Interferon-Alpha-Induced Destructive Thyroiditis Followed by Graves' Disease in a Patient with Chronic Hepatitis C: A Case Report

Interferon-induced thyroiditis (IIT) is a major clinical problem for patients receiving interferon-alpha (IFN-α) therapy. But, destructive thyroiditis followed by Graves' disease associated with IFN-α therapy is very rarely reported. Herein, we report a rare case of pegylated IFN-α (pegIFN-α) induced destructive thyroiditis followed by Graves' disease in a patient with HCV infection. A 31-yr-old woman suffered from chronic active hepatitis C and was treated with pegIFN-α and ribavirin for 12 months. Results of a thyroid function test and autoantibody levels were normal before IFN-α therapy was initiated. Destructive thyrotoxicosis appeared seven months after the initiation of IFN-α therapy, followed by Graves' thyrotoxicosis two months after the cessation of therapy. The diagnoses of destructive thyroiditis and Graves' disease were confirmed by the presence of TSH receptor antibodies in addition to Tc-99m scintigraphy findings. The patient's antithyroglobulin antibody titer increased gradually during IFN-α therapy and remained weakly positive after IFN-α therapy was discontinued

The spectrum of thyroid dysfunction in an Australian hepatitis C population treated with combination Interferon-α2β and Ribavirin

BACKGROUND: The study aims to assess the pattern of thyroid response to combination Interferon-α2β (IFN-α) and Ribavirin (RBV) anti-viral therapy in an Australian hepatitis C cohort. These include the prevalence of thyroid dysfunction (TD) including hyperthyroidism and hypothyroidism and their possible predictors, the common overall pattern of thyroid function tests whilst receiving therapy and TD outcomes, and the correlation with HCV status outcome. METHODS: A retrospective analysis of all medical records was performed to assess thyroid function in Hepatitis C Virus (HCV) patients who were treated at the Hunter Area hepatitis C treatment center between 1995 and March 2004. The centre is part of the John Hunter hospital, a major tertiary referral centre in New South Wales, Australia. RESULTS: There were 272 cases available for review. The prevalence of TD is 6.7 percent and is made up predominantly of females (80 percent). There were 3 (1.1 percent) cases of hyperthyroidism with 2 (67 percent) females. Thirteen out of fifteen (80 percent) cases of hypothyroidism were females with the overall prevalence of 5.5 percent. The majority of hypothyroid patients still required Thyroxine supplement at the end of follow up. CONCLUSION: Ninety three percent of HCV treated patients have intact thyroid function at the end of treatment. The predominant TD is hypothyroidism. The predominant pattern of thyrotoxicosis (TTX) is that of thyroiditis although the number is small. Graves' like disease was not observed. People with pre-existing thyroid auto-antibodies should be closely monitored for thyroid dysfunction, particularly hypothyroidism

Plasma concentrations of diazepam, noradiazepam and amylobarbitone after short-term treatment of anxious patients

Twenty-four anxious inpatients were treated with diazepam, amylobarbitone and placebo, each given in flexible dosage for one week, according to a fully-balanced design. Plasma concentrations of diazepam and of its metabolite nordiazepam and of amylobarbitone were determined after two, four and seven days of treatment. Clinical and psychological assessments were made after seven days of each treatment by means of psychiatrist rating scales, patient's self-rating and a comprehensive battery of performance measures. Diazepam and nordiazepam but not amylobarbitone were accumulating over the seven days of treatment. In patients on diazepam without previous amylobarbitone, nordiazepam accumulated more rapidly than diazepam over the week so that the ratio of diazepam to nordiazepam was 2.21 after two days but only 1.14 after seven days; those with previous amylobarbitone on the other hand always had nordiazepam concentrations higher than those of the administered drug and both were accumulating equally. Diazepam and nordiazepam were still detectable in most patients two weeks after the interruption of treatment. No correlations were found between drug concentrations and clinical and psychological effects

Energy and exergy analysis of a biomass power plant

The fulfilment of energy targets regarding the use of renewable energy has been a strong incentive to the development of dedicated power plants using biomass. Because these facilities operate with low value residues, this orientation has also received a strong incentive by the quest to reduce the amount of fuel in the woods and lowering the risk of fire. This issue is a major problem in dry climates. Although the number of plants planned for Portugal was very large, the actual number of units in operation is small. The first plant to enter production in Portugal was the thermal power plant of Mortágua. In this paper the energy and exergy analysis in this plant is presented. The objective of this work is to develop an analysis for the energy conversion in the plant. This is based on parameters that were retrieved during its normal operation and include: biomass and air flow rate, temperature measurements of the flue gases throughout the facility including the economizer, the two superheaters and flue gas composition. The elemental analysis of the biomass resulting from a blend of various sources was measured in addition to its moisture (ranging between 20 and 45% depending on the sources). The analysis was carried out for a fuel batch with a moisture of 35%. The plant was operated at three loads (full load, 80% and 65% load) and from the energy/mass balances the overall efficiency was calculated to be approximately 26%. The data were also used to perform a second law analysis of the plant which enables the calculation of the exergy destruction in the various components of the facility, including the external irreversibility. It was observed that the combustion chamber is the prime contributor to the overall loss of efficiency. The exergy efficiency was found approximately 22%.The authors are grateful to the management and staff of EDP for their collaboration and for providing technical design data of the biomass power plant in this paper. This work was financed by FCT, under the Strategic Project UID/SEM/04077/2013. Additionally, by COMPETE: POCI-01-0145-FEDER-007043 and FCT within the Project Scope: UID/CEC/00319/2013.info:eu-repo/semantics/publishedVersio

DIETARY COUNSELING IN REHABILITATION FOLLOWING GASTRIC CANCER SURGERY

Gastric cancer patients undergoing surgical procedures, such as total or subtotal gastrectomy, often encounter a range of challenging symptoms during postoperative rehabilitation. Indeed, surgery alters patients' gastrointestinal anatomy and physiological functions, affecting nutrient absorption and giving rise to gastrointestinal symptoms. Common symptoms include dumping syndrome, diarrhea, gastroesophageal reflux as well as nausea and early satiety. Moreover, the severity of these symptoms can lead to additional psychological distress and negatively impact oral food intake. Disturbances in symptoms and systemic inflammation, related to cancer and surgery along with emotional distress, can progressively contribute to wasting, ultimately resulting in weight loss. Following gastrectomy, most patients experience insufficient protein and calorie intake, leading to continued weight loss over an extended period. Malnutrition stands as a risk factor for postoperative complications and a poor prognosis. Therefore, to prevent this and ensure a swift recovery after surgery, individualized nutritional interventions led by dietary counseling should be consistently carried out. This should be done both during the postoperative hospitalization period (aimed at gradually increasing oral feeding intake) and in the subsequent phase at home (by providing nutritional advice to fully meet nutritional requirements and regain an adequate diet). Understanding the issues that affect patients' nutritional status after gastric cancer surgery is a critical aspect of rehabilitation programs, which are designed to enhance clinical outcomes and optimize quality of life

CFD modeling of combustion in biomass furnace

Due to the need for the optimization of industrial furnaces Computational Fluid Dynamics (CFD) is an important and indispensable tool for understanding for instance the mixing between flue gases, combustion air and the pollutant formation. This paper reports a computational fluid dynamics analysis of an industrial biomass boiler. The analysis was carried out using a CFD model for the combustion of the volatile gases released from the biomass combustion in the grate. The results obtained for the temperature, velocity and concentration of species fields within the boiler are now being used to enable the analysis and optimization of the combustion process. Moreover, the results show that inside the furnace the mixing of the gases with the combustion air could be improved, for instance through the optimization of the secondary air flow in relation to the operating conditions of the boiler, which would lead to the lower pollutant emissions.The authors are grateful to the management and staff of EDP for their collaboration and for providing technical design data of the biomass power plant in this paper. This work was financed by FCT, under the Strategic Project UID/SEM/04077/2013. Additionally, by COMPETE: POCI-01-0145-FEDER-007043 and FCT within the Project Scope: UID/CEC/00319/2013.info:eu-repo/semantics/publishedVersio