A new bunya-like virus associated with mass mortality of white-clawed crayfish in the wild.

We report the discovery of a new enveloped, spherical virus belonging to the Phenuiviridae family of negative ssRNA viruses associated with a massive outbreak in a French population of the endangered white-clawed crayfish Austropotamobius pallipes. We call this virus Bunya-like Brown Spot Virus (BBSV) and characterize it using transmission electronic microscopy, genome sequencing and clinical signs. Infected specimens show discolored brown spots on the cuticle. Using RNA-seq data we assembled a partial sequence for the L, M and S genome segments of BBSV. Phylogenetic analyses using all three segments show this virus is closely related to the Wenling crustacean virus 7 (China) and to a bunya-like virus found in feces of the European otter. Our survey of the mass mortality event indicates the virus is less virulent than the crayfish plague caused by Aphanomyces astaci. Overall, the discovery of BBSV provides a new important asset to monitor A. pallipes populations.

Ethical and medical management of a pregnant woman with brain stem death resulting in delivery of a healthy child and organ donation.

Maternal brain death during pregnancy remains an exceedingly complex situation that requires not only a well-considered medical management plan, but also careful decision-making in a legally and ethically delicate situation. Management of brain dead pregnant patients needs to adhere to special strategies that support the mother in a way that she can deliver a viable and healthy child. Brain death in pregnant women is very rare, with only a few published cases. We present a case of a pregnant woman with previously diagnosed multiple brain cavernomas that led to intracranial hemorrhage and brain stem death during the 21st week of pregnancy. The condition that can be proven unequivocally, using tests that do not endanger viability of the fetus, is brain stem death, diagnosed through absence of cranial reflexes. The patient was successfully treated until delivery of a healthy female child at 29weeks of gestation. The patient received continuous hormone substitution therapy, fetal monitoring and extrinsic regulation of maternal homeostasis over 64days. After delivery, the final diagnosis of brain death was established through multi-slice computerized tomography pan-angiography. This challenging case discusses ethical and medical circumstances arising from a diagnosis of maternal brain death, while showing that prolongation of somatic life support in a multidisciplinary setting can result in a successful pregnancy outcome.

Interferon lambda-2 levels in sputum of patients with pulmonary Mycobacterium tuberculosis infection.

In humans, there are three members of type III interferon family, designated as IFN-λ1 (IL-29), IFN-λ2 (IL-28A) and IFN-λ3 (IL-28B). Bacterial infections, including Mycobacterium tuberculosis infection, trigger the expression of interferon I and II genes, but little is known about their effect on IFN-λ genes. It has been found that M. tuberculosis infection in A549 lung epithelial cells stimulate upregulation of IFN-λ2 genes in vitro. The aim of this study was to determine the IFN-λ2 levels in sputum of patients with active pulmonary tuberculosis comparing with levels in healthy persons sputum and sputum of persons with latent tuberculosis. IFN-λ2 level in the samples was quantified with sandwich enzyme-linked immunoassay kit for quantization of human IFN-λ2 (IL-28A). The IFN-λ2 level in sputum of patients with pulmonary tuberculosis was significantly higher comparing with IFN-λ2 levels in healthy group (P = 0.001) and latent tuberculosis group (P = 0.005). Logistic regression analysis has shown that IFN-λ2 level in sputum is related to culture result (OR = 4.14; 95% CI = 1.28-17.5; P = 0.019). There was the correlation between Bartlett score and IFN-λ2 levels in group with pulmonary tuberculosis (r = 0.641; P < 0.01). In conclusion, we have found that the inflammatory cells in sputum can be source of IFN-λ after receptor stimulation by M. tuberculosis components.

Specific binding of paraprotein to platelet receptors as a cause of platelet dysfunction in monoclonal gammopathies.

The study included 48 untreated patients with monoclonal gammopathies (MG). Paraprotein was isolated from the serum of 10 patients with decreased platelet aggregation. Platelet aggregation was measured before and after the addition of the isolated paraprotein to platelet-rich plasma (PRP) from 10 healthy donors, in vitro. Expression of platelet von Willebrand factor (vWF) receptor glycoprotein (GP)Ib and platelet collagen receptor GPVI was determined by flow cytometry in the PRP of healthy donors before and after the addition of isolated paraprotein using the monoclonal antibodies, CD42b (for GPIb) and CD36 (for GPVI). Flowcytometry showed that expression of CD42b and CD36 positive cells was reduced after the addition of isolated paraprotein to PRP from healthy donors (p < 0.001). These investigations demonstrated that paraprotein causes platelet dysfunction in patients with MG due to specific binding to the platelet vWF receptor GPIb and platelet collagen receptor GPVI.

Transcranial Doppler in brain death confirmation in clinical practice.

PURPOSE: Transcranial Doppler (TCD) can be used as a confirmatory test in brain death. The aim was to present the usefulness of TCD in brain death confirmation. MATERIALS AND METHODS: Forty-four patients with severe brain lesions leading to brain death were treated over a 4-year period. After the clinical diagnosis of brain death was made, the appropriate confirmatory test was chosen according to patient condition, taking into consideration the restrictions of the test protocol. Due to the inconclusive test results, some patients underwent repeat testing. RESULTS: Among 44 patients, 19 had neurotrauma, 11 massive aneurysmal subarachnoidal hemorrhages, 1 arteriovenous subarachnoidal and parenchymal hemorrhage, 12 hypertensive parenchymal hemorrhages, and 1 ischemic stroke. As a primary test, TCD was used in 30, brain scintigraphy in 2, multislice CT angiography (CTA) in 10, and cerebral angiography in 2 patients, and the diagnosis was confirmed in 26, 3, 9 and 2 patients, respectively. Due to inconclusive results CTA was repeated in five patients. In patients in whom TCD was applied, the time to confirm the diagnosis was the shortest, and in most (61 %) cerebral circulatory arrest was confirmed within 2 hours of clinical diagnosis. CONCLUSION: TCD is a favorable confirmatory test for cerebral circulatory arrest in brain death diagnosis.

[Selective digestive decontamination. Why don't we apply the evidence in the clinical practice?]. / Descontaminación digestiva selectiva. 'Por qué no aplicamos la evidencia en la práctica clínica?

Selective digestive decontamination (SDD) is a prophylactic strategy whose objective is to reduce the incidence of infections, mainly mechanical ventilation associated pneumonia in patients who require intensive cares, preventing or eradicating the oropharyngeal and gastrointestinal carrier state of potentially pathogenic microorganisms. Fifty-four randomized clinical trials (RCTs) and 9 meta-analysis have evaluated SDD. Thirty eight RCTs show a significant reduction of the infections and 4 of mortality. All the meta-analyses show a significant reduction of the infections and 5 out of the 9 meta-analyses report a significant reduction in mortality. Thus, 5 patients from the ICU with SDD must be treated to prevent pneumonia and 12 patients from the ICU should be treated to prevent one death. The data that show benefit of the SDD on mortality have an evidence grade 1 or recommendation grade A (supported by at least two level 1 investigations). The aim of this review is to explain the pathogeny of infections in critical patients, describe selective digestive decontamination, analyze the evidence available on it efficacy and the potential adverse effects and discuss the reasons published by the experts who advise against the use of SDD, even though it is recognized as the best intervention evaluated in intensive cares to reduce morbidity and mortality of the infections.

Descontaminación digestiva selectiva. ¿Por qué no aplicamos la evidencia en la práctica clínica? / Selective digestive decontamination. Why don’t we apply the evidence in the clinical practice?

La descontaminación digestiva selectiva (DDS) es una estrategia profiláctica cuyo objetivo es reducir la incidencia de infecciones, principalmente la neumonía asociada a la ventilación mecánica, en los pacientes que requieren cuidados intensivos, previniendo o erradicando el estado de portador orofaríngeo y gastrointestinal de microorganismos potencialmente patógenos. Cincuenta y cuatro ensayos clínicos randomizados (ECR) y nueve metaanálisis han evaluado la DDS. Treinta y ocho ECR muestran una reducción significativa de las infecciones y cuatro de la mortalidad. Todos los metaanálisis muestran una reducción significativa de las infecciones y 5 de los 9 metaanálisis de la mortalidad. Se necesita tratar 5 pacientes de Unidad de Cuidados Intensivos (UCI) con DDS para prevenir una neumonía y 12 pacientes de UCI deben ser tratados para prevenir una muerte. Los datos que muestran un beneficio de la DDS sobre la mortalidad tienen un grado de evidencia 1 o un grado de recomendación A (soportada por al menos dos investigaciones de nivel 1). El objetivo de esta revisión es exponer la patogenia de las infecciones en los enfermos críticos, describir la DDS, analizar la evidencia disponible sobre su eficacia y los potenciales efectos adversos, y discutir las razones publicadas por los expertos que desaconsejan el uso de la DDS, a pesar de ser reconocida como la intervención mejor evaluada en cuidados intensivos para reducir la morbilidad y mortalidad de las infecciones

Selective digestive decontamination (SDD) is a prophylactic strategy whose objective is to reduce the incidence of infections, mainly mechanical ventilation associated pneumonia in patients who require intensive cares, preventing or eradicating the oropharyngeal and gastrointestinal carrier state of potentially pathogenic microorganisms. Fifty-four randomized clinical trials (RCTs) and 9 meta-analysis have evaluated SDD. Thirty eight RCTs show a significant reduction of the infections and 4 of mortality. All the meta-analyses show a significant reduction of the infections and 5 out of the 9 meta-analyses report a significant reduction in mortality. Thus, 5 patients from the ICU with SDD must be treated to prevent pneumonia and 12 patients from the ICU should be treated to prevent one death. The data that show benefit of the SDD on mortality have an evidence grade 1 or recommendation grade A (supported by at least two level 1 investigations). The aim of this review is to explain the pathogeny of infections in critical patients, describe selective digestive decontamination, analyze the evidence available on it efficacy and the potential adverse effects and discuss the reasons published by the experts who advise against the use of SDD, even though it is recognized as the best intervention evaluated in intensive cares to reduce morbidity and mortality of the infections

Spinal spindle cell haemangioma: an atypical location.

We present a case of the 31-year-old male patient who complained of weakness in both legs and progressed slowly. Neuroimagine of the thoracic spine showed an intraspinal, extradural mass lesion, measuring 5.3 x 1.2 cm at the Th1-Th3 level. Histologically the lesion was a spindle cell haemangioma composed of dilated vascular spaces and a proliferation of bland appearing interspersed spindle cells. Immunohistochemical analysis was diffusely positive for VIM, SMA and focally for CD34. This lesion is uncommon and shows a predilection for distal extremities. Spindle cell haemangioma within the spine has not been previously reported in the literature.

Dermatitis artefacta: unusual appearance in an older woman.

Dermatitis artefacta is a rare and difficult condition for diagnosis and treatment, with the highest incidence of onset in late adolescence to early adult life. Most patients are young women who have a personality disorder; borderline features are common and the patient's denial of psychological distress makes management and treatment difficult. Patients use a variety of means to cause the skin changes. Clinical presentation of the skin lesions does not conform to those of known dermatoses and are located on easily reached parts of the skin. We report an unusual case of a 72-year-old woman with symmetrical changes under the breasts and in the right inguinal region. The lesions were composed partly of haemorrhagic round lesions and partly of scars. A skin biopsy was taken and consultations with the psychiatrist, internist and the patient's family led to the diagnosis of self-induced dermatitis. The skin lesions were covered by occlusion techniques and the lesions improved very rapidly. The patient was discharged from the hospital under psychiatric and family care.

Pachyonychia congenita. Case report.

A 17-year old female patient was referred to our Department. Clinical examination revealed white, hyperkeratotic lesions on the dorsal part of the tongue, together with symmetric lesions on the buccal mucosa. The patient also showed dystrophic changes of the nails, both on hands and on feet, as well as bullous lesions on the soles. After detailed clinical and histologic examinations, diagnosis of pachyonychia congenita was made.

Serum sialic acid in subjects with impaired glucose tolerance and in newly diagnosed type 2 diabetic patients.

Several general population studies and those carried out in diabetic patients with complications have pointed to serum sialic acid as a marker of inflammation in atherosclerosis. In this study we examined whether total sialic acid (TSA) was changed in the sera of 28 newly diagnosed subjects with type 2 diabetes (type 2 DM), 47 subjects with impaired glucose tolerance (IGT) and 72 subjects with normal glucose tolerance (NGT). The associations between sialic acid and other atherosclerotic risk factors such as lipid profile, baseline diene conjugates in low-density lipoproteins (LDL-BDC) and fasting insulin were also investigated. We found a trend to TSA increase in subjects with impaired glucose tolerance and a significant increase in TSA in newly diagnosed patients with type 2 DM (2.2+/-0.3 vs. 1.9+/-0.3 mmol/l; p<0.03) when compared to subjects with NGT. Lipid profile and LDL-BDC, as a marker of circulating oxidized LDL, did not differ among glucose tolerance categories. Significant associations between total sialic acid and 2-h post-load glucose level, fasting insulin, insulin sensitivity, HDL-cholesterol and log of triglycerides were found in the examined subjects. Multiple regression analysis showed significant correlations between serum sialic acid and 2-h post-load glucose levels and insulin sensitivity. This study indicates that measurement of TSA as a marker of subclinical inflammation may be valuable as an independent parameter in identifying subjects at higher risk of developing type 2 diabetes and those who might benefit from anti-inflammatory treatment.

Permanent inflammatory effect of N-butylcyanoacrylate on vascular wall immunohistochemical analysis.

SUMMARY: We report a case with atypical pattern and time course of inflammatory response after partial embolization of a cerebral arteriovenous malformation with N-butylcyanoacrylate (NBCA), examined by immunohistochemical analysis. This pathomorphological finding of permanent acute inflammation has not been previously reported in humans.

Baseline diene conjugation in LDL lipids from newly diagnosed type 2 diabetic patients.

BACKGROUND: To determine whether the susceptibility of low-density lipoproteins (LDL) to oxidation was altered in subjects with newly diagnosed type 2 diabetes mellitus and impaired glucose tolerance using the measurement of LDL baseline diene conjugation (LDL-BDC) as an indicator of circulating mildly oxidized LDL in vivo. METHODS: LDL was isolated from sera of 26 newly diagnosed patients with type 2 diabetes mellitus (type 2 DM), 43 subjects with impaired glucose tolerance (IGT), and 67 subjects with normal glucose tolerance (NGT), who were matched for age, gender, body mass index and serum lipids. Twenty-seven healthy subjects with normal body mass index and normal values of lipids served as a control group. In all groups the LDL-BDC was compared with the production of conjugated dienes after copper-induced LDL oxidation, and with total antioxidative status. RESULTS: The LDL-BDC levels (micromol/l; mean +/- SD) were similar in the three glucose tolerance categories (NGT 66.5 +/- 6.9; IGT 67.9 +/- 6.5; type 2 DM, 68.1 +/- 7.1 p = 0.52) and there was no difference in comparison with the control group (68.9 +/- 4.2 micromol/l). Also, no significant differences between the groups were observed in the susceptibility to LDL oxidation in vitro or total antioxidative status. There was no correlation between glycemia and mildly oxidized LDL in vivo, nor with any of the parameters of the LDL oxidation in vitro. CONCLUSIONS: In the examined population of newly diagnosed diabetic patients with mild hyperglycemia, as evidenced by the level of glycated haemoglobin (HbA(1C)), a lack of changes in the susceptibility of LDL to oxidation both in vivo and in vitro was established.

Syringoid eccrine carcinoma.

A rare case of a syringoid eccrine carcinoma in a 52-year-old male patient is described. During the first hospitalization, syringoma was diagnosed, both clinically and histologically, keeping in mind the possibility of its malignant alteration. Difficulties in making a diagnosis with histological and immunohistochemical examinations are reported. The possibility of differential diagnosis of primary breast carcinoma and methods of its exclusion are also described. Treatment of the patient was surgical with good results.

Effect of creatine on erythrocyte rheology in vitro.

To evaluate how creatine influences erythrocyte deformability, we determined its effect on erythrocyte filterability in 9 subjects with insulin dependent diabetes (IDDM) without complications, 14 diabetics with uremia and 10 non-diabetic controls. The short-term incubation (15 min at 37 degrees C) of diabetic erythrocytes with 3 mM creatine improved cell filterability (assessed according to the Reid method) from IDDM subjects without complications by 28.4% and that from diabetics with uremia by 18.9%. No rheological effect of creatine was found in erythrocytes from non-diabetic controls. However, a significant protective effect against erythrocyte filterability impairment induced by treatment of red blood cells from non-diabetic controls with hydrogen peroxide was observed with 3 mM (p < 0.04) and 5 mM (p < 0.01) creatine, respectively. Measurement of the thiobarbituric acid (TBA) reactivity was used to assess hydrogen peroxide induced formation of malondialdehyde (MDA). We found that creatine inhibits hydrogen peroxide-induced erythrocyte MDA-formation in a dose dependent manner by 20.4%, 22.3% and 41.4% for 1, 3 and 5 mM creatine, respectively. These results suggest that creatine by its ability to inhibit erythrocyte lipid peroxidation may contribute to the maintenance of normal cell deformability.

In vitro inhibition of superoxide anion production and superoxide dismutase activity by zinc in human spermatozoa.

The in vitro effect of zinc on superoxide anion (O2-) generation and on SOD-like activity in spermatozoa of infertile men was investigated. The formation of superoxide anion was stimulated by NADPH and the level of superoxide anion was measured by the reduction of ferricytochrome c. Both Percoll-isolated (n = 14) and washed spermatozoa (n = 14) exposed to 1 mmol/L zinc (60 min, 37 degrees C), released less (p < 0.002 and p < 0.04, respectively) superoxide anions than did zinc-untreated spermatozoa. These results implicate a possible role for zinc as a scavenger of excessive superoxide anions produced by defective spermatozoa in semen after ejaculation. Additionally, zinc was found to dose-dependently inhibit superoxide dismutase (SOD)-like activity of spermatozoa in vitro. The inhibition of SOD-like activity by an equal concentration of zinc (1 mmol/L) was less pronounced in oligospermic (p < 0.002; n = 16) and asthenozoospermic (p < 0.0005; n = 20) than in normozoospermic samples (p < 0.0001; n = 20). This differential ability of zinc to inhibit SOD-like activity may be relevant to the physiological function of spermatozoa in fertilization. The evidence that zinc may elicit an inhibition of both superoxide anion production and SOD-like activity in human spermatozoa, indicate the existence of novel, zinc-related mechanism(s) involved in the oxidative events occurring after ejaculation, with a possible modulatory effect on germ cell function.

The application of GnRH analogues in the treatment of uterine myomas in perimenopausal women.

Our objective was to determine whether long GnRH agonists induce effective and persistent shrinkage of uterine myomas in perimenopausal women, as well as to determine the usefulness of Doppler sonography study in evaluating the therapy benefit. The study covers 30 patients with symptomatic myomas in perimenopausal period. We used long GnRH agonist-Decapeptyl (Ferring) at 28 days intervals in the course of 4 months. After discontinuing the application of Decapeptyl, medroxyprogesterone acetate was introduced for 6 months. The GnRH/gestagens therapy is useful and effective in treatment of symptomatic myomas in perimenopausal patients, and may be a valid alternative to hysterectomy. Doppler sonography is reliable in monitoring of uterine circulation in patients under GnRH therapy.

Superoxide dismutase activity in lymphocytes and polymorphonuclear cells of diabetic patients.

Copper-zinc superoxide dismutase (Cu,Zn-superoxide dismutase) activity was evaluated in lymphocytes and polymorphonuclear cells of insulin-dependent (n = 33) and non-insulin-dependent (n = 34) diabetic patients. A commercial method for the measurement of superoxide dismutase activity was adapted for use on a discrete analyser and evaluated for interference by other antioxidants with superoxide anion-scavenging properties. In comparison to healthy control subjects (n = 32), a significantly lower Cu,Zn-superoxide dismutase activity was found in both lymphocytes and polymorphonuclear cells of insulin-dependent (2.08 +/- 0.58 vs. 1.70 +/- 0.46 U/mg protein, p < 0.05, and 1.06 +/- 0.46 vs. 0.64 +/- 0.40 U/mg protein, p < 0.001, respectively) and non-insulin-dependent diabetic patients (2.08 +/- 0.58 vs. 1.61 +/- 0.48 U/mg protein, p < 0.01, and 1.06 +/- 0.46 vs. 0.53 +/- 0.24 U/mg protein, p < 0.001, respectively). There was a week, but significant negative correlation between age and Cu,Zn-superoxide dismutase activity in lymphocytes and polymorphonuclear cells (r = -0.22 and r = -0.28, p < 0.05, respectively), whereas no influence of gender, diabetes duration and glycaemic control was observed. The results indicate that diabetes mellitus could elicit a significant disturbance in superoxide anion-scavenging potential of lymphocytes and polymorphonuclear cells.