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Medicaid reimbursements for physician services are determined by each state. However, how these reimbursements vary between states, and how these reimbursements vary in comparison to Medicare reimbursements is unknown for musculoskeletal radiology studies.To evaluate the variability in Medicaid and Medicare physician reimbursements for musculoskeletal imaging studies between states.We evaluated the Medicare and Medicaid physician reimbursements for the most commonly performed musculoskeletal radiology studies (15 radiographs and 10 MRIs) based on Medicare's 2017 National Summary Data File. Medicare and Medicaid reimbursements for these studies were compared by dollar difference (difference in reimbursement in dollars between Medicare and Medicaid). State-wide variability in these reimbursements was quantified by the coefficient of variation (COV) and by the dollar difference in reimbursement amounts. Medicaid and Medicare reimbursement rates were compared using a paired t-test, since the data was paired by state.The mean Medicaid reimbursement rates were lower for musculoskeletal radiographs (p 0.05) but higher for musculoskeletal MRI studies than the Medicare rates (p 0.05). As hypothesized, there was variation in both Medicare and Medicaid imaging reimbursements between states, however, the variation was substantially higher for Medicaid reimbursements. We found the Medicare reimbursement COV between states was 0.07 for all imaging studies, whereas the Medicaid reimbursement COV between states varied from 0.23 to 0.55 for radiographs and from 0.31 to 0.45 for MRIs.The data show that there is mild, but constant variation across imaging studies in Medicare reimbursement for musculoskeletal imaging studies between states. However, there is more variation in the Medicaid reimbursements across imaging studies and between states. More appropriate reimbursement may increase access to care for Medicaid patients.

Introduction: Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. Smell and/or taste disorders have emerged as a very frequent symptom as the disease has spread in Europe. Spain is one of the European countries with the highest number of infections. Objective: This study aimed to investigate the clinical progression of smell and taste disorders in Spanish patients with mild COVID-19. Methods: An online survey was used to conduct a cross-sectional study of patients who presented sudden smell and/or taste disorders during the 2 months of total lockdown due to COVID-19 in Spain. Results: In our sample, 91.18% of respondents with impaired smell and/or taste and who were able to undergo PCR testing were positive for SARS-CoV-2 infection. Anosmia and ageusia presented in isolation in 6.5% of participants. The remaining 93.5% presented other mild symptoms: headache (51.6%), cough (51.6%), myalgia (45.2%), asthaenia (38.7%), nasal congestion or rhinorrhoea (35.5%), fever (41.9%), low-grade fever (29.0%), odynophagia (25.8%), or diarrhoea (6.5%). The mean duration of anosmia was 8.33 days, with patients subsequently manifesting hyposmia; complete resolution occurred after a mean of 17.79 days. In 22.6% of respondents, olfactory deficits persisted. All participants recovered their sense of taste. Conclusions: Olfactory and gustatory disorders are prevalent symptoms in mild COVID-19. Most patients do not present associated nasal congestion or rhinorrhoea and a small group of patients present these alterations in isolation. Resumen: Introducción: La enfermedad por coronavirus-2019 (COVID-19), se ha expandido con gran rapidez en todo el mundo. Las alteraciones del olfato y/o gusto han emergido como un síntoma muy frecuente a medida que la enfermedad se propagó en Europa. Uno de los países con mayor número de contagios en este continente ha sido España. Objetivo: Investigar la evolución clínica de los trastornos del olfato y el gusto en la enfermedad leve por COVID-19 en pacientes españoles. Métodos: Se realizó un estudio transversal a través de encuesta on‐line, en pacientes que presentaron afección súbita del olfato y/o el gusto, durante los dos meses de confinamiento total por COVID-19 en España. Resultados: El 91,18% de los sujetos con afectación del olfato y/o el gusto, que tuvieron a acceso a la realización de PCR, fueron positivos para COVID-19. El 6,5% presentó anosmia y ageusia de forma aislada. El 93,5% manifestó otros síntomas leves asociados: cefalea (51,6%), tos (51,6%), mialgias (45,2%), astenia (38,7%), congestión nasal o rinorrea (35,5%), fiebre (41,9%), febrícula (29,0%), odinofagia (25.8%) y diarrea (6,5%). La duración media de la anosmia fue de 8,33 días, posteriormente los pacientes manifestaron hiposmia, con resolución completa en 17,79 días de media. En el 22,6% de los pacientes el déficit olfatorio persistió. Todos los sujetos recuperaron el sentido del gusto. Conclusiones: Los trastornos olfativos y gustativos son síntomas prevalentes en la infección leve por COVID-19. Gran parte de los pacientes no presentan congestión nasal o rinorrea asociada y un grupo reducido de pacientes los presentan de forma aislada.

Resumen: Introducción: La enfermedad por coronavirus-2019 (COVID-19) se ha expandido con gran rapidez en todo el mundo. Las alteraciones del olfato o gusto han emergido como un síntoma muy frecuente a medida que la enfermedad se propagó en Europa. Uno de los países con mayor número de contagios en este continente ha sido España. Objetivo: Investigar la evolución clínica de los trastornos del olfato y el gusto en la enfermedad leve por COVID-19 en pacientes españoles. Métodos: Se realizó un estudio transversal a través de encuesta on-line, en pacientes que presentaron afección súbita del olfato o el gusto, durante los 2 meses de confinamiento total por COVID-19 en España. Resultados: El 91,18% de los sujetos con afectación del olfato o el gusto, que tuvieron acceso a la realización de PCR, fueron positivos para COVID-19. El 6,5% presentó anosmia y ageusia de forma aislada. El 93,5% manifestó otros síntomas leves asociados: cefalea (51,6%), tos (51,6%), mialgias (45,2%), astenia (38,7%), congestión nasal o rinorrea (35,5%), fiebre (41,9%), febrícula (29,0%), odinofagia (25,8%) y diarrea (6,5%). La duración media de la anosmia fue de 8,33 días, posteriormente los pacientes manifestaron hiposmia, con resolución completa en 17,79 días de media. En el 22,6% de los pacientes el déficit olfatorio persistió. Todos los sujetos recuperaron el sentido del gusto. Conclusiones: Los trastornos olfativos y gustativos son síntomas prevalentes en la infección leve por COVID-19. Gran parte de los pacientes no presentan congestión nasal o rinorrea asociada y un grupo reducido de pacientes los presentan de forma aislada. Abstract: Introduction: Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. Smell and/or taste disorders have emerged as a very frequent symptom as the disease has spread in Europe. Spain is one of the European countries with the highest number of infections. Objective: This study aimed to investigate the clinical progression of smell and taste disorders in Spanish patients with mild COVID-19. Methods: An online survey was used to conduct a cross-sectional study of patients who presented sudden smell and/or taste disorders during the 2 months of total lockdown due to COVID-19 in Spain. Results: In our sample, 91.18% of respondents with impaired smell and/or taste and who were able to undergo PCR testing were positive for SARS-CoV-2 infection. Anosmia and ageusia presented in isolation in 6.5% of participants. The remaining 93.5% presented other mild symptoms: headache (51.6%), cough (51.6%), myalgia (45.2%), asthaenia (38.7%), nasal congestion or rhinorrhoea (35.5%), fever (41.9%), low-grade fever (29.0%), odynophagia (25.8%), or diarrhoea (6.5%). The mean duration of anosmia was 8.33 days, with patients subsequently manifesting hyposmia; complete resolution occurred after a mean of 17.79 days. In 22.6% of respondents, olfactory deficits persisted. All participants recovered their sense of taste. Conclusions: Olfactory and gustatory disorders are prevalent symptoms in mild COVID-19. Most patients do not present associated nasal congestion or rhinorrhoea and a small group of patients present these alterations in isolation.

Background Despite improvements in fetal survival for pregnancies that are affected by twin-twin transfusion syndrome since the introduction of laser photocoagulation, prematurity remains a major source of neonatal morbidity and death. Objective To investigate the indications and factors that influence the timing of delivery after laser treatment, we collected delivery information regarding twin-twin transfusion syndrome cases in a large multicenter cohort. Study Design Eleven North American Fetal Therapy Network centers conducted a retrospective review of twin-twin transfusion syndrome patients who underwent laser photocoagulation. Clinical, demographic, and ultrasound variables that included twin-twin transfusion syndrome stage and gestational age at treatment and delivery were recorded. Primary and secondary maternal and fetal indications for delivery were identified. Univariate analysis was used to select candidate variables with significant correlation with latency and gestational age at delivery. Multivariable Cox regression with competing risk analysis was used to determine the independent associations. Results A total of 847 pregnancies were analyzed. After laser therapy, the average latency to delivery was 10.11±4.8 weeks, and the mean gestational age at delivery was 30.7±4.5 weeks. Primary maternal indications for delivery comprised 79% of cases. The leading indications included spontaneous labor (46.8%), premature rupture of membranes (17.1%), and placental abruption (8.4%). Primary fetal indications accounted for 21% of cases; the most frequent indications included donor nonreassuring status (20.5%), abnormal donor Doppler evaluations (15.1%), and donor growth restriction (14.5%). The most common secondary indications for delivery were premature rupture of membranes, spontaneous labor, and donor growth restriction. Multivariate modeling found gestational age at diagnosis, stage, history of previous amnioreduction, cerclage, intertwin membrane disruption, procedure complications, and chorioamniotic membrane separation to be predictors for both gestational age at delivery and latency. Conclusion Premature delivery after laser therapy for twin-twin transfusion syndrome is primarily the result of spontaneous labor, preterm premature rupture of membranes, and nonreassuring status of the donor fetus. Placental abruption was found to be a frequent complication that resulted in early delivery. Future research should be directed toward the goal of prolonging gestation after laser photocoagulation to further reduce morbidity and mortality rates that are associated with twin-twin transfusion syndrome.

Background The aim of the article was to determine if anatomical findings on fetal magnetic resonance imaging (MRI) of venolymphatic malformations of the face and neck (VLMFN) can be used to create a staging system predictive of airway outcomes. Methods We reviewed 13 fetuses evaluated for VLMFN. Stage was assigned based on anatomical findings on fetal MRI. Stage I: no evidence of polyhydramnios with free egress of amniotic fluid and clear visualization of the aryepiglottic folds and larynx. Stage II: lesions of the tongue or epiglottis but with normal aryepiglottic folds without polyhydramnios. Stage III: lesions of the tongue or larynx; nonvisualization of the aryepiglottic folds without free egress of amniotic fluid along with polyhydramnios. Results Six met stage I criteria with no airway involvement, nor any subsequent issues. Two met stage II criteria and were managed by ex-utero intrapartum therapy and intubated. One had minimal involvement of the upper airway, was extubated, and had no subsequent issues. Child two had involvement of the tongue and larynx and received a tracheostomy. Five were assigned stage III, delivered by ex-utero intrapartum therapy and intubated. Postnatal evaluation showed involvement of the upper airway by the lesion and was managed with tracheostomy. All treated by tracheostomy remain cannulated because of persistent symptomatic lesions at follow-up (relative risk 4.0; confidence interval 1.2-13.3). Median follow-up was 4 y (range 2-7 y). Conclusions Although numbers are small, data suggest anatomical details obtained by antenatal fetal MRI appear to correlate with airway outcomes in children affected by a VLMFN. This information may be useful when counseling expectant families of affected fetuses.

Purpose Pre and post-operative administration of sevoflurane in myocardial revascularization surgery provides enhanced cardioprotective effects exerted by pharmacologic pre- and post-conditioning, as compared to propofol. The identification of the enzymes involved in conditioning mechanisms is crucial to the understanding of the effects of sevoflurane in cardiac surgery patients. The impact of sevoflurane on another crucial target organ—the kidney—was also assessed. Methods Ninety patients undergoing off-pump myocardial revascularization surgery were allocated to receive either intra- and postoperative sevoflurane (SS), intraoperative sevoflurane and postoperative propofol (SP), or intra- and postoperative propofol (PP)). Troponin I and hemodynamic parameters were monitored during the first 48 postoperative hours; blood and urine samples were collected at baseline and at 24h to determine Akt, ERK1/2, PKG, iNO, bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. Results The enzymes were overexpressed in the SS group, remained unchanged in the SP group, and decreased in the PP group. Renal function was best preserved in the SS group. Conclusions The overexpression of enzymes induced by intraoperative anesthesia and postoperative sedation with sevoflurane reduces myocardial damage and improves renal function in patients undergoing off-pump myocardial revascularization surgery.

Transgenic corn and cotton expressing Cry and/or Vip3Aa proteins from Bacillus thuringiensis (Bt) have been planted for managing lepidopteran and coleopteran insect pests for more than two decades in the U.S. Evolution of insect resistance to these Bt proteins is a major threat for the continued efficacy of Bt technology. Understanding patterns of cross-resistance and dominance of resistance in target insects is essential for resistance management and pest control. The bollworm, also called corn earworm, Helicoverpa zea (Boddie), is a major target pest of pyramided Bt crops in the U.S. In this study, we evaluated the responses of Cry2Ab2-resistant (RR), susceptible (SS), and heterozygous (RS) strains of H. zea to the Cry1Ac, Cry1A.105, Cry2Ab2 and Vip3Aa39 proteins using diet-overlay bioassays. The Cry2Ab2-resistant H. zea also possessed high levels of resistance to Cry1Ac and Cry1A.105, but were very susceptible to Vip3Aa. The resistance to Cry1 and Cry2 proteins in RR H. zea varied from incompletely recessive to completely dominant depending on the protein concentration. These data suggest that the RR H. zea possess multiple non-recessive resistance to Cry1/Cry2 proteins. These results have significant implications for understanding field-evolved resistance of H. zea to Cry1 and Cry2 proteins in U.S. Bt corn and cotton fields and should contribute to developing effective management strategies for control of H. zea.

Purpose Aflibercept has the potential advantage of reducing capacity problems by allowing 2 monthly visits for patients with neovascular macular degeneration (nAMD) compared with monthly pro re nata regimens that are the most commonly used in the United Kingdom. This study aimed to report the visual outcomes achieved in routine clinical practice using the VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD (VIEW) protocol at 1 year and compare with trials data and other real-world reports. Design Retrospective data analysis from an electronic medical record. Participants Consecutive series of treatment-naive patients initiated on aflibercept for nAMD at least 1 year before data extraction. Methods Data were anonymized and remotely extracted from 16 centers in the United Kingdom that use the same electronic medical record (EMR) system (Medisoft Ophthalmology; Medisoft Limited, Leeds, UK). Main Outcome Measures The minimum data set defined before first data entry and mandated by the EMR included age, gender, visual acuity, injection episodes, and complications. Results The mean age was 80.0 years (median, 81.0 years) and 63.7% were women. During the first year of treatment with aflibercept, 1840 treatment-naive eyes of 1682 patients received a median of 8 (mean, 7.0) injections at a median of 8 (mean, 7.3) visits. The mean baseline visual acuity was 53.7 letters, improving to 58.8 letters (+5.1-letter gain) at 1 year. In first-treated eyes, the respective figures were 52.7 letters at baseline and 58.2 letters at 1 year, a gain of +5.5 letters. The proportion achieving 70 letters or more increased from 16.4% at baseline to 33.7% at 1 year, and 92% avoided moderate visual loss at 1 year. Conclusions The visual acuity outcomes are comparable to randomized trials and better than many previous real-world data collections, with a mean +5.1-letter gain at 1 year compared with +8.4 letters in the integrated analysis of the VIEW 1 and VIEW 2 studies. Early visual gains were maintained through the year. Collection of outcomes beyond clinical trials can have limitations but better reflect the full pool of patients actually treated and are important to determine whether a particular treatment is performing as expected. Such data also have the potential to improve services by setting up a mechanism to compare sites.

Neurogenic stunned myocardium is an unusual clinical entity. It mimics an acute coronary syndrome with electrocardiographic abnormalities, cardiac dysfunction and elevated cardiac enzymes with absence of obstructive coronary disease. It may occur after a neurosurgical procedure. A case is presented of neurogenic stunned myocardium occurring in a child after removal of a posterior fossa medulloblastoma. The patient developed nodal tachycardia with hemodynamic impairment. The clinical course was satisfactory due to antiarrhythmic therapy, with biochemical, echocardiographic, and clinical improvement within a week.

Live attenuated Leishmania donovani parasites such as LdCen(-/-) have been shown elicit protective immunity against leishmanial infection in mice and hamster models. Previously, we have reported on the induction of strong immunogenicity in dogs upon vaccination with LdCen(-/-) including an increase in immunoglobulin isotypes, higher lymphoproliferative response, higher frequencies of activated CD4(+) and CD8(+) T cells, IFN-γ production by CD8(+) T cells, increased secretion of TNF-α and IL-12/IL-23p40 and, finally, decreased secretion of IL-4. To further explore the potential of LdCen(-/-) parasites as vaccine candidates, we performed a 24-month follow up of LdCen(-/-) immunized dogs after challenge with virulent Leishmania infantum, aiming determination of parasite burden by qPCR, antibody production (ELISA) and cellular responses (T cell activation and cytokine production) by flow cytometry and sandwich ELISA. Our data demonstrated that vaccination with a single dose of LdCen(-/-) (without any adjuvant) resulted in the reduction of up to 87.3% of parasite burden after 18 months of virulent challenge. These results are comparable to those obtained with commercially available vaccine in Brazil (Leishmune(®)). The protection was associated with antibody production and CD4(+) and CD8(+) proliferative responses, as well as T cell activation and significantly higher production of IFN-γ, IL-12/IL-23p40 and TNF-α, which was comparable to responses induced by immunization with Leishmune(®), with significant differences when compared to control animals (Placebo). Moreover, only animals immunized with LdCen(-/-) expressed lower levels of IL-4 when compared to animals vaccinated either with Leishmune(®) or PBS. Our results support further studies aiming to demonstrate the potential of genetically modified live attenuated L. donovani vaccine to control L. infantum transmission in endemic areas for CVL.

BACKGROUND The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown. METHODS Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score. RESULTS At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV 1 ), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George's Respiratory Questionnaire score). Risks were similar for those with and without COPD. CONCLUSIONS Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.

Resumen: Introducción: El objetivo del presente trabajo es demostrar si la aplicación del índice biespectral (BIS®) en la monitorización de la anestesia general en respiración espontánea en endoscopias digestivas altas (EDA) diagnósticas en el paciente pediátrico es útil para: a) disminuir la dosis de fármaco necesaria; b) disminuir el tiempo del despertar, y c) mejorar la seguridad del paciente. Pacientes y método: estudio prospectivo cuasi experimental de casos y controles en el ámbito de una unidad de cuidados intensivos pediátricos y neonatales de segundo nivel. Pacientes: niños entre 12 meses y 13 años. Caso: paciente ASA I que precisa EDA diagnóstica; sujetos elegibles 36, participantes 30. Población control: serie histórica de pacientes que precisaron EDA (años 2008-2010): 50 pacientes. Intervenciones: realización de EDA, aplicando protocolo de anestesia, monitorización de constantes vitales, nivel de sedación (escala de Ramsay) y nivel BIS. Variables de interés: dosis total de propofol (mg/kg), tiempo de inducción, tiempo de EDA y tiempo de despertar (min); índice BIS al inicio de la EDA (BISi) y durante la EDA; efectos adversos. Resultados: Sin diferencias significativas entre casos (B) y controles (C) respecto a sexo, edad y peso. Sin diferencias significativas en: dosis total de propofol (B 4,9 ± 1,4 mg/kg; C 5,2 ± 1,6 mg/kg, p = 0,492), Tiempo de despertar (B 12,2 ± 4,6 min; C 12,8 ± 4,4 min, p = 0,402), tiempo de procedimiento (B 9,5 ± 4,8 min; C 11,3 ± 6,5 min, p = 0,335) y tiempo de inducción (B 11,1 ± 2,6 min; C 10,1 ± 4,2 min, p = 0,059). BISi 55,4 ± 6,9. Sin diferencias significativas en efectos adversos (2 casos de desaturación leve en el grupo control). Conclusiones: La monitorización anestésica con índice biespectral en endoscopias digestivas altas en respiración espontánea en la población pediátrica es factible, pero no parece disminuir ni la dosis de fármaco necesaria ni el tiempo de despertar. Tampoco disminuye la incidencia de efectos adversos de forma significativa. Abstract: Introduction: The objective of this investigation is to determine whether bispectral index (BIS®) monitoring during intravenous anaesthesia with spontaneous breathing for upper gastrointestinal endoscopy (UGE) in a pediatric population is useful for: a) decreasing the amount of drug, b) decreasing the time for awakening, and c) improving patient safety. Patients and method: A quasi-experimental case-control prospective study was conducted in the setting of a second level hospital pediatric intensive care unit. Patients: Children aged 1-13 years. Case: ASA I patient who needed a diagnostic UGE; eligible, 36, participants, 30. Control: historical cohort of patients who needed UGE (years 2008-2010): 50 patients. Intervention: UGE performed with anaesthetic protocol, vital signs monitoring, sedation level (Ramsay scale) and BIS monitoring. Variables of interest: propofol total dose (mg/kg), induction time, time in performing the UGE, awakening time (min); initial BIS (iBIS), and BIS during the UGE; adverse effects. Results: There were no significant differences in sex, age or weight between case (B) and control (C) population. No significant differences in total propofol doses: (B 4.9 ± 1.4 mg/kg; C 5.2 ± 1.6 mg/kg, P=.492), awakening time (B 12.2 ± 4.6 min; C 12.8 ± 4.4 min, P=.402), time for execution of UGE (B 9.5 ± 4.8 min; C 11.3 ± 6.5 min, P=.335) and induction time (B 11.1 ± 2.6 min; C 10.1 ± 4.2 min, P=.059), iBIS 55.4 ± 6.9. There were no significant differences in adverse effects: 2 patients suffered from mild desaturation in the control group. Conclusions: BIS monitoring for diagnostic UGE in spontaneous breathing in a pediatric population is feasible, but does not appear to decrease awakening time or the amount of propofol needed. Furthermore, there was no statistically significant decrease in the number of adverse effects.

Zoonotic visceral leishmaniasis, caused by the intracellular protozoan parasite Leishmania infantum, is a neglected tropical disease that is often fatal when untreated. Dogs are considered the main reservoir of L. infantum in zoonotic VL as the presence of infected dogs may increase the risk for human infection. Canine visceral leishmaniasis (CVL) is a major veterinary and public health problem in Southern Europe, Middle East and South America. Control of animal reservoirs relies on elimination of seropositive dogs in endemic areas. However, treatment of infected dogs is not considered a favorable approach as this can lead to emergence of drug resistance since the same drugs are used to treat human infections. Therefore, vaccination against CVL remains the best alternative in control of the animal reservoirs. In this study, we present data on the immunogenicity profile of a live attenuated parasite LdCen(-/-) in a canine infection model and compared it to that of Leishmune(®), a commercially available recombinant vaccine. The immunogenicity of the LdCen(-/-) parasites was evaluated by antibody secretion, production of intracytoplasmic and secreted cytokines, activation and proliferation of T cells. Vaccination with LdCen(-/-) resulted in high immunogenicity as revealed by the higher IgGTotal, IgG1, and IgG2 production and higher lymphoproliferative response. Further, LdCen(-/-) vaccinated dogs showed higher frequencies of activated CD4+ and CD8+ T cells, IFN-γ production by CD8+ T cells, increased secretion of TNF-α and IL-12/IL-23p40 and decreased secretion of IL-4. These results contribute to the understanding of immunogenicity elicited by live attenuated L. donovani parasites and, consequently, to the development of effective vaccines against visceral leishmaniasis.

Guabiraba, Rodrigo Campanha-Rodrigues, Ana Lucia Souza, Adriano L S Santiago, Helton C Lugnier, Claire Alvarez-Leite, Jacqueline Lemos, Virginia S Teixeira, Mauro M Netherlands Eur J Pharmacol. 2010 May 10;633(1-3):85-92. doi: 10.1016/j.ejphar.2010.01.021. Epub 2010 Feb 10.; International audience; Reactive oxygen species, cytokines and chemokines produced at inflammatory sites are pivotal events in the progression of many diseases. Flavonoids are well-known for their antioxidant and anti-inflammatory activities. Here, we investigated the effects of the flavonoid dioclein on the production of mediators of inflammation in vitro and possible underlying mechanisms. Murine macrophages were pretreated with dioclein, rolipram, a PDE4 (cyclic nucleotide phosphosdiesterase type 4) inhibitor, or butylated hydroxytoluene (BHT), an antioxidant, and then activated with LPS or LPS/IFN-gamma. The concentration of TNF-alpha, IL-6, CXCL1/KC, CCL2/JE, and nitric oxide (NO) was determined on culture supernatants. To evaluate potential mechanisms of action, dioclein was tested for inhibition of PDE4 activity and for antioxidant properties by chemiluminescence assays. Dioclein was efficient in reducing the production of cytokines, chemokines and NO in a concentration-dependent manner (from 5 to 50muM). Dioclein was more effective than BHT and rolipram, while having similar inhibitory effects to the combination of BHT plus rolipram. Dioclein inhibited PDE4 activity with an approximate IC(50) of 16.8+/-1.4muM and strongly reduced the concentration of reactive oxygen species in cell and cell-free systems, being more effective than the standard antioxidant BHT. The flavonoid dioclein possesses significant antioxidant and PDE4 inhibitory activity, showing that the substance may have substantial advantages over mechanisms of action already described for many flavonoids. Such effects account for the anti-inflammatory effects of dioclein, mainly by reducing the concentration of mediators of inflammation, such as cytokines, chemokines and reactive oxygen species by macrophages.

El objetivo del tratamiento quirurgico para la esco-liosis, cifosis y otro tipo de deformidades del raquis esla fusion de las vertebras para que la columna verte-bral no pueda curvarse. Se colocan implantes metali-cos (barras, tornillos, alambres, placas, etc.), paramantener el raquis mientras las vertebras se fusionan.La artrodesis vertebral se potencia con injerto (autoge-nico y/o alogenico) de hueso. El abordaje quirurgicopuede ser posterior, anterior o combinacion de ambos.La cirugia toracoscopica se puede utilizar en el abor-daje anterior del raquis dorsal.La cirugia correctora del raquis en pediatria y adultoses un procedimiento prolongado (en general mas de 4horas), tiene las complicaciones potenciales de la ciru-gia mayor (hemorragia grave, hipotermia, infeccion,embolismo graso o aereo, hipotension arterial, etc.)

The horizontal transmission capacity of the autochthonous Metarhizium anisopliae strain EAMa 01/58-Su among Ceratitis capitata adults was evaluated in laboratory tests. Males and females inoculated either with dry conidia or with wet conidia became infected exhibiting 95.0–100.0% mortality rates with mycosis and Average Survival Time values of 8.30–9.30 days. Both the inoculation method and the sex, however, had a significant effect on the effectiveness of transmission; thus, inoculation with dry conidia resulted in higher transmission rates than inoculation with wet conidia. In both inoculation methods, the male-to-female rate of transmission ranging between 90.0% (wet) and 100.0% (dry) was higher than the female-to-male rate, which varied from 60.0% (wet) to 90.0% (dry). While the effectiveness of transmission was highly correlated with the sexual proportion between inoculated males and clean females, the mean number of females infected by males tended to be constant (4.5–5.5). SEM micrographs of clean C. capitata females than had been paired during 24 h with inoculated males revealed the presence of conidia in the dorsal thoracic and abdominal sclerites, with many conidia either germinated or not being observed in the female ovipositor. The horizontal transmission potential of M. anisopliae strain EAMa 01/58-Su was evaluated against C. capitata in cage experiments using an experimental autoinoculation device consisting of a plastic mineral water bottle. Adults of C. capitata of both sexes entered and exited the autoinoculation device for the 48 h of exposure and became infected with the fungus with 100.0% male and female mortality followed by mycosis. Moreover, adults of C. capitata that were maintained for 48 h in contact with the autoinoculation device transmitted the fungal inoculum to clean adults of the opposite sex, with 95.0% mortality rates of clean males or females. These results reveal the relevant contribution that horizontal transmission has on the overall efficacy of fungal treatment for medflies, and they indicate that medflies might potentially be controlled through the use of EAMa 01/58-Su strain in an autoinoculation device.

Intracellular replication of Toxoplasma gondii requires cholesterol uptake by host cell low-density lipoprotein receptor (LDLr), a critical element in atherosclerosis. We evaluated host parasitism, inflammatory responses and development of atherosclerosis in LDLr knockout (LDLr(-/-)) and their controls C57BL/6 mice infected with T. gondii. Our results show that T. gondii cysts were reduced in LDLr(-/-) mice when compared to C57BL/6 mice. However, in presence of hypercholesterolemic diet, parasite growth in LDLr(-/-) mice was similar to that seen in infected C57BL/6 mice. In presence of a hypercholesterolemic diet, T. gondii infection leads to a 60% reduction of serum triacylglycerol, total and atherogenic lipoprotein cholesterol. When aortic valve lesion was analyzed, infected mice showed a reduction of atherosclerotic lesion area as well as CD36 expression. MCP-1, SRA-I, SRA-II, ICAM-1 and VCAM-1 mRNA expression was kept similar between infected and control groups. Thus, despite the intense inflammatory process, the drastic reduction in serum lipids seems to limit the development of atherosclerosis in LDLr(-/-) mice infected with T. gondii. In conclusion, our results indicate that T. gondii employs host LDLr to acquire cholesterol and favor its growth. However, in the presence of hypercholesterolemia, T. gondii parasites are able to acquire cholesterol-rich lipoproteins through an alternative host receptor, and overcome LDLr deficiency, favoring host parasitism and impairing lipid loading of foam cells.

Passive samplers with polyurethane disks (PUF) were applied in the determination of the concentration of polycyclic aromatic hydrocarbons (PAHs) in ambient air in six residential areas in the Philippines during four simultaneous sampling periods. The uptake profiles of PAHs were determined at one site during one sampling period. Most of the PAHs that were detected in air at concentrations that were significantly higher than their analytical detection limits exhibited a linear uptake trend on the PUF disk. The linear uptake profiles of some high molecular weight (HMW) PAHs were not established and this is attributed to the low concentration of the compounds in air in the gaseous phase. The retention concentrations of phenanthrene-d-10 were determined after depuration in four sampling sites during two sampling periods. The sampling rate for phenanthrene-d-10 was calculated at the linear phase of the uptake using the k A derived from depuration experiments and the relationship of k A and sampling rate which was established in a previous passive sampling study. The average sampling rate obtained for phenanthrene d-10 (2.94±0.69 m 3 d −1 ) was applied for derivation of the concentrations of the PAHs in the field samples. The passive sampler with PUF disk and short integration time of 42–56 days is applicable for the derivation of the concentrations of PAHs in ambient air in the Philippines. The concentrations of the organic pollutants derived from the passive sampler showed variability for the six residential areas; reflecting the influence of possible sources of emission of the pollutants at the sites at the different sampling periods. The weather conditions, including the occurrence of a tropical cyclone, increased rainfall and high-relative humidity during the rainy season, had an influence on the concentrations of PAHs derived by the passive sampler.

Encephalitis rarely occurs during acute Trypanosoma cruzi infection. However, the central nervous system (CNS) is the major site of infection reactivation in immunocompromised patients. We show that the acute T. cruzi-triggered CD8-enriched meningoencephalitis paralleled the in situ expression of CCL3/MIP-1alpha and CCL5/RANTES mRNA. The frequency of CCR5-bearing cells was increased among peripheral blood mononuclear cells (PBMC) of infected mice. Further, CCL5/RANTES-driven in vitro PBMC migration was partially abrogated by the CCR1/CCR5 antagonist Met-RANTES. However, Met-RANTES treatment of infected mice altered neither parasitism nor intensity and nature of the CNS inflammation, indicating that T. cruzi-elicited meningoencephalitis is a CCR1/CCR5 independent process.

Chagas' disease, caused by Trypanosoma cruzi, is a major cause of cardiovascular disease in Latin America. Exacerbated inflammation disproportional to parasite load characterizes chronic myocardial lesions in chagasic patients. Chemokines and their receptors are expected to account for the renewed inflammatory processes after the inoculation of the parasite, but their potential unique functions are far from being clear. Herein, we evaluated the effect of a DNA vaccine encoding CCL4/MIP-1beta, a CC-chemokine, in T. cruzi-elicited myocarditis in rats. Holtzman rats were given intramuscularly cardiotoxin and the CCL4/MIP-1beta DNA-containing plasmid (100microg) was delivered in this muscular site four times. Fourteen days after last immunization, animals were inoculated with a myotropical CL-Brener T. cruzi clone. Peak of parasitism was observed at day 15 after infection, preceding the peak of myocardial inflammation at day 20. Myocarditis was still intense at day 30, but the inflammatory infiltrates showed a more focal distribution. The expression of CCL2/MCP-1 and CCL4/MIP-1beta correlated closely with the kinetics of myocardial inflammation. The CCL4/MIP-1beta DNA vaccine induced an increase of the levels of the anti-CCL4/MIP-1beta observed in T. cruzi-infected animals. This was associated with an exacerbation of myocardial inflammation and fibrosis, although alterations in parasitemia and myocardial parasitism were not observed. Our data suggest that CCL4/MIP-1beta plays a role in preventing excessive inflammation and pathology rather than in controlling parasite replication.

We investigated the role of the platelet activation factor (PAF) receptor (PAFR) in the outcome of infection with Leishmania amazonensis. PAFR deficient (PAFR(-/-)) mice were infected with L. amazonensis and the course of infection was followed. We found that PAFR(-/-) mice in the C57BL/6 background were more susceptible to infection with L. amazonensis than the wild-type controls, as seen both by lesion size and parasite number at the site of infection. Interferon (IFN)-gamma production was delayed in PAFR(-/-) mice, and lower levels of Ccl5 were found in lesions. Expression of nitric oxide synthase-2 mRNA was found impaired in PAFR(-/-) associated with higher levels of arginase-1 mRNA. Moreover, higher levels of antibodies were produced in response to L. amazonensis by PAFR(-/-) mice. We conclude that signaling through the PAFR is essential for the ability of the murine host to control L. amazonensis infection by driving an adequate immune response.

As part of a 3-fold approach to select potential mycoinsecticides for whitefly control, we evaluated infectivity, thermal requirements, and toxicogenic activity of the entomopathogenic fungus Beauveria bassiana (Ascomycota: Clavicipitaceae) under laboratory conditions. Twenty-five native B. bassiana isolates and a commercially available mycoinsecticide (based on B. bassiana) were evaluated for virulence to fourth instar nymphs of sweetpotato whitefly, Bemisia tabaci, and greenhouse whitefly, Trialeurodes vaporariorum, at a concentration of 1 × 107 conidia/ml. All isolates were pathogenic for both whitefly species, whereas mortality rates varied from 3 to 85%. A second series of bioassays was conducted on 10 selected isolates using four 10-fold concentrations ranging from 1 × 105 to 1 × 108 conidia/ml. Median lethal concentrations (LC50) of the four most virulent isolates varied from 1.1 × 105 to 6.2 × 106 conidia/ml and average survival time (AST) of treated nymphs from 5.9 to 7.4 days. T. vaporariorum were significantly more susceptible to all B. bassiana isolates than B. tabaci. The thermal biology of the eight most virulent isolates to both whitefly species was investigated at six temperatures (10–35 °C). The colony radial growth rate was estimated from the slope of the linear regression of colony radius on time and data were then fitted to a modified generalized β function that accounted for 90.5–99.3% of the data variance. Optimum temperatures for extension rate ranged from 23.1 to 27.1 °C, whereas maximum temperatures for fungal growth varied from 31.8 to 36.6 °C. On the basis of their virulence and thermal requirements, three isolates showed promise as candidates for whitefly management in Mediterranean greenhouses. Whilst in vitro production of macromolecular compounds toxic to Galleria mellonella larvae was not a requisite for virulence, ASTs of larvae injected with Sephadex G-25 fractions from candidate isolates ranged from 1.4 to 3.7 days compared with 5–6 days for non-toxic G-25 fractions. In addition, proteinase K treatment significantly reduced their toxic activity suggesting that they were proteins and revealing the potential of these isolates to be further improved through biotechnology to kill the pest more quickly.

Objetivo Analizar las frecuencias de mutaciones geneticas en alcohol deshidrogenasa (ADH), aldehido deshidrogenasa (ALDH) y citocromo P450 2E1 (CYP2E1) y establecer su posible asociacion con el desarrollo de hepatitis alcoholica aguda (HAA). Metodologia Estudio de casos-control en un total de 85 pacientes espanoles. Distinguimos tres grupos (un grupo de casos y dos grupos control) en funcion de lesion histologica hepatica y consumo de alcohol: controles (grupo 1: abstemios; grupos 2: bebedores sin HAA; casos: grupo 3: bebedores con HAA). El diagnostico de caso se establecio en base a la presencia de infiltrado de leucocitos polimorfonucleares en el estudio histologico. Analizamos mediante reaccion en cadena de la polimerasa (PCR) y electroforesis capilar la presencia de las mutaciones geneticas R47H y R369C (ADH2), E487K (ALDH2) y la mutacion Rsa I de CYP2E1 (alelo c2). Resultados El alelo c2 de CYP2E1 se hallo en el 10%, 16% y 50% de los pacientes de los grupos 1, 2 y 3, respectivamente. La presencia de la mutacion Rsa I mostro influencia sobre el desarrollo de HAA (odds ratio [OR]: 3,63; intervalo de confianza [IC] del 95%: 0,88-15,02). Conclusiones Los datos sugieren una posible asociacion entre la presencia de la mutacion Rsa I de CYP2E1 y el desarrollo de HAA en pacientes con consumo cronico de alcohol.

The purpose of this study was to evaluate the prevalence of hepatitis B and hepatitis C virus co-infection among pregnant women who are infected by human immunodeficiency virus and who attend an obstetric complications prenatal clinic.A de-identified research obstetric human immunodeficiency virus database was reviewed regarding patient demographic characteristics, risk factors for infection, history of sexually transmitted diseases, and initial CD4 count.Four hundred fifty-five women who are infected with human immunodeficiency virus with 572 pregnancies were delivered over 11 years. The overall prevalence of human immunodeficiency virus and hepatitis B or C virus co-infection in our population was 6.3%. More specifically, 1.5% was co-infected with hepatitis B virus, and 4.9% was co-infected with hepatitis C virus. Patients with hepatitis virus were more likely to use intravenous drugs (52% vs 18%; P.01) and alcohol (38% vs 5%; P.01). Co-infected patients were older (28 vs 25.6 years; P=.04), but there were no racial differences. Median baseline CD4 counts in hepatitis B virus co-infected patients were significantly lower (310 cells/mm3) than those in either hepatitis C virus co-infected patients (453 cells/mm3) or patients who were not co-infected with human immunodeficiency virus (414 cells/mm3).One of 16 pregnant women who were infected with human immunodeficiency virus was co-infected with hepatitis B or hepatitis C virus. Hepatitis B co-infections appear to be associated with more compromised immune status in our cohort.

During its 48-h asexual life cycle within human erythrocytes, Plasmodium falciparum grows to many times its own size and divides to produce 16-32 new parasites. This rapid multiplication requires active synthesis of new membranes and is fueled by phospholipid precursors and fatty acids that are scavenged from the human host. Plasmodium membrane biogenesis relies heavily on the expression of parasite enzymes that incorporate these precursors into phospholipids. However, little is known about the genes involved in membrane biogenesis or where this process takes place within the parasite. Here, we describe the analysis in P. falciparum of the first step of phospholipid biosynthesis that controls acylation of glycerol 3-phosphate (GPAT) at the sn-1 position. We show that this activity is of parasite origin and is specific for glycerol 3-phosphate substrate. We have identified the gene, PfGAT, encoding this activity in P. falciparum and reconstituted its codon composition for optimal expression in the yeast Saccharomyces cerevisiae. PfGAT complements the lethality of a yeast double mutant gat1Deltagat2Delta, lacking GPAT activity. Biochemical analysis revealed that PfGatp is a low affinity GPAT enzyme with a high specificity for C16:0 and C16:1 substrates. PfGatp is an integral membrane protein of the endoplasmic reticulum expressed throughout the intraerythrocytic life cycle of the parasite but induced mainly at the trophozoite stage. This study, which describes the first protozoan GPAT gene, reveals an important role for the endoplasmic reticulum in the initial step of Plasmodium membrane biogenesis.

Objetivos . El valor del electrocardiograma en el estudio del riesgo cardiovascular es controvertido en la poblacion general. Aunque sus alteraciones tienen valor pronostico en algunos grupos de riesgo elevado, no se conoce su valor en la poblacion diabetica. El objetivo de este trabajo es estudiar el valor pronostico de los trastornos del electrocardiograma en diabeticos de tipo 2 libres de enfermedad cardiovascular conocida. Metodos . Se ha realizado seguimiento a 221 pacientes diabeticos tipo 2 menores de 80 anos y libres de enfermedad cardiovascular, extraidos de toda la poblacion diabetica conocida de dos centros de salud de una misma poblacion. Se ha realizado electrocardiograma anual y se ha estudiado segun una clasificacion derivada del codigo Minnesota. Se ha analizado la capacidad de los trastornos de electrocardiograma para predecir la aparicion de eventos cardiovasculares, comparandola con el valor predictivo de los factores de riesgo clasicos. Resultados . El 44,3% de los pacientes diabeticos sin eventos previos tenian un electrocardiograma anormal. Treinta y tres pacientes (15,9%) tuvieron eventos cardiovasculares en el seguimiento. El riesgo relativo de quienes tenian un electrocardiograma anormal era de 8,28, (intervalo de confianza 3,36-20,42). La hipertension arterial mostro un incremento del riesgo (2,29, intervalo de confianza 1,24-4,22), pero no los demas factores de riesgo. El electrocardiograma fue un predictor independiente de riesgo cuando se hacia analisis multivariado incluyendolo con lo demas factores de riesgo. Conclusion . La aparicion de trastornos del electrocardiograma en pacientes diabeticos de tipo 2 libres de enfermedad cardiovascular conocida predice la aparicion de eventos cardiovasculares, y lo hace con mayor potencia que los factores de riesgo clasicos. Este hecho debe tenerse en cuenta a la hora de estratificar el riesgo de estos enfermos, prevenirlo y planificar su atencion sanitaria.

Objetivos Describir la situacion clinica y el estado funcional de los pacientes con diagnostico previo de cancer e identificar diferencias de dichos parametros en funcion de variables demograficas y de la localizacion tumoral. Metodologia Se revisaron las historias clinicas de todos los canceres prevalentes en adultos en el Area de Salud de Guadalajara (133.539 mayores de 14 anos). Se identifico su estado clinico segun grado de actividad o invasividad y de su situacion funcional y capacidad ambulatoria segun escala ECOG (Eastern Cooperative Oncology Group). Se establecio la comparacion de dichos parametros en funcion de localizacion tumoral y el sexo. Se procedio al analisis de diferencias mediante tecnica de Chi cuadrado e intervalos de confianza al 95%. Resultados Se estudiaron 2.595 pacientes con 2.717 neoplasias distintas que corresponden el 56,8% (1.543 tumores) a varones y el 43,2% (1.174) a mujeres. Las localizaciones mas frecuentes se produjeron en mama, prostata, vejiga y colon. En un 25% de los casos no existieron datos actualizados de la situacion clinica. En el 50,3% de los casos no hubo actividad tumoral, siendo este porcentaje mas alto en mujeres (p Conclusiones El antecedente diagnostico de cancer se produce en un 2% de la poblacion adulta. La mayor parte de los pacientes (casi tres cuartas partes) estan totalmente asintomaticos y con total capacidad ambulatoria, no requiriendo cuidados asistenciales especiales. La proporcion de pacientes con cancer en situacion clinica invasiva o terminal es escasa.

The diagnostic imaging of osteomyelitis can require the confluence of multiple imaging technologies. Conventional radiography should always be the first imaging modality. Sonography is most useful in the diagnosis of fluid collections in a joint or in the extra-articular soft tissues but is not useful for evaluating presence of osseous infection. CT scan can be a useful method to detect early osseous erosion and to document the presence of sequestrum, foreign body, or gas formation but generally is less sensitive than other modalities for the detection of bone infection. Nuclear medicine and MRI are the most sensitive and most specific imaging modalities for the detection of osteomyelitis. Nuclear medicine is particularly useful in identifying multifocal involvement, which is common in children. MRI provides more accurate information of the local extent of the soft tissues and possible soft tissue abscess in patients with musculoskeletal infection.

Notch receptors modulate transcriptional targets following the proteolytic release of the Notch intracellular domain (NotchIC). Phosphorylated forms of NotchIC have been identified within the nucleus [1, 2] and have been associated with CSL members [3, 4], as well as correlated with regions of the receptor that are required for activity [4, 5]. Genetic studies have suggested that the Drosophila homolog of glycogen synthase kinase-3β (GSK3β), Shaggy, may act as a positive modulator of the Notch signaling [6, 7]. GSK3β is a serine/threonine kinase and is a component of the Wnt/wingless signaling cascade [8]. Here, we observed that GSK3β was able to bind and phosphorylate Notch1IC in vitro, and attenuation of GSK3β activity reduced phosphorylation of NotchIC in vivo. Functionally, ligand-activated signaling through the endogenous Notch1 receptor was reduced in GSK3β null fibroblasts, implying a positive role for GSK3β in mammalian Notch signaling. As a possible mechanistic explanation of the effect of GSK3β on Notch signaling, we observed that inhibition of GSK3β shortened the half-life of Notch1IC. Conversely, activated GSK3β reduced the quantity of Notch1IC that was degraded by the proteasome. These studies reveal that GSK3β modulates Notch1 signaling, possibly through direct phosphorylation of the intracellular domain of Notch, and that the activity of GSK3β protects the intracellular domain from proteasome degradation.

Resumen Objective Evaluar el valor predictivo del patronanormal de velocimetria Doppler en el territorio ute-roplacentario realizado despues de la semana 26 engestantes de alto riesgo para el desarrollo de complicaciones perinatales relacionadas con el desarrollo dela placenta. Material y metodo Estudio prospectivo realizadoen 85 embarazos de alto riesgo durante un periodo de18 meses. Mediante Doppler color se estudio la ondade velocidad de flujo de ambas arterias uterinas y arteria umbilical entre las semanas 26 y 34 de gestacion. El estudio Doppler se considero anormal si elindice de pulsatilidad para los casos estudiados se encontraba por encima del percentil 95 para la edad gestacional o si existian muescas en una o ambas arteriasuterinas. Se determino la incidencia de preeclampsia,muerte fetal intrautero, retraso de crecimiento intrauterino, parto prematuro espontaneo ( Resultados Un total de 42 gestantes presento unpatron Doppler uteroplacentario patologico mientrasque los 43 casos restantes presentaron un patron normal. Treinta y seis de las 42 gestantes con Dopplerpatologico (85,6%) desarrollaron alguna de las complicaciones estudiadas mientras que solo lo hicieronocho de las 43 gestantes con Doppler normal (18,6%)(p Conclusion El estudio Doppler uteroplacentario secomporta como un fuerte predictor de complicacionesperinatales estudiadas en gestantes de alto riesgo.

Resumen El hidrops fetal temprano es un fenomeno frecuente que forma parte de numerosos procesos patologicos. Sin embargo, la tasa de diagnosticos se encuentrapor debajo de su incidencia. Los hallazgos ecograficos indirectos relacionados con fallo cardiaco de diferente origen son mas frecuentes en el primer trimestre. Es estos casos, el aumento del pliegue nucal sueleser el primer signo ecografico de hidrops temprano.En el estudio realizado sobre 30 casos en los que sedetermino el cariotipo fetal por un pliegue nucal mayor de 3 mm antes de la semana 14 de gestacioncomo indicacion, el indice de cromosomopatias fue del 36,7 frente al 3,1% de cariotipos anormales obtenidos cuando la indicacion fue otra. Ademas, se observo un 50% de anomalias asociadas entre los quepresentaron algun signo temprano de hidrops y un 47% de mortalidad fetal asociada. La medicion delpliegue nucal ofrece la oportunidad de realizar un cribado temprano de aneuploidias, cardiopatias u otrasafecciones fetales.

We compared in vitro and in vivo induction of IL-12 (p40) and IFN-gamma by mouse cells stimulated with Toxoplasma gondii, Trypanosoma cruzi, and different species of Leishmania. Spleen cells cultured in vitro with T. cruzi or T. gondii, but not with Leishmania, produced IL-12 (p40) and IFN-gamma. Accordingly, IL-12 (p40) was produced by macrophages stimulated in vitro with live T. cruzi or T. gondii or membrane glycoconjugates obtained from trypomastigotes or tachyzoites. No IL-12 production was detected when macrophages were stimulated with live parasites or glycoconjugates from Leishmania, regardless of priming with IFN-gamma. In vivo, only T. cruzi and T. gondii induced the synthesis of IL-12 and IFN-gamma by mouse spleen cells after intraperitoneal injection of parasites. When injected subcutaneously, live Leishmania sp. induced IL-12 (p40) and IFN-gamma production by draining lymph node cells, albeit the levels were slightly lower than those induced by infection with T. gondii or T. cruzi using the same route. Together our results indicate that under different conditions, the intracellular protozoa T. gondii and T. cruzi are more potent stimulators of IL-12 and IFN-gamma synthesis by host immune cells than parasites of the genus Leishmania.

La diálisis peritoneal aguda (DPA) continúa siendo una medida útil en el paciente pediátrico crítico. En el shock séptico el fracaso renal agudo puede precisar medidas invasivas de depuración y aunque la hemofiltración es muy efectiva, en ciertas Unidades de Cuidados Intensivos Pediátricas no se dispone aún de ella. La DPA pediátrica se suele iniciar con pases horarios, permanencias cortas y volumen por pase de unos 10 ml/kg. Mostramos la evolución de la DPA de dos pacientes críticos con fallo renal en los que la monitorización de los cocientes dializado/plasma de urea y creatinina y del cociente de concentración de glucosa del dializado (efluente)/concentración de glucosa de la solución de diálisis infundida fue útil para la prescripción de la DPA.