A rare case of pulmonary lymphomatoid granulomatosis complicated with venous thrombosis

Lymphomatoid granulomatosis (LG) is Epstein-Barr virus associated and aggressive B cell lymphoproliferative disease. The most common sites of involvement are lungs, skin, kidneys, liver and central nervous system. The clinical presentation of pulmonary LG may mimic infectious diseases, malignancies or vasculitis. While treatment approach of low grade disease is watch and wait, patients with advanced stage require aggressive treatment with chemotherapy. Patients with hematological malignancy as well as solid tumors are at increased risk of venous thromboembolic events (VTE). We reported here in a case of pulmonary LG who was complicated with VTE during treatment with chemo-immunotherapy After 4 cycles of R-CHOP, she achieved complete remission for LG and was followed up without relapse for 2 years. She was anticoagulated with Low-Molecular-Weight Heparin (LMWH) during chemotherapy period, and the thrombus improved over the next several weeks. While on this paper written, patient completed her pregnancy successfully under anticoagulation prophylaxis.     

Impact of nicotine on bone healing.

A limited number of experimental animal studies and in vitro data confirm that nicotine impairs bone healing, diminishes osteoblast function, causes autogenous bone graft morbidity, and decreases graft biomechanical properties. Therefore, our long-term goal is to develop an effective therapy to reverse the adverse impact of nicotine from tobacco products. However, before accomplishing this goal, we had to develop an animal model. Our hypotheses were nicotine administration preceding and following autogenous bone grafting adversely affected autograft incorporation and depressed donor site healing in a characterized animal wound model. Hypothesis testing was accomplished in bilateral, 4-mm diameter parietal bone defects prepared in 60 Long-Evans rats (male, 35-day-old). A 4-mm diameter disk of donor bone was removed from the left parietal bone and placed in the contralateral defect. The donor site served as a spontaneously healing bone wound. The rats were partitioned equally among three doses of nicotine administered orally in the drinking water (12.5, 25, and 50 mg/L). For each dose, the duration and sequence of nicotine treatment followed four courses, including no nicotine and designated combinations of nicotine administration and abatement prior to and following osseous surgery. Experimental sites were recovered on 14 and 28 days postsurgery, responses quantitated, and data analyzed by analysis of variance and post hoc statistics (p < or = 0.05). We developed a convenient and effective osseous model, and the results validated our hypothesis that nicotine negatively impacts on bone healing.     

Anti-Glioma Effect of Pseudosynanceia melanostigma Venom on Isolated Mitochondria from Glioblastoma Cells

Background: Glioblastoma is the most common primary malignant tumor of the central nervous system thatoccurs in the spinal cord or brain. Pseudosynanceia melanostigma is a venomous stonefish in the Persian Gulf, whichour knowledge about is little. This study’s goal is to investigate the toxicity of stonefish crude venom on mitochondriaisolated from U87 cells. Methods: In the first stage, we extracted venom stonefish and then isolated mitochondria haveexposed to different concentrations of venom. Finally, mitochondrial toxicity parameters (Succinate dehydrogenase(SDH) activity, Reactive oxygen species (ROS), cytochrome c release, Mitochondrial Membrane Potential (MMP),and mitochondrial swelling) have evaluated. Results: To determine mitochondrial parameters, we used 115, 230, and460 μg/ml concentrations. The results of our study show that the venom of stonefish selectively increases upstreamparameters of apoptosis such as mitochondrial swelling, cytochrome c release, MMP collapse and ROS. Conclusion:This study suggests that Pseudosynanceia melanostigma crude venom has selectively caused toxicity by increasingactive mitochondrial oxygen radicals. This venom could potentially be a candidate for the treatment of glioblastoma.     

The Modifying Influence of Country Development on the Effect of Individual Educational Attainment on Self-Rated Health

Objectives. We investigated how much the Human Development Index (HDI), a global measure of development, modifies the effect of education on self-reported health.Methods. We analyzed cross-sectional World Health Survey data on 217 642 individuals from 49 countries, collected in 2002 to 2005, with random-intercept multilevel linear regression models.Results. We observed greater positive associations between educational levels and self-reported good health with increasing HDI. The magnitude of this effect modification of the education–health relation tended to increase with educational attainment. For example, before adjustment for effect modification, at comparable HDI, on average, finishing primary school was associated with better general health (b = 1.49; 95% confidence interval [CI] = 1.18, 1.80). With adjustment for effect modification by HDI, the impact became 4.63 (95% CI = 3.63, 5.62) for every 0.1 increase in HDI. Among those who completed high school, these associations were, respectively, 5.59 (95% CI = 5.20, 5.98) and 9.95 (95% CI = 8.89, 11.00).Conclusions. The health benefits of educational attainment are greater in countries with greater human development. Health inequalities attributable to education are, therefore, larger in more developed countries.The association between education and health has been widely researched. Individuals with higher educational attainment generally have lower rates of mortality and morbidity.1–4 Higher levels of education are also associated with decreased risk of poor health and functional limitations.5 It is apparent that, in addition to socioeconomic factors at the individual level, socioeconomic conditions at the population level play a role in the pathway to health. One common measure of a country’s human development is the Human Development Index (HDI). The HDI is intended to serve as a frame of reference for both social and economic development attained by a country’s citizens.The role of the political context of human development and health cannot be disregarded. Welfare regimes in which the financial emphasis, in terms of percentage of the gross domestic product, is on redistributive and full-employment policies are generally most successful in promoting a population’s health.6,7Although the effects of education and national development on health are well understood separately, little is known about the influence of national development on the relationship between education and health. This raises important questions about how education and increasing national development affect health in conjunction. This also has implications for educational inequalities in health. Does health inequality still play a prominent role in highly developed countries, or is it mainly a problem in less developed countries? Does investing in the national development of a country have a positive effect on educational inequalities in health? Although we do not yet have concrete answers to these questions, some work has been done. For instance, Rehkopf et al. compared the association of cardiovascular risk factors with education in Costa Rica and the United States and reported that the differential importance of education depends on the country context.8 The differences in mortality by educational attainment between the 2 countries could be attributable to the modifying effect development has on the relationship between education and health.We attempted to quantify the modifying influence of national development, as measured by the HDI, on the association of educational attainment with self-reported general health.     

The use of superficial and deep partial-thickness burned tissue for flap fabrication

Abstract. When flaps are indicated for early wound closure in extensive burns, and there is limited unburned local tissue to design these, one option may be to use a partial-thickness burned area as a flap for construction in the acute phase. This study examined the proportions of superficial and deep partial-thickness burned skin that can safely be included in an island flap. Eighty male Wistar rats were divided into four groups, with varying extent of burning of the right epigastric flap site: group 1, 50% superficially burned; group 2, 100% superficially burned; group 3, 50% deeply burned; and group 4, 100% deeply burned. In each group the left epigastric flaps served as controls. The superficially burned flaps in groups 1 and 2 healed at 2-4 weeks, and the deeply burned flaps in groups 3 and 4 healed at 4-6 weeks postoperatively. In all cases hair grew on the burned flap sites, and the flaps healed in such a way that they were almost impossible to distinguish, even after the hair was shaved at week 8. It was observed that the superficially burned flaps healed perfectly without scarring, but small portions of the deeply burned flaps developed scars. In conclusion, superficially and deeply burned island flaps survived completely in this animal model, even when the entire flap surface was burned. In the future, under appropriate conditions the transfer of partial-thickness burned tissue as flaps may provide a good alternative for reconstruction of the acute burn wound.     

Periorbital reconstruction using variations of the upper eyelid flap.

Tissues that have characteristics identical or similar to periorbital soft tissue are preferred for reconstruction in the eye region. The upper eyelid is part of the periorbital area that provides an ideal reserve of tissue for this purpose, without producing a donor-site deformity. We used the upper eyelid flap with different pedicle designs in various parts of the periorbital region in 21 patients, and achieved favourable results. The flap was medially-based in five, superomedially-based in seven, laterally-based in eight, and superolaterally-based in one. The tissue defects were the result of the excision of tumours in 18 patients, and of injury in three. The defects were located in the upper eyelid in two, the lower eyelid in five, the medial canthus in eight, the lateral canthus in four, and in the neighbouring orbitonasal zones in two. Different sized flaps were used according to the dimensions of the defects, which ranged from about 1 to 8 cm2. The upper eyelid flap is versatile, and provides tissue of ideal colour and texture. The procedure can be done quickly in one stage with minimal morbidity.     

T cell dysfunction and patient age are associated with poor outcomes after mechanical circulatory support device implantation

Immunologic impairment may contribute to poor outcomes after implantation of mechanical circulatory support device (MCSD), with infection often as a terminal event. The study of immune dysfunction is of special relevance given the growing numbers of older patients with heart disease. The aim of the study was to define which immunologic characteristics are associated with development of adverse clinical outcomes after MCSD implantation.We isolated peripheral blood mononuclear cells (PBMC) from patients pre- and up to 20?days post-MCSD implantation and analyzed them by multiparameter flow cytometry for T cell dysfunction, including terminal differentiation, exhaustion, and senescence. We used MELD-XI and SOFA scores measured at each time point as surrogate markers of clinical outcome.Older patients demonstrated increased frequencies of terminally differentiated T cells as well as NKT cells. Increased frequency of terminally differentiated and immune senescent T cells were associated with worse clinical outcome as measured by MELD-XI and SOFA scores, and with progression to infection and death.In conclusion, our data suggest that T cell dysfunction, independently from age, is associated with poor outcomes after MCSD implantation, providing a potential immunologic mechanism behind patient vulnerability to multiorgan dysfunction and death. This noninvasive approach to PBMC evaluation holds promise for candidate evaluation and patient monitoring.     

Burnout and its correlates among nursing staff: questionnaire survey

AIM: This paper is a report of a study to determine the burnout level and its correlates in nurses. BACKGROUND: Healthcare providers and especially nurses are generally considered a high risk group regarding work stress and burnout and this syndrome has been a major concern in the field of occupational health. METHOD: The study was carried out at a university hospital in Turkey during May-June 2005. A total of 418 nurses from the 474 working at the hospital at the time (88.2%) answered a self-administered questionnaire including the Maslach Burnout Inventory. FINDINGS: All the nurses were female, with a mean age of 30.6 (5.4) and a median age of 29 years. The mean score was 17.99(6.35) for the Emotional Exhaustion subscale, 5.72 (3.87) for the Depersonalization subscale and 19.83 (4.66) for the Personal Accomplishment subscale. Emotional Exhaustion decreased with increasing age (P < 0.05). Total time in the job, weekly working hours, shift-working and the unit where employed influenced burnout scores (P < 0.05). Not being happy with relations with superiors, not finding the job suitable, feeling anxious about the future, perceived poor health, problems with personal life and financial difficulties were also factors influencing burnout scale scores (P < 0.05). CONCLUSION: It is necessary to consider nurses having the characteristics shown as the correlates of burnout in this study as a target group, to screen periodically the burnout status and improve their working conditions, especially relationships with colleagues.