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Background: High prevalence of metabolic abnormalities and poor bone health in ethnic minorties may stem from differences in body composition and alterations in endocrine milieu. South Asian Indians (SAIs) are at greater risk for metabolic syndrome (MetS) and poor bone health than Caucasians. Often these differences are reported later in life and/or in a resident immigrant population compared to a Caucasian population. In this study, we determined whether vitamin D status, bone, body composition differed in young SAIs and Caucasians. Notably we compared differences amongst recent SAI immigrants and Caucasians. Methods: We examined differences in bone density, body composition, serum 25-hydroxy vitamin D (s25(OH)D), parathyroid hormone (sPTH), vitamin D binding protein (sDBP), osteocalcin (sOC), and dietary intakes in young healthy SAI and Caucasian men. Results: Sixty men (N = 30 SAIs and N = 30 Caucasians) with a mean age of 27.8 ± 7.4 years completed the study. Compared to the Caucasians, SAIs had statistically significantly lower s25(OH)D and higher sPTH (p < 0.05). We also found that s25(OH)D was negatively associated with sPTH only among the SAIs (r = - 0.389, p = 0.037). Also, lean mass% (LM%) and fat-free mass% (FFM%) were lower in SAIs (p < 0.05) compared to caucasians. s25(OH)D correlated with nearly all body composition parameters, while sPTH correlated negatively with LM% and FFM%, and positively with FM% (all p < 0.05) in the Caucasian group. Bone mineral density at most sites were also significantly lower (p < 0.05) in the SAI's compared to caucasians. Conclusion: Young SAIs have a poor vitamin D status and less favorable bone and body composition parameters compared to Caucasians. These findings highlight the possible complex interplay between skeletal and metabolic health in different ethnicities which may be evident early on in life. Interventions to improve bone and metabolic health should therefore target younger ethnic minorities.
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Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder in children. It is currently diagnosed by behaviour-based assessments made by observation and interview. In 2018 we reported a discovery study of a blood biomarker diagnostic test for ASD based on a combination of four plasma protein glycation and oxidation adducts. The test had 88% accuracy in children 5-12 years old. Herein, we present an international multicenter clinical validation study (N = 478) with application of similar biomarkers to a wider age range of 1.5-12 years old children. Three hundred and eleven children with ASD (247 male, 64 female; age 5.2 ± 3.0 years) and 167 children with typical development (94 male, 73 female; 4.9 ± 2.4 years) were recruited for this study at Sidra Medicine and Hamad Medical Corporation hospitals, Qatar, and Hospital Regional Universitario de Málaga, Spain. For subjects 5-12 years old, the diagnostic algorithm with features, advanced glycation endproducts (AGEs)-Nε-carboxymethyl-lysine (CML), Nω-carboxymethylarginine (CMA) and 3-deoxyglucosone-derived hydroimidazolone (3DG-H), and oxidative damage marker, o,o'-dityrosine (DT), age and gender had accuracy 83% (CI 79 - 89%), sensitivity 94% (CI 90-98%), specificity 67% (CI 57-76%) and area-under-the-curve of receiver operating characteristic plot (AUROC) 0.87 (CI 0.84-0.90). Inclusion of additional plasma protein glycation and oxidation adducts increased the specificity to 74%. An algorithm with 12 plasma protein glycation and oxidation adduct features was optimum for children of 1.5-12 years old: accuracy 74% (CI 70-79%), sensitivity 75% (CI 63-87%), specificity 74% (CI 58-90%) and AUROC 0.79 (CI 0.74-0.84). We conclude that ASD diagnosis may be supported using an algorithm with features of plasma protein CML, CMA, 3DG-H and DT in 5-12 years-old children, and an algorithm with additional features applicable for ASD screening in younger children. ASD severity, as assessed by ADOS-2 score, correlated positively with plasma protein glycation adducts derived from methylglyoxal, hydroimidazolone MG-H1 and Nε(1-carboxyethyl)lysine (CEL). The successful validation herein may indicate that the algorithm modifiable features are mechanistic risk markers linking ASD to increased lipid peroxidation, neuronal plasticity and proteotoxic stress.
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Trastorno del Espectro Autista , Biomarcadores , Productos Finales de Glicación Avanzada , Oxidación-Reducción , Humanos , Masculino , Femenino , Biomarcadores/sangre , Niño , Preescolar , Productos Finales de Glicación Avanzada/sangre , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/sangre , Glicosilación , Lisina/análogos & derivados , Lisina/sangre , Trastorno Autístico/sangre , Trastorno Autístico/diagnóstico , Proteínas Sanguíneas/metabolismo , Proteínas Sanguíneas/análisis , Lactante , Sensibilidad y EspecificidadRESUMEN
Background: Patients with metabolic syndrome components were frequently noted to have increased nasal and parotid activity on clinically referred scintigraphic whole-body blood pool scans. This increase in activity was not observed in patients without metabolic syndrome. Increased nasal blood pool activity in patients with elevated body mass indices (BMIs) has implications for (1) sleep apnea, (2) risk of nasal infection, and (3) possible impaired nasal lymphatic drainage of brain waste proteins. Methods: To follow-up this clinical observation, a retrospective study was performed on 200 patients having whole-body blood pool scans referred over a 3-year period. The whole-body blood pool scans were evaluated for an association between nose and parotid region of interest (ROI) to heart ROI maximum (max) pixel ratios as correlated with clinical conditions, including obesity, diabetes, hypertension, and sleep apnea. Continuous variables of BMI, hemoglobin A1c (HbA1c), blood glucose, and blood lipids were also correlated with these ratios. Results: A direct association of nose to heart max ratio (NHMR) with diabetes, sleep apnea, and hypertension was found with an increase in the ratio of +0.10 (P = 0.002), +0.13 (P = 0.0002), +0.08 (P = 0.0123), respectively. Correlation of NHMR with continuous variables had moderate correlation with BMI (r = 0.36, P < 0.0001), glucose (r = 0.27, P = 0.0001), HbA1c (r = 0.25, P = 0.0008) and less association with the number of diabetes medications (r = 0.22, P = 0.0021). Similar associations were found for parotid to heart max ratios but were weaker than the NHMR. Conclusions: Patients with metabolic syndrome components have significantly increased nasal and parotid activity on blood pool scans. These associations have implications for the treatment of sleep apnea, for nasal infections involving such agents as Covid-19, and for the risk of dementias related to decreased clearance of brain waste proteins through nasal turbinate lymphatics in patients with metabolic syndrome. If further studies support these findings, the nasal turbinates and the increased parasympathetic activity controlling their dilation could become a new therapeutic target.
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COVID-19 , Hipertensión , Síndrome Metabólico , Síndromes de la Apnea del Sueño , Apnea Obstructiva del Sueño , Hemoglobina Glucada/análisis , Humanos , Hipertensión/complicaciones , Síndrome Metabólico/metabolismo , Estudios Retrospectivos , Síndromes de la Apnea del Sueño/complicacionesRESUMEN
Chronic deep brain stimulation (CDBS) is a surgical treatment that reduces the cardinal signs of Parkinson's disease (PD). Although CDBS has been in use for a long time, very little has been reported on its supposed effects on cognition, particularly in relation to implants in the subthalamic nucleus. The results of the rare studies that do exist are controversial, and in many cases the studies have several design flaws. The present study compared cortical activation during three tasks (action execution, action observation and motor imagery) in PD patients with and without subthalamic implants. The study sample consisted of 36 volunteers, divided into three groups: healthy controls, PD patients with CDBS of the subthalamic nucleus, and PD patients without CDBS. Through a quantitative electroencephalogram assessment, absolute beta power was examined to observe the interaction between group and cognitive motor tasks. The electrodes at sites Fp1, Fp2, F7, F8, F3, Fz and F4, located in the prefrontal and frontal regions, were analyzed and a Group x Task interaction (p < 0.05) was observed for all of them. These findings suggest that CDBS of the subthalamic nucleus is efficient in reducing some of the effects of PD in these study tasks. At the same time, the dysfunctions found in several cortical areas, characteristic of PD, limited the effects of the CDBS. The results of this study suggest that CDBS of the subthalamic nucleus can modulate cognitive-motor aspects of PD.
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BACKGROUND: Bacteria in the conjunctiva present a potential risk of vitreous cavity infection during 23-gauge pars plana vitrectomy (PPV). Current preoperative procedures used in Sweden include irrigation with chlorhexidine solution (CHX) 0.05% only and no iodine solutions. We evaluated the bacterial diversity and load before and after this single antibacterial measure. METHODS: In a prospective, consecutive cohort we investigated bacterial growth in samples from 40 eyes in 39 consecutive individuals subjected to vitrectomy. A conjunctival specimen was collected from each preoperative patient before and after irrigating of eye with CHX, 0.05% solution. Iodine was not used during any part of the surgery. One drop of chloramphenicol was administered prior to surgery. Samples from vitreous cavity were collected at the beginning and end of vitrectomy. All conjunctival specimens were cultured for different species and quantified using colony forming units (CFU). RESULTS: There was a significant 82% reduction in the total number of CFUs for all bacteria in all eyes (P < 0.0001), and 90% reduction for coagulase negative staphylococci (CoNS) alone (P = 0.0002). The number of eyes with positive bacterial growth in conjunctival samples decreased from 33 to 18 after irrigation with CHX (P = 0.0023). The most common bacteria prior to surgery were CoNS (70%), Propionibacterium acnes (55%) and Corynebacterium species (36%). No case of post-vitrectomy endophthalmitis was reported during mean follow-up time, which was 4.6 ± 2.3 (range; 1.5 to 9) months. CONCLUSIONS: Patients undergoing PPV harbored bacteria in conjunctiva capable of causing post-vitrectomy endophthalmitis. Preoperative preparation with CHX significantly reduced the bacterial load in the conjunctival samples subsequently leading to very low inoculation rates in recovered vitreous samples. Thus, CHX used as a single disinfectant agent might be an effective preoperative procedure for eye surgery in Sweden. This is a relatively small study but the results could be a reference for other intraocular surgeries.
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Carga Bacteriana , Clorhexidina/administración & dosificación , Infecciones Bacterianas del Ojo/prevención & control , Cuidados Preoperatorios/métodos , Infecciones Estafilocócicas/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Anciano , Anciano de 80 o más Años , Antiinfecciosos Locales/administración & dosificación , Conjuntiva/microbiología , Endoftalmitis/epidemiología , Endoftalmitis/microbiología , Endoftalmitis/prevención & control , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Bacterianas del Ojo/microbiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Estafilocócicas/microbiología , Staphylococcus/aislamiento & purificación , Infección de la Herida Quirúrgica/microbiología , Suecia/epidemiología , Irrigación Terapéutica/métodos , Cuerpo Vítreo/microbiologíaRESUMEN
Despite few institutions stenting the ascending aorta, it has been discouraged because of the proximity of the aortic valve, the coronary artery orifices, and the aortic arch branches. We describe a small case series of patients having acquired stenosis of the ascending that was relieved successfully by stenting. © 2017 Wiley Periodicals, Inc.
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Angioplastia de Balón/instrumentación , Aorta , Enfermedades de la Aorta/terapia , Arteriopatías Oclusivas/terapia , Stents , Adulto , Aorta/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico por imagen , Aortografía/métodos , Arteriopatías Oclusivas/diagnóstico por imagen , Niño , Angiografía por Tomografía Computarizada , Constricción Patológica , Humanos , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
Cardiac implantable electronic devices (pacemakers and defibrillators) are increasingly common in modern cardiology practice, and health professionals from a variety of specialties will encounter patients with such devices on a frequent basis. This article will focus on the subset of patients who may request, or be appropriate for, device deactivation and discuss the issues surrounding end-of-life decisions, along with the ethical and legal implications of device deactivation.
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Dispositivos de Terapia de Resincronización Cardíaca , Desfibriladores Implantables , Cuidado Terminal/métodos , Australia , Humanos , Cuidado Terminal/legislación & jurisprudenciaRESUMEN
In regions where Chagas disease is endemic, canine Trypanosoma cruzi infection is highly correlated with the risk of transmission of the parasite to humans. Herein we evaluated the novel TcTASV protein family (subfamilies A, B, C), differentially expressed in bloodstream trypomastigotes, for the detection of naturally infected dogs. A gene of each TcTASV subfamily was cloned and expressed. Indirect enzyme-linked immunosorbent assays (ELISA) were developed using recombinant antigens individually or mixed together. Our results showed that dogs with active T. cruzi infection differentially reacted against the TcTASV-C subfamily. The use of both TcTASV-C plus TcTASV-A proteins (Mix A+C-ELISA) enhanced the reactivity of sera from dogs with active infection, detecting 94% of the evaluated samples. These findings agree with our previous observations, where the infected animals exhibited a quick anti-TcTASV-C antibody response, coincident with the beginning of parasitaemia, in a murine model of the disease. Results obtained in the present work prove that the Mix A+C-ELISA is a specific, simple and cheap technique to be applied in endemic areas in screening studies. The Mix A+C-ELISA could help to differentially detect canine hosts with active infection and therefore with high impact in the risk of transmission to humans.
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Anticuerpos Antiprotozoarios/sangre , Antígenos de Protozoos/genética , Antígenos de Protozoos/aislamiento & purificación , Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/veterinaria , Enfermedades de los Perros/diagnóstico , Trypanosoma cruzi/inmunología , Animales , Antígenos de Protozoos/inmunología , Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/parasitología , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/parasitología , Perros , Ensayo de Inmunoadsorción Enzimática/economía , Ensayo de Inmunoadsorción Enzimática/métodos , Ensayo de Inmunoadsorción Enzimática/veterinaria , Ratones , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Low-range troponin elevations without clear coronary manifestations remain a major diagnostic challenge. We sought to determine if troponin velocity could allow for early identification of patients without an obvious cardiac diagnosis and who are at increased risk for cardiac-specific events. METHODS & RESULTS: All patients presenting to South Australian public hospitals between 1 September 2011 and 30 September 2012, with at least two troponin measurements during the first 6h after ED presentation were included. Diagnoses were classified as 'coronary', 'non-coronary cardiac', and 'non-cardiac' using the International Classification of Diseases 10 codes. The relationship between troponin velocity and cardiac-specific mortality and combined cardiac outcome (death and myocardial infarction) was assessed using Fine and Gray competing risk models in patients with an initial troponin <52 ng/L. Sensitivity analyses were performed using different initial and maximum troponin cut-off values. In total, 7300 patients were identified. A troponin velocity of 2.5 ng/L/h or greater in the non-cardiac (n=2793) patient group was significantly associated with an increased risk for 12-month cardiac mortality (sub-hazard ratio [SHR] 2.90, 95% CI 1.33-6.34) and combined cardiac outcome (SHR 2.08, 95% CI 1.01-4.27). This association was consistent for coronary (n=3835) and non-coronary cardiac (n=672) patient groups, and remained after sensitivity analyses. CONCLUSIONS: The significant association observed across all patient groups suggests that troponin velocity could be used for early risk stratification of patients with low-range troponin elevations without clear cardiac symptoms. These results may help guide future clinical trials aimed at assessing the utility of cardiac-targeted interventions in this challenging patient population.
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Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/diagnóstico , Troponina T/sangre , Síndrome Coronario Agudo/epidemiología , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Estudios de Cohortes , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Australia del Sur/epidemiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Myonecrosis provoked by illness unrelated to unstable coronary plaque is common, but uncertainty about a cause-effect relationship with future events challenges the appropriateness of initiating therapies known to be effective in cardiac conditions. We examined the causal relationship between troponin elevation in non-coronary diagnoses and late cardiac events using the Bradford Hills criteria for causality. METHODS AND RESULTS: Patients presenting acutely to South Australian public hospitals receiving at least one troponin between September 2011-September 2012 were included. Diagnoses were classified as coronary, non-coronary cardiac and non-cardiac using the International Classification of Diseases, version 10 Australian Modified, codes. The relationship between peak in-hospital troponin, using a high-sensitivity troponin T assay and adjudicated cardiac and non-cardiac mortality, and subsequent myocardial infarction (MI) was assessed using competing-risk flexible parametric survival models. Troponin results were available for 38,161 patients of whom, 12,645 (33.6%), 3237 (8.5%), and 22,079 (57.9%) patients were discharged with coronary, non-coronary cardiac and non-cardiac diagnoses, respectively. Troponin >14 ng/l was observed in 43.6%. The relationship between troponin and cardiac mortality was stronger among the non-coronary diagnosis group (troponin 1000 ng/l: coronary hazard ratio: 5.1 (95% confidence interval (CI) 4.0-6.6) vs non-coronary hazard ratio: 16.3 (95% CI 12.6-22.4)). The temporal hazard for cardiac death was marked within 30 days in both groups. Among non-coronary diagnoses, the hazard for recurrent MI was higher but did not vary with time. CONCLUSIONS: Consistency with causal criteria between secondary myonecrosis and cardiac events suggest the potential benefit for extending cardiac specific interventions to this population if supported in trials appropriately designed to address competing risks. Troponin elevation precipitated by non-coronary events is common and demonstrates an associations with late mortality that are analogous to spontaneous MI resulting from unstable coronary plaque. These observations help inform the design of randomized clinical trials exploring the benefits and risk of therapies with established benefits in other cardiac conditions. Such studies will need to appropriately account for competing risks in this population of patients.
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Cardiopatías/sangre , Infarto del Miocardio/sangre , Troponina T/sangre , Troponina/sangre , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Biomarcadores/sangre , Causalidad , Causas de Muerte/tendencias , Femenino , Cardiopatías/mortalidad , Cardiopatías/patología , Cardiopatías/terapia , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Infarto del Miocardio/mortalidad , Infarto del Miocardio/patología , Infarto del Miocardio/terapia , Evaluación de Resultado en la Atención de Salud , Sensibilidad y EspecificidadRESUMEN
Dogs are considered the main mammal reservoir of Trypanosoma cruzi in domiciliary environments. Consequently, accurate detection of T. cruzi infection in canine populations is epidemiologically relevant. Here, we analysed the utility of the T. cruzi recombinant antigens FRA, SAPA, CP1, Ag1 and a SAPA/TSSA VI mixture, in an ELISA format. We used a positive control group of sera obtained from 38 dogs from the Chaco region in Argentina with positive homogenate-ELISA reaction, all of them also positive by xenodiagnosis and/or PCR. The negative group included 19 dogs from a nonendemic area. Sensitivity, specificity, area under the curve (AUC) of the receiver operating charactheristic (ROC) curve and Kappa index were obtained to compare the diagnostic efficiency of the tests. The SAPA/TSSA VI had the highest performance, with a sensitivity of 94.7% and an AUC ROC of 0.99 that indicates high accuracy. Among individual antigens, SAPA-ELISA yielded the highest sensitivity (86.8%) and AUC ROC (0.96), whereas FRA-ELISA was the least efficient test (sensitivity = 36.8%; AUC ROC = 0.53). Our results showed that the use of SAPA/TSSA VI in ELISAs could be a useful tool to study dogs naturally infected with T. cruzi in endemic areas.
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Antígenos de Protozoos/análisis , Antígenos/análisis , Enfermedad de Chagas/veterinaria , Enfermedades de los Perros/diagnóstico , Animales , Antígenos/genética , Antígenos de Protozoos/genética , Argentina , Enfermedad de Chagas/diagnóstico , Perros , Ensayo de Inmunoadsorción Enzimática/veterinaria , Proteínas Recombinantes/análisis , Proteínas Recombinantes/genética , Sensibilidad y Especificidad , Trypanosoma cruzi/inmunologíaRESUMEN
A total of 221 children from two rural settlements in Northeast Argentina were examined for T. cruzi infection. Blood samples were taken for serology tests and PCR assays. In addition, T. cruzi Discrete Typing Units (DTUs) were determined by hybridization with specific DNA probes of the minicircle hypervariable regions (mHVR). Serological results indicated that 26% (57/215) were reactive against T. cruzi antigens. PCR analyses were performed on seropositive samples showing presence of parasite DNA in 31 out of 53 samples (58.5%). All seropositive children underwent specific chemotherapy with Benznidazole (5mg/kg/day) for a period of two months and were monitored two and five years after treatment. Overall the treatment was well tolerated and low side effects were observed. Serological conversion was observed at two years post -treatment in one child form Pampa Ávila and at five years in two children from Tres Estacas. However, at the end of the follow-up period, T. cruzi DNA could not be detected by PCR in samples from treated children, except in two cases. In addition, the results of hybridizations with specific DNA probes showed that DTU TcV was detected in 68% (21/31), TcVI in 7% (2/31) and TcV/VI in 3% (1/31) of the samples. Altogether, results of the follow-up of treated children showed a low rate of seroconversion; however trend toward seroconversion was evident at five years post-treatment. On the other hand, detection of T. cruzi DNA by PCR significantly decreased after Benznidazole treatment. The existence of data regarding serological and molecular follow-ups from controlled studies in the Chaco Region will be important for future treatment efforts against T. cruzi infection in this region. The results obtained in the present study represent a contribution in this regard.
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Antiprotozoarios/uso terapéutico , Enfermedad de Chagas/tratamiento farmacológico , Nitroimidazoles/uso terapéutico , Trypanosoma cruzi/aislamiento & purificación , Adolescente , Anticuerpos Antiprotozoarios/sangre , Argentina , Niño , Preescolar , Enfermedad Crónica , ADN de Cinetoplasto , ADN Protozoario/genética , Femenino , Estudios de Seguimiento , Genotipo , Humanos , Masculino , Hibridación de Ácido Nucleico , Población Rural , Resultado del Tratamiento , Trypanosoma cruzi/clasificación , Trypanosoma cruzi/genéticaRESUMEN
OBJECTIVE: The activity of dopamine-dependent retinal signaling can be assessed using electroretinography. Response of this system to oral food stimulation might provide accessible insight into the brain dopamine response to oral stimuli as retinal dopamine concentration is dependent upon mid brain dopamine concentration was postulated. DESIGN AND METHODS: Nine individuals had cone ERG (b wave) response to oral food stimulation and oral methylphenidate (MPH) administration measured on separate days, and completed self reported eating behavior questionnaires. RESULTS: Significant and similar increases in b wave response to both stimuli (P = 0.012 and P = 0.042, MPH and food, respectively) and significant correlations of the food stimulated b wave amplitude with binge eating related behavior as measured by the Gormally Binge Eating Scale (r = 0.68, P = 0.044) and self-reported trait hunger as measured by the Stunkard and Messick Three Factor Eating Questionnaire (r = 0.67, P = 0.048) were found. CONCLUSION: The significant increase in food stimulated dopamine dependent b wave amplitude and correlation with methylphenidate stimulated b wave amplitude suggest that ERG may offer a relatively inexpensive and accessible methodology for potentially assess dopaminergic responses to food and other externally applied stimuli that have been implicated in the pathogenesis of a number of human diseases.
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Trastorno por Atracón/metabolismo , Encéfalo/metabolismo , Dopamina/metabolismo , Ingestión de Alimentos/fisiología , Electrorretinografía/métodos , Alimentos , Retina/fisiología , Adulto , Bulimia , Inhibidores de Captación de Dopamina/farmacología , Femenino , Humanos , Hambre , Masculino , Metilfenidato/farmacología , Persona de Mediana Edad , Células Fotorreceptoras Retinianas Conos/efectos de los fármacos , Células Fotorreceptoras Retinianas Conos/metabolismo , Transducción de Señal , Encuestas y CuestionariosRESUMEN
Seromucinous hamartoma is a benign lesion of the sinonasal tract. Since its description in 1974, only a small number of additional cases have been reported. It is composed of a proliferation of seromucinous glands and ducts within a variable fibrous stroma. The serous component typically stains positively for S100 (at least focally) and lacks p63 positive abluminal cells. The lack of myoepithelial/basal cells is an important diagnostic feature of seromucinous hamartoma; their absence could lead to an incorrect diagnosis of low-grade sinonasal adenocarcinoma. We report the case of a polypoid mass resected from the posterior nasal cavity and nasopharynx of a 54-year-old woman. The lesion contained a population of small and large glands lined by cuboidal to flattened cells within a hypocellular stroma varying from dense and sclerotic to myxoid. Additionally, there was a superficial focus of ciliated invaginated surface epithelium and glands. Throughout the lesion there were no cytologic or architectural features of malignancy. The histologic features were diagnostic of seromucinous hamartoma. Immunohistochemistry showed focal S100 positivity of the serous glands. However, in contrast to previously reported cases, the glands focally showed an outer basal layer that was calponin, p63 and actin positive. Our case demonstrates two important points. First, complete absence of p63 staining should not necessarily be a required feature in the diagnosis of seromucinous hamartoma. Second, the ciliated larger glands--in keeping with respiratory epithelial adenomatoid hamartoma (REAH)--support the suggestion that seromucinous hamartoma and REAH are a spectrum of lesions, often seen together.
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Hamartoma/patología , Senos Paranasales/patología , Células Epiteliales/patología , Femenino , Humanos , Persona de Mediana Edad , Miocitos del Músculo Liso/patologíaRESUMEN
The rTSSA-II (recombinant Trypomastigote Small Surface II) antigen was evaluated by ELISA to detect anti-Trypanosoma cruzi antibodies in sera from naturally infected dogs and humans. For this evaluation ELISA-rTSSA-II was standardized and groups were classified according to the results obtained through xenodiagnosis, ELISA and PCR. Sensitivity (Se), Specificity (Sp), Kappa index (KI) and area under curve (AUC) were determined. The Se was determined by using 14 sera from dogs infected with T. cruzi VI (TcVI) whereas Sp was determined by using 95 non-chagasic sera by xenodiagnosis, ELISA-Homogenate and PCR. The performance of ELISA-rTSSA-II in dog sera was high (AUC=0·93 and KI=0·91). The Se was 92·85% (1 false negative) and Sp was 100%. Two sera from dogs infected with TcI and 1 with TcIII were negative. For patients infected with T. cruzi, reactivity was 87·8% (36/41), there was only 1 indeterminate, and Sp was 100%. Fifty-four sera from non-chagasic and 68 sera from patients with cutaneous leishmaniasis did not react with rTSS-II. ELISA-rTSSA-II showed a high performance when studying sera from naturally infected dogs and it also presented 100% Sp. This assay could be an important tool to carry out sero-epidemiological surveys on the prevalence of T. cruzi circulating lineages in the region.
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Anticuerpos Antiprotozoarios/sangre , Antígenos de Protozoos , Enfermedad de Chagas/diagnóstico , Enfermedades de los Perros/diagnóstico , Trypanosoma cruzi/inmunología , Animales , Antígenos de Protozoos/inmunología , Antígenos de Protozoos/aislamiento & purificación , Antígenos de Superficie/inmunología , Antígenos de Superficie/aislamiento & purificación , Argentina/epidemiología , Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/parasitología , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/parasitología , Perros , Ensayo de Inmunoadsorción Enzimática/métodos , Ensayo de Inmunoadsorción Enzimática/veterinaria , Humanos , Proteínas Recombinantes/inmunología , Proteínas Recombinantes/aislamiento & purificación , Sensibilidad y Especificidad , Estudios SeroepidemiológicosAsunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/patología , Biopsia del Ganglio Linfático Centinela , Carcinoma de Células Escamosas/cirugía , Protocolos Clínicos , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Escisión del Ganglio Linfático , Cintigrafía , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To compare angiographic features in women with and without type II diabetes mellitus. SUBJECTS AND METHODS: One hundred and six consecutive women who underwent diagnostic coronary angiography in the Chest Diseases Hospital, Kuwait, were chosen for the study. Quantitative coronary angiography was performed and the angiographic features were assessed. RESULTS: Eighty-two patients had coronary artery disease. Of these, 59 (72%) had type II diabetes mellitus and 23 (28%) were non-diabetics. Segmental disease involving the mid and distal left anterior descending artery was more common in diabetics than non-diabetics. Diabetics had a greater number of long lesions and more distal coronary artery disease. However, the caliber and suitability of the distal vessels for grafting was similar. CONCLUSION: Angiographic severity of coronary artery disease in this selective group of mostly Arab women was more in those with type II diabetes mellitus than non-diabetics. However, the distal luminal diameter was similar in both groups.
Asunto(s)
Angiografía Coronaria , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico por imagen , Diabetes Mellitus Tipo 2/complicaciones , Distribución de Chi-Cuadrado , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To examine long-term safety and efficacy for weight loss of an herbal Ma Huang and Kola nut supplement (90/192 mg/day ephedrine alkaloids/caffeine). DESIGN: Six-month randomized, double-blind placebo controlled trial. SUBJECTS: A total of 167 subjects (body mass index (BMI) 31.8+/-4.1 kg/m(2)) randomized to placebo (n=84) or herbal treatment (n=83) at two outpatient weight control research units. MEASUREMENTS: Primary outcome measurements were changes in blood pressure, heart function and body weight. Secondary variables included body composition and metabolic changes. RESULTS: By last observation carried forward analysis, herbal vs placebo treatment decreased body weight (-5.3+/-5.0 vs. -2.6+/-3.2 kg, P<0.001), body fat (-4.3+/-3.3 vs. -2.7+/-2.8 kg, P=0.020) and LDL-cholesterol (-8+/-20 vs. 0+/-17 mg/dl, P=0.013), and increased HDL-cholesterol (+2.7+/-5.7 vs. -0.3+/-6.7 mg/dl, P=0.004). Herbal treatment produced small changes in blood pressure variables (+3 to -5 mm Hg, P< or =0.05), and increased heart rate (4+/-9 vs. -3+/-9 bpm, P<0.001), but cardiac arrhythmias were not increased (P>0.05). By self-report, dry mouth (P<0.01), heartburn (P<0.05), and insomnia (P<0.01) were increased and diarrhea decreased (P<0.05). Irritability, nausea, chest pain and palpitations did not differ, nor did numbers of subjects who withdrew. CONCLUSIONS: In this 6-month placebo-controlled trial, herbal ephedra/caffeine (90/192 mg/day) promoted body weight and body fat reduction and improved blood lipids without significant adverse events.
Asunto(s)
Cafeína/uso terapéutico , Ephedra , Efedrina/uso terapéutico , Preparaciones de Plantas/uso terapéutico , Pérdida de Peso , Glucemia/análisis , Presión Sanguínea/efectos de los fármacos , Composición Corporal , Peso Corporal , Cafeína/administración & dosificación , Cafeína/efectos adversos , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Cola/efectos adversos , Suplementos Dietéticos , Electrocardiografía Ambulatoria , Ephedra/efectos adversos , Ephedra/química , Ephedra sinica/efectos adversos , Efedrina/administración & dosificación , Efedrina/efectos adversos , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Cooperación del Paciente , Placebos , Preparaciones de Plantas/administración & dosificación , Preparaciones de Plantas/efectos adversos , Estudios Prospectivos , Triglicéridos/sangreRESUMEN
OBJECTIVE: To examine in overweight humans the short-term safety and efficacy for weight loss of an herbal supplement containing Ma Huang, Guarana and other ingredients. DESIGN: An 8 week randomized, double-blind placebo controlled study of a herbal dietary supplement (72 mg/day ephedrine alkaloids and 240 mg/day caffeine). SUBJECTS: Overweight men and women (body mass index, > or =29 and < or =35 kg/m2). MEASUREMENTS: The primary outcome variable was body weight change. Secondary variables included anthropometric, metabolic and cardiovascular changes. RESULTS: Sixty-seven subjects were randomized to either placebo (n=32) or active Ma Huang/Guarana (n=35). Twenty-four subjects in each group completed the study. Active treatment produced significantly (P<0.006) greater loss of weight (X+/-s.d.,-4.0+/-3.4 kg) and fat (-2.1+/-3.0% fat) over the 8-week treatment period than did placebo (-0.8+/-2.4 kg and 0.2+/-2.3% fat). Active treatment also produced greater reductions in hip circumference and serum triglyceride levels. Eight of the 35 actively treated subjects (23%) and none of the 32 placebo-treated control subjects withdrew from the protocol because of potential treatment-related effects. Dry mouth, insomnia and headache were the adverse symptoms reported most frequently by the herbal vs placebo group at the final evaluation visit. CONCLUSIONS: This herbal mixture of Ma Huang and Guarana effectively promoted short-term weight and fat loss. Safety with long-term use requires further investigation.
Asunto(s)
Cafeína/administración & dosificación , Suplementos Dietéticos , Medicamentos Herbarios Chinos/administración & dosificación , Obesidad/prevención & control , Teobromina/administración & dosificación , Teofilina/administración & dosificación , Pérdida de Peso , Adulto , Antropometría , Presión Sanguínea , Método Doble Ciego , Combinación de Medicamentos , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Triglicéridos/sangreRESUMEN
PURPOSE: To compare post-operative pain in children undergoing tonsillectomy by blunt dissection or electrocautery. METHOD: Thirty-six children between the ages of 5 and 15 years were recruited for the study. Tonsillectomy was done in a standardized fashion with uniform anaesthetic practices. Each child kept a pain diary for 10 days, recording pain twice daily on a Visual Analog Scale and Faces Pain Scale. Doses of analgesics were recorded. RESULTS: There were no statistically significant differences in the pain scores for the groups, although there was a trend toward more pain in the blunt dissection group. There were more complications in this group, and these children used significantly more doses of acetaminophen. Sources of bias are discussed. CONCLUSION: These results suggest a trend toward greater postoperative pain in children who have tonsillectomies by blunt dissection techniques.