Evaluation of succulent plants Echeveria elegans as a biomonitor of heavy metals and radionuclides.

This work evaluates the use of Echeveria elegans as a biomonitor of metals and radionuclides, using semi-urban soils as a study area. The study area is exposed to various trace elements of concern for various social groups in nearby localities. The quantification of metals and radionuclides was performed by X-ray fluorescence spectrometry and gamma spectrometry, respectively. Cumulative frequency distribution curves, descriptive statistics, and multivariate analysis were used to estimate the local geochemical baseline and identify geochemical and anthropogenic patterns of metals and radionuclides from topsoil and E. elegans. The evaluation of contaminants and the contribution of possible exposure routes (topsoil and atmospheric deposition) was performed with the enrichment factor (EF) and the relative concentration factor (CFR). The results suggest that the plant does not present significant physical stress due to the environmental conditions to which it was exposed. Likewise, it can bioaccumulate heavy metals from natural and anthropogenic sources. The quantification of radionuclides in the plant is below the detection limits, indicating a low bioavailability and transfer factor. The CFR and EF results showed that the plant accumulates metals from the topsoil and atmospheric deposition. The bioaccumulation mechanism would be related to the functioning of Crassulaceae Acid Metabolism (CAM). In topsoil, the organic acids of the plant would modify the solubility of the metals present in an insoluble form in the soil, acting as ligands and, subsequently, following the transport route of these metabolites. In atmospheric deposition, the metals deposited in the leaves would be incorporated into the plant through the opening of the stomata because of the capture of CO2 (at night, day, or during environmental stress) by the CAM. Overall, the evidence showed that the succulent can be used as a biomonitor of heavy metals. However, additional studies are required to determine its usefulness as a radionuclide biomonitor.

Dermoscopy in Patch Testing: How Can It Help? / Uso del dermatoscopio en la lectura de pruebas epicutáneas: ¿qué puede aportar?

Interpreting patch test reactions is not easy. It requires experience and is characterized by high intraobserver and interobserver variability. It can sometimes be truly difficult to discern between a weak allergic reaction and an irritant reaction. A number of recent studies have investigated the dermoscopic features of patch test reactions. Homogeneous erythema is the main feature observed in patients with a positive allergic reaction, although dotted vessels, vesicles, crusts and yellow-orange areas may also provide clues. These features are somewhat similar to those observed in inflammatory conditions, such as eczema. In patients with an irritant reaction, the most common dermoscopic findings are the pore reaction pattern and perifollicular erythema. Dermoscopy could be useful for establishing a diagnosis in the case of doubtful patch test reactions.

Value of microscopy in the diagnosis of dysentery associated with invasive Entamoeba histolytica.

AIMS: To assess the reliability of the detection of erythrophagocytic amoebic trophozoites in stool samples in the diagnosis of dysentery associated with invasive Entamoeba histolytica. METHODS: Amoebic culture was carried out on single stool samples collected from patients from Mexico, Colombia, and Bangladesh. The stools had been examined by light microscopy. Amoebic dysentery was diagnosed when erythrophagocytic E histolytica trophozoites were observed in a case of bloody diarrhoea. E histolytica isolates were characterised by isoenzyme electrophoresis and results correlated with microscopical findings in stools. Statistical analysis was performed using the chi 2 test. RESULTS: Where erythrophagocytic amoebae had been observed in dysenteric stool specimens the E histolytica phenotype was invariably invasive (p < 0.0001). Observation of erythrophagocytic amoebae in dysentery is 100% specific and predictive of infection with invasive E histolytica. When amoebic culture-positive cases only are considered it is 96% sensitive. In this study E histolytica of zymodeme XIV was more commonly associated with amoebic dysentery than zymodeme II. There was no significant difference between the carriage rate of invasive and non-invasive E histolytica in non-dysenteric diarrhoea. Asymptomatic subjects carried non-invasive E histolytica more frequently than invasive E histolytica. Patients with non-amoebic dysentery, when shown to be infected with E histolytica, carried non-invasive strains (12%). CONCLUSIONS: Sensitivity and specificity of microscopical examination of a single stool specimen for diagnosing amoebic dysentery is very high; intestinal carriage of invasive E histolytica detected by culture is not necessarily an indication of active disease as patients with diarrhoea and asymptomatic subjects shed invasive and non-invasive E histolytica. There are possibly two subpopulations of invasive E histolytica with different pathogenic potential which can be differentiated by zymodeme analysis.

Further diagnostic use of an invasive-specific monoclonal antibody against Entamoeba histolytica.

Genotypic differences between invasive and non-invasive E. histolytica could explain the 1:10 ratio of symptomatic/asymptomatic infection worldwide. Currently, zymodeme analysis is used to differentiate invasive from non-invasive E. histolytica strains but the technique is cumbersome and expensive. In accordance with the WHO research priorities for amebiasis we report here the further use of an invasive-specific monoclonal antibody against E. histolytica in immunofluorescence, to identify isolates cultured from stool samples of patients from three geographically distant endemic regions: Bangladesh, Colombia and Mexico. We tested 107 E. histolytica isolates and the correlation between zymodeme characterization and the immunofluorescence assay was 100%.

Dapsone in low doses prevents Pneumocystis carinii pneumonia in the rat model.

Less toxic drugs are needed for the prophylaxis and treatment of Pneumocystis carinii pneumonia (PCP) in patients with AIDS. Rats immunosuppressed with cortisone were given dapsone, chlorproguanil (CPG) and chlorcycloguanil (CCG), alone or in combination, in the diet and the P. carinii attack rate was compared with that of untreated controls. Dapsone alone at doses of 25 and 5 mg/kg/day was 100% effective in preventing PCP. The efficacy of CPG and CCG, however, could not be properly assessed because of the lack of acceptance of the diet by the animals. Even so, as a result of the findings with dapsone in this study, and because of its pharmacokinetics and minimum inhibitory concentration for P. carinii in vitro, a clinical trial of reduced dosage of dapsone given prophylactically to human beings is suggested. Such a trial may show a decrease in the toxicity of the drug that usually accompanies its long-term administration but retention of its efficacy.

Renal excretion of urate by hyperuricaemic-hyperlipidemic patients.

We studied the renal urate excretory function in two groups of hyperuricaemic male patients composed of individuals with associated hyperlipidemia and hyperuricaemic-normolipidemic individuals, respectively. Both the hyperlipidemia and the hyperuricaemia were primary inasmuch as none of the patients studied was obese or had an above-normal alcohol intake or blood hypertension. The results obtained show that hyperuricaemic-hyperlipidemic patients have higher serum levels of uric acid and poorer urate excretion as reflected in smaller clearance and fractioned excretion of the metabolite than hyperuricaemic-normolipidemic patients. This, in turn, suggests the occurrence of differences in the extent of the urate handling anomalies between the two groups of patients.

Failed prostaglandin abortion associated with placenta accreta. A case report.

Prostaglandin E2 vaginal suppositories are a highly effective method of second-trimester pregnancy termination. Management of a failed prostaglandin abortion must include a search for the cause of the failure. This case report is the first description of a failed prostaglandin abortion associated with placenta accreta.

Captopril in severe preeclampsia.

Captopril is an inhibitor of angiotensin I converting enzyme and is used for treating intractable chronic hypertension. However, the use of captopril during pregnancy is limited because of reported fetal and neonatal side effects. This study explored the efficacy of sublingual captopril in postpartum management of severe preeclampsia. Captopril controlled the systolic and diastolic pressures within normal range in two patients. The other three patients responded moderately and were switched to hydralazine, clonidine, or nifedipine after 12 hours. The systolic and diastolic pressures of these three patients remained moderately elevated over the 24-hour duration of the study while their pulse rates increased. Captopril did not significantly increase the pulse rate in any of the patients studied, and no other side effects were noted. All patients had normal pressures at their 2- and 6-week postpartum check-up. We conclude that sublingual captopril may be used safely and effectively in managing postpartum hypertension in patients with severe preeclampsia.

Comparison of capillary and plasma glucose values in screening and oral glucose tolerance testing in pregnancy.

The substitution of capillary reflectance meter glucose values for plasma or serum glucose values would be practical and cost saving. A direct comparison was performed of simultaneous capillary reflectance meter and plasma glucose values in routine screening and oral glucose tolerance testing in a pregnant population. The use of capillary glucose in 50-g glucola screening had a sensitivity of 82.6% and specificity of 98.1% as compared to the standard plasma method. Even though our data demonstrate a good correlation (r = 0.897) between capillary and plasma glucose values, our results do not support the direct substitution of plasma glucose values with capillary reflectance meter glucose values in screening for or diagnosing glucose intolerance in an obstetric population.

[Lipoprotein profile in patients with isolated hyperuricemia]. / Perfil lipoproteico en pacientes con hiperuricemia aislada.

There have been described abnormalities in the lipoprotein profile of hyperuricemic patients, it has not been clarified wether these abnormalities are due to the hyperuricemia or to the hyperlipidemia often associated to these patients. Our aim is to study the apolipoprotein profile in hyperuricemic patients without hyperlipidemia compared to a control population. 30 hyperuricemic patients and 26 healthy controls. Measurements were of blood uric acid, total cholesterol, total triglycerides, creatinine, HDL-C, and VLDL cholesterol, triglyceride, Apo B, Apo CII and Apo CIII (1 and 2). Uric acid clearance and fractionated excretion were measured in 24 h. urine samples. No significant differences were found between hyperuricemic and control patients in cholesterol, triglycerides and apo B in VLDL, or LDL and HDL cholesterol. The levels of apo B, Apo AI levels and apo CIII/apo CII were similar in the hyperuricemic and controls. There are two types of hyperuricemic patients, one group associated to hyperlipidemia and would be included in the X Syndrome. The other group not associated to other metabolic abnormalities. Is important to distinguish between these two groups to define the prognosis of a given patient because the greater cardiovascular risk linked hyperuricemic patients could be related to the association to others cardiovascular risks factors.

Daptomycin for outpatient parenteral antibiotic therapy: a European registry experience.

A retrospective analysis of data from patients receiving daptomycin as outpatient parenteral antimicrobial therapy (OPAT) within the European Cubicin Outcomes Registry and Experience (EU-CORE(SM)) was performed. Of 4592 enrolled patients in 15 countries, 550 (12%) received daptomycin OPAT. Of these, 149 (27%) received daptomycin without hospital admission, 84% had significant underlying diseases and 44% were ≥65 years of age. Most frequently treated infections were complicated skin and soft-tissue infections (28%), osteomyelitis (17%), foreign body/prosthetic infections (15%) and endocarditis (14%). In patients with culture results available, Staphylococcus aureus and coagulase-negative staphylococci were the most commonly isolated primary pathogens [n = 218 (46%) and n = 102 (21%), respectively]. Daptomycin was typically used at doses of 6 mg/kg (n = 210; 38%) and 4 mg/kg (n = 160; 29%), with concomitant antibiotics used in 41%. The median treatment duration was 22 days (range 1-300 days), with a median of 13 OPAT days (range 1-290 days). Overall clinical success was observed in 89%, with high success rates across the wide range of infections, including those caused by meticillin-resistant and meticillin-susceptible S. aureus (88% and 90%, respectively). Daptomycin exhibited a favourable safety profile; 3.1% of patients discontinued treatment owing to an adverse event. These data demonstrate that daptomycin is effective and well tolerated in the treatment of a wide range of Gram-positive infections in the outpatient setting. Ease of administration of daptomycin, via a daily 2-min injection, and its efficacy and safety combine to make it an attractive treatment option for OPAT.

Are glycopeptides still appropriate and convenient for empiric use?

The glycopeptides vancomycin and teicoplanin are widely used, and indeed recommended for, the treatment of severe or resistant Gram-positive infections. Therapeutic drug monitoring is widely used for vancomycin but less commonly for teicoplanin, and remains controversial. We report the cost savings of a formulary decision to replace teicoplanin with daptomycin for the empiric treatment of complicated skin and soft tissue infections (CSSTIs), staphylococcal bacteraemia and hospital-acquired Gram-positive sepsis. In the Intensive Therapy Unit (ITU) we optimised treatment of serious Gram-positive infections by substituting teicoplanin with vancomycin administered by continuous infusion. Costs were calculated using British National Formulary (BNF) prices and costs for therapeutic drug monitoring. Daptomycin (350 mg/d) use was associated with a cost saving per 7 days of treatment of 86 pounds and vancomycin with 51 pounds (4 g/d) to 276 pounds (2 g/d) compared to the 600 mg teicoplanin dose. Our own formulary re-positioning of glyco/lipopeptides, i.e. the preferential use of vancomycin in the ITU and substitution of teicoplanin with daptomycin, is cost-effective and provides better therapeutic alternatives. Continuous vancomycin infusion in the ITU setting guarantees optimal dosing for severely ill patients. Daptomycin use on surgical and medical wards, apart from being marginally cheaper than teicoplanin, guarantees optimal dosing without the need for drug monitoring.