Donor-Derived ALECT2 Amyloidosis and Recurrent Fibrillary Glomerulonephritis in a Transplant Allograft.

The occurrence of renal amyloidosis and fibrillary glomerulonephritis in the same biopsy specimen is exceptional and poses a diagnostic challenge. We describe the case of a non-Hispanic White patient with end-stage kidney disease due to fibrillary glomerulonephritis who received a second living donor kidney from a Hispanic individual. A 40-month-posttransplantation biopsy performed for an elevated serum creatinine level revealed interstitial congophilic deposits and glomerular noncongophilic fibrillary deposits, in addition to rejection. Separate laser microdissections of the glomerular and interstitial deposits followed by liquid chromatography-tandem mass spectrometry (LC MS/MS) revealed DNAJB9 peptide spectra in glomeruli and a peptide profile consistent with leukocyte chemotactic factor 2 (ALECT2) amyloidosis in the interstitium. Based on these findings, a 2-week-posttransplantation biopsy was re-reviewed and analyzed using LC MS/MS, which revealed a peptide profile consistent with ALECT2 amyloidosis in the interstitium, without peptide spectra for ALECT2 or DNAJB9 in glomeruli. The findings were consistent with donor-derived ALECT2 amyloidosis and recurrent fibrillary glomerulonephritis. At 49 months posttransplantation, allograft function was stable with minimal proteinuria. Thus, LC MS/MS was crucial to establish the accurate diagnosis of these 2 nephropathies characterized by fibrillary deposits. The indolent posttransplantation course suggests that donated kidneys with focal interstitial ALECT2 deposits may be suitable for transplantation but the deposits persist for many years.

Influenza as a Cause of SIADH Related Hyponatremia: A Case Report.

Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) is one of the most common causes of hyponatremia in hospitalized patients. The distinct aetiologies and co-morbidities associated with hyponatremia pose substantial challenges in identifying and managing this disorder. Several infectious causes of SIADH are reported but hyponatremia associated with SIADH and influenza virus infection is less commonly seen. We present a case of hyponatremia associated with influenza, which was subsequently diagnosed as SIADH.

Socioeconomic factors and vulnerability to outbreaks of leptospirosis in Nicaragua.

Leptospirosis is an epidemic-prone zoonotic disease that occurs worldwide, with more than 500,000 human cases reported annually. It is influenced by environmental and socioeconomic factors that affect the occurrence of outbreaks and the incidence of the disease. Critical areas and potential drivers for leptospirosis outbreaks have been identified in Nicaragua, where several conditions converge and create an appropriate scenario for the development of leptospirosis. The objectives of this study were to explore possible socioeconomic variables related to leptospirosis critical areas and to construct and validate a vulnerability index based on municipal socioeconomic indicators. Municipalities with lower socioeconomic status (greater unsatisfied basic needs for quality of the household and for sanitary services, and higher extreme poverty and illiteracy rates) were identified with the highest leptospirosis rates. The municipalities with highest local vulnerability index should be the priority for intervention. A distinction between risk given by environmental factors and vulnerability to risk given by socioeconomic conditions was shown as important, which also applies to the "causes of outbreaks" and "causes of cases".

Molecular epidemiology of Plasmodium vivax in Latin America: polymorphism and evolutionary relationships of the circumsporozoite gene.

BACKGROUND: The origins and dispersal of Plasmodium vivax to its current worldwide distribution remains controversial. Although progress on P. vivax genetics and genomics has been achieved worldwide, information concerning New World parasites remains fragmented and largely incomplete. More information on the genetic diversity in Latin America (LA) is needed to better explain current patterns of parasite dispersion and evolution. METHODS: Plasmodium vivax circumsporozoite protein gene polymorphism was investigated using polymerase chain reaction amplification and restriction fragment length polymorphism (PCR-RFLP), and Sanger sequencing in isolates from the Pacific Ocean coast of Mexico, Nicaragua, and Peru. In conjunction with worldwide sequences retrieved from the Genbank, mismatch distribution analysis of central repeat region (CRR), frequency estimation of unique repeat types and phylogenetic analysis of the 3' terminal region, were performed to obtain an integrative view of the genetic relationships between regional and worldwide isolates. RESULTS: Four RFLP subtypes, vk210a, b, c and d were identified in Southern Mexico and three subtypes vk210a, e and f in Nicaragua. The nucleotide sequences showed that Mexican vk210a and all Nicaraguan isolates were similar to other American parasites. In contrast, vk210b, c and d were less frequent, had a domain ANKKAEDA in their carboxyl end and clustered with Asian isolates. All vk247 isolates from Mexico and Peru had identical RFLP pattern. Their nucleotide sequences showed two copies of GGQAAGGNAANKKAGDAGA at the carboxyl end. Differences in mismatch distribution parameters of the CRR separate vk247 from most vk210 isolates. While vk247 isolates display a homogeneous pattern with no geographical clustering, vk210 isolates display a heterogeneous geographically clustered pattern which clearly separates LA from non-American isolates, except vk210b, c and d from Southern Mexico. CONCLUSIONS: The presence of vk210a in Mexico and vk210e, f and g in Nicaragua are consistent with other previously reported LA isolates and reflect their circulation throughout the continent. The vk210b, c and d are novel genotypes in LA. Their genetic relationships and low variability within these vk210 and/or within the vk247 parasites in Southern Mexico suggest its recent introduction and/or recent expansion to this region. The global analysis of P. vivax csp suggests this parasite introduction to the region and likely LA by different independent events.

Guía de autoformación asistida postgrado: especialidad en seguridad alimentaria y desarrollo humano / It guides of attended self-teaching graduate-level: specialty in food security and human development

Esta guía se constituye en una herramienta didactica, con la cual podras facilitar el trabajo de lectura comprensiva, analisis y estudio de los textos y documentos, ello permitira que el proceso de enseñanza, se desarrolle de un modo mas agil, sobre la base de un aprendizaje ya trabajado y elaborado.(au)

Fototerapia continua y concentración plasmática de calcio en neonatos ictéricos / Continuos phototherapy and calcium im plasma in jaundice newborns

Se estudiaron 25 recién nacidos, 14 con ictericia, que recibieron tratamiento con fototerapia continua (grupo A). El grupo tomado como control comprendió 21 recién nacidos sanos (grupo B). Todos los recién nacidos incluidos en el estudio fueron de término y eutróficos. En los dos grupos se estudió la concentración de calcio, proteína y albúmina plasmática. El promedio de horas de luminoterapia en el grupo "A" fue de 71.3 h, el valor promedio de calcio sérico de 8.6 mg/dL, la albúmina de 3.8 g/dL y las proteínas de 6.8 g/dL; en el grupo "B" el valor promedio de calcio sérico fue 8.8 mg/dL, la albúmina de 3.9 g/dL y las proteínas de 6.8 g/dL. No se observaron diferencias estadísticamente significativas en la concentración de calcio en relación a las horas de exposición a la fototerapia. Los autores concluyen que fototerapia continua es un método seguro para el tratamiento de la ictericia en los recién nacidos de término eutróficos; la fototerapia no modifica las cifras de calcio sérico

Enfermedad de Niemann Pick: informe de un caso / Niemann Pick disease: report of a case

Se presenta un caso de enfermedad de Niemann-Pick en un paciente de trece meses de edad con retraso psicomotor severo y hepatoesplenomegalia acentuada. Se le practicaron diversos estudios, incluyendo aspiración de médula ósea y biopsia de un ganglio linfático periférico, las que mostraron alteraciones histopatológicas y ultraestructurales diagnósticas de esta enfermedad. Este artículo hace énfasis en el diagnóstico diferencial en casos de hepatoesplenomegalia de causa no determinada; se revisan también algunos aspectos fisiopatológicos, clínicos y de pronóstico de la enfermedad