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La difenhidramina tiene efectos antihistamínico anti-H1 específico y antimuscarínico que pueden ocasionar un desenlace fatal según la dosis total ingerida. Se reporta un caso de intoxicación por difenhidramina tratado de forma exitosa con emulsiones lipídicas a pesar de ingesta de dosis letal. Se presenta el caso de un paciente de 19 años que ingresó por intoxicación por difenhidramina a dosis de 25 mg/kg (1.5 g) después del tiempo de descontaminación, con toxidrome anticolinérgico, con neurotoxicidad, cardiotoxicidad (QRS y QT prolongados) y sin respuesta al enfoque inicial, se iniciaron emulsiones lipídicas y, a su vez, se logró alta temprana por evolución clínica favorable y resolución de la prolongación del intervalo QTc y del cuadro anticolinérgico. La emulsión lipídica es una opción terapéutica para disminuir la morbimortalidad y la estancia hospitalaria por contrarrestar la cardiotoxicidad y neurotoxicidad producidas por moléculas lipofílicas como la difenhidramina.

Discurso del Papa Juan Pablo II tiene como telón de fondo la huelga de Brasil, la de los constructores de automóviles, con este decide poner frente a dos problemas esenciales de la ciudad, el trabajo de la fábrica y el poder mortífero de la urbanización.

La redacción de “CONTROVERSIA” se ha propuesto una tarea que de antemano se sabía extremadamente difícil: presentar las posiciones de los grupos más significativos que conforman la llamada “Izquierda Colombiana” en la coyuntura electoral “mitaca” 1976. Todavía al cierre de la edición se recibieron informaciones sobre nuevas alianzas, nuevas subdivisiones y nuevos desplazamientos teóricos de algunos grupos políticos revolucionarios. Presentaremos las posiciones como se daban exactamente in mes antes de las elecciones del 18 de abril de 1976.

La visita del Papa a Colombia demostró, por su longitud, un grado especial de predilección. Tuvo también una característica benevolencia, al ofrecer un resumen del pensamiento de Juan Pablo II. Sus 29 alocuciones fueron cuidadosamente planeadas para llegar a todos los auditores en los que se puede dividir un país como Colombia: estos grupos abarcaron desde dirigentes hasta reclusos. Se tuvo cuidado de aludir, en cada caso, a las coordenadas de lugar y tiempo bien conocidas por los asistentes. El Papa habló a los sacerdotes sobre la fidelidad al ministerio sacerdotal, a los dirigentes políticos sobre la inspiración evangélica en la organización de la sociedad, a los obispos sobre su tarea de reunir la Iglesia, a los jóvenes sobre la esperanza que en ellos funda la religión, a los laicos sobre la vocación laical en la Iglesia. Y a todos, de una manera general exhortó a la construcción de paz en Cristo, al establecimiento de la justicia, al servicio de los pobres, a la religiosidad y a la reconciliación.

Discurso del Papa Juan Pablo II alrededor del trabajo de la tierra y de quienes hacen uso de ella, como trabajadores de otros, como poseedores, o de quienes nisiquiera tienen un pedazo de ella para poder subsistir. La presencia del Papa en esta ciudad tenía como explicación el agudo problema social que la pobreza de sus habitantes ha generado. Región agrícola, el nordeste tipifica los términos de lo que se ha llamado el problema agrario, es decir, la desigual distribución de la tierra. Esta disparidad tiene como consecuencia la imposibilidad de encontrar trabajo que aflige a gran cantidad de campesinos, o sea, de personas que buscan la substiencia por el trabajo de la tierra. Y semejante imposibilidad conduce a la poca o nula participación social de gente que no tiene ni medios de subsistencia, o que está esclavizada por el trabajo en la tierra de otro.

Calcium phosphates coatings are capable to biofuntionalize surfaces of the Ti-6Al-4V alloy for biomedical implant applications. Synthesis of these coatings by the electrolytic deposition technique allows to determine its properties as well as physical and chemical characteristics in accordance with the electrodeposition process mode and time. Additionally, the condition of the metallic substrate surface determines the adhesion strength with the coating. The coatings were electrodeposited by pulsed and traditional (continuous) modes during 30 and 60 min of time processing, on three different pretreated surfaces with anodizing, pickling and alkaline bath. The coatings obtained through the pulsed mode resulted free of cracks and porosities. Furthermore, with pulsed mode and 60 min of electrodeposition time on the pickled and anodized surface resulted in coatings with a morphology of semi-hexagonal bar clusters, Ca/P and crystallographic structure closer to hydroxyapatite; also, the best adhesion strength. In conclusion, these are the most ideal conditions to improve the biocompatibility and osteointegration properties of the Ti-6Al-4V alloy. The TiO2 nanotube matrix produced by the anodization formed a strong anchorage with the electrodeposited coating, while the titanate layer obtained during the alkaline bath affected the integrity of the coating. [ABSTRACT FROM AUTHOR]

In the design of biomaterials, it has been sought to optimize the synthesis of nanostructures on metallic implants in order to improve the anchorage between the bone and the metal, for which various techniques have been applied that allow control over the growth and dimensions of the metal oxide layer. For the development of this work, the morphology of TiO2 nanostructured layers anodized in two-steps was studied, using Glycerol and Ethylene Glycol as organic solvents, and water percentages of 2 and 20%. An experimental design was carried out to determine the effect of the electrolyte composition on the synthesis of TiO2 nanostructures; subsequently, the anodic layers were characterized by SEM and EDS; its response to wettability was also evaluated by contact angle and surface energy measurements, and thus determine its applicability as a biomedical material. As a result, it was observed that the variation of the solvent gives rise to the formation of nanoporous and nanotubular TiO2 layers, due to the difference in viscosity and its polyalcoholic nature; likewise, the increase in the water content favored the increase in the diameter of the nanostructures, influencing, in turn, the response to wettability (a larger diameter induces a greater surface wetting). The best condition in which acceptable values were obtained for its use as a biomedical material was the sample anodized in two-steps with Ethylene Glycol + 20% H2O + 0.35% NH4F. [ABSTRACT FROM AUTHOR]

The use of titanium as a biomaterial has resulted in an advance in science and engineering, since it allows the manufacture of medical prostheses with a longer useful life together with an increase in the life expectancy of patients. However, it has been shown that passivation through the electrochemical anodizing process improves the properties of the base material through the formation of titanium dioxide (TiO2) nanotubes, so it is desired to study the variation of the type of electrolyte and voltage used in the formation of nanostructures and their resistance to corrosion. Nanotubes were obtained from a third generation electrolyte with internal diameters of 109.36 and 131.95 nm, thickness of 20.29 and 29.76 nm, on the other hand, in the process with a fourth generation electrolyte, no tubular layer, due to the poor stability of the Ti4+ ion in the formation of intermediate compounds. Additionally, it was found that the anodizing processes in the four conditions under study improve corrosion resistance, since a decrease in the corrosion rate of up to 26% is obtained, decreasing from 0.43 mmpy in the starting condition. up to 0.11 mmpy for nanotubes manufactured through third-generation anodizing, which, together with the optimal diameter requirements, allows the piece to fulfill its function in biomedical applications. [ABSTRACT FROM AUTHOR]

Adipocitos grandes y pequeños tienen patrones de expresión génica diferente; en los grandes disminuye la expresión de transportadores Glut-4 al mayor estímulo insulinémico y aumentan la expresión de Leptina, Adiponectina, IL-6, IL-8, TNF-a, IL-1a. En sujetos obesos la tendencia a la resistencia a la insulina se relaciona con el aumento del tamaño de los adipocitos subcutáneos. El objetivo de este trabajo fue establecer la relación entre el tamaño de los adipocitos uniloculares en grasa abdominal subcutánea de pacientes obesos mórbidos hipotiroideos y resistentes a la insulina. Con consentimiento informado en el Centro Médico Quirúrgico Bioestetic Center, 20 pacientes participaron en el estudio; 9 con criterio de inclusión índice de masa corporal (IBM) mayor a 30 y demostración de Insulina Basal (IB) arriba de 20 mcUI/ml, Hormona estimulante de Tiroides (TSH) mayor a 2,3 uU/L y T3 libre menor a 75 ng/dl, intervenidos para lipectomía abdominoplástica; otros 11 pacientes con normopeso e (IBM) menor a 25 con Insulina, TSH y T3 en los rangos de normalidad intervenidos por lipectomía abdominoplástica con fines estéticos fueron grupo control. El tejido adiposo extraído se submuestreó con sacabocados tomando muestras de 0,5 cm cúbicos fijados en Formol Alcohol Acético y procesados en parafina; cortes de 3 mieras se colorearon con H-E. Con microscopio digital se midieron los diámetros mayores y menores de los adipocitos de manera aleatoria y sobre las medidas finales de 7 placas histológicas tomadas al azar se compararon medias estadísticas y desviaciones estándar de los tamaños adipocitarios; con estadística no paramétrica se calcularónxdiferencias de adipocitos de pacientes con normopeso y obesos mórbidos con hipotiroidismo y resistencia a la insulina. Pacientes con Tiormopeso fueron 11 mujeres con edad promedio 24 años e índice de rhaísa corporal (BMI) promedio 21,9; mostraron un tamaño adipocitario promedio de 88,22 mm (DE 6,7); en ellos el perfil bioquímico mostró; glucosa basal de 89 mg/dl, triacilglicéridos de 182 mg/dl, insulina basal de 7,31 mcUI/ mi, TSH y T3 libre de 1,7 uU/L y 76,4 ng/dl respectivamente. Los 9 pacientes obesos mórbidos fueron mujeres de edad promedio 26,7 años con BMI promedio 31,4 y un tamaño adipocitario promedio de 84,13 mm (DE 11,52), en ellos el perfil bioquímico de glucosa basal en 117,2 mg/dl, triacilglicéridos de 211,8 mg/dl, insulina basal de 32,5 mcUI/ml, TSH de 2,7 uU/L y T3 libre de 54,5 ng/dl. No hay diferencias significativas entre el tamaño de los adipositos subcutáneos entre de pacientes con normopeso y obesos mórbidos hipotiroideas y resistente a la insulina, pero las desviaciones estándar son menores en el paciente con normopeso de aquellos obesos mórbidos, aspecto explicable por que en las endocrinopatias reseñadas que además de adipogenicas se incrementar la lipólisis por incapacidad de usar la glucosa como fuente de energía, disminuye los triacilgliceroles en adipocitos uniloculares, aumentando entre otros su concentración en sangre [ABSTRACT FROM AUTHOR]

El melanoma cutáneo afecta mas frecuentemente a los adultos que a niños y es mas más agresivo asociado al envejecimiento; el diagnóstico histopatológico estándar usa criterios profundidad de Clark y espesor de Breslow, los cuales correlacionan pronósticos. S-100 es una proteína de la familia ligadoras de calcio como troponina C y Calmodulina, se encuentra en citoplasma y el nucleoplasma actuando en desensamble de microtúbulos en la contractibilidad celular. Hay descripciones de sobre-expresión de S-100 en células neoplásicas como glioblastomas, adenocarcinomas mamarios y melanomascutáneos. No hay descripciones de patrones de distribución celular de S-100 en melanomas cutáneos juveniles y del adulto en correlación con el pronóstico según escala de Breslow y Clark. Provenientes de la Clínica Dermatológica Colderm IPS, bloques de parafina con biopsias de espalda y cuello de 4 pacientes promedio de edad 16 años y biopsias de brazo, pierna y cabeza de 4 pacientes promedio de edad 78 años, se enviaron a un laboratorio comercial para marcar proteína s-100; con microscopía óptica en las laminas se buscaron en 100X ,10 campos con patrones celulares ahusados, y estrellados discriminando distribución celular de S-100 en núcleo (N) y/o citoplasma (C). Los resultados de correlacionaron con criterios pronósticos de Breslow y Clark adoptado por la OMS (12) Clínicamente se hicieron seguimientos de reincidencia post biop-sia a un año. El patrón de distribución celular de s-100 de cuatro melanomas juveniles mostraron; para paciente uno 165 células teñidas, 78 NC, 29 C y 58 N, según Clark- Breslow con pronóstico favorable; paciente dos 262 células teñidas 47 NC, 126 C y 89 N, con pronóstico favorable; paciente tres 252 células teñidas 122 NC, 38 C y 92 N con prosnóstico muy desfavorable; paciente cuatro con 285 células teñidas 116 NC, 38 C y 92 N con pronostico Breslow muy desfavorable. El patrón de distribución celular de S-100 de cuatro melanomas en adultos mostraron para paciente cinco 352 células teñidas 144 NC 168 C y 40 N con pronostico Clark - Breslow muy desfavorable, paciente seis 841 células teñidas, 161 NC, 516 C y 164 N con pronostico muy desfavorable; paciente siete 137 células teñidas, ninguna en NC, 137 C y ninguna en N con pronostico desfavorable; paciente ocho con 74 células teñidas, 20 NC, 47 C y 7 N con pronóstico muy desfavorable. En los melanocitos de melanomas juveniles y del adulto se halló un patrón de distribución S-100 predominantemente citoplasmático, seguido del núcleo-citoplasmático y finalmente nuclear. Sin embargo para el paciente uno de melanomas juveniles, con pronostico de Breslow- Clark favorable, se demostró distribución S-100 predominante núcleo citoplasmático; aspecto este que indica el máximo estado de activación celular lo que puede cambiar el pronostico a desfavorable, corroborado clínicamente por reincidencia al primer año post biopsia. Para los pacientes cinco, seis y ocho de melanomas del adulto, todos los pronósticos Clark y Breslow fueron muy desfavorables y para el paciente siete desfavorable, sin embargo en este último la distribución celular de S-100 con predominio exclusivamente citoplasmático restó desfavorabilidad, corroborado clínicamente al no mostrar reincidencia al primer año post biopsia. [ABSTRACT FROM AUTHOR]

(1) Background: Acute pain in hospitalized children remains under-recognized and under-treated. Our objective is to benchmark pain assessment, documentation, treatment, and patient experience in children admitted to a US children's hospital. (2) Methods: A cross-sectional, mixed-method survey of pain for children hospitalized ≥24 h. Charts were reviewed for modalities of pain assessment and treatment for all inpatients. If pain was documented, patients/caregivers were surveyed regarding their experience with pain and its management. (3) Results: Chart review: All 107 patients had ≥1 pain score documented. A total of 47 patients had a pain score ≥0, 35 (74.5%) of whom had ≥1 moderate-severe score. Seventy (65.4%) patients received ≥1 intervention for pain, including medications from ≥1 class (e.g., opioids) ( n = 55, 51.4%) and/or integrative/non-pharmacologic intervention(s) (n = 39, 36.4%). There were assessment and documentation gaps. Patient survey: A total of 39 (83.0%) interviews were attempted; 25 (53.2%) were completed. The worst pain was mostly caused by acute illness ( n = 13, 52%) and painful procedures ( n = 10, 40%). Suggestions for improvement included increasing the use of integrative modalities and optimizing patient-clinician communication. (4) Conclusions: All patients admitted ≥24 h had ≥1 pain score documented; however, gaps in documentation were common. Multimodal treatment and integrative modalities were underutilized. Procedures were a frequent cause of under-treated pain, prompting an institution-wide quality improvement project.

Objective.: To explore the feasibility of developing a sheep model of neurocysticercosis (NCC) by intracranial infection with T. solium oncospheres., Materials and Methods.: We carried out an experimental infection model of NCC in sheep. Approximately 10 T. solium oncospheres previously cultured for 30 days were inoculated intracranially into ten sheep. The oncospheres, in 0.1 mL of physiological saline, were injected into the parietal lobe through an 18-gauge needle., Results.: After three months, granulomas were found in two sheep. In a third sheep we identified a 5 mm diameter cyst in the right lateral ventricle and histological evaluation confirmed that the cyst corresponded to a T. solium larva. Immunohistochemistry with monoclonal antibodies directed against membrane components and excretory/secretory antigens of the T. solium cyst was also used to confirm the etiology of the found granulomas. One of them showed reactivity to the monoclonal antibodies used, thus confirming that it was a cysticercus., Conclusion.: This experiment is the proof of concept that it is possible to infect sheep with cysticercosis by intracranial inoculation.

Background: The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children's and community hospitals., Methods: We purposefully sampled participants from both community and children's hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2-3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes., Results: We interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians' mental health, and they stressed the importance of mental health resources and wellness activities/spaces., Conclusions: We identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians' expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians' mental health and well-being, re-evaluating trainees' skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises., (© 2021. The Author(s).)

Gender-related differences in COVID-19 clinical presentation, disease progression, and mortality have not been adequately explored. We analyzed the clinical profile, presentation, treatments, and outcomes of patients according to gender in the HOPE-COVID-19 International Registry. Among 2,798 enrolled patients, 1,111 were women (39.7%). Male patients had a higher prevalence of cardiovascular risk factors and more comorbidities at baseline. After propensity score matching, 876 men and 876 women were selected. Male patients more often reported fever, whereas female patients more often reported vomiting, diarrhea, and hyposmia/anosmia. Laboratory tests in men presented alterations consistent with a more severe COVID-19 infection (eg, significantly higher C-reactive protein, troponin, transaminases, lymphocytopenia, thrombocytopenia, and ferritin). Systemic inflammatory response syndrome, bilateral pneumonia, respiratory insufficiency, and renal failure were significantly more frequent in men. Men more often required pronation, corticosteroids, and tocilizumab administration. A significantly higher 30-day mortality was observed in men vs women (23.4% vs 19.2%; P = .039). Trial Numbers: NCT04334291/EUPAS34399.

Pyrazinamide (PZA) susceptibility testing in Mycobacterium tuberculosis (Mtb) is a current area of development and PZA-resistant strains are increasingly prevalent. Previous studies have demonstrated that the detection of pyrazinoic acid (POA), the metabolite produced by the deamidation of PZA, is a good predictor for PZA resistance since a resistant strain would not convert PZA into POA at a critical required rate, whereas a susceptible strain will do, expelling POA to the extracellular environment at a certain rate, and allowing for quantification of this accumulated analyte. In order to quantify POA, an indirect competitive ELISA (icELISA) test using hyperimmune polyclonal rabbit serum against POA was developed: for this purpose, pure POA was first covalently linked to the highly immunogenic Keyhole Limpet Hemocyanine, and inoculated in rabbits. A construct made of bovine serum albumin (BSA) linked to pure POA and fixed at the bottom of wells was used as a competitor against spiked samples and liquid Mtb culture supernatants. When spiked samples (commercial POA alone) were analyzed, the half maximal inhibitory concentration (IC50) was 1.16 mg/mL, the limit of detection 200 μg/mL and the assay was specific (it did not detect PZA, IC50 > 20 mg/mL). However, culture supernatants (7H9-OADC-PANTA medium) disrupted the competition and a proper icELISA curve was not obtainable. We consider that, although we have shown that it is feasible to induce antibodies against POA, matrix effects could damage its analytical usefulness; multiple, upcoming ways to solve this obstacle are suggested., Competing Interests: The authors have declared that no competing interests exist.

Introduction and Aim: Epidemiological information regarding drug-induced liver injury in some Latin American countries remains limited. Therefore, disease prevention and health promotion strategies are imperative to reduce drug-induced liver injuries and its fatal outcomes. This study aimed to collect epidemiological data regarding drug-induced liver injury and identify associated factors in patients admitted to a university hospital in Colombia., Methods and Patients: A prospective study was conducted for 1 year to assess the incidence of drug-induced liver injury in patients aged >18 years who showed elevated values in liver tests. Data were collected after obtaining informed consent from the patients. The updated Roussel Uclaf Causality Assessment Method was applied to assess the causality of drug-induced liver injury., Results: The study included 286 patients with elevated values in liver tests, 18 of whom presented with drug-induced liver injury. The mean age of patients was 54.7±19.1 years. The associated pharmacological groups were anti-infectives and anticonvulsants (isoniazid, rifampicin, nitrofurantoin, phenytoin, and valproic acid), with a total of 15 drugs. The affected patients presented with cytopenia, jaundice, nausea, vomiting, or hepatomegaly. The most common type of liver injury was hepatocellular, and most patients recovered satisfactorily. The number of patients who had highly probable and probable causality grading was 1 and 9, respectively., Conclusion: The incidence of drug-induced liver injury in a university hospital in Colombia was 6%. Comorbidities and concomitant drugs are risk factors for drug-induced liver injury., Trial Registration: Registered in The Cuban Public Registry of Clinical Trials (identifier RPCEC00000242)., (Copyright © 2019 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)

Diagnosis of clinical toxoplasmosis remains a challenge, thus limiting the availability of human clinical samples. Though murine models are an approximation of human response, their definitive infection status and tissue availability make them critical to the diagnostic development process. Hydrogel mesh nanoparticles were used to concentrate antigen to detectable levels for mass spectrometry. Seven Toxoplasma gondii isolates were used to develop a panel of potential peptide sequences for detection by parallel reaction monitoring (PRM) mass spectrometry. Nanoparticles were incubated with decreasing concentrations of tachyzoite lysate to explore the limits of detection of PRM. Mice whose toxoplasmosis infection status was confirmed by quantitative real-time PCR had urine tested by PRM after hydrogel mesh concentration for known T. gondii peptides. Peptides from GRA1, GRA12, ROP4, ROP5, SAG1, and SAG2A proteins were detected by PRM after nanoparticle concentration of urine, confirming detection of T. gondii antigen in the urine of an infected mouse., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Detection of Trypanosoma cruzi antigens in clinical samples is considered an important diagnostic tool for Chagas disease. The production and use of polyclonal antibodies may contribute to an increase in the sensitivity of immunodiagnosis of Chagas disease., Methodology/principal Findings: Polyclonal antibodies were raised in alpacas, rabbits, and hens immunized with trypomastigote excreted-secreted antigen, membrane proteins, trypomastigote lysate antigen and recombinant 1F8 to produce polyclonal antibodies. Western blot analysis was performed to determine specificity of the developed antibodies. An antigen capture ELISA of circulating antigens in serum, plasma and urine samples was developed using IgY polyclonal antibodies against T. cruzi membrane antigens (capture antibody) and IgG from alpaca raised against TESA. A total of 33 serum, 23 plasma and 9 urine samples were analyzed using the developed test. Among serum samples, compared to serology, the antigen capture ELISA tested positive in 55% of samples. All plasma samples from serology positive subjects were positive in the antigen capture ELISA. All urine positive samples had corresponding plasma samples that were also positive when tested by the antigen capture ELISA., Conclusions: Polyclonal antibodies are useful for detection of circulating antigens in both the plasma and urine of infected individuals. Detection of antigens is direct evidence of the presence of the parasite, and could be a better surrogate of current infection status.

Background: Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a rare and serious syndrome of small blood vessels with a high mortality rate. Calciphylaxis lesions require intensive wound management with medical interventions for the patient to survive the sequelae of sepsis and present unique challenges when found in the peristomal skin., Case: A 33-year-old man presented with multiple malodorous stage 4 pressure injuries of his sacrococcygeal and gluteal area. His medical history included chronic kidney disease requiring hemodialysis since 2007, diabetes mellitus, and incomplete paraplegia. He underwent diverting colostomy to enhance wound healing. His hospital stay was complicated by the development of a peristomal calciphylaxis lesion (PCL) that made ostomy pouching especially challenging for the nursing staff. His care needs were also aggravated by nonadherence to diet restriction, pressure injury prevention efforts, and a continued need for high doses of analgesic medication. Collectively, these issues presented a challenge for the health care team during his hospital course and during safe discharge planning., Conclusions: The peristomal calciphylaxis lesion decreased in surface area and improved in appearance with the use of various wound care products as his medical condition improved. Skilled nursing management in the context of ongoing interdisciplinary collaboration assisted in managing the patient's peristomal calciphylaxis, ultimately leading to safe discharge from hospital.

Pigs were infected with a Bolivian strain of Trypanosoma cruzi (genotype I) and evaluated up to 150 days postinoculation (dpi) to determine the use of pigs as an animal model of Chagas disease. Parasitemia was observed in the infected pigs during the acute phase (15-40 dpi). Anti-T. cruzi immunoglobulin M was detected during 15-75 dpi; high levels of anti-T. cruzi immunoglobulin G were detected in all infected pigs from 75 to 150 dpi. Parasitic DNA was observed by western blot (58%, 28/48) and polymerase chain reaction (27%, 13/48) in urine samples, and in the brain (75%, 3/4), spleen (50%, 2/4), and duodenum (25%, 1/4), but no parasitic DNA was found in the heart, colon, and kidney. Parasites were not observed microscopically in tissues samples, but mild inflammation, vasculitis, and congestion was observed in heart, brain, kidney, and spleen. This pig model was useful for the standardization of the urine test because of the higher volume that can be obtained as compared with other small animal models. However, further experiments are required to observe pathological changes characteristic of Chagas disease in humans., (© The American Society of Tropical Medicine and Hygiene.)

Background: The transitional period between the oncosphere and the cysticercus of Taenia solium is the postoncospheral (PO) form, which has not yet been completely characterized. The aim of this work was to standardize a method to obtain T. solium PO forms by in vitro cultivation. We studied the morphology of the PO form and compared the expression of antigenic proteins among the PO form, oncosphere, and cysticerci stages., Methodology/principal Findings: T. solium activated oncospheres were co-cultured with ten cell lines to obtain PO forms, which we studied at three stages of development--days 15, 30, and 60. A high percentage (32%) of PO forms was obtained using HCT-8 cells in comparison to the other cell lines. The morphology was observed by bright field, scanning, and transmission electron microscopy. Morphology of the PO form changed over time, with the six hooks commonly seen in the oncosphere stage disappearing in the PO forms, and vesicles and microtriches observed in the tegument. The PO forms grew as they aged, reaching a diameter of 2.5 mm at 60 days of culture. 15-30 day PO forms developed into mature cysticerci when inoculated into rats. Antigenic proteins expressed in the PO forms are also expressed by the oncosphere and cysticerci stages, with more cysticerci antigenic proteins expressed as the PO forms ages., Conclusions/significance: This is the first report of an in vitro production method of T. solium PO forms. The changes observed in protein expression may be useful in identifying new targets for vaccine development. In vitro culture of PO form will aid in understanding the host-parasite relationship, since the structural changes of the developing PO forms may reflect the parasite's immunoprotective mechanisms. A wider application of this method could significantly reduce the use of animals, and thus the costs and time required for further experimental investigations.

Neurocysticercosis is caused by Taenia solium infecting the central nervous system and is the leading cause of acquired epilepsy and convulsive conditions worldwide. Research into the pathophysiology of the disease and appropriate treatment is hindered by lack of cost-effective and physiologically similar animal models. We generated a novel rat neurocysticercosis model using intracranial infection with activated T. solium oncospheres. Holtzman rats were infected in two separate groups: the first group was inoculated extraparenchymally and the second intraparenchymally, with different doses of activated oncospheres. The groups were evaluated at three different ages. Histologic examination of the tissue surrounding T. solium cysticerci was performed. Results indicate that generally infected rats developed cysticerci in the brain tissue after 4 months, and the cysticerci were observed in the parenchymal, ventricle, or submeningeal brain tissue. The route of infection did not have a statistically significant effect on the proportion of rats that developed cysticerci, and there was no dependence on infection dose. However, rat age was crucial to the success of the infection. Epilepsy was observed in 9% of rats with neurocysticercosis. In histologic examination, a layer of collagen tissue, inflammatory infiltrate cells, perivascular infiltrate, angiogenesis, spongy change, and mass effect were observed in the tissue surrounding the cysts. This study presents a suitable animal model for the study of human neurocysticercosis., (Copyright © 2015 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)

The non alcoholic fatty liver disease (NAFLD) manifests with liver damage and it is associated with obesity. The objective of this work was to detect the risk of obese school students of developing NAFLD, through an analytical, observational study, comparing their liver function with that of a control group, and its relationship with physical activity, dietary, biochemical and anthropometric variables. One hundred and sixty school students (ages 7-11) were evaluated according to their socio-economic status; nutritional status by the body mass index (BMI) and mid-upper arm fat area (MUAC) (Project Venezuela 1994); body fat percentage by anthropometry (% BF), waist circumference (WC); and metabolism by oral glucose tolerance, basal insulin and post-load glucose, total cholesterol (TC), cLDL, cVLDL, cHDL, triglycerides (TG), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma glutamil transpeptidasa (GGTP) and albumin. Their diet was analyzed by the 24-hour recall and their physical activity by a clinical trial. Mean levels of GPT (p < 0.05), greater frequencies of elevated GOT and GPT (p < 0.05) and lower albumin levels (p < 0.05) were observed in 88 obese school students when compared to controls. The GPT correlated significantly with the BMI, MUAC, % BF, WC, basal insulin and post-load glucose, HOMA, cVLDL, cHDL and TG, while the GOT correlated with MUAC and the GGTP with MUAC, basal insulin, HOMA and cLDL. Albumin was negatively correlated with BMI, MUAC, % BF and WC. TGP reflected better the hepatic compromise of obesity. To assess the risk of NAFLD, the TGO/TGP values should be standardized according to age, gender and race.

Unlabelled: Obesity leads to a deterioration of glucose tolerance and the action of insulin. The purpose of this study was to determine insulin resistance (IR) by indirect methods, and its correlation with clinical, anthropometric and biochemical variables in obese normoglycemic school children. This was a descriptive-correlational study of 72 school prepubescent children, who attended the ambulatory "El Concejo" of the University of Carabobo (UC) and at the Gastroenterology and Pediatric Nutrition service of the city hospital "Enrique Tejera" (CHET), in Valencia, Venezuela, between January-April 2011., Inclusion Criteria: exogenous obesity. We assessed personal and family history, presence of Acanthosis Nigricans and nutritional and biochemical status. We found a higher percentage of IR, through the use of the QUICKI method (66.7%), followed by the HOMA (55.6%) and basal insulin (45.9%). The mean (chi) indexes of body mass and waist circumference were significantly greater (p < 0.05) in patients with IR, by HOMA and QUICKI techniques. The QUICKI method detected significant differences (p < 0.05) in the values of glycemia, basal insulin and postprandial insulin, among patients with diminished and normal insulin sensitivities. While HOMA, detected these differences (p < 0.05) in the values of glycemia and basal insulin. A statistically significant relationship was observed (p < 0.05), between the presence of Acanthosis Nigricans and IR, by the HOMA, QUICKI and basal insulin methods. In conclusion, the evaluated techniques, QUICKI, HOMA and basal insulin indexes, were most effective for detecting the IR.

We studied cell death by apoptosis and necrosis in cardiac remodeling produced by Trypanosoma cruzi infection. In addition, we evaluated collagen I, III, IV (CI, CIII and CIV) deposition in cardiac tissue, and their relationship with serum levels of procollagen type I carboxy-terminal propeptide (PICP) and procollagen type III amino-terminal propeptide (PIIINP). Eight infected and two uninfected guinea pigs were necropsied at seven time points up to one year post-infection. Cell death by necrosis and apoptosis was determined by histopathological observation and terminal deoxynucleotidyl transferase dUTP nick end labeling, respectively. Deposition of cardiac collagen types was determined by immunohistochemistry and serum levels of PICP, PIIINP, and anti-T. cruzi IgG1 and IgG2 by ELISA. IgG2 (Th1 response) predominated throughout the course of infection; IgG1 (Th2 response) was detected during the chronic phase. Cardiac cell death by necrosis predominated over apoptosis during the acute phase; during the chronic phase, both apoptosis and necrosis were observed in cardiac cells. Apoptosis was also observed in lymphocytes, endothelial cells and epicardial adipose tissue, especially in the chronic phase. Cardiac levels of CI, CIII, CIV increased progressively, but the highest levels were seen in the chronic phase and were primarily due to increase in CIII and CIV. High serum levels of PICP and PIIINP were observed throughout the infection, and increased levels of both biomarkers were associated with cardiac fibrosis (p = 0.002 and p = 0.038, respectively). These results confirm the role of apoptosis in cell loss mainly during the chronic phase and the utility of PICP and PIIINP as biomarkers of fibrosis in cardiac remodeling during T. cruzi infection.

The diagnosis of Chagas disease in humans is generally limited to the detection of specific antibodies. Detection of T. cruzi antigens in urine has been reported previously, but is not used in the diagnosis. In this study, soluble T. cruzi antigens and DNA were detected in urine samples and were associated with kidney injury and systemic detection of the parasite. We used 72 guinea pigs infected with T. cruzi Y strain and 18 non-infected guinea pigs. Blood, kidney, heart and urine samples were collected during the acute phase and chronic phase. Urine samples were concentrated by ultrafiltration. Antigens were detected by Western Blot using a polyclonal antibody against trypomastigote excretory-secretory antigen (TESA). T. cruzi DNA was detected by PCR using primers 121/122 and TcZ1/TcZ2. Levels of T. cruzi DNA in blood, heart and kidney were determined by quantitative PCR. T. cruzi antigens (75 kDa, 80 kDa, 120 kDa, 150 kDa) were detected in the acute phase (67.5%) and the chronic phase (45%). Parasite DNA in urine was detected only in the acute phase (45%). Kidney injury was characterized by high levels of proteinuria, kidney injury molecule-1 (KIM-1) and urea, and some histopathological changes such as inflammation, necrosis, fibrosis and scarce parasites. The detection of antigens and DNA in urine was associated with the presence of parasite DNA in blood and heart and with high levels of parasite DNA in blood, but not with the presence of parasite in kidney or kidney injury. These results suggest that the detection of T. cruzi in urine could be improved to be a valuable method for the diagnosis of Chagas disease, particularly in congenital Chagas disease and in immunocompromised patients.

In response to osmotic stress, global translation is inhibited, but the mRNAs encoding stress-protective proteins are selectively translated to allow cell survival. To date, the mechanisms and factors involved in the specific translation of osmostress-responsive genes in Saccharomyces cerevisiae are unknown. We find that the mRNA cap-binding protein Cbc1 is important for yeast survival under osmotic stress. Our results provide new evidence supporting a role of Cbc1 in translation initiation. Cbc1 associates with polysomes, while the deletion of the CBC1 gene causes hypersensitivity to the translation inhibitor cycloheximide and yields synthetic "sickness" in cells with limiting amounts of translation initiator factor eIF4E. In cbc1Δ mutants, translation drops sharply under osmotic stress, the subsequent reinitiation of translation is retarded, and "processing bodies" containing untranslating mRNAs remain for long periods. Furthermore, osmostress-responsive mRNAs are transcriptionally induced after osmotic stress in cbc1Δ cells, but their rapid association with polysomes is delayed. However, in cells containing a thermosensitive eIF4E allele, their inability to grow at 37ºC is suppressed by hyperosmosis, and Cbc1 relocalizes from nucleus to cytoplasm. These data support a model in which eIF4E-translation could be stress-sensitive, while Cbc1-mediated translation is necessary for the rapid translation of osmostress-protective proteins under osmotic stress.

Due to international migration, Chagas disease, endemic in Latin America, has become more common in non-endemic areas. Chronic Chagas disease can cause damage to the digestive system leading to constipation. However, a range of factors influences constipation and a better understanding of the role of non-Chagas related factors is required to improve management of Chagas-related digestive problems. This study explores perceptions of constipation and changes in food and exercise habits amongst Bolivians in Barcelona, Spain. Bolivian migrants attending the Tropical Medicine Unit (Hospital Clínic, Barcelona) were interviewed about their food habits in Spain and Bolivia, migratory experience, work and leisure activities. Chagas seropositive participants also received radiological examinations. Bolivian migrants experienced dietary changes, influenced by work-related factors, which included reductions in quantities of food and liquid consumed. Almost half the participants reported changes in digestive rhythm since arriving in Spain. Constipation, which was common, in some cases was only recounted during interviews. Bolivian migrants' constipation may be associated with chronic Chagas disease or migration-related dietary changes. Careful questioning using the Rome III criteria is however required to ensure its diagnosis. Radiological studies are also required to confirm the role of Chagas disease and identify potentially serious intestinal damage.

The guinea pig (Cavia porcellus) is a natural reservoir for Trypanosoma cruzi but has seldom been used as an experimental infection model. We developed a guinea pig infection model for acute and chronic Chagas disease. Seventy-two guinea pigs were inoculated intradermally with 10(4) trypomastigotes of T. cruzi strain Y (experimental group); 18 guinea pigs were used as control group. Eight animals from the experimental group and two from the control group were sacrificed 5, 15, 20, 25, 40, 55, 115, 165, and 365 days after inoculation. During the acute phase (15 to 55 days), we observed parasitemia (with a peak on day 20) and positive IgM and IgG Western blots with anti-shed acute-phase antigen bands. The cardiac tissue showed vasculitis, necrosis (on days 40 to 55), moderate to severe inflammation, and abundant amastigote nests. Smaller numbers of amastigote nests were also present in kidney, brain, and other organs. In the early chronic phase (115 to 165 days), parasitemia disappeared and anti-T. cruzi IgG antibodies were still detectable. In cardiac tissue, the number of amastigote nests and the grade of inflammation decreased. In the chronic phase (365 days), the cardiac tissue showed vasculitis and fibrosis; detectable parasite DNA was associated with higher grades of inflammation. The experimental T. cruzi infection model in guinea pigs shows kinetics and pathologic changes similar to those of the human disease., (Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)

Background: We conducted a study of congenital Trypanosoma cruzi infection in Santa Cruz, Bolivia. Our objective was to apply new tools to identify weak points in current screening algorithms, and find ways to improve them., Methods: Women presenting for delivery were screened by rapid and conventional serological tests. For infants of infected mothers, blood specimens obtained on days 0, 7, 21, 30, 90, 180, and 270 were concentrated and examined microscopically; serological tests were performed for the day 90, 180, and 270 specimens. Maternal and infant specimens, including umbilical tissue, were tested by polymerase chain reaction (PCR) targeting the kinetoplast minicircle and by quantitative PCR., Results: Of 530 women, 154 (29%) were seropositive. Ten infants had congenital T. cruzi infection. Only 4 infants had positive results of microscopy evaluation in the first month, and none had positive cord blood microscopy results. PCR results were positive for 6 (67%) of 9 cord blood and 7 (87.5%) of 8 umbilical tissue specimens. PCR-positive women were more likely to transmit T. cruzi than were seropositive women with negative PCR results (P < .05). Parasite loads determined by quantitative PCR were higher for mothers of infected infants than for seropositive mothers of uninfected infants P < .01). Despite intensive efforts, only 58% of at-risk infants had a month 9 specimen collected., Conclusions: On the basis of the low sensitivity of microscopy in cord blood and high rate of loss to follow-up, we estimate that current screening programs miss one-half of all infected infants. Molecular techniques may improve early detection.