Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia.

INTRODUCTION: Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers. METHODS: Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p-value <0.05 was considered statistically significant. RESULTS: Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46-18.58]; p = 0.01. CONCLUSION: The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.

Ectodysplasin A in Biological Fluids and Diagnosis of Ectodermal Dysplasia.

The tumor necrosis factor (TNF) family ligand ectodysplasin A (EDA) is produced as 2 full-length splice variants, EDA1 and EDA2, that bind to EDA receptor (EDAR) and X-linked EDA receptor (XEDAR/EDA2R), respectively. Inactivating mutations in Eda or Edar cause hypohidrotic ectodermal dysplasia (HED), a condition characterized by malformations of the teeth, hair and glands, with milder deficiencies affecting only the teeth. EDA acts early during the development of ectodermal appendages-as early as the embryonic placode stage-and plays a role in adult appendage function. In this study, the authors measured EDA in serum, saliva and dried blood spots. The authors detected 3- to 4-fold higher levels of circulating EDA in cord blood than in adult sera. A receptor binding-competent form of EDA1 was the main form of EDA but a minor fraction of EDA2 was also found in fetal bovine serum. Sera of EDA-deficient patients contained either background EDA levels or low levels of EDA that could not bind to recombinant EDAR. The serum of a patient with a V262F missense mutation in Eda, which caused a milder form of X-linked HED (XLHED), contained low levels of EDA capable of binding to EDAR. In 2 mildly affected carriers, intermediate levels of EDA were detected, whereas a severely affected carrier had no active EDA in the serum. Small amounts of EDA were also detectable in normal adult saliva. Finally, EDA could be measured in spots of wild-type adult or cord blood dried onto filter paper at levels significantly higher than that measured in EDA-deficient blood. Measurement of EDA levels combined with receptor-binding assays might be of relevance to aid in the diagnosis of total or partial EDA deficiencies.

Kinetic and Energetic Parameters of Carob Wastes Fermentation by Saccharomyces cerevisiae: Crabtree Effect, Ethanol Toxicity, and Invertase Repression.

Carob waste is a useful raw material for the second-generation ethanol because 50% of its dry weight is sucrose, glucose, and fructose. To optimize the process, we have studied the influence of the initial concentration of sugars on the fermentation performance of Saccharomyces cerevisiae. With initial sugar concentrations (S0) of 20 g/l, the yeasts were derepressed and the ethanol produced during the exponential phase was consumed in a diauxic phase. The rate of ethanol consumption decreased with increasing S0 and disappeared at 250 g/l when the Crabtree effect was complete and almost all the sugar consumed was transformed into ethanol with a yield factor of 0.42 g/g. Sucrose hydrolysis was delayed at high S0 because of glucose repression of invertase synthesis, which was triggered at concentrations above 40 g/l. At S0 higher than 250 g/l, even when glucose had been exhausted, sucrose was hydrolyzed very slowly, probably due to an inhibition at this low water activity. Although with lower metabolic rates and longer times of fermentation, 250 g/l is considered the optimal initial concentration because it avoids the diauxic consumption of ethanol and maintains enough invertase activity to consume all the sucrose, and also avoids the inhibitions due to lower water activities at higher S0.

Failure of early nasal continuous positive airway pressure in preterm infants of 26 to 30 weeks gestation.

OBJECTIVE: To identify variables associated with early nasal continuous positive airway pressure (ENCPAP) failure in preterm neonates less than 30 weeks gestational age. STUDY DESIGN: Multicenter prospective study including 131 preterm newborns, over a period of 2 years. Patients and respiratory variables were assessed using univariate analysis. RESULT: Variables associated with ENCPAP failure were: the need of resuscitation with a FiO(2)>0.30; a CPAP pressure of 6.4±1.2 cm H(2)O; the need of a FiO(2) of 0.40 in the first 4 h of life; male gender maintaining the need of a FiO(2)>0.25 in the first 4 h of life; and respiratory distress syndrome with criteria for surfactant administration. CONCLUSION: The need for oxygen in resuscitation and maintained in first hours of life, male gender, a CPAP pressure over 5 cm H(2)O and surfactant need are predictors of ENCPAP failure in preterm neonates 26 to 30 weeks gestational age.

Recomendaciones de vacunación antineumocócica en el adulto por indicación médica / No disponible

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Opposite modulation of astroglial proliferation by adenosine 5'-O-(2-thio)-diphosphate and 2-methylthioadenosine-5'-diphosphate: mechanisms involved.

The contribution of P2Y(12,13) receptors to astroglial proliferation was investigated by testing the effects of two agonists with high affinity for these receptors, adenosine 5'-O-(2-thio)-diphosphate (ADPßS) and 2-methylthioadenosine-5'-diphosphate (2-MeSADP), in the incorporation of [(3)H]-thymidine. The effect of ATP, an endogenous inducer of astroglial proliferation, was also investigated. ADPßS and ATP (0.01-1 mM) increased astroglial proliferation up to 282%, an effect inhibited by the P2Y(1) receptor antagonist MRS 2179 (30 µM). The P2Y(12) receptor antagonists MRS 2395 (10 µM) and AR-C 66096 (10 µM) also reduced ADPßS proliferative effect, whereas the effect of ATP was attenuated by the A(2A) and A(2B) receptor antagonists SCH 58261 (30 nM) and MRS 1706 (10 nM), respectively. Studies of the signalling pathway activated showed that ADPßS effect was attenuated by pertussis toxin and by inhibition of phopholipase C (PLC), protein kinase C (PKC) and extracellular signal-regulated kinase1/2 (ERK1/2). The effect of ATP was also attenuated by inhibition of protein kinase A (PKA). The agonist 2-MeSADP (0.001-10 µM) had no effect in astroglial proliferation, but at higher concentrations (0.1-1 mM) it inhibited up to 63%, by mechanisms independent of P2Y(1,12,13) receptors activation. It was metabolised into 2-methylthioadenosine (2-MeSADO), the metabolite responsible for inhibition of astroglial proliferation. The effect of 2-MeSADO (0.1 mM) was attenuated by the A(3) receptors antagonist MRS 1523 (10 µM) and by the inhibitor of nucleoside transporters uridine (0.3 mM). 2-MeSADO did not induce apoptosis but increased lactate dehydrogenase release, an indicator of necrotic cell death. Astroglial proliferation induced by ADPßS was mediated by P2Y(1) and P2Y(12) receptors, leading to activation of PLC-PKC-ERK1/2 signalling pathway. The ATP proliferative effect was also mediated by PKA, supporting the contribution of the A(2) receptors. 2-MeSADP inhibition of astroglial proliferation depended on its conversion into 2-MeSADO, which activated A(3) receptors, blocked [(3)H]-thymidine uptake by astrocytes and led to cell death.

International survey of Cronobacter sakazakii and other Cronobacter spp. in follow up formulas and infant foods.

A coordinated survey for Cronobacter and related organisms in powdered infant formula, follow up formula and infant foods was undertaken by 8 laboratories in 7 countries in recognition of and in response to the data needs identified in an FAO/WHO call for data in order to develop global risk management guidance for these products. The products (domestic and imported) were purchased from the local market and were categorised according to their principle ingredients. A total of 290 products were analysed using a standardised procedure of pre-enrichment in 225 ml Buffered Peptone Water (BPW), followed by enrichment in Enterobacteriaceae Enrichment (EE) broth, plating on the chromogenic Cronobacter Druggan-Forsythe-Iversen (DFI) agar and presumptive identification with ID 32 E. Presumptive Cronobacter isolates were identified using 16S rRNA gene sequence analysis. Aerobic plate counts (APC) of the products were also determined on nutrient agar. Fourteen samples had APC>10(5) cfu/g, 3 of which contained probiotic cultures. C. sakazakii was isolated from 27 products; 3/91 (3%) follow up formulas (as defined by Codex Alimentarius Commission), and 24/199 (12%) infant foods and drinks. Hence C. sakazakii was less prevalent in follow up formula than other foods given to infants over the same age range. A range of other bacteria were also isolated from follow up formulas, including Acinetobacter baumannii, Enterobacter cloacae, Klebsiella pneumoniae, Citrobacter freundii, and Serratia ficaria. There was significant variation in the reconstitution instructions for follow up formulas. These included using water at temperatures which would enable bacterial growth. Additionally, the definition of follow up formula varied between countries.

A model of the specific growth rate inhibition by weak acids in yeasts based on energy requirements.

Zygosaccharomyces bailii, a spoilage yeast, capable of metabolic activity in food environments with low pH, low a(w) and in the presence of weak acid preservatives was chosen for a study on the effect of benzoic acid on growth parameters. In batch cultures, under controlled pH, this food preservative inhibited growth, decreasing the specific growth rate (mu) and the yield coefficient (Y(S)) on glucose. Data obtained at pH 3.5, 4.0 and 4.5 showed that this inhibition was exclusively promoted by the undissociated form of the acid since the effect was independent of pH when the concentration of the acid was expressed in this form. Moreover, the relationship between the values for mu and Y(S), provided evidence that the specific consumption rate of glucose (q(S)) was not affected by benzoic acid, indicating that the inhibition of growth should be completely explained by a decrease of Y(S). The outcome of parallel experiments performed in continuous culture was that the decrease of Y(S) was due to an increase of the maintenance coefficient (m), defined as the fraction of q(S) diverted from growth to cope with stress, represented in this case by the presence of the preservative. Based on these results a model was built, assuming that m increased hyperbolically with the concentration of benzoic acid, from zero in the absence of the acid up to q(S) when growth was completely inhibited. The concentration of the acid, for which m=q(S)/2, is a constant (K(W)), and represents a measure of the tolerance for a preservative, in this case benzoic acid. The simple equation mu/mu(0)=1+W/K(W) predicts the value of mu for a concentration (W) of the preservative, requiring the knowledge of two parameters: the specific growth rate in the absence of the preservative (mu(0)) and K(W). The equation fitted very well the data of the effect of benzoic acid on the specific growth rate of Z. bailii, having K(W)=0.96 mM benzoic acid. The model was also validated with other spoilage yeasts grown in the presence of benzoic acid in microtiter plates in an automated spectrophotometer. The values obtained for K(W) under these conditions confirm Z. bailii as the most tolerant (K(W)=2.1 mM) followed by Pichia sp. (K(W)=0.78 mM), Saccharomyces cerevisiae (K(W)=0.53 mM) and Debaryomyces hansenii (K(W)=0.11 mM).

Bocio fetal. Diagnóstico y conducta / Fetal goitre. Diagnosis and management

El hipertiroidismo relacionado con la enfermedad de Graves afecta a 1-5 de cada 1.000 embarazos y puede tener como resultado complicaciones maternas, fetales y neonatales, especialmente si no se realiza un adecuado control metabólico. Se presenta un caso de enfermedad de Graves diagnosticada en el segundo trimestre del embarazo con resultado de bocio fetal. En el recién nacido se confirmó el diagnóstico de bocio neonatal, asociado con hipotiroidismo, probablemente yatrogénico debido al tratamiento materno durante el embarazo. La evolución posnatal se caracterizó por cuadros alternativos e hipotiroidismo e hipertiroidismo, necesitando un tratamiento con tiroxina y otros fármacos antitiroideos (AU)

Tos ferina y personal sanitario / Whooping cough and health care personnel

La incidencia de la tos ferina está en aumento en los países industrializados, pese a una cobertura de inmunización considerable y extensa. Este hecho representa un desafío para el personal asistencial sanitario activo en centros de atención a la salud y hospitalarios, y se hace necesario el desarrollo de nuevas estrategias para el diagnóstico precoz y el aislamiento de nuevos casos con el fin de evitar y prevenir el riesgo de brotes nosocomiales. Las vacunas acelulares ya disponibles en diversos países para uso en el adulto representan un avance significativo en la prevención primaria en el entorno de la atención a la salud y la asistencia hospitalaria (AU)

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Effects of salts on Debaryomyces hansenii and Saccharomyces cerevisiae under stress conditions.

The effect of Na+ and K+ on growth and thermal death of Debaryomyces hansenii and Saccharomyces cerevisiae were compared under stress conditions as those commonly found in food environments. At the supraoptimal temperature of 34 degrees C both cations at concentrations of 0.5 M stimulated growth of D. hansenii, while K+ had no effect and Na+ inhibited growth of S. cerevisiae. At 8 degrees C, close to the minimum temperature for growth in both species, both cations inhibited both yeasts, this effect being more pronounced with Na+ in S. cerevisiae. At extreme pH values (7.8 and 3.5) both cations at concentrations of 0.25 M stimulated D. hansenii while Na+ inhibited S. cerevisiae. K+ inhibited this yeast at pH 3.5. Thermal inactivation rates, measured at 38 degrees C in D. hansenii and at 48 degrees C in S. cerevisiae, decreased in the presence of both cations. This protective effect could be observed in a wider range of concentrations in D. hansenii. These results call the attention to the fact that not all yeasts have the same behaviour on what concerns synergy or antagonism of salt together with other stress factors and should be taken into consideration in the establishment of food preservation procedures.

[Segmental neurofibromatosis]. / Neurofibromatosis segmentaria.

Four cases of segmental neurofibromatosis (SNF) are reported. It is a rare entity considered to be a localized variant of neurofibromatosis (NF)-Riccardi's type V. Two cases are male and two female. The lesions are located to the head in a patient and the other three cases in the trunk. No family history nor transmission to progeny were manifested. The rest of the organs are undamaged.

[Spitz's nevus: clinicopathologic study of 25 cases]. / Nevus de Spitz: estudio clinicopatológico de 25 casos.

We reviewed the clinical and histopathologic findings in 25 Spitz's nevus who were evaluated at our institution from 1980-1988. 18 cases in patients aged 20 years or less and 7 cases in adults. 14 are female and 11 are male. Represent the 3.88% of melanocytic nevi etude in the same time. Eosinophilic globules were find in 64% of the cases. We include a pigmented spindle cell nevi (non-Spitz), we thinks is a variant of Spitz's nevus.

Perforating pilomatricoma.

A case of perforating pilomatricoma is described. A few published cases have shared the following features: rapid development, reddish exophytic clinical appearance with surface alterations suggestive of perforation, relatively shallow location making contact with the epidermis, and the occurrence of transepithelial elimination phenomena.