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BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4 DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4 DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.
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BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.
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Objetivo: Reportar un caso clínico de acrometástasis de cáncer de colon. Materiales y Métodos: Se obtiene información de la ficha clínica electrónica. Se realiza revisión de literatura, utilizando los términos "acrometastasis", "metástasis óseas", "metástasis en la mano", "metástasis en falanges". Resultados: Se presenta el caso de un paciente con antecedente de cáncer de colon sigmoides etapa IV sometido a resección de metástasis hepáticas, quimioterapia y radioterapia. Consulta por lesión ulcerada en dedo anular derecho, cuya biopsia indica metástasis de adenocarcinoma de colon. Se realiza amputación transfalángica proximal con biopsia que confirma diagnóstico. Discusión: Las metástasis en mano dan cuenta del 0,0070,2% de todas las metástasis a distancia. Se presentan como aumento de volumen doloroso de aspecto granulomatoso o asociado a ulceración con empeoramiento progresivo. El tratamiento tiene por objetivo el manejo del dolor y la preservación de la funcionalidad de la extremidad. Conclusión: El adenocarcinoma de colon, raramente, da metástasis falángicas. Corresponden a una manifestación tardía de la enfermedad con una alta tasa de mortalidad a 6 meses asociada. Se deben considerar como diagnóstico diferencial en pacientes oncológicos.
Objective: To report a clinical case of achrometastases of colon cancer. Materials and methods: Information is obtained from the electronic medical record. A literature review is performed, using the terms "achrometastases", "bone metastases", "hand metastases", "phalangeal metastases". Results: We present the case of a patient with a history of stage IV sigmoid colon cancer who underwent resection of liver metastases, chemotherapy and radiotherapy. Consultation due to an ulcerative lesion on the right ring finger, whose biopsy indicated colon adenocarcinoma metastases. Proximal transphalangeal amputation is performed with biopsy confirming diagnosis. Discussion: Hand metastases account for 0.007-0.2% of all distant metastases. They present as a painful increase in volume with a granulomatous appearance or associated with progressively worsening ulceration. The treatment aims to manage pain and preserve the functionality of the limb. Conclusion: Colon adenocarcinoma rarely gives phalangeal metastases. They correspond to a late manifestation of the disease with a high associated 6-month mortality rate. They should be considered as a differential diagnosis in cancer patients.
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Background : Escherichia coli is the main bacterium associated with urinary tract infections (UTIs), including cystitis and pyelonephritis. Uropathogenic E. coli (UPEC) harbors numerous genes that encode diverse virulence factors contributing to its pathogenicity. The treatment of UTIs has become complicated due to the natural selection of E. coli strains that are multiresistant to several groups of antibiotics regularly used in clinical settings such as hospitals. Genomic reports of the global composition and distribution of the antibiotic resistance and virulence genes of these pathogenic strains are lacking in the Mexican population. Purpose and methods : The aim of this study was to globally characterize the genomes of a group of UPEC strains by massive parallel sequencing to determine the prevalence and distribution of virulence and antibiotic resistance genes associated with different serotypes and phylogenetic groups. Results: The strains exhibited 138-197 virulence genes and 29 antibiotic resistance genes related to antibiotics that are commonly used in clinical practice. Conclusions: These findings are relevant to the definition of new strategies for treating urinary tract infections in public hospitals and private practice. To further define the epidemiological distribution and composition of these virulence and antibiotic resistance genes, larger studies are needed.
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Mujer de 54 años con antecedentes de Hipertensión arterial e Hipotiroidismo. Historia de aproximadamente 3 meses de evolución caracterizado al inicio por ánimo bajo, cambios en el comportamiento con aparición progresiva de conductas extraña, ideas delirantes y alucinaciones visuales y auditivas, junto con disminución en requerimientos de hormonas tiroídeas hasta la suspensión. Consulta en varios centros donde se cataloga como Trastorno depresivo severo con síntomas psicóticos, Síndrome confusional, Síndrome Psicótico. En este contexto se pesquisa Hipertiroidismo con títulos elevados de Anticuerpos Antitiroídeos e inicia tratamiento con Metimazol y Betabloqueo. Tras extenso estudio que descartan causas infecciosas, neoplásicas y autoinmunes; se inicia tratamiento con pulsos de Metilprednisolona con excelente y rápida respuesta clínica, la cual mantiene durante el curso del seguimiento con dosis decrecientes de corticoides.
A 54-year-old woman with a history of arterial hypertension and hypothyroidism. History of approximately 3 months of evolution characterized at the beginning by low mood, changes in behavior with progressive appearance of bizarre behaviors, delusional ideas and visual and auditory hallucinations. Consultation in several centers where it is classified as severe Depressive disorder with psychotic symptoms, Confusional syndrome, Psychotic syndrome. Hyperthyroidism is investigated with high titers of Antithyroid Antibodies and initiates treatment with Methimazole and Betablock. After extensive study that ruled out infectious, neoplastic and autoimmune causes; Treatment with Methylprednisolone pulses is initiated with excellent and rapid clinical response, which is maintained during the course of follow-up with decreasing doses of corticosteroid.
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Humanos , Feminino , Pessoa de Meia-Idade , Tireoidite Autoimune/complicações , Tireoidite Autoimune/tratamento farmacológico , Encefalopatias/etiologia , Tireoidite Autoimune/diagnóstico , Metilprednisolona/uso terapêutico , Metimazol/uso terapêutico , Anticorpos/análiseRESUMO
Mesenchymal stem cells (MSCs) are multipotent stem cells that are able to immunomodulate cells from both the innate and the adaptive immune systems promoting an anti-inflammatory environment. During the last decade, MSCs have been intensively studied in vitro and in vivo in experimental animal model of autoimmune and inflammatory disorders. Based on these studies, MSCs are currently widely used for the treatment of autoimmune diseases such as rheumatoid arthritis (RA) characterized by complex deregulation of the immune systems. However, the therapeutic properties of MSCs in arthritis are still controverted. These controversies might be due to the diversity of MSC sources and isolation protocols used, the time, the route and dose of MSC administration, the variety of the mechanisms involved in the MSCs suppressive effects, and the complexity of arthritis pathogenesis. In this review, we discuss the role of the interactions between MSCs and the different immune cells associated with arthritis pathogenesis and the possible means described in the literature that could enhance MSCs therapeutic potential counteracting arthritis development and progression.
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Determinar qué porcentaje de una población sin dolor anterior de rodilla tiene un test de Zohlen positivo, además determinar el ángulo Q de esta población y buscar si existe alguna relación entre la positividad del test de Zohlen y alteraciones en el ángulo Q. Material y método: Estudio descriptivo-prospectivo observacional. Aplicación del test de Zohlen y medición del ángulo Q. La población se dividió en 2 grupos: test de Zohlen positivo y test de Zohlen negativo. Cuantificación y comparación de medias del ángulo Q en los dos grupos. Resultados: 90 sujetos evaluados, promedio de edad 20,18 años (18-40). Veinte sujetos (22,2 por ciento) con test de Zohlen positivo. Ángulo Q promedio en los sujetos con test de Zohlen negativo: 14,95°; ángulo Q promedio en los sujetos con test de Zohlen positivo: 16,9° (p < 0,05). Ángulo Q promedio en hombres con test de Zohlen negativo 13,4°; ángulo Q promedio en hombres con test de Zohlen positivo: 16° (p < 0,05). Ángulo Q promedio en mujeres con test de Zohlen negativo: 16,5°; ángulo Q promedio en mujeres con test de Zohlen positivo: 18°, sin diferencias estadísticamente significativas entre ambos grupos. Conclusiones: El test de Zohlen tiene una correlación positiva con el ángulo Q en sujetos de sexo masculino. Dada la correlación entre un ángulo Q alterado y la presencia de dolor anterior de rodilla, en los pacientes que presentan un test de Zohlen positivo sin haber consultado por dolor anterior de rodilla, la prevención primaria de dolor anterior de rodilla puede ser de utilidad...
To determine the percentage of a population without anterior knee pain with a positive Zohlen test, and also to determine the Q angle of this population and to determine if there is any relationship between the Zohlen test and Q angle anomalies. Methods:A prospective observational study was conducted in which Zohlen¿s test was applied and the Q angle was measured. The population was divided into 2 groups: Zohlen¿s positive and Zohlen¿s negative. Q angle was compared in the 2 groups. Results: The study included 90 subjects, with a mean age 20.18 years (18-40), of whom 20 subjects (22.2 percent) had positive Zohlen¿s test. The mean Q angle in subjects with negative Zohlen¿s test was 14.95°, and the mean Q angle in subjects with positive Zohlen¿s test was 16,9° (p<.05). The mean Q angle in men with negative Zohlen¿s test was 13.4°, and the mean Q angle in men with positive Zohlen¿s test was 16° (p < .05). The mean Q angle in women with negative Zohlen¿s test was 16.5°, with a mean Q angle of 18° in women with positive Zohlen¿s test, with no statistically significant differences found between groups. Conclusions: Zohlen¿s test has a positive correlation with the Q angle in male subjects. Given the correlation between the Q angle and the presence of anterior knee pain in patients who have a positive test without symptoms, primary prevention of anterior knee pain can be achieved...
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Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Joelho/fisiologia , Joelho/fisiopatologia , Síndrome da Dor Patelofemoral/diagnóstico , Articulação Patelofemoral/fisiologia , Articulação Patelofemoral/fisiopatologia , Artralgia/diagnóstico , Estudo Observacional , Estudos ProspectivosRESUMO
Rose (Rosa spp.) is the most important ornamental plant cultivated in greenhouse and open fields in Mexico but its quality has been limited by powdery mildew (PM). High incidence and disease damage is common during winter in Sinaloa, Mexico (temperature range 18 to 25°C and prolonged episodes of relative humidity ≥90%). The fungus attacks leaves and flowers and grows abundantly on the pedicels, sepals, and receptacles, especially when the flower bud is unopened (2). Field advisors in Mexico have referred to Sphaerotheca pannosa (Wallr. ex Fr.) Lév. as a causal agent of the disease. However, there has not been solid scientific evidence to support this statement. Morphometric and molecular analysis were conducted to elucidate the identity of the fungal isolates collected from 2012 through 2013 in northern Sinaloa. PM specimens included eight different rose varieties. Conidiophores and conidia were observed under a compound microscope. The mycelium had a mean diameter of 4.7 to 6.0 µm; conidiophores (Euoidium type) 2 to 5 celled, occasionally 6 celled emerged from the superficial mycelium; conidiophores were unbranched with conidia produced in chains from the apex. The average length of the conidiophores was 54.9 to 98.0 µm; the foot cell of the conidiophores was straight and was 24.9 to 53.6 µm long with a diameter from 8.2 to 9.8 µm across its medium part. Conidia originated from unswollen conidiogenous cells, with fibrosin bodies, formed in long chains, and were cylindrical to ovoid, 25.8 to 30.4 µm long and 13.9 to 17.3 µm wide. The outline of the conidial chains was crenate. Conidia exhibited a slight constriction at one end. The germ tubes emerged from a shoulder of the conidia. The outer wall of partially collapsed conidia showed longitudinal and transversal wrinkling and slight constrictions at the ends; the terminal end of the conidia was concentrically ridged. For molecular characterization, the ITS region of the specimens was amplified with primers ITS1F and ITS4. Phylogenetic analysis was performed with MEGA 6.0 (bootstrap = 1,000) using Kimura 2 parameter (K2P) substitution model. The resulting phylogeny grouped our specimens (GenBank KM001665 to 69) within a clade of Podosphaera pannosa (Wall.: Fr.) de Bary (formerly known as Sphaerotheca pannosa) sequences (e.g., AB525938; bootstrap (1,000) = 98). Phylogenetic and morphometric data are in agreement with descriptions of the anamorphic P. pannosa (1,3). Morphological studies indicate that P. macularis (previously known as S. humuli) and P. pannosa are not indistinctly different (2). Phylogenetic analysis showed relationship to P. pannosa, but not to P. macularis. Typical symptoms caused by P. pannosa were observed. Morphological studies (4) reported the anamorph of P. pannosa on Rosa spp. in central Mexico. To date, no report exists on the molecular identification of P. pannosa associated to roses in northern Sinaloa, Mexico. Future research directions should focus on finding the teleomorph of the fungus to support its identity, and to explore disease management tools such as effective fungicides and developing resistant rose cultivars. References: (1) U. Braun et al. Page 13 in: The Powdery Mildews: A Comprehensive Treatise. APS Press, St. Paul, MN, 2002. (2) R. K. Horst. Compendium of Rose Diseases. APS Press, St. Paul, MN, 1983. (3) L. Leus et al. J. Phytopathol. 154:23, 2006. (4) Yañez-Morales et al. Some new reports and new species of powdery mildew from Mexico. Schlechtendalia 19:46, 2009.
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The aim of this study is to estimate the prevalence of Trichomonas vaginalis and Candida albicans in low-risk patients treated at a first level clinic (primary health care represents the first level of contact of individuals, families, and the community with the system national health). Using a cross-sectional study in patients treated in clinical laboratory of the Sanitary District no. 7 of the city of Orizaba during the months June-July, 252 urine samples were collected for the identification of T. vaginalis and C. albicans by PCR. Furthermore, we analyzed the sociodemographic characteristics of the studied population. We observed an overall prevalence of 23.41% (95% CI 22.10-24.72) for T. vaginalis and 38.88% (95% CI 37.73-40.03) for C. albicans. There was also presence of coinfection in 14.28% (95% CI 13.10-15.46), which was associated with the presence of pain. Most of the positive cases were observed in women house-maker (80%, 95% CI 50.36-48.98). The results of this study provide evidence that the majority of positive cases observed in the studied population are presented in an asymptomatic form and usually are not associated with any risk factor.
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Candida albicans/isolamento & purificação , Candidíase/urina , Instalações de Saúde , Reação em Cadeia da Polimerase/métodos , Vaginite por Trichomonas/urina , Trichomonas vaginalis/isolamento & purificação , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Candida albicans/genética , Candidíase/diagnóstico , Candidíase/microbiologia , Feminino , Geografia , Humanos , México , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/parasitologia , Trichomonas vaginalis/genética , Adulto JovemRESUMO
AIM(S): To explore the relationship between biomarkers of systemic inflammation in plasma and gingival crevicular fluid in early pregnancy and the subsequent development of pre-eclampsia in patients with periodontitis. MATERIALS AND METHODS: A case-control study was performed. From a cohort composed of 126 pregnant women, 43 normotensive healthy pregnant women were randomly selected, and 11 cases of preeclampsia were identified. Plasmatic and gingival crevicular fluid (GCF) samples were collected in early pregnancy (11-14 wk gestation). The levels of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were measured in the plasma and GCF samples, whereas the level of C-reactive protein (CRP) was measured in plasma samples. Biomarkers were determined by ELISA assays. The data were analysed using descriptive statistics, and the association between variables was estimated through logistic regression models. RESULTS: There was observed an association between pre-eclampsia and plasmatic levels of CRP (OR: 1.07; p = 0.003). Additionally, pre-eclampsia also was associated with IL-6 levels in GCF samples in early pregnancy (OR: 1.05; p = 0.039). A multiple logistic regression model suggests that increased levels of IL-6 in GCF (OR = 1.06; p = 0.02; CI 95% 1.007-1.117) in early pregnancy increase the risk of developing pre-eclampsia. CONCLUSION(S): Pregnant women with periodontitis who later development pre-eclampsia, shows increased levels of IL-6 in GCF and CRP in plasma during early pregnancy. Periodontal disease could contribute to systemic inflammation in early pregnancy via a local increase of IL-6 and the systemic elevation of CRP. Therefore, both inflammatory markers could be involved in the relationship between periodontal disease and pre-eclampsia.
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Proteína C-Reativa/metabolismo , Líquido do Sulco Gengival/química , Interleucina-6/metabolismo , Periodontite/complicações , Pré-Eclâmpsia/etiologia , Primeiro Trimestre da Gravidez/metabolismo , Adulto , Proteína C-Reativa/análise , Estudos de Casos e Controles , Feminino , Humanos , Interleucina-6/análise , Interleucina-6/sangue , Modelos Logísticos , Periodontite/sangue , Periodontite/metabolismo , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/metabolismo , Gravidez , Primeiro Trimestre da Gravidez/sangue , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/metabolismo , Adulto JovemRESUMO
Powdery mildew of mango is an important disease in Mexico's northern Sinaloa state. Identification of the causal fungal agent has been hindered by the absence of information regarding its teleomorph, as well as a detailed morphometric analysis of the anamorph and molecular characterization. The first symptoms of the disease appear in mango inflorescences of early February, and it subsequently affects young fruits. The disease progresses during March and early April, causing significant fruit abortion and a scabby appearance in a high percentage of fruits that remain attached to the trees. We observed the disease on inflorescences but not in leaves during our sampling period. Powdery mildew specimens were collected during 2011 and 2012 and included Kent and Keith varieties from commercial orchards, and creole materials from backyards of private residences in the Ahome and Fuerte Counties of northern Sinaloa, Mexico. Symptomatic inflorescences were analyzed morphologically. Conidiophores and conidia were prepared by touching the whitish lesions with clear adhesive tape, which was then placed over microscope slides with a drop of distilled water and observed under a compound microscope. The anamorph structures of the pathogen were measured. The mycelium was septate and ramified on the surface of the host, forming a dense coat of branching hyphae. The mycelium had a diameter of 2.5 to 8.7 µm; conidiophores (Pseudoidium type) emerged from the superficial mycelium, were unbranched, and consisted of 1 to 3 cells with conidia forming singly from the apex. The length of the conidiophores varied from 30.0 to 77.5 µm; the foot cell of the conidiophores was straight, 10.0 to 47.5 µm long and with a diameter of 5.0 to 15.5 µm across its midpoint. Conidia without fibrosin bodies were borne singly, and were ellipsoid/ovoid, 22.5 to 46.2 µm long and 15.0 to 27.5 µm wide. Eighty percent of the germ tubes were forked (lobed); the rest were simple, emerged from the end, and were occasionally on the side of the conidia. Germ tubes ranged from 2.0 to 7.2 µm at the midpoint. The surface of the conidia appeared smooth under the scanning electron microscope, and elliptical conidia appeared constricted at their ends; this, however, was not observed in the ovoid conidia. In both cases, the terminal end of the conidia was smooth. The teleomorph was not found. Molecular and phylogenetic analysis of the ITS rDNA (2) region showed that samples are closely related to specimens of Pseudoidium anacardii (1) (teleomorph: Erysiphe quercicola [4]) collected from mango trees in diverse countries. Measurements of somatic and asexual structures are in agreement with descriptions of P. anachardii (formerly known as Oidium mangiferae) from India (3). The nucleotide sequences derived from this research were deposited in GenBank (Accession Nos. JX893951 to JX893957). To our knowledge, this is the first report of P. anacardii associated to mango inflorescences in Sinaloa, Mexico. Due to the economic importance of powdery mildew of mango trees in Sinaloa, future research directions should focus on finding the teleomorph of the fungus to support its identity. References: (1) U. Braun and R. T. A. Cook CBS Biodiversity Series No. 11, 2012. (2) S. Limkaisang et al. Mycoscience 47:327, 2006. (3) O. Prakash and K. C. Srivastava. Mango diseases and their management. A World Review Today and Tomorrow Publishers. New Delhi, India, 1987. (4) S. Takamatsu et al. Mycol. Res. 111:809, 2007.
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Mesenchymal stem cells (MSCs) exert suppressive effects in several disease models including lupus prone mice. However, autologous MSC therapy has not been tested in human systemic lupus erythematosus (SLE). We evaluate the safety and efficacy of bone marrow (BM)-derived MSCs in two SLE patients; the suppressor effect of these cells in-vitro and the change in CD4+CD25+FoxP3+ T regulatory (Treg) cells in response to treatment. Two females (JQ and SA) of 19 and 25 years of age, fulfilling the 1997 American College of Rheumatology (ACR) criteria for SLE were infused with autologous BM-derived MSCs. Disease activity indexes and immunological parameters were assessed at baseline, 1, 2, 7 and 14 weeks. Peripheral blood lymphocyte (PBL) subsets and Treg cells were quantitated by flow cytometry, and MSCs tested for in-vitro suppression of activation and proliferation of normal PBLs. No adverse effects or change in disease activity indexes were noted during 14 weeks of follow-up, although circulating Treg cells increased markedly. Patient MSCs effectively suppressed in-vitro PBL function. However, JQ developed overt renal disease 4 months after infusion. MSC infusion was without adverse effects, but did not modify initial disease activity in spite of increasing CD4+CD25+FoxP3+ cell counts. One patient subsequently had a renal flare. We speculate that the suppressive effects of MSC-induced Treg cells might be dependent on a more inflammatory milieu, becoming clinically evident in patients with higher degrees of disease activity.
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Lúpus Eritematoso Sistêmico/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Linfócitos T Reguladores/metabolismo , Adulto , Proliferação de Células , Feminino , Citometria de Fluxo , Seguimentos , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Linfócitos/metabolismo , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Índice de Gravidade de Doença , Transplante Autólogo , Adulto JovemRESUMO
BACKGROUND: Anxiety and depression have been related with seeking medical care by IBS patients, however their impact over the clinical characteristics and health related quality of life (HRQOL) of the patients, is unknown. AIMS: To evaluate the impact of these traits over the symptoms, number of consultations and HRQOL in IBS. METHODS: Consecutive moderate to severe IBS-Rome I patients that consulted a reference center in Mexico City, answered the HAD, a Bowel Symptom Questionnaire and the SF-36. Patients were compared according to the presence or absence of anxiety or depression. RESULTS: Anxiety was found in 70%, depression in 46% and both traits among 40%. The majority of those with depression were single compared to a married majority in those without this trait (p = 0.03). Those with anxiety (p = 0.03) and depression (p = 0.006) reported more number of days with abdominal pain/ discomfort and both traits (p = 0.000) were associated with a higher frequency of fullness, distention, abdominal pain, incomplete evacuation, abnormal bowel movements and lower HRQOL. Patients with anxiety reported a more severe IBS and those with depression a higher frequency of diarrhea predominance (p = 0.047). CONCLUSIONS: Traits anxiety and depression negatively impacted over the number of days, symptom frequency and HRQOL of patients with moderate to severe IBS. More studies are needed to determine if these psychological symptoms are causing these outcomes or if the gastrointestinal symptoms and poor HRQOL are triggering anxiety and depression in IBS.
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Ansiedade/etiologia , Depressão/etiologia , Síndrome do Intestino Irritável/complicações , Qualidade de Vida , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
Acute rheumatic fever (ARF) and its chronic valvular sequelae are the delayed consequence of a pharyngeal infection with group A Streptococcus (GAS). Several GAS proteins have been shown to be superantigens, raising the possibility that the expansion or deletion of T cells expressing specific Vbeta regions might play a role in the pathogenesis of ARF or chronic rheumatic heart disease (RHD). We therefore analyzed by four-color flow cytometry, the Vbeta repertoire on CD3, CD4 and CD8 T cells from four ARF patients, 10 RHD patients and also nine healthy controls. A selective depletion of Vbeta2+ T cells was found only in the CD8 subset of chronic RHD patients. This is of interest since a number of GAS superantigens exert their effects on Vbeta2+ cells and because only CD8+ T cells from ARF and RHD patients undergo anergy in response to GAS superantigens. Our results suggests that an ongoing immune process is present in RHD patients and that CD8+ T cells may have an important immunoregulatory role in the pathogenesis of the disease.
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Linfócitos T CD8-Positivos/metabolismo , Cardiopatia Reumática/metabolismo , Adolescente , Adulto , Linfócitos T CD4-Positivos/metabolismo , Divisão Celular/fisiologia , Humanos , Subpopulações de Linfócitos/metabolismoRESUMO
Rheumatic Heart Disease (RHD) is a delayed consequence of a pharyngeal infection with group A streptococcus (GAS), usually ascribed to a cross-reactive immune response to the host's cardiac tissues. Several GAS proteins have been reported to be superantigens, also raising the possibility that T cells in RHD could be driven by superantigens. We therefore analysed the variable beta (V beta) repertoire of T cells infiltrating heart valves from chronic RHD patients undergoing elective valvular surgery. We analysed 15 valve specimens from patients with longstanding quiescent RHD and control valves from four non-rheumatic individuals. Total RNA was extracted from fresh valve tissue and employed to amplify 22 V beta genes by RT-PCR. In valvular tissue, a restricted number of only 2 to 9 V beta regions were detected as opposed to the findings in control valves. In 8 RHD valves, the expression of V beta1, 2, 3, 5.1, 7, 8, 9 or 14 was marked. These V beta regions have been related to GAS superantigens. Our results evidence the presence of a restricted set of T lymphocytes in valvular tissue from a majority of patients with chronic RHD and suggest that valvular sequelae in these patients might be related to a local antigen or superantigen driven inflammatory process that persists even many years after the initial triggering event.
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Valvas Cardíacas/imunologia , Região Variável de Imunoglobulina/imunologia , Cardiopatia Reumática/imunologia , Linfócitos T/imunologia , Adulto , Idoso , Feminino , Valvas Cardíacas/patologia , Humanos , Região Variável de Imunoglobulina/genética , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Receptores de Antígenos de Linfócitos T/genética , Receptores de Antígenos de Linfócitos T/imunologia , Cardiopatia Reumática/fisiopatologiaRESUMO
OBJECTIVE: To determine the frequency of occurrence and long term evolution of subclinical carditis in patients with acute rheumatic fever. DESIGN: Valvar incompetence was detected by clinical examination and Doppler echocardiographic imaging during the acute and quiescent phases of rheumatic fever. Patients were followed prospectively and submitted to repeat examinations at one and five years after the acute attack. Persistence of acute mitral and aortic lesions detected solely by echocardiography (subclinical disease) was compared with that of disease detected by clinical examination as well (thereby fulfilling the latest 1992 Jones criteria for rheumatic carditis). SETTING: Three general hospitals with a university affiliation in Chile. PATIENTS: 35 consecutive patients fulfilling the revised Jones criteria for rheumatic fever. Clinical and echocardiographic examination was repeated in 32 patients after one year and in 17 after five years. Ten patients had subclinical carditis on admission, six of whom were followed for five years. MAIN OUTCOME MEASURES: Auscultatory and echocardiographic evidence of mitral or aortic regurgitation during the acute attack or at follow up. RESULTS: Mitral or aortic regurgitation was detected by Doppler echocardiographic imaging in 25/35 rheumatic fever patients as opposed to 5/35 by clinical examination (p = 0.03). Doppler echocardiography revealed acute valvar lesions in 10 of 20 rheumatic fever patients who had no auscultatory evidence of rheumatic carditis (subclinical carditis). Three of these subclinical lesions and three of the clinical or auscultatory lesions detected on admission were still present after five years of follow up, emphasising that subclinical lesions are not necessarily transient. CONCLUSIONS: Doppler echocardiographic imaging improves the detection of rheumatic carditis. Subclinical valve lesions, detected only by Doppler imaging, can persist. Echocardiographic findings should be accepted as a major criterion for the diagnosis of rheumatic fever.
Assuntos
Ecocardiografia Doppler em Cores , Doenças das Valvas Cardíacas/diagnóstico , Cardiopatia Reumática/diagnóstico , Adolescente , Adulto , Insuficiência da Valva Aórtica , Criança , Pré-Escolar , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Insuficiência da Valva Mitral , Miocardite/complicações , Estudos Prospectivos , Febre Reumática/complicações , Cardiopatia Reumática/diagnóstico por imagemRESUMO
During the last few decades, basic scientists and clinicians have gained a deeper insight of the cellular and molecular physiology of the immune system. The widespread application of molecular biology and genetic techniques has advanced our understanding of states of health and disease, bringing forth renewed hopes concerning the advent of a more "specific" therapeutic era of clinical immunology. The precise structural and genetic characterization of molecular complexes such as B and T-cell receptors, the Major Histocompatibility Complex (MHC), cytokines, chemokines, cellular receptors and co-receptors has produced a wealth of information open to both diagnostic and therapeutic purposes. We herein review several recent advances in the molecular and genetic characterization of immune deficiency states, autoimmunity and the induction of antigen specific immune unresponsiveness or tolerance, together with the therapeutic implications of these findings.
Assuntos
Síndromes de Imunodeficiência/genética , Síndromes de Imunodeficiência/terapia , Imunoterapia/métodos , Adenosina Desaminase/deficiência , Adenosina Desaminase/genética , Humanos , Transtornos Linfoproliferativos/imunologia , Complexo Principal de Histocompatibilidade/genética , Imunodeficiência Combinada Severa/genéticaRESUMO
The effect of solar radiation on photosynthesis and chlorophyll fluorescence associated to photosystem II (PS II) was determined in the Phaeophyta Macrocystis pyrifera, the Rhodophyta Chondrus crispus and the Chlorophyta Ulva lactuca by oxygen evolution and pulse-amplitude-modulated (PAM) fluorescence. The algae were maintained in 1.2 m3 outdoor tanks with constant aeration and at 8, 26 and 100% incident irradiance (E(o)). All three species showed a decrease in deltaF/F'm values during solar noon compared to values in the morning and afternoon, suggesting a photoinhibition of photosynthesis. In general, photoinhibition was negatively correlated to increasing daily irradiance in all three species. Photoinhibition in C. crispus occurred in tissue incubated at 8, 26 and 100% E(o), while in M. pyrifera and U. lactuca a decrease in deltaF/F'm values was only observed in tissue incubated at 100% E(o). This suggests that species that naturally grow at greater depths might be more susceptible to excessive light when cultured in shallow waters compared to species that naturally inhabit shallower depths. In M. pyrifera, deltaF/F'm values were lower in the afternoon than those in the morning, suggesting slower repair mechanisms of the photosystem II compared to the other species. The results suggest that photoinhibition could be reduced by reducing incident irradiance to culture systems or increasing of biomass to promote self-shading. Gross oxygenic photosynthesis increased linearly at low electron transport rates after which it saturated in all three species. This suggests that chlorophyll fluorescence could be used as an indicator of the physiological status of macroalgae maintained in dense aquaculture systems.
Assuntos
Phaeophyceae/efeitos da radiação , Fotossíntese/efeitos da radiação , Rodófitas/efeitos da radiação , Clorofila/metabolismo , Clorofila A , Phaeophyceae/fisiologia , Rodófitas/fisiologiaRESUMO
BACKGROUND: Neuroendocrine factors play an important role in the expression of autoimmune diseases. Prolactin (PRL) can induce T-cell proliferation and macrophage activation. Elevated PRL levels have been described in patients with rheumatoid arthritis (RA). AIM AND METHODS: We studied immunological and clinical effects of PRL suppression in 9 RA patients with active disease, treated for 3 months with bromocriptine (BRC), an inhibitor of PRL secretion. RESULTS: BRC induced a significant depression of the peripheral blood mononuclear cells response to antigen (p = 0.008) and mitogen (p = 0.008) which was significantly correlated with improvements in the HAQ disability index (r = 0.68; p = 0.04) and grip strength (r = 0.7; p = 0.02). Also, the in-vitro production of IL-2, nitric oxide and poliamines--that are critical for the proliferative response of lymphoid cells--decreased significantly. The group experienced significant improvement of grip strength (p = 0.028) and the HAQ disability index (p = 0.025), whereas 4 individuals achieved clinical improvement according to the American College of Rheumatology preliminary definition. We conclude that BRC treatment induces a significant depression of in-vitro immune function in RA patients and that these changes are related to parameters of disease activity. The effects of BRC on immune function and disease activity in RA patients warrant further investigation.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Bromocriptina/uso terapêutico , Antagonistas de Hormônios/uso terapêutico , Prolactina/efeitos dos fármacos , Análise de Variância , Artrite Reumatoide/imunologia , Bromocriptina/imunologia , Bromocriptina/farmacologia , Relação Dose-Resposta Imunológica , Feminino , Antagonistas de Hormônios/imunologia , Antagonistas de Hormônios/farmacologia , Humanos , Pessoa de Meia-Idade , Óxido Nítrico/imunologia , Prolactina/imunologiaRESUMO
This paper describes long term research efforts wich have lead: 1) to the identification of peptides present in pepsanurin, a peptidic fraction obtained by pepsin hydrolisis of plasma globulins that inhibits the renal excretory action of atrial natriuretic peptide (ANP) and 2) to the discovery of an unexpected role of glucose, as a requisite, for these inhibitory effects. The active peptides identified in pepsanurin are derived from plasma kininogens, substrates of the kallikrein-kinin system. Pro-kinins of 15, 16 and 18 aminoacids, and bradykinin itself, block ANP-induced diuresis and natriuresis when injected iv, ip or into, the duodenal lumen of anesthetized rats in picomol doses. Furthermore, a novel 20 aminoacids fragment derived from kininogen dominium-1, named PU-D1, is the most potent and longer lasting blocker of ANP renal effects. The anti-ANP effects of those peptides are prevented by B2- kinin receptor antagonists. The inhibition of ANP by kinins and PU-D1 was evident only in rats infused with isotonic glucose; whereas the excretory effect of ANP was not affected in fasted rats not infused, or infused with saline. These findings provide evidence that glucose facilitates liquid retention through a kinin-mediated inhibition of ANP excretory action that may be related to the prandial cycle