Disc degeneration induces a mechano-sensitization of disc afferent nerve fibers that associates with low back pain.

OBJECTIVE: We aimed to investigate mechano-sensitivity at the afferent nerve fibers projecting to degenerated intervertebral disc (IVD) and nociceptive behaviour in a rat model of low back pain (LBP). DESIGN: Animal model with LBP was established by lumbar 4/5 IVD puncture and nucleus pulposus aspiration. In vivo single nerve recordings (n = 121) were introduced to measure discharge frequency at the afferent nerve fiber innervating the IVD during mechanical stimulations (von Frey filament or intradiscal pressure). Nerve growth factor (NGF) expression levels in the IVD (n = 20) were assessed by Western blot. LBP-related behaviour (n = 22) was assessed by measuring changes in rearing, mechanical paw-withdrawal threshold, and dynamic weight bearing in a freely walking rat. Inhibitory effect of morphine on the neuronal excitability (n = 19) and painful behaviour (n = 28) was also assessed. RESULTS: Compared to those with sham or naïve IVD, animal group with degenerated IVD displayed the sensitized neuronal responses and painful behaviour, with hyperexcitability of the afferent nerve fibers in any range of mechanical stimulations (von Frey filament stimulation; 1, 2, and 26 g; intradiscal pressure, 1,500-3,000 mm Hg), strong upregulation of NGF (200-250 % increase), and LBP-like behaviour such as failure of rearing, front limbs-dependent walking pattern, and hypersensitivity in hind-paws. However, the neuronal hyperexcitability and pain behaviour were attenuated after local (30 µM) or systemic (3 mg kg-1) morphine administration. CONCLUSIONS: Our study suggests that enhanced mechano-sensitivity at the afferent nerve fiber innervating degenerated IVD is deeply correlated with LBP development, which supports the hypothesis that hyperexcited responses at the nerve fibers represent a decisive source of LBP.

Tracking Medical Graduates in Jamaica and The Bahamas / Tras los graduados de medicina en Jamaica y las Bahamas

ABSTRACT Objective: To determine the availability of employment and retention for the increased number of medical graduates in Jamaica and The Bahamas. Methods: The availability of internships and junior medical posts for graduates of The University of the West Indies in Jamaica and The Bahamas over the five-year period of 2012 to 2016 was reviewed. Results: There were 947 medical graduates between 2012 and 2016 in Jamaica; 69.4% of them were female. The number of graduates increased annually. The majority of graduates were Jamaicans; non-Jamaicans comprised 18.2%. All Jamaican graduates obtained internship posts in the public hospitals and at the University Hospital of the West Indies, Jamaica, with a phased increase of approximately 20% in the posts available over the period. The public hospitals employed 75% of the graduates. There were 172 non-Jamaican graduates, the majority of whom were from Trinidad and Tobago, who did not seek employment in Jamaica. In The Bahamas, there were 132 graduates, all of whom obtained internship posts in public hospitals. Of the 2259 applicants, 664 were accepted to postgraduate programmes in Jamaica and The Bahamas between 2012 and 2016. Seventy per cent of all graduates were working in the English-speaking Caribbean, with the majority in Jamaica. Conclusion: The number of medical graduates trained increased, with a predominance of females. All graduates obtained employment in Jamaica and The Bahamas, mainly in public institutions. Although there was 70% retention of graduates, there is an urgent need to increase the number of postgraduate posts and accredited training institutions in the Caribbean.

RESUMEN Objetivo: Determinar la disponibilidad de empleo y la retención para el número creciente de graduados de medicina en Jamaica y las Bahamas. Métodos: Se revisó la disponibilidad de pasantías y puestos médicos para recién graduados de la Universidad de West Indies en Jamaica y las Bahamas durante el período de cinco años de 2012 a 2016. Resultados: Hubo 947 graduados de medicina entre 2012 y 2016 en Jamaica, de los cuales el 69.4% eran mujeres. El número de graduados aumentó anualmente. La mayoría de los graduados eran jamaicanos; los no jamaicanos comprendían el 18.2%. Todos los graduados jamaicanos obtuvieron puestos de pasantía en los hospitales públicos y en el Hospital Universitario de UWI, Jamaica, con un aumento gradual de aproximadamente 20% de los puestos disponibles durante el período. Los hospitales públicos emplearon el 75% de los graduados. Hubo 172 graduados no jamaicanos, la mayoría de los cuales eran de Trinidad y Tobago, y no buscaban empleo en Jamaica. En las Bahamas, hubo 132 graduados, todos los cuales obtuvieron puestos de pasantía en hospitales públicos. De los 2259 solicitantes, 664 fueron aceptados en los programas de postgrado en Jamaica y las Bahamas entre 2012 y 2016. El setenta por ciento de todos los graduados trabajaban en el Caribe de habla inglesa, mayormente en Jamaica. Conclusión: El número de graduados médicos entrenados aumentó, con predominio de las mujeres. Todos los graduados obtuvieron empleo en Jamaica y las Bahamas, principalmente en instituciones públicas. Aunque hubo 70% de retención de graduados, hay una necesidad urgente de aumentar el número de puestos de posgrado y formación acreditada en las instituciones del Caribe.

The relationship between clinical characteristics including presence of exposed lesions and health-related quality of life (HRQoL) in patients with psoriasis: analysis from the nationwide epidemiologic study for psoriasis in Korea (EPI-PSODE study).

BACKGROUND: Psychological aspect and quality of life should be considered in treating patients with psoriasis. OBJECTIVE: We sought to ascertain which clinical characteristics including presence of exposed lesions are associated with impairment of health-related quality of life (HRQoL) in patients with psoriasis. METHODS: The EPI-PSODE study was a nationwide, multicenter, cross-sectional study conducted in Korea that included 1260 adult patients with psoriasis. In addition to clinical characteristics including presence of exposed lesions, data were collected using the Psoriatic Arthritis (PsA) Screening and Evaluation (PASE), Dermatology Life Quality Index (DLQI), MOS 36-Item Short-Form Health Survey (SF-36), Work Productivity and Activity Impairment Questionnaire Psoriasis (WPAI: PSO) and Medication Satisfaction Questionnaire (MSQ). RESULTS: Patients with a DLQI score > 5 (n = 990) were younger, had an earlier onset of psoriasis, scored higher on the Psoriasis Area and Severity Index (PASI), had higher body surface area (BSA) and had higher PASE scores than patients with DLQI ≤ 5 (n = 266). The group of patients with exposed lesions (n = 871) were younger and male predominance, earlier onset of psoriasis, longer disease duration, higher PASI/BSA score and a higher proportion with drinking and smoking history each than the group of patients without exposed lesions (n = 389). Presence of exposed lesions negatively influenced DLQI, 36-Item Short-Form Health Survey (SF-36) (mental component), presenteeism, total work productivity impairment and total activity impairment in the WPAI: PSO. In multiple regression model, PASI score was the only variable which was significantly associated with all HRQoL measures. Presence of exposed lesions was a significant factor affecting DLQI and SF-36 (mental). CONCLUSION: The presence of exposed lesions has a negative impact on quality of life, mental health and work productivity. Therefore, effective treatments are particularly needed for psoriasis patients with exposed lesions.

The effect of horse simulator riding on visual analogue scale, body composition and trunk strength in the patients with chronic low back pain.

BACKGROUND: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders, and thus effective treatments are required. Recently, real horseback riding has been reported to be beneficial for the patients. However, it has some limitations, such as limited approaches and safety issues. OBJECTIVE: The purpose of this study was to investigate the effect of horse simulator riding on back pain, body composition and trunk strength in the patients with CLBP. PARTICIPANTS: Forty-seven men with CLBP (mean age 20.55 ± 1.38 years) were randomly divided into a control group (n = 23) and a horse simulator riding group (n = 24), and visual analogue scale (VAS), body composition and isokinetic trunk strength were measured after 8 weeks for which subjects in a horse simulator riding group had performed the horse simulator exercise (HSE). RESULTS: Horse simulator exercise significantly reduced pain scores of VAS and enhanced isokinetic torques of trunk at 30 and 90°/s. There were also significantly increased muscle mass and decreased fat mass in horse simulator riding group. CONCLUSION: It can be inferred that HSE may be helpful in relief of back pain and recovery of back function through developing trunk strength and balancing the ratio of trunk flexor/extensor muscles.

Whipple's disease in an Afro-Caribbean national / Enfermedad de whipple en un nacional afrocaribeño

Whipple's disease is a rare multi-organ infectious disease caused by Tropheryma whipplei. It is fatal without treatment. We report on a 40-year old Afro-Jamaican man who presented with a six-month history of weight loss and diarrhoea. Investigations revealed iron deficiency anaemia and hypoalbuminaemia. Upper gastrointestinal endoscopy revealed white patchy lesions in the duodenum. The duodenal biopsy showed broadening and thickening of the villi by a dense infiltrate of foamy histiocytes within the lamina propria and focally extending into the attached submucosa. Periodic Acid-Schiff stains were positive. Electron microscopy was confirmatory and polymerase chain reaction testing conclusively identified the organisms as T whipplei. Antibiotic treatment resulted in resolution of symptoms. Although the diagnosis of Whipple's disease is difficult, increased awareness should lead to an increase in reported cases with the improvements in diagnostic capabilities.

La enfermedad deWhipple es una rara enfermedad infecciosa multiorgánica causada por el Tropheryma whipplei. Es fatal sin tratamiento. Reportamos un hombre afro-jamaicano de 40 años que se presentó con una historia de seis meses de pérdida de peso y diarrea. Las investigaciones revelaron hipoalbuminemia y anemia ferropénica. La endoscopia gastrointestinal superior reveló lesiones blancas irregulares en el duodeno. La biopsia duodenal mostró la ampliación y engrosamiento de las vellosidades por un denso infiltrado de histiocitos espumosos dentro de la lámina propia, que se extienden hasta la submucosa adjunta. Las tinciones con ácido peryódico de Schiff fueron positivas. La microscopia electrónica fue confirmatoria y la prueba de la reacción en cadena de la polimerasa, identificó los organismos como T whipplei de forma concluyente El tratamiento antibiótico trajo como resultado la resolución de los síntomas. Si bien el diagnóstico de la enfermedad de Whipple es difícil, un aumento de la conciencia debe conducir a un aumento en los reportes de casos divulgados que reflejan un mejoramiento en la capacidad para hacer el diagnóstico.

The antioxidative effect of heat-shock protein 70 in dendritic cells.

Reactive oxygen species (ROS) are produced by dendritic cells (DCs) during antigen presentation in contact hypersensitivity (CHS). ROS cause a number of non-enzymatic protein modifications, such as carbonylation. Carbonylated proteins in DCs in response to hapten have not been fully identified yet. To identify the proteins carbonylated by ROS, murine epidermis-derived DC line XS106 was challenged with a hapten, 2,4,6-trinitrobenzene sulphonic acid (TNBS). MALDI-TOF analysis revealed that heat-shock protein 70 (HSP70) was one of the carbonylated proteins induced by TNBS. To verify the role of HSP70 in TNBS-treated XS106 cell, we fused protein transduction domain (PTD) with HSP70 to facilitate protein delivery into the cell. The transfected fusion protein HSP70 within the cell caused transient increase of the cellular level of HSP70. Transient increase of HSP70 level in XS-106 DCs resulted in inhibition of ROS production, carbonylation of HSP70, p38 MAPK activation and subsequently IL-12 secretion. To investigate the effects of PTD-HSP70 in vivo, ear-swelling experiments with 2,4,6-trinitro-1-chlorobenzene (TNCB) were performed in BALB/c mice. Pretreatment of PTD-HSP70 reduced the CHS response to TNCB in vivo. We report here that carbonylation of HSP70 by ROS is associated with the pathogenesis of CHS, suggesting possibility of HSP70-targeting therapy in CHS.

ZNF313 is a novel cell cycle activator with an E3 ligase activity inhibiting cellular senescence by destabilizing p21(WAF1.).

ZNF313 encoding a zinc-binding protein is located at chromosome 20q13.13, which exhibits a frequent genomic amplification in multiple human cancers. However, the biological function of ZNF313 remains largely undefined. Here we report that ZNF313 is an ubiquitin E3 ligase that has a critical role in the regulation of cell cycle progression, differentiation and senescence. In this study, ZNF313 is initially identified as a XIAP-associated factor 1 (XAF1)-interacting protein, which upregulates the stability and proapoptotic effect of XAF1. Intriguingly, we found that ZNF313 activates cell cycle progression and suppresses cellular senescence through the RING domain-mediated degradation of p21(WAF1). ZNF313 ubiquitinates p21(WAF1) and also destabilizes p27(KIP1) and p57(KIP2), three members of the CDK-interacting protein (CIP)/kinase inhibitor protein (KIP) family of cyclin-dependent kinase inhibitors, whereas it does not affect the stability of the inhibitor of CDK (INK4) family members, such as p16(INK4A) and p15(INK4B). ZNF313 expression is tightly controlled during the cell cycle and its elevation at the late G1 phase is crucial for the G1-to-S phase transition. ZNF313 is induced by mitogenic growth factors and its blockade profoundly delays cell cycle progression and accelerates p21(WAF1)-mediated senescence. Both replicative and stress-induced senescence are accompanied with ZNF313 reduction. ZNF313 is downregulated during cellular differentiation process in vitro and in vivo, while it is commonly upregulated in many types of cancer cells. ZNF313 shows both the nuclear and cytoplasmic localization in epithelial cells of normal tissues, but exhibits an intense cytoplasmic distribution in carcinoma cells of tumor tissues. Collectively, ZNF313 is a novel E3 ligase for p21(WAF1), whose alteration might be implicated in the pathogenesis of several human diseases, including cancers.

Klippel-Trenaunay syndrome / Síndrome de Klippel-Trenaunay

Klippel-Trenaunay syndrome (KTS) is a rare congenital, vascular disorder affecting one or more limbs. The syndrome is characterized by capillary malformations, soft tissue or bony hypertrophy and varicose veins or venous malformations. We present a case of this disorder in a twelveyear old boy who had an enlarged right lower limb with varicosities. Investigations revealed extensive superficial and deep venous varices, with dilatation of the right common iliac and external iliac veins. Klippel-Trenaunay syndrome should be suspected in a child presenting with capillary haemangioma and an enlarged limb.

El síndrome de Klippel-Trenaunay (KTS) es un raro trastorno congénito vascular que afecta a una o más extremidades. El síndrome se caracteriza por malformaciones capilares, hipertrofia ósea o del tejido suave, y várices o malformaciones venosas. Presentamos un caso de este trastorno en un muchacho de doce años que tenía una extremidad inferior derecha agrandada con varicocidades. Las investigaciones revelaron varices superficiales y várices venosas profundas, con dilatación de las venas ilíacas comunes derecha y las venas ilíacas externas. El síndrome de Klippel-Trenaunay se debe sospechar en un niño que se presenta con hemangioma capilar y agrandamiento de un miembro.

The effect of gadoxetic acid enhancement on lesion detection and characterisation using T2 weighted imaging and diffusion weighted imaging of the liver.

OBJECTIVES: To evaluate the effect of gadoxetic acid enhancement on the detection and characterisation of focal hepatic lesions on T(2) weighted and diffusion weighted (DW) images. METHODS: A total of 63 consecutive patients underwent T(2) weighted and DW imaging before and after gadoxetic acid enhancement. Two blinded readers independently identified all of the focal lesions using a five-point confidence scale and characterised each lesion using a three-point scale: 1, non-solid; 2, indeterminate; and 3, solid. For both T(2) weighted and DW imaging, the accuracies for detecting focal lesions were compared using the free-response receiver operating characteristic analysis; the accuracies for lesion characterisation were compared using the McNemar test between non-enhanced and gadoxetic acid-enhanced image sets. For hepatic lesions ≥ 1 cm, the lesion-to-liver contrast-to-noise ratio (CNR) and the apparent diffusion coefficient (ADC) were compared in the non-enhanced and enhanced image sets using the generalised estimating equations. RESULTS: For both T(2) weighted and DW images, the accuracies for detecting focal lesions (p ≥ 0.52) and those for lesion characterisation (p ≥ 0.63) did not differ significantly between the non-enhanced and enhanced image sets. The lesion-to-liver CNR was significantly higher on enhanced DW images than on non-enhanced DW images (p=0.02), although the difference was not significant for T(2) weighted imaging (p=0.65). The mean ADC values of lesions did not differ significantly on enhanced and non-enhanced DW imaging (p=0.75). CONCLUSION: The acquisition of T(2) weighted and DW images after administration of gadoxetic acid has no significant effect on the detection or characterisation of focal hepatic lesions, although it improves the lesion-to-liver CNR on DW images.

Acute respiratory distress syndrome caused by miliary tuberculosis: a multicentre survey in South Korea.

BACKGROUND: Miliary tuberculosis (TB) is an unusual cause of acute respiratory distress syndrome (ARDS). OBJECTIVE: To evaluate the clinical characteristics and outcomes of patients with ARDS caused by miliary TB admitted to the intensive care unit (ICU). DESIGN: A total of 67 patients were enrolled during the period 1999-2008. RESULTS: The median age of the patients was 56 years (range 17-81), 19 (28.4%) were aged >71 years, and 38 (56.7%) were male. All-cause mortality in the ICU and hospital were respectively 58.2% and 61.2%. Of the total number of enrolled patients, 49 (73.1%) were prescribed anti-tuberculosis medication within 3 days of hospital admission. On the day of ARDS diagnosis (10.0 ± 3.7 vs. 7.4 ± 3.5, P = 0.005), non-survivors had a significantly higher Sequential Organ Failure Assessment (SOFA) score than survivors. Multivariate analysis showed that SOFA score on the day of ARDS diagnosis was a significant predictor of survival (OR 0.809, 95%CI 0.691-0.946, P = 0.008). It was difficult to determine the efficacy of systemic corticosteroids on patient survival. CONCLUSION: ARDS caused by miliary TB was associated with a high in-hospital mortality rate, with SOFA score on the day of ARDS diagnosis being a valuable prognostic indicator.

Modulation of presynaptic GABA(A) receptors by endogenous neurosteroids.

BACKGROUND AND PURPOSE: Although 3α-hydroxy, 5α-reduced pregnane steroids, such as allopregnanolone (AlloP) and tetrahydrodeoxycorticosterone, are endogenous positive modulators of postsynaptic GABA(A) receptors, the functional roles of endogenous neurosteroids in synaptic transmission are still largely unknown. EXPERIMENTAL APPROACH: In this study, the effect of AlloP on spontaneous glutamate release was examined in mechanically isolated dentate gyrus hilar neurons by use of the conventional whole-cell patch-clamp technique. KEY RESULTS: AlloP increased the frequency of glutamatergic spontaneous excitatory postsynaptic currents (sEPSCs) in a dose-dependent manner. The AlloP-induced increase in sEPSC frequency was completely blocked by a non-competitive GABA(A) receptor blocker, tetrodotoxin or Cd(2+) , suggesting that AlloP acts on presynaptic GABA(A) receptors to depolarize presynaptic nerve terminals to increase the probability of spontaneous glutamate release. On the other hand, γ-cyclodextrin (γ-CD) significantly decreased the basal frequency of sEPSCs. However, γ-CD failed to decrease the basal frequency of sEPSCs in the presence of a non-competitive GABA(A) receptor antagonist or tetrodotoxin. In addition, γ-CD failed to decrease the basal frequency of sEPSCs after blocking the synthesis of endogenous 5α-reduced pregnane steroids. Furthermore, γ-CD decreased the extent of muscimol-induced increase in sEPSC frequency, suggesting that endogenous neurosteroids can directly activate and/or potentiate presynaptic GABA(A) receptors to affect spontaneous glutamate release onto hilar neurons. CONCLUSIONS AND IMPLICATIONS: The modulation of presynaptic GABA(A) receptors by endogenous neurosteroids might affect the excitability of the dentate gyrus-hilus-CA3 network, and thus contribute, at least in part, to some pathological conditions, such as catamenial epilepsy and premenstrual dysphoric disorder.

Juvenile polyposis syndrome / Síndrome de poliposis juvenil

Juvenile polyposis syndrome (JPS) is rare and is present when there are multiple juvenile polyps in the gastrointestinal tract, usually the colon. The importance of this condition is the association with the development of colorectal and upper gastrointestinal cancer at a young age. We report the case of a 21- year old male with a two-year history of intermittent rectal bleeding and anal protrusion. Colonoscopy revealed multiple pedunculated cherry red polyps mainly in the left colon. Histology confirmed juvenile polyps. Juvenile polyposis syndrome should be considered in young patients with colonic symptoms, especially rectal bleeding. It is important to distinguish between patients with JPS and patients with an isolated harmatomatous juvenile polyp.

El síndrome de poliposis juvenil (SPJ) es raro y se presenta en forma de pólipos juveniles múltiples en el tracto gastrointestinal, generalmente en el colon. La importancia de esta condición estriba en su asociación con el desarrollo del cáncer colorectal y el cáncer gastrointestinal superior en la edad juvenil. Reportamos el caso de un joven de 21 años con una historia de dos años de sangramiento rectal intermitente y protrusión anal. La colonoscopía reveló múltiples pólipos pedunculados de color rojocereza, principalmente en el colon izquierdo. La histología confirmó la presencia de pólipos juveniles. El síndrome del poliposis juvenil debe ser considerado en los pacientes jóvenes con síntomas colónicos, especialmente cundo hay sangramiento rectal. Es importante distinguir entre pacientes con SPJ y pacientes con un pólipo juvenil harmatomatoso aislado.

The prevalence of Helicobacter pylori infection in patients undergoing upper gastrointestinal endoscopy in the Turks and Caicos islands / Prevalencia de la infección por Helicobacter pylori en pacientes sometidos a endoscopía gastrointestinal superior en las Islas Turcas y Caicos

BACKGROUND: Helicobacter pylori infection remains a common problem and previous studies in the Caribbean revealed infection in over 50% of patients undergoing upper endoscopy. Objective: The present study determined the prevalence of H pylori infection in patients undergoing upper gastrointestinal endoscopy in the Turks and Caicos Islands over a two- year interval. METHODS: All patients with upper gastrointestinal symptoms requiring endoscopy were evaluated clinically and H pylori testing performed histologically. RESULTS: There were 57 patients (21 males, 36 females) with a mean age of 43 years. Twenty-six patients presented with gastroesophageal reflux, 17 with upper abdominal pain, 10 with dyspepsia and 4 with upper gastrointestinal bleeding. H pylori infection was present in 24 patients (42%) and negative in 33 (58%). Upper gastrointestinal endoscopy was normal in 27 patients, 13 (54%) were H pylori positive and 14 (43%) negative. Antral gastritis was present in 13 patients, 7 (54%) were H pylori positive and 6 (46%) negative. Duodenal ulcer was present in 6 (33% H pylori positive) and gastric ulcer in 5 patients (40% H pylori positive). Distal oesophagitis was present in 5 patients (all negative for H pylori) and gastric carcinoma in 1 (H pylori positive). CONCLUSION: In patients with dyspepsia, 60% were positive for H pylori. H pylori infection was common in the patients in this study with gastrointestinal symptoms. However, the prevalence in endoscopic patients and peptic ulcer disease is lower than in other reports from the Caribbean.

ANTECEDENTES: La infección por Helicobacter pylori sigue siendo un problema común y los estudios previos en el Caribe revelaron infección en más del 50% de los pacientes sometidos a endoscopía superior. OBJETIVO: El objetivo del presente estudio fue determinar la prevalencia de la infección por H pylori en pacientes sometidos a endoscopía gastrointestinal superior en las Islas Turcas y Caicos por un período de dos años. MÉTODOS: Los sujetos fueron 57 pacientes (21 varones, 36 hembras) con una edad promedio de 43 años. Veintiséis pacientes se presentaron con reflujo gastroesofágico, 17 con dolor abdominal superior, 10 con dispepsia y 4 con sangramiento gastrointestinal superior. La infección por H pylori estuvo presente en 24 pacientes (42%) y fue negativa en 33 (58%). Resultados: El endoscopía gastrointestinal superior fue normal en 27 pacientes, 13 (54%) fueron positivos al H pylori y 14 (43%) fueron negativos. La gastritis antral estuvo presente en 13 pacientes, 7 (54%) dieron positivo al H pylori y y 6 (46%) dieron negativo. La úlcera duodenal estuvo presente en 6 (33% positivos a H pylori) y la úlcera gástrica en 5 pacientes (40% positivos a H pylori). Se halló esofaguitis distal en 5 pacientes (todos negativos a H pylori) y carcinoma gástrico en 1 (positivo a H pylori). CONCLUSIÓN: Entre los pacientes con dispepsia, 60% dieron positivo positivos a H pylori. En este estudio, la infección por H pylori fue común en pacientes con síntomas gastrointestinales. Sin embargo, la prevalencia en los pacientes sometidos a endoscopía y con úlcera péptica, fue menor en relación con los otros reportes del Caribe.

Knowledge and practice of occupational infection control among healthcare workers in Jamaica / Conocimientos y práctica del control ocupacional de infecciones entre los trabajadores de la salud en Jamaica

OBJECTIVE: To assess the knowledge, compliance and practice among healthcare workers of occupational infection control at two hospitals in Jamaica. METHODS: Employing a cross-sectional study design, medical personnel (physicians and nurses) at two hospitals in Jamaica, were studied, utilizing a structured questionnaire consisting of 14 items to collect the data. RESULTS: Participants considered the following fluids, not blood stained, high risk for HIV transmission: breast milk (79%), saliva (14%), urine (27%), pleural fluid (53%), CSF (55%), synovial fluid (37%), faeces (27%), peritoneal fluid (53%) and vomitus (21%). The respondents estimated the risk of transmission of infection after a needlestick injury from a patient with: HIV, mean 22.5%, HBV, 34% and HCV, 26%. Needles for drawing blood were identified as having the highest risk for transmission of infections in 63%. The following precautions were adhered to all the time: wearing gloves (38%), not resheathing needles (22%), not passing needles directly to others (70%), properly disposing of sharps (86%) and regarding patients' blood and other high risk fluid as potentially infected (62%). Post exposure, 43% indicated bleeding/squeezing the NSI site as the initial first-aid procedure, washing with soap and water (29%) and irrigating the area with water (20%) CONCLUSIONS: Healthcare workers are aware of the risk of transmission of infection, however compliance with universal precautions was inadequate. An improvement in knowledge and practice with clear guidelines are needed and a comprehensive programme to educate HCWs regarding compliance with universal precautions is urgently required.

OBJETIVO: Evaluar los conocimientos, el cumplimiento de medidas, y la práctica entre los trabajadores de la salud encargados del control ocupacional de infecciones en dos hospitales en Jamaica. MÉTODOS: Empleando un diseño de estudio transversal, se estudió el personal médico (médicos y enfermeras) de dos hospitales en Jamaica. En el estudio se utilizó una encuesta estructurada de 14 puntos, para recoger los datos. RESULTADOS: Los participantes consideraron que los fluidos siguientes, no sanguinolentos, presentan un alto riesgo de transmisión de VIH: leche materna (79%), saliva (14%), orina (27%), fluido pleural (53%), LCR (55%), fluido sinovial (37%), heces (27%), fluido peritoneal (53%) y vómito (21%). Los encuestados estimaron el riesgo de transmisión de infección después de una lesión por punción con aguja de un paciente con: VIH, media 22.5%, VHB, 34% y VHC, 26%. Las agujas para extraer sangre fueron identificadas como el factor de mayor riesgo en la transmisión de infecciones, con 63%. Las precauciones siguientes se observaron todo el tiempo: uso de guantes (38%), no recapar agujas usadas (22%), no pasar agujas directamente a otros (70%), eliminar adecuadamente los desechos cortopunzantes (86%), y considerar la sangre de los pacientes y otros fluidos de alto riesgo de los pacientes, como potencialmente infectados (62%). En cuanto a la post-exposición, el 43% indicó hacer sangrar/ejercer presión sobre el sitio de la LPA como el procedimiento inicial para los primeros auxilios, lavando con jabón y agua (29%) e irrigando el área con agua (20%) CONCLUSIONES: Los trabajadores de la salud tienen conciencia del riesgo de la transmisión de infecciones. No obstante, el cumplimiento de las medidas universales era inadecuado. Es necesario mejorar los conocimientos y las prácticas con normas claras, y se requiere con urgencia un programa integral para educar a los trabajadores de la salud en relación con el cumplimiento de las medidas universales.

Prevalence of needlestick injuries and other high risk exposures among healthcare workers in Jamaica / Prevalencia de las lesiones por punción con aguja y otras exposiciones de alto riesgo entre los trabajadores de la salud en Jamaica

OBJECTIVE: To assess the prevalence of needlestick injuries (NSIs) and other high risk exposures among healthcare workers at two hospitals in Jamaica. METHODS: Employing a cross-sectional study design, medical personnel (physicians, nurses) at two hospitals in Jamaica, were studied, utilizing a structured questionnaire consisting of 14 items to collect data on needle stick injuries and other injuries. RESULTS: There were 67 needlestick injuries in 47 persons. Of those sustaining an injury, 52% of physicians and 40% of nurses had NSIs. re-capping needles accounted for 21% of injuries, various minor procedures, 21%, injury during surgery, 19.4% and taking blood, 12%. In those sustaining NSIs, 47% were reported and 26% of reported cases received counselling. Appropriate blood tests were performed on 34% and post-exposure prophylaxis (PEP) for HIV was administered to 30%. Hollow bore needles caused 47.8% of injuries, 25.4% occurred with suture needles and 19.4% with intravenous branulas. Other occupational exposure was reported by 31%, including blood on hands and other body parts 39%, blood to face and eyes, 18%, splashed with liquor, 18%, splashed with bloody fluid, 11% and contact with vomitus and urine in eye, 4%. CONCLUSION: Needlestick injuries and other high risk exposures were high; incident reporting and post exposure management were inadequate. A comprehensive programme to address factors that contribute to the occurrence of NSIs and other occupational exposures is urgently needed.

OBJETIVO: Evaluar la prevalencia de lesiones por punción con aguja (LPA) y otras exposiciones de alto riesgo entre trabajadores de la salud en dos hospitales de Jamaica. MÉTODOS: Empleando un diseño de estudio transversal, se estudió el personal médico (médicos y enfermeras) de dos hospitales en Jamaica. En el estudio se utilizó una encuesta estructurada de 14 puntos, para recoger datos sobre lesiones por punción con aguja y otros tipos de lesiones. RESULTADOS: Hubo 67 lesiones por punción con agujas en 47 personas. De las personas con heridas, 52% fueron médicos y 40% enfermeras que sufrieron lesiones por punción con agujas. El intento por recapar agujas dio cuenta del 21% de las lesiones; varios procedimientos menores, representaron el 21%; las lesiones durante cirugías, 19.4%; y la recogida de sangre, 12%. Entre los que tuvieron LPAs, 47% fueron reportados y el 26% de los casos reportados recibieron aconsejamiento. Se realizaron análisis de sangre apropiados en 34% y la profilaxis post-exposición (PPE) para el VIH se administró al 30%. Las agujas hipodérmicas causaron el 47.8% de las lesiones; el 25.4% ocurrieron con agujas de sutura, y 19.4% con bránulas IV. Otra exposición ocupacional fue reportada por 31%, incluyendo sangre en las manos y otras partes del cuerpo, 39%; sangre en la cara y los ojos, 18%; salpicados con fluido corporal, 18%; salpicados con fluido sanguinolento, 11%; y contacto con vómito y orina en los ojos, 4%. CONCLUSIÓN: Las lesiones por punción con agujas y otras exposiciones de alto riesgo fueron altas. Los reportes de incidentes y el tratamiento de la post exposición fueron inadecuados. Se necesita urgentemente un programa integral para abordar los factores que contribuyen a que se produzcan LPAs y otras exposiciones ocupacionales.

Febrile neutropaenia in cancer patients / Neutropenia febril en pacientes con cáncer

BACKGROUNDS: Febrile neutropaenia is a common complication of chemotherapy in cancer patients. Empirical antibiotic regimes are based on the epidemiological characteristics of bacterial isolates globally and locally. METHOD: This study retrospectively reviewed all cases of febrile neutropaenia in patients with confirmed cancer admitted at the University Hospital of the West Indies in the four-year period between, January 1, 2003 and December 31, 2006 and who received chemotherapy. Cases were identified from blood culture records and hospital charts which were reviewed to determine the aetiological agents causing bacteraemia, their antimicrobial susceptibilities and clinical features. These cases were compared with non-neutropaenic cancer patients admitted with fever. RESULTS: A total of 197 febrile episodes in cancer patients were reviewed. Thirty-seven per cent had febrile neutropaenia while 62% were non-neutropaenic. Acute myeloid leukaemia was the most common haematological malignancy and the most common solid tumour was breast cancer. Twenty-six per cent of patients had a positive blood culture. In febrile neutropaenic patients, Escherichia coli was the most common organism isolated followed by coagulase-negative staphylococci while in non-neutropaenic patients, coagulase-negative staphylococci was most common. Acinetobacter infections was prominent in non-neutropaenic patients but absent in neutropaenic patients. More than one organism was cultured in 9 neutropaenic and 18 non-neutropaenic patients. Mortality was 10.8% in neutropaenic and 24.4% in non-neutropaenic patients. CONCLUSION: Gram-negative organisms are the predominant isolates in febrile neutropaenic episodes in this cohort of patients. Non-neutropaenic patients had an increased mortality with an increase in Acinetobacter infections and multiple isolates.

ANTECEDENTES: La neutropenia febril es una complicación común de la quimioterapia en pacientes con cáncer. Los regimenes de antibióticos empíricos se basan en las características epidemiológicas de aislados bacterianos, tanto global como localmente. MÉTODO: Este estudio examinó retrospectivamente todos los casos de neutropenia febril con confirmación de cáncer, ingresados y tratados con quimioterapia en el Hospital Universitario de West Indies, Jamaica, en el período de cuatro años entre el 1ero, de enero de 2003 y el 31 de diciembre de 2006. Se identificaron casos con historias de cultivos de sangre e historias clínicas que fueron examinadas para determinar los agentes etiológicos causantes de la bacteriemia, sus susceptibilidades antimicrobianas y características clínicas. Estos casos fueron comparados con pacientes de cáncer no neutropénicos ingresados con fiebre. RESULTADOS: Se examinaron un total de 197 episodios febriles en pacientes de cáncer. El treinta y siete por ciento tuvo neutropenia febril, mientras que el 62% eran no neutropénicos. La leucemia mieloide aguda fue la malignidad hematológica más común, y el tumor sólido más común fue el cáncer de mamas. Veintiséis por ciento de .los pacientes tuvieron cultivos de sangre positivos. En los pacientes neutropénicos febriles, Escherichia coli fue el organismo aislado más común, seguido de los estafilococos coagulasa-negativos, mientras que en los pacientes no neutropénicos, los estafilococos coagulasa-negativos fueron los más comúnes. Las infecciones por Acinetobacter fueron prominentes en pacientes no neutropénicos pero ausentes en los pacientes neutropénicos. Más de un organismo fue cultivado en 9 pacientes neutropénicos y 18 en no neutropénicos. La mortalidad fue de 10.8% en los pacientes neutropénicos y 24.4% en los no neutropénicos. CONCLUSIÓN: Los organismos gram-negativos son los aislados que predominan en los episodios neutropénicos febriles en Jamaica. Los pacientes no neutropénicos vieron su mortalidad aumentada con el incremento en infecciones Acinetobacter y aislados múltiples.

Pancreatic ductal adenocarcinoma with intratumoral cystic lesions on MRI: correlation with histopathological findings.

The purpose of this study was to evaluate intratumoral cystic lesions of pancreatic ductal adenocarcinoma (PDAC) depicted on MRI, and to correlate these cystic lesions with their histopathological findings. This study included 12 patients (7 males and 5 females; mean age, 59 years) with intratumoral cystic lesions of PDAC detected on a retrospective MRI review. We reviewed the histopathological findings of the cystic lesions within PDACs and analysed the MRI findings, focusing on the appearance of the intratumoral cystic lesions, i.e. the size, number, margin and intratumoral location, and on the ancillary findings of PDAC, i.e. peripancreatic infiltration, upstream pancreatic duct dilatation and distal parenchymal atrophy. Intratumoral cystic lesions were classified as neoplastic mucin cysts (n = 7, 58%) or cystic necrosis (n = 5, 42%) according to the histopathological findings; they ranged in greatest dimension from 0.5 cm to 3.4 cm (mean, 1.7 cm). Seven patients had only one cystic lesion each, while the remaining five had multiple cystic lesions. Most of the neoplastic mucin cysts had smooth margins (n = 6, 86%) and eccentric locations (n = 6), whereas most cystic necroses had irregular margins (n = 4, 80%) and centric locations (n = 4). The most common ancillary findings of PDAC were peripancreatic infiltration, distal pancreatic atrophy and upstream pancreatic duct dilatation (92%, 75% and 58%, respectively). The intratumoral cystic lesions of PDACs on MRI were classified as either neoplastic mucin cysts with smooth margins and eccentric locations or cystic necroses with irregular margins and centric locations.

Development of an effective method for dendritic cell immunotherapy of mouse melanoma.

Dendritic cell (DC) immunotherapy is a strong candidate for the treatment of incurable cancers especially malignant melanoma. Nevertheless, the proper guideline of DC immunotherapy does not exist. The absence of the guideline is also an obstacle to clinical trials of DC immunotherapy. So we conducted this study in order to develop an effective DC preparation method for immunotherapy in mouse malignant melanoma. Mouse bone marrow-derived DC were stimulated with tumour antigen alone or tumour antigen plus a cocktail (anti-CD40 antibody +TNF-alpha+ IL-1beta) for 8, 24 or 48 h and the characteristics of these DC, such as surface molecules (CD40, CD80, CD86, MHC class II, CCR7), cytokines(IL-12, IFN-gamma, and IL-10), DC-induced T cell proliferation in vitro, and the production of IFN-gamma by those cells, were evaluated. Mice with melanoma were then treated with DC stimulated with tumour antigen alone and tumour antigen plus cocktail for 8 or 48 h. The tumour size and survival rate of these mice were then evaluated. (1) Beneficial clinical effects such as a reduction of tumour size and an increased survival rate were best observed in the group treated with DC stimulated for 8 h with tumour antigen plus cocktail. (2) The single prominent characteristic of DC stimulated for 8 h with tumour antigen plus cocktail was an elevated IL-12 secretion. The cytokine IL-12 was not secreted by other DC. Consequently, proper production of IL-12 was found to be an important requirement for DC used in immunotherapy of mouse melanoma.