Oligoclonal banding detected by urinary protein electrophoresis and immunofixation in two patients with the acquired immune deficiency syndrome and proteinuria

Monoclonal and oligoclonal banding has been observed in electrophoretograms of serum, cerebrospinal fluid, and urinary protein from patients infected with the human immunodeficiency virus (HIV). This is the first report of kappa oligoclonal banding in the protein electrophoretograms for urine but not for serum of two patients with the acquired immune deficiency syndrome (AIDS). Both patients had proteinuria, but only one had the nephrotic syndrome and renal failure. Serum oligoclonal banding in HIV-infected patients occurs much more frequently than in age-matched controls and may be detected before AIDS or lymphadenopathy syndrome evolves. The use of oligoclonal banding as a marker for HIV infection is currently under investigation. Urine as well as serum samples should be included in this research.     

Intravenous Immunoglobulins as a new opportunity to treat discoid lupus erythematosus: A case report and review of the literature

Discoid lupus erythematosus (DLE) is a chronic dermatological disease that can lead to scarring, alopecia and dyspigmentation, if not properly treated. Actually, no drugs are specifically approved for the treatment of CLE, although the first-line therapy usually consists of photoprotection associated to topical or oral steroids, topical calcineurin inhibitors and hydroxychloroquine (HCQ). In cases of DLE refractory to these medications, many other agents have been employed, such as dapsone, methotrexate, azathioprine, cyclophosphamide, biologic drugs and Intravenous Immunoglobulin (IVIG).We described the case of a DLE patient resistant to combination therapy with steroid and HCQ who was successfully treated with cyclical IVIG therapy. The treatment with IVIG resulted rapidly effective with persistent efficacy and low rates of relapses, although more cycles of IVIG are needed to achieve a stable clinical remission.We also discussed the beneficial and promising effects of IVIG in patients with Cutaneous Lupus reporting the previously published data.     

Manutenção da anestesia inalatória com a máscara facial Janus para substituição de válvula aórtica transcateter: uma série de casos

Background and objectives

Aortic stenosis is the most common type of heart valve disease. Percutaneous aortic valve replacement has become the alternative for patients considered at high risk for surgery. Controlled mechanical ventilation with tracheal intubation has been the choice for this type of procedure, however the use of noninvasive ventilation in cardiac patients has shown to be beneficial. Janus is a novel full‐face mask that allows application of noninvasive ventilation support during anesthesia. Our main objective was to evaluate the feasibility of transcatheter aortic valve replacement with prolonged transesophageal echocardiographic monitoring under deep inhalational sedation delivered through a new mask for noninvasive ventilation.

Avaliação do programa de aprimoramento em anestesia cardiovascular por seus ex‐estagiários

Background

After advancement of cardiovascular surgery, there is also exponential development of anesthetic techniques in this field. Patients with increasing clinical complexity challenge cardiac anesthesiologists to keep constantly updated. An evaluation of Brazilian's cardiovascular anesthesia fellowship at Dante Pazzanese Institute of Cardiology has been made and information has been collected to evaluate the fellowship program in cardiovascular anesthesia.

Chronic maternal morphine alters calbindin D‐28k expression pattern in postnatal mouse brain

The distribution pattern of calbindin (CB)‐D28k‐expressing neurons results to be altered in several brain regions of chronic morphine exposed adult mice. In this study, the influence of chronic maternal exposure to morphine on the distribution pattern of CB‐D28k‐expressing neurons in the brain of mouse offspring was investigated. Females of CD‐1 mice were daily administered with saline or morphine for 7 days before mating, during the whole gestation period, and until 21 day post‐partum. Their offspring were sacrificed on postnatal day 18, and the brains were examined by histology using cresyl violet and by immunohistochemistry using a rabbit polyclonal anti‐CB‐D28k antibody. Histology revealed no significant differences in the distribution pattern and the number of neurons between the offspring forebrain of the control group of mice and the two groups of mice treated with different doses of morphine. However, immunohistochemical analysis revealed that the number of CB‐D28k‐immunoreactive neurons remarkably decreased in the cingulate cortex, in the layers II–IV of the parietal cortex and in all regions of the hippocampus, while it increased in the layers V–VI of the parietal cortex and in the subicular region of the offspring brain of morphine treated mice. Overall, our findings demonstrate that maternal exposure to morphine alters the pattern of CB‐D28k‐expressing neuron pattern in specific regions of murine developing brain, in a layer‐ and dose‐dependent way, thus suggesting that these alterations might represent a mechanism by which morphine modifies the functional aspects of developing brain. Synapse 70:15–23, 2016. © 2015 Wiley Periodicals, Inc.     

Low-level laser therapy improves the VO<Subscript>2</Subscript> kinetics in competitive cyclists

Some evidence supports that low-level laser therapy (LLLT) reduces neuromuscular fatigue, so incrementing sports performance. A previous randomized controlled trial of our group showed increased exercise tolerance in male competitive cyclists treated with three different LLLT doses (3, 6, and 9 J/diode; or 135, 270, and 405 J/thigh) before time-to-exhaustion cycling tests. Now, the present study was designed to evaluate the effects of these LLLT doses on the VO₂ kinetics of athletes during cycling tests. Twenty male competitive cyclists (29 years) participated in a crossover, randomized, double-blind, and placebo-controlled trial. On the first day, the participants performed an incremental cycling test to exhaustion to determine maximal oxygen uptake (VO_2MAX) and maximal power output (PO_MAX), as well as a familiarization with the time-to-exhaustion test. In the following days (2 to 5), all participants performed time-to-exhaustion tests at PO_MAX. Before the exhaustion test, different doses of LLLT (3, 6, and 9 J/diode; or 135, 270, and 405 J/thigh, respectively) or placebo were applied bilaterally to the quadriceps muscle. All exhaustion tests were monitored online by an open-circuit spirometry system in order to analyze the VO₂ amplitude, VO₂ delay time, time constant (tau), and O₂ deficit. Tau and O₂ deficit were decreased with LLLT applications compared to the placebo condition (p < 0.05). No differences (p > 0.05) were found between the experimental conditions for VO₂ amplitude and VO₂ delay time. In conclusion, LLLT decreases tau and O₂ deficit during time-to-exhaustion tests in competitive cyclists, and these changes in VO₂ kinetics response can be one of the possible mechanisms to explain the ergogenic effect induced by LLLT.