Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management.

OBJECTIVE: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed. RESULTS: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.

Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico / Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management

Objetivo: Las invaginaciones intestinales en adultos son de difícil diagnóstico debido a la inespecificidad de los síntomas. Sin embargo, la mayoría tienen una causa estructural que requiere tratamiento quirúrgico. El objetivo de este estudio es revisar sus características epidemiológicas, hallazgos en imagen y manejo terapéutico. Materiales y métodos: Estudio retrospectivo de las invaginaciones intestinales que precisaron ingreso hospitalario diagnosticadas en nuestro hospital entre 2016 y 2020. De un total de 73 casos fueron excluidos errores de codificación (n=6) y pacientes menores de 16 años (n=46), resultando 21 invaginaciones en adultos. Resultados: La edad media fue de 57 años, y el dolor abdominal fue la manifestación clínica más frecuente en el 38% de los casos (n=8). El diagnóstico mediante tomografía computarizada (TC), con la presencia “del signo de la diana”, alcanzó una sensibilidad del 100%, siendo la región ileocecal la localización más frecuente en un 38% de los pacientes (n=8). Un 85,7% de los casos (n=18) tenían una causa estructural y el 81% (n=17) requirió cirugía. Los resultados anatomopatológicos fueron concordantes con la TC en un 94,1%, siendo la etiología más frecuente la neoplásica: 35,3% benignas (n=6) y 64,7% malignas (n=9). Conclusiones: La TC es la prueba de elección en el diagnóstico de las invaginaciones intestinales y resulta determinante a la hora de identificar la etiología y decidir el manejo terapéutico.(AU)

Objective: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methods: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. Results: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). Conclusions: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.(AU)

Gamma irradiation of adenine and guanine adsorbed into hectorite and attapulgite.

This study focuses on the radiolysis (up to 36 kGy) of guanine and adenine (nitrogenous bases) adsorbed in hectorite and attapulgite to highlight the potential role of clays as protective agents against ionizing radiation in prebiotic processes. In this framework, the study investigated the nitrogenous bases' behavior in two types of systems: a) aqueous suspension of adenine-clay systems and b) guanine-clay systems in the solid state. This research utilized spectroscopic and chromatographic techniques for its analytical purposes. Regardless of the reaction medium conditions, the results reveal that nitrogenous bases are stable under ionizing irradiation when adsorbed on both clays.

Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management. / Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico.

OBJECTIVE: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. RESULTS: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.

Histidine Self-assembly and Stability on Mineral Surfaces as a Model of Prebiotic Chemical Evolution: An Experimental and Computational Approach.

The abiotic synthesis of histidine under experimental prebiotic conditions has proven to be chemically promising and plausible. Within this context, the present results suggest that histidine amino acid may function as a simple prebiotic catalyst able to enhance amino acid polymerization. This work describes an experimental and computational approach to the self-assembly and stabilization of DL-histidine on mineral surfaces using antigorite ((Mg, Fe)3Si2O5(OH)4), pyrite (FeS2), and aragonite (CaCO3) as representative minerals of prebiotic scenarios, such as meteorites, and subaerial and submarine hydrothermal systems. Experimental results were obtained through polarized-light microscopy, IR spectroscopy (ATR-FTIR), and differential scanning calorimetry (DSC). Molecular dynamics was performed through computational simulations with the MM + method in HyperChem software. IR spectra suggest the presence of peptide bonds in the antigorite-histidine and aragonite-histidine assemblages with the presence of amide I and amide II vibration bands. The FTIR second derivative inspection supports this observation. Moreover, DSC data shows histidine stabilization in the presence of antigorite and aragonite by changes in histidine thermodynamic properties, particularly an increase in histidine decomposition temperature (272ºC in antigorite and 275ºC in aragonite). Results from molecular dynamics are consistent with DSC data, suggesting an antigorite-histidine closer interaction with decreased molecular distances (cca. 5.5 Å) between the amino acid and the crystal surface. On the whole, the experimental and computational outcomes support the role of mineral surfaces in prebiotic chemical evolution as enhancers of organic stability.

First record of larval microhabitats of sandflies in Mexico with the description of the fourth instar larva of Brumptomyia hamata.

Despite the medical importance of sandflies as vectors (Diptera: Phlebotominae) of Leishmania spp., immature stages of phlebotomine sandflies have never been found in the wild in Mexico. In the present investigation, we sought to identify specific microhabitats associated with the presence of sandfly immature stages. Field work was conducted in 11 localities of the Yucatan Peninsula and we collected soil samples from each site during two periods (November 2007 to April 2008, November 2008). Soil samples were transported to our base camp and were processed using the Berlese's funnels. We processed a total 242 soil samples with an average weight of 362 ± (SD) 317 gr. From these samples, we were able to recover 51 phlebotomine larvae in five different microhabitats and largest number was obtained from mammal burrows (88%) and from tree-buttresses of Brosimium alicastrum (Berg) (6%). We identified larval microhabitat for Brumptomyia hamata (Fairchild & Hertig) and those specimens provided the material to describe for the first time the fourth instar larva. We also include information of a larval microhabitat of Lutzomyia cruciata (Coquillett). In addition, we recorded a total of 4872 arthropods from 15 taxa in all those soil samples in which sandfly larvae were found, being Collembola (76%) and Acari (10%) the most abundant.

Salbutamol tolerability and efficacy in patients with spinal muscular atrophy type II.

Spinal muscular atrophy (SMA) is an autosomal recessive disease caused by homozygous deletions or loss-of-function mutations in SMN1, which result in a degeneration of motor neurons in the spinal cord and brain stem. Even without a randomized placebo-controlled trial, salbutamol has been offered to patients with SMA in the neuromuscular clinics of most of hospitals for many years. We describe the response to salbutamol in 48 patients with SMA type II who were not taking any other medication. We investigate the changes over an eighteen-month period in motor functional scales and we analyze side effects and subjective response to treatment. Our results suggest that oral administration of salbutamol might be helpful in the maintenance of motor function in patients with SMA type II. An apparent beneficial effect was observed in functional scales of children under the age of 6, especially during the first 6 months of therapy. The majority of patients of all ages referred some kind of subjective positive effect associated with therapy intake. Salbutamol seemed safe and was well tolerated without serious side effects.

New Geographical Records of Bat Flies (Diptera: Streblidae) Associated With Phyllostomid Bats (Chiroptera: Phyllostomidae) in the West Highlands of Mexico.

Streblidae are ectoparasites exclusive to bats and feed only on their blood. Studies on ectoparasite fauna have increased our ecological knowledge of the parasitic relationship between streblids and their bat hosts. We evaluate assemblages of phyllostomid bats and their ectoparasitic flies in three scenarios with different types of anthropogenic use: pine-oak forest, avocado orchards, and an urban park during an annual cycle in the highlands of Michoacan, Mexico. We recorded a total of 325 bats belonging to nine species in three subfamilies: Glossophaginae, Desmodontinae, and Stenodermatinae, and obtained 225 bat flies belonging to seven species. The nectivorous bat Anoura geoffroyi Gray, 1838, had the highest prevalence of infestation and the hematophagous bat Desmodus rotundus (É. Geoffroy, 1810) was the host with the highest mean parasite abundance and mean intensity. Aspidoptera delatorrei Wenzel, 1966, Megistopoda proxima (Séguy, 1926), Paratrichobius longicrus (Miranda Ribeiro, 1907), Trichobius brennani Wenzel, 1966, and T. parasiticus Gervais, 1844, are new records for the state of Michoacan reported in this study.

Evolutionary algorithm optimization of biological learning parameters in a biomimetic neuroprosthesis.

Biomimetic simulation permits neuroscientists to better understand the complex neuronal dynamics of the brain. Embedding a biomimetic simulation in a closed-loop neuroprosthesis, which can read and write signals from the brain, will permit applications for amelioration of motor, psychiatric, and memory-related brain disorders. Biomimetic neuroprostheses require real-time adaptation to changes in the external environment, thus constituting an example of a dynamic data-driven application system. As model fidelity increases, so does the number of parameters and the complexity of finding appropriate parameter configurations. Instead of adapting synaptic weights via machine learning, we employed major biological learning methods: spike-timing dependent plasticity and reinforcement learning. We optimized the learning metaparameters using evolutionary algorithms, which were implemented in parallel and which used an island model approach to obtain sufficient speed. We employed these methods to train a cortical spiking model to utilize macaque brain activity, indicating a selected target, to drive a virtual musculoskeletal arm with realistic anatomical and biomechanical properties to reach to that target. The optimized system was able to reproduce macaque data from a comparable experimental motor task. These techniques can be used to efficiently tune the parameters of multiscale systems, linking realistic neuronal dynamics to behavior, and thus providing a useful tool for neuroscience and neuroprosthetics.

Comparison of the analytical and clinical performance of five tests for the detection of human papillomavirus genital infection.

HPV-based screening provides greater protection against cervical cancer (CC) than cytology-based strategies. Currently, several molecular diagnostic assays for the detection of human papillomavirus (HPV) are available. In this study, we analyzed 5 different HPV testing and genotyping techniques (Hybrid Capture 2 [HC2; Qiagen, Hilden, Germany], AnyplexTMII HPV28 [Anyplex; Seegene, Seoul, Korea], Linear Array [Roche, Branchburg, NJ, USA], GP5+/6+ PCR-EIA-RH [Labo Bio-medical Products, Rijswijk, The Netherlands] and CLART2 [Genomica, Madrid, Spain]) in 295 women referred to the hospital Colposcopy Clinic from 2007 to 2008 due to positive HPV test results or an abnormal Pap test. DNA extraction for HPV genotyping was performed in cervical sample specimens after Pap test and HPV detection by HC2. The inclusion criteria were: (1) adequate cervical sampling with sufficient material for the Pap test and HPV detection and genotyping, and (2) colposcopically-directed biopsy and/or endocervical curettage. HC2 showed the highest sensitivity for high-grade squamous intraepithelial lesion and CC (HSIL+) detection (96.1%), but all the HPV genotyping tests showed a higher specificity. (Anyplex 86.8%; Linear Array 86.0%; GP5+/6+ 78.8%; CLART2 76.5%). The agreement between HC2 results and the other techniques was similar: 82.4%, kappa=0.650 for Anyplex; 83.4%, kappa=0.670 for Linear Array, 79.93%, kappa=0.609 for GP5+/6+ and 82.4%, kappa=0.654 for CLART2. HPV 16 and/or 18 infection was a risk factor for underlying HSIL+ in the univariate analysis. Anyplex showed the highest risk of underlying HSIL+ after positive HPV 16 and/or 18 tests (OR 31.1; 95% CI 12.1-80.0).

Prevalence and distribution of hepatitis C virus genotypes in Spain during the 2000-2015 period (the GEHEP 005 study).

We report the largest study on the prevalence and distribution of HCV genotypes in Spain (2000-2015), and we relate them with clinical, epidemiological and virological factors. Patients from 29 hospitals in 10 autonomous communities (Andalusia, Aragon, Castilla-Leon, Catalonia, Galicia, Canary Islands, Madrid Community, Valencian Community, Murcia Region and Basque Country) have been studied. Annual distribution of HCV genotypes and subtypes, as well as gender, age, transmission route, HIV and/or HBV coinfection, and treatment details were recorded. We included 48595 chronically HCV-infected patients with the following characteristics: median age 51 years (IQR, 44-58), 67.9% male, 19.1% HIV-coinfected, 23.5% HBV-coinfected. Parenteral transmission route was the most frequent (58.7%). Genotype distribution was 66.9% GT1 (24.9% subtype 1a and 37.9% subtype 1b), 2.8% GT2, 17.3% GT3, 11.4% GT4 and 0.1% GT5 and 0.02% GT6. LiPA was the most widely HCV genotyping test used (52.4%). HCV subtype 1a and genotypes 3 and 4 were closely associated with male gender, parenteral route of infection and HIV and HBV coinfection; in contrast, subtype 1b and genotype 2 were associated with female gender, nonparenteral route and mono-infection. Age was related to genotype distribution, and different patterns of distribution and biodiversity index were observed between different geographical areas. Finally, we describe how treatment and changes in transmission routes may have affected HCV genotype prevalence and distribution patterns. We present the most recent data on molecular epidemiology of hepatitis C virus in Spain. This study confirms that genotype distributions vary with age, sex, HIV and HBV coinfection and within geographical areas and epidemiological groups.

Reduced Meloidogyne ethiopica Parasitism in Vitis vinifera Grafted on Six Resistant Rootstocks Under Field and Greenhouse Conditions.

Meloidogyne ethiopica, an aggressive nematode, causes significant economic losses to Vitis crops. Rootstocks can successfully manage phytoparasitic nematodes. However, no studies exist on M. ethiopica-resistant rootstocks under field conditions. This study assessed the resistance of six Vitis rootstocks to M. ethiopica under field and greenhouse conditions. The number of galls and eggs in vine roots, quantity of second stage juveniles and males in 250 ml of soil, root weight, and shoot weight were determined for the Harmony, SO4, 101-14 MG, 110R, 3309C, and Kober 5BB rootstocks, and the own-root Chardonnay variety as a control. In the field, Harmony, SO4, 101-14 MG, Kober 5BB, and 110R were highly resistant to nematode parasitism and reproduction. In turn, 3309C was the least resistant rootstock. In the greenhouse, all rootstocks similarly limited M. ethiopica attack and reproduction. In both conditions, Chardonnay was the most susceptible vine to nematode attack, with high quantities of galls, eggs, and nematode reproduction. In conclusion, most of the evaluated rootstocks reduced M. ethiopica parasitism. Harmony, SO4, 101-14 MG, 110R, and Kober 5BB rootstocks are options for vineyard use, with final selection dependent on winegrower requirements.

Descriptions of the Immature Stages of Lutzomyia (Tricholateralis) cruciata (Coquillett) (Diptera: Psychodidae, Phlebotominae).

The present study presents morphological and chaetotaxic descriptions of the immature stages of Lutzomyia (Tricholateralis) cruciata (Coquillett), a probable vector of leishmaniasis in Mexico. The egg exochorion is consistent with the species already known as Lu. (Tricholaterialis), but different from the Lu. cruciata egg of Chiapas, Mexico. The fourth instar larva of Lu. (Tricholateralis) cruciata possesses a novel antenna, combining morphological characteristics of categories 2 and 3 for neotropical sandflies. Differences between the chaetotaxy of first and fourth instar larvae of Lu. cruciata with those of Lu. (Lutzomyia) and Lu. (Tricholaterlis) are compared and discussed. This is the first time in which the chaetotaxy and morphology of pupa of a species belonging to Lutzomyia (Tricholateralis) sensu Galati have been described, and we recorded for the first time the anterior prothorax setae, which was previously only considered for Old World species.

Prácticas, aceptabilidad y percepción de cuidadores de niños/ as beneficiarios del programa alimentario nutricional integral- PANI de 2 hospitales del departamento central del Paraguay / Practices, acceptability and perception of children’s caretaker beneficiaries of integral nutritional food program-INFP of 2 hospitals of central department of Paraguay

Introducción: el Dengue es una enfermedad infecciosa, sistémica y dinámica. Es una sola enfermedad, con diferentes presentaciones clínicasy evolución impredecible. Se hizo endémica en Paraguay desde el año 2002; el objetivo de este trabajo es determinar las características clínicas y epidemiológicas de la epidemia de diciembre de2012 a febrero de 2013. Materiales y Métodos: Diseño descriptivo, retrospectivo, transversal. Fueron incluidos pacientes que desarrollaron criterios de casos probables de Dengue que consultaron al Servicio de Urgencias del Hospital de Clínicas. 1037 pacientes cumplían los criterios de inclusión. Resultados: La frecuencia de casos de Dengue fuedel 14%. La edad promedio fue de 37,7 ± 16,3. El56% era del sexo femenino. El 87% de los pacientes provenían del departamento Central. El mes de mayor número de casos con 48% fue febrero. El83% de los pacientes fue tratado de forma ambulatoria. El promedio de días de internación fue de 2,39 ± 1,65. Sólo el 20% de los pacientes presentó algún tipo de comorbilidad. La fiebre estuvo presente en el 99,3% de los pacientes. El 20% de los pacientes tenía signos de alarma al momento de laconsulta. La presión de pulso promedio fue 40,4± 12,1 La frecuencia cardiaca media fue de 93,8± 17,3. Promedio de hematocrito fue 42,2 ± 5,07.Promedio de plaquetas fue 111.500 ± 79972,1. Promediode leucocitos 4561 ± 3717. Se registró unóbito. Conclusión: Este trabajo muestra las diferentesaristas de una de las epidemias más importantes desarrollada a nivel país.

Introduction: assessment by beneficiaries of social programs is needed to evaluate their managementand impact, mainly of nutritional programs .Objective: To determine the practices, acceptability and the perception of the of children’s caretakers who are beneficiaries of the Integral Nutritiona Food Program-INFP in 2 hospitals of the Central department of Paraguay. Methodology: Cross-sectional, observational and descriptive design. 125 children’s caretakers wereinterviewed. Results: The caretaker’s scholarship average was of 9±3 years. The manipulation and the storage ofthe PANI milk were adapted to 85.2% and to 95.3% respectively; 59.4% was improperly prepared, mainly due to incorrect dilution (34.2%) and becausethey did not respect the preparation steps (31.6%). 99.2% consumes 2 or more times/day and 51.6% combines it with other foods. 75.8% and 83.6% consider that the milk’s taste and smell isgood and 9.4 % reported some discomfort regardingits consumption. 43% of the children’s caretakers expressed that they like the milk a lot and 40.6 % love it the 90.6% thought the program was very important. Conclusion: The handling of INFP’s milk is adequate however, strengthening of caretakers skills regarding its preparation is required. There is anexcellent acceptability and perception of the program.

Attitudes Toward Organ Donation and Transplantation in Guanajuato, Mexico.

BACKGROUND: Chronic diseases have become a main cause of morbidity and mortality provoking function loss in organs. Quality of life is poor and expensive with replacement therapy. Transplantation offers a higher survival rate and a better life; however, the donation rate in Mexico is low, making it important to know the opinion of the population. METHODS: Six hundred forty-two people in Guanajuato, Mexico, (>15 years old) were enrolled. Demographic characteristics, education, religion, organ donation, and transplantation attitudes were evaluated. RESULTS: Donation attitudes in life or death were: very willing to donation (82.8% vs 61.5%), refuse to donate (12.7% vs 29.4%), and undecided (4.5% vs 9.1%). Reasons for donation were: altruism (63%), being useful to someone (28.6%), and empathy (7.1%). Negative causes were: personal beliefs (35.6%), fear (23.7%), and ignorance or "I don't know the recipient" (18.5%). Finally, 94.5% of the population is willing to receive a transplant if they need it. CONCLUSIONS: Guanajuato has a high tendency to donate their own organs, but less to donate from a family member. Refusal to donate has originated from lack/misinformation that people received from health professionals. Although most people are willing to donate, this is not reflected in donation rates. To be able to make this intention reality, we must create educational models for health care personnel that will allow them to transmit proper information to the population.

Diabetes gestacional, hipotiroidismo y concentración urinaria de yodo en embarazadas. Yodurias en escolares en Paraguay: Exceso de yodo en la sal y riesgo de hiper e hipotiroidismo / Gestational diabetes, hypothyroidism and iodine urinary concentration in pregnant women. Urinary iodine in schoolage children in Paraguay: Iodine excess in salt and hyper and hypothyroidism risk

The main inclicator of iodine nutritional status of salt for human con-sumption is the urinary concentration of iodine, which is useful in monitoring universal levels in salt. Paraguay has suffered deficiency in salt with highprevalence of goiter in thepopulation reaching48.6%. In 2000, results of the ThyroidMobileproject in Latin America showed a goiter prevalence of 17% but 79.6% of the consumed iodized salt was adequate in paraguayan households (more than 15 ppm of iodine). The average values of iodine urinary concentration in 4487 scholars was 437 µg/L, 30% of the average value was between the ideal of 100 to 199 µg/L and 46.1% were above 300 mg/L, with risk of excess iodine. Urinary concentration of iodine during pregnancy was measure for the first time in Paraguay in 200 women; the average was 484 µg/L but diabetes and hypothyroidism during pregnancy was observe in 50% of them. Objective: Determine iodine concentration in urine of the school population in 17 departments of the country and measure the levels of iodine in urine in 200 pregnant women from 15-37 years of age and their levels of glycaemia, and thyroid TSH. Methods: During the years, 2006 and 2007 were evaluated 4487 school randomized, in a probabilistic sample, 3198 in rural areas and 1,289 in urban areas; casual urine samples was collected to determine iodine content. The urinary concentration of iodine in two hundredpregnant women, concentration of iodine in salt, and levels of glycaemia and TSH were also included in the present study All candidates agreed with the informed consent under the ethics rules. Results: These data showed by comparing the levels of iodine in urine concentration in more than adequate and excessive level but this last was markedly elevated (93.8%). The median level greater than 300 µg/L was observed in 100% of the 4,487 urine samples, while the median urinary iodine levels of300-500 µg/L was 91.3% and above 500 was 9.7%. These levels showed the risk of developing thyroid autoimmune diseases. In 200 pregnancy women the average of urine concentration of iodine was 498 pcg/L, subclinical and clinical hypothyroidism and gestational diabetes was 50% of both. Conclu-sion: To obtain normal median urinary iodine levels is necessary to decrease the amount of iodine in salt. The main recommendation is to insist on adequate monitoring of iodized salt consumption. Also continue surveillance and monitoring in sentinel sites reporting the importance of adequate iodine intake of the population especially in pregnant women that also need to be warm about the diabetes during pregnancy but also a regimen is necessary to keep them within the normal levels of glycemia. The subclinical hypothyroidism has been also studied in the same patients.

El principal indicador del impacto de la yodación de la sal de consumo humano es la concentración urinaria de yodo la cual es útil en el monitoreo de la sal. En la encuesta del año 1988 realizada en el Paraguay, se alcanzó una prevalencia de bocio de 48,6% en la población escolar con un déficit de yodo en la sal, pero el año 2000 en el estudio del proyecto de Tiroides Móvil, se redujo por el método ecográfico a 17%. Ese mismo año la mediana de los niveles urinarios en niños escolares de 6-12 años fue 258 µg/L, considerando que 30% se encontraba entre el valor ideal de 100 a 199 µg/L y 46,1% sobre 300 µg/L, implicando un riesgo de exceso de yodo en dicha población con las posibles consecuencias de aparición tanto de hipo como de hipertiroidismo. El 93% presentó exceso de yodo en la sal y la mediana urinaria fue 437 ug/ mL. Un grupo de embarazadas han sido estudiadas en el Hospital San Pablo por primera vez en el Paraguay para la determinación de la yoduria, yodo en sal, diabetes gestacional, hipotiroidismo en el embarazo y sus valores antropométricos resultando un hipotiroidismo subclínico del 50% y diabetes gestacional del 50%. Objetivo: Determinar las yodurias en la población escolar de 6-12 años pre púber de ambos sexos en 17 departamentos del país y en una submuestra en embarazadas y también niveles de glicemia en el embarazo en un hospital de Asunción. Sujetos y Métodos: En el periodo del 2006-2007 fueron evaluados 4.487 escolares randomizados, en una muestra probabilística, 3.198 en el área rural y 1.289 en el área urbana con muestras en orina casual. El año 2015, doscientas embarazadas fueron estudiadas con muestras de glicemia en ayunas y 2 horas post prandial, dosaje de TSH, yodo en sal de 100 gramos de la sal de consumo en sus hogares y de orina para ver la concentración de yodo en sal y urinaria de yodo. Todos los candidatos fueron estudiados bajo consentimiento autorizado y de acuerdo a normas éticas. Resultados: Al comparar los niveles de yodo en orina en el nivel más que adecuado y el excesivo de la yoduria se vió que éste último nivel estaba marcadamente elevado (93.8%), que la mediana de los niveles mayores a 300 ug/L era del 100% del total de las 4.487 muestras de orina, mientras que la mediana de los niveles de yoduria entre 300-500 µg/L fue de 91,3% y por encima de 500 fue 9.7% lo cual implicó el riesgo de desarrollar enfermedades tiroideas autoinmunes. Las embarazadas presentaron una mediana urinaria de yodo 484 µg/L, diabetes gestacional e hipotiroidismo subclínico en 50%. Conclusión: Para normalizar los niveles de yoduria, es necesario disminuir la cantidad de yodo en la sal. La recomendación es insistir en el monitoreo de la adecuada yodación de las sales de consumo familiar y continuar con la vigilancia y el monitoreo constante en sitios centinelas divulgando la importancia de la adecuada ingesta de yodo a la población. Un régimen dietético a las embarazadas es necesario implementar en el primer trimestre del embarazo.

Performance of the NG OligoGen kit for the diagnosis of Neisseria gonorrhoeae: comparison with cobas 4800 assay.

PCR assays are nowadays between the most sensitive and reliable methods for screening and diagnosing sexually transmitted infections (STIs). The aim of this study was to analyze the reliability, accuracy, and usefulness of the new NG OligoGen kit in comparison with the cobas 4800 assay for the detection of Neisseria gonorrhoeae in clinical samples. A prospective study was designed for detection of N. gonorrhoeae including urine samples (n=152), rectal (n=80), endocervical (n=67), pharyngeal (n=41), and urethral swabs (n=5) that were sent from a regional STI clinic in Seville, Spain. Samples were collected from 255 (73.9%) men and 90 women. Sensitivity, specificity, positive and negative predicative values, and kappa value for N. gonorrhoeae detection using the NG OligoGen kit were 99.6%, 100%, 100%, 99.1%, and 0.99, respectively. Statistical data obtained in this study confirm the usefulness and reliable results of this new assay.

Differential characteristics of healthcare-associated compared to community-acquired febrile urinary tract infections in males.

The objective of this study was to analyse the characteristics of healthcare-associated febrile urinary tract infection (HCA-FUTI) compared to community-acquired FUTI (CA-FUTI) in men. An ambispective cross-sectional study in which we recorded clinical and microbiology data and outcomes from males with FUTI attended in the Emergency Department was carried out. A total of 479 males with FUTI, 162 (33.8%) HCA-FUTI and 317 (66.2%) CA-FUTI, were included. HCA-FUTI patients were older (p < 0.001), had higher Charlson scores (p < 0.001) and received previous antimicrobial treatment more frequently (p < 0.001) compared to CA-FUTI patients. HCA-FUTI was less likely caused by Escherichia coli (p < 0.001) and more frequently by Klebsiella spp. (p = 0.02), Enterobacter spp. (p < 0.001) and Pseudomonas aeruginosa (p < 0.001). Resistance to ceftriaxone (p = 0.006), gentamicin (p < 0.001), quinolones (p < 0.001), co-trimoxazole (p = 0.001) and fosfomycin (p = 0.009) was higher among E. coli strains isolated from males with HCA-FUTI and so was the prevalence of extended-spectrum beta-lactamase and AmpC E. coli and Klebsiella spp.-producing strains (p = 0.012). Inadequate antimicrobial treatment and all-cause in-hospital mortality was associated with HCA-FUTI (p < 0.001 and p = 0.004, respectively). Independent factors for mortality were severe sepsis or septic shock [odds ratio (OR) 29; 95% confidence interval (CI): 3.9-214] and cirrhosis (OR 23.7; 95% CI: 1.6-350.6). Male patients with HCA-FUTI have different clinical characteristics, outcomes and microbiological features compared to CA-FUTI patients. Previous contact with the healthcare system has to be taken into consideration when deciding the optimal antimicrobial treatment in males with FUTI.

Dermatosis perforante adquirida: presentación de 8 casos / Acquired Perforating Dermatosis: A Report of 8 Cases

La dermatosis perforante adquirida (DPA) es una enfermedad infrecuente caracterizada por la aparición de lesiones que presentan eliminación transepidérmica de colágeno o fibras elásticas. Afecta a adultos y se asocia a enfermedades sistémicas, principalmente diabetes mellitus e insuficiencia renal. Presentamos 8 casos de DPA, 7 con diabetes mellitus e insuficiencia renal crónica (IRC) y uno con cirrosis alcohólica. Los pacientes con IRC tuvieron un empeoramiento transitorio de la misma coincidiendo con la aparición de la DPA. La creatinina se elevó de media 1,14 mg/dl. El deterioro agudo de la función renal podría estar implicado en la DPA. Se necesitan más estudios para confirmar esta relación

Acquired perforating dermatosis (APD) is an uncommon disease characterized by lesions exhibiting transepidermal elimination of collagen or elastic fibers. APD affects adults and is associated with systemic diseases, mainly diabetes mellitus and renal failure. We present 8 cases of APD. Seven patients had concomitant diabetes mellitus with or without chronic renal failure, and 1 had alcoholic cirrhosis. In the patients with chronic renal failure, the onset of APD coincided with transient worsening of renal function. The mean increase in creatinine concentrations above baseline was 1.14 mg/dL. Acute deterioration of renal function may be involved in APD. Further studies are needed to investigate this association

Minimum spread of the new Swedish variant of Chlamydia trachomatis and distribution of C. trachomatis ompA genotypes in three geographically distant areas of Spain, 2011-2012.

PURPOSE: The aim of this study was to determine the presence of the new Swedish Chlamydia trachomatis (C. trachomatis) variant (nvCT) and the distribution of C. trachomatis ompA genotypes in three geographically distant regions of Spain. METHODS: The genotypes of strains causing 624 episodes of infection (January 2011-September 2012) were studied using a nested PCR that amplifies a fragment of the ompA gene, followed by sequencing. To detect nvCT, a real-time PCR was used that amplifies a fragment of the cryptic plasmid with a 377 base pair deletion, which identifies the nvCT. RESULTS AND CONCLUSION: The ompA genotype was identified in 565 (90.5%) episodes. Eleven genotypes were detected, of which nine were found in all three regions. Only one nvCT strain was detected (0.4%), despite the predominance of genotype E (41%). Other frequent genotypes were genotypes D (19%), F (13%), G (11 %), and J (7%). Genotype L2b, causing lymphogranuloma venereum, was detected in men who have sex with men (MSM) in all three regions. Genotypes E and F were more frequent in women and heterosexual men, and genotypes D, G, J and L2b in MSM. In men, the main factor causing differences in the distribution of C. trachomatis was sexual behavior (MSM versus heterosexual men), while the distribution of C. trachomatis genotypes was similar in women and heterosexual men.