Changes in symptoms, lipid and hormone levels after the administration of a cream with phytoestrogens in the Climacteric--preliminary report.

OBJECTIVE: To establish the changes in lipid and hormone levels, as well as in symptoms, after topical application of a cream with phytoestrogens in postmenopausal women. METHODS: 30 postmenopausal women were studied. At baseline and 1 month after the beginning of treatment, levels of FSH, estradiol, estrone, testosterone, androstenedione, dehydroepiandrosterone, total cholesterol, HDL-C, LDL-C, and triglycerides were measured. Climacteric symptoms were evaluated with a modified Kupperman's index (KI). The subjects received a cream with phytoestrogens (n = 15) or placebo (cold cream) (n = 15) in a randomized, double-blind manner. Statistically significant differences were determined by Student's t test. RESULTS: No differences were found in hormones, lipids, or in KI between the groups. When comparing each group separately, only a significant decrease in KI was found, in both groups, at the end of the treatment. CONCLUSIONS: This cream with phytoestrogens had an effect only in climacteric symptoms, but similar to the placebo. The lack of effect in the other variables was probably due to the administration route, or to a lack of effect of this product.     

Leukocyte-technetium-99m uptake in Crohn’s disease: Does it show subclinical disease?

AIM: To evaluate inflammatory activity in patients with Crohn’s disease (CD) using technetium-99m-hexamethylpropyleneamine oxime (99mTc-HMPAO) granulocyte scintigraphy.METHODS: Twenty patients (7 male and 13 female) with CD and five healthy volunteers were selected for 99mTc-HMPAO granulocyte scintigraphy. The Crohn’s Disease Activity Index (CDAI), blood tests and C-reactive protein (CRP) of each patient were performed 7 d before the scintigraphic images. The leukocytes were labeled according to the International Society of Radiolabeled Blood Elements (ISORBE) consensus protocol and the scintigraphic images, including single photon emission computed tomography, were obtained 30 min and 2 h after injection of the radiolabeled leukocytes.RESULTS: The labeling yield of the leukocytes with the lipophilic complex 99mTc-HMPAO was 55.0% ± 10%. Six of the 20 patients (30%) presented congruent results for the three parameters investigated (CDAI, Scintigraphic Index and CRP). On the other hand, 14 patients (70%) did not show congruent results. There was no significant correlation between the indices analyzed according to the Spearman test (P > 0.05, n = 20).CONCLUSION: The results suggest that 99mTc-HMPAO-labeled leukocyte scintigraphy could be important for determining inflammatory activity in CD even in the absence of clinical symptoms.     

First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve

BACKGROUND: We report the first human experience with an endoscopic duodenal-jejunal bypass sleeve (DJBS) in a community hospital. METHODS: The DJBS is a 60-cm sleeve anchored in the duodenum to create a duodenal-jejunal bypass. In a 12-patient prospective, open-label, single-center, 12-week study, the device was endoscopically implanted, left in situ, and retrieved. The study included 5 men and 7 women, with a mean body mass index of 43 kg/m(2). Of the 12 patients, 4 had type 2 diabetes. The primary endpoints were the incidence and severity of adverse events. The secondary outcomes included the percentage of excess weight loss and changes in co-morbid status. RESULTS: The DJBS was endoscopically delivered and retrieved in all patients (mean implant/explant time of 26.6 and 43.3 min, respectively). Of the 12 patients, 10 were able to maintain the device for 12 weeks and 2 underwent explantation after 9 days secondary to poor device placement. Several self-limited adverse events were possibly or definitely related to the device, including 6 episodes of abdominal pain, 18 of nausea, and 16 of vomiting, mainly within 2 weeks of implantation. Two partial pharyngeal tears occurred during explantation. Implant site inflammation was encountered in all patients. No device-related event was considered severe. The average percentage of excess weight loss for the 10 patients with the device in place for 12 weeks was 23.6%, with all patients achieving at least 10% excess weight loss. All 4 diabetic patients had normal fasting plasma glucose levels without hypoglycemic medication for the entire 12 weeks. Of these 4 patients, 3 had decreased hemoglobin A(1c) of > or =.5% by week 12. CONCLUSION: The DJBS can be safely delivered and removed endoscopically and left in situ for 12 weeks. The device had a favorable safety and encouraging efficacy profile. Randomized prospective trials are warranted.     

Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia.

OBJECTIVE: To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin. DESIGN: Multicentre, prospective, observational study. SETTING: 12 tertiary-care centres in three countries in Latin America. PATIENTS: 240 children aged 3-59 months, hospitalised with severe pneumonia and known in vitro susceptibility of S pneumoniae. INTERVENTION: Patients were treated with intravenous penicillin/ampicillin after collection of blood and, when possible, pleural fluid for culture. The minimal inhibitory concentration (MIC) test was used to determine penicillin susceptibility of the pneumococcal strains isolated. Children were continuously monitored until discharge. MAIN OUTCOME MEASURES: The primary outcome was treatment failure (using clinical criteria). RESULTS: Overall treatment failure was 21%. After allowing for different potential confounders, there was no evidence of association between treatment failure and in vitro resistance of S pneumoniae to penicillin according to the Clinical Laboratory Standards Institute (CLSI)/National Committee for Clinical Laboratory Standards (NCCLS) interpretative standards ((adj)RR = 1.03; 95%CI: 0.49-1.90 for resistant S pneumoniae). CONCLUSIONS: Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 microg/ml.     

Frequency of social phobia and psychometric properties of the Liebowitz social anxiety scale in Parkinson's disease

There are few studies about social anxiety disorder in Parkinson's disease (PD). The objective of this study was to assess its frequency and to explore the psychometric properties of the Liebowitz social anxiety scale (LSAS) in PD. Ninety patients with PD underwent neurologic and psychiatric examination. Psychiatric examination was composed by a structured clinical interview (MINI‐Plus) followed by the application of the LSAS, the Hamilton depression rating scale (Ham‐D), and the Hamilton anxiety rating scale (Ham‐A). Neurologic examination included the MMSE, the UPDRS, the Hoehn‐Yahr Scale, and the Schwab‐England scale of activities of daily living. Social phobia was diagnosed in 50% of PD patients. The disorder was not associated with any sociodemographic or neurological feature, but was associated to major depression (P = 0.023), generalized anxiety disorder (P = 0.023), and obsessive‐compulsive disorder (P = 0.013). The score of LSAS correlated positively with the scores of Ham‐D and Ham‐A (P < 0.001 for both). A ROC curve analysis of the LSAS suggested that a cutoff score in 41/42 provided the best balance between sensitivity and specificity. This disorder seems to be more common and not just restricted to performance as previously thought. © 2008 Movement Disorder Society     

Biochemical and biological characterization of the venoms of Bothriopsis bilineata and Bothriopsis taeniata (Serpentes: Viperidae).

Snake venom is a complex mixture containing diverse protein components with different structures and functions that are used for prey immobilization and death. Snake venoms from the family Viperidae cause pronounced local and systemic effects, such as pain, edema, hemorrhage and necrosis. Here, we investigated the enzymatic and biological activities of venoms from two Amazonian snakes, Bothriopsis bilineata and Bothriopsis taeniata. Both venoms presented high enzymatic activities for proteases kallikrein, thrombin and plasmin, low levels of trypsin, cathepsin C and leucine aminopeptidase activities, while lacked acetylcholinesterase activity. B. taeniata and B. bilineata crude venoms caused inflammation inducing neutrophil recruitment into peritoneal cavity of mice 4h after injection. Neutrophil recruitment induced by B. taeniata venom was accompanied by hemorrhage. EDTA treatment profoundly impaired neutrophil recruitment, suggesting the involvement of a metalloproteinase on venoms-induced neutrophil recruitment. Pretreatment with dexamethasone and zileuton, a 5-lipoxygenase inhibitor, significantly reduced neutrophil migration, but indomethacin and montelukast, a cysteinyl leukotriene receptor antagonist, had no effect, suggesting the involvement of lipoxygenase-derived metabolites, probably LTB(4). Together, these results show that B. bilineata and B. taeniata venoms induce a marked inflammatory reaction, with leukocyte recruitment, and hemorrhage, which parallels to a high proteolytic activity found in these venoms.     

Skin test reactivity and Der p-induced interleukin 10 production in patients with asthma or rhinitis infected with Ascaris.

BACKGROUND: Helminth infections have been associated with reduced reactivity to aeroallergens, which could be related to interleukin 10 (IL-10) production, as reported in schistosomiasis. OBJECTIVE: To compare skin responses to aeroallergens with Der p specific IL-10 production in patients with asthma or rhinitis according to Ascaris infection status. METHODS: Cross-sectional study of 113 patients with asthma or rhinitis from a region endemic for geohelminths. Stool examinations and skin prick tests to aeroallergens were performed in all the patients. Der p specific IL-10 production was measured in the supernatant of peripheral blood mononuclear cell (PBMC) cultures of a subsample of 53 patients. RESULTS: Forty-seven patients had Ascaris in their stool samples. Skin test results were positive in 77% of Ascaris-infected patients and in 71% of uninfected individuals. Median levels of Der p specific IL- 10 in PBMC cultures of infected and uninfected patients were similar (7.8 and 8.4 pg/mL, respectively). The lack of association remained when parasite load was taken into account and when patients with evidence of previous infection were removed from the uninfected group. CONCLUSIONS: In patients with asthma or rhinitis living in an urban area endemic for geohelminths, we found no association between Ascaris infection and skin reactivity to aeroallergens. Furthermore, there was no difference in Der p specific IL-10 production by PBMCs. These negative findings indicate that different from what is observed in Schistosoma infection, Ascaris lumbricoides infection in individuals living in an urban area does not induce strong regulatory responses.     

Consultation-Liaison psychiatric service delivery: results from a European study.

The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.     

Bilateral coordination and motor sequencing in Brazilian children: preliminary construct validity and reliability analysis

This study examined aspects of reliability and validity of the bilateral coordination and motor sequencing items of the Assessment of Motor Coordination and Dexterity (AMCD) for Brazilian children ages 4, 6 and 8 years old. The AMCD aims to identify children with developmental coordination disorder (DCD). A total of 84 children were evaluated. Among the 35 items piloted, all but one presented interrater reliability above 0.80 and 16 (45.7%) items presented intraclass correlation coefficient over 0.60 for test–retest reliability. Most items were sensitive to age difference and only items involving ball handling exhibited significant gender differences. As a result, this section of the AMCD could be reduced to the 20 items that were found to be reliable and more discriminative for age‐related differences. This study advances on the development of the AMCD, but a limitation was the noninclusion of children with DCD. Future research should investigate whether the selected items are useful in differentiating the motor skills of children with and without coordination problems. Copyright © 2009 John Wiley & Sons, Ltd.