Beneficial role of simvastatin in experimental autoimmune myositis.

OBJECTIVE: Statins have immunomodulatory potential in autoimmune diseases but had not been studied as a disease-modifying agent in inflammatory myopathies. The objective of this study is to assess the effect of simvastatin in an experimental model of autoimmune myositis in mice on muscle strength and histopathology. METHODS: Four groups of mice (n = 5 per group) were selected for experimentally induced myositis. Mice were immunized with 1.5 mg myosin in complete Freund's adjuvant weekly for two times and injected with 500 ng pertussis toxin twice immediately after each immunization. From day 1 before immunization to 10 days after the last immunization, mice were treated with oral simvastatin (10 or 20 or 40 mg/kg) diluted in DMSO. The control group mice were injected with complete Freund's adjuvant weekly for two times and did not receive treatment. Non-immunized mice (n = 5 per group) were treated either with simvastatin (5 mg/kg or 20 mg/kg or 40 mg/kg of simvastatin diluted in DMSO) or with DMSO. RESULTS: Inflammation was observed in myositis groups with positive myositis-specific antibodies. Muscle strength dropped significantly after immunization. Immunized simvastatin 20 mg/kg treated group had significantly higher muscle strength versus non-treated myositis mice and versus other simvastatin doses. Besides, a trend toward higher serum Th17 percentage population was found in immunized non-treated mice, versus immunized simvastatin- treated mice, without significant difference. CONCLUSION: Simvastatin at 20 mg/kg decreases the severity of myositis in experimental autoimmune myositis and is a candidate of being a disease-modifying agent in inflammatory myopathies.

Prevalence of Self-Reported Food Allergy in Lebanon: A Middle-Eastern Taste.

Background. Food allergy (FA) is an important health problem in Western countries but there is limited data on the prevalence of food allergy in the Middle East. The main objective of our study is to assess the prevalence of self-reported food allergy in Lebanon. Methods. The survey was conducted by Telephone Calls questionnaire through random selection of landline phone numbers from the white pages all over Lebanon. A study questionnaire addressing the main objectives of the study was filled during the telephone call conversation. Results. Food allergy prevalence is estimated to be 4.1% in infants and children and 3.2% in adults. 65% of patients suffering from food allergy are females and 35% are males. Skin reactions are the most common symptoms among food allergy sufferers, reported in 86% of the cases. Signs of anaphylaxis appeared in 10.8% of cases. Fruits were the most common allergens at 35%, followed by eggs (19%) and nuts (16%). Cow's milk and spices ranked fourth (14%). Only half of food allergy sufferers sought medical advice. Allergists, dermatologists, gastroenterologists, or GPs (general practitioners) were consulted. Blood testing for specific IgE was the main diagnostic tool used by physicians. Conclusion. This is a pilot study of self-reported food allergy prevalence in Lebanon based on telephone survey. General prevalence is estimated to be 4.1% in infants and children and 3.2% in adults. Our study may improve awareness for proper diagnosis, food elimination, and acquisition of epinephrine autoinjectors in this part of the world.

[Choosing the best panel of aeroallergen prick-tests for patients in Lebanon with rhinitis and asthma: A retrospective study of 2350 patients]. / Choix du meilleur panel de prick-tests pour explorer une rhinite ou un asthme au Liban : une étude rétrospective sur 2350 patients.

INTRODUCTION: The aim of this study was to evaluate the profile of skin prick-test reactivity to different aeroallergens in patients with rhinitis and asthma in Lebanon and its geographic variation within the country. It was also to suggest a minimal panel of allergens that should be used to detect sensitized patients. METHODS: All patients who underwent skin prick-testing, because of rhinitis and/or symptoms suggesting asthma, between 2004 to 2011 in the hôtel-Dieu de France university hospital of Beirut, were studied. The total number of patients was 2350 and all were tested with the same panel of 24 aeroallergens. A further series of 208 patients were added because Cupressaceae antigens were not included in the initial series. RESULTS: The overall rate of sensitization to any allergen was 75.6%. A battery of eleven allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia, Parietaria, grass, Salicaceae, oak, Oleaceae, dog, cat, and cockroaches) was found to identify sensitized patients with a sensitivity of 96% and a negative predictive value of 90%. Cupressaceae should be added to this battery in view of the results of the additional series. The Bekaa region had a unique profile of sensitization. CONCLUSION: Twelve allergens are able to detect almost all sensitized patients suffering from respiratory symptoms in Lebanon.

Fracturas de pilón tibial: estado actual de pacientes que ingresaron al Instituto Autónomo Hospital Universitario de Los Andes entre 1998-2007 aplicando la AOFAS: estudio observacional analítico prospectivo no concurrente / Tibial pilon fractures: currents status of patients admitted to the Instituto Autónomo Hospital Universitario de Los Andes between 1998-2007 using the AOFAS: prospective observacional study non-concurrent

Las fracturas de tibia distal han sido consideradas de difícil manejo debido a los resultados desalentadores descritos hasta el año de 1963 situación que comienza a cambiar a mediados de 1968 cuando se promulgan los principios de ORIF de la AO, sin embargo, actualmente sigue constituyendo un verdadero reto para el cirujano traumatólogo. En el presente estudio prospectivo no concurrente se evaluarán los pacientes adultos (mayores de 16 años de edad) que ingresaron al servicio de Ortopedia y Traumatología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA) entre 1998 y 2007 con fracturas de tibia distal (pilon tibial), constituyendo en total una población de 80 pacientes de la cual se toma una muestra de 40 pacientes. Para efectos de este estudio obtuvimos para las fracturas tipo A según la AO/ASIF un total de 33,3 por ciento de excelentes resultados, 33,3 por ciento de regulares resultados y 33,3 por ciento de malos resultados. Para las fracturas tipo B 71 por ciento de excelentes resultados, 15 por ciento de regulares resultados y 14 por ciento de malos resultados; mientras que para las fracturas de tipo C fue un 27 por ciento de excelentes resultados, 27 por ciento de regulares resultados y 46 por ciento de malos resultados, todos evaluados según la escala de evaluación de la AOFAS. A la luz de los estudios consultados, resulta evidente establecer como aspectos pronóstico determinantes el estado de las partes blandas la afectación metafisiaria y/o articular, así como la asociación a una lesión de peroné.

Distal tibia fracture have been considered difficult to use because of the disappointing results described until the years 1963 which begins to change in mid-1968 when it enacted the principles of ORIF of AO, however, currently still be a real challenge to the trauma surgeon. This prospective study will assess the concurrent non-adult patients (older than 16 years of age) who entered the service of Orthopedics and Traumatology Institute of the University Hospital of Los Andes (IAHULA) between 1998 and 2007 with fractures distal tibia (tibia pylon), constituting a total population of 80 patients of which took a sample of 40 patients. For purposes of this study, we obtained for type A fractures according to AO/ASIF a total of 33,3 percent of excellent results, 33,3 percent of regular results, and 33,3 percent poor results. For fractures type B 71 percent of excellent results, 15 percent regular results, and 14 of poor results, whereas for type C fractures was 27 percent excellent results, 27 percent of regular results, and 46 percent of poor results all assessed according to the scale of assessement of the AOFAS. In light of the studies consulted, as is evident establish prognostic determinants respects the status of soft tissue involvement, metaphyseal and/or joints, as well as the association of a fibula injury.

Bronchial carcinoid tumours in southern Saudi Arabia.

Clinical presentation, pathology, surgical management and follow-up of ten bronchial carcinoid tumour (BCT) patients are described. There were five male and five female patients with age range between 5 to 85 years (mean 39.2 +/- 21.5, SD). Pathology revealed BCT on the right side in seven and on left side in three patients. The tumour was an incidental finding in four while the other six had respiratory symptoms. Cough was present in all of the later group and hemoptysis was present in four patients. Recurrent chest infections were seen in two patients. Symptoms ranged from 1 week to 15 years. Successful surgical resection was done in nine with the longest follow-up of 80 months (mean: 23 months +/- 26.3, SD) without recurrence or metastasis. Histopathological examination of these tumours revealed classical morphological features in all but one case. Grimelius stain positivity for argyrophilia confirmed the diagnosis in all the patients in this study. Electron microscopic examination was done in patient no. 9 which showed atypical morphological features and neurosecretory granules. BCT may present like pneumonias or bronchial asthma. Although BCTs have low-grade malignancy, early diagnosis and surgical resection yield curative results almost in all cases.

Empyema thoracis in adults in Saudi Arabia.

Empyema thoracis in adults is an uncommon disease in the Asir region of Saudi Arabia. In a period of seven years (1988 to 1994), 24 patients were treated for empyema thoracis with a hospital incidence of about 23 patients in 100,000 admissions. The community acquired empyemas are more common and less aggressive in non-Saudi patients (six males and one female) as compared to Saudi patients (11 males and 6 females) whose empyemas are mostly nosocomial with an aggressive course. The peak age in both Saudi and non-Saudi patients is 45 years and 25 years respectively, and the right pleura is more commonly affected than the left pleura in both groups. Risk factors include diabetes mellitus, pulmonary tuberculosis, post-pneumonectomy infections, trauma and pneumonia. The commonest organisms grown are Pseudomonas aeruginosa, Klebsiella species and Staphylococcus aureus, although in almost 40% of the patients the empyemas were sterile. The commonest method of treatment was closed thoracostomy tube drainage.

[Pseudoxanthoma elasticum with aortic insufficiency and arterial hypertension in a 12-year-old boy]. / Pseudoxanthome élastique avec insuffisance aortique et hypertension artérielle chez un enfant de douze ans.

Hypertension was found in a 12 year-old Tunisian boy in the weeks following an aortic valvular replacement for aortic regurgitation which was surmised to be rheumatic in origin. In fact, the hypertension and aortic regurgitation were due to the Gröenblad-Strandberg syndrome, or pseudoxanthoma elasticum. The origin of the hypertension was demonstrated by selective renal angiography which showed interruption of the distal cortical renal arteries. Deposition of calcium in the arterial wall was shown by renal ultrasonography. The origin of aortic regurgitation was first imputed to acute rheumatic fever. Thus, the patient presented with complete picture of pseudoxanthoma elasticum with skin, arterial and cardiac involvement. The case reported is the third with a cardiac involvement. The case reported is the third with a cardiac localization of the disease histologically proven in a patient under 20 years of age. The frequency, transmission, histologic findings, etiopathogenesis and clinical aspects of pseudoxanthoma elasticum are reviewed in brief.