Assessment of symptom induction via artificial inoculation of the obligate biotrophic fungus Phyllachora maydis (Maubl.) on corn leaves.

OBJECTIVE: Tar spot is a foliar disease of corn caused by Phyllachora maydis, which produces signs in the form of stromata that bear conidia and ascospores. Phyllachora maydis cannot be cultured in media; therefore, the inoculum source for studying tar spot comprises leaves with stromata collected from naturally infected plants. Currently, there is no effective protocol to induce infection under controlled conditions. In this study, an inoculation method was assessed under greenhouse and growth chamber conditions to test whether stromata of P. maydis could be induced on corn leaves. RESULTS: Experiments resulted in incubation periods ranging between 18 and 20 days and stromata development at the beginning of corn growth stage VT-R1 (silk). The induced stromata of P. maydis were confirmed by microscopy, PCR, or both. From thirteen experiments conducted, four (31%) resulted in the successful production of stromata. Statistical analyses indicate that if an experiment is conducted, there are equal chances of obtaining successful or unsuccessful infections. The information from this study will be valuable for developing more reliable P. maydis inoculation methods in the future.

Rol de enfermería en el área COVID en un hospital pediátrico de alta complejidad / The role of nurses in the COVID area in a pediatric tertiary-care hospital

Introducción: la pandemia por SARS-CoV-2 planteó un desafío para todo el equipo de salud. Fue necesario analizar y pensar en este contexto el rol de enfermería en la atención y cuidados del paciente y su familia. Los procesos asistenciales debieron adaptarse a nuevas y diversas situaciones que generaron la atención de pacientes en su mayoría con comorbilidades asociadas. El objetivo del trabajo fue describir el rol de enfermería y la implementación de diversos protocolos y procesos de atención de pacientes en salas de internación pediátrica del área COVID de un hospital de alta complejidad. Material y métodos: se realizó un estudio retrospectivo y descriptivo sobre el personal de enfermería que participó en la atención de casos sospechosos o confirmados de COVID-19 durante la pandemia y los protocolos implementados para los cuidados de enfermería. Resultados: solo el 52.5% (n 79) del personal tenía experiencia mayor a tres años, el 75% (n: 113) pertenecían al género femenino, el 47% (n: 71) eran licenciados en enfermería. Conclusiones: Los profesionales enfermeros han logrado mediante sus fortalezas disciplinares dar respuesta a las necesidades del paciente pediátrico y su familia frente a la crisis sanitaria. Las competencias desarrolladas en la administración de los recursos disponibles, la adaptación, flexibilidad a los procesos y líneas estratégicas en tiempo real, posicionan al enfermero como un valor fundamental en el cuidado asistencial (AU)

Introduction: The SARS CoV-2 pandemic posed a challenge for the entire healthcare team. It was necessary to analyze and reflect on the role of nursing in the care of patients and their families in this context. Care processes had to be adapted to new and diverse situations that were generated by the care for patients who usually had associated comorbidities. The aim of the study was to describe the nursing role and the implementation of different protocols and processes for patient care in pediatric inpatient wards in the COVID area of a tertiary-care hospital. Material and methods: a retrospective descriptive study was conducted in the nursing personnel involved in the care of suspected or confirmed cases of COVID-19 during the pandemic and the protocols implemented for nursing care. Results: only 52.5% (n: 79) of the personnel had more than three years of experience, 75% (n: 113) were female, and 47% (n: 71) had a nursing degree. Conclusions: Through their disciplinary strengths, nursing professionals have been able to respond to the needs of pediatric patients and their families in the face of the health crisis. The skills developed in the management of available resources, adaptation, and flexibility to processes and real-time strategies, have positioned nurses as a fundamental factor in healthcare (AU)

Relevancia del síndrome piramidal en la esclerosis lateral amiotrófica / Relevance of the pyramidal syndrome in amyotrophic lateral sclerosis

Introducción: Los signos piramidales (hiperreflexia, espasticidad, signo de Babinski) son fundamentales para el diagnóstico de esclerosis lateral amiotrófica (ELA). Sin embargo, no siempre están presentes al comienzo, pueden variar con el tiempo y es controvertido su papel en la evolución. El objetivo del estudio es describir qué signos piramidales están presentes inicialmente y cómo evolucionan en una cohorte de pacientes con ELA, así como su papel pronóstico. Métodos: Análisis retrospectivo de pacientes recogidos de manera prospectiva, diagnosticados de ELA en nuestro centro, desde 1990 hasta 2015. Resultados: Del total de 130 pacientes con ELA, 34 (26,1%) no presentaron inicialmente ningún signo piramidal, mientras que 15 (11,5%) presentaban un síndrome piramidal completo. De aquellos pacientes sin piramidalismo inicial, la mediana de aparición de los primeros signos fue de 4,5 meses. El signo de Babinski estaba presente en 64 (49,2%), la hiperreflexia en 90 (69,2%) y en 22 (16,9%) pacientes existía espasticidad. Los signos piramidales tendían a mantenerse inalterados en el tiempo, aunque existe un porcentaje de pacientes en el que aparecen tardíamente o desaparecen con el tiempo. No se encontró asociación entre supervivencia y la presencia o modificación de signos piramidales, aunque la disminución de la espasticidad se asociaba a mayor deterioro clínico (escala ALSFR) (p < 0,001). Conclusión: Una cuarta parte de pacientes con ELA no presentaron inicialmente ningún signo piramidal y, en algunos casos, estos desaparecen con el tiempo. Esto resalta la necesidad de la inclusión de herramientas para la valoración de la vía piramidal (AU)

Introduction: Pyramidal signs (hyperreflexia, spasticity, Babinski sign) are essential for the diagnosis of amyotrophic lateral sclerosis (ALS). However, these signs are not always present at onset and may vary over time, besides which their role in disease evolution is controversial. Our goal was to describe which pyramidal signs were present and how they evolved in a cohort of patients with ALS, as well as their role in prognosis. Methods: Retrospective analysis of prospectively collected patients diagnosed with ALS in our centre from 1990 to 2015. Results: Of a total of 130 patients with ALS, 34 (26.1%) patients showed no pyramidal signs at the first visit while 15 (11.5%) had a complete pyramidal syndrome. Of those patients without initial pyramidal signs, mean time of appearance of the first signs was 4.5 months. Babinski sign was positive in 64 (49.2%) patients, hyperreflexia in 90 (69.2%) and 22 (16.9%) patients had spasticity. Pyramidal signs tended to remain unchanged over time, although they seem to appear at later stages or even disappear with time in some patients. We found no association between survival and the presence of changes to pyramidal signs, although decreased spasticity was associated with greater clinical deterioration (ALSFR scale) (P < .001). Conclusion: A quarter of patients with ALS initially showed no pyramidal signs and in some cases they even disappear over time. These data support the need for tools that assess the pyramidal tract (AU)

Relevance of the pyramidal syndrome in amyotrophic lateral sclerosis. / Relevancia del síndrome piramidal en la esclerosis lateral amiotrófica.

INTRODUCTION: Pyramidal signs (hyperreflexia, spasticity, Babinski sign) are essential for the diagnosis of amyotrophic lateral sclerosis (ALS). However, these signs are not always present at onset and may vary over time, besides which their role in disease evolution is controversial. Our goal was to describe which pyramidal signs were present and how they evolved in a cohort of patients with ALS, as well as their role in prognosis. METHODS: Retrospective analysis of prospectively collected patients diagnosed with ALS in our centre from 1990 to 2015. RESULTS: Of a total of 130 patients with ALS, 34 (26.1%) patients showed no pyramidal signs at the first visit while 15 (11.5%) had a complete pyramidal syndrome. Of those patients without initial pyramidal signs, mean time of appearance of the first signs was 4.5 months. Babinski sign was positive in 64 (49.2%) patients, hyperreflexia in 90 (69.2%) and 22 (16.9%) patients had spasticity. Pyramidal signs tended to remain unchanged over time, although they seem to appear at later stages or even disappear with time in some patients. We found no association between survival and the presence of changes to pyramidal signs, although decreased spasticity was associated with greater clinical deterioration (ALSFR scale) (P<.001). CONCLUSION: A quarter of patients with ALS initially showed no pyramidal signs and in some cases they even disappear over time. These data support the need for tools that assess the pyramidal tract.

Drug-resistant tuberculosis in Castilla-León, Spain, 1996-2000.

SETTING: During 1996-2000, a regional anti-tuberculosis drug resistance survey was conducted in Castilla-León, Spain. OBJECTIVE: To determine the incidence of drug-resistant tuberculosis (TB) in newly treated human immunodeficiency virus (HIV) negative and HIV-positive TB patients. DESIGN: Nine hundred and eighty-five Mycobacterium tuberculosis strains isolated from HIV-negative (926) and HIV-positive (59) patients were studied (one strain per patient). Univariate and multivariate analyses were used to determine the prevalence of drug resistance in high-risk groups. RESULTS: Thirty-eight isolates (3.8%) showed resistance to one of the following drugs: streptomycin (S), isoniazid (H), rifampicin (R) or ethambutol (E). Of these, 36 (3.9%) were from HIV-negative and 2 (3.4%) from HIV-positive patients. The rate of drug resistance among HIV-negative patients was 1.2%, 2.0%, 0.3% and 0.8%, respectively, for S, H, R and E, and for HIV-positive patients it was 3.4%, 0%, 0% and 1.7%. Among the HIV-negative patients, monoresistance was observed in 32 (3.4%) strains and resistance to both H and R (multi-drug resistance) was detected in one. CONCLUSION: The incidence of primary drug resistance in the surveyed area was low and increased resistance was not observed in the HIV-positive group (P = 0.99). Routine surveillance of drug resistance is recommended by the TB control programme in representative patient populations to optimise treatment regimens.

Leucemia neutrofílica crónica: el interés del diagnóstico diferencial / Chronic neutrophilic leukemia: the worth of a complete differential diagnosis

No disponible

Nuevas alternativas en estroboscopia laríngea: computarizada y/o digital / New alternatives in larynx stroboscopy: computarized and/or digital

En el manejo de las disfonías y de las diferentes patologías laríngeas la estroboscopia es la ayuda diagnóstica más precisa, pues nos permite un análisis de las diferentes estructuras laríngeas tanto en fonación como en reposo. Este método de diagnóstico clínico de consultorio, permite observar la función de las cuerdas vocales y analizar en detalle sus características vibratorias a saber: perceptuales (simetría, periodicidad, cierre glótico, amplitud, onda mucosa); y acústicas (frecuencia fundamental e intensidad)

The effect of a single intravenous dose of metamizol 2 g, ketorolac 30 mg and propacetamol 1 g on haemodynamic parameters and postoperative pain after heart surgery.

Although nonopiate analgesics may be particularly useful in the immediate postoperative period after major surgery, their use has been associated with haemodynamic adverse effects during postoperative pain treatment and in critically ill patients in intensive care. The effect of a single intravenous dose of metamizol (dipyrone) 2 g, ketorolac 30 mg and propacetamol 1 g on haemodynamic variables and pain control in the immediate postoperative period after heart surgery is compared. Seventy-two patients undergoing elective coronary and/or heart valve surgery, were included in a cohort study of 1-years duration (1998). After weaning from mechanical ventilation and extubation, haemodynamic variables and a 4-point verbal rating pain scale were asseseed at base-line and 60 min after the administration of a single doses of metamizol, ketorolac or propacetamol. The Student's t-test for paired samples was used to compare changes produced by the study medications. A significant, but small, decrease in radial artery blood pressure was observed in all treatment groups which had little clinical relevance; no vasodilator effects were observed and ventricular function showed only minor changes: propacetamol decreased cardiac index by 10% and a 15% decrease in right ventricular work was also observed. Metamizol and ketorolac produced a 10% decrease in the left ventricular work index. Pain scores showed a statistically significant decrease in all treatment groups. The analgesic effects of metamizol, ketorolac and propacetamol were not associated with a clinically significant impairment in haemodynamic function when administered to haemodynamically stable patients.

[Francisella tularensis: update on microbiological diagnosis after an epidemic outbreak]. / Francisella tularensis: puesta a punto en el diagnóstico microbiológico tras un brote epidémico.

AIMS: Francisella tularensis is a facultative intracellular gramnegative aerobic coccobacilli which is difficult to isolate. The appearance of an epidemic outbreak of tularemia in Castilla y Leon (Spain) during the first months of 1998 led bur microbiology laboratory to develop the diagnostic methods of this disease which, up to then, were unknown by the authors. METHODS: During the months of January and February, 1998, 25 samples were processed for culture (17, adenopathy pus and 8 necrotic skin ulcers) using enriched culture mediums. In 20, direct immunofluorescence was performed on the sample spread. Serologic study was carried out in 352 patients by the agglutination technique in tubes, with titers > or = 1/160 being considered as positive. Susceptibility tests were performed by the disk plate technique in chocolate agar. RESULTS: Three isolates of F. tularensis were achieved (12%). Seven samples (38.8%) were positive by direct immunofluorescence. By serology 149 negative (42%) and 203 positive (58%) results were obtained. Seroconversion was observed in 53 patients (increase in titer value 4-fold above the basal determination). The strains isolated were sensitive to third generation cephalosporins, aminoglycosides, macrolides and quinolones. CONCLUSIONS: F. tularensis is a microorganism which is highly demanding of its culture. Serology and direct immunofluorescence are more effective techniques for the diagnosis of tularemia than cultures. The strains presented high sensitivity to the antibiotics tested. Since the appearance of this outbreak, tularemia should be included in the differential diagnosis of the infectious processes observed in Spain.