Predictive factors of the contracture test for diagnosing malignant hyperthermia in a Brazilian population sample: a retrospective observational study

Abstract Introduction Malignant Hyperthermia (MH) is a pharmacogenetic, hereditary and autosomal dominant syndrome triggered by halogenates/succinylcholine. The In Vitro Contracture Test (IVCT) is the gold standard diagnostic test for MH, and it evaluates abnormal skeletal muscle reactions of susceptible individuals (earlier/greater contracture) when exposed to caffeine/halothane. MH susceptibility episodes and IVCT seem to be related to individual features. Objective To assess variables that correlate with IVCT in Brazilian patients referred for MH investigation due to a history of personal/family MH. Methods We examined IVCTs of 80 patients investigated for MH between 2004‒2019. We recorded clinical data (age, sex, presence of muscle weakness or myopathy with muscle biopsy showing cores, genetic evaluation, IVCT result) and IVCT features (initial and final maximum contraction, caffeine/halothane concentration triggering contracture of 0.2g, contracture at caffeine concentration of 2 and 32 mmoL and at 2% halothane, and contraction after 100 Hz stimulation). Results Mean age of the sample was 35±13.3 years, and most of the subjects were female (n=43 or 54%) and MH susceptible (60%). Of the 20 subjects undergoing genetic investigation, 65% showed variants in RYR1/CACNA1S genes. We found no difference between the positive and negative IVCT groups regarding age, sex, number of probands, presence of muscle weakness or myopathy with muscle biopsy showing cores. Regression analysis revealed that the best predictors of positive IVCT were male sex (+12%), absence of muscle weakness (+20%), and personal MH background (+17%). Conclusions Positive IVCT results have been correlated to male probands, in accordance with early publications. Furthermore, normal muscle strength has been confirmed as a significant predictor of positive IVCT while investigating suspected MH cases.

Fatigue, depression, and physical activity in patients with malignant hyperthermia: a cross-sectional observational study

Abstract Background Malignant Hyperthermia (MH) is a pharmacogenetic disorder triggered by halogenated anesthesia agents/succinylcholine and characterized by hypermetabolism crisis during anesthesia, but also by day-to-day symptoms, such as exercise intolerance, that may alert the health professional. Objective The study aimed to analyze the incidence of fatigue in MH susceptible patients and the variables that can impact perception of fatigue, such as the level of routine physical activity and depression. Methods A cross-sectional observational study was carried out with three groups - 22 patients susceptible to MH (positive in vitro muscle contracture test), 13 non-susceptible to MH (negative in vitro muscle contracture test) and 22 controls (no history of MH). Groups were assessed by a demographic/clinical questionnaire, a fatigue severity scale (intensity, specific situations, psychological consequences, rest/sleep response), and the Beck depression scale. Subgroups were re-assessed with the Baecke habitual physical exercise questionnaire (occupational physical activity, leisure physical exercise, leisure/locomotion physical activity). Results There were no significant differences among the three groups regarding fatigue intensity, fatigue related to specific situations, psychological consequences of fatigue, fatigue response to resting/sleeping, depression, number of active/sedentary participants, and the mean time and characteristics of habitual physical activity. Nevertheless, unlike the control sub-group, the physically active MH-susceptible subgroup had a higher fatigue response to resting/sleeping than the sedentary MH susceptible subgroup (respectively, 5.9 ± 1.9 vs. 3.9 ± 2, t-test unpaired, p< 0.05). Conclusion We did not detect subjective fatigue in MH susceptible patients, although we reported protracted recovery after physical activity, which may alert us to further investigation requirements.

Susceptibilidad antifúngica de aislados vaginales de Candida spp / Antifungal susceptibility of Candida spp. vaginal isolates

Introducción: la vulvovaginitis constituye una de las principales afecciones ginecológicas, y su causa más frecuente es la candidiasis. Candida albicans se considera el agente etiológico más importante de esta entidad; sin embargo, estudios recientes revelan un incremento en la incidencia de otras especies del género. Algunas de estas tienen la particularidad de presentar resistencia a los tratamientos usuales con antimicóticos. Objetivo: evaluar la susceptibilidad antifúngica de aislados vaginales de pacientes cubanas con sospecha de candidiasis vulvovaginal que se obtuvieron en el 2015. Métodos: a 28 aislados pertenecientes al género Candida, se les realizó las pruebas de susceptibilidad in vitro con la galería ATBTM Fungus 3 frente a diferentes antifúngicos (5-fluorocitosina, anfotericina B, fluconazol, itraconazol y voriconazol). Resultados: todos los aislados fueron sensibles a la anfotericina B y uno de C. albicans se informó resistente a los azoles estudiados. Todas las especies diferentes de C. albicans fueron susceptibles al voriconazol (CMI≤ 1 mg/L). Conclusiones: el estudio de patrones de susceptibilidad en aislados de Candida provenientes de mujeres con vulvovaginitis permite profundizar en cómo abordar la terapéutica de esta afección; el fluconazol resultó el tratamiento de elección. Los resultados alertan sobre la emergencia de C. glabrata, C. krusei, C. parapsilosis, C. tropicalis, C. inconspicua y C. lusitaniae como agentes causales de la candidiasis vulvovaginal(AU)

Introduction: vulvovaginitis is one of the main gynecological diseases frequently caused by candidiasis. Candida albicans is considered as the most important etiological agent for the disease; however, recent students have revealed an increased incidence of other species of the genus. Some of them may show particular resistence to usual antimycotic treatments. Objective: to evaluate the antifungal susceptibility of vaginal isolates from Cuban female patients suspected of vulvovaginal candidiasis in 2015. Methods: twenty eight Candida genus isolates underwent in vitro susceptibility tests with ATBTM Fungus 3 using several antifungal agents (5 fluorocytosine, anphotericin B, fluconazole, itraconazole and vorixonazole). Results: all isolates were susceptible to B anphotericin and one C. albicans isolate was reported as resistant to the studied azoles. All the species other thanC. albicans were susceptible to voriconazole (CMI≤ 1mg/L). Conclusions: the study of susceptibility patterns in Candida isolates from women with vulvovaginitis allow delving into the different ways of approaching the therapeutics of this disease; fluconazole was the treatment of choice. The results show emergence of C. glabrata,C. krusei, C. parapsilosis, C. tropicalis, C. inconspicua and C. lusitaniae as causative agents of vulvovaginal candidiasis(AU)

Influência do tratamento com benzonidazol na resposta imunológica de camundongos infectados com cepas do trypanosoma cruzi de diferentes biodemas / Influence of treatment with benznidazole in the immune response of mice infected with Trypanosoma cruzi strains of different biodemes

A infecção pelo Trypanosoma cruzi determina uma resposta imunológica inata do hospedeiro vertebrado, decorrente da multiplicação parasitaria em macrófagos e a produção de Interferon gama (IFNy) pelas células T ativadas, além de estimulação policlonal de células do baço, com imunossupressão. Por outro lado tem sido demonstrado que o tratamento com quimioterápico Benzonidazol em camundongos infectados, além de determinar uma destruição dos parasitos, tem também uma ação sobre o sistema imunológico em camundongos infectados com cepas do T. cruzi com diferentes graus de suscetibilidade ao Benzonidazol, como a cepa Y (suscetível ao quimioterápico) e a cepa Colombiana (resistente). No presente estudo procura-se investigar a influência do tratamento com o Benzonidazol sobre a resposta imunológica em camundongos infectados com cepa suscetível (Cepa Y) ou resistente (Colombiana). Foram utilizados 320 camundongos, subdivididos em grupos experimentais: Infectados tratados cepa Y (YT) e não tratados (Y-NT); Colombiana tratados (COL-T) e não tratados (COL-NT), Tratados não infectados (TNI) e Controles sem tratamento (CI). O inóculo foi de 1,0 x 104 por via intraperitoneal. O tratamento foi iniciado no pico parasitêmico de cada cepa, sendo no 7º dia após a infecção nos animais infectados pela cepa Y e, nos tratados e não infectados, no 18º dia de infecção na cepa Colombiana. A quimioterapia foi realizada em 60 doses (100mg/kg/dia de Benzonidazol-Benz). Os camundongos sacrificados na fase aguda e na fase crônica em todos os grupos tiveram as secções de coração e músculo esquelético coletadas, fixadas e processadas para o estudo histopatológico em secções coradas pela Hematoxilina & Eosina e Picro-Sirius. Investigou-se a resposta humoral pela sorologia (Imunofluorescência indireta) e pela reação de Elisa. A resposta celular pela proliferação celular do baço, e pela avaliação quantitativa das subpopulações celulares no baço de CD4+, CD8+...

Infection with T. cruzi determines an immunological response in the vertebrate host, wit h parasites multiplication in macrophages, with production of TNFα by these cells an IFNγ, by stimulated T. cells: a polyclonal multiplication of spleen cells is present, with immunossuppression. Treatment of infected mice with BENZ showed that this chemotherapy determines parasitic destruction and also stimulates the immunological system in mice infected either with the Y or the Colombian strain which differs in the susceptibility to chemotherapy with BENZ. In the present study we intend to investigate the influence of treatment with BENZ on the immunological response in mice infected either with the Y strain (susceptible) or the Colombian strain (resistant). This study was performed by comparing the results obtained with the groups of mice not infected and treated, and infected controls, not treated. Material and methods : Number of animals: 320, sub-divided in the experimental groups:Ystrain infected and treated with BENZ(YT) or not-treated (YNT); Colombian treated (COL-T) and not-treated (COL-NT); treated not infected (TNI); Control not treated (COL-NT). Inoculum : 1x104 trypomastigotes, (blood forms) injected intraperitoneally. Treatment was initiated in the peak of parasitemia for each strain:7th day for the Y strain and in the 18th day in the infection with the Colombian strain. Chemotherapy was performed in 60 doses (100mg x kg x day) of BENZ. Mice were killed in the acute and chronic phases post infection; sections of the heart and skeletal muscles were collected, fixed and processed for histopathology, in sections stained with Hematoxylin and Eosin, and with Picro-Sirius staining, for collagen. The humoral response was evaluated by serological reactium of indirect immununofluorescence and ELISA reaction. Celular responses were evaluated by celular proliferation in the spleen of CD4+, CD8+...

Susceptibility variation of Malassezia pachydermatis to antifungal agents according to isolate source

Malassezia pachydermatisis associated with dermatomycoses and otomycosis in dogs and cats. This study compared the susceptibility of M. pachydermatis isolates from sick (G1) and healthy (G2) animals to azole and polyene antifungals using the M27-A3 protocol. Isolates from G1 animals were less sensitive to amphotericin B, nystatin, fluconazole, clotrimazole and miconazole.

Genotipificación de mycobacterium tuberculosis y susceptibilidad a drogas / Genetic characterization of mycobacterium tuberculosis and susceptibility to drugs

Conocer la epidemiología de la tuberculosis y transmisión de cepas resistentes en la población estudiada. Estudio prospectivo de cohortes, 150 pacientes sintomáticos respiratorios que acudieron a la consulta de Neumotisiología del Distrito Sanitario Nº3 (n=115) y a la emergencia de Medicina Interna del Hospital Miguel Pérez Carreño (n=35), desde junio de 1995 hasta agosto de 1996. Se tomaron 2 muestras sucesivas de esputo para baciloscopia, cultivo, susceptibilidad a drogas y genotificación por análisis de polimorfismos de longitud de fragmentos de restricción. Se obtuvieron 14 baciloscopias positivas (9,3 por ciento) y 16 cultivos positivos para Mycobacterium tuberculosis, de los cuales 10 fueron baciloscopias positivas y 6 baciloscopias negativas. Se encontró resistencia en 3 cepas: isoniacida (1), estreptomicina (1) y thiocetazona (1), lo que representa una resistencia global del 20 por ciento. El análisis de polimorfismos de longitud de fragmantos de restricción realizado en 14 cepas demostró patrones diferentes. No hay relación epidemiológica entre las cepas aisladas; la resistencia global fue del 20 por ciento y no se encontró multirresistencia

Tomografia de susceptibilidade magnética com campo gradiente / Tomography of magnetic susceptibility with gradiente field

A tomografia de susceptibilidade magnetica (MST) é uma técnica recente, ainda em fase de desenvolvimento, que consiste em se obter a distribuição tridimensional de susceptibilidade do interior do corpo a partir de medidas da pertubação no campo magnetico imposto detectada por um magnetômetro supercondutor (SQUID). Estudos anteriores mostraram ser possivel a reconstrução em baixa resolução com campo uniforme e não uniforme. Neste trabalho investigamos o cenario onde um campo de gradiente uniforme é empregado.

Abstract - Magnetic susceptibility tomography (MST) is a recent technique still under development that provides a three dimensional susceptibility distribution of the body's interior based on measurements of the perturbation on the imposed magnetic field detected by a superconducting magnetometer (SQUID). On this work we have investigated the scenario where a uniform gradient field is employed

Miasmas, su importancia clínica / Clinical importance of miasma

Partiendo de una concepción unitaria de enfermo-enfermedad, la homeopatía enfoca al enfermo crónico desde una perspectiva miasmática. Entendiendo al miasma como la predisposición diatésica constitucional que desarrollará indefectiblemente como manifestación, las diferentes afecciones del hombre en el sentido de la hipertonía (Psora), de la distonía (Sycosis) o de la hipotonía vital (Syphilis), son reconocibles tanto en las alteraciones de los órganos como en las anomalías de la expresión de su psiquismo. Estas afecciones, cualquiera sea su disarmonía vital y ya se presente en forma aislada o combinada, limitan la maduración e integración del hombre tanto consigo mismo, como con su medio. Por lo tanto la enfermedad -miasmática- constituye en este sentido una limitación, pero también una oportunidad para el cambio y para poder lograr así progresivamente la integración en la unidad, la maduración y la plenitud desde su centro vital. A través de la concepción miasmática podremos reconocer entonces, que en las enfermedades crónicas tratamos el miasma del paciente, por la individualización de un remedio. Nos permite ver, cual es el o los miasmas cubiertos por aquél. Si bien lo habitual es que el remedio seleccionado cubra las diferentes manifestaciones miasmáticas del enfermo, a veces ello no ocurre. En esta situación habrá que determinar cuál es el miasma a ser tratado, para seleccionar los síntomas que lo manifiestan y elegir un remedio que los cubra. De este modo también se facilita el diagnóstico diferencial, entre los medicamentos que pudieran surgir de la repertorización con marcación miasmática

Psicopatología para toxicómanos / Psychopathology for drug adiction

Sintetizando lo expuesto, podemos decir que las toxicomanías aparecen siempre en personalidades, que tanto psíquica como físicamente se encuentran en condiciones de minusvalía para el logro de las salisfacciones naturales. Bajo una toxicomanía se encubre siempre algo más, que es necesario descubrir siempre. para poder realizar una correcta terapia. Nada ganaríamos con quitar al enfermo el uso de su droga si no corregimos tanto su ambiente interno como externo, que sería el único medio verdadero de conseguir una completa recuperación. Planteamos también el problema de que en el fondo de las innumerables causas se encuentra una alteración del perfecto desenvolvimiento, tanto de las reacciones emocionales primarias como de las funciones de adaptación y compensación psicológicas