Epidemiology and factors associated with Extra-pulmonary tuberculosis in a Low-prevalence area.

Background: Tuberculosis is a global public health problem. Extra-pulmonary tuberculosis accounts for an increasing proportion of cases worldwide, although information about epidemiological, clinical, or microbiological factors is lacking. Methods: We conducted a retrospective observational study of tuberculosis cases diagnosed between 2016 and 2021, classified into Pulmonary and Extra-pulmonary tuberculosis. Univariable and multivariable logistic regression models were used to investigate risk factors of Extra-pulmonary tuberculosis. Results: 20.9% of overall cases were classified as Extra-pulmonary tuberculosis, with a rising trend from 22.6% in 2016 to 27.9% in 2021. Lymphatic tuberculosis accounted for 50.6% of cases, followed by pleural tuberculosis (24.1%). 55.4% of cases belonged to foreign-born patients. Microbiological culture tested positive in 92.8% of Extra-pulmonary cases. Logistic regression analysis showed that women were more predisposed to develop Extra-pulmonary tuberculosis (aOR 2.46, 95% CI 1.45-4.20) as well as elderly patients (aged ≥ 65 years) (aOR 2.47, 95% CI 1.19-5.13) and persons with previous history of tuberculosis (4.99, 95% CI 1.40-17.82). Conclusions: Extra-pulmonary Tuberculosis have increased within our study period. A profound decline occurred in 2021 tuberculosis cases, probably due to COVID-19. Women, elderly population, and persons with previous history of tuberculosis are at higher risk of developing Extra-pulmonary tuberculosis in our setting.

Xpert MTB/RIF Ultra CT value provides a rapid measure of sputum bacillary burden and predicts smear status in patients with pulmonary tuberculosis.

Traditionally, smear microscopy has been used to estimate bacillary burden in order to assess infectiousness in tuberculosis (TB) patients. Since Xpert MTB assays might replace smear microscopy as the first-line diagnostic test for pulmonary tuberculosis, an alternative measure of bacillary load that correlates with smear positivity is needed. This study assessed the correlation between CT (with and without normalization), smear status, culture time-to-positivity (TTP), and clinical factors in patients with Xpert ultra positive sputum during a four-year period. A cut-off CT value for smear positivity was also estimated. 204 samples were included. Strong correlation between both Xpert Ultra CT values (raw and normalized) and smear status was obtained (r = 0.78 and - 0.79, respectively). The association between Raw-CT and TTP was weaker than normalized-CT (N-CT) and TTP (r = 0.50 and r = - 0.70, respectively). A Raw-CT cut-off value of 21.4 was identified with 85.7% (95% CI 65.4-95) sensitivity and 92.9% (95% CI 84.3-96.9) specificity. A N-CT cut-off value of 5.2 yielded a sensitivity of 94.3% (95% CI 86.2-97.8) and specificity of 85.7% (95% CI 65.4-95). Our study demonstrates that Xpert Ultra CT value correlates well with other measures of bacillary load such as smear status or TTP. The correlation with TTP is stronger when the CT value is normalized using the internal control. The proposed N-CT cut-off value of 5.2 shows a better sensitivity than the Raw-CT when predicting smear positive status.

Particle beam microstructure reconstruction and coincidence discrimination in PET monitoring for hadron therapy.

Positron emission tomography is one of the most mature techniques for monitoring the particles range in hadron therapy, aiming to reduce treatment uncertainties and therefore the extent of safety margins in the treatment plan. In-beam PET monitoring has been already performed using inter-spill and post-irradiation data, i.e. while the particle beam is off or paused. The full beam acquisition procedure is commonly discarded because the particle spills abruptly increase the random coincidence rates and therefore the image noise. This is because random coincidences cannot be separated by annihilation photons originating from radioactive decays and cannot be corrected with standard random coincidence techniques due to the time correlation of the beam-induced background with the ion beam microstructure. The aim of this paper is to provide a new method to recover in-spill data to improve the images obtained with full-beam PET acquisitions. This is done by estimating the temporal microstructure of the beam and thus selecting input PET events that are less likely to be random ones. The PET detector we used was the one developed within the INSIDE project and tested at the CNAO synchrotron-based facility. The data were taken on a PMMA phantom irradiated with 72 MeV proton pencil beams. The obtained results confirm the possibility of improving the acquired PET data without any external signal coming from the synchrotron or ad hoc detectors.

Monte Carlo simulation tool for online treatment monitoring in hadrontherapy with in-beam PET: A patient study.

Hadrontherapy is a method for treating cancer with very targeted dose distributions and enhanced radiobiological effects. To fully exploit these advantages, in vivo range monitoring systems are required. These devices measure, preferably during the treatment, the secondary radiation generated by the beam-tissue interactions. However, since correlation of the secondary radiation distribution with the dose is not straightforward, Monte Carlo (MC) simulations are very important for treatment quality assessment. The INSIDE project constructed an in-beam PET scanner to detect signals generated by the positron-emitting isotopes resulting from projectile-target fragmentation. In addition, a FLUKA-based simulation tool was developed to predict the corresponding reference PET images using a detailed scanner model. The INSIDE in-beam PET was used to monitor two consecutive proton treatment sessions on a patient at the Italian Center for Oncological Hadrontherapy (CNAO). The reconstructed PET images were updated every 10 s providing a near real-time quality assessment. By half-way through the treatment, the statistics of the measured PET images were already significant enough to be compared with the simulations with average differences in the activity range less than 2.5 mm along the beam direction. Without taking into account any preferential direction, differences within 1 mm were found. In this paper, the INSIDE MC simulation tool is described and the results of the first in vivo agreement evaluation are reported. These results have justified a clinical trial, in which the MC simulation tool will be used on a daily basis to study the compliance tolerances between the measured and simulated PET images.

Aislamiento de vibrio cholerae a partir de lisas y tilapias en Venezuela / Isolates of vibrio cholerae from lisas and tilapias in Venezuela

Un importante patógeno humano es vibrio cholerae, causante de diarreas profusas (cólera) y otros desórdenes. Su transmisión está asociada con el consumo de alimentos marinos contaminados. En el presente estudio se realizaron caracterizaciones fenotípicas de 24 aislados de Vibrio sp. obtenidos por necropsia y del cepario del laboratorio de Bacteriología de Sanidad Animal CENIAP-INIA en Maracay, estado Aragua; entre los cuales fue aislado vibrio cholerae proveniente de lisas y tilapsias. Las técnicas de identificación bacteriana se basan en sus características fenotípicas y metabólicas, desarrollo de colonias en medios de cultivos, morfología microscópica y reacciones tintoriales y características bioquímicas basadas en la utilización de sustratos. En los ejemplares de tilapia estudiados se identificó vibrio cholerae no-O1 y en las lisas, predominaron vibrio parahaemolyticus y vibrio cholerae no-O1. Este hallazgo es de gran importancia sanitaria, ya que los peces son de consumo humano, lo que constituye un riesgo en salud pública

Implementación de un protocolo para la identificación de la tóxina de vibrio cholerae / Implementation of a protocol for the indentification of vibrio cholerae

Vibrio cholerae produce una potente toxina codificada por dos genes: el operón ctxAB. Los estudios epidemiológicos han sido limitados por las técnicas fenotípicas; por ello es necesrio establecer un protocolo para la detección del gen de la subnidad A (ctxA), que codifica la toxina de Vibrio cholerae, por lo cual se realizaron caracterizaciones genéticas de 24 horas aislados de la familia Vibrionaceae obtenidos del cepario del laboratorio de Bacteriología de Sanidad Animal-CENIAP-INIA, que provienen de lisas, tilapias y cachamas. Se siguió la metodología recomendada por Fields et al. (1992) con modificaciones, siendo la secuencia de los iniciadores: 5'-GGGCAGATTCTAGACCTCCTG-3' Y 5'-CGATGATCTTGGAGCATTCCCAC-3'. Los aislados de Vibrio cholerae no 01 analizados no poseen la toxina colérica. La investigación de la toxina colérica en aislados ambientales es necesaria, ya que en los peces en los que fueron aislados son de consumo humano, lo que constituye un riesgo en salud pública.

[Hepatic glycogenosis: the clinical, biochemical and enzymatic aspects in a group of pediatric patients]. / Glucogenosis hepática: aspectos clínicos, bioquímicos y enzimáticos en un grupo de pacientes pediátricos.

Nine children with clinical diagnosis of glycogenoses were studied, types were confirmed through determination of levels and structure of glycogen, stimulation with glucagon and enzymatic defect analyses. Eight patients suffered glycogenoses type III and one, type VI. The major age group un type III was 1 to 2 years old (62.5%), the type VI was diagnosed in a preschool boy. Mean clinical features were: hepatomegaly, doll-like facies and short height. Major biochemical alterations were: transaminases elevation in both types, hypertriglyceridemia, hyperglycemia, metabolic acidosis and hyperuricemia only in glycogenoses III. One III type patient presented cardiovascular alterations. All patients showed increased concentrations of erythrocyte glycogen, with normal structure in type VI and abnormal in 75% of type III. Tree fourths of type III patients had a positive response to glucagon stimulation. No one presented glucose 6 phosphatase deficiency.

Uso del trien en el tratamiento de la enfermedad de Wilson / Use of trien in the treatment of wilson's disease

Enfermedad de Wilson es una afección autosómica, que se caracteriza por el acúmulo de cobre a nivel de los tejidos con afinidad especial por hígado y cerebro. con una incidencia baja de 1/200.000, en las poblaciones estudiadas, exceptuando el Japón con el 1 por ciento (isla Mikura). Estudios en Venezuela han demostrado un foco importante en el área central, que da un 20 por ciento de la población con afectación leve. La D-penicilamina primera droga utilizada en esta enfermedad pero que presenta el problema de los múltiples efectos secundarios, entre otros trombocitopenia, neutropenia y síndrome lupoide así como su alto costo, que dificultan el manejo del paciente. El trien nueva droga descrita desde 1968 aunque no disponible comercialmente, ha sido utilizada en 40 pacientes sin efectos secundarios. En Venezuela se ha utilizado en 5 pacientes con muy buenos resultados, a propósito presentamos los efectos en un paciente asintomático con cirrosis por enfermedad de Wilson, quien con dos años de tratamiento con 300 mg Tid., presentó normalización de las pruebas de funcionalismo hepático y mejoría leve de la imagen histopatológica y sin efectos secundarios. El costo del Trien es 50 veces más económico y sin efectos secundarios hasta ahora, de allí que su utilización es recomendable

Evaluation of humoral immunity to Brucella sp in cattle by use of an agar-gel immunodiffusion test containing a polysaccharide antigen.

Results of a double agar gel immunodiffusion (Ouchterlony) test that contained a polysaccharide (poly-B) antigen of Brucella melitensis strain B115 were compared with those of 5 other serotests. To determine the sensitivity and specificity of the immunodiffusion, standard tube, 2-mercaptoethanol, Rivanol, card, and complement fixation tests, sera obtained from 1,328 vaccinated, infected, and seronegative cattle, 56 of which had been examined bacteriologically, were used to evaluate the humoral response to Brucella sp. The poly-B antigen confirmed infection in 87.5% of the 56 cattle from which Brucella abortus biotype 1 had been isolated, and in 96.6% (205/212) of a group of cattle suspected to be infected on the basis of results of conventional serotests. Likewise, sera from 4 groups of vaccinated cattle did not react with poly-B antigen, whereas they did react in conventional tests. The poly-B antigen was more specific in detecting infected cattle even in a group of vaccinated adults. A useful strategy to identify infected cattle might be screening, using a combination of the Rivanol and card tests together with the agar-gel immunodiffusion test containing poly-B antigen.

Torus palatinus: a segregation analysis.

Segregation analysis of 99 sibships in 2 samples from Venezuela and Japan indicates that a torus palatinus is inherited in simple dominant fashion. The gene shows variable expressivity and penetrance close to 85%, without significant heterogeneity between the populations considered. No evidence of sporadic cases has been found.