Coexistencia de artritis séptica y microcristalina: un reto diagnóstico. A propósito de 25 casos

ObjectiveSeptic arthritis is a medical emergency and crystal-induced arthritis is a risk factor for its development. If both occur simultaneously, crystal-induced arthritis may mask the diagnosis of infection and delay antibiotic therapy.MethodRetrospective analysis of patients with coexistence of septic and crystal-induced arthritis. We included only patients with isolation of crystals in synovial fluid analysis and positive culture of synovial fluid and/or blood culture.ResultsA total of 25 patients (17 men and 8 women) with a mean age of 67 years. The most commonly affected joint was the knee. In synovial fluid cytological studies, the most frequently identified crystals were monosodium urate. Risk factors included diabetes and chronic renal failure. The most frequently isolated germs were methicillin-sensitive S. aureus (48%), methicillin-resistant S. aureus (12%) and Mycobacterium tuberculosis (12%). In all, 36% of subjects required surgical drainage (excluding those caused by M. tuberculosis). Clinical outcome was favorable in 56%, although intercurrent complications were usual (40%). Mortality was 8%.ConclusionsCoexistence of septic and crystal-induced arthritis represents a diagnostic challenge and requires a high index of suspicion. Gout was the most prevalent crystal-induced arthritis. S. aureus was the most commonly causative pathogen, with a high rate of methicillin-resistant S. aureus infection. If treated early, the outcome is usually favorable, making synovial fluid microbiological study imperative.     

Gestación heterotópica espontánea

Heterotopic pregnancy is the combination of intrauterine and ectopic pregnancy. This potentially fatal condition rarely occurs in spontaneous conception cycles and consequently its diagnosis requires a high index of suspicion. We report a case of heterotopic pregnancy in a 30-year old primipara with no known risk factors who presented with acute abdominal pain due to a spontaneous heterotopic pregnancy. The ectopic pregnancy was resected via laparoscopy. After surgery, the intrauterine pregnancy was uneventful.     

Genetic and Epigenetic Determinants of Low Dysferlin Expression in Monocytes

Dysferlinopathies are autosomal recessive inherited muscular dystrophies caused by mutations in the gene DYSF. Dysferlin is primarily expressed in skeletal muscle, cardiac muscle, and peripheral blood monocytes. Expression in skeletal muscle and monocytes strongly correlates in healthy and disease states. We evaluated the efficiency of the monocyte assay to detect carriers and to determine the carrier frequency of dysferlinopathies in the general population. We enrolled 149 healthy volunteers and collected peripheral blood samples for protein analysis. While 18 of these individuals with protein levels in the range of 40%–64% were predicted to be carriers by the monocyte assay, subsequent DYSF sequencing analysis in 14 of 18 detected missense variants in only four. Analysis of DNA methylation patterns at the DYSF locus showed no changes in methylation levels at CpG islands and shores between samples. Our results suggest that: (1) dysferlin expression can also be regulated by factors outside of the dysferlin gene, but not related to DNA methylation; (2) carrier frequency and therefore the number of affected individuals could be higher than previously estimated; and (3) although reliable for evaluating dysferlinopathies, the monocyte assay cannot be used to determine the carrier status; for this, a molecular analysis of DYSF must be performed.     

Allium stent placement after ureteral avulsion repair

International Urology and Nephrology -     

First Epidemiologic Study in Argentina of the Prevalence of BK Viruria in Kidney Transplant Patients

BackgroundThe worldwide seroprevalence of human BK polyomavirus (BKV) in adults is 80%. About 10%–60% of renal transplant recipients experience BKV infection, nephropathy of the graft may occur in 5% of the cases, and up to 45% lose the graft. The aim of this work was to describe the prevalence of BK viruria during the 1st year after transplantation.MethodsAn epidemiologic multicenter cross-sectional study was carried out in consecutive patients at each site with kidney transplantation from August 2011 to July 2012. Clinically significant viruria was defined as >10⁷ copies/mL. Viral DNA was extracted with the use of silica columns. Quantification was performed with the use of real-time polymerase chain reaction with primers that amplify a fragment of the large T-antigen gene and with a specific Taqman-MGB probe for BKV. For each assay, a standard curve with a quantified plasmid was included.ResultsOf 402 renal transplant recipients at 18 renal transplant sites, we analyzed 382; median age was 46.33 years, and 46.40% were female. The median of the temporal distribution for urine samples was 153 days. BK virus was detected in 50/382 samples (13%), 18 with values >10⁷ copies/mL (4.7%). The median of the distribution of positive values was 123 days and the highest frequency of positive values was in months 3–7. The conditions of recipient older than 34 years and donor older than 41 years were the only ones that showed statistically significant association with BK viruria. No association with any specific immunosuppressive drug was observed.ConclusionsThis is the first multicenter study conducted in Argentina to determine the prevalence of BK viruria in renal transplant recipients. Because of the growing number of the population susceptible to this infection, it is important to register and describe data about its epidemiology and associated risk factors.     

Associations of the antioxidant capacity and hemoglobin levels with functional physical performance of the upper and lower body limbs

GeroScience - Herein we considered the role of oxidative stress on deficiencies of functional physical performance that could affect a future pre-frailty condition. Using principal component...     

Corrosion and Microstructural Investigation on Additively Manufactured 316L Stainless Steel: Experimental and Statistical Approach

The use of metal additive manufacturing (AM) has strongly increased in the industry during the last years. More specifically, selective laser melting (SLM) is one of the most used techniques due to its numerous advantages compared to conventional processing methods. The purpose of this study is to investigate the effects of process parameters on the microstructural and corrosion properties of the additively manufactured AISI 316L stainless steel. Porosity, surface roughness, hardness, and grain size were studied for specimens produced with energy densities ranging from 51.17 to 173.91 J/mm³ that resulted from different combinations of processing parameters. Using experimental results and applying the Taguchi model, 99.38 J/mm³ was determined as the optimal energy density needed to produce samples with almost no porosity. The following analysis of variance ANOVA confirmed the scanning speed as the most influential factor in reducing the porosity percentage, which had a 74.9% contribution, followed by the position along the building direction with 22.8%, and finally, the laser energy with 2.3%. The influence on corrosion resistance was obtained by performing cyclic potentiodynamic polarization tests (CPP) in a 3.5 wt % NaCl solution at room temperature for different energy densities and positions (Z axis). The corrosion properties of the AM samples were studied and compared to those obtained from the traditionally manufactured samples. The corrosion resistance of the samples worsened with the increase in the percentage of porosity. The process parameters have consequently been optimized and the database has been extended to improve the quality of the AM-produced parts in which microstructural heterogeneities were observed along the building direction.     

A mechanism for functional segregation of mitochondrial and cytosolic genetic codes

The coexistence of multiple gene translation machineries is a feature of eukaryotic cells and a result of the endosymbiotic events that gave rise to mitochondria, plastids, and other organelles. The conditions required for the integration of these apparatuses within a single cell are not understood, but current evidence indicates that complete ablation of the mitochondrial protein synthesis apparatus and its substitution by its cytosolic equivalent is not possible. Why certain mitochondrial components and not others can be substituted by cytosolic equivalents is not known. In trypanosomatids this situation reaches a limit, because certain aminoacyl-tRNA synthetases are mitochondrial specific despite the fact that all tRNAs in these organisms are shared between cytosol and mitochondria. Here we report that a mitochondria-specific lysyl-tRNA synthetase in Trypanosoma has evolved a mechanism to block the activity of the enzyme during its synthesis and translocation. Only when the enzyme reaches the mitochondria is it activated through the cleavage of a C-terminal structural extension, preventing the possibility of the enzyme being active in the cytosol.