Searching for a prognostic index in lupus nephritis.

BACKGROUND: Currently we do not have an ideal biomarker in lupus nephritis (LN) that should help us to identify those patients with SLE at risk of developing LN or to determine those patients at risk of renal progression. We aimed to evaluate the development of a prognostic index for LN, through the evaluation of clinical, analytical and histological factors used in a cohort of lupus. We have proposed to determine which factors, 6 months after the diagnosis of LN, could help us to define which patients will have a worse evolution of the disease and may be, more aggressive treatment and closer follow-up. METHODS: A retrospective study to identify prognostic factors was carried out. We have included patients over 18 years of age with a clinical diagnosis of systemic lupus erythematosus (SLE) and kidney involvement confirmed by biopsy, who are followed up in our centre during the last 20 years. A multi-step statistical approach will be used in order to obtain a limited set of parameters, optimally selected and weighted, that show a satisfactory ability to discriminate between patients with different levels of prognosis. RESULTS: We analysed 92 patients with LN, although only 73 have been able to be classified according to whether or not they have presented poor renal evolution. The age of onset (44 vs. 32; p = 0.024), the value of serum creatinine (1.41 vs. 1.04; p = 0.041), greater frequency of thrombocytopenia (30 vs. 7%; p = 0.038), higher score in the renal chronicity index (2.47 vs. 1.04; p = 0.015), proliferative histological type (100%) and higher frequency of interstitial fibrosis (67 vs. 32%; p = 0.017) and tubular atrophy (67 vs. 32%; p = 0.018) was observed between two groups. The multivariate analysis allowed us to select the best predictive model for poor outcome at 6 months based on different adjustment and discrimination parameters. CONCLUSION: We have developed a prognostic index of poor renal evolution in patients with LN that combines demographic, clinical, analytical and histopathological factors, easy to use in routine clinical practice and that could be an effective tool in the early detection and management.

Milk production and fatty acid profile of dairy cows grazing four grass species pastures during the rainy season in small-scale dairy systems in the highlands of Mexico.

The study evaluated small-scale dairy systems with continuous grazing of pastures based on three temperate grasses festulolium (FL), tall fescue (TF), and perennial ryegrass (RG), compared with subtropical kikuyu grass (KG). All pastures were associated with white clover (Trifolium repens L.). Twelve multiparous Holstein cows were assigned to a 4 × 4 Latin square replicated three times with 14-day experimental periods. Sampling and analyses of pastures, concentrates, and animal variables followed standard procedures. FL showed a significantly (p < 0.05) higher mean sward height, but there were no differences (p > 0.05) in net herbage accumulation. There were significant differences (p < 0.05) among pastures for CP, NDF, ADF, in vitro digestibility of OM (IVOMD), and estimated metabolizable energy (eME). There were no differences (p > 0.05) between treatments for milk yield and composition, live weight, or body condition score. There were significant differences (p < 0.05) in fatty acid values for pastures in C14:0, C16:1, and C18:3n3. There were significant differences between treatments (p < 0.05) in milk contents for C18:0, C18:1t11, and C18:2c9t11. Grazing FL, TF, RG, or KY pastures showed no differences in milk yields. Higher values for C18:0, C18:1t11, and C18:2c9t11 were detected in KY, RG, and TF. RG had significantly higher MUFA than FL and higher PUFA than TF. A value under 65% of SFA, a ratio of n-6/n-3 lower than 4, and an atherogenic index of 1.7 are indicators of milk with beneficial effects for human health.

Panarteritis nudosa con patrón de respuesta inflamatoria sistémica: respuesta a anti-TNF / Polyarteritis Nodosa with a Systemic Inflammatory Response Pattern: Effectiveness of anti-TNF

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Usefulness of direct fluorescent in buffy coat in the diagnosis of Candida sepsis in neonates.

OBJECTIVE: The objective of this study is to assess the clinical utility of direct fluorescent assay in buffy coat in the diagnosis of Candida sepsis (CS) in neonates. STUDY DESIGN: A cross-sectional study was conducted in a Neonatal Intensive Care Unit and 22 neonates with suspected CS were enrolled. Fungus isolation from blood cultures and direct fluorescent tests in buffy coat were performed and validity parameters were estimated. RESULTS: Candida was isolated in 13/22 (59%) blood cultures. The direct fluorescent test was positive in 12/13 and 1/9 cases with positive and negative blood culture as corresponding. Estimated sensitivity, specificity, positive predictive value, negative predictive value, positive likehood ratio and negative likehood ratio were 92%, 89%, 92%, 89%, 8.31 and 0.09, respectively. CONCLUSION: The direct fluorescent assay in buffy coat might be useful to support early and accurate diagnosis of CS in neonates.

On the time to reach a critical number of infections in epidemic models with infective and susceptible immigrants.

In this paper we examine the time T to reach a critical number K0 of infections during an outbreak in an epidemic model with infective and susceptible immigrants. The underlying process X, which was first introduced by Ridler-Rowe (1967), is related to recurrent diseases and it appears to be analytically intractable. We present an approximating model inspired from the use of extreme values, and we derive formulae for the Laplace-Stieltjes transform of T and its moments, which are evaluated by using an iterative procedure. Numerical examples are presented to illustrate the effects of the contact and removal rates on the expected values of T and the threshold K0, when the initial time instant corresponds to an invasion time. We also study the exact reproduction number Rexact,0 and the population transmission number Rp, which are random versions of the basic reproduction number R0.

Potential of multisyringe chromatography for the on-line monitoring of the photocatalytic degradation of antituberculosis drugs in aqueous solution.

In this study, a multisyringe chromatography system (MSC) using a C18 monolithic column was proposed for the on-line monitoring of the photocatalytic degradation of isoniazid (INH, 10 mg L(-1)) and pyrazinamide (PYRA, 5mgL(-1)) mixtures in aqueous solution using a small sample volume (200 µL) with an on-line filtration device in a fully automated approach. During the photocatalytic oxidation using TiO2 or ZnO semiconductor materials, total organic carbon (TOC) and the formed intermediates were analyzed off-line using ion chromatography, ion exclusion HPLC, and ESI-MS/MS. The results showed that TiO2 exhibits a better photocatalytic activity than ZnO under UV irradiation (365 nm) for the degradation of INH and PYRA mixtures, generating 97% and 92% degradation, respectively. The optimal oxidation conditions were identified as pH 7 and 1.0 g L(-1) of TiO2 as catalyst. The mineralization of the initial organic compounds was confirmed by the regular decrease in TOC, which indicated 63% mineralization, and the quantitative release of nitrate and nitrite ions, which represent 33% of the nitrogen in these compounds. The major intermediates of INH degradation included isonicotinamide, isonicotinic acid, and pyridine, while the ESI-MS/MS analysis of PYRA aqueous solution after photocatalytic treatment showed the formation of pyrazin-2-ylmethanol, pyrazin-2-ol, and pyrazine. Three low-molecular weight compounds, acetamide, acetic acid and formic acid, were detected during INH and PYRA decomposition. PYRA was more resistant to photocatalytic degradation due to the presence of the pyrazine ring, which provides greater stability against OH attack.

Beneficial effects of alpha-lipoic acid plus vitamin E on neurological deficit, reactive gliosis and neuronal remodeling in the penumbra of the ischemic rat brain.

During cerebral ischemia-reperfusion, the enhanced production of oxygen-derived free radicals contributes to neuronal death. The antioxidants alpha-lipoic acid and vitamin E have shown synergistic effects against lipid peroxidation by oxidant radicals in several pathological conditions. A thromboembolic stroke model in rats was used to analyze the effects of this mixture under two oral treatments: intensive and prophylactic. Neurological functions, glial reactivity and neuronal remodeling were assessed after experimental infarction. Neurological recovery was only found in the prophylactic group, and both antioxidant schemes produced down-regulation of astrocytic and microglial reactivity, as well as higher neuronal remodeling in the penumbra area, as compared with controls. The beneficial effects of this antioxidant mixture suggest that it may be valuable for the treatment of cerebral ischemia in humans.