Neopterin is derived from guanosine-triphosphate, produced by stimulated macrophages under the influence of gamma interferon of lymphocyte origin. It has been suggested as an excellent marker for activation of the monocyte/macrophage axis in some clinical situations. We evaluated its concentration in the pleural effusions of 25 individuals (10 tuberculous and 15 neoplastic) as well as in the blood of 22 of them (8 tuberculous and 14 neoplastic), comparing these levels with those of a control group in 99 normal individuals. The concentration of neopterin was determined by radioimmunologic assay. This showed a significant increase (p less than 0.001) of neopterin levels in the tuberculous pleural fluid, compared to the neoplastic group (42 +/- 23/17 +/- 9 nmol/L). In the blood, values were nearly identical to the pleural fluid (41.3 +/- 25/15.8 +/- 6.9 nmol/L), although with significant differences between them and in relation to the control group (p less than 0.001), which had a normal serum value (5.11 +/- 1.92 nmol/L). We emphasize the influence of the neopterin levels in the pleural fluid on the diagnosis of causes of pleurisy and its importance as a marker of immunologic cellular activity.
Background: Charles Bonnet syndrome (CBS) is defined by repetitive experiences of visual hallucinations. This classically affects the elderly with visual impairment, intact cognition and the absence of psychiatric illness. Hallucinations remain indefinitely and can be static, dynamic, elementary or complex, colored or in black and white, centrally or peripherally. Objectives: To analyze the scientific information available on the clinical aspects of CBS. Methods: A bibliographic review was carried out in the PubMed database, in the last 10 years, using the descriptors “Charles Bonnet Syndrome”, “Hallucinations” and “Prognosis”, associated with the Boolean operator “AND’’. English and Portuguese were included, inconclusive studies were excluded, with biases or duplicates, whose approaches did not indicate an outcome in the syndrome, selecting 12 articles. Results: It was observed that there is no consensus on the pathophysiology and age range of CBS involvement, which varies between 70 and 80. The incidence is up to 1.4%. As for the prognosis, one of the articles pointed to the presence of hallucinations between 7 and 18 months, these varying in complexity, frequency and impact on patients’ lives. Diagnosis is made by exclusion, emphasizing the benign character, assertive diagnosis and effective treatment are essential factors for the mild evolution of the disorder. Conclusion: As it is considered a rare disease, it is rarely addressed in the literature and, therefore, new studies are desirable, in order to demystify the condition and ensure an appropriate approach to patients.
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