A neglected symptom? Parietal gait lateropulsion as primary manifestation of acute is-chemic stroke. / ¿Un síntoma negado? Lateropulsión parietal de la marcha como manifestación inicial de ictus isquémico agudo.

INTRODUCTION: Gait disorders are commonly overlooked as a presenting manifestation of stroke and underrepresented in case series. We describe four cases of sudden-onset gait lateropulsion as primary manifestation of parietal lobe stroke. CASE REPORT: Four patients presented after sudden-onset gait lateropulsion. On neurological examination, all patients had at least one cortical sensory deficit and wide-based gait with lateropulsion towards the side of the cortical deficit. Neuroimaging revealed a subacute parietal lobe stroke contralateral to the side of gait lateropulsion. In two patients we found bilateral lateropulsion with predominance towards the side of cortical deficit and increase of unsteadiness with eye closure (an apparent Romberg sign), with neuroimaging revealing bilateral parietal strokes (subacute contralateral and chronic ipsilateral to gait lateropulsion). CONCLUSION: We report gait lateropulsion as a novel primary manifestation of acute stroke of the parietal lobe (parietal gait lateropulsion). Given its role as the destination of proprioceptive pathways, parietal strokes can result in gait lateropulsion, with bilateral lesions even mimicking sensory ataxia with bilateral lateropulsion and unsteadiness upon eye closure.

TITLE: ¿Un síntoma negado? Lateropulsión parietal de la marcha como manifestación inicial de ictus isquémico agudo.Introducción. Los trastornos de la marcha no suelen considerarse dentro de las manifestaciones de presentación del ictus y están subrepresentados en las series de casos. Presentamos cuatro casos de lateropulsión de la marcha de inicio súbito como manifestación primaria de ictus del lóbulo parietal. Caso clínico. Cuatro pacientes se presentaron tras el inicio súbito de lateropulsión de la marcha. En el examen neurológico, todos tenían al menos un déficit sensitivo cortical, marcha de base amplia con lateropulsión ipsilateral al déficit cortical. En la neuroimagen se corroboró un ictus subagudo parietal contralateral al lado de lateropulsión de la marcha. Dos pacientes tenían lateropulsión bilateral con predominio ipsilateral al déficit cortical e incremento de inestabilidad con los ojos cerrados (simulando signo de Romberg), en quienes la neuroimagen demostró un ictus parietal bilateral (subagudo contralateral, crónico ipsilateral al lado de lateropulsión de la marcha). Conclusión. Describimos la lateropulsión de la marcha como una nueva manifestación inicial de ictus agudo del lóbulo parietal (lateropulsión parietal de la marcha), contralateral al lado de desviación de la marcha. Dado el papel del parietal como destino de las vías de propiocepción, los ictus pueden originar alteraciones de la marcha, con lesiones bilaterales que semejan ataxia sensitiva con inestabilidad al eliminar la aferencia visual.

Demographic, clinical and microbiological characteristics of the first 30 human monkeypox confirmed cases attended in a tertiary hospital in Madrid (Spain), during the May-June 2022 international outbreak.

The present outbreak of Human Monkeypox (HMPX) that has begun in May 2022 and has spread across all continents in less than two months has qualitative and quantitative characteristics that make it different from the pattern of human disease previously caused by this virus. It has spread with enormous ease, affects almost exclusively adults, behaves as a sexually transmitted disease and focuses on very specific groups and transmission conditions. The high incidence in the city of Madrid in males that have sex with males (MSM) has allowed us to observe and report the experience with the first 30 cases diagnosed in our institution. Patients presented with febrile symptoms, genital and paragenital skin lesions reminiscent of smallpox, but less extensive and severe. The disease may also cause proctitis, pharyngitis and perioral lesions. The PCR test for diagnostic confirmation has been shown to be very sensitive and effective, not only in skin lesions but also in blood and other fluids such as pharyngeal, rectal exudates and blood. A very high proportion of patients with HMPX also have other sexually transmitted diseases that must be actively detected in this context. The spontaneous evolution of our patients has been good and hospitalization has been practically unnecessary. Transmission to non-sexual cohabitants and health personnel has been nonexistent and the lesions have disappeared in less than 30 days without leaving sequelae and no need for specific antiviral treatment.

¿Un síntoma negado? Lateropulsión parietal de la marcha como manifestación inicial de ictus isquémico agudo / A neglected symptom? Parietal gait lateropulsion as primary manifestation of acute is-chemic stroke

Introducción: Los trastornos de la marcha no suelen considerarse dentro de las manifestaciones de presentación del ictus y están subrepresentados en las series de casos. Presentamos cuatro casos de lateropulsión de la marcha de inicio súbito como manifestación primaria de ictus del lóbulo parietal.Caso clínico: Cuatro pacientes se presentaron tras el inicio súbito de lateropulsión de la marcha. En el examen neurológico, todos tenían al menos un déficit sensitivo cortical, marcha de base amplia con lateropulsión ipsilateral al déficit cortical. En la neuroimagen se corroboró un ictus subagudo parietal contralateral al lado de lateropulsión de la marcha. Dos pacientes tenían lateropulsión bilateral con predominio ipsilateral al déficit cortical e incremento de inestabilidad con los ojos cerrados (simulando signo de Romberg), en quienes la neuroimagen demostró un ictus parietal bilateral (subagudo contralateral, crónico ipsilateral al lado de lateropulsión de la marcha). Conclusión: Describimos la lateropulsión de la marcha como una nueva manifestación inicial de ictus agudo del lóbulo parietal (lateropulsión parietal de la marcha), contralateral al lado de desviación de la marcha. Dado el papel del parietal como destino de las vías de propiocepción, los ictus pueden originar alteraciones de la marcha, con lesiones bilaterales que semejan ataxia sensitiva con inestabilidad al eliminar la aferencia visual.(AU)

Introduction: Gait disorders are commonly overlooked as a presenting manifestation of stroke and underrepresented in case series. We describe four cases of sudden-onset gait lateropulsion as primary manifestation of parietal lobe stroke. Case report: Four patients presented after sudden-onset gait lateropulsion. On neurological examination, all patients had at least one cortical sensory deficit and wide-based gait with lateropulsion towards the side of the cortical deficit. Neuroimaging revealed a subacute parietal lobe stroke contralateral to the side of gait lateropulsion. In two patients we found bilateral lateropulsion with predominance towards the side of cortical deficit and increase of unsteadiness with eye closure (an apparent Romberg sign), with neuroimaging revealing bilateral parietal strokes (subacute contralateral and chronic ipsilateral to gait lateropulsion).Conclusion: We report gait lateropulsion as a novel primary manifestation of acute stroke of the parietal lobe (parietal gait lateropulsion). Given its role as the destination of proprioceptive pathways, parietal strokes can result in gait lateropulsion, with bilateral lesions even mimicking sensory ataxia with bilateral lateropulsion and unsteadiness upon eye closure.(AU)

[Clinical and epidemiological differences and similarities of viral pneumonias in two pandemics]. / Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias.

BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. MATERIAL AND METHODS: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. CONCLUSIONS: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias / Clinical and epidemiological differences and similarities of viral pneumonias in two pandemics

BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. Material and Methods: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. Conclusions: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

[Wernekink's commissural syndrome due to a stroke of the midbrain-pons union]. / Sindrome comisural de Wernekink secundario a un ictus de la union mesencefalo-protuberancial.

TITLE: Sindrome comisural de Wernekink secundario a un ictus de la union mesencefalo-protuberancial.

Stability of regularly prescribed oral liquids formulated with SyrSpend® SF.

The purpose of this research was to evaluate the stability of 12 oral liquid formulations frequently compounded in hospital and community settings formulated in a specific vehicle: SyrSpend® SF. The stability of melatonin, glycopyrrolate, ciclosporin, chloral hydrate, flecainide acetate, tiagabine HCl, labetalol HCl, ciprofloxacin HCl, spironolactone/hydrochlorothiazide, hydrocortisone, itraconazole and celecoxib in SyrSpend SF PH4 (liquid) was investigated at 0, 30, 60 and 90 days and stored at both controlled room temperature and refrigerated. Itraconazole samples were also investigated at 15 and 45 days. No change in odor, color or appearance was observed in the formulations during the test period. Based on the results, a beyond-use date of 30 days can be assigned to tiagabine HCl 1.0 mg/ml in SyrSpend SF when stored at controlled room temperature, and 90 days under refrigeration, improving stability data previously published using other vehicles. A beyond-use date of 60 days can be assigned to chloral hydrate 100.0 mg/ml. In this case, stability is not enhanced by refrigeration. With the rest of the formulations, less than 10% API loss occurred over 90 days at either controlled room temperature or under refrigeration. Including for example itraconazole 20.0 mg/ml, thus providing extended stability compared to simple syrup and other oral liquid vehicles. The findings of this study show that SyrSpend SF is an appropriate suspending vehicle to be used for personalized formulations of the APIs studied here.

Responding to gender and sexual minority stress with functional analytic psychotherapy.

Despite an overwhelming literature detailing the impact of societal bias on the well-being and relationships of gender and sexual minority clients, as well as greater rates of help-seeking from mental health professionals, recent advances in minority stress research have not been fully incorporated into clinical practice. Minority stress factors such as internalized stigma, rejection sensitivity, and concealment interfere with vulnerable and intimate relationships, and likely contribute to the transdiagnostic challenges that GSM clients report, such as loneliness and social isolation (Mereish & Poteat, 2015). Further, behavioral patterns emphasizing inauthentic self-presentation are common interpersonal styles of stigma management (Pachankis & Hatzenbuehler, 2013). Functional analytic psychotherapy is interpersonal therapy grounded in a behavior analytic approach to the therapeutic relationship, which was developed to promote generalizable change in intimate and vulnerable behaviors with meaningful others (Kohlenberg & Tsai, 1991). Functional analytic psychotherapy emphasizes the role of contingent responding by the therapist to clinically relevant behaviors, to increase vulnerable, interpersonal risks that can be responded to in a warm and compassionate way. FAP is ideal for adaptation to target the interpersonal aspects of minority stress on gender and sexual minority clients that often include histories of punishment in response to vulnerable authenticity, possibly even by past therapists (e.g., Flentje, Heck, & Cochran, 2014; Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991). (PsycINFO Database Record

Effectiveness of a training program in compliance with recommendations for venous lines care.

BACKGROUND: The impact of training programs on the care and maintenance of venous lines (VL) has been assessed mainly in patients admitted to the intensive care unit (ICU). Data on the impact of such programs in a whole general hospital are scarce. The objective of this study was to assess compliance with VL care after an extensive training program aimed at nurses caring for adult ICU and non-ICU patients. METHODS: We performed 2 point prevalence studies in a general hospital. A specialized nurse visited all hospitalized adult patients, performed a bedside inspection, and reviewed the nursing records for patients with a VL before and after a 1-year training program. The program included an interactive on-line teaching component and distribution of pocket leaflets and posters with recommendations on VL care. RESULTS: Data recorded for the first and second prevalence studies were as follows: number of patients visited, 753 vs. 682; total number of patients with ≥ 1 VL implanted on the visit day, 653 (86.7%) vs 585 (85.8%); catheters considered unnecessary on the study day, 183 (22.9%) vs 48 (7.1%) (p < 0.001); number of catheters with local clinical evidence of infection on the study day, 18 (2.2%) vs 12 (1.8%) (p = 0.52); registration of insertion day (42.3% vs 50.1%; p = 0.003); and registration of day of dressing change (41.2% vs 49.1%; p = 0.003). Maintenance parameters improved more in non-ICU than in ICU patients. CONCLUSION: A multidisciplinary teaching program to improve VL care and compliance with recommendations is effective. Point prevalence studies are easy to carry out and effective at demonstrating increases in compliance, mainly in non-ICU patients.

Routine aspiration of subglottic secretions after major heart surgery: impact on the incidence of ventilator-associated pneumonia.

Aspiration of subglottic secretions (ASS) is recommended in patients requiring mechanical ventilation for ≥48h. We assessed the impact of the introduction of ASS routinely in all patients after major heart surgery in an ecological study comparing ventilator-acquired pneumonia (VAP) incidence, days of mechanical ventilation, and cost of antimicrobial agents before and after the implementation of ASS. Before and after the intervention the results (per 1000 days) were: VAP incidence, 23.92 vs 16.46 (P = 0.04); cost of antimicrobials, €71,384 vs €63,446 (P = 0.002); and days of mechanical ventilation, 507.5 vs 377.5 (P = 0.009). From the moment of induction of anaesthesia all patients undergoing major heart surgery should routinely receive ASS.

Use of a novel double uterine deposition artificial insemination technique using low concentrations of sperm in pigs.

Currently, the three most important non-surgical artificial insemination systems used in pigs are the conventional, the post-cervical (IUI), and the deep-intrauterine (DIUI) methods. In this study, a new system, termed double uterine deposition insemination (DUDI), which combines aspects of both IUI and DIUI, was evaluated. This method used a thinner, shorter and more flexible catheter than those normally used for DIUI and resulted in the deposition of semen post-cervically, approximately half-way along the uterine horn, thus potentially by-passing the threat of 'unilateral' insemination or pregnancy when using sperm of low concentration. The experiment was carried out over 8 weeks on a group of 166 sows, which were divided into seven groups, inseminated with semen of varying concentration, using the conventional system (control group) or by DUDI. There were no significant differences in fertility at day 35 post-insemination between the controls and the various DUDI sub-groups. Only sows inseminated with 500 million viable spermatozoa in a total of 30 mL of fluid using the DUDI system demonstrated decreased total litter sizes when compared to conventional insemination (P<0.001). While conventional insemination normally uses 2.5-3.5 billion sperm, the findings of this study suggest that DUDI can be used under 'field' conditions with sperm concentrations as low as 750 million spermatozoa in 50-30 mL without any detrimental effect on fertility or litter size. DUDI may provide a viable, robust alternative to IUI and DIUI, and has the potential to become incorporated into on-farm insemination systems.

DFT calculation of four new potential agents muscarinic of bispyridinium type: structure, synthesis, biological activity, hydration, and relations with the potents W84 and DUO-3O.

Four new potential agents muscarinic (allosteric modulators) were synthesized and studied by using the B3LYP density functional method. The optimum conformation and geometry structure of these compounds were determined and analyzed. Solvent effects were considered including a variable number (1-15) of explicit water molecules surrounding the compound in order to simulate the first hydration shell, as well as using the Tomasi's polarized continuum model (PCM). A similar simultaneous analysis of the potents W84 and DUO-3O allosteric modulator of muscarinic receptors was also carried out. The effect of the hydration on the total atomic charges and several intermolecular distances of interest were also discussed. The biological activity against acetylcholine of our four synthesized bispyridinium salts was determined. Relationships/tendencies structure-activity were established. Several general conclusions were underlined.

Fraccionamiento y caracterización de las proteínas solubles de la harina de nuez de Barinas (caryodendron orinocense K. ) / Fractionation and characterization of soluble proteins from nuez de Barinas (caryodendron orinocense K .) flour

La harina de nuez de Barinas (Caryodendron orinocense K.) de acuerdo a estudios realizados presenta un contenido de pro teínas en el rango de 15-18%, que permite se pueda considerar como fuente de proteína. Sin embargo no se conoce la composición de estas proteínas. En este estudio se realizó un proceso de fraccionamiento de acuerdo a la solubilidad en diferentes solventes (agua, cloruro de sodio al 5%, hidróxido de sodio 0,02N, etanol al 70%), y el establecimiento de la composición proteica según el peso molecular de la harina de nuez de Barinas obtenida a partir de las nueces secas, molidas y des grasadas, determinando el rango de pesos moleculares por SDS-PAGE y su comparación con el rango de pesos moleculares de las proteínas de la harina de soya (Glycine max). Asi mismo, se determinó la digestibilidad in vitro por hidrólisis enzimática. Los resultados indican un rango de PM de 20.000- 97.000 daltons para la soya y de 6.500-45.000 daltons para la nuez de Barinas. El peso molecular más bajo sugiere una más fácil digestión de las proteínas, que corrobora el valor de la di - ges tibilidad obtenido de 75%. Las proteínas presentes están cons tituidas por albúminas 50,72%, globulinas 15,56%, prolaminas 23,10% y glutelinas 2,52% que representan el 92,15% del total de proteínas presentes. Estas fracciones presentaron una pureza de 81,57%, 94,01%, 70,86% y 92,53%, respectivamente. Estos resultados sugieren la posibilidad de uso de la harina de Caryodendron orinocense K en el desarrollo de productos alimenticios para niños y ancianos.

Nuez de Barinas (Caryodendron orinocense K.) flour has been reported to have a content of proteins in the range of 15-18% that allows considering it as a source of proteins. However, there is no evidence on the composition of these proteins. The objective of this study was the extraction and separation of the different fractions of proteins based on their solubility in different solvents (water, 5% sodium chloride, sodium hydroxide 0.02N, and 70% ethanol), and the protein composition assessment of the nuez de Barinas flour from dried, milled, and defatted nuts; by analysis of the range of mo lecular weight by SDS-PAGE. Molecular weights of proteins from soybean (Glycine max) flour, were used for comparison. In vitro protein digestibility was determined by enzymatic hydrolysis. Results presented soy proteins in the range of 20.000-97.000 daltons while the nuez de Barinas flour proteins were in the range of 6.500-45.000 daltons. Low molecular weight proteins should suggest a much easier digestibility of these proteins, which is related to the digestibility index of 75% found. Protein composition was found to be 50,72% albumins, 15,56% globulins, 23,10% prolamins, and 2,52% glutelins which represent 92,15% of total proteins present. These fractions showed a percent purity of 81.57, 94.01, 70.86 and 92.53, respectively. These results suggest the possibility to use this flour Caryodendron orinocense K. in developing food products for children and elderly persons.

Nasal carriage of S. aureus increases the risk of surgical site infection after major heart surgery.

Staphylococcus aureus is the main cause of surgical site infection (SSI) after major heart surgery (MHS), with the patient's endogenous flora as the principal source. However, the influence of nasal carriage of S. aureus on the development of SSI after MHS has not been established and Centers for Disease Control and Prevention guidelines do not make a recommendation for or against decolonisation. We performed a one-year observational study in which patients undergoing MHS were screened for nasal carriage of S. aureus before surgery. Cases of SSI were recorded and the risk factors of patients with and without SSI were analysed. During the study period, 357 patients were included in the protocol. Ninety-six patients (27%) were found to be nasal carriers of S. aureus and nine (9.4%) of these had meticillin-resistant (MRSA) strains. The overall incidence of SSI was 6.4%, with 4.2% for mediastinitis and 2.2% for superficial SSI. Nasal carriers of S. aureus had a significantly higher incidence of SSI than non-carriers (12.5% vs 5%, P=0.01). Among MRSA carriers, the incidence of SSI reached 33% (P<0.001). S. aureus was responsible for 64% of SSIs. Multivariate analysis showed that the independent factors for SSI were S. aureus nasal carriage [relative risk (RR): 3.1; 95% confidence interval (CI): 1.4-7.3; P=0.009], reoperation (RR: 3.1; 95% CI: 1.8-19.2; P=0.04) and diabetes mellitus (RR: 5.9; 95% CI: 1.8-19.2; P=0.003). Nasal carriage of S. aureus significantly increases the rate of nosocomial SSI after MHS and decolonisation strategies should be implemented in this population.

Effect of nutritional status and fat reserves on the periparturient immune response to Haemonchus contortus infection in sheep.

A study was made of the effect of body fat stored by ewes in early pregnancy on the subsequent immune response to gastrointestinal parasites around parturition. Pregnant ewes were given access to a lucerne pelleted diet either ad libitum (H) or at approximately 0.70 of their maintenance requirements (L) from the 42nd day of pregnancy in order to achieve a clearly differentiated level of body reserves by the 90th day of pregnancy. Then, all animals were put on the same plane of nutrition till 3 weeks after parturition. All ewes in both groups received 7,000 infective larvae of Haemonchus contortus per week for 7 weeks prior to lambing. The dietary treatments led to large differences between both groups of ewes in back-fat thickness that had a high correlation with mean plasma concentrations of leptin. In spite of the fact that animals were on the same plane of nutrition at infection time, host resistance, as measured by faecal egg counts, was significantly affected by the nutritional treatment established during early pregnancy. This effect produced noticeable differences in worm size and in worm burden at lambing. The response was accompanied by a marked increase in circulating eosinophils in better-fed ewes than in those maintained on a restricted diet in early pregnancy. Serum pepsinogen concentration, however, was inversely affected by the nutritional treatment till lambing, showing a maximum difference as early as 2 weeks after infection. The results support the view that higher levels of nutrition during early pregnancy enhance the expression of immunity against gastrointestinal parasites around parturition. Furthermore, the differences in the immune response appeared associated with serum leptin levels suggesting that leptin may be a key link between nutritional status and the protective immune reactivity against GI nematode infection.