[Hydrostatic enema outcome in patients with long history of ileocolic intussusception]. / Resultados del enema hidrostático en pacientes con clínica prolongada de invaginación ileocólica.

PURPOSE: Hydrostatic enema is the gold standard treatment for ileocolic intussusception in stable patients without radiologic complication. There is no consensus about the influence of long history of symptoms in the outcome of this treatment. The aim of this study is to determine whether hydrostatic enema is effective and safe in patients with history of ileocolic intussusception of over 24 hours. MATERIAL AND METHODS: Retrospective review of all patients with ileocolic intussusception admitted to our hospital between 2014 and 2017. We divided the patients in whom enema was attempted on into two groups according to the length of history: over or under 24 hours. Statistical analysis was done by using the Fisher's exact test. RESULTS: In this study period 59 children presented with ileocolic intussusception. Duration of symptoms was variable (range 2 hours-7 days). Of the total of patients, initial hydrostatic enema was attempted on 49, with a success rate of 91.8% (45 patients). In the group of history <24 hours (33 patients, 67.3%) we observed a 93.9% effectiveness and in the group >24 hours (16 patients, 32.7%) effectiveness was 87.5%. Success rate showed no significant difference when comparing both groups (p=0.588). No complications were seen after enema reduction. CONCLUSIONS: The use of hydrostatic enema in patients with long history of intussusception is successful and safe. We consider it to be the first-line treatment in stable patients with no radiologic complication, regardless the duration of symptoms.

OBJETIVOS: El gold standard para el tratamiento de la invaginación ileocólica en el paciente estable sin complicación radiológica es el enema hidrostático. No hay unanimidad sobre si la sintomatología prolongada de invaginación influye en los resultados de dicho tratamiento. El objetivo de este estudio es determinar si el enema hidrostático es efectivo y seguro en pacientes con clínica de invaginación ileocólica mayor de 24 horas. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes diagnosticados de invaginación ileocólica en nuestro hospital entre 2014 y 2017. Hemos dividido en 2 grupos a los pacientes a los que se realizó enema en función del tiempo de clínica, mayor o menor de 24 horas. El análisis estadístico se realizó mediante el test exacto de Fisher. RESULTADOS: En este periodo se atendieron 59 niños con invaginación ileocólica con duración variable de los síntomas (2 horas a 7 días). Del total de pacientes, en 49 se realizó enema hidrostático inicial con una efectividad del 91,8% (45 pacientes). En el grupo de clínica <24 horas (33 pacientes, 67,3%) se objetivó una efectividad del 93,9% y en el grupo de clínica >24 horas (16 pacientes, 32,7%) se objetivó una efectividad del 87,5%. No hubo diferencias significativas al comparar la efectividad entre ambos grupos (p=0,588). En ningún paciente hubo complicaciones tras el enema. CONCLUSIONES: El empleo del enema hidrostático en pacientes con clínica prolongada de invaginación es efectivo y seguro. Consideramos que debería ser la primera herramienta terapéutica en el paciente estable sin complicación radiológica, independientemente del tiempo de evolución.

[Probabilistic algorithm for management of suspected foreign body aspiration in children]. / Protocolo probabilístico para el manejo del cuerpo extraño en la vía aérea.

INTRODUCTION: The aim is to create a protocol for the managing of foreign body aspiration in children based on a probability scale. MATERIAL AND METHODS: Retrospective observational study, including patients admitted with suspected foreign body aspiration (FBA) in the last 15 years. The parameters were assessed with a SCORE that included witnessed choking, stridor and wheezing during choking, unilateral reduced air entry and abnormal X-Ray. This scale relates them to a probability of FBA, where a score ≤ 1 is associated with less than 10% and ≥ 4 with more than 50% of FBA. According to the probability, we propose: observation, chest Computed Tomography (CT) or bronchoscopy. Then, we tried to adapt it to our casuistry. RESULTS: A total of 109 children admitted between 2002-2017 were included. The median age was 25 months, a foreign body was found in 88 patients, the most frequent being organic (seeds and nuts). Significant predictors of FBA were unilateral reduced air entry and abnormal X-Ray. In our study, we found the same ascending probability between the scale and the presence of foreign body, except for SCORE 1, which was 57% what we attribute to an information bias. If the foreign body were not nuts, inorganic or bone, its aspiration was very unlikely, that is why we included it in the SCORE with -1. CONCLUSION: The use of the algorithm would imply the performance of 7% more of CT in patients without a FBA, but avoiding an 8.5% of bronchoscopy. Our results present an information bias, characteristic of a retrospective study.

OBJETIVOS: Creación de un protocolo de manejo del cuerpo extraño (CE) en vía aérea (VA) basado en una escala de probabilidad. MATERIAL Y METODOS: Estudio retrospectivo observacional de pacientes con sospecha de aspiración de CE en 15 años. Los parámetros fueron valorados con un SCORE que contempla atragantamiento presenciado, estridor y sibilancias durante el atragantamiento, hipoventilación unilateral y radiografía alterada. Dicha escala los relaciona con una probabilidad de presencia de CE en VA, donde una puntuación ≤ 1 se asocia a menos de un 10% y ≥ 4 a > 50%. Según la probabilidad se plantea: observación, TAC o instrumentación de VA. A continuación se intentó optimizar en función de nuestra casuística. RESULTADOS: Se analizaron 109 pacientes (mediana 25 meses), identificándose CE en 88, principalmente frutos secos. De las variables predictoras solo fueron significativas: la hipoventilación unilateral y la radiografía alterada. En nuestra serie se observó la misma probabilidad ascendente entre la escala y la presencia de CE, excepto en la puntuación de 1 que fue del 57%, lo que atribuimos a un sesgo de información. Si el CE no era fruto seco, material inorgánico o hueso, era muy improbable su aspiración (p= 0) por lo que lo incluimos en el SCORE con un -1. CONCLUSIONES: La aplicación de la escala implicaría la realización de un 7,5% más de TAC en pacientes sin CE pero evitando un 8,5% de instrumentaciones de la VA. Nuestros resultados presentan un sesgo de información, propio de un estudio retrospectivo. Actualmente hemos iniciado la implementación prospectiva.

Investigating the link between disease activity and infliximab serum levels in rheumatoid arthritis patients.

OBJECTIVES: The aim of this study was to examine the extent to which infliximab (IFX) serum levels impact disease activity in rheumatoid arthritis (RA) patients. METHODS: In this cross sectional study, serum samples were taken prior to drug infusion from 60 RA patients who had been undergoing IFX therapy > 12 months as a first line of biological treatment. Patient IFX levels were tested and then associated with clinical disease activity. Three DAS28 cut-off points, <2.6, <3.2 and <5.1 were used to determine whether detectable IFX levels were any predictor of clinical disease activity. Logistic regression analysis was run to check other possible factors associated with RA clinical outcomes such as MTX concomitant use, CRP and ESR. RESULTS: Sixteen (27%) out of the 60 patients tested negative; 28 (46%) presented subtherapeutic and 16 (27%) therapeutic IFX levels. Median IFX levels were higher in patients either in remission or showing low disease activity than in those with moderate and high disease activity (p=0.014). Significant association was found between IFX levels and clinical disease activity (p=0.001). Detectable levels of IFX shows better sensitivity and specificity to identify patients with DAS28<3.2 than to identify patients with DAS28<2.6 or DAS28<5.1. Conversely, the best DAS28 cut-off to identify detectable/undetectable IFX was 3.19, with AUC under ROC curve 0.804 (Sd.E 0.070), 76% specificity and 83% sensitivity (p<0.001). MTX use, CRP and ESR did not interfere with this association. Seven out of the 8 patients with anti-IFX antibodies presented DAS28>3.2 (p=0.005). CONCLUSIONS: DAS28 and IFX serum levels were shown to have an inverse correlation. Undetectable IFX serum levels were associated to RA patients presenting DAS28>3.2 meaning that DAS28 <3.2 may be useful to clinicians to evaluate patient response to drug therapy.

Helminth parasites in faecal samples from the endangered Iberian lynx (Lynx pardinus).

The Iberian lynx is the most endangered felid in the world. Enteropathogens may threaten its survival, and therefore we analysed faecal samples from 66 different individuals (37 males and 29 females), the largest population representation studied to date. The samples were obtained from November 2005 to October 2008 in the two areas where the Iberian lynx survives: Sierra Morena and Doñana (Andalusia, southern Spain). A total of 56.1% samples were parasitized with at least 6 species of helminths, including two cestodes (Hymenolepis spp. and Taenia spp.) and four Nematodes (Ancylostoma spp., Toxocara spp., Toxascaris leonina, and Capillaria sp.). In this work, the presence of Hymenolepis is reported for the first time in Lynx pardinus. The relevance of our findings is discussed focussed on the conservation of this endangered felid.

[Analysis and protocolization of rasburicase use in patients with hematologic neoplasms]. / Análisis y protocolización de la utilización de rasburicasa en pacientes con neoplasias hematológicas.

OBJECTIVE: To describe the use of rasburicase in adult patients with hematological neoplasias and to present a protocol for its administration jointly prepared by the hematology and the pharmacy departments based on the scientific evidence available. METHOD: Retrospective study that reviews treatments with rasburicase administered in a tertiary 800-bed hospital from July 2002 to May 2004 to adult patients with hematological neoplasias. The following data were collected: demographic and clinical data, daily dose of rasburicase and length of treatment, plasma levels of creatinine, potassium, phosphate, calcium, LDH, uric acid and white blood cell count daily and until 48 hours after administering the last dose of rasburicase. RESULTS: Rasburicase was administered to a total of 18 adult patients (mean age of 57 years; range 27-84; 11 men and 7 women). Prior to treatment, 16 patient had high levels of LDH, 12 patients had a blood count over 50,000 white blood cells/mm3, and 11 had serum levels of uric acid above 7 mg/dl. The dose of rasburicase administered was 0.2 mg/kg/day and the median length of treatment was 5 days (range 1-10). The levels of uric acid returned to normal values in all patients. Furthermore, an statistically significant decrease of creatinine levels was observed. The other biochemical parameters studied were duly controlled throughout the treatment. CONCLUSIONS: A high variability is observed in the use of rasburicase in our patients. The hematology and pharmacy services have been working jointly to prepare a consensus-based protocol according to which, depending on the patient s risk of developing TLS (tumoral lysis syndrome), standard prophylaxis is administered to low-risk patients (intravenous hydration, alopurinol and urine alcalinization) and rasburicase is administered initially for 1-3 days to patients with high risk of developing TLS.

Biological activity of extracts from Catalpa bignonioides Walt. (Bignoniaceae).

Catalpa bignonioides Walt. (Bignoniaceae) is a species that belongs to a tropical family but has been introduced in many countries as ornamental. Although this plant is consumed by indigenous cultures of South America for medical uses, experimental studies of the biological properties of Catalpa bignonioides are lacking. The aim of this work was to study the biological activity of crude extracts from either pods, seeds or leaves of Catalpa bignonioides which were collected in Spain. Ethyl ether, butanolic and aqueous fractions of the pod extract were also prepared and studied. We have examined the antimicrobial activity against five bacteria and one yeast, the cytotoxic activity against HepG2 cells and the anti-inflammatory and antinociceptive effects in rodents. A preliminary phytochemical analysis of the extracts and fractions was also conducted. Results showed no antimicrobial or antitumoral effects, but prominent anti-inflammatory and antinociceptive actions of the extracts. These last activities may be a result of the presence of either of saponins, sterols or phenols, mainly found in the leaves and pods of the plants.

In vitro development of resistance to three quinolones in Streptococcus pneumoniae.

We studied the in vitro development of resistance to ciprofloxacin, trovafloxacin and moxifloxacin in 5 strains of Streptococcus pneumoniae resistant to penicillin. We detected the great ease of in vitro development of resistance in the case of ciprofloxacin and the much reduced capacity of moxifloxacin to generate resistance (only 1 strain). Trovafloxacin generated resistance, but more slowly than ciprofloxacin. We consider that study of the capacity to generate resistance should be one of the points to consider when deciding on their large-scale use in respiratory infections, but comparative studies between in vitro and in vivo models should be carried out so as to determine the clinical repercussion of these phenomena.

[Seromuscular colocystoplasty lined by urothelium. Experimental study in rats]. / Colocistoplastia seromuscular recubierta de urotelio. Un estudio experimental en ratas.

OBJECTIVE: To determine what technical of vesical extension in rat can offer the best functional and histological results. DESIGN: Comparative experimental study between pre and postoperative parameters of 60 female Wistar rats. The animals were divided in 5 groups using different techniques of vesical augmentation. Sham, colocystoplasty (CC), demucosalised colocystoplasty (DCC), demucosalised colocystoplasty lined by urothelium (AADCC), autoaugmentation (AA). INTERVENTIONS: Preoperative cystometrical study. Microsurgery for vesical augmentation. New cystometric study at the month, previous to the sacrifice of the animal and extraction of bladder for its histological study. Measurement of the volume and pressure of rupture. RESULTS: The technique of seromuscular enterocistoplasty presents the high mortality in the rat (63.6%). The increase of the vesical volume in both groups that carried seromuscular grafts was little (0.22 +/- 0.5 and 0.47 +/- 0.3 ml) in front of the control group (0.11 +/- 0.4 ml). Only standard colocystoplasty and bladder autoaugmentation produced significant increases on vesical volume (0.78 +/- 0.5 and 0.69 +/- 0.6 ml, respectively) and rupture volume. There were not observed significant differences on vesical rupture pressure.

Comparative enhancer effects of Span20 with Tween20 and Azone on the in vitro percutaneous penetration of compounds with different lipophilicities.

Sorbitan monolaurate (Span20) was used in this study to analyze the influence of the polar functional group on the effects that non-ionic surfactants have on skin permeability. Its ethoxylate derivative polysorbate 20 (Tween20) and Azone, both with the same C12 alkyl chain as Span20, were used for comparative purposes. We evaluated the relative potency of the three molecules as enhancers in the permeability of a series of compounds with lipophilicities ranging from log Poct=-0.95 to log Poct=2.33. The influence of the enhancer concentration was also studied. For this purpose the epidermis of Wistar rat was pretreated with ethanolic solutions (1 and 5%, w/v) of each enhancer. Our results indicate that the nature of the enhancer head group greatly influences cutaneous barrier impairment. The enhancer concentration must also be taken into account, even though the influence of the concentration seems to depend on the lipophilicity of the penetrant assayed.

Tecoma sambucifolia: anti-inflammatory and antinociceptive activities, and 'in vitro' toxicity of extracts of the 'huarumo' of peruvian incas.

Aqueous and alcoholic extracts of pods and flowers of Tecoma sambucifolia H.B.K. (Bignoniaceae) ('huarumo') were analysed to determine their anti-inflammatory activity (carrageenan-induced edema test), antinociceptive activity (acetic acid writhing test) and 'in vitro' toxicity in Chinese hamster ovary cells, human hepatome cells and human larynx epidermal carcinoma cells. The cytotoxic effects of both extracts were evaluated by two endpoint systems: neutral red uptake assay and tetrazolium assay. The results showed that all extracts have anti-inflammatory and antinociceptive activity, but the highest potency is that of the alcoholic extracts. There were significant differences in cytotoxicity between extracts and among the response of cells to them. The highest cytotoxicity was noted with the alcoholic extract, and the human hepatome cell line was the most sensitive, especially to the alcoholic extract of flowers. The aqueous pod extract appeared to have the best pharmaco-toxicological profile, since it provided a significant reduction of both pain and inflammation together with the lowest cytotoxicity.

Comparative in vitro antifungal activity of amphotericin B lipid complex, amphotericin B and fluconazole.

Amphotericin B (AMB) is considered the gold standard in the treatment of serious systemic mycoses in spite of its nephrotoxicity and adverse effects. Association with lipids enables larger doses of AMB to be given with a longer t((1/2)) and C(max), without the toxic effects at lower concentrations. Liposome-encapsulated AMB shows a lower affinity for mammalian cells and improves V(d), thus decreasing toxicity. Amphotericin B lipid complex (ABLC) is an AMB formulation associated with a biodegradable phospholipid matrix (5% molar) from which the drug is released by cell phospholipases. ABLC is recommended for serious mycoses refractory to conventional antifungal therapy or when AMB is contraindicated. We compared the in vitro antifungal activity of ABLC, AMB and fluconazole (FLZ) against 328 strains of clinically significant opportunistic fungi using a microdilution method (NCCLS, M-27A). 64.9% of the yeasts were inhibited by MIC of ABLC

[Surgical treatment of hypospadias. Our experience and follow up in 1993-1998]. / Tratamiento quirúrgico del hipospadias. Nuestra experiencia y seguimiento durante el período 1993-1998.

OBJECTIVE: To review our series of hypospadias. The incidence of the different types of hypospadias and the complication rates according to the different surgical techniques and materials utilized are analyzed. METHODS: We reviewed our series of 130 patients with hypospadias who underwent surgical correction at the Department of Pediatric Urology from 1993-1998. RESULTS: The patients presented the following types of hypospadias: glandular (13 cases), balano-preputial (56), distal penile (42), mid-penile (9), proximal penile (2) and penoscrotal hypospadias (8). The surgical techniques utilized were the Mickulitz meatotomy procedure (6 cases), MAGPI (24), Mathieu (77), Crawford (5), onlay (7), Duckett (3), Retik (4), Duplay (1), Denis-Brown (2) and penoscrotal transposition (1). The complications commonly observed were fistula (20 cases), hematoma (4), stricture of urethral meatus (4), infection (3), megaurethra (3), skin necrosis (1). CONCLUSIONS: Surgical repair of this developmental anomaly is performed when the patient is approximately 18 months old. In our series 15% of the patients developed fistula, which is similar to the complication rate reported in the literature. However, since we started using monofilament resorbable material, the incidence of fistula has dropped from 20% to approximately 5%. Although other factors are involved, the lower incidence of fistula formation may be largely due to a reduced tissue reaction to foreign body.

[Determination of the in vitro antifungal susceptibility of clinically important yeasts using the Sensititre system]. / Determinación mediante el sistema Sensititre de la sensibilidad in vitro a los antifúngicos de levaduras de interés médico.

Using Sensititre (AccuMed, USA) we studied the in vitro antifungal activity of amphotericin B, fluconazole, itraconazole, ketoconazole and 5-fluorocytosine against 250 clinical yeast isolates taken from different hospitals, including Candida (151 C. albicans, 15 C. krusei, 14 C. parapsilosis, 11 C. tropicalis, 10 C. glabrata, 4 C. guilliermondii, 3 C. rugosa, 2 C. viswanathii, 2 C. famata and 2 C. kefyr), Cryptococcus (32 C. neoformans and 1 C. laurentii), Trichosporon (2 isolates) and Rhodotorula rubra (1 isolate). All the strains were susceptible to amphotericin B and showed an MIC <1 mg/l. The susceptibility of C. albicans (MIC(90) <256 mg/l), C. krusei (MIC(90) <64 mg/l), C. glabrata (MIC(90) <64 mg/l) and C. neoformans (MIC(90) 32 mg/l) to fluconazole was lower (14% isolates being resistant and 16.8% susceptible depending on the dose). The largest number of strains resistant to itraconazole was observed in C. albicans and C. glabrata (17.2% resistant and 24% susceptible and susceptible depending on the dose, respectively). Ketoconazole and 5-fluorocytosine were not effective in vitro against 12.8% and 2%, respectively, of all the isolates studied. Nine C. krusei and seven C. neoformans (12.9%) showed dose-dependent susceptibility to 5-fluorocytosine.

Comparative study of the in vitro antifungal activity of bifonazole, naftifine and sertaconazole against yeasts.

The in vitro activity of three antifungal agents was tested and compared against 151 yeast strains, including ten Candida species, Cryptococcus neoformans, Rhodotorula rubra, and Trichosporon cutaneum. Minimum inhibitory concentrations (MICs) were determined by a microdilution technique in Shadomy modified liquid medium. The mean MICs of sertaconazole (0.34 mg/L) were lower than those of naftifine (16.3 mg/L) and bifonazole (13.2 mg/L). These results suggest that sertaconazole is more active against Candida spp than other topical agents such as bifonazole and naftifine.

Detection by an immunofluorescence test of Encephalitozoon intestinalis spores in routinely formalin-fixed stool samples stored at room temperature.

Of the several microsporidia that infect humans, Enterocytozoon bieneusi is known to cause a gastrointestinal disease whereas Encephalitozoon intestinalis causes both a disseminated and an intestinal disease. Although several different staining techniques, including the chromotrope technique and its modifications, Uvitex 2B, and the quick-hot Gram-chromotrope procedure, detect microsporidian spores in fecal smears and other clinical samples, they do not identify the species of microsporidia. A need for an easily performed test therefore exists. We reevaluated 120 stool samples that had been found positive for microsporidia previously, using the quick-hot Gram-chromotrope technique, and segregated them into two groups on the basis of spore size. We also screened the smears by immunofluorescence microscopy, using a polyclonal rabbit anti-E. intestinalis serum at a dilution of 1:400. Spores in 29 (24.1%) of the 120 samples fluoresced brightly, indicating that they were E. intestinalis spores. No intense background or cross-reactivity with bacteria, yeasts, or other structures in the stool samples was seen. Additionally, the numbers of spores that fluoresced in seven of these samples were substantially smaller than the numbers of spores that were present in the stained smears, indicating that these samples were probably derived from patients with mixed infections of Enterocytozoon bieneusi and E. intestinalis. Because a 1:400 dilution of this serum does not react with culture-grown Encephalitozoon hellem, Encephalitozoon cuniculi, or Vittaforma corneae or with Enterocytozoon bieneusi spores in feces, we concluded that an immunofluorescence test using this serum is a good alternative for the specific identification of E. intestinalis infections.

New cryptosporidium genotypes in HIV-infected persons.

Using DNA sequencing and phylogenetic analysis, we identified four distinct Cryptosporidium genotypes in HIV-infected patients: genotype 1 (human), genotype 2 (bovine) Cryptosporidium parvum, a genotype identical to C. felis, and one identical to a Cryptosporidium sp. isolate from a dog. This is the first identification of human infection with the latter two genotypes.

Fast and reliable extraction of protozoan parasite DNA from fecal specimens.

BACKGROUND: Polymerase chain reaction (PCR) detection of intestinal protozoa in fecal specimens is hampered by poor recovery of DNA and by the presence of PCR inhibitors. In this study we describe a novel method for DNA extraction from such specimens containing spores and oocysts of Enterocytozoon bieneusi and Cryptosporidium parvum, respectively. METHODS AND RESULTS: Extraction was done using commercial kits modified to maximize the recovery and purity of extracted DNA. In comparison with a procedure we previously reported, we estimate that this method may increase the sensitivity of parasite DNA detection in fecal specimens up to tenfold. An additional advantage of this method is that up to 12 samples may be processed simultaneously within 2 hours. CONCLUSIONS: By using this method, we were able to increase reproducibility of PCR amplification on fecal specimens and significantly reduce the hands-on time required to process the samples.