Coinfections and differential diagnosis in immunocompetent patients with uveitis of infectious origin.

BACKGROUND: Making a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances. Co-infections in immunocompetent patients are not frequently proved with traditional serologic-diagnostic tools. METHODS: Descriptive transversal study, in a Uveitis Service of an Ophthalmology Reference Center, in Bogotá, Colombia, from July 2014 to February 2016. Aqueous humor (AH) and/or vitreous fluid, blood and serum samples were collected from consecutive patients suspected of having infectious uveitis. The diagnosis of ocular toxoplasmosis (OT) was confirmed by the Goldmann-Witmer coefficient (GWC) and by polymerase chain reaction (PCR). Differential diagnosis by PCR in AH was done for viral origin such as Cytomegalovirus (CMV), Herpes simplex virus type 1 (HSV1), Herpes simplex virus type 2 (HSV2), Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and Mycobacterium tuberculosis. RESULTS: In 66 Colombian patients with uveitis of presumed infectious origin: 22 (33.3%) were confirmed as OT, 16 (24.2%) as undetermined OT, five (7.5%) as co-infections and 23 (34.8%) as other uveitis. Toxoplasma coinfection with M. tuberculosis was identified in one case by PCR and in four cases with HSV by GWC. The initial clinical diagnosis changed, after laboratory examination, in 21 cases (31.8%). CONCLUSIONS: Clinical diagnosis can be changed by laboratory examination in a significant proportion of cases of uveitis. Diagnosis of OT should combine the use of PCR and GWC to reach the maximum of confirmation of cases. The use of multiple laboratory methods is necessary to identify co-infections and viral infections that can mimic OT in immunocompetent patients.

Random noise stimulation in the treatment of patients with neurological disorders.

Random noise stimulation technique involves applying any form of energy (for instance, light, mechanical, electrical, sound) with unpredictable intensities through time to the brain or sensory receptors to enhance sensory, motor, or cognitive functions. Random noise stimulation initially employed mechanical noise in auditory and cutaneous stimuli, but electrical energies applied to the brain or the skin are becoming more frequent, with a series of clinical applications. Indeed, recent evidence shows that transcranial random noise stimulation can increase corticospinal excitability, improve cognitive/motor performance, and produce beneficial aftereffects at the behavioral and psychological levels. Here, we present a narrative review about the potential uses of random noise stimulation to treat neurological disorders, including attention deficit hyperactivity disorder, schizophrenia, amblyopia, myopia, tinnitus, multiple sclerosis, post-stroke, vestibular-postural disorders, and sensitivity loss. Many of the reviewed studies reveal that the optimal way to deliver random noise stimulation-based therapies is with the concomitant use of neurological and neuropsychological assessments to validate the beneficial aftereffects. In addition, we highlight the requirement of more randomized controlled trials and more physiological studies of random noise stimulation to discover another optimal way to perform the random noise stimulation interventions.

Seroprevalence and molecular detection of Toxoplasma gondii among donors in a blood bank in Cúcuta, Colombia Introduction: Toxoplasma gondii infection / Seroprevalencia y detección molecular de Toxoplasma gondii en donantes de un banco de sangre de Cúcuta, Colombia

Introduction: Toxoplasma gondii infection manifests differently in humans according to their immunity ranging from asymptomatic profiles to severe disease. There are multiple transmission mechanisms including blood transfusions, but little is known about the frequency of T. gondii infection in Colombia's blood banks. Objective: To determine the prevalence of T. gondii infection in blood donors of a blood bank in the city of Cúcuta by serological and molecular diagnostic techniques. Materials and methods: We identified IgG and IgM antibodies against T. gondii by immunoassay in serum from 348 donors. The frequency of T. gondii DNA was determined by polymerase chain reaction (PCR) in whole blood from seropositive donors and relevant variables were analyzed based on the information obtained from surveys during blood donor selection. Results: Out of the 348 enrolled donors, 134 (38.5%) showed IgG antibodies against T. gondii; two of them (0.6%) had both IgG and IgM, and in two of them (1.5%), parasite DNA was detected in blood samples. A bivariate analysis indicated an association between seropositivity to T. gondii and being over 26 years of age (p=0.020). Conclusions: The prevalence of T. gondii infection found in the blood donors of this study suggests a significant exposure to the infectious agent that becomes relevant when parasitemia is detected.

Introducción. La infección por Toxoplasma gondii puede presentarse en los humanos con un amplio rango de manifestaciones que van desde el estado asintomático hasta la enfermedad grave, según el estado inmunológico del individuo. Los mecanismos de transmisión incluyen la transfusión sanguínea, pero poco se sabe sobre la frecuencia del parásito en los bancos de sangre de Colombia. Objetivo. Determinar la prevalencia de la infección con T. gondii en donantes de un banco de sangre de Cúcuta mediante técnicas de diagnóstico serológico y molecular. Materiales y métodos. Se determinaron los anticuerpos IgG e IgM contra T. gondii mediante un inmunoensayo en suero en 348 donantes. Se determinó la frecuencia de ADN de T. gondii utilizando la reacción en cadena de la polimerasa (PCR) en sangre total de donantes seropositivos y se analizaron las variables de interés con base en la información obtenida durante la selección de donantes. Resultados. De los 348 donantes participantes, 134 (38,5 %) presentaron anticuerpos IgG contra T. gondii; dos (0,6 %) de ellos presentaron tanto IgG como IgM y, en dos (1,5 %), se detectó ADN del parásito en la sangre. Un análisis bivariado evidenció una asociación entre la seropositividad para T. gondii y tener más de 26 años de edad (p=0,020). Conclusiones. La prevalencia de la infección con T. gondii encontrada en los donantes de sangre sugiere una exposición significativa al agente, la cual adquiere relevancia al detectarse la parasitemia.

Seroprevalencia y detección molecular de Toxoplasma gondii en donantes de un banco de sangre de Cúcuta, Colombia / Seroprevalence and molecular detection of Toxoplasma gondii among donors in a blood bank in Cúcuta, Colombia

Resumen Introducción. La infección por Toxoplasma gondii puede presentarse en los humanos con un amplio rango de manifestaciones que van desde el estado asintomático hasta la enfermedad grave, según el estado inmunológico del individuo. Los mecanismos de transmisión incluyen la transfusión sanguínea, pero poco se sabe sobre la frecuencia del parásito en los bancos de sangre de Colombia. Objetivo. Determinar la prevalencia de la infección con T. gondii en donantes de un banco de sangre de Cúcuta mediante técnicas de diagnóstico serológico y molecular. Materiales y métodos. Se determinaron los anticuerpos IgG e IgM contra T. gondii mediante un inmunoensayo en suero en 348 donantes. Se determinó la frecuencia de ADN de T. gondii utilizando la reacción en cadena de la polimerasa (PCR) en sangre total de donantes seropositivos y se analizaron las variables de interés con base en la información obtenida durante la selección de donantes. Resultados. De los 348 donantes participantes, 134 (38,5 %) presentaron anticuerpos IgG contra T. gondii; dos (0,6 %) de ellos presentaron tanto IgG como IgM y, en dos (1,5 %), se detectó ADN del parásito en la sangre. Un análisis bivariado evidenció una asociación entre la seropositividad para T. gondii y tener más de 26 años de edad (p=0,020). Conclusiones. La prevalencia de la infección con T. gondii encontrada en los donantes de sangre sugiere una exposición significativa al agente, la cual adquiere relevancia al detectarse la parasitemia.

Abstract Introduction: Toxoplasma gondii infection manifests differently in humans according to their immunity ranging from asymptomatic profiles to severe disease. There are multiple transmission mechanisms including blood transfusions, but little is known about the frequency of T. gondii infection in Colombia's blood banks. Objective: To determine the prevalence of T. gondii infection in blood donors of a blood bank in the city of Cúcuta by serological and molecular diagnostic techniques. Materials and methods: We identified IgG and IgM antibodies against T. gondii by immunoassay in serum from 348 donors. The frequency of T. gondii DNA was determined by polymerase chain reaction (PCR) in whole blood from seropositive donors and relevant variables were analyzed based on the information obtained from surveys during blood donor selection. Results: Out of the 348 enrolled donors, 134 (38.5%) showed IgG antibodies against T. gondii; two of them (0.6%) had both IgG and IgM, and in two of them (1.5%), parasite DNA was detected in blood samples. A bivariate analysis indicated an association between seropositivity to T. gondii and being over 26 years of age (p=0.020). Conclusions: The prevalence of T. gondii infection found in the blood donors of this study suggests a significant exposure to the infectious agent that becomes relevant when parasitemia is detected.