Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy.

OBJECTIVES: To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS: We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS: We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS: Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.

DNA microarray analysis of the cyanotroph Pseudomonas pseudoalcaligenes CECT5344 in response to nitrogen starvation, cyanide and a jewelry wastewater.

Pseudomonas pseudoalcaligenes CECT5344 is an alkaliphilic bacterium that can use cyanide as nitrogen source for growth, becoming a suitable candidate to be applied in biological treatment of cyanide-containing wastewaters. The assessment of the whole genome sequence of the strain CECT5344 has allowed the generation of DNA microarrays to analyze the response to different nitrogen sources. The mRNA of P. pseudoalcaligenes CECT5344 cells grown under nitrogen limiting conditions showed considerable changes when compared against the transcripts from cells grown with ammonium; up-regulated genes were, among others, the glnK gene encoding the nitrogen regulatory protein PII, the two-component ntrBC system involved in global nitrogen regulation, and the ammonium transporter-encoding amtB gene. The protein coding transcripts of P. pseudoalcaligenes CECT5344 cells grown with sodium cyanide or an industrial jewelry wastewater that contains high concentration of cyanide and metals like iron, copper and zinc, were also compared against the transcripts of cells grown with ammonium as nitrogen source. This analysis revealed the induction by cyanide and the cyanide-rich wastewater of four nitrilase-encoding genes, including the nitC gene that is essential for cyanide assimilation, the cyanase cynS gene involved in cyanate assimilation, the cioAB genes required for the cyanide-insensitive respiration, and the ahpC gene coding for an alkyl-hydroperoxide reductase that could be related with iron homeostasis and oxidative stress. The nitC and cynS genes were also induced in cells grown under nitrogen starvation conditions. In cells grown with the jewelry wastewater, a malate quinone:oxidoreductase mqoB gene and several genes coding for metal extrusion systems were specifically induced.

Escherichia coli mhpR gene expression is regulated by catabolite repression mediated by the cAMP-CRP complex.

The expression of the mhp genes involved in the degradation of the aromatic compound 3-(3-hydroxyphenyl)propionic acid (3HPP) in Escherichia coli is dependent on the MhpR transcriptional activator at the Pa promoter. This catabolic promoter is also subject to catabolic repression in the presence of glucose mediated by the cAMP-CRP complex. The Pr promoter drives the MhpR-independent expression of the regulatory gene. In vivo and in vitro experiments have shown that transcription from the Pr promoter is downregulated by the addition of glucose and this catabolic repression is also mediated by the cAMP-CRP complex. The activation role of the cAMP-CRP regulatory system was further investigated by DNase I footprinting assays, which showed that the cAMP-CRP complex binds to the Pr promoter sequence, protecting a region centred at position -40.5, which allowed the classification of Pr as a class II CRP-dependent promoter. Open complex formation at the Pr promoter is observed only when RNA polymerase and cAMP-CRP are present. Finally, by in vitro transcription assays we have demonstrated the absolute requirement of the cAMP-CRP complex for the activation of the Pr promoter.

[Creutzfeldt - Jakob presenting with isolated visual symptoms: the Heidenhain variant]. / Creutzfeldt - Jakob con debut oftalmológico: la variante Heidenhain.

CLINICAL CASE: We report the case of a 67 year old female complaining of decreased vision and diagnosed with the Heidenhain variant of sporadic Creutzfeldt-Jakob disease. Her past medical history was unremarkable. She died less than three months after the onset. DISCUSSION: The Heidenhain variant of sporadic Creutfeld-Jakob disease should be suspected in patients suffering from early visual disturbances, unremarkable ophthalmic examination, and subsequent rapid decline of their cognitive function. A complete neurological exam including electroencephalogram recordings and magnetic resonance is mandatory. These patients share a common genotype (PRNP codon 129 MM) associated with a clinically typical disease course.

Creutzfeldt - Jakob con debut oftalmológico: la variante Heidenhain / Creutzfeldt - Jakob presenting with isolated visual symptoms: the Heidenhain variant

Caso clínicoPresentamos el caso de una mujer de 67 años con disminución de agudeza visual bilateral que fue diagnosticada de enfermedad de Creutzfeldt-Jakob esporádico en su variante Heidenhain. No presentaba antecedentes de interés. La paciente falleció tres meses después del inicio del cuadro.DiscusiónLa variante Heidenhain de la enfermedad de Creutzfeldt-Jakob esporádico debe sospecharse en todo paciente aquejado de alteraciones visuales y examen oftalmológico inespecífíco, que experimente deterioro cognitivo posterior. Es necesario un examen neurológico completo que incluya electroencefalograma y resonancia magnética. Estos pacientes comparten un mismo genotipo (codón 129 MM en gen PRNP) asociado a un curso clínico característico(AU)

Clinical caseWe report the case of a 67 year old female complaining of decreased vision and diagnosed with the Heidenhain variant of sporadic Creutzfeldt-Jakob disease. Her past medical history was unremarkable. She died less than three months after the onset.DiscussionThe Heidenhain variant of sporadic Creutfeld-Jakob disease should be suspected in patients suffering from early visual disturbances, unremarkable ophthalmic examination, and subsequent rapid decline of their cognitive function. A complete neurological exam including electroencephalogram recordings and magnetic resonance is mandatory. These patients share a common genotype (PRNP codon 129 MM) associated with a clinically typical disease course(AU)

[Successful treatment of surgically induced necrotizing sclerokeratitis (SINS) with systemic immunosuppresive agents and amniotic membrane grafting]. / Tratamiento inmunosupresor sistémico y trasplante de membrana amniótica en escleritis necrotizante inducida por cirugía (ENIC).

CLINICAL CASE: We report the case of a 74-year-old female who developed a necrotizing sclerokeratitis affecting her left eye after uncomplicated cataract surgery. She had no previous history of systemic autoimmune disease. Histopathology of the lesion revealed necrotic granulomatosis with an increased number of plasma cells. DISCUSSION: Surgically induced necrotizing sclerokeratitis (SINS) is a serious entity which requires prompt and aggressive therapy to prevent its potential devastating ocular consequences. Conjunctival resection and amniotic membrane grafting may be necessary to temporarily interrupt local immunologic events in severe cases. However, associated systemic immunomodulatory therapy seems to be mandatory (Arch Soc Esp Oftalmol 2009; 84: 577-580).

Tratamiento inmunosupresor sistémico y trasplante de membrana amniótica en escleritis necrotizante inducida por cirugía (ENIC) / Succesful treatment of surgically induced necrotizing sclerokeratitis (SINS) with systemic immunosuppresive agents and amniotic membrane grafting

Caso clínico: Presentamos el caso de una mujer de74 años que desarrolló una escleroqueratitis necrotizanteen su ojo izquierdo tras cirugía de cataratano complicada. No tenía antecedentes de enfermedadautoinmune sistémica. El análisis histopatológicode la lesión mostró granulomatosis necrotizantecon abundantes células plasmáticas.Discusión: La escleroqueratitis necrotizante inducidapor cirugía (ENIC) es una grave afección querequiere tratamiento precoz y agresivo tratando deprevenir sus potencialmente devastadoras consecuencias.La resección conjuntival junto conimplante de membrana amniótica pueden ser necesariaspara interrumpir temporalmente el procesoinmunológico local. No obstante, es esencial asociarun tratamiento inmunosupresor sistémico(AU)

Clinical case: We report the case of a 74-year-oldfemale who developed a necrotizing sclerokeratitisaffecting her left eye after uncomplicated cataractsurgery. She had no previous history of systemicautoimmune disease. Histopathology of the lesionrevealed necrotic granulomatosis with an increasednumber of plasma cells.Discussion: Surgically induced necrotizing sclerokeratitis(SINS) is a serious entity which requiresprompt and aggressive therapy to prevent its potentialdevastating ocular consequences. Conjunctivalresection and amniotic membrane grafting may benecessary to temporarily interrupt local immunologicevents in severe cases. However, associated systemicimmunomodulatory therapy seems to be mandatory(AU)

[Gas gangrene as presentation of colonic carcinoma in familial adenomatous polyposis]. / Gangrena gaseosa como presentación de un carcinoma de colon sobre poliposis adenomatosa familiar.

One case of gas gangrene by Clostridium septicum associated to colon cancer is herein presented. Spontaneous gas gangrene is often associated with neoplasms among which hematologic and colon neoplasms are the most frequent. The present case has also peculiarity that the colon cancer had developed from a familiar adenomatous polyposis syndrome.