A novel experimental immunomodulatory therapy against Nocardia brasiliensis in a BALB/c murine model.

BACKGROUND: Mycetoma is recognized as a neglected tropical disease and there are still therapeutic challenges, especially in cases recalcitrant to standard therapy or with high risk of dissemination. Subcultures have been used previously to decrease the virulence of human pathogens. Previous reports have demonstrated that after carrying out 200 subcultures of Nocardia brasiliensis, a decrease in virulence was observed. AIM: To evaluate the effect of attenuated N. brasiliensis strains on the development of lesions in an established mycetoma infection. METHODS: Female 8-12-week-old BALB/c mice were injected with N. brasiliensis suspension to establish a mycetoma. Sixty mice were selected and divided into three groups: two of these groups were inoculated in the dorsum with N. brasiliensis subcultured 200 and 400 times, respectively, while the third group served as control. The thickness of each lesion was measured with calipers every week for 12 weeks. RESULTS: After 12 weeks, we observed that inoculation of 1 × 105 colony-forming units of attenuated N. brasiliensis strains was able to modify the natural history of the infection, with a decrease in the size of the lesions, particularly with P400, compared with the control group (P < 0.01). CONCLUSION: In this experimental evaluation of an immunomodulatory therapy with attenuated N. brasiliensis strains in a murine model, there was a greater stability in the size of the lesion over time in BALB/c mice inoculated with the P400 strain. This treatment could open the possibility of using the attenuated strain as immunomodulatory therapy in patients recalcitrant to standard therapy, with high risk of dissemination or who develop drug-related adverse effects.

Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry. / Estrategia invasiva de rutina en el síndrome coronario agudo sin elevación del segmento ST con disfunción renal. Resultados del registro ARIAM-SEMICYUC.

OBJECTIVE: To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. METHODS: A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. RESULTS: A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding). CONCLUSIONS: The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.

Determination of minimal erythema dose and anomalous reactions to UVA radiation by skin phototype.

BACKGROUND: Phototesting is a technique that assesses the skin's sensitivity to UV radiation by determining the smallest dose of radiation capable of inducing erythema (minimal erythema dose [MED]) and anomalous responses to UV-A radiation. No phototesting protocol guidelines have been published to date. METHODOLOGY: This was a multicenter prospective cohort study in which 232 healthy volunteers were recruited at 9 hospitals. Phototests were carried out with solar simulators or fluorescent broadband UV-B lamps. Each individual received a total of 5 or 6 incremental doses of erythemal radiation and 4 doses of UV-A radiation. The results were read at 24hours. RESULTS: At hospitals where solar simulators were used, the mean (SD) MED values were 23 (8), 28 (4), 35 (4), and 51 (6) mJ/cm(2) for skin phototypes i to iv, respectively. At hospitals where broadband UV-B lamps were used, these values were 28 (5), 32 (3), and 34 (5) mJ/cm(2) for phototypes ii to iv, respectively. MED values lower than 7, 19, 27, and 38 mJ/cm(2) obtained with solar simulators were considered to indicate a pathologic response for phototypes I to IV, respectively. MED values lower than 18, 24, and 24mJ/cm(2) obtained with broadband UV-B lamps were considered to indicate a pathologic response for phototypes ii to iv, respectively. No anomalous responses were observed at UV-A radiation doses of up to 20J/cm(2). CONCLUSIONS: Results were homogeneous across centers, making it possible to standardize diagnostic phototesting for the various skin phototypes and establish threshold doses that define anomalous responses to UV radiation.

Modelling of the UV Index on vertical and 40° tilted planes for different orientations.

In this study, estimated data of the UV Index on vertical planes are presented for the latitude of Valencia, Spain. For that purpose, the UVER values have been generated on vertical planes by means of four different geometrical models a) isotropic, b) Perez, c) Gueymard, d) Muneer, based on values of the global horizontal UVER and the diffuse horizontal UVER, measured experimentally. The UVER values, obtained by any model, overestimate the experimental values for all orientations, with the exception of the Perez model for the East plane. The results show statistical values of the MAD parameter (Mean Absolute Deviation) between 10% and 25%, the Perez model being the one that obtained a lower MAD for all levels. As for the statistic RMSD parameter (Root Mean Square Deviation), the results show values between 17% and 32%, and again the Perez model provides the best results in all vertical planes. The difference between the estimated UV Index and the experimental UV Index, for vertical and 40° tilted planes, was also calculated. 40° is an angle close to the latitude of Burjassot, Valencia, (39.5°), which, according to various studies, is the optimum angle to capture maximum radiation on tilted planes. We conclude that the models provide a good estimate of the UV Index, as they coincide or differ in one unit compared to the experimental values in 99% of cases, and this is valid for all orientations. Finally, we examined the relation between the UV Index on vertical and 40° tilted planes, both the experimental and estimated by the Perez model, and the experimental UV Index on a horizontal plane at 12 GMT. Based on the results, we can conclude that it is possible to estimate with a good approximation the UV Index on vertical and 40° tilted planes in different directions on the basis of the experimental horizontal UVI value, thus justifying the interest of this study.

Remission of minimal change disease in Type 2 diabetes after streptococcus bacteremia.

A 41-year-old man with Type 2 diabetes developed sudden onset of nephrotic syndrome. He initially refused a renal biopsy. However, 3 months later, the nephrotic syndrome persisted and percutaneous renal biopsy was performed. The study with light microscopy, immunofluorescence and electron microscopy showed minimal change disease. Three weeks after biopsy, before immunosuppressive therapy was begun, the patient presented Group A Streptococcus (GAS) bacteremia and acute renal failure which needed hemodialysis. Afterwards, the renal function recovered and complete remission of the nephrotic syndrome, maintained during a 22-month follow-up, was observed. We discuss the possible mechanisms implicated in the remission. This report extends the spectrum of infections associated with remission of minimal change disease (MCD).

[Virtual reality and dementia]. / Realidad virtual y demencia.

INTRODUCTION: Virtual reality technology was first used in the treatment of psychological disorders in 1994. Since then, its application has aroused the interest of clinicians and researchers, and it has become a potential tool for use in psychological evaluation and neurorehabilitation. AIM: To review the different studies that have been published on the treatment of dementias in which virtual reality has been used, with the aim of evaluating its efficacy. DEVELOPMENT: A search was conducted over the last 10 years (2007-2017) in different databases (PubMed, PsycINFO and Dialnet), as well as in Google Scholar. Few studies were found and, judging by the results that were obtained, they cannot be said to be conclusive, although they do offer certain evidence suggesting that virtual reality is a promising field for intervention in persons with dementia. CONCLUSIONS: Virtual reality is a growing and very promising area for psychological intervention in general, and more particularly for the treatment of dementia. It seems to enjoy a very favourable acceptance among persons suffering from dementia. Nevertheless, it is important to understand the new technologies as a tool rather than as a substitute for the therapist. Likewise, there is a need for more rigorous and systematic research that determines the efficacy of this kind of intervention.

TITLE: Realidad virtual y demencia.Introduccion. La utilizacion de la tecnologia de realidad virtual para el tratamiento de trastornos psicologicos se llevo a cabo por primera vez en 1994. Desde entonces, su uso ha despertado el interes de clinicos e investigadores y se ha convertido en una potencial herramienta destinada a la evaluacion y neurorrehabilitacion psicologicas. Objetivo. Revisar las diferentes investigaciones existentes para el tratamiento de las demencias en las que se ha utilizado realidad virtual, con la finalidad de evaluar su eficacia. Desarrollo. Se ha realizado una busqueda de los ultimos 10 años (2007-2017) en diferentes bases de datos (PubMed, PsycINFO y Dialnet), y tambien en Google Scholar. Las investigaciones encontradas son escasas y, por los resultados obtenidos, no puede decirse que sean concluyentes, si bien aportan ciertas evidencias que sugieren que la realidad virtual es un campo prometedor para la intervencion en las personas con demencia. Conclusiones. La realidad virtual es un area en crecimiento y muy prometedora para la intervencion psicologica en general, y para el tratamiento de la demencia en particular. Su acogida parece muy favorable entre las personas que padecen demencia. No obstante, es importante entender las nuevas tecnologias como una herramienta mas que no sustituye al terapeuta. Asimismo, se advierte de la necesidad de mas investigaciones rigurosas y sistematicas que determinen la eficacia de este tipo de intervenciones.

An Alternative Treatment Against Acanthocephala ( Prosthenorchis elegans) in Captive Squirrel Monkeys ( Saimiri sciureus) in Mexico.

We provide the first report of Acanthocephala ( Prosthenorchis elegans) in Mexican non-human primates. There has been no known treatment against this parasite except for surgical removal, and this has been relatively ineffective because of the small juveniles. We report the presence of P. elegans in a captive breeding colony of squirrel monkeys ( Saimiri sciureus) in Mexico, and we describe a successful treatment protocol. Treatment involved 2 steps: oral administration of the drugs loperamide chlorhydrate (0.5 mg/0.9 kg/3 days) and niclosamide (0.2 mg/0.9 kg/3 days) followed by surgical removal of adult worms from the intestine. Fecal examination during treatment revealed live adults but no living juveniles and no eggs. Surgery after 1 wk of treatment revealed the presence of adults and an absence of juvenile parasites. All adults were physically extracted during the surgery. All subjects recovered from surgery within 1 wk.

Barrett's esophagus: Ten years of experience at a tertiary care hospital center in Mexico. / Esófago de Barrett: experiencia de 10 años en un centro de tercer nivel en México.

INTRODUCTION: The prevalence of Barrett's esophagus has been calculated at between 1.3 and 1.6%. There is little information with respect to this in Mexico. AIM: To determine the frequency and characteristics of Barrett's esophagus in patients that underwent endoscopy at a national referral center, within a 10-year time frame. MATERIAL AND METHODS: The databases of the pathology and gastrointestinal endoscopy departments of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" were analyzed, covering the period of January 2002 to December 2012. Patients with a histologic diagnosis of Barrett's esophagus were included. The variables of age, sex, the presence of dysplasia/esophageal adenocarcinoma, Barrett's esophagus length, and follow-up were analyzed. RESULTS: Of 43,639 upper gastrointestinal endoscopies performed, 420 revealed Barrett's esophagus, corresponding to a frequency of 9.6 patients for every 1,000 endoscopies. Of those patients, 66.9% (n=281) were men, mean patient age±SD was 57.2±15.3 years, 223 patients (53%) presented with long-segment Barrett's esophagus, and 197 (47%) with short-segment Barrett's esophagus. Dysplasia was not present in 339 patients (80.7%). Eighty-one (19.3%) patients had some grade of dysplasia or cancer: 48/420 (11.42%) presented with low-grade dysplasia, 20/420 (4.76%) with high-grade dysplasia, and 13/420 (3.1%) were diagnosed with esophageal cancer arising from Barrett's esophagus. Mean follow-up time was 5.6 years. CONCLUSIONS: The frequency of Barrett's esophagus was 9.6 cases for every 1,000 upper gastrointestinal endoscopies performed. Dysplasia was not documented in the majority of the patients with Barrett's esophagus and they had no histopathologic changes during follow-up. A total of 19.3% of the patients presented with dysplasia or cancer.

Impact of dust and smoke mixing on column-integrated aerosol properties from observations during a severe wildfire episode over Valencia (Spain).

The most destructive wildfire experienced in Spain since 2004 occurred close to Valencia in summer 2012. A total of 48.500ha were affected by two wildfires, which were mostly active during 29-30 June. The fresh smoke plume was detected at the Burjassot measurement station simultaneously to a severe dust episode. We propose an empirical method to evaluate the dust and smoke mixing and its impact on the microphysical and optical properties. For this, we combine direct-sun measurements with a Cimel CE-318 sun-photometer with an inversion methodology, and the Mie theory to derive the column-integrated size distribution, single scattering albedo (SSA) and asymmetry parameter (g). The mixing of dust and smoke greatly increased the aerosol load and modified the background aerosol properties. Mineral dust increased the aerosol optical depth (AOD) up to 1, while the smoke plume caused an extreme AOD peak of 8. The size distribution of the mixture was bimodal, with a fine and coarse modes dominated by the smoke particles and mineral dust, respectively. The SSA and g for the dust-smoke mixture show a marked sensitivity on the smoke mixing-ratio, mainly at longer wavelengths. Mineral dust and smoke share a similar SSA at 440nm (~0.90), but with opposite spectral dependency. A small dust contribution to the total AOD substantially affects the SSA of the mixture, and also SSA at 1020nm increases from 0.87 to 0.95. This leads to a different spectral behaviour of SSA that changes from positive (smoke plume) to negative (dust), depending on the dust and smoke mixing-ratio.

UV Index on tilted surfaces.

Solar ultraviolet erythemal irradiance (UVER) has been studied on inclined planes with different orientations in Valencia, Spain. To do this a platform was designed that could turn through 90 degrees on its own axis. The radiometers were inclined at an angle close to the latitude of Valencia (39.5 degrees N). Using two timers the platform could be turned through 90 degrees every 5 min. On clear or partially cloudy days, including those with different turbidity values, it was observed that the UVER showed a maximum at 1200 h GMT, very close to solar noon, in the north and south positions, while the maximum for east and west orientations was found at approximately one hour before and one hour after midday respectively. It was also observed how the irradiance for the south orientation was greater and for the north was less than for the horizontal plane, as well as the opposite performances of the east and west orientations, for four days close to the summer and winter solstices and each equinox. Some experimental results were also compared with the results from the SMARTS2.9 model for the same conditions. It was found that the model frequently overestimated the experimental data. With respect to the maximum calculated UV Index in the different planes this was always higher for the south orientation than for the north, while it was similar for east and west orientations throughout the year. Finally the accumulated erythemal dosage for the considered period was obtained as a function of phototype and orientation, confirming that the accumulated erythemal dosage decreased by around 37% in the north orientation compared to the horizontal value, while in the south position it was only 6% less and some 20% and 15% less in the east and west positions, respectively.