Cytomegalovirus Cholangiopathy in an Immunocompetent Patient: A Case Report and Literature Review

A 37-year-old man presented with jaundice, upper right quadrant pain, and intermittent fever with chills. Laboratory assessment showed biliary stasis, with total bilirubin of 203 µmol/L (2–20), conjugated bilirubin of 105 µmol/L, and alkaline phosphatase of 556 U/L (30–120). Markers for hepatitis A–E viruses were negative. Serology assessment for rubeola, herpes simplex virus, Epstein-Barr virus, and Toxoplasma gondii showed negative IgM antibodies. HIV serology status was negative. For cytomegalovirus, both types of antibodies (IgM and IgG) were positive, with an IgM level >300 U/mL. pp65 antigen was also detected as well as CMV DNA. Diagnostic imaging of the abdomen except the dilated common bile duct showed a normal appearance of the gallbladder, liver, pancreas, spleen, and both kidneys. To our knowledge, cytomegalovirus cholangiopathy in the absence of any other underlying disease has not been reported. Therefore, the presence of cholangiopathy in our patient is interesting from an imaging, laboratory, and clinical point of view.

Alterações dimensionais em pastas de óxido de zinco/eugenol: um novo método para sua mensuração

After an extensive review of the literature, regarding zinc.oxide/eugenol impression pastes, we selected 20 of the most representatives as our references. Trough personal information of several of the investigators it was discovered that dimensional changes of theese materials is one of the most difficult properties to be measured. A new method was developed to measure dimensional changes ot 4 (four) of the most widely used zinc.oxide/eugenol impression materials in Brazil. The results, presented through several graphs and tables showed that dimensional changes varied from 0,003%, values which may probably be considered negligible from a clinical point of view. We noticed, however, high values for standard deviation and variance which indicate the high variability within the experiments. Those values were not found when we used the same method with mercaptan and silicone impression materials, in which the measurement of dimensional changes was highly reproducible. One hypothesis (which we intend to investigate in a later research) is that, during storage, a sedimentation could occur, of the components of greater density! Consequently ther might result a change in composition, independent of the method used to establishe the proportion of the two pastes, be it by wheight or measurement of lenght, which could be the cause of variability of the composition of each mixture!

Adjuvant Treatment in Pancreatic Cancer: Shaping the Future of the Curative Setting

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease even in the early stages, despite progresses in surgical and pharmacological treatment in recent years. High potential for metastases is the main cause of therapeutic failure in localized disease, highlighting the current limited knowledge of underlying pathological processes. However, nowadays research is focusing on the search for personalized approaches also in the adjuvant setting for PDAC, by implementing the use of biomarkers and investigating new therapeutic targets. In this context, the aim of this narrative review is to summarize the current treatment scenario and new potential therapeutic approaches in early stage PDAC, from both a preclinical and clinical point of view. Additionally, the review examines the role of target therapies in localized PDAC and the influence of neoadjuvant treatments on survival outcomes.

A Dutchman in London: reflections of a hospital chief executive from the Netherlands in the NHS

BackgroundThe NHS is a fascinating health care system and is enjoying a lot of support from all layers of British society. However, it is clear that the system has excellent features but also areas that can be improved.Story of selfA number of years as a chief executive in one of London’s largest hospital has brought me a wealth of impressions, experiences, and understanding about working in the NHS. Contrasting those to my previous experience as chief executive in Amsterdam (The Netherlands) provides an interesting insight.ObservationsVery strong features of the NHS are the high level of health care professionals, the focus on quality and safety, and involvement of patients and the public. However, the NHS can significantly improve by addressing the lack of clinical professionals in the lead, curtailing ever increasing bureaucracy, and reducing its peculiar preference for outsourcing even the most crucial activities to private parties. The frequent inability to swiftly and successfully complete goal-directed negotiations as well as the large but from a clinical point of view irrelevant private sector are areas of sustained bewilderment. Lastly, the drive for innovation and transformation as well as the level of biomedical research in the NHS and supported by the British universities is fascinating and outstanding.

Progress in oncology biosimilars till 2020: Scrutinizing comparative studies of biosimilar monoclonal antibodies

Stupendous elevation in the healthcare costs has followed with the inception of the current unconventional options of treatment available for cancer patients. There is a dire need of innovative financing approaches to lessen the financial load on healthcare system. Biosimilars are biological drugs consisting of an active ingredient from a reference biological drug that has a great potential of relieving financial load. Strict requirements from regulatory point of view are required as biosimilars are exceedingly similar to but not identical to the reference product. This provides with a certainty that no consequential differences from clinical point of view as compared to the respective biologics exists with regards to efficacy, safety and purity. Safety and effectiveness of biosimilars have been disclosed since more than 10 years of affirmations. However, there is a need to educate the healthcare professionals to abolish potential misconceptions and coalesce biosimilars into regular clinical practice. The present review focuses on providing an overview of regulatory aspects and requirements for biosimilars, the main challenges in the selection and development of biosimilars and the economic impact and financial savings observed in recent studies carried out in different parts of the world. In addition, we have discussed the different successful comparative studies which have been done in different parts of the world to depict the biosimilarity for monoclonal antibodies such as bevacizumab, trastuzumab and rituximab.

Value of positive blood culture for Staphylococcus pettenkoferi - how not to make a mistake while interpreting the microbiological test results

Staphylococcus pettenkoferi is a coagulase negative staphylococcus (CoNS) whose clinical relevance is not fully understood. Hitherto, there are several reports describing the participation of this species in human infections; in most cases S. pettenkoferi was isolated from blood cultures. The purpose of this work is to summarize knowledge about S. pettenkoferi especially in terms of biochemical properties, types of infections caused, factors predisposing to bacteremia and susceptibility to antibiotics. Particular attention was paid to the difficulties in identifying this CoNS bacterium and limitations of microbiological tests. The principles of microbiological bloodstream infection diagnostics and criteria for interpreting test results are summarized, as well. The analysis of published reports and opinions resulted in better characterization of infections in which S. pettenkoferi is the etiological agent. From a clinical point of view, presented knowledge allows to assess the risk of bloodstream infection or sample contamination, help physician to implement the appropriate procedures and making decisions concerning inter alia empirical treatment.

Clinical and trichoscopic features in 18 cases of Folliculotropic Mycosis Fungoides with scalp involvement

Folliculotropic Mycosis Fungoides (FMF) is a rare variant of Mycosis Fungoides involving the scalp leading to alopecia. The clinical and trichoscopic features in 18 patients were analyzed and compared with the reports in the literature. Gender, age, disease stage, site of onset were taken into consideration. Clinical and trichoscopic analyses were performed on each patient. From a clinical point of view, Folliculotropic Mycosis Fungoides lesions involving the scalp presented as generalized alopecia (27.8%) or patchy-plaque alopecia (72.2%). Trichoscopic analysis revealed six most frequent features: single hair (83.3%), dotted dilated vessels (77.8%), broken-dystrophic hairs (66.7%), vellus hairs (61.1%), spermatozoa-like pattern vessels (55.6%), and yellow dots (55.6%). Additional identified trichoscopic patterns were dilation of follicular openings, scales-crusts, purpuric dots, short hair with split-end, pigtail hairs, perifollicular hyperkeratosis, milky-white globules, black dots, white dots/lines and absence of follicular dots. These trichoscopic features were further correlated to clinical presentations and stage of the disease. The rarity of the disease is a limitation. The relatively high number of patients allowed to identify several clinical and trichoscopic patterns that could be featured as specific or highly suspicious for FMF in order to consider trichoscopy as a complementary diagnostic approach and improve the differential diagnoses between FMF and other scalp disorders.

3D Bioprinting of Functional Skin Substitutes: From Current Achievements to Future Goals

The aim of this review is to present 3D bioprinting of skin substitutes as an efficient approach of managing skin injuries. From a clinical point of view, classic treatments only provide physical protection from the environment, and existing engineered scaffolds, albeit acting as a physical support for cells, fail to overcome needs, such as neovascularisation. In the present work, the basic principles of bioprinting, together with the most popular approaches and choices of biomaterials for 3D-printed skin construct production, are explained, as well as the main advantages over other production methods. Moreover, the development of this technology is described in a chronological manner through examples of relevant experimental work in the last two decades: from the pioneers Lee et al. to the latest advances and different innovative strategies carried out lately to overcome the well-known challenges in tissue engineering of skin. In general, this technology has a huge potential to offer, although a multidisciplinary effort is required to optimise designs, biomaterials and production processes.

Peripheral blood abnormalities in patients with Covid 19 hospitalized in the pneumology department of Marrakesh University Hospital

In December 2019, Coronavirus 2019 due to SARS CoV 2 was first discovered in Wuhan, China and then rapidly spread to more than 200 countries. Until now, there is no specific vaccine and no effective treatment, so it is very important from a clinical point of view to predict the evolution of the disease. Thus, in order to further analyze the value of the clinical application of blood count parameters in the diagnosis or management of COVID-19 (Coronavirus disease 2019) patients. Peripheral blood abnormalities of 102 COVID-19 patients hospitalized in the pneumology department of CHU Mohamed VI in Marrakesh were analyzed retrospectively and compared to SARS CoV 2 negative patients. Results: WBCs in the patient group were 8.32 ×109/L vs 5.85 ×109/L, p<0.001, an elevated neutrophil count (5.33 ×109/L vs 3.27 ×109/L, p<0. 001), a lower hemoglobin concentration (13.5 [10.6-16.37] g/dl vs 14.8 [13.5-15.6] g/dl, p<0.001), and a higher Neutrophils-to-lymphocytes ratio (2.63 vs 1.52, p<0.001). The severe cases had a higher white blood cell count (14,279 (±6,564) vs. 7,471 (±2,609) ×109/L, p<0.001), a much higher neutrophil count (12,547 (±6,698) vs. 4,468 (±1,882) ×109/L, p<0.001). Lymphopenia (0.851 (±0.406) vs. 2.138 (±1.103) ×109/L, p<0.001), NLR (14.74 vs. 2.08) and Platelets-to-lymphocytes ratio (145 vs. 117) were higher than the non-severe COVID-19 cases. Conclusion: In light of these data, we deduce that regular monitoring of blood counts should be involved to judge the progression and prognosis of COVID-19.