Hyper-Reflective Outer Nuclear Layer (HONL) in Vogt-Koyanagi-Harada Disease and Sympathetic Ophthalmia

PURPOSE

To describe the optical coherence tomography (OCT) findings of hyper-reflective outer nuclear layer (HONL) in two cases of stromal choroiditis (Vogt-Koyanagi-Harada disease - VKH, and sympathetic ophthalmia - SO).

METHODS

Case report.

RESULTS

Clinical and imaging findings of two patients (37-year-old female with VKH and 34-year-old male with SO) have been described. Both patients showed typical features of the disease with subretinal fluid accumulation and choroidal thickening on OCT. However, OCT of both patients at the initial visit revealed HONL, which was unusual in these conditions. During follow-up, OCT scans revealed thinning and atrophy of the outer retinal layers, irregular thickening of the retinal pigment epithelium, and irregular autofluorescence pattern on autofluorescence imaging.

CONCLUSIONS

The presence of HONL may serve as a poor prognostic factor in VKH and SO, resulting in thinning and atrophy of the outer retinal layers.

Kanamycin treatment in the pre-symptomatic stage of a Drosophila PD model prevents the onset of non-motor alterations

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor alterations, which is preceded by a prodromal stage where non-motor symptoms are observed. Over recent years, it has become evident that this disorder involves other organs that communicate with the brain like the gut. Importantly, the microbial community that lives in the gut plays a key role in this communication, the so-called microbiota-gut-brain axis. Alterations in this axis have been associated to several disorders including PD. Here we proposed that the gut microbiota is different in the presymptomatic stage of a Drosophila model for PD, the Pink1^B9 mutant fly, as compared to that observed in control animals. Our results show this is the case: there is basal dysbiosis in mutant animals evidenced by substantial difference in the composition of midgut microbiota in 8-9 days old Pink1^B9 mutant flies as compared with control animals. Further, we fed young adult control and mutant flies kanamycin and analyzed motor and non-motor behavioral parameters in these animals. Data show that kanamycin treatment induces the recovery of some of the non-motor parameters altered in the pre-motor stage of the PD fly model, while there is no substantial change in locomotor parameters recorded at this stage. On the other hand, our results show that feeding young animals the antibiotic, results in a long-lasting improvement of locomotion in control flies. Our data support that manipulations of gut microbiota in young animals could have beneficial effects on PD progression and age-dependent motor impairments.

An elevated HScore is associated with poor clinical outcomes in COVID-19

BACKGROUND

Patients with Coronavirus Disease 2019 (COVID-19) frequently experience a hyperinflammatory syndrome leading to unfavorable outcomes. This condition resembles Secondary Hemophagocytic Lymphohistiocytosis (sHLH) described in neoplastic, rheumatic and other infectious diseases. A scoring system (HScore) that evaluates underlying immunosuppression, temperature, organomegaly, cytopenias, ferritin, triglycerides, fibrinogen and AST was validated for sHLH, and recently proposed to evaluate hyperinflammation in COVID-19.

AIM

To assess the presence of sHLH among patients with COVID-19 admitted for hospitalization and to evaluate Hscore as a prognostic tool for poor outcomes.

MATERIAL AND METHODS

One hundred forty-three patients aged 21-100 years (64% males) admitted because of COVID-19 were enrolled in a prospective study. HScore was calculated within 72 hours admission. The incidence of sHLH during hospitalization was evaluated. Additionally, the relationship between a HScore ≥ 130 points and either the requirement of mechanical ventilation or 60-days mortality was explored.

RESULTS

The median HScore was 96 (33-169). A SHLH was diagnosed in one patient (incidence 0.7%), whose HScore was 169. After adjusting for age, sex, comorbidities and obesity, HScore ≥ 130 was independently associated with the composite clinical outcome (Hazard rartio 2.13, p = 0.022).

CONCLUSIONS

sHLH is not frequent among COVID-19 patients. HScore can be useful to predict the risk for poor outcomes.

Pembrolizumab in combination with gemcitabine for patients with HER2-negative advanced breast cancer: GEICAM/2015-04 (PANGEA-Breast) study

BACKGROUND

We evaluated a new chemoimmunotherapy combination based on the anti-PD1 monoclonal antibody pembrolizumab and the pyrimidine antimetabolite gemcitabine in HER2- advanced breast cancer (ABC) patients previously treated in the advanced setting, in order to explore a potential synergism that could eventually obtain long term benefit in these patients.

METHODS

HER2-negative ABC patients received 21-day cycles of pembrolizumab 200 mg (day 1) and gemcitabine (days 1 and 8). A run-in-phase (6 + 6 design) was planned with two dose levels (DL) of gemcitabine (1,250 mg/m² [DL0]; 1,000 mg/m² [DL1]) to determine the recommended phase II dose (RP2D). The primary objective was objective response rate (ORR). Tumor infiltrating lymphocytes (TILs) density and PD-L1 expression in tumors and myeloid-derived suppressor cells (MDSCs) levels in peripheral blood were analyzed.

RESULTS

Fourteen patients were treated with DL0, resulting in RP2D. Thirty-six patients were evaluated during the first stage of Simon's design. Recruitment was stopped as statistical assumptions were not met. The median age was 52; 21 (58%) patients had triple-negative disease, 28 (78%) visceral involvement, and 27 (75%) ≥ 2 metastatic locations. Progression disease was observed in 29 patients. ORR was 15% (95% CI, 5-32). Eight patients were treated ≥ 6 months before progression. Fourteen patients reported grade ≥ 3 treatment-related adverse events. Due to the small sample size, we did not find any clear association between immune tumor biomarkers and treatment efficacy that could identify a subgroup with higher probability of response or better survival. However, patients that experienced a clinical benefit showed decreased MDSCs levels in peripheral blood along the treatment.

CONCLUSION

Pembrolizumab 200 mg and gemcitabine 1,250 mg/m² were considered as RP2D. The objective of ORR was not met; however, 22% patients were on treatment for ≥ 6 months. ABC patients that could benefit of chemoimmunotherapy strategies must be carefully selected by robust and validated biomarkers. In our heavily pretreated population, TILs, PD-L1 expression and MDSCs levels could not identify a subgroup of patients for whom the combination of gemcitabine and pembrolizumab would induce long term benefit.

TRIAL REGISTRATION

ClinicalTrials.gov and EudraCT (NCT03025880 and 2016-001,779-54, respectively). Registration dates: 20/01/2017 and 18/11/2016, respectively.

The interaction of deep convection with the general circulation in Titan's atmosphere. Part 1: Cloud Resolving Simulations

The deep convective cloud-environment feedback loop is likely important to Titan's global methane, energy, and momentum cycles, just as it is for Earth's global water, energy, and momentum budgets. General circulation models of Titan's atmosphere are unable to explicitly simulate deep convection and must instead parameterize the impact of this important subgrid-scale phenomenon on the model-resolved atmospheric state. The goal of this study is to better quantify through cloud resolving modeling the effects of deep convective methane storms on their environment and to feed that information forward to improve parameterizations in global models. Dozens of atmospheric profiles unstable with respect to deep moist convection are extracted from the global Titan Atmospheric Model (TAM) and used to initialize the cloud-resolving Titan Regional Atmospheric Modeling System (TRAMS). Mean profiles of heating/cooling and moistening/drying of the large-scale environment in TRAMS indicate that Titan's deep convection forces the environment in a manner analogous to Earth: Large-scale subsidence of the environmental air warms and dries the environment, but clouds can also moisten the environment through the detrainment and evaporation of condensate near cloud top. Relative humidity profiles and characteristic convective time scales are derived to guide the tuning of the deep convective parameterization implemented in TAM, as described in a companion paper. The triggering of convection, the dry convective mixing of the planetary boundary layer, and the entrainment of environmental air into rising air parcels are found to be critical to determining whether a deep convective cloud will form. Only profiles with relatively large convective available potential energy (CAPE) and well mixed planetary boundary layers with high relative humidity were found to produce storms. Environments with low level thermal inversions and planetary boundary layers with low relative humidity or rapidly decreasing moisture with height failed to generate deep convection in TRAMS despite positive CAPE.

[Prevalence and incidence of ictus in Europe: systematic review and meta-analysis]

BACKGROUND

Stroke is the second cause of death and the first cause of disability in Europe. The number of stroke patients shows a rapidly increasing due to the increase in the elderly population. The aim of this meta-analysis is to evaluate the prevalence and incidence of stroke in Europe.

METHOD

We conducted a literature search in MEDLINE, SCOPUS, CINAHL Complete and EMBASE, using the keywords "stroke", "cerebrovascular accident", "epidemiology", "prevalence", "incidence" and "Europe". In order to evaluate the quality and risk of bias, we used the Hoy's modified scale for prevalence studies and the Newcastle Ottawa Scale for incidence studies. A random effects model with 95% confidence intervals (95%CI) was used for the meta-analysis. The I2 statistic was applied to assess heterogeneity.

RESULTS

The prevalence of stroke in Europe adjusted for sex was estimated at 9.2% (95%CI: 4.4-14.0). The prevalence was 9.1% (95%CI: 4.7-13.6) in men and 9.2% (95%CI: 4.1-14.4) in women, and increased with age. The incidence of stroke in Europe adjusted for sex was 191.9 per 100,000 person-years (95%CI: 156.4-227.3); it was 195.7 per 100,000 person-years (95%CI: 142.4-249.0) in men and 188.1 per 100,000 person-years (95%CI: 138.6-237.7) in women. Again, these rates increased with age.

CONCLUSION

The prevalence of stroke in Europe is 9.2%. The incidence of stroke in Europe is 191.9 per 100,000 person-years. The prevalence of stroke has increased, whereas the incidence of stroke is stable in comparison with studies conducted at the beginning of the 21st century.

Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study

Introduction

People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma.

Aim

To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution.

Methods

Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008.

Main Results

Eighty-four patients were included. The most common histological types were Burkitt´s lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin´s lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort.

Conclusion

The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.

A TLR4 agonist improves immune checkpoint blockade treatment by increasing the ratio of effector to regulatory cells within the tumor microenvironment

Brucella lumazine synthase (BLS) is a homodecameric protein that activates dendritic cells via toll like receptor 4, inducing the secretion of pro-inflammatory cytokines and chemokines. We have previously shown that BLS has a therapeutic effect in B16 melanoma-bearing mice only when administered at early stages of tumor growth. In this work, we study the mechanisms underlying the therapeutic effect of BLS, by analyzing the tumor microenvironment. Administration of BLS at early stages of tumor growth induces high levels of serum IFN-γ, as well as an increment of hematopoietic immune cells within the tumor. Moreover, BLS-treatment increases the ratio of effector to regulatory cells. However, all treated mice eventually succumb to the tumors. Therefore, we combined BLS administration with anti-PD-1 treatment. Combined treatment increases the outcome of both monotherapies. In conclusion, we show that the absence of the therapeutic effect at late stages of tumor growth correlates with low levels of serum IFN-γ and lower infiltration of immune cells in the tumor, both of which are essential to delay tumor growth. Furthermore, the combined treatment of BLS and PD-1 blockade shows that BLS could be exploited as an essential immunomodulator in combination therapy with an immune checkpoint blockade to treat skin cancer.

[First isolation de Candida auris in Chile]

Candida auris is an emerging multi-drug-resistant fungus that is rapidly spreading worldwide. Since the first reports in 2009, many isolates across five continents have been identified as agents of hospital-associated infections. Independent and simultaneous outbreaks of C. auris are becoming a major concern for healthcare and scientific community. Moreover, laboratory misidentification and multi-drug-resistant profiles, rarely observed for other non-albicans Candida species, result in difficult eradication and frequent therapeutic failures of C. auris infections. In this article we present the first case of isolation of a strain of C. auris at a hospital in Santiago, in a patient coming from India, who was admitted for treatment of diabetic foot complications. The strain was recovered from a tissue culture and identified by VITEK® 2 Compact. The accurate identification of C. auris was confirmed by means of MALDI-TOF MS and DNA sequence analysis. The isolate was resistant to fluconazole, retaining only susceptibility to amphotericin and caspofungin with MIC breakpoints recommended by CDC. The emergence of C. auris is alarming because the mode of transmission within the healthcare environment is not clear and is likely to be multifactorial.

Wood development regulators involved in apical growth in Pinus canariensis

The shoot apical meristem is responsible of seasonal length increase in plants. In woody plants transition from primary to secondary growth is also produced during seasonal apical growth. These processes are controlled by different families of transcription factors. Levels of transcriptomic activity during apical growth were measured by means of a cDNA microarray designed from sequences related to meristematic activity in Pinus canariensis. The identification of differentially expressed genes was performed using a time-course analysis. A total of 7170 genes were differentially expressed and grouped in six clusters according to their expression profiles. We identified master regulators, such as WUSCHEL-like HOMEOBOX (WOX), to be involved in the first stages of apical development, i.e. growth of primary tissues, while other transcription factors, such as Class III HOMEODOMAIN-LEUCINE ZIPPER (HD-ZIP III) and KNOTTED-like (KNOX) and BEL1-like (BELL) HOMEODOMAIN proteins, were found to be induced during last stages of apical seasonal development, already with secondary growth. Our results reveal the main expression patterns of these genes during apical development and the transition from primary to secondary stem growth. In particular, the regulatory factors identified play key roles in controlling stem architecture and constitute candidate genes for the study of other development processes in conifers.

Prevalence of Spasticity and Postural Patterns in the Upper Extremity Post Stroke

INTRODUCTION

A high number of patients with stroke develop upper extremity spasticity, causing abnormal postures and patterns. These alterations limit the use of arm in functional activities and affect social participation.

AIM

To determine the prevalence of spasticity and postural patterns of the upper extremity post stroke.

MATERIALS AND METHODS

A cross-sectional descriptive design was used with a prospective follow-up. The sample included 136 patients. The study included 3 measuring times; at 10 days (T1), applying a record with sociodemographic-clinical data, the evaluation of muscle tone in the elbow and wrist and the postural patterns of the UE, and at 3 months (T2) and 12 months (T3) post stroke, re-evaluating tone and patterns. Prevalence was calculated through the one-sample chi-squared (χ2) test followed by inspection of the standardized residuals (z) in each cell. The Kappa coefficient evaluated the degree of agreement in elbow and wrist tone.

RESULTS

The prevalence of spasticity in the elbow was 37.5% at T1, 57.4% at T2, and 57.4% at T3. At each time there was a high degree of agreement between elbow and wrist tone. Patients developed increased elbow tone between T1 and T2, with maintained tone between T2 and T3. Postural pattern III was the most prevalent according to Hefter's classification.

CONCLUSION

The prevalence of spasticity in the elbow and wrist increases between 10 days and 3 months post stroke, and is maintained between 3 and 12 months. The onset of spasticity occurs in almost half of patients during the first 10 days post stroke. Postural pattern III according to Hefter's classification presented the greatest prevalence in the spastic UE.

Necrotizing cellulitis due to Rhizopus arrhizus in an extremely premature infant

We report an extremely premature infant with necrotizing cellulitis. After minor trauma to the left arm when removing an adhesive sensor, patient developed rapidly progressive cellulitis, which evolved into a necrotic ulcer. Microbiological studies (mass spectroscopy and molecular assay) identified Rhizopus arrhizus as the responsible fungus.

Host characteristics predict outcome among adult patients admitted by severe acute respiratory infection

BACKGROUND

Except for influenza pandemics, different observational studies have failed to demonstrate differences in mortality between various etiologies in adult patients hospitalized for respiratory infections.

AIM

To compare clinical and mortality differences between different viral pathogens associated with severe acute respiratory infections (SARI) in hospitalized adults.

MATERIAL AND METHODS

One-year prospective study in a sentinel center. We included 132 patients with SARI hospitalized for any of the nine viruses under study by PCR. Clinical variables were compared, excluding cases of coinfection.

RESULTS

A viral coinfection was identified in 12% and influenza infection in 56% of cases. Eighty percent of patients were aged ≥ 65 years, with a high frequency of comorbidities, 27% were bedridden. Twenty four percent were admitted to critical care units, 20% required ventilatory assistance and 16% died. Cases occurred throughout the year, with an expected seasonal peak between autumn and spring and a predominance of infections not associated with influenza during summer months. In the multivariate analysis, only being bedridden was significantly associated with mortality at discharge (Odds ratio 23.46; 95% confidence intervals 3.33-165.12, p < 0.01), without association with age, comorbidity, viral pathogen involved, laboratory parameters, clinical presentation or CURB65 score. No major clinical dissimilarities were found between different viral pathogens.

CONCLUSIONS

In our series of patients, mostly elderly, only bedridden status was significantly associated with mortality at discharge in patients hospitalized for SARI. Viral pathogens were not relevant.

[Syphilitic hepatitis. Report of three cases]

Liver involvement occurs in 0.2 to 3% of patients with syphilis. We report three patients with liver involvement in syphilis. A 52-year-old male presenting with erythema and malaise. Laboratory showed a gamma glutamyl transpeptidase (GGT) of 853 u/l, alkaline phosphatases of 1,010 U/L and VDRL was positive. Treatment with penicillin resolved the skin problem and normalized liver enzymes. A HIV positive 30-year-old male in peritoneal dialysis presenting with itching, malaise and markedly elevated GGT and alkaline phosphatases. VDRL was positive. He was treated with penicillin with remission of symptoms and enzyme normalization. A 43-year-old male presenting with erythema, malaise, arthralgias and elevated GGT and alkaline phosphatases. VDRL was positive and treatment with penicillin reverted symptoms and laboratory abnormalities.

Retinopatía diabética y edema macular diabético: prevalencia en una población de atención primaria de Antofagasta

Introducción: La Retinopatía Diabética (RD) es una complicación microangiopática de la diabetes y una de las principales causas de ceguera a nivel mundial. La principal complicación de la RD es el edema macular diabético (EMD). El objetivo de este trabajo es determinar la prevalencia de RD y sus subtipos, así como de EMD en una población de pacientes diabéticos de la atención primaria (APS) de Antofagasta. Materiales y métodos: Estudio descriptivo de corte transversal realizado en una población de 380 pacientes diabéticos diagnosticados y tratados en siete centros de APS de Antofagasta sometidos a control anual de tamizaje de RD mediante retinografía. Se analizó sexo, edad, presencia de RD y subtipos y EMD. Resultados: Se encontró prevalencia de RD de 19.21%. Dentro de este grupo la mayoría (60.27%) fueron hombres y el rango de edad predominante fue 40-64 años con 60.27%. El subtipo más frecuente fue la RD no proliferativa moderada con 45.21% y la prevalencia de EMD fue de 1.84%. Conclusiones: La RD es una complicación prevalente y prevenible, por lo que es necesario mejorar los programas de control metabólico y métodos de screening. Este estudio aporta nuevos datos a la escasa literatura nacional sobre el tema.

Long-term impact of competitive biddings and an antimicrobial stewardship program in a general hospital in Chile

BACKGROUND

The long-term effect of an antimicrobial stewardship program (ASP) and its integrated impact with competitive biddings have been seldom reported.

AIM

To evaluate the long-term effect of an ASP on antimicrobial consumption, expenditure, antimicrobial resistance and hospital mortality. To estimate the contribution of competitive biddings on cost-savings.

MATERIAL AND METHODS

A comparison of periods prior (2005-2008) and posterior to ASP initiation (2009 and 2015) was done. An estimation of cost savings attributable to ASP and to competitive biddings was also performed.

RESULTS

Basal median antimicrobial consumption decreased from 221.3 to 170 daily defined doses/100 beds after the start of the ASP. At the last year, global antimicrobial consumption declined by 28%. Median antimicrobial expenditure per bed (initially US$ 13) declined to US$ 10 at the first year (-28%) and to US$ 6 the last year (-57%). As the reduction in consumption was lower than the reduction in expenditure during the last year, we assumed that only 48.4% of savings were attributable to the ASP. According to antimicrobial charges per bed from prior and after ASP implementation, we estimated global savings of US$ 393072 and US$ 190000 directly attributable to the ASP, difference explained by parallel competitive biddings. Drug resistance among nosocomial bacterial isolates did not show significant changes. Global and infectious disease-associated mortality per 1000 discharges significantly decreased during the study period (p < 0.05).

CONCLUSIONS

The ASP had a favorable impact on antimicrobial consumption, savings and mortality rates but did not have effect on antimicrobial resistance in selected bacterial strains.

Severe acute respiratory infections (SARI) from influenza in adult patients in Chile: the experience of a sentinel hospital

Objective

To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet).

Methods

Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples.

Results

A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza-associated SARI during the study period. Of this study cohort, 91.4% had risk factors for complications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn–winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analysis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0–164); 2) admission to critical care unit (aOR: 8.9; CI: 1.44–55); 3) Pa0₂/Fi0₂ ratio < 250 (aOR: 5.8; CI: 1.02–33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20–24). Seasonal influenza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021–0.90).

Conclusions

Influenza-associated SARI affected mainly elderly patients with underlying conditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome.

Equilibria and correlation of systems involving 1-hexyl-3-methylpyridinium trifluoromethanesulfonate

Ionic liquids are being proposed for the improvement of many refinery-related applications where water and oil coexist. However, the lack of relevant thermodynamic data on equilibrium processes involving water, oil and an ionic liquid is a stumbling block. Phase diagrams of these systems are complex, with many different regions, especially when the ionic liquid is solid at room conditions. This greatly complicates modelling, which is usually neglected or carried out only partially. In this work, for the first time, the simultaneous correlation not only of liquid–liquid and liquid–liquid–liquid but also solid–liquid equilibrium data for ternary systems involving ionic liquids has been carried out. To that end, the ionic liquid 1-hexyl-3-methylpyridinium trifluoromethanesulfonate, with an alkyl chain length that favours nano-segregation, was selected. Phase diagrams with water and different representative oils (octane, toluene and cyclohexane) have been determined at various temperatures and atmospheric pressure. The great capacity of the NRTL model, a powerful tool used in all chemical process simulators, was shown by simultaneously correlating data from all the equilibrium regions. However, adequate equilibrium equations and pivotal strategies were required. Low deviations and a good representation of phase diagrams was achieved. A topological analysis based on the Gibbs common tangent criterion and a stability test allowed validation of the proposed correlation parameters.

The NRTL model is a useful tool to carry out the simultaneous correlation of all different equilibrium regions found in a phase diagram.

Phase II randomized study of PM01183 versus topotecan in patients with platinum-resistant/refractory advanced ovarian cancer

Background

PM01183 is a new compound that blocks active transcription, produces DNA breaks and apoptosis, and affects the inflammatory microenvironment. PM01183 showed strong antitumor activity in preclinical models of cisplatin-resistant epithelial ovarian cancer.

Patients and methods

Patients with platinum-resistant/refractory ovarian cancer were included in a two-stage, controlled, randomized (in a second stage), multicenter, phase II study. Primary endpoint was overall response rate (ORR) by RECIST and/or GCIG criteria. The exploratory first stage (n = 22) confirmed the activity of PM01183 as a single agent at 7.0 mg flat dose every 3 weeks (q3wk). The second stage (n = 59) was randomized and controlled with topotecan on days 1-5 q3wk or weekly (every 4 weeks, q4wk).

Results

ORR was 23% (95% CI, 13%-37%) for 52 PM01183-treated patients. Median duration of response was 4.6 months (95% CI, 2.5-6.9 months), and 23% (95% CI, 0%-51%) of responses lasted 6 months or more. Ten of the 12 confirmed responses were reported for 33 patients with platinum-resistant disease [ORR = 30% (95% CI, 16%-49%)]; for the 29 patients treated with topotecan in the second stage, no responses were found. Median PFS for all PM01183-treated patients was 4.0 months (95% CI, 2.7-5.6 months), and 5.0 months (95% CI, 2.7-6.9 months) for patients with platinum-resistant disease. Grade 3/4 neutropenia in 85% of patients; febrile neutropenia in 21% and fatigue (grade 3 in 35%) were the principal safety findings for PM01183.

Conclusion

PM01183 is an active drug in platinum-resistant/refractory ovarian cancer and warrants further development. The highest activity was observed in platinum-resistant disease. Its safety profile indicates the dose should be adjusted to body surface area (mg/m2).

Trial code

EudraCT 2011-002172-16.

Data Quality and Assessment, Validation Methods and Error Propagation through the Simulation Software: Report from the Round-Table Discussion at the 10th World Congress of Chemical Engineering in Barcelona (October 1-5, 2017)

The issues of data quality and propagation of data uncertainties into process design and plant specifications are of great current interest. Hence, two Working Parties of the European Federation of Chemical Engineers (EFCE) organized a Round Table Discussion on the topic, as part of the World Congress of Chemical Engineering (WCCE10) in Barcelona, in October 2017. The discussion was guided by industrial and academic experts, with the audience as a key part of the discussion, trying to find some answers in three areas: Data acquisition and evaluation of experimental uncertainties, tools for data reconciliation to improve their quality, and impact of data uncertainties on the process at the end. Several concrete stories are presented that demonstrate the importance of considering data quality and all possible contributions to the uncertainty of chemical process design. Difficulties associated with data quality are discussed at various levels: (1) the experimentalists (measurement issues, evaluation of uncertainties, use of consistency analysis tools); (2) model developers (capture of adequate physics, parameter regression strategies, uncertainty propagation), (3) vendors of process simulation software, and (4) process engineers (who are responsible at the end). Paths for improvements were proposed through better and more efficient communication among different participants, as well as through education.

First clinical symptom as a prognostic factor in systemic sclerosis: results of a retrospective nationwide cohort study

The objective of the study is to determine the importance of the mode of onset as prognostic factor in systemic sclerosis (SSc). Data were collected from the Spanish Scleroderma Registry (RESCLE), a nationwide retrospective multicenter database created in 2006. As first symptom, we included Raynaud's phenomenon (RP), cutaneous sclerosis, arthralgia/arthritis, puffy hands, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), and digestive hypomotility. A total of 1625 patients were recruited. One thousand three hundred forty-two patients (83%) presented with RP as first symptom and 283 patients (17%) did not. Survival from first symptom in those patients with RP mode of onset was higher at any time than those with onset as non-Raynaud's phenomenon: 97 vs. 90% at 5 years, 93 vs. 82% at 10 years, 83 vs. 62% at 20 years, and 71 vs. 50% at 30 years (p < 0.001). In multivariate analysis, factors related to mortality were older age at onset, male gender, dcSSc subset, ILD, PAH, scleroderma renal crisis (SRC), heart involvement, and the mode of onset with non-Raynaud's phenomenon, especially in the form of puffy hands or pulmonary involvement. The mode of onset should be considered an independent prognostic factor in systemic sclerosis and, in particular, patients who initially present with non-Raynaud's phenomenon may be considered of poor prognosis.

Aggregation Patterns, Sampling Plan, and Economic Injury Levels for the New Citrus Pest Delottococcus aberiae (Hemiptera: Pseudococcidae)

Delottococcus aberiae De Lotto (Hemiptera: Pseudococcidae) is the latest exotic mealybug species introduced in citrus in the Mediterranean basin. It causes severe distortion and size reduction on developing fruits. Due to its first interaction with citrus, D. aberiae economic thresholds are still unknown for this crop and the current Integrated Pest Management programs have been disrupted. The objectives of this study were to determine the aggregation patterns of D. aberiae in citrus, develop an efficient sampling plan to assess its population density, and calculate its Economic and Economic Environmental Injury Levels (EIL and EEIL, respectively). Twelve and 19 orchards were sampled in 2014 and 2015, respectively. At each orchard, population densities were monitored fortnightly in leaves, twigs, and fruit, and fruit damage was determined at harvest. Our results showed a clumped aggregation of D. aberiae in all organs with no significant differences between generations on fruit. Fruit damage at harvest was strongly correlated with fruit occupation in spring. Based on these results and using chlorpyrifos as the insecticide of reference, the EIL and EEIL were calculated as 7.1 and 12.1% of occupied fruit in spring, respectively. With all this, we recommend sampling 275 fruits using a binomial sampling method or alternatively, 140 fruits with an enumerative method bimonthly between petal fall and July.

Transcriptomic analysis of wound xylem formation in Pinus canariensis

BACKGROUND

Woody plants, especially trees, usually must face several injuries caused by different agents during their lives. Healing of injuries in stem and branches, affecting the vascular cambium and xylem can take several years. In conifers, healing takes place mainly from the remaining vascular cambium in the margin of the wound. The woundwood formed in conifers during healing usually presents malformed and disordered tracheids as well as abundant traumatic resin ducts. These characteristics affect its functionality as water conductor and its technological properties.

RESULTS

In this work we analyze for the first time the transcriptomic basis of the formation of traumatic wood in conifers, and reveal some differences with normal early- and late-wood. Microarray analysis of the differentiating traumatic wood, confirmed by quantitative RT-PCR, has revealed alterations in the transcription profile of up to 1408 genes during the first period of healing. We have grouped these genes in twelve clusters, according to their transcription profiles, and have distinguished accordingly two main phases during this first healing.

CONCLUSIONS

Wounding induces a complete rearrangement of the transcriptional program in the cambial zone close to the injuries. At the first instance, radial growth is stopped, and a complete set of defensive genes, mostly related to biotic stress, are induced. Later on, cambial activity is restored in the lateral borders of the wound, even at a high rate. During this second stage certain genes related to early-wood formation, including genes involved in cell wall formation and transcription factors, are significantly overexpressed, while certain late-wood related genes are repressed. Additionally, significant alterations in the transcription profile of abundant non annotated genes are reported.

A system for finger tremor quantification in patients with Parkinson's disease

The current diagnosis of Parkinson's disease (PD) is based on a subjective assessment by the specialist. The monitoring of the tremor that presents in the hand index fingers in a patient with Parkinson's is one of the most important parameters to diagnose the evolution of the disease in an objective manner. This research analyze the tremor in the hand index fingers of patients with PD with medication and without medication. A sensor based in a triaxial accelerometer was used to acquire the data produced by the acceleration changes of parkinsonian tremor in the case of three activities: postural tremor, action tremor and rest tremor. Acquired data were processed in Matlab; the data were filtered and the spectral power density (PSD) was estimated with the Burg periodogram. It has been verified that the system presented in this article can accurately detect the parkinsonian tremors of the patients evaluated, additionally has been found that with the medication the tremors do not disappear completely, these remained with the same frequencies of PD but with a very small amplitude.

[Differential diagnosis of bone marrow and lung granulomas: Report of one case]

The differential diagnosis of pulmonary tuberculosis and lymphoma with pulmonary infiltration is very difficult, given their similar clinical characteristics. We report a 59 year old female with weight loss, fever, dyspnea and cough of several months of duration. She had a cavitated mass in lung imaging. A positive conventional PCR lead to the diagnosis of tuberculosis, but she had negative smears and cultures for Mycobacterium tuberculosis. The patient did not respond to treatment and her clinical condition worsened. A peripheral lymph node biopsy confirmed the presence of a diffuse large B cell non-Hodgkin lymphoma. Bone marrow pathology showed non caseating granulomas, again with negative microbiological tests for M. tuberculosis. Findings in the bone marrow were interpreted as a secondary sarcoid reaction to cancer and PCR results as a false positive. The lymphoma was treated, achieving complete remission. This case highlights the importance of the differential diagnosis between these two entities.

[Venezuelan consensus guidelines on the use of magnetic resonance in diagnosis and follow up of patients with multiple sclerosis]

INTRODUCTION

The clinical use of magnetic resonance (MR) in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Several groups around the world have developed consensus guidelines about the role of MR in MS at diagnosis and during follow up. However, in some regions is difficult to extrapolate the recommendations.

AIM

To provide recommendations for the implementation of MR in MS patients at diagnosis and follow up in Venezuela.

DEVELOPMENT

A group of experts from Venezuela that included neurologists and radiologists, by using the online surveys methodology as well as face to face meetings developed the intended consensus for the use of MR during the diagnosis and follow up of MS patients in Venezuela. Seventeen recommendations were established based on published evidence and the expert opinion. Recommendations focused on the role of conventional MR techniques and brain atrophy measurement in MS patients both at diagnosis and during follow-up.

CONCLUSIONS

The recommendations of this consensus guidelines attempts to optimize the health care and management of patients with MS in Venezuela.

[Chagas disease affecting the central nervous system in a patient with AIDS demonstrated by quantitative molecular methods]

Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV/AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.

A system to monitor tremors in patients with Parkinson's disease

In this work the design and development of a system to monitor tremors in patients with Parkinson's disease based on Arduino open-source prototyping platform is presented. For processing data tremors acquired by the sensor device we have developed an Android application which allows an evaluation of the state of PD patients based on three types of tests that are in the Unified Parkinson's Disease Rating Scale recommended by the Movement Disorder Society (MDS-UPDRS); the tests performed in the application are: postural tremor of the hands, kinetic tremors of the hands and resting tremor amplitude. The results of PD Patients showed that despite receiving medication to minimize symptoms of their disease, patients have a considerable tremor amplitude, which affects the normal development of their daily activities. In addition, the spectral analysis of the tremors shows that two of the patients were correctly diagnosed with PD while the third patient showed spectral characteristics which led us to suggest to the treating physician reconsider the diagnosis.

Allele frequencies and other forensic parameters of the HID-Ion AmpliSeq™ Identity Panel markers in Basques using the Ion Torrent PGM™ platform

The HID-Ion AmpliSeq™ Identity Panel amplifies 90 autosomal SNPs and 34 Y- SNPs with massively parallel sequencing (MPS) using the Ion Torrent PGM™ platform. In the present study, 105 Basques were analyzed to assess this panel. All loci were in Hardy-Weinberg equilibrium and no association between them was detected. Forensic parameters were calculated as 5.74×10^-36 for combined match probability and 99.99998% for combined power of exclusion. In conclusion, the HID Identity panel and the use of this new MPS technology are very promising tools for paternity testing and human identification in routine casework in the forensic field.

Flight behaviour and dispersal of Rhynchophorus ferrugineus (Coleoptera: Dryophthoridae) adults using mark-release-recapture method

The flight ability and patterns of an insect influence its spread, and the study of its behaviour can be used to improve the strategies to control the pest. Regarding Rhynchophorus ferrugineus (Olivier) (Coleoptera: Dryophthoridae), one of the worst threats to palm trees worldwide, laboratory experiments have been conducted to analyze their flight potential. However, these data must be complemented with tests that allow us to know its flight behaviour and dispersal patterns under field conditions. Two mark-release-recapture experiments were conducted in areas with R. ferrugineus infestations. In the first, the effects of weevil sex, temperature, solar radiation, and relative humidity, on the take-off and flight mobility of adults were analyzed. The second experiment aimed to determine the maximum flight distance covered by adults in field. The take-off rate for R. ferrugineus males was significantly greater than for females, and was positively influenced by temperature (optimum take-off around 25°C) and solar radiation, both factors being highly correlated. Female weevil recaptures were significantly higher, especially as temperatures increased (optimum recapture around 21°C). Dispersal distances of weevil adults increased when temperatures rose, and while this insect tended to fly short distances (<500 m), it was able to cover up to 7 km. The dispersal of R. ferrugineus adults mainly occurred during the first 7 days after their release, and when relative humidity increased, their dispersal time was reduced. The results obtained will permit a more effective implementation of certain measures used to control R. ferrugineus, such as olfactory trapping or intensive surveillance around pest outbreaks.

Correlation of three-liquid-phase equilibria involving ionic liquids

The difficulty in achieving a good thermodynamic description of phase equilibria is finding a model that can be extended to a large variety of chemical families and conditions. This problem worsens in the case of systems containing more than two phases or involving complex compounds such as ionic liquids. However, there are interesting applications that involve multiphasic systems, and the promising features of ionic liquids suggest that they will play an important role in many future processes. In this work, for the first time, the simultaneous correlation of liquid-liquid and liquid-liquid-liquid equilibrium data for ternary systems involving ionic liquids has been carried out. To that end, the phase diagram of the water + [P6 6 6 14][DCA] + hexane system has been determined at 298.15 K and 323.15 K and atmospheric pressure. The importance of this system lies in the possibility of using the surface active ionic liquid to improve surfactant enhanced oil recovery methods. With those and previous measurements, thirteen sets of equilibrium data for water + ionic liquid + oil ternary systems have been correlated. The isoactivity equilibrium condition, using the NRTL model, and some pivotal strategies are proposed to correlate these complex systems. Good agreement has been found between experimental and calculated data in all the regions (one triphasic and two biphasic) of the diagrams. The geometric aspects related to the Gibbs energy of mixing function obtained using the model, together with the minor common tangent plane equilibrium condition, are valuable tools to check the consistency of the obtained correlation results.

[Cotrimoxazole in bone-related infections: toxicity and clinical and economic impact]

BACKGROUND

Cotrimoxazole is a therapeutic option for bone-related infections but is associated to hyperkalemia and renal failure. Tolerance to this drug may reduce length of stay (LOS) and hospital charges.

AIMS

To evaluate renal, potassium toxicity, clinical outcome, and use of hospital resources in patients treated with cotrimoxazole for bone-related infections.

METHODS

Retrospective analysis of adult patients with bone-related infections confirmed by culture and treated with this drug. Serum potassium and creatinine levels were analyzed during follow-up and risk factors for hyperkalemia were searched. Length of stay (LOS) and hospital charges were compared. Clinical outcome was evaluated as a secondary endpoint.

RESULTS

From 2011 to 2014, 23 patients were identified (mean age 64.7 years). Diabetes mellitus, peripheral vascular disease, and previous amputations prevalence were high (82.6%, 47.8%, and 43.5%, respectively). Median serum potassium concentration increased significantly at first control (4.35 mEq/L to 4.9 mEq/L; p < 0.001), and also creatinine serum concentration (0.9 to 1.1 mg/dL; p < 0.05). Seven patients developed hyperkalemia. Cotrimoxazole was discontinued in 10 patients (43.5%), and in 6, discharge was postponed. Drugs active against the renin-angiotensin system (DAARAS) were associated with kyperkalemia (OR 10.8 IC95 1.37-85; p < 0.05). LOS was higher among patients with cotrimoxazole toxicity (median LOS 56 versus 30 days, p < 0.05). Patients with no cotrimoxazole interruption had less drug-related hospital charges (median values of 563 versus 2820 USD, respectively; p < 0.01).

CONCLUSIONS

Cotrimoxazole use must be monitored in order to detect hyperkalemia or renal toxicity and suspend its prescription. Patients that use DAARAS have a higher risk of kyperkalemia. LOS and drug-related hospital charges are reduced when patients can tolerate cotrimoxazole.

[Severe acute disseminated encephalomyelitis associated with parainfluenza 3 infection: Case report]

Disseminated encephalomyelitis (ADEM) is an infrequent condition with considerable morbidity and mortality in adult patients. It requires a high level of suspicion and diagnosis emerges by gathering clinical information, laboratory exams and images studies. ADEM is related to an immunological phenomena occurring after a bacterial/viral infection or recent vaccination. Glucocorticoids are the first line treatment, reserving immunoglobulins and plasmapheresis to refractory cases. We report a male patient aged 25, with ADEM associated to parainfluenza 3 virus respiratory infection that required mechanical ventilation and that had a complete recovery only after plasmapheresis.

[HIV/AIDS patients in a Critical Care Unit: The experience of a general hospital in a developing country]

INTRODUCTION AND AIMS

Despite general availability of HAART in Chile, admissions of HIV/AIDS patients to Intensive-Intermediate Care Units (IICU) are still happening, and a characterization of patient's profile, mortality and potentially avoidable admissions is necessary.

METHODS

Observational retrospective study in one general hospital in Chile of HIV/AIDS patients admitted to IICU during 9 years.

RESULTS

During 2005-2013, 32 patients were admitted to IICU, with 87,5% in AIDS stage, only 53,1% knew his/her condition, 43,8% were receiving HAART and 16.6% chemoprophylaxis for opportunistic infections, A CD4 count < 200/µL was registered in 75,9% of patients. Most admissions were driven by infectious conditions (84,4%) and 48,1% developed septic shock, IICU hospitalizations were motivated by respiratory failure, neurologic compromise, sepsis or a mixture of them (87,5%), By univariate analysis, admissions by respiratory failure were associated to no HAART, oral candidiasis or CD4 < 250/µL (p < 0.01). Eight patients died during their first hospitalization (25%) and other 5 in the following month after discharge. Death during hospitalization was significantly associated to vasoactive drug use ≥ 7 days (OR 16.5; IC95 2.1-128 p < 0.01). In multivariate analysis, APACHE score ≥ 18 was associated with death during hospitalization of after discharge (OR 3,3 IC95 1,1-10; p < 0,05), Four patients (12,5%) had potentially avoidable admissions.

CONCLUSIONS

Despite HAART availability in Chile, hospitalizations of patients with HIV/AIDS are still happening, affecting those that either are unaware of his/her condition, are not receiving HAART and/or chemoprophylaxis. These admissions generate premature deaths and happen even after discharge in severely ill patients.