Direct oral anticoagulants in antiphospholipid syndrome: a real life case series.

AIM: The aim of this study was to describe a case series of patients with primary or secondary antiphospholipid syndrome (APS) treated with direct oral anticoagulants (DOACs). PATIENTS AND METHODS: Clinical charts of eight patients with thrombotic primary or secondary APS treated with direct oral anticoagulants (DOACs) between January 2012 and May 2015 were reviewed. RESULTS: The mean age was 45 ± 14.36 (range 27-69 years). Four patients had secondary APS (50%). All patients were initially treated with warfarin by a mean time of 70.87 ± 57.32 months (range 17-153 months). Changes in anticoagulation were defined by recurring thrombosis in five patients (62.5%) and life-threatening bleeding in the other three cases. Seven patients (87.5%) received rivaroxaban treatment and one patient (12.5%) apixaban. The mean follow-up period with DOACs was 19 ± 10.06 months (range 2-36 months). There was no recurrence of thrombosis by the time of data collection. CONCLUSIONS: Despite not being the standard treatment in APS, we propose DOACs as a rational alternative for the management of patients with this diagnosis. Further interventional clinical studies are necessary for possible standardization of this therapy in APS patients.

La problemática del endosulfán: aspectos químicos, analíticos y ambientales / The roblem of enndosulfan: chemical, analytical and environmental issues

Introducción. Dado el carácter residual y el alto nivel de toxicidad del endosulfán, se ha incrementado la preocupación a nivel mundial por su impacto ambiental. Por eso la búsqueda de metodologías analíticas que permitan su detección y cuantificación es un tema de investigación vigente. Las propiedades del endosulfán y su patrón de degradación le confieren características que hacen muy compleja la problemática, al tiempo que el pesticida y sus metabolitos se expanden extensivamente por la atmósfera y contaminan tanto matrices lipofílicas como hidrofílicas. Objetivo. Llevar a cabo una revisión sobre las investigaciones más recientes acerca de la problemática del endosulfán, que incluye aspectos químicos, su problemática ambiental y técnicas inmunoquímicas para su análisis, tema en el que ha estado interesado nuestro grupo de investigación en la Universidad de Caldas. Método. El presente artículo de revisión analiza, cualitativamente, la literatura científica disponible en las bases de datos Science Direct, PubMed, Scielo y páginas Web oficiales, empleando como palabras de búsqueda: endosulfán, haptenos, análisis inmunoquímico del endosulfán, problemática ambiental del endosulfán, regulaciones internacionales sobre el endosulfán, normatividad vigente sobre el endosulfán, y métodos instrumentales de análisis. Resultados. Se obtuvo información pertinente relacionada con el objetivo propuesto, la cual se presenta en 3 secciones: aspectos químicos del endosulfán, problemática ambiental y técnicas inmoquímicas para su análisis. Conclusión. El endosulfán ha sido prohibido por los organismos internacionales. Sin embargo, el pesticida se continúa usando en algunos países y éste se difunde fácilmente hacia otras regiones, de tal manera que se ha convertido en un problema global. Hay investigaciones recientes sobre métodos de remediación química o biológica, pero los esfuerzos son modestos frente a la enorme problemática de este pesticida. En lo pertinente a análisis químicos de endosulfán, en los últimos 15 años se han investigado técnicas inmunoquímicas de análisis (basadas en haptenos), como alternativa a los métodos cromatográficos instrumentales.

Introduction. Due to the residual character and high level of toxicity of endosulfan, worldwide concern for its environmental impact has increased. Therefore, the search for analytical methodologies that allow its detection and quantification continues to be a topic of current research. Endosulfan properties and its degradation pattern confer it characteristics that make very complex the problematic while the pesticide and its metabolites are extensively spread throughout the atmosphere and contaminate both lipophilic and hydrophilic matrixes. Objective. To conduct a review on some recent research about the endosulfan problematic including chemical aspects, environmental issues and immunochemical techniques for its analysis, which is an area of current interest in this research group at Universidad de Caldas. Method. This review article analyzes qualitatively scientific literature from Science Direct, PubMed, Scielo databases and official Web pages using key words such as endosulfan, endosulfan immunochemical analysis, endosulfan environmental problematic, endosulfan international regulations, endosulfan current normativity and instrumental methods for the analysis. Results. Relevant information related to the proposed objective was found which is presented in 3 sections: chemical aspects of endosulfan, environmental issues, and immunochemical techniques for its analysis. Conclusions. Endosulfan has been banned by international organizations. However, the pesticide is still being used in some countries and is easily spread to other regions, so that the problem became a global concern. There is some recent research on biological or chemical remediation techniques, but efforts seem insufficient in comparison to the enormous impact of the pesticide. In regard to Endosulfan chemical analyses, during the past 15 years immunochemical hapten-based analysis techniques have been investigated as alternatives to the instrumental chromatographic methods.

Alignment of multiple complete genomes suggests that gene rearrangements may contribute towards the speciation of Mycobacteria.

To more accurately define the taxonomic relationships among species belonging to the genus Mycobacterium we have applied and compared three complete genome sequence comparison procedures to existing systems. These included a nucleotide sequence comparison including both coding and no-coding regions of the genome and two genomic-order comparisons using MAUVE and M-GCAT software to provide comparative gene synteny. These methods clearly differentiated a panel of genomes from reference mycobacterial species. Overall, the speciation of bacteria through determination of gene rearrangements were consistent with the gold standard method for species definition in bacteria, DNA-DNA hybridization however within the context of this system, individual components of the Mycobacterium tuberculosis complex (MTBC) did not show sufficient diversity to classify them as a separate species. The high number of gene rearrangements observed between the species tested suggests that gene reorganization of the genome represents an important contributor to speciation within the genus Mycobacterium and other related genera. The absence of rearrangements amongst MTBC supports their consideration as a single genospecies. Some gene rearrangements provided clear internal synteny between genomes of mycobacterial strains belonging to a same species and we suggest these could be used to classify subspecies.

Tuberculin skin test and CD+4/CD8+ T cell counts in adults infected with the human immunodeficiency virus in Medellin, Colombia

To evaluate the effect of BCG vaccination and T lymphocyte subpopulations on the reactivity to the tuberculin skin test, 113 asymtomatic HIV+ individuals were tuberculin tested by intradermal injection of 5TU of purified protein derivate and the levels of circulating lymphocyte (CD3, CD4 and CD8) subpopulations determined by indirect immunoflurescence. Ninety-two per cent of the subjects included in the study, were males. The mean age of the group was 32.1ñ7.4 years. Sixty-two percent presented a BCG scar. However, only 22 per cent exhibited positive tuberculin reations (ò5mm) irrespective of the presence of the BCG scar. Tuberculin positive individuals exhibited higher CD4+ cell counts (p=0.004) and CD4+/CD8+ ratios (p=0.006) than tuberculin negative (<5mm) HIV+ individuals. The number of individuals with positive tuberculin reactions was significantly higher in subjects with more than 500 CD4+ lymphocytes/µl (p=0.02) or CD4+/CD8+ ratios ò1.12 (p=0.002). These results suggest that a prior BCG vaccination does not influence the reactivity to the tuberculin skin test in HIV+ asymptomatic individuals and that the number of CD4+ lymphocytes and the CD4+ lymphocytes and the CD4+/CD8+ ratio positively correlate with the tuberculin reactivity.

Tuberculin skin test and CD4+/CD8+ T cell counts in adults infected with the human immunodeficiency virus in Medellín, Colombia.

To evaluate the effect of BCG vaccination and T lymphocyte subpopulations on the reactivity to the tuberculin skin test, 113 asymptomatic HIV+ individuals were tuberculin tested by intradermal injection of 5TU of purified protein derivative and the levels of circulating lymphocyte (CD3, CD4 and CD8) subpopulations determined by indirect immunofluorescence. Ninety-two percent of the subjects included in the study were males. The mean age of the group was 32.1 +/- 7.4 years. Sixty-two percent presented a BCG scar. However, only 22% exhibited positive tuberculin reactions (> or = 5 mm) irrespective of the presence of the BCG scar. Tuberculin positive individuals exhibited higher CD4+ cell counts (p = 0.004) and CD4+/CD8+ ratios (p = 0.006) than tuberculin negative (< 5 mm) HIV+ individuals. The number of individuals with positive tuberculin reactions was significantly higher in subjects with more than 500 CD4+ lymphocytes/microliter (p = 0.02) or CD4+/CD8+ ratios > or = 1.12 (p = 0.002). These results suggest that a prior BCG vaccination does not influence the reactivity to the tuberculin skin test in HIV+ asymptomatic individuals and that the number of CD4+ lymphocytes and the CD4+/ CD8+ ratio positively correlate with the tuberculin reactivity.

Trunk muscle endurance measurement. Isometric contrasted to isokinetic testing in normal subjects.

STUDY DESIGN: This cohort study examined a sample (n = 152) of subjects tested for isokinetic lumbar strength and endurance, using novel endurance measures. OBJECTIVES: To validate a new lumbar sagittal isokinetic endurance testing protocol comparing reliability in a normal subject cohort with strength test reliability to include presentation of a gender-specific normative database, and then correlating the results to a Sorenson isometric endurance protocol. SUMMARY OF BACKGROUND DATA: The isometric Sorenson test has been virtually the only validated clinical tool for lumbar extensor trunk muscle endurance testing, using an exercise chair and permitting the subject to maintain the trunk horizontal against gravity for a single timed contraction. Alternative isokinetic sagittal lumbar performance measurement methodology has been developed recently to measure trunk muscle endurance by determining declining work performance on repeated, reciprocal dynamic contractions. METHOD: We compared protocols, performance measures, normative data, and reliability for the static isometric Sorenson test to three different isokinetic endurance measurements: the endurance ratio, final fatigue ratio, and recovery ratio. Subjects were tested on a sagittal Cybex TEF (Lumex, Inc., Ronkonkoma, NY) unit for a strength trial followed by an endurance trial. Subgroups also performed reliability and isometric endurance protocols. RESULTS: We found an extremely low test-retest correlation for the isometric Sorenson trunk extension test. All test-retest correlations for the corresponding isokinetic endurance measures were significant and markedly higher. Extensor muscle performance declined more substantially on all endurance measures than flexors and showed more variability. In contrast, trunk strength measures were more reliable and less variable than corresponding endurance measures. Moreover, correlations between the isometric Sorenson test and the isokinetic endurance measures were all negative; i.e., increases in Sorenson time are moderately correlated to greater decline in work performance. CONCLUSIONS: Reliability of the Sorenson isometric endurance test is unacceptably low, showing negative correlations to all isokinetic endurance tests for lumbar extensors. Isokinetic strength and endurance tests are far more reliable than isometric tests, with normative data showing more consistent results from men than women. Both genders display more substantial fatigue (and greater variability) in extensor endurance compared with flexor testing. Endurance measures are identified as human performance cognitive constructs, and reasons for greater variability than usually shown by trunk strength measurements are discussed.

Nuevos macrolidos / New macrolid antibiotics

Presentación de dos nuevos antibióticos del grupo de los macrólidos, al Claritrimicina y la Azitromicina. Se analiza su aspecto antimicrobiano, indicaciones, efectividad y efectos secundarios...

Trasplantes en el sistema nervioso central: una alternativa para las enfermedades neurodegenerativas / Central nervous system transplantation: an alternative for neurodegenerative diseases

Se presentan los antecedentes basicos en la investigacion animal sobre trasplantes al sistema nervioso central que condujeron a la realizacion de los primeros implantes de medula suprarrenal al cerebro humano. Se hacen consideraciones sobre las posibilidades futuras de esta terapeutica en enfermedades Neurodegenerativas