Use of assisted reproductive technology to separate sperm from human immunodeficiency virus infected men resulting in pregnancy among serodiscordant couples

Due to HIV care improvement, discordant couples more frequently seek help in order to conceive their own biological child. Besides the advance of antiretroviral therapy, unprotected intercourse is not a complete safe option, carrying a low but still present risk of HIV transmission. We report 10 serodiscordant couples in whom the male partner is HIV positive, submitted to sperm washing and intrauterine insemination. The procedure resulted in four pregnancies and no HIV transmission to mother or child was observed. Techniques of assisted reproduction can help HIV discordant couples to conceive biological offspring and is a safer option than unprotected intercourse.     

Correlation between Electrocardiographic Features and Mechanical Dyssynchrony in Heart Failure Patients with Left Bundle Branch Block

Background: Few electrocardiographic parameters beyond the QRS duration were studied with regard to the correlation with mechanical dyssynchrony. This study aims to analyze the correlation between electrocardiographic parameters and mechanical dyssynchrony in patients with symptomatic heart failure (HF) and left bundle branch block (LBBB). Methods: Patients with HF, ejection fraction ≤ 35%, and QRS interval ≥ 120 ms with a LBBB were prospectively studied. We analyzed the correlation between electrocardiographic parameters (QRS duration, R voltage in limb leads, S voltage in precordial leads, Sokolow and Cornell indexes, QRS axis deviation, and QRS notches in lateral and inferior leads) and mechanical dyssynchrony measured by tissue Doppler imaging (TDI). Results: A group of 50 patients were studied, 60% male, 78% with nonischemic cardiomyopathy, NYHA Class III–IV (86%), and ejection fraction of 0.22 ± 0.6. Intra‐ and interventricular dyssynchrony occurred in 68% and 74% of patients, respectively. The S amplitude in precordial leads and the Sokolow and Cornel indexes show a weak correlation with the degree of dyssynchrony. In the patients with QRS notching in the lateral and inferior leads, we observed significantly greater prevalence of intraventricular dyssynchrony, with sensitivity and specificity of 85% and 56%, respectively, for notches in lateral leads. The QRS duration presents moderate correlation with the degree of both intraventricular (r = 0.48) and interventricular dyssynchrony (r = 0.46). Conclusion: The following electrocardiographic parameters were related to the degree of mechanical dyssynchrony: QRS duration and notches in QRS. In addition, the patients tend to have highest S amplitude in precordial leads. Ann Noninvasive Electrocardiol 2011;16(1):41–48     

Non-Alpine thyroid angiosarcoma

INTRODUCTIONAngiosarcoma is a very rare entity of soft tissue neoplasm with an aggressive and destructive biological behavior. Thyroid angiosarcoma is usually reported in Alpine regions, with only exceptionally rare cases arising in non-mountainous areas. In the Alpine regions it constitutes 2–10% of all malignant thyroid tumors.PRESENTATION OF CASEWe report a case of a thyroid non-Alpine angiosarcoma in a 71-year-old female with a 10 years old multinodular goiter. The cervical mass underwent rapid growth in the last year, and she was referred for surgical treatment. A 15 cm mass was found on the right side of the neck invading adjacent tissues and displacing the trachea without obvious invasion of this organ. Fine needle aspiration cytology showed “carcinoma”. Lung metastasis were present. Although difficult, total thyroidectomy was possible with resection of an esophageal implant. Post-operatively, she had respiratory failure that eventually recovered, but, on 39th post-operative day, she died of violent hemoptysis, probably due to invasion by mediastinal metastasis.DISCUSSIONA clear distinction between angiosarcoma and anaplastic carcinoma of the thyroid is considerably difficult, despite treatments and prognosis are practically the same. However, in recent years, a thyroid malignancy exhibiting phenotypical features of endothelial differentiation was described. Keratin positivity cannot be reported as necessarily indicative of epithelial differentiation.CONCLUSIONOptimal treatment for thyroid angiosarcoma remains unclear, not only because the prognosis is poor, despite multimodal therapeutic efforts, but also because it is a very rare entity.     

Antinociceptive and anti-inflammatory activities of Tabernaemontana catharinensis

In this work we describe the analgesic, anti-inflammatory and toxic activities as well as the phytochemical profile of the ethanol extract from Tabernaemontana catharinensis A. DC. (Apocynaceae) stem bark. Analgesic evaluation was carried out against chemical and thermal stimuli. Anti-inflammatory activity was investigated on carrageenan-induced edema in rats and toxicological studies (LD₅₀) were conducted in mice. Phytochemical analyses were performed by standardized methodology. In an analgesic assay, acetic acid-induced writhings were significantly inhibited by extract doses of 37.5?mg/kg (40.97%), 75?mg/kg (77.70%) and 150?mg/kg (88.98%). A central analgesia was also observed using T. catharinensis extract at all doses tested, particularly noticed at 60 and 90?min following administration. The extract significantly reduced edema development by 30.35% (37.5?mg/kg), 34.46% (75?mg/kg), and 56.42% (150?mg/kg) when assessed 180?min following carrageenan intraplantar injection, demonstrating an effective anti-inflammatory action. The LD₅₀ value was 2200?mg/kg. Phytochemical analyses of ethanol extract from Tabernaemontana catharinensis stem bark showed the presence of alkaloids and terpenoids, which may be responsible for the observed pharmacological activities described in this work.     

Nuclear localization of epidermal growth factor receptor (EGFR) in ameloblastomas

Background: Ameloblastoma is a locally invasive neoplasm often associated with morbidity and facial deformities, showing increased Epidermal Growth Factor Receptor (EGFR) expression. Inhibition of EGFR was suggested as a treatment option for a subset of ameloblastomas. However, there are resistance mechanisms that impair anti-EGFR therapies. One important resistance mechanism for EGFR-inhibition is the EGFR nuclear localization, which activates genes responsible for its mitogenic effects, such as Cyclin D1.Methods: We assessed EGFR nuclear localization in encapsulated (unicystic, n = 3) and infiltrative (multicystic, n = 11) ameloblastomas and its colocalization with Cyclin D1 by using anti-EGFR and anti-lamin B1 double labeling immunofluorescence analyzed by confocal microscopy. Oral inflammatory fibrous hyperplasia and oral squamous cell carcinoma samples were used for comparison.Results: Twelve cases of ameloblastoma exhibited nuclear EGFR colocalization with lamin B1. This positive staining was mainly observed in the ameloblast-like cells. The EGFR nuclear localization was also observed in control samples. In addition, nuclear EGFR colocalized with Cyclin D1 in ameloblastomas.Conclusions: Nuclear EGFR occurs in ameloblastomas in association with Cyclin D1 expression, which is important in terms of tumor biology clarification and raises a concern about anti-EGFR treatment resistance in ameloblastomas.     

The erythrocyte alloimmunisation in patients with sickle cell anaemia: a systematic review

Transfusion therapy is a common practice in the treatment of anaemia and can cause erythrocyte alloimmunisation. To systematise data related to erythrocyte alloimmunisation in patients with sickle cell disease (SCD), a bibliographic search was carried out in September 2017 to search for studies in four electronic databases. (i) Referring to the original work, (ii) being cohort or case–control, (iii) having been developed with individuals with SCD and (iv) having evaluated the erythrocyte alloimmunisation. Two reviewers identified the articles for inclusion in the study, extracted the predetermined data and carried out the evaluation of the methodological quality of the work. 21 studies were selected; the studies included data on 20 636 individuals (children and adults), were mostly published in the last 10 years, were developed in the United States and had high methodological quality. The occurrence of erythrocyte alloimmunisation ranged from 4·4 to 76%, and there was a higher rate of alloimmunisation against antigens of the Rh system. The risk factors for alloimmunisation were age; gender (female); red blood cell (RBC) units received; presence of ≥1 autoantibodies, TNF‐α, interleukin (IL1B), human leukocyte antigens (HLA)‐DRB1 gene polymorphisms; first blood transfusion (BT) after 5 years of age, transfusion episodic, multiple or during inflammatory events, acute chest syndrome (ACS) and vase‐occlusive crisis (VOC); increased percentage of CD41 T memory cells; and positive direct antiglobulin test. Transfusion policies should be developed to protect the patient and his or her health based on the main factors associated with its incidence.