Effect of Low-Dose Statins in Addition to Standard Therapy on Brain Perfusion and Neurocognitive Performance in Patients with Major Depressive Disorder.

INTRODUCTION: Major depressive disorder (MDD) is a prevalent condition which has a well-known association with ischemic cardiomyopathy, probably explained by an inflammatory mediator mechanism. Statins, besides reducing cholesterol production, have pleiotropic effects including anti-inflammatory activity. The goal was to evaluate the effect of statins as an addition to standard therapy on mood status, brain perfusion, and neurocognitive performance in MDD. METHODS: We studied 20 MDD patients with brain single-photon emission tomography and Cambridge Neuropsychological Test Automated Battery (CANTAB), half randomized to 10 mg of Rosuvastatin or placebo, in addition to selective serotonin reuptake inhibitors (SSRIs) therapy and being reevaluated 3 months later. The images were compared using Statistical Parametric Mapping; clinical scores (Hamilton Depression Score with 17 items and Beck's Depression Inventory) as well as neurocognitive parameters were applied as covariances (CoV) to estimate regional cerebral blood flow (rCBF) changes with both therapies. RESULTS: Clinical scores decreased in both groups (p = 0.0001); Beck's presented a larger decrease with statins. We observed significantly rCBF changes expressed as significant larger clusters of voxels (p < 0.05) in the pre/subgenual anterior cingulate plus orbitofrontal cortex and a small area in the posterior cingulate gyrus in the statins group, whereas it was not observed with placebo, when using clinical scores as CoV. A similar pattern of rCBF changes was present with emotions recognition, attentional, paired associates learning, spatial planning, and working memory tasks. CONCLUSION: Short-term use of low-dose statins in MDD patients under SSRIs results in important rCBF changes in key mood associated areas to improvement in neurocognitive performance. These findings, even though demonstrated in a small sample, could open a new therapeutic tool in the comprehensive management of this disorder.

Cold growth behaviour and genetic comparison of Canadian and Swiss Listeria monocytogenes strains associated with the food supply chain and human listeriosis cases.

Sixty-two strains of Listeria monocytogenes isolated in Canada and Switzerland were investigated. Comparison based on molecular genotypes confirmed that strains in these two countries are genetically diverse. Interestingly strains from both countries displayed similar range of cold growth phenotypic profiles. Based on cold growth lag phase duration periods displayed in BHI at 4 °C, the strains were similarly divided into groups of fast, intermediate and slow cold adaptors. Overall Swiss strains had faster exponential cold growth rates compared to Canadian strains. However gene expression analysis revealed no significant differences between fast and slow cold adapting strains in the ability to induce nine cold adaptation genes (lmo0501, cspA, cspD, gbuA, lmo0688, pgpH, sigB, sigH and sigL) in response to cold stress exposure. Neither was the presence of Stress survival islet 1 (SSI-1) analysed by PCR associated with enhanced cold adaptation. Phylogeny based on the sigL gene subdivided strains from these two countries into two major and one minor cluster. Fast cold adaptors were more frequently in one of the major clusters (cluster A), whereas slow cold adaptors were mainly in the other (cluster B). Genetic differences between these two major clusters are associated with various amino acid substitutions in the predicted SigL proteins. Compared to the EGDe type strain and most slow cold adaptors, most fast cold adaptors exhibited five identical amino acid substitutions (M90L, S203A/S203T, S304N, S315N, and I383T) in their SigL proteins. We hypothesize that these amino acid changes might be associated with SigL protein structural and functional changes that may promote differences in cold growth behaviour between L. monocytogenes strains.

Fetal Hyperthyroidism Secondary to Maternal Basedow-Graves' Disease.

Fetal hyperthyroidism is a rare prenatal disease and can be life-threatening. The diagnosis is based on ultrasound in mothers with a history of Basedow-Graves' disease and elevation of thyrotropin receptor antibodies (TRAbs) levels. The treatment consists of antithyroid drugs. We present a mother with Basedow-Graves' disease, treated with radioactive iodine 16 years ago. She had an unplanned pregnancy at the age of 29 years, and an elevation of TRAbs (21 U/L) was found at the sixth week of pregnancy. At 22 weeks of gestation, fetal ultrasound displayed tachycardia, goiter, exophthalmos, and suspicion of craniosynostosis, hence methimazole was started. Concomitantly, suppressed maternal thyroid-stimulating hormone (TSH) was found. Her daughter was born at 33 + 6 weeks showing clinical and laboratory findings of hyperthyroidism. Consequently, treatment with methimazole was prescribed. Normal thyroid function was documented in the mother after giving birth. Clear explanation has not been found for the alteration of maternal TSH during pregnancy.

Examination of food chain-derived Listeria monocytogenes strains of different serotypes reveals considerable diversity in inlA genotypes, mutability, and adaptation to cold temperatures.

Listeria monocytogenes strains belonging to serotypes 1/2a and 4b are frequently linked to listeriosis. While inlA mutations leading to premature stop codons (PMSCs) and attenuated virulence are common in 1/2a, they are rare in serotype 4b. We observed PMSCs in 35% of L. monocytogenes isolates (n = 54) recovered from the British Columbia food supply, including serotypes 1/2a (30%), 1/2c (100%), and 3a (100%), and a 3-codon deletion (amino acid positions 738 to 740) seen in 57% of 4b isolates from fish-processing facilities. Caco-2 invasion assays showed that two isolates with the deletion were significantly more invasive than EGD-SmR (P < 0.0001) and were either as (FF19-1) or more (FE13-1) invasive than a clinical control strain (08-5578) (P = 0.006). To examine whether serotype 1/2a was more likely to acquire mutations than other serotypes, strains were plated on agar with rifampin, revealing 4b isolates to be significantly more mutable than 1/2a, 1/2c, and 3a serotypes (P = 0.0002). We also examined the ability of 33 strains to adapt to cold temperature following a downshift from 37°C to 4°C. Overall, three distinct cold-adapting groups (CAG) were observed: 46% were fast (<70 h), 39% were intermediate (70 to 200 h), and 15% were slow (>200 h) adaptors. Intermediate CAG strains (70%) more frequently possessed inlA PMSCs than did fast (20%) and slow (10%) CAGs; in contrast, 87% of fast adaptors lacked inlA PMSCs. In conclusion, we report food chain-derived 1/2a and 4b serotypes with a 3-codon deletion possessing invasive behavior and the novel association of inlA genotypes encoding a full-length InlA with fast cold-adaptation phenotypes.

Brain apparent water diffusion coefficient magnetic resonance image during a prolonged visual aura.

BACKGROUND: Reversible changes in brain magnetic resonance imaging (MRI) weighted in diffusion-weighted images (DWI) and apparent water diffusion coefficient (ADC) maps have been reported in acute stroke, epilepsy, eclampsia, and hypoglycemia, but they are contradictory regarding to migraine aura. OBJECTIVE: A 41-year-old woman with known basilar migraine for 5 years consulted about a persistent visual aura (visual snow phenomenon) plus bilateral paresthesias in the extremities for 4 days. The headache was treated with success with 10 mg of wafer rizatriptan and 600 mg of ibuprophen. METHODS: The neurologic and ophthalmologic examination were normal. An urgent brain MRI detected no lesions in T1, T2, fluid-attenuated inversion recovery, and DWI, but an abnormal signal appeared in the left occipital lobe in ADC and (r)ADC maps. The brain MRI angiography, carotid ultrasound study, transesophageal echocardiography, 24-hour cardiac Holter monitoring, and thrombophilia study were normal. RESULTS: A new brain MRI 8 days after did not show any previous lesion in the same sequences. CONCLUSIONS: We present a patient with migraine and transitory abnormal signals in the ADC map of an occipital region during persistent visual aura. The clinical-radiological relationship is congruent. Some similar cases have showed these MRI signals during the aura, suggesting cytotoxic edema, without ischemic lesions in the MRI controls. Theses ADC images probably appear in complex auras.

Health Status and Experience of the Migrant Workers Returned from Spain to Colombia: A Qualitative Approach.

This study aims to understand the migratory experience and the employment, work and health conditions of the returned migrants from Spain to Colombia. A qualitative study was conducted by means of 23 semi-structured interviews with Colombian returned migrant workers. Qualitative narrative content analysis was performed using Atlas.Ti software. Main findings are represented by nine categories emerged from the participants' discourses: (1) impact of the economic crisis on work and employment conditions in Spain, (2) economic crisis and return, (3) characteristics of returnees, (4) perception of the returnees about Colombia, (5) the role of social support networks, (6) employment and working conditions in Colombia, (7) health and wellbeing, (8) future plans and expectations, (9) the experience of being immigrant. Adjustment difficulties in participants are evidenced by the return migration process and the conditions of the social, political and economic system in Colombia. Return migration represents the reconfiguration of personal and working lives of this population. This situation requires the development of global policies and strategies in public health to facilitate the adaptation of these people.

[Microcystin in plants that treat water for human consumption in a tropical environment: the Metropolitan Area of Costa Rica]. / Microcistina en plantas de tratamiento de agua para consume humano en un ambiente tropical: el Area Metropolitana de Costa Rica.

We measured microcystin levels in water of the Metropolitan Area of Costa Rica by competitive inhibition ELISA and we quantified total coliforms, fecal coliforms, Escherichia coli (by a Most Probable Number method) and aerobic count. We wanted to identify any cyanotoxin correlation with these parameters, as a public health risk. We sampled in the rainy season of 2003 (April-October) and in the dry season of 2004 (February-March) (30 samples/season). We sampled pre-treated, semi-treated and treated water. Microcystin levels < 0.5 ppb were found in the rainy season (and > 0.5 ppb in the dry season). Dry season levels exceeded World Health Organization limits (1.0 ppb). Cyanotoxins occurred in the Tres Rios plant. We did not find a correlation between these microbiologic parameters of water quality and microcystin levels in water.

Signo del remolino: cirugía de urgencia o falacia ad populum / Whirpool sign: emergency surgery or Falacia ad populum

Introducción: Las pruebas de diagnóstico por imagen se han convertido en una pieza crucial en el diagnóstico del abdomen agudo en la urgencia, sin embargo, la conducta médica deberá basarse en los hallazgos iconográficos contextualizados. El signo tomográfico del remolino constituye un paradigma por su asociación con el vólvulo intestinal. Objetivos: Registrar pacientes con diagnóstico de abdomen agudo en busca del "signo del remolino" en la tomografía computada e identificar quiénes requirieron intervención quirúrgica. Métodos: Estudio analítico de corte transversal evaluándose 115 tomografías computadas de abdomen agudo obstructivo en búsqueda del signo del remolino. Resultados: 15 tomografías fueron excluidas por tratarse de estudios solicitados en posoperatorios. El signo del remolino se presentó en el 5%. Los diagnósticos fueron de mal rotación intestinal (2%), vólvulo de intestino delgado (1%), vólvulo de sigma (1%) y enterocolitis (1%). Sólo el 60% de los pacientes requirieron cirugía. Discusión: La presencia del signo del remolino no siempre obedece a una resolución quirúrgica. No es patognomónico de una sola entidad puntual, pudiendo representar un hallazgo en el contexto de otra patología aguda, por lo que se debería reconocer sus variantes para instaurar el tratamiento adecuado, sea quirúrgico o médico.

Introduction: The imaging test have become an important piece on the diagnosis of the acute abdomen in emergency, nevertheless medical conduct should be based on contextualized iconographic findings. The tomographic "whirlpool sign" establishes a surgical paradigm for its association with the bowel volvulus. Objetive: To register patients with diagnosis of acute abdomen looking for the "whirlpool sign" in the computed tomography and identify who needed surgical intervention. Methods: Analytical cross-sectional study. 115 tomographies of acute obstructive abdomen have being evaluated. Results: 15 tomographies were excluded. The prevalence of the whirlpool sign was 5%. Diagnoses were intestinal malrotation (2%), midgut volvulus (1%), sigmoid volvulus (1%) and enterocolitis (1%). Only 60% of the patients required surgery. Discussion: The presence of the "whirlpool sign" not always determines a surgical resolution. It is not a pathognomonic sign of a punctual entity; it could represent an ordinary finding in the context of several pathologies. To apply the correct treatment, surgical or medical, for these patients it was important to recognize "whirlpool sign" variants.

Complete Genome Sequence of Listeria monocytogenes LL195, a Serotype 4b Strain from the 1983-1987 Listeriosis Epidemic in Switzerland.

The complete genome sequence of Listeria monocytogenes LL195, a serotype 4b clinical strain isolated during the 1983-1987 listeriosis epidemic in Switzerland, is presented.

Calidad de vida relacionada con la salud bucal en mujeres en situación de prostitución en Medellín (Colombia) y sus factores relacionados / Oral health-related quality of life of women in prostitution in Medellin (Colombia) and its associated factors

Resumen Introducción y objetivo: La calidad de vida es un elemento a considerar en el análisis de los determinantes sociales en grupos vulnerables. Se pretende determinar la calidad de vida relacionada con la salud bucal (CVRSB) en un grupo de mujeres en situación de prostitución de Medellín y sus factores relacionados. Materiales y métodos: Estudio descriptivo transversal en una muestra a conveniencia de 53 mujeres que ejercen la prostitución. Se aplicó encuesta y examen clínico con información sociodemográfica, uso de servicios de salud y situación de salud bucal. Aplicación del instrumento OHIP-14 (Perfil de Impacto de la Salud Oral en la Calidad de Vida). Descripción del OHIP-14 y sus medidas de resumen según diferentes variables. Resultados: Las dimensiones de malestar psicológico y minusvalía son las que presentaron mayores puntajes. El 85% de las mujeres reportaron uno o más impactos de su salud bucal en la calidad de vida, lo que representa un promedio de 4,8 impactos IC95% (3,8-5,9). Se observaron indicadores de impacto más altos según factores sociodemográficos como: nivel educativo, tiempo en el oficio, cargas familiares, apoyo social o consumo de sustancias psicoactivas. Igualmente, se reportaron mayores impactos de acuerdo a factores como: estar insatisfechas con su salud bucal, estado de salud bucal bajo, tener problemas bucodentales, requerir atención prioritaria y reportar problemas de acceso a la atención odontológica. Conclusiones: Se observaron gradientes en la CVRSB de acuerdo a características sociodemográficas, salud bucal y acceso a la atención odontológica. Se evidencian situaciones de inequidad que deben ser consideradas para promover acciones colectivas en esta población.

Abstract Introduction and objective: The quality of life is an element to consider in the analysis of social determinants in vulnerable social groups. This study aims to determine to determine the oral health related quality of life (OHRQOL) in a group of women in situation of prostitution situation in Medellín (Colombia) and its related factors. Materials and methods: A descriptive study was conducted in a convenience sample of 53 women. A survey and clinical examination was carried out with sociodemographic information, use of health services and oral health status. The instrument OHIP-14 (Profile of Impact of Oral Health on Quality of Life) was used. A description of the OHIP-14 and its summary measures according to different variables was applied. Results: Psychological distress and disability were the dimensions that presented highest scores in the sample. 85% of women reported one or more impacts of their oral health on quality of life, representing an average of 4.8 impacts 95%CI (3.8-5.9). Higher impact indicators were observed according to sociodemographic factors such as: educational level, time at work, family burden, social support or use of psychoactive substances. Likewise, greater impacts were reported according to factors such as: being unsatisfied with their oral health, low oral health status, having oral problems, requiring priority oral health attention and reporting problems of access to dental care. Conclusions: There were gradients in the OHRQOL according to sociodemographic characteristics and oral health and access to oral health care variables. Situations of inequity are evidenced that must be considered in order to promote collective actions in this population.

Estado de salud bucal y factores relacionados en mujeres en situación de prostitución en Medellín (Colombia) / Oral health status and its related factors in a group of women in situation of prostitution in Medellín (Colombia)

Antecedentes: Se requiere analizar la situación de salud bucal en grupos vulnerables desde la perspectiva de los determinantes sociales para establecer estrategias de intervención efectivas. Objetivo: Describir el estado de salud bucal y factores relacionados en un grupo de mujeres en situación de prostitución en la ciudad de Medellin (Colombia). Métodos: Este fue un estudio descriptivo en una muestra por conveniencia de 53 mujeres que ejercen la prostitución. Se aplicó encuesta y examen clínico y se analizaron variables de autopercepción de salud bucal, índice COP-D (cariados, obturados y perdidos), índice de caries significativa (SiC), problemas de articulación temporomandibular (ATM) y estado protésico. Resultados: 88,2 % de las mujeres encuestadas reportaron un mal estado de salud bucal, 81 % se sentían insatisfechas con su estado bucal y 60 % reportó problemas bucales. La prevalencia de caries dental fue del 64 %, con un COP-D de 15,6 (±8,4), y un SiC de 25,5 (±3,6). Se presentaron diferencias en el estado de salud bucal en indicadores clínicos y subjetivos según factores sociodemográficos. Más de tres cuartas partes requerían cambia o realizar nuevas prótesis superiores o inferiores. En casi la mitad se hallaron ruidos articulares en la ATM según evaluación clínica. Conclusiones: El estado de salud bucal según los indicadores analizados es reflejo de las condiciones sociales en que se encuentran estas mujeres. Se encontraron diferencias en los indicadores de salud bucal de acuerdo con diferentes factores sociodemográficos, lo cual sugiere la influencia de los determinantes sociales en las desigualdades en salud bucal.

Background: The analysis of the oral health situation in vulnerable groups from a perspective of social determinants is required to implement effective intervention strategies. Purpose: To describe the oral health status and its related factors in a group of women in situation of prostitution in Medellin (Colombia). Methods: A descriptive study was conducted with a convenience sample of 53 women. A survey and clinical exanimation was earned out. The study analyzed variables related to self-perceived oral health, DTMF Index, Significant Caries Index (SiC), temporomandibular joint problems (TMJ), and the status of fixed/removable prosthesis. Results: 88.2 % of the sun-eyed women reported their oral health status was poor, 81 % of them felt unsatisfied with their mouth, and 60 % reported oral problems. The prevalence of dental caries was 64 %, with a DTMF of 15.6 (± 8.4), and a SiC of 25.5 (± 3.6). There were differences in oral health status in clinical and subjective indicators accordmg to sociodemographic factors. More than three-quarters required changing or making new upper and/or lower partial or fixed dentures. In almost half, articular noises were found in TMJ according to the clinical evaluation. Conclusions: The oral health status, from the basis of the indicators analyzed, reflects the social conditions found in these women. Differences in the oral health indicators were in accordance to sociodemographic factors. This situation suggests that there is an influence of social determinants on oral health inequalities.

Microcistina en plantas de tratamiento de agua para consume humano en un ambiente tropical: el Area Metropolitana de Costa Rica / Microcystin in plants that treat water for human consumption in a tropical environment: the Metropolitan Area of Costa Rica

We measured microcystin levels in water of the Metropolitan Area of Costa Rica by competitive inhibition ELISA and we quantified total coliforms, fecal coliforms, Escherichia coli (by a Most Probable Number method) and aerobic count. We wanted to identify any cyanotoxin correlation with these parameters, as a public health risk. We sampled in the rainy season of 2003 (April-October) and in the dry season of 2004 (February-March) (30 samples/season). We sampled pre-treated, semi-treated and treated water. Microcystin levels < 0.5 ppb were found in the rainy season (and > 0.5 ppb in the dry season). Dry season levels exceeded World Health Organization limits (1.0 ppb). Cyanotoxins occurred in the Tres Rios plant. We did not find a correlation between these microbiologic parameters of water quality and microcystin levels in water.

Se midió la presencia de microcistina en el Área Metropolitana de Costa Rica por la técnica de ELISA de inhibición competitiva y se cuantificó coliformes totales, coliformes termotolerantes, Escherichia coli (por medio de la técnica Numero Más Probable) y recuento total aerobio. Se realizaron dos etapas de muestreo, una durante la estación lluviosa del 2003 (abril-octubre) y otra durante la estación seca del 2004 (febrero-marzo), cada una con 30 muestras de agua. Se muestreó agua pretratada, semitratada y tratada. Se determinaron niveles de microcistina < 0.5 ppb durante la estación lluviosa del 2003, mientras que durante la estación seca, se detectaron concentraciones de microcistina > 0.5 ppb. Se informó la presencia de cianotoxinas en la Planta de Tratamiento de Tres Ríos. No se establece correlación entre los parámetros microbiológicos de calidad del agua y las concentraciones de microcistina en el agua. Los estudios deberían considerar la diversidad y toxicidad de cianobacterias en estas plantas, los efectos del tratamiento, y presencia de otros microorganismos y sustancias (dióxido de carbono, fósforo, Nitrógeno), sobre la presencia, estructura y efecto de estas toxinas.