Evaluación de parámetros inflamatorios, trombóticos y variantes genéticas en pacientes con ataque cerebrovascular isquémico que se asisten en un hospital de Uruguay

Introducción: El ataque cerebrovascular es la segunda causa de muerte en adultos en el mundo occidental y una de las principales causas de discapacidad permanente, aumentando su frecuencia con la edad, el 85 % es de tipo isquémico. Objetivos: Analizar parámetros trombofílicos, hipofibrinolíticos y genéticos en pacientes con ataque cerebrovascular isquémico y evaluar la posible asociación de estos con factores de riesgo cardiovascular. Metodología: Se utilizó un cuestionario para evaluar la presencia de factores de riesgo cardiovascular en 114 pacientes incluidos en el estudio con diagnóstico de ataque cerebrovascular isquémico. Proteína C y antitrombina fueron determinados mediante métodos cromogénicos, resistencia a la proteína C activada e inhibidor lúpico mediante métodos coagulométricos y proteína S libre, inhibidor del activador del plasminógeno-1, homocisteína y lipoproteína (a) por métodos inmunoquímicos. Fibrinógeno fue determinado por coagulometría y proteína C reactiva por inmunoturbidimetría, ambos contra un grupo control. Las variantes genéticas factor V Leiden, protrombina G20210A, rs1205 (gen PCR), rs1800779 (gen NOS3) y rs2257073 (gen ASB10) fueron analizadas mediante real-time PCR, comparando los últimos tres con una población de referencia. La alteración de las frecuencias de las variables fue determinada por análisis estadístico chi-cuadrado. Resultados: Tres de los cuatro pacientes jóvenes estudiados presentaron indicadores de trombofilia. El resto de los parámetros alterados fueron homocisteína 30.1% (22.4-39.1), lipoproteína (a) 32.1% (24.1-41.4), inhibidor del activador del plasminógeno-1 36.0% (27.8-45.1), fibrinógeno 12.3% (7.5-19.6) y proteína C reactiva 78.1% (69.6-84.7). Se encontró asociación (p < 0.05) entre ciertos factores de riesgo cardiovascular y los parámetros evaluados como hipertensión/proteína C reactiva, dislipemia/lipoproteína (a), arritmia/lipoproteína (a) y arritmia/fibrinógeno. Para pacientes con ataque cerebrovascular isquémico solo la variante rs1205 mostró una frecuencia más alta del alelo T. Conclusiones: Este estudio revela la importancia de analizar la trombofilia en pacientes jóvenes, especialmente en aquellos sin factores de riesgo cardiovascular, así como el rol de la hipofibrinolisis, inflamación y algunas variantes genéticas en el desarrollo de ataque cerebro vascular isquémico.

Introduction: Stroke is the second cause of death in adults in the Western world and one of the main causes of permanent disability, increasing in frequency with age; 85% are ischemic. Objectives: To analyze thrombophilic, hypofibrinolytic, inflammatory, and genetic parameters in patients with ischemic stroke and evaluate possible associations with vascular risk factors. Methodology: Questionnaires were used to evaluate vascular risk factors in 114 patients included in the study with ischemic stroke diagnosis. Protein C and Antithrombin were determined by chromogenic assays, Activated Protein C Resistance and Lupus Anticoagulant were determined with by coagulometry and Free Protein S, Plasminogen activator inhibitor-1, Homocysteine and Lipoprotein (a) by immunochemistry. Fibrinogen was assayed by coagulometry and C-reactive protein by immunoturbidimetry, both against a control group. Factor V Leiden, Prothrombin G20210A, rs1205 (CRP gene), rs1800779 (NOS3 gene) and rs2257073 (ASB10 gene) genetic variants were analyzed by Real-Time PCR, comparing the last three with a reference population. Alteration frequencies of the variables were determined by chi-square statistical analysis. Results: Three out of four of the young patients studied presented indicators of thrombophilia. The rest of the altered parameters were Homocysteine 30.1% (22.4-39.1), Lipoprotein (a) 32.1% (24.1-41.4), Plasminogen activator inhibitor-1 36.0% (27.8-45.1), Fibrinogen 12.3% (7.5-19.6) and C-reactive protein 78.1% (69.6-84.7). Associations were found (p<0.05) between certain vascular risk factors and parameters evaluated, namely hypertension/C-reactive protein, dyslipidemia/lipoprotein (a), arrhythmia/lipoprotein (a) and arrhythmia/fibrinogen. For ischemic stroke patients only the genetic variant rs1205 showed higher frequency of the T allele. Conclusions: This study reveals the importance of analyzing thrombophilia in young patients, especially those without vascular risk factors, as well as the role of hypofibrinolysis, inflammation and some genetic variants in the development of ischemic stroke.

Introdução: O AVC é a segunda causa de morte em adultos no mundo ocidental e uma das principais causas de incapacidade permanente, aumentando de frequência com a idade; 85% são isquémicos. Metas: Analisar os parâmetros trombofílicos, hipofibrinolíticos e genéticos em pacientes com acidente vascular cerebral isquêmico e avaliar a possível associação com fatores de risco cardiovascular. Metodologia: Um questionário foi utilizado para avaliar a presença de fatores de risco cardiovascular em 114 pacientes incluídos no estudo com diagnóstico de acidente vascular cerebral isquêmico. Proteína C e antitrombina foram determinadas por métodos cromogênicos, resistência à proteína C ativada e inibidor de lúpus por métodos coagulométricos e proteína S livre, inibidor do ativador do plasminogênio-1, homocisteína e lipoproteína (a) por métodos imunoquímicos. O fibrinogênio foi determinado por coagulometria e a proteína C-reativa por imunoturbidimetria, ambos contra um grupo controle. As variantes genéticas fator V Leiden, protrombina G20210A, rs1205 (gene PCR), rs1800779 (gene NOS3) e rs2257073 (gene ASB10) foram analisadas por PCR em tempo real, comparando as três últimas com uma população de referência. As frequências de alteração das variáveis ​​foram determinadas pela análise estatística qui-quadrado. Resultados: Três dos quatro pacientes jovens estudados apresentaram indicadores de trombofilia. O resto dos parâmetros alterados foram homocisteína 30,1% (22,4-39,1), lipoproteína (a) 32,1% (24,1-41,4), inibidor do ativador de plasminogênio-1 36,0% (27,8-45,1), fibrinogênio 12,3% (7,5-19,6) e proteína C reativa 78,1% (69,6-84,7). Foi encontrada associação (p<0,05) entre alguns fatores de risco cardiovascular e os parâmetros avaliados como hipertensão/proteína C reativa, dislipidemia/lipoproteína (a), arritmia/lipoproteína (a) e arritmia/fibrinogênio. Para pacientes com acidente vascular cerebral isquêmico apenas a variante rs1205 apresentou maior frequência do alelo T. Conclusões: Este estudo revela a importância de analisar a trombofilia em pacientes jovens, especialmente aqueles sem fatores de risco cardiovascular, bem como o papel da hipofibrinólise, inflamação e algumas variantes genéticas no desenvolvimento do acidente vascular cerebral isquêmico.

Histopathological spectrum of adult renal tumours: A single center experience and review of literature

Background: Renal tumors constitute approximately 3% of all malignancies in adults. They form a heterogenous group with variable morphological, immunohistochemical, and molecular features. Aim: The objective of this study was to analyze the spectrum of adult renal tumors at a tertiary care center and study the demographic and histomorphological features. Materials and Methods: In this study, 55/87 nephrectomy specimens resected for adult renal tumors during a 1-year period were analyzed retrospectively. Results: There were 4 benign (7.2%) and 51 (92.7%) malignant tumors. There was a male preponderance with a male: female ratio of 3.42:1. The tumors were seen to occur equally in both kidneys. The most common tumor was clear cell renal cell carcinoma (RCC), the conventional type accounting for 65.5% of our study group. There were one each of multilocular cystic renal neoplasm of low malignant potential, papillary RCC, chromophobe RCC, Mit family RCC, oncocytoma and angiomyolipoma and two clear cell papillary RCC during this 1-year period. Uncommon tumors included neuroendocrine carcinoma (1), epithelioid angiomyolipoma (1), mixed epithelial stromal tumor (1), Ewings sarcoma (2), and glomangioma (1). Five cases of urothelial carcinoma of renal pelvis/ureter also were present. Conclusion: This article gives an overview of the spectrum of adult renal tumors at a tertiary care center with an in-depth literature review providing recent advances in each category of tumors.

Translational Advances in Cancer Prevention Agent Development (TACPAD) Virtual Workshop on Immunomodulatory Agents: Report

The National Cancer Institute (NCI) Division of Cancer Prevention (DCP) convened the “Translational Advances in Cancer Prevention Agent Development (TACPAD) Workshop on Immunomodulatory Agents” as a virtual 2-day workshop on September 13 to 14, 2021. The main goals of this workshop were to foster the exchange of ideas and potentially new collaborative interactions among leading cancer immunoprevention researchers from basic and clinical research and highlight new and emerging trends in immunoprevention. The workshop included an overview of the mechanistic classes of immunomodulatory agents and three sessions covering the gamut from preclinical to clinical studies. The workshop convened individuals working in immunology and cancer prevention to discuss trends in discovery and development of immunomodulatory agents individually and in combination with other chemopreventive agents or vaccines.

Equivalence of entrustable professional activities and context-dependent item sets as summative assessments in undergraduate physical therapy programs

Background@#Summative assessment of student performance should provide information on achievement of program outcomes to support evaluation decisions. Alternative approaches to the traditional assessment systems like the written licensure examinations in Physical Therapy (PT) should be explored to ensure valid measurement of achievement of these terminal outcomes. @*Objective@#The study aimed at establishing equivalence of two summative assessments new to PT in measuring achievement of the PT outcomes: work-based assessment using Entrustable Professional Activities (EPA) and knowledge-based assessment using Context-Dependent Item Sets (CDIS). @*Methodology@#Thirty-two newly graduated PT's underwent a one-week EPA assessment and took a 102-item CDIS test (based on 14 clinical vignettes). Qualitative data from blueprint review, group face-to-face interviews with participants and assessors, and field notes from observations, and quantitative data from EPA entrustment decisions and CDIS scores were utilized to ascertain their comparability in terms of Purpose, Administration, Quality and Decisions. This was used to determine the extent of equivalence of the two assessments. @*Results@#Review of both blueprints show alignment with PT outcomes, with integrative content motivating participants towards professional development. Administration were equally acceptable to users, though EPA had more practice opportunities with a longer assessment time. Entrustment decisions in EPA had a high inter-rater reliability, while CDIS had low reliability, with most items having poor discriminative power. Decisions of “pass” or “fail” had good concordance when high prevalence indices were considered. @*Conclusion@#There is high extent of equivalence in purpose of EPA and CDIS but are not equivalent in terms of administration. There is moderate equivalence in quality and decisions, with potential for increased concordance if improved quality of CDIS is attained.

A cross-sectional self-assessment of burnout amongst a sample of doctors in Ghana

Background: The occurrence of burnout amongst African health professionals has been widely anticipated, but there is a dearth of published data, especially amongst doctors. Burnout has been reported to be as high as 53% amongst doctors in the United States. If not detected, it can result in prescription errors, work-related accidents, substance abuse and depression. Aim: The aim of this study was to determine the prevalence of burnout and its associated factors amongst a sample of physicians in Ghana. Setting: This study was conducted in Kumasi amongst physicians attending a conference organised by the West African College of Physicians, Ghana Chapter. Method: A cross-sectional study. Of the 90 physicians who registered for the conference, 60 responded to a self-administered Maslach Burnout Inventory questionnaire. Data were analysed descriptively and inferentially using STATA® version 14. Results: Approximately 52% of respondents had been in medical practice for 10­19 years (mean 15.4 years). All the major medical specialties were represented. Internal Medicine had the highest number of participants (48.3%). With respect to the components of burnout, 5.5% of respondents experienced depersonalisation, 7.8% had a lack of personal achievement and 10.8% experienced emotional exhaustion. The association between burnout and age, sex, years of practice and clinical specialty was not found to be statistically significant. Conclusion: This pilot study has shown burnout to be common amongst physicians in Ghana. It is recommended that further studies are conducted, involving a larger cross-section of doctors in various parts of Africa

Estilos de vida saludable: práctica social de hábitos alimentarios / Healthy lifestyles: social practice of eating habits

Los estilos de vida, considerados patrones de comportamiento influyen en la salud de la población, y los hábitos alimentarios uno de sus componentes. El habitus bajo la forma de disposiciones durables es construido sobre la base de la cultura correspondida con determinado tipo de conocimientos, ideas, valores, habilidades, entre otras. Las condiciones comunes que caracterizan algunas prácticas sociales como los hábitos alimentarios generados por el habitus son en consecuencia los estilos de vida saludables, prioritarios en "La promoción de la salud "contemplada en la Carta de Ottawa. Se sondea puntos de vista de autores como Pierre Bourdieu y Michael Foucault quienes contribuyen significativamente a desplegar sentires de como a través de la experiencia y de las prácticas se forman los modos y estilos de vida en particular de importancia para la salud. En este documento se pretende describir algunas consideraciones que resaltan la importancia de los estilos de vida saludable como procesos sociales que favorecen la Salud Pública, en especial aquellos relacionados con la práctica social de los hábitos alimentarios(AU)

Lifestyles, considered patterns of behavior influence the health of the population, and eating habits one of its components. the habitus in the form of durable arrangements is built on the basis of the culture matched with a certain type of knowledge, ideas, values, skills, among others. the common conditions that characterize some social practices such as the eating habits generated by the habitus are consequently the healthy lifestyles, priority in "the promotion of health" contemplated in the Ottawa Charter. the points of view of authors such as Pierre Bourdieu and Michael Foucault are explored, who contribute significantly to displaying sentiments of how, through experience and practices, modes and lifestyles are particularly important for health. this document aims to describe some considerations that highlight the importance of healthy lifestyles as social processes that favor public health, especially those related to the social practice of eating habits(AU)

Acute phase proteins in bitches subjected to conventional and minimally invasive ovariohysterectomy / Proteínas de fase aguda em cadelas submetidas à ovariohisterectomia convencional e minimamente invasiva

The aim of this study was to evaluate and to compare the possible inflammatory changes by screening acute phase proteins concentrations in healthy bitches subjected to ovariohysterectomy. Minimally invasive and conventional (laparotomy) ovariohysterectomies were performed in 17 client-owned adult female mixed breed dogs. Nine animals were subjected to minimally invasive and eight animals to conventional ovariohysterectomy. Blood samples were taken before surgery, 24, 48 hours, and seven days postoperatively. Serum C-reactive concentration was determined by a commercial ELISA kit and serum haptoglobin concentration was measured via hemoglobin binding assay, both previously validated for use in dogs. As the data did not meet the normal distribution criteria, the nonparametric Kruskall-Wallis was performed to compare quantitative variables between groups. One-way ANOVA and the Friedman test were used for multiple comparisons between time points, with a P<0.05 considered significant. C-reactive protein concentration was significantly different (P<0.0001) at 24 hours postoperatively between groups. There was no significant difference in haptoglobin concentration between groups. C-reactive protein and haptoglobin concentrations were significantly different at 24 and 48 hours postoperatively for minimally invasive and conventional ovariohisterectomies. These findings provided an overview of the short-term inflammatory effects produced by minimally invasive and conventional ovariohysterectomies.(AU)

O objetivo deste trabalho foi avaliar e comparar o efeito inflamatório, por meio da determinação de proteínas de fase aguda, produzido por dois protocolos cirúrgicos distintos de ovariohisterectomia em cadelas. Para tanto, foram determinadas as concentrações de proteína C reativa (CRP) e haptoglobina (Hp) de 17 cadelas, sem raça definida, adultas, sendo nove animais submetidos à ovariohisterectomia pela técnica convencional por laparotomia e oito a ovariohisterectomia pela técnica minimamente invasiva. Para avaliar a resposta de fase aguda causada pelo trauma cirúrgico, amostras de sangue foram obtidas antes dos procedimentos cirúrgicos e em quatro momentos distintos após as cirurgias (24, 48 horas e sete dias) para as dosagens de CRP e Hp, com kit comercial ELISA e via ensaio de ligação com a hemoglobina, respectivamente, validados para o uso em cães. Como não houve distribuição normal dos dados, utilizou-se o teste de Kruskall-Wallis para comparação das variáveis quantitativas entre os dois grupos. Os testes de Friedman e One-way ANOVA foram usados para comparações múltiplas entre os momentos avaliados, sendo considerado P<0,05 como significante. Houve diferença significativa (P<0,0001) para as concentrações de CRP 24 horas após o procedimento cirúrgico entre os dois protocolos utilizados. Não houve diferença significativa para as concentrações de Hp entre os dois protocolos cirúrgicos. Foram evidenciadas alterações significativas para as concentrações de CRP e Hp 24 e 48 horas após as ovariohisterectomias, independentemente da técnica cirúrgica utilizada. As concentrações de CRP e Hp demonstraram o efeito inflamatório imediato induzido pela ovariohisterectomia convencional e minimamente invasiva.(AU)

Leucemia linfoblástica aguda en niños con síndrome de Down: análisis comparativo con pacientes sin síndrome de Down / Acute lymphoblastic leukemia in children with Down syndrome: Comparative analysis versus patients without Down syndrome

Introducción: Los niños con síndrome de Down (SD) tienen mayor frecuencia de leucemia linfoblástica aguda (LLA) y menor supervivencia que pacientes sin síndrome de Down (NSD). Analizamos las características clínicas, demográficas-biológicas y respuestas al tratamiento en SD-LLA versus NSD-LLA. Pacientes y métodos: Pacientes (0-19 años) con LLA desde enero de 1990 a noviembre de 2016. Se compararon características demográficas biológicas y respuestas al tratamiento con chi cuadrado y Wilcoxon rank sum. La supervivencia global y el intervalo libre de eventos (ILE) se analizaron con Kaplan-Meier y el test log-rank. Resultados: Se incluyeron 1795 pacientes, 54 con SD. Los SD-LLA presentaron edad mayor (p= 0,0189). T odos inmuno fenotipo precursor-B, con menor incidencia de anomalías recurrentes (p < 0,0001). Demostraron mejor tasa de respuesta a prednisona (p= 0,09) y mayor mortalidad en inducción y remisión completa (p < 0,0001). Todas las muertes de los SD-LLA fueron relacionadas con el tratamiento. La sobrevida libre de eventos en niños SD-LLA vs.NSD-LLA fue 47 (± 8)% vs. 73 (± 1)% (p= 0,006) y el ILE de los SD-LLA vs. NSD-LLA fue 54 (± 9)% vs. 75 (± 1)% (p= 0,0297). La tasa de recaídas fue similar en ambos grupos (p= 0,6894). El ILE de los SD-LLA fue menor en el grupo de 6-9 años: 39 (± 19)% (p= 0,7885). Conclusiones: Los niños de 6-9 años con SD-LLA años presentó menor sobrevida. Aunque estos niños presentaron una mejor respuesta temprana, la sobrevida libre de eventos e ILE fueron menores debido a la mortalidad relacionada con el tratamiento.

Introduction. Children with Down syndrome (DS) more commonly have acute lymphoblastic leukemia (ALL) and a lower survival rate than those without Down syndrome (WDS). We analyzed the clinical, demographic, and biological characteristics and treatment response of children with DS-ALL versus those WDS-ALL. Patients and methods: Patients with ALL between January 1990 and November 2016. The demographic and biologic characteristics and treatment response were compared using the χ² and Wilcoxon rank-sum tests. The overall survival and event-free interval (EFI) were analyzed using the Kaplan-Meier and log-rank tests. Results. 1795 patients were included; 54 had DS. Patients with DS-ALL were older (p= 0.0189). All had B-cell precursor immunophenotype and a lower incidence of recurrent abnormalities (p < 0.0001). They showed a better response rate to prednisone (p= 0.09) and a higher mortality in induction and complete remission (p < 0.0001). All deaths of patients with DS-ALL were treatment-related. The event-free survival (EFS) was 47% (± 8%) versus 73% (± 1%) (p= 0.006) and the EFI was 54% (± 9%) versus 75% (± 1%) (p= 0.0297) among patients with DS-ALL versus those WDS-ALL, respectively. The rate of relapse was similar in both groups (p= 0.6894). The EFI of patients with DS-ALL was lower in the group aged 6-9 years: 39% (± 19%) (p= 0.7885). Conclusions. A lower survival was observed among children aged 6-9 years with DS-ALL. Although these children showed a better early response, their EFS and EFI were lower due to treatment-related mortality.

Gastrointestinal and pulmonary nematodes in calves naturally infected in the cities of Botucatu and Manduri, in the Brazilian state of São Paulo / Nematódeos gastrintestinais e pulmonares em bezerros naturalmente infectados nos municípios de Botucatu e Manduri, estado de São Paulo

This study aimed to determine the occurrence of gastrointestinal and pulmonary parasites in calves and to evaluate seasonal and age patterns in parasitism. For this, we used 140 clinically healthy crossbreed calves (two to 12 months old) that belonged to two private farms in the municipalities of Botucatu (n=53) and Manduri (n=87), São Paulo state, Brazil. The calves were monitored for 12 months (from September 2014 to August 2015). Fecal samples were collected directly from the rectum every three months. Fecal egg counts were determined using the modified McMaster technique with a sensitivity of 50 eggs per gram of feces (EPG). Coproculture was performed on pooled samples to identify Strongylida infective larvae. First-stage larvae of Dictyocaulus viviparus were extracted by a modified Baermann method. The data showed non-normal distribution (Shapiro-Wilk) and the nonparametric Kruskall-Wallis test was employed to evaluate the EPG data by seasons and age groups. Dunn's post-test was used for multiple comparisons (P<0.05). The calves from Manduri farm showed significantly higher fecal egg counts (P<0.0001) in the winter when compared to other seasons. At Botucatu farm, young calves (2-3 months old) showed significantly higher EPG than old calves (8-12 months) (P=0.01). The prevalence and overall mean of animals positive for Strongylida type-eggs were 81.1% and 340 in Botucatu, respectively, versus 83.9% and 854 in Manduri, respectively. Furthermore, we found Strongyloides spp., Moniezia spp., and Trichuris spp. eggs and Eimeria spp. oocysts. The prevalent genera in all coprocultures in decreasing order were: Cooperia spp., Haemonchus spp., Oesophagostomum spp., and Trichostrongylus spp. First-stage larvae of Dictyocaulus viviparus were found only in Botucatu farm samples throughout the year, except in spring.(AU)

O objetivo deste estudo foi investigar os parasitas gastrintestinais e pulmonares que acometem bezerros bem como a possível influência de fatores climáticos e da idade no parasitismo. Para isso, durante um período de 12 meses (setembro de 2014 a agosto de 2015), amostras de fezes foram coletadas a cada três meses diretamente da ampola retal de 140 bezerros mestiços (dois a 12 meses de idade), clinicamente saudáveis, pertencentes a duas propriedades leiteiras localizadas nos municípios de Botucatu (n=53) e Manduri (n=87), estado de São Paulo. Realizou-se a contagem de ovos por grama de fezes pela técnica de McMaster modificada com sensibilidade de 50 ovos por grama de fezes (OPG). Coproculturas foram realizadas em pool de amostras para a obtenção das larvas infectantes (L3). Larvas de primeiro estágio de Dictyocaulus viviparus foram recuperadas pela modificação da técnica de Baermann. Os dados não se apresentaram normalmente distribuídos (Shapiro-Wilk), e o teste não paramétrico de Kruskal-Wallis foi utilizado para avaliar os dados de OPG em relação às estações do ano e faixa etária. Para comparações múltiplas, empregou-se o pós-teste de Dunn. Foi verificado que em Manduri, no inverno, houve um aumento significativo (P<0,0001) na contagem de OPG em comparação as demais estações do ano. Em Botucatu, os animais com dois a três meses de idade apresentaram maiores contagens de OPG quando comparados aos animais de oito a 12 meses de idade (P=0,01). A prevalência e a média global de animais positivos para ovos do tipo Strongylida, em Botucatu, foi de 81,1% e 340, respectivamente, e em Manduri foi de 83,9% e 854, respectivamente. Em adição, de maneira geral, foram encontrados ovos de Strongyloides spp., Moniezia spp., Trichuris spp. e oocistos de Eimeria spp. Foram recuperadas, em ordem de prevalência, larvas infectantes de Cooperia spp., Haemonchus spp., Oesophagostomum spp. e Trichostrongylus spp. Larvas de D. viviparus foram recuperadas somente na propriedade de Botucatu durante todo o ano, com exceção da primavera.(AU)

Determinação da potência relativa de extratos alergênicos de Phleum pratense por testes cutâneos / Establishing the relative potency of Phleum pratense allergenic extracts using skin prick tests

Objetivos: Comparar a potência de extratos europeus de Phleum pratense para imunoterapia sublingual (ITSL), em relação ao extrato referência norte-americano. Métodos: Foram selecionados 15 sujeitos, com idade entre 18 e 55 anos, histórico clínico sazonal compatível e teste cutâneo com alta reatividade a gramíneas. O delineamento de estudo foi transversal, triplo cego e randômico, e comparadas as potências dos seguintes extratos alergênicos para ITSL: (A) Soluprick® (30 HEP/mL) e (B) Grazax® 75.000 SQ-T, ambos os extratos da ALK-Abelló; (C) Oralair® e (D) Staloral®, com 300 IR/mL, Stallergènes, França. O extrato de origem norteamericana (E) foi o padrão, contendo 10.000 BAU/mL. Todos os extratos foram usados em forma de concentrados e nas diluições 1:3, 1:10, e 1:30. Os testes foram aplicados em quadruplicata em dois dias não consecutivos. Os diâmetros de pápula e eritema foram registrados após 15 minutos. Resultados: Não houve diferença significativa entre os testes realizados no primeiro e segundo dias (p = 0,37) com extratos concentrados, na diluição 1:3 e também 1:10 (p = 0,20 e p = 0,33, respectivamente). No segundo dia de testes, a média obtida das pápulas do extrato A foi de 16,7 mm na diluição 1:3; de 14,3 mm na diluição 1:10; e de 9,8 mm na diluição 1:30. Houve diferenças significativas entre os extratos A, B, C, D e E na comparação entre as médias das pápulas obtidas em todas as diluições, mostrando diferença de potência entre os extratos. O diâmetro das pápulas obtidas com o material concentrado, em ordem decrescente de potência, foram C > A > E > D > B. As reações observadas com extratos concentrados mostrou que o mais potente foi Staloral, e o menos potente Grazax. Conclusões: Houve variabilidade significativa de potência nos diversos extratos comparados. Isto reforça a necessidade de padronização de extratos alergênicos para ITSL.

Objectives: To compare the potency of European Phleum pratense pollen extracts for sublingual immunotherapy (SLIT) compared to the U.S. reference extract. Methods: Fifteen subjects aged between 18 and 55 years, with compatible seasonal clinical history and skin tests highly reactive to grass, were selected. The design was cross-sectional, blind, randomized. The following extracts were compared for SLIT: (A) Soluprick® (30 HEP/mL) and (B) Grazax® 75,000 SQ-T, both from ALK-Abelló; (C) Oralair® and (D) Staloral®, with 300 IR/mL, Stallergènes, France. The American extract (E) was the standard 10,000 BAU/mL. Extracts were used in concentrate form and also diluted in 1:3, 1:10, and 1:30 ratios. Tests were applied in quadruplicate on two nonconsecutive days. Skin test reading were done after 15 minutes. Results: There were no significant differences between the tests conducted on the first and second days with the extracts in concentrate form (p = 0.37) or diluted at 1:3 or 1:10 (p = 0.20, p = 0.33, respectively). On the second day of tests, mean wheal sizes obtained with extract A were 16.7 mm with the 1:3 dilution, 14.3 mm with the 1:10 dilution, and 9.8 mm with the 1:30 dilution. There were significant differences between extracts A, B, C, D and E when comparing mean wheal sizes obtained with all dilutions, demonstrating differences in the extracts' potency. Mean wheal diameters obtained with the concentrates, in decreasing order of potency, were C > A > E > D > B. The reactions showed that the most potent extract was Staloral, and the least potent, Grazax. Conclusions: There were significant potency variations in the different extracts assessed. These results reinforce the need for standardization of allergenic extracts used for SLIT.

Phylogenic Characteristics of a Unique Antagonistic Micromonospora Sp. Rc5 to S. aureus Isolated from Sinai Desert of Egypt

A distinct strain named Micromonospora sp. Rc5 was isolated from Sinai desert of Egypt and recorded high antagonistic activities against some food and bloodborne pathogens. Morphological and chemotaxonomy characterization confirmed that this isolate belongs to genus Micromonospora. Sequencing of partial 16S rDNA and BLASTN showed that isolate Rc5 is identical to Micromonospora haikouensis (99%) but with low bootstrap value in NJ phylogenetic tree. Comprehensive optimization of several growth factors was performed including initial pH, incubation periods, and different sources of carbon and nitrogen. The highest yield of antimicrobial agent production was obtained after 8 days of incubation at 30°C, pH 6.0, 3 x 105CFU/ml in soya bean meal broth media with agitation of 150 rpm. A dramatic proportional decrease occurred with 0.3, 0.6, 0.9 µg active fraction /ml against Staphylococcus aureus culture and reached to complete inhibition at a minimum inhibitory concentration of (1.5 µg /ml). The physicochemical characterization of the purified fraction was identified as phthalate derivative. Our results indicated that Rc5 generated potential antimicrobial compounds against foodborne pathogens and   may combat resistant strains of Staphylococcus aureus.

Síndrome hepatopulmonar: revisión narrativa / Hepatopulmonary syndrome: a narrative revision

Resumen: el síndrome hepatopulmonar es una de las tres principales condiciones pulmonares en pacientes con enfermedad hepática o hipertensión portal. Esta alteración es causada por la circulación hiperdinámica, los cortocircuitos intrapulmonares y la vasodilatación pulmonar, lo que lleva a alteraciones que generan un compromiso en el intercambio gaseoso, el cual se manifiesta como hipoxemia y aumento del gradiente alveolo arterial. El diagnóstico del síndrome hepatopulmonar consiste en demostrar las alteraciones del intercambio gaseoso, por medio del análisis de los gases arteriales, y las dilataciones vasculares intrapulmonares, documentadas por ecocardiografía transtorácica contrastada con solución salina agitada, la cual es considerada el estándar de referencia. Por el impacto pronóstico del síndrome hepatopulmonar, se recomienda una tamización activa que permita un diagnóstico temprano, y referir a tiempo al paciente a un centro especializado para la valoración de trasplante hepático como único tratamiento disponible curativo. El objetivo de este artículo es proporcionar una revisión narrativa sobre el síndrome hepatopulmonar, con énfasis en la definición, diagnóstico, fisiopatogénesis y medidas terapéuticas disponibles. (AU)

Abstract: Hepatopulmonary syndrome is one of the three main pulmonary disorders affecting patients with liver disease or portal hypertension. This disease is caused by hyperdynamic circulation, intrapulmonary shunts, and pulmonary vasodilation, which leads to disturbances in gas exchange, evidenced by hypoxemia and increased alveolar-arterial gradient. Diagnosis of hepatopulmonary syndrome requires arterial blood gas analysis and documentation of intrapulmonary vascular dilation by transthoracic echocardiogram with agitated saline contrast; the gold standard for hepatopulmonary syndrome diagnosis. Due to the prognostic value of hepatopulmonary syndrome, active screening is recommended in order to achieve early diagnosis and timely patient referral to a specialized center to be evaluated as a candidate for liver transplant, as it currently is the only available curative treatment. The aim of this article is to provide a narrative review of current literature on hepatopulmonary syndrome, focusing on its definition, diagnosis, physiopathogenesis, and available therapeutic approaches. (AU)

Resposta endócrina à contenção física e isolamento em papagaios-verdadeiros / Endocrine response to physical restraint and isolation in blue-fronted parrots

O objetivo deste trabalho foi analisar a resposta dos papagaios-verdadeiros aos procedimentos de contenção e separação física por método não invasivo, como a dosagem das concentrações de metabólitos de glicocorticoides nas excretas. Para tanto, foram utilizadas 24 aves, 17 machos e sete fêmeas, inicialmente mantidas em viveiros amplos e adjacentes, separadas por sexo. Após captura e contenção de três minutos, 13 aves voltaram para os viveiros coletivos e 11 foram alojadas em gaiolas individuais no mesmo recinto dos viveiros, de modo a permitir que as aves isoladas mantivessem contato visual e auditivo com as demais. Para avaliar se os animais responderiam de maneira diferente quando fisicamente isolados ou em grupo, amostras de excretas foram coletadas sequencialmente em intervalos de três horas durante 24 horas para avaliação dos metabólitos de glicocorticoides por enzimaimunoensaio. Não houve efeito significativo de sexo (P=0,5850), tratamento (P=0,6805) e tempo (P=0,2293), e as concentrações de metabólitos de glicocorticoides mantiveram-se dentro da variação diurna esperada para esta espécie. Portanto, ambos os grupos responderam endocrinologicamente de forma semelhante e o estresse de captura e separação física não foi significativo para as aves.(AU)

The aim of this study was to evaluate the response of blue-fronted parrots to restraint procedures and separation by non-invasive methods such as measurement of glucocorticoid metabolites in droppings. For this, we utilized 24 birds, 17 males and 7 females, initially kept in large adjacent aviaries, separated by sex. After capture and 3 minutes of manual contention, by random, 13 birds returned to the aviary and 11 animals were housed in individual cages in the same facility of the aviaries allowing the maintenance of auditory and visual contact between them. In order to evaluate if the physically isolated birds isolated or in groups would react in different ways, all droppings samples were collected at 3-hours intervals during 24 hours to evaluation of excreted glucocorticoid metabolites by enzimeimmunoassay. There were no significant effects of sex (P=0.5850), treatment (P=0.6805) and time (P=0.2293) and the glucocorticoid metabolites concentrations were within the diurnal range expected for this specie. Therefore, the endocrine response of both groups was similar and stress of capture and physical separation was not significant for the birds.(AU)

The prevalence of tic disorders in children and adolescents in Brazil / A prevalência dos transtornos dos tiques em crianças e adolescentes no Brasil

Tourette syndrome (TS) and tic disorders represent events of familiar magnitude characterized by involuntary movements and/or vocalization. To determine the prevalence of TS/tic disorders we studied a sample of 762 subjects (388 M, 374 F), between 1992 and 1997, age 6 to 43 years old, taken out of a population of 10,155 subjects (4,918 M, 5,237 F; age: 3-56 years old). A structured 4-item questionnaire, direct interview (multistaged), >1 yr follow-up, were used. 9,565 subjects (4,614 M, 4,951 F) sent back the questionnaires, 3,354 of these (1,671 M, 1,683 F) with positive answers to tics. 42 subjects (31 M, 11 F, age: 7-21 years old, mean: 11 years old) met the DSM-III-R criteria. The total minimal prevalence of TS is 0.43%, with a 3:1 ratio male/female. The minimal prevalence of chronic tic disorder is 2.27%. The total minimal prevalence for tic disorders at all is 2.91%. No special education students participation.

Síndrome de Tourette e transtornos de tiques representam eventos de magnitude familiar caracterizados por movimentos involuntários e/ou vocalização. Para determinar a prevalência de TS/transtornos de tiques, estudamos uma amostra de 762 indivíduos (286 M, 376 F), entre 1992 e 1997, de 6 a 43 anos de idade, retirados de uma população de 10.155 indivíduos (4.918 M, 5.237 F, idade: 3-56 anos). Questionário de avaliação inicial (4 itens), entrevista direta, follow-up >1 ano, foram utilizados. 9.565 indivíduos (4.614 M, 4.951 F) retornaram seus questionários, 3.354 (1.671 M, 1.683 F), com respostas positivas para tiques. 42 sujeitos (idade 31 M, 11 F, 7-21 anos, média: 11 anos) preencheram os critérios diagnósticos do DSM-III-R. A prevalência total mínima para TS é de 0,43% (3 M:1 F), e para transtornos de tiques crônicos é de 2,27%. A prevalência total mínima para transtornos dos tiques é 2,91%. Nenhuma participação de estudantes de classe especial.

Síndrome de Wiskott Aldrich. Presentación de un caso / Wiskott Aldrich Syndrome. Presentation of a Case

El síndrome de Wiskott Aldrich es una inmunodeficiencia primaria clasificada dentro del grupo de las bien definidas, se hereda con carácter recesivo ligado al X, el gen mutado codifica para una proteína citoplasmática presente en linfocitos y megacariocitos importante en la regulación de la polimerización de la actina y traducción de señales necesarias para la reorganización del citoesqueleto celular. Las manifestaciones clásicas están dadas por sangramientos, infecciones y eczemas; sus primeros síntomas pueden aparecer al nacimiento con hemorragia petequial, diarreas con sangre; mientras las infecciones y el eczema se desarrollan durante el primer año de edad, la otitis media es la infección que se presenta con mayor frecuencia. Desde el punto de vista inmunológico se caracteriza por tener niveles de inmunoglobulina M bajos, las inmunoglobulinas A y E son elevadas, mientras la inmunoglobulina G puede ser normal a lo que se une trombocitopenia. El diagnóstico de esta enfermedad se realizó en un niño de tres meses de edad, el cual permaneció ingresado por largo tiempo en cuidados intensivos y falleció a los dos años de edad por sepsis generalizada.

The Wiscott Aldrich Syndrome is a well-defined primary immunodeficiency X- linked recessive disorder, the mutated gene encodes a cytoplasmatic protein in lymphocytes and megakaryocytes which is important in actin polymerization and cytoskeletal reorganization .The classic manifestations involve bleeding, infections and eczema. The first symptoms may appear at birth with petechial hemorrhage, diarrhea with blood, while infections and eczema are present during the first year of age, otitis media is an infection that occurs more frequently. From the immunological point of view it is characterized by low levels immunoglobulin M, immunoglobulin A and E are high, while immunoglobulin G may be normal together with thrombocytopenia. This disorder was diagnosed in a three- year- month infant who was admitted at intensive care unit for a long period of time. The patient died when he was two years old due to generalized infection.

The Sciences of Learning, Instruction, and Assessment as Underpinnings of the Morningside Model of Generative Instruction / Las Ciencias de Aprendizaje, Instrucción y Evaluación como Cimientos de la Instrucción Generativa del Modelo Morningside

This paper focuses on a subset of the practices that have created the powerful learning technology developed and disseminated by Morningside Academy in Seattle, Washington, U.S.A. We briefly describe this technology, known as the Morningside Model of Generative Instruction, and tell how it builds on the selectionist approach of B. F. Skinner and the pragmatic approach of John Dewey. We also describe the critical role Precision Teaching plays at Morningside Academy and its dependence on findings from the science of learning and the science of instruction, including placement of learners, task analysis, content analysis, instructional protocols, and principles of instructional design. Last, we acknowledge the symbiotic relation between effective Direct Instruction programs that teach skills to accuracy levels and Precision Teaching, which takes these accurate repertoires and systematically turns them into high frequency performances that take on the character of fluent repertoires. Over time, using Precision Teaching across multiple and successive repertoires also creates more agile learners.

Este trabajo se enfoca en una serie de prácticas que han creado la poderosa tecnología de aprendizaje desarrollada y diseminada por la Academia Morningside en Seattle, Washington, E. U. Se describe brevemente dicha tecnología, conocida como el Modelo Generativo de Instrucción Morningside y se menciona cómo se construyó bajo la aproximación seleccionista de B. F. Skinner y la aproximación pragmática de John Dewey. También se describe el rol crítico que la Instrucción de Precisión juega en la Academia Morningside y su dependencia en hallazgos de la ciencia del aprendizaje y en la ciencia de la instrucción, incluyendo el papel de los aprendices, el análisis de tareas, el análisis de contenido, los protocolos instruccionales y los principios del diseño instruccional. Finalmente, se reconoce la relación simbiótica entre los programas de Instrucción Directa efectiva, que enseñan habilidades para lograr niveles de precisión y la Enseñanza de Precisión, que considera dichos repertorios precisos y sistemáticamente los convierte en ejecuciones de alta frecuencia que tienen el carácter de repertorios fluidos. Con el paso del tiempo, usar la Enseñanza de Precisión a través de múltiples repertorios sucesivos también crea aprendices más ágiles.

Universal Combination Antiretroviral Regimens to Prevent Mother-to-Child Transmission of HIV in Rural Zambia: a Two-Round Cross-Sectional Study

To evaluate if a pilot programme to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) was associated with changes in early childhood survival at the population level in rural Zambia.Methods Combination antiretroviral regimens were offered to pregnant and breastfeeding; HIV-infected women; irrespective of immunological status; at four rural health facilities. Twenty-four-month HIV-free survival among children born to HIV-infected mothers was determined before and after PMTCT programme implementation using community surveys. Households were randomly selected and women who had given birth in the previous 24 months were asked to participate. Mothers were tested for HIV antibodies and children born to HIV-infected mothers were tested for viral deoxyribonucleic acid. Multivariable models were used to determine factors associated with child HIV infection or death. Findings In the first survey (2008-2009); 335 of 1778 women (18.8) tested positive for HIV. In the second (2011); 390 of 2386 (16.3) tested positive. The 24-month HIV-free survival in HIV-exposed children was 0.66 (95 confidence interval; CI: 0.63-0.76) in the first survey and 0.89 (95 CI: 0.83-0.94) in the second. Combination antiretroviral regimen use was associated with a lower risk of HIV infection or death in children (adjusted hazard ratio: 0.33; 95 CI: 0.15-0.73). Maternal knowledge of HIV status; use of HIV tests and use of combination regimens during pregnancy increased between the surveys. Conclusion The PMTCT programme was associated with an increased HIV-free survival in children born to HIV-infected mothers. Maternal utilization of HIV testing and treatment in the community also increased

Genetic profile of Mycobacterium Tuberculosis and Treatment Outcomes in Human Pulmonary Tuberculosis in Tanzania

Information on the different spoligotype families of Mycobacterium tuberculosis in Tanzania is limited; and where available; restricted to small geographical areas. This article describes the genetic profile of M. tuberculosis across Tanzania and suggests how spoligotype families might affect drug resistance and treatment outcomes for smear positive pulmonary tuberculosis patients in Tanzania. We conducted the study from 2006 to 2008; and the isolates were obtained from samples collected under the routine drug resistance surveillance system. The isolates were from specimens collected from 2001 to 2007; and stored at the Central and Reference Tuberculosis Laboratory. A total of 487 isolates from 23 regions in the country were spoligotyped. We were able to retrieve clinical information for 446 isolates only. Out of the 487 isolates spoligotyped; 195(40.0) belonged to the Central Asian (CAS) family; 84 (17.5) to the Latin American Mediterranean (LAM) family; 49 (10.1) to the Latin American Mediterranean (LAM) family; 49 (10.1) to the East-African Indian (EAI) family; and 33 (6.8) to the Beijing family. Other isolates included 1 (0.2) for H37Rv; 10 (2.1) for Haarlem; 4 (0.8) for S family; 58 (11.9) for T family and 52 (10.7) for unclassified. No spoligotype patterns were consistent with M. bovis. Regarding treatment outcomes; the cure rate was 80 with no significant variation among the spoligotype families. The overall level of MDR TB was 2.5 (3/121); with no significant difference among the spoligotype families. All Beijing strains (11.8; 30/254) originated from the Eastern and Southern zones of the country; of which 80 were from Dar es Salaam. Isolates from the CAS and T families were reported disproportionately from the Eastern-Southern zone; and EAI and LAM families from the Northern-Lake zones but the difference was not statistically significant. Five isolates were identified as non-tuberculous Mycobacteria. In conclusion; M. tuberculosis isolates from pulmonary tuberculosis cases in Tanzania were classified mostly within the CAS; LAM; and EAI and T families; while the Beijing family comprised about 7 isolates only. Consistently good treatment outcomes were recorded across these spoligotype families. The proportion of drug resistance strains was low. The findings also suggest variation of spoligotype families with varying geographical localities within the country; and identify this area for further research to confirm this finding