Cervical Squamous Intraepithelial Lesions Are Associated with Differences in the Vaginal Microbiota of Mexican Women.

Cervical cancer is an important health concern worldwide and is one of the leading causes of death in Mexican women. Previous studies have shown changes in the female genital tract microbe community related to human papillomavirus (HPV) infection and cervical cancer; yet, this link remains unexplored in many human populations. This study evaluated the vaginal bacterial community among Mexican women with precancerous squamous intraepithelial lesions (SIL). We sequenced the V3 region of the 16S rRNA gene in cervical samples from 228 Mexican women, including 121 participants with SIL, most of which were HPV positive, and 107 healthy women without HPV infection or SIL. The presence of SIL was associated with changes in composition (beta diversity) and with a higher species richness (Chao1). A comparison of HPV-positive women with and without SIL showed that microbiota changes occurred even in the absence of SIL. Multivariate association with linear models (MaAsLin) analysis yielded independent associations between HPV infection and an increase in the relative abundance of Brachybacterium conglomeratum and Brevibacterium aureum as well as a decrease in two Lactobacillus iners operational taxonomic units (OTUs). We also identified a positive independent association between HPV-16, the most common HPV subtype linked to SIL, and Brachybacterium conglomeratum. Our work indicates that HPV infection leading to SIL is primarily associated with shifts in vaginal microbiota composition, some of which may be specific to this human population. IMPORTANCE Human papillomavirus (HPV) plays a critical role in cervical carcinogenesis but is not sufficient for cervical cancer development, indicating the involvement of other factors. The vaginal microbiota is an important factor in controlling infections caused by HPV, and, depending on its composition, it can modulate the microenvironment in vaginal mucosa against viral infections. Ethnic and sociodemographic factors influence differences in vaginal microbiome composition, which underlies the dysbiotic patterns linked to HPV infection and cervical cancer across different populations of women. Here, we provide evidence for associations between vaginal microbiota patterns and HPV infection linked to ethnic and sociodemographic factors. To our knowledge, this is the first report of the species Brevibacterium aureum and Brachybacterium conglomeratum linked to HPV infection or squamous intraepithelial lesions (SIL).

Litiasis en pediatría: correlación de métodos que dependen de la recogida de orina de 24 horas con otros más sencillos que no requieren orina minutada / Renal lithiasis in pediatric patients: correlation of methods that depend on 24-h collections with simpler methods that do not require timed urine

OBJETIVOS: Los objetivos de este trabajo fueron relacionar la eliminación urinaria de los metabolitos vinculados con la litiasis renal que dependen del volumen de orina expulsada en una unidad de tiempo, con otros parámetros que se calculan midiendo la concentración de estas sustancias en sangre y en orina, entre los cuales se incluyen los cocientes urinarios, excreciones fraccionales e índices de excreción. MATERIAL Y MÉTODOS: El estudio incluyó 401 niños sanos de tres a 14 años (187 niños y 214 niñas), con una edad media de 8,78 ± 3,40. El análisis se realizó mediante el coeficiente de correlación de Pearson. RESULTADOS: Existía una muy buena correlación, entre los valores de la eliminación cuantificada en orina de 24 horas de sodio, potasio y cloro con los cocientes urinarios y las excreciones fraccionales de estos iones. Los cocientes urinarios e índices de excreción de calcio, ácido úrico, fosfato, magnesio, citrato y oxalato mostraron una excelente correlación con las determinaciones de estas sustancias en orina de 24 horas. CONCLUSIONES: Estas ecuaciones proporcionan una información muy útil en el estudio de la etiología de la litiasis renal en los niños, así como en la adherencia al tratamiento dietético. También valora la eficacia de los distintos tratamientos utilizados en estos pacientes, sin tener que recurrir a la orina minutada, que presenta grandes dificultades en pediatría

INTRODUCTION: Daily practice requires quick, simple and accessible methods to appropriately assess the urinary excretion of solutes in diagnostic or follow-up evaluations of children with renal lithiasis. OBJECTIVES: The objective of this study was to correlate urine elimination of substances related to renal lithiasis that depend on the volume of excreted urine in a unit of time with other parameters that are calculated by measuring the concentration of these substances in blood and urine, such as urinary ratios, fractional excretions and excretion rates. MATERIALS AND METHODS: The study included 401 healthy children aged 3-14 years (187 boys and 214 girls), mean age 8.78 ± 3.40 years. The analysis was carried out by Pearson's correlation coefficient. RESULTS: There was significant correlation between the elimination of sodium, potassium and chlorine in 24-hour urine sample and the urinary ratios and fractional excretions of these ions. Urinary ratios and rates of excretion of calcium, uric acid, phosphate, magnesium, citrate and oxalate were highly correlated with the determinations of these substances in 24-hour collections. CONCLUSIONS: These equations provide relevant information for the study of the etiology of renal lithiasis in children, as well as about compliance to dietary treatment. They also assess the effectiveness of the various treatments used in these patients, without having to resort to 24-hour collections, which pose a considerable challenge in the pediatric age group

Renal lithiasis in pediatric patients: correlation of methods that depend on 24-hour collections with simpler methods that do not require timed urine. / Litiasis en pediatría: correlación de métodos que dependen de la recogida de orina de 24 horas con otros más sencillos que no requieren orina minutada.

INTRODUCTION: Daily practice requires quick, simple and accessible methods to appropriately assess the urinary excretion of solutes in diagnostic or follow-up evaluations of children with renal lithiasis. OBJECTIVES: The objective of this study was to correlate urine elimination of substances related to renal lithiasis that depend on the volume of excreted urine in a unit of time with other parameters that are calculated by measuring the concentration of these substances in blood and urine, such as urinary ratios, fractional excretions and excretion rates. MATERIALS AND METHODS: The study included 401 healthy children aged 3-14 years (187 boys and 214 girls), mean age 8.78±3.40 years. The analysis was carried out by Pearson's correlation coefficient. RESULTS: There was significant correlation between the elimination of sodium, potassium and chlorine in 24-hour urine sample and the urinary ratios and fractional excretions of these ions. Urinary ratios and rates of excretion of calcium, uric acid, phosphate, magnesium, citrate and oxalate were highly correlated with the determinations of these substances in 24-hour collections. CONCLUSIONS: These equations provide relevant information for the study of the etiology of renal lithiasis in children, as well as about compliance to dietary treatment. They also assess the effectiveness of the various treatments used in these patients, without having to resort to 24-hour collections, which pose a considerable challenge in the pediatric age group.

Asymptomatic Intestinal Colonization with Protist Blastocystis Is Strongly Associated with Distinct Microbiome Ecological Patterns.

Blastocystis is the most prevalent protist of the human intestine, colonizing approximately 20% of the North American population and up to 100% in some nonindustrialized settings. Blastocystis is associated with gastrointestinal and systemic disease but can also be an asymptomatic colonizer in large populations. While recent findings in humans have shown bacterial microbiota changes associated with this protist, it is unknown whether these occur due to the presence of Blastocystis or as a result of inflammation. To explore this, we evaluated the fecal bacterial and eukaryotic microbiota in 156 asymptomatic adult subjects from a rural population in Xoxocotla, Mexico. Colonization with Blastocystis was strongly associated with an increase in bacterial alpha diversity and broad changes in beta diversity and with more discrete changes to the microbial eukaryome. More than 230 operational taxonomic units (OTUs), including those of dominant species Prevotella copri and Ruminococcus bromii, were differentially abundant in Blastocystis-colonized individuals. Large functional changes accompanied these observations, with differential abundances of 202 (out of 266) predicted metabolic pathways (PICRUSt), as well as lower fecal concentrations of acetate, butyrate, and propionate in colonized individuals. Fecal calprotectin was markedly decreased in association with Blastocystis colonization, suggesting that this ecological shift induces subclinical immune consequences to the asymptomatic host. This work is the first to show a direct association between the presence of Blastocystis and shifts in the gut bacterial and eukaryotic microbiome in the absence of gastrointestinal disease or inflammation. These results prompt further investigation of the role Blastocystis and other eukaryotes play within the human microbiome. IMPORTANCE Given the results of our study and other reports of the effects of the most common human gut protist on the diversity and composition of the bacterial microbiome, Blastocystis and, possibly, other gut protists should be studied as ecosystem engineers that drive community diversity and composition.

Search for γ-Ray Line Signals from Dark Matter Annihilations in the Inner Galactic Halo from 10 Years of Observations with H.E.S.S.

Spectral lines are among the most powerful signatures for dark matter (DM) annihilation searches in very-high-energy γ rays. The central region of the Milky Way halo is one of the most promising targets given its large amount of DM and proximity to Earth. We report on a search for a monoenergetic spectral line from self-annihilations of DM particles in the energy range from 300 GeV to 70 TeV using a two-dimensional maximum likelihood method taking advantage of both the spectral and spatial features of the signal versus background. The analysis makes use of Galactic center observations accumulated over ten years (2004-2014) with the H.E.S.S. array of ground-based Cherenkov telescopes. No significant γ-ray excess above the background is found. We derive upper limits on the annihilation cross section ⟨σv⟩ for monoenergetic DM lines at the level of 4×10^{-28} cm^{3} s^{-1} at 1 TeV, assuming an Einasto DM profile for the Milky Way halo. For a DM mass of 1 TeV, they improve over the previous ones by a factor of 6. The present constraints are the strongest obtained so far for DM particles in the mass range 300 GeV-70 TeV. Ground-based γ-ray observations have reached sufficient sensitivity to explore relevant velocity-averaged cross sections for DM annihilation into two γ-ray photons at the level expected from the thermal relic density for TeV DM particles.

Lepra Tardía. Comportamiento clínico epidemiológico. La Habana. Período 2008-2016 / No disponible

La lepra es una enfermedad incluida en el grupo de enfermedades desatendidas según la Organización Mundial de la Salud, en Cuba la enfermedad dejó de ser un problema de salud desde 1993. En La Habana se notifican cada año casos de lepra de forma tardía con diferentes grados de discapacidad. El objetivo de este estudio fue caracterizar a los enfermos notificados de lepra tardíamente en La Habana. Se realizó un estudio longitudinal, descriptivo y retrospectivo de los casos de lepra diagnosticados tardíamente en la provincia entre 2008 y 2016, se incluyeron 96 casos a los cuales se revisó la Encuesta Epidemiológica para enfermos de lepra para evaluar variables como edad, sexo, tiempo transcurrido entre los primeros síntomas y el diagnóstico, grado de discapacidad al diagnóstico, formas clínicas y especialidades involucrados en el diagnóstico tardío. El grupo de edad más afectado fue el de 25 a 59 años, los municipios más afectados fueron Lisa y Arroyo Naranjo, predominó la forma clínica multibacilar, y la discapacidad grado ll se presentó en el 18% de los casos. Se evidenció la importancia de un diagnóstico precoz para evitar la aparición de discapacidades y que los municipios periféricos tienen la mayor posibilidad de diagnosticar casos tardíos

Leprosy is a disease included in the group of neglected diseases by The World Health Organization. In Cuba, the disease has ceased to be a health problem since 1993. In Havana, each year cases of late leprosy are reported with various grades of disability. The aim of this study was to characterize the behavior of patient whom reported with late leprosy in Havana. We conducted a longitudinal, descriptive and retrospective study of the leprosy cases diagnosed late in the province between 2008 and 2016. We included 96 cases in which the epidemiological survey for leprosy patients was carried out, variables such as age, sex, time elapsed between the first symptoms and the diagnosis, degree of disability at diagnosis, clinical forms, and specialties involved in the late diagnosis were evaluated. The most affected age group was between 25-59 years old, the most affected municipalities were Lisa and Arroyo Naranjo, the multibacillary clinical form predominated, and the grade II disability was present in 18% of the cases. The importance of an early diagnosis to avoid the appearance of disability in the patients was put in evidence by the series studied and the most peripheral municipalities are the one with the greatest possibility of diagnosing late cases

Risk factors for mortality after surgery of osteoporotic hip fracture in patients over 65 years of age. / Factores de riesgo de mortalidad tras intervención quirúrgica de fractura de cadera osteoporótica en pacientes mayores.

OBJECTIVE: To evaluate, from a clinical perspective, and with easily identifiable variables, those factors that influence the survival of patients admitted to a care unit designed for the comprehensive treatment of patients with hip fracture after being surgically treated. MATERIAL AND METHODS: A prospective study was conducted on a cohort of patients (n=202) aged 65 years or older with a low impact hip fracture, who were surgically intervened in a tertiary hospital. An analysis was performed to determine mortality at 90 days, and at one and 2years after surgery using demographic, clinical, analytical, and functional variables. RESULTS: The independent risk factors of mortality in the 3periods analysed were age (P=.047, P=.016, and P=.000 at 90 days, 1, and 2 years, respectively) and a low Barthel index (P=.014, P=.005, and P=.004 to 90 days, 1, and 2 years, respectively). Male sex (P=.004) and a high risk for anaesthesia (P=.011) were only independent risk factors of mortality at 2years after surgery. DISCUSSION AND CONCLUSION: Age and dependency were the major determining factors of mortality at 30 days, 1, and 2 years after surgery for hip fracture. Both are easily measurable to identify patients susceptible to poor outcomes, and could benefit from a more thorough care plan.

H.E.S.S. Limits on Linelike Dark Matter Signatures in the 100 GeV to 2 TeV Energy Range Close to the Galactic Center.

A search for dark matter linelike signals iss performed in the vicinity of the Galactic Center by the H.E.S.S. experiment on observational data taken in 2014. An unbinned likelihood analysis iss developed to improve the sensitivity to linelike signals. The upgraded analysis along with newer data extend the energy coverage of the previous measurement down to 100 GeV. The 18 h of data collected with the H.E.S.S. array allow one to rule out at 95% C.L. the presence of a 130 GeV line (at l=-1.5°, b=0° and for a dark matter profile centered at this location) previously reported in Fermi-LAT data. This new analysis overlaps significantly in energy with previous Fermi-LAT and H.E.S.S. RESULTS: No significant excess associated with dark matter annihilations was found in the energy range of 100 GeV to 2 TeV and upper limits on the gamma-ray flux and the velocity weighted annihilation cross section are derived adopting an Einasto dark matter halo profile. Expected limits for present and future large statistics H.E.S.S. observations are also given.

Search for Dark Matter Annihilations towards the Inner Galactic Halo from 10 Years of Observations with H.E.S.S.

The inner region of the Milky Way halo harbors a large amount of dark matter (DM). Given its proximity, it is one of the most promising targets to look for DM. We report on a search for the annihilations of DM particles using γ-ray observations towards the inner 300 pc of the Milky Way, with the H.E.S.S. array of ground-based Cherenkov telescopes. The analysis is based on a 2D maximum likelihood method using Galactic Center (GC) data accumulated by H.E.S.S. over the last 10 years (2004-2014), and does not show any significant γ-ray signal above background. Assuming Einasto and Navarro-Frenk-White DM density profiles at the GC, we derive upper limits on the annihilation cross section ⟨σv⟩. These constraints are the strongest obtained so far in the TeV DM mass range and improve upon previous limits by a factor 5. For the Einasto profile, the constraints reach ⟨σv⟩ values of 6×10^{-26} cm^{3} s^{-1} in the W^{+}W^{-} channel for a DM particle mass of 1.5 TeV, and 2×10^{-26} cm^{3} s^{-1} in the τ^{+}τ^{-} channel for a 1 TeV mass. For the first time, ground-based γ-ray observations have reached sufficient sensitivity to probe ⟨σv⟩ values expected from the thermal relic density for TeV DM particles.

Embolización de arterias uterinas para manejo de miomatosis: experiencia con 200 pacientes / Uterine arteries embolization for the treatment of leiomyomatosis: experience with 200 patients

Objetivos: Evaluar la eficacia y seguridad de la embolización de arterias uterinas en la reducción del volumen uterino, tamaño de miomas, signos y síntomas relacionados a la enfermedad y la satisfacción del paciente. Diseño: Estudio clínico, retrospectivo y longitudinal. Locación: Instituto de Radiología Intervencionista Brazzini. Participantes: Doscientos pacientes sometidos a EAU bilateral. Intervención: Embolización de arterias uterinas realizado con partículas de polyvinyl alcohol de 355 a 500 μm y micro esferas embolizantes de 500 a 900 micras. El seguimiento fue de tres, seis, doce y hasta setenta y dos meses, que incluyeron ecografías uterinas pre y post embolización, reporte de mejoría sintomatológica por pacientes (EAV 0 a 10), satisfacción postratamiento, complicaciones y datos epidemiológicos relevantes. Resultados: De los 200 pacientes estudiados, los síntomas que impulsaron la consulta fueron, en primer lugar y con 42%, los trastornos menstruales, y en segundo lugar con 17%, la anemia. El tipo de mioma más frecuente fue, con 54%, el mioma intramural. La reducción media en el tamaño uterino y del mioma dominante fue 43,4% y 59%, respectivamente. De las pacientes, 56,5% tenía indicación de histerectomía al llegar a la consulta (N° 113), y de estos, luego del tratamiento, dos pacientes fueron sometidas a este procedimiento (1,02%). Las mujeres refirieron mejoría de sus síntomas en la escala análoga visual (0 a 10) de 6,7 puntos (Pre: 9 puntos, Post: 2,3 puntos). La mayoría (95%) refirió estar satisfecha con el procedimiento realizado. Conclusiones: La EAU redujo el tamaño de los miomas, el tamaño total de útero y como resultado del tratamiento se evidenció una disminución significativa de los síntomas. Las pacientes intervenidas refirieron estar satisfechas con el procedimiento, tenían una mejor calidad de vida y estaban contentas de haber evitado someterse a un procedimiento quirúrgico mayor.

Objectives: To determine safety and efficacy of uterine artery embolization (UAE) for uterine volume reduction, leiomyoma size, symptoms relief and patient satisfaction. Design: Clinical retrospective and longitudinal study. Setting: Brazzini Interventional Radiology Institute. Participants: Two hundred patients who underwent a UAE. Interventions: Bilateral UAE with hydrogel microspheres and polyvinyl alcohol particles sized 500-900 microns were applied to 200 women. Follow-up was from three, six, twelve and up to 72 months, and included pre and post embolization uterine ultrasound, complications, and relevant epidemiological data. Results: The most common symptoms were menstrual abnormalities (42%) and anemia (17%), among others. Most common type of leiomyoma was intramural (54%). Median uterine and dominant fibroid volume reductions were 43.4% and 59%, respectively. Out of the 200 women, 113 had previous indication of hysterectomy, and 2 patients were treated surgically (1.02%). Visual analog scale assessment showed improvements of 6.7 points (0 to 10). 95% of the studied and treated population reported satisfaction with the treatment. Conclusions: UAE reduced uterine total volume and fibroids size, resulting in significant symptom relief. Treated patients reported improvements in quality of life and treatment satisfaction.

The use of the acute Pd/Pa drop after intracoronary nitroglycerin infusion to rule out significant FFR: CANICA (Can intracoronary nitroglycerin predict fractional flow reserve without adenosine?) multicenter study.

OBJECTIVE: Functional assessment of coronary artery stenosis is performed by measuring the fractional flow reserve (FFR) under hyperemic conditions (Adenosine). However, the use of adenosine portends limitations. OBJECTIVE: We sought to investigate the relationship and correlation between FFR and the Pd/Pa value obtained just after the intracoronary infusion (acute drop) of nitroglycerin (Pd/Pa-NTG) and if this parameter enhances diagnostic accuracy for FFR prediction compared to the resting baseline Pd/Pa. METHODS: We conducted a multicenter study including prospectively patients presenting intermediate coronary artery stenosis (30-70%) evaluated with pressure wire. Resting baseline Pd/Pa, Pd/Pa-NTG and FFR were measured. RESULTS: 283 patients (335 lesions) were included. Resting baseline Pd/Pa value was 0.72 to 1.0 (0.93 ± 0.04), Pd/Pa-NTG was 0.60 to 1.0 (0.87 ± 0.07) and FFR 0.55 to 1.0 (0.83 ± 0.08). The ROC curves for resting baseline Pd/Pa and for Pd/Pa-NTG, using a FFR ≤ 0.80 showed an AUC of 0.88 (95% CI: 0.84-0.92, P < 0.001) and 0.94 (95% CI: 0.92-0.96, P < 0.001) respectively. The optimal cutoff values of resting baseline Pd/Pa and Pd/Pa-NTG for an FFR > 0.80, were >0.96 and >0.88, respectively. These values were present in a 29.8% (n = 100) and a 47.1% (n = 158), of the total lesions. Scatter plots showed a better correlation and agreement points with Pd/Pa-NTG than resting baseline Pd/Pa. The cutoff value of Pd/Pa-NTG > 0.88 showed an excellent NPV (96.2% for FFR > 0.8 and 100% for FFR > 0.75) and sensitivity (95% for FFR > 0.8 and 100% for FFR > 0.75) which were consistently high across all the subgroups analysis. CONCLUSION: The cutoff value of acute Pd/Pa-NTG > 0.88 has a high NPV meaning adenosine-FFR can be avoided in almost half of lesions.

[Risk assessment in children with lithogenic kidney stones]. / Evaluatión del perfil de riesgo litógeno en niños con litiasis renal.

OBJECTIVE: The aim of this study was to describe the lithogenic risk profile of pediatric patients with lithiasis. METHODS: We retrospectively analyzed the metabolic studies in 24-hour urine samples in 47 pediatric patients with lithiasis. Biochemical determinations were made in blood and 24-hour urine. Oxalate calcium, brushite, struvite and uric acid salt saturations were calculated. 49 healthy children were used as a control group. RESULTS: No significant differences were found in biochemical blood parameters between children with stones and the group without stones. Calciuria, uricosuria and phosphaturia, oxalate calcium, brushite and uric acid saturations were higher in lithiasic children. In the multivariate analysis, using a logistic regression model, we only found hypercalciuria as lithogenic risk factor. (OR = 1.96 p <0.002). CONCLUSIONS: Urinary metabolic abnormalities and elevated salt saturations in urine are a frequent finding in children with urolithiasis, but in our study we only found hypercalciuria as an independent risk factor for the formation of lithiasis.

Evaluación del perfil de riesgo litógeno en niños con litiasis renal / Lithogenic risk assessment in children with kidney stones

OBJETIVO: El objetivo de este trabajo fue describir el perfil de riesgo litógeno de pacientes pediátricos con litiasis, y comparar los datos obtenidos con el grupo de niños sin evidencia de litiasis renal. MATERIAL Y MÉTODOS: Se analizaron retrospectivamente los estudios metabólicos en orina de 24 horas de 47 pacientes pediátricos diagnosticados de litiasis renal. Se determinaron en sangre y en orina de 24 horas creatinina, urea, sodio, potasio, cloro, ácido úrico, calcio, fósforo, magnesio y osmolalidad. Se calculó el nivel de saturación de oxalato cálcico, brushita, estruvita y ácido úrico. Se utilizó como grupo control una cohorte de 49 niños sanos. RESULTADOS: No se encontraron diferencias significativas en los parámetros bioquímicos sanguíneos entre los niños con litiasis y el grupo sin litiasis. La calciuria, uricosuria y fosfaturia eran superiores en el grupo de las litiasis. Las saturaciones de oxalato cálcico, fosfato cálcico y ácido úrico también eran mayores en los niños con litiasis. Al realizar el análisis multivariante mediante un modelo de regresión logística sólo se encontró como factor de riesgo litógeno a la hipercalciuria. (OR= 1,96 p < 0,002). CONCLUSIONES: Es habitual el hallazgo de alteraciones metabólicas urinarias y saturaciones elevadas de distintas sales en orina en los niños con litiasis, pero sólo se confirmó el efecto independiente de la hipercalciuria como factor determinante de riesgo en la aparición de litiasis

OBJECTIVE: The aim of this study was to describe the lithogenic risk profile of pediatric patients with lithiasis. METHODS: We retrospectively analyzed the metabolic studies in 24-hour urine samples in 47 pediatric patients with lithiasis. Biochemical determinations were made in blood and 24-hour urine. Oxalate calcium, brushite, struvite and uric acid salt saturations were calculated. 49 healthy children were used as a control group. RESULTS: No significant differences were found in biochemical blood parameters between children with stones and the group without stones. Calciuria, uricosuria. and phosphaturia, oxalate calcium, brushite and uric acid saturations were higher in lithiasic children. In the multivariate analysis, using a logistic regression model, we only found hypercalciuria as lithogenic risk factor. (OR = 1.96 p >0.002). CONCLUSIONS: Urinary metabolic abnormalities and elevated salt saturations in urine are a frequent finding in children with urolithiasis, but in our study we only found hypercalciuria as an independent risk factor for the formation of lithiasis

Bionanocomposite films based on plasticized PLA-PHB/cellulose nanocrystal blends.

Optically transparent plasticized poly(lactic acid) (PLA) based bionanocomposite films intended for food packaging were prepared by melt blending. Materials were plasticized with 15wt% of acetyl(tributyl citrate) (ATBC) to improve the material processability and to obtain flexibile films. Poly(hydroxybutyrate) (PHB) was used to increase PLA crystallinity. The thermal stability of the PLA-PHB blends was improved by the addition of 5 wt% of cellulose nanocrystals (CNC) or modified cellulose nanocrystals (CNCs) synthesized from microcrystalline cellulose. The combination of ATBC and cellulose nanocrystals, mainly the better dispersed CNCs, improved the interaction between PLA and PHB. Thus, an improvement on the oxygen barrier and stretchability was achieved in PLA-PHB-CNCs-ATBC which also displayed somewhat UV light blocking effect. All bionanocomposite films presented appropriate disintegration in compost suggesting their possible applications as biodegradable packaging materials.

Hiponatremia e hipofosforemia en las neumonías: ¿qué papel desempeña el riñón? / Hyponatremia and hypophosphatemia in pneumonia: what role does the kidney?

Antecedentes: La hiponatremia es una alteración electrolítica relativamente frecuente en pacientes con neumonía, cuya patogenia se relaciona con el síndrome de secreción inapropiada de hormona antidiurética. El objetivo de este estudio era describir las alteraciones hidroelectrolíticas y hormonales en niños, previamente sanos, diagnosticados de neumonía adquirida en la comunidad (NAC), y compararlas con las de los niños sanos. Material y métodos: Se llevó a cabo un estudio de casos y controles. El grupo de casos (n= 25) estuvo formado por pacientes diagnosticados de NAC según criterios de la Organización Mundial de la Salud, con una media de edad de 4,2 ± 2,4 años; ninguno había recibido fluidoterapia intravenosa. En el grupo control (n= 27) se incluyeron niños sanos, con una media de edad de 5 ± 2,6 años, autorizados a participar en el estudio. Se realizó un análisis bioquímico en sangre y en orina (en micción aislada). En el grupo de NAC se determinaron las cifras de proteína C reactiva (PCR), procalcitonina (PCT) y vasopresina (ADH). Resultados: Los valores medios séricos del sodio, aunque en rango normal, fueron significativamente menores en el grupo de casos que en el grupo control, al igual que la excreción fraccional de sodio (EFNa), cuyo valor medio fue significativamente menor que el del grupo control. No hubo relación entre la natremia, la EFNa y los niveles de ADH. Se encontró una relación significativamente negativa entre los valores de sodio y la temperatura axilar (r= -0,64; p <0,001), la PCR (r= -0,41; p <0,04) y el recuento de leucocitos (r= -0,43; p <0,01) en sangre periférica. El valor medio del fósforo sérico era significativamente inferior al del grupo control. Se encontró una relación significativa entre la fosforemia y la reabsorción tubular de fosfato, expresada mediante TP/GFR (r= 0,97; p <0,001), y la PCR (r= -0,4; p <0,04). Conclusiones: En esta serie, los pacientes con NAC muestran una clara tendencia a presentar un descenso de la natremia. Esta tendencia es de causa extrarrenal y se relaciona significativamente con el proceso inflamatorio secundario a la infección. El descenso del fósforo sanguíneo también se relaciona con la infección, y es secundaria a una pérdida excesiva de fósforo por el riñón (AU)

Introduction: Hyponatremia is a relatively common electrolyte disturbance in patients with pneumonia and its pathogenesis has been related with the syndrome of inappropriate secretion of antidiuretic hormone. The aim of this study was to describe the electrolyte and hormonal abnormalities in children diagnosed with community-acquired pneumonia (CAP) and compare them with those obtained in healthy children. Material and methods: This is a case-control study. In the case group we included patients with CAP (n= 25), according to WHO criteria. None of the patients has received intravenous fluids. The control group (n= 27) included healthy children without disease. Biochemical blood and urine (isolated urination) were determined as analytical tests. In the CAP group C-reactive protein (CRP), procalcitonin (PCT) and levels of vasopressin (ADH) were determined. Results: The serum sodium mean values and the fractional excretion of sodium (FENa) were significantly lower in the case group than in the control group, although they were both in the normal range. There was no relationship between serum sodium, FENa and ADH levels. A significantly negative relationship was found between sodium and axillary temperature (r= -0.64; p <0.001), CRP (r= -0.41; p <0.04) and the leukocyte count in peripheral blood (r= -0.43; p <0.01). The mean serum phosphorus level was significantly lower in the case group. A remarkable relationship between phosphoremia and tubular phosphate reabsorption, expressed by TP/GFR (r= 0.97; p <0.001), and CRP (r= -0.4; p <0.04) was found. Conclusions: In this series, cases with CAP show a clear tendency of decreased serum sodium. This trend has an extrarenal cause and it is significantly related to the inflammatory process secondary to the infection. Hypophosphoremia also relates to infection and is secondary to excessive loss of phosphorus by the kidney (AU)

Multifunctional PLA-PHB/cellulose nanocrystal films: processing, structural and thermal properties.

Cellulose nanocrystals (CNCs) synthesized from microcrystalline cellulose by acid hydrolysis were added into poly(lactic acid)-poly(hydroxybutyrate) (PLA-PHB) blends to improve the final properties of the multifunctional systems. CNC were also modified with a surfactant (CNCs) to increase the interfacial adhesion in the systems maintaining the thermal stability. Firstly, masterbatch pellets were obtained for each formulation to improve the dispersion of the cellulose structures in the PLA-PHB and then nanocomposite films were processed. The thermal stability as well as the morphological and structural properties of nanocomposites was investigated. While PHB increased the PLA crystallinity due to its nucleation effect, well dispersed CNC and CNCs not only increased the crystallinity but also improved the processability, the thermal stability and the interaction between both polymers especially in the case of the modified CNCs based PLA-PHB formulation. Likewise, CNCs were better dispersed in PLA-CNCs and PLA-PHB-CNCs, than CNC.

Pielonefritis xantogranulomatosa en niños / Xanthogranulomatous pyelonephritis in children

OBJETIVO: La pielonefritis xantogranulomatosa (PX) es una enfermedad inflamatoria renal crónica poco frecuente en la población infantil que se produce por la asociación de una obstrucción del tracto urinario de larga evolución e infección crónica. Se muestran dos casos pediátricos diagnosticados de PX. MÉTODO: Uno de ellos consultó por orinas turbias. Entre los datos bioquímicos destacaba una hipergammaglobulinemia con la presencia de una banda homogénea en la fracción gamma en el proteinograma. El otro caso se detectó en una ecografía urológica efectuada durante el seguimiento de una enfermedad litiásica renal. En este paciente, encontramos que el riñón destruido por el proceso inflamatorio, estaba adherido a capsula perirrenal, ángulo esplénico del colon y colon descendente. En ambos había leucocituria y proteinuria leve-moderada. Ninguno de los niños mostraba signos clínicos de afectación del estado general y los datos analíticos de valoración de la función renal así como los indicadores de infección eran normales. RESULTADO: Todas estas anomalías desaparecieron después de la nefrectomía del riñón afectado. CONCLUSIONES: Presentamos dos casos clínicos de PX en un grupo de edad poco afectado por esta entidad con una forma de presentación inusual. Debe mantenerse un alto índice de sospecha de la misma para diagnosticarla y tratarla oportunamente, ya que el nivel de afectación renal y extrarrenal es proporcional a la extensión y duración de la enfermedad

OBJECTIVE: Xanthogranulomatous Pyelonephritis (XP) is a renal chronic inflammatory disease infrequent during childhood produced by the association of long-term urinary tract obstruction with chronic infection. We report the cases of two children diagnosed of XP. METHODS: One of them consulted for cloudy urine. Hypergammaglobulinemia with the presence of a homogeneous band in the gamma fraction of the proteinogram stood out among laboratory findings. The other case was diagnosed while performing a urologic ultrasound in the follow up of kidney stone disease. In the latter, the renal inflammation was adhered to the perirenal capsule, colonic splenic flexure and descending colon. Both presented mild proteinuria and hematuria. None of them showed clinical sings of affectation of the general status and their renal function laboratory data as well as the infection markers were normal. RESULTS: All the alterations disappeared after performing a nephrectomy of the affected kidney. CONCLUSIONS: We present two cases of XP in a group of age rarely affected by this disease that also showed an uncommon presentation for their age. A high rate of suspicion must be held to diagnose and correctly treat this disease because the grade of renal and extra renal damage is closely related with the extension and duration of the disease