Epidemiology and risk factors for recurrence in biliary source bloodstream infection episodes in oncological patients.

We aimed to describe the characteristics and outcomes of biliary source bloodstream infections (BSIs) in oncological patients. Secondarily, we analyzed risk factors for recurrent BSI episodes. All episodes of biliary source BSIs in oncological patients were prospectively collected (2008-2019) and retrospectively analyzed. Logistic regression analyses were performed. A rule to stratify patients into risk groups for recurrent biliary source BSI was conducted. Four hundred biliary source BSIs were documented in 291 oncological patients. The most frequent causative agents were Escherichia coli (42%) and Klebsiella spp. (27%), and 86 (21.5%) episodes were caused by multidrug-resistant Gram-negative bacilli (MDR-GNB). The rates of MDR-GNB increased over time. Overall, 73 patients developed 118 recurrent BSI episodes. Independent risk factors for recurrent BSI episodes were prior antibiotic therapy (OR 3.781, 95% CI 1.906-7.503), biliary prosthesis (OR 2.232, 95% CI 1.157-4.305), prior admission due to suspected biliary source infection (OR 4.409, 95% CI 2.338-8.311), and BSI episode caused by an MDR-GNB (OR 2.857, 95% CI 1.389-5.874). With these variables, a score was generated that predicted recurrent biliary source BSI with an area under the receiver operating characteristic (ROC) curve of 0.819. Inappropriate empirical antibiotic treatment (IEAT) was administered in 23.8% of patients, and 30-d mortality was 19.5%. As a conclusion, biliary source BSI in oncological patients is mainly caused by GNB, with high and increasing MDR rates, frequent IEAT, and high mortality. Recurrent BSI episodes are frequent. A simple score to identify recurrent episodes was developed to potentially establish prophylactic strategies. IMPORTANCE This study shows that biliary source bloodstream infections (BSIs) in oncological patients are mainly caused by Gram-negative bacilli (GNB), with high and increasing rates of multidrug resistance. Importantly, recurrent biliary source BSI episodes were very frequent and associated with delays in chemotherapy, high rates of inappropriate empirical antibiotic therapy, and high 30-d mortality (19.5%). Using the variable independently associated with recurrent BSI episodes, a score was generated that predicted recurrent biliary source BSI with high accuracy. This score could be used to establish prophylactic strategies and lower the risk of relapsing episodes and the associated morbidity and mortality.

Case report: Fatal lung hyperinflammation in a preterm newborn with SARS-CoV-2 infection.

Vertical transmission of SARS-CoV-2 from mother to fetus is widely accepted. Whereas most infected neonates present with mild symptoms or are asymptomatic, respiratory distress syndrome (RDS) and abnormal lung images are significantly more frequent in COVID-19 positive neonates than in non-infected newborns. Fatality is rare and discordant meta-analyses of case reports and series relating perinatal maternal COVID-19 status to neonatal disease severity complicate their extrapolation as prognostic indicators. A larger database of detailed case reports from more extreme cases will be required to establish therapeutic guidelines and allow informed decision making. Here we report an unusual case of a 28 weeks' gestation infant with perinatally acquired SARS-CoV-2, who developed severe protracted respiratory failure. Despite intensive care from birth with first line anti-viral and anti-inflammatory therapy, respiratory failure persisted, and death ensued at 5 months. Lung histopathology showed severe diffuse bronchopneumonia, and heart and lung immunohistochemistry confirmed macrophage infiltration, platelet activation and neutrophil extracellular trap formation consistent with late multisystem inflammation. To our knowledge, this is the first report of SARS CoV-2 pulmonary hyperinflammation in a preterm newborn with fatal outcome.

Impact of SARS-CoV-2 viral load and duration of symptoms before hospital admission on the mortality of hospitalized COVID-19 patients.

PURPOSE: Assess the impact of viral load estimated by cycle threshold (Ct) of reverse transcription real time-polymerase chain reaction (rRT-PCR) and the days from symptoms onset on mortality in hospitalized patients with COVID19. METHODS: Retrospective observational study of 782 patients with a positive rRT-PCR from a nasopharyngeal swab was performed within the first 24 h from admission. Demographic data, clinical manifestations and laboratory parameters were collected. Uni- and multivariate analyses were performed to identify factors associated with mortality at 60 days. RESULTS: Ct was divided into three groups and the mortality rate decreased from 27.3 to 20.7% and 9.8% for Ct values of ≤ 20, 21-25 and > 25, respectively (P = 0.0001). The multivariate analysis identified as predictors of mortality, a Ct value < 20 (OR 3.13, CI 95% 1.38-7.10), between 21-25 (OR 2.47, CI 95% 1.32-4.64) with respect to a Ct value > 25. Days from symptoms onset is a variable associated with mortality as well (DSOA) ≤ 6 (OR 1.86, CI 95% 1.00-3.46), among other factors. Patients requiring hospital admission within 6 DSOA with a Ct value ≤ 25 had the highest mortality rate (28%). CONCLUSIONS: The inclusion of Ct values and DSOA in the characterization of study populations could be a useful tool to evaluate the efficacy of antivirals.

Prevalence of Myofascial Trigger Points in Patients with Mild to Moderate Painful Knee Osteoarthritis: A Secondary Analysis.

OBJECTIVE: To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between the number of MTrPs and pain and function in patients presenting knee pain osteoarthritis (OA). METHODS: This was a secondary analysis of data from a cross-sectional study. The prevalence of MTrPs located in tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles was studied in 114 patients (71 men and 43 women) with knee OA. Pain and functionality were assessed with a numerical pain rating scale (NPRS), the Western Ontario, McMaster Universities Osteoarthritis Index (WOMAC) score, the Barthel Index, and the timed up and go test. RESULTS: The prevalence of latent MTrPs was detected via palpation and was estimated to be 50%, 35%, 25%, 29%, 33%, and 12% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. The prevalence of active MTrPs was estimated to be 11%, 17%, 30%, 18%, 25%, and 17% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. Pain was measured with the NPRS scale and was poorly correlated with the prevalence of latent MTrPs (r = 0.2; p = 0.03) and active MTrPs (r = 0.23; p = 0.01) in the hamstrings. Disability was moderately correlated with the number of latent MTrPs in the tensor fasciae latae muscle (Barthel, r = 0.26; p = 0.01 and WOMAC, r = 0.19; p = 0.04). CONCLUSIONS: This secondary analysis found that the prevalence of the MTrPs varied from 11% to 50% in different muscles of patients with mild to moderate painful knee osteoarthritis. Pain was correlated poorly with the prevalence of latent and active MTrPs in the hamstring muscles, and disability correlated moderately with the number of latent MTrPs in tensor fasciae latae.

Is a Combination of Exercise and Dry Needling Effective for Knee OA?

OBJECTIVE: To assess the effectiveness of adding dry needling (DN) to an exercise program on pain intensity and disability in patients with knee osteoarthritis. DESIGN: Double-blind randomized clinical trial with one-year follow-up. SETTING: Older adults in a multicenter study. SUBJECTS: Sixty-two patients with knee osteoarthritis were randomly allocated into one of two groups: exercise plus DN (exercise + DN; N = 31) or exercise plus sham DN (exercise + sham DN; N = 31). METHODS: Participants received six sessions of either DN or sham DN over the leg muscles related to knee pain from osteoarthritis plus a supervised exercise program. We evaluated between-group differences in terms of the numerical pain rating scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. We used the EuroQol Group 5-Dimension Self-Report Questionnaire, Barthel Index, Timed Up & Go Test, and Global Rating of Change Scale to examine between-group differences for health-related quality of life, functional status evaluation, balance assessment, and clinical progress, respectively. RESULTS: The groups were not different in terms of pain intensity (0.32 points, 95% confidence interval [CI] = -1.12 to 1.18, P = 0.92) or WOMAC score (0.29 points, 95% CI = -6.16 to 6.74, P = 0.92) at one year. Both groups presented within-group differences at all follow-up periods (F = 28.349, P < 0.0001, ηp2 = 0.32) on secondary outcomes. Nevertheless, 90.3% of the DN group had reduced medication consumption vs only 26.3% in the sham DN group. CONCLUSIONS: The inclusion of DN to an exercise program does not reduce pain or disability in patients with knee osteoarthritis.

Clinical features and myofascial pain syndrome in older adults with knee osteoarthritis by sex and age distribution: A cross-sectional study.

BACKGROUND: A source of myofascial pain and myofascial trigger points (MTrPs) in muscles of the knee area could play a crucial role in the management of pain in osteoarthritis patients. The aim of this study was to describe and compare demographic, clinical and myofascial pain syndrome characteristics in older adults with knee osteoarthritis by sex and age distribution. METHODS: A cross-sectional study was carried out. 114 patients with osteoarthritis were recruited in older-adult care centers. The diagnosis of active and/or latent MTrPs (AMTrPs/LMTrPs) was performed. Numerical Pain Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Barthel Index, Timed Up and Go Test (TUG), Mini-Mental State Examination, EuroQol Group 5-Dimension Self-Report Questionnaire, chronicity, number of falls, and medication use were collected. All data were compared by sex (male or female) and age (< 70, 70-80, or > 80 years) distributions. RESULTS: The most prevalent muscles with AMTrPs and LMTrPs were the quadriceps vastus medialis (75.43%) and lateralis (65.78%), respectively. The clinical characteristics showed significant differences (P<0.05) for chronicity, WOMAC functionality and total scores, TUG, falls rate and medication between males and females, as well as for chronicity, Barthel index and TUG between age distributions. There were not any significant differences (P>0.05) by sex or age distribution according to the number and presence of active and latent MTrPs. CONCLUSIONS: The demographic and clinical features of older adults with knee osteoarthritis may be influenced by sex and age distribution. Nevertheless, the myofascial pain syndrome associated with knee osteoarthritis did not seem to be related to sex or age distribution.

Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial.

BACKGROUND: Few studies have investigated the dry needling (DN) approach on knee osteoarthritis (KO) patients. The study's aim was to evaluate the short-term efficacy of adding DN to a therapeutic exercise protocol in the treatment of KO in older adults. METHODS: A double-blind, pilot clinical trial with parallel groups [NCT02698072] was carried out for 12 weeks of treatment and follow-up. Twenty patients aged 65 years and older with myofascial trigger points (MTrPs) in the muscles of the thigh were recruited from older-adult care centers and randomly assigned to a DN + Exercise group or a Sham-DN + Exercise group. The Numeric Rating Scale (NRS; primary outcome) and Western Ontario and McMaster Universities Osteoarthritis Index questionnaire (WOMAC) were assessed before and after the intervention. RESULTS: The NRS (analysis of variance, ANOVA) showed statistically significant differences in the time factor (F = 53.038; P < .0001; ηp = 0.747). However, it did not show a significant change in the group-time interaction (F = 0.082; P = .777; ηp = 0.005). The WOMAC scores (ANOVA) showed statistically significant differences in the time factor for total score WOMAC questionnaire (F = 84.826; P < .0001; ηp = 0.825), WOMAC pain (F = 90.478; P < .0001; ηp = 0.834), WOMAC stiffness (F = 14.556; P < .001; ηp = 0.447), and WOMAC function (F = 70.872; P < .0001; ηp = 0.797). However, it did not show a statistically significant change in the group-time interaction. CONCLUSION: Despite the pain intensity and disability clinically relevant improvement for both DN and Sham-DN combined with exercise, 6 sessions of DN added to a therapeutic exercise program for older adults with KO did not seem to improve pain intensity and functionality.

Efficacy of Human-Simulated Exposures of Ceftolozane-Tazobactam Alone and in Combination with Amikacin or Colistin against Multidrug-Resistant Pseudomonas aeruginosa in an In Vitro Pharmacodynamic Model.

Combination therapy is an attractive option for the treatment of multidrug-resistant (MDR) Pseudomonas aeruginosa infections; however, limited data are available on combinations with ceftolozane-tazobactam (C-T). The in vitro pharmacodynamic chemostat model was employed to compare human-simulated exposures of C-T at 3 g every 8 h alone or in combination with amikacin at 25 mg/kg of body weight daily or colistin at 360 mg daily against four MDR P. aeruginosa isolates. C-T alone resulted in 24-h changes in the number of CFU of -0.02 ± 0.21, -1.81 ± 0.55, -1.44 ± 0.40, and +0.62 ± 0.05 log10 CFU/ml against isolates with C-T MICs of 4, 4, 8, and 16 µg/ml, respectively. Amikacin and colistin monotherapy displayed various results. The addition of amikacin to C-T resulted in -2.00 ± 0.23 (P < 0.001, additive)-, -1.50 ± 0.83 (P = 0.687, indifferent)-, -2.84 ± 0.08 (P = 0.079, indifferent)-, and -2.67 ± 0.54 (P < 0.001, synergy)-log10 CFU/ml reductions, respectively. The addition of colistin to C-T resulted in -3.02 ± 0.22 (P < 0.001, additive)-, -3.21 ± 0.24 (P > 0.05, indifferent)-, -4.6 ± 0.11 (P = 0.002, synergy)-, and -3.01 ± 0.28 (P < 0.001, synergy)-log10 CFU/ml reductions, respectively, against the MDR P. aeruginosa isolates with these MICs. Greater overall reductions in bacterial burden, including additive or synergistic interactions at 24 h, with C-T plus amikacin or colistin were observed against 3 out of 4 MDR P. aeruginosa strains tested, particularly those strains that were intermediate or resistant to C-T. Further studies assessing combination regimens containing C-T against MDR P. aeruginosa are warranted.

[ANCA-associated vasculitides at Mexico City's metropolitan Eastern area]. / Vasculitis asociadas a ANCA en la zona metropolitana oriente de la Ciudad de México.

BACKGROUND: The anti-neutrophil cytoplasmic antibody-associated (ANCA) vasculitides includes granulomatosis with polyangiitis (Wegener's) (GPW), Chrug-Strauss syndrome (CSS) and microscopic polyangiitis (MPA). Since it has low incidence in our field, there are a few published papers. The aim of this study was to report the clinical characteristics, activity and damage of these vasculitides in Mexico City's metropolitan eastern area. METHODS: We studied 28 cases with ANCA-associated vasculitis in the aforementioned area. The classification was made according to the ACR 1990 criteria, the Chapel Hill 2012 consensus, and the EULAR 2007 recommendations. We collected demographic data, as well as data of clinical manifestations, laboratory, management and outcomes. The activity was established using the Birmingham Vasculitis Activity Score (BVAS) and the damage using the Vasculitis Damage Index (VDI). We used paired t test and 95% confidence intervals (95% CI). RESULTS: 15 females and 13 males were included, 20 with GPW and 8 with CCS. The mean age was 50.1 ± 12.7 years, and the evolution time was 69 ± 49.6 months. We didn't find cases of MAP. 23 patients (82.1%) had general symptoms. The initial and final BVAS means were 10.5 and 1.5 (p < 0.001) and the global VDI was 2.4. CONCLUSIONS: The presence of ANCA-associated vasculitides is rare in the eastern Metropolitan area of Mexico City. GPW was predominant over CCS, and MPA was absent. They are multi-system vasculitides with high scores of initial activity and moderate damage.

Introducción: las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilo (ANCA) incluyen la granulomatosis con poliangeítis (GPW), el síndrome de Churg-Strauss (SChS) y la poliangeítis microscópica (PAM). Como son de baja incidencia, los informes son escasos. El objetivo fue reportar las características clínicas, la actividad y el daño de casos con estas vasculitis en la zona oriente de la Ciudad de México. Métodos: Se incluyeron 28 casos. La clasificación de las vasculitis se hizo según los criterios ACR 1990, Chapel Hill 2012 y EULAR 2007. Se recabaron datos demográficos, manifestaciones clínicas, de laboratorio, tratamientos y evolución clínica. Se determinó el puntaje de actividad de Birmingham (BVAS) y el daño de la vasculitis (VDI). Se utilizó la prueba t pareada e intervalos de confianza al 95% (IC 95%). Resultados: 15 mujeres y 13 hombres fueron incluidos, 20 con GPW y 8 con SChS, con edad de 50.1 ± 12.7 años y evolución de 69 ± 49.6 meses. No hubo casos con PAM. Presentaron ataque al estado general 23 (82.1%). Los promedios BVAS inicial y final fueron: 10.5 y 1.5 (p < 0.001) y el VDI global fue de 2.4. Conclusiones: las vasculitis asociadas a ANCA son raras en esta zona de la Ciudad de México. Predominaron los casos de GPW sobre SChS y fueron nulos para PAM. Tienen presentación multisistémica, altos puntajes de actividad inicial y daño moderado.

Signo de Beevor «extendido». Un nuevo signo clínico en miositis con cuerpos de inclusión / «Extended» Beevor's sing as a new clinical sign in sporadic inclusion body myositis

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Liver damage and caspase-dependent apoptosis is related to protein malnutrition in mice: effect of methionine.

This study aimed to determine whether the effects on the mouse liver caused by three periods of feeding a protein-free diet for 5 days followed by a normal complete diet for 5 days (3PFD-CD) are prevented by a constant methionine supply (3PFD+Met-CD). The expressions of carbonic anhydrase III (CAIII), fatty acid synthase (FAS), glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and glutathione S-transferase P1 (GSTP1) were assessed by proteomics and reverse transcriptase-polymerase chain reactions. The liver redox status was examined by measuring the activities of superoxide dismutase (SOD) and catalase (CAT), as well as protein carbonylation. Because oxidative stress can result in apoptosis, the activity and content of caspase-3, as well as the x-linked inhibitor of the apoptosis protein (XIAP) and mitochondrial caspase-independent apoptosis inducing factor (AIF) contents were assessed. In addition, the liver histomorphology was examined. Compared to the controls fed a normal complete diet throughout, feeding with 3PFD-CD increased the FAS content, decreased the CAIII content, decreased both the SOD and CAT activities, and increased protein carbonylation. It also activated caspase-3, decreased the XIAP content, decreased the AIF content, increased the number of GSTP1-positive foci and caspase-3-positive cells, and caused fatty livers. Conversely, the changes were lessened to varying degrees in mice fed 3PFD+Met-CD. The present results indicate that a regular Met supply lessens the biochemical changes, damage, and caspase-dependent apoptosis provoked by recurrent dietary amino acid deprivation in the mouse liver.

New biofuel integrating glycerol into its composition through the use of covalent immobilized pig pancreatic lipase.

By using 1,3-specific Pig Pancreatic lipase (EC 3.1.1.3 or PPL), covalently immobilized on AlPO(4)/Sepiolite support as biocatalyst, a new second-generation biodiesel was obtained in the transesterification reaction of sunflower oil with ethanol and other alcohols of low molecular weight. The resulting biofuel is composed of fatty acid ethyl esters and monoglycerides (FAEE/MG) blended in a molar relation 2/1. This novel product, which integrates glycerol as monoacylglycerols (MG) into the biofuel composition, has similar physicochemical properties compared to those of conventional biodiesel and also avoids the removal step of this by-product. The biocatalyst was found to be strongly fixed to the inorganic support (75%). Nevertheless, the efficiency of the immobilized enzyme was reduced to half (49.1%) compared to that of the free PPL. The immobilized enzyme showed a remarkable stability as well as a great reusability (more than 40 successive reuses) without a significant loss of its initial catalytic activity. Immobilized and free enzymes exhibited different reaction mechanisms, according to the different results in the Arrhenius parameters (Ln A and Ea). However, the use of supported PPL was found to be very suitable for the repetitive production of biofuel due to its facile recyclability from the reaction mixture.

[Relapsing polychondritis: clinical and therapeutic analysis of 15 Mexican cases]. / Policondritis recidivante: análisis de 15 casos.

BACKGROUND: relapsing polychondritis (RP) is a rare multisystem disease of unknown etiology, characterized by recurrent episodes of inflammation and cartilage destruction. The aim was to present fifteen cases, analyzed in a clinical and therapeutic perspective. METHODS: fifteen cases from three different cities of Mexico, diagnosed with Damiani criteria, were included. Clinical features, treatment given and outcome were recorded. RESULTS: nine men and six women with mean age of 52.4 years met the criteria for RP; the average change was 86.7 months. The dominant clinical manifestations were: 83 % auricular chondritis, 66 % dysphonia, 60 % arthritis and 53 % with eye involvement. Treatment included: 93 % received corticosteroids, 60 % received methotrexate, 46 % received no steroidal anti-inflammatory treatment, 46 % received immunosuppressant therapy, and two cases received biologic therapy. The clinical course showed 34 relapses in 12 cases. Complications included hoarseness in seven cases, tracheal stenosis in six case, and hearing loss in three cases. There were five deaths, three from respiratory complications, one from renal failure and another from a cerebral vascular event. CONCLUSIONS: the fifteen cases with RP presented were characterized by multisystem clinical courses and serious respiratory complications. The diagnostic and therapeutic situations merited highly medical specialized approaches.

Alternation between dietary protein depletion and normal feeding cause liver damage in mouse

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The effect of frequent protein malnutrition on liver function has not been intensively examined. Thus, the effects of alternating 5 days of a protein and amino acid-free diet followed by 5 days of a complete diet repeated three times (3 PFD-CD) on female mouse liver were examined. The expression of carbonic anhydrase III (CAIII), fatty acid synthase (FAS), glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and glutathione S-transferase P1 (GSTP1) in liver were assessed by proteomics, reverse transcriptase-polymerase chain reaction and Northern blotting. The activities of liver GSTs, glutathione reductase (GR) and catalase (CAT), as well as serum glutamic-oxaloacetic transaminase (SGOT) and glutamic-pyruvic transaminase (SGPT) were also tested. Additionally, oxidative damage was examined by measuring of protein carbonylation and lipid peroxidation. Liver histology was examined by light and electron microscopy. Compared with control mice, 3 PFD-CD increased the content of FAS protein (+90%) and FAS mRNA (+30%), while the levels of CAIII and CAIII mRNAs were decreased (−48% and −64%, respectively). In addition, 3 PFD-CD did not significantly change the content of GSTP1 but produced an increase in its mRNA level (+20%), while it decreased the activities of both CAT (−66%) and GSTs (−26%). After 3 PFD-CD, liver protein carbonylation and lipid peroxidation were increased by +55% and +95%, respectively. In serum, 3 PFD-CD increased the activities of both SGOT (+30%) and SGPT (+61%). In addition, 3 PFD-CD showed a histological pattern characteristic of hepatic damage. All together, these data suggest that frequent dietary amino acid deprivation causes hepatic metabolic and ultrastructural changes in a fashion similar to precancerous or cancerous conditions (AU)

Alternation between dietary protein depletion and normal feeding cause liver damage in mouse.

The effect of frequent protein malnutrition on liver function has not been intensively examined. Thus, the effects of alternating 5 days of a protein and amino acid-free diet followed by 5 days of a complete diet repeated three times (3 PFD-CD) on female mouse liver were examined. The expression of carbonic anhydrase III (CAIII), fatty acid synthase (FAS), glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and glutathione S-transferase P1 (GSTP1) in liver were assessed by proteomics, reverse transcriptase-polymerase chain reaction and Northern blotting. The activities of liver GSTs, glutathione reductase (GR) and catalase (CAT), as well as serum glutamic-oxaloacetic transaminase (SGOT) and glutamic-pyruvic transaminase (SGPT) were also tested. Additionally, oxidative damage was examined by measuring of protein carbonylation and lipid peroxidation. Liver histology was examined by light and electron microscopy. Compared with control mice, 3 PFD-CD increased the content of FAS protein (+90%) and FAS mRNA (+30%), while the levels of CAIII and CAIII mRNAs were decreased (-48% and -64%, respectively). In addition, 3 PFD-CD did not significantly change the content of GSTP1 but produced an increase in its mRNA level (+20%), while it decreased the activities of both CAT (-66%) and GSTs (-26%). After 3 PFD-CD, liver protein carbonylation and lipid peroxidation were increased by +55% and +95%, respectively. In serum, 3 PFD-CD increased the activities of both SGOT (+30%) and SGPT (+61%). In addition, 3 PFD-CD showed a histological pattern characteristic of hepatic damage. All together, these data suggest that frequent dietary amino acid deprivation causes hepatic metabolic and ultrastructural changes in a fashion similar to precancerous or cancerous conditions.

Oxidative stress in mouse liver caused by dietary amino acid deprivation: protective effect of methionine.

The aim of this work was to evaluate the effects of a diet depleted of amino acids (protein-free diet, or PFD), as well as the supplementation with methionine (PFD+Met), on the antioxidant status of the female mouse liver. With this purpose, cytosolic protein spots from two-dimensional non-equilibrium pH gel electrophoresis were identified by several procedures, such as mass spectrometry, Western blot, gel matching and enzymatic activity. PFD decreased the contents of catalase (CAT), peroxiredoxin I (Prx-I), and glutathione peroxidase (GPx) by 67%, 37% and 45%, respectively. Gene expression analyses showed that PFD caused a decrease in CAT (-20%) and GPx (-30%) mRNA levels but did not change that of Prx-I. It was also found that, when compared to a normal diet, PFD increased the liver contents of both reactive oxygen species (+50%) and oxidized protein (+88%) and decreased that of glutathione (-45%). Supplementation of PFD with Met prevented these latter effects to varying degrees, whereas CAT, Prx-I and GPx mRNA levels resulted unmodified. Present results suggest that dietary amino acid deprivation deranges the liver antioxidant defences, and this can be, in part, overcome by supplementation with Met.

Oxidative stress in mouse liver caused by dietary amino acid deprivation: protective effect of methionine

No disponible

The aim of this work was to evaluate the effects of a diet depleted of amino acids (protein-free diet, or PFD), as well as the supplementation with methionine (PFD+Met), on the antioxidant status of the female mouse liver. With this purpose, cytosolic protein spots from two-dimensional non-equilibrium pH gel electrophoresis were identified by several procedures, such as mass spectrometry, Western blot, gel matching and enzymatic activity. PFD decreased the contents of catalase (CAT),peroxiredoxin I (Prx-I), and glutathione peroxidase (GPx) by 67%, 37% and 45%, respectively. Gene expression analyses showed that PFD caused a decrease in CAT (−20%) and GPx (−30%) mRNAlevels but did not change that of Prx-I. It was also found that, when compared to a normal diet, PFD increased the liver contents of both reactive oxygen species (+50%) and oxidized protein (+88%) and decreased that of glutathione (−45%). Supplementation of PFD with Met prevented these latter effects to varying degrees, whereas CAT, Prx-I and GPx mRNA levels resulted unmodified. Present results suggest that dietary amino acid deprivation deranges the liver antioxidant defences, and this can be, in part, overcome by supplementation with Met (AU)

Valoración de la capacidad de ejercicio en los pacientes con hipertensión arterial pulmonar / Assessment of exercise functional capacity in patients with pulmonary arterial hypertension

La valoración de la capacidad funcional en los pacientes con hipertensión arterial pulmonar forma parte del protocolo diagnóstico inicial y del seguimiento. El grado de intolerancia al ejercicio tiene importantes implicaciones pronósticas y en la elección de tratamiento. Clásicamente, esta valoración se ha realizado mediante la prueba de caminata de 6 minutos. La prueba de esfuerzo cardiopulmonar, ampliamente utilizada en la disfunción ventricular izquierda, se está introduciendo como nueva herramienta en la valoración funcional de los pacientes con hipertensión arterial pulmonar, sobre todo en la de aquellos con menos limitaciones funcionales. Aparte de realizar una valoración no invasiva y objetiva de la capacidad de ejercicio, describe cuáles son los mecanismos fisiopatológicos subyacentes a dicha limitación. Es capaz también de identificar a los pacientes con cortocircuito derecha-izquierda secundario a foramen oval permeable. Tiene implicaciones pronósticas y puede emplearse para analizar la respuesta al tratamiento. Sin embargo, es compleja y requiere una gran experiencia para realizarla e interpretar sus resultados. A continuación, revisaremos el comportamiento de los pacientes con hipertensión arterial pulmonar en la prueba de esfuerzo cardiopulmonar describiendo brevemente la respuesta de nuestros pacientes y comparando los resultados con la prueba de caminata de 6 minutos.

The assessment of functional capacity is part of the diagnosisand management of patients with pulmonaryarterial hypertension. Exercise capacity impairment determines prognosis and establishes which is the besttreatment option. Practicing clinicians use various exercisemodalities in pulmonary arterial hypertension: the 6-minute walk test is the one most frequently used. Cardiopulmonary exercise testing, widely used in leftventricle dysfunction, is starting to be incorporated as anew noninvasive tool for functional assessment inpulmonary hypertensive patients, especially in those withless severe disease. Apart from providing objective information about exercise limitation it can describe the pathophysiological bases of functional impairment and it identifies patients with exercise induced right-to-leftshunt due to patent foramen ovale. Cardiopulmonary exercise testing parameters predict prognosis and assessthe response to drugs. However, it is complex and requiresgreat level of experience for interpreting its results. Thisarticle describes pulmonary hypertensive patient responseto cardiopulmonary exercise testing. Finally, we will brieflyanalyze our results comparing them with 6-minute walktest.

[Human trichinosis. A case simulating polymyositis]. / Triquinosis humana. Un caso que simula polimiositis.

The human trichinosis is a cosmopolitan rare zoonosis in Mexico. It presents clinically, with an infectious toxic pattern. Typical symptomatology includes: fever, diarrhea, facial edema and myalgias, which can resemble other illnesses like typhoid fever, angioneurotic edema, septicemia, rheumatic disease-like vasculitis and dermato-polymyositis. The treatment is based on the use of antiparasites. In this paper a trichinosis case is described in a woman, 29 years old who lives in the metropolitan area, with a clinical pattern that suggest polymyositis. The diagnosis was confirmed through a muscle biopsy. The treatment was albendazole and prednisone with successful results.