Epilepsy-associated stigma in Bolivia: A community-based study among the Guarani population: An International League Against Epilepsy/International Bureau for Epilepsy/World Health Organization Global Campaign Against Epilepsy Regional Project

Epilepsy is associated with a significant burden of social stigma that appears to be influenced by psychosocial and cultural factors. Stigma has a negative effect on the management of people with epilepsy (PWE), representing one of the major factors that contribute to the burden of epilepsy. To assess stigma perception among the Guarani population, one hundred thirty-two people living in Guaraní communities in Bolivia were invited to complete the Stigma Scale of Epilepsy questionnaire. The main determinants of stigma identified were: the fear linked to loss of control, the feelings of sadness and pity toward PWE, the difficulties faced by PWE in the professional and relationship fields, the level of education and type of seizure. Our study pointed out that, in this population, PWE face difficulties in everyday life because of epilepsy-associated stigma and the results attest to the importance of promoting community-based educational programs aimed at reducing the stigmatization process.     

In vitro controlled release of antihypertensive drugs intercalated into unmodified SBA-15 and MgO modified SBA-15 matrices

The aim of the present study was two-fold: (1) to investigate the effect of pH and presence of surfactant sodium lauryl sulphate (SLS) on the solubility and dissolution rate of two solid-state forms of piroxicam (PRX), anhydrate (PRXAH) and monohydrate (PRXMH), and (2) to quantitatively assess the solid-phase transformation of PRXAH to PRXMH in slurry with a special interest to the impact on the solubility and dissolution behavior of the drug. X-ray powder diffractometry (XRPD), Raman spectroscopy and scanning electron microscopy (SEM) were used for characterization of the solid-state forms. Phase transformation was monitored in slurry by means of in-line Raman spectroscopy, and the partial least squares (PLS) regression model was used for predicting the amount of PRXMH. The results showed that the solubility and dissolution rate of PRXAH were higher compared to PRXMH at different pHs. The pH and presence of SLS together affected the solubility and dissolution rate of different PRX forms. The lowest solubility values and dissolution rates for PRX forms were observed in distilled water (pH 5.6) at 37 °C. The changes in the dissolution rate could be explained by the hydrate formation during solubility testing. The rate of hydrate formation was also dependent on the pH of the dissolution medium.     

NK cell immunotherapy for high-risk neuroblastoma relapse after haploidentical HSCT

Little is known on strategies to prevent or to treat relapses occurring after haploidentical stem cell transplantation (haplo-HSCT) performed for the high-risk neuroblastoma (NB). We describe a 6-year-old male with refractory NB who relapsed 22 months after haplo-HSCT. A complete remission was obtained with a combination of immuno-chemotherapy based on donor NK cells transplants, IL2 infusions and temozolomide/topotecan. This case is an incentive to explore both the immediate therapeutic effect of haplo-graft provided via haplo-NK cells and the immunogenic platform that haplo-HSCT offers for future treatment. Our post-relapse strategy shows that chemo- and bio-treatment should be viewed as complementary therapeutic options.     

Long-Term Corrosion Testing of Zy-4 in a LiOH Solution under High Pressure and Temperature Conditions

The fuel cladding is one of the most important structural components for maintaining the integrity of a fuel channel and for safely exploitation of a nuclear power plant. The corrosion behavior of a fuel cladding material, Zy-4, under high pressure and temperatures conditions, was analyzed in a static isothermal autoclave under simulated primary water conditions—a LiOH solution at 310 °C and 10 MPa for up to 3024 h. After this, the oxides grown on the Zy-4 sample surface were characterized using electrochemical measurements, gravimetric analysis, metallographic analysis, SEM and XPS. The maximum oxide thicknesses evaluated by gravimetric and SEM measurements were in good agreement; both values were around 1.2 µm. The optical light microscopy (OLM) investigations identified the presence of small hydrides uniformly distributed horizontally across the alloy. EIS impedance spectra showed an increase in the oxide impedance for the samples oxidized for a long time. EIS plots has the best fit with an equivalent circuit which illustrated an oxide model that has two oxide layers: an inner oxide layer and outer layer. The EIS results showed that the inner layer was a barrier layer, and the outer layer was a porous layer. Potentiodynamic polarization results demonstrated superior corrosion resistance of the samples tested for longer periods of time. By XPS measurements we identified all five oxidation states of zirconium: Zr⁰ located at 178.5 eV; Zr⁴⁺ at 182.8 eV; and the three suboxides, Zr⁺, Zr²⁺ and Zr³⁺ at 179.7, 180.8 and 181.8 eV, respectively. The determination of Vickers microhardness completed the investigation.     

When is it a diagnosis of overlap syndrome?

The connective tissue diseases comprise a group of syndromes of unknown etiology affecting as many as 1 person in 40, often with a predilection for the female sex. Included are: systemic lupus erytematosus (SLE), polymyositis and dermatomyositis, Sj?gren syndrome, scleroderma and the vasculitis (polyarteritis nodosa, Wegener's, giant cell arteritis). There are patients who are not easily defined; having features overlapping with those of other connective tissue diseases. A variety of terms such as mixed connective tissue disease, undifferentiated connective tissue syndrome and overlap syndrome have emerged to describe such patients. Although many of these overlap syndromes are unlikely to have life-threatening consequences, they may be extremely debilitating and distressing, significantly reducing quality of life for the patient and his or her family. We present the case of a patient initially diagnosed with dermatomyositis and who eventually evolved to overlap syndrome by developing SLE.     

Effect of Deintensifying Diabetes Medications on Negative Events in Older Veteran Nursing Home Residents

OBJECTIVEGuidelines advocate against tight glycemic control in older nursing home (NH) residents with advanced dementia (AD) or limited life expectancy (LLE). We evaluated the effect of deintensifying diabetes medications with regard to all-cause emergency department (ED) visits, hospitalizations, and death in NH residents with LLE/AD and tight glycemic control.RESEARCH DESIGN AND METHODSWe conducted a national retrospective cohort study of 2,082 newly admitted nonhospice veteran NH residents with LLE/AD potentially overtreated for diabetes (HbA_1c ≤7.5% and one or more diabetes medications) in fiscal years 2009–2015. Diabetes treatment deintensification (dose decrease or discontinuation of a noninsulin agent or stopping insulin sustained ≥7 days) was identified within 30 days after HbA_1c measurement. To adjust for confounding, we used entropy weights to balance covariates between NH residents who deintensified versus continued medications. We used the Aalen-Johansen estimator to calculate the 60-day cumulative incidence and risk ratios (RRs) for ED or hospital visits and deaths.RESULTSDiabetes medications were deintensified for 27% of residents. In the subsequent 60 days, 28.5% of all residents were transferred to the ED or acute hospital setting for any cause and 3.9% died. After entropy weighting, deintensifying was not associated with 60-day all-cause ED visits or hospitalizations (RR 0.99 [95% CI 0.84, 1.18]) or 60-day mortality (1.52 [0.89, 2.81]).CONCLUSIONSAmong NH residents with LLE/AD who may be inappropriately overtreated with tight glycemic control, deintensification of diabetes medications was not associated with increased risk of 60-day all-cause ED visits, hospitalization, or death.     

Simultaneously Embedding Indomethacin and Electrodeposition of Polypyrrole on Various CoCr Alloys from Ionic Liquids

The aim of the present investigation is the electrochemical deposition of polypyrrole films from choline chloride-based ionic liquids at various potential, period times and simultaneously an indomethacin embedding and release. The electrodeposition films were performed on CoCr commercial type Wirobond C (WBC) and, Heraenium CE (Hera) using as electroprocedures for deposition cyclic voltammetry and chronoamperometry. The morphology of obtained films was investigated using scanning electron microscopy (SEM). An FT-IR investigation of CoCr alloys before and after electrodeposition was able to identify the presence of polymer and drug. The research included an evaluation of the hydrophilic character of all studied samples and their electrochemical characterization in Tanni Zuchi artificial saliva. In the electrochemical study, the following methods have been used: open circuit potential, electrochemical impedance spectroscopy and potentiodynamic polarization. Indomethacin release from the polymeric film was determined using UV-VIS spectra. Based on Fick’s law of diffusion and indomethacin release profile, a kinetic law for release was established and discussed.     

Atrapamiento de cabeza fetal en útero septo

Septate uterus, which occurs in approximately 1% of fertile women, is considered the most common uterine anomaly but is associated with the poorest reproductive results. Uterine anomalies are especially associated with difficulty in maintaining a pregnancy to full term, often leading to late miscarriage or preterm delivery. We present a case of fetal microcephaly in a woman with septate uterus as a consequence of trapping of the fetal head between the septum and one of the uterine walls.     

Histiocytic sarcoma that mimicks benign histiocytosis

A 28-year-old man presented with a histiocytic sarcoma of a very uncommon origin, as it had developed for several years like a benign cutaneous histiocytosis resembling generalized eruptive histiocytoma before becoming acute, with nodal and massive pulmonary involvement. Despite various chemotherapies, the patient died within 8 months. Skin biopsies showed histiocytic proliferation in the dermis and node biopsies showed histiocytic proliferation with a sinusoidal pattern. Immunohistochemical analysis, performed on paraffin-embedded sections, demonstrated strong labeling of tumoral cells for CD68 and moderate labeling for CDS and CD4. CD30 labeling was negative. S-100 protein was positive on a Langerhans' cell reactive subpopulation. Electron microscopy confirmed the histiocytic nature of malignant cells and showed cytoplasmic inclusions such as regularly laminated bodies, dense bodies and pleomorphic inclusions. No Birbeck granules were seen. A gene rearrangement study of T-cell receptor γ and immunoglobulin heavy chain genes showed a germline configuration. Histiocytic sarcoma is an extremely rare true histiocytic malignancy, the existence of which has been recently debated since it has often been mistaken in the past for large cell lymphomas. Such a deceptive onset as benign cutaneous histiocytosis has not been described in the literature to our knowledge.