Gerardo Enrique Muñoz-Maldonado

Recombinant Adenovirus Delivery of Calreticulin-ESAT-6 Produces an Antigen-Specific Immune Response but no Protection Against a Mycobacterium Tuberculosis Challenge

Bacillus Calmette–Guerin (BCG) has failed to efficaciously control the worldwide spread of the disease. New vaccine development targets virulence antigens of Mycobacterium tuberculosis that are deleted in Mycobacterium bovis BCG. Immunization with ESAT‐6 and CFP10 provides protection against M. tuberculosis in a murine infection model. Further, previous studies have shown that calreticulin increases the cell‐mediated immune responses to antigens. Therefore, to test whether calreticulin enhances the immune response against M. tuberculosis antigens, we fused ESAT‐6 to calreticulin and constructed a recombinant replication‐deficient adenovirus to express the resulting fusion protein (AdCRT–ESAT‐6). The adjuvant effect of calreticulin was assayed by measuring cytokine responses specific to ESAT‐6. Recombinant adenovirus expressing the fusion protein produced higher levels of interferon‐γ and tumour necrosis factor‐α in response to ESAT‐6. This immune response was not improved by the addition of CFP‐10 to the CRT‐ESAT‐6 fusion protein (AdCRT–ESAT‐6–CFP10). Mice immunized with these recombinant adenoviruses did not decrease the mycobacterial burden after low‐dose aerosol infection with M. tuberculosis. We conclude that calreticulin can be used as an adjuvant to enhance the immune response against mycobacterial antigens, but it is not enough to protect against tuberculosis.

Secretion of biologically active human interleukin 22 (IL-22) by Lactococcus lactis.

Interleukin-22 (IL-22) participates in the modulation of innate immunity and inflammation. This cytokine has important therapeutic potential, such as with ulcerative colitis, liver and lung injury, and infection, in different animal models. We generated a Lactococcus lactis strain that secretes human IL-22 under the regulation of the nisin-inducible promoter. Identification and secretion of this cytokine was demonstrated using western blots of culture supernatants from IL-22-expressing bacteria. The recombinant IL-22 protein produced by L. lactis was biologically active as determined by its ability to induce IL-10 secretion when co-cultured with a colon epithelial cell line in vitro. We consider this novel strain a promising live vaccine for various therapeutic applications.

Sigmoid fixation associated with rectopexy using a laparoscopic approach could prevent relapse of rectal prolapse in pediatric patients with spinal dysraphia

UNLABELLED Recurrent rectal prolapse, resistant to medical treatment, is an indication for surgical treatment. Patients with spinal dysraphia frequently have already been treated by sclerotherapy or other surgical techniques, but unsuccessfully. METHODS We present 2 patients, who underwent laparoscopic rectopexy, with spinal dysraphia and complete rectal prolapse relapse after conservative treatment. In these patients, we performed, as an additional technique, fixation of the rectosigmoid to avoid recurrence by invagination or prolapse of the anterior wall. RESULTS Follow-up at 14 and 11 months, respectively, did not find any recurrence. CONCLUSION We suggest that laparoscopic rectopexy with sigmoid fixation should be considered as an alternative for the treatment for patients with spinal dysraphia and rectal prolapse to avoid recurrence.

Evaluación del uso de antibióticos e impacto de una intervención dirigida a modificar la conducta prescriptiva en profilaxis quirúrgica en 6 hospitales del área metropolitana de Monterrey

BACKGROUND Improper use of antibiotics increases antimicrobial resistance. OBJECTIVE Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. MATERIAL AND METHODS Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. ANALYSIS Frequencies, percentages, medians, ranges and X2 test. RESULTS Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). CONCLUSIONS Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.

CXCL10/XCL1 fusokine elicits in vitro and in vivo chemotaxis.

Fusokines are proteins formed by the fusion of two cytokines. They have greater bioavailability and therapeutic potential than individual cytokines or a combination of different cytokines. Interferon-gamma-inducible protein 10 (CXCL10) and lymphotactin (XCL1) are members of the chemotactic family of cytokines, which induce tumor regression by eliciting immune-system cell chemotaxis. We engineered a replication-deficient adenoviral system expressing CXCL10/XCL1 fusokine (Ad FIL) and assessed its chemotactic response in vitro and in vivo. The CXCL10/XCL1 fusokine elicited a greater chemotactic effect in IL-2 stimulated lymphocytes than individual or combined cytokines in vitro. CXCL10/XCL1 fusokine biological activity was demonstrated in vivo by intratumoral chemoattraction of CXCR3+ cells. Thus, this novel CXCL10/XCL1 fusokine may represent a potential tool for gene therapy treatment of cancer and other illnesses that require triggering immune-system cell recruitment.

Retroperitoneal Schwannoma Associated with Neurofibromatosis Type I: Case Report

Schwannomas are tumors of neural origin. They represent 1% of all the tumors of the retroperitoneum. The majority are benign. However, up to 18% are malignant, and frequently with a low-grade differentiation in their histology. A 46-year-old female with neurofibromatosis type 1 who had right knee pain with irradiation to the ipsilateral leg was described. The diagnostic approach included lumbar magnetic resonance imaging showing a retroperitoneal tumor from L2 to L3. Despite the great development of therapeutic strategies, surgical excision seems to be the only one with curative potential. However, few patients are candidates for this treatment. In our case, we gave the patient a multidisciplinary treatment which leads to a good oncological outcome. Malignant degeneration of schwannomas is not uncommon. We propose the multidisciplinary approach for the diagnosis, the surgical procedure as well as follow-up for better outcomes.

Modulation of Remote Ischemic Preconditioning by Proinflammatory Cytokines in Renal Transplant Recipients

ABSTRACT Aim: Remote ischemic preconditioning (RIPC) has been used as a strategy to reduce acute renal injury and ischemia-reperfusion injury (IRI) in renal transplantation (RT) with controversial results. Objective: To determine if RIPC modifies IRI in cadaveric RT recipients through inflammatory mediators and graft function. Methods: Twenty-nine RT recipients were studied, 12 in the control group (CG) and 17 in the RIPC group. RIPC which was performed on donors using a pneumatic tourniquet placed on both thighs for 10 min followed by the determination of IL-1, IL-6, TNF-α, VEGF, and ICAM-1, and hematological and biochemical parameters in different phases of RT. Results: Serum creatinine levels were significantly lower in the RIPC group versus the CG at 15 and 30 days; however, the estimated glomerular filtration rate (eGFR) showed no significant difference in any phase between either group, only TNF-α showed significantly higher values in the RIPC group versus the CG in almost all phases of the study, meanwhile IL6 was increased at 72 hours (hr) and 30 days, IL1 at 72 hr and 15 days and ICAM-1 post reperfusion, contrary to this VEGF showed a decrease at 7 and 15 days. Conclusion: RIPC did not improve eGFR or serum creatinine; however, it modifies the inflammatory response in RT recipients.

Epidemiología de las lesiones por proyectil de arma de fuego en el Hospital Universitario “Dr. José Eleuterio González” de la Universidad Autónoma de Nuevo León

Resumen Antecedentes La incidencia de heridas y muertes por herida por proyectil de arma de fuego merece una atencion especial en su epidemiologia, protocolos de manejo y tratamiento. Objetivos Determinar las caracteristicas epidemiologicas de las heridas por proyectil de arma de fuego. Material y metodos Entre 2005 y 2015 se analizaron todos los pacientes con diagnostico de heridas por proyectil de arma de fuego. Se estudiaron multiples variables de su atencion hospitalaria. Resultados Se obtuvo un total de 605 casos, los cuales se analizaron como universo total de pacientes y, ademas, se tomo una muestra de 314 casos, para un analisis mas detallado. Se obtuvo una mortalidad total de 7.9%. Se realizaron 324 laparotomias, 124 incisiones de la pared toracica, y 72 exploraciones vasculares. Dentro del grupo de resultados especificos se obtuvo un 16.9% y 42% de laparotomias y exploraciones vasculares, respectivamente, sin evidencia de lesion. Discusion La morbimortalidad aumenta significativamente en pacientes con 2 o mas heridas, multiples transfusiones y con requerimiento de estancia en la unidad de cuidados intensivos. Conclusiones Se propone la incorporacion de un formato de evaluacion fisica de los pacientes con heridas por proyectil de arma de fuego, por parte de los servicios involucrados en su atencion, que promueva la generacion de trabajos de investigacion mas detallados.

Identificación de flora bacteriana en cultivos de bilis y pared de vesícula biliar de pacientes sometidos a colecistectomía laparoscópica en el Hospital Universitario «Dr. José Eleuterio González»

BACKGROUND Through experience it has been accepted that bile in normal conditions remains sterile. Bactibilia is a common finding in individuals at high risk or with complicated cholecystolithiasis, however few data prevails about the prevalence of bactibilia in patients operated on for uncomplicated laparoscopic cholecystectomy. There is s common usage of preoperative and postoperative antibiotics in the different patients without the existence of any actual bacteriologic and epidemiologic evidence. MATERIAL AND METHODS 183 patients with diagnosis of cholecystolithiasis postoperated of laparoscopic cholecystectomy had their bile sent to bacteriology. RESULTS Bactibilia was identified in 31.95% of the cultures of mild cholecystitis and in 35.71% for moderate (p<.0001). A total of 125 negative cultures were obtained (68.3) and 58 positive (31.69%) with a prevalence of enterobacteria group (43.10%) and Enterococcus (27.58). CONCLUSIONS Comparing the groups according to severity there is a significant difference with regard to the presence of bactibilia, in addition to the bacterial groups cultivated. Fluoroquinolones and metronidazole is an option for the treatment of patients with the suspicion of bactibilia. The use of antibiotics is not justified in patients at low risk.