Progressive keratoconus in patients older than 48 years.

PURPOSE: To report cases of progressive keratoconus (KC) in patients aged ≥48 years and the successful arrest of progression using corneal cross-linking (CXL) with riboflavin and ultraviolet-A light. OBSERVATIONS: Five eyes from four patients with progressive KC aged 48, 48, 51 and 54 years are reported in this case series. All eyes were followed regularly after initial diagnosis. Kmax was used as an indicator of progression and KC progressed at a rate of 1.4 diopters in 6 months and 14.6 diopters in 14 months. All patients eventually received CXL, and all were aged ≥50 years at the time of the procedure. One eye required two CXL procedures to successfully stabilize the patient's cornea. CONCLUSION: Despite the probability of KC progression strongly declining after the age of 40 years, it never becomes zero. It is therefore advisable to continue regular follow-up corneal tomography examinations in patients with KC, even in their fifth and sixth decades of life.

Giardial lipid rafts share virulence factors with secreted vesicles and participate in parasitic infection in mice.

Giardia lamblia, a protozoan parasite, is a major cause of waterborne infection, worldwide. While the trophozoite form of this parasite induces pathological symptoms in the gut, the cyst form transmits the infection. Since Giardia is a noninvasive parasite, the actual mechanism by which it causes disease remains elusive. We have previously reported that Giardia assembles cholesterol and GM1 glycosphingolipid-enriched lipid rafts (LRs) that participate in encystation and cyst production. To further delineate the role of LRs in pathogenesis, we isolated LRs from Giardia and subjected them to proteomic analysis. Various cellular proteins including potential virulence factors-e.g., giardins, variant surface proteins, arginine deaminases, elongation factors, ornithine carbomyltransferases, and high cysteine-rich membrane proteins-were found to be present in LRs. Since Giardia secretes virulence factors encapsulated in extracellular vesicles (EVs) that induce proinflammatory responses in hosts, EVs released by the parasite were isolated and subjected to nanoparticle tracking and proteomic analysis. Two types of EV-i.e., small vesicles (SVs; <100 nm, exosome-like particles) and large vesicles (LVs; 100-400 nm, microvesicle-like particles)-were identified and found to contain a diverse group of proteins including above potential virulence factors. Although pretreatment of the parasite with two giardial lipid raft (gLR) disruptors, nystatin (27 µM) and oseltamivir (20 µM), altered the expression profiles of virulence factors in LVs and SVs, the effects were more robust in the case of SVs. To examine the potential role of rafts and vesicles in pathogenicity, Giardia-infected mice were treated with oseltamivir (1.5 and 3.0 mg/kg), and the shedding of cysts were monitored. We observed that this drug significantly reduced the parasite load in mice. Taken together, our results suggest that virulence factors partitioning in gLRs, released into the extracellular milieu via SVs and LVs, participate in spread of giardiasis and could be targeted for future drug development.

HLA class I association with progression to end-stage renal disease in patients from Zulia, Venezuela

The aim of this study was to determine HLA associations with progression to end-stagerenal disease (ESRD) in the mixed Zulian population in Venezuela, regardless of other factors. A retrospective study to determine HLA Class I association was performed on188 patients with ESRD due to different types of glomerulonephritis, and 202 healthy controls. Patients and control groups were serologically typed by Terasaki microlymphocytotoxicity technique using commercial Class I plates including 26 HLA-A and 48 HLA-Bspecificities. The antigens positively associated to the ESRD were: HLA-B38, B51, B53 and B62.Negatively associated antigens were: HLA-A9, B12, B17, B40 and B48. The haplotypes positively associated were: HLA-A2-B51, A2-B53, A23-B38 and A68-B38. The negatively associated haplotypes were: HLA-A2-B12, A2-B48, A9-B35 and A28-B40. The high Odds ratio observed and its statistical corroboration reflect the strength of the described association between HLA antigens and ESRD. Further molecular studies should clarify types and subtypes of the HLA class I alleles involved in the progression to ESRD (AU)

El objetivo principal de este trabajo fue determinar las posibles asociaciones de los antígenos HLA con la progresión a enfermedad renal terminal (ESRD por las siglas en inglés), independientemente de otros factores, en la población Zuliana de Venezuela. Se trata de un estudio retrospectivo, analizando los resultados obtenidos de la tipificación de los antígenos HLA clase I (A y B) en 188 pacientes con enfermedad renal crónica en etapa terminal y con indicación de trasplante renal, en comparación con 202 controles sanos de la misma población. Los antígenos HLA fueron tipificados por la técnica de microlinfocitotoxicidad de Terasaki, utilizando placas comerciales para clase I incluyendo 26 especificidades HLAA y 48 HLA-B. Los antígenos HLA clase I asociados a ESRD fueron: HLA-B38, B51, B53,B62; y los asociados negativamente resultaron HLA-A9, B12, B17, B40, B48. Los haplotipos asociados positivamente fueron: HLA-A2-B51, A2-B53, A23-B38 y A68-B38. Los haplotipos asociados negativamente resultaron: HLA-A2-B12, A2-B48, A9-B35, A28-B40. Los altosriesgos relativos observados y su corroboración estadística reflejan la fortaleza de las asociaciones descritas. Estos resultados podrían orientar los estudios moleculares que permitirán determinar y confirmar de manera más específica cuáles son los alelos HLA clase I asociados con esta patología (AU)

Patrones diferenciales de distribución de los alelos y genotipos HLA-DPA1* en asociación con leucemias linfoides agudas y leucemias mieloides crónicas en pacientes del estado Zulia, Venezuela / Differential pattern of distribution of HLA-DPA1* alleles and genotypes

Poco se sabe aún de la relevancia del polimorfismo y la función del HLA-DP. La leucemia linfoide aguda (LLA) es el cáncer más frecuente en niños y adolescentes en la población zuliana de Venezuela. La leucemia mieloide crónica (LMC) afecta igualmente a niños, jóvenes y adultos. Varios estudios epidemiológicos revelan la presencia de ciertos factores asociados con la susceptibilidad. El locus HLA-DPA1*, alelos HLA-DPA1*01, *02, *03 y *04, se estudiaron utilizando los estuches PCR Olerup SSPTM (Genovision), en una población de 48 pacientes con LLA, 48 con LMC y 48 controles sanos provenientes del Banco de Sangre del Estado Zulia, Venezuela, mestizos no relacionados. El análisis estadístico de las frecuencias se determinó por recuento directo; la comparación de las frecuencias alélicas se realizó con la prueba de x2 corregida por Yates y los valores de p < 0,05 se consideraron estadísticamente significativos. Los riesgos relativos (RR) > 2,5 se consideraron asociaciones positivas y los < 1, negativas. Se obtuvieron asociaciones positivas entre DPA1*01:05 (RR = 3,65; p ≤ 0,05), DPA1*01:06 (RR = 13,88; p ≤ 0,05) y DPA1*01:07 (RR = 10; p ≤ 0,05) con la LLA. El DPA1*01:03:01-01:03:02 (RR = 0,46; p ≤ 0,05) y DPA1*02:01:01-02:01:06 (RR = 0,29; p ≤ 0,05) (..) (AU)

Little is known about the relevance of the polymorphisms in the function of HLA-DP. Acute lymphoblastic leukemia (ALL) is the most frequent cancer in children and adolescents in Zulia population. Chronic myeloid leukemia (CML) is similar in adolescents, young adults and mild adults. The epidemiologic studies suggest the presence of several factors related to the susceptibility. Forty-eight patients with ALL and 48 with CML, were compared with 48 controls from The Blood Bank of Zulia State, Venezuela, all of them unrelated racially mestizos. To evaluate the positive and negative associations between HLA allele and leukemias, the HLA-DPA1 locus and HLA-DPA1*01,*02,*03 and *04 alleles were studied using PCR Olerup (..) (AU)

Asociación HLA clase I y leucemia en pacientes mestizos del estado Zulia, Venezuela

Resumen. La asociación entre los Alelos Leucocitarios Humanos (HLA) clase I (A, B, C) y las Leucemias Linfoides Agudas y Mieloides, se determinó mediante la técnica de Reacción en cadena de la polimerasa con iniciadores de secuencia específica (PCR-SSP) en un grupo de 60 pacientes y 30 controles sanos. Los valores obtenidos se expresaron como frecuencias alélicas y haplotipicas. Se utilizaron como métodos estadísticos la prueba de Chi-cuadrado corregida, test de Fisher, riesgo relativo y la fracción etiológica. Se observó una asociación positiva significativa de los alelos HLA-B*39 (RR = 16,184, p = 0,0237) y HLA C*03 (RR =5,0; p = 0,0127) con las Leucemias Mieloides (aguda y crónica). Así mismo se encontraron asociaciones positivas de los haplotipos de 2 loci: HLA-A*02-C*03 (RR = 6,0; p = 0,0153), A*24-C*03 (RR = 16,184; p = 0,0237), B*40-C*03 (RR = 10,706; p = 0,0021) y un haplotipo de 3 loci: HLA-A*02-B*40-C*03 (RR = 8,11; p = 0,0102) con las Leucemias Mieloides. No se evidenció ningún tipo de asociación con la Leucemia Linfoide Aguda. No se observaron asociaciones negativas con ningún tipo de Leucemia.

Abstract. The Human Leukocyte Allele (HLA) Class I (A, B, C) and Acute Lymphoid Leukemia and Myeloid Leukemia association, was determined by polymerase chain reaction - sequence specific primers (PCR-SSP) in 60 patients and 30 healthy controls. The results were reported as allelic frequencies and haplotype. The Chi-square corrected, Fisher’s Test, Relative risk and etiologic fraction were calculated. A significant positive association was showed between HLA-B*39 (RR = 16.184; p = 0.0237) and HLA C*03 (RR =5.0; p = 0.0127) alleles and Myeloid Leukaemia. Positive associations between haplotypes 2 loci: HLA-A*02-C*03 (RR = 6.0; p = 0.0153), A*24-C*03 (RR = 16.184; p = 0.0237), B*40-C*03 (RR = 10.706; p = 0.0021) and haplotype 3 loci: HLA-A*02-B*40-C*03 (RR = 8.11; p = 0.0102) and Myeloid Leukemia were found. No association was evident in Acute Lymphoid Leukemia. No negative association with Leukemias were observed.

[Association of HLA class I and leukemia in mestizo patients of the state of Zulia, Venezuela]. / Asociación HLA clase I y leucemia en pacientes mestizos del estado Zulia, Venezuela.

The Human Leukocyte Allele (HLA) Class I (A, B, C) and Acute Lymphoid Leukemia and Myeloid Leukemia association, was determined by polymerase chain reaction--sequence specific primers (PCR-SSP) in 60 patients and 30 healthy controls. The results were reported as allelic frequencies and haplotype. The Chi-square corrected, Fisher's Test, Relative risk and etiologic fraction were calculated. A significant positive association was showed between HLA-B*39 (RR = 16.184; p = 0.0237) and HLA C*03 (RR = 5.0; p = 0.0127) alleles and Mycloid Leukaemia. Positive associations between haplotypes 2 loci: HLA-A*02-C*03 (RR = 6.0; p = 0.0153), A*24-C*03 (RR = 16.184; p = 0.0237), B*40-C*03 (RR = 10.706; p = 0.0021) and haplotype 3 loci: HLA-A*02-B*40-C*03 (RR = 8.11; p = 0.0102) and Myeloid Leukemia were found. No association was evident in Acute Lymphoid Leukemia. No negative association with Leukemias were observed.

[Immune response and anergy. Study in tuberculosis patients from the Universitary Hospital, Maracaibo, Venezuela ]. / Respuesta inmunitaria y anergia. Estudio en pacientes tuberculosos del hospital universitario de Maracaibo, Venezuela.

With the aim of evaluate the anergy in Mycobacterium tuberculosis individuals infected we study 57 patients and 15 healthy controls, both sex and with different age, which to practice Sputum Bacteriology culture (BK) and the la reaction intradermic with PDD. The test of tuberculine on skin was achieve inoculate 0.1 ml de PPD intradérmic vía, the results were obtained at 72 h. 28 patient total result BK+ and 29 BK-. The Group BK+, 15 result PPD+ and 13 PPD-, the lastet were classify as anergic patients (BK+ PPD-). From the 29 patient residual (BK-), 20 was PPD+ and 9 PPD-. All the controls resulted BK- PPD-. Only the anergy in patient BK was evaluated + (28 individuals) patient. Was classified from the point of clinical view in three series: N series: 27 patient TBC+ BK-, P Series: 28 patient TBC+ BK+ and EP Series: 2 patient with extra pulmonary TBC. According to the grade of pulmonary complication, the patient separated in two groups, according to the extension and type of lesion found in the evaluation with X. rays The "group 1" with 9 patient (32.14%) it introduced lesions on one side with or without caverns and the "group 2" with 19 patient (67.85%) with bilateral lesions with or without caverns. Was carried out the Lymphoblastic Transformation Test (TTL) stimulating with PHA and PPD, for which patterns of outlying blood with heparina were gathered. The concentrations of IL-4, IL-6 and INF-gamma was gotten inmunoenzimatic in supernatants of cultivations for rehearsals and in plasm, hind to the stimulation with the PPD. The statistical analysis was carried out utilizing the Test T of Student in pair, Varianza Analysis and the square Chi. Only the controls and the patient BK-, they showed normal response to the PHA, in contrast, the patient BK+ PPD+ they introduced a suppression of the response opposite the PHA of aprox. 90%. The patient PPD+ they showed a superior response in cultivation that the patient PPD-. The concentration of IL-4 in the plasm of the anergic patient (PPD-) showed a significant difference (P < 0.05) with concerning the PPD group+. The concentration of INF-gamma was lower in the anergic patient significantly different to the of the patient PPD+. Similar result was gotten in the mensuration of IL-4 and INF-gamma in supernatants of cultivation. One could observe the presence of patient with IL-4+ INF-gamma, and INF-gamma or IL-4 only. In the patient classified clinical like series "P", the concentration of IL-4 was old in the "group 2" with concerning the "group 1." the opposite occurred with the concentrations of the INF-gamma which were old in the "group 1" (both differences were not significant statistical). The increase of IL-4 next to low concentrations of INF-gamma in anergic patient and committed clinical, it suggest a prevalence of the pattern Th2 (T2) in the immune response.

Ileostomía / Ileostomy

Presentamos nuestra experiencia en ileostomías (38 casos). Se mencionan las indicaciones, complicaciones y evolución seguidas. Se hace hincapie en algunos detalles de técnica. Somos partidarios de la ileostomía evertida a la manera de Brooke, lo que asociado a la atención brindada por un Equipo Profesional Multidisciplinario, permite un mejor manejo del paciente y su rápido reintegro a su vida normal