Treponema pallidum ssp. pallidum identification by real-time PCR targetting the polA gene in paraffin-embedded samples positive by immunohistochemistry.

Syphilis is a systemic and sexually transmitted infection caused by Treponema pallidum ssp. pallidum. This spirochete causes different clinical and subclinical stages depending on the duration of infection and immune status of the host. Several tests have been developed for diagnosis, and are classified into direct and indirect methods. The first one includes dark field microscopy, direct fluorescent antibody test in fluids or tissue, and molecular biology techniques. In the indirect method (serologic), the routine tests are used, and are divided in two categories: non-treponemal and treponemal ones. The objective of this work was to identify T. pallidum ssp. pallidum in paraffin-embedded skin biopsies positive by immunohistochemistry, using conventional polymerase chain reaction (PCR) and quantitative real time PCR (qPCR). We included a sample of 17 paraffin-embedded biopsies. DNA was extracted and processed by conventional PCR and real-time PCR with a TaqMan® probe to identify the polA gene. Using PCR, 11 tested positive (64.7%) and 6 (35.3%) were negative. With qPCR and TaqMan® probe, 100% of samples tested positive. The minimum number of spirochetes detected in each sample was 2. With this work, we can conclude that qPCR is a fast and very accurate method for diagnosis of syphilis in tissue specimens.

Frecuencia de tiña del cuerpo en un hospital del estado de Quintana Roo / Frequency of tinea corporis in a hospital in Quintana Roo state

Resumen ANTECEDENTES: las dermatofitosis son micosis superficiales causadas por un grupo de hongos parásitos de la queratina, denominados dermatofitos. Comprenden tres géneros: Trichophyton, Microsporum y Epidermophyton. Son cosmopolitas, predominan en climas cálidos y húmedos, y representan 70 a 80% de todas las micosis. OBJETIVO: identificar la frecuencia de consulta por tiña del cuerpo en una zona urbana tropical. MATERIAL Y MÉTODO: estudio descriptivo, abierto y transversal, en el que durante tres meses en 2015 se registraron todos los pacientes con diagnóstico clínico de tiña del cuerpo que asistieron a la consulta de dermatología de un hospital de segundo nivel de Playa del Carmen, Quintana Roo, México. Se registraron los datos demográficos, tiempo de evolución, topografía y factores predisponentes asociados. Se realizó examen directo en escama con hidróxido de potasio (KOH), cultivo micológico en medio de Sabouraud y examen directo del cultivo con azul de lactofenol para identificar al agente causal. RESULTADOS: de 546 consultas de dermatología general se detectaron 17 pacientes (3%) y se corroboró el diagnóstico con KOH en 14 pacientes (82%, nueve mujeres [64%]), entre éstos hubo crecimiento en el cultivo en 9 muestras (64%). Se aisló Microsporum canis en 4 (44%), Trichophyton rubrum en 4 (44%) y T. mentagrophytes en uno (11%). Los límites de edad fueron 3 y 57 años (4 niños, 28.5%). El tiempo de evolución promedio fue de 15 semanas. La localización más frecuente fueron las extremidades. Los factores predisponentes más comunes fueron el contacto con mascotas infectadas y la administración de corticoesteroides. CONCLUSIONES: la tiña del cuerpo representa 3% de la consulta de dermatología en un hospital de una zona urbana tropical. Fue más frecuente en mujeres, predominó en las extremidades y en 28.5% afectó a población pediátrica. T. rubrum y M. canis fueron los agentes causales más frecuentes.

Abstract BACKGROUND: Dermatophytosis are superficial mycosis caused by dermatophytes, a group of fungi that parasite keratin, and is composed of three genera: Trichophyton, Microsporum and Epidermophyton. They predominate on hot and humid climates, and are responsible of 70-80% of all mycosis. OBJETIVE: To identify the frequency of consultation for tinea corporis. MATERIAL AND METHOD: A descriptive, open and cross-sectional study in which, during three months in 2015, all patients with clinical diagnosis of tinea corporis that attended to the dermatology department in a second level hospital at Playa del Carmen, QR, Mexico, were registered including demographic data, such as progression time, topography and associated predisposing factors; a KOH mount was performed, as well as mycological culture in Sabouraud dextrose agar and microscopic examination of the colony with lactophenol blue to identify the causal agent. RESULTS: Out of 546 visits to the dermatology service, the diagnosis was confirmed in 17 patients (2.5%) and diagnosis was confirmed with a positive KOH mount in 14 patients (82%, nine women [64%]), and in 9 samples there was culture growth (64%). Microsporum canis and Trichophyton rubrum were isolated in 4 cases (44%) each, and Trichophyton mentagrophytes in one case (11%). Age range was 3-57 years, with four children registered (28.5%). The progression time of the disease was 15 weeks in average. The most frequent topography was the extremities. The most common predisposing factors were contact with infected pets and the administration of corticosteroids. CONCLUSIONS: Tinea corporis represents 3% of the dermatology consultation in a second level hospital in urban tropical zone. It is more frequent in female patients, affecting more frequently extremities; 28.5% were children. The isolated causal agents were M. canis and T. rubrum.

[Clinical usefulness and psychometric properties of the Cambridge Behavioural Inventory]. / Utilidad clinica y propiedades psicometricas del inventario conductual de Cambridge.

INTRODUCTION: An important area in neuropsychological assessment is that of psychological and behavioural symptoms. The Cambridge Behavioural Inventory (CBI) is a self-report measure aimed at relatives which takes account of a wide range of behavioural symptoms that may occur during the course of neurological diseases. The main objective of the study is to test the clinical usefulness of its Spanish adaptation. SUBJECTS AND METHODS: The CBI was completed by 215 members of kin of patients referred from neurology and psychiatry services. The CBI profiles of four groups of patients were compared, these being grouped according to their main clinical characteristics, psychometric data, imaging tests and the clinical judgement of the professional requesting the neuropsychological study. RESULTS: Most of the scales (10 out of 13) of the CBI yielded acceptable internal consistency values, and the memory and attention/orientation scales showed high correlations with objective measures of memory and time orientation. The CBI profiles of the groups of patients with different conditions (organic memory disorder, functional memory disorder, behavioural variant of frontotemporal dementia and Alzheimer's disease) were consistent with their main features. CONCLUSIONS: The CBI is a psychometrically reliable instrument with adequate convergent and discriminant validity that can be useful in the process of neuropsychological assessment. It can provide relevant information not only about cognitive functioning and the functional capabilities, but also about the behavioural and psychological symptoms of patients with cognitive disorders.

TITLE: Utilidad clinica y propiedades psicometricas del inventario conductual de Cambridge.Introduccion. Un area importante de la evaluacion neuropsicologica son los sintomas psicologicos y conductuales. El inventario conductual de Cambridge ­Cambridge Behavioural Inventory (CBI)­ es una medida de autoinforme dirigida a allegados que recoge una amplia variedad de sintomas conductuales que pueden darse en el curso de las enfermedades neurologicas. El principal objetivo del estudio es comprobar la utilidad clinica de su adaptacion al castellano. Sujetos y metodos. El CBI fue cumplimentado por 215 allegados de pacientes remitidos desde los servicios de neurologia y psiquiatria. Se compararon los perfiles del CBI de cuatro grupos de pacientes formados sobre la base de sus principales caracteristicas clinicas, datos psicometricos, pruebas de imagen y juicio clinico del profesional solicitante del estudio neuropsicologico. Resultados. La mayoria de las escalas (10 de 13) del CBI tuvo valores de consistencia interna aceptables, y las escalas de memoria y atencion/orientacion, correlaciones elevadas con medidas objetivas de memoria y orientacion temporal. Los perfiles del CBI de los grupos de pacientes con distintas condiciones (trastorno organico de la memoria, trastorno funcional de la memoria, variante conductual de demencia frontotemporal y enfermedad de Alzheimer) fueron consistentes con sus principales caracteristicas. Conclusiones. El CBI es un instrumento psicometricamente fiable y con adecuada validez convergente y discriminante que puede ser util en el proceso de evaluacion neuropsicologica, aportando informacion relevante no solo sobre el funcionamiento cognitivo y las capacidades funcionales, sino tambien sobre los sintomas conductuales y psicologicos de los pacientes con trastornos cognitivos.

Mercury availability by operationally defined fractionation in granulometric distributions of soils and mine wastes from an abandoned cinnabar mine.

Mercury contamination from historic cinnabar mines represents a potential risk to the environment. Asturias, in Northern Spain, was one of the largest metallurgic and mining producer areas of Hg in Europe during the 20th century until the end of activities in 1974. Mining operations have caused Hg release and dispersion throughout the area. In this study, soils collected from calcine piles and surrounding soils at an abandoned Hg mine and metallurgical plant in Mieres (Asturias, Spain) were distributed in different particle-size subsamples. Fractionation of Hg was performed by means of a Hg-specific sequential extraction procedure complemented with the selective determination of organic Hg fraction by a specific extraction method. Extremely high concentrations of total Hg were found in calcine piles. Concentrations and mobility of Hg decreased markedly with the distance in soils located 25 m both above and below the chimney of the metallurgical plant. The sequential extraction results indicated that Hg is primarily found as elemental Hg followed by sulfide Hg in the finest subsamples. However, this distribution is inverted in the coarser grain fractions where sulfide Hg prevails. Calcine piles exhibited exceptionally high values of mobile Hg (up to 5350 µg g(-1) in the finest subsample). Accumulation of Hg in the elemental Hg fraction was observed at decreasing grain size which is indicative of deposition of Hg vapors from the metallurgical plant. Enrichment of sulfide Hg was found in the finest subsamples of soils sampled below the chimney (up to 99 µg g(-1)). Significant organic Hg contents were observed in the soil samples (up to 2.8 µg g(-1)), higher than those found in other abandoned Hg mining sites. A strong correlation was observed between organic Hg and Hg humic and fulvic complexes, as well as with the elemental Hg fraction. This indicates that both humic and fulvic material and elemental Hg must be the primary variables controlling Hg methylation in these soils.

Sensibilidad y especificidad del examen directo micológico con blanco de calcoflúor para el diagnóstico de onicomicosis / Sensitivity and specificity of mycological direct examination with calcofluor white for the diagnosis of onychomycosis

INTRODUCCIÓN: La creciente importancia de la onicomicosis, no sólo por el aumento en su frecuencia sino también por el incremento de patógenos emergentes, plantea un reto diagnóstico y terapéutico. MATERIAL Y MÉTODOS: Estudio comparativo, abierto, observacional y transversal de pacientes con diagnóstico clínico de onicomicosis y se comparó la utilidad diagnóstica del examen directo con KOH-negro de clorazol y el blanco de calcoflúor, tomando como estándar de oro la biopsia de la porción distal de la lámina ungueal teñida con PAS. RESULTADOS: Se incluyeron 165 pacientes (70% mujeres), el 79,4% fueron positivos para onicomicosis (OSDL 50,9%) en uñas de pies (89%) con 6años de evolución. Se reportó una sensibilidad: KOH-negro de clorazol 90,12% (95% CI: 81,46%-95,63%) vs blanco de calcoflúor 86,42% (95% CI:76,99%-93,01%) y una especificidad de 50% para KOH-negro de clorazol (95% CI: 38,89%-61,11%) vs 60,71% para blanco de calcoflúor (95% CI:49,45%-71,20%). Así mismo, se registró un VPP de 63,48% para KOH-negro de clorazol (95% CI: 53,99%-72,26%) y de 67,96% para blanco de calcoflúor (95% CI: 58,04%-76,81%) y un VPN de 84% (95% CI: 70,88%- 92,81%) y 82,26% (95% CI: 70,46%-90,78%), respectivamente. Comentario: El examen directo con blanco de calcoflúor resulta una buena herramienta diagnóstica debido a que es altamente sensible, requiere de poca experiencia por parte del observador, se realiza mediante un procesamiento sencillo, que consume poco tiempo y es de bajo costo

INTRODUCTION: The growing importance of onychomycosis, not only by the increase in frequency but also by the rise of emerging pathogens poses a diagnostic and therapeutic challenge. MATERIAL AND METHODS: A comparative, open, observational, transversal, which included patients with clinical diagnosis of onychomycosis and compared the diagnostic utility of direct examination of KOH-chlorazol black and calcofluor white, on the gold standard biopsy of the distal portion of the nail plate stained with PAS. RESULTS: We included 165 patients (70% women), 79.4% were positive for onychomycosis (OSDL 50.9%) in toenails (89%) with 6 years of evolution. They reported a sensitivity: KOH-black of chlorazol 90.12% (95% CI: 81.46% -95.63%) vs86.42% calcofluor white (95% CI: 76.99% -93.01%) and aspecificity of 50% KOH-black of chlorazol (95% CI: 38.89% -61.11%) vs 60.71% for calcofluor white (95% CI: 49.45% -71.20%). Also, there was aPPV of 63.48% for chlorazol KOH-black (95% CI: 53.99% -72.26%) and 67.96% for calcofluor white (95% CI: 58.04% -76.81%) and a NPV of 84%(95% CI: 70.88% - 92.81%) and 82.26% (95% CI: 70.46% -90.78%), respectively. Comment: The direct examination with calcofluor white is a good diagnostic tool because it is highly sensitive, requires little expertise on the part of the observer, is performed by simple processing, which consumes little time and is inexpensive

Update on adjuvant hormonal treatment of early breast cancer.

Clinical trials conducted over the last two decades have demonstrated that 5 years of treatment with tamoxifen (TAM) after local treatment in postmenopausal patients with positive hormone receptor early breast cancer improves disease-free survival and overall survival. More recently, aromatase inhibitors (AI) have been tested in several randomized clinical trials in this setting. The studies have tested either AI versus TAM or different sequential approaches combining the two agents. While the most effective strategy remains to be determined, overall, incorporation of AI resulted in better disease-free survival, particularly in the worst-prognosis subgroup of patients. In addition, long-term treatment with AI was, in general, well tolerated. However, mature results are needed in order to be able to assess the effect in overall survival. The authors of this supplement paper include the key points of roundtable presentations and discussions of hormonal therapy in breast cancer by topic.

Management of patients with metastatic breast cancer.

Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity.

Síndrome inflamatorio de reconstitucióninmune (SIRI). Una revisión para entenderlo / Immune reconstitution inflammatory syndrome (IRIS). A review to understand

El síndrome inflamatorio de reconstitución inmune se presenta en pacientes con infección por VIH/SIDA, semanas o meses después del inicio del tratamientoantirretroviral. Consiste en síntomas y signos que pueden ser graves cuando fueron tratados previamente por una infección oportunista aparentementecurada, al hacerse evidente una infección oportunista subclínica o cuando una infección oportunista bajo tratamiento se agrava. Se presentaen el 10 al 25% de todos los pacientes de cualquier edad que inician la terapia antirretroviral y hasta en el 45% de quienes tienen una infecciónoportunista previa. Ocurre con más frecuencia con conteos de linfocitos CD4+ menores de 50 cels/mm3, y como resultado de un reestablecimiento dela respuesta inmune.La inmunopatogenia precisa es desconocida, pero se considera que es desencadenada por antígenos y microorganismos infectantes. La duración delsíndrome es de semanas a meses, la mayoría son leves y se resuelven espontáneamente. En el 50% hay manifestaciones en piel. El tratamiento consisteen continuar con la terapia antirretroviral, iniciar, continuar o ajustar el tratamiento de la infección oportunista, y el uso de corticosteroides o antiinflamatoriosno esteroideos cuando sea necesario (AU)

The immune reconstitution inflammatory syndrome is commonly seen in patients with HIV/AIDS after weeks to months of antiretroviral therapy (ART),this condition may be severe. They occur when were treated previously for an opportunistic infection, which we considered successfully cured, orwhen a latent opportunistic infection becomes apparent and finally when an opportunistic infection under treatment exacerbates. Incidence is 10 to25% in patients of all ages which start with ART, and 45% in those with an opportunistic infection. It is seen more frequently when counts of CD4+ are< 50 cels/mm3 and as a result of the recovery of the immune response.The immunopathogenesis is unknown, but it is supposed to be triggered by antigens and infective organisms. This syndrome lasts for weeks tomonths; most of the cases are mild and resolve spontaneously. The cutaneous manifestations are present in 50%. The treatment consists on continuingthe ART and to start, continue or adjust the treatment of the opportunistic infection, and the use of corticosteroids or non steroid anti-inflammatoryagents if needed (AU)

Laparotomía de second look en el tratamiento del cáncer epitelial de ovario / Second look laparotomy in the treatment of ovarian epithelial cancer

Objetivo: Realizar un estudio retrospectivo en las pacientes con cáncer epitelial de ovario (CEO) diagnosticadas en nuestra área de salud (Cabueñes, Gijón) entre 1991 y 2001.Material y métodos: Revisamos las características de las pacientes, del tumor y del tratamiento realizado, con el fin de establecer el papel de la laparatomía de second look (LSL) en el tratamiento del CEO y su posible impacto en la supervivencia de las pacientes. Resultados: Durante el período de estudio, se realizó LSL a 70 pacientes que, tras completar el tratamiento primario con cirugía y quimioterapia, se encontraban aparentemente libres de enfermedad. Aunque las mujeres con LSL negativa tuvieron mejor supervivencia que las pacientes con enfermedad residual, no se encontraron diferencias estadísticamente significativas en la supervivencia global y la supervivencia post-LSL en función del tumor residual después de esta cirugía. Al finalizar el tratamiento, encontramos un 41 por ciento de recurrencias entre las pacientes que se encontraban libres de enfermedad, cifra muy similar al 39 por ciento hallado entre las pacientes con LSL negativa, lo que demuestra el alto índice de falsos negativos de esta cirugía (AU)

Impacto de la cirugía primaria en el tratamiento del cáncer epitelial de ovario / The impact of primary surgery in the treatment of epithelial ovarian cancer

Se realiza un estudio retrospectivo sobre las pacientes con cáncer epitelial de ovario diagnosticadas en el área de salud de Cabueñes (Gijón) entre 1991 y 2001. Revisamos las características de las pacientes, del tumor y del tratamiento realizado, con el fin de establecer el papel de la cirugía primaria citorreductora en el tratamiento del CEO y su posible impacto en la supervivencia de las pacientes. Durante el período del estudio se diagnosticaron 123 casos de cáncer epitelial de ovario. Todas las pacientes fueron sometidas a cirugía primaria con intención citorreductora seguida de un esquema de quimioterapia basado en platino. El tumor residual después de la cirugía se relacionó significativamente con el resultado del second look, la supervivencia global y el índice de recurrencias (AU)

Melanoma de vagina en una mujer de 94 años de edad / Vaginal melanoma in a 94 year old woman

El melanoma primario de vagina es un tumor muy raro asociado a un mal pronóstico. La primera descripción la realizó Parona en 1897 y hasta la fecha hay poco más de 200 casos publicados en la bibliografía médica. La localización más frecuente es el tercio proximal y la pared anterior de la vagina, y la presentación clínica más habitual es en forma de sangrado. El tratamiento óptimo es controvertido, ya que a la escasez de datos publicados se añaden los malos resultados obtenidos independientemente del tratamiento terapéutico. A partir de un caso diagnosticado en nuestro hospital se realiza una revisión bibliográfica y se repasan los principales factores pronósticos y las distintas posibilidades de tratamiento (AU)

[Bilateral ovary massive edema. Unusual gynecologic pathology. Report of 2 cases]. / Edema masivo de ovario bilateral. Patología ginecológica poco frecuente. Informe de dos casos.

We report two cases of bilateral massive ovarian edema occurred in a concentration hospital in the last five years. This condition was first described by Kalstone et al. in 1969. It may be uni or bilateral, the last one is very uncommon, until the moment of this work there have been reported only ten cases in the world literature. The main symptoms are: abdominal pain or distention, menstrual irregularity and infertility. Two features are characteristic of this pathology: 1) Fast growing in size and volume of the ovary, and 2) Abscense of neoplastic changes with extensive edema of the stroma particularly in the medulla. The current treatment is oophorectomy. In bilateral cases may be intended a conservative management with wedge resection and fixation of the ovaries to the uterus in order to prevent further torsion. We conclude that massive ovarian edema is an uncommon pathology more frequent as a cause of abdominal pain and fast growing anexial mass in young women.

[Myomatosis of rare localization]. / Miomatosis de localización poco frecuente.

We described three cases of female patients with myomata of rare location. A 37 year old female with abnormal genital bleeding, secondary to cervical neoplasm; underwent total abdominal hysterectomy in 1993. A year later an excision of anterior vaginal dependent neoplasm was performed. A 16 year old female with Bartholinitis. Excision of vulvar tumor was performed. A 35 year old female with urinary stress incontinence, hematuria, referring foreign body sensation in the vagina, with a neoplasm in the urethra. The patient underwent for excision of the tumor. In all three cases the neoplasm excised underwent histopathologic analysis resulting as vulvar, vaginal and urethral myomata.