Mortalidad entre los pacientes en tratamiento con metadona e infectados con el virus de la inmunodeficiencia humana y/o hepatitis C [Mortality rate in patients on methadone treatment and infected with the human immunodeficiency virus and/or the hepatitis C virus ]

Sr. Director: La adicción a la heroína es una enfermedad recidivante crónica con graves consecuencias, particularmente en términos de prematura y alta mortalidad (Hser, Hoffman, Grella y Anglin, 2001). Los programas de tratamiento de mantenimiento con metadona (TMM) han demostrado ser eficaces para reducir el uso ilícito de opioides, y el riesgo de infección por el virus de la inmunodeficiencia humana (VIH) y/o virus de la hepatitis C (VHC), entre otras variables (Kleber, 2008; Pedrero-Pérez y MethaQoL, 2017). A pesar de todo, la tasa de mortalidad anual entre los pacientes incluidos en programas de TMM, aproximadamente del 1%, es más de 10 veces superior al de la población general (Zanis y Woody, 1998); constituyendo la sobredosis y la infección por VIH y otros virus transmitidos por la sangre (p.e. VHC) las causas más comunes de muerte (Roncero, Vega, Martinez-Raga y Torrens, 2017). En efecto, entre los drogodependientes por vía parenteral e infectados por VIH, la co-infección por VIH y VHC se observa en el 50% -95% de los casos (Muga, Roca, Egea, Tor, Sirera y Rey-Joly, 2000); pudiendo provocar, dicha infección simultanea por VIH, una mayor carga viral del VHC y una evolución más rápida a la cirrosis hepática y sus complicaciones (Santos y Sanz, 22004; Elizalde, Iñarrairaegui, Rodríguez y Zozaya, 2004)... Dear Director, Heroin addiction is a chronic, relapsing disease with serious consequences, particularly in terms of premature and high mortality (Hser, Hoffman, Grella & Anglin, 2001). Methadone maintenance treatment programs (MMT’s) have shown to be effective in reducing illicit opioid use and the risk of infection with human immunodeficiency virus (HIV) and/or Hepatitis C virus (HCV), among other (Kleber, 2008; Pedrero-Pérez & MethaQoL, 2017). Nevertheless, the approximately 1% annual mortality among MMT patients is more than 10 times that of the general population (Zanis &y Woody, 1998); and overdose, HIV infection (VIH), and other viruses transmitted by blood (e.g., HCV infection) constitute the most common causes of death (Roncero, Vega, Martinez-Raga & Torrens, 2017). In fact, among HIV-infected patients, HIV–HCV co-infection is observed in 50–95% of cases (Muga, Roca, Egea, Tor, Sirera & Rey-Joly, 2000); this simultaneous HIV infection can cause an increased viral load of HCV and a more rapid evolution to liver cirrhosis and its complications (Santos & Sanz, 2004; Elizalde, Iñarrairaegui, Rodríguez & Zozaya, 2004)..

Preliminary Experience With the Use of Electromagnetic Navigation for the Diagnosis of Peripheral Pulmonary Nodules and Enlarged Mediastinal Lymph Nodes

Electromagnetic navigation is a new technique that can be used with bronchoscopy to obtain samples of small peripheral nodular lesions and enlarged mediastinal lymph nodes. It is very versatile in that it enables both transbronchial biopsies and fine-needle aspiration to be performed. We describe 2 cases in which navigation with the superDimension/ Bronchus system combined with traditional diagnostic techniques facilitated a definitive diagnosis by bronchoscopy. Electromagnetic navigation can obviate the need for more invasive diagnostic procedures such as surgery, thus saving time and money and avoiding complications

Genomic prediction and quantitative trait locus discovery in a cassava training population constructed from multiple breeding stages

Open Access Article; Published online: 11 Dec 2019Assembly of a training population (TP) is an important component of effective genomic selection‐based breeding programs. In this study, we examined the power of diverse germplasm assembled from two cassava (Manihot esculenta Crantz) breeding programs in Tanzania at different breeding stages to predict traits and discover quantitative trait loci (QTL). This is the first genomic selection and genome‐wide association study (GWAS) on Tanzanian cassava data. We detected QTL associated with cassava mosaic disease (CMD) resistance on chromosomes 12 and 16; QTL conferring resistance to cassava brown streak disease (CBSD) on chromosomes 9 and 11; and QTL on chromosomes 2, 3, 8, and 10 associated with resistance to CBSD for root necrosis. We detected a QTL on chromosome 4 and two QTL on chromosome 12 conferring dual resistance to CMD and CBSD. The use of clones in the same stage to construct TPs provided higher trait prediction accuracy than TPs with a mixture of clones from multiple breeding stages. Moreover, clones in the early breeding stage provided more reliable trait prediction accuracy and are better candidates for constructing a TP. Although larger TP sizes have been associated with improved accuracy, in this study, adding clones from Kibaha to those from Ukiriguru and vice versa did not improve the prediction accuracy of either population. Including the Ugandan TP in either population did not improve trait prediction accuracy. This study applied genomic prediction to understand the implications of constructing TP from clones at different breeding stages pooled from different locations on trait accuracy

Photoplethysmographic Waveform in Hyperbaric Environment

The objective of this work is the identification of significant variations of morphological parameters of the photoplethysmographic (PPG) signal when the subjects are exposed to an increase in atmospheric pressure. To achieve this goal, the PPG signal of 26 subjects, exposed to a hyperbaric environment whose pressure increases up to 5 atm, has been recorded. From this record, segments of 4 minutes have been processed at 1 atm, 3 atm and 5 atm, both in the descending (D) and ascending (A) periods of the immersion. In total, four states (3D, 5, 3A and 1A) normalized to the basal state (1D) have been considered. In these segments, six morphological parameters of the PPG signal were studied. The width, the amplitude, the widths of the anacrotic and catacrotic phases, and the upward and downward slopes of each PPG pulse were extracted. The results showed significant increases in the three parameters related to the pulse width. This increase is significant in the four states analysed for the anacrotic phase width. Furthermore, a significant decrease in the amplitude and in both slopes (in the states 1A) was observed. These results show that the PPG width responds rapidly to the increase in pressure, indicating an activation of the sympathetic system, while amplitude and pulse slopes are decreased when the subjects are exposed to the hyperbaric environment for a considerable period of time

Decrease of apoptosis rate in patients with renal transplantation treated with mycophenolate mofetil

We conclude that treatment with MMF of kidney transplant patients does not affect the proliferative rate of cells of the allograft, but decreases the number of apoptotic cells in tubular epithelium

Ewing Family Tumors: Potential Prognostic Value of Reverse-Transcriptase Polymerase Chain Reaction Detection of Minimal Residual Disease in Peripheral Blood Samples

In more than 95% of patients, the Ewing family of tumors (ET) has chimeric transcripts caused by fusion of the EWS gene to either FLI1 or ERG. The presence of specific EWS-FLI1 or EWS-ERG transcripts in peripheral blood (PB) samples of patients being treated for ET was prospectively evaluated, and these data were correlated to their clinical status. The authors studied 113 PB samples from 28 patients with ET. Treatment included chemotherapy, radiotherapy, and surgical excision of tumor after induction therapy. PB samples were taken prospectively at least 2 weeks after resection of tumor. Nested reverse-transcriptase polymerase chain reaction (RT-PCR) followed by Southern blot was performed in all samples. Resected tumors were reviewed for the degree of response to chemotherapy and volume. Seventy-seven PB samples from 28 patients had EWS-FLI1/ERG transcripts. In 11 patients, PB samples became negative with treatment, and, in 5 of them, the samples remained negative throughout the study. Samples taken during progression were always positive and, in 4 patients, became positive before progression was clinically evident. All patients with transcripts other than EWS-FLI1 type 1 (n = 3) died from tumor progression. This is a sensitive assay to monitor circulating tumor cells in Ewing tumors. The preliminary data suggest that progression is preceded by positive samples and may be related to specific transcript types

Genome-wide association and prediction reveals genetic architecture of cassava mosaic disease resistance and prospects for rapid genetic improvement

Published: 13 May 2016Cassava (Manihot esculenta Crantz) is a crucial, under-researched crop feeding millions worldwide, especially in Africa. Cassava mosaic disease (CMD) has plagued production in Africa for over a century. Biparental mapping studies suggest primarily a single major gene mediates resistance. To investigate this genetic architecture, we conducted the first genome-wide association mapping study in cassava with up to 6128 genotyping-by-sequenced African breeding lines and 42,113 reference genome-mapped single-nucleotide polymorphism (SNP) markers. We found a single region on chromosome 8 that accounts for 30 to 66% of genetic resistance in the African cassava germplasm. Thirteen additional regions with small effects were also identified. Further dissection of the major quantitative trait locus (QTL) on chromosome 8 revealed the presence of two possibly epistatic loci and/or multiple resistance alleles, which may account for the difference between moderate and strong disease resistances in the germplasm. Search of potential candidate genes in the major QTL region identified two peroxidases and one thioredoxin. Finally, we found genomic prediction accuracy of 0.53 to 0.58 suggesting that genomic selection (GS) will be effective both for improving resistance in breeding populations and identifying highly resistant clones as varieties

Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a Bronchus sign on CT imaging: results from a prospective study

Electromagnetic navigation bronchoscopy (ENB) has been developed as a novel ancillary tool for the bronchoscopic diagnosis of pulmonary nodules. Despite successful navigation in 90% of patients, ENB diagnostic yield does not generally exceed 70%. We sought to determine whether the presence of a bronchus sign on CT imaging conditions diagnostic yield of ENB and might account for the discrepancy between successful navigation and diagnostic yield. METHODS: We conducted a prospective, single-center study of ENB in 51 consecutive patients with pulmonary nodules. ENB was chosen as the least invasive diagnostic technique in patients with a high surgical risk, suspected metastatic disease, or advanced-stage disease, or in those who demanded a preoperative diagnosis prior to undergoing curative resection. We studied patient and technical variables that might condition diagnostic yield, including size, cause, location, distance to the pleural surface, and fluorodeoxyglucose uptake of a given nodule; the presence of a bronchus sign on CT imaging; registration point divergence; and the minimum distance from the tip of the locatable guide to the nodule measured during the procedure. RESULTS: The diagnostic yield of ENB was 67% (34/51). The sensitivity and specificity of ENB for malignancy in this study were 71% and 100%, respectively. ENB was diagnostic in 79% (30/38) patients with a bronchus sign on CT imaging but only in 4/13 (31%) with no discernible bronchus sign. Univariate analysis identified the bronchus sign (P = .005) and nodule size (P = .04) as statistically significant variables conditioning yield, but on multivariate analysis, only the bronchus sign remained significant (OR, 7.6; 95% CI, 1.8-31.7). No procedure-related complications were observed. CONCLUSIONS: ENB diagnostic yield is highly dependent on the presence of a bronchus sign on CT imaging