Sialoadenitis aguda por administración de contraste yodado / Acute sialadenitis by iodine contrast medium administration

La sialoadenitis aguda es una reacción adversa muypoco frecuente a la administración de contraste yodado,que causa una inflamación autolimitada de las glándulassalivales. Su patogenia no está bien establecida, aunque la insuficiencia renal puede ser un factor de riesgo.El diagnóstico es inicialmente clínico, y debe realizarsediagnóstico diferencial con angioedema, infecciones y litiasis. Ningún tratamiento o profilaxis ha demostrado beneficio hasta el momento. Aunque tiene buen pronóstico,en algunos casos se han descrito complicaciones.Presentamos el caso de un varón de 68 años que presentó inflamación de las glándulas salivales submandibulares tras la realización de una tomografía computariza-da abdominal con administración de contraste yodado.Dado el uso creciente de contrastes yodados en pruebasde imagen y técnicas intervencionistas, es importante conocer posibles reacciones adversas como esta entidad.(AU)

Acute iodide sialadenitis is a rare adverse reactionto iodinated contrast that causes self-limited salivarygland swelling. Its pathogenesis is still unclear, althoughkidney failure may be a risk factor. The diagnosis isinitially clinical but angioedema, infections and lithiasis should be included in the differential diagnosis. Notreatment or prophylaxis was proven to be beneficial.Although its prognosis is benign, associated complications have been reported.We report a case of 68-year-old man with swelling ofthe submandibular salivary glands after the administration of iodine-based contrast media during an abdomi-nal computed tomography examination. Because of thewidespread use of iodinated contrast enhanced imaging and interventional techniques, clinicians should beaware of this issue.(AU)

[Acute sialadenitis by iodine contrast medium administration].

Acute iodide sialadenitis is a rare adverse reaction to iodinated contrast that causes self-limited salivary gland swell-ing. Its pathogenesis is still unclear, although kidney failure may be a risk factor. The diagnosis is initially clinical but angioedema, infections and lithiasis should be included in the differential diagnosis. No treatment or prophylaxis was proven to be beneficial. Although its prognosis is benign, associated complications have been reported. We report a case of 68-year-old man with swelling of the submandibular salivary glands after the administration of iodine-based contrast media during an abdominal computed tomography examination. Because of the widespread use of iodinated contrast enhanced imaging and interventional techniques, clinicians should be aware of this issue.

Diversity, Co-Occurrence, and Nestedness Patterns of Sand Fly Species (Diptera: Psychodidae) in Two Rural Areas of Western Panamá.

Cutaneous Leishmaniasis transmission in the New World is observed in areas with rich sand fly species' faunas. The diversity and composition of sand fly species can change in response to seasonal weather and land use changes. Here, we present results from a two-year-long study where we collected, using Centers for Disease Control (CDC) light traps, sand flies from two rural areas, Las Pavas (LP) and Trinidad de las Minas (T) in western Panamá. Over 710 trap-nights, we collected 16,156 sand flies from 15 genera and 35 species. We identified 34 species in T, and the most abundant species collected was Nyssomyia trapidoi (Fairchild and Hertig, 1952) (n = 2278, 37%), followed by Psychodopygus panamensis (Shannon, 1926) (n = 1112, 18%), and Trichopygomyia triramula (Fairchild and Hertig, 1952) (n = 1063, 17%). In LP, we identified 26 species, and the most abundant species collected were Ty. triramula (n = 4729, 48%), and Ps. panamensis (n = 3444, 35%). We estimated a higher species' richness in T (Chao2 ± S.E.: 36.58 ± 3.84) than in LP (27.49 ± 2.28). In T, species' richness was significantly higher in the rainy season, but no seasonal differences were observed in LP. Species' assemblages were nested in the two areas. Phlebotomine sand fly species' abundance increased at the two sites during the rainy season. Our data suggest that seasonality is more important than land use as a factor driving sand fly species' diversity at the studied sites.

Involvement of the Inflammasome and Th17 Cells in Skin Lesions of Human Cutaneous Leishmaniasis Caused by Leishmania (Viannia) panamensis.

Localized cutaneous leishmaniasis (LCL) caused by Leishmania (Viannia) panamensis is an endemic disease in Panama. This condition causes ulcerated skin lesions characterized by a mixed Th1/Th2 immune response that is responsible for disease pathology. However, the maintenance of the in situ inflammatory process involves other elements, such as Th17 and inflammasome responses. Although these processes are associated with parasite elimination, their role in the increase in disease pathology cannot be discarded. Thus, the role in Leishmania infection is still unclear. In this sense, the present study aimed at characterizing the Th17 and inflammasome responses in the skin lesions of patients with LCL caused by L. (V.) panamensis to help elucidate the pathogenesis of this disease in Panama. Th17 and inflammasome responses were evaluated by immunohistochemistry (IHQ) in 46 skin biopsies from patients with LCL caused by L. (V.) panamensis. The Th17 immune response was assessed using CD3, CD4, RoRγt, IL-17, IL-6, IL-23, and TGF-ß1 antibodies, and the inflammasome response was assessed by IL-1ß, IL-18, and caspase-1 antibodies. The presence of the Th17 and inflammasome responses was evidenced by a positive reaction for all immunological markers in the skin lesions. An inverse correlation between the density of amastigotes and the density of RoRγt+, IL-17+, IL-1ß +, and caspase-1+ cells was observed, but no correlation between Th17 and the inflammasome response with evolutionary disease pathology was reported. These data showed the participation of Th17 cells and the inflammasome in the inflammatory response of the skin lesions of LCL caused by L. (V.) panamensis infection. These results suggest a role in the control of tissue parasitism of IL-17 and the activation of the NLRP3 inflammasome dependent on IL-1ß but cannot exclude their role in the development of disease pathology.

Prevalence and subtype distribution of Blastocystis sp. infecting children from a rural community in Panama.

Blastocystis sp. is a commonly reported intestinal parasite with a worldwide distribution. Phylogenetic analyses describe at least 17 subtypes for this parasite, and nine of them have been found in humans. However, the prevalence and some epidemiological characteristics of this parasitic infection in rural communities are not well known. The objective of this cross-sectional study was to evaluate the prevalence, subtypes, and epidemiological factors related to Blastocystis sp. Infection in children from of a small rural community in the central area of Panama. For this, 66 fecal samples from children (1 to 12 years old), were initially analyzed for the presence of parasites by a formalin-ethyl acetate/concentration method. Molecular detection and identification of Blastocystis sp. subtypes were carried out by amplification and sequencing of a partial fragment of the small-subunit ribosomal RNA gene. Using data from a questionnaire, analyses of epidemiological conditions potentially associated with Blastocystis sp. transmission were also conducted. Microscopic diagnostics showed that 33.3% (22/66) of the analyzed samples presented entero-parasites. Among them, Blastocystis sp. was the most prevalent, with 21.2% (14/66), followed by the E. histolytica/dispar/moshkovskii complex 4.5% (3/66), Giardia lamblia 1.5% (1/66) and Strongyloides stercoralis 1.5% (1/66). PCR-based analyses detected a prevalence of Blastocystis sp. infection of 74.2% (49/66) in apparently healthy children. Phylogenetic analysis revealed two different subtypes of this parasite: ST1 with 42.2% (28/66) infected, and ST3 with 31.8% (21/66) infected. In addition, recent diarrhea was significantly associated with Blastocystis sp. infection. None of the other risk factors evaluated was statistically associated with infection. These results highlight the need to further investigate clinical, epidemiological, and genetic characteristics of Blastocystis sp. infections in this community.

Performance of immunohistochemistry as a useful tool for the diagnosis of cutaneous leishmaniasis in Panama, Central America.

Cutaneous leishmaniasis (CL) is one of the most frequent parasitic zoonoses in Panama. Currently, conventional, molecular and histopathological tests are performed to diagnose CL. Immunohistochemistry (IHC) has proven to be a valuable tool to facilitate the diagnosis of leishmaniasis and to study the cellular immune response developed during the infection. Therefore, considering the absence of IHC in the diagnostic routine in Panama, the objective of this study is to demonstrate the usefulness of this test as a complementary diagnostic tool for improving the sensitivity of histopathology (HP) and helping to study the cellular immune response of patients. Samples from patients with suspected CL were analysed by intradermal reaction of Montenegro (IDRM), smears, culture, PCR (Viannia, Hsp-70), HP and IHC. According to the diagnostic criteria, 95.8% of patients were positive for Leishmania sp., that was characterized as Leishmania (V.) panamensis by PCR-HSP70/RFLP. From positive samples, Leishmania was detected by the tested diagnostic methods in the following degrees: 100% by IDRM, 60% by smears, 93.3% by culture, 100% by kDNA PCR, 78.3% by PCR Hsp-70, 50% by HP and 73.9% by IHC. Although IHC had a poor correlation (k = 0.191) with the diagnostic criteria, the sensitivities of both HP (76.1%) and smears (89.1%) were improved by combining them with IHC. IHC considerably improved the detection of the Leishmania parasites in the histopathological sections, supporting the need to implement this diagnostic tool in Panama. In addition, immunohistochemistry allows evaluation of the patient's immune response and thus provides new guidelines for the treatment and control of CL in Panama.

Neumomediastino, cuando la crisis asmática no mejora / Pneumomediastinum: When asthma exacerbation does not improve

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Cardiovascular Risk Factors in Cluster Headache.

Background: Patients with cluster headache tend to have a dysregulation of systemic blood pressure such as increased blood pressure variability and decreased nocturnal dipping. This pattern of nocturnal nondipping is associated with end-organ damage and increased risk of cardiovascular disease. Objective: To determine if cluster headache is associated with a higher risk of cardiovascular disease. Methods: Cross-sectional study of 33 cluster headache patients without evidence of cardiovascular disease and 30 age- and gender-matched healthy controls. Ambulatory blood pressure monitoring was performed in all subjects. We evaluate anthropometric, hematologic, and structural parameters (carotid intima-media thickness and ankle-brachial index). Results: Of the 33 cluster headache patients, 16 (48.5%) were nondippers, a higher percentage than expected. Most of the cluster headache patients (69.7%) also presented a pathological ankle-brachial index. In terms of the carotid intima-media thickness values, 58.3% of the patients were in the 75th percentile, 25% were in the 90th percentile, and 20% were in the 95th percentile. In the control group, only five of the 30 subjects (16.7%) had a nondipper pattern ( P = 0.004), with 4.54% in the 90th and 95th percentiles ( P = 0.012 and 0.015). Conclusions: Compared with healthy controls, patients with cluster headache presented a high incidence (48.5%) of nondipper pattern, pathological ankle-brachial index (69.7%), and intima-media thickness values above the 75th percentile. These findings support the hypothesis that patients with cluster headache present increased risk of cardiovascular disease.

Smoking and choroidal thickness in patients over 65 with early-atrophic age-related macular degeneration and normals.

OBJECTIVE: To compare macular choroidal thickness between cigarette smokers, those with a history of smoking, and nonsmokers in patients over 65 years of age with early-atrophic age-related macular degeneration (AMD) and normals. METHODS: Prospective, consecutive, observational case series. Enhanced depth imaging spectral domain optical coherence tomography 12-line radial scans were performed and choroidal thickness manually quantified at 84 points in the central 3 mm of the macula. Data of normals, soft drusen alone, and soft drusen with additional features of early AMD were compared. A multivariate analysis of variance (MANOVA) model, controlling for age, was constructed to evaluate the effect of smoking history and AMD features on choroidal thickness. RESULTS: A history of smoking was significantly associated with a thinner choroid across all patients via logistic regression (P=0.004; O.R.=12.4). Mean macular choroidal thickness was thinner for smokers (148±63 µm) than for nonsmokers (181±65 µm) among all diagnosis categories (P=0.003). Subgroup analysis of patients with AMD features revealed a similar decreased choroidal thickness in smokers (121±41 µm) compared with nonsmokers (146±46 µm, P=0.006). Bivariate analysis revealed an association between increased pack-years of smoking and a thin choroid across all patients (P<0.001) and among patients with features of early AMD (P<0.001). Both the presence of features of macular degeneration (P<0.001) and a history of smoking (P=0.024) were associated with decreased choroidal thickness in a MANOVA model. CONCLUSION: Chronic cigarette smoke exposure may be associated with decreased choroidal thickness. There may be an anatomic sequelae to chronic tobacco smoke exposure that underlies previously reported AMD risk.

Domestic dog health worsens with socio-economic deprivation of their home communities.

Dogs play an important role in infectious disease transmission as reservoir hosts of many zoonotic and wildlife pathogens. Nevertheless, unlike wildlife species involved in the life cycle of pathogens, whose health status might be a direct reflection of their fitness and competitive abilities, dog health condition could be sensitive to socio-economic factors impacting the well-being of their owners. Here, we compare several dog health indicators in three rural communities of Panama with different degrees of socio-economic deprivation. From a total of 78 individuals, we collected blood and fecal samples, and assessed their body condition. With the blood samples, we performed routine hematologic evaluation (complete blood counts) and measured cytokine levels (Interferon-γ and Interleukin-10) through enzyme-linked immunosorbent assays. With the fecal samples we diagnosed helminthiases. Dogs were also serologically tested for exposure to Trypanosoma cruzi and canine distemper virus, and molecular tests were done to assess T. cruzi infection status. We found significant differences between dog health measurements, pathogen prevalence, parasite richness, and economic status of the human communities where the dogs lived. We found dogs that were less healthy, more likely to be infected with zoonotic pathogens, and more likely to be seropositive to canine distemper virus in the communities with lower economic status. This study concludes that isolated communities of lower economic status in Panama may have less healthy dogs that could become major reservoirs in the transmission of diseases to humans and sympatric wildlife.

High-pressure processing decelerates lipolysis and formation of volatile compounds in ovine milk blue-veined cheese.

Enzyme-rich cheeses are prone to over-ripening during refrigerated storage. Blue-veined cheeses fall within this category because of the profuse growth of Penicillium roqueforti in their interior, which results in the production of highly active proteinases, lipases, and other enzymes responsible for the formation of a great number of flavor compounds. To control the excessive formation of free fatty acids (FFA) and volatile compounds, blue-veined cheeses were submitted to high-pressure processing (HPP) at 400 or 600 MPa on d 21, 42, or 63 after manufacture. Cheeses were ripened for 30d at 10°C and 93% relative humidity, followed by 60 d at 5°C, and then held at 3°C until d 360. High-pressure processing influenced the concentrations of acetic acid and short-chain, medium-chain, and long-chain FFA. The effect was dependent on treatment conditions (pressure level and cheese age at the time of treatment). The lowest concentrations of acetic acid and FFA were recorded for cheeses treated at 600 MPa on d 21; these cheeses showed the lowest esterase activity values. Acetic acid and all FFA groups increased during ripening and refrigerated storage. The 102 volatile compounds detected in cheese belonged to 10 chemical groups (5 aldehydes, 12 ketones, 17 alcohols, 12 acids, 35 esters, 9 hydrocarbons, 5 aromatic compounds, 3 nitrogen compounds, 3 terpenes, and 1 sulfur compound). High-pressure processing influenced the levels of 97 individual compounds, whereas 68 individual compounds varied during refrigerated storage. Total concentrations of all groups of volatile compounds were influenced by HPP, but only ketones, acids, esters, and sulfur compounds varied during refrigerated storage. The lowest total concentrations for most groups of volatile compounds were recorded for the cheese pressurized at 600 MPa on d 21. A principal component analysis combining total concentrations of groups of FFA and volatile compounds discriminated cheeses by age and by the pressure level applied to HPP cheeses.

Proteolysis and biogenic amine buildup in high-pressure treated ovine milk blue-veined cheese.

Penicillium roqueforti plays an important role in the ripening of blue-veined cheeses, mostly due to lactic acid consumption and to its extracellular enzymes. The strong activity of P. roqueforti proteinases may bring about cheese over-ripening. Also, free amino acids at high concentrations serve as substrates for biogenic amine formation. Both facts result in shorter product shelf-life. To prevent over-ripening and buildup of biogenic amines, blue-veined cheeses made from pasteurized ovine milk were high-pressure treated at 400 or 600 MPa after 3, 6, or 9 wk of ripening. Primary and secondary proteolysis, biogenic amines, and sensory characteristics of pressurized and control cheeses were monitored for a 90-d ripening period, followed by a 270-d refrigerated storage period. On d 90, treatments at 400 MPa had lowered counts of lactic acid bacteria and P. roqueforti by less than 2 log units, whereas treatments at 600 MPa had reduced lactic acid bacteria counts by more than 4 log units and P. roqueforti counts by more than 6 log units. No residual α-casein (CN) or κ-CN were detected in control cheese on d 90. Concentrations of ß-CN, para-κ-CN, and γ-CN were generally higher in 600 MPa cheeses than in the rest. From d 90 onwards, hydrophilic peptides were at similar levels in pressurized and control cheeses, but hydrophobic peptides and the hydrophobic-to-hydrophilic peptide ratio were at higher levels in pressurized cheeses than in control cheese. Aminopeptidase activity, overall proteolysis, and free amino acid contents were generally higher in control cheese than in pressurized cheeses, particularly if treated at 600 MPa. Tyramine concentration was lower in pressurized cheeses, but tryptamine, phenylethylamine, and putrescine contents were higher in some of the pressurized cheeses than in control cheese. Differences in sensory characteristics between pressurized and control cheeses were generally negligible, with the only exception of treatment at high pressure level (600 MPa) at an early ripening stage (3 wk), which affected biochemical changes and sensory characteristics.

Reproductive versatility and the epigenetic control of female gametogenesis.

Each year, plants and animals perform the task of repopulating the planet through patterns of courtship and mating that have a unifying and compelling logic: the production of offspring. Although life of nearly all organisms is organized around sex and breeding, Darwinian thinking focused more on the struggle for existence than on evolutionary significance of this frantic race to reproduce. In Darwin's own words, "We do not know the final cause of sexuality; why new beings should be produced by the union of the two sexual elements. The whole subject is hidden in darkness…" (Darwin 1862). In plants, a major consequence of this search for survival is the evolution of a multitude of reproductive alternatives that have intrigued botanists, geneticists, and evolutionary biologists for more than 100 years. Because sexually derived genetic diversity is interpreted as essential for adaptation, it is often thought that sex is necessary for the perpetuation of a species; however, many organisms--including several hundred families of flowering plants--are going efficiently about propagating their kind without bothering with meiosis and mating. Whereas many plants can undergo vegetative propagation, through the production of stolons, bulbs, or rhizomes, for example, many others have developed methods to produce an embryo from a single cell whose nucleus is not formed by the fusion of two gametes, offering a direct developmental and evolutionary challenge to sexual reproduction. Recent evidence suggests that epigenetic mechanisms that control transcriptional silencing of DNA repetitive elements and heterochromatin are crucial for the acquisition of cell identity in the ovule, opening the possibility that the developmental distinction between sexual development and apomixis might have evolved as an adaptive response to evolutionary forces that modulate structural variation and reproductive versatility in flowering plants.

Evaluation of PCR for cutaneous leishmaniasis diagnosis and species identification using filter paper samples in Panama, Central America.

Cutaneous leishmaniasis (CL) is a major vectorborne disease in Panama. In this study, the diagnostic performance and usefulness of two DNA extraction procedures from skin scraping samples collected on FTA filter paper for subsequent PCR diagnosis of CL was evaluated. A positive CL laboratory diagnosis was based on a positive parasitological test (Giemsa-stained smears or in vitro culture) and/or positive PCR test performed from skin scrapings collected in TE buffer (PCR-TE). Of 100 patients with skin lesions suggestive of CL, 82 (82%) were confirmed as CL positive. The sensitivity was calculated for each of the PCR approaches from samples collected on filter paper. The highest sensitivity was achieved by PCR-FTA processed by Chelex 100 (PCR-Chelex) (0.94). PCR-FTA extracted using the FTA purification reagent presented a lower sensitivity (0.60). Good concordance between routine PCR-TE and PCR-Chelex was observed (percent agreement=0.88, κ index=0.65). In conclusion, use of FTA filter paper for skin scraping collection combined with PCR is a reliable and convenient method for CL diagnosis in Panama, with comparable performance to the routine PCR method and with improved sensitivity compared with those of conventional parasitological methods.

Fibromatosis plantar / Plantar fibromatosis

La fibromatosis plantar es una enfermedad fibrosa benigna que afecta la aponeurosis plantar. Presentamos el caso (..) (AU)

Plantar fibromatosis is a benign fibrous disease involving plantar aponeurosis. A 27 year old male (..) (AU)

Prevalence of trypanosome infections in dogs from Chagas disease endemic regions in Panama, Central America.

The prevalence of canine trypanosomosis was investigated in two Chagas disease endemic rural communities located in the central region of Panama. Serologic tests for Trypanosoma cruzi infection revealed a prevalence of 11.1%. Hemocultures coupled with PCR analysis demonstrated a Trypanosoma rangeli infection rate of 5.1%. An overall trypanosome infection index of 16.2% (16/99) was detected in this canine population. One dog had a mixed infection of T. cruzi and T. rangeli. Six of the trypanosome-infected dogs belong to people who were diagnosed of Chagas disease. We conclude that dogs from this rural area of Panama are frequently infected with trypanosomes transmitted by the sylvatic vector, Rhodnius pallescens, and suggest that dogs are important in the peridomestic transmission cycle of trypanosomes as reservoirs and hosts. The epidemiological implications of these findings are discussed.

Antimicrobial efficacy of lactoferrin, its amidated and pepsin-digested derivatives, and their combinations, on Escherichia coli O157:H7 and Serratia liquefaciens.

AIMS: To evaluate the in vitro bactericidal efficacy of lactoferrin (LF), its amidated (AMILF) and pepsin-digested (PDLF) derivatives, and their combinations, on Escherichia coli O157:H7 and Serratia liquefaciens. METHODS AND RESULTS: PDLF exhibited the most potent bactericidal efficacy on E. coli O157:H7 (>2·5 log(10) CFU ml(-1) reduction at concentrations ≥ 1 mg ml(-1)), and AMILF on Ser. liquefaciens (1 log(10) CFU ml(-1) reduction at 0·25-0·50 mg ml(-1)). Some combinations of LF with PDLF or AMILF showed a slight synergy on E. coli O157:H7 and Ser. liquefaciens. However, all combinations of AMILF with PDLF were less active than the sum of the individual effects of the two antimicrobials. Production of capsular polysaccharide by bacteria might be involved in antimicrobial resistance. CONCLUSIONS: Escherichia coli O157:H7 and Ser. liquefaciens showed marked differences in the sensitivity to LF and its derivatives. E. coli O157:H7 was strongly inhibited by PDLF, whereas the effect of LF and its derivatives on Ser. liquefaciens was weak to negligible. SIGNIFICANCE AND IMPACT OF THE STUDY: PDLF was the most promising of the tested antimicrobials on E. coli O157:H7. However, the resistance of Ser. liquefaciens to LF and its derivatives hinders their use in the food industry.

Short communication: Antimicrobial effect of lactoferrin and its amidated and pepsin-digested derivatives against Salmonella Enteritidis and Pseudomonas fluorescens.

The antimicrobial effect of bovine lactoferrin (LF) and its amidated and pepsin-digested derivatives, at concentrations varying from 0.25 to 20 mg/mL, against 3 Salmonella Enteritidis strains and 3 Pseudomonas fluorescens strains was investigated. Lactoferrin showed its maximum antimicrobial effect at 10 mg/mL against the 3 Salmonella strains, with reductions ranging from 1.3 to 2.0 log units, and the 3 Pseudomonas strains, with reductions ranging from 1.8 to 5.4 log units. In the case of amidated LF, the maximum effect on the 3 Salmonella strains was recorded at 0.25 mg/mL, with reductions in the range of 0.8 to 1.2 log units, whereas it was recorded at 1 mg/mL for the 3 Pseudomonas strains, with reductions in the range of 4.4 to 6.0 log units. Pepsin-digested LF showed its maximum antimicrobial effect at 1 mg/mL against the 3 Salmonella strains, with reductions ranging from 2.6 to 3.4 log units, and at 20 mg/mL against the 3 Pseudomonas strains, with reductions ranging from 4.5 to 5.4 log units. It is worth noting the pronounced effect (reductions exceeding 2.5 log units) of a low (1 mg/mL) concentration of pepsin-digested LF, which is naturally formed in the gastrointestinal tract, on Salmonella and Pseudomonas strains. A highly significant inverse correlation was found between capsule polysaccharide levels of bacterial strains and their lethality in the presence of different concentrations of amidated lactoferrin.