[Usefulness of test strips for early diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites]. / Utilidad de las tiras reactivas para el diagnóstico temprano de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis.

INTRODUCTION: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. OBJECTIVE: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. MATERIALS AND METHODS: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). RESULTS: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. CONCLUSIONS: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.

[Bronchobiliary fistula. Report of a case]. / Fístula biliopleurobronquial: reporte de un caso.

Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract.

Magnetic Biochar Obtained by Chemical Coprecipitation and Pyrolysis of Corn Cob Residues: Characterization and Methylene Blue Adsorption.

Biochar is a carbonaceous and porous material with limited adsorption capacity, which increases by modifying its surface. Many of the biochars modified with magnetic nanoparticles reported previously were obtained in two steps: first, the biomass was pyrolyzed, and then the modification was performed. In this research, a biochar with Fe3O4 particles was obtained during the pyrolysis process. Corn cob residues were used to obtain the biochar (i.e., BCM) and the magnetic one (i.e., BCMFe). The BCMFe biochar was synthesized by a chemical coprecipitation technique prior to the pyrolysis process. The biochars obtained were characterized to determine their physicochemical, surface, and structural properties. The characterization revealed a porous surface with a 1013.52 m2/g area for BCM and 903.67 m2/g for BCMFe. The pores were uniformly distributed, as observed in SEM images. BCMFe showed Fe3O4 particles on the surface with a spherical shape and a uniform distribution. According to FTIR analysis, the functional groups formed on the surface were aliphatic and carbonyl functional groups. Ash content in the biochar was 4.0% in BCM and 8.0% in BCMFe; the difference corresponded to the presence of inorganic elements. The TGA showed that BCM lost 93.8 wt% while BCMFe was more thermally stable due to the inorganic species on the biochar surface, with a weight loss of 78.6%. Both biochars were tested as adsorbent materials for methylene blue. BCM and BCMFe obtained a maximum adsorption capacity (qm) of 23.17 mg/g and 39.66 mg/g, respectively. The obtained biochars are promising materials for the efficient removal of organic pollutants.

Exposure to Atmospheric Ozone Disruption and Altitude Over 3500 m.a.s.l. are Associated with a Higher Prevalence of Photodermatoses in Pediatric Population of High-Altitude in Peru.

Objective: To determine if exposure to atmospheric ozone disruption and other factors are associated with photodermatoses in the high-altitude pediatric population in Peru. Materials and Methods: A cross-sectional study based on data obtained from studies of dermatological diseases among the population exposed to mine tailings in Peru which included children under the age of 18 in 6 population centers located over 2500 meters above sea level (m.a.s.l). We evaluated the presence of photodermatoses and possible associated factors obtaining the adjusted odds ratio (aOR) and confidence intervals (CI). Results: 594 children below the age of 18 participated in this study, 53.0% girls, the average age was 10.4 ± 4.1 years. 51.3% were exposed to a mini hole in the ozone layer, 60.1% resided at an altitude over 3500 m.a.s.l and 51.9% presented cutaneous manifestations of atopy upon physical examination. The prevalence of photodermatoses was 64.8%, of which the most frequent were actinic prurigo (49.3%), pityriasis alba (18.5%) and actinic cheilitis (4.4%). The multivariate analysis found that residing in a region exposed to the mini hole in the ozone layer (aOR = 4.23; CI 95%: 2.32-7.72) and residing at an altitude over 3500 m.a.s.l (aOR = 2.76; CI 95%: 1.57-4.86) were both independent associated factors to photodermatoses. Conclusion: A high prevalence of photodermatoses exists among the pediatric population living at high-altitude in Peru. Residing in a region exposed to a mini hole in the ozone layer and residing over 3500 m.a.s.l constituted associated factors.

Surface modification of activated carbon cloth with calcium silicate and hydroxyapatite: bioactive composite material.

In this study new compounds consisting of activated carbon cloths (ACC) modified with calcium silicate (CaSiO3) were prepared for hydroxyapatite (HAP) generation. ACC samples were oxidized with 8 M HNO3 at different times (15 min and 2 h), to increase oxygenated functional groups. The CaSiO3 fine powders were prepared by chemical coprecipitation using Ca(NO3)2∙4H2O and Si(OC2H5)4, and 5 M NaOH was used as precipitant. The resulting powders were mixed with ethanol by ultrasound stirring and the previously oxidized activated carbon fibers were placed leaving under stirring for 30 min to allow particle dispersion. Once the formed compounds were dried, the samples were immersed in a simulated body fluid (SBF) solution for 21 days in conical tubes at 36.5 °C to allow the HAP formation on the ACC/CaSiO3 composite surface. The results indicated that the increase in oxidation time improves HAP formation on the surface from ACC/CaSiO3 compounds and this bioactive composite may be a potential material for bone regeneration.

A Brain-Permeable Aminosterol Regulates Cell Membranes to Mitigate the Toxicity of Diverse Pore-Forming Agents.

The molecular composition of the plasma membrane plays a key role in mediating the susceptibility of cells to perturbations induced by toxic molecules. The pharmacological regulation of the properties of the cell membrane has therefore the potential to enhance cellular resilience to a wide variety of chemical and biological compounds. In this study, we investigate the ability of claramine, a blood-brain barrier permeable small molecule in the aminosterol class, to neutralize the toxicity of acute biological threat agents, including melittin from honeybee venom and α-hemolysin from Staphylococcus aureus. Our results show that claramine neutralizes the toxicity of these pore-forming agents by preventing their interactions with cell membranes without perturbing their structures in a detectable manner. We thus demonstrate that the exogenous administration of an aminosterol can tune the properties of lipid membranes and protect cells from diverse biotoxins, including not just misfolded protein oligomers as previously shown but also biological protein-based toxins. Our results indicate that the investigation of regulators of the physicochemical properties of cell membranes offers novel opportunities to develop countermeasures against an extensive set of cytotoxic effects associated with cell membrane disruption.

New Advances in the Determination of Free and Bound Phenolic Compounds of Banana Passion Fruit Pulp (Passiflora tripartita, var. Mollissima (Kunth) L.H. Bailey) and Their In Vitro Antioxidant and Hypoglycemic Capacities.

Banana passion fruit (Passiflora tripartite L.H. Bailey) is a lesser known species of the genus Passiflora. This fruit typically grows in the Andean region of Ecuador and it is locally known as tumbo, taxo or curuba. The juice of this fruit is highly appreciated in South America. Extracts of banana passion fruit were characterized for their content levels of free and bound phenolic compounds by high performance liquid chromatography coupled to high resolution mass spectrometry detector (HPLC-ESI-TOF-MS). A total of 82 polar compounds classified as phenolic acid derivatives, organic acids, benzophenones, flavan-3-ols, flavonols and flavones were detected in the extracts. The total phenolic content was 2356 mg 100 g-1 dry matter, with the bound phenolic fraction representing 37.7% of total amounts. Flavan-3-ols, such as (epi)catechin, (epi)azfelechin and their derivatives, were the main phenolic compounds in the free phenolic fraction; however, phenolic acids represented the most abundant class of bound phenolic extracts. The antioxidant and hypoglycemic capacities reported for banana passion fruit were higher than for other fruits. To our knowledge, this is the first time that bound phenolic compounds have been described in banana passion fruit pulp.

Utilidad de las tiras reactivas para el diagnóstico temprano de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis / Usefulness of test strips for early diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites

Introducción: La peritonitis bacteriana espontánea requiere un diagnóstico temprano para el inicio de antibioticoterapia. El estudio diagnóstico ideal es el citoquímico del líquido ascítico, el cual puede ser costoso, demorado y de disponibilidad limitada en centros primarios de atención en salud. Objetivo: Evaluar la utilidad y precisión diagnóstica de las tiras reactivas Multistix 10SG para el diagnóstico de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis. Materiales y métodos: Estudio observacional descriptivo de prueba diagnóstica en pacientes cirróticos con ascitis. Se determinó el conteo de leucocitos del líquido ascítico por la escala colorimétrica de la tira reactiva Multistix 10SG y se comparó con el gold standard para el diagnóstico (polimorfonucleares ≥ 250 células/mm³). Resultados: De 174 pacientes con ascitis (51,7% mujeres, promedio de edad 59 años) 30 fueron diagnosticados con peritonitis bacteriana espontánea. Con un punto de corte grado ++, la tira reactiva tuvo sensibilidad 73,3%, especificidad 96,5%, valor predictivo positivo 81,4%, valor predictivo negativo 94,5%, razón de probabilidad positiva 21,2 y razón de probabilidad negativa 0,27. Conclusiones: Las tiras reactivas tienen adecuada especificidad y valor predictivo negativo, siendo una herramienta de bajo costo, uso sencillo, rápida interpretación y fácil acceso, para apoyar la decisión de no iniciar antibiótico en pacientes con ascitis y sospecha de peritonitis bacteriana espontánea. Por su baja sensibilidad no reemplazan al estudio citoquímico como prueba de elección para el diagnóstico definitivo, pero si es útil para optimizar el abordaje inicial de estos pacientes.

Introduction: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. Objective: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Materials and methods: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). Results: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. Conclusions: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.

Guidance on the use of handheld survey meters for radiological triage: time-dependent detector count rates corresponding to 50, 250, and 500 mSV effective dose for adult males and adult females.

In June 2006, the Radiation Studies Branch of the Centers for Disease Control and Prevention held a workshop to explore rapid methods of facilitating radiological triage of large numbers of potentially contaminated individuals following detonation of a radiological dispersal device. Two options were discussed. The first was the use of traditional gamma cameras in nuclear medicine departments operated as makeshift wholebody counters. Guidance on this approach is currently available from the CDC. This approach would be feasible if a manageable number of individuals were involved, transportation to the relevant hospitals was quickly provided, and the medical staff at each facility had been previously trained in this non-traditional use of their radiopharmaceutical imaging devices. If, however,substantially larger numbers of individuals (100's to 1,000's) needed radiological screening, other options must be given to first responders, first receivers, and health physicists providing medical management. In this study, the second option of the workshop was investigated--the use of commercially available portable survey meters (either NaI or GM based) for assessing potential ranges of effective dose (< 50, 50-250, 250-500,and >500 mSv). Two hybrid computational phantoms were used to model an adult male and an adult female subject internally contaminated with 241Am, 60Cs, 137Cs, 131I, or 192Ir following an acute inhalation or ingestion intake. As a function of time following the exposure, the net count rates corresponding to committed effective doses of 50, 250, and 500 mSv were estimated via Monte Carlo radiation transport simulation for each of four different detector types, positions, and screening distances.Measured net count rates can be compared to these values, and an assignment of one of four possible effective dose ranges could be made. The method implicitly assumes that all external contamination has been removed prior to screening and that the measurements be conducted in a low background, and possibly mobile, facility positioned at the triage location. Net count rate data are provided in both tabular and graphical format within a series of eight handbooks available at the CDC website (http://www.bt.cdc.gov/radiation/clinicians/evaluation).

Hybrid computational phantoms representing the reference adult male and adult female: construction and applications for retrospective dosimetry.

Currently, two classes of computational phantoms have been developed for dosimetry calculation: (1) stylized (or mathematical) and (2) voxel (or tomographic) phantoms describing human anatomy through mathematical surface equations and 3D voxel matrices, respectively. Mathematical surface equations in stylized phantoms are flexible, but the resulting anatomy is not as realistic. Voxel phantoms display far better anatomical realism, but they are limited in terms of their ability to alter organ shape, position, and depth, as well as body posture. A new class of computational phantoms called hybrid phantoms takes advantage of the best features of stylized and voxel phantoms-flexibility and anatomical realism, respectively. In the current study, hybrid computational phantoms representing the adult male and female reference anatomy and anthropometry are presented. These phantoms serve as the starting framework for creating patient or worker sculpted whole-body phantoms for retrospective dose reconstruction. Contours of major organs and tissues were converted or segmented from computed tomography images of a 36-y-old Korean volunteer and a 25-y-old U.S. female patient, respectively, with supplemental high-resolution CT images of the cranium. Polygon mesh models for the major organs and tissues were reconstructed and imported into Rhinoceros™ for non-uniform rational B-spline (NURBS) surface modeling. The resulting NURBS/polygon mesh models representing body contour and internal anatomy were matched to anthropometric data and reference organ mass data provided by Centers for Disease Control and Prevention and International Commission on Radiation Protection, respectively. Finally, two hybrid adult male and female phantoms were completed where a total of eight anthropometric data categories were matched to standard values within 4% and organ volumes matched to ICRP data within 1% with the exception of total skin. The hybrid phantoms were voxelized from the NURBS phantoms at resolutions of 0.158 × 0.158 × 0.158 cm and 0.126 × 0.126 × 0.126 cm for the male and female, respectively. To highlight the flexibility of the hybrid phantoms, graphical displays are given of (1) underweight and overweight adult male phantoms, (2) a sitting position for the adult female phantom, and (3) extraction and higher-resolution voxelization of the small intestine for localized dosimetry of mucosal and stem cell layers. These phantoms are used to model radioactively contaminated individuals and to then assess time-dependent detector count rate thresholds corresponding to 50, 250, and 500 mSv effective dose, as might be needed during in-field radiological triage by first responders or first receivers.