Cerebral tuberculomas: manifestation of extrapulmonary tuberculosis in an immunocompromised patient. A case report / Tuberculomas cerebrales: manifestación de tuberculosis extrapulmonar en un paciente inmunocomprometido. Un informe de caso

Tuberculosis (Tb) is, currently, the deadliest infectious disease and is caused by organisms of the Mycobacterium tuberculosis complex; the most common clinical manifestation is pulmonary involvement; however, it can also manifest as extrapulmonary affection in immunocompromised patients, especially in patients with human immunodeficiency virus (HIV) chronic infection up to 20% of the cases, despite being on adequate antiretroviral therapy. Within the extrapulmonary manifestations, affection of the central nervous system by hematogenous dissemination occurs in up to 5%, however, the finding of tuberculomas, which is a form of central nervous system involvement, is rare and an important cause in secondary hydrocephalus in these patients. We present the case of a male patient with a history of HIV infection and meningeal tuberculosis, who presented dysfunction of his ventriculoperitoneal shunt and in the imaging study multiple tuberculomas were found, a cerebrospinal fluid study was performed where multi-resistant tuberculosis (MDR) was documented, therefore despite adequate management of Tb, tuberculomas developed. (AU)

La tuberculosis (Tb) es, actualmente, la enfermedad infecciosa más mortífera y está causada por organismos del complejo Mycobacterium tuberculosis; la manifestación clínica más común es la afectación pulmonar; sin embargo, también puede manifestarse como afección extrapulmonar en pacientes inmunocomprometidos, especialmente en pacientes con infección crónica por el virus de la inmunodeficiencia humana (VIH) hasta en un 20% de los casos, a pesar de estar en tratamiento antirretroviral adecuado. Dentro de las manifestaciones extrapulmonares, la afectación del sistema nervioso central por diseminación hematógena se presenta hasta en un 5%, sin embargo, el hallazgo de tuberculomas, que es una forma de afectación del sistema nervioso central, es raro y una causa importante en la hidrocefalia secundaria en estos pacientes. . Presentamos el caso de un paciente masculino con antecedentes de infección por VIH y tuberculosis meníngea, quien presentó disfunción de su derivación ventriculoperitoneal y en el estudio de imagen se encontraron múltiples tuberculomas, se le realizó estudio de líquido cefalorraquídeo donde se encontró tuberculosis multirresistente (MDR). documentados, por lo que a pesar del manejo adecuado de la Tb, se desarrollaron tuberculomas. (AU)

Climate-induced changes in the suitable habitat of cold-water corals and commercially important deep-sea fishes in the North Atlantic.

The deep sea plays a critical role in global climate regulation through uptake and storage of heat and carbon dioxide. However, this regulating service causes warming, acidification and deoxygenation of deep waters, leading to decreased food availability at the seafloor. These changes and their projections are likely to affect productivity, biodiversity and distributions of deep-sea fauna, thereby compromising key ecosystem services. Understanding how climate change can lead to shifts in deep-sea species distributions is critically important in developing management measures. We used environmental niche modelling along with the best available species occurrence data and environmental parameters to model habitat suitability for key cold-water coral and commercially important deep-sea fish species under present-day (1951-2000) environmental conditions and to project changes under severe, high emissions future (2081-2100) climate projections (RCP8.5 scenario) for the North Atlantic Ocean. Our models projected a decrease of 28%-100% in suitable habitat for cold-water corals and a shift in suitable habitat for deep-sea fishes of 2.0°-9.9° towards higher latitudes. The largest reductions in suitable habitat were projected for the scleractinian coral Lophelia pertusa and the octocoral Paragorgia arborea, with declines of at least 79% and 99% respectively. We projected the expansion of suitable habitat by 2100 only for the fishes Helicolenus dactylopterus and Sebastes mentella (20%-30%), mostly through northern latitudinal range expansion. Our results projected limited climate refugia locations in the North Atlantic by 2100 for scleractinian corals (30%-42% of present-day suitable habitat), even smaller refugia locations for the octocorals Acanella arbuscula and Acanthogorgia armata (6%-14%), and almost no refugia for P. arborea. Our results emphasize the need to understand how anticipated climate change will affect the distribution of deep-sea species including commercially important fishes and foundation species, and highlight the importance of identifying and preserving climate refugia for a range of area-based planning and management tools.

Predicted distribution of the glass sponge Vazella pourtalesi on the Scotian Shelf and its persistence in the face of climatic variability.

Emerald Basin on the Scotian Shelf off Nova Scotia, Canada, is home to a globally unique aggregation of the glass sponge Vazella pourtalesi, first documented in the region in 1889. In 2009, Fisheries and Oceans Canada (DFO) implemented two Sponge Conservation Areas to protect these sponge grounds from bottom fishing activities. Together, the two conservation areas encompass 259 km2. In order to ascertain the degree to which the sponge grounds remain unprotected, we modelled the presence probability and predicted range distribution of V. pourtalesi on the Scotian Shelf using random forest modelling on presence-absence records. With a high degree of accuracy the random forest model predicted the highest probability of occurrence of V. pourtalesi in the inner basins on the central Scotian Shelf, with lower probabilities at the shelf break and in the Fundian and Northeast Channels. Bottom temperature was the most important determinant of its distribution in the model. Although the two DFO Sponge Conservation Areas protect some of the more significant concentrations of V. pourtalesi, much of its predicted distribution remains unprotected (over 99%). Examination of the hydrographic conditions in Emerald Basin revealed that the V. pourtalesi sponge grounds are associated with a warmer and more saline water mass compared to the surrounding shelf. Reconstruction of historical bottom temperature and salinity in Emerald Basin revealed strong multi-decadal variability, with average bottom temperatures varying by 8°C. We show that this species has persisted in the face of this climatic variability, possibly indicating how it will respond to future climate change.

Morphological and genetic variation in North Atlantic giant file clams, Acesta spp. (Bivalvia: Limidae), with description of a new cryptic species in the northwest Atlantic.

We analyze the morphological and genetic variability within and between seven species of Acesta and specimens recently collected in the northwest Atlantic using traditional morphological measurements, landmark-based geometric morphometrics, and the cytochrome oxidase subunit I (COI) gene sequences, with particular emphasis on North Atlantic species. Shell morphology and external shell appearance do not allow reliable distinction between the widely recognized northeastern Atlantic A. excavata and other northwest Atlantic species or populations of Acesta, with the exception of A. oophaga. Similarly, shape analysis reveals a wide variability within northeastern Atlantic A. excavata, and significant morphological overlap with A. bullisi from the Gulf of Mexico and A. rathbuni from the southwestern Pacific and South China Sea. Specimens from the northwestern and Mid-Atlantic display shell shapes marginally similar to that of A. excavata. These differences are at least partly related to anterior or posterior shifting of the shell body and to the opposite shifting of the hinge line/dorsal region and upper lunule. These morphological variations, along with the midline-width-ratio, explain much of the variability extracted by principal component analysis. Results from a mitochondrial DNA barcode approach (COI), however, suggest that the northwest Atlantic specimens belong to a new species for which we propose the name Acesta cryptadelphe sp. nov. Differences in larval shell sizes between northeastern and northwestern Atlantic specimens are consistent with this result.

A new species of Pycnogonum Brünnich, 1764 (Arthropoda, Pycnogonida) from Flemish Cap (Northwest Atlantic Ocean).

A new pycnogonid species of the genus Pycnogonum is described from Flemish Cap (Northwest Atlantic Ocean) at 1453-1462 m depth. Pycnogonum bamberi sp. nov. is compared with its congeners, from which it can be distinguished by the combination of a glans-shaped proboscis, the low, transverse ridges that lie on the dorsodistal surfaces of the first coxae and femora of all legs and the distinctive conical tubercle on the mid-dorsal surface of the fourth segment of the trunk.

Kernel density surface modelling as a means to identify significant concentrations of vulnerable marine ecosystem indicators.

The United Nations General Assembly Resolution 61/105, concerning sustainable fisheries in the marine ecosystem, calls for the protection of vulnerable marine ecosystems (VME) from destructive fishing practices. Subsequently, the Food and Agriculture Organization (FAO) produced guidelines for identification of VME indicator species/taxa to assist in the implementation of the resolution, but recommended the development of case-specific operational definitions for their application. We applied kernel density estimation (KDE) to research vessel trawl survey data from inside the fishing footprint of the Northwest Atlantic Fisheries Organization (NAFO) Regulatory Area in the high seas of the northwest Atlantic to create biomass density surfaces for four VME indicator taxa: large-sized sponges, sea pens, small and large gorgonian corals. These VME indicator taxa were identified previously by NAFO using the fragility, life history characteristics and structural complexity criteria presented by FAO, along with an evaluation of their recovery trajectories. KDE, a non-parametric neighbour-based smoothing function, has been used previously in ecology to identify hotspots, that is, areas of relatively high biomass/abundance. We present a novel approach of examining relative changes in area under polygons created from encircling successive biomass categories on the KDE surface to identify "significant concentrations" of biomass, which we equate to VMEs. This allows identification of the VMEs from the broader distribution of the species in the study area. We provide independent assessments of the VMEs so identified using underwater images, benthic sampling with other gear types (dredges, cores), and/or published species distribution models of probability of occurrence, as available. For each VME indicator taxon we provide a brief review of their ecological function which will be important in future assessments of significant adverse impact on these habitats here and elsewhere.

Modeling the distribution of Geodia sponges and sponge grounds in the Northwest Atlantic.

Deep-sea sponge grounds provide structurally complex habitat for fish and invertebrates and enhance local biodiversity. They are also vulnerable to bottom-contact fisheries and prime candidates for Vulnerable Marine Ecosystem designation and related conservation action. This study uses species distribution modeling, based on presence and absence observations of Geodia spp. and sponge grounds derived from research trawl catches, as well as spatially continuous data on the physical and biological ocean environment derived from satellite data and oceanographic models, to model the distribution of Geodia sponges and sponge grounds in the Northwest Atlantic. Most models produce excellent fits with validation data although fits are reduced when models are extrapolated to new areas, especially when oceanographic regimes differ between areas. Depth and minimum bottom salinity were important predictors in most models, and a Geodia spp. minimum bottom salinity tolerance threshold in the 34.3-34.8 psu range was hypothesized on the basis of model structure. The models indicated two currently unsampled regions within the study area, the deeper parts of Baffin Bay and the Newfoundland and Labrador slopes, where future sponge grounds are most likely to be found.

Minilaparotomy vs. laparoscopic cholecystectomy: results of a randomized clinical trial.

BACKGROUND: Currently, laparoscopic cholecystectomy is considered the gold standard for treatment of gallstones with advantages in regard to postoperative pain, hospital stay, early return to activities of daily living and acceptable cosmetic results. Open cholecystectomy in the form of minilaparotomy may be an effective alternative for the management of symptomatic cholelithiasis. We undertook this study to compare the results of laparoscopic cholecystectomy and minilaparotomy cholecystectomy techniques. methods: We conducted a randomized clinical trial between January 2009 and December 2009. We included patients with symptomatic cholelithiasis divided into two groups: group A--minilaparotomy and group B--laparoscopic cholecystectomy. End-point variables were age, gender, pre- and postoperative diagnosis, operative time, conversion or extension, hospital stay, complications and pain. Statistical analysis included Fisher's exact test, χ(2) test and Student t test. RESULTS: There were 88 patients with cholelithiasis: 37 men and 51 women. Mean age was 45.65 years. There were 45 patients in Group A and 43 patients in Group B. Mean operative time was 79.02 min for minilaparotomy and 86.04 min for laparoscopic cholecystectomy (p = 0.33). Average hospital stay was 2.75 days for minilaparotomy and of 2.02 days for laparoscopy (p = 0.60). Complications of minilaparotomy were demonstrated in 6.6% of patients and for laparoscopic cholecystectomy in 16.3% of patients (p = 0.16). There were three extensions and five conversions. CONCLUSIONS: Minilaparotomy cholecystectomy has results similar to laparoscopic cholecystectomy.

Lepra: sepsis en paciente con reacción tipo II. Reporte de un caso / Leprosy: sepsis in patients with type II reaction. A case report

La lepra es una patología infecciosa de carácter crónico, caracterizada por un amplio compromiso cutáneo, asociado a neuropatía, con bajas tasas de mortalidad, pero con un alto índice de discapacidad. Es causada por la infección por el bacilo, Mycobacterium leprae. A pesar que se conoce desde la antigüedad se considera un problema persistente de salud pública en áreas subtropicales donde es endémica. Su mecanismo de transmisión, es por medio de gotitas respiratorias. Su espectro clínico es muy variado, depende de la forma en que el sistema inmunitario del huésped reacciona frente al agente infeccioso, por lo que se reconocen los polos determinados como tuberculoide y lepromatoso, una forma indeterminada y borderline. Por otro lado se considera que las reacciones lepróticas (tipo 1, tipo 2 y fenómeno de lucio) son complicaciones de la hiperreactividad inmunológica que aparece cuando se afecta el equilibrio inmunológico en el huésped. En 1982 la Organización Mundial de la Salud estableció la terapia multidrogas como herramienta eficaz para el control de esta entidad. Actualmente el régimen farmacológico se establece teniendo en cuenta la clasificación que distingue al enfermo en paucibacilar y multibacilar. Presentamos un paciente masculino de 64 años, con antecedente de lepra lepromatosa multibacilar desde 3 años, con tratamiento irregular, suspendido 6 meses antes de clínica de ingreso consistente sepsis de origen urinario, con posterior septicemia asociada al catéter, a quien se le realiza tratamiento antibiótico de amplio espectro, con evolución satisfactoria del estado hemodinámico y manejo de la lepra ambulatorio. [Escalante, E, Trout, G, Oliva J, Mejía F. Lepra: sepsis en paciente con reacción tipo II. Reporte de un caso. MedUNAB 2012; 15:123-129].

Leprosy is an infectious disease of chronic, characterized by extensive skin involvement, neuropathy associated with low mortality rates, but with a high rate of disability. It is caused by infection with the bacillus, Mycobacterium leprae. Although known since ancient times is considered a persistent public health problem in subtropical areas where it is endemic. It is considered that the transmission mechanism is through respiratory droplets. Its clinical spectrum is varied and depends on how the host's immune system reacts against the infectious agent, so the poles are recognized tuberculoid and lepromatous determined as a definite shape and borderline. On the other hand is considered that the leprotics reactions (type 1, type 2 phenomenon pike) are complications of immune hyperreactivity that occurs when immune balance is affected in the host. In 1982 the World Health Organization established multidrug therapy as an effective tool for control of this disease, currently the drug regimen was determined based on the classification that distinguishes the patient in paucibacillary and multibacillary. We report a 64 year old male with a history of multibacillary lepromatous leprosy 3 years, with irregular treatment, suspended 6 months before admission consistent clinical urinary sepsis, with subsequent catheter-associated septicemia, who was with treatment broad-spectrum antibiotic, with satisfactory hemodynamic status and management of leprosy clinic. [Escalante, E, Trout, G, Oliva J, Mejia F. Leprosy: sepsis in patients with type II reaction. A case report. MedUNAB 2012; 15:123-129].