Rusty Pipe Syndrome and Review of Literature.

Presence of blood in colostrum may change the color of breast milk and it is known as "rusty pipe syndrome." It may resolve within days, but it may be a barrier for exclusive breastfeeding. Knowledge of "rusty pipe syndrome" among health professionals is very helpful in the management of breastfeeding initiation.

Joint Bleeding Tendencies in Adult Patients With Hemophilia: It's Not All Pharmacokinetics.

Hemophilic arthropathy from joint bleeding remains a complication with major morbidity in the increasingly aging patients with hemophilia. Prophylactic clotting factor infusions, based on pharmacokinetic dosing to reduce bleeding rates, are being explored more and more. However, there is little evidence on the benefits of pharmacokinetic dosing in direct association with bleeding events. Here, we prospectively followed a cohort of adult patients with hemophilia A and B (n = 26) and arthropathic joints on various clotting factor products over a period of 2 years with clinical and radiographic joint health assessments, frequent joint ultrasound, and pharmacokinetic studies. Joint bleeds and synovitis with synovial vascularity changes were objectively diagnosed by musculoskeletal ultrasound and power Doppler and analyzed in relation to pharmacokinetic, joint- and patient-specific parameters. Results revealed that, contrary to common beliefs, bleeding episodes were not readily explained by pharmacokinetic features, as they were not associated with more time spent below certain clotting factor thresholds. Joint bleeding was found to be associated with prominent vascularity changes, suggesting that vascular remodeling and leakiness may contribute to joint bleeding that cannot be prevented by clotting factor replacement alone.

Prevalence of and risk factors for dermatoporosis: a prospective observational study of dermatology outpatients in a Finnish tertiary care hospital.

BACKGROUND: Dermatoporosis describes the cutaneous signs and complications related to chronic cutaneous fragility related to ageing, chronic sun exposure and long-term use of topical and systemic corticosteroids. Chronic renal failure may be an additional cofactor. The prevalence of dermatoporosis is estimated around 32-37% in France among the elderly. OBJECTIVE: We evaluated the prevalence of dermatoporosis and its risk factors in outpatients who attended a consultation in the department of dermatology of Helsinki University Central Hospital. METHODS: A prospective observational study of 176 consecutive outpatients aged 60 years and older, who attended a consultation in the department of dermatology of Helsinki University Central Hospital. Data collection included age, gender, reason for consultation, local or systemic corticosteroid therapy, antiplatelet drugs and anticoagulant therapy, diabetes and chronic kidney failure (glomerular filtration rate < 60 mL/min/m2 ). The presence of dermatoporosis, location on the body and staging were collected. RESULTS: 30.7% presented dermatoporosis. Lesions were mainly located on the upper limbs (94%), and stage I was the most frequent (75.9% of the cases). Multivariate analysis revealed that dermatoporosis was significantly associated with ultrapotent topical corticosteroids (odds ratio (OR) 5.34, 95% CI 1.85-15.43, P = 0.002), oral corticosteroids (OR 3.22, 95% CI 1.18-8.80, P = 0.022), concomitant corticosteroid therapy, anticoagulant and chronic renal failure (OR 4.02, 95% CI 1.34-12.01, P = 0.013) and age (OR 1.05, 95% CI 1.01-1.10, P = 0.016). Patients with bullous pemphigoid were those with the highest prevalence of dermatoporosis in our cohort (64%). CONCLUSION: Acknowledging the selection bias in our study, the prevalence of dermatoporosis in a dermatology consultation in Finland seems as frequent as in France. These results prompt us to weigh the indications of long-term corticosteroids use in frail elderly patients.

Identification of phenolic compounds from the leaf part of Teucrium pseudo-Scorodonia Desf. collected from Algeria.

In the present paper,we reported for the first time, the identification of the phenolic compounds in butanolic fraction obtained from the leaf part of Teucrium pseudo-Scorodonia Desf. collected from Algeria using RP-HPLC-PDA (Reversed Phase High Performance Liquid Chromatography/Photo Diode Array) technique. Several standards were used for this purpose. The analysis led to the identification of six phenolic acids (ferulic, sinapic, rosmarinic, syringique, caffeic, p-coumaric acids) and one flavonoid (rutin), the last one, has interesting pharmacological properties.

Impacts of frailty on the negative health outcomes of elderly Brazilians / Impactos da Fragilidade sobre desfechos negativos em saúde de idosos brasileiros

Abstract Objective: to verify the association between frailty and the occurrence of falls, hospitalization and death among Brazilian elderly persons. Methods: a representative sample of elderly persons from the city of Juiz de Fora, Minas Gerais, Brazil, who had been evaluated with regard to frailty, socio-demographic conditions and health in 2009, were reevaluated in terms of negative health outcomes between 2014 and 2015 (n=304). Results: The results revealed a greater incidence of falls, hospitalization, and death among frail elderly persons. The frail group also had an increased risk (1.5, crude estimate) of death during the follow-up period than the robust individuals. The pre-frail elderly had a 55% (crude) and 58% (adjusted) greater risk of falls, and an 89% (crude) greater risk of death than robust individuals. Conclusion: frailty, as well as pre-frailty, can increase the risk of adverse events in the health of the elderly. AU

Resumo Objetivos: verificar a relação da fragilidade com a ocorrência de quedas, hospitalização e óbito em idosos brasileiros. Métodos: Para tal, uma amostra representativa de idosos moradores do município de Juiz de Fora, Minas Gerais, Brasil, a qual foi avaliada quanto à fragilidade, condições sociais, demográficas e de saúde no ano de 2009, foi reavaliada quanto aos desfechos negativos em saúde entre os anos de 2014 e 2015 (n=304). Resultados: Os resultados demonstram uma maior incidência de quedas, hospitalização e óbito entre os frágeis. O grupo frágil também apresentou risco aumentado (1.5, bruto) de falecer durante o seguimento do que os robustos. Já os pré-frágeis, exibiram risco 55% (bruto) e 58% (ajustado) superior de quedas e 89% (bruto) de falecer em relação aos indivíduos robustos. Conclusão: Conclui-se que a fragilidade, assim como a pré-fragilidade, podem aumentar o risco de eventos negativos na saúde de idosos.AU

[Capillary fragility and some hemostatic parameters in patients with rosacea].

The aim of the study was to investigate the association between capillary fragility and some hemostatic parameters, lipid profile in patients with rosacea. 50 patients (30 women and 20 men) aged 35 to 65 years were under observation. Control group consisted of 50 healthy persons, adequate to comparison group by sex and age. To determine the resistance of the capillary, Rumpel-Leede cuff (tourniquet test) was used which consists in determining the formation of petechial hemorrhages on the skin in the area of ​​short-term increase in venous pressure. The hemostatic system was evaluated in terms of prothrombin and thrombin time. Content of fibrinogen and fibrinolytic activity of blood were determined also. The serum lipid profile was studied by means of the following parameters: total cholesterol, triglycerides, HDL (high density lipoprotein), LDL (low density lipoproteins). The survey revealed that in 25 patients the arm cuff test was positive, whereas in the control group, only 2 cases it was weakly positive. Manifestations of hypercoagulation were found in half of patients with a positive cuff test, almost in half of the patients an increased level of fibrinogen and the reduced fibrinolytic activity in blood serum has been revealed. Significant correlation with lipid metabolism have not been identified. Phenomenon of hypercoagulation in rosacea patients on the one hand suggests the existence of processes of microcoagulation, on the other hand the connection with the results of a cuff test can be used to predict the severity of the dermatosis and the possible risk for developing of cardiovascular disease.

Alternative to the bentall procedure for elderly patients with aortic root aneurysms.

We describe an alternative technique to the Bentall procedure for elderly patients with aortic root aneurysms. It is the subcoronary implantation of a Freestyle (Medtronic, Minneapolis, MN) aortic bioprosthesis with interposition of a graft material between the upper part of the Freestyle bioprosthesis and the distal aorta. The technique described avoids the proximal anastomosis of the graft and avoids the coronary reimplantations of the Bentall procedure which are still a potential risk of bleeding particularly in elderly patients.

Fragility of pulmonary capillaries.

Although the pulmonary capillaries were discovered in 1661, the ultrastructure of the wall was not elucidated until 60 years ago. Electron micrographs then showed that only 0.2 µm of tissue separated the capillary endothelium from the alveolar space over much of the area. In retrospect this vanishingly small protective layer should have alerted physiologists to the potential fragility of the capillaries, but this was not appreciated until almost 40 years later. This predicament is unique to pulmonary capillaries. No other capillaries in the body are shielded from the outside environment by such a minute amount of tissue. Reasons why the fragility of the capillaries was not recognized earlier include an inappropriate comparison with the properties of systemic capillaries, the mistaken view that the pulmonary capillary pressure is always low, and a misleading use of the Laplace equation. Evidence for the fragility comes from physiological, pathological, and laboratory observations. As expected from evolutionary considerations, the fragility only becomes evident in the normal lung under exceptional conditions. These include elite human athletes at maximal exercise and animals that have developed the capacity for extreme aerobic activity. However, lung and heart diseases frequently cause capillary disruption. Remodeling of pulmonary capillaries occurs in humans in whom the capillary pressure rises over a long period. Neonatal capillaries are extremely fragile, presumably because they have never been exposed to increased transmural pressures. The capillaries conform to the general biological rule that tissue adapts its structure to carry out its required function.

Pseudomoniletrhix: defecto estructural del tallo piloso, fragilidad capilar aumentada / Pseudomonilethrix: structural defect of the hair shaft, increased capillary fragility

Presentamos un caso clínico de pseudomoniletrhix, defecto estructural del tallo piloso con aumento de la fragilidad capilar; en una paciente de sexo femenino de 22 años de edad. Realizamos una revisión de la patología considerando, en especial, el diagnóstico diferencial con el moniletrix.

We report a case of pseudomonilethrix, structural defect of the hair shaft with increased capillary fragility, in a female patient 22 years of age. We review the pathology especially considering the differential diagnosis with monilethrix.

Pseudomoniletrhix: defecto estructural del tallo piloso, fragilidad capilar aumentada / Pseudomonilethrix: structural defect of the hair shaft, increased capillary fragility

Presentamos un caso clínico de pseudomoniletrhix, defecto estructural del tallo piloso con aumento de la fragilidad capilar; en una paciente de sexo femenino de 22 años de edad. Realizamos una revisión de la patología considerando, en especial, el diagnóstico diferencial con el moniletrix. (AU)

We report a case of pseudomonilethrix, structural defect of the hair shaft with increased capillary fragility, in a female patient 22 years of age. We review the pathology especially considering the differential diagnosis with monilethrix. (AU)

Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room.

Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm(3)) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2-7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue.

Physiological responses of erythrocytes of goats to transportation and the mondulatory role of ascorbic acid.

Experiments were performed with the aim of investigating the effect of road transportation for 12 hr on erythrocytes of goats during the hot-dry season and the modulatory role of ascorbic acid. Forty 2.5-3-year-old Red Sokoto goats weighing 23-25 kg and belonging to both sexes served as the subjects of the study. Twenty of the goats served as the experimental group and were administered ascorbic acid (AA) per os at a dosage rate of 100 mg/kg body weight; the other 20 served as controls and were given 10 ml each of sterile water. Forty minutes after the administration and loading, the goats were transported for 12 hr. EDTA blood samples collected before loading, after loading, immediately after transportation and subsequently on the 3rd and 7th days of post-transportation were used to determine the red blood cell (RBC) count, packed cell volume (PCV), hemoglobin (Hb), erythrocyte osmotic fragility (EOF), hematimetric (intrinsic) indices and hemoglobin index levels. The obtained results showed that handling, loading and transportation of the control goats induced significant (P<0.05) increases in RBC, Hb, EOF and hypochromic erythrocytes and a decrease (P<0.05) in the volume and average Hb content in RBCs. AA administration ameliorated all these changes. The present results suggest that road transportation for 12 hr during the hot-dry season could induce serious stress, resulting in hemolysis of erythrocytes, which was ameliorated by AA administration. In addition, the results demonstrated that EOF could be used as a diagnostic tool in road transportation stress.

Acute Dermal Capillary Rupture in a Patient with Diabetic Nephropathy / 대한신장학회지

A 46-year-old diabetic woman visited our hospital with generalized edema and high blood pressure. An appropriately sized noninvasive blood pressure cuff was placed on her right arm above the elbow to measure blood pressure. While we were checking her blood pressure, we noticed small red petechial spots distal to the cuff involving her entire right forearm. Her blood pressure was 170/96 mmHg. The laboratory findings showed no abnormality of anticoagulation. The rest of the patient's extremities were not affected. The petechiae on the right arm resolved spontaneously after ten days. The most likely explanation for these petechiae is acute dermal capillaryrupture, which is called the Rumpel- Leede phenomenon. Acute dermal capillary rupture appears as petechiae in an area following application of vascular constriction such as application of tourniquet to draw blood specimen or use of blood pressure cuff due to capillary fragility or abnormal platelets in numbers or in function. This situation has been reported previously in the literature as the Rumpel-Leede phenomenon in association with prolonged noninvasive BP monitoring. In the patient described herein, increased venous pressure from blood pressure measurement and capillary fragility associated with diabetes mellitus may have increased the risk of acute dermal capillary rupture.

Validación de un algoritmo para el cálculo del riesgo absoluto de fracturas no vertebrales por fragilidad en una cohorte de mujeres posmenopáusicas / Validation of an algorithm to calculate the absolute risk of non-vertebral fragility fractures in a cohort of postmenopausal women

Fundamento y objetivo: La estimación del riesgo absoluto de fractura provee información útil para la toma de decisiones. Recientemente este grupo ha descrito un algoritmo para el cálculo del riesgo absoluto de fractura no vertebral en mujeres españolas de 65 o más años de edad, que incluye parámetros clínicos y los valores de la ecografía cuantitativa ósea de calcáneo (URL: www.ecosap.info). Se ha evaluado el comportamiento del algoritmo mediante el análisis estadístico de la bondad del ajuste del modelo. Sujetos y método: El algoritmo fue resultado del análisis prospectivo de 5.201 mujeres que acudieron por cualquier motivo a consulta de atención primaria y a las que se siguió durante 3 años. El ajuste del modelo se evaluó mediante un modelo de calibración, se compararon los casos esperados (E) mediante la ecuación con los casos observados (O), y su precisión para discriminar entre las mujeres que presentaron o no una fractura .Resultados: No se observaron pruebas estadísticamente significativas de mala calibración. El cociente de casos E y de casos O fue de 1,02 (intervalo de confianza del 95%: 0,91 a 1,14). El test de la χ2 de la calibración (diferencias entre lo estimado y lo observado) no alcanzó significación estadística. El área bajo la curva de eficacia diagnóstica fue aproximadamente de 0,67. Conclusión: Los resultados indican una buena calibración del algoritmo propuesto para la predicción de fracturas no vertebrales. Sería necesaria la calibración con una cohorte independiente para comprobar definitivamente su validez externa (AU)

Background and Objectives: Absolute risk estimate for fractures in the individual subject provides meaningful information for interventions. Recently, we have described an algorithm to calculate the absolute risk for non-vertebral fractures in women from Spain, aged 65 years or older, that includes clinical parameters and quantitative bone ultrasound values of the calcaneus (URL: www.ecosap.info). We assessed the performance of the algorithm by means of the statistical analysis of the model calibration. Subjects and Methods: The algorithm was the result of the prospective analysis of 5.195 women who were attended for any reason in Primary Care Centres and followed-up for 3 years. Model calibration was evaluated by comparing number of estimated (E) cases predicted with the equation with the number of observed (O) cases, and its accuracy to discriminate women with and without a new fracture. Results: No evidence of statistically significant miscalibration of the model was observed. The E/O ratio was 1,02 (CI 95%: 0,91–1,14). Calibration χ2 value (difference between the estimated and observed cases) did not reach statistical significance. Area under the curve-ROC was approximately 0.67. Conclusions: These results suggest a good calibration of the proposed algorithm for non-vertebral fracture prediction. It would be desirable to calibrate it with an independent cohort to definitively test its external validity (AU)