Cerebrolysin improves peripheral inflammatory pain: Sex differences in two models of acute and chronic mechanical hypersensitivity.

Chronic inflammatory pain is a major health problem worldwide with high prevalence in women. Cerebrolysin is a multimodal neuropeptide preparation that crosses the blood brain barrier and displays neuroprotective properties in aging and disease. Previously, we showed that cerebrolysin reduced mechanical allodynia in a model of persistent inflammation and pain. We aim to build upon the findings of our previous study by investigating the response to acute administration of cerebrolysin in two models of peripheral inflammation and assessing sex differences. We utilized the complete Freund's adjuvant (CFA) that produces maximal oedema and mechanical allodynia within days and carrageenan that produces similar effects within hours. Cerebrolysin reversed the mechanical allodynia in both sexes in CFA-treated rats. On the other hand, in rats treated with carrageenan, cerebrolysin was only effective in reducing mechanical allodynia in female rats. In conclusion, the present study shows that cerebrolysin effects may be sex-specific depending on different mechanisms that are at play in these two models of peripheral inflammatory pain. Further investigations are required to determine the factors contributing to sex differences.

Molecular Characterization of Carbapenem-Resistant Acinetobacter baumannii in the Intensive Care Unit of Uruguay's University Hospital Identifies the First rmtC Gene in the Species.

Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are an increasing concern in intensive care units (ICUs) worldwide. The combination of carbapenemases and 16S rRNA-methyltransferases (16S-RMTases) further reduces the therapeutic options. OXA-carbapenemase/A. baumannii clone tandems in Latin America have already been described; however, no information exists in this region regarding the occurrence of 16S-RMTases in this microorganism. In addition, the epidemiology of A. baumannii in ICUs and its associated resistance profiles are poorly understood. Our objectives were as follows: to study the clonal relationship and antibiotic resistance profiles of clinical and digestive colonizing A. baumannii isolates in an ICU, to characterize the circulating carbapenemases, and to detect 16S-RMTases. Patients admitted between August 2010 and July 2011 with a clinically predicted hospital stay > 48 hr were included. Pharyngeal and rectal swabs were obtained during the first fortnight after hospitalization. Resistance profiles were determined with MicroScan® and VITEK2 system. Carbapenemases and 16S-RMTases were identified by PCR and sequencing, and clonality was assessed by pulsed-field gel electrophoresis and multilocus sequence typing. Sixty-nine patients were studied and 63 were diagnosed with bacterial infections. Among these, 29 were CRAB isolates; 49 A. baumannii were isolated as digestive colonizers. These 78 isolates were clustered in 7 pulsetypes, mostly belonging to ST79. The only carbapenemase genes detected were blaOXA-51 (n = 78), blaOXA-23 (n = 62), and blaOXA-58 (n = 3). Interestingly, two clinical isolates harbored the rmtC 16S-RMTase gene. To the best of our knowledge, this is the first description of the presence of rmtC in A. baumannii.

Validación de la punción aspiración con aguja fina (PAAF) en el diagnóstico de linfadenitis tuberculosa en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) / Assessment of fine needle puncture-aspiration assessment (PAAF) for the diagnosis of Tuberculous lymphadenitis in patients with human immunedeficiency virus (HIV)

Objetivo: el objetivo del estudio fue validar la PAAF en el diagnóstico de linfadenitis tuberculosa (TB) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH), utilizando como gold standard el cultivo de Mycobacterium tuberculosis en biopsia ganglionar o la histopatología más la respuesta al tratamiento específico. Material y método: estudio clínico-patológico prospectivo. Se incluyeron pacientes VIH infectados, previo consentimiento informado, mayores a 18 años, con adenomegalias superficiales mayores a 2 cm, asistidos en la Cátedra de Enfermedades Infecciosas entre octubre de 2004 y diciembre de 2006. Se realizó PAAF y biopsia del mismo ganglio. En las muestras citológicas e histopatológicas se realizaron tinciones habituales, Ziehl-Neelsen y cultivos para micobacterias. Se definió como citología sugestiva de linfadenitis TB: 1) linfadenitis reactiva con necrosis; 2) linfadenitis reactiva con células epitelioides y/o macrófagos y/o células gigantes multinucleadas; con o sin bacilos cido-alcohol resistentes en el directo con tinción de Ziehl-Neelsen. De 30 pacientes incluidos, 23 correspondieron a una TB ganglionar. En los 7 pacientes restantes la PAAF descartó el diagnóstico de TB en 6, evitando tratamientos innecesarios, e indicando estudio histológico para diagnóstico definitivo. La sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la PAAF para el diagnóstico de linfadenitis TB fue de 95%, 86%, 95% y 86%. El coeficiente de concordancia de Kappa entre ambos procedimientos fue de 90%. Conclusiones: la PAAF de ganglio linfático en pacientes VIH tiene un elevado rendimiento como técnica diagnóstica de TB ganglionar. A su vez permite seleccionar qué pacientes requieren biopsia ganglionar para diagnóstico definitivo, evitando la realización sistemática de la misma en todos los pacientes con adenomegalias.(AU)

Objective: the objective of the study was to validate PAAF for the diagnosis of tuberculous lymphadenitis in patients with HIV, by using culture for Mycobacodeterium tuberculosis in node biopsy or histopathology as ôgoldstandardö, together to the response to the specific treatment. Method: prospective clinical-pathological study. Patients included in our study: were infected with HIV, provided their informed consent, were older than 18 years of age, had superficial adenomagaly larger than 2 cm, and were seen at the Infectious Diseases Service from October 2004 through December 2006. Fine needle puncture aspiration (PAAF ) and biopsy of the same node were performed. Usual stain and Ziehl-Neelsen stain were use din cytological and histopatological samples, and microbacteria cultures were made. We defined the following citology suggested TB lymphadenitis:1) reactive lymphadenitis with necrosis; 2) reactive lymphadenitis with epithelial cells and/or macrophagos and/or multinuclear giant cells; with or without acid-alcohol resistant bacilli in the direct (sample?) with Ziehl-Neelsen stain. Results: out of 30 patients included in the study, 23 corresponded to node TB. In the remaining seven patients, diagnosis was negative in six of them, according to PAAF, and thus unnecessary treatment was avoided, and histological study was determined for final diagnosis. Sensitivity, specificity, positive and negative predictive value of PAAF for the diagnosis of TB lymphadenitis was 95%, 86%, 95% and 86% respectively. Kappa concordance coefficient between both procedures was 90%. Conclusions: lymph node PAAF in patients with HIV is a high performance diagnostic technique for the diagnosisof node TB. Likewise, it enables selecting patients to undergo node biopsy for final diagnose, avoiding its systematic conduction in all patients with adenomegaly.(AU)

Objetivo: o objetivo deste trabalho foi validar a PAAF no diagnóstico de linfadenite tuberculosa (TB) em pacientes infectados pelo vírus da imunodeficiência humana (VIH), utilizando como ôgold standardö o cultivo de Mycobacterium tuberculosis em biopsia ganglionar ou a histopatologia com resposta ao tratamento específico. Material e método: estudo clínico-patológico prospectivo. Foram incluídos pacientes portadores de VIH, com consentimento informado prévio, maiores de 18 anos, com adenomegalias superficiais maiores que 2 cm, atendidos na Cátedra de Doenças Infecciosas entre outubro de 2004 e dezembro de 2006. Em cada gânglio foi realizada PAAF e biopsia. Nas amostras citológicas e histopatológicas foram realizadas as colorações habituais, Ziehl-Neelsen e cultivos para micobacterias. Foi definida como citologia sugestiva de linfadenite TB: 1) linfadenite reativa com necrose; 2) linfadenite reativa com células epitelioides e/ou macrófagos e/ou células gigantes multinucleadas; com ou sem bacilos ácido-álcool resistentes no exame direto com coloração de Ziehl-Neelsen. Resultados: dos 30 pacientes incluídos, 23 apresentaram TB ganglionar. Nos sete pacientes restantes a PAAF descartou o diagnóstico de TB em seis, evitando tratamentos desnecessários, e indicando exame histológico para diagnóstico definitivo. A sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo da PAAF para o diagnóstico de linfadenite TB foram respectivamente 95%, 86%, 95% e 86%. O coeficiente de concordância de Kappa entre ambos procedimentos foi de 90%. Conclusães: a PAAF de gânglio linfático em pacientes VIH tem alto rendimento como técnica diagnóstica de TB ganglionar. Permite também selecionar os pacientes que necessitam biopsia ganglionar para diagnóstico definitivo, evitando sua realização sistemática em todos os pacientes com adenomegalias.(AU)

Validación de la punción aspiración con aguja fina (PAAF) en el diagnóstico de linfadenitis tuberculosa en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) / Assessment of fine needle puncture-aspiration assessment (PAAF) for the diagnosis of Tuberculous lymphadenitis in patients with human immunedeficiency virus (HIV)

Objetivo: el objetivo del estudio fue validar la PAAF en el diagnóstico de linfadenitis tuberculosa (TB) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH), utilizando como "gold standard" el cultivo de Mycobacterium tuberculosis en biopsia ganglionar o la histopatolog¡a más la respuesta al tratamiento espec¡fico. Material y método: estudio clínico-patológico prospectivo. Se incluyeron pacientes VIH infectados, previo consentimiento informado, mayores a 18 años, con adenomegalias superficiales mayores a 2 cm, asistidos en la Cátedra de Enfermedades Infecciosas entre octubre de 2004 y diciembre de 2006. Se realizó PAAF y biopsia del mismo ganglio. En las muestras citológicas e histopatológicas se realizaron tinciones habituales, Ziehl-Neelsen y cultivos para micobacterias. Se definió como citolog¡a sugestiva de linfadenitis TB: 1) linfadenitis reactiva con necrosis; 2) linfadenitis reactiva con células epitelioides y/o macrófagos y/o células gigantes multinucleadas; con o sin bacilos cido-alcohol resistentes en el directo con tinción de Ziehl-Neelsen. De 30 pacientes incluidos, 23 correspondieron a una TB ganglionar. En los 7 pacientes restantes la PAAF descartó el diagnóstico de TB en 6, evitando tratamientos innecesarios, e indicando estudio histológico para diagnóstico definitivo. La sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la PAAF para el diagnóstico de linfadenitis TB fue de 95%, 86%, 95% y 86%. El coeficiente de concordancia de Kappa entre ambos procedimientos fue de 90%. Conclusiones: la PAAF de ganglio linfático en pacientes VIH tiene un elevado rendimiento como técnica diagnóstica de TB ganglionar. A su vez permite seleccionar qué pacientes requieren biopsia ganglionar para diagnóstico definitivo, evitando la realización sistemática de la misma en todos los pacientes con adenomegalias.

Objective: the objective of the study was to validate PAAF for the diagnosis of tuberculous lymphadenitis in patients with HIV, by using culture for Mycobacodeterium tuberculosis in node biopsy or histopathology as “goldstandard”, together to the response to the specific treatment. Method: prospective clinical-pathological study. Patients included in our study: were infected with HIV, provided their informed consent, were older than 18 years of age, had superficial adenomagaly larger than 2 cm, and were seen at the Infectious Diseases Service from October 2004 through December 2006. Fine needle puncture aspiration (PAAF ) and biopsy of the same node were performed. Usual stain and Ziehl-Neelsen stain were use din cytological and histopatological samples, and microbacteria cultures were made. We defined the following citology suggested TB lymphadenitis:1) reactive lymphadenitis with necrosis; 2) reactive lymphadenitis with epithelial cells and/or macrophagos and/or multinuclear giant cells; with or without acid-alcohol resistant bacilli in the direct (sample?) with Ziehl-Neelsen stain. Results: out of 30 patients included in the study, 23 corresponded to node TB. In the remaining seven patients, diagnosis was negative in six of them, according to PAAF, and thus unnecessary treatment was avoided, and histological study was determined for final diagnosis. Sensitivity, specificity, positive and negative predictive value of PAAF for the diagnosis of TB lymphadenitis was 95%, 86%, 95% and 86% respectively. Kappa concordance coefficient between both procedures was 90%. Conclusions: lymph node PAAF in patients with HIV is a high performance diagnostic technique for the diagnosisof node TB. Likewise, it enables selecting patients to undergo node biopsy for final diagnose, avoiding its systematic conduction in all patients with adenomegaly.

Objetivo: o objetivo deste trabalho foi validar a PAAF no diagnóstico de linfadenite tuberculosa (TB) em pacientes infectados pelo v¡rus da imunodeficiência humana (VIH), utilizando como “gold standard” o cultivo de Mycobacterium tuberculosis em biopsia ganglionar ou a histopatologia com resposta ao tratamento espec¡fico. Material e método: estudo clínico-patológico prospectivo. Foram inclu¡dos pacientes portadores de VIH, com consentimento informado prévio, maiores de 18 anos, com adenomegalias superficiais maiores que 2 cm, atendidos na Cátedra de Doenças Infecciosas entre outubro de 2004 e dezembro de 2006. Em cada gânglio foi realizada PAAF e biopsia. Nas amostras citológicas e histopatológicas foram realizadas as colorações habituais, Ziehl-Neelsen e cultivos para micobacterias. Foi definida como citologia sugestiva de linfadenite TB: 1) linfadenite reativa com necrose; 2) linfadenite reativa com células epitelioides e/ou macrófagos e/ou células gigantes multinucleadas; com ou sem bacilos  cido- lcool resistentes no exame direto com coloração de Ziehl-Neelsen. Resultados: dos 30 pacientes inclu¡dos, 23 apresentaram TB ganglionar. Nos sete pacientes restantes a PAAF descartou o diagnóstico de TB em seis, evitando tratamentos desnecessários, e indicando exame histológico para diagnóstico definitivo. A sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo da PAAF para o diagnóstico de linfadenite TB foram respectivamente 95%, 86%, 95% e 86%. O coeficiente de concordância de Kappa entre ambos procedimentos foi de 90%. Conclusães: a PAAF de gânglio linfático em pacientes VIH tem alto rendimento como técnica diagnóstica de TB ganglionar. Permite também selecionar os pacientes que necessitam biopsia ganglionar para diagnóstico definitivo, evitando sua realização sistemática em todos os pacientes com adenomegalias.