Should cyclosporine be useful in renal transplant recipients affected by SARS-CoV-2?

Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with coronavirus disease 2019 (COVID-19). However, outcomes remain poor. Given the likely benefit of cyclosporine because of its antiviral and immunomodulatory effect, we have been using it as a strategy in KTRs diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied 29 kidney transplant recipients (KTRs) who were admitted to our institution with COVID-19 between March 15and April, 24, 2020. Mycophenolate and/or mammalian target of rapamycin inhibitors (mTORi) were discontinued in all patients. Two therapeutic strategies were compared: Group 1, minimization of calcineurin inhibitors (N = 6); and Group 2, cyclosporine-based therapy (N = 23), with 15 patients switched from tacrolimus. Hydroxychloroquine was considered in both strategies but antivirals in none. Six patients died after respiratory distress (20.6%). Five required mechanical ventilation (17.2%), and 3 could be weaned. Nineteen patients had an uneventful recovery (65.5%). In group 1, 3 of 6 patients died (50%) and 1 of 6 required invasive mechanical ventilation (16.7%). In group 2, 3 of 23 patients died (12.5%). Renal function did not deteriorate and signs of rejection were not observed in any patient on the second treatment regime. In conclusion, immunosuppressant treatment based on cyclosporine could be safe and effective for KTRs diagnosed with COVID-19.

Impact of a Direct Oral Anticoagulant Population Management Tool on Anticoagulation Therapy Monitoring in Clinical Practice

Background: The optimal monitoring and follow-up strategy for long-term direct oral anticoagulant (DOAC) therapy has not been established. Historically, at our medical center, DOAC patients were referred to a clinical pharmacy specialist managed anticoagulation clinic (AC) for monitoring via regularly scheduled encounters (face-to-face or telephone). Objective: To determine if implementation of a DOAC Population Management Tool (PMT) designed to identify patients who most likely require clinical review and possibly intervention, would improve the efficacy (interventions per patient) and efficiency (time invested to generate an intervention) of monitoring over AC practices. Methods: The DOAC PMT group included patients flagged as potentially having a dosing issue or history of valve replacement. The AC group included patients who were scheduled for routine DOAC follow-up. The quantity and character of interventions made were prospectively recorded and compared. Results: A total of 399 patients were included. Data were collected for 131 patients identified by the DOAC PMT, resulting in a review of 170 flags with a total of 94 interventions or 0.55 interventions per flag reviewed. For the AC group, 268 patients were evaluated, leading to 53 interventions or 0.20 interventions per patient encounter (P < 0.001 for comparison). The time to generate an intervention was 16 minutes in the DOAC PMT versus 64 minutes for the AC group. Conclusion and Relevance: A population-based approach to DOAC monitoring represents a more effective and efficient strategy to reduce missed opportunities for interventions between follow-up appointments while also increasing clinic access, particularly for patients who require immediate attention.

Development of an advanced radioactive airborne particle monitoring system for use in early warning networks

Automatic real-time warning networks are essential for the almost immediate detection of anomalous levels of radioactivity in the environment. In the case of Extremadura region (SW Spain), a radiological network (RARE) has been operational in the vicinity of the Almaraz nuclear power plant and in other areas farther away since 1992. There are ten air monitoring stations equipped with Geiger-Müller counters in order to evaluate the external ambient gamma dose rate. Four of these stations have a commercial system that provides estimates of the total artificial alpha and beta activity concentrations in aerosols, and of the ¹³¹I activity (gaseous fraction). Despite experience having demonstrated the benefits and robustness of these commercial systems, important improvements have been made to one of these air monitoring systems. In this paper, the analytical and maintenance shortcomings of the original commercial air monitoring system are described first; the new custom-designed advanced air monitoring system is then presented. This system is based mainly on the incorporation of gamma spectrometry using two scintillation detectors, one of NaI:Tl and the other of LaBr₃:Ce, and compact multichannel analysers. Next, a comparison made of the results provided by the two systems operating simultaneously at the same location for three months shows the advantages of the new advanced air monitoring system. As a result, the gamma spectrometry analysis allows passing from global alpha and beta activity determinations due to artificial radionuclides in aerosols, and the inaccurate measurement of the gaseous ¹³¹I activity concentration, to the possibility of identifying a large number of radionuclides and quantifying each of their activity concentrations. Moreover, the new station's dual capacity is designed to work in early warning monitoring mode and surveillance monitoring mode. This is based on custom developed software that includes an intelligent system to issue the necessary warnings when radiological anomalies or technical problems are identified. Implicitly, for the construction of the advanced station, substantial mechanical and electronic developments have been required. They have essentially consisted of integrating a new replacement device, whose operation has reduced the maintenance tasks.

Zeolite molecular accessibility and host–guest interactions studied by adsorption of organic probes of tunable size

Fluorescent probe molecules of different sizes were synthesized and applied to study the molecular accessibility of zeolite materials.

Lessons learnt from the radiological measures performed by the Radiological Emergency Network of Extremadura in the International Emergency Exercise CURIEX 2013

In late 2013 (5th-7th of November), the Cáceres Urgent Response International Exercise (CURIEX 2013) took place to test the Nuclear Emergency Plan of Cáceres (PENCA) with the collaboration of both national and international support teams. The theme of the exercise was the simulation of a nuclear accident at the Almaraz Nuclear Power Plant located in Extremadura (Spain) with release of radioactive plume. From the point of view of radioactive contamination, the CURIEX exercise objective was to assess the capability of the different radiological teams to quantify the radioactive impact that would occur in this environment, a goal in which the Radiological Emergency Network of Extremadura (RARE) is directly implicated. The present paper analyses in detail the environmental radiological and dosimetrical results obtained by the Radiological Emergency Network of Extremadura during the CURIEX exercise. The rapid radioactivity measurement techniques on air and soil samples performed by the RARE's mobile lab involves great uncertainties. However, the results show a relative good effectiveness both in dose rate car-borne measurements and gamma soil spectrometry with uncertainties over 40%. It also shows a good correlation between the dose rate values measured by car-borne apparatus and those calculated from gamma spectrometry measurements. The capability of the RARE's facilities are evaluated in both the measurements, showing whether or not there is a radiological problem, and the transmission of that data to the decision centres in the shortest time. Although the results were highly satisfactory, some shortcomings were detected and therefore some improvements are proposed in the paper, in order to achieve a greater capacity in response to an event with the characteristics simulated in the CURIEX exercise.

Global Burden of Neural Tube Defects, Risk Factors, and Prevention

Neural tube defects (NTDs), serious birth defects of the brain and spine usually resulting in death or paralysis, affect an estimated 300,000 births each year worldwide. Although the majority of NTDs are preventable with adequate folic acid consumption during the preconception period and throughout the first few weeks of gestation, many populations, in particular those in low and middle resource settings, do not have access to fortified foods or vitamin supplements containing folic acid. Further, accurate birth defects surveillance data, which could help inform mandatory fortification and other NTD prevention initiatives, are lacking in many of these settings. The burden of birth defects in South East Asia is among the highest in the world. Expanding global neural tube defects prevention initiatives can support the achievement of the United Nations Millennium Development Goal 4 to reduce child mortality, a goal which many countries in South East Asia are currently not poised to reach, and the 63rd World Health Assembly Resolution on birth defects. More work is needed to develop and implement mandatory folic acid fortification policies, as well as supplementation programs in countries where the reach of fortification is limited.

Is the presence of oxygen on an exoplanet a reliable biosignature?

We revisit the validity of the presence of O(2) or O(3) in the atmosphere of a rocky planet as being a biosignature. Up to now, the false positive that has been identified applies to a planet during a hot greenhouse runaway, which is restricted to planets outside the habitable zone (HZ) of the star that are closer to the star. In this paper, we explore a new possibility based on abiotic photogeneration of O(2) at the surface of a planet that could occur inside the HZ. The search for such a process is an active field of laboratory investigation that has resulted from an ongoing interest in finding efficient systems with the capacity to harvest solar energy on Earth. Although such a process is energetically viable, we find it to be a very unlikely explanation for the observation of O(2) or O(3) in the atmosphere of a telluric exoplanet in the HZ. It requires an efficient photocatalyst to be present and abundant under natural planetary conditions, which appears unlikely according to our discussion of known mineral photochemical processes. In contrast, a biological system that synthesizes its constituents from abundant raw materials and energy has the inherent adaptation advantage to become widespread and dominant (Darwinist argument). Thus, O(2) appears to continue to be a good biosignature.

Phylogeographic variability in traditional societies

Our perception of the amount, and distribution, of human genetic diversity is becoming radically altered by the introduction of sophisticated molecular techniques into the field of evolutionary biology. Along with the exponential increase in the number of informative DNA markers, has come an increased precision in estimating the evolutionary relationships between populations. Evaluating DNA variability in terms of the phylogenetic analysis of sequence variability at the population level has been especially informative in illuminating the long-term ancestry of our species. An extension of this strategy, phylogeography, aims to evaluate the evolutionary ancestry of specific genomic regions in terms of the geographic distribution of phylogenetic lineages within and among populations. We have started to apply this approach by studying the distribution of mitochondrial DNA sequence diversity within and among a variety of Amerindian tribes. These data provide an illuminating contrast to regional data on sequence variability, especially when analysed within the theoretical framework of the coalescent. To interpret these results, we have analysed a simple model in which the rate of coalescence between subpopulations varies with respect to the rate of coalescence of individual ancestry. The model indicates that extensively isolated subpopulations will have distinct distributions of ancestry, and hence of sequence variability, compared to subpopulations which arise due to a series of rapid fissioning events. Subpopulations within tribes, such as bands, appear to correspond to the latter category, whereas tribal populations appear intermediate between the two extremes.

[Guidelines for the clinical management of neuropathic pain (II)]

INTRODUCTION

Up to 5% of the population suffers from neuropathic pain (NP). A bibliographical search in several databases revealed that, to date, there are no protocols to guide physicians who are not specialists in pain that enable them to treat NP and thus improve patients' quality of life.

AIMS

The aim of this study is to provide Spanish-speaking physicians who are not specialists in pain with a set of guidelines for the treatment of NP. A bibliographical search was performed in order to base the results and conclusions on the evidence-based medicine methodology.

DEVELOPMENT

First, we review the most effective clinical and paraclinical methods for diagnosing NP, and the LANSS pain scale is reported as the most appropriate method of clinically evaluating NP. The anatomical paths and the physiology of pain are then described and we review the molecular variables involved. Finally, we point out the current therapeutic options and propose an algorithm for the treatment of NP.

CONCLUSIONS

There is no specific set of guidelines for the treatment of NP. At the present time, the keystone of NP treatment consists in the use of antidepressant and anticonvulsive drugs. There is a need for further clinical trials to prove the effectiveness of using combined medication.

Limited effect of recombinant porcine interleukin-12 on porcine lymphocytes due to a low level of IL-12 beta2 receptor

The cytokine interleukin-12 (IL-12) is a key molecule in the regulation of CD4 + T cell development and specifically potentiates T helper 1 responses in mouse and man. However, biological effects mediated by IL-12 have not been well defined in pigs. Herein, recombinant porcine IL-12 (rPoIL-12) was expressed in a swine poxvirus system as a biologically active heterodimer and used to stimulate bovine or swine lymphoblast cells. After 3 days of incubation, only bovine blasts were responsive to the rPoIL-12 treatment as monitored by cell proliferation in several independent trials. Similarly, i.m. administration of rPoIL-12 in the hind leg of 3-week-old pigs indicated a reduction in the number of interferon-gamma (IFN-gamma) producing lymphocytes isolated from inguinal lymph nodes. The porcine IL-12R beta2 (IL-12Rbeta2) sequence was cloned and results generated by reverse transcriptase polymerase chain reaction (RT-PCR) demonstrated that the expression of IL-12R on porcine blasts as measured by the relative levels of IL-12Rbeta2 mRNA was less than that in bovine blasts and are in agreement with the reduced proliferation response of swine blast cells to rPoIL-12 treatment. Real time PCR analysis demonstrated that after PBMC stimulation, bovine blasts had an 11-fold increase in IL-12Rbeta2 mRNA levels while porcine blasts had almost no change. These data support a mechanism for IL-12 stimulation in swine inconsistent with that observed in conventional models.

[Migraine: implications for work, disability and request for health services in Colombia]

INTRODUCTION

Migraine causes problems of public health and work.

OBJECTIVES

To describe the pharmaco economic impact of migraine in Colombia.

PATIENTS AND METHODS

The sample group was made up of patients aged between 18 and 65 years diagnosed as having migraine according to the criteria of the International Headache Society. We made a descriptive study of migraine in Colombian patients recruited from five international multicentric clinical trials who responded to a questionnaire on: 1. Frequency of migraine attacks. 2. Days or hours of work lost through migraine. 3. Requests for health services. 4. Occupation of participants. For the statistical analysis we used descriptive techniques of resumption of frequencies, and also non parametric statistics in order to describe how their work was affected.

RESULTS

82% of the patients complained of from one to four migraine attacks per month. 64% considered that migraine had adversely affected between one and twenty hours of work per month. No differences were seen between paid and unpaid work. 15% of the patients lost more than one day of paid work and 36% more than one day of unpaid work in the month prior to the questionnaire. 52% of the patients requested at least one medical consultation for migraine during the year of the questionnaire; 42% consulted the emergency services at least once and 43% did not consult the health services at all.

CONCLUSIONS

These epidemiological and socio economic data are important for a rational approach to the implementation of health resources and to assure effective management of the disorder.

Characterization of hemoglobin Hotel Dieu in a Puerto Rican adolescent

PURPOSE

Hemoglobin Hotel Dieu (HbHD) is a high-oxygen affinity variant of HbA never before reported in a Hispanic patient. This Hb variant was first reported in 1981 by Blouquit et al. in a white person with erythrocytosis with a substitution in the beta 99 aspartic acid residue by glycine.

METHODS

A 13-year-old Puerto Rican boy had pain in his chest, headaches, easy fatigability, and high Hb (as high as 19.1 g/dl). Protein analysis was performed by cellulose acetate, citrate agar, and isoelectric focusing electrophoresis and high-pressure liquid chromatography (HPLC), polymerase chain reaction (PCR) amplification, and DNA sequencing of the second exon of the beta gene in samples obtained from the mother, father, and the patient, and DNA fingerprinting to determine paternity.

RESULTS

The variant found in the patient migrated on cellulose acetate electrophoresis to a cathodic position relative to HbF, and a band cathodal to HbA and close to HbF on isoelectric focusing electrophoresis. The patient showed an abnormal well-resolved peak on HPLC with a retention time slightly shorter than that for HbS. DNA analysis by direct sequencing of the PCR product demonstrated heterozygosity for codon 99 (GAT-->GGT) in the patient but not in either parent. DNA fingerprinting by multiplex PCR amplification of three simple tandem repeat loci showed that the patient shared alleles in all three loci with both parents, ruling out nonpaternity.

CONCLUSIONS

The protein and DNA analysis indicate that the erythrocytosis is caused by the presence of HbHD in this Hispanic adolescent.

Genetic and linguistic differentiation in the Americas

The relationship between linguistic differentiation and evolutionary affinities was evaluated in three tribes of the Pacific Northwest. Two tribes (Nuu-Chah-Nulth and Bella Coola) speak Amerind languages, while the language of the third (Haida) belongs to a different linguistic phylum--Na-Dene. Construction of a molecular phylogeny gave no evidence of clustering by linguistic affiliation, suggesting a relatively recent ancestry of these linguistically divergent populations. When the evolutionary affinities of the tribes were evaluated in terms of mitochondrial sequence diversity, the Na-Dene-speaking Haida had a reduced amount of diversity compared to the two Amerind tribes and thus appear to be a biologically younger population. Further, since the sequence diversity between the two Amerind-speaking tribes is comparable to the diversity between the Amerind tribes and the Na-Dene Haida, the evolutionary divergence within the Amerind linguistic phylum may be as great as the evolutionary divergence between the Amerind and Na-Dene phyla. Hence, in the New World, rates of linguistic differentiation appear to be markedly faster than rates of biological differentiation, with little congruence between linguistic hierarchy and the pattern of evolutionary relationships.

MSA-36: a chromosomal and mitotic spindle-associated protein

We have identified a novel M(r) 36,000 protein (MSA-36) that has a complex cell cycle dependent distribution. This protein is first detected in interphase nuclei just prior to the onset of chromosome condensation. MSA-36 is found along condensing chromosomes and is a component of the centromere through metaphase. At anaphase, this protein is no longer detected in association with the chromosomes but appears at the forming stembodies and subsequently within the intercellular bridge at either side of the midbody. At the completion of cell division, the amount of MSA-36 in the bridge appears to decline concurrent with the appearance of this protein briefly within the reforming nucleus. To investigate whether MSA-36 is an active component of the chromosome or a passive passenger protein, we studied the behaviour of this protein in cells exhibiting premature chromosome condensation and in cells during and following recovery from mitotic arrest. These studies suggest that MSA-36 is not essential for a variety of major chromosome-associated events.