CA lung presenting with vasculitis.

A 67 year old man presented to us with petechial skin rash and blebs on the legs. He was on anti-tuberculous treatment for right sided pleural effusion since 1 month. A provisional diagnosis of Rifampicin induced drug rash was made and his effusion reaspirated and sent for AFB and cytology. The pleural fluid cytology demonstrated metastasis of adenocarcinoma and biopsy of skin lesion confirmed vasculitis. There was no thrombocytopenia. CT thorax showed right lower lobe mass with right sided pleural effusion. Thus a final diagnosis of skin manifestation of carcinoma of lung was made. This was a Paraneoplastic syndrome.

[Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department]. / Potenciales biomarcadores predictores de mortalidad en pacientes COVID-19 en el Servicio de Urgencias.

OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. METHODS: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.

Treatment outcome of extrapulmonary tuberculosis under Revised National Tuberculosis Control Programme.

BACKGROUND: Extrapulmonary tuberculosis (EPTB) constitutes 15-20% of tuberculosis cases in India. Earlier studies have evaluated treatment outcomes of EPTB with little information on outcomes of individual site of EPTB. AIMS: The objective was to study the outcome of Directly Observed Treatment Short course (DOTS) treatment of EPTB in different organ systems under Revised National Tuberculosis Control Programme. METHODS: Multi-centric retrospectives record review was carried out in three states in India. Data were collected from TB registers and analysed. RESULTS: Of the total 2219 patients studied, there were more males in age group 15-45. The commonest sites of EPTB were lymph node (34.4%) and pleural effusion (25.2%) followed by abdominal (12.8%) and central nervous system (CNS) (9.4%). Lymph node involvement was more common in females (58%) and pleural effusion in males (70%). Overall treatment completion rate was 84% in EPTB patients. Treatment completion was 86% in HIV negative EPTB patients compared to 66% in HIV positive patients. Individually, treatment completion rate observed as follows: lymph node 90.9%, genitourinary 92.6%, bone and joint 86%, pleural effusion 84.7%, abdominal 76% and CNS (tuberculoma and meningitis) 63.7%. The site of EPTB was not recorded in 173 (7.8%) patients. CONCLUSION: Treatment outcome of EPTB was poor in HIV infected patients and those with CNS tuberculosis. More efforts are needed to improve the treatment completion rates in these groups of patients.

Evaluation of low-contrast perceptibility in dental restorative materials under the influence of ambient light conditions.

OBJECTIVES: This study aimed to assess how details on dental restorative composites with different radio-opacities are perceived under the influence of ambient light. METHODS: Resin composite step wedges (six steps, each 1-mm thick) were custom manufactured from three materials, respectively: (M1) Filtek™ Z350 (3M/ESPE, Saint Paul, MN); (M2) Prisma AP.H™ (Dentsply International Inc., Brazil) and (M3) Glacier(®) (SDI Limited, Victoria, Australia). Each step of the manufactured wedge received three standardized drillings of different diameters and depths. An aluminium (Al) step wedge with 12 steps (1-mm thick) was used as an internal standard to calculate the radio-opacity as pixel intensity values. Standardized digital images of the set were obtained, and 11 observers independently recorded the images, noting the number of noticeable details (drillings) under 2 dissimilar conditions: in a light environment (light was turned on in the room) and in low-light conditions (light in the room was turned off). The differences between images in terms of the number of details that were observed were statistically compared using ANOVA, Cronbach's alpha coefficient and Wilcoxon and Kruskal-Wallis tests, with a significance level setting of 5% (α = 0.05). RESULTS: The M2 showed higher radio-opacity, the M1 displayed intermediate radio-opacity and the M3 showed lower radio-opacity, respectively; however, all three were without significance (p > 0.05) compared with each other. The differences in radio-opacity resulted in a significant variation (p < 0.05) in the number of noticeable details in the image, which were influenced by characteristics of details, in addition to the ambient-light level. CONCLUSIONS: The radio-opacity of materials and ambient light can affect the perception of details in digital radiographic images.

Simultaneous spectrophotometric determination of nickel and iron in copper-base alloy with bromo-PADAP.

The reaction of nickel (II) with Br-PADAP, in the presence of tergitol NPX surfactant, forms a complex with absorption peaks at 520 and 560 nm. The iron(II)-Br-PADAP system at the same conditions forms a chelate with absorption peaks at 560 and 748 nm. This allows the simultaneous spectrophotometric determination of nickel and iron by measuring the absorbance at 560 and 748 nm. The proposed method, at ph 4.0-5.7, shows a molar absorptivity of 1.22 x 10(5)l . mole(-1) . cm(-1) for nickel at 560 nm and 8.20 x 10(4)l . mole(-1) . cm(-1) at 560 nm and 3.35 x 10(4)l . mole(-1) . cm(-1) at 748 nm for iron(II). Beer's law is obeyed up to 0.40 mu/ml of nickel(II) and up to 0.65 mu/ml of iron(II). Thiosulphate as masking agent allows the simultaneous determination of iron and nickel in the presence of high concentrations of copper. The ethylene glycol 2-(2-amino-ethyl) tetracetic acid provides the elimination of many other interferences. The method has been applied successfully to the simultaneous determination of nickel and iron in reference samples.

Oral ciprofloxacin for treatment of severe infections.

Twenty adult patients with severe infections were treated with oral ciprofloxacin, 500 or 750 mg twice daily. Treatment ranged from 8 to 25 days. Efficacy was good: 14 patients (70%) were cured, four (20%) improved and there were only two (10%) failures. Tolerance was very satisfactory, the most common side-effects being mild gastrointestinal symptoms (three patients). Only one adverse laboratory result was observed: a transient rise in blood urea nitrogen and creatinine levels. None of the adverse effects led to discontinuation of treatment. Thus, ciprofloxacin presents as a promising drug for treatment of severe infections caused by susceptible organisms when ambulatorial therapy, at least during a large part of the treatment, is possible and desirable.

Oral ciprofloxacin for treatment of chronic osteomyelitis.

Seventeen adult patients with chronic osteomyelitis were treated with oral ciprofloxacin, 750 mg twice daily. Treatment ranged from 28 to 254 days. Efficacy was considered to be good, based upon clinical resolution observed in 13 patients (76%). Clinical and microbiological failure was observed in 3 patients (18%), and there was one case of reinfection. Tolerance was very satisfactory, since the adverse reactions were mild and transitory; these occurred in 7 patients (41%), being cutaneous rash in 4 patients and diarrhoea in 3 patients. No patient had to discontinue treatment. Thus, oral ciprofloxacin may be useful option for the prolonged treatment of chronic osteomyelitis, provided that it is always associated with surgical debridement. Due to the probable development of ciprofloxacin resistance in the S. aureus multiresistant strain, already observed in two patients in the present investigation, it is suggested that for the treatment of such infections another drug with antistaphylococcal activity should be associated with the ciprofloxacin.

Successful use of a defined antigen/GM-CSF adjuvant vaccine to treat mucosal Leishmaniasis refractory to antimony: A case report.

Immunotherapy has been proposed as a method to treat mucosal leishmaniasis for many years, but the approach has been hampered by poor definition and variability of antigens used, and results have been inconclusive. We report here a case of antimonial-refractory mucosal leishmaniasis in a 45 year old male who was treated with three single injections (one per month) with a cocktail of four Leishmania recombinant antigens selected after documented hypo-responsiveness of the patient to these antigens, plus 50 microg of GM-CSF as vaccine adjuvant. Three months after treatment, all lesions had resolved completely and the patient remains without relapse after two years. Side effects of the treatment included only moderate erythema and induration at the injection site after the second and third injections. We conclude that carefully selected microbial antigens and cytokine adjuvant can be successful as immunotherapy for patients with antimonial-refractory mucosal leishmaniasis.

Etiological drug treatment of human infection by Trypanosoma cruzi.

Forty-nine American Trypanosomiasis (Chagas' disease) patients, with xenodiagnosis proven parasitemia were treated by the authors. Forty-one of these patients were given benznidazole, at dosages ranging from 5mg/kg/day to 8mg/kg/day, during a pre-established period of 60 days. In this group, 17 patients had an undetermined form of the disease, whereas 22 had cardiologic disease and 4 had digestive disease (two patients had a mixed form of the disease). Side effects were frequent, and led to the discontinuation of treatment in 17 patients. The follow-up period ranged from 1 to 20 years (mean follow-up period of 6 yrs. 7 mo). 26 (63.4%) of the patients became parasitemia-negative. The other eight patients were treated with nifurtimox, during 120 days, following a variable dose regime of 5mg/kg/day (initial dose) to 17 mg/kg/day (final dose). Six of them had severe side effects, and only one patient remained parasitemia-negative throughout the observation period (ranging from 1 to 18 years). Benznidazole proved to be better tolerated and more effective in the management of parasitemia when compared to nifurtimox, although more effective and less toxic drugs are still desirable.

Comparison of screening methods for conductive hearing loss identification in children: low-cost proposal.

OBJECTIVE: To evaluate the effectiveness of two screening methods (imitanciometry screening and questionnaire) to identify children at risk for conductive hearing loss, comparing this data with complete audiologic evaluation. METHODS: Of 507 children aged between three and six, 111 completed all procedures. The observational methods used were: imitanciometry screening, a questionnaire to identify risk factors for hearing loss and complete audiologic evaluation. Results obtained in the first two instruments were compared with results from complete audiologic evaluation (gold standard). From these comparisons, sensitivity and specificity, accuracy, positive and negative predictive values, and odds ratio were determined for the two screening methods and for the combination of both methods. RESULTS: The two methods applied in series (questionnaire and after imitanciometry screening) showed a greater odds ratio and better correlation between sensitivity and proportion of false-positives (ROC curve). CONCLUSION: Combining the two tests in series improved screening accuracy. This combination was the best tool for identifying children at risk for conductive hearing loss.

Isotopic composition as a tool for assessment of origin and dynamic of organic matter in tropical freshwater.

The isotopic composition (13C and 15N) and C:N ratio of sediment and particulate were investigated to assess the origin and dynamic of the organic matter in two river basins located in the Parana State, Brazil. The main sources of organic matter, plants, litter and soil, were analyzed in the study. This study was carried out during the dry and wet seasons. Although organic matter contribution for the particulate material has been mixed, the main contribution in the two seasons for both rivers was autochthonous characterized by delta13C and C:N ratio values ranging from -31.0 to -21.8 per thousand and from 5.1 to 11.4, respectively. The soil with delta13C values ranging from -25.9 to -20.6 per thousand, and C:N ratio from 10.2 to 15.8, was the main carbon source for the river sediment for the two tributaries in the wet and dry seasons. The sediment delta15N values for both the rivers in the wet season showed an 15N enrichment trend in most of studied sites when compared to the dry season values, suggesting major input of nutrients as dissolved organic nitrogen and sewage nitrate. In the dry season, 14N enriched compounds, could have been used by phytoplankton, causing 15N enrichment. The isotope and C:N ratio data clearly showed that the agricultural activity has been influencing the origin and dynamic of organic matter in the two rivers, with potential biochemical consequences for the lower basin of the major Tibagi river.

Avaliação da atividade antibacteriana e prospecção fitoquímica de Solanum paniculatum Lam. e Operculina hamiltonii (G. Don) D. F. Austin & Staples, do semi-árido paraibano / Evaluation of antibacterial activity and phytochemical prospection of Solanum paniculatum Lam. and Operculina hamiltonii (G. Don) D. F. Austin & Staples from the semi-arid region of Paraíba State, Brazil

Devido ao aparecimento de populações de parasitos resistentes, as drogas farmacêuticas, alternativas de controle, estão sendo pesquisadas utilizando plantas medicinais. O objetivo deste estudo foi avaliar a atividade antibacteriana e realizar a análise fitoquímica do extrato etanólico de duas espécies do semi-árido paraibano, Solanum paniculatum Lam. e Operculina hamiltonii (G. Don) D. F. Austin & Staples. As referidas espécies são muito utilizadas pela população rural contra verminoses gastrintestinais de ovinos. A prospecção fitoquímica foi obtida a partir dos extratos etanólicos para análise dos constituintes químicos existentes nas duas espécies. As análises dos extratos indicaram a presença de taninos flobabênicos, flavononóis, flavononas e alcalóides em ambas as espécies. A atividade antibacteriana foi determinada inicialmente pelo método de difusão em cavidade. A espécie S. paniculatum apresentou atividade contra Staphylococcus aureus (ATCC 12692), Escherichia coli (ATCC 25922) e Pseudomonas aeruginosa (ATCC 15442), no entanto O. hamintonii não demonstrou atividade contra as linhagens bacterianas testadas.

The emergence of resistant parasite populations has led to the study of pharmaceutical drugs, which represent an alternative control. This study aimed to evaluate the antibacterial activity and to perform the phytochemical analysis of the ethanol extract from two species belonging to the semi-arid region of Paraíba State, Brazil: Solanum paniculatum Lam. and Operculina hamiltonii (G. Don) D. F. Austin & Staples. Such species have been largely used by the rural population against ovine gastrointestinal helminthes. Phytochemical prospection was obtained from ethanol extracts for analysis of chemical compounds present in both species. Extract analyses indicated the presence of condensed tannins, flavonols, flavanones, and alkaloids in both species. The antibacterial activity was initially determined by the cavity method. The species S. paniculatum had activity against Staphylococcus aureus (ATCC 12692), Escherichia coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 15442); however, O. hamintonii did not present activity against the tested bacterial strains.

Groups I, II and III extracellular phospholipases A2: selective inhibition of group II enzymes by indomethacin but not other NSAIDs.

The three types (groups I, II and III) of stable extracellular 14 kDa phospholipase A2 enzymes differ in their primary amino acid sequences and their properties. It may thus be possible to design low-molecular weight inhibitors targeted to the secretory form of mammalian PLA2. This enzyme has been implicated in inflammatory disorders. We have studied the inhibition of four distinct PLA2 enzymes by a range of NSAIDs, using 3H-oleate release from prelabelled membranes of E. coli for assay. The enzymes used were cobra venom PLA2 (Naja naja, a group I enzyme), bee venom PLA2 (Apis mellifera, group III), recombinant human synovial PLA2 (group II) and rat peritoneal PLA2 (group II). Under the conditions of the 3H-oleate E. coli assay, 1 mM concentrations of aspirin, sodium salicylate, paracetamol (acetaminophen), oxphenbutazone, ibuprofen, flurbiprofen and nabumetone failed to inhibit significantly any of the four enzymes. However, indomethacin inhibited all four enzymes, although effects were greatest on the two group II enzymes (rat peritoneal and human synovial PLA2). Approximate IC50 values were 28 and 35 microM, respectively. Inhibition by indomethacin was not time dependent and was greater at micromolar rather than millimolar levels of calcium. We conclude that indomethacin but not the other tested classes of NSAID inhibits the group II PLA2 enzyme in a selective manner and suggest that this may be relevant both to its clinical spectrum and to the design of novel pharmaceutical leads.

Inhibitory activity of a series of coumarins on leukocyte eicosanoid generation.

Sixteen plant-derived or synthetic coumarins with different patterns of substitution were tested for their capacity to modify A23187-induced synthesis of leukotriene B4 and thromboxane B2 via the 5-lipoxygenase and cyclooxygenase pathways of arachidonate metabolism in rat peritoneal exudate leukocytes. Five of the 16 coumarins inhibited LTB4 production: all contain orthodihydroxy substitutions (approximate IC50 values 8-100 microM). The mechanism is likely to depend upon a combination of the coumarins' iron-chelating and iron ion-reducing abilities, properties which also confer beneficial activities of these compounds as scavengers of reactive oxygen species (Payá et al., Biochem. Pharmacol. 44, 205-214 (1992)). Inhibition of the cyclooxygenase pathway was only demonstrated by one compound, 5,7-dihydroxy-4-methylcoumarin, which did not inhibit 5-lipoxygenase, indicating that the cyclooxygenase inhibitory mechanism is different. Similar effects of the active coumarins were obtained using arachidonic acid as substrate for rat leukocyte eicosanoid generation, confirming that they act at the 5-lipoxygenase/cyclooxygenase level. The same profile of activity was also shown when the coumarins were tested against 5-lipoxygenase in human polymorphonuclear neutrophils. Taken together, these antioxidant and anti-eicosanoid properties of coumarins could be exploited for the design of potentially valuable non-toxic anti-inflammatory agents for treating diseases in which eicosanoid generation and the production of reactive oxygen species are involved.

Does acetaldehyde mediate ethanol action in the central nervous system?

BACKGROUND: Some of the effects of ethanol in the central nervous system are due to changes in function of ligand-gated ion channels. Production of detectable amounts of acetaldehyde, a primary metabolite of ethanol, has been demonstrated in brain homogenates. The aim of this study was to determine whether central actions that are often attributed to ethanol may actually be mediated by acetaldehyde. METHODS: The effects of acetaldehyde (1-1000 microM) were tested by two-electrode voltage-clamp electrophysiology in Xenopus laevis oocytes expressing 10 different ligand-gated ion channel receptors [alpha1 glycine; alpha1beta2gamma2Sgamma-aminobutyric acid (GABA)A; rho1 GABAc; 5-hydroxytryptamine-3A; NR1a/NR2A NMDA; GluR1/GluR2 AMPA; GluR6/KA2 kainate; and alpha4beta2, alpha4beta4, and alpha2beta4 nicotinic-acetylcholine] and the G-protein-coupled inward rectifying potassium channel GIRK2. We also investigated the effect of acetaldehyde on the dopamine transporter (DAT), performing dopamine uptake assays in oocytes expressing DAT. RESULTS: Acetaldehyde (1 and 10 microM) significantly enhanced alpha1 glycine receptor-mediated currents. Acetaldehyde did not affect the function of any of the other receptors tested or the potassium currents measured in GIRK2 channels. Moreover, acetaldehyde did not alter the DAT-mediated dopamine uptake. CONCLUSIONS: Our results suggest a potential minor role for acetaldehyde in the glycine receptor-mediated effects of ethanol. Otherwise, acetaldehyde does not modulate function of the neuronal receptors tested in this study, in GIRK channels or DAT, when expressed recombinantly in Xenopus laevis oocytes.