The Impact and Effectiveness of Weight Loss on Kidney Transplant Outcomes: A Narrative Review.

Obesity is a worldwide epidemic that leads to several non-communicable illnesses, including chronic kidney disease (CKD). Diet and lifestyle modifications have shown a limited impact in the treatment of obesity. Because the group of end-stage renal disease (ESRD) patients examined in this study had limited access to kidney transplantation (KT), patients with obesity were thought to be at an increased risk of intraoperative and postoperative KT complications. Although bariatric surgery (BS) is now recognized as the gold standard treatment for morbid obesity, its role in ESRD or kidney transplant patients remains unknown. It is critical to know the correlation between weight loss and complications before and after KT, the impact of the overall graft, and patients' survival. Hence, this narrative review aims to present updated reports addressing when to perform surgery (before or after a KT), which surgical procedure to perform, and again, if strategies to avoid weight regain must be specific for these patients. It also analyzes the metabolic alterations produced by BS and studies its cost-effectiveness pre- and post-transplantation. Due to the better outcomes found in KT recipients, the authors consider it more convenient to perform BS before KT. However, more multicenter trials are required to provide a solid foundation for these recommendations in ERSD patients with obesity.

Gut microbiota and obesity: New insights.

Obesity is a pathology whose incidence is increasing throughout the world. There are many pathologies associated with obesity. In recent years, the influence of the microbiota on both health and pathological states has been known. There is growing information related to changes in the microbiome and obesity, as well as its associated pathologies. Changes associated with age, exercise, and weight changes have been described. In addition, metabolic changes associated with the microbiota, bariatric surgery, and fecal matter transplantation are described. In this review, we summarize the biology and physiology of microbiota in obese patients, its role in the pathophysiology of several disorders associated, and the emerging therapeutic applications of prebiotics, probiotics, and fecal microbiota transplantation.

Thyroiditis: Evaluation and Treatment.

Thyroiditis is a general term for inflammation of the thyroid gland. The most common forms of thyroiditis encountered by family physicians include Hashimoto, postpartum, and subacute. Most forms of thyroiditis result in a triphasic disease pattern of thyroid dysfunction. Patients will have an initial phase of hyperthyroidism (thyrotoxicosis) attributed to the release of preformed thyroid hormone from damaged thyroid cells. This is followed by hypothyroidism, when the thyroid stores are depleted, and then eventual restoration of normal thyroid function. Some patients may develop permanent hypothyroidism. Hashimoto thyroiditis is an autoimmune disorder that presents with or without signs or symptoms of hypothyroidism, often with a painless goiter, and is associated with elevated thyroid peroxidase antibodies. Patients with Hashimoto thyroiditis and overt hypothyroidism are generally treated with lifelong thyroid hormone therapy. Postpartum thyroiditis occurs within one year of delivery, miscarriage, or medical abortion. Subacute thyroiditis is a self-limited inflammatory disease characterized by anterior neck pain. Treatment of subacute thyroiditis should focus on symptoms. In the hyperthyroid phase, beta blockers can treat adrenergic symptoms. In the hypothyroid phase, treatment is generally not necessary but may be used in patients with signs and symptoms of hypothyroidism or permanent hypothyroidism. Nonsteroidal anti-inflammatory drugs and corticosteroids are indicated for the treatment of thyroid pain. Certain drugs may induce thyroiditis, such as amiodarone, immune checkpoint inhibitors, interleukin-2, interferon-alfa, lithium, and tyrosine kinase inhibitors. In all cases of thyroiditis, surveillance and clinical follow-up are recommended to monitor for changes in thyroid function.

Pituitary hyperplasia secondary to primary hypothyroidism.

Severe primary hypothyroidism should be considered in the differential diagnosis of pituitary enlargement. Thyroid hormone replacement therapy should lead to regression of pituitary hyperplasia.

Political Practices and Citizen Education with Gender Perspective. Analysis in Some Universities in Bucaramanga, Colombia / Prácticas políticas y formación ciudadana con perspectiva de género. análisis de algunas universidades de bucaramanga, colombia

RESUMEN El proyecto de investigación "Prácticas políticas y formación ciudadana con perspectiva de género. Análisis de las universidades de Bucaramanga", se propuso contribuir al mejoramiento de los planes de formación ciudadana de las Instituciones de Educación Superior (IES). Para eso, se examinaron los enfoques teóricos que fundamentan la formación ciudadana en los planes educativos-formativos de las IES y sus programas institucionales; se identificaron los mecanismos que estructuran las subjetividades y las identidades de género y que sustentan las prácticas sociales sobre la ciudadanía, de los(as) estudiantes de las Instituciones de Educación Superior de Bucaramanga; finalmente, se entregaron estrategias de formación ciudadana coherentes con las expectativas e intereses de la comunidad juvenil a las IES de Bucaramanga. En el trabajo de campo participaron seis Instituciones de Educación Superior de la ciudad y su área metropolitana, en donde se desarrollaron 13 entrevistas semiestructuradas a los directivos de las instituciones. De igual manera, se realizaron seis Grupos de Discusión con la participación de 163 estudiantes de ambos sexos. Los elementos encontrados demuestran que las Instituciones de Educación Superior en Bucaramanga y su área metropolitana deben implementar la propuesta dada en sus Proyectos Educativos Institucionales, en cuanto a la formación integral. Así mismo, la formación ciudadana debe conducir a la juventud a cuestionar todas las estructuras que median sus relaciones interpersonales. De igual manera, será el espacio para lograr comunicaciones efectivas, críticas y a reconocer las voces y criterios de los(as) otros(as); a interactuar con la diversidad y a poner en escena los valores de la tolerancia, el respeto y la solidaridad dentro de un pensamiento pluralista.

ABSTRACT The research project "Political practices and citizen education with gender perspective. Analysis in some universities in Bucaramanga, Colombia", had the purpose of improving citizen education plans in Higher Institutions. To accomplish the research objective, it as considered: to know the theoretical approaches that base the citizen education in educative/ formative plans of Higher institutions and their institutional programs; to identify the mechanisms that structures subjectivities and gender identities that support social practices on the citizenship of Higher Institution's' students in Bucaramanga, and finally, to contribute to Higher Institutions in Bucaramanga with coherent strategies of citizen education according to the expectations and interests of youth community. During the work field six Higher Institutions of Bucaramanga participated and were conducted 13 semi-structured interviews to institution's chiefs' officers. Moreover, they were conducted six focus groups with 163 students of both genders. The results show that Higher Institutions of Bucaramanga should focus on developing their institutional educative projects regarding integral education action plans. Those findings indicate a teaching-learning process guided by competences where Know and Be allows to build a personal identity and the conscience to have attitudinal control. Likewise, citizen education should lead youth to argue all the structures that mediate their relationships. Similarly, citizen education would be the room to achieve affective and critic communication, and to recognize the voices and criteria of others to interact with diversity and to stage the tolerance, respect and solidarity within a pluralistic thought. The methodology used to collect the information has been qualitative, through semi-structured in-depth interviews and workshops with different actors. analysis leads to identify some key elements that obscure the legislative and jurisprudential successes that de Colombian State has achieved in terms of reparation with a gender approach. The results indicate the need to go beyond gender as a differentiating category, to achieve greater effectiveness in the reparation proposed to the victims.

Aortic dissection after transcatheter aortic valve replacement.

Aortic dissection is a rare but life- threatening complication of transcatheter aortic valve replacement, clinicians should be aware of this complication and should consider timely diagnostic evaluations, as well as, establish a prompt treatment plan based on a multidisciplinary team approach.

Analysis of real time PCR amplification efficiencies from three genomic region of dengue virus.

Early diagnosis of dengue virus (DENV) infection represents a key factor in preventing clinical complications attributed to the disease. The aim of this study was to evaluate the amplification efficiencies of an in-house quantitative real time-PCR (qPCR) assay of DENV, using the non-structural conserved genomic region protein-5 (NS5) versus two genomic regions usually employed for virus detection, the capsid/pre-membrane region (C-prM) and the 3'-noncoding region (3'NC). One-hundred sixty seven acute phase serum samples from febrile patients were used for validation purposes. Results showed that the three genomic regions had similar amplification profiles and correlation coefficients (0.987-0.999). When isolated viruses were used, the NS5 region had the highest qPCR efficiencies for the four serotypes (98-100%). Amplification from acute serum samples showed that 41.1% (67/167) were positive for the universal assay by at least two of the selected genomic regions. The agreement rates between NS5/C-prM and NS5/3'NC regions were 56.7% and 97%, respectively. Amplification concordance values between C-prM/NS5 and NS5/3'NC regions showed a weak (kappa = 0.109; CI 95%) and a moderate (kappa = 0.489; CI 95%) efficiencies in amplification, respectively. Serotyping assay using a singleplex NS5-TaqMan format was much more sensitive than the C-prM/SYBR Green I protocol (76%). External evaluation showed a high sensitivity (100%), specificity (78%) and high agreement between the assays. According to the results, the NS5 genomic region provides the best genomic region for optimal detection and typification of DENV in clinical samples.

A single amino acid substitution in the MurF UDP-MurNAc-pentapeptide synthetase renders Streptococcus pneumoniae dependent on CO2 and temperature.

The respiratory tract pathogen Streptococcus pneumoniae encounters different levels of environmental CO2 during transmission, host colonization and disease. About 8% of all pneumococcal isolates are capnophiles that require CO2 -enriched growth conditions. The underlying molecular mechanism for caphnophilic behaviour, as well as its biological function is unknown. Here, we found that capnophilic S. pneumoniae isolates from clonal complex (CC) 156 (i.e. Spain(9V) -3 ancestry) and CC344 (i.e. Norway(NT) -42 ancestry) have a valine at position 179 in the MurF UDP-MurNAc-pentapeptide synthetase. At ≤ 30°C, the growth characteristics of capnophilic and non-capnophilic CC156 strains were equal, but at > 30°C growth and survival of MurF(V) (179) strains was dependent on > 0.1% CO2 -enriched conditions. Expression of MurF(V) (179) in S. pneumoniae R6 and G54 rendered these, otherwise non-capnophilic strains, capnophilic. Time-lapse microscopy revealed that a capnophilic CC156 strain undergoes rapid autolysis upon exposure to CO2 -poor conditions at 37°C, and staining with fluorescently labelled vancomycin showed a defect in de novo cell wall synthesis. In summary, in capnophilic S. pneumoniae strains from CC156 and CC344 cell wall synthesis is placed under control of environmental CO2 levels and temperature. This mechanism might represent a novel strategy of the pneumococcus to rapidly adapt and colonize its host under changing environmental conditions.

Analysis of real time PCR amplification efficiencies from three genomic region of dengue virus / Análisis de las eficiencias de amplificación por PCR en tiempo real de tres regiones genómicas del virus dengue

Early diagnosis of dengue virus (DENV) infection represents a key factor in preventing clinical complications attributed to the disease. The aim of this study was to evaluate the amplification efficiencies of an in-house quantitative real time-PCR (qPCR) assay of DENV, using the non-structural conserved genomic region protein-5 (NS5) versus two genomic regions usually employed for virus detection, the capsid/pre-membrane region (C-prM) and the 3’-noncoding region (3’NC). One-hundred sixty seven acute phase serum samples from febrile patients were used for validation purposes. Results showed that the three genomic regions had similar amplification profiles and correlation coefficients (0.987-0.999). When isolated viruses were used, the NS5 region had the highest qPCR efficiencies for the four serotypes (98-100%). Amplification from acute serum samples showed that 41.1% (67/167) were positive for the universal assay by at least two of the selected genomic regions. The agreement rates between NS5/C-prM and NS5/3’NC regions were 56.7% and 97%, respectively. Amplification concordance values between C-prM/NS5 and NS5/3’NC regions showed a weak (k= 0.109; CI 95%) and a moderate (k= 0.489; CI 95%) efficiencies in amplification, respectively. Serotyping assay using a singleplex NS5-TaqMan® format was much more sensitive than the C-prM/SYBR Green® I protocol (76%). External evaluation showed a high sensitivity (100%), specificity (78%) and high agreement between the assays. According to the results, the NS5 genomic region provides the best genomic region for optimal detection and typification of DENV in clinical samples.

El diagnóstico precoz de la infección por el virus dengue (DENV) constituye un elemento clave para la prevención de las complicaciones clínicas propias de la enfermedad. El objetivo del estudio fue evaluar la detección de DENV mediante un ensayo cuantitativo de PCR-tiempo real (qPCR), desarrollado localmente, utilizando la región no-estructural-5 (NS5), versus dos regiones tradicionalmente empleadas para la detección del virus, la región cápside/pre-membrana (C-prM), y la región noncodificante-3’ (3’NC). Se recolectaron 167 muestras de suero de pacientes en fase aguda de la enfermedad. Las tres regiones génicas tuvieron perfiles de amplificación/coeficientes de correlación similares (0,987-0,999). Sin embargo, la región NS5 tuvo la eficiencia de amplificación más elevada para los cuatro serotipos (98-100%). Durante el proceso de validación, 41,1% (67/167) de las muestras de suero resultaron positivas para DENV al menos por dos de las regiones genómicas empleadas. Los valores de concordancia entre las regiones NS5/C-prM y NS5/3’NC fueron de 56,7% y 97%, respectivamente. La concordancia fue débil entre las regiones NS5/C-prM (k= 0,109; CI 95%), sin embargo, fue moderada entre las regiones NS5/3’NC (k= 0,489; CI 95%). El ensayo de tipificación uniplex en formato NS5/TaqMan® mostró alta sensibilidad (100%) que el protocolo C-prM/SYBRGreen®-I (76%). La validación externa del ensayo mostró una alta sensibilidad (100%), especificidad (78%) y acuerdo alto entre los ensayos utilizados. De acuerdo a los resultados obtenidos, la región NS5 ofrece la mayor opción para la detección y serotipificación del DENV en muestras clínicas.

Genetic diversity of Tn916-related transposons among drug-resistant Streptococcus pneumoniae isolates colonizing healthy children in Venezuela.

Among a collection of 48 multidrug-resistant pneumococcal strains colonizing healthy children in a small municipality of Mérida, Venezuela, we identified sequence types (STs) related to a variety of internationally spreading drug-resistant clones, as well as ST135, thus far isolated only in Europe. The clones invariably harbored one or more of the Tn916-related transposons Tn3872, Tn5253, Tn6002, Tn2009, and Tn2010. Finally, our data suggest both structural rearrangements in certain transposons and occurrence of novel transposable elements.

Carbonic anhydrase is essential for Streptococcus pneumoniae growth in environmental ambient air.

The respiratory tract pathogen Streptococcus pneumoniae needs to adapt to the different levels of carbon dioxide (CO(2)) it encounters during transmission, colonization, and infection. Since CO(2) is important for various cellular processes, factors that allow optimal CO(2) sequestering are likely to be important for pneumococcal growth and survival. In this study, we showed that the putative pneumococcal carbonic anhydrase (PCA) is essential for in vitro growth of S. pneumoniae under the CO(2)-poor conditions found in environmental ambient air. Enzymatic analysis showed that PCA catalyzes the reversible hydration of CO(2) to bicarbonate (HCO(3)(-)), an essential step to prevent the cellular release of CO(2). The addition of unsaturated fatty acids (UFAs) reversed the CO(2)-dependent in vitro growth inhibition of S. pneumoniae strains lacking the pca gene (Deltapca), indicating that PCA-mediated CO(2) fixation is at least associated with HCO(3)(-)-dependent de novo biosynthesis of UFAs. Besides being necessary for growth in environmental ambient conditions, PCA-mediated CO(2) fixation pathways appear to be required for intracellular survival in host cells. This effect was especially pronounced during invasion of human brain microvascular endothelial cells (HBMEC) and uptake by murine J774 macrophage cells but not during interaction of S. pneumoniae with Detroit 562 pharyngeal epithelial cells. Finally, the highly conserved pca gene was found to be invariably present in both CO(2)-independent and naturally circulating CO(2)-dependent strains, suggesting a conserved essential role for PCA and PCA-mediated CO(2) fixation pathways for pneumococcal growth and survival.

[Serotype profile and antibiotyping of Streptococcus pneumoniae strains isolated from nasal carriage in pediatric patients]. / Perfil serológico y antibiotipia de cepas de Streptococcus pneumoniae aisladas de portadores nasales pediátricos.

The aim of this study was to determine the serotype profile and antibiotyping of Streptococcus pneumoniae from nasal isolates in children. Nasopharyngeal swab samples obtained from 125 children were cultivated and screened for the presence of S. pneumoniae. Strains were identified according to standard microbiological methods. The isolates were serotyped by the Quellung reaction and resistance patterns were determined by the microdilution method according to NCCLS guidelines. Results indicate an overall pneumococcal carriage rate of 24% (n = 30). The most commonly isolated serotypes were 23F (20%), 6B (20%) and 14 (13%). 73% of isolates were resistant at least to one of the tested antibiotics. 47% of the strains were consistently resistant to penicillin and the serotypes 6B and 23F were frequently associated with this marker. 60% of the strains were resistant to doxycycline, 37% to trimethoprim/sulfamethoxazole and clindamycin, 30% to erythromycin, 23% to cloramphenicol, 7% to ceftriaxone and 3% to cefepime. All strains were sensible to ofloxacin, rifampin and vancomycin. The most common combined resistance patterns were PNC-ERI-TMP/SMX-DOX-CLO-CLI (16.59%) and PNC-DOX (13.27%). The results obtained in this study will allow to orient the empiric therapy for pneumococcal infections and a rational use of antibiotics in clinical practice, as well as the application of an appropriate vaccination program specially adapted to the serotypes more frequently found in children.

Perfil serológico y antibiotipia de cepas de Streptococcus pneumoniae aisladas de portadores nasales pediátricos / Serotype profile and antibiotyping of Streptococcus pneumoniae strains isolated from nasal carriage in pediatric patients

El objetivo de este trabajo fue determinar el perfil serológico y la antibiotipia de S. pneumoniae aislados de portadores nasales pediátricos. Ciento veinticinco muestras de secreción nasal provenientes de niños fueron cultivadas y estudiadas para detectar la presencia de Streptococcus pneumoniae. Las cepas fueron identificadas según métodos microbiológicos estandarizados, la serotipificación por la reacción de Quellung y los patrones de resistencia por el método de microdilución de acuerdo al National Committee for Clinical Laboratory Standards. Los resultados indicaron que la frecuencia de aislamiento de neumococos en la región nasal fue de 24 por ciento (n=30), y los serotipos más comúnmente identificados fueron el 23F (20 por ciento), el 6B (20 por ciento) y el 14 (13 por ciento). El 73 por ciento de los aislados fueron resistentes por lo menos a uno de los antibióticos probados. El 47 por ciento de las cepas mostraron resistencia a la penicilina y los serotipos más frecuentemente asociados a este marcador fueron el 6B y el 23F. El 60 por ciento de las cepas mostró resistencia a la doxiciclina, el 37 por ciento al trimetoprim/sulfametoxasol y a la clindamicina, el 30 por ciento a eritromicina, el 23 por ciento al cloramfenicol, el 7 por ciento a ceftriaxona y el 3 por ciento a cefepima. Todas las cepas fueron sensibles a la ofloxacina, rifampicina y vancomicina. Los patrones de multirresistencia más comunes fueron PNC-ERI-TMP/SMX-DOX-CLO-CLI (16,59 por ciento) y PNC-DOX (13,27 por ciento). Los resultados obtenidos en este estudio permitirán orientar la terapia empírica para las infecciones neumocócicas y el uso racional de los antibióticos en la práctica clínica, así como la aplicación de un programa de vacunación adaptado a los serotipos más frecuentemente encontrados en la población infantil

Epidemiología y caracterización fenotípica y serológica de strepcoccus pneumoniae resistentes a la penicilina provenientes de portadores nasales / Epidemiology and characterization fenotypic and serology of resistant streptococcus pneumonie of the penicillin coming from nasal payees

Las infecciones producidas por Streptococcus pneumoniae son unas de las principales causa de enfermedad respiratoria en niños menores de 5 años. El transporte nasofaríngeo de S. pneumoniae ha sido correlacionado con la aparición de la enfermedad clínica. De manera que, las características que presentan estos aislados en su condición de transporte en el huesped humano podría servir como indicador de la prevalencia de estas cepas en una población específica. Un total de 125 niños fueron incluidos en este estudio, de los cuales 30 (24 por ciento) resultaron positivos al aislamiento de S. pneumoniae en secreción nasal. La frecuencia de aislamiento se relacionó con la presencia de infección respiratoria recurrente (41 por ciento, p=0.009. Inicialmente las cepas fueron identificadas de acuerdo a la apariencia colonial, la producción de alfa-hemólisis y la tinción al Gram. La identificación definitiva se realizó mediante la sensibilidad a la optoquina, la solubilidad en bilis y la aglutinación en látex. Sin embargo, la serotipificación sólo fue posible en el 90 por ciento de las cepas, siendo los serotipos 6B, 23F y 14 los más frecuentes. El 47 por ciento de las cepas aisladas presentaron resistencia a la penicilina (CIM>0,12 µg/ml) y un 3 por ciento de estas cepas mostraron altos niveles de resistencia a la penicilina (>2 µg/ml). Los serotipos 6B y 23F fueron los que comúnmente se asociaron con este marcador. Ninguna de las cepas resistentes a la penicilina se les detectó la producción de B-lactamasa. Este estudio demostró que el tratamiento previo con antibióticos constituyó el principal factor de riesgo relacionado con la prevalencia de S. pneumoniae resistentes a la penícilina en la población infantil estudiada (64 por ciento, p=0.05). Los resultados obtenidos permitirán orientar la terapia empirica de patologías producidas por S.pneumoniae, así como la aplicación de un programa de vacunación adaptado a los serotipos más frecuentemente encontrados en la población infantil