Factor V Leiden and prothrombin G20210A mutations in young adults with cryptogenic ischemic stroke

The association between factor V Leiden (FVL) and prothrombin G20210A (PT 20210) mutations and ischemic stroke remains controversial, particularly in young adults with cryptogenic stroke. Prevalence of FVL (4.1%) and PT 20210 (8.2%) mutations was assessed in 49 patients under 50 years with cryptogenic stroke and compared with controls. Odd ratio (OR) for cryptogenic stroke was 2.62 (95% CI, 0.49-13.95) for FVL and 3.75 (95% CI, 1.05-13.34) for PT 20210 and 3.28 (95% CI, 1,17-9.20) for some recognized genetic thrombophilic defect. Moreover, the OR for cryptogenic stroke in young women using oral contraceptives (OC) was 3.59 (95% CI, 1.28-10.5). When some genetic thrombophilic defect was associated with OC, the OR was much higher (OR: 14.27; 95% CI, 0.66-309.99). Our results suggest that in the Mediterranean populations the PT 20210 mutation, but not FV Leiden, is a risk factor for cryptogenic stroke in young adults. OC use is also a significant risk factor for cryptogenic stroke, which is increased in women with some genetic thrombotic risk factor.

Thrombophilic risk factors and homocysteine levels in Behçet’s disease in eastern Spain and their association with thrombotic events

Behçet’s disease (BD) is a chronic inflammatory disorder in which thrombosis occurs in about 30% of patients. The prothrombotic mechanisms are unknown. Thrombophilic defects and hyperhomocysteinaemia may be involved in the pathogenesis of thrombotic events, although results have been controversial. Moreover, no information is available on this issue for eastern Spain.We studied the prevalence of inherited and acquired thrombophilic risk factors in 79 patients with BD (43 men, 36 women) who had (n = 23) or did not have (n = 56) thrombosis, and in 84 healthy control subjects (42 men, 42 women). Risk factors examined were antithrombin, protein C and protein S levels, factor V Leiden, the prothrombin G20210A mutation, the methylenetetrahydrofolate reductase C677T polymorphism, and acquired thrombophilic risk factors, including anticardiolipin antibodies, lupus anticoagulant, and serum homocysteine levels. There were no differences between patients and controls in any of the parameters studied.When we studied BD patients with and without thrombotic events, the only thrombophilic defect that differed was the prothrombin G20210A mutation: Three out of 23 patients with thrombosis were carriers, compared with none of 56 patients without thrombosis (p = 0.022).Two of the three carriers developed catastrophic or recurrent thrombotic episodes; one wasa homozygous carrier of the G20210A prothrombin mutation and the other was doubly heterozygous for the G20210A prothrombin mutation and factor V Leiden. A meta-analysis demonstrated an association of factor V Leiden and prothrombin mutation with thrombosis in BD. When studies from Turkey were excluded from the meta-analysis, only the prothrombin G20210A mutation was associated with thrombosis.

Mitochondrial Modification Techniques and Ethical Issues

Current strategies for preventing the transmission of mitochondrial disease to offspring include techniques known as mitochondrial replacement and mitochondrial gene editing. This technology has already been applied in humans on several occasions, and the first baby with donor mitochondria has already been born. However, these techniques raise several ethical concerns, among which is the fact that they entail genetic modification of the germline, as well as presenting safety problems in relation to a possible mismatch between the nuclear and mitochondrial DNA, maternal mitochondrial DNA carryover, and the "reversion" phenomenon. In this essay, we discuss these questions, highlighting the advantages of some techniques over others from an ethical point of view, and we conclude that none of these are ready to be safely applied in humans.

A Personalist Ontological Approach to Synthetic Biology

Although synthetic biology is a promising discipline, it also raises serious ethical questions that must be addressed in order to prevent unwanted consequences and to ensure that its progress leads toward the good of all. Questions arise about the role of this discipline in a possible redefinition of the concept of life and its creation. With regard to the products of synthetic biology, the moral status that they should be given as well as the ethically correct way to behave towards them are not clear. Moreover, risks that could result from a misuse of this technology or from an accidental release of synthetic organisms into the environment cannot be ignored; concerns about biosecurity and biosafety appear. Here we discuss these and other questions from a personalist ontological framework, which defends human life as an essential value and proposes a set of principles to ensure the safeguarding of this and other values that are based on it.

Spontaneous Renal Subcapsular Hematomain an Anticoagulated Patient

This is a case report of spontaneous subcapsular renal hematoma in an anticoagulated patient who was without excessive hypocoagulability and who was hemodynamically stable. Active bleeding was ruled out and a conservative treatment of discontinuing anticoagulant therapy was chosen. The patient was observed expectantly with serial abdominal computed tomography and abdominal ultrasound during her stay in the hospital. When diminution of the hematoma was detected, oral anticoagulation was resumed.

Nosocomial Outbreak of Pseudomonas aeruginosa Endophthalmitis

We describe an outbreak of nosocomial endophthalmitis due to a common source, which was determined to be trypan blue solution prepared in the hospital's pharmacy service. We assume that viable bacteria probably gained access to the trypan blue stock solution during cooling after autoclaving. The temporal cluster of Pseudomonas aeruginosa endophthalmitis was readily perceived on the basis of clinical and microbiological findings, and an exogenous source of contamination was unequivocally identified by means of DNA fingerprinting.

Use of Embryonic Stem Cells to Treat Severe Eye Diseases

BACKGROUND

The use of stem cells in regenerative medicine has major therapeutic potential. Recent clinical trials using cells derived from human stem cells are showing encouraging results, although these should be assessed with the necessary caution.

DISCUSSION

Some media have reported the results of these trials without due care, perhaps creating expectations that do not match the reality of the facts. This paper describes some of the recent advances in the use of human stem cells, particularly those made in the area of ophthalmology, and more specifically, in Stargardt's disease and age-related macular degeneration (AMD). We also present promising studies with induced pluripotent stem cells (iPS), aimed at obtaining retinal pigmented epithelium and light-sensitive retinal rods in the aforementioned ocular diseases, with encouraging preclinical and clinical results.

CONCLUSIONS

From a medical point of view, we must not forget that the transplanted retinal epithelium cells may cause tumours, since they have been obtained from Embryonic Stem cells, and may trigger immune rejection problems since they are heterologous. These considerations attest to the ethical uncertainty of the results of these clinical trials, but above all, it must be stressed that whenever Embryonic Stem cells are used, a human embryo must be destroyed to obtain them, which of course has objective ethical difficulties.

Ethical aspects of nuclear and mitochondrial DNA transfer

Somatic cell nuclear transfer (SCNT) (cloning), as a reproductive or therapeutic method, and mitochondrial DNA transfer, as a method to prevent the transmission of mitochondrial diseases, are analyzed in this paper from a bioethics perspective. The licit purpose of being able to treat certain diseases, as in the case of SCNT, cannot justify, in any case, resorting to illicit means such as the manipulation, selection, and elimination of human embryos in the blastocyst phase, by using cell lines obtained from them. Crossing this line paves the way (as utilitarian ethics advocates) to assuming any cost in scientific experimentation so long as satisfactory results are obtained. With mitochondrial replacement, either human embryos are directly manipulated (pronuclear transfer) or germline cells are manipulated (maternal spindle transfer); changes in these could be transmitted to the offspring.

LAY SUMMARY

This article analyzes somatic cell nuclear transfer (cloning) and mitochondrial DNA transfer techniques, in both reproductive and therapeutic applications, and preventive methods in the transmission of mitochondrial diseases, from a bioethical perspective. The manipulation, selection, and elimination of human embryos delimits the ethical acceptability of these promising techniques.

Clinical validation of a real-time polymerase chain reaction assay for rapid detection of Acinetobacter baumannii colonization

Real-time polymerase chain reaction (PCR)-based approaches have not been assessed in terms of their ability to detect patients colonized by Acinetobacter baumannii during active surveillance. This prospective, double-blind study demonstrated that a real-time PCR assay had high sensitivity (100%) and specificity (91.2%) compared with conventional culture for detecting A. baumannii in 397 active surveillance samples, and provided results within 3h. Receiver-operator curve analyses demonstrated that the technique has diagnostic accuracy of 97.7% (95% confidence interval 96.0-99.3%). This method could facilitate the rapid implementation of infection control measures for preventing the transmission of A. baumannii.

Use of antibodies neutralizing epithelial cell infection to diagnose patients at risk for CMV Disease after transplantation

OBJECTIVES

Although a CMV-specific T-cell response is associated with reduced risk for infection after transplantation, some patients still develop CMV disease. Thus, the characterization of additional parameters of the CMV-specific immune response that correlate with the control of CMV infection and disease and their use in defining thresholds that can be applied to clinical practice is of interest.

METHODS

In a cohort of high risk solid organ transplant recipients we characterized CMV-specific T-cell responses using intracellular cytokine staining upon stimulation with pp65 and IE-1 peptides, and levels of CMV-specific antibodies neutralizing infection in fibroblast (MRC-5) and epithelial (ARPE-19) cells using microneutralization assays.

RESULTS

Although patients with a positive (≥0.25%CD8(+)CD69(+)IFN-γ+) T-cell response were 6.4 fold more protected (OR 6.4, 95% CI 1.6-25.3; p < 0.001) from CMV infection than patients without a response, 2 (4.2%) patients developed disease. We defined a cut-off titer for epithelial cell neutralizing antibodies of ≥480 that correlated with disease protection. Thus, patients with a CMV-specific T-cell response and titers ≥480 were 14.2 fold more protected from CMV infection (OR 14.2, 95% CI 5-40.2; p < 0.001) and had no episodes of CMV disease.

CONCLUSIONS

Our results indicate that antibodies neutralizing epithelial cell infection may have an important role in long-term protection. Quantification of antibodies neutralizing epithelial cells, in addition to the T-cell response, may be useful for identifying patients with lower risk for CMV disease.

Environmental Presence of Mycobacterium tuberculosis Complex in Aggregation Points at the Wildlife/Livestock Interface

The members of the Mycobacterium tuberculosis complex (MTC) cause tuberculosis (TB). Infection is transmitted within and between livestock and wildlife populations, thus hampering TB control. Indirect transmission might be facilitated if MTC bacteria persist in the environment long enough to represent a risk of exposure to different species sharing the same habitat. We have, for the first time, addressed the relationship between environmental MTC persistence and the use of water resources in two TB endemic areas in southern Spain with the objective of identifying the presence of environmental MTC and its driving factors at ungulates' water aggregation points. Camera-trap monitoring and MTC diagnosis (using a new MTC complex-specific PCR technique) were carried out at watering sites. Overall, 55.8% of the water points tested positive for MTC in mud samples on the shore, while 8.9% of them were positive in the case of water samples. A higher percentage of MTC-positive samples was found at those waterholes where cachectic animals were identified using camera-trap monitoring, and at the smallest waterholes. Our results help to understand the role of indirect routes of cross-species TB transmission and highlight the importance of certain environmental features in maintaining infection in multihost systems. This will help to better target actions and implement control strategies for TB at the wildlife/livestock interface.

Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action

BACKGROUND

Recent studies have identified that levonorgestrel administered orally in emergency contraception (LNG-EC) is only efficacious when taken before ovulation. However, the drug does not consistently prevent follicular rupture or impair sperm function.

OBJECTIVE

The present systematic review is performed to analyze and more precisely define the extent to which pre-fertilization mechanisms of action may explain the drug's efficacy in pregnancy avoidance. We also examine the available evidence to determine if pre-ovulatory drug administration may be associated with post-fertilization effects.

CONCLUSION

The mechanism of action of LNG-EC is reviewed. The drug has no ability to alter sperm function at doses used in vivo and has limited ability to suppress ovulation. Our analysis estimates that the drug's ovulatory inhibition potential could prevent less than 15 percent of potential conceptions, thus making a pre-fertilization mechanism of action significantly less likely than previously thought. Luteal effects (such as decreased progesterone, altered glycodelin levels, and shortened luteal phase) present in the literature may suggest a pre-ovulatory induced post-fertilization drug effect.

LAY SUMMARY

Plan B is the most widely used emergency contraceptive available. It is important for patients and physicians to clearly understand the drug's mechanism of action (MOA). The drug was originally thought to work by preventing fertilization. Recent research has cast doubt on this. Our review of the research suggests that it could act in a pre-fertilization capacity, and we estimate that it could prevent ovulation in only 15 percent or less of cases. The drug has no ability to alter sperm function and limited ability to suppress ovulation. Further, data suggest that when administered pre-ovulation, it may have a post-fertilization MOA.

DNA Detection Reveals Mycobacterium tuberculosis Complex Shedding Routes in Its Wildlife Reservoir the Eurasian Wild Boar

Since the intensity and frequency of pathogen shedding by hosts determine the probability of infection through direct and indirect contact, the shedding characterization of Mycobacterium tuberculosis complex (MTC) in the key host reservoir in Iberia, the Eurasian wild boar (Sus scrofa), is crucial. We aimed (i) to describe the natural shedding routes of MTC in free-ranging wild boar by a new semi-automated PCR method and (ii) to determine the association of MTC shedding pattern with tuberculosis (TB) progression and individual factors. MTC shedding (by any of the possible routes) was detected in a total of 30.8% (±7.5) out of the sampled individuals with valid or interpretable test results (n = 39). The proportion of TB-positive shedders according to the route was 13.6% (±7.5) for oral swabs, 4.5% (±4.5) for nasal swabs, 4.5% (±4.4) for faecal swabs and 13.6% (±7.5) for individuals being positive to all swabs concomitantly. The probability of shedding mycobacteria (by any route) statistically associated with TB generalization, and the TB score was significantly higher in individuals testing positive to at least one route compared to negatives. Overall, a diversity of shedding routes in wild boar is possible, and it is remarkable that for the first time, the faecal shedding is confirmed for naturally infected wild boar. Our results are consistent with the role wild boar plays for TB maintenance in host communities and environments in Iberia and confirm that it is an important source of mycobacteria infection by different routes. Finally, we evidenced the use of a new PCR technique to detect MTC DNA in excretions can be practical and defined the target routes for sampling wild boar shedding in future studies, such as interventions to control TB in wild boar that can be measured in terms of impact on mycobacteria excretion and transmission (i.e. vaccination).

Ethical considerations of universal vaccination against human papilloma virus

BACKGROUND

From an epidemiological perspective, the practice of universal vaccination of girls and young women in order to prevent human papilloma virus (HPV) infection and potential development of cervical cancer is widely accepted even though it may lead to the neglect of other preventive strategies against cervical cancer.

DISCUSSION

It is argued that removing the deterrent effect--the fear of developing cancer--could encourage teenage sex. This paper reflects on the ethical legitimacy of the universal vaccination of girls and young women against HPV infection, especially regarding safety issues, the need to vaccinate people who have opted to abstain from sex, the presumption of early onset of sexual relations, the commercial interests of the companies that manufacture the vaccine, and the recommendation of universal vaccination in males.

SUMMARY

Based on the aforementioned information, we believe that the universal vaccination against HPV in young women is acceptable from an ethical point of view, given the medical advantages it presents.