Conocimientos actuales en encefalopatía de Hashimoto: revisión de la literatura / Current knowledge on Hashimoto's encephalopathy: a literature review

Resumen La encefalopatía de Hashimoto es una enfermedad rara. Se reporta una prevalencia de 2,1 por cada 100 000 habitantes. Entre las manifestaciones clínicas se describen confusión, disminución del estado de consciencia, déficit cognitivo, convulsiones, mioclonus, ataxia y/o déficits neurológicos focales. Debido a la amplia variedad de signos y síntomas, la sospecha clínica diagnóstica es fundamental. El diagnóstico se basa en tres pilares: la presencia de manifestaciones clínicas neurológicas, con la exclusión de otras causas de encefalopatía; presencia de anticuerpos antitiroideos aumentados; una mejoría clínica notable luego de la administración de inmunomoduladores. El tratamiento de la encefalopatía de Hashimoto tiene dos objetivos: controlar el proceso autoinmune y controlar las complicaciones de la enfermedad. Aunque en la mayoría de los casos la recuperación es completa con el tratamiento, el riesgo de recaídas puede oscilar entre 12,5 a 40% en seguimientos a dos años.

Abstract Hashimoto's encephalopathy is a rare disease, with a reported prevalence of 2.1 per 100 000. Clinical manifestations include confusion, decreased state of consciousness, cognitive deficit, seizures, myoclonus, ataxia, and focal neurological deficits. Due to the wide variety of signs and symptoms, clinical diagnostic suspicion is essential. Diagnosis is based on three pillars: the presence of neurological clinical manifestations after ruling out other causes of encephalopathy. 2) Presence of increased antithyroid antibodies. 3) Significant clinical improvement after the administration of immunomodulation. The treatment of Hashimoto's encephalopathy pursues two objectives: to control the autoimmune process and to control the complications of the disease. Although in most cases recovery is complete with treatment, the risk of relapse can range from 12.5 to 40% in follow-ups to 2 years.

Ethanolic extract of Casearia sylvestris Sw exhibits in vitro antioxidant and antimicrobial activities and in vivo hypolipidemic effect in rats / Extrato etanólico de Casearia sylvestris Sw apresenta atividade antioxidante e antimicrobiana in vitro e efeito hipolipemiante em ratos

ABSTRACT: The Casearia sylvestris Sw (Flacourtiaceae) is a shrub that occurs in forests of Southern Brazil; its leaves are widely used in folk medicine as a depurative, analgesic, anti-inflammatory and antiulcerogenic agent. The objective of this study was to perform the phytochemical description and to evaluate the pharmacological activities (antimicrobial, antifungal, antioxidant and toxicity) of the ethanolic extract (EE) of C. sylvestris Sw. In addition, we also evaluated the effect of the EE of C. sylvestris Sw on the glucose levels and lipid profile in blood serum of rats submitted to a model of streptozotocin-induced diabetes. Material and Methods: In vitro assay: the detection of chemical groups was done through chemical reactions with the development of color or precipitate and by chromatographic profile; the antioxidant activity was measured by the method of reduction of DPPH free radical (2,2-diphenyl-1-picrylhydrazyl); the Minimum Inhibitory Concentration was evaluated by the broth microdilution method, and the Minimum Bactericide Concentration and the Minimum Fungicide Concentration were performed in Petri dishes; the cytotoxic activity was measured by the Artemia salina test. In vivo assay: diabetic and non-diabetic rats were treated with EE of C. sylvestris Sw (300 mg/kg) for 45 days, and the glycaemia and lipid profile were analyzed. Results: The EE showed a Lethal Dose50 of 724.76 μg.mL-1 and important antioxidant, fungicide and fungistatic activities. The EE showed better antimicrobial activity regarding the microorganisms Staphylococcus aureus, Escherichia coli and Salmonella setubal. Conclusion: The EE of C. sylvestris Sw produces a significant decrease in triglycerides, total cholesterol and VLDL levels without any significant alteration in the glycaemia. The EE of C. sylvestris Sw presents antioxidant and antimicrobial activities and it exhibits a potent hypolipidemic effect.

RESUMO: Casearia sylvestris Sw (Flacourtiaceae) é uma planta comumente encontrada em florestas do sul do Brasil; suas folhas são amplamente utilizadas na medicina popular como depurativa, analgésica, anti-inflamatória e anti ulcerogênica. O objetivo deste estudo foi apresentar uma descrição fitoquímica e da atividade farmacológica (antimicrobiana, antifúngica, antioxidante e toxicidade) do extrato etanólico (EE) da C. Sylvestris Sw. Adicionalmente, procurou-se avaliar o efeito do EE da C. Sylvestris Sw sobre os níveis séricos de glicose e perfil lipídico de ratos submetidos a um modelo de diabetes induzida por estreptozotocina. A detecção de grupos químicos foi realizada por reações químicas de coloração ou precipitação, e também por cromatografia; a atividade antioxidante foi mensurada pelo método de redução do DPPH (2,2-difenil-1-picril-hidrazil); a concentração mínima inibitória foi realizada pela técnica de micro-diluição, e concentração mínima bactericida e concentração mínima fungicida foram realizadas em placa de Petri; enquanto a atividade citotóxica foi conduzida pelo teste da Artemia salina. Nos ensaios in vivo, ratos diabéticos e não-diabéticos foram tratado com EE da C. Sylvestris Sw (300mg/kg) por 45 dias, e os níveis glicêmico e perfil lipídico foram medidos. A dose Letal50 do EE foi de 724.76 μg.mL-1; mostrando importante atividades antioxidante, fungicida e fungistática e melhor atividade antimicrobiana contra Staphylococcus aureus, Escherichia coli e Salmonella setubal. O EE da C. Sylvestris Sw promoveu diminuição significativa nos níveis de triglicerídeos, colesterol total e VLDL; porém sem efeito significativo nos níveis glicêmicos. O EE da C. Sylvestris Sw, além de apresentar atividade antioxidante e antimicrobiana; possui também potente efeito hipolipidêmico.

Herencia autosómica recesiva en paciente no sindrómico con múltiples dientes supernumerarios / Autosomal recessive inheritance in a non-syndromic patient with multiple supernumerary teeth

La hiperdoncia es una condición caracterizada por la presencia de un número de dientes superior al normal en el arco dentario. Su etiología es incierta, aunque factores genéticos y ambientales así como varias teorías han sido propuestas para explicarlo. Describir las características clínicas y radiográficas presentes en un paciente no sindrómico con múltiples supernumerarios, heredados de manera autosómica recesiva. Se presenta el caso de un hombre de 27 años de edad que acudió a consulta para evaluación odontológica. Al examen físico y extrabucal no reveló deformidades, retardo mental ni presencia de ningún síndrome. Al examen intrabucal se evidenció la presencia de irritantes locales y maloclusión dentaria, ocasionada por el aumento del número dientes en los arcos dentarios. Radiográficamente se observaron múltiples imágenes radiopacas compatibles con 9 unidades dentarias incluidas y 2 erupcionadas. Los exámenes de laboratorio no revelaron alteraciones ni relación con algún síndrome. Se solicitaron radiografías panorámicas a los padres, hermanos e hija del paciente, para descartar la presencia de dientes supernumerarios, encontrándose 9 dientes supernumerarios incluidos en un hermano varón, determinándose la trasmisión del rasgo de manera autosómica recesiva. El hallazgo de la trasmisión de manera autosómica recesiva de múltiples supernumerarios en un paciente no sindrómico encontrado en este caso, no es común, lo cual indica que el examen clínico y estudio de cada paciente debe ser llevado a cabo de manera exhaustiva, para determinar este tipo de trastorno o cualquier otro sin evidencias o manifestaciones clínicas.

Hyperdontia is a condition characterized by the presence of a higher number of teeth than normal in the dental arch. Even though genetic and environmental factors as well as a series of theories have been proposed to explain hyperdontia, its etiology is uncertain. To describe clinical and radiographical characteristics found in a non-syndromic patient with multiple supernumerary teeth by autosomal recessive inheritance. A 27-year-old male referred for dental assessment. Physical and extraoral examinations did not reveal deformities, mental retardation or the presence of syndromes. Intraoral examination evidenced the presence of local irritants and dental malocclusion produced by the increased number of teeth in both dental arches. Radiographs revealed multiple radiopaque images compatible with 9 unerupted and 2 erupted teeth. Laboratory tests did not show alterations or a connection to any syndromes. Panoramic radiographs were requested from parents, siblings and daughter of the patient to rule out the presence of supernumerary teeth. Nine supernumerary unerupted teeth were found in one brother, which determined the transmission of characteristics by autosomal recessive inheritance. The incidental finding of the autosomal recessive transmission of multiple supernumerary teeth in a non-syndromic patient observed in this case is not a common result, indicating that clinical examinations and the study of each patient must be carried out thoroughly in order to determine this or any other type of disorders without evidence or clinical manifestations.

Lipid peroxidation and total radical-trapping potential of the lungs of rats submitted to chronic and sub-chronic stress

Exposure to stress induces a cluster of physiological and behavioral changes in an effort to maintain the homeostasis of the organism. Long-term exposure to stress, however, has detrimental effects on several cell functions such as the impairment of antioxidant defenses leading to oxidative damage. Oxidative stress is a central feature of many diseases. The lungs are particularly susceptible to lesions by free radicals and pulmonary antioxidant defenses are extensively distributed and include both enzymatic and non-enzymatic systems. The aim of the present study was to determine lipid peroxidation and total radical-trapping potential (TRAP) changes in lungs of rats submitted to different models of chronic stress. Adult male Wistar rats weighing 180-230 g were submitted to different stressors (variable stress, N = 7) or repeated restraint stress for 15 (N = 10) or 40 days (N = 6) and compared to control groups (N = 10 each). Lipid peroxidation levels were assessed by thiobarbituric acid reactive substances (TBARS), and TRAP was measured by the decrease in luminescence using the 2-2'-azo-bis(2-amidinopropane)-luminol system. Chronic variable stress induced a 51 percent increase in oxidative stress in lungs (control group: 0.037 ± 0.002; variable stress: 0.056 ± 0.007, P < 0.01). No difference in TBARS was observed after chronic restraint stress, but a significant 57 percent increase in TRAP was presented by the group repeatedly restrained for 15 days (control group: 2.48 ± 0.42; stressed: 3.65 ± 0.16, P < 0.05). We conclude that different stressors induce different effects on the oxidative status of the organism.

Effect of repeated stress on novelty-induced antinociception in rats

There is extensive evidence that acute stress induces an analgesic response in rats. On the other hand, repeatedly stressed animals may present the opposite effect, i.e., hyperalgesia. Furthermore, exposure to novelty is known to induce antinociception. The effects of repeated restraint stress on nociception after exposure to novelty, as measured by the tail-flick latency (TFL), were studied in adult male rats. The animals were stressed by restraint 1 h daily, 5 days a week for 40 days. The control group was not submitted to restraint. Nociception was assessed with a tail-flick apparatus. After being familiarized with the TFL apparatus, each group was subdivided into two other groups, i.e., with or without novelty. Animals were subjected to the TFL measurement twice. For the animals exposed to novelty, the first TFL measurement was made immediately before, and the second 2 min after a 2-min exposure to a new environment. While the control group presented an increased TFL after exposure to a novel environment, chronically stressed animals did not show this effect. These results suggest that repeated restraint stress induces an alteration in the nociceptive response, perhaps as a result of an alteration in endogenous opioids in these animals

Effect of acute and repeated restraint stress on glucose oxidation to CO2 in hippocampal and cerebral cortex slices

It has been suggested that glucocorticoids released during stress might impair neuronal function by decreasing glucose uptake by hippocampal neurons. Previous work has demonstrated that glucose uptake is reduced in hippocampal and cerebral cortex slices 24 h after exposure to acute stress, while no effect was observed after repeated stress. Here, we report the effect of acute and repeated restraint stress on glucose oxidation to CO2 in hippocampal and cerebral cortex slices and on plasma glucose and corticosterone levels. Male adult Wistar rats were exposed to restraint 1 h/day for 50 days in the chronic model. In the acute model there was a single exposure. Immediately or 24 h after stress, the animals were sacrificed and the hippocampus and cerebral cortex were dissected, sliced, and incubated with Krebs buffer, pH 7.4, containing 5 mM glucose and 0.2 æCi D-[U-14C] glucose. CO2 production from glucose was estimated. Trunk blood was also collected, and both corticosterone and glucose were measured. The results showed that corticosterone levels after exposure to acute restraint were increased, but the increase was smaller when the animals were submitted to repeated stress. Blood glucose levels increased after both acute and repeated stress. However, glucose utilization, measured as CO2 production in hippocampal and cerebral cortex slices, was the same in stressed and control groups under conditions of both acute and chronic stress. We conclude that, although stress may induce a decrease in glucose uptake, this effect is not sufficient to affect the energy metabolism of these cells

Comparación de métodos de diagnóstico citológico, inmunofluorescencia y aislamiento viral en la detección de citomegalovirus (CMV) en orina / Comparision of diagnosis methods: cytology, immunofluorescence and viral isolation in the detection of urine cytomegalovirus

Las infecciones por citomegalovirus humano (CMV), ampliamente diseminadas, han sido señaladas como la principal causa de morbimortalidad en individuos inmunocomprometidos. Es característico en estas infecciones la aparición de grandes células con inclusiones intranucleares y/o intracitoplasmática. Con esta base se diseñó una investigación para evaluar el método de diagnóstico citológico y la detección de antígenos virales mediante la técnica de inmunofluorescencia indirecta (IFI) en relación al aislamiento viral en muestras de orina. Se estudiaron 70 casos con búsqueda de cuerpos de inclusión citomegálicos (CIC) y aislamiento viral. En 55 de estos se estudió además con IFI. Se encontro CIC en el 84% (59/70) de los casos, el aislamiento resultó positivo en un 29% (20/70) y la IFI alcanzó un 42% de positividad (23/55). En todos los casos con aislamiento positivo se encontró CIC en el sedimento de orina. La IFI que en relación al aislamiento viral parece carecer de especificidad, debe ser considerada ya que es un método que detecta específicamente antígenos virales. Finalmente, se recomienda trabajar estos métodos de diagnóstico con tres muestras de orina para optimizar su rendimiento

Etiología de las infecciones respiratorias bajas agudas en lactantes hospitalizados / Studies on the etiology of lower respiratory infections

Con el propósito de contribuir al conocimiento de la etiología de las infecciones respiratorias bajas de los niños menores de dos años, se estudiaron 235 lactantes menores de 1 año ingresados al Hospital Roberto del Río durante los años 1987, 88 y 89 por infección respiratoria aguda baja (IRAB) comprobada por radiología, con no más de 5 días de evolución de la enfermedad y no más de 2 días de hospitalización y en 74 niños sanos, como grupo control. En todos se hicieron cultivos de secreción faríngea, hemocultivos, ensayos de antígenos para Streptococus pneumoniae y Haemophilus influezae b en orina concentrada, mediante aglutinación de látex; IgM específica para Chlamydia trachomatis por inmunofluorescencia (IF) indirecta; virus respiratorio sincicial (VRS), adenovirus, virus parainfluenza y virus influenza mediante serología, aislamiento e IF en aspirados faríngeos. Se detectaron virus respiratorios en 57,5%de los niños con IRAB y 28,3%de los controles, predominando el VRS. En 18 de 119 pacientes con IRAB se encontró antígeno para H. influenzae y en 2 para S. pneumoniae en la orina. También se encontró antigenuria en 6 de 24 controles, lo que plantea dudas sobre la especificidad del método, que son discutidas. En 80 pacientes se investigó C. trachomatis, con resultado positivo en 5 (títulos 1:32), todos menores de 5 meses de edad. En 80 pacientes se emplearon todos los métodos disponibles, detectándose presunto agente causal en 70%: 57,5%algún virus respiratorio, 10%H. influenzae, 1,2%de S. pneumoniae y en 6,2%de C. trachomatis. Con sólo los métodos habituales de estudio bacteriológico (cultivo nasofaríngeo, hemocultivo) no se obtuvieron identificaciones; pero al agregarles serología y aislamiento viral la postividad aumentó a 30%y sumándole IF para virus respiratorio, antigenuria y determinacion de IgM específica para C. trachomatis se llegó a 70%. No se encontró una relación satisfactoria clínica, radiológica y etiológica, tomando en cuenta edad, fiebre, frecuencia respiratoria, apnea, síndrome bronquial obstructivo, leucocitosis sobre 15.000, baciliformes sobre 5.000, VHS, proteína C reactiva y aspecto radiológico, que permitiera diferenciar infecciones presuntamente virales y bacterianas, a excepción de un niño con derrame pleural en el que se detectó antigenuria positiva para H. influenzae

Infecciones respiratorias agudas intrahospitalarias / Hospital acute respiratory infections

Se estudiaron 31 lactantes ingresados entre mayo y agosto de 1988 a una sala índice del Servicio de Pediatría, Hospital San Juan de Dios, Santiago de Chile, con diagnóstico de IRA baja, con el propósito de conocer la incidencia de la infección nosocomial respiratoria en la primera semana de hospitalización. En cada niño se realizó estudio virológico y bacteriológico seriado. En 13 de los 31 pacientes se detectó uno o más agentes virales nuevos en la segunda muestra (18 nuevos aislamientos en total), los que podrían haber sido adquiridos durante la hospitalización; los segundos virus fueron: Ad (n = 8), VRS (n = 5) y CMV (n = 5). No se detectaron cambios significativos de la flora bacteriana en el período estudiado

Estudio comparativo de la prueba de coaglutinacion con la de bacitracina y precipitacion para el diagnostico de los estreptococos beta hemoliticos / Comparative study of the coagglutination, bacitracin and precipitation tests for the diagnosis of the beta hemolytic streptococci

En el presente estudio se comparan los metodos de precipitacion en tubos capilares, la sensibilidad a la bacitracina y la prueba de coaglutinacion Phadebact Estreptococcus test para la identificacion serologica de los estreptococos de los grupos A, B, C y G. De las 90 cepas estudiadas se observa una correlacion de 100% entre el Phadebact y la prueba de precipitacion empleando el metodo de Rantz y Randall, para esta ultima, el 6.6% de las cepas presenta reacciones cruzadas con el grupo G. Con la prueba de sensibilidad a la bacitracina, en el 4.4% de las cepas se observan reacciones falsas. Por los resultados obtenidos, consideramos la prueba de Phadebact Estreptococcus aceptable por su rapidez, confiabilidad y facilidad de ejecucion para se utilizada en los laboratorios de rutina para la determinacion de los grupos serologicos de estreptococos beta hemoliticos grupos A, B, C y G