Glomerular Membranopathy in Children with IgA Nephropathy and Henoch Schönlein Purpura

We evaluated renal biopsies from 34 children with IgA nephropathy or Henoch Schönlein purpura to further characterize the ultrastructural features of the glomerular membranopathy that occurs in these disorders. Focal glomerular basement membrane damage was identified in 29 children and was severe in 4 of the children. Alterations included focal and segmental attenuation, splitting, duplications, and spike-like subepithelial protrusions of the lamina densa, along with saccular glomerular microaneurysms arising at the paramesangium. Those cases with extensive glomerular basement membrane lesions had either moderate or severe glomerular alterations apparent by light microscopy. Over half of the cases with glomerular membranopathy had immunohistological or ultrastructural evidence of focal peripheral glomerular capillary wall immune deposits and electron-dense deposits occurred at sites of glomerular basement membrane splitting. Despite the focal attenuation of the glomerular basement membrane, we did not identify any biopsy with findings of thin basement membrane disease. The glomerular basement membrane ultrastructural findings we describe are characteristic of IgA nephropathy and Henoch Schönlein purpura, are common in children with these disorders, and are similar to the ultrastructural alterations of the basement membrane that occur in other glomerulonephritides. These basement membrane injuries may be inflammatory cell or immune mediated but their pathogenesis requires further study.     

Treatment of acne using a 3-milligram drospirenone/20-microgram ethinyl estradiol oral contraceptive administered in a 24/4 regimen: a randomized controlled trial

OBJECTIVE: To assess the efficacy of the combined oral contraceptive containing 3-mg drospirenone/20-microgram ethinyl estradiol (3-mg drospirenone/20-microgram ethinyl estradiol) administered as 24 consecutive days of active treatment after a 4-day hormone-free interval (24/4 regimen) compared with placebo for the treatment of moderate acne vulgaris. METHODS: Healthy females aged 14-45 years with moderate acne were randomized in this double-blind study to 3-mg drospirenone/20-microgram ethinyl estradiol (n=270) or placebo (n=268) for six cycles of 28 days. The primary outcome measures of acne lesion counts and Investigator Static Global Assessment scale ratings were assessed at baseline and during cycles 1, 3, and 6. RESULTS: The percentage reduction from baseline to endpoint for total lesions is 46.3% for 3-mg drospirenone/20-microgram ethinyl estradiol 24/4 combination oral contraceptive group and 30.6% for placebo group (P<.001). The likelihood of participants in the 3-mg drospirenone/20-microgram ethinyl estradiol 24/4 regimen group having "clear" or "almost clear" skin as rated by the investigators at endpoint was about threefold (odds ratio 3.13, 95% confidence interval 1.69-5.81; P=.001) greater than in the placebo group. The 3-mg drospirenone/20-microgram ethinyl estradiol 24/4 regimen was well tolerated. CONCLUSION: The low-dose combined oral contraceptive containing 3-mg drospirenone/20-microgram ethinyl estradiol administered in a 24/4 regimen significantly reduced acne lesion counts more effectively than placebo and demonstrated greater improvement in the Investigator Static Global Assessment rating of acne. The safety profile was consistent with low-dose combined oral contraceptive use.     

Purposiveness and Leisure-Time Physical Activity in Women in Early Midlife

Physical activity in early midlife has important implications for women's health. The present cross-sectional study investigated the relation of purposiveness to leisure-time physical activity, as mediated by health investment, in a sample of women in early midlife. Participants were 211 women between the ages of 35 and 45 years (mean 40.55 years, SD = 3.11) who responded to the second wave of the study of Midlife Development in the United States. Participants were originally selected by means of a nationally representative random-digit-dialing procedure. A structural equation analysis of data with latent variables was conducted with MPLUS. Purposiveness was indexed by measures of purpose in life, personal growth, and future planning. Health investment was indexed by thought and effort committed to health and the extent to which individuals worked hard to stay healthy. Leisure-time physical activity was indexed by both moderate and vigorous leisure-time activity. Results, controlling for sociodemographic factors, showed that purposiveness was associated with more physical activity and that the relation between purposiveness and leisure-time physical activity was fully mediated by health investment. These results suggest that women with a sense of purpose may be better able to achieve acceptable levels of physical activity.     

A RE I NTERFACILITY G ROUND T RANSPORTS OF P ATIENTS U TILIZING I NTRA - AORTIC B ALLOON P UMPS S AFE ?

Objective. To determine whether the interfacility ground transport of patients with intra-aortic balloon pumps results in morbidity or mortality during transfer. Methods. Charts of all intra-aortic balloon pump transports by a private ambulance company occurring from January 1998 through December 1999 (24 months) were reviewed retrospectively. Records were assessed by a single reviewer for adverse events, explicitly defined as any notation on the record describing death, chest pain, dyspnea, altered mental status, device malfunction, bleeding, unstable vital signs (heart rate <50 beats/min or ≥120 beats/min, respiratory rate <12 breaths/min or ≥30 breaths/min, systolic blood pressure <90?mm?Hg), or hypoxia (oxygen saturation <93%). Unstable vital signs as defined above did not count as adverse events if they represented a patient's baseline condition prior to transport. Results. Thirty-two transports were identified during the study period. Twenty-seven patients (84.4%) had no adverse events. There were no mortalities. Adverse events, none of which resulted in morbidity, were: 1) chest pain and transient paroxysmal atrial tachycardia (relieved with increasing the nitroglycerin infusion); 2) continuous mild chest pain (began during transport and diminished with giving sublingual nitroglycerin and increasing the nitroglycerin infusion); 3) dyspnea and hypoxia (relieved with increased oxygen); 4) transient hypotension (spontaneously resolved); 5) hypotension (resolved by increasing the dopamine infusion). Conclusion. Although a few adverse events occurred, interfacility ground transport of patients with intra-aortic balloon pumps was not associated with morbidity or mortality in this study.     

Case Report: Halicephalobus gingivalis: A Rare Cause of Fatal Meningoencephalomyelitis in Humans

The genus Halicephalobus consists of eight species of free-living nematodes. Only one species (H. gingivalis) has been reported to infect vertebrates. Human infection is extremely rare, and only four cases have been reported in the literature. These nematodes seem to exhibit neurotropism, but their life cycle, mode of infection, and risk factors are poorly understood. Neurohelminthiases are not commonly recognized in the United States and when they do occur, pose great diagnostic challenges because of lack of appropriate non-invasive screening and/or confirmatory tests. We report a challenging case of meningoencephalomyelitis caused by a Halicephalobus sp., in which the patient had a rapidly deteriorating clinical course. The case did not raise any clinical suspicion of neurohelminthiases, although increased eosinophils were present in the cerebrospinal fluid. This case presents an opportunity to highlight the importance of considering parasitic infection in meningoencephalitis or meningoencephalomyelitis presenting atypically.     

Molecular analyses of patients with hyperferritinemia and normal serum iron values reveal both L ferritin IRE and 3 new ferroportin (slc11A3) mutations

Unexplained hyperferritinemia is a common clinical finding, even in asymptomatic persons. When early onset bilateral cataracts are also present, the hereditary hyperferritinemia-cataract syndrome (HHCS), because of heterozygous point mutation in the L ferritin iron-responsive element (IRE) sequence, can be suspected. We sequenced the L ferritin exon 1 in 52 DNA samples from patients referred to us for molecular diagnosis of HHCS. We identified 24 samples with a point mutation/deletion in the IRE. For the 28 samples in which no IRE mutation was present, we also genotyped HFE mutations and sequenced both H ferritin and ferroportin genes. We found an increased frequency of His63Asp heterozygotes (12 of 28) but no H ferritin mutations. We identified 3 new ferroportin mutations, producing, respectively, Asp157Gly, Gln182His, and Gly323Val amino acid replacements, suggesting that these patients have dominant type 4 hemochromatosis. This study demonstrates that both L ferritin IRE and ferroportin mutations can account for isolated hyperferritinemia. The presence of cataract does not permit the unambiguous identification of patients with HHCS, although the existence of a family history of cataract was only encountered in these patients. This raises the intriguing possibility that lens ferritin accumulation might be a factor contributing to age-related cataract in the general population. Additional causes of isolated hyperferritinemia remain to be identified.