Placental chemical elements concentration in small fetuses and its relationship with Doppler markers of placental function.

INTRODUCTION: In this study, we aimed at quantifying placental concentrations of 22 chemical elements in small fetuses (SGA) as compared with normally grown fetuses (AGA), and to assess the relationship with Doppler markers of placental function. METHODS: Prospective cohort study, including 71 SGA fetuses (estimated fetal weight < 10th percentile) and 96 AGA fetuses (estimated fetal weight > 10th percentile), recruited in the third trimester of gestation. The placental concentration of 22 chemical elements was determined by inductively coupled plasma optical emission spectrophotometer (ICP-OES, ICAP 6500 Duo Thermo): aluminum (Al), beryllium (Be), bismuth (Bi), calcium (Ca), cadmium (Cd), cobalt (Co), chrome (Cr), copper (Cu), magnesium (Mg), manganese (Mn), molybdenum (Mo), nickel (Ni), phosphorus (P), lead (Pb), rubidium (Rb), sulfur (S), strontium (Sr), titanium (Ti), thallium (Tl), antimony (Sb), selenium (Se), and zinc (Zn). Placental function was assessed by measuring the following fetal-maternal parameters: Uterine artery Pulsatility Index (UtA PI), Umbilical artery Pulsatility Index (UA PI) and Middle Cerebral artery Pulsatility Index (MCA PI). The association between the chemical elements concentration and study group and the association with Doppler measures were evaluated. RESULTS: SGA was associated with significantly (p < 0.05) lower concentrations of Al (AGA 21.14 vs SGA 0.51 mg/kg), Cr (AGA 0.17 vs SGA 0.12 mg/kg), Cu (AGA 0.89 vs SGA 0.81 mg/kg), Mg (AGA 0.007 vs SGA 0.006 g/100g), Mn (AGA 0.60 vs SGA 0.47 mg/kg), Rb (AGA 1.68 vs SGA 1.47 mg/kg), Se (AGA 0.02 vs SGA 0.01 mg/kg), Ti (AGA 0.75 vs SGA 0.05 mg/kg) and Zn (AGA 9.04 vs SGA 8.22 mg/kg). Lower placental concentrations of Al, Cr, Mn, Se, Ti were associated with abnormal UtA, UA and MCA Doppler. DISCUSSION: Lower placental concentrations of Al, Cr, Cu, Mn, Rb, Se, Ti and Zn are associated with SGA fetuses and abnormal fetal-maternal Doppler results. Additional studies are required to further understand how chemical elements affect fetal growth and potentially find strategies to prevent SGA.

Primer aislamiento de Salmonella Javiana con portación de KPC-2 en Paraguay / First isolation of Salmonella Javiana with KPC-2 in Paraguay

Varios mecanismos de resistencia a diversos agentes antimicrobianos que se han incorporado al arsenal terapéutico, han emergido en los últimos años, destacando la aparición de carbapenemasas en enterobacterias, siendo Klebsiella pneumoniae carbapenemasa (KPC) una de las más importantes, identificada originalmente en los Estados Unidos en 1996. En Paraguay, los primeros aislamientos de cepas portadoras de carbapenemasa tipo KPC se obtuvieron en septiembre del año 2009, a partir del cual se confirmaron la presencia en varias especies de enterobacterias, siendo Klebsiella pneumoniae la de mayor prevalencia entre ellas. Según datos del centro de referencia, Salmonella entérica serotipo Typhimurium es el serovar más común identificado en muestras de heces hasta la fecha, y el serotipo Javiana el cuarto. En este informe se describe el primer aislamiento resistente a carbapenemes por carbapenemasa del tipo KPC-2 en Salmonella entérica serotipo Javiana aislado en febrero de 2015 de una muestra fecal. Además, en muestras de la misma paciente, fueron aisladas las especies Klebsiella pneumoniae resistente a carbapenemes por presencia de la misma enzima (KPC-2) en secreción orotraqueal y Enterococcus faecalis resistente a vancomicina en muestra fecal. Este hallazgo, confirma la portación del gen que codifica para la carbapenemasa tipo KPC-2 por cepa de Salmonella entérica, y que el mismo ocurre en un serotipo poco frecuente (serotipo Javiana). Además, la recuperación en otra muestra de la paciente de K. pneumoniae productora de carbapenemasa tipo KPC- 2 evidencia la diseminación de este mecanismo de resistencia entre las enterobacterias. Palabras claves: Salmonella, KPC, carbapenemasas, enterobacterias.

At the global level have emerged over the years, microorganisms resistant to various antimicrobial agents that have been incorporated to the therapeutic arsenal. Several mechanisms of resistance have emerged in recent years, highlighting the emergence of carbapenemases in enterobacterias, entity which Klebsiella pneumoniae carbapenemasa (KPC), being one of the most important, originally identified in the United States in 1996. In Paraguay, the first isolates of KPC carbapenemasecarrying strains were obtained in september 2009, from which the presence of several Enterobacteria species was confirmed, with Klebsiella pneumoniae being the most prevalent among them. According to data from the reference center, Salmonella enterica serotype Typhimurium is the most common serovar identified in stool samples to date, and the Javiana serotype the fourth. This report describes the first KPC-2 carbapenemase isolate in Salmonella enterica serovar Javiana isolated in February 2015 from a fecal sample. In addition, in samples from the same patient, Klebsiella pneumoniae species resistant to carbapenems were isolated by the presence of the same enzyme (KPC-2) in orotracheal secretion and vancomycin-resistant Enterococcus faecalis in fecal samples. Key words: Salmonella, KPC, carbapenemases, enterobacterias.

Early Cerebellar Network Shifting in Spinocerebellar Ataxia Type 6.

Spinocerebellar ataxia 6 (SCA6), an autosomal dominant degenerative disease, is characterized by diplopia, gait ataxia, and incoordination due to severe progressive degeneration of Purkinje cells in the vestibulo- and spinocerebellum. Ocular motor deficits are common, including difficulty fixating on moving objects, nystagmus and disruption of smooth pursuit movements. In presymptomatic SCA6, there are alterations in saccades and smooth-pursuit movements. We sought to assess functional and structural changes in cerebellar connectivity associated with a visual task, hypothesizing that gradual changes would parallel disease progression. We acquired functional magnetic resonance imaging and diffusion tensor imaging data during a passive smooth-pursuit task in 14 SCA6 patients, representing a range of disease duration and severity, and performed a cross-sectional comparison of cerebellar networks compared with healthy controls. We identified a shift in activation from vermis in presymptomatic individuals to lateral cerebellum in moderate-to-severe cases. Concomitantly, effective connectivity between regions of cerebral cortex and cerebellum was at its highest in moderate cases, and disappeared in severe cases. Finally, we noted structural differences in the cerebral and cerebellar peduncles. These unique results, spanning both functional and structural domains, highlight widespread changes in SCA6 and compensatory mechanisms associated with cerebellar physiology that could be utilized in developing new therapies.

Enterobacterias resistentes a Carbapenemes por producción de KPC, aisladas en hospitales de Asunción y Departamento Central / Enterobacteria Carbapenem-resistant KPC by production, isolated inhospitals and Asunción and Central Department

Las infecciones por enterobacterias resistentes a carbapenemes o productoras de carbapenemasas (KPC) han emergido como un importante desafío en los centros de salud de todo el mundo, incluyendo el Paraguay. Este estudio describe los hallazgos de estos patógenos en diferentes centros de Asunción y Departamento Central, donde han sido aisladas 76 cepas de enterobacterias con resistencia a carbapenemes por producción de esta enzima, confirmadas por métodos moleculares. Además, en las mismas, han sido detectadas otros mecanismos de resistencia, como producción de betalactamasa de espectro extendido (CTX-M y PER-2) y genes que codifican la resistencia a quinolonas (qnr). Palabras claves: KPC, Enterobacterias, Klebsiella pneumoniae, Carbapenemes

Infections caused by carbapenem resistant or carbapenemase producing (KPC) enterobacteria have emerged as an important challenge in healthcare centers throughout the world, including Paraguay. This study describes findings of these pathogens in different facilities in Asunción and the Central Department, where 76 families of carbapenem resistant bacteria have been isolated through detection of this enzyme, and confirmed through molecular methods. In addition, other resistance mechanisms have been detected in the same families, such as broad spectrum betalactamase resistance (CTX-M and PER-2) and genes that codify quinolone resistance. Key words: KPC, Enterobacteria, Klebsiella pneumoniae, Carbapenems

Patient-acceptable symptom state as an outcome measure in the daily care of patients with ankylosing spondylitis.

OBJECTIVE: We assessed the prevalence of patients with ankylosing spondylitis (AS), rating their state as acceptable (patient-acceptable symptom state; PASS), among 190 patients with AS seen in daily practice. Factors associated with PASS status and PASS thresholds for outcome measures were also analyzed. METHODS: The characteristics of patients with affirmative and negative assignment to PASS were compared. Associated factors were estimated by logistic regression models and PASS thresholds by the 75th percentile and receiver-operating characteristic curve methods. RESULTS: A total of 77% of patients rated their state as acceptable (95% CI 62-91). These patients were taking fewer nonsteroidal antiinflammatory drugs and corticosteroids, practiced more exercise, had less anxiety and depression, and had lower values of all patient-reported outcome measures, physicians' assessment, AS Disease Activity Score (ASDAS) and C-reactive protein. Lower values of Bath AS Disease Activity Index and physician's global assessment were independent factors associated with acceptable symptom state. High rates of anxiety and depression were found in patients not in PASS. The thresholds with the 75th percentile approach were 4.55 for the BASDAI and 2.84 for the ASDAS. Fifty-three percent of patients in PASS had a high or very high disease activity state according to ASDAS cutoff values. CONCLUSION: A high percentage of patients with AS in daily practice declared that their symptom state was acceptable. PASS status correlated with physician global assessment and BASDAI. PASS thresholds for common recommended outcome measures were relatively high and many patients in PASS had unacceptably high disease activity states according to ASDAS. Other factors such as psychological problems may influence a negative PASS state.

Maternal hair testing for the assessment of fetal exposure to drug of abuse during early pregnancy: Comparison with testing in placental and fetal remains.

UNLABELLED: Drug use by pregnant women in the first trimester of pregnancy and subsequent fetal exposure during early gestation can be assessed only by repetitive/systematic maternal blood/urine analysis or segmental hair analysis. No evidence of any relationship between maternal/fetal exposure during this specific period of gestation has been demonstrated to date in a human model. METHODS: To clarify drugs toxicokinetics and transplacental passage during early pregnancy, the presence of the most widely used recreational drugs of abuse and metabolites was investigated in the proximal 4cm hair segments of women undergoing voluntary termination of pregnancy (n=280) during the 12th week of gestation and the results were compared to those from placenta and fetal tissue samples in order to verify whether maternal hair testing can reflect fetal exposure and, if so, to what extent. Hair, placenta and fetal remains were analyzed by validated gas chromatography mass spectrometry assays. RESULTS: Eighty one positive hair samples were identified: 60 were positive for cannabis (74.1%), 28 for cocaine (34.6%), 7 for opiates (8.6%), 3 for MDMA (3.7%) and 18.5% were positive for more than one drug. The positive hair test results were confirmed in placenta/fetal tissues in 10 cases out of 60 for cannabis (16. 7%); in 7 out of 28 for cocaine (25%); and none for the 6 opiates positive cases and 3 MDMA cases, respectively. CONCLUSION: Drugs/metabolites in hair of pregnant women can be used as biomarkers of past drug use (repetitive or sporadic), although the use is not always reflected in fetal/placental tissues. There are several possible hypotheses to explain the results: (1) the use occurred before the start of pregnancy, (2) past sporadic consumption which could be measured in hair but not in fetal and placental remains because of the narrow window of drug detection in placental/fetal tissues; (3) the sensitivity of the analytical methods was not high enough for the detection of the minute amount of drugs of abuse and metabolites which reached these tissues (4) there is a large variability in the transplacental passage of drugs of abuse and in the placenta's metabolizing capacity.

A survey of Italian and Spanish neonatologists and paediatricians regarding awareness of the diagnosis of FAS and FASD and maternal ethanol use during pregnancy.

BACKGROUND: Ethanol is the most widely used drug in the world and a human teratogen whose consumption among women of childbearing age has been steadily increasing. There are no Italian or Spanish statistics on ethanol consumption during pregnancy nor any information regarding prevalence of fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD). There is also a reasonable suspicion that these two diseases are underdiagnosed by professionals from the above-reported countries. The objectives of this study were: 1) to evaluate the experience, knowledge and confidence of Italian and Spanish neonatologists and paediatricians with respect to the diagnosis of FAS and FASD, and 2) to evaluate professionals awareness of maternal drinking patterns during pregnancy. METHODS: A multiple-choice anonymous questionnaire was e-mailed to Italian neonatologists registered in the mailing list of the corresponding Society and administered to Italian and Spanish paediatricians during their National Congress. RESULTS: The response rate was 16% (63/400) for the Italian neonatologists of the National Society while a total of 152 Spanish and 41 Italian paediatricians agreed to complete the questionnaire during National Congress. Over 90% of the surveyed physicians declared that FAS is an identifiable syndrome and over 60% of them identified at least one of the most important features of FAS. Although over 60% Italian responders and around 80% Spanish responders were aware that ethanol use in pregnancy is dangerous, approximately 50% Italian responders and 40% Spanish ones allowed women to drink sometimes a glass of wine or beer during pregnancy.Neonatologists and paediatricians rated confidence in the ability to diagnosis FAS and FASD as low, with over 50% responders feeling they needed more information regarding FAS and FASD identification in newborn and child. CONCLUSIONS: Italian and Spanish neonatologists and paediatricians do not feel confident about diagnosing FAS and FASD. More training is needed in order to accurately diagnose ethanol use during pregnancy and correctly inform pregnant women on the consequences on the newborn.

Removal of polycyclic aromatic hydrocarbons from organic solvents by ashes wastes.

Polycyclic aromatic hydrocarbons (PAHs) can be formed during the refinery processes of crude petroleum. Their removal is of great importance. The same happens with other organic solvents used for the extraction of PAHs (hexane, acetonitrile...), which can be polluted with PAHs. Kinetic and equilibrium batch sorption tests were used to investigate the effect of wood ashes wastes as compared to activated carbon on the sorption of three representative PAHs from n-hexane and acetonitrile. Mussel shell ashes were discarded for batch sorption experiments because they were the only ashes containing PAHs. The equilibrium time was reached at 16 h. Physical sorption caused by the aromatic nature of the compounds was the main mechanism that governed the PAHs removal process. Our investigation revealed that wood ashes obtained at lower temperature (300 degrees C) did not show any PAHs sorption, while ashes obtained at higher temperature (>500 degrees C) have adsorbent sites readily available for the PAH molecules. An increase in the molecular weight of PAHs has a strong effect on sorption wood ashes wastes. As low the wood ashes particle size as high the sorption of PAHs, as a result of differences in adsorbent sites. The performance of wood ash wastes vs. activated carbon to remove 10 PAHs from organic solvents is competitive in price, and a good way for waste disposal.

Exposure to psychoactive substances in women who request voluntary termination of pregnancy assessed by serum and hair testing.

Drug abuse is a worldwide phenomenon with significant health and socioeconomic impact and it is of particular concern in women of reproductive age and in pregnant women. We aimed to investigate the prevalence of drug use by serum and hair testing in a cohort of pregnant women at 12th week gestation who decided voluntarily to interrupt their pregnancy and to investigate the relationship between drug exposure and induced abortions (IA), repeated IA and contraception. The study was conducted in an obstetrics clinic authorised to perform IA in Murcia, Spain during an 18 months period (2007-2009). Apart from serum and/or hair testing, the 142 women enrolled in the study completed a detailed questionnaire regarding drug, alcohol and tobacco use in the previous 3 months. Serum and hair samples were analyzed by gas chromatography mass spectrometry assays. Hair and serum samples showed a 30% overall positivity to drugs of abuse. Of these samples, 20.4, 14.1, 4.2 and 1.4% were positive for cannabinoids, cocaine, opiates, and MDMA, respectively, with polydrug use in 5.6% cases. In this cohort, a positive association was found between drug use and repeated IA. The results highlight the need for promoting pregnancy planning for young women in general, especially when consuming psychoactive substances as well as promote safe and accessible contraception in women of reproductive age. In women requesting IA, specific drug abuse counselling should be implemented.

Electrochemical and AFM characterization on gold and carbon electrodes of a high redox potential laccase from Fusarium proliferatum.

The redox potential of the T1 copper site of laccase from Fusarium proliferatum was determined by titration to be about 510 mV vs. SCE (750 mV vs. NHE), which makes it a high redox potential enzyme. Anaerobic electron transfer reactions between laccase and carbon and gold electrodes were detected, both in solution and when the enzyme was adsorbed on these surfaces. In solution, a single high-potential signal (660 mV vs. SCE) was recorded at the carbon surfaces, attributable to the T1 copper site of the enzyme. However, a well-defined oxidative process at about 660 mV and an anodic wave at 350 mV vs. SCE were recorded at the gold electrode, respectively associated with the T1 and T2 copper sites. Laccase-modified carbon electrodes behaved analogously when the enzyme was in solution, unlike laccase adsorbed on gold, which showed only a low-potential signal. Laccase molecules were successfully imaged by AFM; obtaining a thick compact stable film on Au(111), and large aggregates forming a complex network of small branches leaving voids on the HOPG surface. Laccase-modified carbon electrodes retained significant enzymatic activity, efficiently oxidising violuric acid and reducing molecular oxygen. Explanations are proposed for how protein-film organisation affects the electrode function.

High prevalence of ST-78 infection-associated vancomycin-resistant Enterococcus faecium from hospitals in Asunción, Paraguay.

Forty infection-associated VanA-type vancomycin-resistant Enterococcus faecium (VRE) strains obtained from five collaborating hospitals in Asunción, Paraguay were investigated. Genotyping using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing revealed the presence of 17 cluster types and four STs, with 93% (37/40) of isolates comprising ST type 78. Other ST types included ST-132, ST-210 and one new ST type (ST-438). All but one isolate (ST-438) were associated with clonal complex 17 (CC17), and 97% of the total isolates carried the esp gene. Three Tn1546 variants were found, including a new lineage containing an ISEfa5 insertion in an existing IS1251 element.

Analysis of ionic ratios in the interventricular wall and their relation with cardiac damage as seen in anatomo-pathological and cardiac biomarkers.

UNLABELLED: In the present work, we have compared the behaviour of some commonly used markers for the immunohistochemical diagnosis of cardiac suffering (myoglobin, myosin, troponin I), with the modifications of the ionic quotients (K(+)/Na(+), Ca(2+)/Mg(2+) and Ca(2+)/Zn(2+)) that are observed in the interventricular partition in different causes of death. MATERIALS AND METHOD: we have studied a total of 50 hearts coming from autopsies carried out in the Legal Medicine Institute of Murcia (Spain) deceased 21 by natural cardiac deaths, 9 by mechanical asphyxias, 5 by politraumatism, 5 cardiac ruptures and 10 by craneoencephalic trauma. For the biochemical analysis, samples were taken from weave of 0.5 g of the interventricular partition, the corresponding dilutions were made in bidistilled water for flame atomic absorption spectrophotometry with a hollow cathode multielement lamp. For the immunohistochemical study, samples were taken from the same locations, kept in tamponed formol, dyed with hematoxylin-eosin and later 3 microm-sections were practised, antigenic recovery by heat, in pressure cooker. Our results show the existence of a statistically significant relation between the modifications of the K(+)/Na(+) quotient and the found values of troponin, which confirms its utility for the precocious diagnosis of the cardiac ischemia.

Onychomycosis by Chaetomium spp.

Onychomycosis is one of the most common infections of the nail. It can be caused by dermatophytes, Candida species and other fungi. Although moulds can cause onychomycosis, they account for a minority of cases, mainly great toenail onychomycosis. We describe a case of an 11-year-old girl who developed an onychomycosis by Chaetomium species in second and third toenails.

[Necrotizing systemic sarcoidosis with pulmonary and central nervous system involvement]. / Sarcoidosis sistémica necrotizante con afectación pulmonar y del sistema nervioso central.

Sarcoidosis is a multisystemic disease which diagnosis depends on the presence of nonnecrotizing granulomas in the biopsy. However there are variants such as necrotizing sarcoidal granulomas or nodular sarcoidosis which have atypical findings and make difficult the differential diagnosis with other infectious processes. We describe a case of a man who develops granulomas with extensive necrosis in a systemic sarcoidosis that affected the lung and the central nervous system. This finding made us to make the diagnosis of tuberculosis and delay the specific treatment.

Ethical problems related to information and pharmaceutical care in Spain.

This paper represents a reflection on the limits and objectives of the information pharmacists should offer in pharmacies. The obligation of a pharmacist to follow the patient's therapeutic progress makes it necessary to integrate this figure into an ethical-legal framework and to define the objective of the health-related information offered, taking into account the patient's welfare and constitutional rights.