Prevalence of community-acquired and nosocomial infections in hospitalized patients with systemic lupus erythematosus.

Infections are an important cause of morbidity and mortality in systemic lupus erythematosus. We aimed to determine the incidence and characteristics of infections in patients hospitalized because of systemic lupus erythematosus, and to identify which factors influence their outcome. The medical records of patients with systemic lupus erythematosus hospitalized between January 2002 and December 2007 were reviewed according to a standardized case form including demographic, clinical, and therapeutic data. The diagnosis of infection was based on clinical findings, the identification of the causative agent or response to antibiotic treatment. The study included 473 patients (mean age 30 +/- 11 years; 421 (89%) female) who were hospitalized for a mean of 13 +/- 9 days. A community-based infection was suspected in 268 (57%) at admission; the diagnosis was confirmed in 96 patients (22%) and ruled out in 20 (4.2%); nevertheless, 152 patients (32%) received antibiotics on an empirical basis. A nosocomial infection was suspected in 63 (13.3%) of 453 patients and was confirmed in 59 (12.5%). The two most common community-acquired and nosocomial infections affected the respiratory and genitourinary tracts. Gram-negative bacteria were major etiological agents isolated. In the multivariate analysis, community-based infections associated with mucocutaneous, renal, or central nervous system disease activity as well as fever, and Mex-SLEDAI at admission and nosocomial infections to azathioprine use, infection at admission, disease duration, and hospitalization >7 days. We conclude that infections are an important cause of hospitalization of systemic lupus erythematosus patients. Risk factors include disease activity, use of immunosuppressants, disease duration, and length of hospital stay.

[Tick-borne relapsing fever in a rural area of southern Spain]. / Fiebre recurrente transmitida por garrapatas en área rural del sur de España.

INTRODUCTION: Tick-borne relapsing fever (TBRF) is a zoonotic disease caused by spirochetes of the genus Borrelia. This disease is underdiagnosed in our area due to a low index of suspicion among clinicians, as well as its difficult diagnosis. This study aims to present our experience in the diagnosis and therapeutic management of TBRF and a literature review. METHODS: A retrospective medical chart review was carried out on children diagnosed of TBRF from 2002 to 2012 in our hospital, and included clinical, epidemiological, microbiological, treatment, and outcome data. RESULTS: Nine children with TBRF were identified. Median age was 11 years. All cases occurred during warm months. The most frequent presenting clinical findings were fever, chills, headache, vomiting, myalgia and abdominal pain. Meningeal involvement was identified in 2 cases. In the case of 2 patients, Borrelia infection was identified in several relatives at the time of diagnosis. Mean C-protein reactive was 187 mg/L, and low platelet counts were observed in 56% of the cases. Borreliaspp. was visualized in peripheral blood smears in 67% of cases. All of the patients received antibiotic treatment. Doxycycline was used in children older than 8 years and erythromycin and penicillin in the younger ones. Jarisch-Herxheiner reaction occurred in one patient. All cases resolved without sequelae. CONCLUSIONS: We emphasize the importance of maintaining a high level of suspicion in endemic regions of TBRF. Early diagnosis and a correct therapy can prevent the appearance of subsequent fever recurrences and potential complications.

Effects of percutaneous oestradiol versus oral oestrogens on bone density.

In order to compare the effects on bone density of 1.5 mg/day percutaneous 17 beta-oestradiol (E2) and of 0.625 mg/day oral conjugated oestrogens (CEE), 68 women who had undergone hysterectomy were studied. The subjects were randomly allocated to one of three study groups. A total of 15 women dropped out from these groups during the study. The percutaneous group (n = 20) received treatment for 36 months and the oral group (n = 17) for 24 months, while the untreated group (n = 16) served as controls over a period of 24 months. Bone mineral density (BMD) was measured by dual gammagraphic densitometry (Novo 22A densitometer) in the lumbar spine (L2-L4). The percentage gain in the percutaneous group was 1.7% +/- 3.9% after 12 months, 5.6% +/- 2.9% (P < 0.001) after 24 months and 4.7% +/- 3.2% (P < 0.01) after 36 months. In the oral group the gain was 3.5% +/- 13.0% after 12 months and 4.3% +/- 9.2% (P < 0.001) after 24 months. In the untreated group the bone density loss was 6.6% +/- 3.5% (P < 0.001) after 12 months and 9.1% +/- 3.4% (P < 0.001) after 24 months. On the basis of our results we concluded that both 1.5 mg/day percutaneous E2 and 0.625 mg/day oral CEE not only prevented bone loss but also increased BMD, as was confirmed by our findings after 36 and 24 months of treatment, respectively.

Effects of oestradiol administration via different routes on the lipid profile in women with bilateral oophorectomy.

To determine the influence of various oestrogenenic administrations on lipid response, 63 women with total abdominal hysterectomy and bilateral anexectomy were studied before and 6 and 12 months after receiving 17 beta-oestradiol by different means. The effect on the levels of lipids and lipoproteins of the 2 mg/24 h administration of oestradiol valerate was compared with 1.5 mg/day of percutaneous 17 beta-oestradiol and 0.05 mg/day of transdermic oestradiol. The treatments were given continuously over a year. The oestradiol valerate produced a statistically significant increase (P < 0.05) of the HDL-C levels both after 6 and 12 months (10.6% vs. 11.6%). A significant increase was also observed (P < 0.05) in the Apo AI levels during the treatment (18 and 25%). On the other hand, unfavorable side effects with oestradiol were not produced, either percutaneous or transdermic, on lipid plasmatic or lipoprotein levels. These data show the benefit of oral oestrogenic therapy and the maintenance of the lipid profile in percutaneous and transdermic therapies in oophorectomized women.

Changes in sex behaviour after menopause: effects of tibolone.

In order to analyse both sexual desire after menopause and its response to treatment with tibolone, a randomized placebo/tibolone trial has been designed with 28 postmenopausal patients. They were asked to answer a questionnaire designed by us to obtain quantitative measurements to describe changes in sexual desire. After selection, the patients were randomly assigned to two groups as follows: 14 in the group treated with 2.5 mg/day of tibolone and 14 in the placebo group treated with 500 mg/day of calcium. The patients were monitored after 3, 6 and 12 months. Before joining this study, they had signed a written consent. It was observed that the sexual desire after menopause underwent a significant fall, with decline in arousability and intercourse. The comparative results show that the patients treated with tibolone experience an improvement after the third month of treatment and this improvement was maintained until the end of treatment. We conclude that the questionnaire proposed here is a useful non-parametric method to diagnose a patient's sexuality status at the baseline assessment and a valuable tool for monitoring various therapies. Furthermore, tibolone proved to be effective in managing reduced sexual desire which appears in postmenopausal patients.

Oliguria during laparoscopic surgery: evidence for direct renal parenchymal compression as an etiologic factor.

Abdominal insufflation during laparoscopy has been associated with transient oliguria, which abates after desufflation. Direct renal compression evoking a Page kidney effect was proposed as a mechanism. In an effort to confirm this theory, the left kidney was subjected to 15 mm Hg compression in six anesthetized mongrel dogs. For this, a pressure cuff was placed around the kidney excluding the renal hilar structures. The contralateral kidney was left untouched to serve as a control. After a steady-state period, the pressure cuff was inflated to 15 mm Hg for 2 hours. Cuff desufflation was followed by a 1-hour recovery period. Urine output, glomerular filtration rate (GFR), and effective renal blood flow (ERBF) were measured for both kidneys during each clearance period. For the treated kidneys, the mean urine output decreased 63% (P < 0.05) during compression and increased 109% (P < 0.05) after cuff desufflation. The GFR decreased 21% (P < 0.01) during compression and increased 25% (P < 0.05) during recovery. The ERBF decreased 26% (P < 0.05) during compression, and during the 1-hour recovery period, ERBF did not recover to baseline values. For the control kidneys, there were no significant changes in urine output or GFR during the experimental and recovery periods. These data support the view that direct renal parenchymal compression is an important factor in the development of insufflation-induced oliguria. The clinical implications of insufflation-induced oliguria during laparoscopy deserve further investigation.

[Hormonal profile and participation of nitric oxide in salt-sensitive and salt-resistant essential arterial hypertension]. / Perfil hormonal y participación del óxido nítrico en la hipertensión arterial esencial "sal sensible" y "sal resistente".

Recent studies have shown that cardiovascular events and end-organ damage occur more frequently in patients with salt-sensitive essential hypertension (SH) than in salt-resistant essential hypertension (RH). Nitric oxide (NO) plays an important role in regulating the pressure-natriuresis relationship. Therefore impaired NO synthesis may produce or aggravate salt-sensitive hypertension. This study was conducted to determine the hormonal levels and nitric oxide metabolites in hypertensive patients. 25 patients underwent salt sensitivity testing. 24 h ambulatory blood pressure was recorded after a 5-day period on low salt diet (20 mEq/d) and after a 5-day period on a high salt diet (200 mEq/d). Subjects showing > or = 10 mmHg increase in mean BP when changing from low to high dietary salt intake were classified as salt sensitive and as salt resistant when the BP changes were < 10 mmHg. Based on BP recordings 13 patients were characterised as white coat hypertension (WC), 13 patients as salt resistant (SR) and 12 as salt sensitive (SS). A significative relationship was seen between plasma glucose-insulin concentration and body mass index. The ventricular mass index was similar in SS and SR patients. The plasma uric acid, triglicerides and PAI-I were elevated in SS compared with SR, and control group (C). During low sodium intake, plasma renin and aldosterone were decreased in SS compared with SR, and C. No differences in plasma catecholamines or their changes with intake sodium modifications were seen among the patients. During high sodium intake urinary NO excretion increased in SR (38 +/- 9 vs 18 +/- 2 mg/g creat), and C (24 +/- 2 vs 16 +/- 3 mg/g creat) (p < 0.01) but not in SS patients (21 +/- 3 vs 26 +/- 4 mg/g creat). The NO excretion changes showed negative correlation with BP changes (r = 0.49, p < 0.01). During low sodium intake, SR and SS patients showed a normal nocturnal decrease of BP (dippers). During high sodium intake SS patients became non-dippers. Our results showed that patients with salt sensitive hypertension displayed a suppressed renin-aldosterone system, an attenuated nocturnal decline in blood pressure on high-salt diet and an impairment of endothelial function. The relationship between urinary nitrate excretion and arterial pressure suggest that the salt sensitivity of arterial pressure may be related bo blunted generation of endogenous nitric oxide.

Human papillomavirus genotypes in genital warts in Latin America: a cross-sectional study in Bogota, Colombia.

Epidemiological studies on benign lesions related to human papillomavirus (HPV) infection are scarce in Latin America. We enrolled 342 consecutive patients with lesions suspected of being genital warts (GW). All patients underwent confirmatory biopsy and GP5+/GP6+/- Reverse Line Blot HPV testing on frozen tissue. In 261 (81%) cases, the diagnosis was confirmed by histopathology and HPV was detected in 90.6% of men and 87.7% of women. HPV 6 was by far the most common type in both women (62%) and men (56%), followed by HPV 11 (∼20%). Co-infection with these two types occurred in 7% and 12% of women and men, respectively. HPV16 ranked third in prevalence, with 16% of patients testing positive. Twenty-five percent of cases tested positive for multiple HPV genotypes. Although HPV 6 and HPV 11 were the main types detected and no differences between men and women were observed, we found HPV 11 contributed more to GW aetiology compared with previous reports, showing a variability of HPV type distribution in GW across populations. This information is valuable baseline data in Latin America for future estimations of the burden of GW in men and women and shows the potential benefit obtainable by prophylactic vaccination against HPV types 6 and 11.

Low grade radiographic sacroiliitis as prognostic factor in patients with undifferentiated spondyloarthritis fulfilling diagnostic criteria for ankylosing spondylitis throughout follow up.

OBJECTIVE: To determine the rate and factors associated with ankylosing spondylitis in a cohort of patients with undifferentiated spondyloarthritides (SpA). METHODS: 62 consecutive patients with undifferentiated SpA seen between 1998 and 1999 underwent clinical and imaging evaluations throughout follow up. The main outcome measure was a diagnosis of ankylosing spondylitis. RESULTS: 50 patients with peripheral arthritis (n = 35) and inflammatory back pain (n = 24) (26 male; mean (SD) age at onset, 20.4 (8.8) years; disease duration 5.4 (5.7) years) were followed up for 3-5 years. At baseline, >90% of patients had axial and peripheral disease, while 38% had radiographic sacroiliitis below the cut off level for a diagnosis of ankylosing spondylitis (BASDAI 3.9, BASFI 2.9). At the most recent evaluation, 21 patients (42%) had ankylosing spondylitis. Two factors were associated with a diagnosis of ankylosing spondylitis in multivariate analysis: radiographic sacroiliitis grade <2 bilateral, or grade <3 unilateral (odds ratio (OR) = 11.18 (95% confidence interval, 2.59 to 48.16), p = 0.001), particularly grade 1 bilateral (OR = 12.58 (1.33 to 119.09), p = 0.027), and previous uveitis (OR = 19.25 (1.72 to 214.39), p = 0.001). Acute phase reactant levels, juvenile onset, and HLA-B27 showed a trend to linkage with ankylosing spondylitis (NS). CONCLUSIONS: Low grade radiographic sacroiliitis is a prognostic factor for ankylosing spondylitis in patients originally classified as having undifferentiated SpA. Low grade radiographic sacroiliitis should be regarded as indicative of early ankylosing spondylitis in patients with undifferentiated SpA.

The effect of popcorn and carbonization on neodymium: YAG laser dosimetry in the canine model.

Neodymium:YAG laser irradiation of the canine prostate provides an experimental model for the study of the laser-tissue interaction in laser prostatectomy. Prostate irradiation was undertaken using right-angle-firing laser fibers through an open suprapubic cystotomy, and the procedure was monitored by video endoscopy via a perineal urethrostomy. The effects of popcorn and surface carbonization on intraprostatic heating profiles were determined by interstitial thermometry. We found that popcorn reduced intraprostatic temperatures but that continued irradiation resulted in the restoration of heating. Carbonization resulted in the loss of heating ability deep in the prostate. These observations allow the urologist to understand the thermal implications of observed surface change and to modify lasing parameters during surgery to obtain the desired laser-tissue interaction.

Alteration of laser-tissue interaction with the 805 nm diode laser using indocyanine green in the canine prostate.

BACKGROUND AND OBJECTIVE: Research interests in laser prostatectomy continue to evaluate a variety of wavelengths and treatment parameters in an effort to optimize treatment. Recently, a semiconductor diode laser with a wavelength of 805 nm has become available for clinical use; however, free-beam noncontact applications were limited by the low power output (25 W). In this study in the canine prostate, the possible potentiating effects of intravenously administered indocyanine green (ICG) were evaluated with the 805 nm diode laser. STUDY DESIGN/MATERIALS AND METHODS: A total of 16 fixed position, free-beam lasings were performed at 25 W for 60 sec in four dogs with eight lasings before and eight lasings after ICG administration. Endoscopic observations and measurements of lesion volumes were used to evaluate the laser-tissue interactions. RESULTS: Prior to ICG administration, we observed that side fire irradiation produced primarily small coagulative lesions. Following ICG administration, however, immediate and more noticeable tissue vaporization occurred, although total lesion size was not increased. Pathologic review demonstrated less coagulation and hyperemia, but a larger vaporized cavity in the ICG treated tissue. CONCLUSION: These findings suggest intravenous ICG alters laser-tissue interaction with the 805 nm diode laser in the canine prostate. The use of the 805 nm diode laser with enhancing chromophores deserves further investigation.

Plasmodium gallinaceum: effect of insect cells on ookinete development in vitro.

In vitro culture conditions affecting the transformation efficiency from zygote to ookinete for Plasmodium gallinaceum were examined, as a step toward improving the overall efficiency of in vitro culture systems for sporogonic stages. Gametocytes from infected chickens were allowed to fertilize in vitro and the resulting zygotes were purified and cultured. The time course for ookinete development in vitro was similar to that seen in Aedes aegypti mosquitoes. Supplementing a basal M-199 culture medium with heat-inactivated chicken serum and glucose did not affect transformation efficiency, but resulted in a four-fold increase in infectivity to mosquitoes when fed back to Ae. aegypti. Transformation from zygote to ookinete increased 5- to 10-fold when zygotes were cocultured with one of six different mosquito cell lines or a Drosophila cell line. Under optimal conditions, transformation efficiencies of up to 75% were observed. The presence of insect cells also increased the longevity of ookinetes in culture up to 42 h, while in acellular cultures ookinetes degenerated after about 24 h. The stimulatory effect was apparently not due to a factor secreted into the medium by the cells.

The evolutionary distribution and structural organization of the homeobox-containing repeat D4Z4 indicates a functional role for the ancestral copy in the FSHD region.

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant neuromuscular disease that has been linked to deletions within a tandem array of 3.2 kb repeats adjacent to the telomere of 4q. These repeats are also present in other locations in the human genome, including the short arms of all the acrocentric chromosomes. Here, we examine two models for the role of this repeat in FSHD. First, because of the extensive similarity between the 3.2 kb repeats on 4q and those adjacent to rDNA on the acrocentric chromosomes, we investigated whether the FSHD region on 4q is involved in sub-nuclear localization, specifically to the nucleolus. The results likely exclude any involvement of nucleolar localization in the development of FSHD. Second, we investigated a model that suggests that a functional gene may be buried within the tandem array of 3.2 kb repeats. Toward this end, we evaluated the evolutionary conservation of the repeat and a double homeodomain sequence within the repeat in a variety of primate species. The genomic organization of the 3.2 kb repeat in humans, great apes and lower primates identified the FSHD-associated repeat on chromosome 4q as the likely ancestral copy. The sequence of the rhesus monkey double homeodomain reveals significant sequence identity with the human 4q sequence. These results strongly suggest a functional role for a component of the FSHD-associated repeat.