Epidemiology and factors associated with Extra-pulmonary tuberculosis in a Low-prevalence area.

Background: Tuberculosis is a global public health problem. Extra-pulmonary tuberculosis accounts for an increasing proportion of cases worldwide, although information about epidemiological, clinical, or microbiological factors is lacking. Methods: We conducted a retrospective observational study of tuberculosis cases diagnosed between 2016 and 2021, classified into Pulmonary and Extra-pulmonary tuberculosis. Univariable and multivariable logistic regression models were used to investigate risk factors of Extra-pulmonary tuberculosis. Results: 20.9% of overall cases were classified as Extra-pulmonary tuberculosis, with a rising trend from 22.6% in 2016 to 27.9% in 2021. Lymphatic tuberculosis accounted for 50.6% of cases, followed by pleural tuberculosis (24.1%). 55.4% of cases belonged to foreign-born patients. Microbiological culture tested positive in 92.8% of Extra-pulmonary cases. Logistic regression analysis showed that women were more predisposed to develop Extra-pulmonary tuberculosis (aOR 2.46, 95% CI 1.45-4.20) as well as elderly patients (aged ≥ 65 years) (aOR 2.47, 95% CI 1.19-5.13) and persons with previous history of tuberculosis (4.99, 95% CI 1.40-17.82). Conclusions: Extra-pulmonary Tuberculosis have increased within our study period. A profound decline occurred in 2021 tuberculosis cases, probably due to COVID-19. Women, elderly population, and persons with previous history of tuberculosis are at higher risk of developing Extra-pulmonary tuberculosis in our setting.

Mercury speciation in mine tailings amended with biochar: Effects on mercury bioavailability, methylation potential and mobility.

Biochar is a low-cost and environmentally friendly amendment with strong ability for adsorption of mercury (Hg) from aqueous solutions, contaminated soils, and sediments. In the present study, six biochars were prepared from the pyrolysis of cocoa pod husk, sugarcane bagasse and banana pseudostem at 400 and 600 °C in order to use them as an organic amendment and to evaluate their capacities to reduce the bioavailability, methylation potential, and mobility of Hg present in mine tailings without environmental treatment. To quantify the effects of each variety of biochar, incubation experiments of soil were established by mixing mine tailings with 5% by weight of biochar for 90 days. Once the incubation time concluded, sequential extraction procedures were carried out to determine the fractionation of the Hg species. Speciation analysis results indicated that the remedial effects of biochar depended on the source of organic matter and pyrolysis temperature. The bioavailable and organic Hg fractions decreased respectively by up to 75 and 79%, indicating a methylation potential reduction. Immobile Hg fraction increased to 76% with respect to the control. Adsorption and stabilization to HgS from the soluble forms of Hg reduce the percentage of bioavailable Hg. The organic Hg fraction reduction was correlated with the decrease of the bioavailable Hg fraction and with direct adsorption processes in the biochar structure. Highly porous biochars developed at high temperature, with large contents of superficial polar functional groups (H/C), and high pH, electrical conductivity, ash percentage and cation exchange capacity values favor the stabilization and adsorption of Hg in mine tailings. In summary, the application of biochar could be an effective method for the remediation of Hg-contaminated mine tailings, transforming the Hg species into less toxic, soluble, reactive, and bioavailable forms.

Transgenic Citrange troyer rootstocks overexpressing antimicrobial potato Snakin-1 show reduced citrus canker disease symptoms.

Citrus canker is a major disease caused by Xanthomonas citri pv. citri. Snakin-1 is an antimicrobial peptide, which was previously shown to be effective against different bacterial and fungal diseases in potato, wheat and lettuce when expressed in transgenic plants. We generated transgenic Citrange Troyer citrus rootstocks constitutively expressing this peptide and 5 different transgenic lines were challenged against virulent X. citri isolates. Challenge assays conducted in vitro using detached leaves and in planta by infiltration revealed a significant reduction of the number and size of canker lesions in some of the transgenic lines.

RNA-binding protein immunoprecipitation as a tool to investigate plant miRNA processing interference by regulatory proteins of diverse origin.

BACKGROUND: Due to the nature of viral RNA genomes, RNA viruses depend on many RNA-binding proteins (RBP) of viral and host origin for replication, dissemination and evasion of host RNA degradation pathways. Some viruses interfere with the microRNA (miRNA) pathway to generate better fitness. The development of an adjusted, reliable and sensitive ribonucleoprotein immunoprecipitation (RIP) assay is needed to study the interaction between RBP of different origin (including viral origin) and miRNA precursors. The method could be further applied to transiently expressed heterologous proteins in different plant species. RESULTS: Here we describe a modified RIP assay applied to nuclear epitope-tagged proteins of heterologous origin and transiently expressed in Nicotiana benthamiana. The assay includes a combination of optimized steps as well as the careful selection of control samples and rigorous data analysis. It has proven efficient to detect and quantify miRNA processing intermediates associated with regulatory proteins. CONCLUSIONS: The RIP method described here provides a reliable tool to study the interaction of RBPs, such as transiently expressed regulatory proteins with lowly represented host RNA, as is the case of miRNA precursors. This modified method was efficiently adjusted to recover nuclear proteins and reduce unspecific background. The purification scheme optimized here for GFP-tagged proteins can be applied to a wide array of RBPs. The subsequent application of next-generation sequencing technologies will permit to sequence and characterize all RNA species bound in vivo by a given RBP.

[Breast Cancer Survival: Clinical andPathological Prognostic Factors Analysis]. / Supervivencia de pacientes con cáncer de mama. Análisis por factores pronóstico, clínicos y patológicos.

Background: Breast cancer is the leading cause of cancer death in women in Mexico, is a heterogeneous disease, and knowledge of prognostic factors are critical in making treatment decisions. Objetive: determine the overall survival (OS) and disease-free survival (DFS) at 5 years, analyzed by risk groups. Material and methods: Patients diagnosed with breast treated at the Institute of Breast Diseases FUCAM from July 2005 to December 2014 were included. Simple frequencies were used for analysis of the general characteristics, and 5- year OS and DFS were analyzed using Kaplan-Meier curves. A subset analysis of the clinical stage and comparing survival in those patients diagnosed by mammography screening program was performed. Results: 4,902 patients with breast cancer were included, general clinical and pathological features are described and 3,762 patients were included for analysis of 5-year OS and DFS. The average age at diagnosis was 53.7 years; 13.3% were <40 years, which deleteriously reflects on the supervivencia global 76 vs 84% in >40. At diagnosis predominated locally advanced stages (45%), OS and DFS at 5 years was 96.8 ± 0.6% and 93.4%±0.9 respectively for early stages, 74.6 ± 1.7% and 68.7 ± 2% for locally advanced and 35.9 ± 5.1% and 37.4 ± 10.3% for metastatic tumors. Women diagnosed in the screening program had significantly better OS and DFS compared with symptomatic patients (95 and 93% vs 79 and 77%). For biological subtypes, OS and DFS was 89 and 84% for luminal, 81 and 81% for luminal Her +, 74 and 78% for pure Her 2, and 69 and 73% for triple negative. Conclusion: Knowledge of the prognostic factors that affect survival of patients with breast cancer is essential for categorizing risk groups and to individualize treatment in order to improve life expectancy.

Perinatal development of endothelial nitric oxide synthase-deficient mice.

The purpose of this study was to evaluate the influence of endothelial nitric oxide synthase (eNOS) deficiency on fetal growth, perinatal survival, and limb development in a mouse model with a targeted mutagenesis of the Nos3 gene. Wild-type (Nos3+/+) and eNOS-deficient fetuses (Nos3-/-) were evaluated on Gestational Day (E)15 and E17, and newborn pups were observed on Day 1 of life (D1). The average term duration of pregnancy was 19 days. For the evaluation of postnatal development, a breeding scheme consisting of Nos3+/- x Nos3+/- and Nos3-/- x Nos3-/- mice was established, and offspring were observed for 3 wk. Southern blotting was used for genotyping. No significant differences in fetal weight, crown-rump lengths (CRL), and placental weight were seen between Nos3+/+ and Nos3-/- fetuses on E15. By E17, Nos3-/- fetuses showed significantly reduced fetal weights, CRL, and placental weights. This difference in body weight was also seen throughout the whole postnatal period. In pregnancies of Nos3-/- females, the average number of pups alive on D1 was significantly decreased compared to either E15 or E17. Placental histology revealed no abnormalities. On E15, E17, and D1, Nos3(-/-) fetuses demonstrated focal acute hemorrhages in the distal limbs in 0%, 2.6%, and 5.7%, respectively, of all mutant mice studied on the respective days. Bone measurements showed significantly shorter bones in the peripheral digits of hindpaws of Nos3-/- newborns. We conclude mice deficient for eNOS show characteristically abnormal prenatal and postnatal development including fetal growth restriction, reduced survival, and an increased rate of limb abnormalities. The development of this characteristic phenotype of eNOS-deficient mice dates back to the prenatal development during the late third trimester of pregnancy.

Evolutionary computation in medicine: an overview.

The term evolutionary computation encompasses a host of methodologies inspired by natural evolution that are used to solve hard problems. This paper provides an overview of evolutionary computation as applied to problems in the medical domains. We begin by outlining the basic workings of six types of evolutionary algorithms: genetic algorithms, genetic programming, evolution strategies, evolutionary programming, classifier systems, and hybrid systems. We then describe how evolutionary algorithms are applied to solve medical problems, including diagnosis, prognosis, imaging, signal processing, planning, and scheduling. Finally, we provide an extensive bibliography, classified both according to the medical task addressed and according to the evolutionary technique used.

A fuzzy-genetic approach to breast cancer diagnosis.

The automatic diagnosis of breast cancer is an important, real-world medical problem. In this paper we focus on the Wisconsin breast cancer diagnosis (WBCD) problem, combining two methodologies-fuzzy systems and evolutionary algorithms-so as to automatically produce diagnostic systems. We find that our fuzzy-genetic approach produces systems exhibiting two prime characteristics: first, they attain high classification performance (the best shown to date), with the possibility of attributing a confidence measure to the output diagnosis; second, the resulting systems involve a few simple rules, and are therefore (human-) interpretable.

[Use of a questionnaire for screening people with undiagnosed diabetes]. / Utilidad de un cuestionario en la detección de individuos con riesgo de diabetes mellitus asintomática.

OBJECTIVE: To evaluate a screening questionnaire to identify individuals with undiagnosed diabetes. DESIGN AND METHODS: We conducted a community survey to detect people at increased risk for diabetes using a questionnaire proposed by Herman et al. (1995), that incorporates major risk factors as age, obesity, family history of diabetes, sedentary lifestyle and personal history of delivering a macrosomic infant. Blood glucose test was made by means of reagent strip and a reflectance meter system. We used the ADA recommendations and cut-points for screening programs, adjusted for fasting and random blood glucose. RESULTS: We included 360 participants older than 20 years of age. A total of 200 subjects (55.5%) were at risk for diabetes according to the questionnaire, of whom 31 (15.5%) had an abnormal glucose test compared to the 4.4% of the low-risk group (p < 0.001). The 1995 Herman et al. Questionnaire had sensitivity of 81.6%, specificity of 47.5, positive predictive value of 15.5 and negative predictive value of 95.6%. The high-risk group was older (44.9 vs. 34.6 y, p < 0.001) and heavier (30.5 vs. 24.4 kg/m2, p < 0.001) than the low-risk group. There were 38/360 (10.5%) abnormal glucose readings, of which 31 (81.5%) had a positive questionnaire (p < 0.01). The mean fasting glucose in the high-risk group was higher (90.6 vs. 84.2 mg/dL, p = 0.015) than in those with low risk by questionnaire, as well as for random blood glucose (116.1 vs. 100 mg/dL, p < 0.01). CONCLUSIONS: The questionnaire proposed by Herman et al. combined with capillary blood glucose testing performance good in mexican population to identify people at high risk for undiagnosed diabetes, and improved the detection rate.

Disfunçäo do nódulo sino-atrial: clínica e terapêutica / Sick sinus syndorme: clinical approach and treatment

Disfunçäo do nódulo sino-atrial é a incapacidade apresentada pelo coraçäo em manter uma frequência adequada às necessidades orgânicas, provocando sintomas, devido ao fluxo snaguineo diminuido. Habitualmente, a reduçäo da frequência cardíaca se manifesta no eletrocardiograma (ECG) como: bradicardia sinusal persistente, bloqueio sino-atrial de 2 grau, pausas ou paradas sinusais passageiras, ritmos de escape passivos, juncionais ou idioventriculares, flutter ou fibrilaçäo atrais com resposta ventricul lenta e síndrome bradicardia-taquicardia. Todos estes distúrbios devem surgir sem a utilizaçäo de agentes farmacológicos bradicardizantes. Os principais sintomas referidos säo: síncopes, pré-síncopes, lipotímias, tonturas, palpitaçöes, insuficiência cardíaca congestiva, edema agudo de pulmäo e agravamento de quadros anginosos. a investigaçäo diagnóstica compreende: história clínica, ECG (em repouso, ambulatorial e de esforço), testes da funçäo autonômica, incluindo a massagem do seio carotídeo e avaliaä dos parâmetros eletrofisiológicos do nódulo sino-atrial. A evoluçäo natural desta enfermidade é lenta e episódica: a bradicardia persiste por períodos prolongados de tempo, até a apariçäo dos sintomas. O prognóstico geralmente é benigno; entretanto podem surgir complicaçöes graves, potencialmente letais: fenômenos embólicos säo comuns, quando exite fibrilaçäo atrial paroxística. A síncope do seio carotídeo é causada por reflexo barorreceptor exagerado, ocasionando assistolias prolongadas, após manobra povocativas mínimas sobre a bifurcaçäo da artéria carótida comum; pode ser subdividida em dois tipos: cardioinibitória e vasodepressora. O uso de fármacos com açäo aceleradora da frequência cardíaca, na disfunçäo do nódulo sino-atrial, näo produz resultados satisfatórios e conduz, precocemente, ao aparecimento de efeitos secundários. Nos casos sintomáticos o tratamento ideal é o implante de marcapasso artificial definitivo: de acordo com as circunstâncias, pode-se utilizar gerador unicameral com eletroo etimulador posicionado em átrio ou dispositivo de dupla câmara, com ou sem modulaçöes de frequencia. Na miocardiopatia chagásica crônica, é relativamente comum a presença de disfunçäo do nódulo sino-atrial, sendo acompanhada, na maioria dos casos por lesöes extensas do sistema de conduçäo; apesar de todas as medidas terapêuticas, farmacológicas ou näo, existe progressäo contínua no comprometimento muscular cardíaco, evoluindo, após ...

Cardiologia: atualizaçäo e reciclagem / Cardiology: uptade

Säo aquelas originadas e mantidas por estruturas localizadas acima da bifurcaçäo do feixe de His. Os complexos QRS apresentam duraçäo de 0,11s ou menos. Podem se originar no nódulo sinusal (taquicardia sinusal secundária a hiperautomatismo ou reentrada); nos átrios (taquicardia atrial automática, taquicardia atrial multifocal, flutter atrial, fibrilaçäo atrial); no nódulo AV (taquicardia juncional paroxística por reentrada nodal, forma comum); no tronco do feixe de His (taquicardia juncional näo-paroxística); envolvendo uma via acessória (síndrome de Wolff-Parkinson-White) e reentrada atrioventricular por via acessória com conduçäo unidirecional retrógrada ("WPW oculto").