Parálisis facial alternobárica: a propósito de un caso y revisión de la literatura / Alternobaric facial palsy: case report and literature review

La parálisis o paresia facial alternobárica es una neuropraxia del séptimo nervio cra-neal debido a cambios de presión. Se produce en el contexto de una disfunción de la trompa de Eustaquio, una dehiscencia canal del nervio facial y cambios en la presión atmosférica. Se considera una rara complicación de barotrauma. Su prevalencia es difícil de estimar y, probablemente, se encuentre subreportada. La forma de presentación más habitual incluye paresia facial, plenitud aural, hipoacusia, otalgia, parestesias faciales y linguales. La mayoría de los episodios son transitorios, con una duración entre minutos y algunas horas, con recuperación posterior completa. Entre los diagnósticos diferenciales se encuentran causas periféricas y centrales de paresia facial, las cuales hay que sospechar ante la persistencia de los síntomas en el tiempo o ante la presencia de otros signos o síntomas neurológicos. La evaluación inicial debe incluir un examen otoneurológico completo. La tomografía computarizada de hueso temporal favorece la visualización de posibles dehiscencias del canal del facial. La prevención de nuevos episodios incluye la práctica de ecualización efectiva, la resolución de la disfunción de la trompa de Eustaquio y en algunos casos específicos, métodos alternativos de ventilación del oído medio como la colocación de tubos de ventilación. Una vez instalada la parálisis facial, si no se produce recuperación espontánea, el uso de corticoides es una opción. Se presenta un caso de paresia facial alternobárica recurrente y una revisión de literatura.

Alternobaric facial palsy or paralysis is a neuropraxia of the seventh cranial nerve due to pressure changes. It occurs in the context of Eustachian tube dysfunction, facial nerve canal dehiscence, and changes in atmospheric pressure. It is considered a rare complication of barotrauma. Its prevalence is difficult to estimated, and this condition is probably underreported. The most common form of presentation includes facial weakness, ear fullness or pressure, hearing loss, otalgia, facial and lingual paresthesias. Most episodes are transient, lasting from minutes to a few hours, with a subsequent complete recovery. Among the possible differential diagnoses are peripheral and central causes of facial paralysis, which must be suspected due to the persistence of symptoms over time or the presence of other neurological signs or symptoms. The initial evaluation should include a complete otoneurological examination. Computed tomography of the temporal bone is useful for the visualization of facial canal dehiscence. Prevention of further episodes includes practicing effective equalization, Eustachian tube dysfunction treatment, and in certain specific cases, alternative middle ear ventilation methods such as tympanostomy tubes. Once facial paralysis is established, if spontaneous recovery does not occur, the use of corticosteroids is considered an option. A case of recurrent alternobaric facial paresis and a review of the literature are presented.

Induction of anaesthesia with propofol according to the adjusted ideal body mass in obese and non-obese patients: an observational study

Background: Obesity changes body composition including fat free mass (FFM), regarded as the "pharmacologically active mass". Scaling drug doses to obese patients by total body mass (TBM) results in overdose. We aimed to determine the success rate of inducing anaesthesia in normal, overweight and obese patients with propofol, using an adjusted body mass scalar (ABM), which embodies the increased FFM of obese patients. Methods: Ninety-six patients were divided into three groups according to body mass index (BMI): normal, overweight and obese. Propofol 2 mg/kg ABM was administered according to the equation: ABM = IBM + 0.4(TBM ­ IBM), where IBM = ideal body mass. Induction success was assessed clinically and by electroencephalographic spectral entropy. Results: The groups were similar regarding gender, age, height and IBM. One patient was morbidly obese (BMI = 44). State entropy (SE) decreased to < 60 in 33/33, 28/29 and 33/34 patients in the normal-weight, overweight and obese groups respectively, an overall success rate of 97.5% (95% confidence interval 92.7% to 99.4%). Median lowest achieved SE values and median times that SE remained < 60 did not differ between groups, however the individual values ranged widely in allthree groups. Induction failed in the two patients whose SE did not decrease to < 60 (one overweight and one obese). Conclusions: The ABM-based propofol induction dose has a high success rate in normal, overweight and obese patients. Further studies are required to determine the feasibility among morbidly obese patients

Cytokine Profile and Clinical Correlates in HIV-Exposed Infants with Severe (Hypoxic) Pneumonia

Introduction. Severe pneumonia in infants who are HIV-infected is a common problem in many parts of the developing world; especially sub-Saharan Africa. What has been missing from previous studies of severe pneumonia in HIV-infected infants; however; is a description of the host inflammatory response and cytokine/chemokine profile that accompanies this disease. Objective. To describe the cytokine profiles associated with severe hypoxic pneumonia in HIV-infected infants Methods. In a cohort of HIV-infected children diagnosed clinically with severe hypoxic pneumonia; paired serum and sputum cytokines were tested. A control group of HIV-infected children with bronchiectasis contributed matching controls.Results. A total of 100 infants (mean age 2.8 months) with a clinical diagnosis of severe hypoxic pneumonia were included in this study. IP-10 was markedly elevated in both sputum (mean 560.77pg/ml) and serum (mean 9091.14pg/ml); while IP-10 was elevated in serum (mean 39.55 pg/ml); with both these cytokines being significantly higher than in stable children with HIV-related bronchiectasis. Conclusion. This study of HIV-infected infants with severe hypoxic pneumonia suggests that IL-10 and IP-10 are associated with more severe lung disease. However; further investigation of this association is required

Knowledge of and Misconceptions about the Spread and Prevention of HIV Infection among Older Urban Women Attending the Tshwane District Hospital; South Africa

Background:Statistics around the world show a rapid increase in HIV infection in the older population. Many older women remain sexually active and are therefore exposed to heterosexual transmission of HIV infection. Older women are most likely considered respected opinion leaders within the families and communities and are likely to influence others' attitudes and behaviours. An increase in knowledge through information plays a fundamental role and is a prerequisite for behavioural change that may prevent new HIV infections. The purpose of the current study was to assess the knowledge and misconceptions regarding the spread and prevention of HIV in older women attending the Tshwane District Hospital (TDH) in South Africa. Methods: A prospective cross-sectional study of 100 women; aged 50 to 80 years; attending the TDH out-patient section during November and December 2006 was done. The levels of knowledge were determined by using a directed questionnaire. Results: Eight per cent of the participants answered all the questions correctly; showing knowledge gaps in the remaining 92(95confidence interval: 86.7-97.3). Many participants were unaware of the protective effects of condom use; especially female condoms; and of HIV spread by anal transmission; the sharing of needles and blood transfusion. Three or more misconceptions were present in 48of the participants; such as HIV spread by casual contact; the sharing of personal items; air-borne infection; mosquito bites; HIV testing and AIDS prevention or cure by traditional medicines or alternatives. Sixty-two per cent of the older women were found to have adequate knowledge (95confidence interval: 52-71.5); knowing the basic concepts regarding HIV transmission.Conclusion: There is a significant need for HIV-related preventive health education in older women; not only to decrease potential high-risk behaviours; but also to reduce unnecessary feelings of anxiety and misconceptions. Family physicians; due to their unique role; might be able to use the present study in their practices in order to optimise the planning and structuring of awareness interventions and prevention programmes

Hereditary Non-Polyposis Colorectal Cancer is Predicted to Contribute towards Colorectal Cancer in Young South African Blacks

A disproportionately large number of young (50 years); those from young black patients presented more often with a low methylation phenotype (CIMP-L) and high levels of microsatellite instability (MSI-H). Furthermore; as determined by real-time PCR using probe technology; the tissues from35of young blacks showed mutations within exon 1 of the KRAS gene. The BRAF-V600E mutation was only evident in the case of a single young black patient. Based on these results it seems likely that a proportion of CRC cases in young black patients from South Africa develop through the accumulation of mutations resulting in a mismatch repair deficiency linked to MSI-H and; possibly; germline mutations in the mismatch repair genes. The features in these patients are consistent with a diagnosis of the Hereditary Non-Polyposis Colorectal Cancer (HNPCC) syndrome. This finding has important implications for patient management and suggests that family members may be at high risk for CRC

Colorectal Cancer in South Africa: a Heritable Cause Suspected in many Young Black Patients

Background. Colorectal carcinoma (CRC) has a low incidence among the black African population. Largely unrecognised in the scientific literature is the fact that a disproportionately large number of young black patients (50 years old) present with CRC. Objectives. To analyse those tumours; which we propose may link them to morphological features associated with known genetic pathways. Methods. A retrospective review of South African patients histologically diagnosed as having CRC by the Division of Anatomical Pathology; National Health Laboratory Service (NHLS) and the University of the Witwatersrand (1 732 patients from 1990 to 2003). The histology was fully reviewed in 609 patients (1997 - 2002); and all specimens from patients 50 years of age were subjected to immunohistochemistry tests for mismatch repair proteins; as well as APC and p53 proteins. Results. Most young patients (50 years) were black (41v. 10white; p=0.001). Blacks had predominantly proximal tumours and significantly more poorly differentiated and/or mucinous tumours (p=0.006); and loss of mismatch repair protein expression was more evident than in whites. Conclusions. It seems likely that CRC in young blacks develops through the accumulation of mutations; most probably via mis- match repair deficiency or promoter methylation; which in turn is linked to poor differentia- tion and a mucinous architecture

Biological Variation of Ischaemia-Modified Albumin in Healthy Subjects : Cardiovascular Topic

Aim : Ischaemia-modified albumin (IMA); as measured by the albumin-cobalt binding (ACB) testr; has been cleared by the US Food and Drug administration as a biomarker to exclude the presence of myocardial ischaemia in patients. Although there are a number of published studies detailing the clinical utility of IMA; data on the biological variation of IMA are still lacking. In this study we determined the analytical and biological variance components of ischaemia-modified albumin; and compared the distribution of IMA values in our patient population to those provided by the kit manufacturer. Methods : IMA was determined once a week for five consecutive weeks on a cohort of healthy subjects using a colorimetric method; the ACB testr on a Roche modular analyser. Results : The analytical coefficient of variation (CVA) was 5; and the within-subject (CVI) and between-subject (CVG) biological variations were 3 and 7; respectively. Analysis of the repeated measures with gender and race (black and Caucasian) as between-subject factors; and weeks (1-5) as the within-subject factor showed that gender had no significant effect on circulating IMA concentrations (p = 0.3146); whereas race did have a significant effect (p = 0.0062). A significant (p = 0.0185) interaction was observed between gender and race. Conclusion : The ACB testr could bring a new dimension to the care and management of patients with acute coronary syndrome. Further studies for normal population distributions by gender and ethnicity; and an optimum cut-off value appear to be required

Effect of Music on Submaximal Cycling

OBJECTIVE. Athletes frequently report training to music; yet there have been relatively few studies that have addressed the benefit of exercising with music. Design. Volunteer men and women (N=30); aged between 18 and 40 years; performed an initial familiarisation session. Part of this session involved the measurement of maximal oxygen consumption. With at least a 48-hour intervening period; this was then followed by a first 20-minute submaximal cycling session; at 80of maximal oxygen consumption. At least 48 hours later a second submaximal cycling session was performed. Subjects were randomly divided into two groups. Group A cycled without music and group B cycled with music for the first submaximal cycling session. Subjects underwent the same testing procedure for the second submaximal cycling session; but this time group A cycled to music and group B cycled without music. Subjects served as their own controls. SETTING. The study was performed in the physiology exercise laboratory; at the University of the Witwatersrand. MAIN OUTCOME MEASURES. During the submaximal sessions heart rate; perceived exertion (Borg scale) and plasma lactate concentration were assessed. Subjects completed a post-test questionnaire once both submaximal cycling sessions were completed. RESULTS. There were no significant differences in physiological variables (change in plasma lactate and heart rate); nor were there any significant differences in Borg scale ratings when the subjects cycled with and without music. However; according to the post-test questionnaire 67of subjects identified the cycling session with music to be easier than the session without music. CONCLUSION. Listening to music while performing submaximal cycling resulted in no physiological benefit. Yet; the cycling session done in conjunction with music was deemed; by the majority of the subjects; to be easier than the cycling session without music

The Effect of Developmentally Supportive Positioning (DSP) on Preterm Infants' Stress Levels

Research has proven that developmentally supportive care (DSC) improves the developmental outcomes for preterm infants. Available evidence regarding the similar effect of one of its principles; developmentally supportive positioning (DSP); was inconclusive; which lead to this study. The study was conducted in two phases: firstly; the Hennessy Stress Scale for the Preterm Infant was developed and; secondly; using a within-subject design; the effects of DSP n the stress levels of preterm infants were measured. Using the Hennessy Stress Scale for the Preterm Infant; observed qualitative data could be quantified to reflect the infant's stress levels as a percentage. Nonprobability sampling was used to select twenty-two preterm infants of gestational age 37 weeks. The stress levels of these infants; who were admitted to a specific neonatal intensive care unit and not sedated; were observed before and after the implementation of DSP; and were then quantified; and recorded. The pre-test (infants without DSP) and post-test (same infants with DSP) mean stress level scores were 29.07 vs. 16.87 (mean shift of 12.2 and standard deviation of 3.97); which were significantly different (p 0.0001; Student's paired t-test). The conclusion was that DSP significantly decreases premature infants' stress levels

A comparison of EEG spectral entropy with conventional quantitative EEG at varying depths of sevoflurane anaesthesia

Background and Aim: Recently an electroencephalographic (EEG) spectral entropy module (M-ENTROPY) for an anaesthetic monitor has become commercially available. We compared its performance as an indicator of the state of anaesthesia with that of an older conventional quantitative EEG (QEEG) module (M-EEG) by the same manufacturer (Datex-Ohmeda Division; Instrumentarium Corp.; Helsinki; Finland). Methods: There were 40 ASA class I or II subjects; aged between 16-60 years; who underwent elective abdominal surgery. EEG data were collected from the printouts of the respective modules. The data presented here were related to four levels of anaesthesia: Pre-anaesthetic wakefulness (state A); 2 sevoflurane endtidal (ET) concentration after completion of surgery (state B); low ET sevoflurane concentrations (~ 0.5) just prior to regaining responsiveness (state C); and post-anaesthetic responsiveness (state D). Results: In terms of the prediction probability (Pk statistic); response entropy (RE) and state entropy (SE) produced higher values (0.95-1.0) than the best performing QEEG variable; frontal amplitude (0.86-0.95). Only RE scores did not overlap between states A and B or between B and D. The misclassification of subjects between states C and D was far lower for RE (28) than for any of the conventional QEEG measures (90). Conclusion: In on-line monitoring spectral entropy is superior in distinguishing states of anaesthesia and is also easier to use than conventional QEEG. It is speculated that the artefact rejection strategies accorded spectral entropy might significantly benefit conventional QEEG analysis

Ausência de micorrizas vesículo-arbusculares efetivas em lecythidaceas numa área de floresta primária da amazônia central

Lecythidaceae comprise one of the four most common tree families in the Amazon forest, but there have been few studies of vesicular-arbuscular mycorrhizae in this taxon. In this study roots of 31 species in six genera of Lecythidaceae were collected in a primary forest on an acid oxisol. No vesicular-arbuscular mycorrhizae, as indicated by the presence of vesicles or arbuscules were detected. Only some hyfas were found on some species roots, but not enough for increasing the nutrient absorption from the soil. This indicated that under the edaphic condiction and the time which the samples were collected, these species worked as no mycor-rhizal plants. These informations confirm datas found for other researches, and may be important for exploring more efficiently and by a not predatory way, the species of Lecythidaceae on agroforestry systems in the Amazon.

As Lecythidaceae compreendem uma das quatro famílias de árvores mais abundantes na floresta amazônica, mas foram pouco estudadas no que sc refere à simbiose com fungos micorrízicos dos solos. Foram coletadas raízes de 31 espécies de seis gêneros desta família numa floresta de terra firme da Amazônia Central, próxima a Manaus, sob um latossolo amarelo. Em algumas espécies observou-se uma ausência total de fungos nas raízes, enquanto que em outras, apenas algumas hifas de fungos, mas sem vesículas ou arbúsculos, estruturas que serviriam para confirmar a presença de micorrizas vesículo-arbusculares efetivas nas mesmas. As poucas bifas encontradas não seriam suficientes para aumentar a absorção de nutrientes do solo, indicando que nas condições edáficas e épocas de coletas do presente estudo, as plantas se comportaram como não micorrizicas. Estas informações reforçam dados obtidos por outros autores e podem servir de embasamento para uma exploração mais eficiente e não predatória de espécies desta família em sistemas agroflorestais na Amazônia.

Transfer of DDT used in malaria control to infants via breast milk

The transfer of p,p'-DDT (1,1,1-tricholoro-2,2-bis(4-chlorophenyl)ethane) and its metabolites to infants via breast-feeding was studied in an area of KwaZulu, South Africa, where DDT is used to interrupt malaria transmission. Samples of whole blood were collected from 23 infants, together with samples of breast milk from their respective mothers. The mean sigma DDT (total DDT) in the whole blood was 127.03 micrograms.l-1 and that in the breast milk, 15.06 mg.kg-1 (milk fat). The % DDT (% DDT of sigma DDT) was significantly higher in the infant blood than in the breast milk (P less than 0.05). A multiplicative regression analysis indicated that sigma DDT increased significantly (P less than 0.01) in infant whole blood with infant age. Multiple regression showed that 70.0% of the variation in sigma DDT was due to the variation in parity of the mother, age of the infant, and the sigma DDT in breast milk. These variables accounted also for 76.3% of the variation in p,p'-DDE but only for 38.2% of that in p,p'-DDT. Organochlorines were therefore largely transferred to the infant from the mother, with DDT in the environment playing a secondary role

Lack of efficacy of the standard potency Edmonston-Zagreb live, attenuated measles vaccine in African infants

The efficacy of standard potency Edmonston-Zagreb (E-Z) measles vaccine was tested in a randomized trial of Black infants in a rural area of South Africa where a measles epidemic was occurring. The following immunization schedules were used: 48 infants aged 4-8.5 months who received 3.9 log 50 infectious units of E-Z vaccine (group A); 48 infants aged 4-8.5 months who received 3.28 log 50 infectious units of Schwarz vaccine (group B); and 28 infants aged greater than 9 months who received 3.28 log 50 infectious units of Schwarz vaccine and served as controls (group C). For infants aged less than 23 weeks who were given either the E-Z or Schwarz vaccine, the number of seropositives was low (28%), irrespective of the pre-vaccination level of measles antibody. There was a higher number of seropositives (68%) among those in the age range greater than 23 weeks to less than 36 weeks who received the E-Z vaccine rather than the Schwarz vaccine (36%). When administered to children aged greater than 36 weeks, the Schwarz vaccine produced a satisfactory, though suboptimal response rate (61%). There was no correlation between seropositivity and pre-vaccination measles antibody status. Use of the standard dose of E-Z vaccine may have been one of the factors for this poor response, and this supports the WHO recommendation that titres higher than the standard potency vaccine are needed if 6-month-old infants are to be successfully immunized against measles

Resultados de la cirugía conservadora en el carcinoma invasor de mama precoz / Results of the conservative surgery in the early breast invasive carcinoma

Se analizan los resultados de la cirugía conservadora sin vaciamiento axilar, seguida de radioterapia y la sobrevida en 127 pacientes con cáncer de mama en estadio T1 - T2 No Mo a 144 meses. La población en estudio está constituida por 59 pacientes (46,4%) en T1 y 68 (53,5%) en T2. La edad promedio fue de 53 años para T1 y de 56 años para T2. El 83,2% de las pacientes en T1 tiene una SSEE a 120 meses. La mediana de seguimiento es de 54 meses. La sobrevida total actuarial es de 89,9%. El 11,8% (7/59) fracasaron. Tres (5%) en la zona locorregional y 4 (6,6%) a distancia. El 8% de los fracasos locorregionales lo hicieron en axila, mientras que en mama fue el 1,7%. Dos pacientes tienen fracaso en 2 o más localizaciones simultáneas. El 60,5% de las pacientes en T2 tienen una SSEE a 120 meses. La mediana de seguimiento es de 61 meses. La sobrevida total actuarial es de 77,7%. El 30% (21/68) fracasaron, 4 en la zona locorregional y 17 a distancia. Dos de los fracasos locorregionales fueron en axila y dos en la mama. Seis pacientes tienen dos o más fracasos simultáneos (locorregionales a distancia). Se concluye que en comparación a publicaciones con tratamientos similares, los resultados obtenidos son semejantes; pero al compararlos con los resultados obtenidos con técnicas conservadoras, en que se hace vaciamiento axilar, aquéllos son significativamente superiores, especialmente por los resultados obtenidos en axila

Levels of DDT and metabolites in breast milk from Kwa-Zulu mothers after DDT application for malaria control

Concentrations of DDT, DDE and DDD were determined in the breast milk of Kwa-Zulu mothers residing in two different areas--with and without annual intra-domiciliary applications of DDT for the interruption of malaria transmission (exposed and control groups, respectively). While no significant change in levels with time was found in the control group, both DDT and DDE in breast milk of the exposed group increased after DDT application and this continued for three more months, after which it did not decrease appreciably. Percentage DDT increased from 42.57% (sigma DDT = 12.21 mg/kg milk fat) before spraying to 50.87% (sigma DDT = 13.79 mg/kg milk fat) following DDT application. At 6 and 9 months after the application it was 45.85% (sigma DDT = 19.49 mg/kg milk fat) and 43.27% (sigma DDT = 18.34 mg/kg milk fat), respectively. These results suggest a risk to the health of the infants in the exposed group