Utilidad de las pruebas analíticas en el diagnóstico de alergia a las proteínas de la leche de vaca / Usefulness of analytic tests for the diagnosis of cow's milk protein allergy

Introducción. La alergia a las proteínas de la leche de vaca es la alergia alimentaria más frecuente en los niños y para su diagnóstico se emplean historia clínica dirigida y prueba de provocación oral (PPO), el dosaje sérico de inmunoglobulina E específica (sIgE) y pruebas cutáneas de puntura (SPT, por su sigla en inglés). Sin embargo, su utilidad diagnóstica es difícil de establecer en la población local. El objetivo fue evaluar la utilidad de las pruebas para el diagnóstico de alergia a las proteínas de la leche de vaca (PLV) en la población estudiada. Población y métodos. Análisis retrospectivo de datos de pacientes atendidos en la Unidad de Alergia del Hospital Elizalde entre 2015 y 2018. Se evaluaron SPT y sIgE para leche, alfa-lactoalbúmina, beta-lactoglobulina y caseína, seguidos de PPO y se determinó la utilidad diagnóstica para cada prueba, y sus combinaciones. Resultados. Se evaluaron las pruebas de 239 pacientes. La PPO fue hospitalaria en el 54,8 % de los casos, por reexposición domiciliara en el 35,5 % y en el 9,6 % por incorporación de PLV a la madre. La mayor especificidad fue la de SPT con caseína (96,7 %; intervalo de confianza [IC95%]: 90,8-99,3) y la mayor sensibilidad, la de la combinación de SPT y sIgE con los 4 alérgenos (55,3 %; IC95%: 45,7-64,6). Conclusiones. El trabajo estableció la utilidad diagnóstica de las SPT y el sIgE en la población estudiada.

Introduction. Cow's milk protein allergy is the most common food allergy among children. It can be diagnosed based on a guided history taking and using an oral food challenge (OFC), serum specific immunoglobulin E levels (sIgE), and skin prick tests (SPT). However, it is difficult to establish their diagnostic performance in the local population. Our objective was to assess the usefulness of tests used to diagnose cow's milk protein (CMP) allergy in the studied population. Population and methods. Retrospective analysis of data from patients seen at the Unit of Allergy of a tertiary care pediatric hospital between 2015 and 2018. SPT and sIgE tests were done for milk, alpha-lactalbumin, beta-lactoglobulin, and casein, followed by an OFC, and the diagnostic usefulness of each test, as well as their combination, was established. Results. The tests of 239 patients were assessed. OFC was performed at the hospital in 54.8 % of cases, via a rechallenge test at home in 35.5 %, and through CMP intake by the mother in 9.6 %. The highest specificity was observed with the casein SPT (96.7 %; 95 % confidence interval [CI]: 90.8-99.3) and the highest sensitivity, with the 4-allergen SPT and sIgE combination (55.3 %; 95 % CI: 45.7-64.6). Conclusions. The study established the diagnostic usefulness of SPT and sIgE in the studied population.

Usefulness of analytic tests for the diagnosis of cow's milk protein allergy. / Utilidad de las pruebas analíticas en el diagnóstico de alergia a las proteínas de la leche de vaca.

INTRODUCTION: Cow's milk protein allergy is the most common food allergy among children. It can be diagnosed based on a guided history taking and using an oral food challenge (OFC), serum specific immunoglobulin E levels (sIgE), and skin prick tests (SPT). However, it is difficult to establish their diagnostic performance in the local population. Our objective was to assess the usefulness of tests used to diagnose cow's milk protein (CMP) allergy in the studied population. POPULATION AND METHODS: Retrospective analysis of data from patients seen at the Unit of Allergy of a tertiary care pediatric hospital between 2015 and 2018. SPT and sIgE tests were done for milk, alpha-lactalbumin, beta-lactoglobulin, and casein, followed by an OFC, and the diagnostic usefulness of each test, as well as their combination, was established. RESULTS: The tests of 239 patients were assessed. OFC was performed at the hospital in 54.8% of cases, via a rechallenge test at home in 35.5%, and through CMP intake by the mother in 9.6%. The highest specificity was observed with the casein SPT (96.7%; 95% confidence interval [CI]: 90.8-99.3) and the highest sensitivity, with the 4-allergen SPT and sIgE combination (55.3%; 95% CI: 45.7-64.6). CONCLUSIONS: The study established the diagnostic usefulness of SPT and sIgE in the studied population.

Introducción. La alergia a las proteínas de la leche de vaca es la alergia alimentaria más frecuente en los niños y para su diagnóstico se emplean historia clínica dirigida y prueba de provocación oral (PPO), el dosaje sérico de inmunoglobulina E específica (sIgE) y pruebas cutáneas de puntura (SPT, por su sigla en inglés). Sin embargo, su utilidad diagnóstica es difícil de establecer en la población local. El objetivo fue evaluar la utilidad de las pruebas para el diagnóstico de alergia a las proteínas de la leche de vaca (PLV) en la población estudiada. , M. Verónica Souzaa INTRODUCCIÓN Población y métodos. Análisis retrospectivo de datos de pacientes atendidos en la Unidad de Alergia del Hospital Elizalde entre 2015 y 2018. Se evaluaron SPT y sIgE para leche, alfa-lactoalbúmina, beta-lactoglobulina y caseína, seguidos de PPO y se determinó la utilidad diagnóstica para cada prueba, y sus combinaciones. La prevalencia de alergia alimentaria en el mundo se ha incrementado,1 tanto en los países desarrollados como en los países en desarrollo.2 Esto es especialmente problemático en los niños y afecta su calidad de vida.3 En todo el mundo, entre 220 y 250 millones de personas pueden tener una alergia alimentaria.4 La alergia a las proteínas de la Resultados. Se evaluaron las pruebas de 239 pacientes. La PPO fue hospitalaria en el 54,8 % de los casos, por reexposición domiciliara en el 35,5 % y en el 9,6 % por incorporación de PLV a la madre. La mayor especificidad fue la de SPT con caseína (96,7 %; intervalo de confianza [IC95%]: 90,8-99,3) y la mayor sensibilidad, la de la combinación de SPT y sIgE con los 4 alérgenos (55,3 %; IC95%: 45,7-64,6). Conclusiones. El trabajo estableció la utilidad diagnóstica de las SPT y el sIgE en la población estudiada.

Plakinamine P, A Steroidal Alkaloid with Bactericidal Activity against Mycobacterium tuberculosis.

Tuberculosis is the leading cause of death due to infectious disease worldwide. There is an urgent need for more effective compounds against this pathogen to control the disease. Investigation of the anti-mycobacterial activity of a deep-water sponge of the genus Plakina revealed the presence of a new steroidal alkaloid of the plakinamine class, which we have given the common name plakinamine P. Its structure is most similar to plakinamine L, which also has an acyclic side chain. Careful dissection of the nuclear magnetic resonance data, collected in multiple solvents, suggests that the dimethyl amino group at the 3 position is in an equatorial rather than axial position unlike previously reported plakinamines. Plakinamine P was bactericidal against M. tuberculosis, and exhibited moderate activity against other mycobacterial pathogens, such as M. abscessus and M. avium. Furthermore, it had low toxicity against J774 macrophages, yielding a selectivity index (SI, or IC50/MIC) of 8.4. In conclusion, this work provides a promising scaffold to the tuberculosis drug discovery pipeline. Future work to determine the molecular target of this compound may reveal a pathway essential for M. tuberculosis survival during infection.

[Successful treatment of disseminated fusariosis in a febrile neutropenic patient with combined antifungal therapy of voriconazol plus amphotericin B deoxycholate]. / Tratamiento exitoso de una fusariosis diseminada en un paciente neutropénico febril con terapia antifúngica combinada de voriconazol más anfotericina B deoxicolato.

We report a case of a patient with acute lymphoblastic leukemia (ALL), who developed a disseminated infection by Fusarium verticillioides during chemotherapy-induced neutropenia. He was successfully treated only after combination therapy with voriconazole plus amphotericin B deoxycolate was used, but not when these compounds were used in an isolated form.

Mesophotic sponges of the genus Callyspongia (Demospongiae, Haplosclerida) from Cuba, with the description of two new species.

This study presents the description of two Callyspongia species new to science, and the distribution of all Callyspongia species recorded during the first joint Cuba-U.S. expedition to characterize Cuban mesophotic coral ecosystems (May-June 2017). Additionally, we propose a key to identify thin branching species of the genus in the Greater Caribbean. The observations here presented are the result of underwater explorations with the Mohawk Remotely Operated Vehicle dives at 35 sites around the island, at depths of 25-188 m, recording images and videos, and collecting specimens. The depth range of five species of Callyspongia, reported before in Cuba, has been extended to deeper waters. Two specimens of branching Callyspongia were collected and described: Callyspongia (Callyspongia) pedroi sp. nov. and Callyspongia (Cladochalina) alcoladoi sp. nov. Morphometric comparisons of external and skeletal traits show clear differences with the other Callyspongia species from the Central West Atlantic with a similar thin branching habit. Callyspongia (C.) pedroi sp. nov. consists of pinkish delicate cylindrical microconulose branches (3-6 mm in diameter, 10-14 cm long) that rarely anastomose, with relatively large oval oscules (1-3 mm in diameter), and a skeleton dominated by primary and secondary fiber reticulations, discretely cored by fusiform oxeas. Callyspongia (C.) alcoladoi sp. nov. consists of grayish, smooth thin branches (3-8 mm in diameter, 20-30 cm long), profusely dividing and occasionally anastomosing, with few spiny projections (2-4 mm wide, 2-4 cm long). Its skeleton includes a highly developed ectosomal tertiary reticulation within the secondary and primary reticulation, and fibers discretely cored by predominant mucronate oxeas. Clear morphometric differences of spicules and their skeletal reticulation distinguish these species from the other six thinly branching Callyspongia species known from the Caribbean.

New Poecilosclerida from mesophotic coral reefs and the deep-sea escarpment in the Pulley Ridge region, eastern Gulf of Mexico: Discorhabdella ruetzleri n.sp. (Crambeidae) and Hymedesmia (Hymedesmia) vaceleti n.sp. (Hymedesmiidae).

Pulley Ridge, a limestone ridge that extends nearly 300 km along the southwestern Florida shelf in the eastern Gulf of Mexico, supports a mesophotic coral ecosystem (59 to 94 m deep), surrounded by deeper waters. An ongoing evaluation of Porifera biodiversity observed and collected during expeditions by Harbor Branch Oceanographic Institute (2003-2015) have shown the existence of approximately 102 sponge species, with at least 20 species new to science. The present paper describes two novel Poecilosclerida from mesophotic reefs and deep escarpments in the Pulley Ridge Region, Eastern Gulf of Mexico, namely Discorhabdella ruetzleri n.sp. (Crambeidae, Poecilosclerida) and Hymedesmia (Hymedesmia) vaceleti n. sp. (Hymedesmiidae, Poecilosclerida). This is the first record of Discorhabdella for the greater Caribbean and the Central West Atlantic. The skeleton of D. ruetzleri n.sp. includes the unique pseudoastrose acanthostyles of the genus, and it is distinct from congeners in the size ranges of the megascleres and in the occurrence of predominantly smooth instead of tuberose choanosomal and ectosomal subtylostyles. The intense blue color and the spicule combination of Hymesdesmia (H.) vaceleti n.sp. makes this species unique among other Hymedesmia spp. from the western Atlantic. The discovery represents a considerable expansion in the known biogeographical distribution of the genus Discorhabdella which is represented now by six species with a discrete geographic distribution (New Zealand, Azores, Western Mediterranean Sea, Eastern Pacific in Panama). This work is the first contribution to an ongoing effort to discover and document the importance of sponge biodiversity on mesophotic reefs and associated deep-water habitats in the Gulf of Mexico and the Caribbean.

Tratamiento exitoso de una fusariosis diseminada en un paciente neutropénico febril con terapia antifúngica combinada de voriconazol más anfotericina B deoxicolato / Successful treatment of disseminated fusariosis in a febrile neutropenic patient with combined antifungal therapy of voriconazol plus amphotericin B deoxycholate

Resumen Presentamos el caso clínico de un paciente con una leucemia linfoblástica aguda (LLA) que desarrolló una fusariosis diseminada por Fusarium verticillioides durante un episodio prolongado de neutropenia febril post quimioterapia. Fue exitosamente tratado cuando se usó terapia combinada de voriconazol más anfotericina B deoxicolato.

We report a case of a patient with acute lymphoblastic leukemia (ALL), who developed a disseminated infection by Fusarium verticillioides during chemotherapy-induced neutropenia. He was successfully treated only after combination therapy with voriconazole plus amphotericin B deoxycolate was used, but not when these compounds were used in an isolated form.

Diversity of sponges (Porifera) from cryptic habitats on the Belize barrier reef near Carrie Bow Cay.

The Caribbean barrier reef near Carrie Bow Cay, Belize, has been a focus of Smithsonian Institution (Washington) reef and mangrove investigations since the early 1970s. Systematics and biology of sponges (Porifera) were addressed by several researchers but none of the studies dealt with cryptic habitats, such as the shaded undersides of coral rubble, reef crevices, and caves, although a high species diversity was recognized and samples were taken for future reference and study. This paper is the result of processing samples taken between 1972 and 2012. In all, 122 species were identified, 14 of them new (including one new genus). The new species are Tetralophophora (new genus) mesoamericana, Geodia cribrata, Placospongia caribica, Prosuberites carriebowensis, Timea diplasterina, Timea oxyasterina, Rhaphidhistia belizensis, Wigginsia curlewensis, Phorbas aurantiacus, Myrmekioderma laminatum, Niphates arenata, Siphonodictyon occultum, Xestospongia purpurea, and Aplysina sciophila. We determined that about 75 of the 122 cryptic sponge species studied (61%) are exclusive members of the sciophilic community, 47 (39 %) occur in both, light-exposed and shaded or dark habitats. Since we estimate the previously known sponge population of Carrie Bow reefs and mangroves at about 200 species, the cryptic fauna makes up 38 % of total diversity.

Sponge hybridomas: applications and implications.

Many sponge-derived natural products with applications to human health have been discovered over the past three decades. In vitro production has been proposed as one biological alternative to ensure adequate supply of marine natural products for preclinical and clinical development of drugs. Although primary cell cultures have been established for many marine phyla, no cell lines with an extended life span have been established for marine invertebrates. Hybridoma technology has been used for production of monoclonal antibodies for application to human health. We hypothesized that a sponge cell line could be formed by fusing sponge cells of one species with those of another, or by fusing sponge cells with rapidly dividing, marine-derived, non-sponge cells. Using standard methods for formation of hybridomas, with appropriate modifications for temperature and salinity, cells from individuals of the same sponge species, as well as cells from individuals of two different sponge species were successfully fused. Research in progress is focused on optimizing fusion to produce a cell line and to stimulate expression of natural products with therapeutic relevance. Experimental hybridomas may also be used as models to test hypotheses related to naturally occurring sponge chimeras and hybridomas.

Neopetrosiquinones A and B, sesquiterpene benzoquinones isolated from the deep-water sponge Neopetrosia cf. proxima.

Two new marine-derived sesquiterpene benzoquinones which we designate as neopetrosiquinones A (1) and B (2), have been isolated from a deep-water sponge of the family Petrosiidae. The structures were elucidated on the basis of their spectroscopic data. Compounds 1 and 2 inhibit the in vitro proliferation of the DLD-1 human colorectal adenocarcinoma cell line with IC(50) values of 3.7 and 9.8 µM, respectively, and the PANC-1 human pancreatic carcinoma cell line with IC(50) values of 6.1 and 13.8 µM, respectively. Neopetrosiquinone A (1) also inhibited the in vitro proliferation of the AsPC-1 human pancreatic carcinoma cell line with an IC(50) value of 6.1 µM. The compounds are structurally related to alisiaquinone A, cyclozonarone, and xestoquinone.

Chemical constituents of the deep reef caribbean sponges Plakortis angulospiculatus and Plakortis halichondrioides and their anti-inflammatory activities.

Chemical investigations of two collections of the deep reef Caribbean sponge Plakortis angulospiculatus resulted in the isolation of a new compound (1) along with the known compound spiculoic acid B (2) belonging to the spiculoic acid class and four other new compounds (3-6) belonging to the zyggomphic acid class. Three new aromatic compounds (7-9) were isolated from the Caribbean sponge Plakortis halichondrioides. The structural determination of the compounds was based on extensive NMR and mass spectroscopic analysis. The isolated compounds 1-7 were tested for their anti-inflammatory activity using in vitro assays for inhibition of inducible nitric oxide synthase and nuclear factor kappa B (NFκB) activity, as well as inhibition of intracellular reactive oxygen species generation as a result of oxidative stress. The cytotoxicity of these compounds was also evaluated to determine the selectivity index of their bioactivity with respect to cytotoxicity. Compounds 1 and 4 were more potent than the positive control in inhibiting NFκB activity and had IC(50) values of 0.47 and 2.28 µM, respectively.

Preliminary assessment of sponge biodiversity on Saba Bank, Netherlands Antilles.

BACKGROUND: Saba Bank Atoll, Netherlands Antilles, is one of the three largest atolls on Earth and provides habitat for an extensive coral reef community. To improve our knowledge of this vast marine resource, a survey of biodiversity at Saba Bank included a multi-disciplinary team that sampled fishes, mollusks, crustaceans, macroalgae, and sponges. METHODOLOGY/PRINCIPAL FINDINGS: A single member of the dive team conducted surveys of sponge biodiversity during eight dives at six locations, at depths ranging from 15 to 30 m. This preliminary assessment documented the presence of 45 species pooled across multiple locations. Rarefaction analysis estimated that only 48 to 84% of species diversity was sampled by this limited effort, clearly indicating a need for additional surveys. An analysis of historical collections from Saba and Saba Bank revealed an additional 36 species, yielding a total of 81 sponge species recorded from this area. CONCLUSIONS/SIGNIFICANCE: This observed species composition is similar to that found on widespread Caribbean reefs, indicating that the sponge fauna of Saba Bank is broadly representative of the Caribbean as a whole. A robust population of the giant barrel sponge, Xestospongia muta, appeared healthy with none of the signs of disease or bleaching reported from other Caribbean reefs; however, more recent reports of anchor chain damage to these sponges suggests that human activities can have dramatic impacts on these communities. Opportunities to protect this extremely large habitat should be pursued, as Saba Bank may serve as a significant reservoir of sponge species diversity.

[Disseminated fusariosis by Fusarium oxysporum in an adult patient with acute myeloid leukemia and severe febrile neutropenia]. / Fusariosis diseminada por Fusarium oxysporum en un paciente adulto con leucemia mieloide aguda y neutropenia severa febril.

We report the first case of disseminated fusariosis in an adult patient in Chile, with a hematologic neoplasia and chemotherapy that evolved with febrile prolonged neutropenia, refractory, treated with wide spectrum antibiotics and that developed a systemic infection with sinusal, cutaneous and pulmonary compromise by Fusarium oxysporum. He was refractory to antifungal treatment with amphotericin B deoxycholate and caspofungin that were administered in a sequential schedule. The fatal outcome of this patient was associated to persistent neutropenia and infection caused by a filamentous fungus usually resistant to antifungal therapy.

Candidiosis orofaríngea: hallazgos clínicos y micológicos en pacientes VIH positivos / Oropharyngeal candidosis: Clinical and mycological findings in HIV positive patients

Se determinó la presencia de levaduras del genero Candida en la cavidad oral de pacientes VIH (+) y se correlacionó con motivo de consulta, estadio clinico (CDC1992), recuento CD4 y tratamiento antiretroviral y se evaluó la susceptibilidad in vitro por E-test frente a Fluconazol. Se incluyeron 107 pacientes (104 hombres y 3 mujeres) entre 19-67 años, CETS-SSM Central. Se practicó hisopado de cavidad oral y faringea, cultivado en Agar Sabouraul glucosado para aislamiento de levaduras identificadas por morfología y pruebas fisiológicas. Los motivos de consulta mßs frecuentes fueron: Candidosis orofaringea 22(20,6 porciento);control de rutina 28 (26.2 porciento);dermatitis seborreica 11(10.3 porciento), leucoplasia vellosa 7 (6.5 porciento). Los pacientes correspondieron a:Esta- dio A=67; B=20;C=20; Recuentos CD4<199=25; 200-400 = 58 y > de 500= 24, ademßs 33 pacientes recibian terapia antiretroviral . En 50 pacientes se aisló C.albicans (46.7 porciento), correspondiendo al estadio A=26.8 porciento; Estadio B=95 porciento y Estadio C=65 porciento. Según motivo de consulta, el cultivo fue positivo en 95.5 porciento de todos los pacientes que presentaron candidosis orofaringea y en 21.4 porciento de aquellos que asistieron al control de rutina, y en el 45.5 porciento de los pacientes con tratamiento antiretroviral. El 68 porciento de los cultivos positivos correspondieron a pacientes con recuentos CD4 <199. Seis de 37 cepas estudiadas fueron resistentes al Fluconazol con CIM >256 mcg/ml ( 13.5 porciento). El aislamiento de C.albicans es frecuente en pacientes VIH(+) con recuentos CD4 < 199 y a estadio clínico B yC. No se relaciona con terapia antiretroviral y es necesario considerar la resistencia a Fluconazol.

Reproducibilidad del grado nuclear en el cáncer de mama: una experiencia multicéntrica / Reproducibility of nuclear grade in breast neoplasm: a multicenter experience

El grado nuclear es considerado uno de los elementos de valor pronóstico en el carcinoma de mama. Resulta de interés verificar cuál es el grado de reproducibilidad de los patólogos generales al consignar el grado nuclear considerando que la mayor parte de los estudios anatomopatológicos de los carcinomas de mama los realizan patólogos "no expertos". Para ello se tomó una serie de 15 carcinomas de mama de los cuales 10 fueron seleccionados al azar y 5 por su particular dificultad para clasificar el grado nuclear. Diez patólogos generales trabajando en forma separada examinaron los casos y les asignaron el grado nuclear. Se hizo una primera asignación de acuerdo al criterio que cada observador utilizaba habitualmente para sus informes y una segunda siguiendo a una guía escrita. e estudiaron los datos por medio del análisis de la varianza. Los resultados mostraron que tanto para los casos seleccionados al azar como para la serie total no hubo diferencias significativas entre los observadores. La guía escrita, sorprendentemente, en lugar de disminuir las diferencias las aumentó. Un análisis del comportamiento individual de los observadores permitió detectar que dos de ellos tenían una gran variación entre ambas asignaciones, lo que se consideró como una influencia determinante para los resultados de todo el grupo. Cuando se analizó la diferencia interobservador para discriminar los tumores de alto grado (G3) del resto, se observó una buena reproducibilidad en todo el grupo participante. Estos resultados nos permiten concluir que, en esta serie examinada por patólogos generales, se obtuvo una aceptable reproducibilidad, en especial cuando se trató de identificar a los tumores con mayor riesgo.

Reproducibilidad del grado nuclear en el cáncer de mama: una experiencia multicéntrica / Reproducibility of nuclear grade in breast neoplasm: a multicenter experience

El grado nuclear es considerado uno de los elementos de valor pronóstico en el carcinoma de mama. Resulta de interés verificar cuál es el grado de reproducibilidad de los patólogos generales al consignar el grado nuclear considerando que la mayor parte de los estudios anatomopatológicos de los carcinomas de mama los realizan patólogos "no expertos". Para ello se tomó una serie de 15 carcinomas de mama de los cuales 10 fueron seleccionados al azar y 5 por su particular dificultad para clasificar el grado nuclear. Diez patólogos generales trabajando en forma separada examinaron los casos y les asignaron el grado nuclear. Se hizo una primera asignación de acuerdo al criterio que cada observador utilizaba habitualmente para sus informes y una segunda siguiendo a una guía escrita. e estudiaron los datos por medio del análisis de la varianza. Los resultados mostraron que tanto para los casos seleccionados al azar como para la serie total no hubo diferencias significativas entre los observadores. La guía escrita, sorprendentemente, en lugar de disminuir las diferencias las aumentó. Un análisis del comportamiento individual de los observadores permitió detectar que dos de ellos tenían una gran variación entre ambas asignaciones, lo que se consideró como una influencia determinante para los resultados de todo el grupo. Cuando se analizó la diferencia interobservador para discriminar los tumores de alto grado (G3) del resto, se observó una buena reproducibilidad en todo el grupo participante. Estos resultados nos permiten concluir que, en esta serie examinada por patólogos generales, se obtuvo una aceptable reproducibilidad, en especial cuando se trató de identificar a los tumores con mayor riesgo. (AU)