Comparison of different PCR amplification targets for molecular diagnosis of Strongyloides stercoralis.

Molecular techniques are an alternative for the diagnosis of strongyloidiasis, produced by Strongyloides stercoralis. However, it is necessary to determine the best amplification target for the populations of this parasite present in a geographical area and standardize a polymerase chain reaction (PCR) protocol for its detection. The objectives of this work were the comparison of different PCR targets for molecular detection of S. stercoralis and the standardization of a PCR protocol for the selected target with the best diagnostic results. DNA extraction was performed from parasite larvae by saline precipitation. Three amplification targets of the genes encoding ribosomal RNA 18S (18S rDNA) and 5.8S (5.8S rDNA) and cytochrome oxidase 1 (COX1) of S. stercoralis were compared, and the PCR reaction conditions for the best target were standardized (concentration of reagents and template DNA, hybridization temperature, and number of cycles). The analytical sensitivity and specificity of the technique were determined. DNA extraction by saline precipitation made it possible to obtain DNA of high purity and integrity. The ideal target was the 5.8S rDNA, since the 18S rDNA yielded non-reproducible results and COX1 never amplified under any condition tested. The optimal conditions for the 5.8S rDNA-PCR were: 1.5 mM MgCl2, 100 µM dNTPs, 0.4 µM primers, and 0.75 U DNA polymerase, using 35 cycles and a hybridization temperature of 60 °C. The analytical sensitivity of the PCR was 1 attogram of DNA, and the specificity was 100%. Consequently, the 5.8S rDNA was shown to be highly sensitive and specific for the detection of S. stercoralis DNA.

Efecto condicional de las actitudes hacia pacientes con diagnósticos de salud mental sobre la toma de decisiones en contexto de urgencia según la autopercepción de conocimientos asociados al trabajo con pacientes de salud mental

Introducción: En la actualidad existen pocos estudios con respecto a la evaluación de actitudes y autopercepción de conocimientos de los profesionales de la salud hacia los pacientes con alguna condición de salud mental, y la relación de estas variables con la toma de decisiones respecto de estos pacientes. Desde la experiencia se conoce la dificultad que tienen médicos que no están relacionados con el área de salud mental de afrontar a pacientes con alguna patología psiquiátrica y más aún en las urgencias, ya sea porque reconocen falta de conocimientos del tema, instancias no adecuadas para evaluación además de la alta exigencia de estos servicios. Metodología: El estudio consistió en una encuesta online de carácter transversal aplicada a profesionales de la salud pertenecientes al Hospital Dr. Hernán Henríquez Aravena, ubicado en la ciudad de Temuco, Chile. La encuesta incluyó preguntas sociodemográficas, caracterización de experiencias asociadas a diagnósticos de salud mental, y escalas dedicadas a medir variables (autopercepción, actitudes y toma de decisiones). Resultados: A medida que la autopercepción de conocimientos es mayor, el efecto de las actitudes sobre la toma de decisiones también es mayor. Conclusiones: Tanto las actitudes de los profesionales de la salud hacia este tipo de pacientes, así como su autopercepción de conocimientos, son dos componentes fundamentales para asegurar un buen manejo clínico. Resulta importante que exista un balance en cómo se manejan ambas dentro de un servicio, con el fin de asegurar una atención apropiada y centrada en el bienestar del paciente.

Introduction: Currently there are few studies regarding the evaluation of attitudes and self-perception of knowledge of health professionals towards patients with some mental health condition, and the relationship of these variables with decision making regarding these patients. From experience, its known the difficulty that doctors who are not related to the area of mental health have in dealing with patients with some psychiatric pathology and even more so in emergencies, either because they recognize a lack of knowledge of the subject and instances that are not suitable for evaluation. in addition to the high demand of these services. Methodology: The study consisted of a cross-sectional online survey applied to health professionals belonging to the Dr Hernán Henriquez Aravena Hospital, located in the city of Temuco, Chile. The survey included sociodemographic questions, characterization of experiences associated with mental health diagnoses, and scales dedicated to measuring variables (self-perception, attitudes and decision making). Results: As self-perception of knowledge grows, the effect of attitudes on decision making also increases. Conclusions: Both the attitudes of health professionals towards this type of patients, as well as their self-perception of knowledge, are two fundamental components to ensure good clinical management. It is important that there is a balance in how both are managed within a service, in order to ensure appropriate care focused on the patient's well-being.

Ceftaroline as salvage therapy for methicillin susceptible Staphylococcus aureus complicated bacteremia.

Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with complicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.

Las infecciones causadas por Staphylococcus aureus sensible a la meticilina (SASM) todavía se asocian con una morbilidad y mortalidad significativas. Se han informado fallas en el tratamiento de cefazolina (CFZ) probablemente relacionadas con efecto inóculo. Nuevos tratamientos son necesarios para estas infecciones y ceftarolina fosamil (CPT) podría ser una opción. Nuestro objetivo fue describir las características clínicas de cinco pacientes con bacteriemia por SASM complicada con falla a CFZ y que fueron exitosamente tratados con CPT. Realizamos una revisión retrospectiva de historias clínicas en un hospital de Buenos Aires, Argentina; en un período de 12 meses, cinco pacientes (24%) de 21 con bacteriemia por SASM experimentaron falla a CFZ y fueron tratados con CPT. La mediana de tiempo de la terapia con CFZ fue de 10 días antes de cambiar a CPT; cuatro pacientes presentaban evidencia de diseminación metastásica y 2 tenían endocarditis. Todos los pacientes experimentaron curación microbiológica y clínica con CPT, que se utilizó como monoterapia en 4 y en combinación con daptomicina en otro. Un paciente interrumpió CPT debido a neutropenia el día 23 de tratamiento. En enfermos con infecciones graves por SASM que fallan en la terapia actual, CPT podría ser una buena opción terapéutica.

Ceftaroline as salvage therapy for methicillin susceptible staphylococcus aureus complicated bacteremia / Ceftarolina como tratamiento de rescate para la bacteriemia complicada por Staphylococcus aureus sensible a la meticilina

Abstract Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with com plicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.

Resumen Las infecciones causadas por Staphylococcus aureus sensible a la meticilina (SASM) todavía se asocian con una morbilidad y mortalidad significativas. Se han informado fallas en el tratamiento de cefazolina (CFZ) probablemente relacionadas con efecto inóculo. Nuevos tratamientos son necesarios para estas infecciones y ceftarolina fosamil (CPT) podría ser una opción. Nuestro objetivo fue describir las características clínicas de cinco pacientes con bacteriemia por SASM complicada con falla a CFZ y que fueron exitosamente tratados con CPT. Realizamos una revisión retrospectiva de historias clínicas en un hospital de Buenos Aires, Argentina; en un período de 12 meses, cinco pacientes (24%) de 21 con bacteriemia por SASM experimentaron falla a CFZ y fueron tratados con CPT. La mediana de tiempo de la terapia con CFZ fue de 10 días antes de cambiar a CPT; cuatro pacientes presentaban evidencia de diseminación metastásica y 2 tenían endocarditis. Todos los pacientes experimen taron curación microbiológica y clínica con CPT, que se utilizó como monoterapia en 4 y en combinación con daptomicina en otro. Un paciente interrumpió CPT debido a neutropenia el día 23 de tratamiento. En enfermos con infecciones graves por SASM que fallan en la terapia actual, CPT podría ser una buena opción terapéutica.

Vigilancia tecnológica de la utilización de criterios de riesgo para la gestión de equipos biomédicos / Technological surveillance for the use of risk assessment criteria used to manage biomedical equipment / Vigilância tecnológica da utilização de critérios de risco para a gestão de equipamentos biomédicos

El presente artículo expone una vigilancia tecnológica realizada para encontrar criterios de evaluación de riesgos usados para gestionar equipos biomédicos. Se presentan las ecuaciones de búsqueda planteadas con sus respectivos resultados y el análisis de acuerdo con la ecuación con la cual se hallaron los resultados de mayor relevancia. El análisis presentado corresponde a la dinámica de publicación en el tiempo, medios de publicación, autores relacionados, instituciones destacadas, países destacados, tipos de documento y áreas temáticas con el fin de identificar particularmente autores, países, instituciones y medios de publicación líderes en el tema. En la sección de resultados se analizan los artículos de los principales medios de publicación debido a la pertinencia de los enfoques según el marco regulatorio, paciente y dispositivos médicos que ofrecen. Con el análisis de resultados se obtuvo información concluyente que permitió observar la importancia de la generación de normativa que regule los dispositivos médicos durante su ciclo de vida apoyada en la gestión del riesgo, así como la conveniencia de realizar análisis de riesgos basado en evidencia.

This article presents a technological surveillance proposal for risk assessment criteria used to manage biomedical equipment. We present the search equations, along with their respective results and the analysis according to the equation with which the most relevant results were found. The analysis presented corresponds to the dynamics of publications in time, means of publication, related authors, prominent institutions, highlighted countries, document types and thematic areas, in order to identify particular authors, countries, institutions and publishing media leaders on the subject. In the results section, the articles of the main means of publication are analyzed per the pertinence of approaches, according to the regulatory framework, and the patient and medical devices that they offer. From the analysis of results, we obtained conclusive information that enabled us to observe the importance of the generation of norms regulating medical devices during their life cycle, supported by risk management, as well as, the convenience of conducting evidence-based risk analysis.

O presente artigo expõe uma vigilância tecnológica realizada para encontrar critérios de avaliação de riscos usados para gerenciar equipamentos biomédicos. Apresentam-se as equações de busca propostas com seus respectivos resultados e a análise de acordo à equação com a qual acharam-se os resultados de maior relevância. A análise apresentada corresponde à dinâmica de publicação no tempo, meios de publicação, autores relacionados, instituições destacadas, países destacados, tipos de documento e áreas temáticas com o fim de identificar particularmente autores, países, instituições e meios de publicação líderes no tema. Na secção de resultados analisam-se os artigos dos principais meios de publicação devido à pertinência dos enfoques segundo o marco regulamentar, paciente e dispositivos médicos que oferecem. Com a análise de resultados obteve-se informação concludente que permitiu observar a importância da geração de regulamento que regule os dispositivos médicos durante seu ciclo de vida apoiada na gestão do risco, bem como a conveniência de realizar análise de riscos baseado em evidência.

Polymorphism C242T in the Cyp19 gene in meat sheep.

The objective of this study was to evaluate the frequency of C242T polymorphism on the aromatase gene and the allelic and genotypic frequency of these variants in sheep belonging to four breed groups. Blood samples were collected from 187 animals of four breed groups: Dorper, Santa Inês, Texel and White Dorper, originated from herds in the region of Maringá/PR, Brazil. The genomic DNA was extracted using alkaline extraction, with subsequent amplification of the fragments via PCR with specific primer. The samples resulting from amplification were subjected to digestion process using the Dpn II restriction enzyme and to polyacrylamide gel electrophoresis 10.0% and stained with silver nitrate. Three distinct genotypes were observed: homozygous (CC), heterozygous (CT) and homozygous for no cut (TT). The resulting data were analyzed using the POPGENE software with 5% significance. Genotypic frequencies among the breed groups were: Texel (CC - 0.426; CT - 0.511; TT - 0.064), Dorper (CC - 0.073; CT - 0.732; TT - 0.439), White Dorper (CC - 0.021; CT - 0.255; TT - 0.723) and Santa Inês (CC - 0.115; CT - 0.462; TT - 0.423).

Polymorphism C242T in the Cyp19 gene in meat sheep / Polimorfismo no gene cyp19 em ovinos de corte

Abstract The objective of this study was to evaluate the frequency of C242T polymorphism on the aromatase gene and the allelic and genotypic frequency of these variants in sheep belonging to four breed groups. Blood samples were collected from 187 animals of four breed groups: Dorper, Santa Inês, Texel and White Dorper, originated from herds in the region of Maringá/PR, Brazil. The genomic DNA was extracted using alkaline extraction, with subsequent amplification of the fragments via PCR with specific primer. The samples resulting from amplification were subjected to digestion process using the Dpn II restriction enzyme and to polyacrylamide gel electrophoresis 10.0% and stained with silver nitrate. Three distinct genotypes were observed: homozygous (CC), heterozygous (CT) and homozygous for no cut (TT). The resulting data were analyzed using the POPGENE software with 5% significance. Genotypic frequencies among the breed groups were: Texel (CC - 0.426; CT - 0.511; TT - 0.064), Dorper (CC - 0.073; CT - 0.732; TT - 0.439), White Dorper (CC - 0.021; CT - 0.255; TT - 0.723) and Santa Inês (CC - 0.115; CT - 0.462; TT - 0.423).

Resumo O objetivo deste trabalho foi avaliar as frequências alélicas e genotípicas do polimorfismo do C242T no gene da aromatase em ovinos pertencentes a quatro grupos raciais. Foram coletadas amostras de sangue de 187 animais de quatro grupos raciais: Dorper, Santa Inês, Texel e White Dorper, provenientes de rebanhos da região de Maringá, PR - BR. O DNA genômico foi extraído utilizando o método de extração alcalina, com posterior amplificação dos fragmentos via PCR com primer específico. As amostras resultantes da amplificação foram submetidas ao processo de digestão com auxilio da enzima restrição Dpn II e submetido à eletroforese em gel de poliacrilamida de 10,0% e corado nitrato de prata. Foram observados três genótipos distintos: Homozigoto (CC), heterozigoto (CT) e homozigoto para não corte (TT). Os dados resultantes foram analisados utilizando o software POPGENE com significância de 5%. As frequências genotípicas entre os grupos raciais foram: Texel (CC - 0,426; CT - 0,511; TT - 0,064), Dorper (CC - 0,073; CT - 0,732; TT - 0,439), White Dorper (CC - 0,021; CT - 0,255; TT - 0,723) e Santa Inês (CC - 0,115; CT - 0,462; TT - 0,423).

Effect of silymarin plus vitamin E in patients with non-alcoholic fatty liver disease. A randomized clinical pilot study.

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized health problem. Various treatment strategies such as thiazolidinediones, metformin, lipid-lowering agents and antioxidants have been evaluated. So far, no single intervention has convincingly improved liver histology. Experience of using silymarin alone or in combination with other agents in patients with NAFLD is limited in the medical literature. The present study was conducted to evaluate the efficacy of silymarin plus vitamin E in the treatment of NAFLD. PATIENTS AND METHODS: A sample of 36 patients was enrolled. The diagnosis of NAFLD was confirmed by percutaneous liver biopsy. All patients were randomized to one of the following intervention groups: group I: treated with 2 tablets per day of silymarin plus vitamin E (Eurosil 85®, MEDAS SL) and a lifestyle modification program consisting of hypocaloric diet (1520 kcal, 52% of carbohydrates, 25% of lipids and 23% of proteins) and exercise for 3 months and group II (only with the hypocaloric diet). Anthropometric variables as waist circumference, weight, body mass index (BMI) were measured. Biochemical parameters: Glucose, triglycerides, AST, ALT, GGt levels and insulin resistance (HOMA-IR) were determined under fasting conditions. Non-invasive NAFLD-index were applied before and after the treatments: Fatty liver index (FLI), liver accumulation product (LAP) and NAFLD-Fibrosis score (FS). RESULTS: The mean age was 47.4 ± 11.2 years old (range 18-67); 22 men and 14 women. In group I, 11 patients (61%) have a NAS-score > 5 and 10 (55.5%) in the group II (NS). Anthropometric parameters decreased after treatment in both groups. Patients in both groups showed a decrease in GGt levels after treatment (group I: 68 IU/L vs. 46.2 ± 27 IU/L; p < 0.05 and group II 80.5 ± 46 IU/L vs. 50.3 ± 27 IU/L; p < 0.05). Only in group II we observed a significant decrease in AST and ALT levels. In both groups, we observed a decrease in: FLI index (group I: 86.2 ± 19 vs. 76.9 + 20; p < 0.05 and in group II: 85.2 ± 18 vs. 77.5 ± 23; p < 0.05), and NAFLD-FS index (group I: -1.6 ± 1.8 vs. -2.1 ± 1.5; p < 0.05 and in group II -1 ± 1.9 vs. -1.5 ± 2.1; p < 0.05). Patients in group I who did not get a 5% loss of weight also displayed decreased GGt levels, and in the FLI and NAFLD-FS indexes; whereas patients in group II without decrease of 5% by weight showed no improvement in any of the analyzed parameters. CONCLUSIONS: Treatment with silymarin plus vitamin E and a hypocaloric diet ameliorate function hepatic test, and non-invasive NAFLD index. Silymarin can be an alternative valid therapeutic option particularly when other drugs are not indicated or have failed or as a complementary treatment associated with other therapeutic programs.

Características de carcaça de cordeiras Pantaneiras abatidas com diferentes espessuras de gordura subcutânea / Carcass characteristics of Pantaneiro lambs slaughtered with different subcutaneous fat thickness

Foram utilizadas 24 cordeiras do grupo genético Pantaneiro, abatidas com 2,0; 3,0 e 4,0 mm de espessura de gordura, avaliadas por ultrassonografia no Longissimus dorsi. Avaliaram-se características quantitativas de carcaça, do lombo e índice de musculosidade da perna. As cordeiras receberam ração completa misturada calculada para ganho de peso diário de 0,300 kg. Foram realizadas avaliações por ultrassonografia (entre a 12ª e a 13ª costela) e pesagens a cada 14 dias, sendo que os abates ocorriam à medida que as cordeiras atingiam a espessura de gordura pré-determinada: 2,0; 3,0 e 4,0mm. Não houve efeito para rendimento verdadeiro da carcaça, rendimento comercial da carcaça e índice de compacidade da perna. Foi observado maior rendimento do lombo para cordeiras abatidas com 4,0mm de espessura de gordura subcutânea. As espessuras de gordura subcutânea não influenciaram a área de olho de lombo, porém animais com 4,0 mm apresentaram maiores medidas. Foram observadas diferenças nas proporções de músculo, osso e gordura da perna entre as espessuras de gordura subcutânea avaliadas. A musculosidade da perna não foi influenciada com o aumento da espessura da gordura subcutânea. Com base neste estudo e também com as exigências do mercado consumidor, recomenda-se o abate de animais com aproximadamente 3,00 mm de gordura.

Twenty-four female lambs, all from the Pantaneiro genetic group, slaughtered with 2.0; 3.0 and 4.0 mm of subcutaneous fat thickness measured by ultrasound in Longissimus dorsi, were used. We evaluated quantitative carcass traits, loin and leg muscularity. The lambs were fed with total ration calculated for daily weight gain of 0.3 kg. Ultrasound evaluations (between the 12th and the 13th ribs) and weightings were carried out each 14 days; the slaughter occurred as the lambs reached the predetermined fat thickness: 2.0, 3.0 and 4.0 mm regardless of body weight. There was no effect for real income carcass, commercial carcass yield and index of leg compactness. Higher yield of loin for lambs slaughtered at 4.0 mm fat thickness was observed. The thickness of subcutaneous fat did not affect loin eye area, but animals with 4.0 mm had higher measures. There were differences in the proportions of muscle, bone and fat leg between subcutaneous fat thicknesses measured. The leg musculature was not influenced by increasing the thickness of subcutaneous fat. Based on this study and also with the requirements of the consumer market, it is recommended that the slaughter of animals occur with approximately 3.00 mm fat.

Premature ageing of the immune system relates to increased anti-lymphocyte antibodies (ALA) after an immunization in HIV-1-infected and kidney-transplanted patients.

Low-affinity immunoglobulin (Ig)G with potential autoreactivity to lymphocytes and hypergammaglobulinaemia have been described previously in HIV-1-infected patients. Whether such antibodies increase after challenging the immune system, for example with an immunization, is not known. In the present study, the modulation of antibodies with low affinity and potential autoreactivity was evaluated after 2012-13 seasonal flu vaccination with a simple empirical laboratory test measuring the titres of anti-lymphocyte antibodies (ALA) in two different models of secondary immunodeficiency: HIV-1 vertically infected patients (HIV) and patients treated with immunosuppressive therapies after kidney transplantation (KT) compared to healthy individuals (HC). In parallel, the activation status of B cells and their degree of immune senescence was evaluated by measuring the B cell interleukin (IL)-21R expression/plasma IL-21 levels and the frequencies of mature-activated (MA) and double-negative (DN) B cells. A significant increase of ALA titres was observed after vaccination in HIV and KT but not in HC, and this correlated directly with the frequencies of both MA and DN and inversely with the B cell IL-21R expression. This suggests that the quality of an immune response triggered by flu vaccination in HIV and KT may depend upon the activation status of B cells and on their degree of immune senescence. Further investigations are needed to verify whether high frequencies of MA and DN may also relate to increase autoimmunity after immunization in high-risk populations.

25-Hydroxyvitamin D Supplementation and BMI Change: A Meta-Analysis of Randomized Controlled Trials.

The impact of 25-hydroxyvitamin D (25[OH]D) supplementation on weight change remains controversial. The objective of this study was to summarize the effects of 25[OH]D supplementation (cholecalciferol or ergocalciferol) on BMI change through a meta-analysis of published clinical trials. We completed a systematic review of English articles, using MEDLINE (Ovid, Pubmed) from January 1, 1998 through January 1, 2013. The articles selected focused on 25[OH]D supplementation and body mass index (BMI) in randomized controlled trials (RCT's). The association between 25[OH]D and mean BMI change was estimated utilizing a random effects model. A total of 30 studies were reviewed and 9 were included in the meta-analysis. Total participants included 1651 adults (82.6% women and mean age 47.9 years) and mean follow-up ranged between 6 to 196 weeks and mean daily 25[OH]D dose ranged from 200 IU to 1,110 IU. Five of the 9 studies included calcium supplementation in both groups. Average baseline BMI was 30.7 and 30.4 kg/m2 in the intervention and control groups, respectively. Five studies suggested a beneficial effect for 25[OH]D supplementation for BMI change whereas 3 studies showed no effect of 25[OH]D supplementation on BMI change, and one showed a non-perceptible change. Meta-analysis of BMI values at end of trial showed no statistically significant difference in BMI change by use of 25[OH]D supplementation. Based on existing published trials, oral 25[OH]D supplementation does not significantly impact BMI change.

Primer consenso venezolanode enfermedad por reflujo gastroesofágico / Venezuelan consensus on gastroesophageal reflux diseases

El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

New vaccines require potent adjuvants like AFPL1 and AFCo1.

Neisseria meningitidis B proteoliposome (AFPL1 when used as adjuvant) and its derivative-Cochleate (AFCo1) contain immunopotentiating and immunomodulating properties and delivery system capacities required for a good adjuvant. Additionally, they contain meningococcal protective antigens and permit packaging of other antigens and pathogen-associated molecular patterns (PAMP). Consequently, we hypothesized that they would function as good vaccine adjuvants for their own antigens and also for non-related antigens. AFPL1 is a detergent-extracted outer membrane vesicle of N. meningitidis B transformed into AFCo1 in calcium environment. Both are produced at Finlay Institute under good manufacture practices (GMP) conditions. We show their exceptional characteristics: combining in the same structure, the potentiator activity, polarizing agents and delivery system capacities; presenting multimeric protein copies; containing multiprotein composition and multi and synergistic PAMP components; acting with incorporated or co-administrated antigens; inducing type I IFN-gamma and IL-12 cytokines suggesting the stimulation of human plasmocytoid precursor and conventional dendritic cells, respectively, inducing a preferential Th1 immune response with TCD4(+), TCD8(+), cross-presentation and cytotoxic T-lymphocyte (CTL) in vivo responses; and functioning by parenteral and mucosal routes. AFPL1-AFCo1 protective protein constitutions permit per se their function as a vaccine. In addition to Phase IV Men BC vaccine, AFPL1 has ended the preclinical stage in an allergy vaccine and is concluding the preclinical stage of a nasal meningococcal vaccine. In conclusion, AFPL1 and AFCo1 induced signal 1, 2 and 3 polarizing to a Th1 (including CTL) response when they acted directly as vaccines or were used as adjuvants with incorporated or co-administered antigens by parenteral or mucosal routes. Both are very promising adjuvants.

Expression of histo-blood group antigens in bronchial squamous metaplasia.

The aim of the present study was to evaluate the expression of blood group antigens in squamous bronchial metaplasia in order to determine whether this factor could identify patients at risk of lung cancer. In total, 100 bronchial biopsies were included in the present study. The cases were classified according to the World Health Organization grading system. Immunohistochemical stains for histo-blood groups A and B, and reactivity tests to p53 and the cellular proliferation index were performed. A total of 56 (56%) patients belonged to blood group A. Among them, six (10.7%) patients who did not express antigen in squamous metaplasia, showed carcinoma at the moment of the biopsy (n = 3) or developed synchronous lung carcinoma (n = 3). A total of nine (9%) patients belonged to blood group B. Loss of antigenic expression was observed in five cases. All of them developed synchronous lung carcinoma. The patients with low- and high-grade dysplasia developed lung cancer in 71 and 100% of the cases, respectively. In conclusion, the findings of the present study suggest that the loss of histo-blood antigens expression is an event in the carcinogenesis of bronchial mucosa and it is usually associated with high-grade lesions and hyperproliferative activity.

Mucoepidermoid tumors of the bronchus. Ultrastructural and immunohistochemical study. Histiogenic correlations.

UNLABELLED: Bronchial mucoepidermoid tumors are uncommon neoplasms, morphologically similar to their salivary gland counterpart. The histogenesis is controversial. The aim of this study is to identify myoepithelial cells and speculate on their role in the origin of these tumors. METHODS AND RESULTS: Sixteen bronchial mucoepidermoid tumor surgical specimens were formalin-fixed, paraffin-embedded and studied using a panel of nine antibodies in order to identify a myoepithelial differentiation. Additional antigens against several cytokeratins were performed in four cases and five of the biopies were studied using the electron microscopy. The different types of cells of the primary bronchial mucoepidermoid tumor (mucous luminal, intermediate and squamous) reacted strongly against AE1, CK7, 34bE12 and weakly with AE3, CK18 and CK8/18/19. S-100, alpha-smooth muscle actin, muscle actin HHF35 and alpha-actinin were consistently negative in all cell types. CD10 was positive in very few cells in just one case. CONCLUSION: The immunohistochemical and the ultrastructural study of bronchial mucoepidermiod tumors support a ductal unit origin, without a myoepithelial participation.

Hip spine relationships: application to total hip arthroplasty.

Lumbo-sacral orientation in the sagittal plane is of utmost importance, as it plays a critical role in the function of the spine and the hip joints. Equilibrium of the trunk influences the tridimensional orientation of the acetabulum and the functional range of motion of the hips. Each patient is characterized by a "morphological" parameter named incidence angle; its sagittal balance is the consequence of a postural adaptation for other functional parameters (pelvic tilt, sacral slope, lumbar lordosis, acetabular sagittal tilt, functional anteversion). Understanding variations of the sacral slope on lateral pelvic X-rays is essential for planning total hip arthroplasty and identifying patients at risk of impingement, as lumbosacral posture influences functional anteversion of the acetabulum. Posterior pelvic version as in sitting position (sacral slope decrease) is linked to the increase of the functional acetabular anteversion. Anterior pelvic version as in standing position (sacral slope increase) is linked to the decrease of the functional acetabular anteversion.

[Clinicopathological features of solitary fibrous tumors of the pleura: a case series and literature review]. / Tumor fibroso solitario pleural: características clinicopatológicas de una serie de casos y revisión de la bibliografía.

We assessed the clinicopathological features of solitary fibrous tumors of the pleura in a case series comprising 30 patients (20 women, 66.6%) with a mean age of 58.39 years. Forty-five percent of the cases were asymptomatic. In 70% of the cases the tumors arose in the visceral pleura. Twenty percent presented multiple tumors, a finding that was associated with intrapulmonary localization and malignant behavior (P<.0001) Histology revealed low cell density in 15% of the cases, moderate density in 50%, and high density in 35%; further findings showed atypia in 45% of the cases, necrosis in 25%, and hemorrhage in 15%. More than 4 mitoses per 10 high-power fields were noted in 30% of the cases. Immunohistochemistry results were positive for vimentin in all cases; cells were CD34+ in 85% of the cases, BCL2+ in 65%, and CD99+ in 40%. Findings for keratin and protein S100 were negative in all cases. Malignant biological behavior (local recurrence and metastasis) was observed in 4 cases, 2 of which were CD34-. Solitary fibrous tumors of the pleura are uncommon neoplasms with unpredictable biological behavior; follow-up should therefore be based on early detection of recurrence or metastasis.

Cannibalism in paranoid schizophrenia: a case report.

In ancient times, cannibalism was deemed acceptable for reasons of survival when faced with extreme need or for religious or magic reasons. In today's society, these cases are extremely rare and are generally associated with severe mental illness. We present a case of cannibalism in an individual with schizophrenia. The patient who lacked insight into his illness admitted to committing acts of cannibalism and offered in-depth explanations of the procedures used to prepare the bodies. He made statements on television and to the press and was given the nickname of "the people-eater", an identity he readily accepted and integrated into his system of delusions. Cases of this nature are exceedingly unusual, but the fact that people with schizophrenia commit uncommon, unpredictable crimes attracts the media. This circumstance not only interferes with the natural course of the disease, but also affects the therapeutic behavior and how the patient is perceived by society.

Respiratory burst and NAD(P)H oxidase activity are involved in capacitation of cryopreserved bovine spermatozoa.

Heparin (a glycosaminoglycan) and quercetin (a calcium-ATPase plasma membrane specific inhibitor) induce bovine sperm capacitation. Mitochondria from frozen semen are capable of generating oxidative energy. The aim of the study was to determine oxygen uptake variation and the participation of diphenileneiodonium (DPI)-sensitive oxidases from spermatozoa capacitated with heparin or quercetin. Oxygen uptake was measured polarographically and 2 microM diphenileneiodonium (DPI) was used as a specific inhibitor of NAD(P)H-oxidases. Sperm capacitation was determined by the chlorotetracycline technique. Heparin produced a respiratory burst (17.0+/-3.2 microL O2/h/10(8) spermatozoa; mean+/-S.D.) versus control (11.3+/-0.9 microL O2/h/10(8) spermatozoa; P<0.05). Oxygen uptake and sperm hypermotility were inhibited by cyanide. Treatment with DPI blocked heparin capacitation and oxygen uptake (cyanide-sensitive) decreased to control levels. Respiration of quercetin-treated samples (cyanide-sensitive; 9.7+/-0.7 microL O2/h/10(8) spermatozoa) was not significantly different from the controls; oxygen uptake was not modified by DPI, but quercetin capacitation was inhibited (P<0.05). The effect of DPI with heparin confirmed that oxidases participate in capacitation induction. The addition of superoxide dismutase and/or catalase to heparin- or quercetin-treated samples, failed to modify oxygen uptake and blocked capacitation (P<0.05), suggesting that the superoxide anion (O2*-) participates in the capacitation induction. High mitochondrial activity from heparin-treated samples indicated that energy requirements, especially for hypermotility, were supported by the respiratory chain. Although a respiratory burst was not produced by quercetin, DPI-sensitive-oxidases (O2*- source) were necessary for capacitation. In cryopreserved bovine spermatozoa, heparin- or quercetin-induced capacitation required different levels of mitochondrial energy and DPI-sensitive oxidase activity.

Antigenic profile of human bronchial gland.

Bronchial glands have been regarded as modified salivary glands. It is well known that there no previous reviews concerning the antigenic profile of the bronchial wall. The aim of this study is a systematic survey of the antigenic profile and to describe the histology of normal human bronchial glands. Six formalin-fixed, paraffin-embedded surgical specimens were studied using a panel of 22 polyclonal and monoclonal antibodies by the avidin-biotin-peroxidase method. Bronchial glands disclosed a tubuloacinar structure. The smallest ducts intercalated originated from a cluster of secretory acini and converge to form an excretory duct. No striated duct was observed. Acinar united is composed by mucous, serous and mixed units. Myoepithelial cells are found in relation to the intercalated ducts and secretory acinis. Secretory cells of bronchial glands reacted strongly with cytokeratin AE1 and moderately for CK7, CK18. Additionally, serous acinar cells reacted with AE3, CK19, CK5/6/8/18, CK8/18/19, and Leu7. Myoepithelial cells reacted strongly with a-smooth muscle actin, CD10 and CK34betaE12. Ductal system cells differed from acinar secretory cells in expressing CK34betaE12 and HSP27. In conclusion, the detailed knowledge of the immunohistochemical reactivities of normal cell types of normal human bronchial glands will prove useful in studies of bronchial pathology, especially of neoplastic processes.