Cytomegalovirus reactivation in patients diagnosed with severe COVID-19: A point prevalence study in a general hospital.

OBJECTIVE: To determine the prevalence of CMV reactivation in a population admitted for severe COVID-19 to a general hospital. METHODS: Point prevalence study in all hospitalized patients with severe COVID-19 (admitted either to general wards or ICU). Determination of the presence of CMV DNA in circulating blood. COVID-19 was confirmed in patients with compatible clinical manifestations, usually with pneumonia and a positive nasopharyngeal PCR test. RESULTS: We included 140 hospitalized patients with COVID-19 who consented to participate. A total of 16 patients (11.42%), had circulating CMV-DNA in peripheral blood at the time of the study. Patients with positive CMV viral load were mainly ICU patients (11/37 -29,7%) and only 5/103 cases (4,85%) were hospitalized into general wards. The accumulated doses of corticosteroids (prednisone equivalents) in the study day were (median and IQR) 987.50 mg (396.87-2,454.68) and 187.50 mg (75.00-818.12) respectively in CMV positive and negative patients (p < 0.001). A significant proportion of CMV positive patients were discovered because of the study and were clinically unsuspected by their physicians. The coinfected COVID-CMV positive population had a higher risk of accumulated secondary nosocomially-acquired infections and a worse prognosis. CONCLUSIONS: CMV reactivation should be systematically searched in patients in COVID-19 cases admitted to the ICU.

Validación de un instrumento de desarrollo profesional en educación física infantil / Validation of an Instrument of Professional Development in Infant Physical Education

El objetivo consiste en construir y diseñar un cuestionario que evalúa el desarrollo profesional de los docentes de Educación Infantil en su vinculación con la Educación Física. Se han estudiado sus propiedades psicométricas con una muestra de 526 docentes mediante el programa estadístico SPSS v.23 y AMOS. Se llevaron a cabo análisis de confiabilidad, análisis factorial exploratorio, correlación ítem con puntaje total y análisis factorial confirmatorio. La consistencia del instrumento ha sido elevada (α = 0,836). Además, hay una adecuada correlación ítem con puntaje total, y la presencia de siete factores en el análisis factorial exploratorio. El análisis factorial confirmatorio mostró un adecuado ajuste a los datos del modelo del cuestionario (gi2 /gl = 1,635; GFI=0,929; CFI=0,963; RMSEA=0,039). Los resultados sugieren que este cuestionario es un instrumento fiable y válido y se recomienda su uso en futuras investigaciones

The objective is to build and design a questionnaire that assesses the professional development of Early Childhood Education teachers in their connection with Physical Education. Their psychometric properties have been studied with a sample of 526 teachers through the statistical program SPSS v.23 and AMOS. Reliability analysis, exploratory factor analysis, item correlation with total score and confirmatory factor analysis were carried out. The consistency of the instrument has been high (α = 0.836). In addition, there is an adequate item correlation with total score, and the presence of seven factors in the exploratory factor analysis. The confirmatory factor analysis showed an adequate adjustment to the model data of the questionnaire (chi2 / gl = 1.635, GFI = 0.929, CFI = 0.963, RMSEA = 0.039). This questionnaire is a reliable and valid instrument and its use is suggested in future researches

Lupus eritematoso sistémico en niños en su transición a adultos: experiencia basada en 17 casos / Systemic lupus erythematosus in children during their transition into adulthood: experience based on 17 cases

Foreword: Systemic Lupus Erythematosus (SLE) is an inflammatory, autoimmune and multisystemic disease featured by the presence of multiple antibodies, and which appears in both genders and at any age, including children, albeit rare under 5 years of age. Objective: To assess its clinical and in-lab manifestations, and the evolution of pediatrics patients and of those who transition into adulthood. Results: Seventeen (17) patients with infantile inception were assessed; they met the SLICC/ACR diagnose criteria over a time span running between years 2001 and 2013. They recorded an 88 percent of musculoskeletal compromise, 88 percent of renal compromise, 47 percent of alopecia, 47 percent of photosensitivity, and 42 percent of neurological compromise. All (100 percent) of them tested positive for antinuclear antibodies (ANA), 88 percent for anti-DNA, and 53 percent were Sm-positive. Anaemia was found in 42 percent of them, Leukopenia in 12 percent, and Lymphopenia in 35 percent. As regards the treatment, all of them (100 percent) received hydroxychloroquine, 94 percent were administered prednisone, 82 percent mycophenolate, and 71 percent cyclophosphamide. Fifteen of them (88 percent) have transitioned to the adults’polyclinic, and from them 6 (35 percent) have evidenced SLE reactivations associated to the lack of adherence to treatment. In this series the survival rate is of 100 percent of patients during the follow-up period. Conclusion: Infantile-inception Lupus, although less frequent, is more severe than that with an inception during adulthood, with a high prevalence of nephropathy, above half of the Classes III or IV. Early treatment with corticoids, immunosuppressants and hydroxychloroquine enables a favorable evolution and an appropriate transition into adulthood, with a survival rate of 100 percent. It is necessary to strengthen a good doctor-patient relationship during this transition, including a proper communication between the pediatric...

Introducción: El Lupus Eritematoso Sistémico (LES) es una enfermedad inflamatoria, autoinmune y multisistémica, caracterizada por la presencia de múltiples autoanticuerpos y que se presenta en ambos sexos y a cualquier edad, incluido en niños, siendo raro bajo los 5 años de edad. Objetivo: Evaluar sus manifestaciones clínicas, de laboratorio y evolución en pacientes pediátricos y en los que pasan a adultos. Resultados: Se analizó a 17 pacientes de inicio infantil que cumplieron los criterios diagnósticos SLICC y ACR en un periodo comprendido entre los años 2001 y 2013. Presentaron compromiso musculoesquelético 88 por ciento, renal 88 por ciento, alopecia 47 por ciento, fotosensibilidad 47 por ciento y neurológico 42 por ciento. Un 100 por ciento tuvieron anticuerpos antinucleares (AAN) positivos, 88 por ciento anti-DNA y 53 por ciento Sm positivos. Se encontró anemia en 42 por ciento, leucopenia en 12 por ciento y linfopenia en 35 por ciento. En relación al tratamiento, el 100 por ciento recibió hidroxicloroquina, prednisona 94 por ciento, micofenolato 82 por ciento y ciclofosfamida 71 por ciento. Quince (88 por ciento) han hecho la transición al Policlínico de Adultos, de los cuales seis (35 por ciento) han presentado reactivaciones del LES asociadas a falta de adherencia al tratamiento. En esta serie la sobrevida es del 100 por ciento de los pacientes durante el periodo de seguimiento. Conclusión: El Lupus de inicio infantil, si bien menos frecuente, es más severo que el de inicio adulto, con alta prevalencia de nefropatía, sobre la mitad de clase III o IV. El tratamiento precoz con corticoides, inmunosupresores e hidroxicloroquina permite una evolución favorable y un adecuado paso a la adultez, con 100 por ciento de sobrevida. Es necesario reforzar una buena relación médico-paciente en esta transición, incluida una comunicación adecuada entre el reumatólogo infantil y de adulto, que asegure mantener una adherencia y control óptimo de la enfermedad.

Evidence for protein kinase C-dependent and -independent activation of mitogen-activated protein kinase in T cells: potential role of additional diacylglycerol binding proteins.

Activation of mitogen-activated protein kinases (MAPK) is a critical signal transduction event for CTL activation, but the signaling mechanisms responsible are not fully characterized. Protein kinase C (PKC) is thought to contribute to MAPK activation following TCR stimulation. We have found that dependence on PKC varies with the method used to stimulate the T cells. Extracellular signal-regulated kinase (ERK) activation in CTL stimulated with soluble cross-linked anti-CD3 is completely inhibited by the PKC inhibitor bisindolylmaleimide (BIM). In contrast, only the later time points in the course of ERK activation are sensitive to BIM when CTL are stimulated with immobilized anti-CD3, a condition that stimulates CTL degranulation. Surprisingly, MAPK activation in response to immobilized anti-CD3 is strongly inhibited at all time points by the diacylglycerol (DAG)-binding domain inhibitor calphostin C implicating the contribution of a DAG-dependent but PKC-independent pathway in the activation of ERK in CTL clones. Chronic exposure to phorbol ester down-regulates the expression of DAG-responsive PKC isoforms; however, this treatment of CTL clones does not inhibit anti-CD3-induced activation of MAPK. Phorbol ester-treated cells have reduced expression of several isoforms of PKC but still express the recently described DAG-binding Ras guanylnucleotide-releasing protein. These results indicate that the late phase of MAPK activation in CTL clones in response to immobilized anti-CD3 stimulation requires PKC while the early phase requires a DAG-dependent, BIM-resistant component.

Mechanical properties of model membranes studied from shape transformations of giant vesicles.

Membrane deformations occur frequently in cell functioning. From the physical point of view, the understanding of such shape changes requires the introduction of mechanical parameters like bending elasticity. In this article it is shown how this physical property can be obtained from the analysis of small or large shape transformations from giant vesicles. Then it is demonstrated that the bending modulus is strongly dependent on the membrane composition and environmental conditions. This is the case for one-component bilayers (dilauroylphosphatidylcholine (DLPC), dimyristoylphosphatidylcholine (DMPC), dipalmitoylphosphatidylcholine and stearoyloleoyl-phosphatidylcholine (SOPC) and for two-component lipid mixtures (DMPC/cholesterol, DLPC/dilauroylphosphatidic acid). Further it is shown that the bending elasticity of natural lipid extracts (egg phosphatidylcholine, digalactosyl diglyceride and red blood cell lipid extracts) is generally smaller than that of comparable synthetic model membranes. The role of transmembrane proteins is examined by measuring the bending elasticity of SOPC/gramicidin mixtures. Finally, larger scale shape transformations of giant vesicles under an alternative electric field are discussed.

Sustained TCR signaling is required for mitogen-activated protein kinase activation and degranulation by cytotoxic T lymphocytes.

Requirements for T cell activation are not fully established. One model is that receptor occupancy and down-regulation are essential for activation, and another, not necessarily mutually exclusive, model is that sustained signals are important. Here we examine the importance of signal duration in T cell activation. First, we demonstrate that immobilized, but not soluble cross-linked, Abs to CD3 stimulate degranulation by CTL. The cross-linked Abs are not deficient in their ability to signal since they stimulate the same tyrosine phosphorylation pattern as immobilized Ab, but it is very transient relative to that stimulated by immobilized Ab. Furthermore, novel decreased migratory forms of Lck occur to a significant extent only after stimulation with immobilized Abs. A dramatic difference in the duration of signals is very evident when mitogen-activated protein kinase (MAPK) activity is examined. Immobilized anti-CD3 stimulates very high levels of MAPK activation that is still detectable 1 h after stimulation. In contrast, cross-linked Ab stimulates only transient and incomplete activation of MAPK. Taken together, these results suggest that TCR engagement and induction of tyrosine phosphorylation alone are not sufficient for T cell activation and that the duration of TCR-stimulated signals is critical to attain a functional response.

Use of yellow-pigmented enterococci as a specific indicator of human and nonhuman sources of faecal pollution.

Antibiotic susceptibility tests and restriction enzyme analysis (REA) of genomic DNA were performed to characterize the relationship between sources of isolates of yellow-pigmented enterococci. Antibiotic susceptibility tests were conducted with 10 therapeutic antibiotics and 54 isolates grouped by source (wild and other) depending on their origin. In three antibiotics, cephalothin, erythromycin, and vancomycin, there was a significant (p < or = 0.05) association between susceptibility and source. Vancomycin resistance was significantly (p < or = 0.001) higher in isolates from wild sources compared with that in isolates from other sources. The REA technique was performed on genomic DNA obtained from 17 Enterococcus mundtii isolates from: human (3), dog (4), horse (4), Canada goose (4), domestic goose (1), and Enterococcus mundtii ATCC 43186. A total of 12 different DNA types (A-L) were identified. Except for type D, 11 DNA types were unique and were distributed among dog (A, B, and C), human (E), horse (F, G, and H), Canada goose (I, J, and K), and domestic goose (L). Results suggested that vancomycin-susceptibility testing of yellow-pigmented enterococci may have potential value in the identification of sources of faecal pollution, especially when combined with traditional quantitative methods.

[Congenital pulmonary arteriovenous fistulas]. / Fístulas arteriovenosas pulmonares congénitas.

Pulmonary arteriovenous fistulas are a very infrequent illness. The majority of these cases are associated with hereditary haemorrhagic telangiectasia, therefore their isolated presentation is exceptional. We present a patient that was diagnosed of two arteriovenous fistulas non associated with hereditary haemorrhagic telangiectasia. His main symptom was progressive dyspnea on exertion, with cyanosis and clubbing. His evolution after surgery was satisfactory. Theirs clinical, diagnosis and therapeutic peculiarities ware discussed.

Bending elasticities of model membranes: influences of temperature and sterol content.

Giant liposomes obtained by electroformation and observed by phase-contrast video microscopy show spontaneous deformations originating from Brownian motion that are characterized, in the case of quasispherical vesicles, by two parameters only, the membrane tension sigma and the bending elasticity k(c). For liposomes containing dimyristoyl phosphatidylcholine (DMPC) or a 10 mol% cholesterol/DMPC mixture, the mechanical property of the membrane, k(c), is shown to be temperature dependent on approaching the main (thermotropic) phase transition temperature T(m). In the case of DMPC/cholesterol bilayers, we also obtained evidence for a relation between the bending elasticity and the corresponding temperature/cholesterol molecular ratio phase diagram. Comparison of DMPC/cholesterol with DMPC/cholesterol sulfate bilayers at 30 degrees C containing 30% sterol ratio shows that k(c) is independent of the surface charge density of the bilayer. Finally, bending elasticities of red blood cell (RBC) total lipid extracts lead to a very low k(c) at 37 degrees C if we refer to DMPC/cholesterol bilayers. At 25 degrees C, the very low bending elasticity of a cholesterol-free RBC lipid extract seems to be related to a phase coexistence, as it can be observed by solid-state (31)P-NMR. At the same temperature, the cholesterol-containing RBC lipid extract membrane shows an increase in the bending constant comparable to the one observed for a high cholesterol ratio in DMPC membranes.

Oral pseudolymphoma: a report of two cases.

Although 2% to 10% of lymphomas present first in the oral cavity and lymphomas are the third most common oral malignancy, pseudolymphoma is a very infrequent problem within oral pathology. Two cases of oral pseudolymphoma are presented. Both were old persons with an infiltrative lesion on the oral mucosa that histologically showed a dense polymorphous infiltrate with some nuclear atypia that raised the problem of lymphoma versus pseudolymphoma. Both lesions disappeared with no relapse after 2-years' follow-up. Histologically, case 1 was mainly a lymphohistiocytic infiltrate whose histiocytic component showed nuclear features that mimicked Hodgkin's cells. In case 2, the infiltrate was mainly composed of histiocytes and eosinophils. The suspicion of malignancy here was a consequence of a high mitotic rate of histiocytes and of the large hyperchromatic nuclei of the intraepithelial lymphocytes. Similarities and differences with other pseudomalignant (lymphomatoid papulosis and atypical histiocytic granuloma) and inflammatory (traumatic ulcerative granuloma with stromal eosinophilia) disorders, as well as with some histiocytoses, are discussed. In the absence of a wider experience on this subject, an objective description of new cases seems appropriate.

Angioplastía transluminal percutánea con catéter balón en coartación aórtica nativa: experiencia a largo plazo / Long term study of percutaneous angioplasty in native aortic coarctation

De agosto de 1988 a octubre de 1993, 19 pacientes portadores de coartación aórtica nativa (CoAo) fueron sometidos a angioplastía transluminal percutánea con balón (ATPB). Doce fueron hombres (63.1 por ciento) y 7 mujeres (36.9 por ciento), con edad promedio de 22 ñ 7.7 años (extr. 16-52). Todos eran portadores de hipertensión arterial al momento del procedimiento, con una presión sistólica de 190 ñ 32.3 mmHg (extr. 160-240). El gradiente de presión sistólica (GPS) fue de 77 ñ 24 mmHg (extr. 45-130), un diámetro del anillo de coartación de 4.2 ñ 0.9 mm, el diámetro promedio de los catéteres balón utilizados fue de 18.3 ñ 1.7 mm (extr. 15-20). En todos los pacientes, el procedimiento se efectuó bajo anestesia local y con la técnica habitual de Seldinger. Después de efectuar el procedimiento, el GPS así como la presión arterial descendieron a 5.0 ñ 4.1 mmHg y 130 ñ 20.6 mmHg respectivamente y la ampliación del anillo presentó un aumento de 4.2 ñ 0.9 a 14.1 ñ 1.6 mm. En ninguno de los procedimientos se presentaron complicaciones: en el seguimiento 11 pacientes se han vuelto a cateterizar en un lapso de 24.7 ñ 12.6 meses (extr. 10-48) con un GPS de 5 ñ 2 mmHg y se observó un aumento en el diámetro del anillo a 15.4 ñ 1.2 mm. En estos sujetos vueltos a estudiar no se evidenciaron aneurismas en el sitio de la dilatación; el resto de los sujetos intervenidos llevan un control por consulta externa: 17 de ellos se mantienen normotensos sin tratamiento médico y dos únicamente han requerido de terapia antihipertensiva con mejor control a dosis bajas. Nuestra experiencia sugiere que la ATPB en CoAo tipo diafragma a cualquier edad es segura y muy efectiva con mejoría sostenida a mediano y largo plazo

[Comparative study of 2 diagnostic tests of aspecific bronchial hyperreactivity]. / Estudio comparativo de dos pruebas de diagnóstico de la hiperreactividad bronquial inespecífica.

Bronchial challenge test are useful in diagnosis of bronchial hyperresponsiveness (BH). To assess the sensitivity of histamine test (HT) and exercise test (ET), 45 asthmatic patients (31 men, 14 women, ages 9-34) with normal resting pulmonary function test were studied. HT and ET were performed in two different days. HT was positive in 40 (6 severe, 23 moderate and 11 mild) and ET was positive in 13 (88.8% vr 28.8%, p < 0.001). All patients with positive ET had positive HT. There is a relationship between the degree of BH severity and the response to ET (chi 2 = 5.995; p < 0.05). The HT has a high profitability the diagnosis of BH. The ET has a low sensitivity.

Effects of cefpirome in comparison with cefuroxime against human polymorphonuclear leucocytes in vitro.

The interaction of cefpirome and cefuroxime, with human polymorphonuclear leucocytes (PMNs) was examined. The effects of therapeutic concentration (1, 10, and 50 mg/L) of both antimicrobial agents on the adherence, spontaneous mobility, chemotaxis, chemokinesis, phagocytosis and candidacidal capacity were studied in vitro. No statistically significant variations, in relation to the control, were observed in the ability of PMNs to adhere to nylon fibre at the concentrations of cefuroxime and cefpirome used. With both antimicrobial agents, PMN mobility increased as the antibiotic concentration was increased. A statistically significant increase (P < 0.05) in spontaneous mobility, chemotaxis and chemokinesis was observed with cefpirome at only 10 mg/L. However, only spontaneous mobility was increased significantly with cefuroxime at 10 mg/L. The strongest effects were observed with cefpirome at 50 mg/L with variations of about 70% (P < 0.01), in chemotaxis and chemokinesis. In general, cefpirome had a positive effect on phagocytosis and candidacidal power, which was significant at a concentration of 50 mg/L (P < 0.01). Cefuroxime, in general, produced no modifications in either phagocytosis or candidacidal power.

Nasal continuous positive airway pressure in patients with COPD in acute respiratory failure. A study of the immediate effects.

The aim of this study was to assess the effect of nasal continuous positive airway pressure (CPAP) breathing on patients with COPD when they are in respiratory failure during acute episodes of the disease. We studied 15 male patients with COPD who were in acute, unstable condition, without mechanical ventilatory support, before and during 4 h of nasal CPAP. The respiratory rate decreased (initial, 30 +/- 6; final, 25 +/- 6; p < 0.001), as did the subjective sensation of dyspnea (initial Borg index, 3 +/- 3; final, 2 +/- 2; p < 0.05). A significant decrease in the average PaCO2 (before, 73 +/- 10 mm Hg; after, 61 +/- 9 mm Hg; p < 0.001) and a significant increase in the PaO2 (before, 57 +/- 13 mm Hg; after 64 +/- 14 mm Hg; p < 0.05) were also observed. Nasal CPAP was generally well tolerated. According to these results, nasal CPAP should be considered as a possibility for treatment in patients with COPD who are in acute respiratory failure, in order to avoid mechanical ventilation.

Activity of vancomycin and teicoplanin against human polymorphonuclear leucocytes: a comparative study.

The in-vitro effects of therapeutic concentrations of teicoplanin and vancomycin on the adherence, spontaneous mobility, chemotaxis, phagocytic and candidacidal capacity of human polymorphonuclear leukocytes (PMNs) were studied. Adherence was not affected by the tested concentrations of teicoplanin. A progressive diminishing of adherence was observed in relation to the control, which reached 30% with the maximum concentration of vancomycin (50 mg/L), although this was not statistically significant. An increase in spontaneous mobility was noted after 30 min incubation in the presence of any one of the tested concentrations of both antibiotics, although the results were only significant (P less than 0.05) for 50 mg/L of teicoplanin. Chemotaxis increased, although not significantly (P greater than 0.05) in the presence of 10 and 50 mg/L of teicoplanin, and diminished with respect to the control very significantly (P less than 0.019) when 1 and 50 mg/L of vancomycin were tested. The study of the phagocytic and candidacidal capacity of the PMNs on Candida albicans showed that teicoplanin had a favourable effect on both functions, even though the differences were not statistically significant.