The efficacy of antivenom in loxoscelism treatment.

Loxoscelism or brown spider envenomation is the most important form of araneism in some countries and constitutes the third cause of accidents by venomous animals in Brazil. The treatment of Loxosceles bites is still controversial, with a variety of interventions proposed and tried, such as antivenom. The majority of clinical studies demonstrate a significant delay between a spider's bite and presentation for treatment, and this delay is thought to lead to an ineffective administration of a specific antivenom. Even in Brazil, where the antivenom therapy has been indicated more frequently than in other countries, there are still doubts about its real capacity to neutralize local and systemic effects of the envenomation and the ideal period for its administration. Thus, various studies in animal models have tried to correlate the time of envenomation with the application of the antivenom and the permanence of the venom in circulation or in dermonecrotic lesions. The purpose of this study was to evaluate the use of antivenom in loxoscelism treatment and to systematize the results of studies in animals and humans available in the last 30 years, making possible a more critical analysis of the efficacy of the antivenom or its therapeutic value in bites by spiders of the genus Loxosceles.     

Cortical bone mineral density in the mandible and osteoporosis status in postmenopausal women

Mineral density of the cortical bone of the mandible was determined by single-energy QCT (quantitative computed tomography) for 77 menopausal women. Bone mineral densities (BMD) were measured in the buccal and lingual layers of the cortex, distally from the foramen mentale, on both sides of the mandible. All the women were edentulous in that region, and the alveolar processes were far resorbed. These results were compared with the BMD values of the femoral neck, lumbar spine, and trabecular portion of the mandible between the detected layers of cortex. The BMD of the buccal cortex correlated remarkably well with all values, except those of the trabecular portion. Of the women tested, the correlations were lowest in the least osteoporotic group. The values for the lingual cortex did not correlate with other variables as well as did those for the buccal cortex, but in the most osteoporotic part of the sample the lingual cortex values correlated significantly with the BMD of the trabecular portion. The BMD values for the buccal cortex were significantly higher than those for the lingual cortex.     

Acute exposure to alcohol during early postnatal life causes a deficit in the total number of cerebellar Purkinje cells in the rat

Alcohol taken regularly over a lengthy period of time has been claimed to cause to loss of neurons in both the adult and developing brain. However, it remains uncertain whether acute, as opposed to chronic, exposure to alcohol at specified periods can also cause disruption in the neuronal population of the developing brain. This question was investigated by exposing Wistar rat pups to 7.5 g/kg body weight of ethanol administered as a 10% solution via an intragastric cannula over an 8 hour period either on the 5th (PND5) or the 10th (PND10) postnatal day of age. Gastrostomy controls received a 5% sucrose solution substituted isocalorically for the ethanol. Another set of pups raised by their mothers was used as “suckle controls”. All surgical procedures were carried out under halothane vapour anaesthesia. After the artificial feeding regimes, all pups were returned to the lactating dams and weaned at 21 days of age. Between 52 and 54 days of age, the rats were anaesthetised with an intraperitoneal injection with Nembutal and killed by intracardiac perfusion with 3% glutaraldehyde in 0.1 M phosphate buffer. The relatively unbiased stereological procedure known as the “fractionator” method was used to estimate the total number of Purkinje cells in the cerebellum of each animal. The Purkinje cell nucleolus was used as the counting unit; it was assumed that each Purkinje cell contained only one nucleolus. PND10 ethanol-treated rats and gastrostomy and suckle controls had between about 210,000-232,000 Purkinje cells in the cerebellum. However, the PND5 ethanol-treated rats had only about 137,000 Purkinje cells. Two-way analysis of variance procedures revealed significant main effects of age at time of alcohol exposure and groups as well as a significant interaction between them. It is concluded that the Purkinje cell population numbers can be disrupted by acute exposure to alcohol on the 5th, but not the 10th, postnatal day of age. © 1995 Wiley-Liss, Inc.     

Elevated levels of the complement regulator protein CD59 in severe acute pancreatitis

Objective. Complement activation occurs in patients with acute pancreatitis (AP) and may contribute to the development of organ failure. Because a number of enzymes are released during AP that could influence the complement inhibitor CD59, the purpose of this study was to examine serum levels of CD59 in relation to severity of AP. Material and methods. Twelve patients with severe AP had organ failure (referred to as the grade 2 group). For each of them, we found 2–3 age-matched AP patients who served as controls (n=27). Of these, a total of 13 had mild AP (grade 0 group) and 14 severe AP without organ failure (grade 1 group). Blood samples were collected at admission and on days 1 and 3–7 post-admission. Grade 2 patients were compared with grade 0 and grade 1 patients. CD59 levels were measured by a sandwich enzyme immunoassay. Results. At admission, median CD59 levels were significantly higher (p=0.002) in grade 2 patients (median 104.2 ng/ml, range 26.1–186.3) than in grade 0 patients (37.3, range 30.3–75.9) and grade 1 patients (38.6, range 19.9–96.1). CD59 levels remained higher in grade 2 patients than in grade 0 and 1 patients on day 1 (p=0.001) and days 3–7 (p=0.002). The CD59 levels correlated significantly (p<0.05) with C-reactive protein (CRP) levels (R=0.40) and APACHE II scores (R=0.32) on admission. Conclusions. Organ failure and severity of AP are associated with elevated serum levels of CD59.     

Parental views on participation in their child's pain relief measures and recommendations to health care providers

The purpose of this study was to describe parental views on the factors influencing participation in their 8- to 12-year-old hospitalized child's surgical pain relief measures, and the recommendations to health care providers concerning alleviation of their child's pain. The data were collected by a questionnaire completed by parents (N = 192) whose child was hospitalized in one of the pediatric surgical wards in the five university hospitals of Finland. Results revealed that most of the parents (98%) agreed to having adequate opportunities to participate in their child's care according to their personal preferences; however, only 23% of the parents totally agreed that they had a clearly defined role in their child's pain relief measures. Feelings such as concern, fear, helplessness, anxiety, and depression were commonly experienced by the parents during their child's hospitalization. Most of the parents' recommendations concerned the topic of providing information. The findings of this study have implications for nursing practice.     

ECT response after relapse during continuation repetitive transcranial magnetic stimulation. A case report.

Research on repetitive transcranial magnetic stimulation (rTMS) indicates that the treatment of non-psychotic depression is comparable to electroconvulsive therapy (ECT) in terms of short-term outcome. We report on a woman who exerted a recurrent moderate major depressive episode, 6 months after discontinuation of maintenance ECT. She responded to acute rTMS treatment which was followed by the rTMS maintenance-protocol. Within 2 months of continuation rTMS she relapsed suffering from a severe non psychotic depressive episode and had to be switched to a successful ECT. In this patient rTMS had a good clinical impact as an acute treatment strategy, but failed to prevent relapse as the continuation ECT previously did in the same patient.     

Clinical characteristics of monkeypox virus infections among men with and without HIV: A large outbreak cohort in Germany

Background

Since May 2022, increasing numbers of monkeypox virus (MPXV) infections have been reported from across Europe and North America. Studies, mainly from Africa, have suggested a higher risk for severe MPXV cases in people living with HIV.

Methods

This was a retrospective study of all confirmed MPXV infections observed in the participating centres since 19 May 2022. We conducted a chart review to evaluate clinical characteristics, comorbidities, and coinfections, including HIV, viral hepatitis, and sexually transmitted infections (STIs).

Results

By 30 June 2022, a total of 546 MPXV infections were reported from 42 German centres. All patients were men who have sex with men (MSM), of whom 256 (46.9%) were living with HIV, mostly with a preserved immune system and with viral suppression. In total, 232 (42.5%) MSM were also taking HIV pre-exposure prophylaxis (PrEP) and 58 (10.6%) MSM had no known HIV infection or PrEP use. The median age was 39 years (range 20–67), and comorbidities were rare. However, 52.4% and 29.4% of all patients had been diagnosed with at least one STI within the last 6 months or within the last 4 weeks, respectively. The most frequent localizations of MPXV infection were genital (49.9%) and anal (47.9%), whereas fever (53.2%) and lymphadenopathy (42.6%) were the most frequent general symptoms. The hospitalization rate was low (4.0%), and no fatal course was observed. The clinical picture showed no apparent differences between MSM with or without HIV.

Conclusions

In this preliminary cohort analysis from a current large outbreak among MSM in Germany, the clinical picture of MPXV infection did not differ between MSM with and without HIV infection. Severe courses were rare and hospitalization rates were low. However, most patients were relatively healthy, and only a few people living with HIV were viremic or severely immunosuppressed.