Nocardiosis is a life-threatening infection usually affecting immunocompromised patients. Very rarely it presented with intracranial abscesses and pleuro-parenchymal infections. We herein report a ...very challenging case of a 34-year-old obese and diabetic man affected by disseminated nocardiosis with multiple brain abscesses and pleural empyema. Despite rare, this entity should be taken into account by the pathologists and urgently communicated to clinicians in order to promptly start an effective treatment.
Abstract Study question Do Rekovelle® and Gonal-F® modulate preparation-specific signalling? Summary answer Gonal-F® and Rekovelle® induce preparation-specific pattern of intracellular signalling. ...What is known already Rekovelle® and Gonal-F® are two commercial preparations of recombinant FSH used in assisted reproduction. These preparations differ in originator cells (PER.C6® cell line of human fetal retinal origin for Rekovlle®; modified Chinese Hamster Ovary cell line for Gonal-F®), likely reflecting glycosylation profiles impacting their mode of action. Study design, size, duration 3-year in vitro functional comparison of Rekovelle® and Gonal-F®, using the transfected HEK293 cell line expressing FSH receptor (FSHR). Participants/materials, setting, methods FSHR-expressing HEK293 cells were treated with increasing concentrations of GonalF® and Rekovelle® (pM-µM) to evaluate receptor-receptor interaction and trafficking, intracellular cyclic adenosine monophosphate (cAMP) and Ca2+ increase by bioimaging techniques, as well as phospho-protein by Western blotting, and genomic effects by CRE-luciferase reporter gene activity. Main results and the role of chance Both the preparations induced similar, dose-dependent increase of receptor trafficking through intracellular organelles. These data were obtained by evaluation of the interaction between FSHR and endosomal markers RAB-GTPases (Rab) 5 and 7. Rekovelle® induced more pronounced steroifogenic signals than Gonal-F®, detected as FSHR-FSHR interactions at the cell membrane, cAMP accumulation, cAMP-responsive elements binding protein (CREB) phosphorylation and CRE promoter activity. Interestingly, while cell treatment by Gonal-F® mediated complete dose-response of cAMP, consisting in the continuous increase of the second messenger together with the increase of FSH concentration, Rekovelle® had biphasic action where cAMP increased from 0 to 100 nM although decreased at 1 µM Rekovelle® dose. Moreover, Rekovelle® was 10-times more potent than Gonal-F® in activating intracellular Ca2+ activation. The two preparations induced similar pattern of extracellular signal-regulated kinases 1 and 2 (ERK1/2) phosphorylation. In conclusion, Rekovelle® has higher potency than Gonal-F® in activating cAMP- and Ca2+-dependent intracellular events, potentially resulting in preparation-specific steroidogenic pattern. Limitations, reasons for caution Experiments were performed in the transfected HEK293 cell line in vitro and should be confirmed by clinical observations. Wider implications of the findings We described different intracellular events mediated by Gonal-F® and Rekovelle® in vitro, likely originated by different glycan profiles and possibly impacting the ovarian response during assisted reproduction. Trial registration number Not Applicable
Living donor liver transplantation (LDLT) for children and adults has gained widespread acceptance due to the severe organ shortage. LDLT provides potential recipients with timely transplantation, ...but this procedure engenders a potentially significant risk to the donor. This study analyzed medical, functional, and psychological donor outcomes after LDLT. Nineteen donors (mean age 33.9 ± 12 years), who underwent hepatectomy for LDLT (13 right lobectomy for adult LDLT) from March 1998 to November 2002, were interviewed at a median of 13 months after donation (range, 2 to 58 months). According to the Clavien System classification, major complications occurred in three donors (16%), and minor in four (21%). The mean length of hospital stay was 5.7 ± 1.6 days. Five patients (27%) needed rehospitalization. Complete recovery was achieved at a mean time of 8.5 ± 3.5 weeks. All 19 donors were able to return to predonation activities. The donor's relationship to the recipient and to their families was improved after donation in all cases; 12 (63%) cited a positive psychological impact on their lives. About 90% would donate again and 84% would recommend donation to someone contemplating it. In conclusion, all donors are alive and well after donation and were able to return to their predonation occupation. Most of them felt that this experience changed their lives for the better and would donate again. Donor safety and quality of life should remain the priority in all donation processes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Quality of life is affected during any illness, especially chronic diseases, such as renal failure.
To evaluate the quality of life after kidney transplantation.
One hundred patients were interviewed ...(60 men, 40 women, mean age 36 ± 10.4 years, median 35 years) from July to October 2000 using the multidimensional questionnaire WHOQL-Bref.
Eighty-eight percent of patients were satisfied/very satisfied with their general health condition. Seventy-seven percent manifested a good capacity to carry out daily activities, and 75% considered themselves satisfied with their work capacity. Quality of life was considered “very good” or “good” among 80%, and “neither good nor bad” in 20%. None considered quality of life in general as “bad” or “very bad.” Most (87%) were satisfied with their current condition and with themselves after the kidney transplant.
Patients perceive kidney transplant as capable of improving their quality of life. The most important finding in this study is that the results of the physical and psychological domains did not show any significant difference. It was possible to conclude that the quality of life for most subjects is related to reduction or disappearance of the symptoms caused by the previous disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing a massive outbreak throughout the world. In this period, diseases other than coronavirus disease (COVID-19) have not ...disappeared; however, it is hard for doctors to diagnose diseases that can mimic the clinical, radiological, and laboratory features of COVID-19, especially rare lung diseases such as acute eosinophilic pneumonia (AEP). We report the clinical case of a young patient who presented to the Emergency Department with respiratory failure and clinical symptoms, radiological aspects, and blood tests compatible with COVID-19; two swabs and a serology test for SARS-CoV-2 were performed, both resulted negative, but the respiratory failure worsened. Peripheral eosinophilia guided us to consider the possibility of a rare disease such as AEP, even if radiology findings were not pathognomonic. Therefore, we decided to perform a flexible bronchoscopy with bronchoalveolar lavage (BAL) at the lingula, which showed the presence of eosinophilia greater than 40%. As a consequence, we treated the patient with high-dose corticosteroids that completely resolved the respiratory symptoms. This case report highlights the difficulty of making alternative diagnoses during the COVID-19 pandemic, especially for rare lung diseases such as AEP, which may have initial characteristics similar to COVID-19. Keywords: COVID-19, acute eosinophilic pneumonia, bronchoalveolar lavage, ground glass opacities
Engagment and retention in care is one of the main aspects not only for the prognosis of the single patient, but also for the treatment as prevention strategy. American data showed a percentage of ...engagement in care ranging between 50 and 59%. Aim of our study was to evaluate the engagement in care after diagnosis and the percentage of viral load suppression in an Italian Public Health System. A retrospective study was conducted in the Modena HIV Surveillance Cohort, which includes all HIV test performed at the Laboratory of Virology of Modena. All new HIV infections diagnosed in subjects older than 17 years and resident in the province of Modena between January 1996 and December 2011 were included. Subjects were classified as currently in care (IC) if followed until June 2011, and lost to follow‐up (LF) if their last visit was recorded more than one year before June 2011. 962 subjects, 638 males (66.3%), had an HIV diagnosis during the study period. 71 (7.4%) were not linked to care, 891 were linked to care (92.6%) and 96 (10.8) of them died during the study period. In the 15 years, 625 out of 795 prevalent patients (excluding dead) (78.6%) were IC and 170 (21.4%) were LF. As June 2011, 570 patients were on antiretroviral treatment and 516 (90.5%) of them had an undetectable HIV RNA. At univariate analysis LF were younger than IC (median 32 vs 36 years; p<0.001); more frequently had a foreign origin (49.4% vs 30.6%; p<0.001) and were drug users (17.1% vs 7.0%; P<0.001). Determinants to be a LF, by using a multivariate model, were: age (OR 0.97; 95% CI 0.94‐0.99; p≤0.001), foreign origin (OR 3.45; 95% CI 2.24–5.33; p<0.001); while, being MSM vs drug user (p=0.001), heterosexual vs drug users (p<0.001) and having received an HIV diagnosis in more recent years, i.e. 2006–2011 vs 1996–2000 (p<0.001) were good predictors to be a IC. Considering the all prevalence, 962 subjects, the percentage of subject receiving antiretroviral treatment was 71.7% and that of those with an undetectable HIV RNA was 64.9%.
In conclusion, in a public health system setting, the percentage of patients not engaged in care or lost to follow‐up could be lower than in other situations as the American one. Nevertheless, if we consider the strategy of treatment as prevention, there is still a lot to do, especially following the patients for a long period.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
To investigate lower urinary tract function in ambulatory children with myelomeningocele.
The urological course of 45 children with myelomeningocele who walked either independently (19 children) or ...with ankle-foot orthotics (26 children) was reviewed. Follow-up ranged from 9 months to 13.5 years (mean 4.75 years).
A normal pattern of voiding was observed both clinically and during urodynamic evaluation in only three of the 45 children, with the remainder displaying neurogenic lower urinary tract dysfunction. The independent walkers and those with orthotics did not differ in the spectrum of lower urinary tract dysfunction or other variables. Those patients with persistent incontinence underwent an initial urodynamic evaluation when older (mean 3.7 years versus 6.4 weeks in those who were continent).
Ambulatory children with myelomeningocele suffer the full spectrum of lower urinary tract dysfunction. Given the potential danger of untreated lower urinary tract dysfunction, ambulatory children with myelomeningocele should receive the same diagnostic and therapeutic attention as their peers with more overt neurological deficits.
Quality of life is affected during any illness, especially chronic diseases, such as renal failure.
To evaluate the quality of life after kidney transplantation.
One hundred patients were interviewed ...(60 men, 40 women, mean age 36 +/- 10.4 years, median 35 years) from July to October 2000 using the multidimensional questionnaire WHOQL-Bref.
Eighty-eight percent of patients were satisfied/very satisfied with their general health condition. Seventy-seven percent manifested a good capacity to carry out daily activities, and 75% considered themselves satisfied with their work capacity. Quality of life was considered "very good" or "good" among 80%, and "neither good nor bad" in 20%. None considered quality of life in general as "bad" or "very bad." Most (87%) were satisfied with their current condition and with themselves after the kidney transplant.
Patients perceive kidney transplant as capable of improving their quality of life. The most important finding in this study is that the results of the physical and psychological domains did not show any significant difference. It was possible to conclude that the quality of life for most subjects is related to reduction or disappearance of the symptoms caused by the previous disease.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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