Effects of different surgical treatments on pain, disability, anxiety and quality of life in lumbar disc herniation.

OBJECTIVE: This study aims to compare the effects of microscopic microdiscectomy and microendoscopic discectomy on pain, disability, fear of falling, kinesiophobia, anxiety, quality of life in patients with lumbar disc herniation (LDH). METHODS: A total of 90 patients who underwent microscopic microdiscectomy (n = 40) and microendoscopic discectomy (n = 50) for LDH were included in this study. The patients' pain, disability, fear of falling, kinesiophobia, anxiety, and quality of life were evaluated before the surgery, in the early postoperative period and three months after. RESULTS: In patients who underwent microendoscopic discectomy, the results of pain, disability, fear of falling, kinesiophobia and anxiety were statistically decreased compared with the microscopic microdiscectomy in the early postoperative period and three months later (p < 0.05). Also, a statistically higher increase was observed in the general health perception of patients who underwent microendoscopic discectomy three months after the operation (p < 0.01). CONCLUSION: Microendoscopic microdiscectomy, remains the most effective and widely applied method with advantages on pain, quality of life, and improved physical functions.

OBJETIVO: Este estudio tiene como objetivo comparar los efectos de la microdiscectomía microscópica y la discectomía microendoscópica sobre el dolor, la discapacidad, el miedo a caer, la kinesiofobia, la ansiedad y la calidad de vida en pacientes con hernia de disco lumbar (LDH). MÉTODOS: Se incluyeron en este estudio un total de 90 pacientes sometidos a microdiscectomía microscópica (n = 40) y discectomía microendoscópica (n = 50) por LDH. Se evaluó el dolor, la discapacidad, el miedo a caer, la kinesiofobia, la ansiedad y la calidad de vida de los pacientes antes de la cirugía, en el postoperatorio temprano y tres meses después. RESULTADOS: En los pacientes sometidos a discectomía microendoscópica, los resultados de dolor, discapacidad, miedo a caer, kinesiofobia y ansiedad disminuyeron estadísticamente en comparación con la microdiscectomía microscópica en el postoperatorio temprano y tres meses después (p < 0.05). Además, se observó un aumento estadísticamente mayor en la percepción de salud general de los pacientes sometidos a discectomía microendoscópica tres meses después de la operación (p < 0.01). CONCLUSIÓN: La microdiscectomía microendoscópica sigue siendo el método más eficaz y ampliamente aplicado con ventajas sobre el dolor, la calidad de vida y la mejora de las funciones físicas.

Alerta de atraso no diagnóstico de colite microscópica em idosos. Uma série de casos / Warning to delay in diagnosing microscopic colitis in older adults. a series of cases

ABSTRACT Background: Microscopic colitis (MC) is a chronic inflammatory bowel disease causing non-bloody diarrhea, and several cases are undiagnosed as a hidden cause of chronic diarrhea. Objective: We aimed to report the symptoms, delay diagnosis and the treatment of MC in a case series. Methods: All patients were treated at a Gastroenterology reference office from May 2022 to June 2023. Personal history including preexisting disorders, use of medications and smoking habits were collected. The delay between the onset of symptoms and the correct diagnosis was informed. All patients consented to use budesonide MMX (Corament®) off label. Results: During the study period, six Caucasoid patients were diagnosed with MC, five females and one male, between the ages of 65 and 74. All patients had comorbities and were taking multiple prescription drugs. Laboratory findings showed negative serology for celiac disease for all patients, normal levels of albumin and vitamin B12. The delay between the symptoms and the MC diagnosis varied from 2 months to 6 years. All patients had a previous diagnosis of irritable bowel syndrome. All patients were in complete clinical remission during the treatment and referred no side effects of the drug. Conclusion: Older females using high-risk medications are suggestive of MC. Preventing delay in the diagnosis of MC is crucial to improvement in patients´ quality of life. Budesonide MMX appears to be effective, safe and well-tolerated.

RESUMO Contexto: A colite microscópica (CM) é uma doença inflamatória intestinal crônica que causa diarreia não sanguinolenta, e vários casos não são diagnosticados como uma causa oculta de diarreia crônica. Objetivo: Esse estudo visou relatar os sintomas, qual o atraso diagnóstico e o tratamento da CM em uma série de casos. Métodos: Todos os pacientes foram atendidos em um consultório de referência em Gastroenterologia no período de maio de 2022 a junho de 2023. Foram coletados antecedentes pessoais, incluindo distúrbios preexistentes, uso de medicamentos e tabagismo. Foi buscado o período entre o início dos sintomas e o diagnóstico correto. Todos os pacientes consentiram em usar budesonida MMX (Corament®) off label. Resultados: Durante o período do estudo, seis pacientes caucasóides foram diagnosticados com CM, cinco mulheres e um homem, com idades entre 65 e 74 anos. Todos os pacientes apresentavam comorbidades e faziam uso de vários medicamentos prescritos. Os achados laboratoriais mostraram sorologia negativa para doença celíaca em todos os pacientes, níveis normais de albumina e vitamina B12. O atraso entre os sintomas e o diagnóstico de CM variou de 2 meses a 6 anos. Todos os pacientes tinham diagnóstico prévio de síndrome do intestino irritável. Todos os pacientes apresentaram remissão clínica completa durante o tratamento e não referiram efeitos colaterais da droga. Conclusão: As mulheres mais velhas que usam medicamentos de alto risco são sugestivas de CM. Evitar o atraso no diagnóstico de CM é fundamental para melhorar a qualidade de vida dos pacientes. A budesonida MMX foi eficaz, segura e bem tolerada.

Telocytes in Human Embryonic Development: A Preliminary Microscopic Anatomy Study / Telocitos en el Desarrollo Embrionario Humano: Un Estudio Preliminar de Anatomía Microscópica

SUMMARY: Telocytes are a cell population described in 2011 with a multitude of functions such as tissue support, regulation of stem cell niches or intercellular signal transmission. However, there are no studies about their embryonic origin, their function in development, or their moment of appearance. The objective of this work is to try to answer these questions through histological and immunofluorescence studies with samples from the embryological collection of the Department of Anatomy of the University of Granada. In the results obtained, as demonstrated by immunofluorescence for CD34, the presence of these cells can be seen in the fourth week of embryonic development in the perinotochordal region. Its presence is evident from the sixth week of development in a multitude of organs such as the heart, skeletal muscle tissue and supporting tissue of various organs such as the kidney, brain or pericardium. Its function seems to be when the embryonic histological images are analyzed in an evolutionary way, to act as a scaffold or scaffold for the subsequent population by mature tissue elements. In conclusion, telocytes appear at a very early stage of embryonic development and would have a fundamental role in it as scaffolding and directors of organ and tissue growth.

Los telocitos son una población celular descrita en 2011 con multitud de funciones como el sostén tisular, la regulación de los nichos de células madre o la transmisión de señales intercelulares. Sin embargo, no existen estudios acerca del origen embrionario de los mismos, su función en el desarrollo ni su momento de aparición. El objetivo de este trabajo es tratar de responder a estos interrogantes mediante estudios histológicos y por inmunofluorescencia con muestras de la colección embriológica del Departamento de Anatomía de la Universidad de Granada. En los resultados se puede observar como se demuestra mediante inmunofluorescencia para CD34, la presencia de estas células en la cuarta semana del desarrollo embrionario en la región perinotocordal. Su presencia se evidencia a partir de la sexta semana del desarrollo en multitud de órganos como corazón, tejidos músculo esqueléticos y tejidos de sostén de diversos órganos como riñón, encéfalo o pericardio. Su función parece ser al ser analizadas las imágenes histológicas embrionarias de forma evolutiva, la de actuar como un andamiaje o scafold para el posterior poblamiento por elementos tisulares maduros. Como conclusión, los telocitos aparecen en un momento muy precoz del desarrollo embrionario y presentarían una función fundamental en el mismo como andamiajes y directores del crecimiento de los órganos y tejidos.

Colite microscópica: considerações para gastroenterologistas, endoscopistas e patologistas / Microscopic colitis: considerations for gastroenterologists, endoscopists, and pathologists

ABSTRACT Microscopic colitis is a chronic inflammatory bowel disease characterized by non-bloody diarrhea that can range from mild to severe. It is difficult to attribute up to 10-20% of chronic diarrhea to microscopic colitis. The three determinants factors of the diagnosis are characteristic clinical symptoms, normal endoscopic picture of the colon, and pathognomonic histological picture. This manuscript aimed to update considerations and recommendations for professionals involved (gastroenterologist, endoscopists and pathologist) in the diagnosis of MC. In addition, a short recommendation about treatment.

RESUMO A colite microscópica é uma doença intestinal inflamatória crônica caracterizada por diarreia não sanguinolenta que pode variar de leve a grave. Atribui-se que cerca de 10-20% das diarreias crônicas são devidas à colite microscópica. Os três fatores determinantes para o diagnóstico são sintomas clínicos característicos, quadro endoscópico normal do cólon e quadro histológico patognomônico. Este manuscrito tem como objetivo atualizar e trazer recomendações para os profissionais envolvidos (gastroenterologista, endoscopista e patologista) no diagnóstico de colite microscópica. Adicionalmente, uma breve recomendação sobre o tratamento.

Real-world nailfold videocapillaroscopy in a referral centre in north-western Colombia: A real-life cohort

Introduction: Nailfold videocapillaroscopy is a non-invasive tool for the assessment of peripheral microcirculation, the main indication is the study of Raynaud's phenomenon, poorly standardized outside of this context. There is no clear information in real-life about the rea-sons for referral, the presence of clinical findings of autoimmune diseases, the frequency of patterns of autoantibodies, and specific capillaroscopic findings. Objective: The purpose of this survey is to describe the sociodemographic, clinical, paraclinical, and angioscopy findings of a cohort of subjects referred to a capillaroscopy service in North-western Colombia. Methods: A retrospective study was conducted, from 2015 to 2018. Categorical variables were expressed in frequency and percentage and quantitative variables in mean and standard deviation or median with interquartile range, depending on the distribution of the data. Results: A total of 318 capillaroscopies were performed for the first time. The main referral reason was Raynaud's phenomenon (n = 134; 42.1%). The most frequent baseline capillaroscopic pattern found was normal (n = 123; 38.7%). Of the 12 capillaroscopies that presented a non-specific pattern at a 6-month follow-up, only one (8.3%) progressed to a scleroderma pattern. In the subjects with systemic sclerosis, the most frequent clinical finding was sclerodactyly (n = 34; 37.8%), and 42/44 individuals (95.4%) had positive antinuclear antibodies; the most frequent pattern was centromere (n = 27; 64.3%) Conclusions: In a real-world setting, the main referral reason for capillaroscopy was Raynaud's phenomenon; more than a third of the subjects had normal capillaroscopic findings. Sclerodactyly was the most frequent clinical finding in patients with scleroderma capillaroscopic pattern.

Introducción: La videocapilaroscopia del lecho ungular es una herramienta no invasiva para la evaluación de la microcirculación periférica; la indicación principal es el estudio del fenómeno de Raynaud. Luego de una revisión de la literatura, no hay información clara sobre los motivos de remisión, presencia de hallazgos clínicos de enfermedades autoinmunes, frecuencia de patrones de autoanticuerpos y hallazgos capilaroscópicos específicos. Objetivo: Describir los hallazgos sociodemográficos, clínicos, paraclínicos y capilaroscópicos de sujetos remitidos a un servicio de capilaroscopia en el noroccidente colombiano. Métodos: Estudio retrospectivo de 2015 a 2018. Las variables categóricas se expresaron en frecuencias absolutas y porcentajes, y las variables cuantitativas en media y desviación estándar o mediana con rango intercuartílico, dependiendo de la distribución de los datos. Resultados: Se realizaron 318 capilaroscopias por primera vez. El principal motivo de remisión fue el fenómeno de Raynaud (n = 134; 42,1%). El patrón capilaroscópico basal más frecuente fue el normal (n = 123; 38,7%). De las 12 capilaroscopias que presentaron un patrón no específico en un seguimiento de seis meses, solo una (8,3%) progresó a un patrón de esclerodermia. En los sujetos con esclerosis sistémica, el hallazgo clínico más frecuente fue la esclerodactilia (n = 34; 37,8%), y 42/44 individuos (95,4%) tenían anticuerpos antinucleares positivos; el patrón más frecuente fue el centromérico (n = 27; 64,3%). Conclusiones: La razón principal de remisión para realizar una capilaroscopia fue el fenómeno de Raynaud; más de un tercio de los sujetos tenían hallazgos capilaroscópicos normales. La esclerodactilia fue el hallazgo clínico más frecuente en pacientes con patrón capilaroscópico de esclerodermia.

Binswanger and the carotid sinus (Historical Note) / Binswanger e o seio carotídeo (Nota Histórica)

The 'carotid sinus' is an arterial dilatation placed usually at the beginning of the internal carotid artery. The medial wall of this dilatation appears modified, with a reduction of the media, and an increase of the adventitia, besides containing nervous terminations, forming thus a sensorial structure. This dilatation was possibly first observed by John Bell (1808), and clearly described and named by Cruveilhier (1834). However, many authors credited the initial finding to Burns (1811), followed by a number of researchers, as Luschka (1862), Manson (1866), Meyer (1876), Schäfer (1878), most with a view related to aneurysm formation, but some seeing the formation as a normal trait. Finally, Binswanger (1879) reaffirmed that the dilatation meant a normal feature of the region, based on his own observations, and on the opinion of some forerunners. Besides, he was the first to classify this dilatation regarding the variability of its localization. The thinning of this region was initially identified by Meyer (1876) and detailed by Binswanger (1879), at bare eye visual inspection and on microscopic examination, observing there an important reduction of the width of the tunica media. Despite Meyer's effort, and mostly Binswanger's, the microscopic findings are incipient, what can be explained by the limitations of the histological techniques at the time. However, there is no doubt that Binswanger and his forerunners provided important information for the upcoming research, comprising the structure, innervation, and function of this formation.

O 'seio carotídeo' é uma dilatação arterial situada geralmente no início da artéria carótida interna. A parede medial dessa dilatação apresenta-se modificada, com redução da média e aumento da adventícia, além de conter terminações nervosas, constituindo assim uma estrutura sensorial. Essa dilatação foi possivelmente observada primeiro por John Bell (1808) e claramente descrita e denominada por Cruveilhier (1834). Entretanto, muitos autores creditam o achado inicial a Burns (1811), seguido por numerosos pesquisadores, como Luschka (1862), Manson (1866), Meyer (1876), Schäfer (1878), a maioria com olhar relacionada à formação de aneurisma, mas alguns vendo a formação como uma característica normal. Finalmente, Binswanger (1879) reafirmou que a dilatação representava um aspecto normal da região, baseado em observações próprias e na opinião de alguns de seus antecessores. Além disso, foi o primeiro a classificar essa dilatação quanto a variabilidade de sua localização. O adelgaçamento dessa região foi identificado inicialmente por Meyer (1876) e detalhado por Binswanger (1879), à inspeção visual a olho nu e ao exame microscópico, observando lá uma importante redução da espessura da túnica média. Apesar do esforço de Meyer e sobretudo de Binswanger, os achados microscópicos são incipientes, o que pode ser explicado pelas limitações das técnicas histológicas daquele tempo. Todavia, não há dúvida que Binswanger e seus precursores proveram importante informação para as pesquisas que se sucederam, compreendendo a estrutura, inervação e função dessa formação.

Factores de riesgo asociados a pacientes con colitis microscópica / Risk factors associated with patients with microscopic colitis / Fatores de risco associados a pacientes com colite microscópica

RESUMEN Introducción: La primera descripción de la colitis microscópica se realizó en el año 1976. Actualmente, agrupa tres subgrupos de patologías, las clásicas colitis linfocítica y colitis colagenosa, el tercer subgrupo corresponde a la colitis microscópica incompleta. Objetivo: Identificar los principales factores asociados al desarrollo de colitis microscópica en el Hospital General Provincial ¨Carlos Manuel de Céspedes¨, de Bayamo, Granma, en el período marzo de 2019 hasta agosto de 2021. Método: Se realizó un estudio observacional, analítico de casos y controles en pacientes con edad igual o mayor de 18 años con diarreas acuosas crónicas atendidos en el servicio de gastroenterología de dicho hospital, donde se estudiaron las variables: presencia de colitis microscópica, edad, sexo, hábito de fumar, uso de medicamentos, comorbilidades, dolor abdominal, fatiga, incontinencia fecal, pérdida de peso. El tamaño de la muestra para estudios pareados se determinó mediante el programa STATA 17. Para su estimación se consideró lo siguiente: nivel de confianza, poder del estudio, relación de casos y testigos y Odds Ratio mínimo. Resultados: No existió asociación entre la edad mayor de 50 años y la probabilidad de presentar colitis. Predominó el sexo femenino (62,5 %). Del total de pacientes con colitis microscópica (n=16) el 62,5 % fumaba. El OR obtenido indicó que los pacientes fumadores tienen 2,5 veces más riesgo. La diabetes mellitus se asoció significativamente al diagnóstico de colitis microscópica y quintuplicó el riesgo. Conclusiones: Existe una relación entre el sexo femenino, el hábito de fumar, la diabetes mellitus, la colecistectomía, el consumo de tres o más fármacos y la incontinencia fecal con la presencia de colitis microscópica.

ABSTRACT Introduction: The first description of microscopic colitis was made in 1976. Currently, it groups three subgroups of pathologies, the classic lymphocytic colitis and collagenous colitis, the third subgroup corresponds to incomplete microscopic colitis. Objective: To identify the main factors associated with the development of microscopic colitis at the Hospital General Provincial "Carlos Manuel de Céspedes", Bayamo, Granma, from March 2019 to August 2021. Method: An observational, analytical study of cases and controls was carried out in patients aged 18 years or older with chronic watery diarrhea treated at the gastroenterology service. The variables studied were: presence of microscopic colitis, age, sex, smoking habit, use of medications, comorbidities, abdominal pain, fatigue, fecal incontinence and weight loss. The sample size for paired studies was determined using the STATA 17 program. For its estimation, the following were considered: confidence level, statistical power of the test, ratio of cases and controls and minimum Odds Ratio. Results: There was no association between age over 50 years and the probability of presenting colitis. The female sex prevailed (62.5%). Of the total number of patients with microscopic colitis (n=16), 62.5% smoked. The OR obtained indicated that smoker patients have 2.5 times more risk. Diabetes mellitus was significantly associated with the diagnosis of microscopic colitis and increased the risk fivefold. Conclusions: There is a relationship between female sex, smoking, diabetes mellitus, cholecystectomy, consumption of three or more drugs and fecal incontinence with the presence of microscopic colitis.

RESUMO Introdução: A primeira descrição da colite microscópica foi feita em 1976. Atualmente, agrupa três subgrupos de patologias, a colite linfocítica clássica e a colite colagenosa, o terceiro subgrupo corresponde à colite microscópica incompleta. Objetivo: Identificar os principais fatores associados ao desenvolvimento de colite microscópica no Hospital Geral Provincial ¨Carlos Manuel de Céspedes¨, em Bayamo, Granma, de março de 2019 a agosto de 2021. Método: Estudo observacional analítico de casos e controles em pacientes com 18 anos ou mais com diarreia aquosa crônica atendidos no serviço de gastroenterologia do referido hospital, onde foram estudadas as variáveis: presença de colite microscópica, idade, sexo, tabagismo, uso de medicamentos, comorbidades, dor abdominal, fadiga, incontinência fecal, perda de peso. O tamanho da amostra para estudos pareados foi determinado por meio do programa STATA 17. Para sua estimativa foram considerados: nível de confiança, poder do estudo, razão de casos e controles e Odds Ratio mínimo. Resultados: Não houve associação entre idade acima de 50 anos e probabilidade de apresentar colite. O sexo feminino prevaleceu (62,5%). Do total de pacientes com colite microscópica (n=16), 62,5% fumavam. A OR obtida indicou que pacientes tabagistas apresentam risco 2,5 vezes maior. O diabetes mellitus foi significativamente associado ao diagnóstico de colite microscópica e aumentou o risco em cinco vezes. Conclusões: Existe relação entre sexo feminino, tabagismo, diabetes mellitus, colecistectomia, consumo de três ou mais medicamentos e incontinência fecal com a presença de colite microscópica.

Human hookworms from Argentina: Differential diagnosis of Necator americanus and Ancylostoma duodenale in endemic populations from Buenos Aires and Misiones.

Hookworm infection is endemic in many countries throughout the world; however, the information about the prevalence of each species, Necatoramericanus and Ancylostomaduodenale, is inaccurate in many South American countries. We aimed to determine the prevalence of human hookworm species by combining the results of both microscopy and PCR among endemic populations in Argentina, represented by natives and immigrants. A total of 140 serial fecal specimens were obtained from natives in the province of Misiones and an immigrant community living in the province of Buenos Aires. Samples were examined using the formalin-ethyl acetate concentration technique (FECT) and one flotation technique (screening tests) and specific PCRs for N. americanus and A. duodenale. We characterized samples containing N. americanus by sequencing a fragment of the cytochrome b gene. The observed hookworm prevalence as assessed by the screening tests and PCR were 24.3% and 32.8%, respectively. PCR positive samples were identified as N. americanus. PCR had 100% sensitivity compared with 73.9% of screening tests. A total of 12 samples from individuals with hookworm-infected household members were positive only by PCR. N. americanus sequences showed 90.5% identity, being more similar to each other than to any of the sequences obtained from GenBank. This is the first study that provides molecular data and characterization of N. americanus in Argentina. The complementary use of FECT and one flotation technique to screen hookworm infections, followed by PCR to differentiate the species contribute to produce better prevalence estimates.

Microscopic colitis: Case series and literature review / Colitis microscópica, serie de casos y revisión de la literatura

Abstract Introduction: Microscopic colitis is a benign and multifactorial disease characterized by watery diarrhea and histological alterations in the colonic mucosa. The incidence of this disease is increasing, being diagnosed more frequently. Materials and methods: In this retrospective study, patients were examined employing colonoscopy and biopsy due to a diagnosis of chronic diarrhea in a gastroenterology unit throughout 22 months. Their diagnosis of colitis was confirmed by clinical picture and microscopic analysis. Results: In the study period, a total of 2849 colonoscopies were performed, 116 in patients with chronic diarrhea. We identified 15 patients with microscopic colitis, 12 were men (80 %), and only three were older than 60 (20 %). Conclusion: Unlike the world literature, this study found that microscopic colitis in our patients affects the male sex primarily (male/female ratio: 4/1) and occurs in young people, with an average age of 47.5 years (range: 21-82 years).

Resumen Introducción: la colitis microscópica es una enfermedad benigna y multifactorial caracterizada por la presencia de diarrea acuosa y alteraciones histológicas en la mucosa colónica. La incidencia de esta enfermedad viene en aumento y su diagnóstico se realiza cada vez con mayor frecuencia. Métodos: estudio retrospectivo en el que se revisaron los pacientes por medio de colonoscopia y biopsias por diagnóstico de diarrea crónica en un período de 22 meses en una unidad de gastroenterología, y en quienes mediante la clínica y el análisis histológico se confirmó el diagnóstico de colitis microscópica. Resultados: en el período de estudio se realizó un total de 2849 colonoscopias, 116 en pacientes con diarrea crónica. Se identificaron 15 pacientes con colitis microscópica, 12 fueron hombres (80 %) y solo hubo 3 mayores de 60 años (20 %). Conclusión: a diferencia de lo informado en la literatura mundial, en este estudio se encontró que la colitis microscópica en nuestros pacientes compromete especialmente al sexo masculino (relación hombre/mujer: 4/1) y se presenta en personas jóvenes, con un promedio de edad de 47,5 años (rango de 21 a 82 años).

Peripheral ulcerative keratitis as presenting manifestation of systemic microscopic polyangiitis: a case report / Ceratite ulcerativa periférica como manifestação de poliangiíte microscópica sistêmica: relato de caso

ABSTRACT Microscopic polyangiitis is a rare autoimmune disease of unknown etiology, characterized by inflammation and necrosis of blood vessels. It forms a part of the antineutrophil cytoplasmic antibody-associated vasculitides-a heterogeneous group of disorders characterized by vasculitis. It is a systemic disease affecting multiple organs. The patients may present with a wide variety of symptoms. Ocular manifestations may present as its initial clinical symptoms, necessitating a multidisciplinary approach for reducing the morbidity and mortality. Early diagnosis aids in the formulation of appropriate treatment and prevention of further complications. Aggressive treatment, including surgery, is often necessary to limit structural damage and preserve visual function. We present the case of an 82-year-old woman who initially presented with peripheral ulcerative keratitis that led to the diagnosis of microscopic polyangiitis.

RESUMO A poliangeíte microscópica é uma doença autoimune rara de etiologia desconhecida, caracterizada por inflamação e necrose dos vasos sanguíneos. Faz parte das vasculites associadas a anticorpos citoplasmáticos antineutrófilos - um grupo heterogêneo de doenças caracterizadas por vasculite. É uma doença sistêmica que afeta vários órgãos. Os pacientes podem apresentar uma grande variedade de sintomas. As manifestações oculares podem apresentar-se como seus sintomas clínicos iniciais, necessitando de abordagem multidisciplinar para redução da morbimortalidade. O diagnóstico precoce ajuda na formulação do tratamento adequado e na prevenção de complicações futuras. O tratamento agressivo, incluindo cirurgia, muitas vezes é necessário para limitar o dano estrutural e preservar a função visual. Apresentamos o caso de uma mulher de 82 anos que inicialmente apresentou ceratite ulcerativa periférica que levou ao diagnóstico de poliangite microscópica.

Características epidemiológicas, clínicas y respuesta al tratamiento en 113 pacientes con colitis microscópica / Epidemiological and clinical characteristics, and response to treatment in 113 patients with microscopic colitis

Objetivo: Estudiar las características epidemiológicas, clínicas y la respuesta al tratamiento en pacientes con colitis microscópica. Pacientes y método: Se recopilaron retrospectivamente los datos epidemiológicos, clínicos, analíticos y endoscópicos de 113 pacientes con colitis microscópica. La respuesta al tratamiento se analizó en 104 de ellos. La eficacia y la recidiva tras la administración de budesonida se evaluaron mediante curvas de supervivencia (Kaplan-Meier). Resultados: El 78% de los pacientes fueron mujeres, con una edad media de 65 ± 16 años. En los fumadores, la edad media fue 10 años menor. Un 48% tenía alguna enfermedad inmunomediada concomitante. El 60% sufrió un único brote de la enfermedad. La presentación clínica fue similar en ambos subtipos, aunque los pacientes con colitis colágena tuvieron con mayor frecuencia un curso crónico (48 vs. 29%, p = 0,047). La tasa de remisión con budesonida fue del 93% (IC 95%: 82-98). La incidencia acumulada de recidiva, tras una mediana de seguimiento de 21 meses, fue del 39% (IC 95%: 26-54%): 19% al año, 32% a los dos años y 46% a los tres años de seguimiento. No hubo diferencias en la respuesta clínica a la budesonida en función del tabaquismo o del subtipo de colitis microscópica. Conclusiones: La colitis microscópica es más frecuente en mujeres de edad avanzada. El tabaco se asoció a una aparición más precoz de la enfermedad, aunque no influyó en la evolución clínica o en la respuesta al tratamiento. La mayoría (> 90%) de los pacientes tratados con budesonida alcanzaron la remisión, aunque casi la mitad recidivaron posteriormente.(AU)

Objective: To study the epidemiological and clinical characteristics, and response to treatment in patients with microscopic colitis. Patients and method: Epidemiological, clinical, blood test and endoscopic data were retrospectively collected from 113 patients with microscopic colitis. Response to treatment was analyzed in 104 of them. Efficacy and relapse after treatment with budesonide were assessed using survival curves (Kaplan-Meier). Results: 78% of the patients were women, with a mean age of 65 ± 16 years. In smokers, the mean age was 10 years younger. 48% of them had some concomitant autoimmune disease; 60% suffered a single outbreak of the disease. The clinical presentation was similar in both subtypes, although patients with collagenous colitis had a chronic course more frequently (48% vs. 29%, p = 0.047). The remission rate with budesonide was 93% (95% CI 82-98). The cumulative incidence of relapse, after a median follow-up of 21 months, was 39% (95% CI 26-54%): 19% at one year, 32% at two years, and 46% at three years of follow-up. There were no differences in clinical response to budesonide based on smoking habit or microscopic colitis subtype. Conclusions: Microscopic colitis is more frequent in elderly women. Smoking was associated with earlier onset of the disease, although it did not influence the clinical course or response to treatment. The majority (> 90%) of patients treated with budesonide achieved remission, although nearly half subsequently relapsed.(AU)

Serum cytokines in ANCA-associated vasculitis: Correlation with disease-related clinical and laboratory findings / Citocinas séricas en la vasculitis asociada a ANCA: correlación con los hallazgos clínicos y de laboratorio relacionados con la enfermedad

Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic, autoimmune disease. Cytokine dysregulation during active disease and clinical remission, reflects significant immunological activity in various disease stages, and might be responsible for the potential relapse of ANCA-vasculitis.ObjectivesThis study aimed to screen serological profiles in active granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), and to determine their associations with clinical characteristics.Materials and methodsSerum IL-10, IL-12, IL-17, IL-21, IL-23, B cell activating factor (BAFF) concentrations were determined by Quantikine HS ELISA in 71 patients, 47 with GPA and 24 with MPA, and compared with 16 healthy controls. Subsequently, the correlations between serum IL-10, IL-12, IL-17, IL-21, IL-23, BAFF levels, and both laboratory and clinical abnormalities were investigated.ResultsBAFF levels were significantly higher in GPA than MPA, and healthy controls. IL-10 and BAFF levels were elevated in GPA patients with pulmonary involvement. Higher BAFF levels might reflect severe GPA. IL-10 and IL-12 levels were higher in MPA than GPA. In MPA, IL-10 levels were highest in patients with short disease duration, and young individuals. IL-12 correlated positively with BVAS and was elevated in patients with cardiovascular involvement and nasal S. aureus carriers.ConclusionsIn MPA, IL-12 correlates positively with disease activity, and is significantly increased in patients with cardiovascular involvement and nasal S. aureus carriers. Increased IL-10 is observed in young MPA patients and in those with short MPA duration. Elevated BAFF and IL-10 levels are associated with pulmonary involvement in GPA. High BAFF levels might reflect severe GPA. (AU)

Antecedentes: Las vasculitis asociadas a anticuerpos anti-citoplasma de neutrófilos (ANCA) son enfermedades sistémicas autoinmunes. La desregulación de las citocinas durante la enfermedad activa y la remisión clínica refleja una actividad inmunológica significativa en diversas etapas de la enfermedad, pudiendo ser presumiblemente responsable de la recidiva potencial de la vasculitis ANCA.ObjetivosEl objetivo de este estudio fue cribar los perfiles serológicos de la granulomatosis con poliangeítis activa (GPA) y la poliangeítis microscópica (PAM), así como determinar sus asociaciones con las características clínicas.Materiales y métodosSe determinaron las concentraciones séricas de IL-10, IL-12, IL-17, IL-21, IL-23, y el factor activador de célula B (BAFF) utilizando quantikine® HS ELISA en 71 pacientes, 47 con GPA y 24 con PAM, comparándose con 16 controles sanos. A continuación, se estudiaron las correlaciones entre los niveles séricos de IL-10, IL-12, IL-17, IL-21, IL-23 y BAFF, así como las alteraciones de laboratorio y clínicas.ResultadosLos niveles de BAFF fueron significativamente más altos en GPA que en PAM y los controles sanos. Los niveles de IL-10 y BAFF fueron elevados en los pacientes de GPA con compromiso pulmonar. Los niveles más altos de BAFF podrían reflejar presumiblemente GPA severa. Los niveles de IL-10 eIL-12 fueron más altos en PAM que en GPA. En PAM, los niveles de IL-10 fueron más altos que en pacientes con corta duración de la enfermedad y en individuos jóvenes. IL-12 guardó una correlación positiva con puntuación de actividad de vasculitis de Birmingham (BVAS), y los niveles fueron elevados en pacientes con compromiso cardiovascular y portadores de S. aureus nasal. (AU)

Antibody prevalence of Leptospira spp. and Brucella abortus in domestic cats from Araguaína, Tocantins, North Region of Brazil / Prevalência de anticorpos para Leptospira spp. e Brucella Abortus em gatos domésticos de Araguaína, Tocantins, Região Norte do Brasil

Leptospira spp. and Brucella abortus are bacterial pathogens that can infect humans and animals. The present study aimed to detect anti-Leptospira and anti-B. abortus antibodies and verified the presence of factors associated with seropositivity in cats. One hundred and eighty serum samples were collected from domestic cats (Felis silvestris catus) from the urban area of the municipality of Araguaína-Tocantins by phlebocentesis of the cephalic and jugular veins. The samples were subjected to detection of anti-Leptospira and anti-B.abortus antibodies, respectively, by microscopic seroagglutination and buffered acidified antigen testing, followed by confirmation by the 2-mercaptoethanol test and slow seroagglutination in tubes. Data from the epidemiological questionnaire (the age, sex, origin, breed, and presence of clinical signs) were analyzed using Epi Info® software with seropositivity data found to search for associated factors using the chi-square test. In the present study, the prevalence of Leptospira spp. was 5.56% (10/180). However, no sample was reactive to B. abortus. None of the studied variables were associated with seropositivity for the pathogens evaluated. Therefore, there is contact between Leptospira spp. and the feline population of the municipality, indicating the possibility of the circulation of pathogenic serovars and that the presence of anti-Leptospira antibodies does not depend on the variables analyzed.

Leptospira spp. e Brucella abortus são patógenos bacterianos que podem infectar humanos e animais. O presente estudo teve como objetivo detectar anticorpos anti-Leptospira e anti-B.abortus e verificar a presença de fatores associados com a soropositividade em gatos. Foram coletadas 180 amostras de soro de gatos domésticos (Felis silvestris catus) da zona urbana do município de Araguaína-Tocantins por flebocentese das veias cefálica e jugular. As amostras foram submetidas à detecção de anticorpos anti-Leptospira e anti-B. abortus, respectivamente, por soroaglutinação microscópica e teste do antígeno acidificado tamponado, seguido de confirmação pelo teste de 2-mercaptoetanol e soroaglutinação lenta em tubos. Os dados do questionário epidemiológico (idade, sexo, procedência, raça e presença de sinais clínicos) foram analisados no software Epi Info® com os dados de soropositividade encontrados para pesquisa de fatores associados pelo teste do qui-quadrado. No presente estudo, a prevalência de Leptospira spp. foi de 5,56% (10/180). No entanto, nenhuma amostra foi reativa para B. abortus. Nenhuma das variáveis estudadas foi associada com a soropositividade para os patógenos avaliados. Portanto, há contato entre Leptospiraspp. e a população felina do município, indicando a possibilidade de circulação de sorovares patogênicos e que a presença de anticorpos anti-Leptospira independe das variáveis analisadas.

Clinical characteristics and prognostic factors in an argentinian cohort with ANCA-associated vasculitis / Características clínicas y factores pronósticos en una cohorte argentina de vasculitis asociada a ANCA

Abstract ANCA-associated vasculitis is a heterogeneous group of rare autoimmune conditions of unknown cause. Clinical characteristics and prognostic factors were analyzed in 47 patients: 20 (42.5%) with granulomatosis with polyangiitis, 17 (36.2%) with microscopic polyangiitis, 6 (12.8%) with renal-limited vasculitis, and 4 (8.5%) with eosinophilic granulomatosis with polyangiitis. Mean age at diagnosis was 53.5 ± 16.5 years and the median of BVAS (Birmingham Vasculitis Activity Score) was 14 (4-42). The most frequent clinical manifesta tions were: general in 44 (93.6%), renal in 30 (63.8%) and respiratory in 28 (59.6%). All received corticosteroids at the beginning of treatment. Intravenous cyclophosphamide was associated in 20 (42.5%) and oral route in 14 (29.8%); azathioprine in 3 (6.4%) and rituximab in 2 (4.2%). At a median follow-up of 35.5 months (range 0.14- 234), 21 relapses were recorded in 14 patients. Overall mortality was 3.5 deaths per 100 patient-year in the whole group. Those over 55 years old, the presence of alveolar hemorrhage, those with FFS (Five Factor Score) of 2, and patients with MPA had poor prognosis. Renal involvement, ANCA pattern and BVAS were not associated to a poorer prognosis.

Resumen Las vasculitis asociadas a ANCA son un grupo heterogéneo de entidades autoinmunes, poco frecuentes, de etiología desconocida. Analizamos las características clínicas y factores pronóstico en 47 pacientes: 20 (42.5%) granulomatosis con poliangeítis, 17 (36.2%) poliangeítis microscópica, 6 (12.8%) vasculitis limitada al riñón y 4 (8.5%) granulomatosis eosinofílica con poliangeítis. La edad promedio al diagnóstico fue 53.5 ± 16.5 años y la mediana de BVAS (Birmingham Vasculitis Activity Score) 14 (4-42). Las manifestaciones clínicas más frecuentes fueron: generales en 44 (93.6%), renales 30 (63.8%) y respiratorias en 28 (59.6%). Todos recibieron corticoides al inicio del tratamiento. Se asoció ciclofosfamida endovenosa en 20 (42.5%) y oral en 14 (29.8%); azatioprina en 3 (6.4%) y rituximab en 2 (4.2%). En una mediana de seguimiento de 35.5 meses (rango 0.14-234), se registraron 21 recaídas en 14 pacientes. La mortalidad fue 3.5 por cien pacientes-año en todo el grupo. Los mayores de 55 años, con presencia de hemorragia alveolar, FFS (Five Factor Score) de 2, y los casos con poliangeítis microscópica tuvieron peor pronóstico. El compromiso renal, el patrón de ANCA y el BVAS no se asociaron a peor pronóstico.

Flowering and Seed Production across the Lemnaceae.

Plants in the family Lemnaceae are aquatic monocots and the smallest, simplest, and fastest growing angiosperms. Their small size, the smallest family member is 0.5 mm and the largest is 2.0 cm, as well as their diverse morphologies make these plants ideal for laboratory studies. Their rapid growth rate is partially due to the family's neotenous lifestyle, where instead of maturing and producing flowers, the plants remain in a juvenile state and continuously bud asexually. Maturation and flowering in the wild are rare in most family members. To promote further research on these unique plants, we have optimized laboratory flowering protocols for 3 of the 5 genera: Spirodela; Lemna; and Wolffia in the Lemnaceae. Duckweeds were widely used in the past for research on flowering, hormone and amino acid biosynthesis, the photosynthetic apparatus, and phytoremediation due to their aqueous lifestyle and ease of aseptic culture. There is a recent renaissance in interest in growing these plants as non-lignified biomass sources for fuel production, and as a resource-efficient complete protein source. The genome sequences of several Lemnaceae family members have become available, providing a foundation for genetic improvement of these plants as crops. The protocols for maximizing flowering described herein are based on screens testing daylength, a variety of media, supplementation with salicylic acid or ethylenediamine-N,N'-bis(2-hydroxyphenylacetic acid) (EDDHA), as well as various culture vessels for effects on flowering of verified Lemnaceae strains available from the Rutgers Duckweed Stock Cooperative.

Factores predictivos de alta carga residual ganglionar axilar post biopsia de ganglio centinela positiva / Predictive factors of high residual burden in axillary lymph node after positive sentinel node biopsy

El estado axilar es un factor pronóstico para los estadios tempranos de cáncer de mama. Existen factores que podrían predecir riesgo de mayor enfermedad axilar. El objetivo es determinar cuáles son los factores predictivos independientes de alta carga residual ganglionar axilar (4 o más GNC comprometidos) luego de la BGC positiva. Estudio analítico, observacional, cohorte retrospectiva de pacientes con tumores T1-2, axila clínicamente negativa, a las que se les realizó cirugía conservadora (CC) y BGC con resultado positivo (marco o micrometástasis) y se les realizó posterior linfadenectomía axilar (LA). Del total de 325 pacientes, 96 tuvieron resultado positivo para metástasis en el ganglio centinela (29,5%) y también se les realizó LA. Se dividió a la población seleccionada en dos grupos según el compromiso de los GNC: baja carga axilar 0-3 GNC positivos, y alta carga axilar 4 o más GNC positivos. Se observaron como factores que demostraron mayor riesgo para alta carga axilar ganglionar residual al grado histológico, ki-67 y la invasión extracapsular en el GC; pero solamente la invasión extracapsular en el GC demostró ser significativa en el análisis multivariado. Probablemente con un mayor número de pacientes otras variables pudieran haber resultado factores de riesgo independiente

Axillary status is a prognostic factor for early stages of breast cáncer. There are predictive factors that might indicate the risk of greater axilary disease. The aim is to determine which are the independent predictive factor sor a high residual axillary nodal burden (four or more non-sentinel lymph nodes involved) after a positive sentinel node biopsy. Retrospective cohort analytic observational study of patients with T1-2 tumors, negative axilla, who underwent breast conserving surgery and sentinel node biopsy with a positive result (macro ­ or micro-metastasis) and later underwent lymph node dissection. Out of the total 325 patients, 96 got a positive result for metástasis in the sentinel lymph node (29.5%) and also underwent lymph node dissection. The selected population was divided into two groups according to the involvement of NSLNs: low axillary burden: 0-3 NSLNs, and high axillary burden: 4 or more positive NSLNs. Among the factors found to have a higher risk of high residual axillary nodal burden were the histologic grade, Ki-67 and the extracapsular invasión of the SLN, but only the extracapsular invasión of the SLN was found to be significant in the multivariate analysis. It is likely that with a higher number of patients, other variables might have been independent risk factors

Síndrome de Alport: una actualización en fisiopatología, genética, diagnóstico y tratamiento / Alportsyndrome: anupdate in pathophysiology, genetics, diagnosis, and treatment

RESUMEN El síndrome de Alport es una enfermedad renal hereditaria de curso progresivo, que ocurre por defectos genéticos en los genes responsables de la constitución de la membrana basal glomerular. Las mutacionespatogénicas en los genes para el colágeno tipo IV (COL 4A3/4/5) producen una alteración en el arreglo correcto de la membrana basal a nivel glomerular.La presentación clínica puede variar dependiendo de la mutación que presente el paciente. Luego de confirmar el diagnóstico,con estudios genéticoso mediante biopsia, se hace necesaria la correlación genotipo-fenotipo para determinar pronóstico y tratamiento. La reducción de la proteinuria, según sugieren las guías de manejo, ha resultado en un retraso en la progresión a enfermedad renal crónica, mientras se concluyen los estudios con medicamentos innovadores dirigidos a receptores específicos.

ABSTRACT Alportsyndromeis a renal hereditarydisease of progressivecourse, causedby geneticdefects in the genes responsible for the constitution of the glomerular basementmembrane. Mutation in genes fortype IV collagen occurs at COL 4A3/4/5, whichproducesinterference in thecorrectmembranearrangement. Clinicalpresentationmayvarydependingonmutationtype. Afterconfirming diagnosis, withgenetic studiesorbiopsies, managementincludesidentification of risk and treatment. Reduction of proteinuria, as managementguidelinessuggest, has resulted in delay in progressiontochronickidneydisease. In themeantime, studiesfor new treatmentdevelopments are in progress, directedtospecificreceptors.

Antibodies against Leptospira spp. in bovine serum samples from several Brazilian states analyzed in the period from 2007 to 2015 / [Anticorpos contra Leptospira spp. em amostra de soro bovino de diversos estados brasileiros analisados no período entre 2007 e 2015]

Bovine leptospirosis assumes great economic importance since it affects several production aspects. Therefore, knowledge about the occurrence and distribution of this disease is fundamental to adopt the correct prevention measures. The present study aimed to evaluate the frequency of anti-Leptospira spp. antibodies in 24,483 bovine serum samples received between 2007 to 2015 from 21 Brazilian states. Of these, 8,643 (35.3%) were reagents in the microscopic agglutination test to one or more serovars of Leptospira spp. The most frequent serovars were Wolffi (61.47%), Tarassovi (9.62%) and Pomona (7.20%). Hardjo serovar presented a prevalence of 6.27%. Among the 21 states analyzed, the State of Pernambuco had the highest frequency with 88.24% and the State of São Paulo was the origin of the largest number of analyzed samples (13,838), with a frequency of 31.54% of reagents. The results demonstrate a high exposure to several serovars of Leptospira spp. in bovine species in Brazilian states, showing the importance of adopting prophylactic measures in order to reduce the risk of infection in this specie.(AU)

Com o objetivo de avaliar a frequência de anticorpos anti-Leptospira spp., foram analisadas 24.483 amostras de soro sanguíneo bovino, provenientes de 21 estados brasileiros, recebidas no período de 2007 a 2015. Destas, 8.643 (35,3%) foram reagentes no teste de soroaglutinação microscópica a uma ou mais sorovariedades de Leptospira spp., e as sorovariedades com maior frequência foram Wolffi (61,47%), Tarassovi (9,62%) e Pomona (7,20%). A sorovariedade Hardjo apresentou prevalência de 6,27%. Entre os 21 estados analisados, o estado de Pernambuco apresentou a maior frequência, com 88,24%, e o estado de São Paulo foi a origem do maior número de amostras para análise, 13.838, com frequência de 31,54% de reagentes.(AU)

Use of the cryostat to prepare slides for trichological analysis / [Uso do aparelho criostato para preparação de lâminas para a análise tricológica]

A análise dos padrões morfológicos e morfométricos das microestruturas capilares é uma técnica não invasiva que pode ser utilizada para identificar espécies de mamíferos. Esta técnica pode ser aplicada em diversas áreas da ciência animal, tais como controle de qualidade de alimentos e análises forenses. Dada a dificuldade de obter seções transversais de pelos de guarda para expor o córtex, a maioria dos estudos analisou apenas os componentes medulares e cuticulares do pelo. A inclusão do córtex capilar de guarda em uma análise tricológica pode proporcionar uma descrição mais precisa das raças ou espécies de mamíferos. O presente estudo propõe um novo método para a execução de cortes transversais que expõem o córtex do pelo guarda de mamíferos utilizando um criostato.(AU)