Pediatric postmortem CT angiography: validation of vascular access for PMCT angiography in stillbirths, babies and toddlers.

PURPOSE: The use of angiography in postmortem CT angiography (PMCTA) has several advantages. In adults, femoral vascular access is well established. Due to the small and specific anatomy in fetuses and infants, the technique has to be adapted, especially regarding the vascular access. The aim of this study was to evaluate vascular access for pediatric PMCTA (pedPMCTA). MATERIALS AND METHODS: Ten pedPMCTAs were performed in stillbirths, babies, and one toddler. A femoral approach by cannulation of the femoral artery and vein, an umbilical approach by cannulation of the umbilical vessels, and an intraosseous approach by an intraosseous needle were evaluated by handling and resulting imaging. RESULTS: The insertion of a cannula with a size of 18-20 G in the femoral vessels was possible in babies. An umbilical access with peripheral venous cannulas with a size of 14-20 G was feasible in stillbirths and newborns. An intraosseous access is advisable as equal alternative to umbilical and in cases where a femoral access is not possible. The most significant problem with the vascular access is the extravasation of contrast media, but this can be reduced significantly with practice. CONCLUSION: When performing pedPMCTA, an umbilical vascular access is recommended if an umbilical cord with open vessels is still present. Otherwise, a bone marrow access should be preferred in the presence of an arteriovenous shunt or if only the venous system needs to be shown. If that is not the case, the femoral access with the possibility to separate venous and arterial scan should be used.

Increased expression of in situ IL-31RA and circulating CXCL8 and CCL2 in pemphigus herpetiformis suggests participation of the IL-31 family in the pathogenesis of the disease.

BACKGROUND: Pemphigus herpetiformis (PH) is a rare clinical subtype of pemphigus with the presence of urticarial plaques, severe pruritus, rare acantholysis and eosinophilic spongiosis. OBJECTIVES: The aim of this study was to investigate the influence of IL-31 and pro-inflammatory cytokines/chemokines in the pathogenesis of PH. METHODS: Twenty-five patients with PH and three groups: pemphigus foliaceus (PF = 14), pemphigus vulgaris (PV = 15) and healthy controls (HC = 20) were selected for this study. The groups were analysed by immunohistochemistry utilizing IL-31, IL-31RA, IL-4, IL-17 and TNF-α antibodies. Serum levels of IL-4, IL-13, TNF, CXCL8, CCL5 and CCL2 were evaluated by cytometric bead array. RESULTS: Analysis of IL-31 family of PH patients revealed the following findings: (i) Enhanced in situ expression of IL-31 in PH samples, compared to PF and to PV (epidermis); (ii) Cutaneous IL-31RA expression in PH samples was higher than in PF, PV and HC groups (epidermis and dermis); (iii) PF patients that evolved to PH showed significant increased IL-31RA epidermal expression during the PH phase. Profile of pro-inflammatory cytokines (IL-4, IL-17 and TNF-α) in PH patients' skin exhibited: (i) Enhanced IL-4 expression, when compared to patients with PF (epidermis and dermis) and with PV (epidermis); (ii) Augmented IL-17 expression than PF and PV patients (epidermis); (iii) Augmented expression of TNF-α when compared to PF at the epidermal level. Evaluation of circulating cytokines and chemokines showed higher levels of CXCL8 and CCL2 in PH sera compared to HC group. CONCLUSIONS: IL-31 and IL-31RA, cytokines related to pruritus, and pro-inflammatory chemokines (CXCL8 and CCL2) seem to exert a role in the pathogenesis of PH. These findings support future studies to clarify the role of IL-31 pathway as a potential therapeutic target for patients with PH.

Antifungal activity of tyrosol and farnesol used in combination against Candida species in the planktonic state or forming biofilms.

AIM: This study examined the antifungal activity of the combination of tyrosol and farnesol against Candida albicans and Candida glabrata in the planktonic state or forming biofilms. METHODS AND RESULTS: The effect of drug association against Candida planktonic cells was assessed by the fractional inhibitory concentration index. Mono- and dual-species biofilms were developed during 24 h and then treated with the compounds for 3 days, with two daily treatments of 1 min each. After, the total biomass, metabolic activity and the number of cultivable cells were quantified. Planktonic cells of the two species showed a similar susceptibility to the drug combination, however, a synergistic effect was only verified for C. glabrata. Regarding biofilm susceptibility, significant reductions in C. glabrata biomass, metabolism of C. albicans and mixed biofilms, and cultivable cells of single biofilms were verified for the drug combination, indicating an additive effect. For all other experiments, the effects were classified as indifferent. CONCLUSION: The combined use of tyrosol and farnesol was advantageous for some of the analysed parameters against Candida species. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings may contribute to the development of oral care products containing tyrosol and farnesol to combat oral infections caused by Candida species.

Polarized Raman and Infrared Spectroscopy and ab Initio Calculation of Palmitic and Stearic Acids in the Bm and C Forms.

A complete experimental study on the vibrational properties of palmitic and stearic acids crystallized in the Bm and C forms, both belonging to the monoclinic system with the P21/a (C2h5) space group, through polarized Raman and infrared spectroscopy, is reported in this paper. Density functional theory calculations were also performed to assign the normal modes and to help in the interpretation of the experimental data. The different polarizations were compared and their influence on the spectral profiles, in both the lattice and the internal mode regions, was discussed. In general, the Raman and infrared spectra exhibit accentuated differences among the polymorphic forms, which are associated with the different molecular modifications, defined as gauche and all-trans conformations. Insights about interaction among different groups are also furnished.

Combined effect of seawater and load on methacrylate adhesive.

Although the shipbuilding industry is constantly demanding new advanced joining solutions, adhesive technology is not as developed in the marine as compared to other industries. The main reason is the lack of specific knowledge that guarantees the durability of the bonded joints in optimal conditions during the life cycle of a ship. This work simulates in the laboratory a marine-like environment by immersing an adhesive in seawater and subjecting it to constant loading. The objective is to characterize the seawater absorption behavior and its consequences on the mechanical, thermal, and chemical properties of the adhesive after this aging process. Seawater ingress was determined through gravimetric tests at several load conditions of the tensile strength of the adhesive. Besides, absorption process was studied using Fick's Law, determining the diffusion coefficients. The thermal behavior was monitored with differential scanning calorimetry (DSC) and the chemical degradation was analyzed using Fourier transform infrared spectroscopy (FTIR). Also, the mechanical properties were determined by tensile tests. The surface of the adhesive (dried) was studied by Scanning Electron Microscopy (SEM) technique and the porosity was measured by physisorption with a high-performance adsorption analyzer. A numerical simulation was developed using Darcy's Law combined with continuity equation. The results show that application of loads and immersion in seawater until full saturation of seawater improve the mechanical properties of the adhesive, but it affects negatively to the glass transition temperature. This should be considered when designing adhesive bonding joints on ships.

PLUNC protein expression in major salivary glands of HIV-infected patients.

OBJECTIVE: To analyse and compare the expression of Palate, Lung, and Nasal Epithelium Clone (PLUNC) proteins in salivary glands from patients with and without AIDS (control group) using autopsy material. METHODS: We analysed the expression of PLUNCs using immunohistochemistry in parotid (n = 45), submandibular (n = 47) and sublingual gland (n = 37) samples of AIDS patients [30 with normal histology, 21 with mycobacteriosis, 14 with cytomegalovirus (CMV) infection, 30 with chronic non-specific sialadenitis, and 30 HIV-negative controls. In situ hybridization (ISH) for SPLUNC 2 in the HIV-negative group was performed. RESULTS: SPLUNC 1 expression was detected in the mucous acini of submandibular and sublingual glands, and SPLUNC 2 were seen in the serous cells. LPLUNC 1 expression was only positive in the salivary ducts. There was a higher expression of SPLUNC 2 in AIDS patients with CMV infection and mycobacteriosis when compared with all other groups. The intensity of staining for SPLUNC 2 was greater around the lesions than the peripheral ones. ISH for SPLUNC 2 showed perinuclear positivity in the serous cells in all HIV-negative cases. CONCLUSIONS: SPLUNC 1 and LPLUNC 1 proteins were similarly expressed in the salivary glands of AIDS patients and non-HIV patients. CMV infection and mycobacteriosis increase SPLUNC 2 expression in serous cells in the salivary gland of AIDS patients.

Severe novel influenza A (H1N1) infection in cancer patients.

BACKGROUND: The natural history and consequences of severe H1N1 influenza infection among cancer patients are not yet fully characterized. We describe eight cases of H1N1 infection in cancer patients admitted to the intensive care unit of a referral cancer center. PATIENTS AND METHODS: Clinical data from all patients admitted with acute respiratory failure due to novel viral H1N1 infection were reviewed. Lung tissue was submitted for viral and bacteriological analyses by real-time RT-PCR, and autopsy was conducted on all patients who died. RESULTS: Eight patients were admitted, with ages ranging from 55 to 65 years old. There were five patients with solid organ tumors (62.5%) and three with hematological malignancies (37.5%). Five patients required mechanical ventilation and all died. Four patients had bacterial bronchopneumonia. All deaths occurred due to multiple organ failure. A milder form of lung disease was present in the three cases who survived. Lung tissue analysis was performed in all patients and showed diffuse alveolar damage in most patients. Other lung findings were necrotizing bronchiolitis or extensive hemorrhage. CONCLUSIONS: H1N1 viral infection in patients with cancer can cause severe illness, resulting in acute respiratory distress syndrome and death. More data are needed to identify predictors of unfavorable evolution in these patients.

Pulmonary periarterial inflammation in fatal asthma.

BACKGROUND: To date, little information has been available about pulmonary artery pathology in asthma. The pulmonary artery supplies the distal parts of the lungs and likely represents a site of immunological reaction in allergic inflammation. The objective of this study was to describe the inflammatory cell phenotype of pulmonary artery adventitial inflammation in lung tissue from patients who died of asthma. METHODS: We quantified the different inflammatory cell types in the periarterial region of small pulmonary arteries in lung tissue from 22 patients who died of asthma [fatal asthma (FA)] and 10 control subjects. Using immunohistochemistry and image analysis, we quantified the cell density for T lymphocytes (CD3, CD4, CD8), B lymphocytes (CD20), eosinophils, mast cells (chymase and tryptase), and neutrophils in the adventitial layer of pulmonary arteries with a diameter smaller than 500 microm. RESULTS: Our data (median/interquartile range) demonstrated increased cell density of mast cells [FA=271.8 (148.7) cells/mm2; controls=177.0 (130.3) cells/mm2, P=0.026], eosinophils [FA=23.1 (58.6) cells/mm2; controls=0.0 (2.3) cells/mm2, P=0.012], and neutrophils [FA=50.4 (85.5) cells/mm2; controls=2.9 (30.5) cells/mm2, P=0.009] in the periarterial space in FA. No significant differences were found for B and T lymphocytes or CD4+ or CD8+ subsets. Chymase/tryptase positive (MCCT) mast cells predominated over tryptase (MCT) mast cells in the perivascular arterial space in both asthma patients and controls [MCCT/(MCCT+MCT)=0.91 (0-1) in FA and 0.75 (0-1) in controls, P=0.86]. CONCLUSIONS: Our results show that the adventitial layer of the pulmonary artery participates in the inflammatory process in FA, demonstrating increased infiltration of mast cells, eosinophils, and neutrophils, but not of T and B lymphocytes.

Ramsay Hunt syndrome in patients infected with human immunodeficiency virus.

Ramsay Hunt syndrome (RHS) is defined as herpes zoster infection of the head and neck that involves the facial nerve. Immunocompromised people, such as those infected with human immunodeficiency virus (HIV), are predisposed to herpes zoster. However, reports of RHS in patients with HIV are rare. We report two cases of RHS in patients with HIV at our hospital, located in southern Brazil. We hope this report will increase the awareness of this condition among doctors caring for patients with HIV.

Trihexyphenidyl and isoprinosine in the treatment of subacute sclerosing panencephalitis.

Six cases of subacute sclerosing panencephalitis (1 stage I, 3 stage II, 2 stage III) were diagnosed at our institution in the last 10 years. Five patients were treated with isoprinosine and the antiepileptic drug valproic acid. Three patients presented with myoclonic seizures refractory to valproic acid and the usual antiepileptic therapy. They received trihexyphenidyl with good results. We suggest the use of trihexyphenidyl in combination with isoprinosine in patients with subacute sclerosing panencephalitis with myoclonic seizures refractory to valproic acid.

[Syndrome of Munchausen and pseudoparaplegia. Case report]. / Síndrome de Munchausen e pseudoparaplegia. Relato de caso.

We present a 36 years old female, with a 8 years history of "paraplegia", who was admitted to our department to have "some needles withdrawn" from her back. She referred previous admittances to general and psychiatric hospitals in order to treat several episodes of renal failure, combined with other clinical conditions like pulmonary tuberculosis and esophagus, ovary and breast cancer. On the psychiatric evaluation, we found a patient who seemed to be indifferent to her disease, giving accurate and very elaborated description of her symptoms. She was always complaining about previous medical therapies. She moved her both legs simultaneously, without any impairment on reflexes and sensibility. We did not find evidence of tumor processes. The electromyography, cranial CT scan, abdominal ultrasound scan and chest X-ray were normal. Lumbosacral X-ray and CT scan showed 16 sewing needles widespread in the lumbosacral soft tissues. A diagnosis of Munchausen syndrome was formed. After a 15-day trial of anti depressive drug, physiotherapy and psychotherapy, her clinical status significantly improved, reverting its neurological picture after treatment.

[Work conditions of patients with controlled epileptic crises]. / Situación laboral de pacientes con crisis epilépticas controladas.

OBJECTIVES: To study the employment conditions in a group of patient epileptic adults with control of its seizures, assisted in the University Hospital of Cajuru. PATIENTS AND METHODS: We studied 70 patients that we applied the specific protocol, obtaining data of its origin, profession and job situation. RESULTS: We examined 46 men and 24 women, with mean age 34 years old, where 63 of urban origin and 7 rural. All the patients were in treatment with antiepileptic drugs and without seizures or less than three seizures in the last twelve months. The largest group of patients (35) they met unemployed: 14 retired, 11 of the motivated by the disease, 10 worked as autonomous, 3 only studied and 3 were public employees.

[Living with coronary disease: between authentic living and living with daily ties]. / O ser-coronariopata: entre o viver autêntico e as amarras ao cotidiano.

Phenomenological study, which purpose is the meaning that the persons suffering from coronary diseases ascribe to the experiences undergone. From the interviews, significances were obtained: fear of death and of the return of the acute symptoms; perceiving the social, professional and sexual life transformations; feeling watched; resigning oneself to the new conditions; and feel sadness and no resignation. These significances permitted the comprehensive analyses, that was supported by Martin Heidegger in his book Being and time. The person suffering from coronary diseases showed themselves as inauthentic existences when fearing "something", by becoming tied to chatter and to the satisfaction they once had. Moreover, they transcend to the authentic living when they feel anguished, assuming coronary illness as a possibility of existence, although they fail and become tied to daily life traps. The study reflects about the need to privilege the existential dimension in health assistance and in the training of professionals, getting ahead the idea of the other as a guidance to be followed.

[Contribution of phenomenological studies to nursing care]. / Contribuição dos estudos fenomenológicos para o cuidado de enfermagem.

This essay reflects the contributions of phenomenological studies to nursing care, as exemplified in the knowledge concerning the adhesion of persons suffering from coronary diseases to daily idle talk. It considers that the understanding of human manifestations allows one to interpret attitudes and behaviors and that the contributions of phenomenological studies can facilitate the reach of excellence in nursing care.

[Nursing care: its meaning to nurses and patients]. / Cuidado de enfermagem: o sentido para enfermeiros e pacientes.

The objective of this research is to clarify the concept of nursing care through the analysis of the discourse of nurses and patients. The data were collected in a clinic of a university hospital in Fortaleza-Ceará, in January 2001. The sampling frame was categorized through forms, and the speech of nurses and patients was obtained through semi-structured interviews. Data were formatted into textual form and analyzed according to the discourse analysis method. In the following phase, results were interpreted based on hermeneutic principles. Results showed that nursing professionals link the concept of care to the satisfaction of patients' needs and to their physical and emotional well-being. However, even though, these professionals value the interpersonal relationship they establish with their patients, their main concern is technical. Patients, on the other hand, link nursing care to the manifestation of attention, affection and patience. The hermeneutic analysis revealed that nursing care is based on a human predisposition for assistance. This assistance can either be committed and conscious, when it is concerned and solicitous, or uncompromising when it is an inauthentic occupation which only meets mundane immediatisms. We concluded that this study promotes the consolidation of comprehensive-philosophical investigations which can contribute to the qualification of the nursing care.