Elevated reticulocyte count – a clue to the diagnosis of haemolytic-uraemic syndrome (HUS) associated with gemcitabine therapy for metastatic duodenal papillary carcinoma: a case report

In adults, the haemolytic-uraemic syndrome (HUS) is associated with probable causative factors in the minority of all cases. Cytotoxic drugs are one of these potential causative agents. Although metastatic cancer by itself is a recognized risk-factor for the development of HUS, therapy with mitomycin-C, with cis-platinum, and with bleomycin carries a significant, albeit extremely small, risk for the development of HUS, compared with all other cytotoxic drugs. Gemcitabine is a novel cytotoxic drug with promising activity against pancreatic adenocarcinoma. We are reporting on one patient with metastatic duodenal papillary carcinoma developing HUS while on weekly gemcitabine therapy. The presenting features in this patient were non-cardiac pulmonary oedema, renal failure, thrombocytopenia and haemolytic anaemia. The diagnosis of HUS was made on the day of admission of the patient to this institution. Upon aggressive therapy, including one single haemodialysis and five plasmaphereses, the patient recovered uneventfully, with modestly elevated creatinine-values as a remnant of the acute illness. Re-exposure to gemcitabine 6 months after the episode of HUS instituted for progressive carcinoma, thus far has not caused another episode of HUS. © 1999 Cancer Research Campaig

Chondroitin sulfates and their binding molecules in the central nervous system

Chondroitin sulfate (CS) is the most abundant glycosaminoglycan (GAG) in the central nervous system (CNS) matrix. Its sulfation and epimerization patterns give rise to different forms of CS, which enables it to interact specifically and with a significant affinity with various signalling molecules in the matrix including growth factors, receptors and guidance molecules. These interactions control numerous biological and pathological processes, during development and in adulthood. In this review, we describe the specific interactions of different families of proteins involved in various physiological and cognitive mechanisms with CSs in CNS matrix. A better understanding of these interactions could promote a development of inhibitors to treat neurodegenerative diseases

The dominant Anopheles vectors of human malaria in the Asia-Pacific region: occurrence data, distribution maps and bionomic précis

<p>Abstract</p> <p>Background</p> <p>The final article in a series of three publications examining the global distribution of 41 dominant vector species (DVS) of malaria is presented here. The first publication examined the DVS from the Americas, with the second covering those species present in Africa, Europe and the Middle East. Here we discuss the 19 DVS of the Asian-Pacific region. This region experiences a high diversity of vector species, many occurring sympatrically, which, combined with the occurrence of a high number of species complexes and suspected species complexes, and behavioural plasticity of many of these major vectors, adds a level of entomological complexity not comparable elsewhere globally. To try and untangle the intricacy of the vectors of this region and to increase the effectiveness of vector control interventions, an understanding of the contemporary distribution of each species, combined with a synthesis of the current knowledge of their behaviour and ecology is needed.</p> <p>Results</p> <p>Expert opinion (EO) range maps, created with the most up-to-date expert knowledge of each DVS distribution, were combined with a contemporary database of occurrence data and a suite of open access, environmental and climatic variables. Using the Boosted Regression Tree (BRT) modelling method, distribution maps of each DVS were produced. The occurrence data were abstracted from the formal, published literature, plus other relevant sources, resulting in the collation of DVS occurrence at 10116 locations across 31 countries, of which 8853 were successfully geo-referenced and 7430 were resolved to spatial areas that could be included in the BRT model. A detailed summary of the information on the bionomics of each species and species complex is also presented.</p> <p>Conclusions</p> <p>This article concludes a project aimed to establish the contemporary global distribution of the DVS of malaria. The three articles produced are intended as a detailed reference for scientists continuing research into the aspects of taxonomy, biology and ecology relevant to species-specific vector control. This research is particularly relevant to help unravel the complicated taxonomic status, ecology and epidemiology of the vectors of the Asia-Pacific region. All the occurrence data, predictive maps and EO-shape files generated during the production of these publications will be made available in the public domain. We hope that this will encourage data sharing to improve future iterations of the distribution maps.</p

Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study

Crohn's disease and ulcerative colitis are the two major forms of inflammatory bowel disease; treatment strategies have historically been determined by this binary categorisation. Genetic studies have identified 163 susceptibility loci for inflammatory bowel disease, mostly shared between Crohn's disease and ulcerative colitis. We undertook the largest genotype association study, to date, in widely used clinical subphenotypes of inflammatory bowel disease with the goal of further understanding the biological relations between diseases

Representação da prática gerencial do enfermeiro na unidade de internação: perspectiva da equipe de enfermagem

Objetivo: Compreender os significados que a equipe de enfermagem atribui à prática gerencial do enfermeiro nas unidades de internação.Métodos: Pesquisa exploratória, descritiva, de abordagem qualitativa, desenvolvida em um hospital geral de uma cidade do Sul de Minas Gerais. Utilizou-se a Teoria das Representações Sociais como referencial teórico. A amostra foi composta por 23 técnicos e cinco auxiliares de enfermagem. Os dados foram coletados por um roteiro de entrevista semiestruturada no período de dezembro de 2011 a janeiro de 2012. Para análise dos dados utilizou-se a análise do discurso, na concepção da psicologia social.Resultados: Os significados atribuídos à gerência são elaborados a partir da relação de proximidade/distanciamento da equipe e das ações de cuidado aos pacientes.Conclusões: A gerência, apreendida como processo aparte do cuidado, é qualificada como prática não familiar, de difícil compreensão e valoração.Palavras-chave: Gerência. Enfermagem. Recursos humanos de enfermagem no hospital. Pesquisa qualitativa

Expectativas positivas com o uso de álcool e o beber se embriagando: diferenças de gênero em estudo do Projeto GENACIS, São Paulo, Brasil Positive expectations towards alcohol use and binge drinking: gender differences in a study from the GENACIS project, São Paulo, Brazil

O objetivo deste trabalho foi investigar as expectativas de homens e mulheres com relação ao uso do álcool e a associação dessas com o comportamento de beber com embriaguez. Foi realizado inquérito epidemiológico, domiciliar, transversal, de base populacional, com amostra probabilística estratificada por conglomerados, na Região Metropolitana de São Paulo, Brasil. Foram entrevistadas 2.083 pessoas de ambos os sexos utilizando-se o questionário GENACIS (Gender, Alcohol and Culture: An International Study). Beber com embriaguez foi considerada variável dependente, e foram construídos modelos de regressão logística para cada sexo, ajustando-se os modelos para idade, escolaridade e renda. Todas as expectativas, exceto achar mais fácil falar com companheiro, associaram-se ao comportamento de beber com embriaguez. Nosso estudo mostrou que beber com embriaguez pode estar associado a expectativas com uso do álcool. Compreender essas expectativas pode contribuir para elaboração de estratégias mais efetivas de prevenção do beber excessivo.<br>The objective was to investigate expectations towards alcohol use among men and women and the association between these expectations and binge drinking (or heavy episodic drinking). An epidemiological cross-sectional population-based household survey with a stratified probabilistic sample was conducted in Greater Metropolitan São Paulo, Brazil. Males and females were interviewed (n = 2,083) with the GENACIS questionnaire (Gender, Alcohol, and Culture: an International Study). The dependent variable was binge drinking, and logistic regression models were constructed for each gender, adjusting for age, schooling, and income. All expectations, with the exception of increased ease in talking with one's partner, were associated with binge drinking. The study shows that binge drinking can be associated with expectations towards alcohol use. Understanding such expectations can contribute to the design of effective polices to prevent binge drinking

A role for histone acetylation mechanisms in adolescent alcohol exposure-induced deficits in hippocampal brain-derived neurotrophic factor expression and neurogenesis markers in adulthood

Binge drinking during adolescence is a risk factor for neuropsychiatric disorders that can develop later in life. Histone acetylation is an important epigenetic mechanism that contributes to neurodevelopment. We investigated the effects of adolescent intermittent ethanol (AIE) exposure, as opposed to normal saline (AIS) exposure, on histone acetylation-mediated regulation of brain-derived neurotrophic factor (BDNF) expression and developmental stages of neurogenesis (proliferating and immature neurons) in the hippocampus in adulthood. AIE exposure increased whole hippocampal histone deacetylase (HDAC) activity and decreased binding protein of cyclic adenosine monophosphate response element binding protein (CBP) and histone H3-K9 acetylation levels in the CA1, CA2, and CA3 regions of the hippocampus. BDNF protein and exon IV mRNA levels in the CA1 and CA3 regions of the hippocampus of AIE exposed adult rats were decreased as compared to AIS exposed adult rats. AIE induced anxiety-like behaviors and deficits in histone H3 acetylation at BDNF exon IV promoter in the hippocampus during adulthood, which were reversed by treatment with the HDAC inhibitor, trichostatin A (TSA). Similarly, neurogenesis was inhibited by AIE in adulthood as demonstrated by the decrease in Ki-67 and doublecortin (DCX)-positive cells in the dentate gyrus, which was normalized by TSA treatment. These results indicate that AIE exposure increases HDACs and decreases CBP levels that may be associated with a decrease in histone H3 acetylation in the hippocampus. These epigenetic changes potentially decrease BDNF expression and inhibit neurogenesis in the hippocampus that may be involved in AIE-induced behavioral abnormalities, including anxiety, in adulthood