Malignant Transformation of Hymenolepis nana in a Human Host.

Neoplasms occur naturally in invertebrates but are not known to develop in tapeworms. We observed nests of monomorphic, undifferentiated cells in samples from lymph-node and lung biopsies in a man infected with the human immunodeficiency virus (HIV). The morphologic features and invasive behavior of the cells were characteristic of cancer, but their small size suggested a nonhuman origin. A polymerase-chain-reaction (PCR) assay targeting eukaryotes identified Hymenolepis nana DNA. Although the cells were unrecognizable as tapeworm tissue, immunohistochemical staining and probe hybridization labeled the cells in situ. Comparative deep sequencing identified H. nana structural genomic variants that are compatible with mutations described in cancer. Invasion of human tissue by abnormal, proliferating, genetically altered tapeworm cells is a novel disease mechanism that links infection and cancer.

Long-term/bioinert labeling of rat mesenchymal stem cells with PVA-Gd conjugates and MRI monitoring of the labeled cell survival after intramuscular transplantation.

Noninvasive in vivo imaging of transplanted stem cells is an effective method to clarify the mechanisms involved in stem cell transplantation therapy. We labeled rat mesenchymal stem cells (MSCs) with water-soluble magnetic resonance imaging (MRI) contrast agent poly(vinyl alcohol)-gadolinium (PVA-Gd) in order to ascertain the fate of transplanted MSCs in vivo. PVA-Gd was retained and localized in the cytosolic compartment of MSCs for a longer period of time. The effect of PVA-Gd labeling on MSC proliferation was much less than that of the commercially available contrast agent ProHance, and the labeled MSCs were found to have osteoblastic differentiation ability. To study the MSC lifetime in vivo, MSCs were seeded and trapped in the cytocompatible three-dimensional porous scaffolds of Spongel and transplanted. The MRI signal attributed to MSCs was eliminated from the transplanted site in 14 days. Because free PVA-Gd was rapidly eliminated from the site, this signal reduction indicated MSC death in the transplantation site. The low efficiency of MSC transplantation for ischemic tissue may be due to their short lifetime, making it important to develop highly effective stem cell transplantation systems that address cell number, injection position, and cell formulation (suspension, sheet, and aggregates). Our cell survival tracking system would be a very powerful tool to this end and would be applicable in clinical cell therapies.

HIV/AIDS infection in critical care: epidemiological profile and risk factors for mortality in a Colombian cohort.

INTRODUCTION: Outcomes of human immunodeficiency virus (HIV) infected patients admitted to intensive care units (ICU) have improved with antiretroviral therapy (ART). However, whether the outcomes have improved in low- and middle-income countries, paralleling those of high-income countries is unknown. The objective of this study was to describe a cohort of HIV-infected patients admitted to ICU in a middle-income country and identify the risk factors associated with mortality. METHODOLOGY: A cohort study of HIV-infected patients admitted to five ICUs in Medellín, Colombia, between 2009 and 2014 was done. The association of demographic, clinical and laboratory variables with mortality was analyzed using a Poisson regression model with random effects. RESULTS: During this time period, 472 admissions of 453 HIV-infected patients were included. Indications for ICU admission were: respiratory failure (57%), sepsis/septic shock (30%) and central nervous system (CNS) compromise (27%). Opportunistic infections (OI) explained 80% of ICU admissions. Mortality rate was 49%. Factors associated with mortality included hematological malignancies, CNS compromise, respiratory failure, and APACHE II score ≥ 20. CONCLUSIONS: Despite advances in HIV care in the ART era, half of HIV-infected patients admitted to the ICU died. This elevated mortality was associated to underlying disease severity (respiratory failure and APACHE II score ≥ 20), and host conditions (hematological malignancies, admission for CNS compromise). Despite the high prevalence of OIs in this cohort, mortality was not directly associated to OIs.

[Perception of epidemiological competencies by public health students in Mexico and Colombia during the influenza A (H1N1) epidemic]. / Percepción de competencias en epidemiología en México y Colombia durante la epidemia de influenza A (H1N1) entre estudiantes de salud pública.

OBJECTIVE: Learn about the perception of public health students in Mexico and Colombia regarding the management of the influenza A (H1N1) epidemic to determine which curriculum contents in epidemiological education can be improved. METHODS: Survey administered to graduate students during the epidemic, from June to August 2009. The 30 epidemiological competencies for "intermediate epidemiologists" of the Council of State and Territorial Epidemiologists were evaluated. The results were described through stratification by covariables, and the less developed competencies were identified through exploratory factor analysis. RESULTS: A total of 154 students participated, 55.8% of whom were in Mexico. Significant differences in the student profile from each country were observed, which partially explains the perception of response to the epidemic. The first factor, which explains 21.5% of the variance, had lower scores in the factor analysis. This factor was associated with competencies related to the links between health personnel and the community, in which knowledge of the social sciences and communication skills are relevant. CONCLUSIONS: The students perceived that the response to the epidemic could have been better. It is suggested that public health human resources education include subjects related to the impact of culture on behavior and thinking, recognition of the prejudices of experts, effective community-level communication, and the ability to adapt to new situations. The "natural experiment" of the epidemic facilitated the identification of areas of opportunity to improve the teaching of epidemiology to health personnel.

Genetic Diversity of Multidrug-Resistant Pseudomonas aeruginosa Isolates Carrying bla VIM-2 and bla KPC-2 Genes That Spread on Different Genetic Environment in Colombia.

Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen with an increase in the frequency of infections caused by multidrug resistant (MDR) and extensively drug resistant (XDR) strains, limiting the available therapeutic options. The most troublesome resistance is the acquisition and production of carbapenemases such as Verona integron-encoded metallo-ß-lactamases (VIM), the most frequent and widespread, and the Klebsiella pneumoniae carbapenemases (KPC), which has continuously spread in the last decade. Its dissemination is linked to their location on mobile genetic elements (MGEs). In Colombia, VIM and KPC have been increasing in its frequency showing major successful dissemination. In this article, we molecularly characterized and analyzed the genetic context of bla VIM and bla KPC in carbapenem-resistant P. aeruginosa (CRPA) isolates from infected and colonized patients in two tertiary-care hospitals, one in Medellín and the other in a municipality close to Medellín, both areas with high carbapenemase endemicity in Colombia (2013-2015). Using whole-genome sequencing (WGS), we identified a remarkable variety of genetic backgrounds in these MDR P. aeruginosa isolates carrying bla KPC- 2 and bla VIM- 2. There were a diversity of class 1 integron and variations in the gene cassettes associated to bla VIM- 2, as well as a possible event of spread of bla KPC- 2 mediated by a plasmid that contained part of Tn4401b in one infection case. The dissemination of bla VIM- 2 and bla KPC- 2 in P. aeruginosa in this area in Colombia has been strongly influenced by successful international clones, carrying these genes and additional determinants of resistance on MGEs, accompanied by gene rearrangement under an antimicrobial selection pressure. These findings emphasize the need to implement control strategies based on rational antibiotic use.

The development of alternative vitrification solutions for microencapsulated islets.

Bioartificial pancreas in which islets of Langerhans (islets) are enclosed in a semipermeable membrane is one of the approaches to treat insulin-dependent diabetic patients. Although there are advantages in this method, one of the issues that still remains is the long-term storage of tissue engineering devices before transplantation. One of the possible routes to address this is through cryopreservation. In this study, a freezing solution, 2 m DMSO in RPMI-1640, a conventional vitrification solution, VS55, and the newly developed vitrification solution KYO-1 were examined to cryopreserve microencapsulated islets in agarose hydrogel. The insulin release ability, morphology of islets, and physico-chemical properties of the agarose gel membrane were examined after a cryopreservation and thawing process. Frozen and vitrified (by KYO-1) groups showed a similar insulin secretion. Frozen groups by 2 m DMSO, however, showed destruction of agarose capsules and some islets were out of the capsule. When KYO-1 was used, islets still maintained the ability to release insulin in response to glucose stimulation, and agarose capsule showed morphological integrity, and mechanical properties. In conclusion, vitrification using KYO-1 which is composed of 5.38 m ethylene glycol, 2 m DMSO, 0.1 m PEG 1000 and 0.00175 m PVP K10 in EuroCollins, is a suitable method for cryopreservation of microencapsulated islets.

[Health in Andean regional integration]. / Integración regional andina en salud.

Despite their shared history, the Andean countries are socially and politically diverse, with heterogeneous health realities and complex integration processes. General developments such as the Latin American Free Trade Association and Latin American Integration Association have existed for decades, along with others of a regional scope, like the Andean Community of Nations, Caribbean Community, and Central American Common Market. The health field has a specific instrument in the Andean Region called the Hipólito Unánue Agreement, created in 1971. Integration processes have concentrated on economic aspects, based on preferential customs agreements that have led to an important long-term increase in trade. Less progress has been made in the field of health in terms of sharing national experiences, knowledge, and capabilities. Analysis of experiences in health has shown that integration depends on the countries' respective strengths and to a major extent on national political processes.

[Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient]. / Linfadenitis cervical por Salmonella no Typhi en una paciente diabética.

No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.

Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals.

We studied 52 patients with disseminated histoplasmosis, 30 with the acquired immunodeficiency syndrome (AIDS) (cohort 1) and 22 not co-infected with the human immunodeficiency virus (cohort 2). Demographic, clinical, laboratory, mycologic findings, as well as antifungal therapy and highly active antiretroviral (HAART), were analyzed. Skin lesions were significantly higher in cohort 1 than in cohort 2 (P = 0.001). Anemia, leukopenia, and an elevated erythrocyte sedimentation rate were also more pronounced in cohort 1 than in cohort 2 (P < 0.001). Histoplasma capsulatum was isolated more often in cohort 1 than in cohort 2 (P < 0.05) patients, but antibodies to H. capsulatum were detected more frequently in cohort 2 than in cohort 1 (P < 0.05). Itraconazole treatment was less effective in cohort 1 than in cohort 2 (P = 0.012). In cohort 1 patients, HAART improved response to antifungals when compared with individuals not given HAART (P = 0.003), who exhibited higher mortality rates (P = 0.025). Cohort 1 patients who were given dual antifungal and anti-retroviral therapies responded as well as the non-HIV patients in cohort 2, who were treated only with itraconazole. These results indicate the need to promote restoration of the immune system in patients with AIDS and histoplasmosis.

[Perceptions, practice and attitudes concerning malaria in the Colombian Amazon region]. / Percepciones, actitudes y prácticas en malaria en el Amazonas Colombiano.

OBJECTIVE: Obtaining information about the perceptions, attitudes and practices which people living in the Colombian Amazon region hold about the aetiology of malaria, its diagnosis, prophylaxis, therapy, prevention and their perception concerning the risk of contracting malaria. METHODS: A qualitative study was carried out; focal groups were used as the research technique. A total of 23 were held, each one involving 6 to 10 people classified according to some inclusion variables which were pertinent for the study. RESULTS: The study revealed that the people having the best knowledge of preventative and control measures were those having a high risk of acquiring malaria; however, they did not put them into practice. There are difficulties in gaining access to diagnosis and treatment of malaria and problems of self-medication in high risk populations. CONCLUSIONS: The behavioural factors of those populations exposed to malaria could facilitate and/or hamper control interventions in Colombia's Amazonas Department.

Development of an observation method for assessing pain behavior in rheumatoid arthritis patients.

Four studies examined the reliability and validity of a behavioral observation method for the assessment of pain associated with rheumatoid arthritis (RA). The major purpose of experiment 1 was to evaluate the interobserver reliability of the observation method. Two observers recorded the frequencies of pain behaviors displayed by 20 RA patients. Each of 3 types of reliability estimates indicated that the pain behavior could be reliably observed. The purpose of experiment 2 was to examine the concurrent validity of the observation system by correlating 53 patients' self-reports of pain with the frequencies of their pain behaviors. Significant and positive correlations were found between patients' total pain behavior and 3 self-report measures of pain and functional disability. Furthermore, unlike the self-reports of pain, total pain behavior was only minimally related to self-report of depression. Experiment 3 was performed in order to assess the observation method's construct validity. Naive observers viewed video recordings of 25 RA patients and made global estimates of patients' pain severity and unpleasantness. Highly significant and positive correlations were found between these global estimates and total pain behavior. In experiment 4, the pain behaviors of 11 RA patients were recorded prior to and immediately following cognitive-behavioral treatment for the reduction of RA pain. There was a significant decrease in total pain behavior from pretreatment to posttreatment. The data indicate that the observation method provides a reliable, valid, and relatively objective measure of RA patient pain behavior. Future validation studies of the observation method are discussed.

Prediction of pain behavior and functional status of rheumatoid arthritis patients using medical status and psychological variables.

This study examined the extent to which the psychological variables of depression, anxiety, and helplessness predicted the pain behavior and functional status of 64 rheumatoid arthritis (RA) patients beyond what could be predicted on the basis of demographic and medical status variables. Pain behavior was evaluated using a standardized observation method, and functional status was assessed using a modified Health Assessment Questionnaire (MHAQ) and rheumatologists' ratings. Regression analyses revealed that a modified rheumatoid activity index and/or disease duration were significant predictors of levels of guarding, rigidity, and total pain behavior. The psychological variables examined did not predict independently RA pain behavior. The rheumatoid activity index explained a significant proportion of the variance in functional status ratings and MHAQ daily function scores. Age, disease duration and depression also were independent predictors of functional status ratings. Thus, depression had a significant relationship with physician ratings of functional status but not with patient self-reports of disability. Psychological factors not examined in this study that might influence RA pain behavior and self-reports of functional status are discussed.

[Use of health services and epidemiological profiles as parameters for adjusting the Compulsory Health Plan in Colombia]. / Utilización de servicios de salud y perfiles epidemiológicos como parámetros de adecuación del Plan Obligatorio de Salud en Colombia.

OBJECTIVE: To evaluate the use of health services and the epidemiological profiles as parameters for adjusting the contents of the Compulsory Health Plan--POS. METHODS: An evaluative study of the contents of the Compulsory Health Plan--POS was performed regarding the use of health services and the regional epidemiological profiles, within the framework of the current problems of the General System of Health Social Security. The 1994 Survey on Equity of the Fiscal Expenditure, the 1997 National Survey on Quality of Life, and the 2000 National Household Survey estimated the use of services. The epidemiological profiles were obtained from the 2000 mortality data of the National Administrative Statistics Department--DANE. RESULTS: Affiliation to the health system has only reached 56% of the total population. However, health expenditure has increased constantly between 1993 and 2000, from 7.2% to nearly 10% of the GNP. Greater use of health services was found among the elderly population, and people with greater levels of spending. Women, particularly those residing in urban areas and on the higher quintile of spending, are the people who most use the health services. The people who use health services the least are men in urban areas in the lower quintile of spending. CONCLUSIONS: Organizing the Compulsory Health Plan with a modular structure makes it possible to adjust it according to the parameters of the use of health services and epidemiological profiles, in such a way that it contributes to the opportunity and pertinence of services, as well as to increase the affiliation to the system.

Magnetic resonance imaging detection of an uncommon granuloma formation after endothelial progenitor cells transplantation.

Magnetic resonance imaging (MRI) has been recognized as a non-invasive technique for visualizing the ultrastructure of a tissue at high resolution. The work reported here showed the utility of MRI for visualizing the fate of EPCs, and demonstrate how it can be used to further our understanding of angiogenesis mechanisms.The recently developed contrast agent dextran mono-N-succinimidyl 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate-gadolinium³âº (Dex-DOTA-Gd³âº) was used to label endothelial progenitor cells (EPCs). The faith of the transplanted labeled cells in the rat models of ischemic hind limbs was studied by images obtained by MRI.The pattern of migration of Dex-DOTA-Gd³âº-labeled EPCs could be observed and tracked by MRI for a long time and analyzed the change in the migration of the labeled cells. The ability of Dex-DOTA-Gd³âº to provide a clear pattern of cell migration to the limb was confirmed and most importantly, a different behavioral pattern was identified in the migration of labeled cells when an anomaly appeared in the MRI acquisition images 5 days post transplantation.

Synthesis, properties, and endothelial progenitor cells labeling stability of dextranes as polymeric magnetic resonance imaging contrast agents.

Magnetic resonance imaging is one of the most important fields for cellular imaging due to its non-invasive capacity, spatial resolution, and sensibility to visualized transplanted cells. An enhanced magnetic resonance image can be achieved by using contrast agents containing paramagnetic gadolinium chelates, which have the widest clinical use. To obtain a better contrast-enhancement and reduce the concentration of Gd for payload, one strategy is to conjugate the gadolinium(III) chelate to polymeric materials that will lead into an increase in the rotational correlation time and therefore improve the relaxivity. Four series of dextran gadolinium chelates were synthesized which are of interest as potential MRI contrast agents to track bone marrow-derived endothelial progenitor cells in vivo. The dextranes with molecular weights were characterized, introduced into the endothelial progenitor cells by electroporation, and injected in aqueous solution into rats to acquire the MR images. We have shown that by selecting polymers of the appropriate molecular weight, stability into the cell after labeling, relaxivity, and retention into the body can be accomplished.

Linfadenitis cervical por Salmonella no Typhi en una paciente diabética / Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient

Resumen La infección por Salmonella no Typhi es una de las enfermedades transmitidas por alimentos más común y ampliamente extendida en el mundo. Aunque la mayoría de los casos se limitan al tracto gastrointestinal, el compromiso extraintestinal no es infrecuente. Sin embargo, la adenitis como manifestación aislada, es una forma inusual de presentación de la enfermedad. Comunicamos el caso clínico de una mujer de 67 años de edad con diagnóstico de diabetes mellitus y una linfadenitis cervical por Salmonella no Typhi tratada con ciprofloxacina y y que requirió resección quirúrgica.

No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.

The use of magnetic resonance cell tracking to monitor endothelial progenitor cells in a rat hindlimb ischemic model.

A water-soluble magnetic resonance imaging (MRI) contrast agent, Dextran mono-N-succinimidyl 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate-gadolinium(3+) (Dex-DOTA-Gd(3+)), was shown to enable monitoring of the anatomical migration and the survival period of transplanted stem cells for up to 1 month. Gadolinium molecules in the cells were rapidly eliminated from the site and excreted upon cell death. Endothelial progenitor cells (EPCs) transplanted into the inguinal femoral muscle of rats migrated distally through the knee in rats after hindlimb ischemia but did not migrate in non-ischemic rats. Interestingly, the survival period of transplanted EPCs was notably prolonged in the ischemic limb, indicating that EPCs are required by the ischemic tissues and that the fate of transplanted EPCs was affected by the disease. Compared to the commonly used particle type of MRI contrast agents, the system described in this study is expected to be invaluable to help clarifying the process of stem cell transplantation therapy.

Tuberculosis and histoplasmosis co-infection in AIDS patients.

Abstract. Coinfection with tuberculosis in some countries occurs in 8-15% of human immunodeficiency virus (HIV) -infected patients who have histoplasmosis. This coinfection interferes with prompt diagnosis, and treatment is difficult because of drug interactions. We retrospectively reviewed the cases of 14 HIV-infected patients who had concomitant tuberculosis and histoplasmosis. The most frequent clinical manifestations were weight loss (85.7%), asthenia (78.5%), and fever (64.2%). The diagnosis of histoplasmosis was made primarily by histopathology (71.4%), and the diagnosis of tuberculosis was made by means of direct microscopic examination (71.4%). Death occurred in two patients, and relapse of both infections occurred in one patient. Moxifloxacin was substituted for rifampicin in six patients, with good outcomes noted for both infections. The clinical presentation does not readily identify acquired immunodeficiency syndrome (AIDS) patients who have tuberculosis and histoplasmosis. The use of a fluoroquinolone as an alternative agent in place of rifampicin for tuberculosis allows effective therapy with itraconazole for histoplasmosis.

Long-term in vivo magnetic resonance imaging tracking of endothelial progenitor cells transplanted in rat ischemic limbs and their angiogenic potential.

Stem cell therapy has been used to repair ischemic tissues in the limbs, in myocardial infarctions, and in the brain. To understand the mechanisms of healing, a contrast agent capable of inducing sufficient magnetic resonance (MR) contrast would be useful in providing fundamental information about the cell migration and incorporation into the ischemic tissue. A magnetic resonance imaging contrast agent composed of dextran and gadolinium chelate was synthesized. Hydroxyl groups of dextran were activated with 1,1'-carbonylbis-1H-imidazole and reacted with propanediamine to obtain aminated dextran. This modified polymer was then reacted with mono-N-succinimidyl 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate, then with fluorescein isothiocyanate, and finally reacted with gadolinium chloride solution (Dex-DOTA-Gd3(+)). Endothelial progenitor cells (EPCs) were selected as a stem cell model for magnetic resonance imaging tracking. Cells were isolated from the bone marrow harvested from the femurs and tibias of rats. Dex-DOTA-Gd3(+) was then introduced into the EPCs by electroporation. The intracellular stability and cytotoxicity of Dex-DOTA-Gd3(+) were evaluated in vitro. Dex-DOTA-Gd3(+)-labeled EPCs were transplanted into a rat model of ischemic limb, and MR images were acquired. Dex-DOTA-Gd3(+) was found to efficiently label EPCs over a long duration without significant cytotoxicity. This provides an MR signal sufficient for tracking the EPCs intramuscularly injected into the limb.

Adrenal function status in patients with paracoccidioidomycosis after prolonged post-therapy follow-up.

This study assessed adrenal function in patients with paracoccididioidomycosis who had been treated to determine a possible connection between high antibody titers and adrenal dysfunction attributable to persistence of the fungus in adrenal gland. Adrenal gland function was studied in 28 previously treated patients, 2 (7.1%) of whom were shown to have adrenal insufficiency and 7 (259%) who showed a below normal response to stimuli by adrenocorticotropic hormone. Paracoccidioides brasiliensis was detected in the adrenal gland from one of the patients with adrenal insufficiency. Although the study failed to demonstrate a significant difference between high antibody titers and low cortisol levels, the proportion of adrenal insufficiency detected and the subnormal response to adrenocorticotropic hormone confirmed that adrenal damage is an important sequela of paracoccidioidomycosis. Studies with a larger number of patients should be conducted to confirm the hypothesis of persistence of P. brasiliensis in adrenal gland after therapy.