Diagnostic benefits of adding EspC, EspF and Rv2348-B to the QuantiFERON Gold In-tube antigen combination.

Interferon (IFN)-γ release assays (IGRAs) are used to diagnose latent tuberculosis (TB) infection (LTBI). To improve the accuracy of these tests, different approaches, such as alternative cytokine detection and using different antigens, are considered. Following this purpose, this study aims to evaluate the addition of EspC, EspF and Rv2348-B to those present in the QuantiFERON-TB Gold In-Tube (QFN-G-IT). We included 115 subjects: 74 active TB patients, 17 LTBI individuals and 24 healthy controls. Whole blood samples were collected in QFN-G-IT and in-house tubes containing different combinations of EspC, EspF and Rv2348-B, together with ESAT-6, CFP-10, and TB7.7. After overnight incubation at 37 ºC, plasma was harvested and IFN-γ quantified. IFN-γ levels in the QFN-G-IT and in-house tubes correlated very good (Spearman Rho(r) > 0.86). In-house antigen combinations distinguished healthy individuals from those with active TB and LTBI (specificities and sensitivities higher than 87.5% and 96.3%, respectively [AUC > 0.938]). Adding EspC, EspF and Rv2348-B, increased the sensitivity of the test, being the addition of EspC and Rv2348-B the combination that yielded a higher sensitivity with no specificity loss. Addition of these antigens could improve diagnosis in patients with impaired or immature immune response who are at high risk of developing TB.

Successful treatment of hypocomplementemic urticarial vasculitis with omalizumab: a case report

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Percepciones de los estudiantes sobre sus vivencias en las prácticas clínicas / Students' perceptions about their experiences in their clinical practices / Percepciones dos estudantes sobre suas vivências nas práticas clínicas

Resumen Introducción Los estudiantes de enfermería deben adquirir conocimientos, habilidades, actitudes y valores, para proporcionar cuidados de calidad. Las prácticas clínicas son el contexto ideal para lograr algunas de las competencias requeridas. Objetivo Explorar las percepciones de los estudiantes sobre sus vivencias durante sus prácticas clínicas. Método Abordaje metodológico descriptivo de tipo cualitativo y con un encuadre sociocrítico. Se analizaron los 45 portafolios de estudiantes de 4º curso de la Escuela Universitaria de Enfermería (EUE) Cruz Roja, donde explican sus vivencias en prácticas. Se optó por un portafolio semiestructurado en función de la competencia a demostrar definiendo previamente las tareas o evidencias Se realizó un análisis de contenido que comprendía las siguientes fases: reducción de los datos; categorización-codificación, presentación de datos y conclusiones/verificación de los datos. Se alcanzó saturación en la información sobre las categorías presentadas. Resultados Del análisis de los datos emergen distintas unidades de significado que se engloban en tres categorías: aprendizaje en prácticas, dificultades del entorno, crecimiento personal y profesional. Conclusiones El estudio evidencia la importancia de las prácticas clínicas para los estudiantes dentro del plan de estudios, ya que es donde aplican lo que han aprendido en el aula y son conscientes de la realidad a la que se enfrentan. El entorno clínico y la relación que se establezca entre este y el estudiante determina en muchas ocasiones el aprendizaje. Queda patente que los estudiantes durante sus prácticas clínicas toman conciencia de aquellos conocimientos del saber, saber hacer y saber estar.

Abstract Introduction Nursing students need specific knowledge, skills, attitudes and values in order to provide quality of care; and the clinical practices represent an ideal context to develop some of these required competences. Objective To explore the perceptions of nursing students about their own experiences in their clinical practices. Method This a qualitative descriptive study with social and critical focus. 45 practice-files from nursing students in the 4th course of a Mexico Red Cross School of Nursing were analyzed considering the following stages: data reduction, categorization-coding, data presentation, and data verification and conclusions. Data saturation was reached from the identified categories. Results From the data analysis, diverse units of meaning emerged within three main categories: learning in practices, difficulties in the environment, and personal and professional growth. Conclusions The study highlights the importance of clinical practices since it is there where students apply in real life what they learn in the classroom. The relationship between the student and the clinical environment greatly determines the quality of learning. So, it is suggested that students keep in mind reflecting on their to know, to know how, and to know how to be.

Resumo Introdução Os estudantes de enfermagem devem adquirir conhecimentos, habilidades, atitudes e valores, para proporcionar cuidados de qualidade. As práticas clínicas são o contexto ideal para atingir algumas das competências requeridas. Objetivo Explorar as percepções dos estudantes sobre suas vivências durante suas práticas clínicas. Método Abordagem metodológica descritiva de tipo qualitativo e com um enfoque sociocrítico. Analisaram-se os 45 portfolios de estudantes de 4º curso da Escuela Universitaria de Enfermería (EUE) Cruz Roja, onde explicam suas vivências em práticas. Optou-se por um portfólio semiestruturado em função da competência a demostrar definindo previamente as tarefas ou evidências. Realizou-se uma análise de conteúdo que compreendia as seguintes fases: redução dos dados; categorização-codificação, apresentação de dados e conclusões/verificação dos dados. Atingiu-se saturação na informação sobre as categorias apresentadas. Resultados Da análise dos dados emergem distintas unidades de significado que abrangem três categorias: aprendizagem em práticas, dificuldades do entorno, crescimento pessoal e profissional. Conclusões O estudo evidencia a importância das práticas clínicas para os estudantes dentro do plano de estudos, já que é onde aplicam o que aprenderam na aula e são conscientes da realidade à que se enfrentam. O entorno clínico e a relação que se estabeleça entre este e o estudante determina em muitas ocasiões a aprendizagem. É evidente que os estudantes durante suas práticas clínicas tomam consciência daqueles conhecimentos do saber, saber fazer e saber estar.

[Effectiveness of the virtual reality in the rehabilitation of the upper limb in the spinal cord injury. A systematic review]. / Efectividad de la realidad virtual en la rehabilitacion del miembro superior en la lesion de la medula espinal. Revision sistematica.

INTRODUCTION: Spinal cord injury is a complex and life-disrupting condition. The functional recovery of the upper limb has been considered as an important objective in tetraplegia because it improves significantly the quality of living in these patients. Virtual reality is a new emerging tool of rehabilitation in spinal cord injured patients. AIM: To carry out a systematic review about the information about the application of these systems in spinal cord injury in the rehabilitation of the upper limb. PATIENTS AND METHODS: This review includes clinical trials dated until April 2018, which investigate the functional recovery of the upper limb through virtual reality systems in patients with complete or incomplete tetraplegia. The following databases were used to search for those clinical trials: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL and Brain. RESULTS: Five articles were selected for this review, including randomized clinical trials and clinical trials. The main results show a good tendency on the functional recovery with the combination of virtual reality systems and conventional therapy. CONCLUSIONS: The main limitations and the low quality of the studies show the necessity of further investigations with this new tool of rehabilitation. However, the incorporation of virtual reality systems as a rehabilitation supplement might be a beneficial tool on the functional recovery in spinal cord injury.

TITLE: Efectividad de la realidad virtual en la rehabilitacion del miembro superior en la lesion de la medula espinal. Revision sistematica.Introduccion. La lesion de la medula espinal es un estado funcional complejo que limita gravemente la vida de la persona. Por ello, la recuperacion de la funcionalidad del miembro superior en la tetraplejia se considera un objetivo primordial, ya que mejora significativamente la calidad de vida de estas personas. Ademas de las terapias convencionales, la realidad virtual supone un nuevo enfoque terapeutico en la rehabilitacion del lesionado medular. Objetivo. Realizar una revision sistematica sobre la efectividad de la rehabilitacion del miembro superior en pacientes con lesion medular a traves de la realidad virtual. Pacientes y metodos. Se recopilaron datos de ensayos clinicos hasta abril de 2018 que investigaran la rehabilitacion con sistemas de realidad virtual en los miembros superiores de pacientes con lesion medular completa e incompleta. Las bases de datos consultadas en esta revision incluyeron: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL y Brain. Resultados. Se analizaron cinco articulos, los cuales incluyeron ensayos controlados aleatorizados y ensayos clinicos. Los principales resultados de los estudios muestran buena tendencia de la rehabilitacion a traves de la realidad virtual en combinacion con terapia convencional. Conclusiones. Las limitaciones encontradas en los estudios, asi como su baja calidad metodologica, suponen la necesidad de mayores investigaciones acerca de la efectividad de esta nueva herramienta. Aun asi, la buena tendencia de los estudios se considera de interes para futuras investigaciones.

Sociodemographic factors affecting the comprehension of clinical information by inpatients undergoing trauma surgery. / Determinantes sociodemográficos de la comprensión de la información clínica en pacientes hospitalizados intervenidos de cirugía traumatológica.

INTRODUCTION: The clinical information process is the basis of the doctor-patient relationship. It starts with the information provided before signing informed consent and ends on the termination of the doctor-patient relationship. The influence of demographic variables in the information process has not been thoroughly studied for inpatients undergoing surgery. In this study we aim to answer two questions: 1) Does gender have an influence on the information process for these patients? 2) Are there other factors that affect the process? METHOD: A prospective study carried out using an 'ad hoc' designed survey on a 200-inpatient sample after undergoing surgery in the trauma and orthopaedics department of our hospital. Sampling was simple random. RESULTS: We found differences in the consistency of the answers by gender in the question regarding surgical priority, with the women having a better understanding of it (p=.04). The rest of the questions show no differences by gender. However, in the population analyzed, age and educational level are the main modifiers of understanding, and they are both related to gender (p<.0001; p=.003, respectively). CONCLUSIONS: In clinical practice, it is fundamental to keep in mind the factors that affect the information process. According to our results, the factors that define greater vulnerability in relation to the information process are age and low educational level.

Inorganic arsenic content in Ecuadorian rice-based products.

Arsenic intake in the world is linked with drinking water and food; the main sources of inorganic As (i-As) exposure in food are rice and rice-based products. The consumption of rice in Ecuador is 53.2 kg year-1 and it is the most commonly used cereal for the preparation of many popular dishes especially for subjects with celiac disease. Objectives of this research were: (i) to determine the content of i-As in foods widely consumed by Ecuadorians with celiac disease, (ii) to calculate the i-As dietary intake, and (iii) to model and predict the health risks of the population under study as a result of their exposure to i-As from rice-based food. The estimated daily intakes of Ecuadorian children (below 3 years of age) and adults were established at 0.52 and 0.55 µg kg-1 body weight d-1, respectively. These values were above the lower BMDL01 value established for i-As established by the EFSA; consequently, it can be concluded that health risk cannot be excluded for the Ecuadorian population with celiac disease.

Use of IP-10 detection in dried plasma spots for latent tuberculosis infection diagnosis in contacts via mail.

The aim of this study was to test the use of IP-10 detection in dried plasma from contact studies individuals (contacts of smear positive patients), by comparing it with IP-10 and IFN-γ detection in direct plasma, to establish IP-10 detection in DPS as a useful assay for LTBI diagnosis. Whole blood samples were collected from 80 subjects: 12 with active tuberculosis (TB), and 68 from contact studies. The amount of IFN-γ produced by sensitized T cells was determined in direct plasma by QuantiFERON Gold In-Tube test. IP-10 levels were determined in direct and dried plasma by an in-house ELISA. For dried plasma IP-10 determination, two 25 µl plasma drops were dried in Whatman903 filter paper and sent by mail to the laboratory. Regarding TB patients, 100.0%, 91.7% and 75.0% were positive for IFN-γ detection and IP-10 detection in direct and dried plasma, respectively. In contacts, 69.1%, 60.3% and 48.5% had positive results after IFN-γ and IP-10 in direct and dried plasma, respectively. The agreement among in vitro tests was substantial and IP-10 levels in direct and dried plasma were strongly correlated (r = 0.897). In conclusion, IP-10 detection in dried plasma is a simple and safe method that would help improve LTBI management.

¿Es la apendicectomía un tratamiento válido en las neoplasias mucinosas apendiculares de bajo grado? / Is appendectomy a valid treatment in low-grade appendiceal mucinous neoplasms (lamn)?

Introducción: las neoplasias mucinosas apendiculares de bajo grado son una patología infrecuente, cuyo manejo quirúrgico ha variado en los últimos anos. Métodos: estudio retrospectivo de pacientes con diagnostico anatomopatologico de neoplasias mucinosas apendiculares de bajo grado. Resultados: se incluyeron 28 pacientes con una edad mediana de 63 años. La clínica predominante de presentación fue la apendicitis aguda en 11 pacientes (39,3%). El 35,7% se abordaron mediante laparoscopia. En el 39,3% se describe perforación apendicular y el 25% presentan moco libre en la cavidad abdominal. En el 60,7% se realizo de inicio una apendicectomia, presentando el estudio anatomopatologico afectación de los bordes en 5 pacientes. En 4 de los 5 se amplió la resección, sin evidencia de enfermedad residual. Conclusiones: la apendicetomía es el tratamiento recomendado en las neoplasias mucinosas de bajo grado. Si existen márgenes afectos se debe individualizar el tratamiento, valorando el seguimiento como una opción a considerar

Introduction: low-grade appendiceal mucinous neoplasms are an infrequent pathology, whose surgical management has varied in recent years. Methods: retrospective study of patients with anatomopathological diagnosis of low grade appendiceal mucinous neoplasms. Results: twenty-eight patients with a median age of 63 years were included. The main clinical presentation was acute appendicitis in 11 patients (39.3%). 35.7% were approached by laparoscopy. In 39,3% patients is described appendicular perforation and 25% present free mucus in the abdominal cavity. In 60,7% patients was performed an appendectomy, presenting the pathological study the border affected in 5 patients. In 4 of the 5 resection was extended, without evidence of residual disease. Conclusions: appendectomy is the recommended treatment in low grade mucinous neoplasms. If there borders are affected, treatmentshould be individualized, assessing follow-up as an option to be considered

[Resistance rates and phenotypic characterization of Streptococcus pyogenes in a paediatric population in Northern Spain (2005-2015)]. / Cambios evolutivos en las tasas y fenotipos de resistencia de Streptococcus pyogenes en una población pediátrica de Asturias, España (2005-2015).

OBJECTIVE: Streptococcus pyogenes is a significant cause of bacterial infections in children. The aim of the study is to analyse resistance rates and phenotypes of S. pyogenes isolates in a paediatric population in Northern Spain over the last 11 years. METHODS: Descriptive retrospective study of S. pyogenes isolates from paediatric patients between 2005 and 2015 in a region of Asturias (Spain). Resistance rates and changes in erythromycin resistance phenotypes in two time periods (2005-2009 and 2010-2015) were studied. RESULTS: A total of 1,794 S. pyogenes isolates were registered (70% from 2005 to 2009). 87.5% were obtained from pharyngeal swabs and 0.2% from blood cultures. Resistance rates to tetracycline (8.8% to 4.3%, p=0.02), erythromycin (22% to 9.3%, p<0.01) and clindamycin (6% to 1.7%, p<0.01) decreased between the two study periods. A reduction in erythromycin-resistant isolates with the MLSB phenotype was observed. CONCLUSIONS: A decrease in S. pyogenes resistance rates to erythromycin and clindamycin and a change in the erythromycin resistance phenotype were observed along the study period.

Clinical and mutational features of X-linked agammaglobulinemia in Mexico.

X-linked agammaglobulinemia (XLA) is caused by BTK mutations, patients typically show <2% of peripheral B cells and reduced levels of all immunoglobulins; they suffer from recurrent infections of bacterial origin; however, viral infections, autoimmune-like diseases, and an increased risk of developing gastric cancer are also reported. In this work, we report the BTK mutations and clinical features of 12 patients diagnosed with XLA. Furthermore, a clinical revision is also presented for an additional cohort of previously reported patients with XLA. Four novel mutations were identified, one of these located in the previously reported mutation refractory SH3 domain. Clinical data support previous reports accounting for frequent respiratory, gastrointestinal tract infections and other symptoms such as the occurrence of reactive arthritis in 19.2% of the patients. An equal proportion of patients developed septic arthritis; missense mutations and mutations in SH1, SH2 and PH domains predominated in patients who developed arthritis.

Evaluation of GenoFlow DR-MTB Array Test for Detection of Rifampin and Isoniazid Resistance in Mycobacterium tuberculosis.

The aim of this study was to evaluate the GenoFlow DR-MTB array test (DiagCor Bioscience, Hong Kong) on 70 cultured isolates and 50 sputum specimens. The GenoFlow array test showed good sensitivity and specificity compared to the phenotypic Bactec 460TB. This array accurately detected mutations inrpoB,katG, andinhAassociated with resistance to rifampin and isoniazid.

A NEW OBSERVATION OF 13q DELETION SYNDROME: SEVERE UNDESCRIBED FEATURES.

A new observation of 13q deletion syndrome: severe undescribed features: 13q deletion syndrome is characterized by a wide phenotypic spectrum resulting from a partial deletion-of the long arm of chromosome 13. It consists predominantly of mental and motor retardation, craniofacial dysmorphia, growth retardation, and several congenital malformations. We present a new case with 13q deletion syndrome phenotypically characterized by severe major malformations, some of them still undescribed, consisting of left diaphragmatic hernia, right pulmonary sequestration, hypoplastic left heart syndrome, pancreatic agenesis, polysplenia, and catastrophic central nervous system malformations: semilobar holoprosencephaly, occipital myelomeningocele, partial agenesis of the corpus callosum and agenesis of olfactory bulbs. Fluorescence in situ hybridization technique using the probe LSI D13S319 (13q1l4) SO/ LSI 13q34 SG determined partial monosomy of chromosome 13 in 39/100 cells (mosaicism).

Batch and Pulsed Fed-Batch Cultures of Aspergillus flavipes FP-500 Growing on Lemon Peel at Stirred Tank Reactor.

Aspergillus flavipes FP-500 grew up on submerged cultures using lemon peel as the only carbon source, developing several batch and pulsed fed-batch trials on a stirred tank reactor. The effect of carbon source concentration, reducing sugar presence and initial pH on exopectinase and endopectinase production, was analyzed on batch cultures. From this, we observed that the highest substrate concentration favored biomass (X max) but had not influence on the corresponding specific production (q p) of both pectinases; the most acid condition provoked higher endopectinase-specific productions but had not a significant effect on those corresponding to exopectinases; and reducing sugar concentrations higher than 1.5 g/L retarded pectinase production. On the other hand, by employing the pulsed fed-batch operation mode, we observed a prolonged growth phase, and an increase of about twofold on endopectinase production without a significant raise on biomass concentration. So, pulsed fed-batch seems to be a good alternative for obtaining higher endopectinase titers by using high lemon peel quantities without having mixing and repression problems to the system. The usefulness of unstructured kinetic models for explaining, under a theoretic level, the behavior of the fungus along the batch culture with regard to pectinase production was evident.

Análisis de las coinfecciones mixtas por el virus del papiloma humano (VPH) de alto y bajo riesgo en lesiones de significado incierto / Analysis of mixed co-infections with high-and low-risk lesions of uncertain significance of human papillomavirus (HPV)

Introducción: El virus del papiloma humano (VPH) está implicado en infecciones humanas (enfermedades de transmisión sexual [ETS]), de piel y en enfermedades tumorales femeninas como es el cáncer de cuello de útero. Las técnicas moleculares de detección de VPH son necesarias para conocer el grado de agresividad del tratamiento y seguimiento clínico. La utilidad de las técnicas de detección del VPH, como cribado, forman parte de los esquemas diagnósticos y terapéuticos de las sociedades oncológicas y ginecológicas más importantes. Material y métodos: Se ha realizado un estudio retrospectivo de 996 citologías desde noviembre de 2008 hasta diciembre de 2011. Los objetivos de nuestro estudio han sido analizar las lesiones preneoplásicas (lesiones de significado incierto [ASCUS], lesiones escamosas intraepiteliales de bajo riesgo [LSIL], lesiones escamosas intraepitelies de alto riesgo [HSIL]) o sospechosas por parte del servicio de ginecología y la coinfección mixta entre virus del papiloma humano de alto y bajo riesgo (VPH-AR/BR), incluyendo las infecciones por el VPH-AR o VPH-BR y la trascendencia clínica de dichos hallazgos. Resultados: De 996 determinaciones de VPH-AR/BR, se hallaron 541 VPH positivos (alto, bajo o ambos) procedentes de citologías en medio líquido de 541 pacientes distintas. El número total de coinfecciones mixtas (VPR-AR/BR) en muestras normales, ASCUS, inflamación, HSIL y LSIL de VPH-AR/BR fue de 37, 100, 1, 3 y 29 respectivamente. Conclusiones: Existe un alto porcentaje de infecciones mixtas por el VPH de alto y bajo riesgo en lesiones de significado incierto o lesiones precancerosas

Introduction: Human papillomavirus (HPV) is involved in human infections (sexually-transmitted infections [STI]), and in skin and female tumoral disease such as cervical cancer. Molecular techniques for HPV detection are required to determine the aggressiveness of treatment and clinical follow-up. Evaluating the usefulness of techniques to detect HPV, such as as screening, are among the most important diagnostic and therapeutic activities of oncology and gynecological societies. Material and methods: We performed a retrospective study of 996 smears from November 2008 to December 2011. The objectives of our study were to analyze preneoplasic lesions (atypical squamous cells of undetermined significance [ASCUS], low-grade squamous intraepithelial lesions [LSIL], high-grade squamous intraepithelial lesions [HSIL]), those suspected by the department of gynecology, mixed infections with high-risk (HR)/low-risk (LR) HPV, including HR-HPV or LR-HPV infections, and the clinical significance of these findings. Results: Of 996 HR/LR HPV determinations, 541 were HPV positive (high, low or both) in liquid-based Pap smears from 541 different patients. The total number of mixed infections (HR/LR HPV) was 37 in normal samples, 100 in ASCUS, 1 in inflammation, 3 in LSIL and and 29 in HSIL. Conclusions: There are a high percentage mixed HR/LR HPV infections in lesions of undetermined significance and precancerous lesions