Late diagnosis of extra-pulmonary tuberculosis leads to irreversible kidney failure in a non-immunocompromised patient

We report a case of extra pulmonary tuberculosis with multiple localizations including bone and kidney in a 21-year-old Pakistani immigrant living in Belgium. Late diagnosis of tuberculosis may lead to end stage renal disease and dialysis. Countries with low prevalence of tuberculosis should be vigilant towards high risk groups for tuberculosis because this preventable and curable disease may lead to devastating complications when diagnosed late.     

Validity and reliability of the Western Ontario Rotator Cuff Index (WORC) for use in Brazil.

OBJECTIVE: To evaluate the validity and reliability of the Brazilian Portuguese version of the Western Ontario Rotator Cuff Index (WORC). DESIGN AND SETTING: A cross-sectional survey at the Physiotherapy Unit and Outpatient Orthopedic and Traumatology Clinic, Universidade Federal de S?o Paulo. METHODS: To test validity, 100 patients with rotator cuff disorders were evaluated using the WORC, clinically relevant outcomes for patients with shoulder disorders (pain, range of motion, and strength), and the Disabilities of Arm, Shoulder, and Hand (DASH), University of California Los Angeles Shoulder Rating Scale (UCLA), and Short Form-36 (SF-36) self-report measures. The WORC was repeated on 50 patients on the same day (more than 1 hour later) and after a mean interval of 7 days to evaluate the test-retest reliability. Concurrent validity was tested by correlating the WORC to the other outcome measures using Pearson's correlation coefficient. Test-retest reliability and internal consistency were determined by the intraclass correlation coefficient and Cronbach's alpha coefficient, respectively. The scores were used to assess the standard error measurement (SEM) and minimal detectable change (MDC). RESULTS: Analysis between the WORC and clinically relevant outcomes for patients with shoulder disorders revealed weak to strong correlations; the weakest for active internal rotation (r = -0.22) and the strongest for pain during movement (r = -0.75). Strong correlations were found among the WORC and the DASH and UCLA (r = -0.86 and r = 0.80, respectively). There were moderate correlations between the WORC and SF-36 domains (0.37 to 0.69); the best correlations related to the physical domains. Reliability analysis revealed excellent results, with the intraclass correlation coefficient ranging from 0.95 to 0.99 and Cronbach's alpha ranging from 0.88 to 0.97. The SEM was 5.2 and 3.0 for time 0 and after a mean interval of 7 days, respectively. The MDC was 7.1 over this mean time interval (90% confidence interval). CONCLUSIONS: The Brazilian version of the WORC proved to be a valid and reliable measurement tool for assessing health-related quality of life in patients with rotator cuff diseases.     

Immunoexpression of hMSH2 and hMLH1 in oral squamous cell carcinoma and its relationship to histological grades of malignancy

Background: The aim of this study was to describe the human mutS homolog 2 (hMSH2) and human mutL homolog 1 (hMLH1) immunoexpression in different areas of oral squamous cell carcinoma (OSCC) – central/superficial (C/S) and invasive tumor front (ITF) – in an attempt to verify if the histological grade of malignancy interferes in this expression. Methods: Forty‐six samples of OSCC were analyzed histologically. Twenty‐six cases (56.5%) presented ITF. Histological grades of malignancy were evaluated in all samples, and immunohistochemistry was applied using specific antibodies against hMSH2 and hMLH1 proteins. Immunoexpression was semiquantitatively scored, and results were correlated with their histological grades of malignancy. Results: The hMSH2 immunoexpression in both C/S and ITF was not correlated with histological grades of malignancy, whereas hMLH1 overexpression was correlated (P = 0.043) and associated (P = 0.041) with well‐differentiated tumors. In addition, hMHL1 reduction or negative expression was detected in poorly differentiated tumors. Moreover, negative expression for hMSH2 and hMLH1 proteins was demonstrated in some cases of OSCC. Conclusions: The findings of the present study indicate that the histological grade of malignancy interferes in hMLH1 immunoexpression. The negativity for both hMSH2 and hMLH1 proteins in some cases suggests a possible association between OSCC and hereditary non‐polyposis colorectal cancer. Further investigation from future studies is needed to elucidate this supposition.     

Wegener's Granuloma. A Series of 265 British Cases Seen Between 1975 and 1985. A Report by a Sub-committee of the British Thoracic Society Research Committee

In order to describe the British experience of Wegener's granuiomatosisHospital Activity Analysis was used to collect cases diagnosedin England, Wales and Scotland between 1975 and 1985. Wherepossible clinical details, histological material and chest radiographswere obtained. Two hundred and sixty five patients were consideredto have Wegener's granuiomatosis. In 109 a single pathologistconfirmed the diagnosis by finding both granulomas and vasculitisin biopsy material. The diagnosis was made on clinical groundsor clinical grounds together with histological diagnosis inthe local hospital in 156 patients. Wegener's granuiomatosiswas confined to the lung or upper respiratory tract in 22 percent of patients and renal disease occurred in 58 per cent.Laboratory tests showed a pattern of mild anaemia, polymorphleucocytosis, eosinophilia and an elevated ESR and hypergammaglobulinaemia,with no specific pattern of changes. Histological confirmation was most frequently obtained by examinationof nasal biopsy specimens, but multiple biopsies were oftenrequired. Renal biopsies showed focal proliferative glomerulonephritisbut granulomatous glomerulonephritis was uncommon. Of availablechest radiographs 61 per cent were abnormal, large opacitiesbeing most common. Small irregular opacities were found lessoften and other abnormalities were uncommon. Treatment varied widely and 10 per cent of patients receivedno drug therapy. This large series illustrates that even withoutspecific treatment, patients with Wegener's granuiomatosis cansurvive for several years and with modern treatment survivalfor more than a decade is possible. Conclusions about the effectivenessof the various therapies cannot be drawn from this restrospectivestudy. Renal failure and disseminated vasculities were the commonestcauses of death; death was considered to result from complicationsof treatment with cytotoxic drugs or prednisolone in 6 per centof patients.     

Meanings and factors that influence nursing research at the Walter Cantídio University Hospital

This study analyzed the meanings and factors that may interfere in Nursing research in the point of view of assistant nurses working in a public University Hospital in the city of Fortaleza, State of Ceará. A quantitative-qualitative survey was carried out with 22 nurses between March 4 and April 30, 2005. The findings pointed out that nurses value the importance of research for enriching their profession. However, although research produces knowledge and solves problems that occur in their daily activities, it demands heavy investment from professionals who are overburdened with work in an environment lacking human, physical and material conditions and often have inadequate academic formation, which points out to the need for improving research skills in Nursing courses. In conclusion, nurses consider research rewarding professionally and for self-development, but it depends exclusively on the individuals' effort and thus become a painstaking, unmotivating activity that requires an organizational policy to be enhanced.     

Characterization and biocompatibility of a fibrous glassy scaffold

Bioactive glasses (BGs) are known for their ability to bond to living bone and cartilage. In general, they are readily available in powder and monolithic forms, which are not ideal for the optimal filling of bone defects with irregular shapes. In this context, the development of BG‐based scaffolds containing flexible fibres is a relevant approach to improve the performance of BGs. This study is aimed at characterizing a new, highly porous, fibrous glassy scaffold and evaluating its in vitro and in vivo biocompatibility. The developed scaffolds were characterized in terms of porosity, mineralization and morphological features. Additionally, fibroblast and osteoblast cells were seeded in contact with extracts of the scaffolds to assess cell proliferation and genotoxicity after 24, 72 and 144 h. Finally, scaffolds were placed subcutaneously in rats for 15, 30 and 60 days. The scaffolds presented interconnected porous structures, and the precursor bioglass could mineralize a hydroxyapatite (HCA) layer in simulated body fluid (SBF) after only 12 h. The biomaterial elicited increased fibroblast and osteoblast cell proliferation, and no DNA damage was observed. The in vivo experiment showed degradation of the biomaterial over time, with soft tissue ingrowth into the degraded area and the presence of multinucleated giant cells around the implant. At day 60, the scaffolds were almost completely degraded and an organized granulation tissue filled the area. The results highlight the potential of this fibrous, glassy material for bone regeneration, due to its bioactive properties, non‐cytotoxicity and biocompatibility. Future investigations should focus on translating these findings to orthotopic applications. Copyright © 2015 John Wiley & Sons, Ltd.