Síndrome de Hirata, causa poco frecuente de hipoglucemia / Hirata syndrome, a rare cause of hypoglycemia

Mujer de 32 años, asmática en tratamiento irregular con prednisona (ultima dosis hace 1 mes), Enfermedad de Graves Basedow desde hace 3 años, reiniciótratamiento hace 3 meses (metimazol 40 mg/día), antecedente de aborto dos semanas previas al ingreso. Acude por pérdida del conocimiento, constatándose hipoglucemia. Al persistir el cuadro de hipoglucemia a pesar del tratamiento instaurado y descartadas otras causas etiológicas, la evaluación endocrinológica confirma hipoglucemia autoinmune, niveles de autoanticuerpos contra la insulina e insulina extremadamente elevados.

A 32-year-old woman, asthmatic on irregular treatment with prednisone (last dose 1 month ago), Graves Basedow's disease for 3 years, restartedtreatment 3 months before(methimazole 40 mg / day).History of abortion two weeks prior to admission. She came for loss of consciousness, finding hypoglycemia. As hypoglycemia persists despite the treatment instituted and other etiological causes ruled out, the endocrinological evaluation confirms autoimmune hypoglycemia,autoantibody levelsagainst insulinandextremely high insulin.

Sleep Phases in Crayfish: Relationship Between Brain Electrical Activity and Autonomic Variables.

In vertebrates like mammals and birds, two types of sleep have been identified: rapid eye movement and non-rapid eye movement sleep. Each one is associated with specific electroencephalogram patterns and is accompanied by variations in cardiac and respiratory frequencies. Sleep has been demonstrated only in a handful of invertebrates, and evidence for different sleep stages remains elusive. Previous results show that crayfish sleeps while lying on one side on the surface of the water, but it is not known if this animal has sleep phases. Heart rate and respiratory frequency are modified by diverse changes in the crayfish environment during wakefulness, and previously, we showed that variations in these variables are present during sleep despite that there are no autonomic anatomical structures described in this animal. Here, we conducted experiments to search for sleep phases in crayfish and the relationships between sleep and cardiorespiratory activity. We used the wavelet transform, grouping analysis with k-means clustering, and principal component analysis, to analyze brain and cardiorespiratory electrical activity. Our results show that (a) crayfish can sleep lying on one side or when it is motionless and (b) the depth of sleep (measured as the power of electroencephalographic activity) changes over time and is accompanied by oscillations in cardiorespiratory signal amplitude and power. Finally, we propose that in crayfish there are at least three phases of sleep.

Actinomicosis mandibular

RESUMEN Mujer de 46 años, tiroidectomizada por bocio hiperfuncionante, con bicitopenia (anemia y leucopenia) en estudio, acude por tumoración y dolor del maxilar inferior y secreción purulenta, de 4 meses de evolución, con fiebre intermitente. Presentó disminución de ingesta de alimentos con pérdida de 20 kg de peso aproximadamente. Ya recibió varios esquemas de tratamiento entre los que se incluye antimicrobianos, sin mejoría. Muestras de secreción con cultivo: negativos. Tomografía del macizo facial con lesiones osteolíticas y fractura del maxilar inferior. La biopsia muestra inflamación crónica inespecífica y presencia de Actinomyces sp. Biopsia osteomedular: probable efecto tóxico medular. Recibió tratamiento prolongado con antimicrobiano, mejorando. Actualmente en planes de reconstrucción de maxilar inferior.

ABSTRACT A 46-year-old woman, thyroidectomized by hyperfunctional goiter, with bicytopenia (anemia and leukopenia) under study, consults because of a tumor, pain of the lower jaw and purulent secretion of 4 months of evolution, with intermittent fever. She presented decrease in food intake with loss of approximately 20 kg of weight. She has already received several treatment schemes, including antimicrobials, without improvement. Culture secretion samples: negative. Tomography of the facial massif showed osteolytic lesions and fracture of the lower jaw. The biopsy shows nonspecific chronic inflammation and the presence of Actinomyces sp. Osteomedullary biopsy: probable spinal toxic effect. She received prolonged treatment with antimicrobial, improving. Currently she is in reconstruction plans of the lower jaw.

Coinfección de tuberculosis ganglionar y paracoccidioidomicosis

RESUMEN Se presenta caso de varón joven, fumador y etilista, que consulta por tos y expectoración hemoptoica crónica, ulceraciones en boca, tumoraciones en cuello y fiebre de tres meses de evolución. El paciente presenta hábito tísico, nariz tipo tapiroide con amputación de la úvula. El laboratorio muestra anemia e hipoalbuminemia. La punción aspirativa de la tumoración cervical informa con la coloración de Ziehl-Neelsen, presencia de BAAR (+) y el examen micológico directo elementos micóticos multibrotantes compatibles con paracoccidioidomicosis. Diagnóstico final: coinfección de tuberculosis extrapulmonar (ganglionar) y paracoccidioidomicosis. Tratado con medicación antibacilar esquema HRZE y anfotericina B desoxicolato, posteriormente itraconazol, con buena evolución.

ABSTRACT This is the case of a young male, smoker and elitist, who consults for cough and chronic hemoptoic expectoration, ulcerations in the mouth, tumors in the neck and fever of three months of evolution. The patient has a tubercular habit, tapiroid nose with amputation of the uvula. The laboratory shows anemia and hypoalbuminemia. The expiratory puncture of the cervical tumor reports the presence of AFB (+) with Ziehl-Nielsen staining and multiple budding fungal elements compatible with paracoccidioidomycosis in the direct mycological examination. Final diagnosis: extrapulmonary tuberculosis (lymph node) and paracoccidioidomycosis. The patient was treated with anti-tuberculosis medication, HRZE regimen, and amphotericin B deoxycholate, followed by itraconazole, with good evolution.

Meningoencefalitis herpética en mujer adulta

RESUMEN Se presenta el caso de una mujer adulta mayor, previamente sana, con antecedente de astenia y cuadro confusional de seis días de evolución, con sensación febril y episodio convulsivo en una oportunidad. Presenta hemiparesia braquiocrural derecha y rigidez de nuca. Tomografía simple de cráneo con imagen hipodensa en región frontotemporal izquierda. Líquido cefalorraquídeo muestra leucocitos a predominio de mononucleares, PCR para herpes simple tipo 1 positivo. Resonancia magnética encefálica con imágenes sugerentes de encefalitis herpética. Recibió tratamiento con aciclovir con lo que recupera la fuerza muscular en los miembros, pero alternan periodos de lucidez e incoherencia.

ABSTRACT We present the case of an older adult woman, previously healthy, with a history of asthenia and confusion symptoms of six days of evolution, febrile sensation and convulsive episode in one occassion. She presents right brachiocrural hemiparesis and neck stiffness. Simple skull tomography with hypodense image in the left frontotemporal region. Cerebrospinal fluid shows predominantly mononuclear leukocytes, PCR for herpes simplex type 1 positive. Encephalic magnetic resonance with images suggestive of herpetic encephalitis. She was treated with acyclovir recovering muscle strength in the limbs, but periods of lucidity and incoherence alternate.

Who is the boss? Individual recognition memory and social hierarchy formation in crayfish.

Under laboratory conditions, crayfish establish hierarchical orders through agonistic encounters whose outcome defines the dominant one and one, or more, submissive animals. These agonistic encounters are ritualistic, based on threats, pushes, attacks, grabs, and avoidance behaviors that include retreats and escape responses. Agonistic behavior in a triad of unfamiliar, size-matched animals is intense on the first day of social interaction and the intensity fades on daily repetitions. The dominant animal keeps its status for long periods, and the submissive ones seem to remember 'who the boss is'. It has been assumed that animals remember and recognize their hierarchical status by urine signals, but the putative substance mediating this recognition has not been reported. The aim of this work was to characterize this hierarchical recognition memory. Triads of unfamiliar crayfish (male animals, size and weight-matched) were faced during standardized agonistic protocols for five consecutive days to analyze memory acquisition dynamics (Experiment 1). In Experiment 2, dominant crayfish were shifted among triads to disclose whether hierarchy depended upon individual recognition memory or recognition of status. The maintenance of the hierarchical structure without behavioral reinforcement was assessed by immobilizing the dominant animal during eleven daily agonistic encounters, and considering any shift in the dominance order (Experiment 3). Standard amnesic treatments (anisomycin, scopolamine or cold-anesthesia) were given to all members of the triads immediately after the first interaction session to prevent individual recognition memory consolidation and evaluate its effect on the hierarchical order (Experiment 4). Acquisition of hierarchical recognition occurs at the first agonistic encounter and agonistic behavior gradually diminishes in the following days; animals keep their hierarchical order despite the inability of the dominant crayfish to attack the submissive ones. Finally, blocking of protein synthesis or muscarinic receptors and cold anesthesia impair memory consolidation. These findings suggest that agonistic encounters induces the acquisition of a robust and lasting social recognition memory in crayfish.

Disruption of behavior and brain metabolism in artificially reared rats.

Early adverse life stress has been associated to behavioral disorders that can manifest as inappropriate or aggressive responses to social challenges. In this study, we analyzed the effects of artificial rearing on the open field and burial behavioral tests and on GFAP, c-Fos immunoreactivity, and glucose metabolism measured in anxiety-related brain areas. Artificial rearing of male rats was performed by supplying artificial milk through a cheek cannula and tactile stimulation, mimicking the mother's licking to rat pups from the fourth postnatal day until weaning. Tactile stimulation was applied twice a day, at morning and at night, by means of a camel brush on the rat anogenital area. As compared to mother reared rats, greater aggressiveness, and boldness, stereotyped behavior (burial conduct) was observed in artificially reared rats which occurred in parallel to a reduction of GFAP immunoreactivity in somatosensory cortex, c-Fos immunoreactivity at the amygdala and primary somatosensory cortex, and lower metabolism in amygdala (as measured by 2-deoxi-2-[18 fluoro]-d-glucose uptake, assessed by microPET imaging). These results could suggest that tactile and/or chemical stimuli from the mother and littermates carry relevant information for the proper development of the central nervous system, particularly in brain areas involved with emotions and social relationships of the rat. © 2017 Wiley Periodicals, Inc. Develop Neurobiol 77: 1413-1429, 2017.

Accidente cerebro vascular isquémico como reactivación de lupus eritematoso sistémico

Presentamos el caso de un varón adulto con lupus eritematoso sistémico (LES) que ingresó al Servicio de Urgencias con historia de hemiparesia faciobraquial derecha y disartria. El ictus isquémico se confirma con los métodos auxiliares de diagnóstico. El perfil colagénico fue positivo para IF-ANA, anti-ADN e hipocomplementemia. Los anticuerpos antifosfolípidos fueron negativos. El tratamiento se realiza con corticosteroides y anticoagulación. Este caso pone de relieve la importancia de la detección precoz y el tratamiento oportuno de estas manifestaciones en pacientes con enfermedades del tejido conectivo como el LES.

We present the case of a male adult with systemic lupus erythematosus (SLE) admitted to the Urgency Service with a history of right faciobrachial hemiparesis and dysarthria. The ischemic stroke was confirmed by the auxiliary diagnostic methods. Collagen profile was positive for IF-ANA, anti-DNA and hypocomplementemia. Antiphospholipid antibodies were negative. Treatment was made with corticosteroids and anticoagulation. This case emphasizes the importance of early detection and opportune treatment of these manifestations in patients with connective tissues diseases like SLE.

Sleep in invertebrates: crayfish.

Although sleep is a very conspicuous behavior in all animals that we are frequently in contact with and possibly in many others, its scientific study was for many years restricted to very few of them. However, since the end of the XX century there have been studies about sleep in several animals and currently many of them attempt to found, first, if all animals sleep and second, if their sleep is similar to that of other animals. An important objective of this search is to identify the animal species in which sleep originated, which might gives us clues about the need that was fulfilled by such behavior. The search started with insects, among the most developed arthropods, but has now been expanded to include other invertebrates, among them crustaceans. In this work we review some aspects of sleep in invertebrates, focusing on the crustacean crayfish, animals in which both, behavioral and electrophysiological studies have been conducted and whose results show surprising similarities with sleep in mammals.

Slow waves during sleep in crayfish. Origin and spread.

Previous results show that when unrestrained crayfish sleep, the electrical activity of the brain changes from multiple spikes (frequencies above 300 Hz) on a flat baseline to continuous slow waves at a frequency of 15-20 Hz. To study the temporal organization of such activity, we developed a tethered crayfish preparation that allows us to place electrodes on visually identified regions of the brain. Recording the electrical activity of different brain areas shows that when the animal is active (awake), slow waves are present only in the central complex. However, simultaneously with the animal becoming limp (sleeping), slow waves spread first to deuto- and then to protocerebrum, suggesting that the central complex of the crayfish brain acts as the sleep generator.

Slow wave sleep in crayfish.

Clear evidence of sleep in invertebrates is still meager. Defined as a distinct state of reduced activity, arousability, attention, and initiative, it is well established in mammals, birds, reptiles, and teleosts. It is commonly defined by additional electroencephalographic criteria that are only well established in mammals and to some extent in birds. Sleep states similar to those in mammals, except for electrical criteria, seem to occur in some invertebrates, based on behavior and some physiological observations. Currently the most compelling evidence for sleep in invertebrates (evidence that meets most standard criteria for sleep) has been obtained in the fruit fly Drosophila melanogaster. However, in mammals, sleep is also characterized by a brain state different from that at rest but awake. The electrophysiological slow wave criterion for this state is not seen in Drosophila or in honey bees. Here, we show that, in crayfish, a behavioral state with elevated threshold for vibratory stimulation is accompanied by a distinctive form of slow wave electrical activity of the brain, quite different from that during waking rest. Therefore, crayfish can attain a sleep state comparable to that of mammals.

Massive excystation of Toxoplasma gondii sporozoites.

In the present study, several stimuli were tested to liberate Toxoplasma gondii sporozoites from oocysts. Incubation in Na(2)CO(3)-CO(2) buffer at 40 degrees C with ultrasound, followed by incubation at 40 degrees C with bile or deoxycholic acid, was the only method that resulted in 95% liberation of motile infective sporozoites. A protocol of reproducibly high efficiency is provided, that compares favorably with any of the methods previously published.

Evaluación de las pérdidas económicas debidas a toxoplasmosis en ovinos en el Uruguay / Evaluation of economic losses due to sheep toxoplasmosis in Uruguay

Se determinó la presencia de anticuerpos contra Toxoplasma gondii, antes y después de la gestación, con la reacción de aglutinación directa para toxoplasmosis (AD), en 1613 ovejas de 18 establecimientos de diferentes Departamentos del Uruguay, de 1992 a 1994. La prevalencia total de la infección ascendió de 28,7 por ciento antes de la gestación a 38,5 por ciento, luego de la misma. La incidencia fue, por lo tanto de 9,8 por ciento. Las pérdidas debidas a la infección toxoplásmica durante la gestación se estimaron teóricamente con una fórmula que contempla el nivel de incidencia así como algunos factores de la patogénesis de la enfermedad en el ovino. Sobre esta base, de 1,4 a 3,9 por ciento del total de las ovejas investigadas pudieron haber perdido sus corderos debido a la toxoplasmosis. Esto representa una pérdida económica anual para la industria ovina en el Uruguay de 1,9 a 5,2 millones de dólares americanos. En la estación de parición de 1993, de 562 ovejas y borregas que fueron servidas en uno de los establecimientos. 154 tuvieron corderos y 125 abortaron. Se aisló Toxoplasma mediante bioensayos, a partir de los fetos abortados. Veintiocho sueros de ovejas que abortaron presentaron títulos de 1:16.384 o mayores con el test de AD. Se apreciaron puntos blancos de necrosis del tamaño de la cabeza de un alfiler sobre la superficie de los cotiledones placentarios de las ovejas que abortaron. Los hallazgos histopatológicos fueron necrosis y calcificación de las vellosidades cotiledonarias y encefalitis, hepatitis y neumonía. Seis meses luego de los abortos, 55,6 por ciento de 300 ovejas presentaron títulos de 1:1.024 o mayores, reflejando la extensión de la infección. Se detectaron abortos toxoplásmicos en otros establecimientos, el mismo año. Se destaca la situación de subdiagnóstico de la toxoplasmosis ovina, al quedar enmascarada por otras causas de pérdidas de corderos más extensivos, salvo que adopte la magnitud inusual del caso relatado