Worldwide comparison between the potential distribution of Rhipicephalus microplus (Acari: Ixodidae) under climate change scenarios.

The cattle tick Rhipicephalus microplus (Acari: Ixodidae) has demonstrated its ability to increase its distribution raising spatially its importance as a vector for zoonotic hemotropic pathogens. In this study, a global ecological niche model of R. microplus was built in different scenarios using Representative Concentration Pathway (RCP), Socio-Economic Pathway (SSP), and a climatic dataset to determine where the species could establish itself and thus affect the variability in the presentation of the hemotropic diseases they transmit. America, Africa and Oceania showed a higher probability for the presence of R. microplus in contrast to some countries in Europe and Asia in the ecological niche for the current period (1970-2000), but with the climate change, there was an increase in the ratio between the geographic range preserved between the RCP and SSP scenarios obtaining the greatest gain in the interplay of RCP4.5-SSP245. Our results allow to determine future changes in the distribution of the cattle tick according to the increase in environmental temperature and socio-economic development influenced by human development activities and trends; this work explores the possibility of designing integral maps between the vector and specific diseases.

20 años de experiencia en trasplante renal en bloque de donantes pediátricos en receptores adultos / A 20-year experience in cadaveric pediatric en bloc kidney transplantation in adult recipients

Introducción y objetivos El trasplante renal en bloque de donantes pediátricos en receptores adultos permite aumentar el pool de donantes, pero son pocos los centros que lo realizan. Mostramos los resultados de la técnica en nuestro centro tras su introducción en el año 1999.Material y métodos Análisis retrospectivo de los 42 procedimientos realizados en nuestro centro con una mediana de seguimiento de 73 meses (5-233) en los que se monitorizó la función renal de los pacientes y se registraron las complicaciones sucedidas.Resultados Se han realizado 42 trasplantes renales en bloque en adultos de donantes pediátricos en nuestro centro hasta el momento. La media de edad de los receptores fue de 44,1±11,8 años y la de los donantes de 22,4±14,7 meses, con un peso medio de 11,3±3,6kg. El tiempo medio de isquemia fría fue de 15,7±4,5 h. Al finalizar el seguimiento, 35 injertos eran funcionantes (83,3%) y mantenían una excelente función. Hubo 7 pérdidas de injerto (16,7%) en el postoperatorio inmediato (4 trombosis vasculares, una dehiscencia de anastomosis y 2necrosis corticales) y un fallecimiento durante el seguimiento por una causa no relacionada.Conclusiones El uso de injertos renales en bloque de origen pediátrico en adultos es un procedimiento seguro y con un excelente rendimiento funcional a medio y largo plazo. El postoperatorio inmediato es el periodo en el que se establecen la mayoría de las complicaciones importantes que pueden derivar en la pérdida del injerto. La adecuada selección de donantes y receptores, así como una correcta técnica quirúrgica, son imprescindibles para minimizar la aparición de eventos adversos (AU)

Background En bloc kidney transplantation from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of bloc kidney transplantation from pediatric donors into adult recipients in a single center.Material and methods Retrospective analysis of 42 patients who received pediatric cadaveric bloc kidney transplantation in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered.ResultsWe have performed 42 bloc kidney transplantation from pediatric donors into adult recipients in our center. The recipients’ age was 44.1±11.8 years. Pediatric donors were 22.4±14.7 months old and weighted 11.3±3.6kg. Cold ischemia time was 15.7±4.5hours. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99±0.25mg/dl). There were 7graft losses (16.7%) in the immediate postoperative period (4 cases of vascular thrombosis, one anastomosis dehiscence and 2cortical necrosis).Conclusions The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events (AU)

A 20-year experience in cadaveric pediatric en bloc kidney transplantation in adult recipients.

BACKGROUND AND OBJECTIVES: En bloc kidney transplantation (EBKT) from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of EBKT from pediatric donors into adult recipients in a single center. MATERIAL AND METHODS: Retrospective analysis of 42 patients who received pediatric cadaveric EBKT in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered. RESULTS: We have performed 42 EBKT from pediatric donors into adult recipients in our center. The recipients' age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 h. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were seven graft losses (16.7%) in the immediate postoperative period (four cases of vascular thrombosis, one anastomosis dehiscence and two cortical necrosis). CONCLUSIONS: The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.

Colchicine in Recently Hospitalized Patients with COVID-19: A Randomized Controlled Trial (COL-COVID).

BACKGROUND: Colchicine has been proposed as a potential therapy in coronavirus disease 2019 (COVID-19) due to their anti-inflammatory actions. METHODS: The COL-COVID study was a prospective, randomized, controlled and open-label clinical trial that compared colchicine added to standard treatment vs standard treatment in hospitalized COVID-19 patients that do not need mechanical ventilatory support. Colchicine was initiated within the first 48 hours of admission at a 1.5 mg loading dose, followed by 0.5 mg b.i.d. for one week and 0.5 mg per day for 28 days. The study endpoints were clinical status (7-points WHO ordinal scale) and inflammatory biomarkers (IL-6 and CRP). RESULTS: A total of 103 patients (51±12 years, 52% male) were randomly allocated to colchicine arm (n=52) and control arm (n=51). At day 28, all patients in the colchicine group were alive and discharged, whereas in the control group, two patients died in-hospital and one patient remained hospitalized. Clinical improvement in terms of changes on WHO scale at day 14 and 28 and time to 1-point clinical improvement did not differ between the two groups. Clinical deterioration (increase of at least 1-point in WHO scale) was observed in a higher proportion of cases in colchicine group (13.8%) vs control group (5.8%) (p=0.303); after adjustment by baseline risk factors and concomitant therapies, colchicine therapy was associated with a lower risk of clinical deterioration (p=0.030). Inflammatory biomarkers CRP and IL-6 concentrations course did not differ between the two arms. CONCLUSION: In hospitalized COVID-19 patients, colchicine treatment neither improved the clinical status, nor the inflammatory response, over the standard treatment. Nevertheless, a preventive effect for further clinical deterioration might be possible. TRIAL REGISTRATION: NCT04350320.

Testosterone Replacement Therapy in Deficient Patients With Chronic Heart Failure: A Randomized Double-Blind Controlled Pilot Study.

BACKGROUND: Testosterone deficiency is associated with heart failure (HF) progression and poor prognosis. Testosterone therapy has been shown to improve exercise capacity in patients with chronic HF, but no trial has evaluated the impact of replacement in patients with demonstrated testosterone deficiency. METHODS: Prospective, randomized, double-blind, placebo-controlled, and parallel-group trial comparing testosterone replacement with placebo in males with chronic HF with reduced ejection fraction (HFrEF) and testosterone deficiency (NCT01813201). Long-acting undecanoate testosterone at a fixed dose of 1000 mg was supplied by intramuscular injection at inclusion and then every 3 months. The placebo group received isotonic saline serum. Patients were randomly allocated 1:1 to testosterone or placebo while receiving optimal medical therapy, and the study was conducted for 12 months. RESULTS: The final sample comprised 29 patients, 15 in the placebo group and 14 in the testosterone group (aged 65 ± 8, 62% with an ischemic etiology, left ventricular ejection fraction [LVEF] 30% ± 6%, 69% New York Heart Association functional [NYHA II]). After 12 months, testosterone replacement increased testosterone levels ( P = .002) but was not associated with benefit in terms of clinical symptoms and functional capacity including NYHA class, Framingham score, Minnesota Living Heart Failure Questionnaire, 6-minute walk test, or LVEF and N-terminal pro-B-type natriuretic peptide levels. No significant side effects associated with testosterone treatment were observed. No effects were found in other hormonal, metabolic, and bone turnover biomarkers. CONCLUSION: In patients with HFrEF and testosterone deficiency, replacement therapy was not associated with any significant improvement.

High frequency of Taenia pisiformis metacestodes and high sex-associated susceptibility to cysticercosis in naturally infected wild rabbits.

Sexual dimorphism is a well-documented phenomenon observed at all levels of the animal kingdom, with the inclusion of both sexes in clinical trials and basic research becoming mandatory. Regarding parasitosis, in several animal species, the signs and virulence of the disease may change depending on the sex of the affected animal. In the cestodiasis caused by Taenia solium and Taenia crassiceps, females are more susceptible to experimental infection than males. Cysticercosis by Taenia pisiformis in rabbits has acquired relevance due to its economic impact, namely affecting welfare and production. In America, specifically in Mexico, there are no formal reports on the infection with T. pisiformis metacestodes in populations of wild rabbits, despite being the country with more endemic species (about 15 species), among them, the volcanoes rabbits or the endangered teporingo (Romerolagus diazi). In this study, 31 wild rabbits were obtained by hunters of some regions of Morelos state during several hunting seasons, and sex, physiological stage, and number of metacestodes were recorded. A high frequency of infection by T. pisiformis metacestodes (67.7%) was found. Also, a higher susceptibility to this infection was observed in does (80% infected) compared to bucks (40%), finding 84.2% of metacestodes (235 metacestodes) in does and 15.8% of metacestodes (44 metacestodes) in bucks. The percentage of infection was higher in lactating compared with pregnant and non-pregnant does, with metacestodes lodging mainly in the uterus. Increasing our knowledge regarding parasitic infections can help us better understand transmission circles as well as the parasite-host interaction of these increasingly at risk rabbit species.

Diagnostic reference levels and complexity indices in interventional radiology: a national programme.

OBJECTIVES: To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. METHODS: Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. RESULTS: The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. CONCLUSIONS: The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. KEY POINTS: • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made.

Lens density measurement with Scheimpflug camera in vitrectomised eyes. / Densidad critaliniana medida con cámara de Scheimpfug en ojos vitrectomizados.

OBJETIVE: To determine whether vitrectomised eyes have a higher lens optical density, when measured with a Scheimpflug camera, compared to non-vitrectomised eyes. METHOD: The peak and linear Scheimpflug optical density (DOS), and area of both eyes were measured in a sample size of 81 vitrectomised phakic patients. A comparison was made between the DOS of the vitrectomised eye lens and the contralateral non-vitrectomised eye using the Student-t test. RESULTS: A significantly higher linear DOS and area was obtained in the 81 vitrectomised phakic eyes when compared to the non-vitrectomised eyes (P<.001). The peak DOS is not significantly increased in respect to non-vitrectomised eyes (P=.59). CONCLUSIONS: The lens DOS in vitrectomised eyes is higher than in non-vitrectomised eyes. The importance of the vitreous in the maintenance of lens transparency is emphasised.

Diferencia en la población de células cebadas de glándulas apocrinas de sacos anales de perros adultos y seniles / Difference in the population of mast cells of anal sac apocrine glands of adult and senile dogs

Se estudió la población de células cebadas (CC) presentes en sacos anales de perros adultos y seniles mediante su conteo en cortes de tejido procesado con la técnica de inclusión en parafina y teñidos con azul de toluidina. El promedio de CC obtenido para el grupo de perros adultos jóvenes fue de 18,16 +/- 7,58 (n=12 perros) y para el grupos de adultos maduros fue de 73,75 +/- 16,29 (n=12 perros). Al comparar el número de células de ambos grupos con la prueba de U Mann-Withney se encontró que son significativamente diferentes (P< 0,0001), siendo mayor en el grupo de perros seniles. Esta mayor población de CC puede estar relacionada con una mayor susceptibilidad de los perros seniles a reacciones inflamatorias del tejido de los sacos anales causadas por cambios en la dieta, obesidad y diarrea crónica.

We studied the population of mast cells (CC) present in anal sacs of adult and senile dogs by its count in tissue processed with the technique of embedding in paraffin and stained with toluidine blue. The average CC obtained for the group of adult dogs (n=12) was 18.16 +/- 7.58 and for group of senile dogs (n=12) was 73.75 +/- 16.29. When comparing the number of cells in both groups with Mann-Whitney U test were found to be significantly different (P0.0001), being higher in the group of senile dogs. The largest population of CC may be related to an increased susceptibility of senile dogs to inflammatory reactions in the tissue of the anal sacs caused by changes in diet, obesity and chronic diarrhea.

Lymphocytes and T lymphocyte subsets are regionally distributed in the female goat reproductive tract: influence of the stage of the oestrous cycle.

The reproductive tract of the female is a part of the mucosal system which protects from pathogens invasion. We have analysed the presence and distribution of total lymphocytes, plasma cells (antibody secreting B cells) and T lymphocytes subsets in the reproductive tract of the female goat. The influence of the oestrous cycle on the densities of lymphocytes and plasma cells of the cervix and uterus horn was evaluated in sections prepared for conventional histology. Immunocytochemistry was used for the study of lymphocyte subsets by confocal microscopy and immunoperoxidase techniques. Present results show that the reproductive tract of the goat is a site rich in lymphocytes. These cells were found mingled with the epithelial cells of the endometrium and distributed throughout the stroma. Lymphocyte aggregates were observed in the stroma. Lymphocyte but not plasma cell number changed depending on the reproductive stage of the goats. The impact of the hormonal environment was different for the cervix and uterine horn. Immunocytochemistry studies evidenced the presence of cells displaying immunoreactivity for both CD 4+ and CD 8+ antibodies in the epithelial layer and stroma of the cervix and uterine horn. These cells were more numerous in the cervix and were also found infiltrating the luminal epithelia of endometrial glands. Overall, our results indicate that lymphocyte distribution is different in the cervix and the horn, and is influenced by the stage of the reproductive cycle. In summary, CD 4+ and CD 8+ T lymphocytes subsets could be found in the endometrium of both the cervix and uterine horn of the goat reproductive tract.

Patient dose from barium procedures.

The objective of this work was to estimate patient doses (dose-area product, organ dose, effective dose and entrance surface dose) for barium procedures. A total of 175 procedures, in 175 patients, for five different examination categories was analysed. Dose-area product was determined using a transmission ionization chamber. Organ dose and effective dose were assessed using a knowledge of the examination and the software. For all patients, the contribution of fluoroscopy to the total dose was greater than that from radiography. Dose-area product from double contrast barium enema, enteroclysis and intestinal tract procedures was higher than that obtained for the other procedures. The average effective dose was 1.04 mSv and 13.99 mSv for oesophageal tract and enteroclysis examinations, respectively. Entrance surface dose in the oesophageal tract was 16 mGy, 10 times lower than for the other four procedures. Patient dose reduction in barium procedures may be achieved by improved training of resident radiologists, senior radiologists and other specialists in radiation protection.

Organ doses, detriment and genetic risk from interventional vascular procedures in Málaga (Spain).

Nowadays, the radiological risk from simple X-ray procedures is well known. The purpose of this work has been to estimate the population risk from digital angiographic and interventional procedures and to compare it with the one from simple procedures in the same population. The population risk has been estimated according to the following quantities: genetically significant dose, somatic significant dose, collective effective dose, annual per caput effective dose and detriment. These have been estimated from dose area product and organ dose. Organ dose values were estimated with the Eff-Dose software. A population of 605410 people were included in the study. In 1996, 1312 patients were to digital interventional vascular procedures in Malaga, and 159 of them were selected in this research project to obtain the dose area product and organ dose. The results obtained for the quantities evaluated are: genetically significant dose, 4.1 microGy; somatic significant dose, 0.9 mSv; collective effective dose, 11.65 person-Sv: annual per caput effective dose, 0.02 mSv and detriment, 0.65 radiogenic cancers per year. These procedures supply a high radiation dose, so they should have a greater contribution to population dose and risk than simple examinations. However, our results indicate just the opposite.

Stochastic risk estimate for barium radiological examinations in Malaga (Spain).

The aim of this research work has been the estimation of the stochastic risk for five barium examinations. The sample was the population attending the Radiological Service of the 'Nuestra Señora de la Victoria' University Hospital, who had been treated with some barium examinations, set in five different groups: oesophagus tract, oesophagus-gastric-duodenal tract, intestinal tract, enteroclysis and double enema. To estimate the stochastic risk, it is necessary to know the organ dose. This can be calculated from the dose-area product which allows us to determine the effective dose using software. The dose-area product is the most suitable quantity to measure in these types of examination. We have evaluated the contribution that each procedure provides to the genetically significant dose, somatically significant dose, collective effective dose, annual effective dose 'per capita' and detriment, which are useful for assessing the population risk of cancer or hereditary effects after x-ray exposure. The contribution to the genetically significant dose is 6.7 microGy, to the somatically significant dose 8.82 mSv-yr, 16.07 person-Sv for the collective effective dose, 0.03 mSv for the 'per capita' annual effective dose and the annual aggregated detriment is 0.33.

[Primary laryngeal lymphoma]. / Linfoma laríngeo primario.

We report a new case of supraglottic primary laryngeal lymphoma. The tumor was a B-cell, non-Hodgkin lymphoma with good response to polychemotherapy and radiotherapy. Although the head and neck region is a frequent site of origin of extranodal non-Hodgkin lymphomas, laryngeal involvement is exceptional. Including this case, 88 primary laryngeal lymphomas have been reported in the literature.