This study describes a nosocomial outbreak of influenza in high-risk-hematological patients, and the usefulness of epidemiological measures and zanamivir administration for its control.
Fifteen ...patients who had been in contact with a patient with influenza A were included in the study. Viral culture of nasopharyngeal exudate was performed and the epidemiological data, risk factors and clinical outcome were evaluated. The efficacy of early therapy and preventive use of zanamivir was also assessed.
Seven out of 15 patients (46.6%) developed symptoms and in 5 of these 7 cases (71.4%), influenza A virus was isolated. Eight patients did not develop symptoms and viral culture was sterile. All symptomatic patients were isolated, and treatment with inhaled zanamivir (10 mg/12 h, 5 days) was initiated as soon as possible; only one patient developed respiratory failure; the remaining cases had self-limited upper respiratory tract symptoms. There was no associated mortality. Zanamivir prophylaxis was used in three non-symptomatic patients considered to be at high risk. Tolerance to zanamivir was excellent. No new cases were observed after initiation of the preventive measures and use of zanamivir.
The attack rate in a nosocomial influenza outbreak can be very high in immunocompromised patients. Prompt initiation of preventive measures, early treatment and prophylaxis with zanamivir may help to limit the extension of these outbreaks.
A new species, Gochnatia hiriartiana Medrano, Villaseñor & Medina (Asteraceae, tribe Mutisieae), of the desert scrubland of the state of Hidalgo, Mexico, is described. Its distinctive morphological ...traits are discussed and compared with the other Mexican species of Gochnatia. A key to the Mexican species of the genus is provided.
The hspA gene (XAC1151) from Xanthomonas axonopodis pv. citri encodes a protein of 158 amino acids that belongs to the small heat‐shock protein (sHSP) family of proteins. These proteins function as ...molecular chaperones by preventing protein aggregation. The protein was crystallized using the sitting‐drop vapour‐diffusion method in the presence of ammonium phosphate. X‐ray diffraction data were collected to 1.65 Å resolution using a synchrotron‐radiation source. The crystal belongs to the rhombohedral space group R3, with unit‐cell parameters a = b = 128.7, c = 55.3 Å. The crystal structure was solved by molecular‐replacement methods. Structure refinement is in progress.
Penetrating cardiac trauma constitutes a serious threat for life. Less than the third part of all patients who suffer it arrives at the hospital alive, and half of them die. Most of the penetrating ...foreign bodies in the heart are metallic, and are frequently caused by firearms and rarely by self-injury. The accidental penetration is uncommon but inadvertent penetration is extremely rare. We present the case of a patient who suffered a closed-chest trauma and did not notice the penetration of a foreign body (copper wire fragment) in the heart. It remained lodged in the left ventricle for more than 3 months. This it is the only case reported in the literature where a strange body: a) crosses the free wall of the right ventricle, the right ventricular cavity, interventricular septum, and the mitral valve apparatus; b) occupies almost all the anteroposterior diameter of the heart, and c) did not produce acute or chronic bleeding.
Pancreatic tumors and periampullary tumors have a similar clinical presentation; pancreatoduodenectomy represents the only possibility of cure or of increasing survival; with an average mortality of ...5-10% and a morbidity of 20-40%.
To determine the morbidity and mortality secondary to the pancreatoduodenectomy intervention in patients with pancreatic cancer or periampullary tumors in the Oncology Hospital of Centro Médico Nacional Siglo XXI (Mexico City) from 2008 to 2013.
Historical, observational and descriptive cohort carried out in the department of sarcomas and tumors of the upper digestive tube of the Oncology Hospital of Centro Médico Nacional Siglo XXI, postoperative pancreatoduodenectomy from 2008 to 2013.
We included 71 patients who underwent pancreatoduodenectomy, 47 (66.2%) were female and 24 (33.8%) were male. The average age was 60.3 years. The most common histology was cancer of the Vater's ampulla (66.2%). The resections were R0 in 95.8% of the cases. Mortality was 4.22% and morbidity was 69%. The most frequent complication was pancreatic fistula (23.9%). In the statistical analysis, perioperative transfusion was associated with surgical complications (p < 0.007).
The morbidity of pancreatoduodenectomy is greater than that reported in the literature, however, it does not influence mortality that is similar to that reported in other centers. The number of lymph nodes resected; as well as the percentage of negative margins are those accepted worldwide; It is concluded that this is derived from the experience of the center where these procedures are performed. No factor with statistical significance was found, only the transfusion that increased the complications.
In liver transplant recipients the most frequent infection is that produced by cytomegalovirus (CMV). One of the methods to reduce the incidence of that infection is the CMV pp65 antigenemia-guided ...preemptive therapy with intravenous ganciclovir.
Liver transplant recipients were tested for CMV antigenemia at days 14, 28, 45, 60, 90 and 180 postransplantation and when clinically indicated. Patients showing > 50/200.000 leukocytes received ganciclovir 5 mg/kg/12 h for 14 days. Risk factors for active CMV disease where studied.
182 CMV seropositive patients where included in the study. 16 patients with > 50/200.000 leukocytes received ganciclovir as preemptive therapy. CMV disease appeared in 9/182 patients (4.9%): 2/16 who received PT and 7/166 among those who did not receive preemptive therapy. The only factor associated with increased incidence of CMV disease was to have missing samples for CMV antigenemia during the follow up (p < 0.0042; OR = 8,17; 95% CI, 1.94-34.36).
Ganciclovir antigenemia-guided preemptive therapy is associated with a low incidence of CMV disease. Bad adherence to the protocol of antigenemia samples increases the risk for CMV disease.
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Pepsinogen C is a proteolytic enzyme involved in the digestion of proteins in the stomach; it is also synthesized by a significant percentage of female breast carcinomas. In addition, it has been ...demonstrated that pepsinogen C is one of the few proteins induced by androgens in breast carcinoma cells. Here we evaluate the expression of pepsinogen C by immunoperoxidase staining in normal breast tissue from 3 male patients, 15 gynecomastia tissues, 2 male in situ breast carcinomas, and 68 male invasive breast carcinomas. Pepsinogen C immunostaining values were quantified in male breast tumors using the HSCORE system, which considers both the intensity and the percentage of cells staining at each intensity. The results indicated positive immunohistochemical staining for pepsinogen C in all gynecomastia tissues, the two in situ ductal carcinomas, and 52 of 68 invasive breast carcinomas (76.4%). The three normal breast tissues analyzed showed negative staining for pepsinogen C, whereas invasive tumors showed clear differences among them with regard to the intensity and percentage of staining cells. In addition, pepsinogen C scores were significantly higher in well‐differentiated (grade I, 188.7) and moderately differentiated (grade II, 145.8) tumors than in poorly differentiated (grade III, 98.5) tumors (p= 0.032). Similarly, significant differences in pepsinogen C content were found between estrogen receptor (ER)‐positive tumors and ER‐negative tumors (158.5 vs. 44.3, respectively; p= 0.009). Patients with pepsinogen C‐positive tumors reached longer relapse‐free and overall survival periods than did those with tumors with negative staining, but no statistical differences were observed between survival curves calculated for these two groups of patients. This results demonstrate expression of pepsinogen C by gynecomastias and by a high percentage of male breast carcinomas and may indicate an important role of pepsinogen C in the pathophysiology of male breast diseases.
To analyze the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for ...polypathological patients (PPPs).
Multicentre cross-sectional study. We considered 2 cut-off points for the BI (≥90 points for screening frailty and <60 points for diagnosing severe dependence). For each measure and combination of 2 measures, we calculated the sensitivity, specificity, PPV and NPV with respect to the full BI.
The mean BI of the 1632 included PPPs (mean age, 77.9±9.8years; 53% men) was 69±31 (<90 for 58.7% and <60 for 31.4% of the patients). The “feeding” measure achieved the highest NPV, for a BI≥60 and ≥90 points (87% and 99.6%, respectively). The “walking” and “going up and down stairs” measures achieved the highest PPV, for a BI≥60 and ≥90 (99.2%/99.5% and 81%/92%), respectively. The combination of the 2 measures increased the PPV to 95% and 99.6%, respectively.
PPPs in hospital settings have a high rate of functional impairment. The measure for feeding achieved the highest NPV and can therefore be employed for diagnosing severe dependence. The combination of the measures for walking and going up and down stairs achieved the highest PPV and can therefore be employed to propose frailty screening for PPPs.
Analizar la sensibilidad (S), la especificidad (E) y los valores predictivos positivo (VPP) y negativo (VPN) de cada dimensión del índice de Barthel (IB) con respecto al cuestionario completo en pacientes pluripatológicos (PPP).
Estudio transversal multicéntrico. Se consideraron dos puntos de corte del IB (≥90 puntos para el cribado de fragilidad y <60 puntos para el diagnóstico de dependencia severa). Para cada dimensión y combinaciones de dos dimensiones se calcularon la S, la E, el VPP y el VPN con respecto al IB completo.
El IB medio de los 1.632 PPP incluidos (edad media de 77,9±9,8años, 53% varones) fue 69±31 (<90 en el 58,7% y <60 en el 31,4% de pacientes). La dimensión «alimentación» obtuvo los mayores VPN para tener un IB≥60 y ≥90 puntos (87% y 99,6%, respectivamente). Las dimensiones «deambular» y «subir y bajar escaleras» obtuvieron el mayor VPP para tener un IB≥60 y ≥90 (99,2/99,5% y 81/92%), respectivamente; la combinación de ambas preguntas aumentó el VPP al 95 y al 99,6%, respectivamente.
Los PPP de ámbito hospitalario presentan con elevada frecuencia deterioro funcional. La dimensión referente a alimentarse obtuvo el mayor VPN, por lo que se puede utilizar para el diagnóstico de dependencia severa, mientras que la combinación de deambular y subir y bajar escaleras obtuvo el mayor VPP, pudiendo utilizarse para plantear el cribado de fragilidad de los PPP.
Electrically-induced twitch responses of the prostatic segment of vas deferens (0.1 Hz, 65 V, 1 ms) are mainly due to the transient presynaptic release of ATP, which acts postsynaptically on ...non-adrenergic receptors to contract smooth muscle cells. These responses were fully blocked by nanomolar concentrations of the omega-conotoxins GVIA, MVIIA, and MVIIC, most likely by inhibiting Ca2+ entry through presynaptic N-type Ca2+ channels controlling the release of ATP. Repeated washout of the toxins allowed the recovery of contractions, except for omega-conotoxin GVIA, whose inhibitory effects remained unchanged for at least 60 min. In addition, micromolar concentrations of omega-conotoxin MVIIC were unable to protect against the irreversible inhibition of twitch contractions induced by nanomolar concentrations of omega-conotoxin GVIA. At low extracellular Ca2+ concentrations (1.5 mM), 20 nM of omega-conotoxin GVIA or MVIIA inhibited completely the twitch contractions in about 10 min. In 5 mM Ca2+ the blockade of twitch contractions after 10 min was 70% for both toxins. In 1.5 mM Ca2+ omega-conotoxin MVIIC (1 microM) inhibited completely the twitch contraction after 10 min. In 5 mM Ca2+ blockade developed very slowly and was very poor after 30 min, omega-conotoxin MVIIC depressed the response by only 20%. These results are compatible with the idea that the three omega-conotoxins block the purinergic neurotransmission of the vas deferens by acting on presynaptic N-type voltage-dependent Ca2+ channels. However, omega-conotoxin MVIIC seems to bind to sites different from those recognised by omega-conotoxin GVIA and MVIIA, which are markedly differentiated by their Ca2+ requirements for binding to their receptors.
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