Unsuspected pulmonary alveolar proteinosis in a patient with acquired immunodeficiency syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Diffuse lung infiltrates are a common finding in patients with acquired immunodeficiency syndrome and causes range from infectious processes to malignancies or interstitial lung diseases. Pulmonary alveolar proteinosis is a rare pulmonary disorder rarely reported in patients infected with human immunodeficiency virus. Secondary pulmonary alveolar proteinosis is associated with conditions involving functional impairment or reduced numbers of alveolar macrophages. It can be caused by hematologic malignancies, inhalation of toxic dust, fumes or gases, infectious or pharmacologic immunosuppression, or lysinuric protein intolerance.</p> <p>Case presentation</p> <p>A 42-year-old African American man infected with human immunodeficiency virus was admitted with chronic respiratory symptoms and diffuse pulmonary infiltrates. Chest computed tomography revealed bilateral spontaneous pneumothoraces, for which he required bilateral chest tubes. Initial laboratory investigations did not reveal any contributory conditions. Histological examination of a lung biopsy taken during video-assisted thoracoscopy showed pulmonary alveolar proteinosis concurrent with cytomegalovirus pneumonitis. After ganciclovir treatment, our patient showed radiologic and clinical improvement.</p> <p>Conclusion</p> <p>The differential diagnosis for patients with immunosuppression and lung infiltrates requires extensive investigations. As pulmonary alveolar proteinosis is rare, the diagnosis can be easily missed. Our case highlights the importance of invasive investigations and histology in the management of patients infected with human immunodeficiency virus and pulmonary disease who do not respond to empiric therapy.</p

Clinical course of children of mothers with addictions into a neonatal intensive care unit in western Mexico [Evoluci�n cl�nica de hijos de madres con adicciones internados en una unidad de terapia intensiva neonatal del Occidente de M�xico]

Background: Pregnancy in women addicted represents, in itself, a major risk of destruction of physical and mental health of the unborn child; urgent prevention is the same as essential to providing quality care to the mother and child knowledge. Objective: Describe the physical and sociodemographic characteristics of neonates in intensive care units, born of mothers with addictions. Materials and Method: Cross-sectional, descriptive study of neonates with addict mothers, analyzing age, gender, clinical symptoms and complications. Findings for frequency-percentages with regard to qualitative variables, and medians and ranges for quantitative variables. SPSS-20.0-Windows Statistics software package. Results: 618 patients admitted to the NICU, 180(29%) showing withdrawal symptoms; irritability in 117(63%), intensive crying in 93(51%), spontaneous Moro reflex 74(42%), diarrhea 61(30%), fever 61(30%). Birth defects 124(20%), from greater to lesser occurrence: disorders in central nervous system, digestive tract and abdominal wall, extremities, kidneys, and others. 309(50%) weight lower than 2600g. The most frequent metabolic disorders were hypoglycemia, Metabolic Acidosis and jaundice, among others. Conclusions: Every day, we see more children born of substancedependent mothers in the Mexico. Our study reveals high mortality rate and many complications for this group; thus, it becomes necessary to institute preventive measures among Mexican women of childbearing age in order to prevent illegal drug use and to increase treatment among pregnant addicts. Gynecologists, pediatricians and neonatologists must have extensive knowledge regarding the entire clinical-social spectrum of symptoms that may be observed in children of mothers suffering addictions

Clinical course of children of mothers with addictions into a neonatal intensive care unit in western Mexico [Evolución clínica de hijos de madres con adicciones internados en una unidad de terapia intensiva neonatal del Occidente de México]

Background: Pregnancy in women addicted represents, in itself, a major risk of destruction of physical and mental health of the unborn child; urgent prevention is the same as essential to providing quality care to the mother and child knowledge. Objective: Describe the physical and sociodemographic characteristics of neonates in intensive care units, born of mothers with addictions. Materials and Method: Cross-sectional, descriptive study of neonates with addict mothers, analyzing age, gender, clinical symptoms and complications. Findings for frequency-percentages with regard to qualitative variables, and medians and ranges for quantitative variables. SPSS-20.0-Windows Statistics software package. Results: 618 patients admitted to the NICU, 180(29%) showing withdrawal symptoms; irritability in 117(63%), intensive crying in 93(51%), spontaneous Moro reflex 74(42%), diarrhea 61(30%), fever 61(30%). Birth defects 124(20%), from greater to lesser occurrence: disorders in central nervous system, digestive tract and abdominal wall, extremities, kidneys, and others. 309(50%) weight lower than 2600g. The most frequent metabolic disorders were hypoglycemia, Metabolic Acidosis and jaundice, among others. Conclusions: Every day, we see more children born of substancedependent mothers in the Mexico. Our study reveals high mortality rate and many complications for this group; thus, it becomes necessary to institute preventive measures among Mexican women of childbearing age in order to prevent illegal drug use and to increase treatment among pregnant addicts. Gynecologists, pediatricians and neonatologists must have extensive knowledge regarding the entire clinical-social spectrum of symptoms that may be observed in children of mothers suffering addictions

Safety and efficacy of ustekinumab or golimumab in patients with chronic sarcoidosis

Sarcoidosis is characterised by non-caseating granulomas that secrete pro-inflammatory cytokines, including interleukin (IL)-12, IL-23, and tumour necrosis factor (TNF)-alpha. Ustekinumab and golimumab are monoclonal antibodies that specifically inhibit IL-12/IL-23 and TNF-alpha, respectively. Patients with chronic pulmonary sarcoidosis (lung group) and/or skin sarcoidosis (skin group) received either 180 mg ustekinumab at week 0 followed by 90 mg every 8 weeks, 200 mg golimumab at week 0 followed by 100 mg every 4 weeks, or placebo. Patients underwent corticosteroid tapering between weeks 16 and 28. The primary end-point was week 16 change in percentage predicted forced vital capacity (Delta FVC % pred) in the lung group. Major secondary end-points were: week 28 for Delta FVC % pred, 6-min walking distance, St George's Respiratory Questionnaire (lung group), and Skin Physician Global Assessment response (skin group). At week 16, no significant differences were observed in Delta FVC % pred with ustekinumab (-0.15, p=0.13) or golimumab (1.15, p=0.54) compared with placebo (2.02). At week 28, there were no significant improvements in the major secondary end-points, although a nonsignificant numerically greater Skin Physician Global Assessment response was observed following golimumab treatment (53%) when compared with the placebo (30%). Serious adverse events were similar in all treatment groups. Although treatment was well tolerated, neither ustekinumab nor golimumab demonstrated efficacy in pulmonary sarcoidosis. However, trends towards improvement were observed with golimumab in some dermatological end-points

Distinguishing groundwater flow paths in different fractured-rock aquifers using groundwater chemistry:\ud Dandenong Ranges, southeast Australia

Major ion geochemistry is used to qualitatively\ud interpret groundwater residence times within an aquifer,\ud and the extent of mixing between aquifers with distinctive\ud mineralogy. In conjunction with hydraulic heads and\ud stable isotope geochemistry, flow paths and inter-aquifer\ud exchange are defined in a fractured-rock aquifer system in\ud the Dandenong Ranges, southeast Australia. Stable isotopes\ud indicate modern seasonal recharge throughout the\ud system. At high elevations in the sub-catchment, which\ud includes both marine Silurian-Devonian sedimentary and\ud Tertiary basalt aquifers, Cl is derived primarily from cyclic salts, and differences in mineralogy result in groundwater from the basalt aquifer having higher TDS contents (123–262 mg/L) and (Ca+Mg)/Na ratios (0.9–1.3) than\ud groundwater from the sedimentary aquifer (TDS: 55–\ud 79 mg/L; (Ca+Mg)/Na: 0.1–0.2). At low elevations, in\ud areas of local groundwater discharge, the more regional\ud flow system in the Silurian-Devonian sediments contains\ud additional Cl from water–rock interaction and has distinctly\ud higher TDS contents (517–537 mg/L). Differences\ud in groundwater chemistry between the aquifers and between\ud shallower and deeper flow systems highlights areas\ud of inter-aquifer mixing. This is particularly important for\ud aquifer vulnerability where groundwater quality in the\ud deeper aquifer may be impacted by surface activities