Genome sequence of an Acinetobacter pittii strain obtained from a red-lored parrot with pneumonia.

Acinetobacter pittii 978-A_19 was obtained from a parrot with pneumonia. It is resistant to ampicillin, carbenicillin, cephalosporins, clindamycin, and trimethoprim + sulfamethoxazole. The genome encodes a new blaADC allele, a blaOXA-502 gene, possesses several virulence genes related to adherence and biofilm formation, and has types I, II, and IV secretion systems.

Alteraciones en el nervio óptico y retina en pacientes con COVID-19. Una revisión teórica / Alterations in the optic nerve and retina in patients with COVID-19. A theoretical review

El objetivo de la presente investigación es identificar y sistematizar las afectaciones generadas por el SARS-CoV-2 en el nervio óptico y en la retina de pacientes jóvenes, adultos y adultos mayores que padecieron COVID-19 en el período del 2019 al 2022. Se realizó una revisión teórica documental (RTD) en el marco de una investigación para determinar el estado actual del conocimiento del tema objeto de estudio. La RTD contempla el análisis de publicaciones en las bases de datos científicas PubMed/Medline, Ebsco, Scielo y Google. Se encontraron un total de 167 artículos de los cuales se estudiaron a profundidad 56 artículos; se evidencia el impacto de la infección por COVID-19 en la retina y el nervio óptico de los pacientes contagiados, tanto durante la fase aguda como en la recuperación posterior. Entre los hallazgos reportados sobresalen: neuropatía óptica isquémica no arterítica anterior y posterior, neuritis óptica, oclusión vascular central o de rama, maculopatía medial aguda paracentral, neurorretinitis, así como también diagnósticos concomitantes como enfermedad posible de Vogt Koyanagi Harada, síndrome de múltiples puntos blancos evanescentes (MEWDS), retinopatía Purtscher-like, y otros (AU)

The objective of this research is to identify and systematize the medical conditions generated by SARS-CoV-2 on the optic nerve and retina of young, adult, and elderly adults who suffered from COVID-19 in the period 2019-2022. A theoretical documentary review (TDR) was conducted within the framework of an investigation to determine the current state of knowledge of the subject under study. The TDR includes the analysis of publications in the scientific databases PubMed/Medline, Ebsco, Scielo and Google. A total of 167 articles were found, of which 56 were studied in depth, and these evidence the impact of COVID-19 infection on the retina and optic nerve of infected patients, both during the acute phase and in subsequent recovery. Among the reported findings, the following stand out: anterior and posterior non-arteritic ischemic optic neuropathy, optic neuritis, central or branch vascular occlusion, paracentral acute medial maculopathy, neuroretinitis, as well as concomitant diagnoses such as possible Vogt-Koyanagi-Harada disease, multiple evanescent white dot syndrome (MEWDS), Purtscher-like retinopathy, among others (AU)

Alterations in the optic nerve and retina in patients with COVID-19. A theoretical review.

The objective of this research is to identify and systematize the medical conditions generated by SARS-CoV-2 on the optic nerve and retina of young, adult, and elderly adults who suffered from COVID-19 in the period 2019-2022. A theoretical documentary review (TDR) was conducted within the framework of an investigation to determine the current state of knowledge of the subject under study. The TDR includes the analysis of publications in the scientific databases PubMed/Medline, Ebsco, Scielo and Google. A total of 167 articles were found, of which 56 were studied in depth, and these evidence the impact of COVID-19 infection on the retina and optic nerve of infected patients, both during the acute phase and in subsequent recovery. Among the reported findings, the following stand out: anterior and posterior non-arteritic ischemic optic neuropathy, optic neuritis, central or branch vascular occlusion, paracentral acute medial maculopathy, neuroretinitis, as well as concomitant diagnoses such as possible Vogt-Koyanagi-Harada disease, multiple evanescent white dot syndrome (MEWDS), Purtscher-like retinopathy, among others.

Cardiac Metastasis From Solid Cancers: A 35-Year Single-Center Autopsy Study.

CONTEXT.­: Cardiac metastases are more prevalent than primary cardiac tumors, and although rare, the incidence is anticipated to increase with the extended survival of oncology patients. OBJECTIVE.­: To estimate the current incidence of cardiac metastasis from solid tumors in adult autopsies. DESIGN.­: Adult autopsy cases from 1984 through 2019 from patients diagnosed with any type of solid cancer were retrieved. The medical charts and pathologic autopsy data were reviewed in detail. RESULTS.­: A total of 1294 adult autopsies performed on patients diagnosed with any type of cancer within the past 35 years were reviewed. We found 124 secondary cardiac tumors. Eighty-five were due to cardiac involvement by solid tumors. Of these, 61 were true cardiac metastases of solid cancers. We focused on these 61 cases. The age range was 32 to 85 years. Forty-four patients were men and 17 were women. The lung was the most common primary site, with 21 cases (34.43%). The most frequent histologic type was carcinoma, with 54 cases (88.52%). The predominant layer of the heart involved was the pericardium, with 35 cases (57.38%). Twenty-one cases (34.43%) had pericardial effusion, with 4 being hemorrhagic. All cases had multiple extracardiac metastases, with 56 cases (91.8%) having distant metastases in 4 or more different organs. CONCLUSIONS.­: Cardiac metastasis is a rare occurrence, with an incidence of 4.71% (61 of 1294 cases) in our series. Lung cancer accounted for most of the cardiac metastases seen, and carcinomas were the most frequent histologic type. The pericardium was the most frequent location. Cardiac metastases occurred most frequently in cases of massive metastatic dissemination.

Genomic characterization of antifungal Acinetobacter bacteria isolated from the skin of the frogs Agalychnis callidryas and Craugastor fitzingeri.

Chytridiomycosis, a lethal fungal disease caused by Batrachochytrium dendrobatidis (Bd), is responsible for population declines and extinctions of amphibians worldwide. However, not all amphibian species are equally susceptible to the disease; some species persist in Bd enzootic regions with no population reductions. Recently, it has been shown that the amphibian skin microbiome plays a crucial role in the defense against Bd. Numerous bacterial isolates with the capacity to inhibit the growth of Batrachochytrium fungi have been isolated from the skin of amphibians. Here, we characterized eight Acinetobacter bacteria isolated from the frogs Agalychnis callidryas and Craugastor fitzingeri at the genomic level. A total of five isolates belonged to Acinetobacter pittii,Acinetobacter radioresistens, or Acinetobactermodestus, and three were not identified as any of the known species, suggesting they are members of new species. We showed that seven isolates inhibited the growth of Bd and that all eight isolates inhibited the growth of the phytopathogen fungus Botrytis cinerea. Finally, we identified the biosynthetic gene clusters that could be involved in the antifungal activity of these isolates. Our results suggest that the frog skin microbiome includes Acinetobacter isolates that are new to science and have broad antifungal functions, perhaps driven by distinct genetic mechanisms.

Prolonged Capillary Refilling as a Predictor of Mortality in Patients With Septic Shock.

INTRODUCTION: Microcirculatory alterations characterize septic shock; increased blood lactate level has been described as markers of microcirculation alteration in patients with septic shock. Although useful, this serological analysis is not always feasible in all settings worldwide. OBJECTIVE: To determine if a prolonged capillary refilling is a predictor of mortality in patients with septic shock. METHODOLOGY: A 10-months prospective cohort study was carried out on 175 patients admitted to the Intensive Care Unit (ICU) with the diagnosis of septic shock. The capillary refilling time (CRT) was evaluated Immediately upon admission and after 6 hours post-resuscitation. Traditional tissue perfusion markers were also used to compare and analyze their predictive value on mortality at 28 days. RESULTS: The area under the ROC curve (AUC) to estimate mortality in patients with septic shock with CRT at admission was 0.666 (0.584-0.748), while at 6 hours was 0.819 (0.753-0.885), with a cut-off point of 4.5 seconds at admission (PPV 52.87% NPV 72.73%) and 3.5 sec at 6 hours (PPV 95.56% NPV 79.23%). In those with CRT > 3.5 seconds at 6 hours, they had a RR of 4.60, while a CRT > 4.5 seconds at admission had a RR of 1.94, with a non-survivor proportion of 95.56% for a CRT > 3.5 sec at 6 hours vs 20.77% for CRT ≤ 3.5 sec (P value < 0.001). The CRT at 6 hours showed significant differences in the survival curves with P-value < 0.001, where for values > 3.5 sec, survival at 28 days was 4.44% vs 79.20% for values ≤ 3.5 sec. CONCLUSION: CRT is a strong predictor of mortality in patients with septic shock. Evaluating changes in CRT during resuscitation from septic shock might be used as an important clinical tool to predict mortality; especially in low-resources settings where using other biomarkers might be sometimes difficult.

Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology - Veterinary (STROBE-Vet) Statement.

BACKGROUND: Reporting of observational studies in veterinary research presents challenges that often are not addressed in published reporting guidelines. OBJECTIVE: To develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety. DESIGN: Consensus meeting of experts. SETTING: Mississauga, Canada. PARTICIPANTS: Seventeen experts from North America, Europe, and Australia. METHODS: Experts completed a pre-meeting survey about whether items in the STROBE statement should be modified or added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. During the meeting, each STROBE item was discussed to determine whether or not rewording was recommended and whether additions were warranted. Anonymous voting was used to determine consensus. RESULTS: Six items required no modifications or additions. Modifications or additions were made to the STROBE items 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources/measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding). CONCLUSION: The methods and processes used were similar to those used for other extensions of the STROBE statement. The use of this STROBE statement extension should improve reporting of observational studies in veterinary research by recognizing unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture, and wildlife.

Explanation and Elaboration Document for the STROBE-Vet Statement: Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary Extension.

The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement was first published in 2007 and again in 2014. The purpose of the original STROBE was to provide guidance for authors, reviewers, and editors to improve the comprehensiveness of reporting; however, STROBE has a unique focus on observational studies. Although much of the guidance provided by the original STROBE document is directly applicable, it was deemed useful to map those statements to veterinary concepts, provide veterinary examples, and highlight unique aspects of reporting in veterinary observational studies. Here, we present the examples and explanations for the checklist items included in the STROBE-Vet statement. Thus, this is a companion document to the STROBE-Vet statement methods and process document (JVIM_14575 "Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary (STROBE-Vet) Statement" undergoing proofing), which describes the checklist and how it was developed.

Explanation and Elaboration Document for the STROBE-Vet Statement: Strengthening the Reporting of Observational Studies in Epidemiology - Veterinary Extension.

The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement was first published in 2007 and again in 2014. The purpose of the original STROBE was to provide guidance for authors, reviewers and editors to improve the comprehensiveness of reporting; however, STROBE has a unique focus on observational studies. Although much of the guidance provided by the original STROBE document is directly applicable, it was deemed useful to map those statements to veterinary concepts, provide veterinary examples and highlight unique aspects of reporting in veterinary observational studies. Here, we present the examples and explanations for the checklist items included in the STROBE-Vet Statement. Thus, this is a companion document to the STROBE-Vet Statement Methods and process document, which describes the checklist and how it was developed.

Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology - Veterinary (STROBE-Vet) Statement.

The reporting of observational studies in veterinary research presents many challenges that often are not adequately addressed in published reporting guidelines. A consensus meeting of experts was organized to develop an extension of the STROBE statement to address observational studies in veterinary medicine with respect to animal health, animal production, animal welfare and food safety outcomes. The consensus meeting was held 11-13 May 2014 in Mississauga, Ontario, Canada. Seventeen experts from North America, Europe and Australia attended the meeting. The experts were epidemiologists and biostatisticians, many of whom hold or have held editorial positions with relevant journals. Prior to the meeting, 19 experts completed a survey about whether they felt any of the 22 items of the STROBE statement should be modified and whether items should be added to address unique issues related to observational studies in animal species with health, production, welfare or food safety outcomes. At the meeting, the participants were provided with the survey responses and relevant literature concerning the reporting of veterinary observational studies. During the meeting, each STROBE item was discussed to determine whether or not re-wording was recommended, and whether additions were warranted. Anonymous voting was used to determine whether there was consensus for each item change or addition. The consensus was that six items needed no modifications or additions. Modifications or additions were made to the STROBE items numbered as follows: 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources/measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations) and 22 (funding). Published literature was not always available to support modification to, or inclusion of, an item. The methods and processes used in the development of this statement were similar to those used for other extensions of the STROBE statement. The use of this extension to the STROBE statement should improve the reporting of observational studies in veterinary research related to animal health, production, welfare or food safety outcomes by recognizing the unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture and wildlife.

Methods and processes of developing the strengthening the reporting of observational studies in epidemiology - veterinary (STROBE-Vet) statement.

BACKGROUND: The reporting of observational studies in veterinary research presents many challenges that often are not adequately addressed in published reporting guidelines. OBJECTIVE: To develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety. DESIGN: A consensus meeting of experts was organized to develop an extension of the STROBE statement to address observational studies in veterinary medicine with respect to animal health, animal production, animal welfare, and food safety outcomes. SETTING: Consensus meeting May 11-13, 2014 in Mississauga, Ontario, Canada. PARTICIPANTS: Seventeen experts from North America, Europe, and Australia attended the meeting. The experts were epidemiologists and biostatisticians, many of whom hold or have held editorial positions with relevant journals. METHODS: Prior to the meeting, 19 experts completed a survey about whether they felt any of the 22 items of the STROBE statement should be modified and if items should be added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. At the meeting, the participants were provided with the survey responses and relevant literature concerning the reporting of veterinary observational studies. During the meeting, each STROBE item was discussed to determine whether or not re-wording was recommended, and whether additions were warranted. Anonymous voting was used to determine whether there was consensus for each item change or addition. RESULTS: The consensus was that six items needed no modifications or additions. Modifications or additions were made to the STROBE items numbered: 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources/measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding). LIMITATION: Published literature was not always available to support modification to, or inclusion of, an item. CONCLUSION: The methods and processes used in the development of this statement were similar to those used for other extensions of the STROBE statement. The use of this extension to the STROBE statement should improve the reporting of observational studies in veterinary research related to animal health, production, welfare, or food safety outcomes by recognizing the unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture, and wildlife.

Strengthening the Reporting of Observational Studies in Epidemiology - nutritional epidemiology (STROBE-nut): An extension of the STROBE statement.

Concerns have been raised about the quality of reporting in nutritional epidemiology. Research reporting guidelines such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement can improve quality of reporting in observational studies. Herein, we propose recommendations for reporting nutritional epidemiology and dietary assessment research by extending the STROBE statement into Strengthening the Reporting of Observational Studies in Epidemiology - Nutritional Epidemiology (STROBE-nut). Recommendations for the reporting of nutritional epidemiology and dietary assessment research were developed following a systematic and consultative process, co-ordinated by a multidisciplinary group of 21 experts. Consensus on reporting guidelines was reached through a three-round Delphi consultation process with 53 external experts. In total, 24 recommendations for nutritional epidemiology were added to the STROBE checklist. When used appropriately, reporting guidelines for nutritional epidemiology can contribute to improve reporting of observational studies with a focus on diet and health.

Draft Genome Sequence of a Hypermucoviscous Extended-Spectrum-ß-Lactamase-Producing Klebsiella quasipneumoniae subsp. similipneumoniae Clinical Isolate.

A clinical isolate of extended-spectrum-ß-lactamase-producing Klebsiella quasipneumoniae subsp. similipneumoniae 06-219 with hypermucoviscosity phenotypes obtained from a urine culture of an adult patient was used for whole-genome sequencing. Here, we report the draft genome sequences of this strain, consisting of 53 contigs with an ~5.6-Mb genome size and an average G+C content of 57.36%. The annotation revealed 6,622 coding DNA sequences and 77 tRNA genes.

Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary (STROBE-Vet) Statement.

Reporting of observational studies in veterinary research presents challenges that often are not addressed in published reporting guidelines. Our objective was to develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety. We conducted a consensus meeting with 17 experts in Mississauga, Canada. Experts completed a premeeting survey about whether items in the STROBE statement should be modified or added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. During the meeting, each STROBE item was discussed to determine whether or not rewording was recommended, and whether additions were warranted. Anonymous voting was used to determine consensus. Six items required no modifications or additions. Modifications or additions were made to the STROBE items 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources and measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding). The methods and processes used were similar to those used for other extensions of the STROBE statement. The use of this STROBE statement extension should improve reporting of observational studies in veterinary research by recognizing unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture, and wildlife.

A bacterial interference strategy for prevention of UTI in persons practicing intermittent catheterization.

STUDY DESIGN: Non-randomized pilot trial. OBJECTIVES: To determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism and (2) decrease the rate of symptomatic urinary tract infection (UTI). SETTING: Outpatient SCI clinic in a Veterans Affairs hospital (USA). METHODS: Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least one UTI and had documented bacteruria within the past year. All participants received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days and then removed. Participants were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (>or=10(2) cfu ml(-1)) of E. coli 83972 in urine cultures for >3 days after catheter removal and (2) the rate of symptomatic UTI during colonization with E. coli 83972. RESULTS: Thirteen participants underwent 19 insertions of study catheters. Eight participants (62%) became successfully colonized for >3 days after catheter removal. In these 8 participants, the rate of UTI during colonization was 0.77 per patient-year, in comparison with the rate of 2.27 UTI per patient-year before enrollment. CONCLUSIONS: E. coli 83972-coated urinary catheters are a viable means of achieving bladder colonization with this potentially protective strain in persons practicing ICP.

Hipertensión arterial en las glomerulonefritis primarias crónicas biopsiadas: prevalencia e influencia en el pronóstico renal / Systemic arterial hypertension in primary chronic glomerulonephritis: prevalence and its influence in the prognosis

Las glomerulonefritis constituyen una causa importante de insuficiencia renal crónicaterminal. Varios factores pueden influir negativamente en su pronóstico; deentre ellos destaca la hipertensión arterial. Su prevalencia en las glomerulonefritises variable según las series, probablemente debido a diferencias demográficas, detipos histológicos, de tiempo de evolución en el momento del análisis o a que esdifícil diferenciar si es secundaria a la propia nefropatía o a la insuficiencia renalque puede producir ésta. Su influencia negativa en el pronóstico renal puede estarmediada más por la propia insuficiencia renal, de la que puede ser a su vez consecuenciacuando es lo suficientemente severa, que por la propia hipertensión.Nuestros objetivos fueron analizar la prevalencia de hipertensión en el momentode la biopsia renal de los 394 pacientes diagnosticados de glomerulonefritis primariaen dos décadas en la Bahía de Cádiz y su influencia en el pronóstico desdeentonces y aún en ausencia de insuficiencia renal severa.La prevalencia global de hipertensión fue del 39%, siendo más frecuente en lospacientes de mayor edad. La tasa acumulada de supervivencia renal para los hipertensosfue del 54%, 28%, 20% y 4% a los 5, 10, 15 y 20 años respectivamente;mientras que para los normotensos fue del 83%, 75%, 66% y 62% paralos mismos períodos (p < 0,001). Esta peor tendencia para los hipertensos se observaen cada tipo histológico, con especial significación en las nefropatías IgA ymembranosa. Esta influencia negativa de la hipertensión se mantuvo igualmentecuando no coexistía insuficiencia renal severa en el momento de la biopsia.Conclusiones: La hipertensión es frecuente en las glomerulonefritis primarias,condicionando el pronóstico renal a largo plazo, desde el momento del diagnósticoe incluso antes de la existencia de insuficiencia renal severa

Nowadays, glomerulonephritis are one of the most common causes of End-stageRenal Disease and starting point of dialysis in Spain. Several factors may influencenegatively in this prognosis; among them, we may show up the systemic arterialhypertension. Though its prevalence in the glomerulonephritis is consideredhigher than in other nephropathies, with variations among series, probably due todifference in ages, in geographical areas, in histological types, in time on evolutionof the nephritis… and because it is difficult to distinguish if the hypertensionis a consequence of the nephritis or a consequence of the renal failure that canbe present in several cases. In the same way, its negative influence in the renalprognosis may be influenced more by this renal failure, which can be its causewhen it is quite severe, than by the hypertension itself. Our aims were to analyse,on the one hand the prevalence of hypertension in the 394 patients diagnosedof primary glomurolonephritis by means of a renal biopsy during two decadesin the Bay of Cadiz, as well as its influence in the renal prognosis since themoment of the diagnosis, even with the absence of severe renal failure. We gathereddemographic, clinical, analytical and histological data, as well as the situationof the renal function and the survival period of it at the end of each patientstudy. For the analysis prognosis and renal survival, Kaplan-Meier curves and thelong-rank test were used.Of the 394 patients, 247 are men and 147 are women, with an average age of36.7 ± 17.7 years old. The global prevalence of hypertension was 39%, with ahigher frequency in older patients. The gathered rate of renal survival for hypertensivepatients was 54%, 28%, 20% and 4% at 5, 10, 15 and 20 years respectively;while for non-hypertensive patients, it was 83%, 75%, 66% and 62% forthe same periods of time (p < 0,001). This worse tendency for hypertensive patientsis observed too in each particular histological type, especially in the IgAnephropathy and membranous nephropathy. These results were the same for thepatients who did not have severe renal failure in the moment of the biopsy.Conclusions: Hypertension is a common fact in the primary glomerulonephritis,which also conditions, in an important way, the renal prognosis itself in a longterm, from the moment of diagnosis and even before the existence of a significantrenal failure

Informe de diálisis y trasplante correspondiente al año 2002 de la Sociedad Española de Nefrología y Registros Autonómicos / The year 2002 Spanish Nephrology Society Report on Dialysis and Transplantation and Autonomic Registries

No disponible

Estudio del síndrome nefrótico biopsiado durante 20 años en la bahía de Cádiz: correspondencia histológica, pronóstico renal y factores clínicos que influyen en el mismo / Study of the biopsied nephrotic syndrome for 20 years in the Cadiz bay area: histological correspondence, renal prognosis and clinical prognostic factors

Objetivos: Analizar la correspondencia histológica, la supervivencia renal y losfactores pronósticos clínicos en el síndrome nefrótico, a la vez que estudiar la influenciade la proteinuria nefrótica en la supervivencia renal de los distintos tiposhistológicos de glomerulonefritis crónicas.Pacientes y métodos: 542 pacientes diagnosticados de glomerulonefritis primariaso secundarias mediante biopsia renal durante dos décadas en la Bahía de Cádiz, delos que en 242 la presentación clínica e indicación de biopsia fue el síndrome nefrótico.Estadística: Medias,medianas, percentiles, porcentajes, curvas de Kaplan-Meier,test de long-rank, t de student, chi-cuadrado, modelo de riesgo proporcional de Cox.Resultados: De los 542 pacientes con glomerulonefritis 242 presentaban síndromenefrótico (44,66%). Edad media 39,15 ± 18 años. Proteinuria media 6,75 ±4,53 g/día. Etiología: nefropatía membranosa (33,85%), lúpica (14,46%), cambiosmínimos (11,57%), focal y segmentaria (10,33%), amiloidosis renal (9,95%). El33%, 45%, 63% y 72% de los pacientes con síndrome nefrótico evolucionaron ala IRCT a los 5, 10, 15 y 20 años respectivamente (media de supervivencia renalde 10,6 años). Mediante análisis multivariante, los factores pronósticos clínicos independientesfueron la edad mayor de 60 años, los niveles elevados de proteinuriay la presencia de HTA o insuficiencia renal en el momento del diagnóstico. Laproteinuria nefrótica condicionó negativamente el pronóstico en las distintas formashistológicas, fundamentalmente en las nefropatías IgA y lúpica.Conclusiones: El síndrome nefrótico es la principal indicación de biopsia renalen nuestro medio. En general, y como grupo único, independiente de su etiologíaconcreta, su evolución es lentamente progresiva hacia la IRCT, pudiendo sercondicionada además por determinados factores clínicos presentes en el momentode la biopsia. La proteinuria nefrótica es, además, un factor de progresión enmuchas de las glomerulonefritis

Aims: To analyse the histological correspondence, the renal survival and the clinicalprognostic factors in the nephrotic syndrome for more than 20 years in ourenvironment as well as the influence of the nephrotic proteinuria in the renal survivalin the different histological particular types of glomerulonephritis.Patients and methods: Among the 542 primary and secondary glomerulonephritisdiagnosed by kidney biopsy for two decades in the Cadiz Bay Area, we selected242 patients whose clinical presentation and the biopsy indication was thenephrotic syndrome. Statistics methods: means ± typical deviation, percentiles, percentages,Kaplan-Meier curves, long-rank test, student’s t-test, chi-square analysisand Cox proportional hazards model test.Results: 242 patients with nephrotic syndrome (44.66% out of the total of glomerulonephritis),average age of 39.15 ± 18 years old. Average proteinuria 6.75± 4,53 g/day. Etiology: membranous nephropathy (33.85%), lupus nephritis(14.46%), minimal change disease (11.57%), focal segmental glomerulosclerosis(10.33%), renal amyloidosis (9.95%). 33%, 45%, 63% and 72% of the patientswith nephrotic syndrome developed to the End-stage Renal Disease and startingpoint of dialysis in 5, 10, 15 and 20 years respectively. After the multivariate model,the age older than 60 years old, the high levels of proteinuria and the coexistencewith hypertension or renal failure, in the moment of diagnosis, showed to beindependents clinical prognostic factors. The nephrotic proteinuria had a negativeinfluence in the prognosis in the different histological types, especially in the IgAnephropathy and the lupus nephritis.Conclusions: The nephrotic syndrome is the main indication of the renal biopsyin our environment. In general, as an independent group, its development is slowlyprogressive to the End-stage Renal Disease, having the possibility of being alsoconditioned by certain clinical factors present in the moment of the biopsy. Thepresence of nephrotic proteinuria is also a negative factor in the progression inmany of the glomerulonephritis

RepA negatively autoregulates the transcription of the repABC operon of the Rhizobium etli symbiotic plasmid basic replicon.

The basic replicon of Rhizobium etli CE3, like other members of the repABC plasmid family, is constituted by the repABC operon. RepC is essential for replication, and RepA and RepB play a role in plasmid segregation. It has been shown that deletion derivatives lacking the repAB genes have an increased copy number, indicating that these genes participate in the control of plasmid copy number. RepA is also a trans-incompatibility factor. To understand the regulation of the repABC operon, in this paper: (i) the transcription start site of the repABC operon was determined; (ii) the promoter region was identified by site-directed mutagenesis of the putative -35 and -10 hexameric elements; and (iii) RepA was recognized as a negative regulator of the transcription of the repABC operon.