Clinical, Pathological Characteristics and Progression of Urothelial Bladder Cancer in Young Adult Patients. Our Experience and Literature Review.

BACKGROUND: Bladder cancer is highly prevalent even though its incidence is considerably lower in patients younger than 40 years, thus raising the issue of the influence of age at diagnosis on the natural history of this disease. This study aimed to evaluate the characteristics and progression of young patients with urothelial bladder carcinoma with at least 10 years of follow-up and to compare the results with those of previously reported studies. MATERIAL AND METHODS: A retrospective study between 1990 and 2007 was conducted. The medical records and tissue samples of patients with urothelial bladder tumours were reviewed, and patients with a first diagnosis of urothelial carcinoma of the bladder at age 40 years or younger were selected. Their clinical and pathological data and disease-free survival were analysed. RESULTS: This study included 43 patients, with a median follow-up of 152 months (interquartile range (IQR): 96-222) and a mean age at diagnosis of 34 years (SD: 4.6). Thirty-five patients (81.4%) had non-muscle invasive tumours at diagnosis, and 53.5%, 27.9% and 18.6% had tumour grades of G1, G2 and G3, respectively. Fifteen patients (34.9%) experienced recurrence, and eight (18.6%) progressed. At 24 and 60 months, the recurrence-free survival rates were 84.8% (95% confidence interval (CI): 69.2%-92.9%) and 68.9% (95% CI: 51.7%-81%), respectively, and the progression-free survival rates were 94.9% (95% CI: 81%-98.7%) and 92.2% (95% CI: 77.8%-97.4%), respectively. CONCLUSIONS: Bladder cancer is an uncommon disease in young patients. In most cases, it consists of non-muscle-invasive tumours, with a low rate of recurrence and progression. The prognosis is based on the tumour's characteristics and not on the patient's age.

A human genome editing-based MLL::AF4 ALL model recapitulates key cellular and molecular leukemogenic features.

Cellular ontogeny and MLL breakpoint site influence the capacity of MLL-edited CD34+ hematopoietic cells to initiate and recapitulate infant patients' features in pro-B-cell acute lymphoblastic leukemia (B-ALL). We provide key insights into the leukemogenic determinants of MLL-AF4+ infant B-ALL.

A Comparative Study Regarding the Impact of Covid-19 on Latin American College Students

COVID-19 has changed educational opportunities for students around the world, and, in the process, affected their lifestyle, happiness, and engagement. The present research is part of a project from six universities in different countries across Latin America to examine the impact of COVID-19 on university students. Objectives: The purpose of this study was to assess and compare the impact of COVID-19 on lifestyle changes, orientations to happiness, and student engagement among a sample of college students in Mexico, El Salvador, Colombia, the Dominican Republic, Peru, and the US. Methods: Participants were 1764 students from the six previously identified countries. Data were collected using the Student Health Behavior Inventory, the Orientations to Happiness Scale, and the University Student Engagement Inventory. Results: Student respondents were mostly female, with a median age of 22. Most reported no changes in academic performance and statistically significant changes in some lifestyle behaviors such as nutrition and physical activity. Conclusions: The global pandemic led to behavioral changes among college students in Latin America, and it affected their orientations to happiness and engagement. Institutions of higher learning are called to create opportunities for their students to reintegrate into an in-person learning environment to facilitate positive lifestyle changes for their students.

El COVID-19 ha cambiado las oportunidades educativas para los estudiantes de todo el mundo y en el proceso afectó su estilo de vida, felicidad y compromiso. La presente investigación es parte de un proyecto de seis universidades en diferentes países de América Latina para determinar el impacto de COVID-19 en estudiantes universitarios. Objetivos: El propósito de este estudio fue evaluar y comparar el impacto del COVID-19 en los cambios de estilo de vida, las orientaciones hacia la felicidad y el compromiso de los estudiantes entre una muestra de estudiantes universitarios en México, El Salvador, Colombia, República Dominicana, Perú y Estados Unidos. Métodos: Los participantes fueron 1764 estudiantes de los seis países previamente identificados. Los datos se recolectaron utilizando el Inventario de Conducta de Salud del Estudiante, la Escala de Orientaciones a la Felicidad y el Inventario de Participación de los Estudiantes Universitarios. Resultados. Los estudiantes encuestados eran en su mayoría mujeres con una edad promedio de 22 años. La mayoría informó que no hubo cambios en el rendimiento académico y cambios estadísticamente significativos en algunos comportamientos de estilo de vida, como la nutrición y la actividad física. Conclusiones: La pandemia global provocó cambios de comportamiento entre los estudiantes universitarios de América Latina y afectó sus orientaciones hacia la felicidad y su compromiso. Las instituciones de educación superior están llamadas a crear oportunidades para que sus estudiantes se reintegren en un entorno de aprendizaje en persona para facilitar cambios positivos en el estilo de vida de sus estudiantes.

A story of a lone star tick: an imported case of Amblyomma americanum (Linnaeus, 1758) infected with Rickettsia amblyommatis that parasitized a US traveler returning to Mexico

ABSTRACT In this study, we report the presence of a female Amblyomma americanum tick attached to a former resident of the East Coast of the United States who moved to Mexico city. The amplification and sequencing of gene fragments of the 16S-rDNA and cytochrome c oxidase subunit 1 corroborated the identification of the species of the tick. Additionally, the presence of DNA of Rickettsia amblyommatis was confirmed. This work is the first report of an exotic tick of the genus Amblyomma in a traveler from the US to Mexico and represents the second record of an imported tick attached to humans in Mexico.

Seroprevalencia de leptospirosis y brucelosis en búfalos de agua (Bubalus bubalis) en Tierralta Córdoba, Colombia

En la producción zootécnica, la brucelosis y la leptospirosis ocasionan problemas reproductivos y son una limitante en salud y en producción animal. El objetivo fue determinar la presencia de anticuerpos contra Leptospira spp. y Brucella abortus, en una población bufalera, en el municipio de Tierralta, Córdoba. Se realizó un estudio descriptivo de corte transversal, que incluyó un total de 144 búfalos de la raza Murrah, destinados al doble propósito. Para el diagnóstico de Leptospira spp., se implementó la prueba de aglutinación microscópica, con 13 serogrupos, 19 serovares pertenecientes a 5 especies de Leptospira patógenas y para brucelosis Rosa de Bengala y C-Elisa. La seroprevalencia para Leptospira spp. fue del 87,5 %, el serogrupo Mini fue el de mayor frecuencia, pero Grippotyphosa presentó el mayor título. El 16,67 % de los búfalos evaluados presentaron títulos iguales o superiores a 1:800, asociados con infección actual o reciente. La alta seroprevalencia, se puede deber a las características ambientales de la zona, que brinda las condiciones favorables para el crecimiento y el mantenimiento de este patógeno que, sumado al comportamiento de los búfalos de revolcarse, los hace propensos a las infecciones con bacterias del género Leptospira sp., porque a menudo, las fuentes de agua están contaminadas por este patógeno. La seroprevalencia contra B. abortus por Rosa de Bengala y Elisa-C fue del 2,08 %. Todos los títulos determinados corresponden a procesos infecciosos. No hubo signos clínicos de enfermedad y la carencia de registros productivos no permitió determinar el efecto sobre los parámetros reproductivos.

In animal production, brucellosis and leptospirosis cause reproductive problems and limit animal health and production. The objective was to determine the presence of antibodies against Leptospira spp. and Brucella abortus in a buffalo population in the municipality of Tierralta, Cordoba. A descriptive, transversal study was carried out including a population of 144 Murrah´s breed buffalos destined for beef and milk production. For the Leptospira spp. diagnostic, was used a rapid slide agglutination test with 13 serogrups and 19 serovars belonging to 5 pathogenic Leptospira species was implemented and for Brucella abortus Rose Bengal and C-Elisa was used. Seroprevalence of Leptospira spp. was 87,5 %, serogrup Mini was the most frequent, but Grippotyphosa showed the higher titer. The 16,67 % of the buffaloes evaluated presented titles equal to or above than 1:800 associated with current or recent infection. High seroprevalence may be due to environmental characteristics of the zone, which gives favorable conditions for the growth and maintenance of this pathogen, these factors in conjunction with the habit of wallowing makes them prone to suffering infections caused by bacteria of the genera Leptospira sp. since water sources are often contaminated. Seroprevalence against B. abortus by Rose-Bengal and C-Elisa was 2,08 %, the determined titers correspond to infectious processes. There were no clinical manifestations of disease and the effects on reproductive parameters were not determined because of the lack of productive registries.

[Mucinous tubular and spindle cell renal cell carcinoma: two novel cases and a literature review.] / Carcinoma mucinoso tubular y de células fusiformes renal: aportación de 2 nuevos casos y revisión de la literatura.

INTRODUCTION: Mucinous tubularand spindle cell carcinomas (MTSC) are a relativelyrare subtype of renal cell carcinoma (RCC) . Thesetumors are composed by tubular and spindle cellareas within a mucinous stroma. They are generallylow-grade nuclei tumors and limited to the kidney, sothey usually have a favorable prognosis. We report twonew cases of MTSC treated at our institution. MATERIALS AND METHODS: We reviewed therenal tumors surgery database of our hospital from2008 to 2019, selecting patients diagnosed with CMTF.We evaluated clinicopathological data and evolution ofthe patients. We also reviewed the published literatureto compare it with our findings. RESULTS: Two patients were included in the study,a 50-year-old male (case 1) and a 55-year-old female(case 2). The diagnosis was made by ultrasound asan incidental fi nding in case 1 and during the studyof fl ank pain in case 2. Treatment was surgical withpartial and radical nephrectomy respectively. After amean follow-up of 70 months, both patients are aliveand disease-free. CONCLUSION: Mucinous tubular and spindle cellcarcinomas (MTSC) is a rare renal tumor, approximatelytwo hundred cases have been published. Thereare questions yet to be answered about their diagnosisand behaviour so it is of utmost importance to reportnew cases in order to increase our knowledge and improvepatient care.

INTRODUCCIÓN: Los carcinomasmucinosos tubulares y de células fusiformes (CMTF)son un subtipo relativamente infrecuente de carcinomarenal (CCR). Están compuestos por célulastubulares y fusiformes con un estroma mucinoso.Generalmente son tumores de bajo grado y estánlimitados al riñón, por lo que habitualmente tienenbuen pronóstico. Reportamos dos nuevos casos deCMTF tratados en nuestra institución. MATERIAL Y MÉTODOS: Se realizó una revisiónde todos los tumores renales intervenidos en nuestrohospital desde el año 2008 has ta el año 2019, seleccionandolos pacientes diagnosticados de CMTF.Se evaluaron las características clinicopatológicasy la evolución de los pacientes. Así mismo, se realizóuna revisión exhaustiva de la literatura publicadapara comparar los hallazgos descritos con los denuestros casos. RESULTADOS: Dos pacientes fueron incluidos enel estudio, un varón de 50 años ( caso 1) y una mujer de55 años ( caso 2). El diagnóstico fue ecográfico, de forma incidental en el caso 1 y a partir del estudio de undolor en flanco, en el caso 2. El tratamiento fue quirúrgicomediante nefrectomía parcial y radical respectivamente.Tras un seguimiento medio de 70 meses ambospacientes están vivos y libres de enfermedad. CONCLUSIÓN: El carcinoma mucinoso tubular yde células fusiformes (CMTF) es un tumor renal infrecuente,habiéndose publicado aproximadamente doscentenares de casos. Aún hay incógnitas que resolversobre su diagnóstico y comportamiento, de ahí la importanciade reportar nuevos casos que nos permitanaumentar su conocimiento y mejorar el manejo denuestros pacientes.

From the Obama Brand to digital antagonism of Donald Trump / De la marca obama 2. 0 al antagonismo digital de donald trump

RESUMEN El 45° presidente de Estados Unidos, Donald J. Trump, irrumpió en la sociedad americana con un discurso irreverente y haciendo un uso antagónico en las redes sociales que le sitúa como el antiparadigma de la marca Obama. Para demostrarlo, hemos realizado una comparación de la primera campaña (2016) y la precampaña a la reelección (2020) presidencial de Trump, tanto en Twitter como en Instagram, a través de un análisis de contenido (recogida de datos, análisis y valoración de los resultados) basado en tres categorías de análisis relevantes: retórica, comunicación política y nuevas tecnologías. De este análisis incluimos el uso asimétrico que hace de las redes sociales con un discurso políticamente incorrecto y con un apoyo bastante pobre de recursos extralingüísticos, pero que, sin embargo, le generan un liderazgo político muy notable.

ABSTRACT Donald trump, the 45 th president of United States, broke into American society with an irreverent speech by using social media in a very antagonist way, being this exactly the opposite of the Obama brand. In order to determinate this aspect, we have prepared a comparison between the first political campaign (2016) and the presidential pre-election (2020) of Donald J Trump, making a content analysis (data collection and an assessment of the results) of both Twitter and Instagram. This analysis is based on three relevants characteristics: rhetoric, political communication, and new technologies. From this analysis we have concluded an asymmetric use of social media with an inappropriate political speech and a very poor use of extralinguistic resources. However, these elements make him a significant political leader.

The genus Rickettsia in Mexico: Current knowledge and perspectives.

The genus Rickettsia encompasses 35 valid species of intracellular, coccobacilli bacteria that can infect several eukaryotic taxa, causing multiple emerging and re-emerging diseases worldwide. This work aimed to gather and summarise the current knowledge about the genus Rickettsia in Mexico, updating the taxonomy of the bacteria and their hosts by including all the records available until 2020, to elucidate host-parasite relationships and determine the geographical distribution of each Rickettsia species present in the country. Until now, 14 species of Rickettsia belonging to four groups have been recorded in Mexico. These species have been associated with 26 arthropod species (14 hard ticks, three soft ticks, two sucking lice, and seven fleas) and 17 mammal species distributed over 30 states in Mexico. This work highlights the high biological inventory of rickettsias for Mexico and reinforces the need to approach the study of this group from a One Health perspective.

Isquemia miocárdica por consumo de dibutilona / Myocardial ischemia from dibutylone use / Isquemia miocárdica por uso de dibutilona

Resumen: Las catinonas sintéticas son drogas estimulantes de síntesis, comercializadas en el mercado ilegal por sus propiedades estimulantes y perturbadoras del sistema nervioso central, para su uso recreativo, solas, o como adulterantes de cocaína y derivados anfetamínicos. A nivel mundial existe un número creciente de reportes de intoxicaciones agudas y complicaciones por consumo de estas sustancias. En Uruguay fueron detectadas por primera vez en el año 2015, existiendo una información epidemiológica muy limitada. Las catinonas sintéticas no se detectan por las técnicas inmunocromatográficas disponibles en los laboratorios de los servicios de urgencias de nuestro país. Se describe el primer caso de intoxicación por una catinona sintética (dibutilona) en Uruguay, en un paciente de 45 años, por consumo de un polvo vendido como "éxtasis", presentando como complicación un síndrome coronario agudo, con una buena evolución posterior. La confirmación diagnóstica se realizó mediante su detección en orina por cromatografía de gases acoplada a espectrometría de masas. La estructura química de la dibutilona y su mecanismo de acción explican las manifestaciones clínicas y la complicación isquémica por vasoespasmo coronario. En ausencia de una noción clara de exposición y ante la situación epidemiológica actual, la presencia de un cuadro clínico compatible con una droga estimulante y resultado negativo para cocaína y anfetaminas en estudios inmunocromatográficos, debe hacer plantear la sospecha de otros estimulantes de síntesis como las catinonas, tal como ocurrió en este caso.

Summary: Synthetic cathinone are stimulating synthetic drugs used for recreational purposes on their own or as adulterants in cocaine and amphetamines derivatives that are traded in illegal markets given their stimulating and disturbing properties on the central nervous system. Globally, there is a growing number of acute intoxications and complications as a consequence of consumption of these substances. In Uruguay they were first detected in 2015, there being limited epidemiological data. Synthetic cathinone are not detected by the immunochromatographic tests available at the laboratories of the emergency services in our country. The study describes the first case of intoxication by a synthetic cathinone (dibutylone) in Uruugay, in a 45 year old patient as a result of powder sold as "ecstasy". The patient presented an acute coronary syndrome, subsequent evolution being good. Diagnostic confirmation was made in urine using gas chromatography coupled with mass spectrometry. The chemical structure of dibutylone and its action mechanism explain the clinical manifestations and the coronary vasospasm causing ischemia. When there is no clear sign of a patient having been exposed to this substance and upon the current epidemiological state, the presence of clinical symptoms that are compatible with a stimulating drug and a negative result for cocaine and amphetamines in immunochromatographic tests must lead us to be suspicious about the presence of synthetic stimulating substances as cathinone, as in the case studied.

Resumo: Catinonas sintéticas são drogas estimulantes sintéticas, comercializadas no mercado ilegal por suas propriedades estimulantes e perturbadoras do sistema nervoso central, para uso recreativo isoladamente ou como adulterantes da cocaína e derivados de anfetaminas. Em todo o mundo cresce o número de relatos de intoxicações agudas e complicações decorrentes do uso dessas substâncias. No Uruguai, foram detectados pela primeira vez em 2015 com informações epidemiológicas muito limitadas. As catinonas sintéticas não são detectadas pelas técnicas imunocromatográficas disponíveis nos laboratórios de pronto-socorro de nosso país. Descreve-se o primeiro caso de intoxicação por catinona sintética (dibutilona) em nosso país, em um paciente de 45 anos, devido ao consumo de um pó vendido como "ecstasy", apresentando como complicação uma síndrome coronariana aguda, com boa evolução posterior. A confirmação diagnóstica foi feita por sua detecção na urina por cromatografia gasosa acoplada à espectrometria de massa. A estrutura química da dibutilona e seu mecanismo de ação explicam as manifestações clínicas e complicações isquêmicas devido ao vasoespasmo coronariano. Na ausência de uma noção clara de exposição e dada a situação epidemiológica atual, a presença de quadro clínico compatível com droga estimulante e resultado negativo para cocaína e anfetaminas em estudos imunocromatográficos, deve levantar a suspeita de outros estimulantes sintéticos como as catinonas, como aconteceu neste caso.

Usefulness of infection biomarkers for diagnosing bacteremia in patients with a sepsis code in the emergency department.

The objective of this study was to assess the usefulness of the biomarkers lactate, C-reactive protein (CPR) and procalcitonin for the diagnosis of bacteremia in patients with suspected sepsis in the emergency department (ED) and according to the focus of infection. We conducted a retrospective study among patients included in the sepsis code of our ED between November 2013 and December 2017. We analyzed demographic variables, co-morbidity according to the Charlson Index and focus of infection, blood cultures and classification according to Gram staining. We determined the diagnostic performance of the biomarkers quantitatively and calculated the area under the curve (AUC) for global bacteremia and as a function of the focus of infection. We included 653 patients with a median age of 79 years (interquartile range: 66-86), of whom 287 (44.0% were women. The most frequent infectious focus was respiratory (36.1%]. Blood cultures were requested in 87.5% (569 cases). Of the tested samples, 31.3% were positive, of which 63.5% revealed Gram-negative (GN) bacteria. Procalcitonin obtained globally the best AUC 0.70 (95% CI: 0.65-0.75). The values with the best sensitivity and specificity were 2.54 ng/mL for procalcitonin, 4.1 mmol/L for lactate and 156 mg/L for CRP. We found an association between the median procalcitonin value and GN bacteria (6.02; IQR: 1.39-39.40) and Gram-positive bacteria (1.74; IQR: 0.22-15.61). Procalcitonin is the biomarker with the greatest capacity to diagnose bacteremia, particularly in GN infection. Stratification by focus is important since not all biomarkers discriminate in the same way.

Retinoid receptor turnover mediated by sumoylation, ubiquitination and the valosin-containing protein is disrupted in glioblastoma.

Resistance to therapeutic use of retinoids in glioma has been observed for over 20 years; however, the exact mechanism of resistance remains unknown. To understand retinoic acid resistance in glioma, we studied the turnover mechanism of retinoid receptor proteins in neural stem cells and glioma stem-like cells. Here, we show that in normal neural stem cells, proteasomal degradation of retinoid receptors involves sumoylation, ubiquitination and recognition by the valosin-containing protein (VCP/p97/Cdc48). We find that Sumo1 modification has a dual role to stabilize the retinoid receptor from unwanted degradation and signal additional modification via ubiquitination. Subsequently, the modified receptor binds to the VCP chaperone and both proteins are degraded by the proteasome. Additionally, we reveal that all trans retinoic acid (ATRA) induces VCP expression, creating a positive feedback loop that enhances degradation. In contrast, the pathway is impaired in the glioma stem-like cells resulting in the accumulation of sumoylated and high molecular weight forms of retinoid receptors that lack transcriptional activity and fail to be recognized by the proteasome. Moreover, modified receptor accumulation occurs before ATRA treatment; therefore, the transcritptional defect in glioma is due to a block in the proteasomal degradation pathway that occurs after the sumo modification step.

Análisis de usos y resistencia a antibióticos en una UCI de Montería, Colombia / Analysis of antibiotic uses and resistance in an ICU from Monteria, Colombia

Resumen Introducción: El uso de antibióticos, enfrenta grandes problemas que deben ser resueltos en pro de la calidad de vida de los pacientes buscando un equilibrio en el costo-efectividad. Los análisis farmacoeconómicos son una herramienta útil para determinar qué fármacos deben estar disponibles en guías farmacoterapéuticas. Aunque el método de selección de fármacos varía en cada institución, el principio general es que deben ser elegidos los más efectivos al menor costo. El objetivo fue establecer el costo de los tratamientos, la evaluación de susceptibilidad y resistencia a los antibióticos en una Unidad de Cuidados Intensivos de Montería. Métodos: La muestra se integró por todos los pacientes ingresados a la UCI, que recibieron tratamiento antibiótico, durante doce meses. De las historias clínicas, se identificaron y se clasificaron los tratamientos aplicados, duración del tratamiento, costo del tratamiento por paciente, consumos por paciente de los antibióticos con el fin de estimar los costos de los antibióticos utilizados en pacientes de la UCI. Resultados: Se registraron 670 ingresos, de los cuales el 48,40% recibieron terapia antimicrobiana. Las principales causas de ingreso a la UCI fueron: evento coronario agudo (16,69%), insuficiencia respiratoria aguda (13,83%), sepsis (12,48%). Los microorganismos encontrados fueron: E. coli, K. pneumoniae, S. aureus, P. aeruginosa, S. epidermidis, A. baumanni, A. haemolyticus. Conclusión: Los sistemas estandarizados de vigilancia para el uso de antibióticos es una herramienta esencial en el uso racional y en el control de la resistencia antibacteriana.

Abstract The use of antibiotics, faces major problems that must be solved to ensure high-quality care of patients, which seeking a balance in cost-effectiveness. Pharmacoeconomics analyzes are a useful tool for determining which drugs should be available for pharmacotherapy strategies. Although the method of drug selection varies in each institution, the general principle is that the most effective ones should be chosen amongst the lowest-cost. The objective was to establish the cost of treatments, susceptibility assessment and resistance to antibiotics in an Intensive Care Unit in Montería. The sample was integrated by all the patients admitted to the ICU, who received antibiotic treatment, during twelve months. From the clinical records served, the treatments applied, duration of treatment, cost of treatment per patient, consumption per patient of the antibiotics were identified and classified to estimate the costs in relation to the therapeutic effectiveness of the antibiotics used in patients in the ICU. A total of 670 patients were registered, of whom 48,40% received antimicrobial therapy. The main causes of ICU admission were: acute coronary event (16,69%), acute respiratory failure (13,83%), sepsis (12,48%). The strains were: E. coli, K. pneumoniae, S. aureus, P. aeruginosa, S. epidermidis, A. baumanni, A. haemolyticus. Standardized surveillance systems for the use of antibiotics are an essential strategic intervention for the rational use and control antimicrobial resistance.

Prognosis of Clostridium difficile infection in adult oncohaematological patients: experience from a large prospective observational study.

The aim of the study is to evaluate demographics, epidemiology, clinical characteristics, treatment and outcomes of Clostridium difficile infection (CDI) in patients with and without concurrent cancer. This is a prospective cohort study of consecutive primary CDI episodes in adults (January 2006-December 2016). CDI was diagnosed on the presence of diarrhoea and positive stool testing for toxigenic C. difficile. Univariate analysis assessed differences between cancer and non-cancer patients. Risk factors of all-cause 30-day mortality were determinate using the logistic multivariable procedure. In total, 787 CDI episodes were recorded, 191 in cancer patients (median age 64, IQR 50-73). Of these, 120 (63%) had solid and 71 (37%) haematological malignancies (24 received a stem cell transplant). At the CDI diagnosis, 158 (82.7%) cancer patients had prior antibiotics and 150 (78.5%) were receiving proton pump inhibitors. Fifty-seven (80.3%) patients with haematological and 52 (43.3%) with solid malignancies were under chemotherapy at diagnosis; 25 (35.2%) with haematological and 11 (9.2%) with solid malignancies had an absolute neutrophil count < 1000/mm3. Overall, 30-day mortality was higher in cancer patients than in those without (19.2 vs. 8.6% respectively, p < 0.001); recurrence rates did not vary significantly (11.1 vs. 11%, p = 0.936). By type of neoplasm, 30-day mortality was higher in patients with haematological malignancies and solid tumours than in patients without cancer (respectively, 25.4 vs. 8.6%; p < 0.001 and 15 vs. 8.6%; p < 0.001). Our results suggest that the prognosis of CDI (30-day mortality) is poorer in patients with cancer than in those without although percentages of recurrent infection are similar in these two patient populations.

Value of Exhaled Nitric Oxide (FeNO) And Eosinophilia During the Exacerbations of Chronic Obstructive Pulmonary Disease Requiring Hospital Admission.

The aim of this study was to analyze whether FeNO levels in acute exacerbation of COPD (AECOPD) with hospital admission have better diagnostic value than eosinophilia in blood, and to evaluate its usefulness in predicting a better clinical response. An observational prospective study of patients with AECOPD was carried out. FeNO determinations were made on arrival at the emergency room (ER), at discharge and during stability 3-6 months after discharge. Co-morbidities, bronchodilators, inhaled (IGC) and systemic (SGC) glucocorticoids, eosinophils, systemic inflammation markers (procalcitonin, C-reactive protein), eosinophil cationic protein, and total IgE were collected. Fifty consecutive patients (92% men, mean age 75 ± 6 years) were included in this study. Phenotypes were 26% Asthma-COPD Overlap Syndrome (ACOS), 42% chronic bronchitis (CB) and 32% emphysema. ACOS patients showed significantly higher levels of FeNO (73 ppb) and eosinophils (508 cells/mm3) than the rest (CB: 23 ppb, 184 cells/mm3, emphysema: 27 ppb, 159 cells/mm3; p < 0.05). A significant correlation between FeNO levels measured in ER and eosinophils was observed (r = 0.7; p < 0.001), but not at discharge or in stable phase. No significant association was found with parameters of systemic inflammation and mean stay. In conclusion, the determination of FeNO in AECOPD does not offer advantages over the evaluation of eosinophilia. These parameters rise at arrival in ER, descend at discharge, and remain unchanged in the stable phase. Both present similar diagnostic utility and are able to better identify the ACOS phenotype, which helps select a population that could benefit from a glucocorticoids therapy.

A Core Regulatory Circuit in Glioblastoma Stem Cells Links MAPK Activation to a Transcriptional Program of Neural Stem Cell Identity.

Glioblastoma, the most common primary malignant brain tumor, harbors a small population of tumor initiating cells (glioblastoma stem cells) that have many properties similar to neural stem cells. To investigate common regulatory networks in both neural and glioblastoma stem cells, we subjected both cell types to in-vitro differentiation conditions and measured global gene-expression changes using gene expression microarrays. Analysis of enriched transcription factor DNA-binding sites in the promoters of differentially expressed genes was used to reconstruct regulatory networks involved in differentiation. Computational predictions, which were biochemically validated, show an extensive overlap of regulatory circuitry between cell types including a network centered on the transcription factor KLF4. We further demonstrate that EGR1, a transcription factor previously shown to be downstream of the MAPK pathway, regulates KLF4 expression and that KLF4 in turn transcriptionally activates NOTCH as well as SOX2. These results demonstrate how known genomic alterations in glioma that induce constitutive activation of MAPK are transcriptionally linked to master regulators essential for neural stem cell identify.

Raw milk quality in Northwestern Colombia / Calidad de leche cruda en el noroeste de Colombia / Qualidade do leite cru no noroeste da Colômbia

Summary Background: the worldwide trend in agro industries is to optimize food quality and obtain safe products for human consumption. It is important to produce milk with excellent physicochemical and microbiological quality to reduce public health risks. Objective: to evaluate the physicochemical and microbiological quality of milk and udder health in northwest Colombia, through the raw milk received at a leading dairy plant in Valledupar (Colombia). Methods: a non-probability sampling and a crosssectional study were conducted. Raw milk samples from 186 beef and milk (dual purpose) farms were collected. Physicochemical parameters, mesophilic and somatic cell counts were determined. Data were analyzed by descriptive statistics using SAS software. Results: physicochemical parameters were within the normal range in accordance with Colombian Decree No. 616 of 2006. The average mesophilic and somatic cell count was 305,279 colony forming units (CFU)/mL, and 523,207 somatic cells (SC)/mL, respectively. Sixty-eight percent of the farms had somatic cell counts greater than 200,000 SC/mL, which is the threshold for bovine mastitis. Conclusion: physicochemical quality of milk was good, but there were shortcomings in microbiological quality and udder health. Therefore, efforts are required to prevent this problems and to implement excellent management practices in the farms.

Resumen Antecedentes: la tendencia mundial en prácticas agroindustriales es la obtención de alimentos de excelente calidad e inocuidad para el consumo humano. Es importante producir leche de excelente calidad fisicoquímica y microbiológica para disminuir los riesgos en salud pública. Objetivo: evaluar la calidad fisicoquímica y microbiológica de la leche asi como la salud de la ubre en el noroeste de Colombia, a traves de la leche cruda recibida en una planta procesadora de Valledupar (Colombia). Métodos: se utilizó un muestreo no probabilístico por conveniencia y un estudio de corte transversal. Muestras de leche cruda de 186 fincas doble propósito fueron recolectadas. Se determinaron parámetros fisicoquímicos, conteo de células somáticas y mesófilos. Los datos obtenidos se analizaron por estadística descriptiva mediante el programa estadístico SAS. Resultados: los parámetros fisicoquímicos se encontraron dentro de los valores normales de acuerdo al decreto 616 de 2006. El promedio del recuento de mesófilos fue de 305.279 unidades formadoras de colonia (UFC)/mL y 523.207 células somáticas (CS)/mL. En el 68% de las empresas ganaderas, el conteo de células somáticas fue mayor a 200.000 CS/mL, lo cual, es un indicio de mastitis bovina. Conclusión: la calidad fisicoquímica es buena, pero hay deficiencias en la calidad microbiológica y sanidad de la ubre, por lo cual se deben implementar excelentes prácticas de manejo y de prevención.

Resumo Antecedentes: a obtenção de alimentos de excelente qualidade e segurança para o consumo humano é uma tendência mundial. É importante produzir leite de excelente qualidade físico-química e microbiológica para reduzir os riscos na saúde pública. Objetivo: avaliar a qualidade físico-química e microbiológica do leite cru produzido no noroeste da Colômbia, recebeu em um laticínio líder em Valledupar (Colômbia). Métodos: foi utilizada uma amostragem não probabilística e um estudo transversal. Amostras de leite cru foram coletadas em 186 fazendas de dupla aptidão. Foram determinados parâmetros fisico-químicos, mesófilos e contagem de celulas somanticas. Os dados obtidos foram analisados pela estatística descritiva mediante a utilizacao do programa estadistico SAS. Resultados: os parâmetros físico-químicos foram encontrados dentro da normalidade de acordo com o decreto 616 de 2006, a média da contagem de mesólitos foi de 305.279 unidades formadoras de colónias (UFC)/mL e a contagem de células somáticas (CS) foi 523.207 CS/mL. Em 68% das empresas produtoras de gado, a contagem de células somáticas foi maior do que 200.000 CS/mL. Conclusão: a qualidade físico-química é boa, mas há falhas na qualidade microbiológica e a saúde do úbere, por isso os esforços nas fazendas devem procurar a implementação de excelentes práticas de gestão e prevenção.

Discapacidad a concecuencia de traumas por accidentes de tránsito en pacientes ingresados en el Hospital Escuela de Rehabilitación de referencia nacional, Aldo Chavarría. Managua, Nicaragua. nero - noviembre 2015

OBJETIVO: Determinar las discapacidades a consecuencia de traumas poraccidentes de tránsito en pacientes ingresados en el Hospital Escuela de Rehabilitación de Referencia Nacional. Aldo Chavarría. Así mismo se identificó lascaracterísticas socio demográficas, tipología de los accidentes, tipos de traumas ygrado de funcionalidad en las actividades de la vida diaria en relación a lassecuelas de los traumas ocasionados por los accidentes de tránsito en lapoblación estudiada. METODOLOGÍA: Se trata de un estudio de tipo descriptivo, transversal y cuantitativo.El universo estuvo conformado por la población con diagnóstico de trauma poraccidentes de tránsito ingresados en el período de Enero a Noviembre del 2015.La unidad de análisis fueron los expedientes de los pacientes y los instrumentosutilizados para la recolección de la información fueron la ficha de revisióndocumental y la escala de medición estandarizada del Índice de Barthel. RESULTADOS: El estudio muestra que la población más afectada fueron: losvarones (85.7%), en edades productivas de (21 a 38 años), con niveles deescolaridad bajos y procedentes del departamento de Managua (45.2%). EL(52.4%), de los accidentes de tránsito son originados por motocicletas, seguido delos automóviles (14.3%), siendo los conductores, el principal actor vial involucrado.Los principales traumas ocasionados fueron; fracturas de miembros inferiores(61.9%), columna (19.1%) y los traumatismos craneoencefálicos (19%), queoriginaron discapacidades motoras permanentes como: amputaciones, (61.9%)paraplejías (14.3%), hemiplejias (9.5%) y tetraplejías (14.3%) con diversos gradosde severidad de dependencia funcional en las actividades de la vida diaria enrelación al tipo de secuela.

Efectos del método de aplicación y tiempo de fotopolimerización de un nuevo adhesivo autograbador / Effects of application method and curing time of a new self-etching adhesive

Evaluar el método de aplicación y tiempo de fotopolimerización de dos sistemas adhesivos autograbadores sobre esmalte. Materiales y Métodos: Fueron utilizados 30 molares, los cuales fueron divididos en 8 grupos de 10 muestras cada uno a los cuales se les aplico dos tipos de adhesivos autograbadores (1 Adhese y 2 Unniversal Single bond) de manera activa y pasiva con diferentes tiempos de fotopolimerización para evaluar la resistencia de unión de estos adhesivos autograbadores, después de la conformación de los tygon fue llevado a microcizallamiento. Resultados: Mostraron que la extensión de irradiación de luz para los adhesivos (1 Adhese y 2 Universal Single bond) no dio diferencia significativamente independientemente del tipo de aplicación (p<0.005). En cuanto al tipo de aplicación si hubo diferencia significativa para los dos adhesivos (p<005). Conclusiones: La aplicación activa aumenta los valores de resistencia de unión en adhesivos autograbadores de un paso y dos pasos en esmalte.

Introduction: To evaluate the method of application and curing time of two adhesive systems on enamel-etching. Materials and Methods: The study involved 30 molars, which were divided into 8 groups of 10 samples each in which we applied two types of self-etching adhesives (1 AdheSE and 2 Universal Single bond) actively and passively with different times of photopolymerization to evaluate the bonding strength of these etching adhesives, after forming of the tygon microshear was carried. Results: showed that the extension of light for adhesives (1 AdheSE Universal Single bond and 2) did not differ significantly regardless of the type of application (p>0.005). As for the type of applications if no significant difference for the two adhesive (p<0.005). Conclusions: The active application increases the values of bond strength of self etching adhesives one step and two steps in enamel.