Effect of Limestone and Quartz Fillers in UHPC with Calcined Clay.

Ultra-high-performance concrete (UHPC) is a material developed to maximize the engineering characteristics of hydraulic concrete, in terms of durability and mechanical properties, but the adoption of this technology in practice has not turned out as desired, mainly due to the high amounts of cement and silica fume required for its production, and for its consequences on both economic and ecological costs. As an option to improve the impact of UHPC, both on costs and on sustainability, this work evaluates four UHPC series with metakaolin additions of 5%, 10%, 15% and 20%, and the substitution of 37.5% of the Portland cement volume by limestone or quartz filler. The compressive strength, the bulk electrical resistivity and a set of tests for microstructural characterization (TGA, XRD and quantitative EDS) were utilized to better understand the role of calcite on the hydration and pozzolanic reactions in ternary Portland cement-metakaolin-limestone filler. Results indicate that the reaction of calcite is scarce and should be considered as a mere filler, as no increase in AFm phases were found. Nevertheless, the ternary mixture with 15% of metakaolin in addition to cement, and with 37.5% of the Portland cement volume substituted by limestone filler, was the one that presented the best performance in terms of compressive strength and bulk electrical resistivity. The results of the microstructural characterization indicate that the high kaolin content in the metakaolin originated the most significant hydration and pozzolanic reactions development between the ages of 7 and 28 days, as between 28 and 91 the reaction remained dormant. In general, the whole set of results included in this work indicate that limestone filler doesn't act as a better filler than other kind of powders when used in ternary Portland cement-metakaolin- filler systems.

Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice.

OBJECTIVE: To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting. METHODS: A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies. RESULTS: In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P <0.05). National differences were also identified in eye care practitioner attitudes and perceptions ( P <0.05). CONCLUSIONS: The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels.

Opportunities and threats to contact lens practice: A global survey perspective.

AIM: To understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice. METHODS: A self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners' perspective on the future of their CL practice over the next five years. RESULTS: A total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10). CONCLUSIONS: Overall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas.

Interstitial lung disease related to rheumatoid arthritis: evolution after treatment

Objetivo: Describir la evolución de la función pulmonar en una cohorte de pacientes con enfermedad pulmonar intersticial asociada a la artritis reumatoide (EPI-AR), tratados de acuerdo al juicio de sus médicos tratantes. Métodos: Estudio de cohorte retrospectivo de pacientes con EPI-AR, demostrada con un patrón restrictivo en las pruebas de función pulmonar, y de enfermedad pulmonar intersticial en las tomografía de alta resolución (HRCT). Los pacientes tuvieron una evaluación basal de la función pulmonar que incluyó espirometría, DLCO y HRCT. En un mínimo de 4 meses, una segunda evaluación de la función pulmonar fue realizada. Todos los pacientes recibieron una dosis alta de prednisona (1 mg/kg/día) por 6 semanas con un esquema de reducción, con una dosis de prednisona de 10 mg/día a los 6 u 8 meses de seguimiento. Se prescribió metotrexate en 18/40 (45%) pacientes, leflunamida o azatioprina, o ambas en 22/40 (55%) pacientes. Resultados: Se identificaron 40 pacientes con EPI-AR, El patrón más frecuente en la HRCT fue el indeterminado, con imágenes reticulares y de vidrio despulido en un 50% de los casos. A los 4 meses de seguimiento se observó una mejoría de los valores de la capacidad vital forzada (CVF), mediana basal de 1.47 Lts, intervalo inter cuartil (IIC): 0.99-1.91 Lts., Vs. Mediana de 1.66 Lts., IIC:1.37-2.1 Lts., p < 0.004. Los pacientes con los puntajes menores de la escala de Kazerooni para fibrosis pulmonar, (< 0.47) fueron los que presentaron una mejoría en los valores de la CVF. Conclusion: Los pacientes con EPI-AR pueden tener una mejoría en la CVF después del tratamiento con dosis altas de corticosteroides y fármacos modificadores de la enfermedad. (FARMES) (AU)

Objective: To describe the evolution of lung function in a cohort of rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) treated according to the medical judgment of attending physicians. Methods: Retrospective cohort of RA patients with ILD, defined by a restrictive pattern in lung function tests and evidence of ILD in high resolution computed tomography (HRCT). Patients had an assessment of lung function including spirometry, diffusing capacity for carbon monoxide (DLCO), and HRCT. At a minimum of 4 months of follow up, a second assessment of lung function was done. All patients received a high dose of prednisone (1 mg/kg/day) scheme for 6 weeks with a reduction scheme ending with a dose of 10 mg/day of prednisone at about 6-8 months of follow up. Methotrexate was used in 18/40 (45%) patients and leflunomide or azathioprine or both were indicated in 22/40 (55%). Results: Forty patients were identified. An indeterminate pattern with diffuse ground glass and reticulation images (50%) was the most prevalent pattern on HRCT scans. At a minimum of 4 months of follow up, an improvement in basal FVC values was observed (median (IQR)) 1.47 Lts. (0.99-1.91) vs 1.66 Lts. (1.37-2.1)), P < 0.004. Patients with lower Kazerooni scores for fibrosis (<0.47) had a better improvement in the FVC values. Conclusions: Patients with RA and ILD may have an improvement in the FVC after a treatment with high doses of corticosteroids and disease modifying antirheumatic drugs (DMARDs) (AU)

Interstitial lung disease related to rheumatoid arthritis: evolution after treatment.

OBJECTIVE: To describe the evolution of lung function in a cohort of rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) treated according to the medical judgment of attending physicians. METHODS: Retrospective cohort of RA patients with ILD, defined by a restrictive pattern in lung function tests and evidence of ILD in high resolution computed tomography (HRCT). Patients had an assessment of lung function including spirometry, diffusing capacity for carbon monoxide (DLCO), and HRCT. At a minimum of 4 months of follow up, a second assessment of lung function was done. All patients received a high dose of prednisone (1 mg/kg/day) scheme for 6 weeks with a reduction scheme ending with a dose of 10 mg/day of prednisone at about 6-8 months of follow up. Methotrexate was used in 18/40 (45%) patients and leflunomide or azathioprine or both were indicated in 22/40 (55%). RESULTS: Forty patients were identified. An indeterminate pattern with diffuse ground glass and reticulation images (50%) was the most prevalent pattern on HRCT scans. At a minimum of 4 months of follow up, an improvement in basal FVC values was observed (median (IQR)) 1.47 Lts. (0.99-1.91) vs 1.66 Lts. (1.37-2.1)), P<0.004. Patients with lower Kazerooni scores for fibrosis (<0.47) had a better improvement in the FVC values. CONCLUSIONS: Patients with RA and ILD may have an improvement in the FVC after a treatment with high doses of corticosteroids and disease modifying antirheumatic drugs (DMARDs).

Morphologic diversity of chronic pigeon breeder's disease: clinical features and survival.

Morphology in chronic HP is characterized by bronchiolocentric mononuclear inflammation, poorly formed granulomas and variable degree of fibrosis. However, recent findings suggest that this disease may present different pathologic patterns. In this study we evaluated the clinical behavior and survival of patients with pigeon breeder's disease according to the pathologic pattern. One-hundred ten biopsies were classified as "typical" (n = 58), non-specific interstitial pneumonia (NSIP)-pattern (n = 22), usual interstitial pneumonia (UIP)-like (n = 10), mixed pattern (n = 9), organizing pneumonia (OP)-pattern (n = 3), airway-centered interstitial fibrosis (ACIF)-pattern (n = 3), and non-classified (n = 5). Clinical features and survival were compared between patients with "typical", NSIP, and UIP patterns. There were no statistical differences between the groups in age, gender, time of symptoms, smoking, clubbing, and PaO(2). By the one-way ANOVA test we found differences in the percent of lymphocytes in bronchoalveolar lavage (BAL; p < 0.002) and in the forced vital capacity (p < 0.05) between the 3 groups. After Bonferroni correction the difference in BAL lymphocytes remained significant among the UIP-like and the typical pattern (36.1 ± 22.9 versus 64.6 ± 20.9, p = 0.001). UIP-like patients exhibited the worst survival rate (HR: 4.19; 95% CI: 1.66-14.47; p < 0.004) while NSIP-like pattern showed the best survival (HR: 0.18; 95% CI: 0.04-0.82; p < 0.03). Multivariate Cox regression analysis revealed that patients with a UIP-like pattern retained a significantly worse survival (HR: 3.4 (IC 95%: 1.15-10.29; p < 0.03), and mortality for the NSIP group was best and approached statistical significance (p = 0.07). These findings demonstrate that a variety of histopathologic and imaging patterns are seen in PBD, and the presence of a UIP-like pattern confers the worst prognosis.

Risk factors for idiopathic pulmonary fibrosis in a Mexican population. A case-control study.

The etiology of idiopathic pulmonary fibrosis (IPF) remains poorly understood, but some studies have suggested that cigarette smoking or other occupational or environmental exposures, diabetes mellitus, or gastroesophageal reflux may play a role. In this study we evaluated the clinical records of a group of 97 consecutive patients with IPF, and 560 patients suffering 5 different respiratory disorders that were examined as controls: asthma (n=111), chronic obstructive pulmonary disease (n=132), squamous cell lung carcinoma (n=118), lung adenocarcinoma (n=101) and patients with otorhinolaryngology problems but without lung disease (n=98). In bivariate analyses male sex, diabetes mellitus and being former cigarette smoker were associated with IPF. After adjusting by these variables, multivariate analysis revealed that type 2 diabetes mellitus [11.3% in IPF patients vs 2.9% in controls, OR=4.3 (95% CI: 1.9-9.8), p<0.0001] was an independent risk factor associated to IPF. Our results provide additional evidence of a putative relationship between DM2 and idiopathic pulmonary fibrosis. Experimental research is necessary for thorough assessment of the pathogenic mechanisms involved in this association.

Fibrosis pulmonar familiar en 2 hermanas mexicanas con síndrome de Hermansky-Pudlak / Familial Pulmonary Fibrosis in 2 Mexican Sisters with Hermansky-Pudlak Syndrome

El síndrome de Hermansky-Pudlak (SHP) es una enfermedad autosómica recesiva que comúnmente se presenta en latinos de ascendencia puertorriqueña. Presentamos 2 casos clínicos de fibrosis pulmonar familiar en 2 hermanas mexicanas con SHP. La fibrosis pulmonar se confirmó por biopsia en una paciente. Esta comunicación demuestra que el SHP puede aparecer en población mexicana(AU)

Hermansky-Pudlak syndrome is an autosomal recessive disorder commonly found in individuals of Puerto Rican ancestry. We present 2 cases of familial pulmonary fibrosis in 2 Mexican sisters with Hermansky-Pudlak syndrome. Pulmonary fibrosis was biopsy-proven in 1 of the patients. This report shows that Hermansky-Pudlak syndrome may occur in individuals of Mexican ancestry(AU)

Silicone injection causing acute pneumonitis: a case series.

Local and systemic complications following injected silicone have been described, especially after cosmetic procedures by unlicensed practitioners. We report a retrospective case series of acute pneumonitis following silicone injection to the buttock. Medical records, pulmonary function tests, blood arterial gases, chest radiographs, and high-resolution computed tomography scans were reviewed. Five patients with acute pneumonitis after injected silicone were identified. All cases were men with a mean age was 25 years. Three patients had the procedure performed by the same practitioner. The amount of injected silicone ranged from 30 to 500 ml. The onset of clinical symptoms began as early as 24 h after injection to as late as 15 days. All cases had diffuse, peripheral, occasionally wedge-shaped opacities on high-resolution computed tomography. At presentation the mean oxygen saturation was 84%. All were treated with steroids and had clinical resolution of their illness within 1 month of presentation. Injection of silicone can lead to serious pulmonary complications but treatment with steroids seems to be beneficial.

[Familial pulmonary fibrosis in 2 Mexican sisters with Hermansky-Pudlak syndrome]. / Fibrosis pulmonar familiar en 2 hermanas mexicanas con síndrome de Hermansky-Pudlak.

Hermansky-Pudlak syndrome is an autosomal recessive disorder commonly found in individuals of Puerto Rican ancestry. We present 2 cases of familial pulmonary fibrosis in 2 Mexican sisters with Hermansky-Pudlak syndrome. Pulmonary fibrosis was biopsy-proven in 1 of the patients. This report shows that Hermansky-Pudlak syndrome may occur in individuals of Mexican ancestry.

Idiopathic pulmonary fibrosis and emphysema: decreased survival associated with severe pulmonary arterial hypertension.

BACKGROUND: It has been suggested that the presence of emphysema modifies the outcome of patients with idiopathic pulmonary fibrosis (IPF). In this article we compare clinical features, smoking history, pulmonary function, estimated systolic pulmonary artery pressure (eSPAP), and mortality in IPF with emphysema vs IPF without emphysematous changes. METHODS: A cohort of 110 IPF patients was evaluated. Clinical data were collected from clinical charts. High-resolution CT (HRCT) scans were examined by an expert blinded to clinical data, and patients were classified into the following two groups: patients with IPF with emphysema; and patients with IPF without emphysema. The Kaplan-Meier method, log-rank test, and Cox regression model were used for statistical analyses. RESULTS: The prevalence of emphysema in the IPF cohort was 28% (31 of 110 patients). IPF with emphysema was significantly associated with male gender (odds ratio [OR], 18; 95% confidence interval [CI], 2.7 to 773.7; p = 0.0003), and smoking (OR, 3.8; 95% CI, 1.36 to 11.6; p = 0.004). Patients with IPF and emphysema had a higher mean (+/- SD) decrease in oxygen saturation during rest and exercise (16.3 +/- 6.7% vs 13.5 +/- 4.6%, respectively; p = 0.04), a higher mean fibrosis HRCT scan score (1.75 +/- 0.36 vs 1.55 +/- 0.38, respectively; p = 0.015), a higher eSPAP (82 +/- 20 vs 57 +/- 15 mm Hg, respectively; p < 0.0001), and lower median survival time (25 vs 34 months, respectively; p = 0.01) than patients with IPF without emphysema. The Cox regression model showed that the two most important variables associated with mortality were FVC < 50% predicted (hazard ratio [HR], 2.6; 95% CI, 1.19 to 5.68; p = 0.016) and eSPAP >or= 75 mm Hg (HR, 2.25; 95% CI, 1.12 to 4.54; p = 0.022). CONCLUSIONS: IPF patients with emphysema exhibited higher mortality compared with those with IPF without emphysema. This dire prognosis seems to be at least partially associated with the development of severe pulmonary arterial hypertension.

[Effect of Mexican propolis extracts from Apis mellifera on Candida albicans in vitro growth]. / Efecto de extractos de propóleos mexicanos de Apis mellifera sobre el crecimiento in vitro de Candida albicans.

Propolis is a resinous substance collected by bees (Apis mellifera) from different trees and bushes. Due to its antifungal, antibacterial, antiviral and antiparasitic properties, it has continued to be very popular throughout the time showing variable activity depending on its geographical origin. In Mexico, information about this product is very limited. The aim of this work was to evaluate the antifungal activity of four propolis ethanolic extracts from three different Mexican states, and four commercial extracts on Candida albicans growth. A reference strain (ATCC 10231) and 36 clinical isolates of C. albicans were used. The Minimal Inhibitory Concentration (MIC) was determined by the dilution on agar method. Growth curves on Sabouraud Dextrose broth with and without different propolis ethanolic extracts concentrations were performed. In addition, whether the effect was fungistatic or fungicide was determined. The propolis ethanolic extract obtained from Cuautitlán Izcalli, State of Mexico, showed the best biological activity, inhibiting 94.4% from the clinical isolates at 0.8 mg/ml; the reference strain was inhibited at 0.6 mg/ml. The propolis effect was fungistatic in low concentrations and fungicide in concentrations higher to MIC. The Mexican propolis ethanolic extract could be further investigated for its alternative use for the treatment of some C. albicans infections.

Efecto de extractos de propóleos mexicanos de Apis mellifera sobre el crecimiento in vitro de Candida albicans / Effect of Mexican propolis extracts from Apis mellifera on Candida albicans in vitro growth

El propóleos es una sustancia resinosa recolectada por las abejas (Apis mellifera)a partir de diferentes árboles y arbustos. Sus propiedades medicinales hanmantenido su popularidad a través de los años debido a que posee actividadantifúngica, antibacteriana, antiviral y antiparasitaria, mostrando variación en suactividad biológica dependiendo de su origen geográfico. En México, lainformación respecto a la actividad de este producto es muy limitada. El objetivode este trabajo fue evaluar la actividad antifúngica de cuatro extractos etanólicosde propóleos de tres diferentes Estados de la República Mexicana, y de cuatroextractos comerciales sobre el crecimiento de Candida albicans. Se emplearonuna cepa de referencia (ATCC 10231) y 36 aislamientos clínicos de origenhumano de C. albicans. Se determinó la concentración mínima inhibitoria (CMI)por el método de dilución en agar. Se realizaron curvas de crecimiento en caldoglucosado de Sabouraud solo y con diferentes concentraciones de los extractosetanólicos de propóleos; además se determinó si el efecto era fungicida ofungistático. El extracto obtenido en Cuautitlán Izcalli, Estado de Méxicopresentó la mayor actividad biológica, inhibiendo el 94,4% de los aislamientosclínicos a una concentración de 0,8 mg/ml; la cepa de referencia fue inhibida auna concentración de 0,6 mg/ml. El efecto fue fungistático a bajasconcentraciones y fungicida a concentraciones superiores a la CMI. El extractoetanólico de propóleos mexicano podría ser investigado como un tratamientoalternativo en algunas infecciones causadas por C. albicans(AU)

Propolis is a resinous substance collected by bees (Apis mellifera) from differenttrees and bushes. Due to its antifungal, antibacterial, antiviral and antiparasiticproperties, it has continued to be very popular throughout the time showingvariable activity depending on its geographical origin. In Mexico, informationabout this product is very limited. The aim of this work was to evaluate theantifungal activity of four propolis ethanolic extracts from three different Mexicanstates, and four commercial extracts on Candida albicans growth. A referencestrain (ATCC 10231) and 36 clinical isolates of C. albicans were used.The Minimal Inhibitory Concentration (MIC) was determined by the dilution onagar method. Growth curves on Sabouraud Dextrose broth with and withoutdifferent propolis ethanolic extracts concentrations were performed. In addition,whether the effect was fungistatic or fungicide was determined. The propolisethanolic extract obtained from Cuautitlán Izcalli, State of Mexico, showed thebest biological activity, inhibiting 94.4% from the clinical isolates at 0.8 mg/ml;the reference strain was inhibited at 0.6 mg/ml. The propolis effect wasfungistatic in low concentrations and fungicide in concentrations higher to MIC.The Mexican propolis ethanolic extract could be further investigated for itsalternative use for the treatment of some C. albicans infections(AU)

Accelerated variant of idiopathic pulmonary fibrosis: clinical behavior and gene expression pattern.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is characterized by the insidious onset of dyspnea or cough. However, a subset of patients has a short duration of symptoms with rapid progression to end-stage disease. In this study, we evaluated clinical and molecular features of "rapid" and "slow" progressors with IPF. METHODS AND FINDINGS: 26 patients with <6 months of symptoms before first presentation [rapid progressors] and 88 patients with >24 months of symptoms [slow progressors] were studied. Survival was analyzed by the Kaplan-Meyer method and proportional hazard's model. Lung microarrays and tissue proteins were measured in a subset of patients. No differences were found in age, physiologic impairment and bronchoalveolar lavage (BAL) cellular profile. There were more males (OR = 6.5; CI:1.4-29.5; p = 0.006) and smokers (OR = 3.04; CI:1.1-8.3; p = 0.04) in the rapid progressors group. Survival from the beginning of symptoms was significantly reduced in rapid progressors (HR = 9.0; CI:4.48-18.3; p<0.0001) and there was a tendency for decreased survival from the time of diagnosis (HR = 1.5; CI:0.81-2.87; p = 0.18). We identified 437 differentially expressed genes. Lungs of rapid progressors overexpressed genes involved in morphogenesis, oxidative stress, migration/proliferation, and genes from fibroblasts/smooth muscle cells. Upregulation of two of these genes, adenosine-2B receptor and prominin-1/CD133, was validated by immunohistochemistry and were expressed by alveolar epithelial cells. BAL from rapid progressors showed a >2-fold increase of active matrix metalloproteinase-9, and induced a higher fibroblast migration compared with slow progressors and controls [238+/-98% versus 123+/-29% (p<0.05) and 30+/-17% (p<0.01)]. CONCLUSIONS/SIGNIFICANCE: A subgroup of IPF patients, predominantly smoking males, display an accelerated clinical course and have a gene expression pattern that is different from those with slower progression and longer survival. These findings highlight the variability in the progression of IPF, and may explain, in part, the difficulty in obtaining significant and reproducible results in studies of therapeutic interventions in patients with IPF.

Caracterización de receptores de melatonina en membranas de linfocitos caprinos / Characterization of melatonin receptors in membranes of lymphocytes caprines

Los sistemas neuroendocrino e inmunol¢gico est n conectados estructural y funcionalmente. La neurohomona melatonina juega un papel importante en la regulación del sistema inmunológico, lo cual se basa en la existencia de sitios de unión en las células linfoides, sistema nervioso y órganos periféricos. Las cabras son animales domésticos con baja susceptibilidad a infecciones y cáncer. El objetivo del presente trabajo fue caracterizar receptores de melatonina en membranas de linfocitos de sangre periférica de caprinos, a través de estudios de ligadura con iodomelatonina tritiada. La unión fue dependiente del tiempo, temperatura y concentración celular, además fue estable, reversible y saturable. Los ensayos de saturación demostraron un sitio de alta afinidad (Kd= 3,61+0,21 nM) y baja capacidad (Bmax= 350,11+18,5 fmol/mg). Cuando los animales fueron mantenidos bajo luz constante por 10 días la capacidad aumentó significativamente. Los resultados indican que los linfocitos de cabras adultas poseen receptores de alta afinidad que cambian con la exposición prolongada a la luz, lo cual confirma interacción y comunicación entre la glándula pineal y el sistema inmune

Hypersensitivity pneumonitis : a broader perspective.

Hypersensitivity pneumonitis (HP) represents a group of lung disorders caused by the inhalation of a wide variety of organic particles by susceptible individuals. HP occurs mainly in nonsmokers, but smoking may promote an insidious and chronic disease. The prevalence of HP is difficult to estimate accurately since several antigens can produce the disease, but the range spans infancy to old age. Regardless of the causative antigen or its environmental setting, the clinical manifestations are essentially the same. Three different clinical presentations have been recognized: acute, subacute, and chronic. In the acute form, patients show flu-like symptomatology, followed by dyspnea and dry cough. Symptoms subside a few hours or days later. The subacute and chronic forms result from recurrent low-level antigen exposure and are characterized by progressive dyspnea and dry cough. Other constitutional symptoms such as fatigue, anorexia, and weight loss can be apparent. Fever may occur in the subacute form. Importantly, chronic HP may evolve insidiously or may result from repeated acute/subacute episodes. Recurrent acute, subacute, and chronic HP may progress to irreversible lung fibrosis or provoke emphysematous changes.HP can be difficult to identify, and precise diagnosis requires a history of exposure and a constellation of clinical, imaging, laboratory, bronchoalveolar lavage and pathologic findings. General laboratory tests show an increase of acute phase reactants. Specific precipitating antibodies, when present, are evidence of antigen exposure, and are a hallmark for diagnosis. Chest radiograph usually reveals widespread ground-glass attenuation, and nodular or reticulonodular shadowing. High-resolution CT features include diffuse or patchy ground-glass opacities with small poorly defined nodules and air trapping. Pulmonary function tests are characterized by a predominantly restrictive ventilatory defect with loss of lung volume and hypoxemia at rest that worsens with exercise. Bronchoalveolar lavage reveals a significant increase in lymphocytes, mostly over 40%. In the acute form there is also an increase in neutrophils. Antigen-induced lymphocyte proliferation, and environmental or laboratory-controlled inhalation challenge, may be used for diagnostic purposes and can help to establish a diagnosis of insidious forms of HP. In subacute or chronic cases, lung biopsy may be necessary. Typical findings include bronchiolitis, lymphocytic alveolitis, and loosely formed granulomas, although occasionally other morphologic patterns such as nonspecific interstitial pneumonia may exist. Treatment focuses on avoiding further exposure to the offending antigen(s). Corticosteroids are recommended in subacute and chronic forms. The usual regimen consists of initial high doses of systemic corticosteroid (e.g. prednisone 0.5-1.0 mg/kg/day), followed by gradual tapering.

Synthesis, characterization, and tautomerism of four novel copper(I) complexes from 3-hydroxy-3-(p-R-phenyl)-2-propenedithioic acids.

The paper describes the synthesis and structural characterization of four novel copper(I) complexes [CuL(PPh(3))(2)] (L = 3-hydroxy-3-(p-R-phenyl)-2-propenedithioate). In addition, a tautomeric equilibrium in solution was found and Hammett correlations with (13)C NMR parameters were studied. The structure of one complex was fully established by X-ray diffraction analysis.

Increased surfactant protein-A levels in patients with newly diagnosed idiopathic pulmonary fibrosis.

STUDY OBJECTIVES: To measure surfactant protein-A (SP-A) in the BAL of patients with idiopathic pulmonary fibrosis (IPF). DESIGN: We examined SP-A in BAL and lung tissue of patients with IPF who met the stricter recommended criteria for IPF at the time of diagnosis and prior to the beginning of treatment. PATIENTS: Twenty-six patients with IPF confirmed at biopsy and 22 patients with hypersensitivity pneumonitis (HP) were compared with 9 normal volunteers. INTERVENTIONS: All patients were subjected to pulmonary function testing, BAL, and lung biopsy prior to the beginning of treatment. MEASUREMENTS AND RESULTS: We measured SP-A in BAL fluids and performed SP-A immunohistochemistry on lung specimens. Lung tissues of patients with IPF showed extensive type II cell hyperplasia, usually containing greatly increased levels of immunoreactive SP-A. By enzyme-linked immunosorbent assay, we found a twofold increase over normal values in BAL SP-A without changes in total phospholipids. These data were in agreement with semiquantitative assessments of SP-A by protein immunoblotting and by Western blotting of sodium dodecyl sulfate gels. Patients with HP exhibited a threefold increase of BAL SP-A. CONCLUSIONS: The reasons for the difference between our results and previously published reports describing decreased SP-A levels in IPF is not clear. It may relate to the stricter criteria for diagnosis, the absence of treatment prior to BAL, differences in the patient population, or to other methodologic differences.

El reflujo gastroesofágico en pacientes asmáticos: estudio de frecuencia y correlación clínica / Gastroesophageal reflux in asthmatic patients: frequency study and clinical correlation

Se presume que la prevalencia de reflujo gastroesofágico (RGE) en pacientes asmáticos es elevada, pero la frecuencia exacta se desconoce. En México no existen estudios que determinen la asociación entre RGE y asma. Los objetivos de este estudio son determinar la frecuencia de RGE en pacientes asmáticos mexicanos y conocer su relación con la gravedad del asma. Se estudiaron 50 pacientes con asma de inicio en la edad adulta según los criterios de los Institutos Nacionales de Salud de los E.U.A. La evaluación diagnóstica incluyó cuestionario de síntomas, espirometría, manometría, endoscopia y pH-metría esofágica de 24 horas. Veintitrés pacientes tenían asma leve (46 por ciento), 16 asma moderada (32 por ciento) y 11 asma grave (22 por ciento). Veintisiete pacientes (54 por ciento) presentaron pirosis y regurgitaciones dos o más veces por semanas, se detectó RGE patológico mediante pH-metría en 37 pacientes (74 por ciento) y sólo 7 casos (14 por ciento) tuvieron esofagitis en el estudio endoscopico. La pH-metría demostró RGE patológico en 13 pacientes con asma leve (57 por ciento), en 13 con asma moderadas (81 por ciento) y los 11 enfermos con asma grave (100 por ciento). La prevalencia de RGE en pacientes asmáticos mexicanos es elevada, principalmente en aquellos con asma grave. Sugerimos incluir la pH-metría esofágica en el estudio integral del paciente asmático

La hernia hiatal en pacientes asmáticos: prevalencia y su asociación con reflujo gastroesofágico / Hiatal hernia in asthmatic patients: prevalence of and its association to gastroesophageal reflux

Antecedentes. Se ha informado que existe una alta prevalencia de hernia hiatal y reflujo gastroesofágico en asmáticos, pero en México no contamos con estudios al respecto. La relación entre hernia hiatal y reflujo gastroesofágico en asmáticos no ha sido estudiada. Objetivos. 1) conocer la prevalencia de hernia hiatal en asmáticos, 2) comparar la prevalencia de hernia hiatal en asmáticos frente a sujetos no asmáticos, 3) establecer la posible asociación de la hernia hiatal con el reflujo gastroesofágico en enfermos asmáticos. Material y métodos. Se practicó endoscopia a pacientes asmáticos y no asmáticos para conocer y comparar la prevalencia de hernia hiatal. Con el fin de establecer la posible asociación entre asma y reflujo gastroesofágico se analizaron los resultados de un cuestionario de síntomas gastrointestinales, manometría esofágica y pH-metría en asmáticos con y sin hernia hiatal. Resultados. La prevalencia de hernia hiatal en asmáticos fue alta y significativa mayor a la detectada en no asmáticos (62 vs. 34 por ciento, p= 0.002). La frecuencia de síntomas típicos de reflujo gastroesofágico fue similar en asmáticos con y sin hernia hiatal (54 vs. 43 por ciento, p=0.3). La manometría detectó incompetencia del esfínter esofágico inferior en una proporción semejante de asmáticos con hernia hiatal (35 por ciento) y sin hernia hiatal (22 por ciento) (p=0.4). Se detectó reflujo gastroesofágico patológico mediante pH-metría en 81 por ciento de los asmáticos con hernia hiatal y en 65 por ciento de aquéllos sin hernia hiatal (p=0.1). Conclusiones. La prevalencia de hernia hiatal en asmáticos es elevada y mayor a la encontrada en sujetos no asmáticos. La presencia de hernia hiatal no se correlaciona con la detección de reflujo gastroesofágico patológico por pH-metría en este grupo de enfermos