The Effects of Testosterone Therapy Combined with Swimming Exercise on Adipose Tissue and Biochemical Parameters in Male Obese Wistar Rats.

Context: Exercise and anabolic steroids are anticipated to promote fat mass reduction and so to decrease the number of comorbidities related to excessive weight. Objective: The aim of this study was to verify the influence of aerobic exercise and the use of steroids on the accumulation of adipose tissue and on the biochemical limitations of Wistar rats nourished by a hypercaloric diet. Methods: Forty, young male Wistar rats were split into four groups: obese control (n=10), obese under treatment (n=10), obese under aerobic exercise (n=10) and obese under aerobic exercise and treatment (n=10). All animals were fed with a hypercaloric diet and animals under treatment received intramuscular testosterone. Body (weight and visceral fat) and blood (lipidogram, glucose, and liver enzymes) parameters were assessed. Results: The group treated with aerobic exercise and testosterone revealed a reduction in body weight and visceral, perirenal, retroperitoneal and epididymal fats, accompanied by the blood levels of glucose, lactate, LDL-cholesterol, HDL-cholesterol, and lactate dehydrogenase; following high-intensity physical activity. Conclusion: The results support the theory that the combination of steroids and physical activity reduces the side-effects of androgenic-anabolic hormones and conveys benefits to some constraints.

Intestinal perforation in very preterm neonates: risk factors and outcomes.

OBJECTIVE: To compare neonatal outcomes of preterm infants (born at <32 weeks' gestation) with focal/spontaneous intestinal perforation (SIP), necrotizing enterocolitis (NEC)-related perforation, NEC without perforation or no NEC/perforation. STUDY DESIGN: Retrospective cohort study of 17,426 infants admitted to Canadian neonatal intensive care units during 2010 to 2013. The primary outcome was a composite of mortality or morbidity (bronchopulmonary dysplasia, severe retinopathy, periventricular leukomalacia or nosocomial infection). Association of intestinal perforation with neonatal outcome was evaluated using multivariate logistic regression. RESULT: SIP was present in 178 (1.0%) infants, NEC-related perforation in 246 (1.4%) and NEC without perforation in 538 (3.1%). Any intestinal perforation was associated with higher odds of the composite outcome (adjusted odds ratio (AOR): 8.21, 95% confidence interval (95% CI) 6.26 to 10.8); however, the odds were significantly lower for focal/SIP compared with NEC-related perforation (AOR: 0.29, 95% CI 0.17 to 0.51). CONCLUSION: Of the two types of intestinal perforation, NEC-related perforation was associated with the highest risk of an adverse neonatal outcome.

Neonatal outcomes are associated with latency after preterm premature rupture of membranes.

OBJECTIVE: To determine factors associated with latency time to birth after preterm premature rupture of membranes (PPROM) and the impact on neonatal outcomes. STUDY DESIGN: Data on singleton pregnancies with PPROM (n=1535 infants) were prospectively collected in a computerized perinatal/neonatal database at a tertiary care perinatal center. Latency was characterized as ≤72h versus >72 h after PPROM. RESULT: The percentage of women with latency to birth >72 h decreased from 67% in very preterm (gestational age (GA) 25 to 28 weeks) to 10% in late preterm women (GA 33 to 36 weeks). PPROM women with latency ≤72 h were more likely to have pregnancy-induced hypertension and birth weight <3%; PPROM women with latency >72 h were more likely to have received steroids and develop clinical chorioamnionitis. PPROM <32 weeks GA with latency ≤72 h was associated with a two-fold higher incidence of severe neonatal morbidity, while PPROM between 29 to 34 weeks GA and latency ≤72 h was associated with a higher incidence of moderate neonatal morbidity. CONCLUSION: A latency period >72 h was associated with a decreased incidence of adverse neonatal outcomes up to 32 weeks GA for severe and 34 weeks GA for moderate morbidity indices.

A clinical follow up of PRK and LASIK in eyes with preoperative abnormal corneal topographies.

AIM: To assess the safety and predictability of photorefractive keratotomy (PRK) and laser in situ keratomileusis (LASIK) based on preoperative corneal topography. METHODS: A non-randomised comparative study was carried out on 84 eyes that presented with topographic abnormalities before undergoing PRK (n = 44) or LASIK (n = 40) procedures. 84 spherical equivalent paired normal eyes served as the control group. Either PRK or LASIK procedures were performed on 168 eyes using the Summit apex plus excimer laser. Topographic abnormalities, including apex displacement (AD), increased asphericity (AS), meridional irregularity (MI), increased inferior-superior asymmetry (IS), increased curvature (CU), and combined features (CO), were assessed preoperatively using the EyeSys analysis system. Safety and predictability of the two procedures were defined as a postoperative visual acuity of 20/40 or better and the loss of one or more lines of spectacle corrected visual acuity (SCVA). RESULTS: All patients were followed for 6 months. There was a significant loss of best corrected visual acuity in the PRK-AD (p<0.001), PRK-CO (p<0.05), and LASIK-AS (p<0.001) patients. The number of eyes within plus or minus 1.0D of the surgical plan postoperatively was similar in all groups. CONCLUSION: These data suggest that although predictability was similar, PRK and LASIK performed in corneas with topographic abnormalities might cause loss of vision.

Flumazenil's reversal of myoclonic-like movements associated with midazolam in term newborns.

Sedation is an important aspect of care for critically ill newborns. Proper sedation reduces stress during procedures such as mechanical ventilation. Midazolam, a short-acting benzodiazepine, is widely administered as a sedative in newborn intensive care units but is not without side effects. Three term newborns developed myoclonic-like abnormal movements after receiving midazolam. In one, flumazenil controlled the abnormal movements. Flumazenil is a potent benzodiazepine antagonist that competitively blocks the central effects of benzodiazepines. It can reverse the sedative effects of benzodiazepines occurring after diagnostic or therapeutic procedures or after benzodiazepine overdose. Flumazenil may be considered in cases of abnormal movements associated with midazolam. However, further studies are needed to provide guidelines for the administration of this drug in newborns.

Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Varying degrees of success have been reported with strategies to increase milk production when lactation is failing. The objective of this study was to investigate the efficacy of domperidone in augmenting milk production in mothers of premature newborns. METHODS: Twenty patients were randomly assigned to receive either domperidone or placebo for 7 days. Milk volume was measured daily. Domperidone levels were measured in randomly selected milk and serum samples on day 5 of the study. Serum prolactin levels were measured before the start of the study, on day 5 and on day 10 (3 days after the last dose of the study medication). RESULTS: Data from 16 patients were available for analysis (7 in the domperidone group and 9 in the placebo group). When compared with baseline values, the mean increase in the volume of milk production from day 2 to 7 was 49.5 (standard deviation [SD] 29.4) mL in the domperidone group and 8.0 (SD 39.5) mL in the placebo group (p < 0.05); proportionally this represented an increase of 44.5% and 16.6% respectively. The serum prolactin levels were similar in the 2 groups at baseline; by day 5 they were significantly higher in the domperidone group than in the placebo group, returning to baseline levels in both groups 3 days after the last dose of the study medication. Very small amounts of domperidone were detected in the breast milk samples. INTERPRETATION: In the short term domperidone increases milk production in women with low milk supply and is detected at low levels in breast milk.

Effects of morphine on the electroencephalograms of neonates: a prospective, observational study.

OBJECTIVES: Although opiates have been reported to profoundly alter the EEG and cause seizures in full-term and premature newborn babies, no prospective study has systematically studied the effects of morphine on the EEG of normal neonates. METHODS: A prospective observational study was conducted on 20 neurologically and metabolically normal newborn babies of > or =26 weeks post-conceptional age, with EEG recordings performed while on and off morphine infusions. RESULTS: The recordings performed while the babies were on morphine were all abnormal; the principal abnormalities consisted of prolonged periods of electrical quiescence (PPEQs) and excessive interictal epileptiform activity. After the morphine was discontinued, the PPEQs resolved and the EEG background rhythms were normal for age, but 5 continued to have excessive sharp transients. All babies did well clinically and did not require anti-epileptic drug therapy. CONCLUSIONS: Morphine produces a profound, largely reversible alteration of all neonatal EEGs at various post-conceptional ages. The study has implications for caution in formulating conclusions regarding the clinical significance of EEGs of critically ill neonates on morphine infusions.

[American cutaneous leishmaniasis in the sugar cane-producing area of Pernambuco, North-East Brazil]. / La leishmaniose tégumentaire américaine dans la région sucrière du Pernambouc, Nord-Est du Brésil.

The cases of American cutaneous leishmaniasis reported here were observed between 1995 and 1998 in outpatients at a health clinic in the sugar cane-producing region in the south of Pernambuco State (Brazil), in which the disease is known to be endemic. Two hundred thirty eight cases were reported, equivalent to about ten cases per thousand patients. The disease affected patients of all ages, with a slight male predominance. The lesions were generally single and located on the legs. They were successfully treated with Glucantime. Vectors of the disease, sandflies of the genus Lutzomyia, were captured in and around homes, particularly in stables. This field work demonstrates the extent of a long-standing endemic that can be effectively treated within motivated health structures.

Contribution to the sand fly fauna (Diptera: Phlebotominae) of Rio Grande do Sul, Brazil and Leishmania (Viannia) infections.

American cutaneous leishmaniasis (ACL) is endemic in the State of Rio Grande do Sul, Brazil. As reports of nearby hospitals suggest, the Parque Estadual do Turvo seems to serve as a source for the disease. During three months from November 1996 to February 1997 we collected, in this park, 2,228 sandflies (10 Lutzomyia species and 2 6species). We applied the polymerase chain reaction to 920 females which belong to the following species: Lutzomyia migonei, Lu. pessoai, Lu. fischeri, Lu. misionensis, Lu. lanei, Lu. neivai, Lu. shannoni, and Lu. monticola, in an attempt to verify natural infection by Leishmania (Viannia), the causative agent of ACL. Le. (Viannia) infections were demonstrated by DNA amplification from two Lu. pessoai and one Lu. misionensis female. Lu. pessoai have been found with leptomonas in the gut believed to be Le. (V.) braziliensis in other endemic areas of northeastern and southeastern Brazil. However, Lu. misionensis has never been found carrying a natural infection of Le. (Viannia).

Complications of airway management in very-low-birth-weight infants.

OBJECTIVE: To define the incidence of complications of endotracheal intubation and the factors associated with these complications. STUDY DESIGN: During a 22-month period, 227 intubated infants weighing <1,501 g were followed prospectively in a neonatal intensive care unit. Detailed records of events associated with airway management were kept after every intubation, in addition to clinical data. RESULTS: Eleven infants (4.8%) developed respiratory stridor after extubation which was treated with either systemic corticosteroids, racemic epinephrine and/or reintubation for respiratory failure. Four infants were submitted for bronchoscopy, mild subglottic stenosis with tracheal edema was found in 1 patient, granulation tissue and airway edema were noted in 3 infants. Traumatic intubation, prolonged ventilation, multiple intubations and bacterial colonization of the endotracheal tube were the factors associated with postextubation stridor. CONCLUSIONS: Subglottic stenosis is an infrequent complication of endotracheal intubation with current airway management of very-low-birth-weight infants. Less severe complications are still common, but they are usually amenable to clinical treatment. Bronchoscopy should be performed selectively only in infants with clinical evidence of airway obstruction after extubation.

Seizure and electroencephalographic changes in the newborn period induced by opiates and corrected by naloxone infusion.

OBJECTIVE: To describe the association between opioid administration in the newborn period and neurologic abnormalities. STUDY DESIGN: Case reports of two infants who presented with seizure activity and abnormal electroencephalograms associated with opiate administration, and reversed by naloxone. RESULTS: The first was a preterm infant who developed a burst-suppression pattern on the electroencephalogram while receiving a continuous infusion of morphine and muscle paralysis. Naloxone injection during the electroencephalogram recording reversed the burst-suppression pattern. The second was a term infant receiving fentanyl infusion for pain control following surgery, who presented with motor seizure that was only partially controlled with barbiturates. An abnormal electroencephalogram recording during the opiate infusion improved with naloxone administration. CONCLUSION: Our observations indicate a potential for neurologic abnormalities, including induction of seizure activity and electroencephalogram abnormalities, suggesting caution when opiates are used for sedation and/or pain control in the newborn period.

Release-recapture experiments with canopy mosquitoes in the genera Haemagogus and Sabethes (Diptera: Culicidae) in Brazilian Amazonia.

In 2 forested areas near Belém (Para State, Brazil), 2 Haemagogus and 6 Sabethes species were marked released and recaptured in May 1989 and in April 1993. The recapture rates were high, 4.9 and 13.1% for Haemagogus and Sabethes spp., respectively. For Haemagogus janthinomys Dyar, females were recaptured until 27 d after release. The duration of the gonotrophic cycle was between 5.0 and 9.5 d and the survival rate was 0.90-0.92. Haemagogus leucocelaenus (Dyar & Shannon) was recaptured once, 21 d after release. Twelve Sabethes chloropterus (Von Humboldt) were recaptured, with a peak at 15-18 d; 1 female was recaptured at 44 d, indicating extended survival. Seven Sabethes amazonicus Gordon & Evans and 7 Sabethes cyaneus (F.) were recaptured, mostly at 14-39 d. These results indicate that Haemagogus and Sabethes spp. have a gonotrophic cycle in nature longer than inferred from laboratory studies, and that cycle length varies seasonally. The capacity of these species to sustain epizootics or epidemics of arboviruses may depend on local weather, with risk greatest at the end of the rainy season.

The value of standard electroencephalograms in the evaluation of the newborn with recurrent apneas.

OBJECTIVE: To determine the usefulness of the standard electroencephalograms in the evaluation of prematurely born infants admitted to a neonatal intensive care unit with recurrent apneas and bradycardias. STUDY DESIGN: Retrospective review. RESULTS: During the study period, 94 infants were evaluated for seizure activity. Twenty of these were prematurely born infants with recurrent apneas and bradycardias without clinically recognized seizures. The recordings were entirely normal in 10 cases, and in 9 showed interictal epileptiform discharges in excess of or in atypical locations than those expected for the gestational age at the time of the investigation. One had an abnormal electroencephalogram (EEG) pattern with episodes of generalized flattening occurring repeatedly throughout the entire recording. None had electrographic seizures. All infants were free of sepsis and gastroesophageal reflux and all had normal biochemistry at the time of the EEG recordings. CONCLUSION: In our study, routine EEG was not found to be useful in the investigation and management of prematurely born infants with recurrent apneas not associated with clinically recognized seizure activity.

How accurate are leukocyte indices and C-reactive protein for diagnosis of neonatal sepsis?

Early diagnosis of neonatal sepsis is often difficult to make. Treatment on the basis of clinical suspicion and risk factors may result in overtreatment. A previous review of the usefulness of C-reactive protein and leukocyte indices concluded that these test results should be interpreted with caution. The present paper reviews and, when appropriate, revises, in light of new information, the conclusions reached in the previous systematic review of the topic.

Role of Ureaplasma urealyticum and Chlamydia trachomatis in development of bronchopulmonary dysplasia in very low birth weight infants.

OBJECTIVE: To investigate the relationship between Ureaplasma urealyticum and Chlamydia trachomatis colonization of the very low birth weight infant and the development of bronchopulmonary dysplasia (BPD). METHODS: Endotracheal and/or nasopharyngeal aspirates and clinical data were obtained prospectively from 108 infants with a birth weight of < 1501 g and analyzed for U. urealyticum and C. trachomatis by culture and polymerase chain reaction (PCR). RESULTS: U. urealyticum was detected by culture in 40 (37%) infants and by PCR in 49 (45%) infants on at least one occasion. BPD was present at 28 days in 26 of 40 (65%) U. urealyticum culture-positive infants and 39 of 68 (57%) culture-negative infants (relative risk (RR) 1.13, 95% confidence interval 0.83 to 1.54; P = 0.538). BPD was present at 28 days in 34 of 49 (69%) U. urealyticum PCR-positive infants and in 31 of 59 (53%) PCR-negative infants (RR 1.32, 95% confidence interval 0.97 to 1.79; P = 0.135). At 36 weeks postconceptional age culture-positive or PCR-positive infants were at no greater risk of BPD than infants with negative results (RR = 1.02, P = 0.92 and RR = 1.2, P = 0.523, respectively). In addition the presence of U. urealyticum was not associated with any significant difference in the length of hospital stay, days of ventilation, days of oxygen supplementation, birth weight or gestational age. C. trachomatis was detected in only 2 infants. CONCLUSION: C. trachomatis was found infrequently in the airways of premature very low birth weight infants. U. urealyticum was frequently detected but its presence was not significant with regard to development of BPD, duration of ventilatory support, oxygen dependency and length of hospital stay.

Interleukin-10 and interleukin-4 inhibit intracellular killing of Leishmania infantum and Leishmania major by human macrophages by decreasing nitric oxide generation.

The host response to Leishmania infection is regulated by a specific pattern of local cytokine production. We investigated the effect of interleukin (IL)-10 and IL-4 on the leishmanicidal activity of human macrophages (M phi). As with L. major, intracellular killing of L. infantum by human M phi was obtained following ligation of surface CD23 or cell treatment with interferon-gamma (IFN-gamma). This leishmanicidal activity required nitric oxide (NO) generation by activated M phi, and it was partially mimicked by cell treatment with chemical NO donors. Addition of recombinant human IL-10 or IL-4 to CD23 mAb or IFN-gamma decreased L. infantum and L. major killing by infected M phi. IL-10 was more potent than IL-4 in inhibiting the leishmanicidal activity of human M phi. Inhibition of Leishmania killing by IL-4 and IL-10 correlated with decreased NO generation from M phi, and was reversed when exogenous NO was added to cell cultures. Therefore, IL-10 and IL-4 down-regulate leishmanicidal activity of human M phi, in part by inhibiting NO generation by these cells.

Yeasts associated with nests of the leaf-cutting ant Atta sexdens rubropilosa Forel, 1908.

A total of 137 yeasts associated with the leaf-cutting ant Atta sexdens rubropilosa Forel, 1908 were characterized, being selected 93 for analysis. Twenty four species belonging to seven genera (Candida, Cryptococcus, Rhodotorula, Sporobolomyces, Tremella, Trichosporon, Pichia) were isolated from the different analysed material. The genus Candida was widely distributed, with C. homilentoma, C. colliculosa-like, C. famata and C. colliculosa being the most prevalent. A few isolates did not fit the standard descriptions and probably some of them could be new biotypes or even new species. Three strains of black yeasts were also isolated, and four other were identified as being Candida spp. The effective number of yeast species was higher in newer sponge. The origin, distribution and relative importance of these microorganisms for the ants are discussed.

Nonimmune hydrops fetalis, pulmonary sequestration, and favorable neonatal outcome.

BACKGROUND: The association of pulmonary sequestration and nonimmune fetal hydrops reportedly carries a very poor prognosis for survival. We describe three newborns with good outcomes despite the diagnosis of pulmonary sequestration; two cases were associated with hydrops fetalis and one with isolated fetal ascites. CASES: Two neonates with severe hydrops fetalis had pulmonary sequestration diagnosed postnatally. A third infant presented early in gestation with marked fetal ascites that regressed spontaneously before delivery; this infant also had pulmonary sequestration. Despite severe respiratory insufficiency requiring aggressive management, all three infants survived after surgical resection of the sequestered lung mass. CONCLUSION: These cases demonstrate the difficulties associated with antenatal counseling regarding long-term prognosis for infants with nonimmune hydrops and pulmonary sequestration. With optimal care in a tertiary perinatal center, a less pessimistic outlook than previously described in the literature may be appropriate.