Dapsone Hypersensitivity Syndrome In An Adolescent During Treatment Of Leprosy

A 12 y old girl was admitted 24 days after start a WHO multidrug therapy scheme for multibacillary leprosy (dapsone, clofazimine and rifampicin) with intense jaundice, generalized lymphadenopathy, hepatoesplenomegaly, oral erosions, conjunctivitis, morbiliform rash and edema of face, ankles and hands. The main laboratory data on admission included: hemoglobin, 8.4 g/dL; WBC, 15,710 cells/mm3; platelet count, 100,000 cells/mm3; INR = 1.49; increased serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transpeptidase, alkaline phosphatase, direct and indirect bilirubin. Following, the clinical conditions had deteriorated, developing exfoliative dermatitis, shock, generalized edema, acute renal and hepatic failure, pancytopenia, intestinal bleeding, pneumonia, urinary tract infection and bacteremia, needing adrenergic drugs, replacement of fluids and blood product components, and antibiotics. Ten days after admission she started to improve, and was discharged to home at day 39th, after start new supervised treatment for leprosy with clofazimine and rifampicin, without adverse effects. This presentation fulfils the criteria for the diagnosis of dapsone hypersensitivity syndrome (fever, generalized lymphadenopathy, exfoliative rash, anemia and liver involvement with mixed hepatocellular and cholestatic features). Physicians, mainly in geographical areas with high prevalence rates of leprosy, should be aware to this severe, and probably not so rare, hypersensitivity reaction to dapsone.466331334Aldday, E.J., Barnes, J., Toxic effects of diaminodiphenylsulphone in leprosy (1951) Lancet, 2, pp. 205-206Andrade, Z.M.V., França, E.R., Teixeira, M.A.G., Santo, I.B., Síndrome sulfônica: Relato de um caso (1999) An. Bras. Derm., 74, pp. 59-61Barbosa, A.M., Martins Jr., E., Fleury, R.N., Opromolla, D.V.A., Mais um caso de síndrome da sulfona (2000) Hansenol. Int., 25, pp. 159-162Bluhm, R.E., Adedoyin, A., Mccarver, D.G., Branch, R.A., Development of dapsone toxicity in patients with inflammatory dermatoses: Activity of acetylation and hydroxylation of dapsone as risk factors (1999) Clin. Pharmacol. Ther., 65, pp. 598-605Bocquet, H., Bourgault-Villada, I., Delfau-Larue, M.H., Syndrome d'hypersensibilité à la dapsone. Clone T circulant transitoire (1995) Ann. Derm. Vénér., 122, pp. 514-516Brasil, M.T.L.R.F., Opromolla, D.V., Marzliak, M.L.C., Nogueira, W., Results of a surveillance system for adverse effects in leprosy's WHO/MDT (1996) Int. J. Leprosy, 64, pp. 97-104Chalasani, P., Baffoe-Bonnie, H., Jurado, R.I., Dapsone therapy causing sulfone syndrome and lethal hepatic failure in an HIV-infected patient (1994) Sth. Med. J., 87, pp. 1145-1146Frey, H.M., Gershon, A.A., Borkowsky, W., Bullock, W.E., Fatal reaction to dapsone during treatment of leprosy (1981) Ann. Intern. Med., 94, pp. 777-779Gallo, M.E.N., Nery, J.A.C., Garcia, C.G., Interconências pelas drogas utilizadas nos esquemas poliquimioterápicos em hanseníase (1995) Hansenol. Int., 20, pp. 46-50Johnson, D.A., Cattau Jr., E.L., Kurltsky, J.N., Zimmerman, H.J., Liver involvement in the sulfone syndrome (1986) Arch. Intern. Med., 146, pp. 875-877Kaluarachchi, S.I., Fernandopulle, B.M., Gunawardane, B.P., Hepatic and haematological adverse reactions associated with the use of multidrug therapy in leprosy: A five year retrospective study (2001) Indian J. Leprosy, 73, pp. 121-129Kumar, R.H., Kumar, M.V., Thappa, D.M., Dapsone syndrome: A five year retrospective analysis (1998) Indian J. Leprosy, 70, pp. 271-276Lastória, J.C., De Mello, M.S., Putinatti, A., Souza, V., Síndrome de hipersensibilidade à dapsona (2004) Diagn. Tratam., 9, pp. 19-21Leta, G.C., Simas, M.E.P.A.S., Oliveira, M.L.W., Gomes, M.K., Síndrome de hipersensibilidade à dapsona: Revisão sistemática dos critérios diagnósticos (2003) Hansenol. Int., 28, pp. 79-84Lowe, J., Treatment of leprosy with diamino diphenylsulphone by mouth (1950) Lancet, 1, pp. 145-150Mandell, G.L., Petri Jr., W.A., Drugs used in the chemotherapy of tuberculosis, Mycobacterium avlum complex disease and leprosy (1996) Goodman & Gilman's Pharmacological Basis of Therapeutics. 9. International Ed., pp. 1155-1174. , Hardman, J.G.Limbird, L.E.Molinoff, P.B.Ruddon, R.W. & Gilman, A.G., ed. New York, McGraw HillOpromolla, D.V.A., Fleury, R.N., Sindrome da sulfona e reação reversa (1994) Hansenol. Int., 19, pp. 70-76Prussik, R., Shear, N.H., Dapsone hypersensitivity syndrome (1996) J. Amer. Acad. Derm., 35, pp. 346-349Rao, P.N., Lakshmi, T.S., Increase in the incidence of dapsone hypersensitivity syndrome: An appraisal (2001) Leprosy Rev., 72, pp. 57-62Reeve, P.A., Ala, J.L., Hall, J.J., Dapsone syndrome in Vanuatu: A high incidence during multidrug treatment (MDT) of leprosy (1992) J. Trop. Med. Hyg., 95, pp. 266-270Risse, L., Bernard, P., Brosset, A., Syndrome d'hypersensibilitȩ a la disulone® (1994) Ann. Derm. Vȩnȩr., 121, pp. 242-244Saito, S., Ikezawa, Z., Miyamoto, H., Kim, S., A case of dapsone syndrome (1994) Clin. Exp. Derm., 19, pp. 152-156Santos, M.E., Leta, G.C., Oliveira, M.L.W., Dapsone hypersensitivity syndrome (DHS): Not so rare to be minimized in endemic countries (2002) International Leprosy Congress, 16 (PART 16). , Salvador, Brazil. Book of abstractsThong, B.Y., Leong, K.P., Chng, H.H., Hypersensitivity syndrome associated with dapsone/pyrimethamine (Maloprim) antimalaria chemoprophylaxis (2002) Ann. Allergy Asthma Immunol., 88, pp. 527-529Tomecki, K.J., Catalano, C.J., Dapsone hypersensitivity. The sulfone syndrome revisited (1981) Arch. Derm., 117, pp. 38-39(2004) Leprosy Elimination Project. Status Report, 2003, , http://www.who.int/lep/Reports/s20042.pdf, WHO, Genev

Association between interpregnancy interval and pregnancy complications by history of complications: A population-based cohort study

Objective: To examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications. Design and setting Population-based longitudinally linked cohort study in Western Australia (WA). Participants: Mothers who had their first two (n=252 368) and three (n=96 315) consecutive singleton births in WA between 1980 and 2015. Outcome measures: We estimated absolute risks (AR) of preeclampsia (PE) and gestational diabetes (GDM) for 3–60 months of IPI according to history of each outcome. We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 3, 6, 12, 24, 36, 48 and 60 months, with 18 months as reference. Results: Risks of PE and GDM were 9.5%, 2.6% in first pregnancies, with recurrence rates of 19.3% and 41.5% in second pregnancy for PE and GDM, respectively. The AR of GDM ranged from 30% to 43% across the IPI range for mothers with previous GDM compared with 2%–8% for mothers without previous GDM. For mothers with no previous PE, greater risks were observed for IPIs at 3 months (RR 1.24, 95% CI 1.07 to 1.43) and 60 months (RR 1.40, 95% CI 1.29 to 1.53) compared with 18 months. There was insufficient evidence for increased risk of PE at shorter IPIs of <18 months for mothers with previous PE. Shorter IPIs of <18 months were associated with lower risk than at IPIs of 18 months for mothers with no previous GDM. Conclusions: The associations between IPIs and risk of PE or GDM on subsequent pregnancies are modified by previous experience with these conditions. Mothers with previous complications had higher absolute, but lower RRs than mothers with no previous complications. However, IPI remains a potentially modifiable risk factor for mothers with previous complicated pregnancies.Amanuel Tesfay Gebremedhin, Gizachew Assefa Tessema, Annette K Regan, Gavin F Pereir

Feature Extraction and Classification of Biosignals - Emotion Valence Detection from EEG Signals

In thisworkavalencerecognitionsystembasedonelectroencephalogramsispresented.Theperformanceof the systemisevaluatedfortwosettings:singlesubjects(intra-subject)andbetweensubjects(inter-subject). The featureextractionisbasedonmeasuresofrelativeenergiescomputedinshorttimeintervalsandcertain frequencybands.Thefeatureextractionisperformedeitheronsignalsaveragedoveranensembleoftrialsor on single-trialresponsesignals.Thesubsequentclassificationstageisbasedonanensembleclassifier,i.e.a random forestoftreeclassifiers.Theclassificationisperformedconsideringtheensembleaverageresponsesof all subjects(inter-subject)orconsideringthesingle-trialresponsesofsinglesubjects(intra-subject).Applying a properimportancemeasureoftheclassifier,featureeliminationhasbeenusedtoidentifythemostrelevant features of the decision making.info:eu-repo/semantics/publishedVersio

Hypercalcemia And Multiple Osteolytic Lesions In A Child With Disseminated Paracoccidioidomycosis And Pulmonary Tuberculosis

Objective: To describe the case of a child with paracoccidioido-mycosis who presented hypercalcemia with multiple osteolytic lesions. Description: A 6-year-old boy was admitted with a one-month history of fever and hepatosplenomegaly. On admission, he looked sick, pale, and had disseminated lymphadenopathy and hepatosplenomegaly. The laboratory findings included anemia (hemoglobin = 6.8 g/dl), eosinophilia (1,222/mm 3), thrombocytopenia (102,000/mm 3), and hypoalbumlnemia (serum albumin = 2.2 g/dl). Paracoccidioides brasiliensis was identified in bone marrow examination. In the second week after admission, the patient presented joint pain, poor activity and difficulty in walking. He presented hypercalcemia (maximum value = 14.9 mg%) and reduction in renal function, which lasted for two weeks. On the 42nd day after admission, his chest X-ray showed lytic lesions in clavicle, scapula, ribs, and humerus, with bilateral slipped capital humeral epiphysis. The patient presented nephrocalcinosis and nephrolithiasis, reduction in creatinine clearance and evidence of tubular lesions. At the end of the second month after admission, Mycobacterium tuberculosis was isolated in gastric lavage. The child received treatment for paracoccidioidomycosis and tuberculosis and has not had any sequelae for 3 years. Comments: The development of symptomatic hypercalcemia leading to renal lesion, associated with multiple osteolytic lesions, had never been described in paracoccidioidomycosis. Although pulmonary tuberculosis was diagnosed and could be related to hypercalcemia, the sudden onset of hypercalcemia and its normalization without specific treatment for tuberculosis suggests that bone lysis was the most important factor in the genesis of hypercalcemia. Copyright © 2005 by Sociedade Brasileira de Pediatria.814349352Brummer, E., Castaneda, E., Restrepo, A., Paracoccidioidomycosis: An update (1993) Clin Microbiol Rev, 6, pp. 89-117Bittencourt, A.L., Andrade, J.A., Filho, S.P., Paracoccidioidomycosis in a four-year-old boy (1986) Mycopathologia, 93, pp. 55-59Castro, R.M., Del Negro, G., Particularidades clínicas da paracoccidioidomicose na criança (1976) Rev Hosp Clin Fac Med, 31, pp. 194-198Hildebrando, T.M., Filho, N.A., Filho, F.Q., Costa, O., Miasaki, N., Mira, J.G., Paracoccidioidomicose na criança. Aspectos clínicos e laboratoriais em 25 casos (1987) J Pediatr, 63, pp. 92-97Londero, A.T., Melo, I.S., Paracoccidiodomycosis in childhood - A critical review (1983) Mycopathologia, 82, pp. 49-55Suva, A.F., (1976) Contribuição aos Estudos da Paracoccidioidomicose no Paraná e das Lesões Ósseas e Articulares Paracoccidióidicas [Tese de Livre Docência], , Curitiba (PR): Universidade Federal do ParanáPereira, R.M., Bucaretchi, F., Barison, E.M., Tresoldi, A.T., Paracoccidioidomycosis in children: Clinical presentation, follow-up and outcome (2004) Rev Inst Med Trop, 46, pp. 127-131. , S. PauloAdams, J.S., Gacad, M.A., Characterization of 1 α hydroxylation of vitamin D3 sterols by cultured alveolar macrophages from patients with sarcoidosis (1985) J Exp Med, 161, pp. 755-765Abbasi, A.A., Chemplavil, J.K., Muller, B.F., Arnstein, A.R., Hypercalcemia in active pulmonary tuberculosis (1979) Ann Intern Med, 90, pp. 324-328Bilezikian, J.P., Etiologies and therapy of hypercalcemia (1989) Endocrinol Metab Clin North Am, 18, pp. 389-414Murray, J.J., Heim, C.R., Hypercalcemia in disseminated histoplasmosis (1985) Am J Med, 78, pp. 881-884Silva, L.C., Ferrari, T.C., Hypercalcaemia and paracoccidioidomycosis (1998) Trans R Soc Trop Med Hyg, 92, p. 187Daher, R.R., Wasconcelos, W.M., Cardoso, V.M., Fígado e blastomicose sul-americana (1973) J Bras Med, 25, pp. 83-90Nahomi, N., Icterícia obstrutiva na doença de Lutz (1962) A Propósito de Dois Casos, 62, pp. 1243-1254. , Hospital (Rio de Janeiro)Pinto, W.P., (1980) Contribuição ao Estudo do Comprometimento Hepático na Paracoccidioidomicose [Dissertação], , São Paulo (SP): Universidade de São PauloDel Negro, G., Outras lesões. Formas de ocorrência rara e associações com outros processos (1982) Paracoccidioidomicose - Blastomicose Sulamericana, pp. 229-243. , Del Negro G, Lacaz CS, Fiorelo AM, editores. São Paulo: Savier - EduspHarrison, H.E., Harrison, H.C., Calcium and phosphate homeostasis (1979) Disorders of Calcium and Phosphate Metabolism in Childhood and Adolescence. 1st Ed., pp. 15-46. , Harrison HE, Harrison HC, editors. Philadelphia: W. B. SaundersKanis, J.A., Handy, M.A., Hypo-Hypercalcemia (1998) Oxford Textbook of Clinical Nephrology. 2nd Ed., pp. 225-249. , Oxford: Oxford University PressHarrison, H.E., Harrison, H.C., Hypercalcemic states (1979) Disorders of Calcium and Phosphate Metabolism in Childhood and Adolescence. 1st Ed., pp. 100-140. , Harrison HE, Harrison HC, editors. Philadelphia: W. B. SaundersAli, M.Y., Gopal, K.V., Llerena, L.A., Taylor, H.C., Hypercalcemia associated with infection by Criptococcus neoformans and Coccidioides immitis (1999) Am J Med Sci, 318, pp. 419-423Lawn, S.D., Macallan, D.C., Hypercalcemia: A manifestation of immune reconstitution complicating tuberculosis in an HIV-infected person (2004) Clin Infect Dis, 38, pp. 154-155Caldwell, J.W., Arsura, E.L., Kilgore, W.B., Reddy, C.M., Johnson, R.H., Hypercalcemia in patients with disseminated coccidioidomycosis (2004) Am J Med Sci, 327, pp. 15-1

ERP correlates of error processing during performance on the HalsteadCategory Test

The Halstead Category Test (HCT) is a neuropsychological test that measures a person's ability to formulate and apply abstract principles. Performance must be adjusted based on feedback after each trial and errors are common until the underlying rules are discovered. Event-related potential (ERP) studies associated with the HCT are lacking. This paper demonstrates the use of amethodology inspired on Singular SpectrumAnalysis (SSA) applied to EEG signals, to remove high amplitude ocular andmovement artifacts during performance on the test. This filtering technique introduces no phase or latency distortions, with minimum loss of relevant EEG information. Importantly, the test was applied in its original clinical format, without introducing adaptations to ERP recordings. After signal treatment, the feedback-related negativity (FRN) wave, which is related to error-processing, was identified. This component peaked around 250ms, after feedback, in fronto-central electrodes. As expected, errors elicited more negative amplitudes than correct responses. Results are discussed in terms of the increased clinical potential that coupling ERP informationwith behavioral performance data can bring to the specificity of theHCT in diagnosing different types of impairment in frontal brain function.info:eu-repo/semantics/publishedVersio

Pisolithus arhizus (Scop.) Rauschert improves growth of adventitious roots and acclimatization of in vitro regenerated plantlets of Pinus pinea L.

Stone pine (Pinus pinea L.) is an economically important forest tree in the Mediterranean region and has been the target of breeding and selection through micropropagation mainly for its ecological and ornamental aspects. A crucial step in micropropagation is adventitious rooting of microshoots, which often is highly inefficient in most conifer species including stone pine. Hence, we conducted in vitro co-culture of Pinus pinea microshoots with the ectomycorrhizal fungus Pisolithus arhizus (isolated from natural stands) in order to promote adventitious root growth and plant survival during acclimatization. Significant differences were found in the number of branches, in the number of roots plus branches, in total length of roots, in total length of roots plus branches, in average root length and in the length of the longest root in inoculated plants during in vitro rooting compared with non-inoculated plants. The roots of inoculated plants also grew better in vermiculite and during acclimatization in a mixed substrate compared with roots of control plants resulting in the development of vigorous root system. Overall, mycorrhizal inoculation increased the survival rate of the regenerated pine

Estudo Comparativo Entre Ultrassonografia Duplex E Angiotomografia No Acompanhamento Pós-operatório Da Correção Endovascular De Aneurismas Do Eixo Aortoilíaco

To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson’s correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem.49422923

Avocado (Persea americana) pulp improves cardiovascular and autonomic recovery following submaximal running: a crossover, randomized, double-blind and placebo-controlled trial

Previous studies have demonstrated that regular avocado consumption presents advantageous effects on cardiovascular system. However, little attention has been paid to the use of avocado as a dietary supplement, in particular, for individuals involved in physical exercise training. Therefore, this study aims to evaluate the effect of acute avocado pulp intake on cardiovascular and autonomic recovery subsequent to moderate exercise. Using a crossover, randomized, double-blind and placebo-controlled trial design, 16 healthy female adults underwent two protocols: Avocado pulp (600 mg in capsule) and placebo (600 mg starch in capsule). After the ingestion of Avocado pulp or placebo, the subjects were seated for 60 min at rest, followed by running on a treadmill at a submaximal level and then remained seated for 60 min during recovery from the exercise. Heart rate (HR), heart rate variability (HRV) [rMSSD, SD1, HF (ms2)] and skin conductance were evaluated before and during exercise, as well as during recovery. HR, systolic blood pressure, HRV and skin conductance recovered faster when subjects were given avocado pulp prior to exercise. In conclusion, avocado pulp improved cardiovascular and autonomic recovery after exercise, suggesting a reduced risk of cardiovascular events after exertion. The current results support the beneficial effects of ingestion of avocado prior to submaximal treadmill running