Jejunal multiple perforations for combined abdominal typhoid fever and miliary peritoneal tuberculosis

Typhoid fever and tuberculosis, considered rare diseases in western countries, is still considered a notable problem of health issue in developing countries. The gastrointestinal manifestations of typhoid fever are the most common and the typhoid intestinal perforation (TIP) is considered the most dangerous complication. Abdominal localization of tuberculosis is the 6^th most frequent site for extra pulmonary involvement, it can involve any part of the digestive system, including peritoneum, causing miliary peritoneal tuberculosis (MPT). This is the case report of a 4 years old girl with multiple jejunal perforations in a setting of contemporary miliary peritoneal tuberculosis and typhoid fever occurred in "Hopital Saint Jean de Dieu" in Tanguietà, north of Benin. The patient was admitted in the emergency department with an acute abdomen and suspect of intestinal perforation, in very bad clinical conditions, underwent emergency laparotomy. The finding was a multiple perforations of the jejunum in a setting of combined abdominal typhoid fever and miliary peritoneal tuberculosis. Typhoid intestinal perforations and peritoneal tuberculosis are a very rare cause of non-traumatic peritonitis in western country, but still common in developing country. Considering the modern migratory flux and the diffusion of volunteer missions all around the world, the western surgeon should know this pathological entities, and the best treatments available, well known by surgeons with experience of working in developing countries. The combination of both TIP and MPT in the same patient, is a very rare finding which can worsen the outcome of the patient itself.

Pharmacogenetics as a tool to tailor antiretroviral therapy: A review

Highly active antiretroviral therapy (HAART) has substantially changed human immunodeficiency virus (HIV) infection from an inexorably fatal condition into a chronic disease with a longer life expectancy. This means that HIV patients should receive antiretroviral drugs lifelong, and the problems concerning with a chronic treatment (tolerability, side effects, adherence to treatment) have now become dominant. In this context, strategies for the treatment personalization have taken a central role in optimizing the therapeutic response and prevention of adverse drug reactions. In this setting, the study of pharmacogenetics features could be a very useful tool in clinical practice; moreover, nowadays the study of genetic profiles allows optimizations in the therapeutic management of People Living With HIV (PLWH) through the use of test introduced into clinical practice and approved by international guidelines for the adverse effects prevention such as the genetic test HLA-B*5701 to detect hypersensitivity to Abacavir. For other tests further studies are needed: CYP2B6 516 G > T testing may be able to identify patients at higher risk of Central Nervous System side effects following standard dosing of Efavirenz, UGT1A1*28 testing before initiation of antiretroviral therapy containing Atazanavir may aid in identifying individuals at risk of hyperbilirubinaemia. Pharmacogenetics represents a ​​research area with great growth potential which may be useful to guide the rational use of antiretrovirals.

Identification of the IFITM3 gene as an inhibitor of hepatitis C viral translation in a stable STAT1 cell line

To investigate the functions of signal transducers and activators of transcription 1 (STAT1)-induced anti-hepatitis C viral (HCV) effects, a stable Huh7.5 cell line (Huh7.5-STAT1ER) was established that constitutively expresses a fusion protein (STAT1ER) of STAT1 and the mouse oestrogen receptor (ER), which forms STAT1ER homodimers after 4-hydroxytamoxifen (4-HT) treatment. This inducible and cytokine/receptor-independent STAT1 activation system allowed us to investigate the anti-HCV effects of STAT1ER activation after inducing IFN-stimulated gene (ISG) expression. The anti-HCV effects of dimerized STAT1ER fusion protein were determined by real-time PCR in a time-dependent fashion post-HCV (JFH-1) infection. HCV (JFH-1) RNA decreased 48% at 72 h after 4-HT treatment. To distinguish the inhibitory effects of STAT1ER activation on HCV RNA replication or HCV internal ribosomal entry site (IRES)-mediated translation, a dicistronic pRL-HL construct was used in the studies. Both cellular (Cap-dependent) and HCV IRES-mediated (Cap-independent) translation were decreased by 63% and 57% at 72 h post-STAT1ER activation in the STAT1ER cell line. In our previous studies, interferon-induced transmembrane protein 3 [(IFITM3) (1-8U)] was found to inhibit HCV RNA replication. Subsequently, elevated expression of the 1-8U gene was confirmed by Western blotting in the Huh7.5-STAT1ER cell line. To further investigate the 1-8U function with both in vivo and in vitro studies, the 1-8U gene was found to suppress cellular and HCV IRES-mediated translation.

Diagnosis of pancreatic cancer and prediction of unresectability using the tumor-associated antigen CA19-9

Marked elevations of the tumor-associated antigen CA19-9 are relatively specific for pancreatic carcinoma and are associated with more advanced malignancies. We retrospectively reviewed 53 patients with CA19-9 values > 90 U/ml in whom the test had been done because of clinical suspicion of pancreatic malignancy. Pancreatic cancer was found in 45 patients (85%). If a cutoff value of CA19-9 > 200 U/ml is used, 36 of 37 (97%) patients had pancreatic cancer. Thirty patients with pancreatic cancer and no radiographic criteria of unresectability underwent attempted resection; five of these patients were judged to be potentially resectable and four of them underwent attempted resection. In only one patient with a CA19-9 value > 300 U/ml was resection possible; this patient had advanced carcinoma. Our results suggest that, in patients in whom the clinician suspects pancreatic carcinoma, CA19-9 > 90 U/ml is highly suggestive of pancreatic malignancy, while CA19-9 > 200 U/ml is virtually diagnostic of pancreatic malignancy. In similar patients with CA19-9 > 300 U/ml, resection is rarely possible and tumors are advanced.

Treatment of chronic hepatitis

Chronic hepatitis is an etiologically diverse syndrome. The approach to treatment depends on the cause of the disease. The efficacy of immunosuppressive treatment of chronic autoimmune hepatitis has long been established, and most patients with this disease can be treated successfully with prednisone and azathioprine. Interferon therapy has revolutionized the treatment of chronic viral hepatitis. Although the response in chronic hepatitis delta is disappointing, hepatitis C is often controlled, and certain patients with chronic hepatitis B may actually be cured of the disease. Future studies will seek to optimize the therapeutic effects of interferon in these viral diseases. Certainly, studies with other antiviral agents and biologic response modifiers are forthcoming. We have entered a new era in the treatment of chronic liver disease. It is reasonable to hope and expect that progress will continue and that most forms of chronic viral hepatitis will become curable within the next several years.

Isolation of keratinophilic fungi from floors in Roman kindergarten and secondary schools

We examined the dust collected from the floors of forty classrooms, twenty in kindergarten schools (children aged 2-5) and twenty in secondary schools (students aged 11-14) in order to determine the diffusion of keratinophilic fungi in respect to such different factors as human presence and children's age. In the kindergarten schools 268 colonies of keratinophilic fungi were isolated: 50 were Microsporum, 6 Trichophyton and 212 Chrysosporium species. Members of the Chrysosporium genus were found the widely diffused. It is interesting to note the isolation of M. gypseum in two schools. In the secondary schools 847 colonies of keratinophilic fungi were isolated: 727 were Chrysosporium, 81 Microsporum, 38 Trichophyton and 1 Epidermophyton species. Again the Chrysosporium species were the most widely diffused. It is remarkable to point out the isolation of pathogenic species such as Epidermophyton floccosum, Microsporum canis, Microsporum gypseum and the rather rare Microsporum vanbreuseghemii.

Isolation of keratinophilic fungi from floors in Roman primary schools

Keratinophilic fungi are present in the environment with variable distribution patterns that depend on different factors, one of which, of fundamental importance, is human and or animal presence. The present study was conducted in the environment and classrooms of schools in order to evaluate the relationship between the human presence and the presence of keratinophilic fungi. In order to achieve this goal, a new isolation technique was used. From 20 samples, 253 colonies of keratinophilic fungi were isolated. The results showed that species of the genus Chrysosporium were present in 100% of the samples, while Microsporum and Trichophyton species were present in 40% and 65% of the samples respectively. The percentage of three pathogenic species, M. canis (25), T. mentagrophytes (10) and M. gypseum (10) was significant. The other species isolated were: T. terrestre (55%), Trichophyton sp. (35%), M. cookei (25%) and T. ajelloi (10%). A correlation between the amount of gathered dust and the number of colonies of keratinophilic fungi isolated was not found.