Closure of the nephrosplenic space for treatment of recurring left dorsal displacement of the large colon in standing horses

The article has no abstract

The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients

OBJECTIVES: Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients. METHODS: We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) level >;1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes. RESULTS: We included 58 patients (65.5% male, age 43.5±11 years) with a mean left ventricular ejection fraction of 27±6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale) was significantly correlated with a higher number of B-lines (p = 0.016). Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >;1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017). CONCLUSION: In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified

Sinusite fúngica: uma análise clínica em nosso meio

OBJECTIVE: To report the microbiological, histopathological, radiological, and endoscopic findings associated with clinical observations in patients with fungal sinusitis.MATERIALS AND METHODS: A prospective analysis of 829 cases compatible with chronic sinusitis was carried out. Diagnosis of fungal sinusitis was cofirmed in 33patients through computed tomography and nasal endoscopy associated with clinical, laboratorial, microbiological and histopathological findings. These patients were classified as having one of the following: fungus ball sinusitis, alergic fungal sinusitis , acute invasive sinusitus or indolent or slowly invasive sinusitus.RESULTS: 18 patients presented with fungus ball sinusitis, 13 matched the criteria for AFS and two for slowly invasive fungus sinusitis. There were no occurences of fulminant fungal sinusitis. Clinical cure was obtained in 24 patients. Recidivation took place in four alergic fungal sinusitis patients.CONCLUSIONS: Fungal sinusitis presents itself in many different ways and can be treated with a large variety of therapeutical techniques. Therefore it demands not onlya diagnosis of the etiology of the fungus, but also the identification of the sort of sinusitis, through an association of nasal endoscopy, computed tomography, macroscopic examination of the secretion, direct exam, and culture in appropriate medium.OBJETIVO: Relatar os achados microbiológicos, histopatológicos, radiológicos e endoscópicos associados às observações clínicas de pacientes portadores de sinusite fúngica.MATERIAIS E MÉTODOS: Foi realizada uma análise prospectiva de 829 casos compatíveis com sinusopatia crônica. De acordo com os achados obtidos nos examesde tomografia computadorizada e endoscopia nasal, juntamente com as análises clínicas, laboratoriais, microbiológicas e histopatológicas, atentou-se para o diagnóstico de sinusite fúngica em 33 pacientes da série, os quais foram enquadrados dentro de uma das seguintes classificações: bola fúngica, sinusite fúngica alérgica , sinusite invasiva aguda (fulminante) ou sinusite indolente ou lentamente invasiva.RESULTADOS: 18 pacientes apresentaram-se com bola fúngica, 13 com critérios para sinusite fúngica alérgica. Sinusite lentamente invasiva foi identificada em doiscasos e não houve nenhuma ocorrência de sinusite fúngica fulminante. Cura clínica foi obtida em 24 pacientes. Houve recidiva da sinusite fúngica alérgica em quatro casos.CONCLUSÕES: As várias formas de apresentação e de abordagem terapêutica da sinusite fúngica exigem, além do diagnóstico etiológico fúngico, a identificação dotipo de sinusite fúngica através da associação de endoscopia nasal, tomografia computadorizada, exame macroscópico da secreção, exame direto e cultura em meio adequado

7th Drug hypersensitivity meeting: part two

No abstract availabl

Metformin attenuates the exacerbation of the allergic eosinophilic inflammation in high fat-diet-induced obesity in mice

A positive relationship between obesity and asthma has been well documented. The AMP-activated protein kinase (AMPK) activator metformin reverses obesity-associated insulin resistance (IR) and inhibits different types of inflammatory responses. This study aimed to evaluate the effects of metformin on the exacerbation of allergic eosinophilic inflammation in obese mice. Male C57BL6/J mice were fed for 10 weeks with high-fat diet (HFD) to induce obesity. The cell infiltration and inflammatory markers in bronchoalveolar lavage (BAL) fluid and lung tissue were evaluated at 48 h after ovalbumin (OVA) challenge. HFD obese mice displayed peripheral IR that was fully reversed by metformin (300 mg/kg/day, two weeks). OVA-challenge resulted in higher influx of total cell and eosinophils in lung tissue of obese mice compared with lean group. As opposed, the cell number in BAL fluid of obese mice was reduced compared with lean group. Metformin significantly reduced the tissue eosinophil infiltration and prevented the reduction of cell counts in BAL fluid. In obese mice, greater levels of eotaxin, TNF-α and NOx, together with increased iNOS protein expression were observed, all of which were normalized by metformin. In addition, metformin nearly abrogated the binding of NF-κB subunit p65 to the iNOS promoter gene in lung tissue of obese mice. Lower levels of phosphorylated AMPK and its downstream target acetyl CoA carboxylase (ACC) were found in lung tissue of obese mice, which were restored by metformin. In separate experiments, the selective iNOS inhibitor aminoguanidine (20 mg/kg, 3 weeks) and the anti-TNF-α mAb (2 mg/kg) significantly attenuated the aggravation of eosinophilic inflammation in obese mice. In conclusion, metformin inhibits the TNF-α-induced inflammatory signaling and NF-κB-mediated iNOS expression in lung tissue of obese mice. Metformin may be a good pharmacological strategy to control the asthma exacerbation in obese individuals.Fundação de Amparo à Pesquisa do Estado de São Paulo, 2012/14225-