Echocardiographic Abnormalities and Antiphospholipid Antibodies in Patients with Systemic Lupus Erythematosus

OBJECTIVE: Lupus anticoagulant and anticardiolipin antibodies (aCL) have been associated with thrombosis, recurrent abortion, and thrombocytopenia in patients with systemic lupus erythematosus (SLE), but their relationship with cardiac disease is less clear. The purpose of this study was to evaluate the association between antiphospholipid antibodies (aPL) and echocardiographic abnormalities in patients with SLE. METHODS: A total of 70 consecutive patients and 42 control subjects underwent M-mode, 2-dimensional and Doppler echocardiography and tests for lupus anticoagulant, aCL IgG, IgM, and IgA. Lupus anticoagulant was assayed with the dilute Russell viper venom time, and aCL IgG, IgM, and IgA were measured by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Lupus anticoagulant showed a prevalence of 10%. As a whole, aCL had a prevalence of 44.3% and aPL had a prevalence of 50%. Patients with echocardiographic abnormalities had a prevalence of 54.3% and showed a trend towards an association with aCL IgG (P=0.06). The presence of pulmonary hypertension (PH) was significantly associated with aCL IgG (p=0.02). CONCLUSION: aCL IgG was significantly associated with PH and showed a strong trend towards an association with echocardiographic abnormalities taken together. These findings suggest a role for aCL IgG in the development of lupus cardiovascular disease.

Endomyocardial fibrosis in infancy

The patient was a 4-month-old infant, who underwent persistent ductus arteriosus interruption with titanium clips at the age of 13 days and, since the age of 2 months, had crises of hypoxia and hypertonicity. After clinical investigation, the presence of pulmonary hypertension was confirmed and left ventricular inflow tract obstruction was suspected. The patient underwent surgical treatment at the age of 4 months, during which right and left ventricular endocardial fibrosis was identified. The fibrosis was resected, but the infant had an unfavorable clinical evolution with significant diastolic restriction and died on the sixth postoperative day. Anatomicopathological and surgical findings suggested endomyocardial fibrosis, although that pathology is very rare at the patient's age.

Prevalence of systemic hypertension in students aged 7 to 14 years in the municipality of Barbacena, in the State of Minas Gerais, in 1999

OBJECTIVE: To detect the prevalence of systemic hypertension in children and to establish the relation between blood pressure levels and sex, age, ethnicity, weight, and height. METHODS: The prevalence of systemic hypertension and its relation to sex, age, ethnicity, weight, and height were studied in 611 students aged 7 to 14 years out of 19.928 students classified according to age, ethnicity, and sex, who underwent anthropometric evaluation and blood pressure measurement. Hypertensive individuals were considered those whose blood pressure level was > the 95th percentile for age and sex, confirmed on 3 examinations. RESULTS: The prevalence of hypertension was 16.6% in the first evaluation, and 4.6% and 2.5% in the subsequent evaluations. The mean blood pressure levels increased with age. Weight was important, not only to determine blood pressure in healthy children, but also to determine systemic hypertension in children, which was not observed with height despite the different studies. The prevalence of systemic hypertension in the different ethnic groups and the mean blood pressure levels according to sex were similar. CONCLUSION: In addition to routine physical examinations, age, weight, and appropriate cuff size should be considered when assessing blood pressure in children to prevent hypertension, morbidity and mortality, and to avoid placing a financial burden on health care providers.

Noninvasive cardiac assessment in children of women with systemic lupus erythematosus

OBJECTIVE: Noninvasive cardiac assessment of newborns and infants of women with systemic lupus erythematosus. The children had no congenital total atrioventricular block and were compared with the children of healthy women. METHODS: We prospectively assessed 13 newborns and infants aged 1 to 60 days, children of women with systemic lupus erythematosus and without congenital total atrioventricular block. These children were compared with 30 children of women who had no lupus or anti-Ro/SSA antibodies, and no risk factors for congenital heart disease either. Their age groups matched. The following examinations were performed: cardiological physical examination, electrocardiography, echocardiography, and signal-averaged electrocardiography. RESULTS: The statistical analysis showed no significant difference in ventricular function or in the cardiac conduction system between the groups. CONCLUSION: In regard to the conduction system and ventricular function in the absence of total atrioventricular block, no statistically significant difference was observed between the children of women with systemic lupus erythematosus and children of healthy women.

Hepatitis C (HCV) crónica en Córdoba: impacto de la coinfección HIV / HCV, predicción del grado de fibrosis/cirrosis por un método no invasivo

Hasta el momento no existen datos epidemiológico – moleculares publicados acerca de la coinfección HCV/HIV y su impacto en la región central de Argentina. Este proyecto tiene como objetivos estudiar la prevalencia de infección activa y la distribución de genotipos de HCV en individuos infectados con HIV y evaluar su impacto en la terapia antiretroviral (HAART). Y por otra parte, implementar un método no invasivo, simple y de mayor adhesión, basado en análisis bioquímicos, para predecir grados de fibrosis y cirrosis en individuos infectados con HCV. Dicho método podrá ser transferido a otros laboratorios públicos y privados en un futuro cercano. Se estudiarán (bajo consentimiento informado) muestras de suero de individuos coinfectados HIV/HCV y monoinfectados con HCV. Se realizará el screening de anticuerpos contra HCV (anti-HCV), la confirmación de la infección (RNA HCV) y el diagnóstico suplementario (genotipificación, carga viral y biopsia). Además, se realizarán análisis bioquímicos y se completarán fichas clínico-epidemiológicos. Este proyecto intenta aportar información de la situación de HCV a los programas sanitarios para reforzar el sistema de vigilancia, mejorar el diagnóstico clínico e impulsar a programas de control, prevención y tratamiento para atenuar la diseminación de HCV en nuestro medio.

Inducción sistémica de la biosintesis de metabolitos secundarios en plantas aromáticas mediada por rizobacterias. Systemic induction of secondary metablolites biosynthesis in aromatic plants by rhizobacteria.

El uso de microorganismos como inoculantes para incrementar la disponibilidad y toma de nutrientes por parte de los cultivos, es una nueva tecnología que ha dado buenos resultados, observándose un incremento en la emergencia, vigor, mayor desarrollo en la parte aérea y de raíces, registrándose aumentos considerables de los rendimientos en cultivos de interés comercial. Esto es debido a que los microorganismos PGPR (Plant Growth promoting rhizobacteria) sintetizan ciertas sustancias reguladoras del crecimiento como giberelinas, citoquininas y auxinas; las cuales estimulan la densidad y longitud de los pelos radicales, aumentando así la cantidad y longitud de las raíces de los vegetales. Así, se incrementa la capacidad de absorción de agua y nutrientes, haciendo que las plantas sean más vigorosas, productivas y tolerantes a condiciones climáticas adversas, como sequías o heladas. Otro factor benéfico es que ciertos microorganismos solubilizan nutrientes poco móviles en el suelo como el caso del fósforo, segundo nutriente, después del nitrógeno en importancia para el crecimiento de los cultivos. Estos microorganismos también tienen una función muy importante en el control natural de agentes patógenos, a través de la inducción del sistema de defensa en las plantas, aumentando su resistencia a enfermedades, a través de la producción de compuestos bacterianos como antibióticos y sideróforos. Los variados mecanismos mediante los cuales la acción PGPR se lleva a cabo no son plenamente conocidos y, por lo tanto, es necesario determinar con precisión su efecto particular en la biología de la planta beneficiada. Las plantas aromáticas y medicinales inoculadas con microorganismos (rizobacterias) registran un incremento en varios parámetros de crecimiento vegetal (peso fresco parte aérea, peso seco de raíz, número de hojas, etc) y en el rendimiento de aceite esencial (AE). El aumento de la síntesis, y la variación de los porcentajes relativos de los componentes principales de AE en plantas aromáticas, como efecto de la inoculación, podría considerarse como una respuesta defensiva de la planta frente a la colonización de microorganismos dado que varios AE poseen propiedades antimicrobianas. El incremento de estos metabolitos también se ha registrado como respuesta frente a la herbivoría. En el presente proyecto se propone dilucidar la existencia de una relación entre las defensas inducidas por rizobacterias con la producción de metabolitos secundarios en plantas aromaticas y medicinales. The use of microorganisms as inoculants to increase the availability and nutrient uptake by crops, is a new technology that has been successfully applied, with an increase in the emergence, vigor, greater development in the shoot and roots, recording significant increases in yields of crop with commercial interest. This is because microorganisms PGPR (Plant Growth Promoting rhizobacteria) synthesize certain growth regulating substances such as gibberellins, cytokinins and auxins, which stimulate the density and length of root hairs, increasing the number and length of roots. Thus, increase the capacity of absorbing water and nutrients, make the plants more vigorous, productive and tolerant to adverse climatic conditions such as drought or frost.Another beneficial factor is that some microorganisms solubilize nutrients mobile in the soil as the case of phosphorus, second nutrient after nitrogen important for plant growth. These organisms also have an important role in the natural control of pathogens through the induction of the plants defense system, increasing their resistance to disease through the production of compounds such as antibiotics and bacterial siderophores. The various mechanisms by which PGPR action takes place are not fully known and therefore it is necessary to accurately determine its particular effect on the biology of the specific plant benefit. Aromatic and medicinal plants inoculated with microorganisms (rhizobacteria) recorded an increase in several parameters of plant growth (shoot fresh weight, root dry weight, leaf number, etc) and essential oil yield (AE). The increase in the biosynthesis, and changes in the relative percentages of the main components of AE in aromatic plants inoculated with rizobacterias, could be regarded as a plant defense response against microbial colonization, since several AE have antimicrobial properties. The increase of these metabolites have also been recorded as a response to herbivory.

Interacciones medicamentosas de los inhibidores de la enzima convertidora de angiotensina y fibrosis renal: rol de la endotelina-1 como biomarcador

Esta propuesta está centralizada en la prevención y detección temprana de daño en el órgano blanco y monitoreo terapéutico para así disminuir las complicaciones derivadas de la hipertensión. Los sistemas internacionales de salud han llegado a disminuir costos de 25-45% aplicando un sistema de prevención eficaz de enfermedad renal crónica. Los pacientes mayores de 65 años tienen una alta tasa de polimedicación asociado a una alta prevalencia de hipertensión arterial. Gran porcentaje de ellos esta tratado con inhibidores de la enzima convertidora de la angiotensina (iECA). Determinar el grado de compromiso en pacientes diagnosticados o no con hipertensión, es fundamental a la hora de comenzar un programa de prevención y monitoreo. Aumentos en la actividad de la ECA se asocia a daño renal, pero son relativamente escasos los datos que analizan el daño renal en relación con los niveles fibrosis renal, variable que hasta ahora solo podía ser observada mediante biopsias. Un 80% de pacientes polimedicados hipertensos desarrollan enfermedad renal crónica, aun teniendo controlada su presión arterial. Actualmente en nuestro conocimiento no hay estudios relacionados con las interacciones medicamentosas de los iECA y el daño en órgano blanco; menos aún con el aumento en la fibrosis renal. Basándonos en ello, se estima que las interacciones medicamentosas de los iECA elevan la concentración de Endotelina-1 urinaria, siendo este un marcador de fibrosis renal. La hipótesis de esta propuesta se basa en que las interacciones medicamentosas de los iECA estimulan la fibrosis renal en pacientes polimedicados hipertensos adultos mayores. Los objetivos de esta propuesta son: 1) Relevar pacientes con interacciones medicamentosas de los iECA y evaluar las interacciones medicamentosas más frecuentes en la población abordada, 2) Evaluar el cumplimiento terapéutico de los pacientes con diagnóstico confirmado de hipertensión arterial. 3) Evaluar el daño de órgano blanco renal en modelos animales de hipertensión (ratas espontáneamente hipertensas). Los resultados de esta propuesta contribuirán al afianzamiento de nuevos biomarcadores de daño renal, proveniente de datos de pacientes polimedicados que, generalmente, desarrollan enfermedad renal crónica con el paso del tiempo.

Patogenesis of pipe-stem fibrosis of the liver (experimental observation on murine Schistosomiasis)

Mice infected with 30 cercariae of Schistosoma mansoni developed portal and septal fibrosis due to the massive and concentrated deposition of eggs in the periportal areas which occurred following the 16th week after infection. The lesion resembled pipe-stem fibrosis seen in human hepatosplenic schistosomiasis in the following characters: portal fibrosis interconnecting portal spaces as well as portal spaces and central canals; portal inflammation; periovular granulomas; vascular obstruction and telangiectasia. The liver parenchyma maintained its normal architecture. Vascular injection techniques with Indian ink and vinylite revealed that the portal system developed numerous dilated collateral venules coming from the large and medium-sized portal branches, about 10 weeks after schistosome infection. The lodging of schistosome eggs into these collaterals resulted in granulomatous inflammation and fibrosis along all the portal tracts, thus forming the pipe-stem lesion. Although not readily demonstrable grossly, the pipe-stem fibrosis of murine schistosomiasis has many similarities with the human lesion and can be considered to have the same basic pathogenesis.

Raising the Level of Moral Thinking among Managers Will Not Help. Kohlberg's Conventionality and Systemic Ethical Flaws in Business

Business ethicists often assume that unethical behavior arises when individuals deviate from the norms and responsibilities that are institutionalized to frame economic activities. People's greed motivates them to violate the rules of the game. In Kohlberg's terms, it is assumed that such actors make decisions in a preconventional way and act opportunistically. In this article, we propose an alternative interpretation of deviant behavior, arguing that such behavior does not result from a lack of conventional moral guidance but rather from the fact that characteristics attributed to preconventional morality by Kohlberg - the purely incentive and punishment driven opportunistic morality - have become the conventionalized morality. The prevailing norms that economic actors have internalized as their yardstick are those of the preconventional Homo economicus. Not the deviation from, but the compliance with the rules of the game explains many forms of harmful and illegal decisions made in corporations.

Cell-matrix interactions in Schistosomal portal fibrosis: a dynamic event

In recent years, one of the most significant progress in the understanding of liver diseases was the demonstration that liver fibrosis is a dynamic process resulting from a balance between synthesis and degradation of several matrix components, collagen in particular. Thus, fibrosis has been found to be a very early event during liver diseases, be it of toxic, viral or parasitic origin, and to be spontaneously reversible, either partially or totally. In liver fibrosis cell matrix interactions are dependent on the existence of the many factors (sometimes acting in combination) which produce the same events at the cellular and molecular levels. These events are: (i) the recruitment of fiber-producing cells, (ii) their proliferation, (iii) the secretion of matrix constituents of the extracellular matrix, and (iv) the remodeling and degradation of the newly formed matrix. All these events represent, at least in principle, a target for a therapeutic intervention aimed at influencing the experimentally induced hepatic fibrosis. In this context, hepatosplenic schistosomiasis is of particular interest, being an immune cell-mediated granulomatous disease and a model of liver fibrosis allowing extensive studies in human and animals as well as providing original in vitro models.

Sclérodermie et risques oncologiques [Systemic sclerosis and cancer]

The combination of skin induration with clinical features such as dyspnea, facial telangiectasia, digital infarctions and/or dysphagia supports the diagnosis of systemic sclerosis. The oesophageal dysmotility is associated with symptoms which may delay the diagnosis of gastro-oesophageal cancer. Herein we report a case of long standing systemic sclerosis with heartburn and dysphagia symptoms which were monitored closely. Unfortunately, these symptoms delayed the diagnosis of gastric adenocarcinoma. This case prompted us to review the evidence of the association of cancer and systemic sclerosis and if any oncologic evaluation is required during the follow-up of patients affected with systemic sclerosis.

Uric acid is a danger signal activating NALP3 inflammasome in lung injury inflammation and fibrosis.

RATIONALE: Lung injury leads to pulmonary inflammation and fibrosis through myeloid differentiation primary response gene 88 (MyD88) and the IL-1 receptor 1 (IL-1R1) signaling pathway. The molecular mechanisms by which lung injury triggers IL-1beta production, inflammation, and fibrosis remain poorly understood. OBJECTIVES: To determine if lung injury depends on the NALP3 inflammasome and if bleomycin (BLM)-induced lung injury triggers local production of uric acid, thereby activating the NALP3 inflammasome in the lung. Methods: Inflammation upon BLM administration was evaluated in vivo in inflammasome-deficient mice. Pulmonary uric acid accumulation, inflammation, and fibrosis were analyzed in mice treated with the inhibitor of uric acid synthesis or with uricase, which degrades uric acid. MEASUREMENTS AND MAIN RESULTS: Lung injury depends on the NALP3 inflammasome, which is triggered by uric acid locally produced in the lung upon BLM-induced DNA damage and degradation. Reduction of uric acid levels using the inhibitor of uric acid synthesis allopurinol or uricase leads to a decrease in BLM-induced IL-1beta production, lung inflammation, repair, and fibrosis. Local administration of exogenous uric acid crystals recapitulates lung inflammation and repair, which depend on the NALP3 inflammasome, MyD88, and IL-1R1 pathways and Toll-like receptor (TLR)2 and TLR4 for optimal inflammation but are independent of the IL-18 receptor. CONCLUSIONS: Uric acid released from injured cells constitutes a major endogenous danger signal that activates the NALP3 inflammasome, leading to IL-1beta production. Reducing uric acid tissue levels represents a novel therapeutic approach to control IL-1beta production and chronic inflammatory lung pathology.

Quantitative and qualitative research on brief systemic therapies carried out within the framework of an ambulatory consultation for couples and families

Abstract: This article presents both a brief systemic intervention method (IBS) consisting in 6 sessions developed in an ambulatory service for couples and families, and two research projects done in collaboration with the Institute for Psychotherapy of the University of Lausanne. The first project is quantitative and it aims at evaluating the effectiveness of ISB. One of its main feature is that outcomes are assessed at different levels of individual and family functioning: 1) symptoms and individual functioning; 2) quality of marital relationship; 3) parental and co-parental relationships; 4) familial relationships. The second project is a qualitative case study about a marital therapy which identifies and analyses significant moments of the therapeutic process from the patients' perspective. Methodology was largely inspired by Daniel Stem's work about "moments of meeting" in psychotherapy. Results show that patients' theories about relationship and change are important elements that deepen our understanding of the change process in couple and family therapy. The interest of associating clinicians and researchers for the development and validation of a new clinical model is discussed.