The concept of "compartment allergy": prilocaine injected into different skin layers

We herein present a patient with delayed-type allergic hypersensitivity against prilocaine leading to spreading eczematous dermatitis after subcutaneous injections for local anesthesia with prilocaine. Prilocaine allergy was proven by positive skin testing and subcutaneous provocation, whereas the evaluation of other local anesthetics - among them lidocaine, articaine and mepivacaine - did not exhibit any evidence for cross-reactivity

Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Background: Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. Methods: Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. Findings: Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity. Interpretation: No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels. Funding: Bill & Melinda Gates Foundation

Flavonoids and Triterpenoid Saponins from <i>Pimenta dioica</i> (Merr.) L

The defatted and desalted 80% methanolic extract of the leaves of Pimenta dioica (Mirr.) L. resulted in the isolation of three triterpenoid saponins, 23-hydroxy-3α-[( O-α-L-rhamnopyranosyl-(1→2)- O-α-L-arabinopyranosyl) oxy] olean-12-en-28-oic acid O-α-L-rhamnopyranosyl-(1→4)- O-β-D-galactopyranosyl-(1→6)- O-β-D-galactopyranosyl ester (1), 2α,3α,23-trihydroxyolean-12-en-28-oic acid O-β-D-glucopyranosyl ester (2), and 2α,3α,23-trihydroxyolean-13(18)-en-28-oic acid O-β-D-glucopyranosyl ester (3), along with a novel dihydrokaempferol glucoside, namely, 3-carboxy-6,8-di- C-methyl-dihydrokaempferol 3- O-β-D-glucopyranoside (4), together with three known flavonoids, quercetin 3- O-β-D-glucuronopyranoside (5), quercitrin (6) and mernesitin (7), all for the first time from the genus Pimenta. The structures were identified on the basis of chemical and physicochemical analysis (UV, HRESI-MS, 1 and 2D NMR). </jats:p

Antioxidant and Anti-Proliferative Active Constituents of <i>Tecoma Stans</i> against Tumor Cell Lines

A new phenylethanoid, 2-(3,4-dihydroxyphenyl)ethyl-,2-O-(6-deoxy-α-L-mannopyranosyl-,4-(3,4-dihydroxyphenyl)-2-propenoate)-β-D-glucopyranoside (3) and a novel monoterpene alkaloid, 5-hydroxy-skytanthine hydrochloride (8), along with eleven known compounds have been isolated from Tecoma stans Juss. fruits and flowers. 4-O-E-Caffeoyl-α-L-rhamnopyranosyl-(1′→3)-α/β-D-glucopyranose (1), E/Z-acetoside (2), isoacetoside (4), rutin (5), luteolin 7-O-β-D-neohespridoside (6), luteolin 7-O-β-D-glucopyranoside (7) and sucrose (9) were isolated from the fruits, while luteolin 7-O-β-D-glucuronopyranoside (10), diosmetin 7-O-β-D-glucuronopyranoside (11), diosmetin 7-O-β-D-glucopyranoside (12), diosmetin 7-O-β-D-glucuronopyranoside methyl ester (13), and 2 from the flowers. Their structures were determined on the basis of chemical and spectroscopic evidence. It was found that the extract of T. stans fruits and compounds 1, 2 and 4 possess strong scavenging activity to DPPH, peroxyl and hydroxyl radicals. Unlike 4, which potentially induced NO generation in bacterial lipopolysaccharide-stimulated Raw murine macrophages (RAW 264.7), the extract, and compounds 1, 2, and 8 significantly inhibited NO generation. The extract, and compounds 2 and 4 exhibited a cytotoxic effect on human hepatocarcinoma cells (Hep-G2), while the extract, 2 and 8 were potent growth inhibitors of human breast carcinoma (MCF-7). Also, 1 and 2 were remarkable growth inducers of human lymphoblastic leukemia cells (1301), whereas the extract, 2, and 8 stimulated the macrophage proliferation rate. </jats:p

A retrospective cohort study of patients diagnosed with bladder cancer referred with visible haematuria: the impact of source of referral on prognostic indicators

Objective: Our aim was to establish whether there is a difference in prognostic indicators for bladder urothelial carcinoma (UC) between the patients referred via the 2-week wait (2WW) and those presenting to the emergency department (ED). Patients and methods: We performed a retrospective cohort study of all patients referred with visible haematuria, comparing tumour stage and grade between patients diagnosed with bladder UC via the ED and 2WW at two London hospitals. Results: From 09/2009−09/2011, 51 patients referred from the ED, and 146 from the 2WW clinic were diagnosed with bladder UC. Regarding tumour stage: 57% of the ED group had muscle-invasive UC compared with 23% from 2WW ( p=0.001). Regarding tumour grade: 82% of the ED group had G3 tumours, versus 54% from 2WW ( p&lt;0.001). ED referrals were significantly older than those from the 2WW ( p&lt;0.001). Conclusions: Patients with UC who present as emergencies had worse prognostic indicators and were older than those referred from the 2WW pathway. This supports the need for the inclusion of haematuria in the out-of-hours urology guidelines within the Acute Oncology Service. </jats:sec