Combined antidiabetic benefits of exenatide and dapagliflozin in diabetic mice.

The combined glucose-lowering effect of exenatide and dapagliflozin has not yet been studied. We investigated this combination (single-dose or 4-week dosing) in diabetic ob/ob mice. Vehicle-corrected basal glucose showed greater reduction 1 h following exenatide + dapagliflozin than with exenatide or dapagliflozin alone, and stayed significantly lower for all groups versus vehicle over 3 h. During an oral glucose tolerance test, glucose excursion (30 min post-dose) was significantly lower for exenatide + dapagliflozin versus exenatide or dapagliflozin, or vehicle. Exenatide + dapagliflozin and exenatide, but not dapagliflozin alone, reduced glucose excretion over 24 h versus vehicle. After dosing for 4 weeks, exenatide, dapagliflozin and exenatide + dapagliflozin similarly decreased haemoglobin A1c (HbA1c). Body weight was reduced only with exenatide or exenatide + dapagliflozin. The glomerular filtration rate was similar with exenatide, dapagliflozin and vehicle, and increased with exenatide + dapagliflozin. Optimized combinatorial dosing of these antidiabetic agents may provide additive glucose lowering in type 2 diabetes mellitus.

Acute hepatitis due to dengue virus in a chronic hepatitis patient

We present a case of acute hepatitis caused by dengue virus, with a significant increase in aspartate transferase and alanine transferase levels in a chronic hepatitis patient attended at the Cane Sugar Planters Hospital of Campos dos Goytacazes, RJ.

Acute hepatitis due to dengue virus in a chronic hepatitis patient.

We present a case of acute hepatitis caused by dengue virus, with a significant increase in aspartate transferase and alanine transferase levels in a chronic hepatitis patient attended at the Cane Sugar Planters Hospital of Campos dos Goytacazes, RJ.

Production of interferon-gamma by natural killer cells and aging in chronic human schistosomiasis.

BACKGROUND: Aging is associated with several alterations in the phenotype, repertoire and activation status of lymphocytes as well as in the cytokine profile produced by these cells. As a lifelong condition, chronic parasitic diseases such as human schistosomiasis overlaps with the aging process and no systematic study has yet addressed the changes in immune response during infection with Schistosoma mansoni in older individuals. AIM: Herein we study the influence of immunological alterations brought about by senescence in the course of schistosomiasis. MATERIALS AND METHODS: Individuals 10-95 years of age, from both sexes, from an endemic area for S. mansoni infection were matched by intensity of infection as measured by egg counts. We analyzed, as a parameter, cytokine expression by lymphocytes and natural killer cells after in vitro stimulation with soluble egg antigen and soluble worm antigen using flow cytometry. RESULTS: We demonstrated that the frequency of CD16+ interferon-gamma (IFN-gamma)+ natural killer cells in negative individuals over the age of 70 years is significantly higher than in positive individuals after in vitro stimulation with S. mansoni antigen extracts. The frequency of these cells is increased in all individuals over the age of 50 years and only declines in positive individuals after 70 years of age. Analysis of either CD4? or CD8? cells after antigen stimulation show no significant increase in frequency of IFN-gamma in negative or in positive individuals of this age group, suggesting that the effect on CD16+ cells is not T-cell dependent. CONCLUSION: Since production of IFN-gamma has been related to resistance to schistosome infection, our data suggest that age-associated changes in CD16+ cells may play a role in controlling infection intensity in the elderly in S. mansoni endemic areas of Brazil.

Pancreatic tuberculosis.

Tuberculosis infrequently involves pancreas. The clinical features in patients with pancreatic tuberculosis are usually non-specific. The radiological features mimic pancreatic malignancy or pancreatitis. Ultrasound or CT scan guided fine needle aspiration cytology or biopsy may show caseating granulomatous inflammation. The present report includes two cases of pancreatic tuberculosis and review of relevant literature. One of our patients was diagnosed at laparotomy and the other with a CT scan guided fine needle aspiration cytology. Both patients responded well to anti tubercular chemotherapy and are now asymptomatic.

Effect of platelet-activating factor antagonists (BN-52021, WEB-2170, and BB-882) on bacterial translocation in acute pancreatitis.

Bacterial translocation is an important source of pancreas infection in acute pancreatitis. The effect of platelet-activating factor (PAF) in the pathogenesis of acute pancreatitis has been proved in various studies. The aim of this study was to determine whether potent PAF antagonists influence bacterial translocation in acute pancreatitis. Acute pancreatitis was induced in 62 Wistar rats by injection of 2.5% sodium taurocholate into the biliopancreatic duct. The rats treated with PAF factor antagonists received intravenous injection of WEB-2170 (10 mg/kg), lexipafant (5 mg/kg), and BN-52021 (5 mg/kg) 30 minutes before induction of acute pancreatitis. Six hours after induction of acute pancreatitis, bacteriologic cultures and histologic scoring of tissues were performed. There was a statistically significant reduction in bacterial translocation to the mesenteric lymph nodes and liver but not to the pancreas of the rats treated with PAF antagonists. No significant increase in the intestinal bacterial population of any group was found. There were no statistical differences between the pancreatic histologic scores of the groups. PAF antagonists reduced bacterial translocation to distant sites other than the pancreas, preventing the bacterial dissemination that occurs in the early phase of acute pancreatitis and may have beneficial effects on the evolution of this disease.

[A family's experience of home accidents--report of an experience]. / A família vivenciando o acidente doméstico--relato de uma experiência.

This study aims at knowing the behaviour of the family facing the home accidents among children, identifying the risk factors in the home environment, in the family's perception and analysing the socioeconomic-cultural context contributing to the occurrence of children's home accident. The work was made in a family that had experienced a case of poisoning of a 4 year-old child. Participant observation and the semi-structured interview were used as methodology. The results evidenced that the family constantly lives among children's home accidents and the socioeconomic-cultural context has a strong influence in the amount and quality of these cases.

[Bibliographic review of children's accidents]. / Revisão bibliográfica sobre acidentes com crianças.

The study's proposal was to evidence a bibliography review about children' accidents. The bibliography and documental researches were used as methodology. The data made clear that children accidents are the bigger public health problem in England. In the United States, in 1989, had happened about 2,700 deaths as accident results in children under 14 years old. In Brazil has been registered high index of attendance at pediatric emergencies that involves home accidents. It has been concluded that these cases have been increasing and they need special attention and preventive approach.

Gastric carcinoids--a clinicopathologic study.

AIM: Our objective was to document the clinical and pathological findings in eight patients with gastric carcinoids seen in our institution over a 16-year period (1980-96). METHODS: All cases reported during this period as microcarcinoids, atypical carcinoids and mixed carcinoid-carcinoma of the stomach were retrieved from pathology records. Eight cases with typical histologic features of carcinoid were studied. RESULTS: Seven cases were men (median age 53 years, range 35-55). Four patients presented with upper abdominal pain. Serum gastrin level was elevated in two cases. The endoscopic appearances and the endoscopic biopsy histology were not diagnostic. Surgical treatment ranged from simple nodule excision to partial, subtotal or extended gastrectomy and Whipple's pancreatico-duodenectomy. Lymph node and liver metastasis were seen in four patients each. The median duration of follow-up was one year. CONCLUSION: Gastric carcinoids have varied etiopathogenesis. These may arise in a background of hypergastrinemic conditions or may be sporadic. Most appear to be slow growing but aggressive neoplasms are capable of distant metastasis.

[Nobody wants to lose a child--nurses' observations of family reactions]. / Ninguém quer perder um filho--reações dos familiares observadas pela enfermagem.

The presence of veterinary products in the houses without any minimum security procedures has led to a poisoning case for a one-year old child who developed a serious systemic reaction. This child was interned at a Pediatric Intensive Care Unit at a public hospital in Fortaleza, Ceara. This study aims at identifying the family reaction facing a poisoning of a child and analyzing these reactions, interpreting its social cultural context. It has been developed as an ethnographic study case, consisting of the exploration, decision and discovery phases. It has been observed through the results that the family recognizes the existence of risk factors in home environment but does not adopt any coherent preventive methods with this experience. We do believe that these occurrences reduction demand transforming educative actions which may lead the family to be conscious towards the problematic that concerns poisoning for children, occurred under their responsibility.

Symptom control problems in an Indian hospice.

Symptom control is the essence of palliative care but is not without problems, especially in the difficult socio-economic conditions of a developing country. We present our experience with over 2000 hospice admissions over six years in India's first hospice, to highlight our problems and the measures we have taken to solve them. The prevalent habit of tobacco smoking and chewing in India gives rise to a high incidence of head and neck cancers which form 50% of our admissions. Another 24% is formed by breast and gynaecological cancers. The difficult symptoms in head and neck cancers are pain, dysphagia, fungation and trismus. Almost 25% of our head and neck cancers have feeding tubes, which we feel are justified and most useful for medication and basic nutrition. Difficult problems in gynaecological cancers are pain, chronic blood loss, ulcerations and fistulae. The inadequate or sporadic availability of oral and injectable morphine adds to our problems in pain control. Non-compliance of patients to take adequate medications and the resistance from relatives make it sometimes difficult to achieve optimum symptom control. India has many systems of alternate and unorthodox medicine. We find that these are best tried outside the hospice unless they are in fully-studied clinical trials. In the end there is always the difficult choice of either remaining in the hospice for optimal symptom control or going back to their homes, where this may not be available.

Isolated pancreatic metastasis from locally controlled breast cancer: a case report.

An unusual isolated metastatic carcinoma to the head of pancreas following modified radical mastectomy for operable breast cancer (T2NOMO) done three years earlier is reported. Patient remains free of disease at 27 months following whipple's pancreaticoduodenectomy.

The role of total gastrectomy in locally advanced gastric carcinoma.

The role of total gastrectomy in adenocarcinoma of the stomach has been controversial due to the high morbidity and mortality rates associated with the procedure. A retrospective analysis of all total gastrectomies performed for adenocarcinoma of the stomach, between January 1975 and December 1986 at the Tata Memorial Hospital was undertaken to evaluate the results and establish the usefulness of the procedure.

Results of operative treatment of displaced external rotation-abduction fractures of the ankle.

One hundred and fifty patients with a displaced fracture of the ankle caused by external rotation-abduction forces were treated by open reduction and rigid internal fixation. After an average follow-up of three and one-half years, the results were satisfactory in 90 per cent. Less satisfactory results were noted in the more severely injured ankles. We found that the ruptured deltoid ligament did not need to be repaired if the lateral side was anatomically and rigidly fixed; in the Maisonneuve fracture, restoration of the fibular length was as important as stabilization of the fracture; with the use of the suprasyndesmotic screw, walking was permissible with the screw in situ; conforming the plate to the bend of the lateral malleolus was essential; and as much as two millimeters of lateral residual displacement of the lateral and medial malleoli was compatible with a satisfactory result, as was a similar displacement of the talus provided there was anatomical restoration of the lateral side.