Anti TNF como inductor de lupus cutáneo: caso clínico / Anti TNF as inducer of cutaneous lupus: clinical case

El mayor acceso a las terapias biológicas para el tratamiento de múltiples enfer-medades autoinmune trae consigo el mayor riesgo de padecer eventos adversos relacionados al uso de estos2,4. Presentamos un caso clínico de una paciente con diagnóstico de artritis reumatoide en tratamiento con ANTI TNF

The greater access to biological therapies for the treatment of multiple autoim-mune diseases brings with it the greatest risk of suffering adverse events related to the use of these (2,4). We present a clinical case of a patient diagnosed with rheumatoid arthritis in treatment with ANTI TNF

Caffeine and paraxanthine in aquatic systems: Global exposure distributions and probabilistic risk assessment.

This study presents one of the most complete applications of probabilistic methodologies to the risk assessment of emerging contaminants. Perhaps the most data-rich of these compounds, caffeine, as well as its main metabolite (paraxanthine), were selected for this study. Information for a total of 29,132 individual caffeine and 7442 paraxanthine samples was compiled, including samples where the compounds were not detected. The inclusion of non-detect samples (as censored data) in the estimation of environmental exposure distributions (EEDs) allowed for a realistic characterization of the global presence of these compounds in aquatic systems. EEDs were compared to species sensitivity distributions (SSDs), when possible, in order to calculate joint probability curves (JPCs) to describe the risk to aquatic organisms. This way, it was determined that unacceptable environmental risk (defined as 5% of the species being potentially exposed to concentrations able to cause effects in>5% of the cases) could be expected from chronic exposure to caffeine from effluent (28.4% of the cases), surface water (6.7% of the cases) and estuary water (5.4% of the cases). Probability of exceedance of acute predicted no-effect concentrations (PNECs) for paraxanthine were higher than 5% for all assessed matrices except for drinking water and ground water, however no experimental effects data was available for paraxanthine, resulting in a precautionary deterministic hazard assessment for this compound. Given the chemical similarities between both compounds, real effect thresholds, and thus risk, for paraxanthine, would be expected to be close to those observed for caffeine. Negligible Human health risk from exposure to caffeine via drinking or groundwater is expected from the compiled data.

Ectoparasites of small-mammals: determinants of community structure in South American savannah.

This study aimed to assess the contribution of hosts characteristics (rodents and marsupials) in the organization of ectoparasite communities present in woodland patches in western central Brazil. We verified the effect of host species, sex, body mass and vertical strata in addition to the role of seasonality on the ectoparasite composition, richness and abundance. The total sampling effort was 22 032 trap-nights equally distributed in 54 woodland patches. Variance partition and principal coordinate analysis were used to verify the existence of significant relationships between response variables and predictors. As expected, host species was the most important variable in ectoparasite community assembly. The composition, richness and abundance of mites and lice were highly influenced by host species, although higher for mites than for lice. Host body mass had a determining role on the richness and abundance of tick species. Vertical stratification and seasonality had weak influence, while the sex of the host had no influence on the organization of these communities. The results are closely related to the evolutionary characteristics of the species involved, as well as with local environmental characteristics of the study area.

Ectoparasites of small-mammals: determinants of community structure in South American savannah

This study aimed to assess the contribution of hosts characteristics (rodents and marsupials) in the organization of ectoparasite communities present in woodland patches in western central Brazil. We verified the effect of host species, sex, body mass and vertical strata in addition to the role of seasonality on the ectoparasite composition, richness and abundance. The total sampling effort was 22 032 trap-nights equally distributed in 54 woodland patches. Variance partition and principal coordinate analysis were used to verify the existence of significant relationships between response variables and predictors. As expected, host species was the most important variable in ectoparasite community assembly. The composition, richness and abundance of mites and lice were highly influenced by host species, although higher for mites than for lice. Host body mass had a determining role on the richness and abundance of tick species. Vertical stratification and seasonality had weak influence, while the sex of the host had no influence on the organization of these communities. The results are closely related to the evolutionary characteristics of the species involved, as well as with local environmental characteristics of the study area.

The role of melanism in oncillas on the temporal segregation of nocturnal activity.

The occurrence of coat colour polymorphisms in populations may promote the ecological success of species by permitting a wider spectrum of use of different subsets of available resources. We conducted an analysis of temporal segregation by comparing night brightness with nocturnal activity of spotted and melanistic oncillas (Leopardus tigrinus). Melanistic oncillas were more active during bright nights and spotted oncillas and other species were more active during dark nights. Each colour morph occupied a temporal niche outside the confidence interval of the other colour morph, demonstrating the ecological significance of polymorphic colour patterns in this felid species.

Delia del Carril, revisión biográfica e identitaria / Delia del Carril, biographical and identity review

For the analysis of a clinical case I’ve chosen a woman that belongs to the latin-american artistic history, and that was also Pablo Neruda’s partner for nearly twenty years. Delia del Carril’s life is colored by the effort and the defence of social ideals of change, which did not free her from dealing with the difficulties and costs that this implied. However, she can be looked as a stoic and strong woman concerned about her beliefs and personal decisions. “The Ant” is personified in this article from a narrative/constructivist perspective, referring to personal myths and the process of identity construction to reveal some social and ideological elements that are important, and to be considered in therapeutic work

A modo de análisis de caso clínico, he elegido a una mujer que forma parte de la historia artística de Latinoamérica, además de haber sido pareja por veinte años del vate Pablo Neruda. La vida de Delia del Carril está teñida por el esfuerzo y la defensa de ideales de cambio social, frente a lo cual no queda exenta de la vivencia de las dificultades y costos que esto implicaba. Sin embargo, se observa como una mujer estoica y firme respecto de sus creencias y opciones. “La Hormiga” es personificada en este trabajo desde una perspectiva narrativo/constructivista, tomando los mitos personales y el proceso de construcción de identidad para hacer alusión a ciertos elementos sociales e ideológicos que son relevantes de ser considerados en el trabajoterapéutico

Effectiveness and safety of a treatment regimen based on isoniazid plus vaccination with Mycobacterium tuberculosis cells' fragments: field-study with naturally Mycobacterium caprae-infected goats.

The identification of a herd of goats with tuberculosis let us test a new treatment regimen against latent tuberculosis infection (LTBI). Using large animal experimental models allows a better approach to understanding human tuberculosis according to immunopathological parameters. Based on an initial study showing a correlation between the ESAT-6-specific interferon (IFN)-gamma secretion and the severity of pulmonary lesions, this parameter was used in combination with an X-ray examination to screen the animals to be included in the efficacy and safety studies. All the animals proved to be infected with Mycobacterium caprae. The efficacy study was run in animals distributed in three experimental groups according to treatment: untreated (CT), treated with isoniazid (INH), and treated with INH + RUTI (a vaccine based on M. tuberculosis cell fragments) inoculated twice. RUTI temporarily increased the IFN-gamma production after stimulating the peripheral blood with ESAT-6, purified protein derivative and RUTI in vitro. The INH chemotherapy reduced both pulmonary and extra pulmonary affectation, but not disease in pulmonary lymph nodes. The addition of RUTI may have decreased extrapulmonary disease further but had no benefit to lung or lung lymph-nodes itself. Safety studies showed that inoculation of RUTI caused a temporary increase of rectal temperature (1-2 degrees C) and local swelling, both adverse effects being well tolerated. Neither systemic toxicity nor mortality was induced by the vaccination. The control of goats' infection by the therapeutic regimen consisting in INH chemotherapy + RUTI as well as its safety, represented a further step towards testing its effects in human LTBI in a future.

Extended safety studies of the attenuated live tuberculosis vaccine SO2 based on phoP mutant.

Safety is one of the main concerns for attenuated live vaccine candidates. Here we extend the stability and attenuation studies of the promising tuberculosis vaccine candidate based on Mycobacterium tuberculosis phoP mutant strain, SO2. Stability of the phoP mutation was tested after sub-culturing SO2 strain for 6 months in laboratory media and also after 3 months of infection in SCID mice. Results showed no reversion of the phoP mutation either in vitro or in vivo. In addition, SO2 was fully sensitive to four major first-line antituberculous drugs against tuberculosis. Safety and toxicity studies were performed in guinea pigs. Animals were infected with a quantity of SO2 equivalent to 50 vaccination doses (2.5x10(6) CFUs) and weight was monitored for 6 months. All animals survived and no histological lesions were found, showing full attenuation of SO2. Studies in a post-exposure model of guinea pigs and mice, previously infected with M. tuberculosis, were performed and no toxicity effects were found after inoculation of SO2. All these results together confirm that SO2 has a secure safety profile that encourages its use in clinical trials.

Aberrant signal transduction pathways in myeloproliferative neoplasms.

The BCR-ABL-negative myeloproliferative neoplasms (MPNs), polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF), entered the spotlight in 2005 when the unique somatic acquired JAK2 V617F mutation was described in >95% of PV and in 50% of ET and PMF patients. For the very rare PV patients who do not harbor the JAK2 V617F mutation, exon 12 JAK2 mutants were discovered also to result in activated forms of JAK2. A minority of ET and PMF patients harbor mutations that constitutively activate the thrombopoietin receptor (TpoR). In bone marrow reconstitution models based on retroviral transduction, the phenotype induced by JAK2 V617F is less severe and different from the rapid fatal myelofibrosis induced by TpoR W515L. The reasons for these differences are unknown. Exactly by which mechanism(s) one acquired somatic mutation, JAK2 V617F, can promote three different diseases remains a mystery, although gene dosage and host genetic variation might have important functions. We review the recent progress made in deciphering signaling anomalies in PV, ET and PMF, with an emphasis on the relationship between JAK2 V617F and cytokine receptor signaling and on cross-talk with several other signaling pathways.

Detección sensible y específica de mycobacterium tuberculosis a partir de muestras clínicas, mediante la amplificación de un elemento repetitivo de la familia rep13e12 / Sensitive and specific detection of Mycobacterium tuberculosis from clinical samples by amplification of a repeated sequence of the REP13E12 family

Objetivos: Diseñar e implementar un método de PCR para la detección sensible y específica de M. tuberculosis, orientado al oportuno diagnóstico de la tuberculosis mediante su adecuada aplicación en muestras clínicas. Materiales y métodos: Se diseñaron oligonucleótidos específicos para la amplificación de un fragmento de 318pb luego de una alineación múltiple de secuencias REP13E12 de M. tuberculosis. Se realizó la estandarización del método de PCR y se evaluó la sensibilidad y especificidad diagnóstica utilizando muestras clínicas con diagnóstico baciloscópico y cultivo. Resultados: El REP13E12-PCR detectó hasta 100 fg de ADN genómico, fue específico para la detección del complejo M. tuberculosis y capaz de distinguirlos de micobacterias atípicas. Esta evaluación preliminar proporcionó 100% de sensibilidad y especificidad en muestras clínicas de pacientes con diagnóstico de TB. Conclusiones: La amplificación de REP13E12 mediante PCR es una alternativa para el diagnóstico rápido de pacientes con TB, especialmente en casos cuyo diagnóstico pueda ser dificultoso o poco claro mediante el uso de los métodos convencionales..

Objectives: To design and implement of PCR method for sensitivity and specific detection of M. tuberculosis oriented to opportune and correctly diagnosis of tuberculosis by the application on clinical specimens. Material an methods: Specific oligonucleotides for the amplification of a fragment of 318pb after a multiple alignment of sequences REP13E12 were designed. The PCR method was standarize and also the analytical and diagnostic sensibility and specifity was evaluate; using clinical samples with smear or culture diagnosis positive and negative. Results: The REP13E12-PCR detected up to 100 fg of genomic DNA. It was specific for the detection of complex M. tuberculosis and able to distinguish them of non-tuberculous mycobacteria. This preliminary evaluation provided 100% of sensitivity and specificity in sputum samples of patients with TB diagnosis. Conclusions: The REP13E12 amplification by PCR is an alternative method for the rapid diagnosis of patients with TB, especially for cases which difficult or unclear diagnosis by the gold standard technique.

Intervención de terapia ocupacional en prevención y tratamiento de obesidad y diabetes mellitus tipo II: nunca pensamos que era algo más que una dieta1 / O.T. intervention for prevention and treatment of obesity and diabetes: we never thought was more than a diet

El presente artículo muestra la experiencia de intervención de Terapia Ocupacional con personas Obesas y Pre Diabéticas, realizado en un Centro de Salud Familiar de la Comuna El Bosque. La experiencia se enmarca dentro de un Programa de Intervención Integral, para personas con Obesidad y Pre Diabetes, financiado por el Fondo Nacional de la Salud FONASA y desarrollado como una experiencia piloto en cinco establecimientos de salud durante el año 2004 Y 2005, experiencia que por sus resultados en el presente año, está siendo implementada a lo largo de todo Chile. La intervención, que considera el abordaje integral de las patologías antes señaladas, es llevada a cabo por un equipo multiprofesional compuesto por: Nutricionista, Médico, Terapeuta Ocupacional, Kinesiólogo y Auxiliar Paramédico. La experiencia en la práctica fue desarrollada por una Terapeuta Ocupacional, miembro del equipo del Centro de Salud Familiar y docente de la Universidad Andrés Bello, y cuatro alumnas en práctica de la Carrera de Terapia Ocupacional, de la misma casa de estudios, quienes realizaron intervenciones individuales y grupales por espacio de 10 meses, entre Julio de 2004 y Abril de 2005.Lo que se presenta en este artículo, así como el análisis y reflexiones que de éste surgen, constituyen un espacio innovador y pionero para la Terapia Ocupacional como disciplina y abren un camino para la inserción del Terapeuta Ocupacional en la prevención y tratamiento de patologías crónicas, así como la promoción de la salud en la atención primaria.

The present article is about the experience of working in Occupational Therapy with fat and pre-diabetic people, carried out in a Family Health Center in El Bosque commune. This knowledge is applied to a program of integral intervention to pre-diabetic and fat people, subsidized by FONASA National Funds of Health and realized as a pilot experience in five different establishment of health between 2004 and 2005. For its excellent results this experience in the current year is being applied to others communes of our country. The intervention that considers the complete attention of the pathologies before mentioned is performances by a multiprofessional team integrated by Nutritionist, Doctors, Occupational Therapist, Kinesyologist and Paramedical Assistant.Interventions that, in the practice were developed by an Occupational Therapists member of the team of the Family Health Center and teacher from Andres Bello University, and four students making practicing in the occupational therapy career from the some establishment, who carried out individual and group interventions approximately ten months between July 2004 and April 2005.The analysis and reflections we can observe in this paper constitute an innovative and pioneer space for the occupational therapy as a discipline, in the prevention and treatment of the chronic pathologies, and to the health promotion in the primary attention.

Binomiomadre niño: un modelo de capacitacion del equipo de salud en atencion primaria / Mother-child binomial: primary health care traning model for health teams

El 60 por ciento de las muerte infantiles se relacionan con la saludmaterna por eso la importancia de trabajar el binomio madreniño.El bajo peso al nacer está relacionado con escasos controlesprenatales, espacios intergenéticos cortos, enfermedadesmaternas como hipertensión, alteraciones de la nutrición y escasaeducación. El objetivo del presente trabajo es presentar un modelo deenseñanza de la pediatría en el post grado que integre el binomiomadre-niño b) Abordar la capacitación y actualizacióninterdisciplinaria del equipo de salud de APS a traves de unamodalidad a distancia c)Favorecer la articulación docenteasistencial. (Universidad, Provincia, Municipio).La modalidad a distancia brinda oportunidad a losprofesionales a actualizarse sin dejar su medio social y laboral.El material de estudio, módulos, se envía por correo electrónicoo en soporte digital (CD). Las actividades que se proponen sonla mayoría de resolución colectiva, lo que permite la integraciónde las diferentes disciplinas del equipo de salud. Se implementóla figura del tutor y dos evaluaciones presenciales, además deuna encuesta de satisfacción.

Binomiomadre niño: un modelo de capacitacion del equipo de salud en atencion primaria / Mother-child binomial: primary health care traning model for health teams

El 60 por ciento de las muerte infantiles se relacionan con la saludmaterna por eso la importancia de trabajar el binomio madreniño.El bajo peso al nacer está relacionado con escasos controlesprenatales, espacios intergenéticos cortos, enfermedadesmaternas como hipertensión, alteraciones de la nutrición y escasaeducación. El objetivo del presente trabajo es presentar un modelo deenseñanza de la pediatría en el post grado que integre el binomiomadre-niño b) Abordar la capacitación y actualizacióninterdisciplinaria del equipo de salud de APS a traves de unamodalidad a distancia c)Favorecer la articulación docenteasistencial. (Universidad, Provincia, Municipio).La modalidad a distancia brinda oportunidad a losprofesionales a actualizarse sin dejar su medio social y laboral.El material de estudio, módulos, se envía por correo electrónicoo en soporte digital (CD). Las actividades que se proponen sonla mayoría de resolución colectiva, lo que permite la integraciónde las diferentes disciplinas del equipo de salud. Se implementóla figura del tutor y dos evaluaciones presenciales, además deuna encuesta de satisfacción.(AU)

Estrogen receptor-alpha populations change with age in commercial laying hens.

Older hens in production lay larger but fewer eggs than younger birds, and the incidence of soft and broken shells is greater in older hens than younger. These changes are attributable at least in part to changing hormone profiles and diminished ability of the hen to transport calcium at the duodenum. In further exploration of this relationship, a study was conducted with three ages of Hy-Line W-36 birds: prelay pullets (PL; 19 wk, 0% production), peak-production hens (PP; 29 wk, approximately 93% production), and late-stage hens (LS; 71 wk, approximately 80% production). Hens from the PP and LS groups were palpated for presence of an egg in the shell gland; hens were then euthanized and tissues (kidney, shell gland, hypothalamus) were removed for quantification of estrogen receptor-alpha (ERalpha) populations via immunocytochemical and Western blot analyses. Localization of ERalpha by immunostaining in the shell gland showed differences among age groups; however, no differences were noted in localization of ERalpha between age groups in the kidney and hypothalamus. In both the kidney and the shell gland there was a decrease in the amount of ERalpha, as detected by immunoblotting, in the LS hens compared to PL and PP birds (P < 0.05). The results suggest that failure of calcium regulating mechanisms with age may be mediated at least in part through the reduced populations of estrogen receptors in certain critical tissues.

[Pulmonary thromboembolism associated with antiphospholipid syndrome and systemic lupus erythematosus]. / Tromboembolismo pulmonar relacionado a síndrome antifosfolípido y lupus eritematoso sistémico.

The association between systemic lupus erythematosus and antiphospholipid syndrome can cause several complications. We report a 45 years old woman, treated with steroids for a systemic lupus erythematosus. She presented with a clinical picture of a lupus pneumonitis and, subsequently, with the picture of a pulmonary thromboembolism. The diagnosis was confirmed by helicoidal computed axial tomography. The patient was treated with anticoagulants, with a favourable outcome.

Overexpression of the D-alanine racemase gene confers resistance to D-cycloserine in Mycobacterium smegmatis.

D-Cycloserine is an effective second-line drug against Mycobacterium avium and Mycobacterium tuberculosis. To analyze the genetic determinants of D-cycloserine resistance in mycobacteria, a library of a resistant Mycobacterium smegmatis mutant was constructed. A resistant clone harboring a recombinant plasmid with a 3.1-kb insert that contained the glutamate decarboxylase (gadA) and D-alanine racemase (alrA) genes was identified. Subcloning experiments demonstrated that alrA was necessary and sufficient to confer a D-cycloserine resistance phenotype. The D-alanine racemase activities of wild-type and recombinant M. smegmatis strains were inhibited by D-cycloserine in a concentration-dependent manner. The D-cycloserine resistance phenotype in the recombinant clone was due to the overexpression of the wild-type alrA gene in a multicopy vector. Analysis of a spontaneous resistant mutant also demonstrated overproduction of wild-type AlrA enzyme. Nucleotide sequence analysis of the overproducing mutant revealed a single transversion (G-->T) at the alrA promoter, which resulted in elevated beta-galactosidase reporter gene expression. Furthermore, transformants of Mycobacterium intracellulare and Mycobacterium bovis BCG carrying the M. smegmatis wild-type alrA gene in a multicopy vector were resistant to D-cycloserine, suggesting that AlrA overproduction is a potential mechanism of D-cycloserine resistance in clinical isolates of M. tuberculosis and other pathogenic mycobacteria. In conclusion, these results show that one of the mechanisms of D-cycloserine resistance in M. smegmatis involves the overexpression of the alrA gene due to a promoter-up mutation.

[Hepatitis C virus infection presenting as a polyarthritis: report of 2 cases]. / Poliartritis como manifestación de infección por virus C de la hepatitis: presentación de dos casos clínicos.

Several disease have been associated with hepatitis C virus infections, including rheumatologic, hematologic and neoplastic disorders. We report two women, aged 57 and 39 years old whom the initial presentation of hepatitis C virus infection was an arthritis resembling rheumatoid arthritis. Laboratory work up revealed abnormal liver function tests, stimulating the search for hepatitis C virus infection, having both patients positive ELISA tests. Detection of this agent is extremely important when selecting a therapy for the articular disease, since several drugs used in the treatment of rheumatic disorders are potentially hepatotoxic and immunosuppression is risky in the setting of a viral hepatitis.