Chronic interstitial nephritis of nontraditional causes in Salvadoran agricultural communities.

In El Salvador, a form of chronic kidney disease (CKD) of nontraditional causes (CKDnt) affecting farmers is being reported. Its behavior has been epidemic and is responsible for tens of thousands of deaths. This article summarizes the results obtained from a series of studies conducted to identify the epidemiology and clinical behavior of this disease, proposing a case definition and an etiopathogenic hypothesis. Methods included a survey of CKD in agricultural communities studying 2,388 people ≥ 18 years and 1,755 < 18, a descriptive clinical study followed by histopathological assessment conducted in 46 possible cases of CKDnt ≥ 18 years, and a national survey to study the prevalence of CKD and associated risk factors in 4,817 participants ≥ 20 years followed by a nested case-control study. In the agricultural communities, the prevalence of CKD in adults was 18% (men: 23.9%, women: 13.9%), 26.8% in agricultural workers (non-agricultural 13.8%), CKDnt accounted for 51.9% of cases. CKD in the population < 18 years was 3.9% (mean estimated glomerular filtration rate > 160 mL/1.73m2). The national CKD prevalence was 12.6% (urban: 11.3%; rural: 14.4%; males: 17.8%, females 8.5%), and CKDnt was only 3.8%; with associations between CKD and exposure to agrochemicals. The clinical study revealed the presence of markers of kidney damage (A3 albuminuria: 80.4%; ß2-microglobulin: 78.2%), urine electrolyte anomalies (100% hypermagnesuria, 45.7% hypernatriuria, 43.5% osmotic polyuria), abnormal osteotendinous reflexes (45.7%), sensorineural hearing loss (56.5%), and damage of the tibial arteries by Doppler imaging (66.7%). Biopsies revealed a chronic tubulointerstitial nephropathy. The etiopathogenesis of CKDnt is possibly multifactorial, including environmental contamination by agrochemicals, heat stress, and dehydration.

Actinic Prurigo Cheilitis: A Clinicopathologic Review of 75 Cases.

Actinic prurigo (AP) is a chronic idiopathic photodermatosis that primarily affects American Indians in the United States and Mestizos in Latin American countries. Clinically, the onset of the disease is usually in the first decade of life but may appear initially in adult life, and it is characterized by symmetric involvement of sun-exposed areas of the skin, particularly areas of the face, resulting in polymorphic erythematous papules, macules, and plaques in different stages of evolution. Lower lip involvement includes swelling, scaling, fissures, hyperpigmentation, and ulcerations of the vermilion border. and in some cases could represent the only manifestation of the disease. The histopathologic features of AP have been studied; however, there is a controversy regarding whether AP cheilitis has distinct histopathologic features that could allow accurate separation from other specific and nonspecific forms of cheilitis. The diagnosis can be challenging, mainly when lip lesions are the only manifestation of the disease. In this study, the authors investigate the clinicopathologic features of 75 cases of AP cheilitis to provide further criteria for its diagnosis and classification. All 75 patients presented with lip lesions. Thirty-three cases were diagnosed as AP cheilitis with cutaneous lesions and 42 cases were diagnosed as AP cheilitis without cutaneous lesions (only lip lesions). Histologically, of the 33 cases with AP cheilitis with cutaneous lesions, 17 (52%) cases showed follicular cheilitis, and of the 42 cases that had only lip lesions, 18 (43%) cases showed follicular cheilitis. Histologically, AP cheilitis can present as follicular cheilitis; thus, supporting the diagnosis. Also, our findings confirm that lip lesions can present as the only manifestation of the disease, showing typical histological and clinical features. This form of cheilitis has not being well described in the dermatologic and dermatopathologic literature.

Matrix metalloproteinase-9, -10, and tissue inhibitor of matrix metalloproteinases-1 blood levels as biomarkers of severity and mortality in sepsis.

INTRODUCTION: Matrix metalloproteinases (MMPs) play a role in infectious diseases through extracellular matrix (ECM) degradation, which favors the migration of immune cells from the bloodstream to sites of inflammation. Although higher levels of MMP-9 and tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) have been found in small series of patients with sepsis, MMP-10 levels have not been studied in this setting. The objective of this study was to determine the predictive value of MMP-9, MMP-10, and TIMP-1 on clinical severity and mortality in a large series of patients with severe sepsis. METHODS: This was a multicenter, observational, and prospective study carried out in six Spanish Intensive Care Units. We included 192 (125 surviving and 67 nonsurviving) patients with severe sepsis and 50 age- and sex-matched healthy controls in the study. Serum levels of MMP-9, MMP-10, TIMP-1, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-10 were measured in patients with severe sepsis at the time of diagnosis and in healthy controls. RESULTS: Sepsis patients had higher levels of MMP-10 and TIMP-1, higher MMP-10/TIMP-1 ratios, and lower MMP-9/TIMP-1 ratios than did healthy controls (P < 0.001). An association was found between MMP-9, MMP-10, TIMP-1, and MMP-9/TIMP-1 ratios and parameters of sepsis severity, assessed by the SOFA score, the APACHE-II score, lactic acid, platelet count, and markers of coagulopathy. Nonsurviving sepsis patients had lower levels of MMP-9 (P = 0.037), higher levels of TIMP-1 (P < 0.001), lower MMP-9/TIMP-1 ratio (P = 0.003), higher levels of IL-10 (P < 0.001), and lower TNF-alpha/IL-10 ratio than did surviving patients. An association was found between MMP-9, MMP-10, and TIMP-1 levels, and TNF-alpha and IL-10 levels. The risk of death in sepsis patients with TIMP-1 values greater than 531 ng/ml was 80% higher than that in patients with lower values (RR = 1.80; 95% CI = 1.13 to 2.87;P = 0.01; sensitivity = 0.73; specificity = 0.45). CONCLUSIONS: The novel findings of our study on patients with severe sepsis (to our knowledge, the largest series reporting data about MMP levels in sepsis) are that reduced MMP-9/TIMP-1 ratios and increased MMP-10 levels may be of great pathophysiologic significance in terms of severity and mortality, and that TIMP-1 levels may represent a biomarker to predict the clinical outcome of patients with sepsis.

Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis SOLAPSO - Sociedad Latinoamericana de Psoriasis (Latin American Psoriasis Society).

This Clinical Practice Guideline on the systemic treatment of Psoriasis includes the recommendations elaborated by a panel of experts from the Latin American Psoriasis Society SOLAPSO, who assessed the quality of the available evidence using the GRADE system and the PICO process to guide the literature search. To answer each question, the experts discussed the results of randomized controlled trials, observational studies and metanalysis evaluating the interventions identified (non-biologics, biologics and phototherapy) in different populations of patients with moderate to severe plaque-psoriasis, which was summarized in Tables ad-hoc. The main end-points considered to assess efficacy were PASI 50, 75, 90 and 100, PGA 0-1 and significant improvement of health-related quality of life. Specific adverse events, either severe or leading to treatment interruption, were also evaluated. The 31 recommendations included in this CPG follow the structure proposed by GRADE: direction (for or against) and strength (strong or weak). The goal of this CPG is to improve the management of patients with psoriasis by recommending interventions of proved benefit and providing a reference standard for the treating physician. Adhering to the contents of this CPG does not guarantee therapeutic success. The final decision on the specific treatment is the responsibility of the physician based on the individual circumstances and considering the values, the preferences and the opinions of the patient or caregivers.

Fogging Control on LDPE/EVA Coextruded Films: Wettability Behavior and Its Correlation with Electric Performance.

The transformation of fog at a non-visible water layer on a membrane of low-density polyethylene (LDPE) and ethylene-vinyl acetate (EVA) was evaluated. Nonionic surfactants of major demand in the polyolefin industry were studied. A kinetic study using a hot fog chamber showed that condensation is controlled by both the diffusion and permanency of the surfactant more than by the change of the surface energy developed by the wetting agents. The greatest permanency of the anti-fog effect of the LDPE/EVA surface was close to 3000 h. The contact angle results demonstrated the ability of the wetting agent to spread out to the surface. Complementarily, the migration of nonionic surfactants from the inside of the polymeric matrix to the surface was analyzed by Fourier transform infrared (FTIR) microscopy. Additionally, electrical measurement on the anti-fogging membrane at alternating currents and at a sweep frequency was proposed to test the conductivity and wetting ability of nonionic surfactants. We proved that the amphiphilic molecules had the ability to increase the conductivity in the polyolefin membrane. A correlation between the bulk electrical conductivity and the permanency of the fogging control on the LDPE/EVA coextruded film was found.

Metamaterial Behavior of Polymer Nanocomposites Based on Polypropylene/Multi-Walled Carbon Nanotubes Fabricated by Means of Ultrasound-Assisted Extrusion.

Metamaterial behavior of polymer nanocomposites (NCs) based on isotactic polypropylene (iPP) and multi-walled carbon nanotubes (MWCNTs) was investigated based on the observation of a negative dielectric constant (ε'). It is demonstrated that as the dielectric constant switches from negative to positive, the plasma frequency (ωp) depends strongly on the ultrasound-assisted fabrication method, as well as on the melt flow index of the iPP. NCs were fabricated using ultrasound-assisted extrusion methods with 10 wt % loadings of MWCNTs in iPPs with different melt flow indices (MFI). AC electrical conductivity (σ(AC)) as a function of frequency was determined to complement the electrical classification of the NCs, which were previously designated as insulating (I), static-dissipative (SD), and conductive (C) materials. It was found that the SD and C materials can also be classified as metamaterials (M). This type of behavior emerges from the negative dielectric constant observed at low frequencies although, at certain frequencies, the dielectric constant becomes positive. Our method of fabrication allows for the preparation of metamaterials with tunable ωp. iPP pure samples show only positive dielectric constants. Electrical conductivity increases in all cases with the addition of MWCNTs with the largest increases observed for samples with the highest MFI. A relationship between MFI and the fabrication method, with respect to electrical properties, is reported.

Sistema de producción con bovinos de carne en la estación experimental "La Cumaca" I: peso al nacer / Beef cattle production system at La Cumaca experimental station I: birth weight

En este primer artículo de la serie, se presenta una breve descripción del sistema de producción y los resultados de la evaluación del carácter peso al nacer del rebaño Brahman registrado de la Estación Experimental La Cumaca, Alí Benavides Zapata, ubicada en el estado Yaracuy, Venezuela. Se dispuso de 5198 pesos al nacer de becerros de las temporadas 1965 a 2004. Ellos fueron analizados por Modelos Mixtos (incluyendo un Modelo Animal) para evaluar los efectos de sexo del becerro, año de nacimiento, mes de nacimiento, edad de la madre al parto, padre y madre del becerro. El promedio global fue de 29,4 ± 0,20 kg. Todos los efectos fueron significativos (p<0,01), estimándose una tendencia fenotípica anual de 210 g, una tendencia genética directa de 70 g y la materna de 17 g, así como índice de herencia directo y materno de 0,48 ± 0,02 y 0,11± 0,02. Las vacas producen becerros más pesados hasta el quinto parto y, a partir de allí, comienzan a declinar.

Los murciélagos hematófagos como transmisores de la rabia / Blood feeding bats as transmitters of rabies

La presente revisión pretende discutir la importancia que los murciélagos tienen como transmisores de la rabia, los daños que causan las especies hematófagas a las actividades ganaderas y los métodos de control que se emplean para solucionar este problema. Se recopiló información de libros, revistas e informes publicados por la Organización Mundial de la Salud, sobre la biología y ecología de las especies hematófagas, su importancia en la transmisión de la enfermedad y los métodos de control que se han aplicado y los que actualmente se aplican. La rabia transmitida por murciélagos es un problema de salud limitado básicamente al continente americano. Aunque todas las especies de quirópteros son transmisores potenciales de esta enfermedad, en América Latina son las especies hematófagas las principales transmisoras de la rabia paralítica en bovinos, lo que constituye un problema económico para los ganaderos. Existen diferentes métodos de control, algunos de los cuales consisten en la destrucción de los lugares de refugio, pero éstos traen consigo la eliminación no sólo del muerciélago vampiro común, sino de numerosas especies benéficas a los ecosistemas. Actualmente, uno de los métodos más eficaces es el uso de vampiricida, crema anticoagulante que se aplica directamente sobre los murciélagos, o bien en el cuerpo del ganado, sobre las áreas donde ha sido mordido. Pero este método requiere de la asesoría de técnicos para la correcta identificación y manipulación de los murciélagos. Asimismo, es fundamental dar a conocer a través de talleres y conferencias, la importancia del papel que juegan los murciélagos para la conservación y regeneración de los ecosistemas