Supraspinatus tendon affection and sick leave

Rotator cuff disease, among others damage of the supraspinatus tendon mainly caused by work overload, is a common problem in the population resulting in a high incidence of sick leaves. In the present survey we sought to compare the need for sick leaves in relation to different stages of supraspinatus tendon affection and in relation to five different groups of workers. Our study counted with the participation of patients who were diagnosed with this condition. The individuals were grouped according to stages of the disease (tendonitis, partial rupture, total rupture) and according to the biomechanical aspects of their occupation (general services, civil construction, domestic workers, farm workers and security guard services). Statistical analysis was performed using Pearson's chi-square test, dependence analysis and exact test. Results revealed that 62 (55%) of the individuals were on sick leave. The highest rates of sick leaves according to Pearson's test occurred in the groups general services (38.71%) and farm workers (22.58%). According to the dependence analysis, tendonitis (p<0.05) was the most frequent reason for sick leaves and, according to Pearson's test, farm work seems to keep the individual for a longer space of time unfit for duty (p=0.02).     

Maxillary hemophilic pseudotumor in a patient with mild hemophilia A

Hemophilic pseudotumors are rare, but well known complications of severe hemophilia A, which most frequently develops at the femur, tibia, pelvic bones, iliac bones, or rarely in the cranium or gnathic bones. This report describes a case of hemophilic pseudotumor of the maxillary alveolar ridge that occurred in a boy with mild hemophilia A (14% factor VIII activity). The lesion, which presented as an alveolar mucosal swelling, responded well to enucleation, curettage, and intralesional fibrin glue injection.     

Investigation of Propionibacterium acnes in progressive macular hypomelanosis using real-time PCR and culture

Background Progressive macular hypomelanosis (PMH) is a dermatosis of unknown etiology. It has been concluded that it involves the presence of Propionibacterium acnes, a saprophyte of the pilosebaceous follicles. In our study, we investigated the presence of P. acnes in lesional and non‐lesional skin of patients with PMH through quantitative real‐time polymerase chain reaction (PCR) and bacterial culture from a skin fragment. Materials and methods An observational, exploratory study, with laboratory comparison of lesional (study group) and non‐lesional skin (comparison group), in patients with PMH, was carried out with 36 patients, seen in the dermatology outpatient setting at the Oswaldo Cruz University Hospital (OCUH), Recife, Pernambuco, Brazil, between March and May 2008. All patients were submitted to a Wood’s lamp examination, mycological research, and biopsies of lesional and non‐lesional skin from the back. Skin fragments were submitted to a histopathology test, bacterial culture, and a quantitative real‐time PCR test. The program Statistical Package for Social Sciences, version 12.0, was employed for relationship analysis with the Wilcoxon and McNemar tests. Results There was a significant predominance of P. acnes on lesional skin, in comparison to non‐lesional skin (P < 0.001), as demonstrated by culture and quantitative real‐time PCR. Conclusion Although P. acnes is a saprophyte, the hypothesis may be raised that this microorganism participates in the development of PMH.     

Effect of donor-recipient HLA matching at HLA A, B, C, and DRB1 on outcomes after umbilical-cord blood transplantation for leukaemia and myelodysplastic syndrome: a retrospective analysis

Background

The importance of matching at the HLA C locus has not been well defined for unrelated umbilical-cord blood transplantation. The selection algorithm for umbilical-cord blood units generally considers intermediate resolution HLA typing at A and B and allele-level typing at DRB1. We aimed to establish the relative importance of additional matching at HLA C.

Methods

We used Cox regression to assess retrospectively the effect of donor–recipient HLA matching on outcomes of single umbilical-cord blood transplantations for leukaemia and myelodysplastic syndrome. Our primary endpoint was transplant-related mortality. HLA typing was done with molecular techniques with a minimum of intermediate resolution for HLA A, B, and C, and at the allele-level for DRB1.

Findings

The median age of our study population was 10 years (range <1–62) and 552 (69%) of 803 patients were aged 16 years or younger at transplantation. Compared with transplantations matched at HLA A, B, C, and DRB1 (n=69), transplant-related mortality risk was higher after transplantations matched at HLA A, B, and DRB1 and mismatched at HLA C (n=23; HR 3·97, 95% CI 1·27–12·40; p=0·018). Transplant-related mortality risk was also higher after transplantations with a single mismatch at HLA A, B, or DRB1 and mismatched at HLA C (n=234; 1·70, 1·06–2·74; p=0·029) compared with transplantations matched at HLA C with a single mismatch at HLA A, B, or DRB1 (n=127). Assessing the overall effect of HLA disparity on transplant-related mortality, risks were higher with units mismatched at two (n=259; 3·27, 1·42–7·54; p=0·006), three (n=253; 3·34, 1·45–7·71; p=0·005), or four (n=75; 3·51, 1·44–8·58; p=0·006) loci compared with matched units (n=69).

Interpretation

Our data suggest that the present strategy for umbilical-cord blood unit selection should be reassessed; matching at HLA C for units that are matched at HLA A, B, or DRB1 or in the presence of a single locus mismatch at HLA A, B, or DRB1 should be included to minimise mortality risks.

Funding

National Cancer Institute, National Heart Lung and Blood Institute, National Institute for Allergy and Infectious Diseases, Leukemia and Lymphoma Society, US Department of the Navy, Children's Leukemia Research Association, and INSERM.     

Advances and challenges of nursing in the scientific production on Psoriasis

The Psoriasis, chronic disease with uncertain cause, affects 1 to 3% of world population, produces great psychological impact and changes in quality of life, a challenging reality. The objective is to analyze the scientific production of nursing on Psoriasis in 1997/2008, examining the approaches and contributions to care. Bibliographic study based on virtual database Medline using the terms "Psoriasis" and "Nursing". Of the 21 articles selected, 19% focus on the pathophysiology and differential diagnosis, 48% treatment, 28% psychological aspects and 42% in nursing care. The rescue of the scientific knowledge increases the challenge of maximizing the scientific production about this subject, bringing significant contributions to advances to a more holistic intervention and higher quality with this clientele.     

Differences and similarities of postprandial lipemia in rodents and humans

Background

Previous analysis clustered 1,238 individuals from the general population Genetics of Lipid Lowering Drugs Network (GOLDN) study by the size of their fasting very low-density, low-density and high-density lipoproteins (VLDL, LDL, HDL) using latent class analysis. From two of the eight identified groups (N = 251), ~75% of individuals met Adult Treatment Panel III criteria for the metabolic syndrome (MetS). Both showed small LDL diameter (mean = 19.9 nm); however, group 1 (N = 200) had medium VLDL diameter (mean = 53.1 nm) while group 2 had very large VLDL diameter (mean = 65.74 nm). Group 2 additionally showed significantly more insulin resistance (IR), and accompanying higher waist circumference and fasting glucose and triglycerides (all P < .01). Since lipoprotein lipase hydrolyzes triglyceride in the VLDL-LDL cascade, we examined whether these two patterns of lipoprotein diameter were associated with differences across two lipoprotein lipase (LPL) gene variants: D9N (rs1801177) and S447X (rs328).

Findings

Mixed linear models that controlled for age, sex, center of data collection, and family pedigree revealed no differences between the two groups for the D9N polymorphism (P = .36). However, group 2 contained significantly more carriers (25%) of the 447X variant than group 1 (14%; P = .04).

Conclusions

This was the first study this kind to show an association between LPL and large VLDL particle size within the MetS, a pattern associated with higher IR. Future work should extend this to larger samples to confirm these findings, and examine the long term outcomes of those with this lipoprotein diameter pattern.     

Hydrogenated fat intake during pregnancy and lactation caused increase in TRAF-6 and reduced AdipoR1 in white adipose tissue,but not in muscle of 21 days old offspring rats

Background  

Although lipids transfer through placenta is very limited, modification in dietary fatty acids can lead to implications in fetal and postnatal development. Trans fatty acid (TFA) intake during gestation and lactation have been reported to promote dyslipidemia and increase in pro- inflammatory adipokines in offspring. The aim of this study was to evaluate whether the alterations on pro-inflammatory cytokines and dyslipidemia observed previously in 21-d-old offspring of rats fed a diet containing hydrogenated vegetable fat during gestation and lactation were related to alterations in TLR-4, TRAF-6 and adipo-R1 receptor in white adipose tissue and muscle. On the first day of gestation, rats were randomly divided into two groups: (C) received a control diet, and (T) received a diet enriched with hydrogenated vegetable fat, rich in trans fatty acids. The diets were maintained throughout gestation and lactation. Each mother was given eight male pups. On the 21st day of life the offspring were killed. Blood, soleus and extensor digital longus (EDL) muscles, and retroperitoneal (RET) white adipose tissue were collected.     

In Vitro and In Vivo Antifungal Susceptibilities of the Mucoralean Fungus Cunninghamella

We have determined the in vitro activities of amphotericin B (AMB), voriconazole, posaconazole (PSC), itraconazole (ITC), ravuconazole, terbinafine, and caspofungin against five strains of Cunninghamella bertholletiae and four of Cunninghamella echinulata. The best activity was shown by terbinafine against both species (MIC range = 0.3 to 0.6 μg/ml) and PSC against Cunninghamella bertholletiae (MIC = 0.5 μg/ml). We have also evaluated the efficacies of PSC, ITC, and AMB in neutropenic and diabetic murine models of disseminated infection by Cunninghamella bertholletiae. PSC at 40, 60, or 80 mg/kg of body weight/day was as effective as AMB at 0.8 mg/kg/day in prolonging survival and reducing the fungal tissue burden in neutropenic mice. PSC at 80 mg/kg/day was more effective than AMB at 0.8 mg/kg/day in reducing the fungal load in brain and lung of diabetic mice. Histological studies revealed an absence of fungal elements in organs of mice treated with either AMB at 0.8 mg/kg/day or PSC at 60 or 80 mg/kg/day in both models. ITC showed limited efficacy in both models. PSC could be a therapeutic option for the treatment of systemic infections caused by Cunninghamella bertholletiae.The genus Cunninghamella in the order Mucorales encompasses filamentous fungi that are inhabitants of soil and other environments and are common laboratory contaminants. Cunninghamella bertholletiae is the only member of the genus documented to cause human infections (8), although recently the species C. echinulata was also found in clinical samples (3). Infections caused by Cunninghamella are less frequent than those produced by other genera of Mucorales, e.g., Rhizopus and Mucor, but the mortality rate is higher (76%) (5, 19). In general, infections caused by the members of Mucorales are life-threatening and devastating, requiring prompt and aggressive treatment. There are several simultaneous approaches recommended for patient management, including surgical debridement, antifungal therapy, and correction of the underlying predisposing factors, when possible (5, 20).Amphotericin B (AMB) is the drug of choice, although very few data exist on the activity of this drug against some of the less frequent genera of Mucorales, such as Cunninghamella (1, 2). In a recent study in which a large set of clinical isolates of Mucorales was tested, C. bertholletiae demonstrated the highest resistance to AMB in vitro, with only 63% of the isolates tested showing MIC values under the working interpretative breakpoints described by the CLSI (2, 6). In addition, the failure of AMB therapy has been reported in clinical cases caused by Cunninghamella (4, 15, 18, 19). Posaconazole (PSC) appears to be a promising drug for the treatment of zygomycosis, having been successfully used as salvage therapy for patients who are refractory to or intolerant of AMB (10, 23). PSC is safer than AMB and shows good in vitro activity and in vivo efficacy against some zygomycetes (1, 2, 7, 22). There are only two clinical reports on the use of PSC for the management of Cunninghamella infection (9, 16), and there are no data on the use of this drug in animal models of C. bertholletiae infections. The aim of the present study, therefore, was to evaluate the in vitro activities of seven drugs against isolates of both C. bertholletiae and C. echinulata and to assess the in vivo efficacies of AMB, itraconazole (ITC), and PSC in neutropenic and diabetic murine models of disseminated infection by five strains of C. bertholletiae.