Blastocystis spp: revisión literaria de un parásito intestinal altamente prevalente / Safety conditions at work related to exposure to mechanical hazards in a logistics company - Bogotá 2013

Introducción: Blastocystis spp., se ha identificado como un patógeno emergente causante de diarrea en hombre y en animales. Objetivo: Realizar una revisión sobre las principales características de este parásito y su rol patogénico. Metodología: Se realizó una revisión bibliográfica sobre ciclo de vida, subtipos, epidemiología, y sus posibles factores de virulencia Estas revisiones fueron extraídas de bases de datos como PUBMED, SCIENCE DIRECT, SCIELO, EBSCO y HINARI. Resultados: Blastocystis spp., es de interés por su alta prevalencia en diferentes grupos poblacionales, constante en los estudios epidemiológicos de las parasitosis humanas. Se ha evidenciado en pacientes asintomáticos y en otros con síntomas gastrointestinales, lo que depende del subtipo presente en el portador, sin embargo, esta divergencia se presta para problemas de interpretación. Conclusiones: A pesar de los estudios epidemiológicos, terapéuticos e inmunológicos que se han realizado aún no se tiene claro su ciclo de vida completo, factores de virulencia y patogenicidad.

Introduction: Blastocystis spp., has been identified as an emerging pathogen causing diarrhea in humans and animals. Objective: To conduct a review of the main features of this parasite and its pathogenic role. Methodology: A literature review on the major characteristics of Blastocystis spp., life cycle, subtypes, epidemiology and potential virulence factors was performed Reviews and research articles were extracted from databases such as PUBMED, SCIENCE DIRECT, SCIELO, HINARI and EBSCO. Results: Blastocystis spp. is of interest because of its high prevalence in different population groups, being constant in epidemiological studies of human parasitosis. It has been shown in asymptomatic patients with gastrointestinal symptoms in others, depending on the subtype present in the carrier. However, this difference is due to problems of interpretation. Conclusions: Although epidemiological, therapeutic and immunological studies have been conducted yet, it is not clear its entire life cycle, virulence factors and pathogenicity.

Gross anatomical study of the nerve supply of genitourinary structures in female mongrel hound dogs.

Anatomical variations in lumbosacral plexus or nerves to genitourinary structures in dogs are under described, despite their importance during surgery and potential contributions to neuromuscular syndromes. Gross dissection of 16 female mongrel hound dogs showed frequent variations in lumbosacral plexus classification, sympathetic ganglia, ventral rami input to nerves innervating genitourinary structures and pudendal nerve (PdN) branching. Lumbosacral plexus classification types were mixed, rather than pure, in 13 (82%) of dogs. The genitofemoral nerve (GFN) originated from ventral ramus of L4 in 67% of nerves, differing from the expected L3. Considerable variability was seen in ventral rami origins of pelvic (PN) and Pd nerves, with new findings of L7 contributions to PN, joining S1 and S2 input (23% of sides in 11 dogs) or S1-S3 input (5%), and to PdN, joining S1-S2, unilaterally, in one dog. L7 input was confirmed using retrograde dye tracing methods. The PN also received CG1 contributions, bilaterally, in one dog. The PdN branched unusually in two dogs. Lumbosacral sympathetic ganglia had variant intra-, inter- and multisegmental connectivity in 6 (38%). Thus, the anatomy of mongrel dogs had higher variability than previously described for purebred dogs. Knowledge of this variant innervation during surgery could aid in the preservation of nerves and reduce risk of urinary and sexual dysfunctions.

Resveratrol and endometrium: a closer look at an active ingredient of red wine using in vivo and in vitro models.

Resveratrol is a natural phytoestrogen with antiproliferative properties present in red wine, grapes, and berries. Published reports on the effects of resveratrol in human endometrial function are limited. The objective of this study was to investigate the expression of estrogen receptor α (ESR1), Ki-67 (a proliferative marker), aryl hydrocarbon receptor (AhR), and members of the cytochrome P450 superfamily of enzymes (CYP1A1 and CYP1B1) in an in vitro and vivo assay. Alkaline phosphatase assay of estrogenicity was used to compare estrogen activity of different concentrations of resveratrol to estradiol (E2) and diethylstilbestrol (DES), using Ishikawa cell culture. Immunohistochemical expression of ESR1 and Ki67, and reverse transcriptase polymerase chain reaction of AhR, CYP1A1, and CYP1B1 were analyzed from xenograft implants of human endometrial tissue in ovariectomized immunodeficient RAG-2-γ(c) mice, after 30 days of treatment with subcutaneous pellets of E2, E2 plus progesterone (P4), or E2 plus resveratrol (6, 30, or 60 mg) for 30 days. Compared to E2, resveratrol acted as an agonist and antagonist of estrogen in low and high concentrations, respectively, when combined with E2. Xenografts of human endometrial tissues in RAG-2 mice exhibited reduced expression of ESR1 and proliferative activity (Ki67) with 60 mg of resveratrol. This study suggests that resveratrol, at high doses, has the potential benefit to reduce proliferation of human endometrium through ESR1.

Expression of MUC1 and MUC2 and carbohydrate antigen Tn change during malignant transformation of biliary papillomatosis.

AIM: Biliary papillomatosis is characterized by papillary proliferations of biliary lining cells without invasion or metastasis. The neoplastic character and biological behaviour of this disease remain still speculative. These issues were examined in this study. METHODS AND RESULTS: Mucin core protein MUC1, MUC2, MUC3, MUC5AC and carbohydrate antigens (T, Tn and sialosyl Tn) were immunohistochemically examined, using 11 lesions of biliary papillomatosis from seven patients, and five lesions of biliary papillomatosis with foci of carcinoma from four patients. Five cases of papillary intrahepatic cholangiocarcinoma and 12 histologically normal livers were used as a control. Patients with biliary papillomatosis alone or with carcinoma were middle-aged or elderly (five men and six women). Microscopically, biliary papillomatosis showed a villous, papillo-tubular, papillary, or papillo-villous pattern with a thin fibrovascular core. Cytologically, they were classifiable into biliary epithelial or pyloric gland-like type. The former was frequent in the cases associated with carcinoma. Expression of MUC1, Tn antigen and sialosyl Tn antigen was frequent and marked in biliary papillomatosis alone and with carcinoma and also intrahepatic papillary carcinoma. In addition, marked expression of MUC1 and Tn antigen were rather frequent in biliary papillomatosis with carcinoma and intrahepatic biliary papillary carcinoma compared with biliary papillomatosis. MUC2 was rather frequent and marked in biliary papillomatosis alone compared to other two disease groups. Focal expression of MUC5AC and MUC2 was rather frequent and infrequent irrespective of disease group, respectively. Focal expression of T antigen was frequent in papillary ICC. CONCLUSION: Biliary papillomatosis could undergo overt malignant transformation along with altered phenotypic expression of MUC proteins and mucin carbohydrate antigens.

Ultrasound detection of ventricular fibrillation disguised as asystole.

Ultrasonography in the emergency department is being used for many purposes, including the evaluation of patients with cardiac arrest. Ultrasound testing has been shown to be useful in such patients in determining the presence of true electromechanical dissociation and pericardial effusions. We report a case of ventricular fibrillation identified by ultrasonography that appeared as asystole on ECG monitoring. Recognition of this ultrasound application can aid in the prompt diagnosis of occult ventricular fibrillation and allow for proper treatment with defibrillation.

Retinoblastoma protein and proliferating-cell nuclear antigen expression as predictors of recurrence in well-differentiated papillary thyroid carcinoma.

PURPOSE: We analyzed retinoblastoma protein (pRB) and proliferating-cell nuclear antigen (PCNA) expression in primary tumors and recurrent lesions of well-differentiated papillary thyroid carcinoma (PTC) to clarify the relationship between their expression and recurrent disease. PATIENTS AND METHODS: The study included 93 patients with PTC. No recurrent disease had developed in 60 patients within 10 years after surgery (group N). Thirty patients in whom recurrent disease had developed after surgery were enrolled in group R. Levels of pRB and PCNA expression were quantified using the CAS 200 system (Cell Analysis Systems, Elmhurst, IL) following immunohistochemical staining. RESULTS: Mean pRB expression level in the primary tumors in group R was significantly lower than that in group N (P < .0001). pRB expression in the tumors with a diameter up to 20 mm was significantly lower than that in tumors larger than 20 mm in group R (P < .01). There were no significant differences in the levels of expression of PCNA in the primary tumors between group N and group R. Univariate analysis demonstrated that the disease-free survival was significantly correlated with pN category, pRB, and PCNA expression level. The subgroup with high-level expression of pRB (> 25%) showed significantly long disease-free survival (P < .001). Furthermore, the subgroup with low-level expression of PCNA (< 35%) showed significantly longer disease-free survival (P < .05). Multivariate analysis showed pRB expression and pN category to be independent prognostic factors for disease-free survival in PTC. CONCLUSION: pRB expression level can be used as a reliable predictor for recurrence of PTC.

[Transplacental alloimmunization against specific platelet antigens: prevalence and features in a Chilean population]. / Aloinmunización transplacentaria por antígenos plaquetarios específicos: prevalencia y características en una población chilena.

BACKGROUND: Neonatal alloimmune thrombocytopenia (NAIT) is a result of fetomaternal incompatibility. Platelet destruction is caused by a maternal antibody directed against a fetal platelet antigen inherited from the father and lacking on the mother's platelets. The incidence and features of transplacental alloimmunization depend on the frequency of expression of platelet specific antigens; which are highly variable among different populations. AIM: To determine the prevalence and characteristics of transplacental alloimmunization in a large group of pregnant women in Chile. MATERIAL AND METHODS: We studied 3,041 samples obtained during the third trimester of gestation. In all samples, anti platelet antibodies were screened by ELISA with platelet membranes fixed to a microtiter plate. Positive samples were further studied for antigenic specificity with the monoclonal antibody specific immobilization of platelet antigens (MAIPA) test. RESULTS: Anti platelet antibodies were found in 261 samples (8.5%). The MAIPA test identified 6 samples with antibodies directed against major platelet membrane glycoproteins, 2 anti GPIb, 2 anti GPIIb/IIIa and 2 anti GPIa/IIa. In four cases, anti HLA antibodies coexisted. Two cases corresponded to well defined platelet antigen systems: one anti HPA-1a and one anti HPA-5b. No clinical evidence of thrombocytopenia of the newborn was detected in all these cases with anti GP antibodies. CONCLUSIONS: A prevalence of platelet specific antibodies of 0.2% with only one anti HPA-1a was detected. These findings are in contrast with those of other populations but in accordance with the low frequency of the HPA-1 b/b phenotype in the Chilean population. The very low incidence of platelet specific antibodies and the lack of association with clinical thrombocytopenia in the newborn, do not support the recommendation of routine antenatal screening to all women in Chile.

[Platelet alloimmunization in patients with oncologic blood disorders treated with multiple transfusions: prospective study in adults and children]. / Aloinmunización plaquetaria en pacientes onco-hematológicos politransfundidos: estudio prospectivo en adultos y niños.

BACKGROUND: Refractoriness continues to be a major complication of platelet transfusion therapy in patients with multiple transfusions. Despite most cases are secondary to non-immune causes, the most serious is that associated to alloimmunization. The incidence and consequences of HLA and non-HLA (platelet specific) antibodies are unknown in our country. AIM: To prospectively determine the frequency and characteristics of post transfusion alloimmunization and the incidence of platelet specific antibodies. PATIENTS AND METHODS: Forty one adults and 24 children with a recently diagnosed malignancy and undergoing chemotherapy that required multiple transfusions were studied. Screening for antiplatelet antibodies (platelet membrane ELISA) was performed before the first transfusion, every four weeks or whenever the 1 hour corrected count increment for platelet transfusions was lower than 5000. Platelet specific antibodies were identified with a monoclonal antibody-specific immobilization of platelet antigens (MAIPA), with anti-GPIb, GPIIb/IIIa, GPIa/Iia and anti-HLA class I. RESULTS: Adult patients received an average of 10.2 +/- 5.5 units of red blood cells and 58.6 +/- 35.4 units of platelets. Children received 4.8 +/- 3.7 units of red blood cells and 9.6 +/- 6.7 units of platelets. HLA antibodies appeared in 7 of 41 adult patients (17%), platelet specific alloantibodies were found in two patients (one anti GP Ia/IIa and one anti GP Ib). Platelet refractoriness appeared in three alloimmunized patients. No child had detectable serum antibodies during follow up. CONCLUSIONS: Platelet transfusion refractoriness of immune origin occurs infrequently in our population and the presence of platelet antibodies does not mean that it will appear. The use of leukocyte depleted blood components to prevent refractoriness cannot be justified at this time.

Distal tibial triplane fractures: long-term follow-up.

The cases of 35 patients in whom a triplane fracture had been treated at the Ramón y Cajal Hospital were reviewed. The diagnosis of biplane and triplane fracture can now be made by standard radiograph. However, plain radiographs alone did not accurately demonstrate the configuration of the fracture, and computed tomography must be performed. Closed reduction should be attempted first. Failure to obtain or maintain (or both) an adequate closed reduction is an indication for operative treatment. Prognosis is surprisingly good. Only when adequate reduction (< 2 mm displacement) has not been achieved can degenerative changes be seen at long-term follow-up (> 5 years).

The management of limb-length discrepancies in children after treatment of osteosarcoma and Ewing's sarcoma.

The authors present 15 cases of discrepancy of the lower limbs > 5 cm, in children in whom the histological diagnosis was Ewing's sarcoma or osteosarcoma, who were treated using polychemotherapy or radiotherapy or both in some cases and limb-salvage surgery. Ten of these patients required compensation for discrepancy by limb lengthening. In three patients, a second lengthening had to be carried out. A shortening of the contralateral femur was performed in two cases, and in another two, a femur-tibia epiphysiodesis was done. The average lengthening achieved was 8.1 cm with a healing index of 41 days/cm. Leg-length discrepancy in the treatment of sarcomas of the musculoskeletal system is an important sequela, especially when treating children. Compensation for this can be obtained by lengthening healthy bone, with a complication rate similar to that of other etiologies. The difference compensated depends on the biological capacity of bone regeneration of the individual and, therefore, is a definitive solution.

Intramedullary nailing of the femur in children. Effects on its proximal end.

We have studied the medium- and long-term effects of femoral intramedullary nailing in 34 children. There was a high incidence of abnormality at the proximal end of the femur, including coxa valga, arrest of growth of the greater trochanter and thinning of the neck of the femur, because of damage to the trochanterocervical growth plate. These disorders affected 30% of the patients, mostly under the age of 13 years (p < 0.05), and were seen more frequently when the nail had been introduced through the piriform fossa. Other factors, such as the side, gender, aetiology, proximal or retrograde insertion, the size of nail and removal of the implant did not influence the result. We recommend that in patients under the age of 13 years other methods of management should be used to avoid damage to the growth plate.

Dysplasia epiphysealis hemimelica.

A new case of dysplasia epiphysealis hemimelica is reported. It is the third case reported in Spain and presents involvement of almost all the epiphyses of the left side of the body. The involvement of the left hip following surgery is hard to explain. The patient also presents lengthening of the left lower limb. Following a review of the world literature, it seems that this case demonstrates the greatest epiphyseal involvement to date.

Housing: rural roots to urban problems.

PIP: An analysis of housing and urban underdevelopment in Colombia shows the connection between urban problems and the countryside. In the 20th century, industrialization slowed down the modernization of agriculture and placed it in a secondary position. Small farmers were forced to migrate to the city in search of work. The cities could not absorb the large supply of unskilled labor. The low wage situation was exacerbated by industry's adoption of capital-intensive, labor saving techniques that limited job opportunities. High rents and costly land prices produce progressive crowding and a housing shortage. The construction industry further aggravates the problem. With the modern technology came monopolistic prices that are beyond the means of most low wage earners. Limited capital and credit are available. The Integral Project for the Urban Development of the Eastern Sector of Bogota had to be abandoned because of the serious consequences it would have in uprooting thousands of low income families. New development and transportation projects are being implemented just when workers need housing. It is estimated that the housing shortage affects as much as 75% of the economically active population in the main cities of Colombia, and 66% in Bogota.^ieng