Hipertermia maligna: a propósito de un caso / Malignant hyperthermia: a case report

Malignant hyperthermia (MH) is a rare neuromuscular hereditary disorder, triggered in susceptible individuals by exposure to inhalational agents or succinylcholine and manifested as a hypermetabolic state. We report the case of a 22 years old male patient anesthetized with Desflurane in whom MH was suspected because of unexplained increased levels of End-Tidal carbon dioxide. Dantrolene was administered with good response. Respiratory acidosis and hyperkalemia were also detected but could be easily controlled. The postoperative period was uneventful with the exception of a superficial venous thrombosis at the dantrolene’s injection site. The patient was discharged eight days after the episode without sequela. Successful management of a malignant hyperthemia episode must include: early suspicion, asking for help and early treatment with dantrolene.

La Hipertermia Maligna es un trastorno neuromuscular hereditario infrecuente, manifestado por un estado hipermetabólico desencadenado en individuos susceptibles por la exposición a anestésicos halogenados o Succinilcolina. Se reporta el caso de un hombre de 22 años anestesiado con Desflurano, en quien el diagnóstico de Hipertermia Maligna se sospechó por la presencia de elevación inexplicada del CO2 espirado, que respondió a la suspensión del Desflurano y administración de Dantroleno. Se observó además hiperkalemia y acidosis respiratoria, que fueron fácilmente compensadas. La evolución postoperatoria fue satisfactoria, a excepción de una trombosis venosa superficial en el sitio de inyección del Dantroleno. El paciente fue dado de alta al 8avo día postoperatorio, sin secuelas. Las claves del manejo exitoso de un episodio de hipertermia maligna están en: Sospecha precoz, solicitar ayuda e inició rápido del tratamiento con Dantroleno.

Evolution of Socioeconomic Conditions and Its Relation to Spatial-Temporal Changes of Giardiasis and Helminthiasis in Amazonian Children.

This study analyzed the evolution of socioeconomic, sanitary, and personal factors as well as spatiotemporal changes in the prevalence of helminthiasis and giardiasis in urban Amazonian children between 2003 and 2011. Child age, lack of sanitation, and lack of access to bottled water were identified as significant associated factors for helminthiasis and giardiasis. There was an overall improvement in socioeconomic and sanitary conditions in the city resulting in decreased helminth prevalences from 12.42 to 9.63% between 2003 and 2010, but the prevalence increased to 15.03% in 2011 due to migratory movement and unstable sanitary conditions. As for Giardiasis, socioeconomic and environmental changes were not enough to reduce prevalence (16% in 2003 and 23% in 2011). Spatial analysis identified a significant cluster for helminthiasis in an area of poor housing conditions. Control programs in the Amazon need to target high-risk areas focusing changes in sanitation, water usage, and health education.

Valores referenciales de antiestreptolisina O en estudiantes de 10 a 15 años del Municipio "Francisco Linares Alcántara": Estado Aragua, Venezuela / Antistreptolysin O reference values in students of 10 to 15 years of the Municipality "Francisco Linares Alcantara": Aragua state, Venezuela

The most useful for evidence of streptococcal infection of group A beta hemolytic serological response is the determination of antistreptolysin O (ASO). Strep throat is most common infection caused by these organisms, which can lead to non-suppurative complications such as acute rheumatic fever and glomerulonephritis.These complications can be prevented by proper diagnosis and treatment. For determination of ASO in Venezuela imported reagents are used whose reference values have been established in different populations and latitudes; so the aim of this study is to determine the reference values of ASO titlesin 203 students aged 10 to 15 years old enrolled in four institutions of the Municipality "Francisco Linares Alcántara", Aragua state, through an investigation of cross-sectional descriptive.Each student a sample of whole blood was collected for determination of ASO titles using neutralization tests and agglutination.The correlation between positive ASO titles were determined by both methods, the sensitivity, specificity and positive and negative predictive values of the agglutination test was calculated.The results refer to as reference value for the method of neutralization to 250 Todd Units/mL and for technical agglutination 400 International Units/mL. The concordance was weak between the two tests and obtained sensitivity, specificity, positive and negative predictive values of 100%, 60%, 24.2% and 100%, respectively. The disclosure in the health centers in the mentioned municipality of referential values of ASO found in this study is suggested.

La respuesta serológica más útil para evidenciar la infección por estreptococo beta hemolítico del grupo A,es la determinación de antiestreptolisina O (ASTO). La faringitis estreptocócica es la infección más frecuentemente causada por estos microorganismos, que puede conllevar a complicaciones no supurativas como la fiebre reumática aguda y la glomerulonefritis. Dichas complicaciones pueden prevenirse mediante un diagnóstico y tratamiento oportuno. Para la determinación de ASTO en Venezuela se emplean reactivos importados cuyos valores referenciales han sido establecidos en poblaciones y latitudes diferentes a la de nuestro país; por lo que el objetivo del presente estudio es determinar los valores referenciales de ASTO en 203 estudiantes de 10 a 15 años de edad inscritos en cuatro instituciones del Municipio "Francisco Linares Alcántara", estado Aragua, mediante una investigación de tipo descriptivo de corte transversal. De cada estudiante se recolectó una muestra de sangre total para la determinación de ASTO empleando pruebas de neutralización y aglutinación. Se determinó la concordancia entre los títulos positivos de ASTO por ambos métodos; se calculó la sensibilidad, especificidad y valores predictivos positivo y negativo de la prueba de aglutinación. Los resultados refieren como valor referencial para el método de neutralización hasta 250 Unidades Todd/mL y para la técnica aglutinación hasta 400 Unidades Internacionales/mL. La concordancia fue débil entre ambas pruebas y se obtuvo una sensibilidad, especificidad, valores predictivos positivo y negativo de 100%, 60%, 24,2% y 100%, respectivamente. Se sugiere la divulgación de los resultados de este estudio en los centros de salud del municipio mencionado.

Assessing carbon and nitrogen removal in a novel anoxic-aerobic cyanobacterial-bacterial photobioreactor configuration with enhanced biomass sedimentation.

The carbon and nitrogen removal potential of an innovative anoxic-aerobic photobioreactor configuration operated with both internal and external recyclings was evaluated under different cyanobacterial-bacterial sludge residence times (9-31 days) during the treatment of wastewaters with low C/N ratios. Under optimal operating conditions, the two-stage photobioreactor was capable of providing organic carbon and nitrogen removals over 95% and 90%, respectively. The continuous biomass recycling from the settler resulted in the enrichment and predominance of rapidly-settling cyanobacterial-bacterial flocs and effluent suspended solid concentrations lower than 35 mg VSS L(-1). These flocs exhibited sedimentation rates of 0.28-0.42 m h(-1) but sludge volumetric indexes of 333-430 ml/g. The decoupling between the hydraulic retention time and sludge retention time mediated by the external recycling also avoided the washout of nitrifying bacteria and supported process operation at biomass concentrations of 1000-1500 mg VSS L(-1). The addition of additional NaHCO3 to the process overcame the CO2 limitation resulting from the intense competition for inorganic carbon between cyanobacteria and nitrifying bacteria in the photobioreactor, which supported the successful implementation of a nitrification-denitrification process. Unexpectedly, this nitrification-denitrification process occurred both simultaneously in the photobioreactor alone (as a result of the negligible dissolved oxygen concentrations) and sequentially in the two-stage anoxic-aerobic configuration with internal NO3(-)/NO2(-) recycling.

Reflexiones sobre calidad de vida, dignidad y envejecimiento / Thoughts about qua lity of life, dignity and aging

El problema del envejecimiento ha preocupado al hombre desde el principio de su existencia, y en la actualidad se ha acentuado su interés por las implicancias éticas, los cambios sociales y económicos significativos de la población que contribuyen a la modificación del perfil demográfico de un país. Estas condicionantes demográficas se traducen en nuevos escenarios, en los cuales la inequidad, asimetría y exclusión social son factores que influyen en las condiciones de vida del adulto mayor que envejece a pasos acelerados y que plantea principales desafíos, aspiraciones y oportunidades. En consecuencia, las sociedades que envejecen deberían priorizar su preocupación en la dinámica demográfica en función de la percepción de la satisfacción personal, bienestar, calidad y dignidad de vida de sus mayores. El presente trabajo analiza aspectos cruciales del envejecimiento en un intento de una mejor comprensión del proceso de envejecimiento en sí mismo, las condiciones personales, familiares, sociales y ambientales que promueven una vejez digna y en calidad. Destaca que los cambios en las políticas sociales para mejorar la cantidad, calidad y dignidad de vida no son dictados por el avance de los conocimientos científicos, sino por decisiones políticas que reflejan el pensamiento y las necesidades sentidas por la sociedad donde se produce.

The problem of aging has preoccupied man since the beginning of its existence and now has increased its interest in the ethical implications, the social and economic changes significant population contributing to the change in the demographics of a country. These conditions translate into new demographic scenarios, in which inequality, asymmetry and social exclusion are factors that influence the lives of the elderly to age at an accelerated pace and poses major challenges, aspirations and opportunities. Consequently, aging societies should prioritize its concerns on population dynamics based on the perception of personal satisfaction, well being, quality of life and dignity of their elders. This paper analizes key aspects of aging in an attempt to better understand the aging process itself, the personal conditions familiar, social and environmental factors that promote a dignified old age and quality. Stresses that the changes in social policies to improve the quantity, quality and dignity of life are not dictated by the advance of scientific knowledge, but by political decisions that reflect the thought and the felt needs of the society in which it occurs.

Genome-scale phylogeny of the alphavirus genus suggests a marine origin.

The genus Alphavirus comprises a diverse group of viruses, including some that cause severe disease. Using full-length sequences of all known alphaviruses, we produced a robust and comprehensive phylogeny of the Alphavirus genus, presenting a more complete evolutionary history of these viruses compared to previous studies based on partial sequences. Our phylogeny suggests the origin of the alphaviruses occurred in the southern oceans and spread equally through the Old and New World. Since lice appear to be involved in aquatic alphavirus transmission, it is possible that we are missing a louse-borne branch of the alphaviruses. Complete genome sequencing of all members of the genus also revealed conserved residues forming the structural basis of the E1 and E2 protein dimers.

Silent circulation of arboviruses in Cameroon.

OBJECTIVES: To investigate the silent circulation and transmission of arthropod-borne viruses (arboviruses) in the Fako Division of Cameroon. DESIGN: This survey was conducted based on clinical observations and laboratory diagnosis; field collections of mosquitoes. SETTING: This study was conducted in the Fako Division of South West Cameroon. SUBJECTS: One hundred and two sera were obtained from febrile patients (with negative laboratory findings for malaria and typhoid fever) at clinics in the Fako Division, and diurnal anthropophilic mosquitoes (4,764) collected. INTERVENTIONS: Virus isolation was attempted from these, and sera were screened for antibodies against 18 African arboviruses by haemagglutination inhibition (HI) and complement fixation (CF) tests. RESULTS: No virus was isolated. Fifty three of 79 (67.1%) sera reacted with one or more viral antigens. Twenty nine sera (36.7%) reacted with members of the genus Alphavirus, with Chikungunya (CHIKV) and O'nyong-nyong (ONNV) viruses as the most frequent (34.2%). Forty six sera (58.2%) reacted with members of the genus Flavivirus: 24 (30.4%) were cross-reactive, but 11.4% reacted monotypically with Zika, 5.1% with yellow fever virus (YFV), 5.1% with dengue virus-2 (DENV-2), 2.5% with DENV-1 and 1.3% with Wesselsbron virus, respectively. The plaque reduction neutralisation test used to specify the agent that elicited the response could not resolve 33.3% of the cross reactions between CHIKV and ONNV. Neutralising antibody titres against ONNV and CHIKV were very high indicating probable re-infection. CONCLUSION: Our results indicate previously undetected circulation of arboviruses in Cameroon, and suggest that they are important, overlooked public health problems.

Impacto de la pasantía hospitalaria en los conocimientos de los estudiantes de nutrición y dietética de la UCV / Intra-hospital interships in knowledge of students school of nutrition and dietery of UCV

Las pasantías hospitalarias son un conjunto de estrategias de aprendizaje fundamentales para el desempeño clínico de los futuros profesionales. El objetivo del presente estudio fue valorar los conocimientos de los estudiantes de la Escuela de Nutrición y Dietética de la Universidad Central de Venezuela en las áreas de evaluación y diagnóstico nutricional de adultos hospitalizados antes y después de las pasantías para valorar así el impacto de la misma. La metodología consistió en aplicar un instrumento (cuestionario) diecinueve estudiantes a su ingreso a las pasantías hospitalarias en el noveno semestre (marzo – julio 2002) y al finalizar las mismas. El instrumento fue elaborado a partir de la operacionalización de las variables y validado por expertos. Como pruebas estadísticas se utilizó “t de Student” para las muestras correlacionadas, con un nivel de significancia cuando P ≤0,05. Se plantearon cinco pares de hipótesis: evaluación nutricional subjetiva, evaluación nutricional antropométrica, evaluación nutricional bioquímica, diagnóstico nutricional integral y puntaje total. Se encontraron diferencias estadísticas significativas en la evaluación nutricional bioquímica (P =0,050), en el diagnóstico nutricional integral (P =0,001) y en el puntaje total de ambos tests (P=0,013), donde se presentaron mejoras con respecto al pre test. Se concluye que las pasantías hospitalarias ejercieron de manera global un impacto positivo sobre los conocimientos de los estudiantes, sin embargo, se deben plantear cambios en las estrategias instruccionales (de enseñanza y/o aprendizaje) para hacer más eficiente el esfuerzo y la inversión en los recursos de la enseñanza.

Isolation of viruses from mosquitoes (Diptera: Culicidae) collected in the Amazon Basin region of Peru.

As part of a comprehensive study on the ecology of arthropod-borne viruses in the Amazon Basin region of Peru, we assayed 539,694 mosquitoes captured in Loreto Department, Peru, for arboviruses. Mosquitoes were captured either by dry ice-baited miniature light traps or with aspirators while mosquitoes were landing on human collectors, identified to species, and later tested on Vero cells for virus. In total, 164 virus isolations were made and included members of the Alphavirus (eastern equine encephalomyelitis, Trocara, Una, Venezuelan equine encephalomyelitis, and western equine encephalomyelitis viruses), Flavivirus (Ilheus and St. Louis encephalitis), and Orthobunyavirus (Caraparu, Itaqui, Mirim, Murutucu, and Wyeomyia viruses) genera. In addition, several viruses distinct from the above-mentioned genera were identified to the serogroup level. Eastern equine encephalomyelitis virus was associated primarily with Culex pedroi Sirivanakarn & Belkin, whereas Venezuelan equine encephalomyelitis virus was associated primarily with Culex gnomatos Sallum, Huchings & Ferreira. Most isolations of Ilheus virus were made from Psorophora ferox (Von Humboldt). Although species of the Culex subgenus Melanoconion accounted for only 45% of the mosquitoes collected, 85% of the virus isolations were made from this subgenus. Knowledge of the viruses that are being transmitted in the Amazon Basin region of Peru will enable the development of more effective diagnostic assays, more efficient and rapid diagnoses of clinical illnesses caused by these pathogens, risk analysis for military/civilian operations, and development of potential disease control measures.

West Nile virus infection in the golden hamster (Mesocricetus auratus): a model for West Nile encephalitis.

This report describes a new hamster model for West Nile (WN) virus encephalitis. Following intraperitoneal inoculation of a New York isolate of WN virus, hamsters had moderate viremia of 5 to 6 days in duration, followed by the development of humoral antibodies. Encephalitic symptoms began 6 days after infection; about half the animals died between the seventh and 14th days. The appearance of viral antigen in the brain and neuronal degeneration also began on the sixth day. WN virus was cultured from the brains of convalescent hamsters up to 53 days after initial infection, suggesting that persistent virus infection occurs. Hamsters offer an inexpensive model for studying the pathogenesis and treatment of WN virus encephalitis.

Bioindication potential of carbonic anhydrase activity in anemones and corals.

Activity levels of carbonic anhydrase (CA) were assessed in anemones Condylactis gigantea and Stichodactyla helianthus with laboratory exposures to copper, nickel, lead, and vanadium, and also in animals collected from polluted vs pristine field sites. CA activity was found to be decreased with increase in metal concentration and also in animals collected from the polluted field site. Preliminary assessments to adapt the CA assay for use in the widespread coral Montastraea cavernosa show decreased CA activity in specimens from the polluted field site and provide an avenue for future research aimed at more thoroughly describing coral CA activity for potential application in bioindication.

Ultrasound-mediated disruption of cell membranes. I. Quantification of molecular uptake and cell viability.

Ultrasound-mediated drug delivery is a nonchemical, nonviral, and noninvasive method for targeted transport of drugs and genes into cells. Molecules can be delivered into cells when ultrasound disrupts the cell membrane by a mechanism believed to involve cavitation. This study examined molecular uptake and cell viability in cell suspensions (DU145 prostate cancer and aortic smooth muscle cells) exposed to varying peak negative acoustic pressures (0.6-3.0 MPa), exposure times (120-2000 ms), and pulse lengths (0.02-60 ms) in the presence of Optison (1.7% v/v) contrast agent. With increasing pressure and exposure time, molecular uptake of a marker compound, a calcein, increased and approached equilibrium with the extra cellular solution, while cell viability decreased. Varying pulse length produced no significant effect. All viability and molecular uptake measurements collected over the broad range of ultrasound conditions studied correlated with acoustic energy exposure. This suggests that acoustic energy exposure may be predictive of ultrasound's nonthermal bioeffects.

Ultrasound-mediated disruption of cell membranes. II. Heterogeneous effects on cells.

Ultrasound has been shown to reversibly and irreversibly disrupt membranes of viable cells through a mechanism believed to involve cavitation. Because cavitation is both temporally and spatially heterogeneous, flow cytometry was used to identify and quantify heterogeneity in the effects of ultrasound on molecular uptake and cell viability on a cell-by-cell basis for suspensions of DU145 prostate cancer and aortic smooth muscle cells exposed to varying peak negative acoustic pressures (0.6-3.0 MPa). exposure times (120-2,000 ms), and pulse lengths (0.02-60 ms) in the presence of Optison (1.7% v/v) contrast agent. Cell-to-cell heterogeneity was observed at all conditions studied and was classified into three subpopulations: nominal uptake (NUP), low uptake (LUP), and high uptake (HUP) populations. The average number of molecules within each subpopulation was generally constant: 10(4)-10(5) molecules/cell in NUP, approximately 10(6) molecules/cell in LUP, and approximately 10(7) molecules/cell in HUP. However, the fraction of cells within each subpopulation showed a strong dependence on both acoustic pressure and exposure time. Varying pulse length produced no significant effect. The distribution of cells among the three subpopulations correlated with acoustic energy exposure, which suggests that energy exposure may govern the ability of ultrasound to induce bioeffects by a nonthermal mechanism.

Trocara virus: a newly recognized Alphavirus (Togaviridae) isolated from mosquitoes in the Amazon Basin.

This report describes Trocara virus, a newly recognized member of the genus Alphavirus, that has been isolated from Aedes serratus mosquitoes collected at two widely separated sites in the Amazon Basin. Biological, antigenic and genetic characteristics of the new virus are given. Results of these studies indicate that Trocara virus is the first member of a newly discovered antigenic complex within the family Togaviridae genus Alphavirus. The public health and veterinary importance of Trocara virus is still unknown.

Allpahuayo virus: a newly recognized arenavirus (arenaviridae) from arboreal rice rats (oecomys bicolor and oecomys paricola) in northeastern peru.

Allpahuayo virus was initially isolated from arboreal rice rats (Oecomys bicolor and Oecomys paricola) collected during 1997 at the Allpahuayo Biological Station in northeastern Peru. Serological and genetic studies identified the virus as a new member of the Tacaribe complex of the genus Arenavirus. The small (S) segment of the Allpahuayo virus prototype strain CLHP-2098 (Accession No. AY012686) was sequenced, as well as that of sympatric isolate CLHP-2472 (Accession No. AY012687), from the same rodent species. The S segment was 3382 bases in length and phylogenetic analysis indicated that Allpahuayo is a sister virus to Pichinde in clade A. Two ambisense, nonoverlapping reading frames were identified, which result in two predicted gene products, a glycoprotein precursor (GPC) and a nucleocapsid protein (NP). A predicted stable single hairpin secondary structure was identified in the intergenic region between GPC and NP. Details of the genetic organization of Allpahuayo virus are discussed.

Extreme genetic diversity among Pirital virus (Arenaviridae) isolates from western Venezuela.

Pirital-like virus isolates from rodents collected in a variety of habitats within a six-state area of central Venezuela were analyzed genetically by amplifying a portion of the nucleocapsid protein gene using RT-PCR. Comparisons of the sequences from 30 selected Pirital-like virus isolates demonstrated up to 26% divergence in nucleotide sequences and up to 16% divergence in deduced amino acid sequences. Within the Pirital monophyletic group, 14 distinct lineages or genotypes, differing by at least 6% in nucleotide sequences, were identified. Although sample sizes were small for some lineages, many of the different genotypes were sampled in only one region or locality, suggesting allopatric divergence. Complement fixation tests with representatives of the most divergent Pirital virus lineages failed to delineate multiple species or subtypes within the Pirital clade. These results indicate that the previously proposed 12% nucleocapsid protein amino acid sequence divergence cutoff value for delineating arenavirus species is not appropriate for the entire family. When individual clones were examined from PCR amplicons, a mean of 0.17% sequence diversity vs the consensus sequences was detected, suggesting diverse quasispecies populations within infected rodent hosts. Possible explanations for the extreme genetic diversity within and among Pirital virus populations in infected rodents are discussed.

Experimental yellow fever virus infection in the Golden Hamster (Mesocricetus auratus). I. Virologic, biochemical, and immunologic studies.

This report describes the clinical laboratory findings in golden hamsters experimentally infected with yellow fever (YF) virus. An accompanying paper describes the pathologic findings. Following intraperitoneal inoculation of a virulent strain of YF virus, hamsters developed a high-titered viremia (up to 109/mL) lasting 5--6 days and abnormal liver function tests. YF hemagglutination-inhibiting antibodies appeared 4 or 5 days after infection, often while viremia was still present. The mortality rate in YF-infected hamsters was variable, depending on the virus strain and the age of the animals. Clinical and pathologic changes in the infected hamsters were very similar to those described in experimentally infected macaques and in fatal human cases of YF, which indicates that the golden hamster may be an excellent alternative animal model, in place of nonhuman primates, for research on the pathogenesis and treatment of YF and other viscerotropic flavivirus diseases.

Experimental yellow fever virus infection in the Golden hamster (Mesocricetus auratus). II. Pathology.

Subadult and adult hamsters were inoculated intraperitoneally with 10(6) TCID(50) of yellow fever (YF) virus (Jimenez strain). Four animals from each group were subjected daily to histologic examination for 9 days. The liver showed spotty necrosis on day 3 after infection, which was followed by steatosis and focally confluent necrosis. In surviving hamsters, hepatocyte regeneration began on day 8, which was accompanied by decreasing steatosis. The spleen initially exhibited lymphoid hyperplasia, which was followed by lymphoid depletion and increased phagocytosis by splenic macrophages. Focal pancreatic acinar necrosis and spotty adrenal cortical necrosis were seen transiently between days 5 and 7. Viral antigen was detected immunohistochemically in the liver and the spleen. TUNEL analysis showed a dynamic change of hepatocyte necrapoptosis, with activity corresponding to the severity of disease. The histopathologic changes were more severe in younger (subadult) animals. The YF-hamster model appears to be an accurate and inexpensive experimental system for studying the pathophysiology and treatment of YF.