Vitamin B12 Hypersensitivity: A Retrospective Multicenter Study.

BACKGROUND: Vitamin B12 (Vit B12) deficiency affects approximately 20% of those above the age of 60 years in the United Kingdom and United States. If untreated, it leads to detrimental health outcomes. OBJECTIVE: To investigate a cohort of patients with Vit B12 hypersensitivity (VB12H) referred to 3 UK allergy centers and design a pathway for the investigation of VB12H. METHODS: A total of 29 patients seen between 2014 and 2022 underwent skin prick testing (1 mg/mL) with cyanocobalamin (CC) and hydroxycobalamin (HC) and intradermal testing (0.1 and 0.01 mg/mL). Patients with negative skin tests underwent a Vit B12 drug provocation test (DPT) with either the index or the alternative drug. RESULTS: Of 29 patients, 18 (62%) presented with immediate VB12H. Eight experienced anaphylaxis (4 to HC and 4 to CC) and had positive skin tests to the index drug. One patient reacted to oral and 7 patients to injectable Vit B12. Seven patients sensitized to one form of Vit B12-tolerated DPT with an alternative Vit B12. One patient with immediate VB12H reacted to polyethylene glycol (PEG) in oral cobalamin. Of 29 patients, 8 presented with delayed hypersensitivity reaction; 4 patients tolerated the intramuscular index formulation, whereas 2 patients tolerated the per oral formulation. One patient presented with symptoms consistent with symmetrical drug-related intertriginous and flexural exanthema. Three patients were referred because of cobalt allergy. CONCLUSION: Confirmed VB12H is rare. We propose a comprehensive evaluation protocol that includes Vit B12 skin tests and considers PEG allergy in patients presenting with VB12H.

Characterization and evaluation of anti-Salmonella enteritidis activity of indigenous probiotic lactobacilli in mice.

Lactobacilli (n = 24), isolated from human infants and yogurt, showed variable in vitro activity against Salmonella enteritidis (8.0 ± 1.0 to 16.6 ± 0.5 mm) and other gut pathogens (9.0 ± 1.0 to 15.3 ± 0.5 mm), as determined by a well diffusion assay. The isolates were identified as Limosilactobacillus fermentum (FY1, FY3, FY4, IL2, and IL5), Lactobacillus delbrueckii (FY6 and FY7), Lactobacillus sp. (IL7), and Lactobacillus gasseri (IL12). All isolates showed variable in vitro tolerance to acidic pH for 3 h and visible growth at pH 4 and in the presence of 0.3% ox-bile. The antibiotic susceptibility profile of Lactobacillus isolates indicated resistance against vancomycin, ciprofloxacin, streptomycin, and lincomycin. Isolates had variable auto-aggregation and showed variable capabilities to co-aggregate with S. enteritidis. Based on all tested parameters, L. fermentum IL2, L. fermentum IL5, and L. gasseri IL12 were selected for co-culture experiments, followed by in vivo evaluation in Balb/c mice. All the selected isolates resulted in a 100% reduction in S. enteritidis in broth. Lactobacillus isolates efficiently colonized mouse guts and inhibited S. enteritidis colonization. Overall, there was ≥99.06% and ≤4.32 Mean log10 reduction in Salmonella counts in mice feces within 7 days. The study, thus, provided characterized lactobacilli that could be considered as potential ingredients for probiotic formulations intended to prevent S. enteritidis infection in humans.

The 2017 ACR TI-RADS: pictorial essay.

High-resolution ultrasound is the imaging method of choice for the evaluation of thyroid nodules. The method has recently come to be used widely and often, which has increased the rate of thyroid nodule detection. In 2017, the American College of Radiology (ACR) established a risk-stratification system designated the Thyroid Imaging Reporting and Data System (TI-RADS) to be a practical guide for widespread use, with a single lexicon and standardization of ultrasound reports of thyroid nodules. The objective of this study was to present a practical approach, using examples to illustrate the criteria evaluated by the 2017 ACR TI-RADS, in order to help minimize uncertainties regarding its application by sonographers.

A ultrassonografia de alta resolução é a modalidade de escolha para avaliação de imagem dos nódulos tireoidianos, e sua recente aplicação ampla e difusa tornou a detecção de nódulos tireoidianos mais frequentes. O American College of Radiology (ACR) estabeleceu um sistema de estratificação de risco denominado Thyroid Imaging, Reporting and Data System (TI-RADS) para ser um guia prático para utilização ampla com um léxico único e padronização de relatórios ultrassonográficos de nódulos tireoidianos. O objetivo deste trabalho é fazer uma abordagem prática com base em exames para ilustrar e exemplificar os critérios avaliados pelo TI-RADS-ACR 2017, a fim de ajudar a reduzir os pontos de dúvidas de sua aplicação pelos profissionais ultrassonografistas.

The 2017 ACR TI-RADS: pictorial essay / TI-RADS-ACR 2017: ensaio iconográfico

Abstract High-resolution ultrasound is the imaging method of choice for the evaluation of thyroid nodules. The method has recently come to be used widely and often, which has increased the rate of thyroid nodule detection. In 2017, the American College of Radiology (ACR) established a risk-stratification system designated the Thyroid Imaging Reporting and Data System (TI-RADS) to be a practical guide for widespread use, with a single lexicon and standardization of ultrasound reports of thyroid nodules. The objective of this study was to present a practical approach, using examples to illustrate the criteria evaluated by the 2017 ACR TI-RADS, in order to help minimize uncertainties regarding its application by sonographers.

RESUMO A ultrassonografia de alta resolução é a modalidade de escolha para avaliação de imagem dos nódulos tireoidianos, e sua recente aplicação ampla e difusa tornou a detecção de nódulos tireoidianos mais frequentes. O American College of Radiology (ACR) estabeleceu um sistema de estratificação de risco denominado Thyroid Imaging, Reporting and Data System (TI-RADS) para ser um guia prático para utilização ampla com um léxico único e padronização de relatórios ultrassonográficos de nódulos tireoidianos. O objetivo deste trabalho é fazer uma abordagem prática com base em exames para ilustrar e exemplificar os critérios avaliados pelo TI-RADS-ACR 2017, a fim de ajudar a reduzir os pontos de dúvidas de sua aplicação pelos profissionais ultrassonografistas.

Isolation and phylogenetic analysis of Avian orthoavulavirus 1 sub-genotypes VII.2 and XXI.1.2 from caged birds in the Lahore district, Pakistan - Short communication.

In this study, the prevalence of Avian orthoavulavirus-1 (AOAV-1) (also commonly known as Newcastle disease virus) was investigated in caged birds kept in bird markets in the Lahore district of Pakistan. A total of 354 swab samples were obtained from 14 different species of clinically healthy birds. The overall virus prevalence was 12.7% in 9 out of the 14 species. Phylogenetic analysis of the complete fusion protein (F) gene showed that 23 isolates from different avian species belonged to sub-genotype VII.2 while three isolates of pigeon origin clustered with sub-genotype XXI.1.2. The VII.2 viruses isolated had a high nucleotide identity to viruses repeatedly isolated from poultry in Pakistan from 2011 to 2018. To date, sub-genotype XXI.1.2 viruses have only been identified in Pakistan. These findings suggest that the Newcastle disease (ND) outbreaks occurring in Pakistan involve multiple hosts and environments. The study emphasises the importance of continuing to monitor multiple avian species for the presence of AOAV-1s and implementing effective ND control strategies.

Activity and Anti-Aflatoxigenic Effect of Indigenously Characterized Probiotic Lactobacilli against Aspergillus flavus-A Common Poultry Feed Contaminant.

Aflatoxin contamination in human food and animal feed is a threat to public safety. Aflatoxin B1 (AFB1) can be especially damaging to poultry production and consequently economic development of Pakistan. The present study assessed the in vitro binding of AFB1 by indigenously characterized probiotic lactobacilli. Six isolates (Lactobacillus gallinarum PDP 10, Lactobacillus reuetri FYP 38, Lactobacillus fermentum PDP 24, Lactobacillus gallinarum PL 53, Lactobacillus paracasei PL 120, and Lactobacillus gallinarum PL 149) were tested for activity against toxigenic Aspergillus flavus W-7.1 (AFB1 producer) by well diffusion assay. Only three isolates (PL 53, PL 120, and PL 149) had activity against A. flavus W-7.1. The ameliorative effect of these probiotic isolates on AFB1 production was determined by co-culturing fungus with lactobacilli for 12 days, followed by aflatoxin quantification by high-performance liquid chromatography. In vitro AFB1 binding capacities of lactobacilli were determined by their incubation with a standard amount of AFB1 in phosphate buffer saline at 37 °C for 2 h. AFB1 binding capacities of isolates ranged from 28-65%. Four isolates (PDP 10, PDP 24, PL 120, and PL 149) also ceased aflatoxin production completely, whereas PL 53 showed 55% reduction in AFB1 production as compared to control. The present study demonstrated Lactobacillus gallinarum PL 149 to be an effective candidate AFB1 binding agent against Aspergillus flavus. These findings further support the binding ability of lactic acid bacteria for dietary contaminants.

Glicose como causa e tratamento de necrose cutânea / Glucose as a cause of and treatment for cutaneous necrosis

A escleroterapia continua sendo um dos procedimentos mais executados pelos cirurgiões vasculares brasileiros. O conhecimento das suas complicações é imprescindível para que possamos evitá-las. Os efeitos colaterais graves desse método de tratamento para as telangiectasias dos membros inferiores são raros e frequentemente associados a um erro técnico ou à dosagem injetada. São predominantemente locais, apresentando-se, algumas vezes, como uma situação de difícil resolução. Relatamos um caso de formação de necrose cutânea após escleroterapia química com glicose hipertônica (75%) e sua cicatrização utilizando preparação tópica contendo vaselina e glicose 60%, cujo resultado estético foi satisfatório

Sclerotherapy remains one of the procedures most frequently performed by Brazilian vascular surgeons. Knowledge of its complications is indispensable to enable us to avoid them. The severe side effects of this method of treatment for telangiectasias of the lower limbs are rare and are often associated with technical errors or the dose injected. Complications are predominantly local, but are sometimes difficult to resolve. We report a case of formation of cutaneous necrosis after chemical sclerotherapy using hypertonic glucose (75%), which healed when treated with a topical preparation containing vaseline and 60% glucose, with satisfactory esthetic results

Glucose as a cause of and treatment for cutaneous necrosis.

Sclerotherapy remains one of the procedures most frequently performed by Brazilian vascular surgeons. Knowledge of its complications is indispensable to enable us to avoid them. The severe side effects of this method of treatment for telangiectasias of the lower limbs are rare and are often associated with technical errors or the dose injected. Complications are predominantly local, but are sometimes difficult to resolve. We report a case of formation of cutaneous necrosis after chemical sclerotherapy using hypertonic glucose (75%), which healed when treated with a topical preparation containing vaseline and 60% glucose, with satisfactory esthetic results.