Rapid detection of Mycobacterium tuberculosis in children using blood and urine specimens

Abstract INTRODUCTION: Laboratory and clinical features of childhood tuberculosis (TB) are non-specific and establishing an accurate diagnosis remains a challenge. This study evaluated a Single tube nested-PCR (STNPCR) to detect genomic DNA of Mycobacterium tuberculosis complex in blood and urine. METHODS: Biological samples were obtained from children (<15 years old) with clinical suspicion of pulmonary and extrapulmonary TB at public hospitals in Recife-Pernambuco, Brazil. Cultures yielded negative results in a majority of childhood TB cases, which are generally paucibacillary. A set of clinical, epidemiological, radiological, and laboratory criteria with evident clinical improvement after anti-TB treatment were frequently used to define childhood TB cases. RESULTS: Ninety children with clinical suspicion were enrolled in this study (44 with TB and 46 without TB). The pulmonary TB group had 20 confirmed cases and 46 negative controls, while the extrapulmonary TB group had 24 confirmed cases. The STNPCR showed sensitivities to pulmonary and extrapulmonary TB of 47.4% and 52.2% (blood) and 38.8% and 20% (urine), respectively. Considering the low performance of STNPCR on separate samples, we decided to perform a combined analysis (parallel sensitivity analysis) of the results from blood and urine samples. The parallel sensitivity increased to 65% in blood and 62.5% in urine. The specificity in both samples ranged from 93.5-97.8%. CONCLUSIONS: Although STNPCR showed moderate sensitivity, the specificity is high; therefore, the test can be used as an auxiliary tool to diagnose TB in children. It is a rapid test that demonstrated better performance than other diagnostic tests in paucibacillary samples as it does in childhood tuberculosis.

Patient with Recurrent Glioblastoma Responding Favorably to Ketogenic Diet Combined with Intranasal Delivery of Perillyl Alcohol: A Case Report and Literature Review

Introduction Monoterpene perillyl alcohol (POH) is cytotoxic to temozolomideresistant glioma cells, regardless of its O6-methylguanine-methyltransferase (MGMT) promoter methylation status. Moreover, adherence to a ketogenic diet (KD) produced successful outcomes in preclinical and clinical studies in the glioma setting. Case Presentation A 54-year-old Caucasian man had a confirmed diagnosis of refractory glioblastoma multiforme (GBM). The immunohistochemical evaluation was negative for methylation, and failed to detect mutations in the isocitrate dehydrogenase (IDH) 1 and 2 genes. In January 2016, the patient was enrolled in a clinical trial combining daily intranasal delivery of POH in combination with a KD. The KD was administered concomitantly with inhalation of POH (55 mg, 4 times a day) in an uninterrupted administration schedule for 3 months. Results The combination treatment was well-tolerated. The nutritional status and anthropometric measurements of the patient were measured. Adherence to the KD was confirmed by measuring the levels of ketone bodies in the urine. Throughout the treatment, a reduced frequency of seizures was observed. After three months of adherence to the treatment, the patient presented with weight loss, reduced body fat, increased water retention, and a slight increase in bone and muscle mass. A follow-up magnetic resonance imaging (MRI) scan after 3 months of treatment revealed marked reduction of the enhancing lesion. Conclusion Intranasal delivery of POH combined with concomitant adherence to a KD appeared to have a beneficial therapeutic effect in a patient with recurrent GBM. Further studies are needed to evaluate the efficacy of this therapeutic strategy in a larger cohort of treatment-refractory GBM patients.

Introdução O monoterpeno álcool perílico (AP) é citotóxico para linhagens celulares de glioblastoma, independentemente do status do promotor de metilação O6-metilguaninametiltransferase (MGMT). Além disso, a adesão à dieta cetogênica (DC) produziu resultados bem sucedidos em desenho de estudos pré-clínicos e clínicos de glioma. Relato de Caso Homem, 54 anos, caucasiano, com diagnóstico de glioblastoma multiforme (GBM) recidivo. A avaliação imuno-histoquímica foi negativa para metilação e não detectou mutações do gene da isocitrato desidrogenase 1 e 2 (IDH1 IDH2). Em janeiro de 2016, o paciente foi inscrito em um ensaio clínico da administração intranasal diária do AP combinada a DC. A DC foi administrada concomitantemente com inalação de AP (55 mg, 4 vezes ao dia) em um cronograma de administração ininterrupto durante 3 meses. Resultados O tratamento combinado foi bem tolerado. O estado nutricional e as medidas antropométricas do paciente foram avaliadas. Aderência a DC foi confirmada pela presença de corpos cetônicos na urina. Ao longo do tratamento, observou-se redução da frequência de convulsões. Após três meses de adesão ao tratamento, o paciente apresentou perda de peso, redução da gordura corporal, melhor hidratação e um aumento discreto da massa óssea e muscular. O acompanhamento da ressonância magnética após 3 meses de tratamento revelou redução acentuada do volume da lesão. Conclusão A administração intranasal do AP combinada a DC sugere ter um efeito terapêutico benéfico em pacientes com GBM recorrente. São necessários mais estudos para avaliar a eficácia desta estratégia terapêutica em uma coorte maior de pacientes com GBM refratários.

Osteoarticular tuberculosis in an HIV-positive patient: a case report

The authors report a case of a 38-year-old HIV-positive woman, with subcutaneous nodules on the thoracic region with 3 months of evolution. Clinical, laboratory, and epidemiological features were evaluated and associated with apparent damage to the T11-T12 vertebrae, identification by imaging tests, positivity in a polymerase chain reaction-based test, and reactivity to the Mantoux tuberculin skin test (PPD-RT 23). The patient was diagnosed with osteoarticular tuberculosis and received treatment for a year, and clinical cure was achieved.

Phylogeographical analysis of neotropical Rhagoletis (Diptera: Tephritidae): did the Andes uplift contribute to current morphological differences? / Análisis filogeográfico de Rhagoletis neotropicales (Diptera: Tephritidae): ¿ha contribuido el levantamiento de los Andes a explicar las actuales diferencias morfológicas?

Neotropical Rhagoletis species are arranged in four groups: nova,psalida,striatella and ferruginea, which include 18 species. On both sides of the Andes, the evolution of morphological differences among these groups has been suggested to be related to the Andes uplift process. In order to test this hypothesis, a phylogenetic analysis of morphological and molecular data was performed. The results suggest that: 1) Neotropical species of Rhagoletis constitute a separate group from Paleartic and North American species, with the only exception being a member of the striatella group having a certain association with the northern species. 2) Neotropical species seem to form a monophyletic clade, although statistical support for this is weak. 3) The split of South American Rhagoletis from other groups was dated at 4.333 million years ago, which is before the emergence of a continuous landbridge between Central and South América. 4) Within species distributed in South América, morphological and molecular data were coincident, placing species of the ferruginea group separate from the other Neotropical Rhagoletis. 5) The divergence of the ferruginea group from the other groups was dated at 3.882 million years ago, which is before the last uplift of the Andes. These results suggest that diversification of the ferruginea,psalida and nova groups, on each side of the Andes, was the result of a vicariant separation followed by dispersal and isolation processes. Thus, these results support the hypothesis that the Andes uplift has played an important role in Neotropical Rhagoletis diversification.

Las especies de Rhagoletis neotropicales han sido agrupadas en cuatro grupos: nova,psalida,striatella y ferruginea, constituyendo 18 especies. Se han descrito diferencias morfológicas entre estas especies a ambos lados de la cordillera de los Andes que podrían relacionarse con el proceso de levantamiento cordillerano. En este trabajo se evalúa esta hipótesis usando análisis filogenético de atributos morfológicos y moleculares. Los resultados muestran que: a) las especies Neotropicales de Rhagoletis constituyen un grupo separado de las especies Palearticas y Norteamericanas, con la excepción de un miembro del grupo striatella el cual presenta cierta asociación con las especies Norteamericanas; 2) Las especies Neotropicales parece conformar un clado monofilético; 3) La separación de los grupos Sudamericanos de otros grupos fue estimada en 4.333 millones de años antes del presente, proceso anterior a la emergencia del puente de tierra entre América Central y Sudamérica; 4) Dentro de las especies con distribución Sudamericana, los caracteres morfológicos y moleculares coinciden en ubicar algunas especies del grupo ferruginea separadas de especies de Rhagoletis Neotropicales. 5) La separación del grupo ferruginea fue estimada en 3.882 millones de años antes del presente, evento que precede al último levantamiento de los Andes. La diversificación de los grupos ferruginea,psalida y nova a uno y otro lado de la cordillera de los Andes parece responder inicialmente a un proceso vicariante y posteriores eventos de dispersión y aislamiento. Estos resultados sugieren que el levantamiento de los Andes habría participado en los patrones de diversificación de las Rhagoletis Neotropicales.

Marcos de referencia de los maestros fortalecedores del pensamiento matemático en niños / Reference framework of maths teachers in the classroom

Esta investigación tuvo como propósito principal caracterizar los marcos de referencia de los maestros que favorecen la comprensión de las matemáticas en estudiantes de primaria en 10 colegios de Bogotá. Se utilizó una investigación de tipo cualitativo, en la cual se identificaron estudiantes que evidenciaban un desempeño académico en el área de matemáticas por encima del promedio, luego se recogió información a través de la observación en el aula y de la entrevista semiestructurada a los maestros. Se utilizó el análisis de contenido de tipo categorial y las matrices de cotejación. Como resultado se evidenció el papel predominante de la afectividad, los contextos inmediatos y la historia de vida de los estudiantes en los marcos de referencia de los maestros.

The aim of this research was to characterize the reference framework of teachers that favour mathematical comprehension at the elementary level in ten schools in Bogotá. A qualitative research was used in which the students who showed performance above average were identified. The information was then gathered through direct classroom observation and semi- structured interview of the instructors. A categories analysis as a type of content analysis was also used. As a result, the predominant roll of affectivity was found out together with immediate contexts, and the life history of the students in the reference framework of the teachers.

Administração intranasal do agente antitumoral álcool perílico: estratégia terapêutica para pacientes com glioblastoma recidivado / Intranasal delivery of anti-tumor agent perillyl alcohol: potential therapeutic alternative for patients with relapsed glioblastoma

Álcool perílico (AP) é um monoterpeno com ação antitumoral comprovada, em estudos pré-clínicos, sobre diferentes tipos de tumores induzidos em animais. Fase I e II de ensaios clínicos estão correntemente em desenvolvimento. O mecanismo de ação da atividade antitumoral do AP envolve a inibição da isoprenilação pós-traducional de proteinas G, incluindo a p21-Ras, bloqueando a transdução do sinal. A desregulação da função da p21-Ras, como resultado de mutação, superexpressão ou superativação dos fatores de crescimento, contribui para o crescimento de glioblastoma. A administração intranasal é uma abordagem prática e não-invasiva que permite que agentes terpêuticos que não cruzam a barreira hemato-encefálica alcancem o sistema nervoso central, reduzindo os efeitos colaterais provenientes da administração sistêmica. Este artigo discute a administração intranasal do AP, como potencial estratégia terapêutica multimodal para estas neoplasias e apresenta resultado preliminar em um caso.

Prevalencia de la mutacion del factor V de la coagulacion (factor V Leiden) en donantes de banco de sangre en cuatro ciudades colombianas / Mutation of factor V of coagulation

Introducción: la resistencia a la proteína C activada es el factor de riesgo genético más frecuente en los casos de tromboembolismo en la población caucásica, siendo responsable de aproximadamente 20 a 60 por ciento de los casos de trombofilia familiar. La sustitución de arginina (R) por ácido glutámico (Q) en la posición 506 del factor V de la coagulación, mutación denominada factor V Leiden, se encuentra en 95 por ciento de los casos de resistencia a la proteína C activada. Estudios en diferentes poblaciones alrededor del mundo han demostrado que esta mutación se encuentra restringida a las poblaciones con origen o mezcla de genes caucásicos. Objetivo: determinar la prevalencia de la mutación del factor V de la coagulación (factor V Leiden) en donantes de banco de sangre de cuatro ciudades colombianas. Material y métodos: en este estudio fueron genotipificados 495 individuos seleccionados dentro de un grupo de donantes de banco de sangre, distribuidos de la siguiente manera: 370 de Santafé de Bogotá, 50 de Barranquilla, 45 de Bucaramanga y 30 de Medellín. Resultados: se encontró una prevalencia del factor V Leiden de 1,44 por ciento en la población estudiada. Conclusión: la mutación del factor V, factor V Leiden, se encuentra presente en la muestra estudiada, y es un riesgo que debe ser investigado en pacientes con trombosis idiopática