Differentiation and Identification of Cachaça Wood Extracts Using Peptide-Based Receptors and Multivariate Data Analysis.

It is becoming increasingly important to differentiate complex mixtures, especially in forensics. Cachaça, the most popular alcoholic beverage in Brazil, is made from distilled and fermented sugar cane juice. It contains a mixture of naturally occurring polyphenols known as tannins, whose composition is dictated by the type of wood used to age the beverage. These tannins can be differentiated in an Indicator Displacement Assay (IDA) using peptide-based ternary sensing ensembles. This investigation demonstrates a technique for fingerprinting the identity of the woods used to age cachaças. Unknown cachaça samples were tested against a training set of Brazilian woods in addition to oaks from different countries. Results obtained from the analysis showed that 62.5% of the samples were correctly identified. Furthermore, four samples anonymously added to the pool of unknowns from the training set were identified with 100% accuracy, emphasizing both the promising results obtained from this method of differentiation and the importance of analyzing same-age samples.

Cold weather is a predisposing factor for testicular torsion in a tropical country. A retrospective study / Clima frio é um fator predisponente para torção testicular num país tropical. Um estudo retrospectivo

CONTEXT AND OBJECTIVE: Testicular torsion is a medical and urological emergency because it can lead to loss of the organ. The theory of seasonal testicular torsion occurrence is based on studies from institutions located in cold and temperate regions. The objective here was to determine whether cold weather is associated with higher incidence of testicular torsion in a tropical country, such as Brazil. DESIGN AND SETTING: Retrospective study, conducted in a tertiary and teaching hospital. METHODS: Patients with acute testicular torsion confirmed by surgery between April 2006 and March 2011 were studied. Information on weather conditions at the time of symptom onset was collected. RESULTS: A total of 64 testicular torsion cases were identified. The months with the highest incidences of testicular torsion were June (16%), July (19%) and August (11%), which had the lowest mean temperatures, of 17.6 °C, 16.4 °C and 18.2 °C, respectively. Eleven percent of cases occurred during spring (October to December), 16% occurred in summer (January to March), 34% occurred in fall (April to June) and 39% occurred in winter (July to September). There was a significant association between the incidence of testicular torsion and the season (fall and winter), P < 0.001. CONCLUSIONS: Testicular torsion follows a seasonal association even in a tropical country, and is more frequent in the colder months of the year, namely fall and winter, when almost three-quarters of the cases occurred. These observations add further evidence that cold weather has an etiologic role in testicular torsion occurrence. .

CONTEXTO E OBJETIVO: A torção testicular é uma emergência médica e urológica, pois pode levar à perda do órgão. A teoria da ocorrência sazonal da torção testicular é baseada em estudos de instituições localizadas em regiões frias e temperadas. O objetivo foi determinar se o clima frio está associado a uma maior incidência de torção testicular em um país tropical, como o Brasil. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, realizado em um hospital terciário e de ensino. MÉTODOS: Foram estudados pacientes com torção testicular aguda confirmada na cirurgia, durante o período de abril de 2006 a março de 2011. Informações sobre as condições climáticas no início dos sinto-mas foram coletadas. RESULTADOS: Um total de 64 casos de torção testicular foi identificado. Os meses com maiores incidên-cias foram junho (16%), julho (19%) e agosto (11%), que assinalaram as menores temperaturas médias, de 17,6 °C, 16,4 °C e 18,2 °C, respectivamente. Onze por cento dos casos ocorreram durante a primavera (outubro a dezembro), 16% no verão (janeiro a março), 34% no outono (abril a junho) e 39% no inverno (julho, agosto, setembro). Houve associação significante entre a incidência de torção testicular e a estação (outono e inverno), P < 0,001. CONCLUSÃO: Torção testicular obedece a uma predileção sazonal mesmo num país tropical, sendo mais fre-quente nos meses mais frios do ano, particularmente no outono e inverno, quando ocorrem quase três quartos dos casos. Estes achados acrescentam evidência a um papel etiológico do clima frio na torção testicular. .

Cold weather is a predisposing factor for testicular torsion in a tropical country. A retrospective study.

CONTEXT AND OBJECTIVE: Testicular torsion is a medical and urological emergency because it can lead to loss of the organ. The theory of seasonal testicular torsion occurrence is based on studies from institutions located in cold and temperate regions. The objective here was to determine whether cold weather is associated with higher incidence of testicular torsion in a tropical country, such as Brazil. DESIGN AND SETTING: Retrospective study, conducted in a tertiary and teaching hospital. METHODS: Patients with acute testicular torsion confirmed by surgery between April 2006 and March 2011 were studied. Information on weather conditions at the time of symptom onset was collected. RESULTS: A total of 64 testicular torsion cases were identified. The months with the highest incidences of testicular torsion were June (16%), July (19%) and August (11%), which had the lowest mean temperatures, of 17.6 °C, 16.4 °C and 18.2 °C, respectively. Eleven percent of cases occurred during spring (October to December), 16% occurred in summer (January to March), 34% occurred in fall (April to June) and 39% occurred in winter (July to September). There was a significant association between the incidence of testicular torsion and the season (fall and winter), P < 0.001. CONCLUSIONS: Testicular torsion follows a seasonal association even in a tropical country, and is more frequent in the colder months of the year, namely fall and winter, when almost three-quarters of the cases occurred. These observations add further evidence that cold weather has an etiologic role in testicular torsion occurrence.

Resistance to first-line antituberculosis drugs in Spain, 2010-2011. RETUBES Study.

INTRODUCTION: The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors. METHODS: Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011. RESULTS: A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR=2.3; 95%CI: .98-5.67 and OR=2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03). CONCLUSIONS: The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance.

Social, clinical and microbiological differential characteristics of tuberculosis among immigrants in Spain.

BACKGROUND: To identify the differential tuberculosis (TB) characteristics within the immigrant population with respect to natives in Spain. METHODOLOGY/PRINCIPAL FINDINGS: A prospective cohort study design was implemented to examine the TB cases diagnosed and starting standard antituberculous treatment in Spain, between January 1st 2006 and March 31st 2007. A logistic regression analysis was performed to determine differential characteristics. 1,490 patients were included in the study population, 1,048 natives and 442 (29.7%) immigrants. According to the multivariate analysis, the following variables were significantly associated with immigrant TB cases: younger age (OR = 3.79; CI:2.16-6.62), living in group situation (OR = 7.61; CI:3.38-12.12), lower frequency of disabled (OR:0.08; CI:0.02-0.26) and retired (OR:0.21; CI:0.09-0.48) employment status, lower frequency of pulmonary disease presentation (OR = 0.47; CI:0.24-0.92), primary or emergency care admission (OR = 1.80; CI:1.05-3.06 and OR = 2.16; CI:1.36-3.45), drug resistance (OR = 1.86; CI:1.01-3.46), treatment default (OR:2.12; CI:1.18-3.81), lower frequency of alcohol and cigarette consumption (OR = 2.10; CI:1.42-3.11 and OR = 2.85; CI:2.10-3.87 respectively), more directly observed treatment (OR = 1.68; CI:1.04-2.69), and poor understanding of TB disease and its treatment (OR = 3.11; CI:1.86-5.20). The low percentage of primary MDR-TB in the native population (0.1% vs. 2.2% of immigrants) should be noted. CONCLUSIONS/SIGNIFICANCE: The differences show the need to introduce specific strategies in the management of TB within the immigrant population, including the improvement of social and work conditions.

Tuberculosis treatment adherence and fatality in Spain.

BACKGROUND: The adherence to long tuberculosis (TB) treatment is a key factor in TB control programs. Always some patients abandon the treatment or die. The objective of this study is to identify factors associated with defaulting from or dying during antituberculosis treatment. METHODS: Prospective study of a large cohort of TB cases diagnosed during 2006-2007 by 61 members of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Predictive factors of completion outcome (cured plus completed treatment vs. defaulters plus lost to follow-up) and fatality (died vs. the rest of patients) were based on logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Of the 1490 patients included, 29.7% were foreign-born. The treatment outcomes were: cured 792 (53.2%), completed treatment 540 (36.2%), failure 2 (0.1%), transfer-out 33 (2.2%), default 27 (1.8%), death 27 (1.8%), lost to follow-up 65 (4.4%), other 4 (0.3%). Completion outcome reached 93.5% and poor adherence was associated with: being an immigrant (OR = 2.03; CI:1.06-3.88), living alone (OR = 2.35; CI:1.05-5.26), residents of confined institutions (OR = 4.79; CI:1.74-13.14), previous treatment (OR = 2.93; CI:1.44-5.98), being an injecting drug user (IDU) (OR = 9.51; CI:2.70-33.47) and treatment comprehension difficulties (OR = 2.93; CI:1.44-5.98). Case fatality was 1.8% and it was associated with the following variables: age 50 or over (OR = 10.88; CI:1.12-105.01), retired (OR = 12.26;CI:1.74-86.04), HIV-infected (OR = 9.93; CI:1.48-66.34), comprehension difficulties (OR = 4.07; CI:1.24-13.29), IDU (OR = 23.59; CI:2.46-225.99) and Directly Observed Therapy (DOT) (OR = 3.54; CI:1.07-11.77). CONCLUSION: Immigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. To reduce fatality rates, stricter monitoring is required for patients who are retired, HIV-infected, IDU, and those with treatment comprehension difficulties.

Satisfaction level and masticatory performance of patient rehabilitated with implant-supported overdentures / Nível de satisfação e performance mastigatória de pacientes reabilitados com sobredentaduras suportada por implantes

Purpose: To compare the masticatory performance and satisfaction levels of subjects with normal dentition and subjects with implant-supported overdentures with two types of attachments (ball and bar-clip retention systems). Methods: The sample comprised 24 subjects, 12 edentulous patients and 12 dentate subjects. The denture wearers received two dental implants and new maxillary and mandibular dentures. Three months after the first surgical phase, the mandibular dentures were connected to the implants by a gold ball attachment. Two months later new mandibular overdentures were made with a bar-clip attachment. Satisfaction levels (modified OHIP-EDENT and verbal rating scale) and masticatory performance (chewing for 40 masticatory cycles) were measured with the old dentures, with the unattached new dentures, and with the new dentures with ball and bar-clip attachments. Data were analyzed by Friedman and chi-square tests. Results: Both masticatory performance and satisfaction levels significantly improved after implant treatment. No significant differences were observed between the overdentures with ball and bar attachments. However, the masticatory performance after treatment was still significantly lower than the performance of the healthy subjects. Conclusion: The rehabilitation of edentulous patients with overdenture with ball or bar-clip attachment improves both satisfaction and masticatory performance, but the outcomes levels are not equal as those found for dentate subjects.

Objetivo: Comparar o nível de satisfação e a performance mastigatória dos indivíduos com dentição normal e pacientes reabilitados com uma sobredentadura suportada por implantes com dois tipos de conectores diferentes, sistema de retenção bola e barra. Metodologia: Vinte e quatro indivíduos participaram do estudo, sendo 12 pacientes desdentados e 12 indivíduos dentados totais. Os desdentados receberam dois implantes e novas dentaduras, superiores e inferiores. Três meses depois da primeira fase cirúrgica, a dentadura inferior foi conectada aos implantes através do sistema bola. Dois meses depois, uma nova sobredentadura inferior foi realizada, porém desta vez conectado através do sistema barra-clipe. O nível de satisfação (OHIP-EDENT adaptado e escala verbal de medição) e a performance mastigatória (mastigação por 40 ciclos mastigatórios) foram medidos em vários momentos do tratamento, com as dentaduras antigas, novas não conectadas por implantes, e depois de ter conectado a sobredentadura pelo sistema bola e barra-clipe. O teste de Friedman e o teste qui-quadrado foram aplicados para analisar os resultados.Resultados: O nível de satisfação e a performance mastigatória melhoraram significativamente após a reabilitação com os implantes. Nenhuma diferença foi observada entre as sobredentaduras com sistema bola e barra-clipe. Entretanto, a performance mastigatória ainda permaneceu significativamente menor que a performance dos indivíduos dentados. Conclusão: A reabilitação de pacientes edêntulos reabilitados com sobredentadura com bola ou barra-clipe melhora tanto o nível de satisfação quanto a performance mastigatória, porém ainda abaixo do nível dos indivíduos com dentição normal.

[Prognostic value of electrocardiographic findings in hemodynamically stable patients with acute symptomatic pulmonary embolism]. / Valor pronóstico de los hallazgos electrocardiográficos en pacientes estables hemodinámicamente con tromboembolia de pulmón aguda sintomática.

INTRODUCTION AND OBJECTIVES: The aim of this study was to determine the prognostic value of electrocardiography in hemodynamically stable patients with a diagnosis of acute symptomatic pulmonary embolism (PE). METHODS: This prospective study included all hemodynamically stable outpatients who were diagnosed with PE at a university hospital. The electrocardiographic abnormalities investigated were: a) sinus tachycardia (>100 beats/min); b) ST-segment or T-wave abnormalities; c) right bundle branch block; d) an S1Q3T3 pattern, and e) recent-onset atrial arrhythmia. RESULTS: The study included 644 patients. Overall, 5% of those with an ECG abnormality died due to PE in the 15 days after diagnosis compared with 2% of those with normal ECG findings (relative risk [RR]=2.4; 95% confidence interval [CI], 1-5,8; P=.05). Multivariate analysis showed that sinus tachycardia was associated with a 2.2-fold increased risk of death due to all causes in the month after PE diagnosis. After adjusting for age, a history of cancer, immobility, ECG abnormalities, and sinus tachycardia, the presence of recent-onset atrial arrhythmia was significantly associated with death due to PE in the first 15 days (RR=2.8; 95% CI, 1-8.3; P=.05). The negative predictive value of atrial arrhythmia for 15-day PE-related mortality was 97%, while the negative likelihood ratio was 0.79. CONCLUSIONS: In hemodynamically stable patients with acute symptomatic PE, the presence of sinus tachycardia and atrial arrhythmia were independent predictors of a poor prognosis. However, the usefulness of these factors for stratifying risk in PE patients is limited.

Development and results of the Spanish registry of patients with alpha-1-antitrypsin deficiency.

The Spanish registry of alpha-1 antitrypsin deficiency was founded in 1993 and became a member of the International Registry (AIR) in 1999. We describe the updating process following its incorporation into AIR and compare the data collected in the first period (1993-1999) and the second period (1999-2005), during which time patients were included exclusively by internet. The registry included 301 patients during period 1, 69% males and 46% had a history of smoking. Their mean age was 46 years (SD=13) and 284 (94%) had the ZZ phenotype, 49% received augmentation therapy. During period 2, 161 new cases were included, 63% of whom were males with a mean age of 44 years (SD=16). A total of 126 (78%) had the ZZ phenotype. Only 12% received augmentation therapy. A total of 462 different patients were included in both periods. Significant differences were observed in the number of cases with the SZ phenotype and the severity of FEV1 impairment between the two periods. Implementation of an internet-based collection of data did not result in a lower rate of reporting to the registry. However, data from a significant number of patient included in period 1 could not be actualized in the new data base.

Satisfaction level and masticatory capacity in edentulous patients with conventional dentures and implant-retained overdentures

The difficulty of totally edentulous individual in performing the basic oral functions in a satisfactory and pleasant way directs the investigations for improvement of the rehabilitation techniques. This study aimed to perform an intra-patient analysis of the satisfaction level and masticatory capacity during the phases of the rehabilitation treatment with osseointegrated implants. Twelve edentulous patients (mean age: 61 years) participated. Satisfaction level and masticatory capacity were analyzed based on specific questionnaires for edentulous patients and by a verbal rating scale from 0 to 10, at three moments: with the old dentures, with conventional new ones after they had been received two osseointegrated implants in the mandible (after 60 days of use). After 5 months of the first surgical phase, gold cap ball attachments were adapted and the last evaluation was performed with the upper denture and the lower overdenture, after 30 days of use. The Friedman test was applied. The rehabilitation with implants produced a significant improvement in the satisfaction level (95.83%) and the masticatory capacity (94.07%). The new full dentures produced a better satisfaction and masticatory capacity than the old dentures. Besides, lower overdenture supported by two osseointegrated implants and a new upper conventional denture produced a higher scores than the conventional new dentures.

Otimização de estética e função em próteses implantossuportadas através da personalização de pilares: relato de caso clínico / Esthetics and function optimization in implant-supported prostheses with customized abutments: case report

Os pilares personalizados, preparados individualmente para cada situação, vêm sendo cada vez mais utilizados pelos odontólogos devido ao fato de minimizarem problemas de angulação e alinhamento de implantes dando à coroa um perfil de emergência mais natural. O presente estudo relata um caso clínico onde foram utilizados pilares protéticos tipo UCLA personalizados para otimizar função e estética numa reabilitação protética.

Glutathione S-transferase P1 and lung function in patients with alpha1-antitrypsin deficiency and COPD.

BACKGROUND: The glutathione S-transferase P1 (GSTP1) gene is involved in detoxification of electrophilic substances of tobacco smoke. A polymorphism at nucleotide 315 of this gene alters its enzymatic activity. OBJECTIVE: We analyzed the association between the variability in the GSTP1 gene and impairment in lung function in smokers with and without alpha(1)-antitrypsin (AAT) deficiency and COPD. POPULATION AND METHOD: The study population consisted of 99 patients with smoking-related COPD and 69 patients with AAT deficiency; 198 healthy volunteers provided the frequency of the different polymorphisms in the general population. GSTP1 genotyping was performed by a real-time polymerase chain reaction amplification assay. RESULTS: The frequency (0.28) of the 105Val polymorphism was identical in COPD patients and the general population. However, the frequency was significantly increased (0.44) in patients with AAT deficiency (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.17 to 3.72 compared to control subjects; and OR, 2.41; 95% CI, 1.27 to 4.59 compared to COPD). FEV(1) percentage of predicted was significantly impaired in AAT-deficient carriers of 105Val. This effect was not observed in COPD patients. CONCLUSIONS: These findings suggest that the frequency of the GSTP1 105Val polymorphism is increased in patients with AAT deficiency. Globally, GSTP1 genotypes, age, and tobacco smoking explained 41% of total FEV(1) percentage of predicted variability in patients with AAT deficiency. The modulatory role of GSTP1 in lung disease has only been observed in smokers lacking AAT.

Tuberculosis in lung transplant recipients.

BACKGROUND: Post-lung transplant infection is one of the leading causes of morbidity and mortality. The cause and incidence are similar in many series; however, infections such as Mycobacterium tuberculosis are influenced by the epidemiologic situation. The authors present a prospective and observational study to define the incidence, clinical presentation, and course of tuberculosis in a cohort of lung transplant patients at a single center in Spain. METHODS: Between 1990 and 2002, cutaneous delayed-type hypersensitivity testing and pathologic and microbiologic study of explanted lungs were conducted in 187 lung transplant patients. Serial bronchoscopies with transbronchial biopsy and bronchioalveolar lavage were performed during follow-up. The diagnosis of tuberculosis was established only when M. tuberculosis was identified in any sample or when histopathologic study was conclusive. RESULTS: Forty-eight patients were classified as anergic (25.6%) and 61 (32.6%) were classified as having a positive tuberculin skin test. Of the 109 patients, 95 received latent tuberculosis infection prophylaxis. Tuberculosis was diagnosed in 12 patients (6.41%); in six of them, diagnosis was determined from the explanted lungs. The remainder were diagnosed during follow-up. Fever and dyspnea were the most common symptoms. Chest radiographic findings presented an alveolar pattern. All patients responded well to antituberculous therapy; no deaths were attributable to tuberculosis. CONCLUSIONS: In the authors' experience, tuberculosis is not rare in lung transplant patients and can be managed successfully with antituberculous therapy without rifampin. A systematic protocol for diagnosing tuberculosis of the explanted lung is useful for reducing tuberculous complications of the implanted lung.

Paradoxical response to antituberculous therapy in infliximab-treated patients with disseminated tuberculosis.

Six of 284 patients treated with infliximab developed active tuberculosis. Four (67%) of these patients had a paradoxical response to antituberculous therapy. Physicians should be aware of the increased risk of a paradoxical response in this population and should consider the use of corticosteroids when a paradoxical reaction is suspected.

Emphysema due to alpha-antitrypsin deficiency: familial study of the YBARCELONA variant.

A 39-year-old female patient, an ex-smoker with an 8-pack-year smoking history and severe pulmonary emphysema of early onset, received a diagnosis of alpha(1)-antitrypsin (AAT) deficiency and proved to be a carrier of a new deficient variant, YBARCELONA, derived from the normal M1 variant with two substitutions: one in exon III and the other in exon V. AAT genotype of eight members of the same family and study of lung function of the index case and family members at baseline and after 6 years of follow-up were performed. Five subjects were PiYM, with intermediate serum AAT concentrations and normal pulmonary function. No changes were observed over 6 years in pulmonary function of the PiYM patients who were nonsmokers; however, the PiYY index case presented worsening of pulmonary function with FEV(1) of 33%. The heterozygotes PiYM have AAT concentrations similar to the PiMZ and, at 6 years, the nonsmokers presented no worsening in pulmonary function. The risk associated with this variant in its heterozygous form may be similar to that described for PiMZ.

Rapid screening for alpha1-antitrypsin deficiency in patients with chronic obstructive pulmonary disease using dried blood specimens.

We describe two reliable methods for high-throughput screening of proteinase inhibitor (PI) S and PI Z alpha(1)-antitrypsin (alpha(1)-AT) deficiency alleles from dried blood spot (DBS) specimens using the LightCycler fluorimetric analyzer. The method was used to study 72 patients with chronic obstructive pulmonary disease. Results were confirmed with DNA sequencing. The alpha(1)-AT concentration in DBS was determined with immune nephelometry. Sixteen patients (22%) showed no PI Z or PI S mutations. Five patients (7%) had a heterozygous genotype consisting of a PI S allele and a normal allele for the Z and S positions (non-S non-Z). Twenty-five patients (35%) had a heterozygous genotype consisting of a PI Z and a non-S non-Z allele. Two (3%) had the PI SS genotype, 2 (3%) the PI SZ, and 20 (28%) the PI ZZ. All patients with two normal alpha(1)-AT alleles and 10 heterozygous carriers of one normal and one deficient allele had alpha(1)-AT levels that fell within the alpha(1)-AT DBS normal range (1.8-3.1 mg/dl). Two patients with the rare PI MM(malton)- and PI MM(heerlen)-deficient variants showed deficient alpha(1)-AT levels; PI S and PI Z were not detected. Processing 32 samples requires only 40 minutes. This single-step, cost-effective technology is optimal for working with small amounts of DNA, as are present in DBS. The method is suitable for large-scale screening, in cases where PI type is important.