Multidisciplinary practice guidelines for the diagnosis, genetic counseling and treatment of pheochromocytomas and paragangliomas.

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic/parasympathetic neural ganglia, respectively. The heterogeneity in its etiology makes PPGL diagnosis and treatment very complex. The aim of this article was to provide practical clinical guidelines for the diagnosis and treatment of PPGLs from a multidisciplinary perspective, with the involvement of the Spanish Societies of Endocrinology and Nutrition (SEEN), Medical Oncology (SEOM), Medical Radiology (SERAM), Nuclear Medicine and Molecular Imaging (SEMNIM), Otorhinolaryngology (SEORL), Pathology (SEAP), Radiation Oncology (SEOR), Surgery (AEC) and the Spanish National Cancer Research Center (CNIO). We will review the following topics: epidemiology; anatomy, pathology and molecular pathways; clinical presentation; hereditary predisposition syndromes and genetic counseling and testing; diagnostic procedures, including biochemical testing and imaging studies; treatment including catecholamine blockade, surgery, radiotherapy and radiometabolic therapy, systemic therapy, local ablative therapy and supportive care. Finally, we will provide follow-up recommendations.

Clinical Factors Associated with High Glycemic Variability Defined by Coefficient of Variation in Patients with Type 2 Diabetes.

BACKGROUND: High glycemic Variability (HGV) has become a stronger predictor of hypoglycemia. However, clinical factors associate with HGV still are unknown. OBJECTIVE: To determine clinical variables that were associated with a coefficient of variation (CV) above 36% evaluated by continuous glucose monitoring (CGM) in a group of patients with diabetes mellitus. METHODS: A cohort of patients with type 2 diabetes (T2D) was evaluated. Demographic variables, HbA1c, glomerular filtration rate (GFR) and treatment regimen were assessed. A bivariate analysis was performed, to evaluate the association between the outcome variable (CV> 36%) and each of the independent variables. A multivariate model was constructed to evaluate associations after controlling for confounding variables. RESULTS: CGM data from 274 patients were analyzed. CV> 36% was present in 56 patients (20.4%). In the bivariate analysis, demographic and clinical variables were included, such as time since diagnosis, hypoglycemia history, A1c, GFR and treatment established. In the multivariate analysis, GFR <45 mL/min (OR 2.81; CI 1.27,6.23; p:0.01), A1c > 9% (OR 2.81; CI 1.05,7.51; p:0.04) and hypoglycemia history (OR 2.09; CI 1.02,4.32; p:0.04) were associated with HGV. Treatment with iDPP4 (OR 0.39; CI 0.19,0.82; p:0.01) and AGLP1 (OR 0.08; CI 0.01,0.68; p:0.02) was inversely associated with GV. CONCLUSION: Clinical variables such as GFR <45 mL/min, HbA1C>9% and a history of hypoglycemia are associated with a high GV. Our data suggest that the use of technology and treatments able to reduce glycemic variability could be useful in this population to reduce the risk of hypoglycemia and to improve glycemic control.

Cellulose-Silica Nanocomposites of High Reinforcing Content with Fungi Decay Resistance by One-Pot Synthesis.

Hybrid bionanocomposites based on cellulose matrix, with silica nanoparticles as reinforcers, were prepared by one-pot synthesis of cellulose surface modified by solvent exchange method to keep the biopolymer net void for hosting inorganic nanoparticles. Neither expensive inorganic-particle precursors nor crosslinker agents or catalysts were used for effective dispersion of reinforcer concentration up to 50 wt %. Scanning electron microscopy of the nanocomposites shows homogeneous dispersion of reinforcers in the surface modified cellulose matrix. The FTIR spectra demonstrated the cellulose features even at 50 weight percent content of silica nanoparticles. Such a high content of silica provides high thermal stability to composites, as seen by TGA-DSC. The fungi decay resistance to Trametes versicolor was measured by standard test showing good resistance even with no addition of antifungal agents. This one-pot synthesis of biobased hybrid materials represents an excellent way for industrial production of high performance materials, with a high content of inorganic nanoparticles, for a wide variety of applications.

Formulación de políticas públicas sobre el cáncer de mama en América Latina / Public policy-making on breast cancer in Latin America

OBJETIVO: Conocer el proceso de formulación de política pública sobre la atención del cáncer de mama en cinco países de América Latina. MÉTODOS: Estudio evaluativo exploratorio realizado en Argentina, Brasil, Colombia, México y Venezuela en 2010. La muestra de países seleccionados fue de conveniencia. Se realizaron 65 entrevistas semiestructuradas a funcionarios gubernamentales, académicos y representantes de gremios profesionales y de organizaciones de la sociedad civil. Se realizó un análisis de contenido para fuentes secundarias. Se integraron fuentes de información, datos e informantes para el análisis mediante el método de triangulación. RESULTADOS: Los países con mayor avance en la formulación de políticas públicas sobre el cáncer de mama son Brasil y México. Argentina, Colombia y Venezuela, pese a no tener una política definida, disponen de programas y acciones para su atención. Se distinguen dos perspectivas de desarrollo para estas políticas públicas: una con amplia participación de los sectores gubernamental y no gubernamental, y otra más restringida a la participación exclusiva de autoridades gubernamentales. CONCLUSIONES: Los resultados traducen importantes diferencias entre países en la formulación de políticas públicas sobre el cáncer de mama en la Región y destacan el mayor avance en aquellos países donde se han desarrollado a través de procesos de participación incluyente.

OBJECTIVE: To understand the public policy-making process as it relates to breast cancer care in five Latin American countries. METHODS: An exploratory-evaluative study was conducted in Argentina, Brazil, Colombia, Mexico, and Venezuela in 2010, with the selection of countries based on convenience sampling. Sixty-five semi-structured interviews were conducted with government officials, academics, and representatives of trade associations and civil society organizations. A content analysis of secondary sources was performed. Information sources, data, and informants were mixed using the triangulation method for purposes of analysis. RESULTS: The countries that have made the most progress in public policy-making related to breast cancer are Brazil and Mexico. Although Argentina, Colombia, and Venezuela do not have policies, they do have breast cancer care programs and activities. Two perspectives on the development of public policies became evident: the first includes the broad participation of both governmental and nongovernmental sectors, whereas the second, more narrow approach involves government authorities alone. CONCLUSIONS: The results point to significant differences in public policy-making related to breast cancer in the Region. They also show that greater progress has been made in countries where policies have been developed through inclusive participation processes.

Variantes anatómicas de la segmentación bronquial, prevalencia y diagnóstico mediante TC multidetector 64 canales / Bronchial segmentation: anatomical variants, prevalence, and diagnosis by 64-channel multidetector CT

Purpose. A) To determine types and prevalence of anatomical variants of bronchial segmentation in patients who underwent 64-section Multidetector CT (MDCT) of the chest. B) To evaluate the ability of this method as a diagnostic tool. Material and methods. We conducted a retrospective review of chest computed tomography studies of 156 adult patients, performed with Toshiba, Aquilion 64 CFX, CT Scanner Equipment, with chest volumetric acquisitions, and cuts of 0.5 mm. Images obtained allowed MPR and 3D reconstructions, along with virtual endoscopic visualization of the tracheobronchial tree, in the study period from may 2007 to may 2011, irrespective of reasons to request those examinations. Results. Eighty-nine (57 percent) of the 156 cases corresponded to male patients and 67 (43 percent) to female.patients. Fifty-two variants were found in 47 patients, since in five of them two variants were observed. The most commonly encountered variants were: variant of number (28 variants, 53 percent), of which 15 (28 percent) showed sub-superior lobar bronchus, 6 (11 percent) accessory bronchus in the left lower lobe; 5 (10 percent) isomerism of lower lobes, and 2 (4 percent) accessory bronchus in the right upper lobe. Among variations of origin (24 variants, 47 percent) we found 17 variants (33 percent) with right upper lobe bifurcation; 6 (12 percent) exhibited trifurcation of the left upper lobe bronchus, and 1 (2 percent) showed accessory tracheal bronchus. Conclusion. Anatomical variants in the tracheobronchial tree exhibited a prevalence of 33 percent in our study population. We found 52 variants in 47 patients, the most common being bifurcation of the right upper lobe bronchus, and subsuperior lobar bronchus. The study of anatomical variants, along with total anatomy of the tracheobronchial tree by 64 MDCT, irrespective of study protocol applied, can provide useful information prior to performing more invasive procedures, such as conventional bronchoscopy.

Propósito. Conocer tipos y prevalencia de las variantes anatómicas de la segmentación bronquial, en pacientes a quienes se les realizó TC de Tórax Multidetector 64 (TCMD 64). Evaluar la capacidad de este método para el diagnóstico de las mismas. Material y métodos. Se estudiaron en forma retrospectiva los estudios tomográficos que incluyeron el tórax, en 156 pacientes adultos, con tomógrafo Toshiba Aquilion 64, con adquisiciones volumétricas del tórax, cortes de 0.5 mm, obteniendo imágenes que permitieron reconstrucciones MPR, 3D y visualización endoscópica virtual traqueobronquial, en el período entre mayo de 2007 y mayo de 2011, independientemente del motivo por el cual fueron solicitados. Resultados. De los 156 estudios examinados, 89 (57 por ciento) fueron de sexo masculino y 67 (43 por ciento) femenino. En su análisis se encontraron 52 variantes, en 47 pacientes, ya que en cinco de ellos se observaron dos variantes. Entre las más frecuentes fueron: de número (28 variantes-53 por ciento), de las cuales: 15 (28 por ciento) con bronquio sub-superior; 6 (11 por ciento) bronquio accesorio en lóbulo inferior izquierdo; 5 (10 por ciento) isomerismo de lóbulos inferiores; y 2 (4 por ciento) bronquio accesorio en lóbulo superior derecho. Entre las variantes de origen (24 variantes-47 por ciento) encontramos 17 variantes (33 por ciento) con bifurcación del lóbulo superior derecho; 6 (12 por ciento) trifurcación del bronquio del lóbulo superior izquierdo; y 1 (2 por ciento) bronquio traqueal accesorio. Conclusión. Las variantes anatómicas en el árbol traqueobronquial presentaron una prevalencia en nuestra población de estudio del 33 por ciento, hallándose 52 en 47 pacientes, siendo las más frecuentes la bifurcación del lóbulo superior derecho y el bronquio subsuperior. Su estudio y el de la anatomía total del árbol traqueo-bronquial mediante TCMD 64, independientemente del protocolo de estudio empleado, puede aportar información de utilidad...

Biofouling and pollutant removal during long-term operation of an anaerobic membrane bioreactor treating municipal wastewater.

Two different sludge retention times (SRTs) were tested in order to assess the impact on membrane fouling and effluent quality in an anaerobic membrane bioreactor (AnMBR). Two up-flow anaerobic sludge bed (UASB) reactors (1 l volume) coupled to external tubular ultrafiltration membranes (filtration area = 81 cm(2)) were operated at a hydraulic retention time of 3 h and two different SRTs (100 and 60 days). The transmembrane pressure (TMP), flux (J) and relevant parameters to assess water quality were measured. Effluents from UASB reactors were filtered for 500 h without intermediate cleaning. The permeate met Mexican standards for wastewater reclamation in both tested conditions. Abrupt and periodical changes in the TMP and J were noticed during the experimental period. A fouling layer collapse and compression hypothesis was set forth in order to explain these changes. An autopsy performed on biofouled membranes indicated that deposited mass was mainly composed of volatile solids (85%) and the rest related to mineral matter, with the presence of inorganic salts containing Ca, Mg, Fe, P and Si. Biomass in the fouling layer was estimated at 0.27% based on the DNA/biomass ratio for the bacterial biofilm. No clear difference in membrane fouling was detected under the two SRTs applied to the systems. However, when operated over 500 h, repetitive sudden TMP and flux changes occurred later in system A (SRT of 100 days) than in system B (SRT of 60 days) suggesting a stronger fouling layer structure in the former.

Prioridades de investigación en salud en Colombia: perspectiva de los investigadores / Health research priorities in Colombia from the researchers' point of view

Colombia tiene una escasa experiencia en identificar prioridades de investigación en salud. En el año 2004 se inició un proyecto para identificar prioridades de investigación en salud, entendiendo por tales las que resultan de un ejercicio ordenado de ponderación basado en una valoración juiciosa de problemáticas sanitarias cuya respuesta y/o solución puede lograrse en gran parte por medio de conocimientos y procesos de investigación. Como referentes del proyecto se tuvieron en cuenta algunos de los métodos de priorización utilizados y recomendados en el ámbito internacional, entre ellos la matriz combinada del Global Forum for Health Resarch. Se pusieron en práctica dos trayectos metodológicos principales: por una parte, diseño y aplicación de un método para ponderar u ordenar, de manera cualitativa y cuantitativa, las problemáticas de investigación en salud; por otra parte, construcción de consensos con investigadores y representantes de comunidades científicas. Para identificar las problemáticas de salud predominantes se realizaron dos reuniones nacionales, dos reuniones regionales y un foro virtual. Una vez identificadas las problemáticas de salud predominantes, con su respectiva estimación de carga de enfermedad, estas se valoraron por políticos y decisores y se calificaron por investigadores de ciencias básicas, ciencias clínicas y salud pública, en términos del aporte del conocimiento requerido para afrontar, controlar o resolver tales problemáticas. Se obtuvieron unas prioridades de investigación en salud por áreas globales: enfermedades crónicas, enfermedades infecciosas emergentes, Tuberculosis/Lepra, infección nosocomial e infecciones de transmisión sexual/VIH/SIDA.

Colombia lacks experience in identifying health research priorities. A project for idenifying health research priorities was begun in 2004 (meaning those arising from weighting and ordering health and disease problems which could be mainly resolved by research and knowledge). The Global Forum for Health Research combined matrix method, and other methods, was used as reference for developing projects and putting two main methodological paths into practice: designing and applying a method for qualitatively and quantitatively weighting and ordering health research problems and building consensus with researchers and scientific community representatives. Two national meetings, two regional meetings and a virtual forum were held for identifying predo­minant health problems. Once the predominant health problems had been identified (with the respective estimation of disease load), then they were evaluated by politi­cians and decision-makers and rated by basic science, clinical science and public health researchers in terms of making a contribution towards knowledge for facing, controlling or resolving such problems. Some health research priorities were obtained (by areas and others being overall priorities): chronic diseases, emergent infectious diseases, tuberculosis/leprosy, nosocomial infection and sexually transmitted diseases/HIV/AIDS.

Escritura, comunicación científica y acceso abierto: un proyecto internacional y multidisciplinario-NECOBELAC / Scientific writing, scientific communication and open access: an international, multidisciplinary project NECOBELAC

Una red de colaboración entre seis países de Europa, América latina y El Caribe ha iniciado un proyecto para mejorar la comunicación y la diseminación científica en salud pública. El proyecto apunta a fomentar la comunicación científica en aspectos de valor actual y futuro como son la escritura científica y el acceso abierto a la información en salud. El proyecto NECOBELAC (www.necobelac.eu) es auspiciado por la Comunidad Europea (7th Framework Programme) y tiene una duración de tres años. Como un reto, el proyecto reconoce las diferencias socio culturales entre los países que participan y se ocupará de generar redes de instituciones en colaboración estrecha para realizar programas de entrenamiento e intercambio de saberes en producción de información y difusión (incluyendo los aspectos técnicos y éticos). El proyecto NECOBELAC incluye al Istituto Superiore di Sanità (ISS) de Italia, coordinador del mismo, el Consejo Superior de Investigaciones Científicas (CSIC) de España, la Universidad de Nottingham (SHERPA) del Reino Unido, BIREME de Brasil, el Instituto de Salud Pública (ISP) de Colombia y la Universidade de Minho, de Portugal.

A collaboration network involving 6 countries in Europe, Latin-America and the Caribbean has embarked on a project (Network of Collaboration Between Europe and Latin American Caribbean Countries-NECOBELAC; www.necobelac.eu) aimed at improving scientific writing open access and scholarly communication to spread know-how regarding current and future issues and information related to health. The NECOBELAC project is sponsored by the European Community (7th Framework Programme) and will last for 3 years. The project recognises the challenge arising from socio-cultural differences between the participating countries and will deal with generating networks involving institutions working in close collaboration for carrying out training and know-how exchange programmes aimed at producing open access information and spreading it (including technical and ethical aspects). The NECOBELAC project currently involves the Istituto Superiore di Sanità - ISS from Italy (coordinating the project), the Consejo Superior de Investigaciones Científicas (CSIC) from Spain, the University of Nottingham (SHERPA) from the United Kingdom, BIREME from Brazil, the Instituto de Salud Pública (ISP) from Colombia and the Universidade de Minho from Portugal.

[Outbreak of viral meningitis caused by echovirus type 4 in Misiones province]. / Brote epidémico de meningitis viral causado por echovirus tipo 4 en la provincia de Misiones.

A descriptive retrospective study was carried out to describe an epidemic outbreak of enteroviral meningitis in Misiones. We reviewed records of 143 children from 1 month to 14 years of age who were hospitalized with aseptic meningitis in the Pediatric Hospital of Posadas from August to December 2005. Increased number of cases was observed between weeks 33 to 50 which reached a maximum peak in weeks 47 and 48, confirming an outbreak. The median of age was 8 years old, 55.2% were males. Eighty percent of cases were in 5 to 14 years old children. The average length of time spent in the hospital was 4.5+/-1.7 days, no deaths were reported. We performed cell counts, chemical and bacterial studies of CSF, and culture or RT-Nested/PCR for enteroviruses. Isolates were serotyped by RT-PCR amplification and genetic sequencing. Cell counts were from 6 to 5040 cells/mm3. Ninety two percent had less than 500 cells/mm3 and 43.5% had lymphocyte predominance. Glucose levels were normal with slightly elevated protein counts in 56% of cases. Of the cultured samples, 28% (17/60) showed cytopathic effect compatible with enterovirus. RT-n-PCR detected enterovirus in 73% (43/59) of the analyzed CSF. Echovirus type 4 was identified in 6 of them. The positive indicator obtained by combining both techniques was 83% (58/70).

Brote epidémico de meningitis viral causado por echovirus tipo 4 en la provincia de Misiones / Outbreak of viral meningitis caused by echovirus type 4 in Misiones province

Se realizó un estudio retrospectivo a fin de describir un brote epidémico de meningitis causado por enterovirus, que comprometió a 143 niños de 1 mes a 14 años internados en el Hospital Pediátrico de Posadas (Misiones) con diagnóstico de meningitis aséptica, entre agosto y diciembre de 2005. Se observó un aumento de casos entre las semanas 33 a 50, con un pico máximo entre las semanas 47 y 48, lo que confirmó el brote. La mediana de edad de los niños afectados fue de 8 años y el 55,2% fueron varones. El 80% de los casos se observó entre escolares (5 a 14 años). El promedio del tiempo de internación fue de 4,5 ± 1,7 días, y no se registraron fallecidos. Los LCR se estudiaron mediante examen citoquímico y estudios bacteriológicos y virológicos (aislamiento viral, RT- PCR anidada e identificación molecular mediante secuenciación génica). Los recuentos de células en LCR variaron entre 6 y 5040 células /mm3, el 92% fueron inferiores a 500 células/mm3 y el 43,5% mostró predominio linfocitario. El 56% presentó concentraciones de glucosa normal, con proteínas ligeramente elevadas. El 28% de las muestras estudiadas por cultivo (17/60) mostró efecto citopático, compatible con enterovirus. La RT-PCR anidada permitió detectar enterovirus en un 73% de las muestras (43/59), con 6 casos que se tipificaron como echovirus tipo 4. El índice de positividad al combinar ambas técnicas alcanzó el 83%.

A descriptive retrospective study was carried out to describe an epidemic outbreak of enteroviral meningitis in Misiones. We reviewed records of 143 children from 1 month to 14 years of age who were hospitalized with aseptic meningitis in the Pediatric Hospital of Posadas from August to December 2005. Increased number of cases was observed between weeks 33 to 50 which reached a maximum peak in weeks 47 and 48, confirming an outbreak. The median of age was 8 years old, 55.2% were males. Eighty percent of cases were in 5 to 14 years old children. The average length of time spent in the hospital was 4.5±1.7 days, no deaths were reported. We performed cell counts, chemical and bacterial studies of CSF, and culture or RT-Nested/PCR for enteroviruses. Isolates were serotyped by RT-PCR amplification and genetic sequencing. Cell counts were from 6 to 5040 cells/mm3. Ninety two percent had less than 500 cells/mm3 and 43.5% had lymphocyte predominance. Glucose levels were normal with slightly elevated protein counts in 56% of cases. Of the cultured samples, 28% (17/60) showed cytopathic effect compatible with enterovirus. RT-n-PCR detected enterovirus in 73% (43/59) of the analyzed CSF. Echovirus type 4 was identified in 6 of them. The positive indicator obtained by combining both techniques was 83% (58/70).

[Natural contamination with mycotoxins in forage maize and green coffee in Nayarit State (Mexico)]. / Contaminación natural con toxinas en maíz forrajero y granos de café verde en el Estado de Nayarit (México).

The presence of mycotoxins in forage maize (zearalenone, fumonisin B1, T-2 toxin and diacetoxyscirpenol) and green coffee (ochratoxin A) from Nayarit State (Mexico) has been studied. All maize samples analyzed showed fumonisin B1 contamination, with an average concentration of 2,541 microg/kg. Fifteen percent of the samples contained zearalenone, with an average concentration of 1,610 microg/kg. Only one sample showed T-2 toxin contamination (7 microg/kg), and no diacetoxyscirpenol was detected. Sixty-seven per cent of green coffee samples were contaminated with ochratoxin A, with an average concentration of 30.1 microg/kg. This is the first study about mycotoxins developed in Nayarit and it has shown that mycotoxin contamination is a real problem in both foodstuffs studied.

Use of monoclonal antibodies in diagnosis of paracoccidioidomycosis: new strategies for detection of circulating antigens.

The precise diagnosis of paracoccidioidomycosis, in most cases, is established by direct methods and indirect immunological tests. The latter method is reliant on the identification of the host's humoral responses, which are usually impaired or absent in patients with severe juvenile forms of the disease and in immunocompromised patients. Determining disease activity or assessing treatment responses by measuring antibody levels is difficult, since antibody titer may remain elevated or persist at stationary levels, even in the presence of clinical improvement. Consequently, there is a need for alternative tests aimed at the identification of circulating antigens. A modification of the standard hybridoma production method was used to raise a panel of murine monoclonal antibodies (MAbs) against the yeast form of Paracoccidioides brasiliensis. Of these, MAb PIB, directed against an 87-kDa determinant, was used to develop an inhibition ELISA (inh-ELISA) capable of detecting as little as 5.8 ng of circulating antigen per ml of serum. Sera from 46 patients with paracoccidioidomycosis or other mycoses and sera from healthy individuals were evaluated by the inh-ELISA; overall sensitivity was 80.4% (37 of 46 paracoccidioidomycosis patients tested positive), and specificity compared with that of normal controls from areas of endemicity was 81.4%. The inh-ELISA detected circulating antigen in 100% of patients with the acute form of paracoccidioidomycosis and in 83.3 and 60% of patients with the chronic multifocal and unifocal forms of paracoccidioidomycosis according to the patients' clinical presentation. These results indicate that the inh-ELISA with MAb PIB is effective in the detection of circulating antigen and that this test may be useful for monitoring responses to treatment and establishing disease prognoses.

Development of a novel antigen detection test for histoplasmosis.

Histoplasmosis is an important systemic fungal infection, particularly among immunocompromised individuals living or travelling in areas of endemicity, who, without antifungal therapy, may develop a progressive disseminated fatal infection. For such patients, the detection of antibody responses by immunodiffusion or complement fixation test is of limited use. In contrast, the detection of Histoplasma capsulatum circulating antigens may provide a more practical approach to the rapid diagnosis of the disease. Accordingly, an inhibition enzyme-linked immunosorbent assay (ELISA) for the detection of a 69- to 70-kDa H. capsulatum-specific determinant and incorporating a species-specific murine monoclonal antibody was developed. With sera from patients with different forms of the disease (n = 35), the overall sensitivity of the test was found to be 71.4%, while the specificity was found to be 98% with normal human sera from areas of endemicity (n = 44) and 85.4% with sera from patients with other chronic fungal or bacterial infections (n = 48). This novel, highly specific ELISA provides a significant addition to the existing diagnostic tests for the detection of histoplasmosis.

Estudios inmunológicos en pacientes afectos de miastenia gravis / Imunologic studies in patients affected by myasthenia gravis

Se estudiaron algunos aspectos del estado inmunológico de 30 pacientes miasténicos (24 mujeres y 6 hombres) diagnosticados en el Instituto de Neurología y Neurocirugía de Ciudad de la Habana. El grupo control estuvo constituido por 30 individuos sanos. El conjunto de estudios realizados a cada paciente abarcó tanto elementos de la inmunidad humoral como celular. Ellos fueron: RE, marcador de linfocitos T totales; RA, marcador de linfocitos T activos; EA, marcador de receptores para el fragmento Fc de la IgG en linfocitos; EAC, marcador de receptores para C3b en linfocitos B: inmunoglobulinas de superficie, marcador de linfocitos B; inhibición de roseta EAC para determinar inmunocomplejos circulantes; cuantificación de las concentraciones de los componentes C3 y C4 del sistema completo e inmunoelectroforesis de las proteínas séricas para valorar semicuantitativamente las concentraciones de las inmunoglobulinas séricas G, M y A. Las alteraciones inmunológicas encontradas tienen un carácter multifactorial, lo cual apoya el criterio de desequilibrios en la regulación de la repuesta inmune

Estudios inmunológicos en pacientes afectos de miastenia gravis / Immunologic studies in patients affected by myasthenia gravis

Se estudiaron algunos aspectos del estado inmunológico de 30 pacientes miasténicos (24 mujeres y 6 hombres) diagnosticados en el Instituto de Neurología y Neurocirugía de Ciudad de la Habana. El grupo control estuvo constituido por 30 individuos sanos. El conjunto de estudios realizados a cada paciente abarcó tanto elementos de la inmunidad humoral como celular. Ellos fueron: RE, marcador de linfocitos T totales; RA, marcador de linfocitos T activos; EA, marcador de receptores para el fragmento Fc de la IgG en linfocitos; EAC, marcador de receptores para C3b en linfocitos B: inmunoglobulinas de superficie, marcador de linfocitos B; inhibición de roseta EAC para determinar inmunocomplejos circulantes; cuantificación de las concentraciones de los componentes C3 y C4 del sistema completo e inmunoelectroforesis de las proteínas séricas para valorar semicuantitativamente las concentraciones de las inmunoglobulinas séricas G, M y A. Las alteraciones inmunológicas encontradas tienen un carácter multifactorial, lo cual apoya el criterio de desequilibrios en la regulación de la repuesta inmune

South American pemphigus foliaceus: study of an epidemic in El Bagre and Nechi, Colombia 1982 to 1986.

Between 1982 and 1986 we have had the chance to study 21 patients with pemphigus foliaceus of the 'fogo selvagem' type. The patients came from El Bagre and Nechi, rural areas of Colombia with some gold mining. This is the first outbreak of South American pemphigus foliaceus reported in Colombia. The majority of the patients were mestizo men, who worked as farmers or miners or both, with an average age of 44. Five patients were relatives. Eleven patients (52%) had mild disease, three (14%) moderate disease and seven (33%) severe disease. During hospitalization, three patients died due to complications or as a result of immunosuppressive treatment. Of the remaining 18 patients, 10 were in remission with treatment, one was in remission without treatment, while no information was available on the remaining seven.