Hipertensión portal no cirrótica por enfermedad vascular porto-sinusoidal: presentación de un caso y revisión de la literatura / Non-cirrhotic portal hypertension due to porto-sinusoidal vascular disease: Case presentation and literature review

La enfermedad vascular porto-sinusoidal es una causa infrecuente de hipertensión portal no cirrótica, fue descrita recientemente y es poco diagnosticada por el desconocimiento entre los médicos. Se considera en casos de hipertensión portal clínicamente significativa, en ausencia de cirrosis. El diagnóstico se basa en los hallazgos de la biopsia. El pronóstico de la enfermedad es mejor que el de los pacientes cirróticos, y el tratamiento es similar al de la hipertensión portal y al de las complicaciones que presentan los pacientes con cirrosis. Se presenta el caso de una paciente con várices esofágicas con estudios de imágenes no compatibles con cirrosis y hallazgos específicos en la biopsia de enfermedad vascular porto-sinusoidal. Este caso muestra el ejercicio diagnóstico en un caso de enfermedad vascular porto-sinusoidal de una paciente de Colombia, así como el resultado de las intervenciones terapéuticas y la evolución en el tiempo.

Porto-sinusoidal vascular disease is an uncommon cause of non-cirrhotic portal hypertension. It was recently described and is rarely diagnosed due to lack of knowledge among doctors. It is considered in cases of clinically significant portal hypertension in the absence of cirrhosis, and the diagnosis is based on biopsy findings. The prognosis of the disease is better than that of cirrhotic patients, and the treatment is similar to that of portal hypertension, including the management of complications associated with cirrhosis. We present the case of a patient with esophageal varices, whose imaging studies were not compatible with cirrhosis, alongside specific biopsy findings of porto-sinusoidal vascular disease. This case illustrates the diagnostic process in a patient from Colombia with portosinusoidal vascular disease, as well as the outcomes of therapeutic interventions and the patient´s evolution over time.

Crohn's Disease in a Patient with Tuberculosis: A Diagnostic and Therapeutic Challenge

Introduction: Crohn's disease (CD) is unusual in Colombia. Tuberculosis (TB) occurs more frequently, but intestinal involvement is rare. Differentiating these two entities and treating the cases in which they coexist is a challenge. Clinical case: A 28-year-old man with three months of constitutional, respiratory, and GI symptoms was initially diagnosed with pulmonary tuberculosis, and all the clinical manifestations were attributed to this entity. Given the absence of improvement with treatment and the sum of radiological, endoscopic, and pathological findings, CD was confirmed. Treatment was complex due to the coexistence of the two entities, although he finally went into remission with the use of biologicals. Discussion: Diagnosing CD requires the sum of clinical and paraclinical findings. A therapeutic test may be necessary to differentiate it from intestinal TB. The treatment of CD in a patient with TB has some limitations; steroids are not contraindicated, and biologicals must be initiated cautiously. Conclusions: Differentiating CD from intestinal TB is a diagnostic challenge. Therapeutic management when these two entities coexist requires an interdisciplinary approach.

Introducción: la enfermedad de Crohn (EC) es inusual en Colombia. La tuberculosis (TB) se presenta con mayor frecuencia, pero el compromiso intestinal es raro. Diferenciar estas dos entidades y el tratamiento de los casos en los que coexisten es un reto. Caso clínico: hombre de 28 años con 3 meses de síntomas constitucionales, respiratorios y gastrointestinales al que en un inicio se le confirmó el diagnóstico de tuberculosis pulmonar y se le atribuyó a esta entidad todas las manifestaciones clínicas. Ante la ausencia de mejoría con el tratamiento y la suma de hallazgos radiológicos, endoscópicos y patológicos, se confirmó EC. El tratamiento fue difícil debido a la coexistencia de las dos entidades, aunque finalmente presentó remisión con el uso de biológicos. Discusión: diagnosticar la EC requiere de la sumatoria de hallazgos clínicos y paraclínicos. Para diferenciarla de TB intestinal puede llegar a ser necesaria una prueba terapéutica. El tratamiento de EC en un paciente con TB tiene algunas limitaciones, los esteroides no se contraindican de manera absoluta y el inicio de biológicos debe hacerse con precaución. Conclusiones: diferenciar la EC de la TB intestinal es un reto diagnóstico. El enfoque terapéutico cuando coexisten estas dos entidades requiere un abordaje interdisciplinario.

Identification of Zika Virus NS1-Derived Peptides with Potential Applications in Serological Tests.

Zika virus (ZIKV), a mosquito-borne pathogen, is an emerging arbovirus associated with sporadic symptomatic cases of great medical concern, particularly among pregnant women and newborns affected with neurological disorders. Serological diagnosis of ZIKV infection is still an unmet challenge due to the co-circulation of the dengue virus, which shares extensive sequence conservation of structural proteins leading to the generation of cross-reactive antibodies. In this study, we aimed to obtain tools for the development of improved serological tests for the detection of ZIKV infection. Polyclonal sera (pAb) and a monoclonal antibody (mAb 2F2) against a recombinant form of the ZIKV nonstructural protein 1 (NS1) allowed the identification of linear peptide epitopes of the NS1 protein. Based on these findings, six chemically synthesized peptides were tested both in dot blot and ELISA assays using convalescent sera collected from ZIKV-infected patients. Two of these peptides specifically detected the presence of ZIKV antibodies and proved to be candidates for the detection of ZIKV-infected subjects. The availability of these tools opens perspectives for the development of NS1-based serological tests with enhanced sensitivity regarding other flaviviruses.

The Deleterious Effects of Shiga Toxin Type 2 Are Neutralized In Vitro by FabF8:Stx2 Recombinant Monoclonal Antibody.

Hemolytic Uremic Syndrome (HUS) associated with Shiga-toxigenic Escherichia coli (STEC) infections is the principal cause of acute renal injury in pediatric age groups. Shiga toxin type 2 (Stx2) has in vitro cytotoxic effects on kidney cells, including human glomerular endothelial (HGEC) and Vero cells. Neither a licensed vaccine nor effective therapy for HUS is available for humans. Recombinant antibodies against Stx2, produced in bacteria, appeared as the utmost tool to prevent HUS. Therefore, in this work, a recombinant FabF8:Stx2 was selected from a human Fab antibody library by phage display, characterized, and analyzed for its ability to neutralize the Stx activity from different STEC-Stx2 and Stx1/Stx2 producing strains in a gold standard Vero cell assay, and the Stx2 cytotoxic effects on primary cultures of HGEC. This recombinant Fab showed a dissociation constant of 13.8 nM and a half maximum effective concentration (EC50) of 160 ng/mL to Stx2. Additionally, FabF8:Stx2 neutralized, in different percentages, the cytotoxic effects of Stx2 and Stx1/2 from different STEC strains on Vero cells. Moreover, it significantly prevented the deleterious effects of Stx2 in a dose-dependent manner (up to 83%) in HGEC and protected this cell up to 90% from apoptosis and necrosis. Therefore, this novel and simple anti-Stx2 biomolecule will allow further investigation as a new therapeutic option that could improve STEC and HUS patient outcomes.

Identificação dos fatores de risco para o transtorno do processamento auditivo (central) em pré-escolares / Identification of risk factors for the (central) auditory processing disorder in preschool children

OBJETIVOS: identificar os fatores de risco para o Transtorno do Processamento Auditivo (Central) TPA(C) em 79 pré-escolares. MÉTODOS: aplicou-se um questionário para 79 pais , de crianças que cursavam a pré-escola ou o primeiro ano do ensino fundamental, das redes municipal, estadual e particular de Porto Alegre. O questionário continha questões referentes ao desenvolvimento infantil. RESULTADOS: a pesquisa mostra como principais resultados a ocorrência do uso de chupeta (73,4 por cento); do tempo de aleitamento materno (36 por cento); da realização dos exames audiológicos (17,8 por cento); do tempo em frente a televisão (59 por cento); e da quantidade de repetições de instruções (54 por cento); Em relação aos testes de correlação o estudo mostrou a utilização da chupeta (p=0,006) e maior ocorrência de otites (p=0,007) por meninas. As crianças mais velhas realizavam leitura espontânea (p=0,007) e recontavam histórias ordenadamente (p=0,035). CONCLUSÃO: Identificou-se as variáveis: maior número de irmãos (p=0,005), maior solicitação de repetições (p<0,001) e dificuldade de compreensão em ambientes competitivos (p=0,002) significativos como fatores de risco para o Transtorno do Processamento Auditivo (Central).

PURPOSE: to identify the risk factors for (Central) Auditory Processing Disorder in a group of 79 preschool children. METHODS: we applied a questionnaire to 79 parents or guardians of children attending preschool or first year of elementary school of the municipal, state and private schools in Porto Alegre. The questionnaire contained questions related to child development. RESULTS: the research shows as the main results the use of a pacifier use (73.4 percent); the duration of breastfeeding (36 percent); the conduction of audiological testing (17.8 percent); the time watching TV (59 percent); and the number of repetitions of instructions (54 percent); For the correlation tests the study showed the pacifier use (p=0.006) and the higher incidence of otitis (p=0.007) by girls. Older children performed spontaneous reading (p=0.007) and retold stories neatly (p=0.035). CONCLUSION: the risk factors for (Central) Auditory Processing Disorder were identified, being the variables: increased number of siblings (p=0,005), more requesting for repeats (p<0,001) and understanding difficulty in competitive environments (p=0,002) as significant.

Selection of endophytic fungi from comfrey (Symphytum officinale L. ) for in vitro biological control of the phytopathogen Sclerotinia sclerotiorum (Lib. ) / Seleção de fungos endofíticos de confrei (Symphytum officinale L. ), buscando controle biológico in vitro do fitopatógeno Sclerotinia sclerotiorum (Lib. )

Biological control consists of using one organism to attack another that may cause economic damage to crops. Integrated Pest Management (IPM) is a very common strategy. The white mold produced by Sclerotiniasclerotiorum (Lib.) causes considerable damage to bean crops. This fungus is a soil inhabitant, the symptoms of which are characterized by water-soaked lesions covered by a white cottony fungal growth on the soil surface and/or the host plant. Possible biological control agents taken from plants are being investigated as phytopathogen inhibitors. These are endophytic microorganisms that inhabit the intercellular spaces of vegetal tissues and are often responsible for antimicrobial production. The objective of the present study was to select endophytic fungi isolated from comfrey (Symphytumofficinale L.) leaves with in vitro antagonist potential against the phytopathogenic fungus S. sclerotiorum. Twelve isolates of endophytic fungi and a pathogenic strain of S. sclerotiorum were used in the challenge method. With the aid of this method, four endophytes with the best antagonistic activity against S. sclerotiorum were selected. Pathogen growth inhibition zones were considered indicative of antibiosis. The percentages of pathogenic mycelia growth were measured both with and without the antagonist, resulting in growth reductions of 46.7% to 50.0% for S. sclerotiorum. These analyses were performed by evaluating the endophytic/pathogenic mycelia growth in mm/day over an eight-day period of antagonistic tests.

O controle biológico consiste no uso de organismos que atacam outros que causam danos a culturas de plantas. Esta é uma estratégia muito utilizada no Controle Integrado de Pragas (CIP). O mofo branco, causado por Sclerotiniasclerotiorum (Lib.), causa danos em culturas de feijão. Este fungo é encontrado no solo e seus sintomas são caracterizados por lesões úmidas cobertas por micélios algodonosos, crescidos a partir do solo e/ou da planta hospedeira. Há relatos de pesquisas buscando agentes potenciais de controle biológico isolados de plantas para controlar fungos fitopatogênicos. Entre estes agentes encontram-se os microrganismos endofíticos, habitantes de espaços intercelulares de tecidos vegetais, muitas vezes responsáveis pela produção de substâncias antimicrobianas. Este trabalho teve por objetivo selecionar linhagens endofíticas isoladas de folhas de confrei (Symphytumofficinale L.), com potencial de antagonismo in vitro contra a linhagem fitopatogênica S. sclerotiorum. Doze linhagens de fungos endofíticos foram utilizadas na técnica de desafio em placa contra um isolado patogênico de S. sclerotiorum. Com o auxílio desta técnica, quatro linhagens com melhor atividade antagonística contra S. sclerotiorum foram selecionadas. Zonas de inibição no crescimento da linhagem patogênica foram consideradas como indicativo de antibiose. Foram efetuadas análises da porcentagem de elongação micelial com e sem antagonismo, mostrando resultados de 46,7% a 50,0% de redução no crescimento micelial do fitopatógeno. Estas análises consistiram de avaliações das medidas do crescimento em mm/dia das linhagens endofíticas/patogênica em testes de antagonismo.