Non-lysosomal Activation in Macrophages of Atlantic Salmon (Salmo salar) After Infection With Piscirickettsia salmonis

Piscirickettsia salmonis is a facultative intracellular pathogen and etiological agent of the systemic disease salmonid rickettsial septicemia. It has been suggested that P. salmonis is able to survive in host macrophages, localized within a vacuole like-compartment which prevents lysosomal degradation. However, the relevant aspects of the pathogenesis of P. salmonis as the host modulation that allow its intracellular survival have been poorly characterized. In this study, we evaluated the role of lysosomes in the response to P. salmonis infection in macrophage-enriched cell cultures established from Atlantic salmon head kidneys. Bacterial infection was confirmed using confocal microscopy. A gentamicin protection assay was performed to recover intracellular bacteria and the 16S rDNA copy number was quantified through quantitative polymerase chain reaction in order to determine the replication of P. salmonis within macrophages. Lysosomal activity in Atlantic salmon macrophage-enriched cell cultures infected with P. salmonis was evaluated by analyzing the lysosomal pH and proteolytic ability through confocal microscopy. The results showed that P. salmonis can survive ≥120 h in Atlantic salmon macrophage-enriched cell cultures, accompanied by an increase in the detection of the 16S rDNA copy number/cell. The latter finding suggests that P. salmonis also replicates in Atlantic salmon macrophage-enriched cell cultures. Moreover, this bacterial survival and replication appears to be favored by a perturbation of the lysosomal degradation system. We observed a modulation in the total number of lysosomes and lysosomal acidification following infection with P. salmonis. Collectively, the results of this study showed that infection of Atlantic salmon macrophages with P. salmonis induced limited lysosomal response which may be associated with host immune evasion mechanisms of P. salmonis that have not been previously reported

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Esclerosis tuberosa en el adulto: Hallazgos en tomografía computada multicorte, presentación de un caso clínico y revisión de literatura Tuberous sclerosis in adults: Multi slice computed tomography findings. Case report and literature review

La esclerosis tuberosa también conocida como complejo esclerosis tuberosa es una enfermedad autosómica dominante, multisistémica, neurocutánea caracterizada por un amplio espectro de lesiones hamartomatosas que afectan la piel, cerebro, riñones, corazón, etc. La mayoría de las veces es diagnosticada en la niñez. El diagnóstico en pacientes adultos se realiza generalmente por falla renal y alteraciones pulmonares o dermatológicas. Presentamos el caso de una paciente de 57 años con discapacidad mental y dolor en ambos flancos, lo que acompañamos de una revisión de la literatura respecto de las manifestaciones imagenológicas de esta rara enfermedad.Tuberous sclerosis, also known as tuberous sclerosis complex, is an autosomal dominant, multisystemic, neurocutaneous disease characterized by a wide range of hamartomatous lesions involving the skin, brain, kidneys, heart, etc. In most cases, it is diagnosed in childhood. Diagnosis in adult patients is usually made by renal failure and lung or dermatologic alterations. We report the case of a 57-year-old female patient with mental retardation and flank pain. A literature review on imaging manifestations of this rare disease is also provided

Episodes of hypotension and degree of HBP control in the elderly with antihypertensive drug treatment

Ponencia presentada en el Congreso Europeo de Hipertensión 2022 (ESH Conference 2022 Abstracts, 17-20 June)Objective: To determine the prevalence of episodes of hypotension in the elderly receiving antihypertensive treatment and its relationship with the number of drugs and associated symptoms, during 24-hour blood pressure monitoring. Design and method: Multicenter cross-sectional descriptive study in hypertensive patients aged 75 or over. It was designed for a sample of 117 people, calculated for 8% hypotensive episodes, with a 95% confidence interval, 5% precision, and 25% losses. Non-proportional stratified random sampling was performed, excluding patients with modified antihypertensive treatment in the last month and/or arrhythmias. Through 24-hour ambulatory blood pressure monitoring, the incidence of hypotensive episodes was observed. Associated comorbidities, antihypertensive treatment, and sleep quality during ABPM were recorded from the interview and clinical history. Percentages, means, confidence intervals were obtained and the chi square test was performed in the bivariate analysis. Results: Of 117 monitored patients, 100 completed the study, with a mean age of 79.2 years (SD 3.9 years) and 59% women. 91.5% of women and 58.6% of men were overweight or obese. Some type of heart disease was associated with 31% of patients, and 33% had DM2, 38% anxiety-depressive disorder, and vertigo, 16%. 50.8% of the women and 61% of the men did not have good control of the mean TAS figures in the 24-h ABPM. However, DBP was controlled in 84.7% and 80.5% of women and men, respectively. 34% of the patients presented a dipper pattern. 76% of the patients presented at least one episode of hypotension, which was accompanied by symptoms in 11.8% of the cases, with headache and dizziness being the most frequent. No significant association has been observed between the number of antihypertensive drugs and the occurrence of hypotensive episodes. Conclusions: Most of the patients presented at least 1 episode of hypotension, rarely being symptomatic and not related to the number of antihypertensives. the low frequency of the dipper pattern, the high prevalence of obesity, and the poor control of systolic blood pressure require greater control of cardiovascular risk in the study population

Estudios multidisciplinarios en Ciencias de la Salud

Es una distinción, como miembro de la Comisión del Programa del Doctorado en Ciencias de la Salud de la Universidad Autónoma del Estado de México, presentar el libro titulado Estudios multidisciplinarios en Ciencias de la Salud, en el que distinguidos y reconocidos investigadores, entusiastas y comprometidos alumnos del programa nos dan a conocer los resultados de sus proyectos de investigación, trabajos que forman parte de los requisitos para acceder al grado de doctor. Entre las razones que invitan a la lectura del libro destaca su contenido conformado con la participación de autores en cuatro áreas en el campo de la salud: Odontología, Ciencias Médicas y Nutrición, Ciencias de la Conducta, y Enfermería y Obstetricia, quienes contribuyen a incrementar el acervo del conocimiento en cada área, en favor de la ciencia, la tecnología, y la salud física y mental de la población.Universidad Autónoma del Estado de México