Rituximab therapy in severe connective tissue disease associated interstitial lung disease: A retrospective single-centre observational study.

Background: Connective tissue disease-associated interstitial lung disease (CTD-ILD) that progresses despite first-line immunosuppressive therapy is a clinical challenge. Rituximab (RTX) is a chimeric monoclonal antibody targeted to CD20+ B cells, resulting in B-cell depletion, and has been used as a salvage therapeutic modality in severe disease.

Objectives: To investigate the therapeutic effects and safety of RTX in patients with severe CTD-ILD.

Got a Pen for Allergen Immunotherapy? Lessons from Near-Fatal Anaphylaxis with Pulmonary Edema.

On our pediatric intensive care unit, we successfully treated a 10-year-old boy with severe pulmonary edema due to anaphylaxis after his last injection of a 3-year course of allergen immunotherapy (AIT). In view of the severity of the adverse event, we initiated a case analysis with all involved medical professionals. The evaluation revealed delayed administration of epinephrine due to dosing uncertainty and underestimation of severity.

Vitamin D levels in patients admitted to the intensive care unit and the association with organ dysfunction and glutamine levels.

Background: Vitamin D deficiency is common in intensive care unit (ICU) patients (50 - 82%) and is associated with multi-organ dysfunction. Vitamin D deficiency alters pathways of glutamine metabolism in critical illness, but the impact of vitamin D status on glutamine levels is poorly characterised.

Objectives: To assess the prevalence of vitamin D deficiency and its association with organ dysfunction and glutamine levels in a South African (SA) ICU.

Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome.

Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU) , correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria.

Four-oil intravenous lipid emulsion effect on plasma fatty acid composition, inflammatory markers and clinical outcomes in acutely ill patients: A randomised control trial (Foil fact).

Background And Aims: Data in critically ill patients on the effect of intravenous lipid emulsions (LEs), containing omega-3 polyunsaturated fatty acids (PUFAs), in parenteral nutrition (PN) are scarce and conflicting. This study compared the effects of a four-oil LE (30% soybean oil, 30% medium-chain triglycerides, 25% olive oil and 15% fish oil (FO)) (SMOFlipid®) to those of a 100% soybean oil-based LE in critically ill adult intensive care unit (ICU) patients.

Methods: In this double-blind, randomised study, patients (n = 75) predicted to need PN for more than 5 days were randomised to receive either a four-oil LE (Study Group (SG)) or a 100% soybean oil LE (Control Group (CG)).

Takotsubo cardiomyopathy post liver transplantation.

A patient with end-stage liver disease developed stress-induced Takotsubo cardiomyopathy post liver transplantation, with haemodynamic instability requiring a left ventricular assist device. We discuss the diagnosis and management of this condition.

Paediatric liver transplantation in Johannesburg revisited: 59 transplants and challenges met.

Background: A paediatric liver transplant programme was started at the Wits Donald Gordon Medical Centre, Johannesburg, South Africa (SA), in November 2005. We reported on the first 29 patients in 2012. Since then we have performed a further 30 transplants in 28 patients, having met the major challenge of donor shortage by introducing a living related donor programme and increasing the use of split liver grafts.

Antimicrobial treatment and outcomes of critically ill patients with OXA-48like carbapenemase-producing Enterobacteriaceae infections.

We report on the clinical characteristics, antimicrobial therapy, and outcomes of 20 critically ill patients with severe OXA-48like infections. Carbapenem-based therapy demonstrated improved survival (odds ratio = 5.0) as compared with non-carbapenem therapy.

Paediatric liver transplantation in Johannesburg revisited: 59 transplants and challenges met.

Background: A paediatric liver transplant programme was started at the Wits Donald Gordon Medical Centre, Johannesburg, South Africa (SA), in November 2005. We reported on the first 29 patients in 2012. Since then we have performed a further 30 transplants in 28 patients, having met the major challenge of donor shortage by introducing a living related donor programme and increasing the use of split liver grafts.

Procalcitonin and C-reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia.

Pulmonary tuberculosis (PTB) and pneumococcal community-acquired pneumonia (PCAP) are common causes of lower respiratory tract infections in HIV-seropositive patients and may have similar clinical and radiological features. This study aimed to assess the value of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in HIV-seropositive patients with pneumonia, and to investigate their potential role in differentiating pneumococcal from mycobacterial infections. HIV-seropositive patients admitted with pneumonia were evaluated prospectively, 34 with PTB and 33 with PCAP.

CD4 T-lymphocyte subset counts in HIV-seropositive patients during the course of community-acquired pneumonia caused by Streptococcus pneumoniae.

Total lymphocyte counts, CD4 T-lymphocyte counts and CD4/CD8 ratios were measured in 30 anti-retroviral-naive HIV-seropositive patients upon hospital admission for acute community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae, and again 1 month after resolution of infection. There was a significant depression of the total lymphocyte count (p < 0.005) and CD4 T-lymphocyte count (p < 0.

Dual infection with Streptococcus pneumoniae and Mycobacterium tuberculosis in HIV-seropositive patients with community acquired pneumonia.

Pulmonary infections with more than one organism are common in human immunodeficiency virus (HIV) seropositive patients. We describe nine cases of dual infection with Streptococcus pneumoniae and Mycobacterium tuberculosis in HIV-seropositive patients presenting with community acquired pneumonia (CAP). It is important to exclude pulmonary tuberculosis in HIV-seropositive patients with CAP who fail to respond appropriately to initial antibiotic therapy, even if another etiological pathogen has been found.

Effect of human immunodeficiency virus on intensive care unit outcome of patients with Guillain-Barré syndrome.

Objectives: The primary objective of this study was to investigate the effect of human immunodeficiency virus (HIV) infection on the outcome of patients admitted to the intensive care unit (ICU) with severe Guillain-Barré syndrome (GBS) requiring mechanical ventilation. A secondary objective was to compare the clinical and laboratory features of HIV-seronegative and HIV-seropositive patients admitted to the ICU with severe GBS.

Design: Retrospective chart review.

Prevalence of anti-mycolic acid antibodies in patients with pulmonary tuberculosis co-infected with HIV.

Isolation and purification of mycolic acids from Mycobacterium tuberculosis have allowed them to be applied as antigen in an ELISA-based assay to detect specific antibodies in human sera. Tuberculosis patients have previously been shown to contain antimycolic acids antibodies. The aim of this study was to determine whether human immunodeficiency virus (HIV) co-infection increases false-negative testing rate and whether other random diseases for which hospitalisation is normally required will contribute to false-positive results.

Immunohistochemical detection of immature Sertoli cell markers in testicular tissue of infertile adult men: a preliminary study.

Testicular biopsy specimens from oligozoospermic infertile patients are characterized by different types of spermatogenic impairment in adjacent seminiferous tubules, a phenomenon called mixed atrophy. In order to evaluate possible involvement of the state of Sertoli cell differentiation, the distribution pattern of anti-Müllerian hormone (AMH), vimentin and cytokeratin intermediate filament proteins was investigated by means of immunohistochemistry. AMH immunoactivity occurs in Sertoli cells of the normal postnatal prepubertal testis, but it is absent in the adult testis with normal spermatogenesis.

Progestagen nuclear binding sites in the male genital tract of the mouse, studied by autoradiography.

Autoradiograms were prepared after injection of 125I progestagen (sp. act. 2200 Ci/mmol) to prepubertal and young adult mice.

1,25(OH)2 vitamin D3 binding sites in male sex organs of the Siberian hamster (Phodopus sungorus). An autoradiographic study.

Using autoradiography, binding sites for 1,25(OH)2 vitamin D3 are found in certain genital organs of male Siberian hamsters (Phodopus sungorus), in particular in basal epithelial cells and fibroblasts of the lamina propria of prostate glands. Scattered labeled cells are also present in the epithelium of coagulation and urethral glands. In contrast to the findings in mice, under the conditions of the experiment, 1,25(OH)2 vitamin D3 binding sites are not recognizable in other accessory sex glands and gonads.

Differential nuclear binding of [3H]testosterone and its metabolites to androgen and estrogen receptors in brain, pituitary, heart, kidney and accessory sex glands of the mouse: an autoradiographic study.

Nuclear binding of [3H]testosterone ([3H]T) was studied by autoradiography in brain and peripheral tissues of normal male mice and androgen receptor (AR) deficient Tfm (testicular feminized) mice at various time points after injection. All tissues examined contain AR and estrogen receptors (ER). Nuclear binding (accumulation of radioactive hormone) was characterized by competition with excess of dihydrotestosterone (DHT) or estradiol (E2) and by inhibition of aromatization (AI).

Distribution of soltriol [1,25(OH)2-vitamin D3] binding sites in male sex organs of the mouse: an autoradiographic study.

After injection of [3H]-1,25(OH)2-vitamin D3 (soltriol), nuclear labeling is found in Sertoli cells of testes, being highest at the stage of spermiosis, in epithelium of efferent ductules and caput epididymidis and in connective tissue cells of epididymis, in lamina propria and muscular sheath of deferent duct, and in epithelium and muscular sheath of dorsal and ventral prostate of the mouse. This labeling pattern is characteristic for [3H]-soltriol and differs from that for [3H]-dihydrotestosterone and [3H]-estradiol, although with overlap. The nuclear labeling with [3H]-soltriol suggests an action of the hormone on certain processes during spermatogenesis, on sperm maturation, on epididymal fluid resorption, and on secretion and transport of spermatozoa.

Differentiation between androgen and estrogen receptor mediated effects of testosterone on FSH using androgen receptor deficient (Tfm) and normal mice.

The comparison of normal and androgen receptor (AR) deficient Tfm-mice allows distinction between AR mediated and estrogen receptor (ER) mediated effects of testosterone (T)--the latter after aromatization of T to estrogens--on serum and pituitary FSH. Normal male and female as well as Tfm mice were gonadectomized after 8 days and treated for 11 days with either T, estradiol (E2) or vehicle. Serum and pituitary FSH was determined by RIA for rat FSH.

True hermaphroditism with bilateral ovotestis: a case report.

A true hermaphrodite with a 46 XX/47 XXY karyotype, gynaecomastia, hypospadia and scrotal gonads was investigated. Gonadectomy performed at 14 years of age revealed bilateral ovotestes. The ovarian portion contained follicles of all developmental stages.

No evidence for aromatization of [3H]testosterone in oestrogen receptor containing cells of the epididymis.

Oestrogen receptors are found in the principal cells of the caput and in apical and clear cells of the epididymis of the mouse. The distribution pattern of oestrogen receptors is different from that of androgen receptors and suggests a physiological role for oestrogens in the epididymis. We examined by competition experiments and thaw-mount autoradiography to see whether aromatization of [3H]testosterone is the source of oestrogens in the epididymis.

[Thromboembolism as a complication of Pudenz-Heyer drainage with cardiac shunt].

We report the case of a 2.7 year old boy with ventriculoatrial Pudenz Heyer shunt for hydrocephalus internus presenting with symptoms suggestive of shunt infection. 2D-echocardiography showed a pedunculated right atrial thrombus that prolapsed through the tricuspid valve in diastole.