Pancreatic Autoantibodies, HLA DR and PTPN22 Polymorphisms in First Degree Relatives of Patients with Type 1 Diabetes and Multiethnic Background

To evaluate the prevalence of pancreatic auto-antibodies (PAb) as well as its relationship with HLA DR B1 and PTPN22 polymorphisms in first degree relatives (FDR) of Brazilian patients with Type 1 diabetes (T1D) and multiethnic background.

FDR of patients with T1D were interviewed and blood was sampled for PAb measurement, HLA DRB1 and PTPN22 genotyping. Genotyping was also performed in index cases.

In FDR (n=78), 16.7% presented at least one PAb. These individuals had a higher prevalence of HLA DRB1* 03 than others (p=0.03), without differences in PTPN22 genotyping. While the genetic profile was similar in FDR with PAb and their index cases, those without PAb had a lower frequency of HLA DR B1 * 03 than their correspondent patients (p=0.009).

In this multiethnic population, a significant proportion of FDR of T1D patients had PAb, which was associated with HLA DR B1 * 03 but not with the PTPN22 polymorphism.

Type 1 diabetes and relatives: Antibodies, genetics

Histological analysis of short-term vital reactions in skin wounds: potential applications in forensic work

In forensic medical work, in cases with homicide suspicion, it is important to be able to determine with the greatest possible precision when injuries occurred and whether during vital, or post-mortem conditions. Although several markers of vitality can be employed, it has been attested that components of the extra-cellular matrix, such as fibrin, are among the earliest to be evidenced. In the present study, the histological-histochemical Mallory's Trichrome staining method, previously selected was tested to determine the presence of vital reaction in Wistar rats through fibrin accumulation by testing three short reaction time intervals: 15, 30 and 60 minutes after the skin wound infliction. For all time intervals tested, including the shortest (15 minutes), the presence of fibrin at the edges of the skin wound was evidenced. The accumulation of fibrin was, nevertheless, more pronounced at 30 and 60 minutes after the wound. It could be concluded that fibrin is a good marker for vital reaction and that it can be detected very early, within a few minutes after the injury. It is proposed that histological method coupled to the histochemical staining technique here tested can be incorporated into routine forensic work as a tool for evidencing the existence or not of vital reaction.

Severe immune haemolytic anaemia due to ceftriaxone in a patient with congenital nephrotic syndrome

AIM

To describe the first case of ceftriaxone-related haemolysis in a patient with congenital nephrotic syndrome (CNS).

BACKGROUND

Severe haemolysis caused by an immune reaction to ceftriaxone has mostly been described in patients with underlying haematological or immune dysfunction.

CASE REPORT

The authors present a 20-month-old boy with CNS of the Finnish type with several previous severe infections treated with ceftriaxone, admitted for suspected sepsis. Following ceftriaxone administration he developed shock secondary to an acute haemolytic reaction, with severe anaemia. Hypersensitivity to ceftriaxone was documented through positive agglutination tests.

CONCLUSION

Onset of haemolysis following ceftriaxone administration, particularly in a patient previously exposed to the drug, must raise the suspicion of a possible immune reaction.

Peritonitis due to Rhizobium radiobacter

ABSTRACT Rhizobium radiobacter (Agrobacterium radiobacter) is an aerobic Gram-negative rod belonging to Agrobacterium genus, a group of phytopathogenic bacteria present in the soil that has been implicated in human opportunistic infections. We report a clinical case of bacterial peritonitis in a 5-year-old child with chronic renal disease in peritoneal dialysis, who had a history of direct soil contact identified. The infection was treated with ceftazidime and piperaciline+tazobactam without relapses or the need to remove the peritoneal dialysis catheter.

[Surgical management of a congenital abdominal aortic coarctation, associated to renal and mesenteric arteries critical stenosis in a 12-years old young boy]

The clinical case of a 12-years old boy complaining of severe and refractory arterial hypertension is reported, in whom an angio-CT evaluation displayed the diagnosis of a congenital abdominal aortic coarctation, associated to a critical stenosis of both renal and superior mesenteric arteries. The patient underwent a complex revascularization procedure, consisting in the implantation of an aorto-aortic bypass graft, followed by both renals and superior mesenteric artery revascularization. The post-operative course was uneventful and blood pressure turned down immediately to normal values. A post-operative angio-CT control revealed the anatomic and functional integrity of the surgical revascularization procedure. The main features of pathology, clinical presentation, diagnosis and surgical management of this exceedingly rare condition are subjected to a discussion, based on an extensive review of the literature published on the topic.

Perceptions in living kidney donation: what protagonists think and feel

BACKGROUND

Although donor perceptions of donation have been evaluated in several programs, evaluation of associated recipients has not been as frequent.

PURPOSE

Our aim was to evaluate and compare after transplantation, donor and recipient perceptions of donation.

METHODS

After transplantation 35 recipients and 45 donors completed a sociodemographic and a donation perception questionnaire. We applied the Fisher test to descriptive (absolute and relative frequency) data.

RESULTS

57.8% of donors were female and 62.9% of recipients male. 53.3% of donors were siblings, 44.5% parents, and 2.2% a daughter. Most recipients (71.9%) thought that the donation was the donors' initiative and 21.9% that it was suggested by medical team. 96.4% responded that it was the donor's wish that determined their decision; 51.4% had serious or some doubts about accepting the option, but for 48.6% it was an easy decision. Among the donors, 88.9% decided by themselves and 8.9% were asked for donation. For 91.1%, their wish was the main reason of the decision, but 8.9% felt a moral obligation; 77.8% thought it was an easy decision, and 17.8% hesitated a little 84.4% were not worried about their future health.

CONCLUSIONS

Altruistic motivations were predominant in both groups. Most recipients thought that the motivation for donation was self-determined, a finding that agreed with donor perceptions. Perceptions about the quality of and changes in emotional relationship were the same in both groups. Donors and recipients referred to the donation process as positive, but there were some negative emotions and perceptions.

Depression and anxiety in living kidney donation: evaluation of donors and recipients

BACKGROUND

Psychosocial status of donors before and after living kidney donor transplantation has been an important concern. Investigations of psychosocial issues in related recipients are not frequent.

AIM

The aims of this study were to evaluate and compare psychopathologic dimensions in donors and recipients before and after transplantation.

METHODS

Thirty-five recipients and 45 donors completed a psychosocial evaluation before and after transplantation. We applied Pearson chi-square, McNemar, Fisher, Wilcoxon, and Mann-Whitney tests as well as linear and logistic regression statistical methods.

RESULTS

Before transplantation 100% of the recipients presented total anxiety, compared with 64.4% of donors, with higher anxiety levels in all dimensions (P < .001). Also, 38.7% of recipients and 16.3% of donors had moderate/serious depression (P = .029). Men showed higher levels of cognitive anxiety before transplantation (odds ratio [OR] = 4.3; P = .008). After versus before transplantation central nervous system and cognitive anxiety had diminished in recipients (P = .031; P = .035, respectively); there were higher levels of cognitive anxiety than among the donors (P = .007). Depression showed no significant changes in recipients or donors; the differences were no longer significant. There were less severely depressed recipients but an increase among severely depressed donors. Male recipients and donors showed greater cognitive anxiety (P = .02; P = .04, respectively) at both times. Female recipients presented with more severe depression (P = .036).

CONCLUSIONS

Anxiety is an important symptom. Surgery had a positive impact to lower anxiety in recipients. Most protagonists displayed little or no depression; it was more prevalent among recipients. Donors and recipients maintained some psychopathologic symptoms after surgery. We defined vulnerable groups among these cohorts.

Single-crystal study on the heavy-fermion antiferromagnet UZn₁₂

Millimetre size UZn(12) single crystals were grown by the high temperature solution growth method using zinc as the solvent. Single-crystal x-ray diffraction data confirm that this compound crystallizes in the hexagonal high temperature form of SmZn(12) (S.G. P6/mmm) and points to a U(1.01(1))Zn(11.7(1)) stoichiometry for the crystals, with ∼ 4% of the U atoms being located at the 2c site due to the partial substitution of 4h Zn pairs. UZn(12) orders antiferromagnetically at T(N) = 5.0(2) K, and the magnetization and resistivity measurements suggest that the magnetic moments are confined within the a-b plane. The Sommerfeld coefficient, derived from the paramagnetic region by the standard method, is γ(p)≈200 mJ (mol K(2))( - 1), which definitely classifies UZn(12) as a moderate heavy-fermion system. The heavy-fermion character of UZn(12) is also manifested in the overall shape of temperature-dependent electrical resistivity that is dominated by a single-ion Kondo effect at high temperatures and coherent Kondo scattering at low temperatures. The paramagnetic magnetoresistivity isotherms can be fairly well superimposed onto each other using Schlottmann's scaling for the single-ion Kondo model, as expected for a Kondo system.

[Endovascular thrombolysis for massive cerebral venous thrombosis in a teenager with nephrotic syndrome]

Cerebral venous thrombosis is a rare but potentially severe condition in children. We present the case of a teenager with corticodependent nephrotic syndrome diagnosed at five months of age and treated with cyclosporine A. In the context of recurrence of nephrotic syndrome he presented with headache, vomiting and severe intracranial hypertension. While the raised intracranial pressure and the status epilepticus were controlled, the brain imaging revealed venous thrombosis of all venous sinus, with absence of venous drainage. He was submitted to local thrombolysis with recombinant tissue plasminogen activator, with recanalization of the venous sinuses. The outcome was favourable, without neurological deficits. In this case, the early radiologic intervention was crucial, enabling a full neurological recovery, in a teenager whose initial prognosis was very poor.