A novel landscape genetic approach demonstrates the effects of human disturbance on the Udzungwa red colobus monkey (Procolobus gordonorum).

A comprehensive understanding of how human disturbance affects tropical forest ecosystems is critical for the mitigation of future losses in global biodiversity. Although many genetic studies of tropical forest fragmentation have been conducted to provide insight into this issue, relatively few have incorporated landscape data to explicitly test the effects of human disturbance on genetic differentiation among populations. In this study, we use a newly developed landscape genetic approach that relies on a genetic algorithm to simultaneously optimize resistance surfaces to investigate the effects of human disturbance in the Udzungwa Mountains of Tanzania, which is an important part of a universally recognized biodiversity hotspot. Our study species is the endangered Udzungwa red colobus monkey (Procolobus gordonorum), which is endemic to the Udzungwa Mountains and a known indicator species that thrives in large and well-protected blocks of old growth forest. Population genetic analyses identified significant population structure among Udzungwa red colobus inhabiting different forest blocks, and Bayesian cluster analyses identified hierarchical structure. Our new method for creating composite landscape resistance models found that the combination of fire density on the landscape and distance to the nearest village best explains the genetic structure observed. These results demonstrate the effects that human activities are having in an area of high global conservation priority and suggest that this ecosystem is in a precarious state. Our study also illustrates the ability of our novel landscape genetic method to detect the impacts of relatively recent landscape features on a long-lived species.

Estudio clínico-radiológico del riñón displásico multiquístico / Clinical and radiologic study of the multicystic kidney displasia

El Riñón Displásico Multiquístico es una anomalía relativamente frecuente en el recién nacido, y es considerada como una de las causas más comunes de masa abdominal en el neonato. El continuo avance en las técnicas diagnósticas de imagen (especialmente la ecografía) ha contribuido a facilitar el diagnóstico y la toma de decisiones en el manejo de estos niños. En este artículo profundizamos en las características radiológicas del Riñón Displásico Multiquístico y revisamos distintos aspectos relevantes de dicha anomalía (AU)

Meningitis neumocócica en la infancia. Revisión de 28 casos / Pneumococcal meningitis in children. Review of 28 cases

OBJETIVO: Describir las características epidemiológicas, clínicas y los indicadores pronóstico de las meningitis neumocócicas ingresadas en un hospital pediátrico de Madrid. PACIENTES Y MÉTODOS: Estudio retrospectivo de 28 niños que ingresaron en el hospital por meningitis neumocócica diagnosticados mediante la identificación de Streptococcus pneumoniae en sangre o LCR, en el período comprendido entre 1990 y 1999. Se analizaron variables relacionadas con la evolución. Ningún paciente tenía déficit inmunológico previo, ninguno había recibido vacuna antineumocócica. RESULTADOS: La edad de los pacientes fue 2,7 ñ 2,9 años (rango de 2 meses a 11 años). El 82 por ciento (23 casos) de los niños eran menores de 5 años. La relación niño-niña fue de 1:1. Los signos más frecuentes al ingreso fueron fiebre (100 por ciento), vómitos (57 por ciento), cefalea-irritabilidad (53 por ciento) y alteraciones hemodinámicas (10 por ciento). Los hallazgos neurológicos fueron: disminución del nivel de conciencia en 22 casos (escala de coma de Glasgow medio de 9,9 ñ 3,9); convulsiones en 15 casos (53 por ciento); signos meníngeos positivos en 12 casos (42 por ciento) y midriasis arreactiva en 9 casos (32 por ciento). Precisaron ingreso en la unidad de cuidados intensivos 20 pacientes (71 por ciento). Al alta no presentaban secuelas 15 casos (53 por ciento); sordera 8 casos (28 por ciento); hemiparesia 4 casos (14 por ciento); hidrocefalia intensa 2 casos (7 por ciento), y retraso mental un caso (3,5 por ciento). Cuatro pacientes (14 por ciento) fallecieron. La baja puntuación en la escala de coma de Glasgow al ingreso y la TC craneal alterada se asociaron de forma significativa a mayor mortalidad y sordera (p < 0,05). La presencia de convulsiones, el electroencefalograma (EEG) alterado y la hipoglucorraquia también se asociaron a la sordera (p < 0,05). CONCLUSIÓN: Las meningitis producidas por Streptococcus pneumoniae tienen una alta morbimortalidad en la infancia. La sordera neurosensorial es la secuela más frecuente secundaria a esta patología. La baja puntuación en la escala de coma de Glasgow al ingreso, la TC y el EEG alterados, así como las convulsiones y la hipoglucorraquia se relacionaron con un peor pronóstico. La nueva vacuna conjugada antineumocócica permitirá una prevención eficaz desde los dos meses de edad y el descenso drástico de esta grave infección (AU)

Brain death and evoked potentials in pediatric patients.

OBJECTIVE: To define the evoked potential responses (auditory and somatosensory) obtained from pediatric brain-dead patients. DESIGN: Prospective study over an 8-yr period (1988-1996). SETTING: A 14-bed pediatric intensive care unit in a multidisciplinary regional referral center (teaching hospital). PATIENTS: Fifty-one pediatric patients with clinically established brain death. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Auditory brainstem and somatosensory evoked potentials were performed with a mean evolution time of 24 hrs after clinical brain death. The first brainstem auditory evoked potential recording was compatible with the diagnosis in 45 patients (90%): 27 patients (53%) did not respond, wave I was patent in 16 (7 bilateral, 6 from the left side, and 3 from the right side), and 2 patients evoked waves I and II in one or both ears. Gross anomalies were found in the remaining six patients. Sixteen patients were tested for somatosensory evoked potentials. N13 identifiable wave (62.5% of the patients) or a flat record were the obtained findings. Electric silence was noted initially on the electroencephalogram (EEG) in only 14 of 29 patients. Later flattening was observed in seven patients. Missing brainstem evoked response was noted earlier than cortical electric silence (range, 12-144 hrs). Any central wave could be pointed out in the evoked potentials of patients with an isoelectric EEG. CONCLUSIONS: Evoked potential is useful in confirming the diagnosis of brain death in infants and in children as well as in adults. The test can be performed at bedside without interfering with patient care, and results are similar to those obtained in adult patients. Flattening of the EEG requires more time than achieving compatible evoked-potential responses.

Prognostic value of gastric intramucosal pH in critically ill children.

OBJECTIVE: To determine the association of tonometrically measured gastric intramucosal pH (pHi) to the occurrence of multiple organ dysfunction syndrome (MODS) and death in critically ill children. DESIGN: Prospective, observational study. SETTING: Pediatric intensive care unit (ICU) of a teaching children's hospital. PATIENTS: Fifty-one critically ill children admitted (median age 5.4+/-5 [SD] yrs; range 1 mo to 16 yrs) with the following diagnoses: post major surgery (n=26), sepsis (n=8), multiple trauma (n=5), acute respiratory distress syndrome (n=4), and "miscellaneous" (n=8). INTERVENTIONS: Placement of a tonometric catheter. MEASUREMENTS AND MAIN RESULTS: Pediatric Risk of Mortality (PRISM) score and clinical data were collected on admission and pHi daily during their stay in the pediatric ICU. A sigmoid tonometer was used to determine the pHi. Unconditional logistic regression was used to investigate the prognostic value of pHi. On admission, 26 patients presented with low gastric pHi (< or =7.35) and 17 of them had values of <7.30. The mortality rate in children with pHi <7.30 was 47.1% (95% confidence interval, 26.2 to 69) in contrast with an 11.7% mortality rate (95% confidence interval, 4.6 to 26.6) in children having a pHi of > or =7.30 (p=.015). The pHi and PRISM score on admission were independent predictive factors of death. The risk of mortality is increased when the pHi is low (odds ratio=2.5). However, we did not find the pHi to be a predictor for developing MODS. CONCLUSIONS: Our results show that pHi is an independent predictor of mortality in patients admitted to a pediatric ICU. Although no relationship was observed between the risk of MODS and gastric pHi, the univariate difference of 21% vs. 41% is highly suggestive. The pHi determination is a minimally invasive procedure and well tolerated in children of all ages.

[Intralobar pulmonary sequestration as the cause of neonatal respiratory distress]. / Secuestro pulmonar intralobar como causa de distrés respiratorio neonatal.

A male infant 15 hours old with congenital intralobar pulmonary sequestration is described. The boy was born with tachypnea and cyanosis. A chest film revealed mediastinal displacement secondary to a cystic lesions in the lower left lobe. During surgery the lesion was found to be irrigated by an artery coming from the thoracic aorta and venous drainage was into the inferior vena cava. The lesion was spongiform and microscopic examination revealed alveolar parenchyma with irregular, dilated bronchiolar structures. Intralobar sequestrations have seldom been described in infants. Our case suggests that this malformation is congenital. We discuss the diagnostic possibilities of pulmonary cystic lesions that cause respiratory distress in neonates.

Invasive pulmonary aspergillosis with pneumopericardium and pneumothorax.

A case of an invasive pulmonary aspergillosis with pneumopericardium and pneumothorax in an immunocompromised child of 5 years is reported. He was treated with thoracic drainage, amphotericin B and itraconazole. The course was satisfactory.

[Control of vomiting induced by antineoplastic chemotherapy in childhood]. / Control de la emesis inducida por quimioterapia antineoplásica en la infancia.

Twenty four children aged 2 to 13 years who were to receive cancer chemotherapy were enrolled in a prospective study (before-after-trial) in order to evaluate the efficacy of systematic antiemetic prophylaxis. The regimen of three drugs (metilpednisolone 4 mg/Kg/dose/iv 2 doses; metodopamide 0.5 mg/Kg/dose/iv 4 doses; diphenydramine 1 mg/Kg/dose/iv 4 doses) was used. We found a significative reduction (P less than 0.001) in the incidence of vomiting and nauseousness duration when the antiemetic prophylaxis was used. There were very few and slight adverse effects secondary to antiemetic drugs: Sedation happened in 25% of chemotherapic cycles and hypotension without clinical repercussion in 15%. No patient had distonia. We conclude that systematical antiemetic protection should be used in children receiving chemotherapy. The association of metilpednisolone, metopramide and diphenhydramine is a safe and effective combination.