Nox1-derived oxidative stress as a common pathogenic link between obesity and hyperoxaluria-related kidney injury.

Specific relationships among reactive oxygen species, activation pathways, and inflammatory mechanisms involved in kidney injury were assessed in a combined model of obesity and hyperoxaluria. Male Wistar rats were divided into four groups: Control, HFD (high fat diet), OX (0.75% ethylene glycol), and HFD + OX (combined model) Changes in basal O2- levels were evaluated by chemiluminescence in renal interlobar arteries and renal cortex. Furthermore, the effect of different inhibitors on NADPH-stimulated O2- generation was assessed in renal cortex. Oxidative stress sources, and local inflammatory mediators, were also determined, in parallel, by RT-PCR, and correlated with measures of renal function, urinary biochemistry, and renal structure. Rats from the HFD group developed overweight without lipid profile alteration. Tubular deposits of crystals were seen in OX and severely enhanced in HFD + OX groups along with a significantly higher impairment of renal function. Basal oxidative stress was increased in renal cortex of OX rats and in renal arteries of HFD rats, while animals from the combined HFD + OX group exhibited the highest levels of oxidative stress in renal cortex, derived from xanthine oxidase and COX-2. NADPH oxidase-dependent O2- generation was elevated in renal cortex of the OX group and markedly enhanced in the HFD + OX rats, and associated to an up-regulation of Nox1 and a down-regulation of Nox4 expression. High levels of oxidative stress in the kidney, of OX and HFD + OX groups were also associated to an inflammatory response mediated by an elevation of TNFα, COX-2, NFκB1 MCP-1, and OPN. Oxidative stress is a key pathogenic factor in renal disease associated to hyperoxaluria and a common link underlying the exacerbated inflammatory response and kidney injury found under conditions of both obesity and hyperoxaluria. Nox1 pathway must be considered as a potential therapeutic target.

Animal assisted interventions in neurorehabilitation: a review of the most recent literature.

INTRODUCTION: While conventional wisdom has always affirmed the value of animals in promoting human health and well-being, only recently has their therapeutic role in medicine become a topic for dedicated research. Animal assisted interventions (AAI) can be classified as animal-assisted activities, animal-assisted therapy, and service animal programs. OBJECTIVE: The aim of this review is to analyse original papers addressing AAI and neurological diseases and published in the most influential medical journals between 2001 and 2012, and discuss their findings in the light of what may be of interest in the field of neurology. DISCUSSION: We selected a total of 23 articles on neurorehabilitation in cerebral palsy, pervasive developmental disorders, multiple sclerosis, spinal cord injury, stroke, and mental disorders. The main therapeutic results were improvement on the Gross Motor Function Classification Scale and in upper limb dexterity (cerebral palsy); improvement in social functioning and interaction; reductions in stress, anxiety, and loneliness (pervasive developmental disorders and mental disorders); and decreased spasticity with improved balance (multiple sclerosis, spinal cord injury, stroke). CONCLUSION: These interventions, performed with highly specialised animals in very specific neurological populations, deliver an increasing body of scientific evidence suggesting that they are an effective complement to other existing therapies. In these diseases, further high-quality studies are warranted in order to define the most appropriate programmes for therapy.

Role of the physical and rehabilitation medicine specialist regarding of children and adolescents with acquired brain injury.

Acquired brain injury (ABI) is one of the most common causes of mortality and severe disability in children and adolescents. Those with ABI may suffer any of a wide range of disorders that may limit their activity, their participation in family and school life, and their involvement in society in general. This paper describes the different stages of recovery - hospitalisation, preparing for discharge, and long term follow-up, in which PRM specialists are involved. Although the involvement of the PRM specialist is important in all three stages, it is during the latter two stages when his or her expertise is particularly important. An interdisciplinary care team - which the PRM specialist is well placed to lead ­ is required if the best results are to be achieved.

Pielonefritis xantogranulomatosa: conceptos actuales en el diagnóstico y tratamiento / Xanthogranulomatous pyelonephritis: current concepts of diagnosis and treatment

Introducción: La Pielonefritis Xantogranulomatosa (PNF XG) es una patología de baja prevalencia, frecuentemente asociada a litiasis y destrucción del parénquima renal. Dada la gran masificación de la tomografía axial computada su diagnóstico y manejo es cada vez más precoz disminuyendo así la morbi-mortalidad perioperatoria. Objetivos: Describir la experiencia de nuestro servicio en PNF XG y realizar un análisis de la literatura sobre los conceptos actuales en el diagnóstico y tratamiento de esta patología. Materiales y métodos: Análisis retrospectivo de todas la nefrectomías totales realizadas en nuestro servicio entre los años 2000 y 2007. Se incluyeron sólo las piezas con el diagnóstico histológico de PNF XG. Resultados: Se encontraron 11 casos con el diagnóstico histológico de PNF XG. La edad promedio de presentación fue de 54 años con una leve tendencia al sexo femenino. En todos los pacientes se encontró una historia actual o reciente de litiasis urinaria. En todos los casos se realizó un estudio imagenológico preoperatorio, siendo 9 de ellos estudiados con TAC de abdomen y encontrándose la presencia de litiasis en 7 pacientes. Todos los pacientes fueron manejados mediante una nefrectomía total por lumbotomía, sin registrarse mortalidad. Conclusiones: La PNF XG constituye un desafío en sí misma. A pesar de ser una patología rara y de difícil diagnóstico, una cuidadosa evaluación preoperatoria y alto índice de sospecha, pueden ayudarnos a realizar un diagnóstico oportuno y realizar el manejo más adecuado, disminuyendo así las complicaciones perioperatorias.

Introduction: Xanthogranulomatous pyelonephritis (XG PNF) is a low prevalence disease, often associated with lithiasis and renal parenchymal destruction. The wide availability of tomographic (CT) diagnosis allows for frequent early management decreasing perioperative morbidity and mortality. We describe the experience at our institution in XG PNF and perform an analysis of the literature onthe current concepts in diagnosis and treatment of this condition. Materials and methods: Retrospective analysis of all nephrectomies performed at our department between 2000 and 2007. Only surgical specimens with histological diagnosis of XG PNF were included. Results: We found 11 cases with histologic diagnosis of XG PNF. Average age of presentation was 54 years with a slight tendency towards females. All patients had a current or recent history of urolithiasis. In all cases a preoperative imaging study was made, 9 of them were studied with abdominal CT scan and found the presence of stones in 7 patients. All patients were treated by an open total nephrectomy without mortality. Conclusions: The XG PNF is a challenge in itself. Despite being infrequent and difficult to diagnosis, a careful preoperative evaluation and a high index of suspicion can help to make an early diagnosis and management, thus reducing perioperative complications.

[Detection of some zoonotic agents in the domestic pigeon (Columba livia) in the city of Chillán, Chile]. / Detección de algunos agentes zoonóticos en la paloma doméstica (Columba livia) en la ciudad de Chillán, Chile.

INTRODUCTION: There is an increase in the population of doves (Columba livia) as well as their contact with healthy and immunocompromised hosts. OBJECTIVES: detection of some zoonotic agents of the domestic pigeon (Columba livia) in Chillán city, Chile. MATERIALS AND METHODS: From October 2002 to September 2003, 100 domestic pigeons were captured. Blood, organs and intestine contents were sampled from each pigeon. The samples were cultivated in different kinds of agar according to the searched microorganism. Fungi were typified by morphological studies after staining with 2% methylene blue. For the detection of Chlamydophila psittaci a commercial Elisa kit (IDEXX) was used. RESULTS: Pigeons were registered positive for: chlamydiosis (11%), staphylococcus (8%), salmonellosis (4%) and aspergillosis (1%). No pigeon had evidence of cryptococcosis and listeriosis. CONCLUSIONS: these results confirm that domestic pigeon could act as vector of zoonotic agents of public health importance.

Detección de algunos agentes zoonóticos en la paloma doméstica (Columba livia) en la ciudad de Chillán, Chile / Detection of some zoonotic agents in the domestic pigeon (Columba livia) in the city of Chillán, Chile

Introducción: En las últimas décadas, se ha detectado un aumento de las poblaciones de palomas (Columba livia) y un mayor contacto con personas sanas e inmunocomprometidas. Objetivos: detectar algunos agentes zoonóticos en la paloma doméstica (Columba livia) en la ciudad de Chillán. Materiales y Métodos: Desde octubre de 2002 hasta septiembre de 2003 fueron capturadas 100 palomas. Se tomaron muestras de sangre, órganos y contenido intestinal de cada una de ellas, para ser cultivadas en diferentes tipos de agar, de acuerdo al microorganismo buscado. La identificación de hongos se efectuó mediante estudio de morfología con azul de metileno al 2%. Para la detección de Chlamydophila psittaci se realizó un examen serológico utilizando un kit comercial de ELISA (IDEXX). Resultados: se registraron palomas positivas frente a: clamidiosis (11%), estafilococcosis (8%), salmonelosis (4%) y aspergilosis (1%). No se detectaron palomas con evidencias de criptococcosis y listeriosis. Conclusiones: La paloma doméstica de la ciudad de Chillán actúa como portador de agentes zoonóticos de importancia en salud pública.

Introduction: There is an increase in the population of doves (Columba livia) as well as their contact with healthy and immunocompromised hosts. Objectives: detection of some zoonotic agents of the domestic pigeon (Columba livia) in Chillán city, Chile. Materials and Methods: From October 2002 to September 2003, 100 domestic pigeons were captured. Blood, organs and intestine contents were sampled from each pigeon. The samples were cultivated in different kinds of agar according to the searched microorganism. Fungi were typified by morphological studies after staining with 2% methilene blue. For the detection of Chlamydophila psittaci a commercial Elisa kit (IDEXX) was used. Results: Pigeons were registered positive for: clamidiosis (11%), staphylococosis (8%), salmonellosis (4%) and aspergillosis (1%). No pigeon had evidence of cryptococosis and listeriosis. Conclusions: these results confirm that domestic pigeon could act as vector of zoonotic agents of public health importance.

Descentralización en salud y seguros de salud comunitarios: alcances y desafíos en el Ecuador / Decentralization in health and communitarian insurances of health: I reach and challenges in Ecuador

La reforma del sector salud en el Ecuador busca desarrollar modelos descentralizados que impulsen un sistema de aseguramiento universal de servicios de salud. Los seguros prepagados aparecen como una alternativa que mejora el acceso y la cobertura de servicios de salud a través del pago de una cuota de afiliación. Este estudio analiza dos experiencias locales relacionadas con el establecimiento de sistemas descentralizados tipo seguro comunitario (SSCOM) en Ecuadir: (A) UNOCANC-2000 y COCAP-2002. Estos modelos fueron analizados frente a otras experiencias: (B) Sistemas auspiciados por organismos de cooperación multilateral, (Proyecto MODERSA del Banco Mundial y Ministerio de Salud Pública) y (C) Sistemas que recibieron cooperación técnica...

[Count of salivary Streptococci mutans in pregnant women of the metropolitan region of Chile: cross-sectional study]. / Recuento de Streptococci mutans en la saliva de mujeres embarazadas de la Región Metropolitana: estudio transversal.

BACKGROUND: Salivary Streptococci mutans contamination is considered the main microbiological risk factor for the initiation of caries. AIM: To assess the oral health of pregnant women, counting Salivary Streptococci mutants. PATIENTS AND METHODS: One hundred seventy four pregnant women, in the first, second and third trimester of pregnancy, aged 27 +/- 5 years old, consulting at a public primary health center, were studied. Puerperal women that had their delivery two months before, were studied as a control group. Salivary samples were obtained and Streptococci mutans colonies were counted using quantitative and semiquantitative methods. RESULTS: There was a good concordance between both counting methods. No differences in Streptococci mutans counts were observed among the three groups of pregnant women, but the latter as a group had higher counts than puerperal women. Women with more than 5 caries had also higher counts. CONCLUSIONS: Semiquantitative Streptococci mutans counts are easy, rapid and non invasive and have a good concordance with quantitative counts in saliva.

[Dental fluorosis: quantification of Streptococcus mutans in school children from Mamiña, Chile. A longitudinal study]. / Fluorosis dental: recuento de Streptococcus mutans en escolares provenientes de la Primera Región de Chile. Estudio longitudinal.

BACKGROUND: High fluorine concentrations in drinking water are associated with a decrease in the amount of salivary S mutants. Taking into account that clinical dental fluorosis can appear with 1.5 ppm of fluorine in the drinking water, fluorine concentrations in Mamiña is 2.4 ppm. AIM: To quantify salivary S mutans in school age children from Mamiña, a zone with a high fluorine content in the drinking water, during one year. MATERIAL AND METHODS: During 1997 and 1998, dental health was assessed and salivary samples were obtained from 51 children (27 male) aged 10 +/- 2 years to quantify S mutans. RESULTS: Most children studied had more than 10(5) salivary S mutans colony forming units. No changes in the rates of infection or dental health characteristics were observed during the observation year. CONCLUSIONS: High fluorine content in the drinking water did not have an effect on salivary S mutans infection in this population.

Antibiotic treatment in preterm labor and intact membranes: a randomized, double-blinded, placebo-controlled trial.

Although an association between microbial invasion of amniotic cavity and preterm birth has been extensively demonstrated, there is conflicting evidence regarding the benefits of antibiotic therapy in patients with preterm labor and intact membranes. We attempted to assess the efficacy of amoxicillin and erythromycin on pregnancy outcome in those patients. A randomized, double-blinded, placebo-controlled trial was designed and implemented. A total of 196 patients with singleton pregnancies and preterm labor with intact membranes (22-36 weeks) were randomly allocated to receive either antibiotics or placebo, plus adjunctive parenteral tocolysis, and 173 patients (antibiotics group n = 83 vs. placebo group n = 90) completed the treatment. The overall prevalence of microbial invasion of the amniotic cavity was 5.2% (9/173). No significant difference between both groups was found in maternal outcomes, including duration of randomization-to-delivery interval, frequency of preterm delivery, and frequency of clinical chorioamnionitis and endometritis. Rate of cesarean section was significantly higher in the placebo group (28% vs. 12%). Regarding neonatal outcome, no significant difference was detected between both groups in neonatal death, respiratory distress syndrome, proven sepsis, and birthweight. Suspected sepsis was significantly more frequent in the placebo group (6/90 vs. 0/78). The results of this trial indicate that amoxicillin and erythromycin do not prolong pregnancy in patients with preterm labor and intact membranes. A significant reduction in the rate of cesarean section was observed in patients receiving antibiotics. A significant reduction in the rate of neonatal suspected sepsis was also demonstrated.

[Intrauterine growth in full-term twins without risk factors]. / Crecimiento intrauterino en gemelos de término sin factores de riesgo.

Twins are analysed according to the intrauterine growth curve constructed for single fetus. The relationship of twins with length, weight, head circumference and the weight length-index is studied. Twins over 36 weeks gestation age, without maternal or fetal pathologies were selected. It is concluded the twins pregnancy "per se" constitutes on its own, a risk factor regarding the intrauterine growth curve, particularly in relation with the weight curve.

Maternal plasma volume expansion and hormonal changes in women with idiopathic fetal growth retardation.

OBJECTIVE: To explore the mechanisms underlying the reduced maternal plasma volume associated with idiopathic fetal growth retardation (FGR). METHODS: In 30 normotensive women with growth-retarded fetuses and 26 with normal-size fetuses, plasma volume was measured with a modified Evan's blue method. Plasma levels of atrial natriuretic peptide, plasma renin activity, aldosterone, estradiol, and progesterone, and urinary excretion of kallikrein, prostacyclin, and thromboxane A2 were measured at 34-40 weeks' gestation. RESULTS: Compared with controls, gravidas with growth-retarded fetuses had a reduced plasma volume expansion (P < .01), similar atrial natriuretic peptide and plasma renin activity levels, and lower serum aldosterone (P < .001) and placental steroids (P < .03). These women also had decreased urinary kallikrein activity and prostaglandin excretion (P < .05). When both groups were combined, maternal plasma volume correlated significantly with birth weight (r = 0.53) and placental weight (r = 0.66). CONCLUSION: Normotensive women with idiopathic FGR have reduced plasma volume expansion. Although the exact mechanisms of this change are unknown, we postulate that the lower maternal aldosterone levels and reduced levels of vasodilator substances, such as prostacyclin and kallikrein, may have a causal role.

Maternal hemodynamic adjustments in idiopathic fetal growth retardation.

The hemodynamic characteristics of 11 normotensive gravidas with idiopathic fetal growth retardation (FGR), were compared with 11 controls of similar age, parity and body size. At weeks 36-38 of gestation, plasma volume was 3,161 +/- 121 ml in controls and 2,624 +/- 95 ml in the FGR group (p < 0.003); cardiac output (CO) was 6,191 +/- 132 ml/min in controls and 5,483 +/- 186 ml/min in the FGR group (p < 0.01). Total peripheral vascular resistance (TPVR) was lower in controls than in FGR (1,031 +/- 33 vs. 1,306 +/- 62 dyn/s/cm5; p < 0.001). Birth weight was correlated with both plasma volume (r = 0.61; p < 0.01) and CO (r = 0.53; p < 0.02) and inversely correlated with TPVR (r = -0.69; p < 0.001). These results are in line with the hypothesis that a reduced plasma volume leads to a lower CO and, secondarily, to reduced uterine blood flow and FGR.

Hemodynamic changes in underweight pregnant women.

Twelve normal-weight and 12 underweight women were compared to test whether fetal growth retardation in underweight gravidas is related to inadequate maternal hemodynamic adjustments. Plasma volume (+/- standard error) was 3227 +/- 103 mL in normal-weight and 2731 +/- 84 mL in underweight women (P less than .002). Cardiac output was 6340 +/- 167 mL/minute in controls and 5689 +/- 213 mL/minute in underweight women (P less than .03). Total peripheral vascular resistance was lower in controls than in underweight subjects (1025 +/- 31 versus 1198 +/- 58 dyne/second/cm5). Mean birth weight was 2837 +/- 125 g in underweight women and 3362 +/- 106 g in controls (P less than .005). Similarly, placental weight was reduced in the underweight group. All infants delivered by control mothers had a normal birth weight, whereas six infants from underweight gravidas were growth-retarded. In all cases combined, maternal plasma volume correlated significantly with both birth weight (r = 0.6, P less than .002) and placental weight (r = 0.56, P less than .01); total peripheral vascular resistance also correlated significantly and inversely with newborn weight and placental weight. Cardiac output correlated only with placental weight (r = 0.54, P less than .02). These results are consistent with the hypothesis that underweight mothers are at higher risk of fetal growth retardation because of a smaller plasma volume and lower cardiac output.

Neurochemical evidence for the presence of sympathetic nerve terminals in the rat mammary gland: Changes during the lactogenic cycle.

Experiments were undertaken to obtain neurochemical evidence of the presence of sympathetic nerve terminals in the rat mammary gland and the changes occurring in them during the lactogenic cycle. The norepinephrine (NE) content of the gland changed during the lactogenic cycle. Higher levels of NE were found during virginity and involution, whereas a lower level was found at 14 days of lactation. Surgical and chemical (with 6-hydroxydopamine) denervation reduced the norepinephrine content of the gland by 61 and 90%, respectively. Uptake of [(3)H]norepinephrine by the mammary gland was saturable and specifically blocked by cocaine. No changes in the maximal capacity of incorporation during the lactogenic cycle were found, but the affinity of NE for the transmembrane carrier was low during lactation, as was the NE content, suggesting a decrease in the sympathetic nerve activity during this stage of the lactogenic cycle. In support of this, we found a decrease in total NE released after stimulation with 80 mM KCI. The neurochemical evidence obtained during this research strongly suggests that rat mammary gland is innervated by sympathetic nerves and that their activity changes during the lactogenic cycle.

Diffusion of medicaments within root canal dentin. A scanning electron microscopic study.

Root canals of 21 maxillary human teeth were enlarged with reamers and flushed alternatively with sodium hypochlorite and hydrogen peroxide. After its mechanical preparation, root canals were dressed with camphorated paramonochloropherol and/or formocresol delivered by paper points. All three medicaments crystallize both on dentin walls and inside dentinal tubules. The clinical implications of these findings are discussed.