Ecografía prostática transrectal en cáncer de próstata: correlación con tacto rectal y antígeno prostático específico como optimizadores en la selección de pacientes para biopsia prostática

El Cáncer de Prostata ha adquirido una gran importancia en los últimos años, debido al incremeneto de la tasa de mortalidad. El diagnóstico precoz del cáncer prostático asienta sobre el Tacto Rectal (TR), el Antígeno Prostático Específico e suero (APE) y el examen con Ecografía Transrectal (ETR), seguido de la Biopsia Transrectal (BTR). Es conocido el problema de decidir a qué pacientes indicar biopsia en base a parámetros específicos, teniendo en cuenta la morbilidad del procedimiento y sabiendo que sólo un 40 de las biopsias transrectales arrojan resultados positivos. La ecografía transrectal ha aportado elementos para identificar pacientes candidatos a efectuar una biopsia, con más probabilidad de encontrar cáncer: lesión hipoecogénica, alteración del borde glandular, modificación del plano graso perioprostático, y/o un cambio en la vascularización del parenquima.Fil: Marangoni, Alberto Antonio. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

Ecografía prostática transrectal en cáncer de próstata: correlación con tacto rectal y antígeno prostático específico como optimizadores en la selección de pacientes para biopsia prostática

El Cáncer de Prostata ha adquirido una gran importancia en los últimos años, debido al incremeneto de la tasa de mortalidad. El diagnóstico precoz del cáncer prostático asienta sobre el Tacto Rectal (TR), el Antígeno Prostático Específico e suero (APE) y el examen con Ecografía Transrectal (ETR), seguido de la Biopsia Transrectal (BTR). Es conocido el problema de decidir a qué pacientes indicar biopsia en base a parámetros específicos, teniendo en cuenta la morbilidad del procedimiento y sabiendo que sólo un 40 de las biopsias transrectales arrojan resultados positivos. La ecografía transrectal ha aportado elementos para identificar pacientes candidatos a efectuar una biopsia, con más probabilidad de encontrar cáncer: lesión hipoecogénica, alteración del borde glandular, modificación del plano graso perioprostático, y/o un cambio en la vascularización del parenquima.Fil: Marangoni, Alberto Antonio. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

PhTX-II a basic myotoxic phospholipase A2 from Porthidium Hyoprora snake venom, pharmacological characterization and amino acid sequence by mass spectrometry

FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOA monomeric basic PLA2 (PhTX-II) of 14149.08 Da molecular weight was purified to homogeneity from Porthidium hyoprora venom. Amino acid sequence by in tandem mass spectrometry revealed that PhTX-II belongs to Asp49 PLA2 enzyme class and displays conserved domains as the catalytic network, Ca2+-binding loop and the hydrophobic channel of access to the catalytic site, reflected in the high catalytic activity displayed by the enzyme. Moreover, PhTX-II PLA2 showed an allosteric behavior and its enzymatic activity was dependent on Ca2+. Examination of PhTX-II PLA2 by CD spectroscopy indicated a high content of alpha-helical structures, similar to the known structure of secreted phospholipase IIA group suggesting a similar folding. PhTX-II PLA2 causes neuromuscular blockade in avian neuromuscular preparations with a significant direct action on skeletal muscle function, as well as, induced local edema and myotoxicity, in mice. The treatment of PhTX-II by BPB resulted in complete loss of their catalytic activity that was accompanied by loss of their edematogenic effect. On the other hand, enzymatic activity of PhTX-II contributes to this neuromuscular blockade and local myotoxicity is dependent not only on enzymatic activity. These results show that PhTX-II is a myotoxic Asp49 PLA2 that contributes with toxic actions caused by P. hyoprora venom.A monomeric basic PLA2 (PhTX-II) of 14149.08 da molecular weight was purified to homogeneity from Porthidium hyoprora venom. Amino acid sequence by in tandem mass spectrometry revealed that PhTX-II belongs to Asp49 PLA2 enzyme class and displays conserved domains as the catalytic network, Ca2+-binding loop and the hydrophobic channel of access to the catalytic site, reflected in the high catalytic activity displayed by the enzyme. Moreover, PhTX-II PLA2 showed an allosteric behavior and its enzymatic activity was dependent on Ca2+. Examination of PhTX-II PLA2 by CD spectroscopy indicated a high content of alpha-helical structures, similar to the known structure of secreted phospholipase IIA group suggesting a similar folding. PhTX-II PLA2 causes neuromuscular blockade in avian neuromuscular preparations with a significant direct action on skeletal muscle function, as well as, induced local edema and myotoxicity, in mice. The treatment of PhTX-II by BPB resulted in complete loss of their catalytic activity that was accompanied by loss of their edematogenic effect. On the other hand, enzymatic activity of PhTX-II contributes to this neuromuscular blockade and local myotoxicity is dependent not only on enzymatic activity. These results show that PhTX-II is a myotoxic Asp49 PLA2 that contributes with toxic actions caused by P. hyoprora venom630773097FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO2009/51207-

Expiratory flow limitation in intensive care: prevalence and risk factors

Expiratory flow limitation (EFL) is characterised by a markedly reduced expiratory flow insensitive to the expiratory driving pressure. The presence of EFL can influence the respiratory and cardiovascular function and damage the small airways; its occurrence has been demonstrated in different diseases, such as COPD, asthma, obesity, cardiac failure, ARDS, and cystic fibrosis. Our aim was to evaluate the prevalence of EFL in patients requiring mechanical ventilation for acute respiratory failure and to determine the main clinical characteristics, the risk factors and clinical outcome associated with the presence of EFL

Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management

Systemic lupus erythematosus (SLE) is characterized by multisystemic clinical manifestations ranging from a relatively mild involvement to potentially life-threatening complications. Due to this complexity, a multidisciplinary (MD) approach is the best strategy for optimizing patients' care. The main aim of this systematic literature review (SLR) was to scrutinize the published data regarding the MD approach for the management of SLE patients. The secondary objective was to evaluate the outcomes of the MD approach in SLE patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. We performed an SLR to retrieve articles available in English or Italian listed in PubMed, Embase, Cinahl, and Cochrane Library concerning the MD approach used in observational studies and clinical trials. Four independent reviewers performed the study selection and data collection. Of 5451 abstracts evaluated, 19 studies were included in the SLR. The MD approach was most frequently described in the context of SLE pregnancy, reported in 10 papers. MD teams were composed of a rheumatologist, except for one cohort study; a gynecologist; a psychologist; a nurse; and other health professionals. MD approaches had a positive impact on pregnancy-related complications and disease flares and improved SLE psychological impact. Although international recommendations advise an MD approach for managing SLE, our review highlighted the paucity of data supporting this strategy, with most of the available evidence on the management of SLE during pregnancy

Bp-13 Pla2: Purification And Neuromuscular Activity Of A New Asp49 Toxin Isolated From Bothrops Pauloensis Snake Venom.

A new PLA2 (Bp-13) was purified from Bothrops pauloensis snake venom after a single chromatographic step of RP-HPLC on μ-Bondapak C-18. Amino acid analysis showed a high content of hydrophobic and basic amino acids and 14 half-cysteine residues. The N-terminal sequence showed a high degree of homology with basic Asp49 PLA2 myotoxins from other Bothrops venoms. Bp-13 showed allosteric enzymatic behavior and maximal activity at pH 8.1, 36°-45°C. Full Bp-13 PLA2 activity required Ca(2+); its PLA2 activity was inhibited by Mg(2+), Mn(2+), Sr(2+), and Cd(2+) in the presence and absence of 1 mM Ca(2+). In the mouse phrenic nerve-diaphragm (PND) preparation, the time for 50% paralysis was concentration-dependent (P 0.05). The main effect of this new Asp49 PLA2 of Bothrops pauloensis venom is on muscle fiber sarcolemma, with avian preparation being less responsive than rodent preparation. The study enhances biochemical and pharmacological characterization of B. pauloensis venom.201582605

Prevalencia de anticuerpos antifosfolípidos en pacientes con conectivopatías

Objectives: To determine the prevalence of antiphospholipid antibodies in patients with connective tissue diseases. Design: Descriptive transversal study. Setting: Dos de Mayo Hospital and Institute of Clinical Research, San Marcos University, Lima, Peru. Participants: Patients with diagnosis of collagen disease and healthy subjects. Interventions: In 100 patients with collagen disease and 50 healthy subjects, all from Metropolitan Lima and attended between January and November 2008, fibrinogen, prothrombin time, partial activated thromboplastin time, anticardiolipin antibody and lupus anticoagulant were determined. Main outcome measures: Presence of anticardiolipin antibodies and lupus anticoagulant. Results: Patients with collagen diseases presented antiphospholipid antibodies in 17%, lupus anticoagulant in 13%, and IgG anticardiolipin in 4%. Individualizing connective tissue diseases, in 70 patients with systemic erythematous lupus 10 were positive for lupus anticoagulant and 3 had IgG anticardiolipin; of 30 patients with rheumatoid arthritis three were positive to lupus anticoagulant and one presented IgG anticardiolipin. In the group of 50 healthy individuals, only one was positive for lupus anticoagulant. Conclusions: The prevalence of antiphospholipid antibodies in patients with connective tissue was 17%. The most frequent connective tissue disease studied was lupus erythematosus and the most frequent antiphospholipid antibody found was lupus anticoagulant.Objetivos: Determinar la prevalencia de anticuerpos antifosfolípidos en pacientes con conectivopatías. Diseño: Estudio descriptivo transversal. Institución: Hospital Dos de Mayo e Instituto de Investigaciones Clínicas de la UNMSM, Lima, Perú. Participantes: Pacientes con diagnóstico de colagenopatía y sujetos sanos. Intervenciones: En 100 pacientes con diagnóstico de colagenopatía y 50 sujetos sanos, todos provenientes de Lima Metropolitana y atendidos entre enero y noviembre de 2008, se determinó fibrinógeno, tiempo de protrombina, tiempo parcial de tromboplastina activada, anticuerpos anticardiolipina y anticoagulante lúpico. Principales medidas de resultados: Presencia de anticuerpos anticardiolipina y anticoagulante lúpico. Resultados: Los pacientes con conectivopatías presentaron anticuerpos antifosfolípidos en 17%, anticoagulante lúpico en 13% y anticardiolipina IgG 4%. Al dividir el grupo por conectivopatías, en los 70 pacientes con lupus eritematoso sistémico 10 resultaron positivos para anticoagulante lúpico y 3 tuvieron anticardiolipina IgG; de los 30 pacientes con artritis reumatoide, 3 tuvieron anticoagulante lúpico positivo y 1 presentó anticardiolipina IgG. En el grupo de 50 personas sanas, solo se encontró un caso positivo para anticoagulante lúpico. Conclusiones: La prevalencia de anticuerpos antifosfolípidos en pacientes con conectivopatías fue 17%. La conectivopatía estudiada más frecuente fue el lupus eritematoso sistémico. El anticuerpo antifosfolípido más frecuente fue el anticoagulante lúpico

LDL-cholesterol control in the primary prevention of cardiovascular diseases. An expert opinion for clinicians and health professionals

Aims: Although adequate clinical management of patients with hypercholesterolemia without a history of known cardiovascular disease is essential for prevention, these subjects are often disregarded. Furthermore, the scientific literature on primary cardiovascular prevention is not as rich as that on secondary prevention; finally, physicians often lack adequate tools for the effective management of subjects in primary prevention and have to face some unsolved relevant issues. This document aims to discuss and review the evidence available on this topic and provide practical guidance. Data synthesis: Available algorithms and risk charts represent the main tool for the assessment of cardiovascular risk in patients in primary prevention. The accuracy of such an estimate can be substantially improved considering the potential contribution of some additional risk factors (C-reactive protein, lipoprotein(a), family history of cardiovascular disease) and conditions (environmental pollution, sleep quality, socioeconomic status, educational level) whose impact on the cardiovascular risk has been better understood in recent years. The availability of non-invasive procedures to evaluate subclinical atherosclerosis may help to identify subjects needing an earlier intervention. Unveiling the presence of these conditions will improve cardiovascular risk estimation, granting a more appropriate intervention. Conclusions: The accurate assessment of cardiovascular risk in subjects in primary prevention with the use of algorithms and risk charts together with the evaluation of additional factors will allow physicians to approach each patient with personalized strategies, which should translate into an increased adherence to therapy and, as a consequence, a reduced cardiovascular risk

Italian natural history museums on the verge of collapse?

The Italian natural history museums are facing a critical situation, due to the progressive loss of scientific relevance, decreasing economic investments, and scarcity of personnel. This is extremely alarming, especially for ensuring the long-term preservation of the precious collections they host. Moreover, a commitment in fieldwork to increase scientific collections and concurrent taxonomic research are rarely considered priorities, while most of the activities are addressed to public events with political payoffs, such as exhibits, didactic meetings, expositions, and talks. This is possibly due to the absence of a national museum that would have better steered research activities and overall concepts for collection management. We here propose that Italian natural history museums collaborate to instate a “metamuseum”, by establishing a reciprocal interaction network aimed at sharing budgetary and technical resources, which would assure better coordination of common long-term goals and scientific activities