Efectos de un programa de ejercicio neuromuscular en la condición física del adulto mayor de la comunidad: ensayo clínico aleatorizado en grupos paralelos y ciego doble / Effects of a neuromuscular exercise program on the physical condition of the older adult in the community: randomized clinical trial in parallel groups and double blind

OBJETIVO: Comparar los efectos de un programa de ejercicio neuromuscular (ENM) respecto a un programa de ejercicio municipal (EM) sobre la condición física en adultos mayores de la comunidad. Metodología: Ensayo clínico aleatorizado en grupos paralelos y ciego doble. Muestra constituida por 82 sujetos, edad X = 72 años (DE = +/-5 años) pertenecientes a la Casa del Adulto Mayor de la ciudad de Talca. La selección fue de manera no probabilística por conveniencia, la asignación a los grupos mediante aleatorización estratificada y el ocultamiento de la asignación por medio de sobres cerrados. El cegamiento doble fue para los participantes y los evaluadores. Ambos grupos realizaron ejercicio en paralelo durante seis meses, tres veces a la semana. Las comparaciones inter-grupo de la condición física fueron analizados por medio de ANOVA multivariante de un factor. En todos los casos se adoptó un p < 0.05 y se utilizó SPSS 25.Resultados: Los sujetos del grupo ENM lograron significativamente un mejor rendimiento en todas las variables de condición física respecto al grupo EM (p < 0.05). Conclusión: El ENM mejoró significativamente la condición física de adultos mayores de la comunidad respecto a la aplicación de un programa de ejercicio municipal.

OBJECTIVE: To compare the effects of a neuromuscular exercise program (ENM) with respect to a municipal exercise program (EM) on the physical condition of older adults in the community. Methodology: Double blind, parallel group randomized clinical trial. Sample made up of 82 subjects, age X = 72 years (SD = +/- 5 years) belonging to the House for the Elderly in the city of Talca. Selection was non-probabilistic for convenience, group assignment by stratified randomization, and allocation concealment by sealed envelopes. Double blinding was for participants and assessors. Both groups exercised in parallel for 6 months, 3 times a week. The inter-group comparisons of physical condition were by means of one-way multivariate ANOVA. In all cases a p <0.05 was adopted and SPSS 25 was used. Results: The subjects of the ENM group achieved significantly better performance in all the physical condition variables compared to the EM group (p <0.05). Conclusion: The ENM significantly improved the physical condition of older adults in the community with respect to the application of a municipal exercise program.

Psicooncología en cáncer avanzado. Terapia CALM, una intervención canadiense / Psychooncology in advanced cancer. CALM therapy, a canadian intervention

Resumen El cáncer avanzado está asociado a numerosos desafíos incluyendo el deterioro físico progresivo que gatilla miedos referentes a la dependencia y pérdida de autonomía, mortalidad y sentido de la vida. El continuo aumento de la sobrevida en los pacientes oncológicos ha llevado a que estos vivan en un proceso de adaptación y cambios continuos, lo que conlleva una gran carga emocional tanto para el paciente como para su familia. Muchos pacientes oncológicos en fase terminal cumplen criterios para un diagnóstico psiquiátrico y signos de distrés, siendo los síntomas depresivos muy frecuentes. Esto nos hace pensar en la necesidad imperiosa de intervenciones adecuadas para personas en esta situación, en donde las cuestiones existenciales, reestructuración del propósito, relaciones interpersonales, sentido de la vida, proceso de morir y muerte, cumplen un rol fundamental. El objetivo de este trabajo es describir la experiencia canadiense de una terapia psicológica individual breve denominada Managing Cancer And Living Meaningfully (CALM), que ha sido realizada y evaluada durante los últimos 10 años en Toronto, Canadá, con el objetivo de reducir el malestar emocional y promover el bienestar psicológico en pacientes con cáncer avanzado. Este artículo describe sus principales componentes, características y evidencia de su beneficio para esta población.

Advanced cancer is associated with numerous challenges including progressive physical deterioration that triggers fears regarding dependence and loss of autonomy, mortality and meaning of life. The continuous increase in survival in oncology patients has led them to live in a process of adaptation and continuous changes, which carries a great emotional burden for both the patient and his or her family. Many terminal cancer patients meet criteria for a psychiatric diagnosis or sign distress, with depressive symptoms being very frequent. This makes us think of the imperative need for appropriate interventions for people in this situation, where existential issues, restructuring of purpose, interpersonal relationships, meaning of life and the process of dying and death play a fundamental role. The aim of this work is to describe a Canadian experience of a brief individual psychological therapy called Managing Cancer and Living Meaningfully (CALM), which was developed and evaluated over the last 10 years in Toronto. CALM Therapy was designed to reduce distress and promote psychological well-being in patients with advanced cancer; this article will describe its main components, characteristics and evidence of its benefit for this population.

Hipomanía y corticoides en pacientes oncológicos. Reporte de un caso y revisión de la literatura / Hypomania and corticoids in oncological patients. Case report and literature review

Resumen Introducción: Cada año aumenta el número de personas que padece algún tipo de cáncer. Los corticoides son ampliamente utilizados en el tratamiento de los pacientes con cáncer y su uso no está exento de efectos adversos, muchas veces muy invalidantes. Objetivo: Presentar un caso clínico de un brote hipomaníaco en una paciente con cáncer de ovario usuaria de corticoides y realizar una revisión de la literatura del tema. Caso clínico: Paciente, portadora de un cáncer de ovario avanzado, tratado con cirugía y quimioterapia, debuta con episodios de vómitos que son manejados con dexametasona. Durante el tratamiento presenta insomnio, verborrea e ideas de grandiosidad, diagnosticándose un brote hipomaniaco secundario al tratamiento esteroidal. Discusión: En el caso de los pacientes oncológicos, e independientemente del uso de corticoides, aproximadamente el 50% de ellos presentará algún tipo de sintomatologia psiquiátrica, ahora bien, si a esto agregamos el uso de corticoides la incidencia puede aumentar hasta un 65% - 75%. La hipomanía da cuenta prácticamente del 50% de los trastornos psiquiátricos inducidos por corticoides. Con dosis menores de 40 mg/día sólo el 2% de los pacientes se verá afectado por este tipo de trastornos, mientras que con dosis entre 40 a 80 mg/día esta incidencia aumenta hasta un 5%. Conclusión: Los corticoides son ampliamente utilizados en pacientes oncológicos, sin embargo, su uso puede provocar trastornos psiquiátricos. Es importante dar a conocer más al equipo sanitario referente a la asociación de corticoides y cuadros psiquiátricos para su rápida detección y manejo clínico.

Introduction: Every year the number of people affecting by cancer increase. Corticosteroids are widely used in the treatment of patients with cancer and their use is not without adverse effects, often very disabling. Objective: Present a clinical case of hypomanic outbreak in a patient with ovarian cancer using corticosteroids and to carry out a review of the literature on the subject. Clinical case: Patient with an advanced ovarian cancer, treated with surgery and chemotherapy, debuts with episodes of vomiting that are managed with dexamethasone. During the treatment he presented insomnia, verbiage and grandiosity, diagnosing a hypomanic outbreak secondary to steroidal treatment. Discussion: In cancer patients, and independently of the use of corticosteroids, approximately 50% of them will present some type psychiatric disorder. With corticosteroids the incidence can increase up to 65%-75%. Hypomania accounts for almost 50% of psychiatric disorders induced by corticosteroids. With doses lower than 40 mg/day only 2% of patients will be affected by this type of disorders, while with doses between 40 to 80 mg/day this incidence increases up to 5%. Conclusion: Corticosteroids are widely used in cancer patients, however their use can cause psychiatric disorders. It is important to make the healthcare team more aware of the association of corticosteroids and psychiatric symptoms for rapid detection and clinical management.

[The influence of pedagogic and discipline training on the teaching quality of university professors]. / ¿Se relaciona la capacitación docente con las prácticas pedagógicas en académicos de carreras de la salud de Chile?

BACKGROUND: University teachers prioritize acquiring knowledge about their disciplines over pedagogic training. However, the latter is becoming increasingly important in the present teaching scenario. AIM: To relate pedagogic practices with pedagogic training of teachers from health care careers of public and private universities. MATERIAL AND METHODS: Pedagogic practice and training activities participation questionnaires were answered by 296 teachers of undergraduate students from Chilean public and private universities. RESULTS: There was a direct correlation between discipline training and all pedagogic practice factors. However, pedagogic training correlated with all the factors with the exception of teacher centered learning. Teachers with a master degree had higher scores in factors related to teaching planning and process assessment. Having a doctor degree had no impact on these factors. A multiple regression analysis showed that both discipline and pedagogic training and having a master degree were associated with pedagogic practices of teachers. CONCLUSIONS: Both pedagogic and discipline training influence the quality of teaching provided by undergraduate teachers.

¿Se relaciona la capacitación docente con las prácticas pedagógicas en académicos de carreras de la salud de Chile? / The influence of pedagogic and discipline training on the teaching quality of university professors

Background: University teachers prioritize acquiring knowledge about their disciplines over pedagogic training. However, the latter is becoming increasingly important in the present teaching scenario. Aim: To relate pedagogic practices with pedagogic training of teachers from health care careers of public and private universities. Material and Methods: Pedagogic practice and training activities participation questionnaires were answered by 296 teachers of undergraduate students from Chilean public and private universities. Results: There was a direct correlation between discipline training and all pedagogic practice factors. However, pedagogic training correlated with all the factors with the exception of teacher centered learning. Teachers with a master degree had higher scores in factors related to teaching planning and process assessment. Having a doctor degree had no impact on these factors. A multiple regression analysis showed that both discipline and pedagogic training and having a master degree were associated with pedagogic practices of teachers. Conclusions: Both pedagogic and discipline training influence the quality of teaching provided by undergraduate teachers.

Seroprevalence and risk factors associated with within-flock transmission of Leptospira interrogans in transhumant farming systems in Mexico.

A number of recent reports emphasize the risk of zoonotic diseases and the high degree of prevalence of asymptomatic animals infected with Leptospira interrogans. This report sought to assess the prevalence of antibodies to certain serovars of L. interrogans, and to describe the association between seropositivity and risk factors associated with within-flock transmission in a mountainous region of Mexico. Overall seroprevalence to L. interrogans was 54·5% (95% confidence interval 48·3-60·7); the most frequent serovar was Icterohaemorrhagiae. The accumulation of placentas and fetuses at a site close to lambing paddocks can play a significant role as a risk factor for within-flock transmission of L. interrogans in transhumant farming systems in the municipality of Xalatlaco. The high prevalence of L. interrogans antibodies supports the hypothesis that natural foci of this zoonosis are present in sheep flocks in this area. These findings emphasize the need for planning and implementation of control programmes for ovine leptospirosis in Mexico and elsewhere.

Evaluación prospectiva de paratiroidectomías en el tratamiento del hiperparatiroidismo secundario / Parathyroidectomy for secondary hyperparathyroidism in chronic renal failure

Background: Parathyroidectomy is indicated in patients with chronic renal failure and secondary hyperparathyroidism that is persistent and refractory to treatment. Aim: To assess the effects of parathyroidectomy in patients with chronic renal failure and symptomatic hyperparathyroidism. Patients and Methods: Prospective evaluation of 33 patients (20 females), aged between 23 and 78 years, with chronic renal failure and secondary hyperparathyroidism that were subjected to a total parathyroidectomy and autotrasplantation. Patients were followed for six months measuring parathormone (PTH), calcium and phosphorus. Results: In the postoperative period, one patient had a cervical hematoma that had to be operated. Mean serum PTH levels at the moment of hospital discharge and at six months, were 832 and 212 pg/ml respectively. All patients that had bone pain experienced a notable reduction of this symptom on the morning after surgery. One patient had a relapse of her hyperparathyroidism. Conclusions: Parathyroidectomy is safe and effective for secondary hyperparathyroidism in patients with chronic renal failure.

En los pacientes con insuficiencia renal crónica terminal con hiperparatiroidismo severo persistente y refractarios al tratamiento médico, está indicada la paratiroidectomía. El objetivo de este estudio es caracterizar una población y evaluar los efectos clínicos de la paratiroidectomía efectuada en pacientes con insuficiencia renal crónica terminal con sintomatología importante de hiperparatiroidismo y determinar la recurrencia de la enfermedad posterior a la cirugía. Se realizó un estudio prospectivo observacional de pacientes con hiperparatiroidismo, secundario a insuficiencia renal, que ingresaron al subdepartamento de cirugía del Hospital Base de Valdivia, entre abril de 1999 y noviembre de 2006 y que participaron voluntariamente en un protocolo preestablecido. La serie incluye a 33 pacientes, 20 mujeres y 13 hombres, con promedio de edad de 43 años y extremos de 23 y 78 años, que fueron sometidos paratiroidectomía subtotal o total más autotrasplante. En el postoperatorio un enfermo presentó un hematoma cervical, que ameritó una reintervención quirúrgica, con evolución posterior satisfactoria. Los niveles de PTH al ingreso y a los 6 meses de operados los pacientes, fue en promedio de 832 pg/ml y 212 pg/ml respectivamente. Todos los pacientes que manifestaron dolor óseo como síntoma principal, advirtieron una notable disminución subjetiva del dolor a la mañana siguiente de la cirugía. Un paciente (3 por ciento) evolucionó hacia la recidiva de su hiperfunción paratiroidea. Concluimos que la paratiroidectomía es un procedimiento seguro, que resulta efectivo para aliviar rápidamente la sintomatología que afecta a este tipo de pacientes y que el porcentaje de recidiva que hemos constatado en un seguimiento a seis meses postoperatorio es bajo.

Prevalencia de fisura labiopalatina e indicadores de riesgo: Estudio de la población atendida en el Hospital Clínico Félix Bulnes de Santiago de Chile / Prevalence of cleft lip and palate and risk indicators: Study of the reference population of Felix Bulnes University Hospital, Santiago de Chile

Introducción. El estudio de la prevalencia de fisuras labiopalatinasy la determinación de indicadores de riesgo ayuda a prevenir su ocurrenciamejorando las condiciones durante la concepción o gestación. Tambiénfavorece diagnósticos precoces que atenúan el impacto emocionalfavoreciendo el apego madre-hijo y mejorando la respuesta materna al tratamiento.Ambas situaciones permiten optimizar y focalizar los recursossanitarios disponibles. Material y Método. Se determinó la incidencia defisuras labiopalatinas y la asociación a factores de riesgo en los RNV beneficiariosdel Hospital Clínico Félix Bulnes de Santiago de Chile entre enerodel año 1998 y junio del 2005. Se estudió además condiciones y exposiciónmaternas a agentes ambientales asociados a fisura labial y/o palatina.Resultados. Sobre un total de 36.041 RNV consecutivos, se registraron51 casos de fisurados, obteniéndose una tasa de 1,42 x 1000 RNV. Conclusiones.Los indicadores de riesgo identificados correspondieron a edadmaterna menor a veinte años asociado al primer embarazo; alto gradode etnicidad amerindia e historia familiar positiva para este tipo de malformación.Nuestro estudio apoya la teoría de herencia multifactorial de lasusceptibilidad a las fisuras labiopalatinas(AU)

Introduction. The study of the prevalence of cleft lip andpalate and the identification of risk groups helps to improve thetreatment of this condition. Occurrence may be prevented byimproving environmental conditions during pregnancy and ensuringearly diagnosis, thus lessening the emotional impact on the familyand reinforcing the early mother-child bond. The aim of this studywas to improve prevention levels and thus enhance health resources.Material and Method. The frequency of cleft lip and palate and itsassociation with risk factors was studied in live births of the FelixBulnes University Hospital in Santiago between January 1998 andJune 2005. Maternal conditions and exposure to environmentalagents associated with cleft lip and/or palate were examined. Results.Out of a total of 36,041 births, 51 cases of cleft lip and palate werefound, which yielded a rate of 1.42 x 1000 births. Conclusions.Analysis of risk indicators identified: mothers under the age of 20years, usually with their first pregnancy, a high degree of Amerindianadmixture and family history positive for this malformation. Ourstudy supports the multifactorial inheritance theory of susceptibilityto cleft lip and palate(AU)

Herida penetrante cardíaca / Cardiac penetrating wound

Las primeras descripciones de una lesión cardiaca se remontan al papiro de Edwin Smith alrededor del 3000 AC. Hasta el siglo IX, las heridas penetrantes cardiacas eran consideradas intratables y mortales. Fue en 1896, cuando se reportó la primera reparación cardiaca exitosa. Aunque la mortalidad ha disminuido con el paso del tiempo, una herida penetrante al corazón sigue teniendo un grave pronóstico y es causa importante de morbilidad y mortalidad en pacientes de trauma. En la actualidad, cada vez se ven con más frecuencia las heridas penetrantes cardiacas por arma de fuego, lo que indudablemente ensombrece aún más el pronóstico de estas lesiones, por lo que se torna de vital importancia para el cirujano que trabaja en una Unidad de Emergencia, conocer con exactitud los mecanismos fisiopatológicos que se ven involucrados en este tipo de situaciones, además de todas las complicaciones que pueden ocurrir al intentar reparar una herida penetrante cardiaca. Este artículo pretende dar una visión precisa, clara y actual del manejo de un paciente con una herida penetrante cardiaca.

Nódulo pulmonar solitario: desafío diagnóstico y terapéutico / Solitary pulmonary nodule: a challenge in diagnosis and treatment

El concepto de nódulo pulmonar solitario (NPS) corresponde a una imagen radiológica aumentada de densidad, en general esférica, de bordes bien delimitados, que mide menos de 3cm de diámetro.El NPS ha sido siempre una situación de difícil manejo, que requiere de un enfoque ordenado y especializado. Es por esto, que la aproximación diagnóstica en un paciente con NPS debe basarse en una estimación de la probabilidad de tener cáncer, de esta forma, cuando la posibilidad de cáncer sea baja, el nódulo puede ser seguido por medio de tomografía computada de alta resolución cada tres meses el primer año y cada seis el segundo. En caso de alta sospecha de cáncer, la resección quirúrgica es justificada, idealmente mediante videotoracoscopía. Para pacientes con nódulos indeterminados, puede utilizarse el PET para determinar el riesgo de cáncer. A raíz de los múltiples avances de la medicina y los nuevos métodos diagnósticos disponibles hoy en día, creemos importante revisar este tema entregando herramientas actuales y concretas para el estudio de un paciente con NPS.

Manejo endoscópico del pseudoquiste pancreático / Endoscopic management of pancreatic pseudocyst

Los pseudoquistes pancreáticos son colecciones de fluido localizadas, rodeadas por una pared no epitelial, que habitualmente aparecen tras la rotura u obstrucción de un conducto pancreático, secundario a un episodio de pancreatitis o a un traumatismo. Los síntomas independientemente de su origen son: dolor, náusea, fiebre y pérdida de peso. Es frecuente encontrar al examen una masa palpable, generalmente epigástrica y menos frecuentemente ictericia. En relación a su tratamiento este depende tanto del tamaño del pseudoquiste, el tiempo de evolución y el estado en que se encuentra el paciente, pues no es inhabitual que pseudoquistes pequeños, en pacientes estables tengan una resolución espontánea. Sin embargo, cuando esto no ocurre está indicado el drenaje quirúrgico del pseudoquiste, que puede ir desde un drenaje externo, hasta técnicas mimamente invasivas, ya sean laparóscopicas o endoscópicas, que en los últimos años han tenido un fuerte desarrollo. En relación a esto, presentamos un caso de drenaje endoscópico interno realizado en el Hospital Base Valdivia, de un pseudoquiste pancreatico, en un paciente de 36 años secundario a pancreatitis aguda grave.

Propiedades químicas y farmacológicas del fruto guaraná (Paullina cupana) / Chemical and pharmacological properties of the fruit guaraná (paullinia cupana)

Esta revisión tiene por objeto presentar una descripción general del Guaraná, abarcando tanto sus propiedades químicas y farmacológicas como su aspecto económico, producción y consumo. Se han seleccionado un total de 82 artículos en los que se recogen las características botánicas y químicas, la actividad farmacológica y las propiedades medicinales del Guaraná, en el período comprendido entre 1931 y 2005

Insulin sensitizing drugs increase the endogenous dopaminergic tone in obese insulin-resistant women with polycystic ovary syndrome.

To investigate whether the long-term administration of metformin or pioglitazone to women with polycystic ovary syndrome (PCOS) could induce changes in their hypothalamic dopaminergic (DA) tone and to analyze whether these changes correlated with modifications in insulin resistance, we originally studied 57 obese hyperinsulinemic, non-diabetic, insulin resistant women with PCOS, but only 34 completed the study. They were randomly divided into two groups: group one (n=17) received pioglitazone (30 mg/day) and group 2 (n=17) received metformin (850 mg, three times a day) over 24 weeks. All women were identically studied before (basal) and 6 months after (T6) drug administration, including clinical evaluations, a 2 h oral glucose tolerance test (75 g) (OGTT) for glucose and insulin measurements, followed a week later by a 2 h intravenous metoclopramide test (10 mg bolus) for prolactin (PRL) determinations. The areas under the insulin (AUC-insulin) and PRL (AUC-PRL) curves were calculated, along with the index of insulin resistance (HOMA-IR) and the indexes of insulin sensitivity (QUICKI and fasting glucose-insulin ratio). At baseline, women in both groups were of similar age, body weight, body mass index (BMI) and Ferriman-Gallwey hirsutism score (F-G score). At completion of the study, body weight and BMI remained unchanged but the F-G score significantly decreased. Fasting serum insulin concentrations and the AUC-insulin significantly decreased by the end of the trial in a similar fashion in both groups, while the AUC-PRL significantly increased at the end of the trial in both groups. At no time were significant correlations between AUC-PRL and AUC-insulin or the indexes HOMA-IR, QUICKI or fasting glucose-insulin ratio observed. The present results suggests that either pioglitazone or metformin administration was associated with a clear improvement in the endogenous hypothalamic DA tone, simultaneously with an amelioration of the insulin resistance status in these obese women with PCOS.

Responses of serum androgen and insulin resistance to metformin and pioglitazone in obese, insulin-resistant women with polycystic ovary syndrome.

Severe insulin resistance is a key abnormality in obese women with polycystic ovary syndrome (PCOS). The purpose of this study was to evaluate whether pioglitazone decreases insulin resistance (IR) and hyperandrogenism to the same extent as metformin in obese women with PCOS who have not received any previous treatment. Fifty-two women with PCOS were randomly allocated to receive either pioglitazone (30 mg/d, n = 25) or metformin (850 mg three times daily, n = 27) and were assessed before and after 6 months. Body weight, body mass index, and waist to hip ratio increased significantly (P

Analysis of Neisseria lactamica antigens putatively implicated in acquisition of natural immunity to Neisseria meningitidis.

Sera from healthy human volunteers, patients convalescent from meningococcal meningitis, and mice immunized with outer membrane proteins from Neisseria meningitidis and Neisseria lactamica strains were used to analyze and identify antigens cross-reactive to both neisserial species. All classes of meningococcal proteins except class 1 (PorA) and class 5 cross-reacted with N. lactamica proteins and two other proteins of 65 and 55 kDa (an iron-regulated protein). Results obtained with the mouse sera demonstrate that cross-reactive antibodies can be elicited by either N. meningitidis or N. lactamica. These results support the suggestion that N. lactamica contributes to the development of natural immunity against N. meningitidis during the first years of life. The use of vaccines containing proteins other than PorA could interfere in colonization of mucosal surfaces by N. lactamica, hampering the natural mechanisms of immunity acquisition in humans. Only convalescent sera reacted with the 55 and 65 kDa proteins, which suggests that they might be relevant for pathogenicity.

In vitro induction of memory-driven responses against Neisseria meningitidis by priming with Neisseria lactamica.

Natural immunity against Neisseria meningitidis is acquired during childhood and youth through successive colonizations by commensal Neisseria, carrier N. meningitidis, and other bacterial genera sharing cross-reactive antigens with the meningococci. We have analyzed in mice the ability of Neisseria lactamica strains to induce immunological memory so that, upon a later contact with N. meningitidis, quickly raise protective responses against antigens that show cross-reactivity with meningococcal surface proteins. Sera obtained from mice immunized with N. lactamica and boosted with N. meningitidis were able to kill meningococci, with bactericidal activities variable depending on the immunizing strains used in the assays. Different mixtures of those sera resulted in higher killing activities, which agrees with the idea that successive colonizations by N. lactamica enhance the anti-meningococcal response. The existence of such outer membrane cross-reactive antigens has to be kept in mind when using outer membrane vesicle (OMV)-based anti-meningococcal vaccines because their use can affect colonization by N. lactamica and other species, hampering the natural mechanisms of acquisition of immunity to the meningococci, and leaving its ecological niche free for colonization by undesirable microorganisms.

Evaluation of cross-reactive antigens as determinants of cross-bactericidal activity in pathogenic and commensal Neisseria.

Several antisera raised against outer membane vesicles obtained from invasive and carrier Neisseria meningitidis strains and commensal Neisseria and Moraxella catharralis species were assayed to test cross-bactericidal activity on Neisseria meningitidis strains. Results demonstrate that, despite the wide antigenic cross-reactivity previously shown by Western-blotting for the major outer membrane antigenic proteins of all Neisseria species, complement mediated killing shows very variable patterns that can not be predicted on the basis of antigenic cross-reactivity. Results of antibody tritations on homologous and heterologous strains, isotyping, and bactericidal activity of sera raised against denatured purified outer-membrane vesicle proteins, suggest that the responsibility for most of the bactericidal activity of the sera must be conformational and/or shared epitopes not detectable by Western-blotting.

Analysis of the expression of the putatively virulence-associated neisserial protein RmpM (class 4) in commensal Neisseria and Moraxella catarrhalis strains.

The RmpM protein has been reported to be present only in pathogenic Neisseria species. In the present study we demonstrate that this protein is also present at least in N. lactamica and N. sicca strains. The N. lactamica protein reacts with a RmpM-specific monoclonal antibody (185,H-8), having a molecular mass ( approximately 31 kDa) slightly lower than that of the meningococcal RmpM, and mouse antibodies from sera against outer membrane vesicles from both N. lactamica and N. sicca strains cross-react with the meningococcal RmpM. PCR and hybridization experiments with a complete rmpM probe agree with the immunodetection experiments. Our results strongly suggest that the meningococcal RmpM should not be considered a virulence marker, and the presence of this protein in the commensal species agrees with its role as a structural protein, proposed for the RmpM, which should be considerably conserved in the Neisseria species.

Antigenic cross-reactivity between outer membrane proteins of Neisseria meningitidis and commensal Neisseria species.

Two mouse sera against outer membrane proteins from a pathogenic Neisseria meningitidis strain and a commensal N. lactamica strain and two human sera from patients recovering from meningococcal meningitis were used to identify antigens common to pathogenic and commensal Neisseria species. Two major antigens of 55 kDa and 32 kDa, present in all N. meningitidis and N. lactamica strains tested, were demonstrable with all the sera used; the 55-kDa protein was iron-regulated. Demonstration of other common antigens was dependent on the serum used: a 65-kDa antigen was visualised with the human and the mouse anti-N. lactamica sera; a 37-kDa antigen identified as the meningococcal ferric binding protein (FbpA) was only detected with the mouse sera, and two antigens of 83 kDa and 15 kDa were only shown with the mouse anti-N. meningitidis serum. The results demonstrate the existence of several outer membrane antigens common to N. lactamica and N. meningitidis strains, in agreement with the hypothesis that natural immunity against meningitis is partially acquired through colonisation by commensal species, and open new perspectives for the design of vaccine formulations and the development of strategies for vaccination against meningitis.