[Primary renal marginal zone B lymphoma]. / L'image du mois. Lymphome B primitif de la zone marginale rénale.

Primary renal marginal zone B lymphoma is extremely rare. The renal involvement by the lymphoma is most often a manifestation of a disseminated disease. We report the case of a 53-year-old patient who presented lower back pain and kidney failure. The renal biopsy showed a marginal zone B lymphoma type MALT and the PET scan showed bilateral renal involvement. A treatment based on rituximab combined with chemotherapy (cyclophosphamide, prednisone and oncovin) was started with good outcome.

Le lymphome B de la zone marginale rénale comme lésion primitive est extrêmement rare car l'atteinte rénale est le plus souvent une manifestation de la maladie disséminée. Nous rapportons le cas d'un patient âgé de 53 ans présentant des lombalgies chroniques avec insuffisance rénale. La biopsie rénale était en faveur d'un lymphome B de la zone marginale type MALT et la tomographie par émission de positons a objectivé une atteinte rénale bilatérale. Un traitement à base de rituximab couplé à une chimiothérapie (cyclophosphamide, prednisone et oncovin) a été démarré avec une bonne évolution.

Syrian Refugees and Their Impact on Health Service Delivery in the Pediatric Hematology/Oncology Clinics Across Canada.

This study examined the impact of Syrian refugees on 1 area of the Canadian health care sector. We predicted that pediatric hematology clinics across Canada would see a spike in their Syrian refugee patient population in proportion to their recent migration and, as a result, an increase in perceived workload. Data on the number of refugee patients, types of diseases, and perceived workload were gathered from hematology clinics across Canada using a clinical survey (Supplemental Digital Content 1, http://links.lww.com/JPHO/A315). The results showed that Ontario had the most Syrian refugee patients, followed by the Quebec, Western Canadian, and Atlantic regions. The results also showed that perceived workload ranged from "no increase" (4 programs) to "minimal increase" <25% (1 program), "moderate increase" 25% to 75% (4 programs), and "significant increase" >75% (3 programs, 2 of which had no transfusion-dependent thalassemia patients before the immigration).

The advertisement call of Proceratophrys redacta (Anura, Odontophrynidae).

The genus Proceratophrys Miranda-Ribeiro, 1920, frogs from the family Odontophrynidae Lynch, currently contains 41 nominal species with poorly resolved phylogenetic relationships (Frost 2019; Mângia et al. 2018). Molecular data from 15 and 18 Proceratophrys species support the monophyletic hypothesis of the genus (Teixeira-Jr et al. 2012; Dias et al. 2013; respectively) but do not fully resolve the phylogenetic relationship among the species. Currently, there are advertisement call parameters provided for 31 species of Proceratophrys in the literature (Ferreira et al. 2016; Andrade et al. 2018; Mângia et al. 2018; Nascimento et al. 2019). The Proceratophrys advertisement call is composed of pulsed notes, amplitude modulation, short to medium duration calls (0.05-4 s) and only one note in almost all species (see Nascimento et al. 2019 for details). Considering the importance of bioacoustics for taxonomy (Köhler et al. 2017), further descriptions of advertisement calls for the genus could also improve our understanding of the species' relationships.

Clinicopathologic features of experimental Clostridium perfringens type D enterotoxemia in cattle.

This study was designed to experimentally reproduce enterotoxemia by Clostridium perfringens type D in cattle and to characterize the clinicopathologic findings of this disease. Fourteen 9-month-old calves were inoculated intraduodenally according to the following schedule: group 1 (n = 4), C. perfringens type D whole culture; group 2 (n = 3), C. perfringens type D washed cells; group 3 (n = 5), C. perfringens type D filtered and concentrated supernatant; group 4 (n = 2), sterile, nontoxic culture medium. In addition, all animals received a 20% starch solution in the abomasum. Ten animals from groups 1 (4/4), 2 (3/3), and 3 (3/5) showed severe respiratory and neurologic signs. Gross findings were observed in these 10 animals and consisted of acute pulmonary edema, excessive protein-rich pericardial fluid, watery contents in the small intestine, and multifocal petechial hemorrhages on the jejunal mucosa. The brain of one animal of group 2 that survived for 8 days showed multifocal, bilateral, and symmetric encephalomalacia in the corpus striatum. The most striking histologic changes consisted of perivascular high protein edema in the brain, and alveolar and interstitial proteinaceous pulmonary edema. The animal that survived for 8 days and that had gross lesions in the corpus striatum showed histologically severe, focal necrosis of this area, cerebellar peduncles, and thalamus. Koch's postulates have been met and these results show that experimental enterotoxemia by C. perfringens type D in cattle has similar clinical and pathologic characteristics to the natural and experimental disease in sheep.

The Perennial Use of the Green Fluorescent Protein Marker in a Live Vaccinia Virus Ankara Recombinant Platform Shows No Acute Adverse Effects in Mice.

Recombinant virus vectors represent a promising strategy for vaccine research. Among available viral vectors, members of the Poxviridae family-especially the modified Vaccinia virus Ankara (MVA)-stand out as immunogenic and safe vaccine platforms. Because MVA usually does not produce plaques in cell culture, visible selection markers such as the green fluorescent protein (GFP) are frequently incorporated into the constructions in order to facilitate the recognition of recombinants. However, these genetic markers have to be removed before any clinical trial. Here, we evaluated the acute responses generated in mice immunized with a MVA vector in which the GFP marker was not removed. We observed no differences in neutrophil, monocyte, or total leucocyte recruitment among animals inoculated with MVA or MVA-GFP. Likewise, there were no differences in neutrophil activation between mice groups. Hepatic functions were not altered in either MVA or MVA-GFP-inoculated mice, and we observed no histopathological alterations in different tissues from virus-inoculated animals. In conclusion, the presence of GFP is innocuous to immunized animals and do not alter acute physiopathological responses to the MVA vector. We suggest that keeping the GFP marker may be a good strategy for vaccine development, production, and evaluation.

Outcome of Acute Myeloid Leukemia in Children Adolescents and Young Adults Treated with an Uniform Protocol in Casablanca, Morocco.

Treatment of acute myeloblastic leukemia in children, adolescents and young adults (AYA) is a challenge in low-income countries. To evaluate treatment outcomes of children (≤ 15 years) and AYA (15-30 years) diagnosed with novo AML and treated in a single center according to the AML-MA 2011 protocol. From January 2011 to December 2015, eligible patients (age ≤ 30 years) with novo AML had been enrolled on a uniform treatment protocol. The diagnosis was confirmed according to the FAB classification using the WHO 2008 criteria. Patients with WBC ≥ 50 G/L had pretreated 4 days of hydroxyurea followed by two inductions and two consolidations. Supportive care consisted of transfusion of labile blood products, antibiotics and antifungals, and patient and family education by the hygiene team. 155 patients were recruited, 41 were < 15 years old (22 boys, median age 7.8 years). Of the 114 AYA enrolled, (48 women, median age 23 years). Complete remission after two inductions was 28/41 (68.3%) of the children, including 100% of the children in the favorable group and 71/114 (62.3%) of the AYA, 22 of whom (68.7%) were in the favorable group. The number of deaths among children was 6 (14.6%). The evaluation of the AML-MA-2011 National Protocol in the age groups of children and AYA reveals that the objective of treatment is almost achieved in terms of complete remission in the two age groups.

Interference of Lactobacillus plantarum with Pseudomonas aeruginosa in vitro and in infected burns: the potential use of probiotics in wound treatment.

This study evaluated the ability of the probiotic organism Lactobacillus plantarum to inhibit the pathogenic activity of Pseudomonas aeruginosa, both in vitro and in vivo, and investigated the mechanisms involved in such protection. L. plantarum whole cultures, culture filtrates (acid filtrate and neutralised acid filtrate) and isolated, washed cells were tested in vitro for their effects on the production of the P. aeruginosa quorum-sensing signal molecules, acyl-homoserine-lactones (AHLs), and two virulence factors controlled by these signal molecules, elastase and biofilm. All were inhibited by L. plantarum cultures and filtrates, but not by isolated, washed cells. The acid L. plantarum growth medium itself had some inhibitory activity, but the greatest activity was exerted by the whole culture. To test the in-vivo activity of L. plantarum, a burned-mouse model was used in which burns infected with P. aeruginosa were treated with L. plantarum at 3, 4, 5, 7 and 9 days post-infection. Samples from skin, liver and spleen taken after 5, 10 and 15 days demonstrated inhibition of P. aeruginosa colonisation by L. plantarum. There was also an improvement in tissue repair, enhanced phagocytosis of P. aeruginosa by tissue phagocytes, and a decrease in apoptosis at 10 days. These results indicate that L. plantarum and/or its by-products are potential therapeutic agents for the local treatment of P. aeruginosa burn infections.

A natural auto-inhibitory factor of the terminal complement pathway in serum of Ctenodactylus gondi.

The serum of Ctenodactylus gondi, a Tunisian rodent, contains a unique inhibitor of the terminal complement pathway. The auto-inhibitor has been partially characterized as a heat-stable euglobulin that is slightly retarded on a DEAE-ion exchange column at pH 7 and elutes as a symmetrical peak on Sephacryl S-300 in the mol. wt region of approximately 200,000. The inhibitor acts by preventing attachment of cytolytic C5b-9 complexes to natural target cells. It does not appear to affect formation and function of C3-convertase, does not exert inhibitory effects at stages later than C5b-7 formation, and also does not prevent formation of SC5b-9 in serum. That the factor prevents attachment of C5b-7/C5b-9 to cells has been demonstrated in hemolysis model systems using sheep EA + human serum, and in the C3-independent reactive lysis system with the use of ELISA methods and quantitative assays with radioiodinated C8. Addition of partially purified inhibitory factor to human sera or to sera of other animal species abolishes the hemolytic activities of these sera. The inhibitory factor of Gondi serum is the first inhibitor of the terminal pathway which has been shown to be capable of preventing cytolysis of cells undergoing complement attack under physiological conditions. The presence of this factor is probably partially responsible for the remarkable susceptibility of C. gondi towards bacterial and parasitic infections.

[Gaucher's disease. Substitutive enzymatic treatment in one case and a review of the literature]. / La maladie de Gaucher. Traitement enzymatique substitutif à propos d'un cas avec revue de la littérature.

Gaucher's disease, rare, hereditary and potentially mortal affection is characterized by the reduced concentration of the glucocerebroside lipid within the macrophage lysosomes. We report the case of a young 2 years old patient treated by transfusion since he was 9 months because of chronic anemia. According the clinical examination, the general state of the patients was bad ith important delayed stanturoponderal growth, a cutaneomucous paller and enormous splenomegaly. The blood count formula showed anemia with major thrombopenia. The myelogram was poor and the osteomedullar biopsy showed the presence of Gaucher's cells. The diagnosis has been confirmed by enzymatic dosage (Leucocytar b-glucosidase). The treatment of the patient has been substitutive enzymatic (inifucerase) with very favorable response. During Gaucher's disease, the enzymatic deficiency results in the pathologic accumulation of the substrate (glucocerebroside) in the lyososomes, this metabolic overloading may cause polyvisceral disease with spontaneous evolution ofter mortal. The recent discovery of a recombining glucocerebrosidase (imiglucerase) transformed the prognosis of this disease.

Evidence for the contribution of adult neurogenesis and hippocampal cell death in experimental cerebral malaria cognitive outcome.

Cognitive dysfunction is a major sign of cerebral malaria (CM). However, the underlying mechanisms of CM cognitive outcome remain poorly understood. A body of evidence suggests that adult neurogenesis may play a role in learning and memory processes. It has also been reported that these phenomena can be regulated by the immune system. We hypothesized that memory dysfunction in CM results from hippocampal neurogenesis impairment mediated by the deregulated immune response during the acute phase of CM. C57Bl/6 mice were infected with Plasmodium berghei ANKA (PbA) strain, using a standardized inoculation of 10(6) parasitized erythrocytes. Long-term working memory was evaluated using the novel object recognition test. The mRNA expression of brain-derived neurotrophic factor (BDNF), tropomyosin-receptor-kinase (TRK-B) and nerve growth factor (NGF) in the frontal cortex and hippocampus was estimated by real-time polymerase chain reaction (PCR). The protein levels of cytokine interleukin-2 (IL-2), IL-4, IL-6, IL-10, interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and CCL11 and neurotrophins BDNF and NGF were determined using a cytometric bead array (CBA) kit or enzyme-linked immunosorbent assay. Cell viability in the hippocampus was analyzed by Confocal Microscopy. Neurogenesis in the dentate gyrus was determined through quantification of doublecortin (DCX) positive cells. PbA-infected mice presented working memory impairment on day 5 post-infection. At this same time point, CM mice exhibited a decrease in DCX-positive cells in the dentate gyrus in parallel with increased cell death and elevated inflammatory cytokines (IL-6, TNF-α, IFN-γ and CCL11) in the hippocampus and frontal cortex. A significant reduction of BDNF mRNA expression was also found. IL-6 and TNF-α correlated negatively with BDNF and NGF levels in the hippocampus of CM mice. In summary, we provide further evidence that neuroinflammation following PbA-infection influences neurotrophin expression, impairs adult hippocampal neurogenesis and increases hippocampal cell death in association with memory impairment following CM course. The current study identified potential mediators of memory impairment in CM.

Induction of eosinophil apoptosis by hydrogen peroxide promotes the resolution of allergic inflammation.

Eosinophils are effector cells that have an important role in the pathogenesis of allergic disease. Defective removal of these cells likely leads to chronic inflammatory diseases such as asthma. Thus, there is great interest in understanding the mechanisms responsible for the elimination of eosinophils from inflammatory sites. Previous studies have demonstrated a role for certain mediators and molecular pathways responsible for the survival and death of leukocytes at sites of inflammation. Reactive oxygen species have been described as proinflammatory mediators but their role in the resolution phase of inflammation is poorly understood. The aim of this study was to investigate the effect of reactive oxygen species in the resolution of allergic inflammatory responses. An eosinophilic cell line (Eol-1) was treated with hydrogen peroxide and apoptosis was measured. Allergic inflammation was induced in ovalbumin sensitized and challenged mouse models and reactive oxygen species were administered at the peak of inflammatory cell infiltrate. Inflammatory cell numbers, cytokine and chemokine levels, mucus production, inflammatory cell apoptosis and peribronchiolar matrix deposition was quantified in the lungs. Resistance and elastance were measured at baseline and after aerosolized methacholine. Hydrogen peroxide accelerates resolution of airway inflammation by induction of caspase-dependent apoptosis of eosinophils and decrease remodeling, mucus deposition, inflammatory cytokine production and airway hyperreactivity. Moreover, the inhibition of reactive oxygen species production by apocynin or in gp91(phox-/-) mice prolonged the inflammatory response. Hydrogen peroxide induces Eol-1 apoptosis in vitro and enhances the resolution of inflammation and improves lung function in vivo by inducing caspase-dependent apoptosis of eosinophils.

Sporadic cutaneous leishmaniasis in north Tunisia: identification of the causative agent as Leishmania infantum by the use of a diagnostic deoxyribonucleic acid probe.

A diagnostic kinetoplast deoxyribonucleic acid (DNA) probe has been used to identify as Leishmania infantum amastigotes taken from the lesions (in dermal fluid or lesion triturates) of 7 of 8 patients suffering from sporadic cutaneous leishmaniasis in north Tunisia. All 8 isolates were very difficult to culture but, subsequently, sufficient parasites of one isolate have been grown for isoenzyme typing, and were identified as zymodeme MON 24 of L. infantum. The advantages of using recombinant DNA probes for the identification of parasites from lesions are discussed.

Role of yoghurt in the prevention of colon cancer.

The beneficial effect of yoghurt consumption on health and on the improvement of the mucosal immune system is well established, as is the diet-associated risk of colon cancer. In an experimental model in BALB/c mice we demonstrated that yoghurt added to the diet for 10 consecutive days, with the procedure repeated each 10 days for 6 months, inhibited the development of a colorectal carcinoma induced by 1,2 dimethylhydrazine (DMH). The immunoregulatory mechanisms involved in the inhibition of tumour growth by yoghurt were also examined in these studies. We determined B lymphocytes IgA(+) and IgG(+), as well as CD4(+) and CD8(+) T cells in the large intestine. We measured cellular apoptosis and the cytokines TNF-alpha, IFN-gamma and IL-10. An increase in the number of IgA(+) (P<0.01) was observed, but not in IgG(+) (P<0.01), or in the CD4(+) population (P<0.01) in the mice treated with DMH and yoghurt. While in the group with the carcinogen there was an enhancement in the IgG(+) B cells (P<0.01) and CD8(+) T cells (P<0.01). Yoghurt increased the number of apoptotic cells and induced IFN-gamma and TNF-alpha cytokine release, their production being regulated by an increase in IL-10 (P<0.001). We demonstrated that yoghurt may exert antitumour activity by a decrease in the inflammatory immune response mediated by IgA(+) increase, apoptosis induction and IL-10 release.

[Canine leishmaniasis in the region of Enfidha (Central Tunisia). Assessment of seroprevalence with direct agglutination (DAT) and indirect immunofluorescence (IFAT)]. / La leishmaniose canine dans la région d'Enfidha (Tunisie centrale). Estimation de la séro-prévalence par agglutination directe (DAT) et immunofluorescence indirecte (IFAT).

In order to assess canine leishmaniasis prevalence rate in Enfidha area, considered to be the most important kala-azar focus in Sousse Governorate, a serological survey was carried out in 6 localities. 265 sera were examined by DAT and IFAT. 16 (6.03%) showed positive results for anti-leishmania antibodies with significant variations according to the locality. A fairly DAT-IFAT good correlation was observed.

[Clinico-epidemiologic forms of cutaneous leishmaniasis in Tunisia]. / Formes clinico-épidémiologiques des leishmanioses cutanées en Tunisie.

From an analysis of 1,546 cases of cutaneous leishmaniasis collected throughout Tunisia three clinico-epidemiological forms could be determined. These forms are due to three different species of Leishmania and are observed in different geographical areas. Sporadic cutaneous leishmaniasis (SCL), 63 cases. This form is found in Northern Tunisia, in known foci of Kala-azar. 96% of the patients have a single, small, ulcerated and crusty lesion on the face surrounded by an important zone of infiltration. Amastigotes are less than 4 microns in diameter, and it is very difficult to maintain the parasites in cultures. This form is probably due to Leishmania infantum, as has been demonstrated in Algeria in a similar form evolving in the same biotope as the Tunisian form. The vector and reservoirs of SCL are unknown. Zoonotic cutaneous leishmaniasis (ZCL), 1,412 cases. The disease is epidemic in Central and Southern Tunisia. The lesions are multiple; they affect the limbs more frequently than the face and heal in less than 8 months. They are polymorphous, usually large and superinfected. There is a seasonal occurrence of the outbreaks (summer and autumn). Amastigotes are large (4 to 6.5 microns in diameter) and the parasites easily grow in cultures. This form is caused by Leishmania major, and its vector is Phlebotomus papatasi. Three species of rodents harbour the parasite. Anthroponotic cutaneous leishmaniasis (ACL), 71 cases. This form is endemic in South-Eastern Tunisia. 70% of the patients present with single lesions, one half of which affect the face. Dry and proliferating lesions are the most frequent.(ABSTRACT TRUNCATED AT 250 WORDS)

[Infective endocarditis in adolescents. Analysis of risk factors for hospital mortality]. / Endocardite infecciosa em adolescentes. Análise dos fatores de risco de mortalidade intra-hospitalar.

PURPOSE: To study the epidemiological, clinical, therapeutic and evolutive aspects of endocarditis in a group of patients aging 12 to 20 years-old (mean 15.5). METHODS: Thirty-three consecutive patients (14 males, 19 females) admitted with infective endocarditis were retrospectively studied. RESULTS: Infective endocarditis mortality was 42%. Rheumatic heart disease was the predominant underlying condition in 63% of patients. Congenital heart disease (24%) and cardiac prosthesis (12%) were the other affections involved. The majority of patients (78%) were in functional class III and IV, with more deaths than the 22% who were in functional class I and II (p = 0.01). Staphylococcus aureus was the most frequently isolated agent (42% of the positive blood cultures, followed by Staphylococcus viridans, 21%). Multivariate analysis identified total leukocyte count above 10,000/mm3 and functional class, both at admission (p = 0.01 and p = 0.004, respectively), and the occurrence of embolic complications (p = 0.03) as independent predictors of in-hospital mortality. CONCLUSION: Rheumatic heart disease remains, as in adults, the main predisposing factor for infective endocarditis in adolescents, and S. aureus is, like in children, the leading agent. Mortality is high and functional class at hospital admission, embolic complications and leukocytosis are independent predictors of in-hospital mortality.

[Morpho-functional cardiac evaluation in young normotensive children of hypertensive patients. A prospective Doppler-echocardiographic study]. / Avaliação morfo-funcional cardíaca em jovens normotensos, filhos de hipertensos. Estudo Doppler-ecocardiográfico prospectivo.

PURPOSE: Evaluate functional and/or structural cardiac changes in young normotensive subjects with a family history of hypertension. METHODS: Prospective study was performed with 62 normotensive persons, ages 15 to 30 years, divided in 32 children of hypertensive patients (group 1) and 30 children of normotensive persons (group 2) comparable in blood pressure, body surface area, heart rate, age and sex. After clinical examination, all underwent Doppler-echocardiogram to evaluate cardiac structure and left ventricular (LV) systolic and diastolic function. RESULTS: Systolic LV fractional shortening was increased in group 1 when compared with group 2 (38.03 +/- 4.95% and 34.7 +/- 4.48%, respectively--p < 0.01). Mitral deceleration time (DT) ranged from 85 to 160 ms--mean values 116.47 +/- 16.99 ms--in group 1 and from 100 to 220 ms--mean values 126.73 +/- 26.66 ms--in group 2 (p < 0.05). A correlation between LV mass and left atrium (LA) diameter was noted in group 1 (r-0.514, p < 0.01). CONCLUSION: Children of hypertensive patients show increased LV function, similar to what occurs in early hypertension and in borderline hypertension, even when there is no evidence of LV hypertrophy or high blood pressure. Mitral DT (shorten in group 1) was the only diastolic parameter that differed in the groups. The correlation between LV mass and LA dimension suggests that LA size could be related to functional and hemodynamic LV changes.

[Clinical and hemodynamic aspects of non-obstructive coronary lesions. A comparative retrospective study]. / Aspectos clínicos e hemodinâmicos das lesões coronárias não-obstrutivas. Estudo retrospectivo comparativo.

PURPOSE: To study the clinical and hemodynamic aspects of a group of patient presenting non-obstructive coronary lesions. METHODS: We reviewed 963 coronary angiographies performed at a same institution. The 52 patients presenting only stenosis < or = 50% after semi-quantitative measurement composed group I, which was compared with two other groups consisted of 52 patients each: one, with patients presenting univascular lesion > 50% (group II) and the other with normal coronary arteriographies (group III). RESULTS: Mean age was similar in groups I and II (49.4 +/- 6.89 and 51.3 +/- 7.86, p > 0.05) and significantly higher than that of group III (44.8 +/- 6.81, p < 0.05). Risk factors did not discriminate group I (GI) from groups II (GII) and III (GIII). During a follow-up period of 63 months, the number of hospital admissions due to cardiac events and repetitions of coronary arteriography were similar in GI and GII, being significantly less frequent in GIII (p < 0.00001 and 0.001; p < 0.01 and 0.05, respectively). By the end of the follow-up period, though angina and heart failure functional classes had been similar in the three groups, patients in groups I and II were using more medications than those in group III (p < 0.0001 and 0.00001). Mean ejection fractions (%) were lower in GI and GII (67.04 +/- 10.13 and 68.90 +/- 11.32) than in GIII (74.69 +/- 6.40, p < 0.01). Lesions were predominantly proximal in GI when compared with GII (p < 0.05). Length, simmetry, ulceration, thrombus and proximal shoulder showed no difference between GI and GII. CONCLUSION: Patients with non-obstructive coronary lesions were similar to those with univascular lesion > 50% regarding several aspects and were considerably different from those with normal coronary arteries.