Diffuse disseminated Candidiasis in a patient with Felty’s syndrome: a case report

Severe granulocytopenia predispose patients with Felty’s syndrome to severe infectious diseases. The following report deals with an occurrence of chronic disseminated candidiasis in a patient with Felty’s syndrome who presented with prolonged and severe granulocytopenia. To the best of our knowledge this coexistence has never been described before. Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.     

Working conditions in call-centers,the impact on employee health: a transversal study. Part II

Purpose  The present study sought to assess the impact of telephone call center employees’ working conditions on health by identifying at-risk employment situations. Methods  A transversal study was performed in companies followed by 47 occupational physicians taking part (working conditions have been previously described). A self-administered medical questionnaire was used to collect data on absence due to sick leave, hearing and visual problems, musculoskeletal disorders, psychotropic drug use, etc. An analog-scale self-assessment of health status and a general health questionnaire (GHQ-12) were used. Personal or familial events that might underlie health problems and affect GHQ-12 results were quantified and taken into account in a logistic regression. Results  A total of 2,130 call-handlers were included. Workers who had availed sick leave during the previous 12 months were 60%. The most frequent musculoskeletal complaints over the previous 12-month period concerned the cervical region (59%). During the same period, 77.3% of subjects experienced visual fatigue, 50% reported auditory fatigue signs and 47% vocal disturbance or fatigue. According to the Likert scale, 39.4% of workers had showed psychological distress. Almost 24% of the workers had used psychoactive medication during the previous 12 months. A significant association was found between psychological distress and the frequency of musculoskeletal disorders. Psychological distress and musculoskeletal disorders were significantly greater in workers with Job Strain and Iso Strain. After taking non-occupational factors into account, some occupational factors were found to increase the risk of psychological distress (Likert >12): imposed full-time schedule, being unable to simultaneously meet both quality and quantity requirements, situations of tension with clients, negative comments from superiors, and lack of recognition from superiors. Conclusions  This survey of over 2,000 call center employees highlighted the high frequency of psychological distress in this population and the health impact of working conditions. Legal agreements  Approval by the French Ministry of Research (Comité consultatif pour le traitement de l’information en matière de recherche dans le domaine de la santé) and the French data protection authority (Commission Nationale de l’Informatique et des Libertés) was obtained before starting the study.     

Rare cause of intestinal obstruction after laparoscopic radical nephrectomy: internal herniation via a mesenteric defect

A 43-year-old man had painless macroscopic hematuria and was diagnosed with a 9-cm renal carcinoma in the lower pole of the left kidney. He underwent laparoscopic transperitoneal left radical nephrectomy (LRN) with an uneventful recovery. Eleven days later, he developed intestinal obstruction (IO). Abdominal computed tomography scan showed dilated small bowels occupying the left renal fossa. Laparotomy revealed closed-loop small bowel obstruction resulting from internal intestinal herniation via a 5-cm mesenteric defect. It was repaired after the herniated bowels were reduced. This case illustrates a rare cause of IO after LRN, in which mesenteric defect is necessary.     

Dose proportionality and the effect of food on vildagliptin, a novel dipeptidyl peptidase IV inhibitor, in healthy volunteers

Vildagliptin is a potent and selective dipeptidyl peptidase IV inhibitor in development for the treatment of type 2 diabetes that improves glycemic control by enhancing alpha- and beta-cell responsiveness to glucose. Two open-label, single-dose, randomized, crossover studies in healthy subjects (ages 18-45 years) investigated the dose proportionality of vildagliptin pharmacokinetics (n = 20) and the effect of food (n = 24) on vildagliptin pharmacokinetics. There was a linear relationship (r(2) = 0.999) between vildagliptin doses of 25, 50, 100, and 200 mg and area under the plasma concentration-time curve from time zero to infinity (AUC(0-infinity)) and maximum plasma concentration (C(max)). Dose proportionality was assessed using a statistical power model [X = alpha x (dose)(beta)]. The 90% confidence intervals of the proportionality coefficient, beta, for AUC(0-infinity) (1.15-1.19) and C(max) (1.04-1.14) indicated that deviations from dose proportionality were small (<7.7%). Doubling of dose led to 2.1- to 2.3-fold increases in AUC(0-infinity) and C(max) but no dose-dependent changes in time to reach C(max) or terminal elimination half-life. Administration of vildagliptin 100 mg following a high-fat meal decreased C(max) by 19% and AUC(0-infinity) by 10%. Vildagliptin displays approximately dose-proportional pharmacokinetics over the 25- to 200-mg dose range, and administration with food has no clinically relevant effect on vildagliptin pharmacokinetics.     

Piezo1 activation augments sickling propensity and the adhesive properties of sickle red blood cells in a calcium-dependent manner

Haemoglobin S polymerization in the red blood cells (RBCs) of individuals with sickle cell anaemia (SCA) can cause RBC sickling and cellular alterations. Piezo1 is a mechanosensitive protein that modulates intracellular calcium (Ca²⁺) influx, and its activation has been associated with increased RBC surface membrane phosphatidylserine (PS) exposure. Hypothesizing that Piezo1 activation, and ensuing Gárdos channel activity, alter sickle RBC properties, RBCs from patients with SCA were incubated with the Piezo1 agonist, Yoda1 (0.1–10 μM). Oxygen-gradient ektacytometry and membrane potential measurement showed that Piezo1 activation significantly decreased sickle RBC deformability, augmented sickling propensity, and triggered pronounced membrane hyperpolarization, in association with Gárdos channel activation and Ca²⁺ influx. Yoda1 induced Ca²⁺-dependent adhesion of sickle RBCs to laminin, in microfluidic assays, mediated by increased BCAM binding affinity. Furthermore, RBCs from SCA patients that were homo−/heterozygous for the rs59446030 gain-of-function Piezo1 variant demonstrated enhanced sickling under deoxygenation and increased PS exposure. Thus, Piezo1 stimulation decreases sickle RBC deformability, and increases the propensities of these cells to sickle upon deoxygenation and adhere to laminin. Results support a role of Piezo1 in some of the RBC properties that contribute to SCA vaso-occlusion, indicating that Piezo1 may represent a potential therapeutic target molecule for this disease.     

Front Line Workers’ Attitudes towards Psychiatric Advance Directives

Studies have begun to explore provider attitudes’ toward psychiatric advance directives (PADs) and how those attitudes are related to provider characteristics. The study gathered attitudinal data from a sample of 193 social workers serving mentally ill adults. Social workers with pro-healthcare power of attorney (HCPA) attitudes were likely to have prior experience with an HCPA and to believe that involuntary treatment violates the NASW Code of Ethics. Social workers are more favorable of HCPAs than advance instructions. The findings suggest that clinical experiences with PADs may positively impact social worker’s perceptions of the law.     

Screening for anti-infective properties of several medicinal plants of the Mauritians flora

Several plants of the Mauritian flora alleged to possess anti-infective properties were studied against different strains of pathogenic bacteria and fungi. The grounded dried plant materials were extracted with different extractants and screened for anti-microbial activity using the disk diffusion and the micro-dilution techniques. Preliminary screening revealed that the methanol extracts were most active. Salmonella enteritidis, Enterobacter cloacae and Bacillus subtilis were the three test organisms, which were found to be susceptible to all the crude methanolic extracts of the different plants investigated (100% susceptibility), followed by Escherichia coli (57.1%) and Pseudomonas aeruginosa (57.1%), and Staphylococcus aureus (28.6%). The lowest minimum inhibitory concentration recorded for the different crude methanol extracts against Staphylococcus aureus, Escherichia coli, Salmonella enteritidis, Enterobacter cloacae, Bacillus subtilis and the mould fungus Candida albicans were 500, 1000, 125, 250, 1000 and 125 micro g/ml, respectively. Bioautography using Cladosporium cucumerinum revealed that dichloromethane (DCM) extracts had the highest activity against the phytopathogenic fungus. It was also noted that the DCM extracts of Michelia champaca and Antidesma madagascariense yielded the maximum number of growth inhibiting compounds against Cladosporium cucumerinum. Activity of the different crude extracts was also investigated against several phytopathogenic filamentous fungi, Colletotrichum glocosporoides, Rhizoctonia solani, Sclerotinia sclerotium, Guignardia sp. and Fusarium oxysporum. It was found that crude hexane extracts as well as crude DCM extracts exhibited marked activity against several strains of fungi, especially Colletotrichum glocosporoides, Sclerotinia sclerotium and Guignardia sp.