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A.B) using semi-quantitative scores: 0?=?absence; 1?=?mild; 2?=?moderate; and 3?=?intense. In the alveolar space and the alveolar septae, the observers scored the sections for macrophages, lymphocytes, neutrophils, plasma cells and eosinophils. Selleckchem Imatinib In the alveolar wall and lumen, they scored the sections for necrosis, regeneration of pneumocytes, giant cells, oedema, haemorrhage and hyaline membranes. The sections were also scored for septum thickness, oedema, capillary congestion and fibrosis. The pathologist scored the following findings based on standardized scoring protocols previously used [22]. Data were entered into EPIDATA (version 3.0; U.S. Centers for Disease Control and Prevention) and analysed using the SAS system (version 9.1; SAS Institute, Cary, NC, USA). Results are expressed as the median and interquartile range, or as percentages when appropriate. Differences in frequency were evaluated using the ��2 test or Fisher��s exact test. Medians were compared using the Mann�CWhitney�CWilcoxon test. The study protocol was approved by the Investigational Review Board of the Hospital das Cl��nicas, S?o Paulo University and the institutional ethical guidelines were followed. During the study period, we identified necropsies from 37 LPHS patients. Necropsies from seven patients were excluded because the paraffin blocks showed evidence of tissue autolysis, there was inappropriate fixation with artefacts or there was typical bacterial infection. This selection Carnitine palmitoyltransferase II resulted in a final sample of 30 leptospirosis patients who presented with well-defined clinical and histological evidence of lung involvement. Twenty three out of 30 (77%) leptospirosis patients were men, and the median age was 48.5?years (range from 19 to 70). The median duration of symptoms before hospital admission was 6?days (range from 4 to 13). The median platelet count and serum creatinine levels were 54?000 cells/mm3 (range from 10?000 to 222?000) and 6.1?mg/dL (range from 0.6 to 14.2), respectively. All patients required mechanical ventilation, which PD98059 concentration was performed for a median duration of 2?days (range from 0 to 13). Dialysis was performed in 19 out of 30 (63%) cases. The median duration of hospital stay was 3?days (range from 1 to 6) (Table?1). The LPHS patients (n?=?30) differed from control pulmonary haemorrhage patients (n?=?7) in several features: the presence of moderate to high levels of macrophages in the alveolar space (77% vs. 29%, respectively; p 0.02), the presence of the focal hyaline membrane on the alveolar surface (100% vs. 0%; p?