Erythema Nodosum as Azathioprine Hypersensitivity Reaction in a Patient with Bullous Pemphigoid.

A 65-year-old woman with bullous pemphigoid presented with fever and several red-purple nodular subcutaneous lesions on both lower legs 1 week after starting treatment with azathioprine (AZA). Biopsy of a skin nodule was compatible with erythema nodosum (EN) and hypersensitivity reaction to AZA was suspected. AZA was subsequently discontinued, observing complete remission of fever and EN within 2 weeks. This case highlights the importance of recognizing EN as a possible manifestation of hypersensitivity reaction to AZA.

Monotherapy with darunavir/ritonavir is effective and safe in clinical practice.

INTRODUCTION Monotherapy against HIV has undoubted theoretical advantages and has good scientific fundaments. However, it is still controversial and here we will analyze the efficacy and safety of MT with darunavir with ritonavir (DRV/r) on patients who have received this treatment in our hospitals. MATERIALS AND METHODS Observational retrospective study that includes patients from 10 Andalusian hospitals that have received DRV/r in MT and that have been followed over a minimum of 12 months. We carried out a statistical descriptive analysis based on the profile of patients who had been prescribed MT and the efficacy and safety that were observed, paying special attention to treatment failure and virological evolution. RESULTS DRV/r was prescribed to 604 patients, of which 41.1% had a CD4 nadir <200/mmc. 33.1% had chronic hepatitis caused by HCV, had received an average of five lines of previous treatment and had a history of treatment failure to analogues in 33%, to non-analogues 22 and protease inhibitors (PI) in 19.5%. 76.6% proceeded from a previous treatment with PI. The simplification was the main criteria for the instauration of MT in the 81.5% and the adverse effects in the 18.5%. We managed to maintain MT in 84% of cases, with only 4.8% of virological failure (VF) with viral load (VL) >200 c/mL and 3.6% additional losses due to VF with VL between 50 and 200 copies/mL. Thirty three genotypes were performed after failure without findings of resistance mutations to DRV/r or other IPs. Only 23.7% of patients presented some blips during the period of exposition to MT. Eighty seven percent of all determinations of VL had <50 copies/mL, and only 4.99% had >200 copies/mL. Although up to 14.9% registered at some point an AE, only 2.6% abandoned MT because of AE and 1.2% because of voluntary decision. Although the average of total and LDL cholesterol increases 10 mg/dL after 2 years of follow-up, so did HDL cholesterol in 3mg/dL and the values of triglycerides (-14 mg/dL) and GPT (-6 UI/mL) decreased. The average count of CD4 lymphocytes increased from 642 to 714/mm(3) at 24 weeks. CONCLUSIONS In a very broad series of patients obtained from clinical practice, data from clinical trials was confirmed: MT with DRV as a de-escalation strategy is very safe, it's associated to a negligible rate of adverse effects and maintains a good suppression of HIV replication. VF (with >50 or >200 copies/mL) is always under 10% and in any case without consequences.

Combined vemurafenib and cobimetinib in BRAF-mutated melanoma.

BACKGROUND The combined inhibition of BRAF and MEK is hypothesized to improve clinical outcomes in patients with melanoma by preventing or delaying the onset of resistance observed with BRAF inhibitors alone. This randomized phase 3 study evaluated the combination of the BRAF inhibitor vemurafenib and the MEK inhibitor cobimetinib. METHODS We randomly assigned 495 patients with previously untreated unresectable locally advanced or metastatic BRAF V600 mutation-positive melanoma to receive vemurafenib and cobimetinib (combination group) or vemurafenib and placebo (control group). The primary end point was investigator-assessed progression-free survival. RESULTS The median progression-free survival was 9.9 months in the combination group and 6.2 months in the control group (hazard ratio for death or disease progression, 0.51; 95% confidence interval [CI], 0.39 to 0.68; P<0.001). The rate of complete or partial response in the combination group was 68%, as compared with 45% in the control group (P<0.001), including rates of complete response of 10% in the combination group and 4% in the control group. Progression-free survival as assessed by independent review was similar to investigator-assessed progression-free survival. Interim analyses of overall survival showed 9-month survival rates of 81% (95% CI, 75 to 87) in the combination group and 73% (95% CI, 65 to 80) in the control group. Vemurafenib and cobimetinib was associated with a nonsignificantly higher incidence of adverse events of grade 3 or higher, as compared with vemurafenib and placebo (65% vs. 59%), and there was no significant difference in the rate of study-drug discontinuation. The number of secondary cutaneous cancers decreased with the combination therapy. CONCLUSIONS The addition of cobimetinib to vemurafenib was associated with a significant improvement in progression-free survival among patients with BRAF V600-mutated metastatic melanoma, at the cost of some increase in toxicity. (Funded by F. Hoffmann-La Roche/Genentech; coBRIM ClinicalTrials.gov number, NCT01689519.).

Estudio de la albúmina sérica y del índice de masa corporal como marcadores nutricionales en pacientes en hemodiálisis.

Background: Protein calorie malnutrition as well as systemic inflammation and metabolic disorders are common among patients with chronic renal failure undergoing renal replacement therapy (haemodialysis), which contributes to its morbidity and mortality. Aims: The aims of this work was to evaluate the nutritional status of patients in a hemodialysis treatment through the assessment of biochemical parameters nutritional as albumin, and anthropometric parameters of body mass index during ten years of follow up. Methods: In this work has been followed 90 patients of both sexes with chronic kidney disease who were treated with hemodialysis regularly on our unit for ten years. All patients were conducted quarterly measurements of plasma albumin (Alb), and other biochemical determinations, and anthropometric measurements of height, weight and body mass index calculated by the formula weight/height², grouped n BMI < 23 kg/m2 and albumin levels <3.8 g/dl according to the consensus of the panel of experts of the International Society for renal Nutrition and metabolism. Results: During the 10 years all patients showed a significant decline in the biochemical parameters and the albumin, change in BMI does not presented significant changes in relation to malnutrition. Conclusions: Malnutrition in patients on dialysis is a fact patent, BMI does not correspond with the biochemical parameters were observed, for what nutritional impairment in these patients is mainly expressed by serum albumin.

Metabolomic insights into the intricate gut microbial-host interaction in the development of obesity and type 2 diabetes.

Gut microbiota has recently been proposed as a crucial environmental factor in the development of metabolic diseases such as obesity and type 2 diabetes, mainly due to its contribution in the modulation of several processes including host energy metabolism, gut epithelial permeability, gut peptide hormone secretion, and host inflammatory state. Since the symbiotic interaction between the gut microbiota and the host is essentially reflected in specific metabolic signatures, much expectation is placed on the application of metabolomic approaches to unveil the key mechanisms linking the gut microbiota composition and activity with disease development. The present review aims to summarize the gut microbial-host co-metabolites identified so far by targeted and untargeted metabolomic studies in humans, in association with impaired glucose homeostasis and/or obesity. An alteration of the co-metabolism of bile acids, branched fatty acids, choline, vitamins (i.e., niacin), purines, and phenolic compounds has been associated so far with the obese or diabese phenotype, in respect to healthy controls. Furthermore, anti-diabetic treatments such as metformin and sulfonylurea have been observed to modulate the gut microbiota or at least their metabolic profiles, thereby potentially affecting insulin resistance through indirect mechanisms still unknown. Despite the scarcity of the metabolomic studies currently available on the microbial-host crosstalk, the data-driven results largely confirmed findings independently obtained from in vitro and animal model studies, putting forward the mechanisms underlying the implication of a dysfunctional gut microbiota in the development of metabolic disorders.

Stable isotope (C, O, S) systematics of the mercury mineralization at Idrija, Slovenia: constraints on fluid source and alteration processes

The world-class Idrija mercury deposit (western Slovenia) is hosted by highly deformed Permocarboniferous to Middle Triassic sedimentary rocks within a complex tectonic structure at the transition between the External Dinarides and the Southern Alps. Concordant and discordant mineralization formed concomitant with Middle Triassic bimodal volcanism in an aborted rift. A multiple isotopic (C, O, S) investigation of host rocks and ore minerals was performed to put constraints on the source and composition of the fluid, and the hydrothermal alteration. The distributions of the delta(13)C and delta(18)O values of host and gangue carbonates are indicative of a fracture-controlled hydrothermal system, with locally high fluid-rock ratios. Quantitative modeling of the delta(13)C and delta(18)O covariation for host carbonates during temperature dependent fluid-rock interaction, and concomitant precipitation of void-filling dolomites points to a slightly acidic hydrothermal fluid (delta(13)Capproximate to-4parts per thousand and delta(18)Oapproximate to+10parts per thousand), which most likely evolved during isotopic exchange with carbonates under low fluid/rock ratios. The delta(34)S values of hydrothermal and sedimentary sulfur minerals were used to re-evaluate the previously proposed magmatic and evaporitic sulfur sources for the mineralization, and to assess the importance of other possible sulfur sources such as the contemporaneous seawater sulfate, sedimentary pyrite, and organic sulfur compounds. The delta(34)S values of the sulfides show a large variation at deposit down to hand-specimen scale. They range for cinnabar and pyrite from -19.1 to +22.8parts per thousand, and from -22.4 to +59.6parts per thousand, respectively, suggesting mixing of sulfur from different sources. The peak of delta(34)S values of cinnabar and pyrite close to 0parts per thousand is compatible with ore sulfur derived dominantly from a magmatic fluid and/or from hydrothermal leaching of basement rocks. The similar stratigraphic trends of the delta(34)S values of both cinnabar and pyrite suggest a minor contribution of sedimentary sulfur (pyrite and organic sulfur) to the ore formation. Some of the positive delta(34)S values are probably derived from thermochemical reduction of evaporitic and contemporaneous seawater sulfates.

Sellu- ja paperiteollisuuden haitallisimmat ilmapäästöt

Diplomityössä luotiin katsaus sellu- ja paperiteollisuuden haitallisimpiin ilmapäästöihin ja ilmapäästömäärien kehitykseen Suomessa 1990-luvun alusta nykypäivään. Työssä tutustuttiin sellu- ja paperiteollisuuden ilmapäästöjä rajoittavan lainsäädännön ajankohtaisiin asioihin Suomessa ja Euroopan Unionissa, sekä tarkasteltiin nykyisen lainsäädännön perustana olleita ilmastosopimuksia eli kansainvälisen ilmastopolitiikan syntyä ja kehittymistä. Työssä on myös selvitetty ilman osuutta paperinvalmistuksessa, tutustuttu ilmapäästöjen rajoittamismenetelmiin ja eri mittausmenetelmiin ilmapäästöjen toteamiseksi. Työn puitteissa suoritettiin mittalaitetestejä eri paperitehtailla. Haitallisimpia ja määrällisesti suurimpia ilmapäästöjä sellu- ja paperiteollisuudessa ovat typen ja rikin oksidit, pelkistyneet rikkiyhdisteet, hiukkaset, haihtuvat orgaaniset yhdisteet (VOC) ja hiilidioksidi. Ilmapäästömäärät Suomessa ovat typenoksideja lukuun ottamatta olleet laskussa 1990-luvun alusta nykypäivään. Tärkein kasvihuonekaasu on hiilidioksidi, jonka määrää rajoitetaan Kioton sopimuksessa. Vuoden 2002 aikana selvinneekin, mikä on Kioton sopimuksen vaikutus Suomen metsäteollisuuteen. Päästömittauksia tarvitaan lainsäädännön raja-arvojen toteamiseksi, mittauksia suorittavat sertifioidut päästömittauslaboratoriot. Suoritetuissa mittalaitetesteissä havaittiin mittalaitteiden soveltuvuudessa kosteiden paperiprosessin poistokaasujen määrittämiseen suuria eroja.

Rikkiyhdisteiden laskenta simuloinneissa

Diplomityön tarkoituksena on tutkia eri laskentamenetelmien soveltuvuutta kevyiden rikkiyhdisteiden laskentaan ja kuinka mitatusta kaasu-neste tasapainotiedoista sovitetut binääriset vuorovaikutusparametrit parantavat kaasu-neste tasapainojen laskentaa simuloinneissa. Kirjallisuusosassa paneudutaan kevyisiin rikkiyhdisteisiin ja niiden aineominaisuuksiin. Lisäksi käsitellään öljynjalostuksessa nykyisin käytettäviä ja uusia kehitteillä olevia rikinpoistomenetelmiä.Kokeellisessa osassa tarkastellaan eri laskentamenetelmien soveltuvuutta rikkiyhdisteiden ja kevyiden hiilivetyjen kaasu-neste tasapainon laskentaan. Mitatusta rikkiyhdisteiden ja hiilivetyjen kaasu-neste tasapainoista sovitetaan binäärisiä vuorovaikutusparametrejä tarkentamaan käytettäviä laskentamenetelmiä. Osassa verrataan binääristen seosten mittaustuloksia eri laskentamenetelmillä saatuihin simulointituloksiin. Tarkasteluiden perusteella tehdään johtopäätöksiä laskentamenetelmien soveltuvuudesta kevyiden hiilivetyjen ja rikkiyhdisteiden laskentaan. Tarkastellaan kahden prosessin (rikkivetystripperi ja butaaninpoistokolonni) rikkiyhdisteiden laskentaa. Prosesseille tehdään taseajot, joista saatuja analyysituloksia verrataan simulointien antamiin tuloksiin. Työssä tarkastellaan myös veden liukoisuuden laskentaa ja mahdollisten laskentamenetelmien käytön vaikutusta rikkiyhdisteiden laskentaan.

Dimetildioxirano. 1. Oxidação de compostos de enxofre

A brief review of the chemistry of dimethyldioxirane is presented. This article specifically foccus on the preparation of dimethyldioxirane, its chemical reactivity, and specially on the oxidation of sulfur compounds.

Estudo de compostos orgânicos em lixiviado de aterros sanitários por EFS e CG/EM

The main purpose of this work was the qualitative study of organic compounds in landfill leachate. The samples were collected from a sanitary landfill located at Gravataí, a southern Brazilian city, that receive both, industrial and domestic refuse. The samples were submitted to solid phase extraction (SPE) with XAD-4 resin as the stationary phase. The instrumental analysis was performed by Gas Chromatography with a Mass Spectrometry Detector (GC/MSD). The compounds achieved in the SPE extracts were tentatively identified by the GC/MS library. It was found several oxygen and nitrogen compounds like carboxylic acids, ketones, amines and amides. Sulfur compounds and phthalate esters are also identified.

Análise de compostos sulfurados em efluentes gasosos de refinaria de petróleo

This work discusses an analytical procedure for analysis of sulfur compounds in treated petroleum refinery gaseous effluents using a sulfur chemiluminescence detector with dual plasma burner (SCD-DP). Calibration was accomplished by using standards and gaseous streams of known concentration of sulfur compounds. The response factors agree with the calibration table of ASTM standard D 5504 (2008). The detection range for sulfur compounds is in μg m-3. The analytical procedure allowed the construction of a chromatographic chart of sulfur compounds present in several refinery gaseous effluents. SO2 was the most difficult compound to be determined because of its high reactivity.

New strategies for treatment and reuse of spent sulfidic caustic stream from petroleum industry

This work examines traditional and new routes for removal of H2S and other sulfur compounds from spent sufidic caustic (SSC). SH- (hydrogenosulfide) and S2- (sulfide) ions were quantitatively oxidized at 25 ºC using H2O2, NaOCl or a spent sulfochromic mixture. SH-/S2- ions were also removed via reaction with freshly prepared iron or manganese hydroxides, or after passing the SSC through strong basic anion exchange resins (OH- form). The treated caustic solution, as well as iron/manganese hydroxides, removed H2S from diesel samples at 25 ºC. SSC treatment via strong basic anion-exchange resins produced the treated caustic solution with the highest free alkalinity.

Determinação de compostos carbonilados e carboxilados em derivados de petróleo

Although metals and nitrogen/sulfur compounds have been the main concern of the petroleum industry, issues concerning the harmful effects on catalysts poisoning and product contamination by other contaminants such as oxygen-containing compounds have been raised. Trace amounts of carbonyl and carboxyl compounds in petroleum products can lead to catalyst poisoning. Additionally, oxygenates may be present in final polyethylene and polypropylene resins, affecting the quality of food packaging. In this work, we reviewed potential analytical approaches for oxygenates determination in petroleum products and report the features of each potential technique.

Käytetyn voiteluöljyn regenerointilaitoksen prosessivesien karakterisointi

Käytetyn voiteluöljyn regeneroinnissa muodostuu prosessivettä useista lähteistä. Tehokas päästöjenhallinta on yksi tärkeimmistä tavoitteista regenerointilaitoksen operoinnissa ja sen takia sitä tulee kehittää jatkuvasti entistä paremmaksi. Tavoitteisiin pääsemiseksi on oleellista tunnistaa vesienkäsittelyprosessin laadullinen massatase ja laadunvaihtelut ajotilanteiden mukaan. Työssä tutkitaan ja analysoidaan veden sisältämiä epäpuhtauksia sekä kirjallisuuslähteiden perusteella, että standardimenetelmillä ja modifioiduilla menetelmillä, joilla on akkreditointi. Analyysituloksista muodostetaan laadullinen massatase, josta nähdään epäpuhtauksien ja niitä kuvaavien parametrien kuormitukset kussakin prosessivesivirrassa. Tulosten perusteella arvioidaan nykyisen vesienkäsittelyn tehokkuutta, sen säätömahdollisuuksia ja kehitystarvetta. Tarkastelun ulkopuolelle kuitenkin jätetään vesienkäsittelystä ulosjohdettavan prosessiveden puhdistuslaitos. Tutkimusten perusteella regenerointilaitoksessa muodostuvien prosessivesien epäpuhtaudet koostuvat öljystä, BTEX-yhdisteistä, fenoliyhdisteistä, liuottimista, polttoaineiden ja voiteluöljyjen lisäaineista, typpi- ja rikkiyhdisteistä, metalliyhdisteistä sekä kiintoaineesta. Öljy jakautuu kevyisiin (C5-C10), keskiraskaisiin (C10-21) ja raskaisiin (C21-40) jakeisiin. Vesienkäsittelyssä suurin osa öljystä ja epäpuhtauksista saadaan erottumaan vedestä, jolloin puhdistuslaitokselle päätyy jäämäpitoisuudet öljyä, haihtuvia yhdisteitä sekä muita epäpuhtauksia. Puhdistuslaitosta kuormittavat eniten liuenneet orgaaniset yhdisteet sekä korkeaa kemiallista hapenkulutusta aiheuttavat epäorgaaniset yhdisteet (suolat), joiden erottamista prosessivesistä on syytä tulevaisuudessa kehittää.

Gut microbial activity, implications for health and disease: the potential role of metabolite analysis

Microbial metabolism of proteins and amino acids by human gut bacteria generates a variety of compounds including phenol, indole, and sulfur compounds and branched chain fatty acids, many of which have been shown to elicit a toxic effect on the lumen. Bacterial fermentation of amino acids and proteins occurs mainly in the distal colon, a site that is often fraught with symptoms from disorders including ulcerative colitis (UC) and colorectal cancer (CRC). In contrast to carbohydrate metabolism by the gut microbiota, proteolysis is less extensively researched. Many metabolites are low molecular weight, volatile compounds. This review will summarize the use of analytical methods to detect and identify compounds in order to elucidate the relationship between specific dietary proteinaceous substrates, their corresponding metabolites, and implications for gastrointestinal health.