Serum Beta-Defensin-2 is a biomarker for psoriasis but not subclinical atherosclerosis: Role of IL17a, PI-3 kinase and Rac1.

Background: Beta-defensins (BDs) are antimicrobial peptides secreted upon epithelial injury. Both chemotactic and antimicrobial properties of BDs function as initial steps in host defense and prime the adaptive immune system in the body. Psoriasis, a chronic immune-mediated inflammatory disease, has both visible cutaneous manifestations as well as known associations with higher incidence of cardiometabolic complications and vascular inflammation. Objectives: We aimed to investigate the circulating expression of beta-defensin-2 (BD2) in psoriasis at baseline compared to control subjects, along with changes in BD2 levels following biologic treatment at one-year. The contribution of BD2 to subclinical atherosclerosis is also assessed. In addition, we have sought to unravel signaling mechanisms linking inflammation with BD2 expression. Methods: Multimodality imaging as well inflammatory biomarker assays were performed in biologic naïve psoriasis (n=71) and non-psoriasis (n=53) subjects. A subset of psoriasis patients were followed for one-year after biological intervention (anti-Tumor Necrosis Factor-α (TNFα), n=30; anti-Interleukin17A (IL17A), n=21). Measurements of circulating BD2 were completed by Enzyme-Linked Immunosorbent Assay (ELISA). Using HaCaT transformed keratinocytes, expression of BD2 upon cytokine treatment was assessed by quantitative polymerase chain reaction (qPCR) and ELISA. Results: Herein, we confirm that human circulating BD2 levels associate with psoriasis, which attenuate upon biologic interventions (anti-TNFα, anti-IL-17A). A link between circulating BD2 and sub-clinical atherosclerosis markers was not observed. Furthermore, we demonstrate that IL-17A-driven BD2 expression occurs in a Phosphatidylinositol 3-kinase (PI3-kinase) and Rac1 GTPase-dependent manner. Conclusions: Our findings expand on the potential role of BD2 as a tractable biomarker in psoriasis patients and describes the role of an IL-17A-PI3-kinase/Rac signaling axis in regulating BD2 levels in keratinocytes.

Association between Poor Oral Health and Frailty in Middle-Aged and Older Individuals: A Cross-Sectional National Study.

OBJECTIVES: Older adults with poor oral health may be at higher risk of being pre-frail or frail. However, very few studies have examined this association in Latin American countries and middle-aged individuals. Therefore, we aimed to investigate the association between oral health and frailty status among Chilean adults ≥40 years. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: We included 3,036 participants ≥40 years from the Chilean National Health Survey 2016-2017. METHODS: Frailty status was assessed with a 49-item frailty index, while the number of teeth, self-reported oral health, tooth decay, use of prostheses, and oral pain were the oral health conditions included. To assess the association between oral health conditions and frailty, we used multinomial logistic regression models status adjusted for sociodemographic and lifestyle variables. RESULTS: Overall, 40.6% and 11.8% of individuals were classified as pre-frail and frail, respectively. After adjusting for confounders, individuals with ≤20 teeth had a higher likelihood of being frail (odds ratio (OR): 1.94 [95% CI: 1.18-3.20]) than people with >20 teeth. Moreover, people with bad or very bad oral health, as well as oral pain, had a higher likelihood of being pre-frail (OR: 2.04 [95% CI: 1.40-2.97] and OR: 2.92 [95% CI: 1.58-5.39], respectively). Middle-aged individuals with fewer teeth and poor self-reported oral health had a higher likelihood of being pre-frail and frail than people ≥60. CONCLUSIONS AND IMPLICATIONS: Individuals with poor global oral health were more likely to be pre-frail or frail. This association seems to be stronger in people <60 years old. Our results are consistent with previously published reports.

Unexpected diversity in northern Europe: trematodes from salmonid fishes in Iceland with two new species of Crepidostomum Braun, 1900.

In 2018 and 2019, salmonid fishes, Salmo trutta L. and Salvelinus alpinus (L.) from lakes in Iceland were assessed for trematodes during a parasitological examination. Combined morphological and molecular analyses revealed the presence of four trematode species, two of which were previously known to parasitise salmonids in Iceland, Crepidostomum farionis (Müller, 1780) and Phyllodistomum umblae (Fabricius, 1780), and the two remaining species were recognised as new to science. Morphologically and genetically, Crepidostomum brinkmanni n. sp. and C. pseudofarionis n. sp. are closely related to two European species, namely C. metoecus and C. farionis. However, C. brinkmanni n. sp. is distinct by the position of maximum body width and arrangement of vitelline follicles; C. pseudofarionis n. sp. is distinct by its stout body, position of maximum body width, size of muscular papillae relative to oral sucker and the anterior extent of vitelline follicles. The new species were previously molecularly detected in their intermediate and definitive hosts in Norway and Ukraine, but their sequences were not supplemented with any morphological characterisation. In the present study, we provide detailed morphological descriptions and molecular sequences (28S rDNA and ITS2) of the four species of trematodes detected in Iceland. The discovery of the two new species of Crepidostomum indicates that the trematode diversity in fishes in the north is higher than previously known; our finding doubles the species spectrum of fish trematodes for Iceland. The record of C. brinkmanni from Ukraine indicates that its distribution might not be limited to northern latitudes.

Molecular and Morphological Characterization of Anisakid Nematode Larvae from the Sandperches Pseudopercis numida and Pinguipes brasilianus (Perciformes: Pinguipedidae) off Brazil.

Morphological and genetic data on the larvae of Anisakidae parasitizing the sandperches Pseudopercis numida and Pinguipes brasilianus were recorded from Cabo Frio, State of Rio de Janeiro, Brazil (23°S, 42°W). Twenty-five specimens of P. numida and 25 specimens of P. brasilianus were necropsied. The 352 larvae collected included 1 Anisakis sp., 344 Hysterothylacium sp., and 7 Raphidascaris sp. We present mtDNA sequence data for Anisakis sp. and Hysterothylacium sp., and we sequenced the ITS ribosomal DNA (rDNA) of Hysterothylacium sp. and Raphidascaris sp. The morphological and genetic profiles confirmed the identification of Anisakis typica (Diesing, 1860). Hysterothylacium sp. and Raphidascaris sp. were not identified to the species level due to the absence of similar sequences for adult parasites. The mtDNA sequence of Hysterothylacium sp. from P. numida showed a high similarity to the sequence of Hysterothylacium deardorffoverstreetorum. However, a phylogenetic analysis demonstrated the presence of different clades under the same name as the larval H. deardorffoverstreetorum. Pseudopercis numida is a new host record for A. typica.

Lesiones de la columna lumbar en el deportista / Lumbar spine injuries in athletes

El dolor lumbar es relativamente común en deportistas. Su etiología es variada y está determinada por múltiples factores que incluyen la edad, nivel y cargas de entrenamiento y condición física. Existen disciplinas que imponen un riesgo particularmente alto de lesión y adicionalmente los atletas pueden presentar alteraciones que afecten por igual a la población no deportista. Esta revisión se centra en las causas más habituales de dolor lumbar en deportistas y aborda las bases de la rehabilitación y la prevención de nuevas lesiones.

Low-back pain is relatively common in athletes and sports enthusiasts. Etiology is varied and is determined by multiple factors, including age, level of training, training loads and personal body constitution. Although athletes can suffer from lumbar ailments present in the non-athletic population, some disciplines pose a particular risk for specific injury. This review focuses in the more frequent causes of back pain in athletes and in the basics of physiotherapy treatment and prevention of re-injury.

Historic emergence, impact and current status of shrimp pathogens in the Americas.

Shrimp farming in the Americas began to develop in the late 1970s into a significant industry. In its first decade of development, the technology used was simple and postlarvae (PLs) produced from wild adults and wild caught PLs were used for stocking farms. Prior to 1990, there were no World Animal Health Organization (OIE) listed diseases, but that changed rapidly commensurate with the phenomenal growth of the global shrimp farming industry. There was relatively little international trade of live or frozen commodity shrimp between Asia and the Americas in those early years, and with a few exceptions, most of the diseases known before 1980 were due to disease agents that were opportunistic or part of the shrimps' local environment. Tetrahedral baculovirosis, caused by Baculovirus penaei (BP), and necrotizing hepatopancreatitis (NHP) and its bacterial agent Hepatobacterium penaei, were among the "American" diseases that eventually became OIE listed and have not become established outside of the Americas. As the industry grew after 1980, a number of new diseases that soon became OIE listed, emerged in the Americas or were introduced from Asia. Spherical baculovirus, caused by MBV, although discovered in the Americas in imported live Penaeus monodon, was subsequently found to be common in wild and farmed Asian, Australian and African penaeids. Infectious hypodermal and hematopoietic necrosis virus (IHHNV) was introduced from the Philippines in the mid 1970s with live P. monodon and was eventually found throughout the Americas and subsequently in much of the shrimp farming industry in the eastern hemisphere. Taura syndrome emerged in Penaeus vannamei farms in 1991-1992 in Ecuador and was transferred to SE Asia with live shrimp by 1999 where it also caused severe losses. White Spot Disease (WSD) caused by White spot syndrome virus (WSSV) emerged in East Asia in ∼1992, and spread throughout most of the Asian shrimp farming industry by 1994. By 1995, WSSV reached the eastern USA via frozen commodity products and it reached the main shrimp farming countries of the Americas located on the Pacific side of the continents by the same mechanism in 1999. As is the case in Asia, WSD is the dominant disease problem of farmed shrimp in the Americas. The most recent disease to emerge in the Americas was infectious myonecrosis caused by IMN virus. As had happened before, within 3years of its discovery, the disease had been transferred to SE Asia with live P. vannamei, and because of its impact on the industry and potential for further spread in was listed by the OIE in 2005. Despite the huge negative impact of disease on the shrimp farming industry in the Americas, the industry has continued to grow and mature into a more sustainable industry. In marked contrast to 15-20years ago when PLs produced from wild adults and wild PLs were used to stock farms in the Americas, the industry now relies on domesticated lines of broodstock that have undergone selection for desirable characteristics including disease resistance.

Evaluation of a PCR test for detection of treponema pallidum in swabs and blood.

Syphilis diagnosis is based on clinical observation, serological analysis, and dark-field microscopy (DFM) detection of Treponema pallidum subsp. pallidum, the etiological agent of syphilis, in skin ulcers. We performed a nested PCR (nPCR) assay specifically amplifying the tpp47 gene of T. pallidum from swab and blood specimens. We studied a cohort of 294 patients with suspected syphilis and 35 healthy volunteers. Eighty-seven of the 294 patients had primary syphilis, 103 had secondary syphilis, 40 had latent syphilis, and 64 were found not to have syphilis. The T. pallidum nPCR results for swab specimens were highly concordant with syphilis diagnosis, with a sensitivity of 82% and a specificity of 95%. Reasonable agreement was observed between the results obtained with the nPCR and DFM methods (kappa = 0.53). No agreement was found between the nPCR detection of T. pallidum in blood and the diagnosis of syphilis, with sensitivities of 29, 18, 14.7, and 24% and specificities of 96, 92, 93, and 97% for peripheral blood mononuclear cell (PBMC), plasma, serum, and whole-blood fractions, respectively. HIV status did not affect the frequency of T. pallidum detection in any of the specimens tested. Swab specimens from mucosal or skin lesions seemed to be more useful than blood for the efficient detection of the T. pallidum genome and, thus, for the diagnosis of syphilis.

Metodología de adaptación de una guía clínica para el manejo de pacientes adultos con neumonía adquirida en la comunidad en una red de salud privada / The adaptation methodology of a guideline for the management of adults with community-acquired pneumonia

Background: Clinical practice guidelines (CPG) are widely used as tools for improving quality of health care. Guidelines developed elsewhere, can be adapted using a valid and systematic process. Aim: To describe the methodology used in the process of adaptation of a guideline for the management of adults with community-acquired pneumonia (CAP) in a private health care organization. Material and Methods: We used the ADAPTE framework involving three main phases. At the set-up phase a guideline adaptation group integrated by medical specialists from different disciplines, a methodologist and a nurse coordinator was formed. At the adaptation phase, the specific clinical questions to be addressed by the guidelines were identified. Results: Twenty five guidelines were initially retrieved. After their assessment, the number was reduced to only three. Recommendations from these guidelines were 'mapped' and focused searches were carried out where 'evidence gaps' were identified. An initial draft was written and revised by the adaptation group. At the finalization phase, the external review of the guideline was carried out and a process for the regular review and update of the adapted guideline was defined. Conclusions: We developed a guideline for the management of adults with CAP, adapted to the local context of our health care system, using guidelines developed elsewhere. This guideline creation method can be an efficient means of saving professional resources.

[The adaptation methodology of a guideline for the management of adults with community-acquired pneumonia]. / Metodología de adaptación de una guía clínica para el manejo de pacientes adultos con neumonía adquirida en la comunidad en una red de salud privada.

BACKGROUND: Clinical practice guidelines (CPG) are widely used as tools for improving quality of health care. Guidelines developed elsewhere, can be adapted using a valid and systematic process. AIM: To describe the methodology used in the process of adaptation of a guideline for the management of adults with community-acquired pneumonia (CAP) in a private health care organization. MATERIAL AND METHODS: We used the ADAPTE framework involving three main phases. At the set-up phase a guideline adaptation group integrated by medical specialists from different disciplines, a methodologist and a nurse coordinator was formed. At the adaptation phase, the specific clinical questions to be addressed by the guidelines were identified. RESULTS: Twenty five guidelines were initially retrieved. After their assessment, the number was reduced to only three. Recommendations from these guidelines were 'mapped' and focused searches were carried out where 'evidence gaps' were identified. An initial draft was written and revised by the adaptation group. At the finalization phase, the external review of the guideline was carried out and a process for the regular review and update of the adapted guideline was defined. CONCLUSIONS: We developed a guideline for the management of adults with CAP, adapted to the local context of our health care system, using guidelines developed elsewhere. This guideline creation method can be an efficient means of saving professional resources.

Escoliosis: evaluación y manejo / Scoliosis: review and management

La escoliosis es una deformidad de la columna en los 3 planos. En el período de crecimiento, puede tener importantes efectos cosméticos y funcionales. En el adulto, puede conducir a dolor por alteraciones degenerativas, que a su vez participan en su génesis. La mayoría de los casos pediátricos son idiopáticos, pero este siempre es un diagnóstico de exclusión. Para esto, el examen clínico y la radiología simple suelen ser suficientes, aunque algunos niños requerirán de resonancia magnética para excluir patología intraraquidea. El comportamiento de la curva es dependiente de la 4ta dimensión: el tiempo, y puede ser impredecible. Por ello el seguimiento clínico y radiológico es esencial. Una curva leve puede mantenerse así hasta el crecimiento y requerir sólo de observación. El tratamiento con corset puede frenar una curva progresiva, si bien no corregirla. Las curvas severas o que progresen dentro del corset tienen indicación de corrección y fusión quirúrgica. Las curvas no-idiopáticas se comportan en forma diferente y su manejo es también distinto.

Scoliosis is a 3-plane deformity of the spine. In the growing spine, it may lead to significant cosmetic and functional effects. In the adult, it may arise from or lead to pain from degenerative changes. The condition is frequently idiopathic but a primary cause must always be excluded. Clinical evaluation and simple radiology usually suffice, but in some cases, spinal canal pathology must be ruled out with magnetic resonance. Curves depend on the 4th dimension time and their behavior may be unpredictable. This makes clinical and radiological follow-up essential. Aside from surgery, only braces can limit curve progression, although not correct them. Severe curves and those progressing in spite of adequate bracing require surgical correction and fusion. Non-idiopathic curves behave differently and their management also differs.

Pólipos endometiiales: manejo con histeroscopia quirúrgica y correlación histológica / Endometrial polyps: management with surgical hysteroscopy and histological correlation

Se presenta la experiencia quirúrgica en 160 pacientes con diagnóstico ecográfico de pólipo endometrial. Se evalúan las características epidemiológicas, clínicas y la correlación histológica. La edad promedio fue de 50 años, se analizaron las variables diferenciándolas en premenopáusicas o post menopáusicas, y presencia de síntomas. En todos los subgrupos la incidencia fue igualmente alta para los pólipos endometriales, seguida en frecuencia por los leiomiomas, hiperplasia endometrial y endometrio proliferativo, entre otros. Se encontraron 3 casos de adenocarcinoma endometrial, todos en el subgrupo de las pacientes postmenopáusicas sintomáticas. El procedimiento fue bien tolerado, y sin complicaciones. Destacamos a la histeroscopia como el estándar dorado por su alta sensibilidad y especificidad en el diagnóstico de pólipo endometrial.

The surgical experience in 160 patients with echographic diagnostic of endometrial polyps, are analyzed. Clinical and pathological characteristics are evaluated. The patient average age was 50 years old; variables were analyzed differentiating them in pre menopausal or post menopausal, according to the presence of symptoms. In all sub-groups the incidence was equally high for the endometrial polyps, followed in frequency by leiomyomas, endometrial hyperplasia and endometria proliferative among others. Three cases of endometrial adenocarcinoma were found, all in the sub-group of the symptomatic post menopausal patients. The procedure was well tolerated, without complications. We emphasized the hysteroscopy procedure as the gold standard by its high sensitivity and specificity in the endometrial polyp diagnosis.

Application of molecular diagnostic methods to penaeid shrimp diseases: advances of the past 10 years for control of viral diseases in farmed shrimp.

The most important diseases of farmed penaeid shrimp have infectious aetiologies. Among these are diseases with viral, rickettsial, bacterial, fungal and parasitic aetiologies. Diagnostic methods for these pathogens include the traditional methods of gross pathology, histopathology, classical microbiology, animal bioassay, antibody-based methods, and molecular methods using DNA probes and DNA amplification. While methods using clinical chemistry and tissue culture are standard methods in veterinary and human diagnostic laboratories, the former has not been routinely applied to the diagnosis of penaeid shrimp diseases and the latter has yet to be developed, despite considerable research and development efforts that have spanned the past 40 years. No continuous shrimp cell lines, or lines from other crustaceans, have been developed. Hence, when molecular methods began to be routinely applied to the diagnosis of infectious diseases in humans and domestic animals in the mid- to late 1980s, the technology was applied to the diagnosis of certain important diseases of penaeid shrimp for which only classical diagnostic methods were previously available. A DNA hybridization assay for the parvovirus IHHNV was the first molecular test developed for a shrimp disease. This was followed within a year by the first PCR test for MBV, an important baculovirus disease of shrimp. Today, shrimp disease diagnostic laboratories routinely use molecular tests for diagnostic and surveillance purposes for most of the important penaeid shrimp diseases.

¿Por qué un departamento académico de medicina familiar? / Why an academic departament of family medicine?

Over the last fifty years, Family Medicine has became not only an important part of many health systems around the world but also an established academic discipline. However, in the Iberoamerican context its development has been slow and with a number of difficulties. After a decade of work at the Family and Community Medicine Programme of the Catholic University of Chile, the role of Family Medicine as an academic discipline requires a reflection. A definition of Family Medicine is advanced in line with a recent proposal of WONCA Europe including some fundamental aspects in the practice of any family doctor. A set of criteria for considering a medical subject as a discipline is analyzed and discussed with reference to Family Medicine. A unique field of action, an established body of knowledge, a set of analytical techniques, an specific area of research, its own philosophy, and a training which is intellectually rigorous, are all criteria that Family Medicine fulfils. Family Medicine is a medical discipline with a clear definition and it can be considered an academic discipline. Therefore, it is possible to establish an academic department within a Faculty of Medicine in Chile, which will contribute to a more balanced and complete medical education in the country

Prostatectomía radical retropúbica: experiencia Hospital DIPRECA / Radical retropubic prostatectomy: experience in the DIPRECA Hospital

Presentamos la experiencia de nuestro servicio en el tratamiento del cáncer prostático clínicamente órgano confinado, mediante prostatectomía radical retropúbica (PRR) con linfadenectomía ilioobturatriz. Se realizó un estudio retrospectivo de 227 pacientes sometidos a este tratamiento, entre abril de 1993 y febrero de 2002, con un seguimiento mínimo de seis meses. Observamos una subetapificación global de 62,11 porciento y un antígeno prostático específico (APE) promedio de 15,73 ng/ml. Se obtuvo una continencia completa en 96,4 porciento; sólo 2 casos de incontinencia total. Disfunción eréctil se manifestó como severa en 45,9 porciento de 183 pacientes que pudieron ser evaluados en este aspecto. La mortalidad perioperatoria fue de 0,88 porciento (2 pacientes). Progresión de la enfermedad sin terapia complementaria se observó en 37,5 porciento, mientras que la sobrevida global superior a 60 meses fue de 94,3 porciento.

Different reactions obtained using the same DNA detection reagents for Thai and Korean hepatopancreatic parvovirus of penaeid shrimp.

Hepatopancreatic parvovirus (HPV) can cause stunted growth and death in penaeid shrimp including Penaeus monodon. We used PCR primers and a commercial DNA probe designed from HPV of Penaeus chinensis (HPVchin) to examine HPV-infected Thai P. monodon (HPVmon). We found that the PCR primers produced a 732 bp DNA amplicon rather than the 350 bp amplicon obtained with HPVchin template and that the DNA probe gave weak to variable in situ DNA hybridization results. In addition, hybridization to PCR products from HPVmon was weak compared with hybridization with PCR products from HPVchin. By contrast, the 732 bp amplicon hybridized strongly with HPVmon-infected cells by in situ hybridization but not with uninfected shrimp tissue or other shrimp viruses, thus confirming its origin from HPVmon. Cloning, sequencing and analysis of the 732 bp amplicon showed that 696 bp (excluding the primer sequences) contained 47% GC content and had only 78% homology to 701 aligned bases from a 3350 bp DNA fragment of HPVchin from GenBank. These results explain why the reagents based on HPVchin gave a different PCR product and weak hybridization results with HPVmon, and they show that multiple primers or degenerate primers may be necessary for general detection of HPV varieties. Together with previously published information on the estimated total genome sizes for HPVchin (approximately 4 kb) and HPVmon (approximately 6 kb), these data support the contention that HPVchin and HPVmon are different varieties or species, in spite of their similar histopathology.

Identification of the gene immediately downstream of the murine INK4a/ARF locus.

The tumor suppressor gene ARF is formed by three exons, namely exons 1 beta, 2 and 3. Here, we show that embryo fibroblasts from mice genetically deficient in exons 2 and 3 (Delta 2,3) express a transcript formed by exon 1 beta followed by the 3'-terminal exon of the gene immediately downstream of the INK4a/ARF locus, which we have called NTp16 (Next-To-p16). The chimeric ARF-NTp16 transcript is not detectable in wild-type fibroblasts but its expression level in Delta 2,3 fibroblasts is 30% compared to the level of the normal ARF transcript in wild-type cells. Expression of the ARF-NTp16 transcript in Delta 2,3 cells is subject to normal regulatory features, such as upregulation by the accumulation of cell doublings, and by the presence of oncogenic Ras or E1a. The chimeric ARF-NTp16 transcript has the potential to encode a 17kDa peptide; however, this peptide is not accumulated in cells at detectable levels, probably reflecting poor codon usage or protein instability. We conclude that Delta 2,3 cells do not retain ARF functionality, at least to a significant extent. Interestingly, the expression pattern of the full-length NTp16 gene is altered in several tissues by the presence of the Delta 2,3 mutation. Finally, these data identify the gene immediately downstream of the INK4a/ARF locus, a region that has been previously proposed to contain another tumor suppressor different from the INK4a/ARF genes.