Autoantibodies against the platelet glycoprotein IIb/IIIa complex in patients with chronic ITP

Chronic idiopathic thrombocytopenic purpura (ITP) is caused by an antibody reactive with platelet-associated antigens. The present studies provide direct evidence that some patients with chronic ITP have autoantibodies against the platelet glycoprotein (GP) IIb/IIIa complex. Microtiter wells, coated with a monoclonal antibody (2G12) specific for GPIIb/GPIIIa were reacted with GPIIb/GPIIIa contained in a platelet extract. Control wells containing the same antibody were reacted with a cell extract containing no GPIIb/GPIIIa. After washing, the wells were reacted with patient or control plasma, and IgG binding was detected using 125I-Fab2-anti-human IgG. Assay values were expressed as binding ratios (cpm GPIIb/GPIIIa wells/cpm control wells). Plasma from 5 of 56 patients with chronic ITP had ratios (1.36-3.14) greater than 3 standard deviations above the mean (+/- SD) of control plasmas--0.93 +/- 0.12. Elevated values were also noted in two patients with anti-P1A1 antibody (ratios greater than 30) and in one patient with Hodgkin's disease and an ITP-like syndrome (ratio 1.53). Normal values were noted in 34 patients with a variety of immune and nonimmune diseases. Plasma from two of the positive ITP patients was reacted with 125I-surface-labeled platelets and, after solubilization, the IgG and bound antigen were precipitated with Staph-A. Autoradiographs from SDS- PAGE electrophoresis of the Staph-A-bound proteins shows two radioactive bands consistent in size with GPIIb and GPIIIa.     

Renal dysfunction after myocardial revascularization.

OBJECTIVES: In this study, we evaluate the incidence of and analyse the pre and intraoperative risk factors for the development of postoperative renal dysfunction (PRD), and the impact of such an event on perioperative mortality and on hospital length of stay. In addition, we sought to investigate the influence of a mildly increased serum creatinine (1.3-2.0 mg/dl) on perioperative mortality and morbidity. METHODS: The study included 2445 consecutive patients who had no pre-existing renal disease (creatinine or=2.1 mg/dl with a preoperative-to-postoperative increase >or=0.9 mg/dl. Univariate and multivariate analyses were performed where appropriate. RESULTS: Global 30-day mortality was 0.7%. The incidence of PRD was 5.6% (136 patients). Mortality for patients who experienced PRD was 8.8 vs. 0.1% for patients who did not (P<0.001). PRD increased the length of hospital stay by 3.4 days (7.6 vs. 11.0 days; P<0.001), and patients who needed haemodialysis (11%) had a perioperative mortality of 33.3% and a mean hospital length of stay of 16 days. Multivariable logistic regression identified the following variables as independent predictors of PRD: age (P=0.017; odds ratio (OR) 1.3 per 10 years), angina class III/IV (P=0.003; OR 1.7); cardiopulmonary bypass time (P=0.007; OR 1.01 per minute); preoperative serum creatinine levels: group 1 (1.3-1.6 mg/dl (P<0.001; OR 5.5)) and group 2 (1.7-2.0 mg/dl (P<0.001; OR 14.2)). Finally, a mild elevation of the preoperative creatinine level (1.3-2.0 mg/dl) increased significantly the probability of perioperative mortality, low cardiac output, haemodialysis and prolonged hospital stay. CONCLUSIONS: Although the likelihood of PRD in patients without pre-existing renal dysfunction is relatively low, it dramatically increases mortality, morbidity and length of stay after CABG. Mildly elevated (>1.2 mg/dl) preoperative serum creatinine level significantly increases the perioperative mortality and morbidity.     

Assistive technology for communication of older adults: a systematic review

Objective: Describe the use of assistive technology to enhance communication opportunities for older adults.

Methods: A systematic review was conducted in two databases, PubMed and Web of Science, by using two different searches in each. The search was limited to original articles, in English language, including people aged 60 years and older that used any type of assistive technology for communication. The articles found in the initial search were filtered by title, abstracts and the remaining articles were fully read.

Results: Eighteen studies were included in this review after the reading of full-texts. Most of the studies included apparently healthy participants with communication limitations due to aging related changes and the others included people with some pathology that prevent them from normal communication.

Conclusion: Four categories of assistive technology were identified: assistive technology for people with speech problems; robot or videoconferencing systems; Information and Communication Technologies and, other types of assistive technology for communication, such as hearing aids and scrapbooks. Assistive technology for communication of older adults is not only used by people with disabilities that prevent them from usual communication. They are mostly for older adults without a pathological communication problem.     

Quality of Life,Integrative Community Therapy,Family Support,and Satisfaction with Health Services Among Elderly Adults with and without Symptoms of Depression

The aim of this cross-sectional study was to analyse quality of life, socio-demographic characteristics, family support, satisfaction with health services, and effect of integrative community therapy among non-institutionalised elderly adults with and without symptoms of depression in the state of Rio Grande do Norte, Brazil. Data from elderly adults with (n = 59) and without (n = 61) depressive symptoms were compared. The instruments used were the Mini-Mental State Examination, the short version of the Geriatric Depression Scale, a clinical socio-demographic questionnaire, the abbreviated version of the World Health Organisation Quality of Life questionnaire, the Family Assessment Device, and the Patient Satisfaction with Mental Health Services Rating Scale. Elderly adults with depressive symptoms had lower quality of life in the social relations domain than did those without depressive symptoms (p = 0.003). In addition, compared with those without depression, fewer elderly adults with depressive symptoms attended integrative community therapy (p = 0.04); they also reported a low degree of family involvement in problem solving (p = 0.04) and showed apathy regarding their satisfaction with health services (p = 0.007). These results have important implications in the decision-making process with regard to strategies for improving the health status of elderly adults with depressive symptoms.     

Long-term oral treatment with BAY 41-2272 ameliorates impaired corpus cavernosum relaxations in a nitric oxide-deficient rat model

Study Type – Therapy (case control)
Level of Evidence 3b What’s known on the subject? and What does the study add? Erectile dysfunction is defined as the persistent inability to achieve and/or maintain an erection sufficient for satisfactory sexual performance. Nitric oxide (NO) is the main transmitter released from nitrergic nerves and endothelial cells involved in the erectile erection. NO activates the soluble guanylyl cyclase (sGC) in cavernosal smooth muscle to generate cyclic GMP (cGMP) that in turn promotes relaxation and penile erection. Erectile dysfunction genesis can be attributed to a variety of factors such as stress, ageing, drugs, and certain pathological conditions including arterial hypertension, atherosclerosis, dyslipidemia and diabetes mellitus. Inhibitors of phosphodiesterase‐5 (PDE5) like sildenafil (viagra^TM), vardenafil (levitra^TM) and tadalafil (cialis^TM) remain the main oral therapy for erectile dysfunction. These compounds inhibit the cGMP hydrolysis thereby preserving cGMP thus causing an enhancement of corporeal smooth muscle relaxation. The existence of a new NO‐independent regulatory site on sGC has been described. BAY 41‐2272 is a novel compound that generates significant amounts of cGMP by stimulating the sGC in the absence of NO. Compound BAY 41‐2272 also synergize with endogenous NO producing higher cGMP‐dependent cell responses. Using a model of chronic NO deficiency in rats to produce erectile dysfunction, we show that long‐term oral treatment of with BAY 41‐2272 prevents the erectile dysfunction in the NO‐deficient rats. Therefore, this compound may have great therapeutic potential to erectile dysfunction treatment.

OBJECTIVE

? To investigate the potential beneficial effects of 4‐week oral treatment with 5‐cyclopropyl‐2‐[1‐(2‐fluoro‐benzyl)‐1Hpyrazolo[3,4‐b]pyridin‐3‐yl]‐pyrimidin‐4‐ylamine (BAY 41‐2272), a nitric oxide (NO)‐independent soluble guanylate cyclase activator, on impaired rat corpus cavernosum relaxations in NO‐deficient rats.

MATERIAL AND METHODS

? Male Wistar rats were divided into four groups: Control, N (G)‐nitro‐L‐ arginine methyl ester (L‐NAME; 20 mg/rat/day), BAY 41‐2272 (20 mg/kg/day) and L‐NAME + BAY 41‐2272. ? Rats were treated with L‐NAME concomitantly with BAY 41‐2272 for 4 weeks. ? Concentration–response curves to acetylcholine (ACh) and sodium nitroprusside (SNP), along with the nitrergic relaxations (1–32 Hz) were obtained in rat corpus cavernosum (RaCC). ? The RaCC contractile responses to the α₁‐adrenoceptor agonist phenylephrine (PE) were obtained.

RESULTS

? Acetylcholine (0.01–1000 µmol/L) produced concentration‐dependent relaxing responses in RaCC that were significantly enhanced (P < 0.05) in BAY 41‐2272‐treated rats. ? The ACh‐induced relaxations were largely reduced in L‐NAME‐treated rats, and co‐treatment with BAY 41‐2272 failed to significantly modify these impaired relaxations. ? The SNP‐induced relaxations were modified neither by L‐NAME nor by co‐treatment with BAY 41‐2272. ? The nitrergic relaxations were significantly amplified in BAY 41‐2272‐treated rats (at 16 and 32 Hz). A significant reduction in the nitrergic relaxations was observed in L‐NAME‐treated rats, an effect largely restored by co‐treatment with BAY 41‐2272. ? The contractile RaCC responses produced by PE (0.001–100 µmol/L) were significantly higher (P < 0.05) in L‐NAME‐treated rats, and co‐treatment of L‐NAME with BAY 41‐2272 nearly restored these enhanced contractile responses.

CONCLUSION

? Four‐week therapy with BAY 41‐2272 prevents the impaired corpus cavernosum relaxations of rats treated chronically with L‐NAME, indicating that accumulation of cyclic guanosine monophosphate into erectile tissue counteracts the NO deficiency.     

Acesso às vias aéreas guiado por ultrassom

Ultrasound has increasingly growing applications in anesthesia. This procedure has proven to be a novel, non‐invasive and simple technique for the upper airway management, proving to be a useful tool, not only in the operating room but also in the intensive care unit and emergency department. Indeed, over the years mounting evidence has showed an increasing role of ultrasound in airway management. In this review, the authors will discuss the importance of ultrasound in the airway preoperative assessment as a way of detecting signs of difficult intubation or to define the type and/or size of the endotracheal tube as well as to help airway procedures such as endotracheal intubation, cricothyrotomy, percutaneous tracheal intubation, retrograde intubation as well as the criteria for extubation.     

Rolandic encephalopathy and epilepsia partialis continua following bone marrow transplant

Epilepsia partialis continua (EPC) is a condition defined by prolonged focal myoclonus. Often resistant to therapy, EPC in children is frequently present in Rasmussen encephalitis, a form of chronic encephalitis of uncertain etiology. We discuss a child who developed bilateral EPC 5 months after a bone marrow transplant. Neuroimaging studies showed signal abnormalities on both sensory-motor areas. An extensive search failed to reveal the etiology of the disorder, but treatment with a broad-spectrum anti-viral agent was associated with resolution of the process. An unidentified infectious agent may be responsible for an encephalitis of the motor strip in immunosuppressed patients.     

The first report of a patient with interrupted inferior vena cava,multiple post-renal veins and azygos-hemiazygos continuation

The first case of a patient with interrupted inferior vena cava, four post-renal veins and an azygoshemiazygos continuation is presented. The complicated anomalies were omphalocele and atrial septal defect. Cine-magnetic resonance imaging and cardiac catheterization showed an anomalous retroaortic left innominate vein, azygos-hemiazygos continuation in the prerenal portion, arch formed renal vein in the renal portion and four embryonic vessels in the post-renal portion. Combination of these anomalies in the major venous system suggested that the inferior vena cava had failed to form and that the bilateral embryonic venous system, postcardinal and supracardinal veins persisted to be the systemic venous channels.