Endocarditis infecciosa sobre válbula protésica: relación entre sus características, el intervalo de tiempo entre la cirugía y el diagnóstico y el microorganismo causal

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Medicina. Fecha de lectura: 22-Mayo-200

Leishmaniasis: A new method for confirming cure and detecting asymptomatic infection in patients receiving immunosuppressive treatment for autoimmune disease.

Visceral leishmaniasis (VL) in patients receiving immunosuppressant drugs for autoimmune disease has been on the rise. It is important—but difficult—to know when cure has been achieved in these patients since the withdrawal of immunosuppressants during antileishmania treatment is commonly required, and there is a risk of relapse when immunosuppression is restored. The prevalence of asymptomatic infection among those immunosuppressed for autoimmune disease is also uncertain. The present work describes how cytokine release assays can be used to confirm the cure of VL, and to determine the prevalence of asymptomatic infection, in such patients. After collection of blood from volunteers (n = 108), SLA-stimulation of peripheral blood mononuclear cell cultures and of whole blood was found to induce the production of different combinations of cytokines that served to confirm recovery from VL, and asymptomatic Leishmania infection. Indeed, cure was confirmed in 14 patients, all of whom showed a specific Th1 immune response against Leishmania, and the prevalence of asymptomatic infection was determined as 21.27%. Cytokine profiles could be used to manage VL in patients with autoimmune disease, and to identify and better protect those with asymptomatic infection who are at risk of developing this disease.post-print1034 K

Epidemiological Changes in Leishmaniasis in Spain According to Hospitalization-Based Records, 1997-2011: Raising Awareness towards Leishmaniasis in Non-HIV Patients

In Spain, Leishmania infantum is endemic, human visceral and cutaneous leishmaniasis cases occurring both in the Peninsula, as well as in the Balearic Islands. We aimed to describe the clinical characteristics of leishmaniasis patients and the changes in the disease evolution after the introduction of antiretroviral therapy in 1997. In this descriptive study, we used Spanish Centralized Hospital Discharge Database for the hospitalized leishmaniasis cases between 1997 and 2011. We included in the analysis only the records having leishmaniasis as the first registered diagnosis and calculated the hospitalization rates. Disease trend was described taking into account the HIV status. Adjusted odds-ratio was used to estimate the association between clinical and socio-demographic factors and HIV co-infection. Of the total 8010 Leishmaniasis hospitalizations records, 3442 had leishmaniasis as first diagnosis; 2545/3442 (75.6%) were males and 2240/3442 (65.1%) aged between 14-65 years. Regarding disease forms, 2844/3442 (82.6%) of hospitalizations were due to visceral leishmaniasis (VL), while 118/3442 (3.4%) hospitalizations were cutaneous leishmaniasis (CL). Overall, 1737/2844 of VL (61.1%) were HIV negatives. An overall increasing trend was observed for the records with leishmaniasis as first diagnosis (p=0.113). Non-HIV leishmaniasis increased during this time period (p=0.021) while leishmaniasis-HIV co-infection hospitalization revealed a slight descending trend (p=0.717). Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04). The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07). Our findings suggest a significant increase of hospitalization in the absence of HIV co-infection, with a predomination of VL. We consider that clinicians in Spain should be aware of leishmaniasis not only in the HIV population but also in non HIV patients, especially for those having immunosuppression as an associate condition

H2CN/H2NC abundance ratio: a new potential temperature tracer for the interstellar medium

The ${\rm H_2NC}$ radical is the high-energy metastable isomer of ${\rm H_2CN}$ radical, which has been recently detected for the first time in the interstellar medium towards a handful of cold galactic sources, besides a warm galaxy in front of the PKS 1830-211 quasar. These detections have shown that the ${\rm H_2CN}$/${\rm H_2NC}$ isomeric ratio, likewise the HCN/HNC ratio, might increase with the kinetic temperature ($T_{\rm kin}$), but the shortage of them in warm sources still prevents us to confirm this hypothesis and shed light about their chemistry. In this work, we present the first detection of ${\rm H_2CN}$ and ${\rm H_2NC}$ towards a warm galactic source, the G+0.693-0.027 molecular cloud (with $T_{\rm kin} > 70 \, {\rm K}$), using IRAM 30m observations. We have detected multiple hyperfine components of the $N_{K_\text{a}K_\text{c}} = 1_{01} - 0_{00}$ and $2_{02} - 1_{01}$ transitions. We derived molecular abundances with respect to ${\rm H_2}$ of (6.8$\pm$1.3)$\times 10^{-11}$ for ${\rm H_2CN}$ and of (3.1$\pm$0.7)$\times 10^{-11}$ for ${\rm H_2NC}$, and a ${\rm H_2CN}$/${\rm H_2NC}$ abundance ratio of 2.2$\pm$0.5. These detections confirm that the ${\rm H_2CN}$/${\rm H_2NC}$ ratio is $\gtrsim$2 for sources with $T_{\rm kin} > 70 \, {\rm K}$, larger than the $\sim$1 ratios previously found in colder cores ($T_{\rm kin}\sim10 \, {\rm K}$). This isomeric ratio dependence with temperature cannot be fully explained with the currently proposed gas-phase formation and destruction pathways. Grain surface reactions, including the ${\rm H_2NC} \rightarrow {\rm H_2CN}$ isomerization, deserve consideration to explain the higher isomeric ratios and ${\rm H_2CN}$ abundances observed in warm sources, where the molecules can be desorbed into the gas phase through thermal and/or shock-induced mechanisms.Comment: 12 pages, 5 figures, 3 tables, 2 appendix - Accepted for publication in Monthly Notices of the Royal Astronomical Societ

Utilizando la metodología fitosociológica para diferenciar hábitats: un ejemplo con especies chilenas de Schinus (Anacardiaceae) en la Región de Aisén, Chile

Habitats of Schinus patagonicus and Schinus marchandii in the Chilean Patagonia were studied, in order to determinethe plant communities into these species growing and the primary or secondary character of them, to help establishthe conservation status of the two species. We worked with phytosociological methods to characterize floristic andvegetationaly the communities. The vegetation table is ordered with traditional methods, using differential species andwith multivariate statistical classification and ordination methods. The initial vegetation table provided 68 plant speciesof which 26 are introduced weed. In the biological spectrum dominated hemicryptophytes and minor phanerophytes andtherophytes. Traditional management of the vegetation table separated the Mutisio-Schinetum patagonicae (“clavel delaire” and “molle” scrub) and Colliguajo-Schinetum marchandii (“duraznillo” and “laura” steppe scrub) new associations that are described. Comparison of these two communities established that they are floristically very different and thattheir phytosociological affinity is low, the first is a secondary scrub community that replaces the deciduous patagonic“lenga” forest and the “ñire” scrub degraded by human action and the second, a primary steppe community. The abundantpresence of Mulinum spinosum differentiates degraded stages of these two communities specially the first. The secondarycharacter of the “clavel del aire” and “molle” community confirms the more aggressive and competitive position of Schinuspatagonicus, which ensures their survival as a species, but the primary character and the small size of the scrub of “laura”and “duraznillo” scrub also areal reduction of Schinus marchandii indicate that the conservation status of the latter speciesin Chile is poor.Se estudiaron los hábitats de Schinus patagonicus y Schinus marchandii en la Patagonia chilena, con el propósito dedeterminar las comunidades vegetales en que crecen y el carácter primario o secundario de ellas, para ayudar a establecerel estado de conservación de las dos especies. Se trabajó con metodología fitosociológica para caracterizar florística yvegetacionalmente las comunidades. La tabla de vegetación se ordenó con métodos tradicionales, utilizando especiesdiferenciales y estadísticos multivariables de clasificación y ordenación. La tabla fitosociológica inicial presentó 68 especiesvegetales siendo 26 de ellas malezas introducidas. En el espectro biológico predominaron hemicriptófitos y con menorimportancia, fanerófitos y terófitos. La ordenación tradicional separó las asociaciones Mutisio-Schinetum patagonicae(matorral de clavel del aire y molle) y Colliguajo-Schinetum marchandii (matorral estepario de duraznillo y laura) quese describen como nuevas. La comparación de estas dos comunidades permitió establecer que son florísticamente muydiferentes y que su afinidad fitosociológica es baja: la primera es una comunidad de matorral secundario que reemplazaal bosque de lenga y al matorral de ñire caducifolios degradados por la acción humana y la segunda, una comunidadesteparia primaria. La abundante presencia de Mulinum spinosum permite diferenciar estadios degradados para la primeray esteparios extremos para la segunda. El carácter secundario de la comunidad de clavel del aire y molle confirma la mayoragresividad y capacidad de competencia de Schinus patagonicus, lo que asegura su sobrevivencia como especie, pero elcarácter primario y el pequeño tamaño del área del matorral de duraznillo y laura, además de la reducción de tamaño deSchinus marchandii, indican que el estado de conservación de esta última especie en Chile es precario

Motor and Cognitive Performance in Patients with Liver Cirrhosis with Minimal Hepatic Encephalopathy

Minimal hepatic encephalopathy (MHE) is associated with mild cognitive impairment and frailty. This study aims to identify cognitive and motor differences in cirrhotic patients with and without MHE, and the correlations between motor signs and cognitive performance. Gait, balance, hand strength and motor speed performance were evaluated in 66 cirrhotic patients (38 without and 28 with MHE, according to the Psychometric Hepatic Encephalopathy Score (PHES). Cognitive performance was measured with the Mini-Mental State Examination, Verbal Fluency Test, Aprendizaje Verbal España-Complutense Test (TAVEC), Wechsler Adult Intelligence Scale III, Hamilton Depression and Anxiety Rating Scale and Functioning Assessment Short Test (FAST). MHE patients performed worse than patients without MHE in cognitive and autonomous functioning, learning and long-term memory, and verbal fluency. The same pattern was found in gait, center of pressure movement, variability of hand strength performance and hand motor speed. In MHE patients, high correlations were found between balance and FAST test, gait velocity and verbal skills, hand strength variability and anxiety and depression, and motor speed and FAST and TAVEC. MHE patients showed worse motor and cognitive performance than patients without MHE. MHE patients could have impaired movement control expressed as bradykinesia, and this reduced motor performance could correlate with cognitive performance

Multiagent systems

Our future is that of a mixed society of people and AI artifacts. A multitude of devices in our homes will need not only to make intelligent decisions, but they will also need to coordinate with each other to serve us well. Cars will have to coordinate to allow safe road crossings, avoiding accidents. Also, the industry is already beginning to integrate teams of humans and robots collaborating to solve complex problems...Peer reviewe

Genetic diversity of HLA system in four populations from Baja California, Mexico: Mexicali, La Paz, Tijuana and rural Baja California

We studied HLA class I (HLA-A, -B) and class II (HLA-DRB1, -DQB1) alleles by PCR-SSP based typing in 250 Mexicans from the states of Baja California Norte and Baja California Sur living in Mexicali (N = 100), La Paz (N = 75), Tijuana (N = 25) and rural communities (N = 50) to obtain information regarding allelic and haplotypic frequencies. The most frequent haplotypes for the Baja California region include nine Native American and five European haplotypes. Admixture estimates revealed that the main genetic components are European (50.45 ± 1.84% by ML; 42.03% of European haplotypes) and Native American (43.72 ± 2.36% by ML; 40.24% of Native American haplotypes), while the African genetic component was less apparent (5.83 ± 0.98% by ML; 9.36% of African haplotypes)

Dietary Iron, Anemia Markers, Cognition, and Quality of Life in Older Community-Dwelling Subjects at High Cardiovascular Risk

Anemia causes hypo-oxygenation in the brain, which could lead to cognitive disorders. We examined dietary iron intake as well as anemia markers (i.e., hemoglobin, hematocrit, mean corpuscular volume) and diabetes coexistence in relation to neuropsychological function and quality of life. In this study, 6117 community-dwelling adults aged 55-75 years (men) and 60-75 years (women) with overweight/obesity and metabolic syndrome were involved. We performed the Mini-Mental State Examination (MMSE), the Trail Making Test parts A and B (TMT-A/B), Semantic Verbal Fluency of animals (VFT-a), Phonological Verbal Fluency of letter P (VFT-p), Digit Span Test (DST), the Clock Drawing Test (CDT), and the Short Form-36 Health Survey (SF36-HRQL test). Dietary iron intake did not influence neuropsychological function or quality of life. However, anemia and lower levels of anemia markers were associated with worse scores in all neurophysiological and SF36-HRQL tests overall, but were especially clear in the MMSE, TMT-B (cognitive flexibility), and the physical component of the SF36-HRQL test. The relationships between anemia and diminished performance in the TMT-A/B and VFT tasks were notably pronounced and statistically significant solely among participants with diabetes. In brief, anemia and reduced levels of anemia markers were linked to inferior cognitive function, worse scores in different domains of executive function, as well as a poorer physical, but not mental, component of quality of life. It was also suggested that the coexistence of diabetes in anemic patients may exacerbate this negative impact on cognition. Nevertheless, dietary iron intake showed no correlation with any of the outcomes. To make conclusive recommendations for clinical practice, our findings need to be thoroughly tested through methodologically rigorous studies that minimize the risk of reverse causality