Experimentally induced acute sinusitis and efficacy of vitamin A

CONCLUSIONS: Although antibiotics are the mainstays for treatment of sinusitis, they do not specifically treat tissue damage due to free radicals. We propose that antioxidant, anti-infective, immunomodulator vitamin A may be a useful addition in the management of sinusitis. OBJECTIVES: Acute sinusitis is one of the most common diseases in humans. Vitamin A is a fat-soluble vitamin and essential for immunity, cellular differentiation, and maintenance of respiratory and gastrointestinal epithelial surfaces, growth, reproduction, and vision. The objective of this study was to investigate the therapeutic role of vitamin A on healing of acute sinusitis. MATERIALS AND METHODS: This was a prospective controlled animal trial. Experimental sinusitis was induced by blocking the right nose and inoculating Streptococcus pneumoniae into the right maxillary sinuses. Left maxillary sinuses were used as controls. Rabbits were divided in to two groups. At 48 h after inoculation, group I received only parenteral ampicillin-sulbactam (50 mg/kg), group II was treated with parenteral ampicillin-sulbactam (50 mg/kg) and parenteral a dose of 100,000 IU vitamin A in palmitate form. All animals were sacrificed on the 10th day. Mucosal samples were excised from the infected and control sinuses for histopathologic examination, for measurement of activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT), and for evaluation of levels of malondialdehyde (MDA) and nitric oxide (NO). RESULTS: All the infected sinuses displayed signs of inflammation, but there was no statistically significant difference between the study and control groups. In our study, epithelial integrity as well as NO and MDA levels were better in the group receiving both antibiotic and vitamin A than the group receiving antibiotic alone. Nevertheless, SOD activity was significantly increased in the group receiving only antibiotics, compared with the control mucosal SOD activity. There was no difference between the groups as regards CAT and GSH activity.     

Cutaneous anthrax involving the genital area

A 5-year-old girl was admitted with a lesion of the labia majora which was found to be owing to anthrax. She had been licked on the hand by a sick cow (which subsequently died) 5 days prior to admission to a health clinic and 8 days before admission to hospital.     

The Assessment of Validity of Different Asthma Diagnostic Tools in Adults

Background. The diagnosis of asthma is based on the presence of symptoms. Lung function measurements such as forced expiratory volume in one second (FEV₁), peak expiratory flow (PEF) variability and airway hyperresponsiveness support the clinical diagnosis. However, asthma is still an under- or overdiagnosed disease. Objectives. The aim of this study was to identify which test(s) is the most valuable for making the diagnosis of asthma by using patients with asthma-like symptoms as a reference population. Methods. One hundred patients admitted to an asthma outpatient clinic of an education and research hospital and 23 non-smoking healthy control subjects were included in this study. An asthma questionnaire, spirometric tests, monitoring of PEF variability during two weeks, non-specific bronchial challenge test with methacoline, skin prick tests (SPT) with common aeroallergens, measurements of serum total IgE and blood eosinophil counts were applied to all cases. Results. Sixty of one hundred patients were diagnosed with asthma, whereas the 40 remaining participant were accepted as pseudoasthma due to a diagnosis of another cause for their symptoms. The sensitivity and specificity of the methacholine challenge test was 96.5% and 78.4%, respectively. While the most sensitive test was a methacholine challenge test, the most specific test was the reversibility test. The test with the highest correlation of a positive result and asthma was the reversibility test. However, the highest correlation with a negative result was found with the methacholine challenge test. SPT positivity, serum total IgE and eosinophilia had low sensitivity and moderate specificity. The most specific question was “have you had an attack of shortness of breath that came on during the day when you were at rest at any time?”, whereas the most sensitive question was “have you had an attack of shortness of breath that came on following strenuous activity at any time?” In addition, the questions “have you had an attack of shortness of breath that came on following strenuous activity at any time?” and “have you woken up with an attack of wheezing at any time?” had significant correlation with the results of the methacholine challenge test. Conclusions. We have shown that the methacholine challenge test is the most valuable diagnostic tool for asthma. In addition, there is a significant correlation between the methacholine challenge test and some patient symptoms.     

Results of the gastroesophageal reflux assessment in wheezy children

Gastroesophageal reflux (GER) is implicated in the pathogenesis of respiratory symptoms in childhood. It should be taken into account especially in the differential diagnosis of children presenting with wheezing. Although, oesophageal pH monitorisation has been reported to be the best technique in the evaluation of GER, radionuclide studies have also been shown to be very sensitive recently. In this study, 82 children presenting with recurrent wheezing (n=74) and/or vomiting (n=28) (mean age 17.4 months; range 3–48 months) were evaluated. GER scintigraphy was performed to determine the frequency of GER. GER was determined in 18 of the 82 cases (21.9%). The GER was found in 21.1% of children with recurrent wheezing and in 16.6% of children suffering from recurrent vomiting. GER scintigraphy should be kept in mind in the evaluation of children with the complaint of recurrent wheezing since it is a noninvasive and easily applicable method.     

Beneficial Effects of Glycocholic Acid (GCA) on Gut Mucosal Damage in Bile Duct Ligated Rats

In order to investigate the effect of bile acids on gastrointestinal inflammations, bile duct ligated rats (BDL) were treated with GCA (25 mM/ml, oral or colonic) or saline 1 h before ethanol challenge and twice daily for 3 days in the ileitis group, while GCA was given twice daily for 3 days in the colitis group. BDL reduced the macroscopic and microscopic damage scores in the ileitis group compared to sham operated group, while it had no significant effect on ulcer or colitis groups. However, GCA given in BDL group reduced the ulcer index and microscopic damage in colitis group compared to saline-treated groups, but had no effect in ileitis group. Both BDL and GCA administration in BDL group reduced ileitis- or colitis-induced elevations in MPO levels. GCA administration in BDL group inhibited gastric acid output and volume. Our results suggest that oral or colonic administration of primary bile acids may be useful for the treatment of gastrointestinal inflammations.     

Adipokines in Multiple Sclerosis Patients with and without Optic Neuritis as the First Clinical Presentation

Background: Adipocytokines have been implied to be involved in multiple sclerosis (MS) pathogenesis. MS patients whose first clinical episode is optic neuritis (ON) have been reported to display a milder disease course. In this study, we aimed to show whether this milder disease course is related to reduced adipokine production.

Methods: A total of 55 (24 with ON as the first clinical episode) relapsing-remitting MS (RRMS) patients and 40 healthy individuals were recruited. Concentrations of adipokines were measured in sera by ELISA.

Results: The levels of adiponectin, leptin, resistin, monocyte chemoattractant protein-1 (MCP-1) and IL-8 were significantly higher in RRMS patients compared with healthy controls. RRMS cases starting with ON had lower expanded disability status scale scores. Serum adiponectin, leptin, resistin and MCP-1 levels were significantly lower in MS patients, whose first clinical episode was ON.

Conclusions: MS patients with ON as the first manifestation display both lower disability scores and reduced serum adipokine levels implying that adipocytokine production is associated with MS progression. Exact mechanisms of this association in MS patients with first episode ON need to be further studied.     

Tolvaptan treatment in hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH): effects on survival in patients with cancer

Purpose

To investigate the clinical outcomes of patients with hyponatremia who received supportive treatment or tolvaptan plus supportive treatment and the effects of treatment and other variables on overall survival

Methods

This study included oncology patients who were hospitalized at two oncology centers between January 1, 2016 and December 31, 2019 for hyponatremia (sodium levels?<?135 mEq/L) and who received tolvaptan plus supportive treatment (n?=?22) or supportive treatment only (n?=?42).

Results

The median age of all the patients was 59 years (range 26–85) and 64.1% of the patients were male. There was no statistically significant difference between patients in the tolvaptan plus supportive treatment (TpST) group and the supportive treatment only (ST) group in terms of gender and age (p?>?0.05). In the TpST group, recovery days of the hyponatremia after treatment and the length of hospital stay was shorter and hyponatremia symptoms and hospital complications were less frequent compared to the ST group (p?<?0.05). There was no significant difference between the TpST group and the ST group in terms of overall survival (OS). OS was shorter in men who were non-responders to hyponatremia treatment and had recurrent hyponatremia. Multivariable analysis showed that normal sodium levels after treatment decreased the risk of death.

Conclusion

In the treatment of hyponatremia in cancer patients, TpST was found to have more positive effects on blood sodium levels, length of hospital stay, hospital complications, and hyponatremia symptoms compared to ST. A decreased risk of death was observed in patients with normal sodium levels after treatment.

     

Advanced multifocal tuberculous spondylitis without disk involvement and with multidrug-resistant bacilli.

In this brief report, we describe a 23-year-old immunocompetent Nigerian patient with extensive multifocal tuberculous spondylitis without disk involvement. Cultures of sputum samples and biopsy samples from the L4 vertebra were positive for tuberculosis; drug-susceptibility testing of the isolates revealed multidrug resistance. Treatment with second-line drugs resulted in an excellent interim outcome after 6 months, without the need for surgical intervention.