Mioclonías positivas y negativas en paciente con enfermedad renal crónica / Positive and negative myoclonus in a patient with end stage renal disease

Introducción: Las mioclonías son contracciones musculares paroxísticas de corta duración o pérdida abrupta del tono muscular, denominadas mioclonías positivas y negativas, respectivamente. Se presenta un caso clínico de mioclonías positivas y negativas generalizadas y se pretende describir los múltiples mecanismos fisiopatológicos y etiologías que lo desencadenan. Presentación del caso: Hombre de 35 años, con diabetes mellitus tipo 1 complicada con enfermedad renal diabética en hemodiálisis, desarrolló una bacteriemia asociada a catéter por Staphylococcus aureus y presentó mioclonías positivas y negativas. Se identificaron como posibles desencadenantes la uremia, la infección y los fármacos con potencial promioclónico; el hallazgo incidental de una lesión isquémica en núcleo caudado no explicaba la semiología encontrada en el paciente. Se hizo el control y retiro de todos los factores promioclónicos enunciados, junto a manejo farmacológico con levetiracetam, y con ello se logró el control de los síntomas. Discusión: Los pacientes con enfermedad renal crónica son susceptibles a la acumulación de productos tóxicos de tipo guanidinas, que tienen potencial para producir mioclonías. Además, las infecciones, el uso de fármacos con potencial promioclónico y lesiones estructurales como las isquemias corticales son etiologías que deben considerarse en el diagnóstico diferencial. El mayor impacto en los síntomas se observa con el control del factor desencadenante, y, en caso de persistir, la terapia farmacológica proporciona buenos resultados. Conclusión: Las mioclonías son trastornos del movimiento relativamente comunes en la enfermedad renal crónica. La identificación del desencadenante es crucial para su manejo junto al uso de fármacos con actividad antimioclónica.

Introduction: Myoclonus are paroxysmal muscle contractions of short duration or abrupt loss of muscle tone, called positive and negative myoclonus respectively. A clinical case of generalized positive and negative myoclonus is presented and the aim is to describe the multiple pathophysiological mechanisms and etiologies that trigger it. Case presentation: A 35-year-old man with type 1 diabetes mellitus complicated by diabetic kidney disease on hemodialysis developed catheter-associated bacteremia due to Staphylococcus aureus and presented positive and negative myoclonus. Uremia, infection, and drugs with pro-myoclonic potential were identified as possible triggers; The incidental finding of an ischemic lesion in the caudate nucleus did not explain the semiology found in the patient. The control and removal of all the pro-myoclonic factors mentioned was carried out, along with pharmacological management with levetiracetam, thus achieving control of the symptoms. Discussion: Patients with chronic kidney disease are susceptible to the accumulation of guanidine-type toxic products, which have the potential to produce myoclonus. Furthermore, infections, the use of drugs with pro-myoclonic potential and structural lesions such as cortical ischemia are etiologies that should be considered in the differential diagnosis. The greatest impact on symptoms is observed with the control of the triggering factor and if it persists, pharmacological therapy provides good results. Conclusion: Myoclonus are relatively common movement disorders in chronic kidney disease. Identification of the trigger is crucial for its management along with the use of drugs with anti-myoclonic activity.

Inactivación del virus Zika con medio de transporte de ácidos nucleicos, potencialmente aplicable a muestras clínicas para el diagnóstico molecular de SARS-CoV-2 / Inactivation of Zika virus with nucleic acids transport media, potentially applicable to clinical samples for the molecular diagnosis of SARS-CoV-2

RESUMEN Introducción: Los medios de colecta de muestras clínicas con capacidad de desnaturalizar virus reducen los riesgos de contagio durante el transporte y procesamiento. Objetivo: Emplear el medio de transporte de ácidos nucleicos (TAN) en muestras de exudado nasofaríngeo colectadas para el diagnóstico de SARS-CoV-2. Métodos: Se realizó un estudio experimental para demostrar la capacidad del medio de inactivar la infectividad viral. Se tomó como modelo de virus envuelto el virus Zika (VZk), cuyo nivel de bioseguridad es 2. Se evaluó el desempeño clínico del medio TAN para el diagnóstico de SARS-CoV-2. Se empleó una cepa del VZk propagada en la línea celular Vero y, previo a la infección de las células, el VZk se puso en contacto a intervalos de tiempo diferentes (2; 15 y 30 min) con el medio TAN puro; y luego se realizaron diluciones seriadas (10-1-10-4). La inactivación viral se evaluó por RT-PCR, en el sobrenadante y células colectadas, al culminar el periodo de propagación. El desempeño clínico del medio TAN se estimó tomando como referencia el CITOSWAB® VTM, en 30 exudados nasofaríngeos colectados para diagnóstico de la infección por SARS-CoV-2. Resultados: El VZk preservó su infectividad a diluciones del inóculo ≥ 10-2, independientemente del tiempo de contacto. La sensibilidad y especificidad clínica del medio TAN para el diagnóstico de SARS-CoV-2 fueron del 100 %, respectivamente. Conclusiones: Los resultados sugieren que muestras clínicas positivas a VZk en diluciones ≤ 10-1 del medio TAN pueden ser manipuladas de forma segura, lo que pudiera aplicarse potencialmente al diagnóstico molecular del SARS-CoV-2.

ABSTRACT Introduction: Collection media of clinical samples with the capacity to denature viruses reduce the risk of contagion during transportation and processing. Objective: To use the nucleic acids transport media (NATM) in nasopharyngeal swab samples collected for the diagnosis of SARS-CoV-2. Methods: An experimental study was conducted to demonstrate the medium capacity to inactivate viral infectivity. Zika virus (ZIKV), of biosafety level 2, was used as an enveloped virus model. The clinical performance of the NATM for the diagnosis of SARS-CoV-2 was evaluated. A ZIKV strain propagated in the Vero cell line was used and, prior to cells infection, ZIKV was in contact at different intervals (2; 15, and 30 min) with pure NATM; subsequently, serial dilutions (10-1-10-4) were performed. Viral inactivation was evaluated by RT-PCR in the supernatant and the collected cells when the propagation period was completed. CITOSWAB® VTM was used as reference to estimate the clinical performance of the NATM in 30 nasopharyngeal swabs collected for the diagnosis of SARS-CoV-2 infection. Results: ZIKV remained infectious at inoculum dilutions of ≥ 10-2, regardless of contact time. Clinical specificity and sensitivity of the NATM for the diagnosis of SARS-CoV-2 were 100%, respectively. Conclusions: Results suggest that ZIKV positive clinical samples at dilutions ≤ 10-1 of the NATM can be safely handled, which could potentially be applied to the molecular diagnosis of SARS-CoV-2.

Avaliação de soluções antifúngicas de guanidina para resina base de dentadura: um estudo in vitro / Evaluation of guanidine antifungal solutions for denture base resin: an in vitro study

Background: The purposes of this study were: (1) to formulate polyhexamethylene guanidine hydrochloride (PHMGH) solutions at different concentrations; (2) to evaluate their antifungal activity against a mature biofilm of Candida albicans on acrylic resins; (3) to evaluate possible effects on acrylic resins flexural strength and surface roughness. Methods: PHMGH solutions were formulated with distilled water and 0.125, 0.250, or 0.5 wt.% of PHMGH. One group without PHMGH was used as control. For antifungal activity analysis, acrylic resin specimens were contaminated with C. albicans. Specimens were immersed in PHMGH solutions or distilled water for 5 or 10 min. Ultimate flexural strength and surface roughness of acrylic resins were evaluated. Results: All PHMGH solutions at 5 or 10 min showed antifungal activity compared to the control group (p<0.05). The group with 0.5 wt.% of PHMGH showed no countable colonies regardless of the time of contact with the acrylic resins. After 10 min, all PHMGH solutions had antifungal effect without differences from 0.125 to 0.5 wt.% of PHMGH. All groups showed high flexural strength after contact with the solutions compatible with ISO 20795-1:2013 recommendation. The values of surface roughness always remained low, from 0.01 to 0.04 µm for all groups. Conclusion: Within the limitations of this study, it was concluded that the use of a solution composed by distilled water and 0.5 wt.% of PHMGH for 5 min was effective as a disinfectant agent against mature biofilm of C. albicans , maintaining acceptable roughness and flexural strength.

Antecedentes: Os objetivos deste estudo foram: (1) formular soluções de cloridrato de polihexametileno guanidina (PHM-GH) em diferentes concentrações; (2) avaliar sua atividade antifúngica contra biofilme maduro de Candida albicans em resinas acrílicas; (3) avaliar efeitos na resistência à flexão e rugosidade da superfície. Métodos: Soluções de PHMGH foram formuladas com água destilada e 0,125, 0,250 ou 0,5% em peso de PHMGH. Um grupo sem PHMGH foi usado como controle. Para análise da atividade antifúngica, amostras de resina acrílica foram contaminadas com C. albicans, e imersas em soluções de PHMGH ou água destilada por 5 ou 10 min. Resistência à flexão final e rugosidade da superfície foram avaliadas. Resultados: Todas as soluções de PHMGH aos 5 ou 10 minutos apresentaram atividade antifúngica em comparação ao grupo controle (p <0,05). O grupo com 0,5% em peso de PHMGH não mostrou colônias contáveis, independentemente do tempo. Após 10 minutos, todas as soluções de PHMGH tiveram efeito antifúngico sem diferenças de 0,125 a 0,5% em peso de PHM-GH. Os grupos apresentaram alta resistência à flexão após o contato com as soluções compatíveis com a recomendação ISO 20795-1: 2013. Os valores de rugosidade da superfície permaneceram baixos, de 0,01 a 0,04 µm para todos os grupos. Conclusão: Dentro das limitações deste estudo, concluiu-se que o uso de uma solução composta por água destilada e 0,5% em massa de PHMGH por 5 min foi eficaz como agente desinfetante contra o biofilme maduro de C. albicans, mantendo rugosidade e resistência à flexão aceitáveis.

Comparación de métodos de extracción de ADN de sangre para detectar ADN fúngico por PCR / Comparison of different methods of DNA extraction from blood to detect fungal DNA by PCR

La infección fúngica invasora (IFI) está asociada a un alto índice de mortalidad, que alcanza el 50% debido a la frecuente falla en el tratamiento antifúngico. Existen dificultades para realizar un diagnóstico micológico rápido y certero dada la baja sensibilidad de los métodos convencionales, especialmente en pacientes neutropénicos y con SIDA. Numerosos métodos para diagnosticar infecciones micóticas basados en el estudio del ADN fúngico están actualmente en desarrollo. Nosotros evaluamos la utilidad de dos procedimientos de extracción y purificación del ADN fúngico presente en sangre para su posterior detección por PCR. Ambos métodos resultaron igualmente eficientes para obtener ADNs de óptima calidad y para realizar la técnica de PCR con los iniciadores universales para hongos ITS 1 e ITS 4.

Invasive fungal infections (IFI) are associated with high mortality by reaching levels of 50%, and also with a significant failure in antifungical treatments. This fact mostly obeys to difficulties in obtaining a fast and accurate mycologic diagnosis due to the low sensitivity of conventional methods, mainly in neutropenic and AIDS patients. Various methods based on fungal DNA study are currently being used for the diagnosis of mycotic infections. We herein evaluated two procedures of extraction and purification of fungal DNA in blood for their use in PCR detection. Both of them showed equal efficiency in obtaining high performance DNA with universal primers ITS 1and ITS 4 as target.