Infections and systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that presents a protean spectrum of clinical manifestations, and may affect any organ. The typical course of SLE is insidious, slow, and progressive, with potential exacerbations and remissions, and even dramatically acute and rapidly fatal outcomes. Recently, infections have been shown to be highly associated with the onset and/or exacerbations of SLE, and their possible causative and/or protective role has been largely emphasized in the medical literature. However, the etiopathogenesis of SLE is still obscure and far from being completely elucidated. Among infections, particularly Epstein-Barr virus (EBV), parvovirus B19, retrovirus, and cytomegalovirus (CMV) infections might play a pivotal pathogenetic role. The multifaceted interactions between infections and autoimmunity reveal many possibilities for either causative or protective associations. Indeed, some infections, primarily protozoan infections, might confer protection from autoimmune processes, depending on the unique interaction between the microorganism and host. Further studies are needed in order to demonstrate that infectious agents might, indeed, be causative of SLE, and to address the potential clinical sequelae of infections in the field of autoimmunity.

Dog and cat bite-associated infections in children.

Millions of people throughout the world are bitten by animals each year. About 90 % of the bites are caused by dogs and cats, and infections are the most common complications. As children are the most frequently bitten subjects, pediatricians should provide parents with everything they need to know in order to confront the problem. However, this does not seem to be case and, as the treatment of bite wounds is frequently inappropriate and delayed, the risk of acute infection and sequelae is increased. The main aim of this review is to discuss the epidemiology, microbiology, and clinical characteristics of infections due to dog and cat bites in children, and suggest the best approach to their management. Analysis of the published literature shows that prompt treatment is necessary in order to reduce the risk of infection. The therapeutic measures include wound washing, specific prophylaxis (i.e., tetanus and/or rabies), and antibiotics in the case of immunocompromised patients or deep wounds (particularly if there is evidence of edema or crushing), facial bites, or any wound over a tendon or bone.

Circulation of different rhinovirus groups among children with lower respiratory tract infection in Kiremba, Burundi.

The purpose of this investigation was to collect information regarding rhinovirus (RV) circulation in children with lower respiratory tract infections (LRTIs) in Burundi, Central Africa. We enrolled all of the children aged between 1 month and 14 years who were admitted to the hospital of Kiremba, North Burundi, with fever and signs and symptoms of LRTI (i.e., cough, tachypnea, dyspnea or respiratory distress, and breathing with grunting or wheezing sounds with rales) between 1 November 2010 and 31 October 2011, and obtained nasopharyngeal swabs for RV detection by means of polymerase chain reaction (PCR). The VP4/VP2 region of the positive samples was sequenced to determine the species of RV (A, B, or C). Four hundred and sixty-two children were enrolled: 160 (34.6 %) with bronchitis, 35 (7.6 %) with infectious wheezing, and 267 (57.8 %) with community-acquired pneumonia (CAP). RV infection was demonstrated in 186 patients [40.3 %; mean age ± standard deviation (SD) 1.77 ± 2.14 years]. RV infection was detected in 78 patients aged <12 months (40.0 %), 102 aged 12-48 months (44.3 %), and six aged >48 months (16.7 %; p < 0.01 vs. the other age groups). The most frequently identified RV was RV-A (81 cases, 43.5 %), followed by RV-C (47, 25.3 %) and RV-B (18, 9.7 %); subtyping was not possible in 40 cases (21.5 %). RV-A was significantly associated with bronchitis and CAP (p < 0.01) and RV-C with wheezing (p < 0.05). In Burundi, RVs are frequently detected in children with LRTIs. RV-A seems to be the most important species and is identified mainly in patients with bronchitis and CAP.

Meningitis complicated by subdural empyema and deafness caused by pneumoccoccal serotype 7F in a 17-month-old child: a case report.

Despite the availability of effective antibacterial agents and vaccines, pneumococcal meningitis and sepsis are still associated with high mortality rates and a high risk of neurological sequelae. We describe the case of a 17-month-old boy vaccinated with heptavalent pneumococcal conjugate vaccine (PCV7) who developed bacterial meningitis complicated by subdural empyema and deafness caused by Streptococcus pneumoniae serotype 7F. The 7F strain is not contained in PCV7 (the only vaccine on the market at the time of the onset of meningitis) but is included in the new pediatric 13-valent PCV, which may therefore prevent cases such as this in the future.

Clinical presentation of meningococcal disease in childhood.

Although relatively rare, meningococcal disease represents a global health problem being still the leading infectious cause of death in childhood with an overall mortality around 8%. Meningococcal meningitis is the most commonly recognized presentation, accounting for 80% to 85% of all reported cases of meningococcal disease (in half of these cases sepsis is also present concomitantly). The remaining 15-20% of cases are most commonly bloodstream infections only. Meningococcal serogroups A, B, and C account for most cases of meningococcal disease throughout the world. Recently, serogroups W-135 and X (predominantly in Africa) and group Y (in the United States and European countries) have emerged as important disease-causing isolates. Despite recent advances in medical management, the mortality rate of fulminant meningococcemia ranges from 15% to 30%. However, among survivors, 10-30% could have long term sequelae (i.e. sensoneural hearing loss, seizure, motor problems, hydrocephalus, mental retardation, and cognitive and behavioral problems). Considering the clinical severity of meningococcal disease, prevention represents the first approach for avoiding serious complications and possible deaths. The availability of new vaccines able to cover the emerging serotypes including A and Y as well as the availability on the market of new products that could prevent meningococcal B infection represent a great opportunity for the decrease of the burden of this complicated disease.

Sequential morphological changes in pancreatic islets of spontaneously diabetic rats.

This study describes the sequential morphological changes in pancreatic islets from 1-, 6-, and 18-month-old male eSS rats, as compared to aged-matched control animals. Spontaneous diabetes mellitus was confirmed in 6- and 18-month-old eSS rats after an oral glucose tolerance test. Light microscopic immunocytochemical and morphometric techniques were used to study islet-cell populations. The pancreas was normal, and the morphometric methods did not reveal significant changes in islets from 1-month-old rats. However, 6-month-old eSS animals showed disruption of islet architecture and fibrosis in the stroma. The volume density (Vvi) of endocrine tissue and the Vvi and percentage of B cells were increased, whereas the Vvi of exocrine tissue and the Vvi and percentage of A cells were diminished. Eighteen-month-old eSS rats also exhibited conspicuous islet lesions. Nevertheless, the Vvi of endocrine tissue and the Vvi and percentage of B cells were diminished, while the Vvi of exocrine tissue and the Vvi and percentage of D cells were increased. Our results provide further quantitative evidence for the sequential morphological events occurring in the pancreatic islets of a useful animal model of diabetes mellitus.

Changes in insulin secretion and calcium distribution within B cells induced by gliclazide.

Using the pyroantimonate technique, the ultracytochemical distribution of calcium within B cells was studied in isolated rat pancreatic islets incubated during 5, 15 and 30 min with 8.3 mM glucose alone or together with 76 microgram glicazide. Glucose alone produced a continuous increment in the total number of calcium pyroantimonate precipitates (CPP) throughout the incubation period studied. The CPP were mainly associated to the cytoplasmic matrix and the secretory granules at 5 and 15 min and almost evenly distributed between these structures and the plasma membrane at 30 min. Gliclazide plus glucose produced a significant increment, above the glucose values, of the total CPP at 5 min and a later decrease of such values at 15 and 30 min. At 5 min, the incremented total CPP was mainly associated to the secretory granules and the cytoplasmic matrix. The increment in CPP preceded the largest effect of gliclazide on insulin secretion. The latter diminution of CPP induced by gliclazide could contribute to the failure of this drug, as well as other oral hypoglycemic agents, to elicit a second phase of insulin secretion. Changes induced by gliclazide upon B-cell CPP content and distribution might suggest that beyond the effective role of cytosolic calcium in the control of insulin secretion, the cation might reach a threshold concentration in some cell structures to assure the normal development of the secretory process.

[Desmoplastic and neurotropic subungueal melanoma]. / Mélanome sous-unguéal, desmoplastique et neurotrope.

INTRODUCTION: Desmoplastic and neurotropic melanoma is rare and involvement of the subungual skin is an exceptional finding. OBSERVATION: We report the second case of desmoplastic and neurotropic subungual melanoma in the literature occurring in a 71-year-old woman. DISCUSSION: In our patient, the histological diagnosis of desmoplastic melanoma was particularly difficult because of the exceptional involvement of the subungual skin. Microscopic neurotropism and immunohistochemical studies were the clues in diagnosing desmoplastic melanoma.

[White atrophic vasculitis. Infrequent genital lesion. Review of a case]. / Vasculitis atrófica blanca. Lesión en área genital, poco frecuente. Revisión de un caso.

Case report of a 54-year old patient, calling on the emergency unit with testicular pain and necrotic-looking lesions in the skin and the scrotum. After ruling out a Fournier's gangrene, the diagnosis was reached by scrotal biopsy, the pathoanatomic report confirming the presence of an infrequent vascular disease, segmentary hyalinizing vasculitis, on which we make a review of the literature.

[Evaluation of prazosin in the treatment of benign hypertrophy of the prostate. A case-control study]. / Valoración del Prazosín en el tratamiento de la hipertrofia benigna de próstata. Estudio caso-control.

A control-case study conducted in 56 patients, all diagnosed with benign prostate hypertrophy of which 36 were Prazosin-treated patients and the remaining 20 were controls. The patient's mictional signs and symptoms as well as flow parameters were monitored at 3 and 6 months, respectively. We conclude that Prazosin is an alpha-blocker useful in early prostate disorders and when no obstructive urological disease is present.

[Giant fecal impaction as a cause of female incontinence (Fecaloma) and bladder instability. Contribution with one case]. / Fecaloma gigante como causa de incontinencia e inestabilidad vesical femenina. Aportación de un caso.

We present a case of a 60 years old female patient, with previous depressive disorders, an attempted suicide with pelvic injuries, who comes showing two years evolution of emergence incontinence. The was diagnosed with a giant fecal impaction occuping almost all the pelvic zone and leading to a bladder displacement and right ureteral ectasis.

[Verrucous carcinoma of the penis. Presentation of 3 new cases]. / Carcinoma verrucoso de pene. Aportación de tres nuevos casos.

Penis carcinoma shows an incidence between 0.3-1% of all male neoplasias. The verruciform variety represents 5-10% of total penis carcinoma. Verruciform carcinoma is a variety of squamous carcinoma presenting a usually benign behaviour and related to some virus species (H.P.V.). Three cases are presented with ages ranging between 47-87 years-old, all of which undergoing partial penectomy, their progression being monitored for two years.

[Idiopathic thrombosis of the renal vein. Report of a new case]. / Trombosis idiopática de la vena renal. Aportación de un nuevo caso.

Thrombosis of the renal vein in adult patients is a rare entity, commonly associated to tumoral masses or hypercoagulability states. Contribution of one case of thrombosis of the renal vein in an 83-year old male patient, and review of current literature.

[Spontaneous renocolic fistula secondary to pyonephrosis of lithiasic etiology]. / Fistula renocólica espontánea secundaria a pionefrosis de etiología litiásica.

Description of one case of spontaneous fistulization between a renal calix and a descending colon, secondary to lithiasic pyonephrosis. Diagnosis was carried out by means of ascending pyelography without it being clinically suspected. Treatment is surgical, combining nephrectomy, fistula resection and closure of the colic gap. Etiology, favouring factors, diagnosis and treatment are explained.

[Skin lesions of the penis. Prostatic adenocarcinoma metastasis. Report of a case]. / Lesiones cutáneas de pene. Metástasis de adenocarcinoma de próstata. Aportación de un caso.

Presentation of one case of penis-located multiple skin metastasis from prostate adenocarcinoma after hormonal blockade for 11 years. Revision and update of the topic, corroborating the poor prognosis of these patients.

[Undifferentiated pelvic fibrosarcoma. A new case report]. / Fibrosarcoma pelviano indiferenciado. Aportación de un nuevo caso.

Genitourinary sarcomas are very rare entities. This paper contributes one case report of an undifferentiated pelvic fibrosarcoma in a 53-year old patient. It also includes some observations on the clinical development, complementary studies used, difficulties for the pathoanatomical diagnosis and treatment issues.

Preventing influenza in younger children.

Influenza is common in infants and children: attack rates vary from 23% to 48% each year during inter-pandemic periods, and are even higher during pandemics. Severe cases occur more frequently in children with underlying chronic diseases; however, epidemiological studies have clearly shown that influenza also causes an excess of medical examinations, drug prescriptions and hospitalizations in otherwise healthy children (particularly those aged <5 years), as well as a considerable number of paediatric deaths. Childhood influenza also has a number of social and economic consequences. However, many European health authorities are still reluctant to include influenza vaccinations in their national vaccination programmes for healthy children because, among other things, there are doubts concerning their real ability to evoke a protective immune response, especially in children in the first years of life. New hope for the solution of these problems has come from the introduction of vaccines containing more antigens and the possibility of intradermal administration. However, further studies are needed to establish whether universal influenza vaccination in the first years of life should be recommended, and with which vaccine.

Bullous eruption with circulating pemphigus-like antibodies following interferon-alpha therapy.

Two patients with classic Kaposi sarcoma developed bullous lesions and pemphigus-like 'anti-intercellular-substance' antibodies when treated with interferon-alpha (IFN-alpha). In one of them direct immunofluorescence was consistent with pemphigus/pemphigoid features. The immunoprecipitation test showed no specific bands. The mechanism by which IFN-alpha may induce the production of anti-intercellular-substance antibodies is discussed.

Effect of verapamil and trifluoperazine upon glucose-induced calcium distribution within B cells.

Insulin secretion and B-cell calcium distribution, assessed with the pyroantimonate precipitation technique, were studied in rat pancreases perfused with glucose (3.3 or 16.6 mM) alone or together with verapamil or trifluoperazine (TFP). Total calcium pyroantimonate precipitates (CPP), and those bound to every B cell structure, at every sampling period, were larger at 16.6 mM glucose concentration. The largest percentage of CPP was located, at early stages of the glucose stimulatory period, mainly within the clear halo of the B granules, while later on they shifted to the plasma membrane. Verapamil and TFP diminished the second phase of glucose-induced insulin release and greatly affected the above mentioned pattern of B cell CPP distribution. The main changes consist in a diminution in the total number of CPP all throughout the perfusion-time as well as an alteration in the percentage distribution of the CPP within the different B cell organelles, i.e., an early diminution in the CPP present in the B granules and of those attached to the plasma membrane and to the mitochondria at the end of the perfusion, were the most striking changes observed. The results suggest that during the glucose stimulus, different B cell structures take over the control of available calcium within the cell, following a chronological sequence. Such sequence might be determined by the different Ca2(+)-set point of those structures. Intracellular provision of calcium might be sufficient to maintain the early phase of insulin secretion when the cation entrance is blocked. Conversely, this substitution might not be enough to sustain the second phase of insulin release. The different amounts of CPP in every B cell organelle, besides their buffering capacity to control free Ca2+ availability, might also be coupled to a regulatory role of the cation upon their respective metabolic functions. In some cases, this latter effect may be the main role for the cation distribution. Our results support the concept that the level of free calcium, acting as the coupler for the stimulus:secretion process, might be regulated by different calcium pools located in the B cell.

Effect of extracellular alkalosis upon calcium distribution within the B cells.

Insulin secretion and the pattern of calcium distribution in B cells, assessed with the pyroantimonate precipitation technique, were simultaneously studied in rat pancreases perfused with 3.3 and 16.6 mM glucose solutions of pH 7.4 and 7.8. We have previously demonstrated the blocking effect of the latter pH upon glucose-induced insulin secretion. Glucose (16.6 mM) caused an increase in the total number of calcium pyroantimonate precipitates (CPP), as well as their number bound to different B cell structures, at every sampling period studied, with respect to the 3.3 mM glucose experiments. Extracellular alkalosis strongly inhibited both phases of the B cell response to the glucose stimulus, and greatly affected the distribution of CPP in the cells with respect to the pH 7.4 ones. During the first phase of glucose induced-insulin secretion, most of the CPP appeared within B granules at pH 7.4, while on the development of the second phase of secretion, they appeared mainly attached to the cell plasma membranes. Conversely, in pH 7.8 experiments, at the first minutes of the glucose challenge, CPP appeared principally located in the cytoplasm, being almost absent from the plasma membrane during the second phase of insulin secretion. These observations suggest that during the glucose stimulus, the cell calcium distribution within the B cells followed a clear chronological sequence. Such sequence might be determined, at least in part, according to the different Ca2(+)-set points of the different B cell structures. In our case, the extracellular alkalosis might interfere with the normal intracellular calcium fluxes, which in consequence might impair release of insulin by affecting several B cell functions.