Molecular mimicry among human proteinase 3 and bacterial antigens: implications for development of c-ANCA associated vasculitis.

Wegener's granulomatosis is an autoimmune disease where autoantibodies target human autoantigen PR3, a serine protease locates on the neutrophil membrane. This disease affects blood small vessels and could be deadly. The origin of these autoantibodies is unknown, but infections have been implicated with autoimmune disease. In this study, we explored potential molecular mimicry between human PR3 and homologous pathogens through in silico analysis. Thirteen serine proteases from human pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Salmonella sp., Streptococcus suis, Vibrio parahaemolyticus, Bacteroides fragilis, Enterobacter ludwigii, Vibrio alginolyticus, Staphylococcus haemolyticus, Enterobacter cloacae, Escherichia coli and Pseudomonas aeruginosa) shared structural homology and amino acid sequence identity with human PR3. Epitope prediction found an only conserved epitope IVGG, located between residues 59-74. However, multiple alignments showed conserved regions that could be involved in cross-reactivity between human and pathogens serine proteases (90-98, 101-108, 162-169, 267 and 262 residues positions). In conclusion, this is the first report providing in silico evidence about the existence of molecular mimicry between human and pathogens serine proteases, that could explain the origins of autoantibodies found in patients suffering from Wegener's granulomatosis.

Eventos adversos en recién nacidos hospitalizados en una Unidad de Cuidados Intermedios / Adverse events among newborns hospitalized in an Intermediate Care Unit / Eventos adversos em recém-nascidos hospitalizados em una Unidade de Cuidados Intermediários

Resumen Introducción: Los recién nacidos (RN) conforman uno de los grupos poblacionales más vulnerables. El riesgo de ocurrencia de un evento adverso durante su hospitalización se incrementa por diversos factores. Objetivo: Identificar los eventos adversos en recién nacidos hospitalizados en una unidad de cuidados intermedios en 2018. Metodología: Estudio de tipo descriptivo, diseño transversal y retrospectivo, realizado en la Unidad de Cuidados Intermedios Neonatales del Instituto Nacional Materno Perinatal durante el 2018. Se elaboró una ficha de recolección de datos que constó de nueve ítems correspondientes a procedimientos realizados por el personal de enfermería. Se utilizó un análisis univariado de los datos, presentados en tablas y gráficos. Resultados: Fueron analizados 73 eventos adversos, la menor edad gestacional fue de 32 semanas, con un máximo de 28 días de hospitalización. 60% de eventos se produjo en los RN más lábiles y con situación de salud compleja, de los cuales, 58% fueron infecciones asociadas a catéter percutáneo o periférico, cuyo germen frecuente fue Sthapylococcus coagulasa negativo. Solo 20.5% de eventos adversos fueron reportados. Discusión: Los resultados obtenidos coinciden con otras investigaciones en que los factores intrínsecos de los recién nacidos contribuyen en la aparición de eventos adversos; de igual manera concuerdan en la necesidad de prevenirlos y notificarlos. Conclusiones: La prematuridad, el tiempo de hospitalización en una unidad crítica y de exposición a diversos procedimientos, incrementaron el riesgo de ocurrencia de eventos adversos en recién nacidos. Detectar oportunamente estos acontecimientos es importante, así como fomentar la cultura de reporte, con el fin de evitarlos.

Abstract Introduction: Newborns are one of the most vulnerable populations, and their risk of suffering an adverse event during their hospital stay is influenced by diverse factors. Objective: To identify the adverse events among newborns hospitalized in an Intermediate Care Unit in 2018. Methodology: This is a descriptive, transversal, and retrospective study carried out in a Newborn Intermediate Care Unit of the Maternal and Perinatal National Institute during 2018. A data gathering chart with 9 items related to the corresponding nursing procedures was designed. A univariate data analysis was calculated, and the results were shown in tables and graphs. Results: 73 adverse events were analyzed. The lowest gestational age was 32 weeks, and the longest hospitalization was 28 days. 60% of these events were related to the more delicate and with the more complex situation newborns; and 58% of these were related to percutaneous or peripheral catheter infections and the most frequent pathogen was Coagulase-Negative Staphylococcus. Only 28.5% of the events were reported. Discussion: These findings are in line with the results of other research studies. Addressing the diverse factors which contribute to the adverse events in newborns in Intermediate Care Units is suggested. Conclusions: Being premature and the length of the hospital stay increase the risk of adverse events in newborns. It is critical to promote a culture of events reporting.

Resumo Introdução: Os recém-nascidos (RN) constituem um dos grupos populacionais mais vulneráveis. O risco de ocorrência de um evento adverso durante sua hospitalização é incrementado por diversos fatores. Objetivo: Identificar os eventos adversos em recém-nascidos hospitalizados em una unidade de cuidados intermediários em 2018. Metodologia: Estudo de tipo descritivo, desenho transversal e retrospectivo, realizado na Unidade de Cuidados Intermediários Neonatais do Instituto Nacional Materno Perinatal durante 2018. Foi elaborada uma ficha de coleta de dados que constou de nove itens correspondentes a procedimentos realizados pelo pessoal de enfermagem. Utilizou-se uma análise univariáda dos dados, apresentados em tabelas e gráficos. Resultados: Foram analisados 73 eventos adversos, a menor idade gestacional foi de 32 semanas, com máximo de 28 dias de internação. 60% dos eventos produziram-se nos RN mais lábeis e em situação de saúde complexa, dos quais, 58% foram infecções associadas a cateter percutâneo ou periférico, cujo germe frequente foi o Sthapylococcus coagulase negativo. Apenas 20.5% de eventos adversos foram relatados. Discussão: Os resultados obtidos coincidem com outras pesquisas em que os fatores intrínsecos dos recém-nascidos contribuem no aparecimento de eventos adversos; aliás, concordam com a necessidade de preveni-los e notificá-los. Conclusões: A prematuridade, o tempo de hospitalização em uma unidade crítica e de exposição a diversos procedimentos, incrementaram o risco de ocorrência de eventos adversos em recém-nascidos. É importante detectar estes acontecimentos oportunamente, assim como fomentar a cultura de notificação, a fim de evitá-los.

Criterios de clasificación de Esclerosis Sistémica, en una serie de casos de pacientes ecuatorianos / Classification criteria for Systemic Sclerosis, in a series of cases of Ecuadorian patients

RESUMEN La Esclerosis Sistémica (ES) es una enfermedad autoinmune crónica con la tasa más alta de mortalidad y morbilidad entre las enfermedades reumáticas, se caracteriza por daño vascular y fibrosis tanto cutáneo como de órganos internos. Se presenta una serie de cuatro casos clínicos de pacientes femeninos ecuatorianos afectos de dicha patología, en concomitancia con otros padecimientos autoinmunes diagnosticados y en seguimiento en el Hospital General Docente de Calderón de la ciudad de Quito.

ABSTRACT Systemic sclerosis (ES) is a chronic autoimmune disease with a higher rate of mortality and morbidity among rheumatic diseases, it is vascular damage and both skin fibrosis and internal internals. We present a series of four clinical cases of Ecuadorianfemale patients affected by the said pathology, in concomitance with other autoimmune diseases, diagnosis and follow-up in the General Teaching Hospital of Calderón in the city of Quito Ecuador.

An alternative method for mucosal flap closure during peroral endoscopic myotomy using an over-the-scope clipping device.

Maintaining the integrity of the mucosal flap and the reliable closure of mucosal entry during peroral endoscopic myotomy (POEM) is paramount in preventing leakage of esophageal contents into the mediastinal space. We describe our experience with POEM, the problems encountered with closure of mucosal flaps, and successful closure with over-the-scope clips (OTSC). Two patients with achalasia underwent successful endoscopic myotomy during POEM. During both procedures, the proximal end of the longitudinal mucosal incision was noted to be gaping and completion of the closure with standard clips was unsuccessful. The sides of the flap were approximated using a Twin Grasper followed by placement of OTSC. Closure of the mucosal entry appeared to be complete at the end of the procedures. Esophagram the following day revealed no leaks in either patient. There were no other complications and patients were discharged home after 1 - 2 days of hospital observation. Patients reported complete resolution of achalasia symptoms during follow-up. We propose closure of mucosal incisions during POEM using one to two OTSC as an alternative to described techniques. The use of OTSC may simplify the procedure and result in a more durable (i. e. full-thickness) closure.

Improved outcome after intestinal transplantation at a single institution over 12 years.

PURPOSE: To evaluate the outcomes of patients undergoing intestinal transplantation (IT). METHODS: Retrospective review was undertaken using existing medical records and database. RESULTS: Between November 1991 and May 2003, 114 patients were referred for consideration for IT, of which 33 patients received 37 intestinal allografts. All patients had intestinal failure and all patients had significant complications from total parenteral nutrition (TPN). TPN was the predominant cause of liver failure (63%). Combined liver intestinal grafts were used in the majority of patients. Overall 1- and 3-year patient survival is 77% and 52% with patients transplanted since 1999 having a 1- and 3-year survival of 94% and 73%, respectively. The most common cause of death was sepsis. No graft or patient was lost to cytomegalovirus or Epstein-Barr virus disease. Twenty-seven percent of allografts were lost to rejection. Long-term TPN independence is 82% for grafts more than 30 days after IT. Statistical analysis revealed several important factors impacting outcome. CONCLUSIONS: Successful IT defined as prolonged patient and graft survival and TPN independence can be readily achieved in select patients with IF and complications related to TPN therapy. Outcomes have improved with experience gained and control of viral infections and rejection.

Induction therapy with interleukin-2 receptor antagonist after intestinal transplantation is associated with reduced acute cellular rejection and improved renal function.

PURPOSE: To determine the effectiveness of induction immunotherapy with interleukin-2 receptor antagonists (IL2RA) after intestinal transplantation (IT). METHODS: A single-center, retrospective study was undertaken of all patients undergoing IT using existing medical records and database. Immunotherapy was either triple (standard maintenance triple therapy [SMTT]) or IL2RA [induction IL2RA plus SMTTx] or OKT3 [induction antilymphocyte preparations plus SMTTx]). Data was collected for the first 175 postoperative days. Outcomes included pretransplant renal function, posttransplant serum creatinine normalized to age (nl-sCR), rejection (ACR), and survival. Standard statistical analysis was undertaken. RESULTS: There were no significant differences in the groups: triple (n = 10, median age 3.5 years, cGFR 106 +/- 44 mL/min), IL2RA (n = 13, median age 3.2 years, cGFR 101 +/- 61 mL/min), OKT3 (n = 4, median age 7.7 years, cGFR 104 +/- 27 mL/min). nl-sCR was significantly (P <.01) lower in IL2RA at most postoperative weeks. IL2RA had significantly fewer rejection and infectious episodes than the other two groups. Three-year patient survival was 92% in IL2RA versus 50% triple and OKT3. CONCLUSIONS: IL2RA immunotherapy after IT is associated with a lower incidence of renal dysfunction as compared with historical controls. Furthermore, IL2RA therapy resulted in a lower incidence of rejection and improved survival. IL2RA should be considered in select patients undergoing IT.

Seroepidemiology of toxoplasmosis in amerindians from western Venezuela.

A survey of 447 Amerindians aged 1-69 years (mean age, 18.6 +/- 15.8 years) in 3 mountain and 1 lowland communities from Venezuela were studied to determine the seroprevalence of Toxoplasma gondii, the environmental risk factors for the infection, and how the process of acculturation may affect the transmission rate. Serum samples were tested for immunoglobulin G antibodies by a commercial indirect hemagglutination test. The overall prevalence of infection was 49.7% (222 of 447) and ranged 38.2-62.4%. A higher antibody rate was found in the lowland setting as compared with those from the mountain area (P < 0.001). The geometric mean titer in the overall population was 280.3. No age-antibody association was detected in the mountain communities, although a gradual increase in positivity with increasing age (P < 0.01) was observed in the lowland setting, reaching a peak of 83.3% in the oldest group. The results suggest that transmission by infective cat feces may play a predominant role in the spread of infection in this population. This study demonstrates the environmental Toxoplasma infection pressure in this sylvatic population and how transmission rate is facilitated by environmental changes produced by acculturation.

Intestinal parasitic infections, with a special emphasis on cryptosporidiosis, in Amerindians from western Venezuela.

The prevalences of intestinal parasites and intensities of helminth infections were studied in two Amerindian villages in Venezuela. Single stool specimens were collected from 303 individuals from Saimadoyi and 130 from Campo Rosario. Wet mounts, iron-hematoxylin-stained smears, and formalin-ether concentrates were examined for the presence of parasites; modified Ziehl-Neelsen carbol-fuchsin staining of 10% formalin-preserved stool was used to identify Cryptosporidium parvum. Helminth ova counts were made using the standard smear egg count technique. Mixed infections (Campo Rosario = 69.9%, Saimadoyi = 71.6%) were frequent. Overall infection rates with one or more species (Campo Rosario = 79.2%, Saimadoyi = 95.4%; P < 0.01) and with any protozoans (Campo Rosario = 60.8%, Saimadoyi = 72.3%; P < 0.05) were high and predominant (P < 0.05) in Saimadoyi. Cryptosporidiosis was identified in 38 subjects (8.8%) in both villages; 60.6% were asymptomatic carriers. The mean egg counts of helminths were heavier in Campo Rosario (P < 0.05), which was probably due to the drastic reduction of their lands along with their low standard of living. This study documents the change of intestinal parasitism pattern and deterioration of the health of Amerindians by the process of acculturation.

"Troo, the Traumaroo" bicycle and playground safety program: a pilot study of kindergarten through second graders in the southwest.

"Troo, the Traumaroo" bicycle and playground safety education program created for kindergarten, first, and second grade students, was provided to a convenience sample of seven elementary schools in a Southwestern city. Favorable principal, classroom teacher, and school nurse evaluations indicated that the "Troo, the Traumaroo" program was successful in providing young children with bicycle and playground safety in a fun and entertaining way. Results of this pilot study indicated that kindergarten children pre-tested for bicycle safety knowledge prior to participating in the program, had significantly higher bicycle safety knowledge scores 30 days after participating in the program (p < .0001).

Cariocarcinoma postparto normal: un caso clínico / Choriocarcinoma after normal delivery: a clinical case

El término neoplasia trofoblástica gestacional contempla al coriocarcinoma y a otros tumores del trofoblasto. La incidencia de coriocarcinoma en Latioamérica y Europa es de 0,2 casos por 10.000 embarazos. Esta grave patología puede ser precedida por diversos cuadros obstétricos. La principal sintomatología es la hemorragia transvaginal, espontánea o asociada a procedimientos invasivos. Se asocia a un aumento significativo de la hormona gonadotrófica coriónica. El diagnóstico se confirma con la histología. La quimioterapia es la principal herramienta terapéutica. A propósito de un caso clínico, se analizan las características y tratamiento del coriocarcinoma

Cryptosporidium parvum in children with diarrhea in Zulia State, Venezuela.

The prevalence and importance of Cryptosporidium parvum as a causal agent of acute diarrhea among pediatric patients from Zulia State, Venezuela was assessed. Single stool specimens were collected from 310 children 0-60 months of age with acute diarrheal disease who were admitted to three public hospitals and from 150 comparable control children without gastrointestinal symptoms who were seen as outpatients. Cryptosporidium parvum oocysts were identified in 35 (11.2%) of 310 children with diarrhea and the coccidium was the single detectable pathogen in only 12 (34.2%). Other potential pathogenic parasites were present in most of the patients shedding oocysts (23 of 35, 65%). In nondiarrheal control children, oocysts were identified in nine (6%) of 150. The data suggest that C. parvum is relatively highly endemic in children 0-60 months of age in Zulia State and that although C. parvum may be an important pathogen associated with diarrhea, it may be a cause of only a small proportion of diarrheal episodes.

Detection and identification of avian mycoplasmas by polymerase chain reaction and restriction fragment length polymorphism assay.

The polymerase chain reaction (PCR) with primers complementary to the 16S rRNA genes was used to detect avian mycoplasmas. A primer pair designed for the detection of human and rodent mycoplasmal species was examined for its ability to detect the most important avian mycoplasmas. After testing the respective reference strains, we found that Mycoplasma iowae, Mycoplasma meleagridis and Mycoplasma synoviae could be detected by PCR with this primer pair, and distinction could be made among them by restriction fragment length polymorphism (RFLP) assay with two restriction enzymes (BamHI and RsaI). For the detection of Mycoplasma gallisepticum by PCR, we needed species-specific primers. The results of the PCR- and RFLP, based identification procedures of 17 different field isolates agreed with those obtained by conventional methods.

Plantas Medicinales en la práctica estomatológica

El ejercicio de la práctica es tan antiguo como el fénero humano. El instinto natural del hombre hizo que aprovecgase los productos del medio inmediato principalmente las hierbas, raices y después los medicamentos de origen animal y mineral. Desde la decada del 60, se observa en todo el mundo un renacimiento del interés y la utilización de las plantas medicinales. En Cuba el uso de fitofarmacos como una fuente adicional de medicamentos ha adquirido un lugar en la terapéutica estomatológica. En este trabajo presentamos una panorámica sobre las plantas que se muestran más promisorias con este fin.