Ochronotic arthropathy as a paradigm of metabolically induced degenerative joint disease. A case-based review

Clinical Rheumatology - Alkaptonuria is a rare, hereditary metabolic disorder in which a deficiency in the homogentisate 1,2-dioxygenase enzyme results in an accumulation of homogentisic acid....     

Paucisymptomatic infectious prostatitis as a cause of fever without an apparent origin. A series of 19 patients

According to the literature, prostatitis is a rare cause of prolonged fever without an apparent origin. However, this syndrome can be easily diagnosed using specific tests, either two-glass pre- and post-prostatic massage or the Meares–Stamey four-glass test. A retrospective study over a 5-year period (between August 1st 2006 and July 31st 2011) was performed. All patients who met the criteria for microbiological prostatitis were included and assigned to one of two groups, either a study group [paucisymptomatic infectious prostatitis (PIP)] or a control group [classic infectious prostatitis (CIP)]. Epidemiological, clinical, microbiological, and treatment-related variables were collected. A comparative study between both groups was performed. Thirty-nine patients were diagnosed with prostatitis. The main risk factors were unprotected anal intercourse, human immunodeficiency virus (HIV) infection, recent travel, and recurrent urinary tract infections. The most significant differences between the PIP (19 patients) and CIP (20 patients) groups were higher frequency of elevated inflammatory markers, higher frequency of monomicrobial etiology, and longer treatment. In monomicrobial prostatitis, the most common causative agents were coagulase-negative Staphylococcus spp., Escherichia coli, and Corynebacterium glucuronolyticum. According to the findings of this study, we believe that prostatitis should be included as a possible diagnosis in a man who complains of prolonged fever without an apparent origin and having at least one of the following risk factors: unprotected anal intercourse, HIV infection, recent travel, and recurrent urinary tract infections.     

In vivo albendazole treatment of Taenia crassiceps cysticerci strain WFU: proliferation, damage, and recovery

Taenia crassiceps has been widely experimented as a model for in vitro and in vivo studies on drug responses. The purpose of this study was to treat BALB/c mice infected with T. crassiceps strain WFU with commercially available albendazole and to analyze the reduction in parasite infrapopulations. Here, we describe the reduction and apparent damage of T. crassicceps WFU cysticerci in infected mice after antihelminthic drug treatment and subsequent inoculation of those treated parasites into a naïve host. We were able to reduce significantly the parasite counts to 33 and 48 % after albendazole treatment for 20 or 25 days and compared with the untreated mice. We also observed morphological damage such as the partial blebbing in the tegument and parenchyma of treated parasites, as well as disorganized musculature and the loss of cell membranes in subtegumental tissue section. However, larvae from albendazole-treated mice inoculated into the next host were able to become re-established in the next murine host due, probably, to the survival of proliferative parasite cells.     

Refractory ascites in systemic lupus erythematosus: further biological support of intraperitoneal steroid treatment as a suitable therapeutical option

Clinical Rheumatology - The objective of this report was to evaluate the ascitic fluid of a patient with refractory lupus ascites (proband) at different time points—pre- and...     

The Role of Alpha Tocopheryl Succinate (α-TOS) as a Potential Anticancer Agent

In recent years, efforts to improve cancer therapy have focused on developing new anticancer agents, such as mitocans. These agents include vitamin E analogues and suppress cancer by inducing apoptosis by targeting mitochondria. Alpha tocopheryl succinate (α-TOS) is the most effective form of vitamin E analogues causing inhibition of proliferation and apoptosis of cancer cells. Both in vitro and in vivo studies have demonstrated that α-TOS selectively kills tumor cells with little or no effect on normal cells. Treatment with α-TOS shows great promise for future clinical applications, as it causes cell death, at least in part, by selectively inducing apoptosis by mitochondrial destabilization. This review presents an overview of perspectives on α-TOS and the potential uses of α-TOS in cancer treatment and other clinical applications.     

Factors that positively or negatively mediate the effects of age on working memory across the adult life span

Working memory abilities significantly decrease with advancing age; hence, the search for factors that may increase or mitigate this decline is critical. Several factors have been identified that influence working memory; however, their effects have been mainly assessed separately and rarely together with other factors in the same sample. We examined 120 variables to search for factors that jointly act as mediators of working memory decay across the adult life span. A sample of 1652 healthy adults was assessed in spatial and verbal working memory domains. Structural equation modeling analyses were conducted to search for potential mediators that intervened between age and working memory. Only 14 and 10 variables reliably mediated spatial and verbal working memory, respectively. Factors from several domains remained in the models, such as individual characteristics, physiological traits, consumption habits, and regular activities. These factors are sufficiently powerful to influence working memory decline when they jointly interact, as in everyday living.     

Profound CD4+ T lymphocytopenia in human immunodeficiency virus negative individuals,improved with anti-human herpes virus treatment

Lymphocytopenia and CD4+ T lymphocytopenia can be associated with many bacterial, fungal, parasite and viral infections. They can also be found in autoimmune and neoplastic diseases, common variable immunodeficiency syndrome, physical, psychological and traumatic stress, malnutrition and immunosuppressive therapy. Besides, they can also be brought into relation, without a known cause, with idiopathic CD4+ T lymphocytopenia. Among viral infections, the Retrovirus, specially the human immunodeficiency virus, is the most frequently cause. However, many acute viral infections, including cytomegalovirus and Epstein Barr virus can be associated with transient lymphocytopenia and CD4+ T lymphocytopenia. As is well known, transient lymphocytopenia and CD4+ T lymphocytopenia are temporary and overcome when the disease improves. Nonetheless, severe CD4+ T Lymphocytopenia associated with chronic infections by human herpes virus has not been reported. We describe 6 cases of human immunodeficiency virus negative patients, with chronic cytomegalovirus and Epstein Barr virus infections and profound lymphocytopenia with clinical symptoms of cellular immunodeficiency. These patients improved rapidly with ganciclovir or valganciclovir treatment. We claim here that it is important to consider the chronic human herpes virus infection in the differential diagnosis of profoundly CD4+ T lymphocytopenia etiology, when human immunodeficiency virus is absent, in order to start effective treatment and to determine, in future studies, the impact of chronic human herpes virus infection in human beings'' health.     

What do TSECs provide in the menopausal hormone therapy?

Tissue-selective estrogen complex (TSEC) is projected as a progestogen-free option for the treatment of estrogen deficiency symptoms in postmenopausal, non-hysterectomized women. TSEC combines the benefits of estrogen with a selective estrogen receptor modulator (SERM), in this case bazedoxifene acetate (BZA), which has an antagonistic effect on the endometrium, thus avoiding the use of progestins. The authorized TSEC combination (conjugated estrogens [CE] 0.45?mg/BZA 20?mg) for the alleviation of vasomotor symptoms has been demonstrated in randomized clinical trials compared with placebo or menopausal hormone therapy (MHT). In addition, TSEC has shown improvements in quality of life and vaginal atrophy. In respect to MHT using progestins, the benefits of TSEC are found mainly in the bleeding pattern, amenorrhea rate, and reduction in mammary repercussion (i.e., breast tenderness and radiological density). The objective of this guide will be to analyze the efficacy and safety of TSEC consisting of CE/BZA in postmenopausal women.     

Cost‐utility analysis of idelalisib in combination with rituximab in relapsed or refractory chronic lymphocytic leukaemia

Objective

To evaluate the incremental cost‐utility ratio (ICUR) of idelalisib in combination with rituximab (IR) versus rituximab monotherapy (R) in the treatment of patients with relapsed or refractory (R/R) chronic lymphocytic leukaemia (CLL), from the Spanish National Health System (NHS) perspective.

Methods

A partitioned survival Markov model for a lifetime horizon (30 years) was developed to estimate costs (€, 2016) and quality‐adjusted life years (QALY) with IR and R. Initial cohort included patients with CLL receiving a second or subsequent line (2L) of treatment with IR or R. Survival data were based on CLL clinical trial. Drug, administration, monitoring, adverse events and clinical management of CLL costs were included in the model. Costs and outcomes were discounted using a 3% annually. Deterministic and probabilistic sensitivity analyses (PSA) were performed.

Results

Compared to R, 2L IR treatment resulted in QALY gain of 3.147 (4.965 versus 1.818). Total costs were €118 254 for IR versus €23 874 for R. ICUR was €29 990/QALY gained with IR versus R. In the PSA, IR was cost‐effective in 78% of iterations using a threshold of €45 000/QALY.

Conclusion

IR can be considered a cost‐effective treatment compared to R, in the treatment of R/R CLL patients for the Spanish NHS.