Pyronaridine combined with diminazene aceturate inhibits Babesia in vitro and in vivo

Objective:To evaluate the combination therapy of pyronaridine tetraphosphate and diminazene aceturate against Babesia in vitro and in vivo.Methods:Bioinformatic analysis was performed using atom pair fingerprints.An in vitro combination test was performed against Babesia bovis and Theileria equi.Moreover,the in vivo chemotherapeutic efficacy of pyronaridine tetraphosphate in combination with diminazene aceturate was investigated against the growth of Babesia microti in mice using a fluorescence inhibitory assay.Results:Pyronaridine tetraphosphate and diminazene aceturate exhibited nearly similar molecular weights.The in vitro combination of pyronaridine tetraphosphate and diminazene aceturate was synergistic on Babesia bovis and additive on Theileria equi.In addition,5 mg/kg pyronaridine tetraphosphate combined with 10 mg/kg diminazene aceturate inhibited Babesia microti growth significantly compared with those observed after treatment with 25 mg/kg diminazene aceturate alone from day 6 post treatment to day 12 post treatment.The combination therapy also normalized the hematological parameters of infected mice.Conclusions:An oral dose of pyronaridine tetraphosphate combined with a subcutaneous dose of diminazene aceturate inhibits Babesia in vitro and in mice,suggesting it might be a new paradigm for the treatment of babesiosis.

Association of hepatitis C virus infection and diabetes in central Tunisia

AIM：To investigate hepatitis C virus （HCV） seroprevalence in Tunisian patients with diabetes mellitus and in a control group. METHODS： A cross-sectional study was conducted to determine the HCV seroprevalence in 1269 patients with diabetes （452 male, 817 female） and 1315 nondiabetic patients, attending health centers in Sousse, Tunisia. HCV screening was performed in both groups using a fourth-generation enzyme immunoassay. RESULTS： In the diabetic group, 17 （1.3%） were found to be HCV-infected compared with eight （0.6%） in the control group, although the difference was not significant （P = 0.057）. Quantitative PCR was performed in 20 patients. Eleven patients were positive and showed HCV genotype lb in all cases. CONCLUSION： Frequency of HCV antibodies was low in patients with diabetes and in the control group in central Tunisia, with no significant difference between the groups.

Granulocytic sarcoma of the rectum:Report of one case that presented with rectal bleeding

Granulocytic sarcoma is an uncommon and localized extramedullary tumor composed of immature granu-locytic cells.It may present in association with acute myeloid leukaemia,myelodysplastic syndrome and chronic myelogenous leukaemia.Granulocytic sarcoma may occur in any anatomical site but involvement of the gastrointestinal tract is rare,especially in the rectum.We report on the case of a 17 year old female who presented with rectal bleeding,abdominal pain and weight loss one mo prior to admission.Recto-sigmoidoscopy revealed a rectal polypoid and ulcerated mass.The histological examination of the mass showed granulocytic sarcoma.Bone marrow examination was compatible with acute promyelocytic leukaemia(FABtype M3).This case report is a reminder of this peculiar sign of tumoral syndrome in acute myeloid leukaemia.We also discuss diagnostic methods and analyze the disease course.

Cocktail of Theileria equi antigens for detecting infection in equines

Objective:To use two diagnostic antigens belonging to the frequently associated in Theileria domain,Theileria equi(T.equi)protein 82(Te 82)and T.equi 104 k Da microneme-rhoptry antigen precursor(Te 43),to diagnose T.equi infection in horses as compared with equi merozoite antigen-2(EMA-2).Methods:In the current study,we applied a cocktail-ELISA containing two antigens(EMA-2+Te 82)to diagnose T.equi infection either in experimentally infected horses or in field infection.Results:Our findings have revealed that a cocktail formula of EMA-2+Te 82 provided a more practical and sensitive diagnostic candidate for diagnosing T.equi infection in horses as compared with Te 82 or Te 43 alone.Conclusions:The ELISA technique using a cocktail formula of EMA-2+Te 82 offers a practical and sensitive diagnostic tool for diagnosing T.equi infection in horses and using of this promising cocktail formula will be applicable for epidemiological surveys and will help control the infection in horses.

Immune-modulating therapy in acute pancreatitis:Fact or fiction

Acute pancreatitis(AP) is one of the most common diseases of the gastrointestinal tract,bearing significant morbidity and mortality worldwide.Current treatment of AP remains unspecific and supportive and is mainly targeted to aggressively prevent systemic complications and organ failure by intensive care.As acute pancreatitis shares an indistinguishable profile of inflammation with sepsis,therapeutic approaches have turned towards modulating the systemic inflammatory response.Targets,among others,have included pro- and antiinflammatory modulators,cytokines,chemokines,immune cells,adhesive molecules and platelets.Even though,initial results in experimental models have been encouraging,clinical implementation of immuneregulating therapies in acute pancreatitis has had a slow progress.Main reasons include difficulty in clinical translation of experimental data,poor understanding of inflammatory response time-course,flaws in experimental designs,need for multimodal approaches and commercial drawbacks.Whether immune-modulation in acute pancreatitis remains a fact or just fiction remains to be seen in the future.

A Mass Shadow on Chest X-Ray in a 40-Year-Old Man: What’s Your Diagnosis?

A 40-year-old man presented recurrent cough and bloody sputum for 4 months. Chest X-ray showed a large mass in the right upper lobe. Histopathologic examination of tissue from percutaneous biopsy of the lesion revealed actinomycotic granules and branching filamentous bacteria, and therefore pulmonary actinomycosis was diagnosed. These findings suggest that pulmonary actinomycosis should be included in the differential diagnosis of a mass on a chest X-ray film.

Splenic Infarction Associated with Acute Brucellosis: A Case Report

We report a case of a 21-year-old shepherd who presented with fever, left hypochondrium pain and splenomegaly. Blood tests showed thrombocytopenia and high liver enzymes. Computed tomography scan revealed the presence of hypodense lesions suggestive of splenic infarction. Echocardiography was without abnormalities. Laboratory evaluation for thrombophilia was negative. A bone marrow aspiration and a bone marrow biopsy were normal. Brucella serology was positive. The patient was treated with doxycycline, rifampicin and streptomycin for 12 weeks. Fever, abdominal pain and thrombocytopenia resolved promptly. At one year of follow-up, he remained well and no splenic infarction could be detected on ultrasonography.

早期将抗生素由静脉转为口服治疗严重社区获得性肺炎:多中心随机试验

目的比较早期由静脉转换成口服抗生素与常规静脉使用7天抗生素治疗严重社区获得性肺炎(CAP)的疗效。设计多中心随机对照试验。地点荷兰5家教学医院和2所大学的医学中心。参加者非 ICU 住院的严重 CAP 患者302例,其中265例满足研究要求。干预静脉抗生素治疗3天,病情稳定后换成口服抗生素,或静脉使用抗生素治疗7天。主要评价结果临床治愈和住院天数。结果 302例患者被随机分组(平均年龄69.5岁,标准差14.0),肺炎严重度评分平均112.7(26.0)。37例患者因为提前3天退出而未纳入分析,对其余265例患者进行分析研究。第28天的死亡率在干预组是4%,对照组是6%(平均差2%,95%可信区间-3%～8%)。临床治愈率在干预组是83%,对照组是85%(2%;-7%～10%)。与对照组相比,干预组患者静脉治疗时间为3.4天[3.6(1.5)比7.0(2.0)天;2.8～3.9],患者住院天数减少1.9天[9.6(5.0)比11.5(4.9)天;0.6～3.2]。结论早期将抗生素由静脉应用转换成口服治疗严重 CAP 是安全的,并且可以减少住院时间2天。试验注册号临床试验 NCT00273676。