A method for studying the influence of Mn oxyhydroxides on the trace element content of aquatic bryophytes.

The main objective of this study was to develop and test a method of separating externally deposited Mn oxyhydroxides and co-precipitated elements from samples of aquatic moss (the moss Fontinalis antipyretica). The method, which uses 0.1 M hydroxylamine to dissolve the oxyhydroxides, was tested with samples collected in rivers with slightly acidic, well­oxygenated waters, where high rates of Mn precipitation occur. The method was effective (it extracted up to 84 % of the Mn) and selective (Fe oxyhydroxides were not extracted). The elements Ba, Cd, Zn and Ni were associated with the Mn oxyhydroxides, while Al, As, Cr, Cu, Fe, Hg and Pb were not. Deposition of Mn therefore increased the concentration of some elements in the moss samples. However, as Mn precipitation depends on Eh and pH, which are independent of the concentrations of the elements in water, the relationship between water and moss element concentrations is not clear (i.e. the data are noisy). This is a problem in biomonitoring studies, which assume a close relationship between element concentrations in moss and water. The value of the proposed extraction method is that it can be used to correct the effect of Mn deposition. We present an example of this correction applied to the Cd concentrations in the test data. We found that the noise introduced by the Mn, including age-related effects (observed by comparing concentrations in 0-2.5 and 2.2-5.0 cm sections from the shoot apex), can be reduced. Additionally, the correction revealed recent increases in Cd concentrations in one site that were not observed in the uncorrected data. Another finding of interest was the low content of total Mn and different extractability (of most elements) observed in moss samples collected in alkaline waters. Finally, we discuss how future studies designed for different environmental scenarios can benefit from application of the proposed method.

HIV and HCV screening by non-infectious diseases physicians: can we improve testing and hidden infection rates?

Background: Missed opportunities for Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) testing remain high. We aimed to ascertain the knowledge of screening guidelines and attitudes of non-infectious disease (ID) hospital physicians and assess the impact of a 1-h session on screening rates and diagnoses. Methods: This interventional study consisted of a 1-h training session on HIV and HCV epidemiology and testing guidelines for non-ID physicians. Pre-and post-session questionnaires compared the knowledge of the guidelines and attitudes toward screening before and after the session. Rates of screening and diagnoses were compared in three 6 months periods: before, immediately after, and 24 months ±4 after the session. Results: A total of 345 physicians from 31 departments participated in these sessions. Before the session, 19.9% (28% medical, 8% surgical) and 17.9% (30% medical, 2.7% surgical) were aware of HIV and HCV testing guidelines, respectively. The willingness to routinely test increased from 5.6 to 22%, whereas not ordering tests decreased from 34.1 to 2.4%. HIV screening rates significantly increased by 20% after the session (7.7 vs. 9.3 tests per 103 patients; p < 0.001), and the effect persisted until the long-term period. The HIV diagnosis rate increased globally (3.6 vs. 5.2 HIV diagnoses per 105 patients; p = 0.157), mainly because of medical services (4.7 vs. 7.7 per 105 patients; p = 0.082). The HCV screening rate increased significantly immediately and in the long term only in medical services (15.7 and 13.6%, respectively). The new active HCV infection rates increased immediately and declined steeply thereafter. Conclusion: A short session for non-ID physicians can improve HIV/HCV screening, increase diagnosis, and contribute to disease elimination.

Influence of the storage procedure on the trace element content measured in the aquatic moss Fontinalis antipyretica Hedw.

Aquatic bryophytes have been used as pollution biomonitors for decades. Despite this, sample collection and preparation methods have not been standardized, which makes it difficult to compare the results of different studies. Most times, the samples have to be stored before processing, for example, when many of them are collected in a short time, as occurs in extensive pollution studies. Storage must be done in a way that does not change the pollutant concentrations in the samples. We studied whether the concentrations of Al, As, Ba, Cd, Cr, Cu, Fe, Hg, Mn, Ni, Pb, and Zn in the aquatic moss Fontinalis antipyretica were affected by three storage procedures: dry at room temperature, fresh (in refrigerator at 6°C), and frozen at -20°C. In addition, we evaluated whether the subsequent washing of the samples affected the concentrations of these elements differently depending on the storage method. Our results showed that the three methods were, in general, adequate since the concentrations did not change, and we did not observe differences between washed and unwashed samples either. Since the simplest method is refrigeration, we concluded that this is the best of them. However, the concentrations of Hg increased steadily over time in the fresh material, probably because of redistribution after volatilization from the basal parts of the mosses. We believe that the respiration of the plants lowered the concentrations of oxygen inside the hermetically sealed bags containing the samples, thus promoting the reduction of the Hg and its posterior volatilization and redistribution. We did not observe interactions between the storage method and the posterior washing of the samples. PRACTITIONER POINTS: We studied the influence of storage procedure on element content in aquatic mosses. The procedures were as follows: dried at room temperature, stored in refrigerator, and frozen. The procedures did not change the element contents, except for Hg in refrigerator. All the procedures seemed suitable, but refrigeration was the simplest one.

Captive Breeding and Trichomonas gallinae Alter the Oral Microbiome of Bonelli's Eagle Chicks.

Bonelli's eagle (Aquila fasciata) is an endangered raptor species in Europe, and trichomonosis is one of the menaces affecting chicks at nest. In this paper, we attempt to describe the oral microbiome of Bonelli's eagle nestlings and evaluate the influence of several factors, such as captivity breeding, Trichomonas gallinae infection, and the presence of lesions at the oropharynx. The core oral microbiome of Bonelli's eagle is composed of Firmicutes, Bacteroidota, Fusobacteria and Proteobacteria as the most abundant phyla, and Megamonas and Bacteroides as the most abundant genera. None of the factors analysed showed a significant influence on alfa diversity, but beta diversity was affected for some of them. Captivity breeding exerted a high influence on the composition of the oral microbiome, with significant differences in the four most abundant phyla, with a relative increase of Proteobacteria and a decrease of the other three phyla in comparison with chicks bred at nest. Some genera were more abundant in captivity bred chicks, such as Escherichia-Shigella, Enterococcus, Lactobacillus, Corynebacterium, Clostridium and Staphylococcus, while Bacteroides, Oceanivirga, Peptostreptococcus, Gemella, Veillonella, Mycoplasma, Suttonella, Alloscardovia, Varibaculum and Campylobacter were more abundant in nest raised chicks. T. gallinae infection slightly influenced the composition of the microbiome, but chicks displaying trichomonosis lesions had a higher relative abundance of Bacteroides and Gemella, being the last one an opportunistic pathogen of abscess complications in humans. Raptor's microbiomes are scarcely studied. This is the first study on the factors that influence the oral microbiome of Bonelli's eagle.

Molecular epidemiology of Kaposi sarcoma virus in Spain.

BACKGROUND: Since human herpesvirus 8 (HHV-8) infection may be underestimated and HHV-8 subtype circulation in Spain remains unknown, a molecular epidemiologic study is highly desirable. OBJECTIVES: This study aimed to analyse HHV-8 subtype diversity and their distribution in Spain. STUDY DESIGN: The study included 142 HHV-8 infected patients. A nested PCR was developed in order to permit Sanger sequencing of HHV-8 K1 ORF directly from clinical samples received at the CNM from 2013 to 2021. Phylogenetic characterization was performed. RESULTS: Genotypes A and C comprised 55.6% and 42.3% of strains. Regarding subtypes, 25.4% of strains were C3, 19.7% were A3, 14.1% were A5, and C2, A1, A4, C1, A2, C7 were 11.3%, 11.3%, 8.5%, 4.2%, 2.1% and 1.4%, respectively. Subtype E1, E2 and B1 were found in only one patient each (0.7%). The Madrid region accounted for 52.1% of patients and showed a significantly different subtype distribution compared to the others (P = 0.018). Subtypes B1, E1, and E2 were observed to appear sporadically, although overall genotypes A and subtype C3 remained the most frequent and unwavering. Subtype A3 presented the highest diversity as displayed by the highest number of clusters in phylogenetic analysis. Non-significant differences in viral loads between genotypes were found, but significantly higher viral loads in subtype C2 compared to subtype C3 was found, while no significant subtype differences were observed between subtypes within genotype A. Infections with HHV-8 were detected in 94 (66.2%) patients without KS and compared to patients with KS non-significant differences in subtype distribution were found. CONCLUSIONS: Subtype prevalence and regional distribution followed a similar pattern compared to other western European countries. Our study is the first to report HHV-8 subtypes E1 and E2 circulating in Europe that might be reflective of migration of population from Caribbean countries. Our study suggests that infection by HHV-8 is underestimated, and wider screening should be recommended for risk groups.

El diagnóstico diferencial es fundamental: a propósito de un caso de síndrome de Laugier-Hunziker / The differential diagnosis is crucial: a case of Laugier-Hunziker syndrome

El síndrome de Laugier-Hunziker (SLH) es una enfermedad poco frecuente, benigna, no asociada a patología sistémica, cuya forma de presentación en adultos consiste en hiperpigmentación macular mucocutánea que afecta mayoritariamente a labios y mucosa oral, ocasionalmente puede afectar mucosa genital y con menos frecuencia al área palmo plantar. Se encuentra asociada en la mitad de los casos con melanoniquia longitudinal. La importancia de este síndrome es evidente una vez que es diagnóstico de exclusión de enfermedades con significativo riesgo de malignidad. Ante la sospecha de SLH, es obligatorio el despistaje de otras patologías asociadas a hiperpigmentación, lentiginosis y melanoniquia. Los autores presentan el caso de una mujer de63 años con hiperpigmentación de mucosa oral y de dedos de manos y pies, con el diagnóstico final de SLH. Realizan un resumen del estudio realizado que condujo al diagnóstico. Concluyen subrayando la importancia del diagnóstico diferencial con otras patologías. (AU)

Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. OBJECTIVE: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. METHOD: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon's test. RESULTS: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. CONCLUSION: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

INTRODUCCIÓN: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. OBJETIVO: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. MÉTODO: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. RESULTADOS: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. CONCLUSIÓN: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.

Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment / Prevalencia de enfermedad pulmonar obstructiva crónica en pacientes con diagnóstico de VIH sin tratamiento antirretroviral previo

Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. Objective: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. Method: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon’s test. Results: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. Conclusion: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

Resumen Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. Objetivo: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. Método: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. Resultados: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. Conclusión: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.

Serum markers improve current prediction of metastasis development in early-stage melanoma patients: a machine learning-based study.

Metastasis development represents an important threat for melanoma patients, even when diagnosed at early stages and upon removal of the primary tumor. In this scenario, determination of prognostic biomarkers would be of great interest. Serum contains information about the general status of the organism and therefore represents a valuable source for biomarkers. Thus, we aimed to define serological biomarkers that could be used along with clinical and histopathological features of the disease to predict metastatic events on the early-stage population of patients. We previously demonstrated that in stage II melanoma patients, serum levels of dermcidin (DCD) were associated with metastatic progression. Based on the relevance of the immune response on the cancer progression and the recent association of DCD with local and systemic immune response against cancer cells, serum DCD was analyzed in a new cohort of patients along with interleukin 4 (IL-4), IL-6, IL-10, IL-17A, interferon γ (IFN-γ), transforming growth factor-ß (TGF- ß), and granulocyte-macrophage colony-stimulating factor (GM-CSF). We initially recruited 448 melanoma patients, 323 of whom were diagnosed as stages I-II according to AJCC. Levels of selected cytokines were determined by ELISA and Luminex, and obtained data were analyzed employing machine learning and Kaplan-Meier techniques to define an algorithm capable of accurately classifying early-stage melanoma patients with a high and low risk of developing metastasis. The results show that in early-stage melanoma patients, serum levels of the cytokines IL-4, GM-CSF, and DCD together with the Breslow thickness are those that best predict melanoma metastasis. Moreover, resulting algorithm represents a new tool to discriminate subjects with good prognosis from those with high risk for a future metastasis.

Mesothelin, Calretinin, and Megakaryocyte Potentiating Factor as Biomarkers of Malignant Pleural Mesothelioma.

PURPOSE: Malignant pleural mesothelioma (MPM) is a highly lethal cancer caused by exposure to asbestos. Currently, the diagnosis is a challenge, carried out by means of invasive methods of limited sensitivity. This is a case-control study to evaluate the individual and combined performance of minimally invasive biomarkers for the diagnosis of MPM. METHOD: A study of 166 incident cases of MPM and 378 population controls of Mestizo-Mexican ethnicity was conducted. Mesothelin, calretinin, and megakaryocyte potentiating factor (MPF) were quantified in plasma by ELISA. The samples were collected from 2011 to 2016. RESULTS: Based on ROC analysis and a preset specificity of 95%, the combination of the three biomarkers reached an AUC of 0.944 and a sensitivity of 82% in men. In women, an AUC of 0.937 and a sensitivity of 87% were reached. In nonconditional logistic regression models, the adjusted ORs in men were 7.92 (95% CI 3.02-20.78) for mesothelin, 20.44 (95% CI 8.90-46.94) for calretinin, and 4.37 (95% CI 1.60-11.94) for MPF. The ORs for women were 28.89 (95% CI 7.32-113.99), 17.89 (95% CI 3.93-81.49), and 2.77 (95% CI 0.47-16.21), respectively. CONCLUSIONS: To our knowledge, this is the first study evaluating a combination of mesothelin, calretinin, and MPF, and demonstrating a sex effect for calretinin. The biomarker panel showed a good performance in a Mestizo-Mexican population, with high sensitivity and specificity for the diagnosis of MPM.

[Analysis of Biological Properties of Human Adult Mesenchymal Stem Cells and Their Effect on Mouse Hind Limb Ischemia].

BACKGROUND: Due to their self-renewal, proliferation, differentiation, and angiogenesis-inducing capacity, human adipose mesenchymal stem cells (AMSC) have potential clinical applications in the treatment of limb ischemia. AMSC from healthy donors have been shown to induce neovascularization in animal models. However, when cells were obtained from donors suffering from any pathology, their autologous application showed limited effectiveness. We studied whether liposuction niche and obesity could determine the regenerative properties of cells meaning that not all cell batches are suitable for clinical practice. METHODS: AMSC obtained from 10 donors, obese and healthy, were expanded in vitro following a good manufacturing practice-like production protocol. Cell viability, proliferation kinetics, morphological analysis, phenotype characterization, and stemness potency were assessed over the course of the expansion process. AMSC selected for having the most suitable biological properties were used as an experimental treatment in a preclinical mouse model of hind limb ischemia. RESULT: All cell batches were positively characterized as mesenchymal stem cells, but not all of them showed the same properties or were successfully expanded in vitro, depending on the characteristics of the donor and the extraction area. Notably, AMSC from the abdomen of obese donors showed undesirable biological properties. AMSC with low duplication times and multilineage differentiation potential and forming large densely packed colonies, were able, following expansion in vitro, to increase neovascularization and repair when implanted in the ischemic tissue of mice. CONCLUSION: An extensive AMSC biological properties study could be useful to predict the potential clinical efficacy of cells before in vivo transplantation. Thus, peripheral ischemia and possibly other pathologies could benefit from stem cell treatments as shown in our preclinical model in terms of tissue damage repair and regeneration after ischemic injury.

Biomarkers for Predicting Malignant Pleural Mesothelioma in a Mexican Population.

Background: Diagnosis of malignant pleural mesothelioma (MPM) remains a challenge, especially when resources in pathology are limited. The study aimed to evaluate cost-effective tumor markers to predict the probability of MPM in plasma samples in order to accelerate the diagnostic workup of the tissue of potential cases. Methods: We conducted a case-control study stratified by gender, which included 75 incident cases with MPM from three Mexican hospitals and 240 controls frequency-matched by age and year of blood drawing. Plasma samples were obtained to determine mesothelin, calretinin, and thrombomodulin using enzyme-linked immunosorbent assays (ELISAs). We estimated the performance of the markers based on the area under the curve (AUC) and predicted the probability of an MPM diagnosis of a potential case based on the marker concentrations. Results: Mesothelin and calretinin, but not thrombomodulin were significant predictors of a diagnosis of MPM with AUCs of 0.90 (95% CI: 0.85-0.95), 0.88 (95% CI: 0.82-0.94), and 0.51 (95% CI: 0.41-0.61) in males, respectively. For MPM diagnosis in men we estimated a true positive rate of 0.79 and a false positive rate of 0.11 for mesothelin. The corresponding figures for calretinin were 0.81 and 0.18, and for both markers combined 0.84 and 0.11, respectively. Conclusions: We developed prediction models based on plasma concentrations of mesothelin and calretinin to estimate the probability of an MPM diagnosis. Both markers showed a good performance and could be used to accelerate the diagnostic workup of tissue samples in Mexico.

Contribution of atmospheric deposition to tissue concentrations of mercury in aquatic bryophytes.

In this biomonitoring study, we measured the temporal variations in concentrations of mercury in samples of aquatic bryophytes from rivers in a region that received large inputs of the metal via atmospheric deposition. In the first year of sampling, the presence of an important source of atmospheric deposition of Hg (a lignite-fired power plant) led, during the rainy season, to elevated concentrations of the metal in catchments situated downwind of the prevailing winds. High concentrations of the metal were even detected in samples from apparently clean rivers in isolated mountain sites within the downwind catchments. Substitution of the type of fuel (high quality imported carbon instead of brown coal) used in the power plant greatly reduced Hg emissions in subsequent years. Application of spatial interpolation techniques to dense monitoring networks with aquatic bryophytes, without taking into consideration the catchment borders, appears suitable for studying extensive atmospheric pollution derived from a large scale source of contamination. This study also demonstrates the importance of environmental specimen banks in retrospective studies of contamination, as they enable posterior analysis of contaminants that for various reasons cannot be analyzed at the time of sampling.

[Diagnostic strategies in the Tuberculosis Clinic of the Hospital General La Raza National Medical Center]. / Estrategias diagnósticas aplicadas en la Clínica de Tuberculosis del Hospital General Centro Médico Nacional la Raza.

In order to diagnose TB infection, tuberculin skin test and interferon gamma release assay are available. The tuberculin test has a sensitivity of 99 % and a specificity of 95 %. For the detection of interferon gamma in blood there are currently two tests available: TBGold QuantiFERON-In-Tube (with a sensitivity of 0.70 and a specificity of 0.90), and T-SPOT-TB (sensitivity 0.90 and specificity 0.93). To diagnose the disease, a microscopy of direct smears for acid-fast bacilli is used if the physician is facing an extensive cavitary lung disease due to M. tuberculosis (this test has a high sensitivity: 80-90 %). The most common staining techniques used are Ziehl-Neelsen and Kinyoun, and the fluorescent technique, auramine-rhodamine. The culture is the gold standard and it has a sensitivity of 80 % and a specificity over 90 %, but the results take weeks. The nucleic acid amplification test has an overall sensitivity and specificity of 0.85 and 0.97, respectively. In the presence of a pleural effusion is necessary to perform a pleural biopsy for culture with a sensitivity of 85 % if it is percutaneous and 98 % if it was taken by thoracoscopy. The adenosine deaminase can be determined in pleural fluid with a sensitivity and specificity of 95 %.

Para determinar la infección tuberculosa se dispone de pruebas como la tuberculina y el interferón gama. La prueba de la tuberculina tiene una sensibilidad de 99 % y una especificidad de 95 %. Para la detección de interferón gamma en sangre se dispone de 2 pruebas comercializadas: QuantiFERON-TBGold In-Tube (sensibilidad 0.70 y especificidad 0.90) y T-SPOT-TB (sensibilidad 0.90 y especificidad 0.93). Para el diagnóstico de la enfermedad se utiliza la baciloscopia en esputo (BAAR) con una sensibilidad elevada (80-90 %) si se está ante una tuberculosis con patrón cavitario. Las técnicas de tinción más empleadas son las clásicas (Ziehl-Neelsen y Kinyoun) y la fluorescente (Auramina-Rodamina). El cultivo es el estándar de oro y tiene una sensibilidad del 80 % y una especificidad de más del 90 %, pero sus resultados toman semanas. La técnica de amplificación de ácido nucleico (PCR) tiene una sensibilidad y especificidad global de 0.85 y 0.97, respectivamente. Ante la presencia de un derrame pleural, es necesario realizar una biopsia pleural para cultivo con una sensibilidad del 85 % si es percutánea y del 98 % si es tomada por toracoscopia. Se puede determinar en líquido pleural la ADA con una sensibilidad y especificidad del 95 %.

Malignant Pleural Mesothelioma: Accuracy of CT Against Immunohistochemical Test Among the Mexican Population.

BACKGROUND AND AIMS: Malignant pleural mesothelioma (MPM) is associated with occupational and environmental exposure to asbestos. The incidence is expected to increase as the use of asbestos is not prohibited in many countries, such as in Mexico. We undertook this study to determine sensitivity, specificity, predictive values and likelihood ratios of computed tomography (CT) in a sample from Mexican population with suspected MPM and other pleuropulmonary diseases. METHODS: CT films of 38 patients suspected of having MPM were analyzed. A single observer was blinded to MPM diagnoses. The frequencies of ten CT findings were identified. A cut-off point of ≥5 CT findings was established to determine high MPM probability. Sensitivity, specificity, predictive values and likelihood ratio of the CT against biopsy using immunohistochemical testing (IHC) for MPM were calculated. RESULTS: Of the 38 patients, 31 had MPM and seven had lung adenocarcinoma. The five key findings were mediastinal pleural thickening 96.7% (n = 30), nodular pleural thickening 93.3% (n = 29), pleural mass 83.9% (n = 26), diminished lung 70.9% (n = 22) and contracted hemithorax 70.9% (n = 22). Sensitivity 96.8% (83.2-99.4), specificity 85.7% (42.2-97.6), positive likelihood ratio 6.7 (1.1-41.6), and negative likelihood ratio of 0.04 (0.01-0.2) were reported. CONCLUSIONS: Sensitivity and specificity in this study was greater than previously reported, 96.8% and 85.7 vs. 93.2 and 65.6%, respectively. CT is an easily accessible and useful tool that should be incorporated into the medical education of general physicians to improve MPM diagnosis of suspected cases.

Resultados de la cirugía de prolapsos vaginales con mallas de polipropileno / Results of polypropylene mesh surgery for genital prolapse

Objetivo. Describir los resultados de la cirugía de prolapsos genitales con mallas de polipropileno y evaluar el grado de satisfacción de las pacientes. Material y métodos. Estudio descriptivo y retrospectivo de 94 mujeres con prolapsos genitales sintomáticos operadas con mallas de polipropileno. Resultados. La edad media era de 66,6 años y el 96,8% eran posmenopáusicas. Los prolapsos más frecuentes fueron: 47 casos solo cistocele, 14 con rectocele y 21 con cistocele y rectocele. La media del seguimiento fue de 26,7 meses. Las complicaciones fueron 4 casos con sangrado intraoperatorio, 8 infecciones urinarias, 12 incontinencias urinarias postoperatorias y 7 erosiones vaginales de la malla. El porcentaje de curación fue del 93,6%. Un 81,4% de las pacientes se sentían satisfechas y volverían a operarse. Conclusión. Esta cirugía presenta escasas complicaciones, consigue alta tasa de curación y alto grado de satisfacción de las pacientes (AU)

Objective: To describe the results of polypropylene mesh surgery for genital prolapse and to assess patient satisfaction with this procedure. Materials and methods: Descriptive and retrospective study of 94 women with symptomatic genital prolapse who underwent polypropylene mesh surgery. Results: The mean age of the patients was 66.6 years and 96.8% were postmenopausal. The most common prolapses were as follows: cystocele alone in 47 patients, rectocele in 14, and cystocele and rectocele in 21. The mean follow-up was 26.7 months. Complications consisted of intraoperative bleeding in 4 patients, urinary tract infections in 8, postoperative urinary incontinence in 12, and erosion of the mesh in the vagina in 7. The percentage of healing was 93.6%. A total of 81.4% of patients felt satisfied and would undergo the intervention again. Conclusion: This intervention produces few complications and achieves a high rate of healing. Patient satisfaction with this procedure was high (AU)

Development and validation of a questionnaire to identify patients with sleep apnea in Mexican population: Mexican questionnaire to identify sleep apnea.

PURPOSE: To develop and validate a questionnaire to identify patients with obstructive sleep apnea (OSA) in Mexican population. METHODS: We performed a cross-sectional study to develop and validate an instrument in Spanish language, consistent in an 18-item questionnaire. We enrolled patients seen from July 2008 to August 2009. We evaluated the internal consistency with the Kuder Richardson coefficient, a value greater than 0.70 was considered a good index correlation. Sensitivity, specificity, and positive and negative predictive factor was obtained with standard methods by comparison with polysomnographic results. Validity of Mexican questionnaire at baseline and follow-up was assessed using Pearson correlations coefficient. RESULTS: We enrolled 100 patients. The initial pool comprised 25 items, four items were considered confusing and they were omitted; then, a preliminary questionnaire comprising 21 items was obtained, and three items were removed by presenting a response rate lesser than 90%, yielding a total of 18 items for the final questionnaire. This evaluation was performed stratifying in groups related to severity of illness. Snoring was the question with the greatest sensitivity to detect OSA; and obesity class I was the criteria with greatest specificity to detect OSA. CONCLUSION: The screening tool proposed in this study has the advantages of being quick, inexpensive, easy to apply and reproducible, and the result has reliability with acceptable sensitivity; this is a symptom-based questionnaire with good predictive ability and it will avoid unnecessary sleep studies in the subjects who are not at high risk for having OSA.

[A H1N1 influenza infection in pregnant patients]. / Infección por virus influenza A H1N1 en pacientes embarazadas.

BACKGROUND: Despite the severity of infection with influenza virus, little has been reported about its presence in pregnant women. OBJECTIVE: To communicate our experience on influenza virus H1N1 in pregnant women. METHODS: We conducted a retrospective cohort study on 16 hospitalized patients with diagnosis of pregnancy and probable or confirmed case of infection with H1N1 influenza virus. SUSPECTED CASE: Sudden onset of respiratory infectious process, in 2009, in Mexico City. All cases underwent the fast detection test and subsequently confirmation by PCR test. Discharge criteria: clinical improvement, PaO(2) above 60 mm Hg and absence of bilateral consolidation on chest radiographs. Severity criteria: type I respiratory failure (PaO(2) < 50 mm Hg) who required mechanical ventilatory support, radiographic pattern compatible with multisegmental pneumonia and PaO(2)/FiO(2) < 200 mm Hg. RESULTS: The pregnant patient mortality was 4.25%. The average age was 25.8 years, with 24.13 weeks of gestation with 5.6 days average of hospital stay. The main co-morbidity was obesity. CONCLUSIONS: The fatal cases were those with longer time of evolution and late diagnosis.

Design of an aquatic biomonitoring network for an environmental specimen bank.

The aim of the present study was to establish an aquatic biomonitoring network for the Galician Environmental Specimen Bank (BEAG) (NW Spain). For this, a sampling system was designed that comprised of 121 points distributed throughout Galician rivers, from which samples of water and of three species of bryophytes were collected. The results obtained allowed selection of 74 sampling points and 2 species (Fontinalis antipyretica Hedw. and F. squamosa Hedw.) as the most suitable for use in future BEAG sampling surveys. The two species selected showed a strong similarity in their capacity to accumulate the 17 elements determined (Al, As, Ca, Cd, Co, Cr, Cu, Fe, Hg, K, Mg, Mn, Na, Ni, Pb, Se and Zn), as well as in their ecological preferences. Furthermore, the levels of contamination of epicontinental waters were lower than those observed in previous surveys.

Quantitation of cytomegalovirus DNA in cerebrospinal fluid and serum specimens from AIDS patients using a novel highly sensitive nested competitive PCR and the cobas amplicor CMV monitor.

A novel nested quantitative-competitive polymerase chain reaction (nQC-PCR) assay was developed to quantify as few as ten copies per tube of human cytomegalovirus DNA with an overall dynamic range of 10-10(5) copies per tube. This nQC-PCR assay is based on co-amplification of a mimic DNA and it was evaluated with 26 cerebrospinal fluid (CSF) specimens and 44 serum specimens from 70 CMV-infected AIDS patients, 35 of them were diagnosed of CMV retinitis. An excellent correlation was found between nQC-PCR assay and the commercially available Cobas Amplicor CMV Monitor trade mark (CACM) assay (R = 0.9999; P < 0.001; n = 42). Moreover, 13 serum samples with CMV viral loads undetectable with the CACM were successfully quantified by nQC-PCR. CMV viral load was significantly higher in patients with CMV retinitis (P = 0.003). The nQC-PCR assay described below is a very sensitive test for accurate quantitative detection of CMV DNA in different clinical specimens that avoids the need for high-cost instrumentation.