Acellular Dermal Matrix, Osseoplastic Flap, and Transnasal Endoscopic Approach for Frontal Mucocele

PURPOUSE

The primary objective of this study is to suggest the use of acellular dermal matrix through an osteoplastic flap and transnasal endoscopic treatment for the management of frontal mucoceles. The secondary objective is to propose the characteristics to choose this approach.

METHODS

A retrospective cohort study was carried out on patients with frontal mucoceles of different etiologies where an osteoplastic flap was made to address the sinus and subsequently obliterated with acellular dermal matrix.

RESULTS

A cohort of 11 patients were included in the study, 6 (67%) were female and 5 (56%) were male, with a mean age of 56 years (range 35-71). The majority of patients (73%) with a history of trauma and all the patients were treated with frontal osteoplastic flap and obliteration with acellular dermal matrix. No evidence of recurrence in a follow-up period with a mean of 18 months and a low rate of complications.

CONCLUSIONS

The frontal osteoplastic flap and obliteration with acellular dermal matrix is a simple and safe technique to perform with low morbidity. Also, an orbital reconstruction can be performed simultaneously.

Factors associated with microbiological contamination of chicken meat marketed in El Salvador

OBJECTIVE.

To determine the hygienic-sanitary factors associated with the microbiological contamination of chicken meat sold at the municipal markets of El Salvador.

MATERIALS AND METHODS.

An analytical cross-sectional study was conducted in 33 municipal markets of the 14 departmental capitals of El Salvador. The sample consisted of 256 out of 456 possible market stalls. A sample of chicken meat was obtained from each market stall. The microbiological analysis was conducted at the National Public Health Laboratory. Frequencies, percentages, measures of central tendency and association were calculated with SPSS version 21.

RESULTS.

Escherichia coli was found in 74% of the samples, Staphylococcus aureus in 24% and Salmonella spp. in 1%. The presence of Salmonella spp. was associated with not using hand sanitizer and not using towels for drying the hands. S. aureus was associated with the use of personal accessories and improper storage. The presence of S. aureus was associated with the lack of hand washing, not using a towel to dry the hands and not wearing an apron.

CONCLUSION.

The hygienic-sanitary conditions of the handlers and the market stalls were associated with microbiological contamination of chicken meat marketed in El Salvador.

Incidence of nutritional support complications in patient hospitalized in wards. multicentric study

Introduction: Nutritional support generates complications that must be detected and treated on time. Objective: To estimate the incidence of some complications of nutritional support in patients admitted to general hospital wards who received nutritional support in six high-complexity institutions. Methods: Prospective, descriptive and multicentric study in patients with nutritional support; the variables studied were medical diagnosis, nutritional condition, nutritional support duration, approach, kind of formula, and eight complications. Results: A total of 277 patients were evaluated; 83% received enteral nutrition and 17% received parenteral nutrition. Some 69.3% presented risk of malnourishment or severe malnourishment at admittance. About 35.4% of those receiving enteral nutrition and 39.6% of the ones who received parenteral nutrition had complications; no significant difference per support was found (p = 0.363). For the enteral nutrition, the most significant complication was the removal of the catheter (14%), followed by diarrhea (8.3%); an association between the duration of the enteral support with diarrhea, constipation and removal of the catheter was found (p < 0.05). For parenteral nutrition, hyperglycemia was the complication of highest inci­dence (22.9%), followed by hypophosphatemia (12.5%); all complications were associated with the duration of the support (p < 0.05). Nutritional support was suspended in 24.2% of the patients. Conclusions: Complications with nutritional support in hospital-ward patients were frequent, with the removal of the catheter and hyperglycemia showing the highest incidence. Duration of the support was the variable that revealed an asso­ciation with complications. Strict application of protocols could decrease the risk for complications and boost nutritional support benefits.

Incidence of nutritional support complications in patient hospitalized in wards. multicentric study

INTRODUCTION

Nutritional support generates complications that must be detected and treated on time.

OBJECTIVE

To estimate the incidence of some complications of nutritional support in patients admitted to general hospital wards who received nutritional support in six high-complexity institutions.

METHODS

Prospective, descriptive and multicentric study in patients with nutritional support; the variables studied were medical diagnosis, nutritional condition, nutritional support duration, approach, kind of formula, and eight complications.

RESULTS

A total of 277 patients were evaluated; 83% received enteral nutrition and 17% received parenteral nutrition. Some 69.3% presented risk of malnourishment or severe malnourishment at admittance. About 35.4% of those receiving enteral nutrition and 39.6% of the ones who received parenteral nutrition had complications; no significant difference per support was found (p= 0.363). For the enteral nutrition, the most significant complication was the removal of the catheter (14%), followed by diarrhea (8.3%); an association between the duration of the enteral support with diarrhea, constipation and removal of the catheter was found (p < 0.05). For parenteral nutrition, hyperglycemia was the complication of highest incidence (22.9%), followed by hypophosphatemia (12.5%); all complications were associated with the duration of the support (p < 0.05). Nutritional support was suspended in 24.2% of the patients.

CONCLUSIONS

Complications with nutritional support in hospital-ward patients were frequent, with the removal of the catheter and hyperglycemia showing the highest incidence. Duration of the support was the variable that revealed an association with complications. Strict application of protocols could decrease the risk for complications and boost nutritional support benefits.

Functional, immunological and three-dimensional analysis of chemically synthesised sporozoite peptides as components of a fully-effective antimalarial vaccine

Our ongoing search for a fully-effective vaccine against the Plasmodium falciparum parasite (causing the most lethal form of human malaria) has been focused on identifying and characterising proteins' amino acid sequences (high activity binding peptides or HABPs) involved in parasite invasion of red blood cells (RBC) by the merozoite and hepatocytes by the sporozoite. Many such merozoite HABPs have been recognised and molecularly and structurally characterised; however, native HABPs are immunologically silent since they do not induce any immune response or protection against P. falciparum malaria infection and they have to be structurally modified to allow them to fit perfectly into immune system molecules. A deeply structural analysis of these conserved merozoite HABPs and their modified analogues has led to rules or principles becoming recognised for constructing a logical and rational methodology for a minimal subunit-based, multi-epitope, multi-stage, chemically-synthesised vaccine. The same in-depth analysis of the most relevant sporozoite proteins involved in sporozoite cell-traversal and hepatocyte invasion as well as the hepatic stage is shown here. Specifically modifying these HABPs has resulted in a new set of potential pre-erythrocyte targets which are able to induce high, longlasting antibody titres in Aotus monkeys, against their corresponding recombinant proteins and the complete parasite native molecules. This review shows how these rules may be applied against the first stage of parasite invasion (i.e. the sporozoite) to mount the first line of defence against the malarial parasite, which may indeed be the most effective one. Our results strongly support including some of these modified sporozoite HABPs in combination with the previously-described modified merozoite HABPs for obtaining the aforementioned fully-protective, multiepitope, multi-stage, minimal subunit-based, chemically-synthesized, antimalarial vaccine.

[Incidence of nutritional support complications in critical patients: multicenter study]

INTRODUCTION

Nutritional support (NS) leads complications that must be detected and prompt treated.

OBJECTIVE

To estimate the incidence of some complications of nutritional support in critically ill patients.

MATERIALS AND METHODS

A multicenter, descriptive, prospective study in patients with NS in intensive care units. Studied variables included medical diagnosis, nutritional status, length of NS, path, type of formula and ten complications.

RESULTS

419 patients evaluated, 380 received enteral nutrition (EN) and 39 parenteral nutrition (PN). The high gastric residue was the most incident complication in the ENS (24.2%), followed by diarrhea (14%) and withdrawal tube (6.6%). The high gastric residue and diarrhea were associated with the duration of the NS (p < 0.05). For the PNS the complication most incidents were hypophosphatemia (38.5%), followed by catheter sepsis (15.4%). The duration of the NS was associated with cholestasis, sepsis and hypophosphatemia (p < 0.05).

CONCLUSIONS

complications of highest incidence were the high gastric residue for EN and hypophosphatemia for the PN; the withdrawal of the tube is a complication that claims further monitoring. The duration of the NS was the variable that showed greater association with the complications studied. Is a must to get consensus on complications definitions for comparisons establishment and best international standards target, furthermore propose protocols in order to decrease complications incidence of NS to fulfill the critical ill patient requirements.

Androgen-secreting adrenal adenomas

BACKGROUND

The androgen source in women with hirsutism and signs of virilism may be the ovary or adrenal gland.

CASES

Three patients with androgen excess are reported. Two had hyperandrogenemia and Cushing syndrome with an adrenal mass greater than 5.5 cm; the third had a small adrenal adenoma secreting only testosterone and responsive to human chorionic gonadotropin. In all cases, the pathologic report from surgery and the long-term resolution of symptoms confirmed the benign nature of the tumors.

CONCLUSION

Basal and dynamic hormonal tests cannot precisely differentiate ovarian from adrenal tumors. Adrenal adenomas must be considered as a cause of hyperandrogenic syndrome.

Proteolytic processing of the Cyt1Ab1 toxin produced by Bacillus thuringiensis subsp. medellin

Bacillus thuringiensis produces d-endotoxins that require proteolytic processing to become active. The activation of the B. thuringiensis subsp. medellin 28 kDa (Cyt1Ab1) cytolytic toxin by trypsin, chymotrypsin and gut extract from Culex quinquefasciatus larvae was analyzed. The Cyt1Ab1 toxin of B. thuringiensis subsp. medellin was processed by all proteases tested to fragments between 23 and 25 kDa, while processing of the Cyt1Aa1 toxin produce fragments between 22.5 and 24.5 kDa. The Cyt1Ab1 toxin was preferentially processed at the alkaline pH of 12. The in vitro proteolytic processing of the Cyt1Ab1 toxin by C. quinquefasciatus larvae midgut extract showed a 25 kDa fragment; a similar result was observed when the activation was performed in the in vivo experiments. The solubilized Cyt1Ab1 toxin and the protease resistant cores generated by in vitro processing showed hemolytic activity but not mosquitocidal activity. Amino terminal sequence of the C. quinquefasciatus gut extract resistant fragment indicated that the cutting site was located between Lys31 and Asp32, with a sequence DDPNEKNNHNS; while for the trypsin-resistant fragment the cutting site was determined between Leu29 and Arg30, and for the chymotrypsin-resistant fragment between Arg30 and Lys31.

Serine repeat antigen peptides which bind specifically to red blood cells

It has been reported that serine repeat antigen (SERA) binds directly to human erythrocyte membranes, inside-out vesicles and intact mouse erythrocytes. Similarly, mAbs specific against SERA are effective in blocking red blood cell (RBC) invasion by P. falciparum merozoites. Furthermore, the N-terminal recombinant SERA fragment inhibits the merozoite invasion of erythrocyte. In this study of 49 non-overlapping 20-residue-long peptides encompassing the whole SERA protein FCR3 strain, seven peptides having high RBC binding activity were found. Six of these peptides (three from the SERA N-terminal domain) are located in conserved regions and show affinity constants between 150 and 1100 nM, Hill coefficients between 1.5 and 3.0 and 30000-120000 binding sites per cell. Some of these peptides inhibited in vitro merozoite invasion of erythrocyte and intra-erythrocytic development. Residues which are critical in the binding to erythrocytes (in bold face), i.e. 6725 (YLKETNNAISFESNSGSLEKK), 6733 (YALGSDIPEKCDTLASNCFLS), 6737 (YDNILVKMFKTNENNDKSELI), 6746 (DQGNCDTSWIFASKYHLETI), 6754 (YKKVQNLCGDDTADHAVNIVG) and 6762 (NEVSERVHVYHILKHIKDGK), were determined by means of competition assays with high-binding peptide glycine analogues. The identification of peptides which bind to erythrocyte membrane is important in understanding the process of RBC invasion by P. falciparum merozoites.