Frequency of motor alterations detected through manometry in patients with esophageal symptoms and scleroderma. / Frecuencia de alteraciones motoras detectadas por manometría en pacientes con síntomas esofágicos y esclerodermia.

BACKGROUND: Scleroderma can present with esophageal involvement causing important morbidity. AIMS: To describe the manometric findings and clinical characteristics of patients with scleroderma and esophageal symptoms. MATERIALS AND METHODS: Patients with scleroderma and esophageal symptoms were evaluated through esophageal manometry within the time frame of one year. Descriptive statistics were carried out and the continuous variables were expressed as means and standard deviation. Frequencies were expressed as percentages. RESULTS: The study included 24 female patients with a mean age of 53.5 years and mean disease progression of 7.84 years. The most frequent findings were short and hypotonic lower esophageal sphincter (mean length 1.58cm and mean tone 9.49mmHg) and ineffective esophageal motility (mean non-transmitted waves 92.91%, mean effective primary peristalsis 40.05%, and mean amplitude 13.11mmHg). The most frequent symptom was dysphagia. CONCLUSIONS: Scleroderma is associated with lower esophageal sphincter alterations and symptomatic ineffective esophageal motility.

MHC2TA and FCRL3 genes are not associated with rheumatoid arthritis in Mexican patients.

Rheumatoid arthritis (RA) is a multifactorial disease. A combination of genetic and environmental risk factors contributes to its etiology. Several genes have been reported to be associated with susceptibility to the development of RA. The MHC2TA and FCRL3 genes have been associated previously with RA in Swedish and Japanese populations, respectively. In two recent reports, we show an association between FCRL3 and juvenile rheumatoid arthritis (JRA), and MHC2TA and acute coronary syndrome (ACS) in Mexican population. We assessed the association between three single nucleotide polymorphisms (SNPs) of the MHC2TA (-168G/A; rs3087456, and +16G/C; rs4774) and FCRL3 (-169T/C; rs7528684) genes and rheumatoid arthritis in Mexican population through a genotyping method using allelic discrimination assays with TaqMan probes. Our case-control study included 249 patients with RA and 314 controls. We found no evidence of an association between the MHC2TA -168G/A and +1614G/C or FCRL3 -169T/C polymorphisms and RA in this Mexican population. In this cohort of Mexican patients with RA, we observed no association between the MHC2TA or FCRL3 genes and this autoimmune disease.

Neurobehçet disease: clinical and demographic characteristics.

BACKGROUND: Neurobehçet disease (NBD) is a rare complication of Behçet disease (BD) but with important burdens of morbidity and mortality. Little is known about this complication because there are no validated diagnostic criteria, and all the studies have small number of patients. The prevalence reported normally ranges between 5% and 15% and it is more frequent amongst men between 20 and 40 years old. The typical presentations include focal parenchymal lesions, vascular thrombosis, arterial vasculitis, and aseptic meningo-encephalitis. METHODS: We retrospectively studied medical histories of all patients admitted to the hospital and discharged from it with diagnosis of BD from January 1996 to September 2009. NBD was defined as having neurological and/or psychiatric symptoms with compatible abnormalities in MRI and/or cerebrospinal fluid and without another possible explanation for their symptoms. RESULTS: Behcet disease was diagnosed in 25 patients and seven from these patients fulfilled our criteria of Neurobehcet disease (28%). Patients with NBD were significantly younger at the onset of their symptoms and had a significantly longer evolution until diagnosis and treatment compared to patients with non-Neuobehçet disease. Six presented a relapsing-remitting pattern, with a good outcome with corticosteroids. CONCLUSIONS: As reported in previous studies, progressive course was less frequent, with only one case, and had a more aggressive disease. Brainstem involvement bears a poorer prognosis because it is linked with a progressive evolution. In our series, NBD complication was not that infrequent. It is very important to be highly suspicious of this possibility to start early a correct treatment.

Neuro-otological symptoms in patients with migraine.

INTRODUCTION: Neurootological symptoms are common in patients with migraine, and have been reported to be associated with diverse conditions. PATIENTS AND METHODS: A total of 70 patients with a diagnosis of episodic migraine, with or without aura, attending our Migraine Unit were selected. The specific variables studied were the diagnosis of instability, psycho-physiological dizziness, presyncopal symptoms, benign paroxysmal positional vertigo (BPPV), migraine associated recurrent vertigo (MARV), and Meniere's disease. RESULTS: A total of 44.3% of cases had orthostatism or syncope, 15.7% with instability (possibly due to bilateral vestibular hypofunction), 14.2% with MARV and 8.6% with BPPV. The presence of BPPV was observed in older patients (40 years), whilst MARV was a condition seen in younger ones (35 years). These findings are of interest and remind us that benign paroxysmal vertigo is a childhood condition and age is a risk for BPPV. CONCLUSIONS: Migraine patients often present with neuro-otological symptoms that can be classified as inter-episodic and episodic symptoms, and specific and non-specific migraine symptoms. This approach is of obvious pathophysiological interest, given that MARV and the possible vestibular hypofunction of migraine patients are symptoms that share physiological aspects with migraine, while the orthostatism symptoms and BPPV are non-specific and are seen to be associated with other conditions.

First Report of Lasidiplodia theobromae and Cryptovalsa ampelina Associated with Grapevine Decline from Castilla y León, Spain.

Symptoms of grapevine decline were surveyed. Samples from mature vines exhibiting external symptoms of Eutypa dieback and Esca were collected, as were young plants with and without external symptoms, and fungal isolations were performed. In 2007, 3-year-old grapevines (cv. Tempranillo grafted onto 110R rootstock) with low vigor, reduced foliage, and vascular streaking in the wood were observed. Small pieces of discolored wood were placed onto malt extract agar supplemented with 0.25 g/liter of chloramphenicol, incubated at 25°C, and resulting colonies were transferred to potato dextrose agar (PDA). Isolates were characterized by abundant aerial and fast-growing mycelium covering the plate surface after 3 days, mycelium became dark green. Pycnidia contained thick-walled, aseptate conidia 15 to 35 × 10 to 15 µm. Lasidiplodia theobromae was identified based on morphological characteristics (3) and confirmed by banding patterns obtained after the digestion of the 1,200-bp amplicon generated with ITS1 and NL4 primers (2) using restriction endonucleases (2). Single-spore cultures were generated and DNA sequences of the rDNA internal transcribed spacer region, partial sequence of the 5' end of the ß-tubulin gene, and a fragment of the elongation factor further confirmed the identification and revealed genetic similarity with other isolates of L. theobromae. A sequence of each fragment was deposited in GenBank with Accession Nos. EU600925, EU597297, and EU597298, respectively. Pathogenicity tests were conducted on four replicate rootstocks (110R) and 15 canes of current-season growth (cv. Tempranillo). Plants were inoculated with an agar plug containing L. theobromae; controls were treated with agar only. Grapevines were maintained in a greenhouse at 20 to 25°C. After 3 months, L. theobromae was reisolated from internal vascular lesions in 100 and 66% of inoculated rootstocks and canes, respectively. Control plants were asymptomatic and L. theobromae was not recovered. Using the same methodology, a fungus identified based on morphological characteristics in culture as Cryptovalsa ampelina (1) was isolated from grapevines (cv. Tempranillo) planted in 1987. Cultures in PDA were white to creamy white and cottony with diffuse margins. Colonies covered the 90-mm-diameter petri dish surface in 5 days. Conidia were 20 to 23 × 1 to 1.5 µm, unicellular, hyaline, and filiform. PCR amplifications of the DNA extracts of C. ampelina with Camp-1 and Camp-2R primers gave a characteristic DNA fragment of 300 bp (3) and DNA sequences of the ITS4-ITS5 amplicons (GenBank Accession No. EU597296) confirmed the identification. For the first time, the 5' end of the ß-tubulin gene was sequenced and deposited in GenBank (Accession No. EU600926). Pathogenicity tests were conducted as described above for L. theobromae. Both pathogens were examined in the same experiment. C. ampelina was reisolated from internal brown streaking lesions in 25% of the rootstocks and 33% of the canes. Control plants exhibited no symptoms. L. theobromae appeared to be a more aggressive pathogen than C. ampelina on grapevine with more internal brown streaking and greater recovery of pathogen from inoculated samples. To our knowledge, this is the first report of L. theobromae and C. ampelina causing grapevine decline in Castilla y León. References: (1) J. Luque et al. Phytopathol. Mediterr. 45:S101, 2006. (2) M. T. Martin and R. Cobos. Phytopathol. Mediterr. 46:18, 2007. (3) D. Pavlic et al. Stud. Mycol. 50:313, 2004.

Neuroradiologic correlation with aphasias. Cortico-subcortical map of language. / Correlación neurorradiológica de las afasias. Mapa cortico-subcortical del lenguaje.

Aphasia is an acquired language disorder due to a cerebral lesion; it is characterized by errors in production, denomination, or comprehension of language. Although most aphasias are mixed, from a practical point of view they are classified into different types according to their main clinical features: Broca's aphasia, Wernicke's aphasia, conduction aphasia, transcortical aphasia, and alexia with or without agraphia. We present the clinical findings for the main subtypes of aphasia, illustrating them with imaging cases, and we provide an up-to-date review of the language network with images from functional magnetic resonance imaging and tractography.

STAT4 confers risk for rheumatoid arthritis and systemic lupus erythematosus in Mexican patients.

STAT4 has been consistently associated with several autoimmune diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The aim of this study was to determine whether the STAT4 rs7574865G/T polymorphism confers susceptibility for RA and SLE in a sample of Mexican patients. This study included 869 individuals: 415 patients with RA, 128 patients with SLE, and 326 controls. Genotyping using TaqMan probes showed an association between the STAT4 rs7574865G/T polymorphism and RA (GG vs. TT: OR 1.99, p=0.0009; G vs. T: OR 1.42, p=0.0009) and SLE (GG vs. TT: OR 2.98, 0.0003; G vs. T: OR 1.74, p=0.0002). Gender stratification showed an association with RA (GG vs. TT: OR 1.99, 95% CI 1.3-3.1, p=0.002; G vs. T: OR 1.42, 95% CI 1.1-1.8, p=0.002) and SLE (GG vs. TT: OR 3.3, 95% CI 1.7-6.2, p=0.0002; G vs. T: OR 1.8, 95% CI 1.3-2.4, p=0.0002) in women. Thus, the STAT4 rs7574865G/T polymorphism confers risk for RA and SLE in the Mexican population.

The functional PTPN22 C1858T polymorphism confers risk for rheumatoid arthritis in patients from Central Mexico.

Rheumatoid arthritis (RA) is a complex genetic disease. Human leukocyte antigen (HLA) and non-HLA genes are reportedly associated with an increased risk of RA. The protein tyrosine phosphatase non-receptor 22 gene (PTPN22), which encodes the lymphoid tyrosine phosphatase (LYP) protein, is one of the best examples of a non-HLA gene associated with a risk for RA in several populations. The functional PTPN22 C1858T (R620W) non-synonymous polymorphism is widely associated with an increased risk for RA in Europeans and non-Europeans. The aim of this study was to determine if the PTPN22 C1858T polymorphism confers susceptibility to RA in a sample of patients from Mexico. This study included 364 RA patients and 387 non-related controls from Central Mexico. Genotyping of the PTPN22 C1858T (rs2476601) polymorphism was performed using allelic discrimination assays with TaqMan probes. The functional PTPN22 C1858T polymorphism was associated with an increased risk for RA in our study population. The CC vs CT genotype in RA patients versus healthy controls had an odds ratio (OR) of 4.17 (95 % CI 1.79-9.74, p = 0.00036), while T allele had an OR of 4.06 (95 % CI 1.75-9.41, p = 0.00043). PTPN22 is a genetic risk factor for developing RA in the Mexican population.

Strength exercise and training in postprandial lipaemia.

The development of cardiovascular diseases (CVD) has been associated to alterations on lipid profile as well found during postprandial period, phenomenon known as postprandial lipaemia (PL). Physical exercise is currently the major non-pharmacological intervention used to prevention and reduction of risk factors to developing of CVD. For this reason, there is growing interest under the effects of physical exercise, especially strength training, on regulation and balance of lipid metabolism, particularly of risk groups such as post-menopausal women that have more prone to CVD than men and lose much of the cardioprotective effect of estradiol during and after menopause period. In this review, we seek to compare the results of articles that addressed the beneficial effects of strength training on PL. We used articles selected in databases PubMed, Scopus and EBSCO dating from the year 1975-2012, with many quotes from leading researchers in subject and published in international journals. All studies were obtained to report at least three variables of interest. The authors of this review concluded that strength training proves to be effective in reducing PL concentrations by inducing an improvement of basal energy demand, can be seen as an important strategy to treatment of chronic diseases such as atherosclerosis.

Cutaneous manifestations of acrodynia (pink disease).

A 14-month-old girl who presented with multiple systemic complaints was found to have gingivitis, peeling of her palms and soles, and a peculiar acral eruption. A diagnosis of acrodynia, or pink disease, was confirmed by elevated levels of mercury in the urine. The many cutaneous manifestations of this once common disease are discussed.

[Comparison of 2 educational interventions in the training of resident physicians]. / Comparación de dos intervenciones educativas en la formación de médicos residentes.

OBJECTIVE: To compare the results of two educational interventions, habitual versus experimental, in a group of pediatric residents. METHODS: We evaluated 7 residents in the last 4 months of their first year training by incorporating additional hours of an Experimental Intervention (EI) to their Habitual Training (HT). During EI we forced group discussion and debate in the classroom activities in contrast with the HT which was a passive approach of lectures with little or no participation by the trainees. We used a previously developed Differential Scale of a Group Interaction (DSGI) to score groupal activities conducive to better learning during EI and HT at 1, 6 and 11 weeks of starting EI. Simultaneously, the individual participations were scored with an Observation Guide of Discussion and Debate (OGDD) but only during EI as it would score near zero during HT. RESULTS: The DSGI scores were significantly and increasingly higher during EI than during HI at 1, 6 and 11 weeks of EI. All trainees improved their OGDD score after 6 and 11 weeks of EI. CONCLUSIONS: The educational microenvironment created by the Experimental Intervention improved the knowledge and aptitudes for discussion and debate of the trainees. Their increased use of critical exchanges and confrontations of ideas contributed to a better construction of their knowledge as pediatric residents.

[Learning orientation in the specialty of pediatrics]. / La orientación del aprendizaje en la especialidad de pediatría.

OBJECTIVE: To investigate in first year pediatric residents whether they increase their knowledge by questioning, debate and discussion. METHODS: The participants were 53 residents from 6 hospitals of the Mexican Social Security system. A Differential Scale of Group Interaction (DSGI) was constructed and validated. It had subscales A and B to assess group interactions (A) and individual construction of knowledge (B). Scoring with the DSGI was done in the 6 hospitals by two observers on different occasions. RESULTS: Sub-scale A showed a significant interhospitals differences with a Kruskal-Wallis ANOVA (p < .001) whereas the 6 hospitals showed the minimum score in Subscale B with obviously no interhospital differences. Two items in Subscale A (Individual work and Trainee participation) showed a high concordance between observers (weighted kappas of 0.66 and 0.59) but it was negative (kw = -0.20) in "Time participation". CONCLUSIONS: Our results showed that there were differences in group interactions of the hospitals but without any apparent reflection on the construction of knowledge in the trainees. These observations suggest to us that there was an orientation toward a passive consuming of information by these participants.

[Aptitude for the critical reading of clinical research articles among psychiatry residents]. / Aptitud para la lectura crítica de artículos de investigación clínica en residentes de psiquiatría.

OBJECTIVE: To estimate the aptitude for the critical reading of papers of clinic research of psychiatry residents of the Mexican Institute of the Social Security in Mexico City. METHODS: A total of 34 residents from two hospitals (A and B) participated. Measuring instrument with abstracts of published research papers and 96 items was constructed to explore their abilities of interpretation, discernment and critical reading. Its reliability was of 0.88. RESULTS: The median of Hospital A was 11 and Hospital B was 9 and the global of 9.5 (p NS). There were no differences of results according to the year of residency (I, II and III) nor in the indicators. Most of the participants (n = 26, 76%) had a score below 18 which would be the score if answered in a random fashion. CONCLUSIONS: Critical reading of the participants was very low. Our results suggest that the bibliography sessions of the psychiatry residents were oriented to consumption of information and that critical reading of research papers was absent or very poor.

[Epidural abscess after a cervical catheter]. / Absceso epidural consecutivo a catéter cervical.

Epidural abscess following catheterization is a rare complication. When it occurs it usually affects cancer patients with poor or suppressed immune response or patients with sepsis. We present a healthy patient in whom an epidural cervical catheter was placed to provide analgesia during rehabilitation of an upper limb and who developed an epidural abscess one month later after few warning signs. We point out the need to suspect this complication and rule it out or confirm it upon the appearance of any sign of meningeal irritation. We emphasize the importance of imaging techniques computed axial tomography and nuclear magnetic resonance for diagnosis and confirmation, to allow for early surgical resolution.

Human leukocyte antigen typing in tuberculous rheumatism: Poncet's disease.

SETTING: Tuberculous rheumatism (Poncet's disease) is a reactive polyarthropathy associated with extra-pulmonary and pulmonary tuberculosis (TB) without evidence of mycobacterial infection of the involved joints. As all patients with TB do not present with this peculiar clinical feature, a genetic susceptibility is suspected. OBJECTIVE: To determine the major histocompatibility complex (MHC) class I and II alleles in Mexican mestizo patients with Poncet's disease. DESIGN: In this case-control study of 16 Mexican mestizo patients diagnosed with Poncet's disease and 99 ethnically matched healthy controls, high resolution human leukocyte antigen (HLA) typing was performed for HLA-A, B, DR and DQ by polymerase chain reaction. HLA-DRB1 and HLA-DQB1 subtypes were performed by sequence-specific oligonucleotide probe hybridization. RESULTS: A significantly increased frequency of HLA-B27 (corrected P = 0.01) and DQB1*0301 (corrected P = 0.0009) alleles and decreased frequency of HLA-DQB1*0302 (corrected P = 0.00001) were identified in patients compared to healthy controls. CONCLUSION: These data suggest that genes located within the MHC may play a role in the susceptibility to Poncet's disease in patients diagnosed with TB.

[Osmophobia analysis in primary headache]. / Análisis de la osmofobia en las cefaleas primarias.

INTRODUCTION: Osmophobia is often reported by migraine patients. This study evaluates osmophobia in connection with the diagnosis of episodic migraine with or without aura, chronic migraine and episodic and chronic tension-type headache. METHODS: We recruited from our Headache Unit 68 patients (59 female, 9 male; age 37+/-14.7 years), of whom 24 were migraine without aura (MoA), 11 migraine with aura (MA), 10 chronic migraine (CM) and 23 TTH (episodic-TTH). Patients with two or more forms of primary headache were excluded. RESULTS: Among migraine patients, 54% with MoA and 0% with MA, 40 %CM reported osmophobia during the attacks; none of the 23 TTH patients suffered this symptom. The crisis frequency was MoA and osmophobia 2.15 crisis per month; MoA without osmophobia 3,14. MC with osmophobia 22; MC without osmophobia 21.7. CONCLUSIONS: Osmophobia and taste abnormalities were demonstrated to be very specific in diagnosing migraine, but very insensitive. Osmophobia frequency does not depend on migraine frequency. Osmophobia seems to be more frequent in females than in males. The lack of osmophobia in MA patients could be explained by a different pathophysiological mechanism between MA and MoA.