Epidemiological issues regarding suicides in Ecuador: an 8-year report

Aim  

The aim of this study was to analyze the epidemiological issues related to suicide in Ecuadorians.     

Thoracic intradural chordoma

A case of primary intradural chordoma at thoracic level is presented. This report confirms the presence of ectopic intradural chordomas within the spinal canal. It is necessary to include these lesions in the differential diagnosis of intradural-extramedullary tumors.     

Impact of a cortisone injection on the efficacy of a non-operative treatment approach for anterior instability of the glenohumeral joint

The purpose of this case report is to describe the effects of a cortisone injection and a conservative, non-operative physical therapy approach in a patient with anterior instability of the glenohumeral joint. A 73-year-old, right-handed male was referred to physical therapy following a right shoulder subluxation, resulting in pain and decreased function in the right upper extremity. A baseline examination indicating significant pain and right shoulder dysfunction resulted in an initial Western Ontario Shoulder Instability Index (WOSI) score of 1619. The patient was seen for 22 visits divided into Phase I and Phase II. Phase II began following a cortisone injection received after visit 15. Physical Therapy intervention consisted of shoulder pendulum exercises, active ROM, Maitland mobilization, strengthening of rotator cuff and thoracic musculature, electrical stimulation and cryotherapy. WOSI scores at baseline, the conclusion of Phase I and II, and one month post discharge were recorded. They were 1487 (8% improvement), 116 (93% improvement), and 83 (95% improvement), respectively. Percent improvement was calculated based on the initial WOSI score. The patient's WOSI score at discharge (end of Phase II) was similar to his self-report of improvement (95%). Results of the WOSI at the conclusion of Phase I and Phase II suggest that the anti-inflammatory and analgesic effects of a cortisone injection were critical components in the patient's recovery. These findings may indicate the appropriateness of such an injection in cases with significant pain and inflammation when a more traditional, conservative approach to anterior glenohumeral joint instability proves ineffective.     

miR-181b negatively regulates activation-induced cytidine deaminase in B cells

Activated B cells reshape their primary antibody repertoire after antigen encounter by two molecular mechanisms: somatic hypermutation (SHM) and class switch recombination (CSR). SHM and CSR are initiated by activation-induced cytidine deaminase (AID) through the deamination of cytosine residues on the immunoglobulin loci, which leads to the generation of DNA mutations or double-strand break intermediates. As a bystander effect, endogenous AID levels can also promote the generation of chromosome translocations, suggesting that the fine tuning of AID expression may be critical to restrict B cell lymphomagenesis. To determine whether microRNAs (miRNAs) play a role in the regulation of AID expression, we performed a functional screening of an miRNA library and identified miRNAs that regulate CSR. One such miRNA, miR-181b, impairs CSR when expressed in activated B cells, and results in the down-regulation of AID mRNA and protein levels. We found that the AID 3' untranslated region contains multiple putative binding sequences for miR-181b and that these sequences can be directly targeted by miR-181b. Overall, our results provide evidence for a new regulatory mechanism that restricts AID activity and can therefore be relevant to prevent B cell malignant transformation.     

Haploinsufficiency of Activation-Induced Deaminase for Antibody Diversification and Chromosome Translocations both In Vitro and In Vivo

The humoral immune response critically relies on the secondary diversification of antibodies. This diversification takes places through somatic remodelling of the antibody genes by two molecular mechanisms, Class Switch Recombination (CSR) and Somatic Hypermutation (SHM). The enzyme Activation Induced Cytidine Deaminase (AID) initiates both SHM and CSR by deaminating cytosine residues on the DNA of immunoglobulin genes. While crucial for immunity, AID-catalysed deamination is also the triggering event for the generation of lymphomagenic chromosome translocations. To address whether restricting the levels of AID expression in vivo contributes to the regulation of its function, we analysed mice harbouring a single copy of the AID gene (AID^+/−). AID^+/− mice express roughly 50% of normal AID levels, and display a mild hyperplasia, reminiscent of AID deficient mice and humans. Moreover, we found that AID^+/− cells have an impaired competence for CSR and SHM, which indicates that AID gene dose is limiting for its physiologic function. We next evaluated the impact of AID reduction in AID^+/− mice on the generation of chromosome translocations. Our results show that the frequency of AID-promoted c-myc/IgH translocations is reduced in AID^+/− mice, both in vivo and in vitro. Therefore, AID is haploinsufficient for antibody diversification and chromosome translocations. These findings suggest that limiting the physiologic levels of AID expression can be a regulatory mechanism that ensures an optimal balance between immune proficiency and genome integrity.     

High prevalence rate of Entamoeba histolytica asymptomatic infection in a rural Mexican community

The frequency of Entamoeba histolytica and Entamoeba dispar infection was analyzed in a rural community in the state of Morelos, Mexico, using polymerase chain reaction (PCR). Sociodemographic variables as risk factors for the infection were assessed. Results highlighted the number of individuals with intestinal parasites (43.1%) in the community, indicating extensive fecalism. A high frequency of E. histolytica asymptomatic infection, higher than E. dispar infection (13.8% versus 9.6%), was detected by PCR. Anti-amebic antibody levels (IgG) in serum and saliva (IgA) samples were not associated with E. histolytica intestinal infection. These findings suggest a predominant distribution of E. histolytica strains of low invasive potential in this community.     

Effect of Pharmacological Treatment of Depression on A1C and Quality of Life in Low-Income Hispanics and African Americans With Diabetes: A randomized, double-blind, placebo-controlled trial

OBJECTIVE

To determine whether pharmacological treatment of depression in low-income minorities with diabetes improves A1C and quality of life (QOL).

RESEARCH DESIGN AND METHODS

This was a 6-month, randomized, double-blind, placebo-controlled trial. Patients were screened for depression using Whooley''s two-question tool at a county diabetes clinic. Depression was confirmed (or not) with the Computerized Diagnostic Interview Survey (CDIS) software program, and the severity of depression was assessed monthly by the Hamilton Depression Scale (HAM-D). Depressed subjects with A1C levels ≥8.0% were randomly assigned to receive either sertraline or placebo. Diabetes care was provided by nurses following detailed treatment algorithms who were unaware of therapy for depression.

RESULTS

A total of 150 subjects answered positively to at least one question on Whooley''s questionnaire. The positive predictive value for depression diagnosed by CDIS was 69, 67, and 84% for positive answers to question 1 only, question 2 only, or both, respectively. Of the 89 subjects who entered the study, 75 completed. An intention-to-treat analysis revealed significant differences between baseline and 6 months in HAM-D and pain scores, QOL, and A1C and systolic blood pressure levels in both groups, with no differences between groups for the first three but a significantly greater decrease with sertraline in A1C and systolic blood pressure levels. Changes in HAM-D scores and A1C levels were significantly correlated in all subjects (P = 0.45 [P < 10⁻⁶]).

CONCLUSIONS

In this low-income minority population, pharmacological treatment of depression significantly improved A1C and systolic blood pressure levels compared with placebo.The prevalence of depression among people with diabetes is more than twice that of the general population (1). Coexistence of depression in persons with diabetes is associated with worse glycemic control (2), which may be due to less adherence to self-care behaviors and medications (3). Eventually, there is increased morbidity (4) and mortality (5) and higher medical costs (6).The prevalence of untreated depression in people with diabetes is higher in minorities (1). Yet, screening for and treating depression are less common in this population (7). Very little research has been published on diabetes and depression with a focus on minority populations, who have significant disparities in outcomes (8), such as higher A1C levels (9), increased rates of complications (10), and more severe depression (8).Depression is associated with worse glycemic control (2). Some studies have evaluated whether treatment of depression will improve A1C levels (11–20). However, these drug studies were open label, were of short duration, and/or were conducted in highly educated (more than high school education) Caucasian populations. Most showed that although depression was improved, A1C levels were not. We sought to determine whether use of antidepressants in a minority population with uncontrolled diabetes improved their A1C levels, quality of life (QOL), and depression compared with placebo.     

Renal allograft laceration treated by superselective embolization.

PURPOSE: To report an illustrative case demonstrating the efficacy of endovascular treatment for traumatic blunt renal allograft injury. CASE REPORT: A 19-year-old man sustained an injury to his renal allograft after a traffic accident secondary to lap belt compression. Angiography revealed contrast extravasation from 2 disrupted upper pole renal artery branches, which were successfully embolized with microcoils. The creatinine level was transiently elevated to 4.1 mg/dL, but it improved to 2.9 mg/dL at discharge 13 days after admission. After 1 year, the serum creatinine level was 1.9 mg/dL. CONCLUSION: As in the native kidney, superselective embolization can also be used safely in the management of blunt injury to a renal allograft, avoiding surgery and preserving graft function.