Role of ultrasound in detection of lymph nodes metastasis in gynecological cancers: systematic review and meta-analysis

OBJECTIVE

To assess the diagnostic performance of transvaginal ultrasound (TVUS) for preoperative evaluation of lymph node metastasis in gynecological cancers.

METHODS

A systematic review and meta-analysis was performed. All studies published between January 1990 to May 2023 evaluating the role of ultrasound for detecting lymph node metastasis (index test) in gynecological cancers, using histopathological analysis, as reference standard were included. Quality was assessed using QUADAS-2. Pooled sensitivity, specificity and diagnostic odds ratio of TVUS were estimated.

RESULTS

The search identified 2638 citations. Eight studies comprising 967 women were included. The mean prevalence of pelvic lymph nodes metastasis was 24.2%, [14%-65.6%]. The risk of bias was low for most domains assessed. Overall pooled sensitivity, specificity and diagnostic odds ratio of TVUS were 41% (95% confidence interval [CI] =26%-58%), 98% (95%CI=93%-99%) and 32 (95%CI=14-72), respectively. Heterogeneity in TVUS evaluation was high between studies, both for sensitivity and specificity. No publication bias was found (p=0.46).

CONCLUSION

TVUS showed a high-pooled specificity for the detection of pelvic lymph node metastasis in gynecological cancers. However, pooled sensitivity was low. This article is protected by copyright. All rights reserved.

Renal Transplant Immunosuppression in Patients With Hemolytic Uremic Syndrome: Four Case Reports

A high rate of recurrence has been described in atypical hemolytic uremic syndrome renal transplant recipients, favored by certain immunosuppressant drugs that can induce complement activation. We present four case series in which three patients were diagnosed pretransplantation and a fourth who had onset in the very early post-transplantation period. The patients received different immunosuppression schedules, and all had improvement after more than 2-years. We suggest the need to stratify the risk of atypical hemolytic uremic syndrome recurrence using genetic studies and the available drugs as the main factors that allow graft survival improvement today.

Local allergic rhinitis is an independent rhinitis phenotype: The results of a 10-year follow-up study

BACKGROUND

The knowledge about the natural history of local allergic rhinitis (LAR) is limited. One unmet question is to demonstrate whether LAR should be considered the first step in the development of allergic rhinitis (AR) or an independent phenotype. The aim of this study was to prospectively evaluate the natural history of a population with LAR, the potential conversion to AR with systemic atopy and the development of asthma during 10 years.

METHODS

This is the second phase of a 10-year follow-up study of a cohort of 176 patients with LAR of recent onset and 115 age- and sex-matched healthy controls prospectively evaluated from 2005 to 2016. Clinical-demographic questionnaire, spirometry, skin prick test and specific IgE were evaluated yearly. Nasal allergen provocation tests (NAPT) with Dermatophagoides pteronyssinus, Alternaria alternata, Olea europaea and grass pollen were performed at baseline, and after 5 and 10 years.

RESULTS

After 10-year LAR, patients experienced a significant and clinically relevant worsening of the rhinitis, with increase in emergency assistance, development of asthma, loss of allergen tolerance and impairment of the quality of life. This worsening became significant after 5 years and progressed throughout 10 years. A similar rate of development of AR with systemic atopy was detected in patients and controls (9.7% vs 7.8%, log-rank P=.623). In 5 patients, conversion to systemic atopy occurred >10 years (3%).

CONCLUSIONS

LAR is a well-differentiated clinical entity with a low rate of development of systemic atopy, a natural evolution towards worsening and a risk factor for suffering asthma.

Clinical and biochemical correlates of male hypogonadism in type 2 diabetes

The origin of hypogonadism, a condition including both symptoms and biochemical criteria of androgen deficiency, in type 2 diabetes is poorly known. In a cross-sectional study of 267 unselected patients, we analyzed the potential correlation of several clinical and biochemical variables as well as chronic micro- and macrovascular diabetic complications with hypogonadism. Hypogonadism was present in 46 patients (17.2%) using a cutoff of total testosterone 10.4 nmol/L and in 31 (11.6%) with a cutoff of 8 nmol/L. Among these patients, hypogonadotropic hypogonadism was the most prevalent form (82.6%). Compared to eugonadal subjects, hypogonadal men had significantly lower glomerular filtration rate (67.1 ± 23.4 vs. 78.4 ± 24.6 mL/min/1.73 m² , p = 0.005) and higher prevalence of chronic kidney disease (43.5% vs. 20.4%, p = 0.002), abnormal liver function tests (26.7% vs. 12%, p = 0.019), and psychiatric treatment (23.9% vs. 10.4%, p = 0.025). Total testosterone levels correlated inversely with age (R = -0.164, p = 0.007), fasting blood glucose (R = -0.127, p = 0.037), and triglycerides (R = -0.134, p = 0.029) and directly with glomerular filtration rate (R = 0.148, p = 0.015). Calculated free testosterone and bioavailable testosterone correlated directly with hemoglobin (R = 0.171, p = 0.015 and R = 0.234, p = 0.001, respectively). Multivariate logistic regression analysis, after adjusting for relevant confounding variables, showed that age >60 years (OR = 3.58, CI 95% = 1.48-8.69, p = 0.005), body mass index >27 kg/m² (OR = 2.85, CI 95% = 1.14-7.11, p = 0.025), hypertriglyceridemia (OR = 2.16, CI 95% = 1.05-4.41, p = 0.035), glomerular filtration rate <60 mL/min/1.73 m² (OR = 2.51, CI 95% = 1.19-5.29, p = 0.015), and abnormal liver function tests (OR = 3.57, CI 95% = 1.48-8.60, p = 0.005) were independently associated with male hypogonadism. Although older age, body mass index, and hypertriglyceridemia have been previously related to hypogonadism, our results describe that chronic kidney disease and abnormal liver function tests are independently correlated with hypogonadism in type 2 diabetic men.

Antihypertensive effects of oleuropein-enriched olive leaf extract in spontaneously hypertensive rats

The effects of chronic consumption of oleuropein-enriched (15% w/w) olive leaf extract (OLE) on blood pressure, endothelial function, and vascular oxidative and inflammatory status in spontaneously hypertensive rats (SHR) were evaluated. Ten Wistar Kyoto rats (WKY) and twenty SHR were randomly assigned to three groups: a control WKY group, a control SHR group and a SHR group treated with OLE (30 mg kg(-1)) for 5 weeks. Long-term administration of OLE reduced systolic blood pressure, heart rate, and cardiac and renal hypertrophy. OLE treatment reversed the impaired aortic endothelium-dependent relaxation to acetylcholine observed in SHR. OLE restored aortic eNOS phosphorylation at Ser-1177 and Thr-495 and increased eNOS activity. OLE eliminated the increased aortic superoxide levels, and reduced the elevated NADPH oxidase activity, as a result of reduced NOX-1 and NOX-2 mRNA levels in SHR. OLE reduced the enhanced vascular TLR4 expression by inhibition of mitogen-activated protein kinase (MAPK) signaling with the subsequent reduction of proinflammatory cytokines. In conclusion, OLE exerts antihypertensive effects on genetic hypertension related to the improvement of vascular function as a result of reduced pro-oxidative and pro-inflammatory status.

Influence of low-protein dietetic foods consumption on quality of life and levels of B vitamins and homocysteine in patients with chronic renal failure

OBJECTIVE

The aim of the study was to determine whether the consumption of low protein dietetic foods improved the quality of life and nutritional status for vitamins B and homocysteine in patients with chronic renal failure.

METHODOLOGY

This nutritional-intervention involved 28 men and 21 women, divided into two groups. The control-group consumed a low-protein diet prescribed, and the experimental-group consumed a diet in which some commonly used foods were replaced by low-protein dietetic foods. The study lasted 6 months. Food consumption was assessed by 24-h recall. Vitamin B6 as alphaEAST was measured in blood. Creatinine, urea, vitamin B12, folate and homocysteine were measured in plasma. The impact on the patients' quality of life from consuming the dietetic foods was assessed via the SF-36 questionnaire.

RESULTS

After 6 months, the protein intake among the experimental-group had decreased by 40%, and the urea/creatinine ratio and alphaEAST activity were also lower. The results of the SF-36 questionnaire show that the patients in the experimental-group obtained higher scores in the categories of general health and physical status.

CONCLUSIONS

The dietetic foods were very well accepted by all patients and their use allowed a better control of the protein intake, improved B6 status and a better quality of life.

Melatonin expression in periodontal disease

BACKGROUND AND OBJECTIVE

It was the purpose of this study to examine the relationship between periodontal diseases and melatonin level.

MATERIAL AND METHODS

Forty-six patients with periodontal disease, together with 26 age- and gender-matched healthy controls, were included. Periodontal status was assessed using the Community Periodontal Index. Plasma and salivary melatonin levels were determined using specific commercial radioimmunoassays, whereas lymphocyte subpopulations (e.g. CD3, CD4, CD8, C19 and natural killer cells) were analyzed using flow cytometry.

RESULTS

Patients with periodontal disease had significantly (p < 0.001) lower plasma (9.46 +/- 3.18 pg/mL) and saliva (2.55 +/- 0.99 pg/mL) melatonin levels than healthy control patients (14.33 +/- 4.05 and 4.22 +/- 0.87 pg/mL, respectively). A biphasic relationship was observed between plasma melatonin levels and Community Periodontal Indices. The plasma melatonin level was reduced in patients with a lower Community Periodontal Index value (1 or 2) and increased in patients with a higher Community Periodontal Index value (3 or 4). Salivary melatonin parallels the changes of plasma melatonin. The higher the Community Periodontal Index, the older the patient and the higher the total lymphocyte counts. CD4 concentrations also increased as the disease worsened.

CONCLUSION

The results obtained from this study suggest that melatonin could act as a protective function in fighting periodontal infection. However, further studies in this area are encouraged.

Abnormal expression of acid glycosidases in seminal plasma and spermatozoa from infertile men with varicocele

The activities of acid beta-glucuronidase, alpha-mannosidase, alpha-glucosidase, alpha-galactosidase, beta-galactosidase and beta-N-acetylglucosaminidase were analysed in seminal plasma and spermatozoa from 26 infertile men with varicocele and from 36 men of normal fertility. Semen samples from ten men with non-obstructive azoospermia were used as control specimens that contained the other components of semen. Spermatozoa were solubilized by both physical (homogenization) and chemical (Triton-X100) methods to obtain the soluble and non-soluble fractions. The activities of several glycosidases measured both in seminal plasma and spermatozoa were directly correlated with the numbers of spermatozoa and sperm motility, confirming previous studies. As some infertile patients with varicocele have normal semen parameters, whereas others have low numbers of spermatozoa and low sperm motility, the varicocele patients were prospectively divided into two groups: one (n = 15) with normal spermiograms and the other (n = 11) with abnormal spermiograms. The activities (expressed in mU ml(-1)) of alpha-mannosidase, beta-galactosidase and beta-N-acetylglucosaminidase in seminal plasma of normozoospermic infertile patients with varicocele were significantly higher than those of fertile controls, but not when expressed in U per 10(8) spermatozoa. The activities of beta-glucuronidase, alpha-mannosidase, beta-galactosidase and beta-N-acetylglucosaminidase in seminal plasma when expressed in U per 10(8) spermatozoa in varicocele patients with abnormal spermiograms were significantly higher than in those of men of normal fertility. The activity of alpha-mannosidase in the soluble fraction of sperm homogenates, expressed as U per 10(8) spermatozoa, was significantly higher in infertile patients with varicocele and abnormal spermiograms than in controls. In the non-soluble fraction of spermatozoa from infertile patients with varicocele, there was an increase in the expression of beta-galactosidase and beta-N-acetylglucosaminidase activities compared with the fraction of spermatozoa from fertile subjects. In summary, infertile patients with varicocele displayed an overexpression of acid alpha-mannosidase, beta-galactosidase and beta-N-acetylglucosaminidase activities in seminal plasma and spermatozoa that may be associated with functional defects in spermatozoa as these glycosidases play an important role in mammalian fertilization.

P53 protein expression in oral squamous cell carcinoma. survival analysis

BACKGROUND

The present study aimed to analyze the pattern of p53 expression and its influence on survival in patients with oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

An immunohistochemical technique with BP53-12 antibody was performed on stored tissue from 78 patients with OSCC (intraoral cancer n=40; lip cancer n=38). The nuclear and cytoplasmic extension of p53 staining was assessed. Clinical and histopathological data were gathered and the patient survival was analyzed.

RESULTS

57.7% (n=45) of the OSCCs expressed p53, with nuclear expression in 52.6% (n=41) of cases and cytoplasmic expression in 24.4% (n=19). The OSCCs with extensive nuclear expression of p53 showed dissociated patterns of invasion of adjacent tissues (p<0.05). A greater extension of cytoplasmic expression of p53 most commonly appeared in tumors that were better-differentiated (p<0.005), more keratinized (p<0.01) and with less nuclear atypia (p<0.05). The parameters that significantly influenced survival of patients were tumor localization (p<0.01), size (p<0.0001), lymph node invasion (p<0.0001), clinical stage (p<0.0001), differentiation degree (p<0.01) and nucleargrade (p<0.01).

CONCLUSION

The expression of p53 protein did not behave as a marker of prognostic value in patients with OSCC.

Expression of the p53 protein in oral squamous cell carcinomas associated with Epstein-Barr virus

The behaviour of the p53 protein has been investigated in some human carcinomas associated with Epstein-Barr virus (EBV) but not in EBV-positive oral squamous cell carcinomas (OSCC). The present study aimed to compare the p53 protein expression in EBV-positive OSCC with that in EBV-negative OSCC. The cases had been gathered in a study previously published. An immunohistochemical technique with BP53-12 monoclonal antibody was applied on 74 of the 107 OSCC from the earlier work. The nuclear or cytoplasmic expression of the p53 protein was classified as, absent (0% of neoplastic cells positive), mild (<25% positive), moderate (25-30% positive), or extensive (>50% positive). The p53 protein was expressed by 60.8% of the OSCC. Out of the fourteen EBV-positive OSCC, 57.1% (8 cases) expressed p53, always in the nucleus and never in the cytoplasm. Of the 60 EBV-negative OSCC, 61.6% (37 cases) expressed the p53 protein. Of 37 cases 33 (89.1%) showed nuclear expression of p53 and nineteen cases (51.3%) revealed cytoplasmic expression. There was a statistically significant inverse correlation between cytoplasmic expression of the p53 protein and the presence of EBV DNA (p <0.01). Thus, the EBV-positive tumours less frequently expressed p53 in the cytoplasm. No evidence of an accumulation of the p53 protein in OSCC associated with EBV was recorded.

[Malnutrition and mortality in hemodialyzed patients]

BACKGROUND

Due to the ageing of the general population and improved techniques, the acceptance rate of patients starting dialysis has increased. Mortality remains high and the factors involved include nutritional parameters, which also seem to be of value for prognosis in this population.

SCOPE OF THE STUDY

We proposed a prospective study in our haemodialysis population in order to establish the factors with the greatest predictive value for mortality.

PATIENTS AND METHODS

One hundred stabilized patients receiving this technique were included in the study, with registration of any concomitant pathologies, their severity and the presence of HBP; we carried out a clinical assessment measuring nutritional parameters and functional capacity, with anthropometric and analytical measurements with dialysis dosage and protein catabolism rate. The observation period lasted for one year. The statistical analysis compared survivors and dead patients by means of a bivariant analysis, and after selecting the significant variables, log regression was applied.

RESULTS

The annual death rate was 15%. The bivariant analysis highlights the greater age and the prevalence of vascular pathology prior to dialysis, with a greater severity score and prior weight loss, as well as a lessened functional capacity and clinical assessment score among the dead patients. The analytical parameters showed lymphocytes to be significantly lower among the deceased. The log regression analysis revealed the predictive value of severity, followed by initial vascular co-morbidity, lymphocyte levels less than 1,200 and the nutritional clinical assessment score.

CONCLUSIONS

1. Severity was the main factor predicting mortality. 2. The presence of vascular co-morbidity at the start of dialysis increased the likelihood of death by more than ten times. 3. Lymphopenia of less than 1,200 and low scores in the subjective overall assessment were predictors of mortality.

[The relationship between mosquito vectors and aquatic birds in the potential transmission of 2 arboviruses]

The authors studied for two years the role of the chicks of aquatic birds in the arboviral cycles in coastal lagoons in central Panama in order to determine the relation between Culex (Melanoconion) ocossa and Mansonia (Mansonia) dyari mosquitoes in the transmission and dissemination of the viruses of Saint Louis Encephalitis (SLE) and Venezuelan Equine Encephalitis (VEE). Mosquitoes were captured every fifteen days on two consecutive nights to isolate the virus, using light traps (CDC) and baited traps. The attempts to isolate the virus were made using Vero cell cultures and the determination of antibodies was performed. The results of the serologic tests seem to indicate that four bird species: the ex (?) heron (Bubulcus ibis), the American heron (Casmerodius albus), the spoon-billed duck (Cochlearius cochlearius) and the needle crow (Anhinga anhinga) could function as intermediate hosts in the transmission cycle of SLE. Two species, the ibis (Endocimus albus) and the spoon-billed duck (Cochlearius cochlearius) could also be intermediate hosts of VEE in the coastal lagoons of Panama. The presence of antibodies in chicks could indicate an infection acquired recently, after their birth, in this area. The VEE virus was recovered from blood filled mosquitoes which had fed on a spoon-billed duck probably infected and exposed in a Trinidad #10 trap. No SLE virus was isolated. Other unknown viruses were isolated from mosquitoes selected for these studies, such as C. ocossa and M. dyari. The results obtained with these studies indicate the need for more studies utilizing new field techniques in order to establish a link between SLE and VEE, the vector mosquitoes and the aquatic birds in the coastal lagoons of the area under investigation.

Statistical evaluation of the predictive power of fine needle aspiration (FNA) of salivary glands. Results and cytohistological correlation

Fine needle aspiration (FNA) of the salivary glands was carried out on 97 patients. Diagnosis was confirmed by histological findings in 93 patients. There were 75 benign lesions (including 52 benign tumours) and 18 malignant lesions. In our series "positive predictive value" of FNA was 0.900 and the negative predictive value was 0.963. Thus, the probability of a false positive is 0.100 and of a false negative 0.037.

The influence of clinical and pharmacological factors on enuresis treatment with imipramine

1. The aim of this study has been to evaluate the response to imipramine treatment in enuretic children through the use of a series of clinical and pharmacological variables and by applying a multivariate (principal components) analysis technique. 2. The study was carried out on 146 children whose ages ranged from 5 to 14 years, and who received variable doses of imipramine (12.5 to 100 mg day-1). 3. The quantitative variables analyzed were: drug dosage, serum levels of imipramine and its metabolite desipramine, the relationship between them both, the duration of treatment, age and weight. 4. The qualitative variables were: compliance, presence of side-effects, enuretic and/or psychiatric antecedents, intelligence quotient (I.Q.), the existence (or absence) of related pathologies, sex, and the type of enuresis. 5. The response to treatment was quantified by means of the percentage of decrease in frequency of enuresis as compared with the initial frequency. 6. The results obtained show that the variables which are most associated with the reduction of enuresis are, in decreasing order: the dosage of imipramine administered, the duration of treatment, compliance and the level/dose ratio for the sum of the drug and metabolite levels.

Bone marrow histopathologic patterns and immunologic phenotype in B-cell chronic lymphocytic leukaemia

The present work analyzes the clinicobiological and immunological characteristics - the latter hitherto unexplored - of the different bone marrow histopathological patterns of the B-cell chronic lymphocytic leukaemia (B-CLL). In addition, we studied whether any or some of these parameters were able to predict the probability of a particular pattern of bone marrow involvement appearing. Of the 100 B-CLL cases studied 41 had a diffuse pattern and 59 were non-diffuse - interstitial 27, nodular 11 and mixed 21 -. Neither clinical nor immunological differences were observed among the distinct non-diffuse patterns. The patients in the diffuse group displayed an increased incidence of mu+ isotype and a higher proportion of HLA-DR and HAN-PC 1 positive cells while, conversely, reactivity with the FMC 8 McAb was lower. In addition, patients with a diffuse pattern of BM involvement displayed features of a more extensive disease: a higher incidence of adenopathies (p less than 0.05), hepatomegaly (p less than 0.01), splenomegaly (p less than 0.01), anaemia (p less than 0.01) and thrombopenia (p less than 0.01) as well as higher levels of peripheral blood lymphocytosis (p less than 0.05) and a higher percentage of BM lymphocytic infiltration (p less than 0.001). Multiple regression analysis showed that thrombopenia and splenomegaly were the two most important features in predicting the probability of a diffuse pattern.

Clinical and immunological findings in large B-cell chronic lymphocytic leukemia

In order to define the characteristics of B-CLL cases in which the predominant cell population is composed of large lymphocytes, we studied 97 patients with B-CLL, comparing the cell morphological features with the clinical and biological findings and the immunological phenotype of the proliferating cells. Multivariant analysis showed that there were three significantly different morphological groups: Typical CLL, large lymphocyte CLL (LLL), and CLL with prolymphocytes (CLL/PL). The LLL group showed a greater incidence of lymphadenopathies (P less than 0.05) and higher percentages of both mu + delta + cells (P less than 0.01) and Fmc/7+ cells (P less than 0.001) than in typical CLL. The main differences between LLL and CLL/PL were the peripheral blood lymphocyte count and the percentage of Fmc/7+ cells (P less than 0.002)--both higher in the CLL/PL group--and the percentage of mouse rosette-forming cells (P less than 0.01)--lower in CLL/PL. Further studies including functional assays and survival analyses could contribute to elucidating whether these groups are different entities or a single disease with marked heterogeneity.

Eastern equine encephalomyelitis in Panama: the epidemiology of the 1973 epizootic

In late June 1973, a small outbreak of equine encephalitis caused by eastern equine encephalomyelitis (EEE) virus occurred in the Republic of Panama. At least 100 horses were affected by the disease and 40 died. More than 1,700 human sera were obtained from areas of virus activity but no serological evidence for infection was found. Four isolates of EEE virus were recovered, one of which was from a small pool of Culex taeniopus mosquitoes. Serologic studies of infected horses and classification by the short incubation hemagglutination-inhibition tests revealed that these isolates were South American strains. Our evidence suggests that another agent virulent for horses was active during this outbreak.

Culex (Melanoconion) aikenii: natural vector in Panama of endemic Venezuelan encephalitis

Experiments performed in an endemic area of Venezuelan equine encephalitis in the Panama Canal Zone demonstrated transmission of Venezuelan equine encephalitis virus from naturally infected Culex aikenii mosquitoes to laboratory hamsters. Results of experiments indicate that Culex aikenii is an efficient natural vector and the principal species of mosquito transmitting Venezuelan equine encephalitis in this endemic zone.

Evidence of recent jungle Yellow-Fever activity in Eastern Panama

Outbreaks of jungle yellow fever in man have been recorded twice from eastern Panama of recent years, first in 1948 and again in 1956. Since then, a close surveillance has been maintained on virus activity in eastern Panama. Recent field observations and serological tests on 402 monkey sera indicate that there was an outbreak of yellow fever among monkeys of southern Darién Province some time between 1963 and 1965. It does not appear that the outbreak has spread as yet to other areas. Virus transmission may have been permanently disrupted during the drought which affected the region in 1965. However, if the virus had managed to survive this unfavourable period, an epizootic wave might have evolved, invading forested areas immediately east of the Panama Canal, now inhabited by a dense non-immune human population.