Utility of three scales to determine early mortality in patients with alcoholic hepatitis in the Hospital General de Mexico

"Background: There are many models to predict survival in patients with alcoholic hepatitis (AH). The most commonly used are the modified Maddrey′s index, the Glasgow scale and the Model for End stage Liver Disease (MELD). Objective: To evaluate three prognostic scales ability to predict early mortality (first 30 days) in patients with AH. Methods: We retrospectively reviewed the database of hospitalized patients with AH during a 3-years period. Seventy one patients were included. We calculated the modified Maddrey′s index, the Glasgow scale and the MELD scores. We evaluated if the scales predicted early (30-day) mortality. For each scale we determined sensitivity, specificity, positive and negative values (PPV and NPV) and likelihood value of each scale. Results: For modified Maddrey′s index, the values obtained were sensitivity 98.8%, specificity 11.7%, PPV 61.6%, NPV 87.5% and likelihood ratio 1.12. For Glasgow scale corresponding values were sensitivity 98.8%, specificity 61.7%, PPV 78.7%, NPV 97.4% and likelihood ratio 2.64. For the MELD scale sensitivity 98.8%, specificity 0.1%, PPV 59%, NPV 50% and likelihood ratio 1. Conclusions: The three scales were very sensitive. Glasgow′s scale was the most specific and, maybe, the most exact test."     

Production of antigenic extracellular polysaccharides by penicillium aurantiogriseum and penicillium digitatum

Antigenic extracellular polysaccharides (EPS) were produced by Penicillium digitatum and P. aurantiogriseum under various conditions, including different carbon and nitrogen sources, glucose concentrations and incubation periods. With lactate as carbon source no antigenic EPS was produced. EPS consisted mainly of glucose, mannose and galactose. Differences were seen in the monosaccharide composition. The amount of glucose in the medium (1–30 g/l) influenced growth and the production of antigenic EPS moderately. The antigenicity of P. aurantiogriseum EPS, but not that of P. digitatum, decreased with prolonged incubation. P. aurantiogriseum, but not P. digitatum, grew well with nitrate as the nitrogen source.     

Management of the hemophilic pseudotumor of the abdomen: A rare pathological entity

INTRODUCTION

Hemophilic pseudotumor is a rare complication that occurs in patients with severe hemophilia. Results from multiple episodes of bleeding into the bones and soft tissues.

PRESENTATION OF CASE

A 31 years old male patient, with severe hemophilia A. Diagnosed with an abdominal tumor 10 years ago during routine screening, that progressively grew to encompass the entire abdominal area, with symptoms of intestinal obstruction.

DISCUSSION

Hemophilic pseudotumor appears as a painless tumor of slow growth that can compress vital organs producing bone destruction, muscle and skin necrosis. The tumor may have fistulas or break spontaneously.

CONCLUSION

The abdominal hemophilic pseudotumor is a rare pathological entity, with few reports worldwide, but must be considered in hemophilic patients with a well documented abdominal tumor.     

Body Region Involvement and Quality of Life in Psoriasis: Analysis of a Randomized Controlled Trial of Adalimumab

Background

Psoriasis severity and treatment responsiveness vary by body region, which differentially impacts quality of life (QoL).

Objective

The objective of the study was to examine adalimumab efficacy by body region and regional response and QoL relationship.

Methods

Patients (n = 1212) with moderate-to-severe psoriasis were randomized 2:1 to 80 mg at week 0, followed by adalimumab 40 mg or placebo every other week for 16 weeks in the double-blind REVEAL study. Psoriasis Area and Severity Index (PASI) responses and Dermatology Life Quality Index outcomes were analyzed.

Results

Week 16 regional mean PASI improvements were significantly greater with adalimumab (83.1 ± 1.57, 81.3 ± 1.58, 75.7 ± 1.34, and 73.9 ± 1.26% in the trunk, head, upper extremities, and lower extremities, respectively; all p < 0.001 vs. placebo). Likewise, percentages of patients with regional PASI ≥75/≥90/100% reduction from baseline were significantly higher with adalimumab (all p < 0.001); adalimumab responses were greater for the trunk (77.9/65.0/59.1%) and head (74.6/66.1/62.8%; all p ≤ 0.0001 vs. lower) than upper (67.7/45.1/39.6%; p = 0.4, p = 0.04, p = 0.0005, respectively, vs. lower) and lower extremities (65.7/40.0/31.3%). Adalimumab significantly improved Dermatology Life Quality Index scores vs. placebo (8.2- vs 1.7-point decrease from baseline; p < 0.001).

Limitations

The study was a post hoc analysis.

Conclusions

Adalimumab treatment resulted in statistically significant and clinically meaningful improvements in disease severity and QoL. QoL improvements were associated with PASI responses in all body regions.

Trial Registration

ClinicalTrials.gov identifier NCT00237887.

     

Strenuous physical exercise adversely affects monocyte chemotaxis

Physical exercise is important for proper cardiovascular function and disease prevention, but it may influence the immune system. We evaluated the effect of strenuous exercise on monocyte chemotaxis. Monocytes were isolated from blood of 13 young, healthy, sedentary individuals participating in a three-week training program which consisted of repeated exercise bouts. Monocyte chemotaxis and serological biomarkers were investigated at baseline, after three weeks training and after four weeks recovery. Chemotaxis towards vascular endothelial growth factor-A (VEGF-A) and transforming growth factor-β1 (TGF-β1) was completely inhibited immediately after training (p<0.01), and remained so after four weeks recovery. Likewise, monocyte chemoattractant protein-1 (MCP-1)-induced migration declined after training (p<0.01) and improved only partially during the recovery period. MCP-1 serum levels were significantly reduced after four weeks recovery compared to baseline (p<0.01). Total blood antioxidant capacity was enhanced at this time point (p<0.01). Monocyte chemokinesis, TGF-β1 and nitric oxide serum levels remained unchanged during the study. Strenuous three-week training consisting of repeated exercise bouts in healthy, sedentary individuals reduces monocyte chemotaxis. It remains to be established, whether this is a sound adaptation to increased stimuli or an untoward reaction to overtraining. Nevertheless, the effect remains for several weeks with no exercise.