Association between cholera treatment outcome and nutritional status in children aged 2-4 years in Nigeria.

SETTING: Cholera can aggravate or precipitate malnutrition, and children with severe acute malnutrition (SAM) have a higher incidence and longer duration of diarrhoea. OBJECTIVE: To describe 1) characteristics of and treatment outcomes in children aged 2-4 years with cholera, 2) the case fatality rate (CFR) in all children treated, and 3) the associations between nutritional status, hydration status, treatment administered and hospital outcomes. DESIGN: An observational cohort study of children admitted to one cholera treatment centre in Maiduguri, Nigeria, with a focus on children aged 2-4 years. CFRs were examined by cross tabulation and mean length of stay (LOS) using analysis of variance. RESULTS: SAM was identified in 24% of children aged 2-4 years. The CFR for children aged 2-4 years was 1.4%. As the sample size was small, we did not find any association between nutritional status and death due to cholera. The proportion of children discharged within 2 days was 79%, and the longest stay was 8 days. In general, health facility LOS increased with severity of malnutrition. CONCLUSION: Our study found that nutritional status affected the LOS, but was unable to find an association between malnutrition and fatality among children aged 2-4 years.

CONTEXTE: Le choléra peut aggraver ou précipiter la malnutrition et les enfants atteints de malnutrition aiguë grave (SAM) ont une incidence plus élevée et une durée plus longue de diarrhée. OBJECTIF: Décrire 1) les caractéristiques et les résultats du traitement d'enfants de 2­4 ans atteints de choléra, 2) le taux de mortalité de tous les enfants traités, et 3) les associations entre état nutritionnel, hydratation, traitement administré et évolution à l'hôpital. SCHÉMA: Cohorte d'observation d'enfants admis au centre de traitement du choléra de Maiduguri, Nigeria, avec un focus sur les enfants de 2­4 ans. Les taux de létalité ont été examinés par tabulation croisée et la durée moyenne de séjour par analyse de la variance. RÉSULTATS: Une SAM a été identifiée chez 24% des enfants de 2­4 ans. Le taux de létalité des enfants de 2­4 ans était de 1,4%. La petite taille de la population n'a pas permis d'observer d'association entre état nutritionnel et décès dû au choléra. La proportion d'enfants sortis en 48h a été de 79% et la durée la plus longue de séjour de 8 jours. En général, la durée de séjour en structure de santé augmentait avec la gravité de la malnutrition. CONCLUSION: Notre étude a constaté que l'état nutritionnel affectait la durée de séjour mais n'a pas permis de trouver une association entre malnutrition et létalité parmi les enfants de 2­4 ans.

Intake, digestibility, ingestive behavior, production, and composition of goat milk supplemented with detoxified castor bean meal added urea as a replacement of soybean meal.

This study evaluated the castor bean meal detoxified with calcium hydroxide [Ca(OH)2] added urea replacing soybean meal in the diet of lactating goats from milk production and composition, intake, digestibility, and ingestive behavior. Eight Alpine multiparous goats weighting 44.3 ± 5.3 kg and at approximately 60 days of lactation were confined and randomly distributed in 4 × 4 double Latin squares, with four inclusion levels of detoxified castor meal: control (0), 25, 50, and 75 g/kg dry matter (DM) total. Detoxified castor bean meal replacing soybean meal (P > 0.05) in goats diet did not affect intake and digestibility of DM, crude protein, ether extract, neutral detergent fiber (NDF), total carbohydrates, non-fibrous carbohydrates and total digestible nutrients, times spent for eating, and efficiency ratios of rumination and eating. However, the times spent for rumination and idling showed a quadratic trend decrease (P < 0.01) from the level of 50.0-g/kg DM. The milk production, and the milk production correction showed a quadratic trend increase and feeding efficiency a quadratic decrease (P = 0.03) due inclusion of detoxified castor bean meal replacing soybean meal up to the level of 25.0 g/kg. The fat, protein, lactose, total solids, nonfat solids, and milk urea nitrogen content (g/day) presented a quadratic increase (P < 0.05) by detoxified castor meal inclusion. Detoxified castor bean meal added urea in the Alpine goats diet could be included up to the 25.0 g/kg level replacing soybean meal in the diet because improve milk production and composition and feeding efficiency of goats without negatively effect on intake, digestibility and ingestive behavior.

Review of small cell carcinomas of the prostate.

Small cell carcinoma of the prostate is a rare neoplasm, with only a few series hitherto reported. A little less than half of the cases are associated with conventional acinar adenocarcinoma, which are usually high grade. Although consensus has not been reached, the majority of patients with small cell neuroendocrine carcinoma of the prostate have advanced disease at diagnosis and disproportionally low PSA levels compared to patients with conventional acinar adenocarcinoma. Treatment consists mainly of chemotherapy associated with surgery. Radiation therapy is reserved for selected cases. This study reviews the most up-to-date information on small cell carcinomas of the prostate.

Prostatic carcinomas with neuroendocrine differentiation diagnosed in needle biopsies, a morphologic study of 7 cases among 465 sequential biopsies in a tertiary cancer center.

PURPOSE: Neuroendocrine carcinomas (NEC) of the prostate are rare, with only a few series hitherto reported. The objective of this study was to assess in a single institution the clinical and morphologic characteristics of neuroendocrine carcinomas diagnosed in needle core biopsies. MATERIALS AND METHODS: The current study analyses seven cases diagnosed in needle biopsies at a large tertiary regional cancer center from Northeastern Brazil. Two pathologists reviewed specimens retrospectively, and demographic and morphologic characteristics were compared to 458 acinar tumors diagnosed in the same period. RESULTS: There were five small cell carcinomas and two low-grade neuroendocrine carcinomas (carcinoid). NEC were associated with an acinar component in 5/7 cases and the Gleason score of the acinar component was always > 6. The number of cores involved in prostates with NEC was greater (65% compared to 24% of acinar tumors, p < 0.05). The mean PSA at diagnosis was 417.7 (range 5.7-1593, SD 218.3), compared to 100.5 (p = 0.1) of acinar tumors (range 0.3-8545, SD 22.7). Prostates harboring NEC were bigger (p < 0.001, mean volume 240 mL vs. 53 mL of acinar tumors). Treatment of NEC included palliative surgery, chemotherapy, and hormonal therapy. CONCLUSIONS: NEC of the prostate is rare and often associated with a high-grade acinar component. Prostates with NEC tend to be larger and involve a greater number of cores than acinar tumors. PSA at diagnosis does not seem to predict the presence of NE tumors in needle biopsy.

Organ donation: cross-sectional survey of knowledge and personal views of Brazilian medical students and physicians.

OBJECTIVE: To assess the knowledge, attitudes, and behavior associated with cadaver organ donation and transplantation among medical students and physicians. PATIENTS AND METHODS: We randomly selected 350 medical students, 150 physicians, and 150 intensive care unit physicians. Each completed a questionnaire consisting of 9 self-administered items, from which we gathered data about their knowledge about brain death and criteria for the diagnosis of brain death; their hypothetical behaviors, assuming willingness to donate their own or their family's organs; their trust in physicians; and their confidence in a diagnosis of brain death made by physicians. RESULTS: We observed that knowledge about brain death increased with medical education level; the best results were noted in intensive care unit physicians. Agreement to transplant organs from brain-dead donors (odds ratio [OR], 4.58), confidence in brain-death diagnosis by physicians (OR, 2.17), and knowledge about criteria for the diagnosis of brain death (OR, 2.26) were predictors of willingness to donate one's own organs. CONCLUSION: Enhanced medical knowledge of and involvement in donation are needed to achieve cadaver organ donation.

Ovarian dermoid cyst with malignant transformation and rupture of the capsule associated with chemical peritonitis: a case report and literature review.

Malignant transformation of ovarian dermoid cysts is rare and spontaneous rupture provoking chemical peritonitis is even rarer. Laparotomy in a 75-year-old Brazilian woman with abdominal pain and signs of peritoneal irritation revealed a voluminous right ovarian cyst with rupture of the capsule, an abundant quantity of fatty material in the abdominal cavity, and signs of peritonitis. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with partial omentectomy were performed. Histopathology confirmed a dermoid cyst with a well-differentiated area of epidermoid carcinoma. The patient refused additional treatment and is currently in the seventh year of follow-up with no signs of recurrence. Rupture of a dermoid cyst of the ovary resulting in chemical peritonitis is very rare and may be associated with malignant transformation.

CYP2C9 genotypes and the quality of anticoagulation control with warfarin therapy among Brazilian patients.

OBJECTIVE: To evaluate the impact of the two most common CYP2C9 variant alleles (*2 and *3) on the maintenance dose of warfarin and on the quality of anticoagulation control in Brazilians. METHODS: Patients (n = 103) initiated warfarin therapy with 5 mg/day (or 2.5 mg/day when over 80 years old). The international normalized ratio (INR) was targeted between 2 and 3, monitored every week until four consecutive adequate measures had been obtained, and then monthly. Serious hemorrhagic events were defined by the need for inpatient hospitalization. CYP2C9 genotyping was obtained by PCR-RFLP. RESULTS: The frequencies of CYP2C9*2 and CYP2C9*3 were 0.097 and 0.073, respectively, with genotypic distribution fitting Hardy-Weinberg equilibrium. CYP2C9 genotype was the only clinical feature associated with the risk of severe bleeding (one-sided P = 0.019, Fisher exact method), with an odds ratio of 4.8 (95% confidence interval of 1.4-16.6) for any variant genotype as compared to CYP2C9*1*1. Patients with either CYP2C9*2 or CYP2C9*3 were equally difficult to maintain in the INR target range, showing significantly (one-sided P = 0.038, Mann-Whitney U-test) reduced ratio of adequate INR measures (0.54 +/- 0.2), when compared to CYP2C9*1*1 patients (0.63 +/- 0.2). Patients with CYP2C9*3, but not CYP2C9*2, required significantly (one-sided P = 0.001, Mann-Whitney U-test) lower warfarin maintenance doses (3.1 +/- 1.8 mg) than CYP2C9*1*1 patients (5.3 +/- 2.1 mg). CONCLUSION: Patients with either CYP2C9*2 or CYP2C9*3 show higher risk of over-anticoagulation compared to CYP2C9*1*1 subjects and could benefit from a reduction in the initial warfarin standard dose (e.g., to 2.5 mg/day).

Involvement of nitric oxide in the pathogenesis of cyclophosphamide-induced hemorrhagic cystitis.

The involvement of nitric oxide (NO) and the potential modulation of NO synthase (NOS) activity by platelet-activating factor were investigated in a rat model of cyclophosphamide-induced hemorrhagic cystitis. Male Wistar rats received a single intraperitoneal injection of cyclophosphamide, and cystitis was evaluated 6, 12, 24, 48, and 72 hours later by determining the changes in bladder wet weight and plasma protein extravasation and the macro- and microscopic morphological alterations. In addition, NOS activity and NADPH-diaphorase histochemistry were studied in bladder tissues. Normal bladders showed extensive NADPH-diaphorase staining and a high level of constitutive NOS whereas the activity of inducible NOS was almost undetectable. Cyclophosphamide dose- and time-dependently increased the bladder wet weight and bladder plasma protein extravasation. These events were accompanied at a microscopic level by urothelial necrosis, sloughing, ulceration, hemorrhage, and leukocyte infiltration. Cyclophosphamide also increased the levels of inducible NOS but reduced those of constitutive NOS. The NOS inhibitors L-NG-nitroarginine methyl ester and L-NG-nitroarginine significantly reduced the cyclophosphamide-induced plasma protein extravasation and urothelial damage. This reduction was completely reversed by L-arginine but not by D-arginine. The administration of the platelet-activating factor antagonist BN 52021 decreased the cyclophosphamide-induced plasma protein extravasation as well as the rise in inducible NOS activity but had no effect on the fall in constitutive NOS activity. These results suggest that endogenous NO participates in the urothelial damage and in the inflammatory events leading to cyclophosphamide-induced hemorrhagic cystitis. Platelet-activating factor also seems to be involved in the pathogenesis of this condition, possibly by inducing NOS.