Integrating viral hepatitis management into the emergency department: A further step towards viral hepatitis elimination.

Background & Aims: Many people with HCV and HBV infection are unaware of their condition, particularly at-risk and vulnerable populations who face barriers for screening and linkage to care. Emergency departments are often their only point of contact with the health system. Methods: This is a prospective study investigating HBsAg and HCV antibody testing, with reflex testing for HDV antibodies and HCV RNA, in adults attending an emergency department and requiring a blood test. Positive cases were linked to care. A cost-effectiveness analysis was performed. Results: From February 2020 to February 2022, a total of 17,560 individuals were screened. HBsAg was detected in 91 (0.5%), HCV RNA in 128 (0.7%), and HDV antibodies in two (0.01%) individuals. Nearly 40% of positive cases were unaware of their condition. Linkage to care was achieved in 42 of 56 HBsAg-positive and 45 of 69 HCV RNA-positive participants who were candidates for referral. HCV and HBV screening vs. no screening yielded 1.06 and 0.42 additional quality-adjusted life-years, respectively, with incremental cost-utility ratios of €7,629 and -€147 per quality-adjusted life-year gained, respectively, and proved even more cost-effective in patients with hepatitis C aged 40-70 years. Conclusions: On emergency department screening for hepatitis B, C, and D in Barcelona, the prevalence of HBsAg was 0.5% and HCV RNA 0.7%, approximately threefold higher than that observed in the general population. This strategy diagnosed patients with active HCV infection and no risk factors, who would not have been screened according to the current recommendations. Screening and linkage to care of viral hepatitis is cost-effective in this setting. Impact and implications: We evaluated the performance and cost-effectiveness of a viral hepatitis screening programme implemented in an emergency department, which aimed to identify and link to care people living with hepatitis B and C. Our findings reveal a threefold higher prevalence of hepatitis B and C than in the general Spanish population, possibly attributable to the role of the emergency department as the main healthcare gateway for vulnerable populations, who have a higher prevalence of viral hepatitis. Risk factors for viral hepatitis could not be identified in most people living with hepatitis B and C attending the emergency department; hence, screening beyond risk factors should be considered in hepatitis detection strategies. Emergency department screening is cost-effective for hepatitis C and is a cost-saving strategy for hepatitis B in our setting. These data should inform future updates to clinical guidelines.

Diversity, composition, and networking of saliva microbiota distinguish the severity of COVID-19 episodes as revealed by an analysis of 16S rRNA variable V1-V3 region sequences.

Studies on the role of the oral microbiome in SARS-CoV-2 infection and severity of the disease are limited. We aimed to characterize the bacterial communities present in the saliva of patients with varied COVID-19 severity to learn if there are differences in the characteristics of the microbiome among the clinical groups. We included 31 asymptomatic subjects with no previous COVID-19 infection or vaccination; 176 patients with mild respiratory symptoms, positive or negative for SARS-CoV-2 infection; 57 patients that required hospitalization because of severe COVID-19 with oxygen saturation below 92%, and 18 fatal cases of COVID-19. Saliva samples collected before any treatment were tested for SARS-CoV-2 by PCR. Oral microbiota in saliva was studied by amplification and sequencing of the V1-V3 variable regions of 16S gene using an Illumina MiSeq platform. We found significant changes in diversity, composition, and networking in saliva microbiota of patients with COVID-19, as well as patterns associated with severity of disease. The presence or abundance of several commensal species and opportunistic pathogens were associated with each clinical stage. Patterns of networking were also found associated with severity of disease: a highly regulated bacterial community (normonetting) was found in healthy people whereas poorly regulated populations (disnetting) were characteristic of severe cases. Characterization of microbiota in saliva may offer important clues in the pathogenesis of COVID-19 and may also identify potential markers for prognosis in the severity of the disease. IMPORTANCE SARS-CoV-2 infection is the most severe pandemic of humankind in the last hundred years. The outcome of the infection ranges from asymptomatic or mild to severe and even fatal cases, but reasons for this remain unknown. Microbes normally colonizing the respiratory tract form communities that may mitigate the transmission, symptoms, and severity of viral infections, but very little is known on the role of these microbial communities in the severity of COVID-19. We aimed to characterize the bacterial communities in saliva of patients with different severity of COVID-19 disease, from mild to fatal cases. Our results revealed clear differences in the composition and in the nature of interactions (networking) of the bacterial species present in the different clinical groups and show community-patterns associated with disease severity. Characterization of the microbial communities in saliva may offer important clues to learn ways COVID-19 patients may suffer from different disease severities.

Biomarkers for dementia in Latin American countries: Gaps and opportunities.

Limited knowledge on dementia biomarkers in Latin American and Caribbean (LAC) countries remains a serious barrier. Here, we reported a survey to explore the ongoing work, needs, interests, potential barriers, and opportunities for future studies related to biomarkers. The results show that neuroimaging is the most used biomarker (73%), followed by genetic studies (40%), peripheral fluids biomarkers (31%), and cerebrospinal fluid biomarkers (29%). Regarding barriers in LAC, lack of funding appears to undermine the implementation of biomarkers in clinical or research settings, followed by insufficient infrastructure and training. The survey revealed that despite the above barriers, the region holds a great potential to advance dementia biomarkers research. Considering the unique contributions that LAC could make to this growing field, we highlight the urgent need to expand biomarker research. These insights allowed us to propose an action plan that addresses the recommendations for a biomarker framework recently proposed by regional experts.

Presencia de dientes natales o neonatales en pacientes pediátricos con y sin labio y paladar hendido / Presence of natal or neonatal teeth in pediatric patients with and without cleft lip and palate

Objetivo: determinar la presencia de dientes natales y neonatales en pacientes pediátricos con/sin labio y paladar hendido, que han sido atendidos en un hospital de tercer nivel de 2019-2020, mediante la revisión de expedientes clínicos. Métodos: estudio retrospectivo, observacional descriptivo y revisión de expedientes de pacientes atendidos de 2019-2020. Resultados: en el hospital de tercer nivel se reportan 15 nacimientos por día, 5475 al año. De estos, se identificaron 110 bebés con dientes natales revisados en cuneros, 84 pacientes con labio y paladar hendido en consulta, con una relación de 1:50, mayor prevalencia en dientes inferiores centrales. Su manejo fue resuelto con extracciones en todos los casos, debido a la movilidad dental y el riesgo potencial en la alimentación por bronco aspiración del paciente. Conclusiones: los dientes neonatales y natales se encontraron con mayor frecuencia en pacientes de unidades de tercer nivel consultadas, posiblemente por ser centros de referencia. Se identificó confusión en el personal de salud respecto a la nomenclatura de los dientes que presentan los pacientes al nacer (dientes neonatales), además, se encontró una alta frecuencia de dientes natales en los pacientes estudiados en este caso. La relevancia se encuentra en que no hay estudios que definan la razón del porqué los pacientes nacen con dientes. La respuesta puede estar relacionada con un factor hormonal de la madre, aunque no se ha encontrado evidencia sobre esto. Mientras que los dientes neonatales

Objective: To determine the presence of natal and neonatal teeth in pediatric patients with/without cleft lip and palate who have been seen in a tertiary hospital from 2019-2020, by reviewing clinical records. Methods: Retrospective, descriptive observational study and review of patient records from 2019-2020. Results: In the third level hospital 15 births are reported per day, 5475 per year. Of these, 110 babies with natal teeth were identified in the nursery, 84 patients with cleft lip and palate were identified in consultation, with a ratio of 1:50, with a higher prevalence in lower central teeth. Their management was solved with extractions in all cases, due to tooth mobility and the potential risk in feeding by bronchial aspiration of the patient. Conclusions: Neonatal and natal teeth were found more frequently in patients in the tertiary level units consulted, possibly because they were referral centers. Confusion was identified among health personnel regarding the nomenclature of the teeth that patients present at birth (neonatal teeth), and a high frequency of natal teeth was found in the patients studied in this case. The relevance lies in the fact that there are no studies that define the reason why patients are born with teeth. The answer may be related to a hormonal factor of the mother, although no evidence on this has been found. While neonatal teeth occurred less frequently, there are no conclusive studies either.

Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients.

Background: Strategies to determine who could be safely discharged home from the Emergency Department (ED) in COVID-19 are needed to decongestion healthcare systems. Objectives: To describe the outcomes of an ED triage system for non-severe patients with suspected COVID-19 and possible pneumonia based on chest X-ray (CXR) upon admission. Material and methods: Retrospective, single-center study performed in Barcelona (Spain) during the COVID-19 peak in March-April 2020. Patients with COVID-19 symptoms and potential pneumonia, without respiratory insufficiency, with priority class IV-V (Andorran triage model) had a CXR upon admission. This approach tried to optimize resource use and to facilitate discharges. The results after adopting this organizational approach are reported. Results: We included 834 patients, 53% were female. Most patients were white (66%) or Hispanic (27%). CXR showed pneumonia in 523 (62.7%). Compared to those without pneumonia, patients with pneumonia were older (55 vs 46.6 years old) and had a higher Charlson comorbidity index (1.9 vs 1.3). Patients with pneumonia were at a higher risk for a combined outcome of admission and/or death (91 vs 12%). Death rates tended to be numerically higher in the pneumonia group (10 vs 1). Among patients without pneumonia in the initial CXR, 10% reconsulted (40% of them with new pneumonia). Conclusion: CXR identified pneumonia in a significant number of patients. Those without pneumonia were mostly discharged. Mortality among patients with an initially negative CXR was low. CXR triage for pneumonia in non-severe COVID-19 patients in the ED can be an effective strategy to optimize resource use.

Introducción: La pandemia de COVID-19 conlleva una alta ocupación de los servicios de urgencias (SU). Se requieren nuevas estrategias para optimizar la gestión de estos recursos. Objetivos: Describir los resultados de un sistema de triaje en urgencias para pacientes no graves con sospecha de COVID-19 y posible neumonía, basado en la radiografía de tórax (RT). Material y métodos: Estudio retrospectivo, unicéntrico realizado en Barcelona (España) entre marzo y abril de 2020. Se realizó una RT al ingreso en SU de pacientes con síntomas de COVID-19 y sospecha de neumonía, sin insuficiencia respiratoria, con una prioridad clase IV-V (sistema andorrano de triaje). Esta medida pretende optimizar los recursos y facilitar las altas. Se reportan los resultados tras adoptar esta estrategia. Resultados: Se incluyeron 834 pacientes (53% mujeres, 66% caucásicos, 27% hispánicos). La RT mostró neumonía en 523 (62,7%). Comparados con los pacientes sin neumonía, los que sí la padecían eran mayores (55 vs. 46,6 años), con un índice de comorbilidad de Charlson más elevado (1,9 vs. 1,3) y con mayor riesgo de ingreso y/o muerte (91 vs. 12%). La mortalidad fue numéricamente mayor en el grupo con neumonía (10 vs. 1). El 10% de los pacientes sin neumonía en RT consultaron de nuevo al SU (40% con neumonía). Conclusión: La RT identificó neumonía en múltiples pacientes. Los que no tenían neumonía fueron mayoritariamente dados de alta. La mortalidad entre pacientes con RT negativa fue baja. La RT como triaje para neumonía en pacientes con COVID-19 no grave puede ahorrar recursos.

Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients / Sistema de selección en urgencias de pacientes con sospecha de infección por SARS-CoV-2 y con posible neumonía no graves basado en la radiografía de tórax

Background:Strategies to determine who could be safely discharged home from the Emergency Department (ED) in COVID-19 are needed to decongestion healthcare systems.Objectives:To describe the outcomes of an ED triage system for non-severe patients with suspected COVID-19 and possible pneumonia based on chest X-ray (CXR) upon admission.Material and methods:Retrospective, single-center study performed in Barcelona (Spain) during the COVID-19 peak in March–April 2020. Patients with COVID-19 symptoms and potential pneumonia, without respiratory insufficiency, with priority class IV–V (Andorran triage model) had a CXR upon admission. This approach tried to optimize resource use and to facilitate discharges. The results after adopting this organizational approach are reported.Results:We included 834 patients, 53% were female. Most patients were white (66%) or Hispanic (27%). CXR showed pneumonia in 523 (62.7%). Compared to those without pneumonia, patients with pneumonia were older (55 vs 46.6 years old) and had a higher Charlson comorbidity index (1.9 vs 1.3). Patients with pneumonia were at a higher risk for a combined outcome of admission and/or death (91 vs 12%). Death rates tended to be numerically higher in the pneumonia group (10 vs 1). Among patients without pneumonia in the initial CXR, 10% reconsulted (40% of them with new pneumonia).Conclusion:CXR identified pneumonia in a significant number of patients. Those without pneumonia were mostly discharged. Mortality among patients with an initially negative CXR was low. CXR triage for pneumonia in non-severe COVID-19 patients in the ED can be an effective strategy to optimize resource use. (AU)

Introducción:La pandemia de COVID-19 conlleva una alta ocupación de los servicios de urgencias (SU). Se requieren nuevas estrategias para optimizar la gestión de estos recursos.Objetivos:Describir los resultados de un sistema de triaje en urgencias para pacientes no graves con sospecha de COVID-19 y posible neumonía, basado en la radiografía de tórax (RT).Material y métodos:Estudio retrospectivo, unicéntrico realizado en Barcelona (España) entre marzo y abril de 2020. Se realizó una RT al ingreso en SU de pacientes con síntomas de COVID-19 y sospecha de neumonía, sin insuficiencia respiratoria, con una prioridad clase IV-V (sistema andorrano de triaje). Esta medida pretende optimizar los recursos y facilitar las altas. Se reportan los resultados tras adoptar esta estrategia.Resultados:Se incluyeron 834 pacientes (53% mujeres, 66% caucásicos, 27% hispánicos). La RT mostró neumonía en 523 (62,7%). Comparados con los pacientes sin neumonía, los que sí la padecían eran mayores (55 vs. 46,6 años), con un índice de comorbilidad de Charlson más elevado (1,9 vs. 1,3) y con mayor riesgo de ingreso y/o muerte (91 vs. 12%). La mortalidad fue numéricamente mayor en el grupo con neumonía (10 vs. 1). El 10% de los pacientes sin neumonía en RT consultaron de nuevo al SU (40% con neumonía).Conclusión:La RT identificó neumonía en múltiples pacientes. Los que no tenían neumonía fueron mayoritariamente dados de alta. La mortalidad entre pacientes con RT negativa fue baja. La RT como triaje para neumonía en pacientes con COVID-19 no grave puede ahorrar recursos. (AU)

Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients.

BACKGROUND: Strategies to determine who could be safely discharged home from the Emergency Department (ED) in COVID-19 are needed to decongestion healthcare systems. OBJECTIVES: To describe the outcomes of an ED triage system for non-severe patients with suspected COVID-19 and possible pneumonia based on chest X-ray (CXR) upon admission. MATERIAL AND METHODS: Retrospective, single-center study performed in Barcelona (Spain) during the COVID-19 peak in March-April 2020. Patients with COVID-19 symptoms and potential pneumonia, without respiratory insufficiency, with priority class IV-V (Andorran triage model) had a CXR upon admission. This approach tried to optimize resource use and to facilitate discharges. The results after adopting this organizational approach are reported. RESULTS: We included 834 patients, 53% were female. Most patients were white (66%) or Hispanic (27%). CXR showed pneumonia in 523 (62.7%). Compared to those without pneumonia, patients with pneumonia were older (55 vs 46.6 years old) and had a higher Charlson comorbidity index (1.9 vs 1.3). Patients with pneumonia were at a higher risk for a combined outcome of admission and/or death (91 vs 12%). Death rates tended to be numerically higher in the pneumonia group (10 vs 1). Among patients without pneumonia in the initial CXR, 10% reconsulted (40% of them with new pneumonia). CONCLUSION: CXR identified pneumonia in a significant number of patients. Those without pneumonia were mostly discharged. Mortality among patients with an initially negative CXR was low. CXR triage for pneumonia in non-severe COVID-19 patients in the ED can be an effective strategy to optimize resource use.

The impact of SARS-CoV-2 in dementia across Latin America: A call for an urgent regional plan and coordinated response.

The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.

Night Shift Work and Risk of Breast Cancer in Women.

BACKGROUND: Night shift work involving circadian disruption has been associated with increased breast cancer rates in some epidemiological studies, but the evidence is still on debate. AIM OF THE STUDY: The objective of this study is to assess the association between night shift work and breast cancer in Mexican women. METHODS: A Case-control study was conducted with incident cases of breast cancer at the Instituto de Seguridad Social del Estado de México y Municipios. Cases were interviewed about past exposures prior to the final diagnosis. Controls were women without breast cancer matched on multiple sociodemographic characteristics. RESULTS: 101 cases and 101 matched controls were interviewed; this small sample size provided consistent, but wide estimates of the assessed associations. The multivariate conditional logistic regression showed that breast-feeding was associated with reduced risk for breast cancer (OR 0.12; 95% CI: 0.02-0.60); women who experienced early menarche (12 years) were more likely to develop breast cancer (OR 18.58; 95% CI 18: 2.19-148). Women who worked at night were more likely to develop breast cancer compared to women who never did (OR = 8.58; 95% CI: 2.19-33.8). CONCLUSIONS: Our results are consistent with studies from other countries, which positively associated night shift work with breast cancer.

Frecuencia de la afección auditiva y los factores asociados en pacientes con artritis idiopática juvenil / Frequency of auditory involvement and of associated factors in patients with juvenile idiopathic arthritis

Introducción: La artritis idiopática juvenil (AIJ) es una enfermedad autoinmune de curso crónico, caracterizada por la presencia de artritis en menores de 16 años, por más de 6 semanas en ausencia de otra causa conocida. La expresión extra articular en el sistema audiovestibular se relaciona con la afección de las articulaciones de la cadena oscicular, como consecuencia del proceso inflamatorio de la membrana sinovial. Estudios previos realizados en población infantil han reportado que la pérdida auditiva puede ser de tipo neurosensorial y/o conductiva. Objetivo: Determinar la frecuencia de la afección auditiva y los factores asociados en los pacientes con AIJ. Metodología: Estudio prospectivo y analítico. Se incluyó a 62 pacientes con AIJ con edades comprendidas entre 5 y 15 años, a partir de agosto del 2013 a enero del 2014. El estudio fue aprobado por el comité de ética local y los padres firmaron el consentimiento bajo información. Se realizó otoscopia microscópica, audiometría tonal, timpanometría, reflejo estapedial y emisiones otoacústicas transitorias (EOT); la evaluación reumatológica incluyó exploración articular y aplicación de cuestionario para la evaluación del estado de salud en la infancia (CHAQ). Se utilizaron medidas de tendencia y de dispersión; asociación χ2 con una p<0,05 para la significación estadística. Resultados: Se incluyó a 62 pacientes; 56 niñas y 6 niños, edad media 11,9 años, duración media de la enfermedad de 3,4 años; el 46% presentó AIJ poliarticular factor reumatoide (FR) positivo; el 40%, AIJ poliarticular FR negativo; el 15% AIJ sistémica y el 3% oligoarticular. Se encontró enfermedad activa en 29 pacientes y 33 en remisión con medicamentos. Se evaluaron en total 124 oídos; en 78 se encontró curva tipo As de la clasificación de Jerger, curva tipo A en 45 y en uno se reportó curva tipo AD. En la audiometría tonal no se encontró hipoacusia en ningún paciente y esta estuvo acorde con la logoaudiometría. Las EOT se encontraron ausentes en el 4% de los evaluados y sin reflejo estapedial en menos del 10%. Los factores que presentaron una asociación con la afección auditiva fueron la variedad poliarticular FR positivo, el tiempo de evolución, el índice de discapacidad y los niveles de VSG (p<0,001). Conclusión: Se encontró en más de la mitad de los pacientes estudiados alteraciones auditivas presentes en el timpanograma, asociadas con la variedad poliarticular FR positivo, tiempo de evolución, actividad de la enfermedad y la elevación de la VSG

Introduction: Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease characterized by the presence of arthritis in children under 16 years of age for more than 6 weeks in the absence of any other known cause. The extra-articular manifestations, especially in the audiovestibular system, are related to the involvement of the joints of the ossicular chain as a result of the inflammatory process in the synovium. Previous clinical studies in pediatric patients have shown conductive or sensorineural hearing loss. Objective: The aim of this study was to assess the frequency of hearing impairment and of associated factors in patients with JIA. Methodology: A prospective, analytical study was conducted from January 2013 to August 2014 in 62 patients with JIA aged between 5 and 15 years. The study was approved by the local ethics committee and parents signed their informed consent. All subjects underwent audiological examination involving otomicroscopy, audiometry, tympanometry, stapedius reflex and test for transient otoacoustic emissions (TOAE); rheumatologic evaluation included joint examination and the application of a measure of functional ability (disability) using the Childhood Health Assessment Questionnaire (CHAQ). Measures of central tendency and of dispersion were used (chi-square for associations and P<.05 for statistical significance). Results: Sixty-two patients were included: 56 girls and 6 boys, mean age 11.9 years and mean disease duration of 3.4 years; 46% had rheumatoid factor (RF)- positive polyarticular JIA, 40% had RF-negative polyarticular JIA, 15% had disease of systemic onset and 3% had oligoarthritis. Active disease was found in 29 patients and 33 were in remission with medication. Of the total of 124 ears evaluated according to the Jerger classification for tympanometry, abnormal findings were observed in 78 that were type As and in 1 that was type Ad, whereas there were 45 type A ears. Hearing loss was disclosed by speech audiometry, rather than by pure tone audiometry. The TOAE were absent in 4% of those assessed and the stapedius reflex was absent in less than 10%. Factors that had a positive correlation with hearing impairment were RF-positive polyarticular JIA, disease duration, degree of disability and the erythrocyte sedimentation rate level (P<.000). Conclusion: The presence of an abnormal tympanogram suggested early involvement in the structure of the tympanic-ossicular complex; however, 3.4 years later, no hearing loss had been reported

Frequency of auditory involvement and of associated factors in patients with juvenile idiopathic arthritis. / Frecuencia de la afección auditiva y los factores asociados en pacientes con artritis idiopática juvenil.

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease characterized by the presence of arthritis in children under 16 years of age for more than 6 weeks in the absence of any other known cause. The extra-articular manifestations, especially in the audiovestibular system, are related to the involvement of the joints of the ossicular chain as a result of the inflammatory process in the synovium. Previous clinical studies in pediatric patients have shown conductive or sensorineural hearing loss. OBJECTIVE: The aim of this study was to assess the frequency of hearing impairment and of associated factors in patients with JIA. METHODOLOGY: A prospective, analytical study was conducted from January 2013 to August 2014 in 62 patients with JIA aged between 5 and 15 years. The study was approved by the local ethics committee and parents signed their informed consent. All subjects underwent audiological examination involving otomicroscopy, audiometry, tympanometry, stapedius reflex and test for transient otoacoustic emissions (TOAE); rheumatologic evaluation included joint examination and the application of a measure of functional ability (disability) using the Childhood Health Assessment Questionnaire (CHAQ). Measures of central tendency and of dispersion were used (chi-square for associations and P<.05 for statistical significance). RESULTS: Sixty-two patients were included: 56 girls and 6 boys, mean age 11.9 years and mean disease duration of 3.4 years; 46% had rheumatoid factor (RF)- positive polyarticular JIA, 40% had RF-negative polyarticular JIA, 15% had disease of systemic onset and 3% had oligoarthritis. Active disease was found in 29 patients and 33 were in remission with medication. Of the total of 124 ears evaluated according to the Jerger classification for tympanometry, abnormal findings were observed in 78 that were type As and in 1 that was type Ad, whereas there were 45 type A ears. Hearing loss was disclosed by speech audiometry, rather than by pure tone audiometry. The TOAE were absent in 4% of those assessed and the stapedius reflex was absent in less than 10%. Factors that had a positive correlation with hearing impairment were RF-positive polyarticular JIA, disease duration, degree of disability and the erythrocyte sedimentation rate level (P<.000). CONCLUSION: The presence of an abnormal tympanogram suggested early involvement in the structure of the tympanic-ossicular complex; however, 3.4 years later, no hearing loss had been reported.

A novel design of a multi-antigenic, multistage and multi-epitope vaccine against Helicobacter pylori: An in silico approach.

Helicobacter pylori have colonized the gastric mucosa of half of the population worldwide. This bacterium is classified as a definitive type I carcinogen by the World Health Organization and no effective vaccine has been found against it yet. Thus, a logical and rational vaccine design against H. pylori is necessary. Because of its tremendous complexity and elicited immune responses, the vaccine design should considered multiple antigens to enhance immune-protection, involved in the different stages of pathogenesis besides inducing a specific immune response by B- and T-cell multi-epitopes. In this study, emphasis was placed on the design of a new unique vaccine named CTB-multiHp. In silico techniques were used to design a chimeric construct consisting of cholera toxin B subunit fused to multi-epitope of urease B (residue 148-158, 188-198), cytotoxin-associated gene A (residue 584-602), neutrophil activating protein (residue 4-28), vacuolating cytotoxin gene A (residue 63-81), H. pylori adhesine A (residue77-99), heat shock protein A (residue 32-54) and gamma glutamyl transpeptidase (residue 271-293). The tertiary structure and features of the vaccine were analyzed. The chimeric protein was expressed in Escherichia coli BL21 and the serology analyses indicated that the CTB-multiHp protein produced exhibit immune-reactivity. The results showed that CTB-multiHp could be a good vaccine candidate against H. pylori. Ongoing studies will evaluate the effects of CTB-multiHp against H. pylori infection.

Food-Grade Organisms as Vaccine Biofactories and Oral Delivery Vehicles.

The use of food-grade organisms as recombinant vaccine expression hosts and delivery vehicles has been explored during the past 25 years, opening new avenues for vaccinology. Considering that oral immunization is a beneficial approach in terms of costs, patient comfort, and protection of mucosal tissues, the use of food-grade organisms can lead to highly advantageous vaccines in terms of costs, easy administration, and safety. The organisms currently used for this purpose are bacteria (Lactobacillus and Bacillus), yeasts, algae, plants, and insect species. Herein, a comparative and updated scenario on the production of oral vaccines in food-grade organisms is provided and placed in perspective. The status of clinical evaluations and the adoption of this technology by the industry are highlighted.

Accumulation of intra-cellular polyphosphate in Chlorella vulgaris cells is related to indole-3-acetic acid produced by Azospirillum brasilense.

Accumulation of intra-cellular phosphate, as polyphosphate, was measured when the microalga Chlorella vulgaris was immobilized in alginate with either of two wild-type strains of the microalgae growth-promoting bacterium Azospirillum brasilense or their corresponding IAA-attenuated mutants. Wild type strains of A. brasilense induced higher amounts of intra-cellular phosphate in Chlorella than their respective mutants. Calculations comparing intra-cellular phosphate accumulation by culture or net accumulation by the cell and the amount of IAA that was produced by each of these strains revealed that higher IAA was linked to higher accumulations of intra-cellular phosphate. Application of four levels of exogenous IAA reported for A. brasilense and their IAA-attenuated mutants to cultures of C. vulgaris enhanced accumulation of intra-cellular phosphate; the higher the content of IAA per culture or per single cell, the higher was the amount of accumulated phosphate. When an IAA-attenuated mutant was complemented with exogenous IAA, accumulation of intra-cellular phosphate at the culture level was even higher than phosphate accumulation with the respective wild type strains. When calculating the net accumulation of intra-cellular phosphate in the complementation experiment, net intra-cellular phosphate induced by the IAA-attenuated mutant was completely restored and was similar to the wild strains. We propose that IAA produced by A. brasilense is linked to polyphosphate accumulation in C. vulgaris.

Involvement of indole-3-acetic acid produced by Azospirillum brasilense in accumulating intracellular ammonium in Chlorella vulgaris.

Accumulation of intracellular ammonium and activities of the enzymes glutamine synthetase (GS) and glutamate dehydrogenase (GDH) were measured when the microalgae Chlorella vulgaris was immobilized in alginate with either of two wild type strains of Azospirillum brasilense or their corresponding indole-3-acetic acid (IAA)-attenuated mutants. After 48 h of immobilization, both wild types induced higher levels of intracellular ammonium in the microalgae than their respective mutants; the more IAA produced, the higher the intracellular ammonium accumulated. Accumulation of intracellular ammonium in the cells of C. vulgaris followed application of four levels of exogenous IAA reported for A. brasilense and its IAA-attenuated mutants, which had a similar pattern for the first 24 h. This effect was transient and disappeared after 48 h of incubation. Immobilization of C. vulgaris with any bacteria strain induced higher GS activity. The bacterial strains also had GS activity, comparable to the activity detected in C. vulgaris, but weaker than when immobilized with the bacteria. When net activity was calculated, the wild type always induced higher GS activity than IAA-attenuated mutants. GDH activity in most microalgae/bacteria interactions resembled GS activity. When complementing IAA-attenuated mutants with exogenous IAA, GS activity in co-immobilized cultures matched those of the wild type A. brasilense immobilized with the microalga. Similarity occurred when the net GS activity was measured, and was higher with greater quantities of exogenous IAA. It is proposed that IAA produced by A. brasilense is involved in ammonium uptake and later assimilation by C. vulgaris.

Síndrome metabólico como factor asociado a psoriasis en la consulta dermatológica. Centro Médico Naval ôCMSTõ, 2009 / Metabolic syndrome as a factor associated with psoriasis in a dermatology outpatient / clinic. Centro Médico Naval CMST, 2009

Objetivo: determinar si existe asociación entre el síndrome metabólico y la psoriasis. Material y métodos: estudio de casos y controles en el que se revisaron todas las historias clínicas de los pacientes con psoriasis atendidos en el Centro Médico Naval ôCMSTõ durante el periodo de enero a diciembre del 2009, a quienes se les asignaron controles psoriasis negativos vistos en el mismo periodo y pareados por edad y sexo. Resultados: se revisaron 51 casos de pacientes con psoriasis y 51 controles. Entre los casos se hallo una mayor proporción de pacientes con síndrome metabólico que entre los controles (65 por ciento vs. 20 por ciento, p<0.001). En relación a los componentes del síndrome metabólico, los casos presentaron mayores niveles de cintura abdominal (89.9±9.2 vs. 97.1±7.8), triglicéridos (206.2±79.6 vs. 136.9±48.5), presión arterial sistólica (133.1±19.6 vs. 118.2±12.8) y diastólica (81.4±10.4 vs. 71.8±9.1) y glicemia en ayunas (108.0±34.6 vs. 95.3±26.9), además de niveles menores de colesterol HDL (40.6±10.2 vs. 45.5±9.9) en comparación con los controles, diferencia que fue estadísticamente significativa (p<0.001). La obesidad central (OR=3.7 [1.6-8.5]) la hipertrigliceridemia (OR=7.8 [3.2-18.9]), la hipertensión arterial (OR=8.9 [3.4-23.8]) y una glicemia en ayunas ≥100mg/dl (OR=3.5 [1.4-8.9]) se encontraron fuertemente asociados con la presencia de psoriasis, luego del ajuste la asociación se mantuvo fuerte entre entre síndrome metabólico y psoriasis (ORa=7.5, IC95 por ciento [3.1-18.5]; p<0.001). Conclusiones: entre los pacientes atendidos en el Centro Médico Naval ôCMSTõ durante el año 2009 el síndrome metabólico constituyo un factor importante asociado a psoriasis. Dos de sus componentes, hipertrigliceridemia e hipertensión arterial, mostraron en conjunto la mayor asociación.

Objective: to determine the association between metabolic syndrome and psoriasis. Methods: case-control study in which we reviewed all medical records of patients with psoriasis treated at the Navy Medical Center during the period January to December 2009, and assigned psoriasis negative control from the patients also seen at the clinic pared by age and sex. Results: we reviewed 51 cases of psoriasis and 51 controls. In relation to the components of metabolic syndrome, cases had higher levels of waist circumference (89.9±9.2 vs. 97.1±7.8), triglycerides (206.2±79.6 vs. 136.9±48.5), systolic blood pressure (133.1±19.6 vs. 118.2±12.8), diastolic blood pressure (81.4±10.4 vs. 71.8±9.1) and fasting glycemia (108.0±34.6 vs. 95.3±26.9), as well as lower levels of HDL cholesterol (40.6±10.2 vs. 45.5±9.9) than controls, this difference was statistically significant (p<0.001). Central obesity (OR=3.7 [1.6-8.5]), hypertriglyceridemia (OR=7.8 [3.2-18.9]), hypertension (OR=8.9 [3.4-23.8]) and fasting glucose ≥ 100mg/dl (OR=3.5 [1.4-8.9]) were strongly associated with the presence of psoriasis, after adjusting the association remained strong between metabolic syndrome and psoriasis (aOR=7.5, 95 per cent CI [3.1-18.5]; p <0.001). Conclusions: among patients treated at the Navy Medical Center during 2009, metabolic syndrome was an important factor associated with psoriasis. Two of its components, hypertriglyceridemia and hypertension, showed together the largest association with psoriasis.

Nuevo espectro de tuberculide papulosa: aspectos clínicos e histopatológicos a propósito de un caso / New spectrum of papular tuberculid: clinical and pathological aspects due to a case

Presentamos el caso de un paciente varón de 59 años de edad quien inicialmente presentó un cuadro clínico de tuberculide papulosa en rostro o tuberculide rosaceiforme, que progresivamente se extiende a cuero cabelludo, cuello, tronco y miembros superiores. Se plantea la posibilidad de que este nuevo espectro de tuberculides constituiría formas de tuberculosis cutánea paucibacilar.

We present the case of a 59-years-old male patient who was diagnosed of papular tuberculid or rosaceiform tuberculid in face, with progressive extension to the scalp, neck, trunk and arms. We propose that this new spectrum of tuberculids could be a paucibacilar form of cutaneous tuberculosis.

Experiencia en el manejo quirúrgico de sarcomas retroperitoneales en el CMN 20 de Noviembre ISSSTE / Surgical treatment in retropeitoneal sarcoma: experience in the CMN 20 de Noviembre ISSSTE

Se informan los resultados de la experiencia del servicio de Oncología del Centro Médico Nacional 20 de Noviembre ISSSTE, en el manejo quirúrgico de pacientes con diagnóstico de sarcomas retroperitoneales. De enero de 1995 a diciembre de 1999 se detectaron 32 pacientes con sarcomas retroperitoneales, 20 mujeres y 12 hombres, el rango de edad fueron entre 24 y 87 años de edad con una media de 49.2 años la incidencia, de acuerdo al tipo histológico fue: liposarcoma 13 pacientes (40.6 por ciento), leiomiosarcoma nueve pacientes (28.1 por ciento), histiocitoma fibroso maligno cuatro pacientes (12.5 por ciento). Schwannoma tres pacientes (9.4 por ciento). Fibrosarcomas dos pacientes (6.3 por ciento), Angiosarcoma un paciente (3.1 por ciento), en todos los pacientes se practicó tomografía axial computarizada de abdomen (TAC) como método diagnóstico preoperatorio. El diagnóstico histopatológico se obtuvo transoperatoriamente durante la laparotomía exploradora. En siete pacientes (21.8 por ciento) fue irresecable la tumoración. En 25 casos (78.1 por ciento) si fue posible la resección de la tumoración, a 11 de estos (34.3 por ciento), se les practicó cirugía multivisceral. Presentaron recurrencia siete pacientes (21.8 por ciento), (22 recurrencias) durante el seguimiento, los cuales fueron sometidos a reintervención de dos a cuatro ocasiones. De los 32 pacientes 22 (68.7 por ciento), murieron en un periodo entre 4 meses y 72 meses. Sobreviven 10 pacientes (31.2 por ciento), siete sin actividad tumoral (21.8 por ciento) y tres con actividad tumoral (9.3 por ciento).