Gene expression changes in conjunctival cells associated with contact lens wear and discomfort.

PURPOSE: This study aimed to analyze the differences in the expression of pain-related genes in conjunctival epithelial cells among symptomatic contact lens (CL) wearers (SCLWs), asymptomatic CL wearers (ACLWs), and non-CL wearers (non-CLWs). METHODS: For this study, 60 participants (20 non-CLWs, 40 CLWs) were enrolled. The CLW group comprised 20 ACLWs and 20 SCLWs according to the Contact Lens Dry Eye Questionnaire short form©. Conjunctival cells were collected using impression cytology, and RNA was isolated and used to determine the expression levels of 85 human genes involved in neuropathic and inflammatory pain. The effects of CL wear and discomfort were evaluated using mixed-effects ANOVA with partially nested fixed-effects model. Gene set enrichment analysis was performed to assign biological meaning to sets of differentially expressed genes. RESULTS: Six genes (CD200, EDN1, GRIN1, PTGS1, P2RX7, and TNF) were significantly upregulated in CLWs compared to non-CLWs. Eleven genes (ADORA1, BDKRB1, CACNA1B, DBH, GRIN1, GRM1, HTR1A, PDYN, PTGS1, P2RX3, and TNF) were downregulated in SCLWs compared to ACLWs. These genes were mainly related to pain, synaptic transmission and signaling, ion transport, calcium transport and concentration, and cell-cell signaling. CONCLUSIONS: CL wear modified the expression of pain- and inflammation-related genes in conjunctival epithelial cells. These changes may be in part, along with other mechanisms, responsible for CL discomfort in SCLWs.

Associations between Menopausal Hormone Therapy and Colorectal, Lung, or Melanoma Cancer Recurrence and Mortality: A Narrative Review.

Objective: to develop eligibility criteria for use in non-gynecological cancer patients. Methods: We searched all the articles published in peer-reviewed journals up to March 2021. We utilized the PICOS standards and the following selection criteria: menopausal women with a history of non-gynecological and non-breast cancer who underwent hormone replacement therapy (HRT) using various preparations (oestrogens alone or in combination with a progestogen, tibolone, or tissue selective oestrogen complex) and different routes of administration (including oral, transdermal, vaginal, or intra-nasal). We focused on randomized controlled trials as well as relevant extension studies or follow-up reports, specifically examining recurrence and mortality outcomes. Results: Women colorectal cancer survivors who use MHT have a lower risk of death from any cause than those survivors who do not use MHT. Women who are skin melanoma survivors using MHT have a longer survival rate than non-MHT survivors. There is no evidence that women lung cancer survivors who use MHT have a different survival rate than those who do not use MHT. Conclusions: MHT is safe for women who have a history of colorectal, lung, or skin melanoma cancers.

Quality of Tissue Samples Obtained by Endoscopic Ultrasound-Guided Liver Biopsy: A Randomized, Controlled Clinical Trial.

INTRODUCTION: Liver biopsy (LB) remains essential for the diagnosis and staging of parenchymal liver diseases. Endoscopic ultrasound-guided LB (EUS-LB) has emerged as an attractive alternative to percutaneous and transjugular routes. We aimed at comparing the adequacy of samples obtained by EUS-LB with percutaneous LB. METHODS: A single-center, randomized, controlled clinical trial was designed. Patients undergoing LB were randomly assigned to EUS-LB or percutaneous LB groups. EUS-LB was performed with a 19-gauge Franseen core needle through a transduodenal and transgastric route. Percutaneous LB was performed with a 16-gauge Tru-Cut needle. The main outcome was the percentage of adequate samples obtained. Secondary outcomes were the percentage of accurate histologic diagnosis, number of complete portal tracts (CPT), total and longest specimen length (TSL and LSL), sample fragmentation, adverse events, and patients' satisfaction. An adequate specimen was defined as TSL ≥20 mm and including ≥11 CPT. RESULTS: Ninety patients were randomized (44 to EUS-LB and 46 to percutaneous LB) and included in the analysis. The percentage of adequate tissue samples was 32.6% and 70.4% for percutaneous LB and EUS-LB, respectively ( P < 0.001). A final histologic diagnosis was provided in all cases but one. TSL was longer after EUS-LB (23.5 vs 17.5 mm, P = 0.01), whereas the number of CPT was similar in both groups. Sample fragmentation occurred more often after EUS-LB ( P < 0.001). No differences in adverse events were found. Satisfaction reported with both procedures was high. DISCUSSION: EUS-LB is safe and accurate and may be considered an alternative to percutaneous LB for the evaluation of parenchymal liver diseases.

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group.

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

Value of skin tests for managing allergic hypersensitivity reactions to platinum compounds.

Background Platinum-based therapy continues to be one of the pillars of the treatment of different types of cancer. However, many times the responsible clinician renounces its use after the appearance of a hypersensitivity reaction. Objective To assess the value of skin tests (ST) in clinical practice to address the treatment of patients with suspicion of immediate hypersensitivity reactions (HSRs) to platinum compounds. Method Single-center retrospective study of 3 years. Adult patients treated with any platinum compound who experienced HSR symptoms and for whom an oncologist requested ST, were included. ST with cisplatin, carboplatin and oxaliplatin were performed. Results Twenty-two patients were included. ST were positive in 12 patients (54.5%), of which 4 (33%) presented cross-reactivity to another platinum compound. Fifteen patients continued platinum-based chemotherapy: 9 patients with positive ST (4 continued by desensitization and 5 with another platinum compound) and 6 patients with negative ST, of which 1 repeated an HSR. A NPV of 0.91 was calculated. Conclusion ST helped physicians identify patients most susceptible to platinum derivative allergies and resume platinum-based therapy in many patients for whom no suitable therapeutic alternative was clinically acceptable.

Fendrix vs Engerix-B for Primo-Vaccination Against Hepatitis B Infection in Patients With Inflammatory Bowel Disease: A Randomized Clinical Trial.

INTRODUCTION: To compare Engerix-B and Fendrix hepatitis B virus for primo vaccination in inflammatory bowel disease (IBD). METHODS: Patients with IBD were randomized 1:1 to receive Engerix-B double dose or Fendrix single dose at months 0, 1, 2, and 6. Anti-HBs titers were measured 2 months after the third and fourth doses. Response to vaccination was defined as anti-HBs ≥100 UI/L. Anti-HBs titers were measured 2 months after the third and fourth doses and again at 6 and 12 months after the fourth dose. RESULTS: A total of 173 patients were randomized (54% received Engerix-B and 46% Fendrix). Overall, 45% of patients responded (anti-HBs ≥100 IU/L) after 3 doses and 71% after the fourth dose. The response rate after the fourth dose was 75% with Fendrix vs 68% with Engerix-B (P = 0.3). Older age and treatment with steroids, immunomodulators, or anti-tumor necrosis factor were associated with a lower probability of response. However, the type of vaccine was not associated with the response. Anti-HBs titer negativization occurred in 13% of patients after 6 months and 20% after 12 months. Anti-HBs ≥100 IU/L after vaccination was the only factor associated with maintaining anti-HBs titers during follow-up. DISCUSSION: We could not demonstrate a higher response rate of Fendrix (single dose) over Engerix-B (double dose). A 4-dose schedule is more effective than a 3-dose regimen. Older age and treatment with immunomodulators or anti-tumor necrosis factors impaired the success. A high proportion of IBD patients with protective anti-HBs titers after vaccination loose them over time. The risk of losing protective anti-HBs titers is increased in patients achieving anti-HBs <100 IU/L after the vaccination.

Morphological and functional changes of chronic pancreatitis in patients with dyspepsia: A prospective, observational, cross-sectional study.

OBJECTIVE: Whether chronic pancreatitis (CP) may present with dyspepsia is controversial. We aimed at evaluating the frequency and risk factors of changes of CP in patients presenting with epigastric pain syndrome (EPS)-like symptoms. DESIGN: A prospective, observational, cross-sectional study was carried out in patients with EPS-like symptoms. Patients underwent endoscopic ultrasound (EUS) evaluation of the pancreas, and changes of CP were defined as the presence of five or more EUS criteria of the disease. In patients with 3 or 4 EUS criteria, magnetic resonance dynamic evaluation of the pancreas (MRI/sMRCP) and endoscopic pancreatic function test (ePFT) were carried out to confirm or exclude the presence of changes of CP. A multivariate logistic regression analysis was performed to evaluate factors associated with CP findings, and results are shown as odds ratio (OR) and 95% confidence interval (CI). RESULTS: 213 patients were included. Changes of CP were confirmed by EUS (≥5 criteria) in 18 patients (8.4%). Thirty-four patients had 3-4 EUS criteria, and changes of CP were confirmed in 27 of them by MRI/sMRCP and ePFT (12.7%). Morphological and functional findings of CP were then present in 45 patients (21.1%). Male gender (OR 2.97; 95%CI 1.39-6.37) and alcohol and tobacco consumption (OR 6.56; 95%CI 1.97-21.85) were associated with the presence of changes of CP. CONCLUSION: Morphological and functional changes of CP are frequent in patients with EPS-like symptoms. Whether these pancreatic changes explain EPS-like symptoms requires further investigation.

Hysteroscopic Removal of Retained Products of Conception Implanted Over a Focal Area of Adenomyosis: A Case Report.

STUDY OBJECTIVE: To describe a technique for hysteroscopic removal of retained products of conception (RPOC) implanted over an area of adenomyosis. DESIGN: A case report (Canadian Task Force classification III). SETTING: RPOC is an unfortunate complication that may occur after the resolution of a normal pregnancy; it is more common after early pregnancy termination or spontaneous miscarriage [1]. Immediate consequences of RPOC include persistent vaginal bleeding, abdominal pain, pelvic infection, fever, and dilated cervix. Moreover, known long-term complications include the formation of intrauterine adhesions (IUAs) with the potential creation of Asherman syndrome resulting in adverse reproductive outcomes caused by subfertility, chronic pelvic pain, menstrual disturbances, and severe pregnancy complications such as abnormal placentation including the placenta accreta spectrum [2,3]. A recently published American Association of Gynecologic Laparoscopists practice report on IUAs suggests that the surgical approach used to treat intrauterine pathology could have an impact with greater risk for IUA formation when blind versus procedures under direct visualization are performed [4]. INTERVENTIONS: A 35-year-old patient who presented with persistent bleeding for over 5 weeks. The patient has a long history of dysmenorrhea and heavy menstrual bleeding. Magnetic resonance imaging revealed the presence of adenomyosis. She had an unfortunate spontaneous abortion at 8 weeks of gestation. On physical examination, she was found to have a dilated uterine cervix with persistent vaginal bleeding; there were no signs of infection. Pelvic ultrasound revealed an intrauterine hyperechogenic vascularized area of 2 × 2, 8 × 2 cm implanted over a focal area of adenomyosis, which is consistent with the presence of RPOC. With the aim of minimizing possible acute complications such as bleeding, infection, and uterine perforation, a hysteroscopic approach was taken to avoid performing a blind dilation and curettage. A secondary benefit of a hysteroscopic approach is a lower incidence of long-term complications such as IUAs and the consequent Asherman syndrome. We describe a hysteroscopic technique in which the use of electrosurgery is limited to minimize thermal damage of the endometrium, highlighting important tips and tricks of the procedure. CONCLUSION: Hysteroscopic removal of RPOC is a feasible and safe management option of this complication of pregnancy. We strongly suggest avoiding performing blind procedures such as dilation and curettage and favor the adoption of this modality that allows the removal of retained products of conception under direct visualization.

Increased Risk of Mortality Associated With Pancreatic Exocrine Insufficiency in Patients With Chronic Pancreatitis.

BACKGROUND: Pancreatic exocrine insufficiency (PEI) is a common serious complication in chronic pancreatitis (CP); however, little is known about its effect on mortality in these patients. In this study, we assessed the mortality risk of PEI in patients with CP. STUDY: A prospective, longitudinal cohort study conducted in patients with CP under long-term follow-up. CP and PEI were diagnosed using pancreatic imaging and the C-labeled mixed triglyceride breath test, respectively. Multivariate analysis was performed to evaluate the impact of PEI and other clinical features on mortality risk. RESULTS: Patients (N=430) were analyzed (79.1% male; mean age, 47.8 y) during a mean follow-up of 8.6±4.6 years. PEI prevalence was 29.3% and mortality was 10.9%. Most frequent causes of death were cancer (40.4%), infection (21.3%), and acute cardiovascular event (14.9%). Multivariate analyses showed associations between increased mortality and presence of PEI [hazard ratio (HR), 2.59; 95% confidence interval (CI), 1.42-4.71; P<0.003], liver cirrhosis (HR, 3.87; 95% CI, 1.95-7.69; P<0.001), age at diagnosis (HR, 1.05; 95% CI, 1.03-1.09; P<0.001), toxic etiology of CP (HR, 3.11; 95% CI, 1.11-8.70; P<0.05) and respiratory comorbidity (HR, 2.19; 95% CI, 1.12-4.31; P<0.03). Nutritional markers were significantly lower in patients with PEI versus those without PEI (P<0.001) and in those who died versus survivors (P<0.001). CONCLUSIONS: PEI was a significant independent risk factor for mortality in patients with CP. These results support further research into the optimal treatment of PEI to reduce mortality in this population.

The new violet laser dye, Krome Orange, allows an optimal polychromatic immunophenotyping based on CD45-KO gating.

BACKGROUND: Polychromatic immunophenotyping improves characterization of leukocyte subpopulations and their malignant counterparts. However, the lack of various fluorochrome-labeled monoclonal antibodies (MoAbs) hinders the formation of multi-color panels. CD45 appears to be an important MoAb for immunophenotyping of these cells. Plotted against the side scatter, CD45 provides immunological cell differentiation and the ability to recognize various normal and malignant leukocyte subpopulations. CD45 is commonly used and labeled with various fluorochromes and as a result, is incorporated in multi-color panels as a conjugate of less available fluorochromes, such as the violet laser dyes. However, these dyes (e.g. Pacific Orange/PO) often possess low fluorescence intensity, which may be too weak to differentiate between populations. The new organic dye Krome Orange (KO, emission at 528 nm) appears to be a more intense violet laser dye, serving as an alternative to PO. METHODS: Intensities of CD45 conjugated with FITC, PE, ECD, PE-Cy5, PE-Cy7, PO and KO were tested in different cell sources. Various lineage markers were sequentially back gated on CD45-KO to identify subpopulations. A 10-color MoAb panel for determination of aberrancies in small cell samples was composed to test specificity of CD45-KO. CONCLUSIONS: We showed in various fixed and unfixed cells from different sources that KO is a suitable fluorochrome with a significantly higher quantum yield than PO and is even brighter than other violet laser dyes (e.g. Pacific Blue). CD45-KO/SS enables us to distinguish and characterize various normal and malignant leukocyte subpopulations. By using a 10-color MoAb panel to screen on aberrancies, we showed that CD45-KO provides reliable immunophenotyping within small amounts of cells and thereby improves the quality of 10-color stainings.

Comparison of annual dry and wet deposition fluxes of selected pesticides in Strasbourg, France.

This work summarizes the results of a study of atmospheric wet and dry deposition fluxes of Deisopropyl-atrazine (DEA), Desethyl-atrazine (DET), Atrazine, Terbuthylazine, Alachlor, Metolachlor, Diflufenican, Fenoxaprop-p-ethyl, Iprodione, Isoproturon and Cymoxanil pesticides conducted in Strasbourg, France, from August 2000 through August 2001. The primary objective of this work was to calculate the total atmospheric pesticide deposition fluxes induced by atmospheric particles. To do this, a modified one-dimensional cloud water deposition model was used. All precipitation and deposition samples were collected at an urban forested park environment setting away from any direct point pesticide sources. The obtained deposition fluxes induced by atmospheric particles over a forested area showed that the dry deposition flux strongly contributes to the total deposition flux. The dry particle deposition fluxes are shown to contribute from 4% (DET) to 60% (cymoxanil) to the total deposition flux (wet+dry).

El uso de las Guías Internacionales de Diagnóstico y Tratamiento del Asma (GINA) en la práctica clínica de los médicos familiares / Use of international guidelines for the diagnosis and treatment of asthmatic patients in the clinical practice of familial physicians

Objetivo: evaluar el grado de conocimiento que tienen los médicos familiares sobre las Guías Internacionales de Diagnóstico y Tratamiento del Asma (GINA). Material y método: se aplicó un cuestionario a 50 médicos familiares de las Unidades de Medicina Familiar números 1, 21 y 28. Los participantes tenían una edad promedio de 46 años y una proporción 1:1 entre el sexo masculino y el femenino. El análisis se realizó con SPSS y la prueba r de Pearson. Resultados: la correlación entre los conocimientos generales sobre el asma y las nociones sobre las GINA fue de r=0.022; la de los conocimientos generales del asma y la especialidad de medicina familiar, de r=-0.117 y la de los conocimientos sobre las Guías Internacionales del Asma y la medicina familiar, de r=0.33. Conclusiones: existe un escaso conocimiento de las guías GINA.

Criterios de diagnóstico y tratamiento de la rinosinusitis crónica en servicios de medicina familiar, de otorrinolaringología y de alergia / Diagnostic and treatment criteria ofrhinosinusitis in units of familial medicine, otolaryngology and allergy

Antecedentes: la rinosinusitis es una respuesta inflamatoria que involucra a la membrana mucosa de la cavidad nasal de uno o más senos paranasales. Su prevalencia es de 14 y de 5 al 13 por ciento en adultos y niños, respectivamente. La rinosinusitis causa un alto índice de ausentismo escolar y laboral. Objetivo: conocer los criterios de diagnóstico y tratamiento de la rinosinusitis en unidades de medicina familiar, otorrinolaringología y alergia. Material y método: se estudió una serie de 25 pacientes obtenidos al azar de las Unidades de Medicina Familiar números 21 y 28 del IMSS. El diagnóstico se evaluó de acuerdo con el consenso de 1998 y la tomografía computada se consideró el estándar de oro, se realizó a todos los pacientes y se evaluó por un radiólogo cegado al estudio. Resultados: el diagnóstico de rinosinusitis lo realizaron las unidades de medicina familiar en 68 por ciento de los casos, el servicio de otorrinolaringología en 40 por ciento y el de alergia en 64 por ciento. Los criterios clínicos más utilizados fueron la congestión nasal y la descarga nasal anterior y posterior. El examen solicitado con mayor frecuencia fue la tomografía computada (38.7 por ciento) y, en 30 por ciento de los casos, no se prescribió tratamiento médico. Conclusiones: los médicos familiares, los otorrinolaringólogos y los alergólogos utilizan poco los criterios internacionales para el diagnóstico y tratamiento de la rinosinusitis crónica. Los otorrinolaringólogos realizan otros diagnósticos diferenciales.

Absceso cerebral por nocardia en pacientes con HIV-SIDA / Brain abscesso by nocardia in patients with HIV-AIDS

RESUMEN:Se presenta un paciente de 32 años de edad con diagnóstico de HIV-SIDA en 1989 y enfermedad marcadora por PCP en 1997, con recuento de CD4 de 63 mm3 y carga viral de 14.400. Presentando a la consulta crisis convulsivas asociadas a lesión parietal izquioerda con captación de contraste en la tomografía axial computada (TAC) y serología positiva para toxoplasmosis, sin repuesta inicial a tratamiento específico con pirimetamina más sulfadiazina.Frente a la persistencia de la clínica inicial y la aparición de toxidermia madicamentosa, se realiza estudio de resonancia nuclear magnética (RNM) y posterior biopsia estereotáxica, donde se identifica al examen directo bacilos gram positivos-ácido alcohol resistentes, con cultivo posterior negativo. Se comienza tratamiento con sulfadiazina, ceftriaxona, amikacina y continua con drogas antiretroviral (3TC-D4T-IP), presentando buena evolución clínica y resolución de las lesiones tomográficas luego del año de tratamiento. Se realiza una revisión de la literatura sobre nocardia del sistema nervioso central en paciente HIV-SIDA y la metodología en los procedimientos diagnósticos para los pacientes con enfermedad neurológica asociada al SIDA.

Acropaquia tiroidea: informe de un caso clínico documentado con gammagrafía / Thyroid acropachy: report of a clinical case documented using gammagraphy

La acropaquia tiroidea es una manifestación rara de enfermedad de Graves Basedow (0.066%) caracterizada por dedos en palillos de tambor y deformidad digital fusiforme la que generalmente se asocia a exoftalmos. Se describe el caso de un paciente con enfermedad de Graves que desarrolló acropaquia, con estudios radiológicos inespecíficos pero con hipercaptación lineal diafisiaria en falanges que permitieron demostrar demostrar esta complicación mediante estudio gammagráfico. Asimismo, se hacen consideraciones en relación a la fisiopatología de esta manifestación clínica

Cortocircuitos intrahepáticos en hipertensión portal / Intrahepatic shunts in portal hypertension

El cortocircuito intrahepático es aquella fracción del flujo de la vena porta y de la arteria hepática que no pasa por los sinusoides hepáticos debido a la presencia de comunicaciones vasculares entre estos elementos y las venas hepáticas, dirigiendo dicho flujo sanguíneo directamente a la circulación general. El aumento de cortocircuitos puede tener alguna relación pronóstica con la presencia de encefalopatía y hemorragia posterior a cirugía de hipertensión portal. Incluso, se ha tratado de relacionar con la mortalidad operatoria y sobrevida a largo plazo. En nuestra institución se llevó a cabo un estudio de 74 pacientes en donde se practicaron determinaciones de cortocircuitos por arteria hepática y vena porta. Los valores encontrados para la arteria hepática fueron de 12.98 + ou - 11.44% en el grupo de pacientes operados (I) y de 7.56 + ou - 5.9% en el grupo no operado (II). Los valores para la vena porta fueron de 35.19 + ou - 19.26% en el grupo I y de 39.5 + ou - 29.09% en el grupo II. No hubo diferencia estadísticamente significativa entre ambos grupos al comparar la frecuencia de hemorragia, mortalidad operatoria y sobrevida a largo plazo. Sin embargo, en los resultados por vena porta se observa que el 70% de los pacientes que presentaron encefalopatía postoperatoria tenían un promedio de cortocircuitos de 55.5%. Se concluye que en los pacientes con hepatopatía experimentan elevación de los cortocircuitos intrahepáticos. Hay una mayor frecuencia de encefalopatía postoperatoria en aquellos casos que tienen más de 35% de cortocircuitos por vena porta. Se puede decir que el tipo de cortocircuitos es útil como parámetro para seleccionar el tipo de cirugía derivativa en el manejo del enfermo con hipertensión portal hemorrágica