Candida tropicalis infectious endocarditis in a dog with a patent ductus arteriosus.

A 6-month-old male intact miniature Australian Shepherd presented for surgical consultation for a previously diagnosed patent ductus arteriosus. Echocardiogram revealed a patent ductus arteriosus and a hyperechoic oscillating lesion within the main pulmonary artery. Blood cultures and eventual post-mortem examination revealed Candida tropicalis endocarditis. This case report highlights a rare case of fungal endocarditis with both echocardiographic and post-mortem findings.

Respuesta a rehabilitación pulmonar en mujeres con EPOC: comparación entre enfermedad asociada a humo de leña y cigarrillo / Response to pulmonary rehabilitation in women with COPD: Comparison between disease associated with wood smoke and cigarette

Introducción: La enfermedad pulmonar obstructiva crónica es una entidad de alta morbimortalidad que principalmente se genera por exposición a consumo de cigarrillo y exposición a humo de leña; estudios previos han demostrado creciente interés entre los 2 tipos de exposición. Objetivo: Comparar el efecto de la rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica que han tenido exposición a cigarrillo versus pacientes expuestos a humo de leña por biomasa en una clínica de cuarto nivel en Santiago de Cali (Colombia). Materiales y métodos: Estudio prospectivo y longitudinal, se reclutaron a todos los pacientes que asistieron durante enero de 2016 a diciembre de 2017 y cumplieron con los criterios de inclusión; posteriormente se dividieron en 2 grupos: humo de leña y cigarrillo. Se registraron pruebas de función pulmonar, evaluación de calidad de vida relacionada de la salud, valoración de síntomas y comparación de capacidad aeróbica funcional con test de caminata de 6 minutos y consumo de oxígeno estimado antes y después de rehabilitación. Resultados: Quince pacientes con exposición a leña y 17 a cigarrillo culminaron la rehabilitación. En la comparación intragrupo, se encontraron diferencias significativas (p<0,05) en la distancia recorrida, en la escala modificada de disnea del Medical Research Council (mMRC) y en el consumo de oxígeno estimado, también en el Saint George Respiratory Questionnaire. En la comparación entre grupos no se encontraron diferencias en las variables estudiadas. Conclusión: La rehabilitación pulmonar generó cambios clínicos significativos en las variables estudiadas en los 2 tipos de exposición, al ser estos cambios similares en los 2 grupos estudiados en la presente investigación. (AU)

Introduction: Chronic obstructive pulmonary disease is an entity with high morbidity and mortality that is mainly generated by exposure to cigarette smoking and exposure to wood smoke; previous studies have shown increasing interest between the 2 types of exposure. Objective: To compare the effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease who have had exposure to cigarettes versus patients exposed to biomass wood smoke in a fourth level clinic in Santiago de Cali (Colombia). Materials and methods: Prospective and longitudinal study, all patients who attended from January 2016 to December 2017 were recruited and met the inclusion criteria, later they were divided into 2 groups: Wood Smoke and Cigarette. Pulmonary function tests, health-related quality of life assessment, symptom assessment and comparison of functional aerobic capacity were recorded with the six-minute walk test and estimated oxygen consumption before and after rehabilitation. Results: Fifteen patients with exposure to wood smoke and 17 to cigarettes completed the rehabilitation. In the intragroup comparison, significant differences (P<.05) were found in the distance traveled, in modified Medical Research Council dyspnea scale (mMRC) the estimated oxygen consumption, also in the Saint George Respiratory Questionnaire. In the comparison between groups, no differences were found in the variables studied. Conclusion: Pulmonary rehabilitation generated clinics changes significant in the variables studied in the 2 types of exposure; these changes being similar in the 2 groups studied in the present investigation. (AU)

Lesions Observed Post Mortem in Post-hatchling Loggerhead Sea Turtles (Caretta caretta) from a Head Start Programme.

Head start programmes are ex-situ conservation procedures consisting of the captive rearing of sea turtle hatchlings for several months in order to avoid high mortality rates in the first year of life. Studies of the diseases of hatchling and post-hatchling turtles belonging to these programmes are scarce. We describe the gross and histological lesions found in 78 post-hatchling loggerhead sea turtles (Caretta caretta) that died during captive rearing in the conservation programme of the Cape Verde-Canary Islands, initiated with 113 hatchlings. The main organ systems affected were respiratory (57.69%), integumentary (41.02%) and digestive (41.02%), affecting 94.87% of the animals. Other less frequently affected organ systems were cardiovascular (3.85%), excretory (3.85%), muscular (2.56%) and reproductive (1.28%). The most common lesions were different types of dermatitis (41.02%), mainly ulcerative and/or heterophilic ulcerative dermatitis; these lesions were compatible with a traumatic origin caused by biting and subsequent infection with gram-positive cocci. Purulent and/or fibrinonecrotizing rhinitis associated with mixed populations of bacteria were commonly detected respiratory lesions (21.79%). Acute interstitial pneumonia was the most common form of pneumonia diagnosed (20.51%). Fibrinonecrotizing stomatitis associated with sparse gram-negative rods was the most common digestive tract lesion (29.49%). A possible explanation for the high mortality rate (88.50%) observed in this study could be the occurrence of a decrease in water temperature during the growth phase of the turtles. Despite the limitations caused by an absence of microbiological studies, the survey provides useful information on the lesions found in post-hatchling loggerhead turtles from this head start programme. In addition to maintaining water temperature above 20°C, attention must be paid to lesions that can easily be detected, such as dermatitis, rhinitis and stomatitis.

Conocimiento y creencias sobre infección por clamidia en población joven. Revisión narrativa / Knowledge and beliefs about chlamydia infection in a young population. Narrative review

RESUMEN Introducción: La Chlamydia trachomatis es una de las infecciones de transmisión sexual más comunes en la población menor de 25 años, causante de graves problemas para la salud pública y la calidad de vida de las personas. Objetivo: Describir el conocimiento y creencias en la población joven entre 15 y 25 años, en relación a la infección por Clamidia, enmarcado en el contexto chileno e internacional. Métodos: Revisión narrativa que incluye 14 artículos cualitativos y cuantitativos de los últimos 10 años, en idioma inglés y español. Resultados: Existe desconocimiento sobre la infección por Clamidia, en cuanto a las características clínicas, el medio de transmisión y las pruebas diagnósticas, lo que genera que la población joven subestime el riesgo percibido y aumente conductas sexuales riesgosas. Por otro lado, se observa que el conocimiento aumenta de forma proporcional a la edad de la población, nivel educacional e historia previa de ITS. Conclusión: El déficit de conocimientos frente a las conductas sexuales de riesgo en la población joven favorece a un aumento en la prevalencia la infección por Clamidia, por lo cual es de suma importancia realizar nuevos estudios con el fin de aportar datos para potenciar programas de salud orientados a la concientización de los jóvenes frente a esta infección para así lograr disminuir la incidencia de esta enfermedad y sus complicaciones.

SUMMARY Introduction: Chlamydia trachomatis is one of the most common sexually transmitted infections in the population under 25 years old, causing serious problems for public health and the people's quality of life. Objective: Describe the knowledge and beliefs in the young population between 15 and 25 years old, related to Chlamydia infection in the Chilean and international context. Methods: Narrative review that includes qualitative and quantitative articles of the last 10 years, published in English and Spanish. Results: There is a lack of knowledge about Chlamydia infection, in the clinical characteristics, the transmission, and in the diagnostic tests, which causes the young population to underestimate the perceived risk and increase risky sexual behaviors. On the other hand, it is observed that knowledge increases proportionally to the population's age, educational level, and previous history of STIs. Conclusion: The lack of knowledge about risky sexual behavior in young population increase the prevalence of Chlamydia infection, due to this generates risky behaviors in the population, due to this, it is very important to conduct new studies in order to provide data to promote health programs oriented to raising awareness of young people against this infection and thus achieve to reduce the incidence of this disease and complications.

Fecal pollution source tracking and thalassogenic diseases: The temporal-spatial concordance between maximum concentrations of human mitochondrial DNA in seawater and Hepatitis A outbreaks among a coastal population.

Fecal pollution source tracking (FST) studies the origin of fecal contamination and promotes action to eliminate it to improve human health and environmental sustainability. This work presents the temporal and spatial relations of human mitochondrial DNA (HmtDNA), fecal coliforms (FC) and live microbial biomass (ATP) in seawater during a hepatitis A outbreak among a human coastal population. The study area is approximately 100 km along the coastline of the Biobío Region in the southeastern Pacific (Humboldt Current System, Chile). Total data from the swash zone from summer 2015 to autumn 2016 show there were significant positive log-log correlations between FC and HmtDNA (R = 0.32) and ATP (R = 0.31). These correlations were highest during the austral spring of 2015 (R = 0.53 and 0.58 respectively), when HmtDNA also correlated significantly with ATP (R = 0.86). Maximum average values of the parameters measured in this season showed a temporal-spatial concordance with the peak in the number of hepatitis A cases among the nearby coastal population. FC correlated significantly with HmtDNA (R = 0.98) in the water column of the coastal zone close to Concepción Bay during the austral summer of 2016 and in the swash zone of the bay (R = 0.68) throughout the study period. Hepatitis A virus (HAV) has also been detected in organisms and seawater in Concepción Bay, which is consistent with the high incidence of hepatitis A among the coastal population. The concordance between human fecal pollution in the study area and a seasonal hepatitis A outbreak strongly suggests that HmtDNA and its relation with FC and ATP in the coastal zone of marine environments can be used as a proxy to evaluate the risk of outbreaks of thalassogenic diseases.

Enhancement of VP6 immunogenicity and protective efficacy against rotavirus by VP2 in a genetic immunization.

VP2/VP6 virus like particles (VLPs) are very effective in inducing protection against the rotavirus infection in animal models. Individually, VP6 can also induce protection. However, there is no information about the immunogenicity of VP2. The aim of this work was to evaluate the efficacy of DNA vaccines codifying for VP2 or VP6, alone or combined, to induce protection against the rotavirus infection. Murine rotavirus VP2 and VP6 genes were cloned into the pcDNA3 vector. Adult BALB/c mice were inoculated three times by intramuscular (i.m.) injections with 100 or 200µg of pcDNA3-VP2 or pcDNA3-VP6 alone or co-administered with 100µg of pcDNA3-VP2/100µg of pcDNA3-VP6. Two weeks after the last inoculation, mice were challenged with the wild type murine rotavirus strain epizootic diarrhea of infant mice (EDIMwt). We found that both plasmids, pcDNA3-VP2 and pcDNA3-VP6, were able to induce rotavirus-specific serum antibodies, but not intestinal rotavirus-specific IgA; only 200µg of pcDNA3-VP6 induced 35% protection against the infection. A similar level of protection was found when mice were co-administered with 100µg of pcDNA3-VP2/100µg of pcDNA3-VP6 (1:1 ratio). However, the best protection (up to 58%) occurred when mice were inoculated with 10µg of pcDNA3-VP2/100µg of pcDNA3-VP6 (1:10 ratio). These results indicate that the DNA plasmid expressing VP6 is a better vaccine candidate that the one expressing VP2. However, when co-expressed, VP2 potentiates the immunogenicity and protective efficacy of VP6.

Oral mucous membrane pemphigoid and pemphigus vulgaris-a retrospective two-center cohort study.

OBJECTIVES: Few studies have compared oral mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). Descriptive analysis of oral features, extent of extra-oral involvement, and management outcomes were performed. SUBJECTS AND METHODS: Patients with PV and MMP, the latter with exclusive oral involvement at first presentation, were included. RESULTS: There were 26 MMP (46%) and 31 PV (54%) patients. Desquamative gingivitis was evident in 84% of MMP cases compared to 28% of PV cases (P < 0.05). Non-gingival lesions were noted in 6% of MMP cases compared to 55% of PV cases (P < 0.01). Management of MMP consisted of only topical corticosteroids in 88% of cases while 12% of cases required concomitant systemic therapy. All PV cases (100%) required systemic therapy. No patients with MMP developed scarring or ocular lesions, and one patient (4%) developed cutaneous lesions. Five PV cases (16%) had oral cavity involvement only with three (60%) developing pharyngeal involvement and two (40%) developing cutaneous lesions on follow-up. CONCLUSION: Oral MMP presents primarily as desquamative gingivitis, infrequently involving extragingival sites, and is highly amenable to topical therapy, while PV is a systemic mucocutaneous disease with extensive non-gingival oral lesions that almost always requires systemic therapy.

Factores de riesgo cardiovascular en la población Aymara rural del norte de Chile / Prevalence of cardiovascular risk factors in a rural Aymara population from northern Chile

Background: Some rural non-Caucasian ethnic groups have genetic protective factors for the development of chronic non-communicable diseases. Studies performed in Mapuche and Aymara ethnic groups in Chile, found significantly lower prevalence rates. Aymaras are the second most common ethnic population in Chile. Aim: To determine the prevalence of cardiovascular risk factors in a native Aymara ethnic population. Material and Methods: We studied 276 native Aymara people with a median age of 53 years (63% women), registered in the rural clinics of Camiña and Putre. The frequency of hypertension, Type 2 Diabetes Mellitus (DM2), dyslipidemia, overweight, obesity and smoking were determined. Results: The frequency of overweight and obesity was 38% and 38.4% respectively. The prevalence of hypertension and DM2 were 18.5% and 6.9% respectively. Thirty-five percent had elevated total cholesterol, 21% had high LDL cholesterol, 48% had low HDL cholesterol and 45.7% had high triglyceride levels. Two percent smoked. Conclusions: In this group of Aymara individuals, we found a markedly lower prevalence of hypertension and DM2, despite the high prevalence of obesity and dyslipidemia.

[Prevalence of cardiovascular risk factors in a rural Aymara population from northern Chile]. / Factores de riesgo cardiovascular en la población Aymara rural del norte de Chile.

BACKGROUND: Some rural non-Caucasian ethnic groups have genetic protective factors for the development of chronic non-communicable diseases. Studies performed in Mapuche and Aymara ethnic groups in Chile, found significantly lower prevalence rates. Aymaras are the second most common ethnic population in Chile. AIM: To determine the prevalence of cardiovascular risk factors in a native Aymara ethnic population. MATERIAL AND METHODS: We studied 276 native Aymara people with a median age of 53 years (63% women), registered in the rural clinics of Camiña and Putre. The frequency of hypertension, Type 2 Diabetes Mellitus (DM2), dyslipidemia, overweight, obesity and smoking were determined. RESULTS: The frequency of overweight and obesity was 38% and 38.4% respectively. The prevalence of hypertension and DM2 were 18.5% and 6.9% respectively. Thirty-five percent had elevated total cholesterol, 21% had high LDL cholesterol, 48% had low HDL cholesterol and 45.7% had high triglyceride levels. Two percent smoked. CONCLUSIONS: In this group of Aymara individuals, we found a markedly lower prevalence of hypertension and DM2, despite the high prevalence of obesity and dyslipidemia.

Foro de debate: seguridad de las alternativas a la transfusión alogénica en el paciente quirúrgico y/o crítico / Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient

Estos últimos años han aparecido alertas de seguridad, no siempre bien sustentadas, que cuestionan el uso de algunas alternativas farmacológicas a la transfusión de sangre alogénica y/o lo restringen en indicaciones establecidas. Asistimos también a la preconización de otras alternativas, incluyendo productos hemáticos y fármacos antifibrinolíticos, sin que haya una base científica sólida que lo justifique. Por iniciativa del Grupo de Estudios Multidisciplinares sobre Autotransfusión y del Anemia Working Group España se reunió a un panel multidisciplinar de 23 expertos del área de cuidados de la salud en un foro de debate para: 1) analizar las diferentes alertas de seguridad en torno a ciertas alternativas a la transfusión; 2) estudiar los antecedentes que las han propiciado, la evidencia que las sustentan y las consecuencias que conllevan para la práctica clínica, y 3) emitir una valoración argumentada de la seguridad de cada alternativa a la transfusión cuestionada, según el uso clínico de la misma. Los integrantes del foro mantuvieron contactos por vía telemática y una reunión presencial en la que presentaron y discutieron las conclusiones sobre cada uno de los elementos examinados. Se elaboró un primer documento que fue sometido a 4 rondas de revisión y actualización hasta alcanzar un consenso, unánime en la mayoría de los casos. Presentamos la versión final del documento, aprobada por todos los miembros del panel, esperando sea de utilidad para nuestros colegas

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues

Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient.

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.

Targeting of rotavirus VP6 to DEC-205 induces protection against the infection in mice.

Rotavirus (RV) is the primary etiologic agent of severe gastroenteritis in human infants. Although two attenuated RV-based vaccines have been licensed to be applied worldwide, they are not so effective in low-income countries, and the induced protection mechanisms have not been clearly established. Thus, it is important to develop new generation vaccines that induce long lasting heterotypic immunity. VP6 constitutes the middle layer protein of the RV virion. It is the most conserved protein and it is the target of protective T-cells; therefore, it is a potential candidate antigen for a new generation vaccine against the RV infection. We determined whether targeting the DEC-205 present in dendritic cells (DCs) with RV VP6 could induce protection at the intestinal level. VP6 was cross-linked to a monoclonal antibody (mAb) against murine DEC-205 (αDEC-205:VP6), and BALB/c mice were inoculated subcutaneously (s.c.) twice with the conjugated containing 1.5 µg of VP6 in the presence of polyinosinic-polycytidylic acid (Poly I:C) as adjuvant. As controls and following the same protocol, mice were immunized with ovalbumin (OVA) cross-linked to the mAb anti-DEC-205 (αDEC-205:OVA), VP6 cross-linked to a control isotype mAb (Isotype:VP6), 3 µg of VP6 alone, Poly I:C or PBS. Two weeks after the last inoculation, mice were orally challenged with a murine RV. Mice immunized with α-DEC-205:VP6 and VP6 alone presented similar levels of serum Abs to VP6 previous to the virus challenge. However, after the virus challenge, only α-DEC-205:VP6 induced up to a 45% IgA-independent protection. Memory T-helper (Th) cells from the spleen and the mesenteric lymph node (MLN) showed a Th1-type response upon antigen stimulation in vitro. These results show that when VP6 is administered parenterally targeting DEC-205, it can induce protection at the intestinal level at a very low dose, and this protection may be Th1-type cell dependent.