Papel de las colecciones de piezas anatómicas en la enseñanza de la anatomía patológica / The relevance of anatomical specimens in the teaching of Pathology

La trascendencia de la museología relacionada con la anatomía y la anatomía patológica radica tanto en la conservación de piezas anatómicas naturales o de sus reproducciones, como en la posibilidad de ofrecer un valioso material para fines didácticos e investigadores. Los primeros fundamentos para la enseñanza anatómica fueron los theatrum anatomicum y los «gabinetes anatómicos» de las cátedras de anatomía de la facultades de medicina europeas, a los que sucedieron en siglos posteriores los museos anatómicos y anatomopatológicos. Tras una época de auge durante el siglo xviii, la mayor parte de ellos sufrieron un proceso de decadencia progresiva que llevó a la pérdida de muchos de ellos. En la actualidad se observa un interés creciente en la recuperación y puesta en valor de estas colecciones. Este trabajo muestra una aproximación histórica de su desarrollo y una revisión de la situación actual de los principales museos de España y de Europa

The relevance of museums of anatomy and pathology lies both in the conservation of anatomical specimens and their excellent reproductions and their use in education and research. The teaching of anatomy dates from ancient times, originating in the Theatrum Anatomicum and anatomical cabinets, located in the anatomy lecture rooms of European medical schools. These were followed by museums of anatomy and pathology in successive centuries. However, after a golden period in the XVIII century, there was a progressive decline which eventually led to a dramatic loss of many museums. Currently, there is a growing interest in the recovery and importance of these collections. We present an historical approach to their development and a review of the current situation in the principal anatomical museums of anatomy in Spain and the rest of Europe

[The relevance of anatomical specimens in the teaching of Pathology]. / Papel de las colecciones de piezas anatómicas en la enseñanza de la anatomía patológica.

The relevance of museums of anatomy and pathology lies both in the conservation of anatomical specimens and their excellent reproductions and their use in education and research. The teaching of anatomy dates from ancient times, originating in the Theatrum Anatomicum and anatomical cabinets, located in the anatomy lecture rooms of European medical schools. These were followed by museums of anatomy and pathology in successive centuries. However, after a golden period in the XVIII century, there was a progressive decline which eventually led to a dramatic loss of many museums. Currently, there is a growing interest in the recovery and importance of these collections. We present an historical approach to their development and a review of the current situation in the principal anatomical museums of anatomy in Spain and the rest of Europe.

Patterns of Z chromosome divergence among Heliconius species highlight the importance of historical demography.

Sex chromosomes are disproportionately involved in reproductive isolation and adaptation. In support of such a "large-X" effect, genome scans between recently diverged populations and species pairs often identify distinct patterns of divergence on the sex chromosome compared to autosomes. When measures of divergence between populations are higher on the sex chromosome compared to autosomes, such patterns could be interpreted as evidence for faster divergence on the sex chromosome, that is "faster-X", barriers to gene flow on the sex chromosome. However, demographic changes can strongly skew divergence estimates and are not always taken into consideration. We used 224 whole-genome sequences representing 36 populations from two Heliconius butterfly clades (H. erato and H. melpomene) to explore patterns of Z chromosome divergence. We show that increased divergence compared to equilibrium expectations can in many cases be explained by demographic change. Among Heliconius erato populations, for instance, population size increase in the ancestral population can explain increased absolute divergence measures on the Z chromosome compared to the autosomes, as a result of increased ancestral Z chromosome genetic diversity. Nonetheless, we do identify increased divergence on the Z chromosome relative to the autosomes in parapatric or sympatric species comparisons that imply postzygotic reproductive barriers. Using simulations, we show that this is consistent with reduced gene flow on the Z chromosome, perhaps due to greater accumulation of incompatibilities. Our work demonstrates the importance of taking demography into account to interpret patterns of divergence on the Z chromosome, but nonetheless provides evidence to support the Z chromosome as a strong barrier to gene flow in incipient Heliconius butterfly species.

Imported Dengue Infection in a Spanish Hospital with a High Proportion of Travelers from Africa: A 9-Year Retrospective Study.

Epidemiological data on dengue in Africa are still scarce. We investigated imported dengue infection among travelers with a high proportion of subjects from Africa over a 9-year period. From January 2005 to December 2013, blood samples from travelers with clinical suspicion of dengue were analyzed. Dengue was diagnosed using serological, antigen detection, and molecular methods. Subjects were classified according to birthplace (Europeans versus non-Europeans) and last country visited. Overall, 10,307 serum samples corresponding to 8,295 patients were studied; 62% were European travelers, most of them from Spain, and 35.9% were non-Europeans, the majority of whom were born in Africa (mainly Equatorial Guinea) and Latin America (mainly Bolivia, Ecuador, and Colombia). A total of 492 cases of dengue were identified, the highest number of cases corresponding to subjects who had traveled from Africa (N = 189), followed by Latin America (N = 174) and Asia (N = 113). The rate of cases for Africa (4.5%) was inferior to Asia (9%) and Latin America (6.1%). Three peaks of dengue were found (2007, 2010, and 2013) which correlated with African cases. A total of 2,157 of past dengue infections were diagnosed. Non-Europeans who had traveled from Africa had the highest rate of past infection (67.8%), compared with non-Europeans traveling from Latin America (38.7%) or Asia (35%). Dengue infection in certain regions of Africa is underreported and the burden of the disease may have a magnitude similar to endemic countries in Latin America. It is necessary to consider dengue in the differential diagnosis of other febrile diseases in Africa.

Shigellosis in Subjects with Traveler's Diarrhea Versus Domestically Acquired Diarrhea: Implications for Antimicrobial Therapy and Human Immunodeficiency Virus Surveillance.

An increase of sexually transmitted shigellosis is currently being reported in developed countries. In addition, travel-related shigellosis can introduce resistant strains that could be disseminated within this new scenario. Epidemiological features and antimicrobial susceptibility of shigellosis depending on where infection was acquired were investigated. From 2008 to 2013, subjects with shigellosis were studied. Patients were classified according to acquisition of Shigella as traveler's diarrhea (TD) or domestically acquired diarrhea (DAD). Ninety cases of shigellosis were identified: 76 corresponding to the TD group and 14 to the DAD group. In the DAD group, most of patients were human immunodeficiency virus (HIV)-positive men who have sex with men (MSM), being shigellosis associated to male sex (P = 0.007) and HIV infection (P < 0.0001). S. sonnei (47.8%) and S. flexneri (42.2%) were the predominant species. The highest resistance was detected for trimethoprim/sulfamethoxazole (SXT) (81.8%), followed by ampicillin (AMP) (37.8%) and ciprofloxacin (CIP) (23.3%). Resistant Shigella strains were more frequent in subjects with TD than those with DAD, although only for CIP the difference was significant (P = 0.034). Continuous monitoring of patients with shigellosis is necessary to control the spread of resistant Shigella strains and for effective therapy. Men with shigellosis who have not traveled to an endemic area should be screened for HIV infection.

Aposematism increases acoustic diversification and speciation in poison frogs.

Multimodal signals facilitate communication with conspecifics during courtship, but they can also alert eavesdropper predators. Hence, signallers face two pressures: enticing partners to mate and avoiding detection by enemies. Undefended organisms with limited escape abilities are expected to minimize predator recognition over mate attraction by limiting or modifying their signalling. Alternatively, organisms with anti-predator mechanisms such as aposematism (i.e. unprofitability signalled by warning cues) might elaborate mating signals as a consequence of reduced predation. We hypothesize that calls diversified in association with aposematism. To test this, we assembled a large acoustic signal database for a diurnal lineage of aposematic and cryptic/non-defended taxa, the poison frogs. First, we showed that aposematic and non-aposematic species share similar extinction rates, and aposematic lineages diversify more and rarely revert to the non-aposematic phenotype. We then characterized mating calls based on morphological (spectral), behavioural/physiological (temporal) and environmental traits. Of these, only spectral and temporal features were associated with aposematism. We propose that with the evolution of anti-predator defences, reduced predation facilitated the diversification of vocal signals, which then became elaborated or showy via sexual selection.

Molecular markers in plasmodium falciparum linked to resistance to anti-malarial drugs in samples imported from Africa over an eight-year period (2002-2010): impact of the introduction of artemisinin combination therapy.

BACKGROUND: Drug resistance is a major problem to control Plasmodium falciparum infection in endemic countries. During last decade, African countries have changed first-line treatment to artemisinin-based combinations therapy (ACT); sulphadoxine-pyrimethamine (SP) is recommended for Intermittent Preventive Therapy (IPT). Molecular markers related to P falciparum resistance were analysed for the period of transition from SP to ACT, in isolates imported from Africa. METHODS: A first group of samples was taken in the period between June 2002 and June 2006 (n = 113); a second group in the period between November 2008 and August 2010 (n = 46). Several alleles were analysed by nested PCR-RFLP: 51, 59, 108, 164, in the pfdhfr gene; 436, 437, 540, 581, in the pfdhps gene; 86, 1246, in the pfmdr1 gene and 76, in the pfcrt gene. The prevalence of alleles in the groups was compared with the chi-squared or Fisher's exact tests. RESULTS: The pfdhfr N51I, C59R and S108N were over to 90% in the two groups; all samples had the I164. In the pfdhps, 437 G and 581 G, increased up to 80% and 10.9% (p = 0.024), respectively in the second group. The 540 G decreases (24% to 16.%) and the 436A disappears at the end of the follow-up (p = 0.004) in the second group. The 76I-pfcrt stayed over 95% in the two groups. Prevalence of 86Y-pfmdr1 decreased over eight years. CONCLUSIONS: Pharmacological pressure affects the resistance strains prevalence. As for SP, the disappearance of 436A and the decrease in 540 G suggest that these mutations are not fixed. On the other hand, studies carried out after ACT introduction show there was a selection of strains carrying the SNPs N86Y, D1246Y in pfmdr1. In this work, the prevalence of pfmdr1- D1246Y is increasing, perhaps as a result of selective pressure by ACT. Continued surveillance is essential to monitor the effectiveness of treatments.

Is infection by Dermatophilus congolensis underdiagnosed?

Dermatophilus congolensis, which affects animal species, is an uncommon human infection. Few cases, mainly in tropical areas, have been reported. We describe the first human infection in Spain in a traveler returning from Central America. Diagnosis of human infection may be underestimated in people in contact with animals.

Performance of OraQuick Advance Rapid HIV-1/2 Antibody Test for detection of antibodies in oral fluid and serum/plasma in HIV-1+ subjects carrying different HIV-1 subtypes and recombinant variants.

BACKGROUND: Rapid, simple, low-cost, sensitive, and specific tests are needed to detect antibodies to all HIV-1 subtypes, especially in developing countries. OBJECTIVE: To evaluate the performance of a rapid diagnostic test for detection of HIV-1/2 antibodies in oral fluids and sera/plasma from subjects from geographic areas infected with different HIV-1 variants. STUDY DESIGN: OraQuick Rapid HIV-1/2 Diagnostic Test was evaluated in sera and oral fluids from 100 subjects from Spain and South-America. It was also assessed in 56 plasma and 39 oral fluid specimens from 56 Africans carrying HIV-1 non-B subtypes or inter-subtype recombinants defined by phylogenetic analysis at pol and gp41 coding regions. All patients were previously diagnosed as HIV-1 positive by serological tests (Abbott AxSYM HIV-1/2; Western Blot HIV-1/HIV-2 and Pepti-LAV, BIO-RAD). RESULTS: OraQuick provided positive results in all 156 serum/plasma specimens regardless of the infecting HIV-1 subtype, and in 136/139 (97.8%) oral fluids. The three oral specimens (2.2%) that yielded false-negative results by OraQuick were taken from one subtype B-infected Spaniard and from two subtype D-infected Africans. The last two were also negative by Pepti-LAV using plasma samples. Ten additional sera and 32 oral fluids from HIV-negative individuals yielded negative results by OraQuick. This rapid test showed good sensitivity for detecting anti-HIV-1 antibodies in oral fluids and in serum/plasma specimens from subjects carrying different HIV-1 subtypes and recombinant variants. CONCLUSION: OraQuick demonstrated its utility for detecting infections due to HIV-1 subtypes and recombinants common in developing countries.

Sensitivity of laser light depolarization analysis for detection of malaria in blood samples.

Automated light depolarization analysis could be a useful tool for diagnosing malarial infections. This work discusses the results of a diagnostic efficacy study on 411 samples from patients with suspected malaria infection performed with a Cell-Dyn 4000 analyser. Light dispersed at 90 degrees and depolarized can be used for identifying and counting eosinophils. However, other cell populations with depolarizing capacity occur in malarial samples; these result from leukocytes ingesting haemozoin that is derived from the degradation of the haem group of haemoglobin performed by the parasite. A sensitivity of 72 % and specificity of 98 % were recorded, with positive and negative predictive values of 78 % and 97 %, respectively. Although the sensitivity level of the automated light depolarization analysis is not adequate to replace the existing methods for the diagnosis of parasitic diseases, it could alert clinicians to unsuspected infections by parasites, particularly those from the genus Plasmodium.

C-reactive protein levels and prevalence of chronic infections in subjects with hypoalphalipoproteinemia.

Low levels of high-density lipoprotein cholesterol (HDL-C) show a consistent relationship with the development of atherosclerosis. The underlying mechanisms are not well understood, but recent studies in subjects with primary hypoalphalipoproteinemia suggest that this could represent a proinflammatory condition. To better assess the link between HDL-C levels and C-reactive protein levels and the possible role of chronic infections as putative mediators of this relationship, we studied a population sample with nonselected causes of hypoalphalipoproteinemia. Eighty-six consecutive patients with HDL-C levels below 40 mg/dL who attend our lipid clinic and 86 control subjects with normal concentrations matched for gender, age, smoking habit, and weight were included in the study. Mean HDL-C levels were 34 +/- 3.9 and 55.4 +/- 8.8 mg/dL for subjects with hypoalphalipoproteinemia and control subjects, respectively. C-reactive protein concentrations were increased in case patients as compared with control subjects (2.13 +/- 2.0 vs 1.52 +/- 1.8 mg/L; P = .025). The prevalence of herpes simplex virus type 1, cytomegalovirus, Chlamydia pneumoniae , and Helicobacter pylori infections did not differ between the 2 groups. Although a possible confounding variable could be a degree of insulin resistance within the group of patients with low HDL-C levels, our results indicate that C-reactive protein levels are increased in subjects with nonselected hypoalphalipoproteinemia and that chronic infections do not appear to mediate this relationship.

Prevalence of HIV-1 non-B subtypes, syphilis, HTLV, and hepatitis B and C viruses among immigrant sex workers in Madrid, Spain.

Sexually transmitted disease (STD) remains a major public health challenge in developed countries, exacerbated by the advent of the HIV epidemic. The objectives of this study were to assess the prevalence of serological markers of syphilis, HIV-1/2, HTLV-I/II, HBV, and HCV infections among immigrant sex workers in Madrid, Spain and to characterize the HIV-1 variants in seropositive individuals. Sera from 762 immigrant commercial sex workers (75.3% from sub-Saharan Africa, 18.2% from South America, and 6.4% from Eastern Europe) were collected between 1998 and 2003 in Madrid and examined. Antibody detection was performed by screening assays (RPR, ELISAs) and confirmed by FTA-Abs, LIAs and Western-blot tests. HIV-1 subtyping was carried out by phylogenetic analyses of the protease and envelope genes. Antibodies to HIV-1 were found in 5.2%, while 3.5% tested positive for HBsAg, 3% for syphilis antibodies, 0.8% for HCV antibodies, and 0.2% for HTLV-I antibodies. None were reactive for HIV-2 or HTLV-II antibodies. HIV-1 seroprevalence among Africans and Ecuadorians was 4.5 and 10.9%, respectively. All HIV-1 seropositive Ecuadorians were transsexual men, and 28.6% had active syphilis infection. Up to 80% of HIV-1 positive specimens were characterized as non-B subtypes, with subtypes G, A, and G/A recombinants being the most frequent among African individuals. In contrast, South Americans with HIV-1 infection carried exclusively subtype B variants. A relatively high proportion of immigrant sex workers in Madrid were infected with HIV-1 and syphilis, whereas infections with hepatitis viruses or HTLV were uncommon.

High prevalence of seropositivity to a major allergen of Anisakis simplex, Ani s 1, in dyspeptic patients.

Finding evidence of anisakidosis requires invasive methods. We have developed a serological assay based on the detection of an immunoglobulin E (IgE) specifically directed against Ani s 1 protein, a major parasite allergen of Anisakis simplex, which has shown a high level of accuracy in the diagnosis of anisakidosis. We used this tool to determine the prevalence of anti-Ani s 1 IgE in dyspeptic patients and to investigate if its seropositivity could be related to epidemiological factors other than raw fish consumption. A total of 174 dyspeptic patients who submitted to upper digestive tract endoscopy were studied. Specific IgE against Ani s 1 was determined by immunoblotting. Quantitative information on smoking, alcohol consumption, and fish consumption as well as a history of gastric surgery was recorded. Twenty-four (13.8%) patients were seropositive for Ani s 1 protein. The seroprevalence of anti-Ani s 1 IgE increased with age in patients who were less than 62 years old (P = 0.047). Seropositivity to Ani s 1 was associated with the consumption of fish in vinegar (P < 0.001), raw fish (P = 0.001), and smoked fish (P = 0.007). There was no relationship between anti-Ani s 1 IgE seropositivity and the number of cigarettes smoked (P = 0.098) or alcohol intake (P = 0.179). Five patients had undergone previous gastric surgery, and three of those patients were seropositive for Ani s 1 (P = 0.019). In multivariate analysis, the consumption of fish in vinegar (P = 0.006), raw fish (P = 0.017), and smoked fish (P = 0.002) and a history of gastric surgery (P = 0.005) were independent factors associated with anti-Ani s 1 IgE detection. In conclusion, at present, anisakidosis might frequently be underdiagnosed, and it might have a clinical role in patients with upper dyspeptic symptoms. Uncooked-fish ingestion and previous gastric surgery were associated with seropositivity for Ani s 1 protein.

Relación entre detección de anticuerpos anti-CagA, sensibilidad antibiótica y úlcera péptica en pacientes con infección por Helicobacter pylori / Association among anti-CagA antibody detection, antibiotic susceptibility, and peptic ulcer in patients with Helicobacter pylori infection

El propósito de este estudio fue determinar si la presencia de anticuerpos frente a las proteínas de virulencia CagA y VacA de Helicobacter pylori se asociaba con una mayor sensibilidad a los antibióticos, y su relevancia clínica en los pacientes con dispepsia.Métodos. Se estudiaron 98 pacientes adultos con infección por H. pylori que acudieron a realizarse una endoscopia gástrica por sus síntomas dispépticos. La determinación de anticuerpos anti-CagA y anti-VacA se realizó mediante Western-blot (Helicoblot 2.0). Se estudió la concentración mínima inhibitoria a amoxicilina, metronidazol, claritromicina y tetraciclina mediante E-test.Resultados. Fueron diagnosticados de dispepsia ulcerosa 39 pacientes y 59 de dispepsia no ulcerosa. Presentaron anticuerpos anti-CagA 63 pacientes y 52 anti-VacA que en ambos casos se asociaron significativamente con la presencia de dispepsia ulcerosa (p 0,034 y p 0,029, respectivamente). Se detectaron un 38,8 por ciento de cepas resistentes a metronidazol y un 10,3 por ciento a claritromicina.No se observaron resistencias a amoxicilina ni a tetraciclina. La sensibilidad a claritromicina fue más frecuente en pacientes con dispepsia ulcerosa frente a los sujetos con dispepsia no ulcerosa (p 0,046).Los pacientes con anticuerpos anti-CagA presentaron las cepas más sensibles a los antibióticos, siendo para la claritromicina la diferencia estadísticamente significativa (p < 0,001).Conclusión. La detección de anticuerpos anti-CagA se asoció con una mayor sensibilidad a los antibióticos en pacientes con dispepsia ulcerosa y no ulcerosa, por lo que su detección podría ser un marcador de buen pronóstico de éxito terapéutico (AU)

[Association among anti-CagA antibody detection, antibiotic susceptibility, and peptic ulcer in patients with Helicobacter pylori infection]. / Relación entre detección de anticuerpos anti-CagA, sensibilidad antibiótica y úlcera péptica en pacientes con infección por Helicobacter pylori.

INTRODUCTION: The aim of this study was to determine the relationship among antibodies against virulence factors (CagA and VacA), clinical status and primary resistance in dyspeptic patients with Helicobacter pylori infection. METHODS: Ninety-eight adult patients with Helicobacter pylori infection who underwent gastric endoscopy for dyspepsia were studied. Specific serum IgG antibodies against CagA and VacA proteins were detected by Western-blot (Helicoblot 2.0). Minimum inhibitory concentrations of metronidazole, amoxicillin, tetracycline and clarithromycin were determined with the E-test. RESULTS: Thirty-nine patients presented peptic ulcer disease and 59 had non-ulcer dyspepsia. CagA protein was detected in 63 patients, and VacA protein in 52 subjects, and both were significantly associated with peptic ulcers (p 5 0.034 and p 5 0.029, respectively). Susceptibility results showed 38.8% of strains resistant to metronidazole and 10.3% resistant to clarithromycin. No resistance to amoxicillin or tetracycline was found. Susceptibility to clarithromycin was more frequent in ulcer patients than in non-ulcer dyspepsia patients (p 5 0.046). CagA protein was more frequent in patients with clarithromycin-sensitive strains (p < 0.001). CONCLUSION: Antibodies against CagA protein were associated with higher antibiotic susceptibility in patients with ulcers or non-ulcer dyspepsia. Thus, anti-CagA antibody detection could be a useful marker of favorable prognosis with antibiotic treatment.

Escherichia coli O157:H7 en pacientes infectados por el virus de la inmunodeficiencia humana: presentación de un caso / Escherichia coli O157:H7 among HIV infected patients. Case report

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Aislamiento de Roseomonas gilardii en un paciente con sida / Isolation of Roseomonas gilardii in a patient with AIDS

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