Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study.

BACKGROUND: Although the Republic of Angola is one of the 14 countries figuring in the three high tuberculosis (TB) burden country lists, the true multidrug-resistant TB (MDR-TB) situation is unknown. MATERIAL AND METHODS: Patients aged 16 years with a diagnosis of pulmonary TB were prospectively enrolled from June 2014 to July 2015. Sputum samples were collected for culture and drug susceptibility testing in all patients, and for Xpert® MTB/RIF testing in all previously treated patients and in new patients whose sputum remained smear-positive after 2 months of treatment. RESULTS: A total of 422 patients were included; Mycobacterium tuberculosis was isolated in 308 sputum samples. The prevalence of MDR-TB was 8.0% (18/225) in new patients and 71.1% (59/83) in previously treated patients. Male sex (OR 2.95, 95%CI 1.35-6.44, P = 0.007), previous anti-tuberculosis treatment (OR 20.86, 95%CI 9.53-45.67, P < 0.001), presence of pleural thickening (OR 7.68, 95%CI 1.57-37.43, P = 0.012) and duration of illness >4 months (OR 3.34, 95%CI 1.45-7.69, P = 0.005) were independent risk factors for MDR-TB. CONCLUSIONS: The prevalence of MDR-TB in Cubal, Angola, was higher than estimated by the World Health Organization for Angola and one of the highest worldwide. Facilities to diagnose and treat MDR-TB are urgently needed in Angola.

Regulation of human glioma cell migration, tumor growth, and stemness gene expression using a Lck targeted inhibitor.

Migration of human glioma cells (hGCs) within the brain parenchyma makes glioblastoma one of the most aggressive and lethal tumors. Studies of the cellular and molecular mechanisms underlying hGC migration are hindered by the limitations of existing glioma models. Here we developed a dorsal root ganglion axon-oligodendrocyte-hGC co-culture to study in real time the migration and interaction of hGCs with their microenvironment. hGCs interact with myelinated and non-myelinated axons through the formation of pseudopodia. Isolation of pseudopodia-localized polysome-bound RNA reveals transcripts of Lck, Paxillin, Crk-II, and Rac1 that undergo local translation. Inhibition of Lck phosphorylation using a small-molecule inhibitor (Lck-I), blocks the phosphorylation of Paxillin and Crk-II, the formation of pseudopodia and the migration of hGCs. In vivo intraventricular administration of the Lck-I using an orthotopic xenograft glioma model, results in statistically significant inhibition of tumor size and significant down-regulation of Nanog-targeted genes, which are associated with glioblastoma patient survival. Moreover, treatment of human glioma stem cells (hGSCs) with Lck-I, results in significant inhibition of self-renewal and tumor-sphere formation. The involvement of Lck in different levels of glioma malignant progression, such as migration, tumor growth, and regulation of cancer stemness, makes Lck a potentially important therapeutic target for human glioblastomas.

Does mercury presence in soils promote their microbial activity? The Almadenejos case (Almadén mercury mining district, Spain).

Mercury is considered a very toxic element and important efforts are currently being made aimed at reduce or even eliminating its usage. Despite this trend, there are still sites where contamination by this metal is very marked, especially in the mining environment of Almadén where it has been exploited for thousands of years. The several forms in which Hg occurs in the soil interact differently with the organisms that live in/on it. The soil is a place where many biotic and abiotic variables act together. Through a detailed study of the edaphic characteristics of a decommissioned metallurgical enclosure, the presence of different chemical forms of Hg, the study of microbial activity (DHA) and, finally, parameters of the vegetation cover, such as specific distribution and biomass, we have tried to elucidate the effect of the presence of Hg in this precinct with a very high Hg pollution. The obtained results showed the affection patterns by which the different measured parameters vary, with special incidence to the microbial activity of the topsoil and to the specific distribution of the plants found in the studied area. The statistical multivariate analysis showed that significant correlations have been found between soil Hg fractions and between Hg fractions in plants; furthermore, soil conditions seem to be not related with Hg transfer from soils to plants. Biomass and DHA data indicate that the studied area is not affected by the presence of Hg species and lacks the expected toxic effects on the living organisms.

Microalgae removal with Moringa oleifera.

Moringa oleifera seed extract was tested for algae (Chlorella, Microcystis, Oocystis and Scenedesmus) removal by Jar-test technique. This coagulant can be used in drinking water treatment. Jar-test has been carried out in order to evaluate the efficiency of this natural coagulant agent inside real surface water matrix. The influence of variables has been studied in this process, including operating parameters such as coagulant dosage, initial algae concentration, pH, agitation time and water matrix. Removal capacity is verified for water with high contamination of algae while the process is not affected by the pH and water matrix. Coagulation process may be modelling through Langmuir and Freundlich adsorption hypothesis, so acceptable r2 coefficients are obtained.

Self-assembly structures of 1H-indazoles in the solution and solid phases: a vibrational (IR, FIR, Raman, and VCD) spectroscopy and computational study.

1H-indazoles are good candidates for studying the phenomena of molecular association and spontaneous resolution of chiral compounds. Thus, because the 1H-indazoles can crystallize as dimers, trimers, or catemers, depending on their structure and the phase that they are in, the difficulty in the experimental analysis of the structure of the family of 1H-indazoles becomes clear. This difficulty leads us to contemplate several questions: How can we determine the presence of different structures of a given molecular species if they change according to the phase? Could these different structures be present in the same phase simultaneously? How can they be determined? To shed light on these questions, we outline a very complete strategy by using various vibrational spectroscopic techniques that are sensitive (VCD) and insensitive (IR, FIR, and Raman) towards the chirality, together with quantum chemical calculations.

First Report of Fusarium proliferatum Causing Rot of Garlic Bulbs in Spain.

In October of 2008, decayed garlic bulbs (Allium sativum L. cv. Blancomor de Vallelado) were received from a producer in Segovia, Spain. In November of 2009, similar symptoms were observed on stored bulbs (cvs. Blancomor de Vallelado and Garcua) from each of 30 municipalities in northwest Segovia and Valladolid. A minimum of one sample was collected from 12 localities. Pieces of symptomatic bulbs were surface disinfested for 2 to 3 min in 0.5% NaOCl and transferred to potato dextrose agar (PDA) and Komada's media. Colonies had catenate microconidia and curved macroconidia that were usually three to five septate. Microconidia were club shaped with a flattened base, aseptate, and were produced on both mono- and polyphialides. On the basis of morphological features, the fungus was identified as Fusarium proliferatum (T. Matsushima) Nirenberg (2,3). Pathogenicity tests were conducted with 12 isolates of the fungi following the method of Dugan et al. (1). Each assay with an isolate consisted of six cloves (cv. Blancomor de Vallelado) disinfested in 0.5% NaOCl for 45 s, rinsed with sterile water, and injured to a depth of 4.5 mm with a probe 1 mm in diameter. The wound was filled with PDA colonized by the appropriate isolate. Six cloves for each tested isolate received sterile agar as a control. The cloves were incubated at 25°C for 5 weeks. The test was repeated once with cv. Garcua. All isolates produced water-soaked, tan lesions. An isolate of the fungus was deposited in the collection of the Plant Production Department of the University of Almeria. No fungi were recovered from the control cloves. F. proliferatum has been reported on garlic in the northwestern United States (1) and Serbia (4). To our knowledge, this is the first report of a Fusarium sp. in the section Liseola attacking garlic in Spain. The fungus seems to be well established on this host in Spain. References: (1) F. M. Dugan et al. Phytopathology 155:437, 2007. (2) P. E. Nelson et al. Fusarium Species: An Illustrated Manual for Identification. Pennsylvania State University Press, University Park, 1983. (3) H. Nirenberg et al. Mycologia 90:434, 1998. (4) S. Stankovic et al. Eur. J. Plant Pathol. 118:165, 2007.

[Post-varicella purpura fulminans: potentially fatal]. / Púrpura fulminante posvaricelosa: potencialmente mortal.

Although varicella is usually a benign disease, some of its complications, such as post-varicella purpura fulminans, can be fatal. Its pathophysiological mechanism is caused by the production of antibodies to protein C and protein S in the coagulation cascade. This could have fatal consequences for those patients with partial deficiency of these proteins that develop disseminated intravascular coagulation. Treatment is symptomatic: fresh frozen plasma to treat protein depletion, antithrombin III and heparinization against thrombus formation, and anti-inflammatory drugs (steroids). However, new therapies, such as prostaglandin E1 IV and prostacyclin, are being introduced.

[Usefulness of procalcitonin as an early diagnostic test of neonatal sepsis in newborns with risk factors for infection]. / Utilidad de la procalcitonina como prueba diagnóstica precoz de sepsis neonatal en recién nacidos con factores de riesgo de infección.

OBJECTIVE: To investigate the reliability of serum procalcitonin (PCT) as an early diagnostic test (within the first 12 hours of life) of neonatal sepsis in newborns with maternal or neonatal risk factors for infection. MATERIAL AND METHODS: We performed a prospective study of 123 newborns consecutively admitted to neonatal unit over a 2-year period with at least one risk factor for infection. We constructed a 2x2 table between the validated test (serum PCT by semi-quantitative assay, with several cut-off points: 0.5, 2 and 10 ng/ml) and the reference assay (blood culture or clinical, laboratory and microbiological confirmation of sepsis). The validity (sensitivity, specificity), safety [positive predictive value (PPV) and negative predictive value (NPV)] and likelihood ratios (LR+ and LR-) of the test were calculated. RESULTS: Serum PCT was measured within the first 12 hours of life in 95% of the patients (mean and median=6 hours). The best cut-off point for serum PCT was 2 ng/ml, and, taking subsequent clinical-laboratory-microbiological confirmation of sepsis as the best reference assay, showed a sensitivity of 100% (95% CI 65-100), specificity of 82% (95% CI 74-88), PPV of 25% (95% CI 13-44), NPV of 100% (95% CI 96-100), LR+ of 5.5 (95% CI 3.7-8.1), and LR- of 0. CONCLUSIONS: Serum PCT levels<2 ng/ml within the first 6-12 hours of life in newborns with risk factors for infection are useful as a screening assay to rule out neonatal sepsis with a sensitivity of 100% (false negatives=0% and NPV=100%). However, for subsequent confirmation a more specific assay (with a low false positive rate and high PPV) should be used, such as C-reactive protein. The higher cost of the serum PCT test should be weighed against shorter admissions as a result of its use.

Synovial sarcoma in children. A single centre experience.

Synovial sarcoma (SS) is a rare disease in the paediatric population, predominating in adolescents. Surgery remains the best treatment strategy for resectable cases. Adjuvant chemotherapy or radiotherapy can be used but have not proven efficacy. Metastatic disease and unsuccessful surgery are major prognostic factors. We describe four cases in children aged 7-13 years old. All of them were affected by SS of upper and lower limbs, and had satisfactory resections with different outcomes in spite of receiving diverse chemotherapy regimens. One of them is at the moment under treatment for relapse, two are disease-free and another died after metastatic disease.

Synovial sarcoma in children. A single centre experience

Synovial sarcoma (SS) is a rare disease in the paediatric population, predominating in adolescents. Surgery remains the best treatment strategy for resectable cases. Adjuvant chemotherapy or radiotherapy can be used but have not proven efficacy. Metastatic disease and unsuccessful surgery are major prognostic factors. We describe four cases in children aged 7-13 years old. All of them were affected by SS of upper and lower limbs, and had satisfactory resections with different outcomes in spite of receiving diverse chemotherapy regimens. One of them is at the moment under treatment for relapse, two are disease-free and another died after metastatic disease (AU)

[Experimental ocular larva migrans infection in mice]. / Infección experimental en ratones con larva migrans ocular.

OBJECTIVE: To characterize the histologic alterations in the ocular globe of mice infected with eggs of Toxocara canis, during both the acute and chronic stages of the infection. METHOD: Performance of an experimental, prospective study in vivo, with right and left ocular globes [using 5 groups of 4 mice in each study; 2 white (A/J) and 2 black (C57/BL)], infected by the intravenous injection of 1000 embrionated Toxocara canis eggs. The mice were sacrificed sequentially post infection (3-180 days), the eyes evaluated by conventional microscopic techniques and the histopathology findings recorded. RESULTS: All the mice revealed some degree of ocular damage in one or both eyes. The retina was the most affected layer with edema, hemorrhage and severe degenerative changes seen. Other alterations included inflammation of the cornea, and obliteration of the anterior chamber with fibrinoid material. We also demonstrated changes in the normal histology of the uvea and lens. In only two eyes were segments of larvae found in the retina, and in each instance there was no evidence of an inflammatory reaction around them. CONCLUSION: Most of the changes seen were not related to the presence of larval forms, suggesting they were due to the effect of excretion-secretion products during the infective phase.

Prevalencia de clínica depresiva y peleas físicas en adolescentes de Vallecas (Madrid) / Prevalence of depressive clinic and physical fighting in adolescents of Vallecas (Madrid)

Antecedentes: depresión y peleas físicas en la adolescencia son objeto de un interés creciente en nuestro país, si bien no han recibido aún el esfuerzo investigador que merecen. Objetivos: determinar la prevalencia de tales situaciones en población de clase predominantemente obrera. Métodos: estudio descriptivo a partir de una encuesta transversal que incluía el Inventario de Depresión de Beck y posterior comparación con resultados relevantes en la literatura. Población objeto de estudio: todos los escolares en centros de enseñanza de dos zonas básicas de salud de Vallecas, Madrid, desde 2º de enseñanza secundaria (13-14 años). Resultados: 66,8 por ciento de adolescentes no había peleado en el año anterior, en el mismo rango que sociedades consideradas violentas en edad juvenil; pelearon más los más jóvenes que los de 15-17 años, y más los chicos que las chicas.29,6 por ciento presentaron sintomatología depresiva en alguno de sus grados, por encima de otros estudios con jóvenes de raza caucásica en sociedades económicamente favorecidas. Mayor prevalencia y gravedad para las chicas. Conclusiones: nuestros resultados pueden considerarse como altos, tanto en lo referente a conductas agresivas como a depresión; esto contrasta con la escasez de estudios en nuestro medio. Sería deseable establecer la posible asociación entre ambas. (AU)

[Octreotide treatment of post surgical chylothorax]. / Tratamiento del quilotórax posquirúrgico con octreótido.

Chylothorax is an infrequent complication of cardiac surgery in children. Most patients respond to a low-fat diet or to parenteral nutrition, but pleuroperitoneal drainage or thoracic duct ligature is sometimes required. We present the case of a 3-year-old girl with Down syndrome and complex atrioventricular canal defect who presented chylothorax 22 days after the Glenn procedure with bidirectional pulmonary-cava fistula. Low-fat diet and parenteral nutrition produced no improvement and the patient was treated with octreotide 1-2 mcg/kg/min in intravenous continuous perfusion, which produced remission of chylothorax. Subsequently, 20 mcg/kg/day of octreotide was subcutaneously administered in three doses, allowing progressive dietary normalization, without recurrence of chylothorax or adverse effects. In conclusion, octreotide is well tolerated and produces few adverse effects. It could be used as a therapeutic alternative in chylothorax refractory to conservative treatment.

Synthesis of quinolinyl chalcones and evaluation of their antimalarial activity.

Quinolinyl chalcones were synthesized and evaluated for their inhibition of the Plasmodium falciparum cystein protease falcipain and their activity against cultured P. falciparum parasites. They were also tested for in vivo efficacy in a rodent P. berghei model. Their activity against falcipain and as antimalarials was moderate, but antimalarial activity was probably not due to the inhibition of falcipain and may follow a different mechanism. 1-(2,4-Dichlorophenyl)-3-[3-(2-chloro-6,7-dimethoxiquinolinyl)]-2-propen-1-one 3j was the most promising compound among those here reported (IC50 19.0 microM).

Flow dynamics of stenotic aortic valves assessed by signal processing of Doppler spectrograms.

Clinical assessment of aortic stenosis (AS) is sometimes challenging, because all hemodynamic indexes of severity are modified by flow rate. However, the mechanisms underlying flow dependence remain controversial. Analysis of instantaneous flow dynamics has provided crucial information in a number of cardiovascular disorders and may add new insight into this phenomenon. This study was designed to analyze in vivo the effects of flow interventions on instantaneous valvular dynamics of stenotic valves. For this purpose, a custom algorithm for signal processing of Doppler spectrograms was developed and validated against a control population. Digital Doppler recordings at the aortic valve and left ventricular outflow tract were obtained in 15 patients with AS, at baseline and during low-dose dobutamine infusion; 10 normal subjects were studied as controls. Spectrograms were processed by signal averaging, time alignment, modal-velocity enhancement, envelope tracing, and numerical interpolation. Instantaneous relative aortic valve area (rAVA) was obtained by the continuity equation and plotted against normalized ejection time. Curves were classified as either type A (rapid, early-systolic opening) or type B (slow, end-systolic opening). Curves from controls closely matched prior knowledge of normal valve dynamics, but curves from patients were clearly different: all controls except 2 (80%) had type A, whereas all patients except 3 (80%) had a type B pattern (p = 0.03). Dobutamine infusion in patients increased and slightly anticipated peak rAVA by accelerating valve opening. Despite similar values of area and pressure difference, type B dynamics were associated with lower blood pressure (p = 0.01) and worse long-term outcome (>3 years) than type A flow dynamics (p = 0.02). Signal processing of Doppler spectrograms allows a comprehensive assessment of aortic flow dynamics. Differences in timing of valve aperture and in maximal leaflet excursion account for flow-mediated changes in valve area, suggesting complementary effects of inertia and elasticity on the kinetics of stenotic aortic valves. Flow-dynamic analysis provides novel clinical information regarding physiology of AS unavailable to conventional indexes.

[Knowledge and use of contraceptive methods by the female population in a health-care district]. / Conocimiento y uso de métodos anticonceptivos por la población femenina de una zona de salud.

BACKGROUND: The use of contraceptives is related to factors including those of a demographic, social, economic, educational and ideological nature. The purpose of our study is that of ascertaining with what contraceptive methods the women of child-bearing age assigned to a given health care center are familiar, in addition to prevalence of the use thereof. METHODS: Based on the health care card listing, 389 of the 5800 women of child-bearing age (15-45 years old) assigned to the health care center in question were selected by means of a systematic sampling. After sending them a letter notifying them of the reason for this study, they were contacted by telephone to fill out the survey, which included questions regarding their knowledge and use of contraceptive methods, their sociocultural characteristics and sexual activity. Appointments at the health center were made with those women who did not have telephones. RESULTS: 178 women were contacted, 166 of whom took part in the survey (42.7% response rate). 86 of these women (51.8%; CI: 44.2-59.4%) were using some means of contraception. Nevertheless, among women at risk of unwanted pregnancies, the prevalence of use was 70.5% (CI: 62.4-78.6%), being worthy of special mention the fact that solely 45.4% of the women within the 40-45 age group were using contraceptives, revealing a frequency significantly lower than the other age groups. The methods known to the greatest degree were the condom (90.4%), oral contraceptives (89.2%) and the IUD (78.3%), the knowledge of other means being scant. CONCLUSIONS: The rate of use of contraceptive methods among women at risk of unwanted pregnancy is acceptable, although strikingly low among the women in the 40-45 age group. The methods known most were the condom, oral contraceptives and the intrauterine device.

Optimization of control parameters of a hot cold controller by means of Simplex type methods.

This paper describes a hot/cold controller for regulating crystallization operations. The system was identified with a common method (the Broida method) and the parameters were obtained by the Ziegler-Nichols method. The paper shows that this empirical method will only allow a qualitative approach to regulation and that, in some instances, the parameters obtained are unreliable and therefore cannot be used to cancel variations between the set point and the actual values. Optimization methods were used to determine the regulation parameters and solve this identcation problem. It was found that the weighted centroid method was the best one.

Effects of dobutamine on Doppler echocardiographic indexes of aortic stenosis.

OBJECTIVES: This study sought to assess the diagnostic implications of the flow dependence of Doppler echocardiographic indexes of aortic valve stenosis. BACKGROUND: Although valve area has been shown to change with alterations in flow rate, the diagnostic consequences of this phenomenon remain unknown. Valve resistance has been suggested as a more stable index for evaluating aortic stenosis. METHODS: A low dose dobutamine protocol was performed in 35 patients with aortic stenosis. Hemodynamic indexes were obtained by Doppler echocardiography at baseline and at each dobutamine dose. RESULTS: As a result of the shortening of the systolic ejection period, flow increased from (mean +/- SD) 164 +/- 48 to 229 +/- 102 ml/s (p < 0.0001). At peak flow, valve area increased by 28% (from 0.5 +/- 0.2 to 0.6 +/- 0.3 cm2, p < 0.0001), whereas valve resistance decreased by 4% (from 498 +/- 252 to 459 +/- 222 dynes.s.cm-5, p = 0.04). This observed change in resistance was smaller than that for valve area (p < 0.01). The flow dependence of valve area varied among individual patients (p < 0.0001). Multivariate analysis identified calcific degenerative etiology (beta 0.29, p = 0.002), left ventricular velocity of fiber shortening (beta 0.22, p = 0.01), baseline flow (beta -0.28, p = 0.04) and amount of flow increased induced by dobutamine (beta 0.90, p < 0.0001) as factors related to valve area flow dependence. CONCLUSIONS: Although all Doppler echocardiographic indexes of aortic stenosis are affected by flow, valve resistance is more stable than valve area under dobutamine-induced hemodynamic changes. Baseline valve area may be unreliable in patients with calcific degenerative aortic stenosis and low output states.

BCG vaccination in low birth weight newborns: analysis of lymphocyte proliferation, IL-2 generation and intradermal reaction to PPD.

OBJECTIVE: To study vaccinal scar formation and post-vaccinal immune response in newborns with birth weight ranging from 2000 to 2499 g vaccinated in the first week of life with intradermal bacille Calmette-Guérin (BCG) (Moreau-Rio de Janeiro strain). METHOD: Specific immune response to PPD was assessed in 30 low birth weight newborns (mean birth weight = 2311.7 +/- 122.1 g; mean gestational age = 38.1 +/- 1.8 weeks) in comparison to 56 control infants (mean birth weight = 3198.9 +/- 267.2 g; mean gestational age = 38.5 +/- 1.2 weeks. RESULTS: Low birth weight infants have an efficient immune response to vaccinal stimulus when compared to control infants as judged by specific in vitro lymphocyte proliferation (mean SI = 9.7 +/- 12.9 vs SI = 8.8 +/- 10.0, P = 0.72) and IL-2 production (mean SI = 3.1 +/- 3.4 vs SI = 2.6 +/- 2.0, P = 0.38). Intradermal reaction to PPD was also comparable in both groups (mean induration diameter = 9.5 +/- 5.1 mm vs 9.6 +/- 5.0 mm, P = 0.94). CONCLUSION: These data suggest that low birth weight newborns show a good immune response to BCG, thus reinforcing the inclusion of such infants in regular vaccination programs with intradermal BCG.