Coxiella Burnetii Endocarditis In A Patient With Mycotic Cerebral Aneurysms.

Q fever is an ubiquitous zoonosis caused by Coxiella burnetii, an intracellular bacterium that can produce acute or chronic infections in humans. These forms are characterized by different evolution, serological profile and treatment that must be very long to achieve a cure in chronic forms. However, the serological profile for diagnosis and the real value of serology for predicting outcome are controversial, and management dilemmas for many patients with Q fever infection are continuously emerging. In this case report, we present a 20-year-old man from Nicaragua who worked as a farmer with a culture-negative infective endocarditis who presented with a mycotic aneurysm. The present report reviews the clinical presentation and diagnosis of Q fever IE.

Low-Cost, High-Frequency, Data Acquisition System for Condition Monitoring of Rotating Machinery through Vibration Analysis-Case Study.

Data acquisition is a crucial stage in the execution of condition monitoring (CM) of rotating machinery, by means of vibration analysis. However, the major challenge in the execution of this technique lies in the features of the recording equipment (accuracy, resolution, sampling frequency and number of channels) and the cost they represent. The present work proposes a low-cost data acquisition system, based on Raspberry-Pi, with a high sampling frequency capacity in the recording of up to three channels. To demonstrate the effectiveness of the proposed data acquisition system, a case study is presented in which the vibrations registered in a bearing are analyzed for four degrees of failure.

Benefits of Adding Gluteal Dry Needling to a Four-Week Physical Exercise Program in a Chronic Low Back Pain Population. A Randomized Clinical Trial.

OBJECTIVE: To determine if adding dry needling to a four-week exercise program has an additional benefit compared with adding sham dry needling to the same exercise program in subjects with chronic low back pain. DESIGN: Randomized clinical trial. SETTING: Physiotherapy and Pain Clinic of Alcala University. SUBJECTS: Forty-six patients with chronic low back pain. METHODS: Subjects were randomized to two groups: the dry needling group (N = 23) or sham dry needling group (N = 23). Both groups received a four-week exercise program and before the exercise started a session of dry needling or sham dry needling. Pain (visual analog scale), disability (Roland-Morris Questionnaire), and fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire) were assessed at baseline, after treatment, and at three-month follow-up. Pressure pain thresholds (algometer) were measured at baseline, after the dry needling or the sham dry needling, and after treatment. RESULTS: Both groups showed significant improvements for all variables. In the between-group comparison, the dry needling group improved significantly in pain at three-month follow-up and pressure pain thresholds at the end of treatment for all measures, and at three-month follow-up there was no improvement in gluteus medium. CONCLUSIONS: In chronic low back patients, adding dry needling to a four-week exercise program has an additional benefit in pain and sensitivity compared with adding sham dry needling to the same exercise program.

Application of the Barcelona Clinic Liver Cancer therapeutic strategy and impact on survival.

BACKGROUND: The Barcelona Clinic Liver Cancer (BCLC) classification of hepatocellular carcinoma (HCC) has proved useful in the management of HCC patients. However, BCLC-recommended first-line treatment is not always applicable in clinical practice. OBJECTIVE: We performed a multicentre retrospective analysis of reasons for deviation from first-line treatment in 2008-2012. METHODS: One to three-year survival data were analysed using Kaplan-Meier method. RESULTS: A total of 407 consecutive HCC patients (66.6 ± 3 years, 83% male) with cirrhosis were included. Tumours were detected during surveillance in 53% of patients, grouped as Child-Pugh A (67%), B (25%) and C (8%); and BCLC A (including stage 0, 44%), B (26%), C (15%) and D (15%). In 31% of patients, first-line treatment was not feasible (51% in early stages) due to: technical reasons (74%); patient non-conformity (20%); medical decision (3%); and disease progression (3%). One to three-year survival of patients not receiving the recommended first-line treatment was similar to that of patients treated according to BCLC recommendations (log-rank, p = 0.229). CONCLUSION: In real-life practice one-third of HCC patients could not receive first-line BCLC treatment. In our cohort of patients, similar short and medium-term survival was observed. Long-term prospective studies are required to determine the best alternative treatment option when BCLC first-line treatment is not feasible.

Celiac disease and HLA-DQ genotype: diagnosis of different genetic risk profiles related to the age in Badajoz, southwestern Spain.

BACKGROUND AND OBJECTIVES: celiac disease is associated with the HLA class II alleles: DQA1*05-DQB1*02 and DQB1*0302. The genetic risk for celiac disease may depend on the presence or absence of such alleles, their combination or number of copies. This study aimed to establish the differences in HLA genotypes between celiac patients diagnosed during childhood and adulthood, and between patients and healthy controls, and to determine the risk of disease in each genotypic category. METHODS: we classified 350 celiac patients at time of diagnosis and 218 controls into 14 categories according to their HLA genotype, based on the presence or absence of risk alleles. RESULTS: we found statistically significant differences between the genotype frequencies of celiac patients diagnosed as being children and adults. DQA1*05 (x 1 copy), DQB1*02 (x 1 copy), DQB1*0302 (x 0 copies) was the most frequent genotype in individuals diagnosed in childhood, whereas DQA1*05 (x 1 copy), DQB1*02 (x 2 copies), DQB1*0302 (x 0 copies) was the most frequent in adults. The risk for disease in each genotypic category in celiac children and adults turned out to be different. The presence of DQB1*0302 did not increase risk in children, but did in adults. CONCLUSION: in our celiac population, we found a different genetic pattern according to age of diagnosis. That could suggest that the pathogenic mechanism of the disease is not exactly the same in both age groups, which could somehow determine clinical presentation of the disease, its epidemiology, coexisting diseases, and complications.

Celiac disease and HLA-DQ genotype: diagnosis of different genetic risk profiles related to the age in Badajoz, southwestern Spain / Enfermedad celiaca y genotipo HLA-DQ: diagnóstico de diferentes perfiles de riesgo genético relacionados con la edad en Badajoz, suroeste de España

Background and objectives: celiac disease is associated with the HLA class II alleles: DQA1*05-DQB1*02 and DQB1*0302. The genetic risk for celiac disease may depend on the presence or absence of such alleles, their combination or number of copies. This study aimed to establish the differences in HLA genotypes between celiac patients diagnosed during childhood and adulthood, and between patients and healthy controls, and to determine the risk of disease in each genotypic category. Methods: we classified 350 celiac patients at time of diagnosis and 218 controls into 14 categories according to their HLA genotype, based on the presence or absence of risk alleles. Results: we found statistically significant differences between the genotype frequencies of celiac patients diagnosed as being children and adults. DQA1*05 (x 1 copy), DQB1*02 (x 1 copy), DQB1*0302 (x 0 copies) was the most frequent genotype in individuals diagnosed in childhood, whereas DQA1*05 (x 1 copy), DQB1*02 (x 2 copies), DQB1*0302 (x 0 copies) was the most frequent in adults. The risk for disease in each genotypic category in celiac children and adults turned out to be different. The presence of DQB1*0302 did not increase risk in children, but did in adults. Conclusion: in our celiac population, we found a different genetic pattern according to age of diagnosis. That could suggest that the pathogenic mechanism of the disease is not exactly the same in both age groups, which could somehow determine clinical presentation of the disease, its epidemiology, coexisting diseases, and complications (AU)

Utilidad del recuento e inmunofenotipaje de los linfocitos intraepiteliales de la mucosa intestinal en el diagnóstico de la enfermedad celiaca / Usefulness of intraepithelial lymphocytes immunophenotyping in intestinal mucosa for the diagnosis of coeliac disease

Introducción. Se han observado cambios característicos en las poblaciones de linfocitos intraepiteliales (LIE) de la mucosa intestinal en pacientes celiacos infantiles y adultos. Objetivos. Determinar el rango normal de las poblaciones de LIE por citometría de flujo y establecer su rentabilidad diagnóstica en la enfermedad celiaca (EC). Material y métodos. Estudio retrospectivo de 246 niños y 461 adultos con sospecha de EC a los que se había realizado estudio de poblaciones de LIE. El grupo de EC (221 niños y 98 adultos) lo forman individuos con serología celiaca positiva e histología con lesión grado Marsh 1 o mayor. El grupo control (25 niños y 363 adultos) lo constituyen individuos sin lesión intestinal y serología celiaca negativa a los que también se había realizado inmunofenotipo de LIE por citometría de flujo. Resultados. En el grupo de pacientes celiacos se observa un aumento significativo de LIE totales y LIE TCRγδ y un descenso significativo de LIE NK-like en comparación con los grupos control. En función de las curvas ROC, los puntos de corte en la población infantil fueron: %LIE > 14,2%, %LIE TCRγδ > 16,5% y %LIE NK-like < 10,1%. Los puntos de corte en la población adulta fueron: %LIE > 14,2%, %LIE TCRγδ > 16,1% y %LIE NK-like < 4,4%. En ambas poblaciones se obtienen una especificidad y VPP cercano o igual al 100%, con unos CP+ > 5 y CP− < 2 o próximos. Conclusiones. En el presente trabajo se han establecido los valores de corte para los tres parámetros analizados de los LIE. Estos parámetros permiten diagnosticar con una especificidad cercana al 100% la EC en el niño y en el adulto. Los valores de CP+ y CP− obtenidos muestran que estos parámetros son muy útiles en el diagnóstico de EC activa infantil y del adulto. Por lo tanto, el análisis de las poblaciones de LIE por medio de la citometría de flujo es una nueva herramienta diagnóstica de la EC que complementa el estudio anatomopatológico clásico aumentando su especificidad (AU)

Introduction: The intestinal mucosa of children and adult with coeliac disease shows characteristic changes in intraepithelial lymphocyte (IEL) populations. Objectives: Determination of the normal range of IEL populations by flow cytometry and its diagnostic usefulness in coeliac disease (CD). Methods: A retrospective study of 246 children and 461 adults with suspected CD with IEL immunophenotype results. The CD group (221 children and 98 adults) are individuals with positive coeliac serology and a histology lesion Marsh grade 1 or greater. The control group included 25 children and 363 adults without bowel lesion, negative serology and with IEL immunophenotype results. Results: The group of coeliac patients, adults and children, shows a significant increase in total IEL and TCRdeltagamma IEL, and a significant decrease in NK-like IEL compared with control groups. Based on ROC curves, the cut-off in coeliac children was: %IEL >14.2%, %TCRdeltagamma IEL>16.5% and %NK-like IEL<10.1%. The cut-off in the adult coeliac population was: %IEL >14.2%, %TCR IEL>16.1% and %NK-like IEL<4.4%. In both populations the specificity and PPV are close or equal to 100%, a CP+ >5 and a CP− <2 or near. Conclusions: The cut-off values of the LIE population analysed has been established in this study. The values of CP+ and CP− show that these parameters are very useful for the diagnosis of celiac disease in children and adults, with a specificity of approximately 100%. The immunophenotyping of LIE is a very useful technique in the diagnosis of CD, and complements the classical pathological study, thus increasing the specificity (AU)

Mucosal healing and steroid-sparing associated with infliximab for steroid-dependent ulcerative colitis.

BACKGROUND: Corticosteroid therapy for ulcerative colitis (UC) frequently results in Steroid-dependency. The objective of this study was to evaluate the long term clinical and endoscopic efficacy of infliximab (IFX) in steroid-dependent UC. METHODS: An open-label, prospective, single center study was designed. Patients older than 18 years with steroid-dependent UC, either intolerant or did not respond to azathioprine, were consecutively enrolled. Steroid-dependency was defined as the ECCO criteria. Patients received IFX (5 mg/kg) at 0, 2 and 6 weeks and every 8 weeks thereafter for 2 years. All patients were clinically evaluated at weeks 8, 52 and 104 and a colonoscopy was performed at week 104. Response to IFX was defined as clinical remission without steroids together with mucosal healing (endoscopic Mayo score of 0 or 1). RESULTS: Seventeen consecutive patients were included (11 male, mean age 45, range 25-70). Thirteen (76%) had extensive colitis (E3). All patients completed IFX therapy. Clinical response was in 13/17 at weeks 8 and 52. Twelve out of seventeen patients maintained clinical remission without steroids and endoscopic response at week 104. Six out of seventeen patients needed dose intensification of IFX (every 6 weeks); 3/6 patients did not reach remission despite dose intensification. Including those patients who needed dose intensification as non-responders, 9/17 patients were in clinical and endoscopic remission at week 104. A significant correlation was found between clinical and endoscopic findings (p<0.01). CONCLUSIONS: Infliximab therapy is effective for maintenance of clinical remission and mucosal healing in patients with steroid-dependent UC.

Cutaneous intralymphatic histiocytosis associated with rheumatoid arthritis: report of a case and review of the literature.

Various dermatoses have been described associated with rheumatoid arthritis. Recently, a specific cutaneous lesion termed "intravascular histiocytosis" has been proposed as a new entity among these dermatoses. We report the case of a 50-year-old woman with rheumatoid arthritis for about 10 years who developed erythematous patches on the extensor surface of lower extremities. Histopathologically, the lesions showed intraluminal proliferation of CD68-positive histiocytes in vessels lined with endothelial cells expressing D2-40, a selective marker for lymphatic endothelium.

Low grade mucoepidermoid carcinoma arising in cervical lymph nodes. A report of two cases with fine needle aspiration findings.

BACKGROUND: Heterotopic islands of salivary tissue are commonly found in the intraparotid lymph nodes and, less commonly, within extraparotid cervical nodes. Salivary gland tumors, both benign and malignant, can develop within this ectopic salivary tissue. CASES: Two patients presented with a solitary, painless mass in the cervical region. Fine needle aspiration cytology was performed, and the smears revealed a mixture of intermediate and mucus-secreting cells associated with extracellular mucin. The tumors were removed, and the diagnosis of mucoepidermoid carcinoma was confirmed by histologic study. CONCLUSION: The finding of a malignant cervical salivary gland tumor does not necessarily represent a metastasis from an occult site.

Sialadenitis with crystalloid formation. Fine needle aspiration cytodiagnosis of 15 cases.

OBJECTIVE: To assess the utility of fine needle aspiration cytology in the diagnosis of sialadenitis with crystalloid formation. STUDY DESIGN: In 15 cases, salivary gland masses were aspirated using a disposable, 20-mL syringe and 25-gauge needles, maintaining negative pressure. Smears routinely were air dried and stained by Diff-Quik (Dade Behring AG, Düdingen, Germany). Occasionally smears were fixed in alcohol and stained by the Papanicolaou method. RESULTS: The smears showed large numbers of non-birefringent crystalloids of varying sizes and shapes. The crystalloids stained deep blue with Diff-Quik and bright orange with Papanicolaou stain. Multinucleated histiocytes, neutrophilic leukocytes and benign salivary gland parenchyma were found, also. CONCLUSION: Fine needle aspiration cytology provides an accurate diagnosis of sialadenitis with crystalloids and is useful for avoiding unnecessary surgery.