The complexity of classifying ANCA-associated small-vessel vasculitis in actual clinical practice: data from a multicenter retrospective survey.

The different sets of criteria for diagnosis or classification of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) lead to numerous overlapping and reclassified diagnoses in clinical practice. We designed this study to assess the difficulties in classifying patients with AAV. As a secondary objective, different variables were tested to predict prognosis. We conducted a retrospective chart review in a Western Spain multicentre survey. A total of 115 adult patients diagnosed with AAV from 2002 to 2013 and followed for at least 3 years were included. They were classified according to (1) Chapel Hill Consensus Conference (CHCC), (2) European Medicines Agency algorithm and (3) French Vasculitis Study Group/European Vasculitis Society phenotypes. Fifty-three patients (46%) had neither distinctive histopathological data of a single AAV definition nor any surrogate markers for granulomatous inflammation and thus did not fulfill any diagnostic criteria. Ocular, ear, nose, throat, skin, and lung involvement were more frequent with proteinase 3 (PR3) antibodies, whereas peripheral neuropathy was more frequent with myeloperoxidase (MPO) antibodies. When the disease was severe at diagnosis, the HR for mortality was 10.44. When induction treatment was not given in accordance with the guidelines, the HR for mortality was 4.00. For maintenance treatment, the HR was 5.49 for mortality and 2.48 for relapse. AAV classification is difficult because many patients had neither specific clinical data nor distinctive histological features of a single CHCC definition. A structured clinical assessment of patient severity is the best tool to guide the management of AAV.

E2mC: Improving Emergency Management Service Practice through Social Media and Crowdsourcing Analysis in Near Real Time.

In the first hours of a disaster, up-to-date information about the area of interest is crucial for effective disaster management. However, due to the delay induced by collecting and analysing satellite imagery, disaster management systems like the Copernicus Emergency Management Service (EMS) are currently not able to provide information products until up to 48-72 h after a disaster event has occurred. While satellite imagery is still a valuable source for disaster management, information products can be improved through complementing them with user-generated data like social media posts or crowdsourced data. The advantage of these new kinds of data is that they are continuously produced in a timely fashion because users actively participate throughout an event and share related information. The research project Evolution of Emergency Copernicus services (E2mC) aims to integrate these novel data into a new EMS service component called Witness, which is presented in this paper. Like this, the timeliness and accuracy of geospatial information products provided to civil protection authorities can be improved through leveraging user-generated data. This paper sketches the developed system architecture, describes applicable scenarios and presents several preliminary case studies, providing evidence that the scientific and operational goals have been achieved.

Association of haplotypes of the TLR8 locus with susceptibility to Crohn's and Behçet's diseases.

OBJECTIVES: The aim of this study was to investigate the role of the TLR8, a mediator of innate inflammatory response, in susceptibility to two immune-mediated disorders characterised by dysregulation of the immune response, Crohn's and Behçet's diseases (CD and BD). METHODS: A total of 844 CD, 371 BD patients and 1385 controls were genotyped in 8 tag single nucleotide polymorphisms (tSNPs) in the locus TLR8 (chromosome X). All these tSNPs have a minor allele frequency greater than 0.05 in the Caucasian population. RESULTS: The rs2407992 and the rs5744067 were associated with susceptibility to BD and CD, respectively (OR=1.34, 95%CI=1.10-1.62, p=0.0025 and OR=0.82, 95%CI=0.68-0.99, p=0.045, respectively). Although after stratification by gender, statistically significant differences in the distribution of the aforementioned SNPs were only observed in the females groups (BD OR=1.31, 95%CI=1.06-1.64, p=0.012 and CD OR=0.84, 95%CI=0.72-0.98, p=0.044) the trend was similar among males. Since the rs5744067 and rs2407992 are located in the same linkage disequilibrium block, we performed a haplotypic analysis by combination of the tSNPs. One haplotype (H1) was identified as a protective factor in BD (OR=0.75, 95%CI=0.62-0.90, p=0.0027) and another (H2) as a protective factor in CD (OR=0.78, 95%CI=0.64-094, p=0.0102). No statistically significant differences in the mean of the levels of expression attributable to the haplotype variants were found in the in silico analysis performed. CONCLUSIONS: Our results suggest a relationship between the TLR8 and the susceptibility to CD and BD. Nevertheless, these differences could not be imputed to the levels of expression.

Thalidomide in refractory bleeding due to gastrointestinal angiodysplasias.

OBJECTIVES: to assess the efficacy of thalidomide in the treatment of relapsed or refractory bleeding secondary to gastrointestinal angiodysplasia. MATERIAL AND METHODS: we carried out a prospective study of 12 patients with bleeding due to gastrointestinal angiodysplasia refractory to conventional therapy who were treated with thalidomide. For each patient, we considered: age, sex, underlying disease, previous therapies, dose and duration of thalidomide treatment, evolution of haemoglobin levels and adverse effects of treatment. The data obtained were analysed using descriptive statistics with SPSS v. 16. RESULTS: seven men and 5 women with a mean age of 77 years were included in the present study. Five had some underlying pathology and all of them had received prior endoscopic/octreotide treatment. The dose of thalidomide administered was 200 mg/24 h and the duration of the treatment four months, with the exception of two patients in whom treatment was discontinued because of adverse side effects. Mean haemoglobin concentration before onset of treatment was 6.5 g/dL, at two months it was 11.3 g/dL and at the end of treatment 12.1 g/dL. CONCLUSIONS: thalidomide is an effective treatment in gastrointestinal bleeding due to angiodysplasia, but it was withdrawn due to side effects in 16% of the patients included in our study.

[An exceptional case of choledochocele and pancreas divisum in an elderly man]. / Un caso excepcional de coledococele y páncreas divisum de presentación en el anciano.

Choledochocele belongs to type III biliary cysts in Todani's classification and are considered the least frequent cysts in this class. The usual definition of choledochocele is that of a cystic expansion of the distal intramural portion of the bile duct that protrudes into the duodenal lumen. Endoscopic retrograde cholangiopancreatography (ERCP) is one of the tests of choice both for diagnosis and treatment. We report the case of a 77-year-old patient with chronic epigastric pain, nausea/vomiting and episodes of cholangitis due to a choledochocele. Magnetic resonance cholangiography and other radiological procedures (ultrasound, computed tomography, magnetic resonance) were not diagnostic. ERCP was essential to diagnosis and treatment since this procedure provided the treatment by means of biliary sphincterotomy.

Obesity as a Risk Factor for Severe COVID-19 in Hospitalized Patients: Epidemiology and Potential Mechanisms.

SARS-CoV-2 infection is a global public health problem, causing significant morbidity and mortality. Evidence shows that obesity is a recognized risk factor for hospitalization, admission to critical care units, and the development of serious complications from COVID-19. This review analyzes the available epidemiological evidence that relates obesity to a higher risk of severity and mortality from COVID-19, examining the possible pathophysiological mechanisms that explain this phenomenon on a cellular and molecular level.

Predicting mortality for Covid-19 in the US using the delayed elasticity method.

The evolution of the pandemic caused by COVID-19, its high reproductive number and the associated clinical needs, is overwhelming national health systems. We propose a method for predicting the number of deaths, and which will enable the health authorities of the countries involved to plan the resources needed to face the pandemic as many days in advance as possible. We employ OLS to perform the econometric estimation. Using RMSE, MSE, MAPE, and SMAPE forecast performance measures, we select the best lagged predictor of both dependent variables. Our objective is to estimate a leading indicator of clinical needs. Having a forecast model available several days in advance can enable governments to more effectively face the gap between needs and resources triggered by the outbreak and thus reduce the deaths caused by COVID-19.

[Primary small bowel neoplasms as a complication of celiac disease]. / Neoplasias primarias de intestino delgado como complicación de la enfermedad celíaca.

Celiac disease is produced by gluten intake in genetically susceptible children and adults and is the most common severe food intolerance in western countries. Eliminating gluten from the diet is essential in these patients, since most of the complications that can occur are more frequent if there is lack of treatment adherence. The most serious complication in these patients is the development of neoplasms, the most frequent being enteropathy-associated T-cell lymphoma; however, an increase in the incidence of small bowel adenocarcinoma has also been described. We present two cases of small bowel carcinoma in patients with celiac disease, which were diagnosed at the onset of the disease.

[Reproduction, diet and fishery of Octopus (Octopus) hubbsorum (Mollusca: Cephalopoda) in the coast of Oaxaca, Mexico]. / Reproducción, dieta y pesquería del pulpo Octopus (Octopus) hubbsorum (Mollusca: Cephalopoda) en la costa de Oaxaca, México.

The octopus Octopus hubbsorum (Berry 1953) ranges widely and is important for the artisanal fishery in Puerto Angel, Oaxaca, Mexico. Samples were taken approximately at every two weeks from January 2002 to November 2003. All organisms were measured for dorsal mantle length (DLM) and total weight; sex and maturity gonadic stage were registered. For the stomach content analysis, frequency of occurrence and emptying indexes were used. The 352 organisms caught ranged from 4 to 18 cm in DLM; the sex ratio was different from 1 (chi2 = 24.2, p<0.05) throughout the year. The maximum values of the GSI appeared in May (4.1917 for females; 1.2675 in males). LDM for first sexual maturity (LDM50%) was 16 cm (females) and 14 cm (males). Octopus hubbsorum moves from deep waters to the coast, probably in search of better conditions, and lays masses of eggs on rocky substrata. They are fished from March to October, with higher intensity in April and May. Fishing effort was related to the oceanographic characteristics and the atmospheric conditions of the area. From April to September the CPUE monthly mean was 20-10 kg/divers/day. Using the CPUE and environmental condition relationship, the estimated adequate superficial temperature for fishing is 29.5 degrees C.

Experimental Model of HindLimb Suspension-Induced Skeletal Muscle Atrophy in Rodents.

Due to the difficulty of performing research protocols that reproduce human skeletal muscle disuse conditions, an experimental animal model of "hindlimb suspension" (or hindlimb unloading) was developed. This method was created in the 1970s and utilizes rats and mice to mimic space flight and bed rest in humans. It provides an alternative to investigate mechanisms associated with skeletal muscle mass loss and interventions designed to attenuate atrophy induced by hindlimb unloading. The mentioned protocol also allows investigating quality of bones and changes in several physiological parameters such as blood pressure, heart rate, plasma or tissue lipid composition, and glycemia.

Association between CAPN10 UCSNP-43 gene polymorphism and polycystic ovary syndrome in Chilean women.

BACKGROUND: Studies have suggested that the Calpain-10 gene polymorphisms may play a role in polycystic ovary syndrome (PCOS) susceptibility. Thus, the aim of the present study was to evaluate the possible association between three single nucleotide polymorphisms (SNPs) in the calpain-10 gene (UCSNPs -43, -19, and -63) and polycystic ovary syndrome (PCOS) in Chilean women. METHODS: Fifty women with PCOS (28.8+/-8.2 y) and 70 healthy women (28.6+/-8.6 y) were included in this study. Serum lipids, hormonal status, fasting glucose, oral glucose tolerance test (OGTT), insulin, HOMAIR, and uric acid levels were determined by conventional methods. The calpain-10 gene variants were detected by PCR and PCR-RFLP, respectively. RESULTS: The presence of uncommon allele (A) for the UCSNP-43 was associated with increased risk of PCOS (odds ratio=1.93, 95% CI: 1.11-3.34). The UCSNP-63 (OR=1.11, 95% CI: 0.59-2.11) and UCSNP-19 (OR=0.93, 95% CI: 0.55-1.57) were not associated to PCOS. However, the PCOS women carrying the CC genotype for UCSNP-63 exhibited higher values of total cholesterol and LDL-C (P<0.05). Similarly, control women carrying the CC genotype showed higher serum levels of triglycerides, HDL-C and uric acid (P<0.05). CONCLUSION: Our data suggest the contribution of CAPN10 UCSNP-43 gene polymorphism to PCOS in Chilean women. However, further studies with larger samples are necessary to confirm this observation.

[Intestinal lymphoma and mesenteric panniculitis: complications of undiagnosed celiac disease]. / Linfoma intestinal y paniculitis mesentérica: complicaciones de una enfermedad celíaca no diagnosticada.

Celiac disease is the most common severe food intolerance in the Western world and is due to gluten ingestion in genetically susceptible children and adults. The key treatment in these patients is a gluten-free diet, because most complications are more common when dietary compliance is poor. The most serious complication of celiac disease is the development of neoplasms (the most common of which is enteropathy-associated T-cell lymphoma). However, a number of reports have indicated an increased prevalence of ulcerative jejunitis and extraintestinal manifestations, including chronic hepatitis, fibrosing lung disease, and epilepsy syndromes. We report the case of a 53-year-old-man with long-standing diarrhea; because celiac disease was not suspected, the patient developed celiac-associated T-cell lymphoma and mesenteric panniculitis.

Reproduction of the fish Poeciliopsis gracilis (Cyprinodontiformes: Poeciliidae) in Coatetelco, a tropical shallow lake in Mexico.

A reproductive analysis of 1225 specimens of Poeciliopsis gracilis obtained through monthly samples from Coatetelco, a tropical shallow lake in Central Mexico, was made. There was an evident sexual dimorphism, including a difference in body size at the onset of reproduction. Sex ratio deviated significantly from unity. Monthly variations in gonadosomatic (GSI), hepatosomatic (HSI) indexes and ovarian development stages showed that the spawning season was from July to October, coinciding with the rainy season and phytoplankton biomass increase. The largest sizes were 50 mm for females and 43 mm for males.

Age and growth of the tilapia, Oreochromis niloticus (Perciformes: Cichlidae) from a tropical shallow lake in Mexico.

Age and growth of Nile tilapia (Oreochromis niloticus) were determined using 1039 specimens collected in a tropical shallow lake of Mexico, from January to December 1993. Standard length of females ranged from 9.0 to 16.5 cm and males from 8.9 to 14.8 cm. The standard length-weight relationships for all individuals was BW=0.1207 SL2469. The age data, derived from opercular bone readings, were used to estimate the growth parameters of the von Bertalanffy equation: Lx=17.88 cm, K=0.3409, t0=-1.543, and Winfinity=149.21 g. The oldest male and female were 2.5 years old. The sex ratio (female:male) was of 1:1 (chi2=0.02, p>0.05).

Physical Inactivity, Sedentary Behavior and Chronic Diseases.

New research into physical activity suggests that it is no longer sufficient just to meet minimum levels recommended by health guidelines in order to reduce cardiovascular risk. Both physical inactivity and sedentary behavior have their own health hazards and need to be addressed separately, in order to explore their different deleterious mechanisms. The aim of this review was to define and to characterize both concepts, and their relationship with major non-communicable chronic diseases. A PubMed database search was undertaken, using the following key words: physical activity, physical inactivity, sedentarism, sedentary behavior, and non-communicable chronic disease. This literature review provides an updated view on physical inactivity and sedentary behavior, and reevaluates their prevalence and association with major non-communicable chronic disease.

Calcificación miocárdica de etiología multifactorial / Myocardial calcification with multifactorial etiology

En el presente trabajo se describe un caso de muerte súbita en una mujer de 70 años que fallece 20 días después de ser dada de alta tras ingreso por infección urinaria secundaria a litiasis renal complicada con shock séptico e insuficiencia renal y respiratoria. En el corazón se identificó una cardiopatía isquémica crónica y extensas áreas de miocardio calcificado. Además, se exponen los tipos de calcificaciones del miocardio existentes y sus causas; y se analizan aquellos factores que en el caso presentado han podido causar la calcificación del miocardio(AU)

In the present report, we describe a case of sudden death in a 70-year-old woman who died 20 days after been discharged after admission for urinary infection secondary to renal lithiasis complicated with septic shock and renal and respiratory failure. It has been identified chronic ischemic heart disease and extensive areas of calcified myocardium. Also, we review myocardial calfications subtypes and its causes, and we analyze the specifics of the presented case(AU)

Análisis bacteriológico de piezas de mano de alta velocidad utilizadas en la práctica clínica / Bacteriological analysis of high speed handpieces used in clinical practice

Los profesionales de la salud están expuestos a una gran variedad de microorganismos desde esporas, bacterias, hongos, virus y protozoarios que pueden encontrarse en la sangre y/o saliva de los pacientes. Cualquiera de estos microorganismos puede causar una enfermedad infectocontagiosa a través de pinchazos y/o salpicaduras producidas por el aerosol durante la práctica dental. Objetivo: Determinar la presencia bacteriana en las piezas de alta velocidad utilizadas en la práctica clínica. Material y métodos: Es un estudio experimental, observacional y transversal en el que se evaluó la contaminación de 30 piezas de alta velocidad utilizadas en la práctica clínica. Previo al estudio se efectuó una estandarización obteniendo una kappa del 0.85. Se realizó una base de datos en el programa SPSS versión 22, con el que se llevó a cabo el análisis descriptivo para determinar medidas de tendencia central. Resultados: 73.3% de las muestras analizadas tuvieron crecimiento bacteriano, entre las bacterias que se encontraron resultó que 54.5% de ellas fueron bacterias Gram positivas y el resto Gram negativas. La bacteria con mayor presencia en la muestra fue el Bacillus en 45.5% seguida del Streptococcus en 27.3%, el restante 27.2% fue Staphylococcus, Coccus y Streptobacillus. Conclusiones: El uso correcto de las piezas de alta, así como su desinfección en la consulta dental es de suma importancia, ya que nos ayudan a evitar contaminaciones cruzadas y a prevenir que dentro del área de trabajo se formen focos de infección (AU)

Health professionals are exposed to a wide variety of microorganisms from spores, bacteria, fungi, viruses and protozoa that can be found in the blood and/or saliva of patients. Any of these microorganisms can cause an infectious disease through punctures and / or splashes produced by the aerosol during dental practice.1,2 Objective: To determine the bacterial presence in the high-speed pieces used in clinical practice. Material and methods: It are an experimental, observational and transversal study; where the contamination of 30 high-speed pieces used in clinical practice was evaluated. Prior to the study, a standardization was made obtaining a kappa of 0.85. A database was made in the program SPSS version 22, with which the descriptive analysis was carried out to determine measures of central tendency. Results: 73.3% of the analyzed samples showed bacterial growth, among the bacteria that were found, 54.5% of them were gram-positive bacteria and the rest were gram-negative. The bacterium with the highest presence in the sample was for Bacillus in 45.5% followed by Streptococcus in 27.3%, the remaining 27.2% was for Staphylococcus, Coccus and Streptobacillus. Conclusions: The correct use of the discharging parts, as well as their disinfection in the dental practice is of the utmost importance as they help us to avoid cross contamination and to prevent foci of infection from forming within the work area (AU)