Evaluation of surgical treatment results for pneumothorax in patients from the Institute of Tuberculosis and Chest Diseases

2421 patients with pneumothorax (491 women and 1930 men), at the mean age of 42 years were treated in the Institute of TB and Lung Diseases in years 1975-1997. There were 2209 cases with primary pneumothorax and 739 (33%) cases with recurrent pneumothorax. Among these 739 patients, only 439 patients were treated previously in the Institute of TB and Lung Diseases because of the primary pneumothorax. Percentage of the "own recurrences" was 16.7%. Only 34% of patients were admitted to the hospital before the elapse of 12 hours after the appearance of symptoms; the next 11% of patients--before 24 hours. The rest of the patients were hospitalised later than the above mentioned time, even 7 days after the first symptoms. A mean duration of hospitalisation of patients with primary pneumothorax was 12 days, with the recurrent pneumothorax--13.6 days. In 1/3 of patients pneumothorax was related to exertion. Chest X-ray showed partial pneumothorax in 3/4 of patients, total pneumothorax--in 1/4 of patients. The general condition of 1/3 of patients was assessed as medium-heavy and heavy. In 703 cases (29%) coexistence of emphysema bullosa was found, in 524 cases (22%)--a past tuberculosis lesions, in 42 cases--neoplasm, in 589 cases (20%)--inflammation of the respiratory system. Conservative management was applied in 211 patients (7%). It was satisfactory in 94% of cases. The intercostal tube drainage was performed in 2583 patients (88%). The duration of drainage lasted from 2 to 551 days (x = 6.6 (4.9 days). The results of treatment were satisfactory in 76% of cases, without any complications. In 331 patients the most important complication was the leakage of air lasting longer than 7 days. In 167 patients the result of treatment was unsatisfactory. Thoracotomy was performed on 152 patients. Twelve patients (0.46%) died.     

Senile delirium with special reference to situational factors and recurrent delirium

Factors initiating senile delirium were examined in 129 elderly inpatients (65 years or older). Sixty-eight patients were males and 61 females, with a mean age of 76.3 years. Delirium developed in most cases on the first two days of admission in the hospital, and the admission appeared to be a key factor precipitating delirium in about 30% of the patients. Delirium resolved or improved in 80% of the patients, but usually persisted in patients with dementia. Senile delirium tended to reappear repeatedly in patients whose episode of delirium lasted for more than 2 weeks, was associated with dementia, or had a prior history of delirium.     

Stability,permeation, and cytotoxicity reduction of capsicum extract nanoparticles loaded hydrogel containing wax gourd extract

The aim of this study was to develop hydrogel loaded with capsicum extract nanoparticles and wax gourd extract for transdermal delivery of capsaicin. The addition of wax gourd extract was supposed to reduce cytotoxicity of capsaicin in capsicum extract against HaCaT keratinocyte cell line. Capsicum extract nanoparticles were prepared by solvent displacement method using hyaluronic acid as a stabilizer. The physical and chemical stability of capsicum extract nanoparticles were investigated by dynamic light scattering technique and UV–Visible spectrophotometry, respectively. Hydrogel loaded with capsicum extract nanoparticles and wax gourd fruit extract was then formulated by using Carbopol 940® as a gelling agent for transdermal delivery. The skin permeability of capsaicin from the hydrogel was evaluated by Franz diffusion cell approach. The cytotoxicity reduction of capsicum extract nanoparticles and capsicum extract nanoparticles by mixing with wax gourd extract was determined by MTT assay The results showed that capsicum extract nanoparticles exhibited an average diameter of 168.4 ± 5.3 nm with a polydispersity index and zeta potential value of 0.26 ± 0.01 and −45.7 ± 7.1 mV, respectively. After two month-storage, particle size, polydispersity index, and zeta potential values of capsicum extract nanoparticles stored at 4° C, 30° C, and 45 °C did not significantly change. The capsaicin content decreased to 78%, 71%, and 72% when stored at 4 °C, 30 °C, and 45 °C for three months, respectively. The pH values of hydrogel containing capsicum extract nanoparticles were found to be in the range of 5.58–6.05 indicating good stability. The hydrogel exhibited a pseudoplastic character. The rate of permeation flux of capsaicin from hydrogel was 7.96 µg/cm²/h. A significant increase in cell viability was observed when the cells were incubated with capsicum extract nanoparticles mixed with wax gourd, compared to capsicum extract nanoparticles alone. The wax gourd extract in the hydrogel protected HaCaT cells from capsaicin cytotoxicity, thus may provide a new approach for delivery of capsaicin to reduce cytotoxicity to skin cells.     

Autoimmune therapies targeting costimulation and emerging trends in multivalent therapeutics

Proteins participating in immunological signaling have emerged as important targets for controlling the immune response. A multitude of receptor-ligand pairs that regulate signaling pathways of the immune response have been identified. In the complex milieu of immune signaling, therapeutic agents targeting mediators of cellular signaling often either activate an inflammatory immune response or induce tolerance. This review is primarily focused on therapeutics that inhibit the inflammatory immune response by targeting membrane-bound proteins regulating costimulation or mediating immune-cell adhesion. Many of these signals participate in larger, organized structures such as the immunological synapse. Receptor clustering and arrangement into organized structures is also reviewed and emerging trends implicating a potential role for multivalent therapeutics is posited.     

Clinical and Laboratory Characteristics of a Tinea Capitis Outbreak Among Novice Buddhist Monks

Sixty novice Buddhist monks with tinea capitis confirmed according to clinical presentation and mycological laboratory finding were included in this study. Mixed‐type clinical presentation was observed in approximately half of all cases, together with scarring alopecia (95%) and superficial fungal skin infection at locations other than the scalp (43.3%). The major isolated organism was Trichophyton violaceum, and mixed‐organism infection was found in 27 cases (45%). Slow‐onset presentation and an extensive area of infection were significantly associated with mixed‐type clinical presentation.     

Livedoid vasculopathy: Clinical course and long‐term outcome in Asian patients with a review of the literature

Livedoid vasculopathy (LV) is an uncommon, chronic, and recurrent thrombo‐occlusive vascular disorder. Data specific to LV in Thai population remains scarce. This study aimed to evaluate the clinical course and treatment outcomes of LV in Thai patients, and to perform a literature review for studies that reported on anticoagulant treatment in LV. Seventy‐four patients with a mean age of 37.6 ± 14.7 years were included. The female to male ratio was 5.2:1, and the median follow‐up was 10.5 months. Most patients had primary LV disorder. Forty‐eight patients were improved with treatments, with a median duration of 11.4 months. Combination treatments were commonly used, including anti‐inflammatories, antiplatelets, and immunosuppressants. Add‐on therapy with anticoagulant or psoralen plus ultraviolet‐A (PUVA) led to disease improvement in a majority of the patients treated. Kaplan‐Meier analysis demonstrated that 38.5%, 53.7%, and 57.9% would have disease improvement at 1, 2, and 3 years, respectively. Of 39 studies (n = 219) that reported on anticoagulant treatment in LV, anticoagulant drug was used as monotherapy in 104 patients. The mean duration of anticoagulant treatment was 7.2 ± 3.8 months, which led to disease improvement in 97 patients (93.3%). Bleeding side effect was found in 9 patients (8.7%). The highest incidence of LV was found among females aged 30 to 40 years. Combination therapy with anti‐inflammatory drugs, antiplatelet drugs, and immunosuppressants led to disease improvement. The observed efficacy of add‐on PUVA or anticoagulant is promising and should be further investigated. Further studies are needed to guide the development of an LV management guideline.