Relationships between Serum Levels of Atazanavir and Renal Toxicity or Lithiasis.

The main aim of this study is to describe the relationship between serum levels of atazanavir, renal toxicity, and lithiasis. This is a prospective observational study of patients being treated with atazanavir (ATV) at Son Espases Teaching Hospital, Palma de Mallorca, between 2011 and 2013. The study includes 98 patients. Sixteen were found to have a history of urolithiasis. During a median monitoring period of 23 months, nine patients suffered renal colic, in three of whom ATV crystals were evidenced in urine. Cumulative incidence of renal colic was 9.2 per 100 patients. The variables related to having renal colic were the presence of alkaline urine pH and lower basal creatinine clearance. The mean serum level of ATV was slightly higher in patients with renal colic-1,303 µg/L versus 1,161 µg/L-but did not reach statistical significance. Neither were any significant differences detected by analysing the levels according to the timetable for ATV dosage. Cumulative incidence of renal colic was high in patients being treated with ATV, in 33% of whom the presence of ATV crystals was evidenced in urine. We were unable to demonstrate a relationship between ATV serum levels and renal colic or progression towards renal failure.

Infectious spondylitis in the Balearic Islands: An analysis of 51 cases. / Espondilitis infecciosa en Baleares: análisis de 51 casos.

INTRODUCTION: Vertebral osteomyelitis (VO) is a rare entity, although its incidence has increased in recent years. The objective is to describe the patients with this infection in our environment and a comparison with other published series. METHODS: A retrospective review was conducted of epidemiological, clinical, microbiological, treatment, complications and evolution data of patients with VO during 10 years (2004-2014) in two hospitals of Mallorca. RESULTS: 51 cases, median age 66 (range 22-85) years, 37 (72.5%) men with a mean onset of symptoms of 80.1 ± 125.1 days. In thirty-six (70.6%) cases the origin of infection was considered hematogenous, although previous bacteremia was documented in 23 (45%) cases, being of urinary in 10 (43.5%) cases. Clinically at the moment of diagnosis 35 (68.8%) had fever, 32 (62.7%) pain, 14 (27.5%) irradiated nerve pain and 10 (19.6%) paralysis/paresia. MRI was the most performed radiological test 46 (90.2%), being pathological in all cases. S. aureus 23 (52.3%) was the most common microbiological isolates. At the moment of the diagnosis, blood cultures were positive in 27 (65.8%) of 41 cases and 11 (50%) of 22 percutaneous puncture was positive. Paraspinal, epidural or psoas abscesses were observed in 23 (45.1%), neurological deficit in 7 (13.7%) and chronic pain in 6 (11.8%). One patient (1.9%) died in relation with infection. CONCLUSIONS: Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae.

Morphogenic designer--an efficient tool to digitally design tooth forms.

BACKGROUND AND PURPOSE: Different digital software tools are available today for the purpose of designing anatomically correct anterior and posterior restorations. The current concepts present weaknesses, which can be potentially addressed by more advanced modeling tools, such as the ones already available in professional CAD (Computer Aided Design) graphical software. AIM: This study describes the morphogenic designer (MGD) as an efficient and easy method for digitally designing tooth forms for the anterior and posterior dentition. MATERIALS AND METHOD: Anterior and posterior tooth forms were selected from a collection of digitalized natural teeth and subjectively assessed as "average". The models in the form of STL files were filtered, cleaned, idealized, and re-meshed to match the specifications of the software used. The shapes were then imported as wavefront ".obj" model into Modo 701, software built for modeling, texturing, visualization, and animation. RESULTS: In order to create a parametric design system, intentional interactive deformations were performed on the average tooth shapes and then further defined as morph targets. By combining various such parameters, several tooth shapes were formed virtually and their images presented. CONCLUSION: MGD proved to be a versatile and powerful tool for the purpose of esthetic and functional digital crown designs.

Comparación entre la inmunofluorescencia directa y cultivo sell vial en el diagnóstico de las infecciones cutáneas causadas por los herpesvirus 1 y 2 y el virus varicela-zoster en la población pediátrica / Comparison between direct immunofluorescene and Shell-vial culture in the diagnosis of skin infections caused by herpes virus 1 and 2 and varicela-zoster virus in the pediatric population

Introducción. Los herpesvirus son una causa frecuente y tratable de infecciones mucocutáneas en la población pediátrica; su rápido diagnóstico puede ser importante para el manejo de cierto tipo de pacientes. Objetivos. Evaluar de forma prospectiva la eficacia de la inmunofluorescenica directa (IFD) frente al cultivo celular Shell vial en la detección de los herpesviurs tipo 1 y 2 y el virus varicela zoster en lesiones mucocutáneas pediátricas. Material y métodos. Las diferentes muestras fueron remitidas al laboratorio en un medio de transporte líquido para virus. Para la IFD se tomaron 200µ de la muestra y fueron citocentrigugados en 3 portas a 700 rpm durante 10 min. Después de su secado fueron fijados con acetona a 20ºC durante 10 min y luego teñidos con anticuerpos monoclonales específicos frente al VHS-1, VHS-2 y VVZ, siguiendo las recomendaciones del fabricante. Las muestras fueron consideradas adecuadas para la IFD si presentaban un mínimo de 20 células por porta. Las muestras fueron además inoculadas en Shell vials de las líneas celulares Vero y MRC-5 para el aislamiento viral. Los viales fueron incubados a 36º C y luego teñidos con los mismos anticuerpos monoclonales utilizados en la IFD. Resultados. A lo largo del estudio se analizaron 234 muestras cutáneas; 186 (79,4%) fueron consideradas como adecuadas. De ellas la IFD fue positiva en 69 (37,1%) muestras y el cultivo Shell vial en 57 (30,6%) muestras. La IFD detectó el VHS-1 en 41 muestras (59,4%) y el VVZ en 28 muestras (40,6%). El cultivo Shell vial fue positivo para el VHS-1 en 38 muestras (66,6%), para el VHS-2 en 1 muestra (1,7%) y para el VVZ en 18 muestras (31,5%). Utilizando la IFD como método de referencia el cultivo Shell vial presentó una sensibilidad global del 92,6% para el VHS-1 y del 64,2% para el VVZ. El tiempo de respuesta medio para el aislamiento del VHS-1 fue de 1,7 días y de 4.5 días para el VVZ. El tiempo de respuesta de la IFD para ambos virus fue de 2,7 horas. Conclusiones. La IFD es una técnica sensible, rápida y sencilla que ha mostrado ser una buena alternativa al cultivo Shell vial en la detección de las infecciones mucocutáneas causadas por los herpesvirus en la población pediátrica (AU)

Introduction. The herpetic infections are common and treatable causes of mucocutaneous infections in children and the rapid diagnosis is important for patient management. Objectives. To prospectively evaluate the efficacy of a direct immunofluorescence assay (DFA) versus the shell-vial culture in the detection of herpesvirus 1 and 2 (HSV-1 and HSV-2) and varizellazoster virus (VZV) in pediatric skin infections. Material and Methods. The different skin samples were send to the virology laboratory in a virus liquid transport medium. For performance of the DFA, 200µ per slide, were cytocentrifuged on 3 slides at 700 rpm for 10 min. After air drying the slides were fixed with acetone at -20ºC for 10 min, and then stained with fluorescein-labeled mouse monoclonal antibodies to HSV-1 and HSV-2 and to VZV following manufacturer´s instructions. The sample was considered adequate for the DFA if the total number of epithelial cells present was >25 per slide. The samples were inoculated into shell-vials of the Vero and MRC-5 cell lines. The vial were incubated at 36º and stained with the same monoclonal antibodies used in the DFA. Results. In the study period we analyzed 234 skin samples. 186 (79,4%) were considered adequate. Of them the DFA was positive in 69 (37,1%) samples and the shell-vial culture in 57 (30,6%) samples. The DFA detected the HSV-1 in 41 (59,4%) samples, and the VZV in 28 (40,6%). The shell-vial culture was positive for HSV-1 in 38 (66,6%) samples, for HSV-2 in 1 (1.7%), and for VZV in 18 (31.5%). Using the DFA as a reference method, the shell-vial culture has an overall sensitivity of 92,6% for the HSV-1 and 64,2% for VZV. The turnaround time for the herpesvirus isolation in the shell-vial culture was 1.7 days for HSV-1, and 4.5 days for VZV. The turnaround time for the DFA was 2.7 hours. Conclusion. The DFA is a sensitive, rapid and easy alternative to the shell-vial culture in the detection of herpesvirus in pediatric skin samples (AU)

Análisis epidemiológico de los casos de gripe A (H1N1) pandémica en la población pediátrica en las Islas Baleares / Epidemiological analyses of swine flu cases (H1N1) pandemic in the pediatric population in the Balearic Islands

Introducción. En abril de 2009 se comunicaron los primeros casos de gripe causados por una nueva cepa grupal tipo A (H1N1) de origen porcino. Este virus se propagó rápidamente por el mundo dando lugar a la primera pandemia del siglo XXI. Objetivo. Estudiar las características epidemiológicas de los pacientes pediátricos (<15 años) con infección por la nueva cepa gripal pandémica en las Islas Baleares. Material y pacientes. A todos los pacientes con sospecha de infección gripal se les tomó un frotis faríngeo. El diagnóstico específico se realizó mediante una RT-PCR en tiempo real. Se analizaron los datos epidemiológicos de los casos positivos. Resultados. De los 940 casos diagnosticados de gripe A pandémica, 426 (45,4%) pertenecían a la población pediátrica. Se detectaron dos ondas epidémicas, la de verano (julio-septiembre) con 98 casos pediátricos (20%) y la invernal (octubre-diciembre) con 204 casos (45,3%). Globalmente, el grupo de edad con más casos diagnosticados fue el de 0-5 años (19,3%). Se han observado importantes variaciones a lo largo de la pandemia, siendo septiembre (54,6%) y octubre (60,2%) los meses con más casos pediátricos. También se han observado variaciones en los grupos de edad afectados. El grupo de 0-5 años presentó porcentajes de positividad del 10,4% (julio) al 25,3% (diciembre). Conclusiones. En las Islas Baleares, la pandemia de gripe A (H1N1) ha afectado preferentemente a la población pediátrica en la segunda onda epidémica (octubre-noviembre), con predominio en el grupo de edad comprendido entre los 0 y 5 años (AU)

Introduction. In April 2009 influenza caused by the novel influenza A (H1N1) strain of swine origin was reported in Mexico and USA. The virus rapidly disseminated around the world to cause the first pandemic of the 21st century. Aims. To study the epidemiological characteristics of pediatric patients (<15 years) with infection by the new influenza pandemic strain in the Balearic Islands. Materials and patients. A pharyngeal swab was taken to all patients with clinical symptomatology of flu. For the specific diagnosis we used a RT-PCR real-time. We analyze the epidemiological characteristics of positive patients. Results. We detected 940 patients with pandemic influenza A, 426 (45,4%) were children. We observed two epidemic waves, the summer one (jly-september) with 98 pediatric patients (20%) and the winter one (october-december) with 204 patients (45,3%). Overall the age group with more flu patients was the 0-5 years old(19,3%). We detected important variations across the pandemic period, with September (54,6%) and October (60,2%) as the months with actions in the age group more affected by the pandemic flu. The age group of 0-5 years old presented percentages of positivity between 10.4% (july) and 25.3% (December). Conclusions. In the Balearic Island the influenza A (H!N1) pandemic affected preferently to the pediatric patients in the second epidemic wave (October-December) with higher incidence in the 0-5 years age group (AU)

La gripe como principal causa de infecciones respiratorias agudas en la época invernal en la población pediátrica / Flu as the principal cause of acute respiratory infections in Winter in the pediatric population

Se presenta un estudio prospectivo sobre la evolución de las infecciones respiratorias agudas causadas por el VRS y los virus gripales. En las dos últimas temporadas invernales (2007-2008 y 2008-2009) se ha observado por primera vez un porcentaje superior (8,1% y 10,1%) de casos causados por los virus gripales. La gripe parece ser ya la principal causa de infecciones respiratorias agudas en la población infantil en la época invernal (AU)

We present a prospective study about the evolution of acute respiratory tract infections caused by VRS and influenza viruses. In the last two winter season (2007-2008 and 2008-2009) we detected for the first time a higher percent-age (8.1% and 10.1%) of patients with influenza viruses infections. The influenza could be now the first etiological cause of acute respiratory tract infections in the winter season in the paediatric population (AU)

Influencia de la pandemia de gripe A (H1N1) en la epidemia de infección respiratoria causada por el virus respiratorio sincitial en la población pediátrica / Influence of pandemic influenza A (H1N) in the epidemiology of respiratory syncytial virus infections in the pediatric population

Para conocer el posible impacto o influencia de la pandemia gripal sobre la epidemia estacional de VRS que se produce todas las temporadas invernales, se han analizado de forma comparativa la presentación, evolución y número de casos de infección por este virus entre la temporada 2008-2009 y la 2009-2010. Hemos observado cómo en la temporada actual se ha producido un retraso de 3 semanas en el inicio de la epidemia de VRS, sin embargo el número de casos diagnosticados sea incrementado en un 30% (AU)

We report a comparative study about the impact or influence of the pandemic influenza A (h1N1) in the season al presentation, evolution and total number of cases of pediatric RSV respiratory infections between the seasons 2008-2009 and 2009-2010. We observed for the actual RSV epidemiological season a retard of 3 weeks in the begins of the epidemic, but the total number of RSV infections had increased a 30% (AU)

Hypothalamic serotonin in the control of meal patterns and macronutrient selection.

Serotonin (5-HT) is believed to have an inhibitory influence over feeding behavior. The present experiments were designed to investigate the effects of hypothalamic 5-HT on spontaneously motivated feeding and appetite regulation. Freely-feeding rats were injected with 5-HT or norfenfluramine (NORFENF) directly into the paraventricular hypothalamus (PVN), and precise changes in feeding behavior were monitored by a computer. Following PVN 5-HT or NORFENF injection, animals exhibited a marked suppression in food intake, associated with a decrease in meal size, duration and eating rate, and no change in the frequency of meals consumed. This suggests that brain 5-HT may influence primarily the induction of satiety rather than the suppression of hunger. The effect of drugs presumed to affect brain 5-HT transmission on diet selection was also investigated in groups of rats injected centrally with 5-HT or NORFENF or peripherally with either fenfluramine, quipazine or cyproheptadine. In a series of 2-diet tests, rats centrally injected with 5-HT or NORFENF exhibited a selective suppression of the carbohydrate-rich diets. In animals provided with three pure macronutrient diets, protein, carbohydrate, and fat, systemic administration of serotonergic agents had its greatest impact on fat and carbohydrate ingestion, as compared to protein consumption. These findings support a role for hypothalamic 5-HT in modulating meal patterns and appetite for particular macronutrients.

Role of hypothalamic norepinephrine in control of meal patterns.

Feeding behavior has been shown to be strongly affected by central administration of catecholamines. In this study, we examined in freely-feeding rats the effect of hypothalamic norepinephrine (NE) injections on the basic parameters of spontaneous ingestion. Precise changes in feeding behavior in rats maintained on ad lib food and water intake were monitored by a PDP 8 computer connected to an apparatus capable of measuring licks and bites of food. Injections of NE were administered into the hypothalamic paraventricular nucleus, the most sensitive brain area for the elicitation of feeding through direct alpha-noradrenergic stimulation. In tests conducted under both light and dark conditions, NE facilitated food intake, primarily by an increase in meal size rather than meal frequency. The first meal after injection was increased in size and duration; the rate of eating was also enhanced. Whereas the following intermeal interval was significantly larger, subsequent meals and intermeal intervals appeared generally unaffected. This evidence is consistent with the proposal of a role for hypothalamic NE in the maintenance, rather than initiation, of feeding behavior in freely-feeding rats.

Chronic infusion of norepinephrine and clonidine into the hypothalamic paraventricular nucleus.

Previous experiments have shown that acute injection of NE and CLON into the PVN initiates a short-term feeding response in satiated rats. This study examined, in brain-cannulated rats, the impact of remote, chronic injections of NE, CLON, or saline on daily food intake and body weight gain. Over a period of 14 days, NE was infused into the PVN, either continuously at a rate of 12 nm/microliter/hr, or discretely at a rate of 6 nm/microliter/sec. In addition, the alpha 2-adrenergic agonist CLON was infused into the PVN discretely at a rate of 3 nm/0.5 microliter/30 sec. Relative to saline infusion, chronic (continuous or discrete) stimulation of the PVN with either of these drugs was effective in potentiating daily food intake by 12-19% and in increasing body weight gain, from approximately 1.5 g/day to 3.3 g/day. This evidence indicates that medial hypothalamic NE, especially within the PVN, is sufficiently robust to alter long-term feeding patterns and body weight regulation.