Diagnosis of Onychomycosis: Utility of an Immunochromatography Strip Test Compared with Conventional Culture. / Diagnóstico de onicomicosis. La utilidad del test rápido de detección antigénica en comparación con el cultivo.

BACKGROUND: Ringworm is highly prevalent in our setting and is frequently observed in our routine clinical practice. Diagnostic confirmation depends on techniques that are not always accessible (PCR), with highly variable sensitivity depending on the observer (direct microscopy) or delayed results (culture, histopathology). Recently, an immunochromatography-based rapid test (Diafactory®) for the antigenic detection of dermatophytes has been developed. This diagnostic tool can help diagnose ringworm, allowing early initiation of treatment and fewer consultation visits. OBJECTIVE: To determine the sensitivity and specificity of the rapid antigen detection test compared to conventional culture. MATERIAL AND METHODS: For a full year, 333 nail samples were collected from patients with suspected onychomycosis. The rapid test and the conventional culture were simultaneously performed on each sample. Those with a positive antigenic test result began treatment early. The remaining patients had appointments for serial cultures and subsequent medical consultation to evaluate the results. RESULTS: Compared to conventional culture, the sensitivity and specificity rates of the rapid antigen detection test are 97.2% and 80.7%, respectively. CONCLUSION: The effectiveness of the rapid antigen detection test is similar to that of conventional culture for the detection of dermatophytes in nail samples. It is a quick and simple diagnostic technique that reduces the number of patient visits to the hospital, and allows early treatment start.

Comparison of Proliferating Cell Nuclear Antigen (PCNA) Expression among Nasal Polyp and Chronic Rhinosinusitis.

BACKGROUND AND OBJECTIVE: Chronic rhinosinusitis is a common inflammatory disorder in sinonasal mucosa that could be developed with or without nasal polyps. Cellular proliferation is suggested as a possible mechanism of nasal polyp development. However, conducted studies in this context are limited. So, the present study's aim is the comparison of Proliferating cell nuclear antigen (PCNA) expression in nasal polyps and chronic rhinosinusitis. MATERIALS AND METHODS: In this cross-sectional study, 70 nasal polyp and 60 chronic rhinosinusitis samples from patients referred to Mostafa Khomeini Hospital, Tehran from 2017 to 2022 were immunohistochemically stained by PCNA marker. The percentage of PCNA nuclear expression was determined in two groups and its association with the type of pathological lesion and the patient's age and sex was analyzed by SPSS statistic software version 24 statistical software (IBM Statistics, USA). RESULTS: The mean expression of PCNA in nasal polyp and chronic rhinosinusitis samples was 16.55% ±â€¯13.66 and 17.58% ±â€¯12.68 respectively (ranging from 0 to 57% in both groups) however, there was no significant statistical difference between the two groups (p = 0.479). No relationship was found between PCNA expression with age and sex in none of the chronic rhinosinusitis and nasal polyp groups. CONCLUSION: Proliferative activity of the nasal epithelial cell is similar in chronic rhinosinusitis with and without nasal polyps and it is considered that the increase of epithelial cell proliferative activity probably has no role in nasal polyp development in patients with chronic rhinosinusitis.

Evaluación del valor predictivo negativo de la resonancia magnética multiparamétrica de próstata al combinar su puntuación con parámetros del antígeno prostático específico en pacientes con PSA en zona gris / The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients

Objetivo Calcular el valor predictivo negativo (VPN) de la resonancia magnética multiparamétrica (RMmp) de próstata negativa, definida como la ausencia de lesiones en las imágenes, cuando se combina con la densidad del PSA (DPSA) y el índice PSA libre/total (PSA l/t) en pacientes cuyo PSA se encuentra en la zona gris (4-10mg/ml). Métodos Se analizaron 191 pacientes con niveles de PSA entre 4 y 10mg/ml y RMmp negativa. El VPN de la RMmp negativa se calculó de acuerdo con un nivel de DPSA<0,15ng/ml/ml, un índice PSA l/t>0,15 y una combinación de ambos. Los pacientes se dividieron en 3 grupos de riesgo según estos dos parámetros, de la siguiente manera: • DPSA 0,01-0,07ng/ml/ml e índice PSA l/t≥25 en el grupo de bajo riesgo. • DPSA 0,08-0,15ng/ml/ml e índice PSA l/t 0,15-0,24 en el grupo de riesgo intermedio. • DPSA>0,15ng/ml/ml e índice PSA l/t<15 en el grupo de riesgo alto. Resultados El VPN de la RMmp negativa fue del 92,6% para el carcinoma de próstata clínicamente significativo (CPCS). El VPN aumentó al 97,5% en el grupo de riesgo bajo, y disminuyó al 33,3% en el de riesgo alto. El resultado al combinar la RMmp negativa con la DPSA<0,15ng/ml/ml fue muy similar al de su combinación con el PSA l/t>15. Conclusión el índice PSA l/t también podría utilizarse para aumentar el VPN de la RMmp, al igual que la DPSA. No recomendamos evitar la biopsia de próstata con una DPSA>0,15ng/ml/ml y un índice PSA l/t<0,15. Sin embargo, se requieren estudios controlados aleatorizados con más pacientes para confirmar los hallazgos de nuestro estudio. (AU)

Objective To calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. Methods One hundred ninety-one patients with PSA levels between 4-10mg/ml and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/ml/ml, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters: • PSAD 0.01-0.07 ng/ml/ml and f/t PSA ratio ≥25 in a low-risk group. • PSAD 0.08-0.15 ng/ml/ml, and f/t PSA ratio 0.15-0.24 in an intermediate-risk group and high-risk group. • PSAD>0.15 ng/ml/ml and f/t PSA ratio <15 in high-risk group, Results NPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD <0.15 ng/ml/ml and f/t PSA>15. Conclusion f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/ml/ml and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study. (AU)

El papel del antígeno prostático específico (PSA) y el estadio patológico antes de la radioterapia en la predicción de los resultados de la resonancia magnética multiparamétrica (RMmp) en pacientes con recidiva del cancer de próstata tras prostatectomía radical / Role of PSA levels and pathological stadiation before radiation therapy in predicting mp-MRI results in patients with prostate cancer recurrence after radical prostatectomy

Objetivo Evaluar el valor del antígeno prostático específico (PSA) en la predicción de los resultados de la resonancia magnética multiparamétrica (RMmp) en pacientes con cáncer de próstata (CaP) de alto (puntuación de Gleason≥8, pT≥3, pN1) y bajo grado (puntuación de Gleason<8, pT<3, pN0). Materiales y métodos Ciento ochenta y ocho pacientes se sometieron a una RMmp de 1,5-T después de la prostatectomía radical y antes de la radioterapia. Los pacientes se dividieron en 2 grupos: el grupo A incluía pacientes con recidiva bioquímica (RB) y el grupo B pacientes sin RB pero con alto riesgo de recidiva local. Teniendo en cuenta la puntuación de Gleason, pT y pN como variables de agrupación independientes, se realizaron análisis ROC de los niveles de PSA en el momento del diagnóstico del CaP primario y antes de la radioterapia con el fin de identificar el punto de corte óptimo para predecir el resultado de la RMmp. Resultados En los grupos A y B, el área bajo la curva del PSA antes de la radioterapia fue superior a la del PSA en el momento del diagnóstico del CaP, en tumores de bajo y alto grado. Para los tumores de bajo grado, la mejor área bajo la curva fue de 0,646 y 0,685 en el grupo A y B, respectivamente; para los tumores de alto grado, la mejor área bajo la curva fue de 0,705 y 1 en el grupo A y B, respectivamente. Para los tumores de bajo grado, el punto de corte óptimo del PSA fue de 0,565-0,58ng/ml en el grupo A (sensibilidad y especificidad: 70,5% y 66%), y de 0,11-0,13ng/ml en el B (sensibilidad y especificidad: 62,5% y 84,6%). Para los tumores de alto grado, el punto de corte de PSA óptimo fue de 0,265-0,305ng/ml en el grupo A (sensibilidad y especificidad: 95% y 42,1%), y de 0,13-0,15ng/ml en el grupo B (sensibilidad y especificidad: 100%). Conclusión La RMmp se debe realizar como herramienta diagnóstica complementaria siempre que se detecte una RB, especialmente en el CaP de alto grado... (AU)

Objective To evaluate prostate-specific antigen (PSA) value in multiparametric magnetic resonance imagin (mp-MRI) results prediction, analyzing patients with high (Gleason Score ≥8, pT≥3, pN1) and low grade (Gleason Score <8, pT<3, pN0) prostate cancer (PCa). Materials and methods One hundred eighty-eight patients underwent 1.5-T mp-MRI after radical prostatectomy and before radiotherapy. They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score, pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before radiotherapy were performed in order to identify the optimal cut-off to predict mp-MRI result. Results Group A and B showed higher area under the curve for PSA before radiotherapy than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best area under the curve was 0.646 and 0.685 in group A and B; for high grade the best area under the curve was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58ng/ml in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13ng/ml in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305ng/ml in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15ng/ml in B (sensitivity, specificity: 100%). Conclusion Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA>0.1-0.15ng/ml. (AU)

The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients.

OBJECTIVE: To calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. METHODS: 191 patients with PSA levels between 4-10 mg/mL and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/mL/mL, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters, which were PSAD 0.01-0.07 ng/mL/mL and f/t PSA ratio ≥25 in a low-risk group, PSAD 0.08-0.15 ng/mL/mL, and f/t PSA ratio 0.15-0.24 in an intermediate-risk group and high-risk group, in which PSAD > 0.15 ng/mL/mL and f/t PSA ratio <15. RESULTS: NPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD < 0.15 ng/mL/mL and f/t PSA > 15. CONCLUSION: f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/mL/mL and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study.

Role of psa levels and pathological stadiation before radiation therapy in predicting mp-MRI results in patients with prostate cancer recurrence after radical prostatectomy.

OBJECTIVE: To evaluate PSA value in mp-MRI results prediction, analyzing patients with high (GS≥8, pT≥3, pN1) and low grade (GS<8, pT<3, pN0) Prostate Cancer (PCa). MATERIALS AND METHODS: One hundred eighty-eight patients underwent 1.5-Tmp-MRI after Radical Prostatectomy (RP) and before Radiotherapy (RT). They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score (GS), pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before RT were performed in order to identify the optimal cut-off to predict mp-MRI result. RESULTS: Group A and B showed higher AUC for PSA before RT than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best AUC was 0.646 and 0.685 in group A and B; for high grade the best AUC was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58ng/mL in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13ng/mL in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305ng/mL in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15ng/mL in B (sensitivity, specificity: 100%). CONCLUSION: Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA>0.1-0.15ng/mL.

Determinação do potencial do polissacarídeo O157 como antígeno vacinal contra a Escherichia coli produtora de toxina Shiga (STEC)

Diarrheal diseases persist as a global concern due to their significant impact on health. Diarrhea, responsible for the death of 370,000 children worldwide in 2019, ranks as the second leading cause of mortality in children under five. Diverse factors, such as infections by parasitic, viral, or bacterial pathogens, trigger episodes of diarrhea, with Escherichia coli standing out, associated with hemolytic-uremic syndrome (HUS). The E. coli O157:H7 serotype, known for its Shiga toxin production, is linked to gastrointestinal infections and HUS, particularly in children. Treatment primarily involves supportive measures, as antibiotic exposure can exacerbate symptoms, increasing the risk of HUS and other complications. Due to this serotype's association with foodborne outbreaks, strict surveillance in food production, sanitation practices, and processes is essential to prevent infections caused by these pathogens. This study evaluates the potential of O157 polysaccharide as a vaccine candidate against Shiga toxin-producing E. coli (STEC). Results indicate that antibodies generated against O157 polysaccharide could recognize E. coli O157:H7 even in the presence of a capsule. They also assisted the complement system in lysing these bacteria and inhibited their adherence to human epithelial cells. In summary, the findings suggest that O157 polysaccharide could be considered a promising antigen in vaccine formulations against Shiga toxin-producing E. coli.

As doenças diarreicas persistem como uma preocupação global devido ao seu impacto significativo na saúde. A diarreia, responsável pela morte de 370 mil crianças em 2019 no mundo, é a segunda principal causa de óbito em crianças menores de cinco anos. Fatores diversos, como infecções por patógenos parasitários, virais ou bacterianos, desencadeiam episódios de diarreia, destacando-se Escherichia coli, associada à síndrome hemolítico-urêmica (SHU). O sorotipo E. coli O157:H7, reconhecido por sua produção de toxinas Shiga, está associado a infecções gastrointestinais e SHU, especialmente em crianças. O tratamento envolve principalmente medidas de suporte, pois a exposição a antibióticos pode intensificar os sintomas, aumentando o risco de SHU e outras complicações. Devido à associação deste sorotipo com surtos alimentares, é essencial uma vigilância rigorosa na produção de alimentos, práticas sanitárias e processos que resultem na prevenção de infeções causadas por esses patógenos. Esse estudo, portanto, avalia o potencial do polissacarídeo O157 como agente vacinal contra E. coli produtora de toxina Shiga (STEC). Os resultados mostraram que anticorpos gerados contra o polissacarídeo O157 foram capazes de reconhecer E. coli O157:H7 mesmo na presença de cápsula. Eles também auxiliaram o sistema complemento na lise dessas bactérias bem como inibiram a adesão das mesmas a células epiteliais humanas. Em suma, os resultados sugerem que o polissacarídeo O157 pode ser considerado um bom candidato a antígeno em formulações vacinais contra E. coli produtoras de toxina Shiga.

Expressão da proteína recombinante Sm29 em Escherichia coli e purificação a partir dos corpúsculos de inclusão

Schistosomiasis is a neglected chronic parasitic tropical disease caused by the trematode worm Schistosoma spp., common in developing countries. Pharmacological treatments are available, but they are not effective due to the global epidemiological situation. A preventive vaccine could effectively contribute to reduce the infection. Among a number of antigens, the tegumental protein Sm29 from adult worm Shistosoma mansoni has been identified as a promising vaccine candidate. The gene Sm29 was cloned with 393 nucleotides, excluding a signal peptide and the transmembrane domain, to express the protein with 130 amino acids, approximately 18 kDa, with theoretical pI 6.5. Our objectives is to obtain the recombinant Sm29 protein expressed in Escherichia coli without histidine tag. Therefore, we must optimize the Sm29 obtaining processe, upstream and downstream, in order to design the industrial process, improving the yield and quality of the product to be used in clinical trials. Cells of E. coli BL21(DE3)_pET28_Sm29 were cultivated in bioreactor for Sm29 expression and they were separated by centrifugation. The cells were resuspended in buffer and lysed in French Press. The inclusion bodies (IB) were recovered by centrifugation and we studied the clarification of IB by washing with different solutions and using different centrifugation forces. The solubilization of IB was tested with 8 M Urea under different pH conditions. After the treatments, the protein profiles were analyzed by SDS-PAGE, to verify the presence of the expected band of ~18 kDa and the removal of contaminants. The washing solutions and the lower centrigugation speed helped to clarify the material, without causing losses. The pH of the solubilization solutions interfere with protein recovery, determining to work above pH 7.5, to seek the best balance between protein recovery and contaminant elimination. To meet regulatory requirements in the industrial process for vaccine production, we aim to replace purification by metal affinity chromatography (IMAC), allowed by the presence of the his-tag, added to the antigen as a purification strategy. Thus, the purification of rSm29 by IMAC was compared with studies of ion exchange chromatography, evaluating the binding of denatured or renatured proteins to the resins. It was found that the initial IB clarification parameters and solubilization conditions interfere in the chromatography and dialysis stages. It was determined that. to date. the best condition of binding is the renatured protein to the anion exchange resin, Q-Sepharose. As we identified an alternative purification method, we cloned the Sm29 gene without the his tag code to express the protein in BL21(DE3). Furthermore, the Sm29 gene was optimized for E. coli codon usage. The optimized gene was also cloned for expression in BL21(DE3), to evaluate whether it would modify the protein synthesis in terms of amount of expression and solubility. The first tests suggest that the amount of protein expression is similar to that obtained with the original gene. Tests of solubilization by pressurization are planned to analyze whether possible structural modifications in rSm29 may improves protein recovery.

A esquistossomose é uma doença tropical parasitária crônica negligenciada, causada pelo verme trematódeo Schistosoma spp., comum em países em desenvolvimento. Os tratamentos farmacológicos disponíveis não são eficazes devido à situação epidemiológica global. Uma vacina preventiva poderia contribuir eficazmente para a reduzir a infecção. Entre uma série de antígenos, a proteína tegumentar Sm29 do verme adulto Shistosoma mansoni foi identificada como uma promissora candidata a vacina. O gene Sm29 foi clonado com 393 nucleotídeos, excluindo um peptídeo sinal e o domínio transmembrana, para expressar a proteína com 130 aminoácidos, aproximadamente 18 KDa, com pI teórico 6,5. Nosso objetivo é obter a proteína Sm29 recombinante expressa em Escherichia coli sem cauda de histidina. Para tanto, devemos otimizar os processos de fermentação dos clones e os processos de purificação, para então, desenhar o processo industrial para melhorar o rendimento e a qualidade do produto a ser utilizado em ensaios clínicos. Células do clone E. coli BL21(DE3)_pET28_Sm29 foram cultivadas em biorreator para expressão de rSm29, separadas por centrifugação, ressuspensas em tampão e lisadas em “French Press”. Os corpos de inclusão (CI) foram recuperados por centrifugação e estudamos a etapa de clarificação dos CI por lavagens com diferentes soluções e forças de centrifugação. Testamos a solubilização dos CI com Ureia 8 M sob diferentes condições de pH. Após os tratamentos, analisamos os perfis proteicos por SDS-PAGE, verificando a banda esperada de ~18 kDa e a remoção de contaminantes. As soluções utilizadas na lavagem e a menor velocidade de centrifugação clarificam o material, sem causar perdas da proteína de interesse. O pH da solução de solubilização interfere na recuperação da proteína, determinando trabalhar com pH acima de 7,5 para buscar o melhor equilíbrio entre recuperação proteica e eliminação de contaminantes. Para atender aos requisitos regulatórios de processo industrial na produção de vacinas, temos o objetivo de substituir a purificação por cromatografia de afinidade a metal (IMAC) para poder remover a cauda de histidina, adicionada ao antígeno como estratégia de purificação. Assim, comparamos a purificação da rSm29 por IMAC com estudos de purificação por trocas iônicas, avaliando a ligação da proteína desnaturada ou renaturada com as resinas. Verificamos que os parâmetros iniciais de clarificação da CI e as condições de solubilização interferem nas etapas de cromatografia e diálise. Determinamos que a melhor condição, até o momento, é a ligação da proteína renaturada à resina de troca aniônica, Q-Sepharose. Identificado um método alternativo de purificação, clonamos o gene Sm29 sem a cauda de histidina e expressamos a proteína em BL21(DE3). Além disso, o gene Sm29 foi otimizado para uso de códons de E. coli. Um gene otimizado foi clonado para expressão em BL21(DE3), para avaliarmos se modificaria a estrutura da proteína durante a síntese da cadeia primária, em termos de quantidade de expressão e solubilidade. Os primeiros testes sugerem que a expressão é semelhante à obtida com o gene original. Testes de solubilização por pressurização estão planejados para analisar se a possível modificação estrutural na rSm29 melhoraria a recuperação do antígeno.

Estudio comparativo entre un test de antígeno y la prueba de la reacción en cadena de la polimerasa en tiempo real (RT-PCR) para el diagnóstico de infección por COVID-19 en pediatría / Comparative study between an antigen test and the reverse transcription-polymerase chain reaction (RT-PCR) test for the diagnosis of COVID-19 in pediatrics

Introducción. La pandemia por COVID-19 ha puesto de manifiesto la necesidad de pruebas diagnósticas rápidas. La prueba de referencia es la reacción en cadena de la polimerasa en tiempo real (RT-PCR). Requiere un equipo y personal capacitado, y su resultado puede llevar un tiempo de espera prolongado. El sistema BD Veritor® es el método rápido cromatográfico utilizado para la detección del antígeno del coronavirus de tipo 2 del síndrome respiratorio agudo grave, en individuos sintomáticos. El objetivo primario del siguiente trabajo es evaluar sensibilidad y especificidad del test de antígeno (TA) comparadas con la RT-PCR en población pediátrica. Población y métodos. Estudio prospectivo, de prueba diagnóstica. Se incluyó a todo menor de 17 años en los primeros 5 días de inicio de síntomas, que consultó desde julio de 2021 hasta febrero de 2022. Se calculó un mínimo de 300 muestras para lograr una precisión de ± 8,76 % y de ± 3,68 % para sensibilidad y especificidad respectivamente. Se analizaron en paralelo las muestras por ambas metodologías. Resultados. De 316 muestras pareadas, 33 fueron positivas por ambos métodos; 6 fueron positivas solo por RT-PCR. La especificidad del TA fue del 100 %; la sensibilidad, del 84,6 %, con un valor predictivo positivo y negativo del 100 % y del 98 % respectivamente. Conclusiones. El TA demostró ser útil en el diagnóstico de pacientes pediátricos con COVID-19 en los primeros 5 días de inicio de síntomas, aunque aquellos con TA negativo y alta sospecha clínica deberían confirmar su resultado con la RT-PCR.

Introduction. The COVID-19 pandemic has brought to light the need for rapid diagnostic tests. The gold standard test is reverse transcription-polymerase chain reaction (RT-PCR). RT-PCR requires equipment and trained personnel, and results may take a long waiting time. The BD Veritor® System is a rapid chromatographic method used for the detection of severe acute respiratory syndrome coronavirus 2 antigen in symptomatic individuals. The primary objective of this study is to assess the sensitivity and specificity of the antigen test (AT) compared to the RT-PCR in the pediatric population. Population and methods. Prospective study with a diagnostic test. All children younger than 17 years in the first 5 days of symptom onset, who consulted between July 2021 and February 2022, were included. A minimum of 300 specimens was estimated to achieve an accuracy of ±8.76% and ±3.68% for sensitivity and specificity, respectively. Specimens were analyzed in parallel using both methodologies. Results. Of 316 paired samples, 33 were positive by both methods; 6 were positive only by RT-PCR. The specificity of the AT was 100%; sensitivity was 84.6%, with a positive and negative predictive value of 100% and 98%, respectively. Conclusions. The AT proved to be useful in the diagnosis of pediatric patients with COVID-19 in the first 5 days of symptom onset, although those with a negative AT and high clinical suspicion should confirm their result with a RT-PCR.

Factores pronósticos de metástasis ósea en pacientes con cáncer de próstata / Predictive factors for bone metastasis in patients with prostate cancer i: en

El adenocarcinoma de próstata es considerado una de las neoplasias más frecuentes en hombres mayores de 60 años, y su metástasis ósea constituye una de las complicaciones de peor pronóstico. Objetivo: Estimar los factores pronósticos de metástasis ósea en pacientes con cáncer de próstata. Métodos: Se realizó un estudio analítico de 73 pacientes con cáncer de próstata, asistidos en el Hospital Oncológico Conrado Benítez de Santiago de Cuba en el período 2018-2022. Entre las variables analizadas figuraron: edad, color de la piel, manifestaciones clínicas, tiempo de aparición de la metástasis ósea, grado de diferenciación celular, nivel de antígeno prostático específico y diagnóstico imagenológico. Resultados: En la serie predominó el grupo etario de 60-69 años (50,7 %) y el promedio de edad fue de 67 años; asimismo, prevalecieron los pacientes de piel negra, el dolor óseo como síntoma más frecuente y el diagnóstico imagenológico de metástasis ósea por tomografía axial computarizada (48,0 %). Se observó un aumento proporcional de los valores del antígeno prostático específico y de la puntuación de Gleason en relación con la aparición de metástasis. Conclusiones: Los factores pronósticos que permiten estimar la presencia de metástasis ósea en pacientes con cáncer de próstata son la edad avanzada, el color negro de la piel y los valores de antígeno prostático específico por encima de 20 ng/mL.

Prostate adenocarcinoma is considered one of the most frequent neoplasms in men over 60 years, and bone metastasis constitutes one of the complications with the worst prognosis. Objective: Estimate the predictive factors for bone metastasis in patients with prostate cancer. Methods: An analytic study of 73 patients with prostate cancer was carried out. They were assisted at Conrado Benítez Cancer Hospital in Santiago de Cuba during 2018-2022. The variables analyzed included: age, skin color, clinical manifestations, onset time of bone metastasis, degree of cellular differentiation, prostate-specific antigen level and imaging diagnosis. Results: In the series there was a prevalence of the 60-69 age group (50.7%) and the average age was 67 years; also, dark skinned patients, bone pain as more frequent symptom and imaging diagnosis of bone metastasis by computerized axial tomography prevailed (48.0%). A proportional increase of prostate-specific antigen values and Gleason punctuation was observed in relation to the metastasis onset. Conclusions: The predictive factors for estimating the presence of bone metastasis in patients with prostate cancer are the advanced age, black skin color and prostate-specific antigen values above 20 ng/mL.

Evaluation of bowel wall flow by color Doppler ultrasound in the assessment of inflammatory bowel disease activity in pediatric patients / Avaliação do fluxo parietal pela ultrassonografia com Doppler em cores no diagnóstico de atividade na doença inflamatória intestinal em pacientes pediátricos

Abstract Objective: To assess inflammatory bowel disease (IBD) activity with Doppler ultrasound in pediatric patients, comparing the accuracy of the ultrasound findings with that of the concentrations of fecal calprotectin (FC). Materials and Methods: In a consecutive series, we evaluated 53 examinations of 44 pediatric patients seen between 2014 and 2020: 28 with Crohn's disease, 15 with ulcerative colitis, and one with IBD unclassified. The diagnosis of IBD was made in accordance with the Porto criteria. The alteration studied in the greatest detail was bowel wall flow, which was classified by the lead investigator and two pediatric radiologists, all of whom were blinded to the FC concentrations and the other ultrasound findings. Bowel wall flow was categorized as low if there were up to 2 Doppler ultrasound signals/cm2, moderate if there were 3-5 signals/cm2, and high if there were more than 5 signals/cm2. Results: The agreement among the radiologists was substantial (kappa = 0.73). In cases in which ultrasound showed low bowel wall flow, the median FC concentration was 92 µg/g (interquartile range, 33-661 µg/g), whereas it was 2,286 µg/g (interquartile range, 1,728-5,612 µg/g) in those in which ultrasound showed high bowel wall flow. In the sample as a whole, the sensitivity and specificity of ultrasound was 89.7% and 92.0%, respectively, for the detection of inflammatory activity; 95.5% and 90.9%, respectively, for the detection of Crohn's disease; and 81.3% and 100.0%, respectively, for the detection of ulcerative colitis. Conclusion: Ultrasound of the bowel wall showed a strong correlation with FC concentrations in the assessment of inflammatory activity in pediatric patients with IBD.

Resumo Objetivo: Avaliar a atividade da doença inflamatória intestinal (DII) por ultrassonografia (US) com Doppler em cores, comparada à concentração de calprotectina fecal (CF) em pacientes pediátricos. Materiais e Métodos: Em uma série consecutiva, no período entre 2014 e 2020, foram avaliados 53 exames de 44 pacientes pediátricos: 28 casos de doença de Crohn, 15 de colite ulcerativa e um de colite indeterminada. O diagnóstico da DII foi feito pelos critérios de Porto. O fluxo parietal foi a alteração estudada mais detalhadamente e classificada pelo pesquisador principal e por dois radiologistas pediátricos cegados aos valores de CF e de US Doppler. Baixo fluxo parietal foi definido pela captação de até 2 sinais de US Doppler/cm2, fluxo moderado entre 3 e 5 sinais/cm2 e alto fluxo mais de 5 sinais/cm2. Resultados: Houve concordância substancial entre os radiologistas (kappa = 0,73). Nos exames com baixo fluxo parietal a CF média foi 92 μg/g (intervalo interquartil: 33-661 μg/g) e nos exames com alto fluxo a CF média foi 2.286 μg/g (intervalo interquartil: 1.728-5.612 μg/g). Na amostra total, a US demonstrou sensibilidade de 89,7% e especificidade de 92,0% para detecção da atividade inflamatória, 95,5% e 90,9% na doença de Crohn e 81,3% e 100,0% na colite ulcerativa, respectivamente. Conclusão: Houve forte correlação entre a US da parede intestinal e os valores da concentração de CF na avaliação da atividade inflamatória na DII de pacientes pediátricos.

Rol actual del antígeno carcinoembrionario (CEA) en el manejo del cáncer de colon

El antígeno carcinoembrionario (CEA) es un marcador tumoral ampliamente empleado en el manejo del cáncer colorrectal, especialmente en el seguimiento de los pacientes resecados con intención curativa. El objetivo de esta revisión es actualizar el rol del CEA en el manejo de los pacientes intervenidos por un cáncer de colon estadios I-III considerando la mejor evidencia disponible. Dada la sensibilidad modesta en el tumor primario (40%), la cual sube al 60-80% en los casos de recidiva, se propone la medición precoz del marcador (alrededor del mes) de las resecciones R0, toda vez que el valor debiera estar normalizado, especialmente si estaba elevado en el preoperatorio. Una elevación sostenida o un alza > de 10 ng/ml en el control precoz es indicativo de enfermedad residual y/o a distancia, lo que implica un rastreo clínico intensivo. Aunque el CEA preoperatorio tiene un valor pronóstico categórico, el CEA postoperatorio precoz elevado parece tener un valor pronóstico de recidiva superior. Un seguimiento intensivo parece razonable en los pacientes con factores de riesgo de recidiva, lo que incluye la medición del CEA en forma seriada. El umbral óptimo del CEA es motivo de controversia, con una tendencia a bajar el nivel de corte considerado normal (< 5 ng/ml) en los últimos años), lo que podría mejorar el balance entre sensibilidad y especificidad del test. Nuevas técnicas como el ADN circulante en combinación con el CEA se han propuesto para mejorar la oportunidad del diagnóstico de una recidiva, actualmente en evaluación.

Carcinoembryonic antigen (CEA) is a tumor marker widely used in the management of colorectal cancer, especially in the follow-up of patients resected with curative intent. The objective of this review is to update the role of CEA in the management of patients operated on for stage I-III colon cancer considering the best available evidence. Given the modest sensitivity in the primary tumor (40%), which rises to 60-80% in cases of recurrence, early measurement of the marker (around a month) of R0 resections is proposed, since the value should be normalized, especially if it was elevated preoperatively. A sustained elevation or a rise > 10 ng/mL at early check-up is indicative of residual and/or distant disease, which implies intensive clinical follow-up. Although preoperative CEA has a strong prognostic value, elevated early postoperative CEA seems to have a higher prognostic value for recurrence. Intensive follow-up seems reasonable in patients with risk factors for recurrence, which includes serial CEA measurement. The optimal CEA threshold is controversial, with a tendency to lower the cut-off level considered normal (< 5 ng/ml) in recent years), which could improve the balance between test sensitivity and specificity. New techniques such as circulating DNA in combination with CEA have been proposed to improve the chance of diagnosing a recurrence, currently under evaluation.

Etapa al diagnóstico de cáncer de próstata en un hospital institucional. Revisión y comparación de datos nacionales e internacionales

Introducción: El cáncer prostático (CaP) es una patología de alta prevalencia e incidencia mundial. El tamizaje ha perseguido el diagnóstico precoz de esta enfermedad para otorgar tratamientos oportunos. Nosotros buscamos caracterizar los pacientes de un hospital local respecto al diagnóstico y etapificación, y comparar estos resultados con datos previamente reportados. Material y Método: Análisis retrospectivo de pacientes diagnosticados con CaP en un hospital institucional. Se recolectaron variables clínicas al momento del diagnóstico, los métodos de etapificación, el estadío según TNM y grado histológico. Resultados: Se incluyeron 129 pacientes en el análisis. La mediana de APE (ng/mL) al diagnóstico fue de 7,29. El grado histológico fue clasificado como ISUP 1 en 37,5%. Se realizó una resonancia magnética multiparamétrica de próstata (RMmp) en el 42,19% de los pacientes, siendo clasificados como PIRADS 4 en mayor proporción (21,09%). La etapificación con PET-CT PSMA se utilizó principalmente en el grupo de alto riesgo y ante dudas frente a etapificación con medios convencionales. Se prefirió la Tomografía computada (TC) contrastada y la cintigrafía ósea en los otros grupos. 6,25% fue catalogado N1 y 9,37% M1. Conclusión: La etapa al diagnóstico de nuestra serie es algo mayor a lo reportado por países desarrollados, pero considerablemente menor a lo publicado por otros países de Latinoamérica e inclusive de otros hospitales de nuestro país. Pareciera ser de gran relevancia nacional contar con protocolos claros de tamizaje y acceso a APE con el fin de disminuir los casos diagnosticados en etapas avanzadas.

Introduction: Prostate cancer (PCa) is a disease with a high prevalence and incidence worldwide. Screening has pursued the early diagnosis of this disease to provide early treatment. We sought to characterize patients from a local hospital with respect to diagnosis and staging and to compare these results with previously reported data. Methods: We conducted a retrospective analysis of patients diagnosed with PCa at an institutional hospital. Clinical variables were collected at the time of diagnosis, staging methods, TNM stage, and histological grade. Results: 129 patients were included in the analysis. The median PSA (ng/mL) at diagnosis was 7.29. The histological grade was classified as ISUP 1 in 37.5%. An MRI was performed in 42.19% of the patients, being classified mostly as PIRADS 4 (21.09%). PET-CT PSMA staging was used mainly in the high-risk group, preferring contrast-enhanced CT and bone scintigraphy in the other groups. 6.25% were classified as N1 and 9.37% as M1. Conclusion: The stage at diagnosis in our series is somewhat higher than that reported by developed countries but considerably lower than that published by other Latin American countries and even from other hospitals in our country. It is of great national relevance to have clear protocols for screening and access to PSA to reduce the cases diagnosed in advanced stages.

Inmunolocalización de citoqueratina 14, 19 y Ki-67 en el epitelio de pacientes con agrandamiento gingival

R E S U M E N En pacientes con ortodoncia aparecen eventos patológicos no deseados como agrandamiento gingival inducido por tratamiento de ortodoncia (AGTO) o hipertrofia gingival. El objetivo del estudio es identificar la distribución inmunohistoquímica de citoqueratina CK-14, CK-19 y Ki-67 en epitelio gingival de pacientes con AGTO. Se seleccionaron I3 pacientes divididos en: grupo control (n=6), conformado por individuos periodontalmente sanos no portadores de aparatología ortodóntica y grupo test (n=7), integrado por pacientes con AGTO. Los marcadores CK-14, CK-19 y Ki-67 fueron identificados mediante inmunohistoquímica con anticuerpos monoclonales y observados en un microscopio óptico Leica DM 500. En los pacientes del grupo test el tejido epitelial se mostró hipertrófico con pérdida en la continuidad de la membrana basal. La CK-14 y CK-19 fue positiva en el epitelio de todos los sujetos evaluados, con una expresión positiva de alta intensidad en células de la lámina basal del grupo test. El promedio de células positivas para Ki-67 en el grupo test fue de 56%. En conclusión, la CK-14, CK-19 y Ki-67 son marcadores con elevada inmunoreactividad en tejido gingival de pacientes con AGTO portadores de ortodoncia.

During orthodontic treatment, unwanted pathological events such as gingival overgrowth induced by orthodontic treatment or gingival hypertrophy may appear The objective of this study is to identify immunohistochemical distribution of cytokeratin CK-14, CK-19 and Ki-67 in the gingival epithelium of patients with gingival overgrowth induced by orthodontic treatment. Thirteen patients were selected divided into: control group (n = 6), conformed of periodontally healthy individuals without orthodontic appliances and the test group (n = 7), conformed of patients with gingival overgrowth induced by orthodontic treatment. The biomarkers CK-14, CK-19 and Ki-67 were identified by immunohistochemistry with monoclonal antibodies and observed in a Leica DM 500 optical microscope. Hypertrophic epithelial tissue with loss of continuity of the basement membrane was found in the test group patients. CK-14 and CK-19 were positive in the epithelial tissue of all the subjects evaluated, with a high intensity positive expression in the cells of the basal lamina of the test group. The average number of cells positive for Ki-67 in test group was 56%. In conclusion, CK-14, CK-19 and Ki-67 are biomarkers with high immunoreactivity in the gingival tissue of patients with gingival overgrowth induced by orthodontic treatment.

Durante o tratamento ortodôntico, eventos patológicos indesejados como o crescimento gengival induzido pelo tratamento ortodôntico (CGTO) ou hipertrofia gengival podem aparecer: O objetivo deste estudo é identificar a distribuição imuno-histoquímica das citoqueratinas CK -14, CK-19 e Ki-67 no epitélio gengival de pacientes com CGTO. Foram selecionados 13 pacientes divididos em: grupo controle (n=6), conformado por indivíduos periodontalmente saudáveis sem aparelhos ortodônticos e o grupo teste (n=7), conformado por pacientes com CGTO. Os biomarcadores CK-14, CK-19 e Ki-67 foram identificados por imuno-histoquímica com anticorpos monoclonais e observados em microscópio óptico Leica DM 500. Tecido epitelial hipertrófico com perda de continuidade da membrana basal foi encontrado nos pacientes do grupo teste. CK-14 e CK-19 foram positivos no tecido epitelial de todos os sujeitos avaliados, com expressão positiva de alta intensidade nas células da lâmina basal do grupo teste. O número médio de células positivas para Ki-67 no grupo teste foi de 56%. Em conclusão, CK-14, CK-19 e Ki-67 são biomarcadores com alta imunorreatividade no tecido gengival de pacientes com CGTO.

Use of Schirmer strips and conjunctival swabs for virus detection on the ocular surface of adults: a scoping review / Fitas de Schirmer e swab conjunctival para detecção de vírus na superfície ocular de adultos: scoping review

ABSTRACT Schirmer strips and conjunctival swabs are used in ophthalmology for the collection of tears and fluids. One of the biggest challenges during the COVID-19 pandemic has been accurate diagnosis and, in some cases, ocular manifestations are among the first symptoms. In this context, this study aimed to collect evidence to support the use of Schirmer strips and conjunctival swabs as a method of sample collection for viral analysis. A literature search was conducted following the Scoping Review protocol defined by The Joanna Briggs Institute. Studies were analyzed regarding virus research, collection methods, and sample analysis. The findings support that viruses can be detected on the ocular surface through analysis of Schirmer strips and conjunctival swabs. However, additional studies with larger samples and time data are necessary to confirm these conclusions.

RESUMO A fita de Schirmer e o swab conjunctival são utilizados na oftalmologia como métodos de coleta para lágrimas e fluidos. Durante a pandemia da COVID-19, um dos desafios foi o diagnóstico correto e se sabe que, em alguns casos, as manifestações oculares podem ser um dos primeiros sintomas. Nesse contexto, este estudo tem como objetivo levantar evidência que destaque o uso de fitas de Schirmer e de swabs conjuntivais como método de coleta para análise viral. Conduziu-se uma revisão de literatura seguindo o protocolo para Scoping Review definido pelo Joanna Briggs Institute. Os pesquisadores analisaram os estudos em busca do vírus pesquisado, os métodos de coleta e os métodos de análise. Vírus podem ser detectados na superfície ocular através da análise de fitas de Schirmer e de swabs conjuntivais, entretanto novos estudos com populações maiores e com definições claras de tempo são necessários para conclusões mais assertivas no tema.

Rendimiento de la PET/TC con 11C-colina en el seguimiento del cáncer de próstata / Effectiveness of 11C-choline PET/CT in prostate cancer surveillance

Objetivo Analizar el rendimiento diagnóstico de la PET/TC con 11C-colina en el seguimiento del cáncer de próstata (CaP), especialmente en pacientes con antígeno prostático específico (PSA)>1ng/ml. Material y métodos Se evaluaron retrospectivamente 329 exploraciones PET/TC con 11C-colina de 191 pacientes (68,2±7,2 años) con CaP con recaída bioquímica o en seguimiento (PSA en el momento de la PET/TC: 13,0±84,2ng/ml). El tratamiento inicial fue prostatectomía radical en 81 pacientes y otros tratamientos (radioterapia, quimioterapia, hormonoterapia) en 110. La PET/TC se adquirió 20min después de la inyección de 555-740MBq de 11C-colina. El seguimiento mínimo fue superior a 12 meses. Resultados Doscientas diecinueve (66,6%) de las 329 exploraciones PET/TC fueron positivas. El porcentaje de positivos fue significativamente mayor en los pacientes con otro tratamiento inicial diferente a la prostatectomía radical (85,6 frente a 43,6%, respectivamente). Ciento treinta PET/TC (59,4%) mostraron recidiva local, 48 (21,9%) a distancia y 41 (18,7%) local más a distancia. El abordaje terapéutico inicial se modificó en 139 casos (63,5%). De las 81 PET/TC con 11C-colina realizadas con PSA<1ng/ml, 23 (28,4%) fueron positivas. El abordaje terapéutico inicial se modificó en 9 (11,1%). Tres de 63 pacientes (4,8%) fallecieron por CaP. Conclusiones La PET/TC con 11C-colina demostró su eficacia en el seguimiento y la reestadificación del CaP, incluso en pacientes con PSA sérico<1ng/ml. El rendimiento diagnóstico fue diferente según el tratamiento inicial al que fueron sometidos los pacientes, siendo mayor en aquellos tratados inicialmente con otros tratamientos distintos de la PR prostatectomía radical (AU)

Aim Our aim was to analyse the performance of 11C-choline PET/CT in prostate cancer (PCa) surveillance, especially in patients with prostate specific antigen (PSA)<1ng/ml. Material and methods Three hundred and twenty-nine 11C-choline PET/CT examinations from 191 patients (68.2±7.2 years) submitted for PCa surveillance or biochemical recurrence were retrospectively evaluated (PSA at study was 13.0±84.2ng/ml). Main initial treatment was radical prostatectomy in 81 patients, and other treatments (radiotherapy, chemotherapy, hormonotherapy) in 110. PET/CT was acquired 20min after injection of 555-740MBq of 11C-choline. Minimum follow-up was 12 months. Results Two hundred and nineteen (66.6%) out of the 329 PET/CT examinations were positive. The percentage of positive examinations was significantly higher in patients with other initial treatment than radical prostatectomy compared to patients with radical prostatectomy (85.6 vs. 43.6%, respectively). One hundred and thirty PET/CT (59.4%) showed local recurrence, 48 (21.9%) distant recurrence, and 41 (18.7%) local plus distant recurrence. Initial therapeutic approach was changed in 139 cases (63.5%). In the subgroup of 81 11C-choline PET/CT scans performed with PSA<1ng/ml, 23 (28.4%) showed a positive result. Initial therapeutic approach was changed in 9 (11.1%). Three (4.8%) out of 63 patients died as per PCa. Conclusions 11C-choline PET/CT demonstrated its effectiveness in PCa surveillance and restaging, even in patients with serum PSA<1ng/ml. The diagnostic performance was different depending on the initial treatment, been higher in patients with non-surgical treatment (AU)

Agrandamiento gingival asociado al tratamiento de ortodoncia: análisis histológico e inmunohistoquímico de dos casos clínicos

El agrandamiento gingival asociado al tratamiento de ortodoncia (AGTO) es el crecimiento no controlado de la encía. Aquí reportamos dos casos clínicos de pacientes masculinos sistèmicamente sanos con AGTO generalizado, con asociación a la biopelícula dental y sin esta. En ambos pacientes se identificó un tejido epitelial hiperplásico con abundantes células positivas para Ki-67 y tejido conectivo rico en fibras de colágeno distribuidas aleatoriamente. Futuros estudios serán útiles para dilucidar las diferencias fisiopatológicas del AGTO con relación con el biofilm dental y sin esta.

Orthodontic treatment-induce gingival overgrowth (OTGO) is uncontrolled growth of the gingiva. Here, we report two clinical cases of systemically healthy male patients with generalized GH undergoing orthodontic treatment, with and without association with dental biofilm. In both patients, hyperplastic epithelial tissue was identified with abundant Ki-67 positive cells and connective tissue rich in randomly distributed collagen fibers. Future studies will be useful to elucidate the pathophysiological differences of OTGO with and without relation to dental biofilm.

Evaluation of the EUROIMMUN Aspergillus antigen immunoenzyme assay in serum and bronchoalveolar lavage fluid samples.

INTRODUCTION: The most widely used marker for the diagnosis of invasive aspergillosis (IA) is the detection of galactomannan by ELISA. This study describes the evaluation of the results obtained by Euroimmun Aspergillus antigen ELISA (EIA-GM-E) in serum samples and bronchoalveolar lavage fluid (BAL) from patients at risk of IA, and compares these results with those obtained by Bio-Rad Galactomannan EIA (EIA-GM-BR). METHODS: Anonymous retrospective case-control comparative study in 64 serum samples and 28 BAL from 51 patients. RESULTS: Overall agreement of the results of the two assays was observed in 72 of 92 samples (78.3%). The sensitivity of EIA-GM-BR and EIA-GM-E in serum samples was 88.9% and 43.2%, respectively, and 100% and 88.9% for BAL. The specificity of EIA-GM-BR and EIA-GM-E in serum samples was 91.9% for both assays, and 68.4% and 84.2% in BAL. There were no statistically significant differences in the results of both assays. CONCLUSIONS: Both methods show good results for the discrimination of patients with IA when BAL is tested, or serum in case of EIA-GM-BR.

Evaluation of the EUROIMMUN Aspergillus antigen immunoenzyme assay in serum and bronchoalveolar lavage fluid samples / Evaluación del EUROIMMUN Aspergillus antigen immunoenzyme assay en muestras de suero y lavado broncoalveolar

Introduction: The most widely used marker for the diagnosis of invasive aspergillosis (IA) is the detection of galactomannan by ELISA. This study describes the evaluation of the results obtained by Euroimmun Aspergillus antigen ELISA (EIA-GM-E) in serum samples and bronchoalveolar lavage fluid (BAL) from patients at risk of IA, and compares these results with those obtained by Bio-Rad Galactomannan EIA (EIA-GM-BR). Methods: Anonymous retrospective case–control comparative study in 64 serum samples and 28 BAL from 51 patients. Results: Overall agreement of the results of the two assays was observed in 72 of 92 samples (78.3%). The sensitivity of EIA-GM-BR and EIA-GM-E in serum samples was 88.9% and 43.2%, respectively, and 100% and 88.9% for BAL. The specificity of EIA-GM-BR and EIA-GM-E in serum samples was 91.9% for both assays, and 68.4% and 84.2% in BAL. There were no statistically significant differences in the results of both assays. Conclusions: Both methods show good results for the discrimination of patients with IA when BAL is tested, or serum in case of EIA-GM-BR.(AU)

Introducción: El marcador más utilizado para el diagnóstico de aspergilosis invasora (AI) es la detección de galactomanano mediante la técnica de ELISA. Este estudio describe la evaluación de los resultados obtenidos por Euroimmun Aspergillus antigen ELISA (EIA-GM-E) en muestras de suero y lavado broncoalveolar (LBA) de pacientes con factores de riesgo de AI, y compara sus resultados con los obtenidos por Bio-Rad Galactomannan EIA (EIA-GM-BR). Métodos: Estudio comparativo caso-control retrospectivo anónimo en 64 muestras de suero y 28 de LBA de 51 pacientes. Resultados: Se observó una concordancia global de resultados de los dos ensayos en 72 de las 92 muestras (78,3%). Los valores de sensibilidad de EIA-GM-BR y EIA-GM-E en suero fueron 88,9% y 43,2%, respectivamente, y para LBA 100% y 88,9%. La especificidad en suero de EIA-GM-BR y EIA-GM-E fue del 91,9% en ambos ensayos y para LBA 68,4% y 84,2%. No se observaron diferencias estadísticamente significativas en los resultados de ambos ensayos. Conclusiones: Ambos métodos demuestran buenos resultados para la discriminación de pacientes con AI cuando se emplea como muestra el LBA, o el suero en caso de EIA-GM-BR.(AU)

The relationship between uric acid levels and graft function in renal transplant patients who discontinued steroid therapy / Relación entre niveles de ácido úrico y función del injerto en pacientes de trasplante renal que interrumpieron la terapia con esteroides

ABSTRACT Introduction: High uric acid levels are commonly encountered in kidney transplant recipients, and can be associated with allograft dysfunction. Our study aims to examine the relationship between UA levels and graft function in patients discontinuing steroids. Methods: In this single-center-retrospective study, 56 patients discontinued steroid therapy from among 678 RT patients transplanted from living donors between 1999-2020 were included. The mean age of the study group was 45.8±8.8 years. Causes of steroid discontinuation, creatinine levels concurrent with uric acid levels before and after steroid discontinuation (mean 3.9 ± 2.1 years), acute rejection numbers, demographics, durations of dialysis and transplantation, medications, laboratory data, human leukocyte antigen (HLA) mismatch numbers, blood-pressure (BP), body mass index, delayed acute rejection (DAR) numbers (3 months post-transplantation) were all recorded. Results: Creatinine and uric acid levels were seen to have increased after steroid discontinuation, there was a significant relationship between them (p<0.001). Statistically significant correlation was found between increased creatinine levels after steroid discontinuation and graft survival with higher HLA mismatch; 39 (69.6%) patients with mismatch ≥2, and 17 patients with mismatch <2 (30.4%) (p=0.049) . No significant relationship was found between DAR numbers before and after steroid discontinuation, and creatinine levels after steroid discontinuation. Conclusion: Per model obtained as a result of multivariate linear analysis, hyperuricemia and HLA mismatch numbers (p= 0.048 and p= 0.044, respectively) are independent predictive factors for graft dysfunction in patients discontinuing steroids. Accordingly, negative effects of modeling should be kept in mind for long-term graft survival in patients who plan to continue with steroid-sparing regimens.

RESUMEN Introducción: Con frecuencia se registran niveles elevados de ácido úrico en receptores de trasplantes renales que pueden estar asociados a disfunción de aloinjerto. El presente estudio tiene por objeto examinar la relación entre los niveles de AU y la función del injerto en pacientes que interrumpieron la terapia con esteroides. Métodos: En este estudio retrospectivo en un solo centro participaron 56 pacientes con interrupción de la terapia con esteroides de un total de 678 pacientes con TR receptores de trasplante de donantes vivos en el período 1999-2020. La edad promedio de la población de estudio fue de 45,8 ± 8,8 años. En el estudio se registraron causas de la interrupción de la terapia con esteroides, niveles de creatinina concurrentes con niveles de ácido úrico antes y después de la interrupción de la terapia con esteroides (promedio de 3,9 ± 2,1 años), números de rechazo agudo, datos demográficos, duraciones del período de diálisis y trasplante, medicación (uso de inmunosupresores, antihipertensivos), datos de laboratorio, números de desajuste del antígeno leucocitario humano (HLA), presión arterial (PA), índice de masa corporal, números de rechazo agudo retardado (DAR) (3 meses después del trasplante). Resultados: Se observó que los niveles de creatinina y ácido úrico aumentaron tras interrumpir la administración de esteroides, con una relación significativa entre ambos (p<0,001). Se identificó una correlación estadísticamente significativa entre el aumento en los niveles de creatinina tras la interrupción de la terapia de esteroides y la supervivencia del injerto con un mayor desajuste de HLA: 39 pacientes (el 69,6%) con desajuste ≥2 y 17 (el 30,4%) pacientes con desajuste <2 (p=0,049). No se encontró una relación significativa entre el número de DAR antes y después de la interrupción del tratamiento con esteroides, así como en los niveles de creatinina tras la interrupción de la terapia con esteroides. Conclusión: De acuerdo con el modelo obtenido como resultado del análisis lineal multivariable, la hiperuricemia y los números de desajuste de HLA (p=0,048 y p=0,044, respectivamente) constituyen factores predictivos independientes para la disfunción del injerto en pacientes que interrumpen la terapia con esteroides. En consecuencia, se deben tener en cuenta los efectos negativos del modelado para la supervivencia del injerto a largo plazo en pacientes que planean proseguir con regímenes con reducción de la administración esteroides.