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Omphalocele is the result of the abnormal interaction between biological/molecular mechanisms and a genetic predisposition during the first twelve weeks of development, where the return of the intestinal loops to the abdominal cavity is disturbed. Muscle relaxation with botulinum toxin A (TxBtA) has been used as an adjuvant postnatal therapy for the repair of complex abdominal wall defects. A female fetus was diagnosed with a giant omphalocele at 14 weeks of gestation. At 34 weeks and 5 days of gestation, 35 units of TxBtA (diluted at 100 units per 10 ml) were injected under ultrasound guidance into each muscle of the left and right sides of the abdominal wall with a 25G spinal needle. The fetus tolerated the procedure well. Two weeks after the injection, the first ultrasound examination was done and revealed a noteworthy change in the shape of the abdominal circumference, with a 50 % decrease in the omphalocele size. The newborn was delivered at 38 weeks and 3 days of gestation. The omphalocele had a maximum diameter of 7 cm. The patient required mechanical ventilation for 24 hours. The reconstruction of the anterior abdominal wall was completed on the fifth day of life using a component separation technique. Feedings were initiated one day after the closure and the patient was discharged home on the 12th day of life. The patient has not experienced any complications at 2 months of follow up. Our case suggests that prenatal muscle relaxation of the abdominal wall with TxBtA could reduce the need for mechanical ventilation, the time on parenteral nutrition, and the overall hospital stay in newborns with giant omphalocele. [ABSTRACT FROM AUTHOR]

Resumen Introducción El Consejo Mexicano de Reumatología certifica anualmente reumatólogos mediante una prueba teórica y un examen clínico objetivo estructurado (ECOE). Desde el año 2015, se evalúan las habilidades de comunicación (HC) de los candidatos. Los objetivos fueron comparar las HC evaluadas por el paciente (HCP) y por el médico (HCM) y correlacionarlas con el desempeño de los candidatos en el ECOE. Material y métodos Durante los años 2015, 2016 y 2017, se evaluaron las HC en las estaciones dinámicas, mediante una escala de Likert aplicada a 8 áreas. Pacientes y evaluadores fueron entrenados cada año para calificar a los aspirantes, lo cual se realizó el día del ECOE, de manera ciega, por ambos. Se calcularon coeficientes de correlación de Pearson. Resultados En general, a lo largo de los 3 años, los candidatos obtuvieron puntajes altos en las HC. Los pacientes puntuaron mejor a los candidatos que los evaluadores médicos. Las HCP y las HCM correlacionaron entre sí (de leve a moderado) en la mayoría de las estaciones. El puntaje de las HC de cada candidato correlacionó con su desempeño en la estación correspondiente; se encontraron mejores correlaciones con las HCP. El promedio de las HC de cada candidato correlacionó con el desempeño global en el ECOE, pero no así con la prueba teórica (salvo en el año 2017, cuando hubo una correlación baja). Conclusiones Las HC evaluadas durante un examen de certificación en Reumatología correlacionan con el desempeño de cada candidato en cada estación y en el ECOE global. Abstract Background The Mexican Accreditation Council for Rheumatology annually certifies trainees in Rheumatology using a multiple-choice test and an objective structured clinical examination (OSCE). Since 2015, candidate's communication skills (CS) have been rated by both patients and by physician examiners and correlated with results on the OSCE. This study compared the CS from candidates to annual accreditation in Rheumatology as rated by patients and by physician examiners, and assessed whether these correlated with candidate's performance in the OSCE. Material and methods From 2015 to 2017, 8 areas of CS were evaluated using a Likert scale, in each OSCE station that involved a patient. Both patient and physician evaluators were trained annually and their evaluations were performed blindly. The associations were calculated using the Pearson correlation coefficient. Results In general, candidates were given high CS scores; the scores from patients of the candidate's CS were better than those of physician examiners; within the majority of the stations, both scores were found to correlate moderately. In addition, the scoring of CS correlated with trainee performance at the corresponding OSCE station. Interestingly, better correlations were found when the skills were rated by the patients compared to physician scores. The average CS score was correlated with the overall OSCE performance for each trainee, but not with the multiple-choice test, except in the 2017 accreditation process, when a weak correlation was found. Conclusions CS assessed during a national accreditation process correlated with the candidate's performance at the station level and with the overall OSCE. [ABSTRACT FROM AUTHOR]

Resumen Existen varias guías de práctica clínica tanto nacionales como internacionales para el tratamiento del lupus eritematoso sistémico. No obstante, la mayoría de las guías disponibles no están diseñadas para población mexicana o solamente son para el manejo de manifestaciones específicas como nefritis lúpica o para algún estado fisiológico como el embarazo. El Colegio Mexicano de Reumatología se propuso elaborar unas guías de práctica clínica que conjuntaran la mayor parte de las manifestaciones de la enfermedad y que incluyeran adicionalmente pautas en situaciones controversiales como lo son la vacunación y el periodo perioperatorio. En el presente documento se presenta la «Guía de práctica clínica para el manejo del lupus eritematoso sistémico» propuesta por el Colegio Mexicano de Reumatología, que puede ser de utilidad principalmente a médicos no reumatólogos que se ven en la necesidad de tratar a pacientes con lupus eritematoso sistémico sin tener la formación de especialistas en reumatología. En esta guía se presentan recomendaciones sobre el manejo de manifestaciones generales, articulares, renales, cardiovasculares, pulmonares, neurológicas, hematológicas, gastrointestinales, respecto a la vacunación y al manejo perioperatorio. Abstract There are national and international clinical practice guidelines for systemic lupus erythematosus treatment. Nonetheless, most of them are not designed for the Mexican population or are devoted only to the treatment of certain disease manifestations, like lupus nephritis, or are designed for some physiological state like pregnancy. The Mexican College of Rheumatology aimed to create clinical practice guidelines that included the majority of the manifestations of systemic lupus erythematosus, and also incorporated guidelines in controversial situations like vaccination and the perioperative period. The present document introduces the «Clinical Practice Guidelines for the Treatment of Systemic Lupus Erythematosus» proposed by the Mexican College of Rheumatology, which could be useful mostly for non-rheumatologist physicians who need to treat patients with systemic lupus erythematosus without having the appropriate training in the field of rheumatology. In these guidelines, the reader will find recommendations on the management of general, articular, kidney, cardiovascular, pulmonary, neurological, hematologic and gastrointestinal manifestations, and recommendations on vaccination and treatment management during the perioperative period. [ABSTRACT FROM AUTHOR]

Cell fate stability is essential to maintaining "law and order" in complex animals. However, high stability comes at the cost of reduced plasticity and, by extension, poor regenerative ability. This evolutionary trade-off has resulted in most modern animals being rather simple and regenerative or complex and non-regenerative. The mechanisms mediating cellular plasticity and allowing for regeneration remain unknown. We show that signals emitted by senescent cells can destabilize the differentiated state of neighboring somatic cells, reprogramming them into stem cells that are capable of driving whole-body regeneration in the cnidarian Hydractinia symbiolongicarpus. Pharmacological or genetic inhibition of senescence prevents reprogramming and regeneration. Conversely, induction of transient ectopic senescence in a regenerative context results in supernumerary stem cells and faster regeneration. We propose that senescence signaling is an ancient mechanism mediating cellular plasticity. Understanding the senescence environment that promotes cellular reprogramming could provide an avenue to enhance regeneration. [Display omitted] • Amputation injury induces senescence in a small number of head cells in Hydractinia • Senescent cells persist in the tissue for several hours before being expelled • Signals emitted by senescent cells induce reprogramming of neighboring cells • Reprogrammed cells proliferate and drive whole-body regeneration Cellular senescence is a form of permanent cell-cycle arrest in animals that is associated with aging and inflammation. Salinas-Saavedra et al. find that, in the absence of resident stem cells, senescent cells can instruct neighboring somatic cells to reprogram into stem cells that drive whole-body regeneration in the cnidarian Hydractinia symbiolongicarpus. [ABSTRACT FROM AUTHOR]

Copyright of Reumatología Clínica is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: To evaluate 2-year neurodevelopmental outcomes of near-term, small-for-gestational-age (SGA) newborns segregated by presence or absence of histopathology reflecting placental underperfusion (PUP). Patients and methods: A cohort of consecutive near-term (≥34.0 weeks) SGA newborns with normal prenatal umbilical artery Doppler studies was selected. All placentas were inspected for evidence of underperfusion and classified in accordance with established histologic criteria. Neurodevelopmental outcomes at 24 months (age-corrected) were then evaluated, applying the Bayley Scale for Infant and Toddler Development, Third Edition (Bayley-III) to assess cognitive, language, and motor competencies. The impact of PUP on each domain was measured via analysis of covariance, logistic and ordinal regression, with adjustment for smoking, socioeconomic status, gestational age at birth, gender, and breastfeeding. Results: A total of 83 near-term SGA deliveries were studied, 46 (55.4%) of which showed signs of PUP. At 2 years, adjusted neurodevelopmental outcomes were significantly poorer in births involving PUP (relative to SGA infants without PUP) for all three domains of the Bayley scale: cognitive (105.5 vs 96.3, adjusted-p = 0.03), language (98.6 vs 87.8, adjusted-p<0.001), and motor (102.7 vs 94.5, adjusted-p = 0.007). Similarly, the adjusted likelihood of abnormal cognitive, language, and motor competencies in instances of underperfusion was 9.3-, 17.5-, and 1.44-fold higher, respectively, differing significantly for the former two domains. Conclusions: In a substantial fraction of near-term SGA babies without Doppler evidence of placental insufficiency, histologic changes compatible with PUP are still identifiable. These infants are at greater risk of abnormal neurodevelopmental outcomes at 2 years. [Copyright &y& Elsevier]

Copyright of Reumatología Clínica is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reumatología Clínica is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To survey the efficacy of a practical workshop on clinical musculoskeletal anatomy held in five American countries. Methods: A self-assessment competence questionnaire sent to participants 1-3 months after the workshop. Results were compared to the results of a practical, instructor-assessed, pre-workshop test. Results: The response rate of participants was 76.4%. The overall, self-assessed competence score for anatomical items that had been included in the pre-test was 76.9 (scale 0-100) as compared to an overall score of 48.1 in the practical, pre-workshop test (p < 0.001). For items that were addressed in the workshop, but not included in the pre-test, self-assessed competence was rated at 62.9. Differences in anatomical knowledge between individuals from different countries and professional groups noted in the practical pre-test were no longer present in the post-test self-assessment. Conclusions: From this preliminary data and supporting evidence from the literature we believe that our anatomy workshop provides an effective didactic tool for increasing competence in musculoskeletal anatomy. [ABSTRACT FROM AUTHOR]

This paper focuses on the representation of the air surface temperature and precipitation using high spatiotemporal simulations (3 km–1 h) of the WRF3.7.1 model in the central Peruvian area. It covers, from east to west, the coastal zone, the western slope of the Andes, the Andean Mantaro basin (500–5000 masl), and the Andes-Amazon transition region in the eastern Andes. The study covers the January months from 2004 to 2008. Three experiments were conducted using different topography and land use data sources: (1) a control simulation using the default WRF topography and land use datasets from the United States Geological Survey (USGS); (2) a simulation changing only the topography by using the SRTM topography dataset; and (3) a simulation changing the land use data of (2) by a new dataset adapted from Eva et al. (2004). SRTM topography performed better than the control simulation for representing the actual altitudes of 57 meteorological stations that were used for precipitation and surface air temperature data. As a result, the simulations of experiments (2) and (3) produced lower bias values than that of (1). Topography change (experiment (2)) showed improvements in temperature bias that were directly associated with linear modifications of -5.6 and -6.7 °C∙km−1 in minimum and maximum temperature, respectively. Increasing (decreasing) precipitation with topography or land use change was clearly controlled by changes in the moisture flux patterns and its convergence (divergence) in the Andes-Amazon transition. On the western slope, precipitation increase could be associated with the increase in easterly flow by the smaller altitudes of the Andes mountains in SRTM topography and by increasing evaporation with new land use. Inside the Mantaro Basin, low level moisture flux seems to control the rainfall changes. Overall, relative changes (positive or negative) in precipitation due to topography or land use change could reach values above 25%. • Simulations are performed at complex terrain in the Peruvian central Andes during the rainiest month. • Differences between SRTM and USGS topography databases can reach >1 km in the Andes of Peru. • Major impacts on rainfall and temperature are found in the eastern slope of the Andes. • Better representation of topography reduces the bias of rainfall and temperature. [ABSTRACT FROM AUTHOR]

The authors describe a series of learner-centered exercises, highlighting a technique in which the musculoskeletal anatomy is explored and learned through self-examination, with the examiner required to identify designated structures in both the static and dynamic state. The technique of musculoskeletal anatomy through self-examination consists of applying knowledge of the surface anatomy of a region as it exists in the static state, to the analysis and understanding of changes that occur with movement and function of that body part. The sensory input of the examined part may contribute to the overall perception of the exercise. Three tables provide details that allow the reader to understand and perform the exercises describing the anatomic part explored, the physical maneuver required, the expected anatomic finding(s), and their clinical relevance. The authors believe that musculoskeletal self-examination provides an engaging learner-centered pedagogy that may complement that which is learned in peer or model examination. The lack of cost, the absence of intimacy barriers, and the opportunity to extend the method to further areas and functions are additional benefits of musculoskeletal self-examination as a learner-centered, self-study methodology. [ABSTRACT FROM AUTHOR]

Background: Congenital Zika virus (ZIKV) infection can be detected in both the presence and absence of microcephaly and manifests as a number of signs and symptoms that are detected clinically and by neuroimaging. However, to date, qualitative and quantitative measures for the purpose of diagnosis and prognosis are limited.Objectives: Main objectives of this study conducted on fetuses and infants with confirmed congenital Zika virus infection and detected brain abnormalities were (1) to assess the prevalence of microcephaly and the frequency of the anomalies that include a detailed description based on ultrasound and magnetic resonance imaging in fetuses and ultrasound, magnetic resonance imaging, and computed tomography imaging postnatally, (2) to provide quantitative measures of fetal and infant brain findings by magnetic resonance imaging with the use of volumetric analyses and diffusion-weighted imaging, and (3) to obtain additional information from placental and fetal histopathologic assessments and postnatal clinical evaluations.Study Design: This is a longitudinal cohort study of Zika virus-infected pregnancies from a single institution in Colombia. Clinical and imaging findings of patients with laboratory-confirmed Zika virus infection and fetal brain anomalies were the focus of this study. Patients underwent monthly fetal ultrasound scans, neurosonography, and a fetal magnetic resonance imaging. Postnatally, infant brain assessment was offered by the use of ultrasound imaging, magnetic resonance imaging, and/or computed tomography. Fetal head circumference measurements were compared with different reference ranges with <2 or <3 standard deviations below the mean for the diagnosis of microcephaly. Fetal and infant magnetic resonance imaging images were processed to obtain a quantitative brain volumetric assessment. Diffusion weighted imaging sequences were processed to assess brain microstructure. Anthropometric, neurologic, auditory, and visual assessments were performed postnatally. Histopathologic assessment was included if patients opted for pregnancy termination.Results: All women (n=214) had been referred for Zika virus symptoms during pregnancy that affected themselves or their partners or if fetal anomalies that are compatible with congenital Zika virus syndrome were detected. A total of 12 pregnant patients with laboratory confirmation of Zika virus infection were diagnosed with fetal brain malformations. Most common findings that were assessed by prenatal and postnatal imaging were brain volume loss (92%), calcifications (92%), callosal anomalies (100%), cortical malformations (89%), and ventriculomegaly (92%). Results from fetal brain volumetric assessment by magnetic resonance imaging showed that 1 of the most common findings associated with microcephaly was reduced supratentorial brain parenchyma and increased subarachnoid cerebrospinal fluid. Diffusion weighted imaging analyses of apparent diffusion coefficient values showed microstructural changes. Microcephaly was present in 33.3-58.3% of the cases at referral and was present at delivery in 55.6-77.8% of cases. At birth, most of the affected neonates (55.6-77.8%) had head circumference measurements >3 standard deviations below the mean. Postnatal imaging studies confirmed brain malformations that were detected prenatally. Auditory screening results were normal in 2 cases that were assessed. Visual screening showed different anomalies in 2 of the 3 cases that were examined. Pathologic results that were obtained from 2 of the 3 cases who opted for termination showed similar signs of abnormalities in the central nervous system and placental analyses, including brain microcalcifications.Conclusion: Congenital microcephaly is not an optimal screening method for congenital Zika virus syndrome, because it may not accompany other evident and preceding brain findings; microcephaly could be an endpoint of the disease that results from progressive changes that are related to brain volume loss. Long-term studies are needed to understand the clinical and developmental relevance of these findings. [ABSTRACT FROM AUTHOR]

Chagas disease is a major public health problem in Latin America and has spread to other countries due to immigration of infected persons. 10–30% of patients with chronic Chagas disease will develop cardiomyopathy. Chagas cardiomyopathy is the worst form of the disease, due to its high morbidity and mortality. Because of its prognostic value and adequate medical monitoring, it is very important to identify infected people who could develop Chagas cardiomyopathy. The aim of this study was to determine if discrete typing units (DTUs) of Trypanosoma cruzi are related to the presence of heart disease in patients with chronic Chagas disease. A total of 86 untreated patients, 41 with cardiomyopathy and 45 without heart involvement were submitted to clinical study. Electrocardiograms and echocardiograms were performed on the group of cardiopaths, in which all important known causes of cardiomyopathy were discarded. Sinus bradycardia and prolonged QTc interval were the most frequent electrocardiographic alterations and patients were classified in group I (46%) and group II (54%) of New York Hearth Association. In all cases real-time PCR genotyping assays were performed. In the group with cardiomyopathy, the most frequent DTU was TcI (56.1%), followed by TcII (19.5%). Mixed infections TcI + TcII were observed in 7.3% of the patients. In the group without cardiac pathologies, TcI and TcII were found at similar rates (28.9 and 31.1%, respectively) and mixed infections TcI + TcII in 17.8% of the cases. TcIII and TcIV were not detected in any sample. Taken together, our data indicate that chronic Chagas cardiomyopathy in Chile can be caused by strains belonging to TcI and TcII. [ABSTRACT FROM AUTHOR]

: BackgroundOur objective was to assess the efficacy and safety of cyclosporine-A (CsA) plus chloroquine (Clq) in early-onset rheumatoid arthritis (RA) compared to CsA plus placebo.: MethodsWe conducted a prospective, 12-month follow-up, multicenter, double-blind, placebo-controlled study of CsA (2.5–5 mg/kg/day[d]) plus Clq (150 mg/d) vs. CsA plus placebo in active RA of <2 years of evolution.: ResultsA total of 149 patients were included; 111 patients (74.4%) completed the 12-month follow-up period. Evaluation at 6 and 12 months showed improvement for all clinical disease parameters. In both groups there was a decrease in tender joint count, swollen joint count, pain, assessment of efficacy by both investigator and patient, functional assessment, and morning stiffness, all differences statistically significant. With an intention-to-treat analysis, there was 64% in the CsA plus Clq group (CsA/Clq) and 63% in the CsA plus placebo group (CsA/Plac) at 12 months in the American College of Rheumatology (ACR)-20 criteria of improvement. Response rate for ACR-50 was 48 and 47%, and for ACR-70 it was 29% in both groups; the difference was not statistically significant between study groups. Gastrointestinal complaints were common in both groups. Four patients in CsA/Clq group and five patients in CsA/placebo group increased creatinine levels; two patients in each group discontinued treatment due to this reason.: ConclusionsThere was no advantage to adding chloroquine to cyclosporine in patients with RA. [Copyright &y& Elsevier]

• 86-95% goats in Mendoza, Argentina were infected with Trypanosoma cruzi in spring. • Parasite loads were low in all goats tested. • Frequency of infection and parasite loads were higher in spring than in fall. • Infection rates by department were unrelated to goat management type. • Persistence of T. cruzi is confirmed in rural areas of Mendoza. Mendoza province, in central west Argentina, is considered among the high-risk provinces for vector transmission of Trypanosoma cruzi , the causative agent of Chagas disease. Extensive goat farming is common in large parts of rural Mendoza, and goats may act as a reservoir for this parasite. The objective of this study was to determine infection rates, parasite loads, and seasonal variation of these parameters in T. cruzi infection in goats from rural areas of three departments of Mendoza. A total of 349 peripheral blood samples with EDTA / guanidine were analyzed from goats on 11 farms (three in Lavalle, three in San Carlos, and five in Malargüe department) in spring of 2014, 2015, and 2016; and in fall of 2015 and 2016 (only Malargüe). DNA was extracted using a Phenol: Chloroform: Isoamyl protocol. The detection and quantification of T. cruzi was performed through qPCR amplification using satellite oligonucleotides. Of the 349 blood samples, 267 (77%) were positive, with parasite loads ranging between <0.10 and 10.90 par-eq/mL (median 0.10). In spring, frequencies of infection in the three departments ranged between 86% and 95%, but differences were not significant. Median parasite loads were higher in Lavalle than in the other departments, while those in goats from San Carlos were consistently low. The frequency of infection and parasite loads in Malargüe were significantly higher in spring than in fall. This seasonal variation may have been related to a reduced nutritional status and impaired immune response of goats in spring. In conclusion, the high proportion of positive goats confirms the persistence of T. cruzi in rural Mendoza. [ABSTRACT FROM AUTHOR]

Graphical abstract Even though the triatomine Mepraia gajardoi doesn't coexist with the rodent Octodon degus, it is able to acquire and excrete Trypanosoma cruzi obtained from this mammal. Highlights • Mepraia gajardoi and Triatoma infestans acquire Trypanosoma cruzi from Octodon degus. • M. gajardoi detected 100% of infected O. degus whereas T. infestans only 50%. • M. gajardoi and T. infestans detect TcI, TcV and TcV (single and mixed infections). • M. gajardoi detected TcI in all infected O. degus and T. infestans only in 38%. • T. cruzi was more detectable by M. gajardoi at 40 and 120 days post xenodiagnoses. Abstract Chagas disease is a vector-borne disease caused by the parasite Trypanosoma cruzi , and transmitted by triatomine insects to several mammal species. In Chile, the wild triatomine species are the endemic Mepraia species, and the only domestic vector of Chagas disease is Triatoma infestans. The aim of this study was to determine the competence of M. gajardoi compared to T. infestans as a T. cruzi vector using the naturally infected rodent Octodon degus. M. gajardoi amplified T. cruzi present in all O. degus studied while T. infestans only in half of the infected rodents. Both triatomine species excrete metacyclic trypomastigotes and amplified the same three T. cruzi DTUs, however, M. gajardoi showed differences in their ability to amplify TcI. TcV and TcVI had the same probability to be amplified by both triatomine species. Both species amplified mixed infections, with TcI-TcVI as the most represented. This study reports the higher vector competence of M. gajardoi in comparison to T. infestans. [ABSTRACT FROM AUTHOR]

Currently there are no biological markers to indicate which individuals with chronic indeterminate period of Chagas disease develop heart disease and who will remain all his life in this phase. The aim of this survey was to determine if T rypanosoma cruzi burden is related to the presence of heart disease in patients with chronic Chagas disease. 200 patients who had not been treated, 100 with cardiopathy and 100 without, groups A and B respectively, were submitted to clinical study and electrocardiogram, Echo-Doppler was performed for group A in which all important known causes of cardiopathy were discarded. In both groups xenodiagnosis, conventional PCR and quantitative PCR were undertaken. The 100 cardiopaths had 133 electrocardiographic alterations most of them in grade II of the New York Heart Association classification. 98 cardiopaths were classified in grade I by Echo-Doppler and only 2 cases were in grade III due to low ejection fraction. The difference in average parasitemia in patients of group A and B was not significant and no statistically differences were observed between average parasitemia of cardiopaths grade II versus grade I of NYHA. This results allow to characterize same clinical, electrocardiographical and parasitological features in chagasic cardiopaths of Chile. [ABSTRACT FROM AUTHOR]

The etiologic agent of Chagas disease is Trypanosoma cruzi , a protozoan whose life cycle involves obligatory passage through vertebrate and invertebrate hosts in a series of stages. The aim of this study was to explore the transferability of mixed discrete typing units (DTUs) of T. cruzi present in chronic chagasic patients when passed through an invertebrate host during xenodiagnosis (XD) and then when transferred to axenic cultures to obtain T. cruzi isolates. DTUs of T. cruzi present in these two hosts and axenic cultures were identified by kDNA PCR amplification and subsequent hybridization with DTU-specific probes. Mixtures of Tc I, Tc II, Tc V and Tc VI DTUs were detected in blood samples. However as a result of XD and axenic cultures it was possible to identify mostly Tc V. We conclude that the transferability of an isolate of T.cruzi derived from mixed DTUs present in human blood depends upon the starved invertebrate host used for xenodiagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To estimate the prevalence of metabolic syndrome (MetS) in patients with primary antiphospholipid syndrome (PAPS). Patients and methods: Cross sectional study of PAPS patients from the outpatient clinic. MetS was based on three international definitions: World Health Organization (WHO), Adult Treatment Panel III (ATP III), or International Diabetes Federation (IDF). Clinical history and laboratory investigations, including insulin levels, lipid profile, glucose, and CRP, anthropometric and blood pressure measurements, were evaluated. Descriptive statistics was used. Kappa statistics examined the agreement between MetS definitions. Results: 58 PAPS patients were studied, mean age 42.14±11.62, 9 men, 49 women. The most frequent cardiovascular risk (CVR) factors were hypertriglyceridemia, low HDL cholesterol levels, and visceral obesity. Prevalence of MetS was 17.2% according to WHO, 34.5% according to ATP III and 37.9% according to IDF criteria. MetS according to ATP III and WHO criteria was similar to the general population (34.5% vs. 36.8%) (17.2% vs. 13.6%), and lower according to IDF definition (37.9% vs. 49.8%). Conclusions: This study shows a high prevalence of MetS in PAPS patients, similar to that in the general population and other autoimmune diseases. Identification of MetS is very important to indicate preventive strategies and reduce cardiovascular morbidity and mortality in PAPS. [Copyright &y& Elsevier]

• The immune-neuroendocrine system is essential to maintain homeostasis specially during stress situations. COVID-19 infection, produce stress, and activates the immune–neuroendocrine system. During the COVID-19 pandemic, multiple studies indicate that the most vulnerable populations are older adults and patients with comorbidities including autoimmune rheumatic diseases. These patients suffer from extremely important situation that favors the inflammatory hyper response due to an inadequate reaction of the immune-neuroendocrine system. This review aims to analyze the findings of the effect of COVID-19 on the hypothalamic–pituitary–adrenal, hypothalamic–pituitary–gonadal, hypothalamic–pituitary–thyroid, hypothalamic–pituitary–prolactin axes, and central nervous system, as well as the response to this viral infection in older adults and patients with rheumatic diseases and perspectives about this subject. [ABSTRACT FROM AUTHOR]

• High percentage of XD and qPCR-XD positive have concordant results with qPCR-B. • A higher qPCR value in cases XD positive with and without cardiopathy was found. • No difference between presence or absence of cardiopathy and XD, qPCR-B or qPCR-XD. • In absence of XD, low parasite loads are a diagnostic challenge in chronic ChD. It is not currently known which individuals with chronic Chagas disease (ChD) will develop cardiopathy in a determined period and which will be maintained asymptomatic with normal routine laboratory tests all their lives. The parasite burden is a factor that could explain this different evolution. The objective of this study was to quantify Trypanosoma cruzi burden by real-time PCR in blood (qPCR-B) and dejections of triatomines fed by xenodiagnosis (qPCR-XD) in 90 individuals with chronic ChD untreated, classified according to XD results and the presence or absence of cardiopathy. All individuals came from hyperendemic areas of Chile and participated in the study under Informed Consent. The standard qPCR curves for qPCR-B and qPCR-XD were elaborated with a mixture of known concentrations of T. cruzi strains, performing DNA serial dilutions (1/10) with a dynamic range between 105 and 10−1 parasite equivalents/mL. The TaqManⓇ detection system was applied in a Stratagene Mx3000P thermocycler (Agilent Technologies, USA) with cruzi 1 and cruzi 2 satellite primers. 22.2% and 15.6% of cases with cardiopathy or without cardiopathy were XD positive. There was no significant difference between the groups. The positivity of qPCR-B and qPCR-XD in the positive XD group was 82.35% and 100%, respectively, while in the negative XD group was 55.26% and 42.10%, respectively. A superior qPCR value in chronic ChD patients with and without cardiopathy was determined for qPCR in cases with positive XD and positive qPCR-XD. The receiver operating characteristic (ROC) curve analyses show better accuracy for detecting parasite burden (area under the curve, AUC) for qPCR-XD in comparison to qPCR-B. That is to say, major performance in DNA samples obtained of positive XD (gold standard for viable T. cruzi) detected and quantified by qPCR-XD. A high percentage of cases with XD and qPCR-XD positive (80–100%) have result concordant with qPCR-B. In absence of XD, future challenges are especially related to the low parasitic load of chronic ChD patients treated with trypanocidal drugs and post-therapy parasitological evaluations by qPCR-B. Finally, no statistically significant differences were found between presence or absence of cardiopathy and XD, qPCR-B or qPCR-XD. [ABSTRACT FROM AUTHOR]