Electrolyte disturbances in patients hospitalized for COVID-19 infection: An observational study.

There are multiple mechanisms by which The Coronavirus-19 (COVID-19) infection can cause electrolyte abnormalities, which may not be the case for bacterial causes of pneumonia. This study aimed to assess the differences in electrolyte levels between patients suffering from COVID-19 and bacterial pneumonia. This is an original, retrospective study. Two cohorts of hospitalized patients were included, 1 suffering from COVID-19 and the other from bacterial pneumonia. Their day 1 and day 3 levels of sodium, potassium, magnesium, and phosphorus, as well as their outcomes, were extracted from the charts. Statistical analysis was subsequently performed. Mean admission levels of sodium, potassium, phosphorus, and magnesium were 135.64 ±â€…6.13, 4.38 ±â€…0.69, 3.53 ±â€…0.69, and 2.03 ±â€…0.51, respectively. The mean day 3 levels of these electrolytes were 138.3 ±â€…5.06, 4.18 ±â€…0.59, 3.578 ±â€…0.59, and 2.11 ±â€…0.64, respectively. Patients suffering from bacterial pneumonia were significantly older (N = 219, mean = 64.88 ±â€…15.99) than patients with COVID-19 pneumonia (N = 240, mean = 57.63 ±â€…17.87). Bacterial pneumonia group had significantly higher serum potassium (N = 211, mean = 4.51 ±â€…0.76), and magnesium (N = 115, mean = 2.12 ±â€…0.60) levels compared to COVID-19 group (N = 227, mean = 4.254 ±â€…0.60 for potassium and N = 118, mean = 1.933 ±â€…0.38 for magnesium). Only magnesium was significantly higher among day 3 electrolytes in the bacterial pneumonia group. No significant association between electrolyte levels and outcomes was seen. We found that COVID-19 patients had lower potassium and magnesium levels on admission, possibly due to the effect of COVID-19 on the renin-angiotensin-aldosterone system as well as patient characteristics and management. We did not find enough evidence to recommend using electrolyte levels as a determinator of prognosis, but more research is needed.

High-flow nasal cannula during pulmonary rehabilitation for people with chronic obstructive pulmonary disease: A systematic review and meta-analysis.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an increasingly concerning global public health issue due to its high burden of morbidity and mortality. Pulmonary rehabilitation (PR) is a comprehensive intervention to improve patients' physical and psychological conditions, commonly involving oxygen supplementation. The potential benefits of high-flow nasal cannula (HFNC) have recently sparked interest as oxygen therapy. In this context, this study aims to assess the effects of HFNC during the exercise training component of a PR program in people with COPD. METHODS: Systematic review (CRD42022330929). We included randomised controlled trials (RCTs), including crossover RCTs with adults with stable COPD. We included trials using oxygen therapy with HFNC during the exercise training component of a PR programme. PRIMARY OUTCOMES: disease-specific health-related quality of life (HRQoL), exercise capacity (EC) and adverse events. SECONDARY OUTCOMES: treatment adherence, breathlessness and future exacerbations. RESULTS: We included five studies with 300 participants with moderate to severe COPD. The certainty of the evidence was primarily low or very low for all outcomes of interest due to risk of bias, inconsistency or imprecision. HFNC has little to no difference in HRQoL (4 studies, 129 participants, MD 0.17, 95% CI -1.20 to 1.54; I2 50%). HFNC may result in little to no difference in EC (3 studies, 212 participants, mean difference 18.73, 95% CI -20.49 to 28.94; I2 56%), and we are uncertain about the effect of HFNC on breathlessness (4 studies; 244 participants, MD of -0.07, 95% CI -0.4 to 0.26; I2 63%). Only one study with 44 participants reported a participant's withdrawal because of progressive dyspnoea during lower limb exercise. CONCLUSIONS: We are uncertain about the effect of HFNC during the exercise component of a PR programme in HRQoL, EC or dyspnoea compared to usual care or conventional supplementary oxygen. Non-domiciliary oxygen patients showed improvements in HRQoL, EC and dyspnoea.

Valor pronóstico de la hipoglucemia hospitalaria / Prognostic value of hospital hypoglycemia

Resumen Introducción: La hipoglucemia hospitalaria (HH) es un problema importante ya que se vincula a muerte hospitalaria, estadía prolongada y mayores costos, en personas con y sin diabetes, en área crítica y sala general, sobre todo en los casos de hipoglucemia grave. El objetivo de nuestro trabajo fue comparar la mortalidad hospitalaria, pase a área crítica y tiempo de internación en adultos con HH, según la gravedad de la misma. Métodos: Se realizó un estudio de cohorte retrospectiva en pacientes adultos interna dos con hipoglucemia en el Hospital Italiano de Buenos Aires entre 2013 y 2018. Se definieron tres grupos de hipoglucemia: leve (glucemia entre 70 y 54 mg/dl), grave (glucemia < 54 mg/dl ≥ 40 mg/dl) y crítica (glucemia < 40mg/dl). Resultados: Un total de 5994 pacientes tuvieron HH, la mayoría presentó hipoglucemia leve (72%). La hipoglucemia grave y la crítica, comparadas con la hipoglucemia leve se asociaron a una mayor mortalidad: OR 2.6 (IC95% 2.2-3.1) y 4.2 (IC95% 3.5-5.0) respectivamente; y a mayor internación en áreas de cuidados críticos: OR 1.6 (IC95% 1.4-1.9) y 3.2 (IC95% 2.6-4.0) respectivamente. No hubo diferencias en el tiempo de internación. Discusión: Esta información aporta evidencia en nuestro país, sobre el valor pronóstico de la hipo glucemia, cuya mayor gravedad se asocia a mayor internación en áreas críticas y mayor mortalidad hospitalaria.

Abstract Background: Hospital hypoglycemia (HH) is an important problem since it is linked to hospital death, prolonged stay and higher costs, both in people with and without diabetes, in the critical area and general ward, especially in cases of severe hypoglycemia. The objective of our work was to compare hospital mortality, transfer to the critical area and hospitalization periods in adults with HH according to its severity. Methods: We conducted a retrospective cohort of adults hospitalized with hypoglycemia at the Hospital Italiano de Buenos Aires between 2013 and 2018. Three groups of hypoglycemia were defined: mild (glycemia between 70 and 54 mg/dl), severe (glycemia < 54 mg/dl and ≥ 40 mg/dl) and critical (glycemia<40mg/dl). Results: A total of 5994 patients had HH, the majority presented mild hypoglycemia (72%). Severe and critical hypoglycemia, compared with mild hypo glycemia, were associated with higher mortality: OR 2.6 (95%CI 2.2-3.1) and 4.2 (95%CI 3.5-5.0) respectively; and increased hospitalization in critical care areas: OR 1.6 (95%CI 1.4-1.9) and 3.2 (95%CI 2.6-4.0) respectively. There were no differences in length of stay. Discussion: This information provides, in our country, evidence on the prognostic value of hypoglycemia, whose greater severity is associated with increased hospitalization in critical areas and higher hospital mortality.

[Prognostic value of hospital hypoglycemia]. / Valor pronóstico de la hipoglucemia hospitalaria.

BACKGROUND: Hospital hypoglycemia (HH) is an important problem since it is linked to hospital death, prolonged stay and higher costs, both in people with and without diabetes, in the critical area and general ward, especially in cases of severe hypoglycemia. The objective of our work was to compare hospital mortality, transfer to the critical area and hospitalization periods in adults with HH according to its severity. METHODS: We conducted a retrospective cohort of adults hospitalized with hypoglycemia at the Hospital Italiano de Buenos Aires between 2013 and 2018. Three groups of hypoglycemia were defined: mild (glycemia between 70 and 54 mg/dl), severe (glycemia < 54 mg/dl and = 40 mg/dl) and critical (glycemia < 40mg/dl). RESULTS: A total of 5994 patients had HH, the majority presented mild hypoglycemia (72%). Severe and critical hypoglycemia, compared with mild hypoglycemia, were associated with higher mortality: OR 2.6 (95%CI 2.2-3.1) and 4.2 (95%CI 3.5-5.0) respectively; and increased hospitalization in critical care areas: OR 1.6 (95%CI 1.4-1.9) and 3.2 (95%CI 2.6-4.0) respectively. There were no differences in length of stay. DISCUSSION: This information provides, in our country, evidence on the prognostic value of hypoglycemia, whose greater severity is associated with increased hospitalization in critical areas and higher hospital mortality.

Introducción: La hipoglucemia hospitalaria (HH) es un problema importante ya que se vincula a muerte hospitalaria, estadía prolongada y mayores costos, en personas con y sin diabetes, en área crítica y sala general, sobre todo en los casos de hipoglucemia grave. El objetivo de nuestro trabajo fue comparar la mortalidad hospitalaria, pase a área crítica y tiempo de internación en adultos con HH, según la gravedad de la misma. Métodos: Se realizó un estudio de cohorte retrospectiva en pacientes adultos internados con hipoglucemia en el Hospital Italiano de Buenos Aires entre 2013 y 2018. Se definieron tres grupos de hipoglucemia: leve (glucemia entre 70 y 54 mg/dl), grave (glucemia < 54 mg/dl = 40 mg/dl) y crítica (glucemia < 40mg/dl). Resultados: Un total de 5994 pacientes tuvieron HH, la mayoría presentó hipoglucemia leve (72%). La hipoglucemia grave y la crítica, comparadas con la hipoglucemia leve se asociaron a una mayor mortalidad: OR 2.6 (IC95% 2.2-3.1) y 4.2 (IC95% 3.5-5.0) respectivamente; y a mayor internación en áreas de cuidados críticos: OR 1.6 (IC95% 1.4-1.9) y 3.2 (IC95% 2.6-4.0) respectivamente. No hubo diferencias en el tiempo de internación. Discusión: Esta información aporta evidencia en nuestro país, sobre el valor pronóstico de la hipoglucemia, cuya mayor gravedad se asocia a mayor internación en áreas críticas y mayor mortalidad hospitalaria.

Composition, Emissions, and Air Quality Impacts of Hazardous Air Pollutants in Unburned Natural Gas from Residential Stoves in California.

The presence of hazardous air pollutants (HAPs) entrained in end-use natural gas (NG) is an understudied source of human health risks. We performed trace gas analyses on 185 unburned NG samples collected from 159 unique residential NG stoves across seven geographic regions in California. Our analyses commonly detected 12 HAPs with significant variability across region and gas utility. Mean regional benzene, toluene, ethylbenzene, and total xylenes (BTEX) concentrations in end-use NG ranged from 1.6-25 ppmv─benzene alone was detected in 99% of samples, and mean concentrations ranged from 0.7-12 ppmv (max: 66 ppmv). By applying previously reported NG and methane emission rates throughout California's transmission, storage, and distribution systems, we estimated statewide benzene emissions of 4,200 (95% CI: 1,800-9,700) kg yr-1 that are currently not included in any statewide inventories─equal to the annual benzene emissions from nearly 60,000 light-duty gasoline vehicles. Additionally, we found that NG leakage from stoves and ovens while not in use can result in indoor benzene concentrations that can exceed the California Office of Environmental Health Hazard Assessment 8-h Reference Exposure Level of 0.94 ppbv─benzene concentrations comparable to environmental tobacco smoke. This study supports the need to further improve our understanding of leaked downstream NG as a source of health risk.

Microbial Indicators and Possible Focal Points of Contamination during Production and Processing of Catfish.

The catfish industry is important to the United States economy. The present study determined the levels of microbial indicators and the prevalence of Listeria spp. and Listeria monocytogenes at catfish farms and catfish processing plants. Live fish, water, and sediment samples were analyzed in farms. Fish skin, fillets, chiller water, and environmental surfaces were assessed at the processing plants both during operation and after sanitation. Live fish had 2% prevalence of Listeria monocytogenes, while sediment and water were negative for Listeria. Live fish skin counts averaged 4.2, 1.9, and 1.3 log CFU/cm2 aerobic (APC), total coliform (TCC) and generic Escherichia coli counts, respectively. Water and sediment samples averaged 4.8 and 5.8 log CFU/g APC, 1.9 and 2.3 log CFU/g TCC, and 1.0 and 1.6 log CFU/g generic E. coli counts, respectively. During operation, Listeria prevalence was higher in fillets before (57%) and after (97%) chilling than on fish skin (10%). Process chiller water had higher (p ≤ 0.05) APC, TCC, and Listeria prevalence than clean chiller water. After sanitation, most sampling points in which Listeria spp. were present had high levels of APC (>2.4 log CFU/100 cm2). APC combined with Listeria spp. could be a good approach to understand microbial contamination in catfish plants.

Impact of APOE genotype on prion-type propagation of tauopathy.

Apolipoprotein (APOE) is a major risk factor of Alzheimer's disease (AD), with the E2, E3 and E4 isoforms differentially regulating the burden of AD-associated neuropathologies, such as amyloid ß and tau. In AD, pathological tau is thought to spread along neuroanatomic connections following a prion-like mechanism. To provide insights into whether APOE isoforms differentially regulate the prion properties of tau and determine trans-synaptic transmission of tauopathy, we have generated human P301S mutant tau transgenic mice (PS19) that carry human APOE (APOE2, APOE3 or APOE4) or mouse Apoe allele. Mice received intrahippocamal injections of preformed aggregates of K18-tau at young ages, which were analyzed 5 months post-inoculation. Compared to the parental PS19 mice with mouse Apoe alleles, PS19 mice expressing human APOE alleles generally responded to K18-tau seeding with more intense AT8 immunoreactive phosphorylated tau athology. APOE3 homozygous mice accumulated higher levels of AT8-reactive ptau and microgliosis relative to APOE2 or APOE4 homozygotes (E3 > E4~2). PS19 mice that were heterozygous for APOE3 showed similar results, albeit to a lesser degree. In the timeframe of our investigation, we did not observe significant induction of argentophilic or MC1-reactive neurofibrillary tau tangle in PS19 mice homozygous for human APOE. To our knowledge, this is the first comprehensive study in rodent models that provides neuropathological insights into the dose-dependent effect of APOE isoforms on phosphorylated tau pathology induced by recombinant tau prions.

Cecal microbiota contribute to the development of woody breast myopathy.

The objective of this study was to characterize the bacterial diversity of cecal microbiota in broilers related to breast phenotype, diet, and genetic strain. Broilers from 2 genetic strains (120 birds/strain) were fed a control diet (15 birds/pen) and an amino acid reduced diet (15 birds/pen, digestible lysine, total sulfur amino acids, and threonine reduced by 20% compared to the control diet). At 8 wk of age, 4 male broilers with normal breast (NB, 1 chick per pen) and 4 male broilers with woody breast (WB, 1 chick per pen) were selected for each treatment (strain × diet). The DNA of cecal samples was extracted and the 16S rRNA genes were sequenced and analyzed. There were no differences (P > 0.05) in the alpha diversity of gut microbiota between 2 phenotypes (NB vs. WB), 2 strains, or 2 diets (control vs. reduced). However, principal coordinate analysis plots (beta diversity) revealed that there were composition differences in samples between the 2 phenotypes (P = 0.001) and the 2 diets (P = 0.024). The most abundant phyla in all samples were Firmicutes, followed by Bacteroidetes and Proteobacteria. There were differences (false discovery rate, FDR < 0.05) in bacterial relative abundance between phenotypes and between diet treatments, but not (FDR > 0.05) between the 2 genetic strains. Selenomonas bovis (12.6%) and Bacteroides plebeius (12.3%) were the top 2 predominant bacteria in the ceca of WB birds; however, the relative abundances of these 2 bacteria were only 5.1% and 1.2% in NB birds, respectively. Function analysis predicted that the metabolic activities differed (q < 0.05) only between phenotypes. The microbiota of WB birds was characterized as reduced glycolysis and urea cycle but increased tricarboxylic acid (TCA) cycles, sugar degradation, and purine and pyrimidine nucleotides biosynthesis. Further studies are needed to investigate if WB incidence could be reduced by regulating gut microbiota and the potential mechanism that leads to decreased WB incidence.

Sex Differences Among Participants in the Latin American Stroke Registry.

Background Reports on sex differences in stroke outcome and risk factors are scarce in Latin America. Our objective was to analyze clinical and prognostic differences according to sex among participants in the LASE (Latin American Stroke Registry). Methods and Results Nineteen centers across Central and South America compiled data on demographics, vascular risk factors, clinical stroke description, ancillary tests, and functional outcomes at short-term follow-up of patients included from January 2012 to January 2017. For the present study, all these variables were analyzed according to sex at hospital discharge. We included 4788 patients with a median in-hospital stay of 8 days (interquartile range, 5-8); 2677 were male (median age, 66 years) and 2111 female (median age, 60 years). Ischemic stroke occurred in 4293: 3686 as cerebral infarction (77%) and 607 as transient ischemic attack cases (12.7%); 495 patients (10.3%) corresponded to intracerebral hemorrhage. Poor functional outcome (modified Rankin scale, 3-6) was present in 1662 (34.7%) patients and 38.2% of women (P<0.001). Mortality was present in 6.8% of the registry, with 7.8% in women compared with 6.0% in men (P=0.01). Death and poor functional outcome for all-type stroke showed a higher risk in female patients (hazard ratio, 1.3, P=0.03; and hazard ratio, 1.1, P=0.001, respectively). Conclusions A worse functional outcome and higher mortality rates occurred in women compared with men in the LASE, confirming sex differences issues at short-term follow-up.

Epidemiological Data on the Nutritional Status of Cancer Patients Receiving Treatment with Concomitant Chemoradiotherapy, Radiotherapy or Sequential Chemoradiotherapy to the Abdominopelvic Area.

Cancer patients are particularly susceptible to undernourishment so associated weight loss is frequent. Approximately 15% of patients lose >10% of their usual body weight, 40-80% become undernourished, and about 20% die as a result. Well-nourished patients have a higher survival rate when compared with patients at risk of undernourishment (19.9 vs. 3.7 months); hence, nutritional intervention is pivotal. Undernourishment negatively influences the patient's prognosis, and its prevalence depends on the tumor type and location, disease stage, treatment, and the applied nutritional evaluation tool. During abdominopelvic radiotherapy, up to 90% of patients experience symptoms of varying severity; weight loss during radiotherapy is an early indicator of nutritional deterioration, and he the use of radiation is associated with a higher likelihood of undernourishment. In patients with gynecological malignancies, 12.5-54% are malnourished before receiving oncological treatment, worsening after treatment in 35.8-82% of cases. There is also deterioration of the nutritional status in patients with colorectal cancer once pelvic radiotherapy is initiated, whereby 50% of cases are malnourished at the beginning of treatment, and 66.7% are so when it ends. Although there are notable differences in the impact of radiotherapy on weight according to the radiated region, 88% patients receiving abdominal radiotherapy were found to lose weight compared to 38% of patients whose treatment was limited to the pelvis.

Outcome, Recurrence and Mortality after Non-Valvular Atrial Fibrillation Stroke: Long-Term Follow-Up Study.

OBJECTIVE: Non-valvular atrial fibrillation (NVAF) is a major risk factor for ischemic stroke (IS) and a powerful predictor of mortality. This study investigates early and long-term outcome among patients with IS secondary to NVAF and identify the main factors associated with poor outcome, recurrence, and death. METHODS: We analyzed the data from our consecutive NVAF acute IS database, over a period of 23 years. The endpoints were bad outcome (Modified Rankin Score ≥3), recurrence, and mortality at discharge, after 6 months, 12 months, and final follow-up. Multivariate Cox and Kaplan-Meier analysis were used to estimate the probability of death. RESULTS: 129 consecutive acute IS patients were included (77 [59.7%] females, mean age 70.2 ± 10.1 years). Discharge, 6 and 12 months bad outcome was 62%, 63%, and 61%, respectively. After a median follow-up of 17 months (IQR 6-54.5), 35.6% patients had bad outcome, 21.7% had recurrence and 36.4% died. The recurrence and death annual rates were 19.1% and 6.32%. The absence of oral anticoagulation (OAC) and NIHSS score > 12 were the strongest predictors of mortality. CONCLUSIONS: IS secondary to NVAF has a high rate of stroke recurrence and mortality in our population, with the absence of OAC and major stroke as the main risk factors.

[Modified tests basophil degranulation and leukocyte migration inhibition factor in drug allergy. Study 2009-2014]. / Pruebas modificadas de degranulación de basófilos y factor de inhibición de migración de leucocitos en alergia a fármacos. Estudio de 2009 a 2014.

BACKGROUND: Adverse reactions to drugs are increasing and there are few studies for the diagnosis. OBJECTIVE: To determine the utility of modified basophil degranulation (MBD) test and modified leukocyte migration inhibition factor (MLMIF) test to prove drug hypersensitivity. METHODS: 177 patients of both sexes were studied with the diagnosis of drug hypersensitivity, determining MBD, MLMIF, or both, between 2009 and 2014. They were matched with positive and negative controls and the non-allergic population. Applications are issued according to the type of hypersensitivity, considering type I MBD and type IV MLMIF. RESULTS: 170 patients (96.04%) were positive to at least one drug (RR = 4.71). 561 MBD (73.62%) and 201 MLMIF (26.37%) were performed. Female sex was more frequent (64.41%); the average age was 38.5. MBD was positive in 70.23% and MLMIF in 67.16%. The test sensitivity was increased complementarily and with two dilutions. The correlation of MBD and MLMIF was positive and highly significant. CONCLUSIONS: Women have more drug reactions. Modified MBD test is useful at any age. Since medications can activate one or other hypersensitivity mechanism, it is important to request the tests simultaneously.

Antecedentes: Existe incremento de reacciones adversas a medicamentos y pocos estudios para el diagnóstico. Objetivo: Determinar la utilidad de pruebas modificadas de degranulación de basófilos (DB) y del factor inhibidor de la migración de leucocitos (LIF, leukocyte migration inhibition factor) para comprobar la hipersensibilidad a medicamentos. Métodos: Se estudiaron 177 pacientes, de uno y otro sexo, con diagnóstico de hipersensibilidad a medicamentos, en quienes se determinó pruebas modificadas de DB, LIF, o ambas entre 2009 y 2014. Se parearon con controles positivos, negativos y población no alérgica. Las solicitudes se emitieron de acuerdo con el tipo de hipersensibilidad, considerando tipo I a DB y tipo IV a LIF Resultados: 170 pacientes (96.04%) fueron positivos al menos a un medicamento (RR, 4.71). Se realizaron 561 pruebas modificadas de DB (73.62%) y 201 de LIF (26.37%). El sexo femenino fue más frecuente (64.41%); la edad promedio fue de 38.5 años. La prueba modificada de DB resultó positiva en 70.23% y la de LIF en 67.16%. La sensibilidad de las pruebas se incrementó en forma complementaria y a dos diluciones. La correlación de las pruebas fue altamente significativa. Conclusiones: Las mujeres presentan más reacciones a fármacos. La prueba modificada de DB es útil en cualquier edad. Como los medicamentos pueden activar uno u otro mecanismo de hipersensibilidad es importante solicitar las pruebas simultáneamente.

Batrachochytrium dendrobatidis and Chytridiomycosis in Anuran amphibians of Colombia.

In order to investigate the possible presence of the chytrid fungus Batrachochytrium dendrobatidis (Chytridiomycota: Chytridiales) in frogs (Amphibia: Anura) of Colombia, we made a retrospective examination of formalin-fixed specimens preserved in natural history collections. Using the staining technique of hematoxylin and eosin to identify B. dendrobatidis in histological slices, we found evidence of the fungus in 3 of the 53 frog species examined from a total of 672 specimens collected in 17 departments within Colombia between 1968 and 2006. The infected specimens were found dead or dying in recent years in high elevation sites, suggesting that chytridiomycosis (the disease caused by the fungus) may represent a significant threat to Colombian amphibians. We conclude that a more extensive search for B. dendrobatidis in museum specimens and wild-caught frogs should be undertaken as soon as possible, using both histological and molecular genetic techniques, in order to further characterize the geographic and taxonomic extent of infections of B. dendrobatidis.

Evaluation of an indirect immunofluorescence assay for detecting Chlamydia trachomatis as a method for diagnosing tubal factor infertility in Mexican women.

UNLABELLED: To evaluate the clinical impact of the use of an indirect immunofluorescence assay (IFA) against Chlamydia as a method to identify patients with tubal factor infertility (TFI) in a population of infertile Mexican women. METHODS: This was a retrospective analysis made on 100 patients attending the infertility clinic who underwent laparoscopy. Blood and cervical samples were collected during the clinical examination. The presence of anti-Chlamydia trachomatis IgG antibodies was documented using the IFA test, and the presence of active chlamydial infection was evaluated using the nucleic acid hybridization assay. RESULTS: The sensitivity and specificity values of the IFA test to identify patients with periadnexal adhesions were 45% and 82%, respectively; and the positive predictive and negative predictive values were 42% and 84%, and the positive and negative likelihood ratios were 2.5 and 0.7, respectively. CONCLUSION: The IFA test was not usable for the identification of patients with periadnexal adhesions as a cause of infertility in this population. However, it could be useful as a screening test to decide which patients might receive laparoscopic treatment. Furthermore, it could be useful for identifying patients with active chlamydial infections in the upper genital tract, but a study with a larger sample needs to be done.

[Risk factors and reproductive sequelae associated with Chlamydia trachomatis infection in infertile women]. / Factores de riesgo y secuelas reproductivas asociados a la infección por Chlamydia trachomatis en mujeres infértiles.

OBJECTIVE: To assess the clinical and sexual lifestyle characteristics associated with Chlamydia trachomatis infection among women diagnosed with infertility. MATERIAL AND METHODS: Study subjects were women with an infertility diagnosis attending the infertility clinic at the National Institute of Perinatology. Endocervical specimens from 309 women were examined for Chlamydia trachomatis using the direct immunofluorescence method. Vaginal culture samples were taken before initiating treatment. The presence of other sexually-transmitted infections was also assessed. Demographic, sexual behavioral, historical, and clinical data were collected for each subject. RESULTS: Seventy-seven women (24.9%) were infected with C trachomatis. Of these women, 70 (90.9%) had only one sexual partner, 58 (75.3%) were married, and 19 (24.7%) were single or had a common-law sex partner. Intrauterine device (IUD) was the main contraceptive method used in 15 women (19.5%). A coinfection with other sexually-transmitted microorganisms was detected in 41 of these patients (53.2%). Nineteen (24.7%) women had undergone tubal ligation. Among women with C trachomatis infection, reproductive sequelae were found: 24 (31.2%) women had had abortions and 50 (64.9%) had had a miscarriage. In 26 women cervical abnormalities were detected (33.8%); 50 (64.9%) had purulent vaginal discharge and 14 (18.1%) had pelvic pain. Bivariate analysis revealed that the risk factors for C trachomatis infection in women with infertility were: having a sex partner (OR = 2.96, 95% CI 1.22-7.5, p = 0.008), common-law union (OR = 3.68, p = 0.03), and IUD use (OR = 2.42, p = 0.01). CONCLUSIONS: A consistent relationship between C trachomatis infection and infertility was found. Infection with C trachomatis in women with infertility was associated with having one single sexual partner, marital status, and IUD use. The presence of ectropion and friability of the cervix may signal C trachomatis infection. Identification and presumptive therapy should be evaluated as measures to prevent and control C trachomatis infection in patients at risk. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Factores de riesgo y secuelas reproductivas asociados a la infección por Chlamydia trachomatis en mujeres infértiles / Risk factors and reproductive sequelae associated with Chlamydia trachomatis infection in infertile women

OBJETIVO: Comparar la información clínica y el estilo de vida sexual en dos grupos de mujeres con y sin infección por Chlamydia trachomatis que asisten a la clínica de infertilidad del Instituto Nacional de Perinatología, de la Ciudad de México. MATERIAL Y MÉTODOS: De febrero a noviembre de 1998, se realizó un estudio prospectivo en pacientes con diagnóstico de infertilidad. En el estudio se incluyó a pacientes con diagnóstico de infertilidad, tratados en el Instituto Nacional de Perinatologia, de la Ciudad de México, durante 1988. Las muestras endocervicales de 309 mujeres, que incluyeron a 77 con infección y a 232 sin infección, fueron examinadas para Chlamydia trachomatis, usando inmunofluorescencia directa. Los cultivos vaginales fueron obtenidos antes de iniciar el tratamiento. También se investigó la presencia de otros agentes infecciosos de transmisión sexual y la información demográfica, de conducta sexual, histórica y clínica fue recopilada de cada paciente. Los datos clínicos y ginecológicos de ambos grupos fueron comparados por ji2. La magnitud de las asociaciones fueron establecidas por razón de momios en análisis bivariados. Se realizó un análisis de regresión logística para establecer los efectos confusores en relación con los factores analizados. Las diferencias fueron consideradas estadísticamente significativas si p<0.05. RESULTADOS: Para el estudio 309 mujeres fueron elegibles, 77 (24.9 por ciento) cursaron con infección por C trachomatis, de éstas, 70 (90.9 por ciento) mencionaron tener un compañero sexual, 58 (75.3 por ciento) estaban casadas, 19 (24.7 por ciento) eran solteras o vivían en concubinato, 15 (19.5 por ciento) utilizaron el dispositivo intrauterino para el control de la natalidad, 41 (53.2 por ciento) presentaron coinfección con otros agentes infecciosos de transmisión sexual, y 19 (24.7 por ciento) cursaron con infertilidad por obstrucción tubárica. Las secuelas reproductivas observadas en las pacientes con infección por C trachomatis mostraron que 24 (31.2 por ciento) tuvieron abortos, 50 (64.9 por ciento), gestaciones previas, 26 (33.8 por ciento) anormalidades en el cérvix y 50 (64.9 por ciento) secreciones vaginales purulentas, con dolor (18.1 por ciento). El análisis bivariado mostró que los factores de riesgo asociados significativamente con la infección por C trachomatis fueron la presencia de un compañero sexual (OR= 2.96, IC 95 por ciento 1.22-7.5, p=0.008), concubinato (RM=3.68, p=0.03) y uso de...

Induction of tumor necrosis factor-alpha by cefodizime in U-937 cells

La cefodizima presenta efectos moduladores sobre la liberación de diversas citocinas. En esta investigación se determinó la actividad moduladora de este antibiótico sobre la producción del factor de necrosis tumoral (TNF) en una línea de células monocitica humana U-937. La medición de TNF se realizó mediante las pruebas de ELISA y bioensayo de citotoxicidad empleando células L-929. Los resultados mostraron que la cefodizima por si sola indujo la producción de TNF sobre las células U-937, sin embargo, la adición de LPS condujo a una disminución en la liberación de esta citocina (p<0.05). Por otro lado la combinación cefodizima-PMA tuvo un efecto sinérgico (p<0.05), sin embargo, la adición de LPS a esta combinación causó una disminución de la producción de TNF (p<0.05). Con estos resultados observamos que la cefodizima regula la producción de TNF en las células U-937, produciendo una menor concentración de TNF con la adición de LPS.

Tumor necrosis factor in peritoneal fluid from asymptomatic infertile women

Background. Tumor necrosis factor-Ó (TNF-Ó) is a cytokine that can be found in the peritoneal fluid (PF) of patients with endometriosis and pelvic inflammatory disease (PID) as a response to inflammatory disorders and infections. The cytotoxic effect of this cytokine could be a factor participating in the pathology of various gynecological diseases, and could also be accountable for the high immunological response and demage to the tubal epithelium. The objective of this study was ato establish the presence of TNF-Ó in asymptomatic infertility and its association with various isolated bacteria. Methods. Ten milliliters of PF were collected from each of 73 patients by means of laparoscopy and cultured in synthetic medium and McCoy cells for the isolation of aerobic and anaerobic bacteria, as well as for Chlamydia trachomatis. The activity of TNF-Ó was determined by means of a bioassay using L-929 cells. Results. Forty-three parcent of the PFs showed positive TNF-Ó activity, while the laparoscopic evaluation showed that 32 patients had Fallopian tube occlusion (FTO), 7 had endometriosis, 30 had PID. and 4 had myomas and adhesions. TNF-Ó activity was found to be high in FTO patients (P<0.05). Positive cultures were found in 50.7 percent of patients; of these, 31.5 percent had PID (p< 0.05), and only 20.5 percent of positive cultures were TNF-Ó positive. Chlamydia trachomatis (16 percent) was the most frequently isolated bacteria in these patients. Conclusions. The detection of TNF-Ó could be useful in the diagnosis of active infectious and inflammatory diseases in asymptomatic infertile patients