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Cushing's disease and sphenoidal aspergilloma: A case report

A rare case of isolated sphenoid sinus aspergillosis in a 51-year-old patient, with the clinical and laboratory diagnosis of Cushing's disease but no radiologically confirmed tumor is presented. The patient made a complete recovery after treatment. The radiologic findings and the management of this potential disease are discussed.

Reproductive Requirements and Life Cycle of Iberorhyzobius rondensis (Coleoptera: Coccinellidae), Potential Biological Control Agent of Matsucoccus feytaudi (Hemiptera: Matsucoccidae)

Several pine bast scales (Hemiptera: Matsucoccidae) are important pests of pine trees in the Northern Hemisphere. Some species are invasive and cause significant economic and environmental impacts. Such is the case with Matsucoccus feytaudi Ducasse, an invasive pest of maritime pine forests in Southeastern France, Italy, and Corsica. The ladybird Iberorhyzobius rondensis (Eizaguirre) is a recently described species that is endemic to the Iberian Peninsula and is a potential candidate for the biological control of M. feytaudi. However, little is known of the biology of I. rondensis. As part of the risk assessment study for a classical biological control program, the phenology and reproductive mechanisms of the beetle were analyzed. I. rondensis is univoltine and is seasonally synchronized with the phenology of the prey M. feytaudi, which is also univoltine. An obligatory reproductive diapause of 5-6 mo and the need to feed on the eggs of the prey to begin oviposition emerged as the two primary mechanisms that assure life cycle synchronization of the ladybird with its prey. Female fecundity was also higher when the ladybirds were fed M. feytaudi eggs. Life cycle synchronization with M. feytaudi and reproduction triggered by consumption of prey eggs indicate that I. rondensis is a promising biological control agent of the pine bast scale.

A case of ecological specialization in ladybirds: Iberorhyzobius rondensis (Coleoptera: Coccinellidae), potential biocontrol agent of Matsucoccus feytaudi (Hemiptera: Matsucoccidae)

Specialization is an important attribute of a biological control agent. The maritime pine bast scale, Matsucoccus feytaudi Ducasse (Hemiptera Matsucoccidae), is an invasive species in Southeast France and the North of Italy. Iberorhyzobius rondensis Eizaguirre (Coleoptera: Coccinellidae), is a recently described ladybird species. Both adults and larvae are predaceous, feeding on egg masses of M. feytaudi, and are strongly attracted to M. feytaudi's sex pheromone. To evaluate the potential of I. rondensis as a biocontrol agent of the scale, we studied its niche breadth and prey range with emphasis on pine forests and hemipterans as tested prey. In this study, I. rondensis was found to achieve complete development only when fed on M. feytaudi egg masses (92.9% survival) and an artificial prey: eggs of Ephestia kuehniella Zeller (27.6% survival). From the 2nd instar onwards, complete development could be achieved using other prey species, although larvae had significantly higher mortality and slower development. In choice tests, M. feytaudi was the preferred prey. Surveys of the ladybird populations in the Iberian Peninsula revealed that it was found exclusively on Pinus pinaster Aiton, the sole host of M. feytaudi. The unusual specialization of I. rondensis, among other predaceous ladybirds, makes it an appropriate candidate for classical biological control of M. feytaudi.

Pneumatic reduction of childhood intussusception. Is prediction of failure important?

BACKGROUND/PURPOSE

Exclusion criteria for enema reduction of intussusception are still a matter of debate. The current study aimed to search for risk factors and to design and evaluate a predictive model of air enema failure.

METHODS

The design was a cross-sectional study. The study was conducted at a tertiary university hospital. The participants were 164 children (mean [SD] age of 11.6 [10.7] months) with intestinal intussusception. The intervention done was pneumatic reduction only contraindicated in case of peritonitis and/or sepsis. For main outcome measures, logistic regression analysis was used to estimate the contribution of clinical parameters (age, sex, weight, clinical evolution, temperature, rectal bleeding, white blood cell count, and neutrophils) to predict the risk of enema failure. To evaluate the discriminating power of the model, a receiver operating characteristic curve was constructed, and the effectiveness at different cutoffs was calculated.

RESULTS

Overall efficacy was 85%; manual reduction was performed in 12 (7.3%) cases, and there were 9 (6.5%) recurrences. Multivariable analysis adjusted for age and sex revealed that delayed diagnosis (evolution >24 hours) and raised neutrophils (%) were associated with failure: odds ratio of 11.52 (95% CI, 3.73-35.54) and 1.06 (95% CI, 1.02-1.11), respectively. The area under the receiver operating characteristic curve was 0.826 (95% CI, 0.740-0.912). At the best cutoff (0.15), the positive predictive value was 35% and the negative 93%. At the cutoff of 0.50, the positive predictive value was 70% and the negative 87%; the sensitivity was 29%.

CONCLUSIONS

The efficacy and safety of pneumatic reduction in childhood intussusception was confirmed. Delayed diagnosis and neutrophils significantly predict outcome. Despite consistent high negative predictive values, the model has low effectiveness in predicting enema failure and may not be clinically relevant; there is no rationale for stricter exclusion criteria.

Individual genetic identification of biological samples: a case of an aircraft accident

In 2003, an aircraft accident occurred in the Madeira island north coast, in which 10 persons (4 female and 6 male) have died. STRs (autosomic and Y-chromosome) and mtDNA were made in order to identify the recovered human body remains and results compared with relatives.

Evaluation of the Asthma Life Quality test for the screening and severity assessment of asthma

BACKGROUND

Asthma Life Quality (ALQ) test, a 20-question questionnaire developed by the American College of Allergy, Asthma and Immunology, has been shown to be useful for asthma diagnosis. We aimed to determine the relation between ALQ scores and (a) diagnosis of asthma; (b) physician's classification of asthma severity according to National Institutes of Health/Global Initiative for Asthma (GINA).

METHODS

Standard translation and cultural adaptation to Portuguese was performed. Patients self-administered the ALQ in the waiting room; the attending allergist classified them, blindly for the test. The scores of nonasthmatics were compared with those of asthma patients. Asthma patients were analyzed in two severity groups: intermittent and mild persistent asthma (IMPA), and moderate and severe persistent asthma (MSPA); sensitivity, specificity, positive and negative predictive values were calculated and receiver operating characteristic curve plotted. Logistic regression analysis models were computed.

RESULTS

From 283 patients, 237 tests were analyzed. Non-asthmatic patients ALQ scores (mean +/- SD) were 6 +/- 4 and, for asthmatics, 10 +/- 5 [mean difference 4.6 (95%CI 3.3-5.9)]. The odds of positive diagnosis increased 1.27 times (95%CI 1.17-1.38) for each one-unit increase in the test. For asthma severity ALQ scores were 9 +/- 4 for IMPA, 15 +/- 3 for MSPA [difference 6.0 (95%CI 4.8-7.1)]; with a sensitivity of 88% and specificity of 74% for a score of 12. The odds of MSPA increased 1.49 times (95%CI 1.28-1.74) per unit increase in ALQ.

CONCLUSIONS

ALQ can help both to identify patients with asthma and to differentiate those more likely to have moderate/severe asthma. These are relevant characteristics for the possible use of this simple, self-administered questionnaire in the assessment of asthma patients needing additional medical management.

Chemical composition and antifungal activity of the essential oil of Thymbra capitata

The composition and the antifungal activity of the essential oil of Thymbra capitata on Candida, Aspergillus and dermatophyte strains were studied. Twenty-two samples of the essential oils from the aerial parts of the plant were obtained by hydrodistillation and analysed by GC and GC-MS. All samples are of the carvacrol type, with a high content of carvacrol (60.0 - 65.8 %) and its biogenetic precursors, gamma-terpinene (8.2 - 9.5 %) and p-cymene (6.0 - 7.5 %). The minimal inhibitory concentration (MIC) and the minimal lethal concentration (MLC) were used to evaluate the antifungal activity against Candida (7 clinical isolates and 3 ATCC type strains), Aspergillus (5 clinical isolates, 2 CECT and 2 ATCC type strains) and 5 dermatophyte clinical strains. To clarify its mechanism of action on Candida strains, the inhibition of germ tube and a flow cytometry assay with propidium iodide (PI) were used. The oil exhibited antifungal activity for all the tested strains, particularly for dermatophytes, with MIC values ranging from 0.08 to 0.32 microL/mL. Regarding Candida, concentrations lower than the MIC values prevented germ tube formation. After a short incubation time the cells incorporated quickly PI, meaning that the fungicidal effect is mainly due to direct lesion of the membrane.

Antifungal activity of Thymus oils and their major compounds

The increasing recognition and importance of fungal infections, the difficulties encountered in their treatment and the increase in resistance to antifungals have stimulated the search for therapeutic alternatives. Essential oils have been used empirically. The essential oils of Thymus (Thymus vulgaris, T. zygis subspecies zygis and T. mastichina subspecies mastichina) have often been used in folk medicine. The aim of the present study was to evaluate objectively the antifungal activity of Thymus oils according to classical bacteriological methodologies - determination of the minimal inhibitory concentration (MIC) and the minimal lethal concentration (MLC) - as well as flow cytometric evaluation. The effect of essential oils upon germ tube formation, an important virulence factor, was also studied. The mechanism of action was studied by flow cytometry, after staining with propidium iodide. The chemical composition of the essential oils was investigated by gas chromatography (GC) and gas chromatography/mass spectroscopy (GC/MS). The antifungal activity of the major components (carvacrol, thymol, p-cymene and 1,8-cineole) and also possible interactions between them were also investigated. The essential oils of T. vulgaris and T. zygis showed similar antifungal activity, which was greater than T. mastichina. MIC and MLC values were similar for all the compounds tested. At MIC values of the essential oils, propidium iodide rapidly penetrated the majority of the yeast cells, indicating that the fungicidal effect resulted primarily from an extensive lesion of the cell membrane. Concentrations below the MIC values significantly inhibited germ tube formation. This study describes the potent antifungal activity of the essential oils of Thymus on Candida spp., warranting future therapeutical trials on mucocutaneous candidosis.

Cushing's disease and sphenoidal aspergilloma

A rare case of isolated sphenoid sinus aspergillosis in a 51-year-old patient, with the clinical and laboratory diagnosis of Cushing's disease but no radiologically confirmed tumor is presented. The patient made a complete recovery after treatment. The radiologic findings and the management of this potential disease are discussed.

Chemical composition and antifungal activity of the essential oil of Origanum virens on Candida species

The composition and the antifungal activity of the essential oil of Origanum virens on Candida species were studied. The essential oil was obtained from the aerial parts of the plant by hydrodistillation and analyzed by GC and GC-MS. The oil was characterized by its high content of carvacrol (68.1 %) and its biogenetic precursors, gamma-terpinene (9.9 %) and p-cymene (4.5 %). The minimal inhibitory concentration (MIC) and the minimal lethal concentration (MLC) were used to evaluate the antifungal activity against Candida strains (7 clinical isolates and 3 ATCC type strains). The inhibition of germ tube formation and flow cytometry, using the fluorescent probe propidium iodide (PI), were used to evaluate their mechanisms of action. MIC and MLC values were similar for most tested strains, ranging from 0.16 to 0.32 microL/mL. Concentrations lower than MIC values strongly prevent germ tube formation. The fungicidal effect is primarily due to an extensive lesion of the membrane.

Cytometric approach for a rapid evaluation of susceptibility of Candida strains to antifungals

OBJECTIVE

To achieve a fast and reliable determination of the susceptibility of Candida strains to amphotericin B (Am B), fluconazole (Flu) and 5-fluorocytosine (5-FC), using cytometric methods as an alternative to the classical dilution method.

METHODS

Twenty-three clinical isolates of Candida with different susceptibility patterns were treated for 1 h with two concentrations each of Am B (2 and 8 mg/L), Flu (8 and 64 mg/L) and 5-FC (4 and 32 mg/L), followed by staining with three different fluorochromes, under conditions previously defined through an optimisation study. These were 1 mg/L propidium iodide (PI)/10(6) cells for 30 min at 30 degrees C (a marker that only penetrates cells with severe lesions of the membrane); 0.5 microM FUN-1/10(6) cells for 30 min at 30 degrees C (a fluorescent probe which after entering the yeast cell is converted, by metabolically active yeasts, from a diffuse cytosolic pool with a yellow-green fluorescence into red cylindrical intravacuolar structures) and 0.25 microM of JC-1/10(6) cells for 15 min at 37 degrees C (a monomer that changes reversibly from green to red the J-aggregates, with the increased membrane potential). About 50 000 yeast cells were analysed by flow cytometry (FCM), at FL3 (red, 620 nm) for PI and FL2 (yellow-green, 575 nm) for FUN-1 and the ratio of FL3 to FL1 was determined (red, 620 nm/green, 525 nm) for JC-1; 200 cells of each suspension were also analysed by epifluorescence microscopy (EPM). Viability studies were performed in parallel to count the number of colony forming units.

RESULTS

Susceptible (S) strains exposed to Am B and stained with JC-1 showed a dose-dependent decrease in the mitochondrial potential, i.e. a decreased ratio between red/green fluorescence by FCM and a decrease in J-aggregates by EPM. Neither FUN-1 nor PI was useful in the study of Am B activity. Susceptibility to Flu and 5-FC could be detected with FUN-1 staining: metabolic changes were detected by an increase in yellow-green intensity of fluorescence by FCM or a decrease of cylindrical intravacuolar structure formation by EPM, although no decrease in total viability was registered. Staining with JC-1 could predict resistance to both drugs, but did not allow distinction between sensitive dose-dependent strains (S-DD) or intermediate (I) resistance to Flu or 5-FC, respectively, from S strains. PI did not stain Candida cells treated with Flu or 5-FC under our experimental conditions.

CONCLUSION

Susceptibility patterns of Candida strains to Am B can be determined by using JC-1, and to Flu and 5-FC by using FUN-1. PI was not a useful probe with which to study the effect of such antifungals under the conditions described here.

[Poetic motivation of material elements: new categories of analysis in the social-poetic approach]

Gauthier and Santos (1996) describes the socio-poetics as na approach of knowledge of human-being and society, a way for the production of knowledge by means of a variety of research practices and education that poetically transforms knowledge for better understanding. The creators of socio-poetics utilize as analysing categories the geo-mitic places, thus stimulating those who work with this approach to create new technics and life experiences in order to improve data production in the research group. Playing attention to this challenge and inspired in the concepts of Material Imagination Gaston Bachelard, C.G. Jung Active Imagination Technic and in the growth experiments of John Stevens's gestalt-therapy, we created the Technic of Material Elements, based in the images provoked by the 4 elements (water, earth fire and air). We concluded that this new technic favored the expression of unconscious or silenced contents that interfere in nurse care, thus allowing nurses to explore themselves creativity and to improved their professional practicing.

ALATOP-RIA in the screening of atopy in a non Caucasian population

ALATOP is an "in vitro" radioimmunoassay screening test for atopy, previously validated in a caucasian population. The aim of the study was to assess the usefulness of a screening test of atopy in a non caucasian population. We select a non caucasian population (n = 208), from hospital immunoallergy consultations, Cape Verde Republic (Africa). It was determined the sensitivity, specificity and predictive values comparing with skin prick tests (SPT) results for the 208 patients, and with clinical data (Clin) in 115 patients. It was also determined the levels of total IgE, done by IRMA.

RESULTS

Using different corrections factors, 0.85 gives the best results: ALATOP/SPT-Sensitivity-88.5% +/- 4.34; Specificity-73.8% +/- 8.41; Positive predictive value-66.9%; Negative predictive value-91.4%; Efficiency of the test-79.3%. ALATOP/CLIN-Sensitivity-95.2% +/- 3.89; Specificity-71.2% +/- 12.07; Positive predictive value-65.6%; Negative predictive value-96.2%; Efficiency of the test-80.0%. The mean values of total IgE were-406 IU/ml.

CONCLUSIONS

The mean value of total IgE was significantly increased even in the ALATOP-/SPT-not saw in caucasian populations. The use of a different correction factor (0.85) for ALATOP, optimize the test, showing a good negative predictive value, but raises the question of adapted compositions of screening tests for different populations.

The mitochondrial A3243G mutation presenting as severe cardiomyopathy

A 6 year old Portuguese boy with dilated cardiomyopathy had abundant ragged red fibres in muscle (20% of total) and severe lactic acidosis. Molecular genetic analysis showed the A to G transition in the mitochondrial transfer RNALeu(UUR) gene at nt 3243 ("MELAS mutation"), which accounted for 88% and 68% of the total mtDNA in his muscle and blood, respectively. Molecular studies in blood from 16 maternal relatives identified lower percentages of the mutation only in the oligo-symptomatic mother and brother. This case reinforces the notion that cardiomyopathy can be the presenting and predominant clinical expression of the A3243G mutation.

[Hepatic fascioliasis]

Hepatic fascioliasis is a pathology with an increasing incidence, morbidity and mortality all over the world and most particularly in our country, where endemic spots have been found, particularly in rural areas. Based on a clinical case which is supported by a revision of appropriate literature, the authors have made relevant considerations on bio-ecology, diagnosis, prognostic and treatment of this disease.

[Tubo-ovarian abscess. An analysis of 20 cases]

The authors make a 3-year retrospective analysis of the tubo-ovarian abscess cases admitted to the Gynecology Ward of Dr Alfredo da Costa Maternity Hospital. In the period studied (1991 through 1993) there were 20 such cases. The incidence in nulliparous patients was 25%. A significant percentage (30%) of the patients had recently undergone uterine instrumentation. A prior history of pelvic inflammatory disease was obtained in only 15% of the cases. In the IUD users the incidence of unilateral and bilateral abscesses was identical. Most patients (85%) became apyretic within 48 hours of instituting intravenous antibiotics. In most cases (90%) the patients underwent surgical therapy. The mean time elapsed between instituting antibiotics and the surgical procedure was 3 days. There was one case of intra-abdominal rupture of the abscess. Intraoperatively, an appendiceal abscess was found in 3 (15%) patients. In 30% of the cases a total hysterectomy with unilateral or bilateral adnexectomy was performed. One of the 2 (10%) patients treated solely with medical therapy presented abscess recurrence one month after hospital discharge. Although the management of tubo-ovarian abscesses has become more conservative it still includes, in most cases, surgical drainage or extirpation after appropriate antibiotic therapy.

Astigmatism after penetrating keratoplasty. Role of the suture technique

The Authors retrospectively evaluated the evolution of corneal astigmatism 6, 12 and 24 months after penetrating keratoplasty in 75 eyes by comparing 2 suture techniques: running suture (RS) in 14 cases vs interrupted suture (IS) in 61 cases. The mean keratometric astigmatism in patients with RS was 7.75 +/- 3.10 D at 6 months, 5.89 +/- 2.50 D at 12 months and 3.90 +/- 1.70 D at 24 months. In patients with IS these values were 4.82 +/- 4.00 D at 6 months, 2.81 +/- 1.60 D at 12 months and 2.77 +/- 1.34 D at 24 months. A significant lower astigmatism (P < 0.05) was noted after using IS at 6 and 12 months. At 24 months, however, this difference was no longer statistically significant (P > 0.3). The IS suture allowed a better control of the post-surgical astigmatism, and a more rapid recovery of the visual acuity.

Local anaesthesia and dry socket. A clinical investigation of single extractions in male patients

1533 single intra-alveolar permanent tooth extractions in males were investigated in a study to determine if the type and technique of local anaesthesia influenced the occurrence of dry socket. The results show that the incidence of dry socket was significantly greater after the use of Xylocaine compared to Citanest and that the use of repeated injections or intraligamental techniques increased the likelihood of this painful post-extraction condition.