Paravertebral Mass in a Patient with Hemolytic Anemia: Computed Tomographic Findings

Extramedullary hematopoiesis is characterized by the presence of hematopoietic tissue outside of the bone marrow and is typically associated with chronic hemolytic anemias. Intrathoracic extramedullary hematopoiesis is a rare and usually asymptomatic condition. The authors report a case of a 57-year-old man with intrathoracic extramedullary hematopoiesis and hereditary spherocytosis. Clinical and laboratory evaluation, together with radiological findings, are described. The diagnosis of the disease was confirmed by tissue biopsy

DESENVOLVIMENTO DE PELLETS CONTENDO AGREGADOS DE HIFAS DE METARHIZIUM ANISOPLIAE PARA CONTROLE BIOLÓGICO DE ARTRÓPODES

ntrodução e objetivos: Artrópodes são responsáveis por sérios danos a agricultura e a saúde humana e animal, causando expressivos prejuízos à economia brasileira1. Métodos de controle biológico de tais artrópodes estão sendo desenvolvidos com a utilização de propágulos do fungo Metarhizium anisopliae2,3. O objetivo do presente trabalho foi desenvolver pellets contendo agregados de hifas de M. anisopliae CG 47, e avaliar sua viabilidade pós-processamento. Metodologia: Os agregados de hifas foram obtidos através da inoculação de conídios em meio descrito por Mascarin et al. (2014)4, seguido de incubação orbital por 4 dias, a 27ºC e 250 rpm. Os pellets foram desenvolvidos utilizando-se celulose microcristalina e biomassa (1:1,1, p/v) através da técnica de extrusão-esferonização, seguida de secagem em leito fluidizado a 40ºC. A umidade residual dos pellets foi determinada em balança de infravermelho. A viabilidade foi determinada incubando-se 30 mg de pellets em meio ágar-água, a 27ºC por 15 dias, e a germinação dos conídios resultantes foi quantificada após 48h de incubação em meio BDAY. Resultados e discussão: Os pellets apresentaram umidade residual de 5,3% após 90 minutos de secagem em leito fluidizado. A viabilidade dos conídios foi de 96,67%. Conclusões: Os conídios produzidos a partir dos agregados de hifas mantiveram-se viáveis após sua incorporação em pellets de celulose e secagem por 90 minutos a 40ºC; dessa forma, permite-se inferir que foi estabelecida uma metodologia eficiente para formulação de um propágulo de M. anisopliae que apresenta potencial para controle biológico de artrópodes. Agradecimentos: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Tuberous sclerosis with pulmonary lymphangioleiomyomatosis and renal angiomyolipomas. Computed tomographic findings: a case report

The authors describe a case of a 31-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease. Clinical symptoms were chest pain, and progressive dyspnea. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts scattered throughout the lungs characteristic for pulmonary lymphangioleiomyomatosis. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality

Prophylactic Treatment With Simvastatin Modulates the Immune Response and Increases Animal Survival Following Lethal Sepsis Infection

Chronic use of statins may have anti-inflammatory action, promoting immunomodulation and survival in patients with sepsis. This study aimed to analyze the effects of pretreatment with simvastatin in lethal sepsis induced by cecal ligation and puncture (CLP). Male Swiss mice received prophylactic treatment with simvastatin or pyrogen-free water orally in a single daily dose for 30 days. After this period, the CLP was performed. Naïve and Sham groups were performed as non-infected controls. Animal survival was monitored for 60 h after the CLP. Half of mice were euthanized after 12 h to analyze colony-forming units (CFUs); hematological parameters; production of IL-10, IL-12, IL-6, TNF-α, IFN-γ, and MCP-1; cell counts on peritoneum, bronchoalveolar lavage (BAL), bone marrow, spleen, and mesenteric lymph node; immunephenotyping of T cells and antigen presenting cells and production of hydrogen peroxide (H2O2). Simvastatin induced an increase in survival and a decrease in the CFU count on peritoneum and on BAL cells number, especially lymphocytes. There was an increase in the platelets and lymphocytes number in the Simvastatin group when compared to the CLP group. Simvastatin induced a greater activation and proliferation of CD4+ T cells, as well as an increase in IL-6 and MCP-1 production, in chemotaxis to the peritoneum and in H2O2 secretion at this site. These data suggest that simvastatin has an impact on the survival of animals, as well as immunomodulatory effects in sepsis induced by CLP in mice

POTENCIAL ANTI-INFLAMATÓRIO DAS FOLHAS DE Chenopodium ambrosioides L. NO MODELO DE CISTITE HEMORRÁGICA EM CAMUNDONGOS

A cistite hemorrágica (CH) possui etiologia infecciosa, medicamentosa ou radioterápica. Consiste na presença de hematúria macroscópica secundária a sangramento vesical e uma das suas possíveis causas é o uso de ciclofosfamida (CYP). Várias alternativas farmacológicas têm sido investigadas para o tratamento da CH. Dentre as possibilidades, o potencial terapêutico de espécies vegetais tem sido avaliado. A espécie Chenopodium ambrosioides L. (Amaranthaceae), tem sido utilizado popularmente como anti-infamatório, efeito que  tem  sido comprovado cientifcamente. Assim, o objetivo deste estudo  foi investigar os efeitos do extrato bruto hidroalcoólico (EBH) de folhas secas de C. ambrosioides na CH induzida em camundongos pela ciclofosfamida. Camundongos fêmeas da linhagem Swiss receberam 150 mg/kg de CYP por via intraperitoneal para indução de CH. Em seguida, os animais foram tratados em dose única de acordo com protocolo estabelecido para cada grupo: soro fsiológico a 0,9% (grupo Controle); diclofenaco potássico (grupo Diclofenaco); EBH com dose única de 5 (grupo EBH5) ou 50mg/kg (grupo EBH50). Após 12 horas da indução da CH, o sangue dos animais foi retirado para realização do hemograma.  Os animais foram então sacrifcados e as bexigas retiradas, avaliadas macroscopicamente (hemorragia) e pesadas. Foram removidos, ainda, os órgãos linfóides a fm de realizar contagem de células do baço, medula óssea e linfonodos. Os resultados demonstraram que houve diminuição do peso das bexigas e da hemorragia nos grupos Diclofenaco e EBH5 quando comparados ao grupo controle. Houve um aumento das células da medula óssea, baço e linfonodo mesentérico em todos os animais tratados em relação ao controle. Em relação ao hemograma houve apenas aumentos pontuais no grupo EBH50. Em conclusão, o extrato bruto hidroalcoólico de folhas de C. ambrosioides na dose de 5mg/Kg apresentou efeito anti-infamatório e imunoestimulante, pois diminuiu o peso e a hemorragia da bexiga, e aumentou a produção e proliferação de células linfóides. Diante dos resultados desse estudo, bem como da evidência de ausência de toxicidade de outros trabalhos, podemos sugerir o tratamento com este extrato como alternativa terapêutica nos modelos de CH induzida por CYP em camundongos.Descritores: Anti-infamatório. Chenopodium ambrosioides. Ciclofosfamida. Cistite.AbstractHemorrhagic cystitis (HC) has infectious, drug or radiotherapy etiology. Consists in the presence of macroscopic hematuria secondary to bladder bleeding, and one of its possible causes is the use of cyclophosphamide (CYP). Several pharmacological alternatives have been investigated for the treatment of HC. Among the possibilities, the therapeutic potential of plant species have been reported. The species Chenopodium ambrosioides L. (Amaranthaceae) has been popularly used as an anti-infammatory efect that has been proven scientifcally. The objective of this study was to investigate the efects of crude hydroalcoholic extract of dried leaves of C. ambrosioides in HC cyclophosphamide induced in mice. Female mice of the Swiss strain received 150 mg / kg of CYP intraperitoneally to induce HC. Then the animals were treated with a single dose according to protocol established for each group: normal saline 0.9% (control group); diclofenac (diclofenac group); hydroalcoholic extract with a single dose of 5 (EBH5 group) or 50 mg / kg (EBH50 group). After 12 hours from the induction of HC, the bleeding was performed in the animal for the complete blood count. The animals were then sacrifced and had their bladders removed, as assessed macroscopically (bleeding) and weighed. The lymphoid organs were also removed in order to perform spleen, bone marrow and lymph nodes cell count. The results demonstrated that there was a decrease in the weight of bladders and bleeding in the diclofenac group and EBH5 when compared to the control group. There was an increase of cells in the bone marrow, spleen and lymph node in all treated animals as compared to control. In blood count there were only occasional increases in EBH50 group. In conclusion, the hydroalcoholic crude extract of Chenopodium ambrosioides leaves at a dose of 5 mg / kg showed anti-infammatory and immunostimulatory efect as decreased body weight and bleeding of the bladder, and increased production and proliferation of lymphoid cells. Given the results of this study, as well as evidence of absence of toxicity in other studies, we suggest treatment with this extract as an alternative therapy in models of CH-induced CYP in mice.Descriptors: Anti-infammatory. Chenopodium ambrosioides. Cyclophosphamide. Cystitis

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials