Could We Consider Ultrasound-Guided Minimally Invasive Autopsy as a Part of POCUS?

We present a 3-patient case series that support the use of ultrasound guided minimally invasive autopsy (MIA). This technique has a high diagnostic accuracy in specific clinical settings. It makes easier to diagnose pathologies once the patient has died, avoiding body deformation, with a notable reduction in sample processing time compared to the open autopsy study and, therefore, a shorter overall diagnostic response time. MIA shows some similarities with point of care ultrasound (POCUS), like examination protocols or that they can be performed at the bedside.

Dataset of coral reefs monitoring, Puerto Morelos, Mexico, 2019.

Noticeable within the Mexican Caribbean is the Arrecife de Puerto Morelos National Park (APMNP), a marine protected area established as an essential component for managing and protecting coral reefs. In June 2019, we conducted a survey in eight shallow reef sites of the APMNP with the purpose of applying a coral reef assessment method, based on biological indicators of the condition of both benthos and fish communities. In this paper we present tables with data of biological and ecological variables such as: benthos coverage, species composition and abundance of corals, abundance of urchins and coral recruits, bleaching, coral diseases and coral mortality percent, reef relief, and composition and abundance of key commercial and herbivorous fish species. The research article related to these databases was published in the journal Diversity with the title: Puerto Morelos coral reefs, current state and their classification by a scoring system.

Diseño y caracterización de un sistema de entrega de fármacos autoemulsificable (SEDDS) de estradiol por diagramas de fases pseudoternarios y pruebas fisicoquímicas

Introducción: el estradiol es una hormona esteroide sexual femenina usada ampliamente como terapia hormonal que presenta una baja biodisponibilidad, debido a su baja solubilidad acuosa y a su alta hidrofobicidad, perteneciendo a la clase II del sistema de clasificación de biofarmacéutica. Objetivos: diseñar y caracterizar un sistema de entrega de fármacos autoemulsificable (SEDDS) para el fármaco estradiol por pruebas fisicoquímicas con el fin de obtener la relación óptima que permitiera mejorar su solubilidad acuosa, velocidad de disolución y potencialmente su biodisponibilidad. Método: estudios de solubilidad en diferentes solventes, diagramas de fases pseudoternarios constituidos por aceites, tensioactivos, cotensioactivos y agua permitieron reconocer las diferentes regiones de formación de SEDDS e identificar los porcentajes de excipientes que conducen a la formación de soluciones isotrópicas; las formulaciones resultantes fueron caracterizadas en tiempo de autoemulsificación, robustez a la dilución, punto de nube y perfil de disolución en capsula dura. Resultados: las formulaciones que contenían Capmul MCM®, Kolliphor® RH40 y Transcutol®, tuvieron un tiempo de autoemulsificación de aproximadamente 1 min; fueron estables en tres distintos pH (1,2; 4,5 y 7,2), en diferentes volúmenes de dilución, exhibiendo una apariencia transparente, ligeramente azulada, sin precipitados, o separación de fases, puntos de nube mayores en comparación de las formulaciones que contenían Gelucire® 44/14. Conclusiones: las estrategias de caracterización empleadas en el desarrollo de esta investigación demostraron ser eficientes para la selección adecuada de excipientes y su proporción óptima para el diseño eficaz de un sistema de entrega de fármaco autoemulsificable (SEDDS).

SUMMARY Introduction: Estradiol is a female sex steroid hormone widely used as hormonal therapy that has low bioavailability, due to its low aqueous solubility and high hydro-phobicity, belonging to class II of the Biopharmaceutical Classification System. Aim: To design and characterize a self-emulsifying drug delivery system (SEDDS) for the drug estradiol by physicochemical tests to obtain the most optimal ratio that would improve its aqueous solubility, dissolution rate, and potentially its bioavailability. Method: Solubility studies in different solvents; pseudo ternary phase diagrams made up of oils, surfactants, co-surfactants, and water, allowed to recognize the different regions of SEDDS formation and identify the percentages of excipients that lead to the formation of isotropic solutions; The resulting formulations were characterized in autoemulsification time, robustness to dilution, cloud point and dissolution profile in a hard capsule. Results: The formulations containing Capmul MCM®, Kolliphor® RH40, and Transcutol®, had an autoemulsification time of approximately 1 minute; were stable at three different pHs (1.2, 4.5 and 7.2), at different dilution volumes, exhibiting a transparent, slightly bluish appearance, without precipitates, or phase separation, higher cloud points compared to the formulations containing Gelucire® 44/14. Conclusions: The characterization strategies used in the development of this research proved to be efficient for the adequate selection of excipients and their optimal ratio for the effective design of a self-emulsifying drug delivery system (SEDDS).

Introdução: o estradiol é um hormônio esteroide sexual feminino amplamente utilizado como terapia hormonal que apresenta baixa biodisponibilidade devido à sua baixa solubilidade aquosa e alta hidrofobicidade, pertencente à classe II do sistema de classificação biofarmacêutica. Objetivos: projetar e caracterizar um sistema de liberação de drogas autoemulsificante (SEDDS) para o fármaco estradiol por meio de testes físico-químicos a fim de obter a proporção ideal que melhore sua solubilidade aquosa, taxa de dissolução e potencialmente sua biodisponibilidade. Método: estudos de solubilidade em diferentes solventes, diagramas de fases pseudoternários compostos por óleos, tensoativos, cotensoativos e água permitiram reconhecer as diferentes regiões de formação de SEDDS e identificar as porcentagens de excipientes que levam à formação de soluções isotrópicas; as formulações resultantes foram caracterizadas quanto ao tempo de autoemulsificação, robustez à diluição, ponto de turvação e perfil de dissolução da cápsula dura. Resultados: as formulações contendo Capmul MCM®, Kolliphor® RH40 e Transcutol®, tiveram um tempo de autoemulsificação de aproximadamente 1 min; foram estáveis em três diferentes pH's (1,2; 4,5 e 7,2), em diferentes volumes de diluição, apresentando aspecto transparente, levemente azulado, sem precipitados ou separação de fases, pontos de turvação mais elevados em relação às formulações contendo Gelucire® 44/14. Conclusões: as estratégias de caracterização utilizadas no desenvolvimento desta pesquisa mostraram-se eficientes para a seleção adequada de excipientes e sua proporção ideal para o desenho eficaz de um sistema de liberação de fármacos autoemulsificante (SEDDS).

A molecular signature for the metabolic syndrome by urine metabolomics.

BACKGROUND: Metabolic syndrome (MetS) is a multimorbid long-term condition without consensual medical definition and a diagnostic based on compatible symptomatology. Here we have investigated the molecular signature of MetS in urine. METHODS: We used NMR-based metabolomics to investigate a European cohort including urine samples from 11,754 individuals (18-75 years old, 41% females), designed to populate all the intermediate conditions in MetS, from subjects without any risk factor up to individuals with developed MetS (4-5%, depending on the definition). A set of quantified metabolites were integrated from the urine spectra to obtain metabolic models (one for each definition), to discriminate between individuals with MetS. RESULTS: MetS progression produces a continuous and monotonic variation of the urine metabolome, characterized by up- or down-regulation of the pertinent metabolites (17 in total, including glucose, lipids, aromatic amino acids, salicyluric acid, maltitol, trimethylamine N-oxide, and p-cresol sulfate) with some of the metabolites associated to MetS for the first time. This metabolic signature, based solely on information extracted from the urine spectrum, adds a molecular dimension to MetS definition and it was used to generate models that can identify subjects with MetS (AUROC values between 0.83 and 0.87). This signature is particularly suitable to add meaning to the conditions that are in the interface between healthy subjects and MetS patients. Aging and non-alcoholic fatty liver disease are also risk factors that may enhance MetS probability, but they do not directly interfere with the metabolic discrimination of the syndrome. CONCLUSIONS: Urine metabolomics, studied by NMR spectroscopy, unravelled a set of metabolites that concomitantly evolve with MetS progression, that were used to derive and validate a molecular definition of MetS and to discriminate the conditions that are in the interface between healthy individuals and the metabolic syndrome.

Unraveling the Global Phylodynamic and Phylogeographic Expansion of Mycoplasma gallisepticum: Understanding the Origin and Expansion of This Pathogen in Ecuador.

Mycoplasma gallisepticum (MG) is among the most significant problems in the poultry industry worldwide, representing a serious threat to international trade. Despite the fact that the mgc2 gene has been widely used for diagnostic and molecular characterization purposes, there is a lack of evidence supporting the reliability of this gene as a marker for molecular epidemiology approaches. Therefore, the current study aimed to assess the accuracy of the mgc2 gene for phylogenetic, phylodynamic, and phylogeographic evaluations. Furthermore, the global phylodynamic expansion of MG is described, and the origin and extension of the outbreak caused by MG in Ecuador were tracked and characterized. The results obtained strongly supported the use of the mgc2 gene as a reliable phylogenetic marker and accurate estimator for the temporal and phylogeographic structure reconstruction of MG. The phylodynamic analysis denoted the failures in the current policies to control MG and highlighted the imperative need to implement more sensitive methodologies of diagnosis and more efficient vaccines. Framed in Ecuador, the present study provides the first piece of evidence of the circulation of virulent field MG strains in Ecuadorian commercial poultry. The findings derived from the current study provide novel and significant insights into the origin, diversification, and evolutionary process of MG globally.

Omalizumab as a Provoking Factor for Venous Thromboembolism.

A 43-year-old man with a history of severe extrinsic allergic asthma treated with once-monthly omalizumab (600 mg) for the last 15 months. He presented to the emergency room with a 2-week history of right lower limb pain and chest pleuritic pain. Computed tomography pulmonary angiography showed bilateral pulmonary embolism with right-sided pulmonary infarction and ultrasound of right lower limb confirmed distal deep vein thrombosis. No other known risk factors were identified. Treatment with omalizumab was stopped during hospitalization. The Naranjo Adverse Drug Reaction (ADR) Probability Scale classifies this as a probable ADR (score of 6). Omalizumab is a humanized monoclonal anti-IgE antibody indicated for the treatment of persistent moderate-to-severe asthma and certain chronic refractory urticaria. The EXCELS study (The Epidemiologic Study of Xolair (omalizumab): Evaluating Clinical Effectiveness and Long-term Safety in Patients with Moderate-to-Severe Asthma), a postmarketing observational cohort study to assess clinical safety profile of omalizumab, showed a significant increase in venous thromboembolism. In conclusion, omalizumab has been associated with arterial and venous thromboembolic events, although the evidence is not definitive.

[Psoas abscess caused by Staphylococcus lugdunensis]. / Absceso de psoas por Staphylococcus lugdunensis.

Staphylococcus lugdunensis is a coagulase-negative staphylococcus of growing importance and atypical behavior. The infections caused by this microorganism are becoming more frequent, having a broader spectrum. Psoas abscesses caused by this germ are rare, with few cases reported in the literature. In this work, we present a case of a psoas abscess caused by S. lugdunensis in a patient suffering from diabetes mellitus and rheumatoid arthritis, which was treated with intravenous cloxacillin with a good outcome.

Ability of Dental Students in Spain to Identify Potentially Malignant Disorders and Oral Cancer.

The aim of this study was to assess the ability of students at the School of Dentistry, Complutense University of Madrid, Spain, to diagnose oral cancer and other potentially malignant disorders, as well as to compare their ability at different stages of the learning process and evaluate their knowledge retention. Students were surveyed after they had studied oral medicine and oral pathology at two time points: midway through and near the end of their studies. The survey consisted of questions about 40 photographs of benign oral lesions, malignant oral lesions, and potentially malignant disorders. The response rate for all groups was greater than 70%. The results showed that these students' overall success rate in differentiating benign from malignant lesions averaged 73.9%. When the distinction for potentially malignant disorders was included, their average overall success rate decreased to 42.8% (p<0.001). Furthermore, the students' average success rate was at its lowest at the end of the dental program (p<0.001). Results from this study suggest that, given these students' difficulties in identifying potentially malignant disorders, an increased emphasis on cancer education in the dental curriculum may be needed for future practitioners to master this ability.

Diagnostic criteria in proliferative verrucous leukoplakia: Evaluation

OBJECTIVES: to evaluate the ability of the diagnostic criteria proposed by Cerero et al in 2010 to perform an early diagnose in patients with proliferative verrucous leukoplakia. Study DESIGN: retrospective study with patients diagnosed with leukoplakia at Oral Medicine Service at Oral Medicine and Surgery Department at Dentistry Faculty at Universidad Complutense of Madrid. RESULTS: the criteria were applied in 116 patients, turning positive in 40 cases. Out of these, 24 (60%) had been previously diagnosed with PVL. Most frequent criteria were major criteria A and E, concerning lesion's site and histopathology, and minor criteria b and c, concerning sex and smoking habit. CONCLUSIONS: diagnostic criteria developed by Cerero et al can be a useful tool for an early diagnose of PVL, as in 60% of the cases, the criteria would have allowed to make an early diagnose of the disease

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Diagnostic criteria in proliferative verrucous leukoplakia: evaluation.

OBJECTIVES: to evaluate the ability of the diagnostic criteria proposed by Cerero et al in 2010 to perform an early diagnose in patients with proliferative verrucous leukoplakia. STUDY DESIGN: retrospective study with patients diagnosed with leukoplakia at Oral Medicine Service at Oral Medicine and Surgery Department at Dentistry Faculty at Universidad Complutense of Madrid. RESULTS: the criteria were applied in 116 patients, turning positive in 40 cases. Out of these, 24 (60%) had been previously diagnosed with PVL. Most frequent criteria were major criteria A and E, concerning lesion's site and histopathology, and minor criteria b and c, concerning sex and smoking habit. CONCLUSIONS: diagnostic criteria developed by Cerero et al can be a useful tool for an early diagnose of PVL, as in 60% of the cases, the criteria would have allowed to make an early diagnose of the disease.

Binding mode of the activity-modulating C-terminal segment of NS2B to NS3 in the dengue virus NS2B-NS3 protease.

The two-component dengue virus NS2B-NS3 protease (NS2B-NS3pro) is an established drug target but inhibitor design is hampered by uncertainties about its 3D structure in solution. Crystal structures reported very different conformations for the functionally important C-terminal segment of the NS2B cofactor (NS2Bc), indicating open and closed conformations in the absence and presence of inhibitors, respectively. An earlier NMR study in solution indicated that a closed state is the preferred conformation in the absence of an artificial linker engineered between NS2B and NS3pro. To obtain direct structural information on the fold of unlinked NS2B-NS3pro in solution, we tagged NS3pro with paramagnetic tags and measured pseudocontact shifts by NMR to position NS2Bc relative to NS3pro. NS2Bc was found to bind to NS3pro in the same way as reported in a previously published model and crystal structure of the closed state. The structure is destabilized, however, by high ionic strength and basic pH, showing the importance of electrostatic forces to tie NS2Bc to NS3pro. Narrow NMR signals previously thought to represent the open state are associated with protein degradation. In conclusion, the closed conformation of the NS2B-NS3 protease is the best model for structure-guided drug design.

Pacientes con xerostomía: un retoterapéutico para el odontoestomatólogo / Patients with xerostomia: a therapeutic challenge for the dentist

La xerostomía, como manifestación clínica de la hiposialia, es cada vez más frecuente en la práctica diaria debido a su etiología multifactorial: polimedicación, tratamiento oncológico, estrés, edad avanzada, etc. Los pacientes ven afectada en gran medida su calidad de vida, ya que padecerán alteraciones funcionales y orgánicas, siendo estas motivo de consulta. Debido a la inexistencia de un protocolo estandarizado de tratamiento para la xerostomía, se plantea el objetivo de analizarlos productos existentes con sus características e indicaciones, ya que el profesional debe conocerlos métodos terapéuticos. Siempre que sea posible, se tratarán las causas etiológicas que ocasionan xerostomía haciendo hincapié en las medidas preventivas. Deberá acompañarse de un tratamiento sintomático y de estimulación de la producción salival, para mejorar la calidad de vida. Para los casos más graves, se recurrirá a fármacos sistémicos. El tratamiento de la xerostomía es largo y complejo, con resultados muy variables. Se requiere seguir investigando en nuevas alternativas, comprobando y mejorando la eficacia de los métodos ya existentes (AU)

Xerostomia, as a clinical manifestation of hyposialia, is increasingly more frequent indaily practice due to its multifactor etiology: polymedication, oncological treatment, stress, advanced age, etc. The patients’ quality of life is affected to a great extent, since they will suffer functional and organic alterations, without these being a reason for consultation. Due to the non-existence of a standardized protocol of treatment for xerostomia, the objective was posed of analyzing the existing products with their characteristics and indications, since the professional must know the therapeutic methods. Whenever possible, it will deal with the etiological causes that bring about xerostomia, stressing the preventive measures. It must be accompanied by a symptomatic treatment and stimulation of the saliva production, in order to improve the quality of life. For the most serious cases, systemic medicines will be turned to. The treatment of xerostomia is long and complex, with quite variable results. Continued research in new alterations and verifying and improving the effectiveness of the existing methods are required (AU)

Binding of low molecular weight inhibitors promotes large conformational changes in the dengue virus NS2B-NS3 protease: fold analysis by pseudocontact shifts.

The two-component dengue virus NS2B-NS3 protease (DEN NS2B-NS3pro) is an established drug target, but inhibitor design is hampered by the lack of a crystal structure of the protease in its fully active form. In solution and without inhibitors, the functionally important C-terminal segment of the NS2B cofactor is dissociated from DEN NS3pro ("open state"), necessitating a large structural change to produce the "closed state" thought to underpin activity. We analyzed the fold of DEN NS2B-NS3pro in solution with and without bound inhibitor by nuclear magnetic resonance (NMR) spectroscopy. Multiple paramagnetic lanthanide tags were attached to different sites to generate pseudocontact shifts (PCS). In the face of severe spectral overlap and broadening of many signals by conformational exchange, methods for assignment of (15)N-HSQC cross-peaks included selective mutation, combinatorial isotope labeling, and comparison of experimental PCSs and PCSs back-calculated for a structural model of the closed conformation built by using the structure of the related West Nile virus (WNV) protease as a template. The PCSs show that, in the presence of a positively charged low-molecular weight inhibitor, the enzyme assumes a closed state that is very similar to the closed state previously observed for the WNV protease. Therefore, a model of the protease built on the closed conformation of the WNV protease is a better template for rational drug design than available crystal structures, at least for positively charged inhibitors. To assess the open state, we created a binding site for a Gd(3+) complex and measured paramagnetic relaxation enhancements. The results show that the specific open conformation displayed in the crystal of DEN NS2B-NS3pro is barely populated in solution. The techniques used open an avenue to the fold analysis of proteins that yield poor NMR spectra, as PCSs from multiple sites in combination with model building generate powerful information even from incompletely assigned (15)N-HSQC spectra.

Erythrocyte sedimentation rate (ESR) measured by the Streck ESR-Auto Plus is higher than with the Sediplast Westergren method: a validation study.

The erythrocyte sedimentation rate (ESR) is a nonspecific indicator of disease activity and is often used by clinicians in assisting diagnosis and follow-up of many inflammatory disorders. The Westergren method is considered the standard method for measuring ESR. Recently, many automated instruments have become available to address laboratory safety and time efficiency. We validated the Streck ESR-Auto Plus instrument (Streck, Omaha, NE) using the Sediplast (Polymedco, Cortlandt Manor, NY) Westergren method as the reference method. Blood samples collected in 113 EDTA tubes were transferred into Sediplast vials and Streck high-altitude vacuum tubes for measuring the ESR. There was good correlation between the Sediplast and Streck methods (0.95) using Pearson correlation. The y-intercept was at 6.5 using linear regression, indicating systematic bias with a mean difference of 7.13 using the t test (P < .0001). We modified our reference ranges to rectify the systematic bias found during validation.

A new syndrome with multiple capillary malformations, intractable seizures, and brain and limb anomalies.

We present two unrelated male infants with strikingly similar clinical features which have not previously been reported together. The most unusual feature was the presence of multiple small capillary malformations (port-wine stains) on the skin from birth. Both infants had intractable seizures, microcephaly with progressive cortical atrophy, severe developmental delay, dysmorphic facial features, and hypoplasia of the distal phalanges. To our knowledge, no other person with this unique constellation of features has been described.

Using a genetically encoded fluorescent amino acid as a site-specific probe to detect binding of low-molecular-weight compounds.

Development of enzyme inhibitors requires an activity assay for the identification of hits and lead compounds. To determine dissociation constants in a straightforward manner, we explored the use of a genetically encoded fluorescent amino acid for site-specific tagging of the target protein. The unnatural amino acid 7-(hydroxy-coumarin-4-yl) ethylglycine (Hco) was site-specifically incorporated in the target protein by cell-free protein synthesis using an orthogonal amber suppressor tRNA/aminoacyl-tRNA synthetase pair. Using the West Nile virus nonstructural protein 2B-nonstructural protein 3 protease as the target protein, the fluorescence of Hco-tagged samples proved to be exquisitely sensitive to the presence of inhibitors and small ligand molecules if they bind in the vicinity of the Hco residue. No significant change in fluorescence was observed when the ligand-binding site was far from the Hco residue. Hco-tagged proteins thus combine outstanding sensitivity with accurate information on the site of binding, making Hco labeling an attractive tool in drug discovery.

The intermembrane space domain of Tim23 is intrinsically disordered with a distinct binding region for presequences.

Proteins targeted to the mitochondrial matrix are translocated through the outer and the inner mitochondrial membranes by two protein complexes, the translocase of the outer membrane (TOM) and one of the translocases of the inner membrane (TIM23). The protein Tim23, the core component of TIM23, consists of an N-terminal, soluble domain in the intermembrane space (IMS) and a C-terminal domain that forms the import pore across the inner membrane. Before translocation proceeds, precursor proteins are recognized by the N-terminal domain of Tim23, Tim23N (residues 1-96). By using NMR spectroscopy, we show that Tim23N is a monomeric protein belonging to the family of intrinsically disordered proteins. Titrations of Tim23N with two presequences revealed a distinct binding region of Tim23N formed by residues 71-84. In a charge-hydropathy plot containing all soluble domains of TOM and TIM23, Tim23N was found to be the only domain with more than 40 residues in the IMS that is predicted to be intrinsically disordered, suggesting that Tim23N might function as hub in the mitochondrial import machinery protein network.

Eritema multiforme: una posibilidad diagnóstica a considerar ante lesiones agudas de la mucosa oral / Erythema multiforme: a diagnostic possibility to be considered with acute damages of the oral mucous

Introducción: El Eritema Multiforme es una enfermedad aguda de la piel y las mucosas(especialmente de la mucosa oral), de carácter autoinmune, que se manifiesta con lesiones eritematosas y de tipo vesículo - ampollar. Su etiología es desconocida, apareciendo en muchos casos vinculada a la ingesta de fármacos y a factores predisponentes como infecciones por virus, siendo el más frecuente el herpes simple(VHS).Objetivo: El objetivo del presente trabajo es realizar una revisión bibliográfica de los aspectos epidemiológicos, etiopatogénicos, clínicos, terapéuticos y pronósticos del eritema multiforme. Se hace especial hincapié en la importancia del conocimiento de las características clínicas para la realización de un correcto diagnóstico y la instauración de la terapéutica adecuada, tanto para el médico general como para el odontólogo. Material y método: Se presenta una revisión actualizada de la literatura. Resultados y discusión: El eritema multiforme puede presentar diversas manifestaciones clínicas, entre las que se encuentra una forma menor o recurrente, que es la que se produce con mayor frecuencia. La diversidad de las lesiones producidas en piel y mucosas dificulta, en algunos casos, el diagnóstico diferencial. Por ello, el conocimiento de los detalles clínicos, epidemiológicos e histopatológicos es de vital importancia a la hora de instaurar el tratamiento adecuado (AU)

Introduction: The Erythema Multiforme is an autoimmune-nature acute disease of the skin and the mucous membranes (in particular the oral mucous), which appears along with erythematous damages and vesicular-bullosis damages. Its etiology is still unknown, appearing in many cases linked to the intake of drugs and due to predisposing factors such as infections due to virus, being the herpes simplex (VHS) the most frequent one. Purpose: The purpose of this document is to perform a literature review of the epidemiological, aetiopathogenic, clinical, therapeutic aspects and prognosis of the erythema multiforme. We specially underline the importance of the knowledge regarding the clinical characteristics for the performing of a correct diagnosis and the definition of the most appropriate treatment, for the general physician and for the dental practitioner. Materials and method: We present next an updated literature review on the subject Results and discussion: The erythema multiforme may present several clinical signs among which we identify a minor or regular form, which is the most likey to appear. The diversity of the damages produced on the skin and mucous make sit harder, in some cases, to perform differential diagnosis (DD). Thus, the knowledge of the clinical, epidemiological and histopathological details is of the outmost importance when establishing the appropriate treatment (AU)