Clinical-haematological changes and predictors of severity in acute food protein-induced enterocolitis syndrome reactions at oral food challenge: a multicentre observational study.

BACKGROUND: Oral food challenge (OFC) is the gold standard for diagnosis of acute Food Protein-Induced Enterocolitis Syndrome (FPIES). No diagnostic/prognostic biomarkers are available, and OFC assessment criteria are not validated. OBJECTIVE: To assess clinical-haematological changes and predictors of severity of FPIES reactions at OFC. METHODS: Observational multicentre prospective study. Children aged 0-18 years diagnosed with acute FPIES were recruited at follow-up OFC in 12 tertiary centres in Spain and Italy. OFC Outcomes (as positive/negative/inconclusive and mild/moderate/severe) were assessed based on published '2017 FPIES Consensus' criteria. Clinical characteristics were recorded, and full blood count was done at baseline, reaction onset and 4 hours later. Regression analysis was performed to assess predictors of severe reactions at OFC. RESULTS: 81 children had positive OFC (mild in 11% (9/81), moderate in 61% (49/81), severe in 28% (23/81)). Increase in neutrophils and reduction in eosinophils, basophils and lymphocytes was observed (P-value<0.05). OFC was inconclusive in 19 cases despite objective signs or neutrophilia. Regression analysis showed a 2-day OFC protocol where only 25% of an age-appropriate portion is given on day 1 (not gender, age, culprit food, cumulative dose and previous reaction severity) was associated with reduced odds of severe reaction compared to giving multiple doses in a single day. CONCLUSION: Distinct haematological changes may help support FPIES diagnosis. Current OFC assessment criteria may not capture the broad spectrum of acute FPIES presentations. This 2-day protocol may associate a reduced risk of severe reactions. Future work should aim to develop safer OFC and non-OFC diagnostics for FPIES.

Patient's perspective in clinical practice to assess and predict disability in multiple sclerosis.

The information provided by a person with multiple sclerosis (MS) may anticipate changes in the course of the disease. To explore the role of a set of standardized patient-reported outcomes (PRO) in predicting disability progression in MS an observational study was conducted in two cohorts of 30 and 86 persons with progressive MS (pwPMS) and relapsing MS (pwRMS), respectively. The associations between baseline clinical, biochemical variables and results on MS quality of life scale (MusiQol), Modified Fatigue Impact Scale (MFIS) and Beck Depression Inventory II (BDI-II) were analyzed. The progression of disability after 2 years of follow-up in pwRMS was investigated. We show that PRO differentiated pwRMS and pwPMS cohorts with lower MusiQoL and higher MFIS and BDI-II scores in the latter. Only MFIS was correlated with disability in pwRMS and high scores in the physical MFIS domain associated with worse performance in 9HPT, and a trend in T25FW and SDMT. Instead, the cognitive MFIS domain was correlated with CHI3L1 in cerebrospinal fluid, a biomarker of progression. At the end of the study, global MFIS and BDI-II were found to be independent risk factors for disability independent of relapse. Although all PRO measures explored were altered in pwPMS, baseline MFIS discriminated current and prospective disability in pwRMS, identifying patients at risk of progression.

Efficacy of an information system addressed to nursing staff for diminishing contaminated blood cultures: a blind clinical trial.

OBJECTIVE: Evaluate the efficacy of an information system addressed to nursing staff to lower the blood culture contamination rate. METHODS: A blind clinical trial was conducted at Internal Medicine and Emergency Departments during 2011. After following a reeducation program in BC extraction, participants were randomly selected in a 1:1 ratio. Every participant of the experimental group was informed of each worker's individual performance; whereas the control group was only informed of the global results. RESULTS: A total of 977 blood extractions were performed in 12 months. Blood culture contamination rate was 7.5%. This rate was higher in the Emergency Department than in Internal Medicine (10% vs. 3.8%; p=0.001). Factors associated with the higher risk of contamination were, in the univariate analysis, the extraction through a recently implanted blood route and the time of professional experience, while those associated with a lower risk were the extraction in Internal Medicine and through a butterfly needle. On multivariate analysis, extraction through a recently placed access was an independent risk factor for an increased contamination rate (OR 2.29; 95%CI 1.18-4.44, p=0.014), while individual information about the blood culture results (OR 0.11; 95%CI 0.023-0.57; p=0.008), and more than 9 years of professional experience were asso-ciated with fewer contaminations (OR 0.30; 95%CI 0.12-0.77; p=0.012). In the intervention group the contamination rate diminished by a 26 %. CONCLUSIONS: Drawing blood cultures through a recently taken peripheral venous access increased their risk of contamination. The intervention informing the nurse staff of the contamination rate is effective to decrease it.

Predicting extinction phenotype to optimize fear reduction.

Fear conditioning is widely employed to study dysregulations of the fear system. The repeated presentation of a conditioned stimulus in the absence of a reinforcer leads to a decrease in fear responding-a phenomenon known as extinction. From a translational perspective, identifying whether an individual might respond well to extinction prior to intervention could prove important to treatment outcomes. Here, we test the hypothesis that CO2 reactivity predicts extinction phenotype in rats, and that variability in CO2 reactivity as well as extinction long-term memory (LTM) significantly predicts orexin activity in the lateral hypothalamus (LH). Our results validate a rat model of CO2 reactivity and show that subcomponents of behavioral reactivity following acute CO2 exposure explain a significant portion of the variance in extinction LTM. Furthermore, we show evidence that variability in CO2 reactivity is also significantly predictive of orexin activity in the LH, and that orexin activity, in turn, significantly accounts for LTM variance. Our findings open the possibility that we may be able to use CO2 reactivity as a screening tool to determine if individuals are good candidates for an extinction/exposure-based approach.

Effects of deep hypothermic preservation on posttransplant viability of tracheal grafts.

OBJECTIVE: Using an animal model, we performed a study to assess the effects of rapid freezing in the absence of cryoprotectants on the viability of tracheal grafts after allotransplantation. MATERIALS AND METHODS: Ten tracheal heterotopic transplantations were performed with fresh grafts just after harvesting donors, and 20, with cryopreserved specimens at 2 or 6 weeks after hypothermic storage. Cryopreservation consisted of rapid cooling in the absence of cryoadditives with storage for 2 weeks at -80°C. After rewarming, grafts were transplanted into the abdominal cavity of immunosuppressed rats by being embedded into the greater omentum. Fourteen days later, the implants were removed to examine chondrocyte viability, submucosal swelling, and epithelial patterns in comparison with fresh controls. RESULTS: All allografts retained their macroscopic structure after transplantation. Respiratory epithelium was substituted by planar epithelium only in the frozen transplanted specimens. Fresh transplanted grafts exhibited 100% chondral viability in contrast with 5% viability observed among cryopreserved tracheas after transplantation. CONCLUSIONS: The method of rapid freezing was effective to preserve airway grafts. However, the quality of cryopreserved cartilage was disappointing, similar to that obtained using conventional slow-freezing protocols.

Encefalitis granulomatosa amebaina causada por balamuthia mandrillaris. Presentación de cuatro casos en pediatría / Balamutia amebis granulomatous encephalitis

Las amebas de vida libre comprenden los géneros Naegleria,Acanthamoeba y Balamuthia,que se distribuyen en la naturaleza y pueden causar infeccíon en el sistema nervioso central en niños y adultos.La variedad balamuthia mandrillaris produce una encefalitis granulomatosa amebiana(EGA)de evolución crónica y que afecta a inmunosuprimidos.Se decriben 4 pacientes de edad pediátrica que presentaron esta enfermedad.Todos ellos eran inmunocompetentes.Solo dos de los cuatro niños presentaron lesiones en la cara,que se corresponde con el modo de contagio más frecuente por inmersión en aguas contaminadas.Uno de los niños inició el cuadro clínico con osteomielitis crónica.La evolución en nuestros pacientes fue aguda,con grave compromiso neurológico.No existieron datos significativos o patognomónicos en los exámenes de L.C.R e imágenes de TAC y RM.El diagnóstico se realizó por biopsia de una lesión cerebral,confirmado por inmunofluorescencia.Todos los niños fallecieron a pesar de recibir diversos esquemas terapeúticos.Conclusión:se sugiere considerar la infección por ameba de vida libre en el diagnóstico diferencial de un niño que presenta un cuadro de encefalitis aguda,independiente de si es o no inmunocomprometido

Protección del orificio de salida del Catéter en las actividades acuáticas / Protection of the catheter output in water sports

No disponible

Marcadores biologicos en alcoholicos abstinentes / Biological markers in abstinent alcoholics

Se realizó un estudio descriptivo con la finalidad de conocer las modificaciones de marcadores biológicos en una muestra de alcohólicos abstinentes; se utilizó la historia clínica de dichos pacientes. Las variables estudiadas fueron: edad, sexo, hematíes, VCM, GGT y sideremia. Los resultados destacan la superior especificidad de la sideremia con relación al VCM y GGT, lo cual refuerza el criterio del importante papel de hierro en la fisiopatología de la enfermedad alcohólica. La normalidad de los marcadores estudiados corroboró la utilidad de los mismos no sólo en el diagnóstico del alcoholismo sino en la certeza de abstinencia del paciente alcohólico (AU)

Brown adipose tissue response to cafeteria diet-feeding involves induction of the UCP2 gene and is impaired in female rats as compared to males.

Noradrenaline-dependent brown adipose tissue (BAT) thermogenesis is activated by the cold and excess energy intake, largely depends on the activity of the uncoupling protein 1 (UCP1), and is mediated mainly through the beta3-adrenoceptor (beta3-AR). We investigated the expression of ucp2, a gene that encodes a putative UCP1-like uncoupling protein, along with that of ucp1 and beta3-ar, in the interscapular BAT (IBAT) of male and female rats chronically fed a cafeteria diet. After 3 months on this diet, male rats attained a 34% excess body mass and showed IBAT hypertrophy and increased IBAT thermogenic potential, in terms of both UCP1 and UCP2 mRNA expression (both by 1.6-fold), UCP1 protein expression (by 1.75-fold) and GDP binding to IBAT mitochondria (by 2.2-fold); female rats attained a larger excess body weight (50%) and their IBAT, although hypertrophied, showed no signs of increased thermogenic potential per gram of tissue. Interestingly, the IBAT of female rats was already activated compared to males. Treatment of mouse brown adipocytes in primary culture with noradrenaline also triggered a dose-dependent increase of the levels of UCP1 mRNA and UCP2 mRNA. Retroregulatory down-regulation of the beta3-AR mRNA levels was found in the two models used. The results support a physiological role for UCP2, along with UCP1, in rodent BAT thermogenesis.

Glucose erythrocyte transporter in women with breast cancer: changes in lipid composition of erythrocyte membrane.

Women with breast cancer show altered blood glucose compartmentation compared with healthy women, with lower concentrations in plasma and similar concentrations in blood cells. The goal of this paper was to study whether this pattern was the result of changes in the erythrocyte glucose transporter and, if so, to assess the possible changes in lipid environment of the erythrocyte membrane. In 12 women with different degrees of breast cancer and 12 age-matched healthy women, the lipid composition of erythrocyte membrane and erythrocyte glucose transport were studied. Women with breast cancer showed changes in both the kinetic variables and the lipid environment of the glucose transporter, in keeping with an increase in fluidity of the erythrocyte membrane. The results obtained would account, in part, for the changes in glucose compartmentation.

Sex-associated differences in cold-induced UCP1 synthesis in rodent brown adipose tissue.

The effects of acute and chronic acclimation to cold on uncoupling protein 1 (UCP1) levels, as well as on GDP-binding to mitochondria, cytochrome c oxidase activity and mitochondrial protein concentration in brown adipose tissue (BAT) of intact male and female rats have been analyzed. Results reveal that females rats are more sensitive to cold because their threshold temperature for the thermogenic response is set at a higher value (around 22 degreesC) than that of males (around 18 degreesC), hence leading to differences in BAT UCP1 levels between the sexes at different environmental temperatures. In vitro experiments showed that steroid hormones, beta-estradiol, estrone and progesterone, can reduce norepinephrine-induced UCP1 synthesis in brown adipocytes differentiated in primary culture. Thus the different sex-associated response of cold-induced thermogenesis in rats does not appear to be explained by a direct action of sex steroids upon the adipocyte, implying that other factors in the thermogenic regulatory system must be involved.

Changes induced by fasting and dietetic obesity in thermogenic parameters of rat brown adipose tissue mitochondrial subpopulations.

The effects of starvation on the thermogenic parameters of three different mitochondrial subpopulations in brown adipose tissue (BAT) of both post-cafeteria obese and lean rats were investigated. Tissue from different BAT depots from fed and 24 h starved rats were collected, pooled and three mitochondrial subpopulations were isolated by differential centrifugation; the M1 fraction (1000 g), the M3 fraction (3000 g) and the M15 fraction (15,000 g). Thermogenic parameters were measured in the three mitochondrial subtypes, and uncoupling protein (UCP) mRNA was determined in BAT. The results showed that starvation induced a decrease in mitochondrial turnover in BAT from both lean and obese rats. Moreover, a selective net loss of UCP from the lightest mitochondrial fraction (M15) in lean rats, with a concomitant reduction of UCP mRNA was observed. The reductions did not occur in obese rats and, as a result, a change in UCP distribution between the mitochondrial subpopulations was produced, with an increase in the M1 mitochondrial subtype. The lack of response of UCP to starvation observed in BAT of obese rats compared with the decrease seen in lean animals, is a consequence of a different mitochondrial subpopulation composition and/or a different response of a particular subpopulation to starvation.

[Traumatic hemothorax treated by video-assisted thoracoscopic surgery]. / Hemotórax traumático tratado mediante cirugía toracoscópica videoasistida.

The introduction of video-assisted thoracic surgery (VTS) has significantly furthered the use of the thoracoscope in surgery. In the case we describe, a 79-years-old man at high risk for surgery came to our hospital with hemothorax due to trauma. The necessary procedure was performed successfully with VTS, which allowed for the repair of an acute condition that would otherwise have been treated conventionally by way of posterolateral thoracotomy. We conclude that VTS may play an important role in the diagnosis and treatment of certain thoracic injuries, so that surgery involving more extensive bleeding is rendered unnecessary.

Criteria for selecting the side for cochlear implantation.

Choice of the side for cochlear implantation should take into account peripheral (extracortical) factors and central (cerebral dominance) factors. From 111 patients implanted with a Nucleus device, the authors found that significant peripheral factors were the degree of cochlear ossification, the duration of deafness before cochlear implantation, and the preoperative promontory test dynamic range (degree of response on the promontory test in decibels); cause of deafness and residual hearing were not correlated with speech discrimination. Cerebral dominance was indirectly determined by handedness. Handedness laterality was determined by a questionnaire. There was no significant difference in results between patients implanted on their dominant side and patients implanted on their nondominant side. When ears are different according to their peripheral factors, the authors suggest implanting the better ear, provided there is no significant hearing in that ear. When both ears are identical, the side of implantation should be the side of handedness laterality to facilitate device manipulation (a practical reason).