Parasitological versus molecular diagnosis of strongyloidiasis in serial stool samples: how many?

Strongyloidiasis is usually an asymptomatic disease in immunocompetent patients, caused by Strongyloides stercoralis. However, in immunocompromised patients it can produce a severe clinical profile. Therefore, a correct diagnosis is necessary in these cases and in those chronic asymptomatic patients. The low sensitivity of classical parasitological techniques requires the analysis of multiple serial stool samples. Molecular diagnostic techniques represent an improvement in the detection of the parasite. The objective of this study was to evaluate the minimum number of samples necessary to achieve maximum sensitivity by real-time polymerase chain reaction (PCR). A total of 116 stool samples from 39 patients were analysed by direct microscopic observation, agar culture, Harada-Mori and real-time PCR, in one, two, three and four or more consecutive samples. After two serial samples, 6 out of 39 patients were positive by parasitological and molecular techniques, while 16 of them were real-time PCR positive, and all the patients detected by parasitology were also detected by the molecular technique, reaching 100.00% sensitivity versus 83.00% when analysing a single sample. These data also reflect apparently low specificity (51.52%) and positive predictive value (PPV) (27.27 %) values, due to the high number of cases detected by real-time PCR and not by parasitological techniques. These cases were confirmed as true positives when analysing three, four or more samples from the same patient. In conclusion, the application of molecular techniques decreases the number of serial stool samples necessary to give a diagnosis with the maximum sensitivity.

Stem cell-like transcriptional reprogramming mediates metastatic resistance to mTOR inhibition.

Inhibitors of the mechanistic target of rapamycin (mTOR) are currently used to treat advanced metastatic breast cancer. However, whether an aggressive phenotype is sustained through adaptation or resistance to mTOR inhibition remains unknown. Here, complementary studies in human tumors, cancer models and cell lines reveal transcriptional reprogramming that supports metastasis in response to mTOR inhibition. This cancer feature is driven by EVI1 and SOX9. EVI1 functionally cooperates with and positively regulates SOX9, and promotes the transcriptional upregulation of key mTOR pathway components (REHB and RAPTOR) and of lung metastasis mediators (FSCN1 and SPARC). The expression of EVI1 and SOX9 is associated with stem cell-like and metastasis signatures, and their depletion impairs the metastatic potential of breast cancer cells. These results establish the mechanistic link between resistance to mTOR inhibition and cancer metastatic potential, thus enhancing our understanding of mTOR targeting failure.

Factors affecting the viscosity of sodium hypochlorite and their effect on irrigant flow.

AIM: To assess the influence of concentration, temperature and surfactant addition to a sodium hypochlorite solution on its dynamic viscosity and to calculate the corresponding Reynolds number to determine the corresponding flow regimen. METHODOLOGY: The dynamic viscosity of the irrigant was assessed using a rotational viscometer. Sodium hypochlorite with concentrations ranging from 0.6% to 9.6% was tested at 37 and 22 °C. A wide range of concentrations of three different surfactants was mixed in 2.4% sodium hypochlorite for viscosity measurements. The Reynolds number was calculated under each condition. Data were analysed using two-way anova. RESULTS: There was a significant influence of sodium hypochlorite concentration (P < 0.001) and temperature (P < 0.001) on dynamic viscosity: the latter significantly increased with sodium hypochlorite concentration and decreased with temperature. A significant influence of surfactant concentration on dynamic viscosity (P < 0.001) occurred, especially for high surfactant concentrations: 6.25% for benzalkonium chloride, 15% for Tween 80 and 6.25% for Triton X-100. Reynolds number values calculated for a given flow rate (0.14 mL s(-1)), and root canal diameter (sizes 45 and 70) clearly qualified the irrigant flow regimen as laminar. CONCLUSIONS: Dynamic viscosity increased with sodium hypochlorite and surfactant concentration but decreased with temperature. Under clinical conditions, all viscosities measured led to laminar flow. The transition between laminar and turbulent flow may be reached by modifying different parameters at the same time: increasing flow rate and temperature whilst decreasing irrigant viscosity by adding surfactants with a high value of critical micellar concentration.

Deficiencia de vitamina A y síndrome de dermatosis-artritis asociado a intestino secundario a derivación biliopancreática por obesidad / Vitamin A Deficiency and Bowel-Associated Dermatosis-Arthritis Syndrome secondary to Biliopancreatic Diversion for Obesity

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Relación entre el riesgo de metástasis en el ganglio centinela y los receptores estrogénicos en pacientes pre y posmenopáusicas con cáncer de mama / Positive sentinel node risk in relation to oestrogen receptors in breast cancer in premenopausal and postmenopausal women

Objetivo. Investigar la relación entre el estado pre o posmenopáusico de la paciente con carcinoma de mama (CM) y el riesgo de metástasis en el ganglio centinela (GC) y dentro de cada uno de esos grupos el riesgo según el estado de los receptores de estrógeno (RE). Método. Análisis de la base de datos de GC con 1.388 pacientes. Se estudiaron tres grupos de edad: A) posmenopáusicas ancianas, 200 pacientes, ≥70 años; B) posmenopáusicas más jóvenes, 89 pacientes, 55–69 años, y C) premenopáusicas, 85 pacientes, <55 años. En cada grupo se analizaron 2 subgrupos: tumores con RE positivos o negativos. Factores estudiados en cada grupo y subgrupo: pacientes con GC positivo, pacientes con ganglios no centinela (GNC) positivos, número de no detecciones quirúrgicas (NDQ) y pacientes no libres de enfermedad (NLE) tras 52 meses de seguimiento. Análisis estadístico: test de chi-cuadrado; significancia p<=0,05. Resultados. En las premenopáusicas el número de GC positivos es significativamente (p<0,025) mayor que en las posmenopáusicas y dentro de las premenopáusicas fundamentalmente en los tumores con RE negativos. El número de GNC positivos aumenta solo discretamente en las premenopáusicas y ocurre exclusivamente en tumores con RE negativos. El número de pacientes NLE es similar en los 3 grupos y en todos ellos es mucho más frecuente en pacientes con tumores con RE negativos. Conclusiones. El número de pacientes con GC positivo varía significativamente con el estado hormonal y no con la edad de la paciente, siendo más frecuentes en las premenopáusicas y fundamentalmente en tumores con RE negativos(AU)

Objective. The influence of the relationship between pre- and post-menopausal stage of patients with breast cancer (BC) and the risk of sentinel lymph node (SLN) metastasis as well as the influence of oestrogen receptor (ER) status within each one of these groups were analyzed. Methods. A BC database with 1,388 patients was analysed. Three age groups were studied: A, elderly postmenopausal, 200 patients, ≥70 years old; B, younger postmenopausal, 89 patients, 55–69 years old; C, premenopausal, 85 patients, <55 years old. In each group 2 subgroups were analyzed: positive ER and negative ER tumours. Data analysed: SLN-positive patients, non-sentinel node (NSN)-positive patients, non-surgical detections (NSD) and non disease-free (NDF) patients after a follow-up of 52 months. Statistical analysis: chi-squared test, significance: P<=0.05. Results. SLN metastasis was significantly (P<0.025) more common in premenopausal than in postmenopausal patients, and within those, mainly in negative ER tumours. Positive-NSN increases slightly in premenopausal patients (exclusively in negative ER tumours). NDF patients are similar in the 3 groups and in all of them it is much more frequent in negative ER tumours. Conclusion. SLN metastasis varies significantly according to hormonal state and not according to age, being more frequent in premenopausal patients and mainly in ER negative tumours(AU)

[Positive sentinel node risk in relation to oestrogen receptors in breast cancer in premenopausal and postmenopausal women]. / Relación entre el riesgo de metástasis en el ganglio centinela y los receptores estrogénicos en pacientes pre y posmenopáusicas con cáncer de mama.

OBJECTIVE: The influence of the relationship between pre- and post-menopausal stage of patients with breast cancer (BC) and the risk of sentinel lymph node (SLN) metastasis as well as the influence of oestrogen receptor (ER) status within each one of these groups were analyzed. METHODS: A BC database with 1,388 patients was analysed. Three age groups were studied: A, elderly postmenopausal, 200 patients, ≥ 70 years old; B, younger postmenopausal, 89 patients, 55-69 years old; C, premenopausal, 85 patients, <55 years old. In each group 2 subgroups were analyzed: positive ER and negative ER tumours. Data analysed: SLN-positive patients, non-sentinel node (NSN)-positive patients, non-surgical detections (NSD) and non disease-free (NDF) patients after a follow-up of 52 months. STATISTICAL ANALYSIS: chi-squared test, significance: P ≤ 0.05. RESULTS: SLN metastasis was significantly (P<0.025) more common in premenopausal than in postmenopausal patients, and within those, mainly in negative ER tumours. Positive-NSN increases slightly in premenopausal patients (exclusively in negative ER tumours). NDF patients are similar in the 3 groups and in all of them it is much more frequent in negative ER tumours. CONCLUSION: SLN metastasis varies significantly according to hormonal state and not according to age, being more frequent in premenopausal patients and mainly in ER negative tumours.

Control microbiano de agua de mar mediante microfiltración / Microbial control of seawater by microfiltration

El agua de mar refinada aparece en la literatura científica reciente como una potencial ayuda terapéutica en el tratamiento de varias enfermedades en humanos y animales por su contenido de minerales y oligoelementos. En Colombia, Nicaragua y España se utiliza de forma natural por recogida de la orilla e ingesta; sin embargo, esto puede representar un riesgo para la salud por los problemas de contaminación microbiológica y química. Los tratamientos de control microbiano del agua de mar permiten mejorar su calidad microbiológica. Objetivo: comparar la eficiencia de tres métodos de control microbiano: microfiltración, exposición solar y cuarentena. Metodología: se recolectaron 30 muestras de agua de mar en recipientes de polietileno de alta densidad con capacidad de 20 litros, en tres lugares diferentes de la costa atlántica colombiana. Resultados: de 30 muestras recolectadas, 15 resultaron con en- terobacterias como E. coli y bacterias halófilas como Vibrio y Aeromonas. La microfiltración a través de cerámica de 0,5 μm produce una desinfección de 100% de las muestras, mientras que la cuarentena por cinco meses y la desinfección solar son efectivas en 66 y 21% respectivamente. Esta última requiere de ciertas condiciones climáticas para alcanzar la desinfección y solo permite el manejo de pequeños volúmenes. Discusión: Respecto de la contaminación química en ciertos lugares, que no es controlable por los métodos de desinfección, se recomienda recoger el agua en altamar, en lugares limpios, y realizar la microfiltración.

Recent scientific literature presents seawater as a potential aid to solve a variety of health diseases in animals and human beings because by means of its mineral and trace elements content. In Colombia, Nicaragua and Spain it is collected in a natural way from de shore and drunk; however, this can represent a health risk because of the problems related to chemical and microbiological contamination. Microbial control of seawater allows the improvement of its microbiological quality. Objective: to compare the efficiency of three microbial control methods: microfiltration, solar exposition and quarantine. Methodology: 30 samples were collected in 20-liter high density polyethylene containers in three different places in the Colombian Atlantic coast. Results: 15 samples out of 30 showed the presence of bacteria such as E. coli and halophiles bacteria like Vibrio and Aeromonas. Microfiltration through ceramic filters of 0.5 μm produces disinfection in 100% of the samples but the quarantine for five months and solar disinfection are effective in 66 and 21% respectively. The latter requires certain weather conditions to achieve disinfection and it only allows managing small quantities of water. Dicussion: Considering chemical contamination in some places which cannot be controlled through disinfection methods, the collection of water offshore in clean places is suggested and then microfiltration treatment should be performed.

Estudio comparativo in vitro entre la instrumentación manual con limas de acero inoxidable y la instrumentación rotatoria con limas de níquel-titanio en cuanto al transporte apical en conductos curvos / An in vitro comparison of apical transportation in curved root canal preparations with hand stainless steel and nickel-titanium rotary instrumentation

Objetivos: En este estudio se pretende valorar el grado de enderezamiento de los conductos radiculares que se obtiene tras la instrumentación de éstos con limas manuales de acero y con limas rotatoria de Ni-Ti. Material y métodos. Para ello seleccionamos 30 molares inferiores y calculamos el grado de curvatura de cada uno de los 2 conductos mesiales mediante la técnica de Schneider. A continuación instrumentamos el conducto mesiovestibular con limas K de acero inoxidable y técnica de step-back; y el mesiolingual con el sistema rotatorio de limas Ni-Ti Hero Shaper@ según indicaciones del fabricante. Tras la instrumentación volvimos a calcular la angulación de los conductos con la misma técnica. Resultados. Los resultados mostraron que hubo menor transporte apical en el grupo de limas Ni-Ti que en el grupo de limas de acero con una diferencia estadísticamente significativa (p<0,05). Conclusiones: Por ello, pese a que ambas técnicas provocan una deformación del conducto, se recomienda usar en conductos curvos una instrumentación rotatoria con limas Ni-Ti (AU)

Aim: The purpose of this study was to determine the extent to which root canals were straightened after their preparation with hand stainless steel K-files and with rotary Ni-Ti files. Material and methods. Thirty mandibular molars were selected and the degree of root curvature was calculated in each of the two mesial canals, using the Schneider technique. Following this, the mesiobuccal canals were cleaned with stainless steel K-files and step-back technique, and the mesiolingual canals were cleaned with Ni-Ti Hero Shaper® rotary files according to the manufacturer´s instructions. After preparation, the angle of the canals was re-calculated in the same way as before. Results. The results showed that there was less apical transportation in the Ni-Ti files group than in the stainless steel one, with a statistically significant difference (p<0,05). Conclusion: In spite of both techniques cause canal deformation, it is recommended to use Ni-Ti files in curved canals (AU)

Baja genotoxicidad de extracto orgánico de agua de mar de Coveñas (Sucre, Colombia) / Low genotoxicity of organic sea water extracts from Coveñas (Sucre, Colombia)

El agua de mar natural se utiliza en algunos países iberoamericanos como elemento nutritivo y terapéutico, y en los países desarrollados se usa como complemento nutricional de forma refinada y comercial. Los estudios de ingesta de agua de mar tratada muestran que no hay toxicidad; sin embargo, el uso de agua cercana a las playas representa un riesgo para la salud debido a la polución de los centros urbanos. En este estudio se emplearon linfocitos humanos y la electroforesis de células individuales (ensayo cometa), para comparar la genotoxicidad de un extracto orgánico de agua de mar tomada de la orilla respecto a muestras obtenidas mar adentro en el pequeño municipio de Coveñas-Sucre, Colombia, que vierte sus aguas domésticas directamente al mar o a pozos sépticos. Se observa genotoxicidad a 37°C pero no a 4°C, este efecto es dependiente de la concentración del extracto (p<0.0001), del sitio de muestreo (p=0.0026) y de la interacción de estos dos factores (p=0.0001). La muestra orgánica que presenta menor genotoxicidad es la de mar adentro. La citotoxicidad del extracto orgánico de agua de mar es muy baja comparada con la obtenida de muestras del acueducto de Medellín (Colombia)

Ausencia de genotoxicidad del agua de mar de Coveñas: estudio in vitro en eritrocitos y leucocitos humanos / Absence of genotoxicity of sea water from Coveñas: in vitro study on human leukocytes and erythrocytes

En Colombia y América latina se ha iniciado recientemente el uso nutricional y terapéutico del agua de mar natural, por su contenido de minerales y oligoelementos, práctica ya reconocida en Europa desde hace más de un siglo. Objetivo: evaluar la posible toxicidad del agua de mar de Coveñas (costa atlántica colombiana). Materialesy métodos: se incubaron células humanas en agua de mar recogida en Coveñas para determinar fragilidad osmótica de eritrocitos, viabilidad celular y daño en el ADN de linfocitos (ensayo cometa); además, se determinó su capacidad antioxidante. Resultados: los eritrocitos en agua de mar presentaron hemólisis significativamente mayor respecto a la observada en amortiguador PBS hipertónico de concentración similar (4,3 y 2,8 por ciento respectivamente, P = 0,00001); sin embargo, la diferencia de los promedios fue muy pequeña. La viabilidad celular de los linfocitos en agua de mar fue de 95 por ciento, similar a la observada en PBS isotónico. Dicha agua de mar tampoco produjo daño en el ADN de linfocitos humanos, según los resultados de los promedios del momento de Olive del ensayo cometa. Tampoco presentó actividad antioxidante ni prooxidante. Conclusiones: según estos ensayos, el agua de mar obtenida en Coveñas presentó bioseguridad para el consumo humano; sin embargo, se deberá evaluar en el futuro la toxicidad de su componente orgánico concentrado y la genotoxicidad en personas que la consuman.

Adaptation and standardization of the geriatric evaluation of relative's rating instrument (GERRI) for Spain.

BACKGROUND: The Geriatric Evaluation of Relative's Rating Instrument (GERRI) is a scale that evaluates the frequencies of alterations in behavior and functional capacity over a two-week period prior to exploration. The scale depends on the observations done by a relative o first caregiver of the studied subject. AIM: To adapt and standardize the GERRI for the use in the Spanish population as a part of a general project to standardized cognitive and functional tests. METHOD: The scale was administered to 444 subjects: 249 controls, 85 mild memory-cognitive disorders without dementia subjects (DWD) and 110 patients with Alzheimer-type dementia (ATD). An across-sectional statistical study was conducted in our samples stratified by age, gender and education. We evaluated the reliability of repeatability of the test, the internal reliability and the age, sex and education effects on the score of the different subscales. We also took into account the diagnostical validity in the Alzheimer disease and finally we correlated this test results with Mini mental test. RESULTS: The demographic variables age and schooling were found to affect the GERRI subscales differently. Gender did not reach significance. Internal consistency for the GERRI-Social, -Mood and -Cognitive were 0.8620, 0.7647 and 0.9259, respectively. CONCLUSION: The Spanish version of the GERRI may be applied to Spanish clinical series because of its reliable internal consistency and reproducibility.

Adaptación para España y normalización del Instrumento de evaluación geriátrica por puntuaciones del informador (GERRI) / Adaptation and standardization of the Geriatric Evaluation of Relative's Rating Instrument (GERRI) for Spain

FUNDAMENTO: El Instrumento de evaluación geriátrica por puntuaciones del informador (GERRI) es una escala que evalúa la frecuencia de las alteraciones de conducta y la capacidad funcional, durante un período de 2 semanas previas a la exploración. OBJETIVO: Adaptar y normalizar el GERRI para su uso en la población española como parte de un proyecto general para normalizar pruebas cognitivas y funcionales. MÉTODOS: La escala fue administrada a 444 sujetos (249 controles, 85 pacientes con pérdida de memoria leve-alteraciones cognitivas sin demencia y 110 pacientes con demencia tipo Alzheimer). Se realizó un estudio estadístico transeccional en una población estratificada por edad, sexo y educación. Valoramos la fiabilidad en la reproducción de la prueba, la fiabilidad interna y los efectos de la edad, el sexo y la educación en la puntuación de las diferentes subescalas. Valoramos también la validez diagnóstica en la enfermedad de Alzheimer y, finalmente, correlacionamos los resultados de esta prueba con el Mini Mental State Examination. RESULTADOS: Las variables demográficas edad y escolarización afectan a las subescalas del GERRI de forma diferente. Sin embargo el sexo no las afecta de forma significativa. Las consistencias internas para el GERRI social, del humor y cognitivo fueron, respectivamente, de 0,8620, 0,7647 y 0,9259. CONCLUSIONES: La versión española del GERRI puede ser aplicada a series clínicas españolas por que es fiable, consistente y reproducible. (AU)

[Pulmonary thromboembolism associated with antiphospholipid syndrome and systemic lupus erythematosus]. / Tromboembolismo pulmonar relacionado a síndrome antifosfolípido y lupus eritematoso sistémico.

The association between systemic lupus erythematosus and antiphospholipid syndrome can cause several complications. We report a 45 years old woman, treated with steroids for a systemic lupus erythematosus. She presented with a clinical picture of a lupus pneumonitis and, subsequently, with the picture of a pulmonary thromboembolism. The diagnosis was confirmed by helicoidal computed axial tomography. The patient was treated with anticoagulants, with a favourable outcome.

Molecular characterization of the leucine plasmid from Buchnera aphidicola, primary endosymbiont of the aphid Acyrthosiphon pisum.

The complete sequence of the leucine plasmid of Buchnera aphidicola from the aphid Acyrthosiphon pisum (pLeu-BAp) is reported. Its gene organization was concordant with those of other leucine plasmids of Buchnera from aphids of the Aphidini and Macrosiphini tribes. Three inverted repeats are present in pLeu-BAp. Two of them are also present in pLeu from the family Aphididae: (i) SIR1, located downstream the leucine operon, resembles a rho-independent terminator of transcription, and (ii) LIR1, located upstream of the leucine operon, is suggested to be involved in transcription termination or messenger stability. The third, located near the putative ATGC repeats involved in the origin of replication, is specific in aphids of the Macrosiphini tribe. Phylogenetic analyses based on sequences of leuA, leuB, leuC, leuD, repA1 and ORF1 showed a closer relationship between Buchnera (A. pisum) and Buchnera (Diuraphis noxia). However, tree topologies indicate that the split between both aphid species took place soon after the formation of the Macrosiphini lineage.

The prevalence of spondylolysis in the Spanish elite athlete.

The diagnosis of spondylolysis is a major cause of concern for patients and their families, especially when the patients are young athletes with promising futures in their sports. In this study, 3152 case histories of high-level athletes were evaluated to determine which sports had a higher prevalence of spondylolysis. The overall percentage of spondylolysis among athletes in this study (8.02%) was not very much higher than that among the general population, which varies between 3% and 7%. However, when each sport was considered separately we found much higher values for some sports, with the highest percentages occurring in throwing sports (26.67%), artistic gymnastics (16.96%), and rowing (16.88%). The analysis of the biomechanical movements involved in the sports with greater prevalence of spondylolysis has led us to include the element of torsion against resistance as another possible causative factor for spondylolysis that should be added to the already known causative mechanisms, lumbar hyperextension and rotation. We have divided the sports into three risk groups according to the prevalence of spondylolysis shown and the characteristics of the sample, and we recommend systematic radiological examination of the lumbar spine in athletes considered to be at greater risk of developing spondylolysis.