Recomendaciones de la Sociedad Argentina de Reumatología en el manejo de la arteritis de células gigantes / Recommendations of the Argentine Society of Rheumatology in the management of giant cell arteritis

La arteritis de células gigantes (ACG) es una vasculitis sistémica que afecta a personas adultas; compromete vasos arteriales de mediano y gran calibre, con potenciales complicaciones de gravedad, como la ceguera, y es considerada una emergencia médica. El objetivo de estas guías fue desarrollar las primeras recomendaciones argentinas para su tratamiento, basadas en la revisión de la literatura mediante metodología GRADE. Un panel de expertos en vasculitis elaboró las preguntas en formato PICO (población, intervención, comparador y outcomes), y luego un panel de expertos en metodología efectuó la revisión de la bibliografía con la extracción de la evidencia para cada una de las preguntas. Se realizó un focus group de pacientes para conocer sus preferencias y experiencias. Finalmente, con la información recabada, el panel de expertos en vasculitis procedió a la votación de las recomendaciones que a continuación se presentan.

Giant cell arteritis (GCA) is a systemic vasculitis affecting adult patients and involving large and medium vessels. Potential serious complications as blindness may occur and it is considered a medical emergency. The objective of elaborating this guideline was to develop first Argentinian GCA treatment recommendations using GRADE methodology. An expert panel generated clinically meaningful questions addressing aspects of the treatment of GCA in the Population, Intervention, Comparator and Outcome (PICO) format and then a group of methodology experts reviewed and extracted data from literature summarizing available evidence. A patient's focus group discussion took place gathering information on their preferences and experiences. Finally, the vasculitis expert panel, with all the information obtained, voted recommendations here presented.

Guías Argentinas de Vasculitis Suplemento. Tablas arteritis de células gigantes / Argentine Vasculitis Guidelines Supplement. Giant cell arteritis tables

La arteritis de células gigantes (ACG) es una vasculitis sistémica que afecta a personas adultas; compromete vasos arteriales de mediano y gran calibre, con potenciales complicaciones de gravedad, como la ceguera, y es considerada una emergencia médica. El objetivo de estas guías fue desarrollar las primeras recomendaciones argentinas para su tratamiento, basadas en la revisión de la literatura mediante metodología GRADE. Un panel de expertos en vasculitis elaboró las preguntas en formato PICO (población, intervención, comparador y outcomes), y luego un panel de expertos en metodología efectuó la revisión de la bibliografía con la extracción de la evidencia para cada una de las preguntas. Se realizó un focus group de pacientes para conocer sus preferencias y experiencias. Finalmente, con la información recabada, el panel de expertos en vasculitis procedió a la votación de las recomendaciones que a continuación se presentan.

Clonal Distribution and Antibiotic Susceptibility of Staphylococcus aureus from Pediatric Patients: 8-Year Trends in a Children's Hospital in Colombia.

Emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains in healthcare settings has changed the hospital epidemiology of MRSA in the last few years. Despite a global increase in MRSA frequency, infections caused by methicillin-susceptible S. aureus (MSSA) have persisted in healthcare settings and the community. Staphylococcus aureus isolates were collected between 2009 and 2017 at the Children's Hospital of a Caribbean city in South America. Methicillin-resistant isolates were subjected to SCCmec typing. Representative isolates were analyzed by multilocus sequence typing (MLST) and spa typing. Antibiotic susceptibility was assessed by agar dilution method. D-zone test was performed in erythromycin-resistant isolates to determine macrolide/lincosamide/streptogramin resistance. Spa typing revealed 10 different spa types. The main epidemic clones circulating during the study period were: ST8-MRSA-IVc, ST923-MRSA-IVa and ST8-MRSA-IVa. The study found high frequencies of PVL genes and resistance to erythromycin and clindamycin in the isolates. This study provides the first description of the population structure of MRSA and MSSA causing infections attended in the participating Children's Hospital. ST8-MRSA-IVc, ST923-MRSA-IVa and ST8-MRSA-IVa were the most prevalent in the isolate population.

This study was aimed to determine the distribution of sequence types, SCCmec types and antibiotic resistance profiles of MRSA and MSSA isolates recovered from pediatric patients with clinical infections attended in the Children's Hospital of a Caribbean city in South America in a period spanning 8 years. We found high frequencies of PVL genes and resistance to erythromycin and clindamycin in the isolates. The fact that MRSA and MSSA isolates in this study were frequently resistant to erythromycin and clindamycin is an indication of the selective pressure imposed by the extensive use of these two antibiotics in the treatment of skin and soft tissue infections in the geographical area of this study. This is the first study reporting the clonal distribution of Staphylococcus aureus causing infections in the pediatric population of Cartagena, a tropical city in the Caribbean coast of Colombia.

Atypical chemokine receptor CCRL2 is overexpressed in prostate cancer cells.

Atypical chemokine receptors have recently emerged as important molecular players in health and diseases; they affect chemokine availability and function and impact a multitude of pathophysiological events, including the tumorigenesis process. This family of atypical receptors comprises five members: ACKR1/DARC, ACKR2/D6, ACKR3/CXCR7, ACKR4/CCRL1, and ACKR5/CCRL2. This work evaluated the differential expression of these receptors in prostate cancer using quantitative PCR. Further evaluation of CCRL2 at the protein level confirmed its overexpression in a metastatic cell line and in malignant prostatic tissues from patients. CCRL2, a presumed member of the atypical chemokine receptor family, plays a key role in lung dendritic cell trafficking to peripheral lymph nodes. Recent studies have reported the expression of CCRL2 in different human cancer cell lines and tissues. However, its function and expression in prostate cancer has not been previously addressed.

Inflamación y cáncer de próstata: implicaciones biológicas y posible utilidad clínica / Inflammation and prostate cancer: Biological implications and clinical usefulness

El cáncer de próstata es la neoplasia no cutánea que afecta con mayor frecuencia a los hombres en todo el mundo. Existe evidencia que señala un papel de la inflamación crónica en el desarrollo de distintas neoplasias en humanos, entre ellas el cáncer de próstata. Esta asociación fue sugerida hace mucho tiempo por la observación de infiltrados en muestras de tejido prostático de pacientes con cáncer y, más recientemente, por los altos niveles de citocinas proinflamatorias en el suero de pacientes con esta enfermedad. Muchos estudios han determinado la asociación de ciertos polimorfismos de base única en genes asociados a inflamación con el riesgo de desarrollar cáncer de próstata. En los últimos años se han descrito los efectos de moléculas inflamatorias sobre el comportamiento biológico de esta neoplasia; se destacan entre ellos el potencial de inducir la proliferación de células cancerígenas y la des-diferenciación de células del estroma. La influencia de la inflamación en el desarrollo y avance del cáncer de próstata se ha convertido en un asunto de interés debido al potencial diagnóstico y terapéutico de su uso. Se espera que en el futuro una mejor comprensión biológica de esta asociación lleve a una explotación práctica de su utilidad clínica.

Worldwide, prostate cancer is the non-cutaneous neoplasm that most frequently affects men. Recent evidence demonstrates a role for chronic inflammation in the development of different cancer types in humans, including prostate cancer. This association was suggested long ago by the observation of inflammatory infiltrates in tissue samples from patients with prostate cancer. More recently it has been supported by high levels of circulating pro-inflammatory cytokines in serum of patients with this disease. Multiple studies have found association between certain single nucleotide polymorphisms in genes associated with inflammation, and the risk of developing prostate cancer. In the last few years, the effects of inflammatory molecules on the behavior of this disease have been described; among them, the potential to induce cancer cell proliferation and dedifferentiation of stromal cells. The influence of inflammation in the development and progression of prostatic cancer has become a topic of interest because of the potential use in diagnosis and therapy. It is expected that a better biological understanding of the mechanisms underlying this association may lead to a practical exploitation of its clinical usefulness.

Relative bioavailability and comparative clinical efficacy of different ivermectin oral formulations in lambs.

BACKGROUND: Several oral ivermectin (IVM) formulations for use in sheep are available in the pharmaceutical veterinary market in different countries. All of them are indicated at the same dose rate to treat the gastrointestinal nematodes. However, there is a lack of information on the relative systemic exposure (plasma bioavailability) and clinical efficacy among oral formulations routinely used in sheep. The main goal of the work reported here was to perform a pharmaco-parasitological assessment of three different IVM oral formulations in lambs infected with multiple resistant gastrointestinal nematodes. The comparative drug systemic exposure (IVM plasma concentrations) and nematodicidal efficacies (clinical efficacy) in lambs were determined for a reference (RF) and two different test (T1, T2) IVM oral formulations. One hundred and fifty six (n= 156) healthy Corriedale lambs, naturally infected with multiple resistant gastrointestinal nematodes were allocated into four experimental groups (n=39). Animals in each group received treatment (200 µg/kg) with either the RF, one of the test IVM formulations or were kept as untreated control. Blood samples were collected over 15 days post-treatment (n=8). The IVM plasma concentrations were measured by high performance liquid chromatography with fluorescence detection. The faecal nematode egg count reduction test (FECRT) (n=39) and evaluation of the clinical efficacy were performed at day 14 post-treatment (n=6), where a predominance of IVM highly resistant nematodes was observed. RESULTS AND CONCLUSIONS: Neither the overall kinetic behaviour nor the IVM systemic exposure differed among all the tested oral formulations. Equivalent efficacy results were obtained for the different preparations, with an evident therapeutic failure to control Haemonchus spp. and Teladorsagia circumcincta, which correlates with a high degree of nematode resistance to IVM.

Estimación biométrica del volumen de humor acuoso en ojos con aceite de silicona en medios opacos / Biometric estimation aqueous volume in eyes with silicone oil in opaque media

Propósito: Estimar el volumen de humor acuoso como índice de viabilidad ocular. Métodos: El método de cálculo integral de sólidos en revolución por discos, es el utilizado para calcular el volumen del humor acuoso con forma de menisco depositado debajo del aceite de silicona gracias al efecto de la gravedad, y basando dichos cálculos en la mediciones biométricas de diferentes cortes ecográficos, que abarquen tanto el aceite de silicona como el humor acuoso, mediante ecografía ocular. Resultados: De tres modelos matemáticos realizados para el cálculo del volumen del menisco, uno de ellos es el que más se acerca a los valores empíricos, mostrando menor volatilidad en los resultados.

Purpose: To estimate the volume of aqueous humor as an ocular viability index. Methods: The integral calculus of solids in revolution by disks is the method used to calculate the volume of aqueous shaped meniscus deposited under the silicone oil through the effect of gravity, and basing such calculations on biometric measurements of different ultrasound sections, covering both silicone oil as the aqueous humor, by using ocular ultrasound. Results: From the three mathematical models made for calculating the volume of the meniscus, one of them is the closest to the empirical values, showing less volatility in results.

Estimación biométrica del volumen de humor acuoso en ojos con aceite de silicona en medios opacos

Propósito: Estimar el volumen de humor acuoso como índice de viabilidad ocular. Métodos: El método de cálculo integral de sólidos en revolución por discos, es el utilizado para calcular el volumen del humor acuoso con forma de menisco depositado debajo del aceite de silicona gracias al efecto de la gravedad, y basando dichos cálculos en la mediciones biométricas de diferentes cortes ecográficos, que abarquen tanto el aceite de silicona como el humor acuoso, mediante ecografía ocular. Resultados: De tres modelos matemáticos realizados para el cálculo del volumen del menisco, uno de ellos es el que más se acerca a los valores empíricos, mostrando menor volatilidad en los resultados.(AU)

Purpose: To estimate the volume of aqueous humor as an ocular viability index. Methods: The integral calculus of solids in revolution by disks is the method used to calculate the volume of aqueous shaped meniscus deposited under the silicone oil through the effect of gravity, and basing such calculations on biometric measurements of different ultrasound sections, covering both silicone oil as the aqueous humor, by using ocular ultrasound. Results: From the three mathematical models made for calculating the volume of the meniscus, one of them is the closest to the empirical values, showing less volatility in results.(AU)

Colonización nasal y vaginal por Staphylococcus aureus resistente ameticilina en mujeres embarazadas en Cartagena, Colombia / Nasal and vaginal colonization of methicillin-resistant Staphylococcus aureus in pregnant women in Cartagena, Colombia

SummaryIntroduction: The host niche for Staphylococcus aureus (SA) are the anterior nares; however, vaginal colonization rates between 14% and 17.1% in pregnant women have been recently reported, raising interest about the potential risk in postpartum women and in neonates from colonized mothers.Objectives: To determine the prevalence of nasal and vaginal colonization of SA and the antibiotic susceptibility of the isolates in pregnant women attending a maternity hospital in Cartagena, Colombia.Methods: Nasal and vaginal swabs were obtained from participants and subjected to microbiological and molecular assays. A post discharge follow-up was performed for up to four weeks.Results: From 100 pregnant women enrolled in the study, 34 were colonized with SA; 29 only in the nares, three only in the vagina, and two at both sites. Colonization of pregnant women with SA was more common in the nares than in the vagina or at both sites [29/34 (85.3%) vs 3/34 (8.8%) and 2/34 (5.9%); p<0.05]. We obtained 36 SA isolates,nine (25%) of which were methicillin-resistant Staphylococcus aureus (MRSA), one was from the vagina; thus, the overall MRSA colonization rate among pregnant women was 9%. Molecular analysis showed that Panton-Valentine leukocidin (PVL) genes were carried by the vaginal MRSA, seven of the nasal MRSA, and two of the Methicillinsensitive Staphylococcus aureus (MSSA) isolates. Two MRSA isolates carried SCCmec type I and seven carried SCCmec type IV.Conclusions: Nasal colonization rate for SA in the study population was similar to previous reports. However, the frequency of nasal colonization of MRSA was higher while vaginal colonization of SA was lower than previously reported in other studies for similar populations. The MRSA isolates obtained showed a community profile.

ResumenIntroducción: Staphylococcus aureus (SA) ha adoptado como nicho habitual en las narinas anteriores; sin embargo, recientemente se han reportado tasas de colonización del tracto genital de mujeres embarazadas entre 14% y 17.1%, lo que aumenta el interés respecto al riesgo asociado para el neonato y la madre en el posparto.Objetivo: Determinar la prevalencia de colonización nasal y vaginal por SA y los patrones de susceptibilidad a antibióticos de los aislamientos en una comunidad obstétrica de Cartagena, Colombia.

Depositional flux of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans in an urban setting.

Dry and wet deposition fluxes of the PCDD/F substituted congeners were measured at two different sites (Clinton Drive and Lang Road) in Houston, TX between December 2003 and April 2004. Average total dry deposition fluxes of 351 and 125pgm(-2)d(-1) were found at Clinton Drive and Lang Road, respectively. A wet deposition flux of 2.873pgm(-2)d(-1) was measured at the Clinton Drive site. The results indicated that the dry deposition process exhibited spatial variability. In addition, the results also demonstrated that precipitation, although intermittent, is the most important mechanism for the removal of dioxins from atmosphere in the area of study. Combining the contributions of the dry and wet deposition processes at Clinton Drive resulted in a total bulk deposition flux of 527pg m(-2)d(-1). The total dry and wet deposition fluxes were dominated by OCDD followed by 1,2,3,4,6,7,8-HpCDD at both sites. Overall average dry deposition velocities of 0.35 and 0.15cms(-1) were calculated at Clinton Drive and Lang Road sites, respectively. While these velocities were similar to velocities observed in other geographical areas, the contribution of OCDD to the total deposition flux in Houston was significantly higher, probably reflecting the unique nature and character of Houston dioxin sources. The results also showed that lower chlorinated congeners, primarily present in the gas phase, are more likely to be removed from the atmosphere by precipitation. Relationships between the detected congeners in the dry deposition samples and other routinely measured air pollutants/meteorological parameters were found. The results showed that in general, the dry deposition of these congeners was consistently negatively correlated with SO(2) and NO(x) concentrations in the air and positively correlated with relative humidity. However, more research is needed to ascertain those correlations.

Statistical investigation of polychlorinated dibenzo-p-dioxins and dibenzofurans in the ambient air of Houston, Texas.

Polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (dioxins and furans) are persistent, bioaccumulative and highly toxic chemical constituents that appear in the environment at very low and difficult to measure levels. Although dioxins and furans are widely recognized as toxic contaminants needing regulation, their temporal and spatial concentration profiles and the factors impacting their partitioning and congener distribution are only moderately understood. This paper presents the results from one of the most extensive ambient air dioxin and furan sampling efforts conducted in a geographic area to date. The data consist of monthly ambient concentrations of 17 of the most toxic congeners of dioxins and furans collected at five locations in Houston, Texas over a calendar year. The results showed a total annual mean dioxin and furan congener concentration of 1047 fg/m3 and an annual mean summation operatorI-TEQ concentration of 15 fg I-TEQ/m3 (16 fg WHO-TEQ/m3). These results, when compared with proximate data from the USEPA National Dioxin Ambient Monitoring Network (NDAMN), revealed significant (at the P0.05 level) differences between Houston and the NDAMN sites, suggesting the existence of local dioxin sources. A temporal analysis of the data showed that the congener concentration distribution varies over time, depending on the level of chlorination, type of congener, and temperature. The results also suggested that the fluctuations of congener concentrations and I-TEQ concentrations are closely correlated with minimum relative humidity, mean temperature, and mean NOx concentration.