[Avascular necrosis of the femoral head after COVID-19: clinical presentation and management. Clinical-functional outcomes of decompression and supplementation with bone marrow cell aspirate]. / Necrosis avascular de la cabeza femoral tras COVID-19: presentación clínica y manejo. Resultados clínico-funcionales de descompresión y suplementación con aspirado de células de médula ósea.

INTRODUCTION: the pandemic of COVID-19 has led to clinical complications such as avascular necrosis of the femoral head (AVNFH) associated with the use of corticosteroids. The aim of the study is to report the functional and radiographic results of 13 patients with post-COVID-19 ANFH after decompression using Forage and bone marrow aspirate concentrate (BMAC). MATERIAL AND METHODS: single-center, prospective, uncontrolled clinical study. From April 2020 to September 2021, 13 patients (21 hips) with post-COVID-19 ANFH were treated. All received corticosteroids during infection (average daily dose: 480 mg). Clinical, radiographic and magnetic resonance imaging evaluations were performed; the Ficat classification was applied for the classification of AVNFH. The surgical technique used was decompression with Forage and ACMO. RESULTS: the mean age was 47 years, with a follow-up of 30.4 months. Symptoms appeared with a mean of 4.2 months after COVID-19 infection. Harris score improved from 41.2 ± 5.2 to 86.6 ± 3.4. Radiographic evaluation showed that 14.3% of the sample experienced femoral head collapse and underwent total hip arthroplasty. CONCLUSIONS: post-COVID-19 ANFH is a clinical entity with rapid progression and different degrees of severity. Decompression with Forage and ACMO seems a promising initial treatment, however, the variable response and the probability of collapse emphasize the importance of long-term follow-up and identification of patients who may require additional interventions.

INTRODUCCIÓN: la pandemia de COVID-19 ha dado lugar a complicaciones clínicas como la necrosis avascular de la cabeza femoral (NAVCF) asociada con el uso de corticoesteroides. El objetivo del estudio es reportar los resultados funcionales y radiográficos de 13 pacientes con NAVCF post-COVID-19, después de la descompresión utilizando Forage y aspirado de células de medula ósea (ACMO). MATERIAL Y MÉTODOS: estudio clínico unicéntrico, prospectivo, no controlado. Desde Abril de 2020 hasta Septiembre de 2021, se trataron 13 pacientes (21 caderas) con NAVCF post-COVID-19. Todos recibieron corticoesteroides durante la infección (dosis promedio diaria: 480 mg). Se realizaron evaluaciones clínicas, radiográficas y por resonancia magnética nuclear; se aplicó la clasificación de Ficat para la clasificación de NAVCF. La técnica quirúrgica empleada fue descompresión con Forage y ACMO. RESULTADOS: la edad promedio fue 47 años, con un seguimiento de 30.4 meses. Los síntomas aparecieron con una media de 4.2 meses después de la infección por COVID-19. La escala de Harris mejoró de 41.2 ± 5.2 a 86.6 ± 3.4. La evaluación radiográfica demostró que 14.3% de la muestra experimentó colapso de la cabeza femoral por lo que se les realizó artroplastía total de cadera. CONCLUSIONES: la NAVCF post-COVID-19 es una entidad clínica con rápida progresión y diferentes grados de severidad. La descompresión con Forage y ACMO parece un tratamiento inicial prometedor; sin embargo, la respuesta variable y la probabilidad de colapso, enfatizan la importancia de seguimiento a largo plazo e identificación de los pacientes que puedan requerir intervenciones adicionales.

Dexmedetomidine for awake craniotomy without laryngeal mask

OBJECTIVE: This paper reports the use of dexmedetomidine in three epileptic patients with cavernous angiomas that underwent awake surgery in order to map their speech areas. METHOD: Loading dose of dexmedetomidine varied from 1 microg/Kg/h to 3 microg/Kg/h over 20 minutes and maintenance dose from 0.4 microg/Kg/h to 0.8 microg/Kg/h. RESULTS: There was no occurrence of hemodynamic instability, convulsions or respiratory depression. Patients tolerated well the procedure. CONCLUSION: Dexmedetomidine was useful for awake craniotomy as it decreased patients level of consciousness but did not produce agitation. Laryngeal mask was not necessary to keep air ventilation.

OBJETIVO: Este trabalho relata o uso de desmedetomidina em três pacientes com angiomas cavernosos próximos a área de linguagem e epilepsia que foram operados acordados para mapeamento cortical. MÉTODO: A dose de ataque de dexmedetomidina variou de 1 mg/Kg/h a 3 mg/Kg/h durante 20 minutos e dose de manutenção de 0,4 mg/Kg/h a 0,8 mg/Kg/h. RESULTADOS: Os pacientes toleraram bem o procedimento e não houve instabilidade hemodinâmica, convulsões ou depressão respiratória. CONCLUSÃO: Dexmedetomidina foi útil nas craniotomias com o paciente acordado para mapeamento cortical pois gerou sedação sem agitação. A máscara laríngea não foi necessária para manter a ventilação nesses pacientes.

Serine proteinase inhibitors from eggs and larvae of tick Boophilus microplus: purification and biochemical characterization.

The present study describes the purification, characterization, and comparison of serine proteinase inhibitors during the development of egg and larva phases of the tick Boophilus microplus. Samples were collected of eggs between the first day of hatching and the beginning of eclosion (defined as El, E2, and E3) and of larvae between the first day of eclosion and the infectant phase (defined as L1, L2, and L3). Crude extracts of the samples (2.5% w/v in Tris-HCI buffer) were analyzed by SDS-PAGE, and showed three major protein bands of 42, 62, and 85 kDa, differing in intensity, from E1 to L3 samples. The total protein of the larva extracts was 34% less than that of the egg extracts, while no differences in active protein were detected. The apparent dissociation constant Ki determined for trypsin was 10-fold lower from E1 to L3 samples. Serine proteinase inhibitors from tick eggs and larvae (BmTls) were purified on trypsin-Sepharose column and analyzed by SDS-PAGE. The results showed a slight difference in protein pattern, with a protein band of 20 kDa in the E1 and E2 samples which did not appear in the other samples. The Ki for neutrophil elastase was 10-fold lower in L3 than E1. BmTI reverse-phase chromatography showed two and one major peaks in egg and larva samples, respectively. The N-terminal amino acid sequence of the L3 main peak from a C8 column showed a mix of BmTIs with the major sequence AVDFDKGCVPTADPGPCKG. Changes indicated by molecular weight and inhibition activity suggest different roles for BmTIs during the development process.

[Cave-associated acute pulmonary histoplasmosis in two Japanese returning from Mexico].

We report cases of cave-associated acute pulmonary histoplasmosis that occurred in two Japanese returning from Yucatan, Mexico. Patient 1 is a 35-year-old woman who worked in a bat-infested cave in Mexico for about 3 weeks. Almost all her colleagues had developed cough, fever and headache after 5 days in the cave. She was asymptomatic but her chest radiograph showed multiple nodules 5-10 mm in diameter throughout both lungs. The histoplasmal mycelial-phase complement fixation titer on admission was 1:16, and 1:128 one month later. Patient 2, the 53-year-old husband of patient 1, was also infected by histoplasma in the cave, and similar nodules were observed in his chest radiograph. His histoplasmal complement fixation titer did not elevate. To date, about 20 cases of pulmonary histoplasmosis have been reported in Japan. The number of imported mycoses in Japan is increasing, and histoplasmosis should be considered in the differential diagnosis of pulmonary nodules in travelers returning from endemic areas.

Serum n-3 fatty acids, fish consumption and cancer mortality in six Japanese populations in Japan and Brazil.

Japanese people consume significant amounts of long chain n-3 polyunsaturated fatty acids (PUFAs) derived from fish, but the association of PUFAs with cancer mortality has not been fully investigated. To study geographic differences in n-3 PUFAs intake, we compared serum fatty acid and dietary fish intake among various Japanese populations having different rates of cancer mortality. The subjects were 50 men from each of five regions in Japan and 47 Japanese men from Sao Paulo, Brazil. All were randomly selected and aged 40 to 49 years. Serum fatty acids were measured by gas chromatography and the frequency of fish intake was obtained by a food frequency questionnaire. Significant geographic differences in serum fatty acid levels (% of total fatty acids) and fish intake (days/4 weeks) were observed. The percentages of serum total PUFA were similar in the six regions, though there was an almost three-fold difference in n-3 PUFAs content between Brazil (3.9%) and Akita (10.9%). The frequency of total fish intake corresponded to serum n-3 PUFAs composition. The relationship between cancer mortality and serum n-3 PUFAs levels was not clear, though an inverse association between prostate cancer and serum n-3 PUFAs levels appeared to exist. The results suggest that although serum n-3 PUFAs varied significantly, the observed geographic difference did not account for the different cancer risks at the population level.

[Incidence of oral cancer profile at a general hospital in Säo Paulo]. / Perfil de incidência do câncer oral em um hospital geral em São Paulo.

Cancer of the oral cavity are 4% of all cancers, being in 8th place in males and 11th in females. The world incidence in male sex is 7.9:100,000 and 2.2:100,000 in females. Squamous cell carcinoma is the most frequent, corresponding to 90-95% of the cases and tongue, lips and floor of the mouth are the most common sites. Fifty-four patients were surgically treated for cancer of the oral cavity in a General Hospital in São Paulo, during last ten years. It occurs more in males (81.5%), the age ranges of 35-97, with mean age of 58.1 years. Smoking was associated in 88.9%, at the time of treatment 50% of the patients had history of disease inferior of 6 months and 42% were T2 and 38% T4. These results agree with international literature and emphasize the importance of preventive aspects of this cancer.

The reaction of peroxynitrite with tert-butyl hydroperoxide produces singlet molecular oxygen.

Peroxynitrite, a biological oxidant, can induce lipid peroxidation in biological membranes which leads to the formation of various hydroperoxides. Here, we report the formation of singlet oxygen (1O2) in the reaction of peroxynitrite with tert-butyl hydroperoxide (t-BOOH) used as a model compound for organic hydroperoxides. The formation of singlet oxygen was observed by (i) dimol emission in the red spectral region, (ii) monomol emission in the infrared region at 1270 nm and by (iii) chemical trapping of singlet oxygen with anthracene-9,10-diyldiethyl disulfate (EAS). The emission signal was increased when H2O was replaced by deuterium oxide and was quenched by sodium azide. When singlet oxygen was generated in the reaction of peroxynitrite with t-BOOH, the 1O2 quenching rate constant for sodium azide was estimated from a Stern-Volmer plot as 1.3 x 10(8) M(-1) S(-1) which is in line with known values. The 1O2 generation in the peroxynitrite/t-BOOH reaction was also detected by the formation of the endoperoxide of EAS. These data establish the generation of 1O2 in the reaction of peroxynitrite with t-BOOH and suggest a potential involvement of 1O2 in peroxynitrite-mediated reactions in biological systems.

Cervical fetal fibronectin in patients at increased risk for preterm delivery.

OBJECTIVE: This study aimed to evaluate fetal fibronectin concentrations in cervical secretions measured by either a rapid immunoassay or an enzyme-linked immunosorbent assay as a tool for the screening of premature delivery in otherwise asymptomatic pregnant women at high risk for prematurity. STUDY DESIGN: One hundred two pregnant women at high risk for premature delivery were followed up. Samples of the cervical secretion were taken every 2 weeks between the twenty-fourth and the thirty-fourth weeks of pregnancy. The samples were obtained from the ectocervix with two swabs. One cervical sample was used for the immediate-reading membrane test, and the other one for the immunoenzyme test. The correlation between the presence of fetal fibronectin in the cervical secretions and preterm birth was evaluated. In addition, a comparison between tests was made. RESULTS: The rate of preterm birth was 37.25% (38/102). Membrane tests revealed a sensitivity of 73.68% and a specificity of 92.18%; its positive predictive value was 84.84% and the negative predictive value was 85.50%. The enzyme-linked immunosorbent assays revealed a sensitivity of 78.94% and a specificity of 85.93%; its positive predictive value was 76.92%, and the negative predictive value was 87.30%. When compared with each other, the tests were found essentially concordant (p < 0.05). The elapsed time between the last sampling and the occurrence of preterm birth was 2.9 +/- 1.8 weeks. CONCLUSION: The rapid result membrane test is comparable to the standard fetal fibronectin enzyme-linked immunosorbent assays for the detection of fetal fibronectin in cervical secretions between the twenty-fourth and thirty-fourth weeks of gestation. Moreover, both assays were found to be good tools for the prediction of premature delivery in asymptomatic pregnant women at high risk for prematurity. The availability of a rapid search for the presence of cervical fetal fibronectin should improve our ability to efficiently identify patients at risk for preterm delivery to discriminate between such patients and those with benign Braxton Hicks contractions.

PIP: Researchers evaluated the comparative effectiveness of measuring fetal fibronectin concentrations in cervical secretions by either a rapid immunoassay or an enzyme-linked immunosorbent assay as a tool for the screening of premature delivery in otherwise asymptomatic pregnant women at high risk for prematurity. Cervical secretion samples from the ectocervix were taken every two weeks between the 24th and the 34th week of pregnancy from 102 pregnant women at high risk for premature delivery. The samples were obtained with two swabs. One sample was used for the immediate-reading membrane test while the other was used for the immunoenzyme test. There was a 37.25% rate of preterm birth. Membrane tests yielded a 73.68% sensitivity and a 92.18% specificity, with a positive predictive value of 84.84% and a negative predictive value of 85.50%. The enzyme-linked immunosorbent assays were 78.94% sensitive and 85.93% specific, with a positive predictive value of 76.92% and a negative predictive value of 87.30%. The two tests were concordant with each other. There was a mean of 2.9 weeks between the last sampling and the occurrence of preterm birth. The rapid result membrane test is comparable to the standard fetal fibronectin enzyme-linked immunosorbent assays for the detection of fetal fibronectin in cervical secretions between the 24th and the 34th weeks of pregnancy.

Bread as a source of salt: an international comparison.

OBJECTIVE: The salt (NaCl) content of bread, obtained from Belgium and 25 other regions or countries worldwide, was analyzed to evaluate the importance of bread as a source of dietary salt in a population. METHODS: A total of 1166 dried bread samples were analyzed using a hot HCl extraction technique followed by flame photometry and performed by the same laboratory technician in Leuven (Belgium); 534 samples from Leuven were analyzed over 10 time periods from 1967-73 to 1992 together with 562 samples from 11 other European countries, 44 from the United States and Peru, and 26 from Asia. RESULTS: The average mean salt content of fresh bread (= dried bread times 0.6) in European countries was 12.4 +/- 1.7 g/kg for white and 13 +/- 1.0 g/kg for brown bread. In Japan and Korea it was about 8.5 g/kg and in Pakistan, Thailand, Nepal, and Laos about 5 g/kg. The mean sodium/potassium ratio with Na and K in mmol was 8.0 for white and 4.5 for brown bread, much higher than the recommended value of 1.0. Bread with a very low salt content was found in certain areas of Peru, Spain, and Italy. CONCLUSION: The overall salt content of bread in Western countries is excessive, and a gradual reduction is highly desirable.