Abscesos renales bilaterales multifocales por Candida albicans / Bilateral multifocal kidney abscess due to Candida al bicans

Resumen Los abscesos renales son una complicación poco frecuente de las infecciones del tracto urinario y suelen asociarse con un aumento de la morbi-mortalidad. La mayoría de los casos ocurre en pacientes con factores predisponentes como la inmunosupresión. El diagnóstico requiere de una elevada sospecha clínica y el trata miento consiste en el uso de antibióticos y antifúngicos parenterales asociados o no a intervenciones quirúrgicas como nefrostomía y nefrectomía. Son pocos los casos publicados en la literatura médi ca de abscesos renales bilaterales multifocales y menos aún por Candida albicans. Se presenta el caso de una mujer de 20 años de edad con diabetes mellitus tipo 1 diagnosticada a los 8 años, múltiples internaciones por cetoacidosis diabética y reciente internación por can didemia (Candida albicans) completando tratamiento con fluconazol por 23 días. A los 18 días de su externación, consulta por dolor en flancos de tipo sordo y síntomas ge nerales; se realizó tomografía de abdomen con contraste que mostró abscesos multifocales bilaterales. Aislándose Candida albicans en una de las muestras obtenidas de las lesiones; recibió tratamiento con fluconazol 400 mg por 6 semanas endovenoso y 2 semanas vía enteral, evolu cionando favorablemente con mejoría clínica e image nológica continuando seguimiento clínico ambulatorio. Este reporte resalta la importancia del diagnóstico y tratamiento de esta complicación infrecuente en enfer medades complejas como la diabetes.

Abstract Renal abscesses are a rare complication of urinary tract infections and may be associated with increased morbidity and mortality. Most cases occur in patients with predisposing factors such as immunosuppression. Diagnosis requires high clinical suspicion and its treat ment consists in the use of parenteral antibiotics and antifungals associated or not with surgical interventions such as nephrostomy and nephrectomy. Few cases have been published in the medical literature of multifocal bilateral renal abscesses and even fewer due to Candida albicans. We present the case of a 20-year-old woman with type 1 diabetes mellitus, diagnosed at age 8, multiple hospitalizations for diabetic ketoacidosis, and recent hospitalization for candidemia (Candida albicans) treated with fluconazole for 23 days. Eighteen days after her discharge, she consulted for dull flank pain and gen eral symptoms. Contrast enhanced abdominal tomography showed bilateral multifocal abscesses and Candida albicans was isolated in one of the samples obtained from lesions. She received fluconazole 400 mg, 6 weeks i.v. and 2 weeks via enteral route, evolving favorably with clinical and imag ing improvement, continuing outpatient clinical monitoring. This report highlights the importance of diagnosis and treatment of this rare complication in complex diseases such as diabetes mellitus.

The serine-threonine protein phosphatases that regulate the thiazide-sensitive NaCl cotransporter.

The activity of the Na+-Cl- cotransporter (NCC) in the distal convoluted tubule (DCT) is finely tuned by phosphorylation networks involving serine/threonine kinases and phosphatases. While much attention has been paid to the With-No-lysine (K) kinase (WNK)- STE20-related Proline Alanine rich Kinase (SPAK)/Oxidative Stress Responsive kinase 1 (OSR1) signaling pathway, there remain many unanswered questions regarding phosphatase-mediated modulation of NCC and its interactors. The phosphatases shown to regulate NCC's activity, directly or indirectly, are protein phosphatase 1 (PP1), protein phosphatase 2A (PP2A), calcineurin (CN), and protein phosphatase 4 (PP4). PP1 has been suggested to directly dephosphorylate WNK4, SPAK, and NCC. This phosphatase increases its abundance and activity when extracellular K+ is increased, which leads to distinct inhibitory mechanisms towards NCC. Inhibitor-1 (I1), oppositely, inhibits PP1 when phosphorylated by protein kinase A (PKA). CN inhibitors, like tacrolimus and cyclosporin A, increase NCC phosphorylation, giving an explanation to the Familial Hyperkalemic Hypertension-like syndrome that affects some patients treated with these drugs. CN inhibitors can prevent high K+-induced dephosphorylation of NCC. CN can also dephosphorylate and activate Kelch-like protein 3 (KLHL3), thus decreasing WNK abundance. PP2A and PP4 have been shown in in vitro models to regulate NCC or its upstream activators. However, no studies in native kidneys or tubules have been performed to test their physiological role in NCC regulation. This review focuses on these dephosphorylation mediators and the transduction mechanisms possibly involved in physiological states that require of the modulation of the dephosphorylation rate of NCC.

Low-Cost Data Acquisition System for Automotive Electronic Control Units.

The vehicle testing-validation phase is a crucial and demanding task in the automotive development process for vehicle manufacturers. It ensures the correct operation, safety, and efficiency of the vehicle. To meet this demand, some commercial solutions are available on the market, but they are usually expensive, have few connectivity options, and are PC-dependent. This paper presents an IoT-based intelligent low-cost system for vehicle data acquisition during on-road tests as an alternative solution. The system integrates low-cost acquisition hardware with an IoT server, collecting and transmitting data in near real-time, while artificial intelligence (AI) algorithms process the information and report errors and/or failures to the manufacturing engineers. The proposed solution was compared with other commercial systems in terms of features, performance, and cost. The results indicate that the proposed system delivers similar performance in terms of the data acquisition rate, but at a lower cost (up to 13 times cheaper) and with more advanced features, such as near real-time intelligent data processing and reduced time to find and correct errors or failures in the vehicle.

Correlation Analysis of In-Vehicle Sensors Data and Driver Signals in Identifying Driving and Driver Behaviors.

Today's cars have dozens of sensors to monitor vehicle performance through different systems, most of which communicate via vehicular networks (CAN). Many of these sensors can be used for applications other than the original ones, such as improving the driver experience or creating new safety tools. An example is monitoring variables that describe the driver's behavior. Interactions with the pedals, speed, and steering wheel, among other signals, carry driving characteristics. However, not always all variables related to these interactions are available in all vehicles; for example, the excursion of the brake pedal. Using an acquisition module, data from the in-vehicle sensors were obtained from the CAN bus, the brake pedal (externally instrumented), and the driver's signals (instrumented with an inertial sensor and electromyography of their leg), to observe the driver and car information and evaluate the correlation hypothesis between these data, as well as the importance of the brake pedal signal not usually available in all car models. Different sets of sensors were evaluated to analyze the performance of three classifiers when analyzing the driver's driving mode. It was found that there are superior results in classifying identity or behavior when driver signals are included. When the vehicle and driver attributes were used, hits above 0.93 were obtained in the identification of behavior and 0.96 in the identification of the driver; without driver signals, accuracy was more significant than 0.80 in identifying behavior. The results show a good correlation between vehicle data and data obtained from the driver, suggesting that further studies may be promising to improve the accuracy of rates based exclusively on vehicle characteristics, both for behavior identification and driver identification, thus allowing practical applications in embedded systems for local signaling and/or storing information about the driving mode, which is important for logistics companies.

Prevalencia de trastornos respiratorios del sueño en pacientes asmáticos que se controlan en el Hospital Roberto del Río: estudio piloto / Prevalence of sleep breathing disorders in asthmatic patients monitored at Roberto del Río Hospital: a pilot study

Introducción. El asma es una de las enfermedades crónicas más frecuentes en niños. Múltiples estudios han sugerido que en la infancia presenta una asociación significativa con los trastornos respiratorios del sueño, con una prevalencia en niños asmáticos de un 24%. El objetivo fue determinar la prevalencia de trastornos respiratorios del sueño (TRS) en pacientes con asma controlados en un hospital pediátrico (6-15 años). Pacientes y Método. Estudio transversal descriptivo. Se aplicaron los cuestionarios de sueño pediátrico validado en español (pediatric sleep questionnaire, PSQ) y el Cuestionario de Control del Asma en Niños (CAN) a los padres de los niños con diagnósticos de asma controlados en Hospital Roberto del Río, vía telefónica y vía email. Resultados: La prevalencia de TRS fue de 34,8%. Un 20% presenta mal control de asma definido como CAN >8. Un 58,1% de los padres reportaron sobrepeso en los pacientes Conclusiones: la prevalencia de TRS en los niños estudiados es alta y obliga a investigar en cada consulta por estos síntomas. Aplicar la encuesta en cada consulta, de forma online podría aportar al conocimiento de estos pacientes y mantener la prevalencia del problema actualizada, para focalizar las intervenciones apropiadas.

Introduction. Asthma is one of the most frequent chronic diseases in children, multiple studies have suggested that in childhood it presents a significant association with sleep-disordered breathing, with a prevalence in asthmatic children of 24%.The objective was to determine the prevalence of sleep-disordered breathing (RRT) in patients with asthma controlled in a pediatric hospital (6-15 years). Patients and Methods. Descriptive cross-sectional study. The pediatric sleep questionnaire (PSQ) and the Child Asthma Control Questionnaire (CAN) were applied to the parents of children with controlled asthma diagnoses at Hospital Roberto del Río, by telephone and via e-mail. Results: The prevalence of RRT was 34.8%. 20% have poor asthma control defined as CAN> 8. 58.1% of parents reported overweight in patients Conclusions: the prevalence of RRT in the children studied is high and makes it necessary to investigate these symptoms at each visit. Applying the survey in each consultation, online, could contribute to the knowledge of these patients and keep the prevalence of the problem updated, in order to focalized the interventions.

Introducción. Situación mundial del Cáncer de Mama / Introduction. World situation of Breast Cancer

El cáncer de mama es el tumor de la mujer más diagnosticado en la gran mayoría de los países. Los factores no hereditarios son los principales impulsores de las diferencias internacionales e in­ter­étnicas observadas en la incidencia de este cáncer. Las tasas de incidencia del cáncer de ma­ma han aumentado en la mayoría de los países en transición en las últimas décadas, en tanto que en la mayoría de los países más avanzados, las tasas de mortalidad por cáncer de mama han ido en descenso como resultado de la detección temprana de la enfermedad, los avances en el trata­ miento y mayor accesibilidad a los servicios de salud. Los principales factores de riesgo para el cáncer de mama no son fácilmente modificables porque se derivan de exposiciones hormonales endógenas prolongadas. La prevención a través de la promoción de la lactancia materna, parti­cularmente su mayor duración, pudiera ser beneficioso. La incidencia de cáncer de mama en Pa­namá se comporta de manera similar a los países con índice de desarrollo Humano en transición; ha ido en aumento en las últimas décadas como resultado del aumento en la prevalencia de los factores de riesgo conocidos y la mejoría en la recolección de datos.

Breast cancer is the most diagnosed woman's tumor in the vast majority of countries. The non­here­ ditary factors are the main drivers of the international and inter­ethnic differences observed in the incidence of this cancer. Breast cancer incidence rates have increased in most countries in transi­tion in recent decades, while in most of the more advanced countries, breast cancer death rates ha­ve been declining asa result of breast cancer. early detection of the disease, advances in treatment and greater accessibility to health services . The main risk factors for breast cancer are not easily modifiable because they are derived from prolonged endogenous hormonal exposures. Prevention through the promotion of breastfeeding, particularly its longer duration, could be beneficial. The inci­ dence of breast cancer in Panama behaves similarly to countries with a Human Development Index in transition; It has been increasing in recent decades as a result of the inc rease in the prevalence of k nown risk factors and the improvement in data collection.

Evaluación del Riesgo, Tamizaje, Diagnóstico Clínico ­ Patológico y Estadificación del Cáncer de Mama: 1er Consenso Nacional del Cáncer de Mama de la Sociedad Panameña de Oncología (SPO) / Risk Assessment, Screening, Clinical ­ Pathological Diagnos is and Staging of Breast Cancer: 1st National Consensus of Breast Cancer of the Panamanian Society of Oncology

El cáncer de Mama es el tumor más frecuente de la mujer y su incidencia va en aumento. En la atención primaria del paciente, se debe establecer el riesgo de padecer cáncer de mama durante la vida, a través de una historia clínica orientada a los factores de riesgo familiares e individuales, de tal forma que podamos implementar las estrategias de tamizaje apropiadas. Las estrategias de ta­mizaje deben ser aplicadas de manera sistemáticas, y los resultados anormales referidos a un cen­tro con experiencia en el diagnóstico. Los pacientes diagnosticados deben ser evaluador por un equipo multidisciplinario con experiencia en el manejo de la muestra, estadificación y tratamiento del cáncer de mama.

Breast cancer is the most frequent tumor in women and its incidence is increasing. In the primary care of the patient, the risk of suffering from breast cancer should be established during life, through a clinical history focused on family and individual risk factors, in such a way that we can implement the appropriate screening strategies. Screening strategies should be applied systematically, and ab­normal results referred to a center with experience in diagnosis . Patients diagnosed should be eva­luated by a multidisciplinary team with experience in the management of the sample, staging and treatment of breast cancer.

Human exhaled air can efficiently support in vitro maturation of porcine oocytes and subsequent early embryonic development

Air phase is an indispensable environmental factor affecting oocyte maturation and early embryo development. Human exhaled air was previously proved to be a reliable and inexpensive atmosphere that sustains normal early development of mouse and bovine embryos. However, whether human exhaled air can support in vitro maturation (IVM) of porcine oocytes is not yet known. To evaluate the feasibility of maturing oocytes in human exhaled air, we examined oocyte morphology, BMP15 expression, nuclear and cytoplasmic maturation. We found that cumulus expansion status, expression levels of BMP15 important for cumulus expansion and the rate of first polar body emission were similar among human exhaled air, 5% O2 or 20% O2 in air after IVM of 44 h. Furthermore, the percentage of metaphase II (MII) oocytes showing normal cortical and sub-membranous localization of cortical granules and diffused mitochondrial distribution patterns is comparable among groups. The cleavage, blastocyst rate and total cell number were not apparently different for parthenogenetic activated and somatic cloned embryos derived from MII oocytes matured in three air phases, suggesting oocytes matured in human exhaled air obtain normal developmental competence. Taken together, human exhaled air can efficiently support in vitro maturation of porcine oocytes and subsequent early embryonic development.(AU)

Human exhaled air can efficiently support in vitro maturation of porcine oocytes and subsequent early embryonic development

Air phase is an indispensable environmental factor affecting oocyte maturation and early embryo development. Human exhaled air was previously proved to be a reliable and inexpensive atmosphere that sustains normal early development of mouse and bovine embryos. However, whether human exhaled air can support in vitro maturation (IVM) of porcine oocytes is not yet known. To evaluate the feasibility of maturing oocytes in human exhaled air, we examined oocyte morphology, BMP15 expression, nuclear and cytoplasmic maturation. We found that cumulus expansion status, expression levels of BMP15 important for cumulus expansion and the rate of first polar body emission were similar among human exhaled air, 5% O2 or 20% O2 in air after IVM of 44 h. Furthermore, the percentage of metaphase II (MII) oocytes showing normal cortical and sub-membranous localization of cortical granules and diffused mitochondrial distribution patterns is comparable among groups. The cleavage, blastocyst rate and total cell number were not apparently different for parthenogenetic activated and somatic cloned embryos derived from MII oocytes matured in three air phases, suggesting oocytes matured in human exhaled air obtain normal developmental competence. Taken together, human exhaled air can efficiently support in vitro maturation of porcine oocytes and subsequent early embryonic development.

Association of high post-transplant soluble CD30 serum levels with chronic allograft nephropathy.

The purpose of this study was to evaluate the association of post-transplant soluble CD30 (sCD30) levels, isolated or in combination with of anti-HLA class II antibodies and of serum creatinine levels, with kidney graft loss due to chronic allograft nephropathy (CAN), and type of lesions in graft biopsies for cause. The study comprised 511 first kidney graft recipients, transplanted at a single center, with a graft functioning for at least 2.8 years. A single blood sample was collected from each patient. sCD30 levels were determined by ELISA, and HLA antibodies by Luminex assay. The minimum follow-up after testing was 9.3 years. High sCD30 levels, set at sCD30 ≥ 34.15 ng/mL, the presence of HLA class II antibodies, and serum creatinine ≥ 1.9 mg/dL were independently associated with CAN-graft loss (P values <0.0001, 0.05, <0.0001, respectively), and the combined hazard ratio for CAN-graft loss was 20.2. Analyses of 166 biopsies for cause showed that high sCD30 levels and creatinine were independently associated with interstitial lesions. Post-transplant sCD30 serum levels, especially in conjunction with information regarding HLA class II antibodies and serum creatinine levels, provide valuable information regarding graft outcome and could be useful for the management of kidney transplant recipients.

Shaping synaptic plasticity: the role of activity-mediated epigenetic regulation on gene transcription.

Learning and memory are basic functions of the brain that allowed human evolution. It is well accepted that during learning and memory formation the dynamic establishment of new active synaptic connections is crucial. Persistent synaptic activation leads to molecular events that include increased release of neurotransmitters, increased expression of receptors on the postsynaptic neuron, thus creating a positive feedback that results in the activation of distinct signaling pathways that temporally and permanently alter specific patterns of gene expression. However, the epigenetic changes that allow the establishment of long term genetic programs that control learning and memory are not completely understood. Even less is known regarding the signaling events triggered by synaptic activity that regulate these epigenetic marks. Here we review the current understanding of the molecular mechanisms controlling activity-dependent gene transcription leading synaptic plasticity and memory formation. We describe how Ca(2+) entry through N-methyl-d-aspartate-type glutamate neurotransmitter receptors result in the activation of specific signaling pathways leading to changes in gene expression, giving special emphasis to the recent data pointing out different epigenetic mechanisms (histone acetylation, methylation and phosphorylation as well as DNA methylation and hydroxymethylation) underlying learning and memory.

Ocorrência de babesiose canina no Município de Uberlândia, Minas Gerais / Incidence of canine babesiosis in Uberlândia, Minas Gerais / Incidencia de babesiosis canina en el municipalidad de Uberlândia, Minas Gerais

Babesia canis é um protozoário intraeritrocítico transmitido pelo carrapato Rhipicephalus sanguineus que acomete principalmente canídeos domésticos e silvestres, causando manifestações clínicas como anorexia, pirexia, hemoglobinúria, esplenomegalia, hemoglobinemia, anemia grave, podendo o animal recuperar-se lentamente ou morrer. O objetivo desta pesquisa foi determinar a ocorrência da doença em Uberlândia - MG e comparar os métodos de esfregaços sanguíneos de ponta de orelha e Reação de Imunofluorescência Indireta (RIFI) no diagnóstico desta enfermidade. Para realização deste trabalho, foram colhidos aleatoriamente soros de 143 cães atendidos no Hospital Veterinário da Universidade Federal de Uberlândia para exame de RIFI enquanto que 772 esfregaços sanguíneos de ponta de orelha foram feitos e corados pelo Giemsa para a pesquisa de hemoparasito. Após a padronização da RIFI, considerou-se positivo soros com diluição igual ou superior a 1:20 e como negativos soros com diluição inferior a 1:20. Dos soros testados, através de RIFI, 51,74% estavam positivos e 48,26% negativos. Dos esfregaços sanguíneos 2,72% eram positivos para babesiose, 87,83% negativos e 9,45% positivos para outros hemoparasitos. Através do teste Qui-quadrado observou-se diferença significativa, ao nível de significância 5%, entre os métodos comparados.(AU)

Babesia canis is an intra-erythrocyte protozoan transmitted by the tick Rhipicephalus sanguineus that infects especially domestic and wild canids. The most common clinical manifestations include anorexia, pyrexia, hemoglobinuria, splenomegaly, hemoglobinemia, and severe anemia, leading to mortality or even to slow recuperation. The aim of this study was to determine the prevalence of this disease in Uberlândia, MG, and to compare the blood smears from the tip of the ear exam and the indirect immunofluorescence (IFI) test as diagnostic methods used for this disease. Thus, sera from 143 dogs attended at the Veterinary Hospital of the Federal University of Uberlândia were collected to detect IgG anti-Babesia canis by IFI test, while 772 blood smears from the tip of the ear were performed and stained by Giemsa to search the intra-erythrocyte parasite. Sera with titer higher than 1:20 were considered as positive for the IFI test. For this test 51,74% were found positive and 48,26% negative. From the blood smears, 2,72% were Babesia-positive, 97,83% were Babesia-negative and 9,45% were positive to other erythrocyte parasites. By using the chi-square test, there was a significant difference (p<0,05) between the two studied diagnostic methods.(AU)

Babesia canis es un protozoario intraeritrocítico transmitido por la garrapata Rhipicephalus sanguineus que ataca principalmente cánidos domésticos y silvestres causando manifestaciones clínicas como anorexia, pirexia, hemoglobinuria, esplenomegalia, hemoglobinemia, anemia grave, lo que puede levar a la muerte o a una lenta recuperación. El objetivo de esta investigación fue determinar la prevalencia de la enfermedad en Uberlândia MG y comparar los métodos de ricción sanguínea de punta de oreja y el de Inmunofluorescendia Indirecta (RIFI) en el diagnóstico de esta enfermedad. Para la realización de este trabajo fueron recolectados aletoriamente sueros de 143 canes, atendidos en el Hospital Veterinario de la Universidad de Uberlândia, para el examen de IFI. Mientras que 772 fricciones sanguíneas de punta de oreja fueron hechas y erojecidas por el Giemsa para la pesquisa de hemoparásito. Después de la padronización de la RIFI, se consideró positivo sueros con dilución superior a 1:20 y RIFI presentaron 51,74% de positividad y 48,26 % de negatividad. De las fricciones sanguíneas 2,72 % eran positivas para babesose, 87,83% negativas y 9,45% de positivos para otros hemoparásitos. Através del test Qui-cuadrado se observó una diferencia significativa al nivel de significancia del 5% entre los métodos comparados.(AU)

Ocorrência de babesiose canina no Município de Uberlândia, Minas Gerais / Incidence of canine babesiosis in Uberlândia, Minas Gerais

Babesia canis é um protozoário intraeritrocítico transmitido pelo carrapato Rhipicephalus sanguineus que acomete principalmente canídeos domésticos e silvestres, causando manifestações clínicas como anorexia, pirexia, hemoglobinúria, esplenomegalia, hemoglobinemia, anemia grave, podendo o animal recuperar-se lentamente ou morrer. O objetivo desta pesquisa foi determinar a ocorrência da doença em Uberlândia – MG e comparar os métodos de esfregaços sangüíneos de ponta de orelha e Reação de Imunofluorescência Indireta (RIFI) no diagnóstico desta enfermidade. Para realização deste trabalho, foram colhidos aleatoriamente soros de 143 cães atendidos no Hospital Veterinário da Universidade Federal de Uberlândia para exame de RIFI enquanto que 772 esfregaços sangüíneos de ponta de orelha foram feitos e corados pelo Giemsa para a pesquisa do hemoparasito. Após a padronização da RIFI, considerou-se positivo soros com diluição igual ou superior a 1:20 e como negativos soros com diluição inferior a 1:20. Dos soros testados, através da RIFI, 51,74% estavam positivos e 48,26% negativos. Dos esfregaços sangüíneos 2,72% eram positivos para babesiose, 87,83% negativos e 9,45% positivos para outros hemoparasitos. Através do teste Qui-quadrado observou-se diferença significativa, em nível de significância 5%, entre os métodos comparados.