Recommendations for mental health professionals in the NICU.

This article describes recommended activities of social workers, psychologists and psychiatric staff within the neonatal intensive care unit (NICU). NICU mental health professionals (NMHPs) should interact with all NICU parents in providing emotional support, screening, education, psychotherapy and teleservices for families. NMHPs should also offer educational and emotional support for the NICU health-care staff. NMHPs should function at all levels of layered care delivered to NICU parents. Methods of screening for emotional distress are described, as well as evidence for the benefits of peer-to-peer support and psychotherapy delivered in the NICU. In the ideal NICU, care for the emotional and educational needs of NICU parents are outcomes equal in importance to the health and development of their babies. Whenever possible, NMHPs should be involved with parents from the antepartum period through after discharge.

Recommendations for enhancing psychosocial support of NICU parents through staff education and support.

Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents' functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU staff with education and support are discussed. The goal is to deliver care that exemplifies the belief that providing psychosocial care and support to the family is equal in importance to providing medical care and developmental support to the baby.

Emotional distress in mothers of preterm hospitalized infants: a feasibility trial of nurse-delivered treatment.

OBJECTIVE: Mothers of preterm infants in a hospital neonatal intensive care unit (NICU) are at risk for clinically significant depression and anxiety, but for these women their own treatment is likely a secondary priority. This study evaluated the feasibility, acceptability and effectiveness of an evidence-based, nurse-delivered, on-site depression treatment: listening visits (LVs). STUDY DESIGN: Therapeutic LVs were delivered on site to 23 distressed mothers of NICU infants. The intervention was conducted by a neonatal nurse practitioner and the outcome was examined in an open-trial, pre-post evaluation. RESULT: A part-time nurse practitioner delivered six LVs to each participant within a 1-month time frame. LVs were associated with significantly improved mood and well-being in mothers. The majority of eligible women took advantage of LVs and felt satisfied with their care. CONCLUSION: This open trial provides 'proof-of-concept', with results that warrant further evaluation in a multisite randomized controlled trial.

A study on the experimental envenomation in mice with the venom of Tityus trivitattus Kraepelin 1898 (Scorpiones, Buthidae) captured in Argentina.

Although Tityus trivitattus is the only scorpion species reported to cause severe human envenomation in Argentina, no previous studies on its venom have been done. Telson homogenates from T. trivitattus specimens collected in Santiago del Estero, Cordoba, and Buenos Aires were employed to study their protein composition and toxicity to mice. Regardless of the site of collection, electrophoretic analysis showed bands at 205, 150, 100, 40, 32, and 13 kDa or smaller. FPLC gel filtration showed three major peaks and 6-8 minor peaks with similar elution volumes. One of the minor peaks from FPLC containing a component of approximately 8 kDa was lethal to mice. Mice injected intravenously with different doses of homogenates presented severe autonomic signs like tachypnea, tachycardia, sialorrhea, lacrimation, profuse sweating, diarrhea, dyspnea, and death. Pathology studies of lungs showed severe congestion of alveolar capillaries, pulmonary edema, and hemorrhagic areas. The kidneys showed glomerular as well as tubular lesions and exocrine glands showed areas of necrosis. The calculated LD50 was 0.38 +/- 0.08 telsons per 20 g mouse, which suggests a lethal potency similar to that of T. serrulatus venom. The lethal potency of 5.0 LD50 of T. trivitattus telson homogenate was neutralized by both an anti-T. trivitattus and a heterologous anti Tityus with ED50 values of 41 +/- 19 and 170 +/- 42 microl, respectively.

A comparison of different methods to assess the hemorrhagic activity of Bothrops venoms.

The hemorrhagic activity of Bothrops (B.) alternatus, B. ammodytoides, B. jararaca, B. jararacussu, B. moojeni and B. neuwiedii venoms from specimens captured in Argentina was assayed after i.d. injection to mice. The hemorrhagic haloes produced by each venom had different color intensities, although no significant differences were observed by measurement of the average diameters or the weight of the excised hemorrhagic haloes. Conversely, important differences were found by measuring the amount of hemoglobin extracted from excised hemorrhagic haloes of similar size produced by different venoms. The relationship between the amount of hemoglobin extracted and the weight of the excised hemorrhagic haloes was linear, with a slope (hemoglobin released per gram of hemorrhagic halo) characteristic for each venom, and proportional to the potency. On this basis, the activity of B. alternatus, B. ammodytoides and B. jararaca is similar, about 1.5 times higher than that of B. jararacussu and B. moojeni venoms and threefold higher than that of B. neuwiedii venom. Thus, measurement of the of hemoglobin released provides additional information in comparative studies, and may be used to assess the antihemorrhagic potency of antivenoms.

Some toxic and enzymatic activities of Bothrops ammodytoides (yarará ñata) venom.

Bothrops ammodytoides, the smallest representative of this genus, is found only in Argentina. Venom was extracted from thirty adult specimens (35-70 cm in length, 90-300 g in weight) captured in the Province of Buenos Aires and kept in captivity. Venom yield was 3-30 mg. SDS-PAGE showed strong bands at 14.0; 23-25; 45; 54 and 63 kDa and weak bands at 17.0; 30.0; 40.0 and 85.0 kDa. Toxic activities were: LD50 (intravenous, mice) 0.5+/-0.2 microg/g; minimal procoagulant dose on human plasma (MPD-P) 35+/-2 mg/l; and minimal defibrinogenating dose (MDD, mice) 6-12 microg. Hemorrhagic and/or necrotic activities appear to play a major role in lethality; minimal hemorrhagic dose (MHD, mice) is 10+/-2 microg/g and minimal necrotizing dose (MND, mice) is 38+/-5 microg. The LD50, MPD-P and MND are among the lowest in venoms from Bothrops species found in Argentina. B. ammodytoides venom exhibited high proteolytic and phospholipase A2 activities. Most of the B. ammodytoides venom components cross-react with Bivalent Bothropic antivenom (Instituto Nacional de Producción de Biológicos ANLIS Dr. G. Malbrin, against B. alternatus and B. neuwiedii venoms). One ml of antivenom neutralizes 1.2 mg of B. ammodytoides venom.

Professional appraisal of professionally led and self-help groups.

A survey of almost 1,100 mental health professionals found they routinely viewed professionally led groups more positively than they did self-help groups on a number of dimensions. Analyses suggested that the curative factor associated with professionally led groups was valued over factors associated with self-help groups. The implications of the findings are discussed, and an alternative framework for professionals' evaluation of consumer-initiated interventions suggested.

[Cross neutralization of bothrops jararacussu venom by heterologous antivenoms]. / Neutralización cruzada de veneno de Bothrops jararacussu por sueros antiofidicos heterologos.

We have studied the immunochemical cross-reactivity and cross-neutralization of the lethal potency, hemorrhagic, necrotizing, procoagulant and (indirect) hemolytic activities of Bothrops jararacussu venom by the standard antivenoms produced in Argentina. These antivenoms are horse immunoglobulin F (ab')2 fragments from animals immunized with 1) Crotalus durissus terrificus venom (Monovalent Anticrotalic antivenom); 2) Bothrops alternatus and B. neuwiedii venoms (Bivalent Botropic antivenom); 3) B. alternatus, B. neuwiedii, B. jararaca and B. jararacussu venoms (Tetravalent Bothropic, or "Misiones" antivenom) and 4) B. alternatus, B. neuwiedii and C. d. terrificus venoms (Trivalent Botropic-Crotalic antivenom). In preincubation experiments, all the heterologous antivenoms neutralized the toxic and biological activities of B. jararacussu venom with a potency at least as high as the Tetravalent Botropic (i.e. the only homologous) antivenom, in which B. jararacussu venom was included as immunogen. These results suggest the possibility of using heterologous antibothropic antivenoms for the treatment of snake bites by B. jararacussu.

The immunochemical reactivity and neutralizing capacity of polyvalent Vipera (European) antivenom on enzymatic and toxic activities in the venoms of Crotalids from Argentina

The immunochemical reactivity and neutralizing capacity of polyvalent Vipera antivenom (Vipera ammodytes, Vipera aspis, Vipera berus, Vipera lebetina, and Vipera xanthina) were tested on the enzymatic and biological activities of Crotalus durissus terrificus and the following Bothrops venoms from Argentina (Bothrops alternatus, Bothrops ammodytoides, Bothrops neuwiedii, Bothrops jararaca, Bothrops jararacussu, and Bothrops moojeni). The Vipera antivenom reacted weakly when tested by double immunoprecipitation (DIP) and reacted with all the venoms when tested by ELISA. Several components in all the venoms studied were recognized in Western blots. Vipera antivenom deactivated to different degrees in vitro procoagulant, (indirect) hemolytic, and proteolytic activities in all the venoms studied. Preincubation of Bothrops alternatus venom with Vipera antivenom neutralized a lethal potency of 4.5 LD50 in mice with an ED50 of 1.25 ñ 0.25 µl per µg of venom, and with 1.0 µl/µg inhibited 54 per cent of the hemorragic activity and 48 per cent of necrotic activity. Vipera antivenom (2.0 µl per µg toxin) inhibited the phospholipase A2 activity of purified crotoxin and decreased its lethal potency by 60 per cent, while the neutralizing capacity on the lethal potency of crude Crotalus durissus terrificus venom was poor even at a level of 5.0 µl/µg of venom.

Neutralización cruzada de veneno de Bothrops jararacussu por sueros antiofidicos heterologos. / [Cross neutralization of bothrops jararacussu venom by heterologous antivenoms]

We have studied the immunochemical cross-reactivity and cross-neutralization of the lethal potency, hemorrhagic, necrotizing, procoagulant and (indirect) hemolytic activities of Bothrops jararacussu venom by the standard antivenoms produced in Argentina. These antivenoms are horse immunoglobulin F (ab)2 fragments from animals immunized with 1) Crotalus durissus terrificus venom (Monovalent Anticrotalic antivenom); 2) Bothrops alternatus and B. neuwiedii venoms (Bivalent Botropic antivenom); 3) B. alternatus, B. neuwiedii, B. jararaca and B. jararacussu venoms (Tetravalent Bothropic, or [quot ]Misiones[quot ] antivenom) and 4) B. alternatus, B. neuwiedii and C. d. terrificus venoms (Trivalent Botropic-Crotalic antivenom). In preincubation experiments, all the heterologous antivenoms neutralized the toxic and biological activities of B. jararacussu venom with a potency at least as high as the Tetravalent Botropic (i.e. the only homologous) antivenom, in which B. jararacussu venom was included as immunogen. These results suggest the possibility of using heterologous antibothropic antivenoms for the treatment of snake bites by B. jararacussu.

A study on the venom yield of venomous snake species from Argentina.

A study on the venom yield of snakes from Argentina over a three year period was carried out on adult specimens of Bothrops alternatus (n = 74); Bothrops neuwiedii (n = 127); Bothrops ammodytoides (n = 30); Bothrops moojeni (n = 14); Bothrops jararaca (n = 14); B. jararacussu (n = 6); Crotalus durissus terrificus (n = 120) and Micrurus spp. (n = 6) as well as with 12 specimens of newborn C. d. terrificus kept in captivity. While for each species there was a positive correlation between venom yield and number of snakes milked, the correlation with the snake's body weights after individual milkings was even better, suggesting that the size of the snakes is more important in determining the venom yield than the number of snakes milked or the specimen's sex. Individual milkings indicated that, in addition to the snake size, when the amount of venom is normalized per 100 g body weight there is a species specific difference in venom yield. It follows the order B. jararacussu > B. moojeni approximately = B. jararaca approximately = B. alternatus > B. neuwiedii> Micrurus spp approximately = B. ammodytoides> C. d. terrificus. Although the venom yield per 100 g body weight of newborn C. d. terrificus specimens is 2-fold higher than that of adults, no correlation was observed between venom yield and body weight.

Cross-reactivity and heterologous neutralization of crotaline antivenoms used in Argentina.

The immunochemical cross-reactivity and neutralizing capacity of four crotalinae antivenoms consisting in equine F(ab')2 fragments and available in Argentina (bothropic Bivalent, against Bothrops alternatus and B. neuwiedii venoms; bothropic Tetravalent, against B. alternatus, B. neuwiedii; B. jararaca and B. jararacussu venoms; bothropic crotalic Trivalent, against B. alternatus, B. neuwiedii and Crotalus (C.) durissus terrificus venoms and anticrotalic against C. d. terrificus venom) were studied against B. alternatus, B. ammodytoides; B. jararaca; B. jararacussu, B. moojeni; B. neuwiedii and C. d. terrificus venoms. SDS-PAGE analysis of the Bothrops venoms showed protein bands of high (>40 kDa) medium (20-40 kDa) and low (<15 kDa) molecular weights, while that of C. d. terrificus exhibited a large amount of material with molecular weight of 15.0 kDa or lower. Immunoblotting showed a high cross-reactivity of all the major protein bands with all the antivenoms (even heterologous) tested. All the antivenoms were effective in neutralizing the lethal activity of the venoms tested, and in some cases (B. jararaca and B. jararacussu) heterologous antivenoms exhibited similar neutralizing capacity than the homologous ones. In spite of the differences in biochemical composition and pharmacology, Bothropic antivenoms displayed a significant neutralizing capacity on lethal activity of C. d. terrificus venom. In addition, all the antivenoms (including the anticrotalic) were highly effective in neutralizing the hemorragic, necrotizing, procoagulant, and proteolytic activities. The antivenoms tested produced different degrees of inhibition of phospholipase A2 activity, which exhibited a certain specificity but was also related to the enzyme content in the venom.

[Neutralizing capacity of ++antiophidic sera against the venom of Bothrops moojeni (lance-headed viper)]. / Capacidad neutralizante de los sueros antiofídicos frente al veneno de Bothrops moojeni (caisaca, lanzadera).

In the production of current therapeutic antisera used in Argentina for Bothrops snakebite, the Bothrops moojeni venom is not used as immunogen, since this snake is not considered a serious public health problem. Accidents caused by this species have not been reported in this country even though Bothrops moojeni is not unfrequent in some regions of Misiones. Despite the high degree of immunological cross reactivity found among the Crotalinae venoms and, in this particular case, among the venoms from the Bothrops Genus, there exists a significant intraspecific variation in venom composition, particularly in specimens arising from different geographic regions. In this study, the antivenoms prepared at the Instituto Nacional de Producción de Biológicos A.N.L.I.S. Dr. Carlos G. Malbrán have been tested for their immunochemical cross reactivity and neutralizing ability of enzymatic and toxic activities of venom from Argentinian specimens of Bothrops moojeni from Misiones. Immunological cross-reactivity was tested by double-immunoprecipitation, immunoelectrophoresis, Western-blot and ELISA. Neutralizing ability of antivenoms against proteolytic, indirect hemolytic activity, procoagulant activity, he-morrhagic activity and necrotizing activity. The Lethal Dose 50 was 1.5 mg/kg body weight; this value is located in the range to those obtained with the venom from Brazilian specimens. It was observed that all the antivenoms exhibited a strong immunochemical cross reactivity and that they were able to neutralize in different degree both, enzymatic and toxic activities of B. moojeni venom. From these results, it can be assumed that the antivenom tested could be employed successfully in cases of B. moojeni snakebites.

Flow cytometric and histological assessment of 1,2:3,4-diepoxybutane toxicity on mouse spermatogenesis.

The effects of diepoxybutane (DEB) on mouse reproductive cells have been investigated by flow cytometric and histological description of testicular cell populations and alterations of sperm chromatin packaging. Mice were treated with single intraperitoneal injections of DEB, with doses ranging between 8.5 and 78 mg/kg (100-900 microM), and were killed after 7, 14, 21, 28 or 35 d. Dose-dependent reductions of tetraploid cells, round spermatids, and elongated spermatids were detected at 7, 21, and 28 d, respectively, reflecting cytotoxic damage on the differentiating spermatogonia compartment. The dose necessary to reduce the number of differentiating spermatogonia to half the control value was estimated equal to 650 microM or 55 mg/kg. Stem cells were not affected by this treatment. Histological section of seminiferous tubules showed depletion of spermatids and reduction of the secondary spermatocyte layers. In addition, a high although not statistically significant frequency of sperm with altered chromatin packaging was detected after DEB treatment. DEB is one of the key metabolites of butadiene, which is a compound of high environmental and occupational concern. These results contribute to the assessment of the reproductive health impact of butadiene in humans.

4'-Epi-doxorubicin and hyperthermia in a murine mammary carcinoma: influence of the dose and fractionation.

Our aim was to analyse the dose-response rate of 4'-epi-doxorubicin (EP) alone and of EP combined with hyperthermia (HT) treatments in tumor-bearing mice. A spontaneous mammary carcinoma, transplanted into the right foot of female hybrid (C3H/RIxDBA/2J) mice, was used. EP (from 5 to 30 mg/kg) was administered i.p. and local HT (45-60 minutes at 42 or 43 degrees C) was carried out. Mice were treated with EP and/or HT in 1, 2 or 3 doses at 8 day intervals; in the case of 3 HT treatments EP was administered before the first or before each HT session (same EP total dose). When EP was given alone, in 1 or 2 fractions, results showed a clear dose-response relationship: tumor growth delay depended on the total dose only. Combining different EP single doses and 1 HT treatment (43 degrees C), an additive effect and perhaps a synergistic effect at the highest doses was observed. Among all tested combinations, the best results were observed combining 3 HT with only 1 EP treatment.

[Rabies transmission to rodents after ingestion of naturally infected tissues]. / Transmisión de rabia a roedores por la ingestión de tejidos extraídos de animales naturalmente infectados.

We describe seven trials in which Calomys musculinus and Mus Musculus were fed with naturally rabies-infected tissues extracted from vampire bats, dogs, and bovines. The tissues were not subjected to any kind of previous laboratory handling and were administered directly in Petri dishes; rodents ate them voluntarily. The only infectious tissues were bovine brains taken from outbreaks transmitted by vampire bats (Table 1). It was possible to infect the two species of tested rodents, and there was no relationship between infection and amount of virus ingested. From the total number of 132 animals that ingested different kinds of rabies-infected tissues, 3 died of rabies infection. From 128 survivors of all the exposed mice, 22 presented seroconversion to rabies. In the infected Calomys musculinus there was evident nervous symptomatology consisting in excitability, aggressiveness, paralysis and isolation of rabies virus from their salivary glands. The possibility that rodents become rabies infected by the ingestion of naturally infected tissues would indicate that they may constitute a reservoir for rabies because cadaver ingestion is a natural feeding source for many species. Furthermore they may permit the passage of rabies virus in carnivorous, animals since they are an important prey for them. The present observations indicate two situations which may increase rabies risks to man through rodent bites.

Transmisión de rabia a roedores por la ingestión de tejidos extraídos de animales naturalmente infectados. / [Rabies transmission to rodents after ingestion of naturally infected tissues]

We describe seven trials in which Calomys musculinus and Mus Musculus were fed with naturally rabies-infected tissues extracted from vampire bats, dogs, and bovines. The tissues were not subjected to any kind of previous laboratory handling and were administered directly in Petri dishes; rodents ate them voluntarily. The only infectious tissues were bovine brains taken from outbreaks transmitted by vampire bats (Table 1). It was possible to infect the two species of tested rodents, and there was no relationship between infection and amount of virus ingested. From the total number of 132 animals that ingested different kinds of rabies-infected tissues, 3 died of rabies infection. From 128 survivors of all the exposed mice, 22 presented seroconversion to rabies. In the infected Calomys musculinus there was evident nervous symptomatology consisting in excitability, aggressiveness, paralysis and isolation of rabies virus from their salivary glands. The possibility that rodents become rabies infected by the ingestion of naturally infected tissues would indicate that they may constitute a reservoir for rabies because cadaver ingestion is a natural feeding source for many species. Furthermore they may permit the passage of rabies virus in carnivorous, animals since they are an important prey for them. The present observations indicate two situations which may increase rabies risks to man through rodent bites.