Lichen sclerosus et atrophicus in a surgical scar treated with fractional laser

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory disease of unknown cause that typically affects the genital area (1). It has been reported in post-traumatic areas as a result of Koebner phenomenon. LSA responds poorly to treatment making it a therapeutic challenge (2). Laser therapy has been described for LSA with variable results (3,4).     

Surgical results in subaortic stenosis

Since 1965, 46 patients aged 4 to 42 years, underwent cardiac surgery for subaortic stenosis. Resection of the subvalvar obstruction without myomectomy was performed in all cases. Three patients died during the operation, another one after 6 months due to infective endocarditis and one more suddenly 11 years after treatment. One patient was lost to follow-up but 41 were available after at least 1 year of follow-up. Before surgery, 21 cases were in NYHA class I, 17 in class II and 8 in class III. One year after surgery 36 were in class I, 4 in class II and only one in class III. Actuarial survival rate was 91% from 1 to 12 years and 79% from 13 to 18 years. Event-free survival was 45% up to 18 years. The mean preoperative peak systolic gradient was 93.15 +/- 35.57 mm Hg. The first postoperative peak systolic gradient was 21.61 +/- 17.91 mm Hg (P = 0.001). Cases with adverse postoperative events such as aortic regurgitation (13 cases), restenosis (13 cases), death (2 cases) and infective endocarditis (2 cases) had a mean peak systolic gradient of 55.78 +/- 35.97 mm Hg, while in the event-free patients the gradient was 14.61 +/- 13.34 mm Hg (P = 0.001). Recurrent obstruction was observed in seven patients and an increase in the residual gradient in six. The initial mean postoperative peak systolic gradient in these patients had been 18.23 +/- 17.32 mm Hg and the second postoperative cardiac catheterisation showed a mean gradient of 59.23 +/- 37.78 mm Hg (P = 0.001). We conclude that long-term follow-up following removal of subaortic stenosis is mandatory in order to detect and treat adverse events.     

Predictors of atopy in HIV-infected patients.

BACKGROUND: Some studies have reported an increase of atopy in HIV-infected (HIV+) patients, but the cause still remains unclear. OBJECTIVE: To determine the prevalence of atopy in HIV+ patients and to investigate its predictors. METHODS: Seventy-four HIV+ hospitalized patients (46 of them with AIDS) were studied prospectively for the presence of atopy, based on immediate hypersensitivity to common allergens by prick test. Serum immunoglobulins, specific IgE, lymphocyte subsets, and the expression of low affinity IgE receptor (CD23) on B cells were determined. RESULTS: Thirty-one percent of patients presented IgE values greater than 150 ku/L (39% of patients without AIDS and 26% of AIDS patients; P = .23) and 47% showed an increase (> or = 2%) in the percentage of CD23+ B cells. Non-AIDS patients had higher IgE values than AIDS patients (346 +/- 605 versus 175 +/- 276; P = .16). Atopy prevalence was higher in non-AIDS than in AIDS patients (28% versus 11%; P = .06). Specific IgE agreed with positive prick test in 58% of cases. Multivariate analysis showed that a personal history suggestive of allergic disease and IgE > 150 ku/L were predictors of atopy, while gender, risk group, CD4+ T cells, CD23 expression on B cells, and AIDS were not associated. CONCLUSIONS: HIV+ patients present a higher prevalence of atopy in early stages of HIV infection than general population. Since allergic reactions could accelerate HIV-infection by increasing type 2 cytokines, it is important to evaluate the atopic state in HIV+ patients with IgE > 150 ku/L or with suggestive allergic history in order to prevent it.     

Human Infection with Hymenolepis diminuta: Case Report from Spain

We report a case of Hymenolepis diminuta infection in a human. The patient was a 5-year-old girl referred to us through the onset of a cyanotic attack. Treatment with a single dose (10 mg/kg of body weight) of praziquantel was ineffective, but the parasite was eradicated after three treatment cycles with the same drug at dosages of 25 mg/kg/day for 5 days.     

Persistence of Zika virus in semen 93 days after the onset of symptoms

Introduction

Zika virus is mainly transmitted through the bites of infected Aedes mosquitoes, although mother-to-child and sexual transmission have also been described. The presence of Zika virus in semen after infection seems to be not uncommon, but the duration of viral persistence has not been well-determined.

Time to Positivity and Detection of Growth in Anaerobic Blood Culture Vials Predict the Presence of Candida glabrata in Candidemia: a Two-Center European Cohort Study

This study shows the accuracy of exclusive or earlier growth in anaerobic vials to predict Candida glabrata in a large series of candidemic patients from two European hospitals using the Bactec 9240 system. Alternatively, C. glabrata can be predicted by a time to positivity cutoff value, which should be determined for each setting.     

Deletion of the cannabinoid CB1 receptor impacts on the ultrastructure of the cerebellar parallel fiber-Purkinje cell synapses

The cannabinoid CB₁ receptor localizes to the glutamatergic parallel fiber (PF) terminals of the cerebellar granule cells and participates in synaptic plasticity, motor control and learning that are impaired in CB₁ receptor knockout (CB ₁-KO) mice. However, whether ultrastructural changes at the PF-Purkinje cell (PC) synapses occur in CB ₁-KO remains unknown. We studied this in the vermis of the spinocerebellar lobule V and the vestibulocerebellar lobule X of CB ₁-KO and wild-type (CB ₁-WT) mice by electron microscopy. Lobule V, but not lobule X, of CB ₁-KO had significantly less and longer synapses than in CB ₁-WT. PF terminals were significantly larger in both lobules of CB ₁-KO with no changes in PC dendritic spines. The PF terminals in lobule V of CB ₁-KO contained less synaptic vesicles and lower vesicle density; by contrast, vesicle density in lobule X of CB ₁-KO remained unchangeable relative to CB ₁-WT. There were as many vesicles in lobule V of CB ₁-KO as in CB ₁-WT, but their distribution decreased drastically at 300 nm of the active zone. In lobule X of CB ₁-KO, less vesicles were found within 150 nm from the presynaptic membrane; however, no vesicles were at 450–600 nm of the active zone. A significant higher amount of synaptic vesicles close to the active zone in lobule V and X of CB ₁-KO was observed. In conclusion, the absence of CB₁ receptors strikingly and distinctively impacts on the ultrastructural architecture of the PF-PC synapses located in cerebellar lobules that differ in vulnerability to damage and motor functions.