Paternal exposure to bupropion affects postnatal development in the offspring.

The aim of this study was to evaluate whether paternal exposure to bupropion hydrochloride (BUP), an inhibitor of dopamine and noradrenaline reuptake, would affect the postnatal development of offspring. Male mice were divided into a BUP-treated (40mgkg-1day-1 by gavage, 45 days) or control (saline by gavage, 45 days) group (n=20 in each group). From Day 35 to Day 45 of treatment, males were allowed to mate with drug-naïve female mice. Postnatal development of the offspring (both sexes) was evaluated from Postnatal day (PND) 1 to PND60. Physical development parameters (weight gain, body length, incisor eruption, pinna detachment), anogenital distance, vaginal opening, reflexes (palmar grasp, surface righting, negative geotaxis and adult gait) and some behavioural parameters (locomotor activity and anxiety-like behaviour) were altered in the offspring of BUP-treated males. The results demonstrate that paternal exposure to BUP induces long-lasting changes in the postnatal development of the offspring.

Improvement in the outcome of invasive fusariosis in the last decade.

Invasive fusariosis (IF) has been associated with a poor prognosis. Although recent series have reported improved outcomes, the definition of optimal treatments remains controversial. The objective of this study was to evaluate changes in the outcome of IF. We retrospectively analysed 233 cases of IF from 11 countries, comparing demographics, clinical findings, treatment and outcome in two periods: 1985-2000 (period 1) and 2001-2011 (period 2). Most patients (92%) had haematological disease. Primary treatment with deoxycholate amphotericin B was more frequent in period 1 (63% vs. 30%, p <0.001), whereas voriconazole (32% vs. 2%, p <0.001) and combination therapies (18% vs. 1%, p <0.001) were more frequent in period 2. The 90-day probabilities of survival in periods 1 and 2 were 22% and 43%, respectively (p <0.001). In period 2, the 90-day probabilities of survival were 60% with voriconazole, 53% with a lipid formulation of amphotericin B, and 28% with deoxycholate amphotericin B (p 0.04). Variables associated with poor prognosis (death 90 days after the diagnosis of fusariosis) by multivariable analysis were: receipt of corticosteroids (hazard ratio (HR) 2.11, 95% CI 1.18-3.76, p 0.01), neutropenia at end of treatment (HR 2.70, 95% CI 1.57-4.65, p <0.001), and receipt of deoxycholate amphotericin B (HR 1.83, 95% CI 1.06-3.16, p 0.03). Treatment practices have changed over the last decade, with an increased use of voriconazole and combination therapies. There has been a 21% increase in survival rate in the last decade.

Resistant gram-negative infections in the outpatient setting in Latin America.

Latin America has a high rate of community-associated infections caused by multidrug-resistant Enterobacteriaceae relative to other world regions. A review of the literature over the last 10 years indicates that urinary tract infections (UTIs) by Escherichia coli, and intra-abdominal infections (IAIs) by E. coli and Klebsiella pneumoniae, were characterized by high rates of resistance to trimethoprim/sulfamethoxazole, quinolones, and second-generation cephalosporins, and by low levels of resistance to aminoglycosides, nitrofurantoin, and fosfomycin. In addition, preliminary data indicate an increase in IAIs by Enterobacteriaceae producing extended-spectrum ß-lactamases, with reduced susceptibilities to third- and fourth-generation cephalosporins. Primary-care physicians in Latin America should recognize the public health threat associated with UTIs and IAIs by resistant Gram-negative bacteria. As the number of therapeutic options become limited, we recommend that antimicrobial prescribing be guided by infection severity, established patient risk factors for multidrug-resistant infections, acquaintance with local antimicrobial susceptibility data, and culture collection.

Gestational exposure to yellow fever vaccine at different developmental stages induces behavioral alterations in the progeny.

The most effective method to prevent yellow fever and control the disease is a vaccine made with attenuated live virus. Due to the neurological tropism of the virus, preventive vaccination is not recommended for infants under 6 months and for pregnant women. However there is a paucity of data regarding the safety for pregnant women and there are no experimental studies investigating adverse effects to the offspring after maternal exposure to the vaccine. This study aimed to investigate, in mice, the effects of maternal exposure to the yellow fever vaccine at three different gestational ages on the physical and behavioral development of the offspring. Pregnant Swiss mice received a single subcutaneous injection of water for injection (control groups) or 2 log Plaque Forming Units (vaccine-treated groups) of the yellow fever vaccine on gestational days (GD) 5, 10 or 15. Neither maternal signs of toxicity nor alterations in physical development and reflex ontogeny of the offspring were observed in any of the groups. Data from behavioral evaluation indicated that yellow fever vaccine exposure induced motor hypoactivity in 22-day-old females independent of the day of exposure; and in 60-day-old male and female pups exposed at GD 10. Moreover, 22-day-old females also presented with a deficit in habituation memory. Altogether, these results indicate that in utero exposure to the yellow fever vaccine may induce behavioral alterations in the pups that may persist to adulthood in the absence of observed maternal toxicity or disruption of physical development milestones or reflex ontogeny.

Antibody response to the non-adjuvanted and adjuvanted influenza A H1N1/09 monovalent vaccines in renal transplant recipients.

BACKGROUND: The 2009 pandemic influenza A (H1N1) virus spread rapidly throughout Brazil. Non-adjuvanted and the adjuvanted influenza A H1N1/09 monovalent vaccine were recommended as a single dose to persons at risk including renal transplant recipients (RTR). We analyzed the safety and the immune response of 2 influenza A H1N1/09 monovalent vaccines in RTR, and identified factors influencing the immune response. METHODS: A total of 78 RTR received a single dose of either influenza A H1N1 2009 monovalent AS03-adjuvanted vaccine or a non-adjuvanted vaccine, and 58 healthy controls received a single dose of non-adjuvanted vaccine. Antibody responses to influenza A H1N1 were measured by hemagglutination inhibition assay and were compared between groups on the day of vaccination and 21-30 days thereafter, using geometric mean titer (GMT), and seroprotection (SP) and seroconversion (SC) rates. RESULTS: Among RTR, after adjuvanted and non-adjuvanted H1N1 vaccination, the SP rate increased from 16.7% to 61.7% (P < 0.001) and to 50% (P < 0.001), and SC rates were 61.7% and 50%, respectively. For healthy controls, SP rate increased from 25.8% to 89.7% (P < 0.001), and SC rate was 87.9% after vaccination. Pre-vaccination GMT for the adjuvanted and non-adjuvanted RTR vaccine groups and healthy controls was 9.7 (95% confidence interval [CI] 7.3-13.1), 8.9 (95% CI 5.4-14.7), and 12.5 (95% CI8.7-18.2), and significantly increased to 49.8 (95% CI 31.3-79.4, P < 0.001), 43.2 (95% CI 16.3-114.4, P < 0.001), and 323.8 (95% CI 213.9-490.2, P < 0.001), respectively. Deceased-donor type transplant significantly reduced SP (odds ratio [OR] = 4.62, 95% CI 1.36-15.69, P = 0.014) and SC (OR = 6.29, 95% CI 1.89-20.98, P = 0.003) rates, and younger age positively affected SP (OR = 0.11; 95% CI 0.03-0.04, P = 0.001). Adverse events were mild, and renal function showed no change post vaccination. CONCLUSION: RTR vaccinated with either an adjuvanted or non-adjuvanted monovalent influenza vaccine presented poor response compared with healthy controls. Post-vaccination adverse events were mild, and no rejection episode or renal dysfunction was observed.

Piodermite vegetante: estudo clínico e terapêutico / Pyodermitis vegetans: clinical and therapeutic study

Os autores apresentam um caso de piodermite vegetante, ou piodermite semelhante à blastomicose, dermatose rara e de difícil diagnóstico clínico e laboratorial em nosso meio.Manifesta-se com morfologia exuberante e comum a várias dermatoses infecciosas. Trata-se de provável resposta tecidual proliferativa e alteraçäo imunológica individuais à presença dos agentes infecciosos encontados. A resposta terapêutica à corticoterapia foi relevante, pórem introduzida somente após exaustiva procura dos prováveis diagnósticos diferenciais

Tumor glomico solitario de localizacao rara. Diagnostico diferencial com sindrome de Parsonage-Turner. / Unusual site of glomus tumor. Differential diagnosis with Parsonage-Turner syndrome

Os autores comentam a incidencia, dificuldades diagnosticas, peculiaridades anatomicas, historico, aspectos clinicos e histopatologicos do tumor glomico solitario.Descrevem um caso de localizacao rara