Application of the 2015 diagnostic criteria for neuromyelitis optica spectrum disorders in a cohort of Latin American patients.

BACKGROUND: The 2015 International Panel for neuromyelitis optica (NMO) spectrum disorders (NMOSD) diagnosis (IPND) criteria was recently proposed. However, because there are no studies evaluating application of the IPND criteria in Latin American populations, we aimed to assess whether these new criteria improve the diagnostic rate and reduce the time taken to make the diagnosis in a cohort of Latin American patients. METHODS: We reviewed medical records and applied both the 2006 and 2015 diagnostic criteria to all patients seen in four centers in Argentina, Brazil and Venezuela. Patients with multiple sclerosis (MS, n = 915) or other well-established central nervous system (CNS) inflammatory diseases were excluded. AQP4-ab status was measured using indirect immunofluorescence (23%) and cell-based assay (CBA, 77%). In addition, data on gender, ethnicity, age and symptoms at onset, relapses, neuroimaging and immunosuppressive therapy were collected. RESULTS: A total of 104 patients were classified as presenting NMOSD (2015 IPND). Of these, 64 patients (61.5%) fulfilled the 2006 NMO criteria (32 AQP4-ab positive, 17 AQP4-ab negative and 15 unknown). Thus, 40 new patients (38.5%) were classified as presenting NMOSD using the 2015 IPND criteria (33 AQP4-ab positive, 5 AQP4-ab negative and 2 unknown AQP4-ab status), with a median time taken to fulfill the 2015 NMOSD criteria (n = 104) of 1 month (95% CI: 0.6-1.3) and a median time taken to fulfill the 2006 NMO criteria (n = 64) of 18 months (95% CI: 9-26) (log-rank test: p < 0.0001). Females, with median age of 37 years, white ethnicity and recurrent course, predominated in all samples. Ninety-nine patients (95.1%) had at least 1 of the 3 major core clinical characteristics, of which optic neuritis (56.7%) was the most frequent symptom at disease onset. CONCLUSION: This study showed that there was a 62.5% increase in the rate of diagnosing NMOSD through the 2015 IPND criteria, in comparison with the 2006 NMO criteria, with a shorter median time to diagnosis.

[Venezuelan consensus guidelines on the use of magnetic resonance in diagnosis and follow up of patients with multiple sclerosis]. / Consenso venezolano para el uso de la resonancia magnetica en el diagnostico y seguimiento de pacientes con esclerosis multiple.

INTRODUCTION: The clinical use of magnetic resonance (MR) in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Several groups around the world have developed consensus guidelines about the role of MR in MS at diagnosis and during follow up. However, in some regions is difficult to extrapolate the recommendations. AIM: To provide recommendations for the implementation of MR in MS patients at diagnosis and follow up in Venezuela. DEVELOPMENT: A group of experts from Venezuela that included neurologists and radiologists, by using the online surveys methodology as well as face to face meetings developed the intended consensus for the use of MR during the diagnosis and follow up of MS patients in Venezuela. Seventeen recommendations were established based on published evidence and the expert opinion. Recommendations focused on the role of conventional MR techniques and brain atrophy measurement in MS patients both at diagnosis and during follow-up. CONCLUSIONS: The recommendations of this consensus guidelines attempts to optimize the health care and management of patients with MS in Venezuela.

TITLE: Consenso venezolano para el uso de la resonancia magnetica en el diagnostico y seguimiento de pacientes con esclerosis multiple.Introduccion. El uso de la resonancia magnetica (RM) en el diagnostico y seguimiento de pacientes con esclerosis multiple (EM) se ha incrementado considerablemente durante los ultimos años. Diversos grupos de trabajo internacionales han intentado clarificar y normativizar el uso de la RM tanto en el momento del diagnostico como durante el seguimiento de los pacientes. Sin embargo, en muchas ocasiones se extrapolan datos de otras regiones que no contemplan la realidad de cada lugar o son dificiles de implementar. Objetivo. Elaborar un consenso venezolano para el uso de la RM en el diagnostico y seguimiento de pacientes con EM. Desarrollo. Un grupo de expertos de Venezuela, conformado por neurologos y radiologos, mediante metodologia de ronda de encuestas a distancia y reuniones presenciales, llevo adelante la elaboracion del consenso pretendido para el uso de la RM en el diagnostico y seguimiento de pacientes con EM en Venezuela. Se establecieron 17 recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el papel de las tecnicas convencionales de RM, asi como en el de la medicion de la atrofia cerebral en pacientes con EM, tanto en el momento del diagnostico como durante el seguimiento. Conclusion. Las recomendaciones establecidas en el presente consenso permitiran optimizar el cuidado y el seguimiento de los pacientes con EM en Venezuela.

A novel Wnt pathway inhibitor, SM04690, for the treatment of moderate to severe osteoarthritis of the knee: results of a 24-week, randomized, controlled, phase 1 study.

OBJECTIVE: To assess the safety, pharmacokinetics, and exploratory efficacy of SM04690, a novel Wnt pathway inhibitor, as a potential disease modifying treatment for knee osteoarthritis (OA). DESIGN: Subjects with Kellgren-Lawrence grade 2-3 knee OA were randomized in successive dose-escalation cohorts to receive a knee intra-articular (IA) injection with 0.03, 0.07, or 0.23 mg SM04690, or placebo (PBO) (4:1 ratio). Safety, pharmacokinetics, efficacy (WOMAC Total/Function/Pain, Pain VAS, Physician Global Assessment [MDGA], and OMERACT-OARSI Response), OA-related biomarker (P1NP, ß-CTX, and cartilage oligomeric matrix protein [COMP]), and radiographic/imaging data were collected at baseline and during 24-week follow-up. RESULTS: 61 subjects (SM04690 n = 50; PBO n = 11) enrolled. Two dose limiting toxicities (DLTs), increased pain following injection and paroxysmal tachycardia (also the single serious AE), were reported in the 0.07 mg cohort. A total of 72 AEs were reported; Sixteen (occurring in eight subjects) were considered related to study medication. There were three discontinuations; one due to an AE (0.03 mg cohort). Bone marrow edema (BME) remained constant for most subjects. No doses were excluded from further study due to DLT criteria. Plasma levels of SM04690 were below the limit of detection at all time points. At Week 24, improvements from baseline were seen in all cohorts for the exploratory measures WOMAC Total, WOMAC Function, WOMAC Pain, MDGA, Pain VAS, and OMERACT-OARSI response. Joint space width (JSW) improvement was observed in the 0.07 mg cohort (P = 0.02 vs PBO). CONCLUSION: SM04690 appeared safe and well tolerated, with no evidence of systemic exposure. Exploratory efficacy analyses suggested positive trends for measurements of OA pain, function and disease-modifying osteoarthritis drug (DMOAD) properties. CLINICALTRIALS. GOV REGISTRATION: NCT02095548.

Association between abdominal fat distribution, adipocytokines and metabolic alterations in obese low-birth-weight children.

BACKGROUND: In addition to obesity, low birth weight (LBW) has been proposed as another independent risk factor associated with cardiovascular disease and type 2 diabetes mellitus. OBJECTIVE: This study aimed to evaluate the influence of birth weight on abdominal fat distribution, adipocytokine levels and associated metabolic alterations in obese children. METHODS: A cross-sectional study was conducted in 92 children. Children were divided into three groups according to their body mass index and birth weight. Glucose and insulin (0 and 120 min), lipid profile and adipocytokines were measured. Abdominal fat distribution was assessed by magnetic resonance imaging. RESULTS: Obese LBW children had higher fasting glucose (P = 0.054) and insulin (P < 0.001), and 120 min glucose (P < 0.001) and insulin levels (P < 0.001), such as increased HOMA-IR (homeostasis model assessment of insulin resistance index) (P < 0.001). Obesity and LBW were associated with lower concentrations of high molecular weight (HMW) adiponectin (-2.38 [IC 95% -4.27; -0.42, P = 0.018]) and higher subcutaneous adipose tissue (SAT) (28.05 [IC 95% 0.40; 55.7, P = 0.047]) compared with NBW obese children, independent of age or sex. CONCLUSIONS: LBW in obese children is associated with lower HMW adiponectin, increased insulin resistance and greater SAT.

Ecotoxicological assessment of water and sediment of the Corumbataí River, SP, Brazil.

The Corumbataí River drains an economically important area which is mainly represented by the municipalities of Piracicaba and Rio Claro. In view of the impacts caused by the discharge of industrial waste and domestic sewage into the Piracicaba River, the Corumbataí has become increasingly significant as a source of water for the municipality of Piracicaba. However, chemical, physical, and microbiological analyses carried out prior to the present study had already indicated a decline in the quality of the Corumbataí waters. This study aimed to assess, through water and sediment samples, both acute and chronic toxicity to Daphnia magna and Daphnia similis, and to analyze acid-volatile sulfide (AVS) and simultaneously extracted metal (SEM) in the sediment. Resulting data were intended to be a contribution to future projects for the management and recuperation of this system. To that aim, water and sediment were collected at seven Corumbataí sampling stations in November 2003 and March 2004. Acute toxicity to D. similis was detected in water and sediment samples from the Piracicaba station, located at the mouth of the Corumbataí River. Chronic toxicity was identified in the water or sediment samples of all stations, with the exception of Analândia Montante (upstream), at the head of the river. This was found to affect survival, growth, and fecundity of the test-organisms. The AVS and SEM analyses showed the bioavailability of the metals, thus explaining toxicity found in bioassaying samples of water and sediment. The use of two test-organism species made it possible to obtain a better assessment of the condition of both water and sediment samples of the Corumbataí River.

Ecotoxicological assessment of water and sediment of the Corumbataí River, SP, Brazil

The Corumbataí River drains an economically important area which is mainly represented by the municipalities of Piracicaba and Rio Claro. In view of the impacts caused by the discharge of industrial waste and domestic sewage into the Piracicaba River, the Corumbataí has become increasingly significant as a source of water for the municipality of Piracicaba. However, chemical, physical, and microbiological analyses carried out prior to the present study had already indicated a decline in the quality of the Corumbataí waters. This study aimed to assess, through water and sediment samples, both acute and chronic toxicity to Daphnia magna and Daphnia similis, and to analyze acid-volatile sulfide (AVS) and simultaneously extracted metal (SEM) in the sediment. Resulting data were intended to be a contribution to future projects for the management and recuperation of this system. To that aim, water and sediment were collected at seven Corumbataí sampling stations in November 2003 and March 2004. Acute toxicity to D. similis was detected in water and sediment samples from the Piracicaba station, located at the mouth of the Corumbataí River. Chronic toxicity was identified in the water or sediment samples of all stations, with the exception of Analândia Montante (upstream), at the head of the river. This was found to affect survival, growth, and fecundity of the test-organisms. The AVS and SEM analyses showed the bioavailability of the metals, thus explaining toxicity found in bioassaying samples of water and sediment. The use of two test-organism species made it possible to obtain a better assessment of the condition of both water and sediment samples of the Corumbataí River.

O rio Corumbataí drena uma área de importância econômica representada principalmente pelos municípios de Piracicaba e Rio Claro. Face aos impactos causados pelos lançamentos de efluentes industriais e domésticos no rio Piracicaba, o rio Corumbataí assumiu importância para o abastecimento do município de Piracicaba. Entretanto, análises químicas, físicas e microbiológicas realizadas no rio Corumbataí anteriormente a este estudo, indicaram a queda da qualidade de suas águas. Os objetivos deste estudo foram a avaliação da toxicidade aguda e da toxicidade crônica das amostras de água e sedimento, para Daphnia magna e Daphnia similis, e a análise do sulfeto volatilizável por acidificação (SVA) e dos metais simultaneamente extraídos do sedimento (MSE), no sentido de fornecer dados que possam contribuir com projetos futuros de manejo e recuperação desse sistema. Para tanto, água e sedimento provenientes de sete estações de coleta do rio Corumbataí foram coletados em novembro de 2003 e março de 2004. Foi detectada toxicidade aguda para D. similis das amostras de água e sedimento da estação Piracicaba, na foz do rio Corumbataí. A toxicidade crônica foi identificada na água ou no sedimento de todas as estações de coleta, exceto Analândia Montante (nascente do rio), influenciando a sobrevivência, crescimento e fecundidade dos organismos-teste. As análises do SVA e MSE revelaram a biodisponibilidade dos metais, explicando a toxicidade das amostras de água e de sedimento encontrada nos bioensaios. A adoção de duas espécies de organismos-teste possibilitou uma melhor avaliação dos compartimentos amostrados.

Prevalence of Candida albicans and Trichomonas vaginalis in Pregnant Women in Havana City by an Immunologic Latex Agglutination Test / s. t

We aimed to estimate the prevalence of Candida albicans and Trichomonas vaginalis in immunocompetent pregnant women living in Havana City, Cuba, with or without symptoms of vaginitis, using a sample of 640 women from 6 Gyneco-obstetrics hospitals, which represents 2,5 percent of total yearly pregnant women. Diagnosis was made using a new latex agglutination kit (Newvagin C-Kure, La Habana, Cuba)...(AU)

[Diagnosis of tuberculosis meningitis by detection of adenosine deaminase activity and amplification of nucleotide sequences with PCR]. / Diagnóstico de meningitis tuberculosa por la determinación de la actividad de adenosina deaminasa y la amplificación de secuencias nucleotídicas por PCR.

Tuberculous meningitis (TBM) is the most severe and lethal form of tuberculosis. The rapid bacteriological diagnosis with the conventional techniques is nearly impossible in TBM. There for many patients are treated with anti-TBC drugs without a definitive diagnosis. A more fast and accurate diagnostic method is necessary, in order to initiate the treatment on time to prevent the irreversible neurologic sequel or death. We evaluated the use of two rapid methods: Adenosine deaminase activity (ADA) and polymerase chain reaction (PCR) for IS6110 and mtp40 sequences on cerebrospinal fluid (CSF) from chronic meningitis patients. For ADA activity > 8.0 U/L the sensibility and specificity was 80% and 91%. PCR sensibility was 80% and specificity 97%. ADA activity and PCR on CSF could be specially useful as complementary tools in the early diagnosis of TBM.

Consideraciones de diseño de las instalaciones para producciiones estériles de alto riesgo / Considerations of design of the installations for sterile productions of tall risk

En las empresas dedicacas a producciones de alto riesgo, el aseguramiento de la calidad no se limita a la obtención de un producto que satisfaga todas las pexpectativas del cliente, sino que debe involucrar aspectos tan importantes como son la protección del hombre y del medio ambiente, minimizando el riesgo que pueda implicar la manipulación del agente tóxicos.Este trabajo tiene como objetivo fundamental el análisis de los requerimientos de las buenas prácticas de producción aplicadas a instalaciones de producciones stériles de alto riesgo, así como de normas y recomendaciones relacionadas con el diseño de las instalaciones y de esta forma obtener un documento de referencia que contenga los requerimientos exigidos para estas producciones, para ser aplicadas desde la etapa de diseño de las mismas.Conjuntamente se definen las regulaciones aplicables haciendo énfasis en los aspectos más importantes que garantizan el cumplimiento de las buenas prácticas

Consideraciones de diseño de las instalaciones para producciiones estériles de alto riesgo / Considerations of design of the installations for sterile productions of tall risk

En las empresas dedicacas a producciones de alto riesgo, el aseguramiento de la calidad no se limita a la obtención de un producto que satisfaga todas las pexpectativas del cliente, sino que debe involucrar aspectos tan importantes como son la protección del hombre y del medio ambiente, minimizando el riesgo que pueda implicar la manipulación del agente tóxicos.Este trabajo tiene como objetivo fundamental el análisis de los requerimientos de las buenas prácticas de producción aplicadas a instalaciones de producciones stériles de alto riesgo, así como de normas y recomendaciones relacionadas con el diseño de las instalaciones y de esta forma obtener un documento de referencia que contenga los requerimientos exigidos para estas producciones, para ser aplicadas desde la etapa de diseño de las mismas.Conjuntamente se definen las regulaciones aplicables haciendo énfasis en los aspectos más importantes que garantizan el cumplimiento de las buenas prácticas