Intensifying Salvage Therapy in Prostate-specific Antigen Recurrent Prostate Cancer After Radical Prostatectomy with Apalutamide, Salvage Radiation, and Docetaxel: The Phase 2 STARTAR Trial.

BACKGROUND AND OBJECTIVE: Androgen deprivation therapy (ADT) with salvage radiation therapy (RT) improves survival for patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP) for prostate cancer (PC), but many patients suffer further relapse. This study aims to determine the benefit of the combination of ADT, apalutamide, salvage RT, and docetaxel for high-risk PSA recurrent PC. METHODS: STARTAR is a multicenter, investigator-initiated phase 2 trial of men with PSA recurrent PC after RP. The key inclusion criteria included M0 by computed tomography/bone scan, Gleason 7 with either T3/positive margin/N1 disease or Gleason 8-10 prostate adenocarcinoma, PSA relapse (0.2-4 ng/ml) <4 yr after RP, and fewer than four positive resected lymph nodes. Patients received ADT with apalutamide for 9 mo, RT starting week 8, and then six cycles of docetaxel. The primary endpoint was 36-mo progression-free survival (PFS) with testosterone recovery and compared against the prior STREAM trial. KEY FINDINGS AND LIMITATIONS: We enrolled 39 men, including those with Gleason 8-10 (46%), pN1 (23%); the median PSA was 0.58 ng/ml. The median follow-up was 37 mo. All patients achieved undetectable PSA nadir. At 24 and 36 mo, PFS rates were 84% and 71%, respectively, which improved significantly over 3-yr 47% historic PFS and 54% enzalutamide/ADT/RT (STREAM) PFS rates (p = 0.004 and p = 0.039, respectively). Common any-grade adverse events included 98% hot flashes, 88% fatigue, 77% alopecia, 53% rash (10% G3), and 5% febrile neutropenia. CONCLUSIONS AND CLINICAL IMPLICATIONS: In this phase 2 trial of ADT, apalutamide, salvage RT, and six cycles of docetaxel for high-risk PSA recurrence, the 3-yr PFS rate improved to 71%, indicating feasible and efficacious treatment intensification, with durable remissions beyond historic data. PATIENT SUMMARY: Prostate cancer recurrence after surgical removal of the tumor occurs often, and current treatment options to limit recurrence after surgery are only partially effective. In this study, we found that the addition of an androgen receptor inhibitor and docetaxel chemotherapy to standard postsurgery radiation therapy and androgen deprivation therapy significantly improved progression-free survival at 3 yr after treatment. These results suggest that intensification of treatment after surgery can provide long-term benefit to a subset of patients with high-risk prostate cancer.

Survival, Growth, and Toxin Production of Bacillus cereus During Cooking and Storage of Fresh Rice Noodles.

Retail stores maintain fresh rice noodles (FRNs) at room temperature because refrigeration negatively impacts FRNs' texture. The room temperature and high water activity of FRNs help spore-forming Bacillus cereus to grow and produce toxins. In this study, the effect of steam cooking on survival and different storage temperatures on the growth and enterotoxins production of B. cereus in FRNs were investigated. White rice flour was used to make FRNs. Three treatments of FRNs were used in this study; uninoculated, inoculated (with 4.0 log CFU/ml of B. cereus spores), and autoclaved as a negative control. A slurry of rice flour, cornstarch, and water was steam cooked for 4 min at 90°C and incubated for 168 h at 4°C, and for 72 h at 22 and 32°C. Incubated FRNs were tested for pH, B. cereus growth, and enterotoxins production. Steam cooking reduced the total number of B. cereus spores by 0.7 ± 0.3 log CFU/g. Surviving B. cereus spores in inoculated and uninoculated FRNs germinated over 72 h of storage. No B. cereus was detected in negative controls. An interaction was observed across storage temperatures and time (p < 0.05). The B. cereus population in uninoculated FRNs increased by more than 7.0 log CFU/g at 22 and 32°C over 72 h, while inoculated FRNs showed a 5.0 log bacterial increase at these storage temperatures. No growth was observed at 4°C in both inoculated and uninoculated FRNs. The pH of inoculated FRNs was reduced from 6.9 ± 0.1 to 5.7 ± 0.0 at 32°C and to 6.2 ± 0.1 at 22°C, and the pH of uninoculated FRNs was reduced from 7.0 ± 0.1 to 5.8 ± 0.2 at 32°C and to 6.5 ± 0.0 at 22°C, indicative of FRNs spoilage. B. cereus in inoculated FRNs produced enterotoxins after 12 h of storage at 32°C, and over 24 h of storage at 22°C, while no toxin was detected at 4°C. Our findings show that storing FRNs at room temperature for 24 h leads to enterotoxin production, emphasizing the importance of proper FRN storage and their potential risk to consumers. Nevertheless, further research should investigate the effect of other foodborne pathogens on these products.

Profiling toxin genes and antibiotic resistance in Bacillus cereus isolated from pre-launch spacecraft.

Characterization of the microbiomes of pre-launch spacecraft in spacecraft assembly facilities is an important step in keeping crews healthy during journeys that can last several hundred days in small artificial environments in space. Bacillus cereus, a foodborne pathogenic bacterium, has the potential to be a significant source of food contamination in such environments. This bacterium is a spore-forming bacteria that resists different antimicrobial treatments in cleanrooms where spacecraft are assembled. This study evaluated 41 B. cereus isolates from four pre-launch spacecraft in spacecraft assembly facilities for their toxin gene profile and antibiotic resistance. Four enterotoxin genes (hlbC, cytK, nheA, and entFM) and two emetic toxin genes (ces and CER) were targeted for chromosomal DNA and plasmid DNA. Results showed 31.7, 7.3, 85, and 41.5% of isolates contained hblC, cytK, nheA, and entFM, respectively, in chromosomal or plasmid DNA. Overall, 37 isolates (90.2%) showed at least one enterotoxin gene. The emetic toxin gene, ces, was detected in the plasmid DNA of three isolates (7.3%). The antibiotic resistance of isolates was evaluated by the Kirby-Bauer disk diffusion procedure. All the isolates exhibited 100% susceptibility to gentamicin, 97% were susceptible to clindamycin, and 95% to chloramphenicol, imipenem, tetracycline, and vancomycin. The overall susceptibility average is 51%. However, 98% of the isolates were resistant to ß-lactam antibiotics, 97.5% were resistant to sulfamethoxazole/trimethoprim, and 80% were resistant to rifampin. This study provides important information on B. cereus isolates from spacecraft assembly facilities for use in microbial monitoring programs of spacecraft.

Melatonin therapy reverses lead exposure-induced testicular damage in rats despite the lack of effect on serum testosterone levels.

Lead (Pb) exposure induces testicular damage and infertility. The aim of this study was to analyze and compare the therapeutic effects of antioxidants or vitamin D and calcium, which have previously been shown to reduce the toxic effects of Pb co-exposure, in rats. Rats were exposed to Pb for 28 days and subsequently treated with antioxidant (melatonin, silymarin), vitamin D and calcium (VitDCa) or a combination (melatonin or silymarin with VitDCa) for 28 days. Control groups included untreated rats (no Pb exposure or therapy), rats exposed only to melatonin or silymarin and rats exposed to Pb without post exposure therapy. Pb exposure induced testicular damage, increased blood lead level (BLL) and reduced serum testosterone level (STL). Rats exposed to Pb and left untreated for 28 days showed persistent pathological testicular alterations. The two treatments that were most effective in reversing pathological testis damage and restoring spermatogenesis were melatonin and silymarin. However, silymarin and melatonin treatment resulted in significantly different serum testosterone levels in rats. Whereas melatonin therapy reduced serum testosterone to levels lower than those in control rats, silymarin increased serum testosterone to levels higher than those in controls. Our pathological analysis of testes revealed that melatonin promoted spermatogenesis and regression of Pb exposure-induced degenerative changes, despite the associated reduction in serum testosterone levels. This result suggests that circulating testosterone may not have an important role in spermatogenesis. Collectively, our results suggest that melatonin and silymarin are effective therapies against the toxic effects Pb exposure in the male reproductive system.

Modeling the effect of protein and fat on the thermal resistance of Salmonella enterica Enteritidis PT 30 in egg powders.

Microorganisms in low-moisture foods (LMFs) exhibit prolonged survivability and high heat resistance. Various external factors (water, food texture, nutritional compounds, etc.) influence the microbial heat resistance in LMFs; yet, the influential degree of each factor is not fully understood. In this study, the thermal resistance parameters (D and z values) of Salmonella enterica Enteritidis PT 30 (S. Enteritidis) at 80, 85, and 90 °C at the room-temperature water activity (aw, 25°C) of 0.32 ± 0.02 were measured. A series of egg powders with different fat and protein ratios (obtained by mixing egg white and yolk powders) were chosen as the model foods. Primary and secondary models were built from the isothermal inactivation kinetics of S. Enteritidis in the tested samples. The importance of fat and protein was then confirmed by controlling the water activity at the treatment temperature (aw, treatment temperature) via thermal water activity cells. The survivor curves of S. Enteritidis fitted well with the Weibull-type and log-linear models. The D values of S. Enteritidis increased with increasing fat (0-56.7%, w.b.) and decreasing protein contents (83.59-31.81%, w.b.). Incorporating the modified Bigelow model into the log-linear model yielded the zfat and zprotein of 58.96 and 57.14, respectively. At the controlled aw, 90°C of 0.32 ± 0.02, the D90°C values of S. Enteritidis increased remarkably (P < 0.05), but the values in egg white, whole egg, and egg yolk powders (11.73 ± 1.24, 23.82 ± 2.0, and 60.0 ± 2.4 min) were remarkably different. Our study identified that the influential degrees of fat, protein (zfat and zprotein values), and aw on the thermal resistance of S. Enteritidis in egg powders is in the order: aw,treatment temperature > fat > protein. Fat considerably increased the thermal resistance of S. Enteritidis even at the same aw,treatment temperature. This study quantified the effect of fat and protein on the thermal resistance of S. Enteritidis and emphasized the non-negligible effects of food components in LMFs' microbial safety.

Correlation between urinary KIM-1 and kidney protein expression of p-ERK following damage in rats exposed to gentamicin or lead acetate.

Kidney injury molecule-1 (KIM-1) is a membrane receptor upregulated in the proximal tubule cells following various types of kidney injuries. Notably, studies have suggested a correlation between KIM-1 expression and extracellular signal-regulated kinase (ERK) activation. In this study, we aimed to investigate the association between the kidney overexpression pattern of cytoplasmic phosphorylated-ERK (p-ERK) protein and increased urinary KIM-1 levels in rats exposed to gentamicin or lead acetate, both at the end of toxic exposure and after a 4-week recovery period. Although other proteins were evaluated, only kidney overexpression of cytoplasmic p-ERK protein correlated with increased urinary KIM-1 levels. For both toxic substances, the increased urinary KIM-1 levels corresponded with kidney inflammation. Our results suggest that KIM-1 and p-ERK share a common mechanism in kidney injury mediated by both toxic substances that induce proximal tubule damage.

Influence of low water activity on the thermal resistance of Salmonella Enteritidis PT30 and Enterococcus faecium as its surrogate in egg powders.

Egg powders are increasingly popular ingredients, due to their functionality and compactness, in industrial food production and preparation at homes. However, there is a lack of studies that evaluate the thermal resistance of Salmonella Enteritidis PT30 and its potential surrogate Enterococcus faecium NRRL B-2354 in egg powders. This study examined the log-linear relationship between the thermal resistance of Salmonella Enteritidis (D-value) and the water activity (aw) of egg powders. The changes of aw in the egg powders with temperature were measured using a Vapor Sorption Analyzer and a high-temperature cell. The D80 ℃-value of S. Enteritidis PT30 and E. faecium inoculated in the egg powders preconditioned to three aw levels (0.3, 0.45, and 0.6) at 20 ℃ were determined using aluminum thermal death test cells. The aw values increased (P < 0.05) in all three egg powders when the temperature of the samples was raised from room temperature to 80 ℃. The D80 ℃-values ranged from 5.3 ± 0.1 to 25.9 ± 0.2 min for S. Enteritidis while 10.4 ± 0.4 to 43.8 ± 0.4 for E. faecium in samples of the three different aw levels. S. Enteritidis PT30 showed a log-linear relationship between D80 ℃-values and aw80 ℃ for the egg powders. This study contributes to our understanding of the impact of aw on the development of thermal treatments for low-moisture foods.

Artrodesis total de muñeca en paciente con síndrome de Hajdu Cheney: reporte de caso / Total wrist arthrodesis in a patient with Hajdu-Cheney syndrome: a case report

El síndrome de Hajdu-Cheney, es una patología infrecuente caracterizada por alteraciones esqueléticas que se manifiestan con acro-osteolisis y osteoporosis generalizada. Su frecuencia es extremadamente rara y existen escasos reportes en la literatura a nivel mundial. Se presenta un caso de un paciente con colapso avanzado del carpo producto de una no unión de escafoides no tratada. Se describen características clínicas y radiográficas del paciente y la resolución del caso con artrodesis total de muñeca.

Hajdu-Cheney syndrome is an uncommon skeletal disorder characterized by acroosteolysis and generalized osteoporosis. It is an extremely rare condition and few reports have been published in worldwide literature. We present a case of a patient with advanced carpal collapse product of a scaphoid non-union with Hajdu-Cheney syndrome. We describe clinical and radiographic characteristics and resolution of the case with total wrist arthrodesis.

Morphometric study of adipocytes on breast cancer by means of photonic microscopy and image analysis.

Worldwide, breast cancer (BrCa) is currently the leading cause of deaths associated to malignant lesions in adult women. Given that some studies have mentioned that peritumoral adipocytes may contribute to breast carcinogenesis, present work sought to quantitative evaluate the morphometry of these cells in a group of adult women. Three thousand six hundred sixty four breast adipocytes, that came from biopsies of a group of adult females with different types of breast carcinomas (ductal, lobular, and mixed) and one with normal tissues, were evaluated through an image analysis (IA) process regarding six morphometric descriptors: area (A), perimeter (P), Feret diameter (FD ), aspect ratio (AR), roundness factor (RF), and fractal dimension of cellular contour (FDC ). Data showed that the adipocytes of the normal tissues group were bigger (A: 3398 ± 2331 µm2 , P: 239 ± 83 µm, and FD : 79.9 ± 24.5 µm) than those from BrCa samples (A: 2860 ± 1933 µm2 , P: 214 ± 66 µm, and FD : 73.2 ± 22.5 µm), and presented a more irregular contour (FDC of 1.370 ± 0.037 for normal group and of 1.335 ± 0.049 for the oncologic one). Moreover, it could be accounted that adipocytes of mixed carcinomas were largest (FD : 75.1 ± 22.4 µm) than those of lobular lesions (FD : 61.6 ± 22.6 µm), while the adipocytes of ductal carcinomas were the most oval (AR: 1.421 ± 0.524) and roughest (FDC : 1.324 ± 0.050) cells. IA results suggest that BrCa lesions can be categorized through a quantitative morphometric evaluation of peritumoral adipocytes. These findings could let the development of an analytical tool to help the Pathologist to enhance the accuracy of the oncologic diagnose.

Giardia duodenalis in Captive Tigers (Panthera tigris), Palawan Bearcats (Arctictis binturong whitei) and Asian Palm Civet (Paradoxurus hermaphroditus) at a Wildlife Facility in Manila, Philippines.

BACKGROUND: This study was conducted to determine the prevalence of Giardia duodenalis in captive animals in a wildlife facility. This is the first study conducted in these animals from the facility. METHODS: Eight captive tigers (Panthera tigris), two Palawan bearcats (Arctictis binturong whitei) and one Asian Palm Civet (Paradoxurus hermaphroditus) currently housed at a wildlife facility in Manila, Philippines were considered in 2012. These animals were apparently healthy with no signs of disease during the study. Sample collection was done twice at two months interval where freshly voided fecal samples were grossly examined, characterized and preserved in Sodium Acetate Formalin (SAF). The samples were used to determine the presence of G. duodenalis using modified flotation-sedimentation and commercially available immuno-chromatographic assay test kit. RESULTS: All fecal samples tested were negative for the presence of G. duodenalis trophozoites, and cysts using the former. Furthermore, none of the samples tested positive for and G. duodenalis antigen using immune-chromatographic assay. CONCLUSION: There is no existing infection of G. duodenalis among captive tigers, Palawan Bearcats and Asian palm civet housed at the wildlife facility.

High Resolution UHPLC-MS Metabolomics and Sedative-Anxiolytic Effects of Latua pubiflora: A Mystic Plant used by Mapuche Amerindians.

Latua pubiflora (Griseb) Phil. Is a native shrub of the Solanaceae family that grows freely in southern Chile and is employed among Mapuche aboriginals to induce sedative effects and hallucinations in religious or medicine rituals since prehispanic times. In this work, the pentobarbital-induced sleeping test and the elevated plus maze test were employed to test the behavioral effects of extracts of this plant in mice. The psychopharmacological evaluation of L. pubiflora extracts in mice determined that both alkaloid-enriched as well as the non-alkaloid extracts produced an increase of sleeping time and alteration of motor activity in mice at 150 mg/Kg. The alkaloid extract exhibited anxiolytic effects in the elevated plus maze test, which was counteracted by flumazenil. In addition, the alkaloid extract from L. pubiflora decreased [3H]-flunitrazepam binding on rat cortical membranes. In this study we have identified 18 tropane alkaloids (peaks 1-4, 8-13, 15-18, 21, 23, 24, and 28), 8 phenolic acids and related compounds (peaks 5-7, 14, 19, 20, 22, and 29) and 7 flavonoids (peaks 25-27 and 30-33) in extracts of L. pubiflora by UHPLC-PDA-MS which are responsible for the biological activity. This study assessed for the first time the sedative-anxiolytic effects of L. pubiflora in rats besides the high resolution metabolomics analysis including the finding of pharmacologically important tropane alkaloids and glycosylated flavonoids.

GLUCOSA 6 FOSFATO DESHIDROGENASA EN INDÍGENAS PIAROAS EN ZONA ENDÉMICA DE MALARIA / GLUCOSE 6-PHOSPHATE DEHYDROGENASE ON INDIAN PIAROAS IN MALARIA-ENDEMIC AREA

La Glucosa-6-fosfato deshidrogenasa (G6PD) mantiene intactos los grupos sulfidrilos y ayuda en la detoxificación de radicales libres y peróxidos, por tanto, el déficit provoca daño oxidativo irreversible y destrucción de los eritrocitos cuando estos son sometidos a sustancias oxidativas y al estrés. La infección por Plasmodium spp., produce anemia como consecuencia de la ruptura del eritrocito por parte de este parásito, misma que puede verse agravada en personas infectadas con deficiencia de G6PD al ser expuestos a drogas. Estudio de campo y descriptivo en que se determinó por pruebas bioquímicas la actividad enzimática de G6PD en una comunidad de indígenas Piaroa del municipio Atures, estado Amazonas. La muestra estuvo conformada por 186 individuos, 100 mujeres y 86 hombres. La concentración promedio de hemoglobina fue de 10,6 g/dL, 88,6% de los sujetos resultaron con anemia moderada y ninguno presento deficiencia de G6PD. Se concluye que la anemia es común en indígenas Piaroas, de tipo moderada y carencial; que por prueba bioquímicas no se detecta deficiencia de G6PD; y que este estudio provee información útil a los organismos del Estado encargados de administrar los cuidados de la salud en Venezuela.

Glucose-6-phosphate dehydrogenase (G6PD) remains intact sulfhydryl groups and assist in the detoxification of free radicals and peroxides, therefore deficit irreversible oxidative damage and destruction of the erythrocyte when these are subjected to oxidative substances and stress. Plasmodium spp. infection causes anemia as a result of the rupture of the erythrocyte by this parasite, it can be aggravated in people infected with G6PD deficiency when exposed to drugs. Descriptive field study in which the enzymatic activity of G6PD in an indigenous community of Piaroa municipality of Atures, Amazonas state, was determined by biochemical tests. The sample consisted of 186 individuals, 100 women and 86 men. The average concentration of hemoglobin was 10.6 g/dL, 88, 6% of the subjects were moderately anemic and none had G6PD deficiency. It is concluded that anemia is common in indigenous Piaroas, moderate and deficiency type; no biochemical test that G6PD deficiency is detected; and that this study provides useful information to state agencies responsible for administering health care in Venezuela information.

Espectro de neuromielitis óptica en Colombia, primera caracterización clínico imagenológica en tres centros de Bogotá / Spectrum of optic neuromyelitis in colombia, first characterization clinical and radiological in three centers of Bogotá

Introducción: La neuromielitis óptica, es un síndrome clínico caracterizado por la asociación de mielitis transversa y neuritis óptica, hoy en día es reconocida como una enfermedad cuya fisiopatología, clínica, hallazgos en imágenes diagnósticas de laboratorio y tratamiento son específicos. Objetivo: describir las características clínicas, métodos diagnósticos y tratamiento de los pacientes con neuromielitis óptica (NMO) en tres centros asistenciales de cuarto nivel de la ciudad de Bogotá. Materiales y métodos: Diseño: se realizó un estudio de tipo serie de casos. Participantes: se incluyeron casos consecutivos de pacientes de cualquier género, entre los 19 y los 48 años, clasificados en dos grupos según los criterios del Consenso Internacional para el Diagnóstico de Neuromielitis óptica 2015, NMOSD con AQP4-IgG positivos, y NMOSD con AQP4-IgG negativos. Los pacientes fueron reclutados en tres centros hospitalarios, desde junio de 2013 a mayo de 2015. Análisis estadístico: la descripción de las variables se realizó por frecuencias absolutas y relativas, los análisis se realizaron en el paquete estadístico STATA 13®. Resultados: participaron 22 pacientes, con una edad mediana de 36 años, la mayoría mujeres, la mediana de inicio de síntomas fue de 31 años (RIC 24-39). La técnica para el diagnóstico más utilizada fue IFI, la clínica más frecuente del evento inicial fue mielitis y de neuritis óptica en las recaídas posteriores, la mitad de los pacientes presentaron dos o menos eventos, ningún paciente cumplió criterios para otra enfermedad sistémica. Se observaron escalas de discapacidad mas altas en el grupo con AQP4 positivos, y mas bajas en los que recibieron corticoide al inicio. Discusión y conclusiones: esta caracterización constituye la primera descripción de esta enfermedad en Colombia, nuestros hallazgos son similares a los obtenidos en otras poblaciones, algunos datos relevantes requieren más estudios.

Introducción: Optic neuromyelitis, a clinical syndrome characterized by the association of transverse myelitis and optic neuritis, is nowadays recognized as a disease whose pathophysiology, clinical features, and diagnostic and laboratory imaging findings are specific. Objective: To describe the clinical characteristics, diagnostic methods and treatment of patients with neuromyelitis Optica (NMO) in three health centers fourth level of the City of Bogota. Materials and method: Design: A case series type was performed. Participants: consecutive cases of patients of either gender were included between 19 and 48 years, divided into two groups according to the International Consensus criteria for the diagnosis of NMO 2015, NMOSD with AQP4-IgG positive, and NMOSD with AQP4- IgG negative. Patients were recruited from three hospitals from June 2013 to May 2015. Statistical analysis: The description of the variables was performed by absolute and relative frequencies, analyzes were performed in STATA statistical package 13®. Results: A total of 22 patients with a median age of 36, mostly women, median onset was 31 years (IQR 24-39). The technique most commonly used for diagnosis was IFI, the most frequent initial clinical event was myelitis and optic neuritis in subsequent relapses, half of the patients had two or fewer events, no patients met criteria for other systemic disease. higher disability scales were observed in the group with positive AQP4, and lower in those receiving corticosteroids at baseline. Discussion and conclusions: This characterization is the first description of this disease in Colombia, our findings are similar to those obtained in other populations, some relevant data require further study.

Esclerosis múltiple y embarazo / Multiple sclerosis and pregnancy

La esclerosis múltiple es una enfermedad neurodegenerativa común en poblaciones jóvenes en edad reproductiva; el embarazo ha sido motivo de controversia, dada la necesidad de manejo farmacológico, el riesgo de recaídas y la discapacidad resultante. Los estudios son escasos, aunque la mayoría aporta datos confiables.Objetivos: Ofrecer al médico una adecuada orientación preconcepcional y durante el embarazo en pacientes con esta enfermedad, así como una adecuada información acerca del uso de medicamentos y sus efectos a corto y largo plazo, tanto en la madre como en el feto.Materiales y métodos: Para la revisión de la literatura se estructuró una estrategia de búsqueda utilizando los términos embarazo, esclerosis múltiple, tratamientos inmunomoduladores y efectos teratogénicos (MeSH y no MeSH), los cuales se articularon con operadores booleanos en las siguientes bases de datos: Pubmed, Ebscohost y Embase, filtrando los resultados por artículos de revisión.Discusión: Se analizan el efecto protector del embarazo en esclerosis múltiple y la administración de vitamina D.Conclusión: Aunque no hay evidencia suficiente sobre el efecto nocivo del tratamiento en el recién nacido, se recomienda suspenderlo.

Multiple sclerosis is a neurodegenerative disease commonly affecting young adults of fertile age. Pregnancy has been a subject of controversy given that pharmacological management is required, there is a risk of relapses, and it may be disabling. Studies on the topic are scarce, although most of them report reliable data.Objective: To provide the physician with adequate preconception and pregnancy care guidelines for this disease, as well as, adequate information about medications and their effects in the short and long-term, for the mother and the foetus.Materials and methods: A search strategy was created for reviewing the literature, using the terms, pregnancy, multiple sclerosis, immunomodulatory therapies and teratogenic effects (MeSH and not MeSH), which were articulated with Boolean operators in the following databases: Pubmed, Ebscohost and Embase, filtering the results by review article.Discussion: The protective effects of pregnancy on multiple sclerosis were evaluated, as well as, vitamin D administration.Conclusion: Although there is not enough evidence on the harmful effects of treatment on the newborn, discontinuing the treatment is recommended.

Síndrome de apnea hipoapnea obstructiva del sueño en paciente con accidente cerebrovascular isqueémico / Obstructive sleep apnea hypoapnea syndrome in patients with ischemic cerebrovascular accident

El síndrome de apnea hipoapnea obstructiva del sueño es considerado factor de riesgo para accidente cerebrovascular, que es a nivel mundial la segunda causa de muerte y primera de discapacidad. Objetivo: describir la prevalencia de sospecha de SAHOS por escala Epwhort y aumento de circunferencia cervical en pacientes con ACV isquémico en los hospitales de San José e Infantil Universitario de San José, de Bogotá DC, de octubre 2013 a septiembre 30 de 2014. Metodología: estudio descriptivo de corte transversal con población elegida con diagnóstico de ACV isquémico. Resultados: 125 pacientes con edad promedio de 69 años (DE 15.0) y relación hombre/mujer 1:1. Antecedente de SAHOS 1.6% (n: 2). Por Epworth 57% (n: 63/109) tenian sospecha de SAHOS, hombres 60,3%(n: 35). La mediana para Epworth fue 10 (RIQ 7-12). Circunferencia cervical >43 cm en hombres 8,6% (n:5) y en mujeres >40 cm en 28% (n:14). El 30% (19/62) de ACV tenía sospecha de SAHOS por Epworth y circunferencia cervical. Los hombres con Epworth (8-15), tenían circunferencia cervical aumentada 14% (5/35) y las mujeres 51,9% (14/27). La mortalidad intrahospitalaria fue 9,7% (n:12). Conclusión: se encontró que más de la mitad tenía sospecha de SAHOS leve por Epworth. Hubo mayor prevalencia de obesidad cervical en mujeres y una tercera parte tenían sospecha de SAHOS por ambos criterios, lo cual confirma la importancia de explorar de rutina estos indicadores...

Obstructive sleep apnea hypoapnea syndrome is considered a risk factor for cerebrovascular accident which is the second cause of death and leading cause of disability worldwide. Objective: to describe suspicion prevalence of OSAHS estimated by the Epworth score and increase of neck circumference in patients with ischemic CVA at San José and Infantil Universitario de San José hospitals, Bogotá DC, from October 2013 and September 30 2014. Methodology: cross sectional descriptive study including a population diagnosed with ischemic CVA. Results: 125 patients with mean age 69 years (SD 15.0) and male/female ratio of 1:1. History of OSAHS in 1.6% (n: 2). By Epworth score, 57% (n: 63/109) had suspicion of OSAHS, 60.3% (n: 35) corresponded to men. The media for Epworth score was 10 (RIQ 7-12). Neck circumference, >43 cm in men 8.6% (n: 5) and women >40 cm in 28% (n: 14). OSAHS was suspected in 30% of CVAs (19/62) by Epworth score and neck circumference. Men with Epworth score (8-15), had an increased neck circumference 14% (5/35) and women 51.9% (14/27). In-hospital mortality was 9.7% (n: 12). Conclusion: we found that mild SOAHS estimated by Epworth score was suspected in more than half the patients. There was a higher prevalence of neck obesity in women and OSAHS was suspected in one third of them by both criteria, which confirms the importance of routinely exploring these indicators...

Leucoencefalopatía multifocal progresiva asociada al uso de Natalizumab en un paciente con esclerosis múltiple. Primer caso en Latinoamérica. Hospital de San José - Bogotá 2013 / Progressive Multifocal Leukoencephalopathy associated with the use of Natalizumab in Patient with Multiple Sclerosis. First Case Report in Latin America Hospital de San Jose - Bogota, 2013

La Leucoencefalopatía Multifocal Progresiva (LMP) es una condición grave secundaria a la infección por virusJohn Cunningham (VJC) derivada de la deficiencia de inmunidad celular innata o adquirida. Se presenta el primercaso reportado en Latinoamérica de (LMP) asociada a Natalizumab (NZB) en un paciente con diagnóstico deesclerosis múltiple recaída-remisión, quien ingresa a urgencias con cuadro clínico de deterioro cognoscitivo,comportamental, motor y de lenguaje de curso progresivo. Se realizaron neuroimágenes con resonancia magnéticacerebral sugestivas de LMP, estudios de reacción en cadena de polimerasa en líquido cefalorraquídeopara virus JC, que resultaron negativos en dos oportunidades; el diagnóstico se confirmó mediante la técnica dehibridación in situ en biopsia cerebral. Se realiza este reporte con el fin de resaltar la importancia de la vigilanciaclínica y paraclínica en los pacientes con esclerosis múltiple que reciben NZB...

Progressive Multifocal Leukoencephalopathy (PML) is a serious condition secondary to John Cunninghamvirus (JCV) infection derived from an innate or acquired cellular immunity deficiency. We present the firstreported case in Latin America of PML associated with Natalizumab (NZB) in a patient with a diagnostic ofrelapsing – remitting multiple sclerosis, who entered the emergency room with progressive cognitive, behavioral,motor and language impairment. Neuroimaging performed with magnetic resonance imaging was suggestiveof PML. Polymerase chain reactions in cerebrospinal fluid for JC virus were conducted twice with negativeresults. Finally the diagnosis was confirmed by in situ hybridization technique on brain biopsy. This reportis made in order to highlight the importance of clinical and paraclinical monitoring in patients with multiplesclerosis receiving NZB...

[Vitamin D nutrition in Chilean pre-school children living in extreme latitudes]. / Estado nutricional de vitamina D en pre escolares chilenos de zonas australes.

BACKGROUND: Sunlight exposure is the main factor for adequate vitamin D (VitD) nutrition; in extreme latitudes there is an increased risk for its deficiency. AIM: To study VitD nutritional status in pre-school children living in austral latitudes of Chile. SUBJECTS AND METHODS: A blood sample was obtained from 60 pre-school healthy children (aged 2 to 5 years, 24 males), attending to public day-care centers in Coyhaique (45° 35' S), during March (time 1) and September (time 2). 250 HD, parathyroid hormone (PTH), calcium, phosphate and alkaline phosphatases (PA) were measured. Information about weather conditions during three months prior to the sample withdrawal was gathered. RESULTS: Forty nine percent of children had a normal weight and 11% were overweight. Vive children with unreliable 250 HD levels were excluded from analysis. At time 1, 250 HD levels were 21.6 ± 14.5 ngl mh (7.9-71.1). Sixty four percent of children had valúes < 20 ng/mL (deficiency). At time 2, the figures were 21.5 ± 13.2 ng/mL (9.4-68.5) and 67.3% of children were deficient. PTH, serum calcium, phosphate and PA were normal. Prior to time 1, the UVradiation Índex (UVI) was high to extreme (91.3%), with 3.3 and 73% of sunny and cloudy days, respectively. Mean minimal and maximal temperatures were 7 and 17.3°C respectively. Prior to time 2 the IUVwas low in 100%) of days; with 15.2 and 60.9 of sunny and cloudy days, respectively. Mean minimal and maximal temperatures were 0.3 and 6.7°C respectively. No association of 250 HD with the other metabolicparameters was found. CONCLUSIONS: Chilean pre-school children living in austral latitudes have a high rate of vitamin D deficiency, throughout the year, with no association with PTH, calcium, phosphate or PA. Further research is required to study vitamin D deficiency in other latitudes and magnitude of sunlight exposure.

Estado nutricional de vitamina D en pre escolares chilenos de zonas australes / Vitamin D nutrition in Chilean pre-school children living in extreme latitudes

Background: Sunlight exposure is the main factor for adequate vitamin D (VitD) nutrition; in extreme latitudes there is an increased riskfor its deficiency. Aim: To study VitD nutritional status in pre-school children living in austral latitudes of Chile. Subjects and Methods: A blood sample was obtained from 60 pre-school healthy children (aged 2 to 5years, 24 males), attending to public day-care centers in Coyhaique (45° 35' S), during March (time 1) and September (time 2). 250HD, parathyroid hormone (PTH), calcium, phosphate and alkaline phosphatases (PA) were measured. Information about weather conditions during three months prior to the sample withdrawal was gathered. Results: Forty nine percent of children had a normal weight and 11% were overweight. Vive children with unreliable 250HD levels were excluded from analysis. At time 1, 250HD levels were 21.6 ± 14.5 ngl mh (7.9-71.1). Sixty four percent of children had valúes < 20 ng/mL (deficiency). At time 2, the figures were 21.5 ± 13.2 ng/mL (9.4-68.5) and 67.3% of children were deficient. PTH, serum calcium, phosphate and PA were normal. Prior to time 1, the UVradiation Índex (UVI) was high to extreme (91.3%), with 3.3 and 73% ofsunny and cloudy days, respectively. Mean minimal and maximal temperatures were 7 and 17.3°C respectively. Prior to time 2 the IUVwas low in 100%) ofdays; with 15.2 and 60.9 ofsunny and cloudy days, respectively. Mean minimal and maximal temperatures were 0.3 and 6.7°C respectively. No association of250HD with the other metabolicparameters was found. Conclusions: Chilean pre-school children living in austral latitudes have a high rate of vitamin D deficiency, throughout theyear, with no association with PTH, calcium, phosphate or PA. Further research is required to study vitamin D deficiency in other latitudes and magnitude of sunlight exposure.

[Acetabular reconstruction in revision arthroplasty. Retrospective study of 76 cases. Hospital Español de México]. / Reconstrucción acetabular en la artroplastía de revisión. Estudio retrospectivo de 76 casos. Hospital Español de México.

OBJECTIVE: To review our experience with the various acetabular reconstruction techniques used during revision arthroplasty based on the defect in each patient. MATERIAL AND METHODS: We undertook a retrospective, descriptive, observational study of patients who underwent acetabular reconstruction during revision ar. throplasty, from January 1997 to January 2005. We documented the type of acetabular defect, the type of cup and graft used, the complications, and the pre- and postoperative assessment with the Harris scale. Data were analyzed with the SPSS software and the Wilcoxon test (p < 0.05). RESULTS: Seventy-six patients underwent surgery. Mean time elapsed between the primary replacement and the revision was 5 years. The acetabular defects found were: 16 type I, 22 type II, 30 type IIIA, and 8 type IIIB. The mean Harris score was 44 preoperatively and 76 postoperatively. The most frequently used technique involved the use of an autograft, a structural allograft with a porous threaded cup or a reinforcement ring. The most common complications included dislocation 5%, infection 3%, graft loss and cup loosening 21%, and loss of the hip center of rotation 15% (p < 0.05). CONCLUSIONS: Acetabular reconstruction is technically challenging and involves high failure and complication rates, thus providing little improvement in patient activity. It is important to restore the hip center of rotation to improve function. The reconstruction techniques we used are the most common ones and are described in the literature.