Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis

OBJECTIVE

To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard.

METHODS

This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined.

RESULTS

The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses.

CONCLUSIONS

The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

[Awareness of chemsex, pre-exposure prophylaxis, and sexual behavior in primary health care in Spain]

OBJECTIVE

To describe the degree of knowledge of primary care professionals about the practice of chemsex, its potential side effects and pre-exposure prophylaxis against HIV (PrEP).

MATERIAL AND METHODS

Observational, descriptive, cross-sectional, observational study using an online survey aimed at primary care professionals. The survey consisted of 25 questions on: (i)sociodemographic data; (ii)performance of sexual interview in the consultation; (iii) level of knowledge about the use of chemsex and its complications; (iv)degree of knowledge about PrEP, and (v)training needs of professionals. The survey was designed in ArgisSurvey123 and distributed through SEMERGEN via distribution list and corporate mail.

RESULTS

One hundred and fifty-seven responses were obtained during the survey distribution period (February-March 2022). The majority of respondents were women (71.8%). The percentage of sexual interviewing in routine clinical practice was low. Most respondents (73%) had heard of chemsex, but were not comfortable with their knowledge of the pharmacokinetic properties of the main drugs used in this practice. 52.3% of respondents claimed to have no knowledge of PrEP.

CONCLUSIONS

Updating and responding to the training needs of professionals regarding chemsex and PrEP is essential to ensure the care and quality of care for our patients.

[The postal code as a "bar code" of antimicrobial resistance]

OBJECTIVE

The need to integrate local resistances into clinical practice is increasingly urgent, especially in Primary Care where empirical treatment is frequent.

METHODS

A retrospective observational study of positive microbiological isolates of Neisseria gonorrhoeae from any location (urethral, cervical, pharyngeal, rectal or urine) was carried out in the health area of Alcalá de Henares. Sociodemographic characteristics and resistance to cephalosporins, azithromycin, penicillin and quinolones were analyzed. Each isolate was related to its postal code of origin.

RESULTS

We analyzed 256 microbiological samples of N.gonorrhoeae, most of them male (92.9%) with a mean age of 33 years. Half of the samples (49.8%) were resistant to ciprofloxacin. Temporal and spatial evolution of antimicrobial resistance was integrated in heat maps.

CONCLUSIONS

Knowing local resistances can help to prescribe more adequate empirical treatments, especially in Primary Care, avoiding inadequate antibiotics and decreasing resistance rates.

Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España

Introducción

En España, los sistemas sanitarios están transferidos a las Comunidades Autónomas (CC.AA.), constituyendo 19 sistemas sanitarios con gestión y recursos diferenciados. Durante la primera onda epidémica de la COVID-19 se objetivaron diferencias en los sistemas de declaración y en las tasas de letalidad (TL) entre las CC.AA. El objetivo de este estudio fue analizar las TL por CC.AA. durante la segunda onda epidémica (del 20 de julio al 25 de diciembre de 2020) y su relación con la prevalencia de la infección.

Material y métodos

Se realizó un estudio observacional descriptivo con la información disponible sobre el número de fallecidos por COVID-19 registrados en el Ministerio de Sanidad, Consejerías de Salud y los Departamentos de Salud Pública de las CC.AA. y según el exceso de mortalidad informado por el Sistema de Monitorización de Mortalidad Diaria (MoMo). La prevalencia de la infección se estimó a partir de las diferencias entre la segunda y cuarta ronda del estudio ENE-COVID y sus intervalos de confianza del 95%. Se calcularon las TL (fallecidos por cada mil infectados) globales, por sexo, grupos de edad (< 65 y ≥ 65 años) y CC.AA. Se calculó la razón estandarizada de letalidad por edad (REL) de las CC.AA. utilizando las TL de España para cada grupo de etario. Estas estimaciones se realizaron con las defunciones declaradas oficialmente (TLo) y el exceso de defunciones estimadas por MoMo (TLMo). Se estimaron las correlaciones entre las prevalencias de infección y las TLo y TLMo, ponderando por población.

Resultados

Para el conjunto de España, la TLo durante la segunda onda epidémica fue del 7,6%, oscilando entre 3,8% de Baleares y 16,4% de Asturias, y la TLMo fue de 10,1%, oscilando entre el 4,8% de Madrid y el 21,7% en Asturias. Se observaron diferencias significativas entre la TLo y la TLMo en Canarias, Castilla la Mancha, Extremadura, Comunidad Valenciana, Andalucía y las Ciudades Autónomas de Ceuta y Melilla. La TLo fue significativamente mayor en hombres (8,2%) que en mujeres (7,1%). Las TLo y TLMo fueron significativamente mayores en el grupo de edad ≥ 65 años (55,4 y 72,2%, respectivamente) que en el grupo < 65 años (0,5 y 1,4%, respectivamente). País Vasco, Aragón, Andalucía y Castilla la Mancha presentaron una REL significativamente superiores a uno. Las correlaciones entre la prevalencia de infección y las TLo fueron inversas.

Conclusiones

La letalidad por COVID-19 durante la segunda onda epidémica en España mejoró respecto a la primera. Los datos disponibles sugieren que la letalidad de la segunda onda en las CC.AA. estaría influida por la elevada letalidad observada en la primera onda en personas con comorbilidades, así como por las limitaciones de los sistemas de detección y notificación de SARS-CoV-2. Las tasas de letalidad fueron mayores en hombres y personas mayores, y variaban significativamente entre CC.AA. Es necesario profundizar en el análisis de las causas de estas diferencias.

Decalogue for the selection of oral antibiotics for lower respiratory tract infections

Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options beta-lactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected.

[Vaccination against community acquired pneumonia in adults. Update 2021 of the position paper by Neumoexpertos en Prevención Group]

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the practical prevention guide for CAP through vaccination in Spain developed in 2016 and updated in 2018, based on available vaccines and evidence through bibliographic review and expert opinion. The arrival of COVID-19 as a new cause of CAP and the recent availability of safe and effective vaccines constitutes the most significant change. Vaccines against pneumococcus, influenza, pertussis and COVID-19 can help to reduce the burden of disease from CAP and its associated complications. The available evidence supports the priority indications established in this guide, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

Service-Learning, Movies, and Infectious Diseases: Implementation of an Active Educational Program in Microbiology as a Tool for Engagement in Social Justice

Service-Learning is an educational methodology that allows student learning while addressing community needs. A program in microbiology and infectious diseases was implemented in Universidad Complutense de Madrid, Spain. University lecturers, clinical microbiologists, doctorate students, and undergraduates from several Bachelor Degrees and courses worked in an interdisciplinary team along with social institutions that attend disadvantaged persons. Using commercial movies that deal with infectious diseases, the students learn clinical microbiology, prepare divulgation materials, visit social centers to accompany, and help others to know about illnesses and prevention. The program was developed through two academic years and involved 58 voluntary students, 13 teachers and tutors, and 4 social entities as community partners. Postsurvey evaluation of the program revealed a highly satisfactory achievement of goals: acquiring scientific and personal competencies by university students, including critical analysis and science diffusion, solving problems or collaborative team working, and contributing, together with the tutors, to the social responsibility of the university.

[Estimating the number of COVID-19 cases using a web-based tool: Results from the first week of the 'Covid-19 Trends' project in the Basque Country]

OBJECTIVE

In the Basque Country, two cases of COVID-19 were diagnosed on February 28 2020. On March 14, the Spanish Government established a state of alarm. Only cases confirmed by molecular biology (reverse-transcriptase polymerase chain reaction [RT-PCR]) were known. We launched a web-based surveillance tool to estimate the number of symptomatic cases of COVID-19 to contribute to Public Health decision-making.

MATERIAL AND METHODS

We implemented an anonymous web questionnaire and disseminated it through online social media social. We collected epidemiological information about «time» (date of onset of symptoms), «place» (zip code), and «person» (gender, age). We compared cases detected by RT-PCR with the estimated cases, according to the case definition of the Ministry of Health. We calculated the questionnaire response rate and the cumulative incidence at 14days.

RESULTS

Between March 19 and 26, 128,009 people answered the questionnaire (5.5% of the Basque population). Of these, 26,375 met the case definition (symptom prevalence of 21.4%). The estimated cases were almost six times more than COVID-19 positive RT-PCR. The estimated 14-day cumulative incidence was 578.3 per 100,000 population compared to RT-PCR positive cases, which was 139.6 per 100,000 population.

CONCLUSIONS

This tool was useful in estimating the minimum number of symptomatic cases in the Basque Country, which could support Public Health actions.

Chemical signals act as the main reproductive barrier between sister and mimetic Heliconius butterflies

Colour pattern is the main trait that drives mate recognition between Heliconius species that are phylogenetically close. However, when this cue is compromised such as in cases of mimetic, sympatric and closely related species, alternative mating signals must evolve to ensure reproductive isolation and species integrity. The closely related species Heliconius melpomene malleti and H. timareta florencia occur in the same geographical region, and despite being co-mimics, they display strong reproductive isolation. In order to test which cues differ between species, and potentially contribute to reproductive isolation, we quantified differences in the wing phenotype and the male chemical profile. As expected, the wing colour pattern was indistinguishable between the two species, while the chemical profile of the androconial and genital males' extracts showed marked differences. We then conducted behavioural experiments to study the importance of these signals in mate recognition by females. In agreement with our previous results, we found that chemical blends and not wing colour pattern drive the preference of females for conspecific males. Also, experiments with hybrid males and females suggested an important genetic component for both chemical production and preference. Altogether, these results suggest that chemicals are the major reproductive barrier opposing gene flow between these two sister and co-mimic species.

[Adult community acquired pneumonia vaccination: 2018 Update of the positioning of the Pneumonia Prevention Expert Group]

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

A novel fibrinogen mutation: FGA g. 3057 C > T (p. Arg104 > Cys) impairs fibrinogen secretion

Background

Abnormal fibrinogens can be caused by clinically silent hereditary mutations. A new case was detected accidentally in an 11-year-old girl when routine pre-operative coagulation tests were performed for nasal turbinate surgery.

Methods

The fibrinogen genes FGA, FGG and FGB were sequenced using standard protocols. The kinetics of fibrin formation were followed by turbidity at 350 nm. Purified fibrinogen was incubated with plasmin, and the degradation products analyzed by SDS/PAGE. The formation of fibrinogen-albumin complexes was analyzed by immunobloting. Fibrin structure was examined in a Nikon Eclipse TE 2000-U laser microscope. Secretion of the variant protein was analyzed directly by reverse phase-electrospray time of flight-mass spectrometry (TOF-MS).

Results

DNA sequencing revealed a novel heterozygous g. 3057 C > T mutation in the FGA that predicts a p. Arg104 > Cys substitution, in the proband and her father. Both patients were asymptomatic with low functional and antigen fibrinogen concentrations. The proband's plasma fibrinogen polymerization was almost normal, with a 12% decrease in the final turbidity, while, the father's fibrin formation had a diminished slope and final turbidity (2.5× and 40%, respectively). Aα Arg104 is located at a plasmin cleavage site in the coiled-coil region of fibrinogen. However, the father's fibrinogen plasmin degradation was normal. Although the exchanged Cys introduces an unpaired -SH, immunoblotting showed no fibrinogen-albumin complexes. Furthermore, the plasma clot structure observed by confocal microscopy appeared almost normal. TOF-MS showed that the variant Aα chain was underrepresented in plasma and made up only about 25% of the total.

Conclusions

The low expression of the Aα Arg104 > Cys chain in circulation could account for the observed hypodysfibrinogenemia.

Reconstruction Techniques of Choice for the Facial Cosmetic Units

BACKGROUND AND OBJECTIVES

A broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units.

MATERIAL AND METHODS

This was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second.

RESULTS

The total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip.

CONCLUSIONS

The results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.

Effect of hierarchical porosity in Beta zeolites on the Beckmann rearrangement of oximes

Hierarchical Beta zeolites with different Si/Al molar ratios, synthesized by crystallization of silanized protozeolitic units, were investigated in the liquid-phase Beckmann rearrangement of cyclohexanone and cyclododecanone oximes.

Regulation of black-hole accretion by a disk wind during a violent outburst of V404 Cygni

Accretion of matter onto black holes is universally associated with strong radiative feedback and powerful outflows. In particular, black-hole transients have outflows whose properties are strongly coupled to those of the accretion flow. This includes X-ray winds of ionized material, expelled from the accretion disk encircling the black hole, and collimated radio jets. Very recently, a distinct optical variability pattern has been reported in the transient stellar-mass black hole V404 Cygni, and interpreted as disrupted mass flow into the inner regions of its large accretion disk. Here we report observations of a sustained outer accretion disk wind in V404 Cyg, which is unlike any seen hitherto. We find that the outflowing wind is neutral, has a large covering factor, expands at one per cent of the speed of light and triggers a nebular phase once accretion drops sharply and the ejecta become optically thin. The large expelled mass (>10(-8) solar masses) indicates that the outburst was prematurely ended when a sizeable fraction of the outer disk was depleted by the wind, detaching the inner regions from the rest of the disk. The luminous, but brief, accretion phases shown by transients with large accretion disks imply that this outflow is probably a fundamental ingredient in regulating mass accretion onto black holes.

Process of Care for Patients With Benign Cysts and Tumors: Consensus Document of the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV)

Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.

Clinical Pathway for Patients with Acute or Chronic Urticaria: A Consensus Statement of the Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV)

Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity-a key feature of quality.

Hierarchical ZSM-5 zeolite with uniform mesopores and improved catalytic properties

Uniform mesopores are generated in hierarchical ZSM-5 by a mesopore narrowing treatment, showing enhanced activity in the acylation of 2-methoxynaphthalene.

Five-year follow-up of immune response after one or two doses of inactivated hepatitis A vaccine given at 1 year of age in the Mendoza Province of Argentina

Our study was conducted to further investigate the single-dose approach of hepatitis A vaccination, while providing supportive data on the flexibility of booster administration. Participants received at least one dose of Avaxim 80U Pediatric at 11-23 months of age, and they will be followed for 10 years. We report here the fourth and fifth years after the first vaccination. Group assignment was based on whether the children received 1 dose and no booster during the study (Group 1) or 2 doses and no further booster (Group 2). Anti-HAV antibody concentrations were assessed at each annual visit. Of the 546 initial participants, 441 (80.8%) and 412 (75.5%) were followed up 4 and 5 years after vaccination, respectively. Of the 411 subjects evaluable at Year 5, 318 had received one vaccine dose and 85 had received two. Seroprotection rates were still high in Group 1 (99.7%) and in Group 2 (100%) 5 years after one or two doses of Avaxim 80U Pediatric, correspondingly. Anti-HAV geometric mean concentrations decreased in both groups compared to what they were 3 years after vaccination, while remaining well above the 10 mIU/mL threshold 5 years after vaccination. The highest concentrations were found in the children who received 2 vaccine doses. Hepatitis A humoral immunity induced by a single dose of inactivated hepatitis A vaccine can persist for at least 5 years in a paediatric population. The study results also support recommendations in favour of a flexible time window for booster vaccination.

Influence of the structural and textural properties of ordered mesoporous materials and hierarchical zeolitic supports on the controlled release of methylprednisolone hemisuccinate

To alleviate the chronic inflammation, nasal obstruction, and loss of sense of smell that produces the rhinosinusitis disease, ordered mesoporous materials and hierarchical zeolites could be used for slow and sustained corticoid (methylprednisolone hemisuccinate conjugate) release. The correlations between the delivery performance of methylprednisolone hemisuccinate and the physicochemical properties of carriers' release systems, including pore mesostructure, texture and size, and surface chemistry, have been well established. Different two-dimensional (2-D) and three-dimensional (3-D) mesostructured materials (MCM-41, SBA-15, expanded SBA-15, FDU-12, and SBA-16) were employed. In addition, for the first time to the best of our knowledge, materials based on hierarchical zeolites with additional mesoporosity (h-ZSM-5 and h-BETA zeolites) were also tested. In particular, two materials (3-D cubic mesoporous silica SBA-16 and hierarchical Beta zeolite) have been probed to be potential candidates, exhibiting high drug adsorption capacities and slow drug release rates, which is the most favourable way of drug release in the particular rhinosinusitis application. Solid-state ¹H-²⁹Si HETCOR NMR analyses confirm the strong interactions of the drug with the surface of h-BETA and 3-D SBA-16 materials, via hydrogen bonding of carboxylic, ketone, and aliphatic moieties of the methylprednisolone hemisuccinate at surface silanol sites. Because of the remarkable release performance, it is expected that 3-D mesoporous silica SBA-16 and hierarchical Beta zeolite can be attractive candidates for current applications in nasal inflammation treatments. The drug release rate can be further retarded by decreasing the pH to around 4.6; at this point more attraction forces were detected as proved by zeta-potential measurements. Therefore, a slower delivery trend of methylprednisolone hemisuccinate has been observed for all the materials, which is more pronounced in the case of SBA-15 and SBA-16.

[Biological effect of controlled fluid hyperthermia on rabbit healthy bones]

Fluid hyperthermia has been used to treat various types of cancers, but its effects on bone have not been determined. The purpose of this prospective study was to show the structural and metabolic changes of bone exposed to fluid hyperthermia and the effects of the latter on bone healing. Thirty New Zealand rabbits were used, weighting 2.8-3.2 kg; they were divided into 9 groups and 3 subgroups. An osteotomy was performed in the mid third of the right femur and this segment was exposed to hyperthermia at 15, 20 and 25 degrees centigrade for 50, 60 and 70 minutes. A bone scan was performed every 4 weeks and X-rays were taken every week up to week 13. The post-hoc Tukey test was used for the statistical analysis. Differences were found in the concentration of chemicals at temperatures above 60 degrees for 20 minutes with statistical significance; bone healing was delayed and there was evidence of metabolic activity. We conclude that exposure to temperatures above 60 degrees for 20 minutes resulted in morphologic alterations in potassium, magnesium, sulfur and phosphorus, and delayed bone healing. These results are used as parameters for the treatment of bone tumors with fluid hyperthermia.

Expert report on psoriasis: Spanish dermatologists' opinions on the use of biologic agents to manage moderate to severe psoriasis in adults

BACKGROUND

Although national guidelines on biologic agents for treating moderate to severe psoriasis in adults have been published in several countries, increased knowledge on the practical aspects of their implementation is required.

OBJECTIVE

The objective of this study was to survey Spanish dermatologists to determine their expert opinions on practical aspects of psoriasis treatment with biologics.

MATERIALS AND METHODS

An online survey was sent to 309 dermatologists who belong to the Spanish Psoriasis Group and/or the Spanish Academy of Dermatology and Venereology (AEDV). The questionnaire was designed specifically for the study and included items on various aspects of the treatment of psoriasis in clinical practice. Six coordinators in different geographic areas worked together to write the final expert report.

RESULTS

The response rate was 97% (300 returned questionnaires). The biologics preferred, or considered to be the best option (median score 4 out of 4 points) by respondents, were infliximab for its short-term efficacy (74% of the respondents) and rapid onset of action (78%); ustekinumab for convenience of administration (73%); and etanercept because of its suitability for cyclic treatment (71%), safety in long-term use (72%), and the possibility of temporary interruption of treatment under certain circumstances (76%). Etanercept was assigned the highest evaluations for safety and expected survival time (scored 5 on each item by 49% and 33% of the respondents, respectively). Thirty percent of the respondents considered that clinical guidelines contain important information for therapeutic management of psoriasis.

CONCLUSIONS

This study provides a unique perspective on the opinions of a large sample of dermatologists as regards current treatment of psoriasis with biologics in Spain.

[Clinical and demographic characteristics of the cases of dementia diagnosed in the Health District of Girona throughout the period 2007-2010: data from the Girona Dementia Registry (ReDeGi)]

INTRODUCTION

The Girona Dementia Registry (ReDeGi, from Spanish: Registro de Demencias de Girona) is a population-based epidemiological surveillance mechanism that registers the cases of dementia diagnosed by the reference centres in the Girona Health District.

AIM

To report on the frequency of the diagnoses and their clinical and sociodemographic characteristics, as well as to compare differences depending on the different subtypes of dementia.

PATIENTS AND METHODS

The method used consisted in a consecutive standardised register of the diagnoses involving dementia in specialised procedures in the Girona Health District between 2007 and 2010.

RESULTS

A total of 2814 cases were registered, which represents a clinical incidence of 6.6 cases per 1000 persons/year. Of this total number, 69.2% were primary degenerative dementias, 18.9% were dementias secondary to a vascular pathology, 5.4% were other secondary dementias and 6.5% were non-specific dementias. The mean age was 79.2 ± 7.6 years (range: 33-99 years) and 59.3% were females. The mean time elapsed since the onset of symptoms and clinical diagnosis was 2.5 ± 1.7 years. The mean score on the Blessed dementia scale was 7.7 ± 4.5 points and in the minimental test it was 17.6 ± 5.4 points. A family history of dementia was present in 26.6% of cases and 69.6% presented one or more cardiovascular risk factors. In 60.6% of cases they were cases of mild dementia, 28.5% were moderate and 10.9% were severe cases.

CONCLUSIONS

The epidemiological surveillance activity carried out by the ReDeGi throughout the period 2007-2010 has made it possible to record information that is extremely valuable for the planning and management of health care resources.

[Treatment of scalp psoriasis: review of the evidence and Delphi consensus of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology]

Scalp lesions are common in psoriasis and difficult to treat. Scientific evidence on the topic is scant and fragmentary, especially with respect to long-term treatment. This consensus statement is based on a critical assessment of the results of a MEDLINE search for clinical trials of the efficacy and safety of therapies used to treat scalp psoriasis. The recommendations were developed by an expert panel using the Delphi process to reach a consensus and then ratified by the members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. The recommended induction therapy for scalp psoriasis is either a topical corticosteroid or a topical treatment combining calcipotriol and betamethasone. The choice of an appropriate vehicle is crucial in improving effectiveness and patient adherence to treatment. The only formulations that have been studied in the long-term treatment of scalp psoriasis are a combination of calcipotriol and betamethasone in gel and calcipotriol alone in solution.

[Dermatophytoses due to anthropophilic fungi in Cadiz, Spain, between 1997 and 2008]

BACKGROUND AND OBJECTIVES

Cutaneous fungal infections are a major public health problem. The distribution of the dermatophytoses varies between countries and geographical areas. The aim of this study was to determine the incidence, epidemiology, etiology, and clinical course of the dermatophytoses caused by anthropophilic fungi in Cadiz, Spain, over the past 12 years.

MATERIAL AND METHODS

The study, conducted between 1997 and 2008, included 2,235 samples from lesions of the skin, hair, and nails of 2,220 patients with a clinical suspicion of mycosis. Samples were examined by microscopy using potassium hydroxide and were cultured on mycological media. The dermatophytes were identified by their macroscopic and microscopic characteristics.

RESULTS

Cultures were positive in 283 cases (12.7%). Anthropophilic dermatophytes (53.3%) were more common than zoophilic (41.3%) and geophilic (5.3%) dermatophytes. Trichophyton rubrum (38.2%) was the predominant pathogen isolated, followed by Microsporum canis (22.3%) and Trichophyton mentagrophytes (15.5%). Five other species of anthropophilic fungi were identified: Trichophyton tonsurans (5.6%), Trichophyton violaceum (4.9%), Epidermophyton floccosum (2.8%), Trichophyton soudanense (1.0%), and Trichophyton schoenleinii (0.7%). Infections caused by the anthropophilic fungi included tinea unguium (29.1%), tinea corporis (25.8%), tinea pedis (19.2%), tinea cruris (11.9%), tinea capitis (5.3%), and tinea faciei (3.3%).

CONCLUSIONS

The principal fungus responsible for dermatomycosis in Cadiz was T. rubrum, and its incidence has been rising since 2000. The prevalence of other anthropophilic fungi, such as T. tonsurans and T. violaceum, has increased, though this is not directly related to immigration. E. floccosum, T. soudanense, and T. schoenleinii are isolated occasionally.

[Immunological characteristics of limbal epithelial cells: in vitro analysis of TLR4 function]

OBJECTIVE

The aim of the present study was to determine the expression of TLR4 on human limbal epithelial cells cultivated in vitro, and to determine its cellular function after stimulation with lipopolysaccharide (LPS).

METHODS

Limbal epithelial cells were isolated from sclera-corneal rims and stimulated for 24 hours with different doses of LPS from E. coli and from Pseudomonas. After stimulation, the cells were harvested, stained with antibodies against human TLR4 and analysed by flow cytometry. mRNA was obtained and RT-PCR was performed for the identification of TLR4. Secretion of TNF-alpha by these cells was evaluated by ELISA of the supernatant.

RESULTS

Limbal epithelial cells expanded in vitro constitutively expressed the TLR4 molecule. After stimulation of cells with LPS the average fluorescence intensity increased, indicating that the expression of extracellular TLR4 was augmented. The expression of TLR4 mRNA was also increased with LPS stimulation, with maximum expression measured at 10 ng/ml LPS. The level of TNF-alpha in the supernatant was not different between the stimulated and the non-stimulated cells.

CONCLUSIONS

Although stimulation of in vitro limbal epithelial cells with LPS up-regulates the extracellular expression of TLR4, the function of TLR4 does not seem to be associated with the secretion of TNF-alpha by these cells. These results are consistent with the proposal that the corneal epithelium is an immunosilent site in the eye.

[Expression of B7 molecules and TLR-9 on corneal epithelial cells infected with adenovirus: clinico-pathological implications in viral keratoconjunctivitis]

PURPOSE

B7 molecules are a family of proteins that co-stimulate T cells during immune activation. Normally the corneal epithelial cells (CEC) do not express these molecules on their cell surface. Toll-like receptors play an important role in the innate immune response to invading pathogens and recently have been demonstrated to be expressed on mice cornea. The objective of this study was to determine whether adenoviral infection induces B7 molecules and TLR9 on human CEC.

METHODS

CEC were isolated from human corneas treated with dispase-II, and grown in the presence of supplemented hormonal epithelial medium until confluence. Then CEC were then infected with adenovirus 5 (Ad5) and cultured for different times. The CEC were then recovered and stained against human CD80, CD86, TLR-9 and cytokeratin. All cells were analyzed by flow cytometry.

RESULTS

Ad5 infection of CEC induced the expression of B7 molecules and TLR-9 after 24 hours in culture, rising to maximum levels at 72 hours. B7 expression at 72 hours was as follows: CD80 expression on infected CEC was 62% (standard error [SE] 2.6) versus 3% (SE 1.2) on non-infected CEC (p<0.001); CD86 expression on infected CEC was 95% (SE 2.1) versus 5% (SE 1.2) on non-infected CEC (p<0.001). TLR-9 expression at 72 hours was 80% (SE 1.2) on infected CEC versus 5% (SE 1) on non-infected CEC (p<0.001).

CONCLUSIONS

Ad5 infection induced the expression of B7 molecules and TLR-9 on CEC.

Hybrid incompatibility is consistent with a hybrid origin of Heliconius heurippa Hewitson from its close relatives, Heliconius cydno Doubleday and Heliconius melpomene Linnaeus

Abstract Shared ancestral variation and introgression complicates the reconstruction of phylogenetic relationships among closely related taxa. Here we use overall genomic compatibility as an alternative estimate of species relationships in a group where divergence is rapid and genetic exchange is common. Heliconius heurippa, a butterfly species endemic to Colombia, has a colour pattern genetically intermediate between H. cydno and H. melpomene: its hindwing is nearly indistinguishable from that of H. melpomene and its forewing band is an intermediate phenotype between both species. This observation has lead to the suggestion that the pattern of H. heurippa arose through hybridization. We present a genetic analysis of hybrid compatibility in crosses between the three taxa. Heliconius heurippa x H. cydno and female H. melpomene x male H. heurippa yield fertile and viable F1 hybrids, but male H. melpomene x female H. heurippa crosses yield sterile F1 females. In contrast, Haldane's rule has previously been detected between H. melpomene and H cydno in both directions. Therefore, H. heurippa is most closely related to H. cydno, with some evidence for introgression of genes from H. melpomene. The results are compatible with the hypothesis of a hybrid origin for H. heurippa. In addition, backcrosses using F1 hybrid males provide evidence for a large Z(X)-chromosome effect on sterility and for recessive autosomal sterility factors as predicted by Dominance Theory.

Historical demography of Mullerian mimicry in the neotropical Heliconius butterflies

We compare the historical demographies of two Müllerian comimetic butterfly species: Heliconius erato and Heliconius melpomene. These species show an extensive parallel geographic divergence in their aposematic wing phenotypes. Recent studies suggest that this coincident mosaic results from simultaneous demographic processes shaped by extrinsic forces over Pleistocene climate fluctuations. However, DNA sequence variation at two rapidly evolving unlinked nuclear loci, Mannose phosphate isomerase (Mpi) and Triose phosphate isomerase (Tpi), show that the comimetic species have quite different quaternary demographies. In H. erato, despite ongoing lineage sorting across the Andes, nuclear genealogical estimates showed little geographical structure, suggesting high historical gene flow. Coalescent-based demographic analysis revealed population growth since the Pliocene period. Although these patterns suggest vicariant population subdivision associated with the Andean orogeny, they are not consistent with hypotheses of Pleistocene population fragmentation facilitating allopatric wing phenotype radiation in H. erato. In contrast, nuclear genetic diversity, theta, in H. melpomene was reduced relative to its comimic and revealed three phylogeographical clades. The pattern of coalescent events within regional clades was most consistent with population growth in relatively isolated populations after a recent period of restricted population size. These different demographic histories suggest that the wing-pattern radiations were not coincident in the two species. Instead, larger effective population size (N(e)) in H. erato, together with profound population change in H. melpomene, supports an earlier hypothesis that H. erato diversified first as the model species of this remarkable mimetic association.

Sex-linked hybrid sterility in a butterfly

Recent studies, primarily in Drosophila, have greatly advanced our understanding of Haldane's rule, the tendency for hybrid sterility or inviability to affect primarily the heterogametic sex (Haldane 1922). Although dominance theory (Turelli and Orr 1995) has been proposed as a general explanation of Haldane's rule, this remains to be tested in female-heterogametic taxa, such as the Lepidoptera. Here we describe a novel example of Haldane's rule in Heliconius melpomene (Lepidoptera; Nymphalidae). Female F1 offspring are sterile when a male from French Guiana is crossed to a female from Panama, but fertile in the reciprocal cross. Male F1s are fertile in both directions. Similar female F1 sterility occurs in crosses between French Guiana and eastern Colombian populations. Backcrosses and linkage analysis show that sterility results from an interaction between gene(s) on the Z chromosome of the Guiana race with autosomal factors in the Panama genome. Large X (or Z) effects are commonly observed in Drosophila, but to our knowledge have not been previously demonstrated for hybrid sterility in Lepidoptera. Differences in the abundance of male versus female or Z-linked versus autosomal sterility factors cannot be ruled out in our crosses as causes of Haldane's rule. Nonetheless, the demonstration that recessive Z-linked loci cause hybrid sterility in a female heterogametic species supports the contention that dominance theory provides a general explanation of Haldane's rule (Turelli and Orr 2000).

Hevein, an allergenic lectin from rubber latex, activates human neutrophils' oxidative burst

Hevein is an N-acetyl-D-glucosamine (GlcNAc) specific lectin that has been hypothesized to participate in the IgE-mediated allergic reactions in patients with latex allergy. In this work we assessed the specificity and biological effect of hevein purified from rubber latex on human leukocytes, using epifluorescence microscopy and flow cytometry. Purified human granulocytes were stimulated in vitro with hevein, and production of oxidative radicals was measured by reduction of nitroblue tetrazolium formazan. Histochemical staining and flow cytometry showed that hevein recognizes specifically monocytes (CD14+) and neutrophils (CD16+), but not lymphoid cells. Hevein induced oxidative response in purified granulocytes; this effect was 1.3-1.5-fold higher than the effect observed with the lectin WGA (wheat germ agglutinin), or other lectins with different sugar specificity. The induced reactions and cellular recognition by hevein were inhibited with GlcNAc and its oligomers; as well as by glycoproteins containing tri-and tetra-antennary N-glycosydically linked glycans. Our findings suggest that neutrophils are the main target for latex hevein; this lectin induces production of oxidative radicals, which seem to play an important role in tissue damage during latex allergy.

Autoimmune thrombocytopenia associated with hepatitis C virus infection

We have retrospectively analyzed a series of 19 patients with hepatitis C virus (HCV) infection and chronic thrombocytopenia not attributable to hypersplenism or to other causes. Antiplatelet antibodies were present in 81% of cases. Response to prednisone was observed in 6 of 7 patients and 1 of 3 patients responded to intravenous immunoglobulins. No case of reactivation of liver disease was observed during or after therapy. We consider that the possibility of an underlying mechanism should be evaluated in thrombocytopenic patients with HCV infection who do not present hypersplenism. These patients could benefit from steroid treatment.