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Diaz Gonzales J.M.,National Institute of Medical science and Nutrition
Dermatology online journal

At the beginning of the nineteen-eighties, vulvar vestibular papillomatosis (VVP) was thought to be a human papilloma virus (HPV) disease. Based upon these findings many clinicians have been treating this condition with laser ablation or by topical application of podophyllin or trichloroacetic acid. Currently, most authors believe that VVP should be considered an anatomical variant of the vestibular mucosa and not HPV related. We present a case of VVP in which there was no histological or molecular evidence of HPV; unnecessary treatment should be avoided. Source

Louw G.E.,Stellenbosch University | Warren R.M.,Stellenbosch University | Gey Van Pittius N.C.,Stellenbosch University | Leon R.,Medical Research Unit of Natural Products Pharmacology | And 7 more authors.
American Journal of Respiratory and Critical Care Medicine

Rationale: Central dogma suggests that rifampicin resistance in Mycobacterium tuberculosis develops solely through rpoB gene mutations. Objective: To determine whether rifampicin induces efflux pumps activation in rifampicin resistant M. tuberculosis strains thereby defining rifampicin resistance levels and reducing ofloxacin susceptibility. Methods: Rifampicin and/or ofloxacin minimum inhibitory concentrations (MICs) were determined in rifampicin resistant strains by culture in BACTEC 12B medium. Verapamil and reserpine were included to determine their effect on rifampicin and ofloxacin susceptibility. RT-qPCR was applied to assess expression of efflux pump/ transporter genes after rifampicin exposure. To determine whether verapamil could restore susceptibility to first-line drugs, BALB/cmice were infected with aMDR-TB strain and treated with first-line drugs with/without verapamil. Measurements and Main Findings: Rifampicin MICs varied independently of rpoB mutation and genetic background. Addition reserpine and verapamil significantly restored rifampicin susceptibility (p = 0.0000). RT-qPCR demonstrated that rifampicin induced differential expression of efflux/transporter genes in MDR-TB isolates. Incubation of rifampicin mono-resistant strains in rifampicin (2 mg/ml) for 7 days induced ofloxacin resistance (MIC > 2 μg/ml) in strains with an rpoB531 mutation. Ofloxacin susceptibility was restored by exposure to efflux pump inhibitors. Studies in BALB/c mice showed that verapamil in combination with first-line drugs significantly reduced pulmonary CFUs after 1 and 2 months treatment (p < 0.05). Conclusion: Exposure of rifampicin resistant M. tuberculosis strains to rifampicin can potentially compromise the efficacy of the secondline treatment regimens containing ofloxacin, thereby emphasising the need for rapid diagnostics to guide treatment. Efflux pump inhibitors have the potential to improve the efficacy of antituberculosis drug treatment. Source

Baizabal-Carvallo J.F.,Groupe Hospitalier Pitie Salpetriere | Alonso-Juarez M.,National Institute of Medical science and Nutrition | Koslowski M.,Groupe Hospitalier Pitie Salpetriere
Journal of Clinical Rheumatology

Background: Chorea is recognized as one of the neurologic manifestations of systemic lupus erythematosus (SLE). Most reports show an association between chorea and antiphospholipid (aPL) antibodies in SLE patients. Objectives: The objective of this study was to describe the association of aPL antibodies with lupus chorea and its possible role in the pathogenesis of chorea. Methods: We made a retrospective review of all cases of lupus chorea between 1989 and 2007 in a tertiary care center in Mexico City. Results: We found 7 episodes of chorea in 5 patients with SLE. In 2 patients (3 episodes), chorea was associated with cerebral ischemia; one of these cases had positive anticardiolipin (aCL) immunoglobulin G (IgG) antibodies, whereas the other was diagnosed as having vascular lipohyalinosis as the probable cause of cerebral ischemia. In 3 patients (4 episodes), an immune-mediated mechanism was suspected; these cases had negative aPL at the onset of chorea, but IgM aCL antibodies became positive later. Conclusions: In most episodes, chorea seems to be immunologically mediated and was associated with a later appearance of IgM aCL antibodies. Chorea in patients with lupus may also be caused by cerebral ischemia, and in some cases, it may be associated with IgG aCL antibodies. Copyright © 2011 by Lippincott Williams &Wilkins. Source

Roy A.,Pennsylvania State University | Kordas K.,Pennsylvania State University | Lopez P.,National Institute of Medical science and Nutrition | Rosado J.L.,University of Queretaro | And 3 more authors.
Environmental Research

Previous studies suggest adverse effects of arsenic exposure on children's cognitive function. In this study, we examined the potential association between arsenic exposure and children's behavior. Five hundred and twenty-six children, 6-7 years old, living near a metal foundry in Torreón, Mexico, participated in the study. Arsenic exposure was measured as total urinary arsenic (UAs) and arsenic metabolites-monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA) concentrations. Children's behavior was assessed by Conners Behavior Rating Scales for parents and teachers. The median (interquartile range) concentrations of UAs, MMA and DMA were 55.2 (39.7), 6.7 (5.9) and 39.3 (28.5) γg/L, respectively. The mean behavior scores from parent and teacher ratings were within the clinically normal range (T<65). The relationship between behavior and urinary arsenic was modeled in linear and logistic regression models, with UAs, MMA and DMA tested in separate models and entered as quartiles. No significant association was found between any measure of urinary arsenic and parent ratings of behavior. However, higher UAs was modestly associated with higher scores on the Oppositional, Cognitive Problems and ADHD sub-scales of the teacher ratings; a dose-response relationship was not established between UAs quartiles and behavior. Higher urinary DMA was associated with higher ratings on the Oppositional, Cognitive Problems and ADHD Index by teachers. The associations between UAs and behavior became statistically non-significant after adjustment for the Peabody Picture Vocabulary Test scores, suggesting that the harmful effects of arsenic on behavior may be secondary to arsenic-induced cognitive deficits. These data suggest a potential adverse association between arsenic and children's behavior and indicate a need to further study the effects of arsenic and arsenic metabolites on neurobehavioral outcomes in children. © 2011 Elsevier Inc. Source

Saeb-Lima M.,Federal University of Bahia | Charli-Joseph Y.,National Institute of Medical science and Nutrition | Rodriguez-Acosta E.D.,National Institute of Medical science and Nutrition | Dominguez-Cherit J.,National Institute of Medical science and Nutrition
American Journal of Dermatopathology

Neutrophilic dermatoses have long been known to be associated with autoinmune systemic diseases. Recently, a small number of cases of a disorder distinct from Sweet syndrome or bullous lupus erythematosus (LE) have been described as specifically related to systemic LE under diverse terms, including nonbullous neutrophilic dermatosis, nonbullous neutrophilic LE, and Sweet-like neutrophilic dermatosis. We describe 7 patients that developed urticarial lesions in the context of a known or concurrently diagnosed autoimmune connective tissue disease. Of a total of 7 patients, 6 were afflicted by systemic LE and 1 by rheumatoid arthritis and secondary Sjögren syndrome. Histological findings in all patients included an interstitial and perivascular neutrophilic infiltrate with leukocytoclasia, vacuolar alteration along the dermal-edidermal junction, and no vasculitis. Most patients had active systemic disease at the time of the cutaneous eruption. Skin lesions resolved rapidly after the administration of immunomodulating agents. In conclusion, we provide additional evidence of the existence of a recently defined nonbullous neutrophilic dermatosis in the context of autoimmune connective tissue diseases and propose the term autoimmunity-related neutrophilic dermatosis as an appropriate designation. Furthermore, we believe that this entity should prompt physicians to screen the presence of an active systemic disorder in afflicted patients. © 2013 Lippincott Williams &Wilkins. Source

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