[Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department]. / Potenciales biomarcadores predictores de mortalidad en pacientes COVID-19 en el Servicio de Urgencias.

OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. METHODS: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.

Treatment outcome of extrapulmonary tuberculosis under Revised National Tuberculosis Control Programme.

BACKGROUND: Extrapulmonary tuberculosis (EPTB) constitutes 15-20% of tuberculosis cases in India. Earlier studies have evaluated treatment outcomes of EPTB with little information on outcomes of individual site of EPTB. AIMS: The objective was to study the outcome of Directly Observed Treatment Short course (DOTS) treatment of EPTB in different organ systems under Revised National Tuberculosis Control Programme. METHODS: Multi-centric retrospectives record review was carried out in three states in India. Data were collected from TB registers and analysed. RESULTS: Of the total 2219 patients studied, there were more males in age group 15-45. The commonest sites of EPTB were lymph node (34.4%) and pleural effusion (25.2%) followed by abdominal (12.8%) and central nervous system (CNS) (9.4%). Lymph node involvement was more common in females (58%) and pleural effusion in males (70%). Overall treatment completion rate was 84% in EPTB patients. Treatment completion was 86% in HIV negative EPTB patients compared to 66% in HIV positive patients. Individually, treatment completion rate observed as follows: lymph node 90.9%, genitourinary 92.6%, bone and joint 86%, pleural effusion 84.7%, abdominal 76% and CNS (tuberculoma and meningitis) 63.7%. The site of EPTB was not recorded in 173 (7.8%) patients. CONCLUSION: Treatment outcome of EPTB was poor in HIV infected patients and those with CNS tuberculosis. More efforts are needed to improve the treatment completion rates in these groups of patients.

Evaluation of low-contrast perceptibility in dental restorative materials under the influence of ambient light conditions.

OBJECTIVES: This study aimed to assess how details on dental restorative composites with different radio-opacities are perceived under the influence of ambient light. METHODS: Resin composite step wedges (six steps, each 1-mm thick) were custom manufactured from three materials, respectively: (M1) Filtek™ Z350 (3M/ESPE, Saint Paul, MN); (M2) Prisma AP.H™ (Dentsply International Inc., Brazil) and (M3) Glacier(®) (SDI Limited, Victoria, Australia). Each step of the manufactured wedge received three standardized drillings of different diameters and depths. An aluminium (Al) step wedge with 12 steps (1-mm thick) was used as an internal standard to calculate the radio-opacity as pixel intensity values. Standardized digital images of the set were obtained, and 11 observers independently recorded the images, noting the number of noticeable details (drillings) under 2 dissimilar conditions: in a light environment (light was turned on in the room) and in low-light conditions (light in the room was turned off). The differences between images in terms of the number of details that were observed were statistically compared using ANOVA, Cronbach's alpha coefficient and Wilcoxon and Kruskal-Wallis tests, with a significance level setting of 5% (α = 0.05). RESULTS: The M2 showed higher radio-opacity, the M1 displayed intermediate radio-opacity and the M3 showed lower radio-opacity, respectively; however, all three were without significance (p > 0.05) compared with each other. The differences in radio-opacity resulted in a significant variation (p < 0.05) in the number of noticeable details in the image, which were influenced by characteristics of details, in addition to the ambient-light level. CONCLUSIONS: The radio-opacity of materials and ambient light can affect the perception of details in digital radiographic images.

Comparison of screening methods for conductive hearing loss identification in children: low-cost proposal.

OBJECTIVE: To evaluate the effectiveness of two screening methods (imitanciometry screening and questionnaire) to identify children at risk for conductive hearing loss, comparing this data with complete audiologic evaluation. METHODS: Of 507 children aged between three and six, 111 completed all procedures. The observational methods used were: imitanciometry screening, a questionnaire to identify risk factors for hearing loss and complete audiologic evaluation. Results obtained in the first two instruments were compared with results from complete audiologic evaluation (gold standard). From these comparisons, sensitivity and specificity, accuracy, positive and negative predictive values, and odds ratio were determined for the two screening methods and for the combination of both methods. RESULTS: The two methods applied in series (questionnaire and after imitanciometry screening) showed a greater odds ratio and better correlation between sensitivity and proportion of false-positives (ROC curve). CONCLUSION: Combining the two tests in series improved screening accuracy. This combination was the best tool for identifying children at risk for conductive hearing loss.

CA lung presenting with vasculitis.

A 67 year old man presented to us with petechial skin rash and blebs on the legs. He was on anti-tuberculous treatment for right sided pleural effusion since 1 month. A provisional diagnosis of Rifampicin induced drug rash was made and his effusion reaspirated and sent for AFB and cytology. The pleural fluid cytology demonstrated metastasis of adenocarcinoma and biopsy of skin lesion confirmed vasculitis. There was no thrombocytopenia. CT thorax showed right lower lobe mass with right sided pleural effusion. Thus a final diagnosis of skin manifestation of carcinoma of lung was made. This was a Paraneoplastic syndrome.

Avaliação da atividade antibacteriana e prospecção fitoquímica de Solanum paniculatum Lam. e Operculina hamiltonii (G. Don) D. F. Austin & Staples, do semi-árido paraibano / Evaluation of antibacterial activity and phytochemical prospection of Solanum paniculatum Lam. and Operculina hamiltonii (G. Don) D. F. Austin & Staples from the semi-arid region of Paraíba State, Brazil

Devido ao aparecimento de populações de parasitos resistentes, as drogas farmacêuticas, alternativas de controle, estão sendo pesquisadas utilizando plantas medicinais. O objetivo deste estudo foi avaliar a atividade antibacteriana e realizar a análise fitoquímica do extrato etanólico de duas espécies do semi-árido paraibano, Solanum paniculatum Lam. e Operculina hamiltonii (G. Don) D. F. Austin & Staples. As referidas espécies são muito utilizadas pela população rural contra verminoses gastrintestinais de ovinos. A prospecção fitoquímica foi obtida a partir dos extratos etanólicos para análise dos constituintes químicos existentes nas duas espécies. As análises dos extratos indicaram a presença de taninos flobabênicos, flavononóis, flavononas e alcalóides em ambas as espécies. A atividade antibacteriana foi determinada inicialmente pelo método de difusão em cavidade. A espécie S. paniculatum apresentou atividade contra Staphylococcus aureus (ATCC 12692), Escherichia coli (ATCC 25922) e Pseudomonas aeruginosa (ATCC 15442), no entanto O. hamintonii não demonstrou atividade contra as linhagens bacterianas testadas.

The emergence of resistant parasite populations has led to the study of pharmaceutical drugs, which represent an alternative control. This study aimed to evaluate the antibacterial activity and to perform the phytochemical analysis of the ethanol extract from two species belonging to the semi-arid region of Paraíba State, Brazil: Solanum paniculatum Lam. and Operculina hamiltonii (G. Don) D. F. Austin & Staples. Such species have been largely used by the rural population against ovine gastrointestinal helminthes. Phytochemical prospection was obtained from ethanol extracts for analysis of chemical compounds present in both species. Extract analyses indicated the presence of condensed tannins, flavonols, flavanones, and alkaloids in both species. The antibacterial activity was initially determined by the cavity method. The species S. paniculatum had activity against Staphylococcus aureus (ATCC 12692), Escherichia coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 15442); however, O. hamintonii did not present activity against the tested bacterial strains.

Síndrome de Ivemark recidivante / Recurrent Ivemark syndrome

Resumen

The Ivemark syndrome is one of the heterotaxy syndromesor also named cardiosplenic syndromes. During the normal embryological development, as the body left-right axis is established also the organs assume their definitive positions. When variation of the body organs arrangement occurs precociously in embryogenesis, there is a tendency toward symmetric development of normally asymmetric organs or organ systems, with concomitant complex cardiac defects. The most significant forms of heterotaxy syndromes are the polysplenia syndrome and the Ivemark syndrome. Both are rare syndromes and seem to be responsible for 1% of all congenital cardiac defects. The Ivemark syndrome is usually manifested as asplenia, bilaterally trilobed lungs, symmetric liver, with a central position in the upper abdomen, gallbladder centrally positioned or in the left side, and complex cardiopathy. The authors describe a case report of a second gestation of an healthy young couple, to whom a diagnosis of Ivemark syndrome was made at 20th gestacional week. In her obstetric history she had a term pregnancy, with an Ivemark syndrome newborn -anatomo-pathological diagnosis-, who died of cardio-pulmonary insufficiency in the neonatal period. In the current pregnancy an increased nuchal translucency was detected in the first trimester ultrasound. Amniocentesis for fetal cariotype revealed a normal cariotype for a male fetus. In the ultrasound at 21th gestational week a complex cardiopathy was identified and echocardiography confirmed the diagnosis of right isomerism. The couple decided for a pregnancy interruption, which was accepted. The anatomo-pathological exam confirmed the diagnosis of Ivemark syndrome

Isotopic composition as a tool for assessment of origin and dynamic of organic matter in tropical freshwater.

The isotopic composition (13C and 15N) and C:N ratio of sediment and particulate were investigated to assess the origin and dynamic of the organic matter in two river basins located in the Parana State, Brazil. The main sources of organic matter, plants, litter and soil, were analyzed in the study. This study was carried out during the dry and wet seasons. Although organic matter contribution for the particulate material has been mixed, the main contribution in the two seasons for both rivers was autochthonous characterized by delta13C and C:N ratio values ranging from -31.0 to -21.8 per thousand and from 5.1 to 11.4, respectively. The soil with delta13C values ranging from -25.9 to -20.6 per thousand, and C:N ratio from 10.2 to 15.8, was the main carbon source for the river sediment for the two tributaries in the wet and dry seasons. The sediment delta15N values for both the rivers in the wet season showed an 15N enrichment trend in most of studied sites when compared to the dry season values, suggesting major input of nutrients as dissolved organic nitrogen and sewage nitrate. In the dry season, 14N enriched compounds, could have been used by phytoplankton, causing 15N enrichment. The isotope and C:N ratio data clearly showed that the agricultural activity has been influencing the origin and dynamic of organic matter in the two rivers, with potential biochemical consequences for the lower basin of the major Tibagi river.

Does acetaldehyde mediate ethanol action in the central nervous system?

BACKGROUND: Some of the effects of ethanol in the central nervous system are due to changes in function of ligand-gated ion channels. Production of detectable amounts of acetaldehyde, a primary metabolite of ethanol, has been demonstrated in brain homogenates. The aim of this study was to determine whether central actions that are often attributed to ethanol may actually be mediated by acetaldehyde. METHODS: The effects of acetaldehyde (1-1000 microM) were tested by two-electrode voltage-clamp electrophysiology in Xenopus laevis oocytes expressing 10 different ligand-gated ion channel receptors [alpha1 glycine; alpha1beta2gamma2Sgamma-aminobutyric acid (GABA)A; rho1 GABAc; 5-hydroxytryptamine-3A; NR1a/NR2A NMDA; GluR1/GluR2 AMPA; GluR6/KA2 kainate; and alpha4beta2, alpha4beta4, and alpha2beta4 nicotinic-acetylcholine] and the G-protein-coupled inward rectifying potassium channel GIRK2. We also investigated the effect of acetaldehyde on the dopamine transporter (DAT), performing dopamine uptake assays in oocytes expressing DAT. RESULTS: Acetaldehyde (1 and 10 microM) significantly enhanced alpha1 glycine receptor-mediated currents. Acetaldehyde did not affect the function of any of the other receptors tested or the potassium currents measured in GIRK2 channels. Moreover, acetaldehyde did not alter the DAT-mediated dopamine uptake. CONCLUSIONS: Our results suggest a potential minor role for acetaldehyde in the glycine receptor-mediated effects of ethanol. Otherwise, acetaldehyde does not modulate function of the neuronal receptors tested in this study, in GIRK channels or DAT, when expressed recombinantly in Xenopus laevis oocytes.

Successful use of a defined antigen/GM-CSF adjuvant vaccine to treat mucosal Leishmaniasis refractory to antimony: A case report.

Immunotherapy has been proposed as a method to treat mucosal leishmaniasis for many years, but the approach has been hampered by poor definition and variability of antigens used, and results have been inconclusive. We report here a case of antimonial-refractory mucosal leishmaniasis in a 45 year old male who was treated with three single injections (one per month) with a cocktail of four Leishmania recombinant antigens selected after documented hypo-responsiveness of the patient to these antigens, plus 50 microg of GM-CSF as vaccine adjuvant. Three months after treatment, all lesions had resolved completely and the patient remains without relapse after two years. Side effects of the treatment included only moderate erythema and induration at the injection site after the second and third injections. We conclude that carefully selected microbial antigens and cytokine adjuvant can be successful as immunotherapy for patients with antimonial-refractory mucosal leishmaniasis.

Posibilidades endoscópicas de la cirugía tubárica en fertilidad / Endoscopic possibilities of tubal surgery in infertility

La Laparoscopia es un procedimiento diagnóstico inicialmente, que se ha incorporado en los últimos 15 a 20 años al arsenal terapéutico de la ginecología hasta el extremo de desbancar para muchas patologías a la Laparatomía clásica. Hoy, la inmensa mayoría de las patologías anexiales quirúrgicas benignas se abordan por Laparoscopia igual que todas las esterilizaciones; la linfadenectomía pélvica en manos expertas se realiza incluso más fácilmente por Laparoscopia y tan sólo es objeto de discusión el abordaje de la patología ovárica maligna.En el campo de la Fertilidad, la cirugía tubárica que durante algunos años fue sustituida por la fecundación in vitro, vuelve a tener un lugar en el manejo integral de la pareja estéril. La Laparoscopia puede representar una vía de abordaje adecuada igualmente en manos expertas, para el tratamiento quirúrgico del factor tubárico (AU)

Brote de toxiinfección alimentaria por Salmonella enteritidis en un restaurante / An epidemic outbreak gastroenteritis foodborne caused by salmonella enteritidis in a restaurant: gastroenteritis

Fundamento: las toxiinfecciones alimentarias (TIA) son la causa más común de brotes epidémicos en nuestro medio constituyendo un importante problema de salud pública. Objetivo: describir las causas, mecanismos de transmisión y características de un brote de TIA ocurrido en un restaurante. Diseño: estudio de casos y controles. Material y métodos: se consideraron casos aquellas personas que enfermaron y controles aquellas personas que no enfermaron habiendo comido todos en la misma fecha en el restaurante implicado. Los datos se obtuvieron de la cumplimentación de un cuestionario mediante entrevista personal. Se utilizaron los tests estadísticos de Chi cuadrado y t de Student y se ajustaron varios modelos de Regresión Logística para evaluar la asociación de los alimentos consumidos con la TIA. Resultados: se afectaron 183 de los 359 asistentes a dos banquetes celebrados durante el mediodía y la noche el mismo día. Los síntomas más frecuentes fueron: diarrea (88,5 porciento), dolor abdominal (77,1 porciento), fiebre (74,3 porciento), cefalea (50,3 porciento), vómitos (45,1 porciento), mialgias (39,3 porciento) y náuseas (30,6 porciento). El periodo de incubación fue más largo en los casos del primer banquete (p=0,012). Necesitó hospitalización el 35,5 porciento. El alimento responsable fue la merluza rellena (OR ajustado=54,5; IC 95 porciento [6,9-424,1]). Se realizaron 60 coprocultivos en los comensales y 18 en los manipuladores de alimentos del restaurante, siendo positivos 58 y 4, respectivamente, a Salmonella enteritidis. Conclusiones: los posibles factores que originan la aparición de este tipo de brotes son susceptibles de control (AU)

[Epidemic outbreak of tularemia in Palencia]. / Brote epidémico de tularemia en Palencia.

BACKGROUND: Tularemia can become a health problem after its recent emergence in Spain. OBJECTIVE: To describe the clinico-epidemiologic characteristics of a tularemia outbreak occurred in Palencia (October 1997 to March 1998). DESIGN: Case-control study. MATERIAL AND METHODS: A clinico-epidemiologic survey was conducted. The Chi square test and the Student "t" test were used and a logistic regression analysis was made. The diagnosis was made by serology (microagglutination or macroagglutination) or culture. RESULTS: There were 151 cases; 74.5% of cases were confirmed or likely. The ulceroglandular was the most common clinical form of the disease (49%) and 23.2% of patients required hospital admission; 93.4% of patients had exposure to hares, and 86.7% of them handled them. Higher risk practices included skinning (adjusted OR: 3.9; 95% CI [1.03-14.7]; p = 0.04) and cutting/cooking (adjusted OR: 2.7; 95% CI [1.01-6.7]; p = 0.03). Streptomycin therapy was used for 51.6% of cases. CONCLUSIONS: The clinico-epidemiologic surveillance of this disease in Spain is necessary.