Experiencia con el Biofire FilmArray® para meningitis/encefalitis infecciosa en una institución de alta complejidad en Bogotá, Colombia / Experience with the Biofire FilmArray® for infectious meningitis/encephalitis in a high complexity institution in Bogotá, Colombia

Introducción: La meningoencefalitis infecciosa (MEI) es una emergencia neurológica con importante morbimortalidad. El panel Biofire FilmArray? para meningitis/encefalitis (FAME) en el líquido cefalorraquídeo (LCR) ha demostrado ser una valiosa herramienta para el diagnóstico etiológico de la MEI, facilitando una terapia antimicrobiana dirigida. El objetivo es determinar el impacto del panel FAME en las decisiones terapéuticas antimicrobianas en pacientes con sospecha de MEI en las primeras 24 horas de la valoración clínica. Pacientes y métodos: Estudio observacional descriptivo que comenta las manifestaciones cínicas, los resultados de neuroimágenes y paraclínicos, y la antibioticoterapia de pacientes con sospecha de MEI. Se realizó un análisis del impacto que tiene el FAME en la terapia antimicrobiana en las primeras 24 horas de la valoración clínica de los pacientes. Resultados: Se incluyó a 44 pacientes. El tiempo promedio para obtener el resultado del panel FAME en el LCR fue de nueve horas, con un 20,4% (9/44) de pruebas positivas. En las primeras 24 horas de la valoración clínica, su resultado tuvo impacto en las decisiones terapéuticas antimicrobianas en el 75% (33/44) de los casos. En pacientes con alta sospecha clínica de MEI, el resultado del FAME permitió cambiar la terapia empírica inicial a una dirigida en el 15% (3/20) y suspender la terapia empírica inicial en el 35% (7/20) de los sujetos. En pacientes con baja sospecha clínica de MEI, su resultado permitió que al 25% (6/24) se le confirmara la sospecha y se le iniciara antibioticoterapia dirigida; y que al 70,8% (17/24) se le descartara el diagnóstico y no se le iniciara tratamiento. Conclusiones: El resultado del panel FAME en el LCR tiene alto impacto en la toma de decisiones terapéuticas antimicrobianas en las primeras 24 horas de la valoración clínica. Sin embargo, su interpretación debe hacerse con el contexto clínico, la epidemiología local y otros estudios diagnósticos.(AU)

Introduction: Infectious meningoencephalitis (IME) is a neurological emergency with a significant rate of morbidity and mortality. The Biofire FilmArray® meningitis/encephalitis (FAME) panel for testing in cerebrospinal fluid (CSF) has proven to be a valuable tool for the aetiological diagnosis of IME, facilitating targeted antimicrobial therapy. The aim is to determine the impact of the FAME panel on antimicrobial therapeutic decisions in patients with suspected IME in the first 24 hours of clinical assessment. Patients and methods: This is a descriptive observational study that comments on the clinical manifestations, the neuroimaging and paraclinical findings, and the antibiotic therapy of patients with suspected IME. An analysis was performed to determine the impact of FAME on antimicrobial therapy in the first 24 hours of the clinical assessment of patients. Results: Altogether 44 patients were included. The average time required to obtain the result of the FAME panel for testing in CSF was nine hours, with 20.4% (9/44) of tests yielding positive results. Within 24 hours of clinical assessment, their outcome had an impact on antimicrobial treatment decisions in 75% (33/44) of cases. In patients with a high clinical suspicion of IME, the result of FAME made it possible to change the initial empirical therapy to a targeted therapy in 15% (3/20) of cases and to discontinue the initial empirical therapy in 35% (7/20) of the subjects. In patients with low clinical suspicion of IME, their result allowed 25% (6/24) to have their suspicion confirmed and they were started on targeted antibiotic therapy; in contrast, 70.8% (17/24) had their diagnosis ruled out and were not started on treatment. Conclusions: The result of the FAME panel for testing in CSF has a high impact on antimicrobial therapeutic decisions within 24 hours of clinical assessment. However, it must be interpreted with the clinical context, local epidemiology and other diagnostic studies.(AU)

[Experience with the Biofire FilmArray® for infectious meningitis/encephalitis in a high complexity institution in Bogota, Colombia]. / Experiencia con el Biofire FilmArray® para meningitis/encefalitis infecciosa en una institución de alta complejidad en Bogotá, Colombia.

INTRODUCTION: Infectious meningoencephalitis (IME) is a neurological emergency with a significant rate of morbidity and mortality. The Biofire FilmArray® meningitis/encephalitis (FAME) panel for testing in cerebrospinal fluid (CSF) has proven to be a valuable tool for the aetiological diagnosis of IME, facilitating targeted antimicrobial therapy. The aim is to determine the impact of the FAME panel on antimicrobial therapeutic decisions in patients with suspected IME in the first 24 hours of clinical assessment. PATIENTS AND METHODS: This is a descriptive observational study that comments on the clinical manifestations, the neuroimaging and paraclinical findings, and the antibiotic therapy of patients with suspected IME. An analysis was performed to determine the impact of FAME on antimicrobial therapy in the first 24 hours of the clinical assessment of patients. RESULTS: Altogether 44 patients were included. The average time required to obtain the result of the FAME panel for testing in CSF was nine hours, with 20.4% (9/44) of tests yielding positive results. Within 24 hours of clinical assessment, their outcome had an impact on antimicrobial treatment decisions in 75% (33/44) of cases. In patients with a high clinical suspicion of IME, the result of FAME made it possible to change the initial empirical therapy to a targeted therapy in 15% (3/20) of cases and to discontinue the initial empirical therapy in 35% (7/20) of the subjects. In patients with low clinical suspicion of IME, their result allowed 25% (6/24) to have their suspicion confirmed and they were started on targeted antibiotic therapy; in contrast, 70.8% (17/24) had their diagnosis ruled out and were not started on treatment. CONCLUSIONS: The result of the FAME panel for testing in CSF has a high impact on antimicrobial therapeutic decisions within 24 hours of clinical assessment. However, it must be interpreted with the clinical context, local epidemiology and other diagnostic studies.

TITLE: Experiencia con el Biofire FilmArray® para meningitis/encefalitis infecciosa en una institución de alta complejidad en Bogotá, Colombia.Introducción. La meningoencefalitis infecciosa (MEI) es una emergencia neurológica con importante morbimortalidad. El panel Biofire FilmArray? para meningitis/encefalitis (FAME) en el líquido cefalorraquídeo (LCR) ha demostrado ser una valiosa herramienta para el diagnóstico etiológico de la MEI, facilitando una terapia antimicrobiana dirigida. El objetivo es determinar el impacto del panel FAME en las decisiones terapéuticas antimicrobianas en pacientes con sospecha de MEI en las primeras 24 horas de la valoración clínica. Pacientes y métodos. Estudio observacional descriptivo que comenta las manifestaciones cínicas, los resultados de neuroimágenes y paraclínicos, y la antibioticoterapia de pacientes con sospecha de MEI. Se realizó un análisis del impacto que tiene el FAME en la terapia antimicrobiana en las primeras 24 horas de la valoración clínica de los pacientes. Resultados. Se incluyó a 44 pacientes. El tiempo promedio para obtener el resultado del panel FAME en el LCR fue de nueve horas, con un 20,4% (9/44) de pruebas positivas. En las primeras 24 horas de la valoración clínica, su resultado tuvo impacto en las decisiones terapéuticas antimicrobianas en el 75% (33/44) de los casos. En pacientes con alta sospecha clínica de MEI, el resultado del FAME permitió cambiar la terapia empírica inicial a una dirigida en el 15% (3/20) y suspender la terapia empírica inicial en el 35% (7/20) de los sujetos. En pacientes con baja sospecha clínica de MEI, su resultado permitió que al 25% (6/24) se le confirmara la sospecha y se le iniciara antibioticoterapia dirigida; y que al 70,8% (17/24) se le descartara el diagnóstico y no se le iniciara tratamiento. Conclusiones. El resultado del panel FAME en el LCR tiene alto impacto en la toma de decisiones terapéuticas antimicrobianas en las primeras 24 horas de la valoración clínica. Sin embargo, su interpretación debe hacerse con el contexto clínico, la epidemiología local y otros estudios diagnósticos.

Acute stroke in COVID-19 patients: A first year experience in a Colombian hospital.

Background: COVID-19 may be a new risk factor for stroke. Stroke in COVID-19 varies from 1.1 to 8.1%. Various pathophysiological pathways predispose SARS-CoV-2 infected patients to stroke. Aim: To describe COVID-19 patients with acute stroke in one Colombian Center. Methods: From March 6 2020 and March 6 2021 records of patients with acute stroke and in-hospital positive PCR (Polymerase Chain Reaction) test for Sars-CoV-2 infection were reviewed. Demographic, stroke and COVID-19 characteristics were extracted. Continuous variables were reported in means and ranges. Categorical variables were presented in frequencies and percentage. A descriptive narrative was performed. Results: Of 328 acute stroke patients 14 (4.2%) tested positive for PCR SARS-CoV-2. Mean age 56.4 years with 57% males. Five were (35.7%) without vascular risk factors but 9 (64.3%) overweight. Brain infarct diagnosed in 11 (78.5%), 53% with anterior circulation syndromes. Mean NIHSS score 11.8 and 7 (63%) received intravenous thrombolysis. Acute inflammatory blood biomarkers (D-dimer, ferritin, LDH elevated) were positive in all. 11 (78.5%) had symptomatic COVID-19 before stroke with a mean latency of 7 days. 12 (85.7%) had severe COVID-19 and 6 (42.8%) required mechanical ventilation. Outcome was unfavorable in 9 (64.3%) (The Modified Rankin Scale (mRS) > 2), mean hospital stay was 21.8 days and in-hospital case fatality rate was 14.2%. Conclusion: In susceptible individuals COVID-19 predisposes to stroke. Hypercoagulation and immune thrombosis may be at the culprit for this state. In Colombia, COVID-19 patients with stroke have similar characteristics to the described worldwide.

Health risk assessment in children living in an urban area with hydrofluorosis: San Luis Potosí Mexico case study.

BACKGROUND: Fluoride is an inorganic element, which can be found in high concentrations in groundwater. Its consumption and exposure have consequences on human health. The objective of this study was to evaluate fluoride exposure and develop a health risk assessment in children from an urban area with hydrofluorosis in Mexico. METHODS: Water fluoride levels in active wells were provided by the Water State Agency and divided into three zones: agriculture zone (Zone A), metallurgical zone (Zone B), and industrial zone (Zone C). Urinary fluoride levels were determined by potentiometric method using an ion-selective electrode. Health risk assessment was performed through Monte Carlo model analysis and hazard quotient was calculated. RESULTS: According to fluoride well concentration, all zones have high concentration especially Zone B (2.55 ± 0.98 mg/L). Urinary fluoride concentrations were highest in children in Zone B (1.42 ± 0.8 mg/L). The estimated median daily intake dose of fluoride was 0.084 mg/Kg-day for the children living in zone B. The highest mean HQ value was to Zone B (1.400 ± 0.980), followed by Zone C (0.626 ± 0.443). CONCLUSION: The levels of fluoride exposure registered are a potential risk to generate adverse health effects in children in the San Luis Potosi metropolitan area.

Review: Are there indigenous Saccharomyces in the digestive tract of livestock animal species? Implications for health, nutrition and productivity traits.

All livestock animal species harbour complex microbial communities throughout their digestive tract that support vital biochemical processes, thus sustaining health and productivity. In part as a consequence of the strong and ancient alliance between the host and its associated microbes, the gut microbiota is also closely related to productivity traits such as feed efficiency. This phenomenon can help researchers and producers develop new and more effective microbiome-based interventions using probiotics, also known as direct-fed microbials (DFMs), in Animal Science. Here, we focus on one type of such beneficial microorganisms, the yeast Saccharomyces. Saccharomyces is one of the most widely used microorganisms as a DFM in livestock operations. Numerous studies have investigated the effects of dietary supplementation with different species, strains and doses of Saccharomyces (mostly Saccharomyces cerevisiae) on gut microbial ecology, health, nutrition and productivity traits of several livestock species. However, the possible existence of Saccharomyces which are indigenous to the animals' digestive tract has received little attention and has never been the subject of a review. We for the first time provide a comprehensive review, with the objective of shedding light into the possible existence of indigenous Saccharomyces of the digestive tract of livestock. Saccharomyces cerevisiae is a nomadic yeast able to survive in a broad range of environments including soil, grass and silages. Therefore, it is very likely that cattle and other animals have been in direct contact with this and other types of Saccharomyces throughout their entire existence. However, to date, the majority of animal scientists seem to agree that the presence of Saccharomyces in any section of the gut only reflects dietary contamination; in other words, these are foreign organisms that are only transiently present in the gut. Importantly, this belief (i.e. that Saccharomyces come solely from the diet) is often not well grounded and does not necessarily hold for all the many other groups of microbes in the gut. In addition to summarizing the current body of literature involving Saccharomyces in the digestive tract, we discuss whether the beneficial effects associated with the consumption of Saccharomyces may be related to its foreign origin, though this concept may not necessarily satisfy the theories that have been proposed to explain probiotic efficacy in vivo. This novel review may prove useful for biomedical scientists and others wishing to improve health and productivity using Saccharomyces and other beneficial microorganisms.

A new CO2 vent for the study of ocean acidification in the Atlantic.

Natural CO2 vents are considered the gold standard of ocean acidification (OA) studies. In coastal areas these rare vents have only been investigated at the Mediterranean temperate rocky reefs and at Indo-Pacific coral reefs, although there should be more at other volcanic shores around the world. Substantial scientific efforts on investigating OA effects have been mostly performed by laboratory experiments. However, there is a debate on how acute this kind of approach truly represents the responses to OA scenarios, since it generally involves short-term, rapid perturbation and single variable and species experiments. Due to these limitations, world areas with natural CO2 vents are essential to understand long-term marine ecosystem responses to rising human derived atmospheric CO2 concentrations. Here, we presented a new vent found in the subtropical North East Atlantic reefs (28°N, La Palma Island) that shows moderate CO2 emission (900ppm), reducing pH values to an annual average of 7.86±0.16.

Measuring bandgap states in individual non-stoichiometric oxide nanoparticles using monochromated STEM EELS: The Praseodymium-ceria case.

We describe a method to perform high spatial resolution measurement of the position and density of inter-band impurity states in non-stoichiometric oxides using ultra-high energy resolution electron energy-loss spectroscopy (EELS). This can be employed to study optical and electronic properties of atomic and nanoscale defects in electrically-conducting and optically-active oxides. We employ a monochromated scanning transmission electron microscope with subnanometer diameter electron probe, making this technique suitable for correlating spectroscopic information with high spatial resolution images from small objects such as nanoparticles, surfaces or interfaces. The specific experimental approach outlined here provides direct measurement of the Pr inter-band impurity states in Pr0.1Ce0.9O2-δ via valence-loss EELS, which is interpreted with valence-loss spectral simulation based on density of states data to determine the energy level and character of the inter-band state. Additionally, observation of optical color change upon chemically-induced oxygen non-stoichiometry indicates that the population of the inter-band state is accompanied by an energy level shift within the bandgap.

BackCLIP: a tool to identify common background presence in PAR-CLIP datasets.

MOTIVATION: PAR-CLIP, a CLIP-seq protocol, derives a transcriptome wide set of binding sites for RNA-binding proteins. Even though the protocol uses stringent washing to remove experimental noise, some of it remains. A recent study measured three sets of non-specific RNA backgrounds which are present in several PAR-CLIP datasets. However, a tool to identify the presence of common background in PAR-CLIP datasets is not yet available. RESULTS: We used the measured sets of non-specific RNA backgrounds to build a common background set. Each element from the common background set has a score that reflects its presence in several PAR-CLIP datasets. We present a tool that uses this score to identify the amount of common backgrounds present in a PAR-CLIP dataset, and we provide the user the option to use or remove it. We used the proposed strategy in 30 PAR-CLIP datasets from nine proteins. It is possible to identify the presence of common backgrounds in a dataset and identify differences in datasets for the same protein. This method is the first step in the process of completely removing such backgrounds. AVAILABILITY: The tool was implemented in python. The common background set and the supplementary data are available at https://github.com/phrh/BackCLIP. CONTACT: phreyes@gmail.com SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

A refined risk stratification scheme for clinical stage 1 NSGCT based on evaluation of both embryonal predominance and lymphovascular invasion.

BACKGROUND: Active surveillance is an increasingly accepted approach for managing patients with germ-cell tumors (GCTs) after an orchiectomy. Here we investigate a time-to-relapse stratification scheme for clinical stage 1 (CS1) nonseminoma GCT (NSGCT) patients according to factors associated with relapse and identify a group of patients with a lower frequency and longer time-to-relapse who may require an alternative surveillance strategy. PATIENTS AND METHODS: We analyzed 266 CS1 GCT patients from the IRB-approved DFCI GCT database that exclusively underwent surveillance following orchiectomy from 1997 to 2013. We stratified NSGCT patients according to predominance of embryonal carcinoma (EmbP) and lymphovascular invasion (LVI), using a 0, 1, and 2 scoring system. Cox regression and conditional risk analysis were used to compare each NSGCT group to patients in the seminomatous germ-cell tumor (SGCT) category. Median time-to-relapse values were then calculated among those patients who underwent relapse. Relapse-free survival curves were generated using the Kaplan-Meier method. RESULTS: Fifty (37%) NSGCT and 20 (15%) SGCT patients relapsed. The median time-to-relapse was 11.5 versus 6.3 months for the SGCT and NSGCT groups, respectively. For NSGCT patients, relapse rates were higher and median time-to-relapse faster with increasing number of risk factors (RFs). Relapse rates (%) and median time-to-relapse (months) were 25%/8.5 months, 41%/6.8 months and 78%/3.8 months for RF0, RF1 and RF2, respectively. We found a statistically significant difference between SGCT and patients with one or two RFs (P < 0.001) but not between SGCT and NSGCT RF0 (P = 0.108). CONCLUSION: NSGCT patients grouped by a risk score system based on EmbP and LVI yielded three groups with distinct relapse patterns -and patients with neither EmbP nor LVI appear to behave similar to SGCT.

Application of Focused Ultrasound-Assisted Extraction to the Determination of Persistent Organic Pollutants (POPs) in Soil Samples.

A simple and rapid focused ultrasound extraction (FU) based method is presented for the determination of persistent organic pollutants (POPs) in soil using a gas chromatography coupled to a mass detector with electron impact ionization. The main experimental parameters affecting the FU step have been optimized by applying a PERMANOVA and PCO analysis allowing us to obtain a maximum amount of information with a minimum number of assays. The limits of detection for POPs fell within the 0.9-6.8 ng/g d.w. interval; a linear method was used with correlation coefficients (r) higher than 0.99. Recovery percentages at low concentrations (25 ng/g d.w.) were 75.8%-110%, and at high concentrations (75 ng/g d.w.) 82.3%-109%; the evaluated precision as RSD% of repeatability and reproducibility were within a range of 0.5%-11% and 0.3%-18%, respectively.

Rapid analysis of persistent organic pollutants by solid phase microextraction in serum samples.

A simple and rapid headspace solid-phase microextraction (HS SPME) based method is presented for the determination of Persistent Organic Pollutants (POPs) in human serum by gas chromatography (GC) coupled to mass detector (MS) with electron impact ionization (EI). As an outcome of the assessment of several polymer phases; the one with the best result was the PDMS fiber (100 µm). A multivariate analysis of variance by permutations (PERMANOVA) was performed to establish the optimal extraction conditions as a function of temperature and time variables. The results were 1 mL serum+200 µL H2SO4 9M+1 mL of deionized water at 600 rpm with a temperature of 80°C for 50 min to expose the fiber. The limits of detection (LOD) for POPs pesticides fell within the 0.22-5.41 ng/mL interval, and within 0.07-1.79 ng/mL for PCBs; a linear method was used with correlation coefficients (r) higher than 0.99. Recovery percentages at low concentrations (15 ng/mL) were 67.8-120.2%, and at high concentrations (75 ng/mL) 80.2-119.2%. Evaluated precision as percentage Relative Standard Deviation (RSD%) of repeatability and reproducibility was within a range of 0.5-9% and 0.3-21%, respectively. This analytical method prevents some of the main problems for quantifying POPs in human serum, such as the elimination of the solvents, sample handling, integration of extraction steps, pre-concentration and introduction of samples; consequently, the time and cost of analyzing the sample can be significantly reduced. The method developed was applied to determine exposure to POPs in samples of children living in different polluted sites in Mexico. In children living in indigenous communities results show exposure to DDE (median 29.2 ng/mL range 17.4-52.2 ng/mL) and HCB (median 2.53 ng/mL range 2.50-2.64 ng/mL); whereas in the industrial scenario, exposure to HCB (median 2.81 ng/mL range 2.61-3.4 ng/mL) and PCBs (median Σ-PCBs 22.2 ng/ml range 8.2-74.6 ng/mL) and finally in petrochemical scenario was demonstrated exposure to HCB (median 2.81 ng/mL range 2.61-3.4 ng/mL) and PCBs (Σ-PCBs median 7.9 ng/mL range 5.4-114.5 ng/mL).

Infecciones del tracto urinario bajo en adultos y embarazadas: consenso para el manejo empírico / Lower Urinary Tract Infections in Adults and Pregnant Women: A Consensus for Empirical Treatment

Introducción: La infección no complicada del tracto urinario bajo y la bacteriuria asintomática son causas frecuentes de consulta médica ambulatoria y en el servicio de urgencias en Colombia y el mundo. La falta de pautas y consenso para el manejo, así como la emergencia de resistencia a las múltiples opciones terapéuticas disponibles en los uropatógenos provenientes de la comunidad, hacen necesario elaborar unas recomendaciones que orienten al clínico sobre el abordaje óptimo de estas entidades. Objetivo: Definir un consenso sobre el manejo empírico de la bacteriuria asintomática y la infección del tracto urinario (ITU) bajo en adultos y mujeres embarazadas en Colombia. Metodología: Se lleva a cabo una metodología de consenso con expertos en urología, infectología, medicina interna, ginecología y microbiología basada en la revisión de las referencias bibliográficas disponibles en los términos de búsqueda relacionados, haciendo énfasis en estudios locales. Resultados: Se elaboró un algoritmo de manejo para el tratamiento empírico de la ITU baja no complicada en adultos con antisépticos urinarios como nitrofurantoína y fosfomicina trometamol como primera línea, con recomendaciones terapéuticas específicas para el tratamiento de la bacteriuria asintomática en mujeres embarazadas. Adicionalmente, se formuló un algoritmo de decisión para el procesamiento de cultivos de orina. La recurrencia o recaída frecuente justifica remisión a urología e infectología. Conclusiones: Se generan recomendaciones prácticas de fácil implementación en el diagnóstico y manejo de la ITU bajo en adultos y embarazadas, y de los casos donde es necesario tratar la bacteriuria asintomática, con opciones terapéuticas efectivas y de espectro reducido.

Background: Uncomplicated infection of the lower urinary tract and asymptomatic bacteriuria are frequent causes of visits to outpatient clinics and emergency departments in Colombia and worldwide. The lack of guidelines and a consensus for their management, and the emergence of resistance of community-based uropathogens to the available therapeutic options, make it necessary to develop recommendations to guide clinicians on the optimal approach to these entities. Objective: Define a consensus for the empiric management of asymptomatic bacteriuria and Urinary Tract Infection (UTI) in adults and pregnant women in Colombia. Methods: We carried out a consensus methodology with experts in urology, infectious diseases, internal medicine, gynecology and clinical microbiology; based on reviewing the available literature on the related terms, and emphasizing local studies. Results: We developed a management algorithm for the empirical treatment of uncomplicated lower UTI in adults with urinary antiseptics such as nitrofurantoin and fosfomycin trometamol as first line, with specific therapeutic recommendations for the treatment of asymptomatic bacteriuria in pregnant women. Additionally, we created a decision algorithm for processing urine cultures. Frequent recurrence or relapse justifies referral to urology and infectious disease professionals. Conclusions: We generated straightforward and easy-to-implement recommendations for the diagnosis and management of UTI in adults and pregnant women, and in cases where it is necessary to treat asymptomatic bacteriuria, with effective therapeutic and narrow spectrum options.

[Mexican consensus on portal hypertension]. / Consenso Mexicano de Hipertensión Portal.

The aim of the Mexican Consensus on Portal Hypertension was to develop documented guidelines to facilitate clinical practice when dealing with key events of the patient presenting with portal hypertension and variceal bleeding. The panel of experts was made up of Mexican gastroenterologists, hepatologists, and endoscopists, all distinguished professionals. The document analyzes themes of interest in the following modules: preprimary and primary prophylaxis, acute variceal hemorrhage, and secondary prophylaxis. The management of variceal bleeding has improved considerably in recent years. Current information indicates that the general management of the cirrhotic patient presenting with variceal bleeding should be carried out by a multidisciplinary team, with such an approach playing a major role in the final outcome. The combination of drug and endoscopic therapies is recommended for initial management; vasoactive drugs should be started as soon as variceal bleeding is suspected and maintained for 5 days. After the patient is stabilized, urgent diagnostic endoscopy should be carried out by a qualified endoscopist, who then performs the corresponding endoscopic variceal treatment. Antibiotic prophylaxis should be regarded as an integral part of treatment, started upon hospital admittance and continued for 5 days. If there is treatment failure, rescue therapies should be carried out immediately, taking into account that interventional radiology therapies are very effective in controlling refractory variceal bleeding. These guidelines have been developed for the purpose of achieving greater clinical efficacy and are based on the best evidence of portal hypertension that is presently available.

Assessment of exposure to lead in humans and turtles living in an industrial site in Coatzacoalcos Veracruz, Mexico.

The intake of lead from the environment may occur thru various receptors. In order to measure lead levels absorbed, samples were taken from Children who live in three localities surrounding an industrial complex in Coatzacoalcos, Veracruz. Samples were also taken from turtles. Samples were analyzed and results were compared against the general population. In children tested, over 75% of all values were determined to be above CDC's safety levels of (10 µg/dL). The geometric mean lead concentration was 11.4 µg/dL, which is clearly higher around the industrial complex than in the general population. In turtles, lead blood levels in the exposed population were 2-fold above (24.2 µg/dL) those of turtles in the reference population (10.1 µg/dL). Lead levels observed represent a risk for both human and fauna health.

Paramphistomicidal efficacy of an experimental compound in sheep.

The aim of the present study was to determine the paramphistomicidal efficacy of methyl [5-chloro-6-(1-naphthyloxy)-1H-benzimidazol-2-yl]carbamate (alpha-carbamate) in experimentally infected sheep. Sixteen crossbred rams were infected each with 600 metacercariae of Calicophoron calicophorum. Forty five days after infection, they were divided into four groups of four animals each. Groups 1 to 3 received compound alpha-carbamate at a dose of 12, 18, and 24 mg/kg b/w, respectively; group 4 serving as the nontreated control. Ten days after treatment, all animals were killed to obtain the rumen and collect, measure, and quantify the trematodes present. Efficacy was assessed as the percentage of trematode reduction of the treated groups relative to the nontreated control. The obtained efficacy indicated a percentage reduction of 86.7%, 97.5%, and 100% for groups 1, 2, and 3, respectively. This experimental compound showed high efficacy against 45-day-old C. calicophorum in experimentally infected sheep.

Proteolytic activities in body and faecal extracts of the storage mite, Acarus farris.

Trypsin, chymotrypsin, cathepsins B and D, aminopeptidase and carboxypeptidases A and B were detected in body extracts of the storage mite Acarus farris (Oudemans) (Astigmata: Acaridae). Faeces-enriched medium exhibited higher (10-50-fold) specific protease activity rates than those measured with mite body extracts for trypsin, chymotrypsin and carboxypeptidases A and B, suggesting that they are involved in mite digestion. However, the activity of cathepsin B was only three-fold higher in faecal than in body extracts, indicating that its presence in the lumen of the digestive tract is low compared to that of serine proteases. The activity of aminopeptidases was higher in mite bodies, indicating that they might be membrane bound. Cathepsin D activity was only detected in body extracts, indicating that this enzyme is not a digestive protease in this species. Zymograms resolved three major bands of gelatinolytic activity, but at least one protease form was only present in body extracts. Protease inhibitors of different specificity were tested in vivo to establish their potential as control agents. The development of A. farris was significantly retarded when the immature stages were fed on artificial diet containing inhibitors of serine and cysteine proteases and aminopeptidases, whereas no such effect was found with inhibitors of aspartyl proteases and carboxypeptidases. Interestingly, the most significant effects on A. farris occurred when a combination of inhibitors targeting different enzyme classes was supplied mixed in the diet, suggesting a synergistic toxicity. Several plant lectins were also tested, but only wheat germ agglutinin and concanavalin-A affected development.

Management of diarrhoea in HIV-infected patients.

Human immunodeficiency virus (HIV) infection can weaken the immune system causing its inability to combat opportunistic infections. Managing the complexity of these opportunistic infections has created a challenge for healthcare professionals. Our knowledge on the aetiological agents causing opportunistic infections in immunocompromised hosts has increased over the last decade. Diarrhoeal diseases are frequent complications associated with HIV-infected patients. For most of the causes of diarrhoea, the clinical signs are non-specific, and the laboratory diagnostic workup is neither easy nor fast. This review provides data on aetiological approaches of common diarrhoeal diseases including viral, microbacterial, parasitic, bacterial and fungal infections, and HIV enteropathy; diagnostic evaluation; and treatment of diarrhoea in HIV-infected patients. This article will be helpful for those who are in the practice of managing diarrhoea in such patients.

Gallbladder bile tumor marker quantification for detection of pancreato-biliary malignancies.

BACKGROUND: The pre-operative differentiation of tumors of the pancreas, Papilla of Vater and the biliary tract is still unsatisfactory. Tumor marker analysis of the pancreatic juice did not improve the pre-operative diagnosis by a great deal. METHODS: Bile from resected gallbladders of patients suffering from carcinomas of the pancreato-biliary system was analysed for CA 19-9, CEA, CA 72-4, CA 125 and AFP concentrations. The results were compared to patients suffering from acute cholecystitis, cholecystolithiasis as well as those suffering from benign tumors of the pancreato-biliary region. RESULTS: Extreme high CA 19-9 concentrations were found in bile. Evaluations of the tumor-antigens CA 19-9, CA 72-4 and CEA in gallbladder bile were superior to any serum and pancreatic juice examination with respect to sensitivity and specificity. Observed sensitivities amounted to 100% for patients suffering from bile duct carcinoma (CA 19-9) and papillary carcinoma (CEA) at a specificity of 100%. CA 19-9 showed a sensitivity of 76.5% for pancreatic carcinomas at a specificity of 96.4%. CA 19-9 showed significant differences for the local tumor burden and for the degree of lymph node metastasis. Examination of tumor antigens in the gallbladder results in a high degree of discrimination for malignant and benign lesions of the subhepatic pancreato-biliary system. CONCLUSIONS: CA 19-9 must follow a entero-hepatic circulation, since it showed raised bile concentrations (factor: 10(4)) compared to serum analysis. Analysis of CA 19-9, CEA and CA 72-4 gives an opportunity for improvement in the detection of cancers of the pancreato-biliary system. Since the clinical important differentiation of tumors of the head of the pancreas (carcinoma vs. pancreatitis) remains unclear, an improvement by bile analyses must be assumed.

Self-awareness in diabetes: using body cues, circumstances, and strategies.

PURPOSE: This research was the first phase of a study designed to develop and pilot test an educational program to increase self-awareness of salient body cues in adults with Type 1 diabetes. The purpose of this study was to identify (1) the cues, sensations, and circumstances that people with diabetes and their families associate with hypoglycemia, euglycemia, and hyperglycemia; and (2) the types of strategies that people with diabetes use to tune in to body cues and sensations. METHODS: A series of four focus group sessions were held at monthly intervals with four female participants and four family members. These sessions were audiotaped and transcribed verbatim. RESULTS: Participants described the existence of unique as well as usual body cues for hyperglycemia and hypoglycemia and the circumstances associated with these cues. Subjective and objective strategies were identified for tuning into these body cues and sensations. CONCLUSIONS: People with diabetes should be encouraged to identify their own body cues that signify different levels of glycemia because these personal cues may be different than classical textbook symptoms. Even people with hypoglycemia unawareness may recognize unique cues that replace the autonomic ones they have lost.