Encephalopathy in severe SARS-CoV2 infection: Inflammatory or infectious?

Concerning the letter by Moriguchi et al., we describe our experience with a case of encephalopathy with and atypical damage on magnetic resonance imaging (MRI) in a patient with severe infection due to the SARS-CoV2 virus. A 56-year-old woman, without previous pathologies, developed cough, fever, and respiratory failure for five days, after returning from a 6-day trip to Venice. Chest radiography shows a large bilateral interstitial infiltrate. In the first 24 hours, she was admitted to the Intensive Care Unit (ICU) for severe respiratory failure and positive protein chain reaction-PCR in nasal exudate. She needed intubation for ten days. In the first 48 hours outside the ICU, she developed an acute confusional syndrome (hyperactive delirium). Neurological examination showed temporal-spatial disorientation and incoherent fluent speech. An electroencephalogram (EEG) showed generalized hypovoltaic activity. Cranial magnetic resonance imaging showed a bilateral and symmetrical increase in the supratentorial white matter's signal intensity, with a discrete thickening of both temporal lobes, with a slight increase in signal intensity and a sequence of normal diffusion. The lumbar puncture showed no changes (glucose 71 mg/dL, protein 30 mg/dL, 1 leukocyte). Within 72 hours of starting symptoms, she was neurologically asymptomatic. Our final diagnosis was an inflammatory encephalopathy related to a SARS-CoV2 infection.

Prevalencia de la necesidad de restricción de ingesta de sodio y de necesidad de laxantes en pacientes paliativos / Prevalence of the need for sodium intake restriction and the use of laxatives in palliative patients

Antecedentes: la población paliativa suele sufrir patologías que requieren una restricción de sodio en su dieta, aunque se desconoce la prevalencia de este requerimiento. Estas patologías, junto al estreñimiento, hacen que pueda desaconsejarse el uso de laxantes con electrolitos. Objetivo: conocer la prevalencia de la necesidad de restringir la ingesta de sodio en pacientes paliativos y analizar la prevalencia de estreñimiento y del uso de laxantes, incluidos los que contienen sodio. Método: estudio epidemiológico, multicéntrico, descriptivo, transversal y retrospectivo en pacientes mayores de 18 años recibidos en la consulta hospitalaria de paliativos (junio 2015-marzo 2016) tanto externos como hospitalizados. Se recogieron las características demográficas y antropométricas, enfermedades asociadas a la restricción de sodio en la dieta y tratamientos usados. Resultados: se incluyeron 400 pacientes paliativos (edad 77,8 ± 13,0 años, hombres 52,2%). El 68,3% fueron pacientes hospitalizados y el 31,8%, externos. En el 87,0% (IC95%: 83,3-90,0) existía comorbilidad que precisaba una dieta baja o ausente de sodio. Solo el 46,5% (IC95%: 41,5-51,5) tenía una recomendación de dieta baja en sal. Cabe resaltar que el 50,5% (IC95%: 45,5-55,5) de los pacientes presentó la necesidad de dieta baja en sodio y sufría estreñimiento. Un 53,8% (IC95%: 48,7-58,7) de los pacientes tomaba laxantes (54% productos ricos en lactulosa o polietilenglicol [PEG] con electrolitos), el 52,1% debido a estreñimiento y el 42,3% como prevención al tratamiento con opioides. Conclusiones: un alto porcentaje de la población estudiada (87%) padece algún trastorno que requiere la limitación de sodio en su dieta y al menos la mitad presenta estreñimiento. El uso de laxantes, como tratamiento o como prevención del estreñimiento, es frecuente en los pacientes paliativos. Por tanto, la elección de un laxante sin sodio será preferible en este tipo de pacientes

Background: palliative patients usually have diseases that require a restriction of dietary sodium, although the prevalence of this requirement is unknown. Such conditions, combined with constipation, may mean that the use of laxatives with electrolytes should be avoided. Objectives: to ascertain the prevalence of the need to restrict sodium intake in palliative patients and to analyze the prevalence of constipation and the use of laxatives, including those containing sodium. Method: this was a multicenter retrospective, descriptive, cross-sectional, epidemiological study of both inpatients and outpatients over 18 years of age treated at the palliative care clinic (June 2015-March 2016). Demographic and anthropometric characteristics, diseases associated with dietary sodium restriction and treatments administered were recorded. Results: the study sample consisted of 400 palliative patients, with a mean age of 77.8 ± 13.0 years and 52.2% were male. Of these, 68.3% were inpatients and 31.8% were outpatients. Comorbidities requiring low sodium or a sodium-free diet were found in 87.0% (95% CI: 83.3-90.0) of cases. Only 46.5% (95% CI: 41.5-51.5) of patients had been prescribed a low salt diet. It should be noted that 50.5% (95% CI: 45.5-55.5) of patients required a low sodium diet and suffered from constipation. Laxatives (polyethylene glycol or lactulose-rich products [PEG] with electrolytes in 54% of cases) were taken by 53.8% (95% CI: 48.7-58.7) of patients, 52.1% due to constipation and 42.3% as a prevention due to opioid treatment. Conclusions: a high proportion of the study cohort (87%) had some condition that required dietary sodium restriction and at least half the patients had constipation. The use of laxatives to treat or prevent constipation is common in palliative patients. A sodium-free laxative is therefore preferred in these patients

Prevalence of the need for sodium intake restriction and the use of laxatives in palliative patients.

BACKGROUND: palliative patients usually have diseases that require a restriction of dietary sodium, although the prevalence of this requirement is unknown. Such conditions, combined with constipation, may mean that the use of laxatives with electrolytes should be avoided. OBJECTIVES: to ascertain the prevalence of the need to restrict sodium intake in palliative patients and to analyze the prevalence of constipation and the use of laxatives, including those containing sodium. METHOD: this was a multicenter retrospective, descriptive, cross-sectional, epidemiological study of both inpatients and outpatients over 18 years of age treated at the palliative care clinic (June 2015-March 2016). Demographic and anthropometric characteristics, diseases associated with dietary sodium restriction and treatments administered were recorded. RESULTS: the study sample consisted of 400 palliative patients, with a mean age of 77.8 ± 13.0 years and 52.2% were male. Of these, 68.3% were inpatients and 31.8% were outpatients. Comorbidities requiring low sodium or a sodium-free diet were found in 87.0% (95% CI: 83.3-90.0) of cases. Only 46.5% (95% CI: 41.5-51.5) of patients had been prescribed a low salt diet. It should be noted that 50.5% (95% CI: 45.5-55.5) of patients required a low sodium diet and suffered from constipation. Laxatives (polyethylene glycol or lactulose-rich products [PEG] with electrolytes in 54% of cases) were taken by 53.8% (95% CI: 48.7-58.7) of patients, 52.1% due to constipation and 42.3% as a prevention due to opioid treatment. CONCLUSIONS: a high proportion of the study cohort (87%) had some condition that required dietary sodium restriction and at least half the patients had constipation. The use of laxatives to treat or prevent constipation is common in palliative patients. A sodium-free laxative is therefore preferred in these patients.

Serum ferritin as prognostic marker in classical Hodgkin lymphoma treated with ABVD-based therapy.

Ferritin levels might correlate with disease activity in classical Hodgkin lymphoma (cHL). We analyzed the prognostic significance of the ferritin value at diagnosis in 173 cHL patients treated with ABVD between 2003 and 2013. The 5-year overall survival (OS) and progression-free survival (PFS) probabilities were 80% and 64%, respectively. Patients with ferritin ≥ 350 µg/l [high ferritin group (HF), n = 62] were more likely to have advanced stage disease, B-symptoms and higher International Prognostic Score (IPS) compared with patients with ferritin < 350 µg/l [low ferritin group (LF), n = 111]. The complete remission (CR) rate and 5-year PFS and OS probabilities were lower in HF vs. LF patients (69% vs. 89%, p = 0.025; 40% vs. 78%, p < 0.001; 61% vs. 90%, p = 0.001; respectively). Multivariate analysis revealed that advanced stage (p = 0.001) and ferritin levels ≥ 350 µg/l (p = 0.002) were independent predictors for PFS. In conclusion, the ferritin level at diagnosis is a useful prognostic marker for cHL.

Adição de carotenóides naturais e artificiais na alimentação de galinhas poedeiras: efeitos na qualidade de ovos frescos e armazenados / Addition of natural and synthetic carotenoids, in hen feed: effects in the egg quality and storage

A pesquisa teve como objetivo avaliar os atributos de qualidade e de durabilidade dos ovos de duas diferentes linhagens de poedeiras, com dietas contendo aditivos artificiais ou naturais, em diferentes períodos de armazenamento. Foram quantificadas durante o armazenamento as variáveis perda de peso, pH da gema e albúmen, gravidade específica, índice de gema (IG) e foi realizada também classificação por peso e Unidade Haugh (UH). Os resultados foram avaliados segundo teste de Tukey (P≤0,05). As linhagens diferiram quanto à classificação extra dos ovos, com maior porcentagem para a Isa Brown. Os ovos obtidos das poedeiras Carijó apresentaram maior porcentagem de gema (Carijó 30,66 e Isa-Brown 24,55). O tempo de armazenamento fez com que a porcentagem de gema aumentasse nas duas linhagens (Carijó 30,66 tempo zero para 34,85 depois de 36 dias; e Isa- Brown de 24,55 para 27,48). As dietas com aditivos artificiais ou naturais não influenciaram a porcentagem de clara ( por cento Clara 58,72 Controle; 59,52 Aditivo; 60,11 Urucum 1,5 por cento; 59,43 e de gema por centoGema 27,64 Controle; 27,90 Aditivo; 27,21 Urucum 1,5 por cento; 27,66 Urucum 2 por cento). O pH da clara diferiu entre os tratamentos no tempo inicial e aos 36 dias de armazenamento, mas o pH da gema não diferiu durante todo o armazenamento. O índice de gema diferiu nos tempos de armazenamento, mas não diferiu considerando os tratamentos. Em dietas com aditivos artificiais ou naturais, as linhagens e os tempos de armazenamento influenciam na qualidade e durabilidade dos ovos.

The research has the aim of evaluating quality and durability attributes of eggs from two hens lines feed with and without natural or synthetics additives, at several storage periods. During storage, weight lost, albumen and yolk pH, specific gravity andyolk index (IG) were quantified , as well as, weight classification and Haugh Unit (HU) The results were analyzed by Tukey test (P≤0.05). Quality differences are bigger by lines and storage time and the extra classification of eggs were higher for Isa Brown. The egg of Carijó hens presented more yolk percentage (Carijó 30.66 e Isa-Brown 24.55). The storage higher increased yolk percentage (Carijó 30.66 time zero for 34.85 after 36 days; and Isa- Brown 24.55 for 27.48). Two lines diets with natural or synthetics additives didn't influence the white and yolk percentage ( percentwhite 58.72 Control; 59.52 Aditive; 60.11 Urucum 1.5 percent; 59.43 e de yolk and 27.64 Control; 27.90 Aditive; 27.21 Urucum 1.5 percent; 27.66 Urucum 2 percent). Clear pH differs among treatments at initial time and at 36 days of storage, but the yolk pH didn't chage during all storage. The yolk index differed in the storage time, but not at treatments. So, it's possible to concluded that diets with natural and synthetics additives, lines and storage times had influenced quality and durability attributes in the eggs.

Chagas' heart disease in Europe: an emergent disease?

Chagas' disease is caused by Trypanosoma Cruzi. It is considered as endemic in central and South America and is transmitted by several species of triatomic bedbug. However, there are other important ways of transmission between humans: vertical transmission and, above all, through blood products and transplants. In Chagas' disease, cardiac disturbances are the most important cause of morbidity, and they usually take place in the chronic stage. The symptoms are the same as in other dilated cardiomyopathies. The management of Chagas' heart disease may be even more difficult than other dilated cardiomyopathies. The increasing number of immigrants from endemic areas of Chagas' disease to developed countries would cause a radical increase in the incidence of this disease over the next years, however European cardiologists are unfamiliar with the disease. In this manuscript, we present our experience in order to stress the necessity of bearing Chagas' disease in mind as a possible cause of dilated cardiomyopathy in patients from endemic areas.

Efeito de Bixa orellana na alteração de características de ovos de galinhas / Effect of Bixa orellana in the alteration of characteristics of poultry laying eggs

Objetivou-se, no presente trabalho, avaliar os efeitos da adição de urucum (Bixa orellana L.) na ração de galinhas poedeiras, quanto à possível interferência na qualidade dos ovos. Para obtenção das amostras foram utilizados 125 animais, divididos em cinco tratamentos: Controle (0 por cento - T1) e quatro tratamentos com adição de urucum na ração (0,5 por cento - T2; 1,0 por cento - T3; 1,5 por cento - T4 e 2,0 por cento - T5). Os animais foram separados aleatoriamente em cinco blocos de cinco animais, totalizando 25 animais por parcela. Os ovos, após coletados, foram classificados usando ovoscópio, pesados, realizada análise de gravidade específica, unidade Haugh, altura de albúmen e gema, espessura da casca, diâmetro e índice de gema. As diferentes dietas não afetaram: peso; gravidade específica; altura do albumén; espessura da casca; altura de gema; diâmetro de gema. Pôde ser observado que a adição de urucum, na ração de poedeiras, não alterou a maior parte dos parâmetros de qualidade física do ovo, somente a unidade Haugh e o índice de gema apresentaram diferença (p<0,05).

This research evaluated the effects of addition of anatto (Bixa orellana L.) to feed laying hens to verify the possible interference of the anatto on egg quality. The eggs were obtained from 125 animal divided in 5 treatments: Control (0 percent - T1) and four treatments with addition of anatto (0.5 percent - T2; 1.0 percent - T3; 1.5 percent - T4 and 2.0 percent - T5). The laying hens were separated in five blocks, each block with 5 animals, with total 25 animals by parcel. The eggs picked were classified using eggscopic, weighed, specific gravity, Haugh unit, albumen and yolk height, thickness of the shell, diameter and index yolk. Different feeds did not modify: weight; specific gravity; albumen height, thickness of the shell; yolk height and diameter of yolk. About the eggs quality analysis, addition of anatto did not show significance (p>0.05) among the treatments to most of the parameters of physical quality of eggs, only Haugh unit and yolk index showed differences (p<0.05).

Síndrome ascítica em frangos de corte: uma revisão sobre a fisiologia, avaliação e perspectivas / Ascitic syndrome in broiler chickens: a review about physiology, evaluation and perspectives

Os programas de melhoramento genético de frangos de corte que buscam máxima velocidade de ganho de peso, alta eficiência alimentar, alta viabilidade, maior rendimento de carcaça e menor deposição de gordura podem desencadear algumas síndromes fisiológicas, dentre as quais destacam-se o estresse calórico, a morte súbita e a ascite. A ascite se enquadra no conceito das síndromes multifatoriais, uma vez que sua manifestação ocorre quando certos fatores genéticos e ambientais atuam em conjunto determinando o processo. As limitações anatômica e fisiológica da circulação sanguínea nos pulmões provocam a síndrome de hipertensão pulmonar (PHS); esta pode provocar grande acúmulo de fluido na cavidade abdominal, quadro este denominado de ascite. Ocorre redução da eficiência da circulação sangüínea, levando as aves à morte por hipóxia, predominantemente no período entre 30 e 40 dias de idade. Uma vez desencadeado o processo ascítico, a ave dificilmente é aproveitada no abate já que a mesma restringe o consumo de alimento, ganhando menos peso. Adicionalmente, a carcaça apresenta aumento do volume da cavidade abdominal e conseqüente congestão dos órgãos internos. A descrição da fisiologia, medidas de avaliação e perspectivas são apresentadas neste trabalho.

Polymorphism analysis of the hsp70 stress gene in Broiler chickens (Gallus gallus) of different breeds

The promoter region and the beginning of the coding region of the hsp70 stress gene were analysed in broiler chickens of a commercial breed (Hubbard-Pettersen), a breed selected for weight gain (PP1) and a non-selected breed (naked-neck Label Rouge). The naked neck gene (Naked neck, Na), which reduces feathering in birds and is thus related to heat resistance, was present in both PP1 and Label Rouge breeds. Genomic DNA was restricted with PstI and Southern blotting analysis of the samples revealed the absence of polymorphic sites for that enzyme in the promoter region and beginning of the coding region of the hsp70 gene of studied birds. PCR-SSCP analysis of these regions, however, indicated the presence of polymorphisms in the beginning of the coding region and the sequencing of the PCR products confirmed and identified two polymorphic sites in this region: a transition A ® G in position +258 and a transversion C ® G in position +276. Both mutations were considered to be silent, since they did not modify the aminoacid sequence of the protein Hsp70. The promoter region of the hsp70 gene was identical in all studied birds, indicating that the regulation pattern of this gene must be the same in all birds at the promoter region. Three different alleles (hsp70-1, hsp70-2 and hsp70-3) were identified for the hsp70 gene from the observed mutations. The allele hsp70-3 was detected in only two breeds, Hubbard-Pettersen and PP1, but at a low frequency (0,016 and 0,006, respectively)

Capacitación a prestadores de servicios de salud en el diagnóstico de sífilis materna distrito I, La Paz / Training un rendering of services of health in the diagnostic of maternal syphilis district 1 La Paz

Justificación: Las acciones importantes para el control de la sífilis en los programas de salud materno infantil son: la detención de sífilis en las mujeres embarazadas y el tratamiento adecuado de ellas y de sus parejas sexuales.La detección y el tratamiento de la sífilis durante el embarazo con resultados patológicos es una intervención costo efectiva.Todas las mujeres que llegan a su control prenatal (CPN) en el servicio de salud tiene que ser examinadas para sífilis en su primera visita.En nuestro país esto se realiza con una muestra de sangre de la embarazada, que es enviada al laboratorio central donde se realiza el examen para sífilis con una prueba no treponémica de detección ya sea Reagina Plasmática Rápida (RPR) o prueba de VDRL.Este programa así establecido no es efectivo en muchas situaciones puesto que se solicita que la embarazada regresa al servicio de salud para recibir los resultados y cuando requiere tratamiento es derivada a otro centro especializado o se entrega una receta médica para que ella se compre un medicamento y además que ella tenga la responsabilidad de que le administren éste medicamento. A menudo los laboratorios toman días y aún semanas para enviar los resultados, y con frecuencia los resultados nunca llegan a ser conocidos por el proveedor que indicó las pruebas. Tiene con frecuencia las mujeres no regresan con sus resultados y por lo tanto nunca se realiza la referencia para el tratamiento. Este tipo de programa ocaciona que muchas mujeres infectadas no sean tratadas siendo los resultados adversos tanto para las madres como para sus productos...