Oxigenación por membrana extracorpórea como rescate de la insuficiencia cardiovascular y respiratoria en niños. Experiencia del Hospital Universitario Austral / Oxygenation by membrane extracorporeal as a rescue cardiovascular insufficiency and Respiratory in children. Experience of the Austral University Hospital

Introducción: La circulación de membrana extracorpórea consiste en el uso de una bomba de circulación extracorpórea con intercambio gaseoso, de forma prolongada, para proveer soporte vital temporario. Brinda soporte circulatorio, oxigena y remueve dióxido de carbono sin las complicaciones que puede generar la ventilación mecánica convencional. Diseño: Descriptivo, retrospectivo, observacional. Población: Se revisaron los registros clínicos de pacientes pediátricos y neonatos con diagnóstico de patología respiratoria y cardiovascular (0-192 meses) ingresados en ECMO entre el 1 de octubre de 2008 y el 30 de septiembre de 2013. Criterios de inclusión: edad gestacional >34 semanas y >2 kg), sin coagulopatía grave ni hemorragia cerebral grados III o IV, con enfermedad cardíaca reversible, enfermedad respiratoria con hipoxemia o hipercapnia , resistentes al mayor soporte mecánico ventilatorio disponible. Resultados: Ingresaron en ECMO 16 pacientes (mediana de la edad 24 meses, 0-192), 10 niñas y 6 niños. Cuatro ingresados por causas respiratorias y 12, por causas cardiovasculares. La mortalidad por ECMO respiratorio fue del 25% (1/4), cardiovascular 75% (10/12). El PIM de ingreso en la UCIP tuvo una mediana de 3 (1-10). La mediana de estadía en ECMO fue de 7 días (rango 3-16), la de estadía en UCIP-UCIN fue de 22 días (3-120) y en el hospital, de 40 (3-300).Cuatro pacientes recibieron canulación venovenosa y los restantes 12, arteriovenosa. El índice de oxigenación medio de ingreso fue de 26 (DE ± 4); mediana de presión media de la vía aérea, 22 (rango 19-35); media de PartO2 43 (DE ± 8) y la media de PCO2 53 (DE ± 5). El índice Pa/Fi al ingreso tuvo una mediana de 42 (rango 32-74). Conclusión: El ECMO es una herramienta útil para el rescate de pacientes con falla cardíaca e insuficiencia respiratoria, pues permite sostener al paciente, evitando los efectos nocivos de la ventilación mecánica convencional (cuando no se puede mantener la estrategia de protección pulmonar) y de altas dosis de drogas vasoactivas. No obstante, el desarrollo de programas costo- efectivos de ECMO en nuestro país plantea un escenario difícil.(AU)

Introduction: Extracorporeal membrane circulation (ECMO) is the use of cardiopulmonary bypass with prolonged gas exchange to provide temporary life support. The ECMO offers circulatory support, oxygenates and removes carbon dioxide without the complications that can generate conventional mechanical ventilation. Design: Descriptive, retrospective, observational. Population: Clinical records of pediatric and neonatal patients diagnosed with respiratory and cardiovascular disease (0-192 months) admitted to ECMO from October 10, 2008 to September 30, 2013 were reviewed. Inclusion criteria: gestational age >34 weeks and >2 kg, absence of severe coagulopathy and cerebral hemorrhage grade III or IV, with reversible heart disease, respiratory disease with hypoxemia and/or hypercapnia refractory to the most ventilatory mechanical support available. Results: Sixteen children with a median age of 24 months (0-192) (10 girls and 6 boys) were admitted to ECMO. Four children were admitted due to respiratory illness and 12 for cardiovascular disease. Mortality from respiratory ECMO was 25% (1/4), cardiovascular 75% (10/12). PIM at the PICU admissions had a median of 3 (1-10). Median ECMO stay was 7 days (range 3-16), median PICU-NICU stay 22 days (3-120) and hospital stay 40 (3-300). The kind of cannulation was veno-venous (4), and arteriovenous (12). Mean oxygenation index at admission, 26 (SD ± SD 4); median average pressure of air, 22 (range 19-35); average PartO2, 43 (SD ± 8) and mean PCO2 53 (SD ± 5). Median Pa/Fi index at admission, 42 (range 32-74 ). Conclusions: The ECMO is a useful tool for the rescue of patients with heart failure and respiratory failure, avoiding the deleterious effects of conventional mechanical ventilation (when it is not possible to maintain lung protective strategy) and high doses vasoactive drug. However the development of cost-effective ECMO programs in our country poses a difficult scenario.(AU)

HHV-8 infection in patients with AIDS-related Kaposi's sarcoma in Brazil

The aims of the present study were to determine the prevalence of human herpesvirus type 8 (HHV-8) in HIV-positive Brazilian patients with (HIV+/KS+) and without Kaposi's sarcoma (HIV+/KS-) using PCR and immunofluorescence assays, to assess its association with KS disease, to evaluate the performance of these tests in detecting HHV-8 infection, and to investigate the association between anti-HHV-8 antibody titers, CD4 counts and staging of KS disease. Blood samples from 66 patients, 39 HIV+/KS+ and 27 HIV+/KS-, were analyzed for HHV-8 viremia in peripheral blood mononuclear cells by PCR and HHV-8 antigenemia for latent and lytic infection by immunofluorescence assay. Positive samples for latent nuclear HHV-8 antigen (LNA) antibodies were titrated out from 1/100 to 1/409,600 dilution. Clinical information was collected from medical records and risk behavior was assessed through an interview. HHV-8 DNA sequences were detected by PCR in 74.3 percent of KS+ patients and in 3.7 percent of KS- patients. Serological assays were similar in detecting anti-LNA antibodies and anti-lytic antigens in sera from KS+ patients (79.5 percent) and KS- patients (18.5 percent). HHV-8 was associated with KS whatever the method used, i.e., PCR (odds ratio (OR) = 7.4, 95 percent confidence interval (CI) = 2.16-25.61) or anti-LNA and anti-lytic antibodies (OR = 17.0, 95 percentCI = 4.91-59.14). Among KS+ patients, HHV-8 titration levels correlated positively with CD4 counts (rho 0.48, P = 0.02), but not with KS staging. HHV-8 is involved in the development of KS in different geographic areas worldwide, as it is in Brazil, where HHV-8 is more frequent among HIV+ patients. KS severity was associated with immunodeficiency, but no correlation was found between HHV-8 antibody titers and KS staging

Effects of serotonin and fluoxetine on blood glucose regulation in two decapod species

One of the best known crustacean hormones is the crustacean hyperglycemic hormone (CHH). However, the mechanisms involved in hormone release in these animals are poorly understood, and thus constitute the central objective of the present study. Different groups of crustaceans belonging to diverse taxa (Chasmagnathus granulata, a grapsid crab and Orconectes limosus, an astacid) were injected with serotonin, fluoxetine, or a mixture of both, and glycemic values (C. granulata and O. limosus) and CHH levels (O. limosus) were determined after 2 h in either submerged animals or animals exposed to atmospheric air. Both serotonin and fluoxetine caused significant hyperglycemia (P<0.05) after injection into the blood sinus of the two species, an effect enhanced after exposure to atmospheric air. In C. granulata blood glucose increased from 6.1 to 43.3 and 11.4 mg/100 ml in submerged animals and from 5.7 to 55.2 and 22.5 mg/100 ml in air-exposed animals after treatment with serotonin and fluoxetine, respectively. In O. limosus the increases were from 1.2 to 59.7 and 135.2 mg/100 ml in submerged animals and from 2.5 to 200.3 and 193.6 mg/100 ml in air-exposed animals after treatment with serotonin and fluoxetine, respectively. Serotonin and fluoxetine also caused a significant increase in the circulating levels of CHH in O. limosus, from 11.9 to 43 and 45.7 fmol/ml in submerged animals and from 13.2 to 32.6 and 45.7 fmol/ml in air-exposed animals, respectively, thus confirming their action as neuroregulators in these invertebrates

Diffuse adherence, ST-I enterotoxin and CFA/IV colonization factor are encoded by the same plasmid in the Escherichia coli O29: H21 strai

Escherichia coli O29:H21 is a human enterotoxigenic serotype that produces heat-stable (ST-I) enterotoxin, adheres diffusely to HeLa cells, and presents colonization factor antigen IV (CFA/IV) composed of CS5CS6 surface antigens. In one strain studied the genes for diffuse adherence and CFA/IV (CS5CS6) production were found to be present in the same plasmid encoding ST-I. The virulence plasmid (Ent) presented two unrelated basic replicons homologous to repFIC and repW. Gene(s) encoding diffuse adherence did not share homology with the probe for F1845 fimbrial adhesin which is responsible for this phenotype in other E. coli strains. Ent plasmid containing genes for diffuse adherence have not been described previously.

Mouse brain tau proteins: microheterogeneity and phosphorylation

Tau proteins are involved in polymerization of tubulin into microtubules. They comprise a heterogeneous group of proteins that can be resolved by two-dimensional gel electrophoresis using a non-equilibrium pH gradient in the first dimension. Developmental studies show that mouse brain Tau proteins are more heterogeneous in 15-day old mice than in newborn pups or adults. Tau phosphorylation is also more heterogeneous at this stage