Candida Tropicalis Spondylodiscits in an Immunocompetent Host: A Case Report and Literature Review

Background Fungal spondylodiscitis is not common but should be suspected in some cases. Candida tropicalis infections are being more frequently diagnosed due to some factors related to the microorganism. Case Description A C. tropicalis spondylodiscitis is described in a 72-year-old man who was treated with a combination of echinocandin (micafungin) and surgery. Conclusion The presence of some risk factors should promptly raise the suspicion of fungal spondylodiscitis. Treatment should be instituted as early as possible for the best outcome for the patient.

Trastornos linfoproliferativos en una cohorte de pacientes adultos con trasplante hepático atendidos en un hospital de referencia en Bogotá, Colombia / Post-transplant lymphoproliferative disorders in a cohort of adult patients with a liver transplant from a reference hospital in Bogotá, Colombia

Introducción. Los trastornos linfoproliferativos después de un trasplante se caracterizan por la proliferación descontrolada de linfocitos como consecuencia del tratamiento inmunosupresor posterior a este. Objetivo. Caracterizar clínica y patológicamente los casos de trastornos linfoproliferativos después de trasplante (Post-Transplant Lymphoproliferative Disorders, PTLD) en una cohorte de pacientes adultos con trasplante de hígado atendidos a lo largo de 15 años en el Hospital Universitario Fundación Santa Fe de Bogotá. Materiales y métodos. Se hizo un estudio observacional retrospectivo a partir de la revisión de las bases de datos de la Unidad de Trasplante Hepático y del Departamento de Patología del Hospital en busca de los casos de PTLD diagnosticados durante el periodo de estudio. Se recolectó la información epidemiológica, clínica y patológica, y se adelantaron los análisis estadísticos. Resultados. Durante el periodo de estudio, hubo 572 pacientes con trasplante de hígado, la incidencia de trastornos linfoproliferativos fue de 2,44 %, el 79 % en hombres, y la edad promedio en el momento del diagnóstico fue de 62,5 años. El 71 % de los casos se presentó durante los primeros 12 meses después del trasplante y el mismo porcentaje fue seropositivo para el virus de Epstein-Barr (EBV). El fenotipo patológico más frecuente fue el monomorfo y la mayoría de los tumores se detectaron en el hilio hepático. La supervivencia al año fue del 50 %. Conclusiones. Llamó la atención el alto porcentaje de casos de presentación temprana, así como la gran frecuencia de seropositividad para el EBV tanto en los donantes como en los receptores. Deben adelantarse estudios más detallados para una mejor comprensión de esta enfermedad en el país. Este es el primer análisis clínico y patológico de PTLD en pacientes con trasplante de hígado adelantado en Colombia hasta la fecha.

Introduction: The post-transplant lymphoproliferative disorders (PTLD) are characterized by an uncontrolled pathological lymphoid proliferation as a consequence of transplant immunosuppression therapy. Objective: To characterize the clinical and pathological characteristics of PTLD in a cohort of adult patients with liver transplant during a 15 year period at the Hospital Universitario Fundación Santa Fe de Bogota. Materials and methods: We conducted an observational retrospective study by searching for the PTLD cases diagnosed during the study period in the databases of the Liver Transplantation Unit and the Pathology Department. We collected the epidemiological, clinical, and pathological information and performed the corresponding statistics analyses. Results: During the research period, 572 patients were transplanted; the incidence of PTDL was 2.44%; 79% of them were man and the average age at the time of diagnosis was 62.5 years; 71% of the cases were diagnosed during the first year after the transplant and the same percentage EBV-seropositive patients. The most frequent pathological phenotype was monomorphic and the majority of tumors was detected in the hepatic hilum. The one-year survival was 50%. Conclusion: The high proportion of early cases and the high frequency of Epstein-Barr virus seropositivity both in donors and receptors drewour attention. More studies are necessary to have a better understanding of this condition in Colombia. This is the first PTLD clinical and pathological analysis in liver-transplant patients from Colombia to date.

Influence of Family History of Diabetes on Cardiac Autonomic Dysfunction of Adolescents

Abstract Background To evaluate cardiac autonomic modulation of adolescents with a family history of diabetic parents. Objective This study aims to evaluate the influence of a family history of diabetes on cardiac autonomic modulation. Methods This is an analytical and cross-sectional study on adolescents between 11 and 18 years of age, of both genders, who were divided into group with a family history of diabetes and a control group without a family history of diabetes. The study protocol consisted of the analysis of heart rate variability, blood pressure, anthropometric measurements, and body composition. Also, by using questionnaires, level of physical activity, sexual maturation, and sleep quality were evaluated. Normality of data distribution was tested using the Kolmogorov-Smirnov test. Then, statistical significance was evaluated using the Student's t-test, and the Cohen's teste was used for calculation of the effect size. The level of significance adopted in the statistical analysis was 5%. Results When the group of individuals with a family history of diabetes was compared with the control group, statistically significant differences were observed in the variables the standard deviation of the NN time series interval (SDNN) (43.9 ± 2.2 vs. 53.5 ± 2.6 ms), the square root of the quadratic differences (RMSSD) (41.9 ± 3.3 vs. 52.4 ± 3.2 ms), standard deviation of beat-to-beat instantaneous variability (SD1) (29.7 ± 2.3 vs. 37.1 ± 2.3 ms), long-term standard deviation of continuous RR intervals (SD2) (. 54.1 ± 2.6 vs. 66.66 ± 3.5 ms), and in low frequency (LF) (496.0 ± 49.5 vs. 728 ± 71.6 ms2) and high frequency (HF) (1050.0 ± 120.4 vs. 737.4 ± 98.5 ms2) in the frequency domain. Conclusions Global autonomic modulation is decreased in adolescents with a family history of diabetes. We also observed a decrease in vagal activity in this group. So, sympathetic autonomic modulation is predominant in this population. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Caracterización clínica e histopatológica de niños con hepatitis autoinmune en un centro de referencia de Bogotá, Colombia / Clinical and histopathological characterization of children with autoimmune hepatitis at a referral center in Bogotá, Colombia

Resumen La hepatitis autoinmune (HAI) es una enfermedad hepática inflamatoria progresiva poco frecuente en niños y adolescentes, la cual es un reto diagnóstico para clínicos y patólogos. Describimos las características clínicas, bioquímicas e histopatológicas de 21 pacientes pediátricos con HAI diagnosticados en los últimos 14 años. Las biopsias hepáticas se reevaluaron para analizar detalladamente los hallazgos histopatológicos. De los 21 casos evaluados, 12 (57,1%) fueron mujeres, la mediana de edad fue 14 años, y 17 (80,9%) tenían HAI tipo 1. Los signos clínicos más frecuentes fueron ictericia (66,7%) y coluria (44,4%); también hubo evidencia de hipertensión portal con várices esofágicas (47,1%) y esplenomegalia (41,2%). El 11,8% de los pacientes tenía antecedentes de otras enfermedades autoinmunes. El 89,5%, 88,9% y 60,0% de los casos tenía elevación de aminotransferasas, hiperbilirrubinemia y bajos niveles de albúmina sérica, respectivamente. Las biopsias reevaluadas mostraron infiltrado linfoplasmocitario portal (94,4%), hepatitis de interfase (77,8%) y formación de rosetas (50,0%). En el 42,9% de las biopsias se hallaron inclusiones hialinas en las células de Kupffer. Cerca del 33,5% de los casos mostró cirrosis en la biopsia inicial. A pesar del tratamiento inmunosupresor, 4 pacientes requirieron trasplante hepático y 2 están en lista de espera. La HAI en niños puede manifestarse con ictericia y coluria, signos de hipertensión portal, aminotransferasas elevadas, hiperbilirrubinemia y anticuerpos circulantes. Las inclusiones hialinas en las células de Kupffer pueden ser un hallazgo útil en el diagnóstico histopatológico de la HAI en niños.

Abstract Autoimmune hepatitis (AIH) is a progressive inflammatory liver disease. It is uncommon in children and adolescents, and is a diagnostic challenge for clinicians and pathologists. We describe the clinical, biochemical and histopathological characteristics of 21 pediatric patients with AIH diagnosed in the last 14 years. Liver biopsies were reassessed to analyze histopathological findings in detail. Of the 21 cases evaluated, 12 (57.1%) were girls and young women, the median age was 14 years old, and 17 (80.9%) had type 1 AIH. The most frequent clinical signs were jaundice (66.7%), choluria (44.4%), evidence of portal hypertension with esophageal varices (47.1%), and splenomegaly (41.2%). Histories of other autoimmune diseases were found in 11.8% of these patients. Elevated levels of aminotransferases were found in 89.5% of the patients, hyperbilirubinemia was found in 88.9%, and 60.0% of the cases had low levels of serum albumin. Reassessed biopsies showed portal lymphoplasmocytic infiltrate (94.4%), interface hepatitis (77.8%) and rosette formation (50.0%). Hyaline inclusions were found in Kupffer cells in 42.9% of the biopsies. About 33.5% of the cases showed cirrhosis at the initial biopsy. Despite immunosuppressive treatment, four patients required liver transplantation and two are on the waiting list. AIH in children can manifest with jaundice, choluria, signs of portal hypertension, elevated aminotransferases, hyperbilirubinemia and circulating antibodies. Hyaline inclusions in Kupffer cells may be a useful finding in the histopathological diagnosis of AIH in children.

Saber Compartilhado no Cuidado ao Portador de Diabetes Mellitus como Produto de uma Pesquisa de Mestrado Profissional / Knowledge shared in diabetes mellitus patient's care as a product of a professional master's degree research

Introdução: O mestrado profissional promoveu a possibilidade de agregar valor no âmbito do Sistema Único de Saúde (SUS) por meio da qualificação de seus trabalhadores selecionados para o Programa de Mestrado Profissional do Instituto de Saúde, bem como o desenvolvimento de pesquisas cujos objetos respondam as necessidades do Sistema e dos Serviços de Saúde . A partir da percepção dos profissionais sobre uma alta proporção de encaminhamentos desnecessários à atenção especializada foi possível identificar a situação-problema e formular estratégias de enfrentamento. Objetivo: identificar o problema e promover mudanças nas prática de cuidado do paciente portador de diabetes mellitus. Método: Essa pesquisa foi caracterizada como uma pesquisa de implementação, onde foi utilizada triangulação de métodos: pesquisa-ação e pré e pós -testes. Resultados: No âmbito dos serviços a elaboração e implementação do apoio matricial da atenção especializada à atenção básica contemplou a troca de conhecimento entre os profissionais dos diversos pontos da rede; redução na proporção de encaminhamentos desnecessários de pacientes portadores de diabetes mellitus à especialidade de endocrinologia e mudanças na prática do cuidado.

Can sexual transmission support the enzootic cycle of Trypanosoma cruzi?

BACKGROUND Trypanosoma cruzi circulates in sylvatic habitats, mainly through blood-feeding triatomines, although other routes also contribute to its dispersion. Sexual transmission of T. cruzi is an understudied topic, especially among wild mammals. Because of the difficulties inherent to field work, experimentally infected mice are frequently used to evaluate the transmission of T. cruzi. OBJECTIVE This study aimed to evaluate the sexual transmission of T. cruzi in acutely infected mice. METHODS Male and female mice in the acute phase of Chagas disease were mated with naïve partners. Then, parasitological tests, immunohistochemistry, serological assays, and polymerase chain reaction (PCR) assays were used to detect infection. FINDINGS Parasitological analysis showed trypomastigotes in the blood of 20% of the naïve mice after mating with infected partners. Serological assays detected anti-T. cruzi antibodies in all naïve females mated with infected males and in 60% of naïve males mated with infected females. PCR showed T. cruzi nDNA bands for all naïve mice mated with infected partners. The possibility of sexual transmission was also confirmed by visualisation of amastigotes in the testes. MAIN CONCLUSIONS Our results demonstrate that sexual transmission of T. cruzi is an ordinary event that may contribute to maintenance of the parasite's enzootic cycle.

Integralidade da assistência: implementação do apoio matricial especializado à atenção básica com foco na linha de cuidado do diabetes mellitus, na região da Freguesia do Ó / Brasilândia do município de São Paulo / Comprehensiveness of care: implementation of specialized matrix support to primary care focusing on the diabetes mellitus care line, in the region of the Parish of Ó / Brasilândia, São Paulo

Introdução: A microrregião da Freguesia do Ó, situada na zona norte do município de São Paulo, possui 417.685 habitantes, 16 unidades básicas de saúde, 9 unidades especializadas e 1 hospital geral. Na microrregião, o coeficiente de mortalidade por diabetes mellitus é de 26 casos para cada 100 mil habitantes - valor superior ao do município. Para garantir a integração sistêmica das ações em saúde, foram estabelecidas as Redes de Atenção à Saúde e Linhas de Cuidado para as doenças crônicas prioritárias. Os profissionais da atenção básica e da especializada não perceberam avanços na integração dos diversos pontos da rede, pois há falta de capacitação dos profissionais da atenção básica e especializada; longo tempo de espera para atendimento especializado, comunicação ineficiente entre os diversos pontos de atenção e encaminhamentos à média complexidade de casos não contemplados pelo protocolo clínico e de acesso. O apoio matricial vem sendo utilizado no SUS como mecanismos para integração sistêmica nas redes de atenção à saúde e maior resolutividade no cuidado. Objetivo: Implementar e avaliar o apoio matricial da rede de atenção especializada ambulatorial para a atenção básica, com foco na linha de cuidado de diabetes mellitus na região. Método: O estudo foi desenvolvido pelo método da pesquisa-ação. Foram selecionadas as 2 unidades básicas de saúde responsáveis pelas maiores demandas no agendamento de endocrinologia e uma unidade da atenção especializada da microrregião da Freguesia do Ó / Brasilândia. O método proporciona a possibilidade de seleção da população a ser investigada por critérios de intencionalidade. No plano de análise, foram utilizadas técnicas de análise de frequência e comparação antes (fase exploratória) e depois (avaliação) da intervenção. Resultados: No âmbito dos serviços a elaboração e implementação do apoio matricial da atenção especializada à atenção básica contemplou a troca de conhecimento entre os profissionais dos diversos pontos da rede; redução na proporção de encaminhamentos desnecessários de pacientes portadores de diabetes mellitus à especialidade de endocrinologia no local onde a intervenção fora implementada. Foram implementadas ferramentas para facilitar a comunicação (discussão de casos) entre as equipes da atenção básica e especializada e foi introduzida a rotina de encontros presenciais entre as equipes da atenção básica e especializada.

The in vivo effect of L-arginine on skin elasticity in mice

ABSTRACT The human skin aging process is a complex mechanism that can be induced both by intrinsic and extrinsic factors. Observations include a decrease in the biosynthetic and proliferative capacity of cells, increased expression of matrix metalloproteinases, reduction in collagen type I expression, and the progressive disappearance of elastic tissue in the papillary dermis. L-arginine, the substrate of nitric oxide synthesis, is involved in angiogenesis and cell proliferation, as well as an indirect precursor of collagen synthesis via the proline pathway. The aim of this study was to examine the tensile strength, histology, and immunohistochemistry of female and male mice skin receiving different concentrations of topically applied L-arginine, in order to evaluate the possibility of using L-arginine as an active cosmetic ingredient in antiaging products. The results suggest that the application of L-arginine improves the mechanical resistance of skin from older female mice (20 weeks old) and promotes the formation of a larger amount of collagen and elastic fibers in the skin when applied at a concentration of 15%.

Steer performance on deferred pastures of Brachiaria brizantha and Brachiaria decumbens / Desempenho de novilhos de corte em pastos diferidos de Brachiaria brizantha e Brachiaria decumbens

ABSTRACT: The objective of this study was to compare structural, morphological and bromatological characteristics of forage as well as performance of Caracu beef cattle (200 ± 9 kg of initial body weight) supplemented with a multi-mineral mixture (0.25% of body weight) on deferred pastures of Brachiaria brizantha 'Marandu' and Brachiaria decumbens 'Basilisk' under continuous grazing. After the pasture was grazed to 10 cm of height, in March 2014, both grasses were left to rest and subjected to a 126-day deferment period. The experimental period lasted from July to October 2014; the sward characteristics and the animal's weight were evaluated every 28 days. The highest forage mass was recorded in 'Marandu' grass, whereas the highest leaves percentage and lowest dead material percentage were observed in 'Basilisk' pastures. Similarly, the highest crude protein content (8.1 vs. 7.0 ± 0.2%), in vitro organic matter digestibility (57.7 vs. 53.9 ± 0.4%), lowest neutral detergent fiber content (69.2 vs. 72.7 ± 0.4%), and; consequently, the highest average daily gain (680 vs. 530 ± 0.04g animal-1) were recorded for 'Basilisk' pastures. 'Marandu' and 'Basilisk' deferment was associated with a multi-mineral mixture supplementation as a management alternative for rearing beef cattle during the drought periods. Because of the duration of the pasture recovery period in this study, B. decumbens pastures were more likely to achieve the highest animal performance.

RESUMO: O objetivo deste trabalho foi comparar as características estruturais, morfológicas e bromatológicas da forragem e o desempenho de bovinos de corte, da raça Caracu (200±9kg de peso inicial), suplementados com mistura mineral múltipla (0,25% do peso corporal) em pastos diferidos de Brachiaria brizantha , cv. 'Marandu', e Brachiaria decumbens , cv. 'Basilisk', sob pastejo contínuo. Após o rebaixamento dos pastos a 10cm de altura, realizado em março de 2014 por meio de pastejo, ambas as espécies foram vedadas e diferidas por 126 dias. O período experimental foi de julho a outubro de 2014, e as avaliações das características do pasto e as pesagens dos animais foram realizadas a cada 28 dias. A maior massa de forragem foi registrada em pastos de 'Marandu'. A maior porcentagem de folhas e a menor de material morto foram observadas para a 'Basilisk'. Os maiores teores de proteína bruta (8,1 vs 7,0 ± 0,2%), digestibilidade in vitro da matéria orgânica (57,7 vs 53, 9 ± 0,4%), os menores teores de fibra em detergente neutro (69,2 vs 72,7 ± 0,4%) e, consequentemente, o maior ganho médio diário (680 vs 530 ± 0,04g animal-1) foram registrados para a cv. 'Basilisk'. O diferimento de pastagens de 'Marandu' ou 'Basilisk' associado à suplementação com mistura mineral múltipla figura como alternativa de manejo para recria de bovinos de corte durante o período seco. Para a duração do período de vedação utilizada, pastos de B. decumbens são mais indicados para alcançar o maior desempenho animal.

Balanço hídrico e excreção renal de metabólitos em ovinos alimentados com palma forrageira (Nopalea cochenillifera Salm Dyck) / Water balance and renal excretion of metabolites in sheep fed forage cactus (Nopalea cochenillifera Salm Dyck)

Objetivou-se avaliar balanço hídrico e excreção renal de metabólitos em borregos sem raça definida, alimentados com diferentes quantidades de palma forrageira (Nopalea cochenillifera Salm Dyck), na forma in natura e em farelo. Foram utilizados 20 borregos, com peso vivo médio inicial de 20 Kg e foram distribuídos no delineamento inteiramente casualizado, sendo cinco tratamentos e quatro repetições. As dietas experimentais consistiram em uma dieta controle à base de feno de tífton, farelo de soja, suplemento mineral e calcário, os demais tratamentos visaram testar níveis diferentes de palma forrageira corrigida com ureia em duas formas: in natura e farelada e em dois níveis de substituição (50 e 100%) da matéria seca do feno de tífton. Amostras de sangue e urina foram coletadas para determinação de diferentes metabólitos e minerais e utilização de equações para obtenção dos índices de excreção urinária destes metabólitos, taxa de depuração endógena de creatinina e reabsorção de água livre de eletrólitos, além do registro de ingestão de água e volume de urina. A ingestão voluntária de água sofreu influência das dietas, sendo que os animais submetidos às dietas contendo farelo de palma e feno e farelo de palma foram superiores aos demais tratamentos. A ingestão de água via alimentos também sofreu influência da dieta, sendo maior nos animais que receberam palma in natura e farelo mais palma in natura. Com relação à ingestão total de água foi maior para os animais alimentados com dietas contendo palma in natura em relação aos demais tratamentos. As dietas experimentais influenciaram na excreção renal de metabólitos derivados purínicos e minerais, sem alterar a função renal. A presença da palma forrageira tanto na condição de farelo como in natura proporciona aumento do volume urinário sem alterar a função renal, além de que deve ser considerado como uma excelente estratégia alimentar no semiárido.

This study aimed to assess fluid balance and renal excretion of metabolites in lambs without defined breed standard, fed different forage cactus (Nopalea cochenillifera Salm Dyck), in natura and bran. 20 lambs were used, with initial body weight of 20 kg and were distributed in a completely randomized design, with five treatments and four repetitions. The experimental diets consisted of a control diet based on Bermuda grass hay, soybean meal, limestone and mineral supplement, other treatments aimed at testing different levels of cactus pear plus urea in two forms: fresh and mash and two levels of substitution (50 and 100%) of dry matter of hay. Blood and urine samples were collected for determination of different metabolites and minerals and use of equations to determine the rates of urinary excretion of these metabolites, rate of endogenous creatinine clearance and electrolyte reabsorption of free water, in addition to recording of water intake and urine volume. The voluntary water intake was influenced by the diets, and the animals subjected to diets containing soybean meal and hay palm and cactus meal were higher than other treatments. Water intake via food was also influenced by diet, being higher in animals fed palm fresh and bran over palm in nature. With respect to total water intake was greater for cows fed diets containing palm in nature compared to the other treatments. The experimental diets influenced the renal excretion of purine metabolites and minerals derived, without changing renal function. The presence of cactus pear both as bran as in nature provides increased urine volume without changing renal function, and to be considered as an excellent food strategy in semiarid.

Bloqueo auriculoventricular completo como manifestación de amiloidosis cardiaca / Complete atrioventricular block as an evidence of amyloidosis

La amiloidosis cardiaca es una manifestación de un grupo de enfermedades sistémicas que se caracteriza por el mal plegamiento de proteínas que causa un depósito extracelular de la amiloide, conocido como amiloidosis. Es una causa importante de las enfermedades infiltrativas, que pueden ser responsables tanto del compromiso cardiaco como de otros órganos. Es importante el reconocimiento de su etiología primaria o secundaria para dar el tratamiento adecuado según su causa. Describimos un caso de un paciente de 69 años de edad, con amiloidosis que ingresa al servicio de urgencias con un bloqueo auriculoventricular completo.

Cardiac amyloidosis is a manifestation of a systemic diseases group characterized by protein misfolding caused by extracellular deposition of amyloid, known as amyloidosis. It is the main cause of infiltrative diseases that can be responsible of cardiac involvement as to other organs. It is important to recognize its primary or secondary etiology to give the appropriate treatment depending of the cause. We describe a case of a 69 year old patient with cardiac amyloidosis debuting in the emergency room with complete atrioventricular block.

Telediagnóstico para eletroencelografia em Santa Catarina / Telediagnóstico for electroencephalogram in Santa Catarina

No Brasil, estima-se que em torno de 5 a 7% da população apresentará uma crise epiléptica ao longo da vida. O Eletroencefalograma é um método fundamental para diagnóstico de epilepsia. Este artigo apresenta o desenvolvimento de um protótipo integrado ao Sistema Catarinense de Telemedicina e Telessaúde, com o objetivo de dar suporte a exames de Eletroencefalograma com envio, emissão de laudos e visualização a distância. São utilizados CID-10 e Descritores em Ciências da Saúde como linguagem de indexação de laudos a fim de gerar estatísticas em pesquisas futuras. O sistema está implantado em quatro unidades de saúde no município de Florianópolis. Os laudos são emitidos por um médico especialista da própria rede municipal e os exames são enviados à rede de Telemedicina. Com o uso desta metodologia é possível facilitar o dia-a-dia dos médicos, técnicos e pacientes com acessos mais rápidos e eficientes, melhorando a qualidade de vida dos pacientes.

In Brazil is estimated that around 5-7% of the population will have an epileptic seizure lifelong. The electroencephalogram is a fundamental method for the diagnosis of epilepsy. This paper presents the development of an integrated prototype called Santa Catarina Telemedicine System, in order to support electroencephalogram exams with sending, issuing reports and online viewing. We used ICD-10 and Health Sciences Descriptors as reports indexing language, in order to generate statistics in future research. The system is deployed in four health units in the Florianopolis city. A medical specialist that works in own municipal network issues the reports and the exams are sent to the Telemedicine network. Using this new methodology we can facilitate the day-to-day lives of doctors, technicians and patients with faster and more efficient, Improving Quality of Life for Patients.

Gammapatía monoclonal de significado incierto A propósito de un caso de nefropatía por depósito de cadenas ligeras lambda / Monoclonal gammopathy of undetermined significance Apropos of a case of lambda light chain deposition nephropathy

La nefropatía asociada a las gammapatías monoclonales es debida principalmente al depósito de cadenas ligeras. Las enfermedades renales paraproteinémicas son lesiones asociadas con depósito de inmunoglobulinas intactas o fragmentos de inmunoglobulinas (cadenas pesadas y cadenas ligeras). La enfermedad por depósito de cadenas ligeras es una condición rara, caracterizada por el depósito de cadenas ligeras monoclonales en muchos órganos y a nivel renal predominantemente en glomérulos y membranas basales tubulares. La enfermedad está frecuentemente asociada con desórdenes linfoproliferativos, y la mayoría de casos son causados por depósito de cadenas ligeras kappa. Aunque se presenta sobre todo en cuadros malignos, en ocasiones no se detecta patología hematológica y se denomina idiopática o "primaria". Suele manifestarse como una insuficiencia renal severa con proteinuria nefrótica, no tiene tratamiento claramente establecido y el pronóstico es malo. Se describen las características clínicas e histológicas del segundo caso informado en Colombia de nefropatía por depósito de cadenas ligeras diagnosticado en el contexto de una enfermedad renal paraproteinémica sin datos de malignidad. (Acta Med Colomb 2014; 39: 196-201).

Nephropathy associated with monoclonal gammopathies is mainly due to light chain deposition. The paraproteinemic kidney diseases are lesions associated with deposition of intact immunoglobulins or fragments of immunoglobulins (heavy and light chains). The disease due to deposition of light chains is a rare condition characterized by deposition of monoclonal light chains in many organs and as for the kidney, predominantly in glomeruli and tubular basement membranes. The disease is frequently associated with lymphoproliferative disorders and the majority of cases are caused by deposition of kappa light chains. Although presented primarily in clinical pictures of malignancy, sometimes no hematological pathology is detected and is called idiopathic or "primary". It usually manifests as severe renal failure with nephrotic proteinuria, has not a clearly established treatment and the prognosis is poor. The clinical and histological features of the second case reported in Colombia of a light chain deposition nephropathy diagnosed in the context of a kidney paraproteinemic disease without malignancy data, is presented. (Acta Med Colomb 2014; 39: 196-201).

Ocorrência e diferenciação de espécies de Listeria spp. em salsichas tipo hot dog a granel e em amostras de carne moída bovina comercializadas no Distrito Federal / Occurrence and differentiation of Listeria spp. in “hot dog” sausages sold in bulk and ground beef samples marketed in the Federal District, Brazil

Listeria monocytogenes é um patógeno relevante veiculado por alimentos. Sua identificação precisa é importante para a correta determinação do risco associado à ingestão do alimento. O objetivo deste trabalho foi verificar a ocorrência das espécies de Listeria spp. em amostras de salsichas tipo hot dog e carne moída bovina, comercializadas a granel no Distrito Federal. Foram analisadas 162 amostras, sendo 127 de salsichas tipo hot dog e 35 amostras de carne moída bovina. O isolamento e a identificação do gênero foram feitos por metodologia convencional e a distinção das espécies foi verificada por kit bioquímico específico (API-Listeria®) e por análise de restrição de fragmentos da reação em cadeia da polimerase (RFLP-PCR) do gene 23 rRNA. Foram isoladas 26 cepas de Listeria spp. das amostras de salsichas tipo hot dog, sendo identificadas 18 cepas de Listeria innocua e 08 cepas de Listeria monocytogenes. Das 35 amostras de carne moída bovina, foram isoladas 16 cepas de Listeria spp., sendo identificadas 12 cepas de Listeria innocua e 04 de Listeria monocytogenes. Houve concordância total na distinção das espécies de Listeria spp. através dos dois métodos empregados. A presença de Listeria spp. em amostras de salsicha do tipo hot dog a granel e em carne moída bovina a granel, de estabelecimentos comerciais do Distrito Federal, representa risco à saúde do consumidor.

Listeria monocytogenes is a pathogen disclosed by foods. Its accurate identification is important for the correct determination of the risk associated with the ingestion of food. The aim of this research was to determine the occurrence of Listeria spp. in samples of hot dog sausages and ground beef, sold in bulk in the Federal District. A total of 162 samples, 127 hot dog sausages and 35 samples of ground beef cattle, were analyzed. The isolation and identification of the genus were made by conventional methodology and distinction of species was verified by specific biochemical kit (API-Listeria®) and by restriction fragment length polymorphism (PCR-RFLP) of 23S rRNA gene. Twenty-six strains of Listeria spp. were isolated. Samples of hot dog sausages identified 18 strains of Listeria innocua and 08 strains of Listeria monocytogenes. Of the 35 samples of ground beef cattle were isolated, 16 strains of Listeria spp., 12 strains of Listeria innocua and 04 strains of Listeria monocytogenes. There was total agreement in the distinction of Listeria species using the two methods. The presence of Listeria spp. in samples of hot dog sausages and ground beef, sold in bulk in commercial establishment of the Federal District represents a risk to consumer health.

Effects of propofol in lipid-based emulsion and in microemulsion on the incidence of endothelial lesion in rabbits

PURPOSE: To compare the incidence of endothelial injury after single-dose or continuous propofol infusion in conventional lipid-based emulsion (LE) versus microemulsion (ME). METHODS: Forty-two rabbits (2.5-4.5 Kg) were randomly allocated into seven groups of six animals each: SHAM- surgical treatment alone; Bolus Control Group - 3 mL-intravenous (IV) bolus of saline; Continuous Infusion Control Group - 3 mL- IV bolus of saline followed by a continuous infusion of 0.2 ml/kg/min for 60 min; Bolus LE Propofol Group - IV bolus of LE propofol (3 mg/kg); Bolus ME Propofol Group - IV ME propofol bolus (3 mg/kg); Continuous LE Propofol Group - IV LE propofol bolus (3 mg/kg) followed by a continuous infusion of 0.2 ml/kg/min for 60 min; Continuous ME Propofol Group - IV ME propofol bolus (3 mg/kg) followed by a continuous infusion of 0.2 ml/kg/min for 60 min. RESULTS: There were no statistically significant differences between the studied groups in blood pressure, in central venous pressure and in the biochemical profile. No significant differences were found in inflammatory mediators and in tissue analysis between the two emulsions. CONCLUSION: Microemulsion and lipid-based emulsion propofol had similar inflammatory, biochemical and microscopy profiles. Thus, microemulsion propofol can be used as an alternative to lipid-based emulsion propofol.

Correlación de la t(9;22), t(12;21) e hiperdiploidía de ADN con el inmunofenotipo y la tasa de proliferación de células B neoplásicas en niños con leucemia linfoblástica aguda de precursores / Correlation of the t(9;22), t(12;21), and DNA hyperdiploid content with immunophenotype and proliferative rate of leukemic B-cells of pediatric patients with B-cell acute lymphoblastic leukemia

Introducción. Del 60 al 80 % de los pacientes con leucemia linfoblástica aguda de precursores B presentan alteraciones genéticas que influyen en el pronóstico de la enfermedad y en la biología del tumor. Objetivo. Analizar distintas alteraciones genéticas en leucemia linfoblástica aguda de precursores B en niños, y su relación con el inmunofenotipo y con la tasa de proliferación, en comparación con precursores B normales. Materiales y métodos. En 44 pacientes se evaluó, por citometría de flujo, el inmunofenotipo, el contenido de ADN y la proliferación, y por RT-PCR, las traslocaciones t(9;22), t(12;21), t(4;11) y t(1;19). Mediante un análisis jerarquizado de conglomerados se identificaron los patrones inmunofenotípicos de expresión asociados a las traslocaciones, tomando como referencia precursores B normales. Resultados. La cuantificación del ADN mostró que el 21 % de los casos de leucemia linfoblástica aguda de precursores B eran hiperdiploides de índice alto y, el 47,7 %, hiperdiploides de índice bajo. La presencia de hiperdiploidía se asoció con mayor proliferación tumoral y con inmunofenotipos aberrantes, que incluyeron expresión anormal de CD10, TdT, CD38 y CD45 y un mayor tamaño de los linfoblastos. La presencia de t(9;22) y t(12;21) discrimina células normales de células tumorales con aberraciones en la expresión de CD19, CD20, CD13, CD33, CD38, CD34 y CD45. Conclusiones. El perfil de aberraciones fenotípicas detectado en conjunto con anormalidades en la proliferación tumoral, se asocia de forma significativa con hiperdiploidiía de ADN y discrimina de forma clara linfoblastos con t(9;22) y t(12;21) de los precursores B normales. La identificación de estos parámetros será de gran utilidad como herramienta para la clasificación y seguimiento de los pacientes.

Introduction: Between 60 and 80% of patients with B-cell acute lymphoblastic leukemia show genetic abnormalities which influence the prognosis of the disease and the biology of the tumor. Objective: To analyze different genetic abnormalities in acute B lymphoblastic leukemia in children, its relationship with the immunophenotype and the proliferative rate compared with normal B cell precursors. Materials and methods: We assessed immunophenotype, DNA content and proliferative rate in 44 samples by flow cytometry, and translocations t(9;22), t(12;21), t(4;11), and t(1;19) by RT-PCR. Using a hierarchical cluster analysis, we identified some immunophenotypic patterns associated to genetic abnormalities when compared with normal B cell precursors. Results: DNA quantification showed that 21% of the cases had high hyperdiploidy and 47.7% has low hyperdiploidy. The presence of hyperdiploidy was associated with increased tumor proliferation and aberrant immunophenotypes, including abnormal expression of CD10, TdT, CD38, and CD45 and an increased size of the lymphoblasts. The presence of t(9;22) and t(12;21) discriminates normal cells from tumor cells with aberrant immunophenotype in the expression of CD19, CD22, CD13, CD33, CD38, CD34, and CD45. Conclusions: The aberrant immunophenotype profile detected in neoplastic cells along with abnormalities in the proliferative rate were significantly associated with DNA hyperdiploidy and clearly distinguished lymphoblasts with t(9;22) and t(12;21) from normal B cell precursors. The identification of these parameters is useful as a tool for classification and monitoring of these patients.

Determination of the HER2 amplification status by in situ fluorescent hybridization and concordance with immunohistochemistry for breast cancer samples in Colombia / Determinación del estado de amplificación del Oncogén HER2 por hibridación in situ fluorecente y concordancia con el método de inmunohistoquímica en muestras de mujeres Colombianas con Cáncer de seno

Objectives: To determine the status of the HER2 amplification in Breast cancer performed in peripheral laboratories in Colombia by immunohistochemistry and its comparison with central laboratories and the FISH status. Methods: Four thousand one hundred and five cases referred for the determination of the HER2 status by FISH and/or IHQ to the Department of Pathology of the Fundacion Santa Fe were studied. The analysis included correlation between the IHQ HER2 score submitted by the peripheral laboratory (PL), the HER2 score emitted in the CL and the FISH studies performed in the central laboratory (CL). Results: Two thousand five hundred and eight HER2 IHQ studies were performed in the (CL), using the Dako Herceptest. With the following results: 68,2 % negative (0-1+); 16,4% indeterminate (2+); 15,3% 3+ and 2,3 % not adequate. 1360/ 1719 cases studied by FISH came from the (PL), and 329 (19,1%) from the (CL). Comparing the IHQ score emitted by the PL and the positive FISH status showed: 6/28 0+ were positive (21, 4%); 7/31 1+ (22, 5%); 397/1240 2+ (32, 8%) and 74/91 3+ (81, 3%). In the CL the results were 1/9 0+ (11,1%); 3/18 1+ (16,7%); 154/292 2+ (53%); and 9/9 3+ (100%). Only 1/4 negative cases (0/1+) was in house. Conclusion: The false negative rate (22%), and false positive results (18,7%), of the HER2 status performed by IHQ in peripheral laboratories in Colombia is unacceptable high as well as the inadequacy of tissue indicating that pre-analytical factors have to be improved in Colombia in order to get optimal results.

Objetivos: Determinar la correlación entre el estado de amplificación del oncogén HER2 en cáncer de seno por inmunohistoquímica y FISH, en laboratorios periféricos y en un laboratorio central de referencia en Colombia. Métodos: Se estudiaron 4105 casos referidos al Departamento de Patología de la Fundación Santa fe de Bogotá para la determinación del estado de amplificación del HER2 por FISH y/o IHQ. El análisis incluyó la correlación entre los scores del HER2 por IHQ en ambos laboratorios y los estudios de FISH realizados en el laboratorio central. Resultados: Dos mil quinientos ocho casos fueron estudiados para HER2 por IHQ en el LC (Herceptest de DAKO); 68.2% fueron negativos (score de 0-1+); 16.4% indeterminados (2+) y 15,3% positivos (3+); 2,3% fueron inadecuados. 1360 de 1689 casos estudiados por FISH (80.5%) provenían de LP, y 329 (19.5%) del LC. En los LP se encontró amplificación por FISH en: 6/28 casos catalogados por IHQ como 0+ (21.4%); 7/31 1+ (22.5%) ; 397/1210 2+ (2.8%) y 74/91 3+ (81.3%). En el LC se encontró amplificación por FISH en 1/9 casos catalogados por IHQ como 0+ (11.1%); 3/18 1+ (16.7%), 154/292 2+ (53%); y 10/10 3+ (100%) . Un de los 4 casos falsos negativos fue procesado en su totalidad en el LC. Conclusión: Los resultados falsos negativos (22.0%) y falsos positivos (18.7%) en el estado del HER2 determinado por IHQ en los LP son inaceptablemente altos en Colombia, indicando se requiere establecer mecanismos estrictos de control de calidad.

Biological and environmental factors associated with risk of schistosomiasis mansoni transmission in Porto de Galinhas, Pernambuco State, Brazil / Fatores biológicos e ambientais associados ao risco de transmissão da esquistossomose mansoni na localidade de Porto de Galinhas, Pernambuco, Brasil / Factores biológicos y ambientales asociados al riesgo de transmisión de la esquistosomiasis mansoni en la localidad de Porto de Galinhas, Pernambuco, Brasil

Schistosomiasis has expanded to the coast of Pernambuco State, Brazil, where there are frequent reports of Biomphalaria glabrata snails and human cases of the disease. This study analyzes factors related to schistosomiasis transmission risk in Porto de Galinhas. A one-year malacological survey was conducted to identify biological, abiotic, and environmental factors related to the host snail breeding sites. Data analysis used Excel 2010, GTM Pro, and ArcGis 10. A total of 11,012 B. glabrata snails were captured in 36 breeding sites, and 11 schistosomiasis transmission foci were identified. A negative correlation was found between breeding site temperature and snail density and infection rate, and a positive correlation with pH and salinity. The rainy season showed a positive correlation with snail density and infection rate. The study emphasizes the factors involved in the maintenance of schistosomiasis breeding sites, in light of persistence of this disease in Porto de Galinhas for more than 10 years.

A esquistossomose se expande para o litoral de Pernambuco, Brasil, onde têm sido frequente os registros de caramujos Biomphalaria glabrata e de casos humanos da doença. Este estudo apresenta fatores relacionados ao risco de transmissão da esquistossomose na localidade de Porto de Galinhas. Durante um ano, foi conduzido um inquérito malacológico para identificar fatores biológicos, abióticos e ambientais relacionados aos criadouros dos moluscos hospedeiros. Para análise dos dados, foram utilizados os softwares Excel 2010, GTM Pro e ArcGis 10. Foram coletados 11.012 caramujos B. glabrata nos 36 criadouros identificados, sendo diagnosticados 11 focos de transmissão da esquistossomose. Foi verificada correlação negativa entre a temperatura dos criadouros, densidade e taxa de infecção dos caramujos e correlação positiva para pH e salinidade. O período de chuva apresentou correlação positiva com a densidade e taxa de infecção dos moluscos. O estudo enfatiza os fatores envolvidos na manutenção dos criadouros da esquistossomose visto à persistência dessa doença na localidade de Porto de Galinhas há mais de 10 anos.

La esquistosomiasis se expande hacia el litoral de Pernambuco, Brasil, donde han sido frecuentes los registros de caracoles Biomphalaria glabrata y casos humanos de la enfermedad. Este estudio presenta factores relacionados con el riesgo de transmisión de la esquistosomiasis en la localidad Porto de Galinhas. Durante un año se llevó a cabo una investigación malacológica para identificar factores biológicos, abióticos y ambientales, relacionados con los criaderos de los moluscos huéspedes. Para el análisis de los datos se utilizaron los softwares Excel 2010, GTM Pro y ArcGis 10. Se recogieron 11.012 caracoles B. glabrata en los 36 criaderos identificados, siendo diagnosticados 11 focos de transmisión de la esquistosomiasis. Se verificó la correlación negativa entre la temperatura de los criaderos, densidad y tasa de infección de los caracoles, y la correlación positiva entre el pH y salinidad. El período de lluvia presentó una correlación positiva con la densidad y tasa de infección de los moluscos. El estudio enfatiza los factores involucrados en el mantenimiento de los criaderos de la esquistosomiasis, vista la persistencia de esta enfermedad en la localidad de Porto de Galinhas hace más de 10 años.

Actinomycosis mimicking colonic neoplasia

Actinomycosis is a rare inflammatory disease caused by Actinomyces israelii. It can mimic many other diseases, such as malignant neoplasms or inflammatory bowel disease. We present a case in which actinomycosis simulated a colonic neoplasia. (AU)

Actinomicose é uma doença inflamatória rara, causada pelo agente Actinomyces israelii. Pode mimetizar várias outras entidades, como neoplasias malignas e doenças inflamatórias intestinais. Relatamos aqui um caso, no qual a actinomicose simulou neoplasia cólica. (AU)

Coloraciones histológicas vs. Microscopia electrónica de transmisión para detección de biopelículas en pacientes con rinosinusitis crónica en el Hospital Universitario de La Samaritana, en el año 2011 / Histological stainings versus Electronic Microscopy Biofilms transmission for detecting biofilms in patients with chronic rhinosinusitis in the Samaritana’s Hospital. 2011

Objetivo: Determinar la concordancia entre Microscopia de Luz vs. Microscopia Electrónica de Transmisión, para la detección de biopelículas en pacientes con rinosinusitis crónica. Diseño: Estudio de concordancia. Materiales y métodos: Analizamos 34 muestras de pacientes llevados a cirugía endoscópica funcional por rinosinusitis crónica. Fueron procesadas para valoración mediante microscopia de luz usando hematoxilina-eosina, gram, ácido peryódico de Schiff, Giemsa y Microscopia Electrónica de Transmisión (MET). Resultados: No se identificaron biopelículas en ninguna de las muestras analizadas bajo MET; estos resultados concuerdan con los obtenidos con las coloraciones histológicas hematoxilina-eosina (H-E), Gram, Giemsa y ácido peryódico de Schiff (PAS), y muestran una concordancia absoluta con el test de Kappa para resultados negativos del 100%…

Objectives: Determine the concordance between light microscopy vs. Transmission Electron Microscopy for the detection of biofilms in patients with Chronic Rhinosinusitis. Design: Materials and Methods: We analyzed 34 samples of patients who underwent Functional Endoscopic Surgery for Chronic Rhinosinusitis. These were processed for evaluation by light microscopy using Hematoxylin-Eosin, Gram, periodic acid- Schiff, Giemsa and Transmission Electron Microscopy (TEM). Results: Biofilm was not identified in any of the samples analyzed under transmission electron microscopy (TEM), these results are consistent with the results obtained with hematoxylin-eosin histological staining (HE), Gram, Giemsa and periodic acid-Schiff (PAS), showing an absolute concordance with Kappa test of 100% for negative results. Conclusion: There is a high correlation between the findings observed between the TEM and light microscopy for the negative results…