Myopathies with finger flexor weakness: Not only inclusion-body myositis

Muscle disorders are characterized by differential involvement of various muscle groups. Among these, weakness predominantly affecting finger flexors is an uncommon pattern, most frequently found in sporadic inclusion-body myositis. This finding is particularly significant when the full range of histopathological findings of inclusion-body myositis is not found on muscle biopsy. Prominent finger flexor weakness, however, is also observed in other myopathies. It occurs commonly in myotonic dystrophy types 1 and 2. In addition, individual reports and small case series have documented finger flexor weakness in sarcoid and amyloid myopathy, and in inherited myopathies caused by ACTA1, CRYAB, DMD, DYSF, FLNC, GAA, GNE, HNRNPDL, LAMA2, MYH7, and VCP mutations. Therefore, the finding of finger flexor weakness requires consideration of clinical, myopathological, genetic, electrodiagnostic, and sometimes muscle imaging findings to establish a diagnosis.     

Carbapenemasas en especies del género Pseudomonas

Pseudomonas aeruginosa is one of the most relevant nosocomial pathogens, as well as one of the main causes of chronic respiratory infections in patients with underlying diseases such as cystic fibrosis or chronic obstructive pulmonary disease. The high intrinsic antibiotic resistance of this pathogen, together with its extraordinary capacity for acquiring additional resistances through chromosomal mutations, determines a major threat for antimicrobial therapy in hospitals worldwide. Even more concerning is the increasing detection of multiple antimicrobial resistance determinants in this microorganism, frequently located on integrons, acquired by horizontal transfer through plasmids and/or transposons. Among these mechanisms, the carbapenemases are particularly relevant, due to the wide spectrum of antibiotics affected. This work reviews the epidemiology, impact, and detection of the carbapenemases described so far in the Pseudomonas spp., that mainly include class B enzymes (metallo-β-lactamases [MBL]: IMP, VIM, SPM, GIM, AIM, or DIM), but also, to a lower extent, class A (GES y KPC) and D (OXA) beta-lactamases. The presence of transferable carbapenemases is not only important in P. aeruginosa, but also in other less clinically-relevant species of the genus, since they can act as reservoires and dispersion vectors of these resistance determinants. The growing prevalence of carbapenemase-producing clinical isolates calls for the implementation of multidisciplinary strategies to optimize the detection and minimize the dissemination of these multidrug resistant strains and the involved transferable genetic elements.     

Study on the prevalence of human papillomavirus in the anal canal of women with cervical intraepithelial neoplasia grade III

Objective

The objective was to evaluate the prevalence of human papillomavirus (HPV) in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade III.

Study design

Two groups were compared. In group I (study group), 40 women who had undergone cervical biopsy with a histopathological result indicating CIN III were evaluated. Group II (control) consisted of 40 women with normal results from colposcopic examination and colpocytological tests. The women in group I who presented high-grade neoplasia in colpocytological tests underwent collection of material from the uterine cervix and anal canal for investigating HPV DNA using the Hybrid Capture II^® technique. Colposcopy and cervical biopsy were then performed. If CIN III was confirmed, HPV DNA was investigated in the material collected. In group II, colpocytological tests and colposcopy were performed and, if normal, the procedure was similar to that followed for group I, except that no biopsy was performed.

Results

In group I, 39 women (97.5%) were positive for HPV in the uterine cervix and 14 women (35%) in the anal canal. In group II, only four women (10%) had a positive HPV test, for both the uterine cervix and the anal canal.

Conclusions

The prevalence of HPV in the anal canal of the women with CIN III was greater than in the women without CIN III.     

Berichtigung

Ohne Zusammenfassung     

Sialic acid concentration in the attached gingival tissue of rates realted to age and sex

Determination of N-acetylneuraminic acid concentration in the attached gingival tissue of rats related to the age and sex of the animals was carried out. The concentration of the sialic acid decreased with increasing age. Differences between male and female animals were noted.     

Using VLAD scores to have a look insight ICU performance: towards a modelling of the errors

Rationale, aims and objectives Mortality prediction models using logistic regression analysis play a pivotal role in intensive care quality evaluation, allowing a hospital's performance to be compared with a standard. However, when a difference between predicted and observed mortality exists, that is, the numerator of the Variable Life Adjusted Display (VLAD) score, the investigation for a possible explanation could be arduous. In this article we tested the ability of Bayesian Network (BN) to identify factors determining the negative discrepancy between expected and actual outcomes recorded in four Italian intensive care units (ICUs). Methods A BN was implemented to predict the extent of the expected‐observed distance quantified by the VLAD score. BN performance was compared with those of a set of tools including Linear Model, Random Forest Regression Tree analysis, Artificial Neural Networks and Support Vector Machine. Results BN allows the identification of critical areas responsible for bad performance. Compared with other techniques, BN always explains a higher variance percentage and it shows similar or superior discrimination ability. Conclusions BN, being able to guide interpretation of covariates role by means of a graphic representation of relationships, confirms its utility particularly where many interactions between predictors exist and when a coherent set of theories regarding which variables are related and how is not available.     

1型糖尿病妇女接受持续皮下胰岛素输注或传统方法强化治疗后的妊娠结果

29名1型糖尿病妇女在妊娠期间接受持续皮下胰岛素输注（CSII）作为胰岛素强化治疗（其中27名妇女在计划妊娠时开始治疗，2名在怀孕第1个月开始接受治疗），另外29名孕妇接受每日多次胰岛素注射（MDI）治疗。两组人群在年龄、糖尿病病程、White分级、孕前的BMI、孕前已产子女数和HbA1c方面互相匹配。对孕妇的代谢控制情况和急性并发症包括酮症酸中毒、严重低血糖发作、妊娠高血压的发展以及先兆子痫的发作进行登记，