Intranasal Versus Intravenous Dexamethasone to Treat Hospitalized COVID-19 Patients: A Randomized Multicenter Clinical Trial.

BACKGROUND: SARS-CoV2 induces flu-like symptoms that can rapidly progress to severe acute lung injury and even death. The virus also invades the central nervous system (CNS), causing neuroinflammation and death from central failure. Intravenous (IV) or oral dexamethasone (DXM) reduced 28 d mortality in patients who required supplemental oxygen compared to those who received conventional care alone. Through these routes, DMX fails to reach therapeutic levels in the CNS. In contrast, the intranasal (IN) route produces therapeutic levels of DXM in the CNS, even at low doses, with similar systemic bioavailability. AIMS: To compare IN vs. IV DXM treatment in hospitalized patients with COVID-19. METHODS: A controlled, multicenter, open-label trial. Patients with COVID-19 (69) were randomly assigned to receive IN-DXM (0.12 mg/kg for three days, followed by 0.6 mg/kg for up to seven days) or IV-DXM (6 mg/d for 10 d). The primary outcome was clinical improvement, as defined by the National Early Warning Score (NEWS) ordinal scale. The secondary outcome was death at 28 d between IV and IN patients. Effects of both treatments on biochemical and immunoinflammatory profiles were also recorded. RESULTS: Initially, no significant differences in clinical severity, biometrics, and immunoinflammatory parameters were found between both groups. The NEWS-2 score was reduced, in 23 IN-DXM treated patients, with no significant variations in the 46 IV-DXM treated ones. Ten IV-DXM-treated patients and only one IN-DXM patient died. CONCLUSIONS: IN-DMX reduced NEWS-2 and mortality more efficiently than IV-DXM, suggesting that IN is a more efficient route of DXM administration.

Pain prevalence and chronicity in a developing country in Latin America: a population-based survey in Lima, Peru.

Background: No population-based epidemiological studies have estimated pain prevalence and its characteristics in Peru. Patients & methods: A representative sample of adults aged over 18 years (n = 502) living in metropolitan Lima, Peru was enrolled. We analyzed prevalence data of pain in the last 3 months and other pain-related characteristics. Results: Pain prevalence was 65.3% (95% CI: 57.7-70.4%). Chronic pain prevalence was 38.5% (95% CI: 33.5-44.0%) and acute pain prevalence was 24.8% (95% CI: 20.7-29.0%). In participants with chronic pain, almost half (55.7%) reported having not used any medication. Conclusion: Pain is prevalent in this population and our results suggest high undertreatment rates.

Although pain is a very important health problem, little is known in Peru about how many people it affects and what its characteristics are. This study aimed to determine the frequency of pain and other related characteristics such as type and location. A sample of inhabitants of metropolitan Lima were surveyed in their homes and were asked about their pain experience in the last 3 months. We found that about seven out of ten had experienced pain in the last 3 months. More than one-third of the participants had pain that lasted more than 3 months (chronic pain). Nearly one-half of the participants with chronic pain had not used any medication to manage their pain. In conclusion, pain is prevalent in the Peruvian population and the results suggest that a large proportion of these people did not receive adequate medical treatment.

Consenso peruano para el uso de la resonancia magnética en el diagnóstico y seguimiento de pacientes con esclerosis múltiple / Peruvian consensus for the use of Magnetic Resonance Imaging in the diagnosis and follow-up of patients with Multiple Sclerosis

RESUMEN El uso de la resonancia magnética (RM) en el diagnóstico y seguimiento de pacientes con esclerosis múltiple (EM) ha optimizado el cuidado de los pacientes afectados. Diversos grupos internacionales de trabajo han intentado clarificar y normatizar el uso global de la RM pero, en muchas ocasiones, se extrapolan datos de otras regiones que no contemplan la realidad de cada lugar o son difíciles de implementar. Objetivo: Consensuar aspectos relacionados con el uso de RM en el diagnóstico y seguimiento de pacientes con EM en el Perú. Material y Métodos: Un grupo de expertos peruanos, conformado por neurólogos y radiólogos, condujo la elaboración del consenso mediante metodología de ronda de encuestas a la distancia. Resultados: Las recomendaciones, basadas en la evidencia publicada y en el criterio de los expertos, enfocaron tanto el rol de las técnicas convencionales de RM como el de la medición de la atrofia cerebral en pacientes con EM al momento del diagnóstico y durante el periodo de seguimiento. Conclusiones: Las recomendaciones del consenso podrán potencialmente homogenizar y optimizar el cuidado y seguimiento de pacientes con EM en nuestro país.

SUMMARY The use of Magnetic Resonance Imaging (MRI) in the diagnosis and follow-up of patients with Multiple Sclerosis (MS) has optimized the care of the affected patients. Several international working groups have tried to clarify and standardize the global use of MRI but, on many occasions, data are extrapolated from other regions, do not contemplate local realities or are difficult to implement. Objective: To reach a consensus on aspects related to the use of MRI in the diagnosis and follow-up of patients with MS in Peru. Material and Methods: A group of Peruvian experts (neurologists and radiologists) worked on the elaboration of the consensus using a remote survey round methodology. Results: The recommendations, established on the basis of published evidence and on the experts' criteria, focused on the role of both, the conventional MRI techniques and the measurement of brain atrophy in MS patients both at the time of diagnosis and during the follow-up period Conclusions: The consensual recommendations could potentially assist in the standardization and optimization of the care and follow-up of patients with MS in our country.

Factors Associated with Acute Community-Acquired Pyelonephritis Caused by Extended-Spectrum ß-Lactamase-Producing Escherichia coli.

This study aimed to identify the factors associated with the presence of extended-spectrum ß-lactamase-(ESBL) in patients with acute community-acquired pyelonephritis (APN) caused by Escherechia coli (E. coli), with a view of optimising empirical antibiotic therapy in this context. We performed a retrospective analysis of patients with community-acquired APN and confirmed E. coli infection, collecting data related to demographic characteristics, comorbidities, and treatment. The associations of these factors with the presence of ESBL were quantified by fitting multivariate logistic models. Goodness-of-fit and predictive performance were measured using the ROC curve. We included 367 patients of which 51 presented with ESBL, of whom 90.1% had uncomplicated APN, 56.1% were women aged ≤55 years, 33.5% had at least one mild comorbidity, and 12% had recently taken antibiotics. The prevalence of ESBL-producing E. coli was 13%. In the multivariate analysis, the factors independently associated with ESBL were male sex (OR 2.296; 95% CI 1.043-5.055), smoking (OR 4.846, 95% CI 2.376-9.882), hypertension (OR 3.342, 95% CI 1.423-7.852), urinary incontinence (OR 2.291, 95% CI 0.689-7.618) and recurrent urinary tract infections (OR 4.673, 95% CI 2.271-9.614). The area under the ROC curve was 0.802 (IC 95% 0.7307-0.8736), meaning our model can correctly classify an individual with ESBL-producing E. coli infection in 80.2% of cases.

Expression of Dopamine Receptors in Immune Regulatory Cells.

OBJECTIVE: Parkinson's disease (PD) patients are usually treated with L-dopa and/or dopaminergic agonists, which act by binding five types of dopaminergic receptors (DRD1-DRD5). Peripheral immune cells are known to express dopamine receptors on their membrane surface, and therefore they could be directly affected by the treatment. Regulatory cells are the main modulators of inflammation, but it is not clear whether dopaminergic treatment could affect their functions. While only regulatory T cells (Tregs) have been proved to express dopamine receptors, it is not known whether other regulatory cells such as CD8regs, regulatory B cells (Bregs), tolerogenic dendritic cells, and intermediate monocytes also express them. METHODS: The expression of dopamine receptors in Tregs, CD8regs, Bregs, tolerogenic dendritic cells, and intermediate monocytes was herein evaluated. cDNA from 11 PD patients and 9 control subjects was obtained and analyzed. RESULTS: All regulatory cell populations expressed the genes coding for dopamine receptors, and this expression was further corroborated by flow cytometry. These findings may allow us to propose regulatory populations as possible targets for PD treatment. CONCLUSIONS: This study opens new paths to deepen our understanding on the effect of PD treatment on the cells of the regulatory immune response.

Prevalencia de Esclerosis Múltiple en Lima - Perú / Prevalence of Multiple Sclerosis in Lima - Perú

La Esclerosis Múltiple (EM) es la principal enfermedad desmielinizante a nivel mundial. La epidemiología señala una mayor prevalencia de esta entidad en áreas alejadas de la línea ecuatorial. Existen algunos estudios de prevalencia en Latinoamérica, ninguno publicado en el Perú. Objetivo: Determinar la prevalencia de Esclerosis Múltiple en Lima, Perú. Material y métodos: Se utilizó el método captura recaptura para estimar la prevalencia de EM en Lima en 4 centros de pacientes con Esclerosis Múltiple de la ciudad: Hypnos Instituto del Sueño en la Clínica San Felipe, elHospital Nacional Cayetano Heredia, la Clínica El Golf y la Asociación ôEsclerosis Múltiple Perúõ (ESMUP). Resultados: Se calculó la prevalencia de EM en 7,69 x 100 000 habitantes (intervalo de confianza al 95 por ciento 7,09 a 8,30). Conclusiones: La prevalencia estimada de EM, para la ciudad de Lima, se encuentra en rango medio bajo.

Multiple Sclerosis (ME) is the main demyelinating disease over the world. The epidemiology shows a higher prevalence of this entity in areas away from the equatorial line. There are some prevalence studies published in Latinamerica, but no previous information reported in Peru. Objective: To determine the prevalence of ME in Lima, Peru. Material and Methods: Capture-recapture method was used to estimate the prevalence of ME in Lima, four centres of patients with ME in the city were evaluated: Hypnos Sleep Institute in ôSan Felipeõ Clinic, Hospital Nacional Cayetano Heredia, ôEl Golfõ Clinic and ôEsclerosis Múltiple del Perúõ Society (ESMUP). Results: The calculated prevalence of ME was 7.69 x 100 000 habitants (Confidence Interval at 95 per cent: 7.09 to 8.30). Conclusions: The estimated prevalence of ME, for Lima, is about the medium low range.

Status of venous thromboembolism prophylaxis among bariatric surgeons: have we changed our practice during the past decade?

BACKGROUND: Venous thromboembolism (VTE) is considered one of the principal causes of morbidity and mortality in patients requiring bariatric surgery. A survey to all members of the American Society for Metabolic and Bariatric Surgery was conducted in 1998 and published in 2000 in the journal "Obesity Surgery." METHODS: A survey was repeated to all physician members of the American Society for Metabolic and Bariatric Surgery to determine the current practices for VTE prophylaxis. The results were compared with those of the previous study. RESULTS: Of the members, 35% completed the survey for a total of 332 responses. The number of cases annually per surgeon almost doubled since 1998 (145 versus 85). Laparoscopic gastric bypass has replaced open gastric bypass as the most common procedure performed, followed by laparoscopic gastric banding as the second most common procedure. Most surgeons (95%) use chemical prophylaxis to prevent VTE, but almost 60% preferred low-molecular-weight heparin compared with 13% in 1998. More than 60% of bariatric surgeons discharged their patients with chemical prophylaxis compared with 12% in 1998. Inferior vena cava filters for prophylaxis are considered by 55% compared with only 7% in 1998. The incidence of reported deep vein thrombosis was significantly lower in 2007 (2.635 versus .93), as was the incidence of pulmonary embolism (.95% versus .75%). Almost 50% of surgeons still reported > or =1 fatality because of VTE complications. CONCLUSION: Chemical prophylaxis for VTE with some type of heparin is the standard of care for patients undergoing bariatric surgery. Low-molecular-weight heparin is now used by two thirds of the respondents to this survey. Most surgeons who responded to the survey discharged their patients home with heparin, and many consider the use of inferior vena cava filters for VTE prophylaxis. Our findings support the American Society for Metabolic Bariatric Surgery position statement regarding VTE prophylaxis in this patient population. Research is necessary to establish the role of inferior vena cava filters, discharging patients with chemoprophylaxis and to determine the adequate dosage and duration of prophylaxis.

Screening endoscopy before bariatric surgery: a series of 448 patients.

BACKGROUND: The role of upper esophagogastroduodenoscopy (EGD) in morbidly obese patients before bariatric surgery is controversial. The purpose of this study was to determine the diagnostic yield of routine EGD before bariatric surgery. METHODS: A consecutive series of 448 morbidly obese patients, who were otherwise cleared for bariatric surgery, underwent routine EGD. The endoscopic findings were classified by the clinical significance. The findings were tabulated and analyzed. RESULTS: A total of 447 patients (389 women and 58 men) underwent EGD successfully. Of the 447 patients, 85% had a body mass index of 40-59.9 kg/m(2), and 93% had significant co-morbidities. Abnormal findings that did not change the surgical approach or postpone surgery were found in 60 patients (13%), including hiatal hernia and benign polyps. Abnormal findings that changed the medical management before surgery were found in 81 patients (18%), including inflammation and/or ulcers. This group included 9 of 61 patients with gastritis who were treated for Helicobacter pylori found within the biopsy specimen. Findings that changed the surgical approach were found in 1 patient, and findings of severe ulcerations that postponed surgery were found in another patient. Of the 447 patients, 389 actually underwent bariatric surgery, including Roux-en-Y gastric bypass in 57% and adjustable gastric banding in 43%. During follow-up, 37 gastric bypass patients (13%) developed ulceration. Both gastritis and duodenitis, but not the presence of H. pylori, was statistically related to ulcer formation (Fisher's exact test). CONCLUSION: In this consecutive series of 451 successful screening EGDs, positive findings led to a change in medical treatment in a significant number of patients (18%), but a change in the timing of surgery or the surgical technique in relatively few (<1%). In addition, a significant correlation between gastritis and postoperative anastamotic ulceration suggests a causative link, with implications arguing for stronger medical therapy. A randomized trial should be performed to validate the usefulness of preoperative EGD in bariatric patients.

Endoscopic sclerotherapy for dilated gastrojejunostomy of failed gastric bypass.

BACKGROUND: Gastric bypass is an effective treatment for morbid obesity and can result in >60% excess weight loss initially. It has been reported that a 10-15% weight regain can occur in these patients. Few options are available to prevent this weight regain. The injection of morrhuate sodium as sclerotherapy has been suggested to decrease the diameter of the gastrojejunostomy anastamosis. METHODS: A total of 71 patients underwent sclerotherapy at their gastrojejunostomy from July 2004 to August 2006. A retrospective review was performed of this group, including chart review, follow-up data with weight checks, and telephone interview findings. RESULTS: The average age of the patients was 45 years, and all but 4 patients were women. Sclerotherapy was done an average of 2.9 years after gastric bypass. The starting weight at endoscopy was an average of 218 lb-18 lb heavier than the average nadir weight. The average diameter of the gastrojejunostomy was 2.3 cm. An average of 13 mL morrhuate sodium was injected circumferentially. Repeat therapy was performed in 35 patients (49%). No hospital admissions or complications occurred in relation to the procedure. During the 12-month follow-up period, 72% of patients maintained or lost weight. The analysis showed a high body mass index (at endoscopy) to be the only predictive factor for successful weight maintenance or loss. CONCLUSION: These results suggest that the use of endoscopic sclerotherapy could stabilize weight gain after gastric bypass. A randomized controlled study is necessary to validate these findings.

Routine cholecystectomy is not mandatory during morbid obesity surgery.

BACKGROUND: Controversy exists concerning the utility of routine cholecystectomy during bariatric surgery. We report our series of bariatric surgical procedures at our institution without concurrent cholecystectomy. METHODS: From October 2003 to August 2005, 621 morbidly obese patients underwent a weight loss operation. Preoperatively, each patient had undergone abdominal ultrasound (AUS) to evaluate for abnormal gallbladder findings. Patients with previous cholecystectomy were excluded. Symptomatic patients with AUS findings consistent with gallbladder disease underwent concomitant cholecystectomy and bariatric surgery. Asymptomatic patients, despite AUS findings, did not undergo cholecystectomy with their bariatric operation. A comparison between the preoperative AUS-positive and AUS-negative, asymptomatic patients after bariatric surgery was performed. RESULTS: Of the 621 patients who underwent bariatric surgery, 170 (27%) had undergone previous cholecystectomy and were excluded. Of the remaining 451 patients, 17 with positive AUS findings and symptoms underwent cholecystectomy during bariatric surgery. The range of follow-up was 4-25 months. Of the 451 patients, 324 were asymptomatic and had negative AUS findings and 102 were asymptomatic and had positive AUS findings for gallbladder abnormalities. Postoperatively, 29 asymptomatic/AUS-negative patients (9%) developed symptoms and had positive AUS findings. Nine asymptomatic patients with AUS positive findings (9%) developed symptoms. Finally, 38 patients (8.4%) went on to undergo elective cholecystectomy. These 2 groups were not signficantly different statistically. CONCLUSIONS: In this study, the development of symptomatic/AUS-positive gallbladder abnormalities was low after obesity surgery, suggesting that mandatory cholecystectomy is not required at bariatric surgery.

Preventing port site inversion in laparoscopic adjustable gastric banding.

OBJECTIVES: Laparoscopic adjustable gastric banding (LAGB) is a safe, controlled method for weight loss in the morbidly obese patient. Inversion or dislodgement of the port leads to difficulty with access for band adjustments and frequently requires reoperation. We report our experience with port fixation to the rectus sheath of the abdominal wall by using port/mesh fixation to prevent port site complications. METHODS: One hundred and ninety-one morbidly obese patients underwent LAGB between April 2002 and August 2005. The first group had ports fixed to the rectus fascia of the abdominal wall with a standard 4-point suture technique. The second group had ports sutured to a mesh, which was then tacked to the rectus sheath of the abdominal wall. Port site complications were analyzed over a 5-month to 40-month period and compared between the 2 groups. Intraoperative port fixation times were recorded for each technique. RESULTS: Thirty-nine patients in the suture fixation group encountered a 20.5% port site complication rate, with 10.3% of the ports becoming dislodged or inverted. The mesh/tack group consisted of 151 patients. The port site complication rate was 5.3%, with only a 1.3% rate of port dislodgement or inversion. The port dislodgement or inversion rates were significantly different between groups (P = .0049). The average operative times for port insertion were 12 minutes for the sutured technique and 5 minutes for the mesh/tack technique. CONCLUSIONS: The mesh/tack method of port fixation reduced the incidence of dislodgement and rotation in our patient population, which resulted in greater ease of access for adjustments. Furthermore, the mesh/tack technique is a quick, safe approach for port fixation through a small incision.

[Risk factors for the development and persistence of asymptomatic bacteriuria in patients with type 2 diabetes]. / Factores relacionados con el desarrollo y la persistencia de la bacteriuria asintomática en los pacientes con diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: To study the risk factors for the development and persistence of asymptomatic bacteriuria (AB) in type 2 diabetes mellitus (DM) patients from our health zone. PATIENTS AND METHOD: Observational and laboratory prospective cohort study. INCLUSION CRITERIA: women and men with type 2 DM from the 2 health centers of Petrer (Alicante). DATA: questionnaire including particular and epidemiological data. Laboratory values: biochemistry, glycosylated hemoglobin A1C, microalbuminuria, urinary sediment and urine culture. RESULTS: A total of 457 patients with type 2 DM were included; 63.2% women and 36.8% men. The prevalence of AB at baseline was 19.9% (25.6% in women vs 10.1% in men). 78.02% had persistence of AB after the twelve months of follow-up; 21.7% developed symptomatic urinary tract infection (UTI) and 35.2% were treated with antimicrobial agents for any reason different from UTI during the follow-up period. The persistence of AB at the end of the study was 15.5%. Female sex (p = 0.04), leukocyturia (p = 0.008), urinary incontinence (p = 0.04) and elevated C reactive protein concentration (p = 0.009) remained significant risk factors for the presence and the persistence of AB when the multivariate logistical regression analysis was done. The presence of UTI within one year before the study started (p= 0.024) and previous antibiotic treatments (p = 0.04) were also independent significant factors associated with persistent AB. 84.5% of diabetic patients with persistent AB had the same infective organism in the urine culture as those found during the initial AB. CONCLUSIONS: In patients with type 2 diabetes, female sex, urinary incontinence, leukocyturia, and elevated C reactive protein concentration were associated with development of AB. The same occurred with obesity in women and prostatic syndrome in men. The persistence of AB with the same species of isolated microorganisms as those found in AB at study entry is frequent, but it remains to be known if eradication of pathogens is more difficult in diabetic patients or, alternatively, if AB episodes are transient.

Factores relacionados con el desarrollo y la persistencia de la bacteriuria asintomática en los pacientes con diabetes mellitus tipo 2 / Risk factors for the development and persistence of assymptomatic bacteriuria in patients with type 2 diabetes

Fundamento y objetivo: Identificar los factores que predisponen o se asocian con el desarrollo y la persistencia de bacteriuria asintomática (BA) en pacientes con diabetes mellitus (DM) tipo 2. Pacientes y método: Estudio observacional analítico prospectivo de cohortes. Se incluyó a pacientes con DM tipo 2 de los centros de salud de Petrer (Alicante). A todos los pacientes se les aplicó un cuestionario con los datos de filiación, epidemiológicos, bioquímica, hemoglobina glucosilada, microalbuminuria, sedimento urinario y urocultivos. Resultados: Se ha analizado a 457 pacientes con DM tipo 2, de los que un 36,8% eran varones y un 63,2% mujeres. La prevalencia de BA inicial fue del 19,9% (un 25,6% en mujeres comparado con un 10,1% en varones). El 78,02% mantuvo la BA persistentemente al año, a pesar de que el 21,7% desarrolló infección del tracto urinario (ITU) sintomática y recibió tratamiento antibiótico y un 35,2% recibió antimicrobianos por causas distintas de ITU. La prevalencia de BA persistente en el total de la muestra estudiada fue del 15,5%. El sexo femenino (p = 0,04), la presencia de sedimento patológico (p = 0,008), incontinencia urinaria (p = 0,04) y valores elevados de proteína C reactiva (p = 0,009) se asociaron de forma independiente con la presencia de BA y con la BA persistente en el total de la muestra, además de la ITU en el año anterior al inicio del estudio (p = 0,024) y los tratamientos antimicrobianos previos (p = 0,04) en el caso de la BA persistente. En el 84,5% de los pacientes se aisló la misma especie de microorganismo que en el cultivo inicial. Conclusiones: En los pacientes con DM tipo 2, el sexo femenino, la incontinencia urinaria, el sedimento patológico y los valores elevados de proteína C reactiva se asociaron con BA, además de la obesidad en las mujeres y del síndrome prostático en los varones. La persistencia de BA por la misma especie de microorganismo es frecuente. Se desconoce si este hecho representa la persistencia del mismo patógeno no erradicado o nuevas reinfecciones

Background and objective: To study the risk factors for the development and persistence of asymptomatic bacteriuria (AB) in type 2 diabetes mellitus (DM) patients from our health zone. Patients and method: Observational and laboratory prospective cohort study. Inclusion criteria: women and men with type 2 DM from the 2 health centers of Petrer (Alicante). Data: questionnaire including particular and epidemiological data. Laboratory values: biochemistry, glycosylated hemoglobin A1C, microalbuminuria, urinary sediment and urine culture. Results: A total of 457 patients with type 2 DM were included; 63.2% women and 36.8% men. The prevalence of AB at baseline was 19.9% (25.6% in women vs 10.1% in men). 78.02% had persistence of AB after the twelve months of follow-up; 21.7% developed symptomatic urinary tract infection (UTI) and 35.2% were treated with antimicrobial agents for any reason different from UTI during the follow-up period. The persistence of AB at the end of the study was 15.5%. Female sex (p = 0.04), leukocyturia (p = 0.008), urinary incontinence (p = 0.04) and elevated C reactive protein concentration (p = 0.009) remained significant risk factors for the presence and the persistence of AB when the multivariate logistical regression analysis was done. The presence of UTI within one year before the study started (p= 0,024) and previous antibiotic treatments (p = 0,04) were also independent significant factors associated with persistent AB. 84.5% of diabetic patients with persistent AB had the same infective organism in the urine culture as those found during the initial AB. Conclusions: In patients with type 2 diabetes, female sex, urinary incontinence, leukocyturia, and elevated C reactive protein concentration were associated with development of AB. The same occurred with obesity in women and prostatic syndrome in men. The persistence of AB with the same species of isolated microorganisms as those found in AB at study entry is frequent, but it remains to be known if eradication of pathogens is more difficult in diabetic patients or, alternatively, if AB episodes are transient

Entamoeba histolytica: mechanism of decrease of virulence of axenic cultures maintained for prolonged periods.

Intraportal injection of non-virulent E. histolytica (derived from prolonged axenic culture of virulent E. histolytica) strain HM1-IMSS in normal hamsters results in no liver lesions and disappearance of the parasites 48-72 h after injection. Viability of non-virulent E. histolytica after 2 h of in vitro incubation in either fresh or decomplemented hamster serum is the same as control virulent E. histolytica (50-90%). In hamsters made leukopenic, or both leukopenic+hypocomplementemic, or hypocomplementemic+sephadex microspheres (to produce focal liver ischemia) intraportally injected non-virulent E. histolytica cause no lesions and disappear after 24 h. In addition, neither hypocomplementemia nor immunosuppression with cyclosporin A prolonged the survival of non-virulent E. histolytica. Methyl prednisolone treatment of hamsters resulted in survival of large numbers of non-virulent E. histolytica in the liver, with little inflammation and minimal tissue damage, for up to 7 days. Inflammatory cells (macrophages) would appear to be chiefly responsible for elimination of non-virulent E. histolytica. Parallel experiments with E. dispar suggest a different mechanism for its non-pathogenicity.

Necrotic cellulitis by Serratia plymuthica.

This case report describes an uncommon cellulitis caused by Serratia plymuthica in a patient treated with steroids. The evolution was favorable after surgical exploration with debridement and antibiotic treatment. This is the first case of necrotic cellulitis caused by S. plymuthica described in the literature.

Lipossarcoma primário do osso / Primary bone liposarcoma

É apresentado um caso de lipossarcoma primário do terço proximal do úmero, com estudo radiográfico, cintilográfico e anatomopatológico. Apesar da cirurgia radical, com desarticulaçäo no ombro, o paciente faleceu com metástases pulmonares menos de um ano após o diagnóstico. A bibliografia, em 34 casos publicados, complementa nosso estudo quanto ao comportamento clínico e resultados do tratamento, neste raro tumor ósseo

Lepra lepromatosa: estudio de algumas subpoblaciones de linfocitos y su análisis funcional / Lepromatous leprosy: study of some subpopulations of lymphocytes and its functional analysis

Se investigaron en un grupo de pacientes de lepra lepromatosa y en otro de sujetos clínicamente sanos los niveles de linfocitos T totales por medio de formación de rosetas E, determinación de linfocitos T supresores Fc-gamma y de la capacidad de transformación blastoide de sus células linfoides cuando se estimularon con concanavalina A. La determinación de linfocitos T por medio de rosetas E mostró que los pacientes tenían disminución en comparación con el grupo testigo de sujetos normales. La determinación de linfocitos T supresores Fc-gamma evaluados por la formación de rosetas con eritrocitos de pollo sensibilizados con IgG, demostró en los enfermos un incremento significativo en los niveles de dichos linfocitos T supresores. En el cultivo de linfocitos de sangre periférica, la transformación blastoide inducida por estimulación con concanavalina A y medida por incorporación de timidina tritiada presentó niveles bajos en los pacientes leprosos. Los estudios mencionados demostraron que los enfermos de lepra lepromatosa presentan un número significativamente superior de linfocitos T supresores que los mostrados en sujetos clínicamente sanos, y que aquéllos pueden ser los causantes de la transformación insuficiente de sus células linfoides tras el estímulo mitogénico de linfocitos T