Molecular prevalence of Merkel cell polyomavirus in nonmelanoma skin cancer in a Brazilian population.

BACKGROUND: Merkel cell polyomavirus (MCPyV), a newly described oncogenic virus, has been found in association with tumours other than Merkel cell carcinoma (MCC). As yet, little is known about the involvement or influence of MCPyV on the development of these tumours and its prevalence in various populations. AIM: To assess the prevalence of MCPyV DNA in cases of nonmelanoma skin cancer (NMSC). METHODS: The prevalence of MCPyV DNA was assessed in 96 cases of NMSC in a Brazilian population comprising 76 subjects, and these results were correlated with epidemiological and demographical data. RESULTS: MCPyV DNA was detected in 23 of 69 (33.3%) basal cell carcinomas, in 2 of 11 (18%) squamous cell carcinomas, 2 of 4 Bowen disease case, 0 of 1 MCC and 4 of 11 other skin disorders. CONCLUSION: Despite the frequent detection of MCPyV DNA in NMSC, its possible role in the development of NMSC still needs further investigation.

[Application of the motor unit number estimation (MUNE-Poisson) statistical technique in patients with neurogenic processes]. / Aplicación en pacientes con procesos neurogénicos de la técnica estadística de estimación del número de unidades motoras (MUNE-Poisson).

INTRODUCTION: Little research has been conducted on applying the statistical estimation of the number of motor units (the MUNE statistic) in the diagnosis of neurogenic processes. AIMS: To determine the sensitivity of this test in patients with different neurogenic processes and to disseminate and clarify its basic methodological aspects. SUBJECTS AND METHODS: Both the conventional calculation and the modified version of the MUNE-Poisson put forward by Shefner et al (MUNEm) were used to carry out unilateral studies of the extensor digitorum brevis muscle in 82 patients who had previously been clinically and electromyographically diagnosed with sensory-motor axonal polyneuropathy (36 cases), unilateral L5 radiculopathy (26 patients) and second motor neuron disease (20 cases). RESULTS: Overall sensitivity of the two methods was 81.7% and 82.9%, respectively, with no significant differences between them. Similarly, the sensitivity of the MUNE studies does not differ statistically according to the diagnosis. Patients who had a compound muscle action potential (CMAP) with a reduced amplitude displayed significantly higher sensitivity in MUNE studies (94.8%) than those who exhibited a normal CMAP (69.7%) (p < 0.001). CONCLUSIONS: Although routine use of the MUNE statistical method is unnecessary in daily practice, it should be considered for use in processes in which conventional muscle electromyography, especially involving distal ones, offers doubtful results or the aim is to follow the progression of certain neurogenic processes.

[Low obstruction tract by system Reemex]. / Obstrucción infravesical tras cabestrillo tipo Remeex.

The Remeex system it's a sling with regulable tension created for the surgical correction of the female urinary incontinente. The system contains a varitensor central part of the protesis that regulates the tension of the uretra. The screwdriver that acts against the varitensor to the modify the tension under the uretra in the postop inmediately or time after also. We present a clinic case of a patient with diagnostic of urinary stress incontinence and the surgical treatment with advantages against others kind of systems used for incontinence treatment at this time.

Analysis of worldwide sequence mutations in Zika virus proteins E, NS1, NS3 and NS5 from a structural point of view.

Zika virus (ZIKV) is an emergent arbovirus that has attracted attention in the last year as a possible causative agent of congenital malformation; it shows a remarkably increased microcephaly risk during otherwise healthy pregnancies. We present here an analysis of all ZIKV sequences available in Genbank up to April 2016, studying the mutations in the whole polyprotein and their possible structural implications for the proteins E, NS1, NS3 and NS5. This study suggests that microcephaly is not a consequence of any particular amino acid substitution but, conceivably, is a feature of ZIKV itself. Moreover, the structural analysis of ZIKV proteins, together with the mutational landscape of ZIKV and a structure-sequence comparison with other flaviviruses, allows the suggestion of regions that could be exploited as anti-ZIKV targets, including some allosteric sites found in the NS3 and NS5 proteins of DENV.

[Treatment of sleep apnea syndrome with CPAP: compliance with treatment, its efficacy and secondary effects]. / Tratamiento con CPAP del síndrome de apneas del sueño: cumplimiento, efectividad y efectos secundarios.

INTRODUCTION: Continuous positive pressure via the nose (nasal-CPAP) is the first line of treatment in the sleep apnea syndrome (SAS). Long term compliance with treatment is essential for success and this may depend on the relation of benefit to side-effects. OBJECTIVE: To study the improvement in symptoms of SAS patients treated with CPAP, side-effects and compliance with treatment. MATERIAL AND METHODS: In accordance with the objectives a 10 question questionnaire was given to 65 patients diagnosed as having SAS after polysomnographic studies (PSG) who were being treated with CPAP. RESULTS: Eighty per cent of the patients complied with the treatment prescribed and 82% of these considered it to be effective. Ninety per cent of the patients noticed improvement of 50% of their symptoms and 48% noticed improvement of more than 80%. The daytime symptoms which showed most improvement were the feeling of tiredness on waking (94.1%) and of excessive somnolence during the day. The nocturnal symptoms which most improved were snoring and inability to breathe whilst asleep (100% and 95.1% respectively). Ninety per cent of the patients complained of a side-effect and/or problem with the equipment. The commonest complaints were related to nasal problems (dryness, congestion, rhinorrhea, etc), which affected 61.5%. The main complaint about the equipment was of the noise it made (46%). However, only 6% of the patients gave up the treatment because of side-effects. CONCLUSION: CPAP is an effective treatment which is well tolerated in spite of its drawbacks.

Silymarin inhibited proliferation and induced apoptosis in hepatic cancer cells.

OBJECTIVES: The aim of this study was to investigate mechanisms involved in the growth inhibitory effect of silymarin, in humanhepatocellular carcinoma. MATERIALS AND METHODS: The human hepatocellular carcinoma cell line HepG2 was utilized and the MTT assay was performed to study the antiproliferative effect of silymarin. Dual staining was undertaken for ethidium bromide/acridine orange, propidium iodide staining and DNA fragmentation studies were executed to confirm the presence of apoptosis. Cell-cycle analysis was revealed by flow cytometry and mitochondrial transmembrane potential was measured by uptake of the mitochondrial-specific lipophilic cationic dye rhodamine 123. Western blotting analysis for cytochrome c, p53, Bax, Bcl-2, APAF-1, caspase-3, survivin, beta-catenin, cyclin D1, c-Myc and PCNA was carried out. RESULTS: Silymarin inhibited population growth of the hepatocellular carcinoma cells in a dose-dependent manner, and the percentage of apoptotic cells was increased after treatment with 50 and 75 microg/ml silymarin for 24 h. Silymarin treatment increased the proportion of cells with reduced DNA content (sub-G(0)/G(1) or A(0) peak), indicative of apoptosis with loss of cells in the G(1) phase. Silymarin also decreased mitochondrial transmembrane potential of the cells, thereby increasing levels of cytosolic cytochrome c while up-regulating expression of pro-apoptotic proteins (such as p53, Bax, APAF-1 and caspase-3) with concomitant decrease in anti-apoptotic proteins (Bcl-2 and survivin) and proliferation-associated proteins (beta-catenin, cyclin D1, c-Myc and PCNA). CONCLUSIONS: Our results demonstrate that silymarin treatment inhibited proliferation and induced apoptosis in the human hepatocellular carcinoma cell line HepG2.

Effects of coumarin and 7OH-coumarin on bcl-2 and Bax expression in two human lung cancer cell lines in vitro.

Coumarin and its derivative 7-hydroxycoumarin (7-OHC) have antitumor and antimetastatic properties. The purpose of this study was to investigate the possible effects of these compounds on expression of the bcl-2 and Bax oncoproteins in two human lung cancer cell lines, A427 and Calu-1. The cells were cultured in vitro for 24 h in RPMI 1640 with 1.5% (v/v) ethanol, 1.0 mM ethanolic coumarin or 1.0 mM ethanolic 7-OHC. Viability was determined in each cell line by an MTT assay. Total protein was extracted from cell lysates and the bcl-2 and Bax oncoproteins were identified. Western blotting showed a decrease in bcl-2 and an increase in Bax in A427 cells cultured with coumarin or 7-OHC. Neither drug changed bcl-2 expression in Calu-1 cells compared to solvent controls, and Bax expression was only slightly increased by coumarin. We conclude that 7-OHC is a more potent inhibitor of cell proliferation than coumarin and has more marked effects on oncoprotein expression. Also, the A427 cell line was more sensitive to the drugs than Calu-1.

Biomaterials for tissue engineering.

Biomaterials play a critical role in the engineering of new functional genitourinary tissues for the replacement of lost or malfunctioning tissues. They provide a temporary scaffolding to guide new tissue growth and organization and may provide bioactive signals (e.g., cell-adhesion peptides and growth factors) required for the retention of tissue-specific gene expression. A variety of biomaterials, which can be classified into three types--naturally derived materials (e.g., collagen and alginate), acellular tissue matrices (e.g., bladder submucosa and small-intestinal submucosa), and synthetic polymers [e.g., polyglycolic acid, polylactic acid, and poly(lactic-co-glycolic acid)]--have proved to be useful in the reconstruction of a number of genitourinary tissues in animal models. Some of these materials are currently being used clinically for genitourinary applications. Ultimately, the development or selection of appropriate biomaterials may allow the engineering of multiple types of functional genitourinary tissues.

[Norplant contraceptive implants: opinion of Dominican women who used this method]. / Implantes anticonceptivos Norplant: opinion de mujeres dominicanas que usaron el metodo.

PIP: 84 women from the Nuestra Senora maternity ward in Altagracia, 118 women from Moscoso Puello Hospital, and 197 women from the maternity ward of Los Mina, Dominican Republic, were studied. A structured questionnaire was utilized for interviews. The study began March 24 and was completed by April 23, 1987. One-third of the population of Norplant users was under the age of 25 years, and over 80% had none to two children. 56% had secondary or higher education. 200 of the women continued using the implant, while 109 had discontinued its use. Only 28% said that they had problems with the use of Norplant. 103 had excessive bleeding, 47 had irregular menstruation, 35 had amenorrhea, and 80 had other adverse effects. 172 women (55.7%) had amenorrhea for 2 months or longer. 206 (66.7%) had 10 or more days of bleeding or spotting. 118 (38.2%) liked the formulation of Norplant; 117 (37.9%) liked its efficacy; 48 (15.5%) liked its long duration; and only 20 (6.5%) did not like any attribute of this implant. Among 260 women who used methods other than Norplant, 193 said that Norplant was superior, while 55 liked other methods. The reasons why Norplant was liked included the absence of health problems, efficacy, mode of use, and even the weight gain potential. 249 out of 309 women said that they would recommend it to others and 60 said that they would not.^ieng

Prospective randomized comparison of cefepime and cefotaxime for treatment of bacterial meningitis in infants and children.

Ninety infants and children were prospectively randomized to receive cefepime (n = 43) or cefotaxime (n = 47) for therapy of bacterial meningitis. The two treatment groups were comparable in terms of age, duration of illness before enrollment, history of seizures, clinical status on admission, and etiology. Six (7%) patients died--two treated with cefepime and four treated with cefotaxime. Clinical response, cerebrospinal fluid sterilization, development of complications, antibiotic toxicity, and hospital stay were similar for the two treatment regimens. Concentrations of cefepime in cerebrospinal fluid varied from 55 to 95 times greater than the maximal MIC required by the causative pathogens. Audiologic and/or neurologic sequelae were found in 16% of the cefepime-treated patients and 15% of the cefotaxime-treated patients examined 2 to 6 months after discharge. We conclude that cefepime is safe and therapeutically equivalent to cefotaxime for management of bacterial meningitis in infants and children.

Effect of crown ethers on structure, stability, activity, and enantioselectivity of subtilisin Carlsberg in organic solvents.

Colyophilization or codrying of subtilisin Carlsberg with the crown ethers 18-crown-6, 15-crown-5, and 12-crown-4 substantially improved enzyme activity in THF, acetonitrile, and 1,4-dioxane in the transesterification reactions of N-acetyl-L-phenylalanine ethylester and 1-propanol and that of (+/-)-1-phenylethanol and vinylbutyrate. The acceleration of the initial rate, V(0), ranged from less than 10-fold to more than 100-fold. All crown ethers activated subtilisin substantially, which excludes a specific macrocyclic effect from being responsible. The secondary structure of subtilisin was studied by Fourier-transform infrared (FTIR) spectroscopy. 18-Crown-6 and 15-crown-5 led to a more nativelike structure of subtilisin in the organic solvents employed when compared with that of the dehydrated enzyme obtained from buffer alone. However, the high level of activation with 12-crown-4 where this effect was not observed excluded overall structural preservation from being the primary cause of the observed enzyme activation. The conformational mobility of subtilisin was investigated by performing thermal denaturation experiments in 1,4-dioxane. Although only a small effect of temperature on subtilisin structure was observed for the samples prepared with or without 12-crown-4, both 18-crown-6 and 15-crown-5 caused the enzyme to denature at quite low temperatures (38 degrees C and 56 degrees C, respectively). No relationship between this property and V(0) was evident, but increased conformational mobility of the protein decreased its storage stability. The possibility of a "molecular imprinting" effect was also tested by removing 18-crown-6 from the subtilisin-18-crown-6 colyophilizate by washing. V(0) was only halved as a result of this procedure, an effect insignificant compared with the ca. 80-fold rate enhancement observed prior to washing in THF. This suggests that molecular imprinting is likely the primary cause of subtilisin activation by crown ethers, as recently suggested.

Allergy to local anaesthetics in dentistry. Myth or reality?

BACKGROUND: Local anesthetics (LA) are frequently used in dentistry. Although these drugs are usually well-tolerated, they can sometimes provoke adverse reactions of various types and severity. The true incidence of LA allergic reactions is unknown. The objectives of this study were (i) to evaluate the incidence of immediate adverse events in subjects requiring local anesthetic injection in order to receive dental treatment; (ii) to assess the incidence of anaphylactic allergic reactions among those recorded as adverse events and (iii) to analyze the relationship between the atopic antecedents of these patients and documented allergic reactions. MATERIALS AND METHODS: A prospective, open-label, non-comparative study including 5,018 subjects who received LA during dental treatment, despite their age, was carried out in 7 private or public odontological centers. All the possible reactions that could appear during the first hour of anesthetic administration were assessed. RESULTS: Twenty-five adverse reactions were diagnosed, representing 0.5 % of the study population. None of these reactions was due to an allergic cause. Most (22/25) were mild, quickly reversible psychogenic or vasovagal reactions. One case was related to defects in the anesthetic technique. In two further cases, allergic etiology was ruled out after skin and dose provocative challenge tests with the anesthetic. In conclusion, allergic reactions to LA are very rare. Most adverse reactions are psychogenic or vasovagal. Physicians and dentists should be aware of these facts in order to minimize the frequent fears and myths concerning the use of LA in the dentist's office.

Manejo paliativo del carcinoma neuroendocrino de timo / Palliative care of advanced thymic neuroendocrine carcinoma

Los tumores neuroendocrinos de timo son infrecuentes con opciones terapéuticas limitadas. Reportamos un hombre de 44 años con síndrome de vena cava superior asociado a Carcinoma neuroendocrino de timo con metástasis óseas; recibió quimioterapia citotóxica, radioterapia y posteriormente everolimus asociado a Lanreotide lográndose sobrevida libre de progresión (AU)

Neuroendocrine tumors of the thymus are uncommon with limited therapeutic options. We report a 44-year-old man with superior vena cava syndrome associated with thymic neuroendocrine carcinoma with bone metastases, the subject received cytotoxic chemotherapy, radiotherapy and subsequently everolimus associated with Lanreotide achieving a progressionfree tumor (AU)

Áreas de resultado clave: propuesta de niveles para medir su funcionamiento / Key result areas: a proposal of levels to measure their functioning

Como parte del proceso de perfeccionamiento de nuestra gestión, se propone un sistema para evaluar la capacidad de funcionamiento de las áreas de resultado clave (ARC) en Infomed. Con ello se aspira a lograr una más eficiente y eficaz implementación de la dirección por objetivos basada en valores.

Obstrucción infravesical tras cabestrillo tipo Remeex / Low obstruction tract by system reemex

La colocación de un cabestrillo de tensión regulable tipo Remeex, es un procedimiento quirúrgico destinado a corregir la incontinencia urinaria femenina. Contiene un varitensor que regula la tensión del sistema sobre la uretra, elemento central de la prótesis que quedará en la paciente y un manipulador, elemento que actúa sobre el varitensor y modificar la tensión bajo la uretra en el postoperatorio inmediato o incluso tiempo después. Presentamos el caso clínico de una paciente diagnosticada de incontinencia urinaria de esfuerzo y el tratamiento quirúrgico realizado con sus ventajas respecto a otros sistemas de corrección antiincontinencia que se realizan en la actualidad

The Remeex system it’s a sling with regulable tension created for the surgical correction of the female urinary incontinente. The system contains a varitensor central parto f the protesis that regulates the tension of the uretra. The screwdriver that acts against the varitensor to the modify the tension under the uretra in the postop inmediately or time after also. We present a clinic case of a patient with diagnostic of urinary stress incontinence and the surgical treatment with advantages against others kind of systems used for incontinence treatment at this time

Optimización de la reducción de la presión arterial en hipertensos esenciales / Optimization of antihypertensive treatment

Background: A blood pressure below or equal to 140/90 mmHg, the aim of antihypertensive treatment, is rarely achieved. Only 16 percent of patients controlled by our group reach this goal. Aim: To analyze the causes of suboptimal treatment and to assess the effects of an optimization of antihypertensive therapy. Patients and methods: A random sample of 160 patients was analyzed and followed during one year. Results: Sixty six patients (41 percent) had a normal blood pressure, maintained during the first three months of follow up. The main causes of suboptimal reduction of blood pressure in the remaining 94 patients were an incorrect prescription or dosage of medications in 37.5 percent, lack of compliance in 34 percent, insufficient delivery of medications by the health service in 24 percent and secondary effects of drugs in 5 percent. When these factors were corrected, blood pressure normalized in 41 of them. In other 37, a reduction of 5 mmHg or more in blood pressure, was obtained. The most frequent changes introduced were modifications in dosage and addition of a new medication. Therefore, in 90 percent of these patients, blood pressure was reduced or normalized. Conclusions: A correct identification of the cause of antihypertensive treatment failure is imperative. The correction of this cause leads to a further reduction in blood pressure in 90 percent of those subjects with suboptimal treatment

Aplicación en pacientes con procesos neurogénicos de la técnica estadística de estimación del número de unidades motoras (MUNE-Poisson) / Application of the motor unit number estimation (mune-poisson) statistical technique in patients with neurogenic processes

Introducción. Existe poca experiencia sobre la aplicación de la estimación estadística del número de unidades motoras (MUNE estadístico) en el diagnóstico de procesos neurogénicos. Objetivos. Determinar la sensibilidad de dicho test en pacientes con distintos procesos neurogénicos y difundir y aclarar los aspectos metodológicos fundamentales de aquél. Sujetos y métodos. Se ha estudiado mediante MUNE-Poisson, utilizando el calculo convencional y el modificado propuesto por Shefner et al (MUNEm), unilateralmente el músculo extensor digitorum brevis de 82 pacientes previamente diagnosticados clínica y electromiográficamente de polineuropatía axonal sensitivomotora (36 casos), radiculopatía L5 unilateral (26 pacientes) y enfermedad de la segunda motoneurona (20 casos). Resultados. La sensibilidad global de ambos métodos ha sido de 81,7 y 82,9%, respectivamente, sin diferencias significativas entre ellos. La sensibilidad de los estudios MUNE tampoco es estadísticamente diferente según el diagnóstico. Los pacientes que presentaron amplitud del potencial muscular compuesto (CMAP) reducida en amplitud mostraron significativamente mayor sensibilidad en los estudios MUNE (94,8%) que los que exhibieron un CMAP normal (69,7%) (p < 0,001). Conclusión. Aunque es innecesario utilizar rutinariamente en la práctica diaria el método MUNE estadístico, sí se debe considerar su empleo en procesos en los que la electromiografía convencional de músculos, sobre todo distales, presenta resultados dudosos, o se pretende seguir la evolución de ciertos procesos neurogénicos

Introduction. Little research has been conducted on applying the statistical estimation of the number of motor units (the MUNE statistic) in the diagnosis of neurogenic processes. Aims. To determine the sensitivity of this test in patients with different neurogenic processes and to disseminate and clarify its basic methodological aspects. Subjects and methods. Both the conventional calculation and the modified version of the MUNE-Poisson put forward by Shefner et al (MUNEm) were used to carry out unilateral studies of the extensor digitorum brevis muscle in 82 patients who had previously been clinically and electromyographically diagnosed with sensory-motor axonal polyneuropathy (36 cases), unilateral L5 radiculopathy (26 patients) and second motor neuron disease (20 cases). Results. Overall sensitivity of the two methods was 81.7% and 82.9%, respectively, with no significant differences between them. Similarly, the sensitivity of the MUNE studies does not differ statistically according to the diagnosis. Patients who had a compound muscle action potential (CMAP) with a reduced amplitude displayed significantly higher sensitivity in MUNE studies (94.8%) than those who exhibited a normal CMAP (69.7%) (p < 0.001). Conclusions. Although routine use of the MUNE statistical method is unnecessary in daily practice, it should be considered for use in processes in which conventional muscle electromyography, especially involving distal ones, offers doubtful results or the aim is to follow the progression of certain neurogenic processes

Tratamiento de la incontinencia urinaria de esfuerzo en el hombre / Treatment of effort bladder incontinence in the male

Actualmente, el tratamiento de elección de la incontinencia urinaria de esfuerzo (IDE) en el hombre es la colocación de un esfínter artificial. Sin embargo, han aparecido otras opciones terapéuticas como las prótesis reajustables con menor coste y menor número de complicaciones que podrían ser usadas, en algunos casos, como tratamiento alternativo. Presentamos el caso clinico de un varón con IDE, tras prostatectomia radical que se trató de forma exitosa con la colocación de un cabestrllo tipo Remeex. Asimismo, se realizó una revisión bibliográflca del sistema Remeex, en cuanto a su colocación, funcionamiento y manejo postoperatorio

Nowadays the gold standard treatment for stress urinary incontinence (SUI) in male is artificial urinary sphincter. New therapeutics options have been developed using a readjustable prosthesis with less cost and less complications, and that could also be used as an alternative treatment. We present a clinical case of a man with SUI after radical prostatectomy, treated successfully with the Remeex system. And we also reviewed the literature of the surgical approach and postoperative management of this system

Morbi-mortalidad de la hipertensión arterial según magnitud del cambio de los factores de riesgo: seguimiento a 30 años / Morbimortality of arterial systemic hypertension according to risk factor control: a 30 years follow up study

Antecedentes: El tratamiento integral de la hipertensión arterial esencial involucra el tratamiento farmacológico y el control de los factores de riesgo cardiovascular. Objetivo: Estudiar a largo plazo la magnitud y frecuencia del cambio de los factores de riesgo, incluida la presión arterial, sobre la morbi-mortalidad de la hipertensión. Método: Estudio observacional durante 30 años de una cohorte de 1.360 hipertensos esenciales tratados con fármacos habituales (tiazidicos, B-bloqueadores, antagonistas del Ca++ e inhibidores ECA) y medidas dietéticas, educacionales y farmacológicas tendientes a mejorar el estilo de vida (cigarrillo, alcohol y sedentarismo) y controlar adecuadamente las enfermedades concomitantes (diabetes, dislipidemia, obesidad, gota). Se analizó el cambio individual de los 8 factores de riesgo fijando como éxito: PA <140/90 mmHg, cero consumo de cigarrillos, alcohol > 2 vasos de vino al día, colesterol total <200 mg por ciento, glicemia < 120mg por ciento e índice de masa corporal <30 peso/talla². De acuerdo al éxito individual, se separaron dos grupos: B con cambio adecuado de 4 o más FR y M, sin ese resultado. Se comparó la morbi-mortalidad entre ellos, en total y en forma separada para pacientes complicados y no complicados al ingreso. Estadística según tasas acumulativas y diferencias según método de Cox. Resultados: mortalidad general 0.91 por ciento/año y morbilidades comparables a las de la literatura reciente. Cambio de los factores de riesgo inferior al 50 por ciento, en especial diabetes (26 por ciento) obesidad (18 por ciento) y sedentarismo (15 por ciento). El grupo B con control adecuado de más de 4 factores de riesgo presentó significativamente una menor mortalidad, menor morbilidad total y menor incidencia de Infarto miocárdico, tanto en pacientes previamente complicados como sin ellas al ingreso. Conclusión: Este resultado positivo, a pesar del moderado control de los FR, enfatiza la necesidad de realizar no solo prevención primaria sino también secundaria en forma más intensa y agresiva.