Parotid gland tumours in 255 consecutive patients: Mount Sinai Hospital's quality assurance review

Parotid neoplasms represent a diverse group of tumours found in the head and neck. Complications following parotidectomy, including Frey's syndrome, facial nerve paralysis, sialoceles, and parotid fistulae, have been well documented. A retrospective review of 255 patients treated surgically for parotid masses over an 8-year period at Mount Sinai Hospital in Toronto was reviewed as part of a quality assurance program. The sensitivity, specificity, and predictive values for fine-needle aspiration cytology were analyzed. The incidence of benign and malignant lesions is presented. The complications following parotidectomy are reviewed and in our series are consistent with the figures published in the literature.     

Microbiology of choledochal bile in patients with choledocholithiasis admitted to a tertiary hospital

AIM: The present study was designed to investigate the microbiology of choledochal bile of patients with cholangitis and choledocholithiasis. METHODS: We identified and determined the antimicrobial susceptibility of bacteria isolated in the bile of patients with cholangitis and choledocholithiasis diagnosed by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Nineteen (82.6%) of 23 patients with choledocholithiasis had positive bile cultures. A single agent was detected in 11 patients (57.9%), while a mixed growth, with pathogens ranging from two to three species, were seen in eight patients (42.1%). Patients with clinical manifestations of cholangitis had significantly higher counts of colonies per mL of bile (> 105 cfu/mL).The predominant Gram-negative aerobic bacteria isolated were Escherichia coli (9, 31.0%), Klebsiella pneumoniae (5, 17.2%), Enterobacter cloacae (2, 6.9%), Pantoea agglomerans (1, 3.4%), and Pseudomonas aeruginosa (1, 3.4%). The predominant Gram-positive bacteria were Enterococcus faecalis (5, 17.2%) and Streptococcus sp. (5, 17.2%). Bacteroides fragilis was isolated in one patient with mixed growth. All Gram-positive bacteria isolated in bile were sensitive to ampicillin, and all Gram-negative bacteria isolated were sensitive to gentamicin with a minimum inhibitory concentration (CIM90) ranging from 0.5 to 1.0- micro g/mL. Gram-negative bacteria were also sensitive to imipenem, fluorquinolones, second and third generation cephalosporins. Although all five isolates of E. faecalis were sensitive to ampicillin, two of five (40%) E. faecalis isolates demonstrated high levels of resistance to gentamicin. CONCLUSION: E. coli, K. pneumoniae, E. faecalis and Streptoccocus sp. were the most common bacteria isolated in the bile of patients with cholangitis and choledocholithiasis, which were sensitive to a simple therapeutic regimen, such as the combination of ampicilin and gentamicin.     

Gastric mesenchymal tumors as incidental findings during Roux-en-Y gastric bypass

Background

Occurrences of mesenchymal tumors have been more recognized in recent years, and the incidental diagnosis of these lesions during bariatric surgery has been previously reported.

Evaluation of different strategies to promote a protective immune response against leptospirosis using a recombinant LigA and LigB chimera

Leptospirosis is a zoonosis of worldwide distribution, caused by infection with pathogenic Leptospira species. The vaccines that are currently available are bacterins, with limited human use, that confer short-term, serovar-specific immunity. Lig proteins are considered to be the best vaccine candidates to date. Here, we aimed to construct a recombinant Lig chimera (LC) comprised of LigAni and LigBrep fragments, and to evaluate it as subunit or DNA vaccine using different administration strategies. Vaccines were formulated with 50?µg of recombinant LC associated with different adjuvants or with 100?µg of pTARGET/LC. Four-week-old hamsters received two doses of vaccine with different strategies and were challenged with 5?×?DL₅₀ Leptospira interrogans serovar Copenhageni strain Fiocruz L1-130. The immune response generated by Lig chimera conferred 100% protection to hamsters treated with at least one dose of recombinant LC. Despite the high levels of antibodies that vaccinated animals produced, a sterilizing immunity was not achieved. The lack of a sterilizing immunity could indicate the importance of a mixed humoral and cellular immune response. The present study generated insights that will be useful in the future development of improved subunit vaccines against leptospirosis.     

Translation, validation and cultural aspects of postpartum depression screening scale in Brazilian Portuguese

The aim of this study was to determine the validity and reliability of a Portuguese version of the Postpartum Depression Screening Scale (PDSS). A total of 120 new mothers completed the translated version of PDSS and later were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders, our gold standard for clinical status. The best cut-off score for the Portuguese version was 102, with a sensibility of 94%, a specificity of 95%, a positive predictive value of 75% and a negative predictive value of 99%. Reliability, measured by the alpha coefficient of internal consistency, was .95. The PDSS is considered ready for use in the screening of Brazilian new mothers for postpartum depression.     

Effects of melatonin in connection with the antioxidant defense system in the gills of the estuarine crab Neohelice granulata

Numerous studies have shown that melatonin exerts some influence on the antioxidant defense system (ADS) in vertebrates, but for crustaceans no such effect has been demonstrated till now. However, earlier reports did show a similar profile of daily variations in the ADS of the gills and the melatonin content of the eyestalk in the crab Neohelice granulata and, thus, the aim of this study was to take a closer look at the effects of melatonin in the gill ADS of N. granulata. Gill ADS is to a minor extent modulated by reactive oxygen species (ROS), because only the nonproteic sulfhydryl (NP-SH) content increases (p < 0.05) in the presence of hydrogen peroxide (H₂O₂). No significant differences (p > 0.05) were observed in the melatonin content of the hemolymph between intact and eyestalkless crabs. Gills from intact and eyestalkless crabs injected with physiological saline showed a daily variation in the total peroxyl radical scavenging capacity (TPRSC) (p < 0.05) with two peaks, one at the photophase and another at the scotophase. However, in the gills of eyestalkless crabs injected with melatonin (2 × 10⁻¹² mol crab⁻¹), the daily variation in TPRSC values was abolished (p > 0.05). This molecule did not change the NP-SH content (p > 0.05) in vitro, but decreased (p < 0.05) the oxygen consumption in gills when incubated for 120 min. In the in vivo experiments melatonin also decreased (p < 0.05) the oxygen consumption in eyestalkless crabs after 390 min. The results suggest that melatonin does not act directly on the ADS of the gills of N. granulata, but decreases the aerobic metabolism possibly involved in variations of tissue ADS.     

Comparison of Metabolic Effects of Surgical-Induced Massive Weight Loss in Patients with Long-Term Remission Versus Non-remission of Type 2 Diabetes

Background

The aim of this study was to evaluate the pathophysiological mechanisms underlying the non-remission of type 2 diabetes in Roux-en-Y gastric bypass (RYGB) patients.

Methods

A group of patients not in remission (NR) was formed (n?=?13). A remission group (R) was composed of patients who had undergone normalization of fasting glycemia and A1c, without anti-diabetic drugs and matched for selected baseline characteristics (i.e., duration of disease, previous BMI, final BMI, fat distribution, and age; n?=?15). A control group of lean subjects (n?=?41) was formed.

Results

The NR group had higher uric acid (5.1 vs. 3.9 mg/dL), number of leukocytes (6,866.9 vs. 5,423.6), hs-CRP (0.27 vs. 0.12 mg/dL), MCP-1 (118.4 vs. 64.4 ng/mL), HOMA-IR, and AUC_glucose but lower adiponectin (9.4 vs. 15.4 ng/mL), leptin (12.7 vs. 20.7 ng/mL), and AUC_GLP-1 in comparison to R group; the NR group also had lower leptin and higher adiponectin, HOMA-IR, AUC_glucose, AUC_C-peptide, AUC_glucagon, and AUC_GLP-1 than controls. The R group had lower MCP-1 and higher adiponectin compared to controls. Insulin sensitivity was significantly lower in the NR group than in the R and control groups. The insulin secretion index values were lower in the NR group than in the R and control groups.

Conclusions

This study found greater insulin resistance, lower insulin secretion, persistent adiposopathy and chronic subclinical inflammation, and less robust incretin response in the NR group despite a similar level of weight loss. Persistently altered pathophysiological mechanisms can be related to the lack of remission of type 2 diabetes after RYGB.     

Correlations of HOMA2-IR and HbA1c with Algorithms Derived from Bioimpedance and Spectrophotometric Devices

Background

Homeostasis model assessment of insulin resistance (HOMA2-IR) and HbA1c, markers of metabolic syndrome and glycemic control, were compared with Electro Sensor (ES) Complex software algorithms. ES complex software integrates data from Electro Sensor Oxi (ESO; spectrophotometry) and Electro Sensor-Body Composition (ES-BC; bioimpedance).

Methods

One hundred forty-eight Brazilian obese candidates for bariatric surgery underwent complete physical examinations, laboratory tests (fasting plasma glucose, fasting plasma insulin, and HbA1c) and ES complex assessments. HOMA2-IR was calculated from fasting plasma glucose and fasting plasma insulin using free software provided by The University of Oxford Diabetes Trial Unit. ES complex?Cinsulin resistance (ESC-IR) and ES complex?Cblood glucose control (ESC-BCG) were calculated from ESO and ES-BC data using ES complex software. Correlations between HOMA2-IR and ESC-IR and between ESC-BGC and HbA1c were determined.

Results

ESC-BGC was correlated with HbA1c (r?=?0.85). ESC-BCG values >3 were predictive of HbA1c?>?6.5?% (???=?0.94; unweighted ???=?0.9383). ESC-IR was correlated with HOMA2-IR (r?=?0.84). Patients with ESC-IR score >2.5 or >3 were more likely to have metabolic syndrome or insulin resistance, respectively, compared with HOMA2-IR value >1.4 and >1.8, respectively. ESC-IR performance was evaluated by receiver operating characteristic curves. The areas under the curve for metabolic syndrome and insulin resistance were 0.9413 and 0.9022, respectively.

Conclusion

The results of this study in Brazilian subjects with obesity suggest that ES complex algorithms will be useful in large-scale screening studies to predict insulin resistance, metabolic syndrome, and HbA1c >6.5?%. Additional studies are needed to confirm these correlations in non-obese subjects and in other ethnic groups.