stimulation was not changed after the microinjection of kynurenic acid, MK-801, CNQX or MCPG within the A5 region. These results suggest that A5 region glutamate receptors play a role in the cardiovascular response elicited from the DMH-PeF. The possible mechanisms involved in these interactions are discussed

Glutamate receptors of the A5 region modulate cardiovascular responses evoked from the dorsomedial hypothalamic nucleus and perifornical area.

To assess the possible function of glutamate in the interaction between the dorsomedial hypothalamic nucleus-perifornical area (DMH-PeF) and the A5 pontine region (A5), cardiovascular and respiratory changes were studied in response to electrical stimulation of the DMH-PeF (1 ms pulses, 30-50 µA given at 100 Hz for 5 s) before and after the microinjection of kynurenic acid (non-specific glutamate receptor antagonist; 50 nl, 5 nmol), MK-801 (NMDA receptor antagonist; 50 nl, 50 nmol), CNQX (non-NMDA receptor antagonist; 50 nl, 50 nmol) or MCPG (metabotropic glutamate receptor antagonist; 50 nl, 5 nmol) within the A5 region. DMH-PeF electrical stimulation elicited a pressor (p < 0.001) and tachycardic response (p < 0.001) which was accompanied by an inspiratory facilitation characterised by an increase in respiratory rate (p < 0.001) due to a decrease in expiratory time (p < 0.01). Kynurenic acid within the A5 region decreased the tachycardia (p < 0.001) and the intensity of the blood pressure response (p < 0.001) to DMH-PeF stimulation. After the microinjection of MK-801 and CNQX into the A5 region, the magnitude of the tachycardia and the pressor response were decreased (p < 0.05 and p < 0.01; p < 0.001 and p < 0.05, respectively). After MCPG microinjection into the A5 region, a decrease in the tachycardia (p < 0.001) with no changes in the pressor response was observed during DMH-PeF stimulation. The respiratory response elicited by DMH-PeF stimulation was not changed after the microinjection of kynurenic acid, MK-801, CNQX or MCPG within the A5 region. These results suggest that A5 region glutamate receptors play a role in the cardiovascular response elicited from the DMH-PeF. The possible mechanisms involved in these interactions are discussed.

Design of a Mobile Application for Transfusion Medicine.

One of the most frequent error in transfusion medicine is the failure in verifying the patient's identity prior to transfusion. This paper describes the design and development of a Mobile Application (MA) for transfusion medicine. The app uses barcode and QR reading technology for the verification of the patient's identity and the administration of blood components when making a blood transfusion. Physicians, developers, technicians of transfusion medicine and a User Centered Design team participated in the design. The inclusion of end users was fundamental to get full representativeness of their workflow. The project was based on agile methodologies of project management and software development.

Respuesta endocrina a la aplicación de vibraciones de cuerpo completo en humanos / / Resposta endócrina à aplicação da vibração de corpo inteiro em humanos / Endocrine response to the application of Whole-Body Vibration in humans

La realización de ejercicio físico provoca un rompimiento de la homeostasis corporal, induciendo cambios metabólicos, neurales y humorales en el organismo de los seres humanos. Las hormonas cumplen múltiples tareas en el adecuado funcionamiento interno. Las vibraciones de cuerpo completo (VCC) se han sugerido en los últimos años como un medio alternativo para la realización de ejercicio físico. Según la bibliografía consultada a través de las VCC se encuentran modificaciones hormonales dependientes de las características intrínsecas de cada protocolo de intervención. El objetivo de esta revisión es recopilar la literatura científica más destacada sobre los efectos que se producen en el sistema endocrino (SE) de humanos a través del uso de las VCC (AU)

The physical exercise causes a breakdown of body homeostasis, inducing metabolic, neural and humoral changes in the human body. Hormones play multiple roles at the right inner workings. The Whole Body Vibration (WBV) has become an alternative to regular physical exercise. According to the consulted literature, WBV provokes a hormonal modification that is dependent on the intrinsic characteristics of each intervention protocol. The objective of this review is to compile the most prominent scientific literature on the effects that occur in the Endocrine System (ES) of humans through the use of WBV (AU)

O exercício físico causa um rompimento da homeostase corporal, induzindo alterações metabólicas, neurais e humorais no organismo dos seres humanos. Os hormónios desempenham diversas tarefas diretas em nosso funcionamento interno. As vibrações de corpo inteiro foram sugeridas nos últimos anos como um meio alternativo de exercício físico. De acordo com a literatura consultada, através da vibração de corpo inteiro foram encontradas alterações hormonais dependentes das características intrínsecas de cada protocolo de intervenção. O objetivo desta revisão foi reunir a literatura científica relevante sobre os efeitos que ocorrem no sistema endócrino dos seres humanos através do uso da vibração de corpo inteiro

Synergistic effect of porcine follicular fluid and dibutyryl cyclic adenosine monophosphate on development of parthenogenetically activated oocytes from pre-pubertal gilts.

This study investigated the effect of porcine follicular fluid (PFF) and dibutyryl cyclic adenosine monophosphate (dbcAMP) during in vitro maturation (IVM) of porcine oocytes on meiotic maturation, fertilization and embryo development, and compared the effect of supplementing the embryo culture media with PFF or foetal bovine serum (FBS) on embryo development. Oocytes from pre-pubertal gilts were IVM for 44 h, and parthenogenetically activated or in vitro-fertilized. Embryos were cultured in porcine zygote medium (PZM3) for 7 days. Cleavage and blastocyst rates were evaluated at 48 h and 7 days of culture. The supplementation of the IVM medium with 25% PFF and 1 mm dbcAMP for the first 22 h resulted in more (p < 0.05) embryos developing to the blastocyst stage as compared with the inclusion of dbcAMP alone. The dbcAMP + PFF combination increased (p < 0.05) the average number of nuclei per blastocyst as compared with either of these components alone or in its absence. A synergistic effect of dbcAMP + PFF during IVM was also reflected in the capacity of oocytes to regulate sperm penetration and prevent polyspermy, as twice as many oocytes from the control group were penetrated by more than one sperm as compared with those matured in the presence of both dbcAMP and PFF. The supplementation of PZM3 with 10% FBS from days 5 to 7 of culture significantly improved the total cell quantity in embryos derived either from control or dbcAMP + PFF matured oocytes. There was no effect on the total cell quantity when FBS was replaced by the same concentration of PFF. These studies showed that dbcAMP, PFF and FBS can improve both the quantity (57.3% vs 41.5%) and quality (74.8 vs 33.3 nuclei) of porcine blastocysts derived from oocytes recovered of pre-pubertal gilts.

Estudio radiográfico y electromiográfico de los músculos masetero y temporal anterior en individuos con maloclusión tipo II, 1 de angle y controles / Radiographic and electromiographic study of masseter and temporal anterior muscles in subjects with angle II, I malloclusion and controls

El objetivo de este estudio fue comparar la actividad electromiográfica (EMG) de los músculos Masetero (Ms) y Temporal anterior (Ta) de sujetos portadores de maloclusión Angle II, 1 y controles. Se seleccionaron 19 sujetos estudiantes universitarios con características antropométricas similares (edad, peso, talla e IMC). Clínica y radiográficamente se dividieron en dos grupos: Grupo Control (GC) individuos portadores de neutroclusión y Grupo Disto (GD) con individuos portadores de maloclusión Tipo II, 1 de Angle. Se les realizó una electromiografía de superficie (EMG) de acuerdo a la técnica de Ferrario et al. (1993) y se analizaron los datos a partir de Root Mean Square (RMS). A partir de este registro se analizaron la amplitud media de voltaje (mV), la relación Ms/Ta y la distribución de las clases de voltaje, determinadas por los potenciales de acción de unidades motoras (PAUM). De la telerradiografía se analizaron los siguientes datos: ANB, SNA, SNB según Steiner (1992), relación molar, ángulo alfa de inclinación del Ms y brazo de palanca de acuerdo al modelo de Throkcmorton et al. (1980). Se utilizó Test "t" Student para evaluar significancia estadística (p<0,05) entre los grupos. La amplitud de voltaje fue mayor en el GD para todos los músculos estudiados (p<0,05). La relación Ms/Ta fue mayor en el GC. El ángulo alfa fue mayor en GD, también el brazo de palanca. La distribución de PAUM fue mayor en GC (79,0 por ciento), que en GD (57,8 por ciento) (p<0,05). GD presenta mayor amplitud de voltaje que GC, probablemente por presentar menos aferencias inhibitorias periodontales. También GD presenta una menor variedad de PAUM lo que implica que tiene menos reserva funcional que GC.

The of this study is compare the electromiographic activity (EMG) of the Masseter (Ms) and Temporal Anterior (Ta) muscles in subjects with malocclusion Angle II, I and controls. This study involving 19 young adults with similar anthropometric characteristics (Age, weight, hight, BMI). We evaluate clinical and radiographicaly this subject and divided it in to groups: Control Group CG with neutrocclusion and Distal Group (DG) with Angle II, I malocclusion. The both groups was submit a surface EMG according to Ferrario et al. (1993). We used the root mean square (RMS) math operation to calculate the mean voltage amplitude for each muscle. Furthermore we calculate the ratio Ms/Ta and the distribution of voltage class determinate for motor units actions potentials (MUAP). The Rx examination included SNA, SNB and ANB angles according to Steiner (1992), alfa angle and lever arm of Ms according the Throckmorton et al. (1980) mandibular model. The Stundent "t" Test was used to determine whether there were significant differences (p<0.05) between CG and DG parameters. The voltage amplitude was more higher in DG than CG. The ratio Ms/Ta showed protagonism of Ms in CG. The alfa angle and lever arm of Ms were more greater in DG than CG. DG presents a poor number of voltage class (57.8 percent) respect to CG (79.0 percent). DG presents a greater voltage amplitude in relation to CG, probably because the feedback inhibitory periodontal tissue plays an important role. Moreover DG presents a low voltage classes distribution of MUAP that suggest that have minus functional reserve.

An overview of the use of computers in clinical rheumatology: models of care for the next millennium.

Practitioners of rheumatology in the 21st century are increasingly recognizing the benefits of computer technology as they relate to point-of-service care delivered in the hospital or in the outpatient setting. Electronic medical records and other computer-driven aids are resources emerging as affordable tools that can greatly enhance the rheumatologist's ability to provide stellar care, reduce professional and administrative burdens and improve lifestyle measures. Herein, we provide a practical nontechnical introduction to the world of electronic medical records, personal digital assistants, and other computer-dependent tools, with an emphasis placed on how these instruments can be used by the clinical rheumatologist to achieve excellence in medical care.

Production of culture filtrates of Sporothrix schenckii in diverse culture media.

Mycelial-form Sporothrix schenckii was studied to determine if growth in complex (Sabouraud-dextrose) or defined culture media (minimal medium, Gibco Medium 199 with and without Hepes buffer) with differing initial pH levels would affect expression of antigen components. Cultures were evaluated by continuous monitoring and serial sampling for various parameters. Great variation was seen in the protein and antigenic patterns induced by the different media. The expression of a 55 kDa component accompanied by significant acidification of the culture medium at the beginning of the stationary growth phase was notable in Sabouraud medium. In the chemically defined media, a 90 kDa component was expressed that reacted with sera from patients with sporotrichosis. The pH in these media showed little change during the different growth phases of the fungus. Among the media studied, minimal medium favored the expression of the greatest number of antigenic components. In all of the assays, the stationary growth phase appeared to be optimal for content of antigenic components. Cross reactions were not observed with any of the culture filtrates using sera from patients with other mycoses.

Intragastric gallstone-induced bezoar: an unusual cause of acute gastric outlet obstruction.

Bezoars are an uncommon cause of acute gastric outlet obstruction. To our knowledge, this is the first report of a bezoar formed around a gallstone that migrated to the stomach via a cholecystogastric fistula. Our patient was a 42-year-old African American woman with long-standing type 2 diabetes. We suspect that diabetic diathesis was the major factor responsible for producing the pathologic derangement of the gallbladder and stomach, which led to development of the bezoar and serious complications.

Análisis morfoestructural con microscopía óptica y electrónica de transmisión del esmalte dentario humano en superficies oclusales / Morhpostructural analysis with optic and scanning electron microscopy of the human dental enamel in occlusal surfaces

Para el análisis sitemático entre el aspecto clínico e histológico del estado progresivo de la caries dental, es indispensable conocer e interpretar las características estructurales, fisicoquímicas y biológicas del tejido adamantino en estado de salud. El objetivo de este trabajo fue describir las características histológicas, con microscopía óptica y electrónica de transmisión, del esmalte dentario, en premolare sy molares humanos con especial referencia a fosas y fisuras ocluesales y su eventual incidencia con lesiones de caries incipientes. Se usaron 14 unidades experimentales, premolares y molares humano extraídos por razones ortodónticas, quirúrugicas, siguiendo como criterio de inclusión la selección de piezas dentarias sin obturaciones ni evidencias macroscópicas de caries. El análisis estructural con microscopía óptica reveló en todos los especímenes laminillas del esmalte ubicadas en el fondo de una fosa o a nivel de las vertientes cuspídeas que delimitan la fosa oclusal. El análisis de la utraestructura con microscopía electrónica de transmisión reveló a diferentes aumentos: el contenido orgánico de los surcos intercuspídeos en interfase con el tejido adamantino. Por lo observado en este estudio, resultaría de gran interés demostrar la implicancia de las laminillas del esmalte como estructura asociada principalmente a las denominadas caries ocultas en superficies oclusales

Regulation of serine-type exoproteinases by endogenous inhibitors present in exoantigens of the mycelial form of Paracoccidioides brasiliensis.

We have partially characterized some biochemical properties of exoproteinases secreted into culture medium by the mycelial form of Paracoccidioides brasiliensis, a dimorphic fungus that causes human disease in Latin America. Proteinase activity was analyzed in solid- and liquid-phase systems using zymography and Azocoll, respectively. Minimal or no gelatinase activity was observed by zymography in the crude filtrates among proteins with a relative mobility greater than 200 kDa. When the crude filtrate was fractionated by isoelectric focusing or ion exchange chromatography, we observed striking activation of gelatinases, both those of high apparent molecular mass and alkaline isoelectric points (pI), as well as those of lower molecular mass and acidic pI. The apparent high molecular mass gelatinases, pI 10, showed optimal activity at pH 7.0. They were totally inhibited by phenylmethylsulfonylfluoride and partially inhibited by incubation with previously neutralized fractions of pI 5.4 and 6.1. The latter inhibition could be reversed by exposure to 10% isopropanol. These results provide evidence of regulatory mechanisms controlling proteinase activity in secreted proteins. The principal mechanism appears to be the formation of reversible complexes with endogenous inhibitors.