Stalagmite-like pre-retinal deposits in the optical coherence tomography of two vitrectomy patients with panuveitis.

Two patients with panuveitis are presented in whom, after undergoing a vitrectomy, the optical coherence tomography (OCT) revealed some unusual pre-retinal hyper-reflective deposits with the shape of stalagmites, distributed in a multifocal and perivascular pattern. Case 1: 51-year-old male with panuveitis in the right eye. After diagnostic-therapeutic vitrectomy, OCT showed pre-retinal stalagmite-like deposits. There was no clear aetiology, and the deposits persisted over the time. Case 2: 76-year-old woman with panuveitis in the right eye. After a surgery for cataract-vitrectomy and epiretinal membrane peeling, OCT revealed pre-retinal stalagmite-like deposits. The analysis reported elevated Toxoplasma IgG titres. Clarithromycin and corticosteroid were prescribed, resulting in the disappearance of pre-retinal deposits. The stalagmite-like deposits are not a very common tomographic sign of a posterior uveitis process, but they seem to correlate with inflammatory activity. There does not seem to be a clear mechanism or a particular aetiology.

Depósitos prerretinianos tipo estalagmita en la tomografía de coherencia óptica de dos pacientes vitrectomizados con panuveítis / Stalagmite-like pre-retinal deposits in the optical coherence tomography of two vitrectomy patients with panuveitis

Se presentan los casos de dos pacientes con panuveítis que, tras ser vitrectomizados, presentaron en la tomografía de coherencia óptica (OCT), depósitos prerretinianos inusuales en forma de estalagmitas hiperreflectivas, multifocales y de patrón perivascular.Caso 1: Varón de 51 años con panuveítis en el ojo derecho (OD). Tras una vitrectomía diagnóstico-terapéutica, la OCT evidenció depósitos prerretinianos tipo estalagmitas, sin una etiología clara y persistencia de los depósitos.Caso 2: Mujer de 76 años con panuveítis del OD. Tras una cirugía combinada de catarata y pelado de membrana epirretiniana, la OCT reveló depósitos prerretinianos tipo estalagmitas. La analítica reportó títulos IgG elevados para toxoplasma. Se prescribió claritromicina y corticoide con desaparición progresiva de los depósitos prerretinianos.Los depósitos prerretinianos tipo estalagmitas son un signo tomográfico poco común de los procesos uveíticos posteriores, parecen correlacionarse con la actividad inflamatoria, aunque sin un claro mecanismo y sin una etiología en particular.

Two patients with panuveitis are presented in whom, after undergoing a vitrectomy, the optical coherence tomography (OCT) revealed some unusual pre-retinal hyper-reflective deposits with the shape of stalagmites, distributed in a multifocal and perivascular pattern.Case 1: 51-year-old male with panuveitis in the right eye. After diagnostic-therapeutic vitrectomy, OCT showed pre-retinal stalagmite-like deposits. There was no clear aetiology, and the deposits persisted over the time.Case 2: 76-year-old woman with panuveitis in the right eye. After a surgery for cataract-vitrectomy and epiretinal membrane peeling, OCT revealed pre-retinal stalagmite-like deposits. The analysis reported elevated Toxoplasma IgG titres. Clarithromycin and corticosteroid were prescribed, resulting in the disappearance of pre-retinal deposits.The stalagmite-like deposits are not a very common tomographic sign of a posterior uveitis process, but they seem to correlate with inflammatory activity. There does not seem to be a clear mechanism or a particular aetiology.

Stalagmite-like pre-retinal deposits in the optical coherence tomography of two vitrectomy patients with panuveitis. / Depósitos prerretinianos tipo estalagmita en la tomografía de coherencia óptica de dos pacientes vitrectomizados con panuveítis.

Two patients with panuveitis are presented in whom, after undergoing a vitrectomy, the optical coherence tomography (OCT) revealed some unusual pre-retinal hyper-reflective deposits with the shape of stalagmites, distributed in a multifocal and perivascular pattern. Case 1: 51-year-old male with panuveitis in the right eye. After diagnostic-therapeutic vitrectomy, OCT showed pre-retinal stalagmite-like deposits. There was no clear aetiology, and the deposits persisted over the time. Case 2: 76-year-old woman with panuveitis in the right eye. After a surgery for cataract-vitrectomy and epiretinal membrane peeling, OCT revealed pre-retinal stalagmite-like deposits. The analysis reported elevated Toxoplasma IgG titres. Clarithromycin and corticosteroid were prescribed, resulting in the disappearance of pre-retinal deposits. The stalagmite-like deposits are not a very common tomographic sign of a posterior uveitis process, but they seem to correlate with inflammatory activity. There does not seem to be a clear mechanism or a particular aetiology.

Immunological features in pediatric patients with recurrent and severe infection: Identification of Primary Immunodeficiency Diseases in Merida, Venezuela

Introduction and objectives: Primary immunodeficiency diseases (PIDs) are disorders associated mainly with recurrent and severe infection and an increase in susceptibility to autoimmune conditions and cancer. In Venezuela, PIDs are underdiagnosed and there is usually a delay in their diagnosis. Hence there are no data concerning the frequency and type of PIDs that occur. The aim of this study was to identify and quantify the types of PIDs that occur in Merida, a population within Venezuela. Patients or materials and methods: Following an informative program designed to alert local health professionals to the warning signs for PIDs, patients with a history of recurrent infections were referred to the Instituto de Inmunologia Clinica, Universidad de Los Andes. Results and conclusions: During the three-year period January 2014 to January 2017, thirty-two cases of PIDs were identified in pediatric patients, and 17 different types of PIDs, were identified. Predominantly antibody deficiencies were most frequent (40.6%), followed by immunodeficiencies affecting cellular and humoral immunity (21.8%), congenital defects of phagocyte (18.7%), CID with associated or syndromic features (9.3%), defects in intrinsic and innate immunity (6.4%) and diseases of immune dysregulation (3.2%). These results have important implications not only to the future approach for management of patients in our regions, but add important knowledge concerning PIDs in Latin America and worldwide

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Immunological features in pediatric patients with recurrent and severe infection: Identification of Primary Immunodeficiency Diseases in Merida, Venezuela.

INTRODUCTION AND OBJECTIVES: Primary immunodeficiency diseases (PIDs) are disorders associated mainly with recurrent and severe infection and an increase in susceptibility to autoimmune conditions and cancer. In Venezuela, PIDs are underdiagnosed and there is usually a delay in their diagnosis. Hence there are no data concerning the frequency and type of PIDs that occur. The aim of this study was to identify and quantify the types of PIDs that occur in Merida, a population within Venezuela. PATIENTS OR MATERIALS AND METHODS: Following an informative program designed to alert local health professionals to the warning signs for PIDs, patients with a history of recurrent infections were referred to the Instituto de Inmunologia Clinica, Universidad de Los Andes. RESULTS AND CONCLUSIONS: During the three-year period January 2014 to January 2017, thirty-two cases of PIDs were identified in pediatric patients, and 17 different types of PIDs, were identified. Predominantly antibody deficiencies were most frequent (40.6%), followed by immunodeficiencies affecting cellular and humoral immunity (21.8%), congenital defects of phagocyte (18.7%), CID with associated or syndromic features (9.3%), defects in intrinsic and innate immunity (6.4%) and diseases of immune dysregulation (3.2%). These results have important implications not only to the future approach for management of patients in our regions, but add important knowledge concerning PIDs in Latin America and worldwide.

Diferencias histomorfológicas entre tejido gingival clínicamente sano de niños y adultos jóvenes / Differences between histomorphologic clinically healthy gingival tissue of children and young adults

Existe controversia con respecto a la influencia del factor histomorfológico en la menor severidad en la respuesta inflamatoria del tejido gingival de la población infantil con respecto a la población adulta ante la biopelícula dental. El objetivo de ésta investigación fue identificar las diferencias histomorfológicas entre el tejido gingival clínicamente sano de niños y adultos jóvenes. Se realizaron exodoncias de dientes temporales y permanentes sanos con su tejido gingival adherido a niños de 6 a 10 y adultos de 18 a 25 años de edad, para posterior análisis histomorfológico bajo microscopía de luz. El área total del epitelio de unión fue mayor en los niños presentando mayor grosor y número de capas en la zona apical. Se observó además, infiltrado celular inflamatorio adyacente al epitelio de unión, mayor cantidad de vasos, predominio de densidad laxa en las fibras del tejido conectivo y paraqueratinización del epitelio bucal. No se encontraron diferencias en la amplitud de los tejidos ni en su espesor con respecto a los epitelios bucal y surcular, tampoco en las dimensiones del tejido conectivo ni en el grosor de la capa córnea. El presente estudio confirmó la existencia de diferencias histomorfológicas entre los tejidos gingivales de niños y adultos jóvenes en condiciones de salud clínica, resaltando la importancia del factor histomorfológico, como uno de los parámetros que podrían influir en la respuesta de los tejidos gingivales a la biopelícula dental a diferentes de edades

The effect of the histomorphologic features in the minor severity of the inflammatory response in gingival tissues against the dental biofilm in childhood is matter of controversy. The objective was to identify the differences between the histomorphologic characteristics in healthy gingival tissues of children and young adults. Extraction of healthy temporal and permanent teeth and its gingival tissues were carried out in children of 6 -10 years old and adults of 18 - 25 years old, the histological samples were processed and analyzed using light microscopy. Children showed a bigger area of the junctional epithelium, more thickness of the apical area as well as a high number of union layers; presence of inflammatory cell infiltrated around the junctional ephytelium, increased number of blood vessels, predominance of laxe density of the connective tissue and pharaqueratinization of the oral ephytelium. There were no differences in the width and thickness of the oral epithelium and surcular tissues, the width of the connective tissue and the thickness of the stratum corneum did not showed differences. The present study confirmed the occurrence of histomorphologic differences in healthy gingival tissues between children and young adults, highlighting the importance of this parameter as one of the characteristics that could influence the gingival response to the dental biofilm at different age

Modificaciones del flujo sanguíneo de las arterias uterina, umbilical y cerebral media fetal en preeclámpticas tratadas con parches de nitroglicerina / Blood flow modifications of uterine, umbilical and fetal middle cerebral arteries in preeclamptic patients treated with nitroglycerin patches

Objetivo Identificar las modificaciones del flujo sanguíneo de las arterias uterinas, umbilical y cerebral media fetal en preeclámpticas tratadas con parches de nitroglicerina. Método La muestra fue de 31 embarazadas preeclámpticas nulíparas con embarazos de más de 25 semanas que acudieron a la emergencia obstétrica del Hospital Central “Dr. Urquinaona”. Se midieron el índice de pulsatilidad, el índice de resistencia y la relación del flujo sanguíneo sistólico/diastólico de las arterias uterinas, umbilical y cerebral media fetal antes del tratamiento, a las 24 y a las 48h después de éste. El tratamiento fue con parches transdérmicos de nitroglicerina de 5mg, aplicado en la región torácica anterior o lumbar de las pacientes por un período de 12h, por un tiempo total de 48h.Resultados Se observó que el índice de pulsatilidad, el índice de resistencia y la relación de flujo sistólico/diastólico presentaron disminuciones significativas posteriores al uso de los parches de nitroglicerina (p<0,05). Con respecto a la arteria umbilical y cerebral media fetal, no se observaron modificaciones significativas a las 24 y 48 h al compararlo con los valores iniciales (p=ns). No se reportaron efectos adversos. Conclusión Existe disminución en la resistencia al flujo sanguíneo en las arterias uterinas de las preeclámpticas tratadas con parches de nitroglicerina sin producir modificaciones significativas en la arteria umbilical y cerebral media fetal (AU)

Objective To identify modifications in blood flow in uterine, umbilical and fetal middle cerebral arteries in preeclamptic patients treated with nitroglycerin patches.Method The sample consisted of 31 preeclamptic nulliparous patients with pregnancies of more than 25 weeks who attended the obstetric emergency service at the Dr. Urquinaona Central Hospital. The pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine, umbilical and fetal middle cerebral arteries were measured before treatment and after 24 and 48h of treatment administration. Treatment consisted of 5mg transdermal nitroglycerin patches, applied in the anterior thoracic and lumbar region of patients for 12h (total time of 48h).ResultsThe pulsatility index, resistance index and systolic/diastolic blood flow ratio significantly decreased after the use of nitroglycerin patches (p<0.05). There were no significant modifications in the umbilical and fetal middle cerebral arteries at 24 and 48 h when compared with initial values (p=ns). There were no adverse effects. Conclusion Nitroglycerin patches decreased resistance to blood flow in the uterine arteries of preeclamptic patients without producing significant modifications in the umbilical and fetal middle cerebral arteries (AU)

Edema agudo de pulmón secundario a preeclampsia severa / Acute pulmonary edema secondary to severe preeclampsia

El edema agudo de pulmón es una complicación rara y potencialmente fatal durante el embarazo. Se ha reportado que complica del 0,08 al 0,5% de los embarazos. Se presenta un caso de 28 años y embarazo de 35 semanas, quien presentó dificultad respiratoria, cefalea y epigastralgia. Se realizó el diagnóstico de edema agudo de pulmón secundario a preeclampsia severa (AU)

Acute pulmonary edema is a rare and potentially fatal complication during pregnancythat has been reported to affect 0.08 to 0.5% of pregnancies. We report the case of a 28-yearoldpatient with a 35-week pregnancy who presented with shortness of breath, headache andepigastralgia. A diagnosis of acute pulmonary edema secondary to severe preeclampsia wasmade (AU)

Lípidos y lipoproteína (a) en menopáusicas tratadas con tibolona / Lipids and lipoprotein (a) in postmenopausal women treated with tibolone

Objetivo Determinar las modificaciones en los lípidos y la lipoproteína (a) (Lp(a)) en menopáusicas que utilizan tibolona. Materiales y métodos Una muestra de 45 menopáusicas que fueron tratadas con una dosis diaria de 2,5mg de tibolona por 6 meses. Se midieron las concentraciones séricas de colesterol, triglicéridos (TG), lipoproteína de alta densidad (HDL-C), lipoproteína de baja densidad (LDL-C), Lp(a), la relación colesterol/HDL-C y la relación TG/HDL-C. Resultados Se observaron disminuciones significativas en las concentraciones de colesterol, TG, LDL-C y Lp(a) cuando se compararon las concentraciones después de 6 meses de uso de la tibolona con las concentraciones iniciales (p<0,05). Se observó una disminución estadísticamente significativa en las concentraciones de la HDL-C (p<0,05). En cuanto a la relación TG/HDL-C, ésta presentó una diminución estadísticamente significativa de más del 30% (p<0,05). Con respecto a la relación colesterol/HDL-C, no se encontraron diferencias estadísticamente significativas en los valores promedio antes y después del tratamiento (p=ns).Conclusión La tibolona produjo disminuciones significativas en las concentraciones plasmáticas de colesterol, TG, HDL-C, LDL-C y Lp(a), y modificaciones significativas en la relación TG/HDL-C-C luego de seis meses de uso (AU)

Objective To determine modifications in lipids and lipoprotein (a) in postmenopausal women receiving tibolone. Materials and methods A sample of 45 postmenopausal women who were treated with a dose of 2.5mg of tibolone daily for 6 months was selected. Serum concentrations of cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) and the cholesterol/HDL and triglyceride/HDL ratios were measured. Results Cholesterol, triglyceride, LDL-C and lipoprotein (a) concentrations were significantly reduced after 6 months of tibolone use compared with initial concentrations (p<0.05). A statistically significant decrease in HDL-C was observed (p<0.05). The triglyceride/HDL ratio showed a significant reduction of more than 30% (p<0.05). No significant differences in mean cholesterol/HDL ratio values before and after treatment (p=ns) were found. Conclusions Tibolone significantly reduced cholesterol, triglyceride, HDL-C, LDL-C and lipoprotein (a) concentrations and significant modifications in the triglyceride/HDL-C ratio after 6 months of use (AU)

Efecto de diosgenina sobre la proteína C reactiva y homocisteína en pacientes menopáusicas / Effect of diosgenin on homocysteine and C-reactive protein concentrations in postmenopausal women

El objetivo fue investigar las concentraciones de homocisteína y proteína C reactiva en pacientes menopáusicas tratadas con diosgenina como alternativa a la terapia de reemplazo hormonal. Se realizó una investigación de tipo explicativa, prospectiva y longitudinal, con un diseño cuasi experimental y un muestreo no probabilístico de 49 pacientes que asistieron a la consulta de menopausia del Hospital Central Dr. Urquinaona. Se determinaron las concentraciones de homocisteína y proteína C reactiva antes y después de 6 meses de tratamiento con diosgenina. El promedio ± desviación estándar de las mujeres menopáusicas fue de 51,6 ± 2,9 años; la edad ± desviación estándar de aparición de la menopausia fue de 44,6 ± 2,1 años y el tiempo desde la menopausia fue de 45,7 ± 18,4 meses. Se encontró un incremento de más del 56% en la concentración de proteína C reactiva a los 6 meses de tratamiento en comparación con las concentraciones iniciales (p < 0,05). Las concentraciones de homocisteína plasmática presentaron una ligera disminución (aproximadamente mayor del 5%) comparadas con las concentraciones iniciales (p = NS). Se concluye que la diosgenina produce aumento significativo en la concentración de proteína C reactiva sin inducir modificaciones en las concentraciones plasmáticas de homocisteína luego de 6 meses de tratamiento (AU)

The aim of this study was to investigate homocysteine and C-reactive protein concentrations in postmenopausal women treated with diosgenin as an alternative to hormone replacement therapy. An explanatory, prospective and longitudinal study was performed with a quasi-experimental design and non-probabilistic sampling of 49 patients who attended the menopause clinic of the Dr. Urquinaona General Hospital. Homocysteine and C-reactive protein concentrations were determined before and after 6 months of treatment with diosgenin. The mean age of the postmenopausal women was 51.6 ± 2.9 years. Age at menopause onset was 44.6 ± 2.1 years and the time from m e n o p a use was 45.7 ± 18.4 months. C-reactive protein concentrations were increased by more than 56% at 6 months of treatment compared with initial concentrations (P<.05). Plasma homocysteine concentrations slightly decreased (by more than 5%, approximately) compared with initial concentrations (P=NS). We conclude that diosgenin significantly increases C -reactive concentrations, without modifying plasma homocysteine concentrations after 6 months of treatment (AU)

Surgical outcomes for primary rhegmatogenous retinal detachments in phakic and pseudophakic patients: the Retina 1 Project--report 2.

AIMS: To compare anatomical and functional outcomes for 546 phakic and pseudophakic primary rhegmatogenous retinal detachments (RDs) treated by pars plana vitrectomy or scleral buckling. METHODS: Prospective, non-randomised, interventional study in 15 centres in Spain and Portugal, with data from RDs consecutively treated from January 2005 to May 2007. Cases with preoperative proliferative vitreoretinopathy grade C-1 or higher and perforating trauma were excluded. Minimum follow-up was 3 months. Twenty-seven pre-, intra- and post-surgical variables for each patient were analysed. Multivariate analysis was carried out by logistic regression analysis with stepwise selection of variables. RESULTS: Data from 546 patients were analysed. Global anatomical success was 94.7%. Logistic regression analysis showed that only the development of postoperative proliferative vitreoretinopathy was associated with a poor anatomical outcome. The poorest functional results were associated with macular involvement, extension of RD, previous RD surgery, time of evolution of RD, and age of patient. Hierarchical log-linear analysis showed no effect of the lens status (phakic versus pseudophakic) on the functional results. However, pars plana vitrectomy was most often performed in pseudophakic eyes and resulted in a worse final visual acuity (p<0.001). CONCLUSIONS: No differences in anatomical success between phakic and pseudophakic eyes were found in this series. Pars plana vitrectomy was most often performed in pseudophakic eyes and had a greater probability of a worse final visual acuity than scleral buckling.

Heterologous prime-boost vaccination with a non-replicative vaccinia recombinant vector expressing LACK confers protection against canine visceral leishmaniasis with a predominant Th1-specific immune response.

Leishmaniasis caused by Leishmania infantum is a severe endemic disease in the Mediterranean basin, being domestic dogs the main reservoir of the disease that plays a key role in the transmission to humans. Studies on vaccines against canine leishmaniasis, aimed to modify the T cell repertoire, have advanced in recent years. LACK vaccination assays, using protein or DNA vectors, show protection against cutaneous L. major infections by redirecting the early IL-4 responses to a protective Th1 response. The aim of this study was to define the effectiveness and type of immune response in a canine visceral leishmaniasis model of two poxvirus vectors (Western reserve strain, WR and modified vaccinia virus Ankara, MVA) expressing the LACK protein of L. infantum in prime/boost vaccination protocols. The results obtained showed that dog vaccination priming with DNA-LACK followed by a booster with MVA-LACK or rVV-LACK triggered a Th1 type of immune response, leading to protection against canine visceral leishmaniasis. This protection correlated with absence of visceral leishmaniasis symptoms, lower Leishmania-specific antibodies, higher degree of T cell activation in Leishmania-target organs and higher synthesis of Th1 cytokines. In addition, we found that dogs boosted with the non-replicative virus show less VL symptoms and higher degree of T cell activation, providing evidences for a clear advantage of MVA-LACK as a vaccination vector against canine visceral leishmaniasis.

Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR.

BACKGROUND: Pilot studies of complex interventions such as a team checklist are an essential precursor to evaluating how these interventions affect quality and safety of care. We conducted a pilot implementation of a preoperative team communication checklist. The objectives of the study were to assess the feasibility of the checklist (that is, team members' willingness and ability to incorporate it into their work processes); to describe how the checklist tool was used by operating room (OR) teams; and to describe perceived functions of the checklist discussions. METHODS: A checklist prototype was developed and OR team members were asked to implement it before 18 surgical procedures. A research assistant was present to prompt the participants, if necessary, to initiate each checklist discussion. Trained observers recorded ethnographic field notes and 11 brief feedback interviews were conducted. Observation and interview data were analyzed for trends. RESULTS: The checklist was implemented by the OR team in all 18 study cases. The rate of team participation was 100% (33 vascular surgery team members). The checklist discussions lasted 1-6 minutes (mean 3.5) and most commonly took place in the OR before the patient's arrival. Perceived functions of the checklist discussions included provision of detailed case related information, confirmation of details, articulation of concerns or ambiguities, team building, education, and decision making. Participants consistently valued the checklist discussions. The most significant barrier to undertaking the team checklist was variability in team members' preoperative workflow patterns, which sometimes presented a challenge to bringing the entire team together. CONCLUSIONS: The preoperative team checklist shows promise as a feasible and efficient tool that promotes information exchange and team cohesion. Further research is needed to determine the sustainability and generalizability of the checklist intervention, to fully integrate the checklist routine into workflow patterns, and to measure its impact on patient safety.

Interaction between surgical procedure for repairing retinal detachment and clinical risk factors for proliferative vitreoretinopathy.

PURPOSE: To asses risk factors of proliferative vitreoretinopathy (PVR) and a model for predicting it. METHODS: Observational, case-control. 335 patients with non-complicated retinal detachment (RD) were included: 134 developed PVR (Cases); 201 patients did not (Controls). Risk factors for PVR were identified by multivariate analysis. Influence of variables was assayed according to the surgical approach. By logistic regression analysis a model to predict the risk of developing PVR and odds ratio (OR) values for each clinical factor were estimated. RESULTS: Risk was higher in patients > 70 years and with intraocular pressure lower than 14 (OR: 3.84; CI 95%: 2.04-7.30) and in retinal breaks larger than "1 clock hour" (OR: 2.54; CI: 1.28-5.05), extended retinal detachments (OR: 4.01; CI: 1.98-8.10) and reinterventions (OR: 1.55; CI: 1.14-9.22). Scleral surgery also was a risk factor (OR: 3.89; CI: 2.12-7.14) and aphakia/pseudophakia when scleral surgery is performed (OR: 3.33; CI: 1.54-7.22). A model to predict PVR was proposed with these results. CONCLUSIONS: Surgical approach modifies risk factors of PVR, and should be taken into account to improve the models for predicting it.

[Can the use of intraocular silicone oil increase the risk of sympathetic ophthalmia?]. / ¿Puede aumentar el riesgo de oftalmía simpática el uso intraocular de aceite de silicona?

CLINICAL CASES: We report two cases of SO (sympathetic ophthalmia) among 1,456 vitrectomies and 255 silicone oil injections performed since 1990. In both patients intraocular silicone oil was used. Both cases were clinically documented and one pathologically demonstrated. DISCUSSION: No cases were reported among vitrectomies without silicone oil. We found a longer delay between injury and the onset of the disease in comparison to the literature. Pathological findings confirmed a foreign body granulomatous reaction. Chronic inflammation caused by silicone oil might be involved in the development of SO. Larger series are necessary to establish a possible relationship between silicone oil and SO.

Intradermal infection model for pathogenesis and vaccine studies of murine visceral leishmaniasis.

The levels of protection found in vaccine studies of murine visceral leishmaniasis are significantly lower than for cutaneous leishmaniasis; whether this is due to the high-challenge murine model employed and/or is a consequence of differences required in tissue-specific local immune responses is not understood. Consequently, an intradermal murine model of visceral leishmaniasis has been explored. Intradermal inoculation established a chronic infection in susceptible mice which was associated with a pattern of parasite clearance with time postinfection in the liver and skin; in contrast, parasite persistence and expansion was observed in lymphoid tissue (spleen and draining lymph node). The course of disease found appears to be similar to those reported for subclinical canine and human visceral leishmaniasis. Clearance of parasites from the skin was correlated with an inflammatory response and the infiltration and activation of CD4(+) and CD8(+) T cells. In contrast, in lymphoid tissue (lymph node or spleen), the production of Th1/Th2 cytokines (interleukin-4 [IL-4], IL-10, and gamma interferon) appeared to correlate with parasite burden and pathogenesis. In vaccination experiments employing the Leishmania infantum D-13 (p80) antigen, significantly higher levels of protection were found with the intradermal murine model (29 to 7,500-fold more than naive controls) than were found with a low-dose intravenous infection model (9 to 173-fold). Thus, this model should prove useful for further investigation of disease pathogenesis as well as vaccine studies of visceral leishmaniasis.

Biochemical and biological characterization of the protective Leishmania pifanoi amastigote antigen P-8.

The Leishmania pifanoi amastigote antigen P-8 has been previously shown to induce protective immunity in a murine model of cutaneous leishmaniasis (L. Soong, S. M. Duboise, P. Kima, and D. McMahon-Pratt, Infect. Immun. 63:3559-3566, 1995). As this antigen is of interest for further vaccine studies, the biochemical characterization of P-8 was undertaken. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis, Western-blot analysis, and gel filtration chromatography revealed that P-8 antigen consisted of two proteoglycolipid complexes. The P-8 epitope is associated with the L. pifanoi amastigote-specific glycolipid components found in the two complexes. The P-8 complex 1 (P-8c1) consists of a 56-kDa serine metalloproteinase, apolipoprotein E (derived from fetal bovine serum), and amastigote-specific glycolipids. The P-8 complex 2 (P-8c2) consists of a 31-kDa cysteine proteinase associated with amastigote glycolipids. Biochemical analyses suggest that the P-8 antigenic glycolipids may be distinct from previously described Leishmania glycolipids (glycosylinositol-phospholipids and sphingoglycolipids). Protective immunity studies revealed that P-8c1 (serine metalloproteinase-glycolipid complex) confers comparable protection against infection as immunopurified P-8. The isolated P-8c2 (cysteine proteinase-glycolipid complex) does not provide significant protection, nor does stimulation with P-8c2 result in significant T-cell activation in P-8- or P-8c2-vaccinated mice. Consequently, the P-8c1 complex appears to be the immunodominant component of P-8.

Electroencefalografía neonatal: su importancia en el pronóstico de la evolución neurológica de recién nacidos prematuros y a término de alto riesgo / Neonatal electroencephalography: its importance to the prognosis of the neurological evaluation of the premature and term to high risk

A cincuenta y dos neonatos de alto riesgo, prematuros y a término, a quienes se les realizó un electroencefalograma (EEG) durante sus primeros días de vida, se les hizo seguimiento al mes, tres, seis y doce meses y luego cada año, tanto clínico como electroencefalografía, para establecer si existía o no correlación entre hallazgos del primer EEG y su evolución neurológica posterior. El primer EEG se realizó, cuando esto fue posible, en las primeras cuatro semanas de vida. Se realizaron un total de 386 EEG. Se encontró relación entre hallazgos del primer EEG y la evolución neurológica posterior. Los patrones electroencefalográficos con significación estadística fueron; voltaje bajo a través de todos los estadios, discontinuo y asincrónico y el inmaduro persistente. La etiología más frecuente en nuestro casos fue la encefalopatía hipóxico-isquémica con o sin crisis. Concluimos que el EEG en neonatos, es un instrumento valioso, de bajo riesgo y costo para el pronóstico neurológico a largo plazo

The immunologically protective P-4 antigen of Leishmania amastigotes. A developmentally regulated single strand-specific nuclease associated with the endoplasmic reticulum.

The purified membrane-associated Leishmania pifanoi amastigote protein P-4 has been shown to induce protective immunity against infection and to elicit preferentially a T helper 1-like response in peripheral blood mononuclear cells of patients with American cutaneous leishmaniasis. As this molecule is potentially important for future vaccine studies, the L. pifanoi gene encoding the P-4 membrane protein was cloned and sequenced. Southern blot analyses indicate the presence of six tandemly arrayed copies of the P-4 gene in L. pifanoi; homologues of the P-4 gene are found in all other species of the genus Leishmania examined. DNA-derived protein sequence data indicated an identity to the P1 zinc-dependent nuclease of Penicillium citrinum (20.8%) and the C-terminal domain of the 3' nucleotidase of Leishmania donovani (33.7%). Consistent with these sequence analyses, purified L. pifanoi P-4 protein possesses single strand nuclease (DNA and RNA) and phosphomonoesterase activity, with a preference for UMP > TMP > AMP >> CMP. Double-labeling immunofluorescence microscopic analyses employing anti-binding protein antibodies revealed that the P-4 protein is localized in the endoplasmic reticulum of the amastigote. Northern blot analyses indicated that the gene is selectively expressed in the intracellular amastigote stage (mammalian host) but not in the promastigote stage (insect) of the parasite. Based upon its subcellular localization and single-stranded specific nuclease activity, possible roles of the P-4 nuclease in the amastigote in RNA stability (gene expression) or DNA repair are discussed.